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A New Perspective Into Affordable, Quality Healthcare: The Case of Pronto Care
Published in Frederick J. DeMicco, Ali A. Poorani, Medical Travel Brand Management, 2023
Adel Eldin, Frederick J. DeMicco
A good clinical example is focusing on the (Mechanical) approach to treat Coronary Artery Disease by using Balloon Angioplasty or implanting Coronary Stents as a spot-fix and focusing on the mechanical part such as choosing the proper wire type to cross the stenosis (blockage), which guiding catheter to use, which device to use to de-bulk the lesion to make room for the stent (metal mesh used as a scaffold to keep artery patent) to be implanted and prevent the arterial re-narrowing (recoil) which happens frequently after using POBA (Plain Old Balloon Angioplasty). Then the choice of stent mostly now drug-coated with a polymer that prevents cellular replication (endothelial hyperplasia), which is another mechanism leading to re-narrowing of the artery at the stented segment with recurrence of symptoms of Angina (Effort-induced Chest Pain, relieved with rest.) That is mostly done without addressing the entire arterial tree as if stents were inappropriately implanted, this will create a new disease which may require additional stents leading to eventual need for Coronary Artery Bypass Surgery after failed (full-metal jacket) of multiple stents placed. This can also lead to repeated Angina attacks, heart attacks, and subsequent Congestive Heart Failure, adding to already high-cost healthcare bill. Even after Bypass surgery, the bypass grafts can get clogged with further stents placed, which may fail leading to a redo Coronary Artery Bypass Surgery in few years due to progression of coronary artery disease!
Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Cardiac surgery is an effective treatment for ischaemic heart disease and valve disease, relieving symptomatic angina and prolonging survival in selected patient groups. Standard indications for coronary artery bypass surgery include left main stem or triple vessel coronary artery disease, particularly in patients with diabetes and/or LV dysfunction where there is prognostic benefit. Surgery is offered for severe heart valve disease providing specific criteria are met, with either repair or replacement with bioprosthetic or mechanical valves. Surgical treatments for severe HF include cardiac transplantation or LV assist device implantation for eligible patients. Patients with complex congenital heart disease frequently require surgical correction.
The ST segment
Published in Andrew R Houghton, Making Sense of the ECG, 2019
If one or two anti-anginal drugs fail to control symptoms adequately, or if non-invasive investigations indicate that the patient is at high risk of an acute coronary syndrome, consider coronary angiography with a view to: Percutaneous coronary interventionCoronary artery bypass surgery
Tubular basement membrane amyloid deposition: is it an indicator of renal progression in light chain amyloidosis?
Published in Renal Failure, 2023
Csilla Markóth, László Bidiga, László Váróczy, Ibolya File, József Balla, János Mátyus
A 69-year-old male patient had a myocardial infarction in 2002, and a history of kidney stones, Lyme disease, prostate hyperplasia, fatty liver, and diabetes mellitus. In February 2016, he was admitted to the nephrology department due to a decrease to 19 ml/min/1.73 m2 in eGFR and nephrotic syndrome with a uPCR level of 1332 mg/mmol. An increased sFLCk/l value of 7 was verified without detectable monoclonal components in the SPEP. Renal histology revealed one sclerotic glomerulus and 18 glomeruli with extensive kappa restriction with PAS-negative, Congo red positive and apple green birefringent material in the mesangium, efferent, afferent, and smaller arterioles. IFTA was 50%. EM confirmed the presence of 8–12 nm wide amyloid fibrillar structure in the TBM also. Bone marrow biopsy revealed a 10% plasma cell infiltration; FISH was negative, confirming monoclonal gammopathy of renal significance as a cause of kappa LA. The patient had no extrarenal involvement. Chemotherapy was initiated; however, unstable angina developed before the second cycle. Urgent coronarography and coronary artery bypass surgery were performed; however, the patient died three days later.
The next phase in the implementation of value-based healthcare: Adding patient-relevant cost drivers to existing outcome measure sets
Published in International Journal of Healthcare Management, 2023
Gijs J. van Steenbergen, Paul Cremers, Lukas Dekker, Dennis van Veghel
Patient relevant cost drivers are parameters that have an impact on patients and are associated with costs of healthcare delivery. These parameters have their origin in logistics and utilization of healthcare services and can indicate inefficient care processes or that care provided to patients does not fit their individual need. In cardiology, for example, emergency department visits occur in about 12% after coronary artery bypass surgery (CABG) and in about 15% of patients after percutaneous coronary intervention (PCI) in the first 30 days after discharge of which a significant amount can be attributed to non-urgent causes [24]. Furthermore, re-admissions, patient-initiated telephonic consultations and outpatient visits occur often and have partly been attributed to ineffective communication and patient guidance at discharge (see Table 2 for more examples) [25]. These PRCDs hereby have a different viewpoint and require another approach as opposed to clinical outcomes which are often directly related to medical aspects of a condition or treatment (e.g. mortality, complications of surgery or wound infections et cetera).
Poor adherence to beta-blockers is associated with increased long-term mortality even beyond the first year after an acute coronary syndrome event
Published in Annals of Medicine, 2020
Jaakko Allonen, Markku S. Nieminen, Juha Sinisalo
Only few randomized trials on BBs have been done during the reperfusion era. The CAPRICORN randomized trial showed that post-MI patients with left ventricular dysfunction benefit from carvedilol therapy compared to placebo [18]. However, the recent CAPITAL-RCT randomized trial, though underpowered, proposed that long-term carvedilol treatment for low-risk STEMI patients treated with PCI does not appear to be beneficial [19]. These randomized studies strengthen the idea that BBs are prognostic only for high-risk patients with lowered LVEF. Beta-blockers are not prescribed and utilized as guidelines suggest, probably due to the controversial and limited evidence for their use. Adherence to guidelines among cardiologists and physicians varies widely [20]. Adherence to BB therapy also diminishes over time among post-MI patients [21–24]. Alarmingly, high-risk patients in particular seem to have the greatest non-adherence rate towards secondary prevention therapies [25]. Hamood et al. [26] investigated the effect of non-adherence to post-MI medication therapy on all-cause mortality. Interestingly, they observed that non-adherence towards all other medications except BBs increased mortality significantly. On the other hand, Zhang et al. [27] observed that in both non-MI and MI patients after coronary artery bypass surgery, inconsistent use and total absence of BB therapy increased overall mortality when compared to regular use of beta-blockers.