- Email: [email protected]
CPR Discussion: How Good are We?
three and 100% of patients with a CRS of 4. Primary cardiac complications included decompensated heart failure, arrhythmia (supraventricular, second degree AV block) and severe pulmonary hypertension. Two patients underwent termination of pregnancy because of deterioration in valve function. In addition, two patients required inpatient valve replacement in the peripartum period. Conclusion: Women with rheumatic heart disease have a higher than normal risk of complications during pregnancy and the cardiac risk index provides a useful tool in risk stratifying patients. http://dx.doi.org/10.1016/j.hlc.2013.05.607 Social Aspects of Cardiovascular Disease 606 A Cross-sectional Study on Employment After Heart Transplantation in New Zealand C. Samaranayake ∗ , P. Ruygrok, H. Gibbs, C. Wasywich, A. Coverdale Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand Background: The aim of this study was to assess the current employment status in New Zealand heart transplant recipients. Methods: Demographic details, employment prior to and after transplantation were obtained for all patients, alive in July 2012, who underwent heart transplantation between June 2001 and June 2011. Results: Eighty-seven patients were included; median age 52 years (range 15–75) and 20.8% were female. At review 51 (58.6%) were in paid employment, 5.7% students, 13.8% retired and 11.5% homemakers or not working due to lifestyle choice. Two (2.3%) patients were too unwell to work. Seven (8.0%) patients were on an unemployment benefit. Of those working prior to surgery, 88.9% returned to work after a median of 8.5 months (range 2–52), and 70.6% remained employed at a median of 77 months (range 13–113) after transplantation. There was a moderate correlation between the time of stopping work prior to and return to work after transplantation (r = 0.50, p = 0.01). Most (84.1%) patients returned to the same type of work. There was no correlation between age at the time of transplant and return to work. A significant proportion of women were homemakers (31.6% vs 5.9% males, p < 0.01), and more females were in clerical and administrative occupations (21.1% vs 1.5% males, p < 0.01). Fewer Caucasian patients were unemployed compared to other ethnicities (p < 0.05). Conclusion: The rate of paid employment in patients who underwent heart transplantation was similar to the overall employment rate in New Zealand. The most important predictor of returning to work was employment status prior to transplantation. http://dx.doi.org/10.1016/j.hlc.2013.05.608
CSANZ 2013 Abstracts
S255
607 Coronary Angiography Access Via four French Femoral Versus six French Radial Routes: From the Patients’ Perspective R. Hilling-Smith 1,2,∗ , V. Turaga 2 , G. Toogood 2 1 MonashHeart, 2 Frankston
Australia Hospital, Australia
Background: There has been much research into different arterial access and the merits of each. Some clinical situations dictate one route but otherwise the decision is made on operator experience and local protocol. We examined the two routes from a patient perspective to ascertain their preference. Methods and Results: We performed telephone interview on 40 patients who had six French radial or four French femoral approach at a teaching hospital. Patients graded pain during procedure and anxiety out of 10. Four patients in the radial group converted to femoral. Patients who had radial access were younger, 57.9 vs 70.4 years, but otherwise well matched. There was no difference in pain experienced (3.1 vs 2.45, p = 0.36), anxiety (5.8 vs 5.0, p = 0.44) or hospital stay (0.9 vs 0.75 nights, p = 0.77). There was a trend towards quicker return to normal activity in the femoral group (3.25 vs 2.15 days, p = 0.11). Fluoroscopy times were longer in the radial group after correction, for PCI (297.4 vs 199.0 s p = 0.002). Two patients in the radial group sought medical attention for site related complaints (requiring antibiotics and analgesia) versus one (no treatment). Two further patients in the radial group had self-limiting neurological complaints. Seven patients in the radial group had a scar (one bothersome) versus one femoral scar. Conclusion: Six French radial approach was associated with longer fluoroscopy times, a trend towards longer return to normal activity and more site related complications. Four French femoral may be preferable from a patients’ satisfaction perspective if no clinical imperative. http://dx.doi.org/10.1016/j.hlc.2013.05.609 608 CPR Discussion: How Good are We? K. Khokhar 1,∗ , G. Porter 2 , A. Davies 2 1 Waikato
Hospital, Hamilton, New Zealand District Hospital, New Zealand
2 Tauranga
Background: Many patients admitted to the Tauranga Hospital acute medicine service are elderly with chronic end stage disease and death may be an expected outcome. The current default is “resuscitation for every one” with no mandate recommending discussion of CPR with the patient at the time of admission. Aims: Update our District Health Board, resuscitation guidelines we sought to audit prospectively the frequency and documentation of CPR discussions in patients
ABSTRACTS
Heart, Lung and Circulation 2013;22:S126–S266
S256
Heart, Lung and Circulation 2013;22:S126–S266
CSANZ 2013 Abstracts
ABSTRACTS
admitted to acute medicine service during one week in May 2012. Results: Cohort median age was 77 years. Fourteen (17%) patients were independent pre-admission. Only 20 (25%) of 80 acute admissions surveyed, had CPR discussions. Bar chart is showing admission diagnosis and CPR discussion status of the cohort.
Ca with Mets; metastatic cancer, CVD; cerebrovascular disease, GI; gastrointestinal tract Conclusion: We found hesitation to discuss CPR in clinical practise at Tauranga Hospital, leading to inconsistencies in provision of quality of care to patients. We suggest potential strategies including ongoing education for staff to encourage CPR discussions at the “front door”. CPR documentation of the cohort. http://dx.doi.org/10.1016/j.hlc.2013.05.610 609 Initial Presentation to a Non-tertiary Hospital Results in a Prolonged Pre-operative Hospital Stay and an Increased Risk of Nosocomial Infections in Patients Requiring Inpatient Transfer to a Tertiary Centre for Cardio-Thoracic Surgery: A Multi-centre Analysis in Metropolitan Melbourne S. Prabhu 1,3,∗ , M. Stokes 2,3 , A. Kras 1 , S. Arunothayaraj 2 , H. Yi 3 , L. Kong 3 , K. Peck 1 , J. Casan 1 , D. Blusztein 1 , D. Jackson 1 , G. Toogood 1,3 1 The
Alfred Hospital, Melbourne, Australia Vincent’s Hospital, Melbourne, Australia 3 Frankston Hospital, Peninsula Health, Melbourne, Australia 2 St
Background: An increasing number of patients requiring cardiac surgery are presenting to non-tertiary hospitals requiring inpatient transfer. Methods: Patients admitted to a non-tertiary centre (Frankston Hospital, Group 1), over 12-months (June 2011–July 2012) requiring transfer to tertiary centres for cardiac surgery, were analysed. Demographics, procedure, dates of admission, transfer and operation, were collected. Mortality and infection rates were obtained. Outcomes were compared to patients presenting initially directly to tertiary centres, namely the Alfred (Group 2) and St Vincent’s Hospitals (Group 3). Data were obtained from medical records and the National Cardiac Surgery Database.
Results: Eighty-seven patients in Group 1, 78 patients in Group 2 and 65 patients in Group 3 were identified. No significant demographic differences were identified. A higher proportion of the total admission time was spent waiting for an operation in Group 1 compared to Group 2 (52.8% vs 38.3%, p ≤ 0.001) and Group 3 (52.8% vs 26.3%, p ≤ 0.001). In Group 1 patients, 69.26% of
waiting time occurred in the peripheral hospital. A significantly higher proportion of patients in Group 1 suffered from hospital acquired infections compared to Group 2 (20.7% vs 5.1%, p = 0.04, OR = 4.8, 95% CI: 1.56–14.9) and Group 3 (20.7% vs 6%, p < 0.001, OR = 3.13, 95% CI = 1.09–8.94). Non-operative infections (predominately pneumonia) accounted for 80.1% of infections in Group 1. Conclusion: Initial presentation to a non-tertiary centre requiring inpatient cardio-thoracic surgery is associated with longer pre-operative waiting time and higher rates of hospital-acquired infections. A streamlined process facilitating transfer may improve outcomes and reduce treatment costs. http://dx.doi.org/10.1016/j.hlc.2013.05.611 610 National Heart Foundation of Australia Consensus Statement on Depression in Patients with Coronary Heart Disease: Recommendations for Screening, Referral and Treatment D. Colquhoun 1 , S. Bunker 2 , D. Clarke 3 , N. Glozier 4 , D. Hare 5,∗ , I. Hickie 4 , J. Tatoulis 6 , D. Thompson 7 , G. Tofler 8 , A. Wilson 6 , M. Branagan 6 1 University
of Queensland, Brisbane, QLD, Australia Melbourne, VIC, Australia 3 Monash University, Melbourne, VIC, Australia 4 Brain and Mind Research Institute, University of Sydney, NSW, Australia 5 University of Melbourne, Melbourne, VIC, Australia 6 National Heart Foundation of Australia, Melbourne, VIC, Australia 7 Cardiovascular Research Centre, Australian Catholic University, Melbourne, VIC, Australia 8 Royal North Shore Hospital, University of Sydney, NSW, Australia 2 Medibank,
Objective: To present the National Heart Foundation of Australia consensus statement on depression and
CSANZ 2013 Abstracts
S255
607 Coronary Angiography Access Via four French Femoral Versus six French Radial Routes: From the Patients’ Perspective R. Hilling-Smith 1,2,∗ , V. Turaga 2 , G. Toogood 2 1 MonashHeart, 2 Frankston
Australia Hospital, Australia
Background: There has been much research into different arterial access and the merits of each. Some clinical situations dictate one route but otherwise the decision is made on operator experience and local protocol. We examined the two routes from a patient perspective to ascertain their preference. Methods and Results: We performed telephone interview on 40 patients who had six French radial or four French femoral approach at a teaching hospital. Patients graded pain during procedure and anxiety out of 10. Four patients in the radial group converted to femoral. Patients who had radial access were younger, 57.9 vs 70.4 years, but otherwise well matched. There was no difference in pain experienced (3.1 vs 2.45, p = 0.36), anxiety (5.8 vs 5.0, p = 0.44) or hospital stay (0.9 vs 0.75 nights, p = 0.77). There was a trend towards quicker return to normal activity in the femoral group (3.25 vs 2.15 days, p = 0.11). Fluoroscopy times were longer in the radial group after correction, for PCI (297.4 vs 199.0 s p = 0.002). Two patients in the radial group sought medical attention for site related complaints (requiring antibiotics and analgesia) versus one (no treatment). Two further patients in the radial group had self-limiting neurological complaints. Seven patients in the radial group had a scar (one bothersome) versus one femoral scar. Conclusion: Six French radial approach was associated with longer fluoroscopy times, a trend towards longer return to normal activity and more site related complications. Four French femoral may be preferable from a patients’ satisfaction perspective if no clinical imperative. http://dx.doi.org/10.1016/j.hlc.2013.05.609 608 CPR Discussion: How Good are We? K. Khokhar 1,∗ , G. Porter 2 , A. Davies 2 1 Waikato
Hospital, Hamilton, New Zealand District Hospital, New Zealand
2 Tauranga
Background: Many patients admitted to the Tauranga Hospital acute medicine service are elderly with chronic end stage disease and death may be an expected outcome. The current default is “resuscitation for every one” with no mandate recommending discussion of CPR with the patient at the time of admission. Aims: Update our District Health Board, resuscitation guidelines we sought to audit prospectively the frequency and documentation of CPR discussions in patients
ABSTRACTS
Heart, Lung and Circulation 2013;22:S126–S266
S256
Heart, Lung and Circulation 2013;22:S126–S266
CSANZ 2013 Abstracts
ABSTRACTS
admitted to acute medicine service during one week in May 2012. Results: Cohort median age was 77 years. Fourteen (17%) patients were independent pre-admission. Only 20 (25%) of 80 acute admissions surveyed, had CPR discussions. Bar chart is showing admission diagnosis and CPR discussion status of the cohort.
Ca with Mets; metastatic cancer, CVD; cerebrovascular disease, GI; gastrointestinal tract Conclusion: We found hesitation to discuss CPR in clinical practise at Tauranga Hospital, leading to inconsistencies in provision of quality of care to patients. We suggest potential strategies including ongoing education for staff to encourage CPR discussions at the “front door”. CPR documentation of the cohort. http://dx.doi.org/10.1016/j.hlc.2013.05.610 609 Initial Presentation to a Non-tertiary Hospital Results in a Prolonged Pre-operative Hospital Stay and an Increased Risk of Nosocomial Infections in Patients Requiring Inpatient Transfer to a Tertiary Centre for Cardio-Thoracic Surgery: A Multi-centre Analysis in Metropolitan Melbourne S. Prabhu 1,3,∗ , M. Stokes 2,3 , A. Kras 1 , S. Arunothayaraj 2 , H. Yi 3 , L. Kong 3 , K. Peck 1 , J. Casan 1 , D. Blusztein 1 , D. Jackson 1 , G. Toogood 1,3 1 The
Alfred Hospital, Melbourne, Australia Vincent’s Hospital, Melbourne, Australia 3 Frankston Hospital, Peninsula Health, Melbourne, Australia 2 St
Background: An increasing number of patients requiring cardiac surgery are presenting to non-tertiary hospitals requiring inpatient transfer. Methods: Patients admitted to a non-tertiary centre (Frankston Hospital, Group 1), over 12-months (June 2011–July 2012) requiring transfer to tertiary centres for cardiac surgery, were analysed. Demographics, procedure, dates of admission, transfer and operation, were collected. Mortality and infection rates were obtained. Outcomes were compared to patients presenting initially directly to tertiary centres, namely the Alfred (Group 2) and St Vincent’s Hospitals (Group 3). Data were obtained from medical records and the National Cardiac Surgery Database.
Results: Eighty-seven patients in Group 1, 78 patients in Group 2 and 65 patients in Group 3 were identified. No significant demographic differences were identified. A higher proportion of the total admission time was spent waiting for an operation in Group 1 compared to Group 2 (52.8% vs 38.3%, p ≤ 0.001) and Group 3 (52.8% vs 26.3%, p ≤ 0.001). In Group 1 patients, 69.26% of
waiting time occurred in the peripheral hospital. A significantly higher proportion of patients in Group 1 suffered from hospital acquired infections compared to Group 2 (20.7% vs 5.1%, p = 0.04, OR = 4.8, 95% CI: 1.56–14.9) and Group 3 (20.7% vs 6%, p < 0.001, OR = 3.13, 95% CI = 1.09–8.94). Non-operative infections (predominately pneumonia) accounted for 80.1% of infections in Group 1. Conclusion: Initial presentation to a non-tertiary centre requiring inpatient cardio-thoracic surgery is associated with longer pre-operative waiting time and higher rates of hospital-acquired infections. A streamlined process facilitating transfer may improve outcomes and reduce treatment costs. http://dx.doi.org/10.1016/j.hlc.2013.05.611 610 National Heart Foundation of Australia Consensus Statement on Depression in Patients with Coronary Heart Disease: Recommendations for Screening, Referral and Treatment D. Colquhoun 1 , S. Bunker 2 , D. Clarke 3 , N. Glozier 4 , D. Hare 5,∗ , I. Hickie 4 , J. Tatoulis 6 , D. Thompson 7 , G. Tofler 8 , A. Wilson 6 , M. Branagan 6 1 University
of Queensland, Brisbane, QLD, Australia Melbourne, VIC, Australia 3 Monash University, Melbourne, VIC, Australia 4 Brain and Mind Research Institute, University of Sydney, NSW, Australia 5 University of Melbourne, Melbourne, VIC, Australia 6 National Heart Foundation of Australia, Melbourne, VIC, Australia 7 Cardiovascular Research Centre, Australian Catholic University, Melbourne, VIC, Australia 8 Royal North Shore Hospital, University of Sydney, NSW, Australia 2 Medibank,
Objective: To present the National Heart Foundation of Australia consensus statement on depression and