In-SPHERE Spring 2024

In-SPHERE

The official research magazine of Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)

SPRING 2024

CARDIAC SPECIAL: A.I. UNLOCKS ECG HIDDEN DATA

END-OF-LIFE CARE IN CARDIOLOGY

VENOUS ADRENAL SAMPLING

IMPACT OF POLLUTION ON HEART HEALTH IMPROVING SUDDEN CARDIAC ARREST OUTCOMES ... and more

Our Partners

Each of our 15 Partners has a proven record of pioneering advancements across healthcare research, innovation and education.

It is this fusion of these different entities into one potent force that makes The Partnership unique - the whole is greater than the sum of the parts.

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IN THIS ISSUE: SPRING 2024 4

Foreword by Professor Chris White

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AI supercharges ECGS

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Improving Sudden Cardiac Arrest Outcomes

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Sudden Cardiac Arrest: Ian’s story

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Sudden Cardiac Arrest: Aidan’s story

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Uncovering genetic causes of Sudden Cardiac Arrest

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Improving end-of-life care in cardiology

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Unlocking cardiac risks from radiotherapy

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Pollution and Climate crisis - impact on heart health

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Consumer Profile: Audrey Lee

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Adrenal Venous Sampling

17 In-SPHERE, published three times a year, is the official research magazine of Maridulu Budyari Gumal, the Sydney Partnership for Health Education Research and Enterprise (SPHERE).

In-SPHERE showcases the work of our Clinical Themes and Platforms as well as our Partner Organisations.

Executive Director: Professor Christopher White Operations Manager: Elizabeth Henness Editorial Committee Linda Music (Editor/Chief Writer) Bianca Badolato (Sub-Editor) Mehna Alacozy Sophie Gates Stephanie Macmillan Natalie Walsh Want to find out how to get an article about your research published in In-SPHERE? Contact l.music@unsw.edu.au Front cover credit: Alena Butusava (iStock)

NOTE: The information in this magazine is intended as a general introduction to the research being conducted by SPHERE Clinical Themes, Platforms and Partner Organisations. All care is taken to ensure that the information contained herein is free from error and/or omissions.

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A word from our Executive Director

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Professor Chris White

e often somatise how we feel and think about projects, people and situations. We commonly describe being “sick in the stomach”, doing the “heavy lifting”, having the “skeleton of an idea” or enduring a “pain in the neck” as body maps for concepts or emotions relevant to the situation.

We attribute an almost mystical status to our heart. Getting to the “heart” of the matter and dedicating emotions and passions to an organ that we recognise to be both powerful (e.g. lion-hearted) and fragile (i.e. broken) is visceral to all humans, transcending cultural differences. In-SPHERE has dedicated this edition to Research and Clinical Themes at the heart of its research translation mission, cardiovascular medicine (CVM).

Continuing that somatic concept and applying it to an entity like SPHERE, we are a unique partnership of health service delivery and academic thinking, with CVM at its heart. We have highlighted symbiotic relationships between medical research institutes like the Victor Chang Cardiac Research Institute (page 17)

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“...we can never lose sight of the fact that at the heart of everything we do in eponymously dedicated to CVM, The George Institute with world class SPHERE, it is the reputation in CVM clinical trials, universities and institutes with research impact our research themes and programs dedicated to CVM (page 9) and the coal face of will have for our applied cardiology in the Emergency Departments (page 7), wards (page patients and the 15) and clinics (pages 21) of our health service providers. Every organ of our communities that they bodies has a vessel going to it and no part of SPHERE is untouched by some come from that is cardiovascular clinical or research theme priority. at the “heart” of our Therefore, the full gamut of modern mission.” research methodologies has been applied by SPHERE researchers to CVM. From understanding complex computational algorithms in AI and genomics applied to CVM, early proof of concept device, drug and method development, clinical trials, implementation and end of life research.

As awe inspiring as that can be we can never lose sight of the fact that at the heart of everything we do in SPHERE, it is the impact our research will have for our patients and the communities that they come from that is at the “heart” of our mission.

Covering their lifelong journey, the significance expectant parents attribute to the sonic milestone when their child is first noted to have a beating heart mirrors the importance with which we decide how best to manage end of life decisions in our patients with decompensating heart diseases (page 13). Emphasising the reason for SPHERE to have formed in the first place, I stand with Audrey and her comment (page 19) that “I believe in the power of collaboration. Together, we can achieve far more than we could

alone.” A small, targeted research translation enterprise like SPHERE should only concentrate on those activities we couldn’t do as members, alone. In that vein, cardiovascular medicine is not just about the heart and the vessels, but the circulation it supports. The life blood of SPHERE is its readiness, willingness and capacity to collaborate in ways previously unimagined to do things together previously not considered possible. If we do not circulate knowledge, ideas, methods, funds and opportunities in collaboration between us, amplifying the output to transform healthcare, then our efforts will clot as surely as blood pools in a non-circulatory system, and our impact will be the exact opposite of what we intend. When you read this edition of In-SPHERE, our research in cardiovascular medicine is so much more than just a technical wonder, it is a metaphor for ourselves as a research translation centre.

CARDIAC SPECIAL ISSUE Fuelled by dedicated experts and innovative advancements, cardiac research is transforming our understanding and treatment of heart disease, paving the way for enhanced patient care and outcomes.

Photo credit: SewcreamStudio (iStock)

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Photo credit: ipopba (iStock)

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CARDIAC RESEARCH SPECIAL : ARTIFICIAL INTELLIGENCE

AI supercharges ECGs: The future of heart health

AI is transforming cardiology by unlocking hidden insights in ECGs, enabling earlier detection and prevention of heart conditions.

By Linda Music

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rtificial intelligence (AI) is playing an increasingly vital role in healthcare, particularly in cardiology, where it is being leveraged to enhance diagnostic capabilities and improve patient outcomes.

Campbelltown cardiologist, Dr Zaidon Al-Falahi (South West Sydney Local Health District) is at the forefront of this innovative shift. He is researching under the supervision of Professor Martin Ugander, Professor of Cardiac Imaging at the University of Sydney, on the use of AI to transform one of the simplest and most widely accessible tests in cardiology: the electrocardiogram (ECG).

Traditionally, the ECG offers a snapshot of the heart’s electrical activity, but its diagnostic capabilities have been reduced due to reliance on simple visual representation of the dataset, especially in the absence of an acute problem.

However, AI is now enabling researchers to “find the signal in the noise,” as Dr Al-Falahi describes.

The key to AI is data By training explainable and transparent Machine Learning models on carefully curated datasets of ECGs, patterns emerge that reveal far more than what the human eye can detect.

Interest in AI-enabled ECGs was sparked over the past few years by leveraging millions of digitally stored ECGs with matching clinical data from the past decades. This has allowed researchers to create AI models with high reported accuracies.

“The models have become quite good at picking up patterns and predicting diagnoses. One current major limitation of such models is their use of deep neural networks architecture, which are inherently unexplainable, and focus on disease detection with less utility for prevention currently,” says Dr AlFalahi.

“Our current research focus is on the use of Advanced ECG (A-ECG), which has been the result

Dr Zaidon Al-Falahi

of research and collaboration with NASA and the Karolinska Institute in Sweden. A-ECG is simpler and inherently explainable. In contrast to neural network approaches, A-ECG performs more advanced signal processing to quantify ECG measures from the derived vectorcardiogram, and waveform complexity analysis.

A-ECG then uses straightforward multivariable statistical approaches including machine learning to derive the diagnostic insights. This enables the recognition and interpretation of In-SPHERE

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subtle patterns in ECGs that would be otherwise impossible for the human eye to detect,” he says.

The signal in the noise “The ECG in its basic form provides relatively limited information, but if you use the lens of AI to look at ECGs, you can diagnose things that you wouldn’t even think were possible.”

Dr Al-Falahi explains that AI can discern a patient’s gender, age, blood sugar levels, electrolyte imbalances, pumping function, and even the presence of coronary artery disease.

“All from an ECG and all of that by using AI,” he says.

This capability has transformative potential, especially in preventive cardiology, where early detection can lead to more timely preventive interventions.

A Focus on Preventive Cardiology The importance of early detection is a key feature of AI use in cardiology.

AI’s ability to identify subtle changes in an asymptomatic patient’s ECG could prevent conditions from progressing to more serious stages.

“Medicine used to be reactive, but now, more and more, we’re moving towards preventive care.”

Research puts ECG capabilities into smartwatches Dr. Zaidon Al-Falahi’s PhD research is centred on a novel technology that allows individuals to perform their own ECGs at home using a smartwatch. This world-first research project enables users to record a fully diagnostic medical-grade 12-lead ECG using only their Apple Watch and a dedicated iPhone app, which will then undergo Advanced ECG (A-ECG) analysis to detect underlying signatures of heart disease. The project is funded

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AI in hospitals While this technology can be applied in private practice on an individual basis, its true value is realised when scaled up in hospital settings and especially, the community.

Dr Al-Falahi is working hard to bring this technology into everyday use in hospitals. If successful in securing grant funding, he hopes to develop robust backend infrastructure which will support AI integration, aiming to position Campbelltown Hospital as a leader in AI-driven cardiac diagnostics.

“Ideally, what we want is to have every single ECG that gets taken everywhere in southwest Sydney to be available for interpretation through A-ECG, with results accessible at the fingertips of clinicians.”

development of a data-driven cardiology infrastructure needs to be developed by people working in the health system and not by commercial profit-driven companies.

“This is not something that can be rolled out by private enterprise. It needs to be done at a hospital system level where we have the infrastructure, the patient load, and the ability to support these systems in real-time, and more importantly, to learn from the process and implement changes.”

The Future of AI in Cardiology

Dr Al-Falahi is adamant that the

The future of cardiology lies in the integration of AI technologies that can detect, diagnose, and ultimately prevent heart conditions before they pose serious risks. While this research is still evolving, the potential is enormous.

“Actionable diagnostic patient data are no longer limited to the traditional history, examination and some tests.

Every waveform, sound bite and image carries diagnostic information if we learn to decipher it. We aim to create such data pipelines in our hospitals, starting with the ECGs, and validate them with current ground truths like angiograms or echocardiograms,” says Dr Al-Falahi.

to recruit 30,000 apparently healthy individuals and monitor for outcomes.

The ultimate goal is to empower people in the community to monitor their heart health from the comfort of their homes, potentially catching early signs of heart conditions without the immediate need for clinical intervention.

The process is straightforward: a user would launch the dedicated app on their iPhone, which will guide them through the steps of acquiring multiple ECG recordings using their Apple Watch. The app analyses this data and provides researchers with a standard 12-lead ECG and an

A-ECG interpretation of the results.

Furthermore, every ECG will also undergo manual traditional analysis to ensure current standards of care are maintained.

Dr. Al-Falahi’s work is currently in the development phase. His focus currently is on refining the user experience with using the App, ensuring it is intuitive and accessible to a wide range of users regardless of their technical abilities.

Once fully developed and deployed, this app could revolutionise how preventive cardiac care is delivered at home, making heart health monitoring more proactive and accessible.

The process would mean patients who present to an emergency department and who get an ECG would have their results automatically interpreted.

“This is not part of the current workflow. Firstly, we have to create the workflow, and then we have to see how we can interpret the output in a meaningful way to make a different to the way we practise in the hospital setting,” he explains.

Photo credit: SewcreamStudio (iStock)

Improving Sudden Cardiac Arrest (SCA) outcomes

By Linda Music

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ach year in Australia, approximately 3,000 seemingly healthy young individuals experience sudden cardiac arrest (SCA) without any prior warning.

Tragically, fewer than 10% survive.

The aftermath of such events leaves survivors, and the families of those who do not survive, with an urgent need for comprehensive medical and psychological support. Unfortunately, the current healthcare system often falls short, presenting critical gaps in

care that leave many families struggling to navigate the healthcare system and find the help they need.

For survivors, the journey to recovery is fraught with challenges.

They require not only immediate medical intervention but also ongoing support tailored to their unique needs.

This includes specialised cardiac rehabilitation programs that not only address the distinct aspects of their condition but also consider the isolation younger survivors may feel, as

most programs are designed for much older patients. Psychological support to help them cope with the trauma of their experience is equally vital. For the families of those who do not survive, the need for clear and supportive pathways through the healthcare system is equally crucial. These families are often left without adequate guidance, facing immense emotional and practical burdens.

In a pioneering initiative, a new $5 million MRFF funded project, In-SPHERE

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CARDIAC RESEARCH SPECIAL: SUDDEN CARDIAC ARREST

IMPROVE-SCA being run by SPHERE’s partner, Garvan Institute of Medical Research, aims to establish a national virtual centre dedicated to enhancing the diagnosis, management, and support of patients and families affected by young sudden cardiac arrest. IMPROVE-SCA is a transformative project set to redefine care standards and improve outcomes and survivorship across Australia.

The project is led by Associate Professor Jodie Ingles from Garvan, who highlights the significant inconsistencies in the care and information patients and their families receive after a cardiac arrest.

“Some patients and their families get the right support and information, while others miss out on essential tests, rehabilitation, or guidance. This is why we put together this study,” explains A/Prof Ingles.

“This study aims to address these gaps and ensure everyone, especially those facing health disparities like nonEnglish speakers or those in remote areas, can access clear and equitable healthcare pathways.”

Collaborating to Improve Cardiac Care One of the core components of the IMPROVE-SCA project is its multidisciplinary approach. The project brings together a team of national experts across diverse disciplines including ambulance services, intensive care, forensic medicine, cardiology, genetics, nursing, and psychology.

This broad expertise is crucial for creating a comprehensive and integrated care model and is bolstered by collaboration with consumer groups such as the National Heart Foundation of Australia and patient advocacy organisations including End Unexplained Cardiac Death (EndUCD), Heart of the Nation, and Heartbeat of Football.

A significant focus of IMPROVESCA is on addressing current gaps in care, particularly for marginalised groups such as Indigenous Australians and those residing in rural areas. These populations often face additional barriers to accessing quality healthcare and IMPROVE-SCA aims to develop

Ian’s story Ian Hutchison’s story is a reminder of how unpredictable and devastating sudden cardiac arrest (SCA) can be, even for those who seem in peak physical condition. A past Ironman and endurance athlete, Ian had always taken care of his health. But in 2018, he blacked out while cycling, and was taken to the hospital. Cardiac tests came back clear, and doctors attributed his collapse to dehydration.

However, the real threat was yet to reveal itself.

Just after returning his Holter monitor—a test designed to detect heart irregularities—Ian went on a casual bike ride with a friend. Without

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warning, Ian had a full cardiac arrest and spent 24 hours in an induced coma, waking to learn that bystanders, including his cycling partner, had saved his life with CPR. Two weeks in the hospital, an implanted defibrillator, and multiple surgeries followed, including two ablations for scar tissue on his heart.

Despite undergoing genetic testing

new pathways tailored to their specific needs. The project will involve reviewing existing care models and identifying deficiencies, with the goal of creating localised care pathways that are more inclusive and effective.

To achieve this, the project will design a virtual network that enhances diagnosis, management, and support for young patients and their families.

This network will leverage modern technologies, including mobile applications and virtual care options, to provide more accessible and flexible healthcare solutions. The effectiveness of these innovations will be rigorously tested through a trial that will focus on various aspects of patient experience, including stress levels, access to services, and overall well-being.

IMPROVE-SCA is set to revolutionise care for young SCA patients and their families. By fostering innovation and equity through strategic partnerships, this national virtual centre aims to raise care standards and improve outcomes, ensuring comprehensive support for all affected by sudden cardiac arrest. and screening 500 markers, no clear cause for his cardiac arrest has been found. Ian suspects a mix of overtraining and a perfect storm of factors, possibly viral or genetic.

He describes his experience as one of post-traumatic growth, having emerged stronger from his ordeal.

“It feels like I’ve been given extended time—a second chance.”

Ian’s close call highlights the critical need for research into SCA. As one of the few survivors, he feels fortunate and driven to raise awareness.

He now runs a CPR-friendly organisation that teaches CPR skills to the public and offers free resources online. https://www.cprfriendly.org

CARDIAC RESEARCH SPECIAL: SUDDEN CARDIAC ARREST

Aidan’s story At just 22, Aidan Balnaves-James had a bright future ahead of him. A kind and gentle soul, he cherished the simple joys of life, grasping a truth that many spend a lifetime searching for: the best of life is often right in front of us, wrapped in the love and security of family and friends. Alongside this deep appreciation, Aidan had a keen interest in politics and world affairs, was an avid fan of Doctor Who and expressed himself through poetry. He was in his second year of a law degree and was about to receive the Dean’s Award for his academic achievements.

But Aidan never got to personally collect his award. On a May morning in 2018, Aidan started his day like any other—he had breakfast, got dressed, and prepared for uni. But unlike any other day, Aidan never made it out of his house. At some point that morning, his heart simply stopped beating, and his promising life was tragically cut short.

Coping with Aidan’s sudden and unexpected death was devastating for his family, leaving them with an agonising question: How could a seemingly healthy young man, full of life and promise, be gone so quickly?

As they looked back, they realised there were red flags of a rare disease that had been tragically missed. Yet until there is more medical knowledge, the role of this rare disease in causing Aidan’s sudden unexpected arrythmia and subsequent death remains uncertain.

A hidden rare disease

Three years before his death, Aidan experienced a strange episode involving fleeting sensations and he felt momentarily unable to move his limbs. Despite seeing a cardiologist who undertook extensive cardiac tests, all results came back normal. In 2017,

Aidan had a similar episode and again remained fully conscious. The day before he was due to see a neurologist for these strange symptoms, he coughed up blood. The neurologist sent him for a Chest CT scan which revealed a hydropneumothorax and partial lung collapse. Despite these findings, Aidan appeared and felt perfectly fine. He was hospitalised for ten days and treated for pneumonia, but his doctors were puzzled by the

discrepancy between his severe scan results and his lack of symptoms.

Normal blood tests and the absence of an obvious bacterial infection only deepened the mystery. In hindsight, this lung event contained the red flags of a rare disease.

“Aidan had seen a cardiologist, a neurologist and a respiratory specialist.

The question that should have been asked is why is a ‘healthy’ young man seeing these specialists? The possibility of a rare genetic disease should have been thought of,” says Aidan’s mum, Jenny.

Genetic testing and a diagnosis

After his death, Aidan’s family were told the cause of his death was ‘unascertained.’ Whilst this still remains

the case, Aidan’s subsequent genetic results revealed a hidden sinister disease, Vascular Ehlers-Danlos Syndrome (VEDS).

VEDS is a genetic disorder affecting connective tissue, primarily due to mutations in the COL3A1 gene, which impacts the production of type III collagen. This faulty or reduced collagen III can lead to weaknesses in various body systems, making arteries, organs, skin, and lungs prone to potentially life-threatening tears. However, whilst VEDS was the explanation for Aidan’s unusual lung presentation, to date there have been no other known cases in the world literature linking VEDS with a sudden arrhythmic death.

“Until there are other cases linking VEDS with a sudden arrhythmic death, we can’t definitively link the two events. We are in the land of the rare of the rare,” Jenny said.

In the wake of Aidan’s death, his family faced the terrifying prospect that their younger son might also have the disease. The whole family underwent genetic testing for VEDS, a condition that can be inherited or result from a spontaneous gene mutation at the time of conception.

“The fear for our younger son was overwhelming but after several weeks of anxious waiting the genetic tests came back negative, confirming that Aidan’s VEDS was due to a spontaneous mutation.”

Need for research

Jenny is adamant that genetic testing could play a role in preventing future deaths like Aidan’s.

“In a future world, I’d like research which could map all the genetic abnormalities and then uncover methods that allow editing out of genetic faults to prevent sudden unexpected deaths in young people.”

However, she also believes that research is needed to help families In-SPHERE

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CARDIAC SPECIAL: SUDDEN CARDIAC ARREST

Aidan’s story cont’d Photo credit: Alena Butusava (iStock)

Uncovering genetic causes of SCA Improving the diagnosis of the underlying cause of sudden cardiac arrest (SCA) can offer crucial benefits, particularly when the cause is hereditary.

“Many families never receive a definitive diagnosis, which can leave them uncertain and anxious, especially if the condition is suspected to be genetic,” explains A/Prof Ingles.

Garvan’s MRFF-funded Elusive Hearts project uses advanced clinical genetic testing and analysing sequencing data to uncover more about the genetic causes of SCA. “In this 12-month study, we prioritise families who have already undergone genetic testing for inherited cardiac conditions but who have returned a negative result. The study prioritises families most likely to have genetic issues, including those with a history of heart disease, early onset symptoms or severe cases.

These families receive in-depth sequencing and genomic analysis with the aim of gene discovery.”

When a genetic cause is identified, cascade genetic testing can help assess risk among family members, providing valuable information and guiding further monitoring.

“Having a clear diagnosis allows for more effective genetic counselling and better decision-making, helping to reduce anxiety and uncertainty for families. Offering an explanation for a sudden cardiac death can be a powerful way to support grieving families and improve their management options. The goal is to provide clarity about the cause of SCA, ensuring families have the information they need to manage their health and alleviate ongoing concerns.”

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in the aftermath of a young person’s death.

“The immediate aftermath is so cataclysmic and devastating.

You’re filled with anxiety about how to navigate through the medical information as well as learning how to cope with a new world that includes the loss of your beloved child,” explains Jenny.

“We need research around what families need or want after the death of a young person. We need to ask families what information they would have liked and develop some compassionate proactive systems of care that can assist families.”

Jenny describes months of searching for answers led her to read everything she could, not only about sudden unexplained cardiac deaths in the young and VEDS, but also about grief and the experiences of others who are bereaved.

“I was looking for hope, and what I could actively do. And I was looking for evidence that bereaved families can continue to live with purpose because that is what we needed to do to honour Aidan’s life. Aidan was always actively engaged in life, and part of his legacy is to show us all a way of living with ongoing meaning and love.

We must grieve and also live at the

same time. The human spirit can be amazing.”

More education

Jenny is a strong advocate of increasing the availability of, and access to, defibrillators. As a GP herself, she also wants to see increased education around prevention and follow-up of sudden cardiac death and also the red flags of rare disease.

“All medical specialties, including general practice, should be alert to the possibility of these two phenomena, and understand where to turn to for information and how to link in with their colleagues.”

Moving forward

Knowing the difficulties faced by families, Aidan’s parents Jenny and Edmund started up Walk for Life in 2022. The event brings together people who have been affected by the loss of a young person to sudden cardiac arrest.

“People often feel isolated by this experience, and this is a chance to bring people together to be with others who understand while honouring and celebrating the life we lost,” explains Jenny.

This year’s event will be held on 17 November and registrations are now open.

Photo credit: mamypuk (iStock)

Improving end-of-life care in cardiology

Photo credit: gorodenkoff (iStock)

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team of researchers from the SPHERE Nursing and Midwifery Implementation Science Academy has been awarded a highly competitive St Vincent’s Clinic Research Foundation grant to conduct groundbreaking research aimed at improving end-of-life care for patients in Australian cardiology wards.

Led by early-career researcher Dr Nicola Straiton, alongside Tessa Holman and Professor Sandy Middleton from the Nursing Research Institute at St Vincent’s Health Sydney and Australian Catholic University, the project is a collaborative effort.

The team also includes A/Prof Suzanne Sheppard-Law (University of Technology Sydney, Prince of Wales Hospital), Associate Professor Gemma McErlean (University of Wollongong, St George Hospital), and other SPHERE Academy members.

Together, they will focus on enhancing care for patients with life-limiting cardiovascular conditions in hospital settings.

This initiative, part of a larger research program led by Prof Diana Slade, Liza Goncharov, Dr Georgia Carr and her colleagues at the Australian National University, will draw on the collective expertise of clinicians and academic researchers

from hospitals across Sydney, including St Vincent’s Hospital, Prince of Wales Hospital, and St George Hospital. The collaboration also extends to consumer representatives, ensuring that patient and family perspectives are considered throughout the research process.

“Care during the final stages of life is crucial, not only to ease suffering for patients but also to reduce the emotional toll on their loved ones,” said Dr Straiton.

“This research fosters collaboration between hospitals and clinicians to ensure patients receive high-quality care during the end-of-life.”

Hospital cardiology wards face unique challenges in delivering palliative care due to high patient volumes and the unpredictable nature of their conditions. As a result, many patients receive aggressive, non-palliative interventions in the last days of life. In fact, 68% of cardiology patients undergo nonpalliative treatments in the final 48 hours, highlighting the need for better integration of palliative principles into acute care settings.

The research team plans to conduct a multi-site retrospective audit of medical records from the past two years using the End-of-Life Care Audit Tool, developed by the Australian

Professor Sandy Middleton

Commission on Safety and Quality in Health Care (ACSQHC). By analysing adherence to and deviations from best practice guidelines, the team aims to pinpoint areas where improvements can be made and ensure more compassionate, patient-centered care in cardiology wards.

Professor Middleton emphasised the significance of the project, “This is another example of the Academy’s collaborative, multicentre approach to enhancing patient outcomes and care delivery. It highlights the significant impact of nurse and midwifery-led research, demonstrating how routinely collected data can be leveraged to improve patient care—an approach aligned with a learning health system ecosystem.”

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Photo credit: Valerii Apetroaiei (iStock)

CARDIAC RESEARCH SPECIAL: RADIOTHERAPY

Unlocking cardiac risks from radiotherapy Cardiac side effects are a potential risk that can impact on patients’ long term cardiovascular health.

By Linda Music

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horacic radiotherapy is a cornerstone in the fight against breast and lung cancer, but cardiac side effects are a potential risk that can impact on patients’ long term cardiovascular health.

The sensitivity of the heart’s complex substructures, such as the coronary arteries, heart valves, and conduction system, to radiation is an area that requires further research.

As cancer treatments continue to evolve and improve patient survival, there is also an urgent need to better understand and prevent heart disease related to a patient’s treatment.

Understanding the significance of this, Dr Vicky Chin, a SPHERE Cancer CAG PhD Top up Grant recipient, set out to investigate how radiotherapy can affect the heart and its substructures.

“A lot of our current knowledge is based on dose to the whole heart but we need more research into how radiation affects the various components of the heart so we can

minimise damage to the heart and improve long-term survival,” says Dr Chin.

To bridge this critical knowledge gap, Dr. Vicky Chin and a multidisciplinary team comprising computer scientists, cardiologists, radiation oncologists, and medical physicists at the Ingham Institute, developed a tool which delineates the structures of the heart on patient imaging.

“The automatic segmentation Dr Vicky Chin tool we developed and validated can This tool is also open access, accurately and consistently delineate allowing researchers and clinicians the heart and its substructures on worldwide to access the tool to patient images, enabling a more precise improve their own studies and clinical understanding of the radiation doses delivered to the heart during thoracic practices, fostering a global effort to reduce the risk of cardiac toxicity in radiotherapy,” Dr Chin explains. cancer patients.

“We can then utilise data mining “Addressing this issue is vital to and data linkage methods to analyse improving patient outcomes, as it can large quantities of radiotherapy data, lead to more personalised treatments, including cardiac dose distributions ultimately reducing the risk of cardiac and link this with comorbidities and complications and enhancing the outcomes of patients treated for overall quality of care for cancer breast and lung cancer in NSW patients,” Dr Chin says. centres.”

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Photo credit: madsci (iStock)

FROM OUR PARTNER: VICTOR CHANG CARDIAC RESEARCH INSTITUTE

Pollution and climate crisis causing millions of heart deaths annually Man-made pollutants and climate change contribute to millions of deaths from cardiovascular disease each year

By Julia Timms, Victor Chang Cardiac Research Institute

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new series recently published in the Journal of the American College of Cardiology highlights how pollution is a greater health threat than that of war, terrorism, malaria, HIV, tuberculosis, drugs and alcohol combined.

Researchers from SPHERE partner, Victor Chang Cardiac Research Institute and international collaborators focused on global warming, air pollution and exposure to wildfire smoke, and the lesser-known drivers of heart disease including soil, noise and light pollution, and exposure to toxic chemicals.

Professor Jason Kovacic, Director of the Institute and Professor of Medicine at UNSW Sydney, says there is an urgent need to improve the monitoring of these pollutants to

identify communities most at risk, and better understand how exposure to specific pollutants raises the risk of cardiovascular disease at the individual level.

“Every year around 19 million people worldwide die from cardiovascular disease with pollutants playing an ever-increasing role,” says Professor Kovacic.

“Our bodies are being bombarded with pollutants from every angle and they are taking a toll on our heart health. The evidence suggests that the number of people dying prematurely because of these very different forms of pollution is far higher than currently recognised.”

Pollutants are known drivers of cardiovascular disease, but they affect

Professor Jason Kovacic

the body in different ways. Smoke and other toxins can be directly inhaled deep into the lower respiratory tract and reach the blood and then be transported to other organs and throughout our bodies. They can cause In-SPHERE

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FROM OUR PARTNER: VICTOR CHANG CARDIAC RESEARCH INSTITUTE

oxidative stress which can damage cells and organs including the heart.

Other pollutants like noise and light pollution can affect sleep patterns, drive inflammation and lead to an increase in blood pressure and weight gain. Extreme heat can also lead to dehydration, decreased blood volume, increased cardiovascular strain, and acute kidney failure.

“Whilst many of these biological mechanisms are known, we still have a huge gap in our understanding of the link between pollutants and heart disease,” Professor Kovacic adds.

How light pollution can damage your heart

The Victor Chang Cardiac Research Institute has called for more awareness of the health impacts of light pollution.

Exposure to artificial light at

night is associated with an increased risk of coronary heart disease and other cardiovascular events, which researchers say is, in part, related to changes in the body’s circadian rhythm.

“Most Australians are aware of the most common risks of heart disease such as being overweight, a lack of exercise or smoking, but very few would be aware that light pollution is also adding to this health burden,” says Professor Kovacic.

“When we are exposed to artificial lights at night our sleep patterns are disrupted, and it’s easy to see why.

Street lights are left on all night which can stream in through windows and far too many of us are on devices until late in the day.”

Professor Kovacic was part of an international team that examined the current evidence on the links

between light pollution and heart health. They highlighted one study of 60,000 people that found those with the highest light pollution exposure were 23 percent more likely to be hospitalised for coronary heart disease and 29 percent more likely to die from coronary heart disease.

Professor Kovacic says these findings were especially concerning given the levels of light pollution Australians are exposed to as demonstrated by the Global Atlas Map on light pollution.

The light pollution map, which uses US Government satellite data, reveals Australians are exposed to more light pollution than other G20 countries including France, Japan, Brazil, Mexico, India, and China. Light pollution exposure has also increased by over a third in Australia since 2012.

Photo credit: Everlock (iStock)

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CARDIAC RESEARCH SPECIAL; CONSUMER PROFILE

Audrey Lee

Bridging hearts and research

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udrey Lee’s journey as a consumer representative in heart health research was driven by personal experience and a deep commitment to making a difference.

“I have heart disease. I had a stent put in in 2003 and then another one in 2019. My husband also had heart disease. When he died four years ago, like a lot of women who have been married for a very long time, I found myself searching for ways to cope.”

Audrey’s introduction to consumer representation came through her cardiologist’s suggestion to get involved with research.

“It’s through him that I got in touch with The George Institute of Global Health,” she explains.

Since then, Audrey has become an integral part of their Cardiovascular Health Panel, as well as the Brain Health Panel. The Institute’s Panel members provide essential health consumer perspectives and lived experiences in their research programs, enabling consumers to actively influence ongoing and future research. They help identify gaps, barriers, strengths, and opportunities for enhancing Consumer and Community Involvement (CCI) in research initiatives.

“Community representatives on these Panels are extremely well supported by The George Institute.

And I’ve learnt so much. There are so many crossovers between heart and

brain health that I hadn’t considered before. Being on these Panels opened my eyes to new perspectives,” she explains.

As a consumer representative, Audrey plays a crucial role in helping shape research agendas.

“We attend regular meetings where early career researchers present their work,” she describes.

“Our role is to provide immediate feedback and later delve deeper into their papers, ensuring that the research is accessible and relevant to consumers.”

Audrey’s commitment to improving heart health extends beyond her work at the George Institute. She was a member of SPHERE’s Cardiac and Vascular Health CAG Consumer group and is currently actively involved in the National Hypertension Taskforce whose goal is to increase blood pressure control from 32% to 70% by 2030 in Australia. In this Taskforce, Audrey contributes to two working groups, one which focuses on increasing patient activation and engagement, and the other dedicated to raising and maintaining awareness at all levels.

“The researchers in these groups are incredibly engaging and passionate about their work. It’s exciting to collaborate with people who are so dedicated to making a difference.”

Audrey is also involved in various initiatives aimed at improving public health outcomes.

“I’m engaged in two studies focused on reducing salt intake and exploring alternatives. These efforts are about finding ways to introduce these alternatives to various groups who need them.”

Audrey’s commitment extends beyond research panels; she actively promotes outdoor activities for health recovery and fosters intergenerational connections through community programs.

“It’s about giving back and learning from each other,” Audrey explains.

“I enjoy the collaborative spirit within these groups. We bounce ideas off each other, putting forward our views on innovative solutions.”

Reflecting on the evolution of consumer representation in research, Audrey acknowledges initial scepticism but notes a shift in researcher attitudes.

“There was hesitancy at first, but now I do believe researchers appreciate our input. Our perspective complements theirs, ensuring that research outcomes are meaningful and inclusive.”

With her legal background (Audrey was a solicitor for 35 years) and personal journey, Audrey brings a unique perspective to the table.

“I believe in the power of collaboration. Together, we can achieve far more than we could alone.”

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Photo credit: Obencem (iStock)

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CARDIAC RESEARCH SPECIAL: HYPERTENSION

Adrenal Vein Sampling Uncovering a hidden cause of hypertension Adrenal Vein Sampling (AVS) reveals Primary Aldosteronism, a hidden cause of high blood pressure, guiding precise treatment.

By Linda Music

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rimary Aldosteronism (PA) might not be a condition most people have heard of, but it’s a major player in the world of hypertension, quietly contributing to high blood pressure and putting hearts and kidneys at risk. It’s caused by the adrenal glands going into overdrive and producing too much aldosterone, a hormone that controls blood pressure.

Diagnosing PA isn’t just about figuring out what’s wrong; it’s about tailoring treatment to the exact problem. That’s where Adrenal Vein Sampling (AVS) steps in.

By sampling blood directly from each adrenal gland, AVS pinpoints which gland is misbehaving, distinguishing between unilateral (one-sided) and

bilateral (both sides) aldosterone overproduction. If the problem is unilateral, surgery could be a gamechanger, potentially curing the condition. But if it’s bilateral, the patient will need a particular type of life-long blocking medication.

Performed properly, AVS is currently the benchmark for localising PA, but it’s not an easy task. The procedure demands skill and experience, and not every interventional radiologist is in a position to perform it effectively and often.

Limited AVS services

Few hospitals in Australia offer AVS, and those that do often vary in how they perform the procedure.

In Brisbane and Newcastle, where AVS has been centralised at a single facility ensuring higher standards, it can present a logistical challenge for patients who must travel long distances to access this essential service.

Geographical challenges are a real barrier for many patients, highlighting the need for a more widespread and consistent approach to AVS. Recognising the need for a better test or broader access and standardisation, a collaborative network of experienced centres has been established across Australia. This network includes several SPHERE partners in NSW, including St George and The Prince of Wales Hospitals within the South Eastern Sydney In-SPHERE

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CARDIAC RESEARCH SPECIAL: HYPERTENSION

Local Health District. These centres, as well as SPHERE’s Cardiac and Vascular Clinical Theme, are part of a nationwide effort to standardise the diagnosis of PA and implement practices that will improve equity of access and the quality and safety of service provision for PA diagnostics.

Implementing AVS services

To further address these challenges, research at Monash University is also underway to examine the ‘real-world’ implementation of AVS services in hospitals. This study aims to capture the experiences of existing AVS teams, focusing on accessibility, uniformity, and patient experience. By analysing survey data and conducting interviews with AVS implementation teams, researchers hope to identify best practices and areas requiring further attention. The findings will be used to guide future efforts by

Photo credit: Chinnapong (iStock)

SPHERE’s Cardiac and Vascular Health Clinical theme improve existing services before setting up new AVS sites, helping hospitals navigate the complexities of implementation.

This behind-the-scenes work is crucial. By focusing on accessibility and consistency, the push to standardise AVS is about more than

just improving a procedure—it’s about ensuring that all Australians with PA have access to the life-changing care they need. As this effort gains momentum, it promises to make a real difference, turning the tide against a silent but serious health threat and bringing better outcomes within reach for patients across the country.

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Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE) 1 Campbell Street, Liverpool NSW 2170 www.thesphere.com.au Connect with us on: Twitter/X LinkedIn

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