Objective: Atherosclerotic coronary artery disease is well recognised as an inflammatory disorder that is also influenced by oxidative stress. β2-GPI (β-2-glycoprotein-I) is a circulating plasma protein that undergoes post-translational modification and exists in free thiol as well as oxidized forms. The aim of this study was to assess the association between these 2 post-translational redox forms of β2-GPI and atherosclerotic coronary artery disease. Approach and Results: Stable patients presenting for elective coronary angiography or CT coronary angiography were prospectively recruited. A separate group of patients after reperfused ST-segment–elevation myocardial infarction formed an acute coronary syndrome subgroup. All patients had collection of fasting serum and plasma for quantification of total and free thiol β2-GPI. Coronary artery disease extent was quantified by the Syntax and Gensini scores. A total of 552 patients with stable disease and 44 with acute coronary syndrome were recruited. While total β2-GPI was not associated with stable coronary artery disease, a higher free thiol β2-GPI was associated with its presence and extent. This finding remained significant after correcting for confounding variables, and free thiol β2-GPI was a better predictor of stable coronary artery disease than high-sensitivity C-reactive protein. Paradoxically, there were lower levels of free thiol β2-GPI after ST-segment–elevation myocardial infarction. Conclusions: Free thiol β2-GPI is a predictor of coronary artery disease presence and extent in stable patients. Free thiol β2-GPI was a better predictor than high-sensitivity C-reactive protein.

Background and Aim: Chronic heart failure (CHF) places a physical, psychosocial and financial burden on patients and carers. Provision of palliative care to CHF patients can support complex decision-making and significantly improve quality of life. This study describes characteristics of CHF patients at a tertiary referral hospital, including provision of palliative care, in the 12 months before death and during their terminal admission. Method: Retrospective medical review of 150 patients who died from CHF between Dec-2016 to May-2019 was performed. Data collection included patient and illness characteristics, palliative approach utilisation (e.g. symptom control, end-oflife management, goals of care (GOC)), and health service use. Results: Of 150 identified patients, 106 were eligible: 48 (45.3%) females and median age 84 (77.25-89) years. Commonest comorbidities were: ischemic heart disease (56.6%) and atrial fibrillation (57.5%). Referral to specialist palliative care (SPC) services occurred for 9 (8.5%) patients prior to, and 60 (56.6%) during the terminal admission. Inpatient SPC referrals occurred a median of 4 (1-8) days before death, mainly (96.6%) to manage active dying or physical symptoms. Palliative treatments included: opioids (97 patients, 92.4%) and benzodiazepines (81, 81.8%). Disease-directed medications on the day of death included: antiplatelets (18.9%) and statins (12.6%). Comfort/palliation GOC was documented in 9 (8.6%) patients on admission, and changed to this for 40 (37.7%) patients within 48 hours of subsequent death. Conclusion: Recognising and providing appropriate care for the active dying phase in CHF is both limited and challenging. New approaches to palliative care are required for CHF patients and their families.

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