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Dawson LP, Carrington MJ, Haregu T, Nanayakkara S, Jennings G, Dart A, Stub D, Inouye M, Kaye D. Ten-Year Risk Equations for Incident Heart Failure in Established Atherosclerotic Cardiovascular Disease Populations. J Am Heart Assoc 2024:e034254. [PMID: 38780153 DOI: 10.1161/jaha.124.034254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Ten-year risk equations for incident heart failure (HF) are available for the general population, but not for patients with established atherosclerotic cardiovascular disease (ASCVD), which is highly prevalent in HF cohorts. This study aimed to develop and validate 10-year risk equations for incident HF in patients with known ASCVD. METHODS AND RESULTS Ten-year risk equations for incident HF were developed using the United Kingdom Biobank cohort (recruitment 2006-2010) including participants with established ASCVD but free from HF at baseline. Model performance was validated using the Australian Baker Heart and Diabetes Institute Biobank cohort (recruitment 2000-2011) and compared with the performance of general population risk models. Incident HF occurred in 13.7% of the development cohort (n=31 446, median 63 years, 35% women, follow-up 10.7±2.7 years) and in 21.3% of the validation cohort (n=1659, median age 65 years, 25% women, follow-up 9.4±3.7 years). Predictors of HF included in the sex-specific models were age, body mass index, systolic blood pressure (treated or untreated), glucose (treated or untreated), cholesterol, smoking status, QRS duration, kidney disease, myocardial infarction, and atrial fibrillation. ASCVD-HF equations had good discrimination and calibration in development and validation cohorts, with superior performance to general population risk equations. CONCLUSIONS ASCVD-specific 10-year risk equations for HF outperform general population risk models in individuals with established ASCVD. The ASCVD-HF equations can be calculated from readily available clinical data and could facilitate screening and preventative treatment decisions in this high-risk group.
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Affiliation(s)
- Luke P Dawson
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia
- Faculty of Medicine Monash University Melbourne Victoria Australia
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
| | | | - Tilahun Haregu
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
| | - Shane Nanayakkara
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
| | - Garry Jennings
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia
- Faculty of Medicine Monash University Melbourne Victoria Australia
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
| | - Anthony Dart
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
| | - Dion Stub
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia
- Faculty of Medicine Monash University Melbourne Victoria Australia
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
| | - Michael Inouye
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
- Department of Public Health & Primary Care University of Cambridge Cambridge UK
| | - David Kaye
- Department of Cardiology The Alfred Hospital Melbourne Victoria Australia
- Faculty of Medicine Monash University Melbourne Victoria Australia
- Baker Heart and Diabetes Institute Melbourne Victoria Australia
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Zisis G, Carrington MJ, Yang Y, Huynh Q, Lay M, Whitmore K, Hare JL, Hopper I, Dwyer N, Marwick TH. Use of Imaging-guided Decongestion for Reducing Heart Failure Readmission and Death in High-risk Patients: A Multi-site Randomized Trial of a Nurse-led Strategy at the Point of Care. J Card Fail 2024; 30:624-629. [PMID: 38151092 DOI: 10.1016/j.cardfail.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Nurse-led disease management programs (DMPs) decrease readmission after acute decompensated heart failure (HF). We sought whether readmissions could be further reduced by lung ultrasound (LUS)-guided decongestion before discharge and during DMP. METHODS AND RESULTS Of 290 patients hospitalized with acute decompensated HF, 122 at high risk for readmission or mortality were randomized to receive usual care (UC) (n = 64) or UC plus intervention (DMP-Plus) (n = 58), comprising LUS-guided management before discharge and during at-home follow-up. Residual congestion was identified by ≥10 B-lines detected in 8 lung zones. The outcomes included a composite of readmission and/or mortality at 30 and 90 days, and 90-day HF readmission. Residual congestion was detected equally among the patient groups. The 30-day composite outcome occurred in 28% DMP-plus patients and 22% UC patients (odd ratio [OR], 1.36; 95% confidence interval [CI], 0.59-3.1; P = .5) and the 90-day HF readmission outcome occurred in 22% and 31%, respectively (odds ratio, 0.63; 95% CI, 0.28-1.43; P = .3). Residual congestion, identified at predischarge LUS examination in high-risk patients, was associated with early (<14-day) HF readmission (relative risk, 1.19; 95% CI, 1.06-1.32; P = .002) and multiple (≥2) readmissions over 90 days of follow-up (relative risk, 1.09; 95% CI, 1.01-1.16; P = .012), independent of demographics and comorbidities. CONCLUSIONS Readmission in patients with incomplete decongestion before discharge occurs within the first 2 weeks. However, our DMP-plus strategy did not improve the primary outcome.
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Affiliation(s)
- Georgios Zisis
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia; Western Health Melbourne, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences the University of Melbourne, Melbourne, Victoria, Australia; Northern Health, Melbourne, Victoria, Australia; Alfred Health, Melbourne, Victoria, Australia
| | - Melinda J Carrington
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia; Western Health Melbourne, Melbourne, Victoria, Australia
| | - Yang Yang
- Western Health Melbourne, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences the University of Melbourne, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Eastern Health, Melbourne, Victoria, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Maria Lay
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Alfred Health, Melbourne, Victoria, Australia
| | - Kristyn Whitmore
- Menzies Institute for Medical Research, Hobart, Tasmania, Australia
| | - James L Hare
- Alfred Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | - Ingrid Hopper
- Alfred Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | - Nathan Dwyer
- Menzies Institute for Medical Research, Hobart, Tasmania, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia; Western Health Melbourne, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences the University of Melbourne, Melbourne, Victoria, Australia; Alfred Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Menzies Institute for Medical Research, Hobart, Tasmania, Australia.
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3
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Dakic A, Wu J, Wang T, Huynh K, Mellett N, Duong T, Beyene HB, Magliano DJ, Shaw JE, Carrington MJ, Inouye M, Yang JY, Figtree GA, Curran JE, Blangero J, Simes J, Giles C, Meikle PJ. Imputation of plasma lipid species to facilitate integration of lipidomic datasets. Nat Commun 2024; 15:1540. [PMID: 38378775 PMCID: PMC10879118 DOI: 10.1038/s41467-024-45838-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Abstract
Recent advancements in plasma lipidomic profiling methodology have significantly increased specificity and accuracy of lipid measurements. This evolution, driven by improved chromatographic and mass spectrometric resolution of newer platforms, has made it challenging to align datasets created at different times, or on different platforms. Here we present a framework for harmonising such plasma lipidomic datasets with different levels of granularity in their lipid measurements. Our method utilises elastic-net prediction models, constructed from high-resolution lipidomics reference datasets, to predict unmeasured lipid species in lower-resolution studies. The approach involves (1) constructing composite lipid measures in the reference dataset that map to less resolved lipids in the target dataset, (2) addressing discrepancies between aligned lipid species, (3) generating prediction models, (4) assessing their transferability into the targe dataset, and (5) evaluating their prediction accuracy. To demonstrate our approach, we used the AusDiab population-based cohort (747 lipid species) as the reference to impute unmeasured lipid species into the LIPID study (342 lipid species). Furthermore, we compared measured and imputed lipids in terms of parameter estimation and predictive performance, and validated imputations in an independent study. Our method for harmonising plasma lipidomic datasets will facilitate model validation and data integration efforts.
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Affiliation(s)
- Aleksandar Dakic
- Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
| | - Jingqin Wu
- Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
| | - Tingting Wang
- Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
| | - Kevin Huynh
- Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
- Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, VIC, 3086, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, VIC, 3010, Australia
| | - Natalie Mellett
- Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
| | - Thy Duong
- Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
| | - Habtamu B Beyene
- Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
- Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, VIC, 3086, Australia
| | | | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
| | - Melinda J Carrington
- Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, VIC, 3010, Australia
| | - Michael Inouye
- Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
| | - Jean Y Yang
- School of Mathematics and Statistics, The University of Sydney, Camperdown, NSW, 2006, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Gemma A Figtree
- Kolling Institute of Medical Research, The University of Sydney, St Leonards, NSW, 2065, Australia
- Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Joanne E Curran
- Department of Human Genetics and South Texas Diabetes and Obesity Institute, School of Medicine at University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - John Blangero
- Department of Human Genetics and South Texas Diabetes and Obesity Institute, School of Medicine at University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - John Simes
- National Health and Medical Research Council of Australia (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Corey Giles
- Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia.
- Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, VIC, 3086, Australia.
- Baker Department of Cardiometabolic Health, The University of Melbourne, VIC, 3010, Australia.
| | - Peter J Meikle
- Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia.
- Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, VIC, 3086, Australia.
- Baker Department of Cardiometabolic Health, The University of Melbourne, VIC, 3010, Australia.
- Department of Diabetes, Central Clinical School, Monash University, Clayton, VIC, 3800, Australia.
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Whitmore K, Zhou Z, Magnussen CG, Carrington MJ, Marwick TH. Influence of Repeated Plaque Visualization on Cardiovascular Risk Reduction after 3 years; a randomized controlled trial. Eur J Prev Cardiol 2024:zwae026. [PMID: 38243798 DOI: 10.1093/eurjpc/zwae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 01/22/2024]
Abstract
AIMS Helping people to understand their cardiovascular (CV) risk can influence the choices they make for risk reduction, including medication adherence and lifestyle modification. This study sought whether repeated visualization of coronary artery calcium (CAC) images was effective in sustaining long-term risk control in primary prevention, independent of a risk reduction program. METHODS Asymptomatic, statin-naïve participants, 40-70 years, with a family history of premature coronary artery disease and a CAC score from 1-400 were randomised to a nurse-led CV risk reduction program or standard care with bi-annual reviews. Only the intervention group (220 of 449 participants) visualised their CAC image (with repeat exposure in the first 3 months) and were initiated on statin therapy. The primary outcome was change in Framingham Risk Score (FRS) at 36 months, and the impact of CAC image recall on CV risk was assessed. RESULTS The reduction in FRS (difference in differences (DID): -3.4% [95%CI: -4.4% to -2.4%], p=<0.001 and low-density-lipoprotein-cholesterol -1.2mmol/L [95%CI: -1.4 to -1.0], p=<0.001)) over 36 months was greater in the intervention than the control group. Within the intervention group, sustained recall of CAC images at 24 months was associated with lower systolic blood pressure (DID -4.3mmHg [95%CI: -7.7 to-0.9], p=0.01) and waist circumference (DID -2.0cm [95% CI: -3.9 to -0.1], p=0.03) at 36 months compared to unsustained recall. CONCLUSION A nurse-led program, combining personalized patient visualization of CAC imaging with statin therapy, is beneficial for improving CV risk. Recalling the presentation of CAC images through repeated visual exposure may influence risk reduction.
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Affiliation(s)
- Kristyn Whitmore
- Baker Department of Cardiometabolic Health, The University of Melbourne, Victoria Australia
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, 3004
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Tasmania, 7000
| | - Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004
| | - Costan G Magnussen
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, 3004
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Melinda J Carrington
- Baker Department of Cardiometabolic Health, The University of Melbourne, Victoria Australia
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, 3004
| | - Thomas H Marwick
- Baker Department of Cardiometabolic Health, The University of Melbourne, Victoria Australia
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria, 3004
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Tasmania, 7000
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de Moel-Mandel C, Lynch C, Issaka A, Braver J, Zisis G, Carrington MJ, Oldenburg B. Optimising the implementation of digital-supported interventions for the secondary prevention of heart disease: a systematic review using the RE-AIM planning and evaluation framework. BMC Health Serv Res 2023; 23:1347. [PMID: 38049862 PMCID: PMC10694952 DOI: 10.1186/s12913-023-10361-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/22/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND mHealth technologies are now widely utilised to support the delivery of secondary prevention programs in heart disease. Interventions with mHealth included have shown a similar efficacy and safety to conventional programs with improvements in access and adherence. However, questions remain regarding the successful wider implementation of digital-supported programs. By applying the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework to a systematic review and meta-analysis, this review aims to evaluate the extent to which these programs report on RE-AIM dimensions and associated indicators. METHODS This review extends our previous systematic review and meta-analysis that investigated the effectiveness of digital-supported programs for patients with coronary artery disease. Citation searches were performed on the 27 studies of the systematic review to identify linked publications that reported data for RE-AIM dimensions. All included studies and, where relevant, any additional publications, were coded using an adapted RE-AIM extraction tool. Discrepant codes were discussed amongst reviewers to gain consensus. Data were analysed to assess reporting on indicators related to each of the RE-AIM dimensions, and average overall reporting rates for each dimension were calculated. RESULTS Searches found an additional nine publications. Across 36 publications that were linked to the 27 studies, 24 (89%) of the studies were interventions solely delivered at home. The average reporting rates for RE-AIM dimensions were highest for effectiveness (75%) and reach (67%), followed by adoption (54%), implementation (36%) and maintenance (11%). Eleven (46%) studies did not describe relevant characteristics of their participants or of staff involved in the intervention; most studies did not describe unanticipated consequences of the intervention; the ongoing cost of intervention implementation and maintenance; information on intervention fidelity; long-term follow-up outcomes, or program adaptation in other settings. CONCLUSIONS Through the application of the RE-AIM framework to a systematic review we found most studies failed to report on key indicators. Failing to report these indicators inhibits the ability to address the enablers and barriers required to achieve optimal intervention implementation in wider settings and populations. Future studies should consider alternative hybrid trial designs to enable reporting of implementation indicators to improve the translation of research evidence into routine practice, with special consideration given to the long-term sustainability of program effects as well as corresponding ongoing costs. REGISTRATION PROSPERO-CRD42022343030.
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Affiliation(s)
| | - Chris Lynch
- School of Psychology & Public Health, La Trobe University, Melbourne, VIC, Australia.
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia.
- Northern Health, Melbourne, VIC, Australia.
| | - Ayuba Issaka
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia
| | - Justin Braver
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Georgios Zisis
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia
- Northern Health, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Melinda J Carrington
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Western Health, Melbourne, VIC, Australia
| | - Brian Oldenburg
- School of Psychology & Public Health, La Trobe University, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia
- Northern Health, Melbourne, VIC, Australia
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Dawson LP, Carrington MJ, Haregu T, Nanayakkara S, Jennings G, Dart A, Stub D, Kaye D. Differences in predictors of incident heart failure according to atherosclerotic cardiovascular disease status. ESC Heart Fail 2023; 10:3398-3409. [PMID: 37688465 PMCID: PMC10682860 DOI: 10.1002/ehf2.14521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/09/2023] [Accepted: 08/18/2023] [Indexed: 09/11/2023] Open
Abstract
AIMS Heart failure (HF) is a common cause of morbidity and mortality, related to a broad range of sociodemographic, lifestyle, cardiometabolic, and comorbidity risk factors, which may differ according to the presence of atherosclerotic cardiovascular disease (ASCVD). We assessed the association between incident HF with baseline status across these domains, overall and separated according to ASCVD status. METHODS AND RESULTS We included 5758 participants from the Baker Biobank cohort without HF at baseline enrolled between January 2000 and December 2011. The primary endpoint was incident HF, defined as hospital admission or HF-related death, determined through linkage with state-wide administrative databases (median follow-up 12.2 years). Regression models were fitted adjusted for sociodemographic variables, alcohol intake, smoking status, measures of adiposity, cardiometabolic profile measures, and individual comorbidities. During 65 987 person-years (median age 59 years, 38% women), incident HF occurred among 784 participants (13.6%) overall. Rates of incident HF were higher among patients with ASCVD (624/1929, 32.4%) compared with those without ASCVD (160/3829, 4.2%). Incident HF was associated with age, socio-economic status, alcohol intake, smoking status, body mass index (BMI), waist circumference, waist-hip ratio, systolic blood pressure (SBP), and low- and high-density lipoprotein cholesterol (LDL-C and HDL-C), with non-linear relationships observed for age, alcohol intake, BMI, waist circumference, waist-hip ratio, SBP, LDL-C, and HDL-C. Risk factors for incident HF were largely consistent regardless of ASCVD status, although diabetes status had a greater association with incident HF among patients without ASCVD. CONCLUSIONS Incident HF is associated with a broad range of baseline sociodemographic, lifestyle, cardiometabolic, and comorbidity factors, which are mostly consistent regardless of ASCVD status. These data could be useful in efforts towards developing risk prediction models that can be used in patients with ASCVD.
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Affiliation(s)
- Luke P. Dawson
- Department of CardiologyThe Alfred HospitalMelbourneVictoriaAustralia
- Faculty of MedicineMonash UniversityMelbourneVictoriaAustralia
- Department of CardiologyThe Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Melinda J. Carrington
- Baker Heart and Diabetes Institute55 Commercial Rd, PrahranMelbourneVictoriaAustralia
| | - Tilahun Haregu
- Department of CardiologyThe Alfred HospitalMelbourneVictoriaAustralia
- Baker Heart and Diabetes Institute55 Commercial Rd, PrahranMelbourneVictoriaAustralia
| | - Shane Nanayakkara
- Department of CardiologyThe Alfred HospitalMelbourneVictoriaAustralia
- Baker Heart and Diabetes Institute55 Commercial Rd, PrahranMelbourneVictoriaAustralia
| | - Garry Jennings
- Baker Heart and Diabetes Institute55 Commercial Rd, PrahranMelbourneVictoriaAustralia
| | - Anthony Dart
- Department of CardiologyThe Alfred HospitalMelbourneVictoriaAustralia
- Baker Heart and Diabetes Institute55 Commercial Rd, PrahranMelbourneVictoriaAustralia
| | - Dion Stub
- Department of CardiologyThe Alfred HospitalMelbourneVictoriaAustralia
- Faculty of MedicineMonash UniversityMelbourneVictoriaAustralia
- Baker Heart and Diabetes Institute55 Commercial Rd, PrahranMelbourneVictoriaAustralia
| | - David Kaye
- Department of CardiologyThe Alfred HospitalMelbourneVictoriaAustralia
- Faculty of MedicineMonash UniversityMelbourneVictoriaAustralia
- Baker Heart and Diabetes Institute55 Commercial Rd, PrahranMelbourneVictoriaAustralia
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7
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Azcui Aparicio RE, Carrington MJ, Huynh Q, Ball J, Marwick TH. Association of cardiovascular health and risk prediction algorithms with subclinical atherosclerosis identified by carotid ultrasound. Cardiovasc Digit Health J 2023; 4:91-100. [PMID: 37351332 PMCID: PMC10282005 DOI: 10.1016/j.cvdhj.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Background The requirement for laboratory tests to assess conventional cardiovascular disease (CVD) risk may be a barrier to the early detection and management of atherosclerosis in some population groups. A simpler risk assessment could facilitate detection of CVD. Objectives The association of the Fuster-BEWAT Score (FBS), Framingham Risk Score (FRS), and Pooled Cohort Equation (PCE) with the presence of carotid plaque was investigated, with the intention of developing a stepped screening process for the primary prevention of CVD. Methods Asymptomatic participants with a family history of premature CVD had an absolute cardiovascular disease risk (ACVDR) score calculated using the FBS, FRS, and PCE risk equations. This risk classification was compared with the presence or absence of carotid plaque on ultrasound. Prediction of carotid plaque presence by risk scores and risk factors was assessed by logistic regression and area under the curve (AUC) for discrimination and diagnostic performance. A classification and regression-tree (CART) model was obtained for stratification of risk assessment. Results Risk score calculation and ultrasound scanning were performed in 1031 participants, of whom 51 had carotid plaques. Participants with plaque and male sex showed higher risk (higher PCE and FRS and lower FBS, as higher scores of FBS indicate better cardiovascular health). Participants ≤50 years of age showed the FBS was a significant predictor; there was a reduced likelihood of plaque presence with a higher score (OR 0.54, 95% CI 0.39-0.75, P < .01). Higher ACVDR (evidenced by higher PCE and FRS scores and lower FBS score) was associated with an increased likelihood of carotid plaque; however, the FBS and the addition of risk factors not included in the equation showed the highest AUC (AUC = 0.76, P < .001). CART modeling showed that participants with FBS between 6 and 9 would be recommended for further risk stratification using the PCE, whereupon a PCE score ≥5% conferred an increased risk and greater possibility for plaque. Validation of the model using a different cohort showed similar risk stratification for plaque presence according to level of risk by CART analysis. Conclusion FBS was able to identify the presence of carotid plaque in asymptomatic individuals. Its use for initial risk delineation might improve the selection of patients for more specific and complex assessment, reducing cost and time.
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Affiliation(s)
| | - Melinda J. Carrington
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Torrens University Australia, Melbourne, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Jocasta Ball
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Torrens University Australia, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Thomas H. Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Torrens University Australia, Melbourne, Australia
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8
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Yiallourou SR, Magliano D, Haregu TN, Carrington MJ, Rolnik DL, Rombauts L, Rodrigues A, Ball J, Bruinsma FJ, Da Silva Costa F. Long term all-cause and cardiovascular disease mortality among women who undergo fertility treatment. Med J Aust 2022; 217:532-537. [PMID: 36209740 PMCID: PMC9827840 DOI: 10.5694/mja2.51734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To compare age-adjusted all-cause and CVD mortality, relative to the general female population, for women registered for fertility treatment who received it and those who did not. DESIGN Prospective cohort study; analysis of Monash IVF clinical registries data, 1975-2018, linked with National Death Index mortality data. PARTICIPANTS All women who registered for fertility treatment at Monash IVF (Melbourne, Victoria), 1 January 1975 - 1 January 2014, followed until 31 December 2018. MAIN OUTCOME MEASURES Standardised mortality ratios (SMRs) for all-cause and CVD mortality, for women who did or did not undergo fertility treatment; SMRs stratified by area-level socio-economic disadvantage (SEIFA Index of Relative Socioeconomic Disadvantage [IRSD]) and (for women who underwent treatment), by stimulated cycle number and mean oocytes/cycle categories. RESULTS Of 44 149 women registered for fertility treatment, 33 520 underwent treatment (66.4%), 10 629 did not. After adjustment for age, both all-cause (SMR, 0.58; 95% CI, 0.54-0.62) and CVD mortality (SMR, 0.41; 95% CI, 0.32-0.53) were lower than for the general female population. All-cause mortality was similar for women registered with Monash IVF who did (SMR, 0.55; 95% CI, 0.50-0.60) or did not undergo fertility treatment (SMR, 0.63; 95% CI, 0.56-0.70). The SMR was lowest for both treated and untreated women in the fifth IRSD quintile (least disadvantage), but the difference was statistically significant only for untreated women. CVD mortality was lower for registered women who underwent fertility treatment (SMR, 0.29; 95% CI, 0.19-0.43) than for those who did not (SMR, 0.58; 95% CI, 0.42-0.81). CONCLUSION Fertility treatment does not increase long term all-cause or CVD mortality risk. Lower mortality among women registered for fertility treatment probably reflected their lower socio-economic disadvantage.
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Affiliation(s)
- Stephanie R Yiallourou
- Baker Heart and Diabetes InstituteMelbourneVIC,The Turner Institute for Brain and Mental HealthMonash UniversityMelbourneVIC
| | - Dianna Magliano
- Baker Heart and Diabetes InstituteMelbourneVIC,Monash UniversityMelbourneVIC
| | - Tilahun N Haregu
- Baker Heart and Diabetes InstituteMelbourneVIC,Nossal Institute for Global Healththe University of MelbourneMelbourneVIC
| | | | | | - Luk Rombauts
- Monash HealthMelbourneVIC,Monash IVFMelbourneVIC
| | - Andre Rodrigues
- The Parent–Infant Research Institute, Austin HealthMelbourneVIC
| | | | - Fiona J Bruinsma
- Cancer Council VictoriaMelbourneVIC,Centre for Epidemiology and Biostatisticsthe University of MelbourneVIC
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9
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Zisis G, Yang Y, Huynh Q, Whitmore K, Lay M, Wright L, Carrington MJ, Marwick TH. Nurse-Provided Lung and Inferior Vena Cava Assessment in Patients With Heart Failure. J Am Coll Cardiol 2022; 80:513-523. [PMID: 35902175 DOI: 10.1016/j.jacc.2022.04.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/01/2022] [Accepted: 04/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Residual congestion detected using handheld ultrasound may be associated with increased risk of readmission and death after hospitalization for acute decompensated heart failure (ADHF). However, effective application necessitates routine use by nonexperts delivering clinical care. OBJECTIVES The objective of this study was to determine the ability of heart failure (HF) nurses to deliver a predischarge lung and inferior vena cava (IVC) assessment (LUICA) to predict 90-day outcomes. METHODS In this multisite, prospective, observational study, HF nurses scanned 240 patients with ADHF (median age: 77 years; 56% men) using a 9-zone LUICA protocol. Obtained images were reviewed by independent nurses who were blinded to clinical characteristics and outcomes. Based on a B-line cut-off of 10, patients were dichotomized as congested (n = 115) or not congested (n = 125). RESULTS Congested patients were more likely to have previous cardiac operations, long-standing HF (>6 months), and renal impairment. At 90 days, HF readmission or mortality occurred in 42 congested patients (37%) compared with 18 noncongested patients (14%). Pulmonary congestion increased at 30-day (OR: 3.86; 95% CI: 1.65-8.99; P < 0.01) and 90-day (OR: 3.42; 95% CI: 1.82-6.4; P < 0.01) HF readmission or mortality risk and 90-day mortality (OR: 5.18; 95% CI: 1.44-18.69; P < 0.01). Pulmonary congestion increased the 90-day odds of HF readmission and/or death by 3.3- to 4.2-fold (P < 0.01), independent of demographics, HF characteristics, comorbidities, and event risk score. Over 90 days, days alive out of hospital were fewer (78.3 ± 21.4 days vs 85.5 ± 12.4 days; P < 0.01) in congested patients. CONCLUSIONS LUICA can be a powerful tool for detection of predischarge residual congestion. HF nurses can obtain images and provide diagnostic reports that are predictive of ADHF outcomes.
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Affiliation(s)
- Georgios Zisis
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; The University of Melbourne, Baker Department of Cardiometabolic Health, Melbourne, Victoria, Australia; Western Health, Melbourne, Victoria, Australia; The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Yang Yang
- Western Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Eastern Health, Melbourne, Victoria, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; The University of Melbourne, Baker Department of Cardiometabolic Health, Melbourne, Victoria, Australia
| | - Kristyn Whitmore
- Menzies Institute for Medical Research, Hobart, Tasmania, Australia
| | - Maria Lay
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Leah Wright
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Western Health, Melbourne, Victoria, Australia
| | - Melinda J Carrington
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; The University of Melbourne, Baker Department of Cardiometabolic Health, Melbourne, Victoria, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; The University of Melbourne, Baker Department of Cardiometabolic Health, Melbourne, Victoria, Australia; Western Health, Melbourne, Victoria, Australia; The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Menzies Institute for Medical Research, Hobart, Tasmania, Australia.
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10
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Verma KP, Inouye M, Meikle PJ, Nicholls SJ, Carrington MJ, Marwick TH. New Cardiovascular Risk Assessment Techniques for Primary Prevention: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 80:373-387. [PMID: 35863853 DOI: 10.1016/j.jacc.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 10/17/2022]
Abstract
Risk factor-based models fail to accurately estimate risk in select populations, in particular younger individuals. A sizable number of people are also classified as being at intermediate risk, for whom the optimal preventive strategy could be more precise. Several personalized risk prediction tools, including coronary artery calcium scoring, polygenic risk scores, and metabolic risk scores may be able to improve risk assessment, pending supportive outcome data from clinical trials. Other tools may well emerge in the near future. A multidimensional approach to risk prediction holds the promise of precise risk prediction. This could allow for targeted prevention minimizing unnecessary costs and risks while maximizing benefits. High-risk individuals could also be identified early in life, creating opportunities to arrest the development of nascent coronary atherosclerosis and prevent future clinical events.
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Affiliation(s)
- Kunal P Verma
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Baker Department of Cardio-Metabolic Health, University of Melbourne, Melbourne, Victoria, Australia; Monash Heart, Melbourne, Victoria, Australia
| | - Michael Inouye
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Peter J Meikle
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, Victoria, Australia
| | - Stephen J Nicholls
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Monash Heart, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | | | - Thomas H Marwick
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Baker Department of Cardio-Metabolic Health, University of Melbourne, Melbourne, Victoria, Australia; Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia.
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11
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Verma KP, Marwick TH, Duarte C, Meikle P, Inouye M, Carrington MJ. Use of coronary computed tomography or polygenic risk scores to prompt action to reduce coronary artery disease risk: the CAPAR-CAD trial. Am Heart J 2022; 248:97-107. [PMID: 35218726 DOI: 10.1016/j.ahj.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/27/2022] [Accepted: 02/19/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The traditional primary prevention paradigm for coronary artery disease (CAD) centers on population-based algorithms to classify individual risk. However, this approach often misclassifies individuals and leaves many in the 'intermediate' category, for whom there is no clear preferred prevention strategy. Coronary artery calcium (CAC) and polygenic risk scoring (PRS) are 2 contemporary tools for risk prediction to enhance the impact of effective management. AIMS To determine how these CAC and PRS impact adherence to pharmacotherapy and lifestyle measures in asymptomatic individuals with subclinical atherosclerosis. METHODS The CAPAR-CAD study is a multicenter, open, randomized controlled trial in Victoria, Australia. Participants are self-selected individuals aged 40 to 70 years with no prior history of cardiovascular disease (CVD), intermediate 10-year risk for CAD as determined by the pooled cohort equation (PCE), and CAC scores >0. All participants will have a health assessment, a full CT coronary angiogram (CTCA), and PRS calculation. They will then be randomized to receive their risk presented either as PCE and CAC, or PCE and PRS. The intervention includes e-Health coaching focused on risk factor management, health education and pharmacotherapy, and follow-up to augment adherence to a statin medication. The primary endpoint is a change in low-density lipoprotein cholesterol (LDL-C) from baseline to 12 months. The secondary endpoint is between-group differences in behavior modification and adherence to statin pharmacotherapy. RESULTS As of July 31, 2021, we have screened 1,903 individuals. We present the results of the 574 participants deemed eligible after baseline assessment.
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12
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Sewell J, Hussain SM, Wang Y, Wluka AE, Lim YZ, Carrington MJ, Samaras K, Cicuttini FM. Association between arthritis and cardiovascular risk factors in community-based adults: an opportunity to target cardiovascular risk. BMC Cardiovasc Disord 2022; 22:232. [PMID: 35590252 PMCID: PMC9118727 DOI: 10.1186/s12872-022-02674-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 05/13/2022] [Indexed: 11/12/2022] Open
Abstract
Background Undertreated risk factors are major contributors to the burden of cardiovascular disease (CVD). Those with arthritis have an increased prevalence of CVD risk factors. CVD risk factors are often asymptomatic, which may be a barrier their treatment. Arthritis causes pain and immobility, and is a common reason for individuals to seek healthcare. Our aims were to (1) examine the relationship between arthritis and CVD risk factors in Australian adults, and (2) calculate the proportion of CVD risk factors that could be reduced if individuals with arthritis were targeted.
Methods This cross-sectional study uses data from the 2017–18 Australian National Health Survey which included 13,776 participants, categorised into young (18–39 years), middle aged (40–64 years) and older (≥ 65 years) adults. Hypertension, height and weight were measured. Arthritis, dyslipidemia and diabetes were self-reported. The associations between arthritis and CVD risk factors were examined using logistic regression, and the population attributable fraction (PAF) of arthritis for each CVD risk factor was calculated. Results Arthritis was reported by 4.0% of young adults, 28.8% of middle-aged adults and 54.5% of older adults. Those with arthritis were at increased odds of obesity (2.07 fold in young, 1.75 fold in middle-aged and 1.89 fold in older adults), increased odds of diabetes (5.70 fold in young, 1.64 fold in middle-aged and 1.37 fold in older adults), increased odds of hypertension (2.72 fold in young, 1.78 fold in middle-aged and 1.48 fold in older adults) and an increased odds of dyslipidaemia (4.64 fold in young, 2.14 fold in middle-aged and 1.22 fold in older adults) compared to those without arthritis. This elevated chance remained significant even after adjusting for obesity, with the exception of diabetes in the older population. This elevated chance remained significant even after adjusting for obesity, with the exception of diabetes in the older population. The PAF of the presence of arthritis for having at least one CVD risk factor was 30.7% in middle-aged adults and 70.4% in older adults. Conclusion Australian adults of all ages with arthritis are at increased odds of having CVD risk factors. For young and middle-aged adults, this increased odds remains significant even when adjusted for obesity. Presentation to healthcare practitioners with arthritis is an opportunity to screen for asymptomatic CVD risk factors with the potential of improving outcomes for both diseases. By adopting an approach of managing arthritis and CVD risk factors in parallel, rather than in silos, we could reduce the burden of CVD risk factors by 20–30%.
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Affiliation(s)
- Julia Sewell
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Sultana Monira Hussain
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Yuanyuan Wang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Anita E Wluka
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Yuan Z Lim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Melinda J Carrington
- Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Katherine Samaras
- Clinical Obesity, Nutrition and Adipose Biology Laboratory, Healthy Ageing, Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2010, Australia.,Department of Endocrinology, St Vincent's Hospital, Victoria St, Darlinghurst, NSW, 2010, Australia.,St Vincent's Clinnical School, University of New South Wales Sydney, Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
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13
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Zisis G, Carrington MJ, Oldenburg B, Whitmore K, Lay M, Huynh Q, Neil C, Ball J, Marwick TH. An m-Health intervention to improve education, self-management, and outcomes in patients admitted for acute decompensated heart failure: barriers to effective implementation. Eur Heart J Digit Health 2021; 2:649-657. [PMID: 36713108 PMCID: PMC9707948 DOI: 10.1093/ehjdh/ztab085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/30/2021] [Indexed: 02/01/2023]
Abstract
Aims Effective and efficient education and patient engagement are fundamental to improve health outcomes in heart failure (HF). The use of artificial intelligence (AI) to enable more effective delivery of education is becoming more widespread for a range of chronic conditions. We sought to determine whether an avatar-based HF-app could improve outcomes by enhancing HF knowledge and improving patient quality of life and self-care behaviour. Methods and results In a randomized controlled trial of patients admitted for acute decompensated HF (ADHF), patients at high risk (≥33%) for 30-day hospital readmission and/or death were randomized to usual care or training with the HF-app. From August 2019 up until December 2020, 200 patients admitted to the hospital for ADHF were enrolled in the Risk-HF study. Of the 72 at high-risk, 36 (25 men; median age 81.5 years; 9.5 years of education; 15 in NYHA Class III at discharge) were randomized into the intervention arm and were offered education involving an HF-app. Whilst 26 (72%) could not use the HF-app, younger patients [odds ratio (OR) 0.89, 95% confidence interval (CI) 0.82-0.97; P < 0.01] and those with a higher education level (OR 1.58, 95% CI 1.09-2.28; P = 0.03) were more likely to enrol. Of those enrolled, only 2 of 10 patients engaged and completed ≥70% of the program, and 6 of the remaining 8 who did not engage were readmitted. Conclusions Although AI-based education is promising in chronic conditions, our study provides a note of caution about the barriers to enrolment in critically ill, post-acute, and elderly patients.
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Affiliation(s)
- Georgios Zisis
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia,Faculty of Medicine, Nursing and Health Science, University of Melbourne, Melbourne, VIC, Australia,Department of Cardiology, Western Health, Melbourne, VIC, Australia
| | - Melinda J Carrington
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brian Oldenburg
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia,School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Kristyn Whitmore
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Maria Lay
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia
| | - Christopher Neil
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Faculty of Medicine, Nursing and Health Science, University of Melbourne, Melbourne, VIC, Australia,Department of Cardiology, Western Health, Melbourne, VIC, Australia
| | - Jocasta Ball
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia,Faculty of Medicine, Nursing and Health Science, University of Melbourne, Melbourne, VIC, Australia,Department of Cardiology, Western Health, Melbourne, VIC, Australia,School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia,Menzies Institute for Medical Research, University of Tasmania, Australia,Corresponding author. Tel: +61 3 8532 1550. Trial registration: Australia New Zealand Clinical Trials Registry (ACTRN): ACTRN12618001273279
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14
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Azcui Aparicio RE, Carrington MJ, Ball J, Abhayaratna W, Stewart S, Haluska B, Marwick TH. Association of traditional risk factors with carotid intima-media thickness and carotid plaque in asymptomatic individuals with a family history of premature cardiovascular disease. Int J Cardiovasc Imaging 2021; 38:10.1007/s10554-021-02459-x. [PMID: 34731395 DOI: 10.1007/s10554-021-02459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
The use of imaging to detect subclinical atherosclerosis helps to inform decision-making in people classified as having intermediate risk for cardiovascular disease (CVD). This study sought to use carotid plaque as an alternative to carotid intima media thickness (cIMT). Carotid ultrasound for assessment of cIMT and plaque was obtained in 1031 people (53 years, 61% female) with a family history of atherosclerotic CVD. The association of baseline characteristics and standard atherosclerotic risk factors (RFs) were sought with abnormal cIMT and plaque. The strongest association of plaque was a history of hypertension (odds ratio [OR] 1.87 (1.02-3.42), followed by age (OR 1.08 [95% CI 1.02-1.13]). For cIMT, the strongest association was smoking history (OR 1.57 [1.13-2.19]). The area under the receiver operator curve for the presence of plaque was 0.74 (95% CI 0.68-0.81, p < 0.001) and 0.65 (95% CI 0.61-0.70, p < 0.001) for cIMT elevation. Isolated elevation of cIMT (n = 178) was associated with increased total cholesterol, body mass index (BMI) and systolic blood pressure (SBP). Plaque only (n = 29) was associated with hypertension, male sex and older age. The presence of both markers abnormal (n = 22) was associated with a history of smoking. The absence of either abnormal cIMT or plaque (n = 773), was inversely associated with current or past smoking, SBP and BMI. Abnormalities in carotid vessels are present in a minority of intermediate risk patients with familial premature disease. The associations with RFs differ and are more closely associated with plaque.
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Affiliation(s)
- Roberto Enrique Azcui Aparicio
- Baker Heart and Diabetes Institute, P.O. Box 6492, Melbourne, VIC, 3004, Australia
- Torrens University Australia, Adelaide, Australia
| | - Melinda J Carrington
- Baker Heart and Diabetes Institute, P.O. Box 6492, Melbourne, VIC, 3004, Australia
- Torrens University Australia, Adelaide, Australia
| | - Jocasta Ball
- Torrens University Australia, Adelaide, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Brian Haluska
- Department of Medicine, University of Queensland, Brisbane, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, P.O. Box 6492, Melbourne, VIC, 3004, Australia.
- Torrens University Australia, Adelaide, Australia.
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15
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Beale AL, O'Donnell JA, Nakai ME, Nanayakkara S, Vizi D, Carter K, Dean E, Ribeiro RV, Yiallourou S, Carrington MJ, Marques FZ, Kaye DM. The Gut Microbiome of Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2021; 10:e020654. [PMID: 34212778 PMCID: PMC8403331 DOI: 10.1161/jaha.120.020654] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Risk factors for heart failure with preserved ejection fraction (HFpEF) include hypertension, age, sex, and obesity. Emerging evidence suggests that the gut microbiota independently contributes to each one of these risk factors, potentially mediated via gut microbial‐derived metabolites such as short‐chain fatty acids. In this study, we determined whether the gut microbiota were associated with HFpEF and its risk factors. Methods and Results We recruited 26 patients with HFpEF and 67 control participants from 2 independent communities. Patients with HFpEF were diagnosed by exercise right heart catheterization. We assessed the gut microbiome by bacterial 16S rRNA sequencing and food intake by the food frequency questionnaire. There was a significant difference in α‐diversity (eg, number of microbes) and β‐diversity (eg, type and abundance of microbes) between both cohorts of controls and patients with HFpEF (P=0.001). We did not find an association between β‐diversity and specific demographic or hemodynamic parameters or risk factors for HFpEF. The Firmicutes to Bacteroidetes ratio, a commonly used marker of gut dysbiosis, was lower, but not significantly so (P=0.093), in the patients with HFpEF. Compared with controls, the gut microbiome of patients with HFpEF was depleted of bacteria that are short‐chain fatty acid producers. Consistent with this, participants with HFpEF consumed less dietary fiber (17.6±7.7 versus 23.2±8.8 g/day; P=0.016). Conclusions We demonstrate key changes in the gut microbiota in patients with HFpEF, including the depletion of bacteria that generate metabolites known to be important for cardiovascular homeostasis. Further studies are required to validate the role of these gut microbiota and metabolites in the pathophysiology of HFpEF.
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Affiliation(s)
- Anna L Beale
- Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,Department of Cardiology Alfred Hospital Melbourne Australia.,Faculty of Medicine Nursing and Health Sciences Monash University Melbourne Australia
| | - Joanne A O'Donnell
- Hypertension Research Laboratory, School of Biological Sciences, Faculty of Science Monash University Melbourne Australia
| | - Michael E Nakai
- Hypertension Research Laboratory, School of Biological Sciences, Faculty of Science Monash University Melbourne Australia
| | - Shane Nanayakkara
- Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,Department of Cardiology Alfred Hospital Melbourne Australia
| | - Donna Vizi
- Department of Cardiology Alfred Hospital Melbourne Australia
| | - Kaye Carter
- Department of Cardiology Alfred Hospital Melbourne Australia
| | - Eliza Dean
- Department of Cardiology Alfred Hospital Melbourne Australia
| | - Rosilene V Ribeiro
- School of Life and Environmental Sciences, Charles Perkins Centre University of Sydney Australia
| | - Stephanie Yiallourou
- Pre-Clinical Disease and Prevention Baker Heart and Diabetes Institute Melbourne Australia
| | - Melinda J Carrington
- Pre-Clinical Disease and Prevention Baker Heart and Diabetes Institute Melbourne Australia
| | - Francine Z Marques
- Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,Hypertension Research Laboratory, School of Biological Sciences, Faculty of Science Monash University Melbourne Australia
| | - David M Kaye
- Heart Failure Research Group Baker Heart and Diabetes Institute Melbourne Australia.,Department of Cardiology Alfred Hospital Melbourne Australia.,Faculty of Medicine Nursing and Health Sciences Monash University Melbourne Australia
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16
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Yiallourou SR, Carrington MJ. Improved sleep efficiency is associated with reduced cardio-metabolic risk: Findings from the MODERN trial. J Sleep Res 2021; 30:e13389. [PMID: 34080247 DOI: 10.1111/jsr.13389] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/08/2021] [Accepted: 04/27/2021] [Indexed: 11/27/2022]
Abstract
Poor sleep increases cardio-metabolic risk, but limited information on the impact of sleep for the improvement of cardio-metabolic health exists. This analysis examined the impact of sleep on a health and lifestyle modification programme to reduce cardio-metabolic disease risk factors. Secondary analysis of the MODERN randomised controlled trial to reduce cardio-metabolic risk was undertaken at baseline and 24-month follow-up. Participants aged 40-70 years (n = 121) with three or more cardio-metabolic risk factors were randomised to a health and lifestyle modification intervention (n = 59) or usual care (n = 62), and underwent 7 day/night actigraphy to assess total sleep time, sleep efficiency (%), number of awakenings/night and physical activity levels. Blood pressure, blood lipid and glycaemic levels, anthropometric and diet measures were collected. The mean age was 59 ± 7 years and 37% were male. Baseline sleep measures were not different between groups. At the 24-month follow-up, both groups showed improvements in cardio-metabolic risk factors, albeit the change in blood pressure was greater in the intervention compared with the usual care group (systolic blood pressure: -11 versus -4 mmHg, p = .014). There were no differences between groups for diet, physical activity or sleep parameters. An increase in sleep efficiency was independently associated with lower systolic blood pressure (β = -2.117, p = .002) and higher high-density lipoprotein levels (β = 0.040, p = .033); an increase in total sleep time was associated with lower low-density lipoprotein levels (β = -0.003, p = .038) at 24 months. Overall, improvement in sleep quality over time was beneficial to reduce blood pressure and lipid levels. These findings highlight sleep as a potential target to reduce cardio-metabolic risk.
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Affiliation(s)
- Stephanie R Yiallourou
- Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Melinda J Carrington
- Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
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17
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Carrington MJ, Zimmet PZ. Nurse co-ordinated health and lifestyle modification for reducing multiple cardio-metabolic risk factors in regional adults: outcomes from the MODERN randomized controlled trial. Eur J Cardiovasc Nurs 2021; 21:26-35. [PMID: 33899090 DOI: 10.1093/eurjcn/zvab042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/16/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Nurse-led health and lifestyle modification programmes can prevent cardio-metabolic diseases and be advantageous where health disparities exist. AIMS To assess the effectiveness of a nurse-driven health and lifestyle modification programme in improving cardio-metabolic risk parameters for higher-risk regional residing adults. METHODS We conducted an open, parallel-group randomized controlled trial in two sites. Participants were aged 40-70 years with no prior cardiovascular disease who had any three or more of; central obesity, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure (BP) and dysglycaemia. Intervention participants received individual face-to-face and telephone coaching for improving cardio-metabolic risk. Control group participants received standard care and general information about risk factor management. The primary endpoint was the percentage of participants who achieved the target risk factor thresholds or clinically significant minimum changes for any three or more cardio-metabolic risk factors during 24 months of follow-up. RESULTS Participant average age was 57.6 (SD 7.6) years, 61% were female and 71% were employed. The primary endpoint was achieved by 76% intervention (97 of 127) and 71% usual care (92 of 129) participants [adjusted risk ratio (RR): 1.08; 95% CI 0.94, 1.24; P = 0.298]. Improved BP in the intervention group was more likely than in the control group (84% vs. 65%) (adj. RR: 1.28; 95% CI 1.11, 1.48; P = 0.001) but no other cardio-metabolic component. CONCLUSION Nurse intervention to modify cardio-metabolic risk parameters had no enhanced effectiveness compared with usual care. However, participation was associated with improvements in cardio-metabolic abnormalities, with particular emphasis on BP. TRIAL REGISTRATION Registered with the Australian New Zealand Clinical Trial Registry (ACTRN12616000229471).
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Affiliation(s)
- Melinda J Carrington
- Pre-Clinical Disease and Prevention Unit, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne VIC 3004, Australia
| | - Paul Z Zimmet
- Department of Diabetes, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne VIC 3004, Australia
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Zisis G, Huynh Q, Yang Y, Neil C, Carrington MJ, Ball J, Maguire G, Marwick TH. Rationale and design of a risk-guided strategy for reducing readmissions for acute decompensated heart failure: the Risk-HF study. ESC Heart Fail 2020; 7:3151-3160. [PMID: 32696559 PMCID: PMC7524087 DOI: 10.1002/ehf2.12897] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS Heart failure (HF) readmission commonly arises owing to insufficient patient knowledge and failure of recognition of the early stages of recurrent fluid congestion. In previous work, we developed a score to predict short-term hospital readmission and showed that higher-risk patients benefit most from a disease management programme (DMP) that included enhancing knowledge and education by a nurse. We aim to evaluate the effectiveness of a novel, nurse-led HF DMP in selected patients at high risk of short-term hospital readmission, using ultrasound-guided diuretic management and artificial intelligence to enhance HF knowledge in an outpatient setting. METHODS AND RESULTS Risk-HF is a prospective multisite randomized controlled trial that will allocate 404 patients hospitalized with acute decompensated HF, and ≥33% risk of readmission and/or death at 30 days, into risk-guided nurse intervention (DMP-Plus group) compared with usual care. Intervention elements include (i) fluid management with a handheld ultrasound (HHU) device at point of care; (ii) post-discharge follow-up; (iii) optimal programmed drug titration; (iv) better transition of care; (v) intensive self-care education via an avatar-based 'digital health coach'; and (vi) exercise guidance through the digital coach. Usual care involves standard post-discharge hospital care. The primary outcome is reduced death and/or hospital readmissions at 30 days post-discharge, and secondary outcomes include quality of life, fluid management efficacy, and feasibility and patient engagement. Assuming that our intervention will reduce readmissions and/or deaths by 50%, with a 1:1 ratio of intervention vs. usual care, we plan to randomize 404 patients to show a difference at a statistical power of 80%, using a two-sided alpha of 0.05. We anticipate this recruitment will be achieved by screening 2020 hospitalized HF patients for eligibility. An 8 week pilot programme of our digital health coach in 21 HF patients, age > 75 years, showed overall improvements in quality of life (13 of 21), self-care (12 of 21), and HF knowledge (13 of 21). A pilot of the use of HHU by nurses showed that it was feasible and accurate. CONCLUSIONS The Risk-HF trial will evaluate the effectiveness of a risk-guided intervention to improve HF outcomes and will evaluate the efficacy of trained HF nurses delivering a fluid management protocol that is guided by lung ultrasound with an HHU at point of care.
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Affiliation(s)
- Georgios Zisis
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Vic., 3004, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Vic., Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Vic., Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Vic., 3004, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Vic., Australia
| | - Yang Yang
- Faculty of Medicine, University of Melbourne, Melbourne, Vic., Australia.,Western Health, Melbourne, Vic., Australia.,Monash University, Melbourne, Vic., Australia.,Eastern Health, Melbourne, Vic., Australia
| | - Christopher Neil
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Vic., 3004, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Vic., Australia.,Western Health, Melbourne, Vic., Australia
| | - Melinda J Carrington
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Vic., 3004, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Vic., Australia
| | - Jocasta Ball
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Vic., 3004, Australia.,Monash University, Melbourne, Vic., Australia.,Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Vic., Australia
| | - Graeme Maguire
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Vic., 3004, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Vic., Australia.,Western Health, Melbourne, Vic., Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Vic., 3004, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Vic., Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Vic., Australia.,Western Health, Melbourne, Vic., Australia
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Yiallourou SR, Maguire GP, Carrington MJ. Sleep quantity and quality and cardiometabolic risk factors in Indigenous Australians. J Sleep Res 2020; 30:e13067. [PMID: 32526810 DOI: 10.1111/jsr.13067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 01/11/2023]
Abstract
Poor sleep is associated with increased risk of cardiovascular disease (CVD). Indigenous Australians have 1.3 times higher risk of CVD compared to non-indigenous Australians. However, there are limited data describing sleep problems and cardiometabolic risk in this population. This study aimed to investigate sleep quantity and quality in indigenous Australians and assess its association with cardiometabolic risk. Two hundred and forty-five indigenous Australians aged > 18 years were recruited via convenience sampling from communities in the Northern Territory and Queensland. Sleep quantity and quality was assessed subjectively with questionnaires including the Epworth Sleepiness Scale. In a sub-population (n = 46), objective sleep assessment was performed over three nights of actigraphy. Cardiometabolic risk measures included glycated haemoglobin, lipids, anthropometric measurements and sitting blood pressure. Sleep duration measured subjectively and objectively averaged 7.5 ± 2.0 hr/night; however, over one-third of participants (self-report 35%; actigraphy 39%) obtained < 7 hr/night. Overall, more than a third of participants experienced poor-quality sleep, with 27% reporting severe daytime sleepiness (ESS score > 10) and a high number of objectively measured awakenings/night (6 ± 4). Short sleep duration (<6 hr/night) measured both subjectively and objectively was an independent predictor of diastolic (β = 5.37, p = .038) and systolic blood pressure (β = 14.30, p = .048). More objectively measured night-time awakenings were associated with increased glycated haemoglobin levels (β = 0.07, p = .020) and greater sleep fragmentation was associated with lower high-density lipoprotein levels (β = -0.01, p = .025). A large proportion of indigenous Australians experienced short sleep durations and had significant sleep disruption. Poor sleep quantity and quality may contribute to heightened cardiometabolic risk in this population.
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Affiliation(s)
| | - Graeme P Maguire
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,General Internal Medicine, Western Health, Melbourne, Victoria, Australia
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Yiallourou SR, Maguire GP, Eades S, Hamilton GS, Quach J, Carrington MJ. Sleep influences on cardio-metabolic health in Indigenous populations. Sleep Med 2019; 59:78-87. [DOI: 10.1016/j.sleep.2018.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/26/2018] [Accepted: 10/17/2018] [Indexed: 12/27/2022]
Affiliation(s)
- S R Yiallourou
- Baker Heart and Diabetes Institute, Melbourne, Australia.
| | - G P Maguire
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - S Eades
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - G S Hamilton
- Department of Lung and Sleep Medicine at Monash Health, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - J Quach
- Policy, Equity and Translation, Murdoch Children's Research Institute Melbourne, Graduate School of Education, The University of Melbourne, Australia
| | - M J Carrington
- Baker Heart and Diabetes Institute, Melbourne, Australia
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Sacre JW, Wong C, Chan YK, Carrington MJ, Stewart S, Kingwell BA. Left Ventricular Dysfunction and Exercise Capacity Trajectory. JACC Cardiovasc Imaging 2019; 12:798-806. [DOI: 10.1016/j.jcmg.2017.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 10/06/2017] [Accepted: 10/12/2017] [Indexed: 01/23/2023]
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Sacre JW, Ball J, Wong C, Chan YK, Stewart S, Kingwell BA, Carrington MJ. Mild cognitive impairment is associated with subclinical diastolic dysfunction in patients with chronic heart disease. Eur Heart J Cardiovasc Imaging 2019; 19:285-292. [PMID: 28954294 DOI: 10.1093/ehjci/jex169] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/23/2017] [Indexed: 11/12/2022] Open
Abstract
Background To examine mild cognitive impairment and its associations with subclinical cardiac dysfunction in patients with chronic heart disease yet to develop the clinical syndrome of chronic heart failure (CHF). Methods and results Patients from the Nurse-led Intervention for Less Chronic Heart Failure Study (n = 373 with chronic heart disease other than CHF; 64 ± 11 years, 69% men) were screened for mild cognitive impairment [Montreal cognitive assessment (MoCA) score <26] and underwent echocardiographic/clinical profiling. We investigated associations of mild cognitive impairment and MoCA cognitive domain subscores with global cardiac status ('normal' vs. 'diastolic dysfunction' vs. 'other cardiac abnormality') and individual echocardiographic parameters. Patients with mild cognitive impairment (n = 161; 43%) demonstrated a higher age-adjusted prevalence of diastolic dysfunction (37% vs. 24%; P < 0.05). Multivariate logistic regression (adjusted for age, sex, and other relevant clinical factors) indicated that the odds of mild cognitive impairment were two-times higher with diastolic dysfunction (P = 0.030) and 1.7-times higher with 'other cardiac abnormalities' (P = 0.082) vs. normal cardiac status. In turn, mild cognitive impairment was predicted by left-ventricular (LV) filling pressure (based on the ratio of early diastolic filling and annular velocities; adjusted odds ratio 1.07 per unit increase, P = 0.022), but not LV structural parameters. Specific deficits in the cognitive domains of executive functioning and visuo-constructional abilities were also independently predicted by diastolic dysfunction (P < 0.05). Conclusion Mild cognitive impairment is prevalent in patients with subclinical chronic heart disease at high-risk of CHF. Independent associations with LV diastolic dysfunction suggest a link between cardiac and cognitive functioning beyond shared risk factors.
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Affiliation(s)
- Julian W Sacre
- Metabolic and Vascular Physiology Laboratory, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Jocasta Ball
- Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Chiew Wong
- Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Grattan St, Parkville, Victoria 3010, Australia
| | - Yih-Kai Chan
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring St, Melbourne, Victoria 3000, Australia
| | - Simon Stewart
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring St, Melbourne, Victoria 3000, Australia
| | - Bronwyn A Kingwell
- Metabolic and Vascular Physiology Laboratory, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Melinda J Carrington
- Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring St, Melbourne, Victoria 3000, Australia
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Scuffham PA, Ball J, Horowitz JD, Wong C, Newton PJ, Macdonald P, McVeigh J, Rischbieth A, Emanuele N, Carrington MJ, Reid CM, Chan YK, Stewart S. Standard vs. intensified management of heart failure to reduce healthcare costs: results of a multicentre, randomized controlled trial. Eur Heart J 2018; 38:2340-2348. [PMID: 28531281 PMCID: PMC5843128 DOI: 10.1093/eurheartj/ehx259] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/27/2017] [Indexed: 12/28/2022] Open
Abstract
Aims To determine if an intensified form of heart failure management programme (INT-HF-MP) based on individual profiling is superior to standard management (SM) in reducing health care costs during 12-month follow-up (primary endpoint). Methods and results A multicentre randomized trial involving 787 patients (full analysis set) discharged from four tertiary hospitals with chronic HF who were randomized to SM (n = 391) or INT-HF-MP (n = 396). Mean age was 74 ± 12 years, 65% had HF with a reduced ejection fraction (31.4 ± 8.9%) and 14% were remote-dwelling. Study groups were well matched. According to Green, Amber, Red Delineation of rIsk And Need in HF (GARDIAN-HF) profiling, regardless of location, patients in the INT-HF-MP received a combination of face-to-face (home visits) and structured telephone support (STS); only 9% (`low risk') were designated to receive the same level of management as the SM group. The median cost in 2017 Australian dollars (A$1 equivalent to ∼EUR €0.7) of applying INT-HF-MP was significantly greater than SM ($152 vs. $121 per patient per month; P < 0.001), However, at 12 months, there was no difference in total health care costs for the INT-HF-MP vs. SM group (median $1579, IQR $644 to $3717 vs. $1450, IQR $564 to $3615 per patient per month, respectively). This reflected minimal differences in all-cause mortality (17.7% vs. 18.4%; P = 0.848) and recurrent hospital stay (18.6 ± 26.5 vs. 16.6 ± 24.8 days; P = 0.199) between the INT-HF-MP and SM groups, respectively. Conclusion During 12-months follow-up, an INT-HF-MP did not reduce healthcare costs or improve health outcomes relative to SM.
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Affiliation(s)
- P A Scuffham
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, N78_2.42 The Circuit, Nathan, Queensland 4111, Australia
| | - J Ball
- Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - J D Horowitz
- Department of Cardiology, Queen Elizabeth Hospital, University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia
| | - C Wong
- Department of Cardiology, Western Health (Footscray Hospital), Melbourne Medical School, The University of Melbourne, Grattan St, Parkville, Victoria 3010, Australia
| | - P J Newton
- Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, 235 Jones St, Ultimo, New South Wales 2007, Australia
| | - P Macdonald
- Heart Failure and Transplant Unit, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW 2010, Australia
| | - J McVeigh
- Department of Cardiology, Prince of Wales Hospital, Barker St, Randwick, NSW 2031, Australia
| | - A Rischbieth
- National Heart Foundation of Australia, 500 Collins St Melbourne, Victoria 3000, Australia.,Faculty of Health Sciences, University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia
| | - N Emanuele
- National Heart Foundation of Australia, 500 Collins St Melbourne, Victoria 3000, Australia
| | - M J Carrington
- Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia.,Mary MacKillop Institute for Health Research, NHMRC of Australia Centre of Research Excellence to Reduce Inequality in Heart Disease, Australian Catholic University, Level 5, 215 Spring St, Melbourne, Victoria 3000, Australia
| | - C M Reid
- NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement, Curtin University, Kent St, Bentley, Western Australia 6102, Australia
| | - Y K Chan
- Mary MacKillop Institute for Health Research, NHMRC of Australia Centre of Research Excellence to Reduce Inequality in Heart Disease, Australian Catholic University, Level 5, 215 Spring St, Melbourne, Victoria 3000, Australia
| | - S Stewart
- Mary MacKillop Institute for Health Research, NHMRC of Australia Centre of Research Excellence to Reduce Inequality in Heart Disease, Australian Catholic University, Level 5, 215 Spring St, Melbourne, Victoria 3000, Australia
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Ball J, Løchen ML, Carrington MJ, Wiley JF, Stewart S. Impact of body mass index on mortality and hospitalisation of patients with atrial fibrillation. Eur J Cardiovasc Nurs 2018; 17:627-636. [PMID: 29664325 DOI: 10.1177/1474515118772446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Atrial fibrillation represents a substantial clinical and public health issue. The definitive impact of body mass index on prognosis of patients with chronic (persistent or permanent) atrial fibrillation remains undetermined. AIM The purpose of this study was to investigate the association of body mass index with health outcomes (mortality and re-hospitalisation) of patients with chronic atrial fibrillation. METHODS Using data from the Standard versus Atrial Fibrillation spEcific managemenT strategY (SAFETY) trial (a randomised controlled trial of home-based, atrial fibrillation-specific disease management), we performed post-hoc analyses of mortality and re-hospitalisation outcomes during minimum 24-month follow-up according to baseline body mass index profile. RESULTS Of 297 participants (mean age 71±11 years, 47% female, mean body mass index 29.6±6.7 kg/m2), 35.0% of participants were overweight (body mass index 25.0-29.9 kg/m2) and 43.1% were obese (body mass index≥30 kg/m2). During follow-up, n=42 died including 16/65 (24.6%) classified as normal body mass index, 16/104 (15.4%) classified as overweight and 10/128 (7.8%) classified as obese. Increasing body mass index was not associated with increased mortality but was associated with re-hospitalisation due to cardiovascular disease with greater length-of-stay (odds ratio 1.05; 95% confidence interval 1.00-1.09, p=0.032). Obese individuals experienced increased unplanned admissions compared to overweight individuals (incidence rate ratio 0.71; 95% confidence interval 0.53-0.96, p=0.028), and increased cardiovascular-related (incidence rate ratio 0.58; 95% confidence interval 0.39-0.86, p=0.007) and all-cause admissions (incidence rate ratio 0.63; 95% confidence interval 0.45-0.89, p=0.008) compared to those classified as normal body mass index. CONCLUSION Overweight and obesity were not associated with survival in patients with chronic atrial fibrillation but were associated with more frequent hospital care and prolonged stay.
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Affiliation(s)
- Jocasta Ball
- 1 Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, Australia.,2 School of Public Health and Preventive Medicine, Monash University, Australia
| | - Maja-Lisa Løchen
- 1 Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, Australia.,3 Department of Community Medicine, UiT The Arctic University of Norway, Norway.,4 Mary MacKillop Institute for Health Research, Australian Catholic University, Australia
| | - Melinda J Carrington
- 1 Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, Australia.,2 School of Public Health and Preventive Medicine, Monash University, Australia.,4 Mary MacKillop Institute for Health Research, Australian Catholic University, Australia
| | - Joshua F Wiley
- 5 School of Psychological Sciences, Monash University, Australia
| | - Simon Stewart
- 4 Mary MacKillop Institute for Health Research, Australian Catholic University, Australia
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Ball J, Løchen ML, Carrington MJ, Wiley JF, Stewart S. Mild cognitive impairment impacts health outcomes of patients with atrial fibrillation undergoing a disease management intervention. Open Heart 2018. [PMID: 29531768 PMCID: PMC5845397 DOI: 10.1136/openhrt-2017-000755] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective Mild cognitive impairment (MCI) is prevalent in atrial fibrillation (AF) and has the potential to contribute to poor outcomes. We investigated the influence of MCI on survival and rehospitalisation in patients with chronic forms of AF undergoing a home-based, AF-specific disease management intervention (home-based intervention (HBI)) or standard management (SM). Methods The Montreal Cognitive Assessment tool was administered at baseline (a score of <26/30 indicated MCI) in patients with AF randomised to HBI versus SM. Post hoc analyses of mortality and rehospitalisations during a minimum 24-month follow-up were conducted in the overall cohort and in each study group separately. Results Of 260 patients (mean age 72±11, 47% female), 65% demonstrated MCI on screening (34% in SM; 31% in HBI). Overall, the number of days spent alive and out-of-hospital during follow-up (P=0.012) and all-cause rehospitalisation were influenced by MCI during follow-up (OR 3.16 (95% CI 1.46 to 6.84)) but MCI did not influence any outcomes in the SM group. However, survival was negatively influenced by MCI in the HBI group (P=0.036); those with MCI in this group were 5.6 times more likely to die during follow-up (OR 5.57 (95% CI 1.10 to 28.1)). Those with MCI in the HBI group also spent less days alive and out-of-hospital than those with no MCI (P=0.022). MCI was also identified as a significant independent correlate of shortest duration of event-free survival (OR 3.48 (95% CI 1.06 to 11.4)), all-cause rehospitalisation (OR 3.30 (95% CI 1.25 to 8.69)) and cardiovascular disease (CVD)-related rehospitalisation (OR 2.35 (95% CI 1.12 to 4.91)) in this group. Conclusions The effectiveness of home-based, disease management for patients with chronic forms of AF is negatively affected by comorbid MCI. The benefit of adjunctive support for patients with MCI on CVD-related health outcomes requires further investigation.
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Affiliation(s)
- Jocasta Ball
- Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Maja-Lisa Løchen
- Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Melinda J Carrington
- Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Joshua F Wiley
- School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Simon Stewart
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
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Carrington MJ, Zimmet P. Nurse health and lifestyle modification versus standard care in 40 to 70 year old regional adults: study protocol of the Management to Optimise Diabetes and mEtabolic syndrome Risk reduction via Nurse-led intervention (MODERN) randomized controlled trial. BMC Health Serv Res 2017; 17:813. [PMID: 29212477 PMCID: PMC5719565 DOI: 10.1186/s12913-017-2769-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/27/2017] [Indexed: 11/10/2022] Open
Abstract
Background Metabolic syndrome (MetS), the clustering of multiple leading risk factors, predisposes individuals to increased risk for developing type 2 diabetes and/or cardiovascular disease (CVD). Cardio-metabolic disease risk increases with greater remoteness where specialist services are scarce. Nurse-led interventions are effective for the management of chronic disease. The aim of this clinical trial is to determine whether a nurse-implemented health and lifestyle modification program is more beneficial than standard care to reduce cardio-metabolic abnormalities and future risk of CVD and diabetes in individuals with MetS. Methods MODERN is a multi-centre, open, parallel group randomized controlled trial in regional Victoria, Australia. Participants were self-selected and individuals aged 40 to 70 years with MetS who had no evidence of CVD or other chronic disease were recruited. Those attending a screening visit with any 3 or more risk factors of central obesity, dyslipidemia (high triglycerides or low high density lipoprotein cholesterol) elevated blood pressure and dysglycemia were randomized to either nurse-led health and lifestyle modification (intervention) or standard care (control). The intervention included risk factor management, health education, care planning and scheduled follow-up commensurate with level of risk. The primary cardio-metabolic end-point was achievement of risk factor thresholds to eliminate MetS or minimal clinically meaningful changes for at least 3 risk factors that characterise MetS over 2 year follow-up. Pre-specified secondary endpoints to evaluate between group variations in cardio-metabolic risk, general health and lifestyle behaviours and new onset CVD and type 2 diabetes will be evaluated. Key outcomes will be measured at baseline, 12 and 24 months via questionnaires, physical examinations, pathology and other diagnostic tests. Health economic analyses will be undertaken to establish the cost-effectiveness of the intervention. Discussion The MODERN trial will provide evidence for the potential benefit of independent nurse-run clinics in the community and their cost-effectiveness in adults with MetS. Findings will enable more nurse-led clinics to be adopted outside of major cities and encompassing other chronic diseases as a key primary preventative initiative. Trial registration MODERN is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000229471) on 19 February 2016 (retrospectively registered). Secondary identifiers: MODERN is an investigator-initiated trial funded by the National Health and Medical Research Council of Australia from 2014 to 2017 via a Project Grant (ID No. APP1069043) and was approved by the Australian Catholic University Human Research Ethics Committee (Project No: 2014 244 V) and the Department of Health Human Research Ethics Committee (Project No:38/2014) for the release of Medicare claims information.
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Affiliation(s)
- Melinda J Carrington
- Pre-Clinical Disease and Prevention Unit, Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, Victoria, 3004, Australia. .,Centre for Primary Care and Prevention, MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
| | - Paul Zimmet
- Department of Diabetes, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Maru S, Byrnes J, Carrington MJ, Chan YK, Stewart S, Scuffham PA. Economic evaluation of a nurse-led home and clinic-based secondary prevention programme to prevent progressive cardiac dysfunction in high-risk individuals: The Nurse-led Intervention for Less Chronic Heart Failure (NIL-CHF) randomized controlled study. Eur J Cardiovasc Nurs 2017; 17:439-445. [PMID: 29166769 DOI: 10.1177/1474515117743979] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to assess the cost-effectiveness of a long-term, nurse-led, multidisciplinary programme of home/clinic visits in preventing progressive cardiac dysfunction in patients at risk of developing de novo chronic heart failure (CHF). METHODS A trial-based analysis was conducted alongside a pragmatic, single-centre, open-label, randomized controlled trial of 611 patients (mean age: 66 years) with subclinical cardiovascular diseases (without CHF) discharged to home from an Australian tertiary referral hospital. A nurse-led home and clinic-based programme (NIL-CHF intervention, n = 301) was compared with standard care ( n=310) in terms of life-years, quality-adjusted life-years (QALYs) and healthcare costs. The uncertainty around the incremental cost and QALYs was quantified by bootstrap simulations and displayed on a cost-effectiveness plane. RESULTS During a median follow-up of 4.2 years, there were no significant between-group differences in life-years (-0.056, p=0.488) and QALYs (-0.072, p=0.399), which were lower in the NIL-CHF group. The NIL-CHF group had slightly lower all-cause hospitalization costs (AUD$2943 per person; p=0.219), cardiovascular-related hospitalization costs (AUD$1142; p=0.592) and a more pronounced reduction in emergency/unplanned hospitalization costs (AUD$4194 per person; p=0.024). When the cost of intervention was added to all-cause, cardiovascular and emergency-related readmissions, the reductions in the NIL-CHF group were AUD$2742 ( p=0.313), AUD$941 ( p=0.719) and AUD$3993 ( p=0.046), respectively. At a willingness-to-pay threshold of AUD$50,000/QALY, the probability of the NIL-CHF intervention being better-valued was 19%. CONCLUSIONS Compared with standard care, the NIL-CHF intervention was not a cost-effective strategy as life-years and QALYs were slightly lower in the NIL-CHF group. However, it was associated with modest reductions in emergency/unplanned readmission costs.
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Affiliation(s)
- Shoko Maru
- 1 Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
| | - Joshua Byrnes
- 1 Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
| | - Melinda J Carrington
- 2 Centre for Primary Care and Prevention, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.,4 Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Yih-Kai Chan
- 2 Centre for Primary Care and Prevention, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Simon Stewart
- 3 Centre for Research Excellence to Reduce Inequality in Heart Disease, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Paul A Scuffham
- 1 Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
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Rémond MGW, Stewart S, Carrington MJ, Marwick TH, Kingwell BA, Meikle P, O'Brien D, Marshall NS, Maguire GP. Better Indigenous Risk stratification for Cardiac Health study (BIRCH) protocol: rationale and design of a cross-sectional and prospective cohort study to identify novel cardiovascular risk indicators in Aboriginal Australian and Torres Strait Islander adults. BMC Cardiovasc Disord 2017; 17:228. [PMID: 28835227 PMCID: PMC5569545 DOI: 10.1186/s12872-017-0662-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/16/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Of the estimated 10-11 year life expectancy gap between Indigenous (Aboriginal and Torres Strait Islander people) and non-Indigenous Australians, approximately one quarter is attributable to cardiovascular disease (CVD). Risk prediction of CVD is imperfect, but particularly limited for Indigenous Australians. The BIRCH (Better Indigenous Risk stratification for Cardiac Health) project aims to identify and assess existing and novel markers of early disease and risk in Indigenous Australians to optimise health outcomes in this disadvantaged population. It further aims to determine whether these markers are relevant in non-Indigenous Australians. METHODS/DESIGN BIRCH is a cross-sectional and prospective cohort study of Indigenous and non-Indigenous Australian adults (≥ 18 years) living in remote, regional and urban locations. Participants will be assessed for CVD risk factors, left ventricular mass and strain via echocardiography, sleep disordered breathing and quality via home-based polysomnography or actigraphy respectively, and plasma lipidomic profiles via mass spectrometry. Outcome data will comprise CVD events and death over a period of five years. DISCUSSION Results of BIRCH may increase understanding regarding the factors underlying the increased burden of CVD in Indigenous Australians in this setting. Further, it may identify novel markers of early disease and risk to inform the development of more accurate prediction equations. Better identification of at-risk individuals will promote more effective primary and secondary preventive initiatives to reduce Indigenous Australian health disadvantage.
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Affiliation(s)
- Marc G W Rémond
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC, 3004, Australia.
| | - Simon Stewart
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Melinda J Carrington
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC, 3004, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC, 3004, Australia
| | - Bronwyn A Kingwell
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC, 3004, Australia
| | - Peter Meikle
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC, 3004, Australia
| | - Darren O'Brien
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Nathaniel S Marshall
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.,Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia
| | - Graeme P Maguire
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC, 3004, Australia
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Carrington MJ, Cohen N, Wiley JF. Blood glucose levels and glycaemic burden in 76,341 patients attending primary care: Bittersweet findings from a 9-year cohort study. Diabetes Res Clin Pract 2017; 127:89-96. [PMID: 28324867 DOI: 10.1016/j.diabres.2017.02.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/14/2017] [Accepted: 02/22/2017] [Indexed: 01/20/2023]
Abstract
AIMS Diabetes care is principally applied in the primary care setting whereby we examined trends in glycaemic levels and goals and estimated avoidable glycaemic burden. METHODS We retrieved glycated haemoglobin (HbA1C) results and glucose-lowering prescription records from a patient-based medical database during 2005-2013. There were 275,480 available HbA1C measurements from 76,341 individuals managed by 960 general practitioners from 321 clinics across Australia. Change in mean levels and glycaemic control over time were assessed according to sex, age and glucose-lowering therapy. The time that HbA1C levels exceeded 7% (53mmol/mol) in untreated (n=4888), non-insulin (n=11,534) and insulin treated (n=4049) patients was calculated as area under the curve (AUC) and months above threshold. RESULTS Average age of patients was 62.1±15.1years (47.1% women). HbA1C levels decreased from 7.1% (54mmol/mol) in 2005 to 6.6% (49mmol/mol) in 2013 and the proportion of patients who achieved a HbA1C target of <7% improved by 16% in men (53-69%) and 21% in women (55-76%). HbA1C levels decreased with advancing age in men and increased with insulin treatment; correspondingly, HbA1C goal attainment increased and decreased, respectively. Avoidable glycaemic burden was 9.3±17.7months in untreated, 16.2±25.2months in non-insulin, and 26.8±34.6months in insulin-treated patients. CONCLUSIONS Amid considerable improvements, many treated patients still do not attain HbA1C levels ≤7% and time spent above this threshold was delayed. Earlier and more vigorously intensified management may reduce lengthy periods of uncontrolled hyperglycaemia in primary care.
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Affiliation(s)
- Melinda J Carrington
- Centre for Primary Care and Prevention, MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring St, Melbourne, VIC 3000, Australia; Baker IDI Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 8008, Australia.
| | - Neale Cohen
- Baker IDI Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 8008, Australia.
| | - Joshua F Wiley
- Centre for Primary Care and Prevention, MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring St, Melbourne, VIC 3000, Australia; Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Wellington Rd, Clayton, VIC 3800, Australia.
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Abstract
BACKGROUND The cost-effectiveness of a heart failure management intervention can be further informed by incorporating the expected benefits and costs of future survival. METHODS This study compared the long-term costs per quality-adjusted life year (QALY) gained from home-based (HBI) vs specialist clinic-based intervention (CBI) among elderly patients (mean age = 71 years) with heart failure discharged home (mean intervention duration = 12 months). Cost-utility analysis was conducted from a government-funded health system perspective. A Markov cohort model was used to simulate disease progression over 15 years based on initial data from a randomized clinical trial (the WHICH? study). Time-dependent hazard functions were modeled using the Weibull function, and this was compared against an alternative model where the hazard was assumed to be constant over time. Deterministic and probabilistic sensitivity analyses were conducted to identify the key drivers of cost-effectiveness and quantify uncertainty in the results. RESULTS During the trial, mortality was the highest within 30 days of discharge and decreased thereafter in both groups, although the declining rate of mortality was slower in CBI than HBI. At 15 years (extrapolated), HBI was associated with slightly better health outcomes (mean of 0.59 QALYs gained) and mean additional costs of AU$13,876 per patient. The incremental cost-utility ratio and the incremental net monetary benefit (vs CBI) were AU$23,352 per QALY gained and AU$15,835, respectively. The uncertainty was driven by variability in the costs and probabilities of readmissions. Probabilistic sensitivity analysis showed HBI had a 68% probability of being cost-effective at a willingness-to-pay threshold of AU$50,000 per QALY. CONCLUSION Compared with CBI (outpatient specialized HF clinic-based intervention), HBI (home-based predominantly, but not exclusively) could potentially be cost-effective over the long-term in elderly patients with heart failure at a willingness-to-pay threshold of AU$50,000/QALY, albeit with large uncertainty.
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Affiliation(s)
- Shoko Maru
- a Centre for Applied Health Economics, School of Medicine and Population & Social Health Research, Menzies Health Institute Queensland, Griffith University , Nathan , QLD , Australia
| | - Joshua M Byrnes
- a Centre for Applied Health Economics, School of Medicine and Population & Social Health Research, Menzies Health Institute Queensland, Griffith University , Nathan , QLD , Australia
| | - Melinda J Carrington
- b Centre for Primary Care and Prevention, Mary MacKillop Institute for Health Research, Australian Catholic University , Melbourne , Victoria , Australia
| | - Simon Stewart
- c Centre for Research Excellence to Reduce Inequality in Heart Disease, Mary MacKillop Institute for Health Research, Australian Catholic University , Melbourne Victoria , Australia
| | - Paul A Scuffham
- a Centre for Applied Health Economics, School of Medicine and Population & Social Health Research, Menzies Health Institute Queensland, Griffith University , Nathan , QLD , Australia
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Kularatna S, Byrnes J, Chan YK, Carrington MJ, Stewart S, Scuffham PA. Comparison of contemporaneous responses for EQ-5D-3L and Minnesota Living with Heart Failure; a case for disease specific multiattribute utility instrument in cardiovascular conditions. Int J Cardiol 2016; 227:172-176. [PMID: 27865116 DOI: 10.1016/j.ijcard.2016.11.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 11/03/2016] [Accepted: 11/05/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The EQ-5D-3L, a generic multi-attribute utility instrument (MAUI), is widely employed to assist in economic evaluations in health care. The EQ-5D-3L lacks sensitivity when used in conditions such as cardiovascular disease (CVD). Although there are number of CVD specific quality of life instruments, currently, there are no CVD specific MAUIs. The aim of this study is to investigate the discriminative ability and responsiveness of the EQ-5D-3L and the Minnesota Living with Heart Failure Questionnaire (MLHF), a CVD specific quality of life instrument in a group of heart failure patients. METHODS The psychometric performance of the EQ-5D-3L and the MLHF was assessed using data from a randomised trial for a heart failure management intervention. The two instruments were compared for discrimination, responsiveness and agreement. The severity groups were defined using New York Heart Association functional classes. RESULTS The effect sizes for severe classes were generally similar showing good discrimination. The MLHF recorded better responsiveness between the time points than the EQ-5D-3L which was indicated by higher effect sizes and standardised response means. The change in MLHF summary scores between the time points was significant (p<0.005; paired t-test). The overall agreement between the two measures was low. CONCLUSION The low correlation indicates that the two classification systems cover different aspects of health space. Comparison of CVD specific instruments with other generic MAUIs such as EQ-5D-3L and AQOL-8D is recommended for further research.
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Affiliation(s)
- Sanjeewa Kularatna
- Centre for Applied Health Economics, School of Medicine, Griffith University, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Centre for Research Excellence to Reduce Inequality in Heart Disease, Australia.
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Centre for Research Excellence to Reduce Inequality in Heart Disease, Australia
| | - Yih Kai Chan
- Centre for Research Excellence to Reduce Inequality in Heart Disease, Australia; Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Melinda J Carrington
- Centre for Research Excellence to Reduce Inequality in Heart Disease, Australia; Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Simon Stewart
- Centre for Research Excellence to Reduce Inequality in Heart Disease, Australia; Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Paul A Scuffham
- Centre for Applied Health Economics, School of Medicine, Griffith University, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia
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Carrington MJ, Jennings GL, Harris M, Nelson M, Schlaich M, Stocks NP, Burrell LM, Amerena J, de Looze FJ, Swemmer CH, Kurstjens NP, Stewart S. Impact of nurse-mediated management on achieving blood pressure goal levels in primary care: Insights from the Valsartan Intensified Primary carE Reduction of Blood Pressure Study. Eur J Cardiovasc Nurs 2016; 15:409-16. [DOI: 10.1177/1474515115591901] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 05/28/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Melinda J Carrington
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Mark Nelson
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | - Markus Schlaich
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, The University of Western Australia, Australia
| | - Nigel P Stocks
- Discipline of General Practice, University of Adelaide, Australia
| | - Louise M Burrell
- Departments of Medicine and Cardiology, The University of Melbourne, Austin Health, Australia
| | - John Amerena
- Geelong Cardiology Research Department, Deakin University, Australia
| | | | | | | | - Simon Stewart
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Wiley JF, Carrington MJ. A metabolic syndrome severity score: A tool to quantify cardio-metabolic risk factors. Prev Med 2016; 88:189-95. [PMID: 27095322 DOI: 10.1016/j.ypmed.2016.04.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 04/01/2016] [Accepted: 04/12/2016] [Indexed: 11/30/2022]
Abstract
Metabolic syndrome is a cluster of cardio-metabolic risk factors and is associated with increased mortality. There is no standard, validated way to assess the severity of aggregated metabolic syndrome risk factors. Cardiovascular and diabetes risk factor data came from two studies conducted in Australia from 2006 to 2010 in adults aged 18 or above. In medication free adults, sex-specific clinical thresholds and Principal Component Analysis were used to develop a formula to calculate a metabolic syndrome severity score (MetSSS). These scores were compared to scores derived using the same process in subgroups by sex, age, medication status, and time. We also examined the MetSSS in relation to other known risk factors. In 2125 adults (57.6±14.7years of age), the MetSSS ranged from 0 to 8.7 with a mean of 2.6. There were strong correlations (.95-.99) between the MetSSS in medication free adults and the MetSSS calculated from subgroups. MetSSS predicted medication initiation for hypertension, hyperlipidemia and hyperglycemia over six months (OR=1.31, 95% CI [1.00-1.70], per MetSSS unit, p=.043). Lower education, medication prescription, history of smoking and age were associated with higher MetSSS (all p<.05). Higher physical but not mental health quality of life was associated with lower MetSSS (p<.001). A standardized formula to measure cardio-metabolic risk factor severity was constructed and demonstrated expected relations with known risk factors. The use of the MetSSS is recommended as a measure of change within individuals in cardio-metabolic risk factors and to guide treatment and management.
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Affiliation(s)
- Joshua F Wiley
- Centre for Primary Care and Prevention, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Melinda J Carrington
- Centre for Primary Care and Prevention, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
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Rodrigues AL, Ball J, Ski C, Stewart S, Carrington MJ. A systematic review and meta-analysis of primary prevention programmes to improve cardio-metabolic risk in non-urban communities. Prev Med 2016; 87:22-34. [PMID: 26876624 DOI: 10.1016/j.ypmed.2016.02.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Although cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) prevention programmes have been effective in urban residents, their effectiveness in non-urban settings, where cardio-metabolic risk is typically elevated, is unknown. We systematically reviewed the effectiveness of primary prevention programmes aimed at reducing risk factors for CVD/T2DM, including blood pressure, body mass index (BMI), blood lipid and glucose, diet, lifestyle, and knowledge in adults residing in non-urban areas. METHODS Twenty-five manuscripts, globally, from 1990 were selected for review (seven included in the meta-analyses) and classified according to: 1) study design (randomised controlled trial [RCT] or pre-/post-intervention); 2) intervention duration (short [<12months] or long term [≥12months]), and; 3) programme type (community-based programmes or non-community-based programmes). RESULTS Multiple strategies within interventions focusing on health behaviour change effectively reduced cardio-metabolic risk in non-urban individuals. Pre-/post-test design studies showed more favourable improvements generally, while RCTs showed greater improvements in physical activity and disease and risk knowledge. Short-term programmes were more effective than long-term programmes and in pre-/post-test designs reduced systolic blood pressure by 4.02mmHg (95% CI -6.25 to -1.79) versus 3.63mmHg (95% CI -7.34 to 0.08) in long-term programmes. Community-based programmes achieved good results for most risk factors except BMI and (glycated haemoglobin) HbA1c. CONCLUSION The setting for applying cardio-metabolic prevention programmes is important given its likelihood to influence programme efficacy. Further investigation is needed to elucidate the individual determinants of cardio-metabolic risk in non-urban populations and in contrast to urban populations.
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Affiliation(s)
- Andre L Rodrigues
- Dept. of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Jocasta Ball
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Chantal Ski
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Simon Stewart
- Dept. of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
| | - Melinda J Carrington
- Dept. of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
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Kure CE, Chan YK, Ski CF, Thompson DR, Carrington MJ, Stewart S. Gender-specific secondary prevention? Differential psychosocial risk factors for major cardiovascular events. Open Heart 2016; 3:e000356. [PMID: 27099759 PMCID: PMC4836286 DOI: 10.1136/openhrt-2015-000356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/08/2016] [Accepted: 03/15/2016] [Indexed: 11/17/2022] Open
Abstract
Objective To explore the psychosocial determinants and interhospital variability on a major acute cardiovascular event (MACE), during follow-up of a multicenter cohort of patients hospitalised with heart disease, participating in a nurse-led secondary prevention programme. Methods Outcome data were retrospectively analysed from 602 cardiac inpatients randomised to postdischarge standard care (n=296), or home-based intervention (n=306), with prolonged follow-up of individualised multidisciplinary support. Baseline psychosocial profiling comprised depressive status, health-related quality of life (HRQoL), social isolation and mild cognitive impairment (MCI). Multivariate analyses examined the independent correlates of a composite 2-year MACE rate of all-cause mortality and unplanned cardiovascular-related hospitalisation, according to gender. Results Participants were aged 70±10 years, 431 (72%) were men and 377 (63%) had coronary artery disease. During 2-year follow-up, 165 (27%) participants (114 men, 51 women; p=0.431) experienced a MACE. Independent correlates of a MACE in men were depressive status (OR 1.95, 95% CI 1.06 to 3.58; p=0.032), low physical HRQoL (OR 0.98, 95% CI 0.96 to 1.00; p=0.027) and increasing comorbidity (OR 1.14, 95% CI 1.04 to 1.25; p=0.004). In women, age (OR 1.06, 95% CI 1.02 to 1.12; p=0.008), MCI (OR 2.38, 95% CI 1.09 to 5.18; p=0.029) and hospital site predicted a MACE (OR 2.32, 95% CI 1.09 to 4.93; p=0.029). Conclusions Psychological determinants, cognitive impairment and responses to secondary prevention are different for men and women with heart disease and appear to modulate cardiovascular-specific outcomes. Early detection of psychosocial factors through routine screening and gender-specific secondary prevention is encouraged. Trial registration number 12608000014358.
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Affiliation(s)
- Christina E Kure
- Mary MacKillop Institute for Health Research, Australian Catholic University , Melbourne, Victoria , Australia
| | - Yih-Kai Chan
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia; National Health and Medical Research Council of Australia Centre of Research Excellence to Reduce Inequality in Heart Disease, Melbourne, Victoria, Australia
| | - Chantal F Ski
- Mary MacKillop Institute for Health Research, Australian Catholic University , Melbourne, Victoria , Australia
| | - David R Thompson
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia; National Health and Medical Research Council of Australia Centre of Research Excellence to Reduce Inequality in Heart Disease, Melbourne, Victoria, Australia
| | - Melinda J Carrington
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia; National Health and Medical Research Council of Australia Centre of Research Excellence to Reduce Inequality in Heart Disease, Melbourne, Victoria, Australia
| | - Simon Stewart
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia; National Health and Medical Research Council of Australia Centre of Research Excellence to Reduce Inequality in Heart Disease, Melbourne, Victoria, Australia
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Stewart S, Wiley JF, Ball J, Chan YK, Ahamed Y, Thompson DR, Carrington MJ. Impact of Nurse-Led, Multidisciplinary Home-Based Intervention on Event-Free Survival Across the Spectrum of Chronic Heart Disease: Composite Analysis of Health Outcomes in 1226 Patients From 3 Randomized Trials. Circulation 2016; 133:1867-77. [PMID: 27083509 PMCID: PMC4857795 DOI: 10.1161/circulationaha.116.020730] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/11/2016] [Indexed: 12/19/2022]
Abstract
Background— We sought to determine the overall impact of a nurse-led, multidisciplinary home-based intervention (HBI) adapted to hospitalized patients with chronic forms of heart disease of varying types. Methods and Results— Prospectively planned, combined, secondary analysis of 3 randomized trials (1226 patients) of HBI were compared with standard management. Hospitalized patients presenting with heart disease but not heart failure, atrial fibrillation but not heart failure, and heart failure, as well, were recruited. Overall, 612 and 614 patients, respectively, were allocated to a home visit 7 to 14 days postdischarge by a cardiac nurse with follow-up and multidisciplinary support according to clinical need or standard management. The primary outcome of days-alive and out-of-hospital was examined on an intention-to-treat basis. During 1371 days (interquartile range, 1112–1605) of follow-up, 218 patients died and 17 917 days of hospital stay were recorded. In comparison with standard management, HBI patients achieved significantly prolonged event-free survival (90.1% [95% confidence interval, 88.2–92.0] versus 87.2% [95% confidence interval, 85.1–89.3] days-alive and out-of-hospital; P=0.020). This reflected less all-cause mortality (adjusted hazard ratio, 0.67; 95% confidence interval, 0.50–0.88; P=0.005) and unplanned hospital stay (median, 0.22 [interquartile range, 0–1.3] versus 0.36 [0–2.1] days/100 days follow-up; P=0.011). Analyses of the differential impact of HBI on all-cause mortality showed significant interactions (characterized by U-shaped relationships) with age (P=0.005) and comorbidity (P=0.041); HBI was most effective for those aged 60 to 82 years (59%–65% of individual trial cohorts) and with a Charlson Comorbidity Index Score of 5 to 8 (36%–61%). Conclusions— These data provide further support for the application of postdischarge HBI across the full spectrum of patients being hospitalized for chronic forms of heart disease. Clinical Trial Registration— URL: http://www.anzctr.org.au. Unique identifiers: 12610000221055, 12608000022369, 12607000069459.
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Affiliation(s)
- Simon Stewart
- From Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
| | - Joshua F Wiley
- From Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Jocasta Ball
- From Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Yih-Kai Chan
- From Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Yasmin Ahamed
- From Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - David R Thompson
- From Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Melinda J Carrington
- From Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
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Diouf I, Magliano DJ, Carrington MJ, Stewart S, Shaw JE. Prevalence, incidence, risk factors and treatment of atrial fibrillation in Australia: The Australian Diabetes, Obesity and Lifestyle (AusDiab) longitudinal, population cohort study. Int J Cardiol 2015; 205:127-132. [PMID: 26730844 DOI: 10.1016/j.ijcard.2015.12.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 11/26/2015] [Accepted: 12/12/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We sought to describe the prevalence, incidence, risk factors and treatment (according to stroke risk) of atrial fibrillation (AF) in the national, population-based Australian Diabetes, Obesity and Lifestyle (AusDiab) study cohort. METHODS ECG data were available from 8273/11,247 participants of AusDiab study in 1999/2000 and from 5422 participants in 2004/2005. Minnesota coding was used to identify prevalent and incident cases of AF. RESULTS 90 prevalent cases of AF (14.1 per 1000) comprising 56 men (mean age 70.5 ± 1.9 years) and 34 women (aged 78.3 ± 1.2 years) were identified in 1999-2000. AF prevalence was associated with sedentary behaviour versus physically active (PR 2.0, 95% CI 1.2-3.6). 53 incident cases of AF (2.0, 95%, CI 1.5-2.6 per 1000 person-year) were subsequently identified in 2004-2005. Increased risk of incident AF was associated with male sex, obesity, history of angina, myocardial infarction and stroke. Both increased weight gain and increased weight loss appeared to be associated with increased risks of developing AF in women, while no obvious association was observed in men. Despite their high risk for stroke, anti-thrombotic therapy was observed in only 39.3% of participants with CHA2DS2-VASC scores ≥ 2. CONCLUSIONS This study contributes to a better understanding of the AF burden. With the ageing population, coordinated efforts will be needed to anticipate the future health care costs related to AF and its impacts on the health care system. This will include appropriate application of anti-thrombotic therapy according to risk of thrombo-embolic events.
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Affiliation(s)
- Ibrahima Diouf
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.
| | - Dianna J Magliano
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Melinda J Carrington
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Simon Stewart
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Jonathan E Shaw
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
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Pretorius S, Stewart S, Carrington MJ, Lamont K, Sliwa K, Crowther NJ. Is There an Association between Sleeping Patterns and Other Environmental Factors with Obesity and Blood Pressure in an Urban African Population? PLoS One 2015; 10:e0131081. [PMID: 26448340 PMCID: PMC4598123 DOI: 10.1371/journal.pone.0131081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 05/28/2015] [Indexed: 12/02/2022] Open
Abstract
Beyond changing dietary patterns, there is a paucity of data to fully explain the high prevalence of obesity and hypertension in urban African populations. The aim of this study was to determine whether other environmental factors (including sleep duration, smoking and physical activity) are related to body anthropometry and blood pressure (BP). Data were collected on 1311 subjects, attending two primary health care clinics in Soweto, South Africa. Questionnaires were used to obtain data on education, employment, exercise, smoking and sleep duration. Anthropometric and BP measurements were taken. Subjects comprised 862 women (mean age 41 ± 16 years and mean BMI 29.9 ± 9.2 kg/m²) and 449 men (38 ± 14 years and 24.8 ± 8.3 kg/m²). In females, ANOVA showed that former smokers had a higher BMI (p<0.001) than current smokers, while exposure to second hand smoking was associated with a lower BMI (p<0.001) in both genders. Regression analyses demonstrated that longer sleep duration was associated with a lower BMI (p<0.05) in older females only, and not in males, whilst in males napping during the day for > 30 minutes was related to a lower BMI (β = -0.04, p<0.01) and waist circumference (β = -0.03, p<0.001). Within males, napping for >30 minutes/day was related to lower systolic (β = -0.02, p<0.05) and lower diastolic BP (β = -0.02, p = 0.05). Longer night time sleep duration was associated with higher diastolic (β = 0.005, p<0.01) and systolic BP (β = 0.003, p<0.05) in females. No health benefits were noted for physical activity. These data suggest that environmental factors rarely collected in African populations are related, in gender-specific ways, to body anthropometry and blood pressure. Further research is required to fully elucidate these associations and how they might be translated into public health programs to combat high levels of obesity and hypertension.
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Affiliation(s)
- Sandra Pretorius
- Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Preventative Cardiology/National Health and Medical Research Council of Australia Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Simon Stewart
- Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Preventative Cardiology/National Health and Medical Research Council of Australia Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Hatter Cardiovascular Research Institute, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Melinda J. Carrington
- Preventative Cardiology/National Health and Medical Research Council of Australia Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Hatter Cardiovascular Research Institute, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kim Lamont
- Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Preventative Cardiology/National Health and Medical Research Council of Australia Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Karen Sliwa
- Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Preventative Cardiology/National Health and Medical Research Council of Australia Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Hatter Cardiovascular Research Institute, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nigel J. Crowther
- Department of Chemical Pathology, National Health Laboratory Service, University of the Witwatersrand, Johannesburg, South Africa
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Tuttle CSL, Carrington MJ, Stewart S, Brown A. Overcoming the tyranny of distance: An analysis of outreach visits to optimise secondary prevention of cardiovascular disease in high-risk individuals living in Central Australia. Aust J Rural Health 2015; 24:99-105. [PMID: 27087389 DOI: 10.1111/ajr.12222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES We examined the logistical challenges of conducting an outreach, secondary prevention program for adults discharged from Alice Springs Hospital following an acute presentation of cardiovascular disease. DESIGN AND SETTING This represents a sub-study of the Central Australian Heart Protection Study (CAHPS). Clinical, logistic and demographic data were used to examine the characteristics of outreach visits in the intervention arm of the study. PARTICIPANTS Fifty subjects initially allocated to the intervention arm of the trial were studied. MAIN OUTCOME MEASURES Completion of scheduled, plus additional outreach visits according to the intervention protocol. RESULTS The majority of subjects presented with an acute coronary syndrome (44/50 (88%)) and 31 (62%) were of Indigenous ethnicity. However, Indigenous subjects being younger (53.1 ± 11.1 versus 58.0 ± 11.0 years non-Indigenous) had a more complex risk factor and co-morbid profile, with significantly more diabetes (77% versus 26% P < 0.001), hypertension (81% versus 53% P = 0.04) and renal failure (52% versus 21% P = 0.03). Community of origin of Indigenous subjects was 230 ± 208 km from the hospital versus 61 ± 150 km for non-Indigenous subjects (P = 0.004). Indigenous subjects missed a significantly higher number of scheduled visits at six months (1.39 ± 2.14 versus 0.16 ± 0.50 visits; P = 0.02). However, multivariate analyses suggested that distance did not influence successful completion of visits. CONCLUSIONS These early findings from CAHPS are invaluable to understanding and improving the feasibility of secondary prevention programs for Indigenous adults living with heart disease in remote communities.
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Affiliation(s)
- Camilla S L Tuttle
- Baker IDI Central Australia, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Melinda J Carrington
- Baker IDI Central Australia, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Simon Stewart
- Baker IDI Central Australia, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Alex Brown
- Baker IDI Central Australia, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Maru S, Byrnes J, Carrington MJ, Chan YK, Thompson DR, Stewart S, Scuffham PA. Cost-effectiveness of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort - The WHICH? study (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care). Int J Cardiol 2015; 201:368-75. [PMID: 26310979 DOI: 10.1016/j.ijcard.2015.08.066] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/02/2015] [Accepted: 08/03/2015] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the long-term cost-effectiveness of two multidisciplinary management programs for elderly patients hospitalized with chronic heart failure (CHF) and how it is influenced by patient characteristics. METHODS A trial-based analysis was conducted alongside a randomized controlled trial of 280 elderly patients with CHF discharged to home from three Australian tertiary hospitals. Two interventions were compared: home-based intervention (HBI) that involved home visiting with community-based care versus specialized clinic-based intervention (CBI). Bootstrapped incremental cost-utility ratios were computed based on quality-adjusted life-years (QALYs) and total healthcare costs. Cost-effectiveness acceptability curves were constructed based on incremental net monetary benefit (NMB). We performed multiple linear regression to explore which patient characteristics may impact patient-level NMB. RESULTS During median follow-up of 3.2 years, HBI was associated with slightly higher QALYs (+0.26 years per person; p=0.078) and lower total healthcare costs (AU$ -13,100 per person; p=0.025) mainly driven by significantly reduced duration of all-cause hospital stay (-10 days; p=0.006). At a willingness-to-pay threshold of AU$ 50,000 per additional QALY, the probability of HBI being better-valued was 96% and the incremental NMB of HBI was AU$ 24,342 (discounted, 5%). The variables associated with increased NMB were HBI (vs. CBI), lower Charlson Comorbidity Index, no hyponatremia, fewer months of HF, fewer prior HF admissions <1 year and a higher patient's self-care confidence. HBI's net benefit further increased in those with fewer comorbidities, a lower self-care confidence or no hyponatremia. CONCLUSIONS Compared with CBI, HBI is likely to be cost-effective in elderly CHF patients with significant comorbidity.
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Affiliation(s)
- Shoko Maru
- Centre for Applied Health Economics, School of Medicine, Population & Social Health Research, Menzies Health Institute Queensland, Griffith University, Australia.
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine, Population & Social Health Research, Menzies Health Institute Queensland, Griffith University, Australia
| | - Melinda J Carrington
- Centre for Primary Care and Prevention, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Yih-Kai Chan
- Centre for Primary Care and Prevention, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - David R Thompson
- Centre for Primary Care and Prevention, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Simon Stewart
- Centre for Research Excellence to Reduce Inequality in Heart Disease, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Paul A Scuffham
- Centre for Applied Health Economics, School of Medicine, Population & Social Health Research, Menzies Health Institute Queensland, Griffith University, Australia
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Maru S, Byrnes J, Carrington MJ, Stewart S, Scuffham PA. Economic implications of cardiovascular disease management programs: moving beyond one-off experiments. Expert Rev Pharmacoecon Outcomes Res 2015; 15:657-66. [DOI: 10.1586/14737167.2015.1046842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Watts GF, Shaw JE, Pang J, Magliano DJ, Jennings GL, Carrington MJ. Prevalence and treatment of familial hypercholesterolaemia in Australian communities. Int J Cardiol 2015; 185:69-71. [DOI: 10.1016/j.ijcard.2015.03.027] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/02/2015] [Indexed: 11/24/2022]
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Chang S, Davidson PM, Newton PJ, Macdonald P, Carrington MJ, Marwick TH, Horowitz JD, Krum H, Reid CM, Chan YK, Scuffham PA, Sibbritt D, Stewart S. Composite outcome measures in a pragmatic clinical trial of chronic heart failure management: A comparative assessment. Int J Cardiol 2015; 185:62-8. [PMID: 25791092 DOI: 10.1016/j.ijcard.2015.03.071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/03/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND A number of composite outcomes have been developed to capture the perspective of the patient, clinician and objective measures of health in assessing heart failure outcomes. To date there has been a limited examination in the composition of these outcomes. METHODS AND RESULTS Three commonly used scoring systems in heart failure trials: Packer's composite, Patient Journey and the African American Heart Failure Trial (A-HeFT) scores were compared in assessing outcomes from the Which heart failure intervention is most cost-effective & consumer friendly in reducing hospital care (WHICH(?)) Trial. Comparability and interpretability of these outcomes and the influence of each component to the final outcome were examined. Despite all three composite outcomes incorporating mortality, hospitalisation and quality of life (QoL), the contribution of each individual component to the final outcomes differed. The component with the most influence in deteriorating condition for the Packer's composite was hospitalisation (67.7%), while in Patient Journey it was QoL (61.5%) and for A-HeFT composite score it was mortality (45.4%). CONCLUSIONS The contribution made by each component varied in subtle, but important ways. This study emphasises the importance of understanding the value system of the composite outcomes to enable meaningful interpretation of results.
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Affiliation(s)
| | | | | | - Peter Macdonald
- St Vincent's Hospital and Victor Chang Cardiac Research Institute, Sydney, Australia
| | | | | | | | - Henry Krum
- Monash Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Australia
| | - Christopher M Reid
- Monash Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Australia
| | - Yih Kai Chan
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Paul A Scuffham
- Griffith Health Institute, Griffith University, Logan, Australia
| | | | - Simon Stewart
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Stewart S, Ball J, Horowitz JD, Marwick TH, Mahadevan G, Wong C, Abhayaratna WP, Chan YK, Esterman A, Thompson DR, Scuffham PA, Carrington MJ. Standard versus atrial fibrillation-specific management strategy (SAFETY) to reduce recurrent admission and prolong survival: pragmatic, multicentre, randomised controlled trial. Lancet 2015; 385:775-84. [PMID: 25467562 DOI: 10.1016/s0140-6736(14)61992-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Patients are increasingly being admitted with chronic atrial fibrillation, and disease-specific management might reduce recurrent admissions and prolong survival. However, evidence is scant to support the application of this therapeutic approach. We aimed to assess SAFETY--a management strategy that is specific to atrial fibrillation. METHODS We did a pragmatic, multicentre, randomised controlled trial in patients admitted with chronic, non-valvular atrial fibrillation (but not heart failure). Patients were recruited from three tertiary referral hospitals in Australia. 335 participants were randomly assigned by computer-generated schedule (stratified for rhythm or rate control) to either standard management (n=167) or the SAFETY intervention (n=168). Standard management consisted of routine primary care and hospital outpatient follow-up. The SAFETY intervention comprised a home visit and Holter monitoring 7-14 days after discharge by a cardiac nurse with prolonged follow-up and multidisciplinary support as needed. Clinical reviews were undertaken at 12 and 24 months (minimum follow-up). Coprimary outcomes were death or unplanned readmission (both all-cause), measured as event-free survival and the proportion of actual versus maximum days alive and out of hospital. Analyses were done on an intention-to-treat basis. The trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTRN 12610000221055). FINDINGS During median follow-up of 905 days (IQR 773-1050), 49 people died and 987 unplanned admissions were recorded (totalling 5530 days in hospital). 127 (76%) patients assigned to the SAFETY intervention died or had an unplanned readmission (median event-free survival 183 days [IQR 116-409]) and 137 (82%) people allocated standard management achieved a coprimary outcome (199 days [116-249]; hazard ratio 0·97, 95% CI 0·76-1·23; p=0·851). Patients assigned to the SAFETY intervention had 99·5% maximum event-free days (95% CI 99·3-99·7), equating to a median of 900 (IQR 767-1025) of 937 maximum days alive and out of hospital. By comparison, those allocated to standard management had 99·2% (95% CI 98·8-99·4) maximum event-free days, equating to a median of 860 (IQR 752-1047) of 937 maximum days alive and out of hospital (effect size 0·22, 95% CI 0·21-0·23; p=0·039). INTERPRETATION A post-discharge management programme specific to atrial fibrillation was associated with proportionately more days alive and out of hospital (but not prolonged event-free survival) relative to standard management. Disease-specific management is a possible strategy to improve poor health outcomes in patients admitted with chronic atrial fibrillation. FUNDING National Health and Medical Research Council of Australia.
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Affiliation(s)
- Simon Stewart
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.
| | - Jocasta Ball
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - John D Horowitz
- The Queen Elizabeth Hospital and University of Adelaide, Adelaide, SA, Australia
| | | | - Gnanadevan Mahadevan
- The Queen Elizabeth Hospital and University of Adelaide, Adelaide, SA, Australia
| | - Chiew Wong
- Department of Cardiology, Footscray Hospital, Melbourne, VIC, Australia
| | - Walter P Abhayaratna
- Division of Medicine, Canberra Hospital and Australian National University, Canberra, ACT, Australia
| | - Yih K Chan
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Adrian Esterman
- Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - David R Thompson
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Paul A Scuffham
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia
| | - Melinda J Carrington
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
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Ball J, Thompson DR, Ski CF, Carrington MJ, Gerber T, Stewart S. Estimating the current and future prevalence of atrial fibrillation in the Australian adult population. Med J Aust 2015; 202:32-5. [DOI: 10.5694/mja14.00238] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 09/03/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Jocasta Ball
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC
| | - David R Thompson
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC
| | - Chantal F Ski
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC
| | - Melinda J Carrington
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC
| | - Tracey Gerber
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC
| | - Simon Stewart
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC
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Maru S, Byrnes J, Carrington MJ, Stewart S, Scuffham PA. Systematic review of trial-based analyses reporting the economic impact of heart failure management programs compared with usual care. Eur J Cardiovasc Nurs 2014; 15:82-90. [PMID: 25322749 DOI: 10.1177/1474515114556031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/27/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND The cost-effectiveness of heart failure management programs (HF-MPs) is highly variable. We explored intervention and clinical characteristics likely to influence cost outcomes. METHODS A systematic review of economic analyses alongside randomized clinical trials comparing HF-MPs and usual care. Electronic databases were searched for English peer-reviewed articles published between 1990 and 2013. RESULTS Of 511 articles identified, 34 comprising 35 analyses met the inclusion criteria. Eighteen analyses (51%) reported a HF-MP as more effective and less costly; four analyses (11%), and five analyses (14%) also reported they were more effective but with no significant or an increased cost difference, respectively. Alternatively, five analyses (14%) reported no statistically significant difference in effects or costs, and one analysis (3%) reported no statistically significant effect difference but was less costly. Finally, two analyses (6%) reported no statistically significant effect difference but were more costly. Interventions that reduced hospital admissions tended to result in favorable cost outcomes, moderated by increased resource use, intervention cost and/or the durability of the intervention effect. The reporting quality of economic evaluation assessed by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist varied substantially between 5% and 91% (median 45%; 34 articles) of the checklist criteria adequately addressed. Overall, none of the study, patient or intervention characteristics appeared to independently influence the cost-effectiveness of a HF-MP. CONCLUSION The extent that HF-MPs reduce hospital readmissions appears to be associated with favorable cost outcomes. The current evidence does not provide a sufficient evidence base to explain what intervention or clinical attributes may influence the cost implications.
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Affiliation(s)
- Shoko Maru
- Centre for Applied Health Economics, Griffith University, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Australia
| | - Melinda J Carrington
- NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Australia
| | - Simon Stewart
- NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Australia
| | - Paul A Scuffham
- Centre for Applied Health Economics, Griffith University, Australia
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Lyons JG, Sliwa K, Carrington MJ, Raal F, Pretorius S, Thienemann F, Stewart S. Lower levels of high-density lipoprotein cholesterol in urban Africans presenting with communicable versus non-communicable forms of heart disease: the 'Heart of Soweto' hospital registry study. BMJ Open 2014; 4:e005069. [PMID: 25023131 PMCID: PMC4120399 DOI: 10.1136/bmjopen-2014-005069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To investigate if urban Africans displayed lower levels of atheroprotective high-density lipoprotein cholesterol (HDLC) when presenting with communicable versus non-communicable forms of heart disease (HD) as both acute infection and chronic inflammation reduce HDLC levels. DESIGN Hospital registry of 5328 de novo cases of HD over a 3-year period. SETTING Cardiology Unit, Baragwanath Hospital in Soweto, South Africa. PARTICIPANTS A total of 1199 patients of African descent (59% women; 57.0±13.4 years) had fasting blood lipid levels (total cholesterol (TC), triglyceride, HDLC and low-density lipoprotein cholesterol (LDLC)) documented on admission. Serum inflammatory marker C reactive protein (CRP) was measured in a subset of 367 patients (31% of cases). MAIN OUTCOME MEASURES Lipid profiles were compared according to prespecified classification of non-communicable (eg, hypertensive HD) versus communicable (eg, rheumatic HD) HD. Low HDLC was defined as <1.0 mmol/L for men and <1.2 mmol/L for women, according to applicable South African Clinical Guidelines. RESULTS Overall 694 (58%) of those presenting with HD had low HDLC levels; 344 of 678 (51%) and 350 of 521 (67%) for non-communicable and communicable, respectively (p<0.001). Comparatively, overall prevalence of high TC was 32% and high LDLC was 37%. On an adjusted basis, those with non-communicable HD were more likely to record a low HDLC relative to non-communicable presentations (odds ratio (OR) 1.91, 95% CI 1.42 to 2.57; p<0.001). There was a strong relationship between low HDLC and higher levels of CRP, but only in women. CONCLUSIONS Despite largely favourable lipid profiles, there are clear differences according to aetiology of underlying HD in urban Africans, with younger patients with communicable HD having particularly low levels of HDLC. Appropriate prospective evidence is needed to determine if persistent low levels of HDLC expose patients to increased, long-term risk of atherosclerotic forms of HD. The women-only inverse association between HDLC and CRP warrants further investigation.
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Affiliation(s)
- Jasmine G Lyons
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Cape Heart Group and IIDMM, University of Cape Town, Cape Town, South Africa
- Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Melinda J Carrington
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Frederick Raal
- Carbohydrate and Lipid Metabolism Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sandra Pretorius
- Hatter Institute for Cardiovascular Research in Africa, Cape Heart Group and IIDMM, University of Cape Town, Cape Town, South Africa
| | - Friedrich Thienemann
- Hatter Institute for Cardiovascular Research in Africa, Cape Heart Group and IIDMM, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town,South Africa
- Infectious Diseases Referral Clinic, GF Jooste Hospital, Manenberg, South Africa
| | - Simon Stewart
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Hatter Institute for Cardiovascular Research in Africa, Cape Heart Group and IIDMM, University of Cape Town, Cape Town, South Africa
- Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
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Carrington MJ, Stewart S. Cardiovascular disease prevention via a nurse-facilitated intervention clinic in a regional setting: The Protecting Healthy Hearts Program. Eur J Cardiovasc Nurs 2014; 14:352-61. [DOI: 10.1177/1474515114537022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/29/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Melinda J Carrington
- Centre for Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Australia
| | - Simon Stewart
- Centre for Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Australia
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Maru S, Byrnes J, Whitty JA, Carrington MJ, Stewart S, Scuffham PA. Systematic review of model-based analyses reporting the cost-effectiveness and cost-utility of cardiovascular disease management programs. Eur J Cardiovasc Nurs 2014; 14:26-33. [DOI: 10.1177/1474515114536093] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Shoko Maru
- Centre for Applied Health Economics, School of Medicine and Population & Social Health Research, Griffith Health Institute, Griffith University, Meadowbrook, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Population & Social Health Research, Griffith Health Institute, Griffith University, Meadowbrook, Australia
| | - Jennifer A Whitty
- Centre for Applied Health Economics, School of Medicine and Population & Social Health Research, Griffith Health Institute, Griffith University, Meadowbrook, Australia
| | - Melinda J Carrington
- NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Simon Stewart
- NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Paul A Scuffham
- Centre for Applied Health Economics, School of Medicine and Population & Social Health Research, Griffith Health Institute, Griffith University, Meadowbrook, Australia
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Head GA, Andrianopoulos N, McGrath BP, Martin CA, Carrington MJ, Lukoshkova EV, Davern PJ, Jennings GL, Reid CM. Predictors of mean arterial pressure morning rate of rise and power function in subjects undergoing ambulatory blood pressure recording. PLoS One 2014; 9:e93186. [PMID: 24667944 PMCID: PMC3965554 DOI: 10.1371/journal.pone.0093186] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 03/03/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND We determined clinical predictors of the rate of rise (RoR) in blood pressure in the morning as well as a novel measure of the power of the BP surge (BP(power)) derived from ambulatory blood pressure recordings. METHODS BP(power) and RoR were calculated from 409 ambulatory blood pressure (ABP) recordings from subjects attending a cardiovascular risk clinic. Anthropometric data, blood biochemistry, and history were recorded. The 409 subjects were 20-82 years old (average 57, SD = 13), 46% male, 9% with hypertension but not on medication and 34% on antihypertensive medication. RESULTS Average RoR was 11.1 mmHg/hour (SD = 8) and BP(power) was 273 mmHg(2)/hour (SD = 235). Only cholesterol, low density lipoprotein and body mass index (BMI) were associated with higher BP(power) and RoR (P<0.05) from 25 variables assessed. BP(power) was lower in those taking beta-blockers or diuretics. Multivariate analysis identified that only BMI was associated with RoR (4.2% increase/unit BMI, P = 0.020) while cholesterol was the only remaining associated variable with BP(power) (17.5% increase/mmol/L cholesterol, P = 0.047). A follow up of 213 subjects with repeated ABP after an average 1.8 years identified that baseline cholesterol was the only predictor for an increasing RoR and BP(power) (P<0.05). 37 patients who commenced statin subsequently had lower BP(power) whereas 90 age and weight matched controls had similar BP(power) on follow-up. CONCLUSIONS Cholesterol is an independent predictor of a greater and more rapid rise in morning BP as well as of further increases over several years. Reduction of cholesterol with statin therapy is very effective in reducing the morning blood pressure surge.
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Affiliation(s)
- Geoffrey A. Head
- Baker IDI Heart and Diabetes Institute, Melbourne and Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
- * E-mail:
| | - Nick Andrianopoulos
- NHMRC Centre for Clinical Research Excellence in Therapeutics, Monash University, Melbourne, Australia
| | - Barry P. McGrath
- Monash Health Dandenong Australia and Monash University, Melbourne, Australia
| | - Catherine A. Martin
- Monash Health Dandenong Australia and Monash University, Melbourne, Australia
- Australian Catholic University, Fitzroy, Australia
| | - Melinda J. Carrington
- Baker IDI Heart and Diabetes Institute, Melbourne and Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | | | - Pamela J. Davern
- Baker IDI Heart and Diabetes Institute, Melbourne and Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - Garry L. Jennings
- Baker IDI Heart and Diabetes Institute, Melbourne and Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - Christopher M. Reid
- NHMRC Centre for Clinical Research Excellence in Therapeutics, Monash University, Melbourne, Australia
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