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Cashmore B, Tunnicliffe DJ, Palmer S, Blythen L, Boag J, Kostner K, Krishnasamy R, Lambert K, Miller A, Mullan J, Patu M, Phoon RKS, Rix L, Trompf N, Johnson DW, Walker R. Australian and New Zealand Living Guideline cholesterol-lowering therapy for people with chronic kidney disease (CARI Guidelines): Reducing the evidence-practice gap. Nephrology (Carlton) 2024; 29:495-509. [PMID: 38684481 DOI: 10.1111/nep.14295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/23/2024] [Accepted: 03/10/2024] [Indexed: 05/02/2024]
Abstract
AIM People with chronic kidney disease experience high rates of cardiovascular disease. Cholesterol-lowering therapy is a mainstay in the management but there is uncertainty in the treatment effects on patient-important outcomes, such as fatigue and rhabdomyolysis. Here, we summarise the updated CARI Australian and New Zealand Living Guidelines on cholesterol-lowering therapy in chronic kidney disease. METHODS We updated a Cochrane review and monitored newly published studies weekly to inform guideline development according to international standards. The Working Group included expertise from nephrology, cardiology, Indigenous Health, guideline development and people with lived experience of chronic kidney disease. RESULTS The guideline recommends people with chronic kidney disease (eGFR ≥15 mL/min/1.73 m2) and an absolute cardiovascular risk of 10% or higher should receive statin therapy (with or without ezetimibe) to reduce the risk of cardiovascular events and death (strong recommendation, moderate certainty evidence). The guidelines also recommends a lower absolute cardiovascular risk threshold (≥5%) for Aboriginal and Torres Strait Islander Peoples and Māori with chronic kidney disease to receive statin therapy (with or without ezetimibe) (strong recommendation, low certainty evidence). The evidence was actively surveyed from 2020-2023 and updated as required. No changes to guideline recommendations were made, with no new data on the balance and benefits of harms. CONCLUSIONS The development of living guidelines was feasible and provided the opportunity to update recommendations to improve clinical decision-making in real-time. Living guidelines provide the opportunity to transform chronic kidney disease guidelines.
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Affiliation(s)
- Brydee Cashmore
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital of Westmead, Sydney, New South Wales, Australia
| | - David J Tunnicliffe
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital of Westmead, Sydney, New South Wales, Australia
| | - Suetonia Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | | | - Jane Boag
- Consumer Partner, Australia
- School of Health, Federation University, Ballarat, Victoria, Australia
| | - Karam Kostner
- Mater Hospital, University of Queensland, St Lucia, Queensland, Australia
| | - Rathika Krishnasamy
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- Centre for Kidney Disease Research, The University of Queensland, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Kelly Lambert
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Andrea Miller
- Cape York Kidney Care, Weipa Integrated Health Services, Weipa, Queensland, Australia
| | - Judy Mullan
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Maira Patu
- Māori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Richard K S Phoon
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Renal Medicine, Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - Liz Rix
- Adelaide Nursing School, University of Adelaide, Adelaide, South Australia, Australia
| | | | - David W Johnson
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
| | - Robert Walker
- Department of Medicine, University of Otago Dunedin, Dunedin, New Zealand
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McKay CD, Gubhaju L, Gibberd AJ, McNamara BJ, Banks E, Azzopardi P, Williams R, Eades S. Cardiometabolic health markers among Aboriginal adolescents from the Next Generation Youth Wellbeing Cohort Study. Aust N Z J Public Health 2024; 48:100139. [PMID: 38447271 DOI: 10.1016/j.anzjph.2024.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 11/28/2023] [Accepted: 02/11/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE The objective of this study was to investigate cardiometabolic health markers among Aboriginal adolescents aged 10-24 years and relationships with age, gender, and body composition. METHODS Baseline data (2018-2020) from the Next Generation Youth Wellbeing Cohort Study (Western Australia, New South Wales, and Central Australia) on clinically assessed body mass index, waist/height ratio, blood pressure, glycated haemoglobin (HbA1c), total and high-density lipoprotein cholesterol, total/high-density lipoprotein cholesterol ratio, and triglycerides were analysed. RESULTS Among 1100 participants, the proportion with individual health markers within the ideal range ranged from 59% for total cholesterol to 91% for HbA1c. Four percent had high blood pressure, which was more common with increasing age and among males; 1% had HbA1c indicative of diabetes. Healthier body composition (body mass index and waist/height ratio) was associated with having individual health markers in the ideal range and with an ideal cardiometabolic profile. CONCLUSIONS Most Aboriginal adolescents in this study had cardiometabolic markers within the ideal range, though markers of high risk were present from early adolescence. Ideal health markers were more prevalent among those with healthy body composition. IMPLICATIONS FOR PUBLIC HEALTH Specific screening and management guidelines for Aboriginal adolescents and population health initiatives that support maintenance of healthy body composition could help improve cardiometabolic health in this population.
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Affiliation(s)
- Christopher D McKay
- Melbourne School of Population and Global Health, The University of Melbourne, Australia.
| | - Lina Gubhaju
- Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Alison J Gibberd
- Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Bridgette J McNamara
- Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Emily Banks
- Centre for Public Health Data and Policy, National Centre for Epidemiology and Population Health, College of Health & Medicine, Australian National University, Australia
| | - Peter Azzopardi
- Murdoch Children's Research Institute, Australia; Telethon Kids Institute, Australia
| | | | - Sandra Eades
- Melbourne School of Population and Global Health, The University of Melbourne, Australia
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Harrop DL, Bryce V, Kitchener T, Grugan S, Renouf S, Mitchell S, Hasking G, Pauza D, Richards G, Ng ACT, Wang WYS. Effects of a culturally informed model of care for Aboriginal and Torres Strait Islander patients with acute coronary syndrome in a tertiary hospital in Australia: a pre-post, quasi-experimental, interventional study. Lancet Glob Health 2024; 12:e623-e630. [PMID: 38485429 DOI: 10.1016/s2214-109x(23)00601-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND Aboriginal and Torres Strait Islander (Indigenous) peoples with cardiac disease in Australia have worse outcomes than non-Indigenous people with cardiac disease. We hypothesised that the implementation of a culturally informed model of care for Indigenous patients hospitalised with acute coronary syndrome (ACS) would improve their clinical outcomes. METHODS For this pre-post, quasi-experimental, interventional study, cohorts of Indigenous patients before and after the implementation of a model of care were compared. The novel, culturally informed, multidisciplinary-team model of care was a local programme of care developed to reduce morbidity and mortality from cardiac conditions among Indigenous Australians. All index admissions in the 24-month pre-implementation period (Jan 1 2013, to Dec 31, 2014) were analysed, as were all index admissions in the 12-month post-implementation period (Oct 1, 2015, to Sept 30, 2016). Comparisons were also made with non-Indigenous cohorts in the same timeframes. Admissions were excluded if the patient did not survive to hospital discharge. The study was conducted at Princess Alexandra Hospital, a tertiary hospital in metropolitan Brisbane (QLD, Australia). Data on presentation, comorbidities, investigations, treatment, and for outcomes were manually collected from a consolidated clinical information application. Mortality data were obtained from the Queensland Registry of Births, Deaths, and Marriages. The primary outcome was a composite of death, acute myocardial infarction, unplanned revascularisation, and cardiac readmission at 90 days after index admission, assessed in all patients. FINDINGS The Indigenous cohorts included 199 patients admitted with ACS before the model of care was implemented (85 [43%] were female and 114 [57%] were male) and 119 admitted post-implementation (62 [52%] were female and 57 [48%] were male). The non-Indigenous cohorts included 440 patients with ACS before the model of care was implemented (140 [32%] were female and 300 [68%] were male) and 467 admitted post-implementation (143 [31%] were female and 324 [69%] were male). Compared with the pre-implementation group, Indigenous patients admitted post-implementation had a significant reduction in the primary outcome (67 [34%] of 199 vs 24 [20%] of 119; hazard ratio 0·60, 95% CI 0·40-0·90; p=0·012), which was driven by a reduction in unplanned cardiac readmissions (64 [32%] of 199 vs 21 [18%] of 119; 0·55, 0·35-0·85; p=0·0060). There was no significant change in non-Indigenous patients between the pre-implementation and post-implementation timeframes in the composite endpoint at 90 days (81 [18%] of 440 vs 93 [20%] of 467; 1·08, 0·83-1·41; p=0·54). Pre-implementation, there was significantly more incidence of the primary outcome in Indigenous patients than non-Indigenous patients (p<0·0001), with no significant difference in the post-implementation period (p=0·92). INTERPRETATION Clinical outcomes for Indigenous patients admitted to a tertiary hospital in Australia improved after implementation of a culturally informed model of care, with a reduction in the disparity in incidence of primary endpoints that existed between Indigenous and non-Indigenous patients before implementation. FUNDING Queensland Department of Health Aboriginal and Torres Strait Islander Health Division (now First Nations Health Office).
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Affiliation(s)
- Danielle L Harrop
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Vivian Bryce
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Tanya Kitchener
- Aboriginal and Torres Strait Islander Liaison Service, Mater Hospital, Brisbane, QLD, Australia
| | - Sean Grugan
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Sonia Renouf
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Scott Mitchell
- Department of Pharmacy, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | | - Debra Pauza
- First Nations Health Office, Queensland Health, Brisbane, QLD, Australia
| | - Gregory Richards
- Queensland Aboriginal and Islander Health Council, Brisbane, QLD, Australia
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - William Y S Wang
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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Burchill L, Dos Santos A. Progress towards cultural safety in Indigenous cardiovascular health care and research. Lancet Glob Health 2024; 12:e541-e542. [PMID: 38485418 DOI: 10.1016/s2214-109x(24)00080-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Luke Burchill
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | - Angela Dos Santos
- Department of Medicine and Health, University of New South Wales, Campbelltown, NSW, Australia
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Mathew S, Barzi F, Clifford-Motopi A, Brown Nunuccal R, Ward Pitjantjatjara And Nukunu J, Mills R, Turner L, White Palawa And Iningai A, Eaton M, Butler D. Transformation to a patient-centred medical home led and delivered by an urban Aboriginal and Torres Strait Islander community, and association with engagement and quality-of-care: quantitative findings from a pilot study. BMC Health Serv Res 2023; 23:959. [PMID: 37674143 PMCID: PMC10483750 DOI: 10.1186/s12913-023-09955-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The patient-centred medical home (PCMH) is a model of team-based primary care that is patient-centred, coordinated, accessible, and focused on quality and safety. In response to substantial population growth and increasing demand on existing primary care services, the Institute for Urban Indigenous Health (IUIH) developed the IUIH System of Care-2 (ISoC2), based on an international Indigenous-led PCMH. ISoC2 was piloted at an urban Aboriginal and Torres Strait Islander Community-Controlled Health Service in South-East Queensland between 2019-2020, with further adaptations made to ensure its cultural and clinical relevance to local Aboriginal and Torres Strait Islander people. Little is known on the implementation and impact of PCMH in the Australian Indigenous primary care setting. Changes in implementation process measures and outcomes relating to engagement and quality-of-care are described here. METHODS De-identified routinely collected data extracted from electronic health records for clients regularly attending the service were examined to assess pre-post implementation changes relevant to the study. Process measures included enrolment in PCMH team-based care, and outcome measures included engagement with the health service, continuity-of-care and clinical outcomes. RESULTS The number of regular clients within the health service increased from 1,186 pre implementation to 1,606 post implementation; representing a small decrease as a proportion of the services' catchment population (38.5 to 37.6%). In clients assigned to a care team (60% by end 2020), care was more evenly distributed between providers, with an increased proportion of services provided by the Aboriginal and Torres Strait Islander Health Worker (16-17% versus 10-11%). Post-implementation, 41% of clients had continuity-of-care with their assigned care team, while total, preventive and chronic disease services were comparable pre- and post-implementation. Screening for absolute cardiovascular disease risk improved, although there were no changes in clinical outcomes. CONCLUSIONS The increase in the number of regular clients assigned to a team and their even distribution of care among care team members provides empirical evidence that the service is transforming to a PCMH. Despite a complex transformation process compounded by the COVID-19 pandemic, levels of service delivery and quality remained relatively stable, with some improvements in risk factor screening.
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Affiliation(s)
- Saira Mathew
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld, 4030, Australia
- The University of Queensland, Poche Centre for Indigenous Health, 74 High Street, Toowong, Qld, 4066, Australia
| | - Federica Barzi
- The University of Queensland, Poche Centre for Indigenous Health, 74 High Street, Toowong, Qld, 4066, Australia
| | - Anton Clifford-Motopi
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld, 4030, Australia
| | - Renee Brown Nunuccal
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld, 4030, Australia
| | | | - Richard Mills
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld, 4030, Australia
| | - Lyle Turner
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld, 4030, Australia
| | | | - Martie Eaton
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld, 4030, Australia
| | - Danielle Butler
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld, 4030, Australia.
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, 2601, Australia.
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Morgan T, Ralston A, Davey A, Holliday EG, Nelson M, Fielding A, van Driel M, Tapley A, Moad D, Ball J, Presser J, Spike N, Magin P. Absolute cardiovascular risk assessment by Australian early-career general practitioners: a cross-sectional study. Fam Med Community Health 2023; 11:e002251. [PMID: 37604595 PMCID: PMC10445344 DOI: 10.1136/fmch-2023-002251] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVE To determine the prevalence and associations of general practice registrars' performing absolute cardio-vascular risk (ACVR) assessment (ACVRa). DESIGN A cross-sectional study employing data (2017-2018) from the Registrar Clinical Encounters in Training project, an ongoing inception cohort study of Australian GP registrars. The outcome measure was whether an ACVRa was performed. Analyses employed univariable and multivariable regression. Analysis was conducted for all patient problems/diagnoses, then for an 'at-risk' population (specific problems/diagnoses for which ACVRa is indicated). SETTING Three GP regional training organisations (RTOs) across three Australian states. PARTICIPANTS GP registrars training within participating RTOs. RESULTS 1003 registrars (response rate 96.8%) recorded details of 69 105 problems either with Aboriginal and/or Torres Strait patients aged 35 years and older or with non-Indigenous patients aged 45 years and older. Of these problems/diagnoses, 1721 (2.5% (95% CI 2.4% to 2.6%)) involved an ACVRa. An ACVRa was 'plausibly indicated' in 10 384 problems/diagnoses. Of these, 1228 (11.8% (95% CI 11.2% to 12.4%)) involved ACVRa. For 'all problems/diagnoses', on multivariable analysis female gender was associated with reduced odds of ACVRa (OR 0.61 (95% CI 0.54 to 0.68)). There was some evidence for Aboriginal and/or Torres Strait Islander people being more likely to receive ACVRa (OR 1.40 (95% CI 0.94 to 2.08), p=0.10). There were associations with variables related to continuity of care, with reduced odds of ACVRa: if the patient was new to the registrar (OR 0.65 (95% CI 0.57 to 0.75)), new to the practice (OR 0.24 (95% CI 0.15 to 0.38)) or the problem was new (OR 0.68 (95% CI 0.59 to 0.78)); and increased odds if personal follow-up was organised (OR 1.43 (95% CI 1.24 to 1.66)). For 'ACVRa indicated' problems/diagnoses, findings were similar to those for 'all problems/diagnoses'. Association with Aboriginal and/or Torres Strait Islander status, however, was significant at p<0.05 (OR 1.60 (95% CI 1.04 to 2.46)) and association with female gender was attenuated (OR 0.88 (95% CI 0.77 to 1.01)). CONCLUSION Continuity of care is associated with registrars assessing ACVR, reinforcing the importance of care continuity in general practice. Registrars' assessment of an individual patient's ACVR is targeted to patients with individual risk factors, but this may entail ACVRa underutilisation in female patients and younger age groups.
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Affiliation(s)
- Toby Morgan
- School of Population Health, University of New South Wales Faculty of Medicine, Kensington, New South Wales, Australia
| | - Anna Ralston
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Andrew Davey
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Elizabeth G Holliday
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Mark Nelson
- University of Tasmania Menzies Institute for Medical Research, Hobart, Tasmania, Australia
- University of Tasmania School of Medicine, Hobart, Tasmania, Australia
| | - Alison Fielding
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Mieke van Driel
- General Practice Clinical Unit, The University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
| | - Amanda Tapley
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Dominica Moad
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Jennifer Presser
- University of Tasmania School of Medicine, Hobart, Tasmania, Australia
| | - Neil Spike
- Department of General Practice and Primary Health Care, The University of Melbourne, Carlton, Victoria, Australia
- Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Parker Magin
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
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McCallum RK, Kramer AI, Marchand M, Akioyamen LE, Genest J, Brunham LR. Estimating the Prevalence of Hypercholesterolemia in Indigenous Populations: A Systematic Review and Meta-Analysis. JACC. ADVANCES 2023; 2:100315. [PMID: 38939583 PMCID: PMC11198456 DOI: 10.1016/j.jacadv.2023.100315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/09/2023] [Accepted: 02/19/2023] [Indexed: 06/29/2024]
Abstract
Background Hypercholesterolemia is a common condition characterized by elevated levels of low-density lipoprotein cholesterol (LDL-C) and increased risk of atherosclerotic cardiovascular disease (ASCVD). Indigenous populations experience disproportionate rates of ASCVD, however, the extent to which hypercholesterolemia contributes to this burden is unknown. Objectives This study aimed to estimate the prevalence of hypercholesterolemia, severe hypercholesterolemia, and familial hypercholesterolemia (FH) in Indigenous populations in Canada, the United States, Australia, and New Zealand. Methods We searched MEDLINE, EMBASE, Web of Science, Native Health Database, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for peer-reviewed studies reporting on hypercholesterolemia and elevated LDL-C in Indigenous populations. All diagnostic criteria used to classify hypercholesterolemia were included. Pooled prevalence and 95% CIs were calculated using a random-effects model. Results There were no studies reporting the prevalence of FH and one study reporting the prevalence of severe hypercholesterolemia in Indigenous populations. The pooled prevalence of hypercholesterolemia was 28.9% or ∼1 in 3 to 1 in 4 individuals (95% CI: 22.4%-36.4%) and 12.6% (95% CI: 7.7%-19.9%) using an LDL-C cutoff of ≥3.5 mmol/L (135 mg/dL). The pooled prevalence in Indigenous populations in North America was 24.3% (95% CI: 17.1%-33.3%) compared with 40.0% (95% CI: 31.3%-49.3%) in Australia. Meta-regression showed diabetes had a significant effect on prevalence (P = 0.022). Conclusions Hypercholesterolemia is prevalent in Indigenous communities and may contribute to the high burden of ASCVD these populations face. There is insufficient research on FH and severe hypercholesterolemia in Indigenous populations worldwide.
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Affiliation(s)
- Rylan K. McCallum
- Centre for Heart and Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
- Manitoba Métis Federation, Manitoba, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam I. Kramer
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Miles Marchand
- Centre for Heart and Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
- Syilx Okanagan First Nation, British Columbia, Canada
| | - Leo E. Akioyamen
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jacques Genest
- Department of Medicine, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Liam R. Brunham
- Centre for Heart and Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
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Agarwala A, Satish P, Al Rifai M, Mehta A, Cainzos-Achirica M, Shah NS, Kanaya AM, Sharma GV, Dixon DL, Blumenthal RS, Natarajan P, Nasir K, Virani SS, Patel J. Identification and Management of Atherosclerotic Cardiovascular Disease Risk in South Asian Populations in the U.S. JACC. ADVANCES 2023; 2:100258. [PMID: 38089916 PMCID: PMC10715803 DOI: 10.1016/j.jacadv.2023.100258] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 12/20/2023]
Abstract
South Asians (SAs, individuals with ancestry from Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka) are among the fastest growing ethnic subgroups in the United States. SAs typically experience a high prevalence of diabetes, abdominal obesity, and hypertension, among other cardiovascular disease risk factors, which are often under recognized and undermanaged. The excess coronary heart disease risk in this growing population must be critically assessed and managed with culturally appropriate preventive services. Accordingly, this scientific document prepared by a multidisciplinary group of clinicians and investigators in cardiology, internal medicine, pharmacy, and SA-centric researchers describes key characteristics of traditional and nontraditional cardiovascular disease risk factors, compares and contrasts available risk assessment tools, discusses the role of blood-based biomarkers and coronary artery calcium to enhance risk assessment and prevention strategies, and provides evidenced-based approaches and interventions that may reduce coronary heart disease disparities in this higher-risk population.
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Affiliation(s)
- Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, Texas, USA
| | - Priyanka Satish
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Anurag Mehta
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
- Institut Hospital del Mar d’Investigacions Mediques (IMIM), Barcelona, Spain
- Hospital del Mar, Parc Salut Mar, Barcelona, Spain
| | - Nilay S. Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alka M. Kanaya
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA
| | - Garima V. Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Dave L. Dixon
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
| | - Pradeep Natarajan
- Cardiovascular Disease Initiative Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Cardiovascular Research Center Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | - Salim S. Virani
- Aga Khan University, Karachi, Pakistan
- Texas Heart Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Jaideep Patel
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, South Asian Cardiovascular Health Initiative (SACHI), Baltimore, Maryland, USA
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McGee M, Shephard L, Sugito S, Baker D, Brienesse S, Al-Omary M, Nathan-Marsh R, Ngo DTM, Oakley P, Boyle AJ, Garvey G, Sverdlov AL. Mind The Gap, Aboriginal and Torres Strait Islander Cardiovascular Health: A Narrative Review. Heart Lung Circ 2023; 32:136-142. [PMID: 36336616 DOI: 10.1016/j.hlc.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
Australia's First Nations Peoples, Aboriginal and Torres Strait Islanders, have reduced life expectancy compared to the wider community. Cardiovascular diseases, mainly driven by ischaemic heart disease, are the leading contributors to this disparity. Despite over a third of First Nations Peoples living in New South Wales, the bulk of the peer-reviewed literature is from Central Australia and Far North Queensland. Regardless of the site of publication, First Nations Peoples are significantly younger at disease onset and have higher rates of comorbidities, in turn driving adverse health events. On top of this, very few First Nations Peoples specific cardiovascular interventions or programs have been shown to improve outcomes. The traditional biomedical model of care is less efficacious and non-traditional models of communication such as clinical yarning may benefit both clinicians and patients. The key purpose of this review is to highlight the deficiencies of our knowledge of cardiovascular burden of disease for First Nations Peoples; and to serve as a catalyst for more dedicated research. We need to have relationships with communities and concentrate on community improvement and partnerships. By involving First Nations Peoples researchers in collaboration with local communities in all levels of health care design and intervention will improve outcomes.
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Affiliation(s)
- Michael McGee
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Lauren Shephard
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Stuart Sugito
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - David Baker
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Stephen Brienesse
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Mohammed Al-Omary
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Rhian Nathan-Marsh
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Doan T M Ngo
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia. https://twitter.com/DoanNgo4
| | - Patrick Oakley
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia; Aboriginal Health Unit, Hunter New England Health, Wallsend Health Campus, Newcastle, NSW, Australia; General Medicine Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Andrew J Boyle
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Gail Garvey
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Aaron L Sverdlov
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia.
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Banks E, Haynes A, Lovett R, Yadav UN, Agostino J. Output-orientated policy engagement: a model for advancing the use of epidemiological evidence in health policy. Health Res Policy Syst 2023; 21:6. [PMID: 36647155 PMCID: PMC9843894 DOI: 10.1186/s12961-022-00955-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/22/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Use of epidemiological research in policy and practice is suboptimal, contributing to significant preventable morbidity and mortality. Barriers to the use of research evidence in policy include lack of research-policy engagement, lack of policy-relevant research, differences in policymaker and researcher practice norms, time constraints, difficulties in coordination, and divergent languages and reward systems. APPROACH AND OUTCOMES In order to increase policy-relevant research and research uptake, we developed the output-orientated policy engagement (OOPE) model, in Australia. It integrates a foundational approach to engagement with cycles of specific activity focused around selected research outputs. Foundational elements include measures to increase recognition and valuing of policymaker expertise, emphasis on policy uptake, policy awareness of the research group's work, regular policy engagement and policy-relevant capacity-building. Specific activities include (i) identification of an "output"-usually at draft stage-and program of work which are likely to be of interest to policymakers; (ii) initial engagement focusing on sharing "preview" evidence from this output, with an invitation to provide input into this and to advise on the broader program of work; and (iii) if there is sufficient interest, formation of a researcher-policy-maker partnership to shape and release the output, as well as inform the program of work. This cycle is repeated as the relationship continues and is deepened. As well as supporting policy-informed evidence generation and research-aware policymakers, the output-orientated model has been found to be beneficial in fostering the following: a pragmatic starting place for researchers, in often large and complex policy environments; purposeful and specific engagement, encouraging shared expectations; non-transactional engagement around common evidence needs, whereby researchers are not meeting with policymakers with the expectation of receiving funding; built-in translation; time and resource efficiency; relationship-building; mutual learning; policy-invested researchers and research-invested policy-makers; and tangible policy impacts. A case study outlines how the output-orientated approach supported researcher-policymaker collaboration to generate new evidence regarding Aboriginal and Torres Strait Islander cardiovascular disease risk and to apply this to national guidelines. CONCLUSION Output-orientated policy engagement provides a potentially useful pragmatic model to catalyse and support partnerships between researchers and policymakers, to increase the policy-relevance and application of epidemiological evidence.
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Affiliation(s)
- Emily Banks
- grid.1001.00000 0001 2180 7477National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT Australia
| | - Abby Haynes
- grid.1013.30000 0004 1936 834XInstitute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Ray Lovett
- grid.1001.00000 0001 2180 7477National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT Australia
| | - Uday Narayan Yadav
- grid.1001.00000 0001 2180 7477National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT Australia
| | - Jason Agostino
- grid.1001.00000 0001 2180 7477School of Medicine and Psychology, ANU, Canberra, ACT Australia ,National Aboriginal Community Controlled Health Organisation, Canberra, ACT Australia
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Butler D, Clifford-Motopi A, Mathew S, Nelson C, Brown R, Gardner K, Turner L, Coombe L, Roe Y, Gao Y, Ward J. Study protocol: primary healthcare transformation through patient-centred medical homes-improving access, relational care and outcomes in an urban Aboriginal and Torres Strait Islander population, a mixed methods prospective cohort study. BMJ Open 2022; 12:e061037. [PMID: 36175091 PMCID: PMC9528615 DOI: 10.1136/bmjopen-2022-061037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION For over 40 years, Aboriginal and Torres Strait Islander Community-Controlled Health Services (ACCHS) in Australia have led strategic responses to address the specific needs of Aboriginal and Torres Strait Islander populations. Globally, there has been rapid growth in urban Indigenous populations requiring an adaptive primary healthcare response. Patient-centred medical homes (PCMH) are an evidenced-based model of primary healthcare suited to this challenge, underpinned by principles aligned with the ACCHS sector-relational care responsive to patient identified healthcare priorities. Evidence is lacking on the implementation and effectiveness of the PCMH model of care governed by, and delivered for, Aboriginal and Torres Strait Islander populations in large urban settings. METHOD AND ANALYSIS Our multiphased mixed-methods prospective cohort study will compare standard care provided by a network of ACCHS to an adapted PCMH model of care. Phase 1 using qualitative interviews with staff and patients and quantitative analysis of routine primary care health record data will examine the implementation, feasibility and acceptability of the PCMH. Phase 2 using linked survey, primary care and hospitalisation data will examine the impact of our adapted PCMH on access to care, relational and quality of care, health and wellbeing outcomes and economic costs. Phase 3 will synthesise evidence on mechanisms for change and discuss their implications for sustainability and transferability of PCMHs to the broader primary healthcare system ETHICS AND DISSEMINATION: This study has received approval from the University of Queensland Human Research Ethics Committee (2021/HE00529). This research represents an Aboriginal led and governed partnership in response to identified community priorities. The findings will contribute new knowledge on how key mechanisms underpinning the success and implementation of the model can be introduced into policy and practice. Study findings will be disseminated to service providers, researchers, policymakers and, most importantly, the communities themselves.
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Affiliation(s)
- Danielle Butler
- Institute for Urban Indigenous Health Ltd, Windsor, Queensland, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Saira Mathew
- Institute for Urban Indigenous Health Ltd, Windsor, Queensland, Australia
| | - Carmel Nelson
- Institute for Urban Indigenous Health Ltd, Windsor, Queensland, Australia
- UQ Poche Centre for Indigenous Health, Saint Lucia, Queensland, Australia
| | - Renee Brown
- Institute for Urban Indigenous Health Ltd, Windsor, Queensland, Australia
- UQ Poche Centre for Indigenous Health, Saint Lucia, Queensland, Australia
- Nununccal
| | - Karen Gardner
- Business School, University of New South Wales Canberra at ADFA, Canberra, Australian Capital Territory, Australia
| | - Lyle Turner
- Institute for Urban Indigenous Health Ltd, Windsor, Queensland, Australia
- UQ Poche Centre for Indigenous Health, Saint Lucia, Queensland, Australia
| | - Leanne Coombe
- UQ Poche Centre for Indigenous Health, Saint Lucia, Queensland, Australia
| | - Yvette Roe
- Charles Darwin University, Casuarina, Australian Capital Territory, Australia
- Njikena Jawuru
| | - Yu Gao
- Charles Darwin University, Casuarina, Australian Capital Territory, Australia
| | - James Ward
- UQ Poche Centre for Indigenous Health, Saint Lucia, Queensland, Australia
- Pitjantjatjara and Nukunu
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Birhanu MM, Evans RG, Zengin A, Riddell M, Kalyanram K, Kartik K, Suresh O, Thomas NJ, Srikanth VK, Thrift AG. Absolute cardiovascular risk scores and medication use in rural India: a cross-sectional study. BMJ Open 2022; 12:e054617. [PMID: 35459666 PMCID: PMC9036467 DOI: 10.1136/bmjopen-2021-054617] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We compared the performance of laboratory-based cardiovascular risk prediction tools in a low-income and middle-income country setting, and estimated the use of antihypertensive and lipid-lowering medications in those deemed at high risk of a cardiovascular event. DESIGN A cross-sectional study. SETTING The study population comprised adult residents (aged ≥18 years) of the Rishi Valley region located in Chittoor District, south-western Andhra Pradesh, India. PARTICIPANTS 7935 participants were surveyed between 2012 and 2015. We computed the 10-year cardiovascular risk and undertook pair-to-pair analyses between various risk tools used to predict a fatal or non-fatal cardiovascular event (Framingham Risk Score (FRS), World Health Organization Risk Score (WHO-RS) and Australian Risk Score (ARS)), or a fatal cardiovascular event (Systematic COronary Risk Evaluation (SCORE-high and SCORE-low)). Concordance was assessed by ordinary least-products (OLP) regression (for risk score) and quadratic weighted kappa (κw, for risk category). RESULTS Of participants aged 35-74 years, 3.5% had prior cardiovascular disease. The relationships between risk scores were quasi-linear with good agreement between the FRS and ARS (OLP slope=0.96, κw=0.89). However, the WHO-RS underestimated cardiovascular risk compared with all other tools. Twenty per cent of participants had ≥20% risk of an event using the ARS; 5% greater than the FRS and nearly threefold greater than the WHO-RS. Similarly, 16% of participants had a risk score ≥5% using SCORE-high which was 6% greater than for SCORE-low. Overall, absolute cardiovascular risk increased with age and was greater in men than women. Only 9%-12% of those deemed 'high risk' were taking lipid-lowering or antihypertensive medication. CONCLUSIONS Cardiovascular risk prediction tools perform disparately in this setting of disadvantage. Few deemed at high risk were receiving the recommended treatment.
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Affiliation(s)
- Mulugeta Molla Birhanu
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Clayton, Victoria, Australia
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Michaela Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Oduru Suresh
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Nihal Jacob Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Velandai K Srikanth
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
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Gardiner FW, Rallah-Baker K, Dos Santos A, Sharma P, Churilov L, Donnan GA, Davis SM, Quinlan F, Worley P. Indigenous Australians have a greater prevalence of heart, stroke, and vascular disease, are younger at death, with higher hospitalisation and more aeromedical retrievals from remote regions. EClinicalMedicine 2021; 42:101181. [PMID: 34765955 PMCID: PMC8573152 DOI: 10.1016/j.eclinm.2021.101181] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We aimed to determine whether heart, stroke, and vascular disease (HSVD) prevalence and emergency primary evacuation (EPE), hospitalisation, and mortality differ by patient characteristics. METHODS An Australian-wide incidence population based study, with prospective data collected form the 1 July 2019 to the 30 October 2020. FINDINGS Indigenous Australians reported significantly higher prevalence of HSVD at 229.0 per-1000 as compared to 152.0 per-1000 non-Indigenous Australians: risk ratio 1.5 (95% CI 1.2-1.8). 583 remote patients received an EPE for HSVD, consisting of 388 (66.6%; 95% CI: 62.6-70.4) males and 195 (33.0%; 95% CI: 29.6-37.4) females. There were 289 (49.6%; 95% CI 45.4- 53.7) patients who identified as Indigenous, and 294 (50.4%; 95% CI 46.3- 54.6) as non-Indigenous. The mean Indigenous age during EPE was 48.0 (95% CI 45.9-50.1) years old, significantly lower than the non-Indigenous mean age of 55.6 (95% CI 53.8-57.4). Indigenous patients hospitalised for HSVD were younger, the majority younger than 65 years (n=21175; 73.7% 95% CI 73.2-74.2) as compared to non-Indigenous patients (n= 357654; 33.1% 95% CI 33.0-33.15). When adjusted for HSVD prevalence, remote Indigenous patients had a higher hospitalisation rate as compared to non-remote Indigenous patients (rate ratio: 1.6; 95% CI 1.3-2.0) and remote non-Indigenous patients (rate ratio: 1.2; 95% CI 1.0-1.5). More Indigenous patients died of HSVD before the age of 65 years (n=1875; 56.5% 95% CI 54.8-58.2) as compared to non-Indigenous patients (n= 16161; 10.6% 95% CI 10.45-10.8). INTERPRETATION Indigenous Australians have a higher prevalence, and younger age during EPE, and hospitalisation for HSVD than non-Indigenous Australians. FUNDING This is a self/internally-funded study, with the lead organisation being the Royal Flying Doctor Service (RFDS) of Australia. For the duration of the study period, the RFDS provided in-kind support including one full-time equivalent (FTE) and resources (office space, computer, research software, and office equipment). There was no external funding source that had a role in study design or data analysis or interpretation.
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Affiliation(s)
- Fergus W Gardiner
- The Royal Flying Doctor Service, Canberra, Australia
- Corresponding author. Dr Fergus W Gardiner, Royal Flying Doctor Service, Level 2, 10-12 Brisbane Avenue, Barton ACT 2600 Australia
| | - Kristopher Rallah-Baker
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Angela Dos Santos
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | | | - Leonid Churilov
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | - Geoffrey A Donnan
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | - Stephen M. Davis
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | - Frank Quinlan
- The Royal Flying Doctor Service, Canberra, Australia
| | - Paul Worley
- Riverland Mallee Coorong Local Health Network, Murray Bridge, Australia
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14
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Vogel B, Acevedo M, Appelman Y, Bairey Merz CN, Chieffo A, Figtree GA, Guerrero M, Kunadian V, Lam CSP, Maas AHEM, Mihailidou AS, Olszanecka A, Poole JE, Saldarriaga C, Saw J, Zühlke L, Mehran R. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet 2021; 397:2385-2438. [PMID: 34010613 DOI: 10.1016/s0140-6736(21)00684-x] [Citation(s) in RCA: 546] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease is the leading cause of death in women. Decades of grassroots campaigns have helped to raise awareness about the impact of cardiovascular disease in women, and positive changes affecting women and their health have gained momentum. Despite these efforts, there has been stagnation in the overall reduction of cardiovascular disease burden for women in the past decade. Cardiovascular disease in women remains understudied, under-recognised, underdiagnosed, and undertreated. This Commission summarises existing evidence and identifies knowledge gaps in research, prevention, treatment, and access to care for women. Recommendations from an international team of experts and leaders in the field have been generated with a clear focus to reduce the global burden of cardiovascular disease in women by 2030. This Commission represents the first effort of its kind to connect stakeholders, to ignite global awareness of sex-related and gender-related disparities in cardiovascular disease, and to provide a springboard for future research.
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Affiliation(s)
- Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Monica Acevedo
- Divisón de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yolande Appelman
- Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gemma A Figtree
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundations Trust, Newcastle Upon Tyne, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore; Cardiovascular Sciences Academic Clinical Programme, Duke-National University of Singapore, Singapore
| | - Angela H E M Maas
- Department of Women's Cardiac Health, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anastasia S Mihailidou
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia; Cardiovascular and Hormonal Research Laboratory, Kolling Institute, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Agnieszka Olszanecka
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jeanne E Poole
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Clara Saldarriaga
- Department of Cardiology and Heart Failure Clinic, Clinica CardioVID, University of Antioquia, Medellín, Colombia
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Liesl Zühlke
- Departments of Paediatrics and Medicine, Divisions of Paediatric and Adult Cardiology, Red Cross Children's and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Freene N, Brown R, Collis P, Bourke C, Silk K, Jackson A, Davey R, Northam HL. An Aboriginal and Torres Strait Islander Cardiac Rehabilitation program delivered in a non-Indigenous health service (Yeddung Gauar): a mixed methods feasibility study. BMC Cardiovasc Disord 2021; 21:222. [PMID: 33932992 PMCID: PMC8088627 DOI: 10.1186/s12872-021-02016-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 04/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited evidence of Aboriginal and Torres Strait Islander people attending cardiac rehabilitation (CR) programs despite high levels of heart disease. One key enabler for CR attendance is a culturally safe program. This study evaluates improving access for Aboriginal and Torres Strait Islander women to attend a CR program in a non-Indigenous health service, alongside improving health workforce cultural safety. METHODS An 18-week mixed-methods feasibility study was conducted, with weekly flexible CR sessions delivered by a multidisciplinary team and an Aboriginal and/or Torres Strait Islander Health Worker (AHW) at a university health centre. Aboriginal and Torres Strait Islander women who were at risk of, or had experienced, a cardiac event were recruited. Data was collected from participants at baseline, and at every sixth-session attended, including measures of disease risk, quality-of-life, exercise capacity and anxiety and depression. Cultural awareness training was provided for health professionals before the program commenced. Assessment of health professionals' cultural awareness pre- and post-program was evaluated using a questionnaire (n = 18). Qualitative data from participants (n = 3), the AHW, health professionals (n = 4) and referrers (n = 4) was collected at the end of the program using yarning methodology and analysed thematically using Charmaz's constant comparative approach. RESULTS Eight referrals were received for the CR program and four Aboriginal women attended the program, aged from 24 to 68 years. Adherence to the weekly sessions ranged from 65 to 100%. At the program's conclusion, there was a significant change in health professionals' perception of social policies implemented to 'improve' Aboriginal people, and self-reported changes in health professionals' behaviours and skills. Themes were identified for recruitment, participants, health professionals and program delivery, with cultural safety enveloping all areas. Trust was a major theme for recruitment and adherence of participants. The AHW was a key enabler of cultural authenticity, and the flexibility of the program contributed greatly to participant perceptions of cultural safety. Barriers for attendance were not unique to this population. CONCLUSION The flexible CR program in a non-Indigenous service provided a culturally safe environment for Aboriginal women but referrals were low. Importantly, the combination of cultural awareness training and participation in the program delivery improved health professionals' confidence in working with Aboriginal people. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) 12618000581268, http://www.ANZCTR.org.au/ACTRN12618000581268.aspx , registered 16 April 2018.
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Affiliation(s)
- Nicole Freene
- Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia.
- Health Research Institute, University of Canberra, Bruce, ACT, Australia.
| | - Roslyn Brown
- Ngunnawal Centre, Office of Aboriginal and Torres Strait Islander Leadership and Strategy, University of Canberra, Bruce, ACT, Australia
| | - Paul Collis
- Faculty of Arts and Design, University of Canberra, Bruce, ACT, Australia
| | - Chris Bourke
- Australian Healthcare and Hospitals Association, Deakin, ACT, Australia
| | - Katharine Silk
- Australian Healthcare and Hospitals Association, Deakin, ACT, Australia
| | - Alicia Jackson
- Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT, 2617, Australia
| | - Rachel Davey
- Health Research Institute, University of Canberra, Bruce, ACT, Australia
| | - Holly L Northam
- Nursing, Midwifery and Public Health, Faculty of Health, University of Canberra, Bruce, ACT, Australia
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17
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Win KTH, Emeto TI, Adams C, Fairley L, Thomas B, Thavarajah H, Danda N, Wai HN, New RH, Muñoz MA, Basu S, Yadav R. Association Between Indigenous Status and Severity of Coronary Artery Disease: A Comparison of Coronary Angiogram Findings in Patients With Chest Pain Presenting to a Regional Hospital Emergency Department. Heart Lung Circ 2021; 30:1193-1199. [PMID: 33712400 DOI: 10.1016/j.hlc.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/03/2020] [Accepted: 11/08/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) remains the leading cause of death amongst Indigenous Australians accounting for 12.1% of all deaths in this population. However, there is little evidence to suggest that Indigenous status is an independent risk factor for the development of coronary artery disease. This study assessed the association between Indigenous status and the severity of CAD in patients presenting with chest pain at a regional hospital emergency department. METHODS This was a retrospective single-centre audit over 12 months from January to December 2017. Charts were reviewed for both Indigenous and non-Indigenous patients 18 years and older who presented with chest pain and subsequently underwent an invasive coronary angiogram. Multivariable logistic regression was performed to examine the association of Indigenous status with the severity of CAD. RESULTS Indigenous patients are 2.7 times more likely to experience significant CAD compared to non-Indigenous patients (Adjusted odds ratio [AOR]=2.73, 95% CI [1.38, 5.39], p≤0.001) even after adjusting for other risk factors. Those aged 65 years and older are more prone to significant CAD (AOR=2.96, 95% CI [1.12, 7.78], p=0.03), while women were less likely to have significant CAD compared to men, (AOR=0.46, 95% CI [0.27, 0.78], p<0.01). CONCLUSION In this study cohort, our analysis indicates that there is a strong association between Indigenous status and significant coronary artery disease, independent of the increased burden of traditional cardiovascular risk factors among Indigenous Australians.
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Affiliation(s)
- Kyi T H Win
- Department of Cardiology, Townsville University Hospital, Douglas, Qld, Australia; Department of Cardiology, Gold Coast University Hospital, Southport, Qld, Australia.
| | - Theophilus I Emeto
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld, Australia; Australian Institute of Tropical Health and Medicine Health, James Cook University, Townsville, Qld, Australia
| | - Cobi Adams
- Faculty of Medicine, Bond University, Gold Coast, Qld, Australia
| | - Lachlan Fairley
- The Princess Alexandra Hospital, Woolloongabba, Qld, Australia
| | - Benjamin Thomas
- Department of Cardiology, Townsville University Hospital, Douglas, Qld, Australia
| | | | - Nita Danda
- Department of Cardiology, Townsville University Hospital, Douglas, Qld, Australia
| | - Htet N Wai
- Department of Cardiology, Townsville University Hospital, Douglas, Qld, Australia
| | - Ru H New
- Department of Cardiology, Townsville University Hospital, Douglas, Qld, Australia
| | - Miguel A Muñoz
- Department of Cardiology, Townsville University Hospital, Douglas, Qld, Australia
| | - Sonali Basu
- Department of Cardiology, Townsville University Hospital, Douglas, Qld, Australia
| | - Raibhan Yadav
- Department of Cardiology, Townsville University Hospital, Douglas, Qld, Australia
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18
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Ha FJ, Farouque O, Lim HS. Response by Ha et al to Letter Regarding Article, "Sudden Cardiac Death in the Young: Incidence, Trends and Risk Factors in a Nationwide Study". Circ Cardiovasc Qual Outcomes 2021; 14:e007775. [PMID: 33641337 DOI: 10.1161/circoutcomes.121.007775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Francis J Ha
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., O.F., H.S.L.).,St Vincent's Hospital Melbourne, Victoria, Australia (F.J.H.)
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., O.F., H.S.L.).,University of Melbourne, Victoria, Australia (O.F., H.S.L.)
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., O.F., H.S.L.).,University of Melbourne, Victoria, Australia (O.F., H.S.L.)
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19
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Cave L, Cooper MN, Zubrick SR, Shepherd CCJ. Racial discrimination and allostatic load among First Nations Australians: a nationally representative cross-sectional study. BMC Public Health 2020; 20:1881. [PMID: 33287764 PMCID: PMC7720631 DOI: 10.1186/s12889-020-09978-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 11/26/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Increased allostatic load is linked with racial discrimination exposure, providing a mechanism for the biological embedding of racism as a psychosocial stressor. We undertook an examination of how racial discrimination interacts with socioecological, environmental, and health conditions to affect multisystem dysregulation in a First Nations population. METHODS We conducted latent class analysis (LCA) using indicators of life stress, socioeconomic background, and physical and mental health from a nationally representative sample of Australian Aboriginal adults (N = 2056). We used LCA with distal outcomes to estimate the effect of the latent class variable on our derived allostatic load index and conducted a stratified analysis to test whether allostatic load varied based on exposure to racial discrimination across latent classes. RESULTS Our psychosocial, environmental, and health measures informed a four-class structure; 'Low risk', 'Challenged but healthy', 'Mental health risk' and 'Multiple challenges'. Mean allostatic load was highest in 'Multiple challenges' compared to all other classes, both in those exposed (4.5; 95% CI: 3.9, 5.0) and not exposed (3.9; 95% CI: 3.7, 4.2) to racial discrimination. Allostatic load was significantly higher for those with exposure to racial discrimination in the 'Multiple challenges' class (t = 1.74, p = .04) and significantly lower in the 'Mental health risk' class (t = - 1.67, p = .05). CONCLUSIONS Racial discrimination may not always modify physiological vulnerability to disease. Social and economic contexts must be considered when addressing the impact of racism, with a focus on individuals and sub-populations experiencing co-occurring life challenges.
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Affiliation(s)
- Leah Cave
- Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia.
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia.
| | - Matthew N Cooper
- Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
| | - Stephen R Zubrick
- Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
- Centre for Child Health Research, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Carrington C J Shepherd
- Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
- Ngangk Yira Research Centre for Aboriginal Health & Social Equity, Murdoch University, 90 South Street, Murdoch, Western Australia, 6150, Australia
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20
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McBride KF, Rolleston A, Grey C, Howard NJ, Paquet C, Brown A. Māori, Pacific, Aboriginal and Torres Strait Islander Women's Cardiovascular Health: Where Are the Opportunities to Make a Real Difference? Heart Lung Circ 2020; 30:52-58. [PMID: 33162366 DOI: 10.1016/j.hlc.2020.06.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022]
Abstract
Māori and Pacific women in New Zealand and Aboriginal and Torres Strait Islander women in Australia are recognised as nurturers and leaders within their families and communities. However, women's wellbeing, and that of their communities, are affected by a high burden of cardiovascular disease experienced at a younger age than women from other ethnic groups. There has been little focus on the cardiovascular outcomes and strategies to address heart health inequities among Māori, Pacific, Aboriginal and Torres Strait Islander women. The factors contributing to these inequities are complex and interrelated but include differences in exposure to risk and protective factors, rates of multi-morbidity, and substantial gaps within the health system, which include barriers to culturally responsive, timely and appropriate cardiovascular care. Evidence demonstrates critical treatment gaps across the continuum of risk and disease, including assessment and management of cardiovascular risk in young women and time-critical access to and receipt of acute services. Cardiovascular disease in women impacts not only the individual, but their family and community, and the burden of living with disease limits women's capacity to fulfil their roles and responsibilities which support and sustain families and communities. Our response must draw on the strengths of Māori, Pacific, Aboriginal and Torres Strait Islander women, acknowledge health and wellbeing holistically, address the health and social needs of individuals, families and communities, and recognise that Indigenous women in New Zealand, Australia and across the Pacific must be involved in the design, development and implementation of solutions affecting their own health.
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Affiliation(s)
- Katharine F McBride
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia; Australian Centre for Precision Health, Cancer Research Institute, University of South Australia, Adelaide, SA, Australia; Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | | | - Corina Grey
- Auckland District Health Board, Auckland, New Zealand
| | - Natasha J Howard
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Catherine Paquet
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia; Australian Centre for Precision Health, Cancer Research Institute, University of South Australia, Adelaide, SA, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.
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21
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Ha FJ, Han HC, Sanders P, Fendel K, Teh AW, Kalman JM, O'Donnell D, Leong T, Farouque O, Lim HS. Sudden Cardiac Death in the Young: Incidence, Trends, and Risk Factors in a Nationwide Study. Circ Cardiovasc Qual Outcomes 2020; 13:e006470. [PMID: 33079584 DOI: 10.1161/circoutcomes.119.006470] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sudden cardiac death (SCD) in the young is devastating. Contemporary incidence remains unclear with few recent nationwide studies and limited data addressing risk factors for causes. We aimed to determine incidence, trends, causes, and risk factors for SCD in the young. METHODS AND RESULTS The National Coronial Information System registry was reviewed for SCD in people aged 1 to 35 years from 2000 to 2016 in Australia. Subjects were identified by the International Classification of Diseases, Tenth Revision code relating to circulatory system diseases (I00-I99) from coronial reports. Baseline demographics, circumstances, and cause of SCD were obtained from coronial and police reports, alongside autopsy and toxicology analyses where available. During the study period, 2006 cases were identified (median age, 28±7 years; men, 75%; mean body mass index, 29±8 kg/m2). Annual incidence ranged from 0.91 to 1.48 per 100 000 age-specific person-years, which was the lowest in 2013 to 2015 compared with previous 3-year intervals on Poisson regression model (P=0.001). SCD incidence was higher in nonmetropolitan versus metropolitan areas (0.99 versus 0.53 per 100 000 person-years; P<0.001). The most common cause of SCD was coronary artery disease (40%), followed by sudden arrhythmic death syndrome (14%). Incidence of coronary artery disease-related SCD decreased from 2001-2003 to 2013-2015 (P<0.001). Proportion of SCD related to sudden arrhythmic death syndrome increased during the study period (P=0.02) although overall incidence was stable (P=0.22). Residential remoteness was associated with coronary artery disease-related SCD (odds ratio, 1.44 [95% CI, 1.24-1.67]; P<0.001). For every 1-unit increase, body mass index was associated with increased likelihood of SCD from cardiomegaly (odds ratio, 1.08 [95% CI, 1.05-1.11]; P<0.001) and dilated cardiomyopathy (odds ratio, 1.04 [95% CI, 1.01-1.06]; P=0.005). CONCLUSIONS Incidence of SCD in the young and specifically coronary artery disease-related SCD has declined in recent years. Proportion of SCD related to sudden arrhythmic death syndrome increased over the study period. Geographic remoteness and obesity are risk factors for specific causes of SCD in the young.
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Affiliation(s)
- Francis J Ha
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.).,St. Vincent's Hospital Melbourne, Victoria, Australia (F.J.H.)
| | - Hui-Chen Han
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.).,University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., J.M.K., O.F., H.S.L.)
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australia Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital Adelaide, South Australia, Australia (P.S.)
| | - Kim Fendel
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.)
| | - Andrew W Teh
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.).,University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., J.M.K., O.F., H.S.L.)
| | - Jonathan M Kalman
- University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., J.M.K., O.F., H.S.L.).,Melbourne Heart Centre, Royal Melbourne Hospital, Victoria, Australia (J.M.K.)
| | - David O'Donnell
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.)
| | - Trishe Leong
- Department of Anatomical Pathology, St. Vincent's Hospital, Melbourne, Victoria, Australia (T.L.)
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.).,University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., J.M.K., O.F., H.S.L.)
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.).,University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., J.M.K., O.F., H.S.L.).,Department of Cardiology, Northern Health, Melbourne, Victoria, Australia (H.S.L.)
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22
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O'Neil A, Russell JD, Murphy B. How Does Mental Health Impact Women's Heart Health? Heart Lung Circ 2020; 30:59-68. [PMID: 32665170 DOI: 10.1016/j.hlc.2020.05.111] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/13/2020] [Accepted: 05/24/2020] [Indexed: 02/07/2023]
Abstract
From adolescence until old age, women are more vulnerable to common mental disorders (CMDs; depression and anxiety) than men at all stages of the life course. By middle age, women who have clinical depression are at twice the risk of having an incident cardiovascular disease (CVD) than those without. This has important implications for the way we prevent, identify and treat both CMDs and coronary heart disease in women. In this paper, we discuss the various genetic, biological, ethnic/racial, and psychological pathways by which women's vulnerability to CMDs elevate their CVD risk and recovery from a cardiac event. We review the evidence from trials that have, to date, failed to show that treating depression can reduce or delay the onset or recurrence of CVD events, especially for female patients. We discuss the value of lifestyle-based therapies for treating depression, to which women may be more responsive, and finish by discussing how population-based approaches including risk factor assessment could be tailored to consider these factors.
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Affiliation(s)
- Adrienne O'Neil
- Heart & Mind Research, iMPACT Institute, Deakin University, Melbourne, Vic, Australia; Faculty of Health, Deakin University, Melbourne, Vic, Australia.
| | - Josephine D Russell
- Heart & Mind Research, iMPACT Institute, Deakin University, Melbourne, Vic, Australia
| | - Barbara Murphy
- Heart & Mind Research, iMPACT Institute, Deakin University, Melbourne, Vic, Australia; Australian Centre for Heart Health, Melbourne, Vic, Australia; Department of Psychology, University of Melbourne, Melbourne, Vic, Australia
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23
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Fitzgerald X, Herceg A, Douglas K, Siddiqui N. Cardiovascular disease risk assessment in an Aboriginal community-controlled health service: comparing algorithms. Aust J Prim Health 2020; 26:281-286. [PMID: 32654685 DOI: 10.1071/py19216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/24/2020] [Indexed: 01/22/2023]
Abstract
Aboriginal and Torres Strait Islander people have high rates of cardiovascular disease (CVD). The National Vascular Disease Prevention Alliance (NVDPA) CVD risk assessment algorithm is used for all Australians. The Central Australian Rural Practitioners Association (CARPA) algorithm used in the Northern Territory adds five percentage points to all NVDPA risk scores for Indigenous Australians. Information was extracted from an Aboriginal Community-Controlled Health Service for all Aboriginal and Torres Strait Islander regular clients aged 35-74 years without known CVD (n=1057). CVD risk scores were calculated using both algorithms. Prescription of lipid-lowering medications was assessed. Clients with high-risk scores were reviewed and recalled if required. CVD risk scores were calculated for 362 (34.4%) clients. Clients with high CVD risk comprised 17.7% (NVDPA) or 23.8% (CARPA), with most determined clinically. Clients with low CVD risk comprised 73.7% (NVDPA) or 47.2% (CARPA). More than 30% of those with high risk were not on lipid-lowering medications. Significant health and social issues affected treatment uptake. It is unclear which algorithm is most applicable; however, this service has decided to continue to use the NVDPA algorithm. Use of CVD risk assessment and management of high-risk clients could be increased in primary care.
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Affiliation(s)
- Xavier Fitzgerald
- Winnunga Nimmityjah Aboriginal Health and Community Services, 63 Boolimba Crescent, Narrabundah, ACT 2604, Australia; and Corresponding author.
| | - Ana Herceg
- Winnunga Nimmityjah Aboriginal Health and Community Services, 63 Boolimba Crescent, Narrabundah, ACT 2604, Australia; and The Australian National University Medical School Campus, The Canberra Hospital, Building 4, Hospital Road, Garran, ACT 2605, Australia
| | - Kirsty Douglas
- Winnunga Nimmityjah Aboriginal Health and Community Services, 63 Boolimba Crescent, Narrabundah, ACT 2604, Australia; and The Australian National University Medical School Campus, The Canberra Hospital, Building 4, Hospital Road, Garran, ACT 2605, Australia
| | - Nadeem Siddiqui
- Winnunga Nimmityjah Aboriginal Health and Community Services, 63 Boolimba Crescent, Narrabundah, ACT 2604, Australia; and The Australian National University Medical School Campus, The Canberra Hospital, Building 4, Hospital Road, Garran, ACT 2605, Australia
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24
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Hanieh S, High H, Boulton J. Nutrition Justice: Uncovering Invisible Pathways to Malnutrition. Front Endocrinol (Lausanne) 2020; 11:150. [PMID: 32265841 PMCID: PMC7105685 DOI: 10.3389/fendo.2020.00150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/04/2020] [Indexed: 11/20/2022] Open
Abstract
We propose the use of the analytic frame of "nutrition justice" to reconcile the separate imperatives of Global Health for nutritional sufficiency for all, the requirement to eradicate childhood malnutrition, and the need for strategies to check the emerging pandemic of the double burden of malnutrition in the Global South. Malnutrition and its consequences of growth stunting are the result of disruption to the nutritional ecology of childhood from structural violence. This is mediated through loss of food security and perturbation to the cultural status of food, and on the prerequisites for nurture during infancy and early childhood. These socio-political factors obscure the role of biological adaptation to nutritional constraint on growth and hence the causal pathway to the double burden of malnutrition. In this paper we describe how the effects of historical and contemporary structural violence on the nutritional ecology of childhood are mediated using the examples of remote Aboriginal Australia and the Lao PDR. Both populations live by force of circumstance in a "metabolic ghetto" that has disrupted the prerequisites for parental nurturing through loss of food security and of traditional sources of transitional staple foods for weaning. Growth faltering and stunting of stature are markers of adaptation to nutritional constraint yet are also the first steps on the track to the double burden. We discuss the implications of these observations for strategies for global food sufficiency by mean of a thought-experiment of the effect of food and nutrient sufficiency for growth on future health and metabolic adaptation.
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Affiliation(s)
- Sarah Hanieh
- Department of Medicine, Peter Doherty Institute of Immunity and Infection, University of Melbourne, Melbourne, VIC, Australia
| | - Holly High
- The Department of Anthropology, Faculty of Arts and Social Sciences, The University of Sydney, Sydney, NSW, Australia
| | - John Boulton
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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25
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Agostino JW, Wong D, Paige E, Wade V, Connell C, Davey ME, Peiris DP, Fitzsimmons D, Burgess CP, Mahoney R, Lonsdale E, Fernando P, Malamoo L, Eades S, Brown A, Jennings G, Lovett RW, Banks E. Cardiovascular disease risk assessment for Aboriginal and Torres Strait Islander adults aged under 35 years: a consensus statement. Med J Aust 2020; 212:422-427. [PMID: 32172533 DOI: 10.5694/mja2.50529] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cardiovascular disease (CVD) is a leading cause of preventable morbidity and mortality in Aboriginal and Torres Strait Islander peoples. This statement from the Australian Chronic Disease Prevention Alliance, the Royal Australian College of General Practitioners, the National Aboriginal Community Controlled Health Organisation and the Editorial Committee for Remote Primary Health Care Manuals communicates the latest consensus advice of guideline developers, aligning recommendations on the age to commence Aboriginal and Torres Strait Islander CVD risk assessment across three guidelines. MAIN RECOMMENDATIONS: In Aboriginal and Torres Strait Islander peoples without existing CVD: CVD risk factor screening should commence from the age of 18 years at the latest, including for blood glucose level or glycated haemoglobin, estimated glomerular filtration rate, serum lipids, urine albumin to creatinine ratio, and other risk factors such as blood pressure, history of familial hypercholesterolaemia, and smoking status. Individuals aged 18-29 years with the following clinical conditions are automatically conferred high CVD risk: ▶type 2 diabetes and microalbuminuria; ▶moderate to severe chronic kidney disease; ▶systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 110 mmHg; ▶familial hypercholesterolaemia; or ▶serum total cholesterol > 7.5 mmol/L. Assessment using the National Vascular Disease Prevention Alliance absolute CVD risk algorithm should commence from the age of 30 years at the latest - consider upward adjustment of calculated CVD risk score, accounting for local guideline use, risk factor and CVD epidemiology, and clinical discretion. Assessment should occur as part of an annual health check or opportunistically. Subsequent review should be conducted according to level of risk. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: From age 18 years (at the latest), Aboriginal and Torres Strait Islander adults should undergo CVD risk factor screening, and from age 30 years (at the latest), they should undergo absolute CVD risk assessment using the NVDPA risk algorithm.
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Affiliation(s)
- Jason W Agostino
- Australian National University, Canberra, ACT.,National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | - Deborah Wong
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | - Ellie Paige
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | - Vicki Wade
- RHD Australia, Menzies School of Health Research, Darwin, NT
| | - Cia Connell
- National Heart Foundation of Australia, Melbourne, VIC
| | | | - David P Peiris
- George Institute for Global Health, UNSW Sydney, Sydney, NSW
| | - Dana Fitzsimmons
- Top End Health Services, Northern Territory Government, Darwin, NT
| | - C Paul Burgess
- Northern Territory Medical Program, Flinders University, Darwin, NT
| | - Ray Mahoney
- Australian E-Health Research Centre, CSIRO, Brisbane, QLD
| | - Emma Lonsdale
- Australian Chronic Disease Prevention Alliance, Sydney, NSW
| | | | | | - Sandra Eades
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC
| | - Alex Brown
- University of Adelaide, Adelaide, SA.,University of South Australia, Adelaide, SA
| | | | - Raymond W Lovett
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
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26
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Barr ELM, Barzi F, Rohit A, Cunningham J, Tatipata S, McDermott R, Hoy WE, Wang Z, Bradshaw PJ, Dimer L, Thompson PL, Brimblecombe J, O'Dea K, Connors C, Burgess P, Guthridge S, Brown A, Cass A, Shaw JE, Maple-Brown L. Performance of cardiovascular risk prediction equations in Indigenous Australians. Heart 2020; 106:1252-1260. [PMID: 31949024 DOI: 10.1136/heartjnl-2019-315889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/23/2019] [Accepted: 12/30/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the performance of cardiovascular disease (CVD) risk equations in Indigenous Australians. METHODS We conducted an individual participant meta-analysis using longitudinal data of 3618 Indigenous Australians (55% women) aged 30-74 years without CVD from population-based cohorts of the Cardiovascular Risk in IndigenouS People(CRISP) consortium. Predicted risk was calculated using: 1991 and 2008 Framingham Heart Study (FHS), the Pooled Cohorts (PC), GloboRisk and the Central Australian Rural Practitioners Association (CARPA) modification of the FHS equation. Calibration, discrimination and diagnostic accuracy were evaluated. Risks were calculated with and without the use of clinical criteria to identify high-risk individuals. RESULTS When applied without clinical criteria, all equations, except the CARPA-adjusted FHS, underestimated CVD risk (range of percentage difference between observed and predicted CVD risks: -55% to -14%), with underestimation greater in women (-63% to -13%) than men (-47% to -18%) and in younger age groups. Discrimination ranged from 0.66 to 0.72. The CARPA-adjusted FHS equation showed good calibration but overestimated risk in younger people, those without diabetes and those not at high clinical risk. When clinical criteria were used with risk equations, the CARPA-adjusted FHS algorithm scored 64% of those who had CVD events as high risk; corresponding figures for the 1991-FHS were 58% and were 87% for the PC equation for non-Hispanic whites. However, specificity fell. CONCLUSION The CARPA-adjusted FHS CVD risk equation and clinical criteria performed the best, achieving higher combined sensitivity and specificity than other equations. However, future research should investigate whether modifications to this algorithm combination might lead to improved risk prediction.
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Affiliation(s)
- Elizabeth Laurel Mary Barr
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia .,Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Federica Barzi
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Athira Rohit
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Joan Cunningham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Shaun Tatipata
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Robyn McDermott
- Centre for Chronic Disease Prevention, James Cook University - Cairns Campus, Cairns, Queensland, Australia
| | - Wendy E Hoy
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Zhiqiang Wang
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Pamela June Bradshaw
- Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Lyn Dimer
- National Heart Foundation, Perth, Western Australia, Australia
| | - Peter L Thompson
- Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Julie Brimblecombe
- Nutrition Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Kerin O'Dea
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia.,School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Christine Connors
- Primary Health Care Top End Health Services, Northern Territory Department of Health, Casuarina, Northern Territory, Australia
| | - Paul Burgess
- Northern Territory Department of Health, Casuarina, Northern Territory, Australia
| | - Steven Guthridge
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Department of Medicine - Aboriginal Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Alan Cass
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Jonathan E Shaw
- Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Louise Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research Charles Darwin University, Casuarina, Northern Territory, Australia
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27
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Paige E, Agostino J, Phillips C, Elliott J, Cadilhac DA, Connell C, Kowalski M, Jenkins LO, Daluwatta A, Banks E. Living Guidelines for Absolute Cardiovascular Disease Risk Assessment and Management. Heart Lung Circ 2019; 28:829-832. [DOI: 10.1016/j.hlc.2019.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 01/27/2019] [Indexed: 11/30/2022]
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Ouriques Martins SC, Sacks C, Hacke W, Brainin M, de Assis Figueiredo F, Marques Pontes-Neto O, Lavados Germain PM, Marinho MF, Hoppe Wiegering A, Vaca McGhie D, Cruz-Flores S, Ameriso SF, Camargo Villareal WM, Durán JC, Fogolin Passos JE, Gomes Nogueira R, Freitas de Carvalho JJ, Sampaio Silva G, Cabral Moro CH, Oliveira-Filho J, Gagliardi R, Gomes de Sousa ED, Fagundes Soares F, de Pinho Campos K, Piza Teixeira PF, Gonçalves IP, Santos Carquin IR, Muñoz Collazos M, Pérez Romero GE, Maldonado Figueredo JI, Barboza MA, Celis López MÁ, Góngora-Rivera F, Cantú-Brito C, Novarro-Escudero N, Velázquez Blanco MÁ, Arbo Oze de Morvil CA, Olmedo Bareiro AB, Meza Rojas G, Flores A, Hancco-Saavedra JA, Pérez Jimenez V, Abanto Argomedo C, Rodriguez Kadota L, Crosa R, Mora Cuervo DL, de Souza AC, Carbonera LA, Álvarez Guzmán TF, Maldonado N, Cabral NL, Anderson C, Lindsay P, Hennis A, Feigin VL. Priorities to reduce the burden of stroke in Latin American countries. Lancet Neurol 2019; 18:674-683. [PMID: 31029579 DOI: 10.1016/s1474-4422(19)30068-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/27/2019] [Accepted: 02/04/2019] [Indexed: 01/06/2023]
Abstract
The large and increasing burden of stroke in Latin American countries, and the need to meet the UN and WHO requirements for reducing the burden from non-communicable disorders (including stroke), brought together stroke experts and representatives of the Ministries of Health of 13 Latin American countries for the 1st Latin American Stroke Ministerial meeting in Gramado, Brazil, to discuss the problem and identify ways of cooperating to reduce the burden of stroke in the region. Discussions were focused on the regional and country-specific activities associated with stroke prevention and treatment, including public stroke awareness, prevention strategies, delivery and organisation of care, clinical practice gaps, and unmet needs. The meeting culminated with the adoption of the special Gramado Declaration, signed by all Ministerial officials who attended the meeting. With agreed priorities for stroke prevention, treatment, and research, an opportunity now exists to translate this Declaration into an action plan to reduce the burden of stroke.
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Affiliation(s)
- Sheila C Ouriques Martins
- Brazilian Stroke Network, Porto Alegre, Brazil; Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil; Neurology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Claudio Sacks
- Ibero-American Stroke Organization, Porto Alegre, Brazil; Neurology Department, Universidad de Valparaíso, Valparaíso, Chile
| | - Werner Hacke
- World Stroke Organization, Geneva, Switzerland; Neurology Department, University of Heidelberg, Heidelberg, Germany
| | - Michael Brainin
- World Stroke Organization, Geneva, Switzerland; Department of Neurosciences and Preventive Medicine, Danube University Krems, Krems an der Donau, Austria
| | | | | | - Pablo M Lavados Germain
- Department of Neurology and Psychiatry, Clínica Alemana de Santiago, Vitacura, Chile; Neurology and Psychiatry Clinic, Universidad del Desarrollo, Concepción, Chile; Department of Neurological Sciences, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Maria F Marinho
- NonCommunicable Diseases and Health Promotion, Ministry of Health, Brasília, Brazil
| | - Arnold Hoppe Wiegering
- Ibero-American Stroke Organization, Porto Alegre, Brazil; Department of Neurology and Psychiatry, Clínica Alemana de Santiago, Vitacura, Chile; Neurology and Psychiatry Clinic, Universidad del Desarrollo, Concepción, Chile
| | - Diana Vaca McGhie
- American Heart Association and American Stroke Association, Dallas, Texas, TX, USA
| | - Salvador Cruz-Flores
- Department of Neurology, Paul L Foster School of Medicine, Texas Tech University Health Sciences Center, EL Paso, TX, USA
| | - Sebastian F Ameriso
- Ibero-American Stroke Organization, Porto Alegre, Brazil; Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia, Buenos Aires, Argentina
| | | | | | | | | | | | - Gisele Sampaio Silva
- Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Rubens Gagliardi
- Brazilian Academy of Neurology, Santa Casa de São Paulo, São Paulo, Brazil
| | | | | | - Katia de Pinho Campos
- Determinants of Health, Noncommunicable Diseases and Mental Health, Pan American Health Organization/World Health Organization, Brasília, Brazil
| | | | | | - Irving R Santos Carquin
- Noncommunicable Diseases Department, Ministry of Health, Santiago, Chile; Emergency Hospital Public Assistance, Santiago, Chile; Faculty of Medicine, University of Chile, Santiago, Chile
| | | | - Germán E Pérez Romero
- Colombian Stroke Network, Bogota, Colombia; Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia; Servicio de Neurología, Fundación Hospital San Carlos, Bogotá, Colombia
| | | | - Miguel A Barboza
- Neuroscience department, Hospital Dr Rafael A Calderon, CCSS-HRACG, San José, Costa Rica
| | - Miguel Á Celis López
- Instituto Nacional de Neurologia e Neurocirurgia Dr Manuel Velasco Suarez, Ministry of Health of Mexico, Mexico City, Mexico
| | - Fernando Góngora-Rivera
- Asociación Mexicana de Enfermedad Vascular Cerebral. Monterrey, Mexico; Hospital Universitario José Eleuterio González, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | | | - Miguel Á Velázquez Blanco
- National System of Telemedicine, Ministry of Public Health and Social Welfare of Paraguay, Asunción, Paraguay
| | - Carlos A Arbo Oze de Morvil
- National System of Telemedicine, Ministry of Public Health and Social Welfare of Paraguay, Asunción, Paraguay
| | | | | | - Alan Flores
- Hospital de Clínicas, Asunción, Paraguay; Stroke Unit Universidad Nacional de Asunción, Asunción, Paraguay
| | | | | | - Carlos Abanto Argomedo
- Departamento de Enfermedades Neurovasculares, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Liliana Rodriguez Kadota
- Servicio de Enfermedades vasculares y Epilepsia, Departamento de Neurología, Hospital Nacional Edgardo Rebagliati Martins Lima, Peru
| | | | | | - Ana C de Souza
- Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Leonardo A Carbonera
- Neurology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Nelson Maldonado
- Department of Neurology, School of Medicine, Universidad San Francisco de Quito, Hospital de los Valles, Quito, Ecuador
| | - Norberto L Cabral
- Joinville Stroke Registry, University of Joinville, Joinville, Brazil
| | - Craig Anderson
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Anselm Hennis
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
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Braithwaite C. Aboriginal Community Controlled Health Organisation (
ACCHO
) pharmacist: integration into the
ACCHO
model of care. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Schultz R. Absolute cardiovascular disease risk and lipid‐lowering therapy among Aboriginal and Torres Strait Islander Australians. Med J Aust 2018; 209:369. [DOI: 10.5694/mja18.00711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/10/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Rosalie Schultz
- Centre for Remote Health, Flinders University, Alice Springs, NT
- Cooperative Research Centre for Remote Economic Participation, Ninti One, Alice Springs, NT
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Lovett RW. Absolute cardiovascular disease risk and lipid‐lowering therapy among Aboriginal and Torres Strait Islander Australians. Med J Aust 2018; 209:368-370. [DOI: 10.5694/mja18.00836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/13/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Raymond W Lovett
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
- Australian Institute of Aboriginal and Torres Strait Islander Studies, Canberra, ACT
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Reath JS, O'Mara P. Closing the gap in cardiovascular risk for Aboriginal and Torres Strait Islander Australians. Med J Aust 2018; 209:17-18. [DOI: 10.5694/mja18.00345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/10/2018] [Indexed: 11/17/2022]
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33
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Thompson GN, Gee C, Talley Ac NJ. Indigenous health: one gap is closed. Med J Aust 2018; 209:14-15. [PMID: 29954307 DOI: 10.5694/mja18.00483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/17/2018] [Indexed: 11/17/2022]
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