Coronary heart disease risk in volunteer firefighters in Victoria, Australia

Coronary heart disease (CHD) is a major problem for firefighters, even when considering the healthy worker effect (HWE). Although volunteer firefighters outnumber paid personnel, previous research has focused on paid US firefighters. By contrast, no CHD data for Australian firefighters exist. Risk factor data were collected from 2,943 Australian volunteer firefighters and CHD risk was compared with reference "low-risk" and Australian population data. Predicted CHD risk for male and female firefighter was 19.2% and 5.1%, respectively. Female firefighters high blood pressure and fasting glucose was significantly lower than the general population, whereas all other risk factors was similar to the general population. Firefighters' CHD risk was greater than other volunteer and paid emergency services, but the prevalence for most risk factors was similar to the general population. Therefore, Australian volunteer firefighters may not benefit from the HWE.

Impact of high-sensitivity cardiac troponin I assays on patients presenting to an emergency department with suspected acute coronary syndrome

 Objective: To determine whether introduction of high-sensitivity cardiac troponin I (hscTn-I) assays aff ected management of patients presenting with suspected acute coronary syndrome (ACS) to the emergency department (ED) of a tertiary referral hospital. Design, patients and setting: A retrospective analysis of all patients presenting to the Geelong Hospital ED with suspected ACS from 23 April 2010 to 22 April 2013 -2 years before and 1 year after the changeover to hscTn-I assays on 23 April 2012. Main outcome measures: Hospital admission rates, time spent in the ED, rates of coronary angiography, rates of percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABGS), rates of discharge with a diagnosis of ACS, and rates of inhospital mortality. Results: 12 360 consecutive patients presented with suspected ACS during the study period; 1897 were admitted to Geelong Hospital in the 2 years before and 944 in the 1 year after the changeover to hscTn-I assays. Comparing the two patient groups, there was no statistically signifi cant diff erence in allhospital admission rates (95% CI for the diff erence, - 3.1% to 0.3%; P = 0.10) or proportion of patients subsequently discharged with a diagnosis of ACS (95% CI for the diff erence, - 2.3% to 5.4%; P = 0.43). After the changeover, the median time patients spent in the ED was 11.5% shorter (3.85 h v 4.35 h; 95% CI for the diff erence, - 0.59 to - 0.43; P < 0.001) and the proportion of admitted patients undergoing coronary angiography was higher (53.4% v 45.2%; 95% CI for the diff erence, 4.3 to 12.0 percentage points; P < 0.001), but there was no statistically signifi cant rise in the proportion of patients who had invasive treatment (PCI and/or CABGS) (95% CI for the diff erence, - 0.4% to 6.3%; P = 0.08). Inhospital mortality rates from ACS did not change signifi cantly (95% CI for the diff erence, - 1.5% to 0.8%; P = 0.43). Conclusion: The introduction of hscTn-I assays appeared to be associated with more rapid diagnosis, resulting in less time spent in the ED, without a change in hospital admission rates. A higher proportion of patients had coronary angiographies after the changeover, but there was no signifi cant change in rates of invasive treatment or inhospital mortality.

Comorbid depression and health-related quality of life in patients with coronary artery disease.

This article reviews recent studies relating to the impact of depression and its treatment on the health-related quality of life (HRQOL) of patients with coronary artery disease (CAD).

Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease.

Depression is common but frequently undetected in patients with coronary artery disease (CAD). Self-report screening instruments for assessing depression such as the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire-9 (PHQ-9) are available but their validity is typically determined in depressed patients without comorbid somatic illness. We investigated the validity of these instruments relative to a referent diagnostic standard in recently hospitalized patients with CAD.

Cardiovascular medication use following percutaneous coronary intervention: the Australian experience

Despite the guidelines, a "treatment gap" exists in the delivery of pharmacotherapy for secondary prevention. We aimed to analyze the trend in guideline-based medication usage following percutaneous coronary intervention (PCI) using the Melbourne Interventional Group (MIG) registry over a 6-year period (2005-2010).