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PW201

Patterns of diastolic dysfunction in diabetics from South East Asia

Ismail R. Johan*1, Ibrahim Zubin1, Arshad Kamal1, Abd Rahman Effarezan1,Zainal Abidin Hafisyatul1, Lim Chiao Wen1, Kasim Sazzli11Cardiology, UiTM, Sungai Buloh, Malaysia

Introduction: Diabetes mellitus increases the risk of heart failure independent of coronaryheart disease and hypertension. It is also associated with diabetic cardiomyopathy of whichthe epidemiology is not well defined. We sought to study the pattern of diastolicdysfunction in an asymptomatic diabetic population from Malaysia.Objectives: To assess prevalence of diastolic dysfunction and the predicting factors.Methods: Subjects were recruited as part of a community study on cardiovascular diseasesbetween the years 2007 to 2011. Demographic details, cardiovascular risk factors alongwith echocardiogram were obtained. An exclusion criterion is abnormal left ventricularejection fraction less than 40%.Results: A total of 1932 subjects with echocardiogram were analyzed. Mean age was 54.6� 11.6. Majority of the subjects were male 98.3% (1899). Mean systolic ejection fraction(EF) was 64.5% � 7.0. Prevalenve of diastolic dysfunction was 52.8% (1021). Of all thesubjects with diastolic dysfunction, 29.9% (578) had impaired relaxation, 21.0% (406)pseudonormal and 1.9% (37) restrictive defect. Among subjects with diastolic dysfunction,13.8% (266) were diabetic and 9.6% (185) were pre-diabetic (impaired fasting glucose).60.6% (1170) had dyslipidemia of LDL level more than 3.4 mmol/L. 26.1% (505) werehypertensive and 59.1% (1142) were obese. Table below summarize the univariate analysisof the cardiovascular risk factors among the subjects with diastolic dysfunction. Inmultivariate analysis hypertension was the only predictor of diastolic dysfunction ß¼-0.65,t(505)¼18.6, p < 0.001. OR of hypertensive subjects to get diastolic dysfunction is 0.52(0.39-0.70).

CV risk factors

Diastolic

dysfunction (%)

N[1021

No diastolic

dysfunction (%)

N[911 P value OR 95% CI

Diabetes 15.3 12.1 0.04 0.76 0.58-0.99

Hypertension 32.9 18.6 < 0.001 0.45 0.38-0.57

Dyslipidemia 61.5 59.5 0.37 - -

Obesity 64.0 57.3 < 0.001 0.66 0.55-0.79

Conclusion: The prevalanve of diastolic dysfunction in our findings is higher than re-ported. Diabetes mellitus, hypertension and obesity remained significant risk factorsassociated with risk of developing diastolic dysfunction. After adjusted, hypertension re-mains a strong predictor for diastolic dysfunction.Disclosure of Interest: None Declared

PW202

Predictors of exposure to guideline-recommended secondary prevention during ahospital admission for acute coronary syndrome (ACS)

Julie Redfern*1, Karice Hyun1, Carolyn Astley2, Clara Chow1, Bernadette Aliprandi-costa3,Tegwen Howell4, Fiona Turnbull5, Cate Ferry6, Derek Chew7,8, Tom Briffa9, Snapshot ACSInvestigators1Cardiovascular Division, The George Institute; University of Sydney, Sydney, 2Clinical Network,SA Health, Adelaide, 3Cardiology, Concord Hospital, Sydney, 4Qld Snapshot Co-ordinator,Brisbane, 5The George Institute; University of Sydney, 6NSW Heart Foundation, Sydney,7Flinders University, 8Southern Adelaide Local Health Network, Adelaide, 9School of PopulationHealth, University of Western Australia, Perth, Australia

Introduction: Narrowing the well-documented treatment gap in guideline-recommendedsecondary prevention after ACS will reduce the rate of fatal and non-fatal premature out-of-cardiovascular events.Objectives: To investigate the predictors of receipt of guideline-recommended (or optimal)preventive care among ACS in-patients who survived to discharge in Australia and NewZealand.Methods: We conducted a prospective audit, across 517 participating hospitals bi-na-tionally, of consecutive patients hospitalised with a confirmed discharge diagnosis of ACSbetween 14-27 May 2012. Optimal care was defined as documented receipt in a patient’snotes of lifestyle advice (exercise/diet/quit guidance for smokers), referral to cardiacrehabilitation and prescription of �4/5 protective pharmacotherapies (lipid-lowering,aspirin, ADP receptor blocker, beta-blocker, ACE inhibitor/angiotensin receptor agent).Predictors of optimal care were determined using multivariable logistic regression analysis.Results: The 2,299 ACS cases had a mean age of 69�13 years, 35% were female, 40% hada vascular history and 30% had prior coronary revascularisation. Receipt of optimal carewas low (603/2299, 26%) with only 46% (1065/2299) referred to cardiac rehabilitation,46% (1059/2299) receiving lifestyle advice and 65% (1490/2299) discharged on �4protective medicines. Exposure to optimal care was predicted by a diagnosis of ST elevationmyocardial infarction (STEMI) (OR:3.76 [95% CI: 2.75-5.14]; p<0.0001) or non-STEMI(OR:2.68 [95% CI: 2.07-3.46]; p<0.0001) with both more likely to receive optimal carecompared with a diagnosis of unstable angina. Other predictors of optimal care werehaving a percutaneous coronary intervention (PCI) during hospitalisation (OR:4.74 [95%CI: 3.78-5.93]; p<0.0001), a history of hypertension (OR:1.49 [95% CI: 1.18-1.88];p¼0.0009) and younger age (OR:0.78 [95% CI: 0.72-0.85]; p<0.0001).

e298

Conclusion: Less than one-third of ACS in-patients surviving to discharge receivedguideline-eligible secondary prevention. Discharge diagnosis of infarction, in-hospitalrevascularisation, history of hypertension and younger age predicted greater exposure ofguideline-recommended therapies. Efforts to close this treatment gap are clearly required.Disclosure of Interest: None Declared

PW203

Impact of pill burden on the effects of a polypill-based strategy on use of indicatedmedications in people with or at high risk of cardiovascular disease

Michael Truelove*1,2, Ruth Webster1,2,3, Severine Bompoint3, Anushka Patel1,3, the Kanyini-GAPCollaboration1University of Sydney, 2Sydney Medical School, 3The George Institute for Global Health, Sydney,Australia

Introduction: Use of cardiovascular disease (CVD) preventive medications is poorglobally. Increasing pill burden is associated with lower levels of medication adherence.Recent studies have shown that use of ‘polypills’ improves use of indicated combina-tion treatment in individuals with or at high risk of CVD. The Kanyini GuidelinesAdherence with the Polypill trial was one such study, involving 623 participants inAustralia. Participants were randomised to a polypill-based strategy (fixed dose com-bination of aspirin, lisinopril, simvastatin and either atenolol or hydrochlorothiazide)or to usual care. Primary outcomes were self-reported use of indicated combinationtreatment, systolic blood pressure (SBP) and total cholesterol (TC). Median follow-upwas 18 months.Objectives: We aimed to investigate whether the polypill based strategy was effective inreducing pill burden; and also whether the effectiveness of this strategy on the primaryoutcomes was modified by baseline pill burden.Methods: Test of medians were used to compare differences in pill burden at study end.Relative risk of combination treatment use was calculated using log-binomial regression.Analyses of change in SBP and TC were conducted using longitudinal models usinggeneralized estimating equations. Participants were stratified into low (<¼6) or high (>6)total pill burden groups at baseline, and primary analyses were repeated with the additionof this subgroup variable and its interaction with treatment. The same method wasapplied with participants stratified as having low (<¼4) or high (>4) CVD pill burden atbaseline.Results: Median total pill burden at baseline was 6.0 (95% CI: 5.0 to 9.0) and 4.0(3.0, 5.0) for total and CVD pill burden respectively, and significantly lower in thepolypill group compared to usual care at study end (total pill burden: 5.0 vs. 7.0,p<0.0001).Those with baseline pill burden of � 6 medications had greater improvement in com-

bination treatment use with the polypill, compared to those with >6 medications (RR 2.01,[1.54 to 2.62] vs. RR 1.25, [1.08 to 1.46], interaction p¼0.002). No interactions wereobserved for the outcomes of SBP or TC. Similar findings were observed for subgroupsdefined by CVD pill burden at baseline.Conclusion: A polypill based strategy results in significant reductions in total pill burdenand CVD pill burden. The improvement in adherence to indicated medications with apolypill based strategy is significantly less among those with a high pill burden at baseline.Disclosure of Interest: M. Truelove: None Declared, R. Webster Grant/research supportfrom: Dr Reddy’s Laboratories, S. Bompoint: None Declared, A. Patel Grant/researchsupport from: Dr Reddy’s Laboratories

PW205

Personal, social and environmental correlates of active transport to school amongadolescents in Otago, New Zealand

Sandra Mandic*1, Sophia Leon de la Barra2, Enrique Garcia Bengoechea3, Emily Stevens1,Antoni Moore4, Melanie Middlemiss5, Paula Skidmore6, Claire Hodge1, John Williams7,Charlotte Flaherty81School of Physical Education, Sport and Exercise Sciences, 2Preventive and Social Medicine,University of Otago, Dunedin, New Zealand, 3Kinesiology and Physical Education, McGillUniversity, Montreal, Canada, 4School of Surveying, 5Information Science, 6Human Nutrition,7School of Business, University of Otago, 8Dunedin City Council, Dunedin, New Zealand

Introduction: With increasingly sedentary lifestyles becoming more common in adoles-cents, opportunities for physical activity such as active transport to school (ATS) need to bepromoted. ATS is a convenient way to increase daily physical activity and adopt anenvironmentally sustainable travel practice.Objectives: This study examined personal (sociodemographics, behavioural patterns,motivational factors and perceived barriers), social (peer support, family resources, schoolcharacteristics) and environmental (urban/rural setting, distance to school, neighbourhoodsafety perceptions) correlates of ATS among adolescents.Methods: A total of 1,815 adolescents (age: 13 to 19 years; 52% boys) from 22 schoolsacross Otago (New Zealand) completed the online survey as a part of the Otago SchoolStudents Lifestyle Survey in 2009 and 2011. Data collected included usual mode oftransport to school, sociodemographic and behavioural characteristics, social support forATS, and personal and family perceptions of safety of ATS. Multivariate binary logisticregression models were used to compare characteristics of students using ATS to charac-teristics of bus and car users (motorised transport).Results: Overall, 37% of students used ATS, 24% bus, and 39% car. Students wholived in a rural area were more likely to use ATS (48% rural vs. 33% urban; p<0.001)and live closer to school (median distance 2.3 km in rural areas vs. 3.4 in urban areas);p<0.001). In a logistic regression model, parental perceptions of safety (OR (95%CIs):

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters