No abstract

Establishing a HMC has allowed the screening of a large number of patients who would otherwise have low priority for assessment. We have identified a large proportion with significant structural disease, which has allowed for early surgical intervention when appropriate and may potentially result in improved patient outcomes.

2012 at Wellington Hospital. Patients were contacted at 30 days and 1 year to determine outcomes and compliance.Results: We enrolled 293 ACS patients initially treated with clopidogrel. Of these patients, 96 were medically managed (32%), 156 underwent PCI (53%) and 41 had CABG (14%). Clopidogrel was either discontinued in hospital or prescribed for a shorter duration than 12 months at discharge in 73 (25%) patients. The remaining 220 patients had a discharge prescription of 12 months of clopidogrel therapy. Of these, 23 (10%) permanently discontinued clopidogrel prior to 12 months. This was due to major surgery (43%), discontinuation at the discretion of a medical practitioner (39%), discontinued due to bleeding (10%), anticoagulant initiation (17%) and patient misunderstanding of discharge instructions (14%). A further 12 (5%) patients had interruptions of clopidogrel in the 12 months following the index coronary angiogram due to bleeding (4), surgery (6), rash (1) and patient confusion (1).Conclusion: In patients with a planned 12 month prescription of clopidogrel following ACS, a significant number of discontinuations occur. Clopidogrel was most commonly discontinued for surgical intervention, and was not reinitiatied in the majority of these cases.

support was required including inotropes (14), intra-aortic balloon pulsation (9), extra-corporeal membrane oxygenation (4) and emergency percutaneous balloon atrial septostomy for florid pulmonary oedema (2). Eleven patients had immunosuppressive therapy and 6 patients required temporary or permanent pacing. Eight patients made a full recovery, 4 died in intensive care, 1 died suddenly 3 days after discharge (pulmonary embolism) and another 2 years later. One patient had mechanical bridging to cardiac transplantation 7 months after initial hospitalisation. Conclusion: Although fulminant myocarditis has a high morbidity and mortality, more than half the patients survived with intensive haemodynamic support, often to a full recovery.

Background: Cardiac Magnetic Resonance (CMR) imaging is increasingly utilised to assess the aetiology and severity of cardiomyopathies. Non-ischaemic cardiomyopathy (NICM) is a heterogeneous condition, with varying clinical and demographic factors influencing outcome. This study assesses differences in clinical outcomes in European compared with M aori and Pacific NICM patients undergoing CMR in South Auckland.Method: CMR reports from Counties Manukau District Health Board region (2005 -2019) were analysed from an ANZACS-QI linked CMR database. 536 patients with a diagnosis of NICM were identified and linked ethnicity data recorded. 498 patients were grouped according to European (n = 231) vs M aori and Pacific ethnicity (n = 267). Clinical, biochemical, imaging and demographic data was collected from electronic medical records. The primary end point was combined all cause mortality and readmission rate for decompensated heart failure.Results: M aori and Pacific patients were younger (52.3 +/-11.6 vs 57.2 +/-14.6 years, p,0.001), had higher Body Mass Index (36.7 kg/m 2 vs 29.5 kg/m 2 , p,0.001), and weight (105.3kg vs 87.4kg, p,0.001). CMR markers of left ventricular (LV) volumes (p=0.95), LV ejection fraction (p=0.14), and presence of myocardial fibrosis (p=0.13) were similar between the two groups. Implantable Cardiac Defibrillator, and Cardiac Resynchronisation Therapy implantation rates were similar (p=0.58). The primary combined outcome of readmission for decompensated heart failure and all cause mortality was significantly higher in M aori and Pacific patients (96 vs 48, p,0.001).Conclusion: M aori and Pacific patients with NICM have worse clinical outcomes than European patients, despite similar disease severity on CMR.