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Ferreira D, Hardy J, Meere W, Butel-Simoes L, McGee M, Whitehead N, Healey P, Ford T, Oldmeadow C, Attia J, Wilsmore B, Collins N, Boyle A. Safety and care of no fasting prior to catheterization laboratory procedures: a non-inferiority randomized control trial protocol (SCOFF trial). Eur Heart J Open 2023; 3:oead111. [PMID: 38025651 PMCID: PMC10653665 DOI: 10.1093/ehjopen/oead111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023]
Abstract
Aims Cardiac catheterization procedures are typically performed with local anaesthetic and proceduralist guided sedation. Various fasting regimens are routinely implemented prior to these procedures, noting the absence of prospective evidence, aiming to reduce aspiration risk. However, there are additional risks from fasting including patient discomfort, intravascular volume depletion, stimulus for neuro-cardiogenic syncope, glycaemic outcomes, and unnecessary fasting for delayed/cancelled procedures. Methods and results This is an investigator-initiated, multicentre, randomized trial with a prospective, open-label, blinded endpoint (PROBE) assessment based in New South Wales, Australia. Patients will be randomized 1:1 to fasting (6 h solid food and 2 h clear liquids) or to no fasting requirements. The primary outcome will be a composite of hypotension, hyperglycaemia, hypoglycaemia, and aspiration pneumonia. Secondary outcomes will include patient satisfaction, contrast-induced nephropathy, new intensive care admission, new non-invasive or invasive ventilation requirement post procedure, and 30-day mortality and readmission. Conclusions This is a pragmatic and clinically relevant randomised trial designed to compare fasting verse no fasting prior to cardiac catheterisation procedures. Routine fasting may not reduce peri-procedural adverse events in this setting.
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Affiliation(s)
- David Ferreira
- Department of Cardiovascular Medicine, John Hunter Hospital, Lookout Road, Newcastle 2305, Australia
- School of Medicine and Public Health, University of Newcastle, University Drive, Newcastle 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, Newcastle 2305, Australia
| | - Jack Hardy
- Department of Cardiovascular Medicine, John Hunter Hospital, Lookout Road, Newcastle 2305, Australia
| | - Will Meere
- Department of Cardiology, Gosford Hospital, 75 Holden Street, Gosford 2250, Australia
| | - Lloyd Butel-Simoes
- Department of Cardiovascular Medicine, John Hunter Hospital, Lookout Road, Newcastle 2305, Australia
| | - Michael McGee
- Department of Medicine, Tamworth Rural Referral Hospital, Dean Street, Tamworth 2340, Australia
| | - Nicholas Whitehead
- Department of Cardiology, Calvary Mater Hospital, 20 Edith Street, Newcastle 2298, Australia
| | - Paul Healey
- Department of Anaesthesia, John Hunter Hospital, Lookout Road, Newcastle 2305, Australia
| | - Tom Ford
- Department of Medicine, Tamworth Rural Referral Hospital, Dean Street, Tamworth 2340, Australia
| | | | - John Attia
- School of Medicine and Public Health, University of Newcastle, University Drive, Newcastle 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, Newcastle 2305, Australia
| | - Bradley Wilsmore
- Department of Cardiovascular Medicine, John Hunter Hospital, Lookout Road, Newcastle 2305, Australia
- School of Medicine and Public Health, University of Newcastle, University Drive, Newcastle 2308, Australia
| | - Nicholas Collins
- Department of Cardiovascular Medicine, John Hunter Hospital, Lookout Road, Newcastle 2305, Australia
- School of Medicine and Public Health, University of Newcastle, University Drive, Newcastle 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, Newcastle 2305, Australia
| | - Andrew Boyle
- Department of Cardiovascular Medicine, John Hunter Hospital, Lookout Road, Newcastle 2305, Australia
- School of Medicine and Public Health, University of Newcastle, University Drive, Newcastle 2308, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, Newcastle 2305, Australia
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2
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Wilsmore B, Haqqani H. Aligning Guidelines and Practice: The Monitoring of Cardiovascular Implantable Electronic Devices in Australia and New Zealand. Heart Lung Circ 2023; 32:1029-1031. [PMID: 37541815 DOI: 10.1016/j.hlc.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Affiliation(s)
- Bradley Wilsmore
- John Hunter Hospital, Newcastle, NSW, Australia; University of Newcastle, Newcastle, NSW, Australia.
| | - Haris Haqqani
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia; Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
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3
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Garcia-Esperon C, Chew BLA, Minett F, Cheah J, Rutherford J, Wilsmore B, Parsons MW, Levi CR, Spratt NJ. Impact of an outpatient telestroke clinic on management of rural stroke patients. Aust J Rural Health 2022; 30:337-342. [PMID: 35412702 DOI: 10.1111/ajr.12849] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Report on feasibility, use and effects on investigations and treatment of a neurologist-supported stroke clinic in rural Australia. DESIGN Data were collected prospectively for consecutive patients referred to atelehealth stroke clinic from November 2018 to August 2021. SETTINGS, PARTICIPANTS AND INTERVENTIONS Patients attended the local hospital, with a rural stroke care coordinator, and were assessed by stroke neurologist over videoconference. MAIN OUTCOME MEASURES The following feasibility outcomes on the first appointments were analysed: (1) utility (a) change in medication, (b) request of additional investigations, (c) enrolment/offering clinical trials or d) other; (2) acceptability (attendance rate); and (3) process of care (waiting time to first appointment, distance travelled). RESULTS During the study period, 173 appointments were made; 125 (73.5%) were first appointments. The median age was 70 [63-79] years, and 69 patients were male. A diagnosis of stroke or transient ischemic attack was made by the neurologist in 106 patients. A change in diagnosis was made in 23 (18.4%) patients. Of the first appointments, 102 (81.6%) resulted in at least one intervention: medication was changed in 67 (53.6%) patients, additional investigations requested in 72 (57.6%), 15 patients (12%) were referred to a clinical trial, and other interventions were made in 23 patients. The overall attendance rate of booked appointments was high. The median waiting time and distance travelled (round-trip) for a first appointment were 38 [24-53] days and 60.8 [25.6-76.6] km respectively. CONCLUSION The telestroke clinic was very well attended, and it led to high volume of interventions in rural stroke patients.
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Affiliation(s)
- Carlos Garcia-Esperon
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia.,College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Beng Lim Alvin Chew
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Fiona Minett
- Department of Nursing Administration, Manning Base Hospital, Taree, New South Wales, Australia
| | - Joseph Cheah
- Department of Nursing Administration, Manning Base Hospital, Taree, New South Wales, Australia
| | - Jennifer Rutherford
- Hunter New England Information and Communications Technology, Telehealth, Newcastle, New South Wales, Australia
| | - Bradley Wilsmore
- Department of Cardiology, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| | - Mark W Parsons
- College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Department of Neurology, Ingham Institute for Applied Medical Research, Liverpool Hospital, University of New South Wales South Western Sydney Clinical School, Sydney, New South Wales, Australia
| | - Christopher R Levi
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia.,College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Neil J Spratt
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia.,College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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4
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White M, Wilsmore B, Shewa M, Warner T, Walker R, Williams T. Outcomes Following Atrial Fibrillation Hospitalisation in a Regional Australian Setting Between 2011 and 2019. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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5
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Wilsmore B, Lim C, Jell C, Sandgren C. Early Experience With New Digital Platform for Cardiac Device Alert Management and Follow-Up. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Verma A, Boersma L, Haines DE, Natale A, Marchlinski FE, Sanders P, Calkins H, Packer DL, Hummel J, Onal B, Rosen S, Kuck KH, Hindricks G, Wilsmore B. First-in-Human Experience and Acute Procedural Outcomes Using a Novel Pulsed Field Ablation System: The PULSED AF Pilot Trial. Circ Arrhythm Electrophysiol 2021; 15:e010168. [PMID: 34964367 PMCID: PMC8772438 DOI: 10.1161/circep.121.010168] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Pulsed field ablation (PFA) is a novel form of ablation using electrical fields to ablate cardiac tissue. There are only limited data assessing the feasibility and safety of this type of ablation in humans. Methods: PULSED AF (Pulsed Field Ablation to Irreversibly Electroporate Tissue and Treat AF; https://www.clinicaltrials.gov; unique identifier: NCT04198701) is a nonrandomized, prospective, multicenter, global, premarket clinical study. The first-in-human pilot phase evaluated the feasibility and efficacy of pulmonary vein isolation using a novel PFA system delivering bipolar, biphasic electrical fields through a circular multielectrode array catheter (PulseSelect; Medtronic, Inc). Thirty-eight patients with paroxysmal or persistent atrial fibrillation were treated in 6 centers in Australia, Canada, the United States, and the Netherlands. The primary outcomes were ability to achieve acute pulmonary vein isolation intraprocedurally and safety at 30 days. Results: Acute electrical isolation was achieved in 100% of pulmonary veins (n=152) in the 38 patients. Skin-to-skin procedure time was 160±91 minutes, left atrial dwell time was 82±35 minutes, and fluoroscopy time was 28±9 minutes. No serious adverse events related to the PFA system occurred in the 30-day follow-up including phrenic nerve injury, esophageal injury, stroke, or death. Conclusions: In this first-in-human clinical study, 100% pulmonary vein isolation was achieved using only PFA with no PFA system–related serious adverse events. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
- Atul Verma
- Southlake Regional Health Centre, Newmarket, Canada (A.V.)
| | - Lucas Boersma
- St. Antonius Hospital, Amsterdam, the Netherlands (L.B.)
| | | | | | | | | | | | | | - John Hummel
- OSU Wexner Medical Center, Columbus, OH (J.H.)
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7
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Ferreira D, Mikhail P, McGee M, Boyle A, Sverdlov A, William M, Jackson N, Barlow M, Leitch J, Collins N, Ford T, Wilsmore B. Investigating the efficacy of chest pressure for direct current cardioversion in atrial fibrillation: a randomised control trial protocol (Pressure-AF). Open Heart 2021; 8:openhrt-2021-001739. [PMID: 34556559 PMCID: PMC8461712 DOI: 10.1136/openhrt-2021-001739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/27/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide. Direct current cardioversion is commonly used to restore sinus rhythm in patients with AF. Chest pressure may improve cardioversion success through decreasing transthoracic impedance and increasing cardiac energy delivery. We aim to assess the efficacy and safety of routine chest pressure with direct current cardioversion for AF. METHODS AND ANALYSIS Multicentre, double blind (patient and outcome assessment), randomised clinical trial based in New South Wales, Australia. Patients will be randomised 1:1 to control and interventional arms. The control group will receive four sequential biphasic shocks of 150 J, 200 J, 360 J and 360 J with chest pressure on the last shock, until cardioversion success. The intervention group will receive the same shocks with chest pressure from the first defibrillation. Pads will be placed in an anteroposterior position. Success of cardioversion will be defined as sinus rhythm at 1 min after shock. The primary outcome will be total energy provided. Secondary outcomes will be success of first shock to achieve cardioversion, transthoracic impedance and sinus rhythm at post cardioversion ECG. ETHICS AND DISSEMINATION Ethics approval has been confirmed at all participating sites via the Research Ethics Governance Information System. The trial has been registered on the Australia New Zealand Clinical Trials Registry (ACTRN12620001028998). De-identified patient level data will be available to reputable researchers who provide sound analysis proposals.
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Affiliation(s)
- David Ferreira
- Department of Cardiology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia .,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Philo Mikhail
- Department of Cardiology, Gosford Hospital, Gosford, New South Wales, Australia
| | - Michael McGee
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Department of Cardiology, Tamworth Rural Referral Hospital, Tamworth, New South Wales, Australia
| | - Andrew Boyle
- Department of Cardiology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Aaron Sverdlov
- Department of Cardiology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Maged William
- Department of Cardiology, Gosford Hospital, Gosford, New South Wales, Australia
| | - Nicholas Jackson
- Department of Cardiology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Malcolm Barlow
- Department of Cardiology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - James Leitch
- Department of Cardiology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Nicholas Collins
- Department of Cardiology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Thomas Ford
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Department of Cardiology, Gosford Hospital, Gosford, New South Wales, Australia
| | - Bradley Wilsmore
- Department of Cardiology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
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8
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Brienesse SC, Sugito S, Mejia R, Leitch J, Wilsmore B. An electrophysiological and anatomical space-occupying lesion: Lipomatous hypertrophy of the interatrial septum in a patient presenting with atrial tachycardia. HeartRhythm Case Rep 2021; 7:542-545. [PMID: 34434704 PMCID: PMC8377266 DOI: 10.1016/j.hrcr.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Stephen C Brienesse
- Cardiovascular Department, John Hunter Hospital, Newcastle, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Stuart Sugito
- Cardiovascular Department, John Hunter Hospital, Newcastle, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Rosauro Mejia
- Cardiothoracic Surgical Department, John Hunter Hospital, Newcastle, Australia
| | - James Leitch
- Cardiovascular Department, John Hunter Hospital, Newcastle, Australia
| | - Bradley Wilsmore
- Cardiovascular Department, John Hunter Hospital, Newcastle, Australia
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9
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Barlow M, Jackson N, Wilsmore B, Leitch J. Who Has the Most to Gain From Atrial Fibrillation (AF) Ablation? Heart Lung Circ 2020; 29:957-959. [PMID: 32773097 DOI: 10.1016/j.hlc.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Malcolm Barlow
- Department of Cardiology, John Hunter Hospital, Newcastle, NSW, Australia.
| | - Nicholas Jackson
- Department of Cardiology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Bradley Wilsmore
- Department of Cardiology, John Hunter Hospital, Newcastle, NSW, Australia
| | - James Leitch
- Department of Cardiology, John Hunter Hospital, Newcastle, NSW, Australia
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10
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Davies A, Mahmoodi E, Emami M, Leitch J, Wilsmore B, Jackson N, Barlow M. Comparison of Outcomes Using the First and Second Generation Cryoballoon to Treat Atrial Fibrillation. Heart Lung Circ 2019; 29:452-459. [PMID: 31005408 DOI: 10.1016/j.hlc.2019.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/25/2019] [Accepted: 03/18/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary vein isolation using cryoballoon ablation is an effective treatment for patients with atrial fibrillation. We sought to compare outcomes with the first and second generation cryoballoon, with the second generation balloon incorporating the Achieve Lasso catheter, in terms of freedom from symptomatic recurrence and major complications. METHODS The first 200 patients who underwent cryoballoon ablation with the first generation balloon were compared with the first 200 patients using the second-generation balloon. All patients had symptomatic atrial fibrillation and had failed at least one antiarrhythmic drug. The primary efficacy endpoint was freedom from symptomatic recurrence of atrial fibrillation (AF) after a single pulmonary vein isolation (PVI) procedure using the cryoballoon. The primary safety endpoint was major procedural complications. RESULTS At 12 months, freedom from symptomatic AF after a single procedure in the first generation cohort was 64.3% compared with 78.6% in the second-generation cohort (p = 0.002). At 24 months, freedom from symptomatic AF in the first generation cohort was 51.3% compared with 72.6% in the second-generation cohort (p < 0.001). Procedural time (150 min vs 101 min; p < 0.001) and fluoroscopy time (32.5 min vs 21.4 min; p < 0.001) was lower in the second-generation group. The rate of major complications was comparably low in both groups. CONCLUSIONS The second-generation cryoballoon was associated with improved freedom from symptomatic AF with reduction in procedure and fluoroscopy time, with a similar low rate of major complications.
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Affiliation(s)
- Allan Davies
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Lake Macquarie Private Hospital, Gateshead, NSW, Australia.
| | - Ehsan Mahmoodi
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Mehrdad Emami
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - James Leitch
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Lake Macquarie Private Hospital, Gateshead, NSW, Australia
| | - Bradley Wilsmore
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Lake Macquarie Private Hospital, Gateshead, NSW, Australia
| | - Nick Jackson
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Lake Macquarie Private Hospital, Gateshead, NSW, Australia
| | - Malcolm Barlow
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Lake Macquarie Private Hospital, Gateshead, NSW, Australia
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11
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Mahmoodi E, Davis A, Leitch J, Jackson N, Wilsmore B, Barlow M. Treating Atrial Fibrillation with the Second Generation Cryoballoon: Outcomes and Complications. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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12
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Fitzgerald JL, May AN, Wilsmore B, Barlow M, Leitch J, Jackson N. An alternative to QRS alternans. J Cardiovasc Electrophysiol 2018; 30:138-140. [PMID: 30346072 DOI: 10.1111/jce.13773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- John L Fitzgerald
- Department of Cardiology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Austin N May
- Department of Cardiology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Bradley Wilsmore
- Department of Cardiology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Malcolm Barlow
- Department of Cardiology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - James Leitch
- Department of Cardiology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Nicholas Jackson
- Department of Cardiology, John Hunter Hospital, Newcastle, New South Wales, Australia
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13
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Affiliation(s)
| | - Austin May
- John Hunter Hospital, Newcastle, Australia
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14
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Baker D, Wilsmore B, Narasimhan S. Adoption of direct oral anticoagulants for stroke prevention in atrial fibrillation. Intern Med J 2017; 46:792-7. [PMID: 27040617 DOI: 10.1111/imj.13088] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Direct oral anticoagulants (DOAC) are being increasingly utilised for stroke prevention in atrial fibrillation (AF) and atrial flutter. AIMS To analyse the adoption and application of these drugs in a regional hospital inpatient cohort and compare with national prescribing data. METHODS Digital medical records identified prescribed anticoagulants for patients admitted with AF and atrial flutter during 2013-2014. Analysis of patient demographics and stroke risk identified trends in prescribing DOAC versus warfarin. For broader comparison, data from the Pharmaceuticals Benefits Scheme were sourced to determine the nation-wide adoption of DOAC. RESULT Of the 615 patients identified, 505 (255 in 2013, 250 in 2014) had sufficient records to include in the study. From 2013 to 2014, DOAC prescriptions increased from 9 to 28% (P < 0.001), warfarin and aspirin remained comparatively stable (38-34%, 22-20%), and those prescribed no medication declined (17-8%, P < 0.001). DOAC were prescribed to patients with lower CHA2 DS2 VASc scores than warfarin (3.6 vs 4.4; P = 0.005), lower HAS-BLED scores (1.7 vs 2.3; P < 0.01), higher glomerular filtration rates; 70 vs 63 ml/min; P = 0.002) and younger age (74 vs 77 years; P = 0.006). Nationally, warfarin prescriptions are higher in total numbers but increasing at a slower rate than DOAC, which increased 10-fold (101 158 in 2013, 1 095 985 in 2014). CONCLUSION DOAC prescribing grew rapidly from 2013 to 2014, regionally and nationally. Warfarin prescriptions have remained stable, indicating that more patients are being appropriately anticoagulated for AF who previously were not. DOAC were found to be prescribed to patients with lower CHA2 DS2 VASc and HAS-BLED scores, younger age and higher glomerular filtration rates. Aspirin therapy remains over utilised in AF.
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Affiliation(s)
- D Baker
- Cardiology, Manning Base Hospital, Taree, New South Wales, Australia
| | - B Wilsmore
- Cardiology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - S Narasimhan
- Cardiology, Manning Base Hospital, Taree, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia.,University of New England, Armidale, New South Wales, Australia
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15
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16
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Bailey A, McGee M, Wilsmore B. A Case Report of Myopericarditis Associated with Campylobacter Jejuni. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Emami M, Barlow M, Leitch J, Wilsmore B, Mills M, Cambourn M, Meakes S, Davies A, Attia J, Boyle A, Jackson N. Body Mass Index and Ablation for Atrial Fibrillation Predicts Vascular Access Complications in Electrophysiology Procedures. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Ahmad W, Wilsmore B. Epidemiology of cardiac electrophysiology in Australia (1994–2013). Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Baker D, Wilsmore B, Narasimhan S. The adoption of direct oral anticoagulants for stroke prevention in atrial fibrillation. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Wilsmore B, Ahmad W, Sky M, Barlow M, Leitch J. Phased radiofrequency ablation (PVAC), for atrial fibrillation – Acute procedural results. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Collins N, Wilsmore B, Bastian B. Percutaneous retrieval of an embolised vascular stent. Heart Lung Circ 2014; 23:e154-5. [PMID: 24801446 DOI: 10.1016/j.hlc.2014.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/16/2014] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
Affiliation(s)
- N Collins
- Cardiovascular Unit, John Hunter Hospital.
| | - B Wilsmore
- Cardiovascular Unit, John Hunter Hospital
| | - B Bastian
- Cardiovascular Unit, John Hunter Hospital
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Jackson N, Leitch J, Wilsmore B, Barlow M. The Agilis Sheath in Typical Atrial Flutter Ablation Trial. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sengupta J, Kendig AC, Goormastic M, Hwang ES, Ching EA, Chung R, Lindsay BD, Tchou PJ, Wilkoff BL, Niebauer MJ, Martin DO, Varma N, Wazni O, Saliba W, Kanj M, Bhargava M, Dresing T, Taigen T, Ingelmo C, Bassiouny M, Cronin EM, Wilsmore B, Rickard J, Chung MK. Implantable cardioverter-defibrillator FDA safety advisories: Impact on patient mortality and morbidity. Heart Rhythm 2012; 9:1619-26. [PMID: 22772136 DOI: 10.1016/j.hrthm.2012.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND A significant proportion of implantable cardioverter-defibrillators (ICDs) have been subject to Food and Drug Administration (FDA) advisories. The impact of device advisories on mortality or patient care is poorly understood. Although estimated risks of ICD generators under advisory are low, dependency on ICD therapies to prevent sudden death justifies the assessment of long-term mortality. OBJECTIVE To test the association of FDA advisory status with long-term mortality. METHODS The study was a retrospective, single-center review of clinical outcomes, including device malfunctions, in patients from implantation to either explant or death. Patients with ICDs first implanted at Cleveland Clinic between August 1996 and May 2004 who became subject to FDA advisories on ICD generators were identified. Mortality was determined by using the Social Security Death Index. RESULTS In 1644 consecutive patients receiving first ICD implants, 704 (43%) became subject to an FDA advisory, of which 172 (10.5%) were class I and 532 (32.3%) were class II. ICDs were explanted before advisory notifications in 14.0% of class I and 10.1% of class II advisories. Among ICDs under advisory, 28 (4.0%) advisory-related and 15 non-advisory- related malfunctions were documented. Over a median follow-up of 70 months, 814 patients died. Kaplan-Meier 5-year survival rate was 65.6% overall, and 64.2, 61.1, and 69.3% in patients with no, class I, and class II advisories, respectively (P = .17). CONCLUSIONS ICD advisories impacted 43% of the patients. Advisory-related malfunctions affected 4% within the combined advisory group. Based on a conservative management strategy, ICDs under advisory were not associated with increased mortality over a background of significant disease-related mortality.
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Affiliation(s)
- Jay Sengupta
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue J2-2, Cleveland,OH 44195, USA
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Wilsmore B, William M. Epidemiology of Cardiac Electrophysiology in Australia. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wilsmore B, Gunalingam B. Iatrogenic coronary arteriovenous fistula during percutaneous coronary intervention: unique insight into intra-procedural management. J Interv Cardiol 2009; 22:460-5. [PMID: 19732283 DOI: 10.1111/j.1540-8183.2009.00496.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We report the case of a 69-year-old man who presented with worsening exertional angina where subsequent percutaneous coronary intervention resulted in a coronary arteriovenous fistula. Attempts to occlude the fistula using a relatively conservative management approach with acute reversal of intraprocedural heparin and prolonged balloon inflation unfortunately resulted in extensive coronary artery thrombosis without immediate resolution of the arteriovenous fistula. However, follow-up at 6 months revealed resolution of the fistula. This case study emphasizes the uncommon but potentially life-threatening complications of percutaneous coronary interventions with implications not only relating to the hazards of managing iatrogenic arteriovenous fistula, but reversing intraprocedural heparin using protamine, during any coronary angiogram.
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Affiliation(s)
- Bradley Wilsmore
- Department of Cardiology, Gosford Hospital, Gosford, New South Wales, Australia
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Fransen M, Wilsmore B, Winstanley J, Woodward M, Grunstein R, Ameratunga S, Norton R. Shift work and work injury in the New Zealand Blood Donors' Health Study. Occup Environ Med 2006; 63:352-8. [PMID: 16621855 PMCID: PMC2092485 DOI: 10.1136/oem.2005.024398] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate associations between work patterns and the occurrence of work injury. METHODS A cross sectional analysis of the New Zealand Blood Donors Health Study conducted among the 15 687 (70%) participants who reported being in paid employment. After measurement of height and weight, a self-administered questionnaire collected information concerning occupation and work pattern, lifestyle behaviour, sleep, and the occurrence of an injury at work requiring treatment from a doctor during the past 12 months. RESULTS Among paid employees providing information on work pattern, 3119 (21.2%) reported doing shift work (rotating with nights, rotating without nights, or permanent nights) and 1282 (8.7%) sustained a work injury. In unadjusted analysis, work injury was most strongly associated with employment in heavy manual occupations (3.6, 2.8 to 4.6) (relative risk, 95% CI), being male (1.9, 1.7 to 2.2), being obese (1.7, 1.5 to 2.0), working rotating shifts with nights (2.1, 1.7 to 2.5), and working more than three nights a week (1.9, 1.6 to 2.3). Snoring, apnoea or choking during sleep, sleep complaints, and excessive daytime sleepiness were also significantly associated with work injury. When mutually adjusting for all significant risk factors, rotating shift work, with or without nights, remained significantly associated with work injury (1.9, 1.5 to 2.4) and (1.8, 1.2 to 2.6), respectively. Working permanent night shifts was no longer significantly associated with work injury in the adjusted model. CONCLUSION Work injury is highly associated with rotating shift work, even when accounting for increased exposure to high risk occupations, lifestyle factors, and excessive daytime sleepiness.
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Affiliation(s)
- M Fransen
- The George Institute for International Health, University of Sydney, Sydney, Australia.
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