Complex Clinical Cases
The submission process for Complex Clinical Cases for ACC.21 is now closed. Notifications will be sent on or around February 10, 2021. Accepted presenters will have the opportunity to share their science with colleagues from around the world.
Submissions were accepted in the following categories:
- Fellow in Training (FIT) Cases: FIT Cases will be peer-reviewed and selected for presentation in one of two formats — during a special "Stump the Professor" session at ACC.21 or as a traditional or moderated poster. FITs should submit an interesting case based upon the clinical decision-making used to arrive at a diagnosis and/or treatment. The case scenario must illustrate clinical decision-making with teaching points. The first author and presenter must be a medical student or anyone in a fellowship or residency program.
- Cardiovascular Team Cases: Submit an interesting clinical case highlighting collaboration and consultation with interdisciplinary colleagues. Highlight the diagnostic features, care coordination/management strategies and experts involved in managing the case and securing a diagnosis. Relate your experience and share with learners at least one clinical pearl that could be immediately replicated in similar practices. CVT cases are peer reviewed. The first author of the CVT Case must be a non-physician CV team member, which could include nurses, advanced practice nurses, pharmacists, physician assistants, CV practice administrators, technologists, registered dietitian nutritionists or exercise specialists/physiologists. The presenter must be a CVT member.
- MD/PhD Cases: New for ACC.21, we are accepting cases by MD/PhDs. Similar to the FIT cases, these submissions should be an interesting case based upon the clinical decision-making used to arrive at a diagnosis and/or treatment. The case scenario must illustrate clinical decision-making with teaching points. These cases will be peer-reviewed. The first author and presenter must be a medical doctor or researcher.
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Sample Cardiovascular Team Cases
Sample Case 1
|Publishing Title:||Addressing Cardiovascular Health Disparities: Utilizing Team Based Care to Improve Rural Cardiovascular Care|
Background: Compared to their urban counterparts, rural patients seeking cardiac care are faced with disparities in healthcare access. Objectives: The goal of this pilot study was to gain insight into the healthcare perceptions and behaviors of the consumers living in a designated rural community in Illinois and to test a new team-based cardiovascular care delivery model.
Case: Methods: A mixed methods prospective study was performed to assess the quality of cardiovascular care provided by advanced practice providers (APP) compared to physicians in a rural outpatient clinic. Two independent focus groups, one a rural healthcare provider group and the other a patient centered focus group, were conducted to obtain stakeholder input. Two APP clinics per month were added to the existing physician model. Visit metrics were collected after each patient visit (N-355) from September 2016 until February 2017. Each patient encounter was analyzed to determine compliance with evidence-based guidelines (ACC/AHA) for the treatment of patients with coronary artery disease (CAD), Left Ventricular (LV) dysfunction, and patients with neither CAD nor LV dysfunction using Mann-Whitney U tests.
Decision-making: Results: Shared themes were identified across both focus groups and included transportation, access to services/testing, availability of physicians, quality of care, patient-physician relationships including communication, coordination of care and education. There was comparable adherence to guidelines for CAD patients, LV dysfunction patients or the combination of both equating APPs to physicians. There were superior measures of patient satisfaction in the categories of concern and confidence favoring the APPs.
Conclusion: This pilot study demonstrates that APPs provide quality outpatient cardiovascular care in the rural setting. Patient satisfaction scores for APPs were comparable or superior to physicians. Results support the use of APPs to provide cardiovascular care in an underserviced rural area. The focus groups identified that a team-based approach is required to satisfy rural community healthcare needs.
Sample Case 2
|Publishing Title:||Advanced Practice Providers Utilize a Pre-Catheterization Screening Tool to Decrease Contrast Induced Nephropathy|
Background: A collaborative approach to help decrease contrast induced nephropathy in patients undergoing cardiac catheterization reveals favorable outcomes. Our Invasive Cardiology Advanced Practice Providers were utilized to implement a screening tool to decrease contrast induced nephropathy (CIN) on all patients except STEMI patients having a cardiac catheterization in the outpatient and inpatient setting.
Case: A multidisciplinary team was utilized to identify team leaders to develop a screening tool to identify those at risk for CIN. The tool would also incorporate key elements as defined by the NCDR® CathPCI Registry®. Our team consisted of an Interventional Cardiologist, Advance Practice Provider(APP) and the Registry Coordinator. The Registry's Risk Adjusted Acute Kidney Injury (RA AKI) was utilized for benchmarking.
Decision-making: Our current hydration protocol was reviewed and utilized. The pre-cath assessment tool was incorporated into the APPs workflow for both inpatients and outpatients. The tool provides three prompts. The first addresses if the patient is on ACE, ARB or diuretics. The tool prompts the APP if the patient has received contrast dye in the last 48 hours. Patients identified as high risk received additional hydration. Hourly hydration rate is adjusted relative to GFR and ejection fraction as described in our protocol. The APP evaluation of these patients in conjunction with utilizing the screening tool is the key to identifying patients at risk.
Conclusion: The process of utilizing the APP, the screening tool, and our hydration protocol successfully decreased our patients' risk of CIN. Prior to implementation of this process RA AKI was 3.68. After implementing our RA AKI rate decreased to 2.81. With this new process we made improvements toward the 90th percentile of 2.56 for 2017Q1 compared to 4.15 for 2016Q3. The screening tool helps to raise an awareness of each patients' individual risk and guides the provider to implement practices that decrease risk and improves outcomes. Each component was essential to the success of the screening tool. The APP provided key care coordination.
References/Resources: NCDR® CathPCI Registry® Outcomes Reports 2016Q1 and 2017Q1
Sample FIT Clinical Decision-Making Case
|Publishing Title:||The Great Masquerader: Cardiac Sarcoidosis Mimicking Arrhythmogenic Right Ventricular Dysplasia|
Background: Infiltrative cardiomyopathies have overlapping features by conventional imaging criteria; Precise diagnosis requires a multimodality approach and has important implications for treatment.
Case: A 49 year old male presented in ventricular tachycardia which terminated with lidocaine. Baseline EKG was significant for an epsilon wave in V1 (Figure1G). Echocardiography revealed global hypokinesis and catheterization showed non-obstructive coronary disease. Cardiac MRI revealed a right ventricular EF of 26% with a focal aneurysm of the free wall (Figure 1A) and late gadolinium enhancement throughout both ventricles (Figure 1B-C) but no hilar adenopathy (Figure 1D).
Decision‐making: This patient met two 2010 ARVD Task Force major criteria. Cardiac biopsy showed fibrosis without fatty infiltration or granulomas. Genetic testing was negative for known ARVD mutations. Investigation for sarcoidosis was prompted; a PET scan 6 months later noted hypermetabolic hilar adenopathy (Figure 1E-F). A lymph node biopsy showed fibrosis and non-necrotic granulomas (Figure1H) consistent with multiple proposed criteria for the diagnosis of cardiac sarcoidosis. In addition to standard cardiomyopathy therapy, the patient was treated with oral steroids with no further arrhythmias.
Conclusion: This case highlights cardiac sarcoidosis as a masquerader sharing features of ARVD and underlines the importance of a multimodality imaging approach as well as biopsies for proper diagnosis and treatment.