Cardiac Intervention, Surgery And Cognitive Outcome (CISCO) Study
Funder
National Health and Medical Research Council
Funding Amount
$367,739.00
Summary
We propose to investigate the association between the presence of coronary artery disease and changes in brain function after therapeutic interventions. Patients undergoing surgery for coronary heart disease are prone to experience changes in mental function and higher level thought processes (cognition) after surgery, especially if they are elderly. As the population ages this is becoming a more significant problem. There is some limited evidence that this particular group of patients has a hig ....We propose to investigate the association between the presence of coronary artery disease and changes in brain function after therapeutic interventions. Patients undergoing surgery for coronary heart disease are prone to experience changes in mental function and higher level thought processes (cognition) after surgery, especially if they are elderly. As the population ages this is becoming a more significant problem. There is some limited evidence that this particular group of patients has a higher incidence of cognitive impairment than the normal population even before they present for surgery, because cardiovascular disease has also been shown to be associated with changes in cognition. To investigate this, we will measure cognitive status in patients over the age of 55 who have coronary artery disease and are being investigated with coronary angiography. This will provide an indication of the baseline cognitive status in patients presenting with coronary vascular disease. We will use validated neuropsychological tests that have been used to assess potsoperative cognitive decline. These tests are sufficiently sensitive to detect subtle changes in a number of areas of thought processing (cognitive domains) and thus identify those subjects who have cognitive impairment. Patients will then go on to be treated by surgery or angioplasty. We will continue to test these patients at time intervals for 3 months in order to track the changes in cognition in each treatment group. Thus we will be in the position to compare how these modalities of treatment for heart disease impact on patients mental function and cognition. In addition we will be able to tell whether a 'recovery' period might be of benefit following coronary angiography. If we are able to demonstrate different cognitive outcomes from different treatments and also an association with pre-existing cognition, this will guide clinical decision making to minimise harm to the brain.Read moreRead less
Microvascular Function And Outcome In Patients With Acute Coronary Syndromes
Funder
National Health and Medical Research Council
Funding Amount
$79,514.00
Summary
Damage to the small vessels of the heart is a hallmark of heart attacks. Furthermore, small vessel dysfunction (MVD) is associated with a worse prognosis even in the presence of an unblocked major coronary artery following a heart attack. Using novel invasive assessments, we aim to analyse the prevalence and clinical predictors of MVD, assess the impact of MVD on short and long-term outcome after heart attack and address the impact of new treatments on MVD and heart muscle recovery.
The Access Project - Assessment Of Coronary Artery Disease Using CT Effectively For Stable Symptoms
Funder
National Health and Medical Research Council
Funding Amount
$754,369.00
Summary
Invasive Coronary Angiography (ICA) provides x-ray visualisation of coronary disease (CAD) that is essential for coronary surgery/balloon angioplasty. However many patients undergo this procedure without requiring these therapies despite the associated severe complications. The ACCESS Project screens patients scheduled for ICA, identifying those unlikely to have CAD and referring them for non-invasive CT angiography. This strategy reduces procedure complications and result in major cost savings.
The Central Australian Heart Protection Study: A Randomised Trial Of Nurse-Led, Family Based Secondary Prevention Of Acute Coronary Syndromes
Funder
National Health and Medical Research Council
Funding Amount
$1,923,630.00
Summary
Despite the high burden of cardiovascular diseases among Indigenous Australians, few intervention trials have sought to evaluate novel approaches to reducing differential outcomes in this vulnerable group. The Central Australian Heart Protection Study seeks to test the effectiveness of a nurse-led, family based education and assessment program in reducing the incidence of poor outcomes in indigenous and non-indigenous patient’s following an Acute Coronary Syndrome (ACS).
Life! Diabetes Prevention Program: A Randomised Cluster Control Trial Of Its Efficacy And Cost Effectiveness
Funder
National Health and Medical Research Council
Funding Amount
$866,066.00
Summary
Type 2 diabetes is a great and growing epidemic, and Australia's largest public health challenge. Life! is a diabetes prevention program for 25,000 Victorians. This proposal will look at its efficacy, effectiveness and cost effectiveness so that more improvements can be made.
Studying Coronary Physiology Within Human Coronary Arteries Using Computational Fluid Dynamics
Funder
National Health and Medical Research Council
Funding Amount
$383,834.00
Summary
The aim of this project is to combine the recent technological advances within the individual fields of coronary physiology, three-dimensional coronary angiography, and computational fluid dynamics to develop a novel method to calculate realistic coronary blood flow. This technique will provide a simple and clinically applicable method to measure physiological parameters such as microcirculatory resistance and shear stress within _live� human coronary arteries.
In Vivo Evaluation Of Coronary Atheroma Burden And Its Association With Focal Coronary Endothelial Function
Funder
National Health and Medical Research Council
Funding Amount
$123,736.00
Summary
Heart attacks remain the leading cause of death in the western world. It has been recently identified that the burden of plaque buildup in the coronary arteries is a major predictor of future heart attacks. Furthermore, it also known that impaired relaxation within the coronary arteries also increases the future risk of heart attacks. The dynamic relationship between these two critical factors remains unknown and an understanding of this is important for predicting future heart attacks.
Effects Of Risk Factor Control On Atherosclerosis, Vasoreactivity And Cardiac Ischemia In Patients On Dialysis
Funder
National Health and Medical Research Council
Funding Amount
$212,126.00
Summary
End-stage renal failure is one of the commonest serious chronic diseases; in Australia, over 10,000 patients are in dialysis programs or have functioning transplants. The commonest cause of death in this patient group is coronary artery disease, and attempts are routinely made to identify patients with this problem, with the intent of controlling this risk by angioplasty or bypass surgery. Unfortunately, these procedures may be less effective than usual, because the process of artery narrowing i ....End-stage renal failure is one of the commonest serious chronic diseases; in Australia, over 10,000 patients are in dialysis programs or have functioning transplants. The commonest cause of death in this patient group is coronary artery disease, and attempts are routinely made to identify patients with this problem, with the intent of controlling this risk by angioplasty or bypass surgery. Unfortunately, these procedures may be less effective than usual, because the process of artery narrowing is more aggressive in patients with renal disease. Moreover, this process may cause patients with negative testing for coronary disease at one point in time to develop coronary problems over follow-up. In this study, we propose to use a standard stress testing protocol to stratify the risk of coronary events in a group of at risk patients on dialysis. Those at highest risk will undergo bypass surgery, while those at intermediate and low risk will be randomized to usual care, or an aggressive treatment of atheroma with cholesterol reduction, folic acid supplementation (aiming to normalize homocysteine), blood pressure and blood sugar control. The effects of this approach will be followed by examination of biochemical markers of atherosclerosis, and imaging of arterial thickness and reactivity (reflecting tests of structure and function of the vasculature). We will also assess of the progression or reduction of abnormal cardiac stress responses, and the occurence of events at follow-up. Finally, follow-up data will be used to compare the predictive value of the 2 stress testing protocols. The results of this study will enhance our understanding of the importance of the atherosclerotic process in renal patients, and move the management approach for coronary disease in renal failure toward active risk factor control and away from revascularization.Read moreRead less