Patient-Centred Modular Secondary Prevention Improves Risk Factors (RFs), Global Risk and Knowledge Following Acute Coronary Syndrome (ACS): A Randomised Controlled Trial

Abstract

Ralph Reader Prize – Clinical Science 1 Patient-CentredModular SecondaryPrevention Improves RiskFactors (RFs),GlobalRisk andKnowledgeFollowing Acute Coronary Syndrome (ACS): A Randomised Controlled Trial Julie Redfern1,∗, Tom Briffa 2, Elizabeth Ellis 1, Ben Freedman1,3 1University of Sydney, NSW, Australia; 2 University of Western Australia, WA, Australia; 3 Cardiology Department, Concord Hospital, NSW, Australia Background:Approximately 80%of eligibleACSsurvivors receive no cardiac rehabilitation (CR). We have shown their baseline risk factors (RFs) and knowledge are significantly worse than CR attendees and hypothesised they would benefit from a patient-centred modular program. Methods: ACS survivors not accessing CR were randomised to conventional care (n= 72) or a modular program (n= 72) comprising lowering cholesterol and choice of modules to lower other RFs. RFs and knowledge were blindly assessed at baseline, 3 and 12 months and compared with CR attendees (n= 64). All groups had similar demographics. Results: Modular and control groups were well matched 2 Baseline and “On-Treatment” Risk Scores for Predicting Mortality in Patients with Infective Endocarditis R. Sy1,2,∗, C. Chawantanpipat 2, D. Richmond2, L. Kritharides1 1Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia; 2 Department of Cardiology Royal Prince Alfred Hospital, Sydney, Australia Background: Incorporation of baseline and “ontreatment” parameters in the prognostic classification of adults with infective endocarditis (IE) has the potential to guide management and improve prognosis. Methods:Westudied 273 consecutive patients admitted to two independent centres with a diagnosis of IE between 1996 and 2006 (derivation cohort, centre A, n= 192; validation cohort, centre B, n= 81). Clinical and laboratory parameters were collected at baseline (Model 1) and 1 week (Model 2) after admission. Associations with mortality were tested by univariate and multivariate Cox proportional-hazards analysis in the derivation cohort. Independent predictors were combined to derive a risk score for each patient, and Models 1 and 2 were tested against the validation cohort. All-cause mortality at 6months (centreA24%, centreB 32%)wasdetermined from medical records and government registry data. for baseline cardiovascular risk, which was significantly higher thanCR.At12months, themodulargroupachieved significantly lower global risk and RF levels than controls and similar to CR. Knowledge of TC, BP and exercise improved significantly in the modular group and knowledge correlated with lower RFs.