&34 48th Annual Scientific Meeting of CSANZ Heart, Lung and Circulation 2000; 9 INTRA-OBSERVER VARIABILITY OF QUANTITATIVE CORONARY ANGIOGRAPHY MEASUREMENTS USING THE CARDIOVASCULAR MEASUREMENT SYSTEM AT GREEN LANE HOSPITAL ANGIOGRAPHIC CORE LABORATORY 8. Webbet.‘T. West, J. Ormiston Cardiac Investigation Rooms, Green Lane Hospital, Auckland, NZ. Quantitative coronary angiography (QCA) has become an important tool in angiographic trials. Because of its objectivity, accuracy and reproducibility in assessing coronary anatomy, QCA results are freqrentty used as primary or secondary end points. QCA has a degree of variability both inherent and operator introduced which impacts upon the axuracy of the results and ability to detect change. Core angiographic laboratories need to assess their own contribution to this variability. Forty randomly selected projections fmm 27 Green Lane Hospital patients who were entered into a randomised trial had CCA analysis of the same lesion on three occasions; baseline, at one week and four weeks from baseline. Projections were not preselected for suitability for factors that may influence variability. Each film had a “zero” frame identified and each projection had the calibration frame and the frame selected for QCA identtfed and recorded. Identical frames per lesion ware then used for calibration and measurement over three periods. Strict QCA rules were adhered to, including defining the beginning and end points for analysis as at major branch points and within the centre of the coronary lumen. For each of the three analysis periods the forty projections ware randomised into a different order to eliminate prior knowledge affecting the measurements. Results: Baseline 1.036 One week 1.011 Four weeks 0.979 P value 0.161 Ref. Diam Diam % Obs Length 3.261 3.213 3.269 0.165 68.05 68.01 69.73 0.096 12.41 12.02 12.27 0.409 Accuracy and precision One week One week Four weeks Four weeks Accuracy -0.cO5 Precision 0.145 Accuracy -0.034 Precision 0.158 Ref. Diam -0.048 0.227 0.008 0.181 Diam % -0.640 4.235 -1.023 4.905 Obs. Length -0.390 1.969 -0.141 1.870 MLD = Minimum luminal diameter, Obs. = Obstruction, Ref. = Reference, Diam = Diameter, In conclusion, no significant difference was found between baseline, one week and four week measurements of the same frame. The range of accuracy and precision values compares favourably with other published data. OUT-PATIENT EDUCATION FOLLOWING CORONARY INTERVENTIONAL PROCEDURES: THE PATIENTS’ PERSPECTfVE. S Sinclair*. M Cole and CCU nuraina staff, St George Prtvate Hospttal, Kogarah, NSW. Cardiac services at St George Private Hospital have concentrated on the provision of in-patient care that is the primary focus of reimbursement by private health funds. Patients following coronary interventional procedures (CIP) have received in-patient education, whereas comprehensive cardiac rehabilitation has been pmvided post discharge by established programs within the local community. Patients referred to attend these programs in 1998 were reviewed in Jan 1999. of the 119 patients referred, only 30% actually attended the program and 10% completed the B-week program. This patient group perceived their needs to be diierent to the “typical’ cardiac rehab patient as they were younger, returning to work earlier, at a different stage of their disease, and oflen have not experienced a major cardiac event. Consequently, the concerns are that the majority of these patients were not receiving lifestyle modification and rehabilitation education. Research within Australia has shown similar attendance rates of this patient gmup at other cardiac rahab programs. These findings in conjunction with our local experience. became the basis for a needs analysis of this patient group. Needs analysis was implemented via a questionnaire between Dee ‘98 - June ‘99. The results were collated, the patient support pmgram was developed over a 2 month period and implemented in November 1999 by the CCU co-ordinator. Thirty-six (44%) questionnaires were returned. Of these, 60% of respondents preferred attending 1 session for 2 hours within the week following discharge. The topics of most interest were what is comnary artery disease (CAD), living with CAD, medications and exercise. Thirty patients have attended the program since November 1999, improving attendance rates from 30% previously, to 60%. Results of the evaluation questionnaire indicate positive responses following the education session, All in-patients are now pmspectively invited to attend the program and referred to cardiac rehabilitation whilst in hosoital. Desptte small numbers, these preliminary findings support the need for specific interventional cardiology education programs for this patient gmup. Further research is required to evaluate patient outcomes when attending this type of program. IMPROVED OUTCOMES FROM A COMPREHENSIVE MANAGEMENT SYSTEM FOR HEART FAILURE Izflplstr, D. Kave. M. Richardson. eari Failure Centre (HFC), The Alfred Hospital. Melbourne, Victoria Baekgrouod: Congestive heart failure (CHF) is associated with a high readmission rate after diagnosis. Poor patient (pt) compliance and lack of awareness of warning signs are common causes of readmission. We assessed the ability of a comprehensive management programme (CMP) for CHF to reduce admissions with secondary endpoints of improving quality of life (QOL) and exercise capacity. Eligible patients were NYHA Class 3 or 4 CHF, LVEF <40 % and stable outpatient therapy. Ch4P comprised cardiology assessment and follow up, intensive education and referral to a tailored exercise programme. A dedicated practice nurse coordinated CMP. Hospitalisations were compared in the 6 months pre and post enrollment. Other data were analysed at baseline and 6 month follow up 42 pts (35M, 7F, mean age 54yrs) were enrolled. Two pts were transplanted, 2 died during follow up and 2 pts failed to r&m for follow up. 36 pts completed the study. Hospital admissions were dramatically reduced by 87.2% and bed days by 92%. Exercise capacity, QOL and targeted drug dosing improved significantly. 1 Baseline 1 6 mths follow-up 1 P I Total bed da& (d)* NYHA Class 1 7.68i 1.4, , I 1.1+0.05 I I ~~~ I 142% I 0.0008 1 / I I Peta Blocker Dose increase 161% 1 0.00001 * 6 months pre-enrobnent vs. 6 months post emolment # Minnesota Living with Heart Failure Questionnaire Conclusion: A comprehensive heart failure management programme improves QOL and exercise capacity as well as substantially reducing hospital admissions. This study validates the need for intensive outpatient care of CHF and should translate into significantly reduced health care costs. HAND FUNCTION FOLLOWING RADIAL ARTERY HARVESTING A.C.Thomuson*. P.Snratt. D.&miner. Departments of Cardio-Thoracic & Plastic Surgery St. Vincent’s Hospital, Sydney. Due to the presence of deep and superficial palmar arches, blood supply to the hand can occur via the ulnar artery alone. It has been assumed that haemodynamic compensation would be adequate and removal of the radial artery would not reduce hand function. However anatomical variation and atherosclerotic lesions in the brachial and ulnar arteries together with trauma at the harvest site may affect hand function A three-month pilot study was carried out from September 1997. The hand function of 32 patients who had one or both radial arteries harvested was assessed, just prior to discharge from hospital. 31% of these patients demonstrated weakness and hyposensitivity in the harvested arm when compared with the unaffected arm and normative tables, A clinical trial commenced in October 1998, to establish whether removal of the radial artery affected hand function. Forty patients undergoing coronary artery bypass surgery using a radial zutery conduit @ were compared with 40 matched controls 0. Patients were assessed twice, once prior to surgery and again six to eight weeks post surgery. Measurement included, strength using the Jaymar Dynomometer and the B&L Pinch gauge, sensation using the Weinstein Enhanced Sensory Test, perfusion using a timed Allen’s Test and the performance of tine hand function activities. Results of the study to date (6 patients are yet to be reassessed) were analysed using a Chi-square and Fishers Exact Test. Preliminary results show a decline in strength (C=14%, R=25%, p=n.s.) and sensation (C=19%, R=43%, p=O.O3). 25% of the Radial group showed a longer perfusion time with blood flow unchanged in the control group (p=O.O009). Few patients recorded problems with fine hand function (C=2%, R =9%, p=n.s.). In conclusion preliminary results indicate that while perfusion and sensation are affected, function is not.