- Email: [email protected]
The Demographics and Natural History of Rheumatic Heart Disease: A Look into Indigenous Cardiac Outreach Programme Cohort after Nearly a Decade of Service
Abstracts
680 The Demographics and Natural History of Rheumatic Heart Disease: A Look into Indigenous Cardiac Outreach Programme Cohort after Nearly a Decade of Service M. Abdul Halim 1,2,3,∗ , A. Goodman 3 , R. Corpus 3 , S. McKenzie 4 1 Gold Coast University Hospital, Gold Coast, Australia 2 Indigenous Cardiac Outreach Programme, Brisbane, Australia 3 University of Queensland, Brisbane, Australia 4 The Prince Charles Hospital, Brisbane, Australia
Background: Contemporary data regarding rheumatic heart disease in the era of penicillin prophylaxis is still lacking. We attempt to define the demographics and the natural history of rheumatic heart disease in our Indigenous Cardiac Outreach Programme cohort in thirty-five rural and remote Indigenous communities in Queensland. Design: A retrospective longitudinal study based on medical records and echocardiography data from Indigenous Cardiac Outreach Programme database from April 2007 to September 2016. Results: Out of 2202, 114 patients were identified to have rheumatic heart disease. 83 (73%, mean age 36 (range 1383) years; 53 (64%) female) patients were available for data analysis due to availability of medical and echocardiography data. All are of Indigenous background. Lower Gulf communities were overly represented (77%, n = 62). The most common valvular diseases were mitral regurgitation (28%) and mixed mitral aortic valve disease (24%). Median followup period was 65 (range 6-112) months. Half of the patients (51%) remained in the same World Heart Federation (WHF) category. Only a minority improved to normal or better WHF category (5%) or progressed (10%). Almost all who required valvular intervention were in the context of definite WHF category (n = 13, 93%), except one borderline (n = 1,7%) which was due to the complication of infective endocarditis. The most common complications were heart failure (47%, n = 21) and atrial fibrillation (38%, n = 11) Conclusion: Rheumatic heart disease still poses a significant morbidity to young Indigenous Australians with a greater preponderance of female population. A targeted approach for primary prevention should be intensified as once it is established, there is a high likelihood of intervention and morbidity. http://dx.doi.org/10.1016/j.hlc.2017.06.681
S337
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
681 The Impact of Patient Location on Attendance to Cardiology Outpatient Appointments J. Marangou ∗ , G. Hillis, C. Schultz Royal Perth Hospital, Perth, Australia Background: There is a disparity in cardiovascular outcomes between metropolitan and rural Australia. Rural patients travel significant distances to receive specialist care. Travel assistance schemes provide financial support for patients. It is unclear whether attendance rates are equal between metropolitan and rural based patients. Objectives: To determine whether there is a difference in non-attendance rates between metropolitan and non-metropolitan patients attending cardiology outpatient clinics. To determine the cost of travel assistance for nonmetropolitan patients. Method: A retrospective study was performed using coding data from cardiology outpatient clinics at a single tertiary hospital in Perth, Western Australia. Patients were separated into metropolitan or non-metropolitan. Non-metropolitan patients were divided into rural or remote, based on Patient Assisted Travel Scheme (PATS) criteria. PATS cost data was reviewed. Results: Between January 2013 and January 2016, there were 32,988 outpatient appointments, of which 3,091 were rural and 1,089 remote patients. The non-attendance rate was 16% for metropolitan patients and 25% for non-metropolitan patients (p < 0.01). The non-attendance rate was 20% for rural and 38% for remote patients (p < 0.01). The PATS cost per remote patient was $829.95 and per rural patient was $204.87 with a total of $731,460.57 being spent on 1,938 visits. Conclusion: There is a significantly higher non-attendance rate for non-metropolitan patients, particularly for remote patients. There is a significant cost involved in patient travel to access specialist care. Further studies would be useful to determine whether other options such as outreach or telehealth services can improve attendance rates and cost saving. http://dx.doi.org/10.1016/j.hlc.2017.06.682 682 Unpacking High Self-Discharge Rates for Aboriginal Cardiac Patients K. McBride 1,2,∗ , J. Kelly 1,2 , A. Dowling 1,2 , W. Keech 1,2 , A. Brown 1,2 1 South
Australian Health And Medical Research Institute, Adelaide, Australia 2 University of South Australia, Adelaide, Australia Introduction: Aboriginal patients are over-represented in acute cardiac events. However, a significant number selfdischarge, jeopardising care and outcomes. Method: Multivariate logistic regression analysis of South Australian (SA) hospital data to investigate self-discharge rates of CVD (ICD-10: I00-I99) in-patients, July 2010-June
680 The Demographics and Natural History of Rheumatic Heart Disease: A Look into Indigenous Cardiac Outreach Programme Cohort after Nearly a Decade of Service M. Abdul Halim 1,2,3,∗ , A. Goodman 3 , R. Corpus 3 , S. McKenzie 4 1 Gold Coast University Hospital, Gold Coast, Australia 2 Indigenous Cardiac Outreach Programme, Brisbane, Australia 3 University of Queensland, Brisbane, Australia 4 The Prince Charles Hospital, Brisbane, Australia
Background: Contemporary data regarding rheumatic heart disease in the era of penicillin prophylaxis is still lacking. We attempt to define the demographics and the natural history of rheumatic heart disease in our Indigenous Cardiac Outreach Programme cohort in thirty-five rural and remote Indigenous communities in Queensland. Design: A retrospective longitudinal study based on medical records and echocardiography data from Indigenous Cardiac Outreach Programme database from April 2007 to September 2016. Results: Out of 2202, 114 patients were identified to have rheumatic heart disease. 83 (73%, mean age 36 (range 1383) years; 53 (64%) female) patients were available for data analysis due to availability of medical and echocardiography data. All are of Indigenous background. Lower Gulf communities were overly represented (77%, n = 62). The most common valvular diseases were mitral regurgitation (28%) and mixed mitral aortic valve disease (24%). Median followup period was 65 (range 6-112) months. Half of the patients (51%) remained in the same World Heart Federation (WHF) category. Only a minority improved to normal or better WHF category (5%) or progressed (10%). Almost all who required valvular intervention were in the context of definite WHF category (n = 13, 93%), except one borderline (n = 1,7%) which was due to the complication of infective endocarditis. The most common complications were heart failure (47%, n = 21) and atrial fibrillation (38%, n = 11) Conclusion: Rheumatic heart disease still poses a significant morbidity to young Indigenous Australians with a greater preponderance of female population. A targeted approach for primary prevention should be intensified as once it is established, there is a high likelihood of intervention and morbidity. http://dx.doi.org/10.1016/j.hlc.2017.06.681
S337
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
681 The Impact of Patient Location on Attendance to Cardiology Outpatient Appointments J. Marangou ∗ , G. Hillis, C. Schultz Royal Perth Hospital, Perth, Australia Background: There is a disparity in cardiovascular outcomes between metropolitan and rural Australia. Rural patients travel significant distances to receive specialist care. Travel assistance schemes provide financial support for patients. It is unclear whether attendance rates are equal between metropolitan and rural based patients. Objectives: To determine whether there is a difference in non-attendance rates between metropolitan and non-metropolitan patients attending cardiology outpatient clinics. To determine the cost of travel assistance for nonmetropolitan patients. Method: A retrospective study was performed using coding data from cardiology outpatient clinics at a single tertiary hospital in Perth, Western Australia. Patients were separated into metropolitan or non-metropolitan. Non-metropolitan patients were divided into rural or remote, based on Patient Assisted Travel Scheme (PATS) criteria. PATS cost data was reviewed. Results: Between January 2013 and January 2016, there were 32,988 outpatient appointments, of which 3,091 were rural and 1,089 remote patients. The non-attendance rate was 16% for metropolitan patients and 25% for non-metropolitan patients (p < 0.01). The non-attendance rate was 20% for rural and 38% for remote patients (p < 0.01). The PATS cost per remote patient was $829.95 and per rural patient was $204.87 with a total of $731,460.57 being spent on 1,938 visits. Conclusion: There is a significantly higher non-attendance rate for non-metropolitan patients, particularly for remote patients. There is a significant cost involved in patient travel to access specialist care. Further studies would be useful to determine whether other options such as outreach or telehealth services can improve attendance rates and cost saving. http://dx.doi.org/10.1016/j.hlc.2017.06.682 682 Unpacking High Self-Discharge Rates for Aboriginal Cardiac Patients K. McBride 1,2,∗ , J. Kelly 1,2 , A. Dowling 1,2 , W. Keech 1,2 , A. Brown 1,2 1 South
Australian Health And Medical Research Institute, Adelaide, Australia 2 University of South Australia, Adelaide, Australia Introduction: Aboriginal patients are over-represented in acute cardiac events. However, a significant number selfdischarge, jeopardising care and outcomes. Method: Multivariate logistic regression analysis of South Australian (SA) hospital data to investigate self-discharge rates of CVD (ICD-10: I00-I99) in-patients, July 2010-June