Real-world use and accuracy of stress echocardiography: preliminary insights from the EVAREST study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W Woodward ◽  
A McCourt ◽  
C Dockerill ◽  
L Ayres ◽  
D Augustine ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Real World ◽  
Stress Echocardiography ◽  
Significant Coronary Artery Disease ◽  
Phone Call ◽  
Funding Source ◽  
Private Company ◽  
Coronary Syndrome ◽  
Stress Echo ◽  
Cardiac Outcome

Abstract Background Stress echocardiography is a widely used, non-invasive imaging modality used to identify prognostically significant coronary artery disease. High levels of accuracy have been reported, however this is highly dependent on operator training and image quality. There are currently limited data available on the accuracy of stress echo in every day clinical practice. Purpose The EVAREST study links stress echo clinics in 30 NHS Hospital Trusts in England and therefore provides data to evaluate the performance and diagnostic accuracy of stress echo in “real-world” clinical practice. Methods Analysis was performed on the first 7415 patients recruited prospectively between 2015 and January 2020. Participants are included if they have undergone stress echo to investigate for ischaemic heart disease. Data is collected on medical history and stress echo performance. Participants are followed up for 12 months through health records and patient phone call, with all outcomes undergoing expert adjudication. A positive cardiac outcome is defined as initiation of anti-anginal medications, ≥70% stenosis on coronary angiography, revascularisation, confirmed acute coronary syndrome or cardiac-related death. Results Mean age of patients undergoing stress echo is 65±12.3 years and 56% are male. Average BMI is 28.9±5.6 kg/m2. 71.4% undergo dobutamine stress (DSE) and 28.4% exercise with <1% having a pacemaker-mediated stress. Contrast was used in 71.4% of studies. Stress echos were interpreted at time of clinic visit as positive for inducible ischaemia in 18.2% of patients. One-year outcome data is currently available for 1892 participants. Sensitivity and specificity for clinician prediction of a positive cardiac outcome was 88.7% and 94.4%, respectively. Positive and negative predictive value of stress echo was 76.4% and 97.6%, respectively. Conclusion EVAREST provides unprecedented, large-scale information on the “real world” use and accuracy of stress echo across different healthcare settings in the UK, demonstrating performance consistent with best practice. Ongoing data collection will be used to evaluate sources of heterogeneity in the predictive accuracy of stress echo and identify optimal approaches to further improve performance. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Ultromics Ltd., Lantheus Ltd.

Edoxaban treatment of elderly patients with atrial fibrillation in routine clinical practice: 1-year results of the non-interventional Global ETNA-AF program

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Yamashita ◽  
C.C Wang ◽  
Y.-H Kim ◽  
R De Caterina ◽  
P Kirchhof ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Major Bleeding ◽  
Intracranial Haemorrhage ◽  
Clinical Care ◽  
Oral Anticoagulants ◽  
Clinical Event ◽  
Funding Source ◽  
Private Company ◽  
All Cause Mortality

Abstract Background The prevalence of atrial fibrillation (AF) and the need for appropriate anticoagulation increase with age. The benefit/risk profile of direct oral anticoagulants such as edoxaban in elderly population with AF in regular clinical practice is therefore of particular interest. Purpose Analyses of Global ETNA-AF data were performed to report patient characteristics, edoxaban treatment, and 1-year clinical events by age subgroups. Methods Global ETNA-AF is a multicentre, prospective, noninterventional program conducted in Europe, Japan, Korea, Taiwan, and other Asian countries. Demographics, baseline characteristics, and 1-year clinical event data were analysed in four age subgroups. Results Of 26,823 patients included in this analysis, 50.4% were ≥75 years old and 11.6% were ≥85 years. Increase in age was generally associated with lower body weight, lower creatinine clearance, higher CHA2DS2-VASc and HAS-BLED scores, and a higher percentage of patients receiving the reduced dose of 30 mg daily edoxaban. At 1-year, rates of ISTH major bleeding and ischaemic stroke were generally low across all age subgroups. The proportion of intracranial haemorrhage within major bleeding events was similar across age groups. All-cause mortality increased with age more than cardiovascular mortality. Conclusion Data from Global ETNA-AF support the safety and effectiveness of edoxaban in elderly AF patients (including ≥85 years) in routine clinical care with only a small increase in intracranial haemorrhage. The higher all-cause mortality with increasing age is not driven by cardiovascular causes. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Daiichi Sankyo

scholarly journals Is the use of two versus one long-acting bronchodilator by patients with COPD associated with a higher risk of acute coronary syndrome in real-world clinical practice?

2021 ◽  
Vol 8 (1) ◽  
pp. e000840
Author(s):  
Lianne Parkin ◽  
Sheila Williams ◽  
David Barson ◽  
Katrina Sharples ◽  
Simon Horsburgh ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Practice ◽  
Real World ◽  
Chronic Obstructive ◽  
Treatment Intensification ◽  
Cardiovascular Comorbidity ◽  
Coronary Syndrome ◽  
Long Acting ◽  
The Impact

BackgroundCardiovascular comorbidity is common among patients with chronic obstructive pulmonary disease (COPD) and there is concern that long-acting bronchodilators (long-acting muscarinic antagonists (LAMAs) and long-acting beta2 agonists (LABAs)) may further increase the risk of acute coronary events. Information about the impact of treatment intensification on acute coronary syndrome (ACS) risk in real-world settings is limited. We undertook a nationwide nested case–control study to estimate the risk of ACS in users of both a LAMA and a LABA relative to users of a LAMA.MethodsWe used routinely collected national health and pharmaceutical dispensing data to establish a cohort of patients aged >45 years who initiated long-acting bronchodilator therapy for COPD between 1 February 2006 and 30 December 2013. Fatal and non-fatal ACS events during follow-up were identified using hospital discharge and mortality records. For each case we used risk set sampling to randomly select up to 10 controls, matched by date of birth, sex, date of cohort entry (first LAMA and/or LABA dispensing), and COPD severity.ResultsFrom the cohort (n=83 417), we identified 5399 ACS cases during 281 292 person-years of follow-up. Compared with current use of LAMA therapy, current use of LAMA and LABA dual therapy was associated with a higher risk of ACS (OR 1.28 (95% CI 1.13 to 1.44)). The OR in an analysis restricted to fatal cases was 1.46 (95% CI 1.12 to 1.91).ConclusionIn real-world clinical practice, use of two versus one long-acting bronchodilator by people with COPD is associated with a higher risk of ACS.

Prognosis in patients with prior myocardial infarction and PEGASUS-TIMI 54 criteria in the CLARIFY registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Biscaglia ◽  
G Campo ◽  
K Fox ◽  
J.C Tardif ◽  
M Tendera ◽  
...  
Keyword(s):  
High Risk ◽  
Major Bleeding ◽  
Artery Bypass ◽  
Real Life ◽  
Prolonged Treatment ◽  
Funding Source ◽  
Inclusion Criteria ◽  
Private Company ◽  
Exclusion Criteria ◽  
Coronary Syndrome

Abstract Background/Introduction The PEGASUS-TIMI 54 trial showed that prolonged treatment with ticagrelor reduces the cumulative occurrence of ischemic adverse events. CLARIFY is the biggest real life registry on chronic coronary syndrome. Purpose - To evaluate the percentage of patients eligible for long-term ticagrelor therapy in the CLARIFY registry. – To compare the outcome of this subgroup of patients with those with PEGASUS exclusion criteria or without PEGASUS inclusion criteria. Methods Within the CLARIFY population, we selected post MI patients and we excluded those with missing info (post MI evaluable population). Then, we divided patients into 3 groups: excluded (meeting PEGASUS exclusion criteria, namely use of P2Y12 receptor antagonists or chronic oral anticoagulant, any stroke, coronary-artery bypass grafting in the past 5 years); eligible (meeting PEGASUS high-risk inclusion criteria, namely age≥65 years; diabetes; multivessel disease; creatinine clearance <60 ml/min) and ineligible (not meeting PEGASUS high-risk inclusion criteria). We therefore compared the ischemic (CV death, MI and stroke) and bleeding (major bleeding) outcome of the 3 groups adjusting for age, sex, smoking and geographical region. Results Among the 11811 post-MI evaluable patients, 4706 (39.8%) were included in the eligible group, 5715 (48.4%) in the excluded group, and 1390 in the ineligible group (11.8%). Both the ischemic and bleeding endpoints were significantly different among the 3 groups with the excluded patients with the worst and ineligible patients with the best outcome (see table). The same trend was shown for CV death, while the occurrence of MI was not significantly different among the 3 groups. In the eligible group, the ratio between ischemic and bleeding events was 6:1, whereas between CV death and major bleeding was 3.5:1. Conclusions Around 40% of CLARIFY post-MI patients could benefit from prolonged ticagrelor therapy. In this group of patients, ischemic risk seems to be higher than the bleeding one. Ischemic & bleeding risk in the 3 groups Funding Acknowledgement Type of funding source: Private company. Main funding source(s): CLARIFY registry was funded by Servier

scholarly journals Estimating the burden of hyperkalaemia in the UK in high-risk patient populations

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P McEwan ◽  
L Hoskin ◽  
K Badora ◽  
D Sugrue ◽  
G James ◽  
...  
Keyword(s):  
Clinical Practice ◽  
High Risk ◽  
Patient Outcomes ◽  
Real World ◽  
High Risk Patient ◽  
Incidence Rates ◽  
Funding Source ◽  
Eligible Population ◽  
Increased Risk ◽  
The Uk

Abstract Background Patients with chronic kidney disease (CKD), heart failure (HF), resistant hypertension (RHTN) and diabetes are at an increased risk of hyperkalaemia (HK) which can be potentially life-threatening, as a result of cardiac arrhythmias, cardiac arrest leading to sudden death. In these patients, renin-angiotensin-aldosterone system inhibitors (RAASi), are used to manage several cardiovascular and renal conditions, and are associated with an increased risk of HK. Assessing the burden of HK in real-world clinical practice may concentrate relevant care on those patients most in need, potentially improving patient outcomes and efficiency of the healthcare system. Purpose To assess the burden of HK in a real-world population of UK patients with at least one of: RHTN, Type I or II diabetes, CKD stage 3+, dialysis, HF, or in receipt of a prescription for RAASi. Methods Primary and secondary care data for this retrospective study were obtained from the UK Clinical Practice Research Datalink (CPRD) and linked Hospital Episode Statistics (HES). Eligible patients were identified using READ codes defining the relevant diagnosis, receipt of indication-specific medication, or, in the case of CKD, an estimated glomerular filtration rate (eGFR) ≤60 ml/min/1.73m2 within the study period (01 January 2008 to 30 June 2018) or in the five-year lookback period (2003–2007). The index date was defined as 01 January 2008 or first diagnosis of an eligible condition or RAASi prescription, whichever occurred latest. HK was defined as K+ ≥5.0 mmol/L; thresholds of ≥5.5 mmol/L and ≥6.0 mmol/L were explored as sensitivity analyses. Incidence rates of HK were calculated with 95% confidence intervals (CI). Results The total eligible population across all cohorts was 931,460 patients. RHTN was the most prevalent comorbidity (n=317,135; 34.0%) and dialysis the least prevalent (n=4,415; 0.5%). The majority of the eligible population were prescribed RAASi during follow-up (n=754,523; 81.0%). At a K+ threshold of ≥5.0 mmol/L, the dialysis cohort had the highest rate of HK (501.0 events per 1,000 patient-years), followed by HF (490.9), CKD (410.9), diabetes (355.0), RHTN (261.4) and the RAASi cohort (211.2) (Figure 1). This pattern was still observed at alternative threshold definitions of HK. Conclusion This large real-world study of UK patients demonstrates the burden of hyperkalaemia in high-risk patient populations from the UK. There is a need for effective prevention and treatment of HK, particularly in patients with CKD, dialysis or HF where increased incidence rates are observed which in turn will improve patient outcomes and healthcare resource usage. Figure 1. Rates of HK by condition Funding Acknowledgement Type of funding source: Private company. Main funding source(s): AstraZeneca

scholarly journals S114. THE EFFICACY OF “URGENT CONSULTATION REQUEST”; PRELIMINARY ANALYSIS OF A REAL-WORLD APP (REMIDCARE) FOR EARLY PSYCHOSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S77-S78
Author(s):  
Lucia Bonet ◽  
David Arce ◽  
Ignacio Blanquer ◽  
Blanca Llacer ◽  
Sanjuan Julio
Keyword(s):  
Clinical Practice ◽  
Real World ◽  
Psychiatric Care ◽  
Hospital Admissions ◽  
Early Psychosis ◽  
Urgent Care ◽  
Phone Call ◽  
Consultation Request ◽  
High Engagement ◽  
Clinic Hospital

Abstract Background Patients are clamming for more personalized and closer clinical attention (Bonet et al. 2018). To this end, we developed RemindCare app. The app conducts daily and weekly assessments and this information is used to prevent relapses, to improve the therapeutic alliance and it is automatically included at the electronic clinical record of the hospital. Moreover, patients can contact clinicians by an “Urgent Consultation Request” (UCR), which is answered by a phone call in a period of 24-48h. This app was introduced in clinical practice in October 2018. Since then, 81 patients met criteria for inclusion and 57/81 (71%) started using the app. The aim of this study is to analyze the efficacy of this UCR to determine if this function can improve the real-world treatment of patients with early psychosis. Methods RemindCare app, is offered as an extra-service to the usual psychiatric care of patients in an Early Psychosis Program (EPP) at the Clinic Hospital of Valencia, Spain (Bonet et al. 2019). No remuneration is offered to any patient or clinician to use the app. Data of 57 patients diagnosed with a psychotic disorder was analyzed: the 26.3% (15/57) used the UCR (UCR group) and the 73.7% (42/57) did not (Non-UCR group). Mean age of the sample was 31.5 (SD=9.3), 56.1% were male, 87.7% caucasian and 82.5% were single. Mean years of illness was 3.5 (SD=2.8), CGI mean 4.1 (SD=0.9), GAF mean 60.5 (SD=12.3) and PANSS mean 56.6 (SD=12.2). Results Mean of months using the app was 8.4 (SD=4.5), 38.6% (22/57) of patients used the app for more than a year (12–13 months) and mean of engagement was 84.3 (SD=18.9). No significant differences were found between UCR and Non-UCR group in terms of demographic and clinical characteristics. However, there was a difference between groups in terms of engagement to the app (χ2= 6.3, p=0.04). The 93.3% of the UCR group had a percentage of engagement to the app between 81–100% compared to the 66.7% in the Non-UCR group and the number of visits to the Urgent Care Units (UCU) was also higher in the UCR group (χ2= 4.4, p=0.03). Additionally, only the 13.3% (2/15) of patients used the UCR for a psychotic symptom′s aggravation, the 33.3% (3/15) used it to inform of anxiety symptoms and another 33.3% (3/15) to change the clinical appointment. Moreover, the 66.7% (4/6) of patients who attended to UCU had previously made an UCR and they went to the UCU before that period of 24-48h of clinical response ended. Finally, there were no differences in terms of hospital admissions (χ2= 1.1, p=0.3) and psychotic relapses (χ2= 0.08, p=0.8) between groups. However, patients who stopped using the app had more relapses than patients who continued using it (χ2= 15.3, p<0.000). Discussion To our knowledge, this is the first e-Health intervention systematically introduced in clinical practice. Rates of acceptance and engagement are high (71%; 84.3%) and nearly 40% of the sample is using the app for more than a year. Mean of engagement with the app, was extremely high among patients who used the UCR (93.3%; engagement between 81–100%) and although this UCR service was the most required in our previous survey (Bonet et al. 2018), these preliminary results suggest ¡ that the use of this alarm is not related to psychotic relapse detection. However, patients who use RemindCare app had less relapses than the ones who discontinue its use, which highlights the efficacy of the app. This, along with the high engagement and the positive feedback received, suggests that an improvement in real-world treatment of patients with early psychosis may be found in upcoming analysis.

Abstract P11: Use of Hospital Claims Data to Estimate the Clinical and Economic Burden of Acute Coronary Syndrome Rehospitalizations in Real-World Clinical Practice

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Gregory Hess ◽  
Durgesh Bhandary ◽  
Sanjay Gandhi ◽  
Deepa Kumar ◽  
Eileen Fonseca ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Clinical Practice ◽  
Real World ◽  
Hospitalization Rate ◽  
Index Hospitalization ◽  
Coronary Syndrome ◽  
Hospitalization Rates ◽  
St Elevation ◽  
The Mean

Background: Re-hospitalization rates are emerging as quality of care measures with reimbursement implications for inpatient care. Objective: To examine the rates of inpatient re-hospitalization and economic burden of acute coronary syndrome (ACS) patient admissions in real-world clinical practice. Methods: Patients (age >18 years) with an inpatient hospitalization for ACS [ICD-9-CM codes for acute myocardial infarction or unstable angina (UA)] between 1/1/2007-4/30/2009 were identified using claims from 450 hospitals representing 4.8 million inpatient visits. All-cause and ACS-related re-hospitalizations within 30 days and 12 months after index event were evaluated. In addition, the mean inpatient admission charges resulting from inpatient re-admissions at 30 days were also estimated. Results: Of 17,904 ACS patients [52% male; mean age 70.6 (median-73.0) years)], 13.3% had diagnostic coding for ST elevation myocardial infarction (STEMI), 47.9% had coding for non-ST elevation myocardial infarction (NSTEMI), 32.2% had UA, and 6.5% had not otherwise specified (NOS) ACS. The 30-day all-cause inpatient re-hospitalization rate was 14.7% (STEMI: 12.7%, NSTEMI: 17.1%, UA: 12.5%, NOS: 10.8%) and 5.5% for an ACS-related re-hospitalization (STEMI: 7.6%, NSTEMI: 7.0%, UA: 2.8%, NOS: 3.9%). The 12-month all cause re-hospitalization rate was 37.7% (STEMI: 31.3%, NSTEMI: 39.9%, UA: 39.7%, NOS: 25.4%) and 12.5% for an ACS-related re-hospitalization (STEMI: 12.7%, NSTEMI: 14.3%, UA: 10.9%, NOS: 7.0%). For patients with ages > 65 years (N = 12,627), the 30-day all-cause and ACS-related re-hospitalization rates were 15.1% and 5.8%, respectively. The mean per patient additional charges resulting from 30-day all-cause and ACS-related re-hospitalizations in the study cohort with an index hospitalization (N=17,904) were estimated to be $13,160 and $7,216, respectively. Conclusion: High rates of re-hospitalization for ACS patients within 30 days and 12-months post-index hospitalization were observed using real-world clinical practice data. More effective therapies may provide an opportunity to improve important clinical and economic outcomes in ACS patients.

scholarly journals RV Pacing Percentage

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y.M Cha ◽  
M.D Metzl ◽  
R.C Canby ◽  
E.M Fruechte ◽  
M Duggal ◽  
...  
Keyword(s):  
Real World ◽  
Cox Regression ◽  
Funding Source ◽  
Private Company ◽  
Risk Of Death ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Rv Pacing ◽  
First 90 Days ◽  
The Relationship

Abstract Introduction Chronic right ventricular pacing (RVP) has been associated with dyssynchrony, leading to increased mortality. However, there have been discrepancies in previous reports in the effect of RVP levels. Objective To sub-stratify mortality risk by age for different RVP level groups within a large real-world ICD cohort. Methods Optum® de-identified electronic health records were linked to the Medtronic Carelink data to identify dual chamber ICD recipients (2007–2017). RVP level was based on median daily pacing during the first 90 days post-implant and categorized either into groups with a cutoff of 40%, or with groups of 0–9%, 10–19%, 20–29%, 30–39%, 40–49%, and 50–100%. The endpoint was death more than 90 days post-implant. Kaplan-Meier survival curves, log-rank tests, and Cox regression were used to analyze the relationship between RVP and risk of death. Results Among 14,832 ICD patients (median age 67; 74.0% male), there were 2,602 deaths within 10 years after implant. In unadjusted comparisons, high RVP (>40%) increased the risk of death relative to low RVP (≤40%) (p<0.001). This effect remained significant in older cohort (≥67 years old at implant) (p<0.001), but not in younger cohort (<67 years old) (p=0.955) (Figure). After controlling for age, gender, pacing mode, MI, SCA, HF hospitalization, diabetes, and renal dysfunction, similar or increased risk was associated with higher pacing groups relative to the 0–9% pacing group in the older cohort, but not in the younger cohort. Conclusions Our data from a large contemporaneous real-world source suggests that older age or characteristics associated with age make patients more sensitive to chronic RVP effects. These results help reconcile differences observed in prior studies. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Medtronic, Inc.

Apabetalone, a selective BET protein inhibitor, reduces ischemic cardiovascular events and hospitalization for heart failure in patients with acute coronary syndrome and type 2 diabetes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K.K Ray ◽  
S.J Nicholls ◽  
K.A Buhr ◽  
H.N Ginsberg ◽  
K Kalantar-Zadeh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Acute Coronary Syndrome ◽  
Number Needed To Treat ◽  
Funding Source ◽  
Protein Inhibitor ◽  
Private Company ◽  
Coronary Syndrome ◽  
Bet Protein

Abstract Background Despite established treatments, patients with type 2 diabetes mellitus (T2DM) and acute coronary syndrome (ACS) are at higher risk of ischemic cardiovascular (CV) events and hospitalization for heart failure (HHF) compared to those without T2DM. LDL-C lowering or use of GLP-1 agonists predominantly affects ischemic CV events, with little effect on HHF. Conversely, treatment with SGLT-2 inhibitors reduces HHF, with less effect on ischemic CV events. Preclinical studies indicate that bromodomain and extra-terminal (BET) proteins coordinate gene transcription for pathways that promote atherothrombotic events as well as heart failure. We assessed the clinical effect of apabetalone (APB), a novel BET protein inhibitor, on a composite of non-fatal ischemic CV events, HHF, and CV death in a post hoc analysis of the BETonMACE trial Methods BETonMACE was a double-blind, placebo-controlled phase 3 study in patients with T2DM and recent acute coronary syndrome receiving standard of care risk factor management. In 13 countries, 2425 patients were enrolled. We conducted a time-to-event analysis for first adjudicated CV death or non-fatal MI, stroke, or HHF using a log-rank test and Cox proportional hazards model. Results At baseline median age was 62 years, 25.6% were female, 87.6% white, and use of high intensity statin, ACE inhibitors/ angiotensin II blockers, dual antiplatelet therapy and beta blocker were 90, 88, 92 and 91% respectively. A total of 312 subjects had an endpoint event, with 139 (11.5%) patients in the ABP group and 173 (14.3%) among PBO (HR 0.78, 95% CI 0.63–0.98, p=0.03, Figure). At 26 months, the absolute risk reduction was 3.2% and number needed to treat was 31. Numerically favorable HRs were observed for each component endpoint except for stroke (Table). Conclusion This present analysis suggests that BET inhibition with APB may be a novel pathway through which to reduce both HHF and ischemic CV events in high risk patients with T2DM thus impacting broader clinical outcomes with potentially large benefits for patients and healthcare systems. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Resverlogix Corp

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