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S260 Heart, Lung and CirculationAbstracts 2009;18S:S1–S286
595INTERVENTIONS FOR MAINTAINING LONG TERMPHYSICAL ACTIVITY AMONG INDIVIDUALS WITHCORONARY HEART DISEASE
R. Fernandez 1, S. Shamin 1, P. Davidson 2, Y.Salamonson 1, K. Andrews 3
1 University of Western Sydney, Sydney, Australia2 Curtin University Sydney, Australia3 Liverpool Hospital, Sydney, Australia
Participation in recommended levels of physical activ-ity optimizes functional status and is related to reductionin other risk factors among patients with coronary heartdisease. The purpose of this review was to assess and sum-marise the evidence and identify gaps in the literatureregarding interventions for being active in the long termamong individuals with coronary heart disease.
Methods: Extensive literature searching identifiedpublished and unpublished intervention studies that mea-sured physical activity outcomes in patients with coronaryheart disease. Studies were included if the follow-upperiod was 12 months or greater and met the methodolog-ical quality standards.
Results: Data were synthesised from 45 randomisedcontrolled trials. The heterogeneity of the studies lim-its the ability of the review to identify specific successfulintervention details. However, the findings suggest thatinterventions that were multi faceted had a positive effecton physical capacity in the long term. Significantly greaterimprovements in physical activity levels were reportedin interventions conducted over longer durations. Simi-larly a significant effect in favour of intensive regimens onphysical capacity was observed compared to less intensiveregimens.
Conclusion: The findings indicate that adherence tolong-term physical activity among patients with coronaryheart disease is feasible by implementing multifacetedinterventions tailored to the needs of the patients.
doi:10.1016/j.hlc.2009.05.641
596IS DEPRESSION EARLY AFTER ACUTE MYOCAR-DIAL INFARCTION ASSOCIATED WITH LONG-TERMDEATHS? A 25-YEAR FOLLOW-UP STUDY
A. Goble 1, M. Worcester 1,2, P. Elliott 1,2, B. Murphy 1,2,D. Hare 2
1 Heart Research Centre, Melbourne, Australia2 University of Melbourne, Melbourne, Australia
Up to 20% of patients experience severe depressionafter acute myocardial infarction (AMI). Milder depres-sive symptoms are even more common. Strong evidenceof an association between severe depression after AMIand cardiovascular disease (CVD) mortality and morbid-ity has been found but a causal link has been questioned.Using 25-year baseline data concerning 224 men afterAMI, we investigated whether depression, measured by
the Beck Depression Inventory (BDI) at 3 weeks, 4 and12 months, predicted CVD and all cause mortality duringthe ensuing 25 years. The mortality status of 220 (98.4%)of the 224 patients was determined.158 (71.8%) had died,most (n = 111, 70.3%) from CVD. Bivariate analyses, logis-tic regression and Cox Proportional Hazards regressionanalyses were carried out. At baseline, severe depression(BDI score ≥10) was present in 27 (14.4%) patients. A fur-ther 73 (38.8%) reported mild depression (BDI scores 5–9),while 88 (46.8%) had no depression (BDI scores < 5). Aftercontrolling for severity of infarction and age, depressionpredicted death at 5 and 10 years but not at 15 years andbeyond. Mortality was strongly related to severity of ill-ness (Killip class) and reduced functional capacity. Othermarkers of risk were older age, anterior AMI site, a historyof hypertension, early resumption of smoking and havingno confidant. The relationship between depression andother markers of risk requires further investigation.
doi:10.1016/j.hlc.2009.05.642
597LESSONS FROM A WEST AUSTRALIAN STATEWIDEASSESSMENT OF THE IMPLEMENTATION OF THENHMRC RECOMMENDATIONS FOR STRENGTHEN-ING CARDIAC REHABILITATION AND SECONDARYPREVENTION OF ABORIGINAL AND TORRESSTRAIT ISLANDER PEOPLE
S. Thompson 1,2,, J. Smith 4,5, M. Di Giacomo 2, K.Taylor 1,2, L. Dimer 4, F. Eades 3, M. Ali 1,2, M. Wood 5,6, T.Leahy 3, P. Davidson 2
1 Centre for International Health, Curtin University, Australia2 Curtin Health Innovation Health Institute, Australia3 Aboriginal Health Council of WA, Australia4 National Heart Foundation WA, Australia5 Royal Perth Hospital, Australia6 Derbarl Yerrigan Health Service, Australia
Introduction: In 2005, NHMRC published an outline ofprocesses to guide services on improving cardiac rehabil-itation (CR) for Indigenous Australians. This recognisedthe increased incidence and mortality from cardiovascu-lar causes in Indigenous Australians with onset occurringat a younger age then in other Australians.
Methods: Site visits and interviews with CR staff in15 mainstream CR/secondary prevention services (hospi-tals plus community health) across WA and 9 AboriginalCommunity Controlled Health Services. Qualitative andquantitative data regarding CR provision to Indigenouspeople with CVD, involvement of Aboriginal Health work-ers, adaptation to local settings, cultural competency andinteragency collaboration was collected by a CR nurse(±an Aboriginal nurse) using semi-structured interviews.
Results: Within tertiary hospitals the processes for iden-tifying Indigenous patients were suboptimal, there werefew Indigenous staff and processes for linking Indigenouspatients into CR services at discharge were suboptimal.Many CR services are private and others operate for verylimited hours and see very few Aboriginal clients. Of
