Heart and circulatory diseases cause around 160,000 deaths each year, and 7.6 million people are living with cardiovascular disease in the UK (1). Invasive treatment for coronary artery disease (CAD) can be through percutaneous coronary intervention (PCI) or coronary bypass surgery. Approximately 100,000 PCI procedures are carried out in the UK annually (2). There remains a significant variation in outcomes for patients with CAD, however there is a lack of standardisation of definitions and outcomes which limits the validity of international comparisons (3). The CAD Working Group of the International Consortium for Health Outcomes (ICHOM), recommend assessing outcomes at 30-days, 1-year, and 5-years. The aim of this study was to explore the outcomes of patients undergoing primary, emergency and elective PCI at 30-days and 1-year in a tertiary cardiac centre in the UK. Outcome data were collected retrospectively from clinic letters or by purpose-made questionnaires sent to patients. If data could not be obtained by either of these methods, a questionnaire was sent to the patient’s GP. Data were collected at 30-days and 1-year post PCI and were entered into a password protected database. Information was obtained on MACE events, symptoms of chest pain, and the need for further investigation and intervention following the index event. Data are available for patients who underwent PCI between 2010 (1-year outcomes), 2011-2020 (30-day and 1-year outcomes) and 2021 (30-day outcomes only). There were 15,956 patients available for follow-up at 30-days post PCI and 15,945 patients at 1-year – total 31,901 patients. There were no outcome data for 1931 patients at 30-days (12.1%) and 2931 (18.4%) at 1 year. 27,039 patients were therefore included in the analysis. 55.7% of patients had undergone primary PCI at 30-days and 60.0% at 1-year. 69.7% of patients had no angina at 30-days. At 1-year the figure was 57.8%. A further 9.8% and 7.8% had no angina on normal activity respectively at the two time periods. The most frequently used investigation for recurrence of symptoms was myocardial perfusion scanning which was carried out in a total of 1231 patients (4.6%). Post PCI myocardial infarction occurred in 0.35% of patients at 30-days and in 0.69% of patients at 1-year. Unstable angina occurred in 2.3% and 4.0% respectively at the two time periods. PCI is a widely used treatment for CAD. Short and medium-term outcomes for patients are good, with low MACE events and good symptom control. Some of this data is patient-reported and therefore the accuracy cannot be guaranteed.

Alison Pottle, Consultant Nurse, Cardiology, Harefield Hospital, London (A.Pottle@rbht.nhs.uk), was the winner of the Silver Award in the Cardiovascular Nurse of the Year Category in the BJN Awards 2023.

Aims Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement for patients with aortic valve stenosis. The choice between TAVI, surgery, or a conservative approach should be based upon multiple factors including clinical considerations, technical feasibility, and informed patient preference. In this context, engaging patients in a shared decision-making (SDM) process becomes essential, but this practice is generally underused. Methods and results To comply with the European and UK national guidelines, in January 2023 we established a structured SDM pathway in which patients are offered virtual/physical decision aids and after 1 week are invited to a meeting to reach a shared decision. From December 2022 to June 2023, a custom-developed questionnaire was prospectively administered to 23 patients prior to, and 38 patients after, the implementation of the SDM pathway. The answers to 12 core questions were recorded on a Likert scale (1-5). Global satisfaction, as measured by mean Likert score, was significantly higher for the post-SDM group than for the pre-SDM group (4.46 +/- 0.14 vs. 3.78 +/- 0.30, P < 0.001). The percentage of positive (Likert 4-5) responses was significantly higher in the post-SDM group (289/312, 92.6% vs. 155/234, 66.2%, P < 0.001). The percentage of negative (Likert 1-2) responses was significantly lower in the post-SDM group (5/312, 1.6% vs. 53/234, 22.6%, P < 0.001). Conclusion The SDM pathway proved effective in delivering SDM in compliance with national and international guidance. A similar approach leveraging digital technology to minimize cost and enhance patient convenience could be implemented for other treatments and across other institutions.

Abstract Introduction Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement for patients with aortic stenosis. However, the choice between TAVI, surgery, wait and watch or conservative management needs to be based upon multiple factors including comorbidity, life expectancy, anatomy, local experience and, critically, informed patient preference. In this context, engaging patients in a shared decision-making (SDM) process becomes essential, but this practice is generally underused. Purpose To comply with both international guidance and the National Institute for Health and Care Excellence (NICE) UK recommendations, in January 2023 we established a formal SDM pathway for TAVI, utilising digital solutions as much as possible to minimise the logistic impact for both hospital and patients. We aimed to quantitatively measure the compliance of the digital SDM meeting from the patients’ perspective with the NICE recommended essential and enhanced discussion standards. Methods Patients are contacted when the multidisciplinary heart team recommends TAVI, then offered digital or, where appropriate, physical patient decision aids and a link to a TAVI-specific explanatory video. One week later, patients are invited to a virtual comprehensive SDM meeting where a specialist nurse discusses aortic stenosis and treatment options with the patient as per the NICE recommended standards, allowing time for questioning and review. From December 2022 to June 2023, a custom developed questionnaire was administered to 20 patients prior to, and 28 patients after the implementation of the SDM meeting protocol, directly addressing the patients’ perception of adherence to the NICE standards. This was provided to the patients after the TAVI procedure via an online tool. The answers to the 12 core questions were converted into a Likert scale (1 to 5) and the global satisfaction scores for the 2 patient groups, reported as the average Likert score across the 12 questions, were compared with the Wilcoxon Rank-Sum Test. Results The global satisfaction score was significantly higher for the post-SDM group than for the pre-SDM group (mean 4.27 vs 3.55, p<0.001). The percentage of patients who gave positive (Likert 4-5) responses to each individual question was consistently higher in the post-SDM group. The percentage of patients giving negative (Likert 1-2) responses was substantially lower in the post-SDM group. Conclusions The SDM pathway and the virtual tools provided proved effective in delivering SDM in compliance with international guidance and NICE recommended standards from the patient’s perspective. A similar approach leveraging digital technology to minimise cost and enhance patient convenience could be implemented for other treatments and across other institutions.Questionnaire results

Abstract Background Rapid Access Chest Pain Clinics (RACPC) were developed following the publication of the National Service Framework for Coronary Heart Disease in 2000(1). The National Institute for Health and Care Excellence (NICE) produces guidelines for the management of patients with recent onset chest pain of suspected cardiac origin(2). In 2016 the guidance was updated and recommended the use of CT coronary angiography (CTCA) as the initial investigation for patients with chest pain which was typical or atypical of angina. Adherence to the guideline may be dependent upon factors such as local availability of CT scanners and clinician preference. The RACPC in this tertiary centre is nurse-run with no medical involvement. There is good engagement with the CT department and in July 2017 the NICE guidance was adopted in the clinic. Purpose To evaluate the use of CTCA as the first line investigation for patients with typical or atypical chest pain. Methods Data from all patients reviewed in the clinic between 01/07/2017 and 31/12/2023 were prospectively collected, entered into a database, and then retrospectively analysed. The data were organised into 3 groups: patients with typical chest pain; atypical pain and those with non-cardiac sounding chest pain. The number of patients in each group who underwent a CTCA, and the outcome of the scan were evaluated. The CT scans were categorised as showing significant coronary artery disease (CAD), non-obstructive CAD, no CAD, or as inconclusive. The outcome of patients who had a positive CTCA was also recorded. Results 2986 patients were reviewed in the RACPC in the above period. 14.2% of patients presented with typical pain, 47.4% with atypical pain, and 30.6% had non-cardiac pain. The remaining patients presented with other symptoms such as breathlessness. CTCA was used as the first investigation in the majority of patients with typical or atypical pain, unless alternative investigations or management were deemed to be more clinically appropriate. In 59.5% of typical and 78.5% of atypical presentations, the CT scan showed no CAD, or non-significant CAD. There was a low incidence of positive scans in both groups, however patients with typical pain were more likely to have significant CAD (Table). All patients who had a CTCA indicating significant CAD, were referred for invasive angiography. 88.0% of typical presentations, and 64.0% of those with atypical pain, underwent revascularisation. No patient who underwent invasive angiography was found to have normal coronary arteries. Conclusion Atypical pain is the most frequent presentation in the RACPC, however the majority of these patients, and most of those with typical pain, do not have significant CAD. Careful assessment and the use of CTCA as the initial investigation, enable the identification of those patients who need invasive angiography. This is a cost-effective strategy which also reduces risk and radiation exposure for patients.

Lipoprotein(a) (Lp(a)) is a well-recognized causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve stenosis. There are ongoing challenges with screening and management in primary and secondary prevention; however, future recommendations for clinical practice await the outcomes of clinical trials that are in progress.

Abstract Funding Acknowledgements Type of funding sources: None. Background Outcomes measures following PCI usually focus on in-hospital and 30-day mortality and readmission rates following discharge. There are numerous cardiac registries worldwide but there is a lack of data on longer-term patient-centred outcomes. ESC guidance recommends that patients are re-evaluated at least annually following myocardial revascularisation to reassess symptoms and adherence to secondary prevention measures and reinforce medical therapy and lifestyle changes when appropriate (1C recommendation). The International Consortium for Health Outcome Measures have produced a dataset of recommended outcome measures including long-term follow-up to 5 years and beyond, focusing on aspects of health experience that are important to patients. Real life data on long-term outcomes following PCI is needed in addition to short-term outcome measures to establish patient experience of PCI. Purpose The study was carried out to evaluate the long-term outcomes of patients undergoing PCI in this tertiary centre. Method Nurse-led follow-up for all patients post PCI has been carried out since 2001. Outcome data were initially collected prospectively during clinic appointments; short-term at 1-month, and medium-term at 6-months and 1-year. Long-term outcome data at 3 and 5-years were collected from 2012 via telephone appointment or purpose-made questionnaire. Results Data are available from 3-year follow-up for patients who underwent PCI between 2009 and 2014 and 5-year follow-up from patients between 2007 and 2012. The results only relate to patients followed-up in the nurse-led service. There were 3568 patients followed-up at 3-years and 2088 followed-up at 5-years (total 5656). 59.4% of patients had undergone primary PCI at 3-years and 64.1% at 5-years. 76% of the respondents were male at both time periods. The average age was 75.4 years. The data showed that at 3-years, 45.2% of patients reported they had no chest pain, or no angina on normal activity. At 5-years this number was 48.6%. 80.7% were free of MACE events at 3-years and 78.4% at 5-years. Approximately 50.0% of MACE events were non-cardiac hospitalisations. The number of patients requiring further intervention at both time periods was small. Conclusion Procedural outcome from PCI is good in the long, as well as short-term. Patient reported outcomes indicate that symptom control is potentially not as good as would be expected. Patients need long-term follow-up with a healthcare professional to establish if reported symptoms are truly cardiac and therefore warrant further investigation, however, healthcare resources may limit the ability to do this.

Abstract Funding Acknowledgements Type of funding sources: None. Background The nurse-led follow-up service for patients who have undergone percutaneous coronary intervention (PCI) was established in 2001 to standardise post procedural care for this patient group. The appointment focusses on symptom assessment, medication review and optimisation, and risk factor modification and secondary prevention. Timing of appointments is dependent on the procedure the patient has undergone (primary/elective PCI) and the format of the service has changed several times since its inception in response to changes in the PCI service within the hospital. Clinic appointments were carried out face to face or via the telephone until 2020, when all clinics changed to virtual appointments (video or telephone). Methods Data for all patients reviewed in the clinic was collected prospectively and retrospectively analysed. This report covers the period 2010-2021. Results A total of 21,465 appointments were carried out in the above audit period. Most appointments were carried out in the first-year post PCI in accordance with the follow-up protocol (81.7%). Patients reviewed after 1-year were usually referred to the clinic by their GP due to recurrence of symptoms. 71.3% of patients reviewed within the first year were free of any symptoms of angina or had no limitation to physical activity, and 71.2% were not limited by breathlessness at any follow-up appointment. 33.6% patients reviewed within the first year were either attending or had attended a cardiac rehabilitation programme, with fewer patients declining referral in more recent years. 19.3% patients reviewed within the first year were diabetic, with 5.4% diagnosed on admission. 8.5% patients were still smoking, 41.0% had stopped smoking, and less than 1.0% patients had restarted smoking within the first year. 49.2% patients reviewed within the first year had a systolic blood pressure below 140mmHg, and 56.0% patients had a diastolic blood pressure below 90mmHg, however this data was not available for all patients. The data suggests that lipid management has improved within recent years with more patients achieving LDL levels below 2.0mmol/L, however, this data is also incomplete. Over 92.0% patients were taking Aspirin at 1-month and 1-year, with 95.0% patients taking a second antiplatelet agent at 1 month, and 76.6% at 1-year. Beta blocker, ACE inhibitor and statin use has been relatively consistent at 71.6%, 66.1% and 82.5% respectively at all appointment times. Conclusion This nurse-led follow-up service provides consistency of care for patients who have undergone PCI. The nurses in the clinic are able to optimise risk factors and medication, although further work needs to be done to achieve guideline directed targets. Collaboration with primary care is required to ensure secondary prevention is continued.

Introduction Shared decision making (SDM) is a collaborative process empowering patients and healthcare professionals to engage in discussion around treatment goals and options (National Institute of Health and Care Excellence (NICE), 2023). This framework has long been promoted by NICE, but with limited implementation in practice. Methods We have implemented and evaluated initial experience of a formal SDM meeting integrated into our institutional Transcatheter Aortic Valve Implantation (TAVI) pathway. The meeting was structured to address all of the essential and enhanced standards in the NICE SDM framework and undertaken by a clinical nurse specialist. A questionnaire was developed across selected domains (Figure 1) using the Likert scale and based on NICE guidance, Patient Record Standards Body criteria, and SDM Q-9. Scale: 1/2=Completely/Strongly disagree, 3=Neutral, 4/5 = Completely/Strongly agree. The questionnaire was administered to cohorts of post-TAVI patients before and after the implementation of the SDM program. The ‘global satisfaction score’ (GSS) was computed using the raw scores from all questions answered by all patients before and after SDM. This was compared via the Kruskal-Wallis test. In addition, we aimed to report high and low Likert scores for the individual question domains before and after implementing the SDM pathway. Results There were a total of 30 respondents: 20 in the pre-SDM group, and 10 in the post-SDM group for all 12 question domains. 37% of respondents were female and the age range was 55-90 years. 30% reported a mobility difficulty, 20% hearing loss, 30% no disability and 20% did not specify. There was a significant improvement in the ‘global satisfaction score’ of patient satisfaction following the SDM implementation (median GSS 4 (IQR 3-4) vs 4 (4-5), p<0.001, Figure 1). Furthermore, positive responses increased, and negative responses decreased for all question domains (Figure 2). Conclusion We successfully implemented an SDM meeting into our TAVI pathway. Data collection continues, however our initial experience in this small number of patients suggests that this approach appears to significantly improve positive decision-making outcomes. These include patient involvement, discussion around treatment options and their risks, the opportunity to ask questions, and a reduction in negative responses when compared to patients who did not have an SDM meeting. SDM collaboration is widely applicable throughout clinical decision-making and has the potential to increase patient engagement in their management. Conflict of Interest None

Raised lipid levels are a significant risk factor for cardiovascular disease. Alison Pottle provides an overview of how these are measured and the lifestyle measures and medications that can be used to reduce risk in these patients Cardiovascular disease (CVD) is the leading cause of death in England and Wales. Raised lipid levels are a significant risk factor for CVD. Lipids are a heterogeneous group of substances which include cholesterol, triglycerides, lipoproteins and apolipoproteins. The link between increased lipid levels and atherosclerosis was first established in the early 1900s. Numerous clinical studies have demonstrated the critical role of low density lipoproteins and other cholesterol-rich apolipoprotein-B containing lipoproteins in atherosclerotic plaque formation and the subsequent risk of CVD events. There is now clear indication that the lower the achieved LDL levels, the lower the risk of CVD. Multiple interventions including changes in lifestyle together with the use of lipid-lowering therapies may be required to achieve desired lipid levels, and practice nurses can play a key role in this. This article will discuss how cholesterol levels are measured and the treatment strategies now available.

Objective The study evaluated the feasibility of mindfulness-based cognitive therapy (MBCT) in patients with non-cardiac chest pain by assessing their willingness to participate and adhere to the programme, and for these data to help further refine the content of MBCT for chest pain. Patients and methods This prospective 2:1 randomised controlled trial compared the intervention of adapted MBCT as an addition to usual care with just usual care in controls. Among 573 patients who attended the rapid access chest pain clinic over the previous 12 months and were not diagnosed with a cardiac cause but had persistent chest pain were invited. The intervention was a 2-hour, weekly, online guided 8-week MBCT course. Compliance with attendance and the home practice was recorded. Enrolled patients completed the Seattle angina questionnaire (SAQ), Hospital Anxiety and Depression Scale, Cardiac Anxiety Questionnaire, Five-Facet Mindfulness Questionnaire, and Euro Quality of Life–5 Dimensions–5 Level at baseline assessment and after 8-week period. Results Persistent chest pain was reported by 114 patients. Of these, 33 (29%) patients with a mean age of 54.2 (±12.2) years and 68% women, consented to the study. Baseline questionnaires revealed mild physical limitation (mean SAQ, 76.8±25), high levels of anxiety (76%) and depression (53%), modest cardiac anxiety (CAQ,1.78±0.61) and mindfulness score (FFMQ, 45.5±7.3). Six patients subsequently withdrew due to bereavement, caring responsibilities and ill health. Of the remaining 27 participants, 18 in the intervention arm attended an average of 5 sessions with 61% attending ≥6 sessions. Although not statistically powered, the study revealed a significant reduction in general anxiety, improved mindfulness and a trend towards improvement in SAQ scores in the intervention arm. Conclusion One-third of patients with persistent non-cardiac chest pain were willing to participate in mindfulness-based therapy. An improvement in anxiety and mindfulness was detected in this feasibility study. A larger trial is required to demonstrate improvement in chest pain symptoms.

This article explores a new advanced nursing role within interventional cardiology. The role was jointly developed by the lead consultant and clinical nurse specialist, and has received the first official centre of excellence award in the world. As a result, the service will now deliver expert training programmes taught by the consultant team and specialist nurse. This service was created for patients with mitral valve disease. It has a dedicated and structured pathway, with the patient always at the centre of care. This article introduces the role of nurse second operator in complex valvular intervention, which allows the clinical nurse specialist to be fully involved in the entire patient journey from referral to discharge. The author describes how the role was established and the developments that have been made in the first 3 years of the post. The role encompasses both inpatient and outpatient care in a bespoke, nurse-led service, as well as responsibility for maintaining accurate data collection and adherence to the patient pathway throughout the service. This has facilitated a streamlined and tailored service that strives to deliver high-quality, equitable care to patients across the UK. It is hoped that this will encourage other centres to develop such roles for specialist nurses.

Abstract Funding Acknowledgements None Background Rapid Access Chest Pain clinics (RACPCs) were established in the UK in 2000 following the publication of the National Service Framework for Coronary Heart Disease. Patients underwent an exercise test (ETT) in the clinic as part of a ‘one-stop’ protocol with follow-up only if further investigation was required. In 2010, the National Institute for Health and Care Excellence (NICE) produced guidelines for the assessment and diagnosis of chest pain of recent onset (CG95), replacing the recommendation for ETT with non-invasive functional testing for patients with an intermediate pre-test probability of coronary artery disease (CAD), necessitating multiple appointments to evaluate the patient’s symptoms. The guidelines were updated in 2016, with a new recommendation that patients with atypical or typical chest pain should undergo CT coronary angiography (CTCA) as the first diagnostic test. Purpose The aim of this study was to investigate the feasibility and potential benefit of performing same -day CTCA in the RACPC. Method From November 2016 all patients with atypical or typical chest pain attending the RACPC at this tertiary cardiac centre were referred for CTCA unless alternative investigation was clinically indicated. From February 2018, same day CTCA was offered to some patients. Up to two scans could be performed in each clinic, which was increased to up to three in June 2018. Results A total of 985 patients were seen in the nurse-led clinic between 12/02/2018 and 30/11/2019. 473 patients were referred for CTCA (48.0%) and 314 scans were carried out in the clinic (66.4%). Of those scans carried out in clinic, 128 patients had a CTCA which showed no evidence of CAD (40.8%) and 34.4% of scans showed non-obstructive CAD. In 18.2% of patients, the CTCA showed significant CAD and in 21 patients (6.7%) the scan was inconclusive. Patient with inconclusive scans underwent further testing which was negative in all cases. The outcome for patients with significant CAD (57 patients) is shown in the table. Conclusion CTCA on the same day as the RACPC appointment is feasible and facilitates rapid further investigation and treatment of patients with potentially significant CAD. It also enables patients with non-significant or no CAD to be reassured that their symptoms are unlikely to be cardiac which will reduce anxiety and allow timely investigation of other causes of the chest pain. Nurses need training in the risks of radiation in order to be able to request the scans and enable the clinic to be nurse-led.

Despite widespread evidence of the effectiveness of lipid modification for the reduction of cardiovascular disease (CVD) risk, lipid modification goals are commonly underachieved in the United Kingdom (UK). In order to understand current UK lipid management guidance and the corresponding attainment of recommended lipid lowering goals relating to treatment with statins and ezetimibe, a literature review was conducted using PubMed focusing on publications between January 2017 and February 2020 in order to capture the most up-to-date literature. Identified publications were reviewed against key clinical guidelines for lipid management in relation to CVD risk from the National Institute for Health and Care Excellence (NICE, CG181), the Scottish Intercollegiate Guidelines Network (SIGN, 149) and European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS). Cholesterol lowering goals are central to current lipid lowering therapy guidance, although specific goals vary depending on the guideline and patients' individual risk profile. Current guidance by NICE and SIGN specifies that treatment should achieve a greater than 40% reduction in non-high-density lipoprotein cholesterol (non-HDL-C) at 3 months of treatment, while the ESC/EAS place emphasis on the lowering of low-density lipoprotein (LDL-C) and total cholesterol. Yet, despite widespread availability of guidance and consistent messaging that lipid lowering goals should be ambitious, current evidence suggests a significant proportion of UK patients have sub-optimal reductions in cholesterol/non-HDL-C/LDL-C. The reasons for this are reported to be multifactorial, including a lack of compliance with guidelines, particularly regarding high-intensity statin prescribing, patient adherence, statin intolerance and statin reluctance as well as wider genetic factors. A number of possible strategies to improve current lipid management and attainment of lipid-lowering goals were identified, including improving the patient-healthcare professional partnership, conducting audits of local prescribing versus guidance, implementing plans for the refinement of current services and considering alternative options such as cost-effective single pill combinations for improving adherence.

Abstract Funding Acknowledgements None Background Patients undergoing angiography and percutaneous coronary intervention (PCI) were historically reviewed post procedure by a member of the medical team who assesses the patient’s suitability for discharge and completes the discharge letter. Over the past 10 years, the number of patients admitted for these procedures as day cases has increased significantly. In addition, there has been an expansion in nursing roles in the UK with the development of a variety of clinical nurse specialist (CNS) posts which have taken over many of the traditional medical roles. The majority of patients undergoing elective angiography and PCI are admitted to a day case unit at this tertiary cardiac centre. There is no designated medical cover for the unit and medical staff from the acute cardiac unit are called to review patients and complete their discharge paperwork in addition to their other duties. This frequently results in delayed discharge and patients going home without a discharge summary. It was therefore proposed that suitably qualified CNSs could be trained to discharge these patients and others undergoing day case cardiology procedures. From June 2017, the CNS team took over the role of reviewing patients post procedure and completing the discharge letter. Purpose The aim of the study was to evaluate if CNSs were able to discharge patients and provide a timely and effective service following elective cardiology procedures and to obtain patient feedback. Method Data on the number of patients reviewed by the CNSs from June 2017 to the end of December 2019, were prospectively collected in a dedicated database. A pilot study of patient experience was carried out in January 2020. Patients were given a questionnaire which asked about the explanation they received from the CNS regarding the procedure they had undergone, if their medication was reviewed and discussed with them, and if they received a discharge summary to take home. Results 1287 patients were reviewed by the CNS team during the above period. 811 (63.0%) patients had undergone angiography and 423 (32.9%) PCI. Informal feedback from the staff working on the day case unit included that patients were discharged earlier, had improved knowledge about their procedure and that the discharge letter was more detailed when completed by the CNS team. Eight patients completed the pilot questionnaire. Six were discharged by one of the CNS team, one by a doctor and one patient was not sure who did their discharge. All patients were very satisfied with the process and the information they were given. Conclusion Experienced CNSs can deliver high-quality, timely discharge of patients following cardiology procedures. This process is being used as a template to expand nurse-led discharge to other areas in cardiology. Patient experience will continue to be audited with a larger sample size in 2020.

Abstract Background An innovative artificial intelligence (AI) Decision Support System (DSS) ESC guidelines based has already been used at point of care with efficacy for evaluating subjects with stable chest pain (SCP) and it has been proved to correctly identify absence of significant coronary artery disease (CAD) versus standard care approach (SD) without known prognostic implication yet. Purpose The aim is to determine the prognostic value of “no testing/Follow up” AI DSS response in a referral population evaluated for SCP. Methods From 2016 to 2019, an AI DSS ESC guidelines based applicative was used on 1.291 subjects with SCP to determine testing appropriateness compared with human specialist standard evaluation. 590 of them, 332 males, mean age 62±11 years deemed to be completely negative – by “no testing/follow up” response - were evaluated. The negative response was defined and confirmed by a normal Coronary Tomography Angiography scan executed in all these subjects. Mean follow-up was 3.46±1.76 years. Two groups based on pre-test likelihood of having CAD were analyzed – low and intermediate. No subjects with high pre-test likelihood were present. The primary endpoint was cumulative incidence of cardiovascular death, hospitalizations for acute coronary syndrome and coronary revascularizations. Results The primary endpoints classification is displayed in the Table. The unadjusted hazard ratio for primary endpoint was 3.84 (95% CI 0.32–8.68, p=0.009) in patients with intermediate compared to those with low pre-test likelihood of CAD. Moreover, the “no testing and Follow up” response showed an incremental prognostic value over conventional risk factors (χ2=7, P=0.022) and over a combination of conventional factors and ST-T changes (χ2=9, P=0.014). Conclusions In an outpatient population without known CAD evaluated for chest pain, after the administration of AI DSS, a “No tests/Follow up” confers an excellent prognosis regardless of the ESC SCORE Charts and rest ECG abnormalities. These preliminary data confirms the safety of ARTICA AI DSS use in subjects with stable chest pain. Funding Acknowledgement Type of funding source: None

The emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes Coronavirus Disease 2019 (COVID-19) has resulted in a pandemic. SARS-CoV-2 is highly contagious and its severity highly variable. The fatality rate is unpredictable but is amplified by several factors including advancing age, atherosclerotic cardiovascular disease, diabetes mellitus, hypertension and obesity. A large proportion of patients with these conditions are treated with lipid lowering medication and questions regarding the safety of continuing lipid-lowering medication in patients infected with COVID-19 have arisen. Some have suggested they may exacerbate their condition. It is important to consider known interactions with lipid-lowering agents and with specific therapies for COVID-19. This statement aims to collate current evidence surrounding the safety of lipid-lowering medications in patients who have COVID-19. We offer a consensus view based on current knowledge and we rated the strength and level of evidence for these recommendations. Pubmed, Google scholar and Web of Science were searched extensively for articles using search terms: SARS-CoV-2, COVID-19, coronavirus, Lipids, Statin, Fibrates, Ezetimibe, PCSK9 monoclonal antibodies, nicotinic acid, bile acid sequestrants, nutraceuticals, red yeast rice, Omega-3-Fatty acids, Lomitapide, hypercholesterolaemia, dyslipidaemia and Volanesorsen. There is no evidence currently that lipid lowering therapy is unsafe in patients with COVID-19 infection. Lipid-lowering therapy should not be interrupted because of the pandemic or in patients at increased risk of COVID-19 infection. In patients with confirmed COVID-19, care should be taken to avoid drug interactions, between lipid-lowering medications and drugs that may be used to treat COVID-19, especially in patients with abnormalities in liver function tests.

Background and Aims: Familial hypercholesterolemia (FH) is an autosomal dominant disorder usually resulting from a mutation in the low-density lipoprotein (LDL) receptor gene that leads to receptor absence or malfunction. Managing lipids in patients with FH in pregnancy presents a challenge for all involved. Elevated lipoprotein levels during pregnancy can increase maternal susceptibility to atherosclerosis in later life and may also predispose the child to cardiovascular disease. Currently there is very scant literature regarding the use of LA during pregnancy to control lipid levels in patients with FH.

The Authors regret that there is a repetitive error in Table 4 with regards to the use of the term "baseline". Under the Factors TC, LDL-C and Lp(a) the fourth row sub-headings should read "% ↓ C interval mean vs TC, LDL and Lp(a) off treatment" not "% ↓ C interval mean vs baseline TC, LDL and Lp(a)." This also affects the manuscript in the Highlights, Abstract and section 3.5 as follows: Highlight 3 should state "The mean reduction in interval mean LDL-C from values off treatment was43.14% and 37.95% for Lp(a)." The results statement within the abstract should state. "The mean reduction in interval mean LDL-C from values off treatment was 43.14%. The mean reduction in interval mean Lp(a) from values off treatment was 37.95%." In section 3.5, the relevant statement should read "The mean reduction in interval mean LDL-C from values off treatment was 43.14% The mean reduction in interval mean Lp(a) from values off treatment was 37.95%." Lipoprotein apheresis efficacy, challenges and outcomes: A descriptive analysis from the UK Lipoprotein Apheresis Registry, 1989–2017AtherosclerosisVol. 290PreviewIn 2008, the National Institute of Health and Care Excellence in the UK recommended that patients undergoing lipoprotein apheresis (LA) should be included in an anonymised registry. The UK Lipoprotein Apheresis Registry was subsequently established in 2011. Full-Text PDF