Invited Speakers
Dr Neil Oldridge
Director, Fellowship Research and Cardiac Rehabilitation, Aurora Cardiovascular Services, Aurora Health Care, Milwaukee, Wisconsin, USA
Board Certifications: Preventive and Rehabilitative Exercise Program Director (American College of Sports Medicine). Research interests: Patient outcomes research. Effectiveness and cost-effectiveness of cardiac rehabilitation. Patient health-related quality of life
Dr. Oldridge is the Director of Fellowship Research for the Cardiology and Electrophysiology Fellows of Aurora Sinai Medical Center and is responsible for guiding Fellows in the development of research protocols and projects and for mentoring and training Fellows in the techniques and outcomes of cardiac rehabilitation. Dr. Oldridge teaches a regular research seminar series for Fellows with a focus on cardiovascular disease prevention and rehabilitation.
Dr. Oldridge received his Ph.D. at the University of Wisconsin, Madison after completing undergraduate studies including a B.A. in South Africa and M.A. at the University of Florida. He has extensive experience in research and has written and contributed to several dozen books and over 130 articles in peer-reviewed journals. His honors include the Citation Award from the American College of Sports Medicine, the University of Wisconsin-Milwaukee Foundation Research Award, the M. Pollock Established Researcher Award from the American Association for Cardiovascular and Pulmonary Rehabilitation, and the Peter Beckmann Medal for Lifetime Achievement in Research in Cardiac Rehabilitation from the German Society of Prevention and Rehabilitation of Cardiovascular Disease. He is a former President of the American College of Sports Medicine.
He is Clinical Professor of Medicine, School of Medicine and Public Health, University of Wisconsin and Professor Emeritus and Senior Scientist in the College of Health Sciences, University of Wisconsin-Milwaukee; he has held positions as Professor of Health Sciences and Medicine, Indiana University and Professor of Kinesiology and Medicine at McMaster University, Ontario, Canada. Dr. Oldridge has been invited as visiting professor at major universities in Hong Kong and South Africa and was a Visiting Scholar at Stanford in California. He has served on several NIH expert panels and journal editorial panels regarding health research and, cardiac rehabilitation and is a member of several professional organizations including the American College of Sports Medicine, the American Association of Cardiovascular & Pulmonary Rehabilitation, the European Society of Cardiology, the European Association of Cardiovascular Prevention and Rehabilitation and the American Heart Association.
How effective is cardiac rehabilitation and secondary prevention? Clinical and cost benefits?
Chronic disease management programmes improve health outcomes for people with chronic illness and save money on a predictable basis. Clinical trials provide the primary scientific basis for the evidence on which clinical guidelines are based. A systematic review, which may or may not include meta-analysis, is designed to combine and analyze the findings from individual clinical trials and provides a summary or synthesis of an area of research. This information may then be used to evaluate therapeutic effectiveness and cost-effectiveness, to generate hypotheses and to plan new studies. But caution is needed; the results of systematic reviews need to be carefully and judiciously interpreted.
Typically secondary prevention programmes for patients with ischemic heart disease include both exercise and non-exercise based interventions such as group and individual risk factor management, education and counseling. The first two major systematic reviews of exercise-based cardiac rehabilitation were published in 1988 and 1989 and focused on mortality with both reporting a significant 20%-25% reduction in all-cause and cardiovascular mortality. Since 2000 there have been a number of systematic reviews of both exercise and non-exercise based interventions and clinical effectiveness [mortality, morbidity, risk factors and health-related quality of life] as well as cost-effectiveness in patients with ischemic heart disease. The conclusions of these more recent systematic reviews of exercise and non-exercise based interventions confirm the reduced mortality reported earlier with exercise interventions and extend positive observations to morbidity, risk factor management, health-related quality of life outcomes and cost-effectiveness. As a result, secondary prevention exercise and non-exercise based programs for patients with established ischemic heart disease have become increasingly widely accepted as evidenced by National Guidelines including those published in Australia but not as widely incorporated into clinical practice as suggested by the various Guidelines. The clinical and cost benefits of secondary prevention and cardiac rehabilitation, as presented in different systematic reviews, will be examined in light of the lower than desired utilization rates.
Outcome measures in cardiac rehabilitation; What to measure and the potential value.
A critical step in improving patient care is the assessment of patient-reported outcomes [PRO]. A PRO is a report of the status of a patient’s health condition coming directly from the patient, without interpretation of the patient’s response by a clinician or anyone else. “Is there an adequate PRO instrument to assess and measure the concepts of interest?” is the first question to be asked when planning to use a PRO instrument for a specific clinical audit or research purpose. In order to decide whether it does, the population to be audited or studied needs to be defined, the objectives of the audit or study need to be clearly stated, the PRO instrument’s conceptual framework and its measurement properties need to be examined. If it does not, a PRO instrument can be developed de novo or, in some situations, by modifying an existing instrument.
In this case, we are interested in patients with ischemic heart disease [IHD], the objective is the effectiveness of treatment, specifically cardiac rehabilitation, the conceptual framework is health status or health-related quality of life [HRQL] and the instrument measurement properties of interest are primarily reliability, validity [including responsiveness] and burden. IHD specific PRO HRQL instruments are available for patients with the three major diagnoses, angina, myocardial infarction [MI] and heart failure. However, this limits use of any one of these specific instruments when the objective is to make cross-diagnosis comparisons when investigating the effectiveness of a treatment such as cardiac rehabilitation that is routinely used in patients with these three diagnoses.
The HeartQoL Project, under the auspices of the European Association of Cardiovascular Prevention and Rehabilitation and the European Society of Cardiology with the support of the European Society of Health Psychology, was designed to develop a reliable and valid IHD specific core HRQL instrument for use in patients with angina, MI or heart failure. Further, to be of value in international studies, HRQL instruments must be available in a range of languages, as clinical studies require multi-national and multi-language site collaboration. The details of the HeartQoL Project will be discussed. In summary, as of mid-July, 2010, data had been entered on 6,247 patients with IHD [2,331 with myocardial infarction, 2,069 with angina and 1,847 with heart failure] speaking 15 European languages in 21 countries [18 in Europe plus Australia, Canada and USA] with 58 sites worldwide. Analysis of the data with item reduction using the clinical impact method and Mokken scaling, has resulted in a 16-item HeartQoL instrument for the assessment of patient-reported HRQL with the potential to be a reliable and valid core HRQL instrument in patients with IHD. However, the cross-sectional design of the HeartQoL Project specifically precluded demonstration of the responsiveness of the questionnaire. The responsiveness of the HeartQoL questionnaire is presently being addressed in a prospective study with percutaneous coronary intervention and cardiac rehabilitation as the treatment interventions. It is expected that cross-diagnosis comparisons of patients with angina, MI and heart failure will be possible with this single, core IHD HRQL instrument.
Professor Andrew Coats
Professor Andrew Coats, trained at Oxford (pre-clinical) and Cambridge (clinical) before completing his general medical and cardiological training in Melbourne. In 1991, Professor Coats joined the National Heart and Lung Institute, Imperial College School of Medicine and headed the Department of Clinical Cardiology as the first Viscount Royston Professor of Clinical Cardiology. From 1996-2000, he was Director of Cardiology at the Royal Brompton Hospital and from 2001 was Associate Medical Director (R+D). Professor Coats has received the Linacre Medal of the Royal College of Physicians and gave the Inaugural Michael LPollock Memorial Lecture of the American Heart Association. His main research interests are in the pathophysiology and therapy of chronic heart failure, in exercise physiology and in the management of hypertension.
Professor Coats has served in various roles on steering
committees of major international cardiovascular
trials. In 2003, he was appointed Chair of the
NSW Ministerial Council on Medical & Health
Research and Chair of the Australian Health
Information Council. He has published more
than 400 full papers on cardiovascular research.
Professor Coats is proudly sponsored by: 
Dr Doa El-Ansary
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne
Dr El-Ansary is a Lecturer in Physiotherapy and Doctor of Physiotherapy Program (DPhysio) Coordinator at the Department of Physiotherapy in the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne.
She has a background in both Cardiorespiratory and Musculoskeletal physiotherapy with postgraduate qualifications in manual therapy. Prior to her appointment at the University she was a senior cardiothoracic physiotherapist at The Canberra Hospital for 12 years and was part of the inaugural academic team for the Master in Physiotherapy program at the University of Canberra. She was also an honorary staff member at the Australian Institute of Sport (ACT) lecturing on the Masters of Sports Medicine program in functional anatomy.
Dr El-Ansary completed her PhD at the University of Sydney in 2008 on: “Physiotherapy Management of Sternal Instability Following Cardiac Surgery”
Her research interests include: cardiothoracic surgery, sternal instability, atypical chest pain, differential diagnosis of chest pain, ultrasound imaging, and functional anatomy.
Professor Anne Keogh
Joint Head Clinical Research
Senior Cardiologist, Cardiac Transplantation
Victor Chang Cardiac Research Institute,
St Vincent’s Hospital
Professor Keogh is Joint Head of the Clinical Research Program in the Victor Chang Cardiac Research Institute in Sydney and the Senior Cardiologist in Cardiac Transplantation. She completed her Medical Doctorate, University of New South Wales on “Clinical Aspects of Heart Transplantation” in 1989. Dr Keogh was awarded a Fullbright Scholarship in 1989 to work at Stanford University Hospital, Palo Alto, California, USA. She is currently Professor in Medicine at the University of New South Wales, Fellow of the Royal Australian College of Physicians and reviews for an extensive number of international journals. Professor Keogh is a member and a Past President of the International Society for Heart and Lung Transplantation (ISHLT) as well as the Cardiac Society of Australia and New Zealand, Transplantation Society of Australia and New Zealand, and an Honorary Member of the American Society of Transplant Physicians and the American Society of Transplant Surgeons. Her current clinical research interests are left heart failure, pulmonary hypertension, heart transplantation, immunosuppression and alternatives to transplantation. She has published widely with more than 250 peer articles and 300 abstracts since 1984.
Professor Keogh is proudly sponsored by:
Professor David Thompson
BSc MA MBA PhD RN FRCN FAAN FESC
RCN Cardiovascular Network Steering Committee Member 
David is Professor of Nursing at the Australian Catholic University and is based in the Cardiovascular Research Centre at St Vincent's Hospital in Melbourne. Prior to moving to Melbourne in June he was Professor of Cardiovascular Nursing at the University of Leicester (2007-2010) and before that Professor of Nursing at the Chinese University of Hong Kong (2002-2007), the University of York (1998-2002) and the University of Hull (1994-1998). He was also the first Professor of Nursing Research at the UK Department of Health.
David has extensive clinical and research experience in cardiovascular prevention and rehabilitation with a focus on designing and evaluating brief psychosocial interventions and developing and validating patient reported outcome measures. He has around 500 publications, including 15 books, is an editor of the European Journal of Cardiovascular Nursing and a member of the editoirial boards of Heart, the European Journal of Cardiovascular Prevention and Rehabilitation and the British Journal of Cardiac Nursing
Abstract
Cardiac rehabilitation in multi-cultural populations
This presentation draws upon personal experience of working with South Asian and Chinese populations; defines culture and ethnicity; reviews some cultural and ethnic influences pertaining to access and uptake of cardiac rehabilitation services, including evidence of poor service provision and possible barriers; suggests sustainable approaches to improving services for multi-cultural populations; and concludes with a proposed framework for culturally competent cardiac rehabilitation.
Dr Penny Abbott
Aboriginal Medical Service Western Sydney
Clinical senior lecturer, Department of General Practice, Western Clinical School, University of Sydney, University of Sydney - Western Clinical School
Dr Abbott has been a GP at the Aboriginal Medical Service Western Sydney for 18 years where she has a mixture of clinical, health promotion and research duties. She has a special interest in diabetes and cardiovascular disease. Dr Abbott also works in the area of GP research at the University of Western Sydney and as a visiting GP with Justice Health
Promoting cardiovascular health in an Aboriginal community setting
Penny Abbott and Joyce Davison
Despite a much higher burden of cardiovascular disease and diabetes, Aboriginal people access health education programs, including cardiac rehabilitation, much less than non-Aboriginal Australians. In this session an Aboriginal health worker and a GP with a long history of working in an Aboriginal community setting will discuss barriers to health behaviour change and strategies to increase the success of health education programs in this group.