P13
Risk factor and therapeutic management in patients with coronary heart disease: Results from EUROASPIRE III survey in 22 European countries
K Kotseva1, C Jennings1, G De Backer2, D De Bacquer2, D Gaita3, U Keil4, Z Reiner5, D Wood1
1
National Heart and Lung Institute, Imperial College London, London, United Kingdom, 2Ghent University, Ghent, Belgium, 3Institute of Cardiovascular Disease, Timisoara, Romania, 4Institute of Epidemiology and Social Medicine, University of Munster, Munster, Germany, 5Department of Internal Medicine, University Hospital Rebro, Zagreb, Croatia
Topic: Prevention of CVD
Aim: the aim of the third EUROASPIRE survey was to determine whether the Joint European Societies guidelines on cardiovascular disease prevention have been followed in everyday clinical practice in patients with coronary heart disease (CHD) in Europe.
Methods: the EUROASPIRE III survey was undertaken in 2006/2007 under the auspices of European Society of Cardiology, Euro Heart Survey programme in 76 centres in selected geographical areas in 22 European countries. Consecutive patients, men and women <80 years of age, with a clinical diagnosis of CHD were identified retrospectively. Data collection was based on a review of patient s medical notes and a prospective interview and examination by trained research assistants using standardised methods and instruments at least 6 months after their coronary event or procedure.
Results: A total of 13,935 medical records (27.4% women) were reviewed and 8,966 patients were interviewed (participation rate 73.0%). At interview, 56.0% had raised blood pressure (BP = 140/90 mmHg; = 130/80 mmHg for patients with diabetes), 51.1% had elevated total cholesterol =4.5 mmol/l, 36.7% had decreased HDL cholesterol (<1mmol/l for men and <1.2 mmol/l for women), 34.7% had serum triglycerides =1.7 mmol/l and 34.8% had diabetes (self reported or fasting plasma glucose = 7 mmol/L). Only 43.9% of patients using blood pressure lowering medication were controlled (BP <140/90 mmHg; < 130/80 mmHg for patients with diabetes) and 55.0% of patients on lipid-lowering medication achieved the total cholesterol goal of < 4.5 mmol/l. the therapeutic control of diabetes was very poor, with only 10.4% of patients with self-reported diabetes having fasting glucose <6.1 mmol/L and 34.7% having HbA1c < 6.5%. the use of cardioprotective medication was: aspirin or other anti-platelets drugs 90.5%, beta-blockers 79.8%, ACE inhibitors/AT II receptor blockers 70.9%, calcium channel blockers 24.5%, diuretics 30.2%, lipid-lowering drugs 79.8%, statins 78.1%, anticoagulants 5.6%.
Conclusions: the EUROASPIRE III survey shows that despite the existence and wide dissemination of clear, evidence-based guidelines, their implementation in everyday clinical practice is still disappointing, with the majority of coronary patients not achieving blood pressure, lipid and diabetes targets defined in the prevention guidelines. there is still considerable potential to raise the standard of preventive care in Europe through preventive cardiology programmes in order to reduce the risk of recurrent disease in patients with CHD.
P455
Cyprus survey of coronary heart disease
JA Moutiris, E theocharous, A Stylianou, C Kontos, P Mavrommatis
Paphos General Hospital, Department of Cardiology, Paphos, Cyprus
Topic: Prevention of CVD
Objective: To measure the potential for secondary prevention of coronary heart disease in Cyprus and to study the modification in risk factor profile over time.
Design: Consecutive coronary heart disease patients visiting the cardiology clinics of a district public general hospital. Patients were interviewed and examined during the visit.
Setting: A public hospital with a population of 60 thousand people, which represents 10% of the total population of Cyprus.
Subjects: 600 consecutive patients, with history of myocardial infarction, PCI or CABG surgery, who visited the cardiology clinics between Jan 1st 2007 and December 31st 2008.
Main outcome: Cardiovascular risk factor recording and management; the prevalence and control of risk factors at interview with a median time 1.6 years after the event or intervention. Results were compared to the first CHD survey in Cyprus, conducted in years 2002–5 (results announced in WCC/ESC congress 2006).
Results: At interview 27% of patients were still smoking cigarettes (23% in survey I) and 42% were obese (36% in survey I). Up to 40% of patients had total cholesterol > 190 mg/dl (56% in survey I), 55% were still hypertensive (45% in survey I), where as 40% had plasma glucose > 126 mg/dl (33% in survey I). Beta blocker, statin, ACE inhibitor (or ARB) and aspirin (or clopidogrel) was prescribed in 70%, 95%, 74% and 98% of patients respectively (60%, 89%, 63% and 94% in survey I).
Conclusions: Although cardioprotective drugs are used more frequently in survey II, compared to survey I, however, apart from some improvement on cholesterol control, the control of blood pressure and of glucose was very poor. In addition, the prevalence of smoking and of obesity increased over 5 years from survey I to survey II. the results show that there is still considerable potential to reduce the risk of further major events, in patients with established coronary disease, in Cyprus, by effective lifestyle intervention and rigorous management of blood pressure, glucose and cholesterol.
P456
How well supported are high CVD risk smokers to quit their habit? EUROASPIRE III survey of individuals at high risk of developing CVD from 12 European regions
C S Catriona SianJennings1, K Kotseva1, G De Backer2, D De Bacquer2, D Gaita3, U Keil4, A Pajak5, DA Wood1
1
Imperial College London, London, United Kingdom, 2Ghent University, Ghent, Belgium, 3Institute of Cardiovascular Diseases, Timisoara, Romania, 4University Hospital of Munster, Munster, Germany, 5Institute of Public Heath, Krakow, Poland
Topic: Prevention of CVD
EUROASPIRE Study Group
Purpose: High risk smokers require professional support and drug therapies to help them to stop smoking in order to reduce CVD risk and mortality. the EUROASPIRE III survey of general practice investigated lifestyle and risk factor management in high risk patients following prescription of treatments to reduce risk.
Methods: EUROASPIRE III survey was undertaken in selected geographical areas and general practices. Consecutive patients <80 years of age, without a history of atherosclerotic disease, either started on antihypertensive and/or lipid lowering and/or anti-diabetes treatments, were identified retrospectively. Data collection was based on a review of patients’ medical notes and a prospective interview and examination at least six months after the start of medication.
Results: 4366 (78% of all eligible) patients (mean age 60 years, 58% female) were interviewed. Prevalence of smoking at interview was 17% overall (validated self report with breath carbon monoxide >10ppm). In those smoking when started onmedical treatment to control risk factors, 88% were still smoking at interview. Information on smoking habit was available in over 90% of patients medical records except in Germany (59%), Spain (14%) and Poland (11%). Nearly three quarters of smokers were verbally advised to quit, but, only 10% were advised to get specialist support and 11% to use nicotine replacement therapy (NRT). One half said that they intended to quit in the next six months, although 42% reported doing nothing in the last 3 years to address their smoking habit. 12% reported trying to quit but only 3% accessed specialist support to do so. 7% tried NRT and 2% bupropion.
Conclusions: Only a small proportion of smokers received professional support or medications to stop smoking despite strong evidence to do so. Health professionals commonly record smoking status and the majority of smokers are advised to quit. However, professionals require training and resources to deliver smoking cessation.
P457
Short term reduction in absenteeism after implementation of a personalized prevention program
MAJ Niessen1, BE Colkesen2, D Van Pelt1, MR Hoppener1, JJ Mathijssen1, MGW Dijkgraaf2, C Van Kalken1, RA Kraaijenhagen1
1
NIPED, Amsterdam, Netherlands, 2Academic Medical Center, Amsterdam, Netherlands
Topic: Prevention of CVD
Introduction: To facilitate direct-to-user delivery of individualized preventive healthcare, the NDDO Institute for Prevention and Early Diagnostics (NIPED) has developed a web-based personal health navigator portal supported by an evidence-based knowledge and decision support (KDS) system for integrated risk profiling and individually tailored health management: the PreventionCompass. In accordance with stepped care principles and the Chronic Care Model this voluntary KDS system aims at empowering both professionals and individuals in health management. A primary objective is to raise awareness and inspire individuals to take specific actions to promote their own health. It is postulated that this health management approach results in declining absenteeism and presenteeism. In the long run, declining absenteeism is expected as a result of an overall improvement in health. On the short run, however, it has previously been shown that traditional health checks can result in a temporarily increase of absenteeism. In the current study, the short term effect of the PreventionCompass on absenteeism is evaluated.
Methods: the absenteeism records of 14,784 individuals employed at a global financial company were analysed for a 15 month period (January 2008-March 2009). those participants who had at least one recorded day of absence before program participation (n= 1,090) were included in this study. Controls were matched by days of absence during this time period (n= 9,014). Non-parametric tests (Mann-Whitney) were used to compare the average net difference in days of absence for the (comparable) period before and after participation. the mean time periods before and after participation were 7.5 months.
Results: the control group showed an average of 2.19 days of absence per month in the first 7.5 months of the observation period and 1.44 days of absence in the remaining 7.5 months observation period. the baseline decline in absenteeism for these employees was therefore 34.1% in this time period. the average amount of recorded days of absence per month for the attendees in the health maintenance program was 2.20 before enrollment and 1.02 after participation, a decline of 53.7%. T-tests indicated a significant extra decline of 19.6% in the employee group who participated in the program as compared to the non-attendee control group.
Conclusions: these results suggest an immediate, short term effect of the PreventionCompass program within 8 months after participation. Participation in the program results in a measurable short term decline in absenteeism.
P458
Cardiovascular screening for sinister cardiac disorders in non-athletic young individuals using a mobile cardiac screening unit
N Chandra, C Edwards, M Papadakis, J Rawlins, R Vaja, R Mandegaran, S Ahmed, S Sharma
King's College Hospital, London, United Kingdom
Topic: Prevention of CVD
Objectives: the majority of sudden cardiac deaths (SCD) in young individuals occur in the absence of antecedent symptoms. Most deaths are due to hereditary or congenital cardiac abnormalities which can be diagnosed during life. In most Western countries screening of competitive athletes is supported by numerous sporting governing bodies. However, in the non-athletic population screening is confined only to those individuals with cardiovascular symptoms in the context of a family history of premature cardiac disease. As such, most non-athletic individuals at risk of SCD would not be identified. In this study we assessed the impact of screening on the health service.
Methods: Over a 3 month period 2671 subjects (mean age 18.8 years; range 14–35 years) were screened with a health questionnaire (HQ), and 12-lead electrocardiography (ECG). Screening was performed using a mobile trailer equipped with ECG and echocardiography machines and manned by cardiac physiologists and a cardiologist. the HQ related to cardiovascular symptoms and a family history of premature SCD. ECGs were analysed in accordance with the ESC sports cardiology consensus. Individuals with abnormalities on the HQ and/or ECG were investigated further with echocardiography performed on site. Individuals warranting further investigation even after this were referred for 24 hour Holter monitoring and exercise stress testing.
Results: Of the 2671 individuals screened, 2415 (90.4%) had an entirely normal ECG with the remaining 256 (9.6%) requiring on site echocardiography. A further 163 individuals (6.1%) were reassured following echocardiography. thus a total of 96.5% of all individuals screened were reassured that no cardiac disorder could be identified in one visit. Only 93 individuals (3.5%) required further investigation after ECG and echocardiography. Preliminary screening identified 16 individuals (0.59%) with cardiac disorders which could prove potentially fatal in 5 individuals (0.19%) (Brugada ECG pattern: n=2; Wolff-Parkinson-White: n=1; hypertrophic cardiomyopathy: n=1; right ventricular outflow tract ventricular tachycardia (RVOT-VT): n=1).
Conclusions: Extrapolation of this data suggests large scale screening of non-athletic individuals (even in an expert setting) would be associated with a significant number of individuals (3.5%) requiring further investigation even after ECG and echocardiography. However, a huge proportion of individuals screened (96.5%) can be reassured in one visit. this is of particular relevance when considering that these individuals subsequently do not require primary and/or secondary care review.
P459
Free health screening programs in the workplace and community: who is likely to participate?
S Mandic, M Clark-Grill, H Wilson
University of Otago, Dunedin, New Zealand
Topic: Prevention of CVD
Purpose: Increasing prevalence of chronic diseases demands examination of health and lifestyle habits in general population. the purpose of this study was to describe subgroups of the population that are likely to participate in free health screening programs offered through the workplace or community.
Methods: As a part of the Community Health Education and Lifestyle Programme (HELP) Day, 233 Dunedin residents who had their health check performed in May 2009 participated in this study (95% of total sample). Recruitment was predominately done through the major city businesses. Demographic data and medical history were assessed using a self-administered questionnaire. During health checks, third year medical students measured participants height, weight, waist circumference, resting blood pressure and non-fasting levels of blood glucose and assessed physical activity habits using New Zealand Physical Activity Questionnaire. Participants were categorized in 3 activity levels based on the amount of moderate intensity activity performed in the previous week: insufficiently active (< 150 min/week), moderately active (150–300 min/week), and active (>300 min/week). Demographic data including age, gender, education, and annual income were compared to New Zealand CENSUS 2006 data for Dunedin City.
Results: Study participants included 146 (63%) women, age 42±12 years (range: 18 to 84 years), 76% New Zealand Europeans. Compared to average city population, participants were more likely to have a university degree (50% vs. 17%, p<0.05) and higher socioeconomic status (annual income above $40,000 NZ: 58% vs. 21%, p<0.05). Participants reported history of diabetes (2%), hypertension (6%), smoking (7%), cardiovascular disease (5%), and respiratory disease (9%). Elevated waist circumference (23%), high non-fasting glucose levels (8%), and blood pressure =140/90 mmHg (16%) were found in less than a quarter of participants. Average body mass index was 25.6±4.6% with 34% of overweight and 14% of obese individuals. Two-thirds of participants were active (67%), 18% were moderately active, and 15% did not meet minimal physical activity guidelines in a previous week Overall, 58% of study population was free of major cardiovascular risk factors, 29% had one risk factor and 13% had 2 or more risk factors.
Conclusion: Free health screening programs offered through the workplace and community are likely to attract apparently healthy individuals with more favorable lifestyle habits. Future initiatives should be designed to reach less healthy individuals that would benefit most from health checks and lifestyle advice.
P460
Effect of lifestyle modification awareness program on cardiovascular risk profile in high school students
S K Abou Seif, A A Elabd, M A M Saleh, M M Zaki, A S Abdelmesseh
Ain Shams University, Cairo, Egypt
Topic: Prevention of CVD
the aim of this study was to define the cardiovascular risk profile in high school Egyptian students, to provide a lifestyle modification program, and assess its outcome. the study was carried out in three secondary schools with different socioeconomic and cultural backgrounds. the study sample consisted of 157 male adolescent students recruited through systematic random sampling from schools. Data collection tools included a self-administered questionnaire, physical examination and investigations sheet, and questionnaires for nutritional, smoking, and exercise and sports environmental awareness administered as pre and post-tests. Investigations included ECG, fasting blood sugar (FBS), serum cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), and homocysteine. three intervention programs were designed for students who proved to have cardiovascular risk factors; a nutritional program to avoid fast food directed to overweight or obese students, program to quit smoking for smoking students, and a program to encourage exercise and sports directed to those not practicing exercise, as well to overweight or obese students. the program duration was 6 weeks, with a 6-week follow-up. the results showed that 10.2% of students were current smokers, and 58.0% were exposed to passive smoking from family members, 53.5% were practicing regular physical exercise, and 13.0% were overweight or obese. Overall, 10.2% of the students were hypertensive (>120/80 mmHg), 7.6% had elevated cholesterol level, 8.9% had elevated triglycerides, 17.2% had abnormally low HDL, 3.8% had abnormally high LDL, and 27.7% had abnormally high serum homocysteine. Students knowledge scores showed statistically significant improvements at the post-test of nutrition (p=0.001), smoking (p=0.03), and exercise (p=0.003) programs. Statistically significant improvements were revealed in the levels of systolic and diastolic blood pressure, serum cholesterol, LDL, HDL, and triglycerides, and BMI (p<0.001). To conclude, secondary school students in the present study had a number of cardiovascular risk factors. these were related to age, and parents education. the intervention program was successful in improving students knowledge scores, with associated improvements in the levels of blood pressure, serum cholesterol, LDL, HDL, and triglycerides, and BMI. It is recommended to carry out regular periodic screening programs for cardiovascular risk factors at schools, with the application of the designed educational intervention programs on a wider scale, with more prolonged follow-up.
P461
Lifestyle modifications in patients after acute coronary syndromes enrolled in a subset of the AMI-Florence 2 study: which changes after the acute event?
F Sofi1, A Fabbri1, R Marcucci1, D Balzi2, GM Santoro2, N Marchionni1, R Abbate1, GF Gensini1
1
University of Florence, Florence, Italy, 2Unit of Epidemiology, Azienda Sanitaria Firenze, Florence, Italy
Topic: Prevention of CVD
Background and aims: Recent findings showed a poor adherence in terms of modifications of lifestyle habits and drugs prescription among patients with a prior vascular event. Aim of this study was to evaluate the adherence to recommendations for secondary prevention of cardiovascular diseases in patients with acute coronary syndromes (ACS) after an acute event.
Methods and Results: Physical examination, a careful medical interview with assessment for lifestyle habits, adherenceto pharmacological therapy and blood analyses were performedin 130 patients (33 F; 97 M, with a median age of 72.5 years) at the time of the acute event and after 6 months of follow-up. At follow-up examination, 7 patients persisted to smoke (5.4%), 41 (31.5%) continued to have high blood pressure, 34 (26.1%) had high levels of total cholesterol, 38(29.2%) high levels of triglycerides, 64 (49.2%) high levels of LDL-cholesterol and 46 (35.4%) low levels of HDL-cholesterol, despite all the treatments did not significantly change over the follow-up period and laboratory parameters showed a significant decrease after 6 months. A high percentage of patients (47%) reported a lower daily consumption of fruit and vegetables with respect to the recommended daily portions, nearly the whole population (92.3%) did not reach the recommended portions of legumes per week recommended, and a consistent percentage of patients (81.5%) did not consume fish twice a week, as recommended.
Conclusion: these findings demonstrate the difficulty of modifying the lifestyle habits in patients with ACS even after an acute vascular event.
P462
Current patterns of cardioprotective treatment in outpatients in Russia: results of a big multicenter study
N Pogosova, RG Oganov, IY Koltunov, VA Vigodin, OY Sokolova
National Center for Preventive Medicine, Moscow, Russian Federation
Topic: Prevention of CVD
Aim: To assess the current use of cardioprotective treatment in patients with arterial hypertension (AH) and coronary heart disease (CHD) in the Russian Federation.
Materials and Methods: A multicenter study RELIF (REgularnoe Lechenie I proFilaktika) has been performed in 20 big cities of Russia: in each city were randomly selected 5 polyclinics, in each policlinic 5 general practitioners (GPs), each GP enrolled 5 consecutive pts with isolated AH (N=1078) or AH and CHD (N=1439) who came for a visit. Both pts and GP s filled out questionnaires containing questions about current prescriptions.
Results: the most frequently used class of antihypertensive drugs were angiotensin-converting enzyme (ACE) inhibitors. they were prescribed in 72.74% AH pts and 73.81% of patients with AH and CHD (ns). Second most used class were diuretic received by 67.51% and 56.93% respectively (p<0.001). Beta-blockers were prescribed respectively in 37.15% and 50.36% of pts (p<0.001). 19.11% of AH pts and 29.51% of pts with CHD were on calcium antagonists (p<0.001). Angiotensin II receptors antagonists (ARA) were used only in 4.75% AH pts and 7.79% of CHD pts (p<0.01). Respectively 24.25% and 19.55% of pts (p<0.01) received fixed-dose combinations of antihypertensive drugs. the efficacy of antihypertensive treatment was low: 71.56% of AH pts and 73.30% of pts with CHD didn t reach the blood pressure goals (ns). 14.65% of AH pts with high cardiovascular risk received statins. Among pts with established CHD the prescription rate of statins was 33.26% (p<0.001). the majority of pts did not reach target levels of blood lipids: total cholesterol exceeded 5,0 mmol/l in 64.23% of AH pts and 67.13% of pts with CHD (ns).
Conclusion: Present study has shown a big gap between general practice and National (as well as European) standards for secondary prevention in AH and CHD patients. Nevertheless when compared with previous data, our study demonstrated some improvement in use of statins, ACE inhibitors, beta-blockers, fixed-dose antihypertensive drugs in the Russian Federation.
P463
Short and long term effectiveness of a cardiopulmonary resuscitation (CPR) self-instruction program for high-school students
E Venturini, E Talini, S Lubrano, I Gonnelli, L Agostini, F Signorini, R Testa
Department of Cardiology - Civic Hospital, Cecina (LI), Italy
Topic: Prevention of CVD
Purpose: increasing bystander CPR is a fundamental goal because improves survival of cardiac arrest victims, but the proportion of citizens trained to perform CPR is small. A video-based self-instruction can disseminate CPR in general population overcoming the barrier of the traditional course. Students can acquire knowledge and skills to correctly perform CPR spreading notions in relatives and friends. Aim of the study was to evaluate the effectiveness of a self instruction program in the high school.
Methods: in march 2009, 185 students of the 4 class (17 y) have been involved. the CPR kit contain an inflatable manikin, cardboard phone, information folder and an instruction DVD, of the duration of 6 minutes. Each session, with the participation of two nurses as facilitators, lasted 1 hour; the first 10 minutes were employed for a presentation on the epidemiological relevance of sudden cardiac death. Performance was assessed in two way: directly by facilitators, that evaluated global performance as adequate or inadequate, and by a questionnaire filled before and after each lesson. Indicators of correct CPR were: assessing responsiveness, calling 1.1.8, ventilations, hand placementand chest compression. A part of the subjects (64%) was tested again, 6 months later, because is well know that after CPR courses, the skills decay significantly.
Results: immediately after the lesson was observed highly significative reduction of the errors (Pre 70.9% vs. Post 22.3% p<.0001) with marked increase of adequate performance of the CPR. In the group of students that was also examined later, was observed a decline of the skills, even if the errors were statistically less numerous in comparison to the first evaluation.
Conclusions: teaching CPR is feasible in the school, time efficiency and at low cost. the use of a self-instruction program can be an efficacious method of training for young laypersons. the participants experienced a performance decline after 6 months.
Appropriate intervals of retraining (making the CPR matter of teaching in the high-school) should improve retention of CPR skills, expanding the number of layperson able to perform CPR correctly.
P465
Changes in lifestyle, anthropometric measures and quality of life in a novel family-centred preventive cardiology programme in the community
JL Jones1, A Mead1, CS Jennings1, E Turner2, SB Connolly1, K Kotseva1, A Holden1, DA Wood1
1
Imperial College London, London, United Kingdom, 2London School of Hygiene and Tropical Medicine, London, United Kingdom
Topic: Prevention of CVD
the MyAction Group
We piloted a novel cardiovascular health programme integrating care of patients with coronary disease (COR) with asymptomatic high risk individuals (HRI) and their families all together in a community leisure facility.
Methods: COR, HRI >40 years (CVD risk >20% over 10 years) and their partners were invited to attend a 16-week multidisciplinary (nurse-prescriber, dietitian, physical activity specialist & cardiologist) lifestyle & medical management programme. Smoking (self-report, breath CO), diet (Mediterranean Score, anthropometric measures) and physical activity (7-day-recall, aerobic fitness [Chester Step Test], functional limitations [SF-36]) were assessed in all initially (IA) and end of programme (EOP).
Results: 306 patients (164 COR, 142 HRI) were invited to attend. Of these, 87 (61.3%) COR and 119 HRI (72.6%) attended the IA. 93 partners (59.6%) also attended. 59 COR (67.8%), 85 HRI (71.4%) and 58 (63%) partners attended the EOP assessment. Changes in lifestyle were observed (Table 1). Of 20 smokers attending EOP 25% had quit. Median functional limitation score (QoL) significantly increased at EOP (24 vs 22 COR; 27 vs 26 HRI; 25 vs 24 partners; p< 0.02).
Conclusion: this novel programme successfully integrated the care of coronary patients, HRI and their partners with significant improvements in lifestyle, weight management, aerobic fitness and QoL.
P466
Efficacy of intensive cardiovascular prevention program in patients with acute coronary syndrome. A two-year follow up data
R Rey1, M Rostan1, D Conde1, A Delfante2, OO Bazzino2
1
Cardiovascular Institute of Buenos Aires, Buenos Aires, Argentina, 2Italian Hospital of Buenos Aires, Buenos Aires, Argentina
Topic: Prevention of CVD
Medical therapies benefits for secondary prevention are well established but these therapies continue to be underutilized in patients with acute coronary syndrome (ACS).
this study sought to determine whether a multidisciplinary intensive cardiovascular prevention program (ICP), that included cardiologists, nurses, and dieticians, focused on initiation of aspirin, beta blocker, angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor antagonists (ARA), statins, in conjunction with diet, physical activity and cigarette smoking counselling in patients with ACS is better than standard care (SC).
Methods: We included 653 patients ACS with: 22.3% diagnosed with myocardial infarction and 77.7% without ST-segment elevation. 380 were included in the ICP and 275 patients were the SC. Both groups were matched age, gender, diabetes and prior myocardial infarction and the patients were followed during two years.
Results: In the ICP group aspirin usage (95% vs. 85%, p < 0.01), statins usage (84% to 64%, p <0.01), ezetimibe usage (32% to 5%, p<0.01) and ACEi plus ARA usage (66% to 57%, p=0.02) were higher compared to the SC group.
Moreover, a reduction in levels of LDL-C (73.9 ± 20 mg/dl vs. 99.8 ± 32 mg/dl p < 0.001) and triglyceride level (119 ± 27 mg/dl vs. 153 ± 35 mg/dl, p < 0.05), were higher in the ICP group in comparison to SC group. the NECP goals (LDL-C < 100 mg/dl) were achieved in 78% of the ICP vs. 40% of the SC (p < 0.001). Forty two percent of the ICP group achieved LDL-C < 70 mg/dl vs 20% achieved from the SC group; p < 0.001. Blood glucose level < 100 mg/dl were 77% vs. 65%, p = 0.01 (ICP vs SC respectively). Systolic blood pressure goal (<130 mmHg) was reached in 57% of ICP patients compared to 48% of the in the SC group (p = 0.01). Diastolic blood pressure (<80 mmHg) was presented a statistically significant difference in favour of ICP (77% vs. 62% p = 0.03).
there was a significant reduction in cardiovascular events in the ICP group, as follows: unstable angina (10.7% vs. 19.6% P = 0.002), IAM (1.5% vs. 5% p< 0.01), angioplasty (3.4% vs. 9%, p <0.01) and cardiovascular mortality (2.8% vs 6.5% p <0.04)
Conclusion: Intensive cardiovascular prevention program (ICP) was associated with a significant increase in the use of guidelines recommended medications for secondary prevention vs standard care (SC). In addition, there was a significant increase in patients achieving an LDL-C, blood pressure and glucose goals. Finally, after two years follow up, we observed a significant reduction on mayor cardiovascular events in patients with acute coronary syndromes.
P467
Application of secondary prevention measures and their effects in coronary patients in a specialized rehabilitation
I Tasic, S Kostic, D Djordjevic, D Simonovic, M Rihter, V Mitic, M Lovic1, D Vulic2
1
Institute for therapy & Rehabilitation, Niska Banja, Serbia, 2University of Banja, Luka School of Medicine, Banja Luka, Bosnia and Herzegovina
Topic: Prevention of CVD
the aim of our study was to test the implementation of European recommendations for the prevention of cardiovascular disease in the population of coronary patients from the Republic of Serbia, who are on specialized cardiovascular rehabilitation.
554 coronary patients were involved in the assay who were on the rehabilitation in the period July-October 2009. From the base of the Institute analyzed the data that are related to current recommendations.
Results: the tested population average age 58.7 years had 62.5% of men. Myocardial infarction with ST elevation survived is 59.6% and 17.5% of patients surviving myocardial infarction without ST elevation. Coronarography was performed in 80% of patients and 32% of patients had PCI with built stents. Surgical revascularization was performed in 43.7% of patients. Active smokers were 29%, diet was holding 58.7%, exercised regularly active 43.7% while the occasional stress had 71% of patients. Arterial hypertension had a 88%, 91% had hiperlipoproteinemia, 19.7% were obese (BMI> 30 kg/m2), 21% of patients suffered from diabetes mellitus. Recommended target values of BP (<140/90 mmHg) was reached in 81%, cholesterol (<4.5) in 35.7%, LDL cholesterol (<2.5) in 37% and glucose (<6 mmol/l) in 52.2% of patients.
All the recommended drugs for secondary prevention is receiving 55.2% of patients; beta blockers 91.3%, ACE inhibitors 77.6%, statins 86.8% and aspirin 94%.
Conclusion: Our patients were examined in relation to the European population (EUROSPIRE III) higher percentage of smokers (29 vs. 18%) and fewer have reached the target of cholesterol (35.7 vs. 53%) but were less obese (19.7 vs 38%), have better regulation of the BP (81 vs. 39%) and a smaller number of diabetic patients (19 vs. 28%). In the use of medicaments, there was no significant differences.
P468
Secondary-high school students as ambassadors of health: cardiovascular prevention project Bravi e Sani
E Troiani, F Nicolini, N Simetovic, L Marinelli
Ospedale di Stato, Cailungo, Republic of San Marino
Topic: Prevention of CVD
San Marino Society of Cardiology
the Cuore-Vita (Heart-Life) Association, a non-profit organization, legally recognized and made up of cardiac patients from the Republic of San Marino, is currently involved in an education and implementation project for young people in San Marino between the ages of 14 and 18 regarding CVD prevention.
the project, named “Bravi e Sani” (“Good and Healthy”), jointly carried out by the Public School, the Minister of Health and the Minister of Education, consists of 4 scholarships reserved for students of the secondary-high school with the goal of educating younger generations to respect their bodies, thus stimulating the development of a critical spirit which will lead them to examine, in an autonomous and independent manner, one of the most significant aspects (exercise, cardiology, nutritional, psychological, moral) linked to the prevention of CVD. the 25 students who, at the moment joined the project will, by December 15 2009, present a written report which will be examined by a commission of members from the school and from the Association. the prizes for the three best individual works are 1000, 800, and 500 along with a mountain bike and bike helmet. there is an additional prize of 1000 plus ten fitness courses for the best group work.
During the course of the project the students will be followed by a team of tutors comprised of an internist, a sports medicine physician, a cardiologist, a psychiatrist, a nutritionist, chosen according to the proposed topics which are: 1) risk factors in CV and chronic-degenerative diseases such as diabetes, hypertension, obesity, smoking, alcohol, sedentariness; excessive stress; sleep deprivation; 2) nutrition: a correct approach toward healthful eating habits; 3) exercise: the effectiveness of physical activity for well being and in the prevention of risk factors; 4) self-acceptance and the acquisition of a critical spirit with regard to society and the mass media. the students will do an in depth study of a topic which interests them with the assistance of the tutor, putting into practice upon themselves, upon friends and upon their families the healthy life-style they have learned. Subsequently, they will verify the results in terms of well being, body weight, sport and mental performance, reporting their experience in their written report. the contestants accepted this challenge with enthusiasm and are at this time occupied in spreading the message of health to those close to them. It is not presently known which report will be the winning work, but it is certainly important that our young people have become by right ambassadors of health in our small nation.
P469
Socioeconomic circumstances and trends in cardiovascular risk factors in england, 1994–2007
S Scholes1, M Bajekal1, R Raine1, M O'flaherty2, S Capewell2
1
University College London, London, United Kingdom, 2Public Health, University of Liverpool, Liverpool, United Kingdom
Topic: Socio-demographic factors
IMPACTsec Research Group
Recent large falls in coronary heart disease (CHD) mortality rates have been attributed to reductions in behavioural risk factors, particularly smoking, cholesterol and high systolic blood pressure (SBP), and also to the increasingly widespread use of cardiological treatments. Such gains, however, have been partially offset by unfavourable trends in Body Mass Index (BMI), diabetes and physical inactivity, possibly exacerbating inequalities. Using data from the Health Survey for England (HSfE) from 1994 to 2007, we therefore examined differentials in CHD risk factors by socioeconomic circumstances (SEC) over recent years where SEC was defined by grouped quintiles of residential deprivation.
the HSfE is an annual, nationally representative health interview and examination survey containing a core element and a (regularly repeated) disease module. In 1998, 2003 and 2006 the HSfE focused on CHD risk factors. A series of regression models were used to analyse the influence of SEC and time on risk factor levels.
SEC gradients were most pronounced for current smoking, fruit and vegetable consumption, BMI (women only) and diabetes (women aged 55–74). Recent trends present a mixed picture. Smoking and SBP declined year-on-year for most SEC groups; cholesterol levels fell significantly between 2003 and 2006; and [beneficial] physical activity and fruit and vegetable consumption increased. In contrast, mean BMI and, diabetes prevalence among older age-groups, increased across all SEC groups. Despite favourable trends across all social groups, the inequality gap remained essentially unchanged. Persistent SEC differentials in smoking, poor diet and BMI (in women) highlight an important priority for more effective policies for food and tobacco control. Furthermore, research is now crucial to quantify the extent to which these persistent inequalities in CHD risk factor levels might explain the substantial inequalities observed in CHD mortality.
P470
Educational inequalities in cardiovascular risk factors over three decades in Norway: evidence from health examination surveys 1974–2003
S Graff-Iversen, O Naess, BH Strand
Norwegian Institute of Public Health, Oslo, Norway
Topic: Socio-demographic factors
Background: Educational inequality in cardiovascular disease (CVD) mortality is substantial in Norway, and we aimed to study the trend in educational differences in established CVD risk factors over three decades.
Material and Method: We used data from regional Norwegian health examination surveys in 1974–78, 1985–88 and 2000–2003 including 40–45-year old women and men, and present absolute and relative educational inequality in CVD risk factors. To account for changing educational distribution over time we used regression based indices of inequality (Slope Index of Inequality (SII) and Relative Index of Inequality (RII)).
Results: the subgroup with basic education constituted the majority of participants by the 1974–78 survey (68% of men and 76% of women) and a minority by 2000–2003 (13% and 10%, respectively). Across the three surveys the absolute educational inequalities increased for smoking in women by 20 %-points and for leisure-time physical inactivity by 11 %-points in men and 2.4 %-points in women and also for serum triglycerides (both sexes). the absolute differences decreased for total cholesterol and changed little for body mass index (BMI) and blood pressure (both sexes) and for smoking in men. the relative educational differences increased for smoking to a similar extend in men and women, and for the other risk factors the pattern of differences in relative terms were similar to the absolute differences.
In the most recent survey (2000–2003) smoking and physical inactivity showed the steepest educational gradients in absolute and relative terms. For BMI and waist circumference the educational differences were modest, and only small educational gradients were seen for total cholesterol and blood pressure.
Conclusions: In a perspective of social equality in health, this study indicated that tobacco smoking and physical inactivity are the main challenges to CVD prevention in Norway.
P471
Fit for demographic change - results from a workplace health forum
N Schaller1, T Schuster2, J Bischof3, J Fischer4, H Hanssen5, O Zelger1, A Schmidt-Trucksaess5, M Halle1
1
Technical University of Munich, Department of Prevention & Sports Medicine, Munich, Germany, 2IMSE, Technische Universitaet Muenchen, Munich, Germany, 3Health Management, BMW Group, Munich, Germany, 4Mannheimer Institute of Public Health, Mannheim, Germany, 5Institute of Exercise and Health Sciences, Basel University, Basel, Germany
Topic: Occupational health
Purpose: the mean age of the working population is rising in Western countries. To maintain employee aptitude and to prevent chronic diseases resulting in absenteeism and high medical costs, it is important to implement adequate health management strategies. the aim of this study was to assess cardiovascular risk and life-style factors and derive preventative health recommendations for the employees of a large company.
Methods: From 2006 to 2008, 27.359 employees (85% male, Ä 39.6 ± 10.0 years) of a large company voluntarily received a broad medical examination. Anthropometric parameters (BMI, waist circumference), blood values (lipids, fasting glucose, HbA1c), questionnaire-derived lifestyle behaviour (physical activity, smoking status, diet, social status), prevalence of diabetes, hypertension, myocardial infarction and stroke were compared between age and sex groups. In a subgroup (n=6.000) the relationship between lifestyle factors e.g. physical activity (none versus =3×30 min/week), fruit and vegetable consumption (meals per day), smoking status and prevalence of the metabolic syndrome (= 3 risk factors, defined by NCEP ATP III criteria) were assessed.
Results: Analyses revealed lower health status with low social class status and rising age. “Blue-collar” workers were more often physically inactive, overweight and currently smoking than “white-collar” workers. In the subgroup, 24 % of the employees were diagnosed with metabolic syndrome. In groups with low physical activity and especially in the age groups 50–60 years and >60 years, risk factors were accumulated leading to a higher prevalence of metabolic syndrome (40% and >30%, respectively).
Conclusion: Because of the high prevalence of metabolic syndrome in the age group of =50 years and the clustering of unfavourable life-style factors particularly with low physical activity, prevention strategies have to focus on workers younger than 50 years aiming to increase physical activity there by improving other lifestyle and factors of the metabolic syndrome.
P472
Sudden arrhythmic death syndrome: the use of higher intercostal V1 and V2 leads increases the diagnostic yield of Brugada syndrome
M Papadakis1, G Baines2, A Kouloubinis1, A O'sullivan1, N Van Niekerk3, N Chandra1, J Rawlins1, S Sharma1
1
King's College Hospital, University Hospital Lewisham, London, United Kingdom, 2University of Oxford, Oxford, United Kingdom, University Hospital Lewisham, London, United Kingdom
Topic: Sudden Cardiac Death
Background: Brugada syndrome is an established cause of sudden arrhythmic death syndrome (SADS). the use of higher intercostal V1 and V2 leads has been associated with increased surface electrocardiogram (ECG) sensitivity in the detection of the Brugada phenotype, either on the baseline ECG or following provocation using sodium ion channel blocking agents, without compromising specificity. Despite the potential implications, there is a paucity of data relating to the efficacy of this simple methodology in the diagnostic yield of Brugada syndrome in victims of ventricular fibrillation (VF) or 1st-degree relatives of SADS victims.
Methods: We identified 29 families diagnosed with Brugada syndrome based on the presence of a type-1 ECG in =1 family member in the context of an unexplained VF arrest or a SADS death in a 1st-degree relative. the 12-lead ECGs of 117 individual members, who underwent comprehensive cardiac investigations including an Ajmaline provocation test, when appropriate, were reviewed. Electrocardiograms were performed with leads V1 and V2 placed in both the conventional 4th and the higher 2nd intercostal space.
Results: Forty-one of the 117 family members (35%) were diagnosed with Brugada syndrome. Only 6 (16%) subjects exhibited a diagnostic baseline ECG, while the great majority required an Ajmaline provocation test to unmask the Brugada phenotype. the Brugada phenotype was detected in the conventional ECG of 18 (44%) individuals, however it was observed in the modified ECG of 40 (98%) individuals using the higher intercostal V1 and V2 leads (p<0.001). Only 14 (48%) of the 29 families were diagnosed on the basis of the standard ECG lead whereas all 29 (100%) families had at least one member with a positive type-1 ECG in the higher intercostal leads (p<0.001).
Conclusion: Utility of higher intercostal leads for the detection of the Brugada phenotype increases the diagnostic yield when screening victims of VF arrest or 1st-degree relatives of SADS victims. In our cohort more than half of the families (52%) and individual members (56%) harbouring the Brugada gene would have remained undetected based on the standard 12-lead ECG alone.
P473
Cardiovascular screening of potentially sinister cardiac disorders in young individuals: the Northern Ireland experience
N Chandra, C Edwards, M Papadakis, J Rawlins, R Vaja, R Mandegaran, S Ahmed, S Sharma
King's College Hospital, London, United Kingdom
Topic: Sudden Cardiac Death
Objectives: the Italian pre-participation ECG cardiovascular screening (PPS) programme has been shown to reduce the incidence of sudden cardiac death (SCD) from hereditary cardiomyopathy and primary electrical disorders in young competitive athletes. there is a paucity of data regarding the potential outcome of screening all young apparently healthy individuals outside the context of organised competitive sport. the aim of this study was to analyse the outcomes of PPS in order to assess the impact on health care services of general population screening.
Methods: 2847 subjects (mean age 18.3 years; range 14–35 years; male: female ratio 5:1) were screened with a health questionnaire (HQ) and 12-lead electrocardiography (ECG). the questionnaire related to symptoms suggestive of cardiovascular disease and a family history of premature cardiovascular disease and/or SCD. ECGs were analysed for specific abnormalities as described in the ESC sports cardiology consensus. Individuals suspected to harbour a structural cardiac abnormality based on the findings of the HQ and 12-lead ECG underwent trans-thoracic echocardiography (TTE). Individuals suspected to have a primary electrical disorder were referred for additional Holter monitoring and an exercise stress test.
Results: Of the 2847 individuals, 891 (31.3%) expressed one or more symptoms that could be consistent with cardiac disease, 144 (5.1%) had a family history of hereditary cardiomyopathy or SCD and 225 (7.9%) had a 12-lead ECG abnormality warranting further investigation. Following preliminary investigation echocardiography, Holter monitoring and exercise stress testing was necessary in 296 (10.4%), 122 (4.3%) and 111 (3.9%) respectively. A cardiac diagnosis was made in 0.70% of individuals at the first visit (patent formamen ovale: n=4; Wolff-Parkinson-White: n=3, atrial septal defect: n=3; bicuspid aortic valve: n=3; mitral valve prolapse: n=3; atrial septal defect: n=2; and atrial fibrillation; n=2).
Conclusions: the beneficial effect of the Italian PPS in protecting an athlete from SCD should not be undervalued. Extrapolation of this programme to the general young population is associated with a significant number of individuals (combined total of 4.6%) requiring additional investigations that are associated with a relatively low yield for conditions capable of causing SCD.
P474
Relationship of race to risk stratification for sudden cardiac death in patients with hypertrophic cardiomyopathy
M Papadakis1, D Bonnes2, V Panoulas3, J Rawlins1, N Chandra1, A Kouloubinis1, T Fonseca3, S Sharma1
1
King's College Hospital, University Hospital Lewisham, London, United Kingdom, 2King's College Hospital, London, United Kingdom, 3University Hospital Lewisham, London, United Kingdom
Topic: Sudden Cardiac Death
Background: Hypertrophic cardiomyopathy (HCM) is an inherited cardiac muscle disease with a propensity to exercise related sudden cardiac death (SCD). Retrospective autopsy data from the US demonstrate that the prevalence of HCM-related deaths is significantly greater in young athletes of African descent compared to their Caucasian counterparts suggesting that HCM may exhibit a more malignant course in Black individuals. the aim of the study was to compare the prevalence of established risk factors for SCD in a well-characterised cohort of African/Afro-Caribbean (Black patients; BP) and Caucasian patients (CP) with HCM.
Methods: Between 2001 and 2009, 74 patients with a diagnosis of HCM (24 BP) were assessed in our tertiary referral clinic and underwent annual risk stratification testing specifically for conventional risk factors which include: 1) Severe (= 30 mm) left ventricular hypertrophy, 2) Unheralded syncope, 3) Family history of premature sudden death, 4) Abnormal blood pressure response to exercise and 5) Non-sustained ventricular tachycardia (NSVT) on Holter monitor or during exercise.
Results: Both groups were similar with respect to age (BP vs. CP; 43.83±15.46 vs. 49.58±14.38 years, p=0.121), gender (BP vs. CP; 54% vs. 60% male gender, p=0.802) and left ventricular wall thickness (BP vs. CP; 17.04±3.70 vs. 19.00±4.16 mm, p=0.054). None of the patients exhibited a ventricular wall thickness =30 mm. there was no significant difference between BP and CP with HCM in relation to the prevalence of syncope (12.5% vs. 16%, p=0.493), family history of SCD (21% vs. 12%, p=0.909) or abnormal exercise blood pressure response (21% vs. 22%, p=0.582). In contrast, NSVT was identified more frequently in CP compared to BP (36% vs. 12.5%, p=0.030). Similar proportions of Black and Caucasian patients exhibited =2 risk factors to indicate an increased risk of SCD (12.5% vs. 18%, p=0.233).
Conclusion: Hypertrophic cardiomyopathy patients of African/Afro-Caribbean origin do not exhibit an increased frequency of established risk factors for SCD compared to Caucasian subjects to indicate a more malignant course of the disease in this particular ethnic group. On the contrary, CP had an increased frequency of NSVT possibly indicating an increased risk of SCD. Although it is conceivable that exercise on a background of HCM may have a more pronounced effect in African/Afro-Caribbean individuals, it is more likely that the increased death rates from HCM observed in Black athletes in the US reflects higher participation rates at regional level, in common sporting disciplines such as football and basketball.
