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Cardiac Rehabilitation for Patients with Spontaneous Coronary Artery Dissection
Abstracts
S324
765 Cardiac Rehabilitation for Patients with Spontaneous Coronary Artery Dissection R. Zecchin ∗ , J. Thelander, J. Baihn, Y. Chai, K. Haeusler, J. Hungerford, G. Lindsay, M. Pettitt, T. Vail, M. Cooper, A. Ong, C. Chow, R. Denniss Western Sydney LHD, Sydney, Australia Background: Spontaneous coronary artery dissection (SCAD) is an uncommon and under-diagnosed cause of acute coronary syndrome, especially in young women. Increasing clinical awareness with use of invasive angiography has led to an increase of patients with a SCAD diagnosis. Little is known about the effects of cardiac rehabilitation (CR) in patients with SCAD especially in Australia. Aim: To examine the effect of cardiac rehabilitation in patient who present with SCAD. Methods: We reviewed clinical data collected prospectively from January 1994 to December 2015 for patients with angiographically-diagnosed SCAD who commenced CR. This included demographics, precipitant behaviour, cardiac risk factors, functional capacity, quality of life (QOL), morbidity and mortality. Results: Thirteen SCAD patients (mean age 46±10.9 years; 69% female; 69% STEMI; 39% Indian background) commenced the CR service. Precipitant behaviour was physical (46%), emotional (15%) and sedentary (39%). The initial event was complicated by pericarditis (46%) and/or VF arrest (23%). Cardiac risk factors were current smoking (38%), dyslipidaemia (69%), history of depression (29%), and active lifestyle (77%). CR outcomes included an increase in functional capacity (pre-program 8±3.1 METS: post-program 11.1±2.8 METS; p=0.02), a reduction in waist circumference (1.5 cm) and total cholesterol levels (p<0.01), an increase in QOL domains of Vitality and Social–Functioning (p=0.05), and a 100% smoking cessation rate. One patient (0.8%) was readmitted with pericarditis but returned and completed the CR program. There was no mortality associated with exercise stress testing and/ or CR. Conclusion: CR for patients following SCAD appears safe and effective in a traditional program setting. http://dx.doi.org/10.1016/j.hlc.2016.06.768 766 Cardioprotective Diets: Dissecting Fiction from Fact. A Narrative Review D. Colquhoun ∗ , A. Ferreira-Jardim University of Queensland, Brisbane, Australia Background: Surprisingly cardiologists and the wider community are confused as to the basic principlesof diets that prevent or regress coronary atherosclerosis. More than 100 years ago Anichkov and Ignatowski independently used dietary interventions to cause and later regress atherosclerosis. Today there are many self-appointed experts incorrectly critique NHFA, AHA and WHO dietary recommendations.
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This review examines the basis of evidence underpinning cardioprotective diets. Methods: A PubMed and Embase review of dietary studies examining atherosclerosis and CHD involving animal and human studies across epidemiological and clinical trial models using surrogate and CVD endpoints. Results: Epidemiologically, food patterns explain prevalent and incident primary and secondary CVD independent of classic biological risk factors. In those studies diet and biological factors were universal but varied in effect and in rigour of analysis. Within diet, three saturated fatty acids (C12, C14, C16) were the most influential on levels of LDL in humans. Metabolically, EPA/DHA influenced triglyceride load and atherosclerosis extent. Clinically, the PREDIMED and Lyon diet trials were the most successful primary and secondary prevention trials which in turn confirmed the epidemiological data. Conclusion: A rigorous body of pharmacological, epidemiological and clinical evidence supports the preventative dietary recommendations of the NHFA, AHA and the ESC. The cardioprotective diets that have been most successfully validated are the traditional Mediterranean and East Asian diets. http://dx.doi.org/10.1016/j.hlc.2016.06.769 767 Effectiveness of Disease Management in Atrial Fibrillation Patients is Modulated by Mild Cognitive Impairment J. Ball 1,∗ , J. Wiley 1 , M. Carrington 1 , M. Løchen 1,2 , S. Stewart 1 1 Mary
MacKillop Institute for Health Research, Melbourne, Australia 2 The University of Tromsø - The Arctic University of Norway, Norway Background: Mild cognitive impairment (MCI) is common in patients with atrial fibrillation (AF), is often not overtly apparent and can have an impact on self-management. Effectiveness of disease management programs on outcomes in AF patients with MCI is unknown. Aim: To assess the impact of MCI on health outcomes of AF patients undergoing an AF-specific disease management intervention as part of the Standard versus Atrial Fibrillation spEcific managemenT strategY (SAFETY) Trial. Methods: SAFETY is a multicentre, randomised controlled trial conducted in three Australian hospitals. Impact of the nurse-led, home-based intervention on morbidity and mortality was compared to standard management (SM). Screening of MCI (classified as a score <26/30) was via the MoCA. Differences in mortality of patients with and without MCI were assessed using Cox Proportional Hazards model. Effect of MCI on total re-hospitalisations was analysed by negative binomial regression. Results: Patients with MCI (65%) were significantly older (mean 75 vs 68 years) and clinically complex. No differences in mortality were seen between those with and without MCI. However, for every one point decrease in MoCA score patients had 1.08 times more re-admissions (95% CI 1.01-1.16,
S324
765 Cardiac Rehabilitation for Patients with Spontaneous Coronary Artery Dissection R. Zecchin ∗ , J. Thelander, J. Baihn, Y. Chai, K. Haeusler, J. Hungerford, G. Lindsay, M. Pettitt, T. Vail, M. Cooper, A. Ong, C. Chow, R. Denniss Western Sydney LHD, Sydney, Australia Background: Spontaneous coronary artery dissection (SCAD) is an uncommon and under-diagnosed cause of acute coronary syndrome, especially in young women. Increasing clinical awareness with use of invasive angiography has led to an increase of patients with a SCAD diagnosis. Little is known about the effects of cardiac rehabilitation (CR) in patients with SCAD especially in Australia. Aim: To examine the effect of cardiac rehabilitation in patient who present with SCAD. Methods: We reviewed clinical data collected prospectively from January 1994 to December 2015 for patients with angiographically-diagnosed SCAD who commenced CR. This included demographics, precipitant behaviour, cardiac risk factors, functional capacity, quality of life (QOL), morbidity and mortality. Results: Thirteen SCAD patients (mean age 46±10.9 years; 69% female; 69% STEMI; 39% Indian background) commenced the CR service. Precipitant behaviour was physical (46%), emotional (15%) and sedentary (39%). The initial event was complicated by pericarditis (46%) and/or VF arrest (23%). Cardiac risk factors were current smoking (38%), dyslipidaemia (69%), history of depression (29%), and active lifestyle (77%). CR outcomes included an increase in functional capacity (pre-program 8±3.1 METS: post-program 11.1±2.8 METS; p=0.02), a reduction in waist circumference (1.5 cm) and total cholesterol levels (p<0.01), an increase in QOL domains of Vitality and Social–Functioning (p=0.05), and a 100% smoking cessation rate. One patient (0.8%) was readmitted with pericarditis but returned and completed the CR program. There was no mortality associated with exercise stress testing and/ or CR. Conclusion: CR for patients following SCAD appears safe and effective in a traditional program setting. http://dx.doi.org/10.1016/j.hlc.2016.06.768 766 Cardioprotective Diets: Dissecting Fiction from Fact. A Narrative Review D. Colquhoun ∗ , A. Ferreira-Jardim University of Queensland, Brisbane, Australia Background: Surprisingly cardiologists and the wider community are confused as to the basic principlesof diets that prevent or regress coronary atherosclerosis. More than 100 years ago Anichkov and Ignatowski independently used dietary interventions to cause and later regress atherosclerosis. Today there are many self-appointed experts incorrectly critique NHFA, AHA and WHO dietary recommendations.
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
This review examines the basis of evidence underpinning cardioprotective diets. Methods: A PubMed and Embase review of dietary studies examining atherosclerosis and CHD involving animal and human studies across epidemiological and clinical trial models using surrogate and CVD endpoints. Results: Epidemiologically, food patterns explain prevalent and incident primary and secondary CVD independent of classic biological risk factors. In those studies diet and biological factors were universal but varied in effect and in rigour of analysis. Within diet, three saturated fatty acids (C12, C14, C16) were the most influential on levels of LDL in humans. Metabolically, EPA/DHA influenced triglyceride load and atherosclerosis extent. Clinically, the PREDIMED and Lyon diet trials were the most successful primary and secondary prevention trials which in turn confirmed the epidemiological data. Conclusion: A rigorous body of pharmacological, epidemiological and clinical evidence supports the preventative dietary recommendations of the NHFA, AHA and the ESC. The cardioprotective diets that have been most successfully validated are the traditional Mediterranean and East Asian diets. http://dx.doi.org/10.1016/j.hlc.2016.06.769 767 Effectiveness of Disease Management in Atrial Fibrillation Patients is Modulated by Mild Cognitive Impairment J. Ball 1,∗ , J. Wiley 1 , M. Carrington 1 , M. Løchen 1,2 , S. Stewart 1 1 Mary
MacKillop Institute for Health Research, Melbourne, Australia 2 The University of Tromsø - The Arctic University of Norway, Norway Background: Mild cognitive impairment (MCI) is common in patients with atrial fibrillation (AF), is often not overtly apparent and can have an impact on self-management. Effectiveness of disease management programs on outcomes in AF patients with MCI is unknown. Aim: To assess the impact of MCI on health outcomes of AF patients undergoing an AF-specific disease management intervention as part of the Standard versus Atrial Fibrillation spEcific managemenT strategY (SAFETY) Trial. Methods: SAFETY is a multicentre, randomised controlled trial conducted in three Australian hospitals. Impact of the nurse-led, home-based intervention on morbidity and mortality was compared to standard management (SM). Screening of MCI (classified as a score <26/30) was via the MoCA. Differences in mortality of patients with and without MCI were assessed using Cox Proportional Hazards model. Effect of MCI on total re-hospitalisations was analysed by negative binomial regression. Results: Patients with MCI (65%) were significantly older (mean 75 vs 68 years) and clinically complex. No differences in mortality were seen between those with and without MCI. However, for every one point decrease in MoCA score patients had 1.08 times more re-admissions (95% CI 1.01-1.16,