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Related Concept Videos

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

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The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
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Related Experiment Video

Updated: May 22, 2025

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Sustained Improvements After Intervention to Prevent Contrast-Associated Acute Kidney Injury: A Randomized Controlled

Michael E Matheny1,2, Elizabeth Carpenter-Song3, Iben M Ricket4,5

  • 1Department of Biomedical Informatics Vanderbilt University Medical Center Nashville TN USA.

Journal of the American Heart Association
|May 15, 2025
PubMed
Summary

Sustained improvements in acute kidney injury (AKI) outcomes were observed following a team-based coaching and data dashboard intervention. This approach demonstrated durable AKI reduction in cardiac catheterization patients.

Keywords:
acute kidney injurychronic kidney diseasecontrast nephropathyprevention

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Area of Science:

  • Nephrology
  • Cardiology
  • Healthcare Quality Improvement

Background:

  • The IMPROVE AKI trial previously showed a 46% reduction in acute kidney injury (AKI) after cardiac catheterization using team-based coaching and data dashboards.
  • This study aimed to assess the long-term sustainability of these AKI outcome improvements after the active intervention concluded.

Purpose of the Study:

  • To determine if the AKI outcome improvements achieved during the IMPROVE AKI trial were sustained after the active intervention period.
  • To identify barriers and facilitators to sustaining AKI improvements in clinical practice.

Main Methods:

  • An 18-month sustainability phase (April 2021-September 2022) followed the 18-month active intervention (October 2019-March 2021).
  • A 2x2 factorial cluster-randomized trial design was used across 20 Veterans Affairs sites.
  • Data on acute kidney injury (AKI) within 7 days of cardiac catheterization were collected for adult patients not on chronic dialysis.

Main Results:

  • A 40% reduction in AKI was observed during the 18-month sustainability phase in sites using team-based coaching with automated surveillance dashboards compared to technical assistance alone (aOR, 0.60 [95% CI, 0.42-0.86]).
  • Specific implemented practices included standardized orders for procedures, hydration, and contrast limitation.
  • AKI occurred in 440 of 4160 patients overall, and 216 of 1260 patients with pre-existing chronic kidney disease.

Conclusions:

  • Team-based coaching combined with data-driven surveillance dashboards provides durable reductions in acute kidney injury (AKI) post-cardiac catheterization.
  • Process improvement education, care standardization, and automated feedback are effective strategies for sustained AKI reduction.