ANZACS-QI Heart Failure Registry: a new approach using age-stratified sampling of hospital discharges to guide quality improvement (ANZACS-QI 79).

Heart failure is a major healthcare problem in New Zealand. The Acute Decompensated Heart Failure (ADHF) Registry was introduced in 2015, and has identified the need for quality improvement strategies to improve care of patients hospitalised with heart failure. In this paper, we describe the implementation of the revised ANZACS-QI Heart Failure Registry, which has a primary aim to support evidence-based management of and quality improvement measures for patients who are hospitalised with heart failure in New Zealand. Taking the learnings from the initial experience with the ADHF Registry, the revised ANZACS-QI Heart Failure Registry i) utilises age-stratified sampling of hospital discharge coding to identify a representative heart failure cohort, ii) utilises existing ANZACS-QI infrastructure for data-linkage to reduce the burden of manual data entry, iii) receives governance from the Heart Failure Working Group, and iv) focusses on established quality improvement indicators for heart failure management.

Recurrent Takotsubo Syndrome: How Frequent, and How Does It Present?

BACKGROUND: Recurrent Takotsubo syndrome (TS) is not uncommon but experience with TS recurrence is inherently limited by the infrequency of the condition itself and incomplete long-term follow-up. There is limited published data on the clinical features and outcomes of patients with recurrent TS. We aimed to describe the clinical characteristics and outcomes of patients with recurrent TS in a large Auckland cohort. METHOD: The clinical profile, in-hospital, and long-term outcomes were prospectively assessed in consecutive patients with recurrent TS presenting to Auckland's three major hospitals between January 2006 and January 2023. RESULTS: During the study period, 472 TS patients were identified. Of the 467 patients discharged alive after the index event, 45 (9.6%) patients (mean age 62.3±11.0 years), all women, experienced recurrent TS. Median time interval from index event to the first recurrence was 3.14 years (range 27 days to 13.8 years). In 27 (60%) of the 45 patients, the subsequent events involved a stressor (physical triggers, n=8; emotional triggers, n=19). The stressor type differed between the index and recurrent event in 18 (40%) of the 45 patients. Thirteen (28.9%) had a different echocardiographic variant of TS at first recurrence. All patients with recurrent TS were discharged alive. Four patients died late after discharge from the first recurrence, all but one from a non-cardiac cause. CONCLUSIONS: One in 10 patients with TS experience recurrent events. These may occur many years later, and both the stressor type and the echocardiographic variant may be different at the recurrent event.

Pericardial effusion and tamponade in the context of herpes zoster: a novel occurrence.

Background: Pericarditis and pericardial effusion are relatively common hospital presentations, which rarely result in cardiac tamponade. The aetiology is often undetermined and presumed idiopathic or viral. This article reviews varicella zoster virus (VZV)-associated pericardial effusion and peri/myopericarditis and constitutes the first report of VZV-associated cardiac tamponade in the adult population. Case summary: We report the case of a 59-year-old woman who presented to hospital with pleuritic chest pain, haemodynamic instability, and a recent herpes zoster rash in the left T1 distribution. Computed tomography revealed a large pericardial effusion, and echocardiography showed features of cardiac tamponade. The patient was treated with pericardial drainage. Aspirate analysis revealed abundant polynuclear cells and histocytes with no organism. Polymerase chain reaction did not determine a cause. Discussion: There are 13 reported cases of VZV-associated peri/myopericarditis in adults in the literature published in the English language. Of these, only three patients had a pericardial effusion. Aetiological diagnosis of an effusion is challenging and rarely made on virological grounds but rather on clinical features. Varicella zoster virus-associated pericardial effusion should be considered in patients presenting with haemodynamic instability and a dermatomal rash affecting the C3-C5 and T1-T4 distributions.