Pub Date : 2022-06-01DOI: 10.1136/heartjnl-2022-bcs.16
Samuel Watson, R. Dworakowski
{"title":"16 The effects of social deprivation on clinical outcomes in infective endocarditis","authors":"Samuel Watson, R. Dworakowski","doi":"10.1136/heartjnl-2022-bcs.16","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-bcs.16","url":null,"abstract":"","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115595272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1136/heartjnl-2022-bcs.15
Q. Z. Siah, T. T. Ye, B. Tan, J. Ho, N. Syn, Y. Teo, Y. N. Teo, J. Yip, T. Yeo, Weiqin Lin, R. Wong, P. Chai, B. Chan, V. Sharma, L. Yeo, C. Sia
{"title":"15 Ischaemic events in hypertrophic cardiomyopathy patients with and without atrial fibrillation: a systematic review and meta-analysis","authors":"Q. Z. Siah, T. T. Ye, B. Tan, J. Ho, N. Syn, Y. Teo, Y. N. Teo, J. Yip, T. Yeo, Weiqin Lin, R. Wong, P. Chai, B. Chan, V. Sharma, L. Yeo, C. Sia","doi":"10.1136/heartjnl-2022-bcs.15","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-bcs.15","url":null,"abstract":"","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"108 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125717982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1136/heartjnl-2022-bcs.22
L. Coats, B. Chaudhry
Introduction Adults with congenital heart disease (ACHD) are a growing, heterogeneous group requiring lifelong follow-up to detect occurrence of known complications. In contrast to other cardiovascular disorders and chronic conditions, those with ACHD generally remain within the specialist tertiary hospital setting throughout their lives. The costs and burden on the patient of outpatient healthcare are increasingly recognised in the wider healthcare setting. The primary aim of this study was to evaluate present ambulatory healthcare in ACHD for ability to detect clinically relevant problems and consider patient and service provider costs. An additional aim was to define levels of non-attendance. We also summarise clinic activities during the COVID-19 pandemic when a hybrid approach of virtual and face to face consultations were arranged according to clinician perceived priority.Methods The clinic attendances of 100 patients attending the general ACHD clinic, selected by hospital number to minimise bias, were reviewed over a five-year period (1/01/2014-30/11/2019) and the Covid 19 period (23/03/2020-23/07/2021) by interrogation of the electronic patient record. This period represented 1/6 of their total lifetime clinic attendance. Results100 patients (Table 1) were invited to clinic annually. Non-attendance was 10% with 15 patients recurrently non-attending. 80% (459/ 575) of appointments resulted in no decision other than continued review (Figure 1). Electrocardiograms and echocardiograms were performed frequently but new findings were rare (5.1% and 4.0%). Other investigations required separate attendance. Decision-making was more common with higher ACHD AP class and new symptoms. There were 25 elective admissions, and 40 emergency admissions over half following appointments where no notable findings were recorded (Figure 2). Distance travelled to the ACHD clinic, which was supported by six clinical staff, was 14.9km (range 1.6-265) resulting in an estimated 433-564 workdays lost. During Covid 19, 56% appointments were in-person;41% telephone;5% video. Decisions were made at 37% in-person and 19% virtual consultations. Non-attendance was 3.9% and there were 8 emergency admissions. Conclusion The primary purpose of ACHD ambulatory care is surveillance. Despite this, emergency hospital admissions exceed elective hospital admissions. There is a high burden of care for patient and healthcare provider with the traditional outpatient model. The Covid-19 pandemic necessitated provision of ambulatory care in a different way and should encourage development of a new more patient-centred approach to ambulatory care delivery in ACHD.
{"title":"22 Reducing burden of ambulatory care in adult congenital heart disease to improve health outcomes – a cohort study","authors":"L. Coats, B. Chaudhry","doi":"10.1136/heartjnl-2022-bcs.22","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-bcs.22","url":null,"abstract":"Introduction Adults with congenital heart disease (ACHD) are a growing, heterogeneous group requiring lifelong follow-up to detect occurrence of known complications. In contrast to other cardiovascular disorders and chronic conditions, those with ACHD generally remain within the specialist tertiary hospital setting throughout their lives. The costs and burden on the patient of outpatient healthcare are increasingly recognised in the wider healthcare setting. The primary aim of this study was to evaluate present ambulatory healthcare in ACHD for ability to detect clinically relevant problems and consider patient and service provider costs. An additional aim was to define levels of non-attendance. We also summarise clinic activities during the COVID-19 pandemic when a hybrid approach of virtual and face to face consultations were arranged according to clinician perceived priority.Methods The clinic attendances of 100 patients attending the general ACHD clinic, selected by hospital number to minimise bias, were reviewed over a five-year period (1/01/2014-30/11/2019) and the Covid 19 period (23/03/2020-23/07/2021) by interrogation of the electronic patient record. This period represented 1/6 of their total lifetime clinic attendance. Results100 patients (Table 1) were invited to clinic annually. Non-attendance was 10% with 15 patients recurrently non-attending. 80% (459/ 575) of appointments resulted in no decision other than continued review (Figure 1). Electrocardiograms and echocardiograms were performed frequently but new findings were rare (5.1% and 4.0%). Other investigations required separate attendance. Decision-making was more common with higher ACHD AP class and new symptoms. There were 25 elective admissions, and 40 emergency admissions over half following appointments where no notable findings were recorded (Figure 2). Distance travelled to the ACHD clinic, which was supported by six clinical staff, was 14.9km (range 1.6-265) resulting in an estimated 433-564 workdays lost. During Covid 19, 56% appointments were in-person;41% telephone;5% video. Decisions were made at 37% in-person and 19% virtual consultations. Non-attendance was 3.9% and there were 8 emergency admissions. Conclusion The primary purpose of ACHD ambulatory care is surveillance. Despite this, emergency hospital admissions exceed elective hospital admissions. There is a high burden of care for patient and healthcare provider with the traditional outpatient model. The Covid-19 pandemic necessitated provision of ambulatory care in a different way and should encourage development of a new more patient-centred approach to ambulatory care delivery in ACHD.","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"173 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131854436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1136/heartjnl-2022-bcs.6
M. Gorecka, H. Nejadhamzeeigilani, Thomas P. Craven, P. Chew, L. Dobson, L. Brown, A. Chowdhary, N. Jex, S. Thirunavukarasu, N. Sharrack, W. Javed, S. Kotha, E. Levelt, A. Goddard, S. Plein, J. Greenwood
{"title":"6 Silent cerebral microinfarction following mitral valve surgery","authors":"M. Gorecka, H. Nejadhamzeeigilani, Thomas P. Craven, P. Chew, L. Dobson, L. Brown, A. Chowdhary, N. Jex, S. Thirunavukarasu, N. Sharrack, W. Javed, S. Kotha, E. Levelt, A. Goddard, S. Plein, J. Greenwood","doi":"10.1136/heartjnl-2022-bcs.6","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-bcs.6","url":null,"abstract":"","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133778280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1136/heartjnl-2022-bcs.4
H. Khan, D. Gamble, A. Rudd, A. Mezincescu, H. Abbas, A. Noman, A. Stewart, G. Horgan, R. Krishnadas, Chris Williams, G. Waiter, D. Dawson
{"title":"4 Brain phenotype of takotsubo syndrome","authors":"H. Khan, D. Gamble, A. Rudd, A. Mezincescu, H. Abbas, A. Noman, A. Stewart, G. Horgan, R. Krishnadas, Chris Williams, G. Waiter, D. Dawson","doi":"10.1136/heartjnl-2022-bcs.4","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-bcs.4","url":null,"abstract":"","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123359877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.1136/HEARTJNL-2021-BCS.16
S. Thompson, Caitlin Whitehead, Alex S Notley, I. A. Guy, C. Prabhakar, P. Clift, L. Hudsmith
Introduction Exercise is a safe and effective therapy for adults with congenital heart disease (ACHD) with positive effects on morbidity, mortality and quality of life.1 European Society of Cardiology (ESC) guidelines recommend that exercise interventions and promotion of physical activity should occur at every contact between ACHD patients and healthcare professionals.2 We sought to investigate how many ACHD patients recall these interventions. Methods We designed and conducted a data-based prospective survey exploring exercise behaviors of ACHD patients and recall of discussions around physical activity. The questionnaire was distributed to patients in outpatient clinics and inpatient wards at a tertiary ACHD centre in the UK, between October and November 2020. Results In total 125 patients completed the survey. Demographically, 60% were women, 34% were men and 4% preferred not to answer. The majority of respondents were of White British or European ethnicity (73.6%). With regard to baseline physical activity levels, only 66 (52.8%) respondents met recommended exercise targets, participating in moderate physical activity for at least 150 minutes per week. This reduced further to 40.8% following the COVID-19 pandemic lockdown (p=0.03) (figure 1). Common motivations for physical activity were general fitness (53.6%), weight loss (36.0%) and mental health benefits (30.4%). Key reasons for reduced physical activity as a result of the pandemic were fear of COVID-19 (28.0%), loss of motivation (23.2%) and gym/fitness centre closure (15.2%) (figure 2). Almost two thirds (65.6%) of respondents did not recall having a discussion about exercise participation with healthcare professionals. Discussions about individualized exercise prescriptions were recalled by 8 respondents (6.4%). In total, 16% recalled being told to avoid certain exercises by their healthcare team;common responses of exercises to be avoided included high impact/contact sport and heavy weightlifting, with others told not to run, scuba dive or play golf. Conclusions Almost half of the surveyed population did not meet recommended exercise targets before the pandemic, with even fewer meeting recommendations during the first COVID- 19 pandemic lockdown. The majority of patients do not recall ever having discussions about exercise with their healthcare team. Whilst we are unable to determine whether this is due to discussions not occurring or poor patient recall, there are clear deficiencies in the provision and/or retention of health promotional information surrounding exercise. Quality improvement initiatives to improve patient awareness and involvement in physical activity may be considered two-fold. Firstly, attention should be paid to improving patient recall of advice from consultations, which could involve the provision of written aids and individualised exercise prescriptions. Secondly, healthcare professional confidence in providing exercise recommendations to the heterogenous ACHD
{"title":"16 Emphasizing exercise in achd: why aren’t we talking about it?","authors":"S. Thompson, Caitlin Whitehead, Alex S Notley, I. A. Guy, C. Prabhakar, P. Clift, L. Hudsmith","doi":"10.1136/HEARTJNL-2021-BCS.16","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2021-BCS.16","url":null,"abstract":"Introduction Exercise is a safe and effective therapy for adults with congenital heart disease (ACHD) with positive effects on morbidity, mortality and quality of life.1 European Society of Cardiology (ESC) guidelines recommend that exercise interventions and promotion of physical activity should occur at every contact between ACHD patients and healthcare professionals.2 We sought to investigate how many ACHD patients recall these interventions. Methods We designed and conducted a data-based prospective survey exploring exercise behaviors of ACHD patients and recall of discussions around physical activity. The questionnaire was distributed to patients in outpatient clinics and inpatient wards at a tertiary ACHD centre in the UK, between October and November 2020. Results In total 125 patients completed the survey. Demographically, 60% were women, 34% were men and 4% preferred not to answer. The majority of respondents were of White British or European ethnicity (73.6%). With regard to baseline physical activity levels, only 66 (52.8%) respondents met recommended exercise targets, participating in moderate physical activity for at least 150 minutes per week. This reduced further to 40.8% following the COVID-19 pandemic lockdown (p=0.03) (figure 1). Common motivations for physical activity were general fitness (53.6%), weight loss (36.0%) and mental health benefits (30.4%). Key reasons for reduced physical activity as a result of the pandemic were fear of COVID-19 (28.0%), loss of motivation (23.2%) and gym/fitness centre closure (15.2%) (figure 2). Almost two thirds (65.6%) of respondents did not recall having a discussion about exercise participation with healthcare professionals. Discussions about individualized exercise prescriptions were recalled by 8 respondents (6.4%). In total, 16% recalled being told to avoid certain exercises by their healthcare team;common responses of exercises to be avoided included high impact/contact sport and heavy weightlifting, with others told not to run, scuba dive or play golf. Conclusions Almost half of the surveyed population did not meet recommended exercise targets before the pandemic, with even fewer meeting recommendations during the first COVID- 19 pandemic lockdown. The majority of patients do not recall ever having discussions about exercise with their healthcare team. Whilst we are unable to determine whether this is due to discussions not occurring or poor patient recall, there are clear deficiencies in the provision and/or retention of health promotional information surrounding exercise. Quality improvement initiatives to improve patient awareness and involvement in physical activity may be considered two-fold. Firstly, attention should be paid to improving patient recall of advice from consultations, which could involve the provision of written aids and individualised exercise prescriptions. Secondly, healthcare professional confidence in providing exercise recommendations to the heterogenous ACHD ","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"1995 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131172879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.1136/HEARTJNL-2021-BCS.2
Anenta Ramakrishnan, N. Hadjiloizou, Y. Ahmad, S. Sen, I. Malik, K. Parker, D. Francis, A. Hughes, J. Davies, J. Mayet
{"title":"2 Differential effects of left ventricular hypertrophy on coronary haemodynamics in aortic stenosis and hypertension","authors":"Anenta Ramakrishnan, N. Hadjiloizou, Y. Ahmad, S. Sen, I. Malik, K. Parker, D. Francis, A. Hughes, J. Davies, J. Mayet","doi":"10.1136/HEARTJNL-2021-BCS.2","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2021-BCS.2","url":null,"abstract":"","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127590296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.1136/HEARTJNL-2021-BCS.23
E. Luo, K. Chan, L. Tilling, K. Balkhausen, S. Bull
Background The COVID-19 pandemic has presented unprecedented challenges for day-to-day medical practice. In some hospitals face-to-face clinic consultations have significantly reduced, being replaced by virtual clinics where possible. We hypothesised that virtual follow up of many of our Hypertrophic Cardiomyopathy (HCM) patients could continue indefinitely without impacting on the quality of clinical care, with the overall benefits of maintaining patient safety and convenience, and reduced costs for the hospital. Purpose The purpose of this study was to evaluate physician consultations in our HCM clinic prior to the COVID-19 pandemic to determine what proportion of consultations resulted in patients developing new symptoms or requiring medication changes. We further looked to see if we could identify any patient factors that would allow us to predict which patients would be most suitable for future virtual follow up. Methods We retrospectively reviewed the electronic patient records of HCM patients seen in the dedicated Inherited Cardiac Conditions (ICC) clinic for follow-up over a 6-month period in 2018. Patients were classified into high (≥6%), moderate (4-5.9%) and low (<4%) risk groups according to ESC-SCD risk score. Transthoracic echocardiogram and cardiac magnetic resonance features were reviewed. The outcome comprised number of patients developing new symptoms or requiring medication change, as well as hospital admissions for cardiovascular reasons (e.g. angina, arrhythmia, and heart failure) in the 2-years following clinic consultation. Results Forty-seven HCM patients (mean age 61.4 ± 12.2, 55% male) were identified and reviewed from the ICC clinic. Overall, 36% of patients had interventions from the face-to-face clinic;with 21% of patients developing new symptoms and 32% of patients requiring medication changes. There were 38 low-risk, 4 moderate-risk and 4 high-risk patients. 1 patient was not eligible for the risk stratification due to age over 80. 21% of low-risk, 25% of moderate-risk and 25% of high-risk patients developed new symptoms (table 1). Over 50% of patients who had a moderate- high ESC-SCD risk score or echocardiographic evidence of systolic/diastolic impairment required medication changes (table 1 & 2). Only 2 patients had hospital admissions for cardiovascular reasons in the 2-year follow up period, and those with systolic/diastolic impairment also incur high rates of admissions (table 2). Conclusion About 60% of HCM patients from our inherited conditions clinic were asymptomatic and did not require changes in medication, which suggests that this group would be very suitable for virtual follow-up clinic appointments postpandemic. Potential predictive factors would include patients with low ESC-SCD risk score and without left ventricular impairment. Hospital costs may be reduced whilst maintaining patient safety and convenience. HCM patient satisfaction with virtual consultations would be a further area to examine in re
{"title":"23 Feasibility assessment for the implementation of a virtual hypertrophic cardiomyopathy follow up clinic in a district general hospital","authors":"E. Luo, K. Chan, L. Tilling, K. Balkhausen, S. Bull","doi":"10.1136/HEARTJNL-2021-BCS.23","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2021-BCS.23","url":null,"abstract":"Background The COVID-19 pandemic has presented unprecedented challenges for day-to-day medical practice. In some hospitals face-to-face clinic consultations have significantly reduced, being replaced by virtual clinics where possible. We hypothesised that virtual follow up of many of our Hypertrophic Cardiomyopathy (HCM) patients could continue indefinitely without impacting on the quality of clinical care, with the overall benefits of maintaining patient safety and convenience, and reduced costs for the hospital. Purpose The purpose of this study was to evaluate physician consultations in our HCM clinic prior to the COVID-19 pandemic to determine what proportion of consultations resulted in patients developing new symptoms or requiring medication changes. We further looked to see if we could identify any patient factors that would allow us to predict which patients would be most suitable for future virtual follow up. Methods We retrospectively reviewed the electronic patient records of HCM patients seen in the dedicated Inherited Cardiac Conditions (ICC) clinic for follow-up over a 6-month period in 2018. Patients were classified into high (≥6%), moderate (4-5.9%) and low (<4%) risk groups according to ESC-SCD risk score. Transthoracic echocardiogram and cardiac magnetic resonance features were reviewed. The outcome comprised number of patients developing new symptoms or requiring medication change, as well as hospital admissions for cardiovascular reasons (e.g. angina, arrhythmia, and heart failure) in the 2-years following clinic consultation. Results Forty-seven HCM patients (mean age 61.4 ± 12.2, 55% male) were identified and reviewed from the ICC clinic. Overall, 36% of patients had interventions from the face-to-face clinic;with 21% of patients developing new symptoms and 32% of patients requiring medication changes. There were 38 low-risk, 4 moderate-risk and 4 high-risk patients. 1 patient was not eligible for the risk stratification due to age over 80. 21% of low-risk, 25% of moderate-risk and 25% of high-risk patients developed new symptoms (table 1). Over 50% of patients who had a moderate- high ESC-SCD risk score or echocardiographic evidence of systolic/diastolic impairment required medication changes (table 1 & 2). Only 2 patients had hospital admissions for cardiovascular reasons in the 2-year follow up period, and those with systolic/diastolic impairment also incur high rates of admissions (table 2). Conclusion About 60% of HCM patients from our inherited conditions clinic were asymptomatic and did not require changes in medication, which suggests that this group would be very suitable for virtual follow-up clinic appointments postpandemic. Potential predictive factors would include patients with low ESC-SCD risk score and without left ventricular impairment. Hospital costs may be reduced whilst maintaining patient safety and convenience. HCM patient satisfaction with virtual consultations would be a further area to examine in re","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126105860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.1136/HEARTJNL-2021-BCS.32
L. Eveson, Heather Nicholson, Amani Patel, C. MacFarlane, A. Parker, D. Garner, L. Sturridge
Introduction Infective endocarditis (IE) is a rare and potentially fatal infection. Patients often present with generalised symptoms resulting in delays in diagnosis. Complications are common and patients can have long inpatient stays due to intravenous antibiotic requirement. The POET study highlighted non inferiority of oral antibiotic switch in stable patients with left sided IE. The aim of our study is to characterise the IE patient population at our DGH, analyse their management, review adherence of our Endocarditis Team to the ESC 2015 guidelines (figure 1) and to review discharge information and advice, to identify areas for improvement. Methods This was a retrospective study of medical records for patients treated at our DGH with a diagnosis of IE between 1 Oct 2019 and 30 Sep 2020. Demographics, patient characteristics (table 1), IE risk factors, presentation, management, discharge information, patient feedback, and cost analysis was carried out. Adherence of our Endocarditis Team to ESC 2015 guidelines was reviewed. Results Between October 2019 and September 2020, 14 patients were diagnosed with IE according to the Duke Criteria. The median age was 75 (60-89) years and 68.7% of patients were male. 7 patients had a prosthetic valve and 3 had a cardiac device in situ. All patients had CVR risk factors, 50% had T2DM, 36% had renal disease. Only 2 patients had documentation of dental history. The majority of patients (n=12) presented via the Emergency Department. 86% of patients completed a 6-week antibiotic course. Only 14% of patients were managed as outpatients. 21% of patients required surgical management. All patients were reviewed by the Endocarditis Team. All patients were followed up appropriately. Only 1 patient had documented advice regarding dental care. 1 patient died and many patients had complications (figure 2). IE patient support group feedback highlighted concerns regarding delay in diagnosis, challenges of a long inpatient stay and benefits of hearing from other patients about their experiences. Conclusion IE is a rare disease. Documentation of some IE risk factors, and documented discharge advice was poor at our centre. Our Endocarditis Team meet weekly, have a significant input in IE patient management and ensure adequate follow up is arranged for patients. We plan to join an international IE registry. An IE ward round proforma has been created along with a teaching session for staff to improve awareness and understanding of IE. A discharge information pack including information on IE, dental advice and IE and dental warning cards has been created. We plan for a virtual IE support group given current COVID-19 restrictions. We plan to create an outpatient IE treatment pathway with potential for improvement in patient experience and potential for significant cost savings.
{"title":"32 Infective endocarditis: a review of the patient journey at a district general hospital (dgh)","authors":"L. Eveson, Heather Nicholson, Amani Patel, C. MacFarlane, A. Parker, D. Garner, L. Sturridge","doi":"10.1136/HEARTJNL-2021-BCS.32","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2021-BCS.32","url":null,"abstract":"Introduction Infective endocarditis (IE) is a rare and potentially fatal infection. Patients often present with generalised symptoms resulting in delays in diagnosis. Complications are common and patients can have long inpatient stays due to intravenous antibiotic requirement. The POET study highlighted non inferiority of oral antibiotic switch in stable patients with left sided IE. The aim of our study is to characterise the IE patient population at our DGH, analyse their management, review adherence of our Endocarditis Team to the ESC 2015 guidelines (figure 1) and to review discharge information and advice, to identify areas for improvement. Methods This was a retrospective study of medical records for patients treated at our DGH with a diagnosis of IE between 1 Oct 2019 and 30 Sep 2020. Demographics, patient characteristics (table 1), IE risk factors, presentation, management, discharge information, patient feedback, and cost analysis was carried out. Adherence of our Endocarditis Team to ESC 2015 guidelines was reviewed. Results Between October 2019 and September 2020, 14 patients were diagnosed with IE according to the Duke Criteria. The median age was 75 (60-89) years and 68.7% of patients were male. 7 patients had a prosthetic valve and 3 had a cardiac device in situ. All patients had CVR risk factors, 50% had T2DM, 36% had renal disease. Only 2 patients had documentation of dental history. The majority of patients (n=12) presented via the Emergency Department. 86% of patients completed a 6-week antibiotic course. Only 14% of patients were managed as outpatients. 21% of patients required surgical management. All patients were reviewed by the Endocarditis Team. All patients were followed up appropriately. Only 1 patient had documented advice regarding dental care. 1 patient died and many patients had complications (figure 2). IE patient support group feedback highlighted concerns regarding delay in diagnosis, challenges of a long inpatient stay and benefits of hearing from other patients about their experiences. Conclusion IE is a rare disease. Documentation of some IE risk factors, and documented discharge advice was poor at our centre. Our Endocarditis Team meet weekly, have a significant input in IE patient management and ensure adequate follow up is arranged for patients. We plan to join an international IE registry. An IE ward round proforma has been created along with a teaching session for staff to improve awareness and understanding of IE. A discharge information pack including information on IE, dental advice and IE and dental warning cards has been created. We plan for a virtual IE support group given current COVID-19 restrictions. We plan to create an outpatient IE treatment pathway with potential for improvement in patient experience and potential for significant cost savings.","PeriodicalId":152114,"journal":{"name":"ACHD/Valve Disease/Pericardial Disease/Cardiomyopathy","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126354282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-01DOI: 10.1136/HEARTJNL-2021-BCS.22
Kate Hamilton, Eleanor R Joy, J. Oliver, K. Gatenby, S. Winfield, T. Everett, Stewart Prestwich, Tiffany Halsey, K. English, A. Simms
21 Table 2 Follow up intervals, echocardiographic and clinical complications of 294 patients with valve replacement enrolled in our valve clinic *IE = Infective Endocarditis, Mod = Moderate, LV = Left Ventricular, HF = Heart Failure Abstract 22 Table 1 Demographics of patients22 Table 1 Demographics of patients mWHO Classification Number of patients Percentage Age at first pregnancy Number of patients Percentage
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