Safety and effectiveness of medicines and technologies

Beta-blocker therapy after myocardial infarction

Led by Dr Stella Talic and Professor Dion Stub

This research investigated the effectiveness and outcomes of beta-blocker therapy after myocardial infarction (MI), with a focus on all-cause mortality, cardiovascular mortality, and recurrent MI. The work included three complementary studies:

• State-of-the-Art Review: Synthesised the current evidence on beta-blocker therapy post-MI, including efficacy across different LVEF subgroups and patient populations.
• Nested Case-Control Study Using the VCOR Registry: Analysed real-world data from the Victorian Cardiac Outcomes Registry, examining associations between beta-blocker use, LVEF, and clinical outcomes in contemporary practice.
• Umbrella Review: Conducted an overview of systematic reviews and meta-analyses to evaluate the robustness of evidence, stratified by study design, patient subgroups, and risk of bias.

These studies collectively aimed to inform LVEF-stratified, individualised treatment decisions, support guideline refinement, and provide practical recommendations for clinicians.

Outputs

• Cataldo Miranda P, Gasevic D, Trin C, Stub D, Zoungas S, Kaye DM, Orman Z, Eliakundu AL, Talic S. Beta-Blocker Therapy After Myocardial Infarction. JACC: Advances. 2025 Mar;4(3):101582. doi: 10.1016/j.jacadv.2024.101582.
• Cataldo-Miranda P, Koh HJW, Stub D, Zoungas S, Kaye DM, Gasevic D, Brennan A, Dinh D, Lefkovits J, Nanayakkara S, Chew DP, Talic S. Beta-blocker therapy and all-cause mortality after a coronary event: A matched nested case-control study using the Victorian Cardiac Outcomes Registry linked data. Current Problems in Cardiology. 2026 Aug;51(8):103340. doi: 10.1016/j.cpcardiol.2026.103340.

Comparative effectiveness research of glucose monitoring methods and glycaemic control in type 2 diabetes patients

Projects

1. Comparative-effectiveness of glucose monitoring methods and glycaemic control in type 2 diabetes patients: An umbrella review
2. Comparative-effectiveness of glucose monitoring methods and glycaemic control in type 2 diabetes patients: retrospective cohort study from ANDA
3. Cost-effectiveness analysis of implementing CGM monitoring in type 2 diabetes patients in Australia

Outputs

• Foo N, Chodapaneedi S, Gibson B, Koh HJW, Gasevic D, Hamblin P, Trin C, Cataldo P, Zomer E, Russell A, Zoungas S, Talic S. Comparative effectiveness of glucose monitoring methods and glycaemic control in patients with type 2 diabetes: An umbrella review. Diabetes, Obesity and Metabolism. 2026 Mar;28(3):1638-1648. doi: 10.1111/dom.70401.

Immunoglobulin related thromboembolic risk

Led by Dr Mahima Kapoor and Dr Stella Talic

Intravenous immunoglobulin (IVIg) is a critical therapy for many chronic, disabling conditions, particularly in neurology and immunology. As its use continues to expand, driven by increased recognition of treatable neuropathies, inflammatory myopathies, and autoimmune encephalitis, understanding its safety profile becomes increasingly important.

The increasing demand for IVIg across multiple specialties underscores the need for robust evidence on its cardiovascular safety. If IVIg compromises the effectiveness of standard prevention strategies, clinicians may need to adjust risk management approaches for affected patients. This study will provide essential insights to guide safer, more personalized care for individuals receiving IVIg therapy.

Projects

1. Assessing the Risk of Thromboembolic Events Following Intravenous Immunoglobulin Therapy: A Retrospective New User Cohort Study

   This study uses a retrospective new user design to compare TEE incidence in IVIg initiators versus matched non-users, adjusting for baseline risk factors.

2. Emulating a Target Trial to Evaluate the Cardiovascular Safety of Intravenous Immunoglobulin Using Linked Administrative and Clinical Data
   
   This study applies an emulated trial framework using linked hospital, PBS, and mortality data to estimate causal effects of IVIg on TEEs and secondary prevention outcomes.

Drug-drug interactions

Led by Dr Stella Talic and Dr Harvey Koh

Drug–drug interactions (DDIs) are an important clinical and public health consideration, and are emerging as a specialised focus area within pharmacoepidemiology. DDIs are becoming more common especially within the context of polypharmacy and multimorbidity.

A DDI occurs when one medication alters the effect of another, most often resulting in adverse or harmful outcomes. While the majority of interactions produce adverse responses, some combinations can lead to drug synergy, where therapeutic effects are enhanced in beneficial ways. Many DDIs are identified by post market surveillance, for which, further investigations are warranted in upticks of adverse events.

Our team focuses on combining pharmacoepidemiological approaches to identify DDIs and the expansive field of computer science, to develop preventative approaches and novel methods to identify and classify DDIs. By redefining DDI classification and identification to create a foundational dataset of DDIs and building upon the expansive knowledge of mechanistic pathways, we aim to develop prescribing tools to identify DDIs via predictive modelling.

Our research aims to contribute to the global practices in DDI identification and classification to assist clinicians with management and prevention of DDIs.

Current projects

Our research program is advancing methods to improve the detection, classification, and reporting of DDIs:

1. Consensus Study on DDI severity Classification

   We are conducting an international, consensus-based study to determine how DDIs should be systematically classified for clinical and regulatory use.

2. Checklist for Reporting Standards

   We are developing a comprehensive checklist to improve how DDIs are identified, described, and reported across clinical research and regulatory documentation.

3. Agreement Study Across Regulators

   To evaluate consistency in reporting, we are examining how leading regulatory bodies present DDI information in drug monographs and product characteristics.

4. Systematic Review of DDI checkers and their reliability and validity

   Our team is conducting a critical review of existing DDI prediction and extraction models, assessing their strengths, limitations, and clinical applicability.

5. Clinically Relevant DDI Dataset

   We are building a dedicated DDI dataset by using the previously mentioned checklist for classifying DDIs and novel statistical methods.

6. Deep Learning Prediction of DDIs

   Our team is applying advanced prediction models using resources such as UK Biobank data, to estimate biomarker changes associated with DDIs and identify new DDIs through encoding mechanism pathways.

Polypharmacy

Led by Dr Stella Talic and Dr Harvey Koh

Polypharmacy, commonly defined as the use of five or more medications, is a growing global health concern, particularly among older adults with multiple chronic conditions. It is associated with increased risks of falls, hospitalisations, adverse drug reactions, drug–drug interactions, non-adherence, and mortality. Yet, despite its clinical importance, polypharmacy remains inconsistently defined and measured. Over 100 definitions exist in the literature, most relying on arbitrary medication counts, which limits comparability across studies and hinders effective intervention.

Our research will transform how polypharmacy is defined, measured, and managed in both research and clinical practice. By leveraging linked administrative, primary care, and patient-reported data, we aim to identify high-risk prescribing patterns, evaluate deprescribing interventions, and co-design decision-support tools with clinicians and consumers.

Projects

1. A systematic review of polypharmacy definitions, prevalence, and associated outcomes to inform a unified measurement framework.
2. Harmonisation of existing polypharmacy metrics through a consensus-based approach.
3. Development of a new polypharmacy metric and external validation in large international cohorts with the development of risk prediction algorithms and global transportability guidelines.

Lipid Optimisation Study (LOS)

(completed under mentorship of Professor Zanfina Ademi and Professor Danny Liew)

This study investigated future burden of cardiovascular disease and its impact on health and economic outcomes in Australia, in general population and also stratified across different socioeconomic groups. It also projected lost therapeutic benefit of delayed low-density lipoprotein cholesterol control in statin treated patients and assessed the cost-effectiveness of lipid-lowering intensification.

Outputs

• Marquina C, Talic S, Vargas-Torres S, Petrova M, Abushanab D, Owen A, Lybrand S, Thomson D, Liew D, Zomer E, Ademi Z. Future burden of cardiovascular disease in Australia: impact on health and economic outcomes between 2020 and 2029. European Journal of Preventive Cardiology. 2022 May 27;29(8):1212-1219. doi: 10.1093/eurjpc/zwab001.
• Marquina C, Morton J, Zomer E, Talic S, Lybrand S, Thomson D, Liew D, Ademi Z. Lost Therapeutic Benefit of Delayed Low-Density Lipoprotein Cholesterol Control in Statin-Treated Patients and Cost-Effectiveness Analysis of Lipid-Lowering Intensification. Value in Health. 2023 Apr;26(4):498-507. doi: 10.1016/j.jval.2022.11.013.
• Hastings K, Marquina C, Morton J, Abushanab D, Berkovic D, Talic S, Zomer E, Liew D, Ademi Z. Projected New-Onset Cardiovascular Disease by Socioeconomic Group in Australia. PharmacoEconomics. 2022 Apr;40(4):449-460. doi: 10.1007/s40273-021-01127-1.

Evaluation of LDL-C levels in lipid-lowering treated patients in Australia: the GP-EMR analyses

Led by Dr Stella Talic

This project explored general CV lipid management and epidemiology by understanding contemporary lipid management landscape in primary practice. It also identified gaps in optimal lipid management and proposed optimisation strategies from clinical, public health and policy’s perspective.

Outputs

• Talic S, Marquina C, Zomer E, Ofori-Asenso R, Petrova M, Vargas-Torres S, Abushanab D, Wolfe R, Lybrand S, Thomson D, Stratton G, Liew D, Ademi Z. Attainment of low-density lipoprotein cholesterol goals in statin treated patients: Real-world evidence from Australia. Current Problems in Cardiology. 2022 Jul;47(7):101068. doi: 10.1016/j.cpcardiol.2021.101068.
• Marquina C, Talic S, Zomer E, Vargas-Torres S, Petrova M, Wolfe R, Abushanab D, Lybrand S, Thomson D, Stratton G, Ofori-Asenso R, Liew D, Ademi Z. Attainment of low-density lipoprotein cholesterol goals in patients treated with combination therapy: A retrospective cohort study in primary care. Journal of Clinical Lipidology. 2022 Jul-Aug;16(4):498-507. doi: 10.1016/j.jacl.2022.05.002.
• Talic S, Marquina C, Lybrand S, Liew D, Ademi Z. Calling for Urgent Actions to Improve Lipid Management in Australia-Low Medication Adherence and Poor Therapeutic Goal Attainment Lead to Poor Outcomes and Wasted Resources. Current Problems in Cardiology. 2023 Jul 27;48(12):102005. doi: 10.1016/j.cpcardiol.2023.102005.
• C Trin, C Marquina, Z Ademi, S Talic S. Polypharmacy in patients on lipid lowering therapies and its association with liver and kidney function: a retrospective cohort study using primary care data – ongoing.