The Asia Pacific Heart Journal最新文献

Background: Few studies have looked specifically at the outcomes of cardiac valve replacement for rheumatic heart disease (RHD) in developing or indigenous populations. Aims: To describe outcomes of cardiac valve replacement in patients with rheumatic heart disease living in urban and rural communities in northern Australia. Methods: Retrospective chart review with some prospective follow-up of 81 consecutive patients, predominantly aboriginal, who underwent mitral and/or aortic valve replacement for RHD between 1964 and 1996. Survival analyses were performed using the Kaplan-Meier method, and multivariable analyses using the Cox Proportional Hazards model. Results: Most patients received mechanical prostheses. There was 1 (1.2%) perioperative death. 27/29 late deaths were related to RHD. Actuarial probability estimates for survival at 1, 5 and 10 years were 91%, 79% and 68% and for complication-free survival were 81%, 52% and 44%. Linearised rates (per 100 person-years) were: death, 4.82; all complications, 14.62; emboli, 3.92; bleeding, 2.68; endocarditis, 1.25; reoperation, 0.50; non-structural dysfunction, 2.10. Diminished preoperative left ventricular function was the only variable strongly associated with death (hazard ratio 3.38, 95% CI, 1.01 to 11.28), and this effect was greatest in the first 2 postoperative years. Conclusions: Survival and freedom from complications in this population are less than in similar studies from developing countries. Consideration should be given to operating before the left ventricular function diminishes substantially and to using techniques which obviate the need for anticoagulation.

Age-adjusted mortality from cardiovascular disease has fallen by approximately 70% over the past 30 years. The Heart Foundation can claim a significant role in these gains, which relate to both decreased event rates (and risk factor prevalence) and a decrease of case-fatality rates because of better treatment. However, cardiovascular disease remains the major public health burden for Australia and progressive ageing of the population will further increase this burden. Diseases such as coronary artery disease result from interactions between genes and the environment, and it is logical that the Heart Foundation should work across the health-disease spectrum. Current cardiovascular health programs not only centre around major risk factors (tobacco control, nutrition and metabolism, blood pressure and physical activity), but also target high-risk populations (cardiac rehabilitation, Aboriginal people and Torres Strait Islanders, and others in rural and remote areas). Medical activities focus on community education, for example, the need for early presentation with possible acute coronary syndromes, development of better practice guidelines in association with other bodies such as the Cardiac Society of Australia and New Zealand, and monitoring of cardiovascular health. There have been major research achievements by the NHF, particularly noteworthy being the support by the Foundation of the early careers of many national and international leaders in the cardiovascular field.

Background: Advances in technology have produced a plethora of means to perform coronary revascularisation either surgically (that is, off pump CABG, Heartport CABG) and/or percutaneously (that is, stenting, rotablation). When comparing the results obtained by these new technologies, too often reference is made to results from the CABG operation of previous eras. Before tried and tested procedures are superseded by new, radical ones, it is essential to establish what the contemporary results of the CABG operation are on an unselected, general patient population. Aim: To examine contemporary results of primary orthodox CABG surgery in an unselected patient population from an Australian teaching hospital. Method: This was a prospective study of all patients having primary CABG surgery from 1 January 1996 to 30 June 1998. Results: 1002 patients had CABG. The mean age was 63.1 years, 33% were aged more than 70 years. Perioperative AMI occurred in 0.2% and CVA in 0.7%. Operative mortality for urgent or elective CABG was 0.4%. At 12 months, freedom from a repeat revascularisation procedure was 97%. Conclusion: Contemporary CABG surgery is associated with a very low morbidity and mortality. This is the gold standard in surgical coronary artery disease intervention and forms the benchmark to which alternative treatment strategies must be compared.

We report cardiac transplantation for congenital long QT syndrome in a patient who had recurrent cardiac arrests despite beta blockade, implantable cardioverter defibrillator and cervical sympathectomy. This is the first successful case of orthotopic transplantation for refractory cardiac arrhythmias in a patient with an otherwise normally functioning heart.

A hypothetical, anonymous donation of $6 million for research has provided the National Heart Foundation with an opportunity to consider its most effective potential use. A broad-brush approach would aim to make better use of Australia's intellectual resources and of patient and general populations in Australasia. With Australia's strength in epidemiology, clinical research and population genetics, the Foundation would be well positioned to initiate large-scale genetic studies for multiple-cause (genetic and environmental) diseases such as familial hypertension, pre-eclampsia, and coronary artery disease or stroke in the young. In addition, extra funds would mean that a greater collaborative effort could be fostered in the conduct of clinical trials, allowing clinicians to initiate (rather than be passive participants in) national and international trials addressing important questions in the areas of heart disease and stroke. Trials could include issues of screening, nutritional and drug management, invasive and surgical interventions and different patterns of care in primary practice. In aboriginal and other disadvantaged groups, priority should be given to population studies involving testing of primary and secondary preventative measures to improve cardiovascular health. Overlying all these proposals is a need to promote much greater collaboration between researchers of different disciplines.

Adopting new approaches that build on existing activities was the recommendation of The National Health Priority Areas Report on cardiovascular health, released on 4th August 1999. The report, prepared biennially for Australian Health Ministers, presented the following key recommendations for further improving the cardiovascular health of Australians: establishing a long-term national focus on heart disease; coordinating primary prevention programs across Australia; establishing a national mechanism for the production of better practice guidelines; broadening the focus of cardiovascular disease programs to give more emphasis to stroke; addressing issues of inequalities of health status among disadvantaged groups; and expanding the activities of the National Centre for Monitoring Cardiovascular Disease to allow for future strategic planning.