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Diercks DB Kirk JD Lindsell CJ Pollack CV Hoekstra JW Gibler WB Hollander JE 《The American journal of emergency medicine》2006,24(1):1-7
OBJECTIVE: To describe time to electrocardiogram (ECG) acquisition, identify factors associated with timely acquisition, and evaluate the influence of time to ECG on adverse clinical outcomes. METHODS: We measured the door-to-ECG time for emergency department patients enrolled in prospective chest pain registry. Clinical outcomes were defined as occurrence of myocardial infarction or death within 30 days of the visit. RESULTS: Among patients with acute coronary syndrome (ACS), 34% and 40.9% of patients with non-ST-elevation ACS and ST-elevation myocardial infarction (STEMI), respectively, had an ECG performed within 10 minutes of arrival. A delay in ECG acquisition was only associated with an increase risk of clinical outcomes in patients with STEMI at 30 days (odds ratio, 3.95; 95% confidence interval, 1.06-14.72; P = .04). CONCLUSION: Approximately one third of patients with ACS received an ECG within 10 minutes. A prolonged door-to-ECG time was associated with an increased risk of clinical outcomes only in patients with STEMI. 相似文献
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Diercks DB Peacock WF Kirk JD Weber JE 《The American journal of emergency medicine》2006,24(3):319-324
OBJECTIVE: To identify factors that define a low-risk cohort of patients with acute decompensated heart failure who are suitable for management in an observation unit. METHODS: Prospective convenience sample of 538 patients who presented to an ED with a diagnosis of congestive heart failure. Observation unit appropriate was defined as a length of stay less than 24 hours and no adverse events (myocardial infarction, death, arrhythmia, or rehospitalization) during the 30-day follow-up period. RESULTS: Study criteria were met by 499 patients (mean age, 61 +/- 15 years), and 234 (47%) were women. Of these, 133 (27%) met the criteria for observation unit appropriateness. Independent predictors were systolic blood pressure of greater than 160 (odds ratio, 1.8; 95% confidence interval, 1.15-2.7) and normal troponin I (odds ratio, 14.7; 95% confidence interval, 1.9-105). CONCLUSION: Initial blood pressure and troponin I can help identify patients with congestive heart failure at low risk for prolonged hospitalization and adverse events and who are reasonable candidates for observation unit management. 相似文献
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Anna Marie Chang Judd E. Hollander Erica Su Robert E. Weiss Annick N. Yagapen Susan E. Malveau David H. Adler Aveh Bastani Christopher W. Baugh Jeffrey M. Caterino Carol L. Clark Deborah B. Diercks Bret A. Nicks Daniel K. Nishijima Manish N. Shah Kirk A. Stiffler Alan B. Storrow Scott T. Wilber Benjamin C. Sun 《The American journal of emergency medicine》2019,37(5):869-872
Almost 20% of patients with syncope will experience another event. It is unknown whether recurrent syncope is a marker for a higher or lower risk etiology of syncope. The goal of this study is to determine whether older adults with recurrent syncope have a higher likelihood of 30-day serious clinical events than patients experiencing their first episode.
Methods
This study is a pre-specified secondary analysis of a multicenter prospective, observational study conducted at 11 emergency departments in the US. Adults 60?years or older who presented with syncope or near syncope were enrolled. The primary outcome was occurrence of 30-day serious outcome. The secondary outcome was 30-day serious cardiac arrhythmia. In multivariate analysis, we assessed whether prior syncope was an independent predictor of 30-day serious events.Results
The study cohort included 3580 patients: 1281 (35.8%) had prior syncope and 2299 (64.2%) were presenting with first episode of syncope. 498 (13.9%) patients had 1 prior episode while 771 (21.5%) had >1 prior episode. Those with recurrent syncope were more likely to have congestive heart failure, coronary artery disease, previous diagnosis of arrhythmia, and an abnormal ECG. Overall, 657 (18.4%) of the cohort had a serious outcome by 30?days after index ED visit. In multivariate analysis, we found no significant difference in risk of events (adjusted odds ratio 1.09; 95% confidence interval 0.90–1.31; p?=?0.387).Conclusion
In older adults with syncope, a prior history of syncope within the year does not increase the risk for serious 30-day events. 相似文献88.
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G F Diercks A J van Boven H L Hillege W M Janssen J A Kors P E de Jong D E Grobbee H J Crijns W H van Gilst 《European heart journal》2000,21(23):1922-1927
AIM: To assess the value of microalbuminuria as an indicator of increased cardiovascular risk in a non-diabetic population. METHODS AND RESULTS: 7579 non-diabetic subjects were studied with ages ranging from 28 to 75 years selected from a population based cohort. Using computerized Minnesota coding, ischaemic electrocardiographic abnormalities were divided into three categories: infarct patterns, major ischaemia, and minor ischaemia. Urinary albumin excretion was measured as the mean of two 24-h urine collections. Cardiovascular risk indicators were defined as an age above 60 years, male sex, hypertension, hypercholesterolaemia, smoking, obesity and a positive cardiovascular family history. Microalbuminuria was associated with age, sex, blood pressure, serum cholesterol, serum glucose, body mass index and all three categories of electrocardiographic abnormalities. In a multivariate model, adjusted for established cardiovascular risk indicators, microalbuminuria was independently associated with infarct patterns (OR [95% CI] 1.61 [1.12-2.32]), major ischaemia (OR 1.43 [1.08-1.91]) and minor ischaemia (OR 1.32 [1.03-1.68]). CONCLUSIONS: The independent association between microalbuminuria and ischaemic electrocardiographic abnormalities suggests that microalbuminuria has additional value to conventional risk indicators in predicting cardiovascular disease in non-diabetics. Assessment of microalbuminuria could be an instrument to identify those at an increased risk for coronary vascular disease in an early stage. 相似文献
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