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!
Team discovers how bacteria exploit a chink in the body's armor
20.01.2017 | University of Illinois at Urbana-Champaign
Rabies viruses reveal wiring in transparent brains
19.01.2017 | Rheinische Friedrich-Wilhelms-Universität Bonn
An important step towards a completely new experimental access to quantum physics has been made at University of Konstanz. The team of scientists headed by...
Yersiniae cause severe intestinal infections. Studies using Yersinia pseudotuberculosis as a model organism aim to elucidate the infection mechanisms of these...
Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.
While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...
Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales
Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...
Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.
As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...
19.01.2017 | Event News
10.01.2017 | Event News
09.01.2017 | Event News
20.01.2017 | Life Sciences
20.01.2017 | Physics and Astronomy
20.01.2017 | Materials Sciences