A clinical decision support tool helped physicians identify patients at high risk of bleeding complications prior to undergoing a coronary intervention procedure and helped guide the use of bleeding avoidance strategies, leading to less complications and a shorter hospital stay, according to a study being presented March 10 at the American College of Cardiology Scientific Sessions.
More than 1.3 million percutaneous coronary interventions (PCIs) are performed each year in the United States. Bleeding during and after these procedures is a common risk (3 – 6%).
"Bleeding complications after PCI can lead to worse outcomes for the patient, including death, as well as an increase in the length of stay in the hospital, which leads to an increase in hospital costs," says the study's lead author Craig E. Strauss, MD, MPH, a research cardiologist at the Minneapolis Heart Institute Foundation and physician at the Minneapolis Heart Institute® at Abbott Northwestern Hospital in Minneapolis.
Therefore, the cardiologists across the Allina Health System used a validated pre-PCI bleeding risk score to accurately identify high-risk patients, allowing them to employ strategies to avoid bleeding and improve patient outcomes. Among those strategies, bivalirudin (Angiomax, The Medicines Company) is a direct thrombin inhibitor that has been shown to reduce bleeding complications in PCI.
"This risk-stratification tool can be used real-time in the cath lab to identify and mitigate a patient's risk for bleeding around the time of the procedure," says Strauss. "The cath lab team uses a web-based calculator, which takes less than 1-2 minutes, and determines the risk category of each patient." Due to the ease of use, the tool achieved a high adoption rate of 92 percent at three high-volume PCI centers in Minnesota.
Among the 2,608 PCI cases performed at the three PCI centers, 24.4 percent of the patients were identified as high risk for bleeding complications. The use of bivalirudin as a bleeding avoidance strategy in high-risk patients increased from 24.2 percent pre-implementation of the risk-stratification protocol to 60.3 percent after the implementation of the protocol.
Among high bleeding risk patients, the researchers reported significant reductions in overall complications (22.8% vs. 14.9%), bleeding events within 72 hours (7.7% vs. 2.1%), and median length of hospital stay (2.9 vs. 2.3 days) following protocol implementation. There also was a reduction in the use of blood transfusions and death. Finally, the total variable costs decreased from approximately $15,000 to $14,200.
"This clinical decision support tool helps cardiologists objectively validate which patients are at high risk for bleeding complications based on existing evidence," Strauss says. "Previously, we could attempt to identify which patients were at risk based on clinical intuition, but this tool gives a much more accurate assessment, as shown through the improved patient outcomes. Furthermore, this tool can help reduce the variability in practice patterns among physicians that can be costly to the healthcare system."
About the Minneapolis Heart Institute Foundation
The Minneapolis Heart Institute Foundation is dedicated to creating a world without heart disease through groundbreaking clinical research and innovative education programs. MHIF's mission is to promote and improve cardiovascular health, quality of life and longevity for all.
Scientific Innovation and Research – Publishing more than 120 peer-reviewed studies each year, MHIF is a recognized research leader in the broadest range of cardiovascular medicine. Each year, cardiologists and hospitals around the world adopt MHIF protocols to save lives and improve patient care.
Education and Outreach – Research shows that modifying specific health behaviors can significantly reduce the risk of developing heart disease. Through community programs, screenings and presentations, MHIF educates people of all walks of life about heart health. The goal of the Foundation's community outreach is to increase personal awareness of risk factors and provide the tools necessary to help people pursue heart- healthy lifestyles.About the Minneapolis Heart Institute®
Steve Goodyear | EurekAlert!
Antibiotic effective against drug-resistant bacteria in pediatric skin infections
17.02.2017 | University of California - San Diego
Tiny magnetic implant offers new drug delivery method
14.02.2017 | University of British Columbia
In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport
Cells need to repair damaged DNA in our genes to prevent the development of cancer and other diseases. Our cells therefore activate and send “repair-proteins”...
The Fraunhofer IWS Dresden and Technische Universität Dresden inaugurated their jointly operated Center for Additive Manufacturing Dresden (AMCD) with a festive ceremony on February 7, 2017. Scientists from various disciplines perform research on materials, additive manufacturing processes and innovative technologies, which build up components in a layer by layer process. This technology opens up new horizons for component design and combinations of functions. For example during fabrication, electrical conductors and sensors are already able to be additively manufactured into components. They provide information about stress conditions of a product during operation.
The 3D-printing technology, or additive manufacturing as it is often called, has long made the step out of scientific research laboratories into industrial...
Nature does amazing things with limited design materials. Grass, for example, can support its own weight, resist strong wind loads, and recover after being...
Nanometer-scale magnetic perforated grids could create new possibilities for computing. Together with international colleagues, scientists from the Helmholtz Zentrum Dresden-Rossendorf (HZDR) have shown how a cobalt grid can be reliably programmed at room temperature. In addition they discovered that for every hole ("antidot") three magnetic states can be configured. The results have been published in the journal "Scientific Reports".
Physicist Dr. Rantej Bali from the HZDR, together with scientists from Singapore and Australia, designed a special grid structure in a thin layer of cobalt in...
13.02.2017 | Event News
10.02.2017 | Event News
09.02.2017 | Event News
17.02.2017 | Medical Engineering
17.02.2017 | Medical Engineering
17.02.2017 | Health and Medicine