![胸痛指南网页](/Areas/CMS/assets/img/blank.gif)
得到了多个医学协会的认可, the American College of Cardiology (ACC) and the American Heart Association (AHA) recently published the first 临床指南 devoted to the evaluation and management of adult patients presenting with a complaint of chest pain. 该指南提供了当代, 规范临床评价急需明确, 危险分层, and diagnostic testing to manage the 95% of patients who ultimately do not require an emergent trip to the cardiac cath lab.
这是第一次
估计有6人.5 million emergency department (ED) visits attributed to chest pain each year—visits that contribute significantly to the burden on US hospital EDs—it may seem surprising that this is the first 临床指南 aimed at the evaluation and management of chest pain in adult patients. 然而, it’s important to understand the context of our historical approach.
我们是如何走到这一步的
Driven by a mission to reduce death and disability related to acute cardiac events, EDs in the US have employed “rapid rule out” strategies aimed at identifying and mitigating evolving or imminent myocardial injury events due to acute coronary syndrome (ACS). 这次任务非常成功, 高效生产, integrated STEMI systems of care that have reduced mortality and morbidity related to acute myocardial infarction. 然而, 数以千万计的急诊科病人在后视镜里, we now know that ACS is not the source of the complaint in the vast majority of the 6.每年有500万急诊患者与胸痛有关. 事实上,半数以上的病人都不是心脏原因.
迈向新途径
Advances in cardiac imaging and pharmacology are fueling a contemporary approach to screening, 预防, 早期识别, 冠状动脉疾病(CAD)的治疗. Clinical cardiologists armed with tools to evaluate both the anatomic and functional implications of CAD are able to provide patients with a highly individualized plan of care aimed at preventing disease progression and acute cardiac events.
指南对您的组织意味着什么
行政协调会和美国心脏协会提供了 十大关键信息 根据他们的指导方针. Summarized below, these 10 key points have direct implications for CV programs. As a helpful memory aid, the first letter of each numbered message spells out the words “CHEST PAINS.”
1. 胸痛不仅仅意味着胸部疼痛
There should be a continued emphasis on care team education related to anginal equivalents, 文化和民族观点, 护理差异, 以及积极倾听的重要性.
2. 首选高灵敏度肌钙蛋白
尽管肌钙蛋白生物标志物一直是治疗的标准, your program should implement high-sensitivity troponin testing if it is not already in place.
3. 急性症状的早期护理
Activation of the 911 emergency system should remain a high priority due to the possibility of life-threatening causes of chest pain.
4. 分享新决策
The ability to provide a highly individualized plan of care for CV patients creates an imperative for shared decision-making, which will incorporate patients’ values and improve their understanding of risks and benefits.
5. 低风险患者不需要常规检测-新
该指南对CV规划和bet8网站备用具有重要意义. Patients who previously might have been placed in a bed for observation pending testing may now be discharged for follow-up evaluation. 然而, added emphasis must be placed on the standard and consistent use of clinical decision pathways, 临床评价, 以及急诊科的风险分层. Clinical decision pathways should be expanded to guide patients’ follow-up referral for further evaluation and testing in the ambulatory setting when required. Community resources and referral processes for 预防 and wellness programs should be considered in strategic planning for the CV program if not already in place.
6. 通路
Evidence-based clinical decision pathways for chest pain should be used in the ED and ambulatory settings. 虽然这一指导并不新鲜, it is important to ensure your program has implemented a multidisciplinary approach to managing and using the pathways, including a process to monitor compliance and clinical outcomes related to use of the pathways.
7. 伴随的症状
There should be continued emphasis on and awareness of gender variations in presentation, 因为女性更有可能出现伴随胸痛的症状, 比如恶心和呼吸短促.
8. 识别最有可能从进一步测试中受益的患者-新
关于进一步检测的新指南包括检测的类型和方式, 基于阻塞性CAD的风险分层. CV programs should review the recommendations in order to assess community access to traditional and advanced cardiac imaging modalities.
9.“非心脏病”流行,“非典型”过时了
The new guideline points out that “atypical” is a misleading descriptor of chest pain and should be avoided, which may also help programs mitigate coding issues that impact clinical outcome reporting. Educating cardiology and hospital-based providers about this guidance is recommended.
10. 应该使用结构化风险评估——新方法
This guidance clarifies the standardization of 危险分层 for patients presenting with acute or stable chest pain to estimate the risk of CAD and adverse events. CV programs should incorporate the guideline to ensure evidence-based decision-making is used to sequence diagnostic testing.
行政协调会和美国心脏协会提供了一个 胸痛 for ease of keeping these take-home messages front of mind for your care team.
![胸痛,学分结束](/user_area/uploads/Chest-Pain-with-credit-final.png)
展望未来
The strategies we have historically used to quickly identify potentially life-threatening STEMI events have not changed. 然而, if the new ACC and AHA 临床指南 is formally implemented and applied to the management of the chest pain population in the ED, organizations may benefit from safely reducing unnecessary observation stays, 同时确保患者能够从合适的提供者那里得到后续护理, 在适当的时候, 而且在正确的位置.
Looking to improve your organization’s ability to manage chest pain patients?
Discover three building blocks of a cardiovascular program that’s designed for the future.
立即观看出版于2022年2月2日