Chronic heart failure programs : does more equal less? (BENCH study)

The national multi-centre study (49 programs, 1158 patients) developed a quality score (HF-IS) and the national benchmarks for heart programs. The higher a program scored on the HF-IS the greater the reduction in hospital admissions and mortality. This score has the potential to change national nursing practice and improve health outcomes of patients.

Why is type 2 diabetes such a serious risk factor for coronary heart disease in women?

Women with type 2 diabetes were found to display an altered distribution of body fat, higher resistance to the action of insulin, highly increased levels of tryglycerides and significant elevations in the level of plasminogen activator inhibiter. Concludes that interventions which enhance the action of insulin, such as exercise or drug therapy, should lower the risk of coronary heart disease in these women.

The natriuretic peptide system of the heart and central blood vessels of the toad, Bufo marinus

This research has established the presence of a natriuretic peptide system in the cardiovascular system of the toad, Bufo marinus. The presence of atrial natriuretic peptide mRNA and the peptide itself were shown in the heart which does not contain natriuretic peptide receptors in contrast to the large arteries and veins. In arteries these receptors mediated vasodilation. Atrial natriuretic peptide released from the heart may act on large arteries to regulate blood flow, but the action does not target the heart.

The relevance of the Heart Foundation of Australia's dietary recommendations for adult Australians : a comparison of views of general practitioners, cardiologists and dietitians

PURPOSE: To compare the views of general practitioners, cardiologists and dietitians about the relevance of the Heart Foundation of Australia's dietary recommendations for adult cardiac patients.

BASIC PROCEDURES: Quantitative-cross sectional study. Postal questionnaires were self-completed by 248 Victorian general practitioners (30% response), 189 Australia-wide cardiologists (47% response) and 180 Victorian dietitians (45% response). Responses were represented as percentages and analyses of variance were conducted to explore the impact of the independent variables: age, work status and gender on the dependent variable: dietary recommendation.

MAIN FINDINGS: Approximately half of the recommendations were viewed as strongly important to implement; these related to lean meats, limiting takeaways and cakes/biscuits, and adjusting energy intake. Others of importance were eating fruits, vegetables and fish. However, most of these goals were seen as difficult to achieve. Dietitians appeared to share responses of doctors, except for greater importance of eating fruit and vegetables and a greater difficulty in limiting cakes and biscuits. There was a high level of agreement among the three groups (mean 87%) about patients having difficulty implementing adjusting energy intake.

CONCLUSIONS: There is agreement amongst these professionals that many of the recommendations lack importance, specifically those pertaining to unsaturated oils, low fat dairy products, cholesterol rich foods, intake of legumes and grains and the restriction of salt. This may reflect a need for further nutrition education.

The projected impact of population and high-risk strategies for risk-factor control on coronary heart disease and stroke events

Objective: To model the impact of both population and high-risk strategies on cardiovascular disease (CVD) outcomes.

Design, setting and participants: A CVD risk-factor survey was carried out in rural south-eastern Australia from 2004 to 2006. Using a stratified random sample, data for 1116 participants aged 35–74 years were analysed. Applying the Framingham risk equations to risk-factor data, 5-year probabilities of a coronary heart disease event, stroke and cardiovascular event were calculated. The effect of different changes in risk factors were modelled to assess the extent to which cardiovascular diseases can be prevented by changing the risk factors at a population level (population strategy), among the high-risk individuals (high-risk strategy) or both.

Results: Among men, a population strategy could reduce cardiovascular events by 19.3% (193 per 1000 per 5 years), the high-risk strategy by 12.6% (126 per 1000) and a combined strategy by 24.1% (241 per 1000); and among women, by 21.9% (219 per 1000), 19.0% (190 per 1000) and 28.7% (287 per 1000), respectively.

Conclusions: For prevention of CVD in Australia, it is important both to treat high-risk individuals and to reduce the mean risk-factor levels in the population. We show how risk-factor survey data can be used to set targets for prevention and to monitor progress in line with the recommendations of the National Preventative Health Taskforce.

An index of unhealthy lifestyle is associated with coronary heart disease mortality rates for small areas in England after adjustment for deprivation

Indices of socio-economic deprivation are often used as a proxy for differences in the health behaviours of populations within small areas, but these indices are a measure of the economic environment rather than the health environment. Sets of synthetic estimates of the ward-level prevalence of low fruit and vegetable consumption, obesity, raised blood pressure, raised cholesterol and smoking were combined to develop an index of unhealthy lifestyle. Multi-level regression models showed that this index described about 50% of the large-scale geographic variation in CHD mortality rates in England, and substantially adds to the ability of an index of deprivation to explain geographic variations in CHD mortality rates.