Diuretic Diversion; Intravenous Diuretic Delivery in a Clinic Setting Averts Hospitalizations for...

S408 Canadian Journal of Cardiology

consider mechanisms to incorporate the assessment ofpatients’ likelihood to benefit as integral to the multidisci-plinary THV eligibility assessment and case selection processesof care. We will highlight the pivotal role and contributions ofcardiovascular nurses in the conduct of functional statusassessment. Lastly, we will discuss approaches to includingmeasures of utility and futility in program evaluation,including international consensus recommendations foroutcome measurement, and local, provincial, and nationalmodels to support program evaluation.The rapid pace of innovations in THV techniques offers newtreatment options for patients at excessive risk for conven-tional surgery, and future opportunities for a paradigm shift inthe management of structural heart disease. Ensuring theutility of THV procedures, and promoting the role of nursingin patient assessment and advocacy, are essential to the successof THV program development.

N050DIURETIC DIVERSION; INTRAVENOUS DIURETIC DELIVERY INA CLINIC SETTING AVERTS HOSPITALIZATIONS FOR HEARTFAILURE PATIENTS

J Harrison, C Clark, L Blair, J Allen, D Pahal

Southlake Regional Health Centre, Newmarket, ON

Current health care constraints and the recent focus on the costsassociated with heart failure patient admissions, it is imperativethat heart function clinics develop strategies which avert anadmission for the decompensated heart failure patient.Intravenous access and intravenous diuretic delivery withina clinic setting is an optimal initiative to intervene in patientsshowing signs of fluid volume overload where oral diureticsare failing. The ability to assess and safely and effectivelymanage these heart failure patients who would normallyrequire hospital admission is changing the paradigm of heartfailure management in Canada.Assessment and medical optimization of significant exacer-bated heart failure without a hospital admission minimizes thecost to the health care system and impacts hospital budgetburden, however, it is essential that an infrastructure bedeveloped to support this type of care.This presentation will focus on the successful developmentand implementation of a fully integrated intravenous diureticmanagement program in a regional centre heart functionclinic. Discussed will be the critical elements of the clinicinfrastructure, policy development as well as the health careteam responsibilities and the patient outcomes related toemergency room and hospital diversions.

N051CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARYINTERVENTION: STENTING THE PROVERBIAL MOUNTAIN

D Poettcker1, K Coupland2, L Avery1, M Vo2

1WRHA Cardiac Sciences, Winnipeg, MB, 2St. Boniface Hospital, Winnipeg,MB

A coronary chronic total occlusion (CTO) is defined asa complete blockage of a coronary artery which has beenpresent for greater than 3 months and typically may havecollateralization of the distal vessel.The purpose of this presentation is to describe the experienceand the treatment of coronary chronic total occlusion (CTO)and patient outcomes at a local tertiary cardiac centre.According to the 2012 Canadian Registry the prevalence ofCTO lesions is 18%. Traditionally, the approach to treatmenthas been medical management or coronary bypass surgerywith less than a 10% attempt rate for percutaneous coronaryintervention (PCI). Recently, PCI with hybrid techniques hasbecome an alternative treatment strategy but requires experi-enced operators and specialized equipment.In August, 2012, the CTO PCI program was established atour local centre. During the first six months a total of 38procedures were performed. Preliminary pre and post patientdata revealed that CTO PCI is a viable treatment option witha high procedural success rate of over 90% and a lowcomplication rate (none of which resulted in death). Currentlyclinical outcome data is lacking and our compiled local datawill contribute to a larger repertoire of clinical outcomes forthis patient cohort across Canada.Cardiac nurses play an important role in the entire carecontinuum of the CTO PCI population. This includes theassessment and follow-up of patients and the contribution oftheir clinical knowledge and expertise in the overall planningand evaluation of the CTO PCI program.

N052THE CHALLENGE OF PREVENTING CONTRAST INDUCEDNEPHROPATHY IN THE CARDIAC PATIENT

K Pyne, C MacKenzie

Ottawa Hospital Heart Institute, Ottawa, ON

Recent changes in the care of patients undergoing angiographiesand percutaneous interventions have shown that more inter-ventionalists are prescribing pre and post intravenous hydrationtherapy. Hydration therapy minimizes the effects of contrastinduced nephropathy. [CIN] This proves to be a challenge asCIN is the third leading cause of hospital acquired renal failure.The impact of CIN is continuing to rise in hospitals. Literaturehas shown that CIN is associated with increased hospitaladmissions, longer length of stay and increased costs.Patients requiring angiographies or imaging often have some typeof cardiac disease. They are frequently elderly, with manycomorbidities such as diabetes and chronic kidney disease.Contrast and intravenous volume are important contributors totheir risk factors with those that have Acute Coronary Syndrome.Many treatments have been attempted in preventing contrastinduced acute kidney injury, for example using mucomyst,sodium bicarbonate, diaysis and of course intravenoushydration. Intravenous therapy appears to be less invasive andcost effective, the primary standard in managing contrastbased kidney injury.

Volume 29 2013