scholarly journals The transition from hospital to primary care for patients with acute coronary syndrome: insights from registry data

2014 ◽  
Vol 201 (S10) ◽  
Author(s):  
Julie Redfern ◽  
Tom G Briffa
Keyword(s):  
Primary Care ◽  
Acute Coronary Syndrome ◽  
Registry Data ◽  
Coronary Syndrome

scholarly journals Improving early exclusion of acute coronary syndrome in primary care: the added value of point-of-care troponin as stated by general practitioners

2017 ◽  
Vol 18 (04) ◽  
pp. 386-397 ◽  
Author(s):  
Michelle M.A. Kip ◽  
Amber M. Noltes ◽  
Hendrik Koffijberg ◽  
Maarten J. IJzerman ◽  
Ron Kusters
Keyword(s):  
Primary Care ◽  
Acute Coronary Syndrome ◽  
Blood Sample ◽  
General Practitioners ◽  
Point Of Care ◽  
Added Value ◽  
Lower Sensitivity ◽  
Test Duration ◽  
Referral Rates ◽  
Coronary Syndrome

AimTo investigate general practitioners’ (GPs’) desire and perceived added value of point-of-care (POC) troponin, its effect on referral decisions, and test requirements.BackgroundExcluding acute coronary syndrome (ACS) in primary care remains a diagnostic challenges for GPs. Consequently, referral rates of chest pain patients are high, while the incidence of a cardiovascular problem is only 8–15%. Previous studies have shown that GPs are interested in a POC troponin test. This test could enhance rapid exclusion of ACS, thereby preventing unnecessary patient distress, without compromising safety and while reducing costs. However, using this test is not recommended in current guidelines due to uncertainty in the test’s potential added value, and the lower sensitivity early after symptom onset as compared with troponin tests in a regular laboratory.MethodsAn online survey containing 34 questions was distributed among 837 Dutch GPs in June 2015.FindingsA total of 126 GPs (15.1%) completed at least 75% of the questions. 67.1% of GPs believe that POC troponin tests have moderate to very high added value. Although the availability of a POC test is expected to increase the frequency at which troponin tests are used, it likely decreases (immediate) referral rates. Of the responding GPs, 78.3% only accept 10 min as the maximum test duration, 78.1% think reimbursement of the POC device is required for implementation, and 68.9% consider it necessary that it can be performed with a finger prick blood sample. In conclusion, according to GPs, the POC troponin test can be of added value to exclude ACS early on. Actual test implementation will depend on test characteristics, including test duration, type of blood sample required, and reimbursement of the analyzer.

Communicating acute coronary syndrome risk to women in primary care: A scoping review of the literature

2019 ◽  
Vol 102 (12) ◽  
pp. 2156-2161 ◽  
Author(s):  
Elizabeth P. Knight ◽  
Maribeth Slebodnik ◽  
Clare Pinder ◽  
Holli A. DeVon
Keyword(s):  
Primary Care ◽  
Acute Coronary Syndrome ◽  
Scoping Review ◽  
Review Of The Literature ◽  
Coronary Syndrome

Smartphone-based tele-electrocardiography support for primary care physicians reduces the pain-to-treatment time in acute coronary syndrome

2017 ◽  
Vol 24 (8) ◽  
pp. 540-546 ◽  
Author(s):  
Vivek Chauhan ◽  
Prakash C Negi ◽  
Sujeet Raina ◽  
Sunil Raina ◽  
Mukul Bhatnagar ◽  
...  
Keyword(s):  
Primary Care ◽  
Acute Coronary Syndrome ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Intervention Group ◽  
Care Physician ◽  
Medical College Hospital ◽  
College Hospital ◽  
Medical College ◽  
Coronary Syndrome

Background The Himachal Pradesh state acute coronary syndrome registry recorded a median delay of 13 h between the time of onset of pain to the time of making the diagnosis and giving treatment for acute coronary syndrome. We conducted a pilot study on providing 24-h tele-electrocardiography (Tele-ECG) services in the district Kangra of Himachal Pradesh, with the aim to reduce the time taken for diagnosis of acute coronary syndrome. Methods The intervention group for the study included eight rural community health centres, each with one to three primary care physicians, who were all unskilled in electrocardiogram interpretation. We provided them with 24-h Tele-ECG support. The primary care physicians used their smartphones to transmit the electrocardiogram image to the command centre, which was then read by the skilled specialist physicians in our medical college hospital and the report sent back within five minutes of having received the electrocardiogram. Antiplatelets were given by the primary care physician to patients diagnosed with acute coronary syndrome, who was then transported to the medical college hospital. The urban sub-divisional hospitals ( n = 6) formed the control group for the study. These hospitals had five to fifteen unskilled primary care physicians and one to two skilled specialist physicians; no intervention was done in this group. A pilot was run from February 2015–January 2016. Results We received 819 Tele-ECG consultations within the intervention group; 157 cases of acute coronary syndrome were confirmed and transferred to our medical college hospital facility. Similarly, we admitted 177 cases of acute coronary syndrome at the medical college hospital, who were first attended to by the primary care physician in the control group. Aspirin was administered to 91% and 58% of patients with acute coronary syndrome in the intervention and the control groups, respectively ( p < 0.0001). The median hospital-to-aspirin time (h) in the intervention and the control groups was 0.7 ± 1.45 h and 3.5 ± 10 h, respectively ( p < 0.0001). In the intervention group, 72% of the ST elevation myocardial infarction patients were diagnosed within 12 h by the primary care physician using Tele-ECG support. Interpretation and conclusions Smartphone-based Tele-ECG support for primary care physicians reduced the hospital-to-aspirin time in acute coronary syndrome significantly ( p < 0.0001). This is an effective low cost strategy and is easily replicable anywhere in the world.

Findings from a clinical audit in regional general practice of management of patients following acute coronary syndrome

2017 ◽  
Vol 23 (2) ◽  
pp. 170
Author(s):  
Mithilesh Dronavalli ◽  
Manavi M. Bhagwat ◽  
Sandy Hamilton ◽  
Marisa Gilles ◽  
Jacquie Garton-Smith ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Acute Coronary Syndrome ◽  
Risk Factor ◽  
Care Plans ◽  
Coronary Syndrome ◽  
Diet And Exercise ◽  
National Heart Foundation ◽  
To Receive ◽  
Heart Foundation

Patients with acute coronary syndrome (ACS) require ongoing treatment and support from their primary care provider to modify cardiovascular risk factors (including diet, exercise and mood), to receive evidence-based pharmacotherapies and be properly monitored and to ensure their take-up and completion of cardiac rehabilitation (CR). This study assesses adherence to National Heart Foundation guidelines for ACS in primary care in a regional centre in Western Australia. Patients discharged from hospital after a coronary event (unstable angina or myocardial infarction) or a coronary procedure (stent or coronary artery bypass graft) were identified through general practice electronic medical records. Patient data was extracted using a data form based on National Heart Foundation guidelines. Summary statistics were calculated and reported. Our study included 22 GPs and 44 patients in a regional centre. In total, 90% (n=39) of discharge summaries recorded medications. Assessment of pharmacological management showed that 53% (n=23) of patients received four or more classes of pharmacotherapy and that GPs often augmented medication beyond that prescribed at discharge. Of 15 smokers, 13 (87%) had advice to quit documented. Minimal advice for other risk-factor modification was documented in care plans. Patients with type 2 diabetes (n=20) were 70% more likely to receive allied health referral (P=0.02) and 60% more likely to receive advice regarding diet and exercise (P=0.007). However, overall, only 30% (n=13) of those eligible were referred to a dietician, and only 25% were referred to CR (n=10) with six completing CR. Although most GPs did not use standardised tools for mood assessment, 18 (41%) patients were diagnosed as depressed, of which 88% (n=16) were started on antidepressants and 28% (n=6) were referred to a psychologist. Although pharmacotherapy, mood management and smoking cessation management generally followed recommended guidelines, risk factor management relating to diet and exercise by GPs require improvement. Detailed care plans and referral to CR and allied health staff for patient support is recommended.

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