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Establishing a predictive model for aspirin resistance in elderly Chinese patients with chronic coronary heart disease
Abstract
79 Establishing a predictive model for aspirin resistance in elderly Chinese patients with chronic coronary heart disease J. Cao ∗ , L. Gao, T. Chen, L. Fan Chinese PLA General Hospital, China Objective: Resistance to anti-platelet therapy is detrimental to patients. Our aim was to establish a predictive model for aspirin resistance to identify high-risk patients and to propose appropriate intervention. Methods: Elderly patients (n=1130) with stable chronic coronary heart disease who were taking aspirin (75 mg) for >2 months were included. Details of their basic characteristics, laboratory test results, and medication were collected. Logistic regression analysis was performed to establish a predictive model for aspirin resistance. Risk score was finally established according to the coefficient B and type of variables in logistic regression. The Hosmer-Lemeshow (HL) test and a receiver operating characteristic curve were performed to respectively test the calibration and discrimination of the model. Results: Seven risk factors were included in our risk score. They were serum creatinine (>110 mol/L: score of 1); fasting blood glucose (>7.0 mmol/L: score of 1); hyperlipidaemia (score of 1); number of diseased coronary arteries (2 branches: score of 2; ≥3 branches: score of 4); body mass index (20-25 kg/m2: score of 2; >25 kg/m2: score of 4); percutaneous coronary intervention (score of 2); and smoking (score of 3). HL test showed P≥0.05 and area under the receiver operating characteristic curve ≥0.70. Conclusion: We explored and quantified the risk factors for aspirin resistance. Our predictive model showed good calibration and discriminative power. So it would be a good foundation for the further study of patients undergoing antiplatelet therapy. http://dx.doi.org/10.1016/j.hlc.2015.06.080 80 Establishment of a Rapid Access Chest Pain Clinic at the Royal Hobart Hospital A. Elford ∗ , A. Black, J. Flood University of Tasmania, Australia Background: Patients referred for outpatient evaluation of new onset chest pain had long waiting times and inefficient follow-up. Rapid Access Chest Pain Clinic (RACPAC) was established in 2014 to address these issues. This is a single visit clinic with telephone follow-up. Aims: To evaluate the effect of RACPAC on clinic efficiency. Methods: RACPAC data was recorded prospectively (waiting times, time to completion of follow-up, investigations ordered and final diagnosis) from Sept-Dec 2014. For comparison, a retrospective chart review was undertaken for similar patients seen through the general clinic between Sept-Dec 2013. Results: RACPAC and general clinic contributed 199 and 141 patients respectively.
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Waiting times (mean 44.4±32.2 vs 11.2±5.5 days, p<0.0001), and time to completion of service (mean 85.1±75.9 vs 22.4±14.3 days, p<0.0001) were shorter through RACPAC. Frequency of additional follow-up appointments in 2013 was 39% (1 review), 10% (2 reviews), and 1% (3 reviews). No patients had additional RACPAC appointments, however 11% required follow-up in the general clinic (usually because a significant cardiac diagnosis was made). Angiography was ordered less frequently by RACPAC (5.5% vs 17.7%) but ordered more non-invasive assessments (72% vs 52%). Final cardiac diagnosis was identified in 23.1% in RACPAC vs 13.5% in the 2013 comparison group. Conclusion: RACPAC more efficiently handles chest pain patients, reduces waiting times and unnecessary review appointments. Unnecessary invasive testing was reduced at the expense of more frequent non-invasive assessment. Final cardiac diagnosis was made more frequently through RACPAC. http://dx.doi.org/10.1016/j.hlc.2015.06.081 81 Evaluation of cardiology rapid access clinics within a large NSW tertiary referral centre - pilot H. Klimis 1,2,∗ , A. Thiagalingam 1,2 , A. Bhaskaran 1 , P. Kovoor 1,2 , M. Vukasovic 1 , R. Zecchin 1 , R. Denniss 1,4 , C. Chow 1,2,3 1 Westmead
Hospital, Sydney, Australia of Sydney, Sydney, Australia 3 The George Institute for Global Health, Sydney, Australia 4 University of Western Sydney, Sydney, Australia 2 University
Background: Westmead Hospital is establishing Rapid Access Cardiology Clinics (RACC) as part of new integrated health services that aim to provide alternate management pathways for low-intermediate risk chest pain patients. Objectives: To describe RACC and examine performance indicators in the pilot phase. Methods: Referrer information (referrer type), clinic information (timing of appointment, attendance) and patient data (indication, risk profile, diagnosis) was collected for all patients referred to the RACC in the first 4 weeks of its introduction. Results: In total 87 patients were referred, 81% directly from ED and 18% from cardiology early discharge rounds. 9% did not attend clinic. Among patients seen to date, 16% were seen within 48 hours and 76% between 3-10 days. Patient availability and difficulties telephoning patients were the main reasons for exceeding 10 days. All high-risk patients were seen within 10 days. The average age was 52.4 years and 60% were male. 10% had a history of CHD, 8% were diagnosed with new CHD, 10% were high risk, 10% moderate and 62% low cardiovascular risk. In the month of the clinic there were 69 admissions under a cardiologist for chest pain, compared to an average of 101/month over the preceding 12 months. There were three representations, one for recurrent chest pain with normal coronary angiogram, one direct from clinic for
79 Establishing a predictive model for aspirin resistance in elderly Chinese patients with chronic coronary heart disease J. Cao ∗ , L. Gao, T. Chen, L. Fan Chinese PLA General Hospital, China Objective: Resistance to anti-platelet therapy is detrimental to patients. Our aim was to establish a predictive model for aspirin resistance to identify high-risk patients and to propose appropriate intervention. Methods: Elderly patients (n=1130) with stable chronic coronary heart disease who were taking aspirin (75 mg) for >2 months were included. Details of their basic characteristics, laboratory test results, and medication were collected. Logistic regression analysis was performed to establish a predictive model for aspirin resistance. Risk score was finally established according to the coefficient B and type of variables in logistic regression. The Hosmer-Lemeshow (HL) test and a receiver operating characteristic curve were performed to respectively test the calibration and discrimination of the model. Results: Seven risk factors were included in our risk score. They were serum creatinine (>110 mol/L: score of 1); fasting blood glucose (>7.0 mmol/L: score of 1); hyperlipidaemia (score of 1); number of diseased coronary arteries (2 branches: score of 2; ≥3 branches: score of 4); body mass index (20-25 kg/m2: score of 2; >25 kg/m2: score of 4); percutaneous coronary intervention (score of 2); and smoking (score of 3). HL test showed P≥0.05 and area under the receiver operating characteristic curve ≥0.70. Conclusion: We explored and quantified the risk factors for aspirin resistance. Our predictive model showed good calibration and discriminative power. So it would be a good foundation for the further study of patients undergoing antiplatelet therapy. http://dx.doi.org/10.1016/j.hlc.2015.06.080 80 Establishment of a Rapid Access Chest Pain Clinic at the Royal Hobart Hospital A. Elford ∗ , A. Black, J. Flood University of Tasmania, Australia Background: Patients referred for outpatient evaluation of new onset chest pain had long waiting times and inefficient follow-up. Rapid Access Chest Pain Clinic (RACPAC) was established in 2014 to address these issues. This is a single visit clinic with telephone follow-up. Aims: To evaluate the effect of RACPAC on clinic efficiency. Methods: RACPAC data was recorded prospectively (waiting times, time to completion of follow-up, investigations ordered and final diagnosis) from Sept-Dec 2014. For comparison, a retrospective chart review was undertaken for similar patients seen through the general clinic between Sept-Dec 2013. Results: RACPAC and general clinic contributed 199 and 141 patients respectively.
S147
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .
Waiting times (mean 44.4±32.2 vs 11.2±5.5 days, p<0.0001), and time to completion of service (mean 85.1±75.9 vs 22.4±14.3 days, p<0.0001) were shorter through RACPAC. Frequency of additional follow-up appointments in 2013 was 39% (1 review), 10% (2 reviews), and 1% (3 reviews). No patients had additional RACPAC appointments, however 11% required follow-up in the general clinic (usually because a significant cardiac diagnosis was made). Angiography was ordered less frequently by RACPAC (5.5% vs 17.7%) but ordered more non-invasive assessments (72% vs 52%). Final cardiac diagnosis was identified in 23.1% in RACPAC vs 13.5% in the 2013 comparison group. Conclusion: RACPAC more efficiently handles chest pain patients, reduces waiting times and unnecessary review appointments. Unnecessary invasive testing was reduced at the expense of more frequent non-invasive assessment. Final cardiac diagnosis was made more frequently through RACPAC. http://dx.doi.org/10.1016/j.hlc.2015.06.081 81 Evaluation of cardiology rapid access clinics within a large NSW tertiary referral centre - pilot H. Klimis 1,2,∗ , A. Thiagalingam 1,2 , A. Bhaskaran 1 , P. Kovoor 1,2 , M. Vukasovic 1 , R. Zecchin 1 , R. Denniss 1,4 , C. Chow 1,2,3 1 Westmead
Hospital, Sydney, Australia of Sydney, Sydney, Australia 3 The George Institute for Global Health, Sydney, Australia 4 University of Western Sydney, Sydney, Australia 2 University
Background: Westmead Hospital is establishing Rapid Access Cardiology Clinics (RACC) as part of new integrated health services that aim to provide alternate management pathways for low-intermediate risk chest pain patients. Objectives: To describe RACC and examine performance indicators in the pilot phase. Methods: Referrer information (referrer type), clinic information (timing of appointment, attendance) and patient data (indication, risk profile, diagnosis) was collected for all patients referred to the RACC in the first 4 weeks of its introduction. Results: In total 87 patients were referred, 81% directly from ED and 18% from cardiology early discharge rounds. 9% did not attend clinic. Among patients seen to date, 16% were seen within 48 hours and 76% between 3-10 days. Patient availability and difficulties telephoning patients were the main reasons for exceeding 10 days. All high-risk patients were seen within 10 days. The average age was 52.4 years and 60% were male. 10% had a history of CHD, 8% were diagnosed with new CHD, 10% were high risk, 10% moderate and 62% low cardiovascular risk. In the month of the clinic there were 69 admissions under a cardiologist for chest pain, compared to an average of 101/month over the preceding 12 months. There were three representations, one for recurrent chest pain with normal coronary angiogram, one direct from clinic for