The national Cardiovascular Health Leadership Research Forum: a new data‐driven model placing research at the centre of improving patient outcomes DOI Creative Commons
Gemma A. Figtree,

Kerry Doyle,

Lee Nedkoff

et al.

The Medical Journal of Australia, Journal Year: 2024, Volume and Issue: 221(9), P. 452 - 456

Published: Oct. 15, 2024

The Australian health system is recognised as one of the best globally. However, burden chronic disease, including cardiovascular disease (CVD), remains high and associated care sector spend in Australia rapidly expanding. In 2022–2023, Commonwealth expenditure was estimated at $132 billion, representing 16.8% total budget.1 Over $14 billion spent on direct costs CVD per annum.2 Developing new models to harness immense research resources available tackle our nation's key challenges has potential accelerate implementation drive preventive therapeutic strategies foster a vibrant medical technology ecosystem, thereby, positively affecting patient economic outcomes. Until now, there been no mechanism that allows for fully integrated national conversation stroke between system, clinicians, researchers, industry partners, state federal governments, data economics experts. establishment Cardiovascular Health Leadership Research Forum (CV HLRF) 20223 provides opportunities relevant broad range these stakeholders, connecting leaders from all jurisdictions world class researchers. CV HLRF designed hosted by Alliance (ACvA) — peak body ACvA established coordinated solution-focused model across its Flagships Clinical Themes initiatives (Box). It supported senior leadership engagement Commonwealth, territory jurisdictions, cash contribution number jurisdictions. commitment date about $1.5 million 2025–2026. This funding supplemented philanthropy membership fees, well towards specific initiatives. engaged bodies Australia, National Heart Foundation (NHFA), Stroke Foundation, Cardiac Registry, Institute Welfare, Commission Safety Quality Care, who are committed achieving unprecedented levels collaboration shared goal optimal care. also endorsed Chief Executives Forum. ACT = Capital Territory; cardiovascular; NHFA Australia; NSWCVRN New South Wales Network; NT Northern QCVRN Queensland SACVRN TAS Tasmania; VIC Victoria; WACRA Western Alliance. There already wealth information clinical quality improvement, but often fragmented, lack robust metadata unable be accessed systematic timely manner. Visualisation simplified standardised outcomes indicators will optimise utility leaders, working with researchers consumers prioritise solve challenges. Disaggregated analysis such resource allow identification inequities. particularly improving Aboriginal Torres Strait Islander Peoples, people culturally linguistically diverse backgrounds, regional, rural remote populations, inequities driven sex gender differences socio-economic status. Such can guide tailored approaches pathways groups greatest or inequity addition, inform longer term solutions, identifying where fundamental mechanistic studies needed unravel missing biology, development diagnostic tools, novel drug device solutions. international have led evidence-based guidelines.4-7 way comprehensively measuring compliance guideline recommendations interpreting impacts guideline-based Harmonising efforts consensus standardising outcome organisations enhance participation global stage improved heart includes societies associations American College Cardiology, Association8 European Society Cardiology,9 as, more recently, International Consortium Outcomes Measurement (ICHOM).10 identified five initial patient-focused optimisation flow presentation HLRF: coronary artery disease/acute syndrome, stroke, failure, arrhythmia, sudden cardiac death. All different stages regarding consensus. Even achieved, it only aspect journey (eg, acute syndrome agreed primary prevention). major step indicators, enabling near real-time dashboards. These implemented ensure Australians receiving approach line World Federation, which advocating countries an increased focus local monitoring.11 Evolving makes feasible consider automatic population dashboards electronic records (EMR). datasets, Person Level Integrated Data Asset Hub, actively being used moving forwards, provide platforms supporting stroke. Consensus pass clear message providers their responsibility know report reflecting this challenging. A example seen developed field, wide consultation Care.12 few against other than through irregular, retrospective reports, manually populated funded via budgets rather embedded into budgets. collection measures shown evidence how effective be.13, 14 Resetting expectations provider's significant effect. Major efficiencies achieved investing infrastructure skills engineers) facilitate routine extraction EMRs functional Integration EMR would maximise ease value merging registries nationally. Improved coordination additional investment broader improvements health. SWEDEHEART cohort,15 1749 points over 34 000 patients annually (total 1 patients), long follow-up. Insights important changes practice 290 publications, creating "bank knowledge". large biobanks, UK Biobank China Kadoorie Biobank, linked integral relationships genetic, environmental drivers health.16, 17 type trials. continued highlight urgent need prevention treatment strategies. must incremental, require strong vision, leadership, investment. Although competitive streams invested significantly research, addresses prioritised unmet needs leverages partners not maximised. members understand importance team within strategic framework make desired country's rigorously establish priorities implementation, relevance prospectively assess impact real time. support sustainable models, leveraging multiple clearly defines itself providing valuable service improvements. main stream funds 50 years come Medical Endowment Account (MREA) administered Council (NHMRC). Currently, $880 schemes, 10% highly programs. Renowned rigor excellence, NHMRC relies investigators problem presenting proposed solutions so-called bottom-up approach. substantial impactful discoveries innovations NHMRC. translation always clear. Future Fund (MRFF) top-down program complement largely investigator-initiated (bottom-up) $220 MRFF Mission commenced 2021, contributing further advances reducing CVD. accounts less 0.1% cost CVD, we therefore leverage in-kind impact. detailed road map plan incorporated feedback, ambitious collaborations. requires sector-wide if goals achieved. 2023, government announced $3 allocated second ten-year cycle vision: "A informed research". opportunity achieve this, deep states health, community problems. substantially research. $150 ten NSW capacity building, $470 Hospital Victoria. Individual considering state-based aligned models. Supported NHFA, now Networks country. nexus governments sector, focusing jurisdictional Queensland, Tasmania rolling out statewide systems. teams worked closely innovative programs hypertension example. networks align priorities, use existing emerging pragmatic trials evaluation interventions, strategy. benefit immensely grants, move away seeing charitable endeavour, fragmented fashion. What co-investment pipeline appropriate scale problems addressed. Given $14.3 year,2 returns innovation critical informing policies prioritisation future. With current approach, every dollar $3.20 (Deloitte Access Economics estimate18) returned society terms better Notably, highest return NHMRC-funded workforce yielding $9.80 invested.18 enhanced HLRF. benefits data-driven, thriving addressing globe's challenge quantifiable. Philanthropy ready embrace scale. An exemplar area Snow continues play role recognition embed system. During coronavirus 2019 (COVID-19) pandemic, COVID-19 Cabinet played logical "flattening curve". underpinned coordinating involving chief officers Gathering together experts, helped address hurdle facing Australia: separation care, hospital public states, territories regard, non-communicable diseases. We urgently connects regularly updated essential indicators. does just allowing funders invest in, implement, areas. Prioritisation level agility resourcing change management standard breed clinician-researcher multifaceted perspectives, playing decision making developing stronger culture mentoring early mid-career clinician To shift, standardisation minimum required monitoring services essential. Once articulated endorsed, they should monitored individual jurisdiction each equity. activity. help generated needs, measurable Commitment critical. Demonstrating resulting shift dial both benefits, future decisions, translational ecosystem. Writing group: complete writing group responsible manuscript were: Gemma Figtree1,2,3,4 Kerry Doyle4,5,6 David Brieger3,7 Dominique Cadilhac4,8,9,10 Chant11 Derek Chew4,10,12,13 Clara Chow3,14 Seana Gall4,13,15,16 Kim Greaves17,18,19,20 Garry Jennings3 Stefan Larson21,22,23 Jean-Frederic Levesque11,24 Keith McNeil25 Lee Nedkoff4,26,27 Stephen J Nicholls12,13,28 Miriam Lum On29 Julie Redfern3,4,30 Christian Verdicchio3,31,32 T Vernon1,2,3 Zoe Wainer33,34 Jason Kovacic4,24,26,27,35,36,37 Kolling Research, University Sydney, NSW. 2 Royal North Shore Hospital, 3 4 Alliance, 5 Australasian 6 Complementary Medicines, 7 8 Victorian Institute, Monash University, Melbourne, VIC. 9 Health, 10 Florey Neuroscience Mental 11 Ministry 12 13 Westmead Applied Centre (CKC), 15 Menzies Hobart, TAS. 16 Tasmania, Brisbane, QLD. 18 Sunshine Coast Buderim, 19 Canberra, ACT. 20 Services, Birtinya, 21 Measurement, Boston (MA), USA. 22 Karolinska Solna, Sweden. 23 Consulting Group, 24 UNSW 25 Excellence Innovation Adelaide, SA. 26 Victor Chang 27 Perth, WA. 28 MonashHeart, 29 30 George Global 31 Support 32 33 Department 35 St Vincent's 36 Association Institutes, 37 Icahn School Medicine Mount Sinai, York (NY), USA received Government Funding non-profit study. Not commissioned; externally peer reviewed.

Language: Английский

A Dual-Modality Home-Based Cardiac Rehabilitation Program for Adults with Cardiovascular Disease: Single-Arm Remote Clinical Trial (Preprint) DOI Creative Commons

Tim Bilbrey,

Jenny Martin,

Wen Zhou

et al.

JMIR mhealth and uhealth, Journal Year: 2024, Volume and Issue: 12, P. e59098 - e59098

Published: Aug. 16, 2024

Cardiac rehabilitation (CR) is a safe, effective intervention for individuals with cardiovascular disease (CVD). However, majority of eligible patients do not complete CR. Growing evidence suggests that home-based cardiac (HBCR) programs are comparable in effectiveness and safety traditional center-based programs. More research needed to explore different ways deliver HBCR CVD.

Language: Английский

Citations

2
Factors influencing implementation of digital cardiac rehabilitation: A qualitative analysis of health workers perspectives DOI Creative Commons
Irene Gibson, Claire Kerins, Louise Foley

et al.

HRB Open Research, Journal Year: 2024, Volume and Issue: 7, P. 50 - 50

Published: July 26, 2024

Background Despite growing evidence for the effectiveness of digital cardiac rehabilitation (CR) uptake this technology remains low. Understanding factors that influence implementation CR in clinical practice is a area research. The aim nested qualitative study was to explore health worker perspectives on influencing programme. Methods Using convenience sampling, semi-structured interviews were conducted with workers, including care professionals (nurses, dietitians, physiotherapists) and those administrative managerial roles who involved delivering referring patients Croí MySláinte, 12-week intervention delivered during Coronavirus 2019 pandemic. updated Consolidated Framework Implementation Research (CFIR) guided data collection framework analysis. Results Interviews 14 workers. Factors MySláinte multiple, some operating independently others combination. They related to: (i) characteristics individuals (e.g., senior leadership support, commitment motivation Health workers meet patient needs, technical capability, workload perceived fit role); (ii) features programme accessibility patients, platform, self- monitoring tools, multidisciplinary team core components); (iii) external environment partnership connections between organisations, broadband COVID-19); (iv) internal organisational culture, teamwork, resources funding, infrastructure staffing); (v) process engaging through provision support). Conclusion findings suggest operate at multiple levels. Therefore, multi-level strategies are required if true potential improving equitable access, participation outcomes be realised.

Language: Английский

Citations

1
Strategies for reducing the burden of cardiovascular diseases in the United Arab Emirates DOI Creative Commons
Sarra Shorbagi, Mahmoud M. Ramadan

Deleted Journal, Journal Year: 2024, Volume and Issue: 3(3), P. 97 - 102

Published: July 1, 2024

This commentary outlines the strategies implemented by United Arab Emirates (UAE) to reduce burden of cardiovascular diseases (CVDs) through national health policies and initiatives. These aim enable sustainable actions for CVDs prevention control addressing key risk factors, such as tobacco use, unhealthy dietary habits, physical inactivity. Assessment is fundamental early detection timely treatment. The UAE has reported availability essential medicines basic technologies preventing heart attack stroke. Future directions include improving data reporting systems provide up-to-date statistics on prevalence including diet, activity, body weight, smoking, blood pressure, sugar, cholesterol control. In addition, these efforts will cover quality care, procedures, economic costs. Strengthening collaboration between academic research institutes government policymakers crucial shaping UAE’s agenda. Key steps further in enhancing primary care emergency medical services, building health-care worker capacity, accessibility affordability priority interventions.

Language: Английский

Citations

1
The future of education in Preventive Cardiology: a statement of the European Association of Preventive Cardiology of the European Society of Cardiology DOI Creative Commons
Konstantinos C. Koskinas, Matthias Wilhelm, Martin Halle

et al.

European Journal of Preventive Cardiology, Journal Year: 2024, Volume and Issue: 31(16), P. 1904 - 1911

Published: Aug. 6, 2024

In recent years, major advances in our understanding of risk factors implicated the development cardiovascular disease (CVD), available tools for early detection CVD, and effective interventions to prevent subclinical or clinically manifest disease, have led an increasing appreciation prevention as a pillar (CV) medicine. Preventive Cardiology has evolved into dynamic sub-speciality focused on promotion CV health through all stages life, management individuals at developing CVD experiencing recurrent events, interdisciplinary care different settings. As level knowledge, specialized skills, experience, committed attitudes related exceeded core cardiology training, European Association (EAPC) placed emphasis continuous education training physicians allied professionals involved prevention, with aim setting standards practice improving quality care. The EAPC recognizes need comprehensive educational offer across levels (from expert training) well approaches that will promote synergies among prevention. This statement by aims highlight current gaps unmet needs describe framework help standardize, structure, deliver comprehensive, up-to-date, interactive, high-quality using combination traditional novel tools. document form basis ongoing refinements offer, ultimate goal ensuring new evidence field translate better improved outcomes patients.

Language: Английский

Citations

1
The national Cardiovascular Health Leadership Research Forum: a new data‐driven model placing research at the centre of improving patient outcomes DOI Creative Commons
Gemma A. Figtree,

Kerry Doyle,

Lee Nedkoff

et al.

The Medical Journal of Australia, Journal Year: 2024, Volume and Issue: 221(9), P. 452 - 456

Published: Oct. 15, 2024

The Australian health system is recognised as one of the best globally. However, burden chronic disease, including cardiovascular disease (CVD), remains high and associated care sector spend in Australia rapidly expanding. In 2022–2023, Commonwealth expenditure was estimated at $132 billion, representing 16.8% total budget.1 Over $14 billion spent on direct costs CVD per annum.2 Developing new models to harness immense research resources available tackle our nation's key challenges has potential accelerate implementation drive preventive therapeutic strategies foster a vibrant medical technology ecosystem, thereby, positively affecting patient economic outcomes. Until now, there been no mechanism that allows for fully integrated national conversation stroke between system, clinicians, researchers, industry partners, state federal governments, data economics experts. establishment Cardiovascular Health Leadership Research Forum (CV HLRF) 20223 provides opportunities relevant broad range these stakeholders, connecting leaders from all jurisdictions world class researchers. CV HLRF designed hosted by Alliance (ACvA) — peak body ACvA established coordinated solution-focused model across its Flagships Clinical Themes initiatives (Box). It supported senior leadership engagement Commonwealth, territory jurisdictions, cash contribution number jurisdictions. commitment date about $1.5 million 2025–2026. This funding supplemented philanthropy membership fees, well towards specific initiatives. engaged bodies Australia, National Heart Foundation (NHFA), Stroke Foundation, Cardiac Registry, Institute Welfare, Commission Safety Quality Care, who are committed achieving unprecedented levels collaboration shared goal optimal care. also endorsed Chief Executives Forum. ACT = Capital Territory; cardiovascular; NHFA Australia; NSWCVRN New South Wales Network; NT Northern QCVRN Queensland SACVRN TAS Tasmania; VIC Victoria; WACRA Western Alliance. There already wealth information clinical quality improvement, but often fragmented, lack robust metadata unable be accessed systematic timely manner. Visualisation simplified standardised outcomes indicators will optimise utility leaders, working with researchers consumers prioritise solve challenges. Disaggregated analysis such resource allow identification inequities. particularly improving Aboriginal Torres Strait Islander Peoples, people culturally linguistically diverse backgrounds, regional, rural remote populations, inequities driven sex gender differences socio-economic status. Such can guide tailored approaches pathways groups greatest or inequity addition, inform longer term solutions, identifying where fundamental mechanistic studies needed unravel missing biology, development diagnostic tools, novel drug device solutions. international have led evidence-based guidelines.4-7 way comprehensively measuring compliance guideline recommendations interpreting impacts guideline-based Harmonising efforts consensus standardising outcome organisations enhance participation global stage improved heart includes societies associations American College Cardiology, Association8 European Society Cardiology,9 as, more recently, International Consortium Outcomes Measurement (ICHOM).10 identified five initial patient-focused optimisation flow presentation HLRF: coronary artery disease/acute syndrome, stroke, failure, arrhythmia, sudden cardiac death. All different stages regarding consensus. Even achieved, it only aspect journey (eg, acute syndrome agreed primary prevention). major step indicators, enabling near real-time dashboards. These implemented ensure Australians receiving approach line World Federation, which advocating countries an increased focus local monitoring.11 Evolving makes feasible consider automatic population dashboards electronic records (EMR). datasets, Person Level Integrated Data Asset Hub, actively being used moving forwards, provide platforms supporting stroke. Consensus pass clear message providers their responsibility know report reflecting this challenging. A example seen developed field, wide consultation Care.12 few against other than through irregular, retrospective reports, manually populated funded via budgets rather embedded into budgets. collection measures shown evidence how effective be.13, 14 Resetting expectations provider's significant effect. Major efficiencies achieved investing infrastructure skills engineers) facilitate routine extraction EMRs functional Integration EMR would maximise ease value merging registries nationally. Improved coordination additional investment broader improvements health. SWEDEHEART cohort,15 1749 points over 34 000 patients annually (total 1 patients), long follow-up. Insights important changes practice 290 publications, creating "bank knowledge". large biobanks, UK Biobank China Kadoorie Biobank, linked integral relationships genetic, environmental drivers health.16, 17 type trials. continued highlight urgent need prevention treatment strategies. must incremental, require strong vision, leadership, investment. Although competitive streams invested significantly research, addresses prioritised unmet needs leverages partners not maximised. members understand importance team within strategic framework make desired country's rigorously establish priorities implementation, relevance prospectively assess impact real time. support sustainable models, leveraging multiple clearly defines itself providing valuable service improvements. main stream funds 50 years come Medical Endowment Account (MREA) administered Council (NHMRC). Currently, $880 schemes, 10% highly programs. Renowned rigor excellence, NHMRC relies investigators problem presenting proposed solutions so-called bottom-up approach. substantial impactful discoveries innovations NHMRC. translation always clear. Future Fund (MRFF) top-down program complement largely investigator-initiated (bottom-up) $220 MRFF Mission commenced 2021, contributing further advances reducing CVD. accounts less 0.1% cost CVD, we therefore leverage in-kind impact. detailed road map plan incorporated feedback, ambitious collaborations. requires sector-wide if goals achieved. 2023, government announced $3 allocated second ten-year cycle vision: "A informed research". opportunity achieve this, deep states health, community problems. substantially research. $150 ten NSW capacity building, $470 Hospital Victoria. Individual considering state-based aligned models. Supported NHFA, now Networks country. nexus governments sector, focusing jurisdictional Queensland, Tasmania rolling out statewide systems. teams worked closely innovative programs hypertension example. networks align priorities, use existing emerging pragmatic trials evaluation interventions, strategy. benefit immensely grants, move away seeing charitable endeavour, fragmented fashion. What co-investment pipeline appropriate scale problems addressed. Given $14.3 year,2 returns innovation critical informing policies prioritisation future. With current approach, every dollar $3.20 (Deloitte Access Economics estimate18) returned society terms better Notably, highest return NHMRC-funded workforce yielding $9.80 invested.18 enhanced HLRF. benefits data-driven, thriving addressing globe's challenge quantifiable. Philanthropy ready embrace scale. An exemplar area Snow continues play role recognition embed system. During coronavirus 2019 (COVID-19) pandemic, COVID-19 Cabinet played logical "flattening curve". underpinned coordinating involving chief officers Gathering together experts, helped address hurdle facing Australia: separation care, hospital public states, territories regard, non-communicable diseases. We urgently connects regularly updated essential indicators. does just allowing funders invest in, implement, areas. Prioritisation level agility resourcing change management standard breed clinician-researcher multifaceted perspectives, playing decision making developing stronger culture mentoring early mid-career clinician To shift, standardisation minimum required monitoring services essential. Once articulated endorsed, they should monitored individual jurisdiction each equity. activity. help generated needs, measurable Commitment critical. Demonstrating resulting shift dial both benefits, future decisions, translational ecosystem. Writing group: complete writing group responsible manuscript were: Gemma Figtree1,2,3,4 Kerry Doyle4,5,6 David Brieger3,7 Dominique Cadilhac4,8,9,10 Chant11 Derek Chew4,10,12,13 Clara Chow3,14 Seana Gall4,13,15,16 Kim Greaves17,18,19,20 Garry Jennings3 Stefan Larson21,22,23 Jean-Frederic Levesque11,24 Keith McNeil25 Lee Nedkoff4,26,27 Stephen J Nicholls12,13,28 Miriam Lum On29 Julie Redfern3,4,30 Christian Verdicchio3,31,32 T Vernon1,2,3 Zoe Wainer33,34 Jason Kovacic4,24,26,27,35,36,37 Kolling Research, University Sydney, NSW. 2 Royal North Shore Hospital, 3 4 Alliance, 5 Australasian 6 Complementary Medicines, 7 8 Victorian Institute, Monash University, Melbourne, VIC. 9 Health, 10 Florey Neuroscience Mental 11 Ministry 12 13 Westmead Applied Centre (CKC), 15 Menzies Hobart, TAS. 16 Tasmania, Brisbane, QLD. 18 Sunshine Coast Buderim, 19 Canberra, ACT. 20 Services, Birtinya, 21 Measurement, Boston (MA), USA. 22 Karolinska Solna, Sweden. 23 Consulting Group, 24 UNSW 25 Excellence Innovation Adelaide, SA. 26 Victor Chang 27 Perth, WA. 28 MonashHeart, 29 30 George Global 31 Support 32 33 Department 35 St Vincent's 36 Association Institutes, 37 Icahn School Medicine Mount Sinai, York (NY), USA received Government Funding non-profit study. Not commissioned; externally peer reviewed.

Language: Английский

Citations

1