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PW003 Frailty and thromboprophylaxis prescription in heart failure and atrial fibrillation: Preliminary findings from the Atrial Fibrillation And Stroke Thromboprophylaxis in hEart failuRe (AFASTER) cohort study
POSTER ABSTRACTS
PW001 Cardiac electronic device implantation infection - A comparison of patients with infections in newly implanted devices compared with those post generator change or device upgrade Sandeep Prabhu*1,1, Nigel T. Lewis1, Nisha S. Rao1, Matias B. Yudi1, Neil F. Strathmore1 1 Cardiology, Royal Melbourne Hospital, Melbourne, Australia Introduction: Previous studies have demonstrated higher rates of cardiac electronic implantable device (CEID) related infections following a generator change or device upgrade compared to new device implantation. However the extent to which the procedure itself is the source of infection is poorly understood. Objectives: To evaluate the temporal and epidemiological relationship of CEID-related infections in newly-implanted devices versus those having had a generator change or device upgrade, in patients undergoing device extraction. Methods: A retrospective analysis was performed of consecutive patients who underwent CIED extraction at the Royal Melbourne Hospital between January 2012 and February 2013. Patients and device related data was reviewed from the clinical notes and pathology server for analysis. Patients were divided into two groups – those having had a generator change or device upgrade since implantation (group 1), and those with the original implanted CEID (group 2). Results: 53 patients underwent device extraction for infection over the period with significantly more patients in group 1 compared to group 2 (66% vs 34%, p¼0.003). The former had a significantly shorter time period from procedure to infective symptom onset (20.7 vs 42.2 months, p¼0.005) and a significantly higher likelihood of pocket rather than lead infective focus (group 1: 68% vs 27%, p<0.001, OR¼5.8, 95%CI: 2.0-16.6; group 2: 50% vs 44%, p¼0.74). A significantly higher proportion of infections in group 2 were related to Staphylococcus Aureus (44% vs 6%, p<0.001), whereas other non-Staph Aureus skin-related organisms (including other staph species, pseudomonas and fungal species) were more commonly isolated from group 1 (59% vs 22%, p¼0.024). There were no significant differences in demographic characteristics, device type and major co-morbidities between the two populations.
Objectives: The study aims to compare the long term electrical performance (i.e. impedance, threshold and sensing) of RVOT pacing versus RVA pacing in patients with permanent pacemakers in Hospital Universiti Sains Malaysia (HUSM), a leading tertiary referral centre in East Peninsular Malaysia. Methods: This is a retrospective study involving all patients who underwent permanent pacemaker implantation at HUSM from January 2002 until June 2008. The patients were divided into two groups based on the pacing site. Patients’ demographics, symptoms at presentation and indications for pacing, data on stimulation threshold, R wave sensing and lead impedance at time of pacemaker implantation and two years post implantation were collected and analyzed. Results: A total of 96 patients were enrolled, however only 66 patients had complete data for interpretation. Ventricle pacing thresholds, impedance values, and R wave amplitudes measured at implantation were not statistically significant. However, at 2 years postimplantation there was significant difference for the ventricle lead impedance and threshold between the two groups. The impedance of the RVOT lead was significantly higher than RVA site. The threshold of the RVOT lead was significantly better than RVA. However values for both parameters were within the accepted range. Conclusion: The ventricular lead performance of right ventricular outflow tract (RVOT) pacing site is safe and better compared with the right ventricular apical (RVA) group. The pacing parameters are comparable with conventional RVA pacing in the long term follow-up. Disclosure of Interest: None Declared PW003 Frailty and thromboprophylaxis prescription in heart failure and atrial fibrillation: Preliminary findings from the Atrial Fibrillation And Stroke Thromboprophylaxis in hEart failuRe (AFASTER) cohort study Caleb Ferguson*1, Sally C. Inglis1, Phillip J. Newton1, Sandy Middleton2, Peter S. Macdonald3, Patricia M. Davidson4 1 Centre for Cardiovascular & Chronic Care, University of Technology, Sydney, 2National Centre for Clinical Outcomes Research (NaCCOR), Australian Catholic University & St Vincents Hospital, 3Victor Chang Research Institute, St Vincents Hospital & UNSW, 4Centre for Cardiovascular & Chronic Care, University of Technology, Sydney & St Vincents Hospital, Sydney, Australia Introduction: Frailty is a common occurrence in atrial fibrillation (AF). Previous studies have demonstrated that frail patients are less likely to receive thromboprophylaxis in AF. Objectives: 1) To investigate the prevalence of frailty in patients with chronic heart failure and concomitant atrial fibrillation in an inpatient setting. 2) To examine if frailty was associated with non-prescription of anticoagulation at discharge. Methods: Prospective, consecutive participants admitted to a medical cardiology ward were enrolled in the cohort study between April – September 2013. Participants were included with CHF with concomitant AF of any type and any aetiology confirmed by a cardiologist and consistent with international guidelines (minimum CHA2DS2VASc ¼1). Exclusion criteria included age <18 years or AF due to reversible causes. Frailty was measured using the SHARE Frailty Instrument as close to discharge as clinically possible. Results: The analysis included the first 97 participants enrolled between April – September 2013. Mean age was 73 years (SD 15), mostly male (67%), primarily NYHA class II - III (54%), Mean LVEF 43% (SD 20). Most were identified as having permanent AF. Mean CHA2DS2VASc Score ¼ 3.25 (SD 1.94). Mean HASBLED Score ¼ 2.95 (SD 1.55), Mean Charlson Comorbidity Score ¼ 3.07 (SD 1.84), Mean no of medications on discharge ¼ 11 (SD 4). 32% lived alone. The majority of patients were classified as frail ¼ 61% (Non-frail ¼ 17%, Pre-frail 22%) The below analysis is a subset including 74 participants. Table 1. Frailty category and rate of anticoagulation from anticoagulation perspective
Conclusion: Compared to new CEID implants, infections following a generator change or device upgrade present earlier, manifest as indolent pocket infection, and are more commonly due to a range of skin-related flora rather than a virulent organism such as Staphylococcus Aureus. These findings may suggest a procedural source of infection in patients in such patients rather than haematological spread from a distant site. Disclosure of Interest: None Declared
PW002 Electrical Performance In Right Ventricular Outflow Tract Versus Right Ventricular Apical Pacing Site- An East Coast Malaysia Study Seng Loong Ng*1, Siti Mariam Abdul Rahim2, Suhairi Ibrahim1, Meng Hun Tee1, Mohd Sapawi Mohamed1, Zurkurnai Yusof1 1 Department of Internal Medicine, Universiti Sains Malaysia, Kubang Kerian, 2Department of Internal Medicine, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia Introduction: Since the introduction of the transvenous cardiac pacing almost five decades ago, the right ventricular apical (RVA) has been the preferred site for ventricular lead attachment. This is due to the ease of placement, stability and reliability. However, it was associated with progressive left ventricular dysfunction. This led to an interest in alternative RV pacing sites particularly the right ventricular outflow tract (RVOT).
e264
Frailty category
Not prescribed anticoagulation on discharge (n [ 20)
Prescribed anticoagulation on discharge (n [ 54)
Non Frail
0% (n¼ 0)
24% (n¼13)
Pre Frail
20% (n ¼ 4)
24% (n ¼ 13)
Frail
80% (n ¼ 16)
52% (n ¼ 28)
Table 2. Frailty category and rate of anticoagulation from frailty perspective Frailty category
Not prescribed anticoagulation on discharge (n [ 20)
Prescribed anticoagulation on discharge (n [ 54)
Non Frail
0% (n¼ 0)
100% (n¼13)
Pre Frail
23% (n¼ 4)
77% (n ¼ 13)
Frail
36% (n ¼ 16)
64% (n ¼ 28)
Conclusion: The majority of patients in this cohort were identified as being frail. Inpatient assessment of frailty using the SHARE Frailty Instrument demonstrated that frailty is not associated with suboptimal prescription of anticoagulation in patients with chronic heart failure and concomitant atrial fibrillation. This is in contrast to previous research. Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
PW001 Cardiac electronic device implantation infection - A comparison of patients with infections in newly implanted devices compared with those post generator change or device upgrade Sandeep Prabhu*1,1, Nigel T. Lewis1, Nisha S. Rao1, Matias B. Yudi1, Neil F. Strathmore1 1 Cardiology, Royal Melbourne Hospital, Melbourne, Australia Introduction: Previous studies have demonstrated higher rates of cardiac electronic implantable device (CEID) related infections following a generator change or device upgrade compared to new device implantation. However the extent to which the procedure itself is the source of infection is poorly understood. Objectives: To evaluate the temporal and epidemiological relationship of CEID-related infections in newly-implanted devices versus those having had a generator change or device upgrade, in patients undergoing device extraction. Methods: A retrospective analysis was performed of consecutive patients who underwent CIED extraction at the Royal Melbourne Hospital between January 2012 and February 2013. Patients and device related data was reviewed from the clinical notes and pathology server for analysis. Patients were divided into two groups – those having had a generator change or device upgrade since implantation (group 1), and those with the original implanted CEID (group 2). Results: 53 patients underwent device extraction for infection over the period with significantly more patients in group 1 compared to group 2 (66% vs 34%, p¼0.003). The former had a significantly shorter time period from procedure to infective symptom onset (20.7 vs 42.2 months, p¼0.005) and a significantly higher likelihood of pocket rather than lead infective focus (group 1: 68% vs 27%, p<0.001, OR¼5.8, 95%CI: 2.0-16.6; group 2: 50% vs 44%, p¼0.74). A significantly higher proportion of infections in group 2 were related to Staphylococcus Aureus (44% vs 6%, p<0.001), whereas other non-Staph Aureus skin-related organisms (including other staph species, pseudomonas and fungal species) were more commonly isolated from group 1 (59% vs 22%, p¼0.024). There were no significant differences in demographic characteristics, device type and major co-morbidities between the two populations.
Objectives: The study aims to compare the long term electrical performance (i.e. impedance, threshold and sensing) of RVOT pacing versus RVA pacing in patients with permanent pacemakers in Hospital Universiti Sains Malaysia (HUSM), a leading tertiary referral centre in East Peninsular Malaysia. Methods: This is a retrospective study involving all patients who underwent permanent pacemaker implantation at HUSM from January 2002 until June 2008. The patients were divided into two groups based on the pacing site. Patients’ demographics, symptoms at presentation and indications for pacing, data on stimulation threshold, R wave sensing and lead impedance at time of pacemaker implantation and two years post implantation were collected and analyzed. Results: A total of 96 patients were enrolled, however only 66 patients had complete data for interpretation. Ventricle pacing thresholds, impedance values, and R wave amplitudes measured at implantation were not statistically significant. However, at 2 years postimplantation there was significant difference for the ventricle lead impedance and threshold between the two groups. The impedance of the RVOT lead was significantly higher than RVA site. The threshold of the RVOT lead was significantly better than RVA. However values for both parameters were within the accepted range. Conclusion: The ventricular lead performance of right ventricular outflow tract (RVOT) pacing site is safe and better compared with the right ventricular apical (RVA) group. The pacing parameters are comparable with conventional RVA pacing in the long term follow-up. Disclosure of Interest: None Declared PW003 Frailty and thromboprophylaxis prescription in heart failure and atrial fibrillation: Preliminary findings from the Atrial Fibrillation And Stroke Thromboprophylaxis in hEart failuRe (AFASTER) cohort study Caleb Ferguson*1, Sally C. Inglis1, Phillip J. Newton1, Sandy Middleton2, Peter S. Macdonald3, Patricia M. Davidson4 1 Centre for Cardiovascular & Chronic Care, University of Technology, Sydney, 2National Centre for Clinical Outcomes Research (NaCCOR), Australian Catholic University & St Vincents Hospital, 3Victor Chang Research Institute, St Vincents Hospital & UNSW, 4Centre for Cardiovascular & Chronic Care, University of Technology, Sydney & St Vincents Hospital, Sydney, Australia Introduction: Frailty is a common occurrence in atrial fibrillation (AF). Previous studies have demonstrated that frail patients are less likely to receive thromboprophylaxis in AF. Objectives: 1) To investigate the prevalence of frailty in patients with chronic heart failure and concomitant atrial fibrillation in an inpatient setting. 2) To examine if frailty was associated with non-prescription of anticoagulation at discharge. Methods: Prospective, consecutive participants admitted to a medical cardiology ward were enrolled in the cohort study between April – September 2013. Participants were included with CHF with concomitant AF of any type and any aetiology confirmed by a cardiologist and consistent with international guidelines (minimum CHA2DS2VASc ¼1). Exclusion criteria included age <18 years or AF due to reversible causes. Frailty was measured using the SHARE Frailty Instrument as close to discharge as clinically possible. Results: The analysis included the first 97 participants enrolled between April – September 2013. Mean age was 73 years (SD 15), mostly male (67%), primarily NYHA class II - III (54%), Mean LVEF 43% (SD 20). Most were identified as having permanent AF. Mean CHA2DS2VASc Score ¼ 3.25 (SD 1.94). Mean HASBLED Score ¼ 2.95 (SD 1.55), Mean Charlson Comorbidity Score ¼ 3.07 (SD 1.84), Mean no of medications on discharge ¼ 11 (SD 4). 32% lived alone. The majority of patients were classified as frail ¼ 61% (Non-frail ¼ 17%, Pre-frail 22%) The below analysis is a subset including 74 participants. Table 1. Frailty category and rate of anticoagulation from anticoagulation perspective
Conclusion: Compared to new CEID implants, infections following a generator change or device upgrade present earlier, manifest as indolent pocket infection, and are more commonly due to a range of skin-related flora rather than a virulent organism such as Staphylococcus Aureus. These findings may suggest a procedural source of infection in patients in such patients rather than haematological spread from a distant site. Disclosure of Interest: None Declared
PW002 Electrical Performance In Right Ventricular Outflow Tract Versus Right Ventricular Apical Pacing Site- An East Coast Malaysia Study Seng Loong Ng*1, Siti Mariam Abdul Rahim2, Suhairi Ibrahim1, Meng Hun Tee1, Mohd Sapawi Mohamed1, Zurkurnai Yusof1 1 Department of Internal Medicine, Universiti Sains Malaysia, Kubang Kerian, 2Department of Internal Medicine, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia Introduction: Since the introduction of the transvenous cardiac pacing almost five decades ago, the right ventricular apical (RVA) has been the preferred site for ventricular lead attachment. This is due to the ease of placement, stability and reliability. However, it was associated with progressive left ventricular dysfunction. This led to an interest in alternative RV pacing sites particularly the right ventricular outflow tract (RVOT).
e264
Frailty category
Not prescribed anticoagulation on discharge (n [ 20)
Prescribed anticoagulation on discharge (n [ 54)
Non Frail
0% (n¼ 0)
24% (n¼13)
Pre Frail
20% (n ¼ 4)
24% (n ¼ 13)
Frail
80% (n ¼ 16)
52% (n ¼ 28)
Table 2. Frailty category and rate of anticoagulation from frailty perspective Frailty category
Not prescribed anticoagulation on discharge (n [ 20)
Prescribed anticoagulation on discharge (n [ 54)
Non Frail
0% (n¼ 0)
100% (n¼13)
Pre Frail
23% (n¼ 4)
77% (n ¼ 13)
Frail
36% (n ¼ 16)
64% (n ¼ 28)
Conclusion: The majority of patients in this cohort were identified as being frail. Inpatient assessment of frailty using the SHARE Frailty Instrument demonstrated that frailty is not associated with suboptimal prescription of anticoagulation in patients with chronic heart failure and concomitant atrial fibrillation. This is in contrast to previous research. Disclosure of Interest: None Declared
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters