Detection And Management Of Depression In General Practice Patients With Chronic Manifestations Of Ischaemic Heart Disea
Funder
National Health and Medical Research Council
Funding Amount
$499,797.00
Summary
This research will investigate the impact of ischemic heart disease on the prevalence and severity of patients with depression. This will be done via a 12 month general practice based program of 1) systematic screening for depression 2) informing general practitioners of best-practice guidelines for management of depression in these patients, and 3) providing the treating general practitioner with patient-specific, psychiatric advice.
Determinants Of Tissue Response To Nitric Oxide In Health And Disease
Funder
National Health and Medical Research Council
Funding Amount
$385,432.00
Summary
The endothelium, or inner lining layer of blood vessels, exerts a controlling influence on the tendency of blood vessels to constrict or dilate, and on the likelihood that clots will form by aggregation of platelets within the blood vessel. This process is largely mediated by release of nitric oxide (NO) from the endothelium. Importanly, NO is also the active chemical formed when patients are given nitroglycerine (NTG) for the treatment of angina pectoris. There is evidence that conditions predi ....The endothelium, or inner lining layer of blood vessels, exerts a controlling influence on the tendency of blood vessels to constrict or dilate, and on the likelihood that clots will form by aggregation of platelets within the blood vessel. This process is largely mediated by release of nitric oxide (NO) from the endothelium. Importanly, NO is also the active chemical formed when patients are given nitroglycerine (NTG) for the treatment of angina pectoris. There is evidence that conditions predisposing towards development of angina or of heart attacks (such as high cholesterol levels or high blood pressure) are associated with dysfunction of the endothelium, so that less NO is available. The precise cause of this process is uncertain. However, our recent experiments show that in patients with angina, circulating platelets respond poorly to NO. The research to be undertaken will explore the link between blood vessel and platelet function, examing the impact of race (Aboriginals compared to Caucasians) and coronary risk factors. It will also examine the implications of endothelial dysfunction on initial and long-term responses to NTG. The results will shed light on factors predisposing to development of heart attacks, and identify factors preventing optimal responses to anti-anginal treatment.Read moreRead less
Structural And Functional Alterations Of Sarcomeric Proteins In Reperfused Myocardium
Funder
National Health and Medical Research Council
Funding Amount
$271,786.00
Summary
Coronary artery disease remains the major cause of mortality for the adult population in our society. Despite the advances of coronary artery bypass surgery and medical treatment for reperfusion of occluded coronary arteries, the problem of impaired pump function of the heart remains a major obstacle. Although blood flow can be restored to the jeopardised heart muscle by either clot dissolving drugs, balloon angioplasty, or coronary artery surgery, the heart muscle may not regain pump function f ....Coronary artery disease remains the major cause of mortality for the adult population in our society. Despite the advances of coronary artery bypass surgery and medical treatment for reperfusion of occluded coronary arteries, the problem of impaired pump function of the heart remains a major obstacle. Although blood flow can be restored to the jeopardised heart muscle by either clot dissolving drugs, balloon angioplasty, or coronary artery surgery, the heart muscle may not regain pump function for days to weeks after the event. This delayed recovery of pump function, known as myocardial stunning, can lead to heart failure and slow down a patient's recovery from heart surgery or heart attack. The cause of this myocardial stunning is unknown. We suggest that stunning results from damage to essential proteins in the contractile apparatus of the heart, which requires a prolonged time period for repair. This project aims to identify the site and extent of protein damage occurring in the heart following interruption and subsequent restoration of cardiac blood flow. In concert with this, we seek to determine the mechanism of protein damage. The findings of this project should allow us to subsequently investigate new treatment approaches for acute pump dysfunction in patients with ischaemic heart disease.Read moreRead less
COX-2 Inhibitors And The Development Of Unstable Angina And Myocardial Infarction
Funder
National Health and Medical Research Council
Funding Amount
$171,450.00
Summary
Anti-inflammatory drugs (sometimes called NSAIDs) are widely used in the treatment of arthritis and also as general purpose pain killers. Up to 10 million prescriptions are written each year for these drugs in Australia. Some of the older versions of these drugs like ibuprofen (eg Brufen) and naproxen (trade name Naproxen) cause side effects which can be serious. Damage to the stomach is a particular problem and this can lead to serious bleeding or perforation of ulcers. Less well recognized are ....Anti-inflammatory drugs (sometimes called NSAIDs) are widely used in the treatment of arthritis and also as general purpose pain killers. Up to 10 million prescriptions are written each year for these drugs in Australia. Some of the older versions of these drugs like ibuprofen (eg Brufen) and naproxen (trade name Naproxen) cause side effects which can be serious. Damage to the stomach is a particular problem and this can lead to serious bleeding or perforation of ulcers. Less well recognized are the adverse effects of these drugs on the heart and the kidneys. The older fashioned members of this class of drug are rapidly being replaced by newer agents known as COX-2 inhibitors. Popular examples in Australia are celecoxib (trade name Celebrex) and rofecoxib (trade name Vioxx). These drugs are heavily promoted as being safer than the older NSAIDs. In the case of the stomach, this claim seems to be correct. However, the effects of the new COX-2 inhibitors on the circulation have not been fully assessed. Recently, claims have been made that these drugs may increase the risk of heart attacks. If this were true, it would be an effect that was unique to COX-2 inhibitors as it has not been reported with the older NSAIDs. We plan to carry out a 3 year study in Newcastle hospitals in which we compare the use of COX-2 inhibitors in a group of patients admitted to hospital with a heart attack or unstable angina with that of a control group of patients who were admitted to hospital around the same time, but not for heart problems. We are interested in whether COX-2 inhibitors are associated with an increased risk of heart attacks and whether use of small doses of aspirin protects against this effect. Depending on the results we may be able to improve the safety of these drugs in patients at risk of heart attacks.Read moreRead less
Population Monitoring Of Coronary Heart Disease In The Modern Era
Funder
National Health and Medical Research Council
Funding Amount
$636,375.00
Summary
Despite major reductions in mortality from heart attack over the past three decades, coronary heart disease (CHD) remains the leading cause of death and disability in Australia. It generates very large health costs and is one of five National priority areas for disease prevention and control. The most important manifestations of CHD are heart attacks, which require urgent hospital treatment, or sudden death, generally outside hospital. Accurate information to monitor trends in the incidence and ....Despite major reductions in mortality from heart attack over the past three decades, coronary heart disease (CHD) remains the leading cause of death and disability in Australia. It generates very large health costs and is one of five National priority areas for disease prevention and control. The most important manifestations of CHD are heart attacks, which require urgent hospital treatment, or sudden death, generally outside hospital. Accurate information to monitor trends in the incidence and outcomes of heart attack that can be used to assess the effectiveness for public health programs, establish requirements for clinical services, improve quality of care, and support studies of costs of health care, is essential. This study will use the unique capacity for medical record linkage in Western Australia (WA) to establish a comprehensive system to monitor the incidence, outcomes and emergency treatment of heart attack. It will combine information from a number of data sources including the hospital statistical system, emergency departments, ambulance services, laboratories and departments of cardiology. It will also obtain information from Commonwealth Department of Health and Aged care about the prescribing of selected medications, such as cholesterol lowering drugs, used in for the prevention of heart disease. Within this framework, it will undertake a number of sub-studies to improve the accuracy of information about heart attacks in the hospital statistical system to ensure consistency in measuring future trends, provide clinicians with state-wide information about outcomes of hospital care and the uptake of proven therapies, provide health administrators with information for planning services, and policy makers about the most cost-effective options for the preventions and control of heart disease.Read moreRead less
Value-Based Healthcare In Elective Coronary Stenting
Funder
National Health and Medical Research Council
Funding Amount
$1,236,881.00
Summary
Coronary stents are wire mesh tubes inserted into cholesterol blockages in heart blood vessels (arteries) thus improving coronary blood flow and alleviating chest pain. Although life saving in acute heart attacks, their value is limited in stable patients and may be associated with severe complications. In partnership with the health department, this project will evaluate how many patients continue to experience chest pain after elective coronary stenting so that can be used more effectively.