SPC365

The Waiting 4 Surgery study - Prediction of in-hospital events

Session: Posters (Sessão 1 - Écran 3) - Cardiologia em Populações Especiais 1
Speaker: Inês Gomes Campos

Congress: CPC 2023
Topic: K. Cardiovascular Disease In Special Populations
Theme: 30. Cardiovascular Disease in Special Populations
Subtheme: 30.14 Cardiovascular Disease in Special Populations - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Inês Gomes Campos; Inês Oliveira; Isabel Cruz; Bruno Bragança; Rafaela G. Lopes; Joel Ponte Monteiro; Inês Gonçalves; Aurora Andrade

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients with coronary artery and valvular diseases with surgical indication represent a significant proportion of hospitalizations. The Waiting 4 Surgery study (W4S) aims to better study this group of patients and their burden of hospital care. In this work, we aim to identify those with event-free admissions.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Retrospective study of 184 consecutive patients admitted between 2019 and 2021 with coronary artery and/or aortic valve diseases waiting for coronary artery bypass graft (CABG) and aortic valve replacement (AVR). Patients with less than 5 days of hospitalization and those in continuous need of intravenous (IV) drugs were excluded (n=35). The primary endpoint was a composite of death, re-infarction, cardiac pulmonary arrest (CPA), stroke, ventricular tachycardia (VT), acute heart failure (AHF), rest chest pain and reintroduction of IV drugs. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Two approaches were performed to predict events: A) A logistic regression identified independent predictors of in-hospital events. Predictors were combined into a score model; B) A pre-specified clinical score using 7 variables associated with the need to maintain in-hospital care was used. The scores were evaluated using ROC curve analysis.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Total of 149 patients were included, mean age 67.8 years, 71% were submitted to CABG, 21% to AVR and 8% to both. The composite primary endpoint occurred in 23.3% of patients; 16.1% needed reintroduction of IV drugs, 15.4% reported chest pain and 2.7% had AHF. VT, CPA, re-infarction, stroke and death did not occur. 62.5% of patients had an event-free admission.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The variables identified as independent predictors were arterial hypertension, chronic kidney disease, use of beta blockers, calcium channel blockers and QRS duration &gt;120ms. The additive score model showed association with in-hospital events (p&lt;0.014), and a moderate prediction accuracy (AUC = 0.670). In the group of patients with score=0, 1 event occurred (rest chest pain).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The clinical score did not show association with the occurrence of events (p=0.067; AUC of 0.572). In the group of patients with clinical score=0, 10 events occurred (rest chest pain).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">This study shows that clinical criteria often used to decide for hospital stay did not predict events during admission. A variable derived score has moderate predictive power for the occurrence of events but showed no capacity to identify patients that could safely wait for surgery at home. Most patients had a benign hospital stay.</span></span></span></p>