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Current cardiac status of a cohort of patients with congenital Rubella born in the early 1940s
A86
Selected abstracts Cardiology, May
from the XIVth 5-9,2002
World
Congress
of
Heart,
Results There were 44 subjects in the CVD group and 82 subjects in the non CVD group. Ages were similar (50-59 years). The mean pocket depth of the CVD group was 1.56 mm compared with 1.89 mm for the non CVD group. The proportion of sites in the CVD group with pocket depths 3.5-5.5 mm was 34.3% compared with 11.2% in the non-CVD group. The proportion of pockets > 5.5 mm in the CVD group (6.5%) was four times the proportion of sites in the nondisease group (1.2%). The CVD group had fewer remaining teeth (mean 21.75 compared with mean 25.2). The greatest difference was seen in the molars where the CVD participants had a mean of 4.8 remaining teeth compared with 6.5 in the nondisease group. Conclusion These preliminary results suggest that subjects with cardiovascular disease have more severe periodontal disease than noncardiovascular disease subjects and provides further support for the association between cardiovascular and periodontal disease. Key words: Antibodies, Clinical trials, Vascular biology Current Cardiac Status of a Cohort of Patients with Congenital Rubella Born in the Early 1940s Manoikumar U Rohit’, Gary F Sholler’, Richard E Hawker2 ‘Adolph Bnsser Cardiac Institute at The Children’s Hospital at Westmead, Sydney, Australia; 2Adolph Basser Cardiac Institute at The Children’s Hospital at Westmead, Sydney, Australia Methods Cardiac evaluation was undertaken in 31 survivors with congenital rubella, born during the 1939-43 epidemic of rubella in New South Wales, Australia. All the subjects underwent thorough cardiological evaluation. Results Mean age of study group was 60.55 + 0.88 years. Eight (25.8%) subjects were in NYHA class 2 and remaining 23 (74.2%) were in NYHA class 1. One of the subjects had undergone duct ligation at 7 years of age. Two (6.4%) had undergone aortic valve replacement, one at 54 years and the other at 51 years of age. Thirteen (42.0%) subjects were found to be hypertensive with the majority (84%) of them already taking medication. Only one subject had history of angina and two were suffering from diabetes mellitus. A 12-lead electrocardiogram revealed normal sinus rhythm in 28 subjects (90.3%) and first degree heart block in three (9.7%). Bundle branch block was noted in two (6.4%) and T wave inversion in two (6.4%). On transthoracic-echo, no subject was found to have septal defect, ductal patency or peripheral pulmonary artery stenosis. Aortic valve sclerosis was noted in 23 (79%) subjects with two (8.6%) of them having mild stenosis and 13 (56.5%) having trivial to mild aortic regurgitation. Mitral valve sclerosis was observed in one subject and prolapse of anterior mitral leaflet was seen in two (6.4%) subjects. Nineteen (61%) subjects had trivial to mild mitral valve regurgitation. Both aortic and mitral valve regurgitation was present in 10 subjects (32.25%). Conclusion At 60 years, survivors of congenital rubella are in NYHA 1 or 2. While the incidence of both aortic and mitral regurgitation is higher than in reported in epidemiological series of similar age individuals, their severity is only trivial to mild. Key words: Aging, Echocardiography, transthoracic, Follow-up studies Heart Failure and the Ageing Population: An Increasing Burden the 21st Century? Simon Stewart’, John 1 McMurrav2 ‘Adelaide University, Australia; 2Universify of Glasgow, United Kingdom
in
Background Despite an overall decline in age-adjusted mortality from coronary heart disease in developed countries the burden imposed by heart failure (HF) continues to increase, although recent data indicate that the burden will not be as dramatic as first predicted. Methods Scotland has an ageing but stable population (5.1 million). We used accurate estimates of prevalence, general practitioner (GP) consultation rates and hospitalisation rates related to HF to the whole population. We then projected these estimates over the period 2000-2020 based on changes to the demographic structure of the population to estimate the short (2005), medium (2010) and long-term burden of HF (2020). Results There were 40 000 men and 45 000 women aged 45 years or more with HF in Scotland in 2000. Based on population changes alone, these figures will rise in men and women by 2300 (6%) and 1500 (3%) in
Lung
and Circulation
2003; 12
2005 and by 12 300 (31%) and 7800 (17%) in 2020. Similarly, the annual number of male and female GP visits is likely to rise by 6400 (6%) and 2500 (2%) in 2005, and by 35 200 (40%) and 17 300 (16%) in 2020 (to a total of 124 000 and 126 000 visits). In 2000 about 3500 men and 4300 women in Scotland experienced an incident HF admission. By 2020 these figures are likely to increase by 52% (1800 more) and 16% (717 more) in men and women, respectively. If recent trends in short-term case-fatality rates continue to improve, the number of men who survive this event will increase by 59% (1700 more). By 2020, the annual number of male and female admissions with a principal diagnosis of HF is expected to increase by 34% (from 5500 to 7500) and 12% (from 7800 to 8500), respectively. Conclusion Unless rapid and major changes occur in the incidence of HF, the burden it imposes will continue to increase substantially in both primary and secondary care, over the next two decades. The greatest increase is likely to occur in men. Future health service planning must take this into account. Key words: Health services, Heart failure, Resource utilization The treatment gap in coronary heart disease (CHD) in Victoria 1996-98; 1999-2000: how many patients with established CHD are not achieving the target levels for their modifiable risk factors? Comparison with the UK, Europe & USA Maraarite 1 Vale’, Michael V Jelinek2, James D Best2 ‘St Vincent’s Hospital Melbourne, Australia; 2St Vincent’s Hospital Melbourne, Australia Background The difference between the treatment recommended on the basis of clinical trials and the treatment that occurs in the community has often been referred to as ‘the treatment gap (T-GAP)‘. Evidence from international surveys has indicated that only a minority of patients with CHD have achieved the target levels for their particular modifiable risk factors (RF) or are even on treatment. There are no published data available for Australia. We have measured the T-GAP in patients with CHD who completed follow-up in the control groups of 2 RCTs of a RF intervention called ‘TheCoachProgramTM’. We have compared this data to that published from the UK (ASPIRE), Europe (EUROASPIRE I and 11) and the USA (L-TAP). Methods Vsetting: VIC-I is a single teaching hospital in Melbourne. VIC-II is 6 teaching hospitals in Melbourne. Participants: 460 patients: 112 VIC-I, 348 VIC-II. Outcome measures: The T-GAP at 6 months post hospitalisation for the modifiable RF [The T-GAP = 100% - % patients achieving the target level for a particular modifiable RF]. Results The T-GAP declined from 96.4% to 74.1% for TC c 4.0 mmol/L, from 90.2% to 54.0% for TC < 4.5 mmol/L, and from 70.5% to 35.6% for TC < 5.0 mmol/L, from VIC-I to VIC-II. The T-GAPS for ASPIRE, EUROASPIRE I (EU-I) and EUROASPIRE II (EU-II) (TC < 5.0 mmol/L) were 81.9%, 86.2% and 58.8%, respectively. In VIC-II 39.5% of patients had a SBP 2 140 and/or DBP t 90 mmHg. The corresponding figures for EU-I and EU-II were 55.4% and 53.9%, respectively. The prevalence of self-reported diabetes was 17.5% in VIC-II compared with 18% in EU-I, 21.9% in EU-II and 23.6% in L-TAP. The proportion of patients who were obese (BMI 2 30 kglmf) was 29.8% in VIC-II, 27.9% in ASPIRE, 25.3% in EU-I and 32.8% in EU-II. Self report of smoking was 14.7% in VIC-II, 19.1% in ASPIRE, 19.4% in EU-I and 20.8% in EU-II. Conclusion A significant treatment gap exists in Victorian patients with CHD. The T-GAP compares well with international surveys and, at least in the lipid area, is diminishing. Key words: Coronary heart disease, Prevention, Risk factors Seasonal Variation in Heart Failure-related Morbidity and Mortality Simon Stewart’, Kate MacIntyre2, Simon CapewelP, John J McMurray2 IAdelaide University, Australia; 2Llniversity of Glasgow, United Kingdom; 3Universify of Liverpool, United Kingdom Background Studies suggest that cardiovascular-related morbidity and mortality rates are highest in the winter months. However, few studies have specifically examined this phenomenon in relation to congestive heart failure (CHF). Methods Using the unique Scottish Morbidity Record scheme, we examined the timing of all CHF-related hospital admissions during the period 199&96. For each calendar month, we calculated the daily rate of
Selected abstracts Cardiology, May
from the XIVth 5-9,2002
World
Congress
of
Heart,
Results There were 44 subjects in the CVD group and 82 subjects in the non CVD group. Ages were similar (50-59 years). The mean pocket depth of the CVD group was 1.56 mm compared with 1.89 mm for the non CVD group. The proportion of sites in the CVD group with pocket depths 3.5-5.5 mm was 34.3% compared with 11.2% in the non-CVD group. The proportion of pockets > 5.5 mm in the CVD group (6.5%) was four times the proportion of sites in the nondisease group (1.2%). The CVD group had fewer remaining teeth (mean 21.75 compared with mean 25.2). The greatest difference was seen in the molars where the CVD participants had a mean of 4.8 remaining teeth compared with 6.5 in the nondisease group. Conclusion These preliminary results suggest that subjects with cardiovascular disease have more severe periodontal disease than noncardiovascular disease subjects and provides further support for the association between cardiovascular and periodontal disease. Key words: Antibodies, Clinical trials, Vascular biology Current Cardiac Status of a Cohort of Patients with Congenital Rubella Born in the Early 1940s Manoikumar U Rohit’, Gary F Sholler’, Richard E Hawker2 ‘Adolph Bnsser Cardiac Institute at The Children’s Hospital at Westmead, Sydney, Australia; 2Adolph Basser Cardiac Institute at The Children’s Hospital at Westmead, Sydney, Australia Methods Cardiac evaluation was undertaken in 31 survivors with congenital rubella, born during the 1939-43 epidemic of rubella in New South Wales, Australia. All the subjects underwent thorough cardiological evaluation. Results Mean age of study group was 60.55 + 0.88 years. Eight (25.8%) subjects were in NYHA class 2 and remaining 23 (74.2%) were in NYHA class 1. One of the subjects had undergone duct ligation at 7 years of age. Two (6.4%) had undergone aortic valve replacement, one at 54 years and the other at 51 years of age. Thirteen (42.0%) subjects were found to be hypertensive with the majority (84%) of them already taking medication. Only one subject had history of angina and two were suffering from diabetes mellitus. A 12-lead electrocardiogram revealed normal sinus rhythm in 28 subjects (90.3%) and first degree heart block in three (9.7%). Bundle branch block was noted in two (6.4%) and T wave inversion in two (6.4%). On transthoracic-echo, no subject was found to have septal defect, ductal patency or peripheral pulmonary artery stenosis. Aortic valve sclerosis was noted in 23 (79%) subjects with two (8.6%) of them having mild stenosis and 13 (56.5%) having trivial to mild aortic regurgitation. Mitral valve sclerosis was observed in one subject and prolapse of anterior mitral leaflet was seen in two (6.4%) subjects. Nineteen (61%) subjects had trivial to mild mitral valve regurgitation. Both aortic and mitral valve regurgitation was present in 10 subjects (32.25%). Conclusion At 60 years, survivors of congenital rubella are in NYHA 1 or 2. While the incidence of both aortic and mitral regurgitation is higher than in reported in epidemiological series of similar age individuals, their severity is only trivial to mild. Key words: Aging, Echocardiography, transthoracic, Follow-up studies Heart Failure and the Ageing Population: An Increasing Burden the 21st Century? Simon Stewart’, John 1 McMurrav2 ‘Adelaide University, Australia; 2Universify of Glasgow, United Kingdom
in
Background Despite an overall decline in age-adjusted mortality from coronary heart disease in developed countries the burden imposed by heart failure (HF) continues to increase, although recent data indicate that the burden will not be as dramatic as first predicted. Methods Scotland has an ageing but stable population (5.1 million). We used accurate estimates of prevalence, general practitioner (GP) consultation rates and hospitalisation rates related to HF to the whole population. We then projected these estimates over the period 2000-2020 based on changes to the demographic structure of the population to estimate the short (2005), medium (2010) and long-term burden of HF (2020). Results There were 40 000 men and 45 000 women aged 45 years or more with HF in Scotland in 2000. Based on population changes alone, these figures will rise in men and women by 2300 (6%) and 1500 (3%) in
Lung
and Circulation
2003; 12
2005 and by 12 300 (31%) and 7800 (17%) in 2020. Similarly, the annual number of male and female GP visits is likely to rise by 6400 (6%) and 2500 (2%) in 2005, and by 35 200 (40%) and 17 300 (16%) in 2020 (to a total of 124 000 and 126 000 visits). In 2000 about 3500 men and 4300 women in Scotland experienced an incident HF admission. By 2020 these figures are likely to increase by 52% (1800 more) and 16% (717 more) in men and women, respectively. If recent trends in short-term case-fatality rates continue to improve, the number of men who survive this event will increase by 59% (1700 more). By 2020, the annual number of male and female admissions with a principal diagnosis of HF is expected to increase by 34% (from 5500 to 7500) and 12% (from 7800 to 8500), respectively. Conclusion Unless rapid and major changes occur in the incidence of HF, the burden it imposes will continue to increase substantially in both primary and secondary care, over the next two decades. The greatest increase is likely to occur in men. Future health service planning must take this into account. Key words: Health services, Heart failure, Resource utilization The treatment gap in coronary heart disease (CHD) in Victoria 1996-98; 1999-2000: how many patients with established CHD are not achieving the target levels for their modifiable risk factors? Comparison with the UK, Europe & USA Maraarite 1 Vale’, Michael V Jelinek2, James D Best2 ‘St Vincent’s Hospital Melbourne, Australia; 2St Vincent’s Hospital Melbourne, Australia Background The difference between the treatment recommended on the basis of clinical trials and the treatment that occurs in the community has often been referred to as ‘the treatment gap (T-GAP)‘. Evidence from international surveys has indicated that only a minority of patients with CHD have achieved the target levels for their particular modifiable risk factors (RF) or are even on treatment. There are no published data available for Australia. We have measured the T-GAP in patients with CHD who completed follow-up in the control groups of 2 RCTs of a RF intervention called ‘TheCoachProgramTM’. We have compared this data to that published from the UK (ASPIRE), Europe (EUROASPIRE I and 11) and the USA (L-TAP). Methods Vsetting: VIC-I is a single teaching hospital in Melbourne. VIC-II is 6 teaching hospitals in Melbourne. Participants: 460 patients: 112 VIC-I, 348 VIC-II. Outcome measures: The T-GAP at 6 months post hospitalisation for the modifiable RF [The T-GAP = 100% - % patients achieving the target level for a particular modifiable RF]. Results The T-GAP declined from 96.4% to 74.1% for TC c 4.0 mmol/L, from 90.2% to 54.0% for TC < 4.5 mmol/L, and from 70.5% to 35.6% for TC < 5.0 mmol/L, from VIC-I to VIC-II. The T-GAPS for ASPIRE, EUROASPIRE I (EU-I) and EUROASPIRE II (EU-II) (TC < 5.0 mmol/L) were 81.9%, 86.2% and 58.8%, respectively. In VIC-II 39.5% of patients had a SBP 2 140 and/or DBP t 90 mmHg. The corresponding figures for EU-I and EU-II were 55.4% and 53.9%, respectively. The prevalence of self-reported diabetes was 17.5% in VIC-II compared with 18% in EU-I, 21.9% in EU-II and 23.6% in L-TAP. The proportion of patients who were obese (BMI 2 30 kglmf) was 29.8% in VIC-II, 27.9% in ASPIRE, 25.3% in EU-I and 32.8% in EU-II. Self report of smoking was 14.7% in VIC-II, 19.1% in ASPIRE, 19.4% in EU-I and 20.8% in EU-II. Conclusion A significant treatment gap exists in Victorian patients with CHD. The T-GAP compares well with international surveys and, at least in the lipid area, is diminishing. Key words: Coronary heart disease, Prevention, Risk factors Seasonal Variation in Heart Failure-related Morbidity and Mortality Simon Stewart’, Kate MacIntyre2, Simon CapewelP, John J McMurray2 IAdelaide University, Australia; 2Llniversity of Glasgow, United Kingdom; 3Universify of Liverpool, United Kingdom Background Studies suggest that cardiovascular-related morbidity and mortality rates are highest in the winter months. However, few studies have specifically examined this phenomenon in relation to congestive heart failure (CHF). Methods Using the unique Scottish Morbidity Record scheme, we examined the timing of all CHF-related hospital admissions during the period 199&96. For each calendar month, we calculated the daily rate of