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Benefit of Percutaneous Coronary Intervention in Early Latecomers with Acute ST-segment Elevation Myocardial Infarction
The Journal of Emergency Medicine, Vol. 44, No. 2, pp. 570–575, 2013 Copyright Ó 2013 Published by Elsevier Inc. Printed in the USA 0736-4679/$ - see front matter
Abstracts , PREVENTION OF ADVERSE DRUG EVENTS AND COST SAVINGS ASSOCIATED WITH PHARMD INTERVENTIONS IN AN ACADEMIC LEVEL I TRAUMA CENTER: AN EVIDENCE-BASED APPROACH. Hamblin S, Rumbaugh K, and Miller M. J Trauma Acute Care Surg 2012:73:1482–8. Previous studies have demonstrated improved medication safety and prevention of adverse drug events (ADEs) by the inclusion of a clinical pharmacist in the Emergency Department. The present study sought to extend this work, evaluating the interventions and cost savings associated with a clinical pharmacist in the trauma intensive care unit. In this single-center study, pharmacists (or pharmacy residents) logged all interventions, including type of intervention, primary and secondary medications involved, and time required. Interventions were recorded on a web-based program known as Quantifi. Interventions had a pre-determined associated cost savings based on the literature describing ADEs. For example, prevention of a serious ADE, such as use of enoxaparin in a patient with heparin-induced thrombocytopenia, was valued at approximately $6000. Based on a conservative estimate of the rate at which routine pharmacist-driven intervention prevents ADEs (previously described in the literature as 5.2%), the authors calculated the value of each drug therapy recommendation at $153. Different interventions had different costs associated with them. After 1 year, the authors retrospectively reviewed the data on all pharmacy actions. The pharmacists provided 275 interventions per 1000 patient days. Over 50% of these interventions were related to improvement in pharmacotherapy, followed by improvements in quality/ safety, and antibiotic stewardship. Thirty-four interventions were thought to have directly prevented a serious ADE. The most frequent drug categories in which ADEs were prevented were anticoagulants, opioids, and sedatives/antipsychotics. Overall, pharmacy interventions resulted in $565,664 of cost savings, significantly less than the average annual wage of a clinical pharmacist ($108,430). [Benjamin Easter, MD Denver Health Medical Center, Denver, CO]
system, the authors demonstrated a significant cost benefit when clinical pharmacists were present, meriting their expanded presence on multidisciplinary clinical treatment teams. , BENEFIT OF PERCUTANEOUS CORONARY INTERVENTION IN EARLY LATECOMERS WITH ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION. Sim DS, Jeong MH, Ahn Y, et al. Am J Cardiol 2012;110:1275–81. The clinical benefit of percutaneous coronary intervention (PCI) in patients presenting acutely with ST-segment elevation myocardial infarction (STEMI) is well established. However, it remains unclear what benefits PCI provides for patients who present later in the disease course. In particular, the present study examined the efficacy of PCI in ‘‘early latecomers,’’ those patients presenting between 12 and 72 h after symptom onset. The authors performed a retrospective review of the Korea Acute Myocardial Infarction Registry, a national database to collect information on patients with myocardial infarction (MI). They compared patients presenting between 12 and 72 h after symptom onset who underwent elective PCI (median time from arrival to PCI was 23 h) vs. medical therapy. The primary end point was death or recurrent MI at 12 months. Because therapy choice was not randomized, propensity scores were estimated for likelihood of PCI using a multivariate logistic regression. Twelve-month death or MI rate was lower in the PCI group in both unadjusted and adjusted analyses (unadjusted rate 3.8% vs. 11.2%). Among patients with a similar likelihood of having PCI performed (as measured by PCI propensity score quintile), the 12-month death/MI rate was lower for patients who actually underwent PCI. This result was similar across multiple different demographic and clinical subgroups, suggesting an enhanced role for PCI in early latecomers with STEMI. [Benjamin Easter, MD Denver Health Medical Center, Denver, CO] Comments: Emergency physicians are well aware of the indications for and benefits of PCI in patients with STEMI presenting within 12 h of symptom onset. The present study suggests that PCI may also be of benefit to patients presenting later in the disease course. Although both unadjusted and adjusted analyses demonstrated a reduced rate of death or recurrent MI at 12 months in patients treated with PCI compared to medical therapy, the lack of randomization of treatment suggests that other, unobserved factors may account for this improvement. Nevertheless, these data suggest that emergency physicians should not hesitate to consult an interventional cardiologist for patients with STEMI who present between 12 and 72 h after symptom onset.
Comments: This study quantified the actions and potential cost savings associated with the presence of a clinical pharmacist in a single trauma intensive care unit. The study is methodologically limited by the difficulty in ascertaining the costs of avoided events. However, the authors did make use of pre-determined, evidence-based data for cost calculations. In addition, the study took place in a hospital already utilizing a sophisticated computerized order entry system that provides assistance to providers with dosing, interactions, and monitoring. Even with this 570
Abstracts , PREVENTION OF ADVERSE DRUG EVENTS AND COST SAVINGS ASSOCIATED WITH PHARMD INTERVENTIONS IN AN ACADEMIC LEVEL I TRAUMA CENTER: AN EVIDENCE-BASED APPROACH. Hamblin S, Rumbaugh K, and Miller M. J Trauma Acute Care Surg 2012:73:1482–8. Previous studies have demonstrated improved medication safety and prevention of adverse drug events (ADEs) by the inclusion of a clinical pharmacist in the Emergency Department. The present study sought to extend this work, evaluating the interventions and cost savings associated with a clinical pharmacist in the trauma intensive care unit. In this single-center study, pharmacists (or pharmacy residents) logged all interventions, including type of intervention, primary and secondary medications involved, and time required. Interventions were recorded on a web-based program known as Quantifi. Interventions had a pre-determined associated cost savings based on the literature describing ADEs. For example, prevention of a serious ADE, such as use of enoxaparin in a patient with heparin-induced thrombocytopenia, was valued at approximately $6000. Based on a conservative estimate of the rate at which routine pharmacist-driven intervention prevents ADEs (previously described in the literature as 5.2%), the authors calculated the value of each drug therapy recommendation at $153. Different interventions had different costs associated with them. After 1 year, the authors retrospectively reviewed the data on all pharmacy actions. The pharmacists provided 275 interventions per 1000 patient days. Over 50% of these interventions were related to improvement in pharmacotherapy, followed by improvements in quality/ safety, and antibiotic stewardship. Thirty-four interventions were thought to have directly prevented a serious ADE. The most frequent drug categories in which ADEs were prevented were anticoagulants, opioids, and sedatives/antipsychotics. Overall, pharmacy interventions resulted in $565,664 of cost savings, significantly less than the average annual wage of a clinical pharmacist ($108,430). [Benjamin Easter, MD Denver Health Medical Center, Denver, CO]
system, the authors demonstrated a significant cost benefit when clinical pharmacists were present, meriting their expanded presence on multidisciplinary clinical treatment teams. , BENEFIT OF PERCUTANEOUS CORONARY INTERVENTION IN EARLY LATECOMERS WITH ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION. Sim DS, Jeong MH, Ahn Y, et al. Am J Cardiol 2012;110:1275–81. The clinical benefit of percutaneous coronary intervention (PCI) in patients presenting acutely with ST-segment elevation myocardial infarction (STEMI) is well established. However, it remains unclear what benefits PCI provides for patients who present later in the disease course. In particular, the present study examined the efficacy of PCI in ‘‘early latecomers,’’ those patients presenting between 12 and 72 h after symptom onset. The authors performed a retrospective review of the Korea Acute Myocardial Infarction Registry, a national database to collect information on patients with myocardial infarction (MI). They compared patients presenting between 12 and 72 h after symptom onset who underwent elective PCI (median time from arrival to PCI was 23 h) vs. medical therapy. The primary end point was death or recurrent MI at 12 months. Because therapy choice was not randomized, propensity scores were estimated for likelihood of PCI using a multivariate logistic regression. Twelve-month death or MI rate was lower in the PCI group in both unadjusted and adjusted analyses (unadjusted rate 3.8% vs. 11.2%). Among patients with a similar likelihood of having PCI performed (as measured by PCI propensity score quintile), the 12-month death/MI rate was lower for patients who actually underwent PCI. This result was similar across multiple different demographic and clinical subgroups, suggesting an enhanced role for PCI in early latecomers with STEMI. [Benjamin Easter, MD Denver Health Medical Center, Denver, CO] Comments: Emergency physicians are well aware of the indications for and benefits of PCI in patients with STEMI presenting within 12 h of symptom onset. The present study suggests that PCI may also be of benefit to patients presenting later in the disease course. Although both unadjusted and adjusted analyses demonstrated a reduced rate of death or recurrent MI at 12 months in patients treated with PCI compared to medical therapy, the lack of randomization of treatment suggests that other, unobserved factors may account for this improvement. Nevertheless, these data suggest that emergency physicians should not hesitate to consult an interventional cardiologist for patients with STEMI who present between 12 and 72 h after symptom onset.
Comments: This study quantified the actions and potential cost savings associated with the presence of a clinical pharmacist in a single trauma intensive care unit. The study is methodologically limited by the difficulty in ascertaining the costs of avoided events. However, the authors did make use of pre-determined, evidence-based data for cost calculations. In addition, the study took place in a hospital already utilizing a sophisticated computerized order entry system that provides assistance to providers with dosing, interactions, and monitoring. Even with this 570