Judith Masha Katzenellenbogen

Introduction: Rheumatic heart disease (RHD) is the acquired autoimmune heart valve damage resulting from untreated infection with the Streptococcus pyogenes bacterium, which affects people experiencing socioeconomic disadvantage globally. This study measured RHD‐associated major adverse cardiovascular events (MACE) and the increased risk associated with pregnancy among women diagnosed with RHD. Material and Methods: Population‐level analysis of all births to women with RHD in four Australian jurisdictions was conducted, which covered 71% of the total population and 88% of the Aboriginal and Torres Strait Islander population (a group who experience some of the highest RHD rates reported globally). A retrospective cohort study using linked RHD register and midwives, hospital, and death data collections was designed. Females with at least one birth record aged 12–44 years, whose first RHD diagnosis occurred prior to 20 weeks' gestation and age < 35 years, were identified during 2002–2017. Survival methods (incorporating mixed effects and time‐varying covariates) estimated proportions and hazard ratios. Probability of hospitalization for new RHD‐associated MACE was measured for pulmonary hypertension secondary to left heart disease, heart failure, valvular surgery, stroke, infective endocarditis, atrial fibrillation, acute pulmonary edema, cardiomyopathy, and/or death. Results: We identified 558 pregnancies in women with uncomplicated RHD (345 women) and 88 pregnancies in women with complicated RHD (60 women). During pregnancy, 4.5% of women with uncomplicated RHD and 31.8% of women with complicated RHD experienced new RHD‐associated MACE. Risk of RHD‐associated MACE was three‐ to six‐fold higher during periods of pregnancy (compared with non‐pregnancy) and did not differ by RHD stage. Conclusions: After 20 weeks of gestation, women with RHD experienced RHD‐associated MACE outcomes at frequencies that were contingent upon RHD stage at 20 weeks of gestation. Awareness of RHD status before 20 weeks of gestation, especially in regions where RHD is endemic, is critical for ensuring women's cardiovascular health in pregnancy and beyond.

BACKGROUND: Aboriginal Australians experience a disproportionate burden of acute coronary syndrome (ACS), contributing to health disparities. Evidence on changes in ACS incidence is limited. This study investigates temporal changes in the gap between Aboriginal and non-Aboriginal populations in ACS incidence and case fatality within the context of the Closing the Gap initiative, a national policy framework to reduce inequalities. METHODS: This population-based cohort study used linked hospital and mortality data for Western Australian residents aged 25 to 84 years. Incident ACS cases (2003–2020) were identified using a fixed 18-year lookback. Age-standardized incidence rates were calculated using prevalence-adjusted denominators and direct standardization. Average annual percentage changes in incidence, case fatality, and Aboriginal-to-non-Aboriginal incidence rate ratios were estimated from Poisson regression, stratified by sex and age-group (25–54, 55–84 years). Estimates were derived separately for pre–Closing the Gap (2003–2008) and post–Closing the Gap periods (2009–2016; 2017–2020). RESULTS: The annual at-risk population was 1 215 300 in 2003 and 1 765 564 in 2020. We identified 4097 Aboriginal (mean age: 52.3, 40.8% women) and 64 805 non-Aboriginal (mean age: 65.1, 31.3% women) incident ACS cases. Aboriginal people had a higher prevalence of diabetes (58.5% versus 26.4%) and chronic kidney disease (27.5% versus 10.9%). ACS rates declined across all Aboriginal age/sex groups, although only significant between 2009 and 2016 for older men (–4.9%/y [95% CI, −8.9% to −0.7%]) and younger women (–4.8%/y [95% CI, –8.7% to –0.7%]). There were limited changes in incidence rate ratios between 2003 to 2008 and 2017 to 2020, respectively, in men (25–54 years, 5.2–5.6; 55–84 years, 2.9–2.1) and women (25–54 years, 10.3–10.0; 55–84 years, 2.9–3.6). Case fatality remained 20% to 50% higher among Aboriginal than non-Aboriginal people across periods and age-sex strata (risk ratios, 1.2–1.5). CONCLUSIONS: Despite some evidence of declines in ACS incidence among Aboriginal groups, disparities with non-Aboriginal people persisted. Sustained Aboriginal-led efforts are needed to address underlying determinants and reduce the gap.

Objective: To determine age-specific and age-standardised incidence trends of acute rheumatic fever (ARF) or rheumatic heart disease (RHD) among Indigenous Western Australians aged less than 35 years of age. Design: A population-based retrospective cohort study with linked data analysis. Setting: Western Australian hospital admissions (1996–2022) and RHD notifications to the state-based register (2011–2015). Participants: Patients, both Indigenous and non-Indigenous aged <35 years at diagnosis with incident ARF or RHD. Results: Of 1746 incident ARF/RHD cases, 1526 (87%) were Indigenous peoples, with the highest rates observed in patients aged 5–14 years, with an annual estimated increase of 4.3% (95% CI 3.2% to 5.2%). The 0–4 years age group experienced an annual increase in incidence rates of 4.8% (95% CI 1.4% to 8.2%). Overall, Indigenous patients experienced an annual increase of 1.9% (95% CI 1.3% to 2.6%) from 1996 to 2022. However, most cases (n=894) were identified after multiple significant policy developments (2011–2022) with an annual increase of 5.7% (95% CI 3.7% to 7.5%) for this period. Conclusion: Increasing trends of incident ARF/RHD were observed in Indigenous patients aged under 15 years, with the greatest annual increments observed after policy implementation for disease reporting and awareness in the period from 2011 to 2022. Improvement in case ascertainment of ARF/RHD may be contributing towards increasing trends with improved reporting and monitoring of incident cases in very young Indigenous Australians more recently.

Background Australian and international studies have reported an attenuation in previous declines in acute coronary syndrome (ACS) events in young adults. This study examines temporal trends in admission, mortality and incidence rates for ACS in men and women aged Methods This population-based linked data study used hospital and mortality records from New South Wales, Western Australia and South Australia for 2002–2016. We identified all ACS hospitalisations and deaths, and first-ever (incident) events using a 5-year lookback period. Age-specific rates were calculated for ACS subgroups. Average annual percentage changes (95% CI) were estimated from age-adjusted Poisson regression models. Results There were 202 327 ACS events from 2007 to 2016, 27.6% (n=55 764) of which occurred in 20–54 years. ACS admission rates declined in all age and sex groupings, with greater declines in 55–74 years. Substantial declines in mortality rates of 6%–9%/year were seen across all sex and age groups. Reductions in total incidence were driven by declines in hospitalised ACS incidence. A decline in ST-segment elevation myocardial infarction (STEMI) incidence rates was observed, with the smallest reduction in younger women (−1.7%/year). Non-STEMI incidence rates increased by 1.9%/year (95% CI +0.8, +3.0) in women aged 20–54 years while remaining unchanged in young men. Conclusions While reductions in ACS incidence and mortality overall are encouraging, this study highlights increasing NSTEMI incidence and a smaller decline in STEMI incidence in young women compared with young adult men. A better understanding of sex-specific factors responsible for increasing rates is essential to continue to improve cardiovascular health.

Time-restricted eating (TRE) has gained attention as an effective approach for weight management and overall well-being by focusing on limiting the eating window, rather than reducing calories. This study explores the biopsychosocial impacts of TRE in free-living individuals using a qualitative design. Twenty-one adults (aged 27–60 years) from Western Australia who had practised TRE for at least three months were purposively recruited, and semi-structured interviews were conducted. The data were analysed using a thematic analysis to identify key themes. The participants reported a range of benefits, including weight loss, reduced joint pain, better digestion, improved mental clarity, increased energy, and a more positive body image. Socially, TRE facilitated simplified daily routines but also introduced challenges, such as disruptions to social interactions and family meal dynamics. Some mixed and negative impacts were reported, including changes in sleep and exercise patterns. These findings highlight TRE’s potential as a holistic dietary intervention. Further research, particularly well-controlled, randomised controlled trials and longitudinal studies, is needed to confirm these insights and guide their appropriate application in clinical and public health settings.

Background: Research priority setting projects provide a method to engage stakeholders in the prioritisation of research activities. We conducted a priority setting project to identify priorities for research into the primary and secondary prevention of stroke. Methods: A modified James Lind Alliance method was used for this project undertaken in Australia and New Zealand with two online surveys (September–November 2021 and May‐June 2022) and an online workshop (August 2022). The main question addressed was ‘What question about preventing stroke would you like to see answered by researchers?’ Responses to Survey 1 were refined and reviewed to identify evidence uncertainties. Questions with uncertain evidence were presented in Survey 2 where participants rated the importance of questions. Quantitative analysis of the importance ratings identified highly rated questions. These questions were taken to the online workshop with two rounds of facilitated discussion to create a final list of priorities. A postworkshop evaluation questionnaire explored user’s perceptions of the process. Results: In Survey 1, 375 people proposed > 700 research questions. These were refined to 134 questions that were checked against evidence with 47 determined to be unanswered and distributed for consideration in Survey 2. Respondents to Survey 2 ( n = 97) rated 24 of the 47 questions highly that were then discussed in the online workshop ( n = 16 participants). There was agreement on the most highly rated question ‘How can we improve early detection and measurement of stroke risk?’ but limited agreement on the remaining questions. Participants favoured keeping all questions but presenting them thematically. The final list includes 22 questions under behavioural; pharmacological/clinical; structural; policy; individual; population and secondary prevention themes. Participants rated the workshop experience as acceptable. Conclusion: A suite of research priorities for the primary and secondary prevention of stroke were identified by a broad range of stakeholders including people with lived experience of stroke, the public and health professionals.

Background: Time-restricted eating (TRE) shows promise for managing weight and metabolic issues, yet its application in real-world healthcare settings remains underexplored. This study aims to assess the real-world utilisation and short-term outcomes of TRE in clinical practice. Methods: This observational study used a retrospective chart review of 271 adults who attended a metabolic specialist clinic between 2019 and 2023. Descriptive statistics and multivariable logistic regression were used to identify factors associated with TRE adoption, while paired sample t-tests evaluated changes in outcomes among those who received TRE advice. Results: Among the 271 patients, 76% were female, 90% Caucasian, and 94% overweight/obese. Of all patients, 47.2% received TRE advice, mainly using the 16:8 method, alongside additional dietary guidance for 60% of patients. Working status and baseline metabolic profiles were the only factors significantly associated with TRE adoption. Among those who followed TRE, 81% experienced modest but significant reductions in weight (−1.2 kg, p < 0.01), BMI (−0.4 kg/m², p < 0.01), and waist circumference (−3.7 cm, p < 0.01). Conclusions: This study highlights TRE as a feasible and practical dietary strategy for improving metabolic health in healthcare settings. However, further research and improved data capture are needed to explore long-term adherence, potential adverse effects, and the effectiveness of TRE across diverse patient populations.

Purpose: Measures of disease burden using hospital administrative data are susceptible to over-inflation if the patient is transferred during their episode of care. We aimed to identify and compare measures of coronary heart disease (CHD) and myocardial infarction (MI) episodes using six algorithms that account for transfers. Patient and Methods: We used person-linked hospitalisations for CHD and MI for 2000– 2016 in Western Australia based on the interval between discharge and subsequent admission (date, datetime algorithms), pathway (admission source, discharge destination) and any combination to generate machine learning models (random forest [RF], gradient boosting machine [GBM]). The date and datetime algorithms used deidentified patient identifiers to identify records belonging to the same individual. We calculated counts, age-standardised rates (ASR) and age-adjusted trends for CHD and MI for each algorithm. Results: Counts of CHD increased from 11,733 in 2000 to 13,274 in 2016, while MI increased from 2605 to 4480 using the date algorithm. Correspondingly ASR for CHD decreased from 2086.2 to 1463.1 while MI increased from 468.2 to 498.1 per 100,000 person-years. ASR for CHD and MI for datetime algorithm were consistently 1– 2% higher than the date algorithm. Differences in ASR of CHD and MI counts increased over time with the admission source, RF and GBM algorithms relative to the date algorithm. Age-adjusted trends in CHD and MI episode rates using RF and GBM differed significantly from all other algorithms. Only 86.7% and 87.6% of MI episodes identified by the date algorithm were identified by the admission source and discharge destination algorithms, respectively. Conclusion: The date and datetime algorithms produced the most valid measures of CHD and MI episodes. Findings underscore the importance of identifying admission and discharge dates/times belonging to the same individual in enumerating these episodes.