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A superior risk prediction model for in-hospital mortality during acute presentation with pulmonary embolism
Abstract
AF burden was 51±45% for Group 1 and 0.2±0.5% for Group 2, and there were significant improvements in AF symptom severity and QOL only in Group 2 (P<0.05 for all). No clinical/organic variable predicted the magnitude of change. Conclusion: Clinical/organic variables including LA function, age, gender, BMI and particularly the AF burden influence the perceived severity of the AF syndrome, with key differences between patients with intermittent and continuous forms of AF. http://dx.doi.org/10.1016/j.hlc.2015.06.606 604 A study of the psychological predictors of AF severity and quality of life in human AF: personality style is key T. Walters 1,∗ , K. Wick 2 , G. Tan 1 , A. Nisbet 1 , G. Morris 1 , M. Mearns 1 , J. Morton 1 , C. Bryant 2 , P. Kistler 3 , J. Kalman 1 1 Royal
Melbourne Hospital and University of Melbourne, VIC, Australia 2 Royal Women’s Hospital, Parkville, VIC, Australia 3 Alfred Hospital and Baker IDI, Melbourne, VIC, Australia Introduction: We explored the interaction over time of psychological factors with AF symptom severity and QOL. Methods: 103 consecutive patients were prospectively enrolled. 58 patients with AF being managed medically (Group 1), 20 with AF undergoing catheter ablation (Group 2) and 25 control patients with SVT (Group 3) were assessed at baseline, 4, 8 and 12 months. Psychological distress was quantified and detailed assessment of personality style undertaken using validated scales (measuring the degree to which events are perceived as stressful, levels of chronic anxiety, and degree of personal negativity). AF symptom severity and QOL were measured. AF burden was measured using implanted monitors. Results: Groups were well matched for clinical parameters. Psychological distress and all variables of personality style were strong independent predictors of AF symptom severity, global wellbeing, and QOL (P<0.05 for all). In multivariate models the only organic cardiac variable to also consistently predict poor QOL was an elevated AF burden (P<0.05). Over 12 months, AF burden was 51±45% for Group 1 and 0.2±0.5% for Group 2. There were significant improvements in AF symptom severity, QOL and psychological distress only after AF ablation (P<0.05 for all). Higher baseline levels of distress, severe symptoms, and an anxious personality susceptible to perceived stress predicted large improvements following AF ablation. Conclusion: Personality style and psychological distress, along with the AF burden, are key predictors of AF severity and QOL. Effective rhythm control leads to marked improvements in these, and in psychological distress. This suggests that distress is a consequence of AF itself interacting with a vulnerable personality style. http://dx.doi.org/10.1016/j.hlc.2015.06.607
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605 A superior risk prediction model for in-hospital mortality during acute presentation with pulmonary embolism J. Lau ∗ , A. Ng, V. Chow, T. Chung, A. Yong, L. Kritharides Department of Cardiology, Concord Hospital, NSW, Australia Introduction: Pulmonary embolism (PE) remains a major cause of death due to gas exchange and haemodynamic disturbances. Low bicarbonate may reflect metabolic acidosis from tissue hypoperfusion or represent respiratory alkalosis compensation. The combined use of serum sodium (a known predictor) and bicarbonate to improve existing risk prediction models in acute PE has not been studied. Methods: From a confirmed acute PE database involving 1431 consecutive patients admitted to a tertiary-referral centre (2000-2012), 1378 patients had day-1 serum sodium and bicarbonate assessed. Patients were stratified by presence of low bicarbonate (HCO3<24mmol/L) or HCO3≥24mmol/L. Risk stratification for in-hospital death was performed using multivariate logistic-regression modelling. Results: Low bicarbonate was present in 568 (41.2%) patients on their index PE admission. These patients more commonly had a history of cardiovascular disease (42.1% vs 36.4%, p=0.04), hypertension (27.8% vs 22.7%, p=0.03), diabetes (15.7% vs 11.7%, p=0.04), and less concomitant deep vein thrombosis (16.7% vs 22.1%, p=0.02). They also had higher presentation mean heart rate (91bpm vs 87bpm, p=0.001), more frequent right ventricular dysfunction on echocardiography (35.2% vs 23.8%, p<0.0001), longer mean length of stay (8.6 vs 7.5 days, p=0.001) and were more likely to die during admission (5.1% vs 1.7%; odds ratio: 3.1, 95%CI: 1.65.8, p<0.0001) than those with HCO3≥24mmol/L. Adding day-1 serum bicarbonate and sodium to the simplified Pulmonary Embolism Severity Index significantly increased the multivariate modelling c-statistic from 0.72 to 0.85 (p=0.02). Conclusion: Inclusion of day-1 serum bicarbonate and sodium significantly improves a widely used, validated risk prediction model for acute pulmonary embolism. http://dx.doi.org/10.1016/j.hlc.2015.06.608
AF burden was 51±45% for Group 1 and 0.2±0.5% for Group 2, and there were significant improvements in AF symptom severity and QOL only in Group 2 (P<0.05 for all). No clinical/organic variable predicted the magnitude of change. Conclusion: Clinical/organic variables including LA function, age, gender, BMI and particularly the AF burden influence the perceived severity of the AF syndrome, with key differences between patients with intermittent and continuous forms of AF. http://dx.doi.org/10.1016/j.hlc.2015.06.606 604 A study of the psychological predictors of AF severity and quality of life in human AF: personality style is key T. Walters 1,∗ , K. Wick 2 , G. Tan 1 , A. Nisbet 1 , G. Morris 1 , M. Mearns 1 , J. Morton 1 , C. Bryant 2 , P. Kistler 3 , J. Kalman 1 1 Royal
Melbourne Hospital and University of Melbourne, VIC, Australia 2 Royal Women’s Hospital, Parkville, VIC, Australia 3 Alfred Hospital and Baker IDI, Melbourne, VIC, Australia Introduction: We explored the interaction over time of psychological factors with AF symptom severity and QOL. Methods: 103 consecutive patients were prospectively enrolled. 58 patients with AF being managed medically (Group 1), 20 with AF undergoing catheter ablation (Group 2) and 25 control patients with SVT (Group 3) were assessed at baseline, 4, 8 and 12 months. Psychological distress was quantified and detailed assessment of personality style undertaken using validated scales (measuring the degree to which events are perceived as stressful, levels of chronic anxiety, and degree of personal negativity). AF symptom severity and QOL were measured. AF burden was measured using implanted monitors. Results: Groups were well matched for clinical parameters. Psychological distress and all variables of personality style were strong independent predictors of AF symptom severity, global wellbeing, and QOL (P<0.05 for all). In multivariate models the only organic cardiac variable to also consistently predict poor QOL was an elevated AF burden (P<0.05). Over 12 months, AF burden was 51±45% for Group 1 and 0.2±0.5% for Group 2. There were significant improvements in AF symptom severity, QOL and psychological distress only after AF ablation (P<0.05 for all). Higher baseline levels of distress, severe symptoms, and an anxious personality susceptible to perceived stress predicted large improvements following AF ablation. Conclusion: Personality style and psychological distress, along with the AF burden, are key predictors of AF severity and QOL. Effective rhythm control leads to marked improvements in these, and in psychological distress. This suggests that distress is a consequence of AF itself interacting with a vulnerable personality style. http://dx.doi.org/10.1016/j.hlc.2015.06.607
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605 A superior risk prediction model for in-hospital mortality during acute presentation with pulmonary embolism J. Lau ∗ , A. Ng, V. Chow, T. Chung, A. Yong, L. Kritharides Department of Cardiology, Concord Hospital, NSW, Australia Introduction: Pulmonary embolism (PE) remains a major cause of death due to gas exchange and haemodynamic disturbances. Low bicarbonate may reflect metabolic acidosis from tissue hypoperfusion or represent respiratory alkalosis compensation. The combined use of serum sodium (a known predictor) and bicarbonate to improve existing risk prediction models in acute PE has not been studied. Methods: From a confirmed acute PE database involving 1431 consecutive patients admitted to a tertiary-referral centre (2000-2012), 1378 patients had day-1 serum sodium and bicarbonate assessed. Patients were stratified by presence of low bicarbonate (HCO3<24mmol/L) or HCO3≥24mmol/L. Risk stratification for in-hospital death was performed using multivariate logistic-regression modelling. Results: Low bicarbonate was present in 568 (41.2%) patients on their index PE admission. These patients more commonly had a history of cardiovascular disease (42.1% vs 36.4%, p=0.04), hypertension (27.8% vs 22.7%, p=0.03), diabetes (15.7% vs 11.7%, p=0.04), and less concomitant deep vein thrombosis (16.7% vs 22.1%, p=0.02). They also had higher presentation mean heart rate (91bpm vs 87bpm, p=0.001), more frequent right ventricular dysfunction on echocardiography (35.2% vs 23.8%, p<0.0001), longer mean length of stay (8.6 vs 7.5 days, p=0.001) and were more likely to die during admission (5.1% vs 1.7%; odds ratio: 3.1, 95%CI: 1.65.8, p<0.0001) than those with HCO3≥24mmol/L. Adding day-1 serum bicarbonate and sodium to the simplified Pulmonary Embolism Severity Index significantly increased the multivariate modelling c-statistic from 0.72 to 0.85 (p=0.02). Conclusion: Inclusion of day-1 serum bicarbonate and sodium significantly improves a widely used, validated risk prediction model for acute pulmonary embolism. http://dx.doi.org/10.1016/j.hlc.2015.06.608