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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
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Clinical audit of in-patient echocardiography in acute heart failure: real world data from a tertiary hospital
Session:
Painel 1 - Insuficiência Cardíaca 9
Speaker:
Cristiana Monteiro
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.3 Acute Heart Failure – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Cristiana Monteiro; Alet Cojoianu; Ryan Savage; Rebecca Bone; Cassandra Hammond; James Gamble; Jim Newton
Abstract
<p><strong>Background</strong></p> <p>Over the last 10 years, an increase in admission rates for acute heart failure (HF) has been noted in the United Kingdom, with 1-year mortality rates varying between 30% and 60%. Transthoracic echocardiography (TTE) is recommended within 48 hours of admission for suspected acute HF, so to guide treatment accordingly.</p> <p>Our specialist HF team sees suspected HF patients on admission and refers them for urgent in-patient TTE, using 2 priority echo slots per day. Patients are referred for HF assessment by general medics and geriatricians, across non-specialist medical wards. We audited the referrals and results of those who received TTE in this context.</p> <p><strong>Methods and results</strong></p> <p>We screened the medical notes of 252 patients admitted with suspected HF during a period of 12 months, and reviewed the echocardiography results of those who received it during their admission.</p> <p>50% of patients were female and 59% were elderly (>80 years). 245 patients (97.2%) had in-patient echocardiography performed during their hospital stay. The mean wait for echocardiography was 0.58 days, with 92% of scans being performed within 24 hours. The mean admission duration was 8.6 days (SD 10.9). 17.9% of patients were readmitted with suspected HF within 6 months, 69% of which were elderly.</p> <p>The majority of this cohort presented with HF with preserved ejection fraction (HFpEF), 50%), followed by HF with reduced ejection fraction (HFrEF, 29%) and HF with mid-range ejection fraction (HFmrEF, 16%). 41% of the patients who received an echocardiogram were in atrial fibrillation, 51% of which were diagnosed with HFpEF.</p> <p>All patients had their HF medical treatment optimised post-echocardiography and only 18.4% were readmitted within 6 months of the first admission. The majority of these was elderly (68.9%). 38.8% patients who received echocardiography were referred for specialist clinic follow-up, with HFrEF patients more likely to be seen in this setting (42%).</p> <p>6-month mortality occurred in 19.8% patients; cause of death (COD) was undocumented in 25.8% cases. In those where COD was ascertained, the main contributing factor was HF (16.7%), followed by sepsis (13.6%), cardiac (6.1%) and respiratory arrest (6.1%). 66% of the deceased patients were elderly and 48% presented with HFpEF.</p> <p><strong>Conclusion</strong></p> <p>Our cohort is an accurate representation of the current HF statistics seen nationwide. Appropriate treatment was offered to the large majority of patients who received in-patient echocardiography within the first 24 hours of their admission, with low 6-month readmission rates. This approach also allowed for the inclusion of these patients on a systematic review plan, including specialist cardiology follow-up. Our numbers are consistent with the higher awareness about HFpEF currently seen in the medical community.</p>
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