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RHEUMATIC HEART DISEASE SCREENING IN WINDHOEK NAMIBIA USING PORTABLE ECHOCARDIOGRAPHY: A PILOT PROJECT
Abstracts
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245 RHEUMATIC HEART DISEASE SCREENING IN WINDHOEK NAMIBIA USING PORTABLE ECHOCARDIOGRAPHY: A PILOT PROJECT JJ Manolakos, O Salehian, C Kraeker, L Manolakos, CJ Hunter Hamilton, Ontario BACKGROUND:
Recent estimates indicate that rheumatic heart disease (RHD) is responsible for up 1.4 million deaths globally, with the majority of those affected living in low and middle-income countries. The prevalence of RHD detected by echocardiography in asymptomatic school children in Africa has ranged from 14.8 to 30.4 cases per 1000 children screened. The prevalence has never been tested in Namibia. Recently there has been an increased focus on portable echocardiography for the detection of subclinical RHD. A sensitivity of 97.9% for definite RHD with portable echocardiography has been reported. The purpose of this study was to develop and test the feasibility of an organized screening program for RHD in Namibia using portable echocardiography. METHODS: All school children in grades 1-7 at a local school in Windhoek Namibia were screened with a standardized echocardiographic protocol using a GE Vscan portable ultrasound. The protocol was designed to screen for features of of RHD. All echocardiograms were completed by the primary author. A preliminary diagnosis of RHD was made based on the portable echocardiographic diagnostic criteria proposed by Lu et. Al; mitral regurgitation (MR) jet length greater than 1.5cm or any aortic insufficiency (AI). All children that were screened positive were based on portable echocardiography were advanced for a formal echocardiogram and the diagnosis was confirmed based on the World Heart Federation criteria for echocardiographic diagnosis of RHD, see table for details. RESULTS: In total 112 children were screened, 59 males and 63 females. Mean age was 9.4 years and the mean BMI was 15.4 kg/m2. Average scanning time per echocardiogram was 4 minutes and 29 seconds. A preliminary diagnosis of RHD was made for 2 children and the diagnosis was confirmed in both cases with formal echocardiography. The children diagnosed with RHD were 12 and 13 years old. One of the children had mitral valve RHD while the other had combined mitral and aortic valve disease. Both had preserved LV systolic function. CONCLUSION: The early detection of subclinical RHD using portable echocardiography has the potential to decrease the morbidity and mortality associated with RHD through the implementation of prophylactic antibiotic therapy. Our project demonstrates that the prevalence of RHD in Namibia is similar to those previously described in other African countries. With the availability of further resources a larger scale RHD screening program is feasible within Namibia.
246 ENGAGEMENT IN VALUED LIFE ACTIVITIES AS AN INDICATOR OF QUALITY OF LIFE IN HEART FAILURE: A PSYCHOMETRIC ASSESSMENT OF THE QUALITY OF LIFE ACTIVITY SCALE (QOLAS) AY Payne, S Liu, J Surikova, H Ross, RP Nolan Toronto, Ontario BACKGROUND:
Heart failure (HF) is a major cause of hospitalization and mortality in Canada. Quality of life (QOL) is recognized as a meaningful outcome for clinical interventions. Existing HF-specific QOL measures primarily assess symptom severity and activity limitation. Our aim was to expand the clinical definition of QOL to include activities that are deliberately pursued by HF patients in order to live well with their condition. To meet this challenge, we undertook a mixed-methods study to (i) identify key QOL activities, and (ii) to develop an assessment instrument – the Quality of Life Activity Scale (QOLAS). In this study, we assessed the preliminary psychometric validity of the QOLAS. METHODS: We interviewed HF outpatients from the Peter Munk Cardiac Centre, Toronto. Unique QOL activities were extracted from interview transcripts using the interpretive description approach. They became items for the QOLAS. Subsequently, we administered the QOLAS to a sample of subjects who are enrolled in our current CHF-CePPORT trial of e-Counseling. Subjects rated how important each activity was to their QOL and how often they engaged in it in the past month. Data were analyzed using correlations and regressions. RESULTS: Nine men and 4 women (ages 52 - 79 years) were interviewed. Eight subjects were classified as NYHA I/II and 5 were NYHA III/IV. The subjects identified activities that were important to their QOL, including being physically active, enjoying pleasurable activities, maintaining relationships, and pursuing personal goals in their social and work life. From these data, 16 distinct QOL activities were extracted to form the QOLAS. We then administered the QOLAS to 20 men and 6 women (ages 27-70 years, with 19 (86%) of them in NYHA Class I/II). The QOLAS total score correlated moderately with the total score of the Kansas City Cardiomyopathy Questionnaire (KCCQ, r¼.45, p¼.02). After controlling for the KCCQ total score, the sum of QOL activities that were rated as being extremely important was independently associated with readiness to adhere to self-care behavior for exercise (Std. Beta ¼ 0.54, p¼.004).
S129
245 RHEUMATIC HEART DISEASE SCREENING IN WINDHOEK NAMIBIA USING PORTABLE ECHOCARDIOGRAPHY: A PILOT PROJECT JJ Manolakos, O Salehian, C Kraeker, L Manolakos, CJ Hunter Hamilton, Ontario BACKGROUND:
Recent estimates indicate that rheumatic heart disease (RHD) is responsible for up 1.4 million deaths globally, with the majority of those affected living in low and middle-income countries. The prevalence of RHD detected by echocardiography in asymptomatic school children in Africa has ranged from 14.8 to 30.4 cases per 1000 children screened. The prevalence has never been tested in Namibia. Recently there has been an increased focus on portable echocardiography for the detection of subclinical RHD. A sensitivity of 97.9% for definite RHD with portable echocardiography has been reported. The purpose of this study was to develop and test the feasibility of an organized screening program for RHD in Namibia using portable echocardiography. METHODS: All school children in grades 1-7 at a local school in Windhoek Namibia were screened with a standardized echocardiographic protocol using a GE Vscan portable ultrasound. The protocol was designed to screen for features of of RHD. All echocardiograms were completed by the primary author. A preliminary diagnosis of RHD was made based on the portable echocardiographic diagnostic criteria proposed by Lu et. Al; mitral regurgitation (MR) jet length greater than 1.5cm or any aortic insufficiency (AI). All children that were screened positive were based on portable echocardiography were advanced for a formal echocardiogram and the diagnosis was confirmed based on the World Heart Federation criteria for echocardiographic diagnosis of RHD, see table for details. RESULTS: In total 112 children were screened, 59 males and 63 females. Mean age was 9.4 years and the mean BMI was 15.4 kg/m2. Average scanning time per echocardiogram was 4 minutes and 29 seconds. A preliminary diagnosis of RHD was made for 2 children and the diagnosis was confirmed in both cases with formal echocardiography. The children diagnosed with RHD were 12 and 13 years old. One of the children had mitral valve RHD while the other had combined mitral and aortic valve disease. Both had preserved LV systolic function. CONCLUSION: The early detection of subclinical RHD using portable echocardiography has the potential to decrease the morbidity and mortality associated with RHD through the implementation of prophylactic antibiotic therapy. Our project demonstrates that the prevalence of RHD in Namibia is similar to those previously described in other African countries. With the availability of further resources a larger scale RHD screening program is feasible within Namibia.
246 ENGAGEMENT IN VALUED LIFE ACTIVITIES AS AN INDICATOR OF QUALITY OF LIFE IN HEART FAILURE: A PSYCHOMETRIC ASSESSMENT OF THE QUALITY OF LIFE ACTIVITY SCALE (QOLAS) AY Payne, S Liu, J Surikova, H Ross, RP Nolan Toronto, Ontario BACKGROUND:
Heart failure (HF) is a major cause of hospitalization and mortality in Canada. Quality of life (QOL) is recognized as a meaningful outcome for clinical interventions. Existing HF-specific QOL measures primarily assess symptom severity and activity limitation. Our aim was to expand the clinical definition of QOL to include activities that are deliberately pursued by HF patients in order to live well with their condition. To meet this challenge, we undertook a mixed-methods study to (i) identify key QOL activities, and (ii) to develop an assessment instrument – the Quality of Life Activity Scale (QOLAS). In this study, we assessed the preliminary psychometric validity of the QOLAS. METHODS: We interviewed HF outpatients from the Peter Munk Cardiac Centre, Toronto. Unique QOL activities were extracted from interview transcripts using the interpretive description approach. They became items for the QOLAS. Subsequently, we administered the QOLAS to a sample of subjects who are enrolled in our current CHF-CePPORT trial of e-Counseling. Subjects rated how important each activity was to their QOL and how often they engaged in it in the past month. Data were analyzed using correlations and regressions. RESULTS: Nine men and 4 women (ages 52 - 79 years) were interviewed. Eight subjects were classified as NYHA I/II and 5 were NYHA III/IV. The subjects identified activities that were important to their QOL, including being physically active, enjoying pleasurable activities, maintaining relationships, and pursuing personal goals in their social and work life. From these data, 16 distinct QOL activities were extracted to form the QOLAS. We then administered the QOLAS to 20 men and 6 women (ages 27-70 years, with 19 (86%) of them in NYHA Class I/II). The QOLAS total score correlated moderately with the total score of the Kansas City Cardiomyopathy Questionnaire (KCCQ, r¼.45, p¼.02). After controlling for the KCCQ total score, the sum of QOL activities that were rated as being extremely important was independently associated with readiness to adhere to self-care behavior for exercise (Std. Beta ¼ 0.54, p¼.004).