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The Establishment of CTCA at Northland District Health Board
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received CR-TD. There was no difference in baseline characteristics in men and women except women presented a higher proportion of non-ischaemic cardiomyopathy (66.7% versus 47.9%, P = 0.0163), and lower prevalence of chronic atrial fibrillation (6.3% versus 20.3%, P = 0.0198). Women also had higher rates of acute procedural complications (8.3% vs. 1.7%, P = 0.02). During a mean follow-up of 3.6 2.2 years, no genderspecific interaction was observed for appropriate ICD therapies (8.3% vs.17.2%, P = 0.12), inappropriate shocks (10.4% vs. 9.5%, P = 0.79), and all-cause mortality (8.3% vs. 16.9%, P = 0.19). Conclusion: In “real-world” clinical practice, women with HF remain a minority of primary prevention ICD recipients. The incidence of appropriate ICD therapies, inappropriate shocks and all-cause mortality was comparable to men with HF who received primary prevention ICD. The low referral rate for primary prevention ICD in women with HF requires further investigation as do the reasons for higher implantation complications. http://dx.doi.org/10.1016/j.hlc.2016.05.070
Cardiac Imaging P41 Direct Access to Echocardiography in Line with New Zealand Regional Minimum Standards Leads to Early Detection and Treatment of Valvular Pathology. We Provided Quantitative Data to Facilitate Planning of Similar Care Pathways Danielle Gelbart, Tammy Pegg, Nick Fisher, Steve White * Nelson Marlborough DHB, Nelson, New Zealand * Corresponding author. Background: Direct access to echocardiograms by general practitioners for murmur assessment in adult populations is variably available across New Zealand. There is a paucity of published data on detection rates for pathology and for knock-on effects for clinical services. This audit examines outcomes of GP-referred echocardiograms for murmur assessment in the Nelson-Marlborough region. Access was determined by Central Region minimum standards for referral and access to secondary cardiac care. Methods: Detection rates for valvular pathology were audited over a two-year period with subsequent care pathway decisions. Results: In a population of 136,995 residents, 252 echocardiograms were performed. Pathology was found in 133 patients (53%). 75 patients had aortic stenosis, 78 had mitral regurgitation, and 49 had aortic regurgitation. 39% with normal aortic valves had turbulent flow murmurs. 62 patients entered a technician-led valve follow-up service, 25 required a formal first specialist assessment (FSA), and 26 patients required 44 further investigations, leading to nine surgical interventions.
Abstracts
When standardised to a 100,000 patient rate, Nelson-Marlborough could expect to generate 45 valve follow-up scans, 18 FSA appointments, 32 further investigations and seven patients referred for surgery over two years. Conclusion: A direct access pathway to echocardiography if appropriately utilised in line with Central Region minimum standards for access to care leads to early detection and treatment of valvular pathology. This data provides valuable information for clinical services wishing to provide such access. It quantifies detection rates by auscultation for valvulopathies and subsequent effects for clinical services, including expected numbers of further investigations, FSA appointments and valvular operations. http://dx.doi.org/10.1016/j.hlc.2016.05.071
P42 The Establishment of CTCA at Northland District Health Board Stephen Jennison *, Samraj Nandra, Erin Doherty, Bruce O’Brien, Natalie Presnall Northland DHB, Whangarei, New Zealand * Corresponding author. Background: With the arrival of a new GE Revolution scanner at the Northland DHB, the opportunity to establish a CT coronary angiography service presented itself. Prior to this, patients had to travel to Auckland for any coronary artery imaging. Northland’s population of 160,000 has higher than the national average level of deprivation and below average health outcomes. Northland is geographically dispersed and road travel from north to south takes over five hours. Methods: The service was started as a joint project between the radiology and cardiology departments at Whangarei hospital, with the radiologist involved being the only member of the team having had prior experience with CTCA. A multidisciplinary working group was formed to ensure all aspects of service provision were addressed. Cardiologists completed training in Australia and the United Kingdom, and continue to receive clinical support from cardiologists involved in CTCA at Waitemata and Counties Manukau DHBs. Radiology and nursing staff also received support and education from these DHB’s. Results: The service commenced in October 2015. At the time of abstract submission 75 cases had been performed, resulting in 20 patients being referred for coronary angiograms, 16 patients requiring clinic follow-up or further stress testing and 39 patients being discharged from the cardiology service. The impact of CTCA on the region will be evaluated following a year of the service running. Conclusion: The cardiology and radiology teams embraced the fortuity of this scanning capability, and embarked on a path to develop its potential, particularly in the evaluation of low and intermediate risk chest pain patients within the region. http://dx.doi.org/10.1016/j.hlc.2016.05.072
received CR-TD. There was no difference in baseline characteristics in men and women except women presented a higher proportion of non-ischaemic cardiomyopathy (66.7% versus 47.9%, P = 0.0163), and lower prevalence of chronic atrial fibrillation (6.3% versus 20.3%, P = 0.0198). Women also had higher rates of acute procedural complications (8.3% vs. 1.7%, P = 0.02). During a mean follow-up of 3.6 2.2 years, no genderspecific interaction was observed for appropriate ICD therapies (8.3% vs.17.2%, P = 0.12), inappropriate shocks (10.4% vs. 9.5%, P = 0.79), and all-cause mortality (8.3% vs. 16.9%, P = 0.19). Conclusion: In “real-world” clinical practice, women with HF remain a minority of primary prevention ICD recipients. The incidence of appropriate ICD therapies, inappropriate shocks and all-cause mortality was comparable to men with HF who received primary prevention ICD. The low referral rate for primary prevention ICD in women with HF requires further investigation as do the reasons for higher implantation complications. http://dx.doi.org/10.1016/j.hlc.2016.05.070
Cardiac Imaging P41 Direct Access to Echocardiography in Line with New Zealand Regional Minimum Standards Leads to Early Detection and Treatment of Valvular Pathology. We Provided Quantitative Data to Facilitate Planning of Similar Care Pathways Danielle Gelbart, Tammy Pegg, Nick Fisher, Steve White * Nelson Marlborough DHB, Nelson, New Zealand * Corresponding author. Background: Direct access to echocardiograms by general practitioners for murmur assessment in adult populations is variably available across New Zealand. There is a paucity of published data on detection rates for pathology and for knock-on effects for clinical services. This audit examines outcomes of GP-referred echocardiograms for murmur assessment in the Nelson-Marlborough region. Access was determined by Central Region minimum standards for referral and access to secondary cardiac care. Methods: Detection rates for valvular pathology were audited over a two-year period with subsequent care pathway decisions. Results: In a population of 136,995 residents, 252 echocardiograms were performed. Pathology was found in 133 patients (53%). 75 patients had aortic stenosis, 78 had mitral regurgitation, and 49 had aortic regurgitation. 39% with normal aortic valves had turbulent flow murmurs. 62 patients entered a technician-led valve follow-up service, 25 required a formal first specialist assessment (FSA), and 26 patients required 44 further investigations, leading to nine surgical interventions.
Abstracts
When standardised to a 100,000 patient rate, Nelson-Marlborough could expect to generate 45 valve follow-up scans, 18 FSA appointments, 32 further investigations and seven patients referred for surgery over two years. Conclusion: A direct access pathway to echocardiography if appropriately utilised in line with Central Region minimum standards for access to care leads to early detection and treatment of valvular pathology. This data provides valuable information for clinical services wishing to provide such access. It quantifies detection rates by auscultation for valvulopathies and subsequent effects for clinical services, including expected numbers of further investigations, FSA appointments and valvular operations. http://dx.doi.org/10.1016/j.hlc.2016.05.071
P42 The Establishment of CTCA at Northland District Health Board Stephen Jennison *, Samraj Nandra, Erin Doherty, Bruce O’Brien, Natalie Presnall Northland DHB, Whangarei, New Zealand * Corresponding author. Background: With the arrival of a new GE Revolution scanner at the Northland DHB, the opportunity to establish a CT coronary angiography service presented itself. Prior to this, patients had to travel to Auckland for any coronary artery imaging. Northland’s population of 160,000 has higher than the national average level of deprivation and below average health outcomes. Northland is geographically dispersed and road travel from north to south takes over five hours. Methods: The service was started as a joint project between the radiology and cardiology departments at Whangarei hospital, with the radiologist involved being the only member of the team having had prior experience with CTCA. A multidisciplinary working group was formed to ensure all aspects of service provision were addressed. Cardiologists completed training in Australia and the United Kingdom, and continue to receive clinical support from cardiologists involved in CTCA at Waitemata and Counties Manukau DHBs. Radiology and nursing staff also received support and education from these DHB’s. Results: The service commenced in October 2015. At the time of abstract submission 75 cases had been performed, resulting in 20 patients being referred for coronary angiograms, 16 patients requiring clinic follow-up or further stress testing and 39 patients being discharged from the cardiology service. The impact of CTCA on the region will be evaluated following a year of the service running. Conclusion: The cardiology and radiology teams embraced the fortuity of this scanning capability, and embarked on a path to develop its potential, particularly in the evaluation of low and intermediate risk chest pain patients within the region. http://dx.doi.org/10.1016/j.hlc.2016.05.072