Cardiac Rehabilitation Attendees Research Articles

Validity of the Active Australia Survey in an Australian cardiac rehabilitation population

ObjectivesTo examine the long-term validity of the Active Australia Survey in a cardiac rehabilitation population using accelerometry as the reference measure. DesignCohort validation study. MethodsCardiac rehabilitation participants with coronary heart disease were recruited to a prospective cohort study. Over 7-days, 61 participants wore an ActiGraph ActiSleep accelerometer (1-second epoch, 10-minute bout) and completed the self-administered Active Australia Survey at baseline, 6-weeks, 6 and 12-months. Total daily moderate-to-vigorous physical activity from both methods was compared using Bland-Altman plots and Spearman rank-order correlations. ResultsParticipants tended to over-report moderate-to-vigorous physical activity, with more active participants more likely to over-report moderate-to-vigorous physical activity. There was a good level of agreement between the accelerometer 1-second epochs and Active Australia Survey at all time points (mean bias (ratio) 1.04, 1.16, 1.14, and 1.06, respectively), with weak-moderate correlations (ρ = 0.3-0.48). Conversely, there was a poor level of agreement between the accelerometer 10-minute bouts and Active Australia Survey at all time points (mean bias (ratio) 6.78, 9.09, 6.35, and 5.68, respectively), with weak-moderate correlations (ρ = 0.3-0.52). Agreement between the two measures did not improve over time for both 1-second and 10-minute bout accelerometry data. ConclusionsThe Active Australia Survey may be an acceptable self-report measure of moderate-to-vigorous physical activity in cardiac rehabilitation attendees when capturing any time spent in moderate-to-vigorous physical activity. The Active Australia Survey may be useful to routinely monitor physical activity levels over-time in Australian cardiac rehabilitation programs at both individual and group levels. Trial registrationTrial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12615000995572, http://www.ANZCTR.org.au/ACTRN12615000995572.aspx.

Very brief intervention for physical activity behaviour change in cardiac rehabilitation: protocol for the ‘Measure It!’ effectiveness–implementation hybrid trial

IntroductionPhysical inactivity is a risk factor for repeat cardiac events and all-cause mortality in coronary heart disease (CHD). Cardiac rehabilitation, a secondary prevention programme, aims to increase physical activity levels...

Association of device-measured physical activity and sedentary behaviour with cardiovascular risk factors, health-related quality-of-life and exercise capacity over 12-months in cardiac rehabilitation attendees with coronary heart disease

BackgroundFew studies have considered the relationship between risk factors, physical activity and sedentary behaviour in people with heart disease. Here we examine the independent relationship of device-measured physical activity and sedentary behaviour on risk factors, quality-of-life and exercise capacity over 12-months in cardiac rehabilitation attendees.MethodsHospital-based phase II cardiac rehabilitation participants with coronary heart disease were assessed at the start and end of cardiac rehabilitation (6-weeks), 6 and 12-months. Physical activity (moderate-to-vigorous (MVPA), light-intensity (LIPA); min/day) and sedentary behaviour (min/day, bouts, breaks) were measured using an ActiGraph accelerometer. Risk factors included waist circumference, body mass index, systolic blood pressure (SBP), fasting blood lipid and glucose levels, anxiety and depression. Quality-of-life and exercise capacity were also collected. Associations were assessed with Generalized Estimating Equation modeling.ResultsSixty-seven participants were included (mean age = 64 (SD 9) years; 81% male). An association was found between higher MVPA and lower high density lipoprotein (p ≤ 0.001). No significant (p ≤ 0.001) associations were found between sedentary behaviour variables and other outcomes. At p < 0.05 several associations were significant. Increased MVPA and LIPA were associated with decreased total cholesterol. Higher MVPA was associated with decreased SBP, whereas higher LIPA was associated with decreased waist circumference and body mass index. Higher sedentary behaviour bouts and breaks were associated with increased total cholesterol, anxiety and depression, and decreased SBP over time.ConclusionsAny intensity of physical activity was associated with decreased total cholesterol. Increased LIPA was associated with improved measures of adiposity, while breaking up sedentary behaviour and increasing MVPA may decrease SBP over time. Further investigation of MVPA, LIPA and the distribution of sedentary behaviour is indicated in cardiac rehabilitation attendees to explore their relationship with risk factors.Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12615000995572, http://www.ANZCTR.org.au/ACTRN12615000995572.aspx. Registered 22 September 2015.

Association of Device-Measured Physical Activity and Sedentary Behaviour With Cardiovascular Risk Factors, Health-Related Quality-Of-Life And Exercise Capacity Over 12-Months in cardiac Rehabilitation Attendees With Coronary Heart Disease

Few studies have considered the relationship between risk factors, physical activity and sedentary behaviour in people with heart disease. Here we examine the independent relationship of device-measured physical activity and sedentary behaviour on risk factors, quality-of-life and exercise capacity over 12-months in cardiac rehabilitation attendees with coronary heart disease.

Impact of cardiac rehabilitation on 3 year outcomes amongst patients after acute coronary syndrome: (ACS) SNAPSHOT ACS follow-up study

Abstract Background Cardiovascular disease is the leading cause of disease burden globally. With advancements in medical and surgical care more people are surviving initial acute coronary syndrome (ACS) and are in need of secondary prevention and cardiac rehabilitation (CR). Increasing availability of high quality individual-level data linkage provides robust estimates of outcomes long-term. Purpose To compare 3 year outcomes amongst ACS survivors who did and did not participate in Australian CR programs. Methods SNAPSHOT ACS follow-up study included 1806 patients admitted to 232 hospitals who were followed-up by data linkage (cross-jurisdictional morbidity, national death index, Pharmaceutical Benefit Schedule) at 6 and 36 months to compare those who did/not attend CR. Results In total, the cohort had a mean age of 65.8 (13.4) years, 60% were male, only 25% (461/1806) attended CR. During index admission, attendees were more likely to have had PCI (39% v 14%, p&amp;lt;0.001), CABG (11% v 2%, p&amp;lt;0.001) and a diagnosis of STEMI (21% v 5%, p&amp;lt;0.001) than those who did not attend. However, there was no significant difference between CR attendees/non-attendees for risk factors (LDL-cholesterol, smoking, obesity). Only 19% of eligible women attended CR compared to 30% of men (p&amp;lt;0.001). At 36 months, there were fewer deaths amongst CR attendees (19/461, 4.1%) than non-attendees (116/1345, 8.6%) (p=0.001). CR attendees were more likely to have repeat ACS, PCI, CABG at both 6 and 36 months (Table). At 36 months, CR attendees were more likely to have been prescribed antiplatelets (78% v 53%, p&amp;lt;0.001), statins (91% 73%, p&amp;lt;0.001), beta-blockers (11% v 13%, p=0.002) and ACEI/ARBs (72% v 61%, p&amp;lt;0.001) than non-attendees. Conclusions Amongst Australian ACS survivors, participation in CR was associated with less likelihood of death and increased prescription of pharmacotherapy. However, attendance at CR was associated with higher rates of repeat ACS and revascularisation. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): New South Wales Cardiovascular Research Network, National Heart Foundation

Predictors of Quitting Smoking in Cardiac Rehabilitation.

Quitting smoking and participation in cardiac rehabilitation (CR) are effective strategies in reducing morbidity and mortality. However, little is known about the predictors of quitting smoking in those who attend CR. This study aimed to determine the sociodemographic and clinical factors associated with the likelihood of CR attendees who are quitting smoking. Data from the UK National Audit of Cardiac Rehabilitation (NACR) database, between April 2013 and March 2016, were used. Smoking status is categorized as smokers and quitters, assessed by patient self-report. The study used patient demographics, cardiovascular risk factors, comorbidities, and physical and psychosocial health measures. Binary logistic regression was performed to identify the predictors of quitting smoking among CR attendees. Of the 3290 patients who started CR and were entered into the NACR database, 2052 were continued smokers (mean age 58.59 ± 10.49 years, 73.6% men) and 1238 were quitters (mean age 57.63 ± 10.36 years, 75.8% men). The median duration of CR was 9 weeks. Compared to smokers, the quitters were younger, weighed more, were less anxious and depressed, and were more likely to be employed. Single patients had 0.60 times lower odds (95% CI 0.43 to 0.82) of quitting smoking than patients with partners, and low-risk patients had 1.71 times higher odds (95% CI 1.12 to 2.62) of quitting smoking than high-risk patients. Increasing number of comorbidities and depression scores were associated with decreasing likelihood of quitting. This study highlights the routine factors that determine smoking cessation outcomes, which could inform the delivery of CR to better help patients to quit smoking.

Health Literacy of Patients Attending Cardiac Rehabilitation.

Cardiac rehabilitation (CR) is effective at reducing further cardiac events. However, dropout rates are high, and maintenance of behavioral change post-CR is challenging. Health literacy (HL) may influence self-management of cardiac risk, yet few studies have explored this association. This study aimed to describe HL among CR attendees; first to describe the HL profiles of people commencing CR and second to examine HL changes between program entry and completion. CR attendees in Melbourne, Australia, completed the Health Literacy Questionnaire (HLQ) at program admission and completion. The HLQ measures HL across 9 scales. Cluster analysis grouped participants according to their HL profile. Effect sizes were used to determine changes in HLQ scores. Post-program interviews explored the role of HL in participant recovery. Participants completed baseline (n = 60) and post-program (n = 38) data collection. Mean age was 60.3 ± 11.7 yr, and 38.3% had myocardial infarction and/or percutaneous coronary intervention. Approximately 18% of participants did not complete the program. Five HL clusters were revealed. The clusters most likely to drop out were confident users of the health system. The cluster least likely to drop out reported lower confidence in their ability to find health information and navigate services. Information-seeking ability improved over time, but no other HL improvements were seen. There is a wide range of HL profiles in people attending CR. Findings suggest that CR programs should consider a variety of approaches to meet the diverse HL requirements of attendees.

Correction: Translation, Cross-cultural Adaptation and Psychometric Validation of the Korean-Language Cardiac Rehabilitation Barriers Scale (CRBS-K).

Objective To perform a translation and cross-cultural adaptation of the Cardiac Rehabilitation Barriers Scale (CRBS) for use in Korea, followed by psychometric validation. The CRBS was developed to assess patients' perception of the degree to which patient, provider and health system-level barriers affect their cardiac rehabilitation (CR) participation. Methods The CRBS consists of 21 items (barriers to adherence) rated on a 5-point Likert scale. The first phase was to translate and cross-culturally adapt the CRBS to the Korean language. After back-translation, both versions were reviewed by a committee. The face validity was assessed in a sample of Korean patients (n=53) with history of acute myocardial infarction that did not participate in CR through semi-structured interviews. The second phase was to assess the construct and criterion validity of the Korean translation as well as internal reliability, through administration of the translated version in 104 patients, principle component analysis with varimax rotation and cross-referencing against CR use, respectively. Results The length, readability, and clarity of the questionnaire were rated well, demonstrating face validity. Analysis revealed a six-factor solution, demonstrating construct validity. Cronbach's alpha was greater than 0.65. Barriers rated highest included not knowing about CR and not being contacted by a program. The mean CRBS score was significantly higher among non-attendees (2.71±0.26) than CR attendees (2.51±0.18) (p<0.01). Conclusion The Korean version of CRBS has demonstrated face, content and criterion validity, suggesting it may be useful for assessing barriers to CR utilization in Korea.

Improvements in Depressive Symptoms and Affect During Cardiac Rehabilitation: PREDICTORS AND POTENTIAL MECHANISMS.

Depression is indicative of poor prognosis in cardiac patients. Reductions in depression have been observed following cardiac rehabilitation (CR). Whether similar improvements in positive and negative affect occur is unknown. Greater understanding of depressive symptom and affect change is needed to enhance facilitators of emotional improvement after a cardiac event. Cardiac rehabilitation attendees (n = 637) completed measures of depressive symptoms, affect, health status, and social support at CR intake and discharge. Body mass index, metabolic equivalents, and blood pressure were also measured. Relationships between changes in psychosocial and physical health indicators and depressive symptoms, positive affect, and negative affect were examined. From intake to discharge, depressive symptoms (d = 0.40, P < .001) and negative affect (d = 0.26, P < .001) decreased. Positive affect increased (d = 0.34, P < .001). In multivariate regression, predictors of depressive symptom reduction were increased vitality (β = -.26) and decreased bodily pain (β = -.08). Predictors of positive affect increase were increased vitality (β = .25), social support (β = .16), and physical role functioning (β = .09). Predictors of negative affect reduction were increased vitality (β = -.23) and social support (β = -.10). Changes in indicators of physical health were not related to depressive symptom or affect change. Depressive symptom and affect improvements following CR were observed and most strongly associated with improvements in vitality and social support. Future research should explore how enhancement of these mechanisms may further improve depressive symptom and affect during CR.

Examination of clinical and psychosocial determinants of exercise capacity change in cardiac rehabilitation

PurposeMost cardiac rehabilitation (CR) completers improve in multiple functional and psychosocial domains. However, not all demonstrate uniform improvement in functional indicators such as exercise capacity. This study examined baseline predictors and correlates of change in exercise capacity from CR intake to completion. MethodsCR participants (n = 488) completed assessment of metabolic equivalents (METs) via treadmill stress test, depressive symptoms, quality of life, and social support at intake and discharge. Associations between demographic, clinical, and psychosocial factors and MET changes was tested with linear regression. ResultsMETs increased from intake to discharge (1.91 ± 1.48, p < .001). Younger age (p < .001), lower BMI (p < .001), and lower weight (p < .01) were associated with greater MET change. Greater percentage weight loss (p < .05), and self-reported improvements in physical functioning (p < .001) and bodily pain (p < .01) were concurrently related to MET change. ConclusionsOlder CR attendees and those with higher baseline BMI may benefit from tailored intervention to ensure maximum benefit in exercise capacity.

Translation, Cross-cultural Adaptation and Psychometric Validation of the Korean-Language Cardiac Rehabilitation Barriers Scale (CRBS-K).

ObjectiveTo perform a translation and cross-cultural adaptation of the Cardiac Rehabilitation Barriers Scale (CRBS) for use in Korea, followed by psychometric validation. The CRBS was developed to assess patients' perception of the degree to which patient, provider and health system-level barriers affect their cardiac rehabilitation (CR) participation.MethodsThe CRBS consists of 21 items (barriers to adherence) rated on a 5-point Likert scale. The first phase was to translate and cross-culturally adapt the CRBS to the Korean language. After back-translation, both versions were reviewed by a committee. The face validity was assessed in a sample of Korean patients (n=53) with history of acute myocardial infarction that did not participate in CR through semi-structured interviews. The second phase was to assess the construct and criterion validity of the Korean translation as well as internal reliability, through administration of the translated version in 104 patients, principle component analysis with varimax rotation and cross-referencing against CR use, respectively.ResultsThe length, readability, and clarity of the questionnaire were rated well, demonstrating face validity. Analysis revealed a six-factor solution, demonstrating construct validity. Cronbach's alpha was greater than 0.65. Barriers rated highest included not knowing about CR and not being contacted by a program. The mean CRBS score was significantly higher among non-attendees (2.71±0.26) than CR attendees (2.51±0.18) (p<0.01).ConclusionThe Korean version of CRBS has demonstrated face, content and criterion validity, suggesting it may be useful for assessing barriers to CR utilization in Korea.

Cardiovascular Disease Self-Management: Pilot Testing of an mHealth Healthy Eating Program.

Cardiac rehabilitation (CR) is crucial in the management of cardiovascular disease (CVD), yet attendance is poor. Mobile technology (mHealth) offers a potential solution to increase reach of CR. This paper presents two development studies to determine mobile phone usage in adults with CVD and to evaluate the acceptability of an mHealth healthy eating CR program. Methods: CR attendees were surveyed to determine mobile phone usage rates. A second single-subject pilot study investigated perceptions of a 4-week theory-based healthy eating mHealth program and explored pre-post changes in self-efficacy. Results: 74 adults with CVD completed the survey (50/74 male; mean age 63 ± 10). Nearly all had mobile phones (70/74; 95%) and used the Internet (69/74; 93%), and most were interested in receiving CR by text message (57/74; 77%). 20 participants took part in the healthy eating pilot study. Participants read all/most of the text messages, and most (19/20) thought using mobile technology was a good way to deliver the program. The website was not widely used as visiting the website was reported to be time consuming. Exploratory t-tests revealed an increase in heart healthy eating self-efficacy post program, in particular the environmental self-efficacy subset (Mean = 0.62, SD = 0.74, p = 0.001). Conclusions: Text messaging was seen as a simple and acceptable way to deliver nutrition information and behavior change strategies; however, future research is needed to determine the effectiveness of such programs.

Abstract P350: Completion of Cardiac Rehabilitation Reduces Hospital Admission Rates in Long Term Follow-up

Introduction: Cardiac rehabilitation (CR) improves exercise tolerance, quality of life, and mortality among patients with heart disease in short term follow-up. Less is known regarding the sustained benefits attributable to CR after 1 year. Hypothesis: CR attendees have decreased morbidity, represented by lower admission rates. Methods: A database of patients referred to CR between May 2001 and January 2011 was constructed. Data on gender, race, age, and attendance was collected. Completion of CR was designated as 36 sessions. Participants attending 1 to 35 sessions were excluded. All cause hospitalization was recorded from the date of primary cardiac diagnosis. Data was analyzed using a t-test to compare hospitalization rates between participants and non-participants. Baseline admission rates were compared. Results: 162 participants competed CR, 84 (52%) of minority race, 98 (60%) males, 95 (59%) were 65 or older. There were 229 non-participants, 147 (64%) of minority race, 147 (64%) males, 77 (34%) were 65 or older. Mean follow up time was 6 years. Completion of CR resulted in lower mean hospitalization rates (1.19 vs. 2.93, p = 0.001) in all groups: Caucasians 0.92 vs. 2.99 (p = 0.005), minorities 1.44 vs. 2.89 (p = 0.035), males 1.32 vs. 2.89 (p = 0.011), females 1.00 vs. 3.02 (p = 0.003), age 65 or older 0.96 vs. 3.96 (p = &lt;0.001). There was no difference in baseline mean hospitalization rates between participants and non-participants when comparing race or gender: non-participant Caucasians 2.99 vs. minorities 2.89 (p = 0.895), participant Caucasians 0.92 vs. minorities 1.44 (p = 0.246), non-participant males 2.87 vs. females 3.02 (p = 0.834), participant males 1.32 vs. females 1.00 (p=0.489). There was no difference in baseline mean hospitalization rates when comparing participants younger than 65 with 65 or older (1.52 vs. 0.96, p = 0.212). Non-participants 65 or older had significantly higher hospitalization rates than younger non-participants (3.96 vs. 2.33, p = 0.027). Conclusions: Long term follow-up of CR participants demonstrated a sustained morbidity benefit. Previous studies were limited to 1 year follow-up. Race, gender, and age did not influence morbidity, although participants older than 65 may have an additional morbidity reduction.

Perceptions of barriers to cardiac rehabilitation use in Brazil

Cardiovascular diseases (CVD) are the leading cause of mortality in middle-income countries, such as Brazil. However, given the diversity in health care systems in Brazil, access to proven services, such as cardiac rehabilitation (CR), varies widely.PurposeTo describe and compare multilevel barriers to CR enrollment and participation in three Brazilian cohorts: (1) cardiac outpatients not attending CR (public or private system); (2) cardiac outpatients paying for CR; and (3) residents at high-risk of CVD with access to a free comprehensive exercise program but not making use of the program.MethodsBrazilian residents from two cities were invited to participate – Florianopolis, an urban center; and Luzerna, a rural center. Respondents completed a survey including the Cardiac Rehabilitation Barriers Scale. Mann–Whitney U tests were used to compare barriers between cohorts cross-sectionally.ResultsSix hundred twenty-eight Brazilians consented to participate: 237 (37.7%) from Florianopolis, of which 139 (22.1%) participated in CR; and 391 (62.3%) from Luzerna. The mean total CR barriers for the sample were 1.66 ± 0.6 and differed significantly by cohort (P < 0.001). CR nonattendees from Florianopolis (eg, distance and not knowing about CR) and participants from Luzerna (eg, work and family responsibilities) reported significantly higher barriers than CR attendees from Florianopolis.ConclusionCR nonattendees reported significantly greater barriers than CR attendees. It is hoped that the provision of CR will increase, and that the development of the programs will be in a manner which mitigates the chief barriers identified herein.

Clinical outcomes associated with depression, anxiety and social support among cardiac rehabilitation attendees.

While the authors’ [1] conclusion may appear conceptually attractive, there is little evidence to support the twin propositions that ‘depression is one of the most potent psychosocial risk factors ...

Clinical Outcomes Associated with Depression, Anxiety and Social Support Among Cardiac Rehabilitation Attendees

To utilize existing medical record information in order to examine the relationship between depression, anxiety, levels of social support and clinical outcomes in cardiac rehabilitation attendees. In a tertiary care centre 389 records for cardiac rehabilitation outpatients were analysed. Hospital Anxiety and Depression Scales scores collected at week 4 of their cardiac rehabilitation programme were linked with medical record information on demographic, lifestyle, medical and other coronary heart disease risk factors, as well as follow-up cardiovascular events and readmissions for an average of 2.6 years. Variables of interest were anxiety and depression scores and proxy measures of social support. Clinical outcome measures were number of hospital admissions, length of stay and mortality. Multiple variable analysis revealed higher anxiety scores were associated with more hospital admissions and higher depression scores were associated with longer length of stay after controlling for other established prognostic risk factors. Depression, anxiety and social support were not associated with mortality, however there was a low mortality rate in the present study. A comprehensive summary of the characteristics of cardiac rehabilitation patients was gathered through the linkage and examination of existing clinical databases. The results of this study provide some support for a prognostic role of depressive and anxiety symptoms and highlight the need for screening for psychological distress and provision of appropriate interventions when indicated.

Cardiac Rehabilitation, Health Behaviors, and Body Mass Index Post-Myocardial Infarction

Cardiac rehabilitation (CR) is a multifactorial program that encourages healthy behaviors in persons with a recent cardiovascular event or procedure. Research on the association between CR and health-behavior maintenance has focused on physical activity. Therefore, the purpose of this research was to examine the association of health behaviors (fruit/vegetable consumption and physical activity) and body mass index (BMI) with CR attendance and time since participation in respondents reporting history of myocardial infarction (MI). This was a cross-sectional study using the 2003 Behavioral Risk Factor Surveillance System (n = 1,374). Eligible respondents were those with a history of MI. Outcomes were fruit/vegetable consumption, physical activity, and BMI. Time since CR was based on age at MI and age at survey. Logistic (polytomous) regression was used to identify predictors. CR attendees were 69% more likely to meet fruit/vegetable guidelines than were nonattendees (P = .02). CR was not associated with meeting physical activity guidelines. CR had a protective, yet nonsignificant effect on BMI. Meeting fruit/vegetable guidelines was associated with CR attendance in the past year (odds ratio = 4.64, confidence interval, CI: 1.03-20.95). CR attendees were 75% less likely to be overweight 1 to 2 years post-CR (CI: 0.08-0.73) and 59% less likely to be obese 2 to 5 years post-CR than were nonattendees (CI: 0.20-0.85). CR attendance was associated with healthy behaviors, though maintenance diminished over time. Understanding the factors associated with healthy behaviors, and the time when behavior performance decreases, will assist with program planning directed at behavior maintenance.

Exploring the barriers and enablers to attendance at rural cardiac rehabilitation programs

The objectives of this study were to: (i) identify local barriers and enablers to the uptake of hospital-based cardiac rehabilitation (CR) programs, and (ii) identify preferred alternatives for the delivery of CR. A questionnaire administered by local CR coordinators and focus groups facilitated by the research team. Six regional hospitals in south-west Victoria offering hospital-based CR programs. Patients and their carers referred to and eligible for local CR programs; health professionals working within local CR programs. CR attendees and decliners demographics, patient and health professional perceived factors which contribute to enabling hospital-based CR attendance, patient and health professional perceived barriers to CR attendance, and receptiveness and preferences for alternative modes of CR delivery. This study identified distance to travel to hospital-based CR programs the only statistically significant factor in determining uptake of CR. Easy access to transport (63%) and to a lesser extent family support (49%) and work flexibility (43%) were the primary enablers to attendance. Of the 97 study participants, 38% were receptive to alternative CR methods such as programs in outlying communities, evening facility-based programs, home and GP based programs, telephone support and a patient manual/workbook. The results of this study provide valuable information for designing strategies to increase utilisation and improve patient acceptability of existing hospital-based CR programs. It provides a basis for pilot testing alternative modes of CR program delivery for cardiac patients in rural areas unable to access hospital-based CR.

Magnitude of Change in Cardiac Health-Enhancing Behaviours 6 Months Following an Acute Myocardial Infarction

The adoption of health-enhancing behaviours is essential to reduce the likelihood of recurrent coronary events. This study assessed the magnitude of health behaviour change 6 months following a first acute myocardial infarction (AMI), and examined differences between cardiac rehabilitation attendees and non-attendees. One hundred and six first AMI patients (males n=76, Australian-born n=71) participated in a 6-month follow-up of a descriptive longitudinal survey. Data on non-smoking behaviour, weight normalisation, adequate physical activity, low dietary fat intake, medication adherence and cardiac rehabilitation attendance were collected. The magnitude of change in health-enhancing behaviours from baseline to follow-up was calculated. Whilst there was an overall increase in health-enhancing behaviours at the 6-month follow-up (P<0.001), nonsmoking behaviour, low dietary fat intake and medication adherence were more likely to be achieved than adequate physical activity and weight normalisation. Attendees at cardiac rehabilitation were more likely to report positive lifestyle change (P=0.001) and feeling healthier (P=0.040) than non-attendees. The wide variation in the adoption of health-enhancing behaviours at the 6-month follow-up suggested that participants were selective about which behaviours they changed. Cardiac rehabilitation personnel need to emphasise the importance of undertaking all health-enhancing behaviours in order to maximise their multiplicative benefits.

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

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.