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Papers by Edwina McNaughton

Research paper thumbnail of Interobserver Variability Between Expert, Experienced, and Novice Operator Affects Interpretation of Optical Coherence Tomography and 20 MHz Intravascular Ultrasound Imaging

Cardiovascular Revascularization Medicine, Feb 1, 2023

Research paper thumbnail of Incidental coronary artery calcification on non-gated CT thorax correlates with risk of cardiovascular events and death

European Radiology, Jan 27, 2023

Objectives To assess coronary artery calcification (CAC) on non-contrast non-ECG-gated CT thorax ... more Objectives To assess coronary artery calcification (CAC) on non-contrast non-ECG-gated CT thorax (NC-NECG-CTT) and to evaluate its correlation with short-term risk of cardiovascular disease (CVD) events and death. Methods Single-institution retrospective study including all patients 40-70 years old who underwent NC-NECG-CTT over a period of 6 months. Individuals with known CVD were excluded. The presence of CAC was assessed and quantified by the Agatston score (CACS). CAC severity was defined as mild (< 100), moderate (100-400), or severe (> 400). CVD events (including CVD death, myocardial infarction, revascularisation procedures, ischaemic stroke, acute peripheral atherosclerotic ischaemia), and all-cause mortality over a median of 3.5 years were recorded. Cox proportional-hazards regression modelling was performed including CACS, age, gender and CVD risk factors (smoking, hypertension, diabetes mellitus, dyslipidaemia, and family history of CVD). Results Of the total 717 eligible cases, 325 (45%) had CAC. In patients without CAC, there was only one CVD event, compared to 26 CVD events including 5 deaths in patients with CAC. The presence and severity of CAC correlated with CVD events (p < 0.001). A CACS > 100 was significantly associated with both CVD events, hazard ratio (HR) 5.74, 95% confidence interval: 2.19-15.02; p < 0.001, and all-cause mortality, HR 1.7, 95% CI: 1.08-2.66; p = 0.02. Ever-smokers with CAC had a significantly higher risk for all-cause mortality compared to never-smokers (p = 0.03), but smoking status was not an independent predictor for CVD events in any subgroup category of CAC severity. Conclusions The presence and severity of CAC assessed on NC-NECG-CTT correlates with short-term cardiovascular events and death. Key Points • Patients aged 40-70 years old without known CVD but with CAC on NC-NECG-CTT have a higher risk of CVD events compared to those without CAC. • CAC (Agatston) score above 100 confers a 5.7-fold increase in the risk of short-term CVD events in these patients. • The presence and severity of CAC on NC-NECG-CTT may have prognostic and therapeutic implications.

Research paper thumbnail of 8 A Rapid Chest Pain Assessment Pathway including High-Sensitivity Troponin T Testing has a Limited Effect on Length of Stay

Heart, Jun 1, 2015

Patients admitted with chest pain represent a major part of the workload of all acute hospitals. ... more Patients admitted with chest pain represent a major part of the workload of all acute hospitals. High-sensitivity troponin assays provide an opportunity to accelerate assessment of these patients as they can exclude MI earlier after symptom onset, avoiding the need to wait for a 12-hour sample. Both local and national priorities encourage increasing same-day discharge and reducing length of stay for low-risk patients with chest pain, and accordingly these were the metrics we investigated. Methods We introduced a new pathway to the Chest Pain Assessment Unit of a busy District General Hospital. This combined high-sensitivity troponin T (hsTnT) testing at admission and 6 h after symptom onset with formalised clinical risk-assessment using the TIMI risk score combined with these serial troponin results. Hospital episode statistics data was used to identify and compare length of stay and discharge diagnosis. Median length of stay was compared using the Mann-Whitney U test, and the proportion of patients discharged on the same day with the Chi-squared test. Summary discharge diagnosis was available, and this was used to identify patients with diagnoses representing non-cardiac chest pain (NCCP). Results Data on 5271 admissions over the preceding 2 years were used as a baseline, and compared to the 3234 patients admitted between March 2012 and September 2013 inclusive, who were assessed using the new pathway with paired hsTnT testing. 878 (33%) of these patients had a discharge diagnosis that was classed as non-cardiac chest pain. Abstract 8 Table 1 Length of stay before and after changing pathway Group Baseline – Original Pathway Results – New Pathway P N (All diagnoses) 5271 3234 Median length of stay (hours) – All Diagnoses 30.7 26.8 <0.001 Proportion of same day discharges – All Diagnoses 23% 26% 0.01 N (NCCP only) 1622 878 Median length of stay (hours) – NCCP only 16.3 14.8 0.01 Proportion of same day discharges – NCCP only 41% 44% 0.12 Median length of stay was significantly reduced both in all admissions, and in those with a diagnosis identifiable as NCCP from discharge data. Same day discharges were also increased in both populations, although this increase was statistically significant only in the whole population. Abstract 8 Figure 1 Median length of stay each month. Vertical line denotes time of change in protocol The changes provided a net cost benefit to the unit of approximately £12500 per year, mainly driven by increased NHS Payment by Results tariffs for patients discharged on the same day, and despite increased costs for troponin testing. Conclusions The introduction of a modified pathway for the assessment of chest pain including hsTnT testing was successful in decreasing length of stay and increasing the proportion of same-day discharges. This had positive financial implications for the unit and improved the quality of care provided. The magnitude of the effect was smaller than might have been hoped for, suggesting that multiple other factors influence length of stay.

Research paper thumbnail of Management of ST segment elevation myocardial infarction

Medicine, Jul 1, 2022

The degree of adherence to current guidelines for clinical management of ST-segment elevation myo... more The degree of adherence to current guidelines for clinical management of ST-segment elevation myocardial infarction (STEMI) is known in developed countries and large Chinese cities, but in predominantly rural areas information is lacking. We assessed the application of early reperfusion therapy for STEMI in secondary and tertiary hospitals in Henan province in central China. Data were retrospectively collected from 5 secondary and 4 tertiary hospitals in Henan concerning STEMI patients treated from January 2011 to January 2012, including management strategy, delay time, and inhospital mortality. Among 1311 STEMI patients, 613 and 698 were treated at secondary and tertiary hospitals, respectively. Overall, 460 (35.1%) patients received early reperfusion therapy including thrombolysis in 383 patients and primary percutaneous coronary intervention in 77. Compared with secondary centers, early (37.2% vs 32.6%) and successful reperfusion (34.5% vs 25.1%) was significantly higher, whereas thrombolysis was lower in the tertiary hospitals (26.4% vs 32.5%). Median symptom onset-to-first medical contact, and door-to-needle and door-to-balloon time was 168, 18, and 60 minutes, respectively. Delay times closely approached recommended guidelines, especially in secondary centers. Use of recommended pharmacotherapy was low, particularly in secondary hospitals. Inhospital mortality was 5.8%, and similar between secondary and tertiary hospitals (6.0% vs 5.6%; P = 0.183). Two-thirds of STEMI patients did not receive early reperfusion, and tertiary hospitals mostly failed to take advantage of around-theclock primary percutaneous coronary intervention. Actions such as referrals are warranted to shorten prehospital delay, and the concerns of patients and doctors regarding reperfusion risk should be addressed.

Research paper thumbnail of Interobserver variability between expert, experienced and novice operator affects interpretation of Optical Coherence Tomography & 20 MHz Intravascular Ultrasound imaging

Cardiovascular Revascularization Medicine

Research paper thumbnail of TCT-380 Pressure-Bound Coronary Flow Reserve Correlates With Coronary Flow Reserve by Thermodilution and Detects a Significant Proportion of Fractional Flow Reserve–Negative Patients With Coronary Microvascular Dysfunction and Misdiagnosis

Journal of the American College of Cardiology, 2021

Research paper thumbnail of 8 A Rapid Chest Pain Assessment Pathway including High-Sensitivity Troponin T Testing has a Limited Effect on Length of Stay

Heart, 2015

Patients admitted with chest pain represent a major part of the workload of all acute hospitals. ... more Patients admitted with chest pain represent a major part of the workload of all acute hospitals. High-sensitivity troponin assays provide an opportunity to accelerate assessment of these patients as they can exclude MI earlier after symptom onset, avoiding the need to wait for a 12-hour sample. Both local and national priorities encourage increasing same-day discharge and reducing length of stay for low-risk patients with chest pain, and accordingly these were the metrics we investigated. Methods We introduced a new pathway to the Chest Pain Assessment Unit of a busy District General Hospital. This combined high-sensitivity troponin T (hsTnT) testing at admission and 6 h after symptom onset with formalised clinical risk-assessment using the TIMI risk score combined with these serial troponin results. Hospital episode statistics data was used to identify and compare length of stay and discharge diagnosis. Median length of stay was compared using the Mann-Whitney U test, and the proportion of patients discharged on the same day with the Chi-squared test. Summary discharge diagnosis was available, and this was used to identify patients with diagnoses representing non-cardiac chest pain (NCCP). Results Data on 5271 admissions over the preceding 2 years were used as a baseline, and compared to the 3234 patients admitted between March 2012 and September 2013 inclusive, who were assessed using the new pathway with paired hsTnT testing. 878 (33%) of these patients had a discharge diagnosis that was classed as non-cardiac chest pain. Abstract 8 Table 1 Length of stay before and after changing pathway Group Baseline – Original Pathway Results – New Pathway P N (All diagnoses) 5271 3234 Median length of stay (hours) – All Diagnoses 30.7 26.8 <0.001 Proportion of same day discharges – All Diagnoses 23% 26% 0.01 N (NCCP only) 1622 878 Median length of stay (hours) – NCCP only 16.3 14.8 0.01 Proportion of same day discharges – NCCP only 41% 44% 0.12 Median length of stay was significantly reduced both in all admissions, and in those with a diagnosis identifiable as NCCP from discharge data. Same day discharges were also increased in both populations, although this increase was statistically significant only in the whole population. Abstract 8 Figure 1 Median length of stay each month. Vertical line denotes time of change in protocol The changes provided a net cost benefit to the unit of approximately £12500 per year, mainly driven by increased NHS Payment by Results tariffs for patients discharged on the same day, and despite increased costs for troponin testing. Conclusions The introduction of a modified pathway for the assessment of chest pain including hsTnT testing was successful in decreasing length of stay and increasing the proportion of same-day discharges. This had positive financial implications for the unit and improved the quality of care provided. The magnitude of the effect was smaller than might have been hoped for, suggesting that multiple other factors influence length of stay.

Research paper thumbnail of Sun protection – Do we know enough?

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2012

Sun protection, particularly the appropriate use of sunscreens is an important modifiable risk fa... more Sun protection, particularly the appropriate use of sunscreens is an important modifiable risk factor in the prevention of skin cancers. Our aim was to assess the current knowledge levels regarding sun protection, across plastic surgeons in the UK. A 12-point questionnaire based on the points contained in the patient information packs on sun protection produced by the British Association of Dermatology was circulated electronically amongst 551 BAPRAS members. We received 73 responses (13.3%). Questions were formulated around the basic information patients would expect to receive from a skin cancer specialist at the time of the diagnosis. On average, participants could answer only 52.4% of the questions correctly. Only 9.7% (95% CI 3-17) of participants could accurately quantify the role of UV exposure in causation of melanoma. A total of 37.5% correctly identified the duration of action of sunscreen to be 3-4 h. Half of the participants were not aware that geographical conditions like altitude and latitude, as well as shade, could alter sun protection. A similar number could not answer questions related to the protective action of clothing. As principal stakeholders in the treatment and outcomes of skin cancer patients, plastic surgeons could be at the forefront of influencing patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; behaviour regarding sun protection measures. The results demonstrate a need for better awareness and education regarding the knowledge of sunscreens and UV protection. Improved education would lead to health benefits for patients and their relatives and influence the primary prevention of this enlarging health issue of skin cancer.

Research paper thumbnail of Interobserver Variability Between Expert, Experienced, and Novice Operator Affects Interpretation of Optical Coherence Tomography and 20 MHz Intravascular Ultrasound Imaging

Cardiovascular Revascularization Medicine, Feb 1, 2023

Research paper thumbnail of Incidental coronary artery calcification on non-gated CT thorax correlates with risk of cardiovascular events and death

European Radiology, Jan 27, 2023

Objectives To assess coronary artery calcification (CAC) on non-contrast non-ECG-gated CT thorax ... more Objectives To assess coronary artery calcification (CAC) on non-contrast non-ECG-gated CT thorax (NC-NECG-CTT) and to evaluate its correlation with short-term risk of cardiovascular disease (CVD) events and death. Methods Single-institution retrospective study including all patients 40-70 years old who underwent NC-NECG-CTT over a period of 6 months. Individuals with known CVD were excluded. The presence of CAC was assessed and quantified by the Agatston score (CACS). CAC severity was defined as mild (< 100), moderate (100-400), or severe (> 400). CVD events (including CVD death, myocardial infarction, revascularisation procedures, ischaemic stroke, acute peripheral atherosclerotic ischaemia), and all-cause mortality over a median of 3.5 years were recorded. Cox proportional-hazards regression modelling was performed including CACS, age, gender and CVD risk factors (smoking, hypertension, diabetes mellitus, dyslipidaemia, and family history of CVD). Results Of the total 717 eligible cases, 325 (45%) had CAC. In patients without CAC, there was only one CVD event, compared to 26 CVD events including 5 deaths in patients with CAC. The presence and severity of CAC correlated with CVD events (p < 0.001). A CACS > 100 was significantly associated with both CVD events, hazard ratio (HR) 5.74, 95% confidence interval: 2.19-15.02; p < 0.001, and all-cause mortality, HR 1.7, 95% CI: 1.08-2.66; p = 0.02. Ever-smokers with CAC had a significantly higher risk for all-cause mortality compared to never-smokers (p = 0.03), but smoking status was not an independent predictor for CVD events in any subgroup category of CAC severity. Conclusions The presence and severity of CAC assessed on NC-NECG-CTT correlates with short-term cardiovascular events and death. Key Points • Patients aged 40-70 years old without known CVD but with CAC on NC-NECG-CTT have a higher risk of CVD events compared to those without CAC. • CAC (Agatston) score above 100 confers a 5.7-fold increase in the risk of short-term CVD events in these patients. • The presence and severity of CAC on NC-NECG-CTT may have prognostic and therapeutic implications.

Research paper thumbnail of 8 A Rapid Chest Pain Assessment Pathway including High-Sensitivity Troponin T Testing has a Limited Effect on Length of Stay

Heart, Jun 1, 2015

Patients admitted with chest pain represent a major part of the workload of all acute hospitals. ... more Patients admitted with chest pain represent a major part of the workload of all acute hospitals. High-sensitivity troponin assays provide an opportunity to accelerate assessment of these patients as they can exclude MI earlier after symptom onset, avoiding the need to wait for a 12-hour sample. Both local and national priorities encourage increasing same-day discharge and reducing length of stay for low-risk patients with chest pain, and accordingly these were the metrics we investigated. Methods We introduced a new pathway to the Chest Pain Assessment Unit of a busy District General Hospital. This combined high-sensitivity troponin T (hsTnT) testing at admission and 6 h after symptom onset with formalised clinical risk-assessment using the TIMI risk score combined with these serial troponin results. Hospital episode statistics data was used to identify and compare length of stay and discharge diagnosis. Median length of stay was compared using the Mann-Whitney U test, and the proportion of patients discharged on the same day with the Chi-squared test. Summary discharge diagnosis was available, and this was used to identify patients with diagnoses representing non-cardiac chest pain (NCCP). Results Data on 5271 admissions over the preceding 2 years were used as a baseline, and compared to the 3234 patients admitted between March 2012 and September 2013 inclusive, who were assessed using the new pathway with paired hsTnT testing. 878 (33%) of these patients had a discharge diagnosis that was classed as non-cardiac chest pain. Abstract 8 Table 1 Length of stay before and after changing pathway Group Baseline – Original Pathway Results – New Pathway P N (All diagnoses) 5271 3234 Median length of stay (hours) – All Diagnoses 30.7 26.8 <0.001 Proportion of same day discharges – All Diagnoses 23% 26% 0.01 N (NCCP only) 1622 878 Median length of stay (hours) – NCCP only 16.3 14.8 0.01 Proportion of same day discharges – NCCP only 41% 44% 0.12 Median length of stay was significantly reduced both in all admissions, and in those with a diagnosis identifiable as NCCP from discharge data. Same day discharges were also increased in both populations, although this increase was statistically significant only in the whole population. Abstract 8 Figure 1 Median length of stay each month. Vertical line denotes time of change in protocol The changes provided a net cost benefit to the unit of approximately £12500 per year, mainly driven by increased NHS Payment by Results tariffs for patients discharged on the same day, and despite increased costs for troponin testing. Conclusions The introduction of a modified pathway for the assessment of chest pain including hsTnT testing was successful in decreasing length of stay and increasing the proportion of same-day discharges. This had positive financial implications for the unit and improved the quality of care provided. The magnitude of the effect was smaller than might have been hoped for, suggesting that multiple other factors influence length of stay.

Research paper thumbnail of Management of ST segment elevation myocardial infarction

Medicine, Jul 1, 2022

The degree of adherence to current guidelines for clinical management of ST-segment elevation myo... more The degree of adherence to current guidelines for clinical management of ST-segment elevation myocardial infarction (STEMI) is known in developed countries and large Chinese cities, but in predominantly rural areas information is lacking. We assessed the application of early reperfusion therapy for STEMI in secondary and tertiary hospitals in Henan province in central China. Data were retrospectively collected from 5 secondary and 4 tertiary hospitals in Henan concerning STEMI patients treated from January 2011 to January 2012, including management strategy, delay time, and inhospital mortality. Among 1311 STEMI patients, 613 and 698 were treated at secondary and tertiary hospitals, respectively. Overall, 460 (35.1%) patients received early reperfusion therapy including thrombolysis in 383 patients and primary percutaneous coronary intervention in 77. Compared with secondary centers, early (37.2% vs 32.6%) and successful reperfusion (34.5% vs 25.1%) was significantly higher, whereas thrombolysis was lower in the tertiary hospitals (26.4% vs 32.5%). Median symptom onset-to-first medical contact, and door-to-needle and door-to-balloon time was 168, 18, and 60 minutes, respectively. Delay times closely approached recommended guidelines, especially in secondary centers. Use of recommended pharmacotherapy was low, particularly in secondary hospitals. Inhospital mortality was 5.8%, and similar between secondary and tertiary hospitals (6.0% vs 5.6%; P = 0.183). Two-thirds of STEMI patients did not receive early reperfusion, and tertiary hospitals mostly failed to take advantage of around-theclock primary percutaneous coronary intervention. Actions such as referrals are warranted to shorten prehospital delay, and the concerns of patients and doctors regarding reperfusion risk should be addressed.

Research paper thumbnail of Interobserver variability between expert, experienced and novice operator affects interpretation of Optical Coherence Tomography & 20 MHz Intravascular Ultrasound imaging

Cardiovascular Revascularization Medicine

Research paper thumbnail of TCT-380 Pressure-Bound Coronary Flow Reserve Correlates With Coronary Flow Reserve by Thermodilution and Detects a Significant Proportion of Fractional Flow Reserve–Negative Patients With Coronary Microvascular Dysfunction and Misdiagnosis

Journal of the American College of Cardiology, 2021

Research paper thumbnail of 8 A Rapid Chest Pain Assessment Pathway including High-Sensitivity Troponin T Testing has a Limited Effect on Length of Stay

Heart, 2015

Patients admitted with chest pain represent a major part of the workload of all acute hospitals. ... more Patients admitted with chest pain represent a major part of the workload of all acute hospitals. High-sensitivity troponin assays provide an opportunity to accelerate assessment of these patients as they can exclude MI earlier after symptom onset, avoiding the need to wait for a 12-hour sample. Both local and national priorities encourage increasing same-day discharge and reducing length of stay for low-risk patients with chest pain, and accordingly these were the metrics we investigated. Methods We introduced a new pathway to the Chest Pain Assessment Unit of a busy District General Hospital. This combined high-sensitivity troponin T (hsTnT) testing at admission and 6 h after symptom onset with formalised clinical risk-assessment using the TIMI risk score combined with these serial troponin results. Hospital episode statistics data was used to identify and compare length of stay and discharge diagnosis. Median length of stay was compared using the Mann-Whitney U test, and the proportion of patients discharged on the same day with the Chi-squared test. Summary discharge diagnosis was available, and this was used to identify patients with diagnoses representing non-cardiac chest pain (NCCP). Results Data on 5271 admissions over the preceding 2 years were used as a baseline, and compared to the 3234 patients admitted between March 2012 and September 2013 inclusive, who were assessed using the new pathway with paired hsTnT testing. 878 (33%) of these patients had a discharge diagnosis that was classed as non-cardiac chest pain. Abstract 8 Table 1 Length of stay before and after changing pathway Group Baseline – Original Pathway Results – New Pathway P N (All diagnoses) 5271 3234 Median length of stay (hours) – All Diagnoses 30.7 26.8 <0.001 Proportion of same day discharges – All Diagnoses 23% 26% 0.01 N (NCCP only) 1622 878 Median length of stay (hours) – NCCP only 16.3 14.8 0.01 Proportion of same day discharges – NCCP only 41% 44% 0.12 Median length of stay was significantly reduced both in all admissions, and in those with a diagnosis identifiable as NCCP from discharge data. Same day discharges were also increased in both populations, although this increase was statistically significant only in the whole population. Abstract 8 Figure 1 Median length of stay each month. Vertical line denotes time of change in protocol The changes provided a net cost benefit to the unit of approximately £12500 per year, mainly driven by increased NHS Payment by Results tariffs for patients discharged on the same day, and despite increased costs for troponin testing. Conclusions The introduction of a modified pathway for the assessment of chest pain including hsTnT testing was successful in decreasing length of stay and increasing the proportion of same-day discharges. This had positive financial implications for the unit and improved the quality of care provided. The magnitude of the effect was smaller than might have been hoped for, suggesting that multiple other factors influence length of stay.

Research paper thumbnail of Sun protection – Do we know enough?

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2012

Sun protection, particularly the appropriate use of sunscreens is an important modifiable risk fa... more Sun protection, particularly the appropriate use of sunscreens is an important modifiable risk factor in the prevention of skin cancers. Our aim was to assess the current knowledge levels regarding sun protection, across plastic surgeons in the UK. A 12-point questionnaire based on the points contained in the patient information packs on sun protection produced by the British Association of Dermatology was circulated electronically amongst 551 BAPRAS members. We received 73 responses (13.3%). Questions were formulated around the basic information patients would expect to receive from a skin cancer specialist at the time of the diagnosis. On average, participants could answer only 52.4% of the questions correctly. Only 9.7% (95% CI 3-17) of participants could accurately quantify the role of UV exposure in causation of melanoma. A total of 37.5% correctly identified the duration of action of sunscreen to be 3-4 h. Half of the participants were not aware that geographical conditions like altitude and latitude, as well as shade, could alter sun protection. A similar number could not answer questions related to the protective action of clothing. As principal stakeholders in the treatment and outcomes of skin cancer patients, plastic surgeons could be at the forefront of influencing patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; behaviour regarding sun protection measures. The results demonstrate a need for better awareness and education regarding the knowledge of sunscreens and UV protection. Improved education would lead to health benefits for patients and their relatives and influence the primary prevention of this enlarging health issue of skin cancer.