Preventative Cardiology and Heart Failure

Professor Geoffrey Tofler and his research group are investigating new approaches to prevent cardiovascular disease. The team is also examining ways to maximise the outcome of patients with known disease.

The group’s investigations are assisted by local, national and international collaborations. Their work includes population and clinical research, as well as a focus on genetics.

Triggers of heart attack and their prevention

Professor Tofler and his research group are leaders in their field, examining acute triggers of heart attack. They investigate additional ways to prevent heart attacks on top of managing chronic risk factors such as hypertension and high cholesterol. The group developed and currently use the TAMAMI database of patients, which includes patients who suffered a heart attack and received treatment at Royal North Shore Hospital. With access to this database, the group is able to look more closely at specific triggers. A/Prof Tom Buckley, recently published a manuscript on Physical Exertion as a Trigger of Heart Attack, while another paper by the group examines heavy and fatty meals as a trigger.

The group is using these findings to support a larger study investigating acute triggers and prevention. The group is currently applying for grants to continue its work in this field. This project involves collaboration with Professors John McNeil and Andrew Tonkin from Monash University. In addition, Dr Kunwar Bhatia, a Cardiology Advanced Trainee at Royal North Shore Hospital, is an expert in App development. An App will play a central role in the planned study which we anticipate will provide a framework for a large multi-centre trial.

Geoffrey Tofler Photo Professor Geoffrey Tofler

Professor of Preventative Cardiology at University of Sydney,
Senior Staff Specialist in Cardiology,
Royal North Shore Hospital

Psychological Stress and Heart Risk: Cardiovascular Risk in Bereavement and Stress among Family Members of Hospitalised Patients.

The group is examining the use of beta blocker and aspirin to reduce the risk of a heart attack in bereavement. Monica Ruckholdt under the PhD mentorship of A/Professor Buckley and Professor Tofler, is currently analysing psychological and physiological changes in relatives of patients hospitalised in Intensive Care and Cardiology.

Smoking Cessation through Personal Identification

This new approach to smoking cessation was supported by a grant from Heart Research Australia, a SPARK innovation award, and an Australian patent. It uses video to simulate a heart attack and builds on the clinical observation that many smokers can stop smoking once they have experienced a heart attack. In a recent internet-based pilot study, over 60% of the smokers successfully stopped smoking and were still abstinent at six months. These findings were published by the Journal of Smoking Cessation with psychologist, Robin May, as first author. The group is currently looking to expand the work, and recently attended a Bio Asia Conference in Taiwan, where this approachwas well received. We are looking to develop national and international partners in this important quit smoking area.

Framingham Heart Study Collaboration

This ongoing international collaboration with Framingham, Massachusetts, investigates the role of haemostatic risk factors, and genetic determinants, in cardiovascular risk prediction. This collaboration saw an important publication into new associations regulating coagulation Factor VIII and von Willebrand Factor plasma levels, which was published in the prestigious US journal, Circulation.

Patient Directed Discharge Letter

Geoffrey and his team received a $200,000 grant over two years from HCF to further develop his published findings that a one page discharge letter written specifically for the patient using lay language, improved patient understanding of their hospitalisation and discharge plans. This project includes North Shore Private Hospital and Ryde Hospital, as well as Royal North Shore Hospital. Geoffrey is currently on a NSW Health Committee to improve hospital discharge summaries. There is the exciting possibility that the project will be rolled out state-wide.

Masters Football and Cardiovascular Risk

We conducted a survey of 153 masters age footballers to assess their knowledge of their cardiac risk, warning symptoms and support for measures such as defibrillators. The findings showed that there were significant cardiac risk factors among the group, that many potential cardiac symptoms were not appropriately acted upon, and that there were gaps in knowledge of heart disease risk. There was strong support among the group for defibrillator availability. The findings were presented by Matthew Francis, medical student, at the 2019 Annual Meeting of the Cardiac Society of Australia and New Zealand.

Management of Cardiac Failure:

Geoffrey is medical director of the Northern Sydney Management of Cardiac Failure program to improve the management of heart failure. Analysis of the database of over 5000 patients has resulted in a recent publication (Dr Nelson Wang, first author) examining changes in heart failure characteristics and outcome. In addition, a short paper on the role of heart rate in heart failure has been accepted for publication in a peer-reviewed journal. A quality improvement project on polypharmacy in heart failure is currently being conducted in collaboration with pharmacy collaborators. The Management of Cardiac Failure nurses in the area-wide program are Maura Farrell, Susan Hales, Precilla Sharp, and Kelly Hanvey.

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