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PM283 Rheumatic Heart Disease Screening in School Children Through Portable Echocardiography in Brazil: The Provar Study
POSTER ABSTRACTS
Table 1. show the mean and correlation between A¼2Pr2 with planimetry and PHT to estimate mitral valve area. rs (correlation coefficient) (pvalue)
Mitral valve tip separation (A [2Pr2) Median (a)
Pressure Half Time (PHT) Median (b)
Planimetry Median (c)
(a) – (b)
Severe (<1.0cm2)
0.8cm2
0.9cm2
0.9cm2
0.48 (0.006)
Moderate (1.11.49cm2)
1.3cm2
1.2cm2
1.2cm2
0.065 (0.720)
-0.061 (0.79)
Mild (>1.5cm2)
1.9cm2
1.6cm2
1.8cm2
-0.59 (0.847)
-0.29 (0.18)
(a) – (c) 0.7 (0.004)
Objectives: We aimed to develop an adherence index which improves on the PSIR by incorporating aspects of irregularity of treatment. Methods: Due to the linear nature of prophylaxis schedules (injections recommended at constant intervals, such as every 28 days), irregularity of interventions can be statistically assessed using methods of linear modelling in conjunction with established agreement indices. We propose a modified version of the Lin’s concordance coefficient which takes the specifics of adherence data into account. The performance of the proposed measure, the concordance adherence index (CAI), is illustrated using pseudo case series as well as a realworld dataset of prophylaxis injections collected for 320 RHD patients from Fiji. Results: When compared to established adherence measures such as the PSIR, the CAI demonstrated equal or higher diversity across the pseudo case series. Application to the Fiji RHD dataset showed the capability of the CAI to further discriminate individuals with equal or similar PSIR values (Figure 1).
Conclusion: Our study shows in mitral stenosis, there is good correlation of estimation of mitral valve area by mitral valve tip separation to both MVA by PHT and planimetry in severe mitral stenosis. This method can be used to assess severity in mitral valve stenosis and may complement to the standard method. Disclosure of Interest: None Declared PM283 Rheumatic Heart Disease Screening in School Children Through Portable Echocardiography in Brazil: The Provar Study M. D. C. P. Nunes1, A. Beaton2, B. R. Nascimento*1, A. Diamantino1, C. M. Oliveira1, K. B. Oliveira1, L. Perlman2, G. Chequer1, M. C. Galbas1, J. P. Santos1, L. Lafeta3, C. G. Ferreira3, A. L. P. Ribeiro1, C. Sable2 1 UFMG, Belo Horizonte, Brazil, 2Children’s National Health System, Washington, DC, United States, 3UFMG, Montes Claros, Brazil Introduction: The accuracy of clinical examination is limited for early diagnosis of Rheumatic Heart Disease (RHD). The 2012 World Heart Federation (WHF) Criteria provides standardized echocardiographic (echo) guidelines for diagnosis of RHD. There is sparse data on echo prevalence of RHD in Brazil. Objectives: Assess the prevalence of RHD in students (6-18 years) from public schools in low-income areas in Brazil. Methods: Over 13 months, non-physicians and experts used standard portable (GE, VividQ) or handheld machines (GE, VSCAN) and the 2012 WHF Criteria to determine RHD prevalence. All consented and present children were eligible for participation. All studies were officially interpreted remotely using a telemedicine cloud-server by experts in Brazil and the US. RHD prevalence by gender, age (5-11 & 12-18) and region of the state (central or north) were compared using Fisher’s Exact Test. Results: A total of 4,400 students were screened across 17 schools in urban and rural areas of Minas Gerais, Brazil. The mean age was 13.62.8 (6 to 18) years, 52.3% female. The prevalence of RHD was 5.1% (226/4400): 4.6% borderline RHD (n¼205) and 0.5% definite RHD (n¼21). Of these, 83.7% had pathologic mitral regurgitation and 27 (16.3%) had pathologic aortic regurgitation. Ten children had mixed mitral/aortic valve disease and 1 had mitral stenosis. There was no difference in RHD prevalence between younger and older kids (p¼0.49) or between northern (predominantly rural) and central areas (5.9% vs. 5.0%, p¼0.46). Girls had higher prevalence (5.9% vs. 4.1%, p¼0.009). Minor congenital heart disease was detected in 35 additional children (0.8%), including 11 mitral prolapses and 4 ASDs. Kids with abnormal results were referred for follow-up echo. Conclusion: WHF Criteria make it possible to obtain and accurately compare echo prevalence of RHD among different regions of the world. The PROVAR study shows that, among children living in low-socioeconomic conditions in Brazil, RHD remains a significant health burden, comparable to that in other low-resource communities. Contemporary data such as these provide justification for investing in comprehensive RHD control programs in Brazil, and around the globe. Disclosure of Interest: None Declared PM285 A Novel Method to Measure Adherence to Secondary Prophylaxis for Rheumatic Heart Disease – Introducing the Concordance Adherence Index T. Schuster1,2, T. Parks3, D. Engelman*1,2, B. Ward2, A. Steer1,2 1 Paediatrics, University of Melbourne, 2Murdoch Childrens Research Institute, Melbourne, Australia, 3Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, United Kingdom Introduction: Patient adherence to long-term treatment is most frequently expressed using a ratio, measuring the fractional utilisation of the recommended treatment over a given time period. For adherence to secondary antibiotic prophylaxis for rheumatic heart disease (RHD), the proportion of scheduled injections received (PSIR) is the most widely used measure. However, for chronic diseases with long observation periods, patterns of treatment irregularity can substantially vary across individual patients and populations. These variations are not reflected by the established ratio-based adherence measures.
e118
Conclusion: We present a novel adherence index that incorporates the degree of treatment irregularity and therefore allows for a finer discrimination of individual adherence. Reporting the CAI alongside established ratio-based adherence measures will provide increased information for program managers and policy decisions. Disclosure of Interest: None Declared PM286 Surgery for Rheumatic Heart Disease - Factors Associated With Treatment Choice and Short and Long-Term Outcomes in Australia G. P. Maguire*1, L. Tran2, C. Reid2, A. Russell2 Clinical Research Domain, Baker IDI Heart and Diabetes Institute, 2Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
1
Introduction: Rheumatic heart disease (RHD) remains an important preventable cause of heart disease. In Australia it particularly affects younger Indigenous and older non-Indigenous Australians. Despite its impact there is limited understanding of the factors influencing treatment choice and outcome following surgery. Objectives: The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed to identify predictors of treatment choice and outcomes following surgery for RHD and non-RHD valvular disease. Methods: A cohort study was undertaken to describe surgical management of Australian patients with RHD compared with non-RHD related disease. Factors independently associated with treatment choice were identified. Short term (30 day) post-operative complications and short and long term survival (out to ten years) was assessed. Independent factors associated with outcomes were identified. The role of centre and surgeon case load on treatment choice and outcome was further analysed. Results: Outcomes associated with 20116 valve procedures (1560 RHD and 18556 nonRHD-related) at 25 surgical sites and by 93 surgeons were analysed. RHD patients were younger, more likely to be female and Indigenous Australian, to have AF and previous percutaneous balloon valvuloplasty (PBV). RHD patients had longer ventilation, fewer strokes and more readmissions and anticoagulant complications. Factors independently associated with poorer longer term survival following RHD surgery included older age, diabetes and chronic kidney disease, longer invasive ventilation time and prolonged stay in hospital. Survival in Indigenous Australians was comparable to that seen in non-Indigenous Australians. Adjusted thirty day, but not longer term survival, was superior in higher volume centres. In contrast average annual surgeon case load was not related to 30 day mortality but
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS
Table 1. show the mean and correlation between A¼2Pr2 with planimetry and PHT to estimate mitral valve area. rs (correlation coefficient) (pvalue)
Mitral valve tip separation (A [2Pr2) Median (a)
Pressure Half Time (PHT) Median (b)
Planimetry Median (c)
(a) – (b)
Severe (<1.0cm2)
0.8cm2
0.9cm2
0.9cm2
0.48 (0.006)
Moderate (1.11.49cm2)
1.3cm2
1.2cm2
1.2cm2
0.065 (0.720)
-0.061 (0.79)
Mild (>1.5cm2)
1.9cm2
1.6cm2
1.8cm2
-0.59 (0.847)
-0.29 (0.18)
(a) – (c) 0.7 (0.004)
Objectives: We aimed to develop an adherence index which improves on the PSIR by incorporating aspects of irregularity of treatment. Methods: Due to the linear nature of prophylaxis schedules (injections recommended at constant intervals, such as every 28 days), irregularity of interventions can be statistically assessed using methods of linear modelling in conjunction with established agreement indices. We propose a modified version of the Lin’s concordance coefficient which takes the specifics of adherence data into account. The performance of the proposed measure, the concordance adherence index (CAI), is illustrated using pseudo case series as well as a realworld dataset of prophylaxis injections collected for 320 RHD patients from Fiji. Results: When compared to established adherence measures such as the PSIR, the CAI demonstrated equal or higher diversity across the pseudo case series. Application to the Fiji RHD dataset showed the capability of the CAI to further discriminate individuals with equal or similar PSIR values (Figure 1).
Conclusion: Our study shows in mitral stenosis, there is good correlation of estimation of mitral valve area by mitral valve tip separation to both MVA by PHT and planimetry in severe mitral stenosis. This method can be used to assess severity in mitral valve stenosis and may complement to the standard method. Disclosure of Interest: None Declared PM283 Rheumatic Heart Disease Screening in School Children Through Portable Echocardiography in Brazil: The Provar Study M. D. C. P. Nunes1, A. Beaton2, B. R. Nascimento*1, A. Diamantino1, C. M. Oliveira1, K. B. Oliveira1, L. Perlman2, G. Chequer1, M. C. Galbas1, J. P. Santos1, L. Lafeta3, C. G. Ferreira3, A. L. P. Ribeiro1, C. Sable2 1 UFMG, Belo Horizonte, Brazil, 2Children’s National Health System, Washington, DC, United States, 3UFMG, Montes Claros, Brazil Introduction: The accuracy of clinical examination is limited for early diagnosis of Rheumatic Heart Disease (RHD). The 2012 World Heart Federation (WHF) Criteria provides standardized echocardiographic (echo) guidelines for diagnosis of RHD. There is sparse data on echo prevalence of RHD in Brazil. Objectives: Assess the prevalence of RHD in students (6-18 years) from public schools in low-income areas in Brazil. Methods: Over 13 months, non-physicians and experts used standard portable (GE, VividQ) or handheld machines (GE, VSCAN) and the 2012 WHF Criteria to determine RHD prevalence. All consented and present children were eligible for participation. All studies were officially interpreted remotely using a telemedicine cloud-server by experts in Brazil and the US. RHD prevalence by gender, age (5-11 & 12-18) and region of the state (central or north) were compared using Fisher’s Exact Test. Results: A total of 4,400 students were screened across 17 schools in urban and rural areas of Minas Gerais, Brazil. The mean age was 13.62.8 (6 to 18) years, 52.3% female. The prevalence of RHD was 5.1% (226/4400): 4.6% borderline RHD (n¼205) and 0.5% definite RHD (n¼21). Of these, 83.7% had pathologic mitral regurgitation and 27 (16.3%) had pathologic aortic regurgitation. Ten children had mixed mitral/aortic valve disease and 1 had mitral stenosis. There was no difference in RHD prevalence between younger and older kids (p¼0.49) or between northern (predominantly rural) and central areas (5.9% vs. 5.0%, p¼0.46). Girls had higher prevalence (5.9% vs. 4.1%, p¼0.009). Minor congenital heart disease was detected in 35 additional children (0.8%), including 11 mitral prolapses and 4 ASDs. Kids with abnormal results were referred for follow-up echo. Conclusion: WHF Criteria make it possible to obtain and accurately compare echo prevalence of RHD among different regions of the world. The PROVAR study shows that, among children living in low-socioeconomic conditions in Brazil, RHD remains a significant health burden, comparable to that in other low-resource communities. Contemporary data such as these provide justification for investing in comprehensive RHD control programs in Brazil, and around the globe. Disclosure of Interest: None Declared PM285 A Novel Method to Measure Adherence to Secondary Prophylaxis for Rheumatic Heart Disease – Introducing the Concordance Adherence Index T. Schuster1,2, T. Parks3, D. Engelman*1,2, B. Ward2, A. Steer1,2 1 Paediatrics, University of Melbourne, 2Murdoch Childrens Research Institute, Melbourne, Australia, 3Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, United Kingdom Introduction: Patient adherence to long-term treatment is most frequently expressed using a ratio, measuring the fractional utilisation of the recommended treatment over a given time period. For adherence to secondary antibiotic prophylaxis for rheumatic heart disease (RHD), the proportion of scheduled injections received (PSIR) is the most widely used measure. However, for chronic diseases with long observation periods, patterns of treatment irregularity can substantially vary across individual patients and populations. These variations are not reflected by the established ratio-based adherence measures.
e118
Conclusion: We present a novel adherence index that incorporates the degree of treatment irregularity and therefore allows for a finer discrimination of individual adherence. Reporting the CAI alongside established ratio-based adherence measures will provide increased information for program managers and policy decisions. Disclosure of Interest: None Declared PM286 Surgery for Rheumatic Heart Disease - Factors Associated With Treatment Choice and Short and Long-Term Outcomes in Australia G. P. Maguire*1, L. Tran2, C. Reid2, A. Russell2 Clinical Research Domain, Baker IDI Heart and Diabetes Institute, 2Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
1
Introduction: Rheumatic heart disease (RHD) remains an important preventable cause of heart disease. In Australia it particularly affects younger Indigenous and older non-Indigenous Australians. Despite its impact there is limited understanding of the factors influencing treatment choice and outcome following surgery. Objectives: The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed to identify predictors of treatment choice and outcomes following surgery for RHD and non-RHD valvular disease. Methods: A cohort study was undertaken to describe surgical management of Australian patients with RHD compared with non-RHD related disease. Factors independently associated with treatment choice were identified. Short term (30 day) post-operative complications and short and long term survival (out to ten years) was assessed. Independent factors associated with outcomes were identified. The role of centre and surgeon case load on treatment choice and outcome was further analysed. Results: Outcomes associated with 20116 valve procedures (1560 RHD and 18556 nonRHD-related) at 25 surgical sites and by 93 surgeons were analysed. RHD patients were younger, more likely to be female and Indigenous Australian, to have AF and previous percutaneous balloon valvuloplasty (PBV). RHD patients had longer ventilation, fewer strokes and more readmissions and anticoagulant complications. Factors independently associated with poorer longer term survival following RHD surgery included older age, diabetes and chronic kidney disease, longer invasive ventilation time and prolonged stay in hospital. Survival in Indigenous Australians was comparable to that seen in non-Indigenous Australians. Adjusted thirty day, but not longer term survival, was superior in higher volume centres. In contrast average annual surgeon case load was not related to 30 day mortality but
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS