ABSTRACT
Clinical and economic burdens exist within the coronary artery disease (CAD) care pathway despite advances in diagnosis and treatment and the increasing utilization of percutaneous coronary intervention (PCI). However, research presenting a comprehensive assessment of the challenges across this pathway is scarce. This contemporary review identifies relevant studies related to inefficiencies in the diagnosis, treatment, and management of CAD, including clinician, patient, and economic burdens. Studies demonstrating the benefits of integration and automation within the catheterization laboratory and across the CAD care pathway were also included. Most studies were published in the last 5-10 years and focused on North America and Europe. The review demonstrated multiple potentially avoidable inefficiencies, with a focus on access, appropriate use, conduct, and follow-up related to PCI. Inefficiencies included misdiagnosis, delays in emergency care, suboptimal testing, longer procedure times, risk of recurrent cardiac events, incomplete treatment, and challenges accessing and adhering to post-acute care. Across the CAD pathway, this review revealed that high clinician burnout, complex technologies, radiation, and contrast media exposure, amongst others, negatively impact workflow and patient care. Potential solutions include greater integration and interoperability between technologies and systems, improved standardization, and increased automation to reduce burdens in CAD and improve patient outcomes.
Subject(s)
Coronary Artery Disease , Percutaneous Coronary Intervention , Humans , Coronary Artery Disease/surgery , Coronary Artery Disease/diagnosis , Percutaneous Coronary Intervention/methods , Critical Pathways , Treatment Outcome , Patients , Risk FactorsSubject(s)
Health Personnel/ethics , Professionalism/ethics , Students, Medical/statistics & numerical data , Teaching/trends , COVID-19/diagnosis , COVID-19/epidemiology , Curriculum , Education, Medical/statistics & numerical data , Humans , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , United StatesABSTRACT
Venous thromboembolism is prevalent in hospitalized COVID-19 patients. Through systematic review and meta-analysis, we have investigated the differences in clinical characteristics and outcome of hospitalized COVID-19 patients with (+) and without (-) venous thromboembolism (VTE). 45 studies with a total of 8859 patients were included in the qualitative synthesis. Subsequently, 38 studies with a total of 7847 patients, were quantitatively analysed. There was no mortality difference between the VTE (-) and VTE (+) hospitalized COVID-19 patients (RR1.32 (0.97, 1.79);0.07;I2 64%, p<0.001). Patients with VTE (+) were more likely to get admitted to the intensive care unit (RR1.77 (1.26, 2.50);p<0.001;I2 63%, p= 0.03) and mechanically ventilated (RR 2.35 (1.22, 4.53);p=0.01;I2 88%, p<0.001). Moreover, male gender (RR 1.19 (1.14,1.24), p<0.001;I2 0%, p=0.68), increased the risk of VTE. Regarding patients lab values’, VTE (+) was significantly associated with higher white blood cell, neutrophil count, D-Dimer, alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and C-reactive protein (CRP), along with prolonged prothrombin time. On the contrary, VTE (+) was associated with lower albumin and neutrophil-lymphocyte ratio (NLR). This findings provide the initial framework for risk stratification of hospitalized COVID-19 patients with VTE.