28^th International Conference on Cardiology and Healthcare August 09-11, 2018 Abu Dhabi, UAE

Nandkishore Kapadia has completed his MBBS and MS from Indore University, MCh from Madras University, PhD from VGU British-I land, Post-doctoral studies from Allegheny University School of Medicine, Philadelphia, USA. He has published more than 20 papers in reputed journals. He is the Head of the Department of Adult Cardiac Surgery and Director of Heart and Lung Transplant Program at Prestigious Kokilaben Dhirubhai Ambani Hospital, Mumbai India.

Introduction: Surveillance for Acute Rejection (AR) and Cardiac Allograft Vasculopathy (CAV) is essential for graft and patient survival. CAV can arise and progress without symptoms and subclinical ARs can facilitate. Standard surveillance of AR and CAV is based on routine Endomyocardial Biopsies (EMBs) and Coronary Angiographies (CA) at predefined intervals, 9 to 13 times during first post-transplant year, there after 3-4 biopsy annually. These invasive screening tests are distressing, costly and not without complications, yet they cannot identify all sub-clinical ARs. We adopted biopsy free echocardiography surveillance for detection and treatment of rejection.

 

Method: 16 transplants were followed from 2013 November till June 2018. Besides complete blood count, renal function test, liver function test, cyclosporine, tacrolimus level, electrocardiogram and three-monthly echocardiography with color Doppler. 13 patients are long term survivors; only one patient out of these was diagnosed to have acute rejection treated with immune-suppression included methyl prednisolone, anti-thymic antibody after endomyocardial biopsy confirmed Grade- III rejection. Patient fully recovered.

 

Result: Doppler Tissue-Imaging (DTI) and strain-imaging for myocardial wall motion and deformation analysis, allowed quantification of minor myocardial dysfunction for early detection of subclinical AR and CAV. Two patients had mild rejection Grade-IIB were treated by increasing dose of steroid and raising level of calcineurin inhibitor.

 

Conclusion: DTI and strain-imaging are important tools enabling more efficient AR monitoring with fewer EMBs instead of unnecessary and distressing routine EMB-screenings. Myocardial velocity and deformation imaging is also suited for early detection of myocardial dysfunction induced by CAV, prognostic evaluation of CAV and timing of CAs aimed to reduce the number of routine CA-screenings.

Dr Syed Raza graduated from Aligarh University in India in 1993. After completing his postgraduate degree in Medicine from the same university, he moved to the UK for higher specialist studies. He successfully completed MRCP and CCT and later also awarded Fellow of the Royal College of Physicians of Edinburgh. He was awarded Professor John Goodwin prize for outstanding performance in Diploma Cardiology exam at Hammersmith Hospital, University of London in 2001. Dr Raza is Fellow of American College of Cardiology, American College of Chest Physicians as well as Fellow of European Society of Cardiology. He is also on the committee of Acute Cardiovascular Care. Heart Failure and Cardiovascular Imaging (European Society of Cardiology). He is currently serving as consultant in Cardiology and Head of the department of Medicine at Awali Hospital, Bahrain. He is the educational coordinator and chairman of resuscitation committee of the hospital. He is the regional coordinator and examiner for MRCP exam for the Royal College of Physicians of Edinburgh. He is external examiner for Arabian Gulf Medical University.. He has to his credit numerous publications and he has presented his work in different parts of the world. He is peer review author for some well-respected International journals. He is Review author for abstracts for European Society of Cardiology Annual Congress 2018.

Background & Aim: Poor adherence to medications is a common problem among Heart Failure (HF) patients. Inadequate adherence leads to increased HF exacerbations, reduced physical function and higher risk for hospital admission and death. Many interventions have been tested to improve adherence to HF medications, but the overall impact of such interventions on readmissions and mortality is unknown. We conducted a study to explore patients’ understanding and adherence to Heart Failure (HF) medications at a general hospital setting.

 

Method: We prospectively studied 196 patients (outpatients plus inpatients) of HF at our hospital. The information was gathered by oral interview as well as using questionnaire. There is currently no Heart Failure nurse working in our hospital.

 

Result: There were 110 male and 86 female patients with average age of 54 years. Most patients (78%) in NYHA class II and III. 15% of patients stopped or reduced the dose of diuretics on their own as they thought they didn’t need them anymore or they were thought to interfere in their life style. 36% patients believed that ACE inhibitors or ARBs were for blood pressure and therefore they had either stopped or were intending to stop. 43% patients were not keen on taking beta-blocker because of fear of various side effects and 12% of them already stopped the beta-blocker on their own. 56% of patients did not like the idea of increasing the dose of ACE Inhibitor, ARBs or beta-blocker to the maximum. Patients were ignorant of the role of different HF medications Aldosterone antagonists (86%), ACE Inhibitor or ARBs (76%), Beta blocker (70%). None of the patients who were on Ivabradine knew the role of the drug in HF but at the same time were not informed of any known side effects.

 

Conclusion: Heart Failure (HF) medications are evidence based with stringent research and scientific back up. They have proven benefit in terms of reducing morbidity and mortality significantly. However, compliance amongst patients to adhere to prescribed medications is poor. This is largely because of their lack of knowledge and poor understanding about themedications. It is therefore worth spending time and resources in educating patients with the help of multi-disciplinary heart failure team to achieve better outcome.