3. The median time of 10 minutes between symptoms and Out- Of Hospital Cardac Arrest calls for a need to improve bystander resuscitation efforts and Emergency Medical Response services in the community. 4. The results of the study call for increasing awareness on Cardiovascular Health and Cardiac Arrest among the population. Disclosure of Interest: None Declared
PM081 Barriers to Cardiovascular Disease Secondary Prevention Care in The West Bank, Palestine – A Health Professional Perspective V. J. Collier*1 Department of Social Science, Health & Medicine, King’s College London, London, United Kingdom
Introduction: Non-communicable diseases (NCDs) are fast-becoming a global burden on health due to the rise in the rates of conditions such as cardiovascular disease (CVD). This has become increasingly noticeable in developing countries. There is a dearth of earlier studies relating speciﬁcally to patients and their capacity for risk factor behaviour change within secondary care settings. Objectives: (1) ascertaining whether health professionals consider there are speciﬁc barriers for patients in the OPT to participate in lifestyle changes which may improve health outcomes from a cardiovascular event; (2) determining which risk factors for cardiovascular disease hinder patients to change their health behaviour; (3) determining what the barriers and their causes may be; (4) investigating what action, if any, according to health professionals, can be taken and by whom, to overcome any identiﬁed barriers to care at a system- level or at an individual patient-level approach. Methods: A study was carried out in the West Bank of Palestine using semi-structured qualitative interviews to seek health professionals’ views on barriers for patients in the West Bank to participate in lifestyle changes relating to CVD. Results: The current Israeli occupation affects the Palestinian people at both an individual and a system-level approach. Stress is considered both a risk factor for CVD, and a barrier to health behaviour change. Poor communication exists between primary and secondary care services, and primary care facilities are not providing adequate intervention to support the detection and management of risk factors for CVD. Conclusion: This study has provided some insight into how people’s health behaviours are affected by social determinants of health and why behaviour change may be difﬁcult. Similar studies within primary care services, and with patients themselves, may help to inform future health options for collaborative working aimed at addressing CVD in the region. To be effective, however, attention also needs to be given towards a solution for political change. Disclosure of Interest: None Declared
PM082 Interventions to Improve Medication Adherence in Coronary Disease Patients: A Systematic Review of Randomised Controlled Trials K. Santo*1,2, S. Kirkendall2, T. Laba1,2, J. Thakkar1,2,3, R. Webster1,2, J. Chalmers1,2, C. K. Chow1,2,3, J. Redfern1,2 1 The George Institute for Global Health, 2University of Sydney, 3Westmead Hospital, Sydney, Australia
Conclusion: 1. Persons above 40 years with cardiac symptoms and risk factors are at risk for Out- OfHospital Cardiac Arrest. 2. Preventive cardiac interventions among people aged 40 years with risk factors and prior symptoms are encouraged to prevent Out- Of- Hospital Cardiac Arrest.
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Introduction: Medication adherence is a cornerstone of coronary heart disease (CHD) management and prevention. However, adherence to these life-saving cardiovascular (CV) medications is still sub-optimal worldwide and, therefore, interventions to improve adherence are needed. Objectives: This systematic review aimed to examine whether such interventions improved patients’ adherence to multiple CV medications in a CHD population. Methods: Randomised controlled trials were identiﬁed by searching multiple databases and reference lists. Studies were selected if they evaluated any type of intervention aiming to improve adherence to multiple CV medications targeting a population of adults with established CHD and if they provided an appropriate measure of adherence. Interventions were classiﬁed as complex or simple interventions based on the number of intervention components, based on pre-speciﬁed categories. Risk ratios of being adherent were calculated where possible. Results: Sixteen studies (10,706 patients) were included in this review. Methodological heterogeneity precluded quantitative data synthesis. The interventions varied widely and had mixed results. The majority of the interventions were complex with several components (Table 1). Only seven trials achieved statistically signiﬁcant higher adherence in the intervention group. Less than a third of the complex intervention trials was associated with improvements in adherence. Three trials used single-component interventions (text-messages reminders, polypill and ﬁnancial incentives) and were successful in
Methods: Demographic and clinical proﬁle of 123 adult victims of Out-Of- Hospital Cardiac Arrest reported in Warangal,Telangana,India was studied. Information about the age, sex, time of cardiac arrest, risk factors: diabetes, hypertension, tobacco use, family history, physical inactivity, prior symptoms,prior symptoms within 24 hours of cardiac arrest, duration between prior symptoms and cardiac arrest, witnessing or not of cardiac arrest, place of cardiac arrest were studied. Data was entered into MS Excel. Statistical analysis was done using MedCalc Statistical Software version 15.6.1.Appropriate analysis of Quantitative variables with normal and non-normal distribution and categorical variables was done. Results: 1. Males are preponderant compared to females. 2. Mean age of OOHCA is 57 years and is not differing between both sexes. 3. Age groups 40 to 59 years and 60 years are mainly affected. OOHCA is uncommon below 40 years. 4. Majority have at least one of the ﬁve risk factors (DM,HTN,Family History, Tobacco Use and Physical inactivity). 5. OOHCA is common during day time, speciﬁcally 6:30 AM to 11:30 AM. 6. Majority had prior symptoms within 24 hours which were communicated to their attendants but had no cardiac check up. 7. Majority of OOHCA instances were witnessed and occurred at home. 8. Duration between prior symptoms and cardiac arrest (n¼80): Median 10minutes (95% CI 5 to 30 minutes). 9. Preceding Symptoms more than 24 hours (n¼14): Mean: 26.6 days, SEM: 9.4.
improving medication adherence. Few studies evaluated clinical and health outcomes and the majority did not show signiﬁcant improvements.
Conclusion: Interventions to improve adherence to multiple CV medication in a CHD population varied widely and were found to have mixed results. Both complex interventions and single-component interventions, including the use text-message reminders, polypill and ﬁnancial incentives, were associated with improvements in adherence to CV medication. Simple one-component interventions using person-independent strategies might be a promising way to improve medication adherence in a CHD population, as these interventions are easier to replicate in different settings and on a large scale. However, beneﬁts in clinical outcomes and cost-effectiveness are yet to be determined by future research. Disclosure of Interest: None Declared
Conclusion: Behavioral risk-factor modiﬁcation, a key component in the management of CHD, is often neglected in India. This study shows that a comprehensive exercise-cumeducation program helps to achieve and sustain the desired behavior changes in a South Indian patient population. Managing psychosocial stress, however, warrants special attention in the Indian context. Disclosure of Interest: P. Chockalingam Shareholder of: Cardiac Wellness Institute, N. S. Vinayagam Employee from: Cardiac Wellness Institute, N. E. Vani Employee from: Cardiac Wellness Institute, V. Chockalingam: None Declared PM086
PM084 The Effect on Signal Average ECG Parameters After a Cardiac Rehabilitation Program Modifying Behavioral Risk Factors: A Key Component in Coronary Heart Disease Prevention P. Chockalingam*1, N. S. Vinayagam1, N. E. Vani1, V. Chockalingam2 Preventive Cardiology, Cardiac Wellness Institute, 2Cardiology, Dr. MGR Medical University, Chennai, India 1
Introduction: Coronary heart disease (CHD) is a major cause for mortality and morbidity among Indians. However, the focus on behavioral risk-factors (BRF) in the prevention and management of CHD in the country is abysmally low. Objectives: This study aims to analyse the BRF of individuals participating in a comprehensive CHD prevention program in South India. Methods: Among patients referred for an outpatient CHD prevention program from May 2014-October 2015, those who completed the program were included in this study. A typical program consisted of 1-2 sessions per week for 6-12 weeks. Each session lasted 90120 minutes and included an exercise component and an education/counseling component on diet, activity, compliance to therapy, risk-factor modiﬁcation and psychosocial aspects. Apart from demographic, historical and clinical details, the following three BRF were documented at baseline and at end-of-program; unhealthy diet was deﬁned as inadequate intake of fruits, vegetables and whole grains and excessive intake of saturated fats, salt and sugar; inadequate exercise was deﬁned as less than 30 minutes of brisk aerobic activity per day; self-reported level of psychosocial stress was documented. Follow-up was done either in person or by phone. Results: Among the 40 subjects (75% male, 5715 years), 100% had BRF and 65% had CHD at baseline. A total of 404 (106) education/counseling sessions were provided (Figure 1). There was a signiﬁcant improvement in all three BRF at end-ofprogram evaluation performed 32 months after baseline evaluation. Follow-up was done in 83% subjects after 114 months of program completion. Adherence to healthy diet and exercise was better than at end-of-program. Psychosocial stress level, though better than at baseline, was worse than at program completion (Figure 2). The reason for lack of follow-up data in 7 patients was demise due to congestive heart failure (n¼1), less than one month since program completion (n¼2) and lost to contact (n¼4).
J. P. N. Urquiza*1, J. P. Macías Flores1, M. E. Pinto1, F. H. Saldaña2, N. P. Beltrán1, E. C. Montes2, S. L. González2, M. A. A. Gamba2, E. T. García1 1 Cardiac Rehabilitation, 2Cardiology, Instituto de Corazón de Querétaro, Querétaro, Mexico Introduction: In patients suffering from chronic heart failure, myocardial electrical instability is associated with an increased risk of sudden cardiac death. Cardiac rehabilitation (CR) might lead to a favorable electrical remodeling and might thus decrease electrical instability, as assessed by heart rate variability (HRV) and late potentials (LP). However, the potential effect over these measurements are not well understood. Objectives: To assess the effect of CR on clinical measures of electrical instability such as HRV and LP in patients suffering from chronic heart failure. Methods: HRV and LP were obtained in all patients (n¼101) referred to our CR clinic at the beginning of the program. In 43 patients the same measurements were also obtained at the end of CR phase II. Low Amplitude Signal (LAS) >38ms, Root Mean Square of Amplitude in Terminal 40ms (RMS) <20mV, Low Frequency Band (LF) 54 4nu, High Frequency Band (HF) 29 3, LF/HF Index 1.5-2.0 and Triangular Index (TI) <20, were used as threshold to deﬁne electrical instability. Results: In the whole cohort, 85% were male, 19.51% has diabetes mellitus, 43.9% has hypertension; LAS and RMS were signiﬁcantly unfavorable in patients with DM (p0.85 and p0.35, respectively) and LF and HF were signiﬁcantly unfavorable in patients with heart failure (p0.034 and p0.015, respectively). The patients with baseline and ﬁnal observations (n¼43) 86.8% were male, with a median age of 58.61 14.63 years, and 43.90% has hypertension. No signiﬁcant difference was observed in the duration of ﬁltered QRS 92(Q1 86 – Q398.5) vs 91(Q187 - Q397.5), LAS 28(Q122.50 - Q336.50) vs 28(Q123 - Q335), RMS 31(Q124 - Q342.50) vs 33(Q125 - 40.50), LF 60(Q140.80 - 77.10) vs 69(Q148.05 - 80.25), HF 28.3(Q117.85 - Q339.45) vs 24.30 (Q113.05 - 41.40), LF/HF Index 2.14 (Q10.98 Q34.95) vs 2.97 (Q11.20 - Q35.95), TI 6(Q14.50 - 9) vs 7(Q15 - 9). Conclusion: Despite nondifference were observed in these parameters, clinically we have identiﬁed considerable improvement with the CR program as an intervention. At the time of follow up, we haven’t recognized any arrhythmic lethal event, despite the high risk patients we have documented. Disclosure of Interest: None Declared
GHEART Vol 11/2S/2016