Irish Cardiac Society 65th Annual General Meeting of the Irish Cardiac Society in association with Cardiac Clinical Physiologists Irish Atherosclerosis Society Irish Nurses Cardiovascular Association

Body: Background: The most recent ESC guidelines on Heart Failure (2012) recommend Ivabradine for patients in sinus rhythm with left ventricular ejection fraction (LVEF) ≤ 35%, suboptimal heart rate (HR ≥70bpm) and persistent symptoms (New York Heart Association functional class II-IV) despite optimal conventional therapy, to reduce the risk of heart failure hospitalisations. The adoption of guideline recommended therapies is typically slow. Our study aimed to ascertain if our nurse-led heart failure clinic was complying with the recent ESC guidelines regarding the utilisation of Ivabradine. Methods: A 12-month retrospective audit of consultations was collected from our nurse-led heart failure service. The data was analysed to ascertain what proportion of patients attending the heart failure clinic would be eligible for Ivabradine and what proportion of these were currently being treated with Ivabradine. Further analysis was carried out to establish if patient characteristics influenced the decision to initiate Ivabradine therapy. Results: 292 patients attended the nurse-led clinic between April 2012 and March 2013. 23 patients (7.8%) were currently prescribed Ivabradine. Of the remaining 269 patients, 165 (61%) were in sinus rhythm (SR) while the remaining 104 (39%) were in persistent atrial fibrillation. Of the cohort of patients in SR 60 (36%) had a LVEF ≤ 35%, of whom 16 (10%) had a heart rate ≥70bpm despite optimal (or maximally tolerated) beta-blocker dose, or a contraindication to betablockade. Therefore of the 39 patients eligible for treatment with Ivabradine, 23 (59%) were currently prescribed Ivabradine with the remaining 16 (41%) suitable but not yet receiving the drug. There were no significant differences in age, gender, NYHA status, renal function or aetiology (ischaemic vs. non-ischaemic) between patients prescribed Ivabradine compared to those eligible but not prescribed the drug. However patients eligible for Ivabradine but not prescribed it had significantly higher serum NT-proBNP levels (6757 ± 4764 vs. 2209 ± 1368 pg/mL, p=0.048). Conclusions: Despite the inclusion of Ivabradine in the latest ESC guidelines for heart failure management there remains a delay in its initiation in real world practice. This highlights the need for on-going education to improve guideline adherence and prescription rates. 72. Applying the ideal cardiovascular health metrics to couples: a crosssectional study in primary care O’ Flynn AM, McHugh S, Madden J, Harrington J, Perry I, Kearney P University College Cork Background: The American Heart Association (AHA) devised definitions for poor, intermediate and ideal cardiovascular (CV) health based on 7 health metrics; smoking, BMI, physical activity, diet, blood pressure, cholesterol and glucose. There is little research on overall CV health among couples. Our aim was to examine concordance levels for CV health among couples using the AHA health metrics, and to investigate if the CV health of an individual is associated with that of their partner. Methods: The Mitchelstown Study is a population based cohort study of middle-aged Irish adults. Potential couples were identified as 2 study participants living at the same address. This list was cross-referenced with self-reported marital status and telephone number in the electronic patient record. Information on the CV health metrics was collected using standardised methods. Participants were categorised as ideal, intermediate and poor for each of the metrics and for overall CV health. The 0-14 point CV health metrics score was compared within couples using linear regression. Results: Of 2047 participants, 191 potential couples were identified. We excluded 6 sibling pairs, 1 divorced couple and 3 couples who self-reported being single. The analysis includes 181 couples. There were significant associations between partners for smoking, diet, blood pressure, cholesterol and glucose (p<0.05). No couple had ideal CV health (i.e. both partners with 7 ideal metrics). Most couples (n=127, 69%) were concordant for poor CV health. There was a significant relationship between partners for the CV health metrics score (p<0.05). Conclusion: The majority of couples had poor CV health. Our results suggest that an individuals overall CV health status is associated with that of their partner. Therefore interventions targeting couples and families may offer an opportunity to optimise the effect of preventative strategies. 73. The relationship between thyroid dysfunction and advanced lipoprotein cholesterol subfractions: The very large database of lipidsthyroid substudy McEvoy J John Hopkins University Context:The association between thyroid dysfunction and novel advanced lipoprotein cholesterol sub-fractions is poorly defined. Objective: To determine whether thyroid-stimulating hormone (TSH) is associated with changes in cholesterol sub-fractions by interrogating a large clinical database, the Very Large Database of Lipids (VLDL). Design: Cross-sectional convenience sample derived from VLDL.