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Aims To evaluate a self-administered digital education resource for patients after a heart attack (adapted simplified Chinese version of Cardiac College™) on secondary prevention knowledge and health behaviour change outcomes. Methods and results Chinese immigrants recovering from a heart attack were recruited from cardiac rehabilitation programmes at four metropolitan tertiary hospitals. Participants provided access to Cardiac College™ (adapted simplified Chinese version), a self-learning secondary prevention virtual education resource over 4 weeks. The web-based resources include 9 booklets and 10 pre-recorded video education sessions. Assessments included health literacy, secondary prevention knowledge, self-management behaviours, self-reported physical activity, and a heart-healthy diet. Satisfaction, acceptability, and engagement were also assessed. From 81 patients screened, 67 were recruited, and 64 (95.5%) completed the study. The participants' mean age was 67.2 ± 8.1 years old, 81.2% were males, and the majority had no English proficiency (65.6%). Following the intervention, significant improvements were observed for secondary prevention knowledge overall and in all subdomains, with the most improvement occurring in medical, exercise, and psychological domains (P < 0.001). Dietary and self-management behaviours also improved significantly (P < 0.05). According to participants, the educational materials were engaging (100%), and the content was adequate (68.8%); however, 26.6% found the information overwhelming. Overall, 46.9% were highly satisfied with the resources. Conclusion A self-learning virtual patient-education package improved secondary prevention knowledge and self-care behaviour in Chinese immigrants after a heart attack. The culturally adapted version of Cardiac College™ offers an alternative education model where bilingual staff or translated resources are limited. [ABSTRACT FROM AUTHOR]

Aims Sexual activity and intimacy improve quality of life for heart attack survivors. After a heart attack, patients frequently experience sexual dysfunction and anxiety about resuming sexual activity. However, most health professionals do not discuss sex or intimacy with their patients. The aim of this research was to explore the perceptions and practices of Australian health professionals in discussing sexual activity and intimacy with heart attack survivors and the barriers to achieving this. Methods and results This study employed a cross-sectional study design and online self-administered survey questionnaire. Study participants were a convenience sample of Australian health professionals working with cardiac patients, including general practitioners, cardiologists, cardiac rehabilitation specialists, registered nurses, and allied health professionals. Data were analysed using descriptive statistics and cross-tabulations to understand the different perspectives of health professional groups and the overall sample. Of 252 respondents, almost all believed discussing sex and intimacy with heart attack survivors was important, yet less than a quarter reported regularly doing so. About three-quarters reported feeling comfortable discussing sex and intimacy with either men or women, with half comfortable to do so with patients from diverse cultures. Barriers included lack of time, privacy, consumer resources, and protocols to guide discussions. Conclusion This research supports the need for structural changes such as a clinical protocol, longer and more private consultations, staff training, and culturally appropriate patient-oriented resources to support health professionals to guide discussions about sexual activity and intimacy with patients who have had a heart attack. [ABSTRACT FROM AUTHOR]

Background and Aims Atrial fibrillation (AF) and flutter are common causes of hospitalizations but contemporary long-term outcomes following these episodes are uncertain. This study assessed outcomes up to 10 years after an acute AF or flutter hospitalization. Methods Patients hospitalized acutely with a primary diagnosis of AF or flutter from 2008–17 from all public and most private hospitals in Australia and New Zealand were included. Kaplan–Meier methods and flexible parametric survival modelling were used to estimate survival and loss in life expectancy, respectively. Competing risk model accounting for death was used when estimating incidence of non-fatal outcomes. Results A total of 260 492 adults (mean age 70.5 ± 14.4 years, 49.6% female) were followed up for 1 068 009 person-years (PY), during which 69 167 died (incidence rate 6.5/100 PY) with 91.2% survival at 1 year, 72.7% at 5 years, and 55.2% at 10 years. Estimated loss in life expectancy was 2.6 years, or 16.8% of expected life expectancy. Re-hospitalizations for heart failure (2.9/100 PY), stroke (1.7/100 PY), and myocardial infarction (1.1/100 PY) were common with respective cumulative incidences of 16.8%, 11.0%, and 7.1% by 10 years. Re-hospitalization for AF or flutter occurred in 21.3% by 1 year, 35.3% by 5 years, and 41.2% by 10 years (11.6/100 PY). The cumulative incidence of patients undergoing catheter ablation of AF was 6.5% at 10 years (1.2/100 PY). Conclusions Patients hospitalized for AF or flutter had high death rates with an average 2.6-year loss in life expectancy. Moreover, re-hospitalizations for AF or flutter and related outcomes such as heart failure and stroke were common with catheter ablation used infrequently for treatment, which warrant further actions. [ABSTRACT FROM AUTHOR]

Aims Spontaneous coronary artery dissection (SCAD) is an under-recognized cause of myocardial infarction. We aimed to investigate SCAD survivors' perceptions of their quality-of-care and its relationship to quality-of-life. Methods and results An anonymous survey was distributed online to SCAD survivors involved in Australian SCAD support groups, with 172 (95.3% female, mean age 52.6 ± 9.2 years) participants in the study. The survey involved assessment of quality-of-life using a standardized questionnaire (EQ-5DTM-3L). Respondents rated the quality-of-care received during their hospital admission for SCAD with a median of 8/10 [interquartile range (IQR) 7–10]. Respondents ≤ 50 years vs. >50 years were more likely to perceive that their symptoms were not treated seriously as a myocardial infarction (χ2 = 4.127, df = 1, P < 0.05). Participants rated clinician's knowledge of SCAD with a median of 4/10 (IQR 2–8) and 7/10 (IQR 3–9) for Emergency and Cardiology clinicians, respectively (P < 0.05). The internet was the most selected source (45.4%) of useful SCAD information. The mean EQ-5DTM summary index was 0.79 (population norm 0.87). A total of 47.2% of respondents reported a mental health condition diagnosis, with 36% of these diagnosed after their admission with SCAD. Quality-of-life was significantly associated with perceived quality-of-care: EQ-5DTM index/(1-EQ-5DTM index) increased by 13% for each unit increase in quality-of-care after adjusting for age and comorbidities (P < 0.001). Conclusion While SCAD survivors rated their overall hospital care highly, healthcare providers' knowledge of SCAD was perceived to be poor, and the most common source of SCAD information was the internet. Mental health conditions were common, and a significant association was observed between perceived quality-of-care and SCAD survivors' quality-of-life. [ABSTRACT FROM AUTHOR]

The article focuses on the need for improved communication about sexual activity and intimacy between healthcare professionals and heart attack survivors, emphasizing the barriers and proposing solutions to enhance patient care in this aspect.

The article focuses on the effectiveness of culturally sensitive care in improving health outcomes for Chinese immigrants undergoing cardiac rehabilitation, including the importance of culturally competent care in reducing health disparities.

Over the past decades, Australian and New Zealand cardiovascular researchers have participated and led cardiovascular clinical trials which have had a major influence on clinical practice. Strengthening cardiovascular trials across Australia and New Zealand - the Alliance for Cardiovascular Trials (ANZACT) Network Despite these successes of the past, cardiovascular trials in Australia have become more challenging and recruitment of patients decreasing in major tertiary centres who previously led trial recruitment. [Extracted from the article]

Background: The condition onset flag (COF) variable was introduced into the hospitalization coding practice in 2008 to help distinguish between the new and pre-existing conditions. However, Australian datasets collected prior to 2008 lack the COF, potentially leading to data waste. The aim of this study was to determine if an algorithm to lookback across the previous admissions could make this distinction.Methods: All patients requiring kidney replacement therapy (KRT) identified in the Australia and New Zealand Dialysis and Transplant Registry in New South Wales, South Australia and Tasmania between July 2008 and December 2015 were linked with hospital admission datasets using probabilistic linkage. Three different lookback periods entailing either one, two or three admissions prior to the index admission were investigated. Conditions identified in an index admission but not in the lookback periods were classified as a new-onset condition. Conditions identified in both the index admission and the lookback period were deemed to be pre-existing. The degrees of agreement were determined using the kappa statistic. Conditions examined for new onset were myocardial infarction, pulmonary embolism and pneumonia. Conditions examined for prior existence were diabetes mellitus, hypertension and kidney failure. Secondary analyses evaluated whether the conditions identified as pre-existing using COF were captured consistently in the subsequent admissions.Results: 11 140 patients on KRT with 69 403 admissions were analysed. Lookback over a single admission interval (Period 1) provided the highest rates of true positives with COF for all three new-onset conditions, ranging from 89% to 100%. The levels of agreement were almost perfect for all conditions (k = 0.94-1.00). This was consistent across the different time eras. All lookback periods identified additional new-onset conditions that were not classified by COF: Lookback Period 1 picked up a further 474 myocardial infarction, 84 pulmonary embolism and 1092 pneumonia episodes. Lookback Period 1 had the highest percentage of true positives when identifying the pre-existing conditions (64-80%). The level of agreement was moderate to strong and was similar across the time eras. Secondary analysis showed that not all pre-existing conditions identified using COF carried forward to the subsequent admission (61-82%) but increased when looking forward across >1 admission (87-95%).Conclusion: The described algorithm using a lookback period is a pragmatic, reliable and robust means of identifying the new-onset and pre-existing patient conditions, thereby enriching the existing datasets predating the availability of the COF. The findings also highlight the value of concatenating a series of hospital patient admissions to more comprehensively adjudicate the pre-existing conditions, rather than assessing the index admission alone. [ABSTRACT FROM AUTHOR]

Objective: Little is known about the influence that hospital quality systems have on quality at department level, in Australia and elsewhere. This study assessed the relationships between organizational-level quality management systems, and the extent to which hospital-level quality management systems and department-level quality management strategies are related.Design: A multi-level, cross-sectional, mixed-method study.Setting and Participants: As part of the Deepening our Understanding of Quality in Australia (DUQuA) project, we invited all large hospitals in Australia (~200 or more beds) which provided acute myocardial infarction (AMI), hip fracture and stroke care. The quality managers of these hospitals were the respondents for one of seven measures of hospital quality management systems and strategies. Data across the six remaining measures were collected through site visits by external surveyors assessing the participating hospitals.Main Outcome Measures: Relationships were assessed between three organization-level quality management system measures: a self-report measure assessing organization-level quality activities (quality management systems index, QMSI); externally assessed organization-level compliance to procedures used to plan, monitor and improve quality of care (quality management compliance index, QMCI); and externally assessed implementation of quality systems (clinical quality implementation index, CQII). Associations were also assessed between organization-level quality management systems and department-level quality management strategies: how clinical responsibilities are assigned for a particular condition; whether department organization processes are organized to facilitate evidence-based care recommendations; compliance with selected recommendations of international agencies; and whether clinical reviews are performed systematically.Results: Of 78 invited hospitals, 32 participated in the study. QMSI was positively associated with QMCI and CQII, but after controlling for QMSI, no relationship was found between QMCI and CQII. There appears to be a cluster of relationships between QMSI and department-level measures, but this was not consistent across all departments.Conclusion: This is the first national study undertaken in Australia to assess relationships within and between organization-level and department-level quality management systems. These quality management system tools align with many components of accreditation standards and may be useful for hospitals in continuously monitoring and driving improvement. [ABSTRACT FROM AUTHOR]

Objective: The Deepening our Understanding of Quality in Australia (DUQuA) project is a multisite, multi-level, cross-sectional study of 32 of the largest hospitals in Australia. This overview examines relationships between (i) organization-level quality management systems and department-level quality management strategies and (ii) patient-level measures (clinical treatment processes, patient-reported perceptions of care and clinical outcomes) within Australian hospitals.Design: We examined hospital quality improvement structures, processes and outcomes, collecting data at organization, department and patient levels for acute myocardial infarction (AMI), hip fracture and stroke. Data sources included surveys of quality managers, clinicians and patients, hospital visits, medical record reviews and national databases. Outcomes data and patient admissions data were analysed. Relationships between measures were evaluated using multi-level models. We based the methods on the Deepening our Understanding of Quality Improvement in Europe (DUQuE) framework, extending that work in parts and customizing the design to Australian circumstances.Setting, Participants and Outcome Measures: The 32 hospitals, containing 119 participating departments, provided wide representation across metropolitan, inner and outer regional Australia. We obtained 31 quality management, 1334 clinician and 857 patient questionnaires, and conducted 2401 medical record reviews and 151 external assessments. External data via a secondary source comprised 14 460 index patient admissions across 14 031 individual patients. Associations between hospital, Emergency Department (ED) and department-level systems and strategies and five patient-level outcomes were assessed: 19 of 165 associations (11.5%) were statistically significant, 12 of 79 positive associations (15.2%) and 7 of 85 negative associations (8.2%).Results: We did not find clear relationships between hospital-level quality management systems, ED or department quality strategies and patient-level outcomes. ED-level clinical reviews were related to adherence to clinical practice guidelines for AMI, hip fracture and stroke, but in different directions. The results, when considered alongside the DUQuE results, are suggestive that front line interventions may be more influential than department-level interventions when shaping quality of care and that multi-pronged strategies are needed. Benchmark reports were sent to each participating hospital, stimulating targeted quality improvement activities.Conclusions: We found no compelling relationships between the way care is organized and the quality of care across three targeted patient-level outcome conditions. The study was cross-sectional, and thus we recommend that the relationships studied should be assessed for changes across time. Tracking care longitudinally so that quality improvement activities are monitored and fed back to participants is an important initiative that should be given priority as health systems strive to develop their capacity for quality improvement over time. [ABSTRACT FROM AUTHOR]

The aim of the present study was to assess smokers’ level of agreement with smoking-related risks and toxic tobacco constituents relative to inclusion of these topics on health warning labels (HWLs). 1000 adult smokers were interviewed between 2012 and 2013 from online consumer panels of adult smokers from each of the three countries: Australia (AU), Canada (CA) and Mexico (MX). Generalized estimating equation models were estimated to compare agreement with smoking-related risks and toxic tobacco constituents. For disease outcomes described on HWLs across all three countries, there were few statistical differences in agreement with health outcomes (e.g. emphysema and heart attack). By contrast, increases in agreement where the HWLs were revised or introduced on HWLs for the first time (e.g. blindness in AU and CA, bladder cancer in CA). Similarly, samples from countries that have specific health content or toxic constituents on HWLs showed higher agreement for that particular disease or toxin than countries without (e.g. higher agreement for gangrene and blindness in AU, higher agreement for bladder cancer and all toxic constituents except nitrosamines and radioactive polonium in CA). Pictorial HWL content is associated with greater awareness of smoking-related risks and toxic tobacco constituents. [ABSTRACT FROM PUBLISHER]

Aims: To examine risk for coronary heart disease (CHD) and cardiovascular disease (CVD) in relation to alcohol in a cohort of Australian Aborigines. Methods: In 1988-1989, alcohol intake, drinking pattern, and beverage preference were elicited by interviewer-administered questionnaire in Western Australian Aborigines (258 men, 256 women) and cardiovascular outcomes ascertained through linkage to mortality and hospital admission records to 2002. Results: In proportional hazards models, risk for CHD, relative to lifetime abstainers, was significantly increased in ex-drinkers [Hazard ratio (HR) 2.29, 95% CL 1.23, 4.27], those drinking 41-60 g/day in men or 21-40 g/day in women (HR 2.80, 95% CL 1.04, 7.53), and those drinking >150 g/day for men or >100 g/day for women (HR 2.25, 95% CL 1.03, 4.90) with a J-shaped relationship. Low-to-moderate drinkers had lower waist girth, exercised more, and had a lower prevalence of overweight and smoking than at-risk drinkers. A preference for wine was associated with lower HR (0.28, 95% CL 0.10, 0.95). With CVD, only ex-drinkers showed significantly increased risk (HR 1.87, 95% CL 1.20, 2.91). Conclusions: More favourable health-related behaviours in low-to-moderate drinkers suggest that lower risk could be mediated by lifestyle, as proposed in other populations. [ABSTRACT FROM AUTHOR]

The Irukandji syndrome is a jellyfish envenomation caused by Carukia barnesi or related jellyfish. In literature, the distribution of “Irukandji-like” syndromes is restricted to Australia. We report a case of probable Irukandji syndrome in Thailand. With this report, we hope to promote awareness to aid sting prevention and stimulate research. [ABSTRACT FROM AUTHOR]

The article offers information on the evidence-based public health as updated by the Cochrane Collaboration Health Promotion and Public Health Field in Australia. It highlights the aspects of evidence which is important to public health decision making. It also further stresses on the skill required to improve public health practice and the practical assistance available in the field.

This meta-analysis of tea consumption in relation to stroke, myocardial infarction, and all coronary heart disease is based on 10 cohort studies and seven case-control studies. The study-specific effect estimates for stroke and coronary heart disease were too heterogeneous to be summarized (homogeneity p < 0.02 for stroke, p < 0.001 for coronary heart disease). Only the relative risk estimates for myocardial infarction (seven studies) appeared reasonably homogeneous (homogeneity p = 0.20). The incidence rate of myocardial infarction is estimated to decrease by 11% with an increase in tea consumption of 3 cups per day (fixed-effects relative risk estimate = 0.89, 95% confidence interval: 0.79, 1.01) (1 cup = 237 ml). However, evidence of bias toward preferential publication of smaller studies that suggest protective effects urges caution in interpreting this result. The geographic region where the studies were conducted appeared to explain much of the heterogeneity among coronary heart disease, myocardial infarction, and probably stroke results. With increasing tea consumption, the risk increased for coronary heart disease in the United Kingdom and for stroke in Australia, whereas the risk decreased in other regions, particularly in continental Europe. [ABSTRACT FROM PUBLISHER]

The authors report the results of 10 years of monitoring of trends in the rates of major nonfatal and fatal coronary events and in case fataJHy in Auckland, New Zealand, and in Newcastle and Perth, Australia. Continuous surveillance of all suspected myocardial infarctions and coronary deaths in people aged 35–64 years was undertaken in the three centers as part of the World Hearth Organization's Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Project. For nonfatal definite myocardial infarction, there were statistically significant declines in rates in all centers in both men and women, with estimated average changes between 2.5% and 3.7% per year during the period 1984–1993. Rates of all coronary deaths also declined significantly in all three populations for both men and women. In absolute terms, there was, in general, a greater reduction in prehosprtal deaths than in deaths after hospitalization. Although 28-day case fatality remains high at between 35% and 50%, in the Australian centers it declined significantly by between 1.0% and 2.9% per year, and in Auckland there was also a small decline. However, since most deaths occur outside the hospital in people without a previous history of coronary heart disease, an increased emphasis on primary prevention is necessary. Am J Epidemiol 1997; 145: 707–13. [ABSTRACT FROM PUBLISHER]