Dr Harry Klimis

Clinical Lecturer
Central Clinical School / Central Clinical School

Telephone +61 9515 6111

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Biographical details

Harry Klimis is a Cardiology Advanced Trainee at Westmead Hospital (since 2015), PhD
student at The University of Sydney (estimated completion date 2020), Research Fellow at
The Westmead Applied Research Centre (since 2017), Honorary Fellow at The George
Institute for Global Health (since 2016), and Clinical Lecturer for the Westmead Clinical
School, University of Sydney (since 2017). Harry works in an environment with a strong and
growing program of cardiovascular disease prevention research led by Prof Clara Chow. Harry's PhD thesis focuses on novel clinical approaches for cardiovascular disease prevention including utilising text messaging, and the evaluation of Rapid Access Cardiology models of care.

Research interests

My main research interests are in mobile health utilisation in cardiovascular disease prevention, health service development, and advanced cardiac imaging in particular echocardiography and CT coronary angiography.

Teaching and supervision

I have clinical teaching roles both by the bedside and more formally in classrooms/lectures

Thesis work

Thesis title: Novel clinical opportunities for cardiovascular disease prevention within the Western Sydney Local Health District (WSLHD)

Supervisors: Aravinda THIAGALINGAM , Clara CHOW

Thesis abstract:

Background:
The burden of Cardiovascular disease
Cardiovascular disease (CVD) includes coronary artery disease, stroke and peripheral vascular disease, and remains the largest cause of premature death and disability worldwide including Australia.(1, 2) Multiple risk factors contribute to incident cases of cardiovascular disease, many of which are behavioural including smoking, physical inactivity and poor diet. Abnormal lipids, hypertension, smoking, excess alcohol consumption, physical inactivity, diabetes, abdominal obesity, psychosocial factors, and fruit/vegetable consumption accounts for over 90% of the risk of myocardial infarction worldwide.(3) In Australia, whilst the proportion of people dying from Acute Coronary Syndromes (ACS) has almost halved between 1998-9 to 2007-8, the number of hospitalisations for Acute Myocardial Infarction (AMI), Unstable Angina (UA), and chest pain has increased by 80%, 33%, and 205% respectively between 1993-4 to 2007-8.(2)

The need for improved cardiovascular preventive programs
In response to this increasing cardiovascular disease burden, the World Health Organisation (WHO) in 2013 developed a Global action plan on the prevention and control of cardiovascular disease.(1) In this document, WHO states that prevention of cardiovascular disease via an approach targeting multiple risk factors would be more cost effective than treatment decisions based on individual risk factor targets. Similarly, secondary prevention of cardiovascular disease is a priority of the World Heart Federation. Whilst there is strong evidence supporting secondary cardiovascular prevention programs,(4) such evidence for primary prevention programs is limited. A recent meta-analysis demonstrated that there is limited data suggesting that systematic cardiovascular risk assessment (i.e. patients are screened to enter a program based on pre-defined criteria), as opposed to opportunistic risk assessment (i.e. occurring sporadically without systematic planning), lowers cholesterol and lowers systolic and diastolic blood pressures. During a follow-up period of 1-3 years, this did not translate into significant reductions in clinical end points - all-cause mortality, cardiovascular mortality, and non-fatal cardiovascular events. However, the patient population was not restricted to high-risk groups.(5) Furthermore, there is substantial underutilisation of existing cardiac preventative programs, mostly due to access barriers(6). Thus, high quality research looking into novel cost-effective and accessible prevention programs targeting high-risk individuals (rather than population-based risk assessment programs) is needed and may help reduce the incident cases of ACS(7) in Australia.

The need for alternative models of care for managing chest pain
Chest pain is one of the most common causes of presentation to emergency departments and many patients with undifferentiated chest pain are admitted to hospital (8). Differentiating the cause of chest pain is difficult and health care providers struggle with balancing their decision between clinical acumen and the risks and stigma associated with potentially missing an acute coronary syndrome (ACS). Improvements in the sensitivity of troponin have resulted in increased negative predictive value at earlier time points after the onset of chest pain. With increased confidence in the initial phases of presentation with chest pain, treating physicians are considering alternative pathways that may decrease the burden on the hospital system, as well as improve patient experience. Rapid Access Cardiology (RAC) services, first described in the United Kingdom, are hospital-based cardiologist-led outpatient clinics that provide rapid assessment and management but not long-term care of cardiology patients. This service model is now the model of choice for chest pain management and part of the National Service Framework for coronary heart disease in the United Kingdom (UK). If adopted within the Australian healthcare system, a substantial proportion of chest pain patients, without suspected acute coronary syndrome, potentially could be managed in the outpatient setting and a hospital admission avoided. Such a setting also selects higher risk individuals where novel preventative strategies could be adopted. However, the challenge is how to achieve this pathway of management within our current health system.

Objective:
Our unifying objective is to describe and evaluate different innovative clinical approaches to cardiovascular disease prevention. Specifically, we aim to examine two approaches: 1) the role of Rapid Access Cardiology clinics in preventing major adverse cardiac events, and 2) the potential of a mobile-Health prevention program in reducing cardiovascular risk factors in patients opportunistically identified in the clinic setting.

Current projects

1. Mobile health technology in cardiovascular disease prevention

2. Rapid Access Cardiology (RAC) services to manage low to intermediate risk chest pain

Associations

  1. Research fellow, Westmead Applied Research Centre (WARC), Western Clinical School
  2. Clinical lecturer, Western Clinical School, University of Sydney
  3. Honorary fellow, The George Institute for Global Health
  4. Sydney Health Partners Advance Research and Translation Centre

Awards and honours

2014 Graduate Certificate in Clinical Epidemiology, The University of Sydney
2010 Bachelor of Medicine and Bachelor of Surgery, The University of Sydney
2006 Bachelor of Medical Science (Honours Class I and Medal), The University of Sydney
2017 CSANZ Annual Scientific Meeting Travelling Fellowship
2007 The University Medal 2007, The University of Sydney
2002 Award Dean’s Merit List for Academic Excellence 2002 The University of Technology, Sydney2014 Graduate
Certificate
Graduate Certificate in Clinical Epidemiology The University of Sydney
2010 Degree Bachelor of Medicine and Bachelor of Surgery The University of Sydney
2006 Degree Bachelor of Medical Science (Honours Class I and Medal) The University of Sydney
2017 Award CSANZ Annual Scientific Meeting Travelling Fellowship Cardiac Society of Australia and New Zealand
2007 Award The University Medal 2007 The University of Sydney
2002 Award Dean’s Merit List for Academic Excellence 2002 The University of Technology, Sydney

In the media

Some Evidence Mobile Health Interventions Can Lower CVD Risk

https://www.empr.com/news/cardiovascular-disease-risk-mobile-health-apps-mhealth-smartphone/article/772023/

Mobile health technology can potentially transform how patients manage cardiovascular disease risk

https://www.elsevier.com/about/press-releases/research-and-journals/mobile-health-technology-can-potentially-transform-how-patients-manage-heart-disease-risk

https://www.researchgate.net/profile/Harry_Klimis

Selected publications

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Journals

  • Klimis, H., Altman, M., Tan, T., Natividad, J., Abraham, R., Thomas, L. (2018). A Case of Persistent Right Ventricular Failure after Rapid Decompression of a Large Chronic Pericardial Effusion. CASE: Cardiovascular Imaging Case Reports, 2(4), 142-146. [More Information]
  • Klimis, H., Thakkar, J., Chow, C. (2018). Breaking Barriers: Mobile Health Interventions for Cardiovascular Disease. Canadian Journal of Cardiology, 34(7), 905-913. [More Information]
  • Klimis, H., Khan, M., Thiagalingam, A., Bartlett, M., Altman, M., Wynne, D., Denniss, A., Cheung, N., Koryzna, J., Chow, C. (2018). Rapid Access Cardiology (RAC) Services Within a Large Tertiary Referral Centre�First Year in Review. Heart, Lung and Circulation, 27(11), 1381-1387. [More Information]
  • Klimis, H., Thiagalingam, A., Altman, M., Atkins, E., Figtree, G., Lowe, H., Cheung, N., Kovoor, P., Denniss, A., Chow, C. (2017). Rapid-access cardiology services: can these reduce the burden of acute chest pain on Australian and New Zealand health services? Internal Medicine Journal, 47(9), 986-991. [More Information]
  • Klimis, H., Khan, M., Kok, C., Chow, C. (2017). The Role of Text Messaging in Cardiovascular Risk Factor Optimization. Current Cardiology Reports, 19(1), 1-8. [More Information]
  • Gray, B., Klimis, H., Inam, S., Ariyathna, N., Kumar, S., Bailey, B., Patel, S. (2016). Corrigendum to 'Radiation Exposure During Cardiac Catheterisation is Similar for Both Femoral and Radial Approaches' Heart, Lung and Circulation (2015) 24, 264-269. Heart, Lung and Circulation, 25(10), 1043. [More Information]
  • Gray, B., Klimis, H., Inam, S., Ariyathna, N., Kumar, S., Bailey, B., Patel, S. (2015). Radiation Exposure During Cardiac Catheterisation is Similar for Both Femoral and Radial Approaches. Heart, Lung and Circulation, 24(3), 264-269. [More Information]
  • Rashid, I., Klimis, H., Duflou, J., Sullivan, D., Puranik, R. (2014). Utility of post-mortem lipid levels in fatal premature CAD: An autopsy study. International Journal of Cardiology, 174(1), 212-214. [More Information]
  • Napier, I., Klimis, H., Rycroft, B., Jin, A., Alewood, P., Motin, L., Adams, D., Christie, M. (2012). Intrathecal a-conotoxins Vc1.1, AuIB and MII acting on distinct nicotinic receptor subtypes reverse signs of neuropathic pain. Neuropharmacology, 62(7), 2202-2207. [More Information]
  • Klimis, H., Adams, D., Callaghan, B., Nevin, S., Alewood, P., Vaughan, C., Mozar, C., Christie, M. (2011). A Novel Mechanism of Inhibition of High-Voltage Activated Calcium Channels by alpha-Conotoxins Contributes to Relief of Nerve Injury-Induced Neuropathic Pain. Pain, 152(2), 259-266. [More Information]
  • Nevin, S., Clark, R., Klimis, H., Christie, M., Craik, D., Adams, D. (2007). Are alpha 9 alpha 10 nicotinic acetylcholine receptors a pain target for alpha-conotoxins? Molecular Pharmacology, 72(6), 1406-1410. [More Information]
  • Nevin, S., Clark, R., Klimis, H., Christie, M., Craik, D., Adams, D. (2007). Are alpha9alpha10 nicotinic acetylcholine receptors a pain target for alpha-conotoxins? Molecular Pharmacology, 72(6), 1406-1410. [More Information]

2018

  • Klimis, H., Altman, M., Tan, T., Natividad, J., Abraham, R., Thomas, L. (2018). A Case of Persistent Right Ventricular Failure after Rapid Decompression of a Large Chronic Pericardial Effusion. CASE: Cardiovascular Imaging Case Reports, 2(4), 142-146. [More Information]
  • Klimis, H., Thakkar, J., Chow, C. (2018). Breaking Barriers: Mobile Health Interventions for Cardiovascular Disease. Canadian Journal of Cardiology, 34(7), 905-913. [More Information]
  • Klimis, H., Khan, M., Thiagalingam, A., Bartlett, M., Altman, M., Wynne, D., Denniss, A., Cheung, N., Koryzna, J., Chow, C. (2018). Rapid Access Cardiology (RAC) Services Within a Large Tertiary Referral Centre�First Year in Review. Heart, Lung and Circulation, 27(11), 1381-1387. [More Information]

2017

  • Klimis, H., Thiagalingam, A., Altman, M., Atkins, E., Figtree, G., Lowe, H., Cheung, N., Kovoor, P., Denniss, A., Chow, C. (2017). Rapid-access cardiology services: can these reduce the burden of acute chest pain on Australian and New Zealand health services? Internal Medicine Journal, 47(9), 986-991. [More Information]
  • Klimis, H., Khan, M., Kok, C., Chow, C. (2017). The Role of Text Messaging in Cardiovascular Risk Factor Optimization. Current Cardiology Reports, 19(1), 1-8. [More Information]

2016

  • Gray, B., Klimis, H., Inam, S., Ariyathna, N., Kumar, S., Bailey, B., Patel, S. (2016). Corrigendum to 'Radiation Exposure During Cardiac Catheterisation is Similar for Both Femoral and Radial Approaches' Heart, Lung and Circulation (2015) 24, 264-269. Heart, Lung and Circulation, 25(10), 1043. [More Information]

2015

  • Gray, B., Klimis, H., Inam, S., Ariyathna, N., Kumar, S., Bailey, B., Patel, S. (2015). Radiation Exposure During Cardiac Catheterisation is Similar for Both Femoral and Radial Approaches. Heart, Lung and Circulation, 24(3), 264-269. [More Information]

2014

  • Rashid, I., Klimis, H., Duflou, J., Sullivan, D., Puranik, R. (2014). Utility of post-mortem lipid levels in fatal premature CAD: An autopsy study. International Journal of Cardiology, 174(1), 212-214. [More Information]

2012

  • Napier, I., Klimis, H., Rycroft, B., Jin, A., Alewood, P., Motin, L., Adams, D., Christie, M. (2012). Intrathecal a-conotoxins Vc1.1, AuIB and MII acting on distinct nicotinic receptor subtypes reverse signs of neuropathic pain. Neuropharmacology, 62(7), 2202-2207. [More Information]

2011

  • Klimis, H., Adams, D., Callaghan, B., Nevin, S., Alewood, P., Vaughan, C., Mozar, C., Christie, M. (2011). A Novel Mechanism of Inhibition of High-Voltage Activated Calcium Channels by alpha-Conotoxins Contributes to Relief of Nerve Injury-Induced Neuropathic Pain. Pain, 152(2), 259-266. [More Information]

2007

  • Nevin, S., Clark, R., Klimis, H., Christie, M., Craik, D., Adams, D. (2007). Are alpha 9 alpha 10 nicotinic acetylcholine receptors a pain target for alpha-conotoxins? Molecular Pharmacology, 72(6), 1406-1410. [More Information]
  • Nevin, S., Clark, R., Klimis, H., Christie, M., Craik, D., Adams, D. (2007). Are alpha9alpha10 nicotinic acetylcholine receptors a pain target for alpha-conotoxins? Molecular Pharmacology, 72(6), 1406-1410. [More Information]

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