CLINICAL PRACTICE VARIATIONS IN THE MANAGEMENT OF STRESS-INDUCED CARDIOMYOPATHY--A CANADIAN PERSPECTIVE
CCC ePoster Library. Suliman A. 10/26/19; 280521; 286
Dr. Asem Suliman
Dr. Asem Suliman
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Abstract
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BACKGROUND: Takotsubo Syndrome or Stress-Induced Cardiomyopathy (SIC) is characterized by left ventricular dysfunction in the absence of occlusive coronary artery disease (CAD). Previously believed to be benign, contemporary studies report increased rates of complications ranging from cardiogenic shock to long-term mortality exceeding that of ST-elevation myocardial infarctions (STEMI). Despite increased recognition, there are no randomized control trials (RCTs) or guidelines to direct therapeutic strategies and little is known about the local experience in Canada. The objective of this study is to better understand the clinical practice variations in the management of SIC across Canada.

METHODS AND RESULTS: This was a prospective study that utilized an online platform (Google Surveys, 2018) to distribute a series of questions via email to practicing cardiologists throughout Canada (Table 1) between October to November 2018. Cardiology trainees and internists were excluded from the study population. Responses from the survey were descriptively analysed. In total, 172 cardiologists across the country completed the survey, with the highest representation from Quebec, Ontario, Manitoba, Alberta, and British Columbia. Most respondents work primarily in an academic centre (80%). While many cardiologists have managed patients with SIC (99.4%), over 2/3 do not adhere to any guidelines or references. Of those who do, the top referenced resources included expert consensus statements from the ACC and the ESC, general heart failure guidelines, and UpToDate. Regarding investigations, most participants routinely order transthoracic echocardiograms (96%), coronary angiograms (92%), and 11% would order a pheochromocytoma workup. Common medications prescribed for hemodynamically stable patients included beta blockers (92%), ACE inhibitors (88%), antiplatelet agents (42%), and anticoagulation (13%). Three percent of participants reported not prescribing any cardiac medications. Over 85% of respondents would follow-up with SIC patients within a 3-month period. The risk factors most believed to be associated with SIC included female gender, anxiety, older age, hypertension, smoking, ethnicity, and diabetes. No participants believed that male gender was a risk factor. Regarding improvements, many believed there needs to be Canadian guidelines, more RCTs or systemic reviews/meta analyses, or dedicated workshops at the national cardiology conference. Approximately 10% of participants believed that no further improvements are needed.

CONCLUSION: To our knowledge, this is the first study to report the clinical practice variations in the management of SIC throughout Canada. The survey demonstrates that there is great heterogeneity and illustrates a need for high-quality studies to guide medical therapy.
BACKGROUND: Takotsubo Syndrome or Stress-Induced Cardiomyopathy (SIC) is characterized by left ventricular dysfunction in the absence of occlusive coronary artery disease (CAD). Previously believed to be benign, contemporary studies report increased rates of complications ranging from cardiogenic shock to long-term mortality exceeding that of ST-elevation myocardial infarctions (STEMI). Despite increased recognition, there are no randomized control trials (RCTs) or guidelines to direct therapeutic strategies and little is known about the local experience in Canada. The objective of this study is to better understand the clinical practice variations in the management of SIC across Canada.

METHODS AND RESULTS: This was a prospective study that utilized an online platform (Google Surveys, 2018) to distribute a series of questions via email to practicing cardiologists throughout Canada (Table 1) between October to November 2018. Cardiology trainees and internists were excluded from the study population. Responses from the survey were descriptively analysed. In total, 172 cardiologists across the country completed the survey, with the highest representation from Quebec, Ontario, Manitoba, Alberta, and British Columbia. Most respondents work primarily in an academic centre (80%). While many cardiologists have managed patients with SIC (99.4%), over 2/3 do not adhere to any guidelines or references. Of those who do, the top referenced resources included expert consensus statements from the ACC and the ESC, general heart failure guidelines, and UpToDate. Regarding investigations, most participants routinely order transthoracic echocardiograms (96%), coronary angiograms (92%), and 11% would order a pheochromocytoma workup. Common medications prescribed for hemodynamically stable patients included beta blockers (92%), ACE inhibitors (88%), antiplatelet agents (42%), and anticoagulation (13%). Three percent of participants reported not prescribing any cardiac medications. Over 85% of respondents would follow-up with SIC patients within a 3-month period. The risk factors most believed to be associated with SIC included female gender, anxiety, older age, hypertension, smoking, ethnicity, and diabetes. No participants believed that male gender was a risk factor. Regarding improvements, many believed there needs to be Canadian guidelines, more RCTs or systemic reviews/meta analyses, or dedicated workshops at the national cardiology conference. Approximately 10% of participants believed that no further improvements are needed.

CONCLUSION: To our knowledge, this is the first study to report the clinical practice variations in the management of SIC throughout Canada. The survey demonstrates that there is great heterogeneity and illustrates a need for high-quality studies to guide medical therapy.
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