{
  "abstract": "Introduction Heart failure (HF)is a major cause of hospital admissions with high morbidity and mortality. Practice varies regarding the investigative modalities for patients with a new diagnosis of left ventricular (LV) dysfunction presenting with heart failure. The REVIVED trial 1 showed no benefit of PCI in ischaemic left ventricular dysfunction, questioning the use of routine angiography in this patient cohort. This study evaluates the utilisation of imaging modalities in inpatients with a new diagnosis of LV dysfunction in the post-REVIVED1 era.Methods Data were collected on patients coded with heart failure and discharged between September 2023 and February 2024 from Leicester Royal Infirmary and Glenfield Hospital. Clinical records and imaging results (BNP and echo or CMR results) were evaluated to confirm a new diagnosis of HF. These pt were further categorised into (HFrEF (EF <35%) HFmrEF (EF 36–49%), HFpEF (EEF <55 %)) . The types of investigations performed, including echocardiography, cardiac MRI, and coronary angiography, were noted, along with subsequent interventions such as PCI, device implantation, and the associated length of stay.Results Among 1,075 inpatients coded with heart failure, 314 (29.2%) had a new diagnosis. Inpatient echocardiography was performed in 250 pts (79.6%), and 53 (16.8%) scans were done as an outpatient. LV function was severely impaired (EF <35%) in 133 (42.3%), moderately impaired (EF 36–49%) in 74 (23.5%), and preserved (EF >55%) in 61 (19%).Of the 314 patients with a new diagnosis of heart failure, 76 patients (24.2%) had a cardiac MRI scan (41 as IP (53.9%) and 35 as OP (46.1%)). Patients were more likely to have had an MRI scan if they had severely impaired LVSF from ECHO (60 out of 133 patients (45%)) compared to 14 out of 74 patients (18.9%) with impaired LVSF. Patients were also more likely to have had an inpatient MRI if the LV dysfunction was severe (36 out of 60 inpatient scans (60%) compared to 4 out of 14 outpatient scans (28.6%)). Inpatient MRI averaged 10.3 days wait; outpatient MRI median was 97 days.Fifteen patients underwent coronary angiography; 9 of them had HFrEF (40%), and 6 had HFmrEF (40%). Eleven patients underwent inpatient MRI, which mainly showed ischemia (7/11, 63.64%). PCI occurred in two of these patients, but the majority were medically managed irrespective of the extent of coronary disease. One patient with severe aortic stenosis was referred for valve replacement and CABG. Sixteen patients received cardiac devices, 13 as inpatients; 10 had MRI before implantation.Conclusion And Improvements This audit demonstrates that routine angiography is rarely used in heart failure investigations post-REVIVED 1. Cardiac MRI is preferred after echocardiography confirms LV dysfunction. Invasive angiography remains infrequent despite confirmed ischaemia and coronary disease and revascularisation is rare.Improvement areas:Reducing inpatient CMR waits: A 10.3-day average extends hospital stays. Establishing dedicated ‘hot’ CMR slots could decrease both the duration of these stays, and the time required to make treatment decisions.Better outpatient CMR access: 97-day median wait needs resource enhancement.Standardizing pathways: Clearer protocols on immediate angiography versus medical therapy could improve decision-making.This supports an imaging-led heart failure strategy emphasizing efficient cardiac MRI access.Reference Perera D, Clayton T, Petrie MC, et al. Percutaneous revascularization for ischemic left ventricular dysfunction. N Engl J Med. 2022;387(14):1351–1360. doi:10.1056/NEJMoa2206606",
  "authors": [
    {
      "affiliations": [
        "Glenfield Hospital, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "Abubakr Adala"
    },
    {
      "affiliations": [
        "Glenfield Hospital, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "Chijioke Horatio Mosanya"
    },
    {
      "affiliations": [
        "Glenfield Hospital, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "Stephen Baillie"
    },
    {
      "affiliations": [
        "Glenfield Hospital, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "Aisha Gohar"
    },
    {
      "affiliations": [
        "Glenfield Hospital, University Hospitals of Leicester, Leicester, UK"
      ],
      "name": "Shazia Hussain"
    }
  ],
  "title": "5-002 Inpatient investigation strategy for new diagnosis of left ventricular dysfunction",
  "uid": "3de97e41-f863-51fb-bed5-737ffa5980d0"
}