ORCID Profile
0000-0003-3865-1645
Current Organisations
Baker Heart and Diabetes Institute
,
Australian Catholic University
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Publisher: Elsevier BV
Date: 10-2002
DOI: 10.1016/S1388-2457(02)00237-7
Abstract: Despite a relatively large body of literature describing the characteristics of sleep spindles and K-complexes in young adults, relatively little research has been conducted in older in iduals. The general consensus from the few studies that have addressed this issue is that there is a progressive decrease in the number of spindles and K-complexes with age, although there is large intra-in idual variation. Whether or not these changes are an inevitable consequence of the aging process can be addressed by studying healthy older adults who provide an ex le of the effects of age independently from those of disease. Fourteen young adults (mean age=21.4+/-2.5 years) and 20 older adults (mean age=75.5+/-6.3 years) participated in the study. All subjects were neurologically and medically healthy and were not taking any medications with a known effect on the central nervous system or sleep. For each subject, a number of characteristics were determined including the number, density (SS/min), litude and frequency of all spindles as well as the number and density of K-complexes (KC/min). Spindle number, density and duration as well as K-complex number and density were all significantly lower in the elderly compared to the young adults. The EEG frequency within the spindles was significantly higher in the elderly, although the absolute difference was less than 0.5 Hz. Multiple regression analysis indicated that spindle duration and K-complex density were able to predict over 90% of the variance in age. The age-related decrease in sleep spindle and K-complex density is consistent with previous reports and may be interpreted as an age-related alteration of thalamocortical regulatory mechanisms.
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.HLC.2015.04.168
Abstract: Frequent readmissions are a hallmark of chronic heart failure (CHF). We sought to develop an absolute risk prediction model for unplanned cardiovascular readmissions following hospitalisation for CHF. An inception cohort was obtained from the WHICH? trial, a prospective, multi-centre randomised controlled trial which was a head-to-head comparison of the efficacy of a home-based intervention versus clinic-based intervention for adults with CHF. A Cox's proportional hazards model (taking into account the competing risk of death) was used to develop a prediction model. Bootstrap methods were used to identify factors for the final model. Based on these data a nomogram was developed. Of the 280 participants in the WHICH? trial 37 (13%) were readmitted for a cardiovascular event (including CHF) within 28 days, and a further 149 (53%) were readmitted within 18 months for a cardiovascular event. In the proposed competing risk model, factors associated with an increased risk of hospitalisation for CHF were: age (HR 1.07, 95% CI 0.90-1.26) for each 10-year increase in age living alone (HR 1.09, 95% CI 0.74-1.59) those with a sedentary lifestyle (HR 1.44, 95% CI, 0.92-2.25) and the presence of multiple co-morbid conditions (HR 1.69, 95% CI 0.38-7.58) for five or more co-morbid conditions (compared to in iduals with one documented co-morbidity). The C-statistic of the final model was 0.80. We have developed a practical model for in idualising the risk of short-term readmission for CHF. This model may provide additional information for targeting and tailoring interventions and requires future prospective evaluation.
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.IJCARD.2015.03.071
Abstract: 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. 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 in idual 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%). 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.
Publisher: Elsevier BV
Date: 11-2005
DOI: 10.1016/J.AAP.2005.06.008
Abstract: Sleepiness is a significant contributor to car crashes and sleepiness related crashes have higher mortality and morbidity than other crashes. Young adult drivers are at particular risk for sleepiness related car crashes. It has been suggested that this is because young adults are typically sleepier than older adults because of chronic sleep loss, and more often drive at times of increased risk of acute sleepiness. This prospective study aimed to determine the relationship between predicted and perceived sleepiness while driving in 47 young-adult drivers over a 4-week period. Sleepiness levels were predicted by a model incorporating known circadian and sleep factors influencing alertness, and compared to subjective ratings of sleepiness during 2518 driving episodes. Results suggested that young drivers frequently drive while at risk of crashing, at times of predicted sleepiness (>7% of episodes) and at times they felt themselves to be sleepy (>23% of episodes). A significant relationship was found between perceived and predicted estimates of sleepiness. However, the participants nonetheless drove at these times. The results of this study may help preventative programs to specifically target factors leading to increased sleepiness when driving (particularly time of day), and to focus interventions to stop young adults from driving when they feel sleepy.
Publisher: Oxford University Press (OUP)
Date: 09-07-2016
Abstract: Blood pressure targets in in iduals treated for hypertension in primary care remain difficult to attain. To assess the role of practice nurses in facilitating intensive and structured management to achieve ideal BP levels. We analysed outcome data from the Valsartan Intensified Primary carE Reduction of Blood Pressure Study. Patients were randomly allocated (2:1) to the study intervention or usual care. Within both groups, a practice nurse mediated the management of blood pressure for 439 patients with endpoint blood pressure data (n=1492). Patient management was categorised as: standard usual care (n=348, 23.3%) practice nurse-mediated usual care (n=156, 10.5%) standard intervention (n=705, 47.3%) and practice nurse-mediated intervention (n=283, 19.0%). Blood pressure goal attainment at 26-week follow-up was then compared. Mean age was 59.3±12.0 years and 62% were men. Baseline blood pressure was similar in practice nurse-mediated (usual care or intervention) and standard care management patients (150 ± 16/88 ± 11 vs. 150 ± 17/89 ± 11 mmHg, respectively). Practice nurse-mediated patients had a stricter blood pressure goal of ⩽125/75 mmHg (33.7% vs. 27.3%, p=0.026). Practice nurse-mediated intervention patients achieved the greatest blood pressure falls and the highest level of blood pressure goal attainment (39.2%) compared with standard intervention (35.0%), practice nurse-mediated usual care (32.1%) and standard usual care (25.3% p<0.001). Practice nurse-mediated intervention patients were almost two-fold more likely to achieve their blood pressure goal compared with standard usual care patients (adjusted odds ratio 1.92, 95% confidence interval 1.32 to 2.78 p=0.001). There is greater potential to achieve blood pressure targets in primary care with practice nurse-mediated hypertension management.
Publisher: Elsevier BV
Date: 2011
DOI: 10.1016/J.IJCARD.2009.05.061
Abstract: There is a paucity of data to describe advanced forms of cardiovascular disease (CVD) in urban black Africans with hypertension (HT). Chris Hani Baragwanath Hospital services the black African community of 1.1 million people in Soweto, South Africa. We prospectively collected detailed demographic and clinical data from all de novo presentations to the hospital's Cardiology Unit in 2006. Overall, 761 black African patients (56% of de novo cases) presented with a diagnosis of HT with more women (63%, aged 58.5±14.9 years) than men (aged 58.0±15.6 years). On presentation, 396 women (82%) versus 187 men (67%) had dizziness, palpitations and/or chest pain (OR 1.23, 95% 1.12-1.34: p<0.0001). HT was the primary diagnosis in 266 cases (35%). In the rest (n=495), non-ischaemic forms of heart failure were common (54% of total) while only 6.2% had coronary artery disease. Concurrent left ventricular hypertrophy, renal dysfunction and anaemia were present in 39%, 24% and 11% of cases, respectively, with a similar age-adjusted pattern of co-morbidity according to sex. However, men were more likely to present with impaired systolic function (OR 2.13, 95% CI 1.50 to 3.00 p<0.0001). In the absence of effective primary and secondary prevention strategies, these unique data highlight the potentially devastating impact of advanced forms of hypertensive heart disease in urban black African communities with more women than men affected.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2012
Publisher: Elsevier BV
Date: 07-2012
DOI: 10.1016/J.IJCARD.2011.01.022
Abstract: Few data describe the case burden of heart disease and cardiovascular risk factors relative to other conditions in urban Africans seeking primary health care. A clinical registry captured data on 1311 consecutive primary care patients (99% African) from two primary care clinics in Soweto, South Africa. Those with suspected sub-clinical heart disease had more advanced cardiologic assessment. Overall, 862 women (66%, 41 ± 16 years) and 449 men (38 ± 14 years) were studied. Whilst more men were smokers (47% vs. 14% OR 5.23, 95% CI 4.01-6.82), more women were obese (42% vs. 14% OR 4.54, 95% CI 3.33-5.88) blood glucose levels doubling with age in obese women. Although 33% were hypertensive, only 4.9% had type 2 diabetes (n=45), heart disease (n=10) and/or cerebrovascular disease (n=12). Overall, 16% (n=205) had an abnormal 12-lead ECG with more men than women showing a major abnormality (24% vs. 11% OR 2.63, 95% CI 1.89-3.46). Of 99 cases (7.6%) subject to advanced cardiologic assessment, 29 (2.2%) had newly diagnosed heart disease: including hypertensive heart failure (13 women vs. 2 men, OR 4.51 95% CI 1.00-21.2), coronary artery disease (n=3), valve disease (n=3), dilated cardiomyopathy (n=3) and 2 cases of acute myocarditis. These data demonstrate a relatively low burden of heart disease in urban African patients seeking primary health care. Alternatively, high antecedent risk, particularly among obese women, highlights a key role for enhanced primary prevention.
Publisher: Springer Science and Business Media LLC
Date: 12-2017
Publisher: Clinics Cardive Publishing
Date: 12-08-2012
Publisher: Wiley
Date: 18-12-2010
Abstract: The primary objective of the Nurse-led Intervention for Less Chronic Heart Failure (NIL-CHF) Study is to develop a programme of care that cost-effectively prevents the development of chronic heart failure (CHF). Methods NIL-CHF is a randomized controlled trial of a hybrid, home- and clinic-based, nurse-led multidisciplinary intervention targeting hospitalized patients at risk of developing CHF. A target of 750 patients aged >/=45 years will be exposed to usual post-discharge care or the NIL-CHF intervention. The composite primary endpoint is all-cause mortality or CHF-related admission during 3-5 years of follow-up. After 12 months recruitment, approximately 300 eligible patients (40% of target) have been randomized. Overall, 73% are male and the mean age is 65 +/- 10 years. The most common antecedents for CHF thus far are hypertension (70%, 95% CI, 64-75%), coronary artery disease (51%, 95% CI, 31-41%), and type 2 diabetes (26%, 95% CI, 21-31%), whereas 76% (95% CI, 69-82%) of patients have diastolic dysfunction, 29% (95% CI, 23-36%) left ventricular hypertrophy, 71% (95% CI, 64-78%) mitral valve dysfunction, and 7% (95% CI, 4-12%) have a left ventricular ejection fraction </=45%. As one of the largest randomized studies of its kind, NIL-CHF will ultimately provide important insights into the potential to prevent CHF via prolonged and intensive disease management.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2012
Publisher: Elsevier BV
Date: 06-2013
DOI: 10.1016/J.IJCARD.2011.10.065
Abstract: Health outcomes associated with atrial fibrillation (AF) continue to be poor and standard management often does not provide clinical stability. The Standard versus Atrial Fibrillation spEcific managemenT studY (SAFETY) compares the efficacy of a post-discharge, nurse-led, multi-disciplinary programme to optimise AF management with usual care. SAFETY is a prospective, multi-centre, randomised controlled trial with blinded-endpoint adjudication. A target of 320 hospitalised patients with a chronic form of AF will be randomised (stratified by "rate" versus "rhythm" control) to usual post-discharge care or the SAFETY Intervention (SI). The SI involves home-based assessment, extensive clinical profiling and the application of optimal gold-standard pharmacology which is in idually tailored according to a "traffic light" framework based on clinical stability, risk profile and therapeutic management. The primary endpoint is event-free survival from all-cause death or unplanned readmission during 18-36 months follow-up. Secondary endpoints include rate of recurrent hospital stay, treatment success (i.e. maintenance of rhythm or rate control and/or application of anti-thrombotic therapy without a bleeding event) and cost-efficacy. With study recruitment to be completed in early 2012, the results of this study will be available in early 2014. If positive, SAFETY will represent a potentially cost-effective and readily applicable strategy to improve health outcomes in high risk in iduals discharged from hospital with chronic AF.
Publisher: Oxford University Press (OUP)
Date: 16-12-2011
Abstract: Migration, urbanization, and change in socio-economic factors have potentially profound effects on heart disease in low-to-middle income countries. Chris Hani Baragwanath Hospital in Soweto, South Africa, provides health care to >1 million Africans. We systematically captured data from all de novo presentations of suspected heart disease (focusing on 'new' vs. historically prevalent forms) during 2006-2008. There were 3168 female (52 ± 18 years) vs. 2160 male (53 ± 17 years) cases. Overall, 999 (19%) presented with uncomplicated hypertension (n = 988) or type II diabetes, 1862 cases (35%) 'new' heart disease (1146 and 581 cases of hypertensive heart failure and coronary artery disease), and 2092 cases (39%) of historically prevalent heart disease (including 724 with primary valve disease and 502 idiopathic dilated cardiomyopathies). Level of education and non-communicable risk factors were important correlates of advanced disease. The rate of historically prevalent cases was higher in those aged 20-49 years (19-60 cases/100,000 population/annum) whilst being higher for "new" heart disease in those aged >50 years (155-343 cases opulation/annum). Historically prevalent heart disease cases were younger [adjusted odds ratio (OR) 0.98, 95% 0.97-0.99 per year], more likely to be African (OR 4.59, 95% 2.76-7.60) while being less likely to originate from Soweto (OR 0.87, 95% 0.75-1.00) and be female (OR 0.67, 95% 0.49-0.92). Dynamic socio-economic and lifestyle factors characteristic of epidemiological transition appear to have positioned the urban, mainly African community of Soweto at the crossroads between historically prevalent and 'new' forms of heart disease.
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.IJCARD.2014.04.164
Abstract: We compared the longer-term impact of the two most commonly applied forms of post-discharge management designed to minimize recurrent hospitalization and prolong survival in typically older patients with chronic heart failure (CHF). We followed a multi-center randomized controlled trial cohort of Australian patients hospitalized with CHF and initially allocated to home-based or specialized CHF clinic-based intervention for 1368 ± 216 days. Blinded endpoints included event-free survival from all-cause emergency hospitalization or death, all-cause mortality and rate of all-cause hospitalization and stay. 280 patients (73% male, aged 71 ± 14 years and 73% left ventricular systolic dysfunction) were initially randomized to home-based (n=143) or clinic-based (n=137) intervention. During extended follow-up (complete for 274 patients), 1139 all-cause hospitalizations (7477 days of hospital stay) and 121 (43.2%) deaths occurred. There was no difference in the primary endpoint 20 (14.0%) home-based versus 13 (7.4%) clinic-based patients remained event-free (adjusted HR 0.89, 95% CI 0.70 to 1.15 p=0.378). Significantly fewer home-based (51/143, 35.7%) than clinic-based intervention (71/137, 51.8%) patients died (adjusted HR 0.62, 95% CI 0.42 to 0.90: p=0.012). Home-based versus clinic-based intervention patients accumulated 592 and 547 all-cause hospitalizations (p=0.087) associated with 3067 (median 4.0, IQR 2.0 to 6.8) versus 4410 (6.0, IQR 3.0 to 12.0) days of hospital stay (p<0.01 for rate and duration of hospital stay). Relative to clinic-based intervention, home-based intervention was not associated with prolonged event-free survival. Home-based intervention was, however, associated with significantly fewer all-cause deaths and significantly fewer days of hospital stay in the longer-term. Australian New Zealand Clinical Trials Registry number 12607000069459 (www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=81803).
Publisher: Elsevier BV
Date: 04-2014
Publisher: Oxford University Press (OUP)
Date: 20-05-2015
Abstract: Regional-dwelling adults have higher levels of cardiovascular disease (CVD) risk. To determine the potential benefits of a nurse-led, self-management intervention program to reduce CVD and diabetes risk. A six-month pre ost observational study was conducted in a high risk, under-serviced regional community. A nurse-led heart health clinic was established and 530 self-selected adult in iduals (mean age 54±14 years, 62% female) were subject to standardized screening. In idual targets and multidisciplinary strategies to reduce risk factors were in idually tailored according to the Green Amber Red Delineation of rIsk And Need (GARDIAN) system. Changes in participants' CVD risk factors and lifestyle behaviors were compared and independent correlates of improvements in blood pressure (BP), total cholesterol, weight and absolute CVD risk were evaluated. Baseline risk factors for CVD were highly prevalent. Participants required low (43%), moderate (34%) or high (23%) levels of surveillance and management according to GARDIAN criteria. Clinically significant changes in 326 (76%) participants were observed. Average BP decreased by 4 mmHg (systolic) and 1 mmHg (diastolic), weight by almost 1 kg, total cholesterol by 0.6 mmol/l and body mass index (BMI) by 0.3 kg/m(2). A change in absolute CVD risk scores of -0.4% was observed. Primary physician attendance independently predicted improvements in BP (odds ratio (OR) 1.67 95% confidence interval (CI) 1.08-2.58, p=0.022) whereas GARDIAN status, age, physical activity and nurse guidance positively influenced cholesterol, absolute CVD risk and weight outcomes. The feasibility and short-term benefits of a dedicated "heart health" service for high risk regional-dwelling in iduals was shown.
Publisher: Wiley
Date: 08-2011
Abstract: To describe the rationale and design of the Which Heart failure Intervention is most Cost-effective & consumer friendly in reducing Hospital care (WHICH?) trial. WHICH? is a pragmatic, multicentre, randomized controlled trial that seeks to determine if multidisciplinary management of chronic heart failure (CHF) patients post-acute hospitalization delivered in a patient's own home is superior to care delivered via a specialist CHF outpatient clinic. The composite primary endpoint is all-cause, unplanned recurrent hospitalization or death during 12-18 months of follow-up. Of 688 eligible patients, 280 patients (73% male and 66% principal diagnosis of CHF) with a mean age of 71 ± 14 years have been randomized to home- (n = 143) or clinic-based (n = 137) post-discharge management. This will provide 80% power (two-sided alpha of 0.05) to detect a 15% absolute difference in both the primary end-point and rate of all-cause hospital stay. Preliminary data suggest that the two groups are well matched in nearly all baseline socio-economic and clinical parameters. The majority of patients have significant co-morbidity, including hypertension (63%), coronary artery disease (55%), and atrial fibrillation (53%) with an accordingly high Charlson Index of Comorbidity Score (6.1 ± 2.4). Despite its relatively small size, the WHICH? trial is well placed to examine the relative impact of two of the most commonly applied forms of face-to-face management designed to reduce recurrent hospitalization and prolong survival in CHF patients.
Publisher: Public Library of Science (PLoS)
Date: 25-03-2014
Publisher: BMJ
Date: 12-01-2013
DOI: 10.1136/HEARTJNL-2012-303182
Abstract: We examined cognitive function in older hospitalised patients with chronic atrial fibrillation (AF). A prospective substudy of a multicentre randomised trial of an AF-specific disease management intervention (the Standard versus Atrial Fibrillation spEcific managemenT studY SAFETY). Three tertiary referral hospitals within Australia. A total of 260 patients with chronic AF: mean age 72±11 years, 53% men, mean CHA2DS2-VASc score 4±2. Cognitive function was assessed at baseline (during inpatient stay) using the Montreal Cognitive Assessment (MoCA). The extent of mild cognitive impairment (MCI-defined as a MoCA score <26) in AF patients and identification of independent predictors of MCI. Overall, 169 patients (65%, 95% CI 59% to 71%) were found to have MCI at baseline (mean MoCA score 21±3). Multiple deficits in cognitive domains were identified, most notably in executive functioning, visuospatial abilities and short-term memory. Predictors of MCI (age and sex-adjusted) were lower education level (technical/trade school level OR 6.00, 95% CI 2.07 to 17.42 <8 years school education OR 5.29, 95% CI 1.95 to 14.36 vs 8-13 years), higher CHA2DS2-VASc score (OR 1.46, 95% CI 1.23 to 1.74) and prescribed digoxin (OR 2.19, 95% CI 1.17 to 4.10). MCI is highly prevalent amongst typically older high-risk patients hospitalised with AF. Routine assessment of cognitive function with adjustment of clinical management is indicated for this patient group.
Publisher: Oxford University Press (OUP)
Date: 11-2011
Publisher: Oxford University Press (OUP)
Date: 14-08-2016
Abstract: Atrial fibrillation (AF) is the most common cardiac arrhythmia managed in clinical practice. Maintenance of intended rate or rhythm control following hospitalisation is a key therapeutic goal. The purpose of this study was to assess post-discharge maintenance of intended AF control and classify potentially predictive heart rate (HR) phenotypes via electrocardiogram (ECG) Holter monitoring. In a sub-study of a multicentre randomised controlled trial comparing AF-specific management with usual care, 24-hour ECG Holter monitoring was undertaken in 133 patients 7-14 days post-discharge. Intended rate and rhythm control were compared to Holter data. Analysis of the frequency distribution of mean hour-to-hour differences identified those with labile HRs. Mean age was 71 ± 10 years, 67 (50%) were male and mean HR was 72 ± 14 bpm. Most (89%) had persistent AF (median time in AF=39% (IQR 0-100%)). Uncontrolled HR (>90 bpm for >10% of recording) occurred in 35 (26%) patients and 49 (37%) patients did not achieve their intended rate (n=26) or rhythm control (n=23). Patients in the upper quartile of mean hour-to-hour HR variability were identified as persistently labile (n=33). A further group (n=22) with periodically labile HRs was identified. Those with coronary artery disease (OR 0.34 95% CI 0.13-0.91, p=0.033) or renal disease/dysfunction (OR 0.24 95% CI 0.06-0.98, p=0.047) were less likely to demonstrate HR stability (n=78). Post-discharge ECG Holter monitoring of AF patients represents a valuable tool to identify deviations in intended rhythm/rate control and adjust therapeutic management accordingly. It may also identify in iduals who demonstrate labile HRs.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2013
DOI: 10.1161/CIRCOUTCOMES.111.000006
Abstract: We examined the impact of a prolonged secondary prevention program on recurrent hospitalization in cardiac patients with private health insurance. The Young at Heart multicenter, randomized, controlled trial compared usual postdischarge care (UC) with nurse-led, home-based intervention (HBI). The primary end point was rate of all-cause hospital stay (31.5±7.5 months follow-up). In total, 602 patients (aged 70±10 years, 72% men) were randomized to UC (n=296) or HBI (n=306, 96% received ≥1 home visit). Overall, 42 patients (7.0%) died, and 492 patients (82%) accumulated 2397 all-cause hospitalizations associated with 10 258 hospital days costing $17 million. There were minimal group differences (HBI versus UC) in the primary end point of all-cause hospital stay (5405 versus 4853 days median [interquartile range], 0.08 [0.03–0.17] versus 0.07 [0.03–0.13] atient per month). There were similar trends with respect to all hospitalizations (1197 versus 1200 P =0.802) and associated costs ($8.66 versus $8.58 million P =0.375). At 2 years, however, more HBI versus UC (39% versus 27% odds ratio, 1.67 95% confidence interval, 1.15–2.41 P =0.007) patients were assessed as stable and optimally managed. For women, HBI outcomes were predominantly worse than UC outcomes. In men, HBI was associated with reduced risk of cardiovascular hospitalization (adjusted hazard ratio, 0.68 95% confidence interval, 0.46–0.99 P =0.044) with less cardiovascular hospitalizations (192 versus 269 P =0.054) and costs ($2.49 versus $3.53 million P =0.046). HBI did not reduce recurrent all-cause hospitalization compared with UC in privately insured cardiac patients overall. However, it did convey some benefits in cardiac outcomes for men. Australian New Zealand Clinical Trials Registry Unique Identifier: 12608000014358. URL: www.anzctr.org.au/trial_view.aspx?id=82509 .
Publisher: Elsevier BV
Date: 04-2015
Publisher: Clinics Cardive Publishing
Date: 18-07-2012
Publisher: Oxford University Press (OUP)
Date: 07-12-2009
Abstract: Little is known on the incidence and clinical characteristics of newly diagnosed rheumatic heart disease (RHD) in adulthood from urban African communities in epidemiologic transition. Chris Hani Baragwanath Hospital services the black African community of 1.1 million people in Soweto, South Africa. A prospective, clinical registry captured data from all de novo cases of structural and functional valvular heart disease (VHD) presenting to the Cardiology Unit during 2006/07. We describe in detail all cases with newly diagnosed RHD. There were 4005 de novo presentations in 2006/07 and 960 (24%) had a valvular abnormality. Of these, 344 cases (36%) were diagnosed with RHD. Estimated incidence of new cases of RHD for those aged >14 years in the region was 23.5 cases/100 000 per annum. Most were black African females (n = 234-68%) with a similar age profile to males [median 41 (interquartile range 30-55) years vs. 42 (interquartile range 31-55) years]. The predominant valvular lesion (n = 204, 59%) was mitral regurgitation (MR), with 48 (14%) and 43 (13%) cases, respectively, having combination lesions of aortic plus MR and mixed mitral VHD. Impaired systolic function was found in 28/204 cases (14%) of predominant MR and in 23/126 cases (18%) with predominant aortic regurgitation. Elevated right ventricular systolic pressure >35 mmHg (62 cases), atrial fibrillation (34 cases), and anaemia (27 cases) were found in 18, 10, and 8% of 344 RHD cases, respectively. Subsequent valve replacement/repair was performed in 75 patients (22%). A total of 90 cases (26%) were admitted within 30 months of initial diagnosis for suspected bacterial endocarditis. These data reveal a high incidence of newly diagnosed RHD within an adult urban African community. These data argue strongly for the first episode of RHD to be made a notifiable condition in high burden countries in order to ensure control of the disease through register-based secondary prophylaxis programmes.
Publisher: Elsevier BV
Date: 02-2008
DOI: 10.1016/J.IJCARD.2006.12.045
Abstract: Although pulmonary arterial hypertension (PAH) is widely accepted as deadly, if not a rare disease, its prognostic impact beyond reports from specialist centres is unknown. Using the unique Scottish Morbidity Record Scheme and linked survival data, we tracked the survival of all Scottish adults aged < or =65 years admitted for the first time during the period of 1986 to 2001 with a probable diagnosis of Idiopathic PAH and a PAH related to connective tissue disorders (Connective PAH) and congenital abnormalities (Congenital PAH) - the three most common forms of PAH. Overall, 374 Scottish men and women were discharged from the hospital with incident PAH during the period 1986 to 2001. On an unadjusted basis, Congenital PAH (40-45%) was associated with the lowest case fatality at 5 years in both men and women. In both sexes, Idiopathic PAH and Connective PAH were associated with high initial one-year case fatality (20-30%) with a steady accumulation of fatal events in the four years thereafter (60-75% case fatality at 5 years). Overall, the adjusted risk of dying within one year in the period 1986 to 1989 was 2.22-fold greater (OR 95% CI, 1.27 to 3.85) than in 1998 to 2001 (P<0.001). The greatest falls in one year case fatality were seen in those with Connective PAH (18-fold increased risk of dying in 1986 to 1989 versus 1998 to 2001: P=0.013). Similarly, women (adjusted OR 1.38, 95% CI 1.16 to 1.63: P<0.001) and the most deprived in iduals (OR 2.38, 95% CI 1.17 to 4.82: P<0.05) were at greater risk of dying within 5 years. Alternatively, those patients discharged in 1997 were less likely to die during this period compared to their 1986 counterparts, although this difference did not quite reach statistical significance (OR 0.45, 95% CI 0.22 to 1.06: P=0.056). This population-based study has confirmed the deadly impact of the three most common forms of PAH. Overall, there are encouraging trends in relation to one and five year adjusted survival rates particularly in relation to PAH related to connective tissue disorders.
Publisher: Elsevier BV
Date: 06-2008
DOI: 10.1016/J.IJCARD.2007.04.040
Abstract: The aim of this study was to determine the impact of fenofibrate therapy on health care costs in middle-aged patients with type II diabetes at high risk of future cardiovascular events. We undertook an economic analysis of the FIELD study conducted from the perspective of the third party payer (direct costs) with all "within trial" health care costs derived from reported clinical outcomes using pooled data from all 9795 study participants. All analyses were performed on an intention-to-treat-basis and items of expenditure were derived from 2001/2002 health economic data: comparing Diagnostic Related Groupings (DRG) costs of major morbid events from an average of unit costs derived from three European countries (UK, France and Germany). Despite the additional cost of applying fenofibrate therapy, that was off-set slightly by a reduced need for supplementary lipid-lowering therapy (a net cost increase of 20,495 Euros per 1000 person years to apply combined lipid-lowering therapy), fenofibrate was associated with a net saving of 23,607 Euros in health care costs per 1000 person years of follow-up. This represents an approximate 10% net saving in health care costs (total of 227,111 versus 203,415 Euros for the placebo and treatment groups, respectively). As such, based on the 95% CI calculated for observed event rates per 1000 person years at risk, the cost impact of fenofibrate therapy ranged from a 24% net saving to a 4% net increase in health care costs relative to treatment with placebo. When the highest compared to lowest DRG unit costs were applied to observed event rates, the cost impact of fenofibrate therapy varied from a 5% to 12% net saving (low versus high cost health care models) in health care costs relative to usual care. The robust nature of these analyses suggest potential cost advantages in the longer-term by applying fenofibrate in this type of patient cohort (quite possibly in combination with statin therapy) via a marked reduction in costly cardiac events and procedures.
Publisher: Oxford University Press (OUP)
Date: 16-05-2015
Abstract: The reported cost effectiveness of cardiovascular disease management programs (CVD-MPs) is highly variable, potentially leading to different funding decisions. This systematic review evaluates published modeled analyses to compare study methods and quality. Articles were included if an incremental cost-effectiveness ratio (ICER) or cost-utility ratio (ICUR) was reported, it is a multi-component intervention designed to manage or prevent a cardiovascular disease condition, and it addressed all domains specified in the American Heart Association Taxonomy for Disease Management. Nine articles (reporting 10 clinical outcomes) were included. Eight cost-utility and two cost-effectiveness analyses targeted hypertension (n=4), coronary heart disease (n=2), coronary heart disease plus stoke (n=1), heart failure (n=2) and hyperlipidemia (n=1). Study perspectives included the healthcare system (n=5), societal and fund holders (n=1), a third party payer (n=3), or was not explicitly stated (n=1). All analyses were modeled based on interventions of one to two years' duration. Time horizon ranged from two years (n=1), 10 years (n=1) and lifetime (n=8). Model structures included Markov model (n=8), 'decision analytic models' (n=1), or was not explicitly stated (n=1). Considerable variation was observed in clinical and economic assumptions and reporting practices. Of all ICERs/ICURs reported, including those of subgroups (n=16), four were above a US$50,000 acceptability threshold, six were below and six were dominant. The majority of CVD-MPs was reported to have favorable economic outcomes, but 25% were at unacceptably high cost for the outcomes. Use of standardized reporting tools should increase transparency and inform what drives the cost-effectiveness of CVD-MPs.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2013
Publisher: AMPCo
Date: 2015
DOI: 10.5694/MJA14.00238
Abstract: To estimate the current and future prevalence of atrial fibrillation (AF) in the Australian adult population according to age and sex. Application of international AF prevalence statistics to Australian adult population data (for people ≥ 55 years) to estimate population prevalence use of population projections to estimate potential future prevalence of AF. Estimated prevalence of AF in 2014 and future prevalence projected to 2034. We estimated that at 30 June 2014 there would be 328,562 cases of AF among people aged ≥ 55 years (a prevalence of 5.35% 95% CI, 3.79%-7.53%), comprising 174,986 men (prevalence, 5.97% 95% CI, 4.11%-8.54%) and 153,576 women (prevalence, 4.79% 95% CI, 3.50%-6.60%). Without significant changes to the natural history of AF, by 2034 this figure is projected to rise to over 600,000 (prevalence, 6.39% 95% CI, 4.56%-8.90%), with a prevalence of 7.22% among men (95% CI, 4.99%-10.28%) and 5.64% (95% CI, 4.18%-7.64%) among women. The greatest projected regional increase in prevalence between 2014 and 2034 is expected in Queensland, with a likely twofold increase (from 61,613 cases to 123,142 cases), although New South Wales cases will remain predominant, with a 1.7-fold increase (from 110 892 to 191 578). We also predicted that between 2014 and 2034 the number of AF cases would double among older age groups (from 200 638 to 414 377 in iduals aged ≥ 75 years) and would increase 2.5-fold among men aged ≥ 85 years (from 29 370 to 71 582). These data are indicative of a largely underappreciated AF prevalence in Australia. They mandate a more systematic effort to both understand and respond to an evolving AF burden.
Publisher: Public Library of Science (PLoS)
Date: 08-10-2015
Publisher: Wiley
Date: 04-2014
DOI: 10.1111/IMJ.12377
Abstract: Weight gain and hypoglycaemia are common adverse effects associated with anti-diabetic treatments. Our aim was to evaluate the long-term effects of adjunctive exenatide therapy on weight loss and glycaemic control in patients with type 2 diabetes. A review of medical records in a specialist diabetes clinic over 5 years identified 446 patients who were prescribed exenatide therapy. We examined change in glycosylated haemoglobin (HbA1c), weight, albumin-creatinine ratio and hypoglycaemic medication during 24 months follow up. Subjects were aged 59 ± 10 years (49% women) and received exenatide in combination with oral agents and insulin (47%). During an average of 17 ± 14 months follow up, 51% (more women than men odds ratio 1.69, 95% confidence interval 1.14–2.49) remained on treatment. Lack of efficacy (33%) and/or gastrointestinal (27%) side-effects were the main reasons for treatment cessation. At 24 months, there was a reduction in HbA1c of 0.7 ± 1.2% and weight loss of 4.3 ± 5.2 kg. Change in HbA1c was similar regardless of concurrent insulin therapy, yet insulin was associated with greater weight reduction (4.8 ± 5.3 vs 3.8 ± 5.1 kg, P = 0.016). Independent predictors of HbA1c response were higher baseline HbA1c, longer duration of diabetes and use of insulin or sulfonylureas at study end. Predictors of weight response were baseline use of insulin or thiazolidinediones, increased age, female sex and sulfonylurea or thiazolidinediones at study end. Longer exenatide treatment duration was favourable for reducing HbA1c and weight. Exenatide is effective in reducing HbA1c and weight, regardless of concurrent insulin, and in a specialist diabetes outpatient clinic, is recommended for use in clinical practice.
Publisher: Elsevier BV
Date: 10-2012
DOI: 10.1016/J.JACC.2012.06.025
Abstract: The goal of this study was to make a head-to-head comparison of 2 common forms of multidisciplinary chronic heart failure (CHF) management. Although direct patient contact appears to be best in delivering CHF management overall, the precise form to optimize health outcomes is less clear. This prospective, multicenter randomized controlled trial with blinded endpoint adjudication comprised 280 hospitalized CHF patients (73% male, age 71 ± 14 years, and 73% with left ventricular ejection fraction ≤45%) randomized to home-based intervention (HBI) or specialized CHF clinic-based intervention (CBI). The primary endpoint was all-cause, unplanned hospitalization or death during 12- to 18-month follow-up. Secondary endpoints included type/duration of hospitalization and healthcare costs. The primary endpoint occurred in 102 of 143 (71%) HBI versus 104 of 137 (76%) CBI patients (adjusted hazard ratio [HR]: 0.97 [95% confidence interval (CI): 0.73 to 1.30], p = 0.861): 96 (67.1%) HBI versus 95 (69.3%) CBI patients had an unplanned hospitalization (p = 0.887), and 31 (21.7%) versus 38 (27.7%) died (p = 0.252). The median duration of each unplanned hospitalization was significantly less in the HBI group (4.0 [interquartile range (IQR): 2.0 to 7.0] days vs. 6.0 [IQR: 3.5 to 13] days p = 0.004). Overall, 75% of all hospitalization was attributable to 64 (22.9%) patients, of whom 43 (67%) were CBI patients (adjusted odds ratio: 2.55 [95% CI: 1.37 to 4.73], p = 0.003). HBI was associated with significantly fewer days of all-cause hospitalization (-35% p = 0.003) and from cardiovascular causes (-37% p = 0.025) but not for CHF (-24% p = 0.218). Consequently, healthcare costs ($AU3.93 vs. $AU5.53 million) were significantly less for the HBI group (median: $AU34 [IQR: 13 to 81] per day vs. $AU52 [17 to 140] per day p = 0.030). HBI was not superior to CBI in reducing all-cause death or hospitalization. However, HBI was associated with significantly lower healthcare costs, attributable to fewer days of hospitalization. (Which Heart failure Intervention is most Cost-effective & consumer friendly in reducing Hospital care [WHICH?] ACTRN12607000069459).
Publisher: Wiley
Date: 21-04-2015
DOI: 10.1002/EJHF.272
Abstract: The aim of this study was to determine the effectiveness of a long-term, nurse-led, multidisciplinary programme of home/clinic visits in preventing progressive cardiac dysfunction in in iduals at risk of developing de novo chronic heart failure (CHF). A pragmatic, single-centre (tertiary-referral hospital with specialist cardiological services), open-label, randomized controlled trial with blinded endpoint adjudication was carried out. In total, 624 cardiac inpatients (66 ± 11 years, 71% male, and 70% with CAD) were randomly allocated (1:1) to standard care or the study intervention. The intention-to-treat cohort comprised 310 standard care and 301 intervention participants. During 51.0 ± 8.2 months follow-up, 38/310 (12%) standard care [mean event-free survival 1865 days, 95% confidence interval (CI) 1817-1913 days] vs. 41/301 (14%) intervention participants (1855 days, 95% CI 1804-1906 days) experienced the primary composite endpoint of de novo CHF hospitalization or all-cause mortality (P = 0.574). Although there were no statistically significant differences in the rate of cardiovascular-related and emergency hospitalizations, the NIL-CHF (Nurse-led Intervention for Less Chronic Heart Failure) group accumulated 478 (0.214 ± 0.70 vs. 0.095 ± 0.284 days articipant/month P = 0.052) and 1097 fewer days of hospital stay (0.391 ± 1.80 vs. 0.199 ± 0.47 days articipant/month P = 0.023), respectively, compared with standard care. The intervention group also showed better cardiac recovery on echocardiography at 3 years [81/226 (35.8%) vs. 56/225 (24.9%), odds ratio 1.44, 95% CI 1.08-1.92, P = 0.011]. Relative to a high level of standard care, the NIL-CHF intervention was ineffective in preventing CHF and rehospitalization. On the other hand, it was associated with reduced hospital stay and improved cardiac function over the long term. Australian New Zealand Clinical Trials Registry (No. 12608000022369).
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.IJCARD.2012.12.093
Abstract: Atrial fibrillation (AF) represents an increasing public health challenge with profound social and economic implications. A comprehensive synthesis and review of the AF literature was performed. Overall, key findings from 182 studies were used to describe the indicative scope and impact of AF from an in idual to population perspective. There are many pathways to AF including advancing age, cardiovascular disease and increased levels of obesity/metabolic disorders. The reported population prevalence of AF ranges from 2.3%-3.4% and historical trends reflect increased AF incidence. Estimated life-time risk of AF is around 1 in 4. Primary care contacts reflect whole population trends: AF-related case-presentations increase from less than 0.5% in those aged 40 years or less to 6-12% for those aged 85 years or more. Globally, AF-related hospitalisations (primary or secondary diagnosis) showed an upward trend (from ~35 to over 100 admissions/10,000 persons) during 1996 to 2006. The estimated cost of AF is greater than 1% of health care expenditure and rising with hospitalisations the largest contributor. For affected in iduals, quality of life indices are poor and AF confers an independent 1.5 to 2.0-fold probability of death in the longer-term. AF is also closely linked to ischaemic stroke (3- to 5-fold risk), chronic heart failure (up to 50% develop AF) and acute coronary syndromes (up to 25% develop AF) with consistently worse outcomes reported with concurrent AF. Future projections predict at least a doubling of AF cases by 2050. AF represents an evolving, global epidemic providing considerable challenges to minimise its impact from an in idual to whole society perspective.
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1016/J.IJCARD.2009.06.003
Abstract: Recent national data of cardiovascular disease (CVD) risk factors in Australia are limited. Therefore this study sought to gain a contemporary snapshot of the blood pressure (BP) profile of Australian adults. We established 100 metropolitan and regional screening sites. Using a standardized protocol and the same automated, validated BP monitor, Registered Nurses recorded the BP and other risk factors for CVD of self-selected volunteers on a single day. A total of 13,825 subjects (55% female, aged 48±16 years) were assessed. Mean systolic and diastolic BP was 131±18 and 79±12 mm Hg. Overall, 34% had an elevated BP while 10% being treated for hypertension (HT) were normotensive (combined total 44%). Elevated BP was more common in older in iduals, men (42% versus 27% of women), regional dwelling residents (40% versus 32% of metropolitan) and people from lower socio-economic backgrounds (39% versus 30% of higher). Overall, 50% of subjects with a history of HT had elevated BP compared to 30% without a history of HT. Adjusting for age and sex, elevated BP was independently associated with obesity (OR: 1.77, 95% CI 1.52-2.06), regional location (OR: 1.32, 95% CI 1.19-1.45) and modifiable risk factors (OR: 1.28, 95% CI 1.21-1.35) those being treated for CVD or diabetes are less likely to have high BP. In the largest study of its kind in Australia, the findings highlight the need for continued vigilance to detect, monitor and prevent elevated BP within an ageing population in whom metabolic disorders are becoming more frequent.
Publisher: Public Library of Science (PLoS)
Date: 07-03-2013
Publisher: Wiley
Date: 27-08-2003
DOI: 10.1046/J.1365-2869.2003.00364.X
Abstract: Heart rate (HR), blood pressure (BP) and autonomic nervous system (ANS) activity vary diurnally, with a reduction in HR and BP, and a shift to vagal dominance during the dark phase. However, the cause of these changes, particularly the relative influence of sleep and circadian mechanisms, remains uncertain. The present study assessed the effect of sleep onset on HR, BP, high frequency (HF) component of heart rate variability (HRV), low frequency/high frequency (LF/HF) ratio and pre-ejection period (PEP). Sleep onset was dissociated from circadian influences by having subjects go to sleep at two different circadian phases, their normal time of sleep onset (normal sleep onset, NSO), and after a delay of 3 h (delayed sleep onset, DSO). The assumption was that changes caused by sleep onset would occur in association with sleep onset, irrespective of its timing, while circadian effects would have a consistent circadian phase and be independent of when sleep onset occurred. Thirteen and 17 subjects were run in the NSO and DSO conditions, respectively. Following a 1-h adaptation period, data collection began 2 h before subjects' normal time of sleep onset and continued until morning awakening. The lights were turned out after 2 h in the NSO condition and 5 h in the DSO condition. Subjects were required to maintain a supine position throughout the experimental sessions. The night-time decrease in HR was found to be due to both sleep onset and a circadian influence, with the circadian component being more prominent. In contrast, the fall in BP was largely due to a sleep onset effect. Increased vagal activity, as reflected in the HF component and a shift to vagal dominance in the LF/HF ratio, appeared to be primarily a function of the sleep system, while sympathetic activity, as assessed by PEP, reflected a circadian influence.
Publisher: Oxford University Press (OUP)
Date: 29-06-2013
Abstract: A sustained epidemic of cardiovascular disease and related risk factors is a global phenomenon contributing significantly to premature deaths and costly morbidity. Preventative strategies across the full continuum of life, from a population to in idual perspective, are not optimally applied. This paper describes a simple and adaptable 'traffic-light' system we have developed to systematically perform in idual risk and need delineation in order to 'titrate' the intensity and frequency of healthcare intervention in a cost-effective manner. The GARDIAN (Green Amber Red Delineation of Risk and Need) system is an in idual assessment of risk and need that modulates the frequency and intensity of future healthcare intervention. In idual assessment of risk and need for ongoing intervention and support is determined with reference to three domains: (1) clinical stability, (2) gold-standard management, and (3) a broader, holistic assessment of in idual circumstance. This can be applied from a primary prevention, secondary prevention, or chronic disease management perspective. Our experience with applying and validating GARDIAN to titrate healthcare resources according to need has been extensive to date, with >5000 in iduals profiled in a host of clinical settings. A series of clinical randomized trials will determine the impact of the GARDIAN system on important indices of healthcare utilization and health status. The GARDIAN model to delineating risk and need for varied intensity of management shows strong potential to cost effectively improve health outcomes for both in iduals at risk of heart disease and those with established heart disease.
Publisher: Elsevier BV
Date: 2012
DOI: 10.1016/J.IJCARD.2010.08.071
Abstract: Disease management programs have been shown to improve health outcomes in high risk in iduals in many but not all health care systems. Young @ Heart is a multi-centre, randomised controlled study of a nurse-led, home-based intervention (HBI) program vs. usual care (UC) in privately insured patients in Australia aged ≥ 45 years following an acute cardiac admission. Intensity of HBI is tailored to an in idual's clinical stability, management and risk profile. The primary endpoint is the rate of all-cause stay during a mean of 2.5 years follow-up. A target of 602 adults (72% men) were randomised to HBI (n=306) or UC (n=296) their initial profiles being well matched. At baseline, 71% were overweight (body mass index 29.7 ± 3.9 kg/m(2)) and 66% had an elevated blood pressure (153 ± 18/89 ± 7 mm Hg). Over half had a history of smoking and 39% had a sub-optimal total cholesterol level >4 mmol/L. Overall, 62% (376 cases) were treated for coronary artery disease (27% with multi-vessel disease and 39% underwent cardiac revascularisation). A further 20% (120 cases) were treated for a cardiac arrhythmia (predominantly atrial fibrillation) and 19% type 2 diabetes mellitus. At 7-14 days post-discharge, 293 (96%) HBI patients received a home visit triggering urgent clinical review and/or enhanced clinical management in many patients. The Young @ Heart intervention is a well accepted and potentially effective intervention to reduce recurrent hospital stay in privately insured cardiac patients in Australia.
Publisher: Elsevier BV
Date: 02-2009
DOI: 10.1016/J.IJCARD.2007.11.067
Abstract: There is strong anecdotal evidence that many urban communities in Sub-Saharan Africa are in epidemiologic transition with the subsequent emergence of more affluent causes of heart disease. However, data to describe the risk factor profile of affected communities is limited. During 9 community screening days undertaken in the predominantly Black African community of Soweto, South Africa (population 1 to 1.5 million) in 2006-2007, we examined the cardiovascular risk factor profile of volunteers. Screening comprised a combination of self-reported history and a clinical assessment that included calculation of body mass index (BMI), blood pressure and random blood glucose and total cholesterol levels. In total, we screened a total of 1691 subjects (representing almost 0.2% of the total population). The majority (99%) were Black African, there were more women (65%) than men and the mean age was 46+/-14 years. Overall, 78% of subjects were found to have >or=1 major risk factor for heart disease. By far the most prevalent risk factor overall was obesity (43%) with significantly more obese women than men (23% versus 55%: OR 1.76 95% CI 1.62 to 1.91: p<0.001). A further 33% of subjects had high blood pressures (systolic or diastolic) and 13% an elevated (non-fasting) total blood cholesterol level: no statistically significant differences between the sexes were found. There was a positive correlation between increasing BMI and other risk factors including elevated systolic (r(2)=0.046, p<0.001) and diastolic blood pressure (r(2)=0.032, p<0.001) with overweight subjects three times more likely to have concurrent hypercholesterolemia (OR 3.3, 95% CI 2.1 to 5.3: p<0.01). These unique pilot data strongly suggest a high prevalence of related risk factors for heart disease in this urban black African population in epidemiologic transition. Further research is needed to confirm our findings and to determine their true causes and potential consequences.
Publisher: American Physiological Society
Date: 02-2005
DOI: 10.1152/JAPPLPHYSIOL.00702.2004
Abstract: Blood pressure (BP) and heart rate (HR) are influenced by the sleep-wake cycle, with relatively abrupt falls occurring in association with sleep onset (SO). However, the pattern and rate of fall in BP and HR during SO and the processes that contribute to the fall in these variables have not been fully identified. Continuous BP and HR recordings were collected beginning 1 h before lights out (LO) until the end of the first non-rapid eye movement sleep period in 21 young, healthy participants maintained in a supine position. Five consecutive phases were defined: 1) the 30 min of wakefulness before LO 2) LO to stage 1 sleep 3) stage 1 to stage 2 sleep 4) stage 2 sleep to the last microarousal before stable sleep and 5) the first 30 min of undisturbed stable sleep. The data were analyzed on a beat-by-beat basis and reported as 2-min periods for phases 1 and 5 and 10% epochs for phases 2, 3, and 4 (as participants had variable time periods in these phases). The level of baroreflex (BR) activity was assessed by the sequence technique and an autoregressive multivariate model. Furthermore, during phases 3 and 4, the BP and HR responses to arousal from sleep were determined. There were substantial falls in BP and HR after LO before the initial onset of θ-activity (phase 3) and again after the onset of stable sleep after the cessation of spontaneous arousals. During phases 3 and 4 when there were repeated arousals from sleep, the fall in both variables was retarded. Furthermore, both the rate and magnitude of the fall in BP were negatively associated with the number of arousals during phases 3 and 4. There was a small increase in the sensitivity of the BR and indirect evidence of a substantial fall in its set point.
Publisher: BMJ
Date: 20-11-2012
DOI: 10.1136/BMJ.E7156
Publisher: Informa UK Limited
Date: 14-05-2015
DOI: 10.1586/14737167.2015.1046842
Abstract: Substantial variation in economic analyses of cardiovascular disease management programs hinders not only the proper assessment of cost-effectiveness but also the identification of heterogeneity of interest such as patient characteristics. The authors discuss the impact of reporting and methodological variation on the cost-effectiveness of cardiovascular disease management programs by introducing issues that could lead to different policy or clinical decisions, followed by the challenges associated with net intervention effects and generalizability. The authors conclude with practical suggestions to mitigate the identified issues. Improved transparency through standardized reporting practice is the first step to advance beyond one-off experiments (limited applicability outside the study itself). Transparent reporting is a prerequisite for rigorous cost-effectiveness analyses that provide unambiguous implications for practice: what type of program works for whom and how.
Publisher: Wiley
Date: 16-07-2013
DOI: 10.1111/JCH.12164
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2009
Publisher: Elsevier BV
Date: 12-2011
DOI: 10.1016/J.IJCARD.2010.12.055
Abstract: The Valstartan Intensified Primary CarE Reduction of Blood Pressure Study (VIPER-BP) Study is an open-label, randomised controlled trial comparing usual primary care management with an intensive BP management strategy using three forms of valsartan-based therapy (mono-therapy, thiazide diuretic or calcium channel blocker combinations) to achieve in idualised BP control. To identify the features of General Practitioner (GP) management of hypertension in Australia, we analyse the response to a case scenario-based survey of 500 GPs. We subsequently recruited a national cohort of GP Investigators to enrol up to 2500 patients into the VIPER-BP Study. GP responses clearly demonstrated that, compared to the VIPER-BP intervention, a heterogeneous approach to the primary care management of hypertension persists in Australia. By November 2010, 2157 hypertensive patients from 272 actively recruiting GP Investigators were enrolled into the study. Of these, 1965 (91%) patients were entered into a standardised "run-in" phase of 28 days of valsartan 80 mg/day. Subsequently, 1285 patients were randomised to usual care (n=435) or the VIPER-BP intervention (n=850). There was a predominance of males (62%), whilst 55% had pre-existing diabetes or cardiovascular disease and 63% had been previously treated for hypertension. Mean systolic and diastolic BP on randomisation for men and women, respectively, was 148 ± 15/88 ± 11 and 148 ± 18/87 ± 10 mm Hg. In contrast to typical primary care management of hypertension, VIPER-BP combines more intensive and aggressive therapies with structured management to more rapidly attain and sustain in idualised BP targets in hypertensive patients.
Publisher: American Psychological Association (APA)
Date: 10-2009
DOI: 10.1037/A0017080
Abstract: Existing literature on reward motivation pays scant attention to the fact that reward potential of the environment varies dramatically with the light/dark cycle. Evolution, by contrast, treats this fact very seriously: In all species, the circadian system is adapted to optimize the daily rhythm of environmental engagement. We used 3 standard protocols to demonstrate that human reward motivation, as measured in the dynamics of positive affect (PA), is modulated endogenously by the circadian clock. Under naturalistic conditions, 13.0% of PA variance was explained by a 24-hr sinusoid. In a constant routine protocol, 25.0% of PA variance was explained by the unmasked circadian rhythm in core body temperature (CBT). A forced desynchrony study showed PA to align with CBT in exhibiting circadian periodicity independent of a 28-hr sleep/wake cycle. It is concluded that the circadian system modulates reward activation, and implications for models of normal and abnormal mood are discussed.
Publisher: Wiley
Date: 10-2011
Abstract: Preliminary data suggest that right heart failure (RHF) may be more common in urban Africans than first suspected. We examined the characteristics and pathways to RHF in the Heart of Soweto cohort. A clinical registry captured data from 5328 de novo presentations of heart disease to the Cardiology Unit, Chris Hani Baragwanath Hospital in Soweto, South Africa during 2006-08. Of 2505 cases of HF (47% of total cohort), 697 (28%) were diagnosed with RHF (50% primary diagnosis). Despite more females than males (379 vs. 318 cases), proportionately more men presented with RHF [15 vs. 12% of cases odds ratios (OR) 1.27, 95% confidence intervals (CI) 1.08-1.49] and Africans predominated overall (n= 642, 92%). Apart from concurrent left-sided heart disease (213 cases, 31%) there were many pathways to RHF including chronic lung disease (179 cases, 26% including COPD and tuberculosis) and 141 cases (20%) of pulmonary arterial hypertension (PAH). On an adjusted basis, women were almost two-fold more likely to present with PAH (OR 1.72, 95% CI 1.17-2.55 P= 0.006) while those with low levels of education (OR 0.69, 95% CI 0.47-1.01 P= 0.054) and originating from Soweto (OR 0.64, 95% CI 0.42-0.96 P= 0.029) were less likely to present with PAH compared with the rest of the cohort. These data suggest cases of RHF and related PAH are relatively common among urban Africans presenting with de novo heart disease.
Publisher: BMJ
Date: 14-07-2014
Publisher: Springer Science and Business Media LLC
Date: 03-09-2012
Abstract: Cardiovascular disease (CVD) is more prevalent in regional and remote Australia compared to metropolitan areas. The aim of Healthy Hearts was to determine age and sex specific CVD risk factor levels and the potential value of national risk clinics. Healthy Hearts was an observational research study conducted in four purposefully selected higher risk communities in regional Victoria, Australia. The main outcome measures were the proportion of participants with CVD risk factors with group comparisons to determine the adjusted likelihood of elevated risk factor levels. Trained personnel used a standardized protocol over four weeks per community to measure CVD risk factor levels, estimate absolute CVD risk and provide feedback and advice. A total of 2125 self-selected participants were assessed (mean age 58 ± 15 years, 57% women). Overall, CVD risk factors were highly prevalent. More men than women had ≥ 2 modifiable CVD risk factors (76% vs. 68%, p .001), pre-existing CVD (20 vs. 15%, p .01) and a major ECG abnormality requiring follow-up (15% vs. 7%, p .001) . Less men reported depressive symptoms compared to women (28% vs. 22%, p .01). A higher proportion of women were obese (adjusted OR 1.36, 95% CI 1.13 to 1.63), and physically inactive (adjusted OR 1.32, 95% CI 1.07 to 1.63). High CVD risk factor levels were confirmed for regional Victoria. Close engagement with in iduals and communities provides scope for the application of regional risk management clinics to reduce the burden of CVD risk in regional Australia.
Publisher: Wiley
Date: 12-02-2009
DOI: 10.1111/J.1365-2702.2008.02507.X
Abstract: Community awareness of the importance of hypercholesterolemia and the need for appropriate therapy is an important part of global efforts to reduce the population burden of cardiovascular disease. The aim of this study was to assess the knowledge and attitudes about cholesterol and to determine adherence to taking cholesterol-lowering medication among patients at high risk for cardiovascular events. In spite of the availability of lifestyle and medical treatments for lipid management, an estimated 50% of adult Australians (6.4 million) remain at risk for a cardiovascular-related event because they have total blood cholesterol levels which exceed recommended limits. It is within this context that a significant gap remains in meeting cholesterol goals, despite easy to meet targets with readily available therapeutic options. A two-page national self-report postal survey was conducted from August-October 2006. A total of 508 Australian adults previously treated for hypercholesterolemia were surveyed to determine their understanding about cholesterol and their adherence to treatment. The mean age of participants was 67 (SD 10) years (72% male). Many participants (72%) were at risk of a cardiovascular event based on a prior history and 18% had type II diabetes. Participants had been prescribed lipid-lowering therapy (94% statin therapy) for an average of 10 years and visited their general practitioner on average three times per year. For those who knew their most recent cholesterol reading (67%), the total cholesterol was on average 4.5 (SD 1.1) mmol/l. This level was above the recommended limits for 40% of participants. Overall, 85% of participants reported knowing that there was high- and low-density lipoprotein forms of cholesterol, but only 56% and 38%, respectively, said that they understood or showed signs of clearly understanding the different types of cholesterol when their knowledge was assessed further. On the whole, therefore, participants had a limited understanding about cholesterol and its potential impact on cardiovascular events. Moreover, 25% of participants admitted to being non-compliant in taking their medication and only 51% correctly identified modifiable risk factors as most important for heart disease. Encouragingly, despite 85% of participants finding lifestyle changes challenging, most still identified their potential benefits. This study highlights that there are many unresolved issues in relation to educating high-risk patients who regularly visit their general practitioner to learn about and optimise their cholesterol levels via appropriate treatment and monitoring. There is a need for urgent public education and management by in iduals and the health community. Strategies to address 'cholesterol complacency', in the sense of a willingness to accept sub-optimal standards of cholesterol control at both the patient and healthcare system levels (general practitioners in particular), are urgently needed to truncate an anticipated rising tide of cardiovascular disease in Australia.
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.IJCARD.2014.10.137
Abstract: Clinical factors associated with thromboembolic risk in AF patients are well characterized and include new onset AF. Biochemically, AF is associated with inflammatory activation and impairment of nitric oxide (NO) signalling, which may also predispose to thromboembolism: the bases for variability in these anomalies have not been identified. We therefore sought to identify correlates of impaired platelet NO signalling in patients hospitalized with atrial fibrillation (AF), and to evaluate the impact of acuity of AF. 87 patients hospitalized with AF were evaluated. Platelet aggregation, and its inhibition by the NO donor sodium nitroprusside, was evaluated using whole blood impedance aggregometry. Correlates of impaired NO response were examined and repeated in a "validation" cohort of acute cardiac illnesses. Whilst clinical risk scores were not significantly correlated with integrity of NO signalling, new onset AF was associated with impaired NO response (6 ± 5% inhibition versus 25 ± 4% inhibition for chronic AF, p<0.01). New onset AF was a multivariate correlate (p<0.01) of impaired NO signalling, along with platelet ADP response (p<0.001), whereas the associated tachycardia was not. Platelet ADP response was predicted by elevation of plasma thrombospondin-1 concentrations (p<0.01). Validation cohort evaluations confirmed that acute AF was associated with significant (p<0.05) impairment of platelet NO response, and that neither acute heart failure nor acute coronary syndromes were associated with similar impairment. Recent onset of AF is associated with marked impairment of platelet NO response. These findings may contribute to thromboembolic risk in such patients.
Publisher: Wiley
Date: 13-12-2001
DOI: 10.1046/J.1365-2869.2001.00263.X
Abstract: While there is a developing understanding of the influence of sleep on cardiovascular autonomic activity in humans, there remain unresolved issues. In particular, the effect of time within the sleep period, independent of sleep stage, has not been investigated. Further, the influence of sleep on central sympathetic nervous system (SNS) activity is uncertain because results using the major method applicable to humans, the low frequency (LF) component of heart rate variability (HRV), have been contradictory, and because the method itself is open to criticism. Sleep and cardiac activity were measured in 14 young healthy subjects on three nights. Data was analysed in 2-min epochs. All epochs meeting specified criteria were identified, beginning 2 h before, until 7 h after, sleep onset. Epoch values were allocated to 30-min bins and during sleep were also classified into stage 2, slow wave sleep (SWS) and rapid eye movement (REM) sleep. The measures of cardiac activity were heart rate (HR), blood pressure (BP), high frequency (HF) and LF components of HRV and pre-ejection period (PEP). During non-rapid eye movement (NREM) sleep autonomic balance shifted from sympathetic to parasympathetic dominance, although this appeared to be more because of a shift in parasympathetic nervous system (PNS) activity. Autonomic balance during REM was in general similar to wakefulness. For BP and the HF and LF components the change occurred abruptly at sleep onset and was then constant over time within each stage of sleep, indicating that any change in autonomic balance over the sleep period is a consequence of the changing distribution of sleep stages. Two variables, HR and PEP, did show time effects reflecting a circadian influence over HR and perhaps time asleep affecting PEP. While both the LF component and PEP showed changes consistent with reduced sympathetic tone during sleep, their pattern of change over time differed.
Publisher: Wiley
Date: 22-10-2007
DOI: 10.1111/J.1442-2018.2007.00363.X
Abstract: Cardiovascular disease is the leading cause of death worldwide, with a projected increase in incidence in developed and developing countries. This paper will review the literature on the role of poverty and socioeconomic deprivation in cardiovascular disease and outline ways to tackle poverty. The literature acknowledges the in idual risk factors for cardiovascular disease, but highlights the negative effects of neighborhood deprivation on the incidence of cardiovascular disease and its mortality rates. The studies show that equitable access to health care is not evident and those in less affluent neighborhoods have greater disease incidence and increased mortality and morbidity rates, particularly for angina, myocardial infarction, and heart failure. The approach to reducing disease rates needs to be conducted from an in idual level to the societal level and needs to prevent and treat heart disease (particularly in deprived neighborhoods). Nurses and health professionals must drive health policy so that progress can be achieved in reducing the disease rates.
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.IJCARD.2013.12.026
Abstract: This study assessed the burden and determinants of cardiovascular and metabolic risk in a community s le of high risk Indigenous Australians. Indigenous Australians are over-represented in the most disadvantaged strata of Australian society. The role of psychosocial and socioeconomic factors in patterning cardiometabolic disease in this population is unclear. The Heart of the Heart Study was a cross sectional study of 436 Aboriginal adults from remote, urban and peri-urban communities around Alice Springs (Northern Territory, Australia). Participants underwent detailed assessments of socio-demographic, psychosocial, cardiovascular and metabolic status. In iduals with depression were twice as likely to have cardiovascular disease (OR 2.03 1.07-3.88 p<0.05). Chronic kidney disease (39.7%, 37.2% and 18.2%) and diabetes (28.4%, 34.0% and 19.2%) were more common in peri-urban and remote compared to urban communities. Cardiovascular disease did not vary across locations (p=0.069), but coronary artery disease did (p=0.035 for trend). Unemployed in iduals were more likely to have cardiovascular disease (OR 2.32 1.33-4.06 p<0.001). Socioeconomic gradients in coronary artery disease, all cardiovascular disease and diabetes, as measured by income, operated differentially across locations (p for location/socioeconomic status interactions 0.002 0.01 and 0.04 respectively). Participants had high rates of pre-existing cardiovascular disease, diabetes and chronic kidney disease. Cardiovascular risk in these communities was associated with psychosocial factors and socioeconomic indicators. However, gradients operated differentially across location. These data provide a strong foundation for better understanding key drivers of increased levels of cardiovascular and other common forms of non-communicable disease in Indigenous people.
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.IJCARD.2015.08.066
Abstract: 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. 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. 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. Compared with CBI, HBI is likely to be cost-effective in elderly CHF patients with significant comorbidity.
Publisher: Elsevier BV
Date: 02-2015
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.VACCINE.2018.05.120
Abstract: Vibrio cholera is a major contributor of diarrheal illness that causes significant morbidity and mortality globally. While there is literature on the health economics of diarrheal illnesses more generally, few studies have quantified the cost-of-illness and cost-effectiveness of cholera-specific prevention and control interventions. The present systematic review provides a comprehensive overview of the literature specific to cholera as it pertains to key health economic measures. A systematic review was performed with no date restrictions up through February 2017 in PubMed, Econlit, Embase, Web of Science, and Cochrane Review to identify relevant health economics of cholera literature. After removing duplicates, a total of 1993 studies were screened and coded independently by two reviewers, resulting in 22 relevant studies. Data on population, methods, and results (cost-of-illness and cost-effectiveness of vaccination) were compared by country/region. All costs were adjusted to 2017 USD for comparability. Costs per cholera case were found to be rather low: $1000/case. There is adequate evidence to support the economic value of vaccination for the prevention and control of cholera when vaccination is targeted at high-incidence populations and/or areas with high case fatality rates due to cholera. When herd immunity is considered, vaccination also becomes a cost-effective option for the general population and is comparable in cost-effectiveness to other routine immunizations. Cholera vaccination is a viable short-to-medium term option, especially as the upfront costs of building water, sanitation, and hygiene (WASH) infrastructure are considerably higher for countries that face a significant burden of cholera. While WASH may be the more cost-effective solution in the long-term when implemented properly, cholera vaccination can still be a feasible, cost-effective strategy.
Publisher: Public Library of Science (PLoS)
Date: 29-05-2013
Publisher: BMJ
Date: 09-11-2010
Abstract: Little is known about the incidence and clinical characteristics of newly diagnosed atrial fibrillation/flutter (AF) in urban Africans in epidemiological transition. This observational cohort study was carried out in the Chris Hani Baragwanath Hospital in Soweto South Africa. A clinical registry captured detailed clinical data on all de novo cases of AF presenting to the Cardiology Unit during the period 2006-2008. Overall, 246 of 5328 cardiac cases (4.6%) presented with AF (estimated 5.6 cases/100 000 population/annum). Mean age was 59±18 years and the majority were of African descent (n=211, 86%) and/or female (n=150, 61%). Men were more than twice as likely to smoke (OR 2.88, 95% CI 1.92 to 4.04) than women, but women were twice as likely to be obese (OR 1.80, 95% CI 1.28 to 2.52) than men. Lone AF occurred in 22 (8.9%) cases, while concurrent valve disease and/or functional valvular abnormality occurred in 107 cases (44%). Overall, 171 cases (70%) presented with uncontrolled AF (ventricular rate >90 beats/min) with no sex-based differences. Common co-morbidities were any form of heart failure (56%) and rheumatic heart disease (21%). Women with AF were more likely to present with hypertensive heart failure (OR 2.37, 95% CI 1.24 to 4.54) but less likely to present with a dilated cardiomyopathy (OR 0.42, 95% CI 0.23 to 0.76) or coronary artery disease (OR 0.38, 95% CI 0.14 to 1.02) than men. Mean overall CHADS(2) score (in 195 non-rheumatic cases) was 1.51±0.91 and, despite a similar age profile, women had higher scores than men (1.73±0.94 vs 1.24±0.78 p<0.0001). These unique data suggest that urban Africans in Soweto develop AF at a relatively young age. Conventional strategies used to manage and treat AF need to be carefully evaluated in this setting.
Publisher: BMJ
Date: 11-08-2012
DOI: 10.1136/HEARTJNL-2012-302229
Abstract: Limited strategies have been developed to evaluate and address the alarming discrepancy in early mortality between Indigenous and non-Indigenous populations. To assess heart failure (HF), HF risk factors and document cardiac characteristics in an Australian Aboriginal population. Adults were enrolled across six Aboriginal communities in Central Australia. They undertook comprehensive cardiovascular assessments, including echocardiography, to determine HF status, asymptomatic ventricular dysfunction and underlying risk factor profile. Of 436 participants (mean age 44±14 years 64% women) enrolled, 5.3% (95% CI 3.2% to 7.5%) were diagnosed with HF, only 35% of whom had a pre-existing HF diagnosis. Asymptomatic left ventricular dysfunction (ALVD) was seen in 13% (95% CI 9.4% to 15.7%) of the population. Estimates of HF risk factor prevalence were as follows: body mass index (BMI) ≥30 kg/m(2) 42%, hypertension 41%, diabetes mellitus 40%, coronary artery disease (CAD) 7% and history of acute rheumatic fever or rheumatic heart disease 7%. In logistic regression analysis (after adjustment for age and gender), HF was associated with CAD (OR=9.6, p<0.001), diabetes (OR=5.4, p=0.002), hypertension (OR=4.8, p=0.006), BMI ≥30 kg/m(2) (OR=2.9, p=0.02), acute rheumatic fever or rheumatic heart disease (OR=5.6, p=0.001) and B-type natriuretic peptide (OR=1.02, p<0.001). The burden of HF, ALVD and risk factors in this population was extremely high. This study highlights potentially modifiable targets on which to focus resources and screening strategies to prevent HF in this high-risk Indigenous population.
Publisher: Wiley
Date: 19-08-2016
DOI: 10.1111/AJR.12222
Abstract: 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. 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. Fifty subjects initially allocated to the intervention arm of the trial were studied. Completion of scheduled, plus additional outreach visits according to the intervention protocol. 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. 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.
Start Date: 2009
End Date: 2010
Funder: Department of Health and Ageing, Australian Government
View Funded ActivityStart Date: 2021
End Date: 2022
Funder: National Heart Foundation of Australia
View Funded ActivityStart Date: 2021
End Date: 2021
Funder: Baker Heart and Diabetes Institute
View Funded ActivityStart Date: 2020
End Date: 2021
Funder: Ernest Heine Family Foundation
View Funded ActivityStart Date: 2014
End Date: 2017
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2013
End Date: 2016
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2008
End Date: 2012
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2021
End Date: 2023
Funder: HCF Research Foundation
View Funded ActivityStart Date: 2011
End Date: 2016
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2012
End Date: 2017
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2015
End Date: 2015
Funder: Royal Flying Doctors Service Victoria
View Funded ActivityStart Date: 2015
End Date: 2015
Funder: Australian Government’s Collaborative Research Networks (CRN) program
View Funded ActivityStart Date: 2016
End Date: 2019
Funder: National Heart Foundation of Australia
View Funded ActivityStart Date: 2011
End Date: 2012
Funder: Boehringer Ingelheim
View Funded Activity