I am pleased to introduce a new journal that will focus on an important and rapidly growing area in cardiology, the use of critical pathways. Critical pathways are standardized protocols for the diagnosis and treatment of specific disorders. They are used by essentially all hospitals for numerous diagnoses but most often are used in patients with cardiac disorders, such as chest pain and acute myocardial infarction.
Although nearly every hospital has developed critical pathways, there are relatively few publications in the literature on their development, implementation, and outcomes. Given the widespread use of pathways, the American Heart Association has noted that they are very useful in the initial reports, but more research is warranted in this important field.1
To this end, I coedited the first book on this topic, Critical Pathways in Cardiology, published by Lippincott, Williams & Wilkins in March 2001. However, with the rapid advances in cardiology, many of these pathways are in need of updating. Critical Pathways in Cardiology is targeted to fill this gap, by providing a place to clinical researchers to publish both their pathways, including the evidence-based rationale for what is included, and to publish studies that evaluate their efficacy in improving clinical care. The published critical pathways will also seek to define state-of-the-art cardiac care and will include all the newest diagnostic tests or medications as they become available.
There are seven major topic sections in the journal, relating to the major areas of cardiology: 1) acute coronary syndromes, 2) interventional cardiology (including cardiac surgery), 3) congestive heart failure, 4) arrhythmias, 5) preventive cardiology, 6) general cardiology, and 7) emergency medicine. Each of these sections has a section editor, and it is my privilege to work with an outstanding group of leaders in cardiology for these sections. We also have an esteemed Editorial Board of leading cardiologists, emergency physicians, and nurses in the field of critical pathways and cardiology.
This journal will be a multimedia journal. In addition to the quarterly publication, the material will simultaneously be posted on the journal's web site, http://www.critpathcardio.com. However, beyond just providing PDF files of the articles, many articles will have other formats of the information to assist in your using and disseminating the information. For example, in the publication of the results of the Thrombolysis in Myocardial Infarction (TIMI) 9 Registry, we have provided slides of the results that subscribers can download and use for presentations. Because many pathways also contain actual order sheets from hospitals, these are also available. In the article on the ACS ACTION quality improvement program, numerous Microsoft Word documents are available for downloading, including standardized order sheets. Finally, as critical pathways move to the bedside, more information is being formulated for the Palm Pilot (Palm, Inc., Santa Clara, CA). In this issue, Drs. Gelfand, Piazza, and Goldhaber have created a Palm program on venous thromboembolism that can be downloaded. Thus, the aim of this “journal” is to facilitate the dissemination of various formats of critical pathways.
This journal is intended to be helpful to many groups, including cardiologists, internists, primary care physicians, fellows, residents and medical students, and nurses. It is also planned that pathways be relevant to practice both in the United States and around the world.
To potential authors of manuscripts, I invite your submission of all types of manuscripts on critical pathways: from a description of your pathways to reports of data on the implementation and outcomes of patients managed with a pathway. In this issue we have descriptions of various critical pathways. We also have a brief report of a survey done at a tertiary care hospital that evaluated the compliance with the American College of Cardiology/American Hearth Association (ACC/AHA) Guidelines for acute myocardial infarction and unstable angina. We welcome reports of all lengths and research projects of varying scopes. We wish to be a forum for publication of clinical experience with critical pathways that has not previously been available in the cardiac literature. In this electronic age we will plan to do most submissions and reviews via e-mail. This will expedite the review process, so we promise an editorial response in less than 3 weeks from submission.
As you can see, I am very excited about this new journal. I believe that critical pathways afford the opportunity to improve the quality of care we offer patients and at the same time make it more cost-effective. It is hoped that this journal will be a place where we can share critical pathways, report results, and thus advance the practice of medicine.
I welcome any suggestions or comments. Just write to me at the journal's e-mail address: firstname.lastname@example.org.