Reveal Loop Recorders—Should Follow Up Frequency be Driven by Patient Symptoms?

Acute Predict Cardiac Catheter Lab (CCL) One Year on—An Electronic Real-Time Audit, Quality Improvement Process in Middlemore Hospital CCL C. Flynn ∗ , J. White, S. Graham, A. McLachlan, D. Scott, P. Kay, A.J. Kerr Middlemore Hospital, New Zealand Background: The aim was to report one-year findings from Acute Predict electronic system which comprehensively captures and reports all CCL activity and in-hospital outcomes for patients undergoing coronary angiography. Methods: CCL nurses enter data directly into the electronic templates on the day of coronary angiography. Data cross-populates with the Acute Predict acute coronary syndrome (ACS) data-set collected in the CCU thus reducing data entry duplication and improving data accuracy. In-hospital outcomes back-populates to the catheter lab record from the ACS forms completed by the CCU team. A standardised live report is available to all users both specifically to individual patients, and filtering by any data item in the data-set. A quality improvement group supports implementation and use of the data. Results: From mid-November 2010 to end November 2011 all CCL patients (n = 1356) had complete data capture, mean age 62 y, 69% male, 53% non-European, 74% in-patients, 78% were for suspected or known CHD, 87% had radial access, 30% had no obstructive coronary artery disease, 70% had >50 stenosis in one or more vessels, 55% had EF assessed, 424 patients had PCI, 77% had DES. Inhospital adverse outcomes – there were 14 deaths (1.1%), 5 (3.7%) strokes (only one probably related to the coronary angiogram), 3 TIMI minor or major bleeds (2.2%). Conclusion: The Acute Predict CCL system continues to be easy to implement and provides ready access to reliable information to drive quality improvement. This system is due to be implemented in Auckland North Shore and Waikato hospitals by mid 2012. http://dx.doi.org/10.1016/j.hlc.2012.03.035 Reveal Loop Recorders—Should Follow Up Frequency be Driven by Patient Symptoms? M. Fowler ∗ , F. Riddell Auckland City Hospital, Auckland, New Zealand Background: Medtronic Reveal Loop Recorders (RLRs) store recordings either by patient activation or automatically (autoactivations). The first model (9526) had battery life ≤14 months and three-monthly follow-up was instituted. This practice continued with the second model (9528) despite anticipated battery life of ≥3 years. Increasing clinic patient numbers prompted a review to determine if follow up frequency could be lengthened. Method: Pacemaker clinic records were retrospectively reviewed for all RLR implants at Greenlane and Auckland City Hospitals between July 2000 and December 2011. Results: 209 RLRs were implanted in 207 patients. Median age at implant was 48 years (2–85 years). Primary

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implant indication was syncope in 85%. 190 (91%) were followed locally and 84% have completed follow-up – median duration 21 months. 155/190 patients (82%) made patient activated recordings (average 5.6/patient). 128/190 patients (67%) made recordings related to their specific implant indication. Autoactivations showed tachy or bradyarrhythmias in 35/190 patients (18%). Ten of these correlated with patient stored events. Eleven (6%) while asymptomatic were deemed clinically significant. Diagnosis was made in 62/190 (33%) patients with 50/62 being patient activated recordings. 37/190 patients (16%) proceeded to 7 ICDs, 24 pacemakers and 6 electrophysiology studies. 62/190 patients (33%) admitted having typical symptoms but did not attempt to or were unable to make recordings. Only three of these patients had autoactivations correlating with symptoms. Conclusion: As minimal information is obtained from auto activations, patient follow-up of RLRs should be driven by patient symptoms. http://dx.doi.org/10.1016/j.hlc.2012.03.036 Mortality, Morbidity and the Current Standard of Evidence-based Management Amongst Patients Living in Regional New Zealand with Severe Heart Failure (1997–2011): The Nelson Marlborough Heart Failure Study B.T. Grainger 1,∗ , S. White 1 , S. Lake 1 , R. Hipkiss 2 , A. Hamer 1 , N. Fisher 1 , T. Pegg 1 1 Nelson

Marlborough District Health Board, New Zealand of Health, Wellington, New Zealand

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Background: Congestive heart failure is associated with significant mortality, impaired quality of life and repeated hospital admissions. We sought to investigate this and examine the current evidence-based medical and device management of heart failure within Nelson-Marlborough. Methods: A retrospective longitudinal analysis of 1170 patients with left ventricular ejection fraction (LVEF) <36% was undertaken, based on transthoracic echocardiograms performed between December 1, 1997 and March 31, 2011. Five-year survival rates, acute admission numbers, medication use, access to implantable cardioverter-defibrillators (ICDs), quality of life based on the EQ-5D health questionnaire and self-reported New York Heart Association (NYHA) class were derived. Results: Mean LVEF was 25.54 ± 7.25%. Five-year cumulative survival was 36.9%. The mean annual admission rate was 210/100,000; 46.33% were re-admissions in the same year. Acute medical admission was associated with an increased risk of mortality (χ2 = 6.27, p < 0.02). Prescription rates for ACE inhibitors, beta-blockers and spironolactone were 68.3%, 74.2% and 24.9%, respectively. Of these, only 17.6%, 19.0% and 16.4% were on maximum recommended doses. ICDs were inserted in 11.47% of patients aged ≤75 years as of 2006, who had also survived ≥18 months with LVEF persistently ≤30% for ≥3 months. Mean EQ-5D visual analogue score was 72.6 ± 0.032 and self-reported

ABSTRACTS

Heart, Lung and Circulation 2012;21:480–526