Cardiovascular assessment of patients with ischaemic stroke or transient ischaemic attack-which test to order?  

Oleh:

Tullio, Marco R. Di

Jenis: Article from Bulletin/Magazine - ilmiah internasional
Dalam koleksi: Medical Progress vol. 35 no. 03 (Mar. 2008), page 109.

Ketersediaan

Perpustakaan FK Nomor Panggil: M36.K.2008.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

Lihat Detail Induk

Isi artikel

Objective : To evaluated the use, revelance and economics of cardiovascular investigations in an ambulatory stroke clinic. Design : This study was a chart review of 200 patients with stroke or transient ischaemic attack (TIA) who were diagnosed over a 6 month period at a stroke in Canada.THe investigators assessed the use, revelanced and economics of transthoracic echocardiography for the detection of left atrial or left ventricular thrombus or mass, poor left ventricular function, patent foramen ovale or trial septal defect, and other structural abnormalities, and of electrocardiography (ECG) and holter monitoring for the detection of atrial fibrilation or atrial flutter. A cardia investigation was considered to be clinically pertinent if it resulted in a change in treatment paradigm. Results : Transthoracic echocardiography was performed in over two-thirds of patients (n=142,71%). Relevant cardiac findings were detected in six (4%) cases, with one patient having severely impaired left ventricular function (ejection fraction <20%), three patients having moderately impaired left ventricular function (ejection fraction 20% to 39%), and two patients having mildly to moderately impaired left ventricular function. In none of these patients did the findings lead to an alteration of antithrombotic therapy. Holter studies were conducted in three quaters of patients (n=149, 75%), and these investigations detected atrial fibrilation in three (2%) cases. In two patient with newly detected atrial fibrilation, this finding led to a shift from antiplatelet therapy to anticoagulation. The third patien had a previous history of atrial fibrilation, and the antithrobotic regimen was not change. All patients in this study underwent ECG, which also identified the above three cases of atrial fibrilation. TThe total costs for transthoracic echocardiography in this study amounted to CAN$33,029 (cost per study $232.60), the total costs for Holter monitoring were $15,786 (cost per study $105.95), and the total costs for ECG were $3,300 (cost per study $ 16.50). Conclusion : Transthoracic echocardiography and Hoiter monitoring accounted for 94% of the total cardiovascular costs. The use of thoracic echocardiography in this outpatient setting had no clinical impact, however, and Hoiter monitoring did not have any added advantage over ECG.

Opini Anda

Klik untuk menuliskan opini Anda tentang koleksi ini!

Kembali