AB

ST

RA

CT

S

Heart, Lung and Circulation 6512012;21:648–660 Abstracts

The report, launched in June 2010, details 15 specificrecommendations for improvements to coordinated careacross the continuum, hospital systems and culture, pre-hospital diagnosis and evacuation, access to post-hospitalcare, data to support quality improvement and better carefor Aboriginal and Torres Strait Islander people.

The report aims to raise awareness of these issuesamong governments, hospitals, clinicians and other inter-ested parties.

Conclusion: The report is now being used in state andterritories and national advocacy to identify areas for pol-icy, system and practice change.

DOI of original abstract: http://dx.doi.org/10.1016/j.hlc.2011.04.014DOI of this abstract: http://dx.doi.org/10.1016/j.hlc.2012.07.027

09

Inequities in Maori Cardiovascular Health Require Com-bined Population and Clinical Health Responses

Tania Riddell

School of Population Health, The University of Auckland, NewZealand

Background: Maori have the poorest cardiovascularhealth outcomes of all population groups in AotearoaNew Zealand. Although these inequities have been docu-mented for many years progress toward addressing, rathert

otwgcla

catcta(disro

iebaq

DD

10

Indigenous Heart Health Outreach Screening Clinics

Christine Buchanan

Qld Health, Australia

Introduction: Indigenous Heart Health Clinics havebeen able to engage community members to create anenvironment of trust, providing education and healthpromotion to the local community. With close part-nerships and collaboration of the Indigenous Healthworkers we have developed a service with a high levelof cultural appropriateness and established strong part-nerships between Qld Health and Aboriginal and TorresStrait Islander Medical Service (AMS). The service wasapproached by Metropolitan South Health Service Dis-trict (MSHSD) to support establishing an outreach cardiacscreening strategy for the Indigenous community locatedon North Stradbroke Island.

Methods: A working group was established betweenMSHSD and Gold Coast Health Service District (GCHSD).The clinics are supported by a multidisciplinary team toprovide clinical assessments in the early detection andtreatment of cardiovascular disease. Indigenous Healthworkers evaluate risk factors using Heart Foundationguidelines. Each participant is assessed at the clinic byGCHSD cardiologist and cardiac technician to provideoiCvcH

N

iwd

DD

1

HA

LC

a

b

c

Ad

e

coc

han tolerating, them has been alarmingly slow.Methods: Over the past 10 years we have devel-

ped a clinical decision support system, PREDICT,hat provides primary and secondary care cliniciansith patient-specific cardiovascular risk assessment anduideline-based management advice. At the same time itollects risk profile data that we link to service utilisation,aboratory results, pharmaceutical prescribing, hospitaldmissions and deaths via encrypted patient identifiers.A new phase of research to study patterns in cardiovas-

ular disease outcomes, clinical activity and expendituret the population level is described. It aims to identify,rack and improve unwarranted variations in cardiovas-ular risk and risk management. Key elements will beo provide (1) interactive web-based national and localtlases of vascular burden and health service provision,2) feedback to policy-makers and clinicians regardingisparities in clinical outcomes and care, (3) evidence of

nterventions focussed on improving the quality of cardiacervices for Maori, and (4) accurate Maori and non-Maoriisk prediction algorithms to inform appropriate targetingf resources.Results and conclusion: Multi-level approaches to

mproving cardiovascular health for Maori, in whichvidence-based population strategies are complementedy evidence-based clinical strategies, are needed. Thesepproaches must be guided by science and focussed onuality.

OI of original abstract: http://dx.doi.org/10.1016/j.hlc.2011.04.015OI of this abstract: http://dx.doi.org/10.1016/j.hlc.2012.07.028

nsite echocardiogram and ECG. MSHSD provides clin-cal nurse, dietician and Indigenous Health workers.ulturally appropriate education is provided on cardio-ascular physiology and risk factors reduction. Clinic caseonference is supported by the AMS GP and Indigenousealth workers who facilitate appropriate follow ups.Results: The inaugural clinic was held in March 2011 atorth Stradbroke Island. Nine patients attended.Conclusion: MSHSD are in the process of reviewing the

naugural clinic and recruiting future patients. The clinicill continue to be supported by the GCHSD cardiologyepartment.

OI of original abstract: http://dx.doi.org/10.1016/j.hlc.2011.04.016OI of this abstract: http://dx.doi.org/10.1016/j.hlc.2012.07.029

1

eart Health for Our People by Our People: A Culturallyppropriate WA CR Program

yn Dimer a, Jane Jones b, Ted Dowling c, Craigheetham d, Andrew Maiorana e, Julie Smith a

Heart Foundation, AustraliaDerbarl Yerrigan Health Service, AustraliaDerbarl Yerrigan Health Service/Royal Perth Hospital,ustraliaWA Cardiac Rehabilitation Services, AustraliaRoyal Perth Hospital/Curtin University, Australia

Background: Cardiovascular disease is the leadingause of morbidity in Aboriginal Australians, however,nly around 5% of eligible Aboriginal people attendardiac rehabilitation (CR). Through much community

AB

ST

RA

CT

S

652 Heart, Lung and CirculationAbstracts 2012;21:648–660

consultation, and strong collaboration between HeartFoundation, Aboriginal Medical Service (AMS), main-stream cardiology and university staff this culturallyappropriate CR program at Derbarl Yerrigan HealthService (DYHS), was established to help address this treat-ment gap. Guidelines to strengthen CR for Aboriginalpeople (NHMRC, 2005) and a CR model in Wuchopperen,Queensland were used to inform the model.

Methods: Weekly exercise and education sessions aredelivered by Aboriginal staff at the AMS alongside non-Aboriginal health professionals (cardiac nurse, exercisephysiologist) and invited speakers. Yarning, an impor-tant part of Aboriginal culture, is used to discuss positivebehaviour change throughout the day. Sessions begin witha brief physical assessment. Group diabetic education pre-cedes a short walk. Supervised exercise using weightsand static bikes then occurs finishing with discussion ofa chronic disease issue over a healthy lunch.

Results: In 18 months since program commencementin 2008, 120 participants have attended (av 18–25/week).Outcomes include improved medication adherence, bloodglucose monitoring, improved diabetic and cardiovascularhealth knowledge. Cross-cultural learning between staffhas been very beneficial and the program continues toevolve.

catastrophic rhabdomyolysis, although fatal outcomes arereported to be very rare. Risk factors include age, comorbidillness (especially diabetes), dose, interacting medicationsand genetic predispositions. There is little informationregarding risk in Aboriginal and Torres Strait Islander(ATSI) populations.

Objective: To describe a case series of severe statin-induced myopathy in ATSI patients, increasing awarenessof this condition and reduce risk of future events.

Methods: Case reports of severe statin myopathy in ATSIwere collected from conference proceedings, nationaldrug regulatory authorities and personal clinical experi-ence. Cases were reviewed with respect to demographics,clinical features and identifiable risk factors. Populationstatistics were obtained from the Australian Bureau ofStatistics.

Results: Four cases of catastrophic statin myositis werefound. For clinical details refer to table. The populationof ATSI >55 years of age is approximately 40,000 people(Census 2006).

Conclusion: Four cases of severe (three fatal, onenear fatal with permanent disability) statin inducedmyopathy from the relatively small ATSI popula-tion >55 years are described. There is a need forincreased awareness of this condition, to reducefuture probability of avoidable catastrophic harm.

Case Source Demographics Presented Investigations Duration of RX Agent/dose Risk factors Synopsis

10/12

3 years

5/12

Long tRecentincrea

Conclusion: AMS-based CR is well attended, and shownto improve risk factors and health management. An AMS-based model of CR, similar to the one employed at DYHS,could be implemented to suit the specific needs of otherIndigenous communities around Australia.

DOI of original abstract: http://dx.doi.org/10.1016/j.hlc.2011.04.017DOI of this abstract: http://dx.doi.org/10.1016/j.hlc.2012.07.030

12

Catastrophic Statin-Induced Myopathy in Aboriginal andTorres Strait Islanders: A Case Series

Robert McCusker, Genevieve Gabb, Lee Luu

Royal Adelaide Hospital, Australia

Background: Statins are widely prescribed for dyslipi-daemia and vascular risk reduction. Adverse statin effectsinclude myopathy varying from mild pain syndromes to

1 Clinical exp 55 F, SA 8/2010 backpain6/52, proximalmuscle weakness2/52

CK > 17,000,Biopsy:polymyositis

2 Conferenceproceedings

61 M, QLD 2007 weight loss,unsteady gait 2/12

CK > 36,000

3 Conferenceproceedings

62 F, QLD 2009 quadiparesis2/12

CK 9000,biopsy:necrotisingmyositis

4 TGA report 58 F, unknown 9/2008 ARF CK 89000

Atorvastatin 40mg Age, diabetes,high dose statin

Delayed diagnosis, respfailure, ventilated 60days, slow wean,permanent disability,bedbound

Atorvastatin 40 mg Age, diabetes,high dose statin

Late presentation, respfailure, ventilated, died

Simvastatin20 mg/ezetimibe10 mg

Age, diabetes,verapamil,fluoxetine

Late presentation, respfailure, died

erm.dose

se

Simvastatin 80 mg/gemfibrozil 600 mg

Age, high dosestatin

Late presentation, acuterenal failure, died

DOI of original abstract: http://dx.doi.org/10.1016/j.hlc.2011.04.018DOI of this abstract: http://dx.doi.org/10.1016/j.hlc.2012.07.031

13

Infective Endocarditis and Rheumatic Heart Disease

Marc Remond a, Catherine Baskerville b,c, BrendanHanrahan d, Andrew Burke e, Anna Holwell f, GraemeMaguire a

a James Cook University, Cairns, QLD, Australiab Princess Alexandra Hospital, Brisbane, QLD, Australiac University of Queensland, Brisbane, QLD, Australiad Cairns Base Hospital, Cairns, QLD, Australiae The Prince Charles Hospital, Brisbane, QLD, Australiaf St. Vincent’s Hospital, Melbourne, VIC, Australia

Objective: Infective endocarditis (IE) is uncommonbut important. Australian IE data are limited. Whilstrheumatic heart disease (RHD) associated IE is waning in