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PM201 Benznidazole Treatment is Associated With Lower Bnp Levels in Chagas Cardiomyopathy Patients
POSTER ABSTRACTS
PM200 Cohort Profile: Longitudinal Study of Patients With Chronic Chagas Cardiomyopathy in Brazil: (Sami-Trop Project) C. S. Cardoso1,2, E. C. Sabino3, C. D. L. Oliveira1, L. C. Oliveira4, A. M. Ferreira5, E. C. Neto6, A. L. Bierrenbach7, A. L. Reingold2, J. E. Ferreira8, A. L. P. Ribeiro*9 1 School of Medicine, Federal University of São João del-Rei., Divinópolis, Brazil, 2School of Public Health, University of California, Berkeley, United States, 3Department of Infectious Diseases, School of Medicine and Institute of Tropical Medicine., University of São Paulo, São Paulo, 4 Laboratory of Medicine Laboratorial (LIM03), General Hospital, School of Medicine, University of São Paulo., São Paulo, 5School of Medicine, Estadual University of Montes Claros., Montes Claros, 6Laboratory of Immunology, Heart Instituto (InCor), School of Medicine, University of São Paulo., São Paulo, 7Department of Infectious Diseases, School of Medicine and Institute of Tropical Medicine, University of São Paulo, Montes Claros, 8Institute of Mathematics and Statistics, Estadual University of Montes Claros., São Paulo, 9Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil Introduction: The most important consequence of Chagas Disease (ChD) is Chronic Chagas Cardiomyopathy (CCC), which occurs in 20 to 40% of infected persons. It is a potentially lethal condition, but the severity of the disease varies widely and accurate stratification of the risk of disease progression and death remains an unsolved challenge. Objectives: To develop a prognostic algorithm, based on simple electrocardiogram measurements in conjunction with clinical information and Brain Natriuretic Peptide (BNP) levels, that would be used to predict the risk of disease progression and death in CCC patients that can be useful in the clinical management of such patients. Methods: We have established a cohort of 1,959 patients with chronic Chagas cardiomyopathy (CCC) conducted in 21 cities of the northern part of Minas Gerais state in Brazil, and includes a follow up of at least two years. The baseline evaluation included collection of socio-demographic information, social determinants of health, health-related behaviours, comorbidities, medicines in use, history of previous treatment for Chagas Disease (ChD), symptoms, functional class (FC), quality of life, blood sample collection and ECG. Results: Patients were mostly female, aged 50-74 years, with low family income and educational level, with known ChD for >10 years; 46% presented with FC > I. Previous use of benznidazole was reported by 25.2% and permanent use of pacemaker by 6.2%. Almost half of the patients presented with high blood cholesterol and hypertension and one third of them had diabetes mellitus. NT-ProBNP level at baseline were >300 (pg/Ml) in 30% of the sample and a positive Polymerase Chain Reaction was found in 36,3%. Conclusion: Clinical and laboratory markers predictive of severe and progressive ChD were identified in SAMI-TROP cohort, as high NT-ProBNP levels, as well as symptoms of advanced heart failure. The PCR results is suggestive of active parasite replication, associated with inflammation and subsequent cardiac damage. Base line results confirm the important residual morbidity of ChD in the remote areas, thus supporting political decisions that should prioritize besides epidemiological surveillance the medical treatment of CCC in the coming years. Disclosure of Interest: None Declared PM201 Benznidazole Treatment is Associated With Lower Bnp Levels in Chagas Cardiomyopathy Patients C. S. Cardoso1,2, E. C. Sabino3, C. D. L. Oliveira4, L. C. Oliveira5, A. M. Ferreira6, J. L. P. Silva7, A. P. Antunes6, A. L. P. Ribeiro*8 1 School of Medicine, Federal University of São João del-Rei., Divinópolis, Brazil, 2School of Public Health, University of California, Berkeley, United States, 3Department of Infectious Diseases, School of Medicine and Institute of Tropical Medicine., University of São Paulo, São Paulo, 4 Public Health, Federal University of São João del-Rei., Divinópolis, 5Laboratory of Medicine Laboratorial (LIM03), General Hospital, School of Medicine, University of São Paulo., São Paulo, 6 School of Medicine, Estadual University of Montes Claros., Montes Claros, 7University Hospital, 8 Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil Introduction: Chagas Disease, caused by Trypanosoma cruzi infection, is a major cause of cardiomyopathy in Latin America and, due to migratory movements, is present also in developed world. The benefit of anti-parasite treatment with benznidazole (BZN) in cardiomyopathy is not well established. Brain Natriuretic Peptide (BNP) and NT-ProBNP levels are accurate markers of left ventricular systolic and diastolic dysfunction and may be useful in the evaluation of effectiveness of interventions in patients with Chronic Chagas Cardiomyopathy (CCC). Objectives: To evaluate the impact of the use of benznidazole (BZN) in NT-ProBNP levels in patients with Chronic Chagas Cardiomyopathy (CCC). Methods: Patients were selected from the baseline sample of a cohort study of CCC patients with typical ECG findings and no major other systemic disease. Treated Group was composed by CCC subjects that received at least one course of treatment with BZN and a Comparison Group of CCC patients with similar characteristics was composed by using a pairing method (Genetic Matching). Gender, age, income, literacy, time of known Chagas and use of diuretics were used for pairing between the groups. Results: The study was conducted in 22 cities of the north of state of Minas Gerais, Brazil, a highly endemic region, from 2013-2014. A total of 2,157 patients were interviewed and 1,959 (90.8%) of them had positive serology for Chagas disease (Elisa), of which 1803 with NT-ProBNP results were studied. The mean age of this sample was 59 years and 68% were
e104
female. A total of 491patients reported previous use of BZN with average time of use of 90 days, 75% treated more than five years before the interview. The matched Comparison Group had frequencies of covariates identical to the Treatment Group. In paired group analysis, log NT-ProBNP is significantly reduced with previous use of BZN (4.63 versus 4.97, difference: -0.38; CI:-0.46;-0.31). A similar effect size was observed using the whole sample using multiple linear regression (Difference between groups: -0.39; CI:-0.47;-0.32). Conclusion: In an endemic region, when compared to a similar Control Group obtained by genetic matching, patients previously treated with BZN had lower levels of NT-ProBNP, showing that empiric specific treatment of Chagas disease may reduce the severity of CCC. Disclosure of Interest: None Declared PM203 Hypertension Knowledge Retention Among Community Health Workers in Rural Western Kenya: Process Evaluation of the Lark Hypertension Study A. Frawley*1, J. Rotich2, A. K. Delong3, D. Menya4, V. Naanyu5, C. R. Horowitz6, V. Fuster7, D. Litzelman8, J. Kamano9, R. Vedanthan7 1 Preventive Medicine, Icahn School fo Medicine at Mount Sinai, New York City, United States, 2 AMPATH, Eldoret, Kenya, 3Center for Statistical Sciences, Brown University, Providence, United States, 4School of Public Health, Department of Epidemiology, 5School of Medicine, Department of Behavioral Sciences, Moi University College of Health Sciences, Eldoret, Kenya, 6 Population Health Science and Policy, Icahn School fo Medicine at Mount Sinai, New York, 7 Cardiology, Icahn School fo Medicine at Mount Sinai, New York City, 8Indiana University, Bloomington, United States, 9School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya Introduction: Hypertension is the leading global risk factor for mortality, with increasing prevalence in sub-Saharan Africa. Optimizing Linkage and Retention to Hypertension Care in Rural Kenya (LARK) is a randomized controlled trial investigating whether community health workers (CHWs) from Turbo and Kosiari districts in western Kenya, equipped with decision-support tools, can increase linkage and retention of hypertensive individuals to dispensary-based care programs, thereby improving blood pressure control. A critical component of process evaluation is assessing retention and fidelity of the planned interventions. One portion of the LARK process evaluation data is presented here. Objectives: Assess fidelity, 12 to 15 months after initial training, of hypertension-related knowledge by CHWs trained in the LARK study. Methods: Of the 308 CHWs who received specialized hypertension training, 35 were randomly invited from usual care and decision-support tool arms to complete a tenquestion self-administered questionnaire to assess knowledge of hypertension etiology, symptoms, complications, and management strategies. Test scores were compared by CHW gender and study arm using ordinal logistic regression (3 levels: 60%; 70%; and >70% correct). Presented ORs express the relationship between being in a higher test score level and the covariate. Results: 28 CHWs participated (80%); 16 were female (57%), 16 from usual care arm (57%). Mean overall test score was 69% (range 50-90%). Strong knowledge was observed in causes (100% correct), non-pharmacologic treatment (81%), and complications of hypertension (81%). Deficiencies were noted in recalling symptoms (44%) and understanding treatment side effects (19%). There was no difference in test scores across CHW gender (OR¼ 0.94, CI¼ 0.2-3.8); test scores were higher in the decision-support tool arm (OR¼ 8.0, CI 1.7- 38.7, p < 0.01). Conclusion: CHWs had good knowledge of certain aspects of hypertension management. Additional education about signs and symptoms of hypertension and medication complications appears necessary. CHWs with decision-support tools retained knowledge better. CHWs involved in hypertension management may need intensive, repeated training regarding hypertension management. Disclosure of Interest: None Declared PM204 A Rapid Assessment of the Readiness Of Public Health Facilities for Cardiovascular Disease Management in Andhra Pradesh, India R. Joshi*1, B. Essue1, B. Marais2, R. Guggilla3, D. Praveen3, J. Negin4, S. Jan1 1 The George Institute for Global Health, University of Sydney, Camperdown, 2Westmead Hospital, University of Sydney, Westmead, NSW, Australia, 3The George Institute, India, Hyderabad, India, 4University of Sydney, Camperdown, Australia Introduction: Cardiovascular disease (CVD) are responsible for considerable premature morbidity and mortality in India. There is an urgent need to strengthen the Indian healthcare system’s capacity to effectively manage patients with non-communicable disease – a commitment that aligns with the new Sustainable Development Goals (SDGs). Objectives: The aim of this project was to assess the public healthcare system readiness for CVD management in rural India. Methods: The study was conducted in the west Godavari district of Andhra Pradesh, India. The rapid assessment included three components: A) assessing the availability of essential CVD medicines in public pharmacies at 10 primary health centres, 2 community health centres, 2 area hospitals and 1 district hospital B) auditing compliance with the Indian Public Health Standards for workforce and equipment availability, as well as C) in-depth interviews with healthcare providers (n¼12) and three focus group discussions with patients.
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS
PM200 Cohort Profile: Longitudinal Study of Patients With Chronic Chagas Cardiomyopathy in Brazil: (Sami-Trop Project) C. S. Cardoso1,2, E. C. Sabino3, C. D. L. Oliveira1, L. C. Oliveira4, A. M. Ferreira5, E. C. Neto6, A. L. Bierrenbach7, A. L. Reingold2, J. E. Ferreira8, A. L. P. Ribeiro*9 1 School of Medicine, Federal University of São João del-Rei., Divinópolis, Brazil, 2School of Public Health, University of California, Berkeley, United States, 3Department of Infectious Diseases, School of Medicine and Institute of Tropical Medicine., University of São Paulo, São Paulo, 4 Laboratory of Medicine Laboratorial (LIM03), General Hospital, School of Medicine, University of São Paulo., São Paulo, 5School of Medicine, Estadual University of Montes Claros., Montes Claros, 6Laboratory of Immunology, Heart Instituto (InCor), School of Medicine, University of São Paulo., São Paulo, 7Department of Infectious Diseases, School of Medicine and Institute of Tropical Medicine, University of São Paulo, Montes Claros, 8Institute of Mathematics and Statistics, Estadual University of Montes Claros., São Paulo, 9Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil Introduction: The most important consequence of Chagas Disease (ChD) is Chronic Chagas Cardiomyopathy (CCC), which occurs in 20 to 40% of infected persons. It is a potentially lethal condition, but the severity of the disease varies widely and accurate stratification of the risk of disease progression and death remains an unsolved challenge. Objectives: To develop a prognostic algorithm, based on simple electrocardiogram measurements in conjunction with clinical information and Brain Natriuretic Peptide (BNP) levels, that would be used to predict the risk of disease progression and death in CCC patients that can be useful in the clinical management of such patients. Methods: We have established a cohort of 1,959 patients with chronic Chagas cardiomyopathy (CCC) conducted in 21 cities of the northern part of Minas Gerais state in Brazil, and includes a follow up of at least two years. The baseline evaluation included collection of socio-demographic information, social determinants of health, health-related behaviours, comorbidities, medicines in use, history of previous treatment for Chagas Disease (ChD), symptoms, functional class (FC), quality of life, blood sample collection and ECG. Results: Patients were mostly female, aged 50-74 years, with low family income and educational level, with known ChD for >10 years; 46% presented with FC > I. Previous use of benznidazole was reported by 25.2% and permanent use of pacemaker by 6.2%. Almost half of the patients presented with high blood cholesterol and hypertension and one third of them had diabetes mellitus. NT-ProBNP level at baseline were >300 (pg/Ml) in 30% of the sample and a positive Polymerase Chain Reaction was found in 36,3%. Conclusion: Clinical and laboratory markers predictive of severe and progressive ChD were identified in SAMI-TROP cohort, as high NT-ProBNP levels, as well as symptoms of advanced heart failure. The PCR results is suggestive of active parasite replication, associated with inflammation and subsequent cardiac damage. Base line results confirm the important residual morbidity of ChD in the remote areas, thus supporting political decisions that should prioritize besides epidemiological surveillance the medical treatment of CCC in the coming years. Disclosure of Interest: None Declared PM201 Benznidazole Treatment is Associated With Lower Bnp Levels in Chagas Cardiomyopathy Patients C. S. Cardoso1,2, E. C. Sabino3, C. D. L. Oliveira4, L. C. Oliveira5, A. M. Ferreira6, J. L. P. Silva7, A. P. Antunes6, A. L. P. Ribeiro*8 1 School of Medicine, Federal University of São João del-Rei., Divinópolis, Brazil, 2School of Public Health, University of California, Berkeley, United States, 3Department of Infectious Diseases, School of Medicine and Institute of Tropical Medicine., University of São Paulo, São Paulo, 4 Public Health, Federal University of São João del-Rei., Divinópolis, 5Laboratory of Medicine Laboratorial (LIM03), General Hospital, School of Medicine, University of São Paulo., São Paulo, 6 School of Medicine, Estadual University of Montes Claros., Montes Claros, 7University Hospital, 8 Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil Introduction: Chagas Disease, caused by Trypanosoma cruzi infection, is a major cause of cardiomyopathy in Latin America and, due to migratory movements, is present also in developed world. The benefit of anti-parasite treatment with benznidazole (BZN) in cardiomyopathy is not well established. Brain Natriuretic Peptide (BNP) and NT-ProBNP levels are accurate markers of left ventricular systolic and diastolic dysfunction and may be useful in the evaluation of effectiveness of interventions in patients with Chronic Chagas Cardiomyopathy (CCC). Objectives: To evaluate the impact of the use of benznidazole (BZN) in NT-ProBNP levels in patients with Chronic Chagas Cardiomyopathy (CCC). Methods: Patients were selected from the baseline sample of a cohort study of CCC patients with typical ECG findings and no major other systemic disease. Treated Group was composed by CCC subjects that received at least one course of treatment with BZN and a Comparison Group of CCC patients with similar characteristics was composed by using a pairing method (Genetic Matching). Gender, age, income, literacy, time of known Chagas and use of diuretics were used for pairing between the groups. Results: The study was conducted in 22 cities of the north of state of Minas Gerais, Brazil, a highly endemic region, from 2013-2014. A total of 2,157 patients were interviewed and 1,959 (90.8%) of them had positive serology for Chagas disease (Elisa), of which 1803 with NT-ProBNP results were studied. The mean age of this sample was 59 years and 68% were
e104
female. A total of 491patients reported previous use of BZN with average time of use of 90 days, 75% treated more than five years before the interview. The matched Comparison Group had frequencies of covariates identical to the Treatment Group. In paired group analysis, log NT-ProBNP is significantly reduced with previous use of BZN (4.63 versus 4.97, difference: -0.38; CI:-0.46;-0.31). A similar effect size was observed using the whole sample using multiple linear regression (Difference between groups: -0.39; CI:-0.47;-0.32). Conclusion: In an endemic region, when compared to a similar Control Group obtained by genetic matching, patients previously treated with BZN had lower levels of NT-ProBNP, showing that empiric specific treatment of Chagas disease may reduce the severity of CCC. Disclosure of Interest: None Declared PM203 Hypertension Knowledge Retention Among Community Health Workers in Rural Western Kenya: Process Evaluation of the Lark Hypertension Study A. Frawley*1, J. Rotich2, A. K. Delong3, D. Menya4, V. Naanyu5, C. R. Horowitz6, V. Fuster7, D. Litzelman8, J. Kamano9, R. Vedanthan7 1 Preventive Medicine, Icahn School fo Medicine at Mount Sinai, New York City, United States, 2 AMPATH, Eldoret, Kenya, 3Center for Statistical Sciences, Brown University, Providence, United States, 4School of Public Health, Department of Epidemiology, 5School of Medicine, Department of Behavioral Sciences, Moi University College of Health Sciences, Eldoret, Kenya, 6 Population Health Science and Policy, Icahn School fo Medicine at Mount Sinai, New York, 7 Cardiology, Icahn School fo Medicine at Mount Sinai, New York City, 8Indiana University, Bloomington, United States, 9School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya Introduction: Hypertension is the leading global risk factor for mortality, with increasing prevalence in sub-Saharan Africa. Optimizing Linkage and Retention to Hypertension Care in Rural Kenya (LARK) is a randomized controlled trial investigating whether community health workers (CHWs) from Turbo and Kosiari districts in western Kenya, equipped with decision-support tools, can increase linkage and retention of hypertensive individuals to dispensary-based care programs, thereby improving blood pressure control. A critical component of process evaluation is assessing retention and fidelity of the planned interventions. One portion of the LARK process evaluation data is presented here. Objectives: Assess fidelity, 12 to 15 months after initial training, of hypertension-related knowledge by CHWs trained in the LARK study. Methods: Of the 308 CHWs who received specialized hypertension training, 35 were randomly invited from usual care and decision-support tool arms to complete a tenquestion self-administered questionnaire to assess knowledge of hypertension etiology, symptoms, complications, and management strategies. Test scores were compared by CHW gender and study arm using ordinal logistic regression (3 levels: 60%; 70%; and >70% correct). Presented ORs express the relationship between being in a higher test score level and the covariate. Results: 28 CHWs participated (80%); 16 were female (57%), 16 from usual care arm (57%). Mean overall test score was 69% (range 50-90%). Strong knowledge was observed in causes (100% correct), non-pharmacologic treatment (81%), and complications of hypertension (81%). Deficiencies were noted in recalling symptoms (44%) and understanding treatment side effects (19%). There was no difference in test scores across CHW gender (OR¼ 0.94, CI¼ 0.2-3.8); test scores were higher in the decision-support tool arm (OR¼ 8.0, CI 1.7- 38.7, p < 0.01). Conclusion: CHWs had good knowledge of certain aspects of hypertension management. Additional education about signs and symptoms of hypertension and medication complications appears necessary. CHWs with decision-support tools retained knowledge better. CHWs involved in hypertension management may need intensive, repeated training regarding hypertension management. Disclosure of Interest: None Declared PM204 A Rapid Assessment of the Readiness Of Public Health Facilities for Cardiovascular Disease Management in Andhra Pradesh, India R. Joshi*1, B. Essue1, B. Marais2, R. Guggilla3, D. Praveen3, J. Negin4, S. Jan1 1 The George Institute for Global Health, University of Sydney, Camperdown, 2Westmead Hospital, University of Sydney, Westmead, NSW, Australia, 3The George Institute, India, Hyderabad, India, 4University of Sydney, Camperdown, Australia Introduction: Cardiovascular disease (CVD) are responsible for considerable premature morbidity and mortality in India. There is an urgent need to strengthen the Indian healthcare system’s capacity to effectively manage patients with non-communicable disease – a commitment that aligns with the new Sustainable Development Goals (SDGs). Objectives: The aim of this project was to assess the public healthcare system readiness for CVD management in rural India. Methods: The study was conducted in the west Godavari district of Andhra Pradesh, India. The rapid assessment included three components: A) assessing the availability of essential CVD medicines in public pharmacies at 10 primary health centres, 2 community health centres, 2 area hospitals and 1 district hospital B) auditing compliance with the Indian Public Health Standards for workforce and equipment availability, as well as C) in-depth interviews with healthcare providers (n¼12) and three focus group discussions with patients.
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS