General poster session最新文献

{"title":"59 DAPT: are we getting the balance right?","authors":"B. Traynor, A. Dromey, M. Daly, A. Mansur, K. Hasan, E. Keelan, J. Galvin, J. O'Neill","doi":"10.1136/HEARTJNL-2020-ICS.59","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-ICS.59","url":null,"abstract":"Introduction Dual Anti-Platelet Therapy (DAPT) is indicated in Acute Coronary Syndrome (ACS) management and following elective Percutaneous Coronary Intervention (PCI). Optimal duration to balance the risks of bleeding and ischaemic events, including stent thrombosis, is an evolving debate with the advent of newer-generation Drug-Eluting Stents (DES) and evidence from the most recent randomised controlled trials. It should also be tailored to indication and individual patient risk profile. Guidelines concerning DAPT were published by the European Society of Cardiology in 2017 with risk stratification tools to estimate individual bleeding and ischaemic risk to guide and inform these decisions. Our aim was to establish current practice of DAPT prescribing in our department and investigate for adherence to guidelines. Methods Data were collated for 54 prospectively and randomly chosen patients attending general cardiology clinic between February and April 2020 who had commenced DAPT between 12 and 60 months previously following ACS or elective PCI. Patients given DAPT for other indications, or prior to elective angiography where DAPT did not continue thereafter, were not included. Four patients were excluded as insufficient data were available. ‘PRECISE DAPT Score’ at initiation and ‘DAPT score’ 12 months post initiation were retrospectively calculated. Demographic and clinical data were sourced from chart review and electronic laboratory and radiology systems. Data were expressed as mean ± SD and%. Results Fifty patients were included of whom 39 were male and median age was 60.5 years (range 35–90). Of this cohort, 64% were current or ex-smokers, 14% had diabetes, 58% had hypertension, 56% had documented family history of ischaemic heart disease and 46% had hyperlipidaemia. PRECISE DAPT score calculated bleed risk was very low in 24%, low in 42%, moderate in 20% and high in 14%. Mean risk of TIMI major or minor grade bleeding during 12 months DAPT was 1.21% using this score. DAPT score at 12 months following initiation was low in 44% and high in 56%. DAPT Indication was ACS in 62%, elective PCI in 36% and 1 patient underwent 12 months DAPT inappropriately after elective angiography without PCI. Overall, 86% received DESs, 4% drug-eluting balloons and 10% medical therapy. Almost half (48%) did not receive the DAPT duration specified by the cardiologist or based on ESC guidelines where duration was not documented. DAPT was excessive in 40% and insufficient in 8%. Planned DAPT duration was documented at time of angiography or prior to discharge in 80%. Where documented, 12 months DAPT was advised for 92.5% overall and 93.3% following elective PCI. Proton-Pump Inhibitors were not prescribed in 44%. Within 12 months of commencing DAPT, 46 of 50 patients (92%) were reviewed in outpatient clinic. At clinic, planned date of DAPT discontinuation was documented for 35 patients (70%). Among patients who received excessive DAPT, one patient required hospital a","PeriodicalId":214963,"journal":{"name":"General poster session","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134028841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"40 A protein biomarker model for detection of cardiac arrhythmia and prediction of associated heart failure","authors":"C. Tonry, K. McDonald, M. Ledwidge, B. Herandez, N. Glezeva, C. Rooney, B. Morrissey, S. Pennington, J. Baugh, Christopher A. Watson","doi":"10.1136/HEARTJNL-2020-ICS.40","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-ICS.40","url":null,"abstract":"Introduction Cardiac arrhythmia is strongly linked with heart failure (HF) and a primary cause of stroke. The condition affects around 37,000 people in Northern Ireland although it is estimated that many thousands more remain undiagnosed. It is important to be able to diagnose cardiac arrhythmia early, so that appropriate interventions can be made to reduce risk of subsequent stroke or HF. Currently, diagnosis and management of cardiac arrhythmia is reliant on assessment of clinical risk factors, however, routine monitoring of circulating biomarkers would significantly improve accuracy for prediction of arrhythmia and associated adverse events. The aim of this study was to (i) identify protein biomarkers, which can predict cardiac arrhythmia and (ii) identify protein biomarkers that are predictive of HF in patients with arrhythmia. Methods Multiple Reaction Monitoring mass spectrometry-based assays were developed for measurement of a selection of candidate protein biomarkers of cardiovascular injury. Assays were developed using nanoflow reverse phase C18 chromatographic ChipCube based separation, coupled to an Agilent 6460 triple quadrupole mass spectrometer. Optimised MRM assays were applied, in a sample blinded manner, for analysis of a cohort of 410 serum samples. This included 112 patients with cardiac arrhythmia as well as matched controls without cardiac arrhythmia. Results MRM assays were established for measurement of 25 proteins. Individually, a number of the biomarker proteins show significant differential expression between patients with and without cardiac arrhythmia. An 11-protein biomarker model was identified, which was comparable to BNP in prediction of HF within the cardiac arrhythmia subset of patients (Protein panel AUC = 0.856 vs BNP AUC = 0.838). Combination of the 11 proteins with BNP notably enhanced the predictive capacity of BNP (AUC = 0.898). Conclusions/Implications Through this study, assays have been developed for robust, multiplexed measurement of 25 cardiovascular disease-associated proteins in patient serum samples. A number of proteins were identified, which show significant expression changes in association with cardiac arrhythmia and will be further explored. Importantly, a statistical model revealed a panel of 11 proteins, which can predict HF in patients with cardiac arrhythmia, with comparable accuracy to BNP. This panel will need to be further validated in independent patient cohorts.","PeriodicalId":214963,"journal":{"name":"General poster session","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128159269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"47 A review of patients with heart failure with mid-range ejection fraction (HFmrEF): co-morbidities and outcomes","authors":"D. O. Callaghan, P. Wheen, P. Murray, C. Minelli, C. Daly","doi":"10.1136/HEARTJNL-2020-ICS.47","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-ICS.47","url":null,"abstract":"Background The ESC now recognises HF patients with a left ventricular ejection fraction (LVEF) of 40%-49% as having a distinct phenotype, referred to as Heart Failure with mid-range Ejection Fraction (HFmrEF). This classification was implemented to promote research in this group of heart failure (HF) patients. Aims We aimed to compare the co-morbidities of HFmrEF patients with those of Heart Failure with preserved Ejection Fraction (HFpEF) and Heart Failure with reduced Ejection Fraction (HFrEF) patients, and aimed to compare hospitalisations for acute decompensation HF, and mortality between these groups. Methods All new referrals to a HF clinic in three neighbouring hospitals were included between January 1st 2017, and December 31st 2017. Data was collected on co-morbidities associated with each HF classification. Mean follow up was 17.5 months (± 7.6) and we recorded hospitalisations for ADHF and mortality data. Results 286 new patients were referred to one of our 3 HF clinics; following optimisation, the patients were divided as: HFpEF 67 (23.4%), HFmrEF 58 (20.3%), HFrEF 94 (32.9%). 69 patients did not have a repeat echocardiogram. Table 1 presents the co-morbidities. Categorical data was analysed with Chi-square testing and continuous data analysed with unpaired t testing. Significance in HFrEF and HFpEF is in comparison with HFmrEF. Figure 1 is a Kaplan Meier curve demonstrating the events across the follow-up period. Conclusion Co-morbidities were similar in HFmrEF as compared with HFpEF and HFrEF, aside from previous CABG surgery (fewer in HFmrEF as compared with HFpEF and HFrEF) and HTN (there were more in HFpEF). Mortality was similar across the 3 groups over our follow up period of 17.5 months, and there was no difference in mean hospitalisations for ADHF between the groups. In our catchment area, our HFmrEF have a similar phenotype to our HFpEF and HFrEF cohorts.","PeriodicalId":214963,"journal":{"name":"General poster session","volume":"95 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123017854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"55 Influenza vaccine uptake in a cardiology outpatient department setting; a missed cardiovascular disease prevention opportunity","authors":"N. Connolly","doi":"10.1136/HEARTJNL-2020-ICS.55","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-ICS.55","url":null,"abstract":"Aim Management of chronic illness is a cornerstone of care in the secondary care setting. Cardiovascular patients may have multiple indications for influenza vaccination and protection from Flu may improve both mortality and morbidity. Studies have shown a direct link between inflammation, respiratory illness and acute myocardial infarction and there is existing evidence that influenza vaccination reduces acute MI rates in both primary and secondary prevention. The aim of this audit was to evaluate if patients attending a cardiology outpatient department, with an indication for influenza vaccination, as per current guidelines, are adequately vaccinated and if an opportunity lies there in to target this patient cohort and improve outcomes. Method Patients attending two large university teaching hospital outpatient departments were asked to fill out a survey, including simple personal medical history details, seeking to identify; patients with an indication for vaccination, patients that had been offered vaccination and reasons for refusal if they had been offered but declined. Unvaccinated patients were asked if would they avail of vaccination if it were available on the day at the clinic. The results were collated and reviewed. Results 142 respondents in total; average age 66.2 yrs (STD 14.2), 64.7% male, 79.6% >50 yrs, 28.9% attended a Heart Failure Unit, 81.7% overall had an indication for vaccination other than age alone and 90.8% had an indication when age >50 yrs was also included. Of the patients with an indication for vaccination, vaccination rates were; 62.9% males, 60.0% females, 73.2% Heart Failure clinic attendees, 56.8% General Cardiology attendees (p=0.075 for difference in vaccination rates among clinic types). Of the patients with an indication for vaccination that had not been vaccinated thus far, 48.9% would have received the vaccine on the day if offered. This would have improved the overall vaccination rate amongst patients with an indication for vaccination from 62.0% to 80.6% (p=0.015). Of the patients who would not opt to receive the vaccine if offered, 23% believe it doesn’t work, 23% believe they would contract influenza from it and 38.5% have plans to receive the vaccine elsewhere.","PeriodicalId":214963,"journal":{"name":"General poster session","volume":"316 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122096422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"54 Residual risk in cardiac rehab: can we reduce-it more? Eligibility for icosapent ethyl in patients attending cardiac rehabilitation","authors":"S. Gaine, J. Coughlan, V. Maher, M. Waters","doi":"10.1136/HEARTJNL-2020-ICS.54","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-ICS.54","url":null,"abstract":"Introduction Patients with elevated triglycerides (TG) are at increased risk for ischemic events despite statin therapy and controlled low-density lipoprotein cholesterol (LDL-C). The REDUCE IT trial showed that a highly purified Eicosapentaenoic acid (EPA) ester, Icosapent Ethyl or Ethyl Eicosapentaenoic acid (E-EPA), reduces the risk of ischemic events and cardiovascular (CV) death in patients with elevated TG levels despite statin therapy. The NNT for the first occurrence of major adverse cardiac events for the five-point primary composite endpoint was 21. E-EPA is also a dominant strategy from a cost-effectiveness perspective in the study. Thus, the 2019 ESC/EAS guidelines recommend E-EPA for patients with persistently raised TGs despite treatment with a statin. Our aim was to assess the proportion of patients attending cardiac rehabilitation who may benefit from E-EPA therapy as per REDUCE-IT trial criteria and the 2019 ESC/EAS guidelines. Methods We prospectively collected data on all cardiac rehabilitation patients in our centre in 2018/2019. We then performed a hierarchal analysis of these patients to determine the percentage of patients post MI/CABG that would meet criteria for E-EPA as per REDUCE-IT trial criteria and ESC/EAS guidelines. = The REDUCE IT trial criteria were: ≥45 years and established ASCVD 50 years with DM and at least one other CV RF Fasting TG level of 1.69 to 5.63 mmol/L LDL–C level of 1.06 to 2.59 mmol/L Receiving a stable dose of a statin for at least 4 weeks The initial trial protocol enrolled patients with a TG level as low as 1.52 mmol/L to account for the ~10% variability in TG levels. This protocol was amended and changed the lower level for TG to 2.26 mmol/L. We analysed patients as per both protocols. As per ESC: E-EPA 2 × 2 g per day should be considered in combination with a statin for patients with: Persistently high TGs (1.5–5.6 mmol/L) Treatment with a statin Results 398 patients completed cardiac rehab during this study and were included in our database. Of these 275 (69%) had a 6 month TG and LDL recorded and were included. All patients in our cohort had been on a stable dose of statin for at least 4 weeks. Analysis as per initial REDUCE IT protocol: 14/275 patients (5%) were excluded as they were less than 45 years old. 63 patients (23%) had a TG level of 1.5–5.6 and 42 of these had an LDL-C level of 1.06–2.59 mmol/L (15.3%). This led to an overall eligibility of 15.3% for E-EPA. Analysis as per amended REDUCE-IT protocol: 14/275 patients (5%) were excluded as they were less than 45 years old. 30 patients had a TG level eligible as per the amended REDUCE-IT protocol (10.9%) and 20 of these patients had an LDL-C level of 1.06–2.59 mmol/L (7.3%) leading to an overall eligibility of 7.3% for E-EPA. Analysis as per the ESC/EAS guidelines: Notably the ESC guidelines do not specify an LDL level or age required for E-EPA to be considered. 64 patients had a TG level of 1.5–5.6 mmol/L despite statin therapy. A","PeriodicalId":214963,"journal":{"name":"General poster session","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128050083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}