- Email: [email protected]
O161 Using DCE to assess adherence and treatment preferences for combination therapies for cardiovascular disease
ORAL ABSTRACTS
Methods: A computer model of the entire cardiovascular system of a normal neonate (Mynard JP, PhD Thesis, University of Melbourne, 2011) was modified to incorporate aortic coarctation. CCA haemodynamics and wave intensity were assessed for coarctation severities between 0% and 90%. Augmentation index (AI) was calculated by dividing the total pressure rise following the initial inflection point by overall pulse pressure. To evaluate the effect of elevated arterial stiffness, wave speed of all precoarctation arteries was increased by up to 250%. Results: Simulated pressure and wave intensity in the CCA are shown in Fig. 1 for a normal aorta and for 90% coarctation. A single forward compression wave (FCW1) was present in the case of a normal aorta. Coarctation led to partial reflection of the FCW1, and the reflected wave was partially transmitted into the CCA, giving rise to a second forward compression wave (FCW2) whose wave area increased progressively with coarctation severity (Fig. 2). The FCW2 augmented CCA pressure (Fig. 1), producing an increase in AI from 0.22 for 0% coarctation to 0.50 for 90% coarctation, with the most prominent rise occurring when the severity was >50%. Increasing wave speed reduced the FCW1-FCW2 time delay (Fig. 2) and the two waves merged at high wave speeds. Conclusion: Computer modelling data suggest that a reflected wave arising from the site of aortic coarctation may be transmitted into the carotid artery and lead to a substantial pressure augmentation. These wave dynamics may play a role in the higher risk of cerebral aneurysm formation in patients with aortic coarctation. Disclosure of Interest: None Declared O160 Prospective memory in chronic heart failure Tina Habota*1, Jan Cameron2, Skye N. McLennan1, Chantal F. Ski2, David R. Thompson2, Peter G. Rendell1 1 School of Psychology, 2Cardiovascular Research Centre, Australian Catholic University, Melbourne , Australia Introduction: Chronic heart failure (CHF) is a debilitating condition that often results in poor quality of life, reduced survival rates, frequent hospitalisation, and psychopathology. Global cognitive impairment is prevalent in this group. However, no study has investigated one of the arguably most relevant specific memory processes: prospective memory (PM). This is the memory to carry out future intentions and is involved in a range of important daily tasks such as taking medication, and may therefore be particularly important for CHF patients. Objectives: To assess the PM abilities of CHF patients compared to healthy controls. Methods: The CHF group, attending a nurse-led management program at one of three hospital sites in Metropolitan Melbourne, included predominantly male adults (n¼29; mean age¼69.93, SD¼12.08). The healthy control group was recruited from the general community and matched to the CHF group on age, gender, years of education, and premorbid intelligence. Testing of controls is ongoing (currently n¼11). All participants were screened for dementia. Participants underwent a battery of neuropsychological testing; the primary assessment tool was the well-established behavioural measure of PM, Virtual Week. In a computerised board game that simulates daily activities, participants were asked to remember to perform tasks that closely represent PM tasks in daily life. Two key task distinctions were assessed – whether a task is completed at a set time or at a specific event, and whether there were low or high memory demands for the content of the task. Results: Preliminary findings using t-tests indicated that, compared to controls (M¼.70, SD¼.22) the CHF group (M¼.51, SD¼.27) had significantly lower proportions of correct PM responses, overall (Cohen’s d¼.76). The deficits were substantial for the time-based tasks and modest for tasks cued by an event. Deficits in tasks involving high memory demands were also substantial compared to low memory demands. Conclusion: Preliminary findings indicated that the CHF group have deficits in PM that vary according to the task type. In this group, poorest performance was evident in tasks requiring time-monitoring. However, minimising demands of the task content was found to reduce deficits. Disclosure of Interest: None Declared O161 Using DCE to assess adherence and treatment preferences for combination therapies for cardiovascular disease Tracey-Lea Laba*1, Kirsten Howard2, John Rose3, Stephen Jan1, PEAK team 1 Health Economics, The George Institute for Global Health, 2School of Public Health, 3Institute for Transport and Logistics, University of Sydney, Sydney, Australia Introduction: Discrete Choice Experiment (DCE) is a preference elicitation method used to value healthcare technologies. Kanyini-GAP (KGAP), a pragmatic clinical trial, assessed a polypill-based strategy on patient adherence to cardiovascular disease (CVD) treatment in Indigenous and non-Indigenous Australians. In this context DCE could help understand patient preferences for treatment, assisting with clinical evidence translation. Objectives: To assess the influence of treatment attributes and patient characteristics on treatment adherence in CVD prevention. Methods: A DCE was administered to KGAP patients completing end-of-study visits involving choices between two unlabelled treatment options of equivalent efficacy and side effects, as recommended for CVD prevention. Respondents made a choice between the treatments or no treatment given a high CVD risk diagnosis. Treatment preferences were assessed for out-of-pocket costs ($AUD), tablet number, administration time, and prescriber visit frequency. Odds ratios for preferring treatment to no treatment, trade-off between treatment attributes, and the predicted probability of treatment uptake were evaluated. Results: 332 of 487 eligible patients completed a survey (response 68%, mean age 65 (SD ¼11)). Adherence to treatment was chosen 93% compared to no treatment. Preference
e44
to adhere decreased with increased out-of-pocket treatment costs (OR¼0.95 95%CI 0.940.96) and tablet number (OR¼0.83 95%CI 0.71-0.98), but decreased frequency of prescriber visits (OR¼0.84 95%CI 0.75-0.94). In valuing individual treatment attributes, respondents were willing to pay up to $136.65 per month and accept up to 3 additional tablets per dose to reduce administration frequency, with no clear preference for morning over night administration. Respondents with a weekly household income of $400-799 and those with a university-related higher education were less likely to prefer treatment. The predicted probability of uptake of a polypill was greater than for standard individualised combination therapy. Previous experience with CVD medication, including the polypillbased strategy increased adherence preference. Conclusion: Given the scenario in which respondents were at a high CVD risk, most expressed a preference for preventive treatment. Assuming equal efficacy and toxicity of treatment options, a polypill-based strategy should increase CVD preventive therapy uptake especially in treatment-experienced patients. Additional strategies targeting specific socioeconomic groups are warranted. Disclosure of Interest: None Declared O162 Effect of a periodontal intervention on pulse wave velocity in Indigenous Australians with periodontal disease: the PerioCardio randomized controlled trial Kostas Kapellas*1, Louise J. Maple-Brown2, Peter M. Bartold3, Alex Brown4, Kerin O’Dea5, Gary D. Slade6, David S. Celermajer7, Lisa M. Jamieson1, Michael R. Skilton8, on behalf of PerioCardio Study 1 ARCPOH, School of Dentistry, University of Adelaide, Adelaide, 2Division of Medicine, Royal Darwin Hospital, Darwin, 3CACDRC, School of Dentistry, University of Adelaide, 4Aboriginal Health, South Australian Health and Medical Reseach Institute, 5Sansom Institute, University of South Australia, Adelaide, Australia, 6Department of Dental Ecology, University of North Carolina, Chapel Hill, United States, 7Depatrment of Medicine, 8Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, Australia Introduction: Indigenous Australians have high rates of premature cardiovascular disease and high prevalence of periodontitis, an inflammatory disease of the tissues surrounding teeth. Periodontitis has been associated with arterial stiffening and incident cardiovascular events and. periodontal bacteria have been isolated from atheromatous plaques. If periodontitis contributes causally to cardiovascular disease, periodontal treatment may confer important benefits to the health of Indigenous Australians. Objectives: To determine if a single episode of periodontal treatment improved arterial stiffness in otherwise healthy Indigenous Australian adults. Methods: Participants were 273 Indigenous Australian adults (57% male; age 40.3years [SD 10.2]) with moderate or severe periodontal disease in the Northern Territory, Australia. Participants were randomized into intervention (n¼138) or control (n¼135) groups. The intervention involved removal of sub- and supra-gingival calculus and plaque biofilm by scaling and root-planing once, at randomization. Pulse wave velocity (PWV) was assessed by applanation tonometry (SphygmoCor- PVMx device, AtCor Medical, Sydney, Australia) between the carotid and dorsalis pedis arteries, at baseline and again 3-months (n¼169) and 12-months (n¼171) post randomization. Comparison of randomized groups was by complete case analysis using ANCOVA adjusted for baseline measures. Results: At baseline, the average carotid-dorsalis pedis PWV was 8.34 m/s (SD 1.25). The mean reduction in periodontal pocketing from enrollment to 3-months was 0.14 mm greater [95% CI 0.24 to 0.05] in the intervention group compared to control, P¼0.004). This was less marked at 12-months, mean reduction in periodontal pocketing 0.09 mm greater [95% CI -0.01 to 0.18] in the intervention versus control, P¼0.08). In contrast, the intervention did not affect PWV at 3-months [the primary endpoint] (between-group difference in means +0.06 m/s [95% CI -0.17 to 0.29] intervention vs. control, P ¼ 0.59), although there was some evidence that the intervention increased PWV at 12-months, this was not statistically significant (between-group difference in means +0.21 m/s [95% CI -0.01 to 0.43] intervention vs. control, P¼0.06). Conclusion: A single episode periodontal intervention in Indigenous Australians with periodontal disease provides short-term improvement in periodontal health, but did not significantly influence arterial stiffness as measured by pulse wave velocity. Disclosure of Interest: None Declared
O163 Post-discharge ECG Holter monitoring in recently hospitalised individuals with chronic atrial fibrillation to enhance therapeutic monitoring and identify potentially high risk phenotypes Jocasta Ball*1, Melinda Carrington1, David Thompson2, John Horowitz3, Simon Stewart1, on behalf of the SAFETY Study Investigators 1 Preventative Health, Baker IDI Heart and Diabetes Institute, 2Cardiovascular Research Centre, Australian Catholic University, Melbourne, 3The Queen Elizabeth Hospital, Adelaide, Australia Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia managed in clinical practice. Maintenance of intended AF control (rate or rhythm) following an acute hospitalisation is a key therapeutic goal. Objectives: To determine the value of post-discharge ECG Holter monitoring to assess maintenance of intended AF control and enhance the management of patients with AF. Methods: Sub-study of a multicentre randomised controlled trial of AF-specific postdischarge management in typically older individuals with chronic AF. Continuous 24-hour ECG Holter monitoring was undertaken at a home visit 7-14 days post-discharge. Intended versus detected rate and rhythm control was compared to ECG Holter data. Frequency
GHEART Vol 9/1S/2014
j
March, 2014
j
ORAL/2014 WCC Orals
Methods: A computer model of the entire cardiovascular system of a normal neonate (Mynard JP, PhD Thesis, University of Melbourne, 2011) was modified to incorporate aortic coarctation. CCA haemodynamics and wave intensity were assessed for coarctation severities between 0% and 90%. Augmentation index (AI) was calculated by dividing the total pressure rise following the initial inflection point by overall pulse pressure. To evaluate the effect of elevated arterial stiffness, wave speed of all precoarctation arteries was increased by up to 250%. Results: Simulated pressure and wave intensity in the CCA are shown in Fig. 1 for a normal aorta and for 90% coarctation. A single forward compression wave (FCW1) was present in the case of a normal aorta. Coarctation led to partial reflection of the FCW1, and the reflected wave was partially transmitted into the CCA, giving rise to a second forward compression wave (FCW2) whose wave area increased progressively with coarctation severity (Fig. 2). The FCW2 augmented CCA pressure (Fig. 1), producing an increase in AI from 0.22 for 0% coarctation to 0.50 for 90% coarctation, with the most prominent rise occurring when the severity was >50%. Increasing wave speed reduced the FCW1-FCW2 time delay (Fig. 2) and the two waves merged at high wave speeds. Conclusion: Computer modelling data suggest that a reflected wave arising from the site of aortic coarctation may be transmitted into the carotid artery and lead to a substantial pressure augmentation. These wave dynamics may play a role in the higher risk of cerebral aneurysm formation in patients with aortic coarctation. Disclosure of Interest: None Declared O160 Prospective memory in chronic heart failure Tina Habota*1, Jan Cameron2, Skye N. McLennan1, Chantal F. Ski2, David R. Thompson2, Peter G. Rendell1 1 School of Psychology, 2Cardiovascular Research Centre, Australian Catholic University, Melbourne , Australia Introduction: Chronic heart failure (CHF) is a debilitating condition that often results in poor quality of life, reduced survival rates, frequent hospitalisation, and psychopathology. Global cognitive impairment is prevalent in this group. However, no study has investigated one of the arguably most relevant specific memory processes: prospective memory (PM). This is the memory to carry out future intentions and is involved in a range of important daily tasks such as taking medication, and may therefore be particularly important for CHF patients. Objectives: To assess the PM abilities of CHF patients compared to healthy controls. Methods: The CHF group, attending a nurse-led management program at one of three hospital sites in Metropolitan Melbourne, included predominantly male adults (n¼29; mean age¼69.93, SD¼12.08). The healthy control group was recruited from the general community and matched to the CHF group on age, gender, years of education, and premorbid intelligence. Testing of controls is ongoing (currently n¼11). All participants were screened for dementia. Participants underwent a battery of neuropsychological testing; the primary assessment tool was the well-established behavioural measure of PM, Virtual Week. In a computerised board game that simulates daily activities, participants were asked to remember to perform tasks that closely represent PM tasks in daily life. Two key task distinctions were assessed – whether a task is completed at a set time or at a specific event, and whether there were low or high memory demands for the content of the task. Results: Preliminary findings using t-tests indicated that, compared to controls (M¼.70, SD¼.22) the CHF group (M¼.51, SD¼.27) had significantly lower proportions of correct PM responses, overall (Cohen’s d¼.76). The deficits were substantial for the time-based tasks and modest for tasks cued by an event. Deficits in tasks involving high memory demands were also substantial compared to low memory demands. Conclusion: Preliminary findings indicated that the CHF group have deficits in PM that vary according to the task type. In this group, poorest performance was evident in tasks requiring time-monitoring. However, minimising demands of the task content was found to reduce deficits. Disclosure of Interest: None Declared O161 Using DCE to assess adherence and treatment preferences for combination therapies for cardiovascular disease Tracey-Lea Laba*1, Kirsten Howard2, John Rose3, Stephen Jan1, PEAK team 1 Health Economics, The George Institute for Global Health, 2School of Public Health, 3Institute for Transport and Logistics, University of Sydney, Sydney, Australia Introduction: Discrete Choice Experiment (DCE) is a preference elicitation method used to value healthcare technologies. Kanyini-GAP (KGAP), a pragmatic clinical trial, assessed a polypill-based strategy on patient adherence to cardiovascular disease (CVD) treatment in Indigenous and non-Indigenous Australians. In this context DCE could help understand patient preferences for treatment, assisting with clinical evidence translation. Objectives: To assess the influence of treatment attributes and patient characteristics on treatment adherence in CVD prevention. Methods: A DCE was administered to KGAP patients completing end-of-study visits involving choices between two unlabelled treatment options of equivalent efficacy and side effects, as recommended for CVD prevention. Respondents made a choice between the treatments or no treatment given a high CVD risk diagnosis. Treatment preferences were assessed for out-of-pocket costs ($AUD), tablet number, administration time, and prescriber visit frequency. Odds ratios for preferring treatment to no treatment, trade-off between treatment attributes, and the predicted probability of treatment uptake were evaluated. Results: 332 of 487 eligible patients completed a survey (response 68%, mean age 65 (SD ¼11)). Adherence to treatment was chosen 93% compared to no treatment. Preference
e44
to adhere decreased with increased out-of-pocket treatment costs (OR¼0.95 95%CI 0.940.96) and tablet number (OR¼0.83 95%CI 0.71-0.98), but decreased frequency of prescriber visits (OR¼0.84 95%CI 0.75-0.94). In valuing individual treatment attributes, respondents were willing to pay up to $136.65 per month and accept up to 3 additional tablets per dose to reduce administration frequency, with no clear preference for morning over night administration. Respondents with a weekly household income of $400-799 and those with a university-related higher education were less likely to prefer treatment. The predicted probability of uptake of a polypill was greater than for standard individualised combination therapy. Previous experience with CVD medication, including the polypillbased strategy increased adherence preference. Conclusion: Given the scenario in which respondents were at a high CVD risk, most expressed a preference for preventive treatment. Assuming equal efficacy and toxicity of treatment options, a polypill-based strategy should increase CVD preventive therapy uptake especially in treatment-experienced patients. Additional strategies targeting specific socioeconomic groups are warranted. Disclosure of Interest: None Declared O162 Effect of a periodontal intervention on pulse wave velocity in Indigenous Australians with periodontal disease: the PerioCardio randomized controlled trial Kostas Kapellas*1, Louise J. Maple-Brown2, Peter M. Bartold3, Alex Brown4, Kerin O’Dea5, Gary D. Slade6, David S. Celermajer7, Lisa M. Jamieson1, Michael R. Skilton8, on behalf of PerioCardio Study 1 ARCPOH, School of Dentistry, University of Adelaide, Adelaide, 2Division of Medicine, Royal Darwin Hospital, Darwin, 3CACDRC, School of Dentistry, University of Adelaide, 4Aboriginal Health, South Australian Health and Medical Reseach Institute, 5Sansom Institute, University of South Australia, Adelaide, Australia, 6Department of Dental Ecology, University of North Carolina, Chapel Hill, United States, 7Depatrment of Medicine, 8Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, Australia Introduction: Indigenous Australians have high rates of premature cardiovascular disease and high prevalence of periodontitis, an inflammatory disease of the tissues surrounding teeth. Periodontitis has been associated with arterial stiffening and incident cardiovascular events and. periodontal bacteria have been isolated from atheromatous plaques. If periodontitis contributes causally to cardiovascular disease, periodontal treatment may confer important benefits to the health of Indigenous Australians. Objectives: To determine if a single episode of periodontal treatment improved arterial stiffness in otherwise healthy Indigenous Australian adults. Methods: Participants were 273 Indigenous Australian adults (57% male; age 40.3years [SD 10.2]) with moderate or severe periodontal disease in the Northern Territory, Australia. Participants were randomized into intervention (n¼138) or control (n¼135) groups. The intervention involved removal of sub- and supra-gingival calculus and plaque biofilm by scaling and root-planing once, at randomization. Pulse wave velocity (PWV) was assessed by applanation tonometry (SphygmoCor- PVMx device, AtCor Medical, Sydney, Australia) between the carotid and dorsalis pedis arteries, at baseline and again 3-months (n¼169) and 12-months (n¼171) post randomization. Comparison of randomized groups was by complete case analysis using ANCOVA adjusted for baseline measures. Results: At baseline, the average carotid-dorsalis pedis PWV was 8.34 m/s (SD 1.25). The mean reduction in periodontal pocketing from enrollment to 3-months was 0.14 mm greater [95% CI 0.24 to 0.05] in the intervention group compared to control, P¼0.004). This was less marked at 12-months, mean reduction in periodontal pocketing 0.09 mm greater [95% CI -0.01 to 0.18] in the intervention versus control, P¼0.08). In contrast, the intervention did not affect PWV at 3-months [the primary endpoint] (between-group difference in means +0.06 m/s [95% CI -0.17 to 0.29] intervention vs. control, P ¼ 0.59), although there was some evidence that the intervention increased PWV at 12-months, this was not statistically significant (between-group difference in means +0.21 m/s [95% CI -0.01 to 0.43] intervention vs. control, P¼0.06). Conclusion: A single episode periodontal intervention in Indigenous Australians with periodontal disease provides short-term improvement in periodontal health, but did not significantly influence arterial stiffness as measured by pulse wave velocity. Disclosure of Interest: None Declared
O163 Post-discharge ECG Holter monitoring in recently hospitalised individuals with chronic atrial fibrillation to enhance therapeutic monitoring and identify potentially high risk phenotypes Jocasta Ball*1, Melinda Carrington1, David Thompson2, John Horowitz3, Simon Stewart1, on behalf of the SAFETY Study Investigators 1 Preventative Health, Baker IDI Heart and Diabetes Institute, 2Cardiovascular Research Centre, Australian Catholic University, Melbourne, 3The Queen Elizabeth Hospital, Adelaide, Australia Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia managed in clinical practice. Maintenance of intended AF control (rate or rhythm) following an acute hospitalisation is a key therapeutic goal. Objectives: To determine the value of post-discharge ECG Holter monitoring to assess maintenance of intended AF control and enhance the management of patients with AF. Methods: Sub-study of a multicentre randomised controlled trial of AF-specific postdischarge management in typically older individuals with chronic AF. Continuous 24-hour ECG Holter monitoring was undertaken at a home visit 7-14 days post-discharge. Intended versus detected rate and rhythm control was compared to ECG Holter data. Frequency
GHEART Vol 9/1S/2014
j
March, 2014
j
ORAL/2014 WCC Orals