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Conclusion: Overall low awareness about SHS was reported among respondents. Socialinequalities in awareness about SHS were also observed highlighting lower awareness levelsamong youth and lesser-educated respondents compared to the more educated respondents.Hence to protect employees from SHS, smoke free laws should be strictly implemented.Disclosure of Interest: None Declared

O204

Clinical Presentation, Management, And In-Hospital Outcomes Of Patients AdmittedWith Decompensated Heart Failure In Trivandrum, Kerala, India

Harikrishnan Sivadasanpillai*1, Sanjay Ganapathy1, C. G. Bahuleyan2, D. Dalus3,Madhu Sreedharan4, Rao Asok Chandra5, Sunitha Viswanathan6, Suresh Krishnan7, Tiny Nair8,Vijayaraghavan Govindan91Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum,India,2Cardiology, Ananthapuri Hospital, 3Medicine, Medical college, Trivandrum, 4Cardiology,NIMS,Neyyattinkara, 5Cardiology, SUT Hospital, 6Cardiology, Medical college, Trivandrum,7Cardiology, SK Hospital, 8Cardiology, PRS Hospital, 9Cardiology, KIMS, Trivandrum, India

Introduction: Heart failure (HF) is emerging as a leading cause of hospitalization in India. Thereis hardly anydata regardingHF from India. TheTrivandrumHeart Failure Registry (THFR) is thefirst registry in the country supported by the Indian Council of Medical Research (ICMR).Objectives: Is to collect data regarding consecutive HF admissions and outcomes in all thehospitals in Trivandrum city (n¼11) and a selected rural area(n¼5) in the suburbs.Methods: THFR enrolls consecutive patients who are admitted with a diagnosis of HF(satisfying European Society of Cardiology 2012 Criteria). Data regarding diagnosis,treatment and in-hospital outcomes were captured. The registry is running in the year 2013and the first 6 months data is being presented.Results: Total of 624 patients (428, 68.6% males, mean age 60+/- 13.9 years) were enrolledduring the 6 month period. The most common etiology was coronary artery disease (CAD)(69.5%) followed by dilated cardiomyopathy (14.5%) and rheumatic heart disease (8%). Dia-stolic heart failure constituted 3%of the population. Isolated right heart failure (cor-pulmonale,pulmonary embolism) constituted 1%of the total cohort. 14.1%were in Atrial Fibrillation(AF).Of the patients who had CAD, 55% presented with HF related to an acute coronary

syndrome (ACS) and the rest 45% had ischemic cardiomyopathy. 268 of the 624 patients(43%) presented with acute de-novo heart failure, 233 (37%) with acute on chronic heartfailure and 123(37%) had chronic heart failure. Risk factor profile - Diabetes 52%, hy-pertension 55%, smoking 44%, chronic kidney disease (CKD) 15.5%.The mean duration of hospitalization was 7.99 +/- 6.2 days. The total in-hospital

mortality was 9.3% (58 patients). Mortality was higher in females than males (12.7% vs7.7%). Discharge medications were as follows – Beta-blockers (56%), ACEI/ARB (49%),Diuretics(77%), Aldosterone blockers (48%), Digoxin (27%) and anticoagulants (13%).Conclusion: Compared to data from the west, Indian patients are younger; have malepredominance, more have CAD and very few present with diastolic HF. Prevalence ofhypertension, AF and CKD were lesser. In-hospital stay was longer and mortality washigher, especially among females. Usage of evidenced based therapy was not very different.The possible explanations will be discussed.Disclosure of Interest: None Declared

O205

Assessing Knowledge Attitude and Behaviour of Kiosk Owners Selling TobaccoProducts to School Children

Ankur Singh*, Vinay Gupta, Monika Arora1Department of Health Promotion and Tobacco Control, Public Health Foundation ofIndia(PHFI), New Delhi, India

Introduction: With evidence supporting association of restriction in access to tobaccoproducts and lower prevalence of tobacco use among youth it is important to know thekiosk owner’s perspective regarding sale of tobacco products to youth.Objectives: The study was conducted in states of Andhra Pradesh and Gujarat to un-derstand kiosk owner’s knowledge, attitude and practice of Tobacco Control Law;restricting sale within radius of 100 yards of any educational institution and its variationaccording to socio-demographic variables.Methods: A scale was created for awareness about tobacco control law and its implicationsby summing up eight questions with binary options such that higher score on scale isprotective, Cronbac’s alpha ¼ 0.68.Associations between awareness score and kiosk setup and their sociodemographic

profile were tested through nonparametric test. Association of kiosk setup and theirsociodemographic profile with kiosk owners’ opinion on having a shop and kiosk owners’practice on selling tobacco products to children were assessed through chi-square test.Results: Overall awareness was high with median value 6 (IQR¼ 5-6). Kiosk set ups, gender,area, age and education were significantly associated with awareness level. 51.56% male ascompared to 61.21% females scored themedian awareness level, p¼0.015.More kiosk ownersin urban areaswere atmedian awareness level (64.57%) than in semi urban (47.5%) area and inrural area (50.97%). Proportion of kiosk owners who had awareness at median level or morewas significantly more in higher education groups, p¼0.002.Age and education were significantly associated with kiosk owners’ opinion on having a

shop located Also, 50.79% of illiterates in comparison with 38.17% educated up to primary/middle school, 42.94% secondary school and 33.33% higher secondary and above reportedthat it is economic advantage to have a shop within 100 yards of school, p<0.05.Selling tobacco product to childrenSelling tobacco product to children was significantly associated with education only and

showed no trend (Table 4). Overall, 22.76% of illiterates, 31.15% educated up to primary/

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middle school, 33.53% educated up to secondary school and 18.07%% educated up tohigher secondary and above were reportedly selling tobacco products to children, p<0.05.Conclusion: Social inequalities in knowledge and attitude of Kiosk Owners was observedhighligting the need for stricter policies to address the wider determinants in order toreduce access to tobacco products among youth.Disclosure of Interest: None Declared

O206

Association Of Physical Inactivity, Low Fitness And Sedentary Behaviors With BloodPressure In 8-10 Year Old Children

Gilles Paradis*1, Marie-Eve Mathieu2, Katerina Maximova3, Tracie A. Barnett4,Arnaud Chiolero51Epidemiology, Biostatistics and Occupational Health, McGill University, 2Kinesiology, Universitede Montreal, Montreal, 3School of Public Health, University of Alberta, Edmonton, 4ExerciseScience, Concordia University, Montreal, Canada, 5Institut Universitaire de médecine sociale etpréventive, Université de Lausanne, Lausanne, Switzerland

Introduction: High blood pressure (BP) in youth is associated with early markers of car-diovascular diseases and BP levels track from childhood to adulthood. Although sedentarybehaviors, physical inactivity and decreased fitness predict high BP in adults, their rela-tionship in children is not well established.Objectives: To assess the relationship of physical inactivity, sedentary behaviors and fitnesswith BP in 8 to 10 year-old children at high risk of obesity.Methods: Baseline data from a cohort of 630 children (343 boys and 287 girls), originallyaged 8-10 years, with at least one obese biological parent (BMI�30kg/m2 or waist circum-ference >102cm in men and >88cm in women). Five consecutive BP readings at 1-min in-tervals at rest, were obtained with an oscillometric device (Dinamap XL CR9340). Physicalactivity was assessed with 7-day accelerometry (Actigraph LS7164) as well as with validated,self-reported questionnaires which also collected information on sedentary behaviors (TVviewing, computer use, video game playing, studying and reading). Fitness was assessed byVO2peak using a standard incremental exercise test on an electromagnetic bicycle (OxyconPro, Jaeger) with continuously measured indirect calorimetry, and was categorized in tertiles(low, middle and high). Height, weight and sexual maturation (Tanner) were measured andparental self-reports of history of high BP and of socio-economic information were collected.The Odds of elevated systolic (SBP) or diastolic (DBP) BP (defined as age, sex and heightspecific SBP or DBP �90th percentile from cohort distribution) was assessed with logisticregression, adjusted for BMI, Tanner stage, parent education and parent history of high BP.Results: Mean (SD) SBP/DBP were 94.4 (8.3)/48.3 (5.3) and 93.1 (7.9)/48.9 (5.0) mmHgfor boys and girls, respectively. 40% of boys and 31% of girls practiced >2 physical ac-tivities per day for at least 15 min and they spent an average of 3.1 and 2.4 hours per dayrespectively being sedentary. Multivariate logistic regression models showed that >2 hoursper day of TV viewing was associated with an 80% increase in the odds of elevated DBP(OR (95%CI) 1.8 (1.1-3.1)). This association was more pronounced among overweight andobese youth. The OR for elevated BP among low (vs high) fitness children was 3.4 (1.2-9.6). BP was 97/51 vs 92/47 mmHg in the low vs the high fitness group.Conclusion:Watching TV for more than 2 hours per day and low fitness is associated withan increased odds of elevated BP in 8-10 year-olds.Disclosure of Interest: None Declared

O207

Readmissions after first heart failure hospitalization in Aboriginal versus non-Aboriginal patients in Western Australia, 2000-2007

Tiew-Hwa Katherine Teng*1, Judith M. Katzenellenbogen1, Elizabeth Geelhoed2,Matthew Knuiman2, Derrick Lopez1, John A. Woods1, Frank Sanfilippo2, Michael Hobbs2,Joseph Hung3, Sandra C. Thompson11Combined Universities Centre for Rural Health, 2School of Population Health, 3Sir CharlesGairdner Hospital Unit, The University of Western Australia, Perth, Australia

Introduction: Heart failure (HF) is a leading cause of rehospitalizations. Readmission ratesand hospital length of stay (LOS) have major implications for quality of care and resourceutilization.Objectives: To compare the readmission patterns of Aboriginal versus non-Aboriginalpatients aged 20-84 years who were discharged alive following a first (index) HF hospi-talization between 2000 and 2007.Methods: Patients were followed for three years from first admission date for HF read-missions only using the WA Hospital Morbidity Database. Risk-adjusted Poisson regressionmodels were used to examine the rate ratios (RR) of HF readmissions between Aboriginaland non-Aboriginal patients.Results: Of 12,947 patients surviving index HF hospitalization, 727 (5.6%) were Aboriginalwith 77% residing in rural/remote areas. Aboriginal compared to non-Aboriginal patientswere younger (mean age: 54 years vs 71 years), and had higher prevalence of hypertension,diabetes, chronic kidney disease, rheumatic valvular heart disease (all p<0.05).Compared with non-Aboriginal patients, a higher proportion of Aboriginal patients had a

HF readmission within 3-year follow-up (60.7% vs 49.5%, p<0.001) with a greater propor-tion being emergency readmission (89.2% vs 70.8). The interval from index separation to firstHF readmission was shorter for Aboriginal patients aged under 55 years (162.6 vs 199.2 days,p¼0.048). Mean HF readmissions was higher in Aboriginal patients (3.3�3.3 vs 2.5�3.6,p<0.001). The shorter average LOS during index HF admission (4.5�4.9 vs 5.6�7.6 days,p<0.01) in Aboriginal patients might predispose to a greater need for readmission.Risk-adjusted rate ratio of HF readmits was higher in Aboriginal patients (RR 1.17,

p<0.001). Age, Charlson comorbidity index, rural residence, no private insurance, rural

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hospital, ischaemic heart disease, valvular heart disease and chronic kidney disease were allsignificant predictors of increased HF readmissions.Conclusion: Aboriginal HF patients despite being younger have higher readmission ratesand a shorter interval to first HF readmission compared with non-Aboriginal patients.Possible contributory factors include remoteness, a higher patient comorbidity burden,inferior multidisciplinary and coordinated before care after hospital discharge and sub-optimal secondary prevention.Disclosure of Interest: None Declared

O208

Comparison of NZ European and NZ Maori of Patients Hospitalised for Heart Failure:New Zealand Heart Failure Registry

Karthigesh (Kat) Sree Raman*1, Richard Troughton2, Mayanna Lund3, Rob Doughty4,Gerard Devlin1, New Zealand Heart Failure Registry (NZHFR)1Cardiology, Waikato Hospital, Hamilton, 2Cardiology, Christchurch Hospital, Christchurch,3Cardiology, Middlemore Hospital, 4Cardiology, Auckland Hospital, Auckland, New Zealand

Introduction: Prior reviews of the New Zealand Heart Failure Registry (NZHFR) showedthat NZ-Maori present at a younger age with heart failure and have higher prevalence of LVsystolic dysfunction.Objectives: We aim to revisit and compare outcomes for NZ-Maori (NZM) and NZ-Europeans (NZE), based on updated NZHFR data.Methods: NZHFR is a national, prospective, observational, web-based registry. All hospitalsin New Zealand admitting patients with acute heart failure have been invited to participate.Results: A total of 1904 patients are enrolled from July 2006 to September 2013, and 90-day follow up data is available in 90% (1705/1890). There are 446 NZM (mean-age 62years, 69.5% males) and 1094 NZE (mean-age 79.1 years, 61% males). Hypertension andatrial fibrillation are the major aetiological factors for heart failure in both groups. Higherprevalence of severe valvular disease (24.4% vs. 19.6%, p<0.0383) and diabetes (44% vs.29.5%, p<0.0001) in NZM group with ischemic heart disease more prevalent in NZE(22.5% vs. 12.3%, p<0.0001). Predisposing factors for hospital admission for NZM areuncontrolled hypertension (11.4% vs. 4.8%, p<0.0001) and non-compliance with medi-cation (16.1% vs. 3.2%, p<0.0001). NZM have high prevalence of impaired left ventricularsystolic function (LVEF<50%, 83.5% vs. 66.7%, P<0.0001). A higher proportion of NZMhave been referred to heart failure nurse on discharge (59.4% vs. 44.8%, p<0.0001).Discharge medications and 90 days follow up as shown in table:

Discharge medications NZ European NZ Maori p value

Diuretics 96.4% (1001/1037) 98.2% (426/434) 0.12

Beta-blockers 76.9% (797/1037) 80.2% (348/434) 0.16

ACE-i/ARBs 78.4% (813/1037) 88.0% (382/434) <0.0001*

Aldosterone antagonist 28.5% (296/1037) 41.0% (178/434) <0.0001*

Outcomes NZ European NZ Maori p value

Median length of stay 6 days 7 days

In-hospital mortality 5.2% (57/1094) 2.7% (12/446) 0.0298*

Mortality at 90-day follow up 13.1% (128/975) 8.1% (33/407) 0.0076*

Hospital readmission at 90-days 16.9% (165/975) 15.0% (61/407) 0.425

Compliance with treatment 87.4% (852/975) 82.6% (336/407) 0.0217*

HR (95% CI) p-value

Blood hemoglobin, 1.78 g/dL 0.82 (0.72, 0.94) 0.004

Hemoglobin A1c, 1.56% 1.28 (1.14, 1.43) <0.001

Uric acid, 1.92 mg/dL 1.14 (1.02, 1.28) 0.025

Log(C-reactive protein, 0.87 mg/L) 1.12 (1.01, 1.25) 0.038

Log(Interleukin-6, 17.1 pg/mL) 1.16 (1.07, 1.26) <0.001

Conclusion: NZ-Maori present at a much younger age with heart failure and have increasedprevalence of systolic dysfunction. They aremore likely to receive evidence based care with ACE-i/ARBs and aldosterone antagonists but higher compliance is noted in theNZE group. There is nodifference in at 90-day readmission but NZE have higher in-hospital and 90-day mortality.Disclosure of Interest: None Declared

O209

Asian Patients With Heart Failure and Ejection Fraction ‡40%: Predictors of Two-Year Mortality

Andy Neo*1, Jonathan Yap2, Shaw Yang Chia2, Ling Ling Sim2, David Sim2, Chi Keong Ching21Yong Loo Lin School of Medicine, National University of Singapore, 2National Heart Centre,Singapore General Hospital, Singapore, Singapore

Introduction: Despite advances in care, there is a high mortality seen in patients with heartfailure and left ventricular ejection fraction (LVEF)� 40%. Of note, data from Asia is scarce.Objectives: Our objective is to analyse the predictors of two-year mortality in these patients.Methods: Consecutive patients admitted to 2 Asian institutions for heart failure with LVEF� 40% on transthoracic echocardiogram from 1 January 2008 to 31 December 2009 wereincluded. Clinical demographics, risk factors, laboratory and imaging results and medicationhistory were obtained. All patients were followed-up for 2 years. Overall mortality wasobtained from the national registry of deaths in our country.Results: A total of 1055 patients were included. Mean age was 72.4 (standard deviation10.9) years old and there were 407 (39%) males. 771 (73.1%) patients were Chinese, 143(13.6%) Malay, 123 Indian (11.7%) and 18 (1.7%) were of other ethnicities. There were819 (77.6%) patients with LVEF � 50% and 236 (22.4%) with LVEF 40-49%. Mortality at

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one and two years were 19.1% (n¼201) and 28.4% (n¼300) respectively. On multivariateCox regression analysis, significant predictors of two-year mortality were prior myocardialinfarction (HR 1.849; 95% CI 1.411-2.422; p<0.001), previous stroke (HR 1.377; 95% CI1.042-1.819; p¼0.024), increased age (HR 1.017; 95% CI 1.004-1.029; p¼0.009) andincreased serum creatinine (HR 1.002; 95% CI 1.001-1.003; p<0.001). Higher systolicblood pressure (HR 0.993; 95% CI 0.988-0.998; p¼0.011), higher hemoglobin levels (HR0.899; 95% CI 0.844-0.958; p¼0.001) and use of aspirin (HR 0.763; 95% CI 0.592-0.984;p¼0.037) and warfarin (HR 0.576; 95% CI 0.382-0.868; p¼0.008) and lipid-loweringdrugs (HR 0.655; 95% CI 0.511-0.839; p¼0.001) resulted in significantly less mortality.Amongst others, sex, ethnicity, use of beta-blockers and angiotensin-converting-enzymeinhibitors/angiotensin II receptor blockers had no significant effect on mortality.Conclusion: In our Asian population presenting with heart failure and LVEF � 40%, two-year mortality was 28%. Prior myocardial infarction, previous stroke, increased age andincreased serum creatinine resulted in significantly higher mortality. Higher systolic bloodpressure and hemoglobin levels, use of aspirin and lipid-lowering drugs resulted insignificantly lower mortality.Disclosure of Interest: None Declared

O210

Risk factors for congestive heart failure in patients with chronic kidney disease: theCRIC study

Jiang He*1, Wei Yang2, Amanda Anderson2, Harold Feldman2, John Kusek3, Akinlolu Ojo4,Dominic Raj5, Mahboob Rahman6, Michael Shlipak7, Lee Hamm8, CRIC Investigators1Department of Epidemiology, Tulane University, New Orleans, 2Biostatistics and Epidemiology,University of Pennsylvania, Philadelphia, 3Kidney & Urology Branch, NIDDK, Bethesda, 4InternalMedicine, University of Michigan, Ann Arbor, 5Medicine, George Washington University, WashingtonDC, 6Medicine, CaseWestern Reserve University, Cleveland, 7Medicine, University of California, SanFrancisco , San Francisco, 8Internal Medicine, Tulane University, New Orleans, United States

Introduction: Congestive heart failure (CHF) is common in patients with chronic kidneydisease (CKD).Objectives: We studied the prospective relationship of novel cardiovascular risk factorswith the event rate of CHF among 3,939 CKD patients from the Chronic Renal Insuffi-ciency Cohort (CRIC) Study.Methods: Kidney function was assessed by estimated glomerular filtration rate (eGFR)using the CKD-EPI equation, serum cystatin C, and 24-hour urinary excretion of albumin.During an average of 3.6 years of follow up, 390 individuals were hospitalized for CHF.Results: After adjustment for age, gender, race, self-reported history ofCHF and clinical site, thehazard ratio (HR, 95% CI) for CHF associated with 1 standard deviation (SD) lower eGFR (13.5mL/min/1.73m2)was1.53 (1.35,1.73), 1 SDhigher cystatinC (0.55mg/L)was 1.61 (1.47,1.75),and 1 SDhigher log[urine albumin (0.52mg/24h)]was 1.62 (1.48, 1.76), all p<0.001.When all3 kidney function measures were simultaneously included in the model, only cystatin C (HR,1.53, 95%CI1.34, 1.74) and log(urine albumin) (HR1.47, 95%CI1.35, 1.61)were significantlyassociated with increased risk of CHF. These associations remained statistically significant afterfurther adjustment for other known risk factors including education, physical activity, cigarettesmoking, alcohol consumption, history ofmyocardial infarction and diabetes, bodymass index,systolic blood pressure,HDL and LDL cholesterol. After adjustment for all abovementioned riskfactors, the relationships of novel risk factors (1 SDhigher)withCHFare given in the table below:

Conclusion: Our study indicated that cystatin C and urine albumin are better predictorsfor risk of CHF compared to eGFR. Furthermore, anemia, inflammation, higher uric acid,and poor glycemic control are independent risk factors for the development of CHF amongpatients with CKD.Disclosure of Interest: None Declared

O211

Urinary Sodium and Potassium Excretion and Cardiovascular Diseases in Patientswith Chronic Kidney Disease: the Chronic Renal Insufficiency Cohort study

Katherine T. Mills*1, Lawrence J. Appel2, Jing Chen1,3, Patrice Delafontaine3, John Kusek4,Akinlolu Ojo5, Mahboob Rahman6, Raymond R. Townsend7, Peter Yang8, Jiang He1,3, theChronic Renal Insufficiency Cohort (CRIC) Investigators1Department of Epidemiology, Tulane University, New Orleans, 2Welch Center for Prevention,Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore,3Department of Medicine, Tulane University, New Orleans, 4Division of Kidney, Urologic, andHematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, NIH ,Bethesda, 5Department of Internal Medicine, University of Michigan, Ann Arbor, 6Department ofMedicine, Case Western Reserve University, Cleveland, 7Department of Medicine, 8Departmentof Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, United States

Introduction: Chronic kidney disease (CKD) patients are at an increased risk of cardio-vascular disease (CVD) compared to the general population. Prior work has produced

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