November 2012

Medication adherence improves patient outcomes, but U.S. patients generally have low rates of compliance. To help patients stay on top of their dosing regimens, physicians need to identify those most likely to be nonadherent and the reasons for their recalcitrance to implement interventions. But adherence itself bears costs, as do interventions. Payers want proof that strategies are both cost-effective and feasible.

In this issue, we highlight a critical problem in the care of patients with cardiovascular diseases and an approach for managing these patients or possibly even preventing diseases in the first place.

As U.S. healthcare trends toward team-based care with greater focus on preventive services, nurses are stepping into leadership roles and producing positive clinical outcomes. However, this shift in cardiovascular care may require an overhaul of cultures and systems by providers—as well as a fresh look at reimbursement.

Bleeps, chirps and a cacophony of warning alarms assault nurses and physicians in today’s hospital units. But it doesn’t have to be that way. Several hospitals have taken steps to reduce this auditory overload in an effort to help caregivers discern between important notifications and mere noise.

In February 2012, the 117-bed TriStar Centennial Heart & Vascular Center in Nashville, Tenn., started considering ways to expand its success as a STEMI-referral site. The center turned to AirStrip Cardiology to put access to real-time EKG data in the palm of the physicians’ hands. Physicians can now view EKG data via iPad or iPhone before the patient even reaches the hospital. Sponsored by an educational grant from AirStrip.

Fewer pharmaceutical sales representatives try to knock on cardiologists’ doors than in the past, and those who do find access to physicians may be more restricted. Some researchers argue that limiting drug reps’ access potentially deprives physicians of important medical information. Others say that physicians may be more susceptible to marketing manipulation than they realize.

What does the best care look like? How do we give cardiovascular professionals the ability to incorporate the “best care” into their practices or hospitals? This is the question that the American College of Cardiology (ACC) is attempting to answer.

It’s become fashionable to describe the healthcare system as hopelessly broken, and to indirectly blame providers as a key reason for the situation. For instance, a new report from the National Academy of Sciences (NAS) sums up what it terms as a “fundamental paradox” in U.S. healthcare. It warns that American healthcare “is falling short on basic dimensions of quality, outcomes, costs and equity.” It compares the current delivery system to other industries, and concludes that the U.S. system falls significantly short.

While there are no guidelines to recommend how long healthcare professionals should perform resuscitation following in-hospital cardiac arrest, a recent large study indicates that longer efforts may produce better outcomes—in some cases. But, a personalized strategy is always preferred.

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