Search

Background: On 9 June 2021, the Australian Technical Advisory Group on Immunisation and Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommended that pregnant women receive Comirnaty (Pfizer) messenger RNA vaccine at any stage of pregnancy. Aim: This multi‐centre study aimed to assess vaccine acceptance, reasons for hesitancy and determine if differences exist between health districts, to inform future policy strategies for COVID‐19 vaccination in pregnancy. Materials and methods: An online survey (developed based on the World Health Organization Behavioural and Social Drivers survey and modified for the pregnant population) was administered to a sample population of pregnant women attending antenatal clinics at two metropolitan hospitals (Westmead and Royal North Shore Hospital (RNSH)) in New South Wales between 15 September 2021 and 22 October 2021. Results: There were 287 pregnant women surveyed (Westmead 198 (69%), RNSH 66 (23%), no site 23 (8%)). There was a significantly lower Socio‐Economic Indexes for Areas score (5.66 vs 9.45, P = 0.001), fewer women born in Australia (37% vs 53%, P = 0.02) and higher number of children (0.77 vs 0.41, P = 0.01) among Westmead respondents. There was lower vaccination uptake (68% vs 86%, P = 0.01) and willingness to receive vaccine (68% vs 88% P = 0.01) at Westmead compared to RNSH. There was an increased proportion of respondents who were concerned that the vaccine could cause harm to the unborn baby at Westmead (38% vs 11%, P = 0.01). Conclusions: Along with healthcare provider recommendation for vaccination in pregnancy, materials should be targeted to specific safety concerns of pregnant women. [ABSTRACT FROM AUTHOR]

Introduction: Direct current cardioversion (DCCV) remains one of the recommended management strategies for symptomatic atrial fibrillation (AF). Antiarrhythmic drugs (AAD) are prescribed post procedure to maintain sinus rhythm (SR). Limited literature exists on the AAD prescribing practices and their efficacy, post-DCCV in rural Australia., Objective: The primary aim was to determine the preferred AAD post-DCCV and the factors affecting AAD prescribing practices. The secondary aim was to assess the efficacy of the AAD in maintaining SR., Design: A retrospective observational audit of patients with non-valvular AF who underwent successful elective DCCV for symptomatic AF, during 2015-2020 at a regional hospital in New South Wales (NSW) (Dubbo Base Hospital). Patients were followed up for a duration of 12 months post-DCCV., Results: 233 patients underwent successful DCCV during the study duration. Amiodarone was the preferred AAD of choice post-DCCV followed by sotalol and flecainide, respectively (36.5% vs. 27.8% vs. 1.3%). 35.2% patients were not prescribed AAD. Amiodarone and sotalol had similar but modest efficacies and neither were superior to no AAD, in maintaining SR 12 months post-DCCV (AF recurrence rate 61.5% vs. 68.2% vs. 71.6% respectively, p = 0.37). Antecedent cerebrovascular accident (CVA), pulmonary disease, smoking, prior treatment with digoxin, diuretics and left ventricular (LV) dysfunction were factors that influenced AAD prescribing practices., Conclusion: The study demonstrates equal efficacies of amiodarone, sotalol and no AAD in maintaining SR 12 months post-DCCV. Prescribing practices post-DCCV at Dubbo Base Hospital differ from observed national trends and guidelines. AAD prescription requires a multifaceted approach with a key consideration to prioritise safety over efficacy, being mindful of challenges in delivering optimal healthcare in a rural setting., (© 2024 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)