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Thrombolysis for Pulmonary Embolism: Christchurch Experience
Abstracts
tiary hospitals from 1996 to 2006. Glomerular filtration rate (eGFR) was estimated for each patient at the time of admission. The effect of renal dysfunction on all-cause mortality at six months was assessed using Kaplan–Meier analysis, and log-rank Chi-square analysis was used to assess differences between groups. Results: The mean age was 52.0 ± 19.5 years (mean ± SD), and 68.9% were male. On admission, serum creatinine was 167.8 ± 227.9 mol/l (N = 70–110) and mean eGFR was 74.2 ± 57.2 ml/min (N ≥ 60). Renal function was stratified into four groups: (1) eGFR > 60 ml/min (60.6% of patients); (2) eGFR 30–60 ml/min (20.5%); (3) eGFR < 30 ml/min (12.2%); (4) dialysis-dependent (6.7%). Survival at six months for groups (1)–(4) was 86.3%, 55.8%, 59.4%, and 47% respectively (P < 0.01 for trend). Mortality was significantly different between group (1) and each of the other groups, but there was no difference in mortality between groups (2), (3) and (4). Pooled mortality at 6 months for groups (2–4) was 3-fold that of patients without renal dysfunction (44.6% vs 13.7%) (P < 0.01). Conclusion: Patients with infective endocarditis and renal dysfunction defined as eGFR < 60 ml/min demonstrate significantly increased all cause mortality at 6 months. doi:10.1016/j.hlc.2009.05.237 236 THROMBOLYSIS FOR PULMONARY EMBOLISM: CHRISTCHURCH EXPERIENCE W. Chan 1 , T. Campbell 2 , S. MacDonald 2 , I. Crozier 1 1 Department
of Cardiology, Christchurch, New Zealand 2 Department of Radiology, Christchurch, New Zealand
Christchurch
Hospital,
Christchurch
Hospital,
Background: Thrombolysis is an established treatment for massive pulmonary embolism (PE). For less severe PE, it remains controversial. We report our experience with thrombolysis for PE. Methods: A retrospective, chart based review was performed for all patients who received thrombolysis for PE in Christchurch Hospital from 2002 to 2007. Results: 47 patients (23 female) were identified, age 22–87 years. 7 had no known risk factors. 44 had large clot burden confirmed on computed tomography (CT) chest, 34 had CT evidence of right heart strain. 13 were shocked (BP <90 mmHg systolic), of these 10 had echocardiography prior to thrombolysis, all with evidence of right heart strain. 25 had both CT and echocardiography, 23 had concordance for right heart strain. Patients with shock had a higher peak troponin on average, 0.69 vs 0.23. 1 patient died during admission due to unrelated cause. 6 patients required blood transfusion post-thrombolysis, 2 of which had significant wound ooze following recent orthopaedic surgery. 6 had minor bleeds. 44 patients were followed up for 6 months, 3 overseas patients were lost to follow-up. Two recurrences occurred within 6 months, one resulting in death, the other was a result of sub-therapeutic antico-
S105
agulation. 5 had pulmonary hypertension and 4 had heart failure at 6 months. Conclusion: Thrombolysis had been successfully performed in Christchurch Hospital for PE with large clot burden regardless of haemodynamic status. There have been no thrombolysis related deaths. The bleeding complication rate was low and there was a low rate of events at 6 months. doi:10.1016/j.hlc.2009.05.238 Clinical Trials 237 DOES TELEPHONE SUPPORT OF THE RURAL AND REMOTE PATIENT WITH HEART FAILURE IMPROVE CLINICAL OUTCOMES? RESULTS OF THE CHRONIC HEART FAILURE ASSISTANCE BY TELEPHONE (CHAT) STUDY Andrew Tonkin 1 , Julie Yallop 1 , Andrea Driscoll 1 , 1 1 Andrew Forbes , Joanne Croucher , Bianca Chan 1 , Simon Stewart 2 , Robyn Clark 3 , Luan Huynh 1 , Adam Meehan 1 , Helen Egan 4 , Leon Piterman 1 , Ed Kasper 5 , Henry Krum 1 1 Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia 2 Baker IDI, Melbourne, Australia 3 University of South Australia, Adelaide, Australia 4 Barwon Management Group, Northern Territory, Australia 5 School of Medicine, Johns Hopkins University, Washington D.C, United States
Background: Heart failure (HF) remains a condition with high morbidity and mortality. We tested a telephone support (TS) strategy to reduce major events in rural and remote Australians with HF, who have limited healthcare access. TS comprised an interactive telecommunication software tool (Telewatch) with follow-up by trained cardiac nurses. Methods: Patients with a general practice (GP) diagnosis of HF were randomised to TS or usual care (UC) using a cluster design involving 136 GPs throughout Australia. Patients were followed for 12 months. The primary endpoint was the Packer clinical composite score. Secondary end-points included hospitalisation for any cause, death and hospitalisation as well as HF hospitalisation. Results: 405 patients were randomised into CHAT. Patients were well matched at baseline for key demographic variables. The primary end-point was not different between the two groups (P = 0.33), although more patients improved with TS. There were fewer patients hospitalised for any cause (77 versus 117, OR 0.59 [95% CI 0.40–0.88], p = 0.009) and who died or were hospitalised (88 versus 125, OR 0.65 [95% CI 0.43–0.97], p = 0.037), in the TS versus UC group. HF hospitalisations were reduced with TS (24 versus 37, OR 0.71 [95% CI 0.41–1.24]), although this
ABSTRACTS
Heart, Lung and Circulation 2009;18S:S1–S286
tiary hospitals from 1996 to 2006. Glomerular filtration rate (eGFR) was estimated for each patient at the time of admission. The effect of renal dysfunction on all-cause mortality at six months was assessed using Kaplan–Meier analysis, and log-rank Chi-square analysis was used to assess differences between groups. Results: The mean age was 52.0 ± 19.5 years (mean ± SD), and 68.9% were male. On admission, serum creatinine was 167.8 ± 227.9 mol/l (N = 70–110) and mean eGFR was 74.2 ± 57.2 ml/min (N ≥ 60). Renal function was stratified into four groups: (1) eGFR > 60 ml/min (60.6% of patients); (2) eGFR 30–60 ml/min (20.5%); (3) eGFR < 30 ml/min (12.2%); (4) dialysis-dependent (6.7%). Survival at six months for groups (1)–(4) was 86.3%, 55.8%, 59.4%, and 47% respectively (P < 0.01 for trend). Mortality was significantly different between group (1) and each of the other groups, but there was no difference in mortality between groups (2), (3) and (4). Pooled mortality at 6 months for groups (2–4) was 3-fold that of patients without renal dysfunction (44.6% vs 13.7%) (P < 0.01). Conclusion: Patients with infective endocarditis and renal dysfunction defined as eGFR < 60 ml/min demonstrate significantly increased all cause mortality at 6 months. doi:10.1016/j.hlc.2009.05.237 236 THROMBOLYSIS FOR PULMONARY EMBOLISM: CHRISTCHURCH EXPERIENCE W. Chan 1 , T. Campbell 2 , S. MacDonald 2 , I. Crozier 1 1 Department
of Cardiology, Christchurch, New Zealand 2 Department of Radiology, Christchurch, New Zealand
Christchurch
Hospital,
Christchurch
Hospital,
Background: Thrombolysis is an established treatment for massive pulmonary embolism (PE). For less severe PE, it remains controversial. We report our experience with thrombolysis for PE. Methods: A retrospective, chart based review was performed for all patients who received thrombolysis for PE in Christchurch Hospital from 2002 to 2007. Results: 47 patients (23 female) were identified, age 22–87 years. 7 had no known risk factors. 44 had large clot burden confirmed on computed tomography (CT) chest, 34 had CT evidence of right heart strain. 13 were shocked (BP <90 mmHg systolic), of these 10 had echocardiography prior to thrombolysis, all with evidence of right heart strain. 25 had both CT and echocardiography, 23 had concordance for right heart strain. Patients with shock had a higher peak troponin on average, 0.69 vs 0.23. 1 patient died during admission due to unrelated cause. 6 patients required blood transfusion post-thrombolysis, 2 of which had significant wound ooze following recent orthopaedic surgery. 6 had minor bleeds. 44 patients were followed up for 6 months, 3 overseas patients were lost to follow-up. Two recurrences occurred within 6 months, one resulting in death, the other was a result of sub-therapeutic antico-
S105
agulation. 5 had pulmonary hypertension and 4 had heart failure at 6 months. Conclusion: Thrombolysis had been successfully performed in Christchurch Hospital for PE with large clot burden regardless of haemodynamic status. There have been no thrombolysis related deaths. The bleeding complication rate was low and there was a low rate of events at 6 months. doi:10.1016/j.hlc.2009.05.238 Clinical Trials 237 DOES TELEPHONE SUPPORT OF THE RURAL AND REMOTE PATIENT WITH HEART FAILURE IMPROVE CLINICAL OUTCOMES? RESULTS OF THE CHRONIC HEART FAILURE ASSISTANCE BY TELEPHONE (CHAT) STUDY Andrew Tonkin 1 , Julie Yallop 1 , Andrea Driscoll 1 , 1 1 Andrew Forbes , Joanne Croucher , Bianca Chan 1 , Simon Stewart 2 , Robyn Clark 3 , Luan Huynh 1 , Adam Meehan 1 , Helen Egan 4 , Leon Piterman 1 , Ed Kasper 5 , Henry Krum 1 1 Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia 2 Baker IDI, Melbourne, Australia 3 University of South Australia, Adelaide, Australia 4 Barwon Management Group, Northern Territory, Australia 5 School of Medicine, Johns Hopkins University, Washington D.C, United States
Background: Heart failure (HF) remains a condition with high morbidity and mortality. We tested a telephone support (TS) strategy to reduce major events in rural and remote Australians with HF, who have limited healthcare access. TS comprised an interactive telecommunication software tool (Telewatch) with follow-up by trained cardiac nurses. Methods: Patients with a general practice (GP) diagnosis of HF were randomised to TS or usual care (UC) using a cluster design involving 136 GPs throughout Australia. Patients were followed for 12 months. The primary endpoint was the Packer clinical composite score. Secondary end-points included hospitalisation for any cause, death and hospitalisation as well as HF hospitalisation. Results: 405 patients were randomised into CHAT. Patients were well matched at baseline for key demographic variables. The primary end-point was not different between the two groups (P = 0.33), although more patients improved with TS. There were fewer patients hospitalised for any cause (77 versus 117, OR 0.59 [95% CI 0.40–0.88], p = 0.009) and who died or were hospitalised (88 versus 125, OR 0.65 [95% CI 0.43–0.97], p = 0.037), in the TS versus UC group. HF hospitalisations were reduced with TS (24 versus 37, OR 0.71 [95% CI 0.41–1.24]), although this
ABSTRACTS
Heart, Lung and Circulation 2009;18S:S1–S286