Cardiac pathology contributes to a significant proportion of emergency department (ED) attendances. Many could be managed as urgent outpatients and avoid hospital admission. We evaluated a novel rapidaccess general cardiology clinic to achieve this, implemented during the COVID-19 pandemic. We performed a retrospective review of baseline characteristics, investigations, final diagnoses, and 90-day safety (readmission, major adverse cardiovascular events [MACE], mortality) from electronic records and conducted a patient experience survey. There were 216 ED referrals made between 1 June and 30 October 2020. The median time to review was two days (interquartile range 1-5). At 90 days, there were three (1.4%) representations requiring admission, two (0.9%) MACE, and no deaths. There were 205 (95%) successfully managed without hospital admission. Among surveyed patients, 96% felt they had concerns adequately addressed in a timely manner. In conclusion, our rapid-access cardiology clinic is a safe model for outpatient management of a range of cardiovascular presentations to the ED.
Permanent pacemaker (PPM) implantation is a commonly performed life-saving cardiac procedure. Patients often seek further information on medical interventions beyond traditional consultation spaces via the Internet, but such resources can be of variable quality. This has not been assessed for PPM implantation previously. Furthermore, similar assessments of other healthcare-related multimedia have used criteria that do not provide adequate granularity of assessment. Ideally, such an appraisal should include assessment of the design of a resource, its organisation, audio-visual quality, balance, and acknowledgement of authorship, bias, and conflicts of interest.
Purpose
To qualitatively assess the video and information quality of YouTube videos discussing PPM implantation for patients.
Methods
We performed searches on YouTube using the search terms "Pacemaker" and "PPM implantation". Both searches were performed twice for reproducibility. The first 100 results from each search were screened for inclusion. All English language videos covering transvenous pacemaker implantation were included. We assessed videos on the quality of the audio-visual material and the quality of the information across 13 domains, described in table 1. Two authors (SR, RDS) independently assessed the videos for the quality metrics as described.
Results
Of 196 unique results, 33 videos uploaded by 32 users met inclusion criteria (figure 1). None of the videos fulfilled all the quality criteria as specified (table 1). Videos mostly scored highly on authorship, organisation, relevancy of content, and audio quality. However, there were numerous areas, particularly concerning the quality of information contained in the videos, where videos universally scored poorly. Most videos (82%) did not provide a balanced overview of the risks and benefits of PPM implantation (balance/bias), and, following on from this, conflicts of interests or disclosures of content creators were not provided in most cases (94%). Most videos did not provide information on the date the content was created (currency, 85%), and therefore how up to date content was, or where the information used to create the video came from (attribution, 97%). Finally, few videos (15%) directed patients to further resources to gain further information on PPM implantation.
Conclusion
YouTube videos of PPM implantation are of mediocre quality. Patients who come across these videos may be unduly influenced by poorly constructed material that does not allow them to independently assess the quality of the information being presented to them, hindering their ability to gain an adequately informed overview of the procedure. There is a need for a professionally regulated, high-quality, exhaustive audio-visual resource on PPM implantation for patients. There is also need for increased oversight on the quality of healthcare intervention-associated videos on the Internet.
Ventricular tachycardia is a common arrhythmia in patients with structural heart disease and heart failure, and is now seen more frequently as these patients survive longer with modern therapies. In addition, these patients often have multiple comorbidities. While anti-arrhythmic drug therapy, implantable cardioverter-defibrillator implantation and ventricular tachycardia ablation are the mainstay of therapy, well managed by the cardiac electrophysiologist, there are many other facets in the care of these patients, such as heart failure management, treatment of comorbidities and anaesthetic interventions, where the expertise of other specialists is essential for optimal patient care. A coordinated team approach is therefore essential to achieve the best possible outcomes for these complex patients.
Abstract Aims Catheter ablation for atrial fibrillation (AF) has historically required inpatient admission post-procedure, but same-day discharge (SDD) has recently been reported. We aimed to assess the efficacy and safety of SDD compared with overnight stay (OS) post-ablation. Methods and results We performed a systematic search of the PubMed database. Random-effects meta-analysis was performed to assess the efficacy (successful SDD) and safety (24 h complications, 30-day complications, 30-day re-admissions, and 30-day mortality) of a SDD AF ablation strategy. Fourteen non-randomized observational studies met criteria for inclusion, encompassing 26488 patients undergoing AF ablation, of whom 9766 were SDD. The mean age of participants was 61.9 years, and 67.9% were male. Around 61.7% underwent ablation for paroxysmal AF. The pooled success rate of SDD was 83.2% [95% confidence intervals (CIs): 61.5–97.0%, I2 100%]. The risk of bias was severe for all effect estimates due to confounding, as most cohorts were retrospectively identified without appropriately matched comparators. There was no significant difference in 30-day complications [odds ratio (OR): 0.95, 95% CI: 0.65–1.40, I2 53%] or 30-day re-admission (OR 0.96, 95% CI: 0.49–1.89, I2 82%) between groups. There were insufficient data for meta-analysis of 24 h complications and 30-day mortality. Where reported, no re-admissions occurred due to 24 h complications after SDD. Two deaths (0.04%) were reported in both SDD and OS groups. Conclusion Same-day discharge after AF ablation appears to be an effective and safe strategy in selected patients. However, the available evidence is of low quality, and more robust prospective studies comparing SDD to OS are needed.
Percutaneous closure of a patent foramen ovale (PFO) reduces stroke in appropriately selected patients ([1][1]). PFO screening typically employs agitated saline injection into the brachiocephalic vein, which drains via the superior vena cava (SVC) to the right atrium. Bubbles bypassing the lungs are
Reliable diagnosis of severe symptomatic aortic stenosis (AS), usually assessed with echocardiography, is important to ensure timely intervention. Degenerative AS is associated with fibrocalcific degeneration of the valve cusps, which can be visualised using computed tomography (CT). Computed tomographic aortic valve calcium scoring (CT-AVC) has emerged as a marker of severe AS, and guidelines now provide thresholds for this diagnosis. However, published CT-AVC thresholds vary in the primary literature. We therefore aimed to assess the performance of CT-AVC as a discriminative test for severe AS in a local population of patients with AS.
Methods
We performed a single-centre retrospective review of all patients undergoing CT as part of transcatheter aortic valve implantation (TAVI) assessment between 1st October 2021 and 30th September 2023. All patients who underwent a TAVI-CT with a measured CT-AVC Agatston score within 120 days of an echocardiogram providing a concordant assessment of AS severity (i.e. for severe AS, both aortic valve maximum velocity [AV-Vmax] >4 m/s and aortic valve area [AVA] <1 cm2; for non-severe AS, both AV-Vmax <4 m/s and AVA >1 cm2) were included. Patients with discordant echocardiographic AS severity, bicuspid aortic valve, prosthetic valves, or isolated aortic regurgitation, were excluded. Baseline demographic data, CT-AVC, and echocardiographic measurements from the closest study were collected. Guideline-recommended CT-AVC thresholds of 2000 Agatston units (AU) for males and 1200 AU for females were used for calculations of CT-AVC performance for diagnosis of severe AS (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]). Sex-specific receiver-operator characteristic curves were generated to determine the optimal CT-AVC score threshold for severe AS diagnosis.
Results
53 cases were identified (table 1). The majority (91%) had severe or greater AS. In males, CT-AVC >2000 AU had a sensitivity of 0.96 and specificity of 0.50 for severe AS, with a PPV of 0.93 and a NPV of 0.67. In females, CT-AVC >1200 AU had a sensitivity of 0.73 and specificity of 1.0 for severe AS, with a PPV of 1.0 and an NPV of 0.14. The optimal CT-AVC thresholds for severe AS were >886 AU in females (sensitivity 0.91, specificity 1.0) and >1836 AU in males (sensitivity 0.96, specificity 0.75). The overall c-statistic for CT-AVC in diagnosing severe AS was 0.91 in females and 0.86 in males (figure 1).
Conclusion
Although we demonstrate that CT-AVC appears to perform well in diagnosing severe AS, we report that the optimal thresholds in our population appear to be lower compared to those in the literature. If this were true, then CT-AVC using current guideline thresholds could lead to under-diagnosis of severe AS. Further studies investigating this, and factors predicting variation in CT-AVC with varying degrees of AS (including subgroups where different thresholds may be appropriate), are needed.
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