Author: "Kangaharan N." / Search Limiters: Full Text - Searchworks@Jio Institute Digital Library Search Results

Your search keyword '"Kangaharan N."' showing total 36 results

Start Over Author "Kangaharan N." Search Limiters Full Text

36 results on '"Kangaharan N."'

1. Integrated Guidance for Enhancing the Care of Familial Hypercholesterolaemia in Australia.

Author: Hamilton-Craig I., Pang J., Ademi Z., Ardill J.J., Barnett W., Bates T.R., Beilin L.J., Bishop W., Black J.A., Brett P., Brown A., Burnett J.R., Bursill C.A., Colley A., Clifton P.M., Ekinci E.I., Elias L., Figtree G.A., Forge B.H., Garton-Smith J., Graham D.F., Hamilton-Craig C.R., Heal C., Hespe C.M., Hooper A.J., Howes L.G., Ingles J., Irvin J., Janus E.D., Kangaharan N., Keech A.C., Kirke A.B., Kritharides L., Kyle C.V., Lacaze P., Lambert K., Li S.C.H., Malan W., Maticevic S., McQuillan B.M., Mirzaee S., Mori T.A., Morton A.C., Colquhoun D.M., Moullin J.C., Nestel P.J., Nowak K.J., O'Brien R.C., Pachter N., Page M.M., Pedrotti A., Psaltis P.J., Radford J., Reid N.J., Robertson E.N., Ryan J.D.M., Sarkies M.N., Schultz C.J., Scott R.S., Semsarian C., Simons L.A., Spinks C., Tonkin A.M., van Bockxmeer F., Waddell-Smith K.E., Ward N.C., White H.D., Wilson A.M., Winship I., Woodward A.M., Nicholls S.J., Watts G.F., Sullivan D.R., Hare D.L., Kostner K.M., Horton A.E., Bell D.A., Brett T., Trent R.J., Poplawski N.K., Martin A.C., Srinivasan S., Justo R.N., Chow C.K., Hamilton-Craig I., Pang J., Ademi Z., Ardill J.J., Barnett W., Bates T.R., Beilin L.J., Bishop W., Black J.A., Brett P., Brown A., Burnett J.R., Bursill C.A., Colley A., Clifton P.M., Ekinci E.I., Elias L., Figtree G.A., Forge B.H., Garton-Smith J., Graham D.F., Hamilton-Craig C.R., Heal C., Hespe C.M., Hooper A.J., Howes L.G., Ingles J., Irvin J., Janus E.D., Kangaharan N., Keech A.C., Kirke A.B., Kritharides L., Kyle C.V., Lacaze P., Lambert K., Li S.C.H., Malan W., Maticevic S., McQuillan B.M., Mirzaee S., Mori T.A., Morton A.C., Colquhoun D.M., Moullin J.C., Nestel P.J., Nowak K.J., O'Brien R.C., Pachter N., Page M.M., Pedrotti A., Psaltis P.J., Radford J., Reid N.J., Robertson E.N., Ryan J.D.M., Sarkies M.N., Schultz C.J., Scott R.S., Semsarian C., Simons L.A., Spinks C., Tonkin A.M., van Bockxmeer F., Waddell-Smith K.E., Ward N.C., White H.D., Wilson A.M., Winship I., Woodward A.M., Nicholls S.J., Watts G.F., Sullivan D.R., Hare D.L., Kostner K.M., Horton A.E., Bell D.A., Brett T., Trent R.J., Poplawski N.K., Martin A.C., Srinivasan S., Justo R.N., and Chow C.K.
Abstract: Familial hypercholesterolaemia (FH) is a dominant and highly penetrant monogenic disorder present from birth that markedly elevates plasma low-density lipoprotein (LDL)-cholesterol concentration and, if untreated, leads to premature atherosclerosis and coronary artery disease (CAD). There are approximately 100,000 people with FH in Australia. However, an overwhelming majority of those affected remain undetected and inadequately treated, consistent with FH being a leading challenge for public health genomics. To further address the unmet need, we provide an updated guidance, presented as a series of systematically collated recommendations, on the care of patients and families with FH. These recommendations have been informed by an exponential growth in published works and new evidence over the last 5 years and are compatible with a contemporary global call to action on FH. Recommendations are given on the detection, diagnosis, assessment and management of FH in adults and children. Recommendations are also made on genetic testing and risk notification of biological relatives who should undergo cascade testing for FH. Guidance on management is based on the concepts of risk re-stratification, adherence to heart healthy lifestyles, treatment of non-cholesterol risk factors, and safe and appropriate use of LDL-cholesterol lowering therapies, including statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors and lipoprotein apheresis. Broad recommendations are also provided for the organisation and development of health care services. Recommendations on best practice need to be underpinned by good clinical judgment and shared decision making with patients and families. Models of care for FH need to be adapted to local and regional health care needs and available resources. A comprehensive and realistic implementation strategy, informed by further research, including assessments of cost-benefit, will be required to ensure that this new guidance benefits
Published: 2021

2. Left atrial, pulmonary vein, and left atrial appendage anatomy in Indigenous individuals: Implications for atrial fibrillation

Author: Clarke, NAR, Kangaharan, N, Costello, B, Tu, SJ, Hanna-Rivero, N, Le, K, Agahari, I, Choo, WK, Pitman, BM, Gallagher, C, Haji, K, Roberts-Thomson, KC, Sanders, P, Wong, CX, Clarke, NAR, Kangaharan, N, Costello, B, Tu, SJ, Hanna-Rivero, N, Le, K, Agahari, I, Choo, WK, Pitman, BM, Gallagher, C, Haji, K, Roberts-Thomson, KC, Sanders, P, and Wong, CX
Abstract: BACKGROUND: Indigenous Australians experience a greater burden of AF. Whether this is in-part due to differences in arrhythmogenic structures that appear to contribute to AF differences amongst other ethnicities is not known. METHODS: We studied forty individuals matched for ethnicity and other AF risk factors. Computed tomography imaging was used to characterise left atrial (LA), pulmonary vein (PV), and left atrial appendage (LAA) anatomy. RESULTS: There were no significant differences in LA diameters or volumes between Indigenous and non-Indigenous Australians. Similarly, we could not detect any consistent differences in PV number, morphology, diameters, or ostial characteristics according to ethnicity. LAA analyses suggested that Indigenous Australians may have a greater proportion of non chickenwing LAA type, and a tendency for eccentric, oval-shaped LAA ostia; however, there were no other differences seen with regards to LAA volume or depth. Indexed values for LA, PV and LAA anatomy corrected for body size were broadly similar. CONCLUSIONS: In a cohort of individuals matched for AF risk factors, we could find no strong evidence of ethnic differences in LA, PV, and LAA characteristics that may explain a predisposition of Indigenous Australians for atrial arrhythmogenesis. These findings, in conjunction with our previous data showing highly prevalent cardiometabolic risk factors in Indigenous Australians with AF, suggest that it is these conditions that are more likely responsible for the AF substrate in these individuals. Continued efforts should therefore be directed towards risk factor management in an attempt to prevent and minimise the effects of AF in Indigenous Australians.
Published: 2021

3. Synopsis of an integrated guidance for enhancing the care of familial hypercholesterolaemia: an Australian perspective

Author: Watts, G.F., Sullivan, D.R., Hare, D.L., Kostner, K.M., Horton, A.E., Bell, D.A., Brett, T., Trent, R.J., Poplawski, N.K., Martin, A.C., Srinivasan, S., Justo, R.N., Chow, C.K., Pang, J., Ademi, Z., Ardill, J.J., Barnett, W., Bates, T.R, Beilin, L.J., Bishop, W., Black, J.A., Brown, A., Burnett, J.R., Bursill, C.A., Colley, A., Clifton, P.M., Ekinci, E.I., Figtree, G.A., Forge, B.H., Garton-Smith, J., Graham, D.F., Hamilton-Craig, I., Hamilton-Craig, C.R., Heal, C., Hespe, C.M., Hooper, A.J., Howes, L.G., Ingles, J., Janus, E.D., Kangaharan, N., Keech, A.C., Kirke, A.B., Kritharides, L., Kyle, C.V., Lacaze, P., Li, S.C.H., Maticevic, S., McQuillan, B.M., Mirzaee, S., Mori, T.A., Morton, A.C., Colquhoun, D.M., Moullin, J.C., Nestel, P.J., Nowak, K.J., O'Brien, R.C., Pachter, N., Page, M.M., Psaltis, P.J., Radford, J., Reid, N.J., Robertson, E.N., Ryan, J.D.M., Sarkies, M.N., Schultz, C.J., Scott, R.S., Semsarian, C., Simons, L.A., Spinks, C., Tonkin, A.M., van Bockxmeer, F., Waddell-Smith, K.E., Ward, N.C., White, H.D., Wilson, A.M., Winship, I., Woodward, A.M., Nicholls, S.J., Brett, P., Elias, L., Malan, W., Irvin, J., Lambert, K., Pedrotti, A., Watts, G.F., Sullivan, D.R., Hare, D.L., Kostner, K.M., Horton, A.E., Bell, D.A., Brett, T., Trent, R.J., Poplawski, N.K., Martin, A.C., Srinivasan, S., Justo, R.N., Chow, C.K., Pang, J., Ademi, Z., Ardill, J.J., Barnett, W., Bates, T.R, Beilin, L.J., Bishop, W., Black, J.A., Brown, A., Burnett, J.R., Bursill, C.A., Colley, A., Clifton, P.M., Ekinci, E.I., Figtree, G.A., Forge, B.H., Garton-Smith, J., Graham, D.F., Hamilton-Craig, I., Hamilton-Craig, C.R., Heal, C., Hespe, C.M., Hooper, A.J., Howes, L.G., Ingles, J., Janus, E.D., Kangaharan, N., Keech, A.C., Kirke, A.B., Kritharides, L., Kyle, C.V., Lacaze, P., Li, S.C.H., Maticevic, S., McQuillan, B.M., Mirzaee, S., Mori, T.A., Morton, A.C., Colquhoun, D.M., Moullin, J.C., Nestel, P.J., Nowak, K.J., O'Brien, R.C., Pachter, N., Page, M.M., Psaltis, P.J., Radford, J., Reid, N.J., Robertson, E.N., Ryan, J.D.M., Sarkies, M.N., Schultz, C.J., Scott, R.S., Semsarian, C., Simons, L.A., Spinks, C., Tonkin, A.M., van Bockxmeer, F., Waddell-Smith, K.E., Ward, N.C., White, H.D., Wilson, A.M., Winship, I., Woodward, A.M., Nicholls, S.J., Brett, P., Elias, L., Malan, W., Irvin, J., Lambert, K., and Pedrotti, A.
Abstract: Introduction Familial hypercholesterolaemia (FH) is a common, heritable and preventable cause of premature coronary artery disease, with significant potential for positive impact on public health and healthcare savings. New clinical practice recommendations are presented in an abridged guidance to assist practitioners in enhancing the care of all patients with FH. Main recommendations Core recommendations are made on the detection, diagnosis, assessment and management of adults, children and adolescents with FH. There is a key role for general practitioners (GPs) working in collaboration with specialists with expertise in lipidology. Advice is given on genetic and cholesterol testing and risk notification of biological relatives undergoing cascade testing for FH; all healthcare professionals should develop skills in genomic medicine. Management is under-pinned by the precepts of risk stratification, adherence to healthy lifestyles, treatment of non-cholesterol risk factors, and appropriate use of low-density lipoprotein (LDL)-cholesterol lowering therapies, including statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Recommendations on service design are provided in the full guidance. Potential impact on care of FH These recommendations need to be utilised using judicious clinical judgement and shared decision making with patients and families. Models of care need to be adapted to both local and regional needs and resources. In Australia new government funded schemes for genetic testing and use of PCSK9 inhibitors, as well as the National Health Genomics Policy Framework, will enable adoption of these recommendations. A broad implementation science strategy is, however, required to ensure that the guidance translates into benefit for all families with FH.
Published: 2021

4. Essentials of a new clinical practice guidance on familial hypercholesterolaemia for physicians

Author: Watts, G.F., Sullivan, D.R., Hare, D.L., Kostner, K.M., Horton, A.E., Bell, D.A., Brett, T., Trent, R.J., Poplawski, N.K., Martin, A.C., Srinivasan, S., Justo, R.N., Chow, C.K., Pang, J., Ademi, Z., Ardill, J.J., Barnett, W., Bates, T.R., Beilin, L.J., Bishop, W., Black, J.A., Brown, A., Burnett, J.R., Bursill, C.A., Colley, A., Clifton, P.M., Ekinci, E.I., Figtree, G.A., Forge, B.H., Garton‐Smith, J., Graham, D.F., Hamilton‐Craig, I., Hamilton‐Craig, C.R., Heal, C., Hespe, C.M., Hooper, A.J., Howes, L.G., Ingles, J., Janus, E.D., Kangaharan, N., Keech, A.C., Kirke, A.B., Kritharides, L., Kyle, C.V., Lacaze, P., Li, S.C.H., Maticevic, S., McQuillan, B.M., Mirzaee, S., Mori, T.A., Morton, A.C., Colquhoun, D.M., Moullin, J.C., Nestel, P.J., Nowak, K.J., O'Brien, R.C., Pachter, N., Page, M.M., Psaltis, P.J., Radford, J., Reid, N.J., Robertson, E.N., Ryan, J.D.M., Sarkies, M.N., Schultz, C.J., Semsarian, C., Simons, L.A., Spinks, C., Tonkin, A.M., van Bockxmeer, F., Waddell‐Smith, K.E., Ward, N.C., White, H.D., Wilson, A.M., Winship, I., Woodward, A.M., Nicholls, S.J., Elias, L., Malan, W., Irvin, J., Lambert, K., Pedrotti, A., Watts, G.F., Sullivan, D.R., Hare, D.L., Kostner, K.M., Horton, A.E., Bell, D.A., Brett, T., Trent, R.J., Poplawski, N.K., Martin, A.C., Srinivasan, S., Justo, R.N., Chow, C.K., Pang, J., Ademi, Z., Ardill, J.J., Barnett, W., Bates, T.R., Beilin, L.J., Bishop, W., Black, J.A., Brown, A., Burnett, J.R., Bursill, C.A., Colley, A., Clifton, P.M., Ekinci, E.I., Figtree, G.A., Forge, B.H., Garton‐Smith, J., Graham, D.F., Hamilton‐Craig, I., Hamilton‐Craig, C.R., Heal, C., Hespe, C.M., Hooper, A.J., Howes, L.G., Ingles, J., Janus, E.D., Kangaharan, N., Keech, A.C., Kirke, A.B., Kritharides, L., Kyle, C.V., Lacaze, P., Li, S.C.H., Maticevic, S., McQuillan, B.M., Mirzaee, S., Mori, T.A., Morton, A.C., Colquhoun, D.M., Moullin, J.C., Nestel, P.J., Nowak, K.J., O'Brien, R.C., Pachter, N., Page, M.M., Psaltis, P.J., Radford, J., Reid, N.J., Robertson, E.N., Ryan, J.D.M., Sarkies, M.N., Schultz, C.J., Semsarian, C., Simons, L.A., Spinks, C., Tonkin, A.M., van Bockxmeer, F., Waddell‐Smith, K.E., Ward, N.C., White, H.D., Wilson, A.M., Winship, I., Woodward, A.M., Nicholls, S.J., Elias, L., Malan, W., Irvin, J., Lambert, K., and Pedrotti, A.
Abstract: Familial hypercholesterolaemia (FH) is a common, heritable and preventable cause of premature coronary artery disease. New clinical practice recommendations are presented to assist practitioners in enhancing the care of all patients with FH. Core recommendations are made on the detection, diagnosis, assessment and management of adults, children and adolescents with FH. Management is under-pinned by the precepts of risk stratification, adherence to healthy lifestyles, treatment of non-cholesterol risk factors and appropriate use of low-density lipoprotein (LDL)-cholesterol-lowering therapies including statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. The recommendations need to be utilised using judicious clinical judgement and shared decision-making with patients and families. New government-funded schemes for genetic testing and use of PCSK9 inhibitors, as well as the National Health Genomics Policy Framework, will enable adoption of the recommendations. However, a comprehensive implementation science and practice strategy is required to ensure that the guidance translates into benefit for all families with FH.
Published: 2021

5. Integrated guidance for enhancing the care of familial hypercholesterolaemia in Australia

Author: Watts, G.F., Sullivan, D.R., Hare, D.L., Kostner, K.M., Horton, A.E., Bell, D.A., Brett, T., Trent, R.J., Poplawski, N.K., Martin, A.C., Srinivasan, S., Justo, R.N., Chow, C.K., Pang, J., Ademi, Z., Ardill, J.J., Barnett, W., Bates, T.R., Beilin, L.J., Bishop, W., Black, J.A., Brett, P., Brown, A., Burnett, J.R., Bursill, C.A., Colley, A., Clifton, P.M., Ekinci, E.I., Elias, L., Figtree, G.A., Forge, B.H., Garton-Smith, J., Graham, D.F., Hamilton-Craig, I., Hamilton-Craig, C.R., Heal, C., Hespe, C.M., Hooper, A.J., Howes, L.G., Ingles, J., Irvin, J., Janus, E.D., Kangaharan, N., Keech, A.C., Kirke, A.B., Kritharides, L., Kyle, C.V., Lacaze, P., Lambert, K., Li, S.C.H., Malan, W., Maticevic, S., McQuillan, B.M., Mirzaee, S., Mori, T.A., Morton, A.C., Colquhoun, D.M., Moullin, J.C., Nestel, P.J., Nowak, K.J., O'Brien, R.C., Pachter, N., Page, M.M., Pedrotti, A., Psaltis, P.J., Radford, J., Reid, N.J., Robertson, E.N., Ryan, J.D.M., Sarkies, M.N., Schultz, C.J., Scott, R.S., Semsarian, C., Simons, L.A., Spinks, C., Tonkin, A.M., van Bockxmeer, F., Waddell-Smith, K.E., Ward, N.C., White, H.D., Wilson, A.M., Winship, I., Woodward, A.M., Nicholls, S.J., Watts, G.F., Sullivan, D.R., Hare, D.L., Kostner, K.M., Horton, A.E., Bell, D.A., Brett, T., Trent, R.J., Poplawski, N.K., Martin, A.C., Srinivasan, S., Justo, R.N., Chow, C.K., Pang, J., Ademi, Z., Ardill, J.J., Barnett, W., Bates, T.R., Beilin, L.J., Bishop, W., Black, J.A., Brett, P., Brown, A., Burnett, J.R., Bursill, C.A., Colley, A., Clifton, P.M., Ekinci, E.I., Elias, L., Figtree, G.A., Forge, B.H., Garton-Smith, J., Graham, D.F., Hamilton-Craig, I., Hamilton-Craig, C.R., Heal, C., Hespe, C.M., Hooper, A.J., Howes, L.G., Ingles, J., Irvin, J., Janus, E.D., Kangaharan, N., Keech, A.C., Kirke, A.B., Kritharides, L., Kyle, C.V., Lacaze, P., Lambert, K., Li, S.C.H., Malan, W., Maticevic, S., McQuillan, B.M., Mirzaee, S., Mori, T.A., Morton, A.C., Colquhoun, D.M., Moullin, J.C., Nestel, P.J., Nowak, K.J., O'Brien, R.C., Pachter, N., Page, M.M., Pedrotti, A., Psaltis, P.J., Radford, J., Reid, N.J., Robertson, E.N., Ryan, J.D.M., Sarkies, M.N., Schultz, C.J., Scott, R.S., Semsarian, C., Simons, L.A., Spinks, C., Tonkin, A.M., van Bockxmeer, F., Waddell-Smith, K.E., Ward, N.C., White, H.D., Wilson, A.M., Winship, I., Woodward, A.M., and Nicholls, S.J.
Abstract: Familial hypercholesterolaemia (FH) is a dominant and highly penetrant monogenic disorder present from birth that markedly elevates plasma low-density lipoprotein (LDL)-cholesterol concentration and, if untreated, leads to premature atherosclerosis and coronary artery disease (CAD). There are approximately 100,000 people with FH in Australia. However, an overwhelming majority of those affected remain undetected and inadequately treated, consistent with FH being a leading challenge for public health genomics. To further address the unmet need, we provide an updated guidance, presented as a series of systematically collated recommendations, on the care of patients and families with FH. These recommendations have been informed by an exponential growth in published works and new evidence over the last 5 years and are compatible with a contemporary global call to action on FH. Recommendations are given on the detection, diagnosis, assessment and management of FH in adults and children. Recommendations are also made on genetic testing and risk notification of biological relatives who should undergo cascade testing for FH. Guidance on management is based on the concepts of risk re-stratification, adherence to heart healthy lifestyles, treatment of non-cholesterol risk factors, and safe and appropriate use of LDL-cholesterol lowering therapies, including statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors and lipoprotein apheresis. Broad recommendations are also provided for the organisation and development of health care services. Recommendations on best practice need to be underpinned by good clinical judgment and shared decision making with patients and families. Models of care for FH need to be adapted to local and regional health care needs and available resources. A comprehensive and realistic implementation strategy, informed by further research, including assessments of cost-benefit, will be required to ensure that this new guidance benefits
Published: 2021

6. 387 Patterns of Dyslipidaemia in the Northern Territory - Can Low Levels of High Density Lipoprotein Predict the Burden of Coronary Artery Disease?.

Author: Marangou J., Isa M., Yuvaraj J., Cameron W., Che Z., Reynolds G., Wong D., Kangaharan N., Ilton M., Shah R., Roberts-Thomson R., Baumann A., Marangou J., Isa M., Yuvaraj J., Cameron W., Che Z., Reynolds G., Wong D., Kangaharan N., Ilton M., Shah R., Roberts-Thomson R., and Baumann A.
Abstract: Introduction: Coronary artery disease (CAD) contributes to poorer health outcomes for Aboriginal and Torres Strait Islander (ATSI) people and people from rural areas. Lower high-density lipoprotein (HDL) is a major driver of CAD. The CT derived Leaman score provides quantitative total coronary atherosclerotic plaque burden on computed tomography coronary angiography (CTCA). This audit of CTCA in the Northern Territory examines the relationship between CAD and HDL in ATSI and rural cohorts. Method(s): Patients with a CTCA performed between 2013 and 2018 at the Royal Darwin or Alice Springs Hospitals were retrospectively screened. Patients with a full lipid profile within 12 months of CTCA and no previous IHD were included. Result(s): 213 patients were included (Male: 57.7%, Mean age: 48.2 years, ATSI: 17.8%). Patients with CAD adjudged by a positive Leaman score were more likely to have hypertension (41.3% vs 18.3%,p<0.001) and statin use (48.6% vs 22.1%,p<0.001). ATSI patients were significantly younger (41.9 vs 49.9years,p<0.001) with lower HDL (0.91 vs 1.17mmol/L, p<0.001) and higher triglycerides (2.35 vs 1.63mmol/L,p=0.018) whilst there was no difference in LDL (2.8 vs 3.1mmol/L,p=0.25), total cholesterol (4.7 vs 5.0mmol/L,p=0.25), or HbA1c (7.2 vs 7.5,p=0.87).The presence of CAD or magnitude of Leaman score did not significantly vary with respect to serum HDL, ethnicity or geographic location. Conclusion(s): There was no relationship between CAD on CTCA and HDL in a primary prevention cohort, regardless of ethnicity or location. Despite this, Aboriginal and Torres Strait Islander patients were significantly younger with lower HDL and higher triglycerides. More may be revealed in future by examining novel markers of inflammatory coronary plaque on CTCA.Copyright © 2020
Published: 2020

7. P5 Clinical utility of stress echocardiography in remote indigenous and non-indigenous populations: a 10-year study in central Australia

Author: Ratwatte, S, primary, Costello, B, additional, Kangaharan, N, additional, Bolton, K, additional, Kaur, A, additional, Corkhill, W, additional, Kuepper, B, additional, Sanders, P, additional, and Wong, C X, additional
Published: 2020
Full Text: View/download PDF

8. Secondary prevention therapies in acute coronary syndrome and relation to outcomes: Observational study

Author: Chow, CK, Brieger, D, Ryan, M, Kangaharan, N, Hyun, KK, Briffa, T, Chow, CK, Brieger, D, Ryan, M, Kangaharan, N, Hyun, KK, and Briffa, T
Abstract: Objective To ascertain the use of secondary prevention medications and cardiac rehabilitation after an acute coronary syndrome (ACS) and the impact on 2-year outcomes. Methods CONCORDANCE (Cooperative National Registry of Acute Coronary care, Guideline Adherence and Clinical Events) is a prospective, observational registry of 41 Australian hospitals. A representative sample of 6859 patients with an ACS and 6 months' follow-up on 31 May 2016 were included. The main outcome measure was use of ≥75% of indicated medications (≥4/5 (or ≥3/4 if contraindicated) of angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker, beta-blocker, lipid-lowering therapy, aspirin and other antiplatelet). Major adverse cardiovascular events (MACE) included myocardial infarction, stroke or cardiovascular death. Results The mean age was 65±13 years, 29% were women, and the mean Global Registry of Acute Coronary Events (GRACE) score was 106±30. At discharge, 92% were on aspirin, 93% lipid-lowering therapy, 78% beta-blocker, 74% ACE/angiotensin receptor blocker and 73% a second antiplatelet; 89% were taking ≥75% of medications at discharge, 78% at 6 months and 66% at 2 years. At 6 months, 38% attended cardiac rehabilitation, 58% received dietary advice and 32% of smokers reported quitting. Among 1896 patients followed to 2 years, death/MACE was less frequent among patients on ≥75% vs <75% of medications (8.3% vs 13.9%; adjusted OR 0.75, 95 % CI 0.56 to 0.99), and was less frequent in patients who attended versus who did not attend cardiac rehabilitation (4.6% vs 13.4%; adjusted OR 0.44, 95% CI 0.31 to 0.62). Conclusions Use of secondary prevention therapies diminishes over time following an ACS. Patients receiving secondary prevention had decreased rates of death and MACE at 2 years.
Published: 2019

9. Pulmonary Hypertension in Central Australia: A Community-Based Cohort Study.

Author: Haji, K, Wong, CX, Chandra, N, Truong, H, Corkill, W, Kaethner, A, Naing, P, Abeyaratne, A, Brady, SJ, Kangaharan, N, Haji, K, Wong, CX, Chandra, N, Truong, H, Corkill, W, Kaethner, A, Naing, P, Abeyaratne, A, Brady, SJ, and Kangaharan, N
Abstract: BACKGROUND: The burden of pulmonary hypertension (PHT) in Central Australia has not been previously studied. Our aim is to characterise the prevalence, clinical classification, and long-term survival of individuals with PHT in Central Australia. METHODS: A community-based cohort study of all individuals diagnosed with PHT in Central Australia between 2005 and 2016 was undertaken. We estimated PHT prevalence using population data, describe clinical PHT classification, and characterised long-term survival using Kaplan-Meier approaches. RESULTS: A total of 183 patients were identified (mean age 52±16years, 63% female). Of these individuals, 149 (81.4%) were of Aboriginal and Torres Strait Islander (ATSI) descent. The prevalence per 100,000 of any PHT was significantly higher In ATSI (723 [95% CI 608-839] compared to non-ATSI individuals (126 [95% CI 84-168], p<0.001). Furthermore, ATSI individuals were diagnosed at younger ages compared to non-ATSI individuals (49±15 vs 64±16years, p<0.001). Median estimated pulmonary artery systolic pressure (ePASP) was higher in patients with pulmonary arterial hypertension (PAH) compared to other causes (62 [IQR 54-69] vs 50 [IQR 44-58] mmHg, p<0.01). The median survival rate from diagnosis was 9 years (IQR 7.2-13.2). Age and ePASP were significant predictors of mortality (HR 1.05 [95% CI 1.02-1.07] and HR 1.56 [95% 1.00-2.42] respectively). CONCLUSIONS: In this community based study, we found a high burden of PHT in Central Australia. The prevalence of PHT is greater in ATSI individuals and is diagnosed at younger ages compared to non-ATSI individuals. Together with other cardiovascular diseases, PHT may be in-part contributing to the gap in life expectancy between ATSI and non-ATSI individuals.
Published: 2019

10. P2498Exercise capacity and all-cause mortality in remote Indigenous and non-Indigenous populations

Author: Chang, D D, primary, Kangaharan, N, additional, Forde, J, additional, Goh, D, additional, Elangovan, H, additional, Manek, N, additional, Arauz, C, additional, Brady, S, additional, Sanders, P, additional, and Wong, C X, additional
Published: 2019
Full Text: View/download PDF

11. TEXT messages to improve MEDication adherence and Secondary prevention (TEXTMEDS) after acute coronary syndrome: A randomised clinical trial protocol

Author: Chow, CK, Thiagalingam, A, Santo, K, Kok, C, Thakkar, J, Stepien, S, Billot, L, Jan, S, Joshi, R, Hillis, GS, Brieger, D, Chew, DP, Rådholm, K, Atherton, JJ, Bhindi, R, Collins, N, Coverdale, S, Hamilton-Craig, C, Kangaharan, N, Maiorana, A, McGrady, M, Shetty, P, Thompson, P, Rogers, A, Redfern, J, Chow, CK, Thiagalingam, A, Santo, K, Kok, C, Thakkar, J, Stepien, S, Billot, L, Jan, S, Joshi, R, Hillis, GS, Brieger, D, Chew, DP, Rådholm, K, Atherton, JJ, Bhindi, R, Collins, N, Coverdale, S, Hamilton-Craig, C, Kangaharan, N, Maiorana, A, McGrady, M, Shetty, P, Thompson, P, Rogers, A, and Redfern, J
Abstract: Background Identifying simple, low-cost and scalable means of supporting lifestyle change and medication adherence for patients following a cardiovascular (CV) event is important. Objective The TEXTMEDS (TEXT messages to improve MEDication adherence and Secondary prevention) study aims to investigate whether a cardiac education and support programme sent via mobile phone text message improves medication adherence and risk factor levels in patients following an acute coronary syndrome (ACS). Study design A single-blind, multicentre, randomised clinical trial of 1400 patients after an ACS with 12 months follow-up. The intervention group will receive multiple weekly text messages that provide information, motivation, support to adhere to medications, quit smoking (if relevant) and recommendations for healthy diet and exercise. The primary endpoint is the percentage of patients who are adherent to cardioprotective medications and the key secondary outcomes are mean systolic blood pressure (BP) and low-density lipoprotein cholesterol. Secondary outcomes will also include total cholesterol, mean diastolic BP, the percentage of participants who are adherent to each cardioprotective medication class, the percentage of participants who achieve target levels of CV risk factors, major vascular events, hospital readmissions and all-cause mortality. The study will be augmented by formal economic and process evaluations to assess acceptability, utility and cost-effectiveness. Summary The study will provide multicentre randomised trial evidence of the effects of a text message-based programme on cardioprotective medication adherence and levels of CV risk factors. Ethics and dissemination Primary ethics approval was received from Western Sydney Local Health District Human Research Ethics Committee (HREC2012/12/4.1 (3648) AU RED HREC/13/WMEAD/15). Results will be disseminated via peer-reviewed publications and presentations at international conferences. Trial registration number ACT
Published: 2018

12. TEXT messages to improve MEDication adherence and Secondary prevention (TEXTMEDS) after acute coronary syndrome: A randomised clinical trial protocol

Author: Chow, C., Thiagalingam, A., Santo, K., Kok, C., Thakkar, J., Stepien, S., Billot, L., Jan, S., Joshi, R., Hillis, G., Brieger, D., Chew, D., Rådholm, K., Atherton, J., Bhindi, R., Collins, N., Coverdale, S., Hamilton-Craig, C., Kangaharan, N., Maiorana, Andrew, McGrady, M., Shetty, P., Thompson, P., Rogers, A., Redfern, J., Chow, C., Thiagalingam, A., Santo, K., Kok, C., Thakkar, J., Stepien, S., Billot, L., Jan, S., Joshi, R., Hillis, G., Brieger, D., Chew, D., Rådholm, K., Atherton, J., Bhindi, R., Collins, N., Coverdale, S., Hamilton-Craig, C., Kangaharan, N., Maiorana, Andrew, McGrady, M., Shetty, P., Thompson, P., Rogers, A., and Redfern, J.
Abstract: Background: Identifying simple, low-cost and scalable means of supporting lifestyle change and medication adherence for patients following a cardiovascular (CV) event is important. Objective: The TEXTMEDS (TEXT messages to improve MEDication adherence and Secondary prevention) study aims to investigate whether a cardiac education and support programme sent via mobile phone text message improves medication adherence and risk factor levels in patients following an acute coronary syndrome (ACS). Study design: A single-blind, multicentre, randomised clinical trial of 1400 patients after an ACS with 12 months follow-up. The intervention group will receive multiple weekly text messages that provide information, motivation, support to adhere to medications, quit smoking (if relevant) and recommendations for healthy diet and exercise. The primary endpoint is the percentage of patients who are adherent to cardioprotective medications and the key secondary outcomes are mean systolic blood pressure (BP) and low-density lipoprotein cholesterol. Secondary outcomes will also include total cholesterol, mean diastolic BP, the percentage of participants who are adherent to each cardioprotective medication class, the percentage of participants who achieve target levels of CV risk factors, major vascular events, hospital readmissions and all-cause mortality. The study will be augmented by formal economic and process evaluations to assess acceptability, utility and cost-effectiveness. Summary: The study will provide multicentre randomised trial evidence of the effects of a text message-based programme on cardioprotective medication adherence and levels of CV risk factors. Ethics and dissemination: Primary ethics approval was received from Western Sydney Local Health District Human Research Ethics Committee (HREC2012/12/4.1 (3648) AU RED HREC/13/WMEAD/15). Results will be disseminated via peer-reviewed publications and presentations at international conferences. Trial registration numbe
Published: 2018

13. Associations of mortality and cardiovascular disease risks with diabetes and albuminuria in urban Indigenous Australians: the DRUID follow-up study

Author: Barr, ELM, Cunningham, J, Tatipata, S, Dunbar, T, Kangaharan, N, Guthridge, S, Li, SQ, Condon, JR, Shaw, JE, O'Dea, K, Maple-Brown, LJ, Barr, ELM, Cunningham, J, Tatipata, S, Dunbar, T, Kangaharan, N, Guthridge, S, Li, SQ, Condon, JR, Shaw, JE, O'Dea, K, and Maple-Brown, LJ
Abstract: AIM: To assess the relationships of diabetes and albuminuria with all-cause mortality and cardiovascular disease outcomes in a population without prior cardiovascular disease using data from the Darwin Region Urban Indigenous Diabetes (DRUID) study. METHODS: We conducted a prospective cohort study of 706 participants (aged 15-81 years, 68% women) without prior cardiovascular disease who underwent a 75-g oral glucose tolerance test. Deaths and fatal or non-fatal cardiovascular disease were determined over 7 years, and hazard ratios with 95% CIs and population attributable risks were estimated for baseline glycaemia and albuminuria. RESULTS: Compared with normoglycaemia and after adjustment for age, sex, hypertension, dyslipidaemia and smoking, known diabetes was associated with an adjusted hazard ratio of 4.8 (95% CI 1.5-14.7) for all-cause mortality and 5.6 (95% CI 2.1-15.2) for cardiovascular disease. Compared with normoalbuminuria, the respective adjusted risks for macroalbuminuria were 10.9 (95% CI 3.7-32.1) and 3.9 (95% CI 1.4-10.8). The Adjusted all-cause mortality and cardiovascular disease estimated population attributable risks for diabetes were 27% and 32%, and for albuminuria they were 32% and 21%, respectively. CONCLUSIONS: In our study population, the burden of mortality and cardiovascular disease was largely driven by diabetes and albuminuria. This finding on the influence of diabetes and albuminuria is consistent with reports in other high-risk Indigenous populations and should be better reflected in risk scores and intervention programmes.
Published: 2017

14. Outcomes of anaemic patients presenting with acute coronary syndrome (ACS): An analysis of the cooperative national registry of acute coronary care, guideline adherence and clinical events (CONCORDANCE).

Author: Hung J., Brieger D., Kilian J., Ryan M., Chew D., Huynh R., Hyun K., D'Souza M., Kangaharan N., Shetty P., Mariani J., Hung J., Brieger D., Kilian J., Ryan M., Chew D., Huynh R., Hyun K., D'Souza M., Kangaharan N., Shetty P., and Mariani J.
Abstract: Objectives: Anaemia commonly accompanies ACS and is associated with poorer outcomes. This study examines the associations between anaemia, management and outcomes in an Australian ACS population. Method(s): This analysis of the CONCORDANCE database included 8665 ACS patients presenting to 41 Australian hospitals. Baseline characteristics, management and outcomes were compared between patients with anaemia (Hb<=130 for males, Hb<=120 g/L for females) and non-anaemia. Result(s): 1880 (21.7%) patients presenting with ACS were anaemic. These patients were older (72yrs vs. 63yrs, p<0.0001), with higher prevalence of comorbidities. STEMI patients with anaemia were less likely to be emergently reperfused with either thrombolytic therapy (22% vs. 33%, p<0.0001) or primary percutaneous coronary intervention (PCI) (45 vs. 51% p=0.033). For all ACS, anaemic patients less frequently received: coronary angiography (63% vs. 86%, p<0.0001); drug eluting stents if undergoing PCI (50% vs. 58%, p<0.0001); dual antiplatelet therapy (80% vs. 89%, p<0.0001) and parenteral anticoagulants (82% vs. 88%, p<0.0001). Heart failure (20% vs. 9%, p<0.0001), renal failure (13% vs. 4%, p<0.0001), and reinfarction (4% vs. 2%, p=0.0006) were more common among anaemic patients. There was a near-linear relationship between admission haemoglobin and in hospital mortality. Conclusion(s): Anaemic patients with ACS are a high risk group less likely to undergo invasive and antithrombotic therapy. The optimal haemoglobin level in this population warrants further investigation.
Published: 2016

15. Heart Failure in Minority Populations - Impediments to Optimal Treatment in Australian Aborigines

Author: Iyngkaran, P, Kangaharan, N, Zimmet, H, Arstall, M, Minson, R, Thomas, MC, Bergin, P, Atherton, J, MacDonald, P, Hare, DL, Horowitz, JD, Ilton, M, Iyngkaran, P, Kangaharan, N, Zimmet, H, Arstall, M, Minson, R, Thomas, MC, Bergin, P, Atherton, J, MacDonald, P, Hare, DL, Horowitz, JD, and Ilton, M
Abstract: Chronic heart failure (CHF) among Aboriginal/Indigenous Australians is endemic. There are also grave concerns for outcomes once acquired. This point is compounded by a lack of prospective and objective studies to plan care. To capture the essence of the presented topic it is essential to broadly understand Indigenous health. Key words such as 'worsening', 'gaps', 'need to do more', 'poorly studied', or 'future studies should inform' occur frequently in contrast to CHF research for almost all other groups. This narrative styled opinion piece attempts to discuss future directions for CHF care for Indigenous Australians. We provide a synopsis of the problem, highlight the treatment gaps, and define the impediments that present hurdles in optimising CHF care for Indigenous Australians.
Published: 2016

16. Northern Territory Perspectives on Heart Failure with Comorbidities - Understanding Trial Validity and Exploring Collaborative Opportunities to Broaden the Evidence Base

Author: Iyngkaran, P., Majoni, William, Cass, Alan, Sanders, Prashanthan, Ronco, C., Brady, Stephen, Kangaharan, N., Ilton, Marcus, Hare, D. L., Thomas, Merlin C., Iyngkaran, P., Majoni, William, Cass, Alan, Sanders, Prashanthan, Ronco, C., Brady, Stephen, Kangaharan, N., Ilton, Marcus, Hare, D. L., and Thomas, Merlin C.
Abstract: Congestive Heart Failure (CHF) is an ambulatory care sensitive condition, associated with significant morbidity and mortality, rarely with cure. Outpatient based pharmacological management represents the main and most important aspect of care, and is usually lifelong. This narrative styled opinion review looks at the pharmacological agents recommended in the guidelines in context of the Northern Territory (NT) of Australia. We explore the concept of validity, a term used to describe the basis of standardising a particular trial or study and the population to which it is applicable. We aim to highlight the problems of the current guidelines based approach. We also present alternatives that could utilise the core principles from major trials, while incorporating regional considerations, which could benefit clients living in the NT and remote Australia.
Published: 2015

17. Associations of mortality and cardiovascular disease risks with diabetes and albuminuria in urban Indigenous Australians: the DRUID follow-up study

Author: Elizabeth L M Barr, Jonathan E. Shaw, John R. Condon, Nadarajan Kangaharan, Kerin O'Dea, Shaun Tatipata, Louise J. Maple-Brown, Joan Cunningham, Shu Qin Li, Steve Guthridge, Terry Dunbar, Barr, ELM, Cunningham, J, Tatipata, S, Dunbar, T, Kangaharan, N, Guthridge, S, Li, SQ, Condon, JR, Shaw, JE, O'Dea, K, and Maple-Brown, LJ
Subjects: Male, Native Hawaiian or Other Pacific Islander, Indigenous Australians, Diabetic Cardiomyopathies, Endocrinology, Diabetes and Metabolism, 030204 cardiovascular system & hematology, Cohort Studies, 0302 clinical medicine, Endocrinology, Risk Factors, Prevalence, Medicine, Diabetic Nephropathies, Prospective Studies, Prospective cohort study, education.field_of_study, diabetes, Incidence, Hazard ratio, Cardiovascular Diseases, Population study, Female, medicine.symptom, cardiovascular disease risks, Cohort study, Adult, medicine.medical_specialty, Adolescent, Population, 030209 endocrinology & metabolism, albuminuria, 03 medical and health sciences, Internal medicine, Diabetes mellitus, Internal Medicine, Albuminuria, Humans, Mortality, Renal Insufficiency, Chronic, education, Aged, Proportional Hazards Models, business.industry, Proportional hazards model, Australia, Urban Health, medicine.disease, Health Surveys, business, Diabetic Angiopathies, Follow-Up Studies
Abstract: Aim: To assess the relationships of diabetes and albuminuria with all-cause mortality and cardiovascular disease outcomes in a population without prior cardiovascular disease using data from the Darwin Region Urban Indigenous Diabetes (DRUID) study. Methods: We conducted a prospective cohort study of 706 participants (aged 15–81 years, 68% women) without prior cardiovascular disease who underwent a 75-g oral glucose tolerance test. Deaths and fatal or non-fatal cardiovascular disease were determined over 7 years, and hazard ratios with 95% CIs and population attributable risks were estimated for baseline glycaemia and albuminuria. Results: Compared with normoglycaemia and after adjustment for age, sex, hypertension, dyslipidaemia and smoking, known diabetes was associated with an adjusted hazard ratio of 4.8 (95% CI 1.5–14.7) for all-cause mortality and 5.6 (95% CI 2.1–15.2) for cardiovascular disease. Compared with normoalbuminuria, the respective adjusted risks for macroalbuminuria were 10.9 (95% CI 3.7–32.1) and 3.9 (95% CI 1.4–10.8). The Adjusted all-cause mortality and cardiovascular disease estimated population attributable risks for diabetes were 27% and 32%, and for albuminuria they were 32% and 21%, respectively. Conclusions: In our study population, the burden of mortality and cardiovascular disease was largely driven by diabetes and albuminuria. This finding on the influence of diabetes and albuminuria is consistent with reports in other high-risk Indigenous populations and should be better reflected in risk scores and intervention programmes. Refereed/Peer-reviewed
Published: 2017

18. Prevalence and burden of coronary artery disease on computed tomography coronary angiography and its correlation with high-density lipoprotein in the Northern Territory, Australia.

Author: Baumann AAW, Roberts-Thomson RL, Shah R, Reynolds GF, Marangou J, Tayeb H, Psaltis PJ, Brown A, Wong D, Kangaharan N, and Ilton M
Abstract: Indigenous Australians are known to have a higher prevalence of coronary artery disease (CAD) than non-Indigenous counterparts. Atherogenic lipid profiles, characterised by low serum levels of high-density lipoprotein (HDL) and higher serum triglycerides, have been shown to be more prevalent in Indigenous Australians. The use of computed tomography coronary angiography (CTCA) for risk stratification and diagnosis of CAD has been validated in moderate risk populations, but limited data exists in specific high-risk populations such as Indigenous Australians. Through a retrospective study of patient records, we aimed to confirm if an atherogenic lipid profile occurred in Indigenous Australians undergoing CTCA in the Northern Territory of Australia and if so, whether this correlated with the prevalence or burden of CAD. We demonstrate that Indigenous Australians have similar prevalence (52.6% vs . 50.3%, P=0.80) and burden of CAD (Leaman score 6.03±4.66 vs . 6.96±4.82, P=0.44) on CTCA as non-Indigenous patients, but were 8 years younger (41.9±8.9 vs . 50.0±11.9 years, P<0.001) at the time of examination. We confirmed the presence of an atherogenic lipid profile in Indigenous patients and showed low serum-HDL was associated with very premature (patients aged 18-35 years) CAD in comparison to premature (patients aged 36-55 years) and mature-onset (patients aged 56 years and older) CAD (0.71±0.25 vs . 1.09±0.35 vs . 1.18±0.36 mmol/L, P=0.009). Future clinical guidelines should consider the role of CTCA in Indigenous Australians and whether younger patients may benefit. The causes of premature CAD, including atherogenic lipid profiles, require an ongoing focus in order to achieve equitable cardiovascular outcomes for Indigenous and non-Indigenous Australians., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cdt.amegroups.com/article/view/10.21037/cdt-23-458/coif). P.J.P. serves as an unpaid editorial board member of Cardiovascular Diagnosis and Therapy from July 2022 to June 2024. D.W. serves as an unpaid editorial board member of Cardiovascular Diagnosis and Therapy from February 2023 to January 2025. P.J.P. reports that he received speaker honoraria ad hoc from AstraZeneca and Boehringer Ingelheim related to antiplatelet/anticoagulant management of coronary syndromes; received support from Eli Lilly and NovoNordisk; and served as unpaid president of Australian Atherosclerosis Society. The other authors have no conflicts of interest to declare., (2024 Cardiovascular Diagnosis and Therapy. All rights reserved.)
Published: 2024
Full Text: View/download PDF

19. Costs and healthcare use of patients with chronic kidney disease in the Northern Territory, Australia.

Author: Chen W, Howard K, Gorham G, Abeyaratne A, Zhao Y, Adegboye O, Kangaharan N, Talukder MRR, Taylor S, and Cass A
Subjects: Humans, Northern Territory epidemiology, Male, Middle Aged, Female, Retrospective Studies, Adult, Aged, Risk Factors, Patient Acceptance of Health Care statistics & numerical data, Renal Insufficiency, Chronic therapy, Renal Insufficiency, Chronic economics, Renal Insufficiency, Chronic epidemiology, Health Care Costs statistics & numerical data
Abstract: Background: The burden of chronic kidney disease (CKD) is high in the Northern Territory (NT), Australia. This study aims to describe the healthcare use and associated costs of people at risk of CKD (e.g. acute kidney injury, diabetes, hypertension, and cardiovascular disease) or living with CKD in the NT, from a healthcare funder perspective., Methods: We included a retrospective cohort of patients at risk of, or living with CKD, on 1 January 2017. Patients on kidney replacement therapy were excluded from the study. Data from the Territory Kidney Care database, encompassing patients from public hospitals and primary health care services across the NT was used to conduct costing. Annual healthcare costs, including hospital, primary health care, medication, and investigation costs were described over a one-year follow-up period. Factors associated with high total annual healthcare costs were identified with a cost prediction model., Results: Among 37,398 patients included in this study, 23,419 had a risk factor for CKD while 13,979 had CKD (stages 1 to 5, not on kidney replacement therapy). The overall mean (± SD) age was 45 years (± 17), and a large proportion of the study cohort were First Nations people (68%). Common comorbidities in the overall cohort included diabetes (36%), hypertension (32%), and coronary artery disease (11%). Annual healthcare cost was lowest in those at risk of CKD (AUD$7,958 per person) and highest in those with CKD stage 5 (AUD$67,117 per person). Inpatient care contributed to the majority (76%) of all healthcare costs. Predictors of increased total annual healthcare cost included more advanced stages of CKD, and the presence of comorbidities. In CKD stage 5, the additional cost per person per year was + $53,634 (95%CI 32,769 to 89,482, p < 0.001) compared to people in the at risk group without CKD., Conclusion: The total healthcare costs in advanced stages of CKD is high, even when patients are not on dialysis. There remains a need for effective primary prevention and early intervention strategies targeting CKD and related chronic conditions., (© 2024. The Author(s).)
Published: 2024
Full Text: View/download PDF

20. Protocol and rationale of the Australian multicentre registry for serial cardiac computed tomography angiography (ARISTOCRAT): a prospective observational study of the natural history of pericoronary adipose tissue attenuation and radiomics.

Author: Cheng K, Lin A, Psaltis PJ, Rajwani A, Baumann A, Brett N, Kangaharan N, Otton J, Nicholls SJ, Dey D, and Wong DTL
Abstract: Background: Vascular inflammation plays a crucial role in the development of atherosclerosis and atherosclerotic plaque rupture resulting in acute coronary syndrome (ACS). Pericoronary adipose tissue (PCAT) attenuation quantified from routine coronary computed tomography angiography (CCTA) has emerged as a promising non-invasive imaging biomarker of coronary inflammation. However, a detailed understanding of the natural history of PCAT attenuation is required before it can be used as a surrogate endpoint in trials of novel therapies targeting coronary inflammation. This article aims to explore the natural history of PCAT attenuation and its association with changes in plaque characteristics., Methods: The Australian natuRal hISTOry of periCoronary adipose tissue attenuation, RAdiomics and plaque by computed Tomographic angiography (ARISTOCRAT) registry is a multi-centre observational registry enrolling patients undergoing clinically indicated serial CCTA in 9 centres across Australia. CCTA scan parameters will be matched across serial scans. Quantitative analysis of plaque and PCAT will be performed using semiautomated software., Discussion: The primary endpoint is to explore temporal changes in patient-level and lesion-level PCAT attenuation by CCTA and their associations with changes in plaque characteristics. Secondary endpoints include evaluating: (I) impact of statin therapy on PCAT attenuation and plaque characteristics; and (II) changes in PCAT attenuation and plaque characteristics in specific subgroups according to sex and risk factors. ARISTOCRAT will further our understanding of the natural history of PCAT attenuation and its association with changes in plaque characteristics., Trial Registration: This study has been prospectively registered with the Australia and New Zealand Clinical Trials Registry (ACTRN12621001018808)., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cdt.amegroups.com/article/view/10.21037/cdt-23-392/coif). P.J.P. serves as an unpaid editorial board member of Cardiovascular Diagnosis and Therapy from July 2022 to June 2024. S.J.N. as an unpaid editorial board member of Cardiovascular Diagnosis and Therapy from September 2023 to August 2025. D.T.L.W. serves as an unpaid editorial board member of Cardiovascular Diagnosis and Therapy from February 2021 to January 2023. K.C. was supported by the National Health and Medical Research Council postgraduate scholarship (No. APP2002573), which covers a portion of the research-related expenses and stipend to help with living expenses, research-related travel costs and other expenses associated with research project. S.J.N. received consulting fees from Amgen, Akcea, AstraZeneca, Boehringer Ingelheim, CSL Behring, Eli Lilly, Esperion, Kowa, Merck, Takeda, Pfizer, Sanofi- Regeneron, Vaxxinity, CSL Sequiris, and Novo Nordisk; received grants from AstraZeneca, Amgen, Anthera, CSL Behring, Cerenis, Cyclarity, Eli Lilly, Esperion, Resverlogix, New Amsterdam Pharma, Novartis, InfraReDx and Sanofi-Regeneron. D.T.L.W. received honoraria for lectures from Eli-Lilly, Pfizer and Boehringer. The other authors have no conflicts of interest to declare., (2024 Cardiovascular Diagnosis and Therapy. All rights reserved.)
Published: 2024
Full Text: View/download PDF

21. Correction: Developing an integrated clinical decision support system for the early identification and management of kidney disease-building cross-sectoral partnerships.

Author: Gorham G, Abeyaratne A, Heard S, Moore L, George P, Kamler P, Majoni SW, Chen W, Balasubramanya B, Talukder MR, Pascoe S, Whitehead A, Sajiv C, Maple-Brown L, Kangaharan N, and Cass A
Published: 2024
Full Text: View/download PDF

22. Developing an integrated clinical decision support system for the early identification and management of kidney disease-building cross-sectoral partnerships.

Author: Gorham G, Abeyaratne A, Heard S, Moore L, George P, Kamler P, Majoni SW, Chen W, Balasubramanya B, Talukder MR, Pascoe S, Whitehead A, Sajiv C, Maple-Brown L, Kangaharan N, and Cass A
Subjects: Humans, Delivery of Health Care, Northern Territory, Hospitals, Risk Assessment, Decision Support Systems, Clinical
Abstract: Background: The burden of chronic conditions is growing in Australia with people in remote areas experiencing high rates of disease, especially kidney disease. Health care in remote areas of the Northern Territory (NT) is complicated by a mobile population, high staff turnover, poor communication between health services and complex comorbid health conditions requiring multidisciplinary care., Aim: This paper aims to describe the collaborative process between research, government and non-government health services to develop an integrated clinical decision support system to improve patient care., Methods: Building on established partnerships in the government and Aboriginal Community-Controlled Health Service (ACCHS) sectors, we developed a novel digital clinical decision support system for people at risk of developing kidney disease (due to hypertension, diabetes, cardiovascular disease) or with kidney disease. A cross-organisational and multidisciplinary Steering Committee has overseen the design, development and implementation stages. Further, the system's design and functionality were strongly informed by experts (Clinical Reference Group and Technical Working Group), health service providers, and end-user feedback through a formative evaluation., Results: We established data sharing agreements with 11 ACCHS to link patient level data with 56 government primary health services and six hospitals. Electronic Health Record (EHR) data, based on agreed criteria, is automatically and securely transferred from 15 existing EHR platforms. Through clinician-determined algorithms, the system assists clinicians to diagnose, monitor and provide guideline-based care for individuals, as well as service-level risk stratification and alerts for clinically significant events., Conclusion: Disconnected health services and separate EHRs result in information gaps and a health and safety risk, particularly for patients who access multiple health services. However, barriers to clinical data sharing between health services still exist. In this first phase, we report how robust partnerships and effective governance processes can overcome these barriers to support clinical decision making and contribute to holistic care., (© 2024. The Author(s).)
Published: 2024
Full Text: View/download PDF

23. Pericoronary adipose tissue attenuation on coronary computed tomography angiography associates with male sex and Indigenous Australian status.

Author: Yuvaraj J, Lim E, Vo T, Huynh D, Rocco C, Nerlekar N, Cheng K, Lin A, Dey D, Nicholls SJ, Kangaharan N, and Wong DTL
Subjects: Humans, Female, Male, Adult, Middle Aged, Australian Aboriginal and Torres Strait Islander Peoples, Retrospective Studies, Australia, Adipose Tissue diagnostic imaging, Inflammation, Computed Tomography Angiography, RNA, Long Noncoding
Abstract: To evaluate if Indigenous Australians have higher coronary inflammation demonstrated non-invasively using pericoronary adipose tissue attenuation on coronary computed tomography angiography (CCTA). We retrospectively obtained a cohort 54 Indigenous patients age- and sex-matched to 54 non-Indigenous controls (age: 46.5 ± 13.1 years; male: n = 66) undergoing CCTA at the Royal Darwin Hospital and Monash Medical Centre. Patient groups were defined to investigate the interaction of ethnicity and sex: Indigenous + male, Indigenous + female, control + male, control + female. Semi-automated software was used to assess pericoronary adipose tissue attenuation (PCAT-a) and volume (PCAT-v). Males had significantly higher PCAT-a (- 86.7 ± 7.8 HU vs. - 91.3 ± 7.1 HU, p = 0.003) than females. Indigenous patients had significantly higher PCAT-v (1.5 ± 0.5cm 3 vs. 1.3 ± 0.4cm 3 , p = 0.032), but only numerically higher PCAT-a (p = 0.133) than controls. There was a significant difference in PCAT-a and PCAT-v across groups defined by Indigenous status and sex (p = 0.010 and p = 0.030, respectively). Among patients with matching CCTA contrast density, multivariable linear regression analysis showed an independent association between Indigenous status and PCAT-a. Indigenous men have increased PCAT-a in an age- and sex-matched cohort. Male sex is strongly associated with increased PCAT-a. Coronary inflammation may contribute to adverse cardiovascular outcomes in Indigenous Australians, but larger studies are required to validate these findings., (© 2023. Springer Nature Limited.)
Published: 2023
Full Text: View/download PDF

24. Surgery for rheumatic heart disease in the Northern Territory, Australia, 1997-2016: what have we gained?

Author: Doran J, Canty D, Dempsey K, Cass A, Kangaharan N, Remenyi B, Brunsdon G, McDonald M, Heal C, Wang Z, Royse C, Royse A, Mein J, Gray N, Bennetts J, Baker RA, Stewart M, Sutcliffe S, Reeves B, Doran U, Rankine P, Fejo R, Heenan E, Jalota R, Ilton M, Roberts-Thomson R, King J, Wyber R, Doran J, Webster A, and Hanson J
Subjects: Adult, Child, Humans, Northern Territory epidemiology, Retrospective Studies, Comorbidity, Age Factors, Rheumatic Heart Disease epidemiology, Rheumatic Heart Disease surgery, Rheumatic Heart Disease complications
Abstract: Background: Between 1964 and 1996, the 10-year survival of patients having valve replacement surgery for rheumatic heart disease (RHD) in the Northern Territory, Australia, was 68%. As medical care has evolved since then, this study aimed to determine whether there has been a corresponding improvement in survival., Methods: A retrospective study of Aboriginal patients with RHD in the Northern Territory, Australia, having their first valve surgery between 1997 and 2016. Survival was examined using Kaplan-Meier and Cox regression analysis., Findings: The cohort included 281 adults and 61 children. The median (IQR) age at first surgery was 31 (18-42) years; 173/342 (51%) had a valve replacement, 113/342 (33%) had a valve repair and 56/342 (16%) had a commissurotomy. There were 93/342 (27%) deaths during a median (IQR) follow-up of 8 (4-12) years. The overall 10-year survival was 70% (95% CI: 64% to 76%). It was 62% (95% CI: 53% to 70%) in those having valve replacement. There were 204/281 (73%) adults with at least 1 preoperative comorbidity. Preoperative comorbidity was associated with earlier death, the risk of death increasing with each comorbidity (HR: 1.3 (95% CI: 1.2 to 1.5), p<0.001). Preoperative chronic kidney disease (HR 6.5 (95% CI: 3.0 to 14.0) p≤0.001)), coronary artery disease (HR 3.3 (95% CI: 1.3 to 8.4) p=0.012) and pulmonary artery systolic pressure>50 mm Hg before surgery (HR 1.9 (95% CI: 1.2 to 3.1) p=0.007) were independently associated with death., Interpretation: Survival after valve replacement for RHD in this region of Australia has not improved. Although the patients were young, many had multiple comorbidities, which influenced long-term outcomes. The increasing prevalence of complex comorbidity in the region is a barrier to achieving optimal health outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Published: 2023
Full Text: View/download PDF

25. Text Messages to Improve Medication Adherence and Secondary Prevention After Acute Coronary Syndrome: The TEXTMEDS Randomized Clinical Trial.

Author: Chow CK, Klimis H, Thiagalingam A, Redfern J, Hillis GS, Brieger D, Atherton J, Bhindi R, Chew DP, Collins N, Andrew Fitzpatrick M, Juergens C, Kangaharan N, Maiorana A, McGrady M, Poulter R, Shetty P, Waites J, Hamilton Craig C, Thompson P, Stepien S, Von Huben A, and Rodgers A
Subjects: Australia, Female, Humans, Male, Medication Adherence, Middle Aged, Secondary Prevention, Single-Blind Method, Acute Coronary Syndrome drug therapy, Acute Coronary Syndrome prevention & control, Text Messaging
Abstract: Background: TEXTMEDS (Text Messages to Improve Medication Adherence and Secondary Prevention After Acute Coronary Syndrome) examined the effects of text message-delivered cardiac education and support on medication adherence after an acute coronary syndrome., Methods: TEXTMEDS was a single-blind, multicenter, randomized controlled trial of patients after acute coronary syndrome. The control group received usual care (secondary prevention as determined by the treating clinician); the intervention group also received multiple motivational and supportive weekly text messages on medications and healthy lifestyle with the opportunity for 2-way communication (text or telephone). The primary end point of self-reported medication adherence was the percentage of patients who were adherent, defined as >80% adherence to each of up to 5 indicated cardioprotective medications, at both 6 and 12 months., Results: A total of 1424 patients (mean age, 58 years [SD, 11]; 79% male) were randomized from 18 Australian public teaching hospitals. There was no significant difference in the primary end point of self-reported medication adherence between the intervention and control groups (relative risk, 0.93 [95% CI, 0.84-1.03]; P =0.15). There was no difference between intervention and control groups at 12 months in adherence to individual medications (aspirin, 96% vs 96%; β-blocker, 84% vs 84%; angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, 77% vs 80%; statin, 95% vs 95%; second antiplatelet, 84% vs 84% [all P >0.05]), systolic blood pressure (130 vs 129 mm Hg; P =0.26), low-density lipoprotein cholesterol (2.0 vs 1.9 mmol/L; P =0.34), smoking ( P =0.59), or exercising regularly (71% vs 68%; P =0.52). There were small differences in lifestyle risk factors in favor of intervention on body mass index <25 kg/m 2 (21% vs 18%; P =0.01), eating ≥5 servings per day of vegetables (9% vs 5%; P =0.03), and eating ≥2 servings per day of fruit (44% vs 39%; P =0.01)., Conclusions: A text message-based program had no effect on medical adherence but small effects on lifestyle risk factors., Registration: URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364448; Unique identifier: ANZCTR ACTRN12613000793718.
Published: 2022
Full Text: View/download PDF

26. Prosthetic valve endocarditis presenting as meningoencephalitis complicated by pseudo-aneurysms in a remote Aboriginal healthcare setting in Australia: a case report.

Author: Watson AL, Rice G, Hieu Vo T, and Kangaharan N
Abstract: Background: The Australian Aboriginal population has a high burden of cardiac conditions predisposing patients to infective endocarditis. Pseudo-aneurysms are a rare and potentially fatal complication of both prior valvular surgery and endocarditis., Case Summary: A 31-year-old female with a history of bicuspid aortic valve requiring valve replacement presented with meningoencephalitis. Transoesophageal echo and positive blood cultures for Staphylococcus aureus confirmed prosthetic valve endocarditis (PVE). Aortic root mycotic pseudo-aneurysms developed during antimicrobial therapy and two large pseudo-aneurysms remain post-redo valve, root and arch replacement., Discussion: Complications associated with PVE are common, especially due to S. aureus . Redo cardiac surgery is high risk, percutaneous treatments may be technically difficult due to altered post-operative anatomy, and medication adherence issues and lack of healthcare engagement further compromise optimal care in this patient population., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Published: 2021
Full Text: View/download PDF

27. Left atrial, pulmonary vein, and left atrial appendage anatomy in Indigenous individuals: Implications for atrial fibrillation.

Author: Clarke NAR, Kangaharan N, Costello B, Tu SJ, Hanna-Rivero N, Le K, Agahari I, Choo WK, Pitman BM, Gallagher C, Haji K, Roberts-Thomson KC, Sanders P, and Wong CX
Abstract: Background: Indigenous Australians experience a greater burden of AF. Whether this is in-part due to differences in arrhythmogenic structures that appear to contribute to AF differences amongst other ethnicities is not known., Methods: We studied forty individuals matched for ethnicity and other AF risk factors. Computed tomography imaging was used to characterise left atrial (LA), pulmonary vein (PV), and left atrial appendage (LAA) anatomy., Results: There were no significant differences in LA diameters or volumes between Indigenous and non-Indigenous Australians. Similarly, we could not detect any consistent differences in PV number, morphology, diameters, or ostial characteristics according to ethnicity. LAA analyses suggested that Indigenous Australians may have a greater proportion of non chickenwing LAA type, and a tendency for eccentric, oval-shaped LAA ostia; however, there were no other differences seen with regards to LAA volume or depth. Indexed values for LA, PV and LAA anatomy corrected for body size were broadly similar., Conclusions: In a cohort of individuals matched for AF risk factors, we could find no strong evidence of ethnic differences in LA, PV, and LAA characteristics that may explain a predisposition of Indigenous Australians for atrial arrhythmogenesis. These findings, in conjunction with our previous data showing highly prevalent cardiometabolic risk factors in Indigenous Australians with AF, suggest that it is these conditions that are more likely responsible for the AF substrate in these individuals. Continued efforts should therefore be directed towards risk factor management in an attempt to prevent and minimise the effects of AF in Indigenous Australians., (© 2021 The Author(s).)
Published: 2021
Full Text: View/download PDF

28. Case Report: Concurrent Rheumatic Fever and Acute Post-Streptococcal Glomerulonephritis in a High-Burden Setting.

Author: Nakauyaca AV, Ralph AP, Majoni WS, and Kangaharan N
Subjects: Adult, Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents therapeutic use, Anti-Inflammatory Agents administration & dosage, Anti-Inflammatory Agents therapeutic use, Ceftriaxone administration & dosage, Ceftriaxone therapeutic use, Floxacillin administration & dosage, Floxacillin therapeutic use, Heart Diseases microbiology, Heart Diseases pathology, Humans, Male, Prednisolone administration & dosage, Prednisolone therapeutic use, Rheumatic Fever diagnosis, Rheumatic Fever drug therapy, Glomerulonephritis etiology, Rheumatic Fever complications
Abstract: We report a case of acute rheumatic fever with severe pancarditis occurring simultaneously with probable acute post-streptococcal glomerulonephritis in a previously well, Australian Aboriginal, 29-year-old male. These autoimmune streptococcal sequelae are usually considered pathogenetically distinct, and concurrence has not previously been reported from this high-burden setting. We hypothesize that a single type of infecting group A Streptococcus (Strep A) triggered both autoimmune sequelae. Salient features included mitral and aortic regurgitation that worsened during the acute illness, painful pericarditis, and high troponin; severe acute kidney injury with oliguria, hematuria, and macroalbuminuria; reduced complement (C3); and elevated streptococcal serology. The case highlights important diagnostic and management challenges. It also illustrates the serious morbidity impact of the complications of Strep A.
Published: 2019
Full Text: View/download PDF

29. Outcomes of anemic patients presenting with acute coronary syndrome: An analysis of the Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events.

Author: Huynh R, Hyun K, D'Souza M, Kangaharan N, Shetty PC, Mariani J, Kilian J, Hung J, Ryan M, Chew DP, and Brieger D
Abstract: Background: Anemia commonly accompanies acute coronary syndromes (ACS) and is associated with poorer outcomes. This study examines the associations between anemia, management and outcomes in an Australian ACS population., Methods: This analysis of the CONCORDANCE database included 8665 ACS patients presenting to 41 Australian hospitals. Baseline characteristics, management, and outcomes were compared between patients with anemia (Hb ≤ 130 for males, Hb ≤ 120 g/L for females) and non-anemia., Results: A total of 1880 (21.7%) patients presenting with ACS were anemic. These patients were older (72 years vs 63 years, P < .0001), with higher prevalence of comorbidities. STEMI patients with anemia were less likely to be emergently reperfused with either thrombolytic therapy (22% vs 33%, P < .0001) or primary percutaneous coronary intervention (PCI) (45% vs 51% P = 0.033). For all ACS, anemic patients less frequently received: coronary angiography (63% vs 86%, P < .0001); drug eluting stents if undergoing PCI (50% vs 58%, P < .0001); dual antiplatelet therapy (80% vs 89%, P < .0001) ;and parenteral anticoagulants (82% vs 88%, P < .0001). In hospital complications of heart failure (20% vs 9%, P < .0001), renal failure (13% vs 4%, P < .0001), and re-infarction (4% vs 2%, P = .0006) were more common among anemic patients. There was a near-linear inverse relationship between admission hemoglobin and in hospital mortality., Conclusions: Anemic patients with ACS are a high risk group less likely to undergo invasive and antithrombotic therapy. Further investigation is required to determine if more active treatment of anemic patients presenting with ACS will improve their outcomes., (© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.)
Published: 2019
Full Text: View/download PDF

30. Heart failure with preserved ejection fraction: A growing global epidemic.

Author: Naing P, Forrester D, Kangaharan N, Muthumala A, Mon Myint S, and Playford D
Subjects: Aged, Australia epidemiology, Echocardiography methods, Electrocardiography methods, Heart Failure epidemiology, Heart Failure, Diastolic complications, Heart Failure, Diastolic diagnosis, Humans, Male, Prevalence, Prognosis, Risk Factors, Sedentary Behavior, Heart Failure physiopathology, Heart Failure, Diastolic physiopathology, Stroke Volume physiology
Abstract: Background: Heart failure with preserved ejection fraction (HFpEF) is an emerging global health problem of which there is limited awareness. HFpEF has a prognosis similar to that of heart failure with reduced ejection fraction (HFrEF) and accounts for approximately half of all patients with heart failure., Objective: The aim of this article is to review HFpEF and its consequences and management, including examples of patients with HFpEF., Discussion: Patients with HFpEF may present with dyspnoea, fluid retention, lethargy and dizziness, making it difficult to differentiate clinically from HFrEF. The risk factors include increasing age, obesity, hypertension, diabetes, chronic kidney disease and obstructive sleep apnoea. The diagnosis requires good clinical acumen combined with echocardiography and elevated plasma B-type natriuretic peptide concentration. Management of HFpEF, especially in later stages, is difficult as there is no evidence-based therapy to date. Prevention is the best strategy. Early recognition and diagnosis are also very important to tackle this global epidemic.
Published: 2019
Full Text: View/download PDF

31. Secondary prevention therapies in acute coronary syndrome and relation to outcomes: observational study.

Author: Chow CK, Brieger D, Ryan M, Kangaharan N, Hyun KK, and Briffa T
Abstract: Objective: To ascertain the use of secondary prevention medications and cardiac rehabilitation after an acute coronary syndrome (ACS) and the impact on 2-year outcomes., Methods: CONCORDANCE (Cooperative National Registry of Acute Coronary care, Guideline Adherence and Clinical Events) is a prospective, observational registry of 41 Australian hospitals. A representative sample of 6859 patients with an ACS and 6 months' follow-up on 31 May 2016 were included. The main outcome measure was use of ≥75% of indicated medications (≥4/5 (or ≥3/4 if contraindicated) of angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker, beta-blocker, lipid-lowering therapy, aspirin and other antiplatelet). Major adverse cardiovascular events (MACE) included myocardial infarction, stroke or cardiovascular death., Results: The mean age was 65±13 years, 29% were women, and the mean Global Registry of Acute Coronary Events (GRACE) score was 106±30. At discharge, 92% were on aspirin, 93% lipid-lowering therapy, 78% beta-blocker, 74% ACE/angiotensin receptor blocker and 73% a second antiplatelet; 89% were taking ≥75% of medications at discharge, 78% at 6 months and 66% at 2 years. At 6 months, 38% attended cardiac rehabilitation, 58% received dietary advice and 32% of smokers reported quitting. Among 1896 patients followed to 2 years, death/MACE was less frequent among patients on ≥75% vs <75% of medications (8.3% vs 13.9%; adjusted OR 0.75, 95 % CI 0.56 to 0.99), and was less frequent in patients who attended versus who did not attend cardiac rehabilitation (4.6% vs 13.4%; adjusted OR 0.44, 95% CI 0.31 to 0.62)., Conclusions: Use of secondary prevention therapies diminishes over time following an ACS. Patients receiving secondary prevention had decreased rates of death and MACE at 2 years., Competing Interests: Competing interests: None declared.
Published: 2019
Full Text: View/download PDF

32. Reply.

Author: Agahari I, Malik H, and Kangaharan N
Subjects: Humans, Workplace, Bullying, Takotsubo Cardiomyopathy
Published: 2018
Full Text: View/download PDF

33. Takotsubo Cardiomyopathy Associated With Work-Place Bullying.

Author: Malik H, Kangaharan N, and Agahari I
Subjects: Chest Pain etiology, Electrocardiography methods, Female, Humans, Middle Aged, Non-ST Elevated Myocardial Infarction complications, Non-ST Elevated Myocardial Infarction etiology, Takotsubo Cardiomyopathy psychology, Workplace standards, Bullying, Takotsubo Cardiomyopathy complications, Workplace psychology
Abstract: Background: Takotsubo cardiomyopathy (TC) is a condition of transient left ventricular dysfunction precipitated by acute physical or emotional stress. The pathogenesis of TC is not well understood, but it is known to predominantly affect postmenopausal women in the context of physical or emotional triggers., Aims: To describe a case of TC with an association to a never previously described work place stressor of bullying., Case Report: A 48-year-old female lawyer developed acute chest pain after experiencing significant emotional distress at a workplace meeting. She had experienced 18 months of increasing work-related mental stress in a new managerial role. She was initially thought to have a non-ST-elevation myocardial infarction (NSTEMI) with widespread T wave inversion on electrocardiogram and elevated serial troponin. However, a diagnosis of TC was subsequently made given the characteristic apical ballooning morphology of the left ventricle found on echocardiogram, normal coronary arteries on angiography and a normal echocardiogram 3 weeks later. This case report describes TC in a younger demographic and a link with workplace bullying., Conclusions: Chronic workplace bullying has the potential for serious physical harm by precipitating Takotsubo cardiomyopathy., (© The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com)
Published: 2018
Full Text: View/download PDF

34. TEXT messages to improve MEDication adherence and Secondary prevention (TEXTMEDS) after acute coronary syndrome: a randomised clinical trial protocol.

Author: Chow CK, Thiagalingam A, Santo K, Kok C, Thakkar J, Stepien S, Billot L, Jan S, Joshi R, Hillis GS, Brieger D, Chew DP, Rådholm K, Atherton JJ, Bhindi R, Collins N, Coverdale S, Hamilton-Craig C, Kangaharan N, Maiorana A, McGrady M, Shetty P, Thompson P, Rogers A, and Redfern J
Subjects: Blood Pressure, Cell Phone, Cholesterol, LDL blood, Diet, Exercise, Female, Humans, Life Style, Male, Motivation, Patient Readmission, Reminder Systems, Research Design, Risk Factors, Single-Blind Method, Acute Coronary Syndrome drug therapy, Health Promotion methods, Medication Adherence, Patient Education as Topic methods, Secondary Prevention methods, Telemedicine methods, Text Messaging
Abstract: Background: Identifying simple, low-cost and scalable means of supporting lifestyle change and medication adherence for patients following a cardiovascular (CV) event is important., Objective: The TEXTMEDS (TEXT messages to improve MEDication adherence and Secondary prevention) study aims to investigate whether a cardiac education and support programme sent via mobile phone text message improves medication adherence and risk factor levels in patients following an acute coronary syndrome (ACS)., Study Design: A single-blind, multicentre, randomised clinical trial of 1400 patients after an ACS with 12 months follow-up. The intervention group will receive multiple weekly text messages that provide information, motivation, support to adhere to medications, quit smoking (if relevant) and recommendations for healthy diet and exercise. The primary endpoint is the percentage of patients who are adherent to cardioprotective medications and the key secondary outcomes are mean systolic blood pressure (BP) and low-density lipoprotein cholesterol. Secondary outcomes will also include total cholesterol, mean diastolic BP, the percentage of participants who are adherent to each cardioprotective medication class, the percentage of participants who achieve target levels of CV risk factors, major vascular events, hospital readmissions and all-cause mortality. The study will be augmented by formal economic and process evaluations to assess acceptability, utility and cost-effectiveness., Summary: The study will provide multicentre randomised trial evidence of the effects of a text message-based programme on cardioprotective medication adherence and levels of CV risk factors., Ethics and Dissemination: Primary ethics approval was received from Western Sydney Local Health District Human Research Ethics Committee (HREC2012/12/4.1 (3648) AU RED HREC/13/WMEAD/15). Results will be disseminated via peer-reviewed publications and presentations at international conferences., Trial Registration Number: ACTRN12613000793718; Pre-results., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
Published: 2018
Full Text: View/download PDF

35. Heart Failure in Minority Populations - Impediments to Optimal Treatment in Australian Aborigines.

Author: Iyngkaran P, Kangaharan N, Zimmet H, Arstall M, Minson R, Thomas MC, Bergin P, Atherton J, MacDonald P, Hare DL, Horowitz JD, and Ilton M
Subjects: Australia, Chronic Disease, Forecasting, Humans, Life Style, Patient Acceptance of Health Care, Prospective Studies, Heart Failure drug therapy, Native Hawaiian or Other Pacific Islander
Abstract: Chronic heart failure (CHF) among Aboriginal/Indigenous Australians is endemic. There are also grave concerns for outcomes once acquired. This point is compounded by a lack of prospective and objective studies to plan care. To capture the essence of the presented topic it is essential to broadly understand Indigenous health. Key words such as 'worsening', 'gaps', 'need to do more', 'poorly studied', or 'future studies should inform' occur frequently in contrast to CHF research for almost all other groups. This narrative styled opinion piece attempts to discuss future directions for CHF care for Indigenous Australians. We provide a synopsis of the problem, highlight the treatment gaps, and define the impediments that present hurdles in optimising CHF care for Indigenous Australians.
Published: 2016
Full Text: View/download PDF

36. Self Managing Heart Failure in Remote Australia - Translating Concepts into Clinical Practice.

Author: Iyngkaran P, Toukhsati SR, Harris M, Connors C, Kangaharan N, Ilton M, Nagel T, Moser DK, and Battersby M
Subjects: Australia epidemiology, Heart Failure epidemiology, Humans, Native Hawaiian or Other Pacific Islander, Patient Participation, Program Development, Heart Failure therapy, Self Care methods
Abstract: Congestive heart failure (CHF) is an ambulatory health care condition characterized by episodes of decompensation and is usually without cure. It is a leading cause for morbidity and mortality and the lead cause for hospital admissions in older patients in the developed world. The long-term requirement for medical care and pharmaceuticals contributes to significant health care costs. CHF management follows a hierarchy from physician prescription to allied health, predominately nurse-led, delivery of care. Health services are easier to access in urban compared to rural settings. The differentials for more specialized services could be even greater. Remote Australia is thus faced with unique challenges in delivering CHF best practice. Chronic disease self-management programs (CDSMP) were designed to increase patient participation in their health and alleviate stress on health systems. There have been CDSMP successes with some diseases, although challenges still exist for CHF. These challenges are amplified in remote Australia due to geographic and demographic factors, increased burden of disease, and higher incidence of comorbidities. In this review we explore CDSMP for CHF and the challenges for our region.
Published: 2016
Full Text: View/download PDF

Catalog

Books, media, physical & digital resources

See catalog results

Searchworks

Select search scope, currently: Articles Catalog books, media & more in Jio Institute collections Articles journal articles & other e-resources

Search

Search Constraints

Refine your results

Search Limiters

Topic

Publication Year Range

Language

Publication Type

Journal

Region

Database

Publisher

36 results on '"Kangaharan N."'

Search Results

Catalog

Select search scope, currently: Articles

Catalog

books, media & more in Jio Institute collections

Articles

journal articles & other e-resources