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EVIDENCE OF ISCHEMIC HEART DISEASE AMONG CHRONIC LUNG DISEASE PATIENTS ATTENDING A PULMONARY REHABILITATION PROGRAM
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and decreased the most among individuals aged 85 years and older (from 65.1 per 1,000 to 35.3 per 1,000) over the study period. Rates increased with age and were highest among females (33.0 per 1,000 people) and males (40.6 per 1,000 people) aged 85 years and older in 2009/10. Overall, age-standardized prevalence increased from 5.5% to 6.6% during the study period. However, the prevalence peaked in 2006/07 among females and in 2007/08 among males and then slowly started to decline through to 2009/10. IHD prevalence increased with age for both males and females. As with incidence, the highest prevalence was observed among females (38.6%) and males (46.3%) aged 85 years and older in 2009/10. CONCLUSION: The incidence of IHD declined and the prevalence increased between 1999/00 and 2009/10. Much of this decline in the incidence and increase in the prevalence of IHD may be due to improved primary prevention, management and treatment of cardiovascular diseases in Canada. However, with the continued increase in the number of seniors aged 65 years and older, it is too early to conclude whether this trend will be maintained.
041 EVIDENCE OF ISCHEMIC HEART DISEASE AMONG CHRONIC LUNG DISEASE PATIENTS ATTENDING A PULMONARY REHABILITATION PROGRAM CA Sima, BC Lau, A Kirkham, CM Taylor, PG Camp Vancouver, British Columbia BACKGROUND:
Ischemic heart disease (IHD) has emerged as a contributor to morbidity and mortality in individuals with chronic lung diseases (CLD). There is also evidence that IHD, in particular myocardial infarction (MI), remains commonly unrecognized and/or undiagnosed in this population. This is an important observation because IHD requires precautionary measures during pulmonary rehabilitation program (PRP) in order to ensure participants’ safety and training effectiveness. The purpose of this study is (1) to determine the Cardiac Infarction Injury Score (CIIS) in CLD patients attending a PRP, and (2) to investigate the association between CIIS, history of MI, and functional capacity (6 minute walk distance test) in this population. METHODS: A retrospective chart review study was conducted in a population of consecutive CLD patients that were enrolled in a comprehensive PRP at the St. Paul’s Hospital during 2009-2013. Subjects with normal sinus rhythm on resting ECGs, recorded prior to a cardiopulmonary exercise test, were included in the analysis. Twelve ECG features were converted to a score according to the CIIS algorithm, and a CIIS greater than 20 was used to discriminate between the presence and absence of past MI. Pulmonary rehabilitation outcomes were retrieved from the patients’ medical records along with confirmed MI diagnosis. RESULTS: 114 patients with CLD attending a PRP between 2009 and 2013 were identified in the St Paul’s Hospital database. A total of 47 patients with a mean age of 64.610.3 years (53%
Canadian Journal of Cardiology Volume 30 2014
males) met the eligibility criteria. 19 patients (40%) had restrictive lung disease (FVC% predicted 66.810.2; FEV1/FVC% predicted 94.6 10.3) and 28 patients (60%) had obstructive lung disease (FEV1% predicted 47.612.0; FEV1/FVC% predicted 56.510.7). The overall mean CIIS was 14.08.9 with a lower (nonsignificant) CIIS in the restrictive group (12.19.4) compared to the obstructive group (15.38.4). 14 patients (30%) had a CIIS 20, out of whom only three (6%) had a recognized history of MI. CIIS was significantly and negatively correlated with 6 minute walk distance test (6MWD) in both restrictive (r ¼ -0.5; p ¼ 0.02) and obstructive group (r ¼ -0.4; p ¼ 0.04), respectively. CONCLUSION: Unrecognized ischemic heart disease is not negligible among CLD patients attending PRP, and a higher cardiac infarction injury score is associated with a lower functional capacity in this population. More research is needed to explore the potential of PRP to prevent IHD in CLD patients. 042 REAL-WORLD EXPERIENCE OF LONG TERM CLINICAL OUTCOMES FOLLOWING CORONARY ARTERY BYPASS GRAFTING A Murphy, C Janssen, DR Wong, A Della Siega, SD Robinson Glasgow, United Kingdom BACKGROUND:
Coronary artery bypass grafting (CABG) continues to be a widely offered and effective treatment for coronary artery disease. Long term outcomes of CABG patients following surgery is not frequently reported outside of clinical trials. We sought to ascertain long term outcomes of patients in British Columbia who have underwent CABG. METHODS: We submitted an information request to the British Columbia Cardiac Registry, requesting the details of patients in British Columbia who had undergone CABG between the years of 2001 to 2009 inclusive. Outcome (death, surgical complication, repeat angiography, PCI) for this cohort was collated to 31st December 2013. RESULTS: Results for 17316 patients were available. The mean age was 65.9 +/- 9.7 years and most patients were male (81.5%). All cause mortality at 30 days, 90 days, 1 year, 3 years and 4 years were 1.8%, 2.4%, 3.5%, 6.6% and 8.4% respectively. Table 1 shows the annual number of CABG per year with co-morbidity profile and 30 day and 4 year mortality. CABGs performed in later years (2007-09) appear to have improved survival with adjusted 7 year HR of 0.71 (0.63- 0.80). Amongst those patients with DM, 20.7% used insulin, 64.7% were drug controlled and the remaining 15.5% were diet controlled. Diabetics had less favourable outcome compared to non-diabetics with a 3 year adjusted HR for death of 1.38 (1.19 - 1.60). Diet controlled DM had a similar outcome to non-diabetics but drug controlled DM and insulin controlled DM had adjusted HR of 1.36 (1.15 - 1.60) and 1.78 (1.41 - 2.23) respectively. Women were on average 3 years older than men and had higher rates of co-morbidites. Crude mortality for women was higher than for men at all time points. Female gender was a independent predictor of 30 day mortality [HR 1.79 (1.13 - 2.8)] but not at 3 years.
and decreased the most among individuals aged 85 years and older (from 65.1 per 1,000 to 35.3 per 1,000) over the study period. Rates increased with age and were highest among females (33.0 per 1,000 people) and males (40.6 per 1,000 people) aged 85 years and older in 2009/10. Overall, age-standardized prevalence increased from 5.5% to 6.6% during the study period. However, the prevalence peaked in 2006/07 among females and in 2007/08 among males and then slowly started to decline through to 2009/10. IHD prevalence increased with age for both males and females. As with incidence, the highest prevalence was observed among females (38.6%) and males (46.3%) aged 85 years and older in 2009/10. CONCLUSION: The incidence of IHD declined and the prevalence increased between 1999/00 and 2009/10. Much of this decline in the incidence and increase in the prevalence of IHD may be due to improved primary prevention, management and treatment of cardiovascular diseases in Canada. However, with the continued increase in the number of seniors aged 65 years and older, it is too early to conclude whether this trend will be maintained.
041 EVIDENCE OF ISCHEMIC HEART DISEASE AMONG CHRONIC LUNG DISEASE PATIENTS ATTENDING A PULMONARY REHABILITATION PROGRAM CA Sima, BC Lau, A Kirkham, CM Taylor, PG Camp Vancouver, British Columbia BACKGROUND:
Ischemic heart disease (IHD) has emerged as a contributor to morbidity and mortality in individuals with chronic lung diseases (CLD). There is also evidence that IHD, in particular myocardial infarction (MI), remains commonly unrecognized and/or undiagnosed in this population. This is an important observation because IHD requires precautionary measures during pulmonary rehabilitation program (PRP) in order to ensure participants’ safety and training effectiveness. The purpose of this study is (1) to determine the Cardiac Infarction Injury Score (CIIS) in CLD patients attending a PRP, and (2) to investigate the association between CIIS, history of MI, and functional capacity (6 minute walk distance test) in this population. METHODS: A retrospective chart review study was conducted in a population of consecutive CLD patients that were enrolled in a comprehensive PRP at the St. Paul’s Hospital during 2009-2013. Subjects with normal sinus rhythm on resting ECGs, recorded prior to a cardiopulmonary exercise test, were included in the analysis. Twelve ECG features were converted to a score according to the CIIS algorithm, and a CIIS greater than 20 was used to discriminate between the presence and absence of past MI. Pulmonary rehabilitation outcomes were retrieved from the patients’ medical records along with confirmed MI diagnosis. RESULTS: 114 patients with CLD attending a PRP between 2009 and 2013 were identified in the St Paul’s Hospital database. A total of 47 patients with a mean age of 64.610.3 years (53%
Canadian Journal of Cardiology Volume 30 2014
males) met the eligibility criteria. 19 patients (40%) had restrictive lung disease (FVC% predicted 66.810.2; FEV1/FVC% predicted 94.6 10.3) and 28 patients (60%) had obstructive lung disease (FEV1% predicted 47.612.0; FEV1/FVC% predicted 56.510.7). The overall mean CIIS was 14.08.9 with a lower (nonsignificant) CIIS in the restrictive group (12.19.4) compared to the obstructive group (15.38.4). 14 patients (30%) had a CIIS 20, out of whom only three (6%) had a recognized history of MI. CIIS was significantly and negatively correlated with 6 minute walk distance test (6MWD) in both restrictive (r ¼ -0.5; p ¼ 0.02) and obstructive group (r ¼ -0.4; p ¼ 0.04), respectively. CONCLUSION: Unrecognized ischemic heart disease is not negligible among CLD patients attending PRP, and a higher cardiac infarction injury score is associated with a lower functional capacity in this population. More research is needed to explore the potential of PRP to prevent IHD in CLD patients. 042 REAL-WORLD EXPERIENCE OF LONG TERM CLINICAL OUTCOMES FOLLOWING CORONARY ARTERY BYPASS GRAFTING A Murphy, C Janssen, DR Wong, A Della Siega, SD Robinson Glasgow, United Kingdom BACKGROUND:
Coronary artery bypass grafting (CABG) continues to be a widely offered and effective treatment for coronary artery disease. Long term outcomes of CABG patients following surgery is not frequently reported outside of clinical trials. We sought to ascertain long term outcomes of patients in British Columbia who have underwent CABG. METHODS: We submitted an information request to the British Columbia Cardiac Registry, requesting the details of patients in British Columbia who had undergone CABG between the years of 2001 to 2009 inclusive. Outcome (death, surgical complication, repeat angiography, PCI) for this cohort was collated to 31st December 2013. RESULTS: Results for 17316 patients were available. The mean age was 65.9 +/- 9.7 years and most patients were male (81.5%). All cause mortality at 30 days, 90 days, 1 year, 3 years and 4 years were 1.8%, 2.4%, 3.5%, 6.6% and 8.4% respectively. Table 1 shows the annual number of CABG per year with co-morbidity profile and 30 day and 4 year mortality. CABGs performed in later years (2007-09) appear to have improved survival with adjusted 7 year HR of 0.71 (0.63- 0.80). Amongst those patients with DM, 20.7% used insulin, 64.7% were drug controlled and the remaining 15.5% were diet controlled. Diabetics had less favourable outcome compared to non-diabetics with a 3 year adjusted HR for death of 1.38 (1.19 - 1.60). Diet controlled DM had a similar outcome to non-diabetics but drug controlled DM and insulin controlled DM had adjusted HR of 1.36 (1.15 - 1.60) and 1.78 (1.41 - 2.23) respectively. Women were on average 3 years older than men and had higher rates of co-morbidites. Crude mortality for women was higher than for men at all time points. Female gender was a independent predictor of 30 day mortality [HR 1.79 (1.13 - 2.8)] but not at 3 years.