Conclusion: Preliminary results of IMPACT show DAPT to be safe in post ACS patients undergoing CABG. No difference is apparent in clinical outcomes or graft patency at 12 months. http://dx.doi.org/10.1016/j.hlc.2017.05.003 O03 Contemporary Natural History of Patients with Severe and Moderate to Severe Aortic Regurgitation Mehul Lamba *, Paul Bridgman Christchurch Hospital, Christchurch, New Zealand Corresponding author.
Aim: The current guidelines for aortic regurgitation (AR) are based on studies of relatively small sample size with most of the data predating year 2000. Contemporary data regarding clinical outcomes in patients with AR is lacking. The aim of our study was to analyse long-term outcomes in patients with severe and moderate to severe AR. Method: 154 consecutive patients diagnosed with severe and moderate to severe AR between July 2005 and October 2009 were selected. Patients with non-native aortic valve or acute aortic dissection were excluded. The primary endpoint was defined as death or aortic valve surgery. Results: The mean age was 64 years (range 21-90). 36 patients had severe AR and 118 patients had moderate to severe AR. During median follow-up of 9.7 years, 119 patients (77%) died or underwent surgery. In multivariate analysis adjusted for age and symptoms, the predictors of primary endpoint were severity of AR (HR 3.18, p < 0.01) and left ventricular (LV) dysfunction (HR 1.78, p = 0.01). LV size was only a weak predictor in univariate analysis. Valve morphology (bicuspid or tricuspid) and mechanism of regurgitation did not influence the outcome. In secondary analysis, the predictors of referral for surgery were symptoms (OR 4.88), severity of AR (OR 6.05) and dilated LV (OR 3.36) (all p-values < 0.05). Conclusion: Clinical outcomes in patients with severe AR are generally poor. The primary determinants of death or aortic valve surgery in patients with severe and moderate to severe AR are the severity of regurgitation and LV function. http://dx.doi.org/10.1016/j.hlc.2017.05.004 Affiliates Award Abstracts O04 Nurse-Facilitated Elective Cardioversion Pathway Using Procedural Sedation Yvonne Tindall *, Jane Besley, Faith Bagnall, Tammy Pegg, Daniel Garofalo Nelson Marlborough District Health Board, Nelson, New Zealand * Corresponding author. Aim: To analyse the outcome of a nurse-facilitated, patientcentred pathway for cardioversions aimed at providing improved access to rhythm specialists, faster and more personalised treatment, with a more cost-effective use of staff,
equipment and hospital space. Using fentanyl and midazolam would allow a comfortable and safe procedure without involving the anaesthesia team. Method: A proposal for a new pathway was developed to allow consistency of treatment from referral to discharge and follow-up. Cardioversions were overseen by an electrophysiologist. Staff training was provided and patient information and relevant sedation guidelines were updated. We analysed the outcome of our first 20 patients (group A) and compared the results with a random non-matched cohort of anaestheticled cardioversions (group B). Results: Mean (SD) time from referral to treatment was 23 (22.2) days compared with 134 (125.7) in group B (p < 0.003). One patient in group A felt the shock. No interventions for airway or haemodynamic support were required in group A, whereas nine patients in group B received interventions such as bag/mask ventilation and correction of bradycardia/hypotension. Successful cardioversion was achieved in 18 from group A and 17 from group B. Mean length of stay was 280 (106.1) minutes for group A and 293 (59.3) for group B (p = NS). Conclusion: A streamlined nurse-facilitated cardioversion pathway allowed rapid access to more specialised and tailored treatment. In this small cohort less haemodynamic compromise was observed and length of stay was not affected. http://dx.doi.org/10.1016/j.hlc.2017.05.005 O05 Fatu Ola: Closing the Gaps with Home Visits Lani Ioelu, on behalf of the Cardiac Nursing team, Middlemore Hospital*Andrew McLachlan, June Poole 1975, Auckland, New Zealand * Corresponding author. Aim: To improve Pacific peoples’ engagement in CR and to increase their access to health care services in the community within the Counties Manukau region. Method: Efforts to improve Pacific people’s engagement in CR and to increase their access to cardiac-related health care and prevention information resulted in the CR team designing a Pacific Home Model of Care Programme. Led and delivered by a Pacific CR nurse, the program is guided by Pacific belief systems and ways of being embedded within a Pasifika model of care to ensure culturally appropriate and safe engagement with Pacific patients. A data base was created to capture patient’s attendance, referrals and outcomes. Results: Since 2013, 310 patients have been referred (mean age 63 years), 58% were male, Samoan 559%, Tongan 17%, Niuean 3%, Cook Island 18%, other 3%. 310 (100%) patients engaged with the recruiting process and were assessed at least once. Findings indicate increases in the number of patients attending GP appointments from 82% in 2014 to 87% in 2017. Furthermore, adherence to medication has increased from 74% in 2014 to 96% in 2017. Conclusion: Data from this study provides evidence that the Pacific Home Model of Care improves access from Pacific peoples to community health care services, engagement in CR and increased adherence to medications. http://dx.doi.org/10.1016/j.hlc.2017.05.006