It is our pleasure to present to you a summary report of the CRUSADE quality improvement initiative. In this EMCREG newsletter issue, over 200,000 patients teach us how we treat and can improve NSTEACS care. Health disparities, treatment patterns, and outcome trends remind us of how we can continue to learn and advance the care for our patients.The following pages summarize findings from key CRUSADE registry publications and forward critical lessons gleaned from this amazing collaborative endeavor between cardiology and emergency medicine. This demonstration of “real world” care of patients with ACS should give us pause and promote further vigilance in the comprehensive care of this high risk patient population. CRUSADE is a remarkable example of true quality improvement where increased guideline compliance translates to improved patient outcomes.
As you all well know, emergency physicians man the front line when patients present with any acute illness. Heart failure is no exception. With an expected ten million individuals with heart failure by the end of this year, we must be able to accurately and efficiently diagnose and treat this high morbidity condition. Just as important, it is our responsibility to be cognizant of the new research, new language, and treatment progress in the subject. For instance, the catchall words of “heart failure” can no longer be used to refer to any patient. Terms such as “diastolic heart failure” and “acute heart failure syndrome” have specific definitions and are replacing some of the older, less specific nomenclature. Perhaps the most significant contribution to AHFS diagnosis is the testing of natriuretic peptides. (NT)-proBNP and BNP both can be measured in the blood, but each has unique characteristics and differences. Knowledge of these attributes is critical to the diagnosis of AHFS. The interpretation of specific values in varied clinical settings hinges on your knowledge of the platform and its strengths and limitations. Future directions for heart failure diagnosis include the detection of sub-clinically apparent heart sounds, measurement of cardiothoracic width, new models for risk stratification, and heart failure observation units. Join Dr. Alan Storrow as he presents the current and future management of heart failure in the emergency setting.
Venous thromboembolism (VTE) is a clinical entity which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE is a common medical condition affecting up to 117 patients per 100,000 population annually.1 The diagnosis of VTE is often difficult and frequently missed. Mortality in untreated PE is approximately 30%, but with adequate anticoagulant treatment, this can be reduced to 2–8%.2 The purpose of this Newsletter is to focus on the diagnosis and treatment of VTE, including PE and DVT in the emergency department (ED). In this EMCREG-International Newsletter, Dr. Charles Cairns, Associate Professor of Surgery and Medicine and Associate Chief of Emergency Medicine at the Duke University School of Medicine discusses the important disease process venous thromboembolism (VTE) which includes deep venous thrombosis and pulmonary embolism from the perspective of emergency medicine.