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Improving Clinical Efficiency, Timeliness of Revascularisation and Cost Effectiveness Among Patients with New Onset Angina; The Royal Perth Hospital Experience
Abstracts
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107 Improving Clinical Efficiency, Timeliness of Revascularisation and Cost Effectiveness Among Patients with New Onset Angina; The Royal Perth Hospital Experience F. Lee 1,2,∗ , S. Kalathil 1 , C. Schultz 1 , G. Hillis 1 , R. Alcock 1 , J. Spiro 1 1 Department of Cardiology, Royal Perth Hospital, Perth, Australia 2 Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
Background: Managing patients with new onset chest pain continues to place a significant burden on healthcare services. Streamlined pathways, such as a Rapid Access Chest Pain Clinic (RACPC), may improve clinical efficiency, timeliness of revascularisation and provide cost-savings. Methods: We studied patients referred to Royal Perth Hospital, with new onset chest pain, 6-months before and 4-months after the introduction of a RACPC. Comparisons were made between groups; time from referral to (i) clinic assessment, (ii) investigation, (iii) revascularisation as well as unplanned ED presentations. Data expressed as mean (SD) if normally distributed or median (IQR) if skewed. Results: 159 patients (92 pre-RACPC, 67 RACPC) were studied. The cohorts were of similar age (58±13.5 vs 58±13.5, p=0.85). Compared to pre-RACPC, patients managed in RACPC had a higher incidence of high risk characteristics (diabetes, smoking, hypercholesterolaemia); 81% vs 64%, p<0.05. Among patients managed within the RACPC, time from referral to (i) clinic assessment (5 (3-6) vs 83 (53-111) days, p<0.001), (ii) investigation (14 (5-29) vs 107 (80-147) days, p<0.001) and (iii) revascularisation (12 (8-41) vs 76 (48-104) days, p<0.05) was significantly shorter compared to patients referred in the prior 6-months. Between the time of referral to time seen in clinic, 15 patients from the pre-RACPC group presented to ED compared to none managed within the RACPC. Prevention of unnecessary ED presentations translated to an estimated annual cost-saving of $41,790 (based on ABF costing). Conclusion: Introduction of the RACPC dramatically reduced delays in patients being seen, investigated and revascularised and offered significant cost-savings. http://dx.doi.org/10.1016/j.hlc.2016.06.108
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108 Incidence of Lipid Rich Plaque (LRP) by Near Infrared Spectroscopy (NIRS) in Near Normal Coronary Artery of Patients with Stable Presentation Versus Acute Coronary Syndrome S. Sidharta 1,∗ , T. Baillie 1 , N. Montarello 1 , N. Montarello 1 , J. Beltrame 2 , S. Worthley 1 , S. Nicholls 3 , M. Worthley 1 1 Cardiovascular
Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia 2 The Queen Elizabeth Hospital, Adelaide, Australia 3 South Australian Health and Medical Research Institute, Adelaide, Australia Background: Intravascular imaging studies, such as IVUS or OCT have demonstrated greater incidence of LRP in the culprit lesions of ACS compared to chronic stable angina. The prevalence and difference of LRP in non-culprit vessels in patients with stable compared to unstable coronary syndromes remains poorly defined and the focus of this analysis. Methods: NIRS imaging was performed on 47 patients (35 stable; 12 ACS) with <30% angiographic coronary stenosis. For each 2 mm coronary segments, greyscale plaque information and NIRS data, including lipid core burden index (LCBI) and block chemogram derived LRP (yellow: P > 0.98, tan: 0.84 ≤ P ≤ 0.98, orange: 0.57 ≤ P ≤ 0.84, red: P < 0.57) were collected. LRP positive segment was defined as tan or yellow on block chemogram. Percent atheroma volume (PAV) was the primary determinant of IVUS derived segmental plaque burden. Results: A total of 763 matched segments were available for analyses. There was no difference observed in the baseline demographics between stable and ACS cohorts. LCBI was positively correlated with PAV (r=0.3819, p<0.0001). Coronary segments in non culprit ACS group demonstrated greater PAV (median [IQR]: 35.52% (30.33-43.59) vs 29.24% (21.10-38.68, p<0.0001), LCBI (33 (0-169) vs 0 (0-60), p<0.0001), and LRP (28% vs 15%, p=0.0002) when compared with the stable group. PAV, LRP, and eccentricity index (EI) were significant predictors of ACS in the multivariate logistic regression analysis (PAV, p=0.0001; LRP, p=0.014; EI, p=0.033, LCBI, p=0.065). Conclusion: Our findings show that high risk plaques were more common in non-culprit vessels in patients presenting with ACS than in those with stable disease. Further studies are required to determine the impact of these segmental indices on specific risk of plaque progression and clinical events. http://dx.doi.org/10.1016/j.hlc.2016.06.109
S48
107 Improving Clinical Efficiency, Timeliness of Revascularisation and Cost Effectiveness Among Patients with New Onset Angina; The Royal Perth Hospital Experience F. Lee 1,2,∗ , S. Kalathil 1 , C. Schultz 1 , G. Hillis 1 , R. Alcock 1 , J. Spiro 1 1 Department of Cardiology, Royal Perth Hospital, Perth, Australia 2 Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
Background: Managing patients with new onset chest pain continues to place a significant burden on healthcare services. Streamlined pathways, such as a Rapid Access Chest Pain Clinic (RACPC), may improve clinical efficiency, timeliness of revascularisation and provide cost-savings. Methods: We studied patients referred to Royal Perth Hospital, with new onset chest pain, 6-months before and 4-months after the introduction of a RACPC. Comparisons were made between groups; time from referral to (i) clinic assessment, (ii) investigation, (iii) revascularisation as well as unplanned ED presentations. Data expressed as mean (SD) if normally distributed or median (IQR) if skewed. Results: 159 patients (92 pre-RACPC, 67 RACPC) were studied. The cohorts were of similar age (58±13.5 vs 58±13.5, p=0.85). Compared to pre-RACPC, patients managed in RACPC had a higher incidence of high risk characteristics (diabetes, smoking, hypercholesterolaemia); 81% vs 64%, p<0.05. Among patients managed within the RACPC, time from referral to (i) clinic assessment (5 (3-6) vs 83 (53-111) days, p<0.001), (ii) investigation (14 (5-29) vs 107 (80-147) days, p<0.001) and (iii) revascularisation (12 (8-41) vs 76 (48-104) days, p<0.05) was significantly shorter compared to patients referred in the prior 6-months. Between the time of referral to time seen in clinic, 15 patients from the pre-RACPC group presented to ED compared to none managed within the RACPC. Prevention of unnecessary ED presentations translated to an estimated annual cost-saving of $41,790 (based on ABF costing). Conclusion: Introduction of the RACPC dramatically reduced delays in patients being seen, investigated and revascularised and offered significant cost-savings. http://dx.doi.org/10.1016/j.hlc.2016.06.108
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108 Incidence of Lipid Rich Plaque (LRP) by Near Infrared Spectroscopy (NIRS) in Near Normal Coronary Artery of Patients with Stable Presentation Versus Acute Coronary Syndrome S. Sidharta 1,∗ , T. Baillie 1 , N. Montarello 1 , N. Montarello 1 , J. Beltrame 2 , S. Worthley 1 , S. Nicholls 3 , M. Worthley 1 1 Cardiovascular
Investigation Unit, Royal Adelaide Hospital, Adelaide, Australia 2 The Queen Elizabeth Hospital, Adelaide, Australia 3 South Australian Health and Medical Research Institute, Adelaide, Australia Background: Intravascular imaging studies, such as IVUS or OCT have demonstrated greater incidence of LRP in the culprit lesions of ACS compared to chronic stable angina. The prevalence and difference of LRP in non-culprit vessels in patients with stable compared to unstable coronary syndromes remains poorly defined and the focus of this analysis. Methods: NIRS imaging was performed on 47 patients (35 stable; 12 ACS) with <30% angiographic coronary stenosis. For each 2 mm coronary segments, greyscale plaque information and NIRS data, including lipid core burden index (LCBI) and block chemogram derived LRP (yellow: P > 0.98, tan: 0.84 ≤ P ≤ 0.98, orange: 0.57 ≤ P ≤ 0.84, red: P < 0.57) were collected. LRP positive segment was defined as tan or yellow on block chemogram. Percent atheroma volume (PAV) was the primary determinant of IVUS derived segmental plaque burden. Results: A total of 763 matched segments were available for analyses. There was no difference observed in the baseline demographics between stable and ACS cohorts. LCBI was positively correlated with PAV (r=0.3819, p<0.0001). Coronary segments in non culprit ACS group demonstrated greater PAV (median [IQR]: 35.52% (30.33-43.59) vs 29.24% (21.10-38.68, p<0.0001), LCBI (33 (0-169) vs 0 (0-60), p<0.0001), and LRP (28% vs 15%, p=0.0002) when compared with the stable group. PAV, LRP, and eccentricity index (EI) were significant predictors of ACS in the multivariate logistic regression analysis (PAV, p=0.0001; LRP, p=0.014; EI, p=0.033, LCBI, p=0.065). Conclusion: Our findings show that high risk plaques were more common in non-culprit vessels in patients presenting with ACS than in those with stable disease. Further studies are required to determine the impact of these segmental indices on specific risk of plaque progression and clinical events. http://dx.doi.org/10.1016/j.hlc.2016.06.109