Risk Of Further Cardiac Events Research Articles

Protocol for an implementation study of group metacognitive therapy for anxiety and depression in NHS cardiac rehabilitation services in England (PATHWAY-Beacons).

Cardiac rehabilitation (CR) services aim to improve heart disease patients' health and quality of life and reduce the risk of further cardiac events. Depression and anxiety are common among CR patients but psychological treatments have usually had small effects. In contrast, the recent NIHR-funded PATHWAY trial found that group Metacognitive Therapy (MCT) was associated with improvements in anxiety and depression when added to CR and was more effective than usual CR alone. The next stage is to test implementation of MCT within the National Health Service through the creation of a network of CR beacon sites. The study will test the quality of data capture following addition of a new MCT data-field to the national audit of cardiac rehabilitation (NACR), examine level of adoption at sites, examine mental health outcomes benchmarked against usual CR and the PATHWAY data, examine the enablers and barriers to implementation and the expected resource requirements. The study has been registered: NCT05956912 (13th July, 2023). Beacon sites will be recruited as preliminary adopters of group MCT from NHS CR services in England. A national invitation for expressions of interest from CR services will be issued and those meeting eligibility criteria will be considered for inclusion. Two staff at each site will receive training in MCT, and mixed-methods will be used to address questions concerning the quality of patient data recorded, level of adoption at sites, the characteristics of patients attending MCT, the impact of adding MCT to CR on mental health outcomes, and patient, healthcare staff and commissioner views of barriers/enablers to implementation. Exploration of implementation will be informed by Normalisation Process Theory. The study will support development of an NHS roll-out strategy, assess the mental health outcomes associated with MCT, examine treatment fidelity in real-world settings, and evaluate revised data collection structures that can be used to assess the impact of national-level implementation. NCT05956912; 13th July 2023.

Myocardial Infarction: A Comprehensive Review

Myocardial infarction (MI), commonly known as a heart attack, is a critical medical condition resulting from the blockage of one or more coronary arteries. MI has been classified differently over time, with the most recent classification proposed by the European Society of Cardiology and the American College of Cardiology. This new classification considers various types of MI based on clinical presentations and underlying mechanisms. MI is a significant public health issue globally, with a high prevalence and a substantial impact on healthcare resources and the economy. The pathophysiology of MI is multifactorial, with factors such as atherosclerosis, thrombosis, and inflammation playing crucial roles. Complications of MI can include heart failure, cardiogenic shock, and arrhythmias. Diagnosis of MI involves clinical evaluation, imaging studies, and biomarker testing. Treatment of MI includes reperfusion therapy, medical management, and cardiac rehabilitation. Reperfusion therapy, including thrombolytic therapy and primary percutaneous coronary intervention, is the cornerstone of treatment for ST-segment elevation MI. Medical management involves antiplatelet and anticoagulation therapy, as well as beta-blockers, while cardiac rehabilitation can help improve cardiovascular function and reduce the risk of further cardiac events. Prompt diagnosis and appropriate treatment are essential for improving outcomes and reducing morbidity and mortality associated with MI.

Evaluation of an application for self-assessment of cardiovascular risk behaviour: a pilot study

Abstract Funding Acknowledgements Type of funding sources: None. Background An important aim of cardiac rehabilitation (CR) programs is to reduce the risk of further cardiac events and improve the ability of people living with cardiovascular disease to manage their symptoms. Current CR strategies focus on (lifestyle) behaviour change, however, often patients are not activated enough to generate and self-sustain this lifestyle behaviour change. To stimulate adherence to lifestyle change recommendations, health behaviour should be (self-)assessed and then optimized in a personalized treatment plan. Although lifestyle monitoring apps are emerging rapidly, these applications are mostly targeted at a single lifestyle domain and often lack clinical validation. Purpose The purpose of the study was to evaluate the usability of a self-developed mobile application (Lifestylescore), that enables (self-)assessment of all cardiovascular risk behaviour domains (e.g. body composition, physical activity and sedentary behaviour, smoking, alcohol consumption, nutrition behaviour and psychological stress), using a combination of validated instruments. Secondly, it was investigated whether the use of the app was associated with an increase in patient activation and health behaviour improvement. Methods In this single-centre, non-randomized observational pilot study patients referred for CR due to coronary artery disease (stable angina pectoris or acute coronary syndrome, or after coronary revascularization) were recruited. Patients were asked to complete the Lifestylescore application, and, in addition, the Patient Activation Measure (PAM-13), and System Usability Scale (SUS). All measurements were performed during the intake procedure (baseline) and after completion of the rehabilitation program (after three months (follow-up)). After completion of the application, patients discussed the results with their CR case manager and set individual goals. Results All participants (n = 20) completed the study. The participants scored the Lifestylescore application with a SUS-score of above average (>68). Patient activation did not increase after the CR program as compared to baseline. Although the majority of the patients acknowledged that activation for lifestyle improvement is important, only a small minority reported that they took action (Figure 1). Also, there was no improvement in lifestyle behaviour after completion of CR (Figure 2). Conclusions The Lifestylescore application showed acceptable usability among CR patients. However, its use was not associated with an increase in patient activation, nor with an improvement in lifestyle behaviour after CR. Therefore, further research is needed to evaluate how the application should be incorporated in the CR program to further increase patient’s awareness, empowerment and, ultimately, effectuate more sustained behavioral change.

The Role of Lifestyle and Cardiovascular Risk Factors in Dropout From an Australian Cardiac Rehabilitation Program. A Longitudinal Cohort Study

Cardiac rehabilitation (CR) programs reduce the risk of further cardiac events and improve the ability of people living with cardiovascular disease to manage their symptoms. However, many people who experience a cardiac event do not attend or fail to complete their CR program. Little is known about the characteristics of people who drop out compared to those who complete CR. To identify subgroups of patients attending a cardiac rehabilitation program who are more likely to dropout prior to final assessment by (1) calculating the dropout rate from the program, (2) quantifying the association between dropout and socio-demographic, lifestyle, and cardiovascular risk factors, and (3) identifying independent predictors of dropout. The study population is from a large metropolitan teaching hospital in Sydney, Australia, and consists of all participants consecutively enrolled in an outpatient CR program between 2006 and 2017. Items assessed included diagnoses and co-morbidities, quality of life (SF-36), psychological health (DASS-21), lifestyle factors and physical assessment. Dropout was defined as failure to complete the outpatient CR program and post CR assessment. Of the 3,350 patients enrolled in the CR program, 784 (23.4%; 95%CI: 22.0-24.9%) dropped out prior to completion. The independent predictors of dropout were smoking (OR 2.4; 95%CI: 1.9-3.0), being separated or divorced (OR 2.0; 95%CI: 1.5-2.6), younger age (<55 years) (OR 1.9; 95%CI: 1.6-2.4), obesity (OR 1.6; 95%CI: 1.3-2.0), diabetes (OR 1.6; 95%CI: 1.3-2.0), sedentary lifestyle (OR 1.3; 95%CI: 1.1-1.6) and depressive symptoms (OR 1.3; 95%CI: 1.1-1.6). To improve the CR program completion rate, clinicians need to consider the impact of socio-demographic, lifestyle, and cardiovascular risk factors on their patients' ability to complete CR. Tailored strategies which target the independent predictors of dropout are required to promote adherence to CR programs and thereby potentially reduce long-term cardiovascular risk.

Protocol for the economic evaluation of metacognitive therapy for cardiac rehabilitation participants with symptoms of anxiety and/or depression

IntroductionCardiac rehabilitation (CR) is offered to reduce the risk of further cardiac events and to improve patients’ health and quality of life following a cardiac event. Psychological care is a...

Lipid-lowering therapy and low-density lipoprotein cholesterol goal attainment after acute coronary syndrome: a Danish population-based cohort study

BackgroundPatients with acute coronary syndrome (ACS) are at high risk of recurrent cardiovascular (CV) event. The European guidelines recommend low-density lipoprotein cholesterol (LDL-C) levels < 1.8 mmol/L and early initiation of intensive lipid-lowering therapy (LLT) to reduce CV risk.In order to reduce the risk of further cardiac events, the study aimed to evaluate LDL-C goal attainment and LLT intensity in an incident ACS population.MethodsA cohort study of patients with residency at Funen in Denmark at a first-ever ACS event registered within the period 2010–2015. Information on LLT use and LDL-C levels was extracted from national population registers and a Laboratory database at Odense University Hospital. Treatments and lipid patterns were evaluated during index hospitalization, at 6-month and 12-month follow-up.ResultsAmong 3040 patients with an LDL-C measurement during index hospitalization, 40.7 and 39.0% attained the recommended LDL-C target value (< 1.8 mmol/L) within 6- and 12-month follow-up, respectively. During 6- and 12-month follow-up, a total of 89.2% (20.2%) and 88.4% (29.7%) used LLT (intensive LLT). Of the intensive LLT users, 43.4 and 47.7% reached the LDL-C target value at 6- and 12-month follow-up. The frequency of lipid monitoring was low: 69.5, 77.7 and 53.6% in patients with a first-ever ACS during index hospitalization, 6- and 12-month follow-up, respectively.ConclusionUsing national health registers and laboratory data, a considerably gap was observed between treatment guidelines and clinical practice in the management of dyslipidemia leaving very high-risk patients without adequate lipid management strategy. Therefore, improved lipid management strategies aimed at reaching treatment targets are warranted.

Cardiac Rehabilitation: Future of Heart Health in Saudi Arabia, a Perceptual View

Objective: Having a heart healthy life is one of the most rewarding gifts that you can own yourself in the modern lifestyle practices. Cardiac rehabilitation (CR) is the next step to recover and reverse the limitations experienced by patients who have undergone all the adverse pathophysiological and psychological consequences of cardiac events. Design: This is a review article. The need for cardiacrehabilitation: CR describes all the methods and measures used to prevent recurrent cardiac attaches and to return people with heart diseases to an active and a satisfying lifestyle. CR services should be offered by all health professionals who are in direct contact with the patient, like cardiac specialist, general practitioner, and other health care providers. The success rate of the CR program improves dramatically when it comes in parallel with limiting modifiable risk factors of cardiovascular diseases. The CR programs not only manage episodes of cardiac events, but also it is a comprehensive tool for preventing future heart problems and improving the patients’ life standard. Goals of Cardiacrehabilitation (CR): CR program has been evolved with a wide range of indications that aims to regain autonomy and maximize the physical, psychological and social activities. This makes people with cardiac diseases more confident and inspires behaviors that may minimize risk of further cardiac events. Thevision to improve CR in Saudi Arabia: This article will focus on the methods and parameters that will lead to an improvement in the CR services in the Kingdom of Saudi Arabia.

A cross-sectional survey examining cardiopulmonary resuscitation training in households with heart disease

BackgroundHeart disease significantly increases the risk of further cardiac events including out-of-hospital cardiac arrest (OHCA). Given the majority of OHCAs occur in the home, family members of those with heart disease should be trained in cardiopulmonary resuscitation (CPR). AimTo describe CPR training rates in households with heart disease, and examine if training increases knowledge, confidence and willingness to perform CPR in this population. MethodsA cross-sectional, telephone survey was conducted with adults residing in Victoria, Australia. FindingsOf 404 respondents, 78 (19.3%) reported the presence of heart disease in their household. Prevalence of CPR training was the same among households with (67.9%) and without (67.8%) heart disease, with the majority (51.5%) receiving training more than five years ago. There were no significant differences in barriers to training- the most prevalent barrier was lack of awareness to seek training. Among households with heart disease, physical ability was the most common concern relating to the provision of CPR, while households without heart disease described decreased confidence. Those with heart disease in their household who were CPR trained, had higher self-ratings of CPR knowledge and confidence, and were more willing to perform CPR (all p < 0.05). ConclusionsA large proportion of Victorians with heart disease in their household did not have recent CPR training. CPR training should be targeted to high-risk households containing a member with heart disease, as knowledge and confidence in skills are increased. Cardiac health professionals are well placed to provide CPR training information during patient contacts.

Web-based cardiac REhabilitatioN alternative for those declining or dropping out of conventional rehabilitation: results of the WREN feasibility randomised controlled trial

IntroductionCardiac rehabilitation (CR) is typically delivered in hospital-based classes and is recommended to help people reduce their risk of further cardiac events. However, many eligible people are not completing the...

Optimal Gender-Specific Strategies for the Secondary Prevention of Heart Disease in Women: A SYSTEMATIC REVIEW.

There is a paucity of evidence on gender-specific, individually tailored secondary prevention (cardiac rehabilitation [CR]) services for women with heart disease. Women participate less in CR programs, thus increasing their risk of further cardiac events. This review aims to (1) determine the effectiveness of gender-specific interventions specifically designed for women with heart disease, delivered in outpatient CR settings; and (2) classify key elements of effective CR strategies/models for women with heart disease. Using the PRISMA guidelines, this is a systematic review of CR models tailored to women to improve cardiovascular risk. Four databases were searched for randomized controlled trials (RCTs) between January 1974 and July 2017 published in peer-reviewed English language journals. Three RCTs comprising 725 women of gender-specific CR strategies were identified. Significant improvements were found in one-third (1 study) of the included multicomponent CR strategies for outcomes including general health, social functioning, vitality, mental health, depression, and quality of life. Further large-scale RCTs are required to replicate positive findings and accurately assess the capacity for gender-specific multicomponent CR programs that incorporate participant-driven collaborative models to moderate psychological risk and improve functional capacity and quality of life for women with heart disease.

The Effects of Lavender, Valerian, and Oxazepam on Anxiety Among Hospitalized Patients with Coronary Artery Disease

Background and Objectives: Patients with coronary artery disease (CAD) experience different levels of anxiety during their hospital stay. Untreated anxiety among these patients can increase the risk of further cardiac events. The current study aimed at comparing the effects of lavender, valerian, and oxazepam on anxiety among hospitalized patients with CAD. Methods: As a double-blind, randomized, placebo-controlled, clinical trial, the current study was conducted in 2016 on 120 patients with CAD hospitalized in the cardiac care unit (CCU) of Valiasr (PBUH) Hospital, Birjand, Iran. Patients were conveniently recruited and randomly allocated to 30-patient lavender, valerian, oxazepam, and placebo groups using the permuted-block randomization method. Patients in these groups orally received 80 mg of lavender essential oil, 400 mg of valerian essential oil, a 10-mg oxazepam tablet, and 5 mL of distilled water, respectively, 1 hour before bedtime in 3 consecutive nights. Data were collected before and after the intervention via a demographic questionnaire and the Spielberger state-trait anxiety inventory. The data were analyzed with SPSS version 21.0 based on descriptive statistics measures (such as mean, standard deviation, and frequency distributions) using inferential statistics (such as the Chi-square test, the paired-samples t test, the one-way analysis of variance (ANOVA), and Tukey range test). The level of significance was set to 0.05). However, the mean score of total anxiety significantly decreased in all groups, with the greatest decrease in the lavender group, followed by the valerian, oxazepam, and placebo groups (P < 0.05). The pretest-posttest mean differences of state anxiety were significantly greater in the valerian and the lavender groups than the oxazepam and the placebo groups. Moreover, the pretest-posttest mean difference of trait anxiety was significantly greater in the lavender group than the other groups. In addition, the pretest-posttest mean difference of total anxiety was significantly greater in the lavender group than the other groups and in the valerian group it was significantly greater than the oxazepam and the placebo groups (P < 0.05). Conclusions: Oral intake of lavender and valerian essential oils was as effective as oxazepam in alleviating anxiety among patients with coronary artery disease. Of course, the anxiolytic effects of lavender were stronger than those of valerian. These medicinal plants can be good substitutes for chemical anxiolytic medications. Of course, further studies are needed to produce more reliable evidence in this realm.

A cross-sectional survey examining cardiopulmonary resuscitation training in households with heart disease

Abstract Background Heart disease significantly increases the risk of further cardiac events including out-of-hospital cardiac arrest (OHCA). Given the majority of OHCAs occur in the home, family members of those with heart disease should be trained in cardiopulmonary resuscitation (CPR). Aim To describe CPR training rates in households with heart disease, and examine if training increases knowledge, confidence and willingness to perform CPR in this population. Methods A cross-sectional, telephone survey was conducted with adults residing in Victoria, Australia. Findings Of 404 respondents, 78 (19.3%) reported the presence of heart disease in their household. Prevalence of CPR training was the same among households with (67.9%) and without (67.8%) heart disease, with the majority (51.5%) receiving training more than five years ago. There were no significant differences in barriers to training- the most prevalent barrier was lack of awareness to seek training. Among households with heart disease, physical ability was the most common concern relating to the provision of CPR, while households without heart disease described decreased confidence. Those with heart disease in their household who were CPR trained, had higher self-ratings of CPR knowledge and confidence, and were more willing to perform CPR (all p Conclusions A large proportion of Victorians with heart disease in their household did not have recent CPR training. CPR training should be targeted to high-risk households containing a member with heart disease, as knowledge and confidence in skills are increased. Cardiac health professionals are well placed to provide CPR training information during patient contacts.

Cardiac MR Imaging in Acute Coronary Syndrome: Application and Image Interpretation.

Acute coronary syndrome (ACS) is a frequent cause of hospitalization and coronary interventions. Cardiac magnetic resonance (MR) imaging is an increasingly used technique for initial work-up of chest pain and early post-reperfusion and follow-up evaluation of ACS to identify patients at high risk of further cardiac events. Cardiac MR imaging can evaluate with accuracy a variety of prognostic indicators of myocardial damage, including regional myocardial dysfunction, infarct distribution, infarct size, myocardium at risk, microvascular obstruction, and intramyocardial hemorrhage in both acute setting and later follow-up examinations. In addition, MR imaging is useful to rule out other causes of acute chest pain in patients admitted to the emergency department. In this article, a brief explanation of the pathophysiology, classification, and treatment options for patients with ACS will be introduced. Indications of cardiac MR imaging in ACS patients will be reviewed and specific cardiac MR protocol, image interpretation, and potential diagnostic pitfalls will be discussed. © RSNA, 2017 Online supplemental material is available for this article.

Coronary Artery Calcium Score: A Review

ContextCoronary artery disease (CAD) is the foremost cause of death in many countries and hence, its early diagnosis is usually concerned as a major healthcare priority. Coronary artery calcium scoring (CACS) using either electron beam computed tomography (EBCT) or multislice computed tomography (MSCT) has been applied for more than 20 years to provide an early CAD diagnosis in clinical routine practice. Moreover, its association with other body organs has been a matter of vast research.Evidence AcquisitionIn this review article, techniques of CACS using EBCT and MSCT scanners as well as clinical and research indications of CACS are searched from PubMed, ISI Web of Science, Google Scholar and Scopus databases in a time period between late 1970s through July 2013 and following appropriate selection, dealt with. Moreover, the previous and ongoing research subjects and their results are discussed.ResultsThe CACS is vastly applied in early detection of CAD and in many other research fields.ConclusionsCACS has remarkably changed the screening techniques to detect CAD earlier than before and is generally accepted as a standard of reference for determination of risk of further cardiac events.

Designing a theory- and evidence-based tailored eHealth rehabilitation aftercare program in Germany and the Netherlands: study protocol.

BackgroundCardiac rehabilitation programs aim to improve health status and to decrease the risk of further cardiac events. Persons undergoing rehabilitation often have difficulties transferring the learned health behaviors into their daily routine after returning home and maybe to work. This includes physical activity as well as fruit and vegetable consumption. Computer-based tailored interventions have been shown to be effective in increasing physical activity as well as fruit and vegetable consumption. The aim of this study is, to support people in transferring these two learned behavior changes and their antecedents into their daily life after cardiac rehabilitation.MethodsThe study will have a randomized controlled design and will be conducted among German and Dutch people who participated in cardiac rehabilitation. The study will consist of one intervention group which will be compared to a waiting list control group. During the eight week duration of the intervention, participants will be invited to participate in the online after-care program once per week. The intervention encourages participants to define individual health behavior goals as well as action, and coping plans to reach these self-determined goals. The effectiveness of the program will be compared between the intervention condition and the control group in terms of behavior change, antecedents of behavior change (e.g., self-efficacy), ability to return to work and increased well-being. Further, subgroup-differences will be assessed including differences between the two countries, socioeconomic inequalities and across age groups.DiscussionThe present study will make a contribution to understanding how such an online-based tailored interventions enables study participants to adopt and maintain a healthy lifestyle. Implications can include how such an online program could enrich cardiac rehabilitation aftercare further.Trial registrationNTR 3706, NCT01909349

New equipment optimized for emulsified vaccine prepation in the hospital

<h3>Background</h3> Patients with coronary heart disease (CHD) who are depressed have an increased risk of further cardiac events and higher mortality. <h3>Aim</h3> To use a patient generated instrument (PSYCHLOPS) to define categories of concerns in patients with CHD. To define the psychometric characteristics of patients in each category. <h3>Design and setting</h3> Cross-sectional study set in general practices in south London. <h3>Method</h3> Of 3325 patients on the CHD registers in 15 general practices, 655 completed six baseline psychometric and functional instruments: PSYCHLOPS, HADS-Depression, HADS-Anxiety, Clinical Interview Schedule – Revised, SF12-Mental and SF12-Physical. Content analysis was used to categorise patients based on their main problem, as elicited by PSYCHLOPS. Mean psychometric scores were adjusted for confounding by age, sex, deprivation and ethnicity and calculated for each response category. <h3>Results</h3> Response categories were: physical problems, both non-cardiac (23.2%) and cardiac (6.0%); social problems: relationship/family (18.2%), money (7.5%), work (3.1%); functional (9.8%); psychological (6.9%); miscellaneous (7.3%); ‘no problem’ (18.2%). The highest psychological distress scores were found in ‘physical, cardiac’ and ‘psychological’ categories. The ‘no problem’ category had significantly lower psychological distress and higher functional capacity than other categories. <h3>Conclusions</h3> PSYCHLOPS enabled the identification of subtypes of CHD patients, based on a classification of self-reported problems. A high proportion of CHD patients report social problems. Psychological distress was highest in those reporting cardiac or psychological symptoms. Services should be aligned to the reported needs of patients.

Applying optimal model selection in principal stratification for causal inference

Noncompliance to treatment allocation is a key source of complication for causal inference. Efficacy estimation is likely to be compounded by the presence of noncompliance in both treatment arms of clinical trials where the intention-to-treat estimate provides a biased estimator for the true causal estimate even under homogeneous treatment effects assumption. Principal stratification method has been developed to address such posttreatment complications. The present work extends a principal stratification method that adjusts for noncompliance in two-treatment arms trials by developing model selection for covariates predicting compliance to treatment in each arm. We apply the method to analyse data from the Esprit study, which was conducted to ascertain whether unopposed oestrogen (hormone replacement therapy) reduced the risk of further cardiac events in postmenopausal women who survive a first myocardial infarction. We adjust for noncompliance in both treatment arms under a Bayesian framework to produce causal risk ratio estimates for each principal stratum. For mild values of a sensitivity parameter and using separate predictors of compliance in each arm, principal stratification results suggested that compliance with hormone replacement therapy only would reduce the risk for death and myocardial reinfarction by about 47% and 25%, respectively, whereas compliance with either treatment would reduce the risk for death by 13% and reinfarction by 60% among the most compliant. However, the results were sensitive to the user-defined sensitivity parameter.

2 A "direct" transfer protocol for patients with non ST-elevation myocardial infarction reduces time to coronary angiography

Introduction Patients with non-ST elevation myocardial infarctions (NSTEMI) are at high risk of further cardiac events. National guidelines recommend “early” coronary angiography within 96 h of presentation. Most patients with NSTEMI present to their district general hospital (DGH), and await transfer to the regional cardiac centre for angiography. This care model has inherent time delays, and delivery of early angiography is problematic. Methods A novel clinical care pathway for the management of NSTEMI, known locally as the Heart Attack Centre-Extension or HAC-X, has been investigated. This pathway identifies patients with NSTEMI by clinical assessment and rapid point-of-care troponin testing while in the emergency department (ED). Patients meeting criteria for urgent transfer receive evidence based medical therapy for NSTEMI (see [Abstract 2 table 1][1]) in the ED, and are transferred to the tertiary centre within 1 h without referral. All unstable patients are taken straight to the cardiac catheterisation laboratory. For stable patients, coronary angiography is undertaken on the same day, or if patients arrive after 17:00 on the next available routine list. The study group consists of 775 patients divided into two groups; 464 patients treated before the instigation of the HAC-X pathway (Pre-HACX), and 311 patients treated via the novel pathway (Post-HACX). We have undertaken a prospective observational study of post-HAC-X patients, assessing need for angiography and or revascularisation along with discharge diagnosis. We have also compared the waiting time for angiography of pre-HAC-X and post-HAC-X groups. Results 250/311 (80.4%) of HACX patients underwent angiography. Following angiography, 144/250 (57.6%) were treated with coronary revascularisation (108 (75%) PCI and 36 (25%) CABG). 106/250 (42.4%) of patients were treated with medical therapy alone. NSTE-ACS (encompassing NSTEMI and unstable angina) was the discharge diagnosis for 75.4% of HACX patients. 10% of patients had another cause for chest pain symptoms (including pericarditis and, myocarditis); 14.6% had a non-cardiac diagnosis. Mean time from presentation to angiography was pre-HAC-X 7349 mins (±6836) and post HAC-X 754 mins (±458) (p<0.0001) (see [Abstract figure 1][2]). Pre-HAC-X mean wait for transfer to tertiary centre was 4.1 (±4.7) days. Median length of stay for HACX patients was 3 days. HAC-X has reduced wait for coronary angiography by 3.4 days per patient. ![Abstract 2 Figure 1][3]</img> Abstract 2 Figure 1 Time from ED presentation to coronary angiography. Conclusions This novel care pathway allows delivery of early angiography to NSTEMI patients in accordance with national guidance. Importantly, the pathway allows accurate diagnosis of NSTEMI, and inappropriate transfers are infrequent. Its introduction has resulted in a significant reduction in time to angiography for NSTEMI patients, and significant reductions in total hospital bed occupancy for patients with NSTEMI. View this table: Abstract 2 Table 1 Inclusion and exclusion criteria for HACX [1]: #T1 [2]: #F1 [3]: pending:yes

P02-17 - Depression, inflammation and coronary heart disease: prognostical value of c reactive protein and depressive symptoms

IntroductionThe aim of this preliminary study is to assess, in a sample of patients with Coronary Heart Disease (CHD), the specific association between depressive symptoms and systemic inflammation.MethodsSixty-One inpatients with CHD, 31 Unstable Angina and 28 Myocardial Infarction, participated in the study. The plasma levels of C Reactive Protein were measured using Dade Behring’s High Sensitivity CRP assay (hs-CRP) at T0, T30 and T90.At the same timings, they were tested by an examiner, unaware of their diagnosis, with a psychometric battery (SCL90-R, HDRS, MADRS, BDI, QlesQ).ResultsThe elevation of hs-CRP occurs during the whole observation period, with maximum significance at T90 (p = 0,031).A multivariate analysis at T0 indicates a statistical correlation between SCL90-R scores and hs-CRP levels (p = 0.02).The SCL90-R is also associated with the risk of further cardiac events (p = 0.013).Also the BDI could be useful as a prognostic factor (p = 0.026).We found a trend towards correlation between CRP values and depressive symptoms, but it never reaches statistical significance for the other scales.ConclusionsThe feelings of loss and the fear of death, related to the environmental and emotional situation of the hospitalization, may prevail in the acute phase of CHDs.Some patients may overcome this reactive depression, while others may exhibit a biological depression, related to the high level of CRP and thus to an increased risk of re-infarction and other coronary events.

Unstructured cardiac rehabilitation and secondary prevention in rural South Australia: Does it meet best practice guidelines?

Comprehensive cardiac rehabilitation programs that address risk factors, psychological problems, and physical activity are essential in optimizing health and reducing the risk of further cardiac events. Behavioural and lifestyle modification support offered through these programs is predicated on initial identification of risk. Many rural populations in Australia do not have access to structured cardiac rehabilitation (CR) programs, and the level of support available to them in the form of unstructured CR is unclear.A retrospective analysis of medical records of patients presenting to hospital with myocardial infarction in rural South Australia over a 12-month period was undertaken to identify documented evidence of assessment of and intervention for lifestyle and behavioural risk factors in-hospital and at follow up in general practice (GP) clinics. Of 77 eligible participants, permission was received to access the medical records of 55 patients in the hospital setting, and 34 of these 55 patients in GP clinic follow up.Documented evidence of assessment of modifiable risk factors was inadequate for the majority of participants, with the exception of smoking status, hypertension and diabetes. This suggests that the majority of these participants did not receive lifestyle and behavioural interventions in line with current National Heart Foundation Recommendations for Cardiac Rehabilitation.Barriers to comprehensive CR and secondary prevention services in Australia must be addressed, particularly in high risk rural and remote populations. Future research must focus on the ongoing monitoring and evaluation of rural health care services to analyse existing levels of CR and secondary prevention to ensure current guidelines are being implemented, to support the further development and resourcing of CR services and to evaluate the subsequent impact on patient outcomes.