101 research outputs found
An evidence based clinical aid for cardiovascular disease
No full textCopyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.Cardiovascular disease is the commonest cause of mortality in Australia, accounting for more than 30% of deaths. Hypertension, diabetes and lipid disorders account for 15.6% of the total problems encountered in general practice. Therefore all doctors should be familiar with well known risk factors for cardiovascular disease, as well as the benefits of interventions with them.Brian R McAvoy; Greg R Fulcher; John V Amerena; Greg W Conner; John F Beltrame; Graeme J Hankey; Anthony C Keech; Brian L Lloyd; Michael L Neale; Carol A Pollock; Krishna Sudhir; Robert D Waltham; Malcolm J Wes
Invasive management and late clinical outcomes in contemporary Australian management of acute coronary syndromes: observations from the ACACIA registry
No full text©The Medical Journal of Australia 2008OBJECTIVE: To describe the impact of invasive management on 12-month survival among patients with suspected acute coronary syndrome (ACS) in Australia. DESIGN AND SETTING: Prospective nationwide multicentre registry. PATIENTS: Patients presenting to 24 metropolitan and 15 non-metropolitan hospitals with ST-segment-elevation myocardial infarction (STEMI), and high-risk and intermediate-risk non-ST-segment-elevation ACS (NSTEACS) between 1 November 2005 and 31 July 2007. MAIN OUTCOME MEASURES: Death, myocardial infarction (MI) or recurrent MI, revascularisation and stroke at 12 months. RESULTS: Among 3402 patients originally enrolled, vital status at 12 months was available for 3393 (99.7%). Patients from non-metropolitan areas (810) constituted 23.9% of patients. Early invasive management was more commonly undertaken among patients with STEMI (STEMI, 89.7% v non-STEMI, 70.8% v unstable angina, 44.8% v stable angina, 35.8%; P<0.001). Factors most associated with receiving invasive management included admission with suspected STEMI or high-risk NSTEACS, being male and the hospital having an onsite cardiac surgical service. Overall mortality by 12 months among patients with STEMI, non-STEMI, unstable angina and stable angina was 8.0%, 10.5%, 3.3%, and 3.7% (P<0.001), respectively. After adjusting for a propensity model predicting early invasive management and other known confounders, early invasive management was associated with a 12-month mortality hazard ratio of 0.53 (95% CI, 0.34-0.84, P=0.007). CONCLUSIONS: A substantial burden of late morbidity and mortality persists among patients with ACS within contemporary Australian clinical practice. Under-use of invasive management may be associated with an excess in 12-month mortality, suggesting the need for more use of invasive management among these patientsDerek P Chew, John V Amerena, Steve G Coverdale, Jamie M Rankin, Carolyn M Astley, Ashish Soman, David B Brieger...Worthley S... and on behalf of the ACACIA investigator
SYMPATHETIC OVERACTIVITY AND CORONARY RISK IN HYPERTENSION
No full textPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74596/1/j.1472-8206.1997.tb00882.x.pd
Impact of nurse-mediated management on achieving blood pressure goal levels in primary care: insights from the Valsartan Intensified Primary carE Reduction of Blood Pressure Study
No full textBACKGROUND: Blood pressure targets in individuals treated for hypertension in primary care remain difficult to attain. AIMS: To assess the role of practice nurses in facilitating intensive and structured management to achieve ideal BP levels. METHODS: 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. RESULTS: 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). CONCLUSION: There is greater potential to achieve blood pressure targets in primary care with practice nurse-mediated hypertension management.Melinda J Carrington, Garry L Jennings, Mark Harris, Mark Nelson, Markus Schlaich, Nigel P Stocks, Louise M Burrell, John Amerena, Ferdinandus J de Looze, Carla H Swemmer, Nicol P Kurstjens and Simon Stewart, on behalf of the VIPER-BP Study investigator
Efficacy and feasibility of a tele-health intervention for acute coronary syndrome patients with depression: results of the "MoodCare" randomized controlled trial
No full textBackground: Depression is common after a cardiac event, yet there remain few approaches to management that are both effective and scalable.
Purpose: We aimed to evaluate the 6-month efficacy and feasibility of a tele-health program (MoodCare) that integrates depression management into a cardiovascular disease risk reduction program for acute coronary syndrome patients with low mood.
Methods: A two-arm, parallel, randomized design was used comprising 121 patients admitted to one of six hospitals for acute coronary syndrome.
Results: Significant treatment effects were observed for Patient Health Questionnaire 9 (PHQ9) depression (mean difference [change] = −1.8; p = 0.025; effect size: d = 0.36) for the overall sample, when compared with usual medical care. Results were more pronounced effects for those with a history of depression (mean difference [change] = −2.7; p = 0.043; effect size: d = 0.65).
Conclusions: MoodCare was effective for improving depression in acute coronary syndrome patients, producing effect sizes exceeding those of some face-to-face psychotherapeutic interventions and pharmacotherapy
Prevention of cardiovascular disease an evidence-based clinical aid ; for the Practical Implementation Taskforce for the Prevention of Cardiovascular Disease
No full textHospital Pharmacist‐Led Lipid Clinic for Surgical Patients with Peripheral Vascular Disease at a Regional Australian Hospital
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