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Utilisation of Cardiac Resynchronisation Therapy at Auckland District Health Board
Abstracts CSANZ 2013 NZ Abstracts
567
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Utilisation of Cardiac Resynchronisation Therapy at Auckland District Health Board
Using Mobile Technology to Deliver Exercise-based Cardiac Rehabilitation: Participant Perspectives from the Heart Trial
A. Martin 1,2 , C. Pearson 1,∗ , E. Rawson 1 , F. Riddell 1 , N. Lever 1,2 , J. Stewart 1 1 Green
Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand 2 Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand Background: Cardiac resynchronisation therapy (CRT) is an adjunctive treatment indicated for a subgroup of patients with severe left ventricular (LV) systolic dysfunction. We evaluate our CRT implant rate in patients who meet guideline indications. Methods: Retrospective review of Auckland District Health Board (ADHB) patients aged <75 yrs who underwent echocardiography at Auckland City Hospital (ACH) and had an LV ejection fraction (LVEF) < 35%, in association with LBBB (QRS duration > 150 ms). Results: 4133 echocardiograms were data based between October 2008 and January 2013. 427 patients had an LVEF < 35%, of which 40 had LBBB (QRS duration > 150 ms), were aged < 75 yrs, and resided within the ADHB region. Nine (23%) underwent CRT implant, while 31 (77%) did not. Of those who did not, 18 (58% of those who did not) had a clearly defined explanation, including: recovery of LV function (5, 16%), co-morbid illness expected to limit lifespan to <18 mths (4, 13%), patient refusal (1, 3%), and suboptimal medical therapy (2, 6%). Four patients (13%) are actively having medical therapy titrated, 1 (3%) patient has been referred for CRT and is awaiting this, and 1 (3%) has never been reviewed by a Cardiologist. No clear reason could be identified for the remaining 13 (42%). Conclusions: In those identified as being eligible for CRT our implant rate is low. While CRT will not be appropriate for all patients who fulfil the standard criteria for its use (based on echo, ECG, and age) our data strongly suggests this therapy is underutilised in our patients. http://dx.doi.org/10.1016/j.hlc.2013.04.047
L. Pfaeffli 1,∗ , R. Maddison 1 , R. Whittaker 1 , R. Stewart 2 , A. Kerr 3 , Y. Jiang 1 , K. Carter 1 , J. Rawstorn 1 1 National
Institute for Health Innovation, The University of Auckland, Auckland, New Zealand 2 Department of Medicine, The University of Auckland, Auckland, New Zealand 3 Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand Background: A recent trend in disease management research is the use of mobile technologies (mHealth) to deliver behaviour change interventions. The HEART trial examined the efficacy of a mHealth exercise-based cardiac rehabilitation (CR) intervention to increase exercise behaviour in adults with cardiovascular disease (CVD). This mixed methods study aimed to determine the usability and perceptions of the HEART trial. Methods: A six-month intervention aimed to increase exercise behaviour through a theory-based, personalised, automated package of text and video messages, delivered via participants’ mobile phones and a supporting website. To assess study perceptions, intervention participants completed a feedback survey and semi-structured exit interviews during their follow-up assessment. Results: At the end of the intervention period, 75 participants completed the feedback survey, and 17 participants were interviewed (median age = 60). Descriptive information from the survey data was merged with qualitative data, analysed using a general inductive approach, resulting in four overarching themes. (1) Participants were able to use the technology. (2) The messages were motivating and a good reminder to exercise regularly. (3) mHealth delivery was not for everyone. (4) The intervention could be improved by tailoring the content and delivery of the messages to suit their personal circumstances and to offer some personal contact. Conclusions: Older adults with CVD were able to use a mHealth program to receive exercise information and felt text messaging was a good way to deliver CR. While mHealth is designed to be automated, programs could be improved if content and delivery was tailored to individuals’ needs. http://dx.doi.org/10.1016/j.hlc.2013.04.048
ABSTRACTS
Heart, Lung and Circulation 2013;22:548–593
567
42
43
Utilisation of Cardiac Resynchronisation Therapy at Auckland District Health Board
Using Mobile Technology to Deliver Exercise-based Cardiac Rehabilitation: Participant Perspectives from the Heart Trial
A. Martin 1,2 , C. Pearson 1,∗ , E. Rawson 1 , F. Riddell 1 , N. Lever 1,2 , J. Stewart 1 1 Green
Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand 2 Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand Background: Cardiac resynchronisation therapy (CRT) is an adjunctive treatment indicated for a subgroup of patients with severe left ventricular (LV) systolic dysfunction. We evaluate our CRT implant rate in patients who meet guideline indications. Methods: Retrospective review of Auckland District Health Board (ADHB) patients aged <75 yrs who underwent echocardiography at Auckland City Hospital (ACH) and had an LV ejection fraction (LVEF) < 35%, in association with LBBB (QRS duration > 150 ms). Results: 4133 echocardiograms were data based between October 2008 and January 2013. 427 patients had an LVEF < 35%, of which 40 had LBBB (QRS duration > 150 ms), were aged < 75 yrs, and resided within the ADHB region. Nine (23%) underwent CRT implant, while 31 (77%) did not. Of those who did not, 18 (58% of those who did not) had a clearly defined explanation, including: recovery of LV function (5, 16%), co-morbid illness expected to limit lifespan to <18 mths (4, 13%), patient refusal (1, 3%), and suboptimal medical therapy (2, 6%). Four patients (13%) are actively having medical therapy titrated, 1 (3%) patient has been referred for CRT and is awaiting this, and 1 (3%) has never been reviewed by a Cardiologist. No clear reason could be identified for the remaining 13 (42%). Conclusions: In those identified as being eligible for CRT our implant rate is low. While CRT will not be appropriate for all patients who fulfil the standard criteria for its use (based on echo, ECG, and age) our data strongly suggests this therapy is underutilised in our patients. http://dx.doi.org/10.1016/j.hlc.2013.04.047
L. Pfaeffli 1,∗ , R. Maddison 1 , R. Whittaker 1 , R. Stewart 2 , A. Kerr 3 , Y. Jiang 1 , K. Carter 1 , J. Rawstorn 1 1 National
Institute for Health Innovation, The University of Auckland, Auckland, New Zealand 2 Department of Medicine, The University of Auckland, Auckland, New Zealand 3 Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand Background: A recent trend in disease management research is the use of mobile technologies (mHealth) to deliver behaviour change interventions. The HEART trial examined the efficacy of a mHealth exercise-based cardiac rehabilitation (CR) intervention to increase exercise behaviour in adults with cardiovascular disease (CVD). This mixed methods study aimed to determine the usability and perceptions of the HEART trial. Methods: A six-month intervention aimed to increase exercise behaviour through a theory-based, personalised, automated package of text and video messages, delivered via participants’ mobile phones and a supporting website. To assess study perceptions, intervention participants completed a feedback survey and semi-structured exit interviews during their follow-up assessment. Results: At the end of the intervention period, 75 participants completed the feedback survey, and 17 participants were interviewed (median age = 60). Descriptive information from the survey data was merged with qualitative data, analysed using a general inductive approach, resulting in four overarching themes. (1) Participants were able to use the technology. (2) The messages were motivating and a good reminder to exercise regularly. (3) mHealth delivery was not for everyone. (4) The intervention could be improved by tailoring the content and delivery of the messages to suit their personal circumstances and to offer some personal contact. Conclusions: Older adults with CVD were able to use a mHealth program to receive exercise information and felt text messaging was a good way to deliver CR. While mHealth is designed to be automated, programs could be improved if content and delivery was tailored to individuals’ needs. http://dx.doi.org/10.1016/j.hlc.2013.04.048
ABSTRACTS
Heart, Lung and Circulation 2013;22:548–593