Introduction Calcified coronary artery disease continues to present significant challenges when performing percutaneous coronary intervention. Recently, intravascular lithotripsy (IVL) has been introduced into the interventionalist’s armamentarium. The safety and efficacy of IVL has been shown in non-randomized studies. IVL was introduced to Galway University Hospital in 2018. Analysis of patient outcomes in our real-world population has never been performed. We aimed to describe the patient characteristics, procedural aspects and short-term outcomes of patients undergoing calcium modification with IVL in our tertiary referral centre. Methods This is a single centre retrospective cohort study including all patients who underwent calcium modification using IVL in a single tertiary referral centre. Patients >18 years undergoing IVL treatment from December 2018 to April 2023 were eligible for inclusion. Patient demographics, procedural data, in-hospital outcomes and follow-up were obtained from the patient’s electronic health record and recorded in a dedicated database. Results A total of 141 patients underwent IVL in UHG during the study period. Most were male (80.14%) with a mean age 72.4 +/- 9.04 years. High rates of cardiovascular risk factors were noted including hypertension 81.6%, hyperlipidaemia 73%, diabetes 34.8% and smoking history 57.8%. The left anterior descending artery was most commonly treated (60, 42.5%), followed by the right coronary (34, 24%), left circumflex (20, 14%). Eighteen procedures involved IVL to the left main stem (12.7%). IVL was used to treat instent restenosis in 28 cases (19.86%). 47.5% of patients were treated with IVL in the context of an acute coronary syndrome. Procedures were guided by intravascular imaging in 55 patients (39%). Predilation was performed in 92.2%. One IVL balloon was used in 96.5% of cases with only 5 requiring 2 IVL balloons. The median number of pulses delivered was 60 [IQR 40–80]. Twenty patients (14.2%) undergoing IVL for ISR were treated with drug coated balloons. Of the remainder, the median number of stents implanted was 1 [IQR 1–2] and the median stented length was 30mm [IQR 20–41]. Postdilation was performed following stenting in 94%. Procedural complications occurred in 7 patients (5%) including contained perforation 0.7%, slow flow 1.4%, side branch loss 2.1% and conduction abnormalities requiring temporary pacing wire 0.7%. One in-hospital death occurred (0.7%) due to sepsis and multi-organ failure. At 6-months follow up, freedom from all-cause mortality was 92.5% (figure 1A). Subgroup analysis demonstrated no difference in all-cause mortality in diabetics versus non-diabetics or in those with chronic kidney disease (figures 1B and 1C). Conclusion IVL is a recently introduced calcium modification technique. Our data represents a large real-world cohort of consecutive patients treated with IVL at a tertiary referral centre. Our results support current data suggesting the safety and efficacy of IVL. A low procedural complication rate was noted with encouraging short-term outcomes. Further work is required to compare outcomes to other calcium modification techniques and understand appropriate complementary techniques to IVL therapy.

Introduction Stent failure and particularly in-stent restenosis (ISR) remains a common presentation following percutaneous coronary intervention (PCI). Reported data suggests rates of up to 30% following bare metal stenting and 5–10% following drug eluting stents. A number of patient, procedure and stent characteristics are known to increase the risk of ISR. Little is known about ISR amongst patients in the Irish health care setting. We aimed to investigate the patient characteristics, management and outcomes for those presenting with ISR to a large tertiary referral centre. Methods We conducted a retrospective cohort study on consecutive patients presenting with ISR to our tertiary cardiology centre between 2020 to 2021. Patient demographics, type of percutaneous intervention performed and clinical outcomes were recorded in a dedicated database. Results Between 2020 and 2021, 134 cases of ISR were treated in our institution. The median time from index procedure to ISR treatment was 77 months (IQR 22–152). 82.8% of patients were male and mean age was 68.9 years (SD 10.1 years). Patients had a high rate of cardiovascular risk factors including, diabetes 35.1%, hypertension 91.8% and smoking 84.3%. Prior myocardial infarction was common 71.6% and 17.2% had a history of coronary artery bypass grafting. The original stent data was available on 63 patients (47%), all of which were implanted with drug eluting stents. Clinical presentation was with stable angina in 47%, non ST-elevation myocardial infarction 27.6%. ST-elevation myocardial infarction accounted for 11.2% (in the setting of acute stent thrombosis) and unstable angina 11.9%. The right coronary artery (RCA) was most commonly affected, accounting for 38.8% of presentations, the left anterior descending (LAD) was associated with 30.6% of cases, left circumflex artery (LCx) in 14.2%, 5% in saphenous vein grafts and 5.9% involving the left main stem (LMS). Mehran ISR classification was type IC (focal stenosis) in 37.3%, type II (diffuse intrastent) in 26.9%, type IV (occlusive) in 12.7%, type IB (stent margin) in 9.5%, type ID (multifocal intrastent) in 3.7% and type III (diffuse proliferative extending beyond stent margin) in 3%. Percutaneous coronary intervention of the ISR was guided by intracoronary imaging in 38.8%; with 38.5% of these using optical coherence tomography (OCT) and 61.5% using intravascular ultrasound (IVUS). Drug coated balloon application was the most common management strategy (69.4%), and further stenting with drug eluting stents was utilised in 25.4%. Median follow up was 16.6 months (IQR 4–22.9). At 1 year follow up there were 15 deaths (11.2%), 6 myocardial infarctions (4.5%) and 26 required further target lesion revascularisation (19.4%). Conclusion Instent restenosis continues to be common, and accounts for a large proportion of the cath lab workload. Similar to previous studies, a high prevalence of cardiovascular risk factors, particularly diabetes were found among our patients. Additionally, acute coronary syndrome was the presenting event in nearly half of the population, highlighting the non-benign nature of this disease. Despite imaging guided treatment of ISR, a high proportion of patients required further intervention on the ISR vessel and further work is required to identify risk factors for recurrent ISR.

Prior to the use of cystic fibrosis (CF) modulator therapy, exocrine pancreatic insufficiency in CF was thought to be irreversible. Ivacaftor therapy has resulted in exocrine pancreatic function restoration in young children [1] and also in older children after more prolonged use [2]. Restoration of pancreatic function was suspected in a nine year old girl homozygous for p.PHe508del although the authors felt there were many variables in that child's presentation [3]. Improvements in fecal elastase were also seen in a 4 year 6 month old child with genotype p.

IntroductionThe rate of cardiac device insertion continues to rise worldwide, largely due to an aging population but also from technical advances. While these devices confer a clinical benefit, they are also associated with many complications that can cause significant morbidity and financial burden. Our aim was to re-look at rates of implanted cardiac devices in our centre and compare it to a previous 2014 study and the most recent ESC quality indicators for the care and outcomes of cardiac pacing.MethodsWe collected data retrospectively on cardiac device implantation from January to June 2020 in Galway. Patients were identified via device database and complications were recorded as per discharge summaries and documentation available on Evolve IT system.Results164 patients underwent cardiac device implantation from January to June 2020 with 37 (22.6%) of these performed in a private hospital owing to Covid restrictions on activity in UHG. 115 (70.1%) were male;with a mean age of 72.4 (± 13.4 years), similar to previous study (mean 74.8). The most common procedure was pacemaker insertion;85 (51.8%) with the majority being dual chamber at 56 (65.8%), reduced from 2014 at which time pacemakers accounted for 85% of procedures. The most common indication for a pacemaker was symptomatic bradyarrhythmia or pauses;50 (30.5%). Temporary pacing was required in 12 patients (7.3%). ICD accounted for 36 (22%), with 22 (61%) for primary prevention and 14 (38.9%) for secondary prevention. 4 patients had a CRT device inserted with all of them being an upgrade from an existing device. Routine change of generator for end of life accounted for 35 procedures (21.3%). Our patient population had an average of 4.6 comorbidities (SD 2.3), with hypertension, coronary artery disease and atrial fibrillation being the most common. In line with ESC recommendations, most patients (83.5%) received prophylactic antibiotics 1hr pre incision, commonly Flucloxacillin. 15 patients (9.1%) experienced a complication (average age 72 years), including: lead dislodgement 2 (1.2), pneumothorax 3 (1.8%), hematoma 4 (2.4%), pericardial effusion 1 (0.6%), ventricular perforation 1 (0.6%) and replant revision 3 (1.8%). Of the 4 hematoma patients, 1 was on NOAC, 1 therapeutic Enoxaparin and 2 were taking Aspirin monotherapy. Among the 3 patients who experienced an infection, 2 had hypertension, hyperlipidaemia, diabetes and heart failure. Finally, 94 (57%) received the recommended device check within 2–12 weeks of insertion with a mean waiting time of 70 days (IQR 53.5 – 113.5).ConclusionDespite the pandemic, UHG has managed to find alternative solutions to ensure an ongoing high volume of device insertions with a relatively low rate of complications in an at-risk aging population. Potential areas for quality improvement in the future could include: changes to the admission proforma to make important information easier to collect and more timely follow-up post-implantation.

Background Guidelines advise that patients suffering ST-elevation myocardial infarction (STEMI) are revascularized as quickly as possible. If a patient is likely to receive primary percutaneous coronary intervention (PPCI) within 120 mins from diagnosis then this is the preferred treatment strategy. PPCI can only be delivered in specialist centres and timely access can be determined by geographical location. In the south-east region of Ireland, currently only in-hours PPCI care is provided in a single specialist centre. We wished to determine whether patients from the South East had different survival following STEMI than those in the rest of Ireland. Methods All STEMI patients from January 2013 until March 2018 were identified from the Irish national acute coronary syndrome (ACS) registry. Ethical approval and a consent declaration were obtained before accessing data. STEMI patients treated in the single regional specialist centre in the south-east region were identified from an internal hospital database. Patients treated in the south-east region comprised those treated at either the single regional specialist centre and those patients treated after transfer to specialist centres outside the region. The comparator group comprised the remainder of patients with STEMI in the rest of Ireland. Survival was determined from the national death register. Proximity to nearest primary PCI centre was determined from Google Maps. Statistical analyses were performed using Stata. Results 7,483 patients were included in the analysis – 678 in the south-east region (371 treated in the regional centre, 307 transferred outside the region), 6,805 in the rest of Ireland. Minimum follow up was 3 years, median follow up 5.5 years. Baseline characteristics are displayed in table 1. Patients in the South East had similar survival (83.6%) to those in the rest of Ireland (81.9%), Log-Rank p=0.11; HR 0.85 (p=0.088 95%CI 0.69–1.03) (figure 1). Conclusion Patients living in the south-east region of Ireland showed similar unadjusted survival following STEMI compared to patients living in the rest of Ireland.

Aims Our aim was to assess if outcomes for cystic fibrosis (CF) patients at six & sixteen years of age have improved in the last 17 years looking at FEV1, BMI and death. Methods A retrospective observational study using a prospectively maintained database of CF patients at Cork University Hospital. Results 84 patients were included in the 16-year-old data and 89 patients were included in the six-year-old data. The mean FEV1 and BMI (16 years) for the 2002-2007 group was 72.9±21.0% and 18.9±2.53 respectively, 2008-2013 group was 75.4±27.2% and 19.8±2.7 and for the 2014-2018 group was 95.2±16.0% and 22.9±4.1. The percentage of patients (16 years) with chronic pseudomonas status was 37.9% (11/30) in the 2002-2007 group, 51.6 % (16/31) in the 2008-2013 group and 4.2% (1/24) in the 2014-2018 group. The relationship between FEV1 and FVC with BMI remained significant in multivariate analysis (P <0.001). The mean FEV1 (six years) for the 2002-2007 group was 90.7±16.1%, 2008-2013 group was 99.3±17.9% and for the 2014-2018 group was 100.9±15.8%. Conclusions Improvements in FEV1 and BMI aged six and 16 years are notable as well as a significant decline in the number of patients with chronic pseudomonas.

Introduction The National Clinical Programme for Acute Coronary Syndrome in Ireland has successfully improved outcomes for patients presenting with STEMI since its introduction in 2010.1 Appropriate activation of the PPCI protocol is crucial to ensure timely reperfusion for patient with STEMI, while ensuring resources are not over-utilised for patients not requiring urgent PPCI. The aim of this review therefore was to establish the current rate of appropriate activation and false activation for the PPCI service in Galway. Methods Phone records from the dedicated STEMI PPCI telephone number for the Galway PPCI centre were compared to simultaneously transmitted ECGs over a period from 01/01/2019 to 31/03/2019 inclusive (figure 1, table 1). A phone call record corresponding with a transmitted ECG for a new patient was considered activation of the PPCI protocol. These records were compared to the local STEMI database for patients transferred direct to the cardiology team for PPCI. All activations had the corresponding ECG assessed for STEMI criteria as per the ESC guidelines.Abstract 22 Figure 1 Summary of PPCI protocol activations in galway from 01/01/2019 to 31/03/2019 inclusive. Summary of PPCI protocol activations in galway from 01/01/2019 to 31/03/2019 inclusive.Abstract 22 Table 1 Summary of PPCI protocol activations for Galway 01/01/2019 to 31/03/2019 Summary of PPCI protocol activations for Galway 01/01/2019 to 31/03/2019 GRAND TOTAL NAS TOTAL HOSPITALS TOTAL ACTIVATIONS 171 127 44 STEMI CORRECTLY DIAGNOSED – MET ECG AND CLINICAL SYMPTOMS 58 (34%) 39 (31%) 19 (43%) DIRECT TRANSFER TO CARDIOLOGY 13 (8%) 7 (6%) 6 (14%) MET ESC ECG CRITERIA FOR STEMI BUT NO SYMPTOMS 61 (36%) 52 (41%) 9 (21%)  - ST ELEVATION OTHER 8 7 1  - LBBB 30 28 2  - RBBB 17 13 4  - PACED 6 4 2 DID NOT MEET ECG CRITERIA FOR STEMI AND NO SYMPTOMS 39 (23%) 29 (23%) 10 (23%)  - WELLEN’S 2 1 1  - NON-SPECIFIC 30 24 6  - NORMAL SINUS RHYTHM 7 4 3 NAS = National Ambulance Service Results 171 activations of the STEMI PPCI service were recorded from 01/01/2019 to 31/03/2019 inclusive and 71 (42%) were accepted direct to Cardiology for management: 58 patients (34%) were correctly diagnosed with STEMI, 13 patients (7%) were transferred to the direct care of the cardiology team. Five patients (3%) underwent immediate angiography and had no coronary artery disease. Of the 100 patients not transferred directly to cardiology, 61 (36%) patients had ECGs which met ESC ECG criteria2 for STEMI but did not have clinical symptoms consistent with STEMI: LBBB (n=30, 18%), RBBB (n=17, 10%), ST segment elevation (n=8, 5%), paced rhythms (n=6, 4%). 39 patients (23%) had neither ECGs consistent with STEMI nor symptoms requiring urgent transfer for PPCI: Non-specific changes or T-wave inversions (n=30, 18%), normal sinus rhythm (n=7, 5%) and Wellen’s pattern (n=2, 1%). 67 of 100 false activations occurred during on-call hours. The national ambulance service activated the PPCI protocol for 127 cases, of which 39 (31%) cases were correctly diagnosed as STEMI. 52 (39%) patients had ECGs consistent with ESC ECG criteria[2] for STEMI without symptoms and 29 (23%) had neither ECG criteria nor symptoms. In total 44 activations were received from peripheral hospitals, 19 of which were correctly diagnosed as STEMI (43%). 9 (21%) patients had ECG changes consistent with ESC ECG criteria[2] for STEMI without symptoms, and 10 patients(23%) had neither ECG criteria nor symptoms. Conclusion This review identifies important subgroups of patients who were referred for PPCI, in particular 23% of patients who did not require discussion, and 36% of patients who should have discussion with cardiology services before initiating transfer to the catheterisation laboratory.

Background Implantable Cardioverter Defibrillators (ICDs) have been proven to reduce the incidence of sudden cardiac death in both primary and secondary prevention populations. However, it is recognised that shock treatment can be negatively experienced by patients and there is recognition that this may be inappropriate in end-of-life and palliative care situations. Despite the fact that both Heart Rhythm Society and European Heart Rhythm Association Consensus documents both outline the appropriateness of deactivation of ICD shock therapy in these situations, research has shown that 27% of patients receive shock therapy in the last month of life (Goldstein et al 2004). Aim The aim of the study was report on the single centre experiences of a protocol for deactivation of ICDs and Cardiac Resynchronisation Therapy Defibrillators (CRT-Ds) in a large tertiary referral centre. Methods This large tertiary referral centre has had a protocol for Deactivation of ICDs in End-of-Life Situations since late 2009 (figure 1). ICD and CRT-D records for patients implanted in this centre were analysed for deaths which occurred between Jan 2010 and Dec 2018. Follow-up records were analysed for devices which were deactivated prior to death.Abstract 4 Figure 1 Protocol for deactivation of ICDs in end-of-life situations Protocol for deactivation of ICDs in end-of-life situations Results A total of 149 patients with ICDs or CRT-Ds died between Jan 2010 and Dec 2018 which represented 23.8% of the ICD and CRT-D population implanted in the centre. 44 patients had the shock therapy of their device deactivated prior to death. This represented 29.4% of the patients with ICDs or CRT-Ds who died during this period. The numbers of deactivations are showing an upward trend, from one deactivation in 2010 to twelve deactivations in 2018 (figure 2).Abstract 4 Figure 2 Number of device deactivations by year Number of device deactivations by year Of these 44 patients, device deactivation occurred in the following locations 79% in the implanting centre 11.9% in the patients home or nursing home 6.8% in hospice settings 2.3% in an outlying hospital It was noted that the family were present at the time of deactivation in 32% of cases. All deactivations occurred less than 7 days from the date of the patient’s death. All were carried out by Cardiac physiologists and performed in less than 24 hours. Where deactivation occurred in the community, the Cardiac Physiologist was met by a palliative care nurse or GP. In one case the hospital Heart Failure Nurse travelled with the Cardiac Physiologist. In two further cases, requests for deactivation were received but could not be acted upon before the patient’s death. Both of these cases were from the community. Conclusion Deactivation of shock therapy in ICDs and CRT-Ds in end-of life situations is increasing and this service can be delivered by Cardiac Physiologists. Whilst the vast majority of deactivations occur in the implanting centre, over one in five occur in other settings and services should be designed to meet this need. The fact that only 29.4% of patients with ICDs or CRT-Ds implanted had their device deactivated, coupled with the fact that all deactivations occurred less than 7 days prior to date of death, suggest that significant education around this issue with other healthcare providers needs to take place.

BackgroundImplantable Loop Recorders (ILRs) provide long term ECG monitoring for patients for a number of presentations. It has a Class I indication for investigation of recurrent syncope (ESC 2018 Syncope Guidelines) and a Class IIa indication for documenting silent atrial fibrillation in patients with a cryptogenic stroke (ESC 2016 Atrial Fibrillation Guidelines). The miniaturisation of ILRs and their “injectable” nature has increased their clinical use. The addition of remote monitoring with alert notification allows for early detection of significant events in these patients, however false activation of automatic detection algorithms results in inappropriate remote transmissions and unnecessary use of Cardiac Physiologist time.AimThe aim of the study was to look at the true and false activation rates from patients implanted with ILRs from a specific manufacturer, the number of those activations, and to classify the reason for those activations.MethodsThe transmissions from patients implanted with ILRs from a single manufacturer between Aug 2017 and Jun 2018 were analysed retrospectively. All transmissions from the date of implant to Jul 2019 were analysed. Where there was any doubt about the nature of a detection an opinion of a Cardiologist was sought. Data around indication for implant, the number and nature of true and false activations were recorded. For false activations, the reasons for these were also noted.Results41 ILRs were implanted in this period in 21 males and 20 females. Ages at time of implant ranges from 17.93–79.78 yrs (avg 49.41 yrs). 80% were implanted for investigation of syncope, 7% for palpitations, 5% for AF detection and 7% for other indications. The total number of monitoring days across the total patient population was 3185 days with the average monitoring period being 77.68 (range 10–224) days. 23 pts (56.1%) made a total of 93 patient activated events. Only two patients’ recordings showed significant findings, an SVT and a broad complex tachycardia. 6 pts’ (14.6%) ILRs automatically detected a total of 37 true arrhythmias, 26 AF, 1 pause and 10 SVT events 26 pts’ (63.4%) ILRs automatically detected a total of 46,604 false arrhythmia detections. This equated to 14.63 false transmissions per day of monitoring. The types and reasons for false activations are shown in table 1.ConclusionIn this analysis of episodes sent by ILRs on remote monitoring 91.8% of episodes were due to false triggering of automatic device detection. In 96.8% of these cases this was due to undersensing of the QRS complex by the ILR. This analysis highlights the significant burden of remote follow-up of ILRs, particularly that of false triggering of automatic device detection algorithms. It also highlights that over 96% of false triggering are due to undersensing, highlighting the importance of achieving good amplitude QRS signals at implant.

Introduction Cardiac implantable electronic devices (CIED) are associated with low rates of procedure-related complications but many of these complications are associated with significant morbidity and prolonged hospitalisations. The aim of this study was to perform a retrospective ‘real world’ review of CIED complication rates in a tertiary centre in the West of Ireland and compare rates to a multi-centre CIED complication registry, the REPLACE registry1. Methods All patients who received a new device implant (ICD, PPM, CRT) or revision of an existing implant from 01/01/2016 to 31/12/2016 at Galway University Hospital were included (table 1). Data on complications associated with the procedure were collected from patient records including electronic discharge summaries, cardiothoracic surgery records, catheterisation laboratory log book records, patient clinical files and the pacing registry G-Pace. Complication rates were compared to the REPLACE registry1 data using the same major and minor complication criteria (table 2). Results 373 patients were included in the analysis (male = 257 (69%), female = 116 (31%)) and were followed up for an average of 28.6±7.9 months. The mean age was 73±13 years at the time of the procedure. 106 (28%) patients were transfers from peripheral hospitals and 76 (20%) of these patients returned to their referring centre on the same day. 156 (42%) patients were electively admissions, the remaining 111 (30%) patients were acutely admitted. 73 patients developed (19.6%) complications in the follow up period. Of these, 30 (8%) were early (i.e. before discharge, range 0–4 days) and the remaining 43 (11.5%,) occurred post-discharge. 12 (3%) occurred at 0–1 months, 9 (2%) at 1–3 months, 13 (3%) at 3- 12 months, and 9 (2%) >12 months. The complications with the highest rates (>1%) included lead revision (n=23, 8.6%), pneumothorax (n=8, 4.8%), device infection (n=9, 2.4%) and haematoma/swelling (all n=9, 2.4%). One patient (0.3%) died from RV perforation. Conclusion Overall the CIED major complication rate at our centre is comparable to that of the REPLACE registry1. Major complications such as lead revisions, pneumothorax, infection and haematoma were numerically higher when compared to the same study. Our findings illustrate the risk and variety of complications that can occur with these procedures and highlights the need ongoing strategies to minimise the risks of these complications.

Introduction Dyslipidemia is recognised as one of the most important modifiable risk factors for cardiovascular disease. The distribution of lipid parameters for certain populations, most notably in the United States, has been previously characterised in numerous studies, however there has never been a detailed evaluation of lipid distributions in an Irish cohort. Methods 110,620 serum lipid profile requests and result sets in an Irish population between 2004 and 2017 were analysed in relation to changes in age and sex-specific lipid distributions. This group was sub selected from a much larger database to include only first-time requests from primary care and taking precautions to have an untreated population. From this database we calculated age- and sex-related reference intervals for every 5 years of life from the age of 10 years to greater than 90 years for total cholesterol, triglycerides (TG), HDL cholesterol and LDL cholesterol (LDL-C). Results There are notable differences between the sexes and across different age groups in lipid profiles. Figure 1 shows the mean values for LDL-C for our population. The differences appear before the 20-year-old group and show that LDL-C levels rise at a younger age in men and peak at the ages of 40–50 years. In women peak values occur in the older age groups and women have higher mean values than men over the age of 50 years. Total cholesterol distributions follow a similar pattern to that of LDL-C. (Figure 2) The distribution of triglyceride levels for both males and females show a distinct positive skew from childhood through to old age. The positive skew is particularly marked in adult males up to the 60-year age group. In middle age median triglycerides are 0.5 mmol/l higher in males than females, with the sex difference widening to about 2.2 mmol/l amongst those individuals towards the 97.5 percentile of the distribution. Above 65 years triglyceride levels tend to fall or plateau in both sexes. Distributions in an Irish population are similar to international temporal and geographical comparisons, however the elderly Irish population tend to have lower total cholesterol levels than international comparators.Abstract 30 Figure 1 Mean values for LDL-C Mean values for LDL-CAbstract 30 Figure 2 Age and sex distribution for TG Age and sex distribution for TG Conclusions These distributions should be constructive in epidemiological and public health initiatives, providing data for temporal and geographical comparisons with other similar studies. For healthcare professionals advising individual patients it provides useful age-related reference intervals for the interpretation of significant dyslipidaemias.

Background With the prevalence of coronary heart disease increasing globally it is imperative that we explore alternative methods of delivering cardiac rehabilitation (CR) to improve patient outcomes in accordance with national and international CR guidelines. This study examines the feasibility and effectiveness of delivering a community based CR programme on medical and lifestyle risk factor management in the west of Ireland. Methods Patients with coronary heart disease; meeting the inclusion criteria for referral to CR were invited to attend a 12- week CR programme consisting of a professional multi-disciplinary (nurse, dietitian, physiotherapist) lifestyle intervention, with appropriate risk factor and therapeutic management delivered within a community setting. Risk factors such as blood pressure, lipids, smoking, BMI (body mass index), waist circumference and estimated MET max were assessed at baseline and end of programme (EOP). Results 255 patients enrolled in the CR programme. Mean age of the participants was 66.6 yrs, 72.9% were male and 35.4% had previous cardiac history. The programme adopted an integrated approach to care and in addition to cardiac patients it included a cohort of Stroke (17%) and Peripheral Vascular Disease (PVD) (4%) patients. Outcome data on 196 patients who completed the 12 week programme were analysed (table 1). Conclusions Data from this multi-component comprehensive community based CR programme suggest that the management of CR patients can be successfully integrated and delivered within a community setting by a specialist multi-disciplinary team (MDT). This study has demonstrated improvements in patient outcomes across biomedical, anthropometric and lifestyle risk factors. Benefits were also noted in the psychosocial health and wellbeing of the participants including improvements in quality of life (QoL) measures.

Objectives: To assess changing social inequalities in survival in CF and the potentially explanatory roles of factors such as lung function.Methods: We apply recently developed methods for the joint analysis of repeated measurements and time-to-event outcomes to data from 8393 individuals born between 1976 and 2016 captured in the UK CF Registry.We use postcodes to derive small area-level measures of social deprivation, used as a proxy of socio-economic conditions (SECs).We estimate the effect of SECs on survival using a cox-proportional hazards model whilst adjusting for potential confounders and assess whether any association has changed over time.We jointly model survival, lung function and weight trajectories to explore whether these longitudinal characteristics can explain any associations between SECs and survival.Results: Mortality was 40% higher in the most deprived quintile compared to the least deprived quintile (HR 1.4 95% CI 1.1 to 1.8) with indication of a social gradient.There was no evidence that this effect has changed over time.Initial results from our joint model showed that decreased lung function and increased rate of lung function decline are significantly associated with increased mortality but that lung function only partially explains inequalities in survival.Analysis to assess the explanatory role of both weight and lung function trajectories is ongoing.Conclusion: Social inequalities in survival in cystic fibrosis are large, and of similar magnitude to the impact of genotype.Inequalities do not appear to have decreased over a period of increasing average survival.Initial results suggest that lung function does not fully explain these inequalities.

Introduction ST Elevation has a high sensitivity but a relatively low sensitivity of diagnosing an acute myocardial infarction (MI). STEMI (ST Elevation Myocardial Infarction) mimics are cases that have ST segment elevation on a 12 lead ECG but where occlusive coronary artery disease is out ruled as the cause of presentation. International literature suggests that these cases represent approximately 7%–14% of all code STEMI activation’s. These represent an important cohort as they cause a significant workload for a primary PCI centre and expose patients to the risk of an invasive procedure. Methods We conducted a retrospective review of all consecutive CODE STEMI activation’s in our institution from 1st January 2016 to 31st December 2017. A STEMI mimic is defined as an activation of the STEMI pathway with ST segment elevation on a 12 lead ECG without angiographic evidence of occlusive coronary artery disease, or an acute MI being ruled out on clinical or biochemical grounds. We collected demographics on the patients and divided the cohorts by the location of the activation. Patients who were assessed by a physician prior to activation of the pathway were designated hospital activation (HA) and patients assessed by ambulance personal were designated field activation (FA). Results During the 2 year period of our study we had 586 activation’s of the code STEMI pathway. 451 (77%) patients had a final diagnosis of a STEMI, of the remaining 135 there were 21 acute coronary syndrome patients, 2 aborted STEMI’s and 29 NSTEMI’s. Therefore there were 83 STEMI mimics cases representing 10.5% of all activation’s. Table 1 details the demographics and results of the study. The vast majority, 89%, of the mimic group underwent an angiogram. The subsets were very similar in terms of percentage of men, 74% for the STEMI group versus 75% for the mimic group and the number of field activations, 46% in the STEMI group versus 40% for the mimic group. The only significant difference between the cohorts was that the mimic group were younger with a mean age of 58 versus a mean age of 66 in the STEMI group. Figure 1 details the final diagnosis for each mimic case. The most common diagnosis was of non-cardiac pain (53%), followed by pericarditis (24%), arrhythmia (10%), myocarditis (7%) and takotsubo cardiomyopathy (6%). Conclusions False activation of the code STEMI pathway is a significant concern due to the exposure of unnecessary risk of the procedure to the patient and also the resource implications. The only significant difference between the cohorts was that the STEMI mimics patients were younger. There was no difference statistical between field activation and hospital activation, which may reflect that in our institution all ECG’s are reviewed by a cardiology registrar prior to activation of the code STEMI pathway. During our study our false activation’s accounted for 10% of all cases, which correlates well with international standards, however it highlights an area for further educational work with ambulance paramedics, general practitioners and emergency department staff.

Background With the prevalence of Type 2 diabetes increasing globally it is imperative that we explore models of care that seek to improve diabetes outcomes in accordance with the recommended total Cardiovascular(CVD) risk approach to prevention. Purpose: This study examines the effectiveness of a community-based CVD prevention programme on medical and lifestyle risk factor management in a cohort of patients with Type 2 diabetes. Methods Patients with Type 2 diabetes and their family members were invited to attend a 16 week programme consisting of a professional multi-disciplinary (nurse, dietician, physical activity specialist) lifestyle intervention, with appropriate risk factor and therapeutic management in a community setting. Risk factors such as blood pressure, lipids, smoking, blood glucose, BMI (body mass index), waist circumference and physical activity levels were assessed at baseline, end of programme and at 1 year. Results As this study is ongoing, outcome data on patients who completed the 16 week programme and attended the 1 –Year follow-up were analysed (table 1). As of December 2016, 218 patients were invited to attend End of Programme (EOP) assessment, resulting in a 75% response rate (n=164), and 166 were invited to attend 1 Year follow-up (1 year) of which 64.5% responded. Overall a high programme uptake rate of 99% was observed. Conclusions Data from this ongoing lifestyle intervention programme suggests that the management of diabetes and cardiovascular disease can be successfully integrated. In addition, this model of care can improve diabetes outcomes with improvements in biomedical, anthropometric and lifestyle risk factors not only being observed at EOP but being sustained at 1 year.