SAT0603 SYSTEMIC SCLEROSIS IS AN INDEPENDENT RISK FACTOR FOR ISCHEMIC HEART DISEASE WITH AN ADDITIONAL RISK IN THOSE POSITIVE FOR CERTAIN ANTI-PHOSPHOLIPID ANTIBODIES: A VERY LARGE CASE-CONTROL STUDY

Background:A higher prevalence of ischemic heart disease (IHD) in patients with systemic sclerosis (SSc) was reported. However, contrasting findings were published concerning the role of SSc-related autoantibodies in IHD risk which remains controversial.Objectives:The current study explored the link between SSc and IHD, impact of putative links on SSc mortality and the role of SSc-related and antiphospholipid autoantibodies in disease associated IHD.Methods:A large cohort study utilising the Clalit-Health-Service (CHS) database was conducted on 2,431 SSc patients and 12,710 age- and sex matched controls. The proportion of IHD was compared between patients diagnosed with SSc and age- and gender-matched controls. The role of SSc-linked and antiphospholipid autoantibodies in disease associated IHD was assessed.Results:The rate of IHD was significantly higher in SSc than controls (20.4%vs15.0%, p<0.001). At the multivariate analysis, SSc was an independent predictor of IHD with an OR of 1.91 (95%CI 1.57-2.31, p<0.0001). SSc patients with IHD had a higher mortality rate with an HR of 2.67 (95%CI 2.03-3.53, p<0.0001) than those without IHD. SSc patients with positive anti-beta2GPI (IgM-isotype) or anti-cardiolipin (aCL) (IgA-isotype) exhibited a higher risk of IHD than SSc patients without these antibodies with an OR 1.89 (95% 1.04-3.45, p=0.0369) and OR of 3.72 (95% 1.25-11.11, p=0.0184), respectively.Conclusion:Patients with SSc are at higher risk for developing IHD with an additional risk for the latter in those positive for aCL or anti-beta2GPI. A high degree of suspicion is needed during routine patient follow-up and pre-emptive screening should be considered.Disclosure of Interests:Abdulla Watad: None declared, Dennis McGonagle Grant/research support from: Janssen Research & Development, LLC, Nicola Luigi Bragazzi: None declared, Doron Comanesther: None declared, Arnon Cohen: None declared, Merav Lidar: None declared, Howard Amital: None declared

SAT-425 Characteristics of Hypothyroid Patients Achieving Long Term Euthyroidism on Levothyroxine Treatment

Background Studies have shown that hypothyroid patients treated with Levothyroxine replacement therapy often experience fluctuations in TSH levels, while others remain well controlled over time. Aim To assess the association between pre-treatment TSH and other biochemical and clinical characteristics and long-term maintenance of normal TSH under Levothyroxine treatment. Methods This is a retrospective nested case-control study. Study population included patients above age 18 insured by Clalit Health Service (CHS) in the South of Israel between the years 2002-2017, diagnosed with hypothyroidism (ICD 9 code 244.9) and who had at least one TSH measurement before initiating levothyroxine therapy, purchased this medication for at least 5 consecutive years with one annual TSH measurement while on treatment. Patients with surgical, post iodine ablation or congenital hypothyroidism were excluded. Patients with a TSH level within the normal range for 5 consecutive years were defined as cases while the others served as controls. Demographic, laboratory, pregnancy status and pharmacy purchase were extracted from the computerized medical records of CHS and compared between the groups. Results Out of 5472 patients included in the study, 644 had a normal TSH for 5 consecutive years (11.8%, cases). Mean age at first levothyroxine purchase was 55.8±13.7 in cases and 54.10±16.2 in controls (p=0.003) and females comprised 84.8% and 81.4% respectively (p=0.035). Mean pretreatment TSH was 5.15±9.6 in cases and 10.02±29 in controls (p&lt;0.001). Thyroid autoantibodies (anti TPO or anti thyroglobulin) were available in 40.8% and 44.8% of cases and controls respectively (P=0.63) and were positive in 36.5% and 56.7% (p&lt;0.01). Subclinical hypothyroidism was diagnosed in 44.4% of cases and 54.6% of controls with prior to treatment. The odds ratio (OR) for having normal TSH for at least 5 consecutive years, using multivariable logistic regression was 0.99 for pretreatment mean TSH (p=0.89), 0.48 for positive thyroid antibodies (p&lt;0.001), 0.72 for pretreatment diagnosis of subclinical hypothyroidism (p=0.032), 0.69 for use of iron supplements and 1.01 for age at first levothyroxine purchase (per year, p=0.02). Conclusions In our study population of adults with hypothyroidism treated with levothyroxine, only 11.8% were controlled for at least 5 consecutive years. Positive thyroid autoantibodies, pretreatment subclinical hypothyroidism and use of iron supplements lowered probability of long term TSH normalization, while age was associated with the increased rate. Further research should test whether TSH control for 5 consecutive years signals simply “good contol”, or perhaps the possibility of transient forms of hypothyroidism for which treatment discontinuation is recommended.

Validating reported cause of death using integrated electronic health records from a nation-wide database

Background To compare the underlying cause of death reported by the Israeli Central Bureau of Statistics (CBS) with diagnoses in the electronic health records (EHR) of a fully integrated payer/provider healthcare system. Methods Underlying cause of death was obtained from the CBS for deaths occurring during 2009–2012 of all Clalit Health Service members in Israel. The final cohort consisted of members who had complete medical records. The frequency of a supportive diagnosis in the EHR was reported for 10 leading causes of death (malignancies, heart disease, cerebrovascular disease, diabetes, kidney disease, septicemia, accidents, chronic lower respiratory disease, dementia and pneumonia and influenza). Results Of the 45 680 members included in the study, the majority of deaths had at least one diagnosis in the EHR that could support the cause of death. The lowest frequency of supportive diagnosis was for septicemia (52.2%) and the highest was for malignancies (94.3%). Sensitivity analysis did not suggest an alternative explanation for the missing documentation. Conclusions The underlying cause of death coded by the CBS is often supported by diagnoses in Clalit’s EHR. Exceptions are septicemia or accidents that cannot be anticipated from a patient’s EHR, and dementia which may be under-reported.

PROLONGED MECHANICAL VENTILATION: CHARACTERISTICS OF PATIENTS TREATED AT HOME COMPARED TO HOSPITAL LONG-TERM CARE

Rising numbers of patients receiving Prolonged Mechanical Ventilation (PMV) pose a challenge, and advancing technology supports ventilators appropriate for either Home or Hospital Long Term Care (HLTC).Data guiding decisions concerning place of care are lacking. This study describes the characteristics of the majority (120/123) of all PMV patients aged ≥18 (and their caregivers) in Jerusalem, covered by the Clalit Health Service, treated either with Home Hospital or HLTC. Patients were more alert and communicative at Home vs. HLTC (40/46 vs. 22/74), younger (54 vs.73 years, p12 years (36% vs.21%, p=0.1), and without legal guardian (59% vs. 12%, p&lt;0.01). Primary reason for PMV at home was degenerative neuromuscular disease (59% vs. 28%), compared to post resuscitation/sepsis/CVA in HLTC patients (17% vs. 62%), who suffered more comorbidity, functional decline post-PMV, and pressure sores (0% vs. 42%). Ventilation was more likely to be planned at home vs HLTC (33% vs. 8%), and yet 119/120 were without Advanced Directives prior to PMV. Caregivers at home tended to be spouses (48% vs. 31%) and offspring at HLTC (17% vs. 47%), with reduced Modified Caregiver Strain Index at home (10.5 vs. 12.9, p=0.12). Mortality during follow-up was lower at home (15.2% vs. 27%). Costs to the health fund for home versus HLTC were approximately 1:3. Our findings suggest that with appropriate targeting of eligible PMV patients, Home Hospital may be the preferred model of care for patients, caregivers and healthcare providers.