Concise Review of the Rationale for Pulmonary Embolism Treatment and Endovascular Device Therapies

: In the ever-changing landscape of device therapy for pulmonary embolism, it is important to understand the rationale behind the ongoing explosion in the development of new device therapies. There needs to be an in-depth understanding of risk stratification in pulmonary embolism and indications for therapy. Selecting the ideal device for a particular pulmonary embolism subset remains elusive and poorly defined. Knowledge of the risks, bene-fits, capabilities, and potential limitations of each device is crucial.

Ventricular arrhythmias in seniors with heart failure: present dilemmas and therapeutic considerations: a systematic review

Background: Heart failure (HF) is a global public health problem which affects over 23 million people worldwide. The prevalence of HF is higher among seniors in the USA and other developed countries. Ventricular arrhythmias (VAs) account for 50% of deaths among patients with HF. We aim to elucidate on the factors associated with VAs among seniors with HF, as well as therapies that may improve outcomes. Methods: PubMed, Web of Science, Scopus, Cochrane Library databases, Science Direct, and Google Scholar were searched using specific key words. The reference lists of relevant articles were searched for additional studies related to HF and VAs among seniors as well as associated outcomes. Results: The prevalence of VAs increases with worsening HF. 24-hour Holter electrocardiogram may be useful in risk stratifying patients for device therapy if they do not meet the criterion of low ventricular ejection fraction. Implantable cardiac defibrillators (ICDs) are superior to anti-arrhythmic drugs in reducing mortality in patients with HF. Guideline directed medical therapy (GDMT) together with device therapy to reduce symptoms may be required. In general, the proportion of seniors on GDMT is low. A combination of ICDs and cardiac resynchronization therapy may improve outcomes in select patients. Conclusion: Seniors with HF and VAs have a high mortality even with the use device therapy and GDMT. The holistic effect of device therapy on outcomes among seniors with HF is equivocal. More studies focused on seniors with advanced HF as well as therapeutic options is therefore required.

P134 Modified uvulopalatopharyngoplasty and radiofrequency-in-saline tongue in the management of snoring

Objective The modified uvulopalatopharyngoplasty has not been investigated as an option in primary snoring. The aim of this study was to determine whether combined palatal and tongue surgery to enlarge and stabilize the upper airway is an effective treatment for patients with primary snoring who cannot tolerate or decline device therapy. Study design This was a retrospective cohort study, and included adult patients with primary snoring who underwent modified uvulopalatopharyngoplasty and radiofrequency-in-saline tongue between January 2009 and December 2020. Patients with clinically significant obstructive sleep apnoea were excluded. Setting Single centre study, based in New South Wales, Australia. Methods Primary outcome measures were the Snoring Severity Scale (a questionnaire, which indicates loudness and frequency of snoring) completed both prior to and following surgery, and the Epworth Sleepiness Scale. Mean questionnaire scores prior to and at three-month follow-up were analysed. Results 97 adult patients underwent upper airway surgery for simple snoring, of which 68 were included in the present study (37.3 ± 11.5 years, n=17 female). The mean SSS prior to surgery was 7.0 ± 1.6 and 1.9 ± 2.3 at 3-month follow up (P < 0.0001).The mean ESS prior to surgery was 9.0 ± 4.8 and 4.1 ± 2.8 at 3-month follow up (P <0.0001). Conclusion The results of this study indicate that modified uvulopalatopharyngoplasty with radiofrequency-in-saline tongue is an effective treatment modality with a low complication rate. This procedure should be offered to carefully selected patients with primary snoring who have failed or declined device therapy.

Impact of the Covid-19 pandemic on the device therapy for patients with the heart failure

Introduction Hospital admissions of patients with cardiovascular disease were markedly reduced in the UK in 2020 during the Covid-19 pandemic. In many institutions, including ours, patient care was redistributed from a specialty-based approach to a ward-based system, meaning some patients being admitted and managed under the care of non-specialist teams. Purpose We wished to examine the impact of these changes on heart failure (HF) patients presenting during the pandemic and on appropriate delivery of complex device therapies. Methods The study was undertaken in a large UK teaching hospital. The institution audit programme includes cardiac device therapy provision, aiming to ensure that implantable cardioverter defibrillators and cardiac resynchronisation therapy are offered to the target population in accordance with NICE guidance [Technology Appraisal 314]. In accordance with the guidance, patients admitted to hospital with serious ventricular arrhythmia, familial cardiac condition with high risk of sudden cardiac death (SCD), surgical repair of congenital heart disease (CHD) and patients with HF and LVEF<36% were identified from hospital coding. Findings during the pandemic (March to August 2020) were compared with the same period in 2019. Fisher's exact test was used to compare proportions. Results Among non-HF patients, device therapy prescription was consistent in the two periods observed. Table 1 shows how many patients were eligible for device therapy and how many were offered it. Table 2 contains details of HF admissions, showing an 8% reduction in admissions during the pandemic. The proportion of patients eligible for device therapy did not change significantly. However, there was a significant reduction in the proportion of eligible patients who were offered device therapy (79% vs 94% p=0.03). In addition, during the pandemic there was a trend towards a greater chance of patients being considered too frail for device therapy (p=0.08). Among 12 patients overlooked for device therapy, 10 were not under the care of Cardiology. Among 31 patients considered too frail for device therapy, 26 were not under the care of Cardiology. Conclusion During the Covid-19 pandemic, a modest reduction in HF hospital admission was observed with a marked fall in identification of patients eligible for device therapy. Possible explanations include intense pressure to discharge patients quickly, an increased perception of patient frailty during a crisis and the lack of recognition of indications for device therapy when patients are under the care of non-specialists. These findings suggest that cardiac services should actively look for HF patients who may have missed out on life-saving device therapies during the pandemic. FUNDunding Acknowledgement Type of funding sources: None.

Heart Failure: Insights into Device Therapy

not available Cardiovasc j 2021; 14(1): 1-3