- Email: [email protected]
Depression Screening and Screening for Inpatients with STEMI and NSTEMI
Abstracts
if intraoperative TOE is not to be used, the preoperative TTE should be of adequate diagnostic quality.
References [1] America Society of Anesthesiologists and Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Practice guidelines for perioperative transesophageal echocardiography. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology, 2010. 112(5): p. 1084-96. [2] Eltzschig HK, et al. Impact of intraoperative transesophageal echocardiography on surgical decisions in 12,566 patients undergoing cardiac surgery. Ann Thorac Surg 2008;85(3):845–52.
http://dx.doi.org/10.1016/j.hlc.2017.06.635 635 Early Mortality after Isolated Coronary Artery Bypass Grafting (CABG) Surgery Among Hospitals in Australia and New Zealand I. Ranasinghe 1,2,4,∗ , D. Horton 3,4 , C. Labrosciano 1,4,5 , T. Air 1,4,5 , J. Beltrame 1,2,5 , C. Zeitz 1,2,5 , R. Tavella 1,2,5 1 University
of Adelaide, Adelaide, Australia Adelaide Local Health Network, Adelaide, Australia 3 Data 2 Decisions, Adelaide, Australia 4 Health Performance and Policy Research Unit, The Basil Hetzel Institute, Adelaide, Australia 5 Translational Vascular Function Research Collaborative, The Basil Hetzel Institute, Adelaide, Australia 2 Central
Background: Early outcomes of coronary artery bypass grafting (CABG) surgery are uncertain. We assessed variation of in-hospital and 30-day post-discharge mortality after CABG surgery at all public and selected private hospitals in Australia and New Zealand (NZ). Methods: We obtained population-wide hospitalisation data from all Australian State Health Departments (except the Northern Territory) and the NZ Ministry of Health from 20102015 linked with Death Registries to identify post-discharge death. Using Australian Classification of Health Interventions procedure codes, we identified hospitalisations for isolated CABG, excluding combined CABG + valve procedures. The study outcomes were all-cause in-hospital mortality and 30day post-discharge mortality. Hospital-level analyses were limited to unique hospitals with >25 recorded procedures. Results: Of the 57,842 isolated CABG procedures (mean age 66.6 ± 10.2y, 81.0% male; 70% performed as elective), inhospital death occurred in 902(1.6%). A further 178(0.3%) died within 30-days of hospital discharge. Overall, 1,080(1.9%) died in-hospital or within 30 days of the procedure. Analysis of 47 hospitals with > 25 procedures (including all public hospitals performing CABG) revealed institutional variation in in-hospital mortality (0.0% to 4.8%), post-discharge mortality (0.0% to 1.1%) and overall 30-day mortality (0.0% to 5.0%) (Fig. 1).
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Fig. 1. Variation in Crude Mortality Up to 30-Days Post CABG Surgery Among Hospitals.
Conclusion: The overall risk of death within 30 days of isolated CABG surgery is low although there is considerable variability among hospitals. Further risk-adjusted analysis inprogress should determine if the variation reflects variation in care quality. http://dx.doi.org/10.1016/j.hlc.2017.06.636 Cardiovascular Nursing (636–645) 636 This abstract has been withdrawn
http://dx.doi.org/10.1016/j.hlc.2017.06.637 637 Depression Screening and Screening for Inpatients with STEMI and NSTEMI S. McCreanor, F. Love, M. Aquilina ∗ Illawarra Shoalhaven Local Health District, Wollongong, Australia Background: The Illawarra/Shoalhaven has population of approximately 500,000 people and Wollongong Hospital is the major centre for admitting patients with cardiac problems. Depression is a known risk factor for heart disease. Aim: The majority of patients with NSTEMI or STEMI are referred to Cardiac Rehabilitation. About 50% of those referred attend Cardiac Rehab and are subsequently screened for depression. We prospectively planned to screen all patients admitted to hospital with NSTEMI or STEMI for depression to detect depression that was previously undiagnosed. Methods: Form was developed using the PHQ-2 and PHQ9. Nursing staff interview patients the questions on the PHQ2 “yes/no” version on day 2 or 3. If the patient answered yes to either question, they are referred to Cardiac Rehab Nurses to complete the PHQ-9.
Abstracts
S318
Results: There were total of 976 eligible patients from May 2015 to December 2016. Prior to implementing screening tool, in-services were held for the nursing staff on why screening had been implemented and the importance of assessing cardiac patients for depression. Despite good education only 163 patients (16.7%) were screened. Of these, 115 screened negative, 12 for minimal depression, 7 for mild depression, 7 for moderate depression, 3 moderately severe depression, and 3 for severe depression. 16 were not referred onto CR for PHQ-9 to be completed. Conclusion: Despite in service education, the low rate of screening is quite evident in our study and this is being addressed and strategies have been implemented to increase screening of patients for depression. http://dx.doi.org/10.1016/j.hlc.2017.06.638 638 Education Experiences of Patients and Spouses Post an Acute Cardiac Event- Can We Add Cardiopulmonary Resuscitation Training? A Qualitative Study S. Cartledge 1,∗ , S. Feldman 1 , J. Bray 1,2,3 , D. Stub 1,2,4,5,6 , J. Finn 1,3 1 Monash
University, Melbourne, Australia Health, Melbourne, Australia 3 Curtin University, Bentley, Australia 4 Cabrini Hospital, Melbourne, Australia 5 Baker Heart and Diabetes Institute, Melbourne, Australia 6 Western Health, Melbourne, Australia 2 Alfred
Background: Targeting cardiopulmonary resuscitation (CPR) training for high-risk cardiac patients has long been advocated. However, there is a paucity of qualitative data on the attitudes and preferences of this group. We sought to understand the education experiences of patients and spouses following an acute cardiac event; and explore attitudes, beliefs and intent towards CPR training. Methods: We conducted a qualitative study underpinned by phenomenology and the Theory of Planned Behaviour (TPB), to explore attitudes and intent towards CPR training. Semi-structured interviews were conducted with cardiac patients and spouses purposively sampled from a cardiology ward of a public tertiary hospital. Interviews were transcribed verbatim and thematic analysis undertaken. Results: Data saturation was achieved within 12 interviews (9 male patients, 3 female patients, mean age = 62years, range = 47years-75years). Emotional themes related to diagnosis of denial, shock and fear featured for all participants. Three strongly interrelated themes emerged: information (perceived lack of information for the majority), feeling in and out of control, and the caring responsibility of spouses. There was evidence of all three TPB intentions, including recognition of the: great worth placed in receiving CPR training, the social pressure of knowing CPR and facilitators to obtaining training (e.g. integrating training into cardiac rehabilitation). Only the eldest patient spouse pair (75years) were not interested in CPR training.
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Conclusion: There are unmet education needs for cardiac patients and spouses. Information increased control and decreased negative emotions associated with diagnosis. Participants had positive attitudes and intent towards learning CPR if integrated within a cardiac rehabilitation program. http://dx.doi.org/10.1016/j.hlc.2017.06.639 639 Establishing a Nurse Led Multidisciplinary Atrial Fibrillation Clinic M. Harvey ∗ , E. Kotschet, S. Healy, L. Rudolph, J. Alison Monash Cardiovascular Research Centre, MonashHeart, Monash Health and Department of Medicine, Monash University, Melbourne, Australia Background: Patients with atrial fibrillation (AF) receiving timely, multidisciplinary care (MDC) have reduced morbidity and mortality. AF guideline-indicated MDC incorporates early assessment and patient education with medical therapy to improve health outcomes. Aim: We established a Nurse Led MDC clinic within our tertiary hospital cardiology service to provide early assessment of AF patients, guideline based management and patient education. Goals included seeing patients within six weeks of referral, triaging their on-going care and providing them with a single point of contact within our complex hospital system. Methods: From December 2016 referred patients with a diagnosis of AF have attended a Nurse Led, electrophysiologist-supported clinic for assessment, education and therapy optimisation. Data was collected on the referral source, access times and AF subtype. Patients attend a follow-up visit within three months to assess their management strategy and can contact the AF nurse during business hours. Results: 65 referrals were made to our dedicated service. Referral sources were predominantly the Emergency Department (60%) and General Practitioners (28%). First presentation AF made up 60% of cases. These patients were previously referred as low priority to general cardiology outpatients, waiting 4-6 months for appointments. Through this new model of care, average access times for AF patients was reduced to 4 weeks. Conclusion: A Nurse Led, MDC Clinic for AF patients significantly reduces patient access times preventing delays in assessment, optimisation of therapy and patient education. Further research is needed to evaluate the clinic’s impact on patient symptoms, patient satisfaction and hospital readmissions. http://dx.doi.org/10.1016/j.hlc.2017.06.640
if intraoperative TOE is not to be used, the preoperative TTE should be of adequate diagnostic quality.
References [1] America Society of Anesthesiologists and Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Practice guidelines for perioperative transesophageal echocardiography. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology, 2010. 112(5): p. 1084-96. [2] Eltzschig HK, et al. Impact of intraoperative transesophageal echocardiography on surgical decisions in 12,566 patients undergoing cardiac surgery. Ann Thorac Surg 2008;85(3):845–52.
http://dx.doi.org/10.1016/j.hlc.2017.06.635 635 Early Mortality after Isolated Coronary Artery Bypass Grafting (CABG) Surgery Among Hospitals in Australia and New Zealand I. Ranasinghe 1,2,4,∗ , D. Horton 3,4 , C. Labrosciano 1,4,5 , T. Air 1,4,5 , J. Beltrame 1,2,5 , C. Zeitz 1,2,5 , R. Tavella 1,2,5 1 University
of Adelaide, Adelaide, Australia Adelaide Local Health Network, Adelaide, Australia 3 Data 2 Decisions, Adelaide, Australia 4 Health Performance and Policy Research Unit, The Basil Hetzel Institute, Adelaide, Australia 5 Translational Vascular Function Research Collaborative, The Basil Hetzel Institute, Adelaide, Australia 2 Central
Background: Early outcomes of coronary artery bypass grafting (CABG) surgery are uncertain. We assessed variation of in-hospital and 30-day post-discharge mortality after CABG surgery at all public and selected private hospitals in Australia and New Zealand (NZ). Methods: We obtained population-wide hospitalisation data from all Australian State Health Departments (except the Northern Territory) and the NZ Ministry of Health from 20102015 linked with Death Registries to identify post-discharge death. Using Australian Classification of Health Interventions procedure codes, we identified hospitalisations for isolated CABG, excluding combined CABG + valve procedures. The study outcomes were all-cause in-hospital mortality and 30day post-discharge mortality. Hospital-level analyses were limited to unique hospitals with >25 recorded procedures. Results: Of the 57,842 isolated CABG procedures (mean age 66.6 ± 10.2y, 81.0% male; 70% performed as elective), inhospital death occurred in 902(1.6%). A further 178(0.3%) died within 30-days of hospital discharge. Overall, 1,080(1.9%) died in-hospital or within 30 days of the procedure. Analysis of 47 hospitals with > 25 procedures (including all public hospitals performing CABG) revealed institutional variation in in-hospital mortality (0.0% to 4.8%), post-discharge mortality (0.0% to 1.1%) and overall 30-day mortality (0.0% to 5.0%) (Fig. 1).
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Fig. 1. Variation in Crude Mortality Up to 30-Days Post CABG Surgery Among Hospitals.
Conclusion: The overall risk of death within 30 days of isolated CABG surgery is low although there is considerable variability among hospitals. Further risk-adjusted analysis inprogress should determine if the variation reflects variation in care quality. http://dx.doi.org/10.1016/j.hlc.2017.06.636 Cardiovascular Nursing (636–645) 636 This abstract has been withdrawn
http://dx.doi.org/10.1016/j.hlc.2017.06.637 637 Depression Screening and Screening for Inpatients with STEMI and NSTEMI S. McCreanor, F. Love, M. Aquilina ∗ Illawarra Shoalhaven Local Health District, Wollongong, Australia Background: The Illawarra/Shoalhaven has population of approximately 500,000 people and Wollongong Hospital is the major centre for admitting patients with cardiac problems. Depression is a known risk factor for heart disease. Aim: The majority of patients with NSTEMI or STEMI are referred to Cardiac Rehabilitation. About 50% of those referred attend Cardiac Rehab and are subsequently screened for depression. We prospectively planned to screen all patients admitted to hospital with NSTEMI or STEMI for depression to detect depression that was previously undiagnosed. Methods: Form was developed using the PHQ-2 and PHQ9. Nursing staff interview patients the questions on the PHQ2 “yes/no” version on day 2 or 3. If the patient answered yes to either question, they are referred to Cardiac Rehab Nurses to complete the PHQ-9.
Abstracts
S318
Results: There were total of 976 eligible patients from May 2015 to December 2016. Prior to implementing screening tool, in-services were held for the nursing staff on why screening had been implemented and the importance of assessing cardiac patients for depression. Despite good education only 163 patients (16.7%) were screened. Of these, 115 screened negative, 12 for minimal depression, 7 for mild depression, 7 for moderate depression, 3 moderately severe depression, and 3 for severe depression. 16 were not referred onto CR for PHQ-9 to be completed. Conclusion: Despite in service education, the low rate of screening is quite evident in our study and this is being addressed and strategies have been implemented to increase screening of patients for depression. http://dx.doi.org/10.1016/j.hlc.2017.06.638 638 Education Experiences of Patients and Spouses Post an Acute Cardiac Event- Can We Add Cardiopulmonary Resuscitation Training? A Qualitative Study S. Cartledge 1,∗ , S. Feldman 1 , J. Bray 1,2,3 , D. Stub 1,2,4,5,6 , J. Finn 1,3 1 Monash
University, Melbourne, Australia Health, Melbourne, Australia 3 Curtin University, Bentley, Australia 4 Cabrini Hospital, Melbourne, Australia 5 Baker Heart and Diabetes Institute, Melbourne, Australia 6 Western Health, Melbourne, Australia 2 Alfred
Background: Targeting cardiopulmonary resuscitation (CPR) training for high-risk cardiac patients has long been advocated. However, there is a paucity of qualitative data on the attitudes and preferences of this group. We sought to understand the education experiences of patients and spouses following an acute cardiac event; and explore attitudes, beliefs and intent towards CPR training. Methods: We conducted a qualitative study underpinned by phenomenology and the Theory of Planned Behaviour (TPB), to explore attitudes and intent towards CPR training. Semi-structured interviews were conducted with cardiac patients and spouses purposively sampled from a cardiology ward of a public tertiary hospital. Interviews were transcribed verbatim and thematic analysis undertaken. Results: Data saturation was achieved within 12 interviews (9 male patients, 3 female patients, mean age = 62years, range = 47years-75years). Emotional themes related to diagnosis of denial, shock and fear featured for all participants. Three strongly interrelated themes emerged: information (perceived lack of information for the majority), feeling in and out of control, and the caring responsibility of spouses. There was evidence of all three TPB intentions, including recognition of the: great worth placed in receiving CPR training, the social pressure of knowing CPR and facilitators to obtaining training (e.g. integrating training into cardiac rehabilitation). Only the eldest patient spouse pair (75years) were not interested in CPR training.
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
Conclusion: There are unmet education needs for cardiac patients and spouses. Information increased control and decreased negative emotions associated with diagnosis. Participants had positive attitudes and intent towards learning CPR if integrated within a cardiac rehabilitation program. http://dx.doi.org/10.1016/j.hlc.2017.06.639 639 Establishing a Nurse Led Multidisciplinary Atrial Fibrillation Clinic M. Harvey ∗ , E. Kotschet, S. Healy, L. Rudolph, J. Alison Monash Cardiovascular Research Centre, MonashHeart, Monash Health and Department of Medicine, Monash University, Melbourne, Australia Background: Patients with atrial fibrillation (AF) receiving timely, multidisciplinary care (MDC) have reduced morbidity and mortality. AF guideline-indicated MDC incorporates early assessment and patient education with medical therapy to improve health outcomes. Aim: We established a Nurse Led MDC clinic within our tertiary hospital cardiology service to provide early assessment of AF patients, guideline based management and patient education. Goals included seeing patients within six weeks of referral, triaging their on-going care and providing them with a single point of contact within our complex hospital system. Methods: From December 2016 referred patients with a diagnosis of AF have attended a Nurse Led, electrophysiologist-supported clinic for assessment, education and therapy optimisation. Data was collected on the referral source, access times and AF subtype. Patients attend a follow-up visit within three months to assess their management strategy and can contact the AF nurse during business hours. Results: 65 referrals were made to our dedicated service. Referral sources were predominantly the Emergency Department (60%) and General Practitioners (28%). First presentation AF made up 60% of cases. These patients were previously referred as low priority to general cardiology outpatients, waiting 4-6 months for appointments. Through this new model of care, average access times for AF patients was reduced to 4 weeks. Conclusion: A Nurse Led, MDC Clinic for AF patients significantly reduces patient access times preventing delays in assessment, optimisation of therapy and patient education. Further research is needed to evaluate the clinic’s impact on patient symptoms, patient satisfaction and hospital readmissions. http://dx.doi.org/10.1016/j.hlc.2017.06.640