Registro español de hemodinámica y cardiología intervencionista. XXXII informe oficial de la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2022) / Spanish cardiac catheterization and coronary intervention registry. 32nd official report of the Interventional Cardiology Association of the Spanish Society of Cardiology (1990-2022)

Introducción y objetivos: Se presenta el informe de actividad del año 2022 de la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC). Métodos: Se invitó a todos los laboratorios de hemodinámica a participar en el registro. La recogida de datos se realizó a través de un cuestionario telemático. Una empresa externa realizó el análisis de datos, revisados por la junta directiva de la ACI-SEC. Resultados: Participaron 111 centros. El número de estudios diagnósticos aumentó un 4,8% con respecto a 2021, y el número de intervenciones coronarias percutáneas (ICP) se mantuvo estable. Las ICP sobre tronco coronario izquierdo aumentaron un 22%. El abordaje radial sigue siendo preferencial para las ICP (94,9%) y se observa un incremento de uso del balón farmacoactivo. El uso de técnicas de imagen intracoronaria se ha incrementado y se utilizan en el 14,7% de las ICP. También aumenta el uso de guía de presión (el 6,3% con respecto a 2021) y técnicas de modificación de placa. Sigue creciendo la ICP primaria, el tratamiento más frecuente (97%) en el infarto agudo de miocardio con elevación del segmento ST. La mayoría de los procedimientos no coronarios mantienen su tendencia creciente; destacan los implantes percutáneos de válvula aórtica, el cierre de orejuela, la técnica borde-a-borde mitral/tricuspídea, la denervación renal y el tratamiento de la enfermedad de la arteria pulmonar. Conclusiones: El Registro español de hemodinámica y cardiología intervencionista de 2022 demuestra un incremento en la complejidad de la enfermedad coronaria y un crecimiento notable de los procedimientos en cardiopatía estructural valvular y no valvular.(AU)

Introduction and objectives: This article presents the annual activity report of the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) for the year 2022. Methods: All Spanish centers with catheterization laboratories were invited to participate. Data were collected online and were analyzed by an external company in collaboration with the members of the board of the ACI-SEC. Results: A total of 111 centers participated. The number of diagnostic studies increased by 4.8% compared with 2021, while that of percutaneous coronary interventions (PCI) remained stable. PCIs on the left main coronary artery increased by 22%. The radial approach continued to be preferred for PCI (94.9%). There was an upsurge in the use of drug-eluting balloons, as well as in intracoronary imaging techniques, which were used in 14.7% of PCIs. The use of pressure wires also increased (6.3% vs 2021) as did plaque modification techniques. Primary PCI continued to grow and was the most frequent treatment (97%) in ST-segment elevation myocardial infarction. Most noncoronary procedures maintained their upward trend, particularly percutaneous aortic valve implantation, atrial appendage closure, mitral/tricuspid edge-to-edge therapy, renal denervation, and percutaneous treatment of pulmonary arterial disease. Conclusions: The Spanish cardiac catheterization and coronary intervention registry for 2022 reveals a rise in the complexity of coronary disease, along with a notable growth in procedures for valvular and nonvalvular structural heart disease.(AU)

Repercusión de la pandemia COVID-19 en la práctica de la cardiología intervencional en Chile: datos aportados por la encuesta del grupo Stent-Save a Life! LATAM working group / Decrease in the activity of interventional cardiology in Chile: a report from the "Stent-Save a Life! LATAM working group"

RESUMEN: Introducción: El Stent-Save a Life! (SSL) LATAM working group diseñó una encuesta para objetivar la reducción de la actividad de los laboratorios de hemodinamia en Latinoamérica durante la pandemia COVID-19. Ante la amenaza de nuevos confinamientos en Chile, nos propusimos objetivar las consecuencias de la primera ola de contagios en nuestra actividad. Objetivos: Discutir la repercusión de la pandemia en la cardiología intervencional en Chile. Métodos: El grupo SSL realizó una encuesta telemática a todos los países de Latinoamérica incluido Chile. Se registraron las coronariografías (CAG), intervenciones coronarias percutáneas (ACTP) e intervenciones estructurales, comparando dos períodos determinados por el confinamiento por la pandemia, cada uno de dos semanas. Pre-COVID-19: período previo al confinamiento, y COVID-19: período durante el confinamiento. Se analizan, a partir de esta encuesta, los resultados aplicados a nuestro país. Resultados: Se obtuvo respuesta de trece centros. Hubo una reducción en el número global de procedimientos entre período Pre-COVID-19 y COVID-19 de un 65,1%. Se reportó una disminución de 67% en las CAG, de un 59,4% en las ACTP y de un 92% en los procedimientos terapéuticos estructurales. Entre ambos períodos se redujo la consulta por Síndrome Coronario Agudo por elevación del segmento ST (SCACEST) en 40,8%. Conclusiones: En nuestro país se objetivó una reducción marcada de la actividad asistencial de la cardiología intervencional durante la pandemia COVID-19 y una disminución significativa en el número de pacientes tratados por SCACEST. Los resultados de nuestro país son similares a los reportados por países de Latinoamérica, Europa y Norteamérica.

ABSTRACT: Background: The Stent-Save a Life! (SSL) LATAM working group designed a survey to demonstrate the reduction in the activity of cardiac catheterization laboratories in Latin America during the COVID-19 pandemic. Considering the risk of a new confinement in Chile, we decided to assess the impact of the first wave of contagions on our activity. Aims: To discuss the repercussion of the COVID-19 pandemic on the activity of interventional cardiology in Chile. Methods: The SSL group conducted a telematic survey in all Latin American countries. Coronary angiography, coronary interventions (PCI) and structural interventions were registered, comparing two periods of two weeks duration each: before and during COVID-19 confinement. Results obtained in Chile are analyzed. Results: Thirteen centers in Chile answered the survey. There was an overall decrease of 65.1% in the number of procedures between the pre and the post COVID-19 periods. Coronary angiographies decreased 67%, PCI 59.4% and therapeutical structural procedures 92%. The reduction in acute coronary syndrome with ST segment elevation (STEMI) was 40,8% between periods. Conclusions: In Chile, a significant reduction in healthcare activity related to interventional cardiology and a significant decrease in the number of patients treated with STEMI was observed during the COVID-19 pandemic. The results are similar to those reported by Latin American, European and North American countries.

Cardiac teleconsulting in the time of COVID-19 global pandemic: The "Antonio Cardarelli" Hospital project.

Dear Editor, Teleconsulting - defined as real-time consultation between doctors by exploiting video conferencing technology over the Internet network - is exponentially being implemented through the western world lastly triggered by COVID-19 pandemic...

Health Service Utilization Patterns Among Adults With Congenital Heart Disease: A Population-Based Study.

Background Several studies have examined hospitalizations among patients with adult congenital heart disease (ACHD). Few investigated other services or utilization patterns. Our aim was to study service utilization patterns and predictors among patients with ACHD. Methods and Results We identified 11 653 patients with ACHD aged ≥18 years (median, 47 years), through electronic records of 2 large Israeli healthcare providers (2007-2011). The association between patient, disease, and sociogeographic characteristics and healthcare resource utilization were modeled as recurrent events accounting for the competing death risk. Patients with ACHD had high healthcare utilization rates compared with the general population. The highest standardized service utilization ratios (SSRs) were found among patients with complex congenital heart disease including primary care visits (SSR, 1.53; 95% CI, 1.47-1.58), cardiology outpatient visits (SSR, 5.17; 95% CI, 4.69-5.64), hospitalizations (SSR, 6.68; 95% CI, 5.82-7.54), and days in hospital (SSR, 15.37; 95% CI, 14.61-16.12). Adjusted resource utilization hazard increased with increasing lesion complexity. Hazard ratios (HRs) for complex versus simple disease were: primary care (HR, 1.14; 95% CI, 1.06-1.23); cardiology outpatient visits (HR, 1.40; 95% CI, 1.24-1.59); emergency department visits (HR, 1.19; 95% CI, 1.02-1.39); and hospitalizations (HR, 1.75; 95% CI, 1.49-2.05). Effects attenuated with age for cardiology outpatient visits and hospitalizations and increased for emergency department visits. Female sex, geographic periphery, and ethnic minority were associated with more primary care visits, and female sex (HR versus men, 0.89 [95% CI, 0.84-0.94]) and periphery (HR, 0.72 [95% CI, 0.58-0.90] for very peripheral versus very central) were associated with fewer cardiology visits. Arab minority patients also had high hospitalization rates compared with the majority group of Jewish or other patients. Conclusions Healthcare utilization rates were high among patients with ACHD. Female sex, geographic periphery, and ethnicity were associated with less optimal service utilization patterns. Further research should examine strategies to optimize service utilization in these groups.

Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on Acute Admissions at the Emergency and Cardiology Departments Across Europe.

PURPOSE: We evaluated whether the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) pandemic was associated with changes in the pattern of acute cardiovascular admissions across European centers. METHODS: We set-up a multicenter, multinational, pan-European observational registry in 15 centers from 12 countries. All consecutive acute admissions to emergency departments and cardiology departments throughout a 1-month period during the COVID-19 outbreak were compared with an equivalent 1-month period in 2019. The acute admissions to cardiology departments were classified into 5 major categories: acute coronary syndrome, acute heart failure, arrhythmia, pulmonary embolism, and other. RESULTS: Data from 54,331 patients were collected and analyzed. Nine centers provided data on acute admissions to emergency departments comprising 50,384 patients: 20,226 in 2020 compared with 30,158 in 2019 (incidence rate ratio [IRR] with 95% confidence interval [95%CI]: 0.66 [0.58-0.76]). The risk of death at the emergency departments was higher in 2020 compared to 2019 (odds ratio [OR] with 95% CI: 4.1 [3.0-5.8], P < 0.0001). All 15 centers provided data on acute cardiology departments admissions: 3007 patients in 2020 and 4452 in 2019; IRR (95% CI): 0.68 (0.64-0.71). In 2020, there were fewer admissions with IRR (95% CI): acute coronary syndrome: 0.68 (0.63-0.73); acute heart failure: 0.65 (0.58-0.74); arrhythmia: 0.66 (0.60-0.72); and other: 0.68(0.62-0.76). We found a relatively higher percentage of pulmonary embolism admissions in 2020: odds ratio (95% CI): 1.5 (1.1-2.1), P = 0.02. Among patients with acute coronary syndrome, there were fewer admissions with unstable angina: 0.79 (0.66-0.94); non-ST segment elevation myocardial infarction: 0.56 (0.50-0.64); and ST-segment elevation myocardial infarction: 0.78 (0.68-0.89). CONCLUSION: In the European centers during the COVID-19 outbreak, there were fewer acute cardiovascular admissions. Also, fewer patients were admitted to the emergency departments with 4 times higher death risk at the emergency departments.

Direct Admission of Patients With ST-Segment-Elevation Myocardial Infarction to the Catheterization Laboratory Shortens Pain-to-Balloon and Door-to-Balloon Time Intervals but Only the Pain-to-Balloon Interval Impacts Short- and Long-Term Mortality.

Background Shortening the pain-to-balloon (P2B) and door-to-balloon (D2B) intervals in patients with ST-segment-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PPCI) is essential in order to limit myocardial damage. We investigated whether direct admission of PPCI-treated patients with STEMI to the catheterization laboratory, bypassing the emergency department, expedites reperfusion and improves prognosis. Methods and Results Consecutive PPCI-treated patients with STEMI included in the ACSIS (Acute Coronary Syndrome in Israel Survey), a prospective nationwide multicenter registry, were divided into patients admitted directly or via the emergency department. The impact of the P2B and D2B intervals on mortality was compared between groups by logistic regression and propensity score matching. Of the 4839 PPCI-treated patients with STEMI, 1174 were admitted directly and 3665 via the emergency department. Respective median P2B and D2B were shorter among the directly admitted patients with STEMI (160 and 35 minutes) compared with those admitted via the emergency department (210 and 75 minutes, P<0.001). Decreased mortality was observed with direct admission at 1 and 2 years and at the end of follow-up (median 6.4 years, P<0.001). Survival advantage persisted after adjustment by logistic regression and propensity matching. P2B, but not D2B, impacted survival (P<0.001). Conclusions Direct admission of PPCI-treated patients with STEMI decreased mortality by shortening P2B and D2B intervals considerably. However, P2B, but not D2B, impacted mortality. It seems that the D2B interval has reached its limit of effect. Thus, all efforts should be extended to shorten P2B by educating the public to activate early the emergency medical services to bypass the emergency department and allow timely PPCI for the best outcome.

Impacto de la pandemia COVID-19 en la práctica de la electrofisiología cardíaca en Latinoamérica: una encuesta de la Sociedad Latinoamericana del Ritmo Cardíaco / Impact of the COVID-19 pandemic on the practice of cardiac electrophysiology in Latin America: a survey of the Latin American Heart Rhythm Society / Impacto da pandemia COVID-19 na prática da eletrofisiologia cardíaca na América Latina: uma pesquisa da Sociedade Latino-Americana de Ritmo Cardíaco

Al comienzo de la pandemia COVID-19 se implementaron pautas clínicas restrictivas de la asistencia que incluyeron los Servicios de Electrofisiología (SEF). Objetivo: analizar la actividad asistencial y conocer la situación de los SEF en Latinoamérica a dos meses de iniciadas las restricciones. Método: estudio observacional descriptivo-analítico y transversal, utilizando una encuesta a médicos electrofisiólogos en marzo/2020. Se comparó la actividad clínica e invasiva que se realizaba antes y durante la pandemia. Resultados: se incluyeron 147 encuestas, de 74 ciudades y 18 países de Latinoamérica. Los actos clínicos semanales se redujeron de 75 (45/127) a 20 (10/40) (p<0,001), bajaron 71%. Los procedimientos invasivos mensuales se redujeron de 26 (13/39) a 4 (2/9) (p<0,001), bajaron 77%. El 49% encuestado trabajaban en ≥3 centros asistenciales y 89% compartía laboratorio con un servicio de hemodinamia. La ocupación de camas en los hospitales era baja 37%, intermedia 28% y alta 35%. El 30% refirió algún médico de su equipo fue puesto en cuarentena por infección/contacto. El 53% refirió no se hacía ninguna prueba de tamizaje a los pacientes previa a los procedimientos y 77% al personal. La mayoría percibía dificultades como importantes o muy importantes, pero 63% estaba considerando la reapertura al funcionamiento normal. Conclusiones: hubo una reducción importante de la actividad clínica e invasiva. La mayoría no tenía alta ocupación de camas. Los encuestados trabajaban en varios centros y en salas de hemodinamia. Aún no se habían implementado totalmente las medidas de prevención. Existía la percepción de que en poco tiempo se retomaría la normalidad

At the beginning of the COVID-19 pandemic, restrictive clinical guidelines were implemented, including Electrophysiology Services (EFS). Objectives: analyze the healthcare activity and to know the situation of the EFS in Latin America two months after the restrictions began. Method: descriptive-analytical and cross-sectional observational study, using a survey of electrophysiologists in March / 2020. The clinical and invasive activity carried out before and during the pandemic was compared. Results: 147 surveys were included, from 74 cities in 18 Latin American countries. Weekly clinical events were reduced from 75 (45/127) to 20 (10/40) (p <0.001), they fell 71%. Monthly invasive procedures were reduced from 26 (13/39) to 4 (2/9) (p <0.001), down 77%. Forty-nine percent surveyed worked in ≥3 healthcare centers and 89% shared a laboratory with a hemodynamic service. Hospital bed occupancy was low 37%, intermediate 28% and high 35%. Thirty percent referred a doctor from their team was quarantined for infection / contact. Fifty-three percent reported that no screening test was done on the patients prior to the procedures and 77% on the staff. Most perceived difficulties as important or very important, but 63% were considering reopening to normal functioning. Conclusion: There was a significant reduction in clinical and invasive activity. Most did not have high bed occupancy. Respondents worked in various centers and in hemodynamic rooms. Prevention measures had not yet been fully implemented yet. There was a perception that in a short time normality would return.

No início da pandemia de COVID-19 foram implementadas diretrizes clínicas, incluindo os Serviços de Eletrofisiologia (SEF). Objetivo: analisar a atividade assistencial e conhecer a situação do SEF na América Latina dois meses após o início das restrições. Método: estudo descritivo-analítico e observacional transversal, por meio de questionário com eletrofisiologistas em março / 2020. Foi comparada a atividade clínica e invasiva realizada antes e durante a pandemia. Resultados: foram incluídos 147 inquéritos, de 74 cidades e 18 países latino-americanos. O número de procedimentos semanais foi reduzido de 75 (45/127) para 20 (10/40) (p <0,001), com redução de 71%. Os procedimentos invasivos mensais foram reduzidos de 26 (13/39) para 4 (2/9) (p <0,001), com redução de 77%. Dos eletrofisiologistas que responderam ao questionário, 49% trabalhavam em 3 ou mais centros, e 89% compartilhavam o laboratório com serviço de hemodinâmica. A ocupação de leitos hospitalares foi baixa em 37%, intermediária em 28% e alta em 35%. Dos que responderam al questionário, 30% relataram que um médico de sua equipe foi colocado em quarentena por infecção ou contato. Foi relatado que, dentre os que responderam, 53% não realizava teste de triagem nos pacientes antes dos procedimentos, e em 77% na equipe. A maioria percebeu as dificuldades como importantes ou muito importantes, mas 63% consideravam a reabertura ao funcionamento. Conclusões: houve redução significativa da atividade clínica e invasiva. A maioria não tinha grande ocupação de leitos. Os entrevistados trabalhavam em vários centros e em salas de hemodinâmica. As medidas de prevenção ainda não haviam sido totalmente implementadas, porém havia a percepção de que em pouco tempo a normalidade voltaria

Impact of SARS-CoV-2 on Provided Healthcare. Evidence From the Emergency Phase in Italy.

The SARS-CoV-2 (COVID-19) pandemic led to an emergency scenario within all aspects of health care, determining reduction in resources for the treatment of other diseases. A literature review was conducted to identify published evidence, from 1 March to 1 June 2020, regarding the impact of COVID-19 on the care provided to patients affected by other diseases. The research is limited to the Italian NHS. The aim is to provide a snapshot of the COVID-19 impact on the NHS and collect useful elements to improve Italian response models. Data available for oncology and cardiology are reported. National surveys, retrospective analyses, and single-hospital evidence are available. We summarized evidence, keeping in mind the entire clinical pathway, from clinical need to access to care to outcomes. Since the beginning, the COVID-19 pandemic was associated with a reduced access to inpatient (-48% for IMA) and outpatient services, with a lower volume of elective surgical procedures (in oncology, from 3.8 to 2.6 median number of procedures/week). Telehealth may plays a key role in this, particularly in oncology. While, for cardiology, evidence on health outcome is already available, in terms of increased fatality rates (for STEMI: 13.7 vs. 4.1%). To better understand the impact of COVID-19 on the health of the population, a broader perspective should be taken. Reasons for reduced access to care must be investigated. Patients fears, misleading communication campaigns, re-arranged clinical pathways could had played a role. In addition, impact on other the status of other patients should be mitigated.

Decreases in cardiac catheter laboratory workload during the COVID-19 level 4 lockdown in New Zealand.

An increase in coronavirus disease (COVID-19) infections prompted Level 4 lockdown throughout New Zealand from 25 March 2020. We have investigated trends in coronary and electrophysiology (EP) procedures before and during this lockdown. The number of acute procedures for ST elevation myocardial infarction remained stable. In contrast, the number of in-patient angiograms and percutaneous intervention procedures fell by 53% compared with the previous 4 weeks in 2020 and by 56% compared with the corresponding period in 2019. Further study is required to determine the reasons for these trends.

Manejo de los pacientes con insuficiencia cardiaca atendidos en la consulta de cardiología: estudio IC-BERG / Management of patients with heart failure treated in cardiology consultations: IC-BERG Study

OBJETIVO: Conocer la percepción y el manejo del cardiólogo clínico de la insuficiencia cardiaca con fracción de eyección reducida (IC-FER) y establecer un consenso con recomendaciones. MÉTODOS: Se empleó el método Delphi modificado entre un panel de 150 expertos que respondieron un cuestionario que incluyó tres bloques: definición y percepción del paciente con IC-FER «estable» (15 afirmaciones), manejo del paciente con IC-FER «estable» (51 afirmaciones) y recomendaciones para optimizar el manejo y el seguimiento (9 afirmaciones). El nivel de acuerdo se evaluó utilizando una escala tipo Likert de 9 puntos. RESULTADOS: Se llegó a un consenso de acuerdo en 49 afirmaciones, a un consenso en el desacuerdo en 16 y quedaron indeterminadas 10 afirmaciones. Hubo consenso en cuanto a la definición de IC «estable» (82%), en que la IC-FER tiene una naturaleza silenciosa que puede contribuir a aumentar el riesgo de muerte en pacientes poco sintomáticos (96%), y que independientemente de que el paciente con IC-FER se mantenga estable en la misma clase funcional el tratamiento farmacológico debe optimizarse (98,7%). En cambio, hubo consenso en el desacuerdo con respecto a que el tratamiento con un inhibidor de neprilisina y receptor de angiotensina solo está justificado cuando hay un empeoramiento de la clase funcional (90,7%). CONCLUSIONES: El conocimiento actual sobre la IC «estable» es insuficiente; es necesaria la optimización del tratamiento, incluso en pacientes aparentemente estables, para disminuir el riesgo de progresión de la enfermedad

OBJECTIVE: To determine the perception and management of heart failure with reduced ejection fraction (HFrEF) by clinical cardiologists and to establish a consensus with recommendations. METHODS: We employed the modified Delphi method among a panel of 150 experts who answered a questionnaire that included three blocks: definition and perception of patients with «stable» HFrEF (15 statements), management of patients with «stable» HFrEF (51 statements) and recommendations for optimising the management and follow-up (9 statements). The level of agreement was assessed with a Likert 9-point scale. RESULTS: A consensus of agreement was reached on 49 statements, a consensus of disagreement was reached on 16, and 10 statements remained undetermined. There was consensus regarding the definition of «stable» HF (82%), that HFrEF had a silent nature that could increase the mortality risk for mildly symptomatic patients (96%) and that the drug treatment should be optimised, regardless of whether a patient with HFrEF remains stable in the same functional class (98.7%). In contrast, there was a consensus of disagreement regarding the notion that treatment with an angiotensin receptor-neprilysin inhibitor is justified only when the functional class worsens (90.7%). CONCLUSIONS: Our current understanding of «stable» HF is insufficient, and the treatment needs to be optimised, even for apparently stable patients, to decrease the risk of disease progression

First national registry on the effectiveness and safety of evolocumab in clinical practice in patients attended in cardiology in Spain. The RETOSS-CARDIO study. / Primer registro nacional sobre la efectividad y seguridad de evolocumab en la práctica clínica en pacientes atendidos en cardiología en España. Estudio RETOSS-CARDIO.

OBJECTIVE: To present the first registry used to analyse the clinical profile of patients treated with evolocumab in Spain, including the effectiveness on the lipid profile and safety in the «real world¼ setting. METHODS: Multicentre, retrospective, and observational study of patients starting treatment with evolocumab from February 2016 to May 2017 in clinical practice in Spanish cardiology units. RESULTS: A total of 186 patients (mean age 60.3 ± 9.8 years were included, 35.5% with familial hypercholesterolaemia, and 94.1% with a previous cardiovascular event) from 31 cardiology units. Baseline lipid profile: Total cholesterol 219.4 ± 52.2 mg/dL, LDL-cholesterol 144.0 ± 49.0mg/dL, HDL-cholesterol 47.7 ± 13.0mg/dL, and triglycerides 151.0 ± 76.2mg/dL. At the time of initiating evolocumab, 53.8% of patients were taking statins (50% had partial or total intolerance to statins), and 51.1% ezetimibe. In all cases, the dose of evolocumab used was 140 mg, mainly every 2 weeks (97.3%). Evolocumab compliance was high (92.3%). Treatment with evolocumab was interrupted in 6 patients (3.2%), with only 1 (0.5%) due to a probable side effect. Evolocumab significantly reduced total cholesterol (30.9% at week 2, and 39.3% at week 12; P<.001), LDL cholesterol (44.4% and 57.6%, respectively; P<.001), and triglycerides (14.8% and 5.2%, respectively; P<001), with no significant changes in HDL-cholesterol (6.7% and 2.0%; P=.14). CONCLUSIONS: In clinical practice, evolocumab is associated with reductions in LDL cholesterol, with nearly 60% after 12 weeks of treatment, and with low rates of interruptions due to side effects and high medication compliance. These results are consistent with those reported in randomised clinical trials.

[Partnership development between two hospitals: the integration process of Interventional Cardiology Units between the San Luigi Gonzaga University Hospital and the Local Health Unit Torino 3]. / Lo sviluppo di una partnership tra Aziende Sanitarie: l'integrazione dei laboratori di Emodinamica tra l'Azienda Ospedaliera Universitaria San Luigi Gonzaga di Orbassano e l'Azienda Sanitaria Locale Torino 3.

BACKGROUND: The healthcare sector is among the most complex ones where partnerships and interdependencies between different hospitals can achieve real technical and managerial operational models aimed at optimizing resources. However, the construction of this type of interdependence is not simple to implement, making it necessary to integrate at different organizational and professional levels. The aim of this work is to present the integration process and results achieved during the first 3 years of experience after a synergic integration of the interventional cath lab units of the San Luigi Gonzaga University Hospital, Orbassano and the Infermi Hospital Local Health Unit TO 3, Rivoli. METHODS: Starting from March 2016, data concerning number and type of procedures as well as the distribution of workloads of each operator in the two cath labs were recorded and monitored. Moreover, numbers of urgent procedures performed as well as the door-to-balloon time in case of primary angioplasty were recorded. RESULTS: Compared to the first 12 months of non-integrated activity, the number of procedures remained constant with an overall trend of activity increase (total procedures: +2.6% from 2016 to 2017; +8.7% from 2017 to 2018). No statistically significant differences were found in the average door-to-balloon time, either by stratifying by period (year 2015 vs 2016 vs 2017 vs 2017 vs 2018) or by single institution. All ST-elevation myocardial infarctions were treated at the arrival site, displacing the medical availability team. The mortality rate and the number of complications were not different compared to the trend recorded in previous years. The implementation of joint programs with an exchange of expertise between operators has allowed the rapid development of skills necessary for the execution of structural heart procedures not previously performed in one of the operating centers. CONCLUSIONS: The model of an integrated cath lab unit represents an example of a partnership between two hospitals, which allows a synergistic growth of professional skills, even facing daily logistical challenges. The integration has made it possible to expand the number and type of procedures performed as well to join the on-call equipe without impacting on the door-to-balloon time in case of primary coronary angioplasty.

Association Between Hospital Cardiac Catheter Laboratory Status, Use of an Invasive Strategy, and Outcomes After NSTEMI.

BACKGROUND: Increased use of invasive coronary strategies in patients admitted to hospitals with on-site cardiac catheter laboratory (CCL) facilities has been reported, but the utilisation of invasive coronary strategies according to types of CCL facilities at the first admitting hospital and clinical outcomes is unknown. METHODS: We included 452,216 patients admitted with a diagnosis of non-ST-segment-elevation myocardial infarction (NSTEMI) in England and Wales from 2007 to 2015. The admitting hospitals were categorized into no-laboratory, diagnostic, and PCI hospitals according to CCL facilities. Multilevel logistic regression models were used to study associations between CCL facilities and in-hospital outcomes. RESULTS: A total of 97,777 (21.6%) of the patients were admitted to no-laboratory hospitals, and 134,381 (29.7%) and 220,058 (48.7%) were admitted to diagnostic and PCI hospitals, respectively. Use of coronary angiography was significantly higher in PCI hospitals (77.3%) than in diagnostic (63.2%) and no-laboratory (61.4%) hospitals. The adjusted odds of in-hospital mortality were similar for diagnostic (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.83-1.04) and PCI hospitals (OR 1.09, 95% CI 0.96-1.24) compared with no-laboratory hospitals. However, in high-risk NSTEMI subgroup (defined as Global Registry of Acute Coronary Events score > 140), an admission to diagnostic hospitals was associated with significantly increased in-hospital mortality (OR 1.36, 95% CI 1.06-1.75) compared with no-laboratory and PCI hospitals. CONCLUSIONS: This study highlights important differences in both the utilisation of invasive coronary strategies and subsequent management and outcomes of NSTEMI patients according to admitting hospital CCL facilities. High-risk NSTEMI patients admitted to diagnostic hospitals had greater in-hospital mortality, possibly because of reduced PCI use, which needs to be addressed.

Initiation of Extracorporeal Membrane Oxygenation in the Cardiac Catheterization Laboratory: The Mayo Clinic Experience.

INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) support is indicated for the management of patients with cardiogenic shock or refractory cardiac arrest in the cardiac catheterization laboratory. The aim of this study was to review the outcomes of patients initiated on ECMO support in the cardiac catheterization laboratory. METHODS: We performed a retrospective analysis of adult patients (>18 years old) initiated on ECMO support in the cardiac catheterization laboratory from 2010-2017. Baseline demographics, clinical characteristics, procedural details, and indication for ECMO support were reviewed. The outcomes assessed included 30-day mortality, blood product transfusion, vascular injury, prolonged respiratory failure, stroke, ischemic bowel, renal failure requiring hemodialysis, and compartment syndrome. RESULTS: Between January 1, 2010 and December 31, 2017, a total of 25 patients were cannulated for ECMO in the cardiac catheterization laboratory. The mean age was 61 years and 56% of patients were men. Cardiac arrest was the most frequent indication for ECMO support (64%), followed by cardiogenic shock (28%). The 30-day mortality rate was 40%. The most frequent complications associated with ECMO were the need for vascular surgery (52%) and renal failure requiring hemodialysis (36%). The univariate predictors of 30-day mortality were age (P=.02; unit odds ratio [OR], 1.08; 95% confidence interval [CI], 1.01-1.15), history of tobacco use (P=.04; OR, 6; 95% CI, 1.01-35.91), and Apache IV score (P=.02; unit OR, 1.02; 95% CI, 1.01-1.09). CONCLUSIONS: ECMO should be considered early during the resuscitation attempts of selected patients with ongoing cardiopulmonary resuscitation or refractory cardiogenic shock in the cardiac catheterization laboratory.

Current functioning of cardio-oncology units in Spain.

PURPOSE: The aim of the current survey was to describe the functioning of cardio-oncology (C-O) units in Spain. METHODS: All members of the Spanish Society of Cardiology pertaining to scientific communities related to C-O received questionnaires on the existence of specific programs at their institutions. A second, more extensive questionnaire was sent to the centers which reported C-O organization. RESULTS: We identified 56 centers with C-O programs of which 32 (62.5%) replied to the extended questionnaire. 28% of all centers reported having a multidisciplinary unit involving specialists in several areas. More than 80% of the centers developed surveillance protocols locally adapted which included advanced echocardiographic techniques (68%) or troponin (82%). CONCLUSIONS: The number of institutions with C-O programs is still limited but higher than reported in a survey in 2017. Development of multidisciplinary units of C-O should be promoted to improve the cardiovascular health of cancer patients.

Rates and predictors of general practitioner (GP) follow-up postdischarge from a tertiary hospital cardiology unit: a retrospective cohort study.

OBJECTIVE: Previous studies in cardiac patients noted that early patient follow-up with general practitioners (GPs) after hospital discharge was associated with reduced rates of hospital readmissions. We aimed to identify patient, clinical and hospital factors that may influence GP follow-up of patients discharged from a tertiary cardiology unit. DESIGN: Single centre retrospective cohort study. SETTING: Australian metropolitan tertiary hospital cardiology unit. PARTICIPANTS: 1079 patients discharged from the hospital cardiology unit within 3 months from May to July 2016. OUTCOME MEASURES: GP follow-up rates (assessed by telephone communication with patients' nominated GP practices), demographic, clinical and hospital factors predicting GP follow-up. RESULTS: We obtained GP follow-up data on 983 out of 1079 (91.1%) discharges in the study period. Overall, 7, 14 and 30-day GP follow rates were 50.3%, 66.5% and 79.1%, respectively. A number of patient, clinical and hospital factors were associated with early GP follow-up, including pacemaker and defibrillator implantation, older age and having never smoked. Documented recommendation for follow-up in discharge summary was the strongest predictor for 7-day follow-up (p<0.001). CONCLUSION: After discharge from a cardiology admission, half of the patients followed up with their GP within 7 days and most patients followed up within 30 days. Patient and hospital factors were associated with GP follow-up rates. Identification of these factors may facilitate prospective interventions to improve early GP follow-up rates.