bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P113: The Primordial Prevention Project: Pilot Study of Disclosing Child’s Diabetes Genetic Risk Information
Authors: Smith Mitchell , Wessel Jennifer
Published: March 2019

The prevalence of type 2 diabetes (T2D) in children has risen dramatically. NHANES data of 12-19 years old showed a significant increase, from 9% to 23%, in pre-diabetes and diabetes from 1999-2008, which was related to increases in BMI. Lifestyle interventions in adults have been shown to be effective at reducing T2D risk, however, interventions in families have been inconclusive in demonstrating the benefit of lifestyle change in reducing T2D risk. We hypothesized that using child’s genetic risk information in families at high risk of developing T2D would serve as a motivator to improve behaviors related to risk factors for T2D. We conducted a pilot study of 44 families and their children aged 2-8 who consented to participate in baseline, risk-disclosure and 3-month follow-up sessions. We identified families as high risk based on a maternal history of gestational diabetes, large for gestational age, or paternal obesity. Parents were surveyed on their family’s physical activity and dietary behaviors, and attitudes and motivations for lifestyle change at baseline and 3-month follow-up. At baseline, saliva samples were collected from children for genotyping of variants previously associated with obesity and T2D risk in genome-wide association studies. When genotyping was completed families were then scheduled to receive results. Parents completed questionnaires related to their anxiety (STAI-State) and depressive symptoms (POMS) prior to receiving their child’s genetic risk and immediately after the intervention. Parents received their child’s genetic risk report, in combination with a quasi-motivational interviewing session and educational materials. At the end of the session parents set individualized behavior goals for themselves and their children based on their responses to baseline questionnaires related to dietary and PA behaviors. Follow-up at 3 months are still being collected. Results from the risk disclosure session are reported here. Parents were 35±5 years old; 11% Latino, 26% black and 63% White; and 60% were mothers. Parents reported a significant increase in fatigue (ß =0.98, p=0.001), depressiveness (ß=0.35, p=0.04), and anxiety (ß =3.0, p=0.001) from pre-risk disclosure compared to post risk-disclosure. Parents reported a significant increase in their confidence to change their family’s behaviors after receiving the intervention (ß=0.34, p=0.001). All parents committed to a personalized health behavior change after learning of their child’s risk. In conclusion, we were able to demonstrate that genetic risk may be a useful motivator to encourage parents to take immediate action to make improvements to their family’s health behaviors. Short-term follow-up results will determine whether changes were meaningful in actual behavior changes.
Abstract P117: Prediction of Undiagnosed Diabetes in Africans is Optimized by Using Fasting Plasma Glucose at a Threshold of 100 mg/dL: The Africans in America Study
Authors: Horlyck-Romanovsky Margrethe F , Mugeni Regine , Aduwo Jessica Y , Briker Sara M , DuBose Christopher , Mabundo Lilian S , Chung Stephanie , Ha Joon , Sherman Arthur , Sumner Anne E
Published: March 2019

Introduction and Objectives:
Detecting undiagnosed diabetes is the first step towards addressing the diabetes epidemic in Africa. Although there is little experience with diabetes prediction equations in Africans, the A1C-modified Atherosclerosis Risk in Communities (ARIC) diabetes prediction equation was optimized in African Americans. Therefore, we evaluated (a) the ability of the A1C-modified ARIC prediction equation to detect undiagnosed diabetes in African-born blacks living in the United States and (b) the contribution of each biochemical variable to the effectiveness of the equation.

Methods:
Participants were 400 self-identified healthy African-born blacks enrolled in the Africans in America study (age 38 ±10 (mean ±SD) years, BMI 27.5 ±4.5, range 18.2-42.4 kg/m
2
). Glucose tolerance status was diagnosed by glucose criteria for the OGTT. The prediction equation had 9 variables; 5 clinical (age, parent history of diabetes, height, waist circumference, and systolic BP); and 4 biochemical (A1C, fasting plasma glucose (FPG), high density lipoprotein (HDL) and triglycerides (TG)). Area under the receiver operating characteristic curve (AUC-ROC) predicted discrimination and Youden Index identified optimal cut-points. Four models were tested. Model 1 determined the predictive value of the full equation. Model 2 included the clinical variables and 3 of the 4 biochemical variables at a time. Model 3 included the clinical variables and 1 biochemical variable at a time. Model 4 evaluated the independent prediction by each biochemical variable.

Results:
Diabetes, prediabetes and normal glucose tolerance were detected in 7% (26 of 400), 27% (108 of 400) and 66% (266 of 400), respectively. Model 1 had an AUC-ROC of 0.8. Model 2 with FPG excluded had an AUC-ROC of 0.7. When A1C, HDL or TG were the excluded AUC-ROC increased to >0.8. Model 3 with clinical variables and FPG the AUC-ROC was 0.9. However, when A1C, HDL or TG were included AUC-ROC declined to ≤0.7. In Model 4, FPG as a single predictor had an AUC-ROC of 0.9. In contrast, A1C, HDL or TG as single predictors, all had AUC-ROC ≤0.7. For the prediction of diabetes, the optimal cut-point for FPG was 99 mg/dL (sensitivity 85%, specificity 87%).

Conclusions:
As the prediction of prevalent diabetes by the entire equation and FPG alone were similar, FPG ≥100 mg/dL in Africans may be a sufficient and cost-effective way forward.
Abstract P118: Serious Financial Difficulties Impact Subclinical Cardiovascular Disease Among Mexican Women
Authors: Connors Kaela , Flores-Torres Mario H , Valdimarsdóttir Unnur , Lopez-Ridaura Ruy , Cantu-Brito Carlos , Catzin-Kuhlmann Andres , Beatriz Beatriz , Lajous Martin
Published: March 2019

Introduction:
Sudden loss of income has been previously associated to all-cause mortality. Diminished financial resources may result in reduced access to healthcare. On the other hand, the psychological stress associated with economic loss may also affect cardiovascular health through a combination of negative physiological changes and unhealthy lifestyle choices.

Hypothesis:
We hypothesize that serious financial difficulties will increase cardiovascular risk in Mexican women.

Methods:
We categorized 1,764 employed and insured disease-free women from the Mexican Teachers’ Cohort according to their response to ‘Have you ever had serious financial difficulties (for example, not enough money for food or place to live)?’ included in a self-reported instrument on life stressors conducted 2013 and 2016. On the same visit, carotid artery intima-media thickness (IMT) was measured by standardized neurologists on both carotid arteries through ultrasound following international guidelines and log transformed. We defined carotid atherosclerosis as an intima media thickness of ≥0.8mm in either of the carotid arteries or the presence of plaque. We collected data on cofounders (age, site, and socio-economic status calculated based on score of household assets), perceived stress (Perceived Stress Scale-10), and other potential intermediates (body mass index, smoking, hypercholesterolemia, hypertension, and diabetes). We used multivariable linear and logistic regression models to assess the association of serious financial difficulties, IMT, and carotid atherosclerosis.

Results:
The average age of the study population was 49.4 (SD±5.0) years and 312 (17.8%) women reported exposure to serious financial difficulties as adults. High levels of perceived stress (62.2% vs. 42.5%), obesity (42.0% vs. 36.2%), smoking (9.3% vs. 6.7%), hypercholesterolemia (33.3% vs. 31.7%), and diabetes (10.3% vs. 7.5%) were more common among women with serious financial difficulties relative to women without. Women with serious financial difficulties had 1.7% (95% CI 0.2, 3.3) higher mean IMT than women without after adjusting for potential confounders. The prevalence of carotid atherosclerosis was 26.6% in women who experienced serious financial difficulties and 20.9% in women without such exposure. The multivariable-adjusted odds ratio for carotid atherosclerosis among women with serious financial difficulties was 1.40 (95% CI 1.03, 1.90) relative to women without. Adjusting for potential intermediates did not alter the interpretation of our results.

Conclusion:
Serious financial difficulties were associated to subclinical cardiovascular disease among employed and insured Mexican women.
Abstract P120: Feasibility of Cardiac Rehabilitation in Resource Limited Settings
Authors: Ngeno Gedion T , Barasa Felix , Kussin Peter S , Egger Joseph , Kamano Jemima , Wambui Charity , Kwobah Edith , Thielman Nathan , Bloomfield Gerald S
Published: March 2019

Background:
Heart failure (HF) is a growing driver of morbidity and mortality worldwide. Cardiac rehabilitation in HF improves functional status, quality of life, and depression. Global access to cardiac rehabilitation remains poor, and adherence rates are low.

Methods:
We implemented and assessed adherence rates associated with two models of cardiac rehabilitation in Western Kenya. One hundred participants with HF were prospectively enrolled. Choice of rehabilitation model was based on participant preference. Twenty-five participants opted to participate in 36 institution-based sessions (IBCR). Thirty-one participants enrolled into home-based sessions (HBCR). HBCR comprised 12 weekly pedometer step targets. Forty-four participants were later enrolled into an observational arm (OA). We hypothesized that participants would adhere to at least 25% of prescribed sessions. We secondarily compared changes in 6-minute walk time distance (6MWTD), depression screening (PHQ9) and quality of life (SF36) scores using a paired t-test.

Results:
The mean age of participants was 51 years, of whom 73 were female. Rehabilitation participants preferred institution based rehabilitation. Both study arms were adherent to the prescribed protocol as shown in figure 1. All study arms demonstrated significant improvement in 6MWTD, PHQ9 and SF36 scores.

Conclusions:
IBCR and HBCR, are feasible rehabilitation models for HF in this setting. Adherence rates attained in both models are higher than those seen in many developed countries. Although our results demonstrate feasibility, future research should focus on methods to further improve adherence as well evaluate efficacy of cardiac rehabilitation in this setting.
Abstract P125: Cardiovascular Health Improves in High Transportation Vulnerable Girls With Decreased Exposures to Residential Segregation
Authors: D’Agostino Emily M , Patel Hersila H , Hansen Eric
Published: March 2019

Introduction:
Transportation equity ensures that all citizens benefit from a clean, fair, safe and healthy environment. Residential segregation also impacts health, and transportation disadvantage is particularly high in areas with high segregation, where residents typically lack proximity to quality education, jobs, healthy food, safe playgrounds, and medical care. Recent research demonstrates improvements in cardiovascular risk profiles among minority girls after reduced exposure to segregation. There is a need to examine differences in the segregation-youth cardiovascular health association across transportation vulnerability and gender to inform health equity interventions.

Hypothesis:
It was hypothesized that girls with reduced segregation exposure and low transportation vulnerability would have the most improved cardiovascular health.

Methods:
Data for these analyses were drawn from the Fit2Play dataset (2010-2018; N=2742). Youth were followed over 4 consecutive years of participation in a year-long afterschool physical activity program. Change in segregation exposure was based on concentration of minorities living in block groups from the participant’s home to program areas using the 2010 Census. Transportation vulnerability was based on percent of households in the participant’s home zip code with vehicle access (0, 1, 2, or ≥3 vehicles) drawn from the American Community Survey (2012-16). Longitudinal mixed models were used to compare the association between change in residential segregation and five cardiovascular health risk measures (body mass index, systolic and diastolic blood pressure, skinfold thickness and 400 meter run tests) stratified by transportation vulnerability and gender.

Results:
Participants were 54% male, 51% Hispanic, 49% non-Hispanic black, and 52% high poverty (mean age 9.5 years). After accounting for child age, race/ethnicity, poverty, and year, girls with high transportation vulnerability and reduced segregation exposure showed the most reduced cardiovascular health risk profiles, including improvements in body mass index (26%, 95% CI: 23.84, 28.30), skinfold thicknesses (18%, 95% CI: 14.90, 20.46), run time (17%, 95% CI: 14.88, 18.64), systolic blood pressure (15%, 95% CI: 11.96, 17.08), and diastolic blood pressure (12%, 95% CI: 9.09, 14.61). In contrast, no clear patterns emerged for low transportation vulnerable girls, and high or low transportation vulnerable boys.

Conclusions:
In conclusion, high transportation vulnerable girls exposed to reduced segregation had greater improvements in all cardiovascular health risk outcomes compared with low transportation vulnerable girls, and both high and low transportation vulnerable boys. Transportation equity interventions may provide a means to reduce youth cardiovascular health disparities, particularly for girls living highly segregated areas.
Abstract P130: Disparities in Out-of-hospital Cardiac Arrest Rates Among Adults, Aged ≥18 Years Old, With 9-1-1 Emergency Medical Service Activation’s in the United States, 2016
Authors: Nwaise Isaac , Odom Erika C
Published: March 2019

Introduction:
Out-of-hospital cardiac arrest (OHCA) is a significant public health issue.

Hypothesis:
This study aims to assess whether patients’ age, sex, race/ethnicity, and urban/non-urban status are associated with the rate of OHCA events among adults who accessed 9-1-1 emergency medical services (EMS) in 2016.

Methods:
We conducted a cross-sectional analysis using the 2016 National Emergency Medical Services Information System (NEMSIS), a national EMS database. OHCA events among adults aged ≥18 years were extracted by sex, age group, race/ethnicity, urban and non-Urban categories. Those with unknown race/ethnicity (45.8%) or of other race (1.3%) were excluded. Rates of OHCA events were calculated and Chi-square tests were used to assess associations.

Results:
We identified 205,461 OHCA events with EMS activations among non-Hispanic (NH) whites (68.1%), NH blacks (23.2%), and Hispanics (8.7%) in the 2016 NEMSIS dataset. Of the OHCA events, 59.5% were among males, 81.1% among urban residents, and 15.4% among non-urban residents. The overall OHCA rate was 19.6 per 1,000 EMS activations. OHCA rates per 1,000 EMS activations increased with age for adults until age 74, ranging from 11.2 (18-34 years) to 25.1 (65-74 years), then decreased with age for older adults ≥75 ranging from 22.3 (75-84 years) to 20.8 (≥85 years) (
p
<.0001). OHCA rates were higher among males 25.3, Hispanics 20.9, and urban residents 21.7 than females 15.6, other race ethnicities (NH whites 19.8 and NH blacks 18.7), and non-urban residents 17.6 (
p
<.0001) respectively.

Conlusions:
OHCA incidence rates among EMS activations increased with age until age 74. Adult males, Hispanics, and urban patients had statistically significant higher EMS activations for OHCA rates. Findings can be incorporated in community planning for improving EMS services.
Abstract P131: Sex Specific Patterns of Heart Rate Variability Following Acute Coronary Syndrome Do Not Drive 2-Year Hospital Readmission Outcomes
Authors: Oneil Adrienne , Scovelle Anna J , Taylor C. Barr , Hare David L , Thomas Emma , Toukhsati Samia , Oldroyd John , Oldenburg Brian
Published: March 2019

Introduction:
Women experience poorer clinical outcomes after Acute Coronary Syndrome (ACS). While the reason for this differential is unclear, autonomic function -indicative of vagal and sympathetic modulation directed to the sinus node- is a candidate mechanism.

Hypothesis:
That sex-specific differences in heart rate variability (HRV) in the year following ACS drive all-cause readmission outcomes after 2-years.

Methods:
416 ACS patients were enrolled in the ADVENT longitudinal cohort study after admission to a large cardiology hospital (January 2013 to June 2014). At 1 and 12 months following discharge, autonomic functioning was measured by HRV using time and spectral analysis via 3-lead electrocardiogram at the Study Centre. All-cause hospital readmission was collected from an audit of hospital records by medically trained researcher fellows. Hierarchical linear regression analyses were used to determine the extent to which HRV parameters (Standard Deviation of RR, Median RR (millisecond), Low Frequency Power, Very Low Frequency Power), drive sex-specific readmission outcomes (yes/no) over 2-years. Interaction terms (sex x individual HRV parameter) were used to determine the extent to which HRV was a modifier of the main effects model.

Results:
Women were more likely to be rehospitalized for all cause morbidity over the ensuing 2-years, however this was not statistically significant (Coef: 0.09; 95% CIs: -0.03, 0.21). The inclusion of only one of the HRV parameters (Median RR (ms)) substantially ameliorated the chance of women being readmitted (adj. Coef -0.47, 95% CIs: -1.38, 0.43; ns).

Conclusion:
Women experience significantly poorer autonomic functioning in the year following ACS, but this does not appear to influence sex-specific all-cause readmission over 2 years in a statistically meaningful way.
Abstract P133: Psychological Distress, Diabetes Self-Management, and Cardiovascular Disease Risk Factors Among a Primary Care Sample of Spanish Speaking Hispanic/Latinos With Type 2 Diabetes
Authors: Pompano Laura M , Gallo Linda C , Castañeda Sheila F , Garcia Melawhy , Muñoz Fatima , Mendoza Paulina , Talavera Gregory A
Published: March 2019

Aims:
The aim of this study was to examine the relationships between psychological distress (anxiety, depression, and diabetes-distress), diabetes self-management (DSM) behaviors, and cardiovascular disease (CVD) risk factors/diabetes control among adult primary care, non-insulin using Hispanic/Latino patients with type 2 diabetes.

Methods:
This abstract presents a cross-sectional analysis of the baseline data from an ongoing clinical trial of 456 Hispanic/Latino participants with type 2 diabetes (mean age 55.2 ± 9.8 years; 63.7% female) at a federally qualified health center in San Diego. General linear models were used to examine associations between anxiety, depression, and diabetes-distress (assessed using the Patient Health Questionnaire-8 [PHQ-8], the Generalized Anxiety Disorder 7-item scale [GAD-7], and the Diabetes Distress scale-2, respectively), DSM behaviors (assessed using the Summary of Diabetes Self-Care Activities Assessment [SDSCA]), and markers of CVD risk (glycated hemoglobin [HbA1c], body mass index, systolic and diastolic blood pressure, and HDL and LDL cholesterol), controlling for the demographics variables of age, sex, and education.

Results:
Moderate depression and anxiety symptoms (defined as a PHQ-8 and GAD-7 cutoff of 10) were present in the study sample at rates of 21.5% and 15.4%, respectively. Poorly controlled diabetes (HbA1c > 8.0%) was present in 40.6% of the sample. After controlling for covariates, all three indicators of psychological distress showed significant, negative associations with SDSCA (DSM) scores (p < 0.01). Depression and anxiety symptoms were positively associated with LDL cholesterol (p = 0.020 and p = 0.022, respectively). No other associations among psychological distress and CVD risk factors were significant. DSM behaviors were not associated with any CVD risk factors.

Conclusions:
Depression and anxiety affect a large percentage of the Hispanic/Latino population. As greater depression and anxiety symptoms were associated with worsened diabetes self-management behaviors, for example diet and glucose monitoring, there may be implications for DSM and other CVD risk factors. Psychosocial dimensions of health are important to consider when providing care and promoting self-management behaviors in this population, as promoted by frameworks such as the integrative care model.
Abstract P140: Sexual Orientation Disparities in Cardiovascular Risk Factors Differ by Sex and Race/Ethnicity Among High School Aged Youth
Authors: Beach Lauren B , Turner Blair C , Han Ying , Felt Dylan , Marro Rachel , Feinstein Brian A , Phillips Gregory L
Published: March 2019

Compared to their sex-matched heterosexual counterparts, sexual minority high school aged youth have been found to be more likely to be overweight or obese and less likely to meet physical activity guidelines. Racial/ethnic minority (REM) youth have been shown to face similar disparities. These disparities mirror the cardiovascular (CVD) health disparities that have also been detected among sexual minority and REM adults later in life. To date, no national studies have investigated how health disparities associated with poor future CVD outcomes differ at the intersections of sex and race/ethnicity among diverse sexual minority high school aged youth. To compare weight and physical activity outcomes using an intersectional approach, we performed sex-stratified logistic regressions using a pooled national Youth Risk Behavior Surveillance (YRBS) dataset from 2009-2015; White heterosexual students as the dual reference group for all analyses. From these regressions, adjusted Prevalence risk ratios (PRR) were calculated. A total of 409,843 high school aged youth who completed the YRBS surveys across 45 jurisdictions across the United States were included in analyses. Overall, by race/ethnicity, 47.7% of respondents were White, 16.6% were Black, 25.5% were Hispanic/Latino, and 10.2% were “Other” race youth. Among male youth, 92.6% identified as heterosexual, 2.2% as gay, 2.4% as bisexual, and 2.7% as not sure, while among female students, 85.9% identified as heterosexual, 1.86% as lesbian, 8.25% as bisexual, and 4.0% as not sure. With the exception of heterosexual and not sure Other race students, all sexual minority/REM female students had 1.51 to 2.23 times higher risk of being overweight or obese compared to White heterosexual students. All non-White and non-heterosexual male youth were at greater risk of not meeting physical activity guidelines compared to their White heterosexual male student counterparts. Significant interactions between race/ethnicity and sexual identity were detected for both overweight/obesity and physical activity outcomes among female but not male high school aged youth. Future work should continue to characterize CVD risk factors among sexual minority and REM youth and explore how the intersections of these identities may predict risk factors for CVD related outcomes across the life course.
Abstract P143: Late Success in Weight Loss Trials: Do Participants Start Losing Weight After 6 Months?
Authors: Jerome Gerald J , Dalcin Arlene T , Young Deborah R , Coughlin Janelle W , Gudzune Kimberly A , Durkin Nola , Wang Nae-Yuh , Yeh Hsin C , Daumit Gail L , Appel Lawrence J
Published: March 2019

Background:
Weight loss programs often start with an initial phase of intensive lifestyle coaching to facilitate early weight loss, with a typical weight loss goal of ≥ 5%. While early weight loss is associated with long-term weight loss success, less is known about those who do not lose weight in the initial phase. This study examines those without initial weight loss success, but lose weight later.

Methods:
Analyses included 346 obese adults from the POWER Hopkins weight loss trial and 673 overweight to obese adults from the PREMIER hypertension control trial. Mutually exclusive categories are based on weight loss success (≥ 5% reduction from baseline) at 6m and 12m: continued success (success 6m and 12m); regainer (success 6m then regained 12m); no success (no success 6m or 12m); and late success (12m success only).

Results:
No success (NS) was the most common category among control and intervention participants in both studies (see table). There were low rates of late success (LS) in POWER (intervention 5%, control 7%, p=.25) and PREMIER (intervention 5%, control 8%, p=.75). Within the POWER intervention, LS and NS were similar in age, sex, race, and baseline weight. Coaching contact rates were similar at 1-6m (LS 64%, NS 57%, p=.49) and 7-12m (LS 45%, NS 46%, p=.89). Within the PREMIER intervention LS had a lower baseline weight than NS (89 vs 99 kg, p=.01), but were similar in age, sex, and race. Coaching contact rates are similar at 1-6m (LS 77%, NS 72%, p=.23) and 7-12m (LS 66%, NS 62%, p=.58).

Conclusion:
Given the small fraction of intervention participants with late success (only 5%), alternative strategies are needed to address the large fraction of persons without initial weight loss success.
Abstract P146: Trends in Recurrent Coronary Heart Disease Following Myocardial Infarction Among US Men and Women Between 2008 and 2016
Authors: Peters Sanne A , Colantonio Lisandro D , Zhao Hong , Bittner Vera , Farkouh Michael , Dluzniewski Paul , Poudel Bharat , Muntner Paul , Woodward Mark
Published: March 2019

Background:
In the US, morbidity and mortality from coronary heart disease (CHD) has declined considerably from the 1970’s through the 2000’s. We examined whether rates of recurrent MI, recurrent CHD, heart failure hospitalization, and all-cause mortality among US men and women with a MI hospitalization have continued to decline between 2008 and 2016, and whether this differs between the sexes.

Methods:
Data were used from 1,369,617 (53% women) US adults <65 years of age with commercial health insurance in the MarketScan database and US adults ≥66 years of age with government health insurance through Medicare who had a MI hospitalization between January 1, 2008 and September 30, 2016. For each year, sex-specific rates of recurrent MI, recurrent CHD, heart failure hospitalization, and all-cause mortality (Medicare only) per 1,000 person-years were calculated at 30 days from the MI discharge date.

Results:
Between 2008 and 2016, rates of recurrent MI declined by 15%, from 190 to 162/1000 person-years, in men and by 27%, from 220 to 160/1000 person-years, in women. CHD recurrence rates decreased by 22%, from 311 to 244/1000 person-years, in men and by 32%, from 318 to 216/1000 person-years, in women (Figure). Heart failure hospitalization decreased by 4%, from 367 to 352/1000 person-years, in men and by 18%, from 517 to 425/1000 person-years, in women. Rates of 30-day mortality reduced by 5%, from 1,208 to 1,142/1000 person-years, in men and by 4%, from 1,416 to 1,358/1000 person-years, in women.

Conclusion:
Rates of recurrent MI, recurrent CHD, heart failure hospitalization, and all-cause mortality within 30 days after hospitalization for MI continue to decline in US adults, with greater reductions in the recurrence of CHD among women than men. Factors underpinning these trends warrant further investigation.
Abstract P147: Longer Duration on a Chronic Disease Management Plan is Associated with Fewer CVD-Related Readmissions by 3 Years Among Australian Survivors of Stroke
Authors: Ung David , Gerraty Richard P , Frayne Judith , Olaiya Muideen T , Kim Joosup , Srikanth Velandai K , Phan Thanh , Cadilhac Dominique A , Nelson Mark R , Bladin Christopher F , Thrift Amanda G
Published: March 2019

Background:
Chronic Disease Management (CDM) plans are usually administered by general practitioners (GPs) to assist those with a chronic medical condition, such as stroke, and provide better management of risk factors. Despite the prevalent use of CDM plans, its comprehensiveness and the fact that there is a government commitment to fund it, there is limited evidence of its effectiveness in Australian survivors of stroke. We aimed to assess the effectiveness of CDM plans on preventing the recurrence of CVD-related serious adverse events.

Methods:
Patients comprised survivors of stroke/TIA who participated in the Shared Team Approach between Nurses and Doctors For Improved Risk factor Management (STAND FIRM) trial (n = 563). We used standardised anthropometric, biochemical and blood pressure data, collected at baseline, to evaluate risk factors for stroke/TIA. Poisson regression models were used to determine the incidence rate ratio (IRRs) of increasing exposure to being on a CDM plan over 3 years, while adjusting for confounding factors. We used the total count of CVD-related events and deaths within
3
years after stroke/TIA, based on either hospital discharge codes or adjudication by two independent stroke specialists.

Results:
Five hundred and sixty-three patients were included (median age 70; 36% female). There were 305 CVD-related events over the three years (mean 0.54), in which a third (104) were adjudicated and two-thirds (201) were derived from hospital discharge codes alone. Nearly a quarter (27%) did not take up a CDM plan over the three years, a third (33%) were on plans for less than 1.5 years and 40% were on plans from 1.5 years to 3 years. The factors most strongly associated with decreased incidence of CVD-related events were duration on a CDM plan (Adjusted IRR (aIRR) 0.85, 95% confidence interval (95%CI) 0.77-0.93; p<0.001), higher level of education (aIRR 0.55, 95%CI 0.42-0.71; p<0.001), more physically active occupation (aIRR 0.54, 95%CI 0.41-0.70; p<0.001) and greater Assessment of Quality of Life (AQoL) score (aIRR 0.24, 95%CI 0.15-0.41; p<0.001).

Conclusion:
Being on a CDM plan for a longer duration appeared to reduce the occurrence of CVD-related events within 3 years after stroke, potentially via more closely controlled risk factors. Patients should be encouraged to return for regular reviews of their CDM plans to enhance secondary prevention strategies, and maintain a better quality of life.
Abstract P149: Ideal Cardiovascular Health is Associated With the Characteristics of and Better Access to Primary Care in a Publicly Funded Healthcare System
Authors: Singh Sarah S , Frisbee Stephanie J
Published: March 2019

Background:
Cardiovascular health (CVH) and CVD prevention remains a top public health priority across North America. The health of Canadians is largely accredited to the publicly funded healthcare system, which affords “free” healthcare to all its citizens. However, there is little evidence demonstrating whether the characteristics of and access to primary care by Canadians directly impacts their likelihood of ideal CVH.

Objective:
To examine the association between ideal CVH and the characteristics of and access to primary care in Canadians.

Data and Methods:
This study is a cross-sectional design using adult data from the Canadian Community Health Survey (CCHS) 2015-2016 database. The CCHS is a nationwide, nationally representative survey that collects information on the health status, health care access and utilization, and health determinants of the Canadian population. CVH, defined using the AHA CVH Index (CVHI), was determined using self-reported responses in CCHS. Weighted logistic regression was performed to examine the association between ideal CVH and the characteristics of and access to primary care, including having regular care, receiving coordinated care, ER use and access to routine care. Models were also adjusted for individual characteristics known to affect CVH.

Results:
The majority of the population were females (51%), aged 40-60 (37%), with tertiary education (64%) and of the White race (79%). Overall, 19% of the population had ideal CVH (ideal status in 6-7 CVHI factors), representing approximately 6 million individuals nationwide. Individuals reported having a regular primary healthcare provider (82%), insurance for prescription medication (76%), high coordination in their healthcare between health professionals (10%), difficulties in accessing routine care in the past 12 months (3%). The likelihood of ideal CVH were highest in those who reported having: a regular provider (OR 1.11, 95% CI 1.05-1.17), higher coordination of care (OR 1.10, 95% CI 1.01-1.20) and using the ER less frequently (OR 0.90, 95% CI 0.80-0.95). After controlling for age, sex and race, only having a regular provider (OR 1.11, 95% CI 1.02-1.20) and not reporting difficulties in accessing routine care in the past 12 months (OR 1.02, 95% CI 1.01-1.04) were significantly associated with ideal CVH.

Conclusion:
Findings from this study suggest that individuals experiencing better primary healthcare, including having a regular primary care physician or having less difficulty accessing care, are more likely to have ideal CVH than those experiencing poor primary healthcare. Further studies should investigate policies that promote better primary healthcare as interventions for preventing CVD and improving CVH.
Abstract P150: Age, Gender and Race Variations in QRS Duration in Patients With Atrial Fibrillation
Authors: Tahir Hassan , Nguyen Landai , Sachdev Sarina , Omar Bassam , Awan G. Mustafa , Malozzi Christopher , Rahimi Farnoosh
Published: March 2019

Background:
Atrial fibrillation (AF) is associated with increased incidence of congestive heart failure (CHF). While patients with intraventricular conduction delay were shown to have increased risk of atrial fibrillation, recent analysis of a study revealed increased mortality among patients with QRS 90-119 ms and AF. The demographics of QRS duration (QRSD) in AF remain under-studied.

Methods:
A University-based EKG database was randomly searched for 150 total EKGs: 75 EKGs were with AF; another 75 were with sinus rhythm, as a control group. Demographics, heart rate and QRSD were documented. QRSDs were retrieved from the baseline electrocardiograms of patients included in both groups, and were compared using student’s T test. Further subgroup analyses based on age, gender and race were also performed.

Results:
The mean QRSD in AF group was 102 ± 22 ms compared to 92 ± 19 ms in SR group (P < 0.05). In patient’s < 65 years of age, QRSD in AF group was 96 ± 12 ms compared to 92 ± 19 ms in SR group (P = NS); however, In patient’s ≥ 65 years of age, QRSD in AF group was 107 ± 26 ms compared to 91 ± 18 ms in SR group (P < 0.05). In males, QRSD in AF group was 102 ± 22 ms compared to 89 ± 16 ms in SR group (P < 0.05); however, in females, QRSD in AF group was 94 ± 21 ms compared to 93 ± 20 ms in SR group (P = NS). In white patients, QRSD in AF group was 102 ± 20 ms compared to 90 ± 14 ms in SR group (P < 0.05); however, in black patients, QRSD in AF group was 104 ± 27 ms compared to 94 ± 23 ms in SR group (P = NS).

Conclusion:
The incidence of AF, approaching 6 million in the US, continues to rise in epidemic proportions, and is expected to double over the next few decades as the population ages. The poor rate control in AF, in addition to the loss of the atrial contraction, are two main factors thought to be responsible for symptoms and development of CHF. In our cohort, we demonstrated a significant association between AF and widened QRSD, previously shown to correlate with poor outcome in AF patients. In age analysis, the development of intraventricular conduction delay (IVCD) was significant only in the elderly with AF, who are known to be at higher risk of CHF. IVCD was also more common in white patients compared to black patients; of interest, white patients have been previously shown to develop CHF at an older age compared to black patients, suggesting that IVCD may play a role in the CHF mechanism in this subgroup with AF. In our cohort, males, but not females, had a significantly wider QRSD in AF compared to control. Our findings shed some light on a potentially new mechanism of added morbidity and mortality in AF patients, with higher prevalence in elderly white males, a subgroup which may benefit from early detection and treatment of AF and CHF. Further studies will help validate our findings in a larger cohort and in patients with CHF diagnosis.
Abstract P152: A Personalised Home-Based Physical Activity Intervention for Chronic Heart Failure: Do Physiological Changes Correspond with Patient Experiences?
Authors: Okwose Nduka C
Published: March 2019

Background:
Referrals to physical activity and exercise programmes for patients with heart failure is suboptimal with high dropout rates in hospital-based programmes. Home-based programmes have gained popularity and help address this issue. The aim of the present study was to explore patients’ experiences of participating in a personalised homebased physical activity intervention programme and to explore whether experiences corresponded with physiological changes post intervention.

Methods:
Twenty patients (68±7 years) with chronic heart failure (13±11 years) due to reduced ejection fraction underwent a 12-week personalised home-based physical activity programme. This involved increasing daily pedometer step count by 2000 steps from baseline. Patients completed exercise, cardiac function and quality of life tests pre-post intervention. Sixteen of the 20 patients attended one of three focus group discussions to provide their views around the decision to participate in the programme and their experience of the programme when enrolled.

Results:
Seventeen patients (85%) completed the intervention, and 15 patients achieved the daily target step count which increased from baseline to 3 weeks by 2546 (5108±3064 to 7654±3849, p=0.03), and maintained until week 12 (9022±3942). On completion of the intervention, quality of life improved by 15% (26±18 vs. 22±19), cardiac index and stroke volume increased by 11% and 19% respectively (6.8±1.5 vs. 7.6±2.0 L/min/m2; and 127 ± 34 vs 151 ± 34, P=0.05). Workload and O2 consumption at anaerobic threshold increased by 16% (49±16 vs. 59±14 watts, p=0.01) and 10% (11.5±2.9 vs 12.8±2.2 ml/kg/min). Thematic analyses identified 10 themes influencing participation and maintenance. These included patient’s fear of engaging in physical activity, family influences on engagement with physical activity, support from clinicians and research staff, and increased confidence as a result of participating in a personalised programme.

Conclusion:
A personalised home-based physical activity intervention programme is feasible and for patients with stable chronic heart failure and led to improved quality of life and submaximal exercise capacity. However, qualitative findings suggest that outcomes are likely to be contingent on personalised feedback and support from suitably trained team members to increase confidence and self-efficacy, family support, and endorsement of the programme from a clinician.
Abstract P156: Kidney Function and Serum Potassium as Predictors of Spironolactone Initiation in Congestive Heart Failure
Authors: Secora Alex , Shin Jung-Im , Qiao Yao , Alexander G. Caleb , Coresh Josef , Grams Morgan
Published: March 2019

Introduction:
There are a paucity of data on real-world spironolactone use among patients with congestive heart failure (CHF), and whether spironolactone initiation differs by kidney function and serum potassium.

Hypothesis:
Patients with reduced kidney function and elevated serum potassium are less likely to be prescribed spironolactone than patients with normal kidney function and serum potassium.

Methods:
We identified patient cohorts with incident CHF and available laboratory data in the Truven MarketScan Commercial Claims and Encounters database (MS) from 2010-2015 (N=22,881), and the Geisinger Health System Integrated Electronic Health Record (GHS) from 2004-2016 (N=17,470), and assessed medication use through prescription order and dispensing data, and comorbidities using ICD codes. We measured incidence, initial dose, and duration of incident spironolactone use, overall and by levels of kidney function and serum potassium. We used Cox proportional hazards regression models to quantify the association between measures of baseline and time-varying estimated glomerular filtration rate (eGFR) and serum potassium, and incident spironolactone use, adjusting for other medication use and comorbidities.

Results:
Among 22,881 incident CHF patients in the MS database, mean age at CHF was 54.3 (±8.7) years, 47.2% were female, and the mean eGFR was 78.9 ml/min/1.73m
2
(±21). The 17,470 incident CHF patients in GHS were older (74.0 years ±12.9), more likely to be female (51.5%), and have a lower mean eGFR (62.5 ±24.3). Both cohorts had a mean baseline serum potassium of 4.3 mEq/L (±0.5). There were 1,341 (1,774) incident prescriptions for spironolactone over 34,384 (52,187) person-years in MS (GHS). Median starting dose was 25 mg in both cohorts. Women were less likely to start spironolactone in both cohorts, while older patients were less likely to start spironolactone only in GHS. Compared to patients with eGFR >90 ml/min/1.73m
2
, those with eGFR <30 ml/min/1.73m
2
were less likely to initiate spironolactone in MS (hazard ratio [HR] = 0.57, 95% confidence interval [CI]: 0.38-0.84) and GHS (HR = 0.69, CI: 0.48-0.99). Patients with serum potassium <3.5 mEq/L were more likely to initiate spironolactone compared to those with 3.5-4.9 mEq/L (normal) in both cohorts (HR=1.99 [95% CI: 1.57-2.52] in MS; HR=2.70 [95% CI: 2.34-3.26] in GHS).

Conclusion:
Consistent with the labeled guidelines, patients with CHF and reduced kidney function were less likely to use spironolactone, while those with lower serum potassium levels were more likely to use spironolactone.
Abstract P167: Exergaming Experience: Perspectives of Patients With Heart Failure
Authors: Cacciata Marysol C , Evangelista Lorraine
Published: March 2019

Background:
Heart failure (HF) is a chronic illness that affects the physical and psychosocial well being of individuals afflicted with this debilitating disease. Physical activity in patients with HF is known to have positive outcomes. Exergaming is a new form of physical activity that has gained popularity among older adults and with older individuals with chronic illnesses. This home-based exercise platform has the potential to improve the physical activity in patients with HF.

Aims:
To explore HF patients perceived facilitators, attitudes and experiences when using an exergame platform at home utilizing the Nintendo Wii sports. This qualitative study was conducted as part of a larger study to determine feasibility and usability of using a home-based exercise program to improve the physical and psychosocial well-being in patients with HF.

Methods:
Semi-structured face to face interviews were conducted in 13 participants diagnosed with HF (5 women, age range between 35 and 67 years old). The participants were recruited at a university hospital HF clinic in Southern California. Participants were asked about their experience with exergames. Exergaming devices were installed in participants’ homes and they were given advice to use the devices a minimum of 30 minutes a day. The interviews evolved around themes such as acceptance of exergame, usefulness and engagement. Transcribed interviews were analyzed with content analysis.

Results:
The exergame device was easy to use. The virtual reality environment appeared real. However, participants verbalized challenges with hand-eye coordination in playing some of the games. Not all participants felt improvement in their physical activity. Participants reported eagerness and fun with exergaming but engagement diminished overtime. Greater variation of exergames were identified to reduce monotony.

Conclusion:
This study provided insight on the value of home-based exercise platform using technology in improving the physical activity of participants with HF. Participants’ perceptions of usefulness, acceptability and engagement are warranted to ensure that exergaming will achieve the intended aim of improving physical activity and ultimately improve the overall well being and health care delivery in this patient population.
Abstract P169: The Impact of Perceived Cardiovascular Risk on Cardiovascular Prevention Behaviors in People Living With HIV
Authors: Webel Allison R , Currie Jackson , Horvat Davey Christine , Schexnayder Julie , Al Battashi Hamed , Longenecker Christopher
Published: March 2019

Objective:
To examine whether HIV status influences knowledge, beliefs and perception of risk for cardiovascular disease (CVD) and how this influences CVD prevention behaviors (exercise, diet, and adherence to preventative CVD drug therapy).

Methods:
We conducted a cross-sectional study of HIV infected and demographically similar uninfected adults ≥ 30 years of age. Participants completed a self-reported survey on CVD risk perceptions, a self-reported CVD medication adherence survey, and three dietary intake interviews to assess overall diet quality. All wore an ActiGraph accelerometer for 7-10 days to measure physical activity. Wilcoxon rank-sum and
t
-tests were used to analyze the differences between groups and multiple linear regression was used to analyze the extent to which perceptions were associated with CVD prevention behaviors.

Findings:
Overall, 191 (105 HIV-infected and 86 HIV-uninfected) persons participated. Participants were on average 54 years old, 58% male, and 81% African American without difference by group (all
p
>0.05). People living with HIV (PLHIV) engaged in significantly less moderate-to-vigorous physical activity (median 0 vs 34 minutes per week,
p
=0.006). However, participants had similar, but poor, overall diet quality (overall
Healthy Eating Index
score 45.14), and similar smoking rates (56.5%), statin use (51%) and blood pressure medication use (50%;
p
for all comparison >0.05). PLHIV reported significantly better adherence to CVD prevention medications (94 vs 68%,
p
<0.001). There were no differences in perceived CVD risk between the two groups (
p
>0.05). In age and sex-adjusted models, HIV status was positively associated with medication adherence (
p
<0.001), and the interaction of HIV status and perceived severity of CVD were inversely associated with physical activity (
p
<0.05).

Conclusion:
Overall, PLHIV were more likely to adhere to CVD prevention medications than well-matched HIV-uninfected adults and less likely to engage in moderate-to-vigorous physical activity in this study. However, this difference in physical activity is attenuated among those who perceive higher risk from CVD. Interventions targeting perceived CVD susceptibility and severity may help to increase physical activity in this population.