Medicopolitical

New president steps up to CSANZ priorities


Professor Stephen Nicholls

As Australia and New Zealand lean into ‘living with COVID-19’, the new CSANZ president Professor Stephen Nicholls expects to find the space to move forward on the Society’s agenda.

Professor Nicholls, Director of MonashHeart and the Victorian Heart Institute, told the limbic that he and CSANZ immediate past-president Professor Clara Chow had a shared view of the priorities for the Society.

He commended Professor Chow for her ability to steer the Society through the challenge of the pandemic — when the government was asking a lot of health professionals and the clinical world was changing quickly.

“The pressure on the health workforce has been a constant for the last couple of years. I think that we were already seeing that before the pandemic hit with record high levels of burnout fatigue and the pandemic has done nothing to lighten that load.”

But it’s time to get back to business and Professor Nicholls is up for the challenge.

“I’m passionate about the fact that I think that we think we can do things differently. Im pretty inclusive and engaging and consultative. And when I do take a leadership role in different kinds of ventures, its very much working from within the team approach.”

“I overextend myself … but I dont put my hand up for something unless I think Ive got a contribution that I can make.”

Professor Nicholls has been on the board of CSANZ for nearly 10 years in positions such as a state representative, secretary, treasurer and then president-elect.

“I’ve had the opportunity to be involved over a period of time when there’s been considerable change to the Society. We are in a considerably stronger financial position than we were a number of years ago. We navigated a pandemic pretty well. We’ve had a pretty significant review of governance over that period of time and formed a streamlined executive that really allows for the Society to make the day-to-day working decisions a little bit more efficient and seamless.”

Diversity and inclusion

As he and Professor Chow have written about recently in Heart, Lung and Circulation (link) to recognise the 70 years of CSANZ, some of the priorities include greater diversity and inclusion of membership, closing the health gap for Indigenous populations, and increasing engagement with the profession beyond Australia and New Zealand.

“We’ve already had a fair bit of activity… in terms of how we enable our Women in Cardiology (WIC) Working Group for example, to take their activities to another level. How do they plug in with international societies and other groups so there’s a whole range of activities that are going on? Are we making this field in general a field that is attractive for everybody to want to go into? Are we creating a workplace and work opportunities and development opportunities for everybody to be aspirational and upwardly mobile?”

He recognised the “fantastic” work to date by WIC under Associate Professor Sarah Zaman’s leadership and said he expects it to ramp up further with the new chair Associate Professor Sonya Burgess.

Similarly, Professor Nicholls also highlighted the important work to be done by the CSANZ Indigenous Health Council, now co-chaired by Professor Alex Brown (ANU) and Dr Anna Rolleston (NZ).

“We took the view that that group should be chaired by two individuals. They’d be the first to tell you that no one Indigenous individual in this neck of the woods can pretend to represent the view or speak on behalf of everybody in our region. So again, how do we take what have been the early steps in that space and then …make this a more enabling society for our members particularly who identify from an Indigenous perspective, but also how that then plays out into the community and for patients?”

More broadly, CSANZ also intends to extend its partnerships internationally from both research and clinical perspectives.

“That gives Australia and New Zealand a voice and at the same time also gives our members access to more opportunities, whether thats training opportunities, whether thats fellowships, meetings, …and continuing professional development.”

He said CSANZ members already enjoyed a strong reputation overseas. This was evident most recently at the ESC Congress in Barcelona where CSANZ hosted its own session and members were invited speakers, presented submitted abstracts or chaired sessions.

“So I think we punch above our weight …and a really important thing is that these international societies want to engage with us.  So how can we take that goodwill and work with them so that we make sure that we have an opportunity to impact all of our members, not just the researchers who present at these meetings?”

“Those things are important because …again, it comes back to everything we should be doing to represent our membership.”

Collegiality and collaboration

Professor Nicholls said back home, the Society continues to advocate for members with governments and payers in a rapidly evolving clinical landscape.

“And a lot of things changed with the start of COVID. I think the embracement of telehealth is an important advance that will continue to be really important whether there’s a pandemic or not.

He noted that for many people the pandemic was also an opportunity to rethink work-life balance.

“So I think what we can be doing, both the Society by itself but also in association with the college …in terms of trying to support and address those needs, is really important. Because ultimately this really should be about how do we make the work-life balance for our members better? I think that there’s a lot more we can do.”

There’s also work to be done with colleagues from other disciplines.

“Theres no doubt that over the last 10 years our ability to treat advanced forms of heart disease on the tip of the catheter continues to evolve enormously — whether it’s better stents, not needing major cardiac surgery to replace a heart valve, or treating a heart rhythm issue. The advances there have been extraordinary. They are game changers and we think that that will continue to evolve over the next decade, and how that work integrates with our surgical colleagues is really important so that we get the right person to the right strategy.”

As a preventive cardiologist, he’s excited about the new lipid drugs, diabetes drugs, and inflammation-targeted agents that have come through after an earlier new-drug drought.

“We’ve got many more options to be able to prevent the disease in our highest risk patients and that then leads to a challenge which is how are we going to make the decisions moving forward? Because we can’t do all things for all people.”

“I’m talking about the cost. I’m talking about the fact that everything comes with a side effect. So if you take the view that you’re going to give everything to everybody, we expose a lot of people to something that might have side effects, and might not necessarily be advantageous for them from a personal perspective.”

“And I think thats where were going to see this explosion of data science and artificial intelligence…to put all that information together. And then how do we increasingly embrace the digital revolution?”

He said the interaction with primary care also warranted critical review.

“Because they are the specialists that are most commonly involved in the shared management of our patients. Our patients go back to primary care and they live in that world. We just happen to periodically interact with them, but that’s the world they live in.”

“And I think what our interaction with general practice looks like is something that we’re really keen to explore to a much greater degree. Do we end up, for example, having general practitioners more and more involved in some of the specialty clinics that we do in big hospitals? It is an interesting conversation to have,” he said.

He’s also confident that the cardiology profession will accept and meet evolving clinical challenges.

As Program Director for the new Victorian Heart Hospital, his team have had to future-proof its design. For example, there would be services required in the future, that either don’t exist today or are very much in their infancy including a more multidisciplinary approach to the management of patients.

“Cancer survivorship is clearly becoming increasingly recognised. I think we are increasingly appreciating that cardiovascular disease factors significantly in the survivorship of those people. [And] it’s not just going to be in cancer. It’s going to be what does interaction with the rheumatologist look like? What does a better interaction look like with diabetes?”

He said his CSANZ colleagues would step up as required.

“The good thing about the Society is that there are plenty of people prepared to put their hand up and roll their sleeves up if we need some work done.”

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