2023

Implementing the new BSE methods and reference ranges for the Proximal Ascending Aorta and the impact on downstream testing-experience of a District General Hospital (2023)

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Type of publication:

Conference abstract

Author(s):

*Doherty J.; *Ellis C.; *Lee E.;

Citation:

Echo Research and Practice. Conference: British Society of Echocardiography annual meeting 2023. Newport . 11(Supplement 1) (no pagination), 2024. Date of Publication: 01 Jul 2024.

Abstract:

Background: In 2020 the BSE updated the methods and reference values for assessing the proximal ascending aorta (PAA). It is important to quantify how implementing these methods alter the rate of 'dilated' PAAs identified by echocardiography, and how this will impact the wider service and patient pathway. Purpose(s): To compare the rate of dilated PAAs detected by the current BSE methods, and two other methods of assessing the PAA in our patient population. Method(s): All transthoracic echocardiograms where the PAA was measured between January 2018 and December 2019 were included. Studies with incomplete demographics or bicuspid aortic valves were excluded. The PAA was indexed to height (Method 1), body surface area (BSA) (Method 2) and height2.7 (Method 3), compared to the corresponding normal reference values and classified as 'dilated' or 'nondilated' accordingly. The rate of 'dilated' proximal ascending aortas were compared using Chi-squared test. Result(s): 11,828 studies were identified. 2189 were removed due to incomplete patient demographics and 27 with bicuspid aortic valves. 2710 studies were removed as Method 2 does not provide reference values for patients < 45 and Method 3 > 80 years old. 6902 studies were included in the analysis. Method 1 classified significantly more PAAs as 'dilated' (31%, AUC = 0.930) compared to Method 2 (10%, AUC = 0.841) and 3 (3%, AUC = 0.921) (X2(1, N = 6902) = 2435.8, p < 0.001). Figure 1 (abstract ABS004) A comparison of number of Proximal Ascending Aortas classified as dilated using three different methods of normalising and assessing the proximal ascending aorta to body size; Method 1-height and sex, Method 2-body surface area, age and sex and Method 3-height2.7, age and sex.*Significantly different from Method 1 (p < 0.001).**Significantly different to Method 2 (p < 0.001) Figure 2 (abstract ABS004) Receiver Operating Characteristic (ROC) curves of three methods for assessing the size of the proximal ascending aorta (PAA) on echocardiography; BSE recommended methods using height and sex (Method 1, green), body surface area, age and sex (Method 2, red) and height2.7, age and sex (Method 3, blue). Sensitivity and 1-specificty values for each method at the PAA diameter of 4 cm is plotted. Of the 6902 studies, 306 PAAs were > 4 cm. Method 1 classified all PAAs > 4 cm and 1885 < 4 cm as dilated; Method 2 classified 111 PAAs > 4 cm and 82 < 4 cm as dilated; and Method 3 classified 203 PAAs > 4 cm and 476 < 4 cm as dilated. Conclusion(s): Adopting the 2020 BSE recommended methods significantly increase the detection rate of dilated PAAs in our patient population. This will impact subsequent downstream testing, affecting resource planning and patient journey.

DOI: 10.1186/s44156-024-00053-0

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Introducing a falls trolley to ward 8 (2023)

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Type of publication:

Service improvement case study

Author(s):

*Lucy Roberts and *Gemma Styles

Citation:

SaTH Improvement Hub, December 2023

SMART Aim:

The overall PSIRF aim for the Trust is to reduce the number of falls with harm. Ward 8 aimed to increase their compliance with neurological observations to 100%

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Is smoking associated with higher cardiovascular risk and increased unplanned acute medical attendance? A retrospective analysis from the Lung Cancer screening cohort (2023)

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Type of publication:

Conference abstract

Author(s):

Haider R.; Finn E.; *Zeb S.; *Bharwana F.; Fitzgerald A.; Iftikhar S.; Hussain I.;

Citation:

European Respiratory Journal. Conference: European Respiratory Society International Congress, ERS 2023. Milan Italy. 62(Supplement 67) (pp PA1345), 2023. Date of Publication: 01 Sep 2023.

Abstract:

Intro: Active smoking plays a crucial role in cardiovascular disease. We looked at the rate of attendance to primary and secondary care amongst current smokers with increased QRISK and CAT scores.

Methodology: Data were drawn retrospectively from electronic medical records from a large tertiary care hospital covering Staffordshire region over a one year period 2019-2020. Data was extracted from lung cancer screening cohort.

Result(s): The data comprised of 1232 patients (516 female, 716 male). Of these, 566 were exsmokers and 666 current smokers. Average age was 62 years. Analysis was done using ANOVA. This confirms that current heavy smokers, had an increased QRISK score >10 (p value <0.05, 95% CI 0.00 to 0.02). 1 year mortality in this group was 2.8%. Heavy smokers were not at an increased risk of attending primary care (p value 0.862) or at increased risk of unplanned secondary care admissions (p value 0.09) as compared to light smokers. Median length of hospital stay was 8 (0 – 16) bed days in heavy smokers as compared to 4 bed days (0 – 8) in ex smokers. Female ex smokers had fewer hospital attendances as compared to female current smokers, male current and ex smokers (p value <0.05, tests statistic 4.207). A high CAT score was documented as >20 denoting impact of COPD on patient's life. It was not identified as a predictor of increased attendance to primary or secondary care.

Conclusion(s): Heavy smokers have a higher economic burden on acute secondary care on account of higher number of bed days. Early smoking cessation intervention may help reduce attendance into secondary care.

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The continued burden of pleural mesothelioma; a review of 10 years experience at this hospital Trust (2023)

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Type of publication:

Conference abstract

Author(s):

*Gohir Q.; *Mcadam J.; *Crawford E.; *Bosher O.; *Saleem M.; *Srinivasan K.; *Moudgil H.;

Citation:

European Respiratory Journal. Conference: European Respiratory Society International Congress, ERS 2023. Milan Italy. 62(Supplement 67) (pp PA3444), 2023. Date of Publication: 01 Sep 2023.

Abstract:

Background: Prognosis with pleural mesothelioma depends not only on histological typing but also distribution of metastatic disease (including stage 4 with distant spread) and performance status. Analysing all patients presenting at his hospital Trust over 10 years, this work (1) reports the pattern of metastatic disease and, accepting the complex multi-modality approach to treatment, (2) relates findings to survival.

Method(s): Retrospective computer based analysis conferring with oncology and radiology records. 169 patients (84% male) with mean (range) age 74.4 (44 to 93) years.

Result(s): Respectively, performance status was 0 (16%), 1 (34%), 2 (26%), 3 (18%) and 4 (1%). 70% only had thoracic disease (pleural, pericardial, mediastinal, pulmonary) and 30% extrathoracic extension (chest wall/extrapleural, diaphragmatic, peritoneal/omental/ascites), liver/spleen/adrenal, spine and bone, and other (including brain and brachial plexus). Overall, 94% were diagnosed on tissue samples; where histology was clarified, 63% with epithelioid survived longer at (mean) 15 months compared to the 37% with 12.6 months for sarcomatoid or biphasic typing. Although active treatments often involved the complexity of multimodality, 34% had best supported care (usually worse performance status).

Conclusion(s): Findings highlight the aggressive nature of pleural mesothelioma confirming at least 30% had extrathoracic metastases and marginally improved outcomes with epithelioid histology.

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Parenteral Therapy in Domiciliary and Outpatient Setting: A Critical Review of the Literature (2023)

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Type of publication:
Journal article

Author(s):
*Puzovic M.; Morrissey H.; Ball P.A.

Citation:
Archives of Pharmacy Practice. 14(2) (pp 1-12), 2023. Date of Publication: 2023.

Abstract:
The clinical homecare sector is often associated with high-cost drug parenteral (injectable) therapy treatments and has been rapidly growing in the United Kingdom (UK) at a 20% annual rate. It was estimated that this could further rise to 60% if extended to all medicines that are considered to be suitable for care at home. The latest data shows that the homecare medicines services sector continues to grow in number and complexity, with over 500,000 patients and a spend of UK3.2 billion in 2021. Given the extent of the National Health Service (NHS) expenditure and the number of patients involved, it is essential to understand and explore the patients' and HCPs' experiences, views, and perceptions of this therapy. As identified during this literature review, homecare provides opportunities for improved cost savings and improved patient experience, but several issues have already been reported worldwide. Patient education, training, support, and regular supervision, as well as the competency of HCPs to manage these patients, have all been identified as factors that contribute to the success or failure of self-administration of parenteral therapy at home, which might impact treatment outcomes and adherence. This is an area that needs urgent research.

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Assessing opinion on lower LDL-cholesterol lowering, and the role of newer lipid-reducing treatment options (2023)

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Type of publication:
Journal article

Author(s):
Connolly, Derek L; Zaman, Azfar; *Capps, Nigel E; Bain, Steve C; Fernando, Kevin.

Citation:
British Journal of Cardiology. 30(2):14, 2023.

Abstract:
While statins are the gold standard for lipid-lowering therapies, newer therapies, such as PCSK9 inhibitors, have also demonstrated low-density lipoprotein cholesterol (LDL-C) reduction, but with a similar or better
safety profile. Conflicting guidance has contributed to a low uptake. More up-to-date, evidence-led guidance supports greater use of newer therapies, particularly in combination with statins, to reduce LDL-C to levels shown to be effective in trials. The aim of this study was to determine how such guidance can be implemented more effectively in the UK. Using a modified Delphi approach, a panel of healthcare professionals with an interest in the management of dyslipidaemia developed 27 statements across four key themes. These were used to form an online survey that was distributed to healthcare professionals working in cardiovascular care across the UK. Stopping criteria included 100 responses received, a seven-month window for response (September 2021 to March 2022), and 90% of statements passing the predefined consensus threshold of 75%. A total of 109 responses were analysed with 23 statements achieving consensus (four statements <75%). Variance was observed across respondent role, and by UK region. From the high degree of consensus, seven recommendations were established as to how evidence-based guidance can be delivered, including a call for personalised therapy strategies and simplification of LDL-C goals, which should be achieved within as short a time as possible.

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