ABSTRACT
It is often suggested that acute coronary syndrome [ACS] patients admitted during off-duty hours [OH] have a worse clinical outcome than those admitted during regular working hours [RH]. Our objective was to compare the management and hospital outcomes of ACS patients admitted during OH with those admitted during RH. Prospective observational study of ACS patients enrolled in the Saudi Project for Assessment of Acute Coronary Syndrome study from December 2005 to December 2007. ACS patients with available date and admission times were included. RH were defined as weekdays, 8 AM-5 PM, and OH was defined as weekdays 5 PM-8 AM, weekends, during Eid [a period of several days marking the end of two major Islamic holidays], and national days. Of the 2825 patients qualifying for this analysis, 1016 [36%] were admitted during RH and 1809 [64%] during OH. OH patients were more likely to present with heart failure and ST elevation myocardial infarction [STEMI] and to receive fibrinolytic therapy, but were less likely to undergo primary percutaneous coronary interventions [PCI]. The median door to balloon time was significantly longer [P<.01] in OH patients [122 min] than in RH patients. No differences were observed in hospital outcomes including mortality between the two groups, except for higher heart failure rates in OH patients [11.1% vs 7.2%, P<.001]. STEMI patients admitted during OH were disadvantaged with respect to use and speed of delivery of primary PCI but not fibrinolytic therapy. Hospitals providing primary PCI during OH should aim to deliver it in a timely manner throughout the day
ABSTRACT
To measure the effect of providing a detailed description of coronary angiography risks on obtaining informed consent from Saudi Arabian patients. This randomized controlled trial was conducted at King Khalid University Hospital, Riyadh, Saudi Arabia from August 2006 to June 2007. Patients were randomized to either an information sheet containing brief information on procedure-related risks [brief sheet], or full disclosure of risks [detailed sheet]. Both groups completed a brief questionnaire following exposure to either sheet. Primary endpoint was refusal to consent to coronary angiography. Secondary endpoints were anxiety following exposure to the detailed sheet and appropriateness of the amount of risk disclosure contained in both information sheets. One hundred and six Saudi patients were enrolled, 6 patients were later excluded. Mean age was 58 years; 45 patients [45%] were illiterate. Fifty-three patients were randomized to the brief sheet, and 47 to the detailed sheet. Only one patient [1.8%] given the brief sheet refused consent, compared to 5 patients [10.6%] given the detailed sheet [p=0.06, 95% confidence interval 1.2 to 2.8]. Ninety-four patients responding to the questionnaire felt that the information given was enough, including all of the patients randomized to the brief sheet. Twenty-two patients randomized to the detailed sheet indicated increased anxiety after hearing procedure-related risks. We found no significant difference in consent status between the detailed and brief disclosure of procedure-related risk groups. Most patients did not require detailed risk disclosure
Subject(s)
Humans , Male , Female , Coronary Angiography , Informed Consent , Risk , Surveys and QuestionnairesABSTRACT
To explore the diagnostic yield of transthoracic echocardiography [TTE], and assess the effect of echocardiographic findings on subsequent therapy. In this retrospective study, we reviewed TTE reports and hospital records of patients diagnosed with a stroke or transient ischemic attack [TIA], screening for potential cardiac sources of embolism [CSE] from January 2006 to December 2008 at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia by considering at least 15 predefined TTE criteria. The therapeutic interventions employed as a consequence of the TTE findings were sought. We analyzed 240 patients [mean patient age 58.5 +/- 14] out of 10563 TTEs. While only one patient exhibited a definite CSE on TTE, potential CSEs were found in 35 patients [14.6%], most commonly caused by left ventricular [LV] systolic dysfunction [31.4%], followed by LV regional wall motion abnormalities [25.7%]. Multivariate analysis revealed 2 independent predictors for identifying a CSE on TTE: history of coronary artery disease [odds ratio [OR] 6.2, 95% confidence interval [CI]:2.6-14.8, p=0.0001], and nationality [OR 0.16, 95% CI: 0.3-0.7, p=0.019]. The TTE findings affected therapy in only 3 patients [1.2%]. The TTE performed to exclude a CSE in patients with stroke or TIA resulted in low diagnostic yield, and had little impact on therapeutic decisions. Future refinement of clinical strategies to predict a CSE is needed to improve diagnosis, and possibly cost-effectiveness, of TTE