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Evaluation of Psychological Wellbeing in Patients with Hypertrophic Cardiomyopathy
222 National Report Card on Hospital Care Provided to Indigenous Patients with Coronary Heart Disease in Australia T. Lea National Heart Foundation of Australia, Brisbane, Queensland, Australia Background: In 2006 the Australian Institute of Health and Welfare published a ground breaking report titled Aboriginal and Torres Strait Islander People with coronary heart disease: further perspectives on health status and treatment.1 By examining 2002–2003 national hospital and mortality records the AIHW sort to profile the major coronary events and key medical investigations been delivered to Aboriginal and Torres Strait Islander compared to other Australians. The findings: Aboriginal and Torres Strait Islander people were not only considerably more likely to suffer a heart attack and die without being admitted to hospital, but were also more likely to die once admitted to hospital. More alarming however is the findings that once admitted to hospital Aboriginal and Torres Strait Islander people have: • more than twice the in-hospital CHD death rate than other Australians; • a 40% lower rate of being investigated by angiography; • a 40% lower rate of coronary angioplasty or stent procedures; • a 20% lower rate of coronary bypass surgery; Discussion: The AIHW report demonstrates a strong pattern of disparity that expands the picture of Indigenous disadvantage and poor health. As the leading organisation in the fight against cardiovascular disease in Australia the National Heart Foundation of Australia is gravely concerned with these findings. The challenge now for industry specialists, is to work towards addressing the disparities of cardiac care witnessed between Aboriginal and Torres Strait Islander Peoples and other Australians as reported in this AIHW publication.
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223 Adherence to Guidelines in the Management of Rheumatic Heart Disease in an Indigenous Population T. Stewart 1,2,∗ , R. McDonald 1,2 , B.J. Currie 1,2 1 Department of Cardiology, Royal North Shore Hospital, Sydney, Australia; 2 Menzies School of Health Research, Darwin, NT, Australia
Background: The Aboriginal population of the NT has the highest rates of Acute Rheumatic Fever (ARF), and its sequelae Rheumatic Heart Disease (RHD), in the world. RHD is often the result of recurrent episodes of ARF. Longterm treatment with monthly intramuscular penicillin is recommended to prevent recurrent infection and has been shown to significantly reduce the morbidity and mortality associated with ARF and RHD. An ARF Registry Program was initiated in the NT in 1997 in an effort to improve secondary prophylaxis, and adherence has not been evaluated since then. Methods: We performed a retrospective cohort study of community health centre medical records in the Katherine Region of the NT examining the use of monthly prophylactic penicillin and the frequency of echocardiogram and specialist follow-up during the 24 months between September 1, 2002 and 2004. This was compared with the guidelines issued by the NT ARF Registry program. Results: Fifty-nine patients had ARF requiring monthly prophylaxis and all were Indigenous. Mean adherence with prophylaxis was 55.8%. A non-significant trend towards improved adherence was seen in children, patients with less severe disease, and those who attended the clinic more frequently. ARF Registry Guidelines for echocardiogram and specialist review were met by 63% and 59% of subjects, respectively. Conclusion: Within this population, adherence with penicillin prophylaxis is inadequate to protect against recurrent ARF and consequent worsening of RHD. This study highlights the need for further efforts to encourage adherence to ARF Registry Guidelines. doi:10.1016/j.hlc.2007.06.228 Social Aspects of Cardiac Disease – Posters
doi:10.1016/j.hlc.2007.06.227 224 Evaluation of Psychological Wellbeing in Patients with Hypertrophic Cardiomyopathy Jodie Ingles 1,∗ , Joanne M. Lind 1,2 , Philayrath 3 Phongsaven , Christopher Semsarian 1,2,4 1 Agnes
Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia; 2 Central Clinical School, Faculty of Medicine, University of Sydney, Australia; 3 School of Public Health, University of Sydney, Australia; 4 Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia 1 Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander people with coronary heart disease: further perspectives on health status and treatment. September 2006 Cardiovascular Disease Series 25 (cat no. CVD 33).
Background: Hypertrophic cardiomyopathy (HCM) is an inherited chronic heart disease. Diagnosis of HCM can
ABSTRACTS
Heart, Lung and Circulation 2007;16:S1–S201
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Abstracts
Heart, Lung and Circulation 2007;16:S1–S201
ABSTRACTS
have significant implications for an individual, including coming to terms with their risk of sudden death, exercise limitations and risk of transmission to offspring. This study sought to determine the prevalence and predictors of anxiety and depression in an Australian HCM population. Methods: Questionnaires were sent to 184 individuals with HCM and their first-degree relatives who had attended the Royal Prince Alfred Hospital (RPAH) HCM Clinic between September 2003 and September 2006. Patients were either seen on a regular basis or as a one-off consultation. Questionnaires were anonymous and comprised demographics, the Hospital Anxiety and Depression Scale (HADS), patient experience scales and patient satisfaction scales. Results: Completed questionnaires were returned by 109 participants (59.2% response rate); 76.9% had a diagnosis of HCM whilst 23.1% were at-risk relatives attending for clinical screening. Chi-square analysis between the two groups showed no significant difference in the frequency of anxiety and depression. The prevalence of psychological distress amongst HCM patients was high, i.e. 45.3% of HCM patients had HADS anxiety scores ≥8 whilst 17.9% had HADS depression scores ≥8 indicating psychological distress. Univariate analysis of response variables identified many predictors of high HADS scores. Logistic regression analysis adjusting for age, gender and education revealed adjustment and worry scores to be significantly associated with anxiety, whilst adjustment scores and location of patient follow-up (i.e. HCM clinic or another cardiologist) to be significantly associated with depression. Conclusion: Psychological wellbeing is an important consideration in HCM patients. These results highlight the impact a diagnosis has not only on the individual, but also on the family members resigned to long-term clinical screening, and reinforces the need for a multidisciplinary approach to managing these families with HCM. doi:10.1016/j.hlc.2007.06.229 225 Cardiovascular Morbidity and Mortality in a Rural Developing Region of Andhra Pradesh, India R. Joshi 1,∗ , C.K. Reddy 4 , B. Neal 1
Chow 1 , R.
Raju 2 , P.K.
Raju 3 , K.S.
1 The
George Institute for International Health, Sydney, Australia; 2 Byrraju Foundation, Hyderabad, India; 3 CARE Foundation, Hyderabad, India; 4 Centre for Chronic Disease Control, New Delhi, India Introduction: India is rapidly developing and cardiovascular disease (CVD) is becoming an increasingly important cause of morbidity and mortality. Whilst some information is available for urban areas, data about cardiovascular disease in rural areas are scant. Methods: Adult morbidity and mortality data were collected in two large-scale population-based studies. Data on CVD prevalence and risk factor levels were collected on 4535 individuals aged 30 years or over from 20 villages.
Data on CVD death were collected from 1146 deaths at 30 years or above using a verbal autopsy-based mortality surveillance system in 45 villages. Results: The prevalence of hypertension was 27%, diabetes 13.2%, current smoking 25.2% and overweight (BMI ≥ 25 kg/m2 ) 22.3%. One-third of the adult population had total cholesterol above 5.2 mmol/l whilst 15.2% had a positive family history of cardiovascular disease. A diagnosis of coronary heart disease (myocardial infarction and angina) was reported by 4.8% and stroke by 2.0%. Cardiovascular disease was the leading cause of death responsible for one-third (33%) of all deaths (ischaemic heart disease 14%, cerebrovascular disease 13%, and other vascular causes 6%). Conclusions: Data from this study indicate that cardiovascular disease is a major health problem in this rural region. New strategies to address this currently unmet disease burden are urgently required. Only with immediate action will an epidemic of vascular disease be averted. doi:10.1016/j.hlc.2007.06.230 SATURDAY 11 AUGUST Heart Failure 226 Doppler Restrictive Filling Pattern is an Independent Predictor of Survival in Patients with Heart Failure of Both Ischaemic and Non-Ischaemic Aetiology—Results from an Individual Patient Meta-Analysis (MeRGE) R. Doughty ∗ , J. Somaratne, G. Gamble, F. Dini, A. Klein, J. Møller, M. Quintana, C.M. Yu, G. Whalley, on behalf of the MeRGE Collaborators The University of Auckland, Auckland, New Zealand Background: The MeRGE study, a global collaboration of 18 prospective studies, has shown that the echoDoppler restrictive mitral filling pattern (RFP) is an independent predictor of outcome in patients (pts) with heart failure (HF). The aim of this analysis is to investigate whether this relationship holds irrespective of HF aetiology. Methods: This sub-analysis includes 2873 pts in whom aetiology of HF was defined as either ischaemic (IHD) or non-ischaemic (non-IHD). Each group was divided by the presence or absence of RFP and 4 year mortality was examined within each group. Multivariate predictors of outcome were examined within each group. Results: Mortality in the IHD group was 20.8% (336 deaths/1619 pts) and 19.2% in the non-IHD (241 deaths/1254 pts). The prevalence of RFP was 38% in both IHD and non-IHD groups. RFP was associated with higher mortality in both groups—IHD: RFP OR 2.87 (95% CI: 2.25, 3.67); non-IHD: RFP OR 2.72 (95% CI: 2.05, 3.62). There was no difference in the survival of IHD and non-IHD pts irrespective of RFP (P = 0.56). Multivariate analysis revealed
Abstracts
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223 Adherence to Guidelines in the Management of Rheumatic Heart Disease in an Indigenous Population T. Stewart 1,2,∗ , R. McDonald 1,2 , B.J. Currie 1,2 1 Department of Cardiology, Royal North Shore Hospital, Sydney, Australia; 2 Menzies School of Health Research, Darwin, NT, Australia
Background: The Aboriginal population of the NT has the highest rates of Acute Rheumatic Fever (ARF), and its sequelae Rheumatic Heart Disease (RHD), in the world. RHD is often the result of recurrent episodes of ARF. Longterm treatment with monthly intramuscular penicillin is recommended to prevent recurrent infection and has been shown to significantly reduce the morbidity and mortality associated with ARF and RHD. An ARF Registry Program was initiated in the NT in 1997 in an effort to improve secondary prophylaxis, and adherence has not been evaluated since then. Methods: We performed a retrospective cohort study of community health centre medical records in the Katherine Region of the NT examining the use of monthly prophylactic penicillin and the frequency of echocardiogram and specialist follow-up during the 24 months between September 1, 2002 and 2004. This was compared with the guidelines issued by the NT ARF Registry program. Results: Fifty-nine patients had ARF requiring monthly prophylaxis and all were Indigenous. Mean adherence with prophylaxis was 55.8%. A non-significant trend towards improved adherence was seen in children, patients with less severe disease, and those who attended the clinic more frequently. ARF Registry Guidelines for echocardiogram and specialist review were met by 63% and 59% of subjects, respectively. Conclusion: Within this population, adherence with penicillin prophylaxis is inadequate to protect against recurrent ARF and consequent worsening of RHD. This study highlights the need for further efforts to encourage adherence to ARF Registry Guidelines. doi:10.1016/j.hlc.2007.06.228 Social Aspects of Cardiac Disease – Posters
doi:10.1016/j.hlc.2007.06.227 224 Evaluation of Psychological Wellbeing in Patients with Hypertrophic Cardiomyopathy Jodie Ingles 1,∗ , Joanne M. Lind 1,2 , Philayrath 3 Phongsaven , Christopher Semsarian 1,2,4 1 Agnes
Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia; 2 Central Clinical School, Faculty of Medicine, University of Sydney, Australia; 3 School of Public Health, University of Sydney, Australia; 4 Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia 1 Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander people with coronary heart disease: further perspectives on health status and treatment. September 2006 Cardiovascular Disease Series 25 (cat no. CVD 33).
Background: Hypertrophic cardiomyopathy (HCM) is an inherited chronic heart disease. Diagnosis of HCM can
ABSTRACTS
Heart, Lung and Circulation 2007;16:S1–S201
S90
Abstracts
Heart, Lung and Circulation 2007;16:S1–S201
ABSTRACTS
have significant implications for an individual, including coming to terms with their risk of sudden death, exercise limitations and risk of transmission to offspring. This study sought to determine the prevalence and predictors of anxiety and depression in an Australian HCM population. Methods: Questionnaires were sent to 184 individuals with HCM and their first-degree relatives who had attended the Royal Prince Alfred Hospital (RPAH) HCM Clinic between September 2003 and September 2006. Patients were either seen on a regular basis or as a one-off consultation. Questionnaires were anonymous and comprised demographics, the Hospital Anxiety and Depression Scale (HADS), patient experience scales and patient satisfaction scales. Results: Completed questionnaires were returned by 109 participants (59.2% response rate); 76.9% had a diagnosis of HCM whilst 23.1% were at-risk relatives attending for clinical screening. Chi-square analysis between the two groups showed no significant difference in the frequency of anxiety and depression. The prevalence of psychological distress amongst HCM patients was high, i.e. 45.3% of HCM patients had HADS anxiety scores ≥8 whilst 17.9% had HADS depression scores ≥8 indicating psychological distress. Univariate analysis of response variables identified many predictors of high HADS scores. Logistic regression analysis adjusting for age, gender and education revealed adjustment and worry scores to be significantly associated with anxiety, whilst adjustment scores and location of patient follow-up (i.e. HCM clinic or another cardiologist) to be significantly associated with depression. Conclusion: Psychological wellbeing is an important consideration in HCM patients. These results highlight the impact a diagnosis has not only on the individual, but also on the family members resigned to long-term clinical screening, and reinforces the need for a multidisciplinary approach to managing these families with HCM. doi:10.1016/j.hlc.2007.06.229 225 Cardiovascular Morbidity and Mortality in a Rural Developing Region of Andhra Pradesh, India R. Joshi 1,∗ , C.K. Reddy 4 , B. Neal 1
Chow 1 , R.
Raju 2 , P.K.
Raju 3 , K.S.
1 The
George Institute for International Health, Sydney, Australia; 2 Byrraju Foundation, Hyderabad, India; 3 CARE Foundation, Hyderabad, India; 4 Centre for Chronic Disease Control, New Delhi, India Introduction: India is rapidly developing and cardiovascular disease (CVD) is becoming an increasingly important cause of morbidity and mortality. Whilst some information is available for urban areas, data about cardiovascular disease in rural areas are scant. Methods: Adult morbidity and mortality data were collected in two large-scale population-based studies. Data on CVD prevalence and risk factor levels were collected on 4535 individuals aged 30 years or over from 20 villages.
Data on CVD death were collected from 1146 deaths at 30 years or above using a verbal autopsy-based mortality surveillance system in 45 villages. Results: The prevalence of hypertension was 27%, diabetes 13.2%, current smoking 25.2% and overweight (BMI ≥ 25 kg/m2 ) 22.3%. One-third of the adult population had total cholesterol above 5.2 mmol/l whilst 15.2% had a positive family history of cardiovascular disease. A diagnosis of coronary heart disease (myocardial infarction and angina) was reported by 4.8% and stroke by 2.0%. Cardiovascular disease was the leading cause of death responsible for one-third (33%) of all deaths (ischaemic heart disease 14%, cerebrovascular disease 13%, and other vascular causes 6%). Conclusions: Data from this study indicate that cardiovascular disease is a major health problem in this rural region. New strategies to address this currently unmet disease burden are urgently required. Only with immediate action will an epidemic of vascular disease be averted. doi:10.1016/j.hlc.2007.06.230 SATURDAY 11 AUGUST Heart Failure 226 Doppler Restrictive Filling Pattern is an Independent Predictor of Survival in Patients with Heart Failure of Both Ischaemic and Non-Ischaemic Aetiology—Results from an Individual Patient Meta-Analysis (MeRGE) R. Doughty ∗ , J. Somaratne, G. Gamble, F. Dini, A. Klein, J. Møller, M. Quintana, C.M. Yu, G. Whalley, on behalf of the MeRGE Collaborators The University of Auckland, Auckland, New Zealand Background: The MeRGE study, a global collaboration of 18 prospective studies, has shown that the echoDoppler restrictive mitral filling pattern (RFP) is an independent predictor of outcome in patients (pts) with heart failure (HF). The aim of this analysis is to investigate whether this relationship holds irrespective of HF aetiology. Methods: This sub-analysis includes 2873 pts in whom aetiology of HF was defined as either ischaemic (IHD) or non-ischaemic (non-IHD). Each group was divided by the presence or absence of RFP and 4 year mortality was examined within each group. Multivariate predictors of outcome were examined within each group. Results: Mortality in the IHD group was 20.8% (336 deaths/1619 pts) and 19.2% in the non-IHD (241 deaths/1254 pts). The prevalence of RFP was 38% in both IHD and non-IHD groups. RFP was associated with higher mortality in both groups—IHD: RFP OR 2.87 (95% CI: 2.25, 3.67); non-IHD: RFP OR 2.72 (95% CI: 2.05, 3.62). There was no difference in the survival of IHD and non-IHD pts irrespective of RFP (P = 0.56). Multivariate analysis revealed