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Prevalence of Atrial Fibrillation in Maori and non-Maori Inpatients in the Waikato Region
521
Abstracts Abstracts
ABSTRACTS
Heart, Lung and Circulation 2012;21:480–526
Fig. 1.
Conclusion: Our data suggest increasing age is independently associated with elevated levels of hs-TnT. Elderly patients without myocardial infarction commonly have hs-TnT levels above the currently recommended upper limit of normal. It may therefore be necessary to define age specific upper limits of normal for hs-TnT. http://dx.doi.org/10.1016/j.hlc.2012.03.110 Implantable Cardioverter Defibrillator Registry in New Zealand—Initial Experience H.S. Millow 1 , M.R. Webber 1 , P.D. Harding 3 , S.C. Heald 1 , M.K. Stiles 1 1 Waikato
Larsen 2,∗ , S.A.
Hospital, Waikato DHB, Hamilton, New Zealand
2 Department of Surgery and Anaesthesia, University of Otago,
Wellington, New Zealand 3 Wellington Hospital, Capital & Coast DHB, Wellington, New
Zealand Background: Approximately 350 Implantable Cardioverter Defibrillators (ICD) are implanted in New Zealand (NZ) annually. The NZ ICD registry was established in August 2011. The purpose of the registry is to provide data on patient/implant characteristics and clinical outcomes for quality improvement. Method: Patient information collected between 1 August 2011 and 31 January 2012 at first implant or generator change was stored in a central database. Wellington and Waikato hospitals contributed over this period, with Waikato joining on 11 August.
Results: ICD implants (n = 74)
Age, 58 ± 14 years Female, n = 17 (23%) Primary prevention, n = 29 (39%) Heart failure, n = 35 (47%) Single chamber, n = 46 (62%) Dual chamber, n = 14 (19%) Biventricular, n = 12 (16%) Device testing, n = 33 (45%) 30-Day adverse outcomes, n = 6 (8%)
New (n = 48)
Replacement (n = 26)
P value
57 ± 14 21% 50% 56% 69% 13% 15% 50% 10%
62 ± 13 27% 19% 31% 50% 31% 19% 35% 4%
0.1 0.6 0.01 0.051 0.1 0.07 0.7 0.2 0.4
The proportion of heart failure patients and of primary prevention devices was higher in new implants reflecting a change in practice over time. Of replacements the device average lifespan was 6.5 years and 92% were due to battery depletion. Adverse events included three lead dislodgements, one haematoma requiring pressure dressing and two infections requiring antibiotics. Conclusion: This registry is a new tool to provide information regarding use of ICDs in NZ. Over time this will allow us to monitor changes in the way ICDs are used, to follow clinical outcomes and to compare NZ practice with international registries. http://dx.doi.org/10.1016/j.hlc.2012.03.111 Prevalence of Atrial Fibrillation in Maori and non-Maori Inpatients in the Waikato Region M.R. Webber, M. Mannakarra, J. Swampillai ∗ , I. Gray, M.K. Stiles Waikato Hospital, Waikato DHB, Hamilton, New Zealand Background: Atrial fibrillation (AF) precipitates or complicates hospital admission and carries significant morbidity and mortality. International data suggest there may be discrepancies in AF patient characteristics and prevalence between ethnic groups. We aim to describe the characteristics of inpatients with AF and identify disparities between Maori and non-Maori that may guide therapy.
522
Abstracts Abstracts
Heart, Lung and Circulation 2012;21:480–526
ABSTRACTS
Method: Data was collected from Waikato District Health Board clinical coding for hospital admissions between 1/1/2001 and 31/12/2010 coded “atrial fibrillation” as a primary or secondary diagnosis. Results: Of 24,684 admissions, 679 were excluded due to no ethnicity data. Maori comprised 19.7% of admissions; the expected proportion for the Waikato region is 21% (p < 0.001).
AT/AFL and three ICD/PM patients had last dose dabigatran 24 h pre-procedure and resumed post-procedural morning with no heparin. Fourteen patients underwent transseptal puncture (12 AF, 2 AT). One patient developed pericardial tamponade 1 h post-procedure that was drained without sequelae. Mean ± SD ON Dabigatran
Maori (n = 4722) n Age ≥65 years, 2261 n = 17,864 (44%) Female gender, 2133 n = 10,936 (46%) Median length of stay5 (0–881) (days), 5 (range 0–1030) 862 AF as primary diagnosis, 5870 (24%) 2663 Admissions in first 5 years, n = 13,135 (55%)
Non-Maori (n = 19,283)
p value
%
n
%
48
15,603
81
<0.001
45
8803
46
0.6
–
<0.001
–
0 (0–1030)
18
5008
26
<0.001
56
10,472
54
<0.001
Where AF was a secondary diagnosis the most common primary diagnoses were infection/inflammation (3125), congestive heart failure (2103), and myocardial infarction (2048). Conclusions: There are fewer admissions with AF for Maori than expected in the Waikato. Maori inpatients with AF are younger, stay longer and are more likely to have AF as a secondary rather than primary diagnosis when compared to non-Maori. http://dx.doi.org/10.1016/j.hlc.2012.03.112 Periprocedural Dabigatran in Patients Undergoing Electrophysiology Procedures M.R. Webber, I. Gray ∗ , M.K. Stiles Waikato Hospital, Waikato DHB, Hamilton, New Zealand Background: Dabigatran was approved for thromboprophylaxis in atrial fibrillation (AF) or flutter (AFL) in New Zealand in July 2011. We aim to describe the coagulation profile on and off dabigatran and the safety of periprocedural dabigatran in patients undertaking ablation for AF, atrial tachycardia (AT) or AFL, and implantation of pacemakers (PM) or implantable cardioverter defibrillators (ICD). Method: Twenty-seven consecutive patients between July and December 2011 taking dabigatran had thrombin clotting time (TCT), international normalised ratio (INR), and activated partial thromboplastin time (APTT) measured on dabigatran (150 or 110 mg twice daily) at trough level, and at procedure. AF patients had transoesophageal echo to exclude atrial thrombus and received heparin following transseptal puncture. Results: Fourteen patients had ablation for AF; 12 had last dose dabigatran 24 h pre-procedure, two withheld dabigatran >24 h (one moderate renal impairment; one patient error). Most resumed dabigatran the following morning after heparin-bridging at 1000 units/h. Nine
TCT (s) INR APTT (s) Fibrinogen (g/L)
54.5 1.1 37.9 3.0
± ± ± ±
23.4 0.1 9.7 0.5
p-value OFF Dabigatran 22.0 1.1 35.7 2.9
± ± ± ±
12.3 0.1 7.6 0.5
<0.001 0.8 0.2 0.6
Conclusion: Dabigatran significantly alters TCT but not INR, APTT or fibrinogen. TCT normalises promptly and preliminary data suggest electrophysiology procedures may be safely undertaken with peri-procedural dabigatran ceased at least 24 h prior. http://dx.doi.org/10.1016/j.hlc.2012.03.113 Significant Bias Associated with Left Ventricular Volume Measurements by MRI Compared to Echo (2D, 2D-Contrast and 3D)—A Systematic Review S. Anandabaskaran 1,2,3,∗ , J. Christiansen 2 , R. Doughty 3 , R. Gabriel 4 , G. Whalley 1,5 1 Awhina
Health Campus, New Zealand District Health Board, New Zealand 3 University of Auckland, New Zealand 4 Counties Manukau District Health Board, New Zealand 5 Unitec Institute of Technology, Auckland, New Zealand 2 Waitemata
Background and aims: Accurate quantification of left ventricular (LV) volumes and function has significant clinical importance. Although, two-dimensional echocardiography (2DE) remains the most commonly used method of cardiac imaging, contrast-enhanced 2DE (CE2DE) and three-dimensional echocardiography (3DE) have been gaining popularity. MRI remains the gold standard for LV measurements but may render different volumes compared to echocardiography. We performed a systematic review comparing the accuracy of 2DE, CE-2DE and 3DE LV volumes and LV ejection fraction (LVEF) with those of MRI. Methods: We searched Medline for studies published before 2012 with measurements from both echocardiography and MRI (using SSFP cine imaging). We compared end-diastolic volume (LVEDV), end-systolic volume (LVESV) and LVEF. 58 studies involving 2671 patients were included. Results: Mean difference from MRI values
LVEDV (mL) [95% CI]
LVESV (mL) [95% CI]
LVEF (%) [95% CI]
2DE CE-2DE 3DE
−36.07 [−39.59, −32.55] −23.09 [−32.34, −13.84] −17.51 [−21.89, −13.13]
−17.33 [−19.98, −14.69] −10.02 [−18.23, −1.81] −7.24 [−10.50, −3.98]
−1.28 [−2.17, −0.40] −2.01 [−4.20, 0.18] −0.44 [−1.47, 0.58]
Conclusions: This study demonstrates significant differences in LV volumes and LVEF between 2DE and MRI. Although the absolute bias is improved with the use of contrast and further with 3DE, significant differences
Abstracts Abstracts
ABSTRACTS
Heart, Lung and Circulation 2012;21:480–526
Fig. 1.
Conclusion: Our data suggest increasing age is independently associated with elevated levels of hs-TnT. Elderly patients without myocardial infarction commonly have hs-TnT levels above the currently recommended upper limit of normal. It may therefore be necessary to define age specific upper limits of normal for hs-TnT. http://dx.doi.org/10.1016/j.hlc.2012.03.110 Implantable Cardioverter Defibrillator Registry in New Zealand—Initial Experience H.S. Millow 1 , M.R. Webber 1 , P.D. Harding 3 , S.C. Heald 1 , M.K. Stiles 1 1 Waikato
Larsen 2,∗ , S.A.
Hospital, Waikato DHB, Hamilton, New Zealand
2 Department of Surgery and Anaesthesia, University of Otago,
Wellington, New Zealand 3 Wellington Hospital, Capital & Coast DHB, Wellington, New
Zealand Background: Approximately 350 Implantable Cardioverter Defibrillators (ICD) are implanted in New Zealand (NZ) annually. The NZ ICD registry was established in August 2011. The purpose of the registry is to provide data on patient/implant characteristics and clinical outcomes for quality improvement. Method: Patient information collected between 1 August 2011 and 31 January 2012 at first implant or generator change was stored in a central database. Wellington and Waikato hospitals contributed over this period, with Waikato joining on 11 August.
Results: ICD implants (n = 74)
Age, 58 ± 14 years Female, n = 17 (23%) Primary prevention, n = 29 (39%) Heart failure, n = 35 (47%) Single chamber, n = 46 (62%) Dual chamber, n = 14 (19%) Biventricular, n = 12 (16%) Device testing, n = 33 (45%) 30-Day adverse outcomes, n = 6 (8%)
New (n = 48)
Replacement (n = 26)
P value
57 ± 14 21% 50% 56% 69% 13% 15% 50% 10%
62 ± 13 27% 19% 31% 50% 31% 19% 35% 4%
0.1 0.6 0.01 0.051 0.1 0.07 0.7 0.2 0.4
The proportion of heart failure patients and of primary prevention devices was higher in new implants reflecting a change in practice over time. Of replacements the device average lifespan was 6.5 years and 92% were due to battery depletion. Adverse events included three lead dislodgements, one haematoma requiring pressure dressing and two infections requiring antibiotics. Conclusion: This registry is a new tool to provide information regarding use of ICDs in NZ. Over time this will allow us to monitor changes in the way ICDs are used, to follow clinical outcomes and to compare NZ practice with international registries. http://dx.doi.org/10.1016/j.hlc.2012.03.111 Prevalence of Atrial Fibrillation in Maori and non-Maori Inpatients in the Waikato Region M.R. Webber, M. Mannakarra, J. Swampillai ∗ , I. Gray, M.K. Stiles Waikato Hospital, Waikato DHB, Hamilton, New Zealand Background: Atrial fibrillation (AF) precipitates or complicates hospital admission and carries significant morbidity and mortality. International data suggest there may be discrepancies in AF patient characteristics and prevalence between ethnic groups. We aim to describe the characteristics of inpatients with AF and identify disparities between Maori and non-Maori that may guide therapy.
522
Abstracts Abstracts
Heart, Lung and Circulation 2012;21:480–526
ABSTRACTS
Method: Data was collected from Waikato District Health Board clinical coding for hospital admissions between 1/1/2001 and 31/12/2010 coded “atrial fibrillation” as a primary or secondary diagnosis. Results: Of 24,684 admissions, 679 were excluded due to no ethnicity data. Maori comprised 19.7% of admissions; the expected proportion for the Waikato region is 21% (p < 0.001).
AT/AFL and three ICD/PM patients had last dose dabigatran 24 h pre-procedure and resumed post-procedural morning with no heparin. Fourteen patients underwent transseptal puncture (12 AF, 2 AT). One patient developed pericardial tamponade 1 h post-procedure that was drained without sequelae. Mean ± SD ON Dabigatran
Maori (n = 4722) n Age ≥65 years, 2261 n = 17,864 (44%) Female gender, 2133 n = 10,936 (46%) Median length of stay5 (0–881) (days), 5 (range 0–1030) 862 AF as primary diagnosis, 5870 (24%) 2663 Admissions in first 5 years, n = 13,135 (55%)
Non-Maori (n = 19,283)
p value
%
n
%
48
15,603
81
<0.001
45
8803
46
0.6
–
<0.001
–
0 (0–1030)
18
5008
26
<0.001
56
10,472
54
<0.001
Where AF was a secondary diagnosis the most common primary diagnoses were infection/inflammation (3125), congestive heart failure (2103), and myocardial infarction (2048). Conclusions: There are fewer admissions with AF for Maori than expected in the Waikato. Maori inpatients with AF are younger, stay longer and are more likely to have AF as a secondary rather than primary diagnosis when compared to non-Maori. http://dx.doi.org/10.1016/j.hlc.2012.03.112 Periprocedural Dabigatran in Patients Undergoing Electrophysiology Procedures M.R. Webber, I. Gray ∗ , M.K. Stiles Waikato Hospital, Waikato DHB, Hamilton, New Zealand Background: Dabigatran was approved for thromboprophylaxis in atrial fibrillation (AF) or flutter (AFL) in New Zealand in July 2011. We aim to describe the coagulation profile on and off dabigatran and the safety of periprocedural dabigatran in patients undertaking ablation for AF, atrial tachycardia (AT) or AFL, and implantation of pacemakers (PM) or implantable cardioverter defibrillators (ICD). Method: Twenty-seven consecutive patients between July and December 2011 taking dabigatran had thrombin clotting time (TCT), international normalised ratio (INR), and activated partial thromboplastin time (APTT) measured on dabigatran (150 or 110 mg twice daily) at trough level, and at procedure. AF patients had transoesophageal echo to exclude atrial thrombus and received heparin following transseptal puncture. Results: Fourteen patients had ablation for AF; 12 had last dose dabigatran 24 h pre-procedure, two withheld dabigatran >24 h (one moderate renal impairment; one patient error). Most resumed dabigatran the following morning after heparin-bridging at 1000 units/h. Nine
TCT (s) INR APTT (s) Fibrinogen (g/L)
54.5 1.1 37.9 3.0
± ± ± ±
23.4 0.1 9.7 0.5
p-value OFF Dabigatran 22.0 1.1 35.7 2.9
± ± ± ±
12.3 0.1 7.6 0.5
<0.001 0.8 0.2 0.6
Conclusion: Dabigatran significantly alters TCT but not INR, APTT or fibrinogen. TCT normalises promptly and preliminary data suggest electrophysiology procedures may be safely undertaken with peri-procedural dabigatran ceased at least 24 h prior. http://dx.doi.org/10.1016/j.hlc.2012.03.113 Significant Bias Associated with Left Ventricular Volume Measurements by MRI Compared to Echo (2D, 2D-Contrast and 3D)—A Systematic Review S. Anandabaskaran 1,2,3,∗ , J. Christiansen 2 , R. Doughty 3 , R. Gabriel 4 , G. Whalley 1,5 1 Awhina
Health Campus, New Zealand District Health Board, New Zealand 3 University of Auckland, New Zealand 4 Counties Manukau District Health Board, New Zealand 5 Unitec Institute of Technology, Auckland, New Zealand 2 Waitemata
Background and aims: Accurate quantification of left ventricular (LV) volumes and function has significant clinical importance. Although, two-dimensional echocardiography (2DE) remains the most commonly used method of cardiac imaging, contrast-enhanced 2DE (CE2DE) and three-dimensional echocardiography (3DE) have been gaining popularity. MRI remains the gold standard for LV measurements but may render different volumes compared to echocardiography. We performed a systematic review comparing the accuracy of 2DE, CE-2DE and 3DE LV volumes and LV ejection fraction (LVEF) with those of MRI. Methods: We searched Medline for studies published before 2012 with measurements from both echocardiography and MRI (using SSFP cine imaging). We compared end-diastolic volume (LVEDV), end-systolic volume (LVESV) and LVEF. 58 studies involving 2671 patients were included. Results: Mean difference from MRI values
LVEDV (mL) [95% CI]
LVESV (mL) [95% CI]
LVEF (%) [95% CI]
2DE CE-2DE 3DE
−36.07 [−39.59, −32.55] −23.09 [−32.34, −13.84] −17.51 [−21.89, −13.13]
−17.33 [−19.98, −14.69] −10.02 [−18.23, −1.81] −7.24 [−10.50, −3.98]
−1.28 [−2.17, −0.40] −2.01 [−4.20, 0.18] −0.44 [−1.47, 0.58]
Conclusions: This study demonstrates significant differences in LV volumes and LVEF between 2DE and MRI. Although the absolute bias is improved with the use of contrast and further with 3DE, significant differences