ABSTRACT
Introduction: Atrial fibrillation (AF) causes about one-fifth of ischaemic strokes, with a high risk of early recurrence. Oral anticoagulation is highly effective for reducing the long-term risk of recurrent ischaemic stroke in patients with AF. However, its benefit in the acute phase is unclear. OPTIMAS is an RCT aiming to establish the safety and efficacy of early anticoagulation with a direct oral anticoagulant (DOAC). Available evidence and guidelines emphasise the lack of evidence to guide clinicians and support continued randomisation into trials including OPTIMAS. Method(s): OPTIMAS will enrol 3,478 participants with ischaemic stroke and AF from 100+ stroke services in the UK. Participants are randomised 1:1 to early (within 4 days) or standard (day 7 to 14 after stroke) initiation of anticoagulation. Follow-up is at 90 days, blinded to treatment allocation. The primary outcome is the incidence of stroke of any cause, and systemic arterial embolism. Result(s): OPTIMAS opened in June 2019 and is recruiting from 95 sites. 2,053 participants have been randomised as of 29th June 2022. Recruitment and site-set up were reduced during the COVID-19 pandemic, due to national lockdowns and hospital staff being reallocated to COVID-related trials. This did temporarily slow recruitment, but we rapidly developed a successful contingency plan to face these challenges, implementing strategies including: collecting the 90-day follow-ups centrally;obtaining consents by phone;and encouraging sites to sign up to the NIHR Associate PI Scheme to help with trial-related activities. For the last 10 months the trial has consistently been recruiting at least 80 participants per month. Conclusion(s): OPTIMAS will determine the efficacy and safety of early anticoagulation in patients with ischaemic strokes and AF. The trial recruited successfully during the most challenging period of the COVID- 19 pandemic and continues to do so.
ABSTRACT
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.
ABSTRACT
INTRODUCTION: Ear, nose and throat (ENT) specialists are a high-risk group for COVID-19. Although the implications of SARS-CoV-2 infection on physical health are well-documented, the psychological impact is frequently overlooked. AIMS: The aim of this study was to gauge the psychological impact of COVID-19 on ENT specialists in Ireland. METHODS: A national, cross-sectional, web-based survey was distributed to ENT specialists during the peak of the COVID-19 pandemic (21st May 2020-21st June 2020). The questionnaire collected sociodemographic and COVID-19 related data. The GAD-7 was utilized to measure symptoms of clinically significant anxiety disorder. RESULTS: Thirty-eight ENT specialists (M/F:24/12, median age, 38.7 years (23-60 years)) completed the survey. About 34% (n = 13) of participants screened positive for an anxiety disorder, of which 2 (5%) had moderate symptoms. The majority of participants (n = 32, 84%) felt ENT specialists had increased exposure to SARS-CoV-2 compared with other medical specialties. Additionally, 32% (n = 12) felt incapable of protecting themselves from infection. An encouraging proportion of ENT specialists (n = 22, 58%) were aware of psychological support available from national and institutional organizations. CONCLUSIONS: The long-term psychological sequelae of COVID-19 will be felt as the physical burden eases. As we adjust to new normalities, ENT surgeons must be conscientious of the mental health issues that arise from the working environment. Sources of anxiety emanated from a lack of control over infection risk, increased vulnerability to COVID-19 relative to other specialties and the implications this has for ENT specialists and their families. Future interventions must focus on increasing awareness of the available psychological support services for our healthcare workers.