18 results on '"Brieger, D."'
Search Results
2. CSANZ Position Statement on the Evaluation of Patients Presenting With Suspected Acute Coronary Syndromes During the COVID-19 Pandemic.
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Parsonage WA, Cullen L, Brieger D, Hillis GS, Nasis A, Dwyer N, Wahi S, Lo S, Than M, Kerr A, Devlin G, and Chew DK
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- Australia epidemiology, Betacoronavirus, COVID-19, Consensus, Humans, New Zealand epidemiology, SARS-CoV-2, Societies, Medical, Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome epidemiology, Acute Coronary Syndrome therapy, Cardiology methods, Cardiology organization & administration, Cardiology trends, Communicable Disease Control methods, Communicable Disease Control organization & administration, Coronavirus Infections epidemiology, Coronavirus Infections prevention & control, Infection Control organization & administration, Pandemics prevention & control, Patient Care Management methods, Pneumonia, Viral epidemiology, Pneumonia, Viral prevention & control
- Abstract
A pandemic of Coronavirus-19 disease was declared by the World Health Organization on March 11, 2020. The pandemic is expected to place unprecedented demand on health service delivery. This position statement has been developed by the Cardiac Society of Australia and New Zealand to assist clinicians to continue to deliver rapid and safe evaluation of patients presenting with suspected acute cardiac syndrome at this time. The position statement complements, and should be read in conjunction with, the National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Management of Acute Coronary Syndromes 2016: Section 2 'Assessment of Possible Cardiac Chest Pain'., (Copyright © 2020 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.)
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- 2020
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3. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018.
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Brieger D, Amerena J, Attia JR, Bajorek B, Chan KH, Connell C, Freedman B, Ferguson C, Hall T, Haqqani HM, Hendriks J, Hespe CM, Hung J, Kalman JM, Sanders P, Worthington J, Yan T, and Zwar NA
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- Australia, Humans, New Zealand, Atrial Fibrillation diagnosis, Atrial Fibrillation prevention & control, Atrial Fibrillation therapy
- Abstract
Introduction: Atrial fibrillation (AF) is increasing in prevalence and is associated with significant morbidity and mortality. The optimal diagnostic and treatment strategies for AF are continually evolving and care for patients requires confidence in integrating these new developments into practice. These clinical practice guidelines will assist Australian practitioners in the diagnosis and management of adult patients with AF. Main recommendations: These guidelines provide advice on the standardised assessment and management of patients with atrial fibrillation regarding: screening, prevention and diagnostic work-up; acute and chronic arrhythmia management with antiarrhythmic therapy and percutaneous and surgical ablative therapies; stroke prevention and optimal use of anticoagulants; and integrated multidisciplinary care. Changes in management as a result of the guideline: Opportunistic screening in the clinic or community is recommended for patients over 65 years of age. The importance of deciding between a rate and rhythm control strategy at the time of diagnosis and periodically thereafter is highlighted. β-Blockers or non-dihydropyridine calcium channel antagonists remain the first line choice for acute and chronic rate control. Cardioversion remains first line choice for acute rhythm control when clinically indicated. Flecainide is preferable to amiodarone for acute and chronic rhythm control. Failure of rate or rhythm control should prompt consideration of percutaneous or surgical ablation. The sexless CHA2DS2-VA score is recommended to assess stroke risk, which standardises thresholds across men and women; anticoagulation is not recommended for a score of 0, and is recommended for a score of ≥ 2. If anticoagulation is indicated, non-vitamin K oral anticoagulants are recommended in preference to warfarin. An integrated care approach should be adopted, delivered by multidisciplinary teams, including patient education and the use of eHealth tools and resources where available. Regular monitoring and feedback of risk factor control, treatment adherence and persistence should occur.
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- 2018
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4. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.
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Brieger D, Amerena J, Attia J, Bajorek B, Chan KH, Connell C, Freedman B, Ferguson C, Hall T, Haqqani H, Hendriks J, Hespe C, Hung J, Kalman JM, Sanders P, Worthington J, Yan TD, and Zwar N
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- Australia epidemiology, Humans, Morbidity trends, New Zealand epidemiology, Atrial Fibrillation diagnosis, Atrial Fibrillation epidemiology, Atrial Fibrillation prevention & control, Cardiology, Diagnostic Techniques, Cardiovascular standards, Disease Management, Practice Guidelines as Topic, Societies, Medical
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- 2018
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5. Expertise and infrastructure capacity impacts acute coronary syndrome outcomes.
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Astley CM, Ranasinghe I, Brieger D, Ellis CJ, Redfern J, Briffa T, Aliprandi-Costa B, Howell T, Bloomer SG, Gamble G, Driscoll A, Hyun KK, Hammett CJ, and Chew DP
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- Aged, Australia epidemiology, Clinical Audit, Coronary Angiography, Decision Making, Female, Guideline Adherence, Health Care Surveys, Hospital Mortality, Hospitals, Humans, Male, Middle Aged, New Zealand, Practice Guidelines as Topic, Registries, Rural Health Services, Treatment Outcome, Urban Health Services, Acute Coronary Syndrome diagnostic imaging, Acute Coronary Syndrome epidemiology, Acute Coronary Syndrome therapy, Clinical Competence, Quality of Health Care standards
- Abstract
Objective Effective translation of evidence to practice may depend on systems of care characteristics within the health service. The present study evaluated associations between hospital expertise and infrastructure capacity and acute coronary syndrome (ACS) care as part of the SNAPSHOT ACS registry. Methods A survey collected hospital systems and process data and our analysis developed a score to assess hospital infrastructure and expertise capacity. Patient-level data from a registry of 4387 suspected ACS patients enrolled over a 2-week period were used and associations with guideline care and in-hospital and 6-, 12- and 18-month outcomes were measured. Results Of 375 participating hospitals, 348 (92.8%) were included in the analysis. Higher expertise was associated with increased coronary angiograms (440/1329; 33.1%), 580/1656 (35.0%) and 609/1402 (43.4%) for low, intermediate and high expertise capacity respectively; P<0.001) and the prescription of guideline therapies observed a tendency for an association with (531/1329 (40.0%), 733/1656 (44.3%) and 603/1402 (43.0%) for low, intermediate and high expertise capacity respectively; P=0.056), but not rehabilitation (474/1329 (35.7%), 603/1656 (36.4%) and 535/1402 (38.2%) for low, intermediate and high expertise capacity respectively; P=0.377). Higher expertise capacity was associated with a lower incidence of major adverse events (152/1329 (11.4%), 142/1656 (8.6%) and 149/149 (10.6%) for low, intermediate and high expertise capacity respectively; P=0.026), as well as adjusted mortality within 18 months (low vs intermediate expertise capacity: odds ratio (OR) 0.79, 95% confidence interval (CI) 0.58-1.08, P=0.153; intermediate vs high expertise capacity: OR 0.64, 95% CI 0.48-0.86, P=0.003). Conclusions Both higher-level expertise in decision making and infrastructure capacity are associated with improved evidence translation and survival over 18 months of an ACS event and have clear healthcare design and policy implications. What is known about the topic? There are comprehensive guidelines for treating ACS patients, but Australia and New Zealand registry data reveal substantial gaps in delivery of best practice care across metropolitan, regional, rural and remote health services, raising questions of equity of access and outcome. Greater mortality and morbidity gains can be achieved by increasing the application of current evidence-based therapies than by developing new therapy innovations. Health service system characteristics may be barriers or enablers to the delivery of best practice care and need to be identified and evaluated for correlations with performance indicators and outcomes in order to improve health service design. What does this paper add? This study measures two system characteristics, namely expertise and infrastructure, evaluating the relationship with ACS guideline application and clinical outcomes in a large and diverse cohort of Australian and New Zealand hospitals. The study identifies decision-making expertise and infrastructure capacity, to a lesser degree, as enabling characteristics to help improve patient outcomes. What are the implications for practitioners? In the design of health services to improve access and equity, expertise must be preserved. However, it is difficult to have experienced personnel at the bedside no matter where the health service, and engineering innovative systems and processes of care to facilitate delivery of expertise should be considered.
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- 2018
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6. Is There Inequity in Hospital Care Among Patients With Acute Coronary Syndrome Who Are Proficient and Not Proficient in English Language?: Analysis of the SNAPSHOT ACS Study.
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Hyun KK, Redfern J, Woodward M, Briffa T, Chew DP, Ellis C, French J, Astley C, Gamble G, Nallaiah K, Howell T, Lintern K, Clark R, Wechkunanukul K, and Brieger D
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- Aged, Aged, 80 and over, Australia, Cohort Studies, Female, Humans, Logistic Models, Male, Middle Aged, New Zealand, Outcome Assessment, Health Care, Practice Guidelines as Topic, Acute Coronary Syndrome therapy, Healthcare Disparities, Hospitalization, Language
- Abstract
Background: The provision of equitable acute coronary syndrome (ACS) care in Australia and New Zealand requires an understanding of the sources of variation in the provision of this care., Objective: The aim of this study was to compare the variation in care and outcomes between ACS patients with limited English proficiency (LEP) and English proficiency (EP) admitted to Australian and NZ hospitals., Methods: Data were collected from 4387 suspected/confirmed ACS patients from 286 hospitals between May 14 and 27, 2012, who were followed for 18 months. We compared hospital care and outcomes according to the proficiency of English using logistic regressions., Results: The 294 LEP patients were older (70.9 vs 66.3 years; P < .001) and had higher prevalence of hypertension (71.1% vs 62.8%; P = .004), diabetes (40.5% vs 24.3%; P < .001), and renal impairment (16.3% vs 11.1%; P = .007) compared with the 4093 EP patients. Once in hospital, there was no difference in receipt of percutaneous coronary intervention (57.0% vs 55.4%; P = .78) or coronary artery bypass graft surgery (10.5% vs 11.5%; P = .98). After adjustment for medical history, there were no significant differences (P > .05) between the 2 groups in the risk of major adverse cardiovascular events and/or all-cause death during the index admission and from index admission to 18 months., Conclusions: These results suggest that LEP patients admitted to Australian or New Zealand hospitals with suspected ACS may not experience inequity in hospital care and outcomes.
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- 2017
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7. Comparison of the management and in-hospital outcomes of acute coronary syndrome patients in Australia and New Zealand: results from the binational SNAPSHOT acute coronary syndrome 2012 audit.
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Ellis C, Hammett C, Ranasinghe I, French J, Briffa T, Devlin G, Elliott J, Lefkovitz J, Aliprandi-Costa B, Astley C, Redfern J, Howell T, Carr B, Lintern K, Bloomer S, Farshid A, Matsis P, Hamer A, Williams M, Troughton R, Horsfall M, Hyun K, Gamble G, White H, Brieger D, and Chew D
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- Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome therapy, Aged, Australia epidemiology, Coronary Artery Bypass statistics & numerical data, Female, Humans, Male, Medical Audit, Middle Aged, New Zealand epidemiology, Outcome Assessment, Health Care, Patient Admission, Patient Discharge, Survival Rate, Acute Coronary Syndrome mortality, Coronary Angiography statistics & numerical data, Coronary Artery Bypass mortality, Health Services Accessibility statistics & numerical data, Hospital Mortality
- Abstract
Background/aims: We aimed to assess differences in patient management, and outcomes, of Australian and New Zealand patients admitted with a suspected or confirmed acute coronary syndrome (ACS)., Methods: We used comprehensive data from the binational Australia and New Zealand ACS 'SNAPSHOT' audit, acquired on individual patients admitted between 00.00 h on 14 May 2012 to 24.00 h on 27 May 2012., Results: There were 4387 patient admissions, 3381 (77%) in Australia and 1006 (23%) in New Zealand; Australian patients were slightly younger (67 vs 69 years, P = 0.0044). Of the 2356 patients with confirmed ACS, Australian patients were at a lower cardiovascular risk with a lower median Global Registry Acute Coronary Events score (147 vs 154 P = 0.0008), but as likely to receive an invasive coronary angiogram (58% vs 54%, P = 0.082), or revascularisation with percutaneous coronary intervention (32% vs 31%, P = 0.92) or coronary artery bypass graft surgery (7.0% vs 5.6%, P = 0.32). Of the 1937 non-segment elevation myocardial infarction/unstable angina pectoris (NSTEMI/UAP) patients, Australian patients had a shorter time to angiography (46 h vs 67 h, P < 0.0001). However, at discharge, Australian NSTEMI/UAP survivors were less likely to receive aspirin (84% vs 89%, P = 0.0079, a second anti-platelet agent (57% vs 63%, P = 0.050) or a beta blocker (67% vs 77%, P = 0.0002). In-hospital death rates were not different (2.7% vs 3.2%, P = 0.55) between Australia and New Zealand., Conclusions: Overall more similarities were seen, than differences, in the management of suspected or confirmed ACS patients between Australia and New Zealand. However, in several management areas, both countries could improve the service delivery to this high-risk patient group., (© 2015 Royal Australasian College of Physicians.)
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- 2015
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8. Prescription of secondary prevention medications, lifestyle advice, and referral to rehabilitation among acute coronary syndrome inpatients: results from a large prospective audit in Australia and New Zealand.
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Redfern J, Hyun K, Chew DP, Astley C, Chow C, Aliprandi-Costa B, Howell T, Carr B, Lintern K, Ranasinghe I, Nallaiah K, Turnbull F, Ferry C, Hammett C, Ellis CJ, French J, Brieger D, and Briffa T
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- Aged, Australia epidemiology, Female, Humans, Male, Management Audit, Middle Aged, Needs Assessment, New Zealand epidemiology, Patient Discharge standards, Patient Discharge statistics & numerical data, Practice Patterns, Physicians' statistics & numerical data, Preventive Health Services organization & administration, Rehabilitation methods, Rehabilitation psychology, Rehabilitation statistics & numerical data, Secondary Prevention methods, Secondary Prevention organization & administration, Secondary Prevention standards, Acute Coronary Syndrome epidemiology, Acute Coronary Syndrome rehabilitation, Cardiovascular Agents therapeutic use, Inpatients psychology, Inpatients statistics & numerical data, Referral and Consultation statistics & numerical data, Risk Reduction Behavior
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Objective: To evaluate the proportion of patients hospitalised with acute coronary syndrome (ACS) in Australia and New Zealand who received optimal inpatient preventive care and to identify factors associated with preventive care., Methods: All patients hospitalised bi-nationally with ACS were identified between 14-27 May 2012. Optimal in-hospital preventive care was defined as having received lifestyle advice, referral to rehabilitation, and prescription of secondary prevention pharmacotherapies. Multilevel multivariable logistic regression was used to determine factors associated with receipt of optimal preventive care., Results: For the 2299 ACS survivors, mean (SD) age was 69 (13) years, 46% were referred to rehabilitation, 65% were discharged on sufficient preventive medications, and 27% received optimal preventive care. Diagnosis of ST elevation myocardial infarction (OR: 2.64 [95% CI: 1.88-3.71]; p<0.001) and non-ST elevation myocardial infarction (OR: 1.99 [95% CI: 1.52-2.61]; p<0.001) compared with a diagnosis of unstable angina, having a percutaneous coronary intervention (PCI) (OR: 4.71 [95% CI: 3.67-6.11]; p<0.001) or coronary bypass (OR: 2.10 [95% CI: 1.21-3.60]; p=0.011) during the admission or history of hypertension (OR:1.36 [95% CI: 1.06-1.75]; p=0.017) were associated with greater exposure to preventive care. Age over 70 years (OR:0.53 [95% CI: 0.35-0.79]; p=0.002) or admission to a private hospital (OR:0.59 [95% CI: 0.42-0.84]; p=0.003) were associated with lower exposure to preventive care., Conclusions: Only one-quarter of ACS patients received optimal secondary prevention in-hospital. Patients with UA, who did not have PCI, were over 70 years or were admitted to a private hospital, were less likely to receive optimal care., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
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- 2014
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9. The management of acute coronary syndrome patients across New Zealand in 2012: results of a third comprehensive nationwide audit and observations of current interventional care.
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Ellis C, Gamble G, Devlin G, Elliott J, Hamer A, Williams M, Matsis P, Troughton R, Ranasinghe I, French J, Brieger D, Chew D, and White H
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- Aged, Angina, Unstable therapy, Angioplasty, Balloon, Coronary, Coronary Artery Bypass, Female, Hospitalization statistics & numerical data, Humans, Length of Stay, Male, Medical Audit, Myocardial Infarction therapy, New Zealand, Time-to-Treatment, Acute Coronary Syndrome therapy, Angina, Unstable diagnosis, Coronary Angiography statistics & numerical data, Myocardial Infarction diagnosis
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Aims: To audit all patients admitted to a New Zealand (NZ) Hospital with a suspected or definite acute coronary syndrome (ACS) over a 14-day period, to assess their presentation type and management in hospital and at discharge, with emphasis on time delays for invasive management and revascularisation treatments., Methods: We updated the established NZ ACS Audit group of 39 hospitals admitting ACS patients across NZ, and enrolled NZ patients in conjunction with the bi-National Australia and NZ ACS 'SNAPSHOT' audit. Comprehensive data was recorded on all patients admitted between 00.00 hours on 14 May 2012 to 24.00 hours on 27 May 2012. Patient management at intervention centres (7 public, 3 private) was compared with non-intervention centres (29 public)., Results: There were 1007 patient admissions: STEMI (10%), NSTEMI (26%), UAP (17%), other diagnoses including secondary myonecrosis (18%), chest pain thought unlikely to be ischaemic (29%). Cardiac investigations were used in a minority of patients: chest X-ray (91%), echocardiogram (29%), exercise test (23%), computed tomographic (CT) angiogram (4%) and conventional coronary angiogram (33%). Patients admitted to a non-intervention centre (n=439) were less likely to receive an echocardiogram (25 vs 31%, p<0.05). Non-intervention centre patients with NSTEMI/UAP waiting longer for angiography (3.8 vs 2.1 days p<0.0001), and had a longer length of hospital stay (4.0 vs 3.1 days, p=0.043). For patients with a final diagnosis of a definite ACS (n=531), non-intervention centre patients were significantly less likely to be revascularised with PCI (25% vs 37%, p=0.0019) although CABG surgery numbers were not statistically different (4.1% vs 7.3%, p=0.13)., Conclusions: A collaborative group of clinicians and nurses has performed a third nationwide audit of suspected and definite ACS patients, and shown some gaps in the current service, including limited access to echocardiography and cardiac angiography. In particular we noted significant delays for non-intervention centre patients accessing planned invasive assessment. This study reveals areas of clinical need and emphasises the benefit of ongoing clinical audit, with subsequent feedback and a focus on integrated clinical service delivery, which can improve the care of ACS patients in New Zealand.
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- 2013
10. Trends and predictors of rehospitalisation following an acute coronary syndrome: report from the Australian and New Zealand population of the Global Registry of Acute Coronary Events (GRACE).
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Sangu PV, Ranasinghe I, Aliprandi Costa B, Devlin G, Elliot J, Lefkovitz J, and Brieger D
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- Acute Coronary Syndrome therapy, Aged, Female, Follow-Up Studies, Humans, Incidence, Male, New South Wales epidemiology, New Zealand epidemiology, Prognosis, Retrospective Studies, Risk Factors, Acute Coronary Syndrome epidemiology, Myocardial Revascularization, Patient Readmission trends, Registries, Risk Assessment methods
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Background: Readmission following an acute coronary syndrome (ACS) is frequent in our community. Patient specific factors identifying those at risk of readmission are poorly described., Methods: Data were analysed from 5219 patients with an ACS enrolled in the Australian and New Zealand population of the Global Registry of Acute Coronary Events (GRACE) between 1999 and 2007. Patients who were readmitted for cardiovascular disease within 6 months of discharge were identified; regression analysis was used to predict independent patient factors associated with readmission 1 month and 1-6 months after discharge., Results: 1048 patients (20.1%) were readmitted within 6 months, with a significant proportion (n=434, 41.4%) of readmissions occurring within 30 days of discharge. Readmission within 6 months was associated with a higher incidence of unscheduled cardiac catheterisation (HR 25.64, 95% CI 18.41 to 35.71), unscheduled percutaneous coronary intervention (PCI) (HR 15.78, 95% CI 10.56 to 23.59), stroke (HR 1.92, 95% CI 1.08 to 3.43), and death (HR 2.40, 95% CI 1.66 to 3.49). Recurrent ischemia in hospital and a diagnosis of S-T elevation myocardial infarction during the index admission were associated with the strongest risk of early rehospitalisation, while revascularisation by PCI or coronary artery bypass surgery (CABG) was associated with lowest risk of early readmission. A history of heart failure, prior myocardial infarction or angina was associated with a greater likelihood of later rehospitalisation, whereas revascularisation by CABG was associated with the lowest risk of later rehospitalisation., Conclusions: Several patient and clinical factors identify patients at higher risk of readmission. Identifying these factors and escalating in-hospital and post-discharge care for these higher risk patients may prevent readmission and improve outcome.
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- 2012
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11. Recommendations arising from the inaugural CSANZ Conference on Indigenous Cardiovascular Health.
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Kritharides L, Brown A, Brieger D, Ridell T, Zeitz C, Jeremy R, Tonkin A, Walsh W, and White H
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- Australia, Cardiovascular Diseases epidemiology, Cardiovascular Diseases prevention & control, Congresses as Topic, Education, Medical, Graduate organization & administration, Female, Humans, Leadership, Male, New Zealand, Outcome Assessment, Health Care, Population Groups, Program Development, Program Evaluation, Cardiovascular Diseases therapy, Health Services Needs and Demand, Health Services, Indigenous organization & administration
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- 2010
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12. Rheumatic heart disease in indigenous populations.
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White H, Walsh W, Brown A, Riddell T, Tonkin A, Jeremy R, Brieger D, Zeitz C, and Kritharides L
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- Australia epidemiology, Combined Modality Therapy, Drug Therapy, Combination, Female, Health Services, Indigenous organization & administration, Health Status Disparities, Humans, Middle Aged, New Zealand epidemiology, Population Groups, Pregnancy, Prevalence, Primary Prevention methods, Prognosis, Rheumatic Fever epidemiology, Rheumatic Fever prevention & control, Rheumatic Fever therapy, Rheumatic Heart Disease diagnosis, Rheumatic Heart Disease ethnology, Rheumatic Heart Disease prevention & control, Risk Assessment, Severity of Illness Index, Young Adult, Anti-Bacterial Agents administration & dosage, Healthcare Disparities, Heart Valve Prosthesis Implantation methods, Native Hawaiian or Other Pacific Islander statistics & numerical data, Rheumatic Heart Disease epidemiology, Rheumatic Heart Disease therapy
- Abstract
Rates of acute rheumatic fever and chronic rheumatic heart disease in Aboriginal people, Torres Strait Islanders and Māori continue to be unacceptably high. The impact of rheumatic heart disease is inequitable on these populations as compared with other Australians and New Zealanders. The associated cardiac morbidity, including the development of rheumatic valve disease, and cardiomyopathy, with possible sequelae of heart failure, development of atrial fibrillation, systemic embolism, transient ischaemic attacks, strokes, endocarditis, the need for interventions including cardiac surgery, and impaired quality of life, and shortened life expectancy, has major implications for the individual. The adverse health and social effects may significantly limit education and employment opportunities and increase dependency on welfare. Additionally there may be major adverse impacts on family and community life. The costs in financial terms and missed opportunities, including wasted young lives, are substantial. Prevention of acute rheumatic fever is dependent on the timely diagnosis and treatment of sore throats and skin infections in high-risk groups. Both Australia and New Zealand have registries for acute rheumatic fever but paradoxically neither includes all cases of chronic rheumatic heart disease many of whom would benefit from close surveillance and follow-up. In New Zealand and some Australian States there are programs to give secondary prophylaxis with penicillin, but these are not universal. Surgical outcomes for patients with rheumatic valvular disease are better for valve repair than for valve replacement. Special attention to the selection of the appropriate valve surgery and valve choice is required in pregnant women. It may be necessary to have designated surgical units managing Indigenous patients to ensure high rates of surgical repair rather than valve replacement. Surgical guidelines may be helpful. Long-term follow-up of the outcomes of surgery in Indigenous patients with rheumatic heart disease is required. Underpinning these strategies is the need to improve poverty, housing, education and employment. Cultural empathy with mutual trust and respect is essential. Involvement of Indigenous people in decision making, design, and implementation of primary and secondary prevention programs, is mandatory to reduce the unacceptably high rates of rheumatic heart disease., (Copyright 2010 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier B.V. All rights reserved.)
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- 2010
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13. Overview and determinants of cardiovascular disease in indigenous populations.
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Kritharides L, Brown A, Brieger D, Ridell T, Zeitz C, Jeremy R, Tonkin A, Walsh W, and White H
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- Australia epidemiology, Cardiovascular Diseases epidemiology, Comorbidity, Educational Status, Environment, Female, Health Services Accessibility statistics & numerical data, Health Services, Indigenous statistics & numerical data, Health Services, Indigenous trends, Humans, Indians, North American statistics & numerical data, Male, New Zealand epidemiology, Population Groups statistics & numerical data, Prevalence, Risk Assessment, Social Class, Survival Analysis, United States epidemiology, Attitude to Health, Cardiovascular Diseases diagnosis, Cardiovascular Diseases ethnology, Global Health, Native Hawaiian or Other Pacific Islander statistics & numerical data
- Abstract
Cardiovascular disease (CV) is an important problem among the 400 million Indigenous Populations around the world, and has been included in the World Health Organization (WHO) "2008-2013 Action Plan for Non-Communicable Diseases". Our understanding of the causes of CV disease in the Indigenous populations of Australia and New Zealand will be facilitated by better understanding the causes of CV disease in Indigenous populations around the world. The opening scientific presentations of the Inaugural CSANZ Conference on Indigenous Cardiovascular Health were from two international speakers notable for their commitment to Indigenous Health as a global problem., (Copyright 2010. Published by Elsevier B.V.)
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- 2010
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14. Coronary disease in indigenous populations: summary from the CSANZ indigenous Cardiovascular Health Conference.
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Brown A, Brieger D, Tonkin A, White H, Walsh W, Riddell T, Zeitz C, Jeremy R, and Kritharides L
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- Adult, Aged, Angioplasty, Balloon, Coronary mortality, Australia epidemiology, Congresses as Topic, Coronary Artery Bypass mortality, Coronary Disease prevention & control, Female, Follow-Up Studies, Health Services Accessibility trends, Health Status Disparities, Humans, Male, Middle Aged, Needs Assessment, New Zealand epidemiology, Outcome Assessment, Health Care, Population Groups, Primary Prevention methods, Risk Assessment, Severity of Illness Index, Survival Analysis, Treatment Outcome, Angioplasty, Balloon, Coronary statistics & numerical data, Coronary Artery Bypass statistics & numerical data, Coronary Disease ethnology, Coronary Disease therapy, Health Services, Indigenous organization & administration, Native Hawaiian or Other Pacific Islander statistics & numerical data
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- 2010
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15. The Cardiac Society Inaugural Cardiovascular Health Conference: conference findings and ways forward.
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Brown A, Tonkin A, White H, Riddell T, Brieger D, Walsh W, Zeitz C, Jeremy R, and Kritharides L
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- Australia, Cardiovascular Diseases prevention & control, Combined Modality Therapy, Female, Forecasting, Health Services Accessibility trends, Health Services, Indigenous trends, Humans, Incidence, Male, Needs Assessment, New Zealand, Population Groups, Practice Guidelines as Topic, Severity of Illness Index, Societies, Medical, Survival Analysis, Cardiovascular Diseases epidemiology, Cardiovascular Diseases therapy, Health Services Accessibility standards, Health Services, Indigenous standards, Outcome Assessment, Health Care
- Published
- 2010
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16. Implications of diabetes in patients with acute coronary syndromes. The Global Registry of Acute Coronary Events.
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Franklin K, Goldberg RJ, Spencer F, Klein W, Budaj A, Brieger D, Marre M, Steg PG, Gowda N, and Gore JM
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- Acute Disease, Age Factors, Aged, Americas epidemiology, Angioplasty, Balloon, Coronary, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Australia epidemiology, Calcium Channel Blockers therapeutic use, Coronary Disease therapy, Diabetes Mellitus therapy, Europe epidemiology, Female, Heart Failure epidemiology, Heart Failure etiology, Hospitalization, Humans, Male, Middle Aged, Myocardial Infarction therapy, New Zealand epidemiology, Prospective Studies, Risk Factors, Syndrome, Treatment Outcome, Coronary Disease epidemiology, Diabetes Mellitus epidemiology, Myocardial Infarction epidemiology, Registries
- Abstract
Background: There are limited data describing the presenting characteristics, management, and outcomes of diabetic and nondiabetic patients with an acute coronary syndrome (ACS)., Objective: To examine differences in these factors, patients with ST-segment elevation acute myocardial infarction, non-ST-segment elevation acute myocardial infarction, and unstable angina were enrolled in a large multinational coronary disease registry., Methods: The Global Registry of Acute Coronary Events is a prospective observational study of patients hospitalized with an ACS at 94 hospitals in 14 countries. The study sample consisted of 5403 patients with ST-segment elevation acute myocardial infarction, 4725 with non-ST-segment elevation acute myocardial infarction, and 5988 with unstable angina., Results: Approximately 1 in 4 patients presented to participating hospitals with a history of diabetes. Patients with diabetes were older, more often women, with a greater prevalence of comorbidities, and they were less likely to be treated with effective cardiac therapies than nondiabetic patients. Patients with diabetes who developed an ACS were at increased risk for each hospital outcome examined including heart failure, renal failure, cardiogenic shock, and death. These differences remained after adjustment for potentially confounding prognostic factors., Conclusions: A considerable proportion of patients with an ACS has diabetes and is at increased risk for adverse outcomes compared with patients without diabetes. There are certain proven therapeutic strategies that remain underused in the diabetic population. A more widespread awareness of this increased risk and a more diligent use of proven cardiac treatment approaches are indicated for patients with diabetes who develop an ACS.
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- 2004
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17. Stenting and glycoprotein IIb/IIIa inhibition in patients with acute myocardial infarction undergoing percutaneous coronary intervention: findings from the global registry of acute coronary events (GRACE).
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Montalescot G, Van de Werf F, Gulba DC, Avezum A, Brieger D, Kennelly BM, Mazurek T, Spencer F, White K, and Gore JM
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- Adult, Aged, Americas epidemiology, Australia epidemiology, Blood Vessel Prosthesis Implantation, Combined Modality Therapy, Coronary Artery Bypass, Coronary Disease epidemiology, Coronary Disease therapy, Europe epidemiology, Female, Fibrinolytic Agents therapeutic use, Hospital Mortality, Humans, Incidence, Male, Middle Aged, Multivariate Analysis, Myocardial Infarction epidemiology, New Zealand epidemiology, Postoperative Complications epidemiology, Postoperative Complications etiology, Registries, Risk Factors, Time Factors, Treatment Outcome, Angioplasty, Balloon, Coronary, Myocardial Infarction therapy, Platelet Glycoprotein GPIIb-IIIa Complex antagonists & inhibitors, Platelet Glycoprotein GPIIb-IIIa Complex therapeutic use, Stents
- Abstract
Stenting and GP IIb/IIIa inhibition are promising adjunctive therapies in PCI. The Global Registry of Acute Coronary Events (GRACE) is a registry of unselected patients with acute coronary syndromes, allowing for the study of treatments in a real-world environment. Data from GRACE patients with AMI who underwent PCI were analyzed. After adjusting for demographics, baseline characteristics, and previous medications, treatment with GP IIb/IIIa inhibitors and a stent and treatment with a stent alone were significant predictors of survival at 6 months. Stents were used in 90.9% of patients. GP IIb/IIIa inhibitors were used in 59.7%; in most cases they were started after the beginning of the procedure. The in-hospital death rate (7.6%) was highest in patients undergoing urgent PCI. Mortality at 6 months following PCI was 14.4% among patients who received neither GP IIb/IIIa inhibitors nor a stent, compared to patients who received both GP IIb/IIIa inhibitors and a stent (7.3%), GP IIb/IIIa inhibitors alone (12.8%), or a stent alone (6.7%)., (Copyright 2003 Wiley-Liss, Inc.)
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- 2003
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18. Management of acute coronary syndromes. Variations in practice and outcome; findings from the Global Registry of Acute Coronary Events (GRACE).
- Author
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Fox KA, Goodman SG, Klein W, Brieger D, Steg PG, Dabbous O, and Avezum A
- Subjects
- Acute Disease, Aged, Angina, Unstable diagnosis, Angina, Unstable therapy, Angioplasty, Balloon, Coronary, Aspirin therapeutic use, Australia epidemiology, Canada epidemiology, Europe epidemiology, Female, Fibrinolytic Agents therapeutic use, Heart Diseases epidemiology, Humans, Male, Middle Aged, Myocardial Infarction diagnosis, Myocardial Infarction therapy, New Zealand epidemiology, North America epidemiology, South America epidemiology, Treatment Outcome, Heart Diseases diagnosis, Heart Diseases therapy, Registries
- Abstract
Aims: Despite advances in the treatment of acute coronary syndromes based on randomized trial data and published guidelines, the extent to which such treatments are applied in practice remains uncertain. Data from clinical trials derive from selected geographical areas and in highly selected populations of patients, and hence may not reflect the overall population. The aim of the study was to investigate variations in hospital management and outcome using unselected data collected in the prospective Global Registry of Acute Coronary Events (GRACE)., Methods and Results: The 95 hospitals in GRACE were organized into 18 population-based clusters in 14 countries. Information was recorded about patient management and outcome during hospitalization and after discharge. Data on treatments administered were analysed by baseline condition, hospital type, by the presence or absence of a catheterization laboratory, and by geographical region. Of 11543 patients, 44% had an admission diagnosis of unstable angina, 36% presented with myocardial infarction, 9% were admitted to rule out a myocardial infarction, 7% had chest pain and 4% were hospitalized for 'other cardiac' and 'non-cardiac' diagnoses. Of the total GRACE population 38% had a final diagnosis of unstable angina, 30% ST-segment elevation myocardial infarction, 25% non-ST-segment elevation myocardial infarction, and 7% of 'other cardiac' and 'non-cardiac' final diagnoses. The event rates for hospital death or reinfarction were six and 2% for non-ST-segment elevation myocardial infarction, seven and 3% for ST-segment elevation myocardial infarction, and 3% hospital death for unstable angina. The use of aspirin was similar across all hospital types and geographical regions. In contrast, the use of percutaneous coronary intervention and glycoprotein IIb/IIIa inhibitors was higher (P<0.0001) in teaching hospitals and hospitals with catheterization laboratories and was also higher in the United States. At discharge a higher percentage (P<0.0001) of patients received angiotensin-converting enzyme inhibitors in hospitals without catheterization laboratories. The use of statins was lower in non-teaching hospitals and in centres without a catheterization laboratory., Conclusions: The GRACE study reveals substantial differences in the management of patients based on hospital type and geographical location. Further analyses will determine whether such variations translate into differences in longer term outcomes. GRACE provides a multinational reference for the implementation of therapies of proven efficacy., (Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.)
- Published
- 2002
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