- Email: [email protected]
HOSPITAL READMISSION OF CONGENITAL HEART DISEASE PATIENTS IN CANADA
S124 METHODS:
We recruited children 10-18 years of age with CHD. Baseline testing included cardiopulmonary exercise testing and measurement of activity using an accelerometer (GT3X+ ActiGraph LLC; 15s epoch). Physical activity was assessed using the FITT (frequency, intensity, time and type) principle. Participants were randomised; those in the intervention group were given an exercise prescription and activity tracker (MOVband, Cleveland, OH) for 16 weeks. The control group did not receive exercise prescription or activity trackers. Exercise physiologists monitored the intervention group’s physical activity online and provided support on a bi-weekly basis. MVPA was assessed with an accelerometer after 16 weeks. We included those who met usual wear time criteria (2 days with 600 minutes wear time/day, allowing non-wear of 60 minutes of zeros, 2 minutes spike allowance <100 counts per minute (cpm)). Vertical acceleration counts were categorised into sedentary (<100cpm) and MVPA ( 2296cpm) reported as mean daily minutes of MVPA and % sedentary time (sedentary minutes relative to wear time). RESULTS: Eight children (age 13-16 years) participated in the study with 4 randomly allocated to the intervention group. Two were excluded due to wear time <2 days with the accelerometers; both in the control group. Three of four children in the intervention group increased MVPA (2.5 to 24.8 minutes) and decreased %sedentary time (2.3% to 6.1%), while the two control children decreased MVPA (6.9 and 9.6 minutes) and sedentary behaviour was unchanged (0%) or increased (4.0%). CONCLUSION: The use of exercise prescription with an activity tracker is feasible and associated with increases in MVPA and decreases in sedentary time in children with CHD. This new technology provides unique opportunities to promote and remotely monitor activity levels in this population. There is good compliance and tolerability of this device in children with CHD. A larger scale randomised trial is warranted to confirm the results of this pilot study and determine the impact of changes in activity levels on exercise capacity in children with CHD. 235 PREVALENCE AND CORRELATES OF SLEEP-DISORDERED BREATHING IN CONGENITAL HEART DISEASE M Chari, E Oechslin, C Ryan Toronto, Ontario BACKGROUND:
The prevalence of sleep-disordered breathing (SDB) is approximately 10% in the general population and is increased in those with comorbidities such as ischemic heart disease and stroke. The increased survival of patients with congenital heart disease (CHD) into adulthood elevates the risk of both ischemic heart disease and non-cardiovascular diseases. The aim of our study was to assess the prevalence and correlates of SDB in the CHD population at the Toronto Congenital Cardiac Centre for Adults (TCCCA). METHODS: This was a retrospective cross-sectional study of active CHD patients assessed for SDB via polysomnography between 1998 and 2014 from the TCCCA. Subjects were stratified into those with (apnea-hypopnea index (AHI) 5/hr) and without SDB (AHI < 5/hr. SDB was classified as per standard criteria.
Canadian Journal of Cardiology Volume 31 2015 RESULTS:
Of the 7167 active patients in TCCCA database, there were 156 with confirmed CHD who had assessment for SDB within the study period. Of these subjects, 63% were males and 37% females with a mean age of 37.9 14.5 years. SDB was present in 131 (83.9%) subjects. Of those in whom full polysomnography data was available (n ¼ 69), 7.7% had no SDB, 8.2% mild, 9.8% moderate, and 12.6% severe SDB. Those with SDB were significantly older (41 vs 33 years, p ¼ 0.029), and had a higher BMI (31.4 vs. 25.4kg/m2, p ¼ 0.01) than those without SDB. A history of congestive heart failure was significantly associated (p¼0.021) with SDB. CONCLUSION: Two percent of patients with CHD had screening performed for SDB. In those screened for SDB there was a very high prevalence. This suggests that many patients remain undiagnosed and that screening is imperative in this population. In keeping with studies in the general population, increased age and BMI were associated with SDB. 236 HOSPITAL READMISSION OF CONGENITAL HEART DISEASE PATIENTS IN CANADA S Islam, Y Yasui, P Kaul, AS Mackie Edmonton, Alberta BACKGROUND:
Hospital readmissions represent a vast burden on health care resources and in many cases are avoidable. However, little is known about hospital readmission in children or adults with congenital heart disease (CHD) in Canada. We assessed readmission rates among CHD patients stratified by age, sex, and severity of CHD from 2003 to 2012 in Canada and identified risk factors associated with hospital readmission. METHODS: A retrospective cohort study was conducted among CHD patients identified from the hospital discharge abstract database of the Canadian Institute for Health Information from 2003 to 2012. We identified all index hospitalizations and followed them for up to 12 months to determine the readmission rate. The readmission rate for a given period of time, which is a cumulative outcome, was determined using a Poisson regression model and also stratified by age, sex, and severity of CHD. Multivariable logistic regression analyses were performed to identify risk factors associated with readmission within 2 weeks and 1 month after discharge. RESULTS: The readmission rates per 1,000 CHD patients were 48 within 2 weeks, 83 within 1 month, 163 within 3 months, and 353 within 1 year. More adults were readmitted compared to children (5.4% vs. 4.2% at 2 weeks and 8.5% vs. 7.2% at 1 month). Patients age 65 years had a 1.4 to 1.8 times higher readmission rate compared to infants (p<0.001). Among children, infants showed significantly higher readmission rate at 2 weeks (p¼0.014), 1 month (p¼0.03) and 3 months (p<0.001). The readmission rates were 2.5 to 4.9 times higher in complex CHD patients (p<0.001) and 1.3 to 1.8 times higher in moderate CHD patients (p<0.001) than simple CHD patients. Independent risk factors for readmission within 2 weeks and 1 month were age 40 years, age < 1 year, male sex, longer index hospitalization stay, and complex CHD. In adults non-CHD
Abstracts
S125
cardiovascular diagnoses (congestive heart failure, atrial fibrillation and flutter, aortic valve disease, ischemic heart disease) were the most common diagnoses associated with hospital readmission while in children ventricular septal defect and respiratory illness were the most common reasons for readmission. CONCLUSION: Hospital readmission was common in CHD patients, particularly adults aged 40+ years, infants, males and those with complex lesions. Further studies are required to investigate the mechanism for unplanned readmission.
had final PVRi 8 Woodunitm2. Pre and post-treatment with pulmonary vasodilators in high risk ASD closure may aid to improve the outcomes.
237 TREATMENT AND SURVIVAL OF ATRIAL SEPTAL DEFECT IN ASSOCIATED WITH PULMONARY HYPERTENSION
Toronto, Ontario
Y Titaram, K Durongpisitkul, P Chanthong, S Kanjanauthai, J Soongswang, C Vijarnsorn Bangkok, Thailand BACKGROUND:
Atrial septal defect (ASD) is a common congenital shunt lesion which may be complicated by pulmonary hypertension (PH). Decision making for patients with elevated pulmonary vascular resistance index (PVRi) is challenging. This 16-year longitudinal study of patients with ASD and PH aimed to compare survival and freedom of functional class (FC) worsening between ASD repair and conservative medical treatment groups in addition to determine a survival of various borderline PVRi. METHODS: All patients with unrepaired ASD, having evidence of PH on echocardiography requiring right heart catheterization (RHC) to obtain hemodynamic data in Siriraj hospital between 1997 and 2013 were reviewed. 98 patients with mean pulmonary artery pressure (mPAP) > 25 mmHg on RHC were included. 8 patients were excluded due to incomplete data or less than 1 year follow-up. Treatment and clinical outcomes at a year and a recent follow-up were recorded. Kaplan-Meier curves were constructed for different therapies and final PVRi. RESULTS: At a median follow-up of 6.3 years (1 - 16.5 years), 90 patients with ASD size of 23.8 7.4 mm were reviewed. The age at the diagnosis was 36.9 16 years. Twenty patients were pretreated with pulmonary vasodilators. The mPAP was 49 13.1 mmHg and PVRi of 5.7 4.2 Woodunit$m2. 59 patients had a large sized ASD. 13 patients had Eisenmenger syndrome. 18 patients had a small defect associated with PH. 43 patients (47%) underwent ASD closure (19; percutaneous intervention, 20; surgical repair and 4; fenestrated closure). Notably, 25 patients continued pulmonary vasodilators post procedures. Overall, survival rate at 1, 3, 5 and 10 years were 98.9%, 98.9%, 95.5% and 91.5%. Although, predicted survival between PVRi groups either [ 6, > 6] or [ 8, > 8] or [ 10, > 10] Woodunit$m2 were not statistically different, the freedom of worsening FC ( Fc III) were significantly better in PVRi 6 than > 6 (p 0.03) and PVRi 8 than > 8 (p 0.02). In ASD closure group, PVRi 8 Woodunit$m2 showed better freedom from FC worsening than more elevated PVRi (p 0.02). Conversely, the medical treatment group showed no difference (p ¼ 0.55). CONCLUSION: Severity of PH in ASD modulates by PVRi. ASD closure likely remains beneficial in selected patients who
238 THE PREVALENCE METABOLIC OF SYNDROME AMONG JAPANESE ADULT CONGENITAL HEART DISEASE PATIENTS: A SINGLE CENTER EXPERIENCE A Javier BACKGROUND:
Recent western data has shown an increased prevalence of obesity and other traditional cardiovascular risk factors among children, adolescents, and adults with congenital heart disease (ACHD). The prevalence of metabolic syndrome, which increases the 10-year risk of developing cardiovascular disease by two-fold and the onset of diabetes mellitus by five-fold, has never been described in ACHD patients. We sought to determine the prevalence of metabolic syndrome (MS) among Japanese patients seen at our ACHD out-patient clinic, a population known to have one of the lowest prevalence of obesity and metabolic syndrome worldwide. METHODS: This was a cross-sectional study. Consecutive patients seen over a two-month period were included. Height, weight, waist circumference and most recent bloodwork (fasting blood sugar and lipid profile) recorded. The prevalence of metabolic syndrome, overweight/obesity, pre-hypertension, hypertension, impaired fasting glucose, and diabetes mellitus were described. Differences between groups (cyanotic vs. acyanotic lesions, simple vs. complex lesions, normal vs. overweight/obese) were analyzed. RESULTS: There were 119 ACHD patients included, 79.8% of which are of moderate to greatly complex lesions. The average age was 37.21 +/- 15.72 and 45% were males. Cyanotic patients comprise 14% of patients. The prevalence of MS was 16% with elevated fasting blood sugar as the most common component (26.9%). The prevalence of impaired fasting glucose was 5.9 % by World Health Organization criteria and 18.5% by American Diabetes Association criteria. Diabetes mellitus was found in 9.2% of cases. The prevalence of overweight and obesity (BMI > 25) was 21.9%. Body mass index was significantly different between cyanotic and acyanotic patients (p¼0.013). The presence of prehypertension/hypertension (p¼0.001) and the MS (0.008) are significantly found more of often in overweight/ obese ACHD patients. No difference between the prevalence of risk factors were noted between simple and complex lesion groups. CONCLUSION: Metabolic syndrome (16% vs. 5.5%) and obesity (10.1% vs. 3.9%) were more prevalent in Japanese ACHD patients as compared to the general Japanese adult population. The presence of other cardiovascular (CV) risk factors such as hypertension, dyslipidemia, impaired fasting glucose, and diabetes were considerable among Japanese ACHD patients. This study demonstrated that ACHD patients were also at an increased risk of CV risk factors as much as general population. Because of their pre-existing congenital structural cardiac malformations they should as well be subject to aggressive risk factor modification to reduce risk of atherosclerotic CV disease.
We recruited children 10-18 years of age with CHD. Baseline testing included cardiopulmonary exercise testing and measurement of activity using an accelerometer (GT3X+ ActiGraph LLC; 15s epoch). Physical activity was assessed using the FITT (frequency, intensity, time and type) principle. Participants were randomised; those in the intervention group were given an exercise prescription and activity tracker (MOVband, Cleveland, OH) for 16 weeks. The control group did not receive exercise prescription or activity trackers. Exercise physiologists monitored the intervention group’s physical activity online and provided support on a bi-weekly basis. MVPA was assessed with an accelerometer after 16 weeks. We included those who met usual wear time criteria (2 days with 600 minutes wear time/day, allowing non-wear of 60 minutes of zeros, 2 minutes spike allowance <100 counts per minute (cpm)). Vertical acceleration counts were categorised into sedentary (<100cpm) and MVPA ( 2296cpm) reported as mean daily minutes of MVPA and % sedentary time (sedentary minutes relative to wear time). RESULTS: Eight children (age 13-16 years) participated in the study with 4 randomly allocated to the intervention group. Two were excluded due to wear time <2 days with the accelerometers; both in the control group. Three of four children in the intervention group increased MVPA (2.5 to 24.8 minutes) and decreased %sedentary time (2.3% to 6.1%), while the two control children decreased MVPA (6.9 and 9.6 minutes) and sedentary behaviour was unchanged (0%) or increased (4.0%). CONCLUSION: The use of exercise prescription with an activity tracker is feasible and associated with increases in MVPA and decreases in sedentary time in children with CHD. This new technology provides unique opportunities to promote and remotely monitor activity levels in this population. There is good compliance and tolerability of this device in children with CHD. A larger scale randomised trial is warranted to confirm the results of this pilot study and determine the impact of changes in activity levels on exercise capacity in children with CHD. 235 PREVALENCE AND CORRELATES OF SLEEP-DISORDERED BREATHING IN CONGENITAL HEART DISEASE M Chari, E Oechslin, C Ryan Toronto, Ontario BACKGROUND:
The prevalence of sleep-disordered breathing (SDB) is approximately 10% in the general population and is increased in those with comorbidities such as ischemic heart disease and stroke. The increased survival of patients with congenital heart disease (CHD) into adulthood elevates the risk of both ischemic heart disease and non-cardiovascular diseases. The aim of our study was to assess the prevalence and correlates of SDB in the CHD population at the Toronto Congenital Cardiac Centre for Adults (TCCCA). METHODS: This was a retrospective cross-sectional study of active CHD patients assessed for SDB via polysomnography between 1998 and 2014 from the TCCCA. Subjects were stratified into those with (apnea-hypopnea index (AHI) 5/hr) and without SDB (AHI < 5/hr. SDB was classified as per standard criteria.
Canadian Journal of Cardiology Volume 31 2015 RESULTS:
Of the 7167 active patients in TCCCA database, there were 156 with confirmed CHD who had assessment for SDB within the study period. Of these subjects, 63% were males and 37% females with a mean age of 37.9 14.5 years. SDB was present in 131 (83.9%) subjects. Of those in whom full polysomnography data was available (n ¼ 69), 7.7% had no SDB, 8.2% mild, 9.8% moderate, and 12.6% severe SDB. Those with SDB were significantly older (41 vs 33 years, p ¼ 0.029), and had a higher BMI (31.4 vs. 25.4kg/m2, p ¼ 0.01) than those without SDB. A history of congestive heart failure was significantly associated (p¼0.021) with SDB. CONCLUSION: Two percent of patients with CHD had screening performed for SDB. In those screened for SDB there was a very high prevalence. This suggests that many patients remain undiagnosed and that screening is imperative in this population. In keeping with studies in the general population, increased age and BMI were associated with SDB. 236 HOSPITAL READMISSION OF CONGENITAL HEART DISEASE PATIENTS IN CANADA S Islam, Y Yasui, P Kaul, AS Mackie Edmonton, Alberta BACKGROUND:
Hospital readmissions represent a vast burden on health care resources and in many cases are avoidable. However, little is known about hospital readmission in children or adults with congenital heart disease (CHD) in Canada. We assessed readmission rates among CHD patients stratified by age, sex, and severity of CHD from 2003 to 2012 in Canada and identified risk factors associated with hospital readmission. METHODS: A retrospective cohort study was conducted among CHD patients identified from the hospital discharge abstract database of the Canadian Institute for Health Information from 2003 to 2012. We identified all index hospitalizations and followed them for up to 12 months to determine the readmission rate. The readmission rate for a given period of time, which is a cumulative outcome, was determined using a Poisson regression model and also stratified by age, sex, and severity of CHD. Multivariable logistic regression analyses were performed to identify risk factors associated with readmission within 2 weeks and 1 month after discharge. RESULTS: The readmission rates per 1,000 CHD patients were 48 within 2 weeks, 83 within 1 month, 163 within 3 months, and 353 within 1 year. More adults were readmitted compared to children (5.4% vs. 4.2% at 2 weeks and 8.5% vs. 7.2% at 1 month). Patients age 65 years had a 1.4 to 1.8 times higher readmission rate compared to infants (p<0.001). Among children, infants showed significantly higher readmission rate at 2 weeks (p¼0.014), 1 month (p¼0.03) and 3 months (p<0.001). The readmission rates were 2.5 to 4.9 times higher in complex CHD patients (p<0.001) and 1.3 to 1.8 times higher in moderate CHD patients (p<0.001) than simple CHD patients. Independent risk factors for readmission within 2 weeks and 1 month were age 40 years, age < 1 year, male sex, longer index hospitalization stay, and complex CHD. In adults non-CHD
Abstracts
S125
cardiovascular diagnoses (congestive heart failure, atrial fibrillation and flutter, aortic valve disease, ischemic heart disease) were the most common diagnoses associated with hospital readmission while in children ventricular septal defect and respiratory illness were the most common reasons for readmission. CONCLUSION: Hospital readmission was common in CHD patients, particularly adults aged 40+ years, infants, males and those with complex lesions. Further studies are required to investigate the mechanism for unplanned readmission.
had final PVRi 8 Woodunitm2. Pre and post-treatment with pulmonary vasodilators in high risk ASD closure may aid to improve the outcomes.
237 TREATMENT AND SURVIVAL OF ATRIAL SEPTAL DEFECT IN ASSOCIATED WITH PULMONARY HYPERTENSION
Toronto, Ontario
Y Titaram, K Durongpisitkul, P Chanthong, S Kanjanauthai, J Soongswang, C Vijarnsorn Bangkok, Thailand BACKGROUND:
Atrial septal defect (ASD) is a common congenital shunt lesion which may be complicated by pulmonary hypertension (PH). Decision making for patients with elevated pulmonary vascular resistance index (PVRi) is challenging. This 16-year longitudinal study of patients with ASD and PH aimed to compare survival and freedom of functional class (FC) worsening between ASD repair and conservative medical treatment groups in addition to determine a survival of various borderline PVRi. METHODS: All patients with unrepaired ASD, having evidence of PH on echocardiography requiring right heart catheterization (RHC) to obtain hemodynamic data in Siriraj hospital between 1997 and 2013 were reviewed. 98 patients with mean pulmonary artery pressure (mPAP) > 25 mmHg on RHC were included. 8 patients were excluded due to incomplete data or less than 1 year follow-up. Treatment and clinical outcomes at a year and a recent follow-up were recorded. Kaplan-Meier curves were constructed for different therapies and final PVRi. RESULTS: At a median follow-up of 6.3 years (1 - 16.5 years), 90 patients with ASD size of 23.8 7.4 mm were reviewed. The age at the diagnosis was 36.9 16 years. Twenty patients were pretreated with pulmonary vasodilators. The mPAP was 49 13.1 mmHg and PVRi of 5.7 4.2 Woodunit$m2. 59 patients had a large sized ASD. 13 patients had Eisenmenger syndrome. 18 patients had a small defect associated with PH. 43 patients (47%) underwent ASD closure (19; percutaneous intervention, 20; surgical repair and 4; fenestrated closure). Notably, 25 patients continued pulmonary vasodilators post procedures. Overall, survival rate at 1, 3, 5 and 10 years were 98.9%, 98.9%, 95.5% and 91.5%. Although, predicted survival between PVRi groups either [ 6, > 6] or [ 8, > 8] or [ 10, > 10] Woodunit$m2 were not statistically different, the freedom of worsening FC ( Fc III) were significantly better in PVRi 6 than > 6 (p 0.03) and PVRi 8 than > 8 (p 0.02). In ASD closure group, PVRi 8 Woodunit$m2 showed better freedom from FC worsening than more elevated PVRi (p 0.02). Conversely, the medical treatment group showed no difference (p ¼ 0.55). CONCLUSION: Severity of PH in ASD modulates by PVRi. ASD closure likely remains beneficial in selected patients who
238 THE PREVALENCE METABOLIC OF SYNDROME AMONG JAPANESE ADULT CONGENITAL HEART DISEASE PATIENTS: A SINGLE CENTER EXPERIENCE A Javier BACKGROUND:
Recent western data has shown an increased prevalence of obesity and other traditional cardiovascular risk factors among children, adolescents, and adults with congenital heart disease (ACHD). The prevalence of metabolic syndrome, which increases the 10-year risk of developing cardiovascular disease by two-fold and the onset of diabetes mellitus by five-fold, has never been described in ACHD patients. We sought to determine the prevalence of metabolic syndrome (MS) among Japanese patients seen at our ACHD out-patient clinic, a population known to have one of the lowest prevalence of obesity and metabolic syndrome worldwide. METHODS: This was a cross-sectional study. Consecutive patients seen over a two-month period were included. Height, weight, waist circumference and most recent bloodwork (fasting blood sugar and lipid profile) recorded. The prevalence of metabolic syndrome, overweight/obesity, pre-hypertension, hypertension, impaired fasting glucose, and diabetes mellitus were described. Differences between groups (cyanotic vs. acyanotic lesions, simple vs. complex lesions, normal vs. overweight/obese) were analyzed. RESULTS: There were 119 ACHD patients included, 79.8% of which are of moderate to greatly complex lesions. The average age was 37.21 +/- 15.72 and 45% were males. Cyanotic patients comprise 14% of patients. The prevalence of MS was 16% with elevated fasting blood sugar as the most common component (26.9%). The prevalence of impaired fasting glucose was 5.9 % by World Health Organization criteria and 18.5% by American Diabetes Association criteria. Diabetes mellitus was found in 9.2% of cases. The prevalence of overweight and obesity (BMI > 25) was 21.9%. Body mass index was significantly different between cyanotic and acyanotic patients (p¼0.013). The presence of prehypertension/hypertension (p¼0.001) and the MS (0.008) are significantly found more of often in overweight/ obese ACHD patients. No difference between the prevalence of risk factors were noted between simple and complex lesion groups. CONCLUSION: Metabolic syndrome (16% vs. 5.5%) and obesity (10.1% vs. 3.9%) were more prevalent in Japanese ACHD patients as compared to the general Japanese adult population. The presence of other cardiovascular (CV) risk factors such as hypertension, dyslipidemia, impaired fasting glucose, and diabetes were considerable among Japanese ACHD patients. This study demonstrated that ACHD patients were also at an increased risk of CV risk factors as much as general population. Because of their pre-existing congenital structural cardiac malformations they should as well be subject to aggressive risk factor modification to reduce risk of atherosclerotic CV disease.