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Microstructural Evolution of Brazed Ti-joint Using Ti20Zr20Cu50Ni10 Metallic Glass Ribbon as Filler
Abstracts
information may overestimate the true rate of side effects and limit usage of these life-preserving heart failure medications. We compared the adverse effects listed in a systematic review of randomised control trials of beta-blockers with the adverse effects listed in reference texts: The Australian Medicines Handbook Online and MIMS Online [2–4]. 25 of 33 adverse effects listed in the systematic review were listed in AMH or MIMS. Of all listed adverse effects the rates were comparable for 10/25. Adverse effects were overestimated in 15/25 cases. Twelve adverse effects listed as common in reference texts were actually less common in the active treatment arm of randomised control trials. This study demonstrates that Australian reference texts overestimate the true rate of adverse effects attributable to beta-blockers and misinform patients and clinicians. As recognised by Barron et al. [2] overestimating these adverse effects may lead to clinicians and patients ceasing beneficial medications. Reviewing how information on adverse effects is published in Australian prescribing references may improve treatment of many conditions and reduce discontinuation of proven therapies.
References [1] Planès S, Villier C, Mallaret M. The nocebo effect of drugs. Pharmacology Research & Perspectives 2016;4(2). [2] Barron AJ, Zaman N, Cole GD, Wensel R, Okonko DO, Francis DP. Systematic review of genuine versus spurious side-effects of beta-blockers in heart failure using placebo control: recommendations for patient information. International journal of cardiology 2013;168(4):3572–9. [3] Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2019. January. Available from http://amhonline.net.au. [4] Metoprolol. In. MIMS Online. St Leonards, Australia; MIMS Australia. Available from http://www.mimsonline.com.au.
http://dx.doi.org/10.1016/j.hlc.2019.06.059 059 Adherence to Guideline Directed Medical Therapy of Patients Admitted to Hospital with Acute Heart Failure A. Driscoll 1,2,∗ , D. Dinh 3 , J. Wong 4 , G. Toogood 5 , I. Hopper 3,6 , H. Zimmet 3,7 , A. Brennan 3 , J. Lefkovits 3 , H. Carruthers 3 , J. Mariani 6,8 , H. Connor 9 , C. Reid 3,10 1 Deakin
University, Burwood, Australia Health, Heidelberg, Australia 3 Monash University, Prahran, Australia 4 Melbourne Health, Parkville, Australia 5 Peninsula Health, Frankston, Australia 6 Alfred Health, Prahran, Australia 7 Epworth Healthcare, Richmond, Australia 8 Bairnsdale Regional Health Service, Bairnsdale, Australia 9 Central Gippsland Health Service, Gippsland, Australia 10 Curtin University, Perth, Australia 2 Austin
Background: National guidelines for the management of heart failure (HF) inform clinical practice. However,
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translation into clinical practice is suboptimal, denying patients the full benefit of evidence-based therapy. This study evaluated the translation of clinical guidelines in the management of patients admitted to hospital with acute HF. Methods: Sixteen Victorian hospitals participated in a prospective state-wide HF study of patients admitted to hospital with acute HF over one month and followed up for 30 days post-discharge. The project was conducted annually over three consecutive years from 2015–2017. Results: Of the 1222 patients, 56.5% were male with an average age of 77 years (SD 13.17 years) and 73.6% had HFrEF. Hypertension and chronic renal disease were the most common comorbidities (75.5% and 63.6% respectively). In patients with HFrEF, 73.1% were prescribed, at discharge, an ACEI/ARB, 74.8% a beta-blocker and 46.6% an aldosterone antagonist. On average, these patients were prescribed 10.46 ± 4.03 medications. At 30 days, 53.6% of all patients had been seen in outpatients with median time to appointment of 21 (IQR 12–30) days. A third of all patients had been referred to a HF home visiting program. Of these patients, 49% were seen within 30 days post-discharge with median time to first visit of 13 (IQR 6.25–27) days. Thirty-day readmission rates were 24.4% and mortality was 4.8%. Conclusion: Rates of guideline directed medical therapy remain suboptimal in HFrEF patients. Post-discharge follow-up was also inadequate. Strategies to improve rapid review post-discharge and translation of evidence into clinical practice are urgently needed. http://dx.doi.org/10.1016/j.hlc.2019.06.060 060 AF-Mediated Heart Failure: A Retrospective Observational Study A. Rao 1,∗ , S. Hales 1 , B. Patani 1 , D. Mou 1,2 , L. Kanagaratnam 1,3,6 , E. Barin 1,2,3 , A. Sindone 1,3,4,6 , G. Gan 1,5,7 1 Department of Cardiology, Ryde Hospital, Eastwood, Australia 2 Department of Cardiology, Macquarie University Hospital, Macquarie Park, Australia 3 Department of Cardiology, Royal North Shore Hospital, St Leonards, Australia 4 Department of Cardiology, Concord General and Repatriation Hospital, Concord, Australia 5 Department of Cardiology, Blacktown Hospital, Blacktown, Australia 6 University of Sydney, Camperdown, Australia 7 University of New South Wales, Kensington, Australia
Background and Aim: Heart failure is one of the leading causes for hospitalisation and imposes a significant economic burden on the health system. Atrial fibrillation affects one in three patients with heart failure (REF), and is a common cause of heart failure admission. The aim of our study is to evaluate the impact of AF-related heart failure (HF) admissions relative to admissions for HF without AF. Method: Patients admitted to Ryde Hospital with a primary diagnosis of decompensated HF in the time period
Abstracts
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of Jan-2018 to Dec-2018 were evaluated. We grouped patients based on the primary cause of decompensation (AF vs Non AF). We compared admission indices including length of stay and complications during admission. Results: 164 patients were included (Group 1: AF-related decompensation, n = 56; Group 2: Non-AF-related decompensation n = 108). The mean age was (84.59 ± 8.2SD, 45.7% females). 48% of patients had history of ischaemic heart disease, 14.9% had COPD, and 28.4% had diabetes mellitus. On between-group analysis, patients with AF mediated decompensations had a significantly longer length of stay (7.04 ± 5.20 SD vs 5.16 ± 3.94 SD, p = 0.01), compared to nonAF mediated decompensations. Troponin and haemoglobin levels were not significantly different between groups. However, a higher proportion of patients in the AF group had history of anaemia (58% vs 66%, p = 0.40), and raised troponin levels (31% vs 41%, p = 0.40). Conclusion: Our finding suggest AF mediated decompensated HF is associated with longer lengths of stay and trend towards higher complications. http://dx.doi.org/10.1016/j.hlc.2019.06.061 061 Ambulatory Inotropes as a Bridge to Heart Transplantation: A Safe Alternative to Mechanical Support? M. Stubbs ∗ , P. Ruygrok Auckland District Health Board, Auckland, New Zealand Background: Patients with advanced systolic heart failure are susceptible to acute deterioration refractory to standard medical therapies. This case series explores our local experience with ambulatory parenteral inotropic therapy as a means to support susceptible patients on the heart transplant waiting list. Methods and results: We reviewed medical records of all patients treated with ambulatory inotropes through the national transplant centre. Fifteen patients were treated between 2001 and 2018. Mean age was 43.6 years, ranging from 11 to 63 years. Inotropes used consisted of dobutamine (dose range 3–10 mcg/kg/min, mean 4.4 mcg/kg/min) and milrinone (dose range 0.3–0.5 mcg/kg/min, mean 0.46 mcg/kg/min). Levosimendin was used intermittently in 8 of 15 patients. All patients had inotropes administered via peripherally inserted central catheter (PICC). Median duration of therapy was 139 days (range 20–717 days). Fourteen of 15 patients were transplanted successfully (one withdrew from the waitlist by personal choice). Dominant aetiology of heart failure was dilated cardiomyopathy (seven of 15). There was an improvement in functional status in nine of 13 patients (data incomplete in two of 15). During the 2707 patient days on inotropes, there were no deaths, and no patients were withdrawn from inotropes due to adverse effects. Two patients had ventricular arrhythmia requiring ICD therapy, and there were five minor complications in three patients. Conclusion: When managed by a specialist team ambulatory inotropic therapy for advanced heart failure resistant to standard medical therapy appears to be a reasonably safe and
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effective alternative therapy to bridge actively listed patients to heart transplantation. http://dx.doi.org/10.1016/j.hlc.2019.06.062 062 This abstract has been withdrawn http://dx.doi.org/10.1016/j.hlc.2019.06.063 063 Anti-Angiogenic Vascular Endothelial Growth Factor-A Isoform: VEGF-A165b is Present in Human Right Atrial Appendage, but is not Altered in Diabetes A. Croft 1,2,∗ , T. Senanayake 3 , L. Butel-Simões 3 , N. Mabotuwana 1,2 , A. Boyle 1,2,3 , A. Sverdlov 1,2,3 , D. Ngo 1,2 1 University of Newcastle, New Lambton Heights, Australia 2 Hunter Medical Research Insititute, New Lambton Heights, Australia 3 John Hunter Hospital, New Lambton Heights, Australia
Introduction: The alternative splice variant of vascular endothelial growth factor (VEGF-A): VEGF-A165b is antiangiogenic and has been described to regulate angiogenesis in cancer, retinopathy, and obesity. In this study, we describe for the first time, presence of VEGF-A165b in human cardiac tissue, and sought to determine whether VEGF-A165b is altered in patients with diabetes. Methods and Results: A total of 33 right atrial appendage biopsies were collected from consenting patients during cardiac or vascular surgery at the John Hunter Hospital. Patient demographics and co-morbidities were recorded on the day of surgery and confirmed via access to medical records. A majority of patients (82%) were male; 32% of patients had previous MI, n = 10 (30%) patients had diabetes. Detection of VEGF-A165b levels were determined using the ELISA kit (R&D systems). Patients with diabetes tended to have lower VEGF-A165b expression (p = 0.1). There was no difference in VEGF-A165b expressions in patients with previous myocardial infarction or diastolic impairment. On multivariate analysis, presence of diabetes is not associated with changes in VEGF-A165b expression, independent of age, BMI, gender, and cardiovascular co-morbidities. Conclusions: VEGF-A165b is present in human cardiac tissue. In patients who underwent CABG surgery, there was no difference in VEGFA-165b expression between patients with vs without diabetes. Larger study population is required to dissect the regulatory mechanisms of cardiac VEGF-A165b in metabolically-induced cardiovascular pathologies. http://dx.doi.org/10.1016/j.hlc.2019.06.064
information may overestimate the true rate of side effects and limit usage of these life-preserving heart failure medications. We compared the adverse effects listed in a systematic review of randomised control trials of beta-blockers with the adverse effects listed in reference texts: The Australian Medicines Handbook Online and MIMS Online [2–4]. 25 of 33 adverse effects listed in the systematic review were listed in AMH or MIMS. Of all listed adverse effects the rates were comparable for 10/25. Adverse effects were overestimated in 15/25 cases. Twelve adverse effects listed as common in reference texts were actually less common in the active treatment arm of randomised control trials. This study demonstrates that Australian reference texts overestimate the true rate of adverse effects attributable to beta-blockers and misinform patients and clinicians. As recognised by Barron et al. [2] overestimating these adverse effects may lead to clinicians and patients ceasing beneficial medications. Reviewing how information on adverse effects is published in Australian prescribing references may improve treatment of many conditions and reduce discontinuation of proven therapies.
References [1] Planès S, Villier C, Mallaret M. The nocebo effect of drugs. Pharmacology Research & Perspectives 2016;4(2). [2] Barron AJ, Zaman N, Cole GD, Wensel R, Okonko DO, Francis DP. Systematic review of genuine versus spurious side-effects of beta-blockers in heart failure using placebo control: recommendations for patient information. International journal of cardiology 2013;168(4):3572–9. [3] Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2019. January. Available from http://amhonline.net.au. [4] Metoprolol. In. MIMS Online. St Leonards, Australia; MIMS Australia. Available from http://www.mimsonline.com.au.
http://dx.doi.org/10.1016/j.hlc.2019.06.059 059 Adherence to Guideline Directed Medical Therapy of Patients Admitted to Hospital with Acute Heart Failure A. Driscoll 1,2,∗ , D. Dinh 3 , J. Wong 4 , G. Toogood 5 , I. Hopper 3,6 , H. Zimmet 3,7 , A. Brennan 3 , J. Lefkovits 3 , H. Carruthers 3 , J. Mariani 6,8 , H. Connor 9 , C. Reid 3,10 1 Deakin
University, Burwood, Australia Health, Heidelberg, Australia 3 Monash University, Prahran, Australia 4 Melbourne Health, Parkville, Australia 5 Peninsula Health, Frankston, Australia 6 Alfred Health, Prahran, Australia 7 Epworth Healthcare, Richmond, Australia 8 Bairnsdale Regional Health Service, Bairnsdale, Australia 9 Central Gippsland Health Service, Gippsland, Australia 10 Curtin University, Perth, Australia 2 Austin
Background: National guidelines for the management of heart failure (HF) inform clinical practice. However,
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translation into clinical practice is suboptimal, denying patients the full benefit of evidence-based therapy. This study evaluated the translation of clinical guidelines in the management of patients admitted to hospital with acute HF. Methods: Sixteen Victorian hospitals participated in a prospective state-wide HF study of patients admitted to hospital with acute HF over one month and followed up for 30 days post-discharge. The project was conducted annually over three consecutive years from 2015–2017. Results: Of the 1222 patients, 56.5% were male with an average age of 77 years (SD 13.17 years) and 73.6% had HFrEF. Hypertension and chronic renal disease were the most common comorbidities (75.5% and 63.6% respectively). In patients with HFrEF, 73.1% were prescribed, at discharge, an ACEI/ARB, 74.8% a beta-blocker and 46.6% an aldosterone antagonist. On average, these patients were prescribed 10.46 ± 4.03 medications. At 30 days, 53.6% of all patients had been seen in outpatients with median time to appointment of 21 (IQR 12–30) days. A third of all patients had been referred to a HF home visiting program. Of these patients, 49% were seen within 30 days post-discharge with median time to first visit of 13 (IQR 6.25–27) days. Thirty-day readmission rates were 24.4% and mortality was 4.8%. Conclusion: Rates of guideline directed medical therapy remain suboptimal in HFrEF patients. Post-discharge follow-up was also inadequate. Strategies to improve rapid review post-discharge and translation of evidence into clinical practice are urgently needed. http://dx.doi.org/10.1016/j.hlc.2019.06.060 060 AF-Mediated Heart Failure: A Retrospective Observational Study A. Rao 1,∗ , S. Hales 1 , B. Patani 1 , D. Mou 1,2 , L. Kanagaratnam 1,3,6 , E. Barin 1,2,3 , A. Sindone 1,3,4,6 , G. Gan 1,5,7 1 Department of Cardiology, Ryde Hospital, Eastwood, Australia 2 Department of Cardiology, Macquarie University Hospital, Macquarie Park, Australia 3 Department of Cardiology, Royal North Shore Hospital, St Leonards, Australia 4 Department of Cardiology, Concord General and Repatriation Hospital, Concord, Australia 5 Department of Cardiology, Blacktown Hospital, Blacktown, Australia 6 University of Sydney, Camperdown, Australia 7 University of New South Wales, Kensington, Australia
Background and Aim: Heart failure is one of the leading causes for hospitalisation and imposes a significant economic burden on the health system. Atrial fibrillation affects one in three patients with heart failure (REF), and is a common cause of heart failure admission. The aim of our study is to evaluate the impact of AF-related heart failure (HF) admissions relative to admissions for HF without AF. Method: Patients admitted to Ryde Hospital with a primary diagnosis of decompensated HF in the time period
Abstracts
S160
of Jan-2018 to Dec-2018 were evaluated. We grouped patients based on the primary cause of decompensation (AF vs Non AF). We compared admission indices including length of stay and complications during admission. Results: 164 patients were included (Group 1: AF-related decompensation, n = 56; Group 2: Non-AF-related decompensation n = 108). The mean age was (84.59 ± 8.2SD, 45.7% females). 48% of patients had history of ischaemic heart disease, 14.9% had COPD, and 28.4% had diabetes mellitus. On between-group analysis, patients with AF mediated decompensations had a significantly longer length of stay (7.04 ± 5.20 SD vs 5.16 ± 3.94 SD, p = 0.01), compared to nonAF mediated decompensations. Troponin and haemoglobin levels were not significantly different between groups. However, a higher proportion of patients in the AF group had history of anaemia (58% vs 66%, p = 0.40), and raised troponin levels (31% vs 41%, p = 0.40). Conclusion: Our finding suggest AF mediated decompensated HF is associated with longer lengths of stay and trend towards higher complications. http://dx.doi.org/10.1016/j.hlc.2019.06.061 061 Ambulatory Inotropes as a Bridge to Heart Transplantation: A Safe Alternative to Mechanical Support? M. Stubbs ∗ , P. Ruygrok Auckland District Health Board, Auckland, New Zealand Background: Patients with advanced systolic heart failure are susceptible to acute deterioration refractory to standard medical therapies. This case series explores our local experience with ambulatory parenteral inotropic therapy as a means to support susceptible patients on the heart transplant waiting list. Methods and results: We reviewed medical records of all patients treated with ambulatory inotropes through the national transplant centre. Fifteen patients were treated between 2001 and 2018. Mean age was 43.6 years, ranging from 11 to 63 years. Inotropes used consisted of dobutamine (dose range 3–10 mcg/kg/min, mean 4.4 mcg/kg/min) and milrinone (dose range 0.3–0.5 mcg/kg/min, mean 0.46 mcg/kg/min). Levosimendin was used intermittently in 8 of 15 patients. All patients had inotropes administered via peripherally inserted central catheter (PICC). Median duration of therapy was 139 days (range 20–717 days). Fourteen of 15 patients were transplanted successfully (one withdrew from the waitlist by personal choice). Dominant aetiology of heart failure was dilated cardiomyopathy (seven of 15). There was an improvement in functional status in nine of 13 patients (data incomplete in two of 15). During the 2707 patient days on inotropes, there were no deaths, and no patients were withdrawn from inotropes due to adverse effects. Two patients had ventricular arrhythmia requiring ICD therapy, and there were five minor complications in three patients. Conclusion: When managed by a specialist team ambulatory inotropic therapy for advanced heart failure resistant to standard medical therapy appears to be a reasonably safe and
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effective alternative therapy to bridge actively listed patients to heart transplantation. http://dx.doi.org/10.1016/j.hlc.2019.06.062 062 This abstract has been withdrawn http://dx.doi.org/10.1016/j.hlc.2019.06.063 063 Anti-Angiogenic Vascular Endothelial Growth Factor-A Isoform: VEGF-A165b is Present in Human Right Atrial Appendage, but is not Altered in Diabetes A. Croft 1,2,∗ , T. Senanayake 3 , L. Butel-Simões 3 , N. Mabotuwana 1,2 , A. Boyle 1,2,3 , A. Sverdlov 1,2,3 , D. Ngo 1,2 1 University of Newcastle, New Lambton Heights, Australia 2 Hunter Medical Research Insititute, New Lambton Heights, Australia 3 John Hunter Hospital, New Lambton Heights, Australia
Introduction: The alternative splice variant of vascular endothelial growth factor (VEGF-A): VEGF-A165b is antiangiogenic and has been described to regulate angiogenesis in cancer, retinopathy, and obesity. In this study, we describe for the first time, presence of VEGF-A165b in human cardiac tissue, and sought to determine whether VEGF-A165b is altered in patients with diabetes. Methods and Results: A total of 33 right atrial appendage biopsies were collected from consenting patients during cardiac or vascular surgery at the John Hunter Hospital. Patient demographics and co-morbidities were recorded on the day of surgery and confirmed via access to medical records. A majority of patients (82%) were male; 32% of patients had previous MI, n = 10 (30%) patients had diabetes. Detection of VEGF-A165b levels were determined using the ELISA kit (R&D systems). Patients with diabetes tended to have lower VEGF-A165b expression (p = 0.1). There was no difference in VEGF-A165b expressions in patients with previous myocardial infarction or diastolic impairment. On multivariate analysis, presence of diabetes is not associated with changes in VEGF-A165b expression, independent of age, BMI, gender, and cardiovascular co-morbidities. Conclusions: VEGF-A165b is present in human cardiac tissue. In patients who underwent CABG surgery, there was no difference in VEGFA-165b expression between patients with vs without diabetes. Larger study population is required to dissect the regulatory mechanisms of cardiac VEGF-A165b in metabolically-induced cardiovascular pathologies. http://dx.doi.org/10.1016/j.hlc.2019.06.064