Page 485

Karger_ESC London_2013

London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 485 376 Management and economics Hospital resource utilisation for the management of acute stroke patients in a French stroke unit F. Rouanet1, C. Guilhaume-Goulant2, O. Cristeau3, S. Aballea4, C. Droz-Perroteau5, C. Dureau6, S. Lignot7, E. Guiard8, C. Bairras9, S. Ledure10, P. Blin11, N. Moore12 Centre Hospitalier et Universitaire de Bordeaux, Bordeaux, FRANCE1, University of Lyon 1, Lyon, FRANCE2, Creativ-Ceutical, Paris, FRANCE3, Creativ-Ceutical, Paris, FRANCE4, Univer-sity of Bordeaux, Bordeaux, FRANCE5, University of Bordeaux, Bordeaux, FRANCE6, Universi-ty of Bordeaux, Bordeaux, FRANCE7, University of Bordeaux, Bordeaux, FRANCE8, University of Bordeaux, Bordeaux, FRANCE9,Centre Hospitalier et Universitaire de Bordeaux, Bordeaux, FRANCE10, University of Bordeaux, Bordeaux, FRANCE11, University of bordeaux, Bordeaux, FRANCE12 Background: As relatively few stroke patients receive thrombolytic treatment, data on the manage-ment of acute stroke are needed to improve treatment pathways. The analysis compared the manage-ment of stroke during acute phase between patients with and without thrombolysis. Methods: This study was conducted at a stroke unit in Bordeaux (France). Suspected cases of stroke were included at presentation to the emergency department and followed prospectively up to treat-ment administration. A software application was developed and installed on a tablet PC to collect data. Times from admission to different tests, procedures and treatment administration were record-ed, as well as times spent by physicians and nurses on different activities. Results are reported for the subset of patients with confirmed ischemic stroke. Results: 84 patients were included, of whom 48 (57.1%) had a confirmed ischemic stroke. 19 (39.6%) received thrombolysis (T). The time from symptom onset to treatment was <4.5 hours for 79.2% of patients (thrombolysed-T: 84.2%; non-thrombolysed-NT: 75.9%). The time from arrival to imaging was 65’ (T: 20’; NT: 102’). The mean door-to-needle time was 109’ (T: 57’; NT: 155’).. The mean cumulative time spent by physicians was significantly higher for thrombolysed patients (T: 114’; NT: 49’; p<0.0001); a similar trend was observed for nurse time (T: 62’; NT: 36’, p=0.11). Conclusions: This stroke unit achieves a proportion of thrombolysed patients above average. The use of thrombolysis is associated with greater patient management costs in acute phase, due to staff implication and duration of each activity. However, the literature and clinical consensus is that this is cost-effective use of resources as it reduces long-term costs and clinical burden. Heart and Brain (PO 377 - 401) 377 Heart and brain The association of asymptomatic atherosclerosis and incident atrial fibrillation K. Willeit1, G. Egger2, M. Oberhollenzer3, J. Willeit4, S. Kiechl5 Department of Neurology, Medical University Innsbruck, Innsbruck, AUSTRIA1, Depart-ment of Internal Medicine,, Bruneck Hospital, Bruneck, ITALY2, Department of Internal Medicine, Bruneck Hospital, Bruneck, ITALY3, Department of Neurology, Medical University Innsbruck, Inns-bruck, AUSTRIA4, Department of Neurology, Medical University Innsbruck, Innsbruck, AUSTRIA5 Background: Atrial fibrillation and vascular disease are closely related disorders and often coexist. Whether preclinical atherosclerosis predisposes to the development of atrial fibrillation has not yet been fully determined. The aim of this study was to assess the risk of new-onset atrial fibrillation in individuals with and without asymptomatic atherosclerotic disease. Methods: We studied 900 men and women of the Bruneck population cohort, between the ages of 40-79 years and free of atrial fibrillation at baseline (1990). Follow-up examinations were performed at 5-year intervals over a period of 20 years. Incident atrial fibrillation was assessed with repeat-ed standard 12-lead ECGs. Carotid atherosclerosis, a surrogate marker of systemic atherosclerotic disease, was determined using high resolution ultrasound imaging. Multivariable pooled logistic regression analysis with a continuous update of covariates levels was performed to identify indepen-dent risk predictors of new-onset atrial fibrillation between 1990 and 2010. Models were adjusted for age, sex, period of follow-up, soluble VCAM-1, maximum body weight, heart failure and hyper-tension. Results: During 20 years of follow-up, 118 new cases of atrial fibrillation were detected. Individu-als with carotid atherosclerosis at baseline were more likely to develop atrial fibrillation than indi-viduals without. In multivariable models, presence of carotid atherosclerosis was associated with new-onset atrial fibrillation (OR of 1.80, 95%CI: 1.07-3.02, P=0.027). Conclusion: Our study suggests that preclinical atherosclerosis predisposes to the manifestation of atrial fibrillation. Screening for atherosclerosis may enhance the assessment of clinical risk for inci-dent atrial fibrillation and facilitate the potential application of preventive strategies.


Karger_ESC London_2013
To see the actual publication please follow the link above