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AFRICA
Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S12
Prevalence of confusion in cardiogenic shock
Monia El Mourid, Fatima Ez-zahraa Talhi, Zakaria Qechchar, Salim Arous, Imad Nouamou, Ghali Bennouna and Rachida Habbal
Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco
Introduction:
Cardiogenic shock is defined as a failure of the heart pump to supply the needs of the body. It is an important cause of cardiovascular
mortality, especially when it is of coronary origin. The clinical symptoms are haemodynamic, respiratory but also neurological.
The objective of our study is to study the prevalence of confusion among patients admitted with cardiogenic shock.
Methods:
We carried out a prospective, mono-centric study over a period of 18 months, from 1 January 2017 - 1 June 2018, involving 22 patients admitted
for cardiogenic shock in cardiac intensive care unit in the cardiology department of Ibn Rochd Hospital, Casablanca.
Results:
The average age of our patients was 65.14 years, with a sex ratio of 1.7, the origin of the cardiogenic shock was a coronary syndrome in 72%, mainly
STEMI. The delay compared to the beginning of the pain was between 6 and 12 hours in 11.5% only. At admission, mean PAS was 77mmHg and mean PAD
55mmHg, mean Fc was 102bpm, 59% were in PAO and 9.1% had poorly tolerated arrhythmia. Neurological signs, dominated by confusion, were present in
40.9%. The patients were revascularised in 27% of cases but the prognosis was poor with a death rate of 86.4%.
Conclusion:
Cardiogenic shock remains a major public health problem in Morocco and a major cause of cardiovascular death. It is of the utmost importance
to implement cardiogenic shock prevention and palliation measures and to raise awareness as to an early consultation period.
Emergency-NGO Salam Centre for Cardiac Surgery (SCCS), Sudan: Quality assessment of Warfarin treatment in patients with
mechanical heart valves
Nicoletta Erba*, Giulia Pedroni
#
, Sohayda Hussein Abdallah Abdallah
#
, Lorenzo Valgoi
†
, Alessandro Mocini
†
, Franco Masini
†
,
Martin Langer
†
, Gina Portella
†
, Alessandro Salvati
#
, Giorgio Brogiato
#
and Gino Strada
#
*Salam Centre for Cardiac Surgery, Emergency-NGO, Khartoum, Sudan. Italian Federation of Anticoagulation Clinics (FCSA). #Salam Centre for Cardiac Surgery,
Emergency-NGO, Khartoum Sudan.
Introduction:
The SCCS has been active in Khartoum since 2007 and, up to 31 January 2019, 5 184 patients had been submitted for mechanical valve
replacement (MVR) and started on vitamin K antagonist (VKA) therapy. Our aim is to evaluate the quality of VKA treatment by Time in Therapeutic Range
(TTR),(1) a tool to assess VKA therapy.
Methods:
In a prospective observational study which lasted 6 months (1 August 2018 - 31 January 2019), 45 419 samples from 3 639 patients were analysed.
TTR was calculated through the use of PARMA GTS® (WERFEN), a software for VKA management. In accordance with the different target values of International
Normalised Ratio (INR), patients were divided into 2 groups: Group A = target 2.5 (aortic valve without thrombotic risk); Group B = target 3.0 (mitral, multiple
valves, aortic valve with thrombotic risk). Individual TTR is rated as good if the value is in range >70% of the time.
Results:
TTR was available for 3 111 patients, 444 (14%) belonging to Group A and 2 667 (86%) to Group B. Global median TTR was 53% (IQR:
35 - 70), 67.5% (IQR: 51 - 83) in Group A and 51% (IQR: 34 - 67) in Group B. A good quality (TTR >70%) was achieved in 45.8% and 20.8% of patients in Group A
and B respectively (p≤0.0001).
Conclusion:
The quality of anticoagulation in patients with MVR is not well known in western or developing countries. The Italian PLECTRUM multicentre
study(2) involved 2 357 patients. Median TTR was 60%. A Malaysian study(3) showed a mean TTR of 57.1% in 107 patients. Our global results are slightly worse.
TTR is better in low INR target patient group. This is also true in cited studies. Improved education and organisation efforts are needed to further improve
quality of treatment.
(1) Rosendaal Thromb Haemost 1993;69:236 (2) Poli, et al. Int Jour of Card 2018;267: 68-71. (3) Tan CSY, et al. Glob Hear 2018;13:241
Emergency-NGO Salam Centre for Cardiac Surgery (SCCS), Sudan: Gender and age related adherence to Vitamin K Antagonists
(VKA) treatment after mechanical heart valve replacement
Nicoletta Erba*, Giulia Pedroni
#
, Shadia Mohamed Osman Taha
#
, Lorenzo Valgoi
#
, Alessandro Mocini
#
, Franco Masini
#
, Martin Langer
#
,
Gina Portella
#
, Alessandro Salvati
#
and Gino Strada
#
*Salam Centre for Cardiac Surgery, Emergency-NGO, Khartoum, Sudan. Italian Federation of Anticoagulation Clinics (FCSA).
#
Salam Centre for Cardiac Surgery,
Emergency-NGO, Khartoum Sudan.
Introduction:
Time in Therapeutic Range (TTR) is a tool used to evaluate the quality of VKA treatment. A good TTR depends on the prescriber’s expertise and
the patient’s compliance. In African countries, many cultural and socio-economic reasons can influence the achievement of a good TTR. Weight varies with
gender and age. Our aim is to investigate the role of these factors in regard to TTR.
Methods:
In a prospective observational study, from 1 August 2018 - 31 January 2019, 45 419 samples from 3 639 patients were analysed. TTR was then
calculated(1) through the use of PARMA GTS® (WERFEN) software for VKA management. Patients were grouped according to gender and age (3 groups: A:
≤20 years, B: 21 - 40 years and C: >41 years).
Results:
TTR was calculated for 3 111 patients: 45.2% were female; the median TTR was 50% (IQR 33 - 67) for female patients and 56% (IQR 38 - 73) for males
(NS). The median TTR in the 3 age groups was 44% (IQR 27 - 60), 53% (IQR 35 - 70) and 59% (IQR 42 - 73) (p≤0.0001). A worse TTR in females was seen in every
age group: in Group A: 34% for females, 37% for males; Group B: 40% for females, 46% for males; Group C: 47% for females and 51% for males.
Conclusion:
The worse treatment quality is observed in younger patients, both in Western and low-income countries. Treatment strategies for young
patients with chronic diseases is a subject of debate. Also, teenagers with mechanical valves require specific approaches. Economic factors and education
levels could be part of the reason why the worse quality treatment is found with females. Our data show the importance of a gender and age specific
approach to the management of patients taking oral anticoagulants.
(1) Rosendaal Thromb Haemost 1993;69:236