Article

Updated Strategies and Therapies for Reducing Ischemic and Vascular Events (STRIVE) Unstable Angina/Non-ST Elevation Myocardial Infarction Critical Pathway Toolkit

TIMI Study Group, Brigham and Women's Hospital, Boston, MA 02115, USA.
Critical pathways in cardiology 04/2008; 7(1):43-81. DOI: 10.1097/HPC.0b013e3181642955
Source: PubMed

ABSTRACT

The Strategies and Therapies for Reducing Ischemic and Vascular Events (STRIVE) acute coronary syndromes (ACS) critical pathway toolkit, developed in 2002, has been revised and updated. The updated toolkit is based on the American College of Cardiology/American Heart Association 2007 guidelines for the management of patients with unstable angina/non-ST-segment elevation myocardial infarction (UA/NSTEMI). This review highlights the major revisions to the UA/NSTEMI guidelines and illustrates and describes the revised STRIVE critical pathway tools, which include pathway flowcharts, standing orders, pocket cards, posters, and form letters. These materials are being made available online to help physicians, nurses, and hospitals implement the new guidelines and thus improve the quality of care and outcomes for patients with ACS.

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    ABSTRACT: The Strategies and Therapies for Reducing Ischemic and Vascular Events (STRIVE) acute coronary syndromes critical pathway toolkit has been revised again based on the 2007 focused update of the American College of Cardiology/American Heart (ACC/AHA) Association guidelines for the management of patients with ST-segment elevation myocardial infarction (STEMI). A previous update of the toolkit incorporated the 2007 ACC/AHA guidelines for unstable angina/non-ST-segment elevation myocardial infarction. This review highlights the major revisions to the STEMI guidelines, and illustrates and describes the revised STRIVE critical pathway tools for STEMI, which include pathway flowcharts, standing orders, pocket cards, and posters. The updated STEMI tools are available to clinicians online on the STRIVE Website.
    No preview · Article · Jan 2009 · Critical pathways in cardiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Strategies and Therapies for Reducing Ischemic and Vascular Events (STRIVE) acute coronary syndromes critical pathway toolkit has been updated based on the 2009 focused updates of the American College of Cardiology/American Heart Association guidelines for the management of patients with ST-segment elevation myocardial infarction (STEMI) and American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions guidelines on percutaneous coronary intervention (PCI). This review highlights the major changes cited in the focused updates, which have been incorporated into the STRIVE standing orders for STEMI and unstable angina/non-ST-segment elevation myocardial infarction (UA/NSTEMI). The updated STEMI and UA/NSTEMI standing orders and other tools are available to clinicians online on the STRIVE Web site.
    No preview · Article · Jun 2010 · Critical pathways in cardiology
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    ABSTRACT: Patients presenting to the emergency department with chest pain require prompt identification and referral, as early treatment of patients with an acute coronary syndrome (ACS) is crucial to decrease morbidity and mortality (Steurer et al, Emerg Med J. 2010;27:896-902). Although rule-in ACS is critical and time dependant, other difficulties arise during the rule-out ACS process (Steurer et al, Emerg Med J. 2010;27:896-902). Inappropriate discharge of patients with misdiagnosed acute myocardial infarction is associated with significant morbidity and mortality. Concerns relating to inappropriate discharge result in readmission with resultant lengthy hospital stays, high costs, and contribute to overcrowding and bed block (Amsterdam et al, J Am Coll Cardiol. 2002;40:251-256; Cardiol Clin. 2005;23:503-516; Furtado et al, Emerg Med. In press; Karlson, Am J Cardiol. 1991;68:171-175; Ng et al, Am J Cardiol. 2001;88:611-617; Ramakrishna et al, Mayo Clin Proc. 2005;80:322-329; Stowers, Crit Pathw Cardiol. 2003;2:88-94). The challenge of chest pain diagnosis has led to a number of associated problems within the health care system. The growing need for improvements in consistency of patient care, resource efficiency, and quality of patient healthcare has led to the development of chest pain pathways (Erhardt et al, Eur Heart J. 2002;23:1153-1176). The development and implementation of chest pain pathways is not without difficulties. These may arise from differences in the management approaches of health practitioners, poor adherence to guidelines, and concerns for costs. New procedures such as new cardiac injury markers, stress testing, and specialized chest pain units have led to a reduction in admission rates and length of stay, reduced costs, and a reduction of inappropriate discharge of patients with ischemic heart disease.
    Full-text · Article · Jun 2011 · Critical pathways in cardiology