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A Rule-Out Strategy...
A Rule-Out Strategy Based on High-Sensitivity Troponin and HEART Score Reduces Hospital Admissions
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- Ljung, Lina (författare)
- Karolinska Institutet
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- Lindahl, Bertil, 1957- (författare)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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- Eggers, Kai M., 1962- (författare)
- Uppsala universitet,Institutionen för medicinska vetenskaper,Uppsala kliniska forskningscentrum (UCR)
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- Frick, Mats (författare)
- Karolinska Institutet
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- Linder, Rikard (författare)
- Karolinska Institutet
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- Löfmark, Henrik B. (författare)
- Karolinska Inst, Dept Clin Sci, Danderyd Univ Hosp, Stockholm, Sweden
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- Martinsson, Arne (författare)
- Capio St Gorans Hosp, Dept Emergency Med, Stockholm, Sweden
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- Melki, Dina (författare)
- Karolinska Univ Hosp, Heart & Vasc Theme, Stockholm, Sweden
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- Sarkar, Nondita (författare)
- Karolinska Institutet
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- Svensson, Per (författare)
- Karolinska Institutet
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- Jernberg, Tomas (författare)
- Karolinska Institutet
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(creator_code:org_t)
- MOSBY-ELSEVIER, 2019
- 2019
- Engelska.
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Ingår i: Annals of Emergency Medicine. - : MOSBY-ELSEVIER. - 0196-0644 .- 1097-6760. ; 73:5, s. 491-499
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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http://kipublication...
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Abstract
Ämnesord
Stäng
- Study objective: We evaluate whether a combination of a 1-hour high-sensitivity cardiac troponin algorithm and History, ECG, Age, Risk Factors, and Troponin (HEART) score reduces admission rate (primary outcome) and affects time to discharge, health care-related costs, and 30-day outcome (secondary outcomes) in patients with symptoms suggestive of an acute coronary syndrome.Methods: This prospective observational multicenter study was conducted before (2013 to 2014) and after (2015 to 2016) implementation of a strategy including level of high-sensitivity cardiac troponin T or I at 0 and 1 hour, combined with the HEART score. Patients with a nonelevated baseline high-sensitivity cardiac troponin level, a 1-hour change in high-sensitivity cardiac troponin T level less than 3 ng/L, or high-sensitivity cardiac troponin I level less than 6 ng/L and a HEART score less than or equal to 3 were considered to be ruled out of having acute coronary syndrome. A logistic regression analysis was performed to adjust for differences in baseline characteristics.Results: A total of 1,233 patients were included at 6 centers. There were no differences in regard to median age (64 versus 63 years) and proportion of men (57% versus 54%) between the periods. After introduction of the new strategy, the admission rate decreased from 59% to 33% (risk ratio 0.55 [95% confidence interval {CI} 0.48 to 0.63]; odds ratio 0.33 [95% CI 0.26 to 0.42]; adjusted odds ratio 0.33 [95% CI 0.25 to 0.42]). The median hospital stay was reduced from 23.2 to 4.7 hours (95% CI of difference -20.4 to -11.4); median health care-related costs, from $1,748 to $1,079 (95% CI of difference -$953 to -$391). The number of clinical events was very low.Conclusion: In this before-after study, clinical implementation of a 1-hour high-sensitivity cardiac troponin algorithm combined with the HEART score was associated with a reduction in admission rate and health care burden, with very low rates of adverse clinical events.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
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- art (ämneskategori)
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- Av författaren/redakt...
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Ljung, Lina
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Lindahl, Bertil, ...
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Eggers, Kai M., ...
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Frick, Mats
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Linder, Rikard
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Löfmark, Henrik ...
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visa fler...
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Martinsson, Arne
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Melki, Dina
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Sarkar, Nondita
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Svensson, Per
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Jernberg, Tomas
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visa färre...
- Om ämnet
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Kardiologi
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Annals of Emerge ...
- Av lärosätet
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Uppsala universitet
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Karolinska Institutet