{
  "abstract": "Introduction Current evidence supports the stratification of non-ST-segment elevation acute coronary syndromes (NSTE-ACS) into low and high-risk groups, with selective provision of emergent (<24 hour) percutaneous coronary intervention (PCI) to those at high-risk of cardiovascular morbidity and mortality. Despite this need, timely provision of PCI remains a challenge due to the demands on our tertiary level service, which provides PCI to a large population in south-east London.Our quality improvement project aimed to identify how quickly patients admitted under acute medicine in our hospital underwent PCI and whether this was altered by stratification into low and high-risk NSTE-ACS, in line with NICE guidance. We then identified what proportion of this group would meet criteria for an outpatient ‘virtual ward’, as well as the predicted reduction in demand for emergency PCI if this pathway was established.Method We retrospectively collected data from the electronic patient record on all patients admitted under medicine between October 2023 and October 2024 with a NSTE-ACS. Data collected included GRACE score, presence of ongoing chest pain, haemodynamic instability, new heart failure, ventricular arrhythmias or ST segment changes on ECG as well as time from admission to invasive coronary angiography. A Mann-Whitney U test was used to compare time from admission to invasive coronary angiography between low and high-risk groups.Results Between October 2023 and October 2024, 99 patients were admitted under medicine with NSTE-ACS, 74 of whom underwent PCI ( table 1). This predicts a weekly requirement for emergency PCI for 1.42 patients. 53 of these patients met criteria for low-risk NSTE-ACS (table 2). Mean time to PCI was 3.81 days for all patients, 3.55 days for low-risk and 4.48 days for high-risk patients, though the difference between groups was not statistically significant (P=0.103) (figure 1). 44.6% of patients with a GRACE score ≥3% underwent PCI within 72 hours of admission. Mean length of stay for low-risk patients was 9.2 days.Establishment of an outpatient ‘virtual ward’ for low-risk cases, with scheduling into the elective cath lab lists based on estimated capacity, would eliminate 53 cases from the demand for emergency PCI, an estimated 1 case per week. This would reduce the demand placed by medicine on the emergency PCI service by 71.6%. If this low-risk group were discharged to a ‘virtual ward’ at 48 hours after admission this pathway would also create an estimated 384 bed days per year.Abstract 2-028 Table 1Demographic data, GRACE score and length of stay for patients admitted under medicine with NSTE-ACS All patients Low-risk High-risk - Number 74 53 (71.6%) 21 (28.4%) - Age, mean (±SD) 64.2 (±9.8) 62.6 (±9.5) 68.2 (±9.3) - Female, n (%) 27 (36.5%) 19 (35.8%) 8 (38.1%) - Male, n (%) 47 (63.5%) 34 (64.2%) 13 (61.9%) - Race, n (%) - White 31 (41.9%) 23 (43.4%) 8 (38.1%) - Black 24 (32.4%) 16 (30.2%) 8 (38.1%) - Asian 6 (8.1%) 4 (7.5%) 2 (9.5%) - Mixed 3 (4.1%) 3 (5.7%) 0 (0%) - Other 8 (10.8%) 5 (9.4%) 3 (14.3%) - Unknown 2 (2.7%) 2 (3%) 0 (0%) - GRACE (%), mean 5.2 % 4.0 % 8.2 % - Length of stay, mean 10.4 9.2 13.3 - Length of stay, median 8 7 9 Abstract 2-028 Table 2Criteria for low-risk NSTE-ACS to be used for a proposed outpatient ‘virtual ward’ Criteria for low-risk NSTE-ACS GRACE score <140 Pain free >48 hours Minimal or no ST segment change Haemodynamically stable No ventricular arrhythmias No evidence of new heart failureAbstract 2-028 Figure 2Rainforest plots comparing the number of days from admission until percutaneous coronary intervention for low- and high-risk NSTE-ACSConclusion Time from admission to percutaneous coronary intervention averages 3.81 days for patients admitted under medicine at our large tertiary centre. 71.6% of these patients would be suitable for an outpatient ‘virtual ward’, reducing the burden on the emergency PCI service and creating an estimated 384 bed days per year. Establishment of this pathway has the potential to improve time to PCI for high-risk cases as well as improve patient flow.",
  "authors": [
    {
      "affiliations": [
        "King’s College Hospital NHS Foundation Trust"
      ],
      "name": "Hugh Lurcott"
    },
    {
      "affiliations": [
        "King’s College Hospital NHS Foundation Trust"
      ],
      "name": "Sarah O’Connell"
    },
    {
      "affiliations": [
        "King’s College University London"
      ],
      "name": "Lynn Almasri"
    },
    {
      "affiliations": [
        "King’s College Hospital NHS Foundation Trust"
      ],
      "name": "Asma Khan"
    },
    {
      "affiliations": [
        "King’s College Hospital NHS Foundation Trust",
        "King’s College University London"
      ],
      "name": "M Zeeshan Khawaja"
    }
  ],
  "title": "2-028 Time from admission to percutaneous coronary intervention for patients with acute coronary syndromes admitted under medicine at a large tertiary centre. Can an outpatient ‘virtual ward’ improve emergent cath lab capacity for those that need it most?",
  "uid": "792ff7b8-d7e9-56b2-8ac0-137422174bec"
}