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Home Monitoring® for early detection of CRT-patients at high risk of stroke
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ORAL PRESENTATIONS Heart, Lung and Circulation S3 2008;17S:S1–S3 Oral Presentations Demographics of acute decompensated heart failure hos- pitalisations in Asia Pacific Christopher Hayward a,∗ , John Atherton b , I. Gde Rurus Suryawan c , Jesus Jorge d , on behalf of Asia Pacific ADHERE investigators a St Vincent’s Hospital, Australia b Royal Brisbane Hospital, Australia c Dr. Sutomo General Hospital Jl, Australia d Philippines Heart Centre, Philippines Background: Acute decompensated heart failure remains a significant burden on hospital resources. The aim of this registry was to document patient characteristics, thera- pies, in-hospital mortality and length of stay during 2006 in the Asia Pacific region. Where appropriate data was com- pared to the EuroHeart Survey II and ADHERE Registry – USA (2006). Methods: Data was collected retrospectively from con- secutive medical record review. Results: Three thousand six hundred and eighty qual- ified discharges were identified from 43 hospitals in five countries including Indonesia (37%), Thailand (27%), Aus- tralia (25%), Philippines (7%) and Taiwan (4%). Median age at presentation was 65.0 years, 57.8% male. In- hospital mortality was 6.1% and mean length of stay 7.2 days. Coronary artery disease accounted for 47.4% of underlying cause of HF. Diabetes was present in 36.2% of patients, and hypertension in 60.2%. Presen- tation systolic pressure was >140 mmHg in 38%. Renal impairment (serum creatinine > 1.5 mg/dL) was present in 40.5%. Heart failure medications were under pre- scribed at presentation (ACEI/ARB 47.1%, beta-blocker 29.4%, aldosterone antagonist 21.8%) with a slight increase in prescription at discharge (ACEI/ARB 60.5%, beta- blocker 33.1%, aldosterone antagonist 31.0%). There was an increase in diuretic therapy (56.3% to 73.2%), and in antiplatelet/anticoagulation (53% to 68%). Patients with poor LV function had worse outcome (LVEF<40% mor- tality 7.8% versus LVEF > 40% mortality 4.1%). Inotrope use was 19.4% (compared to USA 8%). Differences in mor- tality rates in the Asia Pacific region (6.1%) compared to USA (3.0%) and EuroHeart II (6.7%) may relate to “sicker” patients with a higher rate of assisted ventilation (11.5% compared to USA 3.2% and EuroHeart II 13.9%). Conclusions: Despite accepted guidelines, baseline and discharge heart failure medications remain underutilised. Mortality and in-hospital morbidity remain high in patients admitted with acute decompensated heart failure. doi:10.1016/j.hlc.2007.11.006 Home Monitoring ® for early detection of CRT-patients at high risk of stroke Vincent Paul a,∗ , Christian Wende b , Herbert Naegele c , Wolfgang Bauer d , Klaus Malinowski e , Stefan Sack f a Ashford And St. Peter’s Hospitals NHS Trust, Chertsey, United Kingdom b St. Elisabeth Hospital, Saarlouis, Germany c St. Adolf-Stift, Reinbek, Germany d University Of Wuerzburg, Germany e Helios Clinics, Aue, Germany f University Of Essen, Germany Introduction: Atrial fibrillation (AF) is a common rhythm disturbance in heart failure patients. The prevalence of AF is about 4.2–49.8%, corresponding to the severity of heart failure. According to published data, AF onset increases the risk of stroke increases five-fold. Regard- ing the fact that about 25% of ischemic strokes are based on an underlying cardiovascular disease, the early detec- tion of asymptomatic AF is of major interest. The Home Monitoring ® function implemented in CRT-devices of Biotronik is capable of detecting episodes of atrial tach- yarrhythmias. Methods: Patient data of the Home CARE study, which aims at the development of a predictor for worsening heart failure in CRT patients, were scanned regarding a poten- tial risk of stroke. Patients were considered to be at high risk, if AF was not documented at baseline, but set in later lasting one “AF-day” at minimum, which stands for Mode Switching duration >20% (4.8h) per day. The sub-group was analysed regarding treatment with anticoagulant. Results: Home monitoring data of 367 CRT patients aged 68 ± 10 years, 54.5% ischemic etiology, NYHA functional class I (0.6%), II (12.6%), III (77.8%), and IV (8.9%) were analysed retrospectively. At baseline, 287 patients (78.3%) were free of documented AF episodes. After a mean obser- vational time of 9.7 ± 4.7 months, 36 patients (12.5%) had at least one AF-day. Analysis of the concomitant medica- tion revealed that 66.7% of the patients at potential risk of stroke did not receive anticoagulation therapy accord- ing to the guidelines (36.1% were treated with antiplatelet agents, 30.6% did not receive medication). In 13.9% of the patients medication was unknown. Summary: Device based Home Monitoring ® of CRT patients is capable to detect onset of atrial tachyarrhyth- mias thus facilitating early treatment aimed at stroke prevention. doi:10.1016/j.hlc.2007.11.007
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Transcript of Home Monitoring® for early detection of CRT-patients at high risk of stroke
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Heart, Lung and Circulation S32008;17S:S1–S3 Oral Presentations
Demographics of acute decompensated heart failure hos-pitalisations in Asia Pacific
Christopher Hayward a,∗, John Atherton b, I. Gde RurusSuryawan c, Jesus Jorge d,on behalf of Asia Pacific ADHERE investigators
a St Vincent’s Hospital, Australiab Royal Brisbane Hospital, Australiac Dr. Sutomo General Hospital Jl, Australiad Philippines Heart Centre, Philippines
Background: Acute decompensated heart failure remainsa significant burden on hospital resources. The aim of thisregistry was to document patient characteristics, thera-pies, in-hospital mortality and length of stay during 2006 inthe Asia Pacific region. Where appropriate data was com-pared to the EuroHeart Survey II and ADHERE Registry –USA (2006).
Methods: Data was collected retrospectively from con-secutive medical record review.
Results: Three thousand six hundred and eighty qual-ified discharges were identified from 43 hospitals in fivecountries including Indonesia (37%), Thailand (27%), Aus-tralia (25%), Philippines (7%) and Taiwan (4%). Medianage at presentation was 65.0 years, 57.8% male. In-hospital mortality was 6.1% and mean length of stay7.2 days. Coronary artery disease accounted for 47.4%of underlying cause of HF. Diabetes was present in3tiis2ibaaptutUpc
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Home Monitoring® for early detection of CRT-patients athigh risk of stroke
Vincent Paul a,∗, Christian Wende b, Herbert Naegele c,Wolfgang Bauer d, Klaus Malinowski e, Stefan Sack f
a Ashford And St. Peter’s Hospitals NHS Trust, Chertsey,United Kingdomb St. Elisabeth Hospital, Saarlouis, Germanyc St. Adolf-Stift, Reinbek, Germanyd University Of Wuerzburg, Germanye Helios Clinics, Aue, Germanyf University Of Essen, Germany
Introduction: Atrial fibrillation (AF) is a common rhythmdisturbance in heart failure patients. The prevalence ofAF is about 4.2–49.8%, corresponding to the severityof heart failure. According to published data, AF onsetincreases the risk of stroke increases five-fold. Regard-ing the fact that about 25% of ischemic strokes are basedon an underlying cardiovascular disease, the early detec-tion of asymptomatic AF is of major interest. The HomeMonitoring® function implemented in CRT-devices ofBiotronik is capable of detecting episodes of atrial tach-yarrhythmias.
Methods: Patient data of the Home CARE study, whichaims at the development of a predictor for worsening heartfailure in CRT patients, were scanned regarding a poten-tial risk of stroke. Patients were considered to be at highrlSw
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6.2% of patients, and hypertension in 60.2%. Presen-ation systolic pressure was >140 mmHg in 38%. Renalmpairment (serum creatinine > 1.5 mg/dL) was presentn 40.5%. Heart failure medications were under pre-cribed at presentation (ACEI/ARB 47.1%, beta-blocker9.4%, aldosterone antagonist 21.8%) with a slight increasen prescription at discharge (ACEI/ARB 60.5%, beta-locker 33.1%, aldosterone antagonist 31.0%). There wasn increase in diuretic therapy (56.3% to 73.2%), and inntiplatelet/anticoagulation (53% to 68%). Patients withoor LV function had worse outcome (LVEF < 40% mor-
ality 7.8% versus LVEF > 40% mortality 4.1%). Inotropese was 19.4% (compared to USA 8%). Differences in mor-
ality rates in the Asia Pacific region (6.1%) compared toSA (3.0%) and EuroHeart II (6.7%) may relate to “sicker”atients with a higher rate of assisted ventilation (11.5%ompared to USA 3.2% and EuroHeart II 13.9%).
Conclusions: Despite accepted guidelines, baseline andischarge heart failure medications remain underutilised.ortality and in-hospital morbidity remain high in
atients admitted with acute decompensated heart failure.
oi:10.1016/j.hlc.2007.11.006
isk, if AF was not documented at baseline, but set in laterasting one “AF-day” at minimum, which stands for Modewitching duration >20% (4.8 h) per day. The sub-groupas analysed regarding treatment with anticoagulant.Results: Home monitoring data of 367 CRT patients aged
8 ± 10 years, 54.5% ischemic etiology, NYHA functionallass I (0.6%), II (12.6%), III (77.8%), and IV (8.9%) werenalysed retrospectively. At baseline, 287 patients (78.3%)ere free of documented AF episodes. After a mean obser-
ational time of 9.7 ± 4.7 months, 36 patients (12.5%) hadt least one AF-day. Analysis of the concomitant medica-ion revealed that 66.7% of the patients at potential riskf stroke did not receive anticoagulation therapy accord-
ng to the guidelines (36.1% were treated with antiplateletgents, 30.6% did not receive medication). In 13.9% of theatients medication was unknown.Summary: Device based Home Monitoring® of CRT
atients is capable to detect onset of atrial tachyarrhyth-ias thus facilitating early treatment aimed at stroke
revention.
oi:10.1016/j.hlc.2007.11.007
