A single center experience with same‐day transradial‐PCI patients: A contrast with published guidelines

Objectives: Our goal was to compare recently published Consensus Statement from the SCAI/ACC on appropriateness for same‐day PCI with patient characteristics from a real‐world same‐day PCI experience in the United States. Background: Recent practice statement published by the SCAI /ACC in 2009 describes patients suitable for outpatient PCI procedures. Whether this practice statement reflects actual real‐world practice in the setting of advances in transradial catheterization needs further exploration. Methods: Pre‐existing, deidentified, quality assurance data from 100 sequential patients undergoing transradial PCI, and same‐day discharge were compared with criteria in SCAI/ACC statement on outpatient PCI. Each had been identified post‐PCI as uncomplicated and therefore eligible for same day discharged. Specific attention was placed on whether the patients carried any exclusion to same‐day discharge. Results: One hundred six procedures were recorded in 100 patients including 11 women and 89 men, median age 62 (55,71) years all with stable ischemia. Early follow up was done for medication compliance. None were readmitted nor had post‐PCI complications. Only 15% met appropriateness criteria for same‐day discharge. Older age, distance from the hospital, greater than simple PCI, and the need for specific antiplatelet therapy represented the dominant contraindications to discharge. Conclusions: Using transradial approaches and structured early follow up by advance practice nurses, same‐day discharge can be accomplished successfully in a broad range of patients outside of those suggested by the SCAI/ACC 2009 Consensus Document. Confirmation of these results could result in shorter hospitalizations for US patients and align advances in catheterization technology to optimize heath care delivery. © 2011 Wiley Periodicals, Inc.     

Home-Based Medical Care: High-Value Health Care During Coronavirus Disease 2019 and Beyond

Ms. H is a 78-year-old woman with a history of congestive heart failure, chronic obstructive pulmonary disease, and recent stroke who was discharged 1 month ago from a subacute rehabilitation facility. She moved in with her son because she now requires a walker and cannot return to her third-floor apartment. One evening, Ms. H develops a low-grade fever and mild shortness of breath intermittently relieved by her albuterol inhaler. Her son is worried, but knows that his mom does not want to return to the hospital.     

Knowledge Gaps in Cardiovascular Care of Older Adults: A Scientific Statement from the American Heart Association,American College of Cardiology,and American Geriatrics Society: Executive Summary

The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease (CVD) is the leading cause of death and major disability in adults aged 75 and older. Despite the effect of CVD on quality of life, morbidity, and mortality in older adults, individuals aged 75 and older have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older adults with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in nursing homes and assisted living facilities. As a result, current guidelines are unable to provide evidence‐based recommendations for diagnosis and treatment of older adults typical of those encountered in routine clinical practice. The objectives of this scientific statement are to summarize current guideline recommendations as they apply to older adults, identify critical gaps in knowledge that preclude informed evidence‐based decision‐making, and recommend future research to close existing knowledge gaps. To achieve these objectives, a detailed review was conducted of current American College of Cardiology/American Heart Association (ACC/AHA) and American Stroke Association (ASA) guidelines to identify content and recommendations that explicitly targeted older adults. A pervasive lack of evidence to guide clinical decision‐making in older adults with CVD was found, as well as a paucity of data on the effect of diagnostic and therapeutic interventions on outcomes that are particularly important to older adults, such as quality of life, physical function, and maintenance of independence. Accordingly, there is a critical need for a multitude of large population‐based studies and clinical trials that include a broad spectrum of older adults representative of those seen in clinical practice and that incorporate relevant outcomes important to older adults in the study design. The results of these studies will provide the foundation for future evidence‐based guidelines applicable to older adults and enhance person‐centered care of older individuals with CVD in the United States and around the world.     

Components of Comprehensive and Effective Transitional Care

Transitional care (TC) has received widespread attention from researchers, health system leaders, clinicians, and policy makers as they attempt to improve health outcomes and reduce preventable hospital readmissions, yet little is known about the critical elements of effective TC and how they relate to patients’ and caregivers’ needs and experiences. To address this gap, the Patient‐Centered Outcomes Research Institute (PCORI) funded a national study, A chieving patient‐centered C are and optimized H ealth I n care transitions by E valuating the V alue of E vidence (Project ACHIEVE). A primary aim of the study is the identification of TC components that yield desired patient and caregiver outcomes. Project ACHIEVE established a multistakeholder workgroup to recommend essential TC components for vulnerable Medicare beneficiaries. Guided by a review of published evidence, the workgroup identified and defined a preliminary set of components and then analyzed how well the set aligned with real‐world patients' and caregivers' experiences. Through this process, the workgroup identified eight TC components: patient engagement, caregiver engagement, complexity and medication management, patient education, caregiver education, patients' and caregivers' well‐being, care continuity, and accountability. Although the degree of attention given to each component will vary based on the specific needs of patients and caregivers, workgroup members agree that health systems need to address all components to ensure optimal TC for all Medicare beneficiaries.     

Cognitive and Everyday Functioning in Older and Younger Adults With and Without HIV

The purpose of this study was to: (1) examine cognitive performance differences in older and younger adults with and without HIV, and (2) determine if such differences were related to a laboratory measure of instrumental activities of daily living. Ninety-eight HIV-positive (69 younger, 29 older) and 103 HIV-negative (84 younger, 19 older) adults were evaluated on a number of cognitive measures. Controlling for a number of confounders, age by HIV status interactions were found on two cognitive measures, indicating poorer cognitive performance for those aging with HIV. Poorer performance on these cognitive measures corresponded with poorer performance on the Timed Instrumental Activities of Daily Living test. These findings suggest that as adults age with HIV, they may be at risk for cognitive declines that would impair their ability to engage in activities important for maintaining independent living.     

Testing a Family‐Centered Intervention to Promote Functional and Cognitive Recovery in Hospitalized Older Adults

A comparative trial using a repeated‐measures design was designed to evaluate the feasibility and outcomes of the Family‐Centered Function‐Focused‐Care (Fam‐FFC) intervention, which is intended to promote functional recovery in hospitalized older adults. A family‐centered resource nurse and a facility champion implemented a three‐component intervention (environmental assessment and modification, staff education, individual and family education and partnership in care planning with follow‐up after hospitalization for an acute illness). Control units were exposed to function‐focused‐care education only. Ninety‐seven dyads of medical patients aged 65 and older and family caregivers (FCGs) were recruited from three medical units of a community teaching hospital. Fifty‐three percent of patients were female, 89% were white, 51% were married, and 40% were widowed, and they had a mean age of 80.8 ± 7.5. Seventy‐eight percent of FCGs were married, 34% were daughters, 31% were female spouses or partners, and 38% were aged 46 to 65. Patient outcomes included functional outcomes (activities of daily living (ADLs), walking performance, gait, balance) and delirium severity and duration. FCG outcomes included preparedness for caregiving, anxiety, depression, role strain, and mutuality. The intervention group demonstrated less severity and shorter duration of delirium and better ADL and walking performance but not better gait and balance performance than the control group. FCGs who participated in Fam‐FFC showed a significant increase in preparedness for caregiving and a decrease in anxiety and depression from admission to 2 months after discharge but no significant differences in strain or quality of the relationship with the care recipient from FCGs in the control group. Fam‐FFC is feasible and has the potential to improve outcomes for hospitalized older adults and their caregivers.     

A “fully upper extremity” bailout of direct transaxillary large bore arterial access: A refinement within arm's reach?

Contemporary direct (“fully percutaneous”) transaxillary (TAx) large-bore arterial access technique advocates for a 0.018” wire to be passed from femoral arterial access to axillary artery to serve percutaneous bailout options. However, in certain patients, avoiding femoral arterial access entirely may be desired. We describe the merits of a “fully upper extremity” (FUE) bailout approach, as a refinement to previously described direct TAx technique.