ABSTRACT
Background: The population of Adults with Congenital Heart Disease (ACHD) is expanding. A significant number will require Cardiac Rhythm Management (CRM) devices. In current UK practice, these patients are routinely seen in non-specialist CRM clinics and little is published regarding best-practice CRM programming and management in the ACHD population. Objective(s): Our objective was to establish a new model of patient-centred/-specific care delivered by specialist CRM physiologists, supported by an EP consultant (with a special interest in ACHD) in a dedicated clinic. We hoped to set new standards of care and patient experience, and improve efficiency and outcomes. Method(s): Data was collected from the electronic record system and CRM device database. A control group of non-ACHD patients was selected at random at our institution over the same period (2018-2022). Result(s): The clinic population n = 468 had a sex ratio of 0.92 (M:F) and mean age of 44 years (range 16 - 86). Mean time since primary implant was 9 years. All device types were represented: loop recorder (52), pacemaker (262), cardioverter defibrillator (116) and cardiac resynchronisation therapy devices (38). The underlying ACHD condition was: simple 46%, moderate 28% and complex 26%. Outcomes of appointments (n = 1,234) are shown vs controls (n = 126) (figure 1). Appointment and patient numbers rose year-on-year (100 to 226 patients, 281 to 367 appointments). There was a lower incidence of 'no review / reprogramming ' in ACHD CRM clinic appointments compared to the non-ACHD population, as well as a higher incidence of programming changes, however the trend over time within the ACHD group showed an increase in 'no review / reprogramming' and a decrease in reviews / reprogramming events. In contrast, non-ACHD patients had an increase in medical reviews and reprogramming required between 2018/19 and 2021/22. This is likely due to the COVID pandemic and deferred time to appointments and review. Conclusion(s): Our data demonstrate that the ACHD CRM population require additional input from the medical and scientist teams when compared to non-ACHD patients, however over time there has been a reduction in major programming/review and a commensurate increase in minor programming/discussion and no review. A reverse trend was observed in the non-ACHD patients pre- and post- COVID. These data support the proposal that specialised clinics provide the optimal management ACHD CRM clinics and should be delivered by dedicated practitioners. [Formula presented]Copyright © 2023
ABSTRACT
Objective: The objective of present study was to assess the treatment pattern in the COVID-19 patients. Methods: The present study was a hospital-based prospective observational conducted in Government Medical College Kathua (UT Jammu and Kashmir) on COVID-19 positive confirmed cases from December 2020 to January 2021. Consent was taken from patients who were willing to participate in the study. The details of presenting complaints and treatment received by them and outcome of management was recorded and evaluated from their treatment files. Results: A total 56 patients of COVID-19 were enrolled for the study. Majority of them were males (60.71%) and maximum of the patients between 18 and 60 years constituted 69.6%. COPD (28.5%), severe anemia (21.42%), and diabetes mellitus and hypertension (19.64% each) were common comorbidities. Sore throat, dry cough, and breathlessness were common presenting symptoms. Pattern of antibiotics and antivirals revealed that azithromycin was frequently prescribed (87.5%) followed by hydroxychloroquine (44.64%), linzolid (21.42%), ceftriaxone (19.64%), and remdesivir (14.28%). Majority of patients (>50%) were treated with steroids, while all patients received multivitamins and Vitamin C (100%) and nearly 40% were administered zinc therapy. Conclusions: Azithromycin, hydroxyquinine, remdesivir, and steroids were frequently prescribed in patients of COVID-19. Steroids were administered in oral, inhaler or in injection forms. Multivitamins including Vitamin C were given to all patients. Most of patients had comorbidities including COPD, diabetes mellitus type 2 and severe anemia.