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PM293 Prevalence of Rheumatic Heart Disease Among Secondary School Children in Samoa Detected by Echocardiography Screening
POSTER ABSTRACTS
care and penicillin adherence is excellent. Interventions to improve retention could further improve the quality of care. Disclosure of Interest: C. Longenecker Grant/research support from: Medtronic Philanthropy, T. Aliku: None Declared, A. Beaton: None Declared, A. Scheel: None Declared, E. Okello: None Declared, L. Perlman: None Declared, C. Sable: None Declared, P. Lwabi: None Declared
collaboration work in this focused region is needed to validate the ecosystem concept and demonstrate benefits of strategic collaboration. Disclosure of Interest: None Declared
PM293
Comparison of Health Related Quality of Life Among Patients Using Novel Oral Anticoagulants or Warfarin for Non-Valvular Atrial Fibrillation
Prevalence of Rheumatic Heart Disease Among Secondary School Children in Samoa Detected by Echocardiography Screening S. Viali*1, V. Futi1, T. Lafaele1 1 Cardiology, National University of Samoa, Apia, Samoa Introduction: The new National Rheumatic Fever Program in Samoa started in 2007. RHD imposes a significant burden on our limited health care system budget. Early detection of RHD is vitally important to minimize the risk of advanced valvular heart disease requiring surgery. The Echo screening program started in primary schools in 2008. The age-standardized prevalence rate for Definite RHD from 5-13 years old was 1.43% (95% CI, 1.17 – 1.69). The age-standardized Borderline RHD prevalence rate was 0.51% (95% CI, 0.35– 0.67). The Echo screening in secondary schools started in 2013. Objectives: As part of our National RHD screening program, we screened as many children in secondary schools (ages 14-18yrs old) as possible, to identify undiagnosed RHD. The RHD screening program in Samoa utilized portable echocardiography examinations. Methods: We screened 5,197 school children in secondary schools aged 14 to 18 years from 2013. Those who had any abnormalities suggestive of RHD in the first examination were brought back for a second confirmatory echocardiography. The pathologies on the second echocardiography were categorized according to the 2012 World Heart Federation RHD criteria and were reported as Definite or Borderline RHD, and Normal. All with Definite RHD were started on penicillin prophylaxis. Results: The first screening echocardiogram detected abnormalities that may be related to RHD in 274 (5.27%) of 5,197 children. The second confirmatory echocardiogram detected 145 (52.92%) definite RHD. The age-standardized prevalence rate for Definite RHD from 14-18 years old was 2.84% (95% CI, 2.52 – 3.10). The age-standardized Borderline RHD prevalence rate was 1.51% (95% CI, 1.35– 1.81). Majority (70%) of RHD were previously undiagnosed. The most common lesion was mitral regurgitation (90% of RHD). Most of the RHD were mild (45%) and moderate (40%) in severity, and only 15% were severe. 4 students required surgery. All of these children were entered into the RF database for follow-up. Conclusion: The prevalence of RHD in secondary school children in Samoa is high. It is higher than the primary school children. Identifying these RHD early, enable the administering of secondary penicillin prophylaxis. Disclosure of Interest: None Declared
PM295
K. Balci1, M. Balci1, U. Canpolat2, F. S¸en1, K. Akboga1, O. Maden1, H. Selcuk1, T. Selcuk1, A. Temizhan*3 1 Turkiye Yuksek Ihtisas Education and Research Hospital, 2Cardiolgy, Hacettepe University, 3 Cardiology, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey Introduction: It was already known that VKAs have been prescribed for many years in prevention of thromboembolic events in both valvular and non-valvular AF. However, the usage of VKA is complicated due to highly variable biological effects and its narrow therapeutic index. Objectives: The aim of this study was to compare health related quality of life (HRQoL) measures between novel oral anticoagulants (NOACs) and warfarin treated Turkish patients who had been started OACs due to non-valvular atrial fibrillation (AF) and to determine the effects of OACs on patient’s emotional status, anxiety and depression. Methods: A total of 182 patients older than 18 years with non-valvular AF and being treated with OACs for at least 6 months according to current AF guidelines who admitted to outpatient clinics in between July 2014 and January 2015 were included in this crosssectional study. Exclusion criteria were receiving OACs for other than non-valvular AF and being unable to answer the questionnaire. A questionnaire was performed in all participants to evaluate HRQoL, depression and anxiety. The mean differences between groups were compared by Student’s t test, otherwise, Mann-Whitney U test was applied for comparisons of the medians. Results: The annual number of hospital admissions was significantly higher in the warfarin group (p<0.001) and all of the HRQoL scores were significantly lower, both of the hospital anxiety and depression scale (HADS) scores were higher in the warfarin group (p<0.001). History of any type bleeding was significantly higher in the warfarin group (p<0.001). However, none of them was classified as a major bleeding. Among patients who experienced bleeding, all of the HRQoL scores were significantly lower and HADS-Depression score was significantly higher (p<0.001; p¼0.002, respectively).
PM294 Collaboration: A Key to Improved Humanitarian Pediatric Cardiac Services Developing Countries N. Nguyen*1, M. R. Barrett2, J. Harisiades3 1 Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, 2Independent Collaboration Consultant, 3Pediatrics, Ann & Robert H. Lurie Children’s of Chicago, Chicago, United States Introduction: Treatment for congenital heart disease (CHD) is not available for 90% of children in LMICs. Humanitarian surgical NGOs work with in-country programs (ICPs) to provide direct patient services, train local clinicians, and support capacity building. However, full potential of these efforts is hampered by poor coordination and divergent approaches. We hypothesize that stakeholders from NGOs and ICPs would be receptive to forming a collaborative ecosystem and working strategically towards shared goals to improve cardiac services for children in LMICs. Objectives: 1) To assess stakeholders’ receptivity and willingness to participate in a collaborative ecosystem and 2) To identify determinants that can lead to successful collaboration. Methods: Stakeholders included leaders from surgical NGOs and ICPs that provide cardiac services to children in South and Central America. A discussion guide was developed to gather insights into potential barriers, enablers, and motivations to participate in a collaborative ecosystem. In-depth telephone interviews were conducted by 3rd party experts in collaborative ecosystem mapping. Qualitative data were analyzed for common themes and insights towards collaboration. Results: Leaders from 13 NGOs and ICPs had participated in interviews for the study. Common challenges faced by NGOs and ICPs include limitations in funding, access to medical volunteers, ill-equipped health systems in host countries, poor communications among involved parties, and a lack of global strategies. Stakeholders acknowledged that greater collaboration may accelerate progress by eliminating redundant efforts, extending care reach to underserved regions, and empowering local programs. Stakeholders identified keys enablers for a successful collaborative ecosystem which include having shared goals, establishing trust and clear rules of engagement, maintaining good communication, and striking a balance between centralized leadership versus NGOs or ICPs independence. Conclusion: Stakeholders from cardiac NGOs and ICPs in South and Central America indicated high receptivity and willingness to participate in a collaborative ecosystem. Pilot
e120
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS
care and penicillin adherence is excellent. Interventions to improve retention could further improve the quality of care. Disclosure of Interest: C. Longenecker Grant/research support from: Medtronic Philanthropy, T. Aliku: None Declared, A. Beaton: None Declared, A. Scheel: None Declared, E. Okello: None Declared, L. Perlman: None Declared, C. Sable: None Declared, P. Lwabi: None Declared
collaboration work in this focused region is needed to validate the ecosystem concept and demonstrate benefits of strategic collaboration. Disclosure of Interest: None Declared
PM293
Comparison of Health Related Quality of Life Among Patients Using Novel Oral Anticoagulants or Warfarin for Non-Valvular Atrial Fibrillation
Prevalence of Rheumatic Heart Disease Among Secondary School Children in Samoa Detected by Echocardiography Screening S. Viali*1, V. Futi1, T. Lafaele1 1 Cardiology, National University of Samoa, Apia, Samoa Introduction: The new National Rheumatic Fever Program in Samoa started in 2007. RHD imposes a significant burden on our limited health care system budget. Early detection of RHD is vitally important to minimize the risk of advanced valvular heart disease requiring surgery. The Echo screening program started in primary schools in 2008. The age-standardized prevalence rate for Definite RHD from 5-13 years old was 1.43% (95% CI, 1.17 – 1.69). The age-standardized Borderline RHD prevalence rate was 0.51% (95% CI, 0.35– 0.67). The Echo screening in secondary schools started in 2013. Objectives: As part of our National RHD screening program, we screened as many children in secondary schools (ages 14-18yrs old) as possible, to identify undiagnosed RHD. The RHD screening program in Samoa utilized portable echocardiography examinations. Methods: We screened 5,197 school children in secondary schools aged 14 to 18 years from 2013. Those who had any abnormalities suggestive of RHD in the first examination were brought back for a second confirmatory echocardiography. The pathologies on the second echocardiography were categorized according to the 2012 World Heart Federation RHD criteria and were reported as Definite or Borderline RHD, and Normal. All with Definite RHD were started on penicillin prophylaxis. Results: The first screening echocardiogram detected abnormalities that may be related to RHD in 274 (5.27%) of 5,197 children. The second confirmatory echocardiogram detected 145 (52.92%) definite RHD. The age-standardized prevalence rate for Definite RHD from 14-18 years old was 2.84% (95% CI, 2.52 – 3.10). The age-standardized Borderline RHD prevalence rate was 1.51% (95% CI, 1.35– 1.81). Majority (70%) of RHD were previously undiagnosed. The most common lesion was mitral regurgitation (90% of RHD). Most of the RHD were mild (45%) and moderate (40%) in severity, and only 15% were severe. 4 students required surgery. All of these children were entered into the RF database for follow-up. Conclusion: The prevalence of RHD in secondary school children in Samoa is high. It is higher than the primary school children. Identifying these RHD early, enable the administering of secondary penicillin prophylaxis. Disclosure of Interest: None Declared
PM295
K. Balci1, M. Balci1, U. Canpolat2, F. S¸en1, K. Akboga1, O. Maden1, H. Selcuk1, T. Selcuk1, A. Temizhan*3 1 Turkiye Yuksek Ihtisas Education and Research Hospital, 2Cardiolgy, Hacettepe University, 3 Cardiology, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey Introduction: It was already known that VKAs have been prescribed for many years in prevention of thromboembolic events in both valvular and non-valvular AF. However, the usage of VKA is complicated due to highly variable biological effects and its narrow therapeutic index. Objectives: The aim of this study was to compare health related quality of life (HRQoL) measures between novel oral anticoagulants (NOACs) and warfarin treated Turkish patients who had been started OACs due to non-valvular atrial fibrillation (AF) and to determine the effects of OACs on patient’s emotional status, anxiety and depression. Methods: A total of 182 patients older than 18 years with non-valvular AF and being treated with OACs for at least 6 months according to current AF guidelines who admitted to outpatient clinics in between July 2014 and January 2015 were included in this crosssectional study. Exclusion criteria were receiving OACs for other than non-valvular AF and being unable to answer the questionnaire. A questionnaire was performed in all participants to evaluate HRQoL, depression and anxiety. The mean differences between groups were compared by Student’s t test, otherwise, Mann-Whitney U test was applied for comparisons of the medians. Results: The annual number of hospital admissions was significantly higher in the warfarin group (p<0.001) and all of the HRQoL scores were significantly lower, both of the hospital anxiety and depression scale (HADS) scores were higher in the warfarin group (p<0.001). History of any type bleeding was significantly higher in the warfarin group (p<0.001). However, none of them was classified as a major bleeding. Among patients who experienced bleeding, all of the HRQoL scores were significantly lower and HADS-Depression score was significantly higher (p<0.001; p¼0.002, respectively).
PM294 Collaboration: A Key to Improved Humanitarian Pediatric Cardiac Services Developing Countries N. Nguyen*1, M. R. Barrett2, J. Harisiades3 1 Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, 2Independent Collaboration Consultant, 3Pediatrics, Ann & Robert H. Lurie Children’s of Chicago, Chicago, United States Introduction: Treatment for congenital heart disease (CHD) is not available for 90% of children in LMICs. Humanitarian surgical NGOs work with in-country programs (ICPs) to provide direct patient services, train local clinicians, and support capacity building. However, full potential of these efforts is hampered by poor coordination and divergent approaches. We hypothesize that stakeholders from NGOs and ICPs would be receptive to forming a collaborative ecosystem and working strategically towards shared goals to improve cardiac services for children in LMICs. Objectives: 1) To assess stakeholders’ receptivity and willingness to participate in a collaborative ecosystem and 2) To identify determinants that can lead to successful collaboration. Methods: Stakeholders included leaders from surgical NGOs and ICPs that provide cardiac services to children in South and Central America. A discussion guide was developed to gather insights into potential barriers, enablers, and motivations to participate in a collaborative ecosystem. In-depth telephone interviews were conducted by 3rd party experts in collaborative ecosystem mapping. Qualitative data were analyzed for common themes and insights towards collaboration. Results: Leaders from 13 NGOs and ICPs had participated in interviews for the study. Common challenges faced by NGOs and ICPs include limitations in funding, access to medical volunteers, ill-equipped health systems in host countries, poor communications among involved parties, and a lack of global strategies. Stakeholders acknowledged that greater collaboration may accelerate progress by eliminating redundant efforts, extending care reach to underserved regions, and empowering local programs. Stakeholders identified keys enablers for a successful collaborative ecosystem which include having shared goals, establishing trust and clear rules of engagement, maintaining good communication, and striking a balance between centralized leadership versus NGOs or ICPs independence. Conclusion: Stakeholders from cardiac NGOs and ICPs in South and Central America indicated high receptivity and willingness to participate in a collaborative ecosystem. Pilot
e120
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS