S214 Canadian Journal of CardiologyVolume 30 2014

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HEALTH LITERACY, ADVOCACY ANDCARDIOVASCULAR DISEASE RISK EDUCATION BYRESIDENT PHYSICIANS FOR PATIENTS USING AMEDICAL APP: DEVELOPMENT, IMPLEMENTATIONAND EVALUATION

RM Mehta

Calgary, Alberta

RATIONALE: Canada faces a future epidemic of cardiovasculardisease caused by high obesity rates, poor eating habits andlow levels of physical activity. The language used in cardio-vascular disease can be quite complex, and patients can beoverwhelmed by the huge amount of information that isavailable to them. Patients therefore, need to learn the lan-guage of cardiovascular disease risks and how to use thatlanguage to understand the disease and ask their physiciansabout various risks and treatment options. The purpose of thisstudy to develop, and independently evaluate an app for useby physicians with patients that will advocate health literacyfor patients about the risk for cardiovascular disease. We havechosen to develop a computerized application becauseresearch shows appropriately designed; evidence-based, onlinemedical education such as apps can produce objectivelymeasured changes in behavior as well as sustained gains inknowledge and attitudes that are comparable or better thanthose found with effective live activities. This innovativeintervention will be accessible to Family Medicine (primarycare) resident physicians.METHODOLOGY: We have developed an app to provide stra-tegies to promote and support health literacy, advocacy andeducation for cardiovascular disease risk in patients by residentphysicians. We are doing an independent randomizedcontrolled trial of the app, comparing knowledge/literacy andattitudinal outcomes between physicians and patients who willbe randomized to an intervention group or control group.RESULTS: We have finished the development of the heart ipadapp. We are in the process of recruiting residents and patientsfor the study.CONCLUSION: All data will be collected in hardcopy and in-depth demographic information will be surveyed for patientsand physicians. Patients and physicians will be surveyed atbaseline, after the clinical encounter and at three monthsfollow-up. For physicians we aim to measure their knowledgeabout screening and diagnosis, goals of treatment and treat-ment options for cardiovascular diseases. A Questionnaire willbe used to assess physician attitudes towards Health Advocacy.Physician attitudes towards cardiovascular disease screeningand treatment will also be assessed using a survey focused onthe resident physician’s attitudes toward cardiovascular diseasescreening and guidelines. Patients will be asked to complete aknowledge questionnaire about the diagnosis and treatment ofcardiovascular disease which is designed to ascertain patients’prior investigations for cardiovascular disease, and knowledgeof the cardiovascular system, cardiovascular disease symptomsand risks, as well as treatment options.

Canadian Cardiovascular Society (CCS) PosterIMAGING POSTER SESSION ISunday, October 26, 2014

312

APPROPRIATENESS OF ECHOCARDIOGRAPHY IN ACANADIAN TEACHING HOSPITAL - ARE WE ANYDIFFERENT?

M Bishay, S Chai, P Gibson, H Becher, J Choy

Edmonton, Alberta

BACKGROUND: In recent years, transthoracic echocardiography(TTE) has been utilized frequently to assess cardiovascularstatus and has rapidly become an extension or even replace-ment of the physical examination. We undertook a study toexamine the appropriateness of TTE in a tertiary care teachinghospital to determine if there were potential gaps that couldreduce expenditure.METHODS: Two separate reviewers graded requisitions for TTEaccording to appropriate use criteria (AUC) published by theAmerican Society of Echocardiography (2011) as appropriate,inappropriate or uncertain. Requisitions were deemed notclassifiable if the clinical indication was not discussed in theguidelines or if there was not information on the requisition.

Abstracts S215

Consensus was achieved by engaging a third reviewer if therewere any disagreements between the first 2 reviewers. Physicianand patient demographics were collected from the College ofPhysicians and Surgeons website and Xcelera database.RESULTS: Of the 336 requisitions reviewed, 313 could begraded with the 2011 AUC. Only 3.3% were classified asinappropriate, while 84.8% of requisitions were appropriate,and 5.1% were uncertain. The most common indications foreach rating are listed in Table 1. The 4 specialties that orderedthe most echocardiograms were cardiology (59.2%), internalmedicine (15.2%), cardiac surgery (7.1%), and critical caremedicine (5.4%). There was a statistically significant differ-ence in the number of appropriate requisitions between in-patients (n¼167) and outpatients (n¼169) (90.4% vs.79.3%, respectively, p < 0.01) (Figure 1). There was nostatistical difference in the number of appropriate requisitionsbetween cardiologists and cardiac surgeons (n¼222) vs. allother specialties (n¼114) (85.1% vs. 84.2%, respectively).CONCLUSION: There is a high rate of appropriateness in TTEutilization,whichdoesnot seem todiffer betweendifferentmedicalspecialties. Appropriateness may be higher amongst inpatients dueto the higher level of acuity of their illness. These findings aresimilar to recently published studies in the US and may reflect therather broad indications for echocardiography. Future study needsto be conducted to examine whether these appropriate echocar-diograms actually lead to a change in patient management andoutcome in order to determine the cost benefits of TTE.

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A SIMPLIFIED APPROACH TO MEASURING LVEFUSING REGIONAL WALL MOTION

A Joshi, G Dwivedi, T Coutinho, K Chan, L Beauchesne,L Mielniczuk, T Ruddy, I Burwash

Ottawa, Ontario

BACKGROUND: Left ventricular ejection fraction (LVEF) isimportant for management and prognostication of various car-diac diseases and is the most common measure of LV function.Biplane Simpson’s method is recommended when using echo-cardiography, but can be cumbersome, time-consuming and notpossible inmany patients. An easy to use and accurate method toderive LVEF would be extremely useful for clinical practice. Thepurpose of this study was (1) to validate a simplified approach toestimating LVEF by echocardiography using regional wall mo-tion (SEF) by comparison with radionuclide ventriculography,and (2) to compare the SEF method with the LVEF reported byLevel 3 echocardiographers in an academic hospital.METHODS: We identified 186 consecutive patients who hadLVEF calculated by both radionuclide ventriculography andechocardiography within 90 days of each other during a 1 yearperiod. SEF was calculated using the completed wall motionanalysis by subtracting 4% for each akinetic or worse segmentand 2% for each hypokinetic segment from a total of 64% (16segments, each valued at 4%). SEF was compared to the LVEFcalculated by radionuclide ventriculography (MEF). SEF wasalso compared to the LVEF reported by Level 3 echocardiog-raphers (REF), and in the patient subgroups using biplaneSimpson’s method, Teichholz method and visual estimate.RESULTS: The results are summarized in the table below. In the186 patients, both SEF and REF correlated highly with MEFwith correlation coefficients of 0.80 and 0.83 respectively.Moreover, SEF was non-inferior to REF in correlating withMEF. However, REF significantly overestimated MEF ascompared to SEF (REF 4.7% vs. SEF 1.6%; p¼< 0.0001). Thecorrelation coefficients for SEF vs. MEF and REF vs. MEF weresimilar when analyzed in the patient subgroups using biplaneSimpson’s method, Teichholz method and visual estimate.CONCLUSION: SEF is a simple, easy to use method to estimateLVEF and is non-inferior to previously validated echocardiogra-phy-derivedLVEFMethods. In addition, overestimation of LVEFby Level 3 echocardiographers when compared to radionuclideventriculography is reduced using this simplified approach.