Background Restrictions as a result of the COVID-19 pandemic have demanded an innovative approach to provide appropriate patient review. We have been running virtual cardiology clinics as per Health Service Executive guidance. Aims Our study aims to determine how virtual clinics change practice vs traditional clinics. Methods A retrospective cohort analysis was conducted on patients attending cardiology clinics in our hospital from 6 January to 13 March 2020 (‘traditional clinic’, n = 1644), compared with clinics during the COVID-19 outbreak, from 16 March to 22 April 2020 (‘virtual clinic’, n = 691), with the same medical staff. Results There was no difference in age (61 vs 60), case mix or new vs return appointments in virtual vs traditional clinics. There were similar rates of clinic participation, 71.8% vs 74.2%. A lower proportion of investigations (e.g. imaging) were booked in virtual (38.5%) vs traditional (55.7%) clinics, p < 0.00001. Management changes (e.g. medication changes) were less frequent in virtual (19.9%) vs traditional (38.5%) clinics, p < 0.00001. However, the discharge rate was higher in virtual (28.8%) vs traditional (19.5%) clinics, p = 0.00003. Conclusion This study highlights that virtual clinic consultations are associated with fewer investigations, fewer management changes, and increased discharge rates compared with traditional consultations. These practice changes would reduce costs and hospital outpatient congestion by avoiding unnecessary hospital reviews. Nonetheless, it is unknown whether patients requiring face-to-face consultations could be missed as a result of this virtual approach. Longitudinal studies are required to assess clinical outcomes as a result of these practice changes and whether patient satisfaction is altered. Supplementary Information The online version contains supplementary material available at 10.1007/s11845-021-02617-z.
Background The EU-wide, cross-sectional observational study of lipid-lowering therapy (LLT) use in secondary and primary care (DA VINCI) assessed the proportion of patients achieving low-density lipoprotein cholesterol (LDL-C) goals recommended by the European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines and provided an insight into regional use of LLT in Europe, including Ireland. Aims This analysis focuses on data from patients in Ireland who participated in the DA VINCI study. Methods The DA VINCI study enrolled patients receiving LLT at primary and secondary care sites across 18 European countries between June 2017 and November 2018. The study assessed the achievement of risk-based 2016 and 2019 ESC/EAS LDL-C goals. This subgroup analysis aimed to evaluate LDL-C goal attainment in an Irish cohort of primary and secondary care patients. Results In total, 198 patients from Ireland were enrolled from three primary care and three secondary care centres. Most patients were White and male, and were receiving moderate- or high-intensity statin therapy (most frequently atorvastatin or rosuvastatin). Few patients (< 10%) were receiving combination therapy of statin and ezetimibe. Approximately 60% of patients achieved their 2016 ESC/EAC LDL-C goals while less than half the patients achieved their 2019 ESC/EAS goals. Approximately half of secondary prevention patients achieved their 2016 ESC/EAS goals and only 20% of secondary prevention patients achieved their 2019 ESC/EAS goals. Conclusions These results highlight the disparity between dyslipidaemia management in clinical practice in Ireland and guideline recommendations. Trial registration ENCePP; EU PAS 22,075; date registered 06 February 2018.
Background A case of stent thrombosis as a complication of coronary bifurcation stenting is described. We review potential complications of bifurcation stenting and established guidelines. Case Summary A 64 year old man presented with a non-ST segment elevation myocardial infarction. High sensitivity troponin I peaked at 99,000 ng/L (normal <5). He previously had coronary stenting for stable angina when residing in another country two years previously. Coronary angiography revealed no significant stenosis with TIMI 3 flow in all vessels. Cardiac magnetic resonance imaging demonstrated a LAD territory regional motion abnormality, late gadolinium enhancement consistent with recent infarction, and a left ventricular apical thrombus. Repeat angiography and intravascular ultrasound (IVUS) confirmed bifurcation stenting at the junction of the LAD and D2 with protrusion of several millimetres of the uncrushed proximal segment of the D2 stent in the LAD vessel lumen. There was under-expansion of the LAD stent in the mid vessel and stent malapposition in the proximal LAD, extending into the distal left main stem coronary artery and involving the ostium of the left circumflex coronary artery. Percutaneous balloon angioplasty was performed along the length of the stent, including an internal crush of the D2 stent. Coronary angiography confirmed uniform expansion of the stented segments and TIMI 3 flow. Final IVUS confirmed full stent expansion and apposition. Discussion This case highlights the importance of provisional stenting as a default strategy and familiarity with procedural steps in bifurcation stenting. Furthermore, it emphasises the benefit of intravascular imaging for lesions characterisation and stent optimisation.
this cohort were already on optimal HF treatment, many being asymptomatic and had low NT-proBNP levels. Some patients were also ineligible for SGLT-2i because of Stage 4 CKD.One-third of the diabetic patients in this HFrEF cohort were not at target HbA1C range and according to the ADA-EASD Guidelines, all these patients should have SGLT-2i added to intensify glycaemic control. Lately, the Canadian Heart Society have updated their guidelines with a strong recommendation to introduce SGLT-2i in diabetics with ischemic cardiomyopathy despite adequate glycaemic control for cardiovascular benefits.SGLT-2i represents an important, but underutilized therapeutic option by cardiologists, likely due to the lack of familiarity on its use. This study reveals that SGLT-2i prescription could potentially increase in HFrEF patients with or without T2DM as guidelines will soon be updated based on robust evidence from large-scale clinical trials and when prescribers become aware of the indication for primary prevention of heart failure hospitalization and death.
up. In the non-PPM group, 3 patients had a RBBB pattern and 15 had a LBBB pattern at baseline. Patients who had a baseline RBBB were more likely to require a PPM post TAVI (p-value = 0.02). Conclusion Baseline RBBB ECG pre-TAVR is a significant predictor of delayed advanced AV block. Our study validates previous suggestions that patients with baseline RBBB should not be considered for early discharge and may require prolonged monitoring to detect delayed AV conduction abnormalities. These patients are less likely to recover from their conduction disturbances as suggested by their pacing requirement at 6 week post-implantation follow-up.
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