Background: In recent years, a rapid-clotting serum tube, BD Vacutainer Õ Rapid Serum Tube (RST TM ), was introduced to improve turn-around times for serum samples. Previous studies reported reduced concentrations of some markers of haemolysis in RST specimens compared to other serum or plasma samples. We aimed to compare RST to plasma tubes for haemolysis markers in an emergency department (ED) setting, where increased rates of haemolysis are commonly seen. Methods: Patients presenting to ED over an eight-day period had an RST, BD Vacutainer Õ PST TM II (plasma) Tube and BD Vacutainer Õ Heparin (non-gel, plasma) Tube collected. Blood was drawn from an intravenous cannula, and samples were promptly analysed for haemolysis index, potassium, phosphate, aspartate aminotrasferase (AST), magnesium and lactate dehydrogenase (LD). Results: A total of 347 patient samples were included, and 9.2% of the PST samples were haemolysed. The RST tubes had small increases in all of the haemolysis markers compared to both plasma tubes (P 4 0.005), except LD which was lower in the RST group. There were no significant differences in the proportion of results above the upper reference limit between the tubes, except for LD which had a lower proportion in RST samples (P 4 0.002). Conclusion: Compared to plasma, RST specimens show small increases in several haemolysis markers, consistent with known differences between serum and plasma, but the proportion of elevated haemolysis markers is similar to plasma. In a setting with a high haemolysis rate such as ED, RST specimens provide a non-inferior sample type for markers of haemolysis.
Aim: Rural patients have higher cardiovascular death rates and poorer access to cardiac services compared to the metropolitan population 1 . NSW now has four regional Cardiac Catheter Labs. These do not have 24/7 PCI services, mandating some patients still be transferred to city centres. We examined the ability of the Orange Catheter service, providing angiography 4 days a week and stenting on Fridays, to comprehensively manage ACS patients. The impact on length of stay and cost was compared with two other rural base hospitals that transferred patients to Sydney for angiography from July 2007 to June 08.Results: During this time, 403 inpatients underwent angiography at Orange, 189 were managed medically, 140 were stented locally, 74 were transferred to Sydney, more than half for CABG. Of all ACS patients 82% were fully managed locally with transport cost savings of $1.2million (approx). The average LOS (length of stay) for ACS patients in Orange was 3.39 days comparing favourably with statewide benchmarks (A1 peer hospital 3.7days and B1 6.0). The average LOS for ACS patients transferred to Sydney hospitals from 2 other rural base hospitals during the same year was 4.2 and 3.8 days. Patients transferred to Orange for angiography from these sites had a shorter LOS (2.8 and 2.4 days).Conclusion: Rural Catheter Labs improve access to cardiac services and provide a cost effective, safe 2 and convenient service for patients. Earlier cardiac catheterisation is achieved, allowing triage of patients based on their anatomy. A large percentage of patients are fully managed locally.
Conclusion: Compared with a healthy population, patients with stable CAD and NoCAD have significantly poorer quality of life. Future management strategies need to address the health outcomes in these patients.Background: Approximately 20-30% of coronary angiograms for the investigation of chest pain show non-obstructive CAD (NoCAD). These patients receive little attention compared to those with obstructive CAD. We therefore assessed the health outcomes of patients with NoCAD as compared with CAD over 12 months.Method: Consecutive patients undergoing angiography for the investigation of chest pain were recruited prior to procedure. The following health outcomes were evaluated at baseline, 1, 6 and 12 months: (a) chest pain, (b) Seattle Angina Questionnaire (SAQ), and (c) Short-Form 36 (SF-36).Results: Of the 1148 patients with chest pain recruited, 28% had NoCAD. Compared with CAD, these patients were younger (62 ± 11 vs 57 ± 12 years, respectively; p < 0.001) and following age-adjusted analysis, were more likely to be female (29% vs 58%, respectively; p < 0.001). Baseline SF-36 and SAQ scores were similar for the two groups and over 12 months, both groups showed an improvement in scores. However, the change in SF-36 Physical Summary Score at 12 months compared to baseline was significantly lower in NoCAD patients. No longitudinal differences were seen in SAQ scores. Self reported chest pain was lower in the CAD patients compared with NoCAD at 1 (64% vs 68%, p > 0.05), 6 (46% vs 61%, p < 0.001) and 12 months (40% vs 48%, p > 0.05).Conclusion: NoCAD patients are younger and more likely to be female. After adjusting for age, they are more likely to have ongoing chest pain and impaired quality of life as assessed by the SF-36.
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