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Thermophilic anaerobic digestion of cheese whey: Coupling H2 and CH4 production
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Heart Failure P49 Characteristics of inpatients with heart failure selected for cardiologist-directed care at North Shore Hospital D. Ukiwe 1, J. Christiansen 2*, C. Edwards 2 1
Counties Manukau District Health Board, Auckland, NZ Waitemata District Health Board, Auckland, NZ * Corresponding author. 2
Background: Waitemata DHB provides comprehensive cardiology inpatient services, with 35 dedicated beds, and 24/7 ward consultation at two acute hospitals. Patients admitted with congestive heart failure (CHF) are cared for by both Cardiology and General Medicine. Cardiologists select patients for admission to the cardiology beds. We investigated differences in the patients selected by Cardiology and those managed by General Medicine at North Shore Hospital. Methods: Audit of admissions in 2013 identified 46 patients with a primary diagnosis of CHF (DRGs = ‘CHF’, ‘left ventricular failure’ or ‘cardiomyopathy’) admitted under Cardiology. We randomly selected 46 out of 748 CHF patients admitted under General Medicine in 2013 as a comparison group. Results: Cardiology patients were more likely to be male (87% vs 43%), younger (<70 years = 64% vs 11%), Maori (20% vs 4%), and have severe systolic dysfunction: EF% <35% = 63% vs 36%. HFPEF was more common in General Medicine patients (3% vs 38%). Myocardial infarction (26% vs 4%) and valvular disease (26% vs 17%) were more common in Cardiology patients. Cardiology patients had far greater outpatient follow-up (72% vs 16%), and lower readmission rates (22% vs 59%). All-cause mortality at 12 months was high in the General Medicine group (15% vs 48%). Conclusion: There are significant clinical differences in patients selected for cardiologist-directed inpatient care. Further work is needed to assess whether this is the best use of specialist resources, and whether there are opportunities for improvement in the care of CHF patients remaining under the General Medicine service. http://dx.doi.org/10.1016/j.hlc.2015.04.147 P50 Obligatory tacrolimus formulation substitution in heart and lung transplant recipients: A national bioequivalence audit S. Fitzsimons *, H. Gibbs, C. Wasywich, T. McWilliams, P. Ruygrok Cardiology Department, Auckland Hospital, Auckland, NZ * Corresponding author. Background: Generic medications are increasingly being prescribed due to the significant cost savings. In New Zealand (NZ) the national pharmaceutical procurement agency (PHARMAC) mandated a tacrolimus formation substitution from tacrolimus Prograf (Janssen Cilag) to a generic tacrolimus (Sandoz, Novartis). We sought to assess whether
Abstracts
substitution achieved bioequivalence in our transplant recipients. Methods: All recipients of a heart or lung transplant in NZ taking tacrolimus switched from tacrolimus Prograf to tacrolimus Sandoz between May-October 2014. Trough levels were taken on day one and ten following substitution. Results: 112 patients were on tacrolimus Prograf prior to 01/10/2014. Median age 49 years (range 8–73 years), 51% female, median time post transplant 5 years (range 0.4–25 years), 19% diabetic and the median creatinine level at time of switch was 101 mmol/L (range 27–265 mmol/L). 18/59 (30%) lung transplant recipients had cystic fibrosis. Twenty patients were excluded. Assuming normal distribution, mean change in trough level post conversion for the remaining 91 patients was 0.47 ug/ml (std+/ 2.57, p=0.08). Both assays were performed at the same laboratory for 57 patients with a mean change in trough level of 0.38 ug/ml (std+/ 2.57 ug/ml, p=0.26, mean pre-trough 8.37 ug/ml (std+/ 3.2), mean post 8.16 ug/ml (std+/ 2.99). 33 patients had levels measured at different laboratories where comparative assays are used (Roche/Abbott, correlation r=0.992) with a mean change in trough level of 0.63 ug/ ml (std+/ 2.6, p=0.17). Four patients had dose adjustments following conversion. All patients tolerated the switch with no significant side effect reported. Conclusion: Tacrolimus Sandoz had similar bioequivalence to tacrolimus Prograf in our cohort of heart and lung transplant recipients. The switch between preparations was well tolerated with no significant complication. http://dx.doi.org/10.1016/j.hlc.2015.04.148 Rehabilitation and Prevention P51 CVD risk assessing 90% of a country: The New Zealand experience K. Arcus 1*, G. Devlin 1, K. Evison 2 1
Heart Foundation (NZ), NZ Ministry of Health, NZ * Corresponding author. 2
Background: Many countries recommend cardiovascular disease (CVD) risk assessment to reduce the likelihood of developing ischaemic heart and cerebrovascular disease. New Zealand established national guidelines for the assessment and management of CVD risk in 2003. The uptake of risk assessments for the eligible population was initially slow. However, with the introduction of a national Health Target in 2012, the proportion being risk assessed increased from 46% to 87% over 2.75 years and continues to rise (Figure 1). Methods/Results: In 2013, case study research was conducted on the drivers of high performance amongst PHOs and practices. Common themes from that research showed high target achievement was associated with: Clinical support and leadership at local, district and national levels, particularly amongst general practice. Use of the whole general practice team and support from PHO facilitators
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Abstracts
Supportive IT systems including electronic prompts, risk
calculators integrated into computer systems and the active use of data/audit feedback to providers Innovative approaches to accessing patients Conclusion: The gains, while largely positive, have not been without debate. For example, many assessments have been non-face-to-face, and some wonder about the level of follow-up given the target’s focus on assessment rather than management. Guidelines were also updated to better reflect contemporary evidence and practice. The key focus for 2015 and beyond is to shift from an adapted Framingham based risk equation to a New Zealand specific equation. This presentation will review these success factors, progress to date with CVD Risk and potential next steps.
16.9%). Relative to national prevalence data, the study group had a higher prevalence of alcohol consumption (52.9 vs. 21.5%), hypertension (46.3 vs. 36.8%), diabetes (9.7 vs. 5.9%), obesity (9.3 vs. 5.9%) and raised triglycerides (47.9 vs. 33.4%). They had a lower prevalence of smoking (8.5 vs. 24.7%), raised total cholesterol (20.8 vs. 29.8%) and low high density lipoprotein cholesterol (56.8 vs. 74.5%). There was a positive and statistically significant association of increasing resident altitude levels with systolic and diastolic BP and triglycerides (P < 0.001) after controlling for potential confounders. Conclusion: A locally resident population of Nepal living at high altitude, especially males, have a higher prevalence of CVD and risk factors. The hypoxic and hypobaric environment may contribute to this. http://dx.doi.org/10.1016/j.hlc.2015.04.150 P53 Fatu Ola - an innovative home-based service to increase CR uptake and engagement for Pacific people in Counties Manukau L. Ioelu *, A. McLachlan, J. Poole, K. McLean, S. Joseph Counties Manukau District Health Board, Auckland, NZ Corresponding author.
*
http://dx.doi.org/10.1016/j.hlc.2015.04.149 P52 Are high altitude populations at high risk of heart disease? A cross-sectional study in Nepal N. Aryal 1, M. Weatherall 1, Y. Kumar Deo Bhatt 2, S. Mann 1* 1
University of Otago, Department of Medicine, Dunedin, NZ 2 Shahid Gangalal National Heart Centre, Nepal * Corresponding author. Background: The cardiovascular health of populations resident at high altitude may depend on the degree of consequent adaptation but also on lifestyle factors and genetic predisposition. The aim of this study was to estimate the prevalence of cardiovascular disease (CVD) and distribution of CVD risk factors among high altitude natives of Nepal. Methods: 270 people aged 30 years and permanently living at an altitude of 2800m were randomly sampled from the Mustang district of Nepal. They completed the WHO STEPS interview questionnaire, undertook measurements of blood pressure (BP), height, weight, waist and hip circumference, and had bio-chemical testing for lipid profile and glycated haemoglobin along with recording of a 12-lead ECG. Results: Abnormal or borderline abnormal ECGs were found in 21.8% of the participants (males 27.4%, females
Background: At Middlemore Hospital, Pacific people attend cardiac rehabilitation (CR) least of all ethnicities. Using a joint approach with patients and the Pacific team, we co-designed a programme to increase the attendance of Pacific people at a community based CR programme. However, a number of patients still failed to attend. Methods: After a period of consultation we introduced a novel, home-based approach to target Pacific patients who expressed difficulty attending the group sessions. A structured approach delivered and led by a Pacific CR nurse was developed using a patient-centred, Pacifica model of health with the Heart Foundation “taking control” resource as a framework. A data base was created to capture referrals, attendance and outcomes. Results: Over 14 months, 113 patients were referred (mean age 62 years, 58% were male, Samoan 53%, Tongan 12%, Niuean 7%, Cook Island 26%, other 2%). 97 (86%) patients engaged with the process and were assessed at least once. 82% had attended their GP, 74% were assessed as fully adherent to medications and 48% had a cardiac out-patient appointment scheduled with a further 45% planned. The Taking Control book was used by 51% patients; the remainder chose a less health literate dependant, nurse supported approach. All patients were encouraged to set personal health goals including healthy eating, weight loss, activity, smoking cessation and medication self-management. 95% were referred for ongoing community activity, cultural and social support Conclusion: This home based initiative has shown to improve Pacific patient’s uptake and adherence in cardiac rehabilitation. http://dx.doi.org/10.1016/j.hlc.2015.04.151
Heart Failure P49 Characteristics of inpatients with heart failure selected for cardiologist-directed care at North Shore Hospital D. Ukiwe 1, J. Christiansen 2*, C. Edwards 2 1
Counties Manukau District Health Board, Auckland, NZ Waitemata District Health Board, Auckland, NZ * Corresponding author. 2
Background: Waitemata DHB provides comprehensive cardiology inpatient services, with 35 dedicated beds, and 24/7 ward consultation at two acute hospitals. Patients admitted with congestive heart failure (CHF) are cared for by both Cardiology and General Medicine. Cardiologists select patients for admission to the cardiology beds. We investigated differences in the patients selected by Cardiology and those managed by General Medicine at North Shore Hospital. Methods: Audit of admissions in 2013 identified 46 patients with a primary diagnosis of CHF (DRGs = ‘CHF’, ‘left ventricular failure’ or ‘cardiomyopathy’) admitted under Cardiology. We randomly selected 46 out of 748 CHF patients admitted under General Medicine in 2013 as a comparison group. Results: Cardiology patients were more likely to be male (87% vs 43%), younger (<70 years = 64% vs 11%), Maori (20% vs 4%), and have severe systolic dysfunction: EF% <35% = 63% vs 36%. HFPEF was more common in General Medicine patients (3% vs 38%). Myocardial infarction (26% vs 4%) and valvular disease (26% vs 17%) were more common in Cardiology patients. Cardiology patients had far greater outpatient follow-up (72% vs 16%), and lower readmission rates (22% vs 59%). All-cause mortality at 12 months was high in the General Medicine group (15% vs 48%). Conclusion: There are significant clinical differences in patients selected for cardiologist-directed inpatient care. Further work is needed to assess whether this is the best use of specialist resources, and whether there are opportunities for improvement in the care of CHF patients remaining under the General Medicine service. http://dx.doi.org/10.1016/j.hlc.2015.04.147 P50 Obligatory tacrolimus formulation substitution in heart and lung transplant recipients: A national bioequivalence audit S. Fitzsimons *, H. Gibbs, C. Wasywich, T. McWilliams, P. Ruygrok Cardiology Department, Auckland Hospital, Auckland, NZ * Corresponding author. Background: Generic medications are increasingly being prescribed due to the significant cost savings. In New Zealand (NZ) the national pharmaceutical procurement agency (PHARMAC) mandated a tacrolimus formation substitution from tacrolimus Prograf (Janssen Cilag) to a generic tacrolimus (Sandoz, Novartis). We sought to assess whether
Abstracts
substitution achieved bioequivalence in our transplant recipients. Methods: All recipients of a heart or lung transplant in NZ taking tacrolimus switched from tacrolimus Prograf to tacrolimus Sandoz between May-October 2014. Trough levels were taken on day one and ten following substitution. Results: 112 patients were on tacrolimus Prograf prior to 01/10/2014. Median age 49 years (range 8–73 years), 51% female, median time post transplant 5 years (range 0.4–25 years), 19% diabetic and the median creatinine level at time of switch was 101 mmol/L (range 27–265 mmol/L). 18/59 (30%) lung transplant recipients had cystic fibrosis. Twenty patients were excluded. Assuming normal distribution, mean change in trough level post conversion for the remaining 91 patients was 0.47 ug/ml (std+/ 2.57, p=0.08). Both assays were performed at the same laboratory for 57 patients with a mean change in trough level of 0.38 ug/ml (std+/ 2.57 ug/ml, p=0.26, mean pre-trough 8.37 ug/ml (std+/ 3.2), mean post 8.16 ug/ml (std+/ 2.99). 33 patients had levels measured at different laboratories where comparative assays are used (Roche/Abbott, correlation r=0.992) with a mean change in trough level of 0.63 ug/ ml (std+/ 2.6, p=0.17). Four patients had dose adjustments following conversion. All patients tolerated the switch with no significant side effect reported. Conclusion: Tacrolimus Sandoz had similar bioequivalence to tacrolimus Prograf in our cohort of heart and lung transplant recipients. The switch between preparations was well tolerated with no significant complication. http://dx.doi.org/10.1016/j.hlc.2015.04.148 Rehabilitation and Prevention P51 CVD risk assessing 90% of a country: The New Zealand experience K. Arcus 1*, G. Devlin 1, K. Evison 2 1
Heart Foundation (NZ), NZ Ministry of Health, NZ * Corresponding author. 2
Background: Many countries recommend cardiovascular disease (CVD) risk assessment to reduce the likelihood of developing ischaemic heart and cerebrovascular disease. New Zealand established national guidelines for the assessment and management of CVD risk in 2003. The uptake of risk assessments for the eligible population was initially slow. However, with the introduction of a national Health Target in 2012, the proportion being risk assessed increased from 46% to 87% over 2.75 years and continues to rise (Figure 1). Methods/Results: In 2013, case study research was conducted on the drivers of high performance amongst PHOs and practices. Common themes from that research showed high target achievement was associated with: Clinical support and leadership at local, district and national levels, particularly amongst general practice. Use of the whole general practice team and support from PHO facilitators
S109
Abstracts
Supportive IT systems including electronic prompts, risk
calculators integrated into computer systems and the active use of data/audit feedback to providers Innovative approaches to accessing patients Conclusion: The gains, while largely positive, have not been without debate. For example, many assessments have been non-face-to-face, and some wonder about the level of follow-up given the target’s focus on assessment rather than management. Guidelines were also updated to better reflect contemporary evidence and practice. The key focus for 2015 and beyond is to shift from an adapted Framingham based risk equation to a New Zealand specific equation. This presentation will review these success factors, progress to date with CVD Risk and potential next steps.
16.9%). Relative to national prevalence data, the study group had a higher prevalence of alcohol consumption (52.9 vs. 21.5%), hypertension (46.3 vs. 36.8%), diabetes (9.7 vs. 5.9%), obesity (9.3 vs. 5.9%) and raised triglycerides (47.9 vs. 33.4%). They had a lower prevalence of smoking (8.5 vs. 24.7%), raised total cholesterol (20.8 vs. 29.8%) and low high density lipoprotein cholesterol (56.8 vs. 74.5%). There was a positive and statistically significant association of increasing resident altitude levels with systolic and diastolic BP and triglycerides (P < 0.001) after controlling for potential confounders. Conclusion: A locally resident population of Nepal living at high altitude, especially males, have a higher prevalence of CVD and risk factors. The hypoxic and hypobaric environment may contribute to this. http://dx.doi.org/10.1016/j.hlc.2015.04.150 P53 Fatu Ola - an innovative home-based service to increase CR uptake and engagement for Pacific people in Counties Manukau L. Ioelu *, A. McLachlan, J. Poole, K. McLean, S. Joseph Counties Manukau District Health Board, Auckland, NZ Corresponding author.
*
http://dx.doi.org/10.1016/j.hlc.2015.04.149 P52 Are high altitude populations at high risk of heart disease? A cross-sectional study in Nepal N. Aryal 1, M. Weatherall 1, Y. Kumar Deo Bhatt 2, S. Mann 1* 1
University of Otago, Department of Medicine, Dunedin, NZ 2 Shahid Gangalal National Heart Centre, Nepal * Corresponding author. Background: The cardiovascular health of populations resident at high altitude may depend on the degree of consequent adaptation but also on lifestyle factors and genetic predisposition. The aim of this study was to estimate the prevalence of cardiovascular disease (CVD) and distribution of CVD risk factors among high altitude natives of Nepal. Methods: 270 people aged 30 years and permanently living at an altitude of 2800m were randomly sampled from the Mustang district of Nepal. They completed the WHO STEPS interview questionnaire, undertook measurements of blood pressure (BP), height, weight, waist and hip circumference, and had bio-chemical testing for lipid profile and glycated haemoglobin along with recording of a 12-lead ECG. Results: Abnormal or borderline abnormal ECGs were found in 21.8% of the participants (males 27.4%, females
Background: At Middlemore Hospital, Pacific people attend cardiac rehabilitation (CR) least of all ethnicities. Using a joint approach with patients and the Pacific team, we co-designed a programme to increase the attendance of Pacific people at a community based CR programme. However, a number of patients still failed to attend. Methods: After a period of consultation we introduced a novel, home-based approach to target Pacific patients who expressed difficulty attending the group sessions. A structured approach delivered and led by a Pacific CR nurse was developed using a patient-centred, Pacifica model of health with the Heart Foundation “taking control” resource as a framework. A data base was created to capture referrals, attendance and outcomes. Results: Over 14 months, 113 patients were referred (mean age 62 years, 58% were male, Samoan 53%, Tongan 12%, Niuean 7%, Cook Island 26%, other 2%). 97 (86%) patients engaged with the process and were assessed at least once. 82% had attended their GP, 74% were assessed as fully adherent to medications and 48% had a cardiac out-patient appointment scheduled with a further 45% planned. The Taking Control book was used by 51% patients; the remainder chose a less health literate dependant, nurse supported approach. All patients were encouraged to set personal health goals including healthy eating, weight loss, activity, smoking cessation and medication self-management. 95% were referred for ongoing community activity, cultural and social support Conclusion: This home based initiative has shown to improve Pacific patient’s uptake and adherence in cardiac rehabilitation. http://dx.doi.org/10.1016/j.hlc.2015.04.151