Author: CSANZ Admin

The CSANZ Board is reviewing the strategic priorities for the society. A short survey was prepared in March 2023 to inform the Board about what areas you consider important that should be prioritised and resourced.  The results were published in the April 2023 edition of On the Pulse.

ON THE PULSE APRIL 2023
Editorial by Prof Will Parsonage. (link to pdf)
In its 70 year history the Cardiac Society of Australia and New Zealand (CSANZ) has grown from a small group of 47 interested physicians and surgeons to a community of nearly 2,400 members spanning all the professional groups essential to the delivery of modern, multidisciplinary healthcare for people and communities with cardiac disease.

CSANZ will always hold true to its constitutional aim of ‘promoting the highest standards of education, training, research and practice in cardiovascular medicine and surgery’ but recognises the importance of incorporating this in line with the thoughts, beliefs and priorities of its broader membership.

The board are frequently approached by members regarding a broad range of issues that apply to this context. We recently conducted a survey to gauge the priority that members attach to several of these. The aim of the survey was not to rigidly define strategic priorities for the society but rather to ‘take the pulse’ of the wider membership on some of the issues more frequently raised by individuals.

Responses were received from over 300 members about 60% of whom were medical staff and around 15% nursing staff. New Zealand and all states and territories of Australia were represented. Although one respondent felt that the survey had ‘missed the mark’ in the selection of priorities that were presented all were considered to be of urgent or high priority by at least 40% of those who participated. Four areas were considered to be of urgent or high priority by more than two-thirds, namely; health of First Nation peoples, clinical appropriateness, government advocacy and workplace planning and development.
Members were also generous with personal views given the opportunity to provide individual comments. These provided a rich source of additional insights beyond the quantitative aspects of the survey. Above all, these emphasise the challenge that a society with broad membership faces in attempting to meet the needs of all.

‘What about planetary health that was brought up… at our AGM?’ (Anon. A)
‘Members who want to be effective… (in these areas) …should be encouraged to join a political party rather than the cardiac society’ (Anon. B)

In considering the outcomes of the survey the leadership of the Society are conscious that we have a limited capacity to ‘change the world’ and that there is a risk in spreading our resources too thinly, achieving nothing and even losing sight of our core purpose. In some areas it may be enough for the Society to state a position and work in support of others to achieve a common goal. In others the society can take a more active role in facilitating change.

The Society are grateful to all those who took the time to complete the survey but we are conscious that, like all surveys of this kind, the outcomes still only reflect the views of a self-selected group of our members. With that in mind we see the survey not as a final word but the beginning of a conversation out of which the Society can move forward in the future better informed about what matters to our members.

For those interested a more detailed presentation of the survey results will be made at the annual general meeting of the society at this year’s annual scientific meeting in Adelaide Board members and state based representatives are always happy to be approached by members to discuss society business. If you are not sure who to contact in representing your region or professional group details of members of the Board (who include representatives of New Zealand and every Australian State) and Councils can be found on the Society website at csanz.edu.au

Hi there, we are Julie and Ciara and we represent the Northern Territory on the Executive of the Allied Health, Science and Technology Council of CSANZ. We both hail from Ireland, completing our BSc in Clinical Measurement Science in 2009 and 2012 respectively. Julie moved to Darwin in 2012, Ciara followed in 2016. We both completed International Board of Heart Rhythm Examiners certification in Ireland, and in Australia, Julie continued her studies to specialise in Echocardiography and Ciara specialised in Electrophysiology.

Since arriving in the Territory, we have both worked for NT Cardiac at Darwin Private Hospital (DPH), as Cardiac Physiologists. NT Cardiac services both private and public patients, across DPH as well as Royal Darwin Public Hospital. DPH has a Catheterisation Lab, where up to five pacemaker / defibrillator devices are implanted per week. Up until very recently, we had a dedicated day for Electrophysiology studies and ablations (Radiofrequency, Cryoablation and 3D Mapping). Unfortunately, this service is temporarily suspended as there is no Electrophysiologist available in the NT.

As part of our role, we service over 25 remote NT communities as part of a multidisciplinary team, consisting of a cardiologist, registrar, cardiac nurse, sonographer and sometimes a pacing trained Cardiac Physiologist. We have assisted with the implementation of new Cardiac Physiologist-led remote pacing clinics, designed to provide a greater level/continuity of service to patients and to ease the burden on the cardiologists on their one or two day remote trips.

Remote clinics present many challenges, some unavoidable. Many communities are often cut off from larger clinics in Darwin for months at a time during the wet season due to flooding. The larger community clinics like Katherine or Nhulunbuy are visited multiple times a year by the multidisciplinary team, however, some more remote clinics might have only 1 visit per year. As a result, providing optimal cardiac management to these patients can be difficult, compounded by the fact that some patients live in different communities depending on the season (wet versus dry season). Our visits sometimes coincide with funerals, cultural ceremonies or sorry business in the local community, which we always try our best to work around.  

To accommodate these challenges, we schedule our pacing patients on a six monthly basis. Ciara has set up a list of patients at each community, and we aim to ensure at least yearly follow-up. Some patients are provided with home monitors at implant or follow-up, this enables us to receive data from remote locations to save medivac flights to Darwin. Remote community patients often lack access to Wi-Fi, often have limited mobile phone signal or access to mobile phones, and possibly intermittent electricity. For this reason, the majority of remote patients have their home monitors left permanently in the community clinic to send information to our clinic in Darwin. This puts added pressure on local dedicated staff that are already extremely busy, but these home monitors become highly useful in the case of emergencies.

Providing echocardiography services to these patients also comes with its challenges. There can be limited facilities available at some clinics, with a lack of adjustable beds and adjustable trolleys for the echo machines. Room availability can be an issue, as there can be multiple visiting teams at the clinic at the one time. We scan a high volume of difficult pathology patients, for example double and triple valve replacements, all of whom are scanned on a portable machine. Patients can often be quite reluctant to come to Darwin, so these echoes in community are potentially their only follow-up scans.

Despite the challenges, the Territory provides a hugely rewarding and unique working experience for allied health professionals. Our remote trips are a wonderful way to experience the NT and to see Territory life from a very different perspective and are a great opportunity to get to know your working team. It provides us with a great opportunity to try to improve systems, protocols and procedures, and therefore make a real impact to healthcare for our patients who live remotely.

Ciara Devoy, Cardiac Physiologist Julianne Pfister, Sonographer

Article recently published in the April On the Pulse – read in full here.

CSANZ is offering young Members the opportunity to apply for a free on-site registration to the 2023 ESC Congress to be held in Amsterdam from 25 – 28 August 2023.

To be eligible you must be:

• A current financial CSANZ Member at the time of application
• Under 40 years of age/or in training
• An ESC Professional Member – become an ESC Professional Member here

To be in the running for one of the free registrations, please email your name, date of birth and ESC Professional ID number to [email protected] by Monday, 22 May 2023.

Preference will be given to eligible CSANZ Members who have had an abstract accepted for the ESC Congress.

Dr Nilufeur McKay, Senior Lecturer, Course coordinator, Master of Nursing (Nurse Practitioner) Program at Edith Cowan University, Cardiology Nurse Practitioner, Omni Corde Rhythm Services, WA, CSANZ ASM Scientific Committee Multidisciplinary Stream Representative for 2024 in Perth.

A career in nursing has provided me the opportunity to travel and work in some of the most prestigious international healthcare institutions. In 2000, I completed my Bachelor of Science (Nursing) at Curtin University and took my very first job at Royal Perth Hospital in the Cardiothoracic surgery unit and later progressed to the Coronary Care unit. At that early stage, I knew advanced heart failure and transplant was an area I wanted to learn more about. In 2003, I sat the NCLEX licensure exam and ventured over to Arizona, USA.

In 2005, I started my Master of Nursing (Adult Nurse Practitioner) degree at Arizona State University while working in a surgical ICU taking care of post op cardiac surgery patients. The experience of working in a critical care setting managing labile haemodynamic and labile cardiothoracic surgeon prepared me well for my career as a cardiology nurse practitioner (NP)!

I commenced my first outpatient cardiology NP job in 2008, which is when I saw the value of –“continuity of care” of the same patients and the contribution I could make to their quality of life. From 2011 to 2017, I was fortunate to work at Mayo Clinic on a busy inpatient heart failure and transplant service. My responsibilities involved admissions, daily rounds, and discharging patients from the hospital. I was also a key member of the outpatient cardiology practice seeing heart failure patient to reduce preventable heart failure readmissions. As a NP my practice involved a combination of independent and collaborative practice with physicians to care for patients with various cardiovascular diseases. Additionally, I coordinated ongoing NP student clinical placements for a dozen specialties throughout the organisation. During my tenure at Mayo, I concurrently completed a Doctor of Nursing Practice degree through Johns Hopkins University in 2014 for which I led a research project and coordinated an interdisciplinary team to achieve positive statistically significant outcomes directly related to improving patient care. I contributed to various ongoing quality improvement initiatives at Mayo, some which are still in place today.

My experience of completing a doctoral degree at Johns Hopkins was more than just an educational achievement. I was exposed to a high calibre of nursing academics and leaders who fuelled my passion for teaching, leading and being a driver of change in nursing. I attribute my career success to having supportive nursing and physician mentors and most importantly strong family support.

My family and I moved to San Diego, California in 2017 where I then worker as a transplant and LVAD NP at Sharp Healthcare and The University of California, San Diego (UCSD) before returning to Perth in 2020.

I feel extremely privileged to be the course coordinator for the only Nurse Practitioner course in Western Australia. My current research in the Scholarship of Teaching and Learning looks at innovative methods to prepare the nurse practitioner workforce with our most recent project on conducting telehealth visits. I am passionate about advocating for all clinicians to work to the top of their licence and education preparation. I believe encouraging multidisciplinary team-based care will promote value-based healthcare and improve patient outcomes in Australia.

Dr Jessica Orchard, Senior Research Fellow at the Sydney School of Public Health, The University of Sydney.

One of the major highlights was catching up with colleagues from around the world, and hearing results of a number of late breaking trials presented at the meeting. In particular, the first results of the LIVE-HCM trial led by Prof Rachel Lampert and Prof Mike Ackerman showed no increased risk among HCM patients undertaking vigorous physical activity compared to those who were less active.

I was fortunate to be an invited speaker and panel member in a session entitled, “Doc, my watch says I have AF: Integrating Consumer-Facing Device Findings Into Clinical Care”. My talk was on the legal and ethical considerations for consumer-led screening, diagnosis and event recording. I explored various issues that arise at the regulatory level, the physician level and the consumer level. Importantly, consumer devices are here to stay and we need to focus on adapting the regulatory environment as well as supporting physicians to maximise the benefits and minimise the harms. I was also invited to record a podcast on this topic with ACCEL.

In addition, I had two abstracts accepted for presentation. The first, looked at ECG features of elite athletes in high intensity sports from New Zealand based on data from 10 years of cardiac screening. This work found that abnormal T wave inversion was significantly more common in female athletes and that Wolff-Parkinson-White syndrome was the most common diagnosis in this cohort. The research was also selected for inclusion in the ‘Highlights in Sports and Exercise Cardiology’ session at the conference.

The second abstract, ‘Endemic COVID is contributing to significant excess cardiac mortality’, looked at rates of cardiac deaths in the US and other countries before and during different stages of the COVID pandemic. We reported that respiratory viruses (including both COVID and influenza) are strongly linked to cardiovascular deaths and that both vaccinations are also important public health measures in terms of prevention of cardiovascular deaths.
This work was featured in The Limbic’s ‘Five Australian highlights from ACC.23.

Jessica’s abstracts were published in the Journal of the American College of Cardiology (JACC)

https://www.jacc.org/doi/abs/10.1016/S0735-1097%2823%2902750-X

https://www.jacc.org/doi/abs/10.1016/S0735-1097%2823%2902805-X