Acute cardiovascular care in the emergency department and beyond: a call for interdisciplinary collaboration in clinical research

Providing optimal care to patients in the emergency department (ED) requires teamwork and interdisciplinary collaboration. This need holds true for patients with a wide range of conditions, particularly those with acute cardiovascular (CV) diseases. With increasing life expectancy of the population in many countries, the rising proportion of ED visits by older patients with multiple medical co-morbidities is resulting in longer ED stays for diagnosis, treatment, and disposition. 1 CV conditions are among the most common presentations among elderly patients presenting to the ED. 2 But even relatively minor complaints can lead to prolonged ED stays in an elderly patient with several co-morbidities, which, for example, require laboratory testing or imaging in order to decide whether a patient can be safely discharged home. In Europe, ED visit rates have been rising at an annual growth rate of up to 8.5% between ∼2001 and 2011 according to an Organisation for Economic Cooperation and Development report. 3 For the USA, an emergency medicine task-force recently projected an increase of ED visits to an estimated 159 million visits by the year 2030, with the highest rate of use among patients >75 years of age. 4 The ED plays a central role in the triage, diagnostic work-up, and short-term treatment of these patients with the goal to only hospitalize those who require care that cannot be provided in the ED or in the outpatient setting (Figure 1). For example, ED observation units and home hospitals can represent alternatives to inpatient admissions for a variety of conditions, such as acute heart failure, atrial fibrillation, and low-risk pulmonary embolism, even in elderly patients. 5 The latter offers hospital-level care for a range of lower acuity conditions with physicians and nurses treating patients at home following initial assessment in the ED. 6 Such efforts, in turn, require close collaboration among team members within the ED and also with inpatient and outpatient colleagues from other specialties, including cardiology. Within the ED, the roles of specialized healthcare providers (e.g. nursing, allied health practitioners , pharmacists) and the increasing demand and complexity of ED care necessitate research focused on optimizing management of patients with both acute and chronic CV conditions at (or before) their arrival in the ED and beyond. Innovative, interdisciplinary approaches to care delivery are now accepted and essential. Key success stories illustrate transformations of care and, in some cases, dramatically improved outcomes of patients with acute CV conditions , such as acute coronary syndromes, ST-elevation myocardial in-farction (STEMI), and acute pulmonary embolism. 7-9 Specifically, STEMI care has evolved from thrombolytics given in the intensive care unit setting in the 1980s to now comprehensive systems of care in many countries. These systems consist of education of the lay public in symptom recognition and Emergency Medical Service (EMS) activation, pre-hospital providers diagnosing STEMIs at the scene to transporting patients directly to a cardiac catheterization facility, and even bypassing the ED in an effort to reduce time to percutaneous coronary intervention. 7 Such improvements in patient management have been based on diverse research, including epidemiology, biomarkers, imaging, drug development , interventional therapies, as well as implementation strategies and ongoing clinician education. The evolution of the evidence to create such meaningful clinical change would not have been possible without the collaboration of diverse teams of researchers from different disciplines and countries. Despite these successes, ongoing challenges in acute care delivery and additional opportunities to improve the outcomes of patients with acute CV conditions necessitate interdis-ciplinary research and innovation. 10 Current challenges in acute CV care delivery in emergency medicine and gaps in evidence vary between countries and depend to some extend on how established emergency medicine is as a specialty in each country and which providers and resources are available in the ED. ED crowding and its impact on care of all patients, including those with acute CV conditions, represent a major challenge in many countries during the post-COVID era. Additional gaps in knowledge include the identification of and therapeutic approaches for patients with acute

Jaar van publicatie:2023

Trefwoorden:Humans, Interdisciplinary Communication, Emergency Service, Hospital, Emergency Medical Services

Toegankelijkheid:Open