Cardiology PopulationHealth Laboratory

Key Research Areas

• Coronary heart disease epidemiology
• Population monitoring of cardiovascular disease (CVD)
• Linked data methods
• Stroke prevention

Research Overview

Accurate surveillance of cardiovascular disease across the whole population and targeting of high-risk population sub-groups is essential so that we know where to focus policy and prevention efforts. This requires an accurate understanding of the burden and distribution of CVD. The Cardiology Population Health Laboratory uses linked data to develop robust methods for monitoring of CVD, and to investigate the burden of various conditions including acute coronary syndromes, stable coronary heart disease and stroke. Our research aims to determine the burden of CVDs at a whole-population level and importantly in specific analyses according to age, sex, socioeconomic status, region, and Indigenous status.

There are 3 key projects underway in the Cardiology Population Health Laboratory, led by Dr Lee Nedkoff:

1. Coronary heart disease monitoring

Coronary heart disease has traditionally been monitored at a population level via measurement of myocardial infarction (MI) using unlinked data. However, the wider advent of linked health data in Australia, and changes in diagnosis and treatment of MI mean that these approaches may no longer be relevant. Our research is investigating optimal methods for identification of MI from linked health data, including:

i) Using linked pathology data to determine the impact of the use of troponin assays on trends in MI;

ii) Using long time series Western Australian data to determine optimal lookback periods for identifying incidence of MI, with comparison against data from other states; and

iii) Developing methods for accurate measurement of case fatality of MI.

Additionally, we are investigating the prevalence of chronic coronary disease in Australia – there are no developed methods for this measure in Australian data, and limited estimates of prevalence.

2. Comparative analyses of CVD epidemiology

Comparisons of CVD burden between states and countries is important for benchmarking between jurisdictions and for identifying population groups where further gains in reducing disease burden can be made. We are undertaking a number of national and international comparative analyses of coronary heart disease incidence, mortality and age-specific trends in collaboration with the Universities of Oxford, Melbourne, Otago, Auckland and Toronto. We are also investigating whether adverse trends in myocardial infarction incidence are seen in other Australian jurisdictions outside of Western Australia.

3. Synergies to Prevent Stroke

Stroke is a significant cause of morbidity and mortality worldwide. We are part of a team of collaborators in Australia and New Zealand undertaking a broad program of work aimed at prevention of stroke. Our research is specifically examining the association of various cardiac diseases, including coronary heart disease, valvular heart disease, atrial fibrillation and congenital heart disease, with the onset of stroke. Another important focus of this work is the development of methods and framework for monitoring stroke at a national level, in collaboration with the Australian Institute of Health and Welfare.

1. Camacho X,* Nedkoff L,* Wright FL, Nhiem N, Buajitti E, Goldacre R, Rosella LR, Seminog O, Tan EJ, Hayes A, Hayen A, Wilson N, Blakely T, Clarke P, (2022). ‘Relative contribution of trends in myocardial infarction event rates and case fatality to declines in mortality: an international comparative study of 1.95 million events in 80.4 million people in four countries’, Lancet Public Health. (*Joint first authors); https://doi.org/10.1016/S2468-...
2. Paige E, Doyle K, Jorm L, Banks E, Hsu M-P, Nedkoff L, Briffa T, Cadhillac DA, Mahoney R, Verjans J, Dwivedi G, Inouye M, Figtree G, (2021). ‘A versatile big data health system for Australia: driving improvements in cardiovascular health’, Heart Lung Circ; doi.org/10.1016/j.hlc. 2021.04.023
3. Wright FL, Townsend N, Greenland M, Goldacre MJ, Smolina K, Lacey B, Nedkoff L, (2021). ‘Long-term trends in population-based hospitalisation rates for myocardial infarction in England: a national database study of 3.5 million admissions, 1968-2016’, J Epidemiol Community Health; https://jech.bmj.co...
4. Lopez D, Nedkoff L, Briffa T, Preen DB, Etherton-Beer C, Flicker L, Sanfilippo FM, (2021). ‘Effect of frailty on initiation of statins following incident acute coronary syndromes in patients aged ≥75 years’, Maturitas; https://www.maturitas.org/article/S0378...
5. Vander Hoorn, S. Murray K, Nedkoff L, Hankey GJ, Flicker L, Yeap BB, Almeida OP, Norman P, Brunekreef B, Nieuwenhuijsen M, Heyworth J, (2021). ‘Long-term exposure to outdoor air pollution and risk factors for cardiovascular disease within a cohort of older men in Perth’, PLOS One; doi.org/10.1371/journal.pone.0248931
6. Weber C, Hung J, Hickling S, Nedkoff L, Murray K, Li I, Briffa TG, (2021). ‘Incidence, risk predictors, and relative mortality risk of new heart failure in a hospitalised atrial fibrillation cohort: a Western Australia population-based study, 2000-2013, Heart; https://doi.org/10.1136/heartj...
7. Katzenellenbogen JM, Bond-Smith D, Seth R, Dempsey K, Cannon J, Stacey I, Wade V, de Klerk N, Greenland M, Sanfilippo F, Brown A, Carapetis J, Wyber R, Nedkoff L, Hung J, Bessarab D, Ralph A, (2020). ‘Contemporary incidence and prevalence of rheumatic fever and rheumatic heart disease in Australia using linked data: the case for policy change’, J Am Heart Assoc; https://doi.org/10.1161/JAHA.1...
8. D Bond-Smith, R Seth, N de Klerk, L Nedkoff, M Anderson, J Hung, J Cannon, K Griffiths, JM Katzenellenbogen, (2020). ‘Development and evaluation of a prediction model for ascertaining rheumatic heart disease status in administrative data’, Clin Epidemiol; https://doi.org/10.2147/clep.s...
9. Greenland M, Knuiman MW, Hung J, Nedkoff L, Arnet I, Rankin JM, Kilkenny MF, Sanfilippo FM, (2020). ‘Cardioprotective medication adherence in Western Australians in the first year after myocardial infarction: restricted cubic spline analysis of adherence-outcome relationships’, Sci Rep; https://www.nature.com/articles/s41598...
10. Nedkoff L,* Kelty EA,* Hung J, Thompson SC, Katzenellenbogen JM, (2020). ‘Differences in stroke risk and cardiovascular mortality for Aboriginal and other Australian patients with atrial fibrillation’, Med J Aust; doi:10.5694/mja2.50496
11. Nedkoff L,* Sarink D,* Briffa T, Shaw JE, Magliano DJ, Stevenson C, Mannan H, Knuiman M, Hung J, Hankey GJ, Norman P, Peeters A, (2018). ‘Trends in age- and sex-specific prevalence and incidence of cardiovascular disease in Western Australia’, Eur J Prev Cardiol; https://academic.oup.com/eurjpc..
12. Nedkoff L, Knuiman M, Hung J, Briffa T, (2014). ‘Comparative trends in the incidence of hospitalized myocardial infarction and coronary heart disease in adults with and without diabetes mellitus in Western Australia from 1998 to 2010’, Circ Cardiovasc Qual Outcomes; https://doi.org/10.1161/CIRCOU...
13. Nedkoff L, Briffa T, Preen D, Sanfilippo F, Hung J, Ridout S, Knuiman M, Hobbs M. 2011. ‘Age-and sex specific trends in the incidence of hospitalized acute coronary syndromes in Western Australia’, Circ Cardiovasc Qual Outcomes; https://doi.org/10.1161/circou...