- Email: [email protected]
PM214 Trends in the Global Burden of Rheumatic Heart Disease During 1990-2013: Findings From the Global Burden Of Disease 2013 Study
POSTER ABSTRACTS
studies were from 1960-1990 and only 6 studies from 1990 to present. We included 5 studies from low- and middle-income countries, 4 of which were from Chagas-endemic areas in South America and one from India. Age-specific rates could not be evaluated from published reports. The total number of people from the general population studies with bradycardia was 1012 and the prevalence ranged from 13.7 to 85.0 per 1000 population, with a pooled mean prevalence of 46.8 per 1000. The total number of people from the general population studies with third degree AV block was 218 and prevalence ranged from 0 to 3 per 1000 population with a pooled mean prevalence of 0.43 per 1000. The prevalence was higher in older age groups. Conclusion: Based on our review of published population-based studies, the prevalence of third degree AV block was small but estimates of prevalence for this condition are important given its high mortality if left untreated in the ageing global population. Disclosure of Interest: None Declared
but not at older ages. RHD history was also significantly more prevalent in Aboriginal than non-Aboriginal AF patients, particularly at younger ages (17.9% vs 4.1%; p<0.001). In stroke survivors, there was a higher proportion of RHD history in Aboriginal people at all ages <70 years. Disparities were highest at age 20-34 years (23% vs 3%; ratio¼8.9), but similar in the 70-84 year age group (ratio¼1.0). Conclusion: RHD is a common co-morbidity and antecedent for HF, AF and stroke in Aboriginal adults, particularly at young ages. Our findings indicate the need for earlier detection of RHD and identification of HF and AF in these patients. Addressing the social determinants of RHD and system strengthening of secondary and tertiary prevention of RHD is required to reduce its impact, ensuring continuity/integration of care across the life course, especially the transition into adulthood. Disclosure of Interest: None Declared PM214
PM210 Trends in the Mortality and Morbidity of Cardiovascular Disease in the UK P. Bhatnagar*1, K. Wickramasinghe1, N. Townsend1 1 Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom Introduction: Previous research has shown that mortality from cardiovascular diseases is declining in Europe and within the United Kingdom. It has been shown that within England, a 50% decline in age-standardised mortality from myocardial infarction was due to both a reduction in incidence and case-fatality. Consequently, there will have been an increase in the number of people living with cardiovascular disease. Objectives: We aimed to investigate how both morbidity and mortality from cardiovascular diseases have changed over time within the United Kingdom. Methods: We obtained statistics on total cardiovascular disease, coronary heart disease and stroke mortality from the national statistics agencies of the United Kingdom. We produced all ages and under 75 age-standardised mortality rates by sex, standardised to the 2013 European Standard Population. We obtained data on hospital admissions from National Health Service records, using the main diagnosis. Prevalence data come from the Quality and Outcome Framework, which is collected through General Practice records. Results: Total cardiovascular disease mortality declined by 68% between 1980 and 2013 in the United Kingdom; deaths below the age of 75 declined by 77% during the same timeperiod. Coronary heart disease mortality decreased by 71% and mortality from stroke decreased by 70% between 1980 and 2013. The number of hospital admissions for all cardiovascular diseases increased by more 46,000 between 2010/11 and 2013/14, however, over 36,500 of these increased admissions were in men. Between these years, male admissions for coronary heart disease increased by almost 3000, but decreased by around 5000 in women. Stroke admissions remained fairly stable for men and decreased by around 4500 in women. Prevalence of coronary heart disease has remained constant at around 3% in England and 4% in Wales and Northern Ireland between 2006/07 and 2013/14. Data for Scotland is available from 2008/09 and also shows a constant trend of around 4%. The prevalence of stroke in the UK has also changed little, remaining at around 2%. Conclusion: Cardiovascular disease mortality has markedly declined for both sexes. Trends in admissions to hospital for coronary heart disease and stroke differ by men and women, with increases seen in coronary heart disease admissions for men, but declines for women. Despite these trends in hospital admissions, prevalence rates have not noticeably changed in either men or women. Disclosure of Interest: None Declared
Trends in the Global Burden of Rheumatic Heart Disease During 1990-2013: Findings From the Global Burden Of Disease 2013 Study D. Watkins*1,2, S. Colquhoun3, C. Johnson4, J. Carapetis5, G. Karthikeyan6, M. Naghavi4, C. Murray4, T. Vos4, G. Roth4,7 1 Department of Medicine, University of Cape Town, Cape Town, South Africa, 2Division of General Internal Medicine, University of Washington, Seattle, United States, 3Centre for International Child Health, Murdoch Childrens Research Institute and University of Melbourne, Melbourne, Australia, 4Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States, 5Telethon Kids Institute, University of Western Australia, Perth, Australia, 6 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India, 7Division of Cardiology, University of Washington, Seattle, United States Introduction: Rheumatic heart disease (RHD) is an important cause of cardiovascular death and disability and a common cause of valvular heart disease, particularly in developing countries. Objectives: We estimated global, regional, and national trends in RHD mortality and prevalence as part of the Global Burden of Disease (GBD) 2013 study. Methods: We systematically reviewed all available sources of data on fatal and non-fatal RHD in 188 nations from 1990-2013. We estimated RHD deaths and mortality rates from vital registration datasets using the Cause of Death Ensemble modeling tool. We estimated RHD cases and prevalence from hospital records (in higher-income countries) and population-based screening studies (in lower-income countries) using DisMod-MR, a Bayesian meta-regression tool. We calculated 95% uncertainty intervals (UI) for all estimates. These estimates do not include mortality from atrial fibrillation, stroke, and infective endocarditis, which are reported separately. Results: Globally, the number of deaths and death rates significantly decreased from 1990 to 2013 (Table). However, large differences in death rates were observed across regions, with no significant decline detected in South Asia, Oceania, and Sub-Saharan Africa. The highest death rates were in South Asia, Eastern and Central Sub-Saharan Africa, followed by Oceania and East Asia. The number of prevalent cases increased from 20.2 million (95% UI 19.2 million to 21.2 million) in 1990 to 32.9 million (95% UI 31.6 million to 34.0 million) in 2013 (Figure). Global age-standardized prevalence increased by 13.5% (95% UI 6.0% to 19.7%) over this period. Countries with the largest number of RHD cases in 2013 were India, China, Pakistan, Bangladesh, and Ethiopia, accounting for more than 67% of global cases.
PM212 Rheumatic Heart Disease Co-Morbidity in Heart Failure, Atrial Fibrillation and Stroke Among Adult Aboriginal Western Australians: Need for Service Strengthening J. Katzenellenbogen*1,2, F. Sanfilippo3, M. Knuiman3, M. Hobbs3, T. H. K. Teng2, D. Lopez3, J. Hung4, S. Thompson2 1 Group A Streptococcus and RHD Research Group, Telethon Kids Institute, 2Western Australian Centre for Rural Health, 3School of Population Health, 4School of Medicine & Pharmacology, University of Western Australia, Perth, Australia Introduction: Cardiovascular disease is the lead contributor to mortality differentials between Aboriginal and non-Aboriginal Australians. Rheumatic heart disease (RHD) rates in Aboriginal Australians are among the highest recorded globally and contribute to the increased risk of heart failure (HF), atrial fibrillation (AF) and stroke in Aboriginal people. Objectives: We compared the prevalence of RHD as a co-morbid or pre-existing condition between Aboriginal and non-Aboriginal adults hospitalised with HF, AF and stroke in Western Australia. Methods: First-ever adult Western Australian (WA) cases of hospitalised HF and AF (lookback period¼15 years) 2000-2009 were identified using person-based linked administrative hospital and death data from the WA Data Linkage System. New and existing cases of ever-hospitalised stroke (lookback¼20 years) at mid-year 2011 were similarly identified. Comorbidity histories (including RHD) were identified from reviewing previous diagnoses (lookback period: HF, AF¼5 years; stroke¼20 years). RHD history was estimated in broad age groups for each cohort. Results: Aboriginal HF, AF and stroke patients were significantly younger than their nonAboriginal counterparts. A history of RHD was more likely in Aboriginal than nonAboriginal first-ever hospitalised HF patients <55 years (19.5% vs 13.7%; p¼0.001),
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campaigns, therefore, must focus not only on health information dissemination but also on attitudinal shift on health-seeking behavior. Care of caregivers is important in the care continuum. Monthly forums with experts helped alleviate stigma and boosted confidence hence patients reported improved glycemic control and reduced complications and uncertainties. Disclosure of Interest: None Declared PM218
PM216 Non Communicable Disease Discovery and Awareness Using Medical Students – A Pilot Project 1
2
2
2
2
2
A. El Sayed* , I. Mutwali , D. Mirghani , B. Hamid , A. S. Ibrahim , I. Mohammad , N. Abdelrahim2, M. E. Dimitri2, A. Abdelrahman2, O. A. Hamid3 1 Cardiothoracic Surgery, 2Faculty of Medicine, Alzaeim Alazhari University, 3Faculty of Medicine, International University of Africa, Khartoum, Sudan Introduction: Non communicable diseases (ncds) are causing a strain on the health services of developing countries which are already overburdened by communicable diseases. The best solution would be to prevent these diseases by raising awareness of their causative risk factors to decrease their effects. This is however easier said than done in developing countries with limited budgets as it also requires resources. We present a trial to raise awareness using medical students. Objectives: To trial using medical students in raising ncd awareness. Methods: After identification of a suitable rural area to trial this project a group of medical students accompanied by one consultant were transported to the area using a specially prepared mobile clinic provided on a trial basis by the Japanese International Cooperation Agency (JICA). Once reaching there the students were divided into groups which would enter all the consenting households and would interview all the consenting adults in the household using questionnaire. The questions asked were prepared to also serve as a a guide to provide awareness about all ncds. After finishing the interviews the students would provide the household members with two brochures — one detailing the ncd risk factors and the other providing information about breast cancer and breast self examination. Consenting interviewees would then be asked to proceed to the mobile clinic which would be parked nearby to have their height, weight, blood sugar, ECG and spirometry (if asthmatic. On two weekdays a consultant and the students visited all the schools in the area distributing to the classes a self administered questionnaire and then giving them awareness about ncds and rheumatic heart disease. Results: The study is still ongoing and final results are to be presented.The visits started on 02/05/2015 and todate (28/10) 25 visits have been done with 960 participants recruited from 328 households. The plan is to complete the target area by the end of December. Conclusion: To date we consider this program a success since it has set the foundations for the university to play a social role by serving a community through raising awareness and finding disease cases and has exposed the participating students to community health issues. It has also allowed to collect data about specific health questions in the community which would form the basis of at least 10 scientific papers. Disclosure of Interest: None Declared PM217
R. Rodriguez-Fernandez*1,2, A. Lerma3, E. Del Rio4, M. J. Bangs2, C. Lerma5 1 Executive Director, The NCD Asia Pacific Alliance, Tokyo, Japan, 2Public Health and Malaria Control, International SOS, Kuala Kencana, Papua, Indonesia, 3Centro de Atención para la Salud de la Mujer, Secretaría de Salud del Estado de Morelos, Cuernavaca, 4Unidad de Electrofisiología Cardiaca, Hospital General de México, Universidad Nacional Autonoma de Mexico, 5Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico Introduction: Non-communicable diseases (NCDs) have steadily been on the rise within the South-East Asia region and are estimated to see the highest increase in NCD-related deaths over the next decade. However, it has been proposed that risk factors leading to NCDs present distinct associations compared to western populations, where the majority of risk classification algorithms come from. Objectives: The aim was to identify risk factors associated independently to ischemic heart disease, hypertension, stroke, chronic obstructive pulmonary disease, asthma and other outcomes in residents from Indonesia who work in a large mining company. Methods: Medical records including metabolic indicators of NCDs among employees (n¼ 13,874) of a large copper–gold mining operation in Papua, Indonesia, were extracted. The study group comprised individuals aged 18–68 years employed for 1 year during 2008. For each outcome, the odds ratio (OR) of each variable was calculated with logistic regression analysis. Variables with significant OR (p < 0.05) were introduced in a multivariate logistic regression model to identify those independently associated with the outcome. Results are shown as OR (95% confidence interval). Results: Ischemic heart disease was associated independently with age (years/10) ¼ 2.1 (1.0 – 4.1) but not with other factors (e.g. gender diabetes mellitus, raised blood pressure). None of the tested variables were associated with stroke, while hypertension was associated with age (years/10) ¼ 2.8 (2.4 – 3.3), body mass index (Kg/m2) ¼ 2.12 (1.09 – 1.15), smoking ¼ 0.76 (0.62 – 0.92) and diabetes mellitus ¼ 1.86 (1.06 – 3.25). Chronic obstructive pulmonary disease was only associated with age (years/10) ¼ 2.2 (1.5 – 3.0). Asthma was associated with age (years/10) ¼ 1.5 (1.1 – 2.0) and smoking ¼ 0.39 (0.27 – 0.57). Tuberculosis was associated with years of employment (years/5) ¼ 0.64 (0.46 – 0.90), smoking ¼ 0.41 (0.21 – 0.80) and cholesterol ¼ 0.48 (0.24 – 0.96). Conclusion: Some risk factors associated typically with NCD were not confirmed in this large study group from South-East Asia. Further studies are warranted to fully understand the interactions between risk factors and NCDs within Asian populations. Disclosure of Interest: None Declared PM219 Clinical Audit and Continuous Improvement of Nursing Records for Analysis of Cardiovascular Clinical Status of Patients
Targeted Screenings, Open Days and Volunteer-Based Peer Support Interventions in Diabetes Prevention, Management and Control in Nairobi, Kenya J. O. Owuor1, G. O. Oguda1, M. A. Nyamongo*2 1 Programs, 2Executive, African Institute for Health & Development (AIHD), Nairobi, Kenya Introduction: Strengthening Community Level Diabetes Interventions in Kenya was implemented in 2011 due to the rising prevalence picked from random screenings of more than 10 multi-cultural and socioeconomically and geographically divergent populations in Kenya. Objectives: To: empower diabetics and their communities to take charge of their own health in diabetes prevention, management and control; improve health literacy through peer support and self-care education; facilitate formation of patients support networks, enhanced advocacy at the community level; and influence NCD policy environment. Methods: Targeted risk factor screening and education campaigns; early detection of complications through baseline and regular assessments; support formation of patient support groups for addressing challenges of living with diabetes, sharing and encouraging each other; support monthly ‘open day forums’ –share issues and meet the experts; and generate and transfer knowledge for adequate self-care. Results: (i) Incresased peer support groups from 1 in 2011 to 17 in 2013, comprising 164 patients in groups of 5-15 members, the diversity ranging from youth-oriented to women and elderly persons support groups; (ii) Representation of patient voices in several advocacy forums including high-level discussion panel and workshop session at the East African Diabetes Study Group Conference held in Nairobi October 2013; (iii) Increased health advocacy campaigns and NCD risk-factor screenings mostly targeting low-income neighborhoods and marginalized groups. Conclusion: Populations seek healthcare only when their health condition deteriorates hence putting them at greater risk for late diagnosis. Preventive and promotive health
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Workplace Screening Within the Extractive Industry: Providing New Insights as to What Causes Non-Communicable Diseases
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O. V. Carolina*1, A. I. González Hernandez1, J. C. Cadena Estrada1, S. S. Olvera Arreola1, C. Leija Hernandez1 1 Dirección de Enfermería, Instituto Nacional de Cardiologia Ignacio Chávez, Mexíco, Mexico Introduction: Nursing records are a process documented, communicated and demonstrates the effectiveness of interventions and the response of the patient to medical treatment for decision-making during their hospital stay. However, there may be gaps in the records that affect the continuity of care and treatment and insufficient for analysis of cardiovascular clinical condition of the patient and the development of nursing interventions information. Objectives: Analyzed through clinical audit if nursing records provide sufficient information to recognize, after an intervention by continuous improvement cardiovascular clinical status of patients. Methods: Comparative study pre and post intervention. 1st stage: a first measurement is made with a convenience sample n ¼ 100, nursing records be audited in adult services hospitalization, intensive care and coronary care unit. 2nd stage: an intervention to continuous improvement is implemented. Stage 3: the records will be audited again to determine the difference in results. Data were collected with a certificate expressly audit that evaluates the compliance process through dichotomous qualitative responses. Period: November 2015 - April 2016. Data analysis with descriptive statistics and Ji2. Significance was accepted p <0.05. Results: It is expected that after the intervention of continuous improvement and provide adequate records true for decision-making in a timely and efficient development of cardiovascular interventions Nursing clinical data. Conclusion: Clinical cardiovascular nursing records are essential to determine the clinical, pharmacological and / or surgical treatment and care; however, they could be improved. Disclosure of Interest: None Declared
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POSTER ABSTRACTS
Conclusion: The global death rate due to RHD has fallen since 1990, but significant declines were seen for only some regions. The number of RHD cases has risen, with most cases found in middle income countries. Differences between crude and age-standardized estimates suggests that global population growth and aging are in part driving RHD trends. Even countries with lower average prevalence rates may continue to face subnational regions with high levels of endemic disease. The rising global prevalence of RHD suggests that additional resources will need to be allocated to its prevention and treatment. Disclosure of Interest: None Declared
studies were from 1960-1990 and only 6 studies from 1990 to present. We included 5 studies from low- and middle-income countries, 4 of which were from Chagas-endemic areas in South America and one from India. Age-specific rates could not be evaluated from published reports. The total number of people from the general population studies with bradycardia was 1012 and the prevalence ranged from 13.7 to 85.0 per 1000 population, with a pooled mean prevalence of 46.8 per 1000. The total number of people from the general population studies with third degree AV block was 218 and prevalence ranged from 0 to 3 per 1000 population with a pooled mean prevalence of 0.43 per 1000. The prevalence was higher in older age groups. Conclusion: Based on our review of published population-based studies, the prevalence of third degree AV block was small but estimates of prevalence for this condition are important given its high mortality if left untreated in the ageing global population. Disclosure of Interest: None Declared
but not at older ages. RHD history was also significantly more prevalent in Aboriginal than non-Aboriginal AF patients, particularly at younger ages (17.9% vs 4.1%; p<0.001). In stroke survivors, there was a higher proportion of RHD history in Aboriginal people at all ages <70 years. Disparities were highest at age 20-34 years (23% vs 3%; ratio¼8.9), but similar in the 70-84 year age group (ratio¼1.0). Conclusion: RHD is a common co-morbidity and antecedent for HF, AF and stroke in Aboriginal adults, particularly at young ages. Our findings indicate the need for earlier detection of RHD and identification of HF and AF in these patients. Addressing the social determinants of RHD and system strengthening of secondary and tertiary prevention of RHD is required to reduce its impact, ensuring continuity/integration of care across the life course, especially the transition into adulthood. Disclosure of Interest: None Declared PM214
PM210 Trends in the Mortality and Morbidity of Cardiovascular Disease in the UK P. Bhatnagar*1, K. Wickramasinghe1, N. Townsend1 1 Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom Introduction: Previous research has shown that mortality from cardiovascular diseases is declining in Europe and within the United Kingdom. It has been shown that within England, a 50% decline in age-standardised mortality from myocardial infarction was due to both a reduction in incidence and case-fatality. Consequently, there will have been an increase in the number of people living with cardiovascular disease. Objectives: We aimed to investigate how both morbidity and mortality from cardiovascular diseases have changed over time within the United Kingdom. Methods: We obtained statistics on total cardiovascular disease, coronary heart disease and stroke mortality from the national statistics agencies of the United Kingdom. We produced all ages and under 75 age-standardised mortality rates by sex, standardised to the 2013 European Standard Population. We obtained data on hospital admissions from National Health Service records, using the main diagnosis. Prevalence data come from the Quality and Outcome Framework, which is collected through General Practice records. Results: Total cardiovascular disease mortality declined by 68% between 1980 and 2013 in the United Kingdom; deaths below the age of 75 declined by 77% during the same timeperiod. Coronary heart disease mortality decreased by 71% and mortality from stroke decreased by 70% between 1980 and 2013. The number of hospital admissions for all cardiovascular diseases increased by more 46,000 between 2010/11 and 2013/14, however, over 36,500 of these increased admissions were in men. Between these years, male admissions for coronary heart disease increased by almost 3000, but decreased by around 5000 in women. Stroke admissions remained fairly stable for men and decreased by around 4500 in women. Prevalence of coronary heart disease has remained constant at around 3% in England and 4% in Wales and Northern Ireland between 2006/07 and 2013/14. Data for Scotland is available from 2008/09 and also shows a constant trend of around 4%. The prevalence of stroke in the UK has also changed little, remaining at around 2%. Conclusion: Cardiovascular disease mortality has markedly declined for both sexes. Trends in admissions to hospital for coronary heart disease and stroke differ by men and women, with increases seen in coronary heart disease admissions for men, but declines for women. Despite these trends in hospital admissions, prevalence rates have not noticeably changed in either men or women. Disclosure of Interest: None Declared
Trends in the Global Burden of Rheumatic Heart Disease During 1990-2013: Findings From the Global Burden Of Disease 2013 Study D. Watkins*1,2, S. Colquhoun3, C. Johnson4, J. Carapetis5, G. Karthikeyan6, M. Naghavi4, C. Murray4, T. Vos4, G. Roth4,7 1 Department of Medicine, University of Cape Town, Cape Town, South Africa, 2Division of General Internal Medicine, University of Washington, Seattle, United States, 3Centre for International Child Health, Murdoch Childrens Research Institute and University of Melbourne, Melbourne, Australia, 4Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States, 5Telethon Kids Institute, University of Western Australia, Perth, Australia, 6 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India, 7Division of Cardiology, University of Washington, Seattle, United States Introduction: Rheumatic heart disease (RHD) is an important cause of cardiovascular death and disability and a common cause of valvular heart disease, particularly in developing countries. Objectives: We estimated global, regional, and national trends in RHD mortality and prevalence as part of the Global Burden of Disease (GBD) 2013 study. Methods: We systematically reviewed all available sources of data on fatal and non-fatal RHD in 188 nations from 1990-2013. We estimated RHD deaths and mortality rates from vital registration datasets using the Cause of Death Ensemble modeling tool. We estimated RHD cases and prevalence from hospital records (in higher-income countries) and population-based screening studies (in lower-income countries) using DisMod-MR, a Bayesian meta-regression tool. We calculated 95% uncertainty intervals (UI) for all estimates. These estimates do not include mortality from atrial fibrillation, stroke, and infective endocarditis, which are reported separately. Results: Globally, the number of deaths and death rates significantly decreased from 1990 to 2013 (Table). However, large differences in death rates were observed across regions, with no significant decline detected in South Asia, Oceania, and Sub-Saharan Africa. The highest death rates were in South Asia, Eastern and Central Sub-Saharan Africa, followed by Oceania and East Asia. The number of prevalent cases increased from 20.2 million (95% UI 19.2 million to 21.2 million) in 1990 to 32.9 million (95% UI 31.6 million to 34.0 million) in 2013 (Figure). Global age-standardized prevalence increased by 13.5% (95% UI 6.0% to 19.7%) over this period. Countries with the largest number of RHD cases in 2013 were India, China, Pakistan, Bangladesh, and Ethiopia, accounting for more than 67% of global cases.
PM212 Rheumatic Heart Disease Co-Morbidity in Heart Failure, Atrial Fibrillation and Stroke Among Adult Aboriginal Western Australians: Need for Service Strengthening J. Katzenellenbogen*1,2, F. Sanfilippo3, M. Knuiman3, M. Hobbs3, T. H. K. Teng2, D. Lopez3, J. Hung4, S. Thompson2 1 Group A Streptococcus and RHD Research Group, Telethon Kids Institute, 2Western Australian Centre for Rural Health, 3School of Population Health, 4School of Medicine & Pharmacology, University of Western Australia, Perth, Australia Introduction: Cardiovascular disease is the lead contributor to mortality differentials between Aboriginal and non-Aboriginal Australians. Rheumatic heart disease (RHD) rates in Aboriginal Australians are among the highest recorded globally and contribute to the increased risk of heart failure (HF), atrial fibrillation (AF) and stroke in Aboriginal people. Objectives: We compared the prevalence of RHD as a co-morbid or pre-existing condition between Aboriginal and non-Aboriginal adults hospitalised with HF, AF and stroke in Western Australia. Methods: First-ever adult Western Australian (WA) cases of hospitalised HF and AF (lookback period¼15 years) 2000-2009 were identified using person-based linked administrative hospital and death data from the WA Data Linkage System. New and existing cases of ever-hospitalised stroke (lookback¼20 years) at mid-year 2011 were similarly identified. Comorbidity histories (including RHD) were identified from reviewing previous diagnoses (lookback period: HF, AF¼5 years; stroke¼20 years). RHD history was estimated in broad age groups for each cohort. Results: Aboriginal HF, AF and stroke patients were significantly younger than their nonAboriginal counterparts. A history of RHD was more likely in Aboriginal than nonAboriginal first-ever hospitalised HF patients <55 years (19.5% vs 13.7%; p¼0.001),
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campaigns, therefore, must focus not only on health information dissemination but also on attitudinal shift on health-seeking behavior. Care of caregivers is important in the care continuum. Monthly forums with experts helped alleviate stigma and boosted confidence hence patients reported improved glycemic control and reduced complications and uncertainties. Disclosure of Interest: None Declared PM218
PM216 Non Communicable Disease Discovery and Awareness Using Medical Students – A Pilot Project 1
2
2
2
2
2
A. El Sayed* , I. Mutwali , D. Mirghani , B. Hamid , A. S. Ibrahim , I. Mohammad , N. Abdelrahim2, M. E. Dimitri2, A. Abdelrahman2, O. A. Hamid3 1 Cardiothoracic Surgery, 2Faculty of Medicine, Alzaeim Alazhari University, 3Faculty of Medicine, International University of Africa, Khartoum, Sudan Introduction: Non communicable diseases (ncds) are causing a strain on the health services of developing countries which are already overburdened by communicable diseases. The best solution would be to prevent these diseases by raising awareness of their causative risk factors to decrease their effects. This is however easier said than done in developing countries with limited budgets as it also requires resources. We present a trial to raise awareness using medical students. Objectives: To trial using medical students in raising ncd awareness. Methods: After identification of a suitable rural area to trial this project a group of medical students accompanied by one consultant were transported to the area using a specially prepared mobile clinic provided on a trial basis by the Japanese International Cooperation Agency (JICA). Once reaching there the students were divided into groups which would enter all the consenting households and would interview all the consenting adults in the household using questionnaire. The questions asked were prepared to also serve as a a guide to provide awareness about all ncds. After finishing the interviews the students would provide the household members with two brochures — one detailing the ncd risk factors and the other providing information about breast cancer and breast self examination. Consenting interviewees would then be asked to proceed to the mobile clinic which would be parked nearby to have their height, weight, blood sugar, ECG and spirometry (if asthmatic. On two weekdays a consultant and the students visited all the schools in the area distributing to the classes a self administered questionnaire and then giving them awareness about ncds and rheumatic heart disease. Results: The study is still ongoing and final results are to be presented.The visits started on 02/05/2015 and todate (28/10) 25 visits have been done with 960 participants recruited from 328 households. The plan is to complete the target area by the end of December. Conclusion: To date we consider this program a success since it has set the foundations for the university to play a social role by serving a community through raising awareness and finding disease cases and has exposed the participating students to community health issues. It has also allowed to collect data about specific health questions in the community which would form the basis of at least 10 scientific papers. Disclosure of Interest: None Declared PM217
R. Rodriguez-Fernandez*1,2, A. Lerma3, E. Del Rio4, M. J. Bangs2, C. Lerma5 1 Executive Director, The NCD Asia Pacific Alliance, Tokyo, Japan, 2Public Health and Malaria Control, International SOS, Kuala Kencana, Papua, Indonesia, 3Centro de Atención para la Salud de la Mujer, Secretaría de Salud del Estado de Morelos, Cuernavaca, 4Unidad de Electrofisiología Cardiaca, Hospital General de México, Universidad Nacional Autonoma de Mexico, 5Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico Introduction: Non-communicable diseases (NCDs) have steadily been on the rise within the South-East Asia region and are estimated to see the highest increase in NCD-related deaths over the next decade. However, it has been proposed that risk factors leading to NCDs present distinct associations compared to western populations, where the majority of risk classification algorithms come from. Objectives: The aim was to identify risk factors associated independently to ischemic heart disease, hypertension, stroke, chronic obstructive pulmonary disease, asthma and other outcomes in residents from Indonesia who work in a large mining company. Methods: Medical records including metabolic indicators of NCDs among employees (n¼ 13,874) of a large copper–gold mining operation in Papua, Indonesia, were extracted. The study group comprised individuals aged 18–68 years employed for 1 year during 2008. For each outcome, the odds ratio (OR) of each variable was calculated with logistic regression analysis. Variables with significant OR (p < 0.05) were introduced in a multivariate logistic regression model to identify those independently associated with the outcome. Results are shown as OR (95% confidence interval). Results: Ischemic heart disease was associated independently with age (years/10) ¼ 2.1 (1.0 – 4.1) but not with other factors (e.g. gender diabetes mellitus, raised blood pressure). None of the tested variables were associated with stroke, while hypertension was associated with age (years/10) ¼ 2.8 (2.4 – 3.3), body mass index (Kg/m2) ¼ 2.12 (1.09 – 1.15), smoking ¼ 0.76 (0.62 – 0.92) and diabetes mellitus ¼ 1.86 (1.06 – 3.25). Chronic obstructive pulmonary disease was only associated with age (years/10) ¼ 2.2 (1.5 – 3.0). Asthma was associated with age (years/10) ¼ 1.5 (1.1 – 2.0) and smoking ¼ 0.39 (0.27 – 0.57). Tuberculosis was associated with years of employment (years/5) ¼ 0.64 (0.46 – 0.90), smoking ¼ 0.41 (0.21 – 0.80) and cholesterol ¼ 0.48 (0.24 – 0.96). Conclusion: Some risk factors associated typically with NCD were not confirmed in this large study group from South-East Asia. Further studies are warranted to fully understand the interactions between risk factors and NCDs within Asian populations. Disclosure of Interest: None Declared PM219 Clinical Audit and Continuous Improvement of Nursing Records for Analysis of Cardiovascular Clinical Status of Patients
Targeted Screenings, Open Days and Volunteer-Based Peer Support Interventions in Diabetes Prevention, Management and Control in Nairobi, Kenya J. O. Owuor1, G. O. Oguda1, M. A. Nyamongo*2 1 Programs, 2Executive, African Institute for Health & Development (AIHD), Nairobi, Kenya Introduction: Strengthening Community Level Diabetes Interventions in Kenya was implemented in 2011 due to the rising prevalence picked from random screenings of more than 10 multi-cultural and socioeconomically and geographically divergent populations in Kenya. Objectives: To: empower diabetics and their communities to take charge of their own health in diabetes prevention, management and control; improve health literacy through peer support and self-care education; facilitate formation of patients support networks, enhanced advocacy at the community level; and influence NCD policy environment. Methods: Targeted risk factor screening and education campaigns; early detection of complications through baseline and regular assessments; support formation of patient support groups for addressing challenges of living with diabetes, sharing and encouraging each other; support monthly ‘open day forums’ –share issues and meet the experts; and generate and transfer knowledge for adequate self-care. Results: (i) Incresased peer support groups from 1 in 2011 to 17 in 2013, comprising 164 patients in groups of 5-15 members, the diversity ranging from youth-oriented to women and elderly persons support groups; (ii) Representation of patient voices in several advocacy forums including high-level discussion panel and workshop session at the East African Diabetes Study Group Conference held in Nairobi October 2013; (iii) Increased health advocacy campaigns and NCD risk-factor screenings mostly targeting low-income neighborhoods and marginalized groups. Conclusion: Populations seek healthcare only when their health condition deteriorates hence putting them at greater risk for late diagnosis. Preventive and promotive health
GHEART Vol 11/2S/2016
Workplace Screening Within the Extractive Industry: Providing New Insights as to What Causes Non-Communicable Diseases
j
June, 2016
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POSTER/WCC_2016-POSTERS
O. V. Carolina*1, A. I. González Hernandez1, J. C. Cadena Estrada1, S. S. Olvera Arreola1, C. Leija Hernandez1 1 Dirección de Enfermería, Instituto Nacional de Cardiologia Ignacio Chávez, Mexíco, Mexico Introduction: Nursing records are a process documented, communicated and demonstrates the effectiveness of interventions and the response of the patient to medical treatment for decision-making during their hospital stay. However, there may be gaps in the records that affect the continuity of care and treatment and insufficient for analysis of cardiovascular clinical condition of the patient and the development of nursing interventions information. Objectives: Analyzed through clinical audit if nursing records provide sufficient information to recognize, after an intervention by continuous improvement cardiovascular clinical status of patients. Methods: Comparative study pre and post intervention. 1st stage: a first measurement is made with a convenience sample n ¼ 100, nursing records be audited in adult services hospitalization, intensive care and coronary care unit. 2nd stage: an intervention to continuous improvement is implemented. Stage 3: the records will be audited again to determine the difference in results. Data were collected with a certificate expressly audit that evaluates the compliance process through dichotomous qualitative responses. Period: November 2015 - April 2016. Data analysis with descriptive statistics and Ji2. Significance was accepted p <0.05. Results: It is expected that after the intervention of continuous improvement and provide adequate records true for decision-making in a timely and efficient development of cardiovascular interventions Nursing clinical data. Conclusion: Clinical cardiovascular nursing records are essential to determine the clinical, pharmacological and / or surgical treatment and care; however, they could be improved. Disclosure of Interest: None Declared
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POSTER ABSTRACTS
Conclusion: The global death rate due to RHD has fallen since 1990, but significant declines were seen for only some regions. The number of RHD cases has risen, with most cases found in middle income countries. Differences between crude and age-standardized estimates suggests that global population growth and aging are in part driving RHD trends. Even countries with lower average prevalence rates may continue to face subnational regions with high levels of endemic disease. The rising global prevalence of RHD suggests that additional resources will need to be allocated to its prevention and treatment. Disclosure of Interest: None Declared