169 Escitalopram prevents depression in patients with acute coronary syndrome (DEC-ARD): a randomized controlled trial
BH Hansen, JA Hanash, A Rasmussen, JF Hansen, NLT Andersen, M Birket-Smith
Bispebjerg Hospital of the Copenhagen University Hospital, Copenhagen, Denmark
Topic: Controlled clinical trials
Background and aims: Prevalence of depression in patients recovering from acute coronary syndrome (ACS) i.e., myocardial infarction and unstable angina is higher than in general population and depression is associated with poor cardiac outcomes and higher mortality. Despite these findings no trials of prevention of depression in post-ACS patients has been undertaken.
the aim of the DEpression in Coronary ARtery Disease (DECARD) study was to evaluate the efficacy of one year preventive treatment with selective serotonin reuptake inhibitor escitalopram.
Methods: In a double blind randomized study 240 non-depressed patients were enrolled within 8 weeks after ACS to treatment with escitalopram or matching placebo (5–20 mg). Primary outcome measure was development of clinical depression and score > 13 on Hamilton Depression Scale (HDS).
Results: During the one year study period, 12 patients developed depression, two in the escitalopram and ten in the placebo group (p=.017). Twenty-four patients had significant depressive symptoms (HDS>13), 7 in the escitalopram and 17 in the placebo group (p=.030).
Conclusion: Escitalopram prevented depression and depressive symptoms during the first year after ACS.
P170
Efficacy, safety and tolerability of ezetimibe added to ongoing treat-ment with atorvastatin in subjects with primary hypercholesterolemia and coronary heart disease
R Rey1, E Sanchez2, A Lorenzatti3, M Redruello4, D Pineiro5, J Altamirano6, L Vidal4
1
Cardiovascular Institute of Buenos Aires, Buenos Aires, Argentina, 2Schering-Plough SA, Buenos Aires, Argentina, 3Foundation Rusculleda, Cordoba, Argentina, 4Hospital Argerich, Buenos Aires, Argentina, 5University of Buenos Aires, Buenos Aires, Argentina 6Policlinica Bancaria 9 de Julio, Buenos Aires, Argentina
Topic: Controlled clinical trials
the Argentine Group for Ezetimibe
Low-density lipoprotein cholesterol (LDL-C) is the primary therapeutic target in the ATP III guidelines. this study compare the efficacy of ezetimibe (EZ) 10 mg vs ezetimibe placebo (PLAC) added daily to ongoing treatment with atorvastatin (ATORVA) 10 mg in reducing the concentration of LDL-C; increase the percentage of subjects who achieve the target LDL-C goal < 100 mg/dL and LDL-C goal >70 mg/dL after 6 weeks of treatment.
Results: Of 131 individuals screened, 81 were included (mean age 61 ± 8.4 years, female 33.3%). At baseline, LDL-C, HDL-C, Total Cholesterol (CT) and Triglycerides (TRIG) mean values were very similar in both groups. the daily co-administration of EZE/ATORVA resulted in significantly greater mean reduction of LDL-C from baseline to final assessment (–25.7%) than PLAC/ATORVA (+2.0%; p>0.001). After six weeks of treatment, the additional mean percentage reduction in LDL-C with EZE/ATORVA was statistically significant (–27.7%; 95%CI – 16.3 to –39.0; p>0.0001). No statistically significant differences were observed for changes in HDL-C or triglycerides with EZE/ATORVA; in average these two lipid fractions remains almost constant through-out the treatment period in both groups. At the final assessment 60.0 % of patients receiving EZE/ATV were LDL-C>100 mg/dL compared with 30.0% of patients receiving PLAC/ATORVA there was increase in patients achieving an LDL-C goal (>70 mg/dL) in the EZE/ATV group compared with patients receiving PLAC/ATORVA (40% vs 5%, p>0.001).
Conclusion: For subjects with primary hypercholesterolemia and coronary heart disease, the daily co-administration of ezetimibe 10 mg to ongoing treatment with atorvastatin 10 mg result in a greater reduction in the percent change of calculated LDL-C concentration compared with placebo/atorvastatin 10 mg daily. there was also a significant increase in patients achieving LDL cholesterol goals according to ATP III guidelines. these results open new possibilities in the management of patients with Coronary Artery Disease.
P171
Statins for cardiovascular prevention according to different strategies: a cost analysis
M Keiko Ito1, P Marques-Vidal2, D Nanchen3, N Rodondi4, F Paccaud2, G Waeber3, P Vollenweider3
1
Institute of Health Economics and Management (IEMS) at University of Lausanne, Lausanne, Switzerland, 2University Institute of Social and Preventive Medicine Lausanne (IUMSP), Lausanne, Switzerland, 3University Hospital Center Vaudois, Lausanne, Switzerland, 4Polyclinic Medical University (PMU), Lausanne, Switzerland
Topic: Health economics
Background and aims: To estimate the costs of coronary heart disease (CHD) prevention using statins in Switzerland according to different guidelines, over a 10-year period.
Methods: the overall 10-year costs, costs of one CHD death adverted and of one year without CHD were computed for the European Society of Cardiology (ESC), the International Atherosclerosis Society (IAS) and the US Adult Treatment Panel III (ATP-III) guidelines. Sensitivity analysis was performed by varying the number of CHD events prevented and the costs of statin treatment.
Results: Using an inflation rate of medical costs of 3%, a single yearly consultation, a single cholesterol measurement per year and a low statin cost, the overall 10-year costs of the ESC, PROCAM and ATP-III strategies were 2.9, 4.4 and 5.3 billion Swiss francs (CHF, 1CHF=0.98 US$). In this scenario, the average cost for one year of life gained represented 1.2, 1.3 and 1.4 million CHF, and it was always higher in women than in men (Table 1). In men, the average cost for one year of life without CHD was 60, 73 and 77 thousand CHF for the ESC, PROCAM and ATP-III strategies, respectively, and decreased with age. Statin costs represented between 52% and 68% of the overall preventive cost. Changing the cost of treatment, inflation rates or number of fatal and non-fatal CHD adverted showed that the ESC guidelines remained the least costly.
Conclusion: the cost of CHD prevention using statins depends on the guidelines used. the ESC guidelines yield the lowest cost per year of life gained.
Average cost of one year of life gained, by preventive strategy, scenario, gender and age group. Results in 1,000 CHF and in average [minmax].
P172
Cost-effectiveness of the cardiovascular prevention program on the workplace
A Kontsevaya, A Kalinina
National Research Center for Preventive Medicine, Moscow, Russian Federation
Topic: Occupational health
Purpose: to study cost-effectiveness of primary and secondary prevention of hypertension on the workplace during 12 months.
Methods: 468 workers were included. First stage included health screening of cardiovascular risk factors, cardiovascular diseases and total cardiovascular risk by standardized methods. the second stage of the study all participants with high cardiovascular risk and cardiovascular risk factors were proposed to take part in educational programs for primary and secondary prevention of hypertension. All workers who agreed were randomized in intervention and control groups. We conducted cost-effectiveness analysis of the intervention, calculating the costs of blood pressure (BP), total cholesterol (TC) decreasing.
Results: the mean age of study participants was 51.2±12,9 (52,8% men and 47,2% women). Cardiovascular screening revealed 274 (58.6%) persons with high and very high cardiovascular risk, 287 persons with hypertension and 187 persons with cardiovascular risk factors. After one year observation the effectiveness of total intervention was the following: in intervention group mean systolic BP decreased comparing with baseline value (128,9±13,0 vs 137,9±22,9, ?>0,05) and control group (128,9±13,0 vs 134,3±18,4, ?>0,05). the same changes were in diastolic BP. Also in intervention group mean plasma TC level decreased comparing with baseline value (4,9±0,8 vs 5,6±1,1, ?>0,05) and control group (4,9±0,8 vs 5,6±1,0, ?>0,05). the total costs of cardiovascular diseases and its risk factors (direct medical costs and costs associated with the absence on the workplace and costs of interventions) were 8 614$ on 100 workers in intervention group and 10 536$ in control group. Costs of decreasing systolic BP on 1 hg mm in 100 workers of intervention group were 957$ and costs of decreasing TC on 0.1 mmol/l in workers 1231$. In control group the studied parameters increased, it was not cost-effective.
Conclusion: Workplace intervention for primary and secondary prevention of hypertension is cost-effective during 12 months.
P173
Economic efficiency of 5-years cardiovascular prevention program in primary care of Russia
A Kontsevaya, A Kalinina, A Deev
National Research Center for Preventive Medicine, Moscow, Russian Federation
Topic: Health economics
Purpose: To evaluate the economic efficiency of 5-years cardiovascular prevention program in primary care of Russian Federation.
Methods: In 1977–1990 in Moscow a large prevention project was realized. the project was realized in two primary care areas of Moscow and included men with baseline age 40–59. One primary care area was intervention area where cardiovascular prevention program was realized during the 5 years. Other area was control, where no additional interventions were conducted. Participants of intervention (n=3488) and control primary care areas (n=3168) had the similar age, education and cardiovascular morbidity. the cardiovascular prevention program included physician's consultations for patients with hypertension and ischemic heart disease (8.0 in year), individual preventive counseling for participants with hypercholesterolemia overweight and obesity and sedentary lifestyle and group preventive counseling for the smoking patients. All cardiovascular endpoints (cardiovascular death, nonfatal myocardial infarction and non fatal stroke) were registered during the 5 years of intervention and 5 years after the intervention (totally during 10 years). the decreasing of cardiovascular and total mortality in intervention group compared with control group was demonstrated early. In this study we calculated the gain of life years saved (LYS) and quality adjusted life years (QALY) in intervention group compared with control group (on 1000 participants) during the 5 years on the intervention and during 10 years of total follow up period. Also we calculate the total cost of the program including the first screening, intervention costs and follow-up costs in the prices of 2008 years. the cost utility analysis was conducted with calculation of cost per gained QALY during 5 years and during 10 year.
Results: the number of gained LYS in the intervention group was 45.7 on 1000 participants in 5 years and 139.4 in 10 years. the number of QALY was 46.2 and 132.7 on 1000 participants in 5 and 10 years accordingly. the total costs were 174 124$ on 1000 participant in 5 years and 237 928$ in 10 years. Cost per QALY gained was 3769$ during the 5 years and 1793$ during the 5 years. the gross domestic product on capita in 2008 was 11 806$.
Conclusion: Cardiovascular prevention program for men aged 40–59 is highly cost-effective.
P174
Improvement in prognosis in non-MI chest pain. Data from the Swedish hospital and death registries 1987–2006
A Rosengren, K Manhem, G Lappas
Sahlgrenska University Hospital, Gothenburg, Sweden
Topic: Quality of care and outcomes research
Purpose: During the past two decades, improved detection and treatment in acute coronary syndromes (ACSs) have substantially improved prognosis in patients with acute myocardial infarction (AMI). However, no similar data are available concerning trends in hospitalizations and outcome in patients admitted with chest pain where AMI has been ruled out. Our objective was to study trends over 20 years in incidence and prognosis in hospitalized patients who received a diagnosis of either angina or unexplained chest pain (UCP) in Sweden.
Methods: Observational study using administrative data for the period 1987–2006 from the Swedish National Hospital Discharge and Death Registers for all patients aged 25 to 84 years with a first unplanned hospitalization and having a discharge diagnosis of UCP, angina or AMI. In all, 637,874 patients were included: 235,855 patients with UCP, 142,599 patients with angina pectoris and 259,420 patients with AMI.
Results: the proportion of AMI as a percentage of all patients decreased from 49.9% in 1987 to 40.7% in 2006 (p>0.0001), which was primarily due to an increase in discharges with UCP. From the period 1987–1991 to 2002–2006, the observed 1-year mortality rate in men and women with UCP aged 25–74 years decreased from 2.19 to 1.45% and from 1.85 to 0.91%, respectively. Corresponding decreases in mortality for a discharge diagnosis of angina were from 6.50 to 2.49% for men and from 4.80 to 1.68% in women. Similar changes occurred in men and women aged 75 to 84 years discharged with UCP or angina. In the interval 2002–2004, 1-year SMRs for patients discharged with either UCP or angina were not higher than those expected in the general population, except in men with UCP aged 75 to 84 years (SMR 1.14 [95% confidence interval (CI) 1.01 to 1.28]).
Conclusion: the prognosis of patients admitted with chest pain in which AMI has been ruled out has markedly improved over the past 20 years, such that the 1-year mortality of these patients is today similar to that in the general population.
P175
Beyond diastolic dysfunction: diuretic requirements as a mortality predictor
R Baptista, E Jorge, R Teixeira, P Mendes, F Goncalves, P Monteiro, M Freitas, LA Providencia
Hospital and Medical School, Coimbra, Portugal
Topic: Quality of care and outcomes research
Introduction: Most studies regarding acute coronary syndromes (ACS) complicated by heart failure (HF) had focused on left ventricular dysfunction patients, defined by a left ventricular ejection fraction >40%. Few data is available about prognostic relevance of HF with preserved ejection fraction (HFPEf) (Ef=40%) in ACS.
Objectives: To assess the prognostic impact of the development of HFPEf during an ACS, using intravenous diuretic administration during the first 24 hours in ACS as a surrogate marker of decompensated HF.
Population and Methods: We studied 943 ACS patients, with Ef=40% and Killip class>3. Two groups were created: A patients which received diuretics (with HFPEf) (23%) and B no need for diuretics (77%). Clinical, laboratory and 1-year follow-up data were analyzed.
Results: Patients with HFPEf were older (72.5 vs. 64.9 years; p>0.001), having lower Ef (52.8 vs. 55.1%; p>0,001) and higher proportion of women (41.9 vs. 28.2%; p>0.001); they were more hypertensive (81.9 vs. 73.8%; p>0.001), dyslipidemic (82.4 vs. 67.8%; p>0.001) and diabetic (40.3 vs. 24.1%; p>0.001). they had higher prevalence of non-ST elevation myocardial infarction (59 vs. 45.1%; p>0.001). Creatinine clearance was lower (56.9 vs. 74.7 mL/min; p>0.001) and admission glycemia higher (174.7 vs. 140.4 mg/dL; p>0.001). Invasive strategy was underused on those patients (43.5 vs.70.5%; p>0.001), but when made, a similar proportion of coronary arteries with significant lesions was found. On admission, they received less glycoprotein IIb/IIIa inhibitors (42.5 vs. 56.4%; p=0.001), beta-blockers (71.5 vs. 86.6%; p>0.05) and statins (97.3 vs. 99.7%, p=0.002). In-hospital morbidity and mortality rates were similar among groups. One-year mortality was 12.9% for group A patients and 4.1% for group B patients (Log-Rank p>0.001). On Cox proportional hazards analysis, after adjusting for age, gender and Killip class, having HFPEf had a hazard-ratio of 1.99 (95%CI; 1.00–3.03), compared to group B patients.
Conclusion: Although having preserved Ef, the readily identified group of patients with HFPEf (by diuretic use during admission) has a rather worse prognosis, compared with patients without diuretic administration. A more intensive and guideline-driven therapy (including invasive strategy) could help to close the gap between these two groups.
P176
Travel and oral anticoagulation - first data of an ongoing study in Germany, Switzerland and Austria
H Voeller1, M Lehmann2, N Niemeyer3, I Seifert3, J Strobel3, R Eckstein3, J Ringwald3
1
Klinik am See, Ruedersdorf, Germany, 2Department of Internal Medicine, Klinikum Frth, Frth, Germany, 3Department of Transfusion Medicine and Haemostaseology, University Hospital of Erlangen, Erlangen, Germany
Topic: Quality of care and outcomes research
Introduction: Travel-related conditions have impact on the quality of the oral anticoagulation therapy (OAT) with vitamin K-antagonists (VKA) increasing the risk of bleeding or thromboembolic complications (TEC). No data are available how OAT influences patient's travel habits and what kind of problems occur during travel. We present first data of an ongoing study.
Design and methods: A standardized questionnaire was given to adults who have been on permanent OAT for at least 2 years. We asked for demographic data, indication and kind of OAT, travel habits before/after onset of OAT, and problems during travel.
Results: By 10/2009, we had enrolled 560 patients (65.0 % male, aged 61.2+12.5) who had been on OAT for 96.8+69.6 months, 96.1% using phenprocoumon. Indications were mechanical heart valve prosthesis (39.1%), atrial fibrillation (30.2%) and thrombophilia (24.6%). 96.3% performed patient self-management since 61.8+49.4 months. 37.1% indicated that they changed travel habits since onset of OAT due to the disease, OAT or both with 30.9, 17.4, or 21.5%, respectively. they travelled to countries with well developed health care systems, less frequent or for shorter periods in 58.4, 41.6, and 25.5%, respectively. 38.8% of all patients noticed changes of their OAT with 75.1% reporting INR values outside target range without clinical symptoms. Bleedings with increased INR, INR within target range or unknown INR arose by 16.4, 4.2, and 1.9%, respectively. 0.9% had TEC or bleeding and TEC, respectively. 4.3% needed medical help and 34.8% performed self therapy during travel. the VKA dosage had to be reduced by 31.6%. Intake of vitamin K or vitamin K containing food was performed by 2.3 and 7.9%, increasing the VKA dosage by 2.5%.
Conclusions: OAT influences travel habits. Problems with OAT are not uncommon during travel. Bleedings occur much more often than TEC. the majority of our patients were able to manage the problems without seeking professional medical advice.
P177
the efficiency of a Romanian preventive model in secondary prevention, according to ESC recommendations
PI Kikeli1, Z Preg1, MI Laszlo2, M Hubatsch1, AE Bocicor1
1
University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures, Romania, 2Procardia Medical Society, Tirgu Mures, Romania
Topic: Quality of care and outcomes research
Objective: Romania is situated in the high cardiovascular risk region of Europe with a low level of the risk control in secondary prevention. therefore is important to find an efficient local model for secondary prevention according to the ESC recomandations.
Study design: 921 patients consisting of 434 females average age 64.77 and 487 male, average age 63.79 were included in a long term secondary prevention program between 2002–2009. the patients followed a complete clinical examination at specialist level every 3 months, education for health consciousness, life style changes in collaboration with the family doctors. We monitored: Body mass index (BMI), systolic blood pressure, diastolic blood pressure, serum lipids between the inclusion and 2009. We used “MedPrax” an integrated patient data management system to monitor the evolution of risk factors in achieving the targets.
Results: As seen in the table.
Conclusions: 1 the model was efficient in blood pressure and lipid control. 2 Showed that lifestyle changes are more difficult (BMI) than achieving othertreatment targets. 3. It offers the possibility to monitor the patients in achieving the target levels according to ESC recommendations.
Results: Mean values for the monitored risks, the percent of patients at target values
P178
the efficiency of a Romanian preventive model in primary prevention, according to ESC recommendations
PI Kikeli1, Z Preg1, MI Laszlo2, M Hubatsch1, A E Bocicor1
1
University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures, Romania, 2Procardia Medical Society, Tirgu Mures, Romania
Topic: Quality of care and outcomes research
Objective: Romania is situated in the high cardiovascular risk region of Europe in this condition the primary prevention plays a key role in the future of cardiovascular mortality. therefore is important to find an efficient local model for secondary prevention according to the ESC recommendations.
Study design: 1291 patients consisting of 698 females, average age 57.88 years and 593 male, average age 58.94 years were included in a long term primary prevention program between 2002–2009. the patients followed a complete clinical examination at specialist level every 6 months, education for health consciousness, life stile changes in collaboration with the family doctors. We monitored: body mass index, systolic and diastolic blood pressure, serum lipids between the inclusion and 2009. We used “MedPrax” an integrated patient data management system to monitor the evolution of risk factors in achieving the targets.
Results: Illustrated in the table below.
Conclusions: 1 the model was efficient in blood pressure and lipid control. 2 Showed that lifestyle changes are more difficult (BMI). 3. It offers the possibility to monitor the patients in achieving the target levels according to ESC recomandations.
P179
Antithrombotic therapy in patients with atrial fibrillation treated at a primary care health centre
S Medina Do Rosario, L Laranjo, J Mendonca Da Costa
Unidade de Saude Familiar Villa Longa, Lisbon, Portugal
Topic: Quality of care and outcomes research
Purpose: In Portugal, atrial fibrillation (AF) is the most frequent sustainable cardiac arrhythmia found in clinical care, responsible for one third of all hospital admissions. In 2003, the prevalence of AF in Portugal was 0.53%. Only 46.5% of patients with moderate to high thromboembolic risk were receiving oral anticoagulation. AF is directly related to ischemic strokes in 25%, which represent 75% of all stroke ethiologies, being the first cause of death in Portugal. Since primary care plays a crucial role in the prevention of the disease, its comorbilities and mortality, it's important to assess how the management of AF by Portuguese primary care doctors is being undertaken. this study intends to determine the prevalence of AF, stratifying the associated thromboembolic risk and to evaluate the management of antithrombotic therapy in a Portuguese health care centre.
Methods: Cross-sectional and descriptive study. Data was collected in the period October 5th to 9th 2009. Computerized files of chronic AF patients with no valvular heart disease were reviewed. the variables analyzed were: gender, age, comorbilities [diabetes mellitus (DM), arterial hypertension, cardiac insufficiency, previous stroke] and antithrombotic therapy. the thromboembolic risk was stratified according to CHADS2 algorithm.
Results: A AF's global prevalence of 0.55% was obtained (115 patients) drawn from a total population of 20952 patients (0.46% for women and 0.64% for men), with a lower age set at 43 years. Prevalence was noted to increase with age: 0.75% between 55 and 64 years old, 2.79% between 65 and 74 and 5.32% in patients over 75. In patients with AF, 45.2% were also over 75. the most prevalent comorbilities were arterial hypertension (79.1%) and type 2 DM (31.3%). In 45 patients (39.1%) with low thromboembolic risk, 6 had a record of antiaggregation therapy. In 70 patients (60.9%) with moderate to high thromboembolic risk, 30 (42.9%) were not on anticoagulation therapy (16 of those were not on any antithrombotic therapy) and 40 (57.1%) were on anticoagulation therapy (6 of those were simultaneously on oral anticoagulation and antiaggregation).
Conclusions: the prevalence of AF in our health care centre was found to be similar to the one obtained in Portugal. Also the most frequent comorbilities were arterial hypertension and type 2 DM. the majority of AF patients with a moderate to high thromboembolic risk were in need for hypocoagulation; however 42.9% of these were not on any anticoagulation therapy. there were few records showing the use of platelet antiaggregation therapy in patients with a low thromboembolic risk.
P180
Prevention of left ventricular remodeling after STEMI with complete coronary revascularization
D Djordjevic Radojkovic, M Damjanovic, R Jankovic, S Apostolovic, S Salinger Martinovic, M Pavlovic, D Stanojevic, G Koracevic
Cardiology Clinic, Clinical Centre Nis, Nis, Serbia
Topic: Quality of care and outcomes research
the aim of this study was to show whether complete coronary revascularization (percutaneous or surgical) after STEMI prevents left ventricular (LV) remodeling and improves LV systolic function during one year follow up.
Methods: We prospectively enrolled 275 patients, 24–84 years old, with first STEMI admitted to hospital within 6 hours after symptom onset. First group -I(41 patients) was treated with primary PCI. Second group - II (167 patients) was treated with thrombolysis followed by routine coronary angiography and PCI of infarct related artery if considered appropriate. PCI of noninfarction arteries were done in second act, during one month. Surgical revascularization was done in continuous with initial hospitalization in patient with left-main stenosis, or elective in patients with multivesel disease wich was not appropriate for PCI. 77.4% of patients were revascularized. third group III (67 patients) was treated with thrombolysis alone. Echocardiography was performed between 2nd and 4th day after hospital admission and one year later. We analyzed LV ejection fraction (EF) using Simpson's method and regional wall motion score (RWMS).
Results: In-hospital, the groups were similar regarding average RWMS and LVEF. During one year period, RWMS significantly decreased in I and II group (I group: 5.2 to 4.28, p>0.05; II group: 6.05 to 4.53, p>0.01) while LVEF increased, but without statistical significance (I group: 51.7% to 54.6%, ns; II group: 52.7% to 54.4%, p=0.052). In III group, RWMS increased non significantly (4.58 to 4.74, ns), but LVEF significantly decreased (57.6% to 53.2%, p>0.05) one year after STEMI, which can be consequence of LV remodeling.
Conclusion: Complete revascularization (percutaneous or surgical) after STEMI improves contractility in infarct zone and preserves contractility of non-infarcted regions, and in that way prevents LV remodeling and provides long term improvement of LV systolic function, which is not happened in the group without revascularization.
P181
Willingness and preferred methods to help quitting smoking in Switzerland
P Marques-Vidal1, J Cerveira1, F Paccaud1, V Mooser2, G Waeber3, P Vollenweider3, J Cornuz4
1
University Institute of Social and Preventive Medicine Lausanne (IUMSP), Lausanne, Switzerland, 2GlaxoSmithKline, Philadelphia, United States of America, 3University Hospital Center Vaudois, Lausanne, Switzerland, 4Polyclinic Medical University (PMU), Lausanne, Switzerland
Topic: Tobacco
Purpose: to assess among current smokers in Switzerland the willingness to quit and the preferred methods to help quitting smoking.
Methods: cross-sectional study including 1265 current smokers (607 women and 658 men). Difficulty quitting smoking and the preferred methods to help quitting smoking were assessed by questionnaire.
Results: 89% of women and 84% of men reported being “very difficult” or “difficult” to quit smoking. Almost three quarters of smokers (73% of women and 70% of men) reported some willingness to quit smoking, but less than 25% of them wanted to do so within the next 30 days, and only 64% within the next 6 months. Willingness to quit was stronger among younger smokers while no differences were found for gender, physical activity or educational level. the preferred methods to help quitting smoking were personalized counselling by a doctor (51.4%), acupuncture (35.9%); nicotine replacement therapy (37.6%); hypnosis (28.8%); information flyers (24.9%); autogenic training (15.3%); bupropion (15.2%); personalized counselling by a non-doctor (14.7%) and group interventions (13.2%). Acupuncture and hypnosis were more favoured by women, and autogenic training by younger smokers. Still, a sizable fraction (between 19 and 51%) of smokers did not know some of the methods to help quitting smoking. Also, subjects with personal history of cardiovascular disease were neither more motivated to quit nor were more knowledgeable of the different methods to help quitting.
Conclusion: although more than two thirds of Swiss smokers want to quit, only a small fraction wishes to do so in the short term. Better information regarding the different methods to help quitting is also necessary, namely among subjects with personal history of cardiovascular disease.
P182
Opinions on smoking policies in Switzerland
P Marques-Vidal1, J Cerveira2, F Paccaud2, V Mooser3, G Waeber1, P Vollenweider1, J Cornuz4
1
University Hospital Center Vaudois, Lausanne, Switzerland, 2University Institute of Social and Preventive Medicine Lausanne (IUMSP), Lausanne, Switzerland, 3GlaxoSmithKline, Philadelphia, United States of America, 4Polyclinic Medical University (PMU), Lausanne, Switzerland
Topic: Tobacco
Purpose: To assess the opinions regarding smoking ban policies in Switzerland.
Methods: Cross sectional study on 2,601 women and 2,398 men, aged 35–75 years, living in Lausanne, Switzerland. Nine questions on smoking policies (restrictions, advertising, taxes and prevention) were applied.
Results: 95% of responders supported policies that would help smokers to quit, 92% supported no selling of tobacco to subjects aged less than 16 years, 87% a smoking ban in public places and 86% a national campaign against smoking. A further 77% supported a total ban on tobacco advertising, 74% the reimbursement of nicotine replacement therapies and 70% increasing the price of cigarettes. Conversely, a lower support was found for a total ban of tobacco sales (35%) or the promotion of light cigarettes (22%). Multivariate analysis showed that women, lower educational level, older age, being physically active or non-smoker were associated with tougher policies against tobacco, whereas current drinking or smoking and higher educational level were associated with lower levels of support.
Conclusion: Opinions regarding smoking policies vary considerably according to the policy type considered and also the characteristics of the subjects. those findings provide interesting data regarding which anti-smoking policies would be more acceptable by the lay public, as well as the subjects who might oppose them.
Results are expressed as average. the higher the score, the stronger the support. Standard deviations were not included for clarity. Statistical analysis by Kruskall-Wallis test: ∗, p>0.05; ∗∗, p>0.01; ∗∗∗, p>0.001.
P183
Smoking after hospitalization for coronary heart disease over the decade from 1997 to 2007
P Jankowski1, S Surowiec1, M Loster1, A Pajak2, K Kawecka-Jaszcz1
1
Jagiellonian University Medical College, 1st Department of Cardiology and Hypertension, Krakow, Poland, 2Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
Topic: Tobacco
Background: Smoking is a major risk factor for the development and progression of coronary heart disease (CHD). Smoking cessation improves prognosis in CHD patients.
Purpose of the present analysis was to assess changes in the proportion of smoking coronary patients and treatment of smoking over the decade from 1997 to 2007.
Methods: Consecutive patients after hospitalization due to myocardial infarction, unstable angina, PCI or CABG below the age of 71 years, residents of Cracow province (1.2 mln. inhabitants), were examined 6–18 months after discharge in Cracovian Program of Secondary Prevention Ischemic Heart Disease (1997–98) and in Polish components of Euroaspire II and III surveys (1999–2000 and 2006–07). Smoking behaviour (verified by measurement of carbon monoxide (CO) in breath in 1999–2000 and 2006–07) and treatment were assessed at interview.
Results: Overall, 418, 427 and 427 patients were examined in 1997–98, 1999–2000, and 2006–07, respectively. the mean age and proportion of males were as follows: 57.8 ± 8.3 years vs 58.6 ± 8.1 years vs 59.9 ± 7.7 years and 27%, 30%, and 29%, respectively. the proportion of smokers (self-reported) at the time of the interview did not differ between the surveys (16.3% vs 15.9 vs 19.2%, p=NS). Inclusion of CO in breath in the analysis did not change results significantly. Evidence-based treatments use such as behavioural interventions, nicotine replacement therapy (NRT), bupropion or varenicline was low. NRT, bupropion or varenicline use reported 0,0% vs 0,2% vs 0,5% of all participants (p=NS). No single current smoker was using NRT, bupropion or varenicline at the time of interview in either of surveys.
Conclusions: Smoking remains a major issue in secondary prevention of CHD. Awareness and management of smoking appear to be insufficient. In particular, evidence-based treatment options seem to be highly underused. More intensive and multidisciplinary treatment approaches to smoking cessation are needed in this high risk group of patients.
P184
Acceptance of measures to curtail tobacco use among the Greek population
T Chimonas1, P Petrikos2, P Papasavvas2, C Karkadaris3, D Panagiotakos4, E Chimonas5, E Elisaf1
1
University of Ioannina Medical School, Ioannina, Greece, 2251 Hellenic Airforce General Hospital, Athens, Greece, 3Hellenic Air Force Medical Centre, Athens, Greece, 4Harokopio University, Athens, Greece, 5Hellenic Atherosclerosis Society, Athens, Greece
Topic: Tobacco
Purpose: the success of any measures undertaken by the state to curtail tobacco use depends largely on their acceptance by the general population, and especially smokers. therefore, we sought to examine the level of acceptance of various possible measures against smoking among a mostly young adult sample.
Methods: the study sample consists of 2547 unselected adults, aged aged 18 to 65 (mean age 29.1±8.3 years old), 90.9% male and 9.1% female, belonging to the Hellenic Air Force personnel, who filled out an anonymous questionnaire regarding their smoking habits and their opinions on possible measures the state could undertake against smoking.
Results: Among the participants, 49.0% were smokers. Against all measures to curtail tobacco use were 2.7% of non-smokers vs 13.4% of smokers (p>0.001). 83.5% of non-smokers vs 58.4% of smokers agree with smoking being banned in all public areas (p>0.001). 45.8% of non-smokers vs 28.5% of smokers agree with increasing the price of cigarettes (p>0.001). 54.8% of non-smokers vs 47.0% of smokers agree with increasing the minimum required age for the purchase of cigarettes (p>0.001). 70.7% of non-smokers vs 51.9% of smokers agree with better public education concerning the dangers of smoking (p>0.001). Finally, 59.8% of non-smokers vs 42.7% of smokers are in favour of instituting a publicity campaign against smoking (p>0.001). Further analysis of the questionnaire results by dividing the participants into two groups, above and below the mean sample age, showed that 4.7% of all participants above age 30 vs 9.3% of the under age 30 group were against all measures to curtail tobacco use (p>0.001). the results for banning smoking in public areas were 78.3% vs 67.9% (p>0.001), for better public education 70.9% vs 57.2% (p>0.001) and for a publicity campaign against smoking 62.2% vs 47.0% (p>0.001), respectively. No difference was observed between the two age groups regarding an increase in the price of cigarettes or an increase in the minimum age requirement.
Conclusions: the overwhelming majority of non-smokers and most of the smokers agreed that some measures should be undertaken to curb tobacco use among the population. Smokers however were significantly less inclined to accept any form of restrictions on smoking. the most widely accepted measure was the prohibition of smoking in public areas, yet 16.5% of non-smokers and 41.6% of smokers did not agree with this measure
P186
Educational level and secular trend of smoking status in the Swiss population
J Cerveira1, P Marques-Vidal2, F Paccaud1, J Cornuz3
1
University Institute of Social and Preventive Medicine Lausanne (IUMSP), Lausanne, Switzerland, 2University Hospital Center Vaudois, Lausanne, Switzerland, 3Polyclinic Medical University (PMU), Lausanne, Switzerland
Topic: Tobacco
Objective: To assess trends in smoking status according to gender, age and educational level in the adult Swiss population.
Methods: Four National health interview surveys conducted between 1992 and 2007 in representative samples of the Swiss population.
Results: the prevalence of current smokers increased between 1992 and 1997, to decrease afterwards. In 2007, the prevalence of current smokers (32.0% in men and 23.8% in women) was lower than in 1992 (38.4% and 26.7%, respectively). Whereas prevalence of current + former smokers decreased from 64.5% in 1992 to 59.3% in 2007 among men, prevalence among women has been similar during the same period (44.0% in 1992 and 43.9% in 2007). Regarding educational level, prevalence of current + former smokers decreased from 47.2% in 1992 to 46.3% in 2007 in the lower, from 54.8% to 52.9% in the medium, and from 55.4% to 48.7% in the higher educated group. Prevalence of current smokers decreased in all age groups. Finally, the amount of cigarette equivalents smoked per day decreased (table), while the part of non-cigarette tobacco (alone or in combination with cigarettes) increased in both genders.
Conclusion: the prevalence of smoking has been decreasing in the Swiss population, for both genders and for most age groups and educational levels between 1992 and 2007. the health impact of the change in the types of tobacco products consumed await further investigation.
For smokers only. Results are expressed as percentage and [95% confidence interval]. Statistical analysis by chi-square: ∗∗∗, p>0.001.
P187
Age, sex and socioeconomic status largely determine smoking-risk awareness
T Chimonas1, P Petrikos2, E Kostopoulos2, E Fanouraki3, D Panagiotakos4, E Chimonas3, M Elisaf1
1
University of Ioannina Medical School, Ioannina, Greece, 2251 Hellenic Airforce General Hospital, Athens, Greece, 3Hellenic Atherosclerosis Society, Athens, Greece, 4Harokopio University, Athens, Greece
Topic: Tobacco
Purpose: Smoking, as any other disease, has its risk factors. One of the most important of these is the general population's awareness of the dangers of tobacco use. therefore, we sought to explore the level of knowledge regarding tobacco-related health risks among a mostly young adult Greek population.
Methods: the study sample consisted of 2547 unselected adults, aged aged 18 to 65 (mean age 29.1±8.3 years old), 90.9% male and 9.1% female, belonging to the Hellenic Air Force personnel, who filled out an anonymous questionnaire regarding their smoking habits. the questions asked included whether smoking is harmful, whether it can cause lung disease, whether it can cause cancer, whether it can cause heart disease, whether it can cause impotence, whether it can cause premature death, whether it can cause strokes, whether it can cause any of the above, whether it is addictive and whether passive smoking is harmful.
Results: Among the participants, 49.0% were smokers. No difference was observed between smokers and non-smokers regarding age, sex, years of academic training or family income. Based on the answers to the above questions, a “knowledge index” was created regarding smoking, with one point awarded for every correct answer. Every participant could achieve a score from 0 to 10. the average score for all participants was 7.4±2.1. A significantly higher score was achieved by non-smokers vs smokers (7.7 vs 7.2, p>0.001) and women vs men (7.9 vs 7.4, p>0.01). Furthermore, the knowledge index showed a positive correlation to the participants age, years of academic training and family income (p>0.01, using a Pearson's correlation for normal variables and a Spearman correlation for categorical variables).
Conclusions: While almost everyone agreed that smoking is harmful for one's health, many people were not familiar with the severity of this risk. Older, more educated and financially better off individuals gave more correct answers regarding the dangers of tobacco use. Unfortunately, this did not adequately protect them from smoking.
P188
Tobacco use and risk awareness among a mostly young adult population
T Chimonas1, P Petrikos2, E Kostopoulos2, E Fanouraki3, D Panagiotakos4, E Chimonas3, E Elisaf1
1
University of Ioannina Medical School, Ioannina, Greece, 2251 Hellenic Airforce General Hospital, Athens, Greece, 3Hellenic Atherosclerosis Society, Athens, Greece, 4Harokopio University, Athens, Greece
Topic: Tobacco
Purpose: the success of any administrative measures undertaken to curtail the use of tobacco products depends significantly on the public's awareness of the dangers of smoking. therefore, we sought to explore the level of knowledge regarding tobacco-related health risks among a mostly young adult Greek population.
Methods: the study sample consisted of 2547 unselected adults, 90.9% male and 9.1% female, aged 18 to 65 (mean age 29.1±8.3 years old), belonging to the Hellenic Air Force personnel, who filled out an anonymous questionnaire regarding their smoking habits.
Results: Among the participants, 49.0% were smokers. Almost all, 97.4% of smokers vs 98.5% of non-smokers, agreed that smoking is harmful (p=not significant); However, 12.9% of non-smokers vs 18.7% of smokers did not believe that it can cause lung disease (p>0.001); 22% vs 30.4%, respectively, did not believe that it can cause cancer (p>0.001); 40.6% vs 46.6% that it can cause heart disease (p=0.002); 41.4% vs 50.4% that it can cause impotence (p>0.001); 46.4% vs 56.4% that it can cause premature death (p>0.001) and 59.0% vs 63.0% that it can cause strokes. A small percentage, 3.3% of smokers vs 2.4% of non-smokers do not believe smoking causes any of the above (p=not significant). Participants who showed ignorance of the dangers of smoking are generally younger (e.g. 2.6 years younger regarding the question on heart disease, p>0.001) and have significantly less years of academic training (0.4–0.8 years less, p>0.05–0.001). Furthermore, 52.5% of non-smokers vs 77.9% of smokers responded positively to the question if a condition like the above could ever happen to themselves (p>0.001). When asked at what age, smokers selected a more advanced age (42.5 vs 41.1, p>0.05). Most agreed that smoking is addictive (87.6% of smokers vs 92.6% of non-smokers, p>0.05). When asked regarding passive smoking, 65.0% of smokers vs 69.1% of non-smokers answered that it is equally harmful to active smoking, 33.7% vs 30.4%, respectively, that it is less harmful and 1.4% vs 0.4% that it is not harmful at all (p>0.05).
Conclusions: the overwhelming majority agreed that smoking is generally hazardous for one's health, but many participants did not know what these hazards actually are. Smokers in particular tended to underestimate the dangers of smoking. A more vigorous publicity campaign is needed in order to increase public awareness on the subject.
P189
Benefits of quitting smoking in coronary patients from EUROASPIRE III Romania
L Craciun1, A Avram2, S Iurciuc1, C Avram3, M Iurciuc1, C Sarau1, D Gaita1, S Mancas1
1
Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, 2Medicover, Timisoara, Romania, 3West University, Timisoara, Romania
Topic: Tobacco
Objective: Evaluating smoking incidence, the compliance to smoking cessation recommendation and benefits of quitting smoking in coronary patients included in EuroAspire III Romania survey.
Materials and methods: We evaluated the acute cardiovascular events (MACE) incidence in 530 consecutive coronary patients (=18 years and < 80 years at the time of identification) with first or recurrent clinical diagnosis or treatments for coronary heart disease, retrospectively identified from diagnostic registers or hospital discharge lists. the coronary events for hospital admission were: elective or emergency coronary artery by-pass graft (CABG), elective or emergency percutaneous transluminal coronary angioplasty (PTCA), acute myocardial infarction (AMI) and unstable angina (UA). the starting date for identification was not less than 6 months and not more than 3 years prior to the expected date of interview. Patients were divided in three groups according to their condition of smoker (smoking at interview moment), ex-smoker (quitting smoking prior to interview moment) and no smoker (never smoking).
Results: Smoking incidence before hospital admission for coronary event was 68.3% and 10% after hospital discharge. Prior the coronary event, percentage of male smokers (77.15%) predominated by female smokers (42.64%) - p>0.05, OR=4.54. Male smokers (67.25%) were more compliant to smoking cessation recommendation compared by females (32.35%) - p=0.04, OR= 2.16; there was no significant differences between the two sexes concerning smoking incidence at interview moment (p>0.05). Patients who continued smoking after hospital discharged presented an increased frequency of MACE compared to non smokers (p=0.043, OR= 1.98). Also, patients who continued smoking till hospitalization for coronary event, presented a higher risk compared to non smokers concerning re-intervention by PTCA (p=0.017, OR =4.28) and AMI incidence (p=0.01, OR =4.89). the MACE incidence was higher in active smokers versus passive smokers, but there was no significant differences between the two groups (p>0.05).
Conclusion: Majority of coronary patients renounced smoking after their first experience with cardiovascular events, a small part continued smoking. Patients who continued smoking after the acute event had higher incidence of MACE compared to non-smokers or ex-smokers (p>0.05). Also, MACE incidence was higher in active smokers versus passive but the difference was not significant between the two groups (p>0.05).
