COVID-19 Antibody Surveillance Among Healthcare Workers in A Non-COVID designated Cardiology Centre

BACKGROUND: Reports on healthcare worker antibody response to COVID-19 infection are scarce. We aim to determine theCOVID-19 antibody prevalence among healthcare workers in a cardiology centre and the relationship between case definitioncriteria with the COVID-19 antibody result. METHODS: Convenience sampling was applied. Healthcare workers in SarawakHeart Centre (SHC) cardiology, radiology, and emergency unit were recruited. A survey form on clinical symptoms and closecontact history was distributed. HEALGEN COVID-19 IgG/IgM rapid test was performed using serum/ whole blood specimen.Staff with positive COVID-19 antibody results were referred to the infectious disease specialist for assessment. RESULTS: Atotal of 310 staff were screened. 220(71%) were female, and the mean age was 36±7.7 years old. 46(14.8%) staff reported havingclinical symptoms at some stage from the end of January 2020 to the time of this surveillance. Number of staff who had a historyof overseas travel, close contact with confirmed COVID-19 patients, or had visited places with identified COVID-19 clusterswere 4(1.3%), 24(7.7%) and 24(7.7%) respectively. There were 14 staff (4.5%) with positive tests positive, 2 for IgM, and 12for IgG. All those with positive antibody were subsequently tested negative with RT-PCR test. The history of having clinicalsymptoms and exposure to COVID-19 cluster area were independently associated with a positive IgG result. CONCLUSION:The application of COVID-19 antibody serology rapid tests could determine true exposure of staff to the infection and allowus to reassess existing measures of infection control within the hospital

Smartphone electrocardiogram for detecting atrial fibrillation after a cerebral ischaemic event: a multicentre randomized controlled trial

Aims: Atrial fibrillation (AF) is a preventable cause of ischaemic stroke but it is often undiagnosed and undertreated. The utility of smartphone electrocardiogram (ECG) for the detection of AF after ischaemic stroke is unknown. The aim of this study is to determine the diagnostic yield of 30-day smartphone ECG recording compared with 24-h Holter monitoring for detecting AF ≥30 s. Methods and results: In this multicentre, open-label study, we randomly assigned 203 participants to undergo one additional 24-h Holter monitoring (control group, n = 98) vs. 30-day smartphone ECG monitoring (intervention group, n = 105) using KardiaMobile (AliveCor®, Mountain View, CA, USA). Major inclusion criteria included age ≥55 years old, without known AF, and ischaemic stroke or transient ischaemic attack (TIA) within the preceding 12 months. Baseline characteristics were similar between the two groups. The index event was ischaemic stroke in 88.5% in the intervention group and 88.8% in the control group (P = 0.852). AF lasting ≥30 s was detected in 10 of 105 patients in the intervention group and 2 of 98 patients in the control group (9.5% vs. 2.0%; absolute difference 7.5%; P = 0.024). The number needed to screen to detect one AF was 13. After the 30-day smartphone monitoring, there was a significantly higher proportion of patients on oral anticoagulation therapy at 3 months compared with baseline in the intervention group (9.5% vs. 0%, P = 0.002). Conclusions: Among patients ≥55 years of age with a recent cryptogenic stroke or TIA, 30-day smartphone ECG recording significantly improved the detection of AF when compared with the standard repeat 24-h Holter monitoring. Keywords: Anticoagulation; Atrial fibrillation; Cryptogenic stroke; Digital health; Smartphone electrocardiogram.

Performance and 12-month Outcomes of a Wire-free Fractional Flow Reserve System for Assessment of Coronary Artery Disease

Background: Fractional flow reserve (FFR) using an invasive pressure wire is recommended to guide coronary revascularisation in stable coronary artery disease. Coronary angiography-based wire-free FFR (CAFFR) determines the significance of a coronary lesion without the requirement of a pressure wire. Deferral of revascularisation of coronary lesions with an FFR >0.8 has been shown to have similar outcomes to patients managed with optimal medical therapy. Objective: The aim of our study was to assess the performance and 12-month clinical outcomes in patients with CAFFR-guided percutaneous coronary intervention (PCI) deferral. Methods: This was a prospective study involving 69 patients (93 vessels) with angiographic stenosis of 30–90%. Patients with CAFFR ≤0.80 or poor image quality were excluded, leaving 29 patients (31 vessels) for analysis. All recruited patients had a CAFFR >0.80 and thus, PCI deferral. This cohort was followed up for 12 months. The primary endpoint was a composite of death from any cause, MI or target vessel revascularisation. Wired FFR was done for comparison on 14 patients (48%) at the operator’s discretion. Results: The mean age was 59.9 (±12.6) years. The majority of patients were men (83%; n=24), 41% (n=12) had diabetes, 62% (n=18) had hypertension, 59% (n=17) had dyslipidaemia, 62% (n=18) had a history of smoking. The mean left ventricular ejection fraction (LVEF) was 52 (±11.4)% and 76% of the patients had a recent acute coronary syndrome. We assessed the left anterior descending artery and 52% (n=16) of vessels had a mean CAFFR was 0.87. At 12 months, all patients were alive, 89.7% remained in chronic coronary syndrome (CCS) class 1 and 3.4% (n=1) of the study population met the primary outcome of target vessel revascularisation. Conclusion: CAFFR showed good agreement with wire-based FFR and 12-month outcomes showed that CAFFR-guided deferral of PCI was safe and comparable to wired-based FFR guidance