- Email: [email protected]
Canadian Cardiovascular Society (CCS) CCS665 Oral: Current Clinical Challenges in Heart Failure Tuesday, October 26, 2010
Abstracts
Canadian Cardiovascular Society (CCS) CCS665 Oral CURRENT CLINICAL CHALLENGES IN HEART FAILURE Tuesday, October 26, 2010 651
THE CANADIAN CARDIOVASCULAR SOCIETY GUIDELINES FOR THE DIAGNOSIS AND MANAGEMENT OF HEART FAILURE: RESULTS OF A 5-YEAR CLOSED LOOP IMPLEMENTATION PROGRAM G Moe, JG Howlett, RS McKelvie, C Pullen Toronto, Ontario BACKGROUND: The Canadian heart failure guidelines are unique among those from other countries in that they are updated every year. In 2005, the Canadian Cardiovascular Society (CCS) undertook a five year plan of dissemination, implementation and evaluation of its guidelines on the diagnosis and management of heart failure. This report highlights our preliminary findings from the past five years of dissemination and evaluation. CONCLUSION: These preliminary results indicate that a collaborative, multi-pronged and multidisciplinary approach to the formulation and dissemination of heart failure management guidelines can be successful in favorably influencing the awareness, knowledge and behavior of providers of heart failure and cardiovascular care.
Student Presentation Award Finalist – Clinical Science Featured Research 652
MORTALITY AND HOSPITAL RE-ADMISSION IN PATIENTS WITH HEART FAILURE UNDERGOING MAJOR OR MINOR NON-CARDIAC SURGERY. AN ANALYSIS OF 40 749 PATIENTS S van Diepen, JA Bakal, FA McAlister, JA Ezekowitz Edmonton, Alberta BACKGROUND: Advances in heart failure (HF) management have improved patient survival, altered the demographics and overall disease prevalence of HF. An increasing number of HF patients undergo noncardiac surgery yet uncertainty exists as to their risk for peri-operative complications when compared to patients with coronary artery disease. CONCLUSION: Patients with HF undergoing major or minor surgical procedures have a higher incidence of death and cardiac re-hospitalization at 30 days than patients with CAD. Even minor procedures in patients with HF led to substantial morbidity and mortality within 30 days. Contemporary peri-operative risk prediction models place greater emphasis on CAD than HF and appear to underestimate the peri-operative risk in HF patients.
conditions and mortality associated with HF among hospital separations in Canada. CONCLUSION: HF has a high mortality in hospital particularly among the elderly Canadians and is associated with many other cardiac and noncardiac conditions. The most common cardiac problems include chronic ischemic heart disease (IHD), atrial fibrillation and flutter (AFF), and myocardial infarction; whereas renal failure, hypertension, diabetes and chronic obstructive pulmonary disease (COPD) are the most common non-cardiac conditions for HF.
654
PATIENT FOLLOW-UP POST EMERGENCY VISIT FOR HEART FAILURE (HF): IS THERE GENDER BIAS IN REFERRAL TO SPECIALIZED CLINICS? D Feldman, L Pilote, J Des Lauriers, H Behlouli, M Frenette, C Michel, R Sheppard, N Gianetti, F Grondin, T Huynh, M Montigny, S Lepage Montréal, Québec BACKGROUND: Multidisciplinary HF Clinics are effective for managing this condition. On average, there are two to three times as many men than women in these clinics despite equal prevalence of HF. The objectives of our study were to: investigate whether men and women who had an emergency department (ED) visit for HF were subsequently referred to specialized HF clinics; describe when this referral occurred and explore factors that were related to prompt referral. CONCLUSION: More than a third of patients (38%) with HF were referred to HF clinics within 6 months following their ED visit. Younger male patients with lower comorbidity are more likely to be referred to clinics. Research has shown that these clinics benefit all HF patients. Standardized referral guidelines should be developed in order to ensure that these clinics are accessible to all patients who may require these services.
655
‘LIFETIME RISK’ OF HOSPITALIZATIONS AND INVASIVE CARDIAC PROCEDURES IN CHRONIC HEART FAILURE PATIENTS: DIFFERENCES BASED ON LEFT VENTRICULAR SYSTOLIC FUNCTION, ISCHEMIC DISEASE, AND SEX IN THE EFFECT REGISTRY S Chun, JV Tu, HC Wijeysundera, X Wang, DS Lee Toronto, Ontario BACKGROUND: Heart Failure (HF) is a common condition with significant morbidity and mortality implications. Despite its prevalence, population-based data on the “real world” burden of HF on the health care system during the lifetime of the HF patient are limited. We examined the events and procedures that occurred during the ‘lifetime’ of patients discharged after their first hospitalization for HF, and to compare patients with systolic (SHF) vs. diastolic HF (DHF), ischemic (IHF) vs. non-ischemic HF (NIHF) and by sex. CONCLUSION: Over the lifetime of HF patients, higher rates of HF and CV hospitalizations and use of invasive cardiac procedures were associated with SHF, IHF, and male sex. The presence of IHF was a significant predictor of HF hospitalization and greater use of invasive cardiac procedures, whereas SHF was not associated with these outcomes and events, confirming the utility of etiology-based classification of HF. Canadian Institutes of Health Research
653
COMORBIDITIES AND MORTALITY OF HEART FAILURE IN CANADA S Dai, P Walsh, A Wielgosz, H Morrison, C Bancej, P Stewart Ottawa, Ontario BACKGROUND: Heart failure (HF) is a leading cause of hospitalizations for elderly people today. HF is often accompanied by a range of comorbidities, increasing the health care burden. The Public Health Agency of Canada is developing new approaches to tracking heart disease and heart failure in Canada. The objective of the study is to identify comorbid
124D
Can J Cardiol Vol 26 Suppl D October 2010
Canadian Cardiovascular Society (CCS) CCS665 Oral CURRENT CLINICAL CHALLENGES IN HEART FAILURE Tuesday, October 26, 2010 651
THE CANADIAN CARDIOVASCULAR SOCIETY GUIDELINES FOR THE DIAGNOSIS AND MANAGEMENT OF HEART FAILURE: RESULTS OF A 5-YEAR CLOSED LOOP IMPLEMENTATION PROGRAM G Moe, JG Howlett, RS McKelvie, C Pullen Toronto, Ontario BACKGROUND: The Canadian heart failure guidelines are unique among those from other countries in that they are updated every year. In 2005, the Canadian Cardiovascular Society (CCS) undertook a five year plan of dissemination, implementation and evaluation of its guidelines on the diagnosis and management of heart failure. This report highlights our preliminary findings from the past five years of dissemination and evaluation. CONCLUSION: These preliminary results indicate that a collaborative, multi-pronged and multidisciplinary approach to the formulation and dissemination of heart failure management guidelines can be successful in favorably influencing the awareness, knowledge and behavior of providers of heart failure and cardiovascular care.
Student Presentation Award Finalist – Clinical Science Featured Research 652
MORTALITY AND HOSPITAL RE-ADMISSION IN PATIENTS WITH HEART FAILURE UNDERGOING MAJOR OR MINOR NON-CARDIAC SURGERY. AN ANALYSIS OF 40 749 PATIENTS S van Diepen, JA Bakal, FA McAlister, JA Ezekowitz Edmonton, Alberta BACKGROUND: Advances in heart failure (HF) management have improved patient survival, altered the demographics and overall disease prevalence of HF. An increasing number of HF patients undergo noncardiac surgery yet uncertainty exists as to their risk for peri-operative complications when compared to patients with coronary artery disease. CONCLUSION: Patients with HF undergoing major or minor surgical procedures have a higher incidence of death and cardiac re-hospitalization at 30 days than patients with CAD. Even minor procedures in patients with HF led to substantial morbidity and mortality within 30 days. Contemporary peri-operative risk prediction models place greater emphasis on CAD than HF and appear to underestimate the peri-operative risk in HF patients.
conditions and mortality associated with HF among hospital separations in Canada. CONCLUSION: HF has a high mortality in hospital particularly among the elderly Canadians and is associated with many other cardiac and noncardiac conditions. The most common cardiac problems include chronic ischemic heart disease (IHD), atrial fibrillation and flutter (AFF), and myocardial infarction; whereas renal failure, hypertension, diabetes and chronic obstructive pulmonary disease (COPD) are the most common non-cardiac conditions for HF.
654
PATIENT FOLLOW-UP POST EMERGENCY VISIT FOR HEART FAILURE (HF): IS THERE GENDER BIAS IN REFERRAL TO SPECIALIZED CLINICS? D Feldman, L Pilote, J Des Lauriers, H Behlouli, M Frenette, C Michel, R Sheppard, N Gianetti, F Grondin, T Huynh, M Montigny, S Lepage Montréal, Québec BACKGROUND: Multidisciplinary HF Clinics are effective for managing this condition. On average, there are two to three times as many men than women in these clinics despite equal prevalence of HF. The objectives of our study were to: investigate whether men and women who had an emergency department (ED) visit for HF were subsequently referred to specialized HF clinics; describe when this referral occurred and explore factors that were related to prompt referral. CONCLUSION: More than a third of patients (38%) with HF were referred to HF clinics within 6 months following their ED visit. Younger male patients with lower comorbidity are more likely to be referred to clinics. Research has shown that these clinics benefit all HF patients. Standardized referral guidelines should be developed in order to ensure that these clinics are accessible to all patients who may require these services.
655
‘LIFETIME RISK’ OF HOSPITALIZATIONS AND INVASIVE CARDIAC PROCEDURES IN CHRONIC HEART FAILURE PATIENTS: DIFFERENCES BASED ON LEFT VENTRICULAR SYSTOLIC FUNCTION, ISCHEMIC DISEASE, AND SEX IN THE EFFECT REGISTRY S Chun, JV Tu, HC Wijeysundera, X Wang, DS Lee Toronto, Ontario BACKGROUND: Heart Failure (HF) is a common condition with significant morbidity and mortality implications. Despite its prevalence, population-based data on the “real world” burden of HF on the health care system during the lifetime of the HF patient are limited. We examined the events and procedures that occurred during the ‘lifetime’ of patients discharged after their first hospitalization for HF, and to compare patients with systolic (SHF) vs. diastolic HF (DHF), ischemic (IHF) vs. non-ischemic HF (NIHF) and by sex. CONCLUSION: Over the lifetime of HF patients, higher rates of HF and CV hospitalizations and use of invasive cardiac procedures were associated with SHF, IHF, and male sex. The presence of IHF was a significant predictor of HF hospitalization and greater use of invasive cardiac procedures, whereas SHF was not associated with these outcomes and events, confirming the utility of etiology-based classification of HF. Canadian Institutes of Health Research
653
COMORBIDITIES AND MORTALITY OF HEART FAILURE IN CANADA S Dai, P Walsh, A Wielgosz, H Morrison, C Bancej, P Stewart Ottawa, Ontario BACKGROUND: Heart failure (HF) is a leading cause of hospitalizations for elderly people today. HF is often accompanied by a range of comorbidities, increasing the health care burden. The Public Health Agency of Canada is developing new approaches to tracking heart disease and heart failure in Canada. The objective of the study is to identify comorbid
124D
Can J Cardiol Vol 26 Suppl D October 2010