pm489 non-physician led exercise stress testing is a feasible and effective practice in low to...

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Conclusion: Patients with chronic heart failure improve after an PT program, both in peakoxygen consumption as in the recovery time of the kinetics of oxygen.Disclosure of Interest: None Declared

PM486

Socio-demographic correlates of disease-related knowledge in cardiac rehabilitationparticipants in Toronto, Canada

Raquel Britto*1, Gabriela L. M. Ghisi2, Nickan Motamedi3, Sherry Grace31Physical therapy Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil,2Faculty of Kinesiology and Physical Education, University of Toronto, 3School of Kinesiology andHealth Science, York University, Toronto, Canada

Introduction: Patient education is a core component of cardiac rehabilitation (CR). Thegoal of patient education is to promote patient understanding of their disease and man-agement. Research shows that knowledge is necessary for patients to engage in risk-reduction behaviors, and hence prolong their life. However, patient education in CR is onlyscantly investigated.Objectives: (1) to assess cardiac patients’disease-related knowledge pre- and post-CR; and,(2) to investigate socio-demographic correlates of this knowledge.Methods: As part of an ongoing program evaluation at 3 CR programs, new patientscompleted an online survey consisted of socio-demographic items and the Coronary ArteryDisease Education Questionnaire (CADE-Q). Patients are emailed a similar survey 6months later. The CADE-Q is a psychometrically-validated scale composed of 19 multiple-choice items, which assess cardiac patients’ knowledge in 4 areas.The maximum score is57, with higher scores indicating greater knowledge. Education was offered by each pro-gram, in individual and group format, either at the beginning and end of the program, oron a weekly basis. Spearman’s correlation, Mann-Whitney U, Wilcoxon and ANOVA testswere computed, as applicable.Results: CADE-Q was completed by 144 patients (n¼43,39% female;meanage¼66.3�9.7; n¼86,60% with college degree or higher). Pre-CR mean total knowl-edge scores were similar among those who completed (41.3�6.9) and did notcompleted CR (38.7�7.6; p>.05). However, post-CR scores were significantly higheramong those who completed CR (41.1�5.8 vs 35.7�8.8; p¼.004). There was nochange in patients’ knowledge in any area over time (p>.05). Greater pre- and post-CRknowledge was significantly associated with greater education and English-languageproficiency, being married, and lower age. Knowledge was unrelated to sex, ethnicity,and work status.Conclusion: Patients initiating CR had high knowledge regarding their disease. This maybe due to inpatient education pre-CR, as well as early CR education (i.e. during intake).These findings suggest that patients are receiving high-quality education that results in ahigh degree of knowledge which is sustained over the course of the 6 month program, orthat patients who gain access to CR are more educated. Those who did not completed CRhad similar scores to a middle-income country sample, as reported previously. Betterdesign of educational programming should be considered for patients who have less formaleducation and limited English-language proficiency.Disclosure of Interest: None Declared

PM487

Impact of Motivational Posters on Improving Attitudes to Stair Climbing AmongStudents

Charmie Vora1, Abraham S. Babu*1, Sundar K. Veluswamy1, Arun G. Maiya1,21Department of Physiotherapy, 2Dr. TMA Pai Endowment Chair in Exercise Science and HealthPromotion, School of Allied Health Sciences, Manipal University, Manipal, India

Introduction: Physical inactivity is an established non-communicable disease risk factor.Stair climbing is a vigorous-intensity physical activity (PA) which is commonly used as partof PA promotion strategies. Nevertheless, stair climbing as PA is grossly under-utilized andthe impact of methods to promote it among students has been under-reported.Objectives: To understand the effects of motivational posters on improving attitudes to-wards stair climbing.Methods: Using a repeat cross-sectional design, 62 randomly chosen students from anAllied Health Sciences college in South India participated in baseline evaluations of atti-tudes towards stair climbing and awareness of its benefits. The college building has fourfloors, connected through an elevator and a staircase with 96 steps around it. All the 618students, of the college were divided according to the floor their department was situatedand a minimum of 10% of each floor’s student strength were recruited for this preliminarystudy. Motivational posters sporting the “Ms. Fitness Freak” mascot, were placed in stra-tegic locations for a period of six months. Following this, a randomly chosen group ofstudents (n¼58) were assessed to determine if the posters had an impact on their attitudesand awareness regarding benefits of stair climbing. A sub-group of 30 participantsanswered questions related to their views on the posters.Results: From the initial assessment, 35.5% of the 62 students (mean age 20�2.1yrs)preferred using the elevator to ascend while 24.2% preferred using the stairs. After sixmonths, it was seen that among 58 students, 34.4% preferred using the stairs for healthbenefits. Students reported benefits of stair climbing in terms of improved fitness (51/58,87.9%) and reduction in weight (25/58, 43.1%) which was much higher than the benefitsreported prior to the display of the posters (35/68, 51.4% and 20/68, 29.4% respectively).A semi-structured interview of 30 random participants revealed that the posters providednew information (24/30) and were motivating (26/30).Conclusion: The use of motivational posters improved students’ attitudes toward stairclimbing in a positive manner while also improving awareness on the benefits of stair

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climbing. However, more research is required in various settings to understand howmotivational posters will directly influence objective measurement of PA.Disclosure of Interest: None Declared

PM488

Challenges and opportunities in applying a “traffic light” approach to risk profiling insecondary prevention: The Green Amber Red Delineation of rIsk And Need(GARDIAN) in action

Simon Stewart*1, Melinda Carrington1, Yih-Kai Chan1, on behalf of the Young @ Heart StudyInvestigators1Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, Australia

Introduction: With a sustained burden of chronic heart disease in our ageing populationsthere is urgent need to optimise secondary prevention of heart disease.Objectives: To determine the potential benefits of applying an innovative traffic lightsystem, the Green Amber Red Delineation of rIsk And Need (GARDIAN), to guide themanagement of hospitalised patients with heart disease.Methods: Multicentre, randomised trial involving privately insured, hospitalised cardiacpatients (n¼602; aged �45 years). A total of 293 subjects randomised into the studyintervention received a post-discharge home visit (7-14 days post discharge) by a cardiacnurse and were classified according to GARDIAN criteria that assesses 3 key criteria(clinical stability, gold-standard management and holistic profile). Secondary preventionand follow-up was then titrated accordingly. We examined subsequent event-free survivalfrom all-cause mortality and hospital readmission during 31.5 � 7.5 months follow-upaccording to GARDIAN status.Results: Mean age was 70�10 years, 70% were male and the most (59%) had coronaryartery disease (39% underwent coronary revascularisation). Overall, 49 (16.7%), 204(69.6%) and 40 (13.7%) patients were designated as low (green), medium (amber) andhigh (red – due to clinical instability) risk of a secondary event or disease progression.Intensity of post-discharge management was applied accordingly. The figure below showsthat the prospectively applied GARDIAN system successfully predicted different diseasetrajectories on an adjusted basis.

Conclusion: GARDIAN appears to accurately predict outcomes in recently hospitalisedpatients with heart disease. Given mixed outcomes (relative to usual care) in men andwomen in this trial the challenge will be cost-effectively utilising GARDIAN profiling.Disclosure of Interest: None Declared

PM489

Non-physician led exercise stress testing is a feasible and effective practice in low tointermediate risk patients with chest pain

Joel A. Archbald*1, Harley T. Cross1, Kate Sanford1, Alice McDonald1, Katie Williams1,Scott Hughes1, William A. Parsonage1,2, Adam C. Scott1,31Cardiology, Royal Brisbane and Women’s Hospital, 2School of Medicine, University ofQueensland, 3Faculty of Health, Queensland University of Technology, Brisbane, Australia

Introduction: Exercise stress testing (EST) is a non-invasive procedure that providesdiagnostic and prognostic information for the evaluation of several pathologies,including arrhythmia provocation, assessment of exercise capacity and coronary heartdisease. Historically, ESTs were directly supervised by physicians; however, cost-containment issues and time constraints on physicians have encouraged the use ofhealth professionals with specific training and experience to supervise selected exercisestress tests. Evidence suggests that non-physician led exercise stress testing is a safeand effective practice with similar morbidity and mortality rates as those performed orsupervised by a physician.Objectives: Demonstrate that appropriately trained Cardiac Scientists can perform andsupervise exercise stress testing, following CSANZ guidelines, without a physician directlypresent in the testing room.Methods: An evidence based training manual was developed and implemented wherebycompetently trained Cardiac Scientists performed non-physician led ESTs. Low/interme-diate risk patients who were deemed as appropriate from a Chest Pain Managementpathway were referred for same day EST. All tests were reported by a Cardiology AdvancedTrainee Registrar who was in the immediate vicinity and available for any emergencies thatarose.

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Results: Over a 2 month period, 102 patients (63 Males: age: 48.6�9.9 years; 39Females: age: 52.7�9.9 years) performed a single non-physician led EST. Overall; 5 ofthe patients were deemed positive (4.91%), 89 negative (87.25%) and 8 equivocal(7.84%). Patients with a positive or equivocal test result were followed up with furthertesting using either coronary angiography, computed tomography coronary angiogramor stress echocardiogram. All 5 positives tests were false positives and the equivocaltests were all deemed negative after further testing or were as a result of a sub-maximaltest (poor exercise tolerance). All patients were able to be returned to the EmergencyDepartment, as per the Chest Pain Pathway, for further management in regards to theiroutcome.Conclusion: The study provides supporting evidence to the existing literature that in-dicates non-physician led EST is a feasible practice when performed by properly trainedhealth professionals.Disclosure of Interest: None Declared

PM491

Identifying those at risk of depression: Development of the Depression RiskAssessment Questionnaire

Jo N. Crittenden*1, Gavin Leslie2, Patricia M. Davidson3, Sean D. Hood4, Peter L. Thompson51Cardiovascular Medicine, Sir Charles Gairdner Hospital, 2School of Nursing, Curtin University,Perth, WA, Australia, 3School of Nursing, Johns Hopkins University, Balitmore, United States,4Dept of Psychiatry, 5Heart Research Insititute, Sir Charles Gairdner Hospital, Perth, WA,Australia

Introduction: Depression is an important comorbid diagnosis in Acute Coronary Syn-drome (ACS) that confers an increased risk of mortality, disability and a reduced healthrelated quality of life. Early detection of depression risk maybe helpful in ameliorating thedevelopment of depression in ACS patients.Objectives: This research project aimed to develop a brief depression risk assessmentinstrument for use by nurses in the acute clinical setting.Methods: The Depression Risk Assessment Questionnaire (DRAQ) was developed using afour step approach. 1. Literature were searched for studies identifying risk factors fordepression in ACS samples then graded for quality of evidence using the Oxford Centrefor Evidence-based Medicine approach. The evidence review provided the basis for thedraft DRAQ. 2. Comprehensiveness and content validity of the DRAQ was assessed by apanel of eight experts and items retained or removed using a Content Validity Indexscore. 3. The refined DRAQ was tested for internal consistency, reliability and temporalstability in a sample of 220 ACS patients admitted to a coronary care unit. 4. Qualitativeacceptability of the DRAQ as a clinical assessment was established in a small survey ofstudy participants.Results: Thirteen risk factors were initially identified as highly relevant to developingdepression from the literature. The structure, layout and choice of question type wereinfluenced by the need for a high level of clinical utility. Following assessment of thecomprehensiveness and content validity, nine questions were retained. The internal con-sistency of the DRAQ was calculated using the Cronbach’s coefficient alpha based on raw(0.71) and standardized (0.68) variables. Temporal stability was assessed using the kappastatistic with results indicating ‘fair agreement’ (0.47) to ‘excellent agreement’ (1.00). Elevenpatient participants reviewed the acceptability of the DRAQ and reported questions wereclear, relevant and appropriate.Conclusion: This project has developed a preliminary tool with acceptable psychometricproperties which could be used by nurses to help screen for the potential development ofdepression amongst ACS patients and then refer to post discharge services. This createsopportunities to explore preventive therapies rather than observing for the onset ofdepression and then treating the disease.Disclosure of Interest: None Declared

PM492

Are We Still Under Treating Depression In Heart Failure?

Todd Moller*1, Jessica M. Suna2, Alison M. Mudge2,3, Jeff S. Coombes1, Adam C. Scott3,4,51School of Human Movement Studies, University of Queensland, 2Internal Medicine ResearchUnit, Royal Brisbane and Women’s Hospital, 3School of Public Health, Queensland University ofTechnology, 4Cardiology, Royal Brisbane and Women’s Hospital, 5White Cloud Foundation,Brisbane, Australia

Introduction: The prevalence of co-morbid depression in the heart failure (HF) populationis high, and its presence leads to poorer health outcomes. Recent evidence supports thesafety and efficacy of antidepressant drugs, but previous studies have shown gaps inrecognition and treatment of depression in HF.Objectives: This study aimed to assess the prevalence and treatment of depression in a HFsample, and describe patient characteristics of those with depression and those beingmedically treated for it.Methods: This investigation represented a sub-study of consecutive participants enrolled ina clinical trial of exercise training for recently hospitalised HF patients. Depression wasdefined as Geriatric Depression Scale >6. Antidepressant drugs, demographic and clinicaldata were obtained from the clinical chart, patient interview and clinical assessments within6 weeks of hospital discharge.Results: Prevalence of depression was 74/207 (35.7%). Patient characteristics signifi-cantly associated with depression included younger age (mean age in depressed

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participants 58 years vs. 64 years, p¼0.005), poor aerobic capacity (mean 6MWT338m vs. 380m, p¼0.016), and greater functional impairment (59% of depressedparticipants NYHA class III/IV vs. 23% non-depressed, p¼0.001). Of those depressedat baseline, only 11/74 (14.9%) received antidepressant medication. Higher ejectionfraction (mean ejection fraction of patients prescribed antidepressant medication 42.3� 17.5 vs. 29.2 � 13.4, p¼0.006) and recent falls (5/11 medically treated patients vs.9/63, p¼0.03) were associated with increased likelihood of receiving antidepressanttreatment.Conclusion: This data suggests that the prevalence of depression remains high in HFpatients, and is still under-treated. Better identification of patients at risk and improvedstrategies for early treatment are needed.Disclosure of Interest: None Declared

PM493

Development of a smartphone-based decision support system (DSS) to facilitateevidence based hypertension management at primary health care facilities in India:The mPower Heart DSS

Ajay S. Vamadevan*1,2,3, Devraj Jindal1, Nikhil Tandon4, Sanjay Kinra3,Dorairaj Prabhakaran1,21Centre for Chronic Disease Control, 2CoE-CARRS, Public Health Foundation of India, NewDelhi, India, 3Dept. of Non-communicable Disease Epidemiology, London School of Hygiene &Tropical Medicine, London, United Kingdom, 4Endocrinology & Metabolism, All India Institute ofMedical Sciences, New Delhi, India

Introduction: Hypertension affects more than 140 million adults in India. However,inadequate use of evidence based guidelines for opportunistic screening and managementof hypertension is a barrier at primary care setting that result in high burden of undiag-nosed and undertreated hypertension in India.Objectives:

1. To develop a smartphone based decision support system (DSS) for the use ofhealthcare team at primary care setting for the management of hypertension inIndia.

2. To assess the feasibility the smartphone-based DSS for hypertension managementat primary care setting in India.

Methods: The design and feasibility assessment of the DSS was carried out in fiveCommunity Health Centers (CHCs) in the Indian state of Himachal Pradesh using mixedmethods in four iterative steps: 1) literature review and expert consultation; 2) needsassessment; 3) adapting the clinical management guideline to local context; and 4)piloting the DSS to assess its feasibility. In-depth interviews with the healthcare teammembers and non-participant observation was adopted to assess the feasibility of theinnovation.Results: Based on the inputs from literature review, and needs assessment carried out atfive CHCs, an adapted version of the hypertension management guideline recommendedby the Government of India was converted into a DSS having four features: 1) computationof personalized management plan based on patient parameters; 2) capability to synchronizewith a central database; 3) search capability to find details of previous visits of patientrecords during follow-up visits; and 4) security features to prevent unauthorized access topatient data. The accuracy of the treatment plan generated by the prototype DSS, whichhad 37 elements, was tested by two researchers using all clinical scenarios possible. The fullversion DSS was then piloted for its feasibility, which due to high number of data elementswas found to be chocking the patient flow. Subsequently, through expert consultation anduser-testing feedback, DSS version 2 with 23 data elements was deployed which underwentseven more minor iterations to suit the local context with high acceptance from thehealthcare team (Image).

Conclusion: A smartphone based DSS for hypertension is feasible for use at primary carefacilities in India.Disclosure of Interest: None Declared

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