Research suggests that high blood pressure is a major cause of heart valve disease

Optimising available treatment for patients with Heart Failure

HFpEF - Polydiuretic Therapy for Heart Failure with Preserved Ejection Fraction

About this study

Heart failure (HF) is a condition where your heart doesn’t pump enough blood for your body’s needs. It is estimated there is approximately 110,000 people diagnosed with HF in Australia affecting approximately 1-2 % of our population. Over half of these people have heart failure with preserved ejection fraction, HFpEF, which has very few treatments proven to help you feel better or stay out of hospital. Polypills containing low dose diuretics have not been extensively studied in patients with HFpEF and this study aims to help improve the treatment for this patient population.

The purpose of this research study is to investigate whether treatment with the polypill (a single pill containing three medications used to treat heart failure, each at low-dose) improves fluid balance, leads to less congestion and fewer side effects when compared with just one of the active medications from the polypill.

Recruitment criteria

Inclusion

  • Adults (≥18 years old) with a diagnosis of heart failure with preserved ejection fraction (EF) which has been present for at least 2 months

Key Exclusions

  • Known contraindication to the study medications.
  • Current acute decompensated HF or hospitalisation due to decompensated HF <4 weeks prior to enrolment.
  • Myocardial infarction, unstable angina, stroke, or transient ischaemic attack (TIA) within 12 weeks prior to enrolment.
  • Symptomatic bradycardia or second or third-degree heart block without a pacemaker.
  • Women who are pregnant, breast feeding or of childbearing potential and are not using and do not plan to continue using medically acceptable form of contraception throughout the study

What’s involved?

  • The HFpEF trial plans to recruit 30 eligible patients across two centres in Sydney, Australia. One will be at the Charles Perkins Centre, Camperdown, and the other at St. Vincent’s Hospital, Darlinghurst.
  • If you are eligible for this study, you will be randomly allocated to either take an active polypill (a single pill containing three medications used to treat heart failure, each at low-dose) or the comparator medicine (just one of the active medications from the polypill) daily, for a total of one month.
  • You will attend a cardiology clinic on a total of 4 occasions across 4 weeks. Blood tests will be performed at each visit, and you will be asked about your adherence to your medication, you will undergo some assessments including the measurement of your BP, HR, and you may have your exercise capacity measured.

Disease or condition

Heart failure
Cardiovascular

Participating Countries

Australia

Improving the cardiovascular health of patients with chronic kidney disease using blood thinning medication

TRACK - Treatment of cardiovascular disease with low dose Rivaroxaban in Advanced Chronic Kidney Disease

About this study

People with advanced kidney disease or those receiving dialysis often have other diseases related to the heart, brain and blood vessels, known as vascular disease (for example, heart attack, stroke and poor blood circulation). However, few treatments have been proven to prevent these conditions in people with advanced kidney disease. Blood thinners (medicines that prevent blood clots) are frequently used and proven to help other groups of people who are at high risk of vascular disease.

There is little understanding of whether blood thinners provide similar benefits in people with advanced kidney disease. The aim of the TRACK study is to find out whether a low dose of blood thinning medicine can reduce heart and vascular disease better than placebo (a look alike tablet that contains no active medication) in people with advanced kidney disease.

Recruitment criteria

Inclusion:

  • Age ≥18 years,
  • Advanced kidney disease (kidney failure on dialysis, or stage 4 or 5 not receiving dialysis)
  • Increased risk of heart or blood vessel disease:
    • History of coronary artery disease or peripheral artery disease or specific types of stroke, or
    • Diabetes, or
    • Age ≥65 years.

Key Exclusions:

  • Indication for, or contraindication to, anticoagulant therapy
  • High bleeding risk
  • Current treatment with P2Y12 inhibitors/ADP receptor inhibitors (clopidogrel, prasugrel, ticagrelor, cangrelor) or phosphodiesterase inhibitors (dipyridamole), where the treating doctor or patient does not wish to stop these medications
  • Haemoglobin <90 g/L, or platelet count <100 x 109/L,

What’s involved?

  • If eligible for the study, you will receive placebo tablets for approximately 3 weeks. This is to ensure you are able to follow the study medication schedule.
  • If you are able to take the placebo tablets twice a day for 3 weeks, you will be eligible for randomisation. This means that you will be placed into one of two groups (blood thinning medication or placebo) using chance (like tossing a coin).
  • From randomisation, you will be required to take the blood thinning medication or placebo (depending on the group you are placed in) twice a day, for the period of the study. The study will continue for up to about 5 years.
  • Study staff will contact you at 1 month and 3 months after randomisation. From then on, you will be contacted every 3 months. These follow up visits can be done in the clinic or via telephone. Researchers will collect information about your health and whether you have been taking the study medication as prescribed.

 

Disease or condition

Cardiovascular
Chronic kidney disease

Participating Countries

Australia
Belgium
Canada
Germany
France
India
Malaysia
Saudi Arabia
Singapore
Tunisia
Taiwan
United Kingdom

Advocacy and Thought Leadership

The George Institute is focused on effective advocacy and thought leadership to improve health, aligned to our research goals.

We are engaging with key stakeholders, sharing insights and fostering discussions to stimulate debate, guide critical health policy decisions and facilitate evidence-based change.

By working with some of the world’s leading health voices we are amplifying our work in non-communicable diseases (NCDs) and injury and improving systems for prevention and treatment.

Policy Statements and Recommendations

PHS Awards Financial COI Policy

Advocacy Networks and Partners

Latin America collaboration

Distinguished Fellows and Emerging Thought Leaders

Thought Leadership_emerging

Our activities

Search by keyword

Filter by type of content

Case studies
Events
News
Data visuals, infographics and interactives
Policy submissions, briefs and recommendations
Blogs
Podcasts
Priority areas
Videos
Event

Prioritising Workforce for Comprehensive Primary Health Care

prioritising workforce CPHC

About the webinar

A multidisciplinary primary health care workforce is crucial for achieving comprehensive primary health care and ultimately universal health care. It is essential to build a health workforce that is adaptive and aligned with community health needs driven by rapid changes in demographics, epidemiology, economics, social, and political conditions.   

The webinar presents our findings from India, Mexico, and Uganda:  

  • How does the health workforce deliver comprehensive primary health care (CPHC) in the world's three most populated countries? 
  • What are the enablers, barriers, and potential solutions to strengthening the health workforce to deliver CPHC?

About the series

In the recent past, several countries have joined the clarion call to strengthen universal health coverage and access through the lens of CPHC. The series deliberates on the three critical aspects of CPHC – service delivery models, workforce management, and performance measurement and shares thought-provoking insights from the results of research studies in South Asia, Eastern Mediterranean, sub-Saharan Africa, and Latin America.

Register Here

Speakers

  • Dr Ileana Beatriz Heredia-Pi, National Institute of Public Health, Mexico

    Ileana currently works at the Centre for Health Systems Research, National Institute of Public Health, Mexico and member of the National System of Researchers (Level II) of the Science and Technology Council of Mexico. She is passionate about maternal and adolescent health care. She is deeply passionate about strengthening community health workforce. She brings on-board deep experience of working in the primary health care setting in Mexico.

    Ileana Beatriz Heredia-Pi

  • Dr Innocent Besigye, Makerere University, Uganda

    Innocent is a primary health care practitioner and researcher from Uganda. He is pursuing his PhD from the University of Makarere, Uganda. He also serves on the executive committee of Primafamed, the family medicine training network in Africa and is linked to the Besrour Forum. He is co-editor of the African Journal of Family Medicine and Primary Health Care. He has deep interest and expertise in primary health care workforce related issues.

    Dr Innocent Besigye, Makerere University, Uganda

  • Dr Renu John, The George Institute for Global Health, India

    Renu is a Dentist by training with a Master's in Public Health Degree. As a Research Fellow at The George Institute, she has contributed and led several studies that explore and mitigate health systems gaps. She is immensely passionate about providing pragmatic solutions for challenges faced by the community health workers through the application of internet of things and digital health solutions. She brings on board deep insights from her field work in rural India.  

    Dr Renu John, The George Institute for Global Health, India

  • Dr Víctor Hugo Borja Aburto, Head of Primary Health Care and Medical Director of the Mexican Institute of Social Security, Mexico

    Victor is a Medical Doctor and Ph.D. in Epidemiology and Public Health Public. He has been Director of Epidemiology and Biostatistics at the School of Public Health of Mexico, Director of the National Center for Environmental Health of the Ministry of Health, Coordinator of Epidemiological Surveillance, Head of Primary Health Care and Medical Director of the Mexican Social Security Institute.  He is a member of the National Academy of Medicine of Mexico and of the National Council of Public Health. He has published 135 scientific articles and book chapters in national and international journals. He is currently involved in the transformation of the health care model in Mexico.

    Dr Víctor Hugo Borja Aburto, Head of Primary Health Care and Medical Director Mexican Institute

Leads

Further reading

Taskforce on Women and NCDs

The George Institute for Global Health, India appointed Secretariat of the Taskforce on Women and NCDs

The George Institute for Global Health, India is delighted to announce that it has been appointed Secretariat of the Taskforce on Women and Non-Communicable Diseases (NCDs). To mark this exciting chapter, a new Taskforce website launches today.

Founded in 2011, the Taskforce on Women and NCDs has been addressing the growing burden of NCDs on women by providing a platform for collaboration and engagement while developing relevant resources and advocacy positions. It brings together leading global health organisations from the women’s health and NCD communities to improve women’s health by expanding programs to meet women’s needs across the lifecycle

“The Taskforce invites organisations with a vested interested in addressing NCDs in women to join us.  Our collective efforts serve to make us stronger and help advance the SDGs and making women a central driver.”

- Diana Vaca McGhie, Global Advocacy Director at the American Heart Association, and Co-Chair of the Taskforce

A number of emerging health challenges are transforming the landscape of women's health needs across low- and middle-income countries (LMICs). Changing demographics, lifestyles, globalisation, and urbanisation are contributing to the rapid rise in NCDs such as cardiovascular disease, cancer, diabetes, and chronic respiratory disease.

“Global efforts to improve the health of women and girls, in the last few decades have largely focused on reducing maternal mortality and morbidity, while in recent years, non-communicable diseases (NCDs) in women have emerged as major global health challenge that hinders their human right to live healthily and reach their highest economic and social potential.  I am delighted that through our hosting of the Secretariat of this Taskforce, we have an opportunity to play a central role in co-ordinating actions to reduce the impact of NCDs on women.”

- Robyn Norton, co-founder & Principal Director of The George Institute for Global Health

Globally, these changes have adversely affected all women, but those living in LMICs are at a greater risk owing to compounding socio-economic inequity: NCDs are estimated to account for the majority of all female deaths in these regions due to persistent social, gender and economic inequalities as well as general pervasive inequalities in access to health information, appropriate care, and life-saving technologies.

“Two of every three deaths among women worldwide are caused by non-communicable diseases (NCDs) – principally heart disease, stroke, cancer, diabetes and chronic respiratory diseases. Unfortunately, the global health agenda has largely overlooked both the burden of NCDs among girls and women and the unique risks and challenges they face in accessing appropriate healthcare. The Taskforce on Women and NCDs seeks to challenge this bias and advocate for better integration of women and their needs in NCD policies and programmes around the world.”

- Kelcey Armstrong - Walenczak, Policy and Advocacy Manager at the World Heart Federation and Co-Chair of the Taskforce

The Secretariat will act as the focal point of the Taskforce and help coordinate the activities undertaken by members to promote education, advocacy, evidence-based policy, and interventions that protect women's health and well-being.

“We at The George Institute for Global Health are honoured to serve as the Taskforce Secretariat and look forward to supporting and contributing to this collaborative effort to address the unique burden of non-communicable diseases on women. The objectives of this Taskforce are aligned perfectly with The George Institute’s Global Women’s Health Program, which focuses on the health and well-being of women throughout their lives.”

- Professor Vivekanand Jha, Executive Director, The George Institute for Global Health, India

Leads

Related people

  • Global Advocacy Director at the American Heart Association, and Co-Chair of the Taskforce Diana Vaca McGhie

  • Policy and Advocacy Manager at theWorld Heart Federation and Co-Chair of the Taskforce Kelcey Armstrong -Walenczak

Further reading

respiratory

Covid-19 restrictions may have exacerbated India's TB problems: study by The George Institute, India

Findings show up to 7% TB patients stopped taking TB medicines during lockdown

A new study by the researchers at The George Institute for Global Health India examines the possible adverse impact of the Covid-19 pandemic restrictions on India's Tuberculosis (TB) control programme. 

The Covid-19 pandemic resulted in hardships for people belonging to the poorer sections of society, but there had been little research into how it may have affected a particularly vulnerable group, such as those with TB, who require long term treatment.

This study is the first to show evidence of the negative impact of the Covid-19 nationwide lockdown on the income and health services utilisation of TB patients in India.

These findings were part of an ongoing cohort study aimed at examining the economic burden on TB patients in India by Dr Susmita Chatterjee, Senior Health Economist, The George Institute for Global Health, India; Palash Das, Research Fellow, The George Institute for Global Health, India; and Dr Anna Vassall, Professor of Health Economist, Department of Global Health and Development, London School of Hygiene and Tropical Medicine. Researchers noticed that patients reported difficulties in collecting TB drugs from public health facilities, with 4-7% of patients compelled to discontinue their medicines during the nationwide lockdown.

“Patients were finding it difficult to continue TB treatment because the government health facilities were focused on the pandemic and also, they could not travel due to travel restrictions.,” – said Palash Das, Research Fellow, The George Institute for Global Health, India  

Findings of the study

The researchers examined the impact of nationwide lockdown on income and health service utilisation pattern on 291 patients with TB, including those from tea garden areas – a high risk group as defined in the national strategic plan for eliminating TB in India, 2017-2025. The findings reveal that more than half of households with a TB patient in the general population group and about a quarter of households with TB patients in high-risk group (in this case, tea garden workers) had no income during the complete ‘lockdown’ period.

“Many recruited patients belong to extremely low-income groups working as daily wage earners, contractual workers, etc. There is a clear need for their protection during such restrictions through measures such as paid sick leave, additional food support, etc.” – Dr. Susmita Chatterjee, Senior Health Economist, The George Institute for Global Health, India

What it means for the TB control programme in India

India has the largest number of TB patients in the world. According to the ‘India TB Report’ (published by the Central TB Division, Ministry of Health and Family Welfare, Government of India), about 2.64 million Indians had TB in 2019, with approximately 450,000 deaths. The Indian National TB control program aims to make the nation TB free by 2025, five years ahead of the Sustainable Development Goal target. These findings suggest that the Covid-19 pandemic may have an impact on the ongoing efforts to control TB in India.

 

The research paper was published in BMC Infectious Diseases. The full paper can be accessed here.

DOI - https://doi.org/10.1186/s12879-022-07681-z 

 

Leads

Further reading

Improving heart outcomes in dialysis patients

ACHIEVE - Aldosterone bloCkade for Health Improvement EValuation in End-stage renal disease

About this study

Individuals receiving dialysis are at risk of heart failure and heart-related death. There is an urgent need for treatments that reduce the risk of these problems in patients that require dialysis.

Spironolactone is a medication used to prevent heart failure and related deaths in patients that do not require dialysis. It works by blocking a hormone (aldosterone) in your body that causes high blood pressure and can damage the heart. Although spironolactone is very effective in patients that do not require dialysis, we do not know if spironolactone is effective in dialysis patients. Our research will help determine if spironolactone reduces heart failure and heart related deaths in dialysis patients.

Recruitment criteria

Inclusion

  • Age
    • ≥45 years or
    • ≥18 with a history of diabetes
  • On dialysis ≥ 90 days
    • On either
      • Haemodialysis prescribed at least 2 treatments per week or
      • Peritoneal dialysis prescribed with at least 1 exchange daily
  • Provides informed consent

What’s involved?

  • This trial plans to recruit over 1,000 eligible patients across Australia, New Zealand, Malaysia and China.
  • Participants will be randomly allocated to either take 25mg of spironolactone or identical placebo tablets.
  • Participants will be followed up on a six-monthly basis through face-to-face/telephone interviews or mail-based/electronic questionnaires.

Disease or condition

Heart failure
Renal dialysis

Participating Countries

Australia
China
India
Malaysia
New Zealand
Subscribe to