News in brief: TMVR outcomes for high risk MR patients; Anaemia underdiagnosed in heart failure patients; One in four patients wait too long for essential procedures

TMVR outcomes for high risk MR patients

An Australian-led study has found good long term outcomes for transcatheter mitral valve replacement (TMVR) in patients with severe mitral regurgitation (MR).

A two year follow-up of 100 high-surgical-risk patients with severe MR who underwent transapical TMVR found that all-cause mortality was 39.0%, and 44% of deaths occurred during the first three months. Valve thrombosis was diagnosed in six patients, all of them during the first 6 months following the procedure, when oral anticoagulation was not yet mandatory.

Heart failure hospitalisation fell from 1.30 to 0.51 events per year in the two years post-TMVR, and 93.2% of surviving patients had no MR, according to results reported by Dr David Muller from the Cardiology Department, St Vincent’s Hospital, Sydney.

The findings published in the Journal of the American College of Cardiology confirmed that the improvement in symptoms seen at one year (88.5% NYHA functional class I or II) was sustained to two years (81.6% NYHA functional class I or II).

Among survivors, the left ventricular ejection fraction was 45.6 ± 9.4% at baseline and 39.8 ± 9.5% at two years. Estimated right ventricular systolic pressure decreased from 47.6 ± 8.6 mm Hg to 32.5 ± 10.4 mm Hg.

An accompanying editorial said the findings were reassuring,  but highlighted the importance of both improving  patient  selection  and  follow-up,  and determining the best antithrombotic strategy in high risk patients.

Anaemia under diagnosed and under treated in heart failure patients

Anaemia and iron deficiency are common in heart failure, though often underdiagnosed and undertreated, an Australian study has shown.

The study of 245 heart failure patients found 137 had anaemia by WHO standards (Hb < 130 in males or < 120 in females), and 70% of those had clinically significant anaemia ( Hb < 110 g/L).

Of the 84 patients who had iron studies, 70% had iron deficiency (absolute iron deficiency in 42 patients and functional deficiency in 17), yet only 18 patients received an iron infusion and gastrointestinal investigations were considered in seven.

Patients with clinically significant anaemia had higher all-cause mortality and readmission rates during the 12 months from diagnosis than those with anaemia by WHO criteria (70.5% vs 51.2%, P = 0.03), the authors noted in the Internal Medicine Journal.

Though not statistically significant, adverse events also occurred more frequently in patients with iron deficiency versus those without (77% vs 60%, P = 0.08).

Anaemia and iron deficiency, both absolute and functional, are common in patients with heart failure, but are often under diagnosed and under treated, the authors wrote.

Readmission and/or all cause morality during 12 months post-discharge appear high among these patients.

One in four patients wait too long for essential procedures: AMA Report Card

The AMA’s latest hospital report card shows that nationally only 75% of patients classified as Category 2 for elective surgery received treatment within the recommended timeframe.

Federal AMA President, Dr Omar Khorshid said the hospital system was already overwhelmed before the COVID-19 pandemic hit in 2020, due to an relentless decline in the number of beds available per head of population.

“While called ‘elective’ surgery, this really is essential surgery that includes serious conditions like heart valve replacements and cancer investigations,” he said.

“In reality, what this means is that 25% of people will wait longer than 90 days for surgeries, which in this category can include treatment for an unruptured brain aneurism, decompression of a spinal cord and treatment for ovarian cysts or unhealed fractures.

Dr Khorshid said the problem was particularly bad for patients in states such as Tasmania where more than a 63% are waiting longer than the recommended period for essential surgery.

The report card showed that the ratio of beds available for people over the age of 65 (the most intensive users of public hospital beds) has been on a downward trend for 27 years, halving from 33 to just over 15 per 1000 people.

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