Risultati per: Passo 10. Intervenire sul singolo paziente in visita: GPG Patient

Circulation, Volume 150, Issue Suppl_1, Page A4139408-A4139408, November 12, 2024. Background:Elevated Lipoprotein(a) [Lp(a)] is independently associated with increased cardiovascular disease (CVD) risk.Purpose:The study aimed to evaluate the Lp(a) levels in Polish population and determine the association between socio-demographic and health-related variables and elevated Lp(a).Methods:The analysis was conducted among 2475 outpatient primary prevention patients (69.7% – women). The median age was 66.0 years ±20 years. Lp(a) levels were assessed in groups:

Circulation, Volume 150, Issue Suppl_1, Page A4145249-A4145249, November 12, 2024. Introduction:Droxidopa (DD) is the second FDA approved drug after midodrine for neurogenic orthostatic hypotension (nOH). Isaacon et al reported that 19 (5.4%) of total 350 patients on droxidopa had 25 cardiac events, most commonly atrial fibrillation in a mean duration of 363 days. Currently, limited long term cardiovascular safety data is available. We encountered a patient with nOH on DD, who developed symptomatic frequent premature ventricular contractions (PVCs) and severe cardiomyopathy (CM).Case:A 52-year-old woman with a long-standing nOH had persistent lightheadedness, dizziness, presyncope and hypotension despite midodrine, fludrocortisone, and non-pharmacological measures. Her past medical history was significant for nodular lymphocyte dominant Hodgkin lymphoma status post AVBD chemotherapy in 2001, with recurrence in 2012, which was treated with autologous stem cell transplantation.Patient was switched to DD from midodrine for nOH and responded well. However, she developed frequent PVCs(13%), left bundle branch block(QRS 127 ms), with new onset CM approximately 2 years later. The ischemic work-up with coronary angiography was normal and cardiac MRI showed no late gadolinium enhancement. DD was stopped and patient was started on GDMT for HFrEF with subsequent improvement in PVC burden(1%). GDMT uptitration was limited due to hypotension. Without EF recovery up to 2 years, she received CRT-D placement.Discussion:CM after anthracycline therapy is rare after 5 years. Our patient’s last exposure to doxorubincin was 17 years before the onset of CM. Serial echocardiograms showed normal cardiac function over years. A potential association of developing takotsubo cardiomyopathy was suggested in patients on DD by Sato et al, the potential mechanism being the increased adrenergic drive. The rapid development of non-ischemic, non-infiltrative CM and cardiac arrythmia, which subsequently improved by stopping the DD, is alarming for DD’s potential side effect.Conclusion:Caution should be taken in prescribing DD in patients with nOH, who are at higher risk for development of cardiac arrythmia and cardiomyopathy. Further studies and data are needed in identifying or excluding the potential cardiovascular side effects.

Circulation, Volume 150, Issue Suppl_1, Page A4139043-A4139043, November 12, 2024. Introduction:Point-of-care ultrasonography (POCUS) is routinely performed across emergency departments (EDs), but interpretation is generally restricted to acute pathology. We sought to evaluate the outcomes of individuals who had undergone an ED POCUS, but were never diagnosed with cardiomyopathy, using artificial intelligence (AI)-defined signatures of left ventricular hypertrophy (LVH) and key sub-phenotypes (hypertrophic cardiomyopathy [HCM], transthyretin amyloid cardiomyopathy [ATTR-CM], and aortic stenosis [AS]) on POCUS.Methods:First, using 261,756 videos from 9,667 standard transthoracic echocardiograms (TTEs) across a large, diverse health system, we trained a view quality-adapted, video-based deep learning model to detect a) LVH, representing the mean of a multi-label classifier for i) moderate or greater nominal severity as reported by the echocardiographer; ii) left ventricular posterior wall thickness [LVPWd] of ≥1.3 cm, and/or iii) interventricular septum thickness [IVSd] of ≥1.3 cm, and b) known cardiomyopathy defined by non-mutually exclusive labels of i) ATTR-CM, ii) HCM, and/or iii) AS (Fig. 1A). We deployed these tools among adult patients without known cardiomyopathy who underwent clinical POCUS across EDs (2013-2023) linked to in-hospital and out-of-hospital death data. We explored the association between distinct label output probabilities and all-cause mortality in age- and sex-adjusted Cox regression models (Fig. 1B).Results:Among 24,448 individuals (median age 58, [IQR 40-73] years; 13,478 [55.1%] women) followed over 2.2 [IQR: 1.1-5.8] years, higher AI-POCUS probabilities for LVH were associated with worse long-term prognosis, with a 29% higher mortality risk in the highest vs lowest AI-defined quintile (adj. HR 1.29 [95%CI: 1.13, 1.46]) (Fig. 2A). When stratifying based on the probability of distinct phenotypes, an ATTR-CM-like phenotype in the highest (vs lowest) quintile conferred a 39% higher adjusted risk of death (adj. HR 1.39 [95%CI: 1.22, 1.59]) (Fig. 2B). Similarly, there was a 14% (adj. HR 1.14 [95%CI: 1.01, 1.30]) and 15% (adj. HR 1.15 [95%CI: 1.02-1.29]) higher risk of death in the highest (vs lowest) AS (Fig. 2C) and HCM (Fig. 2D) phenotypic quintiles, respectively.Conclusions:AI-enabled automated identification and phenotyping of LVH is feasible on routine POCUS studies and identifies individuals who are at risk of premature mortality, potentially due to undiagnosed cardiomyopathy.

Circulation, Volume 150, Issue Suppl_1, Page A4126692-A4126692, November 12, 2024. Background:It is accepted that obesity increases type 2 diabetes risk. Some studies have explored associations between changes in body mass index (BMI) or waist circumference (WC), 2 indicators commonly used to assess obesity, and diabetes risk separately. However, there are few studies on the effect of change in waist-to-height ratio (WHtR), an index that has been suggested to be more strongly associated with diabetes than BMI and WC, on incident diabetes. Even fewer studies simultaneously examined the associations of change rate in the 3 indices with diabetes.Hypothesis:WHtR change may be more strongly associated with diabetes than BMI and WC.Aims:This study aims to investigate the change rates of BMI, WC, and WHtR in the UK adult population, and compare the effects of different adiposity indices’ changes on diabetes development.Methods:To make facilitate quantitative comparison of BMI, WC and WHtR, we used their standardized values. Repeated measures of the 3 indices were obtained from Phase 3 (1991-94), 5 (1997-99), and 7 (2002-04) of the UK Whitehall II Study (included persons participated in at least 2 of the 3 visits). Mixed effects model was used to calculate individual change rate of the 3 indices. Non-diabetic participants at Phase 7 were then followed up for incident diabetes until Phase 9 (2007-09). We examined the prospective association between change rate of the 3 indicators and diabetes by Cox regression analysis.Results:A total of 5,539 persons were included (mean age at Phase 3 was 49.6 years, 28.8% women). All adiposity indicators increased during Phase 3-7. The overall change rate of WHtR (0.07 SD/year) was higher than BMI (0.04 SD/year) and WC (0.06 SD/year). There were 375 non-diabetic (Phase 7) participants developing diabetes after a median follow-up period of 5.0 years. Initial WC value (HR:1.56) and WHtR value (HR:1.50) showed a stronger association with diabetes than initial BMI (HR:1.27). When the 3 indices increased at the same rate, WC change (HR:3.83, 95% CI: 2.48-5.93) had a higher risk of developing diabetes than changes in WHtR (HR:3.19, 95% CI: 2.19-4.64) and BMI (HR:2.57, 95% CI: 1.85-3.56).Conclusions:The rate of increase over time was higher in WHtR than BMI and WC in this UK adult population. Increases in WC and WHtR were more strongly associated with incident diabetes than BMI. When the 3 indices increased at the same rate, change in WC increased a higher risk of developing diabetes relative to BMI and WHtR.

Circulation, Volume 150, Issue Suppl_1, Page A4137527-A4137527, November 12, 2024. Background:The American Heart Association published the new PREVENT equations for estimating atherosclerotic cardiovascular disease (ASCVD) risk.Question:Do the PREVENT equations improve risk prediction for 10-year ASCVD compared with the pooled cohort equations (PCEs) in a large diverse population?Aim:To assess ASCVD risk prediction performance of the two PREVENT equations [PREVENT Base, PREVENT Base plus optional predictors including urine albumin-to-creatinine ratio, glycated hemoglobin, and social deprivation index (PREVENT Full)] compared with the PCEs.Methods:We included adults aged 40-75 years without a history of ASCVD or diabetes from Kaiser Permanente Southern California in 2009 and followed them through 2019. Outcome was incident ASCVD defined as myocardial infarction, fatal coronary heart disease, fatal and nonfatal stroke. We compared model discrimination (Harrell’s C), mean calibration (estimated as the ratio of predicted to observed event rates), and calibration curve among the overall population and stratified by sex and race/ethnicity.Results:Of the 559,111 adults (mean age 54, 11% Black, 32% Hispanic), 10,695 developed an ASCVD event during a median follow-up of 10 years. Harrell’s C among the overall population was 0.741 (95% CI 0.736-0.745) for PREVENT Base, 0.743 (0.738-0.748) for PREVENT Full, and 0.741 (0.736-0.746) for the PCEs (Table). Compared with the PCEs, both PREVENT equations improved Harrell’s C in men but not in women, and in Black adults but not in other racial/ethnic groups. Both PREVENT equations were well-calibrated (mean calibration ranged 0.83-1.37; calibration slope ranged 0.71-1.28), while the PCEs overestimated 10-year ASCVD risk (mean calibration ranged 1.80-2.20; calibration slope ranged 0.34-0.45) (Table&Figure).Conclusion:Compared with the PCEs, both PREVENT Base and Full equations improved calibration in predicting 10-year ASCVD risk, with minimal improvement in discrimination in men and Black adults only.

Circulation, Volume 150, Issue Suppl_1, Page A4117856-A4117856, November 12, 2024. Introduction:Guidelines have recognized the critical role of self-care in heart failure (HF), but people with HF do not adequately practice self-care. The Common-Sense Model (CSM) of Self-Regulation is a widely used theoretical framework for promoting behavior change and improving disease prognosis among patients. However, studies on the effects of the application of this model among people with HF are limited and present mixed results.Aims:To examine the effects of a nurse-led CSM of Self-Regulation-based self-care intervention on illness perceptions, self-care behaviors, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, anxiety, symptom burden, sleep quality, healthcare service utilization, and mortality among people with HF.Methods:A randomized controlled trial was conducted. Participants were recruited from a university-affiliated hospital and randomized at a 1:1 ratio into the intervention or the control groups. Participants in the intervention group received a 6-week nurse-led CSM of Self-Regulation-based self-care program and usual care. Control group participants only received the usual care. Outcomes of interest were measured at baseline, 6 weeks (T1), and 3 months (T2) after enrollment. The generalized estimating equations model and Mann-Whitney U test were used to examine the intervention effects on the study outcomes.Results:138 subjects were enrolled in the study between March and May 2023. Participants in the intervention showed statistically greater improvements in illness perceptions, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, symptom burden, and sleep quality compared with the controls at T1 and T2. We also observed a statistically significant reduction in the number of HF-related unscheduled outpatient department visits in the intervention group compared to the control group at T2. However, no significant differences were found in anxiety, number of HF-related hospital readmissions, length of HF-related hospital stays, number of HF-related emergency department visits, or HF-related mortality between the study groups at T1 and T2.Conclusion:Our program generates favorable effects on promoting behavior change and improving health outcomes among people with HF. It also fills the knowledge gaps around the application of CSM of Self-Regulation in people with HF and provides more empirical evidence supporting the effectiveness of nurse-led interventions.

Circulation, Volume 150, Issue Suppl_1, Page A4142835-A4142835, November 12, 2024. Background:Heart failure (HF) and acute myocardial infarction (AMI) have been a key focus of health policy initiatives targeting hospital readmission risk, but after initial improvements, progress has slowed. Digital remote patient monitoring (RPM) tools have been recognized as potential strategies for enabling better patient outcomes by tracking healthcare outside clinical settings. We evaluated patterns of RPM service use at US hospitals and their association with post-discharge outcomes for HF and AMI.Methods:We used the 2022 American Hospital Association (AHA) Annual Survey data to identify US hospitals offering RPM services and the nature of these services (post-discharge, chronic care, others), overall and across different hospital groups (based on bed size, location, ownership, teaching status, and region). We linked these with hospitals’ benchmarked risk-standardized relative performance on readmissions (excess readmission ratio [ERR]) from CMS Hospital Quality Report (2019-2022) to examine the association between RPM services at hospitals and lower than expected HF and AMI readmission rates (ERR

Circulation, Volume 150, Issue Suppl_1, Page A4139332-A4139332, November 12, 2024. Background:Strong patient-clinician communication may improve health outcomes for marginalized populations, including Hispanic/Latino individuals.Objective:We assessed the association between patient-clinician communication and cardiovascular (CV) events or death in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).Methods:HCHS/SOL is a longitudinal cohort study of individuals aged 18-74 who identified as Hispanic/Latino at 4 U.S. sites. Participants’ ratings of communication with clinicians during the year before enrollment were used to generate a communication score. The primary outcome was the composite of myocardial infarction (MI), heart failure events (HF), stroke, and all-cause mortality. The secondary outcomes included the primary outcome components. The association between the baseline communication score and outcomes of interest was assessed with Cox proportional hazards models adjusting for possible confounders. We also used multivariable linear regression to assess the cross-sectional association between communication and AHA Life’s Essential 8 (LE8), a measure of CV risk factors. All analyses accounted for the complex survey design.Results:Our sample included 10,527 individuals without prior CV events and at least one medical encounter in the year before enrollment. The median age at enrollment was 41 years (IQR 29, 53), 59% were female, and 71% perceived high-quality communication with clinicians. The mean follow-up time was 9.4 years. High-quality communication was associated with the following results in our adjusted analyses: composite outcome (aHR 0.71, 95% CI 0.49, 1.02, p = 0.066), CV events (aHR 0.79, 95% CI 0.41, 1.51, p = 0.47), all-cause mortality (aHR 0.53, 95% CI 0.35, 0.80, p < 0.01).Conclusions:High-quality patient-clinician communication was associated with a non-significant trend toward a lower rate of CV events and death, driven by a significant association with lower all-cause mortality.

Circulation, Volume 150, Issue Suppl_1, Page A4141717-A4141717, November 12, 2024. Introduction:Although 14-day patch-based long-term continuous ambulatory ECG monitoring (LTCM) has shown greater diagnostic yield and lower retest rates compared to other rhythm monitoring modalities, wear can still be limited by factors related to patient comfort and acceptance. Rather than data from small, non-generalizable focus groups, patient survey data at point of care offered to all patients may be valuable in collecting quality improvement data on product experience and satisfaction. We assessed the feasibility of this approach to compare patient satisfaction associated with the prior generation LTCM to that of a new generation, FDA-cleared LTCM product designed with patient-centered features, including a more breathable adhesive, waterproof housing, thinner profile, and lighter weight.Methods:Starting in March 2018, we implemented a survey provided to all patients prescribed Zio® XT LTCM (iRhythm Technologies, San Francisco, CA) to complete and return at end of wear. The survey was completed via paper card or digitally via a web address printed on the card. The survey included questions regarding ease of use, comfort, ability for normal activity, and willingness to wear the device again. Scores of 4 or 5 (i.e., Agree or Strongly Agree) on a Likert scale were considered affirmative responses. Beginning in April 2022, the new Zio® Monitor device was launched for use and the same survey method was used. We compared survey responses for Monitor and XT between Jan 1 and Dec 31, 2023.Results:Among 334,054 respondents, the new LTCM was associated with a greater proportion of affirmative responses across all survey categories (Table 1), with the largest gains in comfort of wear (79.1% vs. 64.7%; p

Circulation, Volume 150, Issue Suppl_1, Page A4142080-A4142080, November 12, 2024. Case Presentation:A 27-year-old-male without any known medical history presented after witnessed sudden cardiac arrest. Initial rhythm in the field was ventricular fibrillation. He underwent CPR with three rounds of external defibrillation with 200 J and after return of spontaneous circulation (ROSC) was transferred to our facility. He was initially normotensive, bradycardic, hypothermic to 35.6°C and hypoxic requiring non-rebreather mask. He was intubated for airway protection. Post ROSC 12-lead surface ECG revealed sinus rhythm with a prolonged QT interval and left ventricular hypertrophy. Initial high-sensitivity Troponin I was elevated to 83 pg/ml that peaked to 4631 pg/m. On transthoracic echocardiogram, ejection fraction was 55-60% with moderate concentric left ventricular hypertrophy and an interventricular septum end diastolic thickness of 1.3 cm as well as normal left ventricular outflow tract pressure gradient. Coronary angiogram was notable for prominent myocardial bridge (MB) of the middle left anterior descending (LAD) artery without any evidence of atherosclerotic disease. Cardiac magnetic resonance imaging (CMR) showed asymmetric left ventricular hypertrophy with reverse septal curvature variant and evidence of patchy late gadolinium enhancement. A dual-chamber implantable cardioverter defibrillator was placed for secondary prevention of ventricular arrhythmias and sudden cardiac death. Metoprolol tartrate was started for management of hypertrophic cardiomyopathy (HCM) and MB. At follow-up visit he was asymptomatic and genetic testing was positive for heterozygous gene mutation in MYBPC3.Discussion:MBs have been recognized as a common congenital anomaly of the epicardial coronary arteries, with a higher prevalence reported in patients with HCM. We present a unique clinical scenario of a young patient with asymmetric HCM, patchy late gadolinium enhancement on CMR and evidence of prominent MB of the LAD artery. Hemodynamically significant MBs have been implicated in the degree of fibrosis in HCM which is significant due to the correlation between extent of fibrosis and adverse cardiac remodeling, and the consequent predisposition to arrhythmogenesis. However, the existing literature is inconclusive regarding the exact association between MBs and cardiovascular mortality in HCM. Here, we highlight the potentially increased risk of sudden cardiac arrest conferred by MB in HCM and the need for further studies to delineate this association.

Circulation, Volume 150, Issue Suppl_1, Page A4126987-A4126987, November 12, 2024. Background:COVID-19 infection has been associated with a broad range of clinical manifestations. There are very few reported cases of COVID-19 patients presenting with syncope as an initial symptom. We present an extraordinary case of recurrent neurocardiogenic syncope in a COVID-19 patient.Case:A 66-year-old male presented after experiencing two episodes of syncope. He denied any prodromal or anginal symptoms. His medications included propranolol 10 mg twice daily for essential tremors. He had no family history of unexplained syncope or sudden cardiac death. He was hemodynamically stable and had one episode of fever at 102°F. Telemetry recording showed vagal-mediated sinus arrest and pauses without escape. Blood work showed normal cell counts, electrolytes, thyroid-stimulating hormone, and erythrocyte sedimentation rate, with a slightly elevated C-reactive protein of 22.2 mg/L. He tested positive for COVID-19 and had negative Lyme and Ehrlichia serologies.Decision Making:Due to symptomatic long sinus pauses, propranolol was discontinued, and he received a temporary pacemaker set at 50 beats per minute (bpm). He had another syncopal episode while being paced at 50 bpm, suggesting a neurocardiogenic mechanism, so the pacing rate was increased to 70 bpm. An echocardiogram showed a normal ejection fraction without any significant valvular disease. The syncope was determined to be vasovagal due to autonomic dysfunction in the setting of COVID-19. After 72 hours without further syncope, the temporary pacemaker was removed, and he was discharged home with an implantable loop recorder (ILR). A one-month follow-up showed no syncope, and ILR interrogation showed no bradycardia or pauses.Conclusion:Neurocardiogenic syncope with prolonged asystole and sinus pauses is an uncommon presentation of COVID-19 infection. The clinical course of autonomic dysfunction following COVID-19 is not very clear, and monitoring with an ILR is reasonable before considering permanent pacemaker implantation.

Circulation, Volume 150, Issue Suppl_1, Page A4143989-A4143989, November 12, 2024. Background:Heart failure (HF) is not a homogeneous condition, and comorbidities, such as renal dysfunction, commonly complicate the clinical picture. However, differences in patient-centered outcomes (PCO), such as depressive symptoms, health-related quality of life, functional status, adherence, and self-care behaviors, have not been explored in patients with HF with and without renal dysfunction.Hypothesis:We hypothesized that there is a significant difference in PCO between patients diagnosed with heart failure with renal dysfunction and those without renal dysfunction.Methods:A secondary data analysis was conducted using the RICH Heart Program Heart Failure Database. We included 517 patients (61 ± 13 years old, 66% male, 66% NYHA class III/IV) with HF with (22%) and without (78%) renal dysfunction. Depressive symptoms were measured using the Patient Health Questionnaire-9, health-related quality of life using the Minnesota Living with Heart Failure Questionnaire, functional status using the Duke Activity Status Index, adherence using the Medical Outcomes Study Specific Adherence Scale, and Self-care using the Self-care of Heart Failure Index. Independent samples t-tests were conducted to compare PCO between the two groups.Results:All PCO were significantly different between the two groups. Compared to patients without renal dysfunction, those with renal dysfunction had worse depressive symptoms (8.1 ± 5.9 vs 10.0 ± 6.0, respectively, p = 0.001), poorer health-related quality of life (50.5 ± 24.9 vs 58.0 ± 25.6, p = 0.005, respectively), and lower functional status (11.7 ± 11.7 vs 77.0 ± 7.1, p < 0.001, respectively). Patients with renal dysfunction had better scores on self-reported adherence (29.2 ± 6.0 vs 25.6 ± 7.7, p < 0.001), self-care maintenance (61.6 ± 21.1 vs 54.3 ± 23.2, p = 0.03), and self-care management (60.9 ± 23.0 vs 53.8 ± 22.9, p = 0.04) than those without.Conclusions:Even though patients with HF and renal dysfunction reported better adherence and self-care behaviors, they still had higher levels of depressive symptoms, worse health-related quality of life, and lower functional status. This suggests that knowledge of their comorbidity prompted better self-care, but other PCO remained poor. Increased attention to promoting specific self-care behaviors that focus on renal dysfunction in the context of HF should be tested to determine if PCO can be improved in this patient population.

Circulation, Volume 150, Issue Suppl_1, Page A4145425-A4145425, November 12, 2024. Introduction:Smartphone applications increasingly are utilized to enhance patient education for optimal implementation of care plans to improve overall outcomes. We demonstrate the use of an app with instructions and built-in reminders for patients in the peri-operative phase of cardiothoracic surgery to reduce readmission rates and improve patient satisfaction.Hypothesis:We postulated that patients undergoing cardiothoracic procedures who used a smartphone application pre and post-procedure would demonstrate improved outcomes compared to non-users, including reduced 90 day rates of hospital readmission, wound complications, or post-op thoracentesis, as well as demonstrate enhanced patient satisfaction.Methods:We prospectively enrolled patients in the pre-operative phase undergoing cardiothoracic procedures including coronary artery bypass graft (CABG), valvular replacement, or patent foramen ovale closure, who either downloaded or declined the app. Patients were tracked for successful registration and use of the app. Post-operative outcomes including readmissions, wound complications, and need for thoracentesis were tracked for 90 days. Patients were also administered an in-person satisfaction survey at 14 days post-op with responses recorded.Results:App users (n=392) and non-users (n=334) with median age 67 years underwent cardiothoracic surgery between May 29, 2023 and February 2, 2024. Among app users, 23 experienced 90-day readmission compared to 49 non-users (5.9% vs 14.7%, p=

Circulation, Volume 150, Issue Suppl_1, Page A4144744-A4144744, November 12, 2024. Importance:Prosthesis-Patients Mismatch (PPM) is associated with multiple adverse event after aortic valve replacement (AVR), especially increased long-term mortality. Despite women are more likely to have PPM, sex-differences in PPM outcomes remain poorly explored.Objectives:To evaluate PPM incidence and sex-differences in PPM impact in a large cohort of patients underwent surgical aortic valve replacement.Design, Setting and Participants:We included 7,319 patients who underwent Surgical AVR between 2000 and 2021. PPM was defined accordingly to Valve-Academic-Research-Consortium-3 criteria, adopting correction for Body Surface Area >30 kg/m2 and retrieving the predicted effective orifice area of the aortic valve prosthesis. The cohort was followed up prospectively from Surgical AVR until November 2023.Main Outcomes and Measures:Primary endpoint was defined as long-term mortality and secondary endpoint as long-term cardiovascular (CV) mortality. Mortality was established and Cardiovascular mortality adjudicated by Quebec national database.Results.Severe PPM incidence was rare (1.1%), more prevalent in women (2.5%) than in men (0.5%, p

Circulation, Volume 150, Issue Suppl_1, Page A4142149-A4142149, November 12, 2024. Background:As patients progress through the single ventricle palliation, changing hemodynamics and non-cardiac conditions can prevent completion of Fontan. We sought to determine the incidence of completion of Fontan at our institution and to investigate the reasons for non-Fontan candidacy.Methods:Institutional database was queried to identify patients who underwent single ventricle palliation from 2010 to 2020. Patients who underwent stage 2 palliation were included for analysis. The primary outcome of interest was reason for non-Fontan candidacy or reason for delayed Fontan.Results:526 patients who reached stage 2 single ventricle palliation were analyzed. 378 (71.9%) underwent Fontan procedure or were referred for Fontan before the age of 4-years-old at our center at the time of the study (Figure 1). 19 patients died prior to the typical age of Fontan and 38 were lost to follow up. Of the remaining 91 patients, 21 (23.1%) had a 1.5 or 2 ventricle repair, 12 (13.2%) had a Fontan at another center, and 29 (32%) had a late Fontan. Most patients with late Fontan were due to provider practice variation (22), whereas there were only 3 patients with medical conditions delaying pre-Fontan testing, and 4 patients had a Kawashima. Only 3 patients out of the 12 who had Fontan at another center were for second opinions, whereas the remainder either moved or had surgery at another center due to family preference. Reasons for non-Fontan candidacy were divided into cardiac and respiratory sources. Cardiac reasons included severely depressed ventricular function (12), diastolic dysfunction (2), atrioventricular valve stenosis or regurgitation (7), and pulmonary vein stenosis (3). Respiratory conditions leading to non-Fontan candidacy included severe OSA (1), pulmonary arterial malformation (1), and pneumonectomy (2). There are 17 patients in the non-candidacy group who had a heart transplant or were listed for transplant at the time of the study. No patient in our study was deemed not a candidate for Fontan after stage 2 palliation for developmental delay or syndrome.Discussion:This study demonstrates that the reasons for non-Fontan candidacy after completion of stage 2 palliation are broadly due to hemodynamic and respiratory condition, with many patients who are not candidates developing severe ventricular dysfunction after stage 2. There is a subset of patients who either move, are lost to follow up, or are delayed due to provider practice variation.

Circulation, Volume 150, Issue Suppl_1, Page A4145759-A4145759, November 12, 2024. Introduction:Despite new advances in heart failure (HF) management, underutilization of guideline-directed medical therapy (GDMT) persists. In addition, contemporary data on GDMT utilization and whether sex differences exist is unclear. We aim to characterize GDMT use across HF subtypes, investigate sex-based disparities in utilization, and explore these impacts on patient quality of life markers and clinical outcomes.Methods:Patients with HF were enrolled in the heart function clinic (HFC) in Edmonton, Alberta, from Feb 2018 to Nov 2022. Medication records (renin-angiotensin system inhibitors [RAASi], angiotensin receptor neprilysin inhibitors [ARNI], β-blockers, mineralocorticoid inhibitors [MRA], sodium-glucose cotransporter 2 inhibitors [SGLT2i], and glucagon-like peptide 1 receptor agonist [GLP-1 RA]) over 3 years and clinical comorbidities using ICD-10 codes were obtained. We administered the Kansas City Cardiomyopathy Questionnaire Score (KCCQ-12) at enrolment and 6—or 12-month follow-ups, with changes ≥5 defined as clinically significant. We assessed the association between GDMT and sex to changes in KCCQ-12 scores and clinical outcomes.Results:Our HFC cohort of 1431 HF patients (median age 68, 29% female) included 52% with reduced (HFrEF), 20% with mildly reduced (HFmrEF), and 28% with preserved (HFpEF) ejection fraction. Median baseline KCCQ-12 score was 75 (IQR 33) and was similar between HF subtypes. ARNI, SGLT2i, and MRA use in HFpEF remains lower compared to HFrEF/HFmrEF (p