- Email: [email protected]
Multidisciplinary Team Approach for a Peer-Support based Cardiac-Diabetes Self-Management Program
S310
Abstracts CSANZ 2012 Abstracts
ABSTRACTS
CRFs
Heart, Lung and Circulation 2012;21:S143–S316
No. of patients
Entry into TCP
Exit from TCP
P-value
4560 4465 3904 3973 4802 4790 2715 976 5544 2617 5325 5093 5335
4.3 (3.6, 5.2) 1.4 (1.0, 2.0) 2.4 (1.8, 3.2) 1.1 (0.9, 1.3) 125 (118, 134) 72 (68, 80) 5.4 (5.0, 5.8) 7.1 (6.3, 8.1) 507 (9.1%) 96 (90, 104) 82.5 (73, 93) 3886 (76.3%) 2721 (51.0%)
3.6 (3.2, 4.1) 1.2 (0.9, 1.6) 1.8 (1.5, 2.1) 1.1 (1.0, 1.4) 121 (116, 129) 72 (68, 80) 5.3 (4.9, 5.6) 6.9 (6.3, 7.6) 288 (5.2%) 94 (88, 100) 81 (72, 91) 4413 (86.6%) 4433 (83.1%)
0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0055 0.0000 0.0000 0.0000 0.0000 0.0000
TC, mmol/L TG, mmol/L LDL-C, mmol/L HDL-C, mmol/L SBP, mmHg DBP, mmHg FBG, mmol/L HbA1c, % (DM only) Smoking status Waist, cm Weight, kg Alcohol at target PA at target
Conclusion: TCP had favourable impact on all behavioural and biomedical risk factors measured. This should be contrasted with routine cardiac rehabilitation in Australia where none of this data is known. http://dx.doi.org/10.1016/j.hlc.2012.05.765 752 Impact of The COACH Program on Coronary Risk Factors (CRFs) in Australians from Different Areas of Remoteness U. Boffa 1 , S. Danielewski 1 , P. Gloury 1 , G. Cosgriff 1 , C. Wong 1 , R. Hall 1 , A. Podubinski 1 , J. Wenban 2 , M. Vale 3 , M. Jelinek 3,∗ 1 Bupa
Australia, Victoria, Australia of Western Australia Department of Health, Australia 3 The University of Melbourne Department of Medicine, Australia 2 Government
People in living in rural areas tend to have shorter lives and higher levels of disease risk factors than those in major cities (AIHW 2010). The aim of this study was to compare and contrast the CRF status in Australians living in different areas of remoteness. The patients in ARIA levels RA1 to RA3 were five years older than those in the combined RA4 & 5 group. The table shows that the CRF status of the patients in RA4 & 5 was worse at entry but similar at exit to RA1 to RA3. This study confirms that remote and very remote patients have CHD five years younger than their more urban counterparts but respond to coaching as well as their less remote counterparts. CRFs
RA1 (n = 1193) Entry
LDL-C < 2 mmol/L BP < 130/80 mmHg HbA1c ≤7% FG < 5.5 mmol/L Not smoking waist at target BMI < 25 kg/m2 Alcohol at target PA at target
30% 54% 47% 48% 88% 34% 28% 84% 55%
Exit 69% 71% 66% 71% 95% 51% 37% 94% 88%
RA2 (n = 446)
RA3 (n = 202)
RA4&5 (n = 130)
Entry
Exit
Entry
Exit
Entry
30% 54% 43% 55% 87% 39% 24% 85% 52%
68% 76% 68% 75% 94% 63% 39% 96% 89%
26% 53% 30% 54% 82% 40% 30% 86% 58%
67% 72% 52% 71% 92% 55% 40% 96% 86%
25% 39% 50% 45% 76% 39% 42% 80% 50%
Exit 64% 58% 67% 74% 89% 67% 50% 95% 89%
753 Mobile Phone Use and Internet/Email Use in Patients with Coronary Disease—Barriers to Use of e-Health Initiatives L. de Keizer 1,3,∗ , J. Redfern 2,3 , A. Thiagalingam 1 , C. Chow 1,2,3 1 Westmead
Hospital, Sydney, Australia of Sydney, Sydney, Australia 3 The George Institute for Global Health, Sydney, Australia 2 University
Background: As technology evolves and becomes increasingly popular and affordable, more opportunities for e-Health initiatives are presented. We aimed to assess mobile telephone, email and internet use to determine the potential for e-Health initiatives. Methods: Fifty-eight patients with diagnosed coronary heart disease (CHD) were recruited from a tertiary referral hospital over a four-week period. Consenting patients were asked what technologies they utilised or had access to. A semi-structured interview was held during which the patients were asked whether they owned a mobile telephone, used an email address or had household internet access. Results: The average age of participants was 65 ± 13years, with 33% being female. Overall, 47% of patients had access to at least one type of technology and 26% access to all three technologies. Almost half of the recruited participants used a mobile telephone but only less than one-third used email or the internet. Males were more likely to have access to technology with 54% having at least one technology. Approximately one third (32%) of females had access to technology. If a female used one type of technology they tended to have all three. The average age of participants utilising all three technologies was 55 ± 10years and of those not accessing any of the three technologies was 77 ± 10years. Gender
Mobile Phone
Internet Access
Email Address
Male (n = 39) 21 (54%) Female (n = 19) 6 (32%) Total (n = 58) 27 (47%)
11 (29%) 5 (26%) 16 (28%)
10 (26%) 5 (26%) 15 (26%)
Utilised all 3 Technologies 10 (26%) 5 (26%) 15 (26%)
Utilised no Technologies 17 (44%) 13 (68%) 30 (52%)
Conclusion: With only one in two patients having access to technology e-Health initiatives may be limited. However, both prevalence of CHD and mobile phone ownership is higher in males highlighting feasibility of e-Health initiatives. http://dx.doi.org/10.1016/j.hlc.2012.05.767 754 Multidisciplinary Team Approach for a Peer-Support based Cardiac-Diabetes Self-Management Program C. Wu Queensland University of Technology (QUT), Australia
http://dx.doi.org/10.1016/j.hlc.2012.05.766
Background: Cardiac patients with diabetes are at higher readmission rates (22%) compared to only 6% for those patients without diabetes. Evidence shows benefits of peer support and using information technology to
improve chronic illness and achieve better health outcomes. However limited evidence suggests that cardiac or diabetes self-management programs incorporating peer supporters (patients with similar conditions) or telephone and text-messaging, have improved health outcomes and reduce health care utilisations. A multidisciplinary research team approach is crucial to accommodate the complex aspects of delivering intervention programs for these at-risk patients. However, challenges such as the inconsistency in significance of key concepts across research fields, as well as practical and operational issues within different contexts are often experienced. Aims: To develop an effective multidisciplinary team approach to deliver a peer support based cardiac-diabetes self-management program incorporating the preparation of lay personnel to provide telephone and text-messaging follow up support. Methods: The approach was used for a multidisciplinary project using randomised controlled trial. Results: The findings from multidisciplinary team approach reveal the feasibility of a Peer support based cardiac-diabetes self-management program. Acknowledgements The full study – Peer Support based Cardiac-Diabetes Self-Management Program is supported by funding from the Department of Health & Ageing through the ‘Sharing Health Care Initiative’. http://dx.doi.org/10.1016/j.hlc.2012.05.768 755 Nurse-Led Exercise Stress Testing Is It Still Safe Practice? R. Zecchin ∗ , J. Baihn, Y. Chai, J. Hungerford, G. Lindsay, M. Owen, M. Pettitt, J. Thelander, P. Vail, R. Denniss Western Sydney Local Health District, Australia Background: Nurse-led exercise-stress testing (NEST) without medical supervision has been performed since 1978 in our hospital-based cardiac rehabilitation units. This study examined the incidence of cardiovascular complications and compared the results with our previous study [1]. Methodology: Data on mortality and morbidity was collected prospectively on all NESTs attended between 1998 and 2011 at 2 sites in Western Sydney. Results: In this study, 11,805 NESTs (97% prognostic) were performed on 4747 patients. The most common entry diagnosis was recent acute myocardial infarction (37%). Mean age was 59 + 12 years and 88% were male. Left ventricular ejection fraction (n = 2323) was 49% + 13. There were no deaths, and there were five major complications requiring emergency action – two episodes of conscious sustained ventricular tachycardia, one mitral valve rupture, one severe ST-segment depression (6.5 mm) and one asystolic cardiac arrest, representing a 0% mortality rate and a 0.038% major morbidity rate. In Phase 2 NESTs (n = 7 863; 92% Bruce), 4.6% had a positive test (ST segment depression >1.9 mm). This study compares favourably to our previous study1 (0% mortality; 0.075% major morbid-
Abstracts CSANZ 2012 Abstracts
S311
ity; 14% positive). In the 26-year period that combines both studies (29 272 NESTs), a 0% mortality and a 0.061% major morbidity rate was demonstrated. Conclusion: This study shows that nurse-led exercise stress testing of higher risk patients continues to be safe practice. Earlier cardiac intervention strategies, ongoing high training standards and re-accreditation of the nurses have contributed to the decrease in major morbidity and positive tests.
Reference [1] Zecchin RP, Chai YY, Roach KA, Speerin R, Lindsay G, Squire J, et al. Is nurse-supervised exercise stress testing safe practice? Heart Lung 1999;2:175–85.
http://dx.doi.org/10.1016/j.hlc.2012.05.769 756 Optimising Secondary Cardiovascular Prevention in Privately Insured Cardiac Patients: The Young @ Heart Multicentre Randomised Controlled Trial Y. Chan 1,∗ , S. Stewart 1 , A. Calderone 1 , P. Scuffham 2 , S. Goldstein 3 , M. Carrington 1 1 Baker
IDI Heart and Diabetes Institute, Melbourne, Australia of Medicine, Griffith University, Brisbane, Australia 3 School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia 2 School
Purpose: While short-term cardiac rehabilitation programs have shown beneficial outcomes, impact of longer-term secondary prevention programs in high-risk individuals is less clear. Methods: The Young @ Heart (Y@H) study examined the impact of a nurse-led, home-based program in privately insured cardiac patients on secondary risk modification, all-cause morbidity and mortality and healthcare utilisation. A ‘sliding-scale’ Y@H intervention system was used to titrate intensity/delivery of care (high, medium or low) based on an individual’s clinical stability, gold-standard management and holistic risk profile during two-year follow-up. Results: A total of 602 (70 ± 10 years, 72% men) cardiac inpatients, of whom 82% had a primary diagnosis of acute coronary syndrome were randomised to usual care (UC, n = 296) or Y@H (n = 306). Baseline assessments (Y@Hgroup) showed 14%, 70%, and 16% of patients required application of high, medium and low intensity management for optimal secondary prevention. At two-year follow-up of 259 (85%) Y@H and 262 (88%) UC patients reported incremental improvements in SBP (−13 ± 27 vs. −8 ± 25 mmHg; p = 0.05) and blood glucose (−0.5 ± 2.7 vs. 0.1 ± 2.2 mmol/L; p = 0.02) in favour of Y@H but minimal differences in total cholesterol and BMI. Overall, there was a significant differential in management intensity between Y@H vs. UC (p = 0.006) with more Y@H patients (39 vs. 27%; OR 1.67; 95% CI: 1.15–1.41; p = 0.007) requiring routine surveillance to optimise secondary prevention in the longer-term.
ABSTRACTS
Heart, Lung and Circulation 2012;21:S143–S316
Abstracts CSANZ 2012 Abstracts
ABSTRACTS
CRFs
Heart, Lung and Circulation 2012;21:S143–S316
No. of patients
Entry into TCP
Exit from TCP
P-value
4560 4465 3904 3973 4802 4790 2715 976 5544 2617 5325 5093 5335
4.3 (3.6, 5.2) 1.4 (1.0, 2.0) 2.4 (1.8, 3.2) 1.1 (0.9, 1.3) 125 (118, 134) 72 (68, 80) 5.4 (5.0, 5.8) 7.1 (6.3, 8.1) 507 (9.1%) 96 (90, 104) 82.5 (73, 93) 3886 (76.3%) 2721 (51.0%)
3.6 (3.2, 4.1) 1.2 (0.9, 1.6) 1.8 (1.5, 2.1) 1.1 (1.0, 1.4) 121 (116, 129) 72 (68, 80) 5.3 (4.9, 5.6) 6.9 (6.3, 7.6) 288 (5.2%) 94 (88, 100) 81 (72, 91) 4413 (86.6%) 4433 (83.1%)
0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0055 0.0000 0.0000 0.0000 0.0000 0.0000
TC, mmol/L TG, mmol/L LDL-C, mmol/L HDL-C, mmol/L SBP, mmHg DBP, mmHg FBG, mmol/L HbA1c, % (DM only) Smoking status Waist, cm Weight, kg Alcohol at target PA at target
Conclusion: TCP had favourable impact on all behavioural and biomedical risk factors measured. This should be contrasted with routine cardiac rehabilitation in Australia where none of this data is known. http://dx.doi.org/10.1016/j.hlc.2012.05.765 752 Impact of The COACH Program on Coronary Risk Factors (CRFs) in Australians from Different Areas of Remoteness U. Boffa 1 , S. Danielewski 1 , P. Gloury 1 , G. Cosgriff 1 , C. Wong 1 , R. Hall 1 , A. Podubinski 1 , J. Wenban 2 , M. Vale 3 , M. Jelinek 3,∗ 1 Bupa
Australia, Victoria, Australia of Western Australia Department of Health, Australia 3 The University of Melbourne Department of Medicine, Australia 2 Government
People in living in rural areas tend to have shorter lives and higher levels of disease risk factors than those in major cities (AIHW 2010). The aim of this study was to compare and contrast the CRF status in Australians living in different areas of remoteness. The patients in ARIA levels RA1 to RA3 were five years older than those in the combined RA4 & 5 group. The table shows that the CRF status of the patients in RA4 & 5 was worse at entry but similar at exit to RA1 to RA3. This study confirms that remote and very remote patients have CHD five years younger than their more urban counterparts but respond to coaching as well as their less remote counterparts. CRFs
RA1 (n = 1193) Entry
LDL-C < 2 mmol/L BP < 130/80 mmHg HbA1c ≤7% FG < 5.5 mmol/L Not smoking waist at target BMI < 25 kg/m2 Alcohol at target PA at target
30% 54% 47% 48% 88% 34% 28% 84% 55%
Exit 69% 71% 66% 71% 95% 51% 37% 94% 88%
RA2 (n = 446)
RA3 (n = 202)
RA4&5 (n = 130)
Entry
Exit
Entry
Exit
Entry
30% 54% 43% 55% 87% 39% 24% 85% 52%
68% 76% 68% 75% 94% 63% 39% 96% 89%
26% 53% 30% 54% 82% 40% 30% 86% 58%
67% 72% 52% 71% 92% 55% 40% 96% 86%
25% 39% 50% 45% 76% 39% 42% 80% 50%
Exit 64% 58% 67% 74% 89% 67% 50% 95% 89%
753 Mobile Phone Use and Internet/Email Use in Patients with Coronary Disease—Barriers to Use of e-Health Initiatives L. de Keizer 1,3,∗ , J. Redfern 2,3 , A. Thiagalingam 1 , C. Chow 1,2,3 1 Westmead
Hospital, Sydney, Australia of Sydney, Sydney, Australia 3 The George Institute for Global Health, Sydney, Australia 2 University
Background: As technology evolves and becomes increasingly popular and affordable, more opportunities for e-Health initiatives are presented. We aimed to assess mobile telephone, email and internet use to determine the potential for e-Health initiatives. Methods: Fifty-eight patients with diagnosed coronary heart disease (CHD) were recruited from a tertiary referral hospital over a four-week period. Consenting patients were asked what technologies they utilised or had access to. A semi-structured interview was held during which the patients were asked whether they owned a mobile telephone, used an email address or had household internet access. Results: The average age of participants was 65 ± 13years, with 33% being female. Overall, 47% of patients had access to at least one type of technology and 26% access to all three technologies. Almost half of the recruited participants used a mobile telephone but only less than one-third used email or the internet. Males were more likely to have access to technology with 54% having at least one technology. Approximately one third (32%) of females had access to technology. If a female used one type of technology they tended to have all three. The average age of participants utilising all three technologies was 55 ± 10years and of those not accessing any of the three technologies was 77 ± 10years. Gender
Mobile Phone
Internet Access
Email Address
Male (n = 39) 21 (54%) Female (n = 19) 6 (32%) Total (n = 58) 27 (47%)
11 (29%) 5 (26%) 16 (28%)
10 (26%) 5 (26%) 15 (26%)
Utilised all 3 Technologies 10 (26%) 5 (26%) 15 (26%)
Utilised no Technologies 17 (44%) 13 (68%) 30 (52%)
Conclusion: With only one in two patients having access to technology e-Health initiatives may be limited. However, both prevalence of CHD and mobile phone ownership is higher in males highlighting feasibility of e-Health initiatives. http://dx.doi.org/10.1016/j.hlc.2012.05.767 754 Multidisciplinary Team Approach for a Peer-Support based Cardiac-Diabetes Self-Management Program C. Wu Queensland University of Technology (QUT), Australia
http://dx.doi.org/10.1016/j.hlc.2012.05.766
Background: Cardiac patients with diabetes are at higher readmission rates (22%) compared to only 6% for those patients without diabetes. Evidence shows benefits of peer support and using information technology to
improve chronic illness and achieve better health outcomes. However limited evidence suggests that cardiac or diabetes self-management programs incorporating peer supporters (patients with similar conditions) or telephone and text-messaging, have improved health outcomes and reduce health care utilisations. A multidisciplinary research team approach is crucial to accommodate the complex aspects of delivering intervention programs for these at-risk patients. However, challenges such as the inconsistency in significance of key concepts across research fields, as well as practical and operational issues within different contexts are often experienced. Aims: To develop an effective multidisciplinary team approach to deliver a peer support based cardiac-diabetes self-management program incorporating the preparation of lay personnel to provide telephone and text-messaging follow up support. Methods: The approach was used for a multidisciplinary project using randomised controlled trial. Results: The findings from multidisciplinary team approach reveal the feasibility of a Peer support based cardiac-diabetes self-management program. Acknowledgements The full study – Peer Support based Cardiac-Diabetes Self-Management Program is supported by funding from the Department of Health & Ageing through the ‘Sharing Health Care Initiative’. http://dx.doi.org/10.1016/j.hlc.2012.05.768 755 Nurse-Led Exercise Stress Testing Is It Still Safe Practice? R. Zecchin ∗ , J. Baihn, Y. Chai, J. Hungerford, G. Lindsay, M. Owen, M. Pettitt, J. Thelander, P. Vail, R. Denniss Western Sydney Local Health District, Australia Background: Nurse-led exercise-stress testing (NEST) without medical supervision has been performed since 1978 in our hospital-based cardiac rehabilitation units. This study examined the incidence of cardiovascular complications and compared the results with our previous study [1]. Methodology: Data on mortality and morbidity was collected prospectively on all NESTs attended between 1998 and 2011 at 2 sites in Western Sydney. Results: In this study, 11,805 NESTs (97% prognostic) were performed on 4747 patients. The most common entry diagnosis was recent acute myocardial infarction (37%). Mean age was 59 + 12 years and 88% were male. Left ventricular ejection fraction (n = 2323) was 49% + 13. There were no deaths, and there were five major complications requiring emergency action – two episodes of conscious sustained ventricular tachycardia, one mitral valve rupture, one severe ST-segment depression (6.5 mm) and one asystolic cardiac arrest, representing a 0% mortality rate and a 0.038% major morbidity rate. In Phase 2 NESTs (n = 7 863; 92% Bruce), 4.6% had a positive test (ST segment depression >1.9 mm). This study compares favourably to our previous study1 (0% mortality; 0.075% major morbid-
Abstracts CSANZ 2012 Abstracts
S311
ity; 14% positive). In the 26-year period that combines both studies (29 272 NESTs), a 0% mortality and a 0.061% major morbidity rate was demonstrated. Conclusion: This study shows that nurse-led exercise stress testing of higher risk patients continues to be safe practice. Earlier cardiac intervention strategies, ongoing high training standards and re-accreditation of the nurses have contributed to the decrease in major morbidity and positive tests.
Reference [1] Zecchin RP, Chai YY, Roach KA, Speerin R, Lindsay G, Squire J, et al. Is nurse-supervised exercise stress testing safe practice? Heart Lung 1999;2:175–85.
http://dx.doi.org/10.1016/j.hlc.2012.05.769 756 Optimising Secondary Cardiovascular Prevention in Privately Insured Cardiac Patients: The Young @ Heart Multicentre Randomised Controlled Trial Y. Chan 1,∗ , S. Stewart 1 , A. Calderone 1 , P. Scuffham 2 , S. Goldstein 3 , M. Carrington 1 1 Baker
IDI Heart and Diabetes Institute, Melbourne, Australia of Medicine, Griffith University, Brisbane, Australia 3 School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia 2 School
Purpose: While short-term cardiac rehabilitation programs have shown beneficial outcomes, impact of longer-term secondary prevention programs in high-risk individuals is less clear. Methods: The Young @ Heart (Y@H) study examined the impact of a nurse-led, home-based program in privately insured cardiac patients on secondary risk modification, all-cause morbidity and mortality and healthcare utilisation. A ‘sliding-scale’ Y@H intervention system was used to titrate intensity/delivery of care (high, medium or low) based on an individual’s clinical stability, gold-standard management and holistic risk profile during two-year follow-up. Results: A total of 602 (70 ± 10 years, 72% men) cardiac inpatients, of whom 82% had a primary diagnosis of acute coronary syndrome were randomised to usual care (UC, n = 296) or Y@H (n = 306). Baseline assessments (Y@Hgroup) showed 14%, 70%, and 16% of patients required application of high, medium and low intensity management for optimal secondary prevention. At two-year follow-up of 259 (85%) Y@H and 262 (88%) UC patients reported incremental improvements in SBP (−13 ± 27 vs. −8 ± 25 mmHg; p = 0.05) and blood glucose (−0.5 ± 2.7 vs. 0.1 ± 2.2 mmol/L; p = 0.02) in favour of Y@H but minimal differences in total cholesterol and BMI. Overall, there was a significant differential in management intensity between Y@H vs. UC (p = 0.006) with more Y@H patients (39 vs. 27%; OR 1.67; 95% CI: 1.15–1.41; p = 0.007) requiring routine surveillance to optimise secondary prevention in the longer-term.
ABSTRACTS
Heart, Lung and Circulation 2012;21:S143–S316