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The Economic Savings of Queensland's Indigenous Cardiac Outreach Program
S254
Heart, Lung and Circulation 2013;22:S126–S266
CSANZ 2013 Abstracts
ABSTRACTS
603 Serious Statin Associated Myotoxicity (SSAM) in Aboriginal and Torres Strait Islanders G. Gabb 1,∗ , A. Vitry 2 1 Royal
Adelaide Hospital, Adelaide, Australia Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, Australia
2 Quality
Background: Muscle adverse effects with statins are recognised, although generally considered mild. There is little information about statin myotoxicity in Aboriginal and Torres Strait Islanders. Methods: Observational case series of serious statin associated myotoxicity (SSAM) in ATSI’s conducted with Good Pharmacovigilance Practice. Cases identified from clinical experience, referral, reports to TGA, medical literature, internet and histopathology reports. Cases had (a) evidence of significant myotoxicity (CK > 10× ULN), or biopsy consistent with statin myopathy (b) exposure to statin (c) ATSI ethnicity. Results: Fifteen cases identified, mean age 55 (R35-69), 7M 8F. Presentation was with predominantly weakness (five), rhabdomyolysis and/or acute renal failure (four), proximal myopathy (three), myalgia (two) and one incidental. Mean CK was 52,889 (R 6230–276,000 U/L). Statin used was atorvastatin 11 cases (20–80 mg), simvastatin, one case (80 mg), and unspecified in three cases. Interacting drugs were prescribed in five cases. Six cases were Vitamin D deficient. Biopsies showed necrotizing myositis (five), and inflammatory polymyositis (three). Effect of ceasing statin was clear in 10 cases. Four had progression after stopping statin. Hypoventilatory respiratory failure developed in three cases due to respiratory muscle weakness requiring prolonged ventilation. There were three deaths and one permanent disability. Conclusion: SSAM occurs in ATSI populations. The most common presentation is weakness, rather than pain. Myositis may progress after statin cessation. Hypoventilatory respiratory failure requiring prolonged ventilation may occur. Increased awareness is required to improve recognition, and early diagnosis. Active pharmacovigilance is important for ATSI populations. http://dx.doi.org/10.1016/j.hlc.2013.05.605 604 The Economic Savings of Queensland’s Indigenous Cardiac Outreach Program S. McKenzie 1,2,∗ , A. Goodman 1 , R. Corpus 1 , M. Brown 1,2
Mahoney 1,3 , R.
1 The
Prince Charles Hospital, Australia of Medicine, University of Queensland, Australia 3 Queensland University of Technology, Australia 2 School
Introduction: The Indigenous Cardiac Outreach Program (ICOP) was established to provide specialist cardiology services to remote communities in Northern,
Central and Western Queensland as part of the Closing the Gap Campaign. Each clinic team consists of a cardiologist, an echosonographer and a program coordinator. We aimed to determine the financial savings achieved by providing this service. Methods: Based upon prospectively collected patient location data, we determined the airfare for those patients to travel to the nearest (or cheapest airfare) public cardiology service from their homes. Based upon flight schedules and predicted driving times (using Google Maps) we determined patients’ expected return travel times. Up to 90% of Indigenous patients require carers to travel, that cost has not been included in calculations. Results: Between January 2007 and March 2013, 2143 occasions of service were provided during 36 outreach trips. Clinic sites were a mean of 859 km (range 562–1337) from the nearest cardiology service with mean predicted driving times of 17.5 h (range 6.75–21.75). Total expected cost of patient airfares: $2,125,947. Total hours of patient travel saved: 15,832. Total cost of travel, meals and accommodation for ICOP team: $959,000. The net saving in travel expenses alone: $1,166,947 over six years. Conclusion: ICOP represents a considerable cost saving in terms of patient airfares alone. When considering the reduced loss of working hours for patients and their carers this service achieves a much greater, unaccounted for saving. Reduction in subsequent health expenditure costs are likely larger. http://dx.doi.org/10.1016/j.hlc.2013.05.606 605 The Value of Cardiac Risk Score Evaluation in Patients with Rheumatic Heart Disease in Pregnancy K. Burns ∗ , R. Yadav The Townsville Hospital, Australia Objective: To assess the burden of rheumatic heart disease in pregnancy at the Townsville Hospital and evaluate the utility of the cardiac risk score (CRS) for predicting adverse cardiac outcomes. Background: Rheumatic heart disease remains a major public health concern among indigenous Australians and Torres Strait islanders despite a decline in the incidence and prevalence in industrialised countries. It remains an important health issue for indigenous women during pregnancy. Method: A retrospective analysis of inpatient notes for pregnant women admitted with rheumatic heart disease at The Townsville Hospital from the 1st July 2008 until the 31st December 2011. The outcome measures included demographic details, obstetric and cardiac outcomes and cardiac risk score. Results: Fifty-six pregnancies were identified of which 79% were of Indigenous background. Sixty percent of patient had mitral valve disease and 40% mixed mitral and aortic valve disease. Cardiac complications occurred in 10.5% of patient with a CRS of 0, 11% with CRS of 1, 50% of patients with a CRS of 2, 90% of patients with a CRS of
Heart, Lung and Circulation 2013;22:S126–S266
CSANZ 2013 Abstracts
ABSTRACTS
603 Serious Statin Associated Myotoxicity (SSAM) in Aboriginal and Torres Strait Islanders G. Gabb 1,∗ , A. Vitry 2 1 Royal
Adelaide Hospital, Adelaide, Australia Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, Australia
2 Quality
Background: Muscle adverse effects with statins are recognised, although generally considered mild. There is little information about statin myotoxicity in Aboriginal and Torres Strait Islanders. Methods: Observational case series of serious statin associated myotoxicity (SSAM) in ATSI’s conducted with Good Pharmacovigilance Practice. Cases identified from clinical experience, referral, reports to TGA, medical literature, internet and histopathology reports. Cases had (a) evidence of significant myotoxicity (CK > 10× ULN), or biopsy consistent with statin myopathy (b) exposure to statin (c) ATSI ethnicity. Results: Fifteen cases identified, mean age 55 (R35-69), 7M 8F. Presentation was with predominantly weakness (five), rhabdomyolysis and/or acute renal failure (four), proximal myopathy (three), myalgia (two) and one incidental. Mean CK was 52,889 (R 6230–276,000 U/L). Statin used was atorvastatin 11 cases (20–80 mg), simvastatin, one case (80 mg), and unspecified in three cases. Interacting drugs were prescribed in five cases. Six cases were Vitamin D deficient. Biopsies showed necrotizing myositis (five), and inflammatory polymyositis (three). Effect of ceasing statin was clear in 10 cases. Four had progression after stopping statin. Hypoventilatory respiratory failure developed in three cases due to respiratory muscle weakness requiring prolonged ventilation. There were three deaths and one permanent disability. Conclusion: SSAM occurs in ATSI populations. The most common presentation is weakness, rather than pain. Myositis may progress after statin cessation. Hypoventilatory respiratory failure requiring prolonged ventilation may occur. Increased awareness is required to improve recognition, and early diagnosis. Active pharmacovigilance is important for ATSI populations. http://dx.doi.org/10.1016/j.hlc.2013.05.605 604 The Economic Savings of Queensland’s Indigenous Cardiac Outreach Program S. McKenzie 1,2,∗ , A. Goodman 1 , R. Corpus 1 , M. Brown 1,2
Mahoney 1,3 , R.
1 The
Prince Charles Hospital, Australia of Medicine, University of Queensland, Australia 3 Queensland University of Technology, Australia 2 School
Introduction: The Indigenous Cardiac Outreach Program (ICOP) was established to provide specialist cardiology services to remote communities in Northern,
Central and Western Queensland as part of the Closing the Gap Campaign. Each clinic team consists of a cardiologist, an echosonographer and a program coordinator. We aimed to determine the financial savings achieved by providing this service. Methods: Based upon prospectively collected patient location data, we determined the airfare for those patients to travel to the nearest (or cheapest airfare) public cardiology service from their homes. Based upon flight schedules and predicted driving times (using Google Maps) we determined patients’ expected return travel times. Up to 90% of Indigenous patients require carers to travel, that cost has not been included in calculations. Results: Between January 2007 and March 2013, 2143 occasions of service were provided during 36 outreach trips. Clinic sites were a mean of 859 km (range 562–1337) from the nearest cardiology service with mean predicted driving times of 17.5 h (range 6.75–21.75). Total expected cost of patient airfares: $2,125,947. Total hours of patient travel saved: 15,832. Total cost of travel, meals and accommodation for ICOP team: $959,000. The net saving in travel expenses alone: $1,166,947 over six years. Conclusion: ICOP represents a considerable cost saving in terms of patient airfares alone. When considering the reduced loss of working hours for patients and their carers this service achieves a much greater, unaccounted for saving. Reduction in subsequent health expenditure costs are likely larger. http://dx.doi.org/10.1016/j.hlc.2013.05.606 605 The Value of Cardiac Risk Score Evaluation in Patients with Rheumatic Heart Disease in Pregnancy K. Burns ∗ , R. Yadav The Townsville Hospital, Australia Objective: To assess the burden of rheumatic heart disease in pregnancy at the Townsville Hospital and evaluate the utility of the cardiac risk score (CRS) for predicting adverse cardiac outcomes. Background: Rheumatic heart disease remains a major public health concern among indigenous Australians and Torres Strait islanders despite a decline in the incidence and prevalence in industrialised countries. It remains an important health issue for indigenous women during pregnancy. Method: A retrospective analysis of inpatient notes for pregnant women admitted with rheumatic heart disease at The Townsville Hospital from the 1st July 2008 until the 31st December 2011. The outcome measures included demographic details, obstetric and cardiac outcomes and cardiac risk score. Results: Fifty-six pregnancies were identified of which 79% were of Indigenous background. Sixty percent of patient had mitral valve disease and 40% mixed mitral and aortic valve disease. Cardiac complications occurred in 10.5% of patient with a CRS of 0, 11% with CRS of 1, 50% of patients with a CRS of 2, 90% of patients with a CRS of