Preventative Health
Head – Professor Simon Stewart
simon.stewart@bakeridi.edu.au
Laboratory Overview
Preventative Health at Baker IDI invests heavily in community-based programs that seek to understand the evolving epidemic of diabetes and heart disease and respond accordingly to improve health outcomes - particularly in vulnerable individuals and communities.
As can be seen from the picture to the right of this page, Preventative Health has a wide-range of large-scale international and national studies (some of which are listed below) that not only quantify the problem of diabetes and heart disease but trial (via appropriately powered randomised studies) new and innovative ways to prevent disease in those at risk, prevent disease progression in those with early disease and, finally, prolong life and reduce disability in those with chronic heart disease.
For example, late in June 2007, the Preventative Health team conducted the largest random screening of blood pressure ever undertaken in Australia. The National Blood Pressure Screening Day involved a team of almost 300 nurses working in 100 separate locations across the country. Set up in specially designed booths in major shopping centres in every state and territory, almost 14,000 passers-by were given 10-minute individual health checks: height, weight and a brief medical history were taken, followed by a blood pressure reading. Those who participated had their blood pressure explained to them and recorded on a card that they could take to their own GP. The results of this unique study led to the development of the national VIPER-BP Study (involving > 250 GPs and 2000 patients) to optimise the management of patients with hypertension in primary care.
Research Focus
- Epidemiology and prognosis of heart disease
- Primary prevention of diabetes and heart disease
- Secondary prevention of diabetes and heart disease
- Individual risk delineation
- Chronic disease management
Research Projects
VIPER-BP Study
Valsartan Intensive Primary carE Reduction of Blood Pressure Study
VIPER-BP Study is a randomised controlled study of intensive blood pressure management (using various combinations of the angiotensin receptor blocker valsartan) that is currently enrolling up to 2,500 hypertensive patients from around Australia via a network of > 300 GP Investigators.
The primary endpoint of the VIPER-BP study is to evaluate the efficacy of applying a more
intensive and aggressive form of BP management for patients who have sub optimal BP (according to National Heart Foundation of Australia guidelines) with the aim of achieving BP control during 26 weeks of active management.
Project Publication
Carrington MJ, Jennings G, Stewart S. Pattern of blood pressure in Australian adults:Results from a national blood pressure screening day of 13,825 adults. Int J Cardiol 2009
SAFETY Study
Standard vs. Atrial Fibrillation spEcific managemenT studY (SAFETY)
SAFETY is a secondary prevention, multi-centre randomised controlled trial that aims to optimise the management of patients with AF by improving the delineation of individual risk factors over and above conventional risk profiling. In collaboration with The University of Queensland and The University of Adelaide, we will utilise the outcomes of this profiling in combination with an AF-specific disease management program (DMP) involving advanced echocardiographic imaging, Holter monitoring and advanced platelet and endothelial function studies to direct and optimise the health status of a cohort of AF patients who have been hospitalised as a result of AF.
The primary endpoint of the SAFETY Study is event-free from survival from death and re-hospitalisation during 24 month follow-up.
IMPRESS
Intima-Media thickness guidance of Primary prevention in Relatives of individuals with Early onSet atherosclerosiS (IMPRESS)
IMPRESS is a primary prevention, multi-centre randomised controlled trial that targets individuals with a known family history of atherosclerotic disease to address modifiable risk factors and prevent them from succumbing to the same morbidity. In collaboration with The University of Queensland and National University of Singapore, IMPRESS will use carotid intima-media thickness (CIMT) ultrasound imaging as a screening tool and as treatment guidance for individuals at low and intermediate absolute cardiovascular risk (according to the Framingham Risk Equation) for experiencing a cardiovascular event in the next 5 years.
The primary endpoint of IMPRESS is change in CIMT from baseline during three years follow-up.
NIL-CHF
Nurse-led Intervention or Less Chronic Heart Failure: The NIL-CHF Study
The NIL-CHF study is a randomised controlled trial evaluating the potential benefits of a nurse-led, home-based health care program relative to usual care for more than 600 patients discharged from the Alfred Hospital with a range of risk factors and pre-established cardiovascular conditions (including diabetes). The aim of the NIL-CHF study is to develop a cost-effective health care program to prevent the development of Chronic Heart Failure (CHF).
The primary end-point is incident CHF-related hospital admission or all-cause mortality during 3 year follow-up.
Project Publication
Carrington M, Stewart S on behalf of the NIL-CHF Investigators. Bridging the gap in heart failure prevention: Rationale and design of the Nurse-led Intervention for Less Chronic Heart Failure (NIL-CHF) Study. Eur J Heart Fail 2010;12:82-88
Young @ Heart
The Young @ Heart study is a randomised controlled study of a multidisciplinary home-based health care program for 600 cardiac patients in the private health care sector- although the results of the study will apply to those in the public health system just as readily.
The primary endpoint of the Young @ Heart study is the rate of all-cause hospital stay during a mean of 2.5 years follow-up and the study will also generate "beyond horizon" estimates of the likely cost-effectiveness of the study intervention.
Project Publication
Chan YK, Stewart S, Calderone A, Scuffham P, Goldstein S, Carrington MC. Exploring the potential to remain "Young @ Heart": Initial findings of a multi-centre, randomised study of a nurse-led, home-based intervention in a hybrid health care system. Int J Cardiol 2010
WHICH?
The Which Heart failure Intervention is most Cost-effective & consumer friendly in reducing Hospital care (WHICH?) study.
Phase 1 of the WHICH? Study is a head-to-head randomised controlled trial of the two most common forms of multidisciplinary Chronic Heart Failure management programs (CHF-MPs): a community-based approach incorporating a comprehensive home visit and a focus on providing community support to the patient versus management via a specialist outpatient clinic.
Specific health outcomes relating to survival, cardiac events, and health-related quality of life measures will be collected as endpoints enabling an evaluation of which management program is most cost-effective in applying gold-standard pharmacotherapy and improving unacceptably high morbidity/mortality rates.
Phase 2 of the WHICH? study will comprise a qualitative analysis of cardiovascular events and the associated health-related quality of life impacts, such that the acceptability and allocative efficiency of CHF-MPs can be determined.
In the 3rd and final phase of the WHICH? study we propose to develop an economic and health policy blue-print for providing the "preferred model" of CHF-MPs to all older Australians living with CHF in metropolitan regions.
Project Publications
Stewart S, Ekman I, Ekman T, Oden A,Rosengren A. Population impact of heart failure and the most common forms of cancer: A study of 1,162,309 hospital cases in Sweden (1988 to 2004). Circulation: Cardiovascular Quality and Outcomes 2010; In press
Inglis SC, Clark RA, McAlister FA, Ball J, Lewinter C, Cullington D, Stewart S, Cleland J. Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Review. Cochrane Database of Systematic Reviews. Aug 4th 2010.
Healthy Hearts
Healthy Hearts Beyond City Limits is a community-based program involving a number of regional communities in Victoria and in collaboration with local Rotary clubs. Involving a mobile, advanced cardiovascular risk assessment unit and public awareness and educational programs, Healthy Hearts focuses on the "heart health" of a community and attempts to identify ways to improve services and individual health. In its pilot visit, the Healthy Hearts van and team screened > 550 adults within the community of Colac. Subsequent visits to Shepparton and East Gippsland involving > 1000 adults confirmed a high burden of risk factors for CVD in rural communities.
Click here to review or download the project methodology.
Project Publication
Russell M, Williams M, May E, Stewart S. The conundrum of detecting angina pectoris in the community setting: A review of the strengths and limitations of current strategies. Nature Cardiology Reviews 2010:7;106-113
Heart of Soweto
The Heart of Soweto Study in Soweto, South Africa is Africa‟s largest study of emergent heart disorders on the African continent. It involves extensive community engagement (> 6000 participants) and local capacity building with the training of nurse and medical researchers from Soweto and wider Africa. Results from the study have been published in The Lancet [IF =25.8], the European Journal of Heart Failure [IF = 3.2], Circulation [IF = 12.9] and the International Journal of Cardiology [IF = 2.9] with many more reports to come.
The primary goal of the "Heart of Soweto Study" is to systematically examine and respond to the epidemiologic transition in risk behaviours and clinical presentations of heart disease in the internationally renowned and celebrated community of Soweto.
In the future this program will be expanded to become the Heart of Africa Study involving up to 10 monitoring sites in 7 sub-Saharan African countries.
Project Publications
Sliwa K, Carrington M, Mayosi B, Zigriades E, Mvungi R, Stewart S. Incidence and characteristics of newly diagnosed rheumatic heart disease in urban African adults: Insights from the Heart of Soweto Study. Euro Heart J - 2010;31:719-27
Stewart S, Carrington M, Pretorius S, Methusi P, Sliwa K. Standing at the crossroads between new and historically prevalent heart disease: Effects of migration and socio-economic factors in the Heart of Soweto cohort study. Euro Heart J 2010; In press
Sliwa K, Carrington M, Klug E, Opie L, Lee G, Ball J, Stewart S. Predisposing factors and incidence of atrial fibrillation/flutter in an urban African community: Insights from the Heart of Soweto Study. Heart 2010; In press
Becker AC, Sliwa K, Stewart S, Libhaber E, Essop AR, Zambakides CA, Essop MR. Acute Coronary Syndromes in Treatment-Naïve Black South Africans with Human Immunodeficiency Virus Infection. J Interv Cardiol. 2010;23(1):70-7
Becker AC, Jacobson B, Singh S, Sliwa K, Stewart S, Libhaber E, Essop MR. The thrombotic profile of treatment-naive HIV-positive black South Africans with acute coronary syndromes. Clin Appl Thromb Hemost. 2010; In press
Stewart S, Sliwa K. Practical considerations for establishing effective cardiovascular disease prevention in a resource poor environment. Nature Cardiology Reviews 2009: 6: 489-492.
Stewart S, Libhaber E, Carrington MC, et al. The clinical consequences and challenges of hypertension in urban-dwelling black Africans:Insights from the Heart of Soweto Study. Int J Cardiol 2009
Sliwa K, Wilkinson D, Hansen C, Ntyintyane L,Tibazarwa K, Becker A, Stewart S. Spectrum of heart disease and risk factors in a black urban population in South Africa (the Heart of Soweto Study): a cohort study. Lancet 2008; 371:915-22. [IF = 30.8] + [Cited 32]
Stewart S, Wilkinson D, Hansen C, et al. A predominance of heart failure in the Heart of Soweto Study cohort: emerging challenges for urban African communities. Circulation 2008;118:2360-2367.
Lab Head Profile
Professor Simon Stewart is the Head of Preventative Health and Group Leader, Population Health and Profiling at Baker IDI. He is also a National Health & Medical Research Council of Australia Senior Research Fellow.
A past recipient of a number of prestigious awards, including a National Heart Foundation of Australia Ralph Reader Fellowship (University of Glasgow, Scotland), American Heart Association Martha Hill Young Investigator Award and a Young Tall Poppy Award, Professor Stewart holds Fellowship titles with the European Cardiac Society, American Heart Association and Cardiac Society of Australia and New Zealand. He also holds adjunct/honorary Professorial titles with Monash University, University of Adelaide, University of Queensland and University of the Witwatersrand (RSA).
Professor Stewart's main focus of research has been developing community models of multidisciplinary care to optimize the prevention and management of chronic cardiac disease. With close to $8 million in competitive funding from the National Health and Medical Research Council, he is Principal Investigator of a number of large-scale clinical trials (including the SAFETY, WHICH? and NIL-CHF Study) examining the cost-efficacy of these models of care. He is also Principal Investigator of the VIPER-BP trial of optimal blood pressure management in primary care involving more than 250 GPs and close to 2000 patients Australia-wide.
Professor Stewart also leads a range of large population-based research programs to monitor the evolving epidemic of cardiovascular disease in Central Australia (e.g. the Heart of the Heart Study in Central Australia) and beyond in Sweden, Scotland and Africa - including that continent's largest study of heart disease to date (the Heart of Soweto Study in South Africa).
His research programs therefore span from Sweden to South Africa and Melbourne to Central Australia.
Professor Stewart is past co-founding Editor of the European Journal of Cardiovascular Nursing and is currently an Associate Editor of the International Journal of Cardiology. Overall, he has published more than 200 research papers and books relating to the epidemiology and management of cardiac disease with seminal reports published in many high impact journals including The Lancet, Circulation and European Heart Journal.
Achievements/Awards
NHFA Ralph Reader Fellow (1999 - 2002)
American Heart Association (AHA) Martha Hill Young Investigator Award
Young Tall Poppy Award
Inaugural Nurse Fellow of the European Society of Cardiology
2010 Anna Reynvaan Invited Lecturer (Amsterdam, May 2010)
Publication Highlights
Stewart S, Marley JE, Horowitz JD. Effects of a multidisciplinary, home-based intervention on unplanned readmissions and survival among patients with chronic congestive heart failure: A randomised controlled study. Lancet 1999;354:1077-83. [Cited = 255 times]
Stewart S, MacIntyre K, Hole DA, Capewell S, McMurray JJV. More ‘malignant' than cancer? Five-year survival following a first admission for heart failure in Scotland. Eur J Heart Fail 2001;3:315-22. [Cited = 237 times] * Most cited article in the history of Eur J Heart Fail
Inglis SC, Pearson S, Treen S, Gallasch T, Horowitz JD, Stewart S. Extending the horizon in chronic heart failure: Effects of multidisciplinary, home-based intervention relative to usual care. Circulation 2006; 114:2466-73. [Cited 25 times + Editorial]
Sliwa K, Wilkinson D, Hansen C, Ntyintyane L, Tibazarwa K, Becker A, Stewart S. Spectrum of heart disease and risk factors in a black urban population in South Africa (the Heart of Soweto Study): a cohort study. Lancet 2008; 371:915-22. [Cited 35 times + 3 related Editorials/Reviews]
Stewart S, Carrington M, Pretorius S, Methusi P. Sliwa K. Standing at the crossroads between new and historically prevalent heart disease: Effects of migration and socio-economic factors in the Heart of Soweto cohort study. Euro Heart J - Accepted October 2010
Key Staff
Scientific Staff
Dr Melinda Carrington
Prof Sandra Eades
Dr Bridgette McNamara
Dr Yih Kai Chan
Dr Anne Abbott
Ms Alicia Calderone
Dr Sally Inglis
Karen Best
Astrid Cuncins-Hearn
Eleanor Tan
Clinical/Nursing Staff
Mr Wayne Dawson
Ms Trischa Edwards
Ms Vivian Mak
Ms Joanne Saliba
Else Jansen
Tania Stewart
Susan Fahy-Scheer
Suzette Treen
Dr Chiew Wong
Students
Ms Jocasta Ball
Ms Jasmine Lyons
Mr Geoff Strange
Related Links
Australia's Future Fat Bomb - article in The Age
Australia's Future Fat Bomb report
Simon Stewart speech @ the Lifeblood Medical Education conference
pro-obesity Melbourne? - article in Monash Medical Student
Obesity epidemic puts Aussies above Americans - article in The Herald Sun
