Authors

Cardiac catheterization in higher-risk NSTE-ACS patients: Why is it being underutilized by physicians?

We compared the rates of cardiac catheterization in 2136 non–ST-segment elevation acute coronary syndrome patients who were stratified according to their baseline thrombolysis in myocardial infarction (TIMI) risk score. Higher-risk patients were referred for catheterization at a similar rate as low-risk patients. The main reasons why physicians did not make referrals included (1) clinical trial evidence did not support an early invasive approach and (2) 68% of patients were thought not to be at high enough risk; however, 59% of these patients were found to be higher risk when their baseline TIMI risk scores were recalculated. Patients who were referred for catheterization had better in-hospital and 1-year outcomes. Our findings indicate that a significant opportunity remains to improve upon accurate risk stratification and adherence to an early invasive strategy for higher-risk patients.

Evaluating the Effectiveness of Tonabersat for Migraine Prophylaxis

A recent review found that tonabersat, a novel benzoylamino benzopyran compound, is well-tolerated, but no better than placebo for migraine prophylaxis.

Can corticosteroids prevent atrial fibrillation after cardiac surgery?

We conducted a prospective, double-blind, randomized, multicenter study among 241 patients who underwent their first on-pump coronary artery bypass graft (CABG) surgery, aortic valve replacement (AVR), or combined CABG and AVR surgery to determine whether the use of hydrocortisone prevents atrial fibrillation after cardiac surgery. Results showed that the incidence of postoperative atrial fibrillation was significantly lower in the hydrocortisone group compared with the placebo group.

Who Needs a Public Insurance Adjuster?

Opinion: As Healthcare Evolves, So Must PA Practice Laws

L. Gail Curtis, PA-C, MPAS, DFAAPA, details the use of Optimal Team Practice by the AAPA, and the role of the physician assistant in medicine.

Impact of Revascularization Clinical Guideline Recommendations on US Clinical Practice

Pulmonologist Visits Related to COPD Rehospitalization Outcomes

For patients hospitalized for chronic obstructive pulmonary disease (COPD) related complications, failing to see pulmonologists after discharge was found to increase readmission risk threefold, researchers reported in CHEST.

Rural Primary Care: Has the Canary Stopped Singing?

Coronary artery disease in asymptomatic diabetic patients

We evaluated the effectiveness of the current American Diabetes Association guidelines for the detection of coronary artery disease (CAD) in asymptomatic patients with type 2 diabetes and assessed whether a more aggressive diagnostic strategy would permit detection of silent CAD at an earlier stage. The prevalence of myocardial perfusion defects and CAD in asymptomatic diabetic patients was high independent of risk factor profile, and an aggressive diagnostic approach in patients who would normally be excluded from screening permitted identification of CAD at an earlier stage, when coronary anatomy is more likely to respond to treatment.

Management of dyslipidemia in African Americans: How does Medicare Part D impact?

A misleading ECG

A 10-year-old girl was brought to her primary care provider by her mother because she complained of chest pain earlier that morning. She also reported abdominal pain and nausea.

Lipids, Screening, and Stroke: What Matters?

As the mean BMI in the U.S. edges higher, I thought that a discussion of 2 recent analyses regarding lipids was pertinent to the season.