Cardiac rehabilitation: interventions and outcomes 629 netic terms, HNF4A CC genotype (OR=1.50; p=0.006) and PCSK9 GG variant (OR=1.30; p=0.047) showed significant increased risk for onset of complication. After logistic regression the two genetic variants remained in the equation: HNF4A CC (OR=3.90; p=0.031) and PCSK9 GG (OR=1.95; p=0.017) with sedentary life (OR=1.71; p<0.0001). Conclusion: According to these results, there are risk factors such as sedentary life and some genetic variants (HNF4A and PCSK9) that are significantly and independently associated with MACE occurrence and allow us to predict vascular complications after CAD diagnosis. If patients have one or more of these conditions, a particularly careful secondary prevention should be ensured. P3359 | BEDSIDE Differential impact of a nurse-led, home-based intervention for optimal secondary cardiac prevention on recurrent hospitalization in men and women: the Young @ Heart multicentre, randomized trial S. Stewart 1 , M.J. Carrington 1 , S. Goldstein 2 , P. Scuffham 3 . 1 Baker IDI Heart and Diabetes Institute, Melbourne, Australia; 2 University of New South Wales, Sydney, Australia; 3 Griffith University, Brisbane, Australia P3360 | BENCH Sodium bicarbonate versus isotonic saline for the prevention of contrast induced nephropathy in patients with diabetes mellitus undergoing coronary angiography and/or intervention: a multicenter study M.G. Kaya 1 , F. Koc 2 , F. Altunkas 2 , A. Celik 2 , M. Akpek 1 . 1 Erciyes University School of Medicine, Department of Cardiology, Kayseri, Turkey; 2 Gaziosmanpasa University, Faculty of Medicine, Department of Cardiology, Tokat, Turkey Objectives: Contrast induced nephropathy (CIN) is a leading cause of acute renal failure and affects mortality and morbidity. Although CIN incidence is quite low in the general population, the incidence of CIN is significantly increased in diabetes mellitus (DM). We compared the efficacy of prophylactic use consisting of a saline infusion or a sodium bicarbonate infusion for the prevention of CIN in patients with DM. Methods: A total of 195 DM patients, who had unselected renal function, were randomized into 2 groups: 101 patients were assigned to saline infusion and 94 patients were assigned patients to bicarbonate infusion. The primary end point was the maximum increase in the serum creatinine (SCr) level. The secondary end point was the development of CIN after the procedure. Results: The maximum increase in SCr levels was significantly lower in the saline group than in the bicarbonate group, -0.03 [IQR = -0.09 to 0.10] mg/dL vs. 0.02 [IQR = -0.09 to 0.13] mg/dL (P=0.014) (Figure). The rate of CIN was significantly lower in the saline group than in the bicarbonate group (5.9% vs. 16%, P=0.024). In the subset of study participants with a baseline creatinine clearance of <60 mL/min, the maximum increase in SCr levels was significantly lower -0.08 [IQR = -0.13 to -0.04] mg/dL in the saline group than in the bicarbonate group 0.03 [IQR = -0.13 to 0.12] mg/dL (P=0.004). Conclusions: The use of prophylactic hydration with isotonic saline before coronary procedures may decrease SCr levels and reduce the incidence of CIN in DM patients with unselected renal functions to a greater extent than sodium bicarbonate P3361 | BEDSIDE Motivational interviewing as educational program in improving cardiac risk factors control in patients post myocardial infarction S.M. Soliman, G. Selim. Ain Shams University, cairo, Egypt Introduction: Motivational interviewing (MI) is a counseling style that was developed as an alternative to more traditional counseling using direct persuasion. It uses the patient’s responses to reinforce talk directed toward change. The study examines MI as a tool for promoting lifestyle change in patients post infarction particularly smoking cessation, decrease saturated fat intake and increase physical activity. Methods: 1850 post myocardial infarction patients were recruited over 2 years period and were randomly assigned to either usual follow up or MI educational program. Patients participated in a 30 min weekly education session for eight weeks. Follow up telephone calls after another 4 weeks. Results: After MI, 95% of patients reported self cessation of smoking versus 75% in usual care patients (p<0.05). Awareness as regards overweight was increased, and 45% took active steps to reduce their weight versus 12% in usual care (p<0.05). Awareness to diet modifications has improved and 88% took active steps to reduce saturated fat versus 43% in usual care (p<0.05). After MI, 56% took active steps to increase their physical activity versus 32% in usual care (p<0.05). Conclusion: MI can promote behavior change in patients post infarction and is advisable to integrate in rehabilitation program. P3362 | BEDSIDE Preoperative levels of pro-inflammatory mediators predict the development of acute heart failure and the need for inotropic support after elective coronary artery bypass surgery M. Demosthenous 1 , C. Antoniades 1 , A.S. Antonopoulos 1 , D. Tousoulis 1 , A. Miliou 1 , N. Koumallos 1 , C. Psarros 2 , C. Bakogiannis 1 , C. Triantafillou 3 , C. Stefanadis 1 . 1 Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece; 2 University of Athens Medical School, Athens, Greece; 3 Hippokration Hospital, 1st Department of Cardiac Surgery, Athens, Greece Background: Coronary bypass grafting (CABG) operation frequently requires prolonged hospitalization, due to complications that include acute left ventricular (LV) failure. It is therefore essential to identify the key mechanisms trigering LV failure post-CABG, and identify novel therapeutic targets. Further to the role of interleukin 6 (IL-6) and high sensitivity C-reactive protein (hsCRP) in inflammatory resposnes post CABG, monocyte chemoattractand protein-1 (MCP-1) has a role in immune cell chemotaxis and regulates cell infiltration to the myocardium. We examined the predictive role of preoperative MCP-1, IL-6 and hsCRP for the development of acute heart failure after CABG. Methods: We recruited 248 patients undergoing elective CABG. LV systolic function was evaluated preoperatively. The morning before surgery, blood samples were obtained and the levels of MCP-1, IL-6 and CRP were determined by ELISA. Downloaded from by guest on November 24, 2014 Background: We examined the impact of a two year secondary prevention program on recurrent hospitalization in cardiac patients with ready access to specialist care. Methods: The Young at Heart Study was a multicentre, randomized controlled trial comparing usual post-discharge care (UC) with a flexible, nurse-led, homebased intervention (HBI). The primary endpoint was rate of all-cause hospital stay during 31.5±7.5 months follow-up. Results: Overall, 602 (mean age 70±10 years, 72% men and 62% hospitalized for coronary artery disease of whom 39% underwent coronary revascularization) patients were randomized to UC (n=296) or HBI (n=306 - 96% received at least one home visit). Women were on average 5 years older (p<0.001) and had greater levels of co-morbidity (p=0.009) than men; these differences were consistent across the two study groups. At 2 years, more HBI versus UC (39 vs. 27%; OR 1.67; 95% CI 1.15 – 2.41; p=0.007) patients were assessed as stable and optimally managed. Overall, 42 patients (7.0%) died and 492 patients (82%) were hospitalized with 2338 all-cause admissions and 10,045 days of hospitalization. There were no group differences (HBI vs. UC) in the primary endpoint of all-cause hospital stay (0.78±2.01 vs. 0.68±1.96/month; p=0.546) or all-cause hospitalization (0.14±0.20 vs. 0.14±0.30/month; p=0.867). Overall, men in the HBI group (40/215 [19%]) were significantly less likely to experience a cardiovascular admission compared to UC (61/216 [28%]) with the reverse situation for women in the HBI group (30/91 [33%]) vs. UC (20/80 [25%]). Independent correlates of cardiovascular admission were living alone (HR 1.62, 95% CI 1.032.54; p=0.038) and increasing comorbidity (HR 1.09, 95% CI 1.02 – 1.16 per unit score; p=0.013) for men and women combined. For men only, assignment to the HBI group (HR 0.61, 95% CI 0.41-0.93 for HBI vs. UC; p=0.019) and advancing age was associated with reduced likelihood of a cardiovascular readmission (HR 0.97, 95% CI 0.94-1.00 per year; p=0.05) with 583 less days of (p=0.036) hospital stay. In women, advancing age (HR 1.06, 95% CI 1.01-1.10 per year; p=0.012) and study site (HR 0.57, 95% CI 0.40-0.82, site A vs. B; p=0.002) were the only significant correlates, with assignment to HBI associated with a non-significant 1.4-fold increased risk of such an event. Conclusions: Despite high levels of engagement and potential clinical improvements at 2 years, HBI did not reduce levels of recurrent hospital stay compared to usual care. However, improved cardiovascular outcomes in men, but not women, requires further investigation. Figure 1 630 Cardiac rehabilitation: interventions and outcomes The patients were followed-up until their discharge from the hospital. The development of acute heart failure and the use of inotropes were recorded. Results: High preoperative levels of MCP-1 (A), IL-6 (B) and hsCRP (C) are more likely to require inotropic support post-CABG. Moreover, in multiple regression analysis, MCP-1 and IL-6 were predictors of the use of inotropes in the postoperative period (P<0.05 for both), independently of risk profile and preoperative LV systolic function. Conclusions: Preoperative levels of MCP-1, IL-6 and hsCRP are independent predictors of the need of post-operative inotropic support independently of preoperative LV systolic function in patients undergoing CABG. Our data identify these pro-inflammatory biomarkers as potential therapeutic targets for the improvement of post-operative recovery after CABG surgery. activities of daily living-8 (PMADL-8) 2 weeks after discharge. The PMADL-8 was used to assess the difficulty in performing specified daily physical activities. To evaluate limiting factors for the ADL, the stepwise multiple regression analysis was performed using indices of respiratory and motor function as predictive variables. Results: The PMADL-8 showed significant univariate correlations to age (r=0.376), FVC (r=-0.507), forced expiratory volume in 1 second (r=-0.495), maximal inspiratory pressure (r=-0.365), maximal expiratory pressure (r=-0.364), quadriceps strength (r=-0.410), one leg standing time (r=-0.341) and 10-meter walking speed (r=-0.581) (p<0.001, respectively). The result of the stepwise multiple regression analysis was shown in Table. The FVC and one leg standing time were detected as significant and independent predictors for the decreased ADL. P3363 | BEDSIDE Number of cardiac and noncardiac comorbidities predict sexual concerns Result of multiple regression analysis 1 1 1 2 2 1 E. Steinke , V. Mosack , T.J. Hill , C. Walker , M. Medina . Wichita State University, Wichita, United States of America; 2 Via Christi Health, Wichita, United States of America Predictors of Sexual Concerns Predictors (constant) Race Ever smoked BMI Number cardiac comorbidities Number non-cardiac comorbidities Number different sexual activities Adjusted R2=0.213** Unstandardized coefficients Beta Std. Error −2.170 1.667 1.303 0.109 0.969 1.513 0.400 2.320 1.663 0.941 0.073 0.273 0.388 0.210 Standardized coefficients Beta t 0.068 0.090 0.100 0.235 0.226 0.123 −0.935 1.003 1.385 1.487 3.550*** 3.903*** 1.907* OLS Regression Analysis: *p=0.058, **p<0.001, ***p<0.0001. Conclusions: Comorbidities, sexual activities, and demographic factors contributed to sexual concerns, fears, symptoms, and dysfunction. Thorough sexual assessment by providers is critical to understand individual concerns and to tailor sexual counseling. P3364 | BEDSIDE Forced vital capacity is an independent determinant for decreased activities of daily living in patients with chronic heart failure N. Hamazaki 1 , K. Kamiya 1 , K. Miida 1 , K. Hotta 2 , R. Shimizu 2 , D. Kamekawa 2 , A. Akiyama 2 , S. Tanaka 2 , C. Noda 3 , T. Masuda 4 . 1 Cardiac Rehabilitation Room, Kitasato University Hospital, Sagamihara, Japan; 2 Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; 3 Department of Cardio-angiology, Kitasato University School of Medicine, Sagamihara, Japan; 4 Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan Purpose: Exercise tolerance is well known to be a limiting factor for activities of daily living (ADL) in patients with chronic heart failure (CHF). Although many studies documented the relationship between forced vital capacity (FVC) and cardiovascular events, it is not evaluated the relationship between respiratory function and ADL in them. The purpose of this study was to investigate whether respiratory function is a limiting factor for the ADL in CHF patients. Methods: We studied 269 patients (194 males) with compensated CHF aged 64.3±14.1 years who underwent a cardiac rehabilitation during the hospitalization. The patients who received a cardiac surgery or had chronic respiratory disease were excluded. We measured pulmonary function, muscle strength and one leg standing time at the hospital discharge. The ADL was evaluated using 10meter comfortable walking speed at discharge and the performance measure for Forced vital capacity One leg standing time R2 10-meter walking speed B β p value 8.323 0.203 0.543 0.267 0.396 <0.001 0.012 B −2.566 −0.083 PMADL-8 β −0.466 −0.308 0.332 p value <0.001 0.006 PMADL-8, performance measure for activities of daily living-8. Conclusion: The FVC was identified as an independent strong determinant for decreased ADL in patients with CHF. P3365 | BENCH Characteristic and outcome in patients with st-evaluation myocardial infarction an out-of hospital reanimation insight from the national amis plus registry 1997-2011 M. Maggiorini 1 , A. Mueller 1 , D. Radovanovic 1 , P. Erne 2 . 1 University Hospital Zurich, Intensive Care Medicine, Zurich, Switzerland; 2 Lucerne Cantonal Hospital, Lucerne, Switzerland Background: Cardiac arrest is one of the most life-threatening complications of ST-Elevation Myocardial Infarction (STEMI). Aim of the study was to identify potential treatable factors jeopardizing the outcome out of hospital resuscitated STEMI patients. Methods: All acute STEMI enrolled in the AMIS PLUS registry between January 1, 1997 and December 31, 2011 were analyzed. Patients were divided into those who had experienced Out-of Hospital Cardiac Arrest (OHCA) and those who did not. OHCA was defined as cardiac arrest requiring resuscitation procedures (chest compression, defibrillation, cardioversion), as defined by the European Resuscitation Council. Successful resuscitation was required in order to be included in this study. The primary outcome was in-hospital mortality. Secondary outcome measures were the rates of in-hospital major adverse cardiac or cerebrovascular events. Results: Between 1997 and 2011, a total of 21,401 patients with STEMI were included in the AMISplus registry. 939 of 20,773 patients (4.5%) with complete data sets had OHCA. There mortality was 31.1% vs. 6.7% (p<0.001). STEMI patients with OHCA were younger, more often males and smokers. The extension of coronary artery disease and comorbidities were similar between groups. More patients with OHCA were in cardiogenic shock and needed catecholamines and/or mechanical ventilation. In hospital CPR was more frequently in OHCA patients. A primary PCI was performed in 55.9% controls and 57.6% OHCA patients (p = 0.31). At hospital discharge less patients with OHCA received aspirin, statins, beta blockers and ACE Inhibitors/AT Antagonists. Since 2009 therapeutic hypothermia was recorded and performed in 55 (46%) out of 119 OHCA patients. In the logistic regression analyses, the OR for mortality for patients who had CPR prior to admission was, unadjusted, 6.3 (95% CI 5.4 to 7.32; p<0.001); and adjusted for age and gender it was 10.18 ((95% CI 8.6 to 12.04; p<0.001). Conclusion: The mortality of STEMI patients with out-of-hospital cardiac arrest is high. Appropriate management of cardiogenic shock and therapeutic hypothermia are key to reduce mortality in these patients. P3366 | BEDSIDE High intensity, interval exercise improves diastolic function and ergometric capacity of patients with chronic heart failure: a phase III randomized clinical trial C. Chrysohoou, G. Tsitsinakis, A. Aggelis, E. Herouvim, D. Tsiachris, J. Vogiatzis, A. Tsantilas, C. Pitsavos, N. Koulouris, C. Stefanadis. University of Athens, Athens, Greece Background: The aim of this work was to evaluate the effect of high intensity, interval exercise on echocardiographic markers of systolic and diastolic ventricular function among chronic heart failure (CHF) patients. Methods: A phase III clinical trial. Of the 100 consecutive CHF patients (NYHA class II-IV, ejection fraction<30%) that were randomly allocated to exercise treatment (n=50) or control (n=50), 72 (exercise group, n=33, 63±9 years, 88% men, 70% ischemic heart failure and exercise group, n=39, 56±11 years, 82% men, 70% ischemic heart failure) completed the study. Particularly, the intervention group followed a high intensity, interval ergometric aerobic training (i.e., 30 sec at 100% of max workload, 30 sec at rest) for 30 min/day-by-12 weeks, whereas Downloaded from by guest on November 24, 2014 Purpose: Cardiac patients frequently report sexual concerns after an acute or chronic cardiac problem. While sexual problems have been generally reported, our study examined demographic variables, co-morbid conditions, and sexual activities as predictive factors of sexual concerns. Methods: Descriptive, cross-sectional survey of patients with CAD, ACS, angina, MI, HF, or CABG. Participants (N=205) responded to demographic questions, a Sexual Concerns Inventory (12 items rated "never" to "frequently", with 3 subscales). Two items on ED were analyzed as one item to measure patient or male partner’s ED; thus, concerns were scored with 11 items (R=0-33). Participants chose from 20 cardiac/noncardiac co-morbidities. Sexual activity score was an index of whether or not the respondents participated in 8 possible activities ranging from kissing/hugging to intercourse. Data were analyzed using t-tests, correlations, and OLS regression. Results: Non-Whites, those not employed, and those who smoked had significantly more sexual concerns; men and those not employed reported more sexual dysfunction, non-Whites reported more fears and symptoms, and smokers reported more symptoms and sexual dysfunction. The number of cardiac and noncardiac comorbidities significantly predicted sexual concerns (R2=0.213; Table). For those sexually active, specific sexual activities yielded significantly greater concerns. Variables
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