Annual Review 2013–14
IN A HEARTBEAT
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CONTENTS
4 At the heart of care and innovation 6 A message from the Director 8 At a glance 10 What we do 12 Delivering quality cardiovascular care 14 Miracle Mum Vanessa 16 Committed to improving community wellbeing 18 Riding in full support 19 Supporting a healthy Timor-Leste 20 Pioneering new frontiers in research and technology 22 Investing in discovery and innovation 24 Putting funds to good use 26 Looking ahead
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AT THE HEART OF CARE AND INNOVATION
MonashHeart is the largest cardiovascular service provider in Victoria, Australia. With 270 staff members operating across three sites, we provide almost 73,000 episodes of cardiological care to the community each year.
OUR MISSION To improve community wellbeing through outstanding cardiovascular healthcare services and provide exceptional quality education, training and research opportunities for our future healthcare professionals.
OUR VISION To be the leading cardiovascular healthcare provider in Australasia.
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A MESSAGE FROM THE DIRECTOR
MonashHeart continues to be an exciting and extraordinary place to work. The academic and clinical strength of our staff, and the depth and breadth of their multidisciplinary talents they bring to MonashHeart continue to astonish me. The commitment, dedication, and collegiality of everyone at MonashHeart is pervasive, and their desire for excellence in patient care is ever apparent.
illnesses every day. Together, they’ve pioneered practice advancements, paradigmshifting therapies, and striking technological developments.
As a world-leading cardiovascular service, MonashHeart is internationally competitive. From clinical care and service delivery to research, education, training, and policy development, we strive to deliver the best to our patients. We maintain an unwavering commitment to the overriding goal of excellent patient care to all members of the community, through the continued application of emerging best practice, and an active involvement in leading clinical trials in cardiology in order to establish international best practice. We continue to be at the forefront of cardiovascular medicine, including structural heart disease, cardiac imaging, and coronary physiology.
In the following pages I invite you to share our experiences and commitment to cardiovascular health. We are committed to the expansion of our clinical services to serve our community, while also continuing to enhance the quality and efficiency of our patient care. All of us at MonashHeart are focused on achieving world’s best practice in treating the full spectrum of cardiovascular disease, with an emphasis on patient-centred outcomes. These are the fundamental foundations on which MonashHeart is based, and which will drive our ongoing success into the future.
Over the years, there have been many inspiring clinical successes and moments to remind us of why we are here, and why we do what we do. Our patients and staff are compassionate people who deal with complex life-threatening
Professor Ian Meredith AM Director of MonashHeart Monash Health
“Our patients and staff are compassionate people who deal with complex life-threatening illnesses every day.” 6
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AT A GLANCE Part of what makes MonashHeart such a success is its people and their commitment and passion to provide better cardiac health for our community. It is them who drive clinical service improvements and expansion initiatives, which, in 2013, saw a substantial 17% increase in MonashHeart cross-site services. We strive that each and every patient receives excellence in clinical care, which is timely, evidence-based and patient-centred, and provided by highly educated and skilled staff who foster innovation at every opportunity.
12-Lead Electrocardiograms (ECG)
13432
14068
636
4.73%
Adult Cardiology Outpatient Clinic Attendances
1208
1170
-38
-3.15%
731
774
43
5.88%
Cardiac Admissions to Inpatient Beds (Public & Private)
7033
7979
946
13.45%
Cardiac CT
2701
2995
294
10.88%
Device Surveillance Clinics (PPM & ICD)
1596
1762
166
10.40%
14372
15511
1139
7.39%
276
283
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2.54%
Exercise Stress Testing (EST)
2048
1890
-158
-7.71%
Holter & Loop Monitoring
2554
2816
262
10.26%
Left Heart Catheterisation Procedures (LHC)
3179
3176
-3
-0.09%
MonashHeart Paediatric Clinic Attendances (PMC & GCC)
541
1340
799
147.69%
Paediatric Cardiology Outpatient Clinic Attendances
754
585
-169
-22.41%
1201
1279
78
6.49%
685
720
35
5.51%
10553
14408
3855
36.53%
2178
2231
53
2.43%
391
383
-8
-2.05%
Ambulatory Blood Pressure Monitoring
Echocardiograms Electrophysiology Studies (EPS)
Percutaneous Coronary and Cardiac Interventional Procedures (PCI) Permanent Pacemaker, Implantable Cardiac Defibrillator & Loop Implant Procedures Private Consulting Room Consultations Rapid Assessment Chest Pain Clinic (RACPC) ST–Elevation Myocardial Infarction Cases (Emergency Heart Attack Cases Treated)
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10% INCREASE IN HOLTER & LOOP MONITORING
E
%
CR EA S
difference
IN
2013
7%
IN ECHOCARDIOGRAMS NOW OVER 15,500 SCANS PER YEAR THE BIGGEST SERVICE IN VICTORIA
37%
2012
INCREASE
IN PRIVATE CONSULTING
ROOM CONSULTATIONS FROM 10,553 CONSULTS
TO 14,408 CONSULTS
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WHAT WE DO
MonashHeart is the cardiology service of Monash Health, the largest health care provider in Victoria.
Each year Monash Health provides integrated health care to one quarter of Melbourne’s population. Uniquely, MonashHeart and indeed Monash Health provides health care across the entire life-span – from in utero and newborns to children, adults and the elderly, including their families and carers. MonashHeart has facilities based at three sites; MonashHeart Clayton, MonashHeart Dandenong and MonashHeart Casey. MonashHeart is composed of six sub-speciality services, acute cardiac services, interventional services, non-invasive services, cardiac CT services, paediatric cardiology services and cardiac rhythm management services, along with a new specific heart failure program. Our MonashHeart team of administration, clerical, nursing, cardiac technology, research and medical staff are committed to not only providing state-of-the-art outstanding cardiac services to patients, but are also driven to innovate and improve through research and education.
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DELIVERING QUALITY CARDIOVASCULAR CARE
Today, Australians are facing an increasing risk: cardiovascular disease is the number one killer of adults in developed countries, and in coming years, the need for cardiovascular care will continue to grow. MonashHeart is pioneering a future where the increasing needs of our patients are met head-on by prepared multidisciplinary health professionals. We are growing our programs and services, while remaining focused on delivering exceptional patient-focused care. In 2013, we had a significant increase in patient services, particularly in MonashHeart paediatric clinic attendances (148% increase), private consulting room consultations (37% increase), admissions to cardiac inpatient beds (13% increase), cardiac CT service (11% increase), Holter and loop monitoring (10% increase) and echocardiography (7% increase). Our focus on improving patient care in 2013 led us to purchase additional telemetry monitors for the cardiac care unit at MonashHeart Dandenong, and Electroboard SMART™ Boards for the cardiac care unit at MonashHeart Clayton. Across all three of our sites, MonashHeart strives to expand facilities, provide expert paediatric and adult cardiac healthcare services, and offer an exceptional patient experience.
148% INCREASE IN
MONASHHEART PAEDIATRIC CLINIC PATIENTS
11%
INCREASE IN CARDIAC CT
JUST UNDER 3,000 PATIENTS PER YEAR – LARGEST SERVICE AUSTRALIA
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MIRACLE MUM VANESSA
“Since my heart attack, my employer Digga has been awesome, helping me get back to my job I enjoy so much.” Vanessa Tanasio Age 41 Cardiac Arrest with Intractable Ventricular Fibrillation Coronary Angioplasty
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Vanessa had developed severe chest pain and suffered a cardiac arrest shortly after the MICA ambulance arrived at her Narre Warren home. The ambulance team successfully resuscitated Vanessa, detected that she was suffering an acute heart attack and transported her directly to MonashHeart, Clayton. While in MonashHeart’s cardiac catheterisation laboratory, Vanessa suffered another cardiac arrest with intractable ventricular fibrillation, a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles of the heart. Dr. Ahmar knew it was essential to open Vanessa’s blocked coronary artery to stop the ventricular fibrillation. But to do that, and avoid neurological damage, a steady supply of oxygen to the heart and brain was necessary. Fortunately the MonashHeart team had access to a LUCAS™ Chest Compression System or ‘thumper’ which delivered automated chest
compressions for 42 minutes while the coronary angioplasty was performed to open Vanessa’s artery. It was only after the artery was opened that Vanessa’s heart could be shocked back into normal heart rhythm. Miraculously, Vanessa had a complete and full recovery, without any brain damage, going home just seven days after her heart attack. “It is truly a miracle that after 40 minutes of reduced circulation that she is alive and well and completely cognisant.” said Professor Ian Meredith. The purchase of the LUCAS™ ‘thumper’ was made possible through money raised in a 520 kilometre partnership bike ride by MonashHeart and Victoria Police in 2012. The LUCAS™ device has been used on many other cardiac arrest cases, but Vanessa’s case is the most miraculous.
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COMMITTED TO IMPROVING COMMUNITY WELLBEING MonashHeart offers patients a unique model of healthcare. We integrate patient education and awareness building with pioneering advancements in technology and medicine. This synthesis of patient care and cutting-edge technology is key to meeting the evolving needs of our patients and our community.
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• Every February, MonashHeart celebrates Love Your Heart Day. In 2013, over 450 members of the public participated by having their blood pressure taken and, if needed, were offered advice on ways to reduce the risk of heart disease.
• Each year, a contingent of cardiac sonographers and staff from our paediatric cardiology subspecialty service travel to Tonga. Here they provide pro-bono support for a congenital heart disease screening program at primary schools.
• Through the East Timor Hearts Fund, young patients from Timor-Leste are flown to Melbourne to undergo heart valve procedures at MonashHeart at no cost to the patient.
• Annually, MonashHeart offers a complete cardiac screening without charge to all cyclists who participate in the Chain Reaction Victorian Bike Challenge.
• Every Wednesday, through a Memorandum of Understanding (MoU) between MonashHeart and HeartKids Victoria, an afternoon tea is organised for families of children with heart disease, providing parents and children with support, encouragement and hope during what is a very stressful time.
• Through the Heart Foundation’s 000 Campaign - It’s OK to call, Professor Ian Meredith AM has made appearances on television and in online videos to emphasise the importance of not ignoring the early warning signs of a heart attack.
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SUPPORTING A HEALTHY TIMOR-LESTE
Nick tackles a challenging day of the 2013 1,000km Chain Reaction ride (Photo courtesy Chain Reaction)
RIDING IN FULL SUPPORT
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It’s not easy – they don’t call it the ultimate bike challenge for nothing. But it’s an amazing experience - to be able to support children’s charities by doing what I absolutely love to do…cycling.
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Since 2011, cardiac technologist Nick Youngs has participated as an ambassador rider in the annual Chain Reaction ride. Chain Reaction challenges senior executives who have a passion for cycling and an awareness of corporate and social responsibility to give back to their community. In seven days, participants ride over 1,000 kilometres, raising funds for children’s charities.
The East Timor Hearts Fund is a medical aid charity founded in Victoria. The organisation provides young people from East Timor with life-threatening heart conditions the opportunity to come to Australia for treatment. Due to socioeconomic hardship and a lack of specialised medical facilities in Timor-Leste, these young patients are unable to undergo urgently needed treatment. Without treatment, many of them will not live to celebrate their next birthday. Through the East Timor Hearts Fund and Monash Health, MonashHeart has provided these patients with part pro bono access to heart procedures they need in order to survive, giving them the chance at a happy, healthy life.
In the weeks leading up to the event, MonashHeart supports this worthy cause by providing a complete cardiac screening which includes a cardiac stress test, cholesterol level check and a full cardiac assessment by a cardiologist, for cyclists participating in the event
Arminda was just 12 years old when she came to MonashHeart in May 2013, the youngest patient treated through the East Timor Heart Fund. Without the heart valve procedure she desperately needed, Arminda was only expected to live another 12 months. At MonashHeart, she underwent a mitral valve procedure, and within hours she was walking around the hospital ward. Gone was the crippling shortness of breath she had lived with for years.
Mr Nick Youngs
Professor Richard Harper
Lead Cardiac Technologist Cardiac Rhythm Management Services MonashHeart
Emeritus Director MonashHeart
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It’s a gradually progressive condition and many are in severe trouble by the time we see them. Without a cardiac procedure, they won’t be able to live long. Every patient that we’ve treated through this program has gone back to leading normal lives.
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Arminda prepares for her heart valve procedure (Photo courtesy Mat Lynn & East Timor Hearts Fund) 19
PIONEERING NEW FRONTIERS IN RESEARCH AND TECHNOLOGY
Participating in global research to excel in the treatment of cardiac disease Translational research is at the core of MonashHeart’s values and goals. We place a strong focus on combining research findings with leading medical techniques to develop practical applications that enhance our patients’ health and well-being. Our faculty and staff are committed to advancing the treatment of cardiac disease, pioneering new frontiers in the use of technology and medicine through well designed and carefully considered clinical trials. 66-year-old Christine from Narre Warren, always knew that there was a history of heart disease in her family. However in 2013, when she began to suffer chest pains, she was unaware that they were in any way related to her heart. An abnormality was found upon review of Christine’s stress echocardiogram results, a coronary angiogram was arranged and showed two critical narrowing’s in her major coronary artery. 20
Christine was offered an opportunity to be a part of the EXCEL study, in which over 1,900 patients from around the world participated, in order to compare treatment with open heart surgery to treatment with coronary artery stenting in severe left main coronary artery disease. The study has now completed enrolment but continues to follow the progress of all participants for five years. At the end of follow-up it is hoped that the results will provide more information regarding the most appropriate treatment for patients like Christine. “I had my stenting in May 2013 and have been very well since and back at work,” said Christine, “I am very grateful for the care I have received. I could have been dead without MonashHeart’s care. All the staff have been so wonderful.”
“Thankfully my GP sent me for a consultation at. MonashHeart’s Rapid Assessment Chest Pain Clinic.” 21
INVESTING IN DISCOVERY AND INNOVATION
The Monash Cardiovascular Research Centre (MCRC) is the formal research arm of MonashHeart and is responsible for all research infrastructure to support the strategic plans of MonashHeart, Monash Health and Monash University. Dr. Siobhan Lockwood
Dr. Brian Ko
Dr. Tony White
Cardiologist, MonashHeart
Cardiologist, MonashHeart
Cardiologist, MonashHeart
The focus of Dr. Siobhan Lockwood’s PhD is the use of novel non-invasive imaging techniques for the assessment of aortic valve disease, particularly degenerative aortic stenosis – the most common valvular heart condition in Australia. Siobhan’s research will be an opportunity for more patients with aortic stenosis to undergo a newer, less invasive aortic valve therapy in the future. Siobhan’s PhD is being undertaken through the Monash Cardiovascular Research Centre, supervised by Professor Ian Meredith AM and Professor James Cameron.
Dr. Brian Ko was recently awarded a PhD for his research on the evaluation of the use of cardiac CT as a ‘one stop shop’ imaging modality to assess the anatomical and functional significance of coronary artery disease. Currently in his early post-doctoral career, Brian remains committed in his quest to investigate and develop other novel CT techniques to assess for coronary artery disease.
Dr. Tony White is conducting stem cell research. He is studying in detail the pathways involved in instructing a primitive ‘undifferentiated’ cell to become a ‘beating’ cardiac cell. This work is at the ‘basic science’ level of investigation, and many years away from being applied to patients. He is supervising a PhD candidate, Deevina Arasaratnam, who is also studying stem cell research.
Robust translational and clinical research across all subspecialty services is integral to MonashHeart’s drive to invest in discovery and innovation. 22
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PUTTING FUNDS TO USE
Contributions from supporters, former patients, charities, and private institutions enabled us to purchase life-saving equipment, grow our services, expand our research efforts and improve the quality of care for our patients. Service expansion • We have acquired more loop monitors ($2,500 each), more Holter monitors ($2,000 each) and another two cardiac CT treatment chairs ($3,250 each) that have cut waiting times and improved patient access to these services. • A former office area in the Cardiac Care Unit, MonashHeart Clayton was refurbished and renovated into a two-bed room specifically dedicated for the admission of elective patients needing an elective procedure. • An in-kind donation by GE of an echocardiogram machine enabled significant expansion of our very busy outpatient imaging service at MonashHeart Clayton, improving access for patients of all ages to this important diagnostic imaging modality. Patient care improvements • Two new 12-lead ECG machines and a new weigh scale chair for the Cardiac Care Unit, MonashHeart Dandenong has led to care improvements for patients while in hospital during management of acute cardiac symptoms.
Over the past year, your support allowed MonashHeart to further our commitment to excellence in patient care. 24
• Eight Electroboard SMART Boards™ were installed and commissioned for the Cardiac Care Unit, MonashHeart Clayton, facilitating greatly improved communication of cardiac health issues between the medical team and patients. • We purchased two handheld oxygen saturation monitors for our paediatric cardiology clinics at MonashHeart Clayton; enabling blood oxygen assessment in our littlest patients. 25
LOOKING AHEAD
We’re rethinking what cardiovascular care means today and in the future, by creating a legacy of community and excellence synonymous with the name and legacy of Sir John Monash. Despite significant advances in treatment, cardiovascular disease remains the cause of more deaths than any other disease. This burden of disease is reflected in increases in the MonashHeart service provision, where each year MonashHeart has responded by providing more tests and procedures along with the creation of new clinics and expanded consulting services for the community. However, our clinical service is now approaching capacity. With this in mind, a transformational new vision is needed to not only meet current demand in a more timely manner but also to future-proof services for the coming 30 years. The MonashHeart Strategic Advisory Board has been formed to help create, shape and negotiate a new platform to enable MonashHeart to continue to provide exceptional care, including expanded purpose-built facilities. These facilities will ensure not only enhanced capacity for clinical services, but will also provide expanded opportunities for educating our future healthcare providers, lead translational research, and provide the ability to shape cardiac policy development into the next decades.
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MonashHeart Monash Medical Centre 246 Clayton Road, Clayton VIC 3168
MonashHeart Dandenong Hospital David Street Dandenong VIC 3175
MonashHeart Casey Hospital 62-70 Kangan Drive Berwick VIC 3806 Enquiries: 1300MHEART www.monashheart.org.au