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CRUSADE
CRUSADE Quality Improvement Initiative

Launched in 2001, CRUSADE is a national quality improvement initiative, designed to increase the practice of evidence-based medicine for patients diagnosed with non-ST segment elevation acute coronary syndromes (NSTE ACS) (i.e., unstable angina or NSTE myocardial infarction).

Through a continuous cycle of data collection, performance feedback and quality improvement interventions, over 500 participating sites in the US are consistently improving the standard of care for patients with NSTE ACS. Because of the dedication of the participating hospitals to this mission, over 200,000 cases have been submitted to the CRUSADE database. For more information visit the CRUSADE website.

In 2007, a milestone occurred. Duke Clinical Research Institute and its CRUSADE leadership joined forces with the American College of Cardiology Foundation's National Cardiovascular Data Registry (NCDR™) to launch a new initiative to improve the safety and outcomes for patients with ACS through the development of NCDR-ACTION™. This initiative will combine the data collection and quality reporting features of two leading national ACS registries to create the largest and most comprehensive national cardiovascular patient database ever developed. For more information visit the NCDR-ACTION Registry™ visit the website or call 800-257-4737 for more information.


Join EMCREG At SAEM in May.
Join EMCREG for our 7th Annual symposium at SAEM. This SAEM-approved event will be held during the 2008 annual meeting in Washington, DC. The symposium represents a unique opportunity to hear and interact with experts in emergency cardiovascular, neurovascular and infectious emergencies care and to gain up-to-date knowledge on the full spectrum of decision making and care these patients populations.

Marriott Wardman Park Hotel, Washington, DC
Friday, May 30, 2008 | 6:00 AM - 8:00 AM

View Agenda | Pre-register | Download brochure
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NEW! THE EMCREG-INTERNATIONAL HYPERTENSION CONSENSUS PANEL: MANAGEMENT OF HYPERTENSIVE EMERGENCIES
THE EMCREG-INTERNATIONAL HYPERTENSION CONSENSUS PANEL: MANAGEMENT OF HYPERTENSIVE EMERGENCIES
The EMCREG-International Hypertension Consensus Panel gathered experts from diverse fields, including Emergency Medicine, Cardiology, Neurology, Neurosurgery, Neuro-Critical Care, Obstetrics/Gynecology, Nephrology, Pediatrics, and Hospital Medicine to discuss, analyze, and provide recommendations for treating hypertension. Through this collaboration, virtually any patient presenting with hypertension to an outpatient or emergency department setting will have clear guidelines for treatment and physician follow-up

View the work in PDF Format.


NEW! ACEP 2007 MONOGRAPH: ADVANCING THE STANDARD OF CARE - CARDIOVASCULAR, NEUROVASCULAR AND INFECTIOUS EMERGENCIES
ACEP 2007 MONOGRAPH: ADVANCING THE STANDARD OF CARE - CARDIOVASCULAR, NEUROVASCULAR AND INFECTIOUS EMERGENCIES
EMCREG–International is pleased to present this complimentary 99-page CME monograph covering the proceedings of our 2007 satellite symposium at the ACEP Scientific Assembly in Seattle, Washington, Louisiana. A number of important topics are covered in this monograph including acute coronary syndrome, the diagnosis of transient ischemic attack and stroke, the treatment of ischemic and hemorrhagic stroke, the management of hypertension in acute neurovascular emergencies, the management of hypertensive urgencies and emergencies, markers for severe bacterial infections, the treatment of sepsis, risk stratification of possible acute coronary syndrome, the optimal management of NSTEMI and STEMI, treatment of acute heart failure syndrome, and the diagnosis and treatment of deep venous thrombosis and pulmonary embolism.

View the work in PDF Format.


NEW! MANAGEMENT OF HYPERTENSION AND HYPERTENSIVE EMERGENCIES IN THE EMERGENCY DEPARTMENT: THE EMCREG-INTERNATIONAL CONSENSUS PANEL RECOMMENDATIONS
Management of Hypertension and Hypertensive Emergencies in the Emergency Department: The EMCREG-International Consensus Panel Recommendation
This supplement [Ann Emerg Med 2008;51(3 Suppl 1):S1-S38] represents the first supplement to Annals of Emergency Medicine in nearly 16 years! These consensus documents on the evaluation and management of hypertension and hypertensive emergencies in the ED was systematically developed between December 2006 and April 2007 in an evidence-based and consensus-based process and culminated in the March 2008 supplement of Annals. The panel members were selected from a multidisciplinary group of specialists, which included physicians from emergency medicine, neurology, neurological surgery, internal medicine, hospital medicine, nephrology, cardiology, pediatrics, anesthesiology, vascular surgery, and gynecology and obstetrics. Each specific hypertension section or topic was assigned at least 2 experts, one of whom was usually an emergency physician.

The Supplement can be obtained on the Annals of Emergency Medicine website.


DRUG TREATMENT FOR HYPERTENSIVE EMERGENCIES
DRUG TREATMENT FOR HYPERTENSIVE EMERGENCIES
For emergency physicians, early diagnosis and appropriate treatment are essential for minimizing injury due to elevated blood pressure. In some cases, this management of hypertension can be life saving. In this EMCREG-International Newsletter, Drs. David Cline and Alpesh Amin provide an excellent guide to parenteral medications for hypertension. Based on an initial concise discussion of the epidemiology, pathophysiology, and clinical presentation of hypertensive emergencies, the authors focus on the specific agents for treating these conditions with appropriate therapeutic objectives and goals for the clinician in the acute care setting.

View the work in PDF Format.


SICK OR NOT SICK? : EVOLVING BIOMARKERS FOR SEVERE BACTERIAL INFECTION
SICK OR NOT SICK? : EVOLVING BIOMARKERS FOR SEVERE BACTERIAL INFECTION
With the difficulties associated with access to primary care and more aggressive emphasis on rapid hospital discharge and outpatient surgeries, sepsis ranks as one of the highest prevalence, highest mortality, and most expensive conditions that an emergency physician will encounter. Inthis publication, Dr. Andra Blomkalns provides up-to-date evidence on biomarkers for serious bacterial infection. Some of these biomarkers will be familiar to you while others may provide new insights into the diagnosis and treatment of this population.

View the work in PDF Format.


RISK STRATIFICATION FOR PATIENTS WITH NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROMES IN THE EMERGENCY DEPARTMENT
RISK STRATIFICATION FOR PATIENTS WITH NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROMES IN THE EMERGENCY DEPARTMENT
Emergency physicians routinely risk stratify multiple patients simultaneously in the emergency setting. In this newsletter, Dr. Gerry Brogan explores this important topic of risk stratification of patients with possible ACS in the ED. Comprehensive in nature, we hope this guide helps provide you with the background necessary to confidently approach this difficult clinical problem. It is our hope this information helps you to continue to provide outstanding care for your patients with possible ACS.

View the work in PDF Format.


...View the Publication Archive

Cardiac Troponin and Outcome in Acute Heart Failure
Peacock WF, Marco T, Fonarow GC, Diercks D, Wynne J, Apple FS, Wu AHB, for the ADHERE Investigators
N Engl J Med 2008;358(20):2117-2126
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The Medical Management of Acute Coronary Syndromes and Potential Roles for New Antithrombotic Agents
Pollack CV, Goldberg AD.
J Emerg Med 2008;34(4):417–42
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Coronary artery bypass surgery in patients with acute coronary syndromes is difficult to predict
Chew DP, Mahaffey KW, White HD, Huang Z, Hoekstra JW, Ferguson JJ, Califf RM, Aylward PE.
Am Heart J 2008;155:841-7
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Safety and Efficacy of Switching From Either Unfractionated Heparin or Enoxaparin to Bivalirudin in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes Managed With an Invasive Strategy: Results From the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) Trial
White HD, Chew DP, Hoekstra JW, Miller CD, Pollack CV, Feit F, Lincoff AM, Bertrand M, Pocock S, Ware J, Ohman EM, Mehran R, Stone GW.
J Am Coll Cardiol 2008;51:1734–41
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Can We Improve How We Treat Patients With Heart Failure in the Emergency Department?
Diercks DB.
Ann Emerg Med. 2008;51:583-4
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Do Emergency Department Patients With Possible Acute Coronary Syndrome Have Better Outcomes When Admitted to Cardiology Versus Other Services?
Katz DA, Aufderheide TP, Bogner M, Rahko PS, Hillis SL, Selker HP
Ann Emerg Med. 2008;51:561-570
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Better Outcomes for Patients Treated at Hospitals That Participate in Clinical Trials
Majumdar SR, Roe MT, Peterson ED, Chen AY, Gibler WB, Armstrong PW.
Arch Intern Med. 2008;168(6):657-662
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Morphine and Outcomes in Acute Decompensated Heart Failure: An ADHERE Analysis
Peacock WF, Hollander JE, Diercks DB, Lopatin M, Fonarow G, Emerman CL
Emerg Med J 2008;25:205–209
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Management of Cocaine-Associated Chest Pain and Myocardial Infarction. A Scientific Statement From the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology
McCord J, Jneid H, Hollander JE, de Lemos JA, Cercek B, Hsue P, Gibler WB, Ohman EM, Drew B, Philippides G, Newby LK.
Circulation 2008;117: published online before print March 17, 2008
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A Proposal To Standardize Dyspnoea Measurement In Clinical Trials Of Acute Heart Failure Syndromes: The Need For A Uniform Approach
Pang PS, Cleland JGF, Teerlink JR, Collins SP, Lindsell CJ, Sopko G, Peacock WF, Fonarow GC, Aldeen AZ, Kirk JD, Storrow AB, Tavares M, Mebazaa A, Roland E, Massie BM, Maisel AS, Komajda M, Filippatos G, Gheorghiade M for the Acute Heart Failure Syndromes International Working Group
EHJ Advance Access published March 1, 2008
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Cockcroft-Gault Versus Modification of Diet in Renal Disease. Importance of Glomerular Filtration Rate Formula for Classification of Chronic Kidney Disease in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes.
Melloni C, Peterson ED, Chen AY, Szczech LA, Newby LK, Harrington RA, Gibler WB, Ohman EM, Spinler SA, Roe MT, Alexander KP.
J Am Coll Cardiol 2008;51:991–6.
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Utility of Routine Testing for Patients With Asymptomatic Severe Blood Pressure Elevation in the Emergency Department
Karras DJ, Kruus LK, Cienki JJ, Wald WW, Ufberg JW, Shayne P, Wald DA, Heilpern KL.
Ann Emerg Med. 2008;51:231-239
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15 May 2008
Cardiac troponin predicts acute decompensated heart failure mortality
A recent NEJM article reports that cardiac troponin elevation is associated with increased in-hospital mortality in patients with acute decompensated heart failure
15 May 2008
Multiple biomarkers can predict cardiovascular death risk
Research suggestes that the use of multiple biomarkers of renal and cardiovascular abnormalities improves cardiovascular disease risk stratification.
13 May 2008
Vulnerable patients have longer delays in STEMI presentation
A study reports that STEMI patients with combined factors such as older age, female gender, Hispanic or Black race, and diabetes have much longer delays in STEMI presentation.
12 May 2008
Bivalirudin switch reduces ACS bleeding risk
Bleeding risk cut in half in ACS patients by switching from unfractionated heparin or low molecular weight heparin to bivalirudin.
9 May 2008
Cardiac troponin-based MI diagnosis supported
Researchers report that the additional patients diagnosed with MI rather than UA since the definition of MI was redefined have an even higher long-term mortality.
9 May 2008
Discrepancies between ACC-AHA and ESC anticoagulant guidelines are being criticized
Experts suggest that discrepancies in recommendations for optimal anticoagulation treatment in updated US and European ACS management guidelines are confusing for clinicians.
8 May 2008
Combination of A- and B-type natriuretic peptide provide additional AMI prognostic information
Researchers report that "midregional" pro-atrial natriuretic peptide is a strong predictor of adverse outcome after AMI, and gives complementary information when combined with measurement of the prohormone of BNP.
7 May 2008
Portable ultrasound device offers effective PE triage
A study reports effective triage using a portable ultrasound device that can accurately screen emergency department patients with dyspnea for venous thromboembolism.
1 May 2008
Transient STEMI management proposed: immediate and intense
Researchers in Israel propose that patients with transient ST-elevation myocardial infarction (TSTEMI) may benefit from immediate, intense medical therapy and an early invasive approach.
28 April 2008
Serial NT-proBNP better than clinical assessment in predicting HF prognosis
Research suggests that monitoring levels of NT-proBNP is better than clinical assessment at predicting outcome in heart failure outpatients.
25 April 2008
Point-of-care D-dimer assay rules out VTE
Researchers test a new 15-minute rapid point-of-care D-dimer assay with diagnostic performance comparable to conventional laboratory D-dimer tests.
24 April 2008
Bivalirudin monotherapy optimal for diabetic ACS patients
The ACUITY data suggests ACS patients with diabetes are likely to have more ischemia and bleeding than other patients, but these adverse events can be minimized by bilvalirudin monotherapy
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