Cardiovascular diseases

A snapshot of an evolving health, social and economic burden

Jocasta Ball BBiomedSci(Hons), PhD · David R Thompson PhD · Chantal F Ski BA(Hons), PhD · Melinda J Carrington PhD, PostgradDip(Psych), BA · Tracey Gerber PhD · Simon Stewart PhD

Fewer in-hospital adverse events with highly sensitive troponin tests, but more non-invasive cardiac investigations

Louise Cullen MB BS, FACEM · John K French MB CHB, PHD, MSc · Tom G Briffa PhD · Julie Redfern BSc, BAppSc, PhD · Christopher J K Hammett BHB, MB ChB, MD · David B Brieger MB BS, PhD, FRACP · William A Parsonage FRACP · Jeffrey Lefkovits MB BS, FRACP, FCSANZ · Chris Ellis BM · Carolyn Astley RN, BN, DrPH · Tegwen Eleanor Howell BEcon, MEcSt · John M Elliott MB ChB, PhD, FRACP · Derek P B Chew FRACP, FCSANZ, FACC

Assessing comprehensive combination therapy from the perspective of the Australian health system

Tracey-Lea Laba PhD, BPharm(Hons), BSc(Hons) · Alison Hayes BSc(Hons), PhD · Serigne Lo PhD · David P Peiris MIPH, PhD, FRACGP · Tim Usherwood MD, FRACGP, FRCP · Graham S Hillis MB ChB, PhD · Natasha Rafter MPH, FAFPHM, NZCPHM · Christopher M Reid PhD · Andrew M Tonkin MD, FRACP, FCSANZ · Ruth Webster BMedSc(Hons), MB BS(Hons), MIPH(Hons) · Bruce C Neal MB ChB, PhD, FRCP · Alan Cass BA, FRACP, PhD · Anushka Patel SM, PhD, FRACP · Anthony Rodgers MB ChB, PhD · Stephen Jan BEc, MEc, PhD

Middle-aged patients with multiple risk factors appear to be well managed, but other age groups may be missing out

Leon A Simons MD, FRACP · Eric Chung BE(Comp), MBA

Judging when troponin testing is best done, in general practice and beyond

Derek P B Chew MB BS, MPH, FRACP · Louise Cullen MB BS, FACEM

Recommendations to reduce emergency presentations, hospitalisations and premature death from CHF

Karen Page RN, DN, BEd · Thomas H Marwick MB BS, PhD, MPH · Rebecca Lee BPharm, MPH · Robert Grenfell MB BS, MPH, FAFPHM · Walter P Abhayaratna FRACP, FACC, DrPH · Anu Aggarwal MB BS, FRACP, PhD · Tom G Briffa PhD · Jan Cameron PhD, MHSc(HealthProm · Patricia M Davidson RN, PhD · Andrea Driscoll PhD · Jacquie Garton-Smith MB BS, FRACGP · Debra J Gascard BN, MNP, NP · Annabel Hickey MMSc(ClinEpi), BApp(OT) · Dariusz Korczyk FRACP, FCSANZ · Julie-Anne Mitchell MPH, BA, RN · Rhonda Sanders RN, MNSt · Deborah Spicer MNg(NP), GradDip(CVNursing), BN · Simon Stewart PhD · Vicki Wade DipAppSci, BHS, MN

GPs should use troponin tests cautiously, aware of sensitivity and predictive value

George A Marshall MB ChB, FRCPA · Nilika G Wijeratne MB BS, FRCPA, FAACB · Devika Thomas MB BS, MSurg, FRCPA,

Less time in emergency department, but with what outcomes and at what cost?

Thomas P Y Yip MB BS(Hons), FRACP, FCSANZ · Heather M Pascoe MB BS(Hons), BMedSci · Stephen E Lane BSc(Hons), PhD

The 12-lead ECG holds the clues to distinguish between ventricular and supraventricular tachycardia

Colin Machado MB BS · Khang-Li Looi MB ChB, FRACP · Ajita Kanthan MB BS, FRACP · David C Adam MB BS, FRACP

Objectives: To understand the changes in the population incidence of inhospital cardiopulmonary arrest (IHCA) and mortality associated with the introduction of rapid response systems (RRSs). Design, setting and participants: Population-based study of 9 221 138 hospital admissions in 82 public acute hospitals in New South Wales, using data linked to a death registry, from 1 Jan 2002 to 31 Dec 2009. Main outcome measures: Changes in IHCA, IHCA-related mortality, hospital mortality and proportion of IHCA patients surviving to hospital discharge. Results: RRS uptake increased from 32% in 2002 to 74% in 2009. This increase was associated with a 52% decrease in IHCA rate, a 55% decrease in IHCA-related mortality rate, a 23% decrease in hospital mortality rate and a 15% increase in survival to discharge after an IHCA (all P < 0.01). The adjusted absolute reductions in IHCA-related mortality and hospital mortality were 1.49 (95% CI, 1.30–1.68) and 4.05 (95% CI, 3.17–4.76) patients per 1000 admissions, respectively. The decrease in IHCA incidence rate accounted for 95% of the reduction in IHCA-related mortality. In contrast, the increase in IHCA survival accounted for only 5% of the reduction in IHCA-related mortality. Conclusions: During nearly a decade, as RRSs were progressively introduced, there was a coincidental reduction in IHCA, IHCA-related deaths and hospital mortality and an increased survival to hospital discharge after an IHCA. Reduced IHCA incidence, rather than improved postcardiac arrest survival, was the main contributor to the reduction in IHCA mortality.

Jack Chen MB BS, PhD, MBA(Exec) · Lixin Ou MBA, MPH, PhD · Kenneth M Hillman MD, FRCA, FCICM · Arthas Flabouris MD, FCICM, FANZCA · Rinaldo Bellomo MD, FCICM, FRACP · Stephanie J Hollis BSc, MMedSc, PhD · Hassan Assareh PhD, MEng, MSc(Manag)

Every Indigenous patient with ACS should be able to expect a coordinated, patient-centred pathway of care

Marcus K Ilton MB BS, FRACP · Warren F Walsh MB BS, FRACP · Alex D H Brown BMed, MPH, PhD · Philip A Tideman FRACP, FCSANZ · Christopher J Zeitz MB BS, PhD · Jinty Wilson MBA

Highlights from the World Heart Federation’s World Congress of Cardiology in Melbourne

Stephen R Leeder MD, PhD, FRACP

We have come so far with achievements in cardiovascular disease control, but have so far yet to travel

Stephen Leeder

Do Australian trends in cardiovascular disease have lessons for other countries?

Peter L Thompson AM, MD, FRACP, FACC

Recent cardiovascular outcome trials confirm the safety of DPP-4 inhibitors, but new questions emerge

Timothy M E Davis DPhil, FRCP, FRACP

Why can television broadcast dubious scientific material without disclosing the experts’ conflicts of interest?

Daniel D L Bernal · Luke R E Bereznicki · Gregory M Peterson