Publications by authors named "Zachary D Goldberger"

Sudden cardiac death (SCD) remains a pervasive public health challenge, accounting for a significant proportion of cardiac and all-cause mortality worldwide. Despite notable advancements in cardiovascular therapies and reductions in overall cardiac mortality, survival following sudden cardiac arrest (SCA) remains dismally low, and prediction strategies remain inadequate. This comprehensive review examines the current landscape of SCD etiologies and the latest guidelines for primary and secondary prevention of SCD with implantable cardioverter defibrillators (ICDs).

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Background: Black patients have worse outcomes after in-hospital cardiac arrest (IHCA). Whether these racial disparities are associated with medical emergency team (MET) evaluation prior to IHCA remains unknown.

Methods: A retrospective cohort study of adults age ≥ 18 years from the American Heart Association Get With The Guidelines® Resuscitation registry who had an IHCA between 2000 and 2021 with acute physiologic decline (modified early warning score [MEWS] ≥ 3) during the 24 h prior to IHCA.

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  • Syncope, or fainting, often affects adolescents and the elderly, leading to a significant number of emergency department visits and healthcare costs as its incidence rises with age.* -
  • A study using data from 2006 to 2019 found that while the incidence of syncope increased, the rate of certain testing types decreased, with women undergoing fewer tests compared to men.* -
  • Despite stable discharge rates from the ED, hospital admissions for patients over 65 increased, indicating a need for more efficient evaluation methods to reduce costs and enhance patient outcomes.*
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  • Recent clinical trials show that different medications can lower cardiovascular death rates and improve patient outcomes, especially in heart failure cases.
  • Key medications include Angiotensin-Neprilysin Inhibitors and Sodium-Glucose Co-transporter 2 inhibitors, which are now essential treatments for heart failure, along with Ivabradine as a supplementary option.
  • Two new treatments for hypertension are being researched (zilebresiran and aprocitentan), and mavacamten is now a recognized option for treating hypertrophic obstructive cardiomyopathy, making it essential for healthcare providers to understand these therapies' uses and side effects.
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  • The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation" aims to provide updated recommendations for clinicians treating atrial fibrillation patients.
  • A thorough literature review was conducted to gather evidence from various medical databases, including studies and reviews published on human subjects from May to November 2022.
  • The guideline updates previous recommendations, introducing new strategies for thromboembolic risk assessment, anticoagulation, and methods for prevention and management of atrial fibrillation.
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  • The 2023 guideline aims to provide healthcare professionals with updated recommendations for diagnosing and managing patients with atrial fibrillation.
  • A thorough literature review was conducted to gather relevant studies and evidence from multiple databases, ensuring the guideline reflects current knowledge and practices.
  • The guidelines build upon earlier recommendations, introducing new insights on thromboembolic risk, anticoagulation, surgical options, and preventive measures related to atrial fibrillation.
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  • Cardiac physiologic pacing (CPP) includes techniques like cardiac resynchronization therapy (CRT) and conduction system pacing (CSP) aimed at reducing heart failure in patients with issues in heart rhythm.
  • The clinical guideline outlines recommendations for when to use CRT in heart failure patients, how to select suitable candidates, and key steps for pre-procedure preparation and ongoing care.
  • It also highlights areas where more research is needed to improve understanding and application of these pacing therapies, especially for children.
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Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.

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  • This document serves as a comprehensive guide for health care professionals on managing arrhythmias associated with neuromuscular disorders (NMDs), focusing on various specific conditions like Duchenne muscular dystrophy and myotonic dystrophy.
  • It includes expert-recommended practices for diagnosing and treating arrhythmic complications, as well as provides insights into end-of-life care for these patients.
  • The recommendations are based on extensive research, a consensus from specialists, and have undergone public and professional review to ensure effective and reliable clinical guidance.
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Aim: The executive summary of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions coronary artery revascularization guideline provides the top 10 items readers should know about the guideline. In the full guideline, the recommendations replace the 2011 coronary artery bypass graft surgery guideline and the 2011 and 2015 percutaneous coronary intervention guidelines. This summary offers a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization, as well as the supporting documentation to encourage their use.

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Aim: The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use.

Methods: A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered.

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Aim: The executive summary of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions coronary artery revascularization guideline provides the top 10 items readers should know about the guideline. In the full guideline, the recommendations replace the 2011 coronary artery bypass graft surgery guideline and the 2011 and 2015 percutaneous coronary intervention guidelines. This summary offers a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization, as well as the supporting documentation to encourage their use.

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Introduction: Cardiac auscultation skills have proven difficult to train and maintain. The authors investigated whether using phonocardiograms as visual adjuncts to audio cases improved first-year medical students' cardiac auscultation performance.

Methods: The authors randomized 135 first-year medical students using an email referral link in 2018 and 2019 to train using audio-only cases (audio group) or audio with phonocardiogram tracings (combined group).

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Syncope is a commonly encountered and challenging problem in medical practice. Presentations are variable, and the causal mechanism often remains elusive even after extensive (and often expensive) evaluation. Clinical practice guidelines have been developed to help guide the multidisciplinary approach necessary to diagnose and manage the broad spectrum of patients presenting with syncope.

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Importance: Several clinical decision rules (CDRs) have been developed to help practitioners know when to safely terminate resuscitative efforts after in-hospital cardiac arrest (IHCA). The UN10 rule, a CDR that uses 3 intra-arrest variables, has been shown to predict a poor chance of survival to discharge. However, its large-scale applicability in clinical settings remains unknown.

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