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Baseline and “On-Treatment” Risk Scores for Predicting Mortality in Patients with Infective Endocarditis
S2
Abstracts
Heart, Lung and Circulation 2007;16:S1–S201
ABSTRACTS
Ralph Reader Prize – Clinical Science 1 Patient-Centred Modular Secondary Prevention Improves Risk Factors (RFs), Global Risk and Knowledge Following Acute Coronary Syndrome (ACS): A Randomised Controlled Trial Julie Redfern 1,∗ , Tom Briffa 2 , Elizabeth Ellis 1 , Ben Freedman 1,3 of Sydney, NSW, Australia; 2 University of Western Australia, WA, Australia; 3 Cardiology Department, Concord Hospital, NSW, Australia 1 University
Background: Approximately 80% of eligible ACS survivors receive no cardiac rehabilitation (CR). We have shown their baseline risk factors (RFs) and knowledge are significantly worse than CR attendees and hypothesised they would benefit from a patient-centred modular program. Methods: ACS survivors not accessing CR were randomised to conventional care (n = 72) or a modular program (n = 72) comprising lowering cholesterol and choice of modules to lower other RFs. RFs and knowledge were blindly assessed at baseline, 3 and 12 months and compared with CR attendees (n = 64). All groups had similar demographics. Results: Modular and control groups were well matched for baseline cardiovascular risk, which was significantly higher than CR. At 12 months, the modular group achieved significantly lower global risk and RF levels than controls and similar to CR. Knowledge of TC, BP and exercise improved significantly in the modular group and knowledge correlated with lower RFs. Baseline Risk factor
Control
12 months Modular
CR
Total cholesterol (mmol/L)
4.6 ± 0.1
4.8 ± 0.1
4.3 ± 0.1*
LDL (mmol/L)
2.6 ± 0.1
2.6 ± 0.1
2.3 ± 0.1
Systolic BP (mmHg)
137.5 ± 2.2 136.6 ± 2.1
135.7 ± 2.6
Control
Modular
4.7 ± 0.1
2.4 ± 0.1 *
143.9 ± 2.4
§
CR
4.0 ± 0.1† , §
3.9 ± 0.1§
2.0 ± 0.1† , §
1.9 ± 0.1
131.6 ± 1.8† , § 135.7 ± 2.1
Physical activity 267 ± 32 (MET-min)
315 ± 38
701 ± 58*
715 ± 103§
1369 ± 167† , § 1489 ± 164§
Smoker (%)
19%
3%*
23%
6%†
3%
4.5 ± 0.4
2.1 ± 0.3*
5.2 ± 0.4
3.7 ± 0.3† , §
2.4 ± 0.3*
22%
LIPID risk score 4.7 ± 0.4
MET: metabolic equivalents. ∗ p < 0.05 CR vs. control + modular. † p < 0.05 modular vs. control. §
p < 0.05 baseline vs. 12 months.
Conclusion: ACS survivors completing patient-centred RF modules lower their risk of recurrent events by improving their coronary risk profile and knowledge over 12 months, providing an effective alternative for the majority not accessing CR. doi:10.1016/j.hlc.2007.06.007
2 Baseline and “On-Treatment” Risk Scores for Predicting Mortality in Patients with Infective Endocarditis R. Sy 1,2,∗ , C. Chawantanpipat 2 , D. Richmond 2 , L. Kritharides 1 1 Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia; 2 Department of Cardiology Royal Prince Alfred Hospital, Sydney, Australia
Background: Incorporation of baseline and “ontreatment” parameters in the prognostic classification of adults with infective endocarditis (IE) has the potential to guide management and improve prognosis. Methods: We studied 273 consecutive patients admitted to two independent centres with a diagnosis of IE between 1996 and 2006 (derivation cohort, centre A, n = 192; validation cohort, centre B, n = 81). Clinical and laboratory parameters were collected at baseline (Model 1) and 1 week (Model 2) after admission. Associations with mortality were tested by univariate and multivariate Cox proportional-hazards analysis in the derivation cohort. Independent predictors were combined to derive a risk score for each patient, and Models 1 and 2 were tested against the validation cohort. All-cause mortality at 6months (centre A 24%, centre B 32%) was determined from medical records and government registry data. Results: At baseline (Model 1), age ≥65 years (p = 0.005), heart failure (p = 0.004), thrombocytopenia (p = 0.009), renal impairment (p = 0.001) independently predicted mortality. At 1 week (Model 2), heart failure (p = 0.009), thrombocytopenia (p = 0.024), renal impairment (p = 0.022), Charlson co-morbidity score ≥3 (p = 0.026), and severe embolic events (p = 0.005) were independent predictors. Models 1 and 2 correctly identified high-risk populations demonstrating a mortality of over 70%. Area under the receiver-operator curves predicting mortality for Models 1 and 2 were 0.81 (CI 0.70–0.93) and 0.80 (CI 0.66–0.93), respectively. Conclusion: The survival of patients with IE can be predicted before and during treatment using dynamic risk scores. These incorporate readily available parameters such as thrombocytopenia, renal impairment, clinical heart failure, and co-morbidity. doi:10.1016/j.hlc.2007.06.008 3 Non-Steroidal Anti-Inflammatory Drugs Antagonise the Irreversible Antiplatelet Effect of Aspirin P.A. Gladding ∗ , M.W. Webster, H. Farrell, I. Zeng, R. Park, N. Ruijine Greenlane Cardiovascular Service, Auckland City Hospital, New Zealand Background: Patients with cardiovascular disease taking some non-steroidal anti-inflammatory drugs (NSAIDs) appear to have increased vascular events. One possible mechanism is that NSAIDs may compete with aspirin for
Abstracts
Heart, Lung and Circulation 2007;16:S1–S201
ABSTRACTS
Ralph Reader Prize – Clinical Science 1 Patient-Centred Modular Secondary Prevention Improves Risk Factors (RFs), Global Risk and Knowledge Following Acute Coronary Syndrome (ACS): A Randomised Controlled Trial Julie Redfern 1,∗ , Tom Briffa 2 , Elizabeth Ellis 1 , Ben Freedman 1,3 of Sydney, NSW, Australia; 2 University of Western Australia, WA, Australia; 3 Cardiology Department, Concord Hospital, NSW, Australia 1 University
Background: Approximately 80% of eligible ACS survivors receive no cardiac rehabilitation (CR). We have shown their baseline risk factors (RFs) and knowledge are significantly worse than CR attendees and hypothesised they would benefit from a patient-centred modular program. Methods: ACS survivors not accessing CR were randomised to conventional care (n = 72) or a modular program (n = 72) comprising lowering cholesterol and choice of modules to lower other RFs. RFs and knowledge were blindly assessed at baseline, 3 and 12 months and compared with CR attendees (n = 64). All groups had similar demographics. Results: Modular and control groups were well matched for baseline cardiovascular risk, which was significantly higher than CR. At 12 months, the modular group achieved significantly lower global risk and RF levels than controls and similar to CR. Knowledge of TC, BP and exercise improved significantly in the modular group and knowledge correlated with lower RFs. Baseline Risk factor
Control
12 months Modular
CR
Total cholesterol (mmol/L)
4.6 ± 0.1
4.8 ± 0.1
4.3 ± 0.1*
LDL (mmol/L)
2.6 ± 0.1
2.6 ± 0.1
2.3 ± 0.1
Systolic BP (mmHg)
137.5 ± 2.2 136.6 ± 2.1
135.7 ± 2.6
Control
Modular
4.7 ± 0.1
2.4 ± 0.1 *
143.9 ± 2.4
§
CR
4.0 ± 0.1† , §
3.9 ± 0.1§
2.0 ± 0.1† , §
1.9 ± 0.1
131.6 ± 1.8† , § 135.7 ± 2.1
Physical activity 267 ± 32 (MET-min)
315 ± 38
701 ± 58*
715 ± 103§
1369 ± 167† , § 1489 ± 164§
Smoker (%)
19%
3%*
23%
6%†
3%
4.5 ± 0.4
2.1 ± 0.3*
5.2 ± 0.4
3.7 ± 0.3† , §
2.4 ± 0.3*
22%
LIPID risk score 4.7 ± 0.4
MET: metabolic equivalents. ∗ p < 0.05 CR vs. control + modular. † p < 0.05 modular vs. control. §
p < 0.05 baseline vs. 12 months.
Conclusion: ACS survivors completing patient-centred RF modules lower their risk of recurrent events by improving their coronary risk profile and knowledge over 12 months, providing an effective alternative for the majority not accessing CR. doi:10.1016/j.hlc.2007.06.007
2 Baseline and “On-Treatment” Risk Scores for Predicting Mortality in Patients with Infective Endocarditis R. Sy 1,2,∗ , C. Chawantanpipat 2 , D. Richmond 2 , L. Kritharides 1 1 Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia; 2 Department of Cardiology Royal Prince Alfred Hospital, Sydney, Australia
Background: Incorporation of baseline and “ontreatment” parameters in the prognostic classification of adults with infective endocarditis (IE) has the potential to guide management and improve prognosis. Methods: We studied 273 consecutive patients admitted to two independent centres with a diagnosis of IE between 1996 and 2006 (derivation cohort, centre A, n = 192; validation cohort, centre B, n = 81). Clinical and laboratory parameters were collected at baseline (Model 1) and 1 week (Model 2) after admission. Associations with mortality were tested by univariate and multivariate Cox proportional-hazards analysis in the derivation cohort. Independent predictors were combined to derive a risk score for each patient, and Models 1 and 2 were tested against the validation cohort. All-cause mortality at 6months (centre A 24%, centre B 32%) was determined from medical records and government registry data. Results: At baseline (Model 1), age ≥65 years (p = 0.005), heart failure (p = 0.004), thrombocytopenia (p = 0.009), renal impairment (p = 0.001) independently predicted mortality. At 1 week (Model 2), heart failure (p = 0.009), thrombocytopenia (p = 0.024), renal impairment (p = 0.022), Charlson co-morbidity score ≥3 (p = 0.026), and severe embolic events (p = 0.005) were independent predictors. Models 1 and 2 correctly identified high-risk populations demonstrating a mortality of over 70%. Area under the receiver-operator curves predicting mortality for Models 1 and 2 were 0.81 (CI 0.70–0.93) and 0.80 (CI 0.66–0.93), respectively. Conclusion: The survival of patients with IE can be predicted before and during treatment using dynamic risk scores. These incorporate readily available parameters such as thrombocytopenia, renal impairment, clinical heart failure, and co-morbidity. doi:10.1016/j.hlc.2007.06.008 3 Non-Steroidal Anti-Inflammatory Drugs Antagonise the Irreversible Antiplatelet Effect of Aspirin P.A. Gladding ∗ , M.W. Webster, H. Farrell, I. Zeng, R. Park, N. Ruijine Greenlane Cardiovascular Service, Auckland City Hospital, New Zealand Background: Patients with cardiovascular disease taking some non-steroidal anti-inflammatory drugs (NSAIDs) appear to have increased vascular events. One possible mechanism is that NSAIDs may compete with aspirin for