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Objective Time spent in the emergency department (ED) before admission to hospital is often considered an important key performance indicator (KPI). Throughout Australia and New Zealand, there is no standard definition of ‘time of admission’ for patients admitted through the ED. By using data submitted to the Australian and New Zealand Intensive Care Society Adult Patient Database, the aim was to determine the differing methods used to define hospital admission time and assess how these impact on the calculation of time spent in the ED before admission to an intensive care unit (ICU). Methods Between March and December of 2010, 61 hospitals were contacted directly. Decision methods for determining time of admission to the ED were matched to 67787 patient records. Univariate and multivariate analyses were conducted to assess the relationship between decision method and the reported time spent in the ED. Results Four mechanisms of recording time of admission were identified, with time of triage being the most common (28/61 hospitals). Reported median time spent in the ED varied from 2.5 (IQR 0.83–5.35) to 5.1 h (2.82–8.68), depending on the decision method. After adjusting for illness severity, hospital type and location, decision method remained a significant factor in determining measurement of ED length of stay. Conclusions Different methods are used in Australia and New Zealand to define admission time to hospital. Professional bodies, hospitals and jurisdictions should ensure standardisation of definitions for appropriate interpretation of KPIs as well as for the interpretation of studies assessing the impact of admission time to ICU from the ED. What is known about the topic? There are standards for the maximum time spent in the ED internationally, but these standards vary greatly across Australia. The definition of such a standard is critically important not only to patient care, but also in the assessment of hospital outcomes. Key performance indicators rely on quality data to improve decision-making. What does this paper add? This paper quantifies the variability of times measured and analyses why the variability exists. It also discusses the impact of this variability on assessment of outcomes and provides suggestions to improve standardisation. What are the implications for practitioners? This paper provides a clearer view on standards regarding length of stay in the ICU, highlighting the importance of key performance indicators, as well as the quality of data that underlies them. This will lead to significant changes in the way we standardise and interpret data regarding length of stay.

Heart failure with preserved ejection fraction (HFPEF) is emerging as the most prevalent form of heart failure. The pathophysiology of HFPEF is complex, most notably characterized by impaired diastolic reserve. In particular, a rapid rise in left ventricular filling pressure is a fundamental feature

A. McLellan1,2,3, L. Ling1,2,3, S. Azzopardi 1,2, G. Lee1,2, G. Lee1,2,3, S. Kumar1,2,3, M. Wong1,2,3, T. Walters 1,2,3, J. Lee 3, K. Halloran3, M. Stiles 7, N. Lever 8, S. Fynn9, P. Heck9, P. Sanders 6, J. Morton3,4, J. Kalman3,4, P. Kistler 1,2,3,4,5,∗ 1 Alfred Heart Centre, Alfred Hospital, Melbourne, Victoria, Australia 2 Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia 3Department of Cardiology, Royal Melbourne Hospital, and Department of Medicine, University of Melbourne, Parkville, Victoria, Australia 4 Melbourne Private Hospital, Parkville, Victoria, Australia 5 Avenue Private Hospital, Windsor, Victoria, Australia 6 Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia 7 Waikato Hospital, New Zealand 8 Auckland City Hospital, Auckland, New Zealand 9 Papworth Hospital, Cambridge, United Kingdom

Introduction: Takotsubo cardiomyopathy (TC) is characterized by a transient left ventricular (LV) dysfunction, but the prognosis of TC is not yet fully established. Objectives: Toevaluate in-hospital andmediumtermprognosis of patientsdiagnosedwithTC. Methods: Multicenter study involving 5 hospital centers that included all patients diagnosed with TC in the last 10 years. Results: We included 71patients with TC, predominantly females (91.5%). Mean age was 67 11 years. Chest pain was the most common clinical presentation (93%). Emotional or physical stress was identified as a possible triggering factor in 60.6% of patients. The admission ECG showed ST-segment elevation (56.3%) or depression (32.4%) in most patients. There was elevation of troponin I on admission in 83.1% of cases (peak value of 4.2 4.3ng/mL). Echocardiogram revealed akinesia of apical and medium LV segments in 97.2% of cases. The coronary angiography revealed no coronary disease(85.9%).During hospitalization (6.1 4.6 days) occurred complications: heart failure (31%), cardiogenic shock (15.5%), atrial fibrillation (9.9%), complete atrioventricular block (4.2 %), acute pulmonary edema (4.2%), stroke / TIA (2.8%), LV thrombus (1.4%) and death (1.4%). Complete reversal of LV dysfunction occurred in 38% during hospitalization and in 43.7% up to 15 days after admission. Over a follow-up of 31 29 months, there were: TC recurrence (4.2%), stroke / TIA (4.2%) and death (1.4%). Conclusion: In the acute phase, TC has a high prevalence of complications, particularly heart failure and cardiogenic shock, and severe complications such as stroke and death may also occur. At the medium term follow-up, the prognosis is good with a low prevalence of stroke / TIA, a low mortality and a low recurrence rate. Disclosure of Interest: None Declared

dimensionalmapping technology to treat arrhythmias that previously have been difficult, if not impossible, to treat. This study aims to review the trends in ablation over a period of 15 years at single tertiary referral site. Methods: Data was extracted from the hospital electrophysiology database for all ablations performed from 1998 to 2012. The data was grouped into a three-year period 1998–2001 and four-year periods there after until 2012. Data analysed included procedure time, X-ray time and ablation sites. Ablation procedures were grouped into complex ablation [atrial fibrillation (AF), ventricular tachycardia (VT) and atrial tachycardia (AT)] and simple ablation [AV nodal re-entry tachycardia (AVNRT), bypass tracts (BT), atrial flutter (AFL) and AV node (AV)]. Results: A total of 2640 procedures were performed over the period analysed. During the period complex ablation increased from 13 to 34% of the workload (Fig. 1). During this time period there been an increase in procedure time (Fig. 2). Conclusions: This analysis shows complex ablations have increased in frequency over the time period and are associatedwith a two-hour longer procedure timeon average. This is placing significant pressure on limitedhospital resources. http://dx.doi.org/10.1016/j.hlc.2013.05.296