Subcutaneous implantable cardioverter-defibrillator placement in a patient with a preexisting transvenous implantable cardioverter-defibrillator

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Performance of First Pacemaker to Use Smart Device App for Remote Monitoring

BACKGROUND: High adherence to remote monitoring (RM) in pacemaker (PM) patients improves outcomes; however, adherence remains suboptimal. Bluetooth low-energy (BLE) technology in newer-generation PMs enables communication directly with patient-owned smart devices using an app without a bedside console. OBJECTIVE: To evaluate the success rate of scheduled RM transmissions using the app compared to other RM methods. METHODS: The BlueSync Field Evaluation was a prospective, international cohort evaluation, measuring the success rate of scheduled RM transmissions using a BLE PM or cardiac resynchronization therapy PM coupled with the MyCareLink Heart app. App transmission success was compared to 3 historical “control” groups from the Medtronic de-identified CareLink database: (1) PM patients with manual communication using a wand with a bedside console (PM manual transmission), (2) PM patients with wireless automatic communication with the bedside console (PM wireless); (3) defibrillator patients with similar automatic communication (defibrillator wireless). RESULTS: Among 245 patients enrolled (age 64.8±15.6 years, 58.4% men), 953 transmissions were scheduled through 12 months, of which 902 (94.6%) were successfully completed. In comparison, transmission success rates were 56.3% for PM manual transmission patients, 77.0% for PM wireless patients, and 87.1% for defibrillator wireless patients. Transmission success with the app was superior across matched cohorts based on age, sex, and device type (single vs dual vs triple chamber). CONCLUSION: The success rate of scheduled RM transmissions was higher among patients using the smart device app compared to patients using traditional RM using bedside consoles. This novel technology may improve patient engagement and adherence to RM

A survey of the workload generated by older surgical patients referred to on-call medical registrars—SNAP-3

BackgroundOlder surgical patients who develop medical problems are commonly referred to medical teams, which can be proactive physician-led teams or through reactive referral to the on-call medical registrar.MethodsA cross-sectional survey of on-call medical registrars who received referrals from surgical teams was conducted in March–June 2022 at 140 NHS hospitals. It focused on the workload derived from referrals of older surgical patients to on-call medical registrars, excluding referrals to existing services such as perioperative medicine, orthogeriatric, or medical specialty teams. To minimise recall bias, completion of the survey was encouraged regardless of whether a registrar had received a referral. The aim of this survey was to estimate the unplanned, acute workload generated by older surgical patients requiring referral to on-call medical registrars. The survey also aimed to estimate the prevalence and nature of training in perioperative medicine amongst medical registrars.ResultsDuring an on-call shift, 41.3% (266/644) of medical registrars received at least one referral regarding an older surgical patient. The commonest indications were arrhythmia, acute respiratory problems, electrolyte abnormalities, suspected myocardial infarction, sepsis, and delirium. Three-quarters of registrars reported not receiving training in perioperative management of older patients.ConclusionsThe findings highlight the significant workload and training gaps faced by medical registrars in managing older surgical patients. Bridging the gap between national recommendations and local services may reduce demands on on-call registrars and improve care

Abstract P346: Left Ventricular Function in Patients With Cardiomyopathy: Predictors of Long Term Improvement

Introduction: Spontaneous improvement in ejection fraction in patients with heart failure has been shown to occur in a small percentage of patients by 8-12 months. No studies exist on the long term improvement in left ventricular function beyond 12 months in patients with ischemic and non-ischemic cardiomyopathy. Methods: A retrospective cohort study was conducted at a tertiary academic center. Electronic medical records were reviewed to abstract data on patients with EF≤35% between July 2001 and June 2006. Echocardiographic reports were reviewed to ascertain if EF has improved over time (&gt;12 months from initial echo) until April 2009. Patients who had an improvement in EF in &lt;12 months were excluded. Mortality records were obtained from social security death index. Patients with improvement in EF were compared to those without. Predictors of LV function improvement were analyzed. Results: Inclusion criteria were met by 718 patients and had a mean EF of 30%. 11.4% of patients improved their EF over 44±19 months from a baseline EF of 27±7% to 48±8%. Mortality in the group with EF improvement was 11% and was 37% in the group without improvement (p=&lt;0.0001). On sub group analysis among patients with EF improvement, 35% had an ICD implanted for primary prevention. In this subgroup, mortality among patients with and without ICD was 20% and 5% respectively (p=0.03). Univariate predictors of EF improvement were found to be lower age, lower QRS duration, dyslipidemia and use of aspirin and statins. Mean age of patients with and without EF improvement was 66±13 and 70±14 years respectively. Predictors of EF improvement on multivariate analysis were lower age and aspirin use. Conclusions: Patients with EF improvement had a lower mortality compared to those who did not. Survival benefit of ICDs in the group with EF improvement is statistically significant but not as much as the EF improvement in itself. Younger patients are more likely to improve their EF over long term. Further studies are necessary to clearly define the patients who are most likely to benefit from an ICD. </jats:p