Background and Aims: Background: New ESC guidelines and statement by EAS have recently been published based on recent advances in lipid lowering treatments. However, real world data are lacking regarding the implementation among the community of French cardiologists. Objective: To determine the current approach and strategies concerning lipid lowering treatments in secondary and primary prevention in France. Methods: : The French LIPIDS (LI pids Prevention In Daily practice Survey) was performed during October and November 2022 in France with an online questionnaire. Four mailings were sent to cardiologists to invite them to answer to the questionnaire. A total of 323 answers of cardiologists were collected during this 2 months period. Results: : for ASCVD patients, cardiologists agree with a LDL-C goal below 55 mg/dL in 69%, below 70 mg/dL in 16.5%, and 14.5% between 70 mg/dL and 100 mg/dL. An upfront strategy using fixed lipid lowering combinations was prescribed in less than 5% of patients, whereas high-intensity statins was prescribed in more than 90% of ASCVD patients. Answers concerning several clinical situations in primary prevention were very heterogenous highlighting the lack of knowledge. Conclusions: Conclusion: in this survey, an excellent agreement of lipid goals in secondary prevention is observed whereas goals in primary prevention aren’t implemented. Despite the consensus concerning the low levels of LDL-C in coronary patients, lipid lowering strategies are still mainly represented by the use of high intensity statins, whereas a combination of statins and ezetimibe is applied only for a minority of patients, and the use of PCSK9i remains marginal.

Abstract Background Atrial Fibrillation (AF) is asymptomatic in 20–30% of cases. New technologic tools for continuous ECG monitoring have been developed to detect and potentially treat AF in specific population with high cardiovascular risk. Purpose We aimed to evaluate the prevalence and the management of AF diagnosed in patients with no previous documented AF but with a high cardiovascular risk and clinical palpitation undergoing systematic 14-day continuous ECG-Holter monitoring and associated characteristics. Methods Patients were prospectively enrolled from December 2019 to December 2021 in this multicentered study, sponsored by the French National College of Cardiology. Patients needed to meet the following criteria: CHA2DS2VASc score ≥3 in women >2 in men associated with clinical palpitation without previous documented arrhythmia, particularly AF. Exclusion criteria were: previous documented AF, participation to another study that could interfere with the current study, pregnancy, previous skin intolerance to ECG-Holter electrodes. Included patients underwent a 14-day monitoring Holter-ECG to detect cardiac arrhythmia, particularly AF. Patients' characteristics, type of arrythmias and management of detected AF were described. Results Among the 336 included patients, 39% were men, median age was 73 [64.5–78] years, 71.5% had hypertension and 46.5% had a previous history of stroke. AF was detected in 14% of patients, among which 23.4% in the first 24 hours monitoring. In univariate analyses, older age (p=0.045) was significantly associated with AF, and a trend was observed regarding male gender (p=0.067) and less antiplatelet therapy (p=0.058). Patients with diagnosed AF had a prescription of anticoagulation therapy in 90% of cases consisting in apixaban and rivaroxaban for 72% and 28% respectively. Antiarrhythmic drugs were administered in 90% of AF patients and 13% underwent AF ablation. Conclusions The systematic AF screening of selected patients based on CHA2DS2VASc score ≥3 in women >2 in men associated with palpitations allows to diagnose AF in 14% of the population with a 14-day continuous ECG-Holter. This strategy seems efficient as it induced the prescription of anticoagulation and antiarrhythmic therapy in 90% of individuals. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): NATIONAL COLLEGE OF FRENCH CARDIOLOGISTS

Background and Aims : Background: Recent international guidelines modified cardiovascular risk factors management and highlighted the importance to reach risk factors target. However, real world data are sparse regarding risk factors care in this specific population. Objective: To determine the current clinical profiles, risk factors control and management in private practice of coronary diabetic patients in France.Methods: The Observatoire des patients DIAbétiques CORonariens (ODIACOR) Registry collected data on consecutive diabetic patients with documented CAD on risk factors (RF),treatments, awareness of risk factors control and goals.574 consecutive patients aged 18 years or older were included. They had either a CCS or an ACS. The survey was performed between March 2019 and December 2020.Baseline clinical characteristics, prevalence of RF, medications, RF control, collaboration between MD, patient's knowledge were collected.Results: Coronary diabetic French patients have a high prevalence of hypertension (81.8%) and hypercholesterolemia (72.4%). 16% had a polyvascular disease. Prevalence of overweight (39.8%), obesity (26.6%) were high. Prescriptions of anti diabetic agents were suboptimal, as Metformin, GLP1RA, Insulin, DPP4i, and sulfonylurea were prescribed in 64%, 11%, 28%, 20,2% and 19,5% of cases. Despite many patients received statins (92.1 %) and antiplatelet agents (78.6%). RF control was poor with only 37% with a LDL-C below 70 mg/dL, 50% with a HBPM below 135/85 mmHg, current smokers were 14,4%, a glycated haemoglobin > 7% for 38% .Conclusions: Conclusion: in this contemporary french cohort of CAD patients, we report major discrepancies between guidelines and treament's strategies. The control of major risk factors remain suboptimal, advocating efforts to obtain a better implementation of European guidelines. Background and Aims : Background: Recent international guidelines modified cardiovascular risk factors management and highlighted the importance to reach risk factors target. However, real world data are sparse regarding risk factors care in this specific population. Objective: To determine the current clinical profiles, risk factors control and management in private practice of coronary diabetic patients in France. Methods: The Observatoire des patients DIAbétiques CORonariens (ODIACOR) Registry collected data on consecutive diabetic patients with documented CAD on risk factors (RF),treatments, awareness of risk factors control and goals. 574 consecutive patients aged 18 years or older were included. They had either a CCS or an ACS. The survey was performed between March 2019 and December 2020. Baseline clinical characteristics, prevalence of RF, medications, RF control, collaboration between MD, patient's knowledge were collected. Results: Coronary diabetic French patients have a high prevalence of hypertension (81.8%) and hypercholesterolemia (72.4%). 16% had a polyvascular disease. Prevalence of overweight (39.8%), obesity (26.6%) were high. Prescriptions of anti diabetic agents were suboptimal, as Metformin, GLP1RA, Insulin, DPP4i, and sulfonylurea were prescribed in 64%, 11%, 28%, 20,2% and 19,5% of cases. Despite many patients received statins (92.1 %) and antiplatelet agents (78.6%). RF control was poor with only 37% with a LDL-C below 70 mg/dL, 50% with a HBPM below 135/85 mmHg, current smokers were 14,4%, a glycated haemoglobin > 7% for 38% . Conclusions: Conclusion: in this contemporary french cohort of CAD patients, we report major discrepancies between guidelines and treament's strategies. The control of major risk factors remain suboptimal, advocating efforts to obtain a better implementation of European guidelines.

Purpose As the medical and surgical complexity of pediatric heart transplants (PHTx) continues to increase, individualized treatment plans are increasingly important. Given the uncertain timing of heart transplant surgeries and the involvement of several different providers, multi-disciplinary communication at the time of transplant surgery is critical to safe execution of the transplant plan. Methods A pre-transplant flight plan (FP) and huddle (PTH) developed by Stanford University was implemented as a quality improvement project at Children's Medical Center of Dallas. The FP is a detailed pre-, peri-, and post-operative management plan developed at listing by all involved stakeholders, and updated monthly until PHTx.(Figure 1) After organ acceptance, the FP is reviewed by the on-call multidisciplinary team at a PTH. Project impact is evaluated with multidisciplinary pre- and post-implementation surveys. Pre-implantation surveys included all Heart Center professionals. Professionals who participated in a huddle participated in the post-implementation survey. The key outcome metric is 30-day post-transplant survival. Results 7 transplants included a FP/PTH, with a 30-day survival of 100%. A pre-implementation survey (n=169) indicated the minority of respondents (24%), agreed or strongly agreed that peri-transplant communication was good. Post-implementation survey (n=16) demonstrated that 87.5% agreed or strongly agreed that the FP/PTH improved multi-disciplinary peri-transplant communication, and 87.5% agreed or strongly agreed peri-transplant multi-disciplinary communication was good. Conclusion A transplant FP/PTH improves multi-disciplinary communication at the time of PHTx. Key lessons include ability to conduct PTH through virtual platform, standard data definitions, and EMR optimization for flight plan. Long-term data collection will indicate whether the flight plan improves delivery of care and/or patient outcomes.

Abstract Calcium scores of the coronary arteries (CCS) and – more recently – of the the thoracic aorta (TCS), have been established as risk markers for cardiovascular events. Yet, little is known about the relationship between these two calcium scores. In this study, CCS and TCS were compared in 1010 patients with a normal SPECT. Mean age was 64.5±8.7 yrs with 73.4% of men. CCS and TCS ranged between 0 and 5827 for CCS and from 0 to 58600 for TCS, with means of 281.1 and 1206 respectively. Such a difference was expected since the vascular surface of the thoracic aorta is approximately 5 times larger than that of the coronary arterial tree. Both CCS and TCS increased with the number of risk factors (p=0.000841 and p=0.000579) No significant relation was found between CCS and TCS for the entire group. However, when adopting a best-fitting curve model, 2 populations could be clearly identified: those with predominant TCS (N=552), and those with a- relatively- predominant CCS – (N=458). In each of these two groups, CCS and TCS were significantly related (r=0.63 and 0.69 respectively p<2.2e-12). Both groups had a comparable exposition to smoking and diabetes, but Group1 patients had more dyslipemia and high blood pressure than group 2 patients. Conclusion Calcified atheroma was frequently observed In patients with a normal SPECT, but no significant relation existed between CCS and TCS; patients with a predominant atheroma of the coronary arteries were not the same than patients with a predominant atheroma of the aorta, with both groups having different expositions to risk factors. This suggests that atheroma of the coronary arteries and of the thoracic aorta are close but not identical diseases.

The authors studied the responses of the main systems of sympathetic and hormonal regulation in valvular aortic stenosis, a special model of dissociation between arterial pressure and left ventricular function. The series comprised 14 patients with an average age of 70 +/- 9 years without diuretic therapy presenting with pure calcific aortic stenosis without other valvular or coronary disease. All were in sinus rhythm; 5 were taking an angiotensin converting enzyme inhibitor. Plasma concentrations of endothelin 1, atrial natriuretic factor (ANF), arginine vasopressin (AVP), catecholamines, plasma renin activity (PRA), angiotensin II and aldosterone were measured in resting, fasting patients, by blood samplings from a peripheral vein immediately before cardiac catheterisation. The results were compared with the severity of the aortic stenosis (aortic valve area greater or less than 0.7 cm2), the ratio of left ventricular work/myocardial mass (greater or less than 0.6) and treatment (with or without ACE inhibitors). Catecholamine levels were much higher in severe aortic stenosis (noradrenaline: 579 +/- 66 pg/ml when valve surface area > 0.7 cm2 versus 900 +/- 92 pg/ml when valve surface area < 0.7 cm2; p < 0.01). Endothelin -1 and AVP concentrations were normal. Whereas PRA was normal, aldosterone levels were increased in patients without treatment by ACE inhibitors. This treatment did not, however, normalise the noradrenaline levels. The increase in ANF concentration was large when left ventricular work decreased with respect to myocardial mass (190.8 +/- 42.3 pg/ml if W/M was decreased versus 82.7 +/- 15.4 pg/ml when W/M was normal): this could be related to the degree of left ventricular hypertrophy.