ABSTRACT
Cardiac tamponade is a medical emergency requiring prompt recognition and intervention to avoid potentially fatal consequences. We present a case series of ventricular dysfunction and cardiogenic shock following pericardiocentesis in 3 patients with pericardial effusions at The Ottawa Hospital between 2014 and 2020. This report highlights the need for monitoring post-pericardiocentesis and raises awareness of this phenomenon, particularly in patients with malignancy. We propose a novel pressure-monitoring protocol to guide drainage and prevent development of pericardial decompression syndrome. The novel teaching points include limiting drainage to prevent development of pericardial decompression syndrome and a protocol for intra-pericardial pressure monitoring.
La tamponnade cardiaque est une urgence médicale qui, à défaut d'une reconnaissance et d'une intervention rapides, peut avoir des conséquences potentiellement fatales. Nous présentons une série de cas sur des dysfonctions ventriculaires et des chocs cardiogéniques survenus après une péricardiocentèse chez trois patients présentant des épanchements péricardiques traités à l'Hôpital d'Ottawa entre 2014 et 2020. Notre article souligne la nécessité de surveiller les patients au cours de la période suivant la péricardiocentèse et met en lumière le phénomène de la tamponnade cardiaque, en particulier chez les patients atteints de cancer. Nous proposons un nouveau protocole de surveillance des pressions conçu pour guider le drainage et prévenir le syndrome de décompression péricardique. Les nouveautés à enseigner comprennent la limitation du drainage afin de prévenir le syndrome de décompression péricardique et un protocole de surveillance des pressions intrapéricardiques.
Subject(s)
Acute Coronary Syndrome/drug therapy , Aspirin/administration & dosage , Percutaneous Coronary Intervention , Platelet Aggregation Inhibitors/administration & dosage , Precision Medicine/methods , Purinergic P2Y Receptor Antagonists/administration & dosage , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/surgery , Aged , Aged, 80 and over , Aspirin/adverse effects , Drug Administration Schedule , Female , Hemorrhage/chemically induced , Hemorrhage/diagnosis , Humans , Male , Percutaneous Coronary Intervention/adverse effects , Platelet Aggregation Inhibitors/adverse effects , Purinergic P2Y Receptor Antagonists/adverse effects , Ticlopidine/administration & dosage , Ticlopidine/adverse effectsABSTRACT
BACKGROUND: Patient decision aids (PtDAs) supplement advice from health care professionals by communicating the absolute risk or benefit of treatment options (i.e., X/100). As such, PtDAs have been amenable to binary outcomes only. We aimed to develop and test the validity of the Conversion to Risk Estimates through Application of Normal Theory (CREATE) method for estimating absolute risk based on continuous outcome data. METHODS: CREATE is designed to derive an estimate of the proportion of those who experience a clinically relevant degree of change (CRDoC). We used a 2-stage validation process using real and simulated change score data, respectively. First, using raw data from published intervention trials, we calculated the proportion of patients with a CRDoC and compared that with our CREATE-derived estimate using chi-square tests of association. Second, 200,000 simulated distributions of change scores were generated with widely varying distribution characteristics. Actual and CREATE-derived estimates were compared for each simulated distribution, and relative differences were summarized graphically. RESULTS: The absolute difference between the estimated and actual CRDoC did not exceed 5% for any of the samples based on real data. Applying the CREATE method to 200,000 simulated scenarios demonstrated that the CREATE method should be avoided for outcomes where the underlying distribution can be reasonably assumed to have high levels of skew or kurtosis. CONCLUSION: Our results suggest that standard statistical theory can be used to estimate continuous outcomes in absolute terms with reasonable accuracy for use in PtDAs; caution is advised if outcome summary statistics are assumed to have been derived from highly skewed distributions.
Subject(s)
Decision Support Techniques , Risk Assessment/methods , Treatment Outcome , Cardiovascular Diseases/therapy , Choice Behavior , Computer Simulation , Humans , Meta-Analysis as Topic , Randomized Controlled Trials as TopicABSTRACT
BACKGROUND: Refractory angina is a severe chronic disease, defined as angina which cannot be controlled by usual treatments for heart disease. This disease is frightening, debilitating, and difficult to manage. Many people suffering refractory have inadequate pain relief, continually revisit emergency departments for help, undergo repeated cardiac investigations, and struggle with obtaining appropriate care. There is no clear framework to help people understand the risks and benefits of available treatment options in Canada. Some treatments for refractory angina are invasive, while others are not covered by provincial health insurance plans. Effective care for refractory angina sufferers in Canada is critically underdeveloped; it is important that healthcare professionals and refractory angina sufferers alike understand the treatment options and their implications. This proposal builds on the recent Canadian practice guidelines for the management of refractory angina. We propose to develop a decision support tool in order to help people suffering from refractory angina make well-informed decisions about their healthcare and reduce their uncertainty about treatment options. METHODS: This project will be conducted in three phases: a) development of the support tool with input from clinical experts, the Canadian refractory angina guidelines, and people living with refractory angina, b) pilot testing of the usability of the tool, and c) formal preliminary evaluation of the effectiveness of the support tool to help people make informed decisions about treatment options. DISCUSSION: A decision support tool for refractory angina is needed and the available data suggest that by developing such a tool, we may be able to help refractory angina sufferers better understand their condition and the effectiveness of available treatment options (in their respective clinical settings) as well as their implications (e.g. risks vs. benefits). By virtue of this tool, we may also be able to facilitate identification and inclusion of patients' values and preferences in the decision making process. This is particularly important as refractory angina is an intractable condition, necessitating that the selected course of treatment be lifelong. This study will yield a much needed patient decision aid for people living with refractory angina and pilot data to support a subsequent effectiveness study.
Subject(s)
Angina Pectoris/therapy , Decision Support Techniques , Angina Pectoris/psychology , Canada , Decision Making , Health Knowledge, Attitudes, Practice , Humans , Pilot Projects , Surveys and QuestionnairesABSTRACT
Refractory angina (RFA) is a debilitating disease characterized by cardiac pain resistant to conventional treatments for coronary artery disease including nitrates, calcium-channel and ß-adrenoceptor blockade, vasculoprotective agents, percutaneous coronary interventions, and coronary artery bypass grafting. The mortality rate of patients living with RFA is not known but is thought to be in the range of approximately 3%. These individuals suffer severely impaired health-related quality of life with recurrent and sustained pain, poor general health status, psychological distress, impaired role functioning, and activity restriction. Effective care for RFA sufferers in Canada is critically underdeveloped. These guidelines are predicated upon a 2009 Canadian Cardiovascular Society (CCS) Position Statement which identified that underlying the problem of RFA management is the lack of a formalized, coordinated, interprofessional strategy between the cardiovascular and pain science/clinical communities. The guidelines are therefore a joint initiative of the CCS and the Canadian Pain Society (CPS) and make practice recommendations about treatment options for RFA that are based on the best available evidence. Concluding summary recommendations are also made, giving direction to future clinical practice and research on RFA management in Canada.
Subject(s)
Angina Pectoris , Cardiovascular Agents/therapeutic use , Disease Management , Myocardial Revascularization , Pain, Intractable , Self Care/methods , Activities of Daily Living , Angina Pectoris/diagnosis , Angina Pectoris/etiology , Angina Pectoris/physiopathology , Angina Pectoris/therapy , Canada , Humans , Meta-Analysis as Topic , Myocardial Revascularization/adverse effects , Myocardial Revascularization/methods , Outcome and Process Assessment, Health Care , Pain, Intractable/complications , Pain, Intractable/physiopathology , Patient Care Team/organization & administration , Quality Indicators, Health Care , Safety Management/standards , Secondary Prevention , Sickness Impact Profile , Societies, Medical , Stress, Psychological/etiologyABSTRACT
Cardiovascular disease is a major health issue for the elderly patient. Many diagnostic, therapeutic and ethical issues are specific for the the older adult with heart disease. The Canadian Cardiovascular Society 2002 Consensus Conference provides recommendations for the most frequently encountered cardiac problems in the elderly patient. A common theme of the recommendations is the need to apply the best evidence based medicine together with an assessment of frailty, comorbidity and quality of life. A major goal of the conference was to identify treatments that are not optimally used in the older patient.
