ESC Congress in Review - Main Edition 2019 - 20

Late-Breaking Science

2. free antihypertensive and cholesterol lowering medication recommended by NPHWs and supervised by
physicians; and
3. a treatment supporter (i.e., friend or family) to improve
adherence to medication and healthy behaviour.
The primary outcome was change in Framingham Risk
Score (FRS) at 12 months. All communities completed
12-month	follow-up	and	provided	data	on	97%	of	living	
participants (n = 1,299).
The results were presented by Jon-David Schwalm,
MD, Msc, Population Health Research Institute, McMaster
University, and Hamilton Health Sciences, Hamilton,
Canada. The reduction in FRS for 10-year CVD risk estimate was 49% larger in the intervention versus control
group:	-11.17	(95%	CI,	-12.88	to	-9.47)	versus	-6.40	(95%	CI,		
8.00	to	-4.80).	The	difference	of	change	is	-4.78%	(95%	
CI,	7.11	to	-2.44;	P < .0001; Table 13).
The intervention group saw an absolute greater reduction in systolic blood pressure of 11.45 mmHg (95% CI, -14.94
to	-7.97;	P < .0001), and an LDL reduction of 0.41 mmol/L
(95% CI, -0.60 to -0.23; P < .0001). Change in blood pressure control status (< 140 mmHg) was 69% in the intervention group versus 30% in the control group (P < .0001). The
intervention also resulted in substantially higher rates of
combination	antihypertensive	medications	(84%	vs	65%;	
P	<	.001),	statins	(84%	vs	38%;	P	<	.001),	and	medication	
adherence (61% vs 40%; P < .0001) at 12 months. There
were no safety concerns described with the intervention.
Dr Schwalm concluded that adaptation of the HOPE
4 strategy to specific contexts and its widespread
implementation, including community screening, can
help achieve the United Nations General Assembly
Action Plan's one-third reduction of premature mortality
from CVD.
Replay presentation on ESC365

High-Sensitivity 1-Hour Troponin
Assay Facilitates Quicker
Discharge in Potential ACS Cases
Written by Rachel Giles

A 1-hour protocol including a high-sensitivity troponin T
assay compared to standard practice (3-hour protocol)
was non-inferior for subsequent death and MI and was
associated with faster discharge of patients with suspected acute coronary syndrome (ACS).
In his late-breaking abstract, Derek P. Chew, MBBS,
MPH, PhD, Flinders University, Adelaide, Australia, presented the results of the Rapid Assessment of Possible
ACS In the emergency Department with high-sensitivity
Troponin	 T	 [RAPID-TnT;	 ACTRN12615001379505],	 which	
were simultaneously published online [Chew DP et al.
Circulation 2019].
	 The	 researchers	 randomly	 allocated	 3,288	 participants	(median	age	59	years;	47%	women)	presenting	to	
the emergency department (ED) between August 2015
and April 2019 to care guided by a 1-hour protocol with
a high-sensitivity troponin T assay or to standard care
guided by a 3-hour protocol. The 1-hour protocol was
based on 2 blood draws, with the relative levels of troponin between the 2 draws stratifying the participants.
Patients with substantial elevations in troponin were
recommended for admission, those with intermediate
levels were recommended for close observation for
ACS, and those with very low-level troponin concentrations were considered at low risk for ACS. The primary
endpoint was death or myocardial infarction (MI) within
30 days, powered for non-inferiority.
At 30 days, the primary endpoint was met; death or MI
occurred in 1% of both groups (incidence rate ratio = 1.06;

Table 13. Incidence Rates of All Secondary Endpoints
Outcome

Baseline mean (SD) or n (%)

Change at 12 months from baseline*
(95% CI)

Test between
intervention and control

Control
(n = 727)

Intervention
(n = 644)

Control
(n = 692)

Intervention
(n = 607)

FRS 10-year risk estimate

35.5%

32.6%

-6.4%
(-8 to -4.8)

-11.2%
(-12.9 to -9.5)

< .0001

SBP (mmHg)

151.8
(15.6)

152.1
(15.4)

-9.7	
(-12.1 to -7.3)

-21.1
(-23.7 to -18.6)

< .0001

125
(17.2%)

74
(11.5%)

30.4
(25.8 to 34.9)

68.9
(64.9 to 72.9)

< .0001

3.4
(1.1)

3.3
(1.1)

-0.2
(-0.3 to -0.06)

-0.6
(-0.7 to -0.5)

< .0001

Controlled SBP < 140 mmHg
LDL (mmol/L)

P-value

*Mean for within-person differences.
FRS, Framingham Risk Score; LDL, low-density lipoprotein; SBP, systolic blood pressure; SD, standard deviation.

20

October 2019

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https://esc365.escardio.org/Congress/ESC-CONGRESS-2019/Hot-Line-Session-3/202176-hope-4-impact-on-cardiovascular-risk-of-a-community-based-multi-faceted-intervention-in-individuals-with-hypertension-in-2-middle-income-countries-the-heart-outcomes-prevention-and-evaluation-4-study http://www.escardio.org/ESCcongressinreview

ESC Congress in Review - Main Edition 2019

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