Search

Background: We developed a hypertension (HTN) care initiative in a metropolitan based Primary Ambulatory Care to advocate and increase adherence to blood-pressure (BP) standards. The strategy involved, Treat to Target (T2T), linked health promotion by addition of BP clinic slots and training Nursing staff to optimize BP monitoring and care. Uncontrolled HTN leads to increased risk CVD complications with a socioeconomic cost attached. Thus, we evaluated the pre- and post-T2T period outcomes for systolic BP control. Methods: Patients that presented to ambulatory clinic prior to and during the T2T initiative were selected in a case control paired chart review (24 months pre & post initiative). Enrollment criteria included BP readings greater than 130 mmHg systolic or 80 mmHg diastolic in the T2T period or change in current BP medication were selected and enrolled into the BP initiative. The nursing staff reviewed BP diary, addressed medication concerns, established a patient center module to promote salt reduction/medication adherence/exercise/weight loss. Final BP outcomes were assessed, pre and post T2T initiative for systolic & diastolic control, number of visits, and meeting the set BP standards. Results: A total of 2729 patients were included in paired review. The mean age was 61.3±9.6 years, 57% were females, and 70% were Latinx & 25% were Blacks. At baseline, mean systolic BP was 143.2mm Hg in the T2T group and 144.1 mmHg in the control group. At last follow-up in the period of the study, mean systolic BP fell by 7.6 mmHg (to 135.5mmHg) in the T2T group and by 9.5 (to 134.6mmHg) in the control group. The average number of visits decreased from control to the T2T period by 31% (5.1±3.0 vs. 3.5±1.5, p Conclusions: The HTN initiate by increasing BP clinic spots run by Nursing to educate, monitor and titrate BP control which resulted in sustained BP reduction with fewer visits and decreased uncontrolled BP events and was a sustainable initiative. Broad-scale implementation is both justified and warranted in a metropolitan ambulatory care setting, which will entail cost initially, and in turn develop continual relationship to reduce HTN related compliance.

Left ventricular thrombi (LVT) is an uncommon complication that can occur after a myocardial infarction thanks to the discovery of revascularization therapies. Before it, an LVT was described in up to 60% of patients with myocardial infarction. The authors present a case of a 46-year-old female who presented to the emergency department with one week of dyspnea, who had symptoms of chest pain for a week, however, did not show up in the hospital due to the ongoing COVID-19 pandemic. In-patient new-onset heart failure workup during that time was minimized due to the state of emergency COVID-19 pandemic. The patient lost to follow up appointment and then presented again to the hospital with Echocardiogram at that time showing mid to distal septal and apical hypokinesis, EF 30%-35% and a highly mobile circumferential echogenic mass of 2.4x2.4 cm noted in the left ventricle (LV) with differentials of LV thrombus vs cardiac tumor. Hospital complicated by LV thrombus embolization with bilateral lower extremities (LEs) arterial thrombi and limb ischemia. Left cardiac cath with a result of severe triple vessel disease requires either coronary artery bypass grafting (CABG) or complex percutaneous coronary intervention (PCI). A tentative plan was to pursue CABG, however, lower extremities must be healed prior to cardiothoracic surgery.