Vascular access in cath lab, costs and complications

Vascular access in cath lab, costs and complications

Abstract 144 Variability of delay time in seeking medical care for chest pain: a global review K. Wechkunanukul 1,∗ , H. Grantham 2 , R. Clark 1 1 Sc...

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Abstract

144 Variability of delay time in seeking medical care for chest pain: a global review K. Wechkunanukul 1,∗ , H. Grantham 2 , R. Clark 1 1 School

of Nursing and Midwifery, Flinders University, Adelaide, Australia 2 Paramedic Unit, Flinders University, Adelaide, Australia Background: Previous research has demonstrated that delay in seeking medical care for chest pain may have major effects on patient’s survival. This review aimed to compare the delay time in seeking care for chest pain within ethnic groups around the globe. Methods: A comprehensive literature review was performed using the Medline, CINALH and Scopus databases, delay time data from research published between 1994 and 2014 was extracted. Results: The search yielded 395 articles and 205 full-text articles were assessed for eligibility. Twenty-three articles have been included. Delay times varied across countries ranging from 1.62 hours (Brazil) to 12.9 hours (Saudi Arabia) with mean and median of 3.40 and 3.04 hours respectively. Seven studies reported that decision time was the largest proportion of pre-hospital delay time ranging from 40.8% in Iran to 82.8% in Australia. Six publications reported patients arrived at hospital within 1 hour, ranging from 11.9% in Lebanon to 28% in Jordan. Utilisation of ambulance ranged from 3.1%, Brazil to 61%, Australia. Only three studies included sub-analysis by ethnicity and reported ethnicity was a significant predictor of delayed presentation, and non-Caucasians had a longer delay time than Caucasians. Conclusion: Variability in delay time occurred regardless of geographic region and health care system. The time taken to seek care for chest pain has not improved for 20 years. The differences in culture and attitudes in each country could influence on seeking care behaviour. Further research is recommended to review the impact of CALD background on patient’s outcomes. http://dx.doi.org/10.1016/j.hlc.2015.06.145 145 Vascular access in cath lab, costs and complications M. Ramadan 1,∗ , T. Pegg 1,2 , N. Fisher 1,2 1 Waikato 2 Nelson

DHB, New Zealand DHB, New Zealand

BG: Radial artery approach (RAA) for diagnostic angiography and intervention is considered the preferred access site, however little is known about the costs of radial or femoral artery approach (FAA). We compared the two strategies in terms of cost effectiveness, hospital stay and post-operative complication in a regional New Zealand secondary care centre.

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Method: Analysis of 200 consecutive patients undergoing elective and acute diagnostic cardiac catheterisation was studied. Patients awaiting transfer to tertiary centres were excluded from the analysis of the hospital stay variable. Equipment and procedural data was retrospectively analysed for all cases. Results: Intra-operative cost was $141for RAA vs. $150 for FAA (RR 1%, P 0.91). 63% of patients undergoing a RAA stayed < 1 day versus only 35% of FAA stayed < 1 day (P 0.003). The mean length of stay for a RAA was 0.54 days vs. FAA 1.2 days. In elective patients RAA mean length of stay < 0.2 days, vs. FAA 0.7 days (p<0.001). Mean contrast volume in RAA was 100 ml vs 120ml with FAA (P 0.002). Fluoroscopy times were 4mins for FFA vs. 5mins for RAA (p=0.8). No patients undergoing RAA experienced a procedure related complication vs. 3/100 FAA patients had major bleeding complications. Conclusion: Radial approach is cost effective and safer than femoral in a real world secondary care regional PCI centre. These results are consistent with the international trials. http://dx.doi.org/10.1016/j.hlc.2015.06.146 146 Vulnerable plaque features on computed tomography coronary angiography are associated with long-term acute coronary syndrome events R. Munnur ∗ , R. Muthalaly, B. Ko, L. Potter, A. Talman, Y. Bae, S. Qian, H. Au-Yeung, D. Tharmaratnam, J. Nogic, J. Moghadas, J. Cameron, I. Meredith, S. Seneviratne, D. Wong MonashHEART, Melbourne, Australia Background: Vulnerable-plaque (VP) features detected on computed-tomography-coronary-angiography (CTCA) correlate well with thin-cap-fibroatheroma classified on intravascular-ultrasound and optical-coherencetomography. Studies have shown their association with acute-coronary-syndrome (ACS) on medium term follow-up. Methods: We examined CTCA scans of patients who have long-term follow-up data with suspected coronaryartery-disease at MonashHeart between 2009 and 2012. CTCA images were qualitatively assessed for lesion severity and presence of VP-features, defined as the presence of positive-remodelling (PR), spotty-calcification (SC) and lowattenuation- plaque (LAP) with <30 Hounsfield-units, by two experienced observers. The primary end-point was ACS events on long-term follow-up. Results: 364 vessels were analysed from 122 patients (62.3±10.8 years, 68% male) who had mean follow-up of 53.5±13.2 months. There were 308 vessels with mild (<50%) or no stenosis, 39 with moderate (50-69%) stenosis and 17 with severe (>70%) stenosis. No VP-features were found in 332 vessels, 11 had only 1 feature (PR), 22 had 2 features (PR and LAP n=16; PR and SC n=6) and 6 had 3 features. During follow-up, 7 patients had an ACS event. All had VP characteristics, with 4 having 3 VP-features (p<0.001) and 3 having 2 features (LAP and PR) (p<0.001). There were no ACS events