Saudi Cultural Missions Theses & Dissertations
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Item Restricted Acute Remote Medicine Based Assessment of High Risk Atherosclerosis Patients(Imperial College London, 2024-07-21) Alshahrani, Nasser Saeed; Khamis, RamziAlthough there have been significant advancements in medical and interventional therapies, myocardial infarction (MI) remains a major cause of death in the UK. Unplanned readmission rates in the UK are high despite a global trend towards short hospital stays post-MI, sitting at approximately 10% at 30 days post-discharge and even higher at 6 months. The 30-day mortality rate post-ACS in the US is 7.3%, with comparably high rates observed in Europe and the UK. The use of telemedicine technology can provide remote, clinically necessary, diagnostic information, thus eliminating the necessity for patients to visit the hospital. Telemonitoring could improve the management of post-ACS care and reduce the number of unexpected readmissions. Despite these potential benefits, there are considerable barriers to its implementation. This thesis present four chapters discussing the impact and efficacy of home telemonitoring for cardiac patients post-ACS. I first used a systematic review and meta-analysis to investigate the existing research on the use of telemedicine for patient management post-ACS. Second, I designed and validated a clinical decision support system algorithm for the remote management of patients post-ACS in a nonhospital setting. Third, I conducted a randomised controlled trial (acronym: TELE-ACS) that used a specialised hybrid remote telemonitoring system to monitor patients following their hospital discharge post-ACS. Fourth, I conducted a 6-month cost-benefit analysis of the TELE-ACS protocol and assessed its impact on the health-related quality of life in patients following ACS. The results demonstrate that a remote monitoring approach in combination with clinical decision algorithm protocol based on patient symptoms, 12-lead ECG data, BP levels, and oxygen saturation levels, significantly decreased the rate of hospital readmissions, emergency department visits, unplanned coronary revascularisations, and patient-reported symptoms for patients post-ACS. Therefore, the TELE-ACS protocol represents a financially viable approach to reducing readmissions in ACS patients.23 0Item Restricted The Effectiveness of Using the HEART Score on Patients Complaining of Chest Pain in The Emergency Department Who Are at Risk of Acute Coronary Syndrome: a systematic review.(Saudi Digital Library, 2023-07-18) Alturbag, May Ali; Bennett, MaggieBackground: Chest pain is one of the most common causes of presentation to the emergency room. The diagnosis of non-ST-elevation acute coronary syndrome is a challenge because this condition doesn't have an easily identifiable electrical pattern like the other main types of heart attacks. The HEART Pathway (history, ECG, age, risk factors, and troponin) is a rapid diagnostic tool that identifies low-risk emergency department patients with chest pain for early discharge without stress testing or angiography. Aim: This systematic review aims to Determine the effectiveness of the HEART score in patients with chest pain who might be suspected of acute coronary syndrome in the Emergency Department. Methodology: Five electronic databases (CHINAL, Medline, PubMed, Cochrane Library, and Web of Science) were searched systematically. A systematic search strategy was formulated with the assistance of an expert librarian. The appraisal tools that are used by RevMan and the Joanna Briggs Institute (JBI) for systematic reviews assess the quality of each study. Results: A total of seven studies are included. Five of the studies were randomised trials; one was quasi-experimental; and the last was an observational cohort study. They looked at the effectiveness of the HEART score to identify low-risk patients who can be safely discharged without stress testing or angiography in the emergency department. Five studies support the implementation of the HEART Pathway, but one caution against the widespread use of the HEART score as the sole determinant of ED disposition, and one study shows that the HEART score was incorrectly calculated for patients, leading to inappropriate risk categorization. Therefore, actions should be taken to improve the score’s use in daily practice. The discussion was based on the HEART Score, and the included studies relate to institutional policy, education, clinical decision-making, and continuing professional development. Conclusions The HEART Pathway reduces objective cardiac testing, shortens stay length, and increases early discharges without major adverse cardiovascular events at 30 days. It supports identifying low-risk patients who can be safely discharged without stress testing or angiography. However, this systematic review found that caution is advised when using the HEART score alone as a standard of care for ED patients with chest pain, as it may be calculated incorrectly.9 0Item Restricted Investigating Sodium-Glucose Co-Transporter 1 (SGLT1) in Myocardium and Its Role in High Glucose Ischemia-Reperfusion Injury(2023-04-28) Almalki, Alhanoof; Bell, RobertBackground: Hyperglycaemia is a common finding in both diabetic and non-diabetic patients presenting with acute coronary syndrome (ACS); it is a strong predictor of prognosis and is associated with an increase in the mortality rate. Interestingly, non- diabetic patients with hyperglycaemia have a worse prognosis than diabetic patients with the same serum glucose concentration. However, the role of hyperglycaemia in ischemia- reperfusion injury is still not fully understood. Clinical outcome trials with sodium-glucose co-transporter-2 (SGLT2) inhibitors demonstrate a significant improvement in cardiovascular outcomes, yet the mechanism is not fully understood especially given that SGLT2 is not expressed in the heart. In contrast, sodium glucose co-transporter-1 (SGLT1) is detected in the heart, but it is currently unknown whether SGLT1 plays a role in infarct augmentation prior to and/or after reperfusion and whether it has a cardioprotective function. Aims: 1) characterise the expression of SGLT1 in the myocardium, (2) determine the role of high glucose during ischemia-reperfusion injury, (3) investigate whether SGLT1 is involved in a glucotoxicity injury during IRI, and (4) whether inhibiting SGLT1 with an SGLT inhibitor may reduce infarct size. Method: SGLT1 mRNA expression in rat myocardium was determined using Reverse transcription polymerase chain reaction (RT-PCR) and in-situ hybridization (RNAScope). Ex-vivo Langendorff ischemia-reperfusion perfusion model was used to examine the effect of high glucose [22mmol] on the myocardium during reperfusion in comparison to standard glucose [11mmol]. Canagliflozin, a mixed SGLT1 and SGLT2 inhibitor (1moL/L to block the SGLT2 and SGLT1 and 5nmol/L to block the SGLT2 only), and mizagliflozin, a novel SGLT1 inhibitor (100nmol/L), were administered after ischemia-reperfusion injury, infarct size was measured using triphenyl tetrazolium chloride (TTC) staining. Results: we found that SGLT1 mRNA is expressed in the whole myocardium. SGLT1 mRNA expression is significantly suppressed by 50% in diabetic heart compared to non-diabetic heart, with no evidence of compensatory expression of myocardial SGLT2. We found that commercially available SGLT1 antibodies were unreliable and not adequate for ascertaining protein expression. We confirmed that high glucose [22mM] at reperfusion exacerbates infarct size by over 40%, and inhibiting SGLT1 with canagliflozinon, at a dose that would block SGLT2 and SGLT1, and mizagliflozin completely abrogates the glucose- induced exacerbation of myocardial infarction. Conclusion: Glucose-mediated exacerbation of infarction is via SGLT1, and this exacerbation can be abrogated by SGLT1 inhibition. SGLT1 expression is downregulated in diabetic states, hence the smaller infarcts in our model, and potentially explains lower mortality rate in diabetic ACS patients. SGLT1 represents a novel approach for clinical translation for ACS patients presenting with hyperglycaemia.6 0