Debate: Who should care for GUCH?

1) Adult congenital heart disease patients require specialized care from centers with expertise in both pediatric and adult congenital heart conditions, as well as relevant volume of complex cases. 2) An ACHD center needs a multidisciplinary team with subspecialty care in areas like cardiology, cardiac surgery, and obstetrics, and should foster academic productivity and education. 3) Building for the future, the presentation advocates for resources to train specialized teams and collaboration between pediatric and adult hospitals to establish a comprehensive ACHD center like the new Boston Adult Congenital Heart center between Boston Children's Hospital and Brigham and Women's Hospital.

Health & Medicine

WE should look after
Adult Congenital Heart Disease Patients
Peta Alexander
Staff Physician, Department of Cardiology
Medical Lead, Cardiac ECMO
Boston Children’s Hospital and Harvard Medical School

DISCLOSURES
Site PI for Novartis serelaxin study
Site PI for Tenax Therapeutics, Inc levosimendan expanded access study
Member of Event Adjudication Committee for Entresto
pediatric randomized control trial (Novartis)
2

Survival from birth to 18 years
1970-1974
1975-1979
1980-1984
P<0.0001
1985-1989
1990-1992
Age
1.00
0.98
0.96
0.94
0.92
0.90
0.88
0.86
0.84
0.82
0.80
0 42 6 8 10 12 14 16 18

RATIO OF ADULTS TO PAEDIATRIC SURVIVORS
1965 1985 2010
Pediatric patients
Adult patients
Williams RG, et al. J Am Coll Cardiol. 2006;47(4):701-707; Marelli, AJ, et al. CirculationAHA. June 2014.
33% 66%

Loss of follow-up from age 6 to 22 years among the entire study cohort
Mackie A S et al. Circulation 2009;120:302-309
0
130
260
390
520
650
<6 6 to 12 13 to 17 18 to 22
Diagnosed
by
Cardiologist
643 (100 %)
Seen by
Cardiologist
413 (64%)
Seen by
Cardiologist
292 (49%) Seen by
Cardiologist
249 (39%)
Attrition
177 (28%)
Attrition
123 (19%)
Attrition
94 (19%)
53 (8%)
51 (8%)
N = 643
(100%)
N = 643
(100%)
N = 466
(72%)
N = 343
(53 %)
LOSSTOFOLLOWUP

LOSS TO FOLLOW UP
7
Mackie A S et al. Circulation 2009;120:302-309
0
10
20
30
40
50
60
70
80
90
100
0 2 4 6 8 10 12 14 16 18
Outpatient visits to cardiologist
Outpatient visit to primary care
Any encounter with health care system

Mylotte D et al. Circulation. 2014;129:1804-1812
100
80
60
40
20
0
20
18
16
14
12
10
8
6
4
2
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Deaths(per1,000ACHDpopulationperyear)
PatientsreferredtoACHDcenters
(per1,000ACHDpopulationperyear)
Guideline
presentation
Guideline
publication
Change-pointvisits
Change-pointdeaths
Interaction
p<0.0001
Interaction
p=0.04
Referral to specialized ACHD centre and mortality

WHAT IS REQUIRED OF AN ACHD CENTRE?
1965 1985 2010
Pediatric patients
Adult patients
Williams RG, et al. J Am Coll Cardiol. 2006;47(4):701-707; Marelli, AJ, et al. CirculationAHA. June 2014.
33% 66%

WHAT IS REQUIRED OF AN ACHD CENTRE?
EXPERTISE

What is required of an ACHD centre?
EXPERTISE with relevant VOLUME
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
0
200
400
600
800
1000
1200
1400
%Mortality
TotalAdmissions
Total # Patients Percentage
CICU ADMISSIONS
1992-2015

What is required of an ACHD centre?
EXPERTISE with relevant VOLUME
CARDIAC SURGICAL
VOLUME
1998-2015
0
200
400
600
800
1000
1200
1400
1600
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
706 691 688 722 677
756
685 698 721
666
766
827 820 848 841 871 880 897
280 306 338
335 395 257 379 387
444
456
496
550
434 381 408
573 583 533
Pump Cases NonPump Cases

What is required of an ACHD centre?
EXPERTISE with relevant VOLUME
0
200
400
600
800
1000
1200
1400
1600
706 691 688 722 677 756 685 698 721 666
766 827 820 848 841 871 880 897
280 306 338 335 395 257 379 387
444
456
496
550
434 381 408
573 583 533
Pump Cases
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
0
200
400
600
800
1000
1200
1400
Total # Patients Percentage
Neonate
15%
1-12 months
26%
1-5 years
27%
5-10 years
10%
10-18 years
13%
18+ years
9%

What is required of an ACHD centre?
SUBSPECIALTY COLLABORATIVE CARE

What is required of an ACHD centre?
ACADEMIC PRODUCTIVITY

What is required of an ACHD centre?
EDUCATION AND COLLABORATION

WhatisrequiredofACHDcentre?
RESOURCESFORTEAMTRAINING

What is required of an ACHD centre?
BUILDING for the FUTURE

BACH
BOSTON CHILDREN’S HOSPITAL
AND BRIGHAM AND WOMEN’S HOSPITAL

The document outlines the development of an osteoporosis and bone health service in Rotherham from 1995-2016. It traces the timeline from early interest groups in 1995 to the official opening of the Rotherham Osteoporosis & Bone Health Service in 2006. It then details the expansion of the service, including the addition of a fracture liaison service in 2015 to form an integrated bone health, falls, and fracture prevention program. The goal of the integrated service is to identify patients at high risk of falls and fractures to provide comprehensive assessment, education, and evidence-based interventions to reduce future fracture risk and injuries from falls.

Osteoporosis 2016 | Calcium, with or without vitamin D supplementation, is no...

International Chair on Interventional Cardiology and Transradial Approach

05a rytting ayasa10 ho

Methodist HealthcareSA

This document discusses treating young adults with acute lymphoblastic leukemia and whether current progress is being made. It notes that ALL represents about 1% of adult malignancies but outcomes differ based on age, with younger patients faring better. The document advocates starting a clinical trial for patients aged 21-39 to test whether a pediatric-based therapy could achieve better results than standard adult protocols given improvements seen in adolescents. Key questions to address include what regimen should be the standard arm and how to overcome obstacles to recruiting this underinsured patient group.

Gilchrist IC 201305

Ultrasound can help with planning and obtaining radial artery access for cardiovascular procedures. Planning ultrasound examines artery size and anatomy to select the optimal access site and sheath size, reducing fluoroscopy time. Ultrasound guided access improves first stick success rates and reduces average access time compared to palpation or blind access techniques. Meta-analyses show ultrasound guidance significantly increases the chance of successful first attempt radial artery access. While radial angiography provides information if access fails, ultrasound is preferable for access planning and guidance due to reduced pain, contrast, and radiation compared to angiography.

Ruzsa Z - AIMRADIAL 2014 Endovascular - Carotid artery stenting

International Chair on Interventional Cardiology and Transradial Approach

The deadly statistics of heart failure.

This document discusses statistics related to heart failure. It summarizes data on outcomes for hospitalized heart failure patients compared to chronic heart failure patients. Hospitalized patients generally have worse outcomes, with high 1-year mortality rates around 25-27%. Chronic heart failure patients have lower but still significant 1-year mortality rates of around 5-6%. The document also reviews real-world data showing high readmission rates after hospitalization for heart failure. It concludes that while treatments for chronic heart failure with reduced ejection fraction have improved outcomes over decades, more efforts are still needed to improve care and outcomes for hospitalized patients and those with preserved ejection fraction.

This study compared ambulation times to discharge for 367 patients who received radial or femoral access for cardiac catheterization. It found that patients with radial access were discharged 41-122 minutes sooner than those with femoral access, depending on the specific procedure. Radial access was associated with shorter discharge times even after controlling for various patient characteristics and procedural factors. The study concluded that radial access results in shorter hospital stays compared to femoral access for cardiac catheterization.

Frailty: a better reflection of long term outcome? by Professor David Pilcher

Virginia Mason Internal Medicine Residency

Frailty is a state of reduced physical, physiological and cognitive reserve. Tools to measure frailty which were developed in geriatric medicine practice, have over recent years been applied to patients admitted to the Intensive Care Unit (ICU). Studies in the ICU suggest that frailty is associated with reduced reduced likelihood of discharge home and reduced survival at one year. Survivors also report lower quality of life measures on both physical and mental assessments. The most common of frailty assessment tool used in the ICU, is the Clinical Frailty Scale which has also been recently adopted by The Australian and New Zealand Intensive Care Society (ANZICS) as part of routine data collection on all ICU admissions. Last year, for the first time 39 sites submitted data about frailty on over 10,000 ICU admissions. Frail patients were more commonly older women admitted with medical diagnoses. Even after adjusting for age, medical co-morbidities and acute severity of illness, frailty was an independent predictor of mortality.

HEALTH ECONOMICS

Imran Javed

This study compared the cost-effectiveness of carotid artery stent placement (CAS) versus carotid endarterectomy (CEA) in high-risk patients based on data from the SAPPHIRE trial. The mean cost per quality-adjusted life year (QALY) gained was higher for CAS ($16,223) than for CEA ($12,745). The incremental cost-effectiveness ratio estimated CAS to be $67,891 more expensive per QALY gained than CEA, with a wide range. Although CAS was not inferior to CEA for outcomes, its higher cost offsets the marginal benefit for high-risk patients.

Goodman et al-2017-arthritis_&_rheumatology

This guideline provides recommendations for the perioperative management of antirheumatic medications in patients with rheumatic diseases undergoing elective total hip or knee arthroplasty. A panel reviewed evidence and developed 7 conditional recommendations based on low to moderate quality evidence. The recommendations address continuing, withholding, and restarting disease-modifying antirheumatic drugs, biologics, tofacitinib, and glucocorticoids in the perioperative period. The goal is to help clinicians and patients make decisions about medication management around the time of surgery to potentially reduce infection risk while maintaining disease control.

What can prescribing data tell us about FLS? Findings from a new analysis - T...

This document analyzes prescribing data from 2013 to 2016 to understand trends in osteoporosis treatment in England. Key findings include: 1) Alendronic acid accounts for 88% of osteoporosis prescriptions while denosumab use has increased slightly; 2) The overall cost per patient year has changed little; 3) The national rate of patients on osteoporosis treatment has declined 11.2% over 44 months. Some CCGs have bucked this trend with Fracture Liaison Services. Crude models suggest FLS could increase the rate of patients on treatment by 26 people per month in a typical CCG population of 300,000.

$Osteoporosis 2016 | Hip fracture, the ultimate challenge: Dr Antony Johansen ...$ $Osteoporosis 2016 | Hip fracture, the ultimate challenge: Dr Antony Johansen ...$

Osteoporosis 2016 | Hip fracture, the ultimate challenge: Dr Antony Johansen ...

Texas Children's Hospital

Documentations of Advanced Heath Care Directives Where Are They TAI_SEALE

HMO Research Network

The document discusses a study examining where advance health care directives (AHCDs) are located in electronic health records (EHRs) and how easily accessible and actionable they are. The study found that while many patients had AHCDs documented, they were often only listed in the problem list and not accompanied by scanned copies, making them difficult to find and not truly actionable. Certain patient characteristics like older age, female gender and illness conditions were associated with AHCDs being more accessible and actionable. The implications are that standardizing and improving the documentation of AHCDs in EHRs could help ensure patients' end-of-life wishes are honored.

Characteristics and Outcomes of Pediatric Patients supported with Ventricular...

Ventricular assist devices (VADs) are being increasingly used to support children with end stage heart failure (HF) as a bridge to transplant or decision to candidacy, with a dramatic increase in the last decade The aims of this study are to review trends in admissions of pediatric patients supported with VADs at children’s hospitals in the U.S. over a ten-year period, to assess rates of major complications in these patients, and to identify risk factors for adverse outcomes Multicenter retrospective analysis of the Pediatric Hospitals Information System (PHIS) database from 2005 to 2015 Inclusion criteria: (i) Age < 21years, (ii) ICD-9 codes for VAD implantation Primary outcome: hospital mortality. Secondary outcomes: total hospital length of stay (LOS), total cost of services (RCC method) Categorical and continuous variables compared using χ2/ Fisher exact and nonparametric tests respectively Univariate and multivariable analyses performed using generalized estimating equations (GEE) for categorical outcomes and mixed modeling for continuous outcomes, to account for clustering within hospitals - factors with p<0.2 on univariate analysis included in the initial multivariable model, and factors with p<0.05 retained in successive models Use of VADs in the pediatric population is continuing to increase over time, with a stable mortality and complication rate There is an increase in patients able to be discharged home with a VAD in place Clinical features including acute renal failure, liver congestion, sepsis, cerebrovascular accident and need for ECMO support continue to complicate peri-implant VAD support, and are associated with mortality VAD repair during the VAD implant admission is associated with longer length of stay and total cost, however was not associated with mortality

Osteoporosis 2016 | Intermittent use of high-dose glucocorticoids and risk of...

International Chair on Interventional Cardiology and Transradial Approach

Hassan nawazish

HassanNawazish

This document summarizes a student's research methodology assignment on developing a device to increase the healing rate of diabetic foot ulcers. The student designed a device that uses sensors, image processing, and a microcontroller to diagnose ulcer stages and deliver controlled doses of medication to the wound site via a motor. The device was tested on 27 patients and used neural networks trained on patients' image and signal data to predict ulcer stages and guide drug delivery. Results showed increased healing rates of ulcers over time compared to traditional care.

Clinical and epidemiological profile of patients undergoing total hip arthro...

David Sadigursky

AMIM Février 2017 New diagnostic tools for GCA luqmani marrakesh

020359

Ultrasound shows promise as a diagnostic tool for giant cell arteritis (GCA) that could reduce the need for temporal artery biopsies. A large study found ultrasound had higher sensitivity (54%) than biopsy (39%) for GCA diagnosis, though lower specificity. Using ultrasound first and only doing biopsies for high-risk cases could avoid 87-98% of biopsies while maintaining high sensitivity for GCA detection. Follow-up ultrasounds may help monitor disease activity and detect relapses in GCA patients treated with steroids.

Ashay Curriculum Vitae

Ashay Karpe

Dr. Ashay Karpe has over 15 years of experience in clinical hematology and oncology. He completed his DM in Medical Oncology in 2015 from Tata Memorial Hospital in Mumbai where he received a gold medal. His areas of specialty include hematological malignancies, stem cell transplants, and solid tumors. He has published several papers in clinical research and presented posters at oncology conferences. He is currently working as an oncologist at Tata Memorial Hospital and has strong references from leaders in the fields of hematology and oncology.

Sreenivasa s. jonnalagadda (eds.) gastrointestinal endoscopy new technologie...

Farhad Safi

Romagnoli E 201305

Hot topics in perioperative research

scanFOAM

This document summarizes hot topics in perioperative research presented by Michelle Chew. It discusses several large studies from Sweden that examine long-term mortality after surgery and complications. It also reviews research on intraoperative hypotension that suggests both the degree and duration of low blood pressure may impact outcomes. Additionally, it mentions that failure to rescue patients after complications occur may affect mortality more than complication rates alone. The document lists several ongoing multicenter research projects in Sweden related to perioperative outcomes.

AHA: Endurant veith 2010

TriMed Media Group

This document summarizes early outcomes from the US IDE trial and global ENGAGE registry of the Endurant AAA endograft. In the US trial (n=150), the 30-day major adverse event rate was 4.0% and there was no mortality. At 1 year, the aneurysm sac size decreased or remained stable in most patients and the reintervention rate was low. The ENGAGE registry includes over 800 patients so far who mirror "real-world" cases. Procedural success was high at 99.6% with a median implant time of 90 minutes. Early outcomes suggest the Endurant endograft is a safe and effective option for treating abdominal aortic aneurysms.

01 aimradial2016 fri2 Z Ruzsa

International Chair on Interventional Cardiology and Transradial Approach

Transradial access for femoral artery intervention was evaluated in a pilot study of 98 patients. The study found: 1. Femoral artery angioplasty can be safely performed via transradial access using sheathless guiding catheters, with a technical success rate of 94.9% and major access site complication rate of 3.1%. 2. While complication rates were promising, larger studies are still needed to determine long-term success rates of this transradial approach to femoral interventions. 3. Selecting the left radial access provided advantages like easier access to the descending aorta and use of shorter delivery systems, though the right radial access was used in most cases (77.6

Future is in assist devices

- LVADs are increasingly being used as a bridge to transplant or destination therapy for advanced heart failure. The number of LVAD implants has grown significantly in recent years and is projected to continue growing as destination therapy becomes more common. LVADs have been shown to improve functional status and quality of life in heart failure patients. While expensive, LVADs can provide survival benefits over medical management for advanced heart failure when transplant is not available. Ongoing research continues to improve device design and outcomes.

Differences in clinical characteristics and its effect for outcomes

International Chair on Interventional Cardiology and Transradial Approach

The document summarizes differences in characteristics and outcomes between Western and Korean patients with acute heart failure based on an analysis of registry data. It finds that compared to Western registries, Korean patients tended to be relatively younger (mean age 69 years old), with a higher rate of first-time heart failure presentations (52.1%) and lower rates of hypertension and coronary artery disease as the cause of heart failure. Korean patients also presented with lower blood pressures on admission. In-hospital mortality rates were similar at around 5%, though Korean patients had lower 90-day mortality. Factors like creatinine levels, blood pressure, BMI and sodium levels similarly predicted outcomes. Rates of beta blocker use at discharge were also lower for Korean

Cancer Control in Australia

Department of Health

What's hot

Gabric ID - AIMRADIAL 2013 - Radial in STEMI

Speiser B - AIMRADIAL 2015 - Ambulation times

International Chair on Interventional Cardiology and Transradial Approach

Frailty: a better reflection of long term outcome? by Professor David Pilcher

Virginia Mason Internal Medicine Residency

HEALTH ECONOMICS

Imran Javed

Goodman et al-2017-arthritis_&_rheumatology

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$Osteoporosis 2016 | Hip fracture, the ultimate challenge: Dr Antony Johansen ...$ $Osteoporosis 2016 | Hip fracture, the ultimate challenge: Dr Antony Johansen ...$

Osteoporosis 2016 | Hip fracture, the ultimate challenge: Dr Antony Johansen ...

Texas Children's Hospital

Documentations of Advanced Heath Care Directives Where Are They TAI_SEALE

HMO Research Network

Characteristics and Outcomes of Pediatric Patients supported with Ventricular...

Osteoporosis 2016 | Intermittent use of high-dose glucocorticoids and risk of...

International Chair on Interventional Cardiology and Transradial Approach

Hassan nawazish

HassanNawazish

Clinical and epidemiological profile of patients undergoing total hip arthro...

David Sadigursky

AMIM Février 2017 New diagnostic tools for GCA luqmani marrakesh

020359

Ashay Curriculum Vitae

Ashay Karpe

Sreenivasa s. jonnalagadda (eds.) gastrointestinal endoscopy new technologie...

Farhad Safi

Romagnoli E 201305

Hot topics in perioperative research

scanFOAM

AHA: Endurant veith 2010

TriMed Media Group

01 aimradial2016 fri2 Z Ruzsa

International Chair on Interventional Cardiology and Transradial Approach

What's hot (19)

Gabric ID - AIMRADIAL 2013 - Radial in STEMI

Speiser B - AIMRADIAL 2015 - Ambulation times

Frailty: a better reflection of long term outcome? by Professor David Pilcher

HEALTH ECONOMICS

Goodman et al-2017-arthritis_&_rheumatology

What can prescribing data tell us about FLS? Findings from a new analysis - T...

$Osteoporosis 2016 | Hip fracture, the ultimate challenge: Dr Antony Johansen ...$ $Osteoporosis 2016 | Hip fracture, the ultimate challenge: Dr Antony Johansen ...$

Osteoporosis 2016 | Hip fracture, the ultimate challenge: Dr Antony Johansen ...

Documentations of Advanced Heath Care Directives Where Are They TAI_SEALE

Characteristics and Outcomes of Pediatric Patients supported with Ventricular...

Osteoporosis 2016 | Intermittent use of high-dose glucocorticoids and risk of...

Hassan nawazish

Clinical and epidemiological profile of patients undergoing total hip arthro...

AMIM Février 2017 New diagnostic tools for GCA luqmani marrakesh

Ashay Curriculum Vitae

Sreenivasa s. jonnalagadda (eds.) gastrointestinal endoscopy new technologie...

Romagnoli E 201305

Hot topics in perioperative research

AHA: Endurant veith 2010

01 aimradial2016 fri2 Z Ruzsa

Similar to Debate: Who should care for GUCH?

Future is in assist devices

Differences in clinical characteristics and its effect for outcomes

International Chair on Interventional Cardiology and Transradial Approach

Cancer Control in Australia

Department of Health

Kalpak O - AIMRADIAL 2014 - Total wrist access for STEMI

EVAPORATE: Icosapent Ethyl on Progression of Coronary Atherosclerosis in Pati...

Chi Pham

$One year mortality rate after hip fracture in the western region of saudi ara...$ $One year mortality rate after hip fracture in the western region of saudi ara...$

One year mortality rate after hip fracture in the western region of saudi ara...

Prof. Hesham N. Mustafa

Background: The mortality rate of elderly patients who sustain a hip fracture is high compared to the general population. Identifying risk factors can help predict patients at risk of hip fracture to reduce the mortality rate. No studies have shown the mortality rate of patients with hip fractures in the western region of Saudi Arabia. Therefore, this study aimed to identify the risk factors associated with the mortality of patients with hip fractures admitted to the King Abdulaziz Hospital and compare the results with other studies. Methods: The mortality rate (within 1 yr or less) in 177 patients over the age of 60 yr who were admitted to the university hospital between July, 2007, and September, 2012, with hip fractures was retrospectively studied. The patients were assessed with regard to gender, age, type of hip fracture, and type of surgical intervention. Results: The overall mortality rate 1 yr after hip fracture was 12.43%, and the mean age was 77.77 yr old. The risk factors most associated with mortality were as follows: advanced age (71 to 80 and 81 to 90 yr old), male, peritrochanteric (extracapsular) fracture, and operative fixation with dynamic hip screw. Conclusions: The mortality rate of patients with hip fractures within 1 yr has a high-risk potential, especially for male patients over 71 yr of age with peritrochanteric (extracapsular) fractures. Surgical treatment with dynamic hip screw also was shown to be a risk factor between the different treatment options. Level of Evidence: Level IV.

PCI & AimRadial 2018 | Experience with Left Main PCI by Radial Access - Zsolt...

International Chair on Interventional Cardiology and Transradial Approach

This document summarizes the experience with percutaneous coronary intervention (PCI) of the left main coronary artery at the Hungarian Institute of Cardiology between 2007-2008 and 2011. It finds that while the radial approach became more common and techniques like fractional flow reserve were used more in 2011, long-term outcomes like death, myocardial infarction, and revascularization remained similar between the periods. The best predictor of 5-year survival after left main PCI was found to be the SYNTAX II score.

Sec innovacion

SHCI - Sección de Hemodinámica y Cardiología Intervencionista

This document discusses challenges facing the Spanish public health system and opportunities for innovation and sustainability. It notes that Spain has an aging population and increasing burden of chronic diseases, putting pressure on the healthcare sector. However, lifestyle changes, prevention efforts, health system improvements, and new treatments have led to significant declines in cardiovascular mortality since the 1980s. Moving forward, the document calls for projects in health services research, cardiovascular prevention and quality improvement to help address these challenges. The Spanish Society of Cardiology can play a key role through initiatives like clinical registries, guidelines, and collaborations between research and industry.

Chronic kidney disease and old age

JimRitchie14

This document discusses chronic kidney disease (CKD) in the elderly. It begins by noting that public perception and healthcare discrimination can impact older patients. It then reviews the burden of CKD based on registry data showing increased prevalence with age. Various sections discuss age-related changes to organs like the kidney and how this impacts disease. Treatment targets for conditions like hypertension in older patients are reviewed based on clinical trial evidence. The challenges of comorbidities in older patients with CKD are also discussed. The document considers quality of life versus longevity and factors like living arrangements that influence end-of-life care decisions in this population.

Management of severe heart failure in japan heart transplantation and lvad

This document provides information about a joint symposium between the European Society of Cardiology and the Japanese Heart Failure Society on the treatment of severe heart failure in Japan. It discusses heart failure epidemiology and causes of death from cardiovascular disease in Japan compared to Europe. It also reviews heart failure etiology, management, and outcomes including survival rates and the use of heart transplantation and left ventricular assist devices in Japan.

Acute Heart Failure - The AU and NZ Experience

Singapore Society for Haematology

Over 65,000 people are diagnosed with heart failure every year in Australia. Heart failure is implicated in the deaths of 61,000 individuals per year. Although the need for cardiovascular support is common in patients in the Intensive Care Unit (ICU) with about 60% of ventilated patients requiring some form of inotropic or vasopressor support, a primary diagnosis of acute heart failure on admission to ICU is much less common. There are about 3000 ICU admissions per year primarily due to cardiogenic shock, cardiomyopathy or congestive heart failure in Australia and New Zealand. This represents 2% of all ICU admissions. Only a minority of these patients have a prior history of significant cardiac disease. The mortality of these three conditions are 40%, 17% and 14%respectively. Since the early 2000’s there has been a progressive decline in risk adjusted mortality of all patients admitted to ANZ ICUs. However, the decline in mortality for patients with acute heart failure has lagged behind other diagnoses. This gap is widening.

Part 1, MHFS,why to build MDHFP

asadsoomro1960

Impact of Research on Australia's Health

Department of Health

Recommendation for stemi treatment in 2013 and stent for life initiative.Petr...

Chaichuk Sergiy

1) The document discusses recommendations for treating ST elevation myocardial infarction (STEMI) and describes the Stent for Life Initiative. 2) It provides an overview of guidelines for STEMI treatment including pharmacotherapy, mechanical reperfusion, and describes studies supporting thrombus aspiration. 3) It then details the objectives and partners involved in the Stent for Life Initiative, which aims to increase access to primary percutaneous coronary intervention (PCI) for STEMI patients across Europe. The initiative involves situational analysis, sharing best practices between countries, and supporting implementation in additional countries.

ueda2013 primary prevention-d.lobna

ueda2015

The JUPITER trial was stopped early due to clear evidence of benefit from rosuvastatin treatment. The trial aimed to test whether rosuvastatin could reduce cardiovascular events in apparently healthy people with normal LDL cholesterol but high hsCRP. Over 17,000 participants were randomized to rosuvastatin 20mg or placebo. After almost 2 years, rosuvastatin showed a highly significant 44% reduction in the primary cardiovascular endpoint compared to placebo, demonstrating its benefit in primary prevention. This clear benefit led to the trial being stopped early.

Men and long-term health conditions

Men's Health Forum

Jeff Szer - WBMT Who are We, What Have We Done, What Will We Do

The Worldwide Network for Blood and Marrow Transplantation (WBMT) was formally created in 2007 and is now an NGO in official relations with the World Health Organization. It aims to promote excellence in stem cell transplantation globally through activities like an annual global survey of transplant centers. The 2013 survey found over 70,000 transplants were reported from 1557 teams in 78 countries. It provides data on transplant numbers and trends by region, disease type, and donor source to support WBMT's goals of standardization, advocacy, and data sharing in hematopoietic cell transplantation.

Health at-glance-2015-tokyo-event-how-japan-compares

OECD Directorate for Employment, Labour and Social Affairs

This document summarizes key findings from the OECD report "Health at a Glance 2015: How Japan Compares?". It finds that: 1) Quality of care in Japan is generally good, though there is room to improve diabetes care and reduce unnecessary hospital admissions. Mortality for heart attacks after admission is also high. 2) Japan has fewer doctors per capita than most OECD countries, though nurse supply is high. There are opportunities to better utilize nurses and improve efficiency. 3) Healthcare spending in Japan has risen faster than most OECD countries in recent years and is now higher than the OECD average as a share of GDP. Achieving greater value for money through efficiency gains is a priority

Wesat2203

Mohamed Rafique

This document summarizes research on scaling up antiretroviral therapy (ART) in resource-limited countries. It discusses using cost-effectiveness analysis to evaluate the value of ART programs in Côte d'Ivoire, India, and South Africa. The research finds that providing both first-line and second-line ART is cost-effective in these countries. It also finds that earlier initiation of ART in South Africa increases survival and is cost-effective. Faster scale-up of ART programs can significantly reduce AIDS-related deaths.

COPD Asthma Workshop

Jitendra Ingole

The document discusses the need for a refresher course on obstructive airways diseases (OAD) in India. It notes that OADs such as asthma and COPD represent a major health burden in India, with prevalence increasing. However, a large number of OAD cases remain undiagnosed due to underuse of spirometry testing and poor management of patients in clinical practice. Inhaler therapy is also not widely used properly. A refresher course could help address these issues to improve diagnosis and management of OADs in India.

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More from CICM 2019 Annual Scientific Meeting

Antidotes by Dr Brad Wibrow

This document discusses a case involving a 2-year-old child who ingested chlorpyrifos, an organophosphate pesticide. The child initially presented with lethargy but later developed worsening symptoms including twitching, bronchospasm, and decreased consciousness. The child was eventually intubated for aspiration but transferred in critical condition. The document questions whether earlier administration of pralidoxime, an oxime antidote for organophosphate poisoning, could have prevented intubation and the worsening condition by regenerating inhibited acetylcholinesterase.

Extracorporeal therapies for toxin ingestion by Dr Darren Roberts

This document discusses extracorporeal therapies for toxin ingestion. It provides an overview of the benefits of enhanced elimination using extracorporeal therapies and considerations for their use. Specific indications for various toxins are reviewed based on a systematic literature review and expert consensus recommendations. The key components of prescribing an extracorporeal therapy for a toxin are discussed, including which therapy to use based on availability and clearance rates, as well as considerations for duration of treatment based on clinical outcomes and biomarker endpoints.

My bloody head: Diagnosis and management of coagulopathy and traumatic brain ...

Lifting the lid on decompressive craniectomy by Associate Professor Lindy Jef...

Emerging neuromonitoring techniques in TBI by Professor Andrew Udy

This document summarizes research on brain oxygen monitoring after traumatic brain injury (TBI). It shows that: 1) Episodes of low brain tissue oxygen (PbtO2) levels below 15 mm Hg are common after TBI and can last from 30 minutes to over an hour. 2) Low PbtO2 levels are associated with worse neurological outcomes. Several studies found patients with PbtO2 levels below 10 mm Hg were 3-10 times more likely to have an unfavorable outcome. 3) Observational studies comparing TBI patients managed with intracranial pressure (ICP) monitoring alone versus ICP plus PbtO2 monitoring found those in the ICP+Pbt

Does ICP monitoring in TBI really help? by Dr Paul Goldrick

This document summarizes research on intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury. It discusses several key points: 1. While ICP monitoring is commonly recommended, the evidence from randomized controlled trials does not clearly support its use. One trial found no benefit to management guided by ICP monitoring over clinical exams and CT scans. 2. Guidelines set ICP thresholds for intervention but the optimal thresholds are unclear. Some studies found thresholds of 22 mmHg for mortality and functional outcomes. 3. Monitoring cerebral perfusion pressure (CPP) in addition to ICP may be important as outcomes improved with better adherence to CPP guidelines over time. 4. Effective treatments for elevated

Blasts by Professor Michael Reade

1) A bomb attack in Brussels in 2016 killed 32 people and injured 300 through the use of acetone/peroxide explosive devices in the airport and a train station. 2) Blast injuries are classified as primary (caused directly by the blast wave), secondary (caused by flying debris and shrapnel), tertiary (caused by victim being thrown by the blast), or quaternary (all other injuries). 3) While myths exist about blast injuries overwhelming hospitals and causing many amputations, in reality penetrating injuries from flying debris are most common in survivors and usually do not require extensive surgery. Management follows conventional trauma principles.

Mass Casualty & Terrorism by Professor Mark Midwinter

This document discusses mass casualty and terrorism incidents from a medical perspective. It begins by outlining the levels of hospital involvement needed to respond, from the emergency department being busy initially to operating theaters, critical care, and general wards being involved for prolonged periods over weeks to months. It notes differences and similarities between terrorism incidents and other disasters. Key aspects discussed include communications throughout response, situation awareness, leadership, triage challenges when most severely injured may not arrive first, and the mechanisms of blast injury particularly for bombs including primary, secondary, tertiary and quaternary effects. Resources on emergency preparedness, resilience and response as well as primers on mass trauma and blast injuries are provided.

Burns by Dr Anthony Holley

This document discusses challenges in managing severely burned patients including a lack of high-quality evidence to guide clinical practice. It notes burned patients require significant resources and outlines complications that can arise from over-resuscitation like fluid overload. The document presents different fluid resuscitation formulas and advocates for a simplified "Rule of 10" approach. It raises questions about how factors like inhalation injuries, age, or delays in care might impact resuscitation needs and calls for stronger evidence to guide practice through prospective data collection and evaluation of interventions.

Trials on the horizon by Professor Michael Reade

1) Several clinical trials are underway to evaluate new trauma interventions such as viscoelastic-guided protocols, lyophilized plasma, tranexamic acid, fibrinogen concentrate, cryopreserved platelets, and cold-stored platelets. 2) Traditional clinical trials in trauma face challenges like patient heterogeneity and dichotomous outcomes like mortality, requiring very large sample sizes. Alternative outcomes being explored include longer term functional outcomes and biological surrogates. 3) Notable ongoing trials include iTACTIC evaluating lyophilized plasma, RePHILL and PATCH-Trauma evaluating tranexamic acid, FEISTY evaluating fibrinogen concentrate, CRYOSTAT-2 evaluating cryoprecipitate, and

Pelvis by Dr Ben Parkinson

This document provides an overview of the practical approach to managing pelvic trauma. It discusses the principles of pelvic fracture management, which are to assess injury severity, stabilize the pelvis, and stop bleeding. Bleeding is the leading cause of death in pelvic fracture patients and depends on fracture type. Clinical examination can reveal pelvic asymmetry, instability, and injuries to associated structures. Investigations include x-rays, CT scans, and specialized imaging of the urethra and rectum if suspected of injury. Early stabilization techniques aim to reduce pelvic volume and provide relative stability, while angiography and embolization or pelvic packing may be needed in unstable patients with continued bleeding.

Airway by Dr Andrew Potter

This document discusses the complex challenges of managing a patient with a traumatic airway injury. It describes various types of airway injuries and stresses the importance of a thorough assessment to determine the location and severity of the injury. It then outlines several options for securing the airway as gently as possible, either through rapid sequence intubation, fiberoptic intubation, or videolaryngoscopy. It emphasizes preparing a plan in advance, having the right team and equipment, and being prepared to escalate to other options like emergency tracheostomy or extracorporeal membrane oxygenation if needed to safely manage the airway.

Penetrating injuries by Professor Mark Midwinter

This document discusses penetrating injuries and management approaches. It provides information on: 1) Factors that determine energy transfer from penetrating weapons including weapon type, range, and tissue properties. Vital structures like brain and liver are more susceptible to injury. 2) Options for managing penetrating torso trauma have expanded from routinely operating to include selective non-operative approaches with monitoring. 3) Indications for emergency thoracotomy or laparotomy include hemodynamic instability, peritonitis on exam, or unexpected drops in vitals or hematocrit. Triple-contrast CT can help determine need for surgery.

Solid organs by Professor Chad Ball

1) Hemodynamically stable patients with evidence of vascular injury on CT or signs of persistent bleeding should undergo angiography for splenic injuries. The role of angiography for other high-risk splenic injuries without clear vascular injuries on CT is unclear. 2) For liver injuries, packing is usually sufficient to control bleeding for most injuries. Pringle maneuver, total vascular exclusion, or post-op angiography may be needed for the uncommon patients with continued bleeding. 3) Balloon tamponade can successfully arrest hemorrhaging in over 90% of cases but overall mortality remains high, especially for injuries of the face, neck, and heart. Survival is better for liver injuries controlled with balloon tamponade

Traumatic cardiac arrest by Dr Adam Holyoak

This document discusses management of traumatic cardiac arrest and compares it to medical cardiac arrest. It notes that traumatic cardiac arrest may have better outcomes if caused by penetrating trauma, witnessed arrest, presenting in PEA rhythm, and receiving prehospital medical management. Interventions for traumatic cardiac arrest focus on treating reversible causes like tension pneumothorax, relieving pericardial tamponade through resuscitative thoracotomy, controlling hemorrhage, and replacing blood loss. The role of chest compressions is de-emphasized. Teamwork between emergency responders, aeromedical services, and trauma centers is important for expeditiously managing traumatic cardiac arrest.

Aorta by Dr Roxanne Wu

This document discusses aortic trauma from blunt force injuries. It notes that aortic trauma most commonly results from rapid deceleration in motor vehicle or motorcycle accidents, falls from heights, air crashes, or heavy objects falling on the chest. It outlines different zones of the thoracic aorta that can be injured and discusses techniques for diagnosing and treating aortic injuries, including open surgery, endovascular stenting, and a resuscitative endovascular balloon occlusion of the aorta (REBOA) technique to control hemorrhaging. REBOA involves inserting a large sheath and balloon catheter into the femoral or axillary artery under ultrasound guidance to occlude blood flow to the damaged area of the aorta.

Brain by Associate Professor Samuel Galvagno

This document summarizes recent literature on the treatment of traumatic brain injury (TBI). It reviews guidelines for managing TBI, including avoiding hypotension and hypoxia. It discusses studies on fluid resuscitation with hypertonic saline or plasma. The document also summarizes three important TBI studies: the BOOST-II trial on brain oxygen monitoring, the POLAR trial on early hypothermia, and the EPIC statewide study implementing prehospital TBI guidelines. Throughout, it notes limitations of animal studies in reproducing complex human TBI pathophysiology and outcomes.

Paediatric burns by Professor Roy Kimble

The document summarizes research from the Pegg Leditschke Children's Burns Centre in Queensland, Australia. It discusses treatments for pediatric burns including fluid resuscitation guidelines, conservative debridement techniques, dressing trials, and scar management strategies. It also presents findings from studies on factors that influence re-epithelialization time like pain levels, parental distress, and delayed transport to a burns center. The centre treats over 1,300 children with burns annually and conducts extensive research to optimize outcomes.

Contemporary management of spinal injury by Dr Jonathon Ball

1) The document discusses the principles and evidence for early management of spinal cord injuries, including early surgery within 24 hours, maintaining mean arterial blood pressure between 85-90 mmHg, and the use of methylprednisolone. 2) Ongoing clinical trials are exploring optimal perfusion pressure targets as well as neuroprotective agents like riluzole. 3) Specialized spinal cord injury units allow for up-to-date management and access to clinical trials exploring new treatments.

Haemothorax: To drain or not to drain?

1) The document discusses whether all traumatic hemothoraces should undergo drainage or if some can be managed expectantly. 2) Recent studies have found that expectant management of hemothoraces may have benefits over drainage such as shorter hospital stays and fewer complications, but larger studies are still needed. 3) The T.H.R.E.A.T. trial aims to further study this question by randomly assigning traumatic hemothorax patients either to chest drainage or expectant management and comparing outcomes between the groups.

More from CICM 2019 Annual Scientific Meeting (20)

Antidotes by Dr Brad Wibrow

Extracorporeal therapies for toxin ingestion by Dr Darren Roberts

My bloody head: Diagnosis and management of coagulopathy and traumatic brain ...

Lifting the lid on decompressive craniectomy by Associate Professor Lindy Jef...

Emerging neuromonitoring techniques in TBI by Professor Andrew Udy

Does ICP monitoring in TBI really help? by Dr Paul Goldrick

Blasts by Professor Michael Reade

Mass Casualty & Terrorism by Professor Mark Midwinter

Burns by Dr Anthony Holley

Trials on the horizon by Professor Michael Reade

Pelvis by Dr Ben Parkinson

Airway by Dr Andrew Potter

Penetrating injuries by Professor Mark Midwinter

Solid organs by Professor Chad Ball

Traumatic cardiac arrest by Dr Adam Holyoak

Aorta by Dr Roxanne Wu

Brain by Associate Professor Samuel Galvagno

Paediatric burns by Professor Roy Kimble

Contemporary management of spinal injury by Dr Jonathon Ball

Haemothorax: To drain or not to drain?

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