AIMS:High-quality, culturally safe, secondary prevention care has the potential to improve the cardiovascular health of Aboriginal and Torres Strait Islander People in Australia (hereafter collectively referred to as First NationsPeoples). Despite this, there is a paucity of comprehensive data on cardiac rehabilitation (CR) participation among First Nations Peoples. The Queensland Cardiac Outcome Registry is a clinical registry that routinely collects point-of-care CR data. Therefore, the aim of this study is to (i) describe the First Nations populations referred to CR across Queensland, (ii) quantify rates of participation, and (iii) determine factors associated with CR attendance and completion. METHODS:The cohort comprised 2,383 patients who identified as Aboriginal and/or Torres Strait Islander and were referred to one of 56 Queensland CR service extracted from Queensland Cardiac Outcome Registry (2020-2022). Bivariate and multivariable logistic regression analyses were used to identify factors associated with CR attendance and completion. RESULTS:Over the study period, 50% (n=1,185) of First Nations patients in Queensland participated in at least one CR session. Of those who attended, 28% (n=333) completed CR (14% of the total cohort). The strongest predictors of CR attendance were having a coronary artery bypass graft or percutaneous coronary intervention procedure, living regionally (as opposed to remotely/very remotely), and coming from areas of higher socio-economic advantage. CR completion was more likely among men, those in older age groups (particularly 55-64 years), living in a major city, and non-smokers. CONCLUSIONS:This study provides the first known large-scale analysis of the uptake of CR programs among First Nations cardiac patients in Australia. We demonstrate that rates of attendance are higher among this cohort than previously reported. Barriers to attendance are described and highlight an important socio-economic gradient. There are clear opportunities for improving access to evidence-based secondary prevention programs for First Nations Peoples and benefits in collectively considering how unmet needs can be supported.
Cardiac distress is common, yet minimal support is available for nurse assessment of patients. We translated the Cardiac Distress Inventory (CDI) into Thai (CDI-Thai) and evaluated its psychometric properties. This was a cross-sectional study of 250 adults who experienced an acute cardiac event in the past year in southern Thailand. The CDI was translated into Thai using forward-backward translation and expert review. The CDI-Thai achieved translation equivalence to the original version. An eight-factor structure was confirmed by factor analysis, with excellent fit. The CDI-Thai was shown to be culturally relevant and psychometrically robust as a measure of cardiac distress.
BACKGROUND:Spontaneous coronary artery dissection (SCAD) is associated with substantial psychological sequelae. Although previous studies have identified individual risk factors for poor mental health post-SCAD, none has examined whether protective and vulnerability factors cluster together. This study aimed to identify distinct post-SCAD psychological profiles. METHOD:A cross-sectional survey of 263 SCAD survivors recruited from the Victor Chang Cardiac Research Institute Arteriopathies and SCAD Cohort (VASC). Participants completed measures of anxiety (GAD-7), depression (PHQ-9), cardiac distress (CDI-SF), health-related quality of life (SF-12), resilience (CD-RISC), social support (ESSI), patient activation (PAM-13), and post-traumatic growth (PTGI), and provided sociodemographic and medical data. K-Prototypes cluster analysis identified subgroups. Between-cluster differences were examined using chi-square tests and ANOVAs. RESULTS:Clustering identified three psychological recovery profiles. Cluster 1 (Psychologically Vulnerable; 39%) comprised younger-to-mid-aged survivors characterised by low resilience, low patient activation, financial strain, and limited social support. Cluster 2 (Established Copers; 32%) were older with moderate-to-high resilience, higher cardiac rehabilitation (CR) attendance, and low financial strain. Cluster 3 (High-Resource Recoverers; 29%), the youngest group, exhibited the highest resilience, patient activation, and post-traumatic growth. Cluster solution validity was supported by convergent evidence across five complementary indices. CONCLUSIONS:Psychological recovery after SCAD is heterogeneous and not necessarily age dependent. Younger survivors who are financially strained and socially unsupported are most vulnerable to poor recovery whereas, in a novel finding, those with favourable personal and social conditions cope well. Among older survivors, financial security and CR attendance may be protective. Interventions should prioritise resilience building, patient engagement, and strengthening social support.
Amyloid PET quantification using the Centiloid (CL) metric is becoming more prevalent and may have a role in clinical decision-making. But what is the intrinsic confidence interval around a given CL value? To what extent is a CL value from one pipeline equivalent to that from another? We systematically assessed repeatability, reproducibility, and reliability across seven CL quantification pipelines applied to 210 [ 18 F]flutemetamol scans. Three datasets were used: (1) an AD test-retest cohort ( N = 10x2); (2) an amnestic MCI cohort ( N = 80); (3) cases from the BioFINDER-1 cohort enriched for amyloid loads around published positivity thresholds (0-50CL) ( N = 110). Three regulatory-approved software (cPET, MIMneuro, syngo . MI Neurology) and four research pipelines (CapAIBL, rPOP, Amypype, SPM8) were evaluated. Dataset 1 was used to assess within-subject repeatability. Dataset 2 was used to assess reproducibility in terms of absolute agreement in continuous CL values. Datasets 2 and 3 were used to assess reliability for dichotomizing amyloid scans into positive and negative. The latter was performed for three thresholds of 11, 25 and 37 CL. The test-retest analysis revealed absolute biases <5 CL, within-subject coefficients of variation 2.6-4.4% and 95% repeatability coefficients 8.1-16.1 CL (Table 1). Strong group-level associations in continuous CL estimates were observed across pairs of software (R 2 ≥0.93, Figure 1), but 95% limits of agreement (LoAs) ranged between 12 and 23 CL. Agreement in +/- status between software was 92-99% (kappa 0.84-0.97) in dataset 2 and 75-97% (kappa 0.48-0.93) in dataset 3. CL values from most software pairs were interchangeable within the range of test-retest variations, with high overall group-level agreement. Ideally, all inter-pipeline LoAs should be reduced to a similar level as test-retest. Inter-software reliability in dichotomization was >92% for scans across a wide range of CL values, but the percentage was lower for scans with amyloid loads closer to the range of typical positivity thresholds. Uncertainty estimates should always be considered when interpreting results.
There is increasing evidence for an association between white matter hyperintensities (WMH) and brain beta-amyloid deposition. WMH are not exclusive correlates of a single etiology, and the spatial topography can associate with different pathologic markers of vascular or neurodegenerative disease. How WMH are longitudinally associated with brain beta-amyloid burden requires further investigation, particularly with respect to co-existent vascular risk factors and differences across brain regions. We retrospectively measured WMH on MRI and vascular risk factors in a combined neuroimaging data set comprised of the ADNI, AIBL and OASIS3 studies, which included harmonized centiloid estimates of beta-amyloid burden from PET imaging. WMH were measured using the TrUE-Net algorithm. Vascular risk factors were extracted from provided clinical data and used to calculate individual revised Framingham Stroke Risk Profile (FSRP) scores. Five established data-driven WM regions (juxtacortical, deep frontal, periventricular, parietal, posterior) were used for regional relationships with WMH volume and growth. Linear mixed effects modelling was used to determine the relationship between the growth rate of normalized regional WMH volumes and baseline beta-amyloid burden, controlling for age, sex, APOE4 status, and vascular risk factors. 1245 participants [48.7% female, mean age 71.7 y (SD 7.6 y)] had at least 3 brain MRIs suitable for WMH volume measurement. Linear mixed models demonstrate robust independent cross-sectional relationships between WMH and baseline beta-amyloid burden ( p <0.001), age ( p <0.001) and FSRP ( p <0.001). Growth rates of WMH increased with baseline beta-amyloid burden ( p <0.05) and decreased with vascular risk ( p <0.001), above and beyond age, sex, and APOE4 status. Regional analyses revealed both baseline beta-amyloid burden and FSRP associated with the juxtacortical deep frontal and periventricular regions, but the parietal region was unique to beta-amyloid ( p <0.05). Longitudinally, the association for beta-amyloid burden ( p <0.005) persisted in only the parietal WMH and no normalized regional values associated longitudinally with FSRP. Our study suggests that in Alzheimer disease research cohorts, WMH progression is associated with beta-amyloid burden, particularly in parietal white matter. Vascular risk associated WMH were influential for WMH volume but did not associate with WMH progression in a regionally specific manner.
