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The New Zealand Heart Failure Registry: Two Years On
Abstracts
13 THE NEW ZEALAND HEART FAILURE REGISTRY: TWO YEARS ON GP Devlin 1,∗ , R Troughton 2 , M Lund 3 , R Doughty 4 , on behalf of the NZHFR Investigators 1 Waikato
Hospital, Hamilton, New Zealand 2 Christchurch Hospital, Christchurch, New Zealand 3 Middlemore Hospital, Auckland, New Zealand 4 Auckland City Hospital, Auckland, New Zealand Background: The New Zealand Heart Failure Registry (NZHFR) commenced enrolment mid 2006 with the primary aim to improve the medical care of heart failure patients, through a better understanding of patient demographics, management, and in-hospital and postdischarge outcomes. Methods: The NZHFR is a national prospective observational web-based registry. All hospitals in New Zealand admitting patients with acute heart failure have been invited to participate with a minimum and maximum requirement of 5 and 15 consecutive patients recruited per month respectively. Eleven hospitals are currently active. Results: At 12 March 2009 741 patients had been enrolled with 90 day follow up data available in 84% (625/741). The mean patient age was 70 years with 2/3rds male. CXR was performed in 98% of patients. Natriuretic peptides were assayed in 50% (369/741). Recent echocardiography was available in 80% (592/741). Systolic dysfunction was present in 41% (301/741). In-hospital death was infrequent (3% (19/741). The median length of hospital stay was 7 days. Medications on discharge are as shown. Device therapy was low (1% 5/741). At 90 days 89% (555/625) were alive and 14% (88/625) readmitted with heart failure. Compliance was reported in 86% (535/625). Meds on discharge ACE inhibitors ARBs B-blockers Aldosterone antagonist Diuretic
549/741 (74%) 74/741 (10%) 543/741 (73%) 241/741 (33%) 709/741 (96%)
Conclusion: Early observations from the NZHFR are encouraging with an evidence-based approach to care and low readmission rates. doi:10.1016/j.hlc.2009.04.016
S7
14 BRAIN NATRIURETIC PEPTIDE AND TROPONIN I AS PREDICTORS OF RIGHT VENTRICULAR DYSFUNCTION AND LONG TERM ADVERSE EVENTS AFTER PULMONARY EMBOLISM P Ding 1,∗ , SP Wong 1 , P Casey 1 , C Wong 2 , J White 1 , I Zeng 3 , T Sutton 1 1 Department
of Cardiology, Middlemore Hospital, Auckland, New Zealand 2 Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand 3 Centre for Clinical Research and Effective Practice, Middlemore Hospital, Auckland, New Zealand Background: Cardiac troponins have been shown to predict right ventricular (RV) dysfunction, severity and mortality of pulmonary embolism (PE). Brain natriuretic peptide (BNP) has been reported to rise after massive PE. We hypothesise that BNP and troponin I are associated with RV dysfunction and mortality in patients with PE. These markers may have important implications for risk stratification and hence management of this potentially life-threatening condition. Methods: An observational prospective study of consecutive patients at Middlemore Hospital, Auckland with pulmonary embolism confirmed by CT pulmonary angiography from April 2002 to December 2004. All patients had BNP, troponin I, right ventricular function by echocardiography and baseline respiratory function (arterial blood gas and spirometry) performed. RV dysfunction, cardio-respiratory events defined as in-hospital, 30-day and 5-year mortality or re-admissions due to cardiorespiratory causes are recorded. Results: Fifty-seven patients had PE, of which 23 had RV dysfunction on echocardiogram. Nine deaths from all cause mortality, five cardio-respiratory causes and four non-cardiorespiratory causes. Sixteen cardio-respiratory re-admissions. BNP associates with all cause mortality (p = 0.02). Troponin I (p = 0.01) and BNP (p = 0.0005) are predictive of RV dysfunction but not cardiorespiratory events. Age (p = 0.038) and lowest diastolic blood pressure (p = 0.048) are independent predictors of cardio-respiratory related events by multivariant analysis. Lowest systolic blood pressure (p = 0.03) and arterial blood gas oxygen saturation (p = 0.02) are also independent predictors for RV dysfunction. Conclusion: Troponin I and BNP are predictive of right ventricular dysfunction but not cardio-respiratory events. However BNP is associated with all cause mortality after PE. doi:10.1016/j.hlc.2009.04.017
ABSTRACTS
Heart, Lung and Circulation 2009;18S:S1–S31
13 THE NEW ZEALAND HEART FAILURE REGISTRY: TWO YEARS ON GP Devlin 1,∗ , R Troughton 2 , M Lund 3 , R Doughty 4 , on behalf of the NZHFR Investigators 1 Waikato
Hospital, Hamilton, New Zealand 2 Christchurch Hospital, Christchurch, New Zealand 3 Middlemore Hospital, Auckland, New Zealand 4 Auckland City Hospital, Auckland, New Zealand Background: The New Zealand Heart Failure Registry (NZHFR) commenced enrolment mid 2006 with the primary aim to improve the medical care of heart failure patients, through a better understanding of patient demographics, management, and in-hospital and postdischarge outcomes. Methods: The NZHFR is a national prospective observational web-based registry. All hospitals in New Zealand admitting patients with acute heart failure have been invited to participate with a minimum and maximum requirement of 5 and 15 consecutive patients recruited per month respectively. Eleven hospitals are currently active. Results: At 12 March 2009 741 patients had been enrolled with 90 day follow up data available in 84% (625/741). The mean patient age was 70 years with 2/3rds male. CXR was performed in 98% of patients. Natriuretic peptides were assayed in 50% (369/741). Recent echocardiography was available in 80% (592/741). Systolic dysfunction was present in 41% (301/741). In-hospital death was infrequent (3% (19/741). The median length of hospital stay was 7 days. Medications on discharge are as shown. Device therapy was low (1% 5/741). At 90 days 89% (555/625) were alive and 14% (88/625) readmitted with heart failure. Compliance was reported in 86% (535/625). Meds on discharge ACE inhibitors ARBs B-blockers Aldosterone antagonist Diuretic
549/741 (74%) 74/741 (10%) 543/741 (73%) 241/741 (33%) 709/741 (96%)
Conclusion: Early observations from the NZHFR are encouraging with an evidence-based approach to care and low readmission rates. doi:10.1016/j.hlc.2009.04.016
S7
14 BRAIN NATRIURETIC PEPTIDE AND TROPONIN I AS PREDICTORS OF RIGHT VENTRICULAR DYSFUNCTION AND LONG TERM ADVERSE EVENTS AFTER PULMONARY EMBOLISM P Ding 1,∗ , SP Wong 1 , P Casey 1 , C Wong 2 , J White 1 , I Zeng 3 , T Sutton 1 1 Department
of Cardiology, Middlemore Hospital, Auckland, New Zealand 2 Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand 3 Centre for Clinical Research and Effective Practice, Middlemore Hospital, Auckland, New Zealand Background: Cardiac troponins have been shown to predict right ventricular (RV) dysfunction, severity and mortality of pulmonary embolism (PE). Brain natriuretic peptide (BNP) has been reported to rise after massive PE. We hypothesise that BNP and troponin I are associated with RV dysfunction and mortality in patients with PE. These markers may have important implications for risk stratification and hence management of this potentially life-threatening condition. Methods: An observational prospective study of consecutive patients at Middlemore Hospital, Auckland with pulmonary embolism confirmed by CT pulmonary angiography from April 2002 to December 2004. All patients had BNP, troponin I, right ventricular function by echocardiography and baseline respiratory function (arterial blood gas and spirometry) performed. RV dysfunction, cardio-respiratory events defined as in-hospital, 30-day and 5-year mortality or re-admissions due to cardiorespiratory causes are recorded. Results: Fifty-seven patients had PE, of which 23 had RV dysfunction on echocardiogram. Nine deaths from all cause mortality, five cardio-respiratory causes and four non-cardiorespiratory causes. Sixteen cardio-respiratory re-admissions. BNP associates with all cause mortality (p = 0.02). Troponin I (p = 0.01) and BNP (p = 0.0005) are predictive of RV dysfunction but not cardiorespiratory events. Age (p = 0.038) and lowest diastolic blood pressure (p = 0.048) are independent predictors of cardio-respiratory related events by multivariant analysis. Lowest systolic blood pressure (p = 0.03) and arterial blood gas oxygen saturation (p = 0.02) are also independent predictors for RV dysfunction. Conclusion: Troponin I and BNP are predictive of right ventricular dysfunction but not cardio-respiratory events. However BNP is associated with all cause mortality after PE. doi:10.1016/j.hlc.2009.04.017
ABSTRACTS
Heart, Lung and Circulation 2009;18S:S1–S31