Cardiology referral is common for patients admitted for non-cardiac diseases. Recommendations from cardiologists may involve complex and aggressive treatments that could be ignored or denied by other ...physicians. The purpose of this study was to compare the outcomes of patients who were given recommendations during cardiology referrals and to examine the clinical outcomes of patients who did not follow the recommendations.
We enrolled 589 consecutive patients who received in-hospital cardiology consultations. Data on recommendations, implementation of suggestions and outcomes were collected.
Regarding adherence of the referring service to the recommendations, 77% of patients were classified in the adherence group and 23% were classified in the non-adherence group. Membership in the non-adherence group (p<0.001; odds ratio: 10.25; 95% CI: 4.45-23.62) and advanced age (p = 0.017; OR: 1.04; 95% CI: 1.01-1.07) were associated with unfavorable outcomes. Multivariate analysis identified four independent predictors of adherence to recommendations: follow-up notes in the medical chart (p<0.001; OR: 2.43; 95% CI: 1.48-4.01); verbal reinforcement (p = 0.001; OR: 1.86; 95% CI: 1.23-2.81); a small number of recommendation (p = 0.001; OR: 0.87; 95% CI: 0.80-0.94); and a younger patient age (p = 0.002; OR: 0.98; 95% CI: 0.96-0.99).
Poor adherence to cardiology referral recommendations was associated with unfavorable clinical outcomes. Follow-up notes in the medical chart, verbal reinforcement, a limited number of recommendations and a patient age were associated with greater adherence to recommendations.
Recent original scientific contributions published in selected Brazilian periodicals and classifiable under cardiovascular and pulmonary subject categories cover a wide range of sub specialties, both ...clinical and exprimental. Because they appear in journals with only recently enhanced visibility, we have decided to highlight a number of specific items appeared in four Brazilian journals, because we understand that this is an important subsidy to keep our readership adequately informed. These papers cover extensive sub-areas in both fields.
Abstract only
Introduction:
Cardiac troponin (cTn) measurements play a pivotal role in diagnosing and managing myocardial infarction (MI). Nonetheless, to prevent unnecessary expenditure, it is ...essential to optimize the usage of cTn testing. The AHA guidelines underscore the importance of minimizing low-value care, considering the widespread prevalence and substantial expenses related to cardiovascular disease. Hence, our study hypothesis is that expert-recommended cTn testing could effectively decrease unnecessary testing requests.
Aims:
This study aims to contrast the frequency of normal and of serial cTn I test results within a General University Hospital (GUH) setting and a specialized Cardiology University Hospital (CUH).
Methods:
Our cross-sectional study encompassed all cTn I tests performed at both GUH and CUH between November 2022 and March 2023. We excluded patients receiving postoperative care following invasive cardiac procedures and those engaged in research protocols. We categorized the study population by sex and age (<60 or ≥60 years), as well as by whether the cTn I test was serially conducted (≥2 times within 24 hours). A serial cTn I test, as recommended by the 4th Universal definition of MI to detect any rise and/or fall, was considered a correct request. We utilized the chi-square test for categorical variables and the Mann-Whitney test for continuous data, setting a 5% significance level. Normal reference levels were <16 and <34 ng/L for women and men, respectively.
Results:
The study incorporated a total of 5,360 tests performed in GUH, with 46.2% on women and 60.9% on individuals aged ≥60 years. In CUH, 8,487 tests were conducted, with 42.0% on women and 53.8% on individuals aged ≥60 years. GUH displayed a higher proportion of normal cTn I test results compared to CUH (70% versus 45%, p < 0.0001) and a lower percentage of serial cTn I tests (40.3% versus 53.4%, p < 0.0001). Moreover, GUH demonstrated a lower median troponin value of 8 (2.5-33.8) versus 37 (7-455) in CUH, p < 0.0001.
Conclusions:
The increased prevalence of normal cTn I results and the lower frequency of serial cTn I tests in GUH indicate potential economic inefficiencies related to excessive cTn I testing requests. Expert intervention could help in avoiding unnecessary cTnI test requests.
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