Prince Charles Hospital Research Articles

Effectiveness of epoprostenol in the management of pulmonary arterial hypertension: findings of an Australian retrospective chart review.

Pulmonary arterial hypertension (PAH) is a progressively fatal disease. Parenteral prostanoids, including intravenous (IV) epoprostenol, are the most effective therapies for PAH. As epoprostenol requires continuous infusion, therapy is challenging and use is managed by specialist units. To describe the clinical outcomes for the use of IV epoprostenol in an Australian pulmonary vascular disease unit and identify opportunities to improve its use. We conducted a retrospective chart review of all adult patients who received IV epoprostenol for PAH at Prince Charles Hospital. Data were collected at baseline, initiation of epoprostenol and quarterly to the end of the audit period or the discontinuation of epoprostenol. Descriptive statistics were performed and comparisons made to epoprostenol initiation. Kaplan-Meier curves were used to estimate survival outcomes. Thirty-nine patients received epoprostenol therapy. Most (87.2%) were female, had connective tissue disease (46.2%) or idiopathic PAH (35.9%) and had a World Health Organization functional Class of III or IV at initiation. The mean duration of epoprostenol therapy was 2.9 years. Intravenous epoprostenol was associated with favourable outcomes; 1, 3 and 5-year survival rates since initiation of 90.0, 75.8 and 68.2%; robust improvements in functional class; and improvements in 6-min walking distance of 160.4 m at 3 years; 94.9% patients experienced at least one drug-related adverse event and line complications were common. Epoprostenol therapy was associated with impressive survival rates and durable improvements in functional outcomes. Epoprostenol therapy is challenging; however, it is manageable by the majority of patients with most experiencing positive, sustainable outcomes.

Long Term Survival After Surgery for Ischaemic Mitral Regurgitation: A Single Centre Australian Experience

Ischaemic mitral regurgitation (IMR) is associated with an increase in both mortality and congestive heart failure in patients undergoing coronary artery bypass grafting (CABG). Intervention for moderate to severe IMR involves either valve repair or replacement. The ideal option is yet to be fully defined with relatively poor long-term survival being noted in the literature. A retrospective observational study was conducted to review the outcomes of patients undergoing CABG in combination with either mitral valve repair (MVr) or mitral valve replacement (MVR) for concurrent coronary artery disease with moderate to severe IMR at The Prince Charles Hospital in Brisbane between the years 2002 to2015. One hundred and five (105) patients were included, 81 patients (77%) undergoing CABG and MVr and 24 patients (23%) undergoing CABG and MVR. There was no difference in 30-day mortality between the two groups (1% in MVr and 0% in MVR, p=0.589), however patients in the MVr group were significantly more likely, in univariate and multivariate analysis, to develop at least moderate MR (40% v. 8%, p=0.006). The 5-year survival was 87% and 55% at 10 years. In patients undergoing CABG and mitral valve intervention for IMR, long-term mortality remains high. There was no difference in short- or long-term mortality between repair and replacement although recurrence of at least moderate mitral regurgitation was significantly higher with mitral valve repair.

S0276 Can iFOBT (Immunochemical Faecal Occult Blood Test) for Bowel Cancer Screening Be Safely Deferred for Five Years After a Colonoscopy?

INTRODUCTION: Australian and international guidelines suggest that immunochemical faecal occult blood test (iFOBT) for colorectal cancer (CRC) screening may be deferred for 5–10 years after a negative colonoscopy. The aim of this retrospective multicentre observational study was to evaluate the outcomes of patients who had a repeat colonoscopy for iFOBT positivity within five years of a previous colonoscopy showing low risk or normal findings, to assess the risk of interval CRC and advanced colorectal neoplasia (ACRN). We sought to determine if having a prior colonoscopy with normal or low risk findings within the last five years would predict for negative findings on a repeat colonoscopy in asymptomatic patients who were iFOBT positive. METHODS: We retrospectively identified patients who underwent a repeat colonoscopy for iFOBT positivity within five years of a previous colonoscopy showing normal or low risk findings from November 2016 to November 2018. Patients identified from Provation, Auscare and the Viewer databases were included from four sites, including The Prince Charles Hospital in Brisbane, Cairns Base Hospital, Innisfail Hospital and Atherton District Hospital in Northern Queensland. We excluded patients with a past history of CRC, patients with a familial malignancy syndrome, patients with poor bowel preparation and patients who were symptomatic. RESULTS: Among 3,795 patients who underwent colonoscopy for a positive iFOBT in the study period, 239 had a previous colonoscopy in the five-year window that met inclusion criteria. Of these, 4 (1.7%) patients had locally advanced CRC at two regional sites, and 19 (7.9%) patients had ACRN. 42 (17.6%) patients had high risk adenoma, 21 (8.8%) patients had sessile serrated adenoma and 87 (36.4%) patients had adenoma of various sizes. Inadequate bowel preparation in the previous colonoscopy was associated with the findings of subsequent high-risk adenomas and CRC. CONCLUSION: Our study observed that a substantial portion of patients have interval ACRN associated with a positive iFOBT performed outside of guidelines. These finding were not uniform between the study sites and may reflect local differences, highlighting the importance of interpretation of guidelines, the ability of the clinician to override guidelines if clinically indicated, the need for colonoscopy care standards and teamwork that may facilitate excellence in practice.

Use of a limited-channel device for obstructive sleep apnoea diagnosis in a tertiary sleep disorders centre.

A major impediment to the provision of obstructive sleep apnoea (OSA) treatment is reliance on labour-intensive and costly laboratory-based polysomnography (PSG). To investigate if measurement of oximetry and nasal flow through the ApneaLink device (AL) could identify patients with moderate-severe OSA among those referred for PSG to a tertiary sleep service. New referrals to The Prince Charles Hospital Sleep Disorders Centre were assessed for suitability. Demographics, anthropometrics, Epworth Sleepiness and OSA50 scores were collected. Exclusion criteria included age <18 years, pregnancy, significant cognitive impairment, poorly controlled psychiatric disorder, domiciliary oxygen and prior OSA treatment. Participants underwent concurrent type 1 PSG and AL assessments. One hundred participants had a mean age of 55 years (standard deviation 17) and were 49% male. Forty-eight (48%) had moderate-severe OSA on PSG. Composite variable AL 3% oxygen desaturation index ≥16 and AL apnoea-hypopnoea index (AHI) ≥15 had receiver operator characteristic area under the curve of 0.87, sensitivity of 80% and specificity of 94% for PSG AHI ≥15. The three false-positives seen with this composite variable had PSG AHI 11-14 and Epworth Sleepiness Score 6-17. The various composites of AL, anthropometric and questionnaire variables did not improve the AUC or specificity but did improve sensitivity. AL is useful in the diagnosis of moderate-severe OSA in patients referred to a tertiary sleep disorders centre. This could lessen reliance on PSG, expedite OSA care, lead to significant cost savings and make diagnosis of OSA more available in non-urban areas.

Incidence of Infection and Antimicrobial Consumption in Ventricular Assist Device (VAD) Recipients at the Prince Charles Hospital (TPCH): A Retrospective Analysis

Ventricular assist devices (VADs) are frequently used as a bridge to heart transplant; however, infections are a common cause of increased morbidity and mortality. The optimal prophylactic antimicrobial regimen has not been effectively evaluated in literature. Forty-three (43) patients received a VAD over the 5-year study period (2012-2017) at The Prince Charles Hospital (TPCH), Brisbane Australia. Of these, 41 patients were followed from implantation until transplantation or death. Antimicrobial prophylactic regimens and individual episodes of infection were recorded. The infection profiles, including types and incidence were compared to published literature using definitions from the International Society for Heart and Lung Transplantation (ISHLT) guidelines for consistency. Median duration of VAD insertion was 79 days (IQR: 36-167). Patients received aztreonam, fluconazole and vancomycin (median duration 8 days). Twenty-two (22) (53.6%) patients experienced a VAD-specific and/or a VAD-related infective episode. Incidence of infection in the study cohort was 0.60 infections per 100 patient days. Thirteen (13) patients (31.7%) experienced 16 VAD-specific infections which were all driveline infections. Thirteen (13) patients (31.7%) experienced 14 VAD-related infections. The predominant VAD-related infection type was bacteraemia (36%). Predominant bacterial profiles of VAD-specific as well as VAD related infections were gram positive. Only three episodes had a gram negative as a causative pathogen which occurred much later post VAD insertion. Median time till VAD-specific or VAD-related infection was 46 and 15 days respectively. Obesity was significantly associated with increased risk of infection (HR: 3.2; 95% CI: 1.3-7.4). Infection is a common complication of VAD implantation. In our study population gram positive bacteria were the predominant causative pathogen. Based on the micro-organism profile there may be scope for a narrowing of the antibiotic regimen. A larger, multicentre study would be able to accurately guide a change. The information gathered in our study offers a strong foundation for such a multicentre study.

Enablers and barriers for the provision of community-based HCV treatment: A case study of a real-world practice.

Although the availability of fully funded direct-acting antivirals (DAAs) and the eligibility of primary care providers (PCPs) to provide hepatitis C virus (HCV) have removed barriers related to access to hospital-based HCV treatment in Australia, there are still many barriers to the provision of HCV treatment in community settings. There is a lack of knowledge regarding the barriers to, and enablers of HCV treatment in community settings in Australia. This study aimed to identify barriers and enablers for the provision of community-based HCV treatment. This study was a part of a mixed-method case study of the Cure-It programme. The programme was studied to better understand barriers and enablers experienced by stakeholders of such programmes. The programme is delivered through the Prince Charles Hospital in Brisbane, Australia, and aimed to improve access to HCV treatment in community settings. Data were collected using semi-structured interviews with 12 healthcare providers and nine patients between July and December 2018. Purposive sampling was used to ensure diverse views were captured. The interview transcripts were analysed using inductive thematic analysis. Ease of access to specialist support, easy and high value treatment, co-location with or providing other services and motivated patients enabled PCPs to be engaged with the Cure-It programme. Several interconnected factors related to patients' characteristics and health system acted synergistically to enable patients to initiate and complete treatment. These included a desire to remove HCV as a source of shame, having children, awareness of HCV consequences, access to DAAs for free, ease of access to general practices and drug and alcohol services, and access to a safe and enabling environment. The identified barriers were interconnected at the levels of patients, PCPs and primary care systems and acted synergistically to prevent patients and PCPs from becoming engaged with HCV treatment. PCPs' related barriers included a lack of knowledge, their perception of HCV as a specialist area and of patients with HCV as 'hard to manage' patients along with the practice preferences and priorities. Patients' related barriers included their socioeconomic characteristics, internalized stigma, perception of not being sick and lack of knowledge. Additionally, the unavailability of support for patients and existence of stigma in primary health care, along with poor communication between the hospital and primary care system, and the unavailability of FibroScan® in primary care discouraged PCPs and patients engagement specifically with the provision of community-based HCV treatment. Various strategies are needed to improve PCPs and patients' knowledge and awareness of HCV treatment. Training and support for PCPs need to be easy to access and should cover both clinical and social aspect of HCV. Connecting PCPs to other related services may improve PCPs' and patients' engagement with HCV treatment.

908 Trends in Balloon Aortic Valvuloplasty and Transcatheter Aortic Valve Implantation in a Single Centre at The Prince Charles Hospital From 2008 to 2019

908 Trends in Balloon Aortic Valvuloplasty and Transcatheter Aortic Valve Implantation in a Single Centre at The Prince Charles Hospital From 2008 to 2019

503 Implementation of a High Sensitivity Troponin Assay and Overnight Rapid Emergency Department (ED) Discharge of Intermediate Risk Patients: Impact on the ED Length of Stay

Rapid evaluation and discharge of patients presenting with chest pain is a key goal of emergency care. We evaluated the length of stay before and after the implementation of a high-sensitivity troponin assay and a new protocol for overnight rapid ED discharge of intermediate risk patients at The Prince Charles Hospital. Patients aged >18years referred with low and intermediate-risk chest pain between 2018 and 2019 presenting to the Chest Pain Assessment Unit were examined using a before and after study design. Pre-intervention group were assessed using the Beckman-Coulter second generation AccuTnI assay (June-October 2018). Post-intervention (September-November 2019), patients were assessed using the High-Sensitive STAT Troponin-I assay (Abbott Laboratories). Post-intervention, intermediate risk patients presenting to ED overnight were also discharged from ED with outpatient functional testing if they had 2 negative serial troponins (3hours apart) and normal serial ECGs, routine blood tests and a chest x-ray. The primary outcome was the ED length of stay. The study consisted of 634 patients (mean age 59.7y±5.1y, 51% females, 35% low-risk and 65% intermediate-risk chest pain). The pre-intervention group (n=308 patients, mean age 61.3y±13.6, 48% female, 33% low and 67% intermediate risk) were comparable with the post-intervention group (n=326 patients, mean age 58.7y±12, 53% female, 36% low and 64% intermediate risk). The ED length of stay was significantly shorter post-intervention (mean LOS 8.6 v 5.2 hrs, p<0.001). Implementing a high-sensitivity troponin assay and protocol driven discharge of chest pain patients overnight is associated with a significantly lower ED length of stay.

770 MyCarelink Heart Smartphone Application: An Early Single Centre Experience

Remote cardiac device monitoring is known to be beneficial to patients, however, has a significant burden on clinicians due to unscheduled transmissions. We report on our early experience with a smartphone-based application utilising Bluetooth vs a traditional monitor with Bluetooth connectivity. Remotely monitored patients with Medtronic Bluetooth enabled pacemakers were analysed. We examined the transmissions sent between October 2019-March 2020 to The Prince Charles Hospital Pacemaker Clinic. Patients had a traditional home monitor (Medtronic 24952), or a smartphone application (MyCarelink Heart). Patients with a smartphone were offered the application. Those without or those not willing to use their smartphone were given a traditional remote monitor. Scheduled transmissions included initial pairing, scheduled and alerts. 715 Medtronic Bluetooth pacemaker transmissions were analysed in this 6-month period. 10 patients utilised the MyCarelink Heart application, while 243 patients utilised the traditional home monitor, with wireless connectivity to their pacemaker. The average number of unscheduled transmissions per patient using the application was 0.5 (range 0-3), while the average number of unscheduled transmissions per patient using the traditional monitor was 1.75 (range 0-29). The ratio of unscheduled transmissions to scheduled using the application was 0.2:1. The ratio of unscheduled transmissions to scheduled using the traditional monitor was 1.6:1. Our early experience with a small number of patients shows that a smartphone-based application provides the known benefits of remote monitoring and can drastically reduce unscheduled transmissions sent by inadvertent patient interaction with the monitor.

'I'm over the moon!': patient-perceived outcomes of hepatitis C treatment.

Understanding patient-perceived outcomes is crucial for assessing the effectiveness and acceptability of hepatitis C virus (HCV) treatment. This study aimed to explore patient-perceived outcomes of receiving direct-acting antivirals (DAAs). This study was a part of a mixed-methods case study of the Prince Charles Hospital program for improving access to HCV treatment in community settings. Data were collected using semi-structured interviews with nine patients who were in different stages of their treatment for HCV. The participants were recruited using purposive sampling. All interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Patients emphasised 'having more energy' when reporting improvements in their physical health following treatment. They also reported a newly developed sense of freedom and hope. Improved physical and mental health empowered them to start a healthy lifestyle and to practise self-protection from the risk of re-infection. Patients highlighted their desire to help other patients to receive treatment, which was connected to their experience of the services that they received and their perceived health outcomes. Patients expect and experience various outcomes that are related to the physical, psychological and social aspects of living with, and being cured of HCV. Emphasis on the short-term outcomes of receiving HCV treatment may improve HCV treatment uptake and adherence rates.

Multivisceral Transplant, The Prince Charles Hospital Experience

Multi-visceral organ transplant is uncommon. As a result of the rarity of these surgeries, there are limited studies, making it difficult to interpret outcomes and identify specific patient complications. We aim to assess the indications for multi-organ transplant, the time on the wait-list and evaluate outcomes including patient survival, graft survival and postoperative complications in an Australian context. Patients undergoing multi-organ transplant from 1993 to 2018 at The Prince Charles Hospital, Brisbane, Australia were retrospectively reviewed, looking at baseline characteristics and post-transplant morbidity, mortality and graft survival. A total of 37 patients were included in the study, comprising 22 heart-lung transplants, eight heart-kidney transplants and seven heart-lung-liver transplants. There were six domino heart transplants performed, all in the heart-lung-liver transplant group. The mean age at transplant was 37 years and the mean wait-list time was 10 months. One patient, receiving a heart-lung transplant, required re-transplantation (bilateral lung) at 3 years. One-year (1-year) survival was 91% for heart-lung transplants, 86% for heart-lung-liver transplants and 87.5% for heart-kidney transplants. Five- and ten-year (5- and 10-year) survival was 79% for both in heart-lung transplant, 43% and 29% for heart-lung-liver transplant and 87.5% for both in heart-kidney transplant. Patients undergoing multi-organ transplant at our unit had long-term survival and organ function comparable to international data. In addition, waitlist time for multi-organ transplant was not found to be excessive.

Outcomes of a tertiary-based innovative approach to engage primary care providers in provision of hepatitis C treatment in community settings

BackgroundAustralia is committed to eliminating the hepatitis C virus (HCV) by 2030. Despite regulations in Australia that enable the prescription of subsidised direct acting antiviral (DAA) by primary health care providers, the number of providers who treat patients for HCV remains low and this limits the prospect of HCV elimination. The Prince Charles Hospital, Brisbane, Australia, implemented an innovative program called Cure-It aimed at engaging primary care providers in community-based HCV treatment. This paper aims to describe initial experiences and short-term patient outcomes of this program.MethodsA formative evaluation was conducted using program data for the period March 2016 to April 2018. Descriptive statistics were used to report the number of engaged primary care providers, patients’ baseline characteristics, treatment plans, and treatment outcomes.ResultsThirty primary care providers from different settings were engaged in HCV treatment. Among 331 patients eligible for community-based treatment, 315 (95.2%) commenced treatment, the completion rate was 92.4 and 66.5% achieved sustained virological response at 12 weeks (SVR12). The SVR12 had not been documented for 26.8% of patients. Among patients whose SVR12 was documented, 98.2% achieved SVR12. Only 1.3% of patients experienced treatment failure.ConclusionA flexible tertiary-led model can improve primary care providers and patients’ engagement with provision of HCV treatment. Tertiary centres need to play their role to improve the accessibility of HCV treatment through providing training and on-going support for primary care providers while enabling those providers to become more confident in providing treatment independently.

P1.03-11 Molecular Testing of Small Bronchoscopy Specimens Using NanoString Technology

Molecular testing for driver variants in oncogenes is crucial for NSCLC management to predict response to targeted therapy. In the majority of cases, NSCLC is diagnosed by trans-thoracic needle aspiration or more commonly bronchoscopy techniques resulting in small diagnostic tissue biopsies or cytological samples. As such specimens may be inadequate for molecular testing, we tested the accuracy of a novel digital molecular barcoding assay to detect actionable mutations in a single-centre cohort. A consecutive cohort of 46 specimens (19 endobronchial biopsy, EnBx; 18 transbronchial biopsy, TBBx; seven bronchoalveolar lavage, BAL; and two transbronchial needle aspirate, TBNA) were obtained ancillary to primary diagnostic specimens from 36 patients undergoing EBUS-guided bronchoscopy at The Prince Charles Hospital. Specimens containing at least 5ng DNA after standard column-based extraction methods were analysed using the NanoString SNV Solid Tumour Panel for testing of 104 somatic variants across 25 genes of clinical significance. NanoString variants calls were compared with routine clinical testing results from the primary diagnostic sample. Agreement analyses for variants common to both methods revealed the positive, negative and overall percentage agreement (PPA, NPA, OPA). One discordant case was validated using droplet digital PCR. Using NanoString, molecular analysis was feasible for 60.1% (28/46) of specimens. At least one variant was identified in 8/28 (28.6%) cases (Table 1). Two (7.1%) cases harboured dual mutations. KRAS mutations were detected in six (21.4%) cases, and EGFR in two (7.1%). Two patients would be eligible for targeted therapy. Agreement analysis for the two methods revealed PPA, NPA and OPA of 100%, 88.9% and 92.3%. In one discordant case, NanoString identified a KRAS G12C mutation and was confirmed by ddPCR with a mutant allele frequency of 5.5%. The mean time for reporting clinical mutation test results was 19.6 days. Of the 18 excluded cases with insufficient DNA, five had routine testing results for comparison however 3/5 cases cited insufficient DNA for reliable EGFR testing.Table 1Clinical and molecular characteristics of bronchoscopy samples used for molecular testingClinical molecular testingNanoStringConcordanceCase no.Sample typeHistological classificationDNA yield (μg)Mutation testing result (MAF)Mutation testing methodTAT to result (days)SNV panel resultAgreement (Yes/No)1BALNo evidence of malignancy2.81Not performedN/AN/AWTNCA2TBNAAC4.39Not performedN/AN/AWTNCA3TBBxSCC0.39Not performedN/AN/AKRAS G12RNCA4TBBxAC1.82EGFR exon 19 (L747_P753>S) del (24%)NGS TruSight21EGFR exon 19 (L747_P753>S) delYes5TBBxNo evidence of malignancy1.24Not performedN/AN/AWTNCA6TBBxNo evidence of malignancy0.62Not performedN/AN/AWTNCA7EnBxAC1.41WT for EGFR, KRAS, NRAS, BRAFNGS TruSight13WTYes8EnBxSCC0.57Not performedN/AN/AWTNCA9TBBxSCC0.53Not performedN/AN/AWTNCA10TBBxAC0.51WT for EGFR, KRAS, NRAS, BRAFNGS TruSight20KRAS G12CNo*11TBBxAC0.31EGFR L858R (12%), EGFR T790M (6%)NGS TruSight13EGFR L858R, EGFR T790MYes12TBBxNo evidence of malignancy0.69Not performedN/AN/AWTNCA13TBBxNSCLC4.26WT for EGFRcastPCR48WTYes14EnBxAC1.37KRAS G12C (10%)NGS TruSight23KRAS G12CYes15EnBxNSCLC19.6KRAS G12A (25%)NGS TruSight20KRAS G12AYes16EnBxCarcinoid1.16Not performedN/AN/AWTNCA17TBBxSCC5.4Not performedN/AN/AWTNCA18EnBxAC4.03WT for EGFR, KRAS, NRAS, BRAFNGS TruSight19WTYes19EnBxSCC2.12Not performedN/AN/AWTNCA20TBBxAC3.85WT for EGFRcastPCR14KRAS G12C, NRAS Q61KNCA21EnBxSCC6.4Not performedN/AN/AWTNCA22TBBxAC1.63WT for EGFRcastPCR20KRAS G12CNCA23EnBxAC0.234WT for EGFR, KRAS, NRAS, BRAFNGS TruSight16WTYes24BALAC0.871BRAF G466V (12%)NGS TruSight24WTYes25TBBxAC0.0918BRAF G466V (12%)NGS TruSightN/AWTYes26TBBxAC0.893WT for EGFRcastPCR13WTYes27TBBxSCC0.66Not performedN/AN/AWTNCA28EnBxAC4.4WT for EGFRcastPCR10WTYesMean2.5819.6 Open table in a new tab The performance of the NanoString platform for SNV characterisation was highly concordant with alternate clinical testing methods for those with sufficient DNA. Advantages of NanoString include its multiplex capacity, high sensitivity, low nucleic acid input, reduced turn-around time (<24hr) compared to alternate testing methods. The NanoString platform is a robust method for identification of actionable variants in NSCLC where at least 5ng of DNA is available.

P: 17 The Two-year Outcome in Patients With MHE and Sarcopenia on Mortality and the Development of OHE

BACKGROUND: Hepatic encephalopathy is a significant complication of liver cirrhosis that is associated with a worse prognosis but also a poorer quality of life. The combination of sarcopenia and hepatic encephalopathy has a cascading and deleterious effect on both conditions. The aim of this study was to evaluate the long-term outcomes in patients who have minimal hepatic encephalopathy (MHE) and sarcopenia on mortality and the development of overt hepatic encephalopathy (OHE). METHODS: In this prospective trial, patients with liver cirrhosis at The Prince Charles Hospital were enrolled and followed for an average two years. An extensive exclusion criterion was used to reduce confounding factors; this included: active psychiatric condition, IVDU/drug use, neurological conditions, current significant alcohol intake, stroke, dementia, ongoing infection, language barrier, active malignancy, vision impairment, uncontrolled sleep apnoea, electrolyte disturbance and grade 1–4 encephalopathy. The diagnosis of MHE was Encephalapp Stroop test (Stroop) &gt;190, Psychometric hepatic encephalopathy score (PHES) &lt; −4 and Critical Flicker Frequency (CFF) &lt;39. The diagnosis of sarcopenia was completed using hand grip strength comparing to standard deviation data based on sex and age. A subset of participants underwent a DEXA scan to assess for lean body mass. Participant's clinical and electronic notes were assessed to evaluate mortality and the development of OHE. RESULTS: A total of 187 patients with a diagnosis of cirrhosis were approached for recruitment in the trial. 98 patients were excluded, whilst 17 patients declined. A total of 72 participants were enrolled in the trial. 37 participants had MHE whilst 35 participants did not have MHE. 16 participants had sarcopenia and MHE, whilst 14 participants had sarcopenia with no MHE. Over the average two year follow up, participants who did not have MHE and were not sarcopenic did not develop overt hepatic encephalopathy. Whilst participants with MHE and Sarcopenia had a significantly higher risk of developing OHE and mortality as can be seen in Figure 1 P value &lt;0.05. The Stroop test had the highest sensitivity 70% [CI 47%–86%] whilst the CFF had the highest specificity 78 % [CI 66%–87%] P value 0.005. In the subset analysis of patients who underwent a DEXA scan to assess lean body mass, this was not able to predict the risk of developing OHE. CONCLUSIONS: MHE and Sarcopenia assessment can be easily completed as a bedside clinical test to predict the long-term risk of mortality and the development of overt hepatic encephalopathy.

Evaluating the prognostic significance of significant weight loss in patients with stage III non-small cell lung cancer (NSCLC) undergoing definitive chemoradiation (CRT) after FDG-PET staging.

e20045 Background: In the pre-PET era, weight loss is a harbinger of occult metastatic disease in patients with stage III NSCLC. Identifying the relationship between weight loss and pattern of relapse (POR), may enable stratification of patients into prognostic groups associated with increased risk of relapse. We sought to identify if weight loss remains a negative independent prognostic factor after FDG-PET staging. Methods: A retrospective audit (using web-based and electronic databases) was conducted in all patients with stage III NSCLC treated with definitive CRT between 01/07/2013 and 30/06/2018 at the Royal Brisbane and Women’s Hospital and The Prince Charles Hospital, Queensland, Australia. A descriptive analysis was applied to describe the primary end-point of PFS and secondary end-points of OS and POR, in relation to the percentage of pre-treatment weight loss (0-10% vs &gt; 10-20% vs &gt; 20%). A subset analysis looked at other prognostic factors identified in NSCLC to account for potential confounders. Results: Of the 127 patients (mean age 65 years, mean weight 76kg, 57% male, 42% current smokers) who commenced treatment during the study period, 24% lost &gt; 10% and 3% lost &gt; 20% weight. Median TTP for the entire cohort was 9 months. Based on multivariable modelling, risk of PD or death was 45% higher with &gt; 10% loss of body weight (p = 0.004), and risk of death was 36% higher with &gt; 10% of body weight (p = 0.05). Of the 54% that died during follow-up, 31 had distant PD, 18 had locoregional PD, 6 had local PD, and 10 had no PD. Males were at increased risk of PD. Conclusions: A prognostic link continues to be identified between significant (&gt; 10%) weight loss and risk of progressive disease or death in stage III NSCLC treated with definitive CRT despite pre-treatment FDG-PET. These findings identify a sub-group of patients where weight loss could still be a surrogate for micro-metastases not detected on PET, or other adverse prognostic markers. Other treatment strategies or improved diagnostic strategies are warranted.

Evaluation of an innovative mobile health programme for the self-management of chronic obstructive pulmonary disease (MH-COPD): protocol of a randomised controlled trial

IntroductionChronic obstructive pulmonary disease (COPD) is the fourth leading cause of death globally. In outpatient care, the self-management of COPD is essential, but patient adherence to this remains suboptimal. The...

Impact of cardiac magnetic resonance imaging on heart failure patients referred to a tertiary advanced heart failure unit: improvements in diagnosis and management

The clinical use of cardiac magnetic resonance (CMR) in Australian heart failure (HF) patients has limited evidence. To examine how CMR, compared with routine echocardiography, affects the diagnosis and management of patients with HF. Single-centre retrospective study of HF patients newly referred to the Advanced Heart Failure and Transplant unit at The Prince Charles Hospital, Brisbane. Between January 2010 and December 2014, all patients clinically referred for both CMR and echocardiography in the workup of HF were analysed. Imaging results, electronic records and medical charts were reviewed for final diagnosis and changes in clinical management. A total of 114 new HF referrals was included. Evaluation of HF of uncertain aetiology (70%) was the most common indication for CMR. In 20% of cases, CMR led to a completely new diagnosis or diagnostic confirmation of suspicions raised by echocardiography. Clinical decision-making was altered in 48%, with the greatest impact on decisions regarding revascularisation. Overall, CMR had a significant impact on 50% of patients. In a multivariable model, the only independent variable significantly associated with clinical impact was the presence/absence of late gadolinium enhancement (P < 0.001). Importantly, body mass index, echocardiography image quality and the presence of sinus rhythm did not show statistical significance in the multivariate analysis. CMR makes a substantial contribution to both the diagnosis and management of HF patients over and above standard echocardiography. This study provides evidence of its clinical utility in the HF population in Australia and supports the role of CMR in the routine assessment of this cohort.

Utility of the Mitral Valve Doppler Velocity Index in Detecting Significant Mitral Regurgitation Post-Surgical Mitral Valve Repair

Background: The mitral valve (MV) Doppler velocity index (DVI) (velocity time integral ratio of the continuous-wave MV and pulsed-wave left ventricular outflow tract (LVOT) measurements) is useful in the detection of MV prosthesis dysfunction (stenosis or regurgitation). The value of this Doppler velocity index (DVI) in the detection of significant mitral regurgitation (MR) post-surgical MV repair is investigated in this large dataset. Methods: A retrospective database search for surgical MV repair transthoracic echocardiograms performed between 2004 and 2019 at the Prince Charles Hospital was executed. Two groups (Group 1 - moderate or more MR and Group 2 - trace or no MR) were compared. DVI was calculated in studies with no or trace aortic regurgitation and no significant LVOT or MV obstruction. For Group 2, studies with a mean MV pressure gradient >3 mmHg were also excluded. Results: Of 7,739 MV repair studies in the database, 1,303 studies in 728 patients (aged 62 ± 17 years, 67% males) met the study criteria. There were 561 studies in Group 1 and 741 studies in Group 2. There was a significant difference in DVI between Group 1 (2.21 ± 0.68) and Group 2 (1.92 ± 0.48, p < 0.0001). The receiver operator curve (ROC) analysis identified a cut-off of 2.13 for differentiating between Groups 1 and 2 with a sensitivity and specificity of 51.69% and 70.72%, respectively and an area under the curve (AUC) of 0.634. Conclusions: A DVI >2.13 may be useful in detecting significant MR following MV repair, especially when MR severity is difficult to evaluate by traditional methods.

Surgical & Interventional Management of Rheumatic Valvular Heart Disease at The Prince Charles Hospital from January 2005–December 2017

Background: The incidence of rheumatic heart disease (RHD) in the indigenous Australian population is the highest in the world. 240 indigenous patients underwent any valve related surgical and interventional procedures at Metro North HHS from January 2005-December 2017. Of these 75 were performed for rheumatic valves at TPCH. Methods: Chart review and electronic database procedural data was analysed, with clinical follow up records, including echocardiography, being collated to identify survival and cardiac status following these interventions. Results: Rheumatic interventions were required over an age range of 10–72 years dominantly female 82%. Percutaneous mitral balloon valvuloplasty was performed in 15 patients, transcatheter aortic valve implantation in 1 patient. Surgical valve repair of 11 isolated mitral valves was achieved. Single valve replacement was done in 10 with multiple valve repair/replacements required in the remaining 38 patients. Mechanical and tissue valves were used almost equally during replacement. Valve failure due to mitral valve thrombus formation, aortic prosthetic patient mismatch, and endocarditis required 8 reoperations. One reoperation following mitral valve repair has been required to date. Pre and post procedure LVEF mean of 56% (range 33–80%) and 57% (range 28–75%) respectively. 30-days hospital survival was 100%, 5 year was 88% and 12 year was 84%. Valve function on follow up with clinical and echo data remains satisfactory. Conclusions: Mitral valve function is durable following valvuloplasty or surgical repair in RHD. Risk to survival during all forms of intervention is low. The type of systemic heart valve utilised for replacement requires close consideration of patient geography, medical access and patient compliance.

The majority of suspected bile duct stones can be managed at time of laparoscopic cholecystectomy

Introduction: Choledocholithiasis can be cleared by either endoscopic retrograde cholangiopancreatography (ERCP) with cholecystectomy as a two-stage procedure or operative bile duct exploration at time of laparoscopic cholecystectomy. The objective of this study is to evaluate the management of choledocholithiasis at our surgical unit where bile duct stones are managed preferentially at time of laparoscopic cholecystectomy. Method: A retrospective review of all laparoscopic cholecystectomies at the Prince Charles Hospital (Brisbane, Australia) between 1 September 2015 and 30 September 2017 was performed. Patients with suspected choledocholithiasis were identified and their management was described. Result: A total of 690 laparoscopic cholecystectomies were performed during the study period. 674/690 (98%) had a successful cholangiogram performed. Of these patients, 69/674 (10%) had suspected choledocholithiasis on operative cholangiogram. Two patients had biliary stents from prior endoscopic retrograde cholangiopancreatography (ERCP) and had no further attempts at bile duct exploration. Saline flushing of the duct +/- intravenous buscopan or glucagon was successful in attaining a clear operative cholangiogram in 21/69 (30%) of cases. Transcystic catheter passage into the duodenum without the use of a basket was successful in 13/69 (19%) of cases. Transcystic catheter with the use of basket was successful in 18/69 (26%) of cases. The choledochoscope was used with a basket in 3 cases. There was one choledochotomy performed amongst these, and this patient had a transpapillary antegrade biliary stent placed. Sixteen patients had post-operative ERCP referrals made. 12/69 (17%) were due to failure to clear their bile ducts at surgery, two were for removal of pre-existing stents and another two were for removal of antegrade transpapillary stents placed at surgery. Conclusion: The majority of patients had their suspected choledocholithiasis managed at time of laparoscopic cholecystectomy.