• Out-of-hospital cardiac arrest in patients aged 35 years and under: a 4-year study of frequency and survival in London

      Donohoe, Rachael T.; Innes, Jennifer; Gadd, Stephen; Whitbread, Mark; Moore, Fionna (2010-01)
    • Out-of-hours primary percutaneous coronary intervention for ST-elevation myocardial infarction is not associated with excess mortality: a study of 3347 patients treated in an integrated cardiac network

      Rathod, Krishnaraj S.; Jones, Daniel A.; Gallagher, Sean M.; Bromage, Dan; Whitbread, Mark; Archbold, Andrew; Jain, Ajay K.; Mathur, Anthony; Wragg, Andrew; Knight, Charles (2013-06)
      OBJECTIVES: Timely delivery of primary percutaneous coronary intervention (PPCI) is the treatment of choice for ST-segment elevation myocardial infarction (STEMI). Optimum delivery of PPCI requires an integrated network of hospitals, following a multidisciplinary, consultant-led, protocol-driven approach. We investigated whether such a strategy was effective in providing equally effective in-hospital and long-term outcomes for STEMI patients treated by PPCI within normal working hours compared with those treated out-of-hours (OOHs). DESIGN: Observational study. SETTING: Large PPCI centre in London. PARTICIPANTS: 3347 STEMI patients were treated with PPCI between 2004 and 2012. The follow-up median was 3.3 years (IQR: 1.2-4.6 years). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary endpoint was long-term major adverse cardiac events (MACE) with all-cause mortality a secondary endpoint. RESULTS: Of the 3347 STEMI patients, 1299 patients (38.8%) underwent PPCI during a weekday between 08:00 and 18:00 (routine-hours group) and 2048 (61.2%) underwent PPCI on a weekday between 18:00 and 08:00 or a weekend (OOHs group). There were no differences in baseline characteristics between the two groups with comparable door-to-balloon times (in-hours (IHs) 67.8 min vs OOHs 69.6 min, p=0.709), call-to-balloon times (IHs 116.63 vs OOHs 127.15 min, p=0.60) and procedural success. In hospital mortality rates were comparable between the two groups (IHs 3.6% vs OOHs 3.2%) with timing of presentation not predictive of outcome (HR 1.25 (95% CI 0.74 to 2.11). Over the follow-up period there were no significant differences in rates of mortality (IHs 7.4% vs OFHs 7.2%, p=0.442) or MACE (IHs 15.4% vs OFHs 14.1%, p=0.192) between the two groups. After adjustment for confounding variables using multivariate analysis, timing of presentation was not an independent predictor of mortality (HR 1.04 95% CI 0.78 to 1.39). CONCLUSIONS: This large registry study demonstrates that the delivery of PPCI with a multidisciplinary, consultant-led, protocol-driven approach provides safe and effective treatment for patients regardless of the time of presentation. https://bmjopen.bmj.com/content/bmjopen/3/6/e003063.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/bmjopen-2013-003063
    • Outcome of 1051 octogenarians after primary percutaneous coronary intervention for ST elevation myocardial infarction: observational cohort from the London Heart Attack Group

      Bromage, Dan; Jones, Daniel A.; Rathod, Krishnaraj S.; Lim, Pitt; Virdi, Gurkamal K.; Jain, A.J.; Singh Kalra, S.; Crake, Tom; Meier, Pascal; Astroulakis, Zoe; et al. (2013-05)
      Introduction The use of primary percutaneous coronary intervention (PCI) in octogenarians to treat ST elevation myocardial infarction (STEMI) is less than in other age groups. This is due in part to underrepresentation in clinical trials and perceived increased risk. We present long-term survival of a large cohort of elderly patients following primary PCI in London. Methods This was an observational study of 10 249 consecutive patients undergoing primary PCI for STEMI at eight London heart attack centres between January 2005 and November 2011. Patient’s details were recorded at the time of procedure into the British Cardiac Intervention Society (BCIS) database. Outcome was assessed by all-cause mortality. Anonymous datasets from the eight centres were merged for analysis. The primary end-point was all-cause mortality at a median follow-up of 3.0 years (IQR range 1.2–4.6 years). Results A total of 1051 octogenarians (10.3% of the study population) with an average age of 84.2 years (IQR 80–101) were treated with primary PCI during the study period. Over time, the annual proportion of octogenarians gradually increased from 9.1% in 2005 to 10.5% in 2010. Unsurprisingly, when compared to patients under 80, octogenarian STEMI patients included a higher proportion of women, and had a higher prevalence of hypertension, hypercholesterolaemia, multi-vessel disease, previous infarction and previous CABG (table 1). They additionally were less likely to undergo radial access, receive GPIIb/IIIa inhibitors or a drug-eluting stent. When compared with younger patients, primary PCI in octogenarians was less likely to achieve TIMI flow grade 3. However between 2005 and 2011 the rates of post-procedural TIMI flow grade 3 increased significantly from 80.5% in 2005 to 90% in 2011 (p for trend 0.05). The cumulative incidence of all-cause mortality during follow-up was significantly higher in the octogenarian group compared to the younger subgroup (51.6% vs 12.8%, p<0.0001) (figure 1). As expected, the hazard of death during follow-up increased with age (unadjusted HR 1.069 per year increase (95% CI 1.064 to 1.074), p<0.0001), which persisted after adjustment for other predictors of mortality (HR of 1.059 (95% CI 1.048 to 1.071), p<0.0001). Table 1 Under 80 Over 80 p Value Gender (female) 1800 (19.6%) 474 (45.4%) <0.0001 Hypertension 3692 (42.3%) 501 (51.3%) 0.02 Hypercholesterolaemia 3708 (42.5%) 548 (56.1%) <0.0001 Previous MI 1442 (16.9%) 182 (18.7%) 0.150 Previous CABG 264 (3.0%) 46 (4.6%) 0.010 Multi vessel disease 3821 (41.8%) 562 (54.0%) <0.0001 GPIIb/IIIa 6515 (74.4%) 530 (53.8%) <0.0001 DES use 4058 (45.9%) 311 (30.9%) <0.0001 Access (radial) 2115 (23.4%) 194 (18.8%) 0.001 Procedural success 6932 (88.3%) 736 (84.7%) 0.003 Figure 1 Heart May 2013 Vol 99 Suppl S2 A27 BCS Abstracts 2013 (NHS). Protected by copyright. on January 7, 2020 at Manchester University NHS Foundation Trust http://heart.bmj.com/ Heart: first published as 10.1136/heartjnl-2013-304019.37 on 24 May 2013. Downloaded from Conclusions Octogenarians constitute an important subgroup of STEMI patients. Data from London ’s experience would suggest that primary PCI rates are increasing in this group and that despite the high long term mortality, acute/year one rates survival rates are very encouraging. https://heart.bmj.com/content/heartjnl/99/suppl_2/A27.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/heartjnl-2013-304019.37
    • Predictors of survival and favorable functional outcomes after an out-of-hospital cardiac arrest in patients systematically brought to a dedicated heart attack center (from the Harefield Cardiac Arrest Study)

      Iqbal, M. Bilal; Al-Hussaini, Abtehale; Rosser, Gareth; Salehi, Saleem; Phylactou, Maria; Rajakulasingham, Ramyah; Patel, Jayna; Elliott, Katharine; Mohan, Poornima; Green, Rebecca; et al. (2015-03)
    • Radial versus femoral access is associated with reduced complications and mortality in patients with non-ST-segment-elevation myocardial infarction: an observational cohort study of 10,095 patients

      Iqbal, M. Bilal; Arujuna, Aruna; Ilsey, Charles D.; Archbold, Andrew; Crake, Tom; Firoozi, Sam; Kalra, Sundeep S.; Knight, Charles; Lim, Pitt; Malik, Iqbal S.; et al. (2014-08)
    • A randomised tRial of Expedited transfer to a cardiac arrest centre for non-ST elevation ventricular fibrillation out-of-hospital cardiac arrest: The ARREST pilot randomised trial

      Patterson, Tiffany; Perkins, Gavin D.; Joseph, Jubin; Wilson, Karen; Van Dyck, Laura; Robertson, Steven; Nguyen, Hanna; McConkey, Hannah; Whitbread, Mark; Fothergill, Rachael; et al. (2017-06)
    • A randomised trial of expedited transfer to a cardiac arrest centre for non-ste out-of-hospital cardiac arrest: arrest

      Patterson, Tiffany; Perkins, Gavin D.; Joseph, Jubin; Wilson, Karen; Van Dyck, Laura; Robertson, Steven; Nguyen, Hanna; McConkey, Hannah; Whitbread, Mark; Fothergill, Rachael; et al. (2018-01)
      Background Wide variation exists in inter-hospital survival from OHCA. Regionalisation of care into cardiac arrest centres (CAC) may improve this. We report a pilot randomised trial of expedited transfer to a CAC following OHCA without ST-elevation. The objective was to assess the feasibility of performing a large-scale RCT. Methods Adult witnessed VF OHCA of presumed cardiac cause were randomised 1:1 to either: (1) intervention: expedited transfer to a CAC for goal-directed therapy including access to immediate reperfusion, or (2) control: current standard of care involving delivery to the geographically closest hospital. The feasibility of randomisation, protocol adherence and data collection of the primary (30 day all-cause mortality) and secondary (cerebral performance category (CPC)) and in-hospital major cardiovascular and cerebrovascular events (MACCE) clinical outcome measures were assessed. Results Between Nov 2014 and April 2016, 118 cases were screened, of which 63 patients (53%) met eligibility criteria and 40 of the 63 patients (63%) were randomised. There were no protocol deviations in the treatment arm. Data collection of primary and secondary outcomes was achieved in 83%. There was no difference in baseline characteristics between the groups: 30 day mortality (Int 9/18, 50% vs Control 6/15, 40%; p=0.73), CPC 1/2 (Int: 9/18, 50% vs Control 7/14, 50%; p>0.99) or MACCE (Int: 9/18, 50% vs Control 6/15, 40%; p=0.73). Conclusions These findings support the feasibility of conducting a large-scale RCT to address a remaining uncertainty in post-arrest care. https://heart.bmj.com/content/104/Suppl_1/A7.2 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/heartjnl-2018-BCIS.13
    • Rationale and design of: A Randomized tRial of Expedited transfer to a cardiac arrest center for non-ST elevation out-of-hospital cardiac arrest: The ARREST randomized controlled trial

      Patterson, Tiffany; Perkins, Alexander; Perkins, Gavin D.; Clayton, Tim; Evans, Richard; Nguyen, Hanna; Wilson, Karen; Whitbread, Mark; Hughes, Johanna; Fothergill, Rachael; et al. (2018-10)
    • Reducing time to angiography and hospital stay for patients with high-risk non-ST-elevation acute coronary syndrome: retrospective analysis of a paramedic-activated direct access pathway

      Koganti, Sudheer; Patel, N.; Seraphim, A.; Kotecha, T.; Whitbread, Mark; Rakhit, Roby D. (2016-06)
      Objective: To assess whether a novel ‘direct access pathway’ (DAP) for the management of high-risk nonST-elevation acute coronary syndromes (NSTEACS) is safe, results in ‘shorter time to intervention and shorter admission times’. This pathway was developed locally to enable London Ambulance Service to rapidly transfer suspected high-risk NSTEACS from the community to our regional heart attack centre for consideration of early angiography. Methods: This is a retrospective case–control analysis of 289 patients comparing patients with high-risk NSTEACS admitted via DAP with age-matched controls from the standard pan-London high-risk ACS pathway (PLP) and the conventional pathway (CP). The primary end point of the study was time from admission to coronary angiography/intervention. Secondary end point was total length of hospital stay. Results: Over a period of 43 months, 101 patients were admitted by DAP, 109 matched patients by PLP and 79 matched patients through CP. Median times from admission to coronary angiography for DAP, PLP and CP were 2.8 (1.5–9), 16.6 (6–50) and 60 (33–116) hours, respectively ( p<0.001). Median length of hospital stay for DAP and PLP was similar at 3.0 (2.0–5.0) days in comparison to 5 (3–7) days for CP ( p<0.001). Conclusions: DAP resulted in a significant reduction in time to angiography for patients with high-risk NSTEACS when compared to existing pathways. https://bmjopen.bmj.com/content/bmjopen/6/6/e010428.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/bmjopen-2015-010428
    • Repeated adrenaline doses and survival from an out-of-hospital cardiac arrest

      Fothergill, Rachael; Emmerson, Amber C.; Iyer, Rajeshwari; Lazarus, Johanna; Whitbread, Mark; Nolan, Jerry P.; Deakin, Charles D.; Perkins, Gavin D. (2019-05)
    • Response to letter regarding article, "waveform analysis-guided treatment versus a standard shock-first protocol for the treatment of out-of-hospital cardiac arrest presenting in ventricular fibrillation: results of an international randomized, controlled trial"

      Freese, John P.; Jorgenson, Dawn B.; Liu, Ping-Yu; Innes, Jennifer; Matallana, Luis; Nammi, Krishnakant; Donohoe, Rachael T.; Whitbread, Mark; Silverman, Robert A.; Prezant, David J.; et al. (2014-06)
    • Safety and efficacy of paramedic treatment of regular supraventricular tachycardia

      Whitbread, Mark; Baker, Victoria; Richmond, Laura; Kirkby, Claire; Robinson, Gemma; Antoniou, Sotiris; Schilling, Richard (2013-04)
    • Safety and efficacy of paramedic treatment of regular supraventricular tachycardia: a randomised controlled trial

      Honarbakhsh, S.; Baker, Victoria; Kirkby, C.; Patel, K.; Robinson, G.; Antoniou, Sotiris; Richmond, L.; Ullah, W.; Hunter, R.J.; Finlay, M.; et al. (2017-09)
      Introduction Supraventricular tachycardias (SVTs) are a common cause of acute hospital presentations. Adenosine is an effective treatment. To date, no studies have directly compared paramedic-with hospital-delivered treatment of acute SVT with adenosine. Method Randomised controlled trial comparing the treatment of SVT and discharge by paramedics with conventional emergency department (ED)-based care. Patients were excluded if they had structural heart disease or contraindication to adenosine. Discharge time, follow-up management, costs and patient satisfaction were compared. Results Eighty-six patients were enrolled: 44 were randomised to paramedic-delivered adenosine (PARA) and 42 to conventional care (ED). Of the 37 patients in the PARA group given adenosine, the tachycardia was successfully terminated in 81%. There was a 98% correlation between the paramedics’ ECG diagnosis and that of two electrophysiologists. No patients had any documented adverse events in either group. The discharge time was lower in the PARA group than in the ED group (125 min (range 55–9513) vs 222 min (range 72– 26 153); p=0.01), and this treatment strategy was more cost-effective (£282 vs £423; p=0.01). The majority of patients preferred this management approach. Being treated and discharged by paramedics did not result in the patients being less likely to receive ongoing management of their arrhythmia and cardiology follow-up. Conclusions Patients with SVT can effectively and safely be treated with adenosine delivered by trained paramedics. Implementation of paramedic-delivered acute SVT care has the potential to reduce healthcare costs without compromising patient care. https://heart.bmj.com/content/heartjnl/103/18/1413.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/heartjnl-2016-309968
    • TCT-193 Effect of drug-eluting stents versus bare-metal stents on long-term mortality following rotational atherectomy for complex calcific coronary lesions

      Iqbal, M. Bilal; Kabir, Tito; Archbold, Andrew; Crake, Tom; Firoozi, Sam; Kalra, Sundeep S.; Knight, Charles; Lim, Pitt; Malik, Iqbal S.; Mathur, Anthony; et al. (2013-10)
    • TCT-241 Drug-eluting stents are superior to bare metal stents in reducing mortality in cardiogenic shock complicating ST-elevation myocardial infarction

      Iqbal, M. Bilal; Hadjiloizou, Nearchos; Kabir, Tito; Archbold, Andrew; Crake, Tom; Firoozi, Sam; Kalra, Sundeep S.; Knight, Charles; Lim, Pitt; Malik, Iqbal S.; et al. (2013-10)
    • Time-trend analyses of bleeding and mortality after primary percutaneous coronary intervention during out of working hours versus in-working hours: an observational study of 11 466 patients.

      Iqbal, M. Bilal; Khamis, Ramzi; Ilsley, Charles; Mikhail, Ghada; Crake, Tom; Firoozi, Sam; Kalra, Sundeep S.; Knight, Charles; Archbold, Andrew; Lim, Pitt; et al. (2015-06)
    • Waveform analysis-guided treatment versus a standard shock-first protocol for the treatment of out-of-hospital cardiac arrest presenting in ventricular fibrillation: results of an international randomized, controlled trial

      Freese, John P.; Jorgenson, Dawn B.; Liu, Ping-Yu; Innes, Jennifer; Matallana, Luis; Nammi, Krishnakant; Donohoe, Rachael T.; Whitbread, Mark; Silverman, Robert A.; Prezant, David J. (2013-08)