Karin du Plessis

The Fontan epidemic: Population projections from the Australia and New Zealand Fontan Registry

BACKGROUND The number and age demographic of the future Fontan population is unknown. METHODS Population projections were calculated probabilistically using microsimulation. Mortality hazard rates for each Fontan recipient were calculated from survivorship of 1353 Fontan recipients in the Australia and New Zealand Fontan Registry, based on Fontan type, age at Fontan, gender and morphology. Projected rates of new Fontan procedures were generated from historical rates of Fontan procedures per population births. RESULTS At the end of 2014, the living Fontan population of Australia and New Zealand was 1265 people from an Australian and New Zealand regional population of 28 million (4.5 per 100,000 population). Of those, 165 (13%) received an atrio-pulmonary (AP) procedure, 262 (21%) a lateral tunnel (LT) procedure and 838 (66%) an extra-cardiac conduit (ECC) procedure. This population is expected to grow to 1917 (95% CI: 1846: 1986) by 2025 (5.8 per 100,000 population), with 149 (8%) AP procedures, 254 (13%) LT procedures, and 1514 (79%) ECC procedures. By 2045, the living Fontan population is expected to reach 2986 (95% CI: 2877: 3085; 7.2 per 100,000 population). The average age of the Fontan population is expected to increase from 18years in 2014 to 23years (95% CI: 22-23) by 2025, and 31years (95% CI: 30-31) by 2045. CONCLUSION The Australian and New Zealand population of patients alive after a Fontan procedure will double over the next 20years increasing the demand for heart-failure services and cardiac transplantation. Greater consideration for the needs of this mostly adult Fontan population will be necessary.

Ten-year outcomes of Fontan conversion in Australia and New Zealand demonstrate the superiority of a strategy of early conversion

OBJECTIVE To investigate the benefits of a strategy of early Fontan conversion. METHODS Using the Australia and New Zealand Fontan Registry, retrospective analysis of their long-term follow-up data was performed. RESULTS Between 1990 and 2014, a total of 39 patients underwent surgical conversion in 6 centres at a median age of 23.8 years (IQR: 19.3-28.2), 18.7 ± 5.0 years post-Fontan. One centre tended to perform conversion earlier: interval since first documented arrhythmia 2.9 ± 4.0 vs 4.0 ± 4.2 years, average NYHA Class 2 ± 0.4 vs 3 ± 0.9 (P = 0.008), mean number of preop anti-arrhythmics 1 ± 0.4 vs 2 ± 0.6 (P = 0.05). Two patients underwent conversion to an extracardiac conduit only, while 36 had concomitant right atrial cryoablation, of which 16 also had pacemaker implantation. Nine patients suffered major cardiac-related complications (7 low output syndrome, 3 ECMO, 3 acute renal failure, one stroke) (2/17 from the early conversion centre and 7/22 of the others; P = 0.14). Four patients died in hospital (10.3%) and 4 late after a median of 0.9 years [95% confidence interval (CI): 0.5-1] after conversion. An additional 2 patients needed transplantation at 1 and 8.8 years after conversion, respectively. The 10-year freedom from heart transplantation was 86% (95% CI: 51-97%). Outcomes from the centre with an early conversion strategy were significantly better: 8-year freedom from death or heart transplantation was 86% (95% CI: 53-96) vs 51% (95% CI: 22-74; log-rank P = 0.007). Eight additional patients required pacemaker implantation and 5 had arrhythmia recurrence. CONCLUSIONS Fontan conversion is associated with lasting survival outcomes up to 10 years after conversion. A strategy of surgical conversion at earlier stage of failure may be associated with better survival free from transplantation.

Australian Blue-Collar Men’s Health and Well-Being Contextual Issues for Workplace Health Promotion Interventions

In Australia, blue-collar workers are predominantly male and form a unique and large (approximately 30%) subset of the Australian workforce. They exhibit particular health-related issues and, in comparison to other groups, often a lack of health promoting behavior. This article briefly discusses the Australian context and some of the key health issues blue-collar men face, in particular as it relates to construction workers. It reviews the impact of gender and socioeconomic factors in designing workplace health promotion interventions. This article considers practice strategies for health promoters in a specific workplace setting: it looks at meta-factors and industry-based contextual factors, including barriers to implementation and participation, while addressing common misconceptions about Australian blue-collar workers.

Three decades later: the fate of the population of patients who underwent the Atriopulmonary Fontan procedure

OBJECTIVE To review our experience of patients with an atrio-pulmonary Fontan circulation to determine their long-term outcomes. METHODS AND RESULTS A retrospective analysis of long-term follow-up data using the Australia and New Zealand Fontan Registry was performed. There were 215 patients surviving hospital discharge after an atrio-pulmonary Fontan completion. A total of 163 patients were alive at latest follow-up, with 52 deaths. Twelve patients had required heart transplantation and 95 had Fontan failure (death, transplantation, Fontan takedown, Fontan conversion, severe systemic ventricular dysfunction or NYHA≥3). Twenty-eight year freedom from death, death and transplantation and Fontan failure were 69% (95% CI 61-78%), 64% (95% CI 56-74%) and 45% (95% CI 36-55%) respectively. One hundred and thirty patients developed atrial arrhythmias. Freedom from arrhythmia at 28years post Fontan was 22.9% (95% CI: 15.1-30.8). Development of arrhythmia increased the likelihood of death (HR:2.97, 95%CI 1.50-5.81; p=0.002), death and heart transplantation (HR:3.11, 95%CI 1.64-5.87; p<0.001) and Fontan failure (HR:4.78 95%CI 2.95-7.74; p<0.001). There were 42 patients who had thromboembolic events, of which only 12 were therapeutically anti-coagulated. Two-thirds of the surviving patients (86/126) with an intact atrio-pulmonary Fontan were regularly reviewed. Patients receiving follow-up care with general cardiologists without specialised training were more likely to face Fontan failure than those managed by cardiologists with specialist training in congenital heart disease (HR: 1.94, 95% CI 1.16-3.24; p=0.02). The majority of the surviving patients (81/86) remained physically active and almost two-thirds (54/86) were currently employed. CONCLUSION Two-thirds of the patients who underwent a classical atrio-pulmonary Fontan are still alive 3 decades later. The majority are affected by the burden of arrhythmias but remain functionally active today. These challenging patients should only receive follow-up care from cardiologists with specialised training.

Harmful Drinking and Experiences of Alcohol-Related Violence in Australian Male Construction Industry Apprentices

This study sought to understand the prevalence of harmful alcohol use in a sample of Australian male construction industry apprentices and also examine alcohol-related violence. Although previous Australian research indicated that 45% of construction industry apprentices had Alcohol Use Disorders Identification Test scores indicative of harmful drinking, the current study identified that 66% of construction industry apprentices were drinking at harmful levels. It also identified positive correlations between harmful drinking behavior and alcohol-related violence (and precursors of violence such as verbal abuse). The article notes the role of masculine identity in alcohol consumption, particularly as it relates to the male-dominated construction industry. The article concludes by making recommendations for implementation of preventative education campaigns in apprentices’ workplaces (or in training colleges), as it provides opportune settings to focus on high-risk groups, which are otherwise often difficult to access.

Socio‐emotional support of apprentices during the school‐to‐work transition

Purpose – The aim of the paper is to locate the role of social and emotional support during the school‐to‐work transitions of apprentices, within the Australian vocational education and training context.Design/methodology/approach – The research reported here is based on an independent evaluation of an apprentice suicide prevention and support program. This program has been implemented in rural and regional Australia, and findings highlight the programs retention of key messages in the long‐term (i.e. 6 months to 2 years post‐completion). The work is based on both quantitative questionnaires from 119 apprentices as well as 18 face‐to‐face interviews.Findings – The research showed that apprentices’ resilience to face school‐to‐work transitional challenges can be enhanced by increasing knowledge of suicide risk factors and sources of social and emotional support had increased. Findings indicate that a number of apprentices had made significant changes in their lives as a result of participating in the prog...

Super-Fontan: Is it possible?

From the Sydney Medical School, University of Sydney; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales; Heart Research Group, Murdoch Children’s Research Institute; Department of Paediatrics, Faculty of Medicine, The University of Melbourne; and Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, Victoria, Australia. This project was supported by a grant from the National Health and Medical Research Council (Project Grant 1047923). The authors acknowledge support provided to the Murdoch Children’s Research Institute by the Victorian Government’s Operational Infrastructure Support Program. Y.d’U. is a National Health and Medical Research Council Clinician Practitioner Fellow (1082186). Received for publication Sept 27, 2017; accepted for publication Oct 16, 2017; available ahead of print Nov 17, 2017. Address for reprints: Yves d’Udekem, MD, PhD, FRACS, Department of Cardiac Surgery, Royal Children’s Hospital, Flemington Rd, Parkville, Victoria 3052, Australia (E-mail: yves.dudekem@rch.org.au). J Thorac Cardiovasc Surg 2018;155:1192-4 0022-5223/

Adolescent and parent perspectives prior to involvement in a Fontan transition program

36.00 Copyright 2017 by The American Association for Thoracic Surgery https://doi.org/10.1016/j.jtcvs.2017.10.047 A whole life with half a heart

Factors influencing Australian construction industry apprentices' dietary behaviors.

Abstract Background Successful transition to adult healthcare is particularly important for congenital heart disease (CHD) patients who have undergone palliative surgery, as they risk adverse events if not followed closely. This study examines young people at the worst end of the CHD spectrum who are born with a single ventricle (pumping heart chamber), and who undergo a series of operations that culminate in the Fontan surgical procedure. Purpose To explore adolescents with a Fontan circulation, and their parents’, readiness for transition to adult care and pre-implementation of a transition program. Methods Seventeen adolescents (15–18 years) and 15 of their parents completed questionnaires at the start of their first transition clinic. Results Adolescents reported poor knowledge about their Fontan circulation, and 41% had a poor understanding of the purpose of their medications/treatments. Over half of the adolescents had poor knowledge around medical help-seeking (when, who, how). Most reported feeling comfortable with discussing their medical issues with their cardiologist, but considerably less so about sensitive adolescent issues, in particular, emotional wellbeing. Parents reported high levels of anxiety around transition to adult care services. Conclusion Findings pre-program indicate poor adolescent health knowledge, a lack of focus in health services on emotional wellbeing and high parental anxiety. These findings highlight the need for dedicated programs that focus on early preparation, parental involvement and acknowledgment, transition as a process, strong integration and prioritisation in the health system with a youth-friendly and holistic focus, in particular, around emotional wellbeing.

Traversing the liminal: what can Fontan adults’ transition experiences and perspectives teach us about optimizing healthcare?

To date there has been a theoretical and empirical gap in workplace-centered health promotion research—particularly as it applies to blue-collar men’s diets. To begin addressing the paucity of research, five qualitative focus groups (N = 53) were conducted in Australian training colleges to explore the dietary behaviors of apprentices. Thematic analysis was used by the researcher who concludes that although some apprentices were health conscious and attempted to eat healthy foods, many had diets high in saturated fats and sugar. These types of diets are associated with increased risks for developing chronic disease and are associated with decreased life expectancy. As such it poses a serious challenge for health promoters. Apprentices’ dietary practices were also found to be moderated by convenience, availability, and cost of foods in their environment. Their nutritional beliefs, significant others, colleagues in the workplace, and their body image also influence their food choices.