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The impact of different diagnostic criteria on the prevalence of left ventricular hypertrophy in elderly hypertensives
Heart,
Lung
and Circulation
2000; 9
TREATMENT OF MAJOR DEPRESSION AFTER ACUTE CORONARY SYNDROMES (ACS): MYOCARDIAL INFARCTION OR UNSTABLE ANGINA: SADHART TRIAL. C.M.
w* for investigators. Dnke University, Durham, Columbia University, New York, USA, Core Research Group, Brisbane, Australia Depression occurs in Z-50% of patients (pts) with ACS and is a major predictor of morbidity and mortality. It is not known whether drug therapy for depression m ACS pts is safe and improves outcomes. AIM: The arm of this study is to access the safety, tolerability and antidepressant efficacy of 24 weeks Sertraline versus placebo in pts hospitalized for ACS and diagnosed with major depression. Multicentre, international randomised double-blind parallel study. The selective serotonin re-uptake Inhibitor (SSRI) Sertraline was compared to placebo in pts hospitalized with ACS and diagnosed with major depression. 400 p’s from 40 sites were enrolled within 30 days of diagnosis of ACS. After 14 day placebo washout, pts were randomised to Sertraline or placebo and followed for 24 weeks. Se&dine dose varied 25-200mg depending on response. Cardiological tests: ECG, resting radionuclide venhiculography (RNV) and holter monitoring. Psychological tests: interview, Hamilton Depression Rating Scale Score (HAM-D,,), Beck Depression Inventory (BDI-I), Medical Outcomes Study (MOS) SF-36. METHODS:
Pts were stratified accordmg to P.NV (ejection fraction < or >30%), extent of depression (HAM-D,, < or >18) and history of prior depression. Enrolment was completed 31 Oct. 99. The 24 week follow up will be completed by May 2000. Results of baseline characteristics, safety and efficacy will be presented.
RESULTS:
CONCLUSION: This is the first stndy ever performed to test the safety and efficacy of dmg treatment of depression in pts with ACS. The results of this study may have a major nnpact on management of pts with coronary heart disease.
CARDIOVASCULAR RISK FACTOR MANAGEMENT IN PATIENTS ATTENDING RURAL VERSUS URBAN GENERAL PRACTICES. MD Rockell*, A Psyche, Z Parsons, CM Reid. Cardiovascular Disease Prevention Unit, Baker Medical Research Institute, Victoria. The control of cardiovascular (CV) risk factors is a national health priority however, there is good evidence that risk factors are not adequately controlled in both hypertensive and hyperlipidaemic populations in Australia. Rural Australians have a higher incidence of cardiovascular disease (CVD) than urban dwellers and this may be related to differences in risk factor management in these communities. Subjects in this general practice based cardiovascular risk assesment program (cvTRAC@) had a baseline assessment of lifestyle habits, height, weight, blood pressure (BP), total cholesterol, HDL, LDL, fasting triglycerides, pharmaceutical management and overall CV risk. 3960 patients from 205 urban and 1991 patients from 117 rural practices participated in cvTRAC?. Mean age was 54.78 years at urban practices and 56.23 years at rural practices @<0.05). Rural patients had lower HDL cholesterol (1.3 vs 1.4 mmoliL: p
48th Annual
Scientific
Meeting
of CSANZ
A133
THE IMPACT OF DIFFERENT DIAGNOSTIC CRITERIA ON THE PREVALENCE OF LEFT VENTRICULAR HYPERTROPHY IN ELDERLY HYPERTENSIVES. G.L Jennings* , C.M. Reid, L. Dewar, Y-L Liu, P. Fletcher, M. Feneley on behalf of the ANBP2 Investigators, High Blood Pressure Research Council of Australia, Melbourne, Vie The prevalence of left ventricular hypertrophy (LVH) has been reported to vary between 12% and 96% depending on the population studied and threshold values. The aim of this study was to determine the prevalence of echocardiographic LVH in elderly essential hypertensives managed in Australian general practice and whether the prevalence estimate was influenced by the choice of published diagnostic criteria. National Blood Pressure Study As part of the 2”d Australian (ANBP2), baseline echo determination of LV structure and function was measured. 2D and doppler echocardiograms were carried out at randomisation by experienced technicians. Videotapes were read at a central analysis facility by a cardiologist blinded to subject identity and treatment. LV Mass was calculated by 3 different published methods, indexed to either body surface area, height or height*.‘. 1291 subjects randomised to ANBP2 underwent echocardiographic examination. The mean age of subjects was 72 years and 51% were women. The mean blood pressure was 168/89 mmHg. For males, the prevalence of LVH ranged from 39% to 96% depending on the formulae for calculating left ventricular maas index and the diagnostic cut-point chosen (42% to 92% for women). These data suggest a high prevalence of LVH in both male and female elderly hypertensives treated in Australian general practices. The extent of the prevalence estimate is highly dependent on the diagnostic criteria adopted.
OUTCOMES OF CORONARY ARTERY BYPASS GRAFTING AND CARDIAC VALVE SURGERY: AN INTERNATIONAL COMPARISON USING THE SOCIETY OF THORACIC SURGEONS DATABASE
Department,
AMed Hospital, Prahran, Vie.
Background: The Society of Thortic Surgeons (STS) National card&z Surgery Database allows comparison of risk stratified outcome data between individual surgeontinstitutions and a national standard. We compared the outcomes of coronary artery bypass grafting (CAEG) and cardiac valve surgery with those contained in the STS Database. Methods: Data from all patients (pts) operated between January 1996 and December 1996 was entered into the STS Database (Summit Medical Systems, Minneapolis, MN) strictly adhering to the published definitions. Version 3.0 soflware was used for analysis of CABG alone outcomes. Crude results of valve surgery were compared with those in a recent publication (1) and also with data available from the Internet. Reaulte: Of the 1667 pts under going CABG alone, the observed mortalii was 42 pts (2.25%; 95% Cl = 1.65 - 3.06%). From the STS Database, the mean expected mortality rate in the population was 2.41% (95%CI=2.27 - 2.55%). The observed/expected mortality ratio for the entire population was 0.93 which was considered favorable. There was no difference between our observed mortality and that mortality predicted from the STS Database for the entire population or for each of the predicted risk groups (p = 0.75). For the 379 pts under going valve surgery, our crude moftalii for AVR (4/l 18. 3.4%), CAffi + AVR (7/135, 5.2%). MVR (l/36, 2.6%), CABG + MVR (l/16. 5.6%), multiple vahre replacement (1113, 7.7%). and CABG + multiple valve replacement (O/4, 0%) compared favorably with that contained within the STS Database (1). Comparative risk-adjusted analysis of the valve surgery population ispending suitable software development. Surgeon specific outcome results for both CABG and valve surgery were also no different from the STS database. Concluskne: Adequate cardii surgical quality at our institution has been confirmed over a three year period. Valid international as well as national outcome comparisons can be performed using the STS Database. 1. Jamieson WR et al. Ann Thorac Surg 1999;67:943-51
Lung
and Circulation
2000; 9
TREATMENT OF MAJOR DEPRESSION AFTER ACUTE CORONARY SYNDROMES (ACS): MYOCARDIAL INFARCTION OR UNSTABLE ANGINA: SADHART TRIAL. C.M.
w* for investigators. Dnke University, Durham, Columbia University, New York, USA, Core Research Group, Brisbane, Australia Depression occurs in Z-50% of patients (pts) with ACS and is a major predictor of morbidity and mortality. It is not known whether drug therapy for depression m ACS pts is safe and improves outcomes. AIM: The arm of this study is to access the safety, tolerability and antidepressant efficacy of 24 weeks Sertraline versus placebo in pts hospitalized for ACS and diagnosed with major depression. Multicentre, international randomised double-blind parallel study. The selective serotonin re-uptake Inhibitor (SSRI) Sertraline was compared to placebo in pts hospitalized with ACS and diagnosed with major depression. 400 p’s from 40 sites were enrolled within 30 days of diagnosis of ACS. After 14 day placebo washout, pts were randomised to Sertraline or placebo and followed for 24 weeks. Se&dine dose varied 25-200mg depending on response. Cardiological tests: ECG, resting radionuclide venhiculography (RNV) and holter monitoring. Psychological tests: interview, Hamilton Depression Rating Scale Score (HAM-D,,), Beck Depression Inventory (BDI-I), Medical Outcomes Study (MOS) SF-36. METHODS:
Pts were stratified accordmg to P.NV (ejection fraction < or >30%), extent of depression (HAM-D,, < or >18) and history of prior depression. Enrolment was completed 31 Oct. 99. The 24 week follow up will be completed by May 2000. Results of baseline characteristics, safety and efficacy will be presented.
RESULTS:
CONCLUSION: This is the first stndy ever performed to test the safety and efficacy of dmg treatment of depression in pts with ACS. The results of this study may have a major nnpact on management of pts with coronary heart disease.
CARDIOVASCULAR RISK FACTOR MANAGEMENT IN PATIENTS ATTENDING RURAL VERSUS URBAN GENERAL PRACTICES. MD Rockell*, A Psyche, Z Parsons, CM Reid. Cardiovascular Disease Prevention Unit, Baker Medical Research Institute, Victoria. The control of cardiovascular (CV) risk factors is a national health priority however, there is good evidence that risk factors are not adequately controlled in both hypertensive and hyperlipidaemic populations in Australia. Rural Australians have a higher incidence of cardiovascular disease (CVD) than urban dwellers and this may be related to differences in risk factor management in these communities. Subjects in this general practice based cardiovascular risk assesment program (cvTRAC@) had a baseline assessment of lifestyle habits, height, weight, blood pressure (BP), total cholesterol, HDL, LDL, fasting triglycerides, pharmaceutical management and overall CV risk. 3960 patients from 205 urban and 1991 patients from 117 rural practices participated in cvTRAC?. Mean age was 54.78 years at urban practices and 56.23 years at rural practices @<0.05). Rural patients had lower HDL cholesterol (1.3 vs 1.4 mmoliL: p
48th Annual
Scientific
Meeting
of CSANZ
A133
THE IMPACT OF DIFFERENT DIAGNOSTIC CRITERIA ON THE PREVALENCE OF LEFT VENTRICULAR HYPERTROPHY IN ELDERLY HYPERTENSIVES. G.L Jennings* , C.M. Reid, L. Dewar, Y-L Liu, P. Fletcher, M. Feneley on behalf of the ANBP2 Investigators, High Blood Pressure Research Council of Australia, Melbourne, Vie The prevalence of left ventricular hypertrophy (LVH) has been reported to vary between 12% and 96% depending on the population studied and threshold values. The aim of this study was to determine the prevalence of echocardiographic LVH in elderly essential hypertensives managed in Australian general practice and whether the prevalence estimate was influenced by the choice of published diagnostic criteria. National Blood Pressure Study As part of the 2”d Australian (ANBP2), baseline echo determination of LV structure and function was measured. 2D and doppler echocardiograms were carried out at randomisation by experienced technicians. Videotapes were read at a central analysis facility by a cardiologist blinded to subject identity and treatment. LV Mass was calculated by 3 different published methods, indexed to either body surface area, height or height*.‘. 1291 subjects randomised to ANBP2 underwent echocardiographic examination. The mean age of subjects was 72 years and 51% were women. The mean blood pressure was 168/89 mmHg. For males, the prevalence of LVH ranged from 39% to 96% depending on the formulae for calculating left ventricular maas index and the diagnostic cut-point chosen (42% to 92% for women). These data suggest a high prevalence of LVH in both male and female elderly hypertensives treated in Australian general practices. The extent of the prevalence estimate is highly dependent on the diagnostic criteria adopted.
OUTCOMES OF CORONARY ARTERY BYPASS GRAFTING AND CARDIAC VALVE SURGERY: AN INTERNATIONAL COMPARISON USING THE SOCIETY OF THORACIC SURGEONS DATABASE
Department,
AMed Hospital, Prahran, Vie.
Background: The Society of Thortic Surgeons (STS) National card&z Surgery Database allows comparison of risk stratified outcome data between individual surgeontinstitutions and a national standard. We compared the outcomes of coronary artery bypass grafting (CAEG) and cardiac valve surgery with those contained in the STS Database. Methods: Data from all patients (pts) operated between January 1996 and December 1996 was entered into the STS Database (Summit Medical Systems, Minneapolis, MN) strictly adhering to the published definitions. Version 3.0 soflware was used for analysis of CABG alone outcomes. Crude results of valve surgery were compared with those in a recent publication (1) and also with data available from the Internet. Reaulte: Of the 1667 pts under going CABG alone, the observed mortalii was 42 pts (2.25%; 95% Cl = 1.65 - 3.06%). From the STS Database, the mean expected mortality rate in the population was 2.41% (95%CI=2.27 - 2.55%). The observed/expected mortality ratio for the entire population was 0.93 which was considered favorable. There was no difference between our observed mortality and that mortality predicted from the STS Database for the entire population or for each of the predicted risk groups (p = 0.75). For the 379 pts under going valve surgery, our crude moftalii for AVR (4/l 18. 3.4%), CAffi + AVR (7/135, 5.2%). MVR (l/36, 2.6%), CABG + MVR (l/16. 5.6%), multiple vahre replacement (1113, 7.7%). and CABG + multiple valve replacement (O/4, 0%) compared favorably with that contained within the STS Database (1). Comparative risk-adjusted analysis of the valve surgery population ispending suitable software development. Surgeon specific outcome results for both CABG and valve surgery were also no different from the STS database. Concluskne: Adequate cardii surgical quality at our institution has been confirmed over a three year period. Valid international as well as national outcome comparisons can be performed using the STS Database. 1. Jamieson WR et al. Ann Thorac Surg 1999;67:943-51