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Assessment of Potential Recipients for Cardiac Resynchronisation Therapy (CRT): Are Current Implantation Rates too Low?
S144
Abstracts
Heart, Lung and Circulation 2008;17S:S1–S209
ABSTRACTS
340 Assessment of Potential Recipients for Cardiac Resynchronisation Therapy (CRT): Are Current Implantation Rates too Low? Justin Ng ∗ , Brendan McQuillan, Cheryl Blanton Sir Charles Gairdner Hospital, Perth, WA, Australia
Table 1. Demographic data Age (year) Males (%) NYHA Class LVEF Duration of HF (year)
Cross-sectional
Universe
P value*
61.2 ± 10.7 85.7 2.4 ± 0.7 26.9 ± 8.7 6.2 ± 5.5
60.6 ± 13.4 80.0 3.12 ± 0.3 28.9 ± 9.3 5.13 ± 6.2
.835 .386 .001 .234 .0821
Results are mean ± S.D. *Based on Mann–Whitney U-test.
Introduction: There is increasing evidence that CRT is a useful adjunct in heart failure (CHF) patients (NYHA class III–IV; EF ≤35%) refractory to medical therapy. Despite this and the rising prevalence of CHF in Australia, biventricular pacemaker (BiV-PM) implantations remain low. Aim: To determine whether the rate of (BiV-PM) implantations at our tertiary institution is due to appropriate use in a limited pool of potential candidates or a failure to identify them. Methods: A search of inpatient morbidity coding between 1/1/05 and 31/12/07 identified 522 patients admitted with a diagnosis of CHF, who were ≤80 years and independent. Results: Echocardiographic or nuclear assessment of EF was performed on 277/522, of which 140 had an EF ≤35%. Selection criteria (NYHA class III–IV; ECG QRS duration ≥120) were assessed among 110 patients with available records (23 women: 87 men; mean age 64; aetiology: IHD 52, non-IHD 50, mixed 8). Of 110 patients, 22 potential candidates for CRT were identified. Only 14 of these 22 patients had been considered for/or received CRT (1 patient refused) NYHA I
NYHA II
NYHA III
NYHA IV
QRS <120
9
35
14
2
QRS ≥120
6
21
20
3
Discussion: The proportion of patients (277/522) who had formal assessment of cardiac function following an admission with CHF was low. This study was limited by complete information regarding only 110/140 patients with an EF ≤35%. Conclusion: Current indications for CRT are only applicable to a minority of patients with CHF. Despite this, CRT appears under-utilised at our tertiary institution. ECG criteria for initial identification of patients may restrict access and evolving echocardiographic techniques to improve assessment of mechanical dyssynchrony warrants attention. doi:10.1016/j.hlc.2008.05.341 341 Effect of Statins on Coenzyme Q10 (CoQ10) Plasma Levels in Patients with Chronic Heart Failure (CHF) Emma Ashton, Henry Krum ∗ Monash University, Melbourne, Victoria, Australia CoQ10 levels in plasma and the myocardium have been shown to be low in patients with CHF, and particularly in the elderly. Treatment with a statin may further decrease these levels. 56 patients with CHF and taking a statin for greater than 12 months were recruited and plasma
CoQ levels were compared to the 86 statin na¨ıve patients recruited for the Universe Trial, that were randomised to statin or placebo for 6 months. CoQ10 results Crosssectional, n = 56
Universe baseline, n = 69
P valuea
Universe Statin group, n = 40
Baseline
1075 ± 398
0.0001
1149 ± 426 993 ± 352 0.101
847 ± 344
6 months Rx a
Based on Mann–Whitney U-test.
b
Based on ANOVA.
Universe Placebo group, n = 46
P valueb
746 ± 330 1030 ± 368 0.001
There was no significant correlation between plasma CoQ10 and LVEF or NYHA class for the cross-sectional group or the Universe group at baseline or 6 months posttreatment. The results confirm that statin therapy has an independent lowering of plasma CoQ10 levels. Further research is required to determine whether this decrease is below the threshold required for numerous redox-dependent processes. doi:10.1016/j.hlc.2008.05.342 342 Hospital Initiated Post-Discharge Home Medication Reviews: Assessment of the Clinical Impact of an Individualised Co-Morbidity Focused Referral Process in a Predominately Chronic Heart Failure (CHF) Population 1 , Robyn Clark 2,∗ , Desmond Colley 3 , ¨ Suzanna Lovgren 1 Gunner Tobin , Sepehr Shakib 4 1 Department
of Pharmacology, Gothenburg University, Gothenburg, Sweden; 2 Faculty of Health Science University of South Australia, Adelaide, Australia; 3 Flinders Medical Centre, South Australia, Adelaide, Australia; 4 Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, Australia Background: Factors contributing to medication related problems often occur in times of change, such as the transition from hospital to community. To improve the quality use of medicines, the Australian Government has funded Home Medication Reviews (HMR), which involves accredited pharmacists visiting patients in their home and reporting back to patients’ general practitioners (GP). One factor limiting the quality of the HMRs is the variability of the referrals to pharmacists. Aim: The aim of this study was to utilise a standardised referral and reporting process to enhance the quality and clinical impact of HMR reports.
Abstracts
Heart, Lung and Circulation 2008;17S:S1–S209
ABSTRACTS
340 Assessment of Potential Recipients for Cardiac Resynchronisation Therapy (CRT): Are Current Implantation Rates too Low? Justin Ng ∗ , Brendan McQuillan, Cheryl Blanton Sir Charles Gairdner Hospital, Perth, WA, Australia
Table 1. Demographic data Age (year) Males (%) NYHA Class LVEF Duration of HF (year)
Cross-sectional
Universe
P value*
61.2 ± 10.7 85.7 2.4 ± 0.7 26.9 ± 8.7 6.2 ± 5.5
60.6 ± 13.4 80.0 3.12 ± 0.3 28.9 ± 9.3 5.13 ± 6.2
.835 .386 .001 .234 .0821
Results are mean ± S.D. *Based on Mann–Whitney U-test.
Introduction: There is increasing evidence that CRT is a useful adjunct in heart failure (CHF) patients (NYHA class III–IV; EF ≤35%) refractory to medical therapy. Despite this and the rising prevalence of CHF in Australia, biventricular pacemaker (BiV-PM) implantations remain low. Aim: To determine whether the rate of (BiV-PM) implantations at our tertiary institution is due to appropriate use in a limited pool of potential candidates or a failure to identify them. Methods: A search of inpatient morbidity coding between 1/1/05 and 31/12/07 identified 522 patients admitted with a diagnosis of CHF, who were ≤80 years and independent. Results: Echocardiographic or nuclear assessment of EF was performed on 277/522, of which 140 had an EF ≤35%. Selection criteria (NYHA class III–IV; ECG QRS duration ≥120) were assessed among 110 patients with available records (23 women: 87 men; mean age 64; aetiology: IHD 52, non-IHD 50, mixed 8). Of 110 patients, 22 potential candidates for CRT were identified. Only 14 of these 22 patients had been considered for/or received CRT (1 patient refused) NYHA I
NYHA II
NYHA III
NYHA IV
QRS <120
9
35
14
2
QRS ≥120
6
21
20
3
Discussion: The proportion of patients (277/522) who had formal assessment of cardiac function following an admission with CHF was low. This study was limited by complete information regarding only 110/140 patients with an EF ≤35%. Conclusion: Current indications for CRT are only applicable to a minority of patients with CHF. Despite this, CRT appears under-utilised at our tertiary institution. ECG criteria for initial identification of patients may restrict access and evolving echocardiographic techniques to improve assessment of mechanical dyssynchrony warrants attention. doi:10.1016/j.hlc.2008.05.341 341 Effect of Statins on Coenzyme Q10 (CoQ10) Plasma Levels in Patients with Chronic Heart Failure (CHF) Emma Ashton, Henry Krum ∗ Monash University, Melbourne, Victoria, Australia CoQ10 levels in plasma and the myocardium have been shown to be low in patients with CHF, and particularly in the elderly. Treatment with a statin may further decrease these levels. 56 patients with CHF and taking a statin for greater than 12 months were recruited and plasma
CoQ levels were compared to the 86 statin na¨ıve patients recruited for the Universe Trial, that were randomised to statin or placebo for 6 months. CoQ10 results Crosssectional, n = 56
Universe baseline, n = 69
P valuea
Universe Statin group, n = 40
Baseline
1075 ± 398
0.0001
1149 ± 426 993 ± 352 0.101
847 ± 344
6 months Rx a
Based on Mann–Whitney U-test.
b
Based on ANOVA.
Universe Placebo group, n = 46
P valueb
746 ± 330 1030 ± 368 0.001
There was no significant correlation between plasma CoQ10 and LVEF or NYHA class for the cross-sectional group or the Universe group at baseline or 6 months posttreatment. The results confirm that statin therapy has an independent lowering of plasma CoQ10 levels. Further research is required to determine whether this decrease is below the threshold required for numerous redox-dependent processes. doi:10.1016/j.hlc.2008.05.342 342 Hospital Initiated Post-Discharge Home Medication Reviews: Assessment of the Clinical Impact of an Individualised Co-Morbidity Focused Referral Process in a Predominately Chronic Heart Failure (CHF) Population 1 , Robyn Clark 2,∗ , Desmond Colley 3 , ¨ Suzanna Lovgren 1 Gunner Tobin , Sepehr Shakib 4 1 Department
of Pharmacology, Gothenburg University, Gothenburg, Sweden; 2 Faculty of Health Science University of South Australia, Adelaide, Australia; 3 Flinders Medical Centre, South Australia, Adelaide, Australia; 4 Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, Australia Background: Factors contributing to medication related problems often occur in times of change, such as the transition from hospital to community. To improve the quality use of medicines, the Australian Government has funded Home Medication Reviews (HMR), which involves accredited pharmacists visiting patients in their home and reporting back to patients’ general practitioners (GP). One factor limiting the quality of the HMRs is the variability of the referrals to pharmacists. Aim: The aim of this study was to utilise a standardised referral and reporting process to enhance the quality and clinical impact of HMR reports.