From the American Heart Association 2007 meeting

Sudden cardiac arrest

Poster data presented at Scientific Sessions 2007 have demonstrated that the application of clinical practice modifications, combined with advanced electronic technologies, can improve the care of patients at risk for sudden cardiac arrest (SCA).

Recognition of at-risk patients improved from a baseline of 24% to 70% at regional clinics not using the process, and to 93% at the main clinic applying this process and technology.
The aim of this prospective, single centre study, sponsored by Medtronic, Inc, was to compare the effect of specific clinical practice processes and tools on the ability of clinicians to recognise patients at risk for SCA and apply the appropriate treatment guidelines for those patients.
The clinic staff was trained to use a new process to better identify at-risk patients. This included:
- A patent-pending clinical decision support tool for Electronic Patient Record (EPR) systems that automatically identifies at risk patients and continues tracking the patients who did not immediately qualify for implantable cardioverter-defibrillator (ICD) therapy
- A standardised patient education system and education video
- Broad operational and workflow changes
The clinical practice process included optimal medical treatment prior to an implantable cardioverter-defibrillator (ICD), temporary and absolute exclusions for ICD therapy, and is based on current AHA/American College of Cardiology (ACC) and the Centres for Medicare and Medicaid Services (CMS) guidelines with practice-specific requirements. An independent review of medical charts for all patients visiting the main clinic (the group utilising the new process) and regional clinics (those that did not use the process) was conducted over a two-month period. Patients were followed for six months.
‘A recent report shows that it takes 10 to 15 years for new advances in medicine to be adopted into clinical practice,’ said William Daniel, M.D., clinical director at Cardiovascular Consultants, P.C., and medical director of Quality and medical director of Inpatient Services at Mid America Heart Institute, Kansas City. ‘Recognising this time lag, and the fact that there are thousands of pages of guidelines for caring for our cardiac patients, the study illustrated that the use of our electronic solution and process changes helped to give physicians the right information at the right time, and allowed them to use their judgment and be extremely accurate in making appropriate treatment decisions. Further, every patient, regardless of age, gender or race, receives the same high quality of care, since the process reduces variability and physician reliance on memory.

15.11.2007

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