Lifestyle management of hypertension : International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension
- Charchar, Fadi, Prestes, Priscilla, Mills, Charlotte, Ching, Siew, Neupane, Dinesh, Marques, Francine, Sharman, James, Vogt, Liffert, Burrell, Louise, Korostovtseva, Lyudmila, Zec, Manja, Patil, Mansi, Schultz, Martin, Wallen, Matthew, Renna, Nicolás, Islam, Sheikh, Hiremath, Swapnil, Gyeltshen, Tshewang, Chia, Yook-Chin, Gupta, Abhinav, Schutte, Aletta, Klein, Britt, Borghi, Claudio, Browning, Colette, Czesnikiewicz-Guzik, Marta, Lee, Hae-Young, Itoh, Hiroshi, Miura, Katsuyuki, Akinnibosun, Olutope, Shane Thomas
- Authors: Charchar, Fadi , Prestes, Priscilla , Mills, Charlotte , Ching, Siew , Neupane, Dinesh , Marques, Francine , Sharman, James , Vogt, Liffert , Burrell, Louise , Korostovtseva, Lyudmila , Zec, Manja , Patil, Mansi , Schultz, Martin , Wallen, Matthew , Renna, Nicolás , Islam, Sheikh , Hiremath, Swapnil , Gyeltshen, Tshewang , Chia, Yook-Chin , Gupta, Abhinav , Schutte, Aletta , Klein, Britt , Borghi, Claudio , Browning, Colette , Czesnikiewicz-Guzik, Marta , Lee, Hae-Young , Itoh, Hiroshi , Miura, Katsuyuki , Akinnibosun, Olutope , Shane Thomas
- Date: 2024
- Type: Text , Journal article
- Relation: Journal of hypertension Vol. 42, no. 1 (2024), p. 23-49
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- Description: Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools. **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliates “Fadi Charchar, Priscilla Prestes, Britt Klein, Colette Browning, Olutope Akinnibosun and Shane Thomas” are provided in this record**
- Description: Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools. **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliates “Fadi Charchar, Priscilla Prestes, Britt Klein, Colette Browning, Olutope Akinnibossun and Shane Thomas” are provided in this record**
- Authors: Charchar, Fadi , Prestes, Priscilla , Mills, Charlotte , Ching, Siew , Neupane, Dinesh , Marques, Francine , Sharman, James , Vogt, Liffert , Burrell, Louise , Korostovtseva, Lyudmila , Zec, Manja , Patil, Mansi , Schultz, Martin , Wallen, Matthew , Renna, Nicolás , Islam, Sheikh , Hiremath, Swapnil , Gyeltshen, Tshewang , Chia, Yook-Chin , Gupta, Abhinav , Schutte, Aletta , Klein, Britt , Borghi, Claudio , Browning, Colette , Czesnikiewicz-Guzik, Marta , Lee, Hae-Young , Itoh, Hiroshi , Miura, Katsuyuki , Akinnibosun, Olutope , Shane Thomas
- Date: 2024
- Type: Text , Journal article
- Relation: Journal of hypertension Vol. 42, no. 1 (2024), p. 23-49
- Full Text:
- Reviewed:
- Description: Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools. **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliates “Fadi Charchar, Priscilla Prestes, Britt Klein, Colette Browning, Olutope Akinnibosun and Shane Thomas” are provided in this record**
- Description: Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools. **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliates “Fadi Charchar, Priscilla Prestes, Britt Klein, Colette Browning, Olutope Akinnibossun and Shane Thomas” are provided in this record**
2022 World Hypertension League, resolve to save lives and International Society of Hypertension dietary sodium (salt) global call to action
- Campbell, Norm, Whelton, Paul, Orias, Marcelo, Wainford, Richard, Cappuccio, Francesco, Ide, Nicole, Neal, Bruce, Cohn, Jennifer, Cobb, Laura, Webster, Jacqui, Trieu, Kathy, He, Feng, McLean, Rachael, Blanco-Metzler, Adriana, Woodward, Mark, Khan, Nadia, Kokubo, Yoshihiro, Nederveen, Leo, Arcand, JoAnne, MacGregor, Graham, Owolabi, Mayowa, Lisheng, Liu, Parati, Gianfranco, Lackland, Daniel, Charchar, Fadi, Williams, Bryan, Tomaszewski, Maciej, Romero, Cesar, Champagne, Beatriz, L’Abbe, Mary
- Authors: Campbell, Norm , Whelton, Paul , Orias, Marcelo , Wainford, Richard , Cappuccio, Francesco , Ide, Nicole , Neal, Bruce , Cohn, Jennifer , Cobb, Laura , Webster, Jacqui , Trieu, Kathy , He, Feng , McLean, Rachael , Blanco-Metzler, Adriana , Woodward, Mark , Khan, Nadia , Kokubo, Yoshihiro , Nederveen, Leo , Arcand, JoAnne , MacGregor, Graham , Owolabi, Mayowa , Lisheng, Liu , Parati, Gianfranco , Lackland, Daniel , Charchar, Fadi , Williams, Bryan , Tomaszewski, Maciej , Romero, Cesar , Champagne, Beatriz , L’Abbe, Mary
- Date: 2023
- Type: Text , Journal article
- Relation: Journal of Human Hypertension Vol. 37, no. 6 (2023), p. 428-437
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- Description: **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliate “Fadi Charchar" is provided in this record**
- Authors: Campbell, Norm , Whelton, Paul , Orias, Marcelo , Wainford, Richard , Cappuccio, Francesco , Ide, Nicole , Neal, Bruce , Cohn, Jennifer , Cobb, Laura , Webster, Jacqui , Trieu, Kathy , He, Feng , McLean, Rachael , Blanco-Metzler, Adriana , Woodward, Mark , Khan, Nadia , Kokubo, Yoshihiro , Nederveen, Leo , Arcand, JoAnne , MacGregor, Graham , Owolabi, Mayowa , Lisheng, Liu , Parati, Gianfranco , Lackland, Daniel , Charchar, Fadi , Williams, Bryan , Tomaszewski, Maciej , Romero, Cesar , Champagne, Beatriz , L’Abbe, Mary
- Date: 2023
- Type: Text , Journal article
- Relation: Journal of Human Hypertension Vol. 37, no. 6 (2023), p. 428-437
- Full Text:
- Reviewed:
- Description: **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliate “Fadi Charchar" is provided in this record**
Addressing global disparities in blood pressure control : perspectives of the International Society of Hypertension
- Schutte, Aletta, Jafar, Tazeen, Poulter, Neil, Damasceno, Albertino, Khan, Nadia, Nilsson, Peter, Alsaid, Jafar, Neupane, Dinesh, Kario, Kazuomi, Beheiry, Hind, Brouwers, Sofie, Burger, Dylan, Charchar, Fadi, Cho, Myeong-Chan, Guzik, Tomasz, Haji Al-Saedi, Ghazi, Ishaq, Muhammad, Itoh, Hiroshi, Jones, Erika, Khan, Taskeen, Kokubo, Yoshihiro, Kotruchin, Praew, Muxfeldt, Elizabeth, Odili, Augustine, Patil, Mansi, Ralapanawa, Udaya, Romero, Cesar, Schlaich, Markus, Shehab, Abdulla, Mooi, Ching
- Authors: Schutte, Aletta , Jafar, Tazeen , Poulter, Neil , Damasceno, Albertino , Khan, Nadia , Nilsson, Peter , Alsaid, Jafar , Neupane, Dinesh , Kario, Kazuomi , Beheiry, Hind , Brouwers, Sofie , Burger, Dylan , Charchar, Fadi , Cho, Myeong-Chan , Guzik, Tomasz , Haji Al-Saedi, Ghazi , Ishaq, Muhammad , Itoh, Hiroshi , Jones, Erika , Khan, Taskeen , Kokubo, Yoshihiro , Kotruchin, Praew , Muxfeldt, Elizabeth , Odili, Augustine , Patil, Mansi , Ralapanawa, Udaya , Romero, Cesar , Schlaich, Markus , Shehab, Abdulla , Mooi, Ching
- Date: 2023
- Type: Text , Journal article , Review
- Relation: Cardiovascular Research Vol. 119, no. 2 (2023), p. 381-409
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- Description: Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework. © 2022 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology. **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliate “Fadi Charchar” is provided in this record**
- Authors: Schutte, Aletta , Jafar, Tazeen , Poulter, Neil , Damasceno, Albertino , Khan, Nadia , Nilsson, Peter , Alsaid, Jafar , Neupane, Dinesh , Kario, Kazuomi , Beheiry, Hind , Brouwers, Sofie , Burger, Dylan , Charchar, Fadi , Cho, Myeong-Chan , Guzik, Tomasz , Haji Al-Saedi, Ghazi , Ishaq, Muhammad , Itoh, Hiroshi , Jones, Erika , Khan, Taskeen , Kokubo, Yoshihiro , Kotruchin, Praew , Muxfeldt, Elizabeth , Odili, Augustine , Patil, Mansi , Ralapanawa, Udaya , Romero, Cesar , Schlaich, Markus , Shehab, Abdulla , Mooi, Ching
- Date: 2023
- Type: Text , Journal article , Review
- Relation: Cardiovascular Research Vol. 119, no. 2 (2023), p. 381-409
- Full Text:
- Reviewed:
- Description: Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework. © 2022 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology. **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliate “Fadi Charchar” is provided in this record**
Development of a short form of the cardiac distress inventory
- Le Grande, Michael, Murphy, Barbara, Rogerson, Michelle, Ski, Chantal, Amerena, John, Smith, Julian, Hoover, Valerie, Alvarenga, Marlies, Higgins, Rosemary, Thompson, David, Jackson, Alun
- Authors: Le Grande, Michael , Murphy, Barbara , Rogerson, Michelle , Ski, Chantal , Amerena, John , Smith, Julian , Hoover, Valerie , Alvarenga, Marlies , Higgins, Rosemary , Thompson, David , Jackson, Alun
- Date: 2023
- Type: Text , Journal article
- Relation: BMC Cardiovascular Disorders Vol. 23, no. 1 (2023), p.
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- Description: Background: Cardiac distress may be viewed as a persistent negative emotional state that spans multiple psychosocial domains and challenges a patient’s capacity to cope with living with their heart condition. The Cardiac Distress Inventory (CDI) is a disease-specific clinical assessment tool that captures the complexity of this distress. In busy settings such as primary care, cardiac rehabilitation, and counselling services, however, there is a need to administer briefer tools to aid in identification and screening. The aim of the present study was to develop a short, valid screening version of the CDI. Methods: A total of 405 participants reporting an acute coronary event in the previous 12 months was recruited from three hospitals, through social media and by direct enrolment on the study website. Participants completed an online survey which included the full version of the CDI and general distress measures including the Kessler K6, Patient Health Questionnaire-4, and Emotion Thermometers. Relationship of the CDI with these instruments, Rasch analysis model fit and clinical expertise were all used to select items for the short form (CDI-SF). Construct validity and receiver operating characteristics in relation to the Kessler K6 were examined. Results: The final 12 item CDI-SF exhibited excellent internal consistency indicative of unidimensionality and good convergent and discriminant validity in comparison to clinical status measures, all indicative of good construct validity. Using the K6 validated cutoff of
- Authors: Le Grande, Michael , Murphy, Barbara , Rogerson, Michelle , Ski, Chantal , Amerena, John , Smith, Julian , Hoover, Valerie , Alvarenga, Marlies , Higgins, Rosemary , Thompson, David , Jackson, Alun
- Date: 2023
- Type: Text , Journal article
- Relation: BMC Cardiovascular Disorders Vol. 23, no. 1 (2023), p.
- Full Text:
- Reviewed:
- Description: Background: Cardiac distress may be viewed as a persistent negative emotional state that spans multiple psychosocial domains and challenges a patient’s capacity to cope with living with their heart condition. The Cardiac Distress Inventory (CDI) is a disease-specific clinical assessment tool that captures the complexity of this distress. In busy settings such as primary care, cardiac rehabilitation, and counselling services, however, there is a need to administer briefer tools to aid in identification and screening. The aim of the present study was to develop a short, valid screening version of the CDI. Methods: A total of 405 participants reporting an acute coronary event in the previous 12 months was recruited from three hospitals, through social media and by direct enrolment on the study website. Participants completed an online survey which included the full version of the CDI and general distress measures including the Kessler K6, Patient Health Questionnaire-4, and Emotion Thermometers. Relationship of the CDI with these instruments, Rasch analysis model fit and clinical expertise were all used to select items for the short form (CDI-SF). Construct validity and receiver operating characteristics in relation to the Kessler K6 were examined. Results: The final 12 item CDI-SF exhibited excellent internal consistency indicative of unidimensionality and good convergent and discriminant validity in comparison to clinical status measures, all indicative of good construct validity. Using the K6 validated cutoff of
DMD-associated dilated cardiomyopathy : genotypes, phenotypes, and phenocopies
- Johnson, Renee, Otway, Robyn, Chin, Ephrem, Horvat, Claire, Ohanian, Monique, Wilcox, Jon, Su, Zheng, Prestes, Priscilla, Smolnikov, Andrei, Soka, Magdalena, Guo, Guanglan, Rath, Emma, Chakravorty, Samya, Chrzanowski, Lukasz, Hayward, Christopher, Keogh, Anne, MacDonald, Peter, Giannoulatou, Eleni, Chang, Alex, Oates, Emily, Charchar, Fadi, Seidman, Jonathan, Seidman, Christine, Hegde, Madhuri, Fatkin, Diane
- Authors: Johnson, Renee , Otway, Robyn , Chin, Ephrem , Horvat, Claire , Ohanian, Monique , Wilcox, Jon , Su, Zheng , Prestes, Priscilla , Smolnikov, Andrei , Soka, Magdalena , Guo, Guanglan , Rath, Emma , Chakravorty, Samya , Chrzanowski, Lukasz , Hayward, Christopher , Keogh, Anne , MacDonald, Peter , Giannoulatou, Eleni , Chang, Alex , Oates, Emily , Charchar, Fadi , Seidman, Jonathan , Seidman, Christine , Hegde, Madhuri , Fatkin, Diane
- Date: 2023
- Type: Text , Journal article
- Relation: Circulation: Genomic and Precision Medicine Vol. 16, no. 5 (2023), p. 421-430
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- Description: Background: Variants in the DMD gene, that encodes the cytoskeletal protein, dystrophin, cause a severe form of dilated cardiomyopathy (DCM) associated with high rates of heart failure, heart transplantation, and ventricular arrhythmias. Improved early detection of individuals at risk is needed. Methods: Genetic testing of 40 male probands with a potential X-linked genetic cause of primary DCM was undertaken using multi-gene panel sequencing, multiplex polymerase chain reaction, and array comparative genomic hybridization. Variant location was assessed with respect to dystrophin isoform patterns and exon usage. Telomere length was evaluated as a marker of myocardial dysfunction in left ventricular tissue and blood. Results: Four pathogenic/likely pathogenic DMD variants were found in 5 probands (5/40: 12.5%). Only one rare variant was identified by gene panel testing with 3 additional multi-exon deletion/duplications found following targeted assays for structural variants. All of the pathogenic/likely pathogenic DMD variants involved dystrophin exons that had percent spliced-in scores >90, indicating high levels of constitutive expression in the human adult heart. Fifteen DMD variant-negative probands (15/40: 37.5%) had variants in autosomal genes including TTN, BAG3, LMNA, and RBM20. Myocardial telomere length was reduced in patients with DCM irrespective of genotype. No differences in blood telomere length were observed between genotype-positive family members with/without DCM and controls. Conclusions: Primary genetic testing using multi-gene panels has a low yield and specific assays for structural variants are required if DMD-associated cardiomyopathy is suspected. Distinguishing X-linked causes of DCM from autosomal genes that show sex differences in clinical presentation is crucial for informed family management. © 2023 American Heart Association, Inc.
- Authors: Johnson, Renee , Otway, Robyn , Chin, Ephrem , Horvat, Claire , Ohanian, Monique , Wilcox, Jon , Su, Zheng , Prestes, Priscilla , Smolnikov, Andrei , Soka, Magdalena , Guo, Guanglan , Rath, Emma , Chakravorty, Samya , Chrzanowski, Lukasz , Hayward, Christopher , Keogh, Anne , MacDonald, Peter , Giannoulatou, Eleni , Chang, Alex , Oates, Emily , Charchar, Fadi , Seidman, Jonathan , Seidman, Christine , Hegde, Madhuri , Fatkin, Diane
- Date: 2023
- Type: Text , Journal article
- Relation: Circulation: Genomic and Precision Medicine Vol. 16, no. 5 (2023), p. 421-430
- Full Text:
- Reviewed:
- Description: Background: Variants in the DMD gene, that encodes the cytoskeletal protein, dystrophin, cause a severe form of dilated cardiomyopathy (DCM) associated with high rates of heart failure, heart transplantation, and ventricular arrhythmias. Improved early detection of individuals at risk is needed. Methods: Genetic testing of 40 male probands with a potential X-linked genetic cause of primary DCM was undertaken using multi-gene panel sequencing, multiplex polymerase chain reaction, and array comparative genomic hybridization. Variant location was assessed with respect to dystrophin isoform patterns and exon usage. Telomere length was evaluated as a marker of myocardial dysfunction in left ventricular tissue and blood. Results: Four pathogenic/likely pathogenic DMD variants were found in 5 probands (5/40: 12.5%). Only one rare variant was identified by gene panel testing with 3 additional multi-exon deletion/duplications found following targeted assays for structural variants. All of the pathogenic/likely pathogenic DMD variants involved dystrophin exons that had percent spliced-in scores >90, indicating high levels of constitutive expression in the human adult heart. Fifteen DMD variant-negative probands (15/40: 37.5%) had variants in autosomal genes including TTN, BAG3, LMNA, and RBM20. Myocardial telomere length was reduced in patients with DCM irrespective of genotype. No differences in blood telomere length were observed between genotype-positive family members with/without DCM and controls. Conclusions: Primary genetic testing using multi-gene panels has a low yield and specific assays for structural variants are required if DMD-associated cardiomyopathy is suspected. Distinguishing X-linked causes of DCM from autosomal genes that show sex differences in clinical presentation is crucial for informed family management. © 2023 American Heart Association, Inc.
Fasting triglycerides are positively associated with cardiovascular mortality risk in people with diabetes
- Wang, Yutang, Fang, Yan, Magliano, Dianna, Charchar, Fadi, Sobey, Christopher, Drummond, Grant, Golledge, Jonathan
- Authors: Wang, Yutang , Fang, Yan , Magliano, Dianna , Charchar, Fadi , Sobey, Christopher , Drummond, Grant , Golledge, Jonathan
- Date: 2023
- Type: Text , Journal article
- Relation: Cardiovascular Research Vol. 119, no. 3 (2023), p. 826-834
- Relation: https://purl.org/au-research/grants/nhmrc/1062671
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- Description: Aims We investigated the association of fasting triglycerides with cardiovascular disease (CVD) mortality. Methods and results This cohort study included US adults from the National Health and Nutrition Examination Surveys from 1988 to 2014. CVD mortality outcomes were ascertained by linkage to the National Death Index records. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of triglycerides for CVD mortality. The cohort included 26 570 adult participants, among which 3978 had diabetes. People with higher triglycerides had a higher prevalence of diabetes at baseline. The cohort was followed up for a mean of 12.0 years with 1492 CVD deaths recorded. A 1-natural-log-unit higher triglyceride was associated with a 30% higher multivariate-adjusted risk of CVD mortality in participants with diabetes (HR, 1.30; 95% CI, 1.08–1.56) but not in those without diabetes (HR, 0.95; 95% CI, 0.83–1.07). In participants with diabetes, people with high triglycerides (200–499 mg/dL) had a 44% (HR, 1.44; 95% CI, 1.12–1.85) higher multivariate-adjusted risk of CVD mortality compared with those with normal triglycerides (<150 mg/dL). The findings remained significant when diabetes was defined by fasting glucose levels alone, or after further adjustment for the use of lipid-lowering medications, or after the exclusion of those who took lipid-lowering medications. Conclusion This study demonstrates that fasting triglycerides of
- Authors: Wang, Yutang , Fang, Yan , Magliano, Dianna , Charchar, Fadi , Sobey, Christopher , Drummond, Grant , Golledge, Jonathan
- Date: 2023
- Type: Text , Journal article
- Relation: Cardiovascular Research Vol. 119, no. 3 (2023), p. 826-834
- Relation: https://purl.org/au-research/grants/nhmrc/1062671
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- Description: Aims We investigated the association of fasting triglycerides with cardiovascular disease (CVD) mortality. Methods and results This cohort study included US adults from the National Health and Nutrition Examination Surveys from 1988 to 2014. CVD mortality outcomes were ascertained by linkage to the National Death Index records. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of triglycerides for CVD mortality. The cohort included 26 570 adult participants, among which 3978 had diabetes. People with higher triglycerides had a higher prevalence of diabetes at baseline. The cohort was followed up for a mean of 12.0 years with 1492 CVD deaths recorded. A 1-natural-log-unit higher triglyceride was associated with a 30% higher multivariate-adjusted risk of CVD mortality in participants with diabetes (HR, 1.30; 95% CI, 1.08–1.56) but not in those without diabetes (HR, 0.95; 95% CI, 0.83–1.07). In participants with diabetes, people with high triglycerides (200–499 mg/dL) had a 44% (HR, 1.44; 95% CI, 1.12–1.85) higher multivariate-adjusted risk of CVD mortality compared with those with normal triglycerides (<150 mg/dL). The findings remained significant when diabetes was defined by fasting glucose levels alone, or after further adjustment for the use of lipid-lowering medications, or after the exclusion of those who took lipid-lowering medications. Conclusion This study demonstrates that fasting triglycerides of
Metabolic syndrome is associated with similar long-term prognosis in those living with and without obesity : an analysis of 45 615 patients from the nationwide LIPIDOGRAM 2004-2015 studies
- Osadnik, Kamila, Osadnik, Tadeusz, Gierlotka, Marek, Windak, Adam, Tomasik, Tomasz, Mastej, Miroslaw, Kuras, Agnieszka, Jóźwiak, Kacper, Penson, Peter, Lip, Gregory, Mikhailidis, Dimitri, Toth, Peter, Catapano, Alberico, Ray, Kausik, Howard, George, Tomaszewski, Maclej, Charchar, Fadi, Sattar, Naveed, Williams, Bryan, MacDonald, Thomas, Banach, Maclej, Jóźwiak, Jacek
- Authors: Osadnik, Kamila , Osadnik, Tadeusz , Gierlotka, Marek , Windak, Adam , Tomasik, Tomasz , Mastej, Miroslaw , Kuras, Agnieszka , Jóźwiak, Kacper , Penson, Peter , Lip, Gregory , Mikhailidis, Dimitri , Toth, Peter , Catapano, Alberico , Ray, Kausik , Howard, George , Tomaszewski, Maclej , Charchar, Fadi , Sattar, Naveed , Williams, Bryan , MacDonald, Thomas , Banach, Maclej , Jóźwiak, Jacek
- Date: 2023
- Type: Text , Journal article
- Relation: European Journal of Preventive Cardiology Vol. 30, no. 12 (2023), p. 1195-1204
- Full Text:
- Reviewed:
- Description: Aims: We aimed to evaluate the association between metabolic syndrome (MetS) and long-term all-cause mortality. Methods and results: The LIPIDOGRAM studies were carried out in the primary care in Poland in 2004, 2006, and 2015. MetS was diagnosed based on the National Cholesterol Education Program, Adult Treatment Panel III (NCEP/ATP III), and Joint Interim Statement (JIS) criteria. The cohort was divided into four groups: non-obese patients without MetS, obese patients without MetS, non-obese patients with MetS, and obese patients with MetS. Differences in all-cause mortality were analysed using Kaplan-Meier and Cox regression analyses. A total of 45 615 participants were enrolled (mean age 56.3, standard deviation: 11.8 years; 61.7% female). MetS was diagnosed in 14 202 (31%) by NCEP/ATP III criteria and 17 216 (37.7%) by JIS criteria. Follow-up was available for 44 620 (97.8%, median duration 15.3 years) patients. MetS was associated with increased mortality risk among the obese {hazard ratio, HR: 1.88 [95% confidence interval (CI) 1.79-1.99] and HR: 1.93 [95% CI 1.82-2.04], according to NCEP/ATP III and JIS criteria, respectively} and non-obese individuals [HR: 2.11 (95% CI 1.85-2.40) and 1.7 (95% CI 1.56-1.85) according to NCEP/ATP III and JIS criteria, respectively]. Obese patients without MetS had a higher mortality risk than non-obese patients without MetS [HR: 1.16 (95% CI 1.10-1.23) and HR: 1.22 (95% CI 1.15-1.30), respectively in subgroups with NCEP/ATP III and JIS criteria applied]. Conclusions: MetS is associated with increased all-cause mortality risk in non-obese and obese patients. In patients without MetS, obesity remains significantly associated with mortality. The concept of metabolically healthy obesity should be revised. © 2023 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved.
- Authors: Osadnik, Kamila , Osadnik, Tadeusz , Gierlotka, Marek , Windak, Adam , Tomasik, Tomasz , Mastej, Miroslaw , Kuras, Agnieszka , Jóźwiak, Kacper , Penson, Peter , Lip, Gregory , Mikhailidis, Dimitri , Toth, Peter , Catapano, Alberico , Ray, Kausik , Howard, George , Tomaszewski, Maclej , Charchar, Fadi , Sattar, Naveed , Williams, Bryan , MacDonald, Thomas , Banach, Maclej , Jóźwiak, Jacek
- Date: 2023
- Type: Text , Journal article
- Relation: European Journal of Preventive Cardiology Vol. 30, no. 12 (2023), p. 1195-1204
- Full Text:
- Reviewed:
- Description: Aims: We aimed to evaluate the association between metabolic syndrome (MetS) and long-term all-cause mortality. Methods and results: The LIPIDOGRAM studies were carried out in the primary care in Poland in 2004, 2006, and 2015. MetS was diagnosed based on the National Cholesterol Education Program, Adult Treatment Panel III (NCEP/ATP III), and Joint Interim Statement (JIS) criteria. The cohort was divided into four groups: non-obese patients without MetS, obese patients without MetS, non-obese patients with MetS, and obese patients with MetS. Differences in all-cause mortality were analysed using Kaplan-Meier and Cox regression analyses. A total of 45 615 participants were enrolled (mean age 56.3, standard deviation: 11.8 years; 61.7% female). MetS was diagnosed in 14 202 (31%) by NCEP/ATP III criteria and 17 216 (37.7%) by JIS criteria. Follow-up was available for 44 620 (97.8%, median duration 15.3 years) patients. MetS was associated with increased mortality risk among the obese {hazard ratio, HR: 1.88 [95% confidence interval (CI) 1.79-1.99] and HR: 1.93 [95% CI 1.82-2.04], according to NCEP/ATP III and JIS criteria, respectively} and non-obese individuals [HR: 2.11 (95% CI 1.85-2.40) and 1.7 (95% CI 1.56-1.85) according to NCEP/ATP III and JIS criteria, respectively]. Obese patients without MetS had a higher mortality risk than non-obese patients without MetS [HR: 1.16 (95% CI 1.10-1.23) and HR: 1.22 (95% CI 1.15-1.30), respectively in subgroups with NCEP/ATP III and JIS criteria applied]. Conclusions: MetS is associated with increased all-cause mortality risk in non-obese and obese patients. In patients without MetS, obesity remains significantly associated with mortality. The concept of metabolically healthy obesity should be revised. © 2023 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved.
Adjustment for body mass index changes inverse associations of HDL-cholesterol with blood pressure and hypertension to positive associations
- Yang, Guang, Qian, Tingting, Sun, Hui, Xu, Qun, Hou, Xujuan, Hu, Wenqi, Zhang, Guang, Drummond, Grant, Sobey, Christopher, Witting, Paul, Denton, Kate, Charchar, Fadi, Golledge, Jonathan, Wang, Yutang
- Authors: Yang, Guang , Qian, Tingting , Sun, Hui , Xu, Qun , Hou, Xujuan , Hu, Wenqi , Zhang, Guang , Drummond, Grant , Sobey, Christopher , Witting, Paul , Denton, Kate , Charchar, Fadi , Golledge, Jonathan , Wang, Yutang
- Date: 2022
- Type: Text , Journal article
- Relation: Journal of Human Hypertension Vol. 36, no. 6 (2022), p. 570-579
- Relation: https://purl.org/au-research/grants/nhmrc/1062671
- Full Text:
- Reviewed:
- Description: The associations between high-density lipoprotein cholesterol (HDL-C) and blood pressure (BP) or hypertension are inconsistent in previous studies. This study aimed to assess these associations in a large cohort of Chinese adults and across different age groups. This cross-sectional association study included 22,081 Chinese adults. Associations of HDL-C with BP and hypertension were analyzed using linear or logistic regression, with or without adjustment for confounding factors. HDL-C was inversely associated with BP and hypertension. These associations were still apparent after adjustment for age, sex, fasting plasma glucose, and low-density lipoprotein cholesterol. Sub-analyses revealed: (1) in the whole cohort and females alone, HDL-C was inversely associated with BP and hypertension in young and middle-aged but not older participants; (2) in males alone, HDL-C was not associated with systolic BP or hypertension. However, HDL-C was either inversely, or not, or positively associated with BP in young, middle-aged, and older males, respectively. After further adjustment for body mass index (BMI), the negative associations of HDL-C with BP and hypertension in the whole cohort became positive ones, and the positive associations only presented in males. These findings suggest that further adjustment for BMI changes inverse associations of HDL-cholesterol with BP and hypertension to positive associations in a cohort of Chinese adults. © 2021, The Author(s), under exclusive licence to Springer Nature Limited.
- Authors: Yang, Guang , Qian, Tingting , Sun, Hui , Xu, Qun , Hou, Xujuan , Hu, Wenqi , Zhang, Guang , Drummond, Grant , Sobey, Christopher , Witting, Paul , Denton, Kate , Charchar, Fadi , Golledge, Jonathan , Wang, Yutang
- Date: 2022
- Type: Text , Journal article
- Relation: Journal of Human Hypertension Vol. 36, no. 6 (2022), p. 570-579
- Relation: https://purl.org/au-research/grants/nhmrc/1062671
- Full Text:
- Reviewed:
- Description: The associations between high-density lipoprotein cholesterol (HDL-C) and blood pressure (BP) or hypertension are inconsistent in previous studies. This study aimed to assess these associations in a large cohort of Chinese adults and across different age groups. This cross-sectional association study included 22,081 Chinese adults. Associations of HDL-C with BP and hypertension were analyzed using linear or logistic regression, with or without adjustment for confounding factors. HDL-C was inversely associated with BP and hypertension. These associations were still apparent after adjustment for age, sex, fasting plasma glucose, and low-density lipoprotein cholesterol. Sub-analyses revealed: (1) in the whole cohort and females alone, HDL-C was inversely associated with BP and hypertension in young and middle-aged but not older participants; (2) in males alone, HDL-C was not associated with systolic BP or hypertension. However, HDL-C was either inversely, or not, or positively associated with BP in young, middle-aged, and older males, respectively. After further adjustment for body mass index (BMI), the negative associations of HDL-C with BP and hypertension in the whole cohort became positive ones, and the positive associations only presented in males. These findings suggest that further adjustment for BMI changes inverse associations of HDL-cholesterol with BP and hypertension to positive associations in a cohort of Chinese adults. © 2021, The Author(s), under exclusive licence to Springer Nature Limited.
Contributions of obesity to kidney health and disease: insights from Mendelian randomization and the human kidney transcriptomics
- Xu, Xiaoguang, Eales, James, Jiang, Xiao, Sanderson, Eleanor, Drzal, Maciej, Saluja, Sushant, Scannali, David, Williams, Bryan, Morris, Andrew, Guzik, Tomasz, Charchar, Fadi, Holmes, Michael, Tomaszewski, Maciej
- Authors: Xu, Xiaoguang , Eales, James , Jiang, Xiao , Sanderson, Eleanor , Drzal, Maciej , Saluja, Sushant , Scannali, David , Williams, Bryan , Morris, Andrew , Guzik, Tomasz , Charchar, Fadi , Holmes, Michael , Tomaszewski, Maciej
- Date: 2022
- Type: Text , Journal article
- Relation: Cardiovascular research Vol. 118, no. 15 (2022), p. 3151-3161
- Full Text:
- Reviewed:
- Description: AIMS: Obesity and kidney diseases are common complex disorders with an increasing clinical and economic impact on healthcare around the globe. Our objective was to examine if modifiable anthropometric obesity indices show putatively causal association with kidney health and disease and highlight biological mechanisms of potential relevance to the association between obesity and the kidney. METHODS AND RESULTS: We performed observational, one-sample, two-sample Mendelian randomization (MR) and multivariable MR studies in
- Authors: Xu, Xiaoguang , Eales, James , Jiang, Xiao , Sanderson, Eleanor , Drzal, Maciej , Saluja, Sushant , Scannali, David , Williams, Bryan , Morris, Andrew , Guzik, Tomasz , Charchar, Fadi , Holmes, Michael , Tomaszewski, Maciej
- Date: 2022
- Type: Text , Journal article
- Relation: Cardiovascular research Vol. 118, no. 15 (2022), p. 3151-3161
- Full Text:
- Reviewed:
- Description: AIMS: Obesity and kidney diseases are common complex disorders with an increasing clinical and economic impact on healthcare around the globe. Our objective was to examine if modifiable anthropometric obesity indices show putatively causal association with kidney health and disease and highlight biological mechanisms of potential relevance to the association between obesity and the kidney. METHODS AND RESULTS: We performed observational, one-sample, two-sample Mendelian randomization (MR) and multivariable MR studies in
- Pengelly, Jacqueline, Royse, Colin, Williams, Gavin, Bryant, Adam, Clarke-Errey, Sandy, Royse, Alistair, El-Ansary, Doa
- Authors: Pengelly, Jacqueline , Royse, Colin , Williams, Gavin , Bryant, Adam , Clarke-Errey, Sandy , Royse, Alistair , El-Ansary, Doa
- Date: 2022
- Type: Text , Journal article
- Relation: Heart Lung and Circulation Vol. 31, no. 3 (2022), p. 395-406
- Full Text: false
- Reviewed:
- Description: Aims: To investigate the effects of a 12-week early moderate-intensity resistance training program compared to aerobic-based rehabilitation on postoperative cognitive recovery following cardiac surgery via median sternotomy. Methods: This was a multicentre, prospective, pragmatic, non-blinded, pilot randomised controlled trial (1:1 randomisation) of two parallel groups that compared a 12-week early moderate-intensity resistance training group to a control group, receiving aerobic-based rehabilitation. English-speaking adults (≥18 years) undergoing elective cardiac surgery via median sternotomy were randomised using sealed envelopes, with allocation revealed before surgery. The primary outcome was cognitive function, assessed using the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), at baseline, 14 weeks and 6 months postoperatively. Results: The ADAS-cog score at 14 weeks was significantly better for the resistance training group (n=14, 7.2±1.4; 95% CI 4.3, 10.2, vs n=17, 9.2±1.3; 95% CI 6.6, 11.9, p=0.010). At 14 weeks postoperatively, 53% of the aerobic-based rehabilitation group (n=9/17) experienced cognitive decline by two points or more from baseline ADAS-cog score, compared to 0% of the resistance training group (n=0/14; p=0.001). Conclusion: Early resistance training appears to be safe and may improve cognitive recovery compared to standard, aerobic-based rehabilitation following cardiac surgery via median sternotomy, however as this was a pilot study, the sample size was small and further research is needed to determine a causal relationship. © 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)
Renin-angiotensin system inhibitors in patients With COVID-19 : a meta-analysis of randomized controlled trials led by the International Society of Hypertension
- Gnanenthiran, Sonali, Borghi, Claudio, Burger, Dylan, Caramelli, Bruno, Charchar, Fadi, Chirinos, Julio, Cohen, Jordana, Cremer, Antoine, Di Tanna, Gian, Duvignaud, Alexandre, Freilich, Daniel, Gommans, D., Gracia-Ramos, Abraham, Murray, Thomas, Pelorosso, Facundo, Poulter, Neil, Puskarich, Michael, Rizas, Konstantinos, Rothlin, Rodolfo, Schlaich, Markus, Schreinlecher, Michael, Steckelings, Ulrike, Sharma, Abhinav, Stergiou, George, Tignanelli, Christopher, Tomaszewski, Maciej, Unger, Thomas, van Kimmenade, Roland, Wainford, Richard, Williams, Bryan, Rodgers, Anthony, Schutte, Aletta
- Authors: Gnanenthiran, Sonali , Borghi, Claudio , Burger, Dylan , Caramelli, Bruno , Charchar, Fadi , Chirinos, Julio , Cohen, Jordana , Cremer, Antoine , Di Tanna, Gian , Duvignaud, Alexandre , Freilich, Daniel , Gommans, D. , Gracia-Ramos, Abraham , Murray, Thomas , Pelorosso, Facundo , Poulter, Neil , Puskarich, Michael , Rizas, Konstantinos , Rothlin, Rodolfo , Schlaich, Markus , Schreinlecher, Michael , Steckelings, Ulrike , Sharma, Abhinav , Stergiou, George , Tignanelli, Christopher , Tomaszewski, Maciej , Unger, Thomas , van Kimmenade, Roland , Wainford, Richard , Williams, Bryan , Rodgers, Anthony , Schutte, Aletta
- Date: 2022
- Type: Text , Journal article
- Relation: Journal of the American Heart Association Vol. 11, no. 17 (2022), p.
- Full Text:
- Reviewed:
- Description: BACKGROUND: Published randomized controlled trials are underpowered for binary clinical end points to assess the safety and efficacy of renin-angiotensin system inhibitors (RASi) in adults with COVID-19. We therefore performed a meta-analysis to assess the safety and efficacy of RASi in adults with COVID-19. METHODS AND RESULTS: MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Controlled Trial Register were searched for randomized controlled trials that randomly assigned patients with COVID-19 to RASi continuation/commencement versus no RASi therapy. The primary outcome was all-cause mortality at ≤30 days. A total of 14 randomized controlled trials met the inclusion criteria and enrolled 1838 participants (aged 59 years, 58% men, mean follow-up 26 days). Of the trials, 11 contributed data. We found no effect of RASi versus control on all-cause mortality (7.2% versus 7.5%; relative risk [RR], 0.95; [95% CI, 0.69–1.30]) either overall or in subgroups defined by COVID-19 severity or trial type. Network meta-analysis identified no difference between angiotensin-converting enzyme inhibitors versus angiotensin II receptor blockers. RASi users had a nonsignificant reduction in acute myocardial infarction (2.1% versus 3.6%; RR, 0.59; [95% CI, 0.33–1.06]), but increased risk of acute kidney injury (7.0% versus 3.6%; RR, 1.82; [95% CI, 1.05– 3.16]), in trials that initiated and continued RASi. There was no increase in need for dialysis or differences in congestive cardiac failure, cerebrovascular events, venous thromboembolism, hospitalization, intensive care admission, inotropes, or mechanical ventilation. CONCLUSIONS: This meta-analysis of randomized controlled trials evaluating angiotensin-converting enzyme inhibitors/angio-tensin II receptor blockers versus control in patients with COVID-19 found no difference in all-cause mortality, a borderline decrease in myocardial infarction, and an increased risk of acute kidney injury with RASi. Our findings provide strong evidence that RASi can be used safely in patients with COVID-19. © 2022 The Authors.
- Description: BACKGROUND: Published randomized controlled trials are underpowered for binary clinical end points to assess the safety and efficacy of renin-angiotensin system inhibitors (RASi) in adults with COVID-19. We therefore performed a meta-analysis to assess the safety and efficacy of RASi in adults with COVID-19. METHODS AND RESULTS: MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Controlled Trial Register were searched for randomized controlled trials that randomly assigned patients with COVID-19 to RASi continuation/commencement versus no RASi therapy. The primary outcome was all-cause mortality at
- Authors: Gnanenthiran, Sonali , Borghi, Claudio , Burger, Dylan , Caramelli, Bruno , Charchar, Fadi , Chirinos, Julio , Cohen, Jordana , Cremer, Antoine , Di Tanna, Gian , Duvignaud, Alexandre , Freilich, Daniel , Gommans, D. , Gracia-Ramos, Abraham , Murray, Thomas , Pelorosso, Facundo , Poulter, Neil , Puskarich, Michael , Rizas, Konstantinos , Rothlin, Rodolfo , Schlaich, Markus , Schreinlecher, Michael , Steckelings, Ulrike , Sharma, Abhinav , Stergiou, George , Tignanelli, Christopher , Tomaszewski, Maciej , Unger, Thomas , van Kimmenade, Roland , Wainford, Richard , Williams, Bryan , Rodgers, Anthony , Schutte, Aletta
- Date: 2022
- Type: Text , Journal article
- Relation: Journal of the American Heart Association Vol. 11, no. 17 (2022), p.
- Full Text:
- Reviewed:
- Description: BACKGROUND: Published randomized controlled trials are underpowered for binary clinical end points to assess the safety and efficacy of renin-angiotensin system inhibitors (RASi) in adults with COVID-19. We therefore performed a meta-analysis to assess the safety and efficacy of RASi in adults with COVID-19. METHODS AND RESULTS: MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Controlled Trial Register were searched for randomized controlled trials that randomly assigned patients with COVID-19 to RASi continuation/commencement versus no RASi therapy. The primary outcome was all-cause mortality at ≤30 days. A total of 14 randomized controlled trials met the inclusion criteria and enrolled 1838 participants (aged 59 years, 58% men, mean follow-up 26 days). Of the trials, 11 contributed data. We found no effect of RASi versus control on all-cause mortality (7.2% versus 7.5%; relative risk [RR], 0.95; [95% CI, 0.69–1.30]) either overall or in subgroups defined by COVID-19 severity or trial type. Network meta-analysis identified no difference between angiotensin-converting enzyme inhibitors versus angiotensin II receptor blockers. RASi users had a nonsignificant reduction in acute myocardial infarction (2.1% versus 3.6%; RR, 0.59; [95% CI, 0.33–1.06]), but increased risk of acute kidney injury (7.0% versus 3.6%; RR, 1.82; [95% CI, 1.05– 3.16]), in trials that initiated and continued RASi. There was no increase in need for dialysis or differences in congestive cardiac failure, cerebrovascular events, venous thromboembolism, hospitalization, intensive care admission, inotropes, or mechanical ventilation. CONCLUSIONS: This meta-analysis of randomized controlled trials evaluating angiotensin-converting enzyme inhibitors/angio-tensin II receptor blockers versus control in patients with COVID-19 found no difference in all-cause mortality, a borderline decrease in myocardial infarction, and an increased risk of acute kidney injury with RASi. Our findings provide strong evidence that RASi can be used safely in patients with COVID-19. © 2022 The Authors.
- Description: BACKGROUND: Published randomized controlled trials are underpowered for binary clinical end points to assess the safety and efficacy of renin-angiotensin system inhibitors (RASi) in adults with COVID-19. We therefore performed a meta-analysis to assess the safety and efficacy of RASi in adults with COVID-19. METHODS AND RESULTS: MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Controlled Trial Register were searched for randomized controlled trials that randomly assigned patients with COVID-19 to RASi continuation/commencement versus no RASi therapy. The primary outcome was all-cause mortality at
The cardiac distress inventory : a new measure of psychosocial distress associated with an acute cardiac event
- Jackson, Alun, Grande, Michael, Rogerson, Michelle, Ski, Chantal, Amerena, John, Smith, Julian, Hoover, Valerie, Alvarenga, Marlies, Higgins, Rosemary, Thompson, David, Murphy, Barbara
- Authors: Jackson, Alun , Grande, Michael , Rogerson, Michelle , Ski, Chantal , Amerena, John , Smith, Julian , Hoover, Valerie , Alvarenga, Marlies , Higgins, Rosemary , Thompson, David , Murphy, Barbara
- Date: 2022
- Type: Text , Journal article
- Relation: BMC Cardiovascular Disorders Vol. 22, no. 1 (2022), p.
- Full Text:
- Reviewed:
- Description: Background: Many challenges are posed by the experience of a heart attack or heart surgery which can be characterised as ‘cardiac distress’. It spans multiple psychosocial domains incorporating patients’ responses to physical, affective, cognitive, behavioural and social symptoms and experiences related to their cardiac event and their recovery. Although some measures of the psychological and emotional impacts of a cardiac event exist, none provides a comprehensive assessment of cardiac distress. To address this gap, the study aimed to develop a Cardiac Distress Inventory (CDI) using best practice in instrument design. Method: An item pool was generated through analysis of cognate measures, mostly in relation to other health conditions and through focus group and individual review by a multidisciplinary development team, cardiac patients, and end-users including cardiac rehabilitation co-ordinators. The resulting 144 items were reduced through further reviews to 74 for testing. The testing was carried out with 405 people recruited from three hospitals, through social media and by direct enrolment on the study website. A two-stage psychometric evaluation of the 74 items used exploratory factor analysis to extract the factors followed by Rasch analysis to confirm dimensionality within factors. Results: Psychometric analysis resulted in the identification of 55 items comprising eight subscales, to form the CDI. The subscales assess fear and uncertainty, disconnection and hopelessness, changes to roles and relationships, overwhelm and depletion, cognitive challenges, physical challenges, health system challenges, and death concerns. Validation against the Kessler 6 supports the criterion validity of the CDI. Conclusion: The CDI reflects a nuanced understanding of cardiac distress and should prove to be a useful clinical assessment tool, as well as a research instrument. Individual subscales or the complete CDI could be used to assess or monitor specific areas of distress in clinical practice. Development of a short form screening version for use in primary care, cardiac rehabilitation and counselling services is warranted. © 2022, The Author(s).
- Authors: Jackson, Alun , Grande, Michael , Rogerson, Michelle , Ski, Chantal , Amerena, John , Smith, Julian , Hoover, Valerie , Alvarenga, Marlies , Higgins, Rosemary , Thompson, David , Murphy, Barbara
- Date: 2022
- Type: Text , Journal article
- Relation: BMC Cardiovascular Disorders Vol. 22, no. 1 (2022), p.
- Full Text:
- Reviewed:
- Description: Background: Many challenges are posed by the experience of a heart attack or heart surgery which can be characterised as ‘cardiac distress’. It spans multiple psychosocial domains incorporating patients’ responses to physical, affective, cognitive, behavioural and social symptoms and experiences related to their cardiac event and their recovery. Although some measures of the psychological and emotional impacts of a cardiac event exist, none provides a comprehensive assessment of cardiac distress. To address this gap, the study aimed to develop a Cardiac Distress Inventory (CDI) using best practice in instrument design. Method: An item pool was generated through analysis of cognate measures, mostly in relation to other health conditions and through focus group and individual review by a multidisciplinary development team, cardiac patients, and end-users including cardiac rehabilitation co-ordinators. The resulting 144 items were reduced through further reviews to 74 for testing. The testing was carried out with 405 people recruited from three hospitals, through social media and by direct enrolment on the study website. A two-stage psychometric evaluation of the 74 items used exploratory factor analysis to extract the factors followed by Rasch analysis to confirm dimensionality within factors. Results: Psychometric analysis resulted in the identification of 55 items comprising eight subscales, to form the CDI. The subscales assess fear and uncertainty, disconnection and hopelessness, changes to roles and relationships, overwhelm and depletion, cognitive challenges, physical challenges, health system challenges, and death concerns. Validation against the Kessler 6 supports the criterion validity of the CDI. Conclusion: The CDI reflects a nuanced understanding of cardiac distress and should prove to be a useful clinical assessment tool, as well as a research instrument. Individual subscales or the complete CDI could be used to assess or monitor specific areas of distress in clinical practice. Development of a short form screening version for use in primary care, cardiac rehabilitation and counselling services is warranted. © 2022, The Author(s).
- Authors: Wang, Yutang
- Date: 2022
- Type: Text , Journal article
- Relation: Journal of hypertension Vol. 40, no. 9 (2022), p. 1840-1840
- Full Text: false
- Reviewed:
Deficiency of MicroRNA-181a results in transcriptome-wide cell-specific changes in the kidney and increases blood pressure
- Paterson, Madeleine, Jackson, Kristy, Dona, Malathi, Farrugia, Gabriella, Visniauskas, Bruna, Watson, Anna, Johnson, Chad, Prieto, Minolfa, Evans, Roger, Charchar, Fadi, Pinto, Alexander, Marques, Francine, Head, Geoffrey
- Authors: Paterson, Madeleine , Jackson, Kristy , Dona, Malathi , Farrugia, Gabriella , Visniauskas, Bruna , Watson, Anna , Johnson, Chad , Prieto, Minolfa , Evans, Roger , Charchar, Fadi , Pinto, Alexander , Marques, Francine , Head, Geoffrey
- Date: 2021
- Type: Text , Journal article
- Relation: Hypertension Vol. 78, no. 5 (Nov 2021), p. 1322-1334
- Full Text:
- Reviewed:
- Description: MicroRNA miR-181a is downregulated in the kidneys of hypertensive patients and hypertensive mice. In vitro, miR-181a is a posttranslational inhibitor of renin expression, but pleiotropic mechanisms by which miR-181a may influence blood pressure (BP) are unknown. Here, we determined whether deletion of miR-181a/b-1 in vivo changes BP and the molecular mechanisms involved at the single-cell level. We developed a KO (knockout) mouse model lacking miR-181a/b-1 genes using CRISPR/Cas9 technology. Radiotelemetry probes were implanted in 12-week-old C57BL/6J WT (wild type) and miR-181a/b-1 KO mice. Systolic and diastolic BP were 4- to 5-mm Hg higher in KO compared with WT mice over 24 hours (P<0.01). Compared with WT mice, renal renin was higher in the juxtaglomerular cells of KO mice. BP was similar in WT mice on a high- (3.1%) versus low- (0.3%) sodium diet (+0.4 +/- 0.8 mm Hg), but KO mice showed salt sensitivity (+3.3 +/- 0.8 mm Hg; P<0.001). Since microRNAs can target several mRNAs simultaneously, we performed single-nuclei RNA sequencing in 6699 renal cells. We identified 12 distinct types of renal cells, all of which had genes that were dysregulated. This included genes involved in renal fibrosis and inflammation such as Stat4, Col4a1, Cd81, Flt3l, Cxcl16, and Smad4. We observed upregulation of pathways related to the immune system, inflammatory response, reactive oxygen species, and nerve development, consistent with higher tyrosine hydroxylase in the kidney. In conclusion, downregulation of the miR-181a gene led to increased BP and salt sensitivity in mice. This is likely due to an increase in renin expression in juxtaglomerular cells, as well as microRNA-driven pleiotropic effects impacting renal pathways associated with hypertension.
- Authors: Paterson, Madeleine , Jackson, Kristy , Dona, Malathi , Farrugia, Gabriella , Visniauskas, Bruna , Watson, Anna , Johnson, Chad , Prieto, Minolfa , Evans, Roger , Charchar, Fadi , Pinto, Alexander , Marques, Francine , Head, Geoffrey
- Date: 2021
- Type: Text , Journal article
- Relation: Hypertension Vol. 78, no. 5 (Nov 2021), p. 1322-1334
- Full Text:
- Reviewed:
- Description: MicroRNA miR-181a is downregulated in the kidneys of hypertensive patients and hypertensive mice. In vitro, miR-181a is a posttranslational inhibitor of renin expression, but pleiotropic mechanisms by which miR-181a may influence blood pressure (BP) are unknown. Here, we determined whether deletion of miR-181a/b-1 in vivo changes BP and the molecular mechanisms involved at the single-cell level. We developed a KO (knockout) mouse model lacking miR-181a/b-1 genes using CRISPR/Cas9 technology. Radiotelemetry probes were implanted in 12-week-old C57BL/6J WT (wild type) and miR-181a/b-1 KO mice. Systolic and diastolic BP were 4- to 5-mm Hg higher in KO compared with WT mice over 24 hours (P<0.01). Compared with WT mice, renal renin was higher in the juxtaglomerular cells of KO mice. BP was similar in WT mice on a high- (3.1%) versus low- (0.3%) sodium diet (+0.4 +/- 0.8 mm Hg), but KO mice showed salt sensitivity (+3.3 +/- 0.8 mm Hg; P<0.001). Since microRNAs can target several mRNAs simultaneously, we performed single-nuclei RNA sequencing in 6699 renal cells. We identified 12 distinct types of renal cells, all of which had genes that were dysregulated. This included genes involved in renal fibrosis and inflammation such as Stat4, Col4a1, Cd81, Flt3l, Cxcl16, and Smad4. We observed upregulation of pathways related to the immune system, inflammatory response, reactive oxygen species, and nerve development, consistent with higher tyrosine hydroxylase in the kidney. In conclusion, downregulation of the miR-181a gene led to increased BP and salt sensitivity in mice. This is likely due to an increase in renin expression in juxtaglomerular cells, as well as microRNA-driven pleiotropic effects impacting renal pathways associated with hypertension.
Evaluation of the prescribing practice of guideline-directed medical therapy among ambulatory chronic heart failure patients
- Parajuli, Daya, Shakib, Sepehr, Eng-Frost, Joanne, McKinnon, Ross, Caughey, Gillian, Whitehead, Dean
- Authors: Parajuli, Daya , Shakib, Sepehr , Eng-Frost, Joanne , McKinnon, Ross , Caughey, Gillian , Whitehead, Dean
- Date: 2021
- Type: Text , Journal article
- Relation: BMC Cardiovascular Disorders Vol. 21, no. 1 (2021), p.
- Full Text:
- Reviewed:
- Description: Background: Studies have demonstrated that heart failure (HF) patients who receive direct pharmacist input as part of multidisciplinary care have better clinical outcomes. This study evaluated/compared the difference in prescribing practices of guideline-directed medical therapy (GDMT) for chronic HF patients between two multidisciplinary clinics—with and without the direct involvement of a pharmacist. Methods: A retrospective audit of chronic HF patients, presenting to two multidisciplinary outpatient clinics between March 2005 and January 2017, was performed; a Multidisciplinary Ambulatory Consulting Service (MACS) with an integrated pharmacist model of care and a General Cardiology Heart Failure Service (GCHFS) clinic, without the active involvement of a pharmacist. Results: MACS clinic patients were significantly older (80 vs. 73 years, p <.001), more likely to be female (p <.001), and had significantly higher systolic (123 vs. 112 mmHg, p <.001) and diastolic (67 vs. 60 mmHg, p <.05) blood pressures compared to the GCHF clinic patients. Moreover, the MACS clinic patients showed more polypharmacy and higher prevalence of multiple comorbidities. Both clinics had similar prescribing rates of GDMT and achieved maximal tolerated doses of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in HFrEF. However, HFpEF patients in the MACS clinic were significantly more likely to be prescribed ACEIs/ARBs (70.5% vs. 56.2%, p = 0.0314) than the GCHFS patients. Patients with both HFrEF and HFpEF (MACS clinic) were significantly less likely to be prescribed
- Authors: Parajuli, Daya , Shakib, Sepehr , Eng-Frost, Joanne , McKinnon, Ross , Caughey, Gillian , Whitehead, Dean
- Date: 2021
- Type: Text , Journal article
- Relation: BMC Cardiovascular Disorders Vol. 21, no. 1 (2021), p.
- Full Text:
- Reviewed:
- Description: Background: Studies have demonstrated that heart failure (HF) patients who receive direct pharmacist input as part of multidisciplinary care have better clinical outcomes. This study evaluated/compared the difference in prescribing practices of guideline-directed medical therapy (GDMT) for chronic HF patients between two multidisciplinary clinics—with and without the direct involvement of a pharmacist. Methods: A retrospective audit of chronic HF patients, presenting to two multidisciplinary outpatient clinics between March 2005 and January 2017, was performed; a Multidisciplinary Ambulatory Consulting Service (MACS) with an integrated pharmacist model of care and a General Cardiology Heart Failure Service (GCHFS) clinic, without the active involvement of a pharmacist. Results: MACS clinic patients were significantly older (80 vs. 73 years, p <.001), more likely to be female (p <.001), and had significantly higher systolic (123 vs. 112 mmHg, p <.001) and diastolic (67 vs. 60 mmHg, p <.05) blood pressures compared to the GCHF clinic patients. Moreover, the MACS clinic patients showed more polypharmacy and higher prevalence of multiple comorbidities. Both clinics had similar prescribing rates of GDMT and achieved maximal tolerated doses of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in HFrEF. However, HFpEF patients in the MACS clinic were significantly more likely to be prescribed ACEIs/ARBs (70.5% vs. 56.2%, p = 0.0314) than the GCHFS patients. Patients with both HFrEF and HFpEF (MACS clinic) were significantly less likely to be prescribed
The adrenal medulla in cardiovascular medicine: an untold story
- Esler, Murray, Jennings, Garry, Schlaich, Markus, Lambert, Gavin, Thompson, Jane, Lambert, Elisabeth, Guo, Ling, Alvarenga, Marlies, Esler, Danielle, Eikelis, Nina, Kaye, David
- Authors: Esler, Murray , Jennings, Garry , Schlaich, Markus , Lambert, Gavin , Thompson, Jane , Lambert, Elisabeth , Guo, Ling , Alvarenga, Marlies , Esler, Danielle , Eikelis, Nina , Kaye, David
- Date: 2021
- Type: Text , Journal article
- Relation: Journal of Hypertension Vol. 39, no. 5 (2021), p. 819-829
- Full Text: false
- Reviewed:
- Description: Unlike noradrenaline, the sympathetic neurotransmitter which overflows to the circulation, adrenaline (ADR) is a secreted hormone, with a low plasma concentration, and plasma concentration for biological action a log order lower than that of noradrenaline. The venous drainage of the left adrenal medulla into the left renal vein does expose this vein to uniquely high plasma ADR concentrations and possible risk of thrombosis at high rates of ADR secretion. There is typically a different timeframe for adrenal medullary and sympathetic nervous system responsesADR release is short term in contrast with sympathetic activation persisting for years in heart failure and hypertension. The historic view of Walter Cannon, subject to recent review, that the sympathoadrenal system is a unified biological system, was deconstructed further with demonstration of frequent mismatching of adrenal medullary and sympathetic nervous responses. Under gravity stimulation with standing, there is prompt sympathetic activation without ADR release. In many diseases, notably obesity, hypertension, heart failure and depressive illness, an activated sympathetic nervous system and silent adrenal medulla coexist. The therapeutic corollary of this is that ADR blockade is much less commonly needed clinically than pharmacological antagonism of the sympathetic nervous system.
Global burden of cardiovascular diseases and risk factors, 1990-2019 : update from the GBD 2019 study
- Roth, Gregory, Mensah, George, Johnson, Catherine, Addolorato, Giovanni, Ammirati, Enrico, Baddour, Larry, Barengo, Noel, Beaton, Andrea, Benjamin, Emelia, Benziger, Catherine, Bonny, Aime, Brauer, Michael, Brodmann, Marianne, Cahill, Thomas, Carapetis, Jonathan, Catapano, Alberico, Chugh, Sumeet, Cooper, Leslie, Coresh, Josef, Criqui, Michael, DeCleene, Nicole, Eagle, Kim, Emmons-Bell, Sophia, Feigin, Valery, Fernández-Sola, Joaquim, Fowkes, Francis, Gakidou, Emmanuela, Grundy, Scott, He, Feng, Rahman, Muhammad Aziz
- Authors: Roth, Gregory , Mensah, George , Johnson, Catherine , Addolorato, Giovanni , Ammirati, Enrico , Baddour, Larry , Barengo, Noel , Beaton, Andrea , Benjamin, Emelia , Benziger, Catherine , Bonny, Aime , Brauer, Michael , Brodmann, Marianne , Cahill, Thomas , Carapetis, Jonathan , Catapano, Alberico , Chugh, Sumeet , Cooper, Leslie , Coresh, Josef , Criqui, Michael , DeCleene, Nicole , Eagle, Kim , Emmons-Bell, Sophia , Feigin, Valery , Fernández-Sola, Joaquim , Fowkes, Francis , Gakidou, Emmanuela , Grundy, Scott , He, Feng , Rahman, Muhammad Aziz
- Date: 2020
- Type: Text , Journal article , Review
- Relation: Journal of the American College of Cardiology Vol. 76, no. 25 (2020), p. 2982-3021
- Full Text:
- Reviewed:
- Description: Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases. © 2020 The Authors. **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliate “Muhammad Aziz Rahman” is provided in this record**
- Authors: Roth, Gregory , Mensah, George , Johnson, Catherine , Addolorato, Giovanni , Ammirati, Enrico , Baddour, Larry , Barengo, Noel , Beaton, Andrea , Benjamin, Emelia , Benziger, Catherine , Bonny, Aime , Brauer, Michael , Brodmann, Marianne , Cahill, Thomas , Carapetis, Jonathan , Catapano, Alberico , Chugh, Sumeet , Cooper, Leslie , Coresh, Josef , Criqui, Michael , DeCleene, Nicole , Eagle, Kim , Emmons-Bell, Sophia , Feigin, Valery , Fernández-Sola, Joaquim , Fowkes, Francis , Gakidou, Emmanuela , Grundy, Scott , He, Feng , Rahman, Muhammad Aziz
- Date: 2020
- Type: Text , Journal article , Review
- Relation: Journal of the American College of Cardiology Vol. 76, no. 25 (2020), p. 2982-3021
- Full Text:
- Reviewed:
- Description: Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases. © 2020 The Authors. **Please note that there are multiple authors for this article therefore only the name of the first 30 including Federation University Australia affiliate “Muhammad Aziz Rahman” is provided in this record**
- Granger, Catherine, Denehy, Linda, Remedios, Louisa, Retica, Sarah, Phongpagdi, Pimsiri, Hart, Nicholas, Parry, Selina
- Authors: Granger, Catherine , Denehy, Linda , Remedios, Louisa , Retica, Sarah , Phongpagdi, Pimsiri , Hart, Nicholas , Parry, Selina
- Date: 2016
- Type: Text , Journal article
- Relation: Annals of the American Thoracic Society Vol. 13, no. 12 (2016), p. 2215-2222
- Full Text: false
- Reviewed:
- Description: Rationale: Evidence-based clinical practice guidelines recommend physical activity for people with lung cancer, however evidence has not translated into clinical practice and the majority of patients do not meet recommended activity levels. Objectives: To identify factors (barriers and enablers) that influence clinicians' translation of the physical activity guidelines into practice. Methods: Qualitative study involving 17 participants (three respiratory physicians, two thoracic surgeons, two oncologists, two nurses, and eight physical therapists) who were recruited using purposive sampling from five hospitals in Melbourne, Victoria, Australia. Nine semistructured interviews and a focus group were conducted, transcribed verbatim, and independently crosschecked by a second researcher. Thematic analysis was used to analyze data. Measurements and Main Results: Five consistent themes emerged: (1) the clinicians perception of patient-related physical and psychological influences (including symptoms and comorbidities) that impact on patient's ability to perform regular physical activity; (2) the influence of the patient's past physical activity behavior and their perceived relevance and knowledge about physical activity; (3) the clinicians own knowledge and beliefs about physical activity; (4) workplace culture supporting or hindering physical activity; and (5) environmental and structural influences in the healthcare system (included clinicians time, staffing, protocols and services). Clinicians described potential strategies, including: (1) the opportunity for nurse practitioners to act as champions of regular physical activity and triage referrals for physical activity services; (2) opportunistically using the time when patients are in hospital after surgery to discuss physical activity; and (3) for all members of the multidisciplinary team to provide consistent messages to patients about the importance of physical activity. Conclusions: Key barriers to implementation of the physical activity guidelines in lung cancer are diverse and include both clinician- and healthcare system-related factors. A combined approach to target a number of these factors should be used to inform research, improve clinical services, and develop policies aiming to increase physical activity and improve survivorship outcomes for patients with lung cancer. © Copyright 2016 by the American Thoracic Society.
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