Can We Prevent Heart Damage Caused By Chemo
First Published: Enews - March 2011
A research team funded by the 2010pinkyellowblueball is investigating the effects chemotherapy for breast cancer has on the heart.
Chemotherapy is critical in the treatment of cancer, but current research is showing more than five per cent of all cancer patients develop abnormalities of the heart as a result of treatment.
Professor Joseph Selva-Nayagam, Professor of Cardiovascular Medicine, Flinders University and Director of Cardiac Imaging, Flinders Medical Centre, and his team are recruiting patients to examine what negative changes occur in the heart from chemotherapy for breast cancer, and whether these changes can aid in the prevention or early detection of heart conditions later in life.
The team hope to recruit 100 patients to the study, which has been funded by the FMC Foundation, and anyone who is newly diagnosed with breast cancer or has a metastatic disease and hasn't yet started treatment is eligible to join.
The heart function of participants will be examined using echocardiography (ultrasound screening) and MRI scanning before, during and after their course of chemotherapy.
"As well as being able to show overall heart function and movement of the heart walls, we will be able to detect subtle changes in the heart such as inflammation and scarring," Professor Selva-Nayagam said.
"By determining which changes happen and when, we hope we can influence chemotherapy regimes to include monitoring of the heart.
"We believe this research could potentially lead to heart-protecting drugs being included with chemotherapy to prevent any irreversible damage occurring."
For more information on the trial please contact Dr Suchi Grover on (08) 8204 5751.
Lifestyle Interventions for Australia's Biggest Killer
First Published: Enews - August 2010
Flinders Medical Centre (FMC) Cardiac researchers are investigating why less than half of eligible patients across Australia attend potentially life-extending rehabilitation programs following heart surgery.
Heart disease requiring interventional surgery is often caused by preventable or modifiable risk factors such as smoking, high cholesterol, diabetes and high blood pressure.
Cardiac rehabilitation programs running in conjunction with surgery aim to prevent subsequent cardiovascular problems, and help the patient to return to a healthy and active life.
"Research shows patients who attend rehabilitation are less often readmitted to hospital for heart disease," Associate Professor Robert Baker, perfusionist and researcher in the Flinders Cardiac Surgery Research Unit, said.
Surgeons at FMC performed more than 440 cardiac surgeries in the 2008/2009 financial year, but during that time half of patients referred back to the hospital for rehabilitation did not attend.
Interstate research has shown it is an even bleaker picture nationally, with only 39 per cent of places available in cardiac rehabilitation programs utilised.
Associate Professor Baker and his research team (pictured) are working with cardiac rehabilitation staff to find ways to improve uptake of the available programs.
The team are conducting a survey of patients to determine the underlying reasons why they do or do not attend rehabilitation at FMC.
Patients currently participating in the study are assessed before undergoing surgery, and at 30 days and six months later, to see whether they have attended rehabilitation programs or what barriers stood in their way.
"We want to determine whether it is something as simple as transport to and from the hospital which influences a patient's decision to attend, or whether it is more complex factors," Associate Professor Baker said.
"We also hope the study will allow us at an early stage to catch patients unlikely to attend so we can do what we can to ensure they return for rehab.
"In the long term we hope that we can educate people that these programs are of value, and also educate the system so that patient attendance in rehabilitation programs can be increased across the country."
Flinders Helps to Close the Gap
First Published: Enews - July 2010
A system to ensure better communication between hospital and patient is improving the journey for remote Aboriginal patients coming to Flinders Medical Centre (FMC) for cardiac procedures, and is currently informing national policy.
The system, developed at FMC by Monica Lawrence as part of her Masters of Nursing project between 2005 and 2007, is currently the only culturally-specific consent program for Aboriginal patients in Australia and has become standard practice in the ward at Flinders.
The project stemmed from observations made by Ms Lawrence, who is now Regional Manager of Clinical Services Development in Aboriginal health in Southern Adelaide, while working as a nurse in the cardio-thoracic ward at FMC.
"Aboriginal patients living in remote Northern Territory and South Australian communities travel over vast cultural or geographic distances to come to Flinders for cardiac surgery," Ms Lawrence said.
"When I first started this project, during a six month period 21 out of 48 Aboriginal people coming for heart surgery at Flinders did not show up for the operation.
"Other patients were inadequately prepared physically or psychologically and the surgery could not be undertaken."
Based on recommendations by Ms Lawrence, a Remote Area Liaison Nurse position was established at FMC to ensure Aboriginal patients are better informed about the treatment they will be having before they arrive at Flinders for surgery.
Daphne Perry is currently appointed in the role and ensures the patient is psychologically and physically prepared for surgery before they arrive in Adelaide; that appropriate carers accompany the patient to Adelaide; and that patient care is continued once they return home.
"Since these changes have been made and patients have been properly briefed in their own language, all of the patients have presented for surgery," Ms Lawrence said.
"While the figures may not always remain at 100 per cent it is certainly a significant improvement."
The findings of Ms Lawrence's research project are now informing a senate enquiry and she is now working with Australian Health Care and Hospital Association to develop a national policy which will translate to other speciality areas such as to sight and hearing health in the Anangu Pitjantjatjara and Yankunytjatjara (APY) lands.
Going Bush? Don't Miss a Beat With This New Diagnostic Heart Tool
First Published: Media Release - July 2010
South Australian business leaders can soon rest easy when they travel to remote areas of Australia, thanks to a remote electronic heart attack decision-making tool currently being developed at Flinders Medical Centre.
They will lean more about the tool during the next inspirational lunch on 26 July, at Adelaide Casino.
Cardiovascular disease (CVD), the term used to describe all conditions and diseases of the heart and blood vessels, is Australia’s number one killer, responsible for 48,000 deaths a year.
Despite the advances in treatment of heart attacks, less than 10 per cent of Australians receive ideal care due to delays in presenting to a doctor because of their remote location or the lack of training of the GPs and young Physicians.
The electronic tool developed at Flinders provides rapid assessment of the risk of the patient that appears to be having heart attack and provides immediate, best practise recommendations to any health service, regardless of their location in a rural, regional or metropolitan area.
Once developed the system will provide doctors with real-time decision-making support and features a package of care that includes: better patient documentation; assessment of patient risks and benefits; and clinical guideline recommendations for patients presenting with chest pains and a possible heart attack.
“We have just completed Stage 1 of the project and we are about to start Stage 2, which is to raise funds so that we can trial the tool in hospitals across Australia, in order to see how effective the tool is and if it actually helps to improve patient outcomes in everyday clinical situations,” said Dr Chew.
The electronic system has been developed as a non-commercial project of the Heart Foundation of Australia, the College of Emergency Physicians, the Cardiac Society of Australia and New Zealand and Flinders Medical Centre Cardiology research teams.
“With one Australian suffering a heart attack every 11 minutes, there is a pressing need for strategies that improve the decision-making process, so that patients that present with chest pain or appear to be having a heart attack can be assessed quickly and efficiently, in order to provide the highest standard of care; this is vital in remote locations where advice from a specialist cardiologist is not often available,” adds Dr Chew.
All media are invited to attend this event and Dr Chew will be available for interview upon request, please contact the FMC Foundation Office on 08 8204 65016 to arrange.
Hosted by Channel 7’s Jane Doyle and supported by Adelaide Casino, this presentation is part of a series of Inspirational Luncheons to help Flinders Medical Centre Foundation inform local business leaders of the groundbreaking work that is being conducted at Flinders.
Bleak Picture For Indigenous Cardiac Patients
First Published: Investigator - June 2009
Flinders research has painted a bleak picture for outcomes of cardiac surgery in Indigenous Australians.
The study, published in the Medical Journal of Australia, found that Indigenous Australians present for cardiac surgery nearly two decades earlier than non-indigenous Australians, and that patient outcomes for those aged under 55 are significantly less favourable.
Survival rates at one and five years are also lower for Indigenous patients – 94 percent and 80 percent for Indigenous patients compared with 97 percent and 88 percent for non-Indigenous patients.
The Flinders research group studied data for 2,635 consecutive patients who underwent cardiac surgery at Flinders Medical Centre between January 2000 and December 2005. The data included baseline patient characteristics, operation details, post-operative complications and late mortality.
The team found that around one in 10 patients undergoing cardiac surgery at Flinders is Indigenous and Indigenous patients are substantially younger (mean average of 47 years, compared to 65 years for non-Indigenous patients). Indigenous patients awaiting surgery are also more likely to have diabetes, renal dysfunction and valvular surgery.
Lead author Dr Sam Lehman said the findings were disturbing, if not expected.
‘Cardiovascular disease is more prevalent among Indigenous Australians and this group is likely to present for cardiac surgery about 20 years earlier, on average.’ He said previous research suggested this is likely to be due both to higher rates of traditional cardiovascular risk factors and the persistence of rheumatic heart disease.
The authors said improving access of Indigenous Australians to advanced cardiovascular therapies was a major public health priority.
‘Improvements in outcomes will require comprehensive strategies that include attention to the primary and secondary prevention of both coronary artery and rheumatic heart disease,’ they said.
Heart Surgeons Focus On Brain Protection
First Published: Investigator - April 2008
Flinders Medical Centre (FMC) is one of the first hospitals in Australia to trial a drug therapy with the potential to reduce cognitive decline in patients following heart surgery.
The trial is known as the SNUG-2 (Studying Neurons Using Glypromate) study.
Studies show that cognitive impairment – which can include diffi culties with memory, concentration, or carrying out everyday tasks - occurs in up to 70 percent of patients who undergo cardiac surgery with cardiopulmonary bypass.
Experts believe that small particles of fat and other material, called microemboli, released when the aorta is unclamped at the end of bypass may be a primary cause of brain damage that causes cognitive impairment in patients.
There is currently no treatment available to treat such damage.
FMC cardiac surgeon Professor John Knight, principal Australian investigator of the SNUG-2 study, said cognitive impairment could be a debilitating condition, hampering a patient’s return to optimal health.
‘Little is more devastating to patient and family than for the patient to have a successful operation that prolongs life, but diminishes the quality of that prolonged life,’ he said.
‘So we’re really excited to be involved in this ground-breaking Phase 3 clinical trial, and to help put the pieces of this particular research puzzle together.’
The drug therapy, called Glypromate, works by ‘cradling’ cells in the brain and neurons – effectively creating a protection mechanism against cell inflammation and damage incurred during surgery. Such protection can significantly prevent cell death.
The randomised, double-blind, placebo-controlled trial is being run across 13 Australian sites including Adelaide, Perth, Melbourne, Brisbane and Sydney.
If the trial proves successful, the drug may also be tested in heart attack and stroke patients in the future.
Mending Hearts At Flinders
First Published: Investigator - February 2007
Dr Majo Joseph, Director of Echocardiography at Flinders Medical Centre works extensively with patients suffering mitral regurgitation, one of the most common types of heart valve insufficiencies with a significant mortality rate.
Mitral regurgitation prevents the valve that separates the left upper chamber of the heart from the left lower chamber from closing properly. This causes blood to leak back into the heart which then must work harder to pump blood to the rest of the body, often resulting in congestive heart failure.
“Surgical techniques for mitral valve repair have advanced but the need for more accurate information prior to surgical intervention has also increased,” said Dr Joseph. “Prior to surgery for mitral valve disease it is important that the surgeon has the most accurate information about the valve possible.”
Before surgery is considered a semi-invasive echocardiograph (TOE) is taken of the patient’s heart by means of a transducer passed down the throat into the oesophagus so an ultrasound of the heart can be taken for examination.
As current ultrasounds are limited to assessing the valve in two dimensions (2D) some abnormalities of the mitral valve are missed which, in some cases, can lead to a change from mitral valve repair to replacement during surgery.
New research software called Tomtec allows the ultrasound to reconstruct the heart in 3D which provides a full reproduction of the mitral valve in one image. This overcomes many limitations inherent in the standard 2D imaging.
The Flinders Medical Centre Foundation has been able to support Dr Joseph and his team with the purchase of the new 3D Tomtec software which will help with surgical procedures and provide better outcomes for mitral regurgitation patients.
Breathing difficulties with CHF
First Published: Investigator - January 2007
A team of researchers and cardiologists at Flinders Medical Centre, led by Prof Andrew Bersten and Dr Dani-Louise Bryan from the Department of Critical Care Medicine and Dr Carmine De Pasquale of the Cardiology Department, are focused on the changes that take place within the lung of those who suffer Chronic Heart Failure (CHF).
CHF is most common within the elderly who have suffered a heart complication and is an ongoing health problem with up to half of over 80 year olds suffering from this condition.
“The biggest problem for sufferers of CHF is the inability to breathe properly,” said Prof Bersten. “So shortness of breath, an inability to exercise and fatiguing easily are all associated with these changes within the lung.”
There are two sorts of heart failure that occur in CHF, systolic heart failure which causes a weakened heart due to an inability to pump blood out and diastolic heart failure, a stiff heart caused by an inability to fill with blood properly. Both of these can lead to fluid or blood backing up into the lung, causing high pressure damage. In turn this can lead to chronic changes in the lung blood vessels and tissues, similar to that seen with pulmonary fibrosis. While this can be beneficial by reducing the amount of fluid in the lung, it also makes the lung stiffer, thereby worsening breathing difficulties.
Fibrosis is a process the body undertakes to heal itself, however, there are circumstances where this causes further problems. In the lung, fibrosis can make the lung stiffer and increase the barrier for oxygen transfer into the blood.
Researchers at Flinders are investigating the mechanisms that cause fibrosis in the lung with the intention of understanding at what point these changes become harmful. This could allow for the creation of an interventional drug to better manage this debilitating part of CHF.
“Currently we are trying to understand what is going on within the lung in CHF with the ambition of eventually being able to modify the changes to allow for patients to breathe easier,” said Dr Bersten.
Taking Care Of Hearts At Flinders
First Published: Investigator - April 2006
Cardiac surgery has become a common procedure with over 20,000 Australians undergoing surgery each year. Since 1992, the Flinders Cardiac Surgery Unit has been involved in groundbreaking research projects into open heart surgery
The Cardiac Surgery Research team, led by Dr Rob Baker and Assoc Prof John Knight, continually review and update open heart surgical knowledge to ensure that patients will continue to benefit from the most up to date procedures, not just locally but globally. While the surgery has been around for over 40 years, there are risks of side effects and complications and it is vitally important to the research team to identify ways to lessen their impact.
Those who have undergone intricate open heart surgery, or are close to someone who has, know that the healing process after the operation can be a long term commitment for both the patients and specialists.
In the 1990’s it became apparent that after open heart surgery, patients experienced a range of neuropsychological side-effects such as memory, concentration and co-ordination loss; and, personality or mood changes.
It is thought that a lack of oxygen to the brain during surgery may be one of the possible reasons to explain these psychological changes. Currently the team is looking at the level of oxygen circulated through the blood into the brain during the surgery.
The team is using a Cerebral Oximeter which sends a non-invasive beam of infrared light through skin, tissue and bone to measure the levels of oxygen within the blood to determine the most effective level of oxygen needed. This information will be used globally to improve cardiac surgery.
The Cardiac Research Team is also participating in a study that is looking into neuropsychological deterioration evident five years after surgery, which is contrary to previous beliefs. Patients who have undergone open heart surgery five years ago will be put through a series of tests to discover what changes they are experiencing.
“These studies help us to understand the subtle changes which may occur after surgery,” says Dr Rob Baker. “Even though cardiac surgery has been around for over 40 years it is a very complicated procedure and in order to get the best possible outcomes for patients, needs to be continually investigated.”