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Who Benefits Most from Assessment of Carotid Intima-media Thickness?
S6
Heart, Lung and Circulation 2010;19S:S1–S268
Abstracts
ABSTRACTS
It remains to be shown that better risk stratification and early intervention changes outcome in these risk groups. doi:10.1016/j.hlc.2010.06.677 Affiliate Nursing Finalists 11 Identifying Mild Cognitive Impairment—What is the Relationship with Self-care in Heart Failure Patients? J. Cameron 1,∗ , L. Worrall-Carter 1 , K. Page 1 , B. Riegel 2 , S. Stewart 3 Conclusion: RV size and EF assessment by 3D, RV FAC, TAPSE and MPI are reliable and produce results consistent with CMR. This will provide incremental information in the serial assessment of CHD patients. doi:10.1016/j.hlc.2010.06.676 10 Who Benefits Most from Assessment of Carotid Intimamedia Thickness? B. Haluska∗ , L. Jeffriess, T. Marwick University of Queensland School of Medicine, Australia Background: Pharmacologic risk reduction in pts with intermediate risk (1–2% per year) is controversial and carotid intima-medial thickness (IMT) has been proposed to guide treatment. We sought to define the outcomes of pts according to their IMT and risk. Methods: In 901 primary prevention pts (505 men; age 54 ± 12) with various degrees of CVD risk, IMT was measured offline in the far wall of the common carotid artery within 2 cm of the bifurcation in three planes. Clinical data were obtained by patient history and Framingham risk was calculated from risk data. Primary outcome was a composite of death or CV hospitalisation. Cox regression analysis was performed to determine correlates of outcome. Results: There were 45 deaths (5%) and 129 hospital admissions (14%) over 5 years. Mean IMT in low, intermediate- and high-risk groups were 0.61 ± 0.11, 0.67 ± 0.11 and 0.70 ± 0.12 mm (p < 0.0001). Independent clinical predictors of outcomes in the low risk group were age > 60 and DBP; in the intermediate risk group age > 60 and gender and in the high risk group DBP and DM. Addition of IMT significantly increased model power in the low (Chi sq 18.4 vs. 29.7; p = 0.01) and intermediate risk groups (Chi sq 24.4 vs. 28.4; p = 0.01), but not in the high risk group (Chi sq 14.5 vs. 14.6; p = NS). There were significant differences in event rate in all risk groups between patients having normal vs. high age corrected IMT; low 7% vs. 19%, intermed 11% vs. 29% and high 14% vs. 28% (all p < 0.0001). Conclusions: Carotid IMT offers incremental predictive value in low and intermediate risk Framingham patients.
1 St
Vincent’s/Australian Catholic University, Australia of Pennsylvania, United States 3 Baker IDI Heart and Diabetes Institute, Australia 2 University
Aims: Cognitive impairment occurs often in patients with chronic heart failure (CHF) and has been proposed to contribute to sub-optimal self-care. This study tests the impact cognitive impairment has on three aspects of selfcare: maintenance, management and confidence. Methods: Self-care (Self-Care of Heart Failure Index) was assessed in consecutively hospitalised CHF patients. Multiple regression analysis was used to test a model of variables hypothesised to predict self-care. Variables in the model were mild cognitive impairment (MCI) defined by scores below the threshold on both Mini Mental State Exam (scores < 27) and Montreal Cognitive Assessment (scores < 26), depressive symptoms (scores > 83 on the Cardiac Depression Scale), age, gender, social isolation, education level, new diagnosis (≤2 months) and co-morbid illnesses. Results: In this elderly group (M = 70 ± 11 years), 68 of 93 patients (73%) studied were identified as having MCI and had significantly lower self-care management (η2 0.07, p < 0.01) and self-confidence scores (η2 0.05, p < 0.05). In multivariate analysis, >2months since diagnosis was the most significant variable explaining 10% of the variance in self-care maintenance scores (F (1, 91) = 9.6, p < 0.01). In comparison MCI, co-morbidity index, NYHA class III or IV explained 20% of the variance in self-care management (p < 0.01); MCI had the largest contribution explaining 9% of the variance. Increasing age and symptoms of depression explained 13% of the variance in self-care confidence scores (p < 0.01). Conclusion: MCI, a hidden co-morbidity, may impede patients’ ability to make apt self-care decisions. Screening for MCI may alert health professionals to those at greater risk of sub-optimal self-care. doi:10.1016/j.hlc.2010.06.678
Heart, Lung and Circulation 2010;19S:S1–S268
Abstracts
ABSTRACTS
It remains to be shown that better risk stratification and early intervention changes outcome in these risk groups. doi:10.1016/j.hlc.2010.06.677 Affiliate Nursing Finalists 11 Identifying Mild Cognitive Impairment—What is the Relationship with Self-care in Heart Failure Patients? J. Cameron 1,∗ , L. Worrall-Carter 1 , K. Page 1 , B. Riegel 2 , S. Stewart 3 Conclusion: RV size and EF assessment by 3D, RV FAC, TAPSE and MPI are reliable and produce results consistent with CMR. This will provide incremental information in the serial assessment of CHD patients. doi:10.1016/j.hlc.2010.06.676 10 Who Benefits Most from Assessment of Carotid Intimamedia Thickness? B. Haluska∗ , L. Jeffriess, T. Marwick University of Queensland School of Medicine, Australia Background: Pharmacologic risk reduction in pts with intermediate risk (1–2% per year) is controversial and carotid intima-medial thickness (IMT) has been proposed to guide treatment. We sought to define the outcomes of pts according to their IMT and risk. Methods: In 901 primary prevention pts (505 men; age 54 ± 12) with various degrees of CVD risk, IMT was measured offline in the far wall of the common carotid artery within 2 cm of the bifurcation in three planes. Clinical data were obtained by patient history and Framingham risk was calculated from risk data. Primary outcome was a composite of death or CV hospitalisation. Cox regression analysis was performed to determine correlates of outcome. Results: There were 45 deaths (5%) and 129 hospital admissions (14%) over 5 years. Mean IMT in low, intermediate- and high-risk groups were 0.61 ± 0.11, 0.67 ± 0.11 and 0.70 ± 0.12 mm (p < 0.0001). Independent clinical predictors of outcomes in the low risk group were age > 60 and DBP; in the intermediate risk group age > 60 and gender and in the high risk group DBP and DM. Addition of IMT significantly increased model power in the low (Chi sq 18.4 vs. 29.7; p = 0.01) and intermediate risk groups (Chi sq 24.4 vs. 28.4; p = 0.01), but not in the high risk group (Chi sq 14.5 vs. 14.6; p = NS). There were significant differences in event rate in all risk groups between patients having normal vs. high age corrected IMT; low 7% vs. 19%, intermed 11% vs. 29% and high 14% vs. 28% (all p < 0.0001). Conclusions: Carotid IMT offers incremental predictive value in low and intermediate risk Framingham patients.
1 St
Vincent’s/Australian Catholic University, Australia of Pennsylvania, United States 3 Baker IDI Heart and Diabetes Institute, Australia 2 University
Aims: Cognitive impairment occurs often in patients with chronic heart failure (CHF) and has been proposed to contribute to sub-optimal self-care. This study tests the impact cognitive impairment has on three aspects of selfcare: maintenance, management and confidence. Methods: Self-care (Self-Care of Heart Failure Index) was assessed in consecutively hospitalised CHF patients. Multiple regression analysis was used to test a model of variables hypothesised to predict self-care. Variables in the model were mild cognitive impairment (MCI) defined by scores below the threshold on both Mini Mental State Exam (scores < 27) and Montreal Cognitive Assessment (scores < 26), depressive symptoms (scores > 83 on the Cardiac Depression Scale), age, gender, social isolation, education level, new diagnosis (≤2 months) and co-morbid illnesses. Results: In this elderly group (M = 70 ± 11 years), 68 of 93 patients (73%) studied were identified as having MCI and had significantly lower self-care management (η2 0.07, p < 0.01) and self-confidence scores (η2 0.05, p < 0.05). In multivariate analysis, >2months since diagnosis was the most significant variable explaining 10% of the variance in self-care maintenance scores (F (1, 91) = 9.6, p < 0.01). In comparison MCI, co-morbidity index, NYHA class III or IV explained 20% of the variance in self-care management (p < 0.01); MCI had the largest contribution explaining 9% of the variance. Increasing age and symptoms of depression explained 13% of the variance in self-care confidence scores (p < 0.01). Conclusion: MCI, a hidden co-morbidity, may impede patients’ ability to make apt self-care decisions. Screening for MCI may alert health professionals to those at greater risk of sub-optimal self-care. doi:10.1016/j.hlc.2010.06.678