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Cardiovascular diseases

Environmental health Perspective 27 May 2026 Open Access

Designing Housing to Reduce Overcrowding-Related Harms: Rheumatic Heart Disease as the Canary in the Coal Mine

Household overcrowding is a major driver of acute rheumatic fever and rheumatic heart disease, along with other adverse social, cultural and health outcomes in remote Aboriginal communities. Overcrowding is compounded by poor thermal performance of current housing, energy insecurity and climate change. Despite strong evidence of the causes of rheumatic heart disease, upstream prevention through housing design remains underexplored. Wilya Janta, an Aboriginal-led organisation in Tennant Creek, has developed the Explain Home design: a culturally responsive, climate-adapted prototype designed to reduce overcrowding-related harms. With an unprecedented $4 billion investment in remote housing, health professionals have a critical role in advocating for evidence-informed, culturally safe housing as a form of preventive health intervention to improve equity and outcomes.

Simon Quilty, Veronica Matthews, Angus Baumann, James Marangou, Bo Remenyi, Gavin Wheaton, Serena Morton Nabanunga, Norman Frank Jupurrurla, Simon Robinson, Steve Mintern, Cary Duffield, Joshua R. Francis, Paul C. Memmott

Mja2 70209
Cardiovascular diseases Systematic review 24 May 2026 Open Access

Evidence for Decreasing the Age of Atrial Fibrillation Screening for Indigenous People in Australia: A Systematic Review With Meta-Analysis

Objective To determine whether the screening age for atrial fibrillation (AF) should be lowered for Indigenous Australians with the goal of reducing risk of stroke and other health burdens. Study Design Systematic review of medical databases identified 24 studies reporting outcome measures: AF incidence/prevalence, age of AF occurrence/diagnosis, cardiovascular risk factors and stroke risk. Risk of bias was evaluated using the Joanna Briggs Institute quality appraisal tools. Meta-analysis of mean age of AF onset was performed. An expert panel reviewed the evidence and formed consensus recommendations regarding screening for AF for Indigenous Australians. Data Sources MEDLINE, Embase, Scopus, Cochrane, CINAHL, Australian Indigenous HealthInfoNet and grey literature. Data Synthesis The review yielded five key findings. Indigenous Australians when compared with non-Indigenous Australians have: (i) higher AF rates at every age group, and meta-analysis showed onset of AF for Indigenous people at 15.9years (95% CI, 11.5–20.4), younger than for other Australians; (ii) higher prevalence of cardiovascular risk factors; (iii) higher stroke rates (38%–47% vs. 10%–15% of all strokes occur before age of 55years), higher mortality and other adverse outcomes after stroke and the nationally age standardised risk ratio of death from AF was 1.8 for 1997–2022; (iv) less likelihood of receiving optimal treatment; and (v) greater cost of care for stroke rehabilitation. Conclusions The evidence supports an amendment to the AF guideline to opportunistically screen Indigenous Australians from at least age 55years, and when AF is found, follow guideline recommendations for management of rate, rhythm, stroke prevention and concomitant risk factors/comorbidities. Further, the logistics of care should be considered when deciding on the localised care pathway. National implementation of these recommendations should minimise missed diagnoses and ensure timely, accessible and appropriate care/treatment. Registration Prospective registration with PROSPERO (CRD42024514586) on 13 May 2024.

Kylie Gwynne

Cardiovascular diseases Consensus statement 13 May 2026 Open Access

Diagnosis and Management of Patent Foramen Ovale for Stroke Prevention: An Australian and New Zealand Consensus Statement Developed by a Modified Nominal Group Approach

Introduction Patent foramen ovale (PFO) is implicated in 25%–50% of cryptogenic strokes in patients aged <60years. Recent clinical trials demonstrated the benefit of PFO closure in selected patients. However, there is considerable variability in Australian and New Zealand clinical practice regarding investigation and management approaches. A multidisciplinary consensus group comprising stroke neurologists and an interventional cardiologist from major centres employed a modified nominal group technique to develop evidence-based recommendations for standardising PFO-associated stroke management. Main Recommendations Twelve recommendations were developed across three domains. For patient selection: Universal PFO screening for cryptogenic stroke patients aged ≤60years, with selective screening for patients aged >60years with embolic stroke of undetermined source, absent vascular risk factors and excluded atrial fibrillation. For diagnostic investigations: Transcranial Doppler (TCD) bubble study as preferred first-line screening where available, with transthoracic echocardiography as an alternative when TCD is unavailable and transoesophageal echocardiography for confirmation before closure consideration. For treatment decisions: Incorporation of the PFO-Associated Stroke Causal Likelihood (PASCAL) classification system rather than the Risk of Paradoxical Embolism (RoPE) score alone, consideration of TCD grading results for risk stratification and mandatory multidisciplinary heart–brain team evaluation for all closure decisions. Changes in Management as a Result of This Consensus Statement These recommendations will standardise practice through enhanced TCD service provision, structured heart–brain team development and evidence-based patient selection using the PASCAL classification. The emphasis on TCD as first-line screening represents a departure from traditional transthoracic echocardiography-based approaches. Implementation will improve patient outcomes through appropriate intervention in suitable candidates while avoiding unnecessary procedures in those unlikely to benefit, thereby promoting equitable access to optimal PFO management across Australia and New Zealand.

Brian R. Chambers, Lauren M. Sanders, Amanda Gilligan, Carlos Garcia-Esperon, Jan Ho, John Fink, Matias Yudi, Matthew Lee-Archer, Vimal Stanislaus, Andrew A. Wong

Mja2 70199
Cardiovascular diseases Perspective 15 February 2026 Free

Integrating Coronary Artery Calcium Scoring Into Cardiovascular Prevention in Australia

Coronary artery disease is a major cause of death among Australians, yet current risk prediction models often misclassify patients. Coronary artery calcium (CAC) scoring provides a reproducible measure of subclinical atherosclerosis and is one of the strongest predictors of future cardiovascular events, particularly in asymptomatic adults. Although CAC scoring is widely used internationally, its uptake in Australia is constrained by the lack of public reimbursement, conditional guideline recommendations and the potential for access, especially among Aboriginal and Torres Strait Islander peoples. Incorporating CAC into national prevention strategies, subsidising scans for appropriate patients and supporting general practitioner use could improve precision and cost-effectiveness in cardiovascular disease prevention.

Shaun Khanna, Tej Dugal, Jason Kaplan, Aditya Bhat

10 5694 mja2 70144
Cardiovascular diseases Guideline summary 15 February 2026 Open Access

National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian Clinical Guideline for Diagnosing and Managing Acute Coronary Syndromes 2025

IntroductionThe Australian clinical guideline for diagnosing and managing acute coronary syndromes 2025 establishes a new clinical standard for the diagnosis and management of acute coronary syndromes (ACS) in Australia. The new guideline replaces the 2016 guideline, representing the first major update in nearly a decade.Main RecommendationsThe new guideline features critical new information, including: (1) new terminology and revised definition of myocardial infarction; (2) electrocardiogram (ECG) patterns of acute coronary occlusion myocardial infarction (ACOMI), beyond ST-segment elevation; (3) use of clinical decision pathways incorporating high-sensitivity cardiac troponin (hs-cTn) assays for more efficient risk assessment; (4) stronger emphasis on the optimal timing of primary percutaneous coronary intervention in people with ST-segment elevation myocardial infarction (STEMI); (5) use of intravascular imaging-guided percutaneous coronary intervention in people with non-ST-segment elevation acute coronary syndromes (NSTEACS); (6) treatment guidance for specific groups, including those with cardiogenic shock, multivessel disease or spontaneous coronary artery dissection; (7) timing of platelet P2Y12 inhibitor administration in STEMI and NSTEACS; (8) more detailed advice on post-discharge care, including cardiac rehabilitation and secondary prevention programs, medicine adherence strategies, vaccinations and screening for mental health conditions; (9) treatment algorithms to enable more tailored prescribing of antiplatelet and anticoagulation therapies; (10) new recommended treatment target for low-density lipoprotein cholesterol (LDL-C); and (11) new recommendations on select medicines including PCSK9 inhibitors, β-blockers and angiotensin receptor-neprilysin inhibitors.Changes in Management as a Result of the GuidelineThe new guideline introduces key practice changes including broader recognition of ECG patterns of ACOMI, integration of hs-cTn testing into clinical decisions pathways and selective use of intravascular imaging in NSTEACS. Updated P2Y12 inhibitor timing, stricter LDL-C targets and PCSK9 inhibitor use support more tailored and evidence-based care in the secondary prevention of ACS. The full guideline is available at www.heartfoundation.org.au/for-professionals/acs-guideline.

David B. Brieger, Louise A. Cullen, Tom G. Briffa, Sarah Zaman, Ian A. Scott, Cynthia Papendick, Elaine Ho, Victoria Leitch, Dannii Dougherty, Garry Jennings

10 5694 mja2 70127
Women's health Research 15 September 2025 Open Access

An Aboriginal women‐led approach to design a maternal and child health model when cardiometabolic complications are experienced in pregnancy in South Australia

Culturally responsive, person-centred care can bridge gaps between Aboriginal knowledge systems and biomedical paradigms, improving maternal, child and family health outcomes holistically

Karrina DeMasi (Barkandji) · Dana Shen (Ngarrindjeri) · Phoebe McColl · Amanda Richards‐Satour (Adnyamathanha and Barngarla) · Carolyn Renehan (Central Arrernte) · Kim Morey (Anmatyerr and Eastern Arrernte) · Karen Glover (Mein:tnk and Wotjobaluk) · Cathy Leane (Dharug) · Kristine Woods‐Hampton (Anmatijerre) · Lorraine Garay (Anangu) · Eloise Baker (Adnyamathanha and Barngarla) · Rebecca Nielsen (Kalkadoon) · Katharine Brown

Mja2 70033
Climate and health Editor’s choice 21 July 2025 Free

Building health system resilience to climate change: lessons from cardiovascular disease

In December 2023, the Australian Government released its first National Health and Climate Strategy.1 Acknowledging that the health effects of a changing climate are already being felt across the country, this strategy set out a whole‐of‐government plan for addressing the health and wellbeing impacts of climate change. A core component of this strategy is health system resilience — that is, building capacity to anticipate, understand, plan for, and respond to escalating climate impacts on health, wellbeing, and the delivery of care. What does it mean in practice to build health system resilience to climate change? In this issue of the MJA, Stewart and colleagues2 present findings from a randomised controlled trial that provides an instructive example. Their research was premised on the recognition that seasonal and acute weather conditions are drivers of cardiovascular events. Climate change is expected to generate more weather extremes that will, in turn, provoke more cardiovascular events. They hypothesised that a tailored, multifaceted intervention designed to build resilience to external provocations to health would increase days alive and out of hospital among people with multimorbid heart disease, compared with standard care. Their intervention aimed to address the bio‐behavioural vulnerability to environmental challenges to cardiovascular health, including participant behaviours, home environmental conditions, clinical factors, and socio‐economic resources. The study did not find statistically significant overall differences between the intervention and standard care groups for the primary outcome (days alive and out‐of‐hospital) and all‐cause hospital readmission and death. However, hospital readmissions were more frequent after dynamic weather events, including storms and acute temperature changes. After adjusting for timing of follow‐up, the intervention was associated with significantly fewer days of hospital stay during the summer months. These findings, the authors contend, “challenge the assumption that the management of people with chronic heart disease should be the same all year round” and provide a compelling basis for future research. Writing in the editorial linked to this research,3 Hunter explains that “despite its negative findings, this trial illustrates a critical inflection point in how we conceptualise health and disease in the context of an increasingly volatile climate” and that “the biopsychosocial model must evolve to more explicitly acknowledge the foundational relationship between human health and the environment”. The National Health and Climate Strategy represents a positive move in this direction, as does the incorporation of climate change, environmentally sustainable health practice, and planetary health into medical school curricula,4 and the development of climate change and health adaptation plans by Australian states and territories.5,6,7 Yet there is still clearly a long way to go, with recent Australian research8 indicating that despite health system adaptations to extreme weather events resulting in workforce capability, costs, demand, and health outcome benefits, important gaps remain in areas such as financing and access to medicines, and, crucially, “how these elements come together to build health system resilience is unclear”. At the MJA, we look forward to the opportunity to publish future work that advances our understanding of this important area.

Elizabeth Zuccala

Environmental health Research 21 July 2025 Open Access

Promoting resilience to weather‐related and seasonal provocations to health in people with multimorbid heart disease: a prospective pragmatic, randomised trial

A multifaceted intervention was ineffective in increasing the proportion of days alive and out of hospital after hospital discharge

Simon Stewart · Sheila K Patel · Terase F Lancefield · Thalys Sampaio Rodrigues · Nicholas Doumtsis · Nasreen Moini · Ashleigh Harley · Emily‐Rose Vaughan‐Fowler · Yih‐Kai Chan · Alexander Chen · David Chye · David FL Liew · Christopher McMaster · Jay Ramchand · Paul A Yates · Jason C Kwong · Christine F McDonald · Louise M Burrell

Mja2 52699
Health services administration Research 17 March 2025 Open Access

The impact of pay‐for‐performance incentives for stroke unit access on public hospital costs and use, Queensland, 2012–17: interrupted time series analysis

Improving quality of care without increasing costs or hospital demand, the pay-for-performance program increased value for health care spending

Rohan Grimley · Joosup Kim · Helen M Dewey · Nadine E Andrew · Taya A Collyer · Eleanor S Horton · Greg Cadigan · Dominique A Cadilhac

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