Evaluation of metoprolol standard dosing pathway in Chinese patients with acute coronary syndrome:a prospective multicenter single-arm interventional study

OBJECTIVE To evaluate the feasibility and tolerability of metoprolol standard dosing pathway(MSDP)in Chinese patients with acute coronary syndrome(ACS).METHODS In this multicenter,prospective,open label,single-arm and interventional study that was conducted from February 2018 to April 2019 in fifteen Chinese hospitals.A total of 998 hospitalized patients aged≥18 years and diagnosed with ACS were included.The MSDP was applied to all eligible ACS patients based on the standard treatment recommended by international guidelines.The primary endpoint was the percentage of patients achieving the target dose at discharge(V2).The secondary endpoints included the heart rate and blood pressure at V2 and four weeks after discharge(V4),and percentage of patients experiencing bradycardia(heart rate<50 beats/min),hypotension(blood pressure<90/60 mmHg)and transient cardiac dysfunction at V2 and V4.RESULTS Of the 998 patients,29.46%of patients achieved the target dose(≥95 mg/d)at V2.The total population was divided into two groups:target group(patients achieving the target dose at V2)and non-target group(patients not achieving the target dose at V2).There was significant difference in the reduction of heart rate from baseline to discharge in the two groups(-4.97±11.90beats/min vs.-2.70±9.47 beats/min,P=0.034).There was no significant difference in the proportion of bradycardia that occurred in the two groups at V2(0 vs.0,P=1.000)and V4(0.81%vs.0.33%,P=0.715).There was no significant difference in the proportion of hypotension between the two groups at V2(0.004%vs.0.004%,P=1.000)and V4(0 vs.0.005%,P=0.560).No transient cardiac dysfunction occurred in two groups during the study.A total of five adverse events(1.70%)and one serious adverse event(0.34%)were related to the pathway in target group.CONCLUSIONS In Chinese ACS patients,the feasibility and tolerability of the MSDP have been proved to be acceptable.

Care Bundles:Enhanced Recovery After Delivery

The care of obstetrics patients has improved dramatically over the past few decades.Unfortunately,rates of cesarean section remain high,and decreasing this rate requires close care and follow-up in the prenatal outpatient setting.Counseling regarding cesarean delivery and vaginal delivery is imperative.Opportunities still exist in helping patients objectively weigh the decision for cesarean delivery versus vaginal delivery.Additional developments have occurred in the intrapartum and the postpartum setting,with an aim to improve patient and neonatal outcomes.Changes have been implemented for patients undergoing cesarean delivery including preoperative and intraoperative treatment of pain,nausea,and vomiting,as well as postoperative care bundles that improve patient outcomes.Innovations have also occurred in the care of postpartum patients after vaginal delivery,again with improvements in patient outcomes.This article summarizes the current evidence,provides care recommendations,and identifies the next steps in improving obstetrics care.