- Email: [email protected]
PT153 Management of ACS in Hospital with limited resources. A single non PCI capable District General Hospital experience
POSTER ABSTRACTS
PT153
PT155
Management of ACS in Hospital with limited resources. A single non PCI capable District General Hospital experience
The National Heart Foundation of Australia Consensus Statement on Psychosocial Risk Factors for Coronary Heart Disease
Ahmed Hailan1, Zia Ul-Haq*1, Aled Jones1, Stephen Hutchison1 1 Cardiology, Nevill Hall Hospital, Abergavenny, United Kingdom
Nick Glozier1, Geoffrey H. Tofler2, David M. Colquhoun3, Stephen J. Bunker4, David M. Clarke5, David L. Hare6, Ian B. Hickie1, James Tatoulis7, David R. Thompson*8, Maree Branagan9, The National Heart Foundation of Australia Psychosocial Risk Factors and Coronary Heart Disease expert committee 1 Brain and Mind Research Institute, University of Sydney, 2Royal North Shore Hospital, University of Sydney, Sydney, 3University of Queensland, Brisbane, 4Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, Warrnambool, Vic, 5Monash University, 6University of Melbourne, 7National Heart Foundation of Australia, 8Cardiovascular Research Centre, Australian Catholic University, 9Clinical Programs, The National Heart Foundation of Australia, Melbourne, Australia
Introduction: ACS requires emergency treatment in hospital. The type of treatment depends on many factors, including pt history, investigations and hospital resources Objectives: We studied diagnoses and outcomes of pts presenting with chest pain at Nevill Hall Hospital a non PCI capable centre in Wales in order to gain a better insight into the patient with chest pain’s route through the health service in South Wales. Methods: We instituted a policy of undertaking early triaging cardiac sounding CP Patients presented at NHH ED to Cardiology ward. The record of 198 pts admitted between JuneAugust 2012 were studied retrospectively and post discharge data was obtained through the cardiac rehabilitation service, patient Demographics, troponins & Grace Scores(all positive trop pts) were checked. We analysed 1 & 6 months mortality, and treatment on discharge including revascularisation therapy. Results: 198 pts mean age 67, 58%male with chest pain were included. 27 (14%) diagnosed with STEMI, 30 (15%) NSTEMI, 13(7%) Angina,128(65%) non cardiac chest pain. Of the STEMI group 9 patients (33%) were admitted directly to tertiary centre for PPCI and 18(66%) admitted to NHH where 22% were transferred for PPCI from ED, 33% received thrombolytic therapy followed by referral for early revascularization (83% PCI & 17% CABG), 2(11%) had late presentation and the rest 33% octogenarians treated medically.The 30 (15%) NSTEMI, 12(40%) underwent inpatient PCI, 2(7%) CABG and 15(50%) treated medically & revascularization strategy reserved for those with persisting anginal symptoms or positive ischemia. The overall 1 & 6 month mortality in our study group was 2% & 1% respectively, 83% of one month mortality was octogenarians and medically treated. 1 & 6 month mortality in STEMI pts 7%, 4%, NSTEMI 7% & 0% & 0.8%, 0% in non cardiac chest pain (Only 1 died of pneumonia). It is noteworthy that Trop levels were statistically higher for STEMI than NSTEMI (p¼0.25). In addition Pts who died following an MI during the 1-6month period had higher GRACE % scores than those who didn’t (22 vs. 13 for NSTEMI and 80 vs. 23 for STEMI). Conclusion: This study shows that a strategy of early triaging to Cardiology Ward following good history taking, risk stratifications of patients presenting with chest pains can lead to high rate of success and safe treatment in hospital with limited resources and non PCI capable centre. Age, high Troponin, and high Grace Score remain a strong predictive of mortality in patients presenting with chest pains. Disclosure of Interest: None Declared
Introduction: New evidence has emerged regarding psychosocial risk factors for coronary heart disease (CHD). Objectives: To present a National Heart Foundation of Australia (NHFA) review of current evidence around psychosocial risk factors and CHD to guide health professionals [1]. Methods: An expert working group performed literature searches with key search phrases including “cardiovascular diseases”, “myocardial infarction”, “angina “work conditions”, “long working hours”, “social isolation”, ”triggers”, “emotion”, “stress”, “takotsubo”, “anger”, “anxiety”, “life events”, and “bereavement”. Psychosocial stressors included acute individual stressors, acute population stressors, and chronic stressors (in particular work stress). Depression is discussed in a separate paper. The Cardiac Society of Australia and New Zealand and Royal Australian and New Zealand College of Psychiatrists have endorsed the content. Results: An acute emotional stress may trigger myocardial infarction (MI) and Takotsubo (“stress”) cardiomyopathy, although the absolute increase in transient risk due to an individual stressor is low. - Perceived chronic job stress and shift work have been associated with a small increased risk of developing CHD. Although notable, this effect is far weaker than that from standard CHD risk factors such as smoking, hypertension, abnormal lipid levels and depression. - Social isolation after MI is associated with an adverse prognosis. Although measures to reduce isolation are likely to produce positive psychological effects, it is unclear whether this would also improve CHD outcomes. - The Heart Foundation evaluates adoption of clinical guidance, and data will be presented around this.
Evidence statement [1]
PT154 Comparison Between In Hospital Outcomes Of Patients Admitted For Acute Coronary Syndromes With Diabetes Mellitus & Without Diabetes Mellitus 1,2
3
Biplob Bhattacharjee* , Sandipan Das , Probir Das Cardiology, Chevron, 2Cardiology, Chittagong Medical College, 3Cardiology, Cmch, Chittagong, Bangladesh Introduction: Acute coronary syndromes are a major cause of morbidity & mortality in the western world & also in Bangladesh. Diabetes mellitus is also a devastating health problem in our country. Several prior studies have shown that patients with diabetes have same fatal complications as acute coronary syndrome. Objectives: To compare thein hospital outcomes of acute coronary syndrome, in patients with Diabetes Mellitus & without Diabetes Mellitus. Methods: this prospective observational study was conducted in Chittagong Medical college hospital during July 2009 – June 2010. The sample size was 200, selected by convenient type of non probability sampling method among the admitted patient in coronary care unit of Chittagong Medical College Hospital. Hypothesis was established as patients with acute coronary syndrome who suffer from diabetes mellitus are at higher risk of in hospital mortality and other adverse outcomes than non diabetic CAD patients. Results: Total 200 patients, among which 100 patients were diabetic and 100 patients were non diabeti were enrlled. Risk score was done by Grace Risk Score. 28% of diabetic & 43% of non diabetic patients were in low risk group. 40% of diabetic & 32% of non diabetic were in intermediate risk group. 32% of diabetic & 25% of non diabetic patients were in high risk group. Cardiogenic shock developed in 10% of diabetic group & 4% of non diabetic group. Heart failure & arrhythmia were higher in diabetic CAD patients compared to that of nondiabetic group, (16% vs 9%), (20% vs 12%). (p¼0.027 vs p¼o.123 respectively.) Recurrent angina occurred in 6% of diabetic & none of the non diabetics. 4% of diabetic group & 0% patients in non diabetic group died during hospital stay ( p¼0.048). Cardiogenic shock developed in 18.7% of high GRACE risk score group & 10% of intermediate risk score group. Heart failure developed in 0% of patients of low risk groups. 05% patients of intermediate risk groups & 34.4% of high risk groups. Death also occurred in 9.4% of patients of only high risk group. Conclusion: This study showed diabetic patients with acute coronary syndrome were mostly in intermediate and high risk category. This encountered in hospital mortality and other adverse outcomes at a greater extent than those of non diabetic patients. Disclosure of Interest: None Declared
e196
B
2. MI can be precipitated by negative emotional states
B
3. CHD events can be precipitated by bereavement
B
Recommendation [1]
Grade of evidence
1. Wider public access to defibrillators should be available where large groups of people gather, such as sporting venues, airports, and as part of the response to disasters.
B
2
1
Grade of evidence
1. Social isolation increases the risk of a poor CHD prognosis
Conclusion: Psychosocial stressors have an impact on CHD however clinical significance requires further study. Awareness of the potential for cardiovascular risk associated with certain psychosocial risk factors may assist health professionals caring for CHD patients. [1] Nick Glozier, et al. Med J Aust 2013; 199 (3): 179-180 Disclosure of Interest: None Declared PT156 National Heart Foundation of Australia Review of Evidence Around Depression In Patients With Coronary Heart Disease David M. Colquhoun1, Stephen J. Bunker2, David M. Clarke3, Nick Glozier4, David L. Hare5, Ian B. Hickie4, James Tatoulis6, David R. Thompson*7, Geoffrey H. Tofler8, Maree G. Branagan9, National Heart Foundation Psychosocial Risk Factors and CHD expert committee 1 University of Queensland, Brisbane, 2Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, Warrnambool, Vic, 3Monash University, Melbourne, 4Brain and Mind Research Institute, University of Sydney, Sydney, 5University of Melbourne, 6National Heart Foundation of Australia, 7Cardiovascular Research Centre, Australian Catholic University, Melbourne, 8Royal North Shore Hospital, University of Sydney, Sydney, 9Clinical Programs, The National Heart Foundation of Australia, Melbourne, Australia Introduction: Depression is an important independent risk factor for first and recurrent coronary heart disease (CHD) events. The prevalence of depression is higher in patients with CHD than in the general population. Objectives: To review current evidence around depression in CHD patients to guide health professionals.
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
PT153
PT155
Management of ACS in Hospital with limited resources. A single non PCI capable District General Hospital experience
The National Heart Foundation of Australia Consensus Statement on Psychosocial Risk Factors for Coronary Heart Disease
Ahmed Hailan1, Zia Ul-Haq*1, Aled Jones1, Stephen Hutchison1 1 Cardiology, Nevill Hall Hospital, Abergavenny, United Kingdom
Nick Glozier1, Geoffrey H. Tofler2, David M. Colquhoun3, Stephen J. Bunker4, David M. Clarke5, David L. Hare6, Ian B. Hickie1, James Tatoulis7, David R. Thompson*8, Maree Branagan9, The National Heart Foundation of Australia Psychosocial Risk Factors and Coronary Heart Disease expert committee 1 Brain and Mind Research Institute, University of Sydney, 2Royal North Shore Hospital, University of Sydney, Sydney, 3University of Queensland, Brisbane, 4Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, Warrnambool, Vic, 5Monash University, 6University of Melbourne, 7National Heart Foundation of Australia, 8Cardiovascular Research Centre, Australian Catholic University, 9Clinical Programs, The National Heart Foundation of Australia, Melbourne, Australia
Introduction: ACS requires emergency treatment in hospital. The type of treatment depends on many factors, including pt history, investigations and hospital resources Objectives: We studied diagnoses and outcomes of pts presenting with chest pain at Nevill Hall Hospital a non PCI capable centre in Wales in order to gain a better insight into the patient with chest pain’s route through the health service in South Wales. Methods: We instituted a policy of undertaking early triaging cardiac sounding CP Patients presented at NHH ED to Cardiology ward. The record of 198 pts admitted between JuneAugust 2012 were studied retrospectively and post discharge data was obtained through the cardiac rehabilitation service, patient Demographics, troponins & Grace Scores(all positive trop pts) were checked. We analysed 1 & 6 months mortality, and treatment on discharge including revascularisation therapy. Results: 198 pts mean age 67, 58%male with chest pain were included. 27 (14%) diagnosed with STEMI, 30 (15%) NSTEMI, 13(7%) Angina,128(65%) non cardiac chest pain. Of the STEMI group 9 patients (33%) were admitted directly to tertiary centre for PPCI and 18(66%) admitted to NHH where 22% were transferred for PPCI from ED, 33% received thrombolytic therapy followed by referral for early revascularization (83% PCI & 17% CABG), 2(11%) had late presentation and the rest 33% octogenarians treated medically.The 30 (15%) NSTEMI, 12(40%) underwent inpatient PCI, 2(7%) CABG and 15(50%) treated medically & revascularization strategy reserved for those with persisting anginal symptoms or positive ischemia. The overall 1 & 6 month mortality in our study group was 2% & 1% respectively, 83% of one month mortality was octogenarians and medically treated. 1 & 6 month mortality in STEMI pts 7%, 4%, NSTEMI 7% & 0% & 0.8%, 0% in non cardiac chest pain (Only 1 died of pneumonia). It is noteworthy that Trop levels were statistically higher for STEMI than NSTEMI (p¼0.25). In addition Pts who died following an MI during the 1-6month period had higher GRACE % scores than those who didn’t (22 vs. 13 for NSTEMI and 80 vs. 23 for STEMI). Conclusion: This study shows that a strategy of early triaging to Cardiology Ward following good history taking, risk stratifications of patients presenting with chest pains can lead to high rate of success and safe treatment in hospital with limited resources and non PCI capable centre. Age, high Troponin, and high Grace Score remain a strong predictive of mortality in patients presenting with chest pains. Disclosure of Interest: None Declared
Introduction: New evidence has emerged regarding psychosocial risk factors for coronary heart disease (CHD). Objectives: To present a National Heart Foundation of Australia (NHFA) review of current evidence around psychosocial risk factors and CHD to guide health professionals [1]. Methods: An expert working group performed literature searches with key search phrases including “cardiovascular diseases”, “myocardial infarction”, “angina “work conditions”, “long working hours”, “social isolation”, ”triggers”, “emotion”, “stress”, “takotsubo”, “anger”, “anxiety”, “life events”, and “bereavement”. Psychosocial stressors included acute individual stressors, acute population stressors, and chronic stressors (in particular work stress). Depression is discussed in a separate paper. The Cardiac Society of Australia and New Zealand and Royal Australian and New Zealand College of Psychiatrists have endorsed the content. Results: An acute emotional stress may trigger myocardial infarction (MI) and Takotsubo (“stress”) cardiomyopathy, although the absolute increase in transient risk due to an individual stressor is low. - Perceived chronic job stress and shift work have been associated with a small increased risk of developing CHD. Although notable, this effect is far weaker than that from standard CHD risk factors such as smoking, hypertension, abnormal lipid levels and depression. - Social isolation after MI is associated with an adverse prognosis. Although measures to reduce isolation are likely to produce positive psychological effects, it is unclear whether this would also improve CHD outcomes. - The Heart Foundation evaluates adoption of clinical guidance, and data will be presented around this.
Evidence statement [1]
PT154 Comparison Between In Hospital Outcomes Of Patients Admitted For Acute Coronary Syndromes With Diabetes Mellitus & Without Diabetes Mellitus 1,2
3
Biplob Bhattacharjee* , Sandipan Das , Probir Das Cardiology, Chevron, 2Cardiology, Chittagong Medical College, 3Cardiology, Cmch, Chittagong, Bangladesh Introduction: Acute coronary syndromes are a major cause of morbidity & mortality in the western world & also in Bangladesh. Diabetes mellitus is also a devastating health problem in our country. Several prior studies have shown that patients with diabetes have same fatal complications as acute coronary syndrome. Objectives: To compare thein hospital outcomes of acute coronary syndrome, in patients with Diabetes Mellitus & without Diabetes Mellitus. Methods: this prospective observational study was conducted in Chittagong Medical college hospital during July 2009 – June 2010. The sample size was 200, selected by convenient type of non probability sampling method among the admitted patient in coronary care unit of Chittagong Medical College Hospital. Hypothesis was established as patients with acute coronary syndrome who suffer from diabetes mellitus are at higher risk of in hospital mortality and other adverse outcomes than non diabetic CAD patients. Results: Total 200 patients, among which 100 patients were diabetic and 100 patients were non diabeti were enrlled. Risk score was done by Grace Risk Score. 28% of diabetic & 43% of non diabetic patients were in low risk group. 40% of diabetic & 32% of non diabetic were in intermediate risk group. 32% of diabetic & 25% of non diabetic patients were in high risk group. Cardiogenic shock developed in 10% of diabetic group & 4% of non diabetic group. Heart failure & arrhythmia were higher in diabetic CAD patients compared to that of nondiabetic group, (16% vs 9%), (20% vs 12%). (p¼0.027 vs p¼o.123 respectively.) Recurrent angina occurred in 6% of diabetic & none of the non diabetics. 4% of diabetic group & 0% patients in non diabetic group died during hospital stay ( p¼0.048). Cardiogenic shock developed in 18.7% of high GRACE risk score group & 10% of intermediate risk score group. Heart failure developed in 0% of patients of low risk groups. 05% patients of intermediate risk groups & 34.4% of high risk groups. Death also occurred in 9.4% of patients of only high risk group. Conclusion: This study showed diabetic patients with acute coronary syndrome were mostly in intermediate and high risk category. This encountered in hospital mortality and other adverse outcomes at a greater extent than those of non diabetic patients. Disclosure of Interest: None Declared
e196
B
2. MI can be precipitated by negative emotional states
B
3. CHD events can be precipitated by bereavement
B
Recommendation [1]
Grade of evidence
1. Wider public access to defibrillators should be available where large groups of people gather, such as sporting venues, airports, and as part of the response to disasters.
B
2
1
Grade of evidence
1. Social isolation increases the risk of a poor CHD prognosis
Conclusion: Psychosocial stressors have an impact on CHD however clinical significance requires further study. Awareness of the potential for cardiovascular risk associated with certain psychosocial risk factors may assist health professionals caring for CHD patients. [1] Nick Glozier, et al. Med J Aust 2013; 199 (3): 179-180 Disclosure of Interest: None Declared PT156 National Heart Foundation of Australia Review of Evidence Around Depression In Patients With Coronary Heart Disease David M. Colquhoun1, Stephen J. Bunker2, David M. Clarke3, Nick Glozier4, David L. Hare5, Ian B. Hickie4, James Tatoulis6, David R. Thompson*7, Geoffrey H. Tofler8, Maree G. Branagan9, National Heart Foundation Psychosocial Risk Factors and CHD expert committee 1 University of Queensland, Brisbane, 2Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, Warrnambool, Vic, 3Monash University, Melbourne, 4Brain and Mind Research Institute, University of Sydney, Sydney, 5University of Melbourne, 6National Heart Foundation of Australia, 7Cardiovascular Research Centre, Australian Catholic University, Melbourne, 8Royal North Shore Hospital, University of Sydney, Sydney, 9Clinical Programs, The National Heart Foundation of Australia, Melbourne, Australia Introduction: Depression is an important independent risk factor for first and recurrent coronary heart disease (CHD) events. The prevalence of depression is higher in patients with CHD than in the general population. Objectives: To review current evidence around depression in CHD patients to guide health professionals.
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters