Type A Dissection Presenting as a Double Aortic Valve

We report a case of spontaneous aortic root dissection in a middle-aged male without history of recent trauma, mimicking double aortic valve on the echocardiogram which extended to the right brachiocephalic artery. The patient immediately underwent Bentall procedure

An integrated and coordinated approach to preventing recurrent coronary heart disease events in Australia: Policy statement from the Australian Cardiovascular Health and Rehabilitation Association

• Implementing existing knowledge about cardiac rehabilitation (CR) and heart failure management could markedly reduce mortality after acute coronary syndromes and revascularisation therapy. • Contemporary CR and secondary prevention programs are cost-effective, safe and beneficial for patients of all ages, leading to improved survival, fewer revascularisation procedures and reduced rehospitalisation. • Despite the proven benefits attributed to these secondary prevention interventions, they are not well attended by patients. • Modern programs must be flexible, culturally safe, multifaceted and integrated with the patient's primary health care provider to achieve optimal and sustainable benefits for most patients

An introduction to the collaborative methodology and its potential use for the management of heart failure

BACKGROUND: Heart failure (HF) is responsible for significant disease burden in developed countries internationally. Despite significant advances and a strong evidence base in therapies and treatment strategies for HF, access to these therapies continues to remain elusive to a significant proportion of the HF population. The reasons for this are multifactorial and range from the financial cost of treatments to the individual attitudes and beliefs of clinicians. The collaborative methodology, based upon a quality improvement philosophy, has been identified as a potentially useful tool to address this treatment gap. AIM: In this manuscript, we review the published literature on the collaborative methodology and assess the evidence for achieving improvement in the management of HF. METHODS: Searches of electronic databases, the reference lists of published materials, policy documents, and the Internet were conducted using key words including "collaborative methodology," "breakthrough series," "quality improvement," "total quality improvement," and "heart failure." Because of the paucity of high-level evidence, all English-language articles were included in the review. RESULTS: On the basis of the identified search strategy, 43 articles were retrieved. Key themes that emerged from the literature included the following: (1) The collaborative methodology has a significant potential to reduce the treatment gap. (2) Leadership is an important characteristic of the collaborative method. (3) The collaborative methodology facilitates sustainability of the quality improvement process. CONCLUSION: The collaborative methodology, when implemented and conducted according to key conceptual principles, has significant potential to improve the outcomes of patients, particularly those with HF and chronic cardiovascular disease. © 2006 Lippincott Williams & Wilkins, Inc

Do Social, Lifestyle and Cardiovascular Risk Factors Predict Dropout from Cardiac Rehabilitation Programs? A Longitudinal Cohort Study

Background: While cardiac rehabilitation (CR) programs reduce the risk of further cardiac events and improve symptom management, many eligible people do not attend or do not complete these programs. Further, little is known about the characteristics of people who drop out compared to those who complete CR. Aims: To determine the prevalence, correlates and predictors of dropout from CR. Methods: This is an administrative database of all participants consecutively enrolled in one outpatient CR program in Sydney between 2006-2017. Items assessed included demographics, diagnoses, co-morbidities, quality of life (MOS SF-36), psychological health (DASS-21), lifestyle factors and physical assessment. Dropout was defined as those who did not complete a 6 or 12-week outpatient CR program and did not complete post CR assessment. Results: Of 3350 who entered CR, 784 (23%) dropped out of a 6 or 12-week CR program. Smoking (OR 2.487; 95% CI: 1.951–3.170) or being divorced or separated (OR 2.066; 95% CI: 1.511-2.824) doubled the risk of dropout from CR, while younger age (,55 years) increased the risk of non-completion by 1.8 times (95% CI: 1.457–2.357). Risk factors including depressive symptoms (OR 1.448, 95% CI: 1.136–1.847) diabetes (OR 1.455; 95% CI: 1.145-1.848), sedentary lifestyle (OR 1.334; 95% CI: 1.059–1.680) and obesity (OR 1.612; 95% CI: 1.284–2.023) also increased the risk of dropout from CR. Conclusion: To improve CR program completion rates, clinicians need to consider the impact of social, lifestyle and cardiovascular risk factors on a person’s ability to adhere to CR

The prevalence and impact of depression and anxiety in cardiac rehabilitation: A longitudinal cohort study.

BACKGROUND:Co-morbid depression and anxiety symptoms are frequently under-recognised and under-treated in heart disease and this negatively impacts self-management. AIMS:The purpose of this study was to determine the prevalence, correlates and predictors of depression and anxiety in cardiac rehabilitation programmes, the impact of cardiac rehabilitation on moderate depression, anxiety and stress symptoms, and the relationship between moderate depression, anxiety and stress symptoms and cardiac rehabilitation adherence. METHODS:This was a retrospective cohort study of 5908 patients entering cardiac rehabilitation programmes from 2006-2017, across two Sydney metropolitan teaching hospitals. Variables included demographics, diagnoses, cardiovascular risk factors, medication use, participation rates, health status (Medical Outcomes Study Short Form-36) and psychological health (Depression Anxiety Stress Scales) subscale scores. RESULTS:Moderate depression, anxiety or stress symptoms were prevalent in 18%, 28% and 13% of adults entering cardiac rehabilitation programmes, respectively. Adults with moderate depression (24% vs 13%), anxiety (32% vs 23%) or stress (18% vs 10%) symptoms were significantly less likely to adhere to cardiac rehabilitation compared with those with normal-mild symptoms (p < 0.001). Anxiety (odds ratio 4.395, 95% confidence interval 3.363-5.744, p < 0.001) and stress (odds ratio 4.527, 95% confidence interval 3.315-6.181, p < 0.001) were the strongest predictors of depression. Depression (odds ratio 3.167, 95% confidence interval 2.411-4.161) and stress (odds ratio 5.577, 95% confidence interval 4.006-7.765, p < 0.001) increased the risk of anxiety on entry by more than three times, above socio-demographic factors, cardiovascular risk factors, diagnoses and quality of life. CONCLUSION:Monitoring depression and anxiety symptoms on entry and during cardiac rehabilitation can assist to improve adherence and may identify the need for additional psychological health support. Exploring the relevance and use of adjunct psychological support strategies within cardiac rehabilitation programmes is warranted