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Long-Term Mortality Benefits of Early Smoking Cessation after Acute Coronary Syndromes
Abstracts
776 Long-Term Mortality Benefits of Early Smoking Cessation after Acute Coronary Syndromes M. Yudi 1,∗ , N. Andrianopoulos 2 , O. Farouque 1 , J. Ramchand 1 , N. Jones 1 , J. Theuerle 1 , A. Brennan 2 , A. Ajani 2 , S. Duffy 3 , G. New 4 , C. Hiew 5 , E. Oqueli 6 , C. Reid 2 , D. Clark 1 1 Department
of Cardiology, Austin Health, Melbourne, Australia 2 Monash University CCRET, Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, Australia 3 Department of Cardiology, Alfred Health, Melbourne, Australia 4 Department of Cardiology, Box Hill Hospital, Box Hill, Australia 5 Department of Cardiology, Geelong Hospital, Geelong, Australia 6 Department of Cardiology, Ballarat Hospital, Ballarat, Australia Introduction: The relative benefit of smoking cessation after acute coronary syndromes (ACS) on long-term mortality is poorly described. Indeed some studies have suggested persistent smokers may have a survival advantages (“smoker’s paradox”). We aim to examine the prognostic importance of smoking status at 30 days post ACS. Methods: Consecutive patients with ACS from the Melbourne Interventional Group registry (2005-2013) who were alive at 30 days following their index percutaneous coronary intervention were included. Patients were divided into four categories based on their smoking status: never smoked; exsmoker (quit smoking prior to ACS); recent quitter (smoker at ACS presentation but quit by 30 days); and persistent smoker (smoker at ACS presentation and continued to smoke at 30 days). Primary endpoint was long-term mortality through National Death Index linkage. Results: Of the 9,375 patients included, 2,728 (29.1%) never smoked, 3,712 (39.6%) were ex-smokers, 1,612 (17.2%) were recent quitters and 1,323 (14.1%) were persistent smokers. Multivariate analysis revealed compared to those who had never smoked that persistent smoking (OR 1.77, 95% CI 1.352.31, p<0.001) was an independent predictor of long-term mortality (mean follow-up 3.9±2.2 years) while being a recent quitter (OR 1.29, 95% CI 0.97-1.71, p=0.08) or an ex-smoker (OR 1.03, 95% CI 0.87-1.23, p=0.67) was not. Conclusion: In this real world ACS study, almost half of smokers continue to smoke despite it being an independent predictor of long-term mortality This underscores the need to improve smoking cessation programs post ACS. http://dx.doi.org/10.1016/j.hlc.2016.06.779
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777 MyHeartMate: Development of a Digital Game to Improve Secondary Prevention of Cardiovascular Disease L. Neubeck 1,∗ , R. Gallagher 1 , K. Ingram 2 , D. Celermajer 1 , T. Schumacher 3 , C. Ferry 4 , T. Buckley 1 , J. Redfern 5 , C. Chow 5 , G. Tofler 1 , G. Figtree 1 1 The
University of Sydney, Sydney, Australia Entertainment, Sydney, Australia 3 The University of Newcastle, Newcastle, Australia 4 The Heart Foundation, Sydney, Australia 5 The George Institute for Global Health, Sydney, Australia 2 Elevator
Background and aim: Low participation in cardiac rehabilitation (CR) means alternative strategies are urgently required to ensure secondary prevention of cardiovascular disease (CVD). Digital games promote behaviour change in other diseases, however, they have not been tested in CVD. The aim was to develop an innovative evidence-based digital game to engage patients in secondary prevention of CVD. Methods: An iterative design process involving key stakeholders (patients, app developers, cardiologists, nurse researchers, CR nurses, physiotherapist, dietitian, and Heart Foundation representative). The two-month process included (i) Literature search and review of available apps; (ii) concept and design review by consumers; (iii) coding of evidence-based guidelines to inform real-world challenges. Through this process, the MyHeartMate app was developed. Results: The literature review identified that mobile apps have potential to improve CVD risk factors. Only two studies were found that incorporated gamification strategies (e.g leaderboards, rewards for goal achievement) in their mobile app, although no studies were found which evaluated a digital game. Similarly, no digital games were found in iOS or Android top-100 CVD apps. Ninety real-world challenges were created from evidence-based guidelines for consumer completion. Consumer feedback determined aesthetics of the app. The eventual MyHeartMate app is an interactive digital game in which the health of the heart (Figure) is influenced by real-world actions undertaken by the participant.
776 Long-Term Mortality Benefits of Early Smoking Cessation after Acute Coronary Syndromes M. Yudi 1,∗ , N. Andrianopoulos 2 , O. Farouque 1 , J. Ramchand 1 , N. Jones 1 , J. Theuerle 1 , A. Brennan 2 , A. Ajani 2 , S. Duffy 3 , G. New 4 , C. Hiew 5 , E. Oqueli 6 , C. Reid 2 , D. Clark 1 1 Department
of Cardiology, Austin Health, Melbourne, Australia 2 Monash University CCRET, Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, Australia 3 Department of Cardiology, Alfred Health, Melbourne, Australia 4 Department of Cardiology, Box Hill Hospital, Box Hill, Australia 5 Department of Cardiology, Geelong Hospital, Geelong, Australia 6 Department of Cardiology, Ballarat Hospital, Ballarat, Australia Introduction: The relative benefit of smoking cessation after acute coronary syndromes (ACS) on long-term mortality is poorly described. Indeed some studies have suggested persistent smokers may have a survival advantages (“smoker’s paradox”). We aim to examine the prognostic importance of smoking status at 30 days post ACS. Methods: Consecutive patients with ACS from the Melbourne Interventional Group registry (2005-2013) who were alive at 30 days following their index percutaneous coronary intervention were included. Patients were divided into four categories based on their smoking status: never smoked; exsmoker (quit smoking prior to ACS); recent quitter (smoker at ACS presentation but quit by 30 days); and persistent smoker (smoker at ACS presentation and continued to smoke at 30 days). Primary endpoint was long-term mortality through National Death Index linkage. Results: Of the 9,375 patients included, 2,728 (29.1%) never smoked, 3,712 (39.6%) were ex-smokers, 1,612 (17.2%) were recent quitters and 1,323 (14.1%) were persistent smokers. Multivariate analysis revealed compared to those who had never smoked that persistent smoking (OR 1.77, 95% CI 1.352.31, p<0.001) was an independent predictor of long-term mortality (mean follow-up 3.9±2.2 years) while being a recent quitter (OR 1.29, 95% CI 0.97-1.71, p=0.08) or an ex-smoker (OR 1.03, 95% CI 0.87-1.23, p=0.67) was not. Conclusion: In this real world ACS study, almost half of smokers continue to smoke despite it being an independent predictor of long-term mortality This underscores the need to improve smoking cessation programs post ACS. http://dx.doi.org/10.1016/j.hlc.2016.06.779
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777 MyHeartMate: Development of a Digital Game to Improve Secondary Prevention of Cardiovascular Disease L. Neubeck 1,∗ , R. Gallagher 1 , K. Ingram 2 , D. Celermajer 1 , T. Schumacher 3 , C. Ferry 4 , T. Buckley 1 , J. Redfern 5 , C. Chow 5 , G. Tofler 1 , G. Figtree 1 1 The
University of Sydney, Sydney, Australia Entertainment, Sydney, Australia 3 The University of Newcastle, Newcastle, Australia 4 The Heart Foundation, Sydney, Australia 5 The George Institute for Global Health, Sydney, Australia 2 Elevator
Background and aim: Low participation in cardiac rehabilitation (CR) means alternative strategies are urgently required to ensure secondary prevention of cardiovascular disease (CVD). Digital games promote behaviour change in other diseases, however, they have not been tested in CVD. The aim was to develop an innovative evidence-based digital game to engage patients in secondary prevention of CVD. Methods: An iterative design process involving key stakeholders (patients, app developers, cardiologists, nurse researchers, CR nurses, physiotherapist, dietitian, and Heart Foundation representative). The two-month process included (i) Literature search and review of available apps; (ii) concept and design review by consumers; (iii) coding of evidence-based guidelines to inform real-world challenges. Through this process, the MyHeartMate app was developed. Results: The literature review identified that mobile apps have potential to improve CVD risk factors. Only two studies were found that incorporated gamification strategies (e.g leaderboards, rewards for goal achievement) in their mobile app, although no studies were found which evaluated a digital game. Similarly, no digital games were found in iOS or Android top-100 CVD apps. Ninety real-world challenges were created from evidence-based guidelines for consumer completion. Consumer feedback determined aesthetics of the app. The eventual MyHeartMate app is an interactive digital game in which the health of the heart (Figure) is influenced by real-world actions undertaken by the participant.