Abstract The 2MACE score was specifically developed as a risk-stratification tool in atrial fibrillation (AF) to predict cardiovascular outcomes. We evaluated the predictive ability of the 2MACE score in the GLORIA-AF registry. All eligible patients from phase II/III of the prospective global GLORIA-AF registry were included. Major adverse cardiac events (MACEs) were defined as the composite outcome of stroke, myocardial infarction and cardiovascular death. Cox proportional hazards were used to examine the relationship between the 2MACE score and study outcomes. Predictive capability of the 2MACE score was investigated using receiver-operating characteristic curves. A total of 25,696 patients were included (mean age 71 years, female 44.9%). Over 3 years, 1583 MACEs were recorded. Patients who had MACE were older, with more cardiovascular risk factors and were less likely to be managed using a rhythm-control strategy. The median 2MACE score in the MACE and non-MACE groups were 2 (IQR 1–3) and 1 (IQR 0–2), respectively (p < 0.001). The 2MACE score was positively associated with an increase in the risk of MACE, with a score of ≥ 2 providing the best combination of sensitivity (69.6%) and specificity (51.6%), HR 2.47 (95% CI, 2.21–2.77). The 2MACE score had modest predictive performance for MACE in patients with AF (AUC 0.655 (95% CI, 0.641–0.669)). Our analysis in this prospective global registry demonstrates that the 2MACE score can adequately predict the risk of MACE (defined as myocardial infarction, CV death and stroke) in patients with AF. Clinical trial registration: http://www.clinicaltrials.gov . Unique identifiers: NCT01468701, NCT01671007 and NCT01937377

Mace

10.1007/s11239-023-02866-y

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Citations (5)

96 Rapid rollout of a pacemaker home monitoring service in somerset during the 2020 COVID-19 pandemic

Guy Furniss Jonathan Shurlock Mark Dayer Rachael Heatley Lauren Wilson

Introduction

In an effort to reduce non-essential face to face contact during the COVD pandemic our pacemaker service was restructured in March 2020 to home monitoring only. Home monitors were issued at implant and wound reviews were done remotely via photo messages at one month or if prompted by the patient. Existing patients were given monitors on an ad hoc basis. A dedicated physiologist worked off site on home monitoring clinics. We assess the impact on our service and on patient experience of these changes one year after implementation.

Methods

Baseline characteristics of age at implant and distance of home address from hospital were collected from all patients undergoing pacemaker home monitoring. Patients were surveyed using an adapted version of the Generic Short Patient Experiences Questionnaire (GS-PEQ). Comparison was made with our standard face-to-face follow-up model (1, 3, and 12 months).

Results

Data was collected for 326 patients. 233 received a new permanent pacemaker from March 2020 onwards and 93 existing patients were issued with a home monitor. Average age at pacemaker implant was 80.6 year (± 9.9 years). The average one-way distance from home to outpatient clinic saved was 15.1 miles (±10.4). 567 face-to-face appointments were saved. In an average day the off-site physiologist reviewed over 100 patient records, contacted 10 patients by phone and dictated reports on 20 patients (14 clinic patients and 6 home monitor alerts).Of patients surveyed 88% agreed with the statement 'I feel safe being cared for solely with a remote monitoring service', 84% agreed with the statement 'I receive the same standard of care via remote monitoring and face-to-face appointments'. Time saved by avoiding a face to face appointment was more than 1 hour for 90% of respondents. Those surveyed requested communication of reassuring monitoring, the ability to contact the pacing team in the event of concerns and clearer instructions for the home monitoring device. Only 34% of newly implanted patients were able to send a photo message of their wound at one month without prompting or assistance. We did not get a post procedure photo in 38% and the rest either spoke to us about the wound or had a face-to face visit. There was a significant difference in mean age between those who sent a photo (73.72) and those who didn't (81.38) (P = 0.000607).

Conclusion

Rapid role out of a remote monitoring service for permanent pacemakers across Somerset was feasible, produced significant savings in clinics and was well received by patients. There were significant time savings for physiologists and patients. However remote wound monitoring in elderly patients was problematic due to the difficulty sending photo messages.

Conflict of Interest

Honaria from Biotronik, Fellowship support from Abbott

Pandemic

10.1136/heartjnl-2021-bcs.95

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Antibiotic Prophylaxis and Incidence of Endocarditis Before and After the 2007 AHA Recommendations

Journal of the American College of Cardiology (2018)

Martin H. Thornhill Teresa B. Gibson Eli Cutler Mark Dayer Vivian H. Chu

The American Heart Association updated its recommendations for antibiotic prophylaxis (AP) to prevent infective endocarditis (IE) in 2007, advising that AP cease for those at moderate risk of IE, but continue for those at high risk. The authors sought to quantify any change in AP prescribing and IE incidence. High-risk, moderate-risk, and unknown/low-risk individuals with linked prescription and Medicare or commercial health care data were identified in the Truven Health MarketScan databases from May 2003 through August 2015 (198,522,665 enrollee-years of data). AP prescribing and IE incidence were evaluated by Poisson model analysis. By August 2015, the 2007 recommendation change was associated with a significant 64% (95% confidence interval [CI]: 59% to 68%) estimated fall in AP prescribing for moderate-risk individuals and a 20% (95% CI: 4% to 32%) estimated fall for those at high risk. Over the same period, there was a barely significant 75% (95% CI: 3% to 200%) estimated increase in IE incidence among moderate-risk individuals and a significant 177% estimated increase (95% CI: 66% to 361%) among those at high risk. In unknown/low-risk individuals, there was a significant 52% (95% CI: 46% to 58%) estimated fall in AP prescribing, but no significant increase in IE incidence. AP prescribing fell among all IE risk groups, particularly those at moderate risk. Concurrently, there was a significant increase in IE incidence among high-risk individuals, a borderline significant increase in moderate-risk individuals, and no change for those at low/unknown risk. Although these data do not establish a cause–effect relationship between AP reduction and IE increase, the fall in AP prescribing in those at high risk is of concern and, coupled with the borderline increase in IE incidence among those at moderate risk, warrants further investigation.

Infective Endocarditis

Rate ratio

Absolute risk reduction

10.1016/j.jacc.2018.08.2178

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Citations (99)

Antibiotic Prophylaxis Against Infective Endocarditis Before Invasive Dental Procedures

Journal of the American College of Cardiology (2022)

Martin H. Thornhill Teresa B. Gibson Frank Yoon Mark Dayer Bernard Prendergast

Infective Endocarditis

10.1016/j.jacc.2022.06.030

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