STORIES FROM THE HEART MonashHeart Annual Review 2012-13
MonashHeart Monash Medical Centre 246 Clayton Road, Clayton Victoria, 3168
MonashHeart Dandenong Hospital David Street Dandenong Victoria, 3175
MonashHeart Casey Hospital 62-70 Kangan Drive Berwick Victoria, 3806 Enquiries: 1300MHEART
www.monashheart.org.au
Ariana Dionisopoulos Age 1 Hole in the heart (VSD) and heart valve abnormality
CONTENTS In this review, we’d like to share with you the opportunities and challenges we’ve faced, the activities we’ve undertaken, our strategy, our performance and the highlights of our year. We’d like to offer you an insight into the MonashHeart story, and also an opportunity to hear from our Director, Professor Ian Meredith AM.
2
4
WHO WE ARE
6
2012 AT A GLANCE
8
A MESSAGE FROM THE DIRECTOR
12
ACTIVITY REPORT
14
CLINICAL SERVICE SUB-SPECIALTIES REPORTS
16
ACUTE CARDIAC SERVICES
17
CARDIAC CT SERVICES
20
CARDIAC RHYTHM MANAGEMENT SERVICES
21
INTERVENTIONAL SERVICES
24
NON-INVASIVE IMAGING SERVICES
25
PAEDIATRIC CARDIOLOGY & ADULT CONGENITAL HEART DISEASE
26
FUNDRAISING REPORT
27
OUR FINANCES
28
MONASH CARDIOVASCULAR RESEARCH CENTRE REPORT
36
OUR ORGANISATION
37
MANAGEMENT TEAM
38
OUR PEOPLE
40
IN THE MEDIA
42
2012 MEDIA HIGHLIGHTS
44
LOOKING AHEAD
47
ACKNOWLEDGEMENTS
3
WHO WE ARE
MonashHeart is the largest cardiology service provider in Victoria, Australia with 270 staff members operating across three sites, providing over 62,400 episodes of cardiological care to the community annually. We provide cardiology healthcare services for patients of all ages, from in-utero and newborns right through to our senior citizens. We are a part of Monash Health, one of the key public health service providers in Victoria.
OUR MISSION
To improve community wellbeing through outstanding cardiology healthcare services and provide exceptional quality education for our future healthcare professionals.
OUR VISION
To be the leading cardiology healthcare service provider in Australasia. We put our vision into action through our: • commitment to provide the best possible experience, atmosphere and environment for our patients • relentless drive to innovate and continually improve through research and technology development • emphasis on real teamwork and authentic relationships.
Visit our website 4
5
2012 AT A GLANCE
PATIENT CARE
MEDICAL PROCEEDURES & TESTS
RESEARCH
Over 62,400 episodes of cardiological care provided across our three sites to the community.
18,765 ECG/stress test/blood pressure/
7,033 people admitted to our cardiac
14,372 echocardiograms performed on
or international meetings.
children and adults.
27 projects/clinical trials undertaken.
care units.
Holter/loop diagnostic investigations provided.
5,385 cardiac catheterisation laboratory
10,553 private consulting room
procedures performed.
consultations provided.
2,701 cardiac CTs (computed tomography)
2,178 patients seen by a cardiologist in the Rapid Assessment Chest Pain Clinic.
1,208 patients reviewed in the Cardiology Outpatients Clinic.
541 children seen in the new MonashHeart paediatric clinics including the Paediatric Murmur Clinic and the General Cardiology Clinic.
performed.
391 emergency heart attack cases treated. 43 percutaneous heart valve implantation procedures performed.
63 papers published. 68 presentations made at national
EDUCATION
6 PhD candidates. 15 registrars and fellows. 2 CVCTA/MonashHeart cardiac CT courses. 13 cardiac CT mini fellowships.
MEDIA
10 episodes of Heart Starters documentary screened on Channel 31. Featured in over 70 positive media articles (print, TV and radio).
ONLINE PRESENCE
41,624 website visits. 123,529 unique page views. Visitors from 129 countries. First steps into social media with 207 Twitter followers.
IN THE SPOTLIGHT Professor Ian Meredith was appointed as a Member of the Order of Australia (AM) in the 2012 Australia Day Honours List in recognition of his many years of outstanding commitment and dedication to medicine.
859 patient satisfaction surveys completed.
6
7
“The opportunity to care for others is a privilege, not a right.”
MESSAGE FROM THE DIRECTOR
Professor Ian Meredith AM Director of MonashHeart, Monash Health
It has been another outstandingly successful year for MonashHeart by all performance standards. Certainly a year worth reflecting upon and one that the community at large as well as MonashHeart staff, Monash Health and Monash University can be proud of. We have managed to grow our clinical services both in volume and dimension while continuing to improve our quality and efficiency. We have remained relentlessly focussed on the world’s best practices and patient-centred outcomes and we continued to be at the forefront of cardiovascular clinical innovation, translational research and education. MonashHeart researchers published more than 20 high impact peer reviewed articles in international cardiovascular scientific literature in 2012 and more than 50 contributions to the Cardiac Society of Australia and New Zealand Scientific meeting held in Brisbane. Our leading researchers presented at numerous international meetings both as invited experts and when presenting new research findings. We continue our active clinical PhD program with six PhD fellows working across the cardiovascular spectrum from basic coronary physiology and central haemodynamics to structural heart disease and advanced cardiac imaging. There were many inspiring clinical successes and moments to remind us of why we are here and why we do what we do. Remarkable stories of remarkable people dealing with, and being successfully treated for complex lifethreatening illnesses, with wonderful practice advancements, paradigm-shifting therapies and striking technological developments. A number of MonashHeart’s world and Australian firsts were highlighted in media. This included 10-year-old Matthew Gaythorpe, who in September became the first child in the world to successfully undergo a renal
8
denervation procedure to treat his lifethreatening genetic illness. In June, 58-year-old John Gregory was one of the first patients in Australia to benefit from a new laser balloon ‘heart light’ procedure for the treatment of atrial fibrillation. While in April, 86-year-old Muriel Satchwell was one of eleven patients to be part of a landmark world-first trial of the repositionable Sadra Lotus™ heart valve and was delighted with her own amazing recovery and return to excellent health. To be a world-leading cardiovascular service the team needs to be internationally competitive in every aspect of clinical care, service delivery, clinical research, education, training and policy development but importantly maintain an unwavering commitment to the essence of good patient care. By that I mean the ability to be kind, compassionate, caring, careful, consistent and conscientious. The opportunity to care for others is a privilege, not a right. MonashHeart is an extraordinary place to work because of the strength and depth of the multidisciplinary talents, the dedication, commitment and collegiality of the staff and the all-pervasive desire to be the best. The staff embrace the unique elements I have outlined above and will undoubtedly continue to drive our success in future years. Professor Ian Meredith AM Director of MonashHeart Monash Health
9
“My life is wonderful. I cannot understand people who say there is nothing to do when they are old.” Muriel Satchwell 86-year-old watercolor artist Great great aunt to 7 nieces & nephews Italian & French language student Opera aficionado
Muriel had no idea she had aortic stenosis until she was rushed to Monash Medical Centre one life-changing Sunday night three years ago. She had been experiencing episodes of tiredness and found it hard to do the things she would normally do while attending to her everyday activities. While she was in hospital, she met Professor Ian Meredith AM who talked to her about the possibility of taking part in the Sadra Lotus™ heart valve study. Muriel’s daughter and son-in-law were concerned, but it was her GP who had just attended a talk given by Professor Meredith who said to her, “Go for it Muriel!” And she did.
Sadra Lotus™ heart valve. Margaret was the first, then me, then Judith. The day after the procedure I really did feel fantastic. I walked to the shower and showered myself. My recovery was very quick. I walked around to see how Margaret and Judith were doing. My son-in-law took me home on the Thursday, and that night I cooked dinner for myself, alone in my little home – it was marvelous.” “My life is wonderful. I cannot understand people who say there is nothing to do when they are old. Life is worth living, especially if you have lots of friends and give back. I give back each month through a donation and I will do this every month until I die. It is my way of saying thank you.”
“Along with two other ladies, we were to be the first people in the world to receive the new
10
11
ACTIVITY REPORT
1. Cardiac admissions to inpatient beds (public and private)
7,033 1,208
2. Cardiology Outpatient Clinic attendances
10,553
3. Private Consulting Room consultations
2,701
4. Cardiac CT
A cardiac CT allows doctors to non-invasively, quickly and easily view the structure and function of the heart. It provides a view of thin cross sections of the anatomy of the heart including the coronary arteries, the heart muscle and heart valves.
b. Holter monitoring and loop monitoring 2701
2011 7365
2012
2008
1085
7. Cardiac Rhythm Management Services – Cardiac Cath Lab services
281
500
3967
2010 2009
2008
2656
d. Exercise stress testing
1000
1500
2000
2500
3000
2861
14,372
5. Echocardiogram
i. Permanent pacemakers ii. Implantable cardiac defibrillator
1406
3000 Dandenong Hospital Casey Hospital
6000
9000
12000
An echocardiogram is a sonograph of the heart. Echocardiography uses ultrasound to capture images of the heart. At MonashHeart, we offer different types of echocardiograms including exercise stress echocardiogram and Dobutamine stress echocardiogram.
iii. Loop
276 685
8. Cardiac Rhythm Management attendances - Device Surveillance Clinics (PPM/ICD)
10. Interventional Services - Cardiac Cath Lab services a. Left heart catheterisation (LHC) procedures b. Percutaneous coronary intervention (PCI) procedures
3,179 1,201
11. Rapid Assessment Chest Pain Clinic (RACPC)
2,178
MH RACPC 2011-12 TOTAL
2178
Qtr 4
456
Qtr 3
571
Qtr 2
414
2011
388 196
Qtr 3 153
14372 13719
2010
500
12658
2009
1000
1500
2000
2500
2012 2011
11968
2008
541
a. Paediatric Murmur Clinic b. General Cardiology Clinic
Qtr 4
2012
1,596
9. MonashHeart Paediatric Clinic attendances including
Qtr 1
Echocardiography 2006-2012
10607
2007
10277
2006
8975
5000 12
a. Electrophysiology studies - EPS procedures b. Device implants
3204 1218
13,432 2,554 731 2,048
1415
2009 5579
2011
c. Ambulatory blood pressure monitoring
1774
2010
3188
MonashHeart cardiac rhythm management (CRM) services diagnose, manage and treat cardiac arrhythmias including bradyarrhythmias and tacharrhythmias in paediatric, adolescent and adult patients. a. 12-lead electrocardiogram (ECG)
Cardiac CT 2010-2012 2012
Private Consulting at MonashHeart 2008-2012
6. Cardiac Rhythm Management Services - non-invasive services
10000
15000
20000 13
CLINICAL SERVICE SUB-SPECIALTIES REPORTS
14
15
ACUTE CARDIAC SERVICES
CARDIAC CT SERVICES
Group leader profile
2012 highlights
Community activity and outreach
Group leader profile
2012 highlights
Community activity and outreach
Dr Paul Antonis
• We provided coordinated healthcare to 7,033 hospital admitted patients.
• Through the goodwill of the Rotary Club of Monash, we were able to purchase a patient weigh chair for CCU Monash Medical Centre, Clayton used for weighing patients while seated, suitable for elderly or disabled people.
Associate Professor Sujith Seneviratne
• The team performed 2,701 cardiac CTs for our patients, which represents an increase of 33% from 2011.
• Through the MonashHeart Annual Fundraising Golf Challenge, funds were allocated to purchase two additional treatment chairs for the cardiac CT service at Clayton.
Dr Paul Antonis, a Monash University graduate, is a Level B CT cardiologist involved in clinical trials focusing on management of Acute Coronary Syndromes (ACS), new stent technologies and transcatheter valve therapies. He practices as an interventional and CT cardiologist and is the head of Acute Cardiac Services, MonashHeart. Paul works closely with the nurse unit managers, ward service consultants and registrars to ensure excellence in medical and nursing care provision to all admitted patients. Ms Chris Rasmussen, Helen Goldsmith, Sarah Jager and Claire Martin Chris, Helen, Sarah and Claire are the nurse unit managers of the inpatient cardiac care bed units at Monash Medical Centre Clayton, Jessie McPherson Private Hospital and Dandenong Hospital. Between them they have over 50 years of cardiac care skills and experience, leading their teams to provide nursing excellence 24/7.
What we do
• The CONCORDANCE (Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events) study found that MonashHeart had the highest acuity patients with the greatest percentage of patients presenting with STEMI (ST segment elevation myocardial infection). Performance wise, MonashHeart ranked the best in 11 out of the 13 key performance indicators. • We completed aesthetic renovations to the CCU and the combined Cardiology and Cardiothoracic Unit (32 South) at Monash Medical Centre Clayton.
• In celebration of Love Your Heart Day on 14 February 2012, our CCU nursing staff supported the heart health checks offered in the foyer of Monash Medical Centre Clayton. Members of the public who participated were able to get their blood pressure readings taken and if needed, were offered advice on ways to reduce the risk of heart disease.
Associate Professor Sujith Seneviratne is considered a leader in cardiac CT in Australia and is the co-head of the luminary site 320-slice cardiac CT facility at MonashHeart where he practices as an interventional cardiologist. Sene’s knowledge, expertise and enthusiasm for cardiac CT has seen our service develop into the largest cardiac CT service in Australia. A dedicated strong-knit team of cardiologists, radiologists, nursing staff and radiographers manage and support the cardiac CT services offered at MonashHeart. What we do
• We increased the number of resident doctors by 40% to improve the care of our patients.
Plans for 2013
• We launched the remote telemetry monitoring service from the CCU to the paediatric wards at Clayton, allowing us to provide healthcare services to children admitted into the paediatric wards rather than having to admit them into the CCU.
• To improve the facilities for patients undergoing elective angioplasty procedures by establishing a dedicated two-bed angioplasty area which will ensure accommodation for patients undergoing this procedure.
Cardiac CT services provide non-invasive angiography to diagnose coronary artery disease and for the assessment of structural and congenital heart disease. A cardiac computed tomography or cardiac CT is a painless, non-invasive test that uses a scanner to take clear, detailed pictures of the heart. Cardiac CT is generally performed for patients
Acute Cardiac Services provide coordinated
with chest pain or shortness of breath who are
healthcare to acute cardiac patients admitted
considered to be at low to intermediate risk of
into hospital. With 21 beds in the Cardiac
coronary artery disease.
Care Unit (CCU) and 10 beds in the combined
Calcium scoring is another type of CT scan
Cardiology and Cardiothoracic Unit (32
used to detect and evaluate calcium build up
South) at Monash Medical Centre Clayton, 26
in the walls of the coronary arteries. It is
beds in the CCU at Jessie McPherson Private
offered to patients who show no symptoms
Hospital and 12 beds in the CCU at Dandenong
but are at intermediate risk of cardiovascular
Hospital, this service allows us to serve acute
events (incidents that may cause damage to
cardiac patients who sometimes have very
the heart muscle).
complex healthcare needs.
16
• In November 2012, we upgraded our cardiac CT scanner (the 320 slice Aquilion One) to a newer, more accurate and powerful model (the Aquilion One ViSION). We are proud to be one of just three sites in the world to have this advanced model in operation. This is Toshiba’s most advanced CT system to date, offering the highest quality images with the lowest radiation dose possible. • Together with our partners CVCTA, we conducted two cardiac CT training courses on site, over a period of six days, training 18 cardiologists and radiologists. • We awarded 13 cardiac CT mini-fellowships to specialists, offering them an opportunity to fulfill their learning requirements and receive reporting accreditation. • We doubled the number of treatment chairs in order to reduce the waiting times for our patients and improve the overall efficiency of our operations. This allows more patients to be prepared concurrently for cardiac CT procedures.
• Throughout 2012 we continued to provide education seminars to educate general practitioners in the appropriate use of cardiac CT and calcium score. • We have helped a number of other Australian bodies set up their cardiac CT services, through on-site educational visits to our service and the sharing of our systems, processes and protocols. Most recently, we assisted with the commencement of a new cardiac CT service in the Northern Territory. Plans for 2013 • In 2013, we will be putting our effort into expanding our services even further. We will also have a strong focus on our research activities particularly in the areas of CT stress perfusion and CT attenuation gradients.
• The team made a number of presentations both nationally and internationally including at the Cardiac Society of Australia and New Zealand (CSANZ) meeting (Brisbane), European Society of Cardiology (Germany) and Asia PCR (Singapore). • Our service is the most well published cardiac CT service in Australia. Our major achievements include publications in the prestigious European Heart Journal and JACC Imaging. • We are involved in an international trial HeartFlowNXT, exploring a novel method of assessing the functional significance of coronary disease using super computers (CT Fractional Flow Reserve).
17
“When I called with the good news, the cardiac technician misheard me and thought I had named her Isuprel after the medication frequently used in the cardiac cath lab, given I love my job so much.” Dr Emily Kotschet Electrophysiologist Cardiologist Lead cardiologist for a first-in-Australia procedure Mother of 3 daughters | Marathon runner
Dr Emily Kotschet undertook her training to become a cardiologist at The Alfred. It was there that she got hooked on ‘those squiggly lines’ called ECG tracings, prompting her to undertake advanced training in electrophysiology at Monash in 2002, followed by a further two years in Victoria, British Columbia, Canada. Here she learnt a breakthrough technique of pulmonary vein isolation for the treatment of atrial fibrillation (AF), subsequently bringing these advanced techniques back to MonashHeart. In 2012 Emily travelled to Frankfurt, Germany to learn a new form of AF treatment called endoscopic laser balloon ablation, in which laser energy is used to isolate the pulmonary veins, instead of freezing them. Emily subsequently successfully performed this technique at MonashHeart in May. It was the first laser balloon procedure performed in Australia.
18
Emily has three young daughters; the first was born whilst she was in Canada. Being the dedicated cardiologist that she was (and still is), she continued to perform her duties in the cardiac cath lab until her 39th week of pregnancy, with Isabelle arriving the following week. “When I called with the good news, the cardiac technician misheard me and thought I had named her Isuprel after the medication frequently used in the cardiac cath lab, given I love my job so much” Over the years Emily has learnt to juggle work and family life, and in turn, the girls have learnt a lot about squiggly ECG tracings, attending numerous weekend rounds, and listening to mum dictate letters at home while supervising bath time. The girls provide a light entertainment after a stressful day at work.
19
CARDIAC RHYTHM MANAGEMENT SERVICES
INTERVENTIONAL SERVICES
Group leader profile
2012 highlights
Community activity and outreach
Group leader profile
2012 highlights
Community activity and outreach
Dr Jeff Alison
• We performed 980 cardiac cath lab procedures for our patients.
• Training in the new technology laser balloon treatment was offered to Australian electrophysiologists in May, with the view that they observe cases at MonashHeart and introduce this technology at their respective centres.
Dr Yuvaraj Malaiapan
• We performed 4,380 cardiac cath lab procedures in 2012 including 3,179 coronary angiograms and 1,201 percutaneous interventions.
• Each year MonashHeart performs mitral valvuloplasty procedures pro bono for critically ill patients from East Timor who need urgent treatment for a condition known as mitral stenosis. In 2012, Professor Richard Harper and the MonashHeart team successfully performed three of these procedures for Sebastina, Natalina and Christina who were well enough to return to East Timor just a week after their procedure.
Dr Jeff Alison has served as the head of Electrophysiology, Monash Medical Centre, Clayton since 1996 and the head of Cardiac Rhythm Management Services, MonashHeart since 2007. Under Jeff’s leadership, MonashHeart’s Cardiac Rhythm Management Service has gone from strength to strength, performing a number of exciting first-inAustralia procedures and establishing an excellent training program for cardiologists interested in electrophysiology as an advanced subspecialty. Mr Nick Youngs Mr Nick Youngs is the lead cardiac technologist for MonashHeart’s Cardiac Rhythm Management Services. Armed with a science degree and subspecialty training in cardiac technology both in Victoria and the UK, Nick leads a team of 15 cardiac technologists who focus on cardiac rhythm, cardiac catheterisation laboratory (cath lab) and electrocardiogram (ECG) service provision. What we do
Cardiac Rhythm Management (CRM) Services diagnose, manage and treat cardiac arrhythmias (irregular rhythm or rate of the heartbeat). This includes both slow heart rate (bradyarrhythmia) and fast heart rate (tacharrhythmia) in patients as young as six years of age. The CRM cardiac catheterisation laboratory is dedicated solely for cardiac rhythm procedures five days a week, performing close to 1000 procedures each year.
• In February of 2012, electrophysiologist Dr Emily Kotschet travelled to Germany to receive advanced training in the latest technology in atrial fibrillation ablation – pulmonary vein isolation using the HeartLight® laser balloon. • On 15 May 2012, Dr Emily Kotschet and Dr Jeff Alison, under the guidance of Dr Andreas Metzer from Germany, successfully performed the first Australian cases of laser balloon pulmonary vein isolation; a major advance in the curative treatment of atrial fibrillation. • Through the MonashHeart Annual Fundraising Golf Challenge, a $40,000 Finapress monitor was purchased. This sophisticated, non-invasive continuous blood pressure and cardiac monitor is used in CRM cath lab cases to more closely monitor patients during their procedure. • Our CRM cardiac cath lab was completely upgraded to a new state-of-the-art $1.2 million laboratory and was officially opened by the Minister for Health, the Honourable David Davis MP on 27 September 2012. • A total of 1,596 patients were seen in our MonashHeart device surveillance clinics, which represents a 25% increase from 2011. This was in part due to the new clinic which commenced at MonashHeart Dandenong.
• In April 2012, MonashHeart hosted a team of visiting cardiologists from China, further developing their knowledge of the Arctic Front cryoballoon procedure. • Dr Jeff Alison continued to travel to Victorian and interstate cardiac centres to proctor other cardiologists in the WATCHMAN device implant technique. • MonashHeart offered its free cardiac screening program to all 2012 Chain Reaction Victorian Bike Challenge cyclists. Staff volunteered their time to provide these checks, with each cyclist undergoing a cardiac stress test, cholesterol level check and a full assessment by a cardiologist. • Our lead cardiac technologist Nick Youngs participated as an ambassador rider in the 2012 Chain Reaction event, cycling a distance of 1,000 km in seven days.
Dr Yuvaraj Malaiapan completed his subspecialty training in cardiology at Penang Hospital, Malaysia, subsequently undertaking interventional training at Monash Medical Centre, Clayton. He was appointed as Director of the Cardiac Catheterisation Laboratories (cath labs) and Interventional Cardiology, MonashHeart in 2005, becoming the head of Interventional Services, MonashHeart in 2007. Mr John Koutsoubos With a background in engineering before turning to nursing Mr John Koutsoubos has found his niche at MonashHeart where he is the nurse unit manager of the cardiac catheterisation laboratories and cardiac CT. John’s very competent nursing team not only staff the three cardiac cath labs, Immediate Care Centre and the cardiac CT service but also manage a busy heart attack service available for emergency heart attack procedures 24/7.
What we do
Interventional cardiology involves tools and techniques to gain quick access to the heart to
Plans for 2013
perform diagnostic and treatment procedures such as coronary angiography, coronary
• Atrial fibrillation is the most common form of cardiac arrhythmia in our community and we are committed to supporting outpatients affected by this condition through a fortnightly atrial fibrillation clinic covering rhythm management and stroke prevention.
angioplasty, congenital hole-in-the-heart
• We are also focusing on our plans to offer a cardiologist led consultative clinic for children and adults with potential genetic heart disease through the commencement of a monthly cardiac inherited diseases clinic at MonashHeart Clayton.
to quickly access arteries of the heart to open
closure procedures, heart valve implantation and heart valve repair procedures. These procedures are especially useful in emergency cases where the cardiologist needs blocked blood vessels and restore blood flow to organs and tissues throughout the body.
• We treated 391 emergency heart attack cases. • On 14 April 2012, we were the first in the world to perform a Sadra Lotus™ Heart Valve implantation (third iteration). • We appointed a dedicated cath lab nurse educator (an Australian first) to provide specialised support and training to the nurses that staff the cath labs. • Reprise I and Reprise II TAVI trials commenced with 25 patients recruited by 31 December 2012. • MonashHeart’s first MitraClip procedure was performed in September 2012. • On 1 February 2012, we performed MonashHeart’s very first renal denervation procedure to treat resistant hypertension. • We also performed the world’s first paediatric renal denervation for 10-year-old Matthew Gaythorpe.
Plans for 2013 • We will be transmitting live cases via satellite in April to Seoul, South Korea. • Expanding our educational program is a top priority for us, and we hope to increase the number of interventional fellowship positions we have in our team. • We will also be commencing the postgraduate Critical Care Nursing course in Interventional (Cath Lab) Nursing, which will be offered through MonashHeart in partnership with Deakin University.
• At the inaugural ANZET Radial Conference in April, held in Adelaide, Professor Ian Meredith AM, Dr Yuvaraj Malaiapan and Mr John Koutsoubos presented and participated as moderators or live case panelists for a number of the sessions. • We are passionate about creating a better experience for our patients, and work hard to reduce or eliminate wait times for blood test results. An i-Stat analyser was purchased from funds raised so that our day patients can have the results of their finger prick blood tests obtained almost instantly.
Interventional services are provided through two dedicated, state-of-the-art cardiac cath labs based at MonashHeart Clayton.
20
21
“This is what inspires me each day I come to work.” John Koutsoubos Registered Nurse | Nurse Unit Manager | Advocate for patients and staff Husband and father of 3 | Church leader Occasional bike rider
As a young engineering undergraduate in Melbourne, John quite by accident glimpsed the intricate workings of a cardiac catheterisation laboratory while moonlighting as a porter to supplement his student income. It was at that very moment that John decided that what he really wanted to do in life, was to become a cardiac nurse. Hailing from a traditional Greek family, switching from engineering to nursing was not a very well regarded move. However, John’s parents recognised his deep interest and passion for working with people, and the rest, as they say, is history. There was no turning back for John. Today 16 years after completing his university training, John is the Nurse Unit Manager of the cardiac catheterisation laboratories and cardiac CT facility at MonashHeart: a role he cherishes, which enables him to work with the most
22
critically ill cardiac patients for whom any delay in treatment can mean the difference between life and death. The joy of leading a team to work harmoniously towards one shared goal under very difficult and sometimes stressful circumstances is one that John says, relates to all aspects of his life. “I put 110% into my family, my wife Val and my three children Elena, Georgia and Flora. It is this same fervour and effort that I put into my work and expect of others as well”. “Even my work as a church leader encourages me as a nurse leader to show by example the ability to give, to work as a team and not expect anything in return but the joy of treating, healing and caring for others”. “This is what inspires me each day I come to work.”
23
NON-INVASIVE IMAGING SERVICES
PAEDIATRIC CARDIOLOGY & ADULT CONGENITAL HEART DISEASE
Group leader profile
2012 highlights
Community activity and outreach
Group leader profile
2012 highlights
Community activity and outreach
Associate Professor Philip Mottram
• We performed 14,372 echocardiograms for our patients in 2012.
• Each year a contingent of cardiac sonographers forgo their annual leave to visit Tonga as part of a pro bono primary school screening program for congenital heart disease. In 2012 sonographers Catherine Mylrea, Stuart Cox and Shona Evans attended.
Associate Professor Sarah Hope
• We introduced a designated fortnightly case conference to discuss which congenital heart disease patients are best considered for surgery or interventional procedure.
• We signed a memorandum of understanding (MOU) with Heart Kids Victoria, with the establishment of a weekly Wednesday afternoon tea for families of children with heart disease, providing parents and children with support, encouragement and hope during what can be a very stressful time.
Associate Professor Philip Mottram is a clinical cardiologist and non-invasive imaging specialist with expertise in all forms of echocardiography as well as cardiac CT. Phil is the head of Non-invasive Imaging Services, MonashHeart, the busiest echocardiography service provider in Victoria, performing over 14,000 echocardiograms per year. Mr Anthony Wald Mr Anthony Wald received his qualifications as a cardiac technologist in South Africa, subsequently expanding and consolidating his skills working in Europe and Australia. With a postgraduate qualification in management, Anthony leads the large cardiac technologist team providing MonashHeart services across three sites. What we do
Echocardiography, or echo, is a painless, non-invasive procedure that uses sound waves to create moving pictures of a patient’s heart. The pictures not only depict the shape and size of the heart, but also show how well the heart’s valves and chambers are working. MonashHeart’s non-invasive imaging services is the largest in Victoria, performing the complete and latest range of echocardiography procedures including transthoracic echo, transoesophageal echo and dobutamine echo. The service is staffed by a dedicated team of subspecialty trained echocardiologists. Our sonographers are trained to the highest standards and are regularly encouraged to update their skills and knowledge of the latest
• In April 2012, we hosted the 3D Symposium attended by over 40 cardiologists and anesthetists. Participants were able to observe a complex procedure transmitted directly from the cardiac cath lab using 3D echo imaging. • Our efforts to expand our services were supported by GE Medical through their generous donation of a new mid-range echocardiography machine to add to our fleet of 10 machines. • We emphasised the importance of education and training: • Two non-invasive imaging fellows graduated after completing our two year advanced echocardiography/CT training program. • Two PhD students commenced their studies in applying advanced imaging techniques in the investigation of aortic valve disease and left ventricular dysfunction. • Trainee sonographers Amanda Way and Damian Haldane passed their echocardiography practical exams. • Two cardiac technologists, Eileen Nah and Rikki Bailey, have enrolled to undertake their echocardiography degree through Queensland University of Technology. • 11 papers were presented at the Cardiac Society of Australia and New Zealand meeting in August.
• We purchased a new echocardiogram bed through the generous donation of $4,000 raised by a former patient (through her workplace, RACV) expressing her gratitude for the care she received at MonashHeart.
Associate Professor Sarah Hope graduated from the University of Edinburgh and trained in paediatric cardiology both in the UK and in Australia. She achieved level 3 cardiac CT training (which is the highest level of training for cardiac CT) at MonashHeart where she has had extensive experience in cardiac CT for congenital heart disease. Sarah is head of Paediatric Cardiology Services, MonashHeart, and practices as a paediatric cardiologist and CT cardiologist.
Plans for 2013
What we do
• One of our main aims for 2013 is to expand our services in order to reduce the waiting time for our outpatient transthoracic service.
MonashHeart offers a comprehensive
• We will be increasing the number of days in which we offer echocardiogram services at Casey Hospital, Berwick from three days to five days per week.
as treatment of adults with congenital heart
• To meet the demand for non-invasive imaging services, we also plan to expand our Saturday echocardiogram service.
kilograms), cardiac CT services and foetal
• We seek to finalise an echocardiogram machine replacement program, to adhere to strict obsolescence management requirements. This will ensure that we always operate state-of-the-art machines to provide the very best images for patient diagnosis and management. • We plan to further expand registrar training in echocardiography and improve the clinical management of MonashHeart inpatients with the use of a CCU echocardiogram machine. This exciting initiative will be supported by the three non-invasive imaging fellows and the six non-invasive imaging consultants.
cardiology service to patients from foetal life right through to the age of 18 as well disease. Services include echocardiography, interventional cardiac rhythm management (for patients weighing greater than 30 echocardiography. Outpatient services include consultation clinics at Clayton and Casey. Inpatient services are predominately at Clayton and include Monash Newborn and Monash Children’s.
• In line with our efforts to offer exceptional education opportunities, we created a second paediatric cardiology fellow training position. • We welcomed Dr Bennett Sheridan into our team as a locum paediatric cardiologist. • To ensure that our paediatric patients are able to enjoy the child-friendly environment of the paediatric ward, we installed a cardiac monitoring system in the paediatric wards at Monash Medical Centre Clayton. This system feeds directly through to the MonashHeart cardiac care unit for remote and continuous analysis by the CCU critical care trained nursing team.
• We will continue to fully support and involve the members of our team in the Rheumatic Heart Disease Screening Program Mafu Sai in Tonga. Plans for 2013 • We are committed to expanding our services to meet the needs of the growing number of paediatric cardiac patients we treat every day. Some of the specific programs we are targeting in 2013 are:
• We are focused on improving the overall experience of our paediatric patients and their family members. In 2012, we also established an innovative weekly paediatric murmur clinic at MonashHeart Clayton, specifically for the early review of children and babies diagnosed with a cardiac murmur.
• the expansion of our consultation services at MonashHeart Dandenong
• In the same vein, we commenced a weekly general paediatric cardiology clinic at MonashHeart Clayton to help manage the long waits experienced at the weekly Monash Children’s clinic. This significantly reduced the waiting times for babies and children needing cardiologist review.
• the expansion of our weekly Monash Children’s outpatient cardiology clinic
• the increase in our echocardiogram service at Casey Hospital to a full day each week • the establishment of an adult congenital heart disease service including a consultation service
• the finalising of a business case for the establishment of a fourth cardiac cath lab specifically for paediatric interventional services. • We also intend to strengthen the Foetal Diagnostic Unit service through the recruitment of a paediatric cardiologist with subspecialty training from an internationally acclaimed training institution.
developments in the field.
24
25
FUNDRAISING REPORT
At MonashHeart we commit to providing the
Fundraising activities
MonashHeart services are principally funded
best possible experience, atmosphere and environment for our patients. Our fundraising activities have enabled us to actively pursue patient service enhancements, purchase additional equipment and develop our infrastructure: activities that are not typically covered under healthcare budgets. Over the course of the year, we received support from the public, former patients, charitable organisations as well as our loyal and caring partners.
TOTAL RAISED
$121,698
26
Revenue
Outlook
During the 2011/2012 financial year, revenue was 34% higher than originally forecasted, primarily due to MonashHeart’s ability to meet the rapidly increasing demand for cardiology healthcare services in Victoria.
It is expected that the demand for quality cardiology healthcare services will continue to increase in the future. MonashHeart is committed to meeting this growing demand and will continue to promote improved wellbeing in the community. The outlook in financial resources required to match the increased demand is positive. Funding from various sources will continue to enable MonashHeart to deliver exceptional quality cardiology healthcare services to our patients into the future.
by the Department of Health, private health • In February of 2012, we launched the first ever Love Your Heart Day, MonashHeart’s very own heart health social awareness campaign and fundraising event celebrated annually in conjunction with Valentine’s Day. During the days leading up to the event, our staff conducted heart health checks for members of the public in the foyer of Monash Medical Centre Clayton.
A large portion of the funds raised in 2012 enabled the purchase of the following equipment, in line with our efforts to continually improve patient services:
fund rebates, Monash Cardiovascular Research
• four cardiac telemetry units for the CCU at Dandenong Hospital ($40,000)
conducted in the cardiac catheterisation
• a two-bed elective bay for the CCU at Monash Medical Centre Clayton ($11,000)
non-invasive imaging and cardiac CT services
• Run Melbourne, held in July 2012, was a fantastic way for MonashHeart staff and friends to participate in one of the biggest fun runs on the Melbourne sporting calendar. The $11,000 raised well exceeded our target and will go towards creating two dedicated bed bays for elective patients needing a short overnight stay after undergoing a coronary angioplasty procedure.
• a patient weigh chair for the CCU at Monash Medical Centre Clayton donated by the Rotary Club of Monash ($2,200)
• The MonashHeart Annual Fundraising Golf Challenge held in December 2012 raised over $30,000 to fund the purchase of additional telemetry monitors for the Cardiac Care Unit (CCU) at Dandenong Hospital. This – our third annual golf challenge – was a great success with 52 golfers braving the challenging weather conditions (wind, cold and intermittent rain) to raise funds to improve the monitoring of acute cardiac patients in Dandenong Hospital.
Support our work
OUR FINANCES
Centre research activities and charitable donations. Funds received are used to deliver services to patients through procedures laboratories, tests offered through our as well as outpatient consultation services.
Expenditure Expenditure for the 2011/2012 year was 16% higher than forecasted values, also because of the increased activity over the period. 51% of our costs were attributed to labour while 49% of costs were spent on consumables to treat patients. This is very uncommon for a healthcare service provider, as the labour cost component is normally far greater than other cost components. However in the case of MonashHeart, due to our high volume of cardiac catheterisation laboratory activity and the extensive use of consumables and devices when performing procedures, consumables represent almost half of our costs.
• an echocardiogram bed for MonashHeart Dandenong purchased with a RACV grant ($4,000) The remainder of the raised funds has been allocated to other expansion and development initiatives including the purchase of more loop monitors and Holter monitors to expand our busy services.
Total Costs 2011/2012
49%
51%
Consumables
Labour 27
MONASH CARDIOVASCULAR RESEARCH CENTRE REPORT
A core component of our vision to become the leading cardiology healthcare service provider in Australia is our relentless drive to innovate and continually improve through research and technology. The Monash Cardiovascular Research Centre (MCRC) is the formal research arm of MonashHeart and is responsible for all research functions to support the MonashHeart, Monash Health and Monash University strategic plans. MCRC is an independent research group bridging Monash Health and the Faculty of Medicine, Nursing and Health Sciences at Monash University. 28
29
RESEARCH CENTRE REPORT
Strategic overview
Referred publications in scientific journals
Building on our strong focus in new cardiology healthcare innovations and pioneering medicine, our ground-breaking discoveries continue to help advance the diagnosis and treatment of cardiovascular disease.
MonashHeart researchers published more than 20 high impact peer reviewed articles in international cardiovascular scientific literature in 2012, including:
MonashHeart and MCRC are recognised as being in the top tier internationally in the fields of cardiac technology, therapeutic devices and invasive treatment of coronary artery disease, structural and valvular heart disease, establishment of new approaches in the management of cardiac disease in the use of Cardiac CT imaging and the application of arterial mechanics and functions to establish a better understanding of cardiovascular pathophysiology. MCRC provides international leadership in cardiovascular research through: • Leadership in clinical and first-in-human studies and evolution of new treatment strategies including transcatheter valve replacement and repair • Recognised presence in international clinical forums such as the American Heart Association, EuroPCR, American Society of Hypertension, European Society of Cardiology, International Society of Vascular Health and Trans Catheter Therapeutics • Leadership in assessment of central haemodynamics, arterial mechanics/function and mechanisms of cardiovascular risk.
1.
Cheng K, Cameron JD, Tung M, Mottram PM, Meredith IT, Hope SA. Association of left ventricular motion and central augmentation index in healthy young men. J Hypertens. 2012 Dec;30(12):2395-402.
2. Ferencik M, Schlett CL, Bamberg F, Truong QA, Nichols JH, Pena AJ, Shapiro MD, Rogers IS, Seneviratne S, Parry BA, Cury RC, Brady TJ, Brown DF, Nagurney JT, Hoffmann U. Comparison of traditional cardiovascular risk models and coronary atherosclerotic plaque as detected by computed tomography for prediction of acute coronary syndrome in patients with acute chest pain. Acad Emerg Med. 2012 Aug;19(8):934-42. 3. Kiropoulos LA, Meredith I, Tonkin A, Clarke D, Antonis P, Plunkett J. Increased psychosocial stress in Greek-born immigrants compared to Anglo-Australians with coronary heart disease: the healthy heart, healthy mind study. Heart Lung Circ. 2012 Dec;21(12):794-802. 4. Ko BS, Cameron JD, Leung M, Meredith IT, Leong DP, Antonis PR, Crossett M, Troupis J, Harper R, Malaiapan Y, Seneviratne SK. Combined CT coronary angiography and stress myocardial perfusion imaging for hemodynamically significant stenoses in patients with suspected coronary artery disease: a comparison with fractional flow reserve. JACC Cardiovasc Imaging. 2012 Nov;5(11):1097-111. 5.
Malaiapan Y, Leung M, Ahmar W, Hutchison AW, Prasad S, Katticaran T, Cameron JD, Harper RW, Meredith IT. Guideline recommended door-to-balloon time can be achieved in transradial primary PCI - the usefulness of a dedicated radial guide catheter. Cardiovasc Revasc Med. 2012 Dec 7.
6. Meredith IT, Verheye S, Dubois CL, Dens J, Fajadet J, Carrié D, Walsh S, Oldroyd KG, Varenne O, El-Jack S, Moreno R, Joshi AA, Allocco DJ, Dawkins KD. Primary endpoint
30
results of the EVOLVE trial: a randomised evaluation of a novel bioabsorbable polymer-coated, everolimus-eluting coronary stent. J Am Coll Cardiol. 2012 Apr 10;59(15):1362-70. 7.
Nasis A, Moir S, Seneviratne SK, Cameron JD, Mottram PM. Assessment of left ventricular volumes, ejection fraction and regional wall motion with retrospective electrocardiogram triggered 320-detector computed tomography: a comparison with 2D-echocardiography. Int J Cardiovasc Imaging. 2012 Apr;28(4):955-63.
8. Obeyesekere MN, Lockwood S, Mottram P, Alison JF. Role for the left atrial appendage occlusion device in managing thromboembolic risk in atrial fibrillation. Intern Med J. 2012 Mar;42(3). 9. Wong DT, Leung MC, Das R, Puri R, Liew GY, Teo KS, Chew DP, Meredith IT, Worthley MI, Worthley SG. Intracoronary ECG ST-segment recovery during primary percutaneous intervention for ST-segment myocardial infarction: insights from a cardiac MRI study. Catheter Cardiovasc Interv. 2012 Nov 1;80(5):746-53. 10. Wong DT, Leung MC, Richardson JD, Puri R, Bertaso AG, Williams K, Meredith IT, Teo KS, Worthley MI, Worthley SG. Cardiac magnetic resonance derived late microvascular obstruction assessment post ST-segment elevation myocardial infarction is the best predictor of left ventricular function: a comparison of angiographic and cardiac magnetic resonance derived measurements. Int J Cardiovasc Imaging. 2012 Dec;28(8):1971-81. 11. Wong DT, Ko BS, Cameron JD, et al. Transluminal attenuation gradient in coronary computed tomography angiography is a novel noninvasive approach to the identification of functionally significant coronary artery stenosis: A comparison with fractional flow reserve. J Am Coll Cardiol 2012 (Accepted). 12. Wong DT, Siang SY, Malaiapan Y. Instent thrombosis due to neo-atherosclerosis: Insight from optical coherence tomography. J Invasive Cardiol 2012 (Accepted).
Invited international presentations
Selected conference presentations
MonashHeart researchers were invited to present at numerous international meetings and events. Key selected invited presentations that were made in 2012 include:
1. Dr Brian Ko presented work including:
1.
Cameron J, “Are the different vascular effects of antihypertensive agents clinically relevant?”, 9th Chinese International Congress of Vascular Medicine, ISVH China Forum and China-US Forum on Hypertension and Vascular Disease, Beijing, China, 2012 June 23.
2. Lockwood SM, “Role of echocardiography in peri-procedural guidance of TAVI”, 60th Annual Scientific Meeting of Cardiac Society of Australia and New Zealand, Brisbane, Australia, 2012 August 15. 3. Meredith IT, Aortic Valve Disease and TAVR. “Long-term outcomes from The CoreValve Transcatheter Aortic Valve AustraliaNew Zealand Study”, Transcatheter Cardiovascular Therapeutics TCT 2012, Miami Convention Centre, Florida, USA, 2012 October. 4. Meredith IT, Bioresorbable Vascular Scaffolds: Latest designs and clinical study evidence. “Vasomotion After Metallic and Bioabsorbable Implants: Evaluation and Clinical Relevance”, Transcatheter Cardiovascular Therapeutics TCT 2012, Miami Convention Centre, Florida, USA, 2012 October. 5.
Meredith IT, Technological progress and newer generation TAVI devices – “Evidence with the Lotus™ Aortic Valve Replacement System”, PCR London Valves 2012 Year of the Textbook, London, UK, 2012 September 30.
6. Meredith IT, “SADRA Lotus™ Valve System: REPRISE I primary endpoint results”, EuroPCR Meeting, Paris, France, 2012 May. 7.
Seneviratne S, “Role of cardiac CT in acute chest pain and radiation dose reduction strategies”, European Society of Cardiology Scientific Meeting 2012, Munich, Germany, 2012.
• “Routine three vessel fractional flow reserve in patients with suspected coronary artery disease referred for elective invasive angiography” at the International Congress of Cardiology, Hong Kong, China in February 2012. • “Combined CT coronary angiography and CT myocardial perfusion imaging to detect functionally significant coronary stenoses in suspected coronary artery disease comparison with fractional flow reserve” at the Congress of European Society of Cardiology, Munich, Germany in August 2012. • “Detection of hemodynamically significant coronary stenoses by assessment of transmural myocardial ischemia on CTcomparison with fractional flow reserve” at the RSNA 98th Scientific Assembly and Annual Meeting, Chicago, USA in November 2012. 2. Dr Siobhan Lockwood presented on the “Relationship of aortic annular eccentricity and paravalvular regurgitation post transcatheter aortic valve implantation with CoreValve” at the European Society Cardiology Congress (ESC), Munich, Germany in August 2012. 3. Dr Arthur Nasis presented on “An abnormal left ventricular exercise stress echocardiography response in the absence of obstructive coronary artery disease is associated with subclinical myocardial dysfunction” at the EuroECHO and Other Imaging Modalities, Athens, Greece in December 2012 and at the 60th Annual Scientific Meeting of the Cardiac Society of Australia and New Zealand, Brisbane, Australia in August 2012. 4. Dr Arthur Nasis presented on “A novel coronary computed tomography angiography-guided algorithm for chest pain evaluation in the Emergency Department is effective and safe at long-term follow-up” at the 61st Annual Scientific Session of the American College of Cardiology, Chicago, USA in March 2012 and at the Radiology Scientific Assembly of
North America, Chicago, USA in November 2012. 5. Dr Dennis Wong presented on the “Transluminal gradient in CT coronary angiography predicts coronary artery stenosis: A comparison with fractional flow reserve” at the RSNA 98th Scientific Assembly and Annual Meeting, Chicago, USA in November 2012.
National meetings MonashHeart presented over 60 presentations (including 10 oral presentations) at the Cardiac Society of Australia and New Zealand in Brisbane, Australia in August 2012.
PhD projects
At MonashHeart we are focussed on exceptional quality research and education. The following is a list of postgraduate (PhD) projects undertaken at MonashHeart in 2012. 1. “A systems approach to the assessment of the left ventricular outflow track – Aortic valve complex and the influence of trans catheter aortic valve replacement on perivalvular haemodynamics”, Dr Robert Gooley. 2. “Approaches to optimising outcomes in STelevation and non-ST elevation myocardial infarction”, Dr Adam Hutchison. 3. “Stress myocardial perfusion imaging using computed tomography in stable coronary artery disease”, Dr Brian Ko. 4. “Multi-modality assessment of the aortic root, aortic valve and ascending aorta – Implications for diagnosis and treatment of cardiac disease”, Dr Siobhan Lockwood. 5. “A comprehensive assessment of central aortic blood pressure and coronary blood flow characteristics in vivo”, Dr Om Narayan. 6. “Use of novel imaging techniques for the diagnosis of coronary artery disease and myocardial ischaemia: Implications for the assessment of patients with chest pain”, Dr Arthur Nasis. 31
RESEARCH CENTRE REPORT
Industry sponsored projects
Top research projects/trials of 2012
Prizes and recognition
MonashHeart lead more than 20 industry sponsored clinical trials comprising a number of first-in-human trials including:
1. Cameron JD, Narayan O, Hope SA, Meredith IT, “Association of left ventricular motion and central augmentation index with comprehensive assessment of central aortic blood pressure and coronary blood flow characteristics in vivo”.
1. Dr Om Narayan won the Registrar Research Prize at the Cardiac Society of Australia and New Zealand Victorian Branch Annual Meeting. “Percutaneous coronary intervention enhances accelerative wave transmission in coronary arteries”.
2. Gooley R, Lockwood S, Cameron JD, Meredith IT, Mottram PM, Moir S, “Aortic valve complex and the influence of trans catheter aortic valve replacement on perivalvular haemodynamics”.
2. Dr Arthur Nasis (as primary author) was named as a finalist for the Alexander R Margulis Award for Scientific Excellence from the Radiological Society of North America, 2012. Arthur Nasis, Ian Meredith, Nitesh Nerlekar, James Cameron, Paul Antonis, Philip Mottram, Michael Leung, John Troupis, Marcus Crossett, Tony Kambourakis, George Braitberg, Udo Hoffman, Sujith Seneviratne. “Acute chest pain investigation: utility of cardiac CT angiography in guiding troponin measurement”. Radiology 2011; 260(2):381-389.
1. CoreValve: CoreValve International Clinical Study: Percutaneous Aortic Valve Replacement (PAVR) with the Medtronic Core Valve System Australia/New Zealand (ANZ) Clinical Study. 2. HeartFlowNXT: HeartFlow Analysis of Coronary Blood Flow Using Coronary CT Angiography: NeXt sTeps. 3. REPRISE II: REpositionable Percutaneous Replacement of Stenotic Aortic Valve through Implantation of Lotus™ Valve System – Evaluation of Safety and Performance TP3687.
Grants and scholarships Monash Cardiovascular Research Centre staff hold grants and scholarships from and including: 1. A National Health and Medical Research Council Postgraduate Scholarship 2. A National Heart Foundation Postgraduate Scholarship 3. The Monash Health Senior Medical Staff Academic Scholarship 4. The Cardiac Society of Australia and New Zealand.
3. Ko BS, Seneviratne SK, Cameron JD, Meredith IT, “CT coronary angiography and stress myocardial perfusion imaging for hemodynamically significant stenoses in patients with suspected coronary artery disease”. 4. Meredith IT, Malaiapan Y, Dundon B, Antonis P, Austin MA, Plunkett JC, “Renal denervation therapy for resistant hypertension”. 5. Wong DT, Cameron JD, Narayan O, Meredith IT, “Impact of severe aortic stenosis on large artery stiffness”. 6. Wong DT, Ko BS, Seneviratne SK, Cameron JD, Meredith IT, “Transluminal attenuation gradient in CT coronary angiography is a novel non-invasive approach to the identification of functionally significant coronary artery stenosis”.
Degrees confirmed Dr Arthur Nasis was conferred the postgraduate degree of Doctor of Medicine from Monash University in December 2012 for his thesis entitled “Advances in cardiac imaging with wide-area multidetector cardiac computed tomography”. This thesis encompassed a body of research that sought to determine the place of wide-area multidetector cardiac computed tomography in contemporary clinical practice for the diagnosis of coronary artery disease and in the assessment of left ventricular function in stable and acute chest pain populations.
“The ability to change lives through both scientific research and clinical practice is truly rewarding.” Dr Arthur Nasis Postgraduate MD recipient Alexander R Margulis Award finalist | PhD Fellow
32
33
“Now, months after the procedure I am absolutely stoked.” Matthew Gaythorpe 10-year old Cricketer | Avid Lego player | Shark enthusiast Younger brother of Ben & William
Born with an incurable kidney disease, Matthew was on multiple medications to lower his blood pressure ever since his blood pressure reading was found to be 165/115 at the tender age of six months (a normal reading is 120/80). “Over the years he had had 28 admissions to hospital to try and control his blood pressure, but we never ever really got any optimal blood pressure control. It was terribly frustrating trying to deal with Matthew’s chronic illness which was so obviously life-threatening.” In 2011, he suffered a stroke and his condition deteriorated even further. Despite taking 37 different tablets daily, Matthew began to suffer seizures regularly. Faced with one last option – the terrible prospect of having Mathew’s kidneys removed and going onto life-long dialysis – Alex and Andrew caught a glimmer of hope when Matthew was referred to see Professor Ian Meredith AM for a second opinion regarding a procedure called renal denervation; a new procedure which, up till then, had only been performed on adults and never on anyone as young or as small as Matthew.
34
Seeking the green light for such a procedure was a journey fraught with many obstacles due to Matthew’s age. However, Alex and Andrew never gave up hope. “Just knowing that there was another option was wonderful. I only wanted to do what was best for Matthew and I did not want to go for radical surgery unless I knew I had exhausted every available option out there,” said Alex. “Sometimes care has to be delivered on compassionate grounds and not clinical or ethical grounds.” Many months later after repeat submissions and even a last-ditch appeal to the Monash Health Ethics Committee, approval was finally obtained to go ahead with this world-first procedure. “Now, months after the procedure I am absolutely stoked,” said Alex. “The number of medications he is required to take as well as his blood pressure readings have reduced substantially”. “Matthew is such a different kid. He has got so much more life now. I don’t know how to thank Ian enough.”
35
OUR ORGANISATION
MANANGEMENT TEAM
OFFICE OF THE DIRECTOR
RESEARCH & EDUCATION
FINANCE OPERATIONS
MONASH CARDIOVASCULAR RESEARCH CENTRE
INTERVENTIONAL SERVICES
36
PAEDIATRIC CARDIOLOGY SERVICES
NON-INVASIVE IMAGING SERVICES
ACUTE CARDIAC SERVICES
CARDIAC CT SERVICES
CARDIAC RHYTHM MANAGEMENT SERVICES
Director of Research & Education
Director of MonashHeart
Operations Manager
Business Manager
Professor James Cameron
Professor Ian Meredith AM
Ms Anne Mennen
Mr Ying Chan
Jim is the Director of Monash Cardiovascular Research Centre, Associate Director (Research and Education) MonashHeart, Monash Health, Professor of Electrical Engineering, Latrobe University and (honorary) Professor of Medicine, Monash University. His qualifications include a Bachelor of Engineering, Masters of Engineering Science, Bachelor of Medicine and Doctor of Medicine. He is internationally know for work on large conduit artery function and mechanics, their influence on mechanisms of disease and their role in risk-assessment and the identification of pre-clinical states. His work provided some of the first evidence that arterial function is modifiable and therefore a therapeutic target.
Ian has over 20 years experience as an interventional cardiologist. He has performed more than 10,000 invasive cardiac and coronary procedures. He is author or co-author of more than 200 published papers and has been principle investigator of over 30 major international multicentre, randomised trials including world first-in-man trials of new drug-eluting stents and the Sadra Lotus™ heart valve. Ian is the Medical Vice President of the Heart Foundation, Victoria, a Cardiac Society of Australia and New Zealand (CSANZ) board member and serves on several advisory boards and government committees.
Anne’s background in both cardiac care and cardiothoracic nursing gives her the skills, knowledge and experience to undertake the role of Operations Manager, MonashHeart. With post graduate qualifications in cardiac care, critical care and business management, she enjoys the challenges of improving and expanding MonashHeart services across Monash Health.
Ying has a Bachelor in Accounting from the South Australian Institute of Technology and has worked extensively across all areas of Monash Health, including acute services, primary, allied health and aged care, and is now the Business Manager for MonashHeart.
37
OUR PEOPLE
Cardiac Care Unit Dandenong Nurse Unit Manager Chris Rasmussen Clinical Nurse Educator Rose Lilo Associate Nurse Unit Managers Rose Arcamo Carol Cheng
Kerry Morten Vicky Syjongtian Mariusz Tragarz Sue Wall Clinical Nurse Specialists Claudette Brown Jason Chong Judy Koh
Michelle D’Lima Joseph Kavitha Sammi Wang Reena Moncy Rosemary XiaYanging Zohra Yaqubi
Registered Nurses Julie Dines
Sally Zhou Maharaj Shobhana Karin Walburgh Joseph Minimol Austine Minimol Lui Suying Phillip Anitha Trish Brindley Charlie Quach
Registered Nurses Sarojani Chand Janine Castillo Rebecca Dean Rebecca Anderson Erinn Vogt Brigita Nogic Lauren Bryce Judith Williams
Dianne D’Rosario Kelly Keir Allana Agnew Heidi Roe Kelli McAlpine Meiling Balintong Caroline Bowman Stella Floros Julia Cvetovac
Enrolled Nurse Shannan Gamble
Angela Coumountouros Stuart Cox Noosha D’Cruze Necia D’Monte Shona Evans Gill Farrell Stephen Farrell Matthew Farrugia Damian Haldane James Harley Rhonda Hassam
Julie Hong Fleur Koval Qin Li Connor McCarthy Eileen Nah Daniel Nicolici Michael Reynolds Lucy Rudolph Karen Sheehy Meena Sumathy Amanda Way
Christie Whatley Jing Zhang Robert Zirafi
Research Coordinators Mary Anne Austin Mauro Baldi Sonia Ciavarella Janise McEwan
Adele Manzoney Wendy Wallace-Mitchell
John Gelman TH Goh Betty Ho Emily Kotschet Jack Krafchek Michael Leung Siobhan Lockwood David McGaw Samuel Menahem Stuart Moir Roger Peverill Bennett Sheridan Tony White
PhD Fellows Robert Gooley Brian Ko Arthur Nasis
Chin Lee Jo Panicker Teresa Page Susan Sadler Liz Seyer Mary Watson
Ward Clerk Suchitra Laxman
Cardiac Catheterisation Laboratories & Cardiac CT
Our people come from all parts of Australia and around the world, with a broad diversity of educational and professional backgrounds – bound by a shared passion for providing unparalleled cardiology healthcare services and making a significant impact on the lives of our patients.
Nurse Unit Manager John Koutsoubos
Administration
Chief Cardiac Technologist Anthony Wald
Business Manager Ying Chan Cardiac Liaison Coordinator Kirsten Garner IT Administrator Val Koval Operations Manager Anne Mennen Billing Supervisor Lorraine Mitsikas
Billing Clerks May Garcia Kelly Grigg Nina Harris Janna Kivi Linda Zou Bookings Supervisor Brooke Wallace Bookings Officers Emma Corrie Craig Pike
Cardiac Catheterisation Laboratory Booking Officer Julie Lukacs Clinical Applications Manager Pei Lee See Personal Assistants Jennielyn Capungcol Kate Moroney
Practice Manager Maree Jones
Gillian Martin Natalija Tsotsoros
Private Consulting Rooms Officers Georgia Georgiou Brylie Vines
Typist Annette McIvor
Clinical Nurse Educator Yasmine Ivankovic Associate Nurse Unit Managers Sarah Cleary Sara Coldicott Kelly Findlay Karen Harrington Crystal Hutton Sia Roussos Kirsten Salvas Rebecca Taylor Loren Wilkie
38
Clinical Nurse Specialists Deidre Ambrose Shannon Barrett Clarissa Bermundo Liezyl Bogaoan Caroline Bowman Lani Caballero Kay Cavanagh Sybil Chong Michelle Donnelly Janice Fernandes Bec Hoskin Jo Jeffs Peter Lovett Lee Manu Madhav Silvi Mathew Vasatha Munasinghe Emma Owen Maryann Pang Michael Romero
Leanne Rudd Linore Ryan Carmen Scully Yee Seak Kim Tucker Kara Watt Cindy Wong Lindy Whelan Mei Zheng Sally Zou Registered Nurses Damian Atherton Irene Backo Angelica Barreno Sarah Bond Charis Brown Danny Carey Helen Chilton Beata Csupor Debra Dai
Associate Nurse Unit Managers Kara Zantuck Anna Petrakos
Laboratory Assistants Marcus Hamilton Grant Short Robert Tyers
Deputy Chief Cardiac Technologist Chris Hunter Cardiac Technologist Educator Catherine Mylrea
Lead Cardiac Rhythm Management Services Technologist Nick Youngs Cardiac Technologists Karen Anderson-Weller Rikki Bailey Julie Banks Mario Blitzman Thi Bui
IBL Students/Cardiac Technologists Duc Bui Sarah Thomas Secretaries Katherine Tompkins Sandra Howorth
Monash Cardiovascular Research Centre
Receptionists Karen Chipperfield Lauren Jones
Stephanie Dawson Melissa Di Cesare Angela Ergrnay Katie Hogan Sixia Hu Leslie Jay Tony Logue Annie McCurrach Meredith McMillian Louise Mollet Chiueh Morrison Jane Mountfort Cindy Nhao Judith Schroeder Mandy Seward Kimberley Hansby Nisha Kumar Anne Weber Danielle Scholfield Tara Thomas Rhiannon Thomas
Clinical Nurse Specialists Jade Geer Maree Lawrence Kathy Ruan Geraldine McBean Rebecca Woodley Nadia Jhoomun Allison Hutton
Cardiac Technologists
Reception Supervisor Margaret Beddoe
Director of Monash Cardiovascular Research Centre James Cameron
Cardiac Care Unit Clayton Nurse Unit Managers Kerrie Aldridge Claire McDonald
Clinical Nurse Educator Kevin White
Catherine Pemberton
Sheejamol Thomaskutty Wendy Wallace-Mitchell Critical Care Students Melissa Harvey Sammi Wang Mei Cai Transition to Speciality Program Student Lucy Fitzpatrick Graduate Nurse Program Jemma Grieve Rachel Paul Ward Clerks Elizabeth McGrath Christine McNamara Janine Wallace
Manager Julie Plunkett Research Assistant Therma Katticaran
Medical Scientist Michael Zhang
Medical Staff Director of MonashHeart Ian Meredith
Head of Interventional Services
Head of Cardiac Rhythm Management Services Jeff Alison
Yuvaraj Malaiapan
Head of Acute Cardiac Services Paul Antonis Head of Research & Education James Cameron Head of Paediatric Cardiology Services Sarah Hope
Head of Non-Invasive Imaging Services Phil Mottram Head of Cardiac CT Services Sujith Seneviratne Emeritus Director Richard Harper Cardiologists David Adam Wally Ahmar Garry Barron Logan Bittinger Lance Fong
Cardiologists (Honorary) Andrew Davis Ben Dundon Sue Ling Liew Andreas Pflaumer
Paediatric Cardiology Services Fellows
Interventional Services Fellows Nicholas Jenkins Dennis Wong Adam Hutchison
Jayashree Mishra Lauren Shearer
Advanced Cardiology Trainees (2nd year) Roland Hilling-Smith Matthew Tung
Cardiac Rhythm Management Services Fellows Stewart Healy Liang Han Ling
Advanced Cardiology Trainees (1st year) Nitesh Nerlekar Harendra Wijesekera
Non-Invasive Imaging Services Fellows Timothy Barton Jonathon Lipshutz Giovanni Romanelli 39
IN THE MEDIA
In 2012 our media exposure grew exponentially, with more than 70 positive media stories featured over a variety of channels and mediums. From print media to social media; from radio and television news to one-on-one live telecast interviews, our successes were not only broadcasted statewide, but also nationwide and even internationally. We also radically diversified our exposure with the broadcasting of our very own 10-episode reality television show entitled Heart Starters. From an online perspective, we took our first tentative steps into social media with the launch of the @MonashHeart Twitter account with 207 followers.
MonashHeart’s reality TV documentary Heart Starters: Heart Starters is a fascinating look into the exciting world of MonashHeart. A 10-episode reality TV documentary which follows the lives of actual patients living with real heart conditions, going behind the scenes to understand their emotions, accompanying them on their journey of diagnosis and treatment and finally capturing their overwhelming sense of gratitude at being given a second chance at life. People like 31-year-old mother Sally and 14-year-old cardiac arrest victim Troy share their personal story of receiving MonashHeart’s care. Presented by Professor Ian Meredith AM, Director of MonashHeart and Executive Producer Suzana Talevski, Heart Starters proved to be the most popular new TV program on Channel 31 for 2012.
Media exposure in 2012 Coverage
Newspapers
Commercial Magazines
Radio
TV News
Online News
3Aw
Channel 7 Channel 10 Channel 9
Local Today
ABC Radio
ABC News
Fox Sports
Star News (Berwick, Mountain Views Mail) Local/Community
Leader (Waverley, Oakleigh/Monash) Weekly (Monash, Casey)
Victorian
Herald Sun The Age
Interstate
Sydney Morning Herald
Australian
The Australian
International
The Financial Express The Telegraph The Standard
Access our media archives 40
Rally Sports Magazine
Zee News India
Follow us on Twitter 41
2012 MEDIA HIGHLIGHTS
JANUARY
Professor Ian Meredith was appointed as a Member of the Order of Australia (AM) in the 2012 Australia Day Honours List in recognition of his many years of outstanding commitment and dedication to medicine through his work as a clinician, researcher and advisor seeking to advance the diagnosis and treatment of cardiovascular disease in Australia.
42
FEBRUARY
In conjunction with Valentine’s Day, MonashHeart launched its first Love Your Heart Day to promote the importance of regular heart health check-ups. Sue Cummings shared her story of her partner, 43-year-old Karl who passed away suddenly at work from a fatal heart attack, leaving herself and their four daughters behind. Sue wanted to share her story to encourage people with any kind of chest pain to seek immediate help.
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
Adam Ternes owes his life to his neighbours and MonashHeart after suffering a cardiac arrest and heart attack. The 37-year-old father of three collapsed after returning from a run and was resuscitated by his quick thinking neighbours who performed CPR on Adam who then received emergency treatment at MonashHeart.
In the past, children would have to wait up to four months in order to have their heart murmur checked at a general cardiology clinic. With the newly launched MonashHeart Paediatric Heart Murmur Clinic, patients like 3-yearold Joel Lang could be seen within a week or two, with same-day access to electrocardiogram and echocardiogram services where required.
Media journalists who were at MonashHeart to interview Professor Ian Meredith AM were privileged to witness him and the MonashHeart team skillfully perform a life-saving procedure on 47-year-old Martin Calam while he was having an acute heart attack.
86-year-old Muriel Satchwell was one of 11 patients selected to be part of MonashHeart’s world-first Sadra Lotus™ heart valve procedure. The 90-minute procedure involved inserting a synthetic heart valve, called a Lotus™ valve, through the groin and into the heart. The trial results were very favourable and now lead the way for further international trials.
Patients at MonashHeart became the first in Australia to benefit from a new technique in which cardiologists use a camera to see directly inside the beating heart while the patient undergoes an ablation procedure. 58-year-old John Gregory, diagnosed with atrial fibrillation after finding he was unable to complete his regular beachside run, became one of the first Australian patients to benefit from this new technique.
MonashHeart celebrated the first year anniversary of the launch of the Rapid Assessment Chest Pain Clinic (RACPC), which in just 12 months had improved the health outcomes for over 2,100 patients and drastically reduced typical waiting periods from months to less than five days. This significantly improved the chances for patients like 49-year-old Frankie Chai to receive the treatment they need in the quickest possible time. By attending the RACPC, Frankie not only received a prompt diagnosis, but also underwent a coronary angioplasty procedure the next day due to the urgency of his case.
SEPTEMBER
On 27 September 2012, the Health Minister, the Honourable David Davis MP visited MonashHeart to officially open the new stateof-art cardiac catheterisation laboratory 9. This $1.2 million laboratory will ensure MonashHeart continues to provide the very best cardiac interventional services for patients.
OCTOBER
NOVEMBER
DECEMBER
After a life-long aortic heart valve abnormality almost led to very serious consequences, 59-year-old Stephen Bidwell was grateful for the life-saving fast-tracked surgery he underwent at MonashHeart. Stephen shared the story of his very positive results as well as his message on the importance of men’s heart health.
10-year-old Matthew Gaythorpe was used to taking 37 different types of medication every day in order to treat two genetic conditions he was diagnosed with as an infant. Professor Ian Meredith AM was determined to perform a procedure that had only been tested in clinical trials involving adults. Matthew’s mother was moved to tears as the world’s first paediatric renal denervation procedure was performed on her son, resulting in a very positive impact on his health and well-being.
Just two months after being hospitalised in Chile for a vertebrae fracture, 54-year-old Dakar Rally champion Bruce Garland had a heart attack while on holiday in Victoria, receiving treatment at MonashHeart. Bruce had an excellent recovery and has returned to Dakar to once again compete in the sport he loves.
43
LOOKING AHEAD
OUR VISION FOR THE FUTURE
Everything that we plan to do at MonashHeart is aligned to our vision: to be the leading cardiology healthcare service provider in Australasia. Key to achieving this vision is our commitment to providing the best possible experience, atmosphere and environment for our patients. We will also continue to relentlessly pursue innovation through research and technology development in our efforts to advance the diagnosis and treatment of cardiovascular disease globally.
Among the patient-centred initiatives we have begun to pursue include: • installing two dedicated procedure beds for elective waiting list angioplasty patients in the Cardiac Care Unit (CCU) at Monash Medical Centre Clayton, ensuring guaranteed bed access to patients who require an overnight recovery bed • initiating the commencement of a new structural heart disease clinic at MonashHeart Clayton, offering streamlined care in the assessment of and workup for complex structural heart disease procedures • expanding our echocardiogram services to cater for the growing demand for both inpatient and outpatient echocardiograms as well as to significantly reduce the current waiting times for both children and adults
“It’s been a tough few weeks. I’m looking forward to having Jesse out of the Neonatal Intensive Care Unit and taking him home.”
In line with our efforts to further expand our services, we recently established the MonashHeart Foundation Strategic Advisory Board. In 2013, the board’s mandate is to lead us to achieve an aspiring vision: • The establishment of a state-of-the-art Acute Cardiac Care Centre incorporating: • four carefully planned and purpose-built cardiac catheterisation laboratories • an expanded Immediate Care Centre to better cater for our many adult and paediatric patients undergoing day procedures • an innovative Chest Pain Centre to manage chest pain patients presenting to hospital.
• incorporating Heart Failure Services as a seventh key sub-specialty service providing acute and chronic heart failure services to the south east region of Melbourne • commencing two new cardiac rhythm management clinics, the Atrial Fibrillation Clinic and the Cardiac Inherited Diseases Clinic for improved patient diagnosis, treatment and education.
Jesse Young (newborn) and Jenny Young Complex heart abnormality “blue baby”
44
45
“Each and every day I thank all of the healthcare professionals who worked on and helped me, giving me more time with my family.” John Kerin Age 51 Acute Heart Attack (Inferior STEMI) Emergency Angioplasty
We would also like to take this opportunity to express our gratitude to the organisations and individuals who made donations or presented gifts-in-kind to MonashHeart in 2012.
46
We gratefully acknowledge the following individuals and organisations for their generous contributions in supporting the work that we do at MonashHeart.
Special thanks to all the individual donors who made contributions of more than $1,000 in 2012 including:
Above Par Commercial Joinery Bonadio Wholesale Fruit Bunning’s South Oakleigh Channel 31 Defries Industries Golf Select Heart Kids, Victoria Kemi Nekvapil Lola Berry Melbourne Heart Football Club Mobile Video Services
Sue Collins Julie Khalid Peter O’Connor
Monash University Paragon Care Point of Care Systems RACV Rotary Club of Clayton Sue Cummings St Jude Medical Toshiba Victoria Golf Club Zouki Clayton Zouki Enterprises
47