S100 Journal of Cardiac Failure Vol. 20 No. 8s August 2014

249Getting the SCOOP - Survey of Cardiovascular Outcomes from OncologyPatients During SurvivorshipNirmanmoh Bhatia1, Daniel J. Lenihan2, Douglas B. Sawyer2, Carrie GeisbergLenneman3,2; 1University of Louisville, Louisville, KY; 2Vanderbilt University,Nashville, TN; 3University of Louisville, Louisville, KY

Background: Cardiovascular (CV) disease is a leading cause of mortality andmorbidity in cancer survivors (CS). Limited data exist on the awareness of CVside-effects of cancer therapy and its effect on cancer survivors’ lifestyle. Methods:A questionnaire was designed to assess the prevalence of CV disease, CV risk factors,CV side-effects of cancer therapy and lifestyle practices in CS. Data was collected byrecruiting volunteers via ResearchMatch.org and CureToday.com. Results: 213 vol-unteers (181 women) with mean age 56 years responded to the survey. 91% wereCaucasian. Breast cancer was the most prevalent (58%) malignancy. Majority(88%) were CS for O 1 year and 44% for O 5 years. 15% of respondents had a his-tory of CV disease before cancer therapy. The use of beta blockers (9%) and angio-tensin converting enzyme inhibitors or angiotensin receptor blockers (9%) was rare.Only a fifth received exercise counseling while half would have liked to receive it.(Table). CV side effects adversely impacted lifestyle in 27%, especially in recentCS. More than a third (36%) of subjects had unanswered questions about CV side-effects and 40% were interested in lifestyle coaching. Conclusions: This surveyshows CS are relatively young with significant CV side effects impacting qualityof life. Only a small percentage of patients were on cardioprotective therapy(ACE/BB) despite CV disease in 15%. The study highlights the need for cardio-oncology collaboration to monitor, treat, and educate CS and improve quality of life.

Table (249). Response to survey questions

Survey QuestionEntire Study

Group (N5213)Cancer Survivors forO 5 years (N593)

Cancer Survivorsfor # 5 years (N5117)

P value(Cancer Survivors

O 5 years vs. # 5 years)

Smokers 41% 43% 38% NSReceived Exercise Counseling 19% 13% 23% 0.057History of Heart Disease before Cancer treatment 15% 20% 10% 0.05Cardiac Side effects affecting lifestyle 27% 18% 37% ! 0.05Offered CV screening services during

chemotherapy26% 24% 27% NS

Counseled about CV side effects of their cancertreatment

40% 37% 43% NS

Have unanswered questions regarding lifestylemanagement of cancer therapy

35% 23% 45% ! 0.001

Would be interested in lifestyle improvementcoaching/counseling

40% 35% 44% NS

Have heard about “Cardio-Oncology” 8% 11% 5% NS

250Prognostic Impacts of Anemia in Patients with Chronic Heart Failure: AnInterim Analysis of the CHART-2 StudyTakeshi Yamauchi; Tohoku Univercity, Sendai, Japan

Background: Anemia is one of the major comorbidities in patients with heart failure(HF). However, it remains to be elucidated whether anemia is associated with poorprognosis independently of cardiac function and/or etiology of HF. Methods: Usingour database of the Chronic Heart Failure Analysis and Registry in the Tohoku Dis-trict-2 (CHART-2) study (N510,219), we examined clinical characteristics, treat-ments and long-term prognosis of anemia patients, and examined the prognosticimpacts of anemia according to left ventricular ejection fraction (LVEF) or HF etiol-ogies. Anemia was defined as blood hemoglobin level of ! 13 mg/dl for males andthat of! 12 mg/dl for females, respectively, according to the definition by the WorldHealth Organization. Results: Among 4,736 patients with Stage C/D HF registered inour CHART-2 study, 1,627 (35%) had anemia. The patients with anemia, ascompared with those without it, were older (73 vs. 66 yrs., P!0.001), characterizedby lower estimated glomerular filtration rate (52.8 vs. 66.1 mL/min/1.73m2, P!0.001) and higher BNP levels (154.5 vs. 81.8 pg/mL, P!0.001) and had lower prev-alence of dilated cardiomyopathy (DCM) (9.1 vs. 16.5%, P!0.001). There were nodifferences in the prevalence of ischemic heart disease (IHD) (47.9 vs. 46.3%,P50.309) or hypertensive heart disease (HHD) (5.5 vs. 6.0 %, P50.471). Anemic pa-tients were less frequently treated with statins (34 vs.41%, P!0.001) and b-blockers(45 vs. 51%, P!0.001) and were more frequently treated with renin-angiotensin sys-tem inhibitors (75 vs. 71%, P50.006). There was no significant difference in LVEFbetween anemic and non-anemic patients (58 vs. 57%, P50.088). During the medianfollow-up 3.8 years, there were 674 deaths. The multivariate Cox regression analysis

revealed that anemia was an independent predictor of all-cause death (adjusted haz-ard ratio (HR) 1.38; 95% confidential interval (CI) 1.13-1.68, P50.002). Subgroupanalysis revealed that anemia was significantly associated with increased mortalityin patients with LVEF$50% (adjusted HR 1.53; 95%CI 1.19-1.98, P50.001) butnot in those with LVEF!50% (adjusted HR 1.08; 95%CI 0.79-1.45, P50.63) (Pfor interaction50.003). Furthermore, anemia was a significant predictor of all-causedeath in patients with HHD (adjusted HR 3.05; 95%CI 1.12-8.31, P50.03) but not inthose with DCM (adjusted HR 1.14; 95%CI 0.66-2.00, P50.62) or those with IHD(adjusted HR 1.002; 95%CI 0.76-1.33, P50.99). Conclusions: These results indicatethat anemia is an independent prognostic factor in patients with HF although itsimpact may vary depending on baseline cardiac function and HF etiologies.

251Epidemiology, Clinical Profile and Cardiac Remodeling of Severe RheumaticHeart Disease in MalaysiaBenjamin R. Levin1, Maizatu A. Sulong2, Siti Nurzaliana Mohd Safari2, NorfazlinaJaffar2, Mohd Faizal Ramli2, Rosli Mohd Ali2; 1Duke University Hospital, Durham,NC; 2National Heart Institute, Kuala Lumpur, Malaysia

Introduction: Rheumatic heart disease (RHD) is the most common cause of valvularheart disease and heart failure in the developing world and a major global publichealth challenge. However, there is little data on severe RHD in Southeast Asia.We first defined both the epidemiology and clinical profile of severe RHD (definedas requiring valve surgery or PTMC) that presented to the largest academic cardiol-ogy hospital in Malaysia from 2010 through 2012. We then defined, by echocardiog-

raphy, the adverse cardiac remodeling in this severe RHD population and examinedthe short term, reverse cardiac remodeling that occurred post-surgical or PTMC reliefof the valvular disease. Hypothesis: There is a significant prevalence of severe RHDin Malaysia with adverse cardiac remodeling that demonstrates significant improve-ment at three days post-surgical and PTMC intervention. Methods: All patients withclinically severe RHD who underwent either PTMC or surgery from January 2010through December 2012 were identified from surgical operating room and cardiaccatheterization lab procedure lists. All of the patients’ medical records were re-viewed. Results: A total of 552 patients were identified (480 adult, 72 pediatric).403 adult (66% female, 34% male) and 70 pediatric (50% male, 50% female) patientsunderwent surgical valve repair or replacement. Of the 403 adult surgical patients,none of them had either a reported history of Group A streptococcal (strep) pharyn-gitis, primary or secondary antibiotic prophylaxis. 6% reported history of acute rheu-matic fever (ARF). Surgery involved 1 (37%), 2 (50%) or 3 heart valves (13%). 90%of adult patients had mitral valve (MV) surgery (16% MV repair), 65% aortic valvesurgery, 47% tricuspid valve surgery. At 3 day post-procedure TTE follow-up, therewas significant improvement in LA size in adult patients with moderate to severe MRwho underwent MV surgery (LA size 41 mm pre and 31 mm post, p-value !0.001).LA size also improved in moderate to severe MS patients who underwent PTMC (LAsize 34.4 mm pre, 29.6 mm post, P-value 0.012). LVEDD significantly decreased insize in both the pediatric and adult patients with moderate to severe MR who under-went MV surgery (P-values 0.01 and 0.006). Conclusions: There was a significantprevalence of severe RHD during the three year period of 2010-2012. Adult patientsdid not report any known history of prior group A strep pharyngitis or primary anti-biotic prophylaxis and low known incidence of ARF. There was significant aorticvalve involvement and a predominance of female adult surgery patients. The adversecardiac remodeling of LA and LV dilation demonstrated significant improvement 3days post procedural intervention. There is a strong need for better public health ed-ucation and prevention of RHD in Malaysia.