Mary MacKillop Institute for Health Research

CRE to Reduce Inequality in Heart Disease

Current research

NHMRC Centre for Research Excellence (CRE) to Reduce Inequality in Heart Disease

The CRE to Reduce Inequality in Heart Disease targets the one of the most critical intervention points for alleviating Indigenous health disadvantage; the delivery of evidence based prevention to high risk individuals and optimal health care to those who have developed heart disease (often in the presence of another major form of CVD). Collaborative Indigenous-led research provides an opportunity for investigating, understanding and determining policy and practice around systems responses to this enormous disease burden. Chronic disease is a critical case study to understand these complicated issues, a natural focus for intervention, and a key indicator of system failures in addressing the needs of disadvantaged populations. This project, using established collaborations, builds on previous innovative research and policy development geared towards health service reform. Our research has significant potential to improve health service delivery and outcomes via the design and testing of best-practice models, developed in partnership with, and specifically for, Aboriginal people.

Visit the CRE to Reduce Inequality in Heart Disease website

  • Professor Simon Stewart, Director, Mary MacKillop Institute for Health Research
  • Professor Alex Brown, Theme Leader, Indigenous Health, South Australian Health and Medical Research Institute
  • Professor David Thompson
  • Professor Nigel Stocks, Head of the Discipline of General Practice at The University of Adelaide and Deputy Head of the School of Population Health.
  • Professor Paul Scuffham, Director of the Centre for Applied Health Economics in the School of Medicine at Griffith University and  the Director of the Population and Social Health Research program in the Griffith Health Institute
  • Associate Professor Melinda Carrington
  • Professor Karen Sliwa, Director of the Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, and Director of the Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
  • Professor Graeme Maguire, Associate Director of the Baker IDI Aboriginal Health Program.

Optimizing health outcomes in heart failure and multimorbidity: A multidisciplinary expert, consensus, scientific statement (Abridged Version)

Multimorbidity in heart failure (HF), defined by the presence of HF of any etiology and two or more concurrent conditions that require active management, represents a growing problem within the ageing HF patient population. Expert guidelines struggle to articulate how this multi-factorial problem can be effectively addressed – hence this initiative.

In recognising the complex clinical challenges inherent to managing HF in the setting of multimorbidity and the role of expert guidelines in providing a comprehensive overview of the relative strengths and applicability of treatment options, the specific aims of this Expert Consensus Statement were two-fold:

  1. To provide a comprehensive overview of the current literature focusing on the most common conditions requiring concurrent treatment and management in patients with HF.
  2. To derive a practical set of recommendations for a systematic response to this increasingly common clinical phenomenon.
    PDF PicDownload Multimorbidity Expert Scientific Statement (PDF, 505kB)
  • Professor Simon Stewart Director, Mary MacKillop Institute for Health Research
  • Professor Barbara Riegel, University of Pennsylvania School of Nursing
  • Associate Professor Cynthia Boyd, Center on Aging and Health, John Hopkins University
  • Dr Yasmin Ahamed, Mary MacKillop Institute for Health Research
  • Professor David R Thompson, Mary MacKillop Institute for Health Research
  • Professor Louise Burrell, The University of Melbourne, Department of Medicine
  • Associate Professor Melinda Carrington, Mary MacKillop Institute for Health Research
  • Professor Andrew Coats, Monash and Warwick Universities
  • Associate Professor Bradi Granger, Duke University, School of Nursing
  • Professor Julie Hides, Mary MacKillop Institute for Health Research
  • Dr William Weintraub, Christiana Care Health Services, Center for Heart & Vascular Health
  • Professor Debra K Moser, University of Kentucky,  Center for Biobehavioral Research in Self-Management of Cardiopulmonary Diseases
  • Assistant Professor Victoria Vaughan, New York University, School of Nursing
  • Professor Michael Rich, Washington Medicine School of Medicine, Cardiovascular Division

The Standard versus Atrial Fibrillation-specific management study (SAFETY)

Chronic atrial fibrillation (AF) is the most common sustained cardiac arrhythmia observed in medical practice and one of the most common cardiovascular disorders overall. The most serious consequences of AF are stroke and heart failure. AF places a significant burden on primary care providers and hospitals. With ageing populations in the developed world, cases are expected to double by the year 2050. AF is also becoming more prevalent as a result of historically high levels of key pathways such as advancing age, hypertension and obesity.

The Standard versus Atrial Fibrillation-spEcific managemenT studY (SAFETY) trial was conducted with the aim of optimising the management of patients with AF. Professor Stewart presented the results, which showed that disease-specific management is a potentially successful strategy to improve poor health outcomes, at the 2014 American Heart Association Scientific Sessions. The results were also published in the Lancet.

Read more about the SAFETY trial

  • Professor Simon Stewart (Australian Catholic University, Australia)
  • Professor Paul Scuffham (Griffith University, Australia)
  • Professor Thomas Marwick (Director, Menzies Research Institute, Australia)
  • Professor John Horowitz (The University of Adelaide, Australia)
  • Professor David Thompson (Australian Catholic University, Australia)
  • Associate Professor Melinda Carrington (Australian Catholic University, Australia)
  • Dr Brian Haluska (The University of Queensland, Australia)
  • Associate Professor Chiew Wong (Footscray Hospital, Australia)
  • Professor Walter Abhayaratna (Australian National University, Australia)
  • Dr Gnanadevan Mahadevan (Queen Elizabeth Hospital, Australia)

NIL-CHF study

The NIL-CHF study addressed the lack of data to support the application of disease management programs that bridge predominantly short-term cardiac rehabilitation programs and chronic heart failure (CHF) management programs. It tested the hypothesis that, relative to standard care, a nurse-led, multidisciplinary management program for hospitalised patients with pre-existing cardiovascular disease and/or common antecedents of CHF would reduce future rehospitalisation and recurrent hospital stay for cardiovascular-related events during a 4.3-year window.

The results showed favourable trends for the key endpoints relating to hospitalisation and hospital stays, with a significant reduction in emergency hospitalisations and adjudicated cardiovascular hospitalisations. Whilst the NIL-CHF intervention did not significantly reduce the incidence of CHF during the 4.3 year follow-up, it did result in significantly reduced emergency and CV-related hospital stays, suggesting significant cost benefits for high-risk patients.

  • Professor Simon Stewart (Australian Catholic University, Australia)
  • Professor Garry Jennings (Baker IDI Heart & Diabetes Institute, Australia)
  • Dr Peter Bergin (Alfred Hospital, Heart Centre, Australia)
  • Dr Barbora de Courten (Baker IDI Heart & Diabetes Institute, Australia)
  • Dr Geraldine Lee (Baker IDI Heart & Diabetes Institute, Preventative Health, Australia)
  • Associate Professor Melinda Carrington (Australian Catholic University, Australia)
  • Associate Professor Karen Walker (Monash University, Nursing & Health Sciences, Australia)

The Valsartan Intensified Primary carE Reduction of Blood Pressure (VIPER-BP) Study

The Valsartan Intensified Primary carE Reduction of Blood Pressure (VIPER-BP) Study was one of the largest contemporary studies, involving more than 250 general practitioners and 2185 uncontrolled hypertensive patients in primary care settings across Australia.

This VIPER-BP Study sought to identify the best way to treat high blood pressure in the community to achieve targets set by the National Heart Foundation. The study compared usual care management with an intensive structured care and guided approach to reduce high levels of blood pressure.

Learn more about the VIPER-BP Study. 

  • Professor Simon Stewart (Australian Catholic University, Australia)
  • Novartis Pharmaceuticals Australia
  • Associate Professor Melinda Carrington (Australian Catholic University, Australia)
  • Dr Carla H Swemmer (Novartis Pharmaceuticals Australia)
  • Professor Craig Anderson (The George Institute, Australia)
  • Dr Nicol P Kurstjens (Novartis Pharmaceuticals, Australia)
  • Associate Professor John Amerena, (Deakin University, Australia)
  • Professor Alex Brown (South Australian Health and Medical Research Institute, Australia)
  • Dr Louise M Burrell (University of Melbourne, Australia)
  • Dr Ferdinandus J de Looze (The University of Queensland, Australia)
  • Professor Mark Harris (University of New South Wales, Australia)
  • Professor Joseph Hung (University of Western Australia, Australia)
  • Professor Henry Krum (Monash University, Australia)
  • Professor Mark Nelson (Menzies Research Institute, Australia)
  • Associate Professor Markus Schlaich (Baker IDI Heart & Diabetes Institute, Australia)
  • Professor Nigel P Stocks (The University of Adelaide, Australia)
  • Professor Garry Jennings (Baker IDI Heart & Diabetes Institute, Australia)

WHICH? Trial

Standing for Which Heart failure Intervention is most Cost-effective and consumer friendly in reducing Hospital care?, the WHICH? Trial compared two different forms of heart failure management to determine the best way to prolong survival and reduce hospital care for those affected by chronic heart failure. The trial compared home-based intervention (HBI) with specialised CHF clinic-based intervention (CBI). Considering that chronic heart failure is one of the most common disorders affecting the heart, the trial sought to improve patient outcomes by identifying the most effective method of care.   

Learn more about the WHICH? Trial. 

The WHICH? Trial initially showed that HBI was not superior to CBI in reducing all-cause death or hospitalisation. However, HBI was associated with significantly lower health care costs, attributable to fewer days of hospitalisation, and, in the long run, significantly prolonged survival and reduced hospital stay.

Based on these results, the trial team recommended that every chronic heart failure management program should consider the provision of at least one home visit post-hospitalisation to maximise the potential of these programs to improve health outcomes in those affected by chronic heart failure.

  • Professor Simon Stewart (Australian Catholic University, Australia)
  • Professor Paul Scuffham (Griffith University, Australia)
  • Professor Thomas Marwick (Director, Menzies Research Institute, Australia)
  • Professor John Horowitz (The University of Adelaide, Australia)
  • Professor Henry Krum (Monash University, Australia)
  • Professor Patricia Davidson (St Vincent’s Hospital Sydney, Australia)
  • Professor Peter Macdonald (St Vincent’s Hospital Sydney, Australia)

WHICH? II trial

Chronic heart failure (CHF) affects more than 300,000 adults per year and is one of the most common and costly components of hospital care in Australia. Following the Which Heart failure Intervention is most Cost-effective and consumer friendly in reducing Hospital care? Trial (WHICH?), this study aims to further inform the cost-effective application of CHF management programs (MPs) to reduce the negative impact on individuals and the wider community.

The WHICH? II Trial will compare two interventions. The first intervention is a standard, post-discharge CHF management program, incorporating a combination of at least one home visit and hospital outpatient clinics for metropolitan-dwelling patients and structured telephone support for patients in remote areas. This will be compared with a more intensive program of management targeting those most at risk of recurrent and costly hospital stays.

Learn more about the WHICH? II Trial

  • Professor Simon Stewart (Australian Catholic University, Australia)
  • Professor David Thompson (Australian Catholic University, Australia)
  • Professor John Horowitz (Queen Elizabeth Hospital, Australia)
  • Associate Professor Melinda Carrington (Australian Catholic University, Australia)
  • Professor Paul Scuffham (Griffith University, Australia)
  • Associate Professor Chiew Wong (Footscray Hospital, Australia)
  • Dr Phillip Newton (St Vincent’s Hospital Sydney, Australia)
  • Associate Professor Amanda Rischbieth (SA Heart Foundation, Australia)
  • Professor Patricia Davidson (St Vincent’s Hospital Sydney, Australia)
  • Professor Henry Krum (Monash University, Australia)
  • Professor Peter Macdonald (St Vincent’s Hospital Sydney, Australia)
  • Professor Thomas Marwick (Menzies Research Institute, Australia)
  • Professor Christopher Reid (Monash University, Epidemiology and Preventative Medicine)
  • Dr Yih Kai Chan (Australian Catholic University, Australia)
  • Dr Jennifer Whitty (Griffith University, Australia)

Heart of Soweto Study

Cardiovascular disease (CVD) continues to rise in low- to middle-income countries. This holds true in Sub-Saharan Africa, particularly in urban communities. The largest and most comprehensive study of heart disease on the African continent, the Heart of Soweto Study, aims to improve understanding of the evolving epidemic of heart disease in Sub-Saharan Africa’s largest urban community, Soweto, in South Africa. Beyond documenting trends, the study also seeks to develop innovative health care services to tackle the challenge of CVD.

Learn more about the Heart of Soweto Study

  • Professor Simon Stewart (Australian Catholic University, Australia)
  • Professor Karen Sliwa (University of Cape Town, Hatter Institute)
  • Ms Sandra Pretorius (University of the Witwatersrand, South Africa)

Optimising Heart Disease Prevention and Management

This program builds on the Centre’s portfolio of health services research to explore a number of critical issues that need to be addressed in order to optimise the cost-benefits of multidisciplinary heart disease prevention and management programs within Australia’s ageing population.

The program aims to deliver cost-benefits derived from the development of newer and more effective prevention and disease management programs to tackle the persistent and evolving epidemic of heart disease. The goal is to positively influence health policy, clinical guideline development and health service delivery. This integrated program of health services research includes:

  • Primary care management of those at risk of developing heart disease
  • Secondary prevention of recurrent but asymptomatic heart disease to prevent progression to more advanced/symptomatic forms of disease
  • Disease management of those with the most common forms of chronic heart disease to improve health-related quality of life, minimise morbidity and prevent disease-related mortality
  • Identification of relevant social determinants of health such as socioeconomic and cultural health inequalities and barriers to available health care resources
  • Assessment of the above factors to identify individuals incurring the greatest health care costs, those who achieve the greatest and least health gain, and the best value-for-money interventions.
  • Additionally, the program is conducting innovative studies of consumer/patient preferences. The aim of these studies is to adapt programs to a “menu-driven” approach that is more conducive to providing individualised health care.

Funding: NHMRC Program Grant
Duration: 2013-2017
Program team: S Stewart, Dr Thompson, P Scuffham

Global Minority Health and Health Disparities Research Training (MHIRT) Program

The Australian Catholic University is collaborating with the University of Miami School of Nursing and Health Studies Center of Excellence for Health Disparities Research: El Centro on a training program that aims to diversify the biomedical and social/behavioural research workforce in the U.S. This program is funded through the National Institute on Minority Health and Health Disparities (NIMHD) at the National Institutes of Health (NIH) for five years (1T37MD008647-01, PI: Gonzalez-Guarda, R.M). Ten under-represented minority undergraduate students are selected each year and receive intensive global health disparities research training. They also work as research assistants to senior researchers in collaborating institutions in Australia, Chile, Dominican Republic or Spain.