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PS083 Knowledge, Attitude and Practice on Coronary Artery Disease in Patients Attending the Tertiary Health Care Center in Nepal
Conclusion: The discontinuation of the use of aspirin has a significant correlation with the incidence of stroke in the postoperative period of noncardiac elective surgery. Disclosure of Interest: None Declared
PS083
P. R. M. N. Almeida*1,2,3, D. R. Rabelo4, E. T. Figueiredo4, L. G. Coelho Junior1, J. A. Almeida2, G. F. Melo2, G. A. Carvalho2 1 Academic of medicine, Atenas College of Medicine, Paracatu, Minas Gerais, 2Department of Gerontology and Physical Education, Catholic University of Brasilia, 3Department of Physical Medicine and Rehabilitation, Armed Forces Hospital of Brasilia, Brasilia, Federal District, 4MD, Professor of Cardiology and Echocardiography, Atenas College of Medicine, Paracatu, Minas Gerais, Brazil
Knowledge, Attitude and Practice on Coronary Artery Disease in Patients Attending the Tertiary Health Care Center in Nepal K. Sherpa*1, P. Shah1, S. Karki2, S. Mahaju2, R. Maharjan2, N. Pandey1, S. Dhungana1, S. Uranw1, P. Karki1 1 Internal Medicine, 2B.P. Koirala Institute of Health Sciences, Dharan, Nepal Introduction: Despite high morbidity and mortality of coronary artery disease (CAD), few studies have been conducted in Nepal on awareness level regarding its risk factors, preventive measures and treatments. Objectives: To assess knowlege and attittude on CAD, its risk factors, symptoms, investigations, treatment and create awareness among them. Methods: Hospital based, descriptive, cross-sectional study enrolled 183 patients attending outpatient department in tertiary center in eastern Nepal. Knowledge and attitude assessment was done using pre-tested semi-structured questionnaire and scoring responses. Results: Mean knowledge score was 14.14 (4.87) with 42.6 % having poor score, 43.7. % having good score and 13.7% having very good score. There was no significant difference between mean knowledge score (p¼0.809) and attitude score (p¼0.272) for male and female patients. Mean knowledge score was significantly higher for educated and with family history of heart disease (P¼0.003, 0.002 respectively). Mean attitude scores was 6.07 1.1 and no significant difference was found between educated and uneducated patients, however educated patients had better mean attitude score. Age (52.5%) was most commonly identified non-modifiable risk factor by followed by family history (50.3%) and male sex (19.1%). Modifiable risk factors, identified were stress (89.1%), sedentary lifestyle (88.0%), fatty diet (86.9), smoking (86.9%), hypertension (77%), diabetes (61 %) and high blood cholesterol level (43%). Around 40 % patients did not know symptoms of heart attack. Electrocardiography was identified by 61.7% as investigation method, while only 17.5% knew about Angiography. 77.6% knew about medication, while only 13.1% knew of percutaneous coronary intervention, Coronary Artery Bypass Grafting and 83.1 % were unaware about government Policy and grants for CAD treatment. For prevention of CAD 78.4% considered exercise, 93.4% considered quitting smoking, 81.7% preferred consuming healthy diet and 85 % considered medical treatment for diabetes and hypertension. Conclusion: Although patients expressed good attitude towards prevention of CAD, they lacked adequate knowledge of the disease to complement their positive views. This study revealed that education plays a crucial role and further studies needed in Eastern Nepal in promoting awareness of CAD and attitude towards preventive medicine. Disclosure of Interest: None Declared PS084 Stroke Due Discontinuance Irregular of Aspirin in Cirurgies Noncardiacs 1
1
1
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2
J. A. D. Silveira , F. J. Matheus , A. Meneghini , A. L. Queiroz , C. J. Arroyo Neto , A. C. P. Chagas*1 1 Cardiology, 2Student, ABC Medical School, Santo Andre, Brazil Introduction: Acetylsalicylic acid (ASA) is related to higher rate of postoperative bleeding, however, its discontinuity implies increasing cardiovascular disease and increased perioperative mortality. Objectives: To evaluate the relationship between discontinuation of AAS with cardiovascular outcomes in the postoperative. Methods: Observational, epidemiological study. Were evaluated in Anchieta Hospital in Sao Bernardo do Campo - SP, hospitalized patients referred for cardiac preoperative evaluation for noncardiac elective surgery. Clinical, epidemiological and healthcare variables were obtained at time of assessment and later from the chart review until hospital discharge or death and carried out a descriptive analysis of all variables of the study. T test were used and Chi Square for the analysis of quantitative and qualitative variables respectively. We used the SPSS 13.0 for Windows for statistical analysis and the level of significance was 5%. Results: We evaluated 144 patients and 99 of them were actually undergoing noncardiac surgery. The average age of this population was 63.2 years, 24% of patients had low functional capacity (<4 METs) and 23% of the procedures were big porteAs incidences of deep vein thrombosis (DVT) and pulmonary embolism thrombus (TEP) were 3.0%, ischemic stroke (stroke) was 2.0% and mortality was 10.1%. The discontinuation of aspirin despite the recommendation was 40% and was significantly correlated with the incidence of stroke (p ¼ 0.008). There was no significant correlation between discontinuation of AAS with mortality (p ¼ 1.0) and deep vein thrombosis or pulmonary thromboembolism (p ¼ 0.253).
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS
PS087 Analysis Echocardiographic of Elderly Undergoing CABG and Cardiovascular Rehabilitation
Introduction: The acute myocardial infarction generates hypertrophy and fibrosis. The Cardiovascular Rehabilitation (CVR) clinically improves cardiac patient. Echocardiography analyzes the evolution of pathophysiological or physiological adaptive mechanisms. Objectives: To relate CVR with Echocardiography in elderly men with (coronary artery bypass graft) CABG. Methods: Cross-sectional descriptive study to Echocardiographic evaluation of 20 elderly men with middle age of 69.0 6.45 year and CVR participants of the program during average period of 4.15 1.63 years. Results: Participants had showed body mass index (24.86 3.9); Initial left ventricular end-diastolic diameter (55.35 6.65) and final (57.65 7.26) (p ¼ 0.05); Posterior wall of initial left ventricular (9.05 1.23) and final (8.00 1.00) (p ¼ 0.07); Initial left ventricular mass (232.35 55.46) and final (219.55 61.43) (p ¼ 0.10); left ventricular ejection fraction in the initial percentage (59.40 10.71) and final (61.67 12.64); Relative to the initial thickness ratio left ventricular (0.33 0.07) and final (0.29 0.04) (p ¼ 0.02); the subjects had significant improvement in the index of relative thickness of the left ventricle ratio to initial left ventricle (0.33 0.07) and final (0.29 0.04) (p ¼ 0.02) (Reference value (RV) 0.42) and index of left ventricular mass for the initial body surface area (135.89 15.67) and final (116.61 29.80) (p ¼ 0.006) (Men for RV 115), showing a statistically significant decrease after CVR. Conclusion: The decline in values showed in the echocardiographic parameters between the start and the end of CVR indicate a positive ventricular remodeling, with the output of a pathological ventricular remodeling pattern for a trend to normalcy. Disclosure of Interest: None Declared
PS089 Low Exercise Tolerance as a Predictive Variable of Malignant Ventricular Arrhythmias H. Ilarraza-Lomelí1, J. Rojano-Castillo*1, M. García-Saldivia1, O. Sifuentes1, M.-D. Rius-Suárez1, E. Franco-Ojeda1, R. Chávez-Domíguez2 1 Cardiac Rehabilitation, 2Epidemiology, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico Introduction: Malignant Ventricular Arrhythmia (MVA) are one of the most frequent cause of mortality, and the role of physical activity on this field remains unclear. On one hand, some authors have described high intensity physical activity as a trigger of cardiac sudden death. In counterpart, other research has found that a higher level of maximal exercise tolerance are associated with lower mortality rates. Objectives: This study searches an association between the peak oxygen uptake (VO2peak) during an exercise testing and the incidence of malignant ventricular arrhythmia. Methods: A cohort of patients with cardiovascular disease that were enrolled in a cardiac rehabilitation program was analyzed. Every patient underwent to a symptom-limited cardiopulmonary exercise testing, using a ramp protocol. The maximum time of follow up was 10 years. Variables are summarized as mean (standar deviation) or median (range) according to data distribution. MVA was defined as a combined outcome of: ventricular fibrillation/flutter/tachycardia or the indication of implantable cardiac defibrillator. Patients were split into 2 groups according to VO2peak, using a ROC curve for establishing a cut point of 25 ml/kg/min (area under the curve ¼ 0.611). A Kaplan and Meier curve was constructed for MVA incidence according to VO2peak. Afterward, a bivariate analysis identified those variables potentially related with MVA (ET, age, gender, etc). Finally, a Cox multivariable regression analysis was performed. All p values less than 0.05 were considered stochastically significant. Results: A total of 1332 individuals were studied, and 91 MVA outcomes occurred. Demographic characteristics are displayed on table I. The patients with low VO2peak were older, overweight, and had higher prevalence of ischemic heart disease and heart failure. Use of cardiovascular drugs (beta-blocker, diuretic or antiarrhythmic) was also more prevalent in patients with lower exercise tolerance. Those patients with a VO2peak less than 25 ml/kg/min had an elevated risk of MVA (RR¼ 2.42, CI95% from 1.44 to 4.1, p < 0.001). A post hoc analysis (Cox) showed that this remained significant (p ¼ 0.02), despite the presence of other confounder variables. Kaplan and Meier plot is showed in figure II.
e29
POSTER ABSTRACTS
(P > 0. 05)between two groups .(2)Enalapril reduced TP(P<0. 05),VLF(P<0. 05),LF(P >0. 05),HF(P<0. 05 )by 27 .5 % ,28 .7 % ,15.9 % ,and 26.8% respectively at late night(3w4 Am)while no effect was manifested during daytime .(3)3D HRPS graph in showed specific characteristics in various patients. Conclusion: (1)Sympathetic and parasympathetic activities were increased at late night in patients with EH I- II,suggesting enhanced compensation of ANA was presented especially in the period of 3-4 AM in the early stage of EH.(2)Enalapril decrease the peak values of ANA at late night after 4 weeks treatment(see 3D HRPS graph. Disclosure of Interest: None Declared
PS083
P. R. M. N. Almeida*1,2,3, D. R. Rabelo4, E. T. Figueiredo4, L. G. Coelho Junior1, J. A. Almeida2, G. F. Melo2, G. A. Carvalho2 1 Academic of medicine, Atenas College of Medicine, Paracatu, Minas Gerais, 2Department of Gerontology and Physical Education, Catholic University of Brasilia, 3Department of Physical Medicine and Rehabilitation, Armed Forces Hospital of Brasilia, Brasilia, Federal District, 4MD, Professor of Cardiology and Echocardiography, Atenas College of Medicine, Paracatu, Minas Gerais, Brazil
Knowledge, Attitude and Practice on Coronary Artery Disease in Patients Attending the Tertiary Health Care Center in Nepal K. Sherpa*1, P. Shah1, S. Karki2, S. Mahaju2, R. Maharjan2, N. Pandey1, S. Dhungana1, S. Uranw1, P. Karki1 1 Internal Medicine, 2B.P. Koirala Institute of Health Sciences, Dharan, Nepal Introduction: Despite high morbidity and mortality of coronary artery disease (CAD), few studies have been conducted in Nepal on awareness level regarding its risk factors, preventive measures and treatments. Objectives: To assess knowlege and attittude on CAD, its risk factors, symptoms, investigations, treatment and create awareness among them. Methods: Hospital based, descriptive, cross-sectional study enrolled 183 patients attending outpatient department in tertiary center in eastern Nepal. Knowledge and attitude assessment was done using pre-tested semi-structured questionnaire and scoring responses. Results: Mean knowledge score was 14.14 (4.87) with 42.6 % having poor score, 43.7. % having good score and 13.7% having very good score. There was no significant difference between mean knowledge score (p¼0.809) and attitude score (p¼0.272) for male and female patients. Mean knowledge score was significantly higher for educated and with family history of heart disease (P¼0.003, 0.002 respectively). Mean attitude scores was 6.07 1.1 and no significant difference was found between educated and uneducated patients, however educated patients had better mean attitude score. Age (52.5%) was most commonly identified non-modifiable risk factor by followed by family history (50.3%) and male sex (19.1%). Modifiable risk factors, identified were stress (89.1%), sedentary lifestyle (88.0%), fatty diet (86.9), smoking (86.9%), hypertension (77%), diabetes (61 %) and high blood cholesterol level (43%). Around 40 % patients did not know symptoms of heart attack. Electrocardiography was identified by 61.7% as investigation method, while only 17.5% knew about Angiography. 77.6% knew about medication, while only 13.1% knew of percutaneous coronary intervention, Coronary Artery Bypass Grafting and 83.1 % were unaware about government Policy and grants for CAD treatment. For prevention of CAD 78.4% considered exercise, 93.4% considered quitting smoking, 81.7% preferred consuming healthy diet and 85 % considered medical treatment for diabetes and hypertension. Conclusion: Although patients expressed good attitude towards prevention of CAD, they lacked adequate knowledge of the disease to complement their positive views. This study revealed that education plays a crucial role and further studies needed in Eastern Nepal in promoting awareness of CAD and attitude towards preventive medicine. Disclosure of Interest: None Declared PS084 Stroke Due Discontinuance Irregular of Aspirin in Cirurgies Noncardiacs 1
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2
J. A. D. Silveira , F. J. Matheus , A. Meneghini , A. L. Queiroz , C. J. Arroyo Neto , A. C. P. Chagas*1 1 Cardiology, 2Student, ABC Medical School, Santo Andre, Brazil Introduction: Acetylsalicylic acid (ASA) is related to higher rate of postoperative bleeding, however, its discontinuity implies increasing cardiovascular disease and increased perioperative mortality. Objectives: To evaluate the relationship between discontinuation of AAS with cardiovascular outcomes in the postoperative. Methods: Observational, epidemiological study. Were evaluated in Anchieta Hospital in Sao Bernardo do Campo - SP, hospitalized patients referred for cardiac preoperative evaluation for noncardiac elective surgery. Clinical, epidemiological and healthcare variables were obtained at time of assessment and later from the chart review until hospital discharge or death and carried out a descriptive analysis of all variables of the study. T test were used and Chi Square for the analysis of quantitative and qualitative variables respectively. We used the SPSS 13.0 for Windows for statistical analysis and the level of significance was 5%. Results: We evaluated 144 patients and 99 of them were actually undergoing noncardiac surgery. The average age of this population was 63.2 years, 24% of patients had low functional capacity (<4 METs) and 23% of the procedures were big porteAs incidences of deep vein thrombosis (DVT) and pulmonary embolism thrombus (TEP) were 3.0%, ischemic stroke (stroke) was 2.0% and mortality was 10.1%. The discontinuation of aspirin despite the recommendation was 40% and was significantly correlated with the incidence of stroke (p ¼ 0.008). There was no significant correlation between discontinuation of AAS with mortality (p ¼ 1.0) and deep vein thrombosis or pulmonary thromboembolism (p ¼ 0.253).
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS
PS087 Analysis Echocardiographic of Elderly Undergoing CABG and Cardiovascular Rehabilitation
Introduction: The acute myocardial infarction generates hypertrophy and fibrosis. The Cardiovascular Rehabilitation (CVR) clinically improves cardiac patient. Echocardiography analyzes the evolution of pathophysiological or physiological adaptive mechanisms. Objectives: To relate CVR with Echocardiography in elderly men with (coronary artery bypass graft) CABG. Methods: Cross-sectional descriptive study to Echocardiographic evaluation of 20 elderly men with middle age of 69.0 6.45 year and CVR participants of the program during average period of 4.15 1.63 years. Results: Participants had showed body mass index (24.86 3.9); Initial left ventricular end-diastolic diameter (55.35 6.65) and final (57.65 7.26) (p ¼ 0.05); Posterior wall of initial left ventricular (9.05 1.23) and final (8.00 1.00) (p ¼ 0.07); Initial left ventricular mass (232.35 55.46) and final (219.55 61.43) (p ¼ 0.10); left ventricular ejection fraction in the initial percentage (59.40 10.71) and final (61.67 12.64); Relative to the initial thickness ratio left ventricular (0.33 0.07) and final (0.29 0.04) (p ¼ 0.02); the subjects had significant improvement in the index of relative thickness of the left ventricle ratio to initial left ventricle (0.33 0.07) and final (0.29 0.04) (p ¼ 0.02) (Reference value (RV) 0.42) and index of left ventricular mass for the initial body surface area (135.89 15.67) and final (116.61 29.80) (p ¼ 0.006) (Men for RV 115), showing a statistically significant decrease after CVR. Conclusion: The decline in values showed in the echocardiographic parameters between the start and the end of CVR indicate a positive ventricular remodeling, with the output of a pathological ventricular remodeling pattern for a trend to normalcy. Disclosure of Interest: None Declared
PS089 Low Exercise Tolerance as a Predictive Variable of Malignant Ventricular Arrhythmias H. Ilarraza-Lomelí1, J. Rojano-Castillo*1, M. García-Saldivia1, O. Sifuentes1, M.-D. Rius-Suárez1, E. Franco-Ojeda1, R. Chávez-Domíguez2 1 Cardiac Rehabilitation, 2Epidemiology, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico Introduction: Malignant Ventricular Arrhythmia (MVA) are one of the most frequent cause of mortality, and the role of physical activity on this field remains unclear. On one hand, some authors have described high intensity physical activity as a trigger of cardiac sudden death. In counterpart, other research has found that a higher level of maximal exercise tolerance are associated with lower mortality rates. Objectives: This study searches an association between the peak oxygen uptake (VO2peak) during an exercise testing and the incidence of malignant ventricular arrhythmia. Methods: A cohort of patients with cardiovascular disease that were enrolled in a cardiac rehabilitation program was analyzed. Every patient underwent to a symptom-limited cardiopulmonary exercise testing, using a ramp protocol. The maximum time of follow up was 10 years. Variables are summarized as mean (standar deviation) or median (range) according to data distribution. MVA was defined as a combined outcome of: ventricular fibrillation/flutter/tachycardia or the indication of implantable cardiac defibrillator. Patients were split into 2 groups according to VO2peak, using a ROC curve for establishing a cut point of 25 ml/kg/min (area under the curve ¼ 0.611). A Kaplan and Meier curve was constructed for MVA incidence according to VO2peak. Afterward, a bivariate analysis identified those variables potentially related with MVA (ET, age, gender, etc). Finally, a Cox multivariable regression analysis was performed. All p values less than 0.05 were considered stochastically significant. Results: A total of 1332 individuals were studied, and 91 MVA outcomes occurred. Demographic characteristics are displayed on table I. The patients with low VO2peak were older, overweight, and had higher prevalence of ischemic heart disease and heart failure. Use of cardiovascular drugs (beta-blocker, diuretic or antiarrhythmic) was also more prevalent in patients with lower exercise tolerance. Those patients with a VO2peak less than 25 ml/kg/min had an elevated risk of MVA (RR¼ 2.42, CI95% from 1.44 to 4.1, p < 0.001). A post hoc analysis (Cox) showed that this remained significant (p ¼ 0.02), despite the presence of other confounder variables. Kaplan and Meier plot is showed in figure II.
e29
POSTER ABSTRACTS
(P > 0. 05)between two groups .(2)Enalapril reduced TP(P<0. 05),VLF(P<0. 05),LF(P >0. 05),HF(P<0. 05 )by 27 .5 % ,28 .7 % ,15.9 % ,and 26.8% respectively at late night(3w4 Am)while no effect was manifested during daytime .(3)3D HRPS graph in showed specific characteristics in various patients. Conclusion: (1)Sympathetic and parasympathetic activities were increased at late night in patients with EH I- II,suggesting enhanced compensation of ANA was presented especially in the period of 3-4 AM in the early stage of EH.(2)Enalapril decrease the peak values of ANA at late night after 4 weeks treatment(see 3D HRPS graph. Disclosure of Interest: None Declared