Westmead Applied Research Centre

Quadruple ultra-low-dose treatment for hypertension

High blood pressure is common and a major cause of heart disease and stroke. While many people with hypertension are on some treatment, in more than half blood pressure targets are not reached and their high blood pressure is uncontrolled.

In this research we investigate whether an approach that combines four types of blood pressure lowering medications at quarter doses into one pill, may be a more effective way of controlling blood pressure.

Investigators: Professor Clara Chow, Professor Anthony Rodgers, Professor Graham Hillis, Professor Markus Schlaich, Professor Tim Usherwood, Dr Ruth Webster Associate Professor Laurent Billot, Emeritus Professor John Chalmers, Dr Jay Thakkar, Henry Krum, Professor Anushka Patel, Professor Bruce Neal, Professor Mark Nelson, Professor Christopher Reid, Amie Cho and Dr Emily Atkins. Funded by the NHMRC.

Text messaging support for patients with chronic disease           

Many Australians have chronic conditions such as cardiovascular disease and diabetes. The introduction of the SupportMe program will transform the delivery of care across hospital and primary care services. The program aims to improve health outcomes for patients and reduce costs from inappropriate and fragmented care.

SupportMe is a pragmatic, randomised controlled trial to determine the effect of mobile phone text messaging interventions on blood pressure and blood glucose for patients with diabetes and cardiovascular diseases.

Investigators: Professor Clara Chow, Professor Wah Cheung, Dr Tien-Ming Hng, Associate Professor Julie Redfern, Emeritus Professor Stephen Leeder, Dr Jin Gun Cho, Simon Raadsma, Cate Ferry, Michael Crampton, Dr Alison Hayes, Bridie Carr, Professor Chris Rissel, Sandra Bahamad, Shelley She, Dr Rabbia Haider, Daniel McIntyre and Sonia Faruquie. Funded by NSW Health.

Technological support for patients with cardiovascular disease via integrated text messaging (ITM)

Many Australians are living with chronic conditions that cause more than half of all preventable hospital admissions. Availability and use of technology can provide simple strategies to improve out-of-hospital management and support for these patients.

The ITM study is evaluating a six-month post-discharge text message support program to help patients with chronic respiratory and/or cardiovascular disease. The program aims to improve their health through healthy living, symptom management and mediation adherence, compared to usual care.

Investigators: Associate Professor Julie Redfern, Professor Clara Chow, Dr John Cullen, Professor Ian Caterson, Dr Lissa Spencer, Dr Jessica Swinbourne, Dr Alison Hayes, Dr Karice Hyun, Simon Raadsma, Cate Ferry, Bridie Carr, Karla Santo, Nashid Hafiz, Polly Huang and Anna Singleton. Funded by the National Heart Foundation of Australia.

Text messages to improve medication adherence and secondary prevention    

Cardiovascular disease is the leading cause of death and disease burden globally. TextMeds is a randomised controlled study that investigates the effectiveness of sending automated mobile text messages to people with cardiovascular disease. The intervention aims to improve adherence to medication, lifestyle and behaviour change.

Investigators: Professor Clara Chow, Professor David Brieger, Professor Graham Hillis, Associate Professor Julie Redfern, Associate Professor Fiona Turnbull, Dr Aravinda Thiagalingam, Associate Professor Federica Barzi, Associate Professor Rohina Joshi, Professor Derek Chew, Professor Stephen Jan, Bernadette Aliprandi-Costa, Professor Anthony Rodgers, Sandra Bahamad, Anu Indrawansa, Gillian Rosic and Daniel McIntyre. Funded by the NHMRC.

Text messaging support for people with chronic disease

TextCare will address the lack of availability, accessibility and effectiveness of support services for people living with chronic disease. Support and rehabilitation programs are effective in improving health outcomes, but for many people they are not available or accessible, resulting in low patient attendance.

TextCare is based on behaviour change theory – it uses computerised algorithms to create personal messages that educate, motivate and support patients. This provides more accessible rehabilitation support services.

Investigators: Professor Clara Chow, Associate Professor Julie Redfern, Tony Barry, Dr Aravinda Thiagalingam, Associate Professor Maree Hackett, Professor Stephen Jan, Professor Anthony Rodgers, Professor Christine Jenkins, Professor Wah Cheung, Dr Vincent Lee, Cate Ferry and Dr Jay Thakkar. Funded by the Google Impact Challenge.

Quality improvement in primary care to prevent hospitalisations and improve effectiveness and efficiency of care for people living with heart disease              

Coronary heart disease accounts for the greatest disease morbidity and nearly one fifth of deaths in Australia. Around half of these deaths occur in people with prior coronary heart disease.

Cost-effective and scalable strategies are needed to prevent associated deaths and hospitalisations. Our aim is to improve secondary prevention in primary care by implementing a scalable strategy and practice-level quality improvement to inform government decision-making.

Quel provides robust data about whether quality improvement reduces hospitalisations and costs and about how it can be implemented in an efficient and sustainable way.

Investigators: Associate Professor Julie Redfern, Professor Clara Chow, Professor Christopher Reid, Professor Nicholas Zwar, Professor Timothy Usherwood, Professor Mark Woodward, Professor Stephen Jan, Professor David Hare, Associate Professor Thomas Briffa, Professor Robyn Gallagher, Rohan Greenland, Julie Anne Mitchell, Colin Frick, Dr Andrew Knight, Associate Professor Laurent Billot, Dr Emily Atkins, Professor Elizabeth Halcomb, Dr Tony Lembke, Dr Robert Herkes, Dr Tracey-Lea Laba and Nashid Hafiz. Funded by the NHMRC and in-kind contributions from partner organisations.

Apps to improve medication adherence in coronary heart disease (MedApp-CHD) study

The MedApp-CHD study will evaluate a highly innovative intervention using mobile phone apps to improve patients’ cardiovascular health and medication adherence.

The MedApp-CHD study is a randomised controlled trial using two types of mobile phone apps to improve adherence to cardiovascular medication in patients with coronary heart disease and, consequently, improve blood pressure and cholesterol levels.

Investigators: Associate Professor Julie Redfern, Dr Karla Santo, Professor Clara Chow, Emeritus Professor John Chalmers, Karla Santo and Anna Singleton. Funded by the Heart Foundation.

A text message-based intervention to support women’s health outcomes after breast cancer treatments          

The number of Australian women who survive breast cancer has dramatically increased over the past 10 years, prompting an urgent need for effective support strategies during their recovery and beyond. Previously, our research team’s text-messaging programs have been used to provide support to people with heart and lung diseases. After a six-month program, people showed improvements in blood pressure, cholesterol, physical activity and healthy eating. Now, we want to know if this same strategy can also help women’s health and wellness after breast cancer treatments.

The Text4BreastCare study is a single-site randomised controlled trial examining if receiving supportive text messages helps improve women’s mental, emotional and physical health after breast cancer treatments compared to not receiving any messages. If effective, this support strategy can be easily scaled-up and tested across Australia.

Investigators: Associate Professor Julie Redfern, Associate Professor Elisabeth Elder and Anna Singleton.

Text message-based behavioural intervention for teens on eating, physical activity and social wellbeing

Overweight and obesity affects nearly one in three adolescents, aged 13 to 18 years, living in Australia. Weight gain in youth is related to cancer, heart disease and diabetes in later life.

To address this we have developed a simple, scalable and engaging text message-based program. We are testing TextBites in adolescents to improve weight and key weight-related lifestyle behaviours, physical activity, healthy eating and social wellbeing.

Investigators: Dr Stephanie Partridge, Associate Professor Julie Redfern, Professor Clara Chow and Professor Adrian Bauman.

Using the time patients spend in waiting rooms to educate them on cardiovascular disease

Knowledge of cardiovascular disease is associated with better adherence to lifestyle changes that improve health. However, there is not enough time in a 15-minute clinic appointment for doctors to both provide care and educate patients on cardiovascular disease. In fact, patients often spend more time waiting to see the doctor than in their consultation.

'While you’re waiting' aims to use time spent in waiting rooms as an opportunity to deliver informative and engaging educational videos on cardiovascular disease that have been selected by health care professionals.

We are interested to see if this will improve overall satisfaction with clinic care and motivate patients to make lifestyle changes that reduce their cardiovascular disease risk.

Investigators: Dr Aravinda Thiagalingam, Daniel McIntyre, Dr Jay Thakkar and Professor Clara Chow.

Text messages for cardiovascular disease prevention optimised via machine learning systems

Our team has developed and evaluated cardiovascular disease support programs delivered via text messaging. The method for maximising and maintaining engagement with these programs for the long term is an implementation challenge.

This study aims to assess whether machine learning and/or increased interaction with a health coach can improve engagement, health behaviour and health outcome measures (cholesterol, blood pressure, weight, physical activity, diet, and smoking) of a text message-based cardiovascular disease prevention program.

It will help answer the currently unanswered questions in mobile health, specifically how to optimise mobile health prevention programs and maintain engagement with patients.

Investigators: Dr Harry Klimis, Dr Aravinda Thiagalingam and Professor Clara Chow.

Tobacco, exercise, and diet messages for primary prevention of cardiovascular disease

Our team has developed and evaluated cardiovascular disease support programs delivered via text messaging and found benefits with people who have established cardiovascular disease (secondary prevention). However, it is unknown if this would work in a primary prevention cohort (those without coronary heart disease). TextMe-2 is a trial which aims to answer this question.

The primary objective of the TextMe-2 study is to determine the impact of a program of lifestyle-focused text messages on multiple modifiable cardiovascular risk factors. The study will focus on high-risk individuals who have been referred to outpatient cardiology services for chest pain but without documented coronary artery disease. In addition, this study will look at the effect of such a program on quality of life, health literacy, medication adherence and depression/anxiety scores.

Investigators: Dr Harry Klimis, Dr Aravinda Thiagalingam and Professor Clara Chow.

The snapshot acute coronary syndrome follow-up study aims to build on the original snapshot project by following up the Australian cohort approximately 18 months after their initial hospital admission.

The study will provide an unprecedented opportunity to determine the experience of these patients after their initial hospital stay including their service usage, health outcomes and associated costs. Ethical approval for conducting the study from the majority of sites has been granted and it is anticipated the follow up will commence in October 2018.

Participants will be asked to complete a questionnaire, which will be entered into an online database. Data linkage with the National Death Index, Pharmaceutical Benefits Scheme, Medical Benefits Scheme and hospital readmission data is currently being collated.

Investigators: Associate Professor Julie Redfern, Associate Professor Fiona Turnbull, Professor David Brieger, Professor Derek Chew, Associate Professor Tom Briffa, Professor Louisa Jorm, Professor Stephen Jan, Dr Beverly Essue, Associate Professor Laurent Billot and Karice Hyun.

The prevalence of childhood overweight and obesity is becoming an increasing concern worldwide. This study is a collaborative project supported by the NSW Office of Preventive Health to study the effectiveness of a behavioural incentive scheme linked to goal achievement in overweight children.

A single-blind, cluster randomised controlled trial with 10 weeks, six-month and 18-month follow-up was conducted within the existing NSW community weight management program. 512 children (7-13 years) and their families were recruited. Parallel process and qualitative evaluations are also being conducted to inform barriers and enablers to implementation and program enhancement.

Investigators: Associate Professor Julie Redfern, Gemma Enright, Simon Raadsma, Margaret Allman-Farinelli, Christine Innes-Hughes, Santosh Khanal, Karice Hyun, Chris Rissel, Hui-Yih Chai, Alex Gyani and Gemma Enright.

Physico-chemical equivalence of generic antihypertensive medicines: protocol for a quality of medicines assessment

Prevention and optimal management of hypertension is paramount to the achievement of the World Heart Federation goal of reducing premature cardiovascular disease mortality by 25 percent by 2025. Widespread access to good quality antihypertensive medicines is a critical component for achieving the goal. EquiMeds aims to determine the physico-chemical equivalence of antihypertensive medicines available in Nigeria.

An observational design will be adopted, which includes literature search, landscape assessment, collection and analysis of medicine samples.

Investigators: Associate Professor Julie Redfern, Rufus Adesoji Adedoyin, Sandra Ofori, Raghupathy Anchala, Vamadevan S Ajay, Luciano De Andrade, Jose Zelaya, Harparkash Kaur, Dina Balabanova and Mahmoud Sani. Funded by the World Heart Federation.