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Heart, Lung and Circulation Abstracts S1972007;16:S1–S201

SUNDAY 12 AUGUST

Heart Failure

487Anaemia in Heart Failure: Influence on Clinical Course

G. Tofler ∗, A. Sullivan, R. Cleary, G. Gillies, S. Hales, I.Pryde, V. Baker

Management of Cardiac Function (MACARF), NSCCAHS,NSW, Australia

Background: Anaemia is increasingly recognised as anadverse factor in patients with heart failure (HF). How-ever, the relationship between anaemia and clinicalfeatures including readmission rates needs to be betterdefined.Methods: We reviewed 959 patients enrolled in sevenhospitals participating in the Management of CardiacFunction (MACARF) programme in 2004–2005.Results: Thirty-eight (n = 369) of patients hospitalised withHF had anaemia (Hb < 12.0 g/L). There was no significantdifference between anaemic and non-anaemic patientsin age (79 versus 77 years). However, anaemic patientswere more likely to be female (51 versus 44%, p = 0.03),have s Creatinine >0.12 [48 versus 29%, p < 0.001], hypona-traemia (s sodium < 134 meq/L) [20 versus 15%, p = 0.053],and LVEF > 40% [49 versus 39%, p = 0.004]. On hospitaldAbsrtvHmpCcrsira

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488An Audit of Percutaneous Coronary Intervention (PCI)Patients Representing Acutely with Chest Pain within 6Months of PCI

Carmel Harris ∗, I. Crozier, D. Smyth, J. Elliott, P. Watson,J. Sands, R. Cuddihy

Cardiology Day Unit, Christchurch Hospital, New Zealand

Background: The 1999 ACC/AHA guidelines for coronaryangiography recommend repeat angiography for patientsadmitted acutely with chest pain within 6 months of PCI toassess coronary revascularisation. As the volumes of PCIincrease so does the demand for repeat angiography.Methods: We audited the clinical notes of all patientswho were re-admitted acutely with chest pain within 6months of PCI procedures performed between 1/4/05 and30/9/05. Ethics approval was granted and an audit tool wasdesigned based on the 2000 ACC/AHA Guidelines for themanagement of patients with unstable angina. The pur-pose of the audit was to determine to what extent bestpractice guidelines were followed in the assessment ofpatients re-admitted with chest pain and to determine ifthere were any indicators (lesional, procedural or risk fac-tors for restenosis) that predicted a normal or abnormalrRparupnCtpcwttw

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ischarge, anaemic patients were less likely to receiveCE inhibitors (72 versus 78%, p = 0.04) although beta-locker, aspirin, and other cardiac medication uses wereimilar. Patients with anaemia had higher 12-month HFeadmission rates (22.4 versus 15.7%, p = 0.01) and tendedo have more multiple (2 or more) HF readmissions (6.3ersus 3.9%, p = 0.11). Anaemic patients had similar non-F readmission rates (26.1 versus 23.1%, p = 0.31), butore multiple non-HF readmissions (12.4 versus 6.3%,= 0.001).onclusion: In-patients hospitalised with HF, anaemia is

ommon (38%), and is associated with female gender,enal impairment, hyponatraemia, relatively preservedystolic function, and less ACE inhibitor use. Anaemiadentifies patients at increased risk for HF and non-HFeadmissions. The role of anaemia in HF is multifactorialnd requires further investigation.

oi:10.1016/j.hlc.2007.06.492

epeat coronary angiogram.esults: Four hundred and forty-eight consecutiveatients had PCI procedures, 36 patients representedcutely with chest pain and had repeat coronary angiog-aphy. In 18 patients, the coronary angiogram wasnchanged, 11 patients demonstrated instent restenosis, 1atient demonstrated thrombus and 6 patients developedew lesions.onclusion: At Christchurch Hospital, assessment prac-

ices are consistent with international guidelines. Ofatients who had repeat angiography 50% had nooronary obstruction for the cause of pain. Thereas a relatively low incidence of acute representa-

ion with chest pain. Our results suggest a revision ofhe guidelines for repeat angiography following PCI isarranted.

oi:10.1016/j.hlc.2007.06.493

89T-elevation Myocardial Infarction in Rural and Remotereas: A Comparison of Prehospital and In-hospitalhrombolysis

.C. Faddy

Cardiac Catheterisation Unit, St Vincent’s Hospital, Sydney,ustralia

ackground: Primary PCI is the accepted treatment forT-elevation myocardial infarction (STEMI). Many infarctsccur in rural and remote areas not serviced by interven-ional cardiology centres and are treated with traditional

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S198 Abstracts Heart, Lung and Circulation2007;16:S1–S201

thrombolytic regimens. Earlier initiation of reperfusiontherapy has been associated with improved outcomes.This study investigates whether commencing throm-bolysis prior to arrival at hospital improves outcomescompared to standard in-hospital thrombolysis.Methods: Studies comparing prehospital thrombolysis(PHT) with in-hospital thrombolysis (IHT) for STEMI weresought. A meta-analysis was performed for in-hospitalmortality, re-infarction, stroke and prehospital complica-tions.Results: Six randomised studies and three non-randomised registries included treatment arms forprehospital and in-hospital thrombolysis. Prehospitalthrombolysis was associated with reduced in-hospitalmortality (RR 0.85, 95% CI 0.73–0.99, p = 0.03). The riskof re-infarction (RR 0.92, 95% CI 0.43–1.93, p = 0.82) andstroke (RR 1.05, 95% CI 0.70–1.57, p = 0.81) were notsignificantly different between the treatments. Therewas no increase in the risk of prehospital complicationsfollowing PHT. In the only study performed in a ruralarea, prehospital thrombolysis led to treatment 130 minearlier than in-hospital thrombolysis. Studies have shownthat earlier thrombolysis leads to improved survival anddecreased infarct size.Conclusions: Administering thrombolytic therapy in theprehospital setting appears to improve survival without asignificant increase in complications. Clinical trials com-

prescribed Angiotensin II receptor blockers (ARBs). By 6months, <25% of the patients who were on sub-optimaldose BBs or ACEIs at baseline, had been up-titrated tomaximum dose (p < 0.0001). In CHF programmes, wherenurses were able to titrate medications, 75% of patientsreached optimal dose of BBs compared to those programswith no nurse-led medication titration, where only 25% ofpatients reached optimal dose (p < 0.004). BBs and ACEIs,were both prescribed in combination in 60% of patients.Conclusion: Whilst prescribing rates for a single medica-tion of BBs, or ACEIs were >70%, an increase in dosage ofthese medications and utilisation of combination therapyof these medications was poor. It is suggested that clini-cal outcomes for this cohort of patients could be furtherimproved by adherence to evidence-based practice, andoptimisation of these medications by heart failure nursesin a CHF program.

doi:10.1016/j.hlc.2007.06.495

491Nicotine Replacement Therapy in the Coronary Care Unit

J. Poole ∗, A.J. Kerr, J. McGuiness, M. Horton, K. Poppe,A. Poole, J. Gilmore

Department of Cardiology, Middlemore Hospital, New Zealand

Background: Abrupt smoking cessation can produce an

paring prehospital and in-hospital thrombolysis in ruralsettings are warranted.

doi:10.1016/j.hlc.2007.06.494

490Titration of Medications by HF Nurses Increases Optimi-sation Doses of Key Therapeutic Agents

A. Driscoll 1,∗, L. Worrall-Carter 1, D.L. Hare 2, P.M.Davidson 3, B. Riegel 4, A. Tonkin 5, S. Stewart 6

1 Deakin University, Melbourne, Australia; 2 University ofMelbourne, Melbourne, Australia; 3 University of WesternSydney, NSW, Australia; 4 University of Pennsylvania, Penn-sylvania, USA; 5 Monash University, Melbourne, Australia;6 Baker Institute, Melbourne, Australia

Background: Chronic heart failure (CHF) has a high mor-tality and morbidity. Large scale RCTs have proven thebenefits of beta blockade (BB) and ACE inhibitors (ACEI)in reducing mortality in patients with CHF and expertguidelines mandate their use. In spite of these recommen-dations, important therapies are under-prescribed andunder-utilised.Method: One thousand and thirty-four consecutivepatients enrolled in CHF management programs were sur-veyed during 2005–2006 and followed up for 6 months todetermine prescribing patterns in heart failure medica-tions.Results: The survey revealed that BB were prescribed to80% of patients (>85% were on sub-optimal doses) and70% were prescribed ACEIs (approximately 50% wereon sub-optimal dose). Nineteen percent of patients were

adverse physiological response but the AHA guidelines(2004) do not recommend nicotine replacement therapy(NRT) during hospitalisation for an acute cardiac eventbecause of potential sympathetic effects of nicotine. How-ever, there was no evidence to suggest that NRT would beunsafe. A protocol was introduced into CCU to offer nico-tine replacement therapy to patients who scored >6 in theFagestrom dependency scale.Aim: A prospectively planned case review has been usedto assess use and safety of NRT in patients with acutecoronary syndromes (ACS).Methods: Data are reported from 99 consecutive ACSpatients who received NRT whilst in CCU. Data were col-lected to assess both clinical and physiological responsesto NRT.Results: No patient self discharged and all patients weredischarged alive. Arrhythmias occurred in four patientsnot related to starting NRT. Eight patients had an episodeof chest pain without elevation in cardiac enzymes. Therewas no significant difference in the average systolic ordiastolic BP or HR pre- and post-NRT. When stratifiedaccording to NRT dose/day started, there was no signif-icant difference in systolic/diastolic BP pre and post NRT.Conclusion: The use of NRT in the Coronary Care Unitappears to be safe and caused no adverse physiologicalresponses or important adverse clinical events. Patientoutcomes may also be improved if self-discharge is pre-vented.

doi:10.1016/j.hlc.2007.06.496