V. Rao

The 2012 Canadian Cardiovascular Society heart failure management guidelines update: focus on acute and chronic heart failure.

The 2012 Canadian Cardiovascular Society Heart Failure (HF) Guidelines Update provides management recommendations for acute and chronic HF. In 2006, the Canadian Cardiovascular Society HF Guidelines committee first published an overview of HF management. Since then, significant additions to and changes in many of these recommendations have become apparent. With this in mind and in response to stakeholder feedback, the Guidelines Committee in 2012 has updated the overview of both acute and chronic heart failure diagnosis and management. The 2012 Update also includes recommendations, values and preferences, and practical tips to assist the medical practitioner manage their patients with HF.

Old School Still Has Merit: ECG as a Marker of Cardiac Recovery at Weaning from Mechanical Circulatory Support

In a case of acute cardiac allograft failure requiring temporary mechanical circulatory support (MCS), serial electrocardiograms (ECG) denoted the degree of myocardial inflammation and damage caused by severe rejection and subsequent recovery. This case highlights the relevance of the ECG during temporary MCS and suggests that resolution of acute electrocardiographic abnormalities might be a marker of myocardial recovery to help guide appropriate timing for weaning from MCS in the setting of acute graft failure.

OUTCOMES FOLLOWING HIGH RISK SURGERY PROVIDED AS AN ALTERNATIVE TO TRANSPLANT IN PATIENTS WITH END-STAGE HEART DISEASE

Background: Heart transplant (Tx) and ventricular assist device (VAD) have become established treatments for end stage heart failure; however, both treatments still have unsolved problems. Patients referred for Tx or VAD are often found to have cardiac lesions amenable to surgical intervention. We examined the results of conventional surgery in patients with severe left ventricular dysfunction to explore the possibility of high risk surgery as an alternative option. Methods: We reviewed our institutional database and identified all surgical patients referred to our senior author with severe LV dysfunction (EF Results: A total of 133 patients were enrolled. 68 patients were Tx-E, and 65 were Tx-NE. Tx-E patients were younger than Tx-NE (57±8 vs 70±8 year-old, p Conclusion: The mortality and morbidity in patients undergoing alternative surgeries appears to be similar to the contemporary results of Tx and VAD destination therapy. Particularly if the pathology of heart failure is graftable coronary artery disease, isolated CABG may be a good option for highly selected patients.

131 Endothelial progenitor cells and functional capacity in heart failure patients

BACKGROUND: Prompt access to care that optimizes outcomes is crucial in the management of heart failure (HF). The Canadian Cardiology Society (CCS) recommends that patients should be seen within two weeks following an emergency department (ED) visit for HF. However, it is unknown whether lack of adherence to this benchmark translates into worse clinical outcomes. OBJECTIVE: The objective was to examine whether delay in consultation following an ED visit for HF was related to adverse outcomes/events (death, hospitalization or repeat ED visit). METHODS: Patients with a confirmed diagnosis of HF were recruited by nurses at 8 hospital EDs in Quebec, Canada. They were interviewed by telephone within 6 weeks of ED discharge and subsequently at 3 months and 6 months. They responded to questions related to use of health services, sociodemographic information, the Minnesota Living with Heart Failure Questionnaire, and the Stanford Self-Efficacy in Chronic Disease Questionnaire. Pertinent clinical variables were extracted from medical charts by trained nurses. We used Cox regression to analyze whether delayed medical follow-up following ED visit was associated with increased risk of adverse events independently of other clinical covariates. RESULTS: We recruited a total of 551 patients. The mean age was 75.5 11.0 years and 51% were males. Only 30% consulted with a physician for their HF within 2 weeks post ED visit. By 4 weeks, 51% consulted a physician. Over the 6 month follow-up, 25% returned to the ED, 23% were hospitalized, and 13.6% died. Patients who consulted a physician within 2 weeks of ED discharge had a non-significantly lower risk of adverse events (HR: 0.69, 95% CI 0.40-1.2). However, by 4 weeks, this relationship became statistically significant: patients who consulted a physician for their HF within 4 weeks were less likely to sustain an adverse event (HR: 0.59, 95% CI 0.36-0.97). In addition to late clinical follow up, factors associated with a higher risk of adverse event included worse Minnesota Score, HF with systolic dysfunction and previous myocardial infarction. CONCLUSION: Prompt follow-up post ED visit for HF is associated with lower risk for major adverse event. Adherence to current CCS benchmarks is crucial. There is an urgent need to improve the rate of medical consultation within 2 to 4 weeks following ED visit for patients with HF. Canadian Institutes of Health Research (CIHR)