ORCID Profile
0000-0003-2560-2537
Current Organisation
University of Western Australia
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Publisher: Springer Science and Business Media LLC
Date: 24-06-2011
Publisher: Elsevier BV
Date: 05-2007
DOI: 10.1016/J.ATHEROSCLEROSIS.2006.05.013
Abstract: We studied the determinants of carotid atherosclerosis in urban-dwelling Australian Aboriginals at high risk of atherosclerotic mortality and morbidity. Cross-sectional study of self-selected adult Australian Aboriginals. Participants (n=602) aged 18-74 years had risk factor assessment and carotid ultrasound to determine carotid intima-medial thickness (IMT) and the presence of plaque. The upper quartile (>0.71 mm in males and >0.62 mm in females) was used as a measure of increased carotid IMT. Over 80% of participants were overweight or obese the prevalence of diabetes was 25%. Age was the major predictor of thick IMT, OR 3.0 (95% CI 2.0-4.5) per decade for males and OR 6.3 (3.3-12.0) for females. Waist circumference and blood glucose were independent predictors of IMT for men, with hypertension, pack-years of smoking, diabetes, and cholesterol ratio additional predictors for women. Plaque was highly prevalent (>40%) in this relatively young population and was predicted by increasing age, a history of smoking and total cholesterol/HDL ratio, but not sex. Urban-dwelling Aboriginal Australians are at increased risk for early atherosclerosis. In this study an excess of obesity-related cardiovascular risk factors were the important contributors to increased IMT carotid atherosclerosis, but not inflammatory markers or other novel risk factors.
Publisher: Wiley
Date: 28-07-2015
DOI: 10.1111/IMJ.12762
Abstract: Funding source/insurance status has been associated with disparity in the management and outcomes of cardiovascular disease, with poorer outcomes among disadvantaged groups. Using proposed quality indicators for permanent pacemaker (PPM) implantation and administrative data, this study aimed to determine whether quality indicator-based outcomes of PPM implantation were comparable for publicly and privately funded patients within Australia's two-tier health system. A population-based cohort study of adults implanted with a PPM between 1995 and 2009 in Western Australia. The association of funding outcomes derived from linked administrative data was tested in multivariate logistic regression models. There were 9748 PPMs implanted, 48% being among privately funded patients. The mean age was 75 years for both public and private patients. Private patients had better health status (fewer with cardiac conditions and lower non-cardiac comorbidity scores), were less likely to be an emergency admission (33% vs 60%, P < 0.001) and more likely to have dual- or triple-chamber pacing. Mean length of stay was significantly greater for private patients (4.3 (standard deviation 6.3) vs 5.1 (6.8) days <0.001), related to longer elective admissions. Crude mortality was lower for private patients in-hospital (0.7 vs 1.3%), 30-day post-procedure (1.3 vs 2.1%) and at 1 year (7.3 vs 9.5%). Emergency admission, comorbidity and other demographic and clinical factors, not funding source, were significant predictors of these outcomes. There was no difference between publicly and privately funded patients in study outcomes, after adjustment for demographic and clinical factors. The exception was longer hospital stay for elective PPM among privately funded patients.
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.IJCARD.2015.04.099
Abstract: Research suggests that survival among the recipients of a cardiac permanent pacemaker (PPM) matches the age- and sex-matched general population in the absence of cardiovascular disease. We used linked administrative data to examine life expectancy-based outcomes for adults requiring a cardiac PPM. Population-level hospital admissions data were used to identify all recipients of an initial PPM during 1995-2008. Expected years of additional life remaining at the time of implantation were calculated for each patient from population life tables. Observed years were calculated using linked mortality data to end 2011. Cox regression was used to determine demographic and clinical predictors of survival. In 8757 patients age-adjusted risk of death to 5 years was associated with male sex, higher Charlson Comorbidity Index score (excluding cardiac disease), a history of heart failure, cardiomyopathy or atrial fibrillation and emergency admission. Coronary revascularisation surgery reduced long-term risk. The observed/expected ratio of additional years of life was 0.80 for men and 0.84 for women overall, varying from 0.92 for women without significant comorbidity to 0.40 for patients with the highest Charlson score and cardiomyopathy. The oldest patients (80-99 years) did relatively well, probably reflecting patient selection. Heart disease was the most frequent cause of death. Life expectancy among PPM recipients without significant comorbidity approached that of the general population. Greater non-cardiac comorbidity, heart failure, atrial fibrillation and, in particular, cardiomyopathy, contributed most to the loss of expected years of life in all age groups. The oldest patients and women did relatively well.
Publisher: Elsevier BV
Date: 03-2003
Publisher: BMJ
Date: 16-01-2020
DOI: 10.1136/HEARTJNL-2019-315889
Abstract: To assess the performance of cardiovascular disease (CVD) risk equations in Indigenous Australians. We conducted an in idual participant meta-analysis using longitudinal data of 3618 Indigenous Australians (55% women) aged 30–74 years without CVD from population-based cohorts of the Cardiovascular Risk in IndigenouS People(CRISP) consortium. Predicted risk was calculated using: 1991 and 2008 Framingham Heart Study (FHS), the Pooled Cohorts (PC), GloboRisk and the Central Australian Rural Practitioners Association (CARPA) modification of the FHS equation. Calibration, discrimination and diagnostic accuracy were evaluated. Risks were calculated with and without the use of clinical criteria to identify high-risk in iduals. When applied without clinical criteria, all equations, except the CARPA-adjusted FHS, underestimated CVD risk (range of percentage difference between observed and predicted CVD risks: −55% to −14%), with underestimation greater in women (−63% to −13%) than men (−47% to −18%) and in younger age groups. Discrimination ranged from 0.66 to 0.72. The CARPA-adjusted FHS equation showed good calibration but overestimated risk in younger people, those without diabetes and those not at high clinical risk. When clinical criteria were used with risk equations, the CARPA-adjusted FHS algorithm scored 64% of those who had CVD events as high risk corresponding figures for the 1991-FHS were 58% and were 87% for the PC equation for non-Hispanic whites. However, specificity fell. The CARPA-adjusted FHS CVD risk equation and clinical criteria performed the best, achieving higher combined sensitivity and specificity than other equations. However, future research should investigate whether modifications to this algorithm combination might lead to improved risk prediction.
Publisher: BMJ
Date: 02-05-2006
Publisher: BMJ
Date: 12-2002
Abstract: To determine 30 day mortality, long term survival, and recurrent cardiac events after coronary artery bypass graft (CABG) in a population. Follow up study of patients prospectively entered on to a cardiothoracic surgical database. Record linkages were used to obtain data on readmissions and deaths. 8910 patients undergoing isolated first CABG between 1980 and 1993 in Western Australia. 30 day and long term survival, readmission for cardiac event (acute myocardial infarction, unstable angina, percutaneous transluminal coronary angioplasty or reoperative CABG). There were 3072 deaths to mid 1999. 30 day and long term survival were significantly better in patients treated in the first five years than during the following decade. The age of the patients, proportion of female patients, and number of grafts increased over time. An urgent procedure (odds ratio 3.3), older age (9% per year) and female sex (odds ratio 1.5) were associated with increased risk for 30 day mortality, while age (7% per year) and a recent myocardial infarction (odds ratio 1.16) influenced long term survival. Internal mammary artery grafts were followed by better short and long term survival, though there was an obvious selection bias in favour of younger male patients. This study shows worsening crude mortality at 30 days after CABG from the mid 1980s, associated with the inclusion of higher risk patients. Older age, an acute myocardial infarction in the year before surgery, and the use of sephenous vein grafts only were associated with poorer long term survival and greater risk of a recurrent cardiac event. Female sex predicted recurrent events but not long term survival.
Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1016/J.AHJ.2013.02.007
Abstract: Automated implantable cardioverter-defibrillators (ICDs) have become standard therapy for patients at high risk for sudden cardiac death. Linked data allow examination of trends in use and long-term survival after ICD implantation in an adult population. Linked state-wide person-based data on hospital admissions and deaths from 1980 to 2009 were used to identify incident cases of ICD implantation. Population rates were calculated using census data. Kaplan-Meier techniques were used to describe cumulative survival. Cox regression models were used to determine the factors associated with the outcomes. Between 1988 and 2009, 1593 devices were implanted in patients in Western Australia, rising from 2 in 1988 to 245 in 2009 standardized population rates rose from 0.8 in 100000 in 1995 to 14.9 in 100000 in 2009. Mean age rose from 52.6 (SD 11.6) to 64.1 (11.4) years. Ventricular tachycardia (23%), cardiomyopathy (18%), and heart failure (16%) were the most frequent principal diagnoses. Ischemic heart disease was present in 49% of patients. Five-year cumulative survival was 0.74 (SE 0.01), and at 10 years, 0.53 (SE 0.03) median survival was 11.3 years. Readmission within a year, older age, heart failure, device complications, and chronic ischemic heart disease were associated with poorer survival. Implantable cardioverter-defibrillator use in adults at risk for sudden cardiac death has grown rapidly. Readmission within 12 months of discharge is associated with worse medium and long-term mortality. Survival for most patients younger than 65 years exceeds 10 years and 5 years for those aged ≥75 years.
Publisher: BMJ
Date: 28-04-2011
Abstract: Age-specific death from cardiovascular disease among Australian Aboriginals is estimated to be four to seven times that of general population, and the major cause of premature death. There is little reliable information on the incidence of coronary heart disease (CHD). This study compares CHD event rates in urban-dwelling Aboriginal people and the general population. The Perth Aboriginal Atherosclerosis Risk Study (PAARS) cohort was assessed at baseline (1998/1999) and 913 participants followed-up to 2006. A comparison group of age-matched, sex-matched and postcode-matched non-Aboriginals (n=3582) were selected from the Perth, Western Australia, Electoral Roll. Electronic record linkage captured prior CHD and first CHD events in both groups. The rates of first CHD events (hospital admission or CHD death) per 1000 person years (PY) and incidence rate ratios (IRR) were calculated. The event rate for the PAARS population was 14.9 per 1000 PY (95% CI 12.3 to 18.2) versus 2.4 (1.9 to 3.1) for the general population. The IRR was 6.1 (4.5 to 8.4). For Aboriginal men the rate was 15.0 (11.2 to 20.0) versus 3.8 (2.5 to 5.0) per 1000 PY, with age-specific rates being two to five times that of non-Aboriginals. Incidence for Aboriginal women was 15.0 (11.5 to 19.5) versus 1.4 (0.9 to 2.1) with age-specific rates being 8-25 times that of non-Aboriginals. Age and sex-specific CHD event rates in urban Aboriginals far exceeded that of a matched general population. Events occurred at a much younger age among the Aboriginal participants and were equally excessive among men and women.
Publisher: Elsevier BV
Date: 06-2009
DOI: 10.1111/J.1753-6405.2009.00388.X
Abstract: To assess the sensitivity of the recording of Aboriginality in the Western Australia Linked Data. This was a follow-up study using record linkage. Demographic data was obtained from 993 adult, urban-dwelling Aboriginal Australian participants in the Perth Aboriginal Atherosclerosis Risk study (PAARS). These were linked to the Western Australian Linked Data (State-wide hospital admissions and discharges, and deaths) to provide the number of admissions and Indigenous status coding from 1980 to 2006. There were 14,413 admissions for PAARS participants in the study period. The sensitivity of coding of Indigenous status in hospital admissions data significantly improved over time, exceeding 0.9 in every year since 2002. Prior to 2002 sensitivity was around 0.8, but poorer for males, with some anomalous years. The coding of Indigenous status in the Western Australia Hospital Morbidity Database since 2002 has improved. The data from earlier decades must be approached with more caution. The improved accuracy of identification of Indigenous status in the Western Australia Hospital Morbidity Database allows comparative studies of adult Aboriginal and non-Aboriginal population health outcomes to be undertaken with confidence.
Publisher: Springer Science and Business Media LLC
Date: 16-11-2015
Publisher: Elsevier BV
Date: 02-2006
DOI: 10.1016/J.AHJ.2005.04.007
Abstract: Health-related quality of life (HRQOL) among long-term survivors of coronary artery bypass surgery is an important outcome that has been little studied at the population level. A postal survey was conducted in 1999 to 2000 in patients 6 to 20 years after coronary artery bypass graft (CABG) surgery in Western Australia. A random stratified s le of 2500 was drawn from 8910 patients who had their first CABG surgery in 1980 to 1993. Health-related quality of life was measured with Short Form 36 and EuroQol visual analogue scale. Response was 82% (n = 2061). Health-related quality of life declined with age and was similar for men and women, although scores for women were worse for physical functioning. Compared with Australian population norms, the age- and sex-standardized scores of survivors of CABG were generally worse, mainly in the physical domain. Reported angina at the time of follow-up (33%), symptoms of heart failure equivalent to New York Heart Association (NYHA) classes II to IV (34%), and comorbidities such as diabetes and hypertension were associated with poorer HRQOL. For both men and women without angina or heart failure at follow-up, HRQOL was no different from that of the general population. Overall, the quality of life among long-term survivors of CABG is worse than that of the general population, the difference being mainly attributable to recurrent symptoms and comorbidities. Quality of life for those without angina or heart failure at follow-up was equivalent to the population norms, providing an incentive to maximize efforts to abolish angina and ameliorate heart failure symptoms.
Publisher: Springer Science and Business Media LLC
Date: 18-09-2014
Publisher: Elsevier BV
Date: 06-2004
Publisher: Elsevier BV
Date: 09-2005
DOI: 10.1016/J.HLC.2004.12.022
Abstract: Return to paid employment may be facilitated by coronary artery bypass graft (CABG) surgery. We assessed work status in a population-based study of long-term outcomes of CABG. To determine the association between returning to work after CABG and clinical and socio-demographic factors. A postal survey of 2,500 randomly selected patients 6-20 years post-CABG. The outcomes assessed were work status in the year before and after CABG and health-related quality of life (HRQOL) measured with SF-36. Response was 82% (n = 2,061). Employment fell from 56% in the year prior to CABG to 42% in the year after. Workers in 'blue-collar' occupations were more likely to reduce their work status than those in 'white collar' occupations (46% versus 29%, p < 0.001). Independent predictors of reducing employment were increasing age (9% per year, 99% CI: 1.06-1.11, p < 0.001), 'blue-collar' versus 'white collar' occupation (OR: 2.1, 99% CI: 1.4-3.1) and female sex (OR: 2.1, 99% CI: 1.1-3.6). HRQOL among participants under 60 years of age at follow-up was better for those who returned to work after CABG surgery. CABG surgery is followed by a net loss to paid employment of working age patients which increases with age, and is more likely for those in blue-collar occupations and women.
Publisher: Elsevier BV
Date: 2007
DOI: 10.1016/S0828-282X(07)70213-1
Abstract: The Thrombolysis In Myocardial Infarction (TIMI) risk index for the prediction of 30-day mortality was developed and validated in patients with ST-segment elevation myocardial infarction (STEMI) who were being treated with thrombolytics in randomized clinical trials. When tested in clinical registries of patients with STEMI, the index performed poorly in an older (65 years and older) Medicare population, but it was a good predictor of early death among the more representative population on the National Registry of Myocardial Infarction-3 and -4 databases. It has not been tested in a population outside the United States or among non-STEMI patients. The TIMI risk index was applied to the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study cohort of 11,510 acute MI patients from Ontario. The model's discriminatory capacity and calibration were tested in all patients and in subgroups determined by age, sex, diagnosis and reperfusion status. The TIMI risk index was strongly associated with 30-day mortality for both STEMI and non-STEMI patients. The C statistic was 0.82 for STEMI and 0.80 for non-STEMI patients, with overlapping 95% CI. The discriminatory capacity was somewhat lower for patients older than 65 years of age (0.74). The model was well calibrated. The TIMI risk index is a simple, valid and moderately accurate tool for the stratification of risk for early death in STEMI and non-STEMI patients in the community setting. Its routine clinical use is warranted.
Publisher: Elsevier BV
Date: 04-2010
DOI: 10.1016/J.HLC.2009.11.001
Abstract: Coronary revascularisation procedures may be under-used for Aboriginal Australians with ischaemic heart disease (IHD). We compared the use of procedures in an urban Aboriginal population and a non-Aboriginal external comparison group. The Perth Aboriginal Atherosclerosis Risk (PAARS) cohort (n=998) and 3695 age- and sex-matched non-Aboriginals were electronically linked to Western Australian hospital morbidity data to identify admissions and revascularisation procedures between 1980 and 2006. There were 731 admissions for IHD for 983 PAARS participants with hospital admissions and 391 in 3150 non-Aboriginals. There were 136 first procedures overall 43% of Aboriginals having a procedure were women versus 18.5% of non-Aboriginals. 41% of Aboriginal patients and 48% of non-Aboriginals had procedures (p=0.12). Aboriginals were more likely to have coronary artery bypass grafts (CABG) (40.5%) than a percutaneous coronary intervention (PCI), compared to the general population (23%, p=0.02). The proportion of first procedures for acute coronary syndrome (ACS) admissions was 61% for both groups, 80% and 85%, respectively, being PCI. Coronary revascularisation procedures for IHD were used with equal frequency in Aboriginal people and matched non-Aboriginals. Aboriginal people were more likely to have CABG than PCI. Revascularisation rate and type in ACS admissions were the same.
Publisher: BMJ
Date: 12-2014
Publisher: BMJ
Date: 11-2007
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2020
No related grants have been discovered for Pamela Bradshaw.