ANCC-CVNC learning - ANCC (RN-BC) Cardiac-Vascular Nursing Updated: 2023

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Technology incorporating artificial intelligence (AI) and electrocardiogram (EKG) testing for patients having a heart attack decreased the time to diagnose and send patients for treatment by almost 10 minutes, according to results of a late-breaking science study conducted in a hospital in Taiwan and presented today at the American Heart Association's Scientific Sessions 2023.

"Modern AI may now be as good as expert cardiologists in diagnosing serious heart attacks," said lead study author Chin-Sheng Lin, M.D., Ph.D., a professor, director of the Medical Technology Education Center and vice dean at the School of Medicine, at the National Defense Medical Center, in Taipei, Taiwan. "Hospitals can use AI tools more to help front-line doctors, especially those with less experience. This could lead to faster treatment and less mistakes when it comes to treating patients who are experiencing heart attacks."

During a heart attack, the heart is deprived of oxygen because the blood flow to the heart is reduced due to a blockage in a coronary artery. This may damage the heart muscle. Timely diagnosis and treatment are critical to restore blood flow and reduce injury to the heart muscle and to increase a person's chance of recovery after a heart attack, according to Systems of Care for ST-Segment–Elevation Myocardial Infarction: A Policy Statement From the American Heart Association.

EKG testing is a non-invasive diagnostic tool that shows the heart's electrical activity. It can also reveal if the cardiac episode is a more serious type of heart attack referred to as ST-elevation myocardial infarction or STEMI, which occurs when a coronary artery is completely blocked. A STEMI often warrants a trip to a cardiac catheterization lab for procedures to open blockages such as coronary angioplasty, or stenting.

This study investigated if using artificial intelligence with EKG testing could help health professionals diagnose STEMIs and get patients to the cardiac catheterization lab faster.

The trial involved more than 43,000 patients seen either in the emergency department or as inpatients at the largest military hospital in Taiwan, Tri-Service General Hospital, between May 2022 and April 2023.

The patients were almost equally divided into two groups: an intervention group, which included the AI-enabled EKG testing; and a control group, which received standard care with a health professional interpreting EKG results to determine if cardiac catheterization was needed. All patients who were diagnosed with STEMI had procedures in the cardiac catheterization lab to determine the size and location of the blockage.

The trial findings included:

• AI-enabled EKGs accurately diagnosed STEMIs patients with positive predictive value of 88% and negative predictive value of 99.9%.
• AI technology helped to reduce the treatment waiting time for patients with STEMI from about 52 minutes to 43 minutes.
• AI-enabled EKGs confirmed STEMI among seven hospitalized patients, while standard care confirmed STEMI in only one hospitalized patient.

"The difference in diagnosing STEMI in the ER wasn't as great between the two groups, however, the improved accuracy for diagnosis in hospitalized patients was astonishing," said Lin, who is also the director of medical education, a physician educator and a cardiologist at Tri-Service General Hospital, where the research was conducted. "This tells us that there's a lot we can do to Boost how we diagnose STEMI in hospitalized patients."

"Due to the accurate AI revolution, the accuracy of clinical decision support systems has improved significantly and doctors are becoming more trusting of this technology," he said. "Using low-cost tech tools can be valuable in everyday medical work. In the future, we might see more of these tech tools being used in new ways, like in ambulances or on wearable devices, which could change how we care for patients with STEMI."

Study background and details:

• On average, the patients were 60 years old, and about half of them were male.
• The trial included 43,176 patients treated by 20 cardiologists.

The study's limitations include that it did not track long-term results, and the number of people studied might have been too small to see long-term outcomes. Additionally, because the study was done in just one hospital in Taiwan, the findings might not apply to other hospitals with different clinical processes.

Q: Why did you go into this career?

A: While I was in my rotations, I was shadowing an Interventional cardiologist, and I was able to witness the immediate impact a cardiac procedure had on a patient.

I saw him take a patient that was critically ill and may have been on death’s door and relieve them of that blockage within minutes.

Observing that case has left a significant impact on me since my early 20s.

After that day, I knew cardiology was the field for me as I wanted to perform that life-saving treatment for my patients.

Q: What services do you provide?

A: General cardiology, which includes consultations on arrhythmia, vascular disorders and chest pain.

Testing related to general cardiology, such as EKGs, Holter monitors, nuclear medicine studies, echocardiograms and transesophageal echocardiograms.

I also can perform a variety of Interventional cardiology procedures such as place and remove loop recorders, and place temporary pacemakers, catheterizations, stenting and ballooning in various vessels throughout the body, from the neck to the toes.

In addition, structural cardiology incorporating TAVR, PFO closures and ASD closures.

Q: What makes this area of medicine fulfilling for you?

A: The follow-up appointments with the patients are a beautiful thing.

For example, a patient might come in during an emergency, but they end up leaving better than they have felt in a year.

For me, that is very fulfilling because I am not just making an impact at that moment, it is something that is longer lasting.

Also, in those follow-up appointments, I create a relationship with the patient.

It is so rewarding because I see my patients grow, get better and get healthier.

It is such a humbling experience for me.

Q: What is the latest advancement in your field that will benefit patients?

A: The field of cardiology is constantly expanding and growing.

New treatments and medications are continuously evolving.

One particular advancement that stands out is the Transcatheter aortic valve replacement (TAVR).

Patients with aortic stenosis, which is a severe narrowing of the aortic valve, are now able to get treatment when previously they may not have even been able to have surgery prior to this new treatment option.

Q: Best advice for current and potential patients?

A: Be active!

For as much medicine and treatments that are out there, nothing helps the body more than being active.

So, increase the amount of time you spend upright doing activities rather than sitting.

The human body is not designed to sit all day long, it needs movement to get the heart pumping to all the blood vessels and organs.

Get to Know Your Health Pro

Name: Wesley A. Romney, MD, FACP

Where are you based: Steward Medical Group — Cardiology, 240 N. Wickham Road., Suite 202, Melbourne, FL 32935

Contact: (321) 541-1746, Providers.steward.org

Melbourne Regional Medical Center, 250 N. Wickham Road, Melbourne, FL 32935

Contact: melbourneregional.orgEducation:

Fellowship: Baylor, Scott, and White/Texas A&M, Round Rock, TX; Coney Island Hospital, Brooklyn, NY

Residency: Coney Island Hospital, Brooklyn, NY

Medical School: St. George’s University School of Medicine, True Blue, Grenada

University: University of Miami, Coral Gables, FL

This article originally appeared on Florida Today: Steward Medical's Dr. Wesley A. Romney loves fixing peoples' hearts

Health First’s Heart & Vascular Program among elite heart bypass surgery in U.S. and Canada

BREVARD COUNTY, FLORIDA – Health First’s Heart & Vascular Program has received a prestigious  3-star overall isolated CABG recognition from the Society of Thoracic Surgeons. The honor recognizes Health First’s patient care and outcomes relative to isolated coronary artery bypass grafting (CABG) procedures.

The three-star rating, which denotes the highest category of quality, places Health First’s Heart & Vascular Program among the elite for heart bypass surgery in the United States and Canada.

The STS star rating system is one of the most sophisticated and highly regarded overall measures of quality in health care, rating the benchmarked outcomes of cardiothoracic surgery programs across the United States and Canada. The star rating is calculated using a combination of quality measures for specific procedures performed by an STS Adult Cardiac Surgery Database participant.

“Our patients and their loved ones put their utmost trust in the skill, knowledge and hands of their surgical team, and when cardiac surgery of any form is advised, we want them to be comfortable and confident that they will receive the very best care,” said Matthew Campbell, MD, chief cardiothoracic surgeon.

“A coronary artery bypass grafting surgery is a highly complex procedure, and so this honor certainly reaffirms to our patients that this team has met the highest levels of excellence.”

“This is a tremendous honor for the entire Heart and Vascular team at Health First, highlighting our commitment to quality and patient outcomes,” added Seiichi Noda, MD, cardiothoracic surgeon. “This 3-star rating is a true testament to high level of expertise, care and service our team and the Heart & Vascular program at Health First have built.”

According to the National Heart, Lung and Blood Institute within the National Institutes of Health (NIH) Coronary artery bypass grafting (CABG), also called heart bypass surgery, is a medical procedure to Boost blood flow to the heart. It may be needed when the arteries supplying blood to the heart, called coronary arteries, are narrowed or blocked.

Surgeons may recommend the surgery to either lower your risk of a heart attack if one is suffering from coronary heart disease, or in an emergency situation – to treat a severe heart attack.

CABG uses healthy blood vessels from another part of the body and connects them to blood vessels above and below the blocked artery. This creates a new route for blood to flow that bypasses the narrowed or blocked coronary arteries. The blood vessels are usually arteries from the arm or chest, or veins from the legs.

Approximately 20 percent of participants receive a three-star rating for isolated CABG surgery. The latest analysis of data for CABG surgery covers a 3-year period.

“The Society of Thoracic Surgeons congratulates STS National Database participants who have received three-star ratings,” said David M. Shahian, MD, chair of the Task Force on Quality Measurement. “Participation in the Database and public reporting demonstrates a commitment to quality improvement in health care delivery and helps provide patients and their families with meaningful information to help them make informed decisions about health care.”

The STS National Database was established in 1989 as an initiative for quality improvement and patient safety among cardiothoracic surgeons. The Database includes four components: the Adult Cardiac Surgery Database (ACSD), the Congenital Heart Surgery Database (CHSD), the General Thoracic Surgery Database (GTSD), and the mechanical circulatory support database (Intermacs).

The STS ACSD houses approximately 6.9 million surgical records and gathers information from more than 3,800 participating physicians, including surgeons and anesthesiologists from more than 90% of groups that perform heart surgery in the US. STS public reporting online enables STS ACSD participants to voluntarily report to each other and the public their heart surgery scores and star ratings.