Research & Resources


A major role of the Integrative Cardiac Wellness Group is to understand the effectiveness and feasibility of new models of integrative, personalised health care. To do this, we undertake research and evaluate the integrative servfices provided.

We are a foundation National Institute of Complementary Medicine (NICM) Collaborative Research Centre

Current research projects

  • Detecting changes in INR levels after taking Fish Oil and Coenzyme Q10 supplements by elective cardiothoracic surgical patients on Warfarin

In November we commenced a prospective clinical study to determine whether international normalized ratio (INR) levels of long-term warfarin users will change after commencing fish oil supplements together with coenzyme Q10 (CoQ10). Warfarin is an anticoagulant (blood thinning) medication and INR levels are a measure of blood clotting. This study will further investigate the safety of these supplements.

Research conducted overseas and at The Alfred has shown that patients taking CoQ10 and fish oil supplements do not have a higher risk of bleeding compared to patients not taking the supplements. Despite this, some confusion still exists in the literature which we aim to clarify with this study. In our annual audits of our integrative cardiac wellness program (ICWP) we examine a number of postoperative outcome measures including peri- and postoperative bleeding and have found no significant increase in the frequency of serious bleeding events. Now we wish to focus more closely on people taking warfarin. The benefits of these supplements when used by cardiac surgery patients have already been demonstrated in several clinical trials, including research conducted at The Alfred Hospital.

Supplements are being supplied free-of-charge by FIT Bioceuticals.

  • Testing vitamin D and zinc status in cardiac surgery patients and the effects on clinical ICU outcomes.

This investigator initiated, open label study recruited 80 elective cardiac surgery patients at The Alfred in 2011/2012 and tested their vitamin D and zinc levels before surgery. The primary aims of this study were to identify the prevalence of vitamin D and zinc deficiency in our cardiac surgery patients and whether low pre-surgery levels had a negative impact on intensive care unit (ICU) outcomes.
We will also look at whether nutrient deficiency is associated with the use of any particular medication, such as hypertensive medication.

Patients found to have insufficient vitamin D before surgery were given oral vitamin D supplements and their blood levels re-checked 6 weeks after being discharged to confirm their levels have gone back towards normal.

Patients found to have zinc deficiency will were notified of the result and encouraged to consume more zinc-rich foods.

Supplements are being supplied free-of-charge by Blackmore’s.
Results of this study are currently being analysed.

Previous research projects

  • Evaluating effects of metabolic supplements in cardiac surgery patients.

This project which built on previous research conducted at the Alfred Hospital which showed fish oils and metabolic supplements (key antioxidants) reduced coronary artery bypass graft (CABG) surgery patients' risk of atrial fibrillation, a common complication after surgery and reduced their time in hospital. The most recent audit demonstrated that use of these supplements before surgery led to a reduced requirement for positive inotropic medication (cardiac function support) after surgery in both valve surgery and CABG patients. Importantly, we confirmed the supplements were safe to use and did NOT increase the risk of a serious bleeding event. 

  •  An observational study to examine the physiological mechanisms associated with cognitive impairment in heart failure patients
This study found that oxidative stress and inflammation are associated with cognitive impairment in older heart failure patients.
Patients were recruited from the Alfred Hospital Heart Centre, and the healthy control group was recruited from the general public and tested at Swinburne University's Brain Sciences Institute.

Biological factors including oxidative stress, inflammation, cerebral blood flow and arterial stiffness were also recorded. Relationships between these biological measures and cognitive performance are currently being analysed.

Findings from this study may assist with devising appropriate interventions to improve cognitive performance in heart failure patients.

For more information contact: Christina Kure, PhD student on ph: 9214 4476

  • Evaluating stress reduction therapy in cardiothoracic surgical patients.

This study compared the effects of massage delivered by trained massage therapists on the wards after surgery to additional undisturbed time during the day. Patients were randomly selected to receive either massage therapy or ‘quiet time'.

This project aimed to determine whether massage therapy reduces anxiety, pain, muscle tension, blood pressure and heart rate.

The project was completed in January 2011. It was found that the massage therapy significantly reduced pain, anxiety and muscular tension and improved relaxation and satisfaction after cardiac surgery.

Click on the link below to read the published paper.
Massage Therapy paper 

• Naturopaths and Western herbalists’ attitudes to evidence, regulation, information sources and knowledge about popular complementary medicines.

This article explores naturopaths’ and Western herbal medicine practitioners’ attitudes towards evidence, information sources, professional regulation and their knowledge about the evidence of efficacy of some commonly used complementary medicines.

Click on the link below to read the published paper.
Naturopaths and Western herbalists’ attitudes  

  •  A randomised controlled study investigating natural supplements in total knee replacement patients.

This study compared fish oil and metabolic supplements (key antioxidants) to placebo (dummy capsules) to see if treatment reduced complications and improved patients' quality of life after surgery. It involved patients at Sandringham, Cabrini and Alfred hospitals. 


Publications from our recent research

2013   A wellness program for cardiac surgery improves clinical outcomes, by Lesley Braun, Cathy Stanguts, Ondine Spitzer, Lisa Hose, Margaretha Gunawan, Christina E. Kure, Lachlan Kwa, Donald Esmore, Michael Bailey, Franklin Rosenfeldt, in Advances in Integrative Medicine

2012: Massage therapy for cardiac surgery patients—a randomized trial, by Lesley A. Braun, Catherine Stanguts, Lisa Casanelia, Ondine Spitzer, Eldho Paul, Nicholas J. Vardaxis, Franklin Rosenfeldt, in Journal of Thoracic & Cardiovascular Surgery
Massage Therapy paper 

2012: Naturopaths and Western herbalists’ attitudes to evidence, regulation, information sources and knowledge about popular complementary medicines, by L.A. Braun, O. Spitzer, E. Tiralongo, J.M. Wilkinson, M. Bailey, S.G. Poole, M. Dooley, in Complementary Therapies in Medicine
Naturopaths and Western herbalists’ attitudes  

2010: Herbs and Natural Supplements - An Evidence Based Guide (3rd edition), by L. Braun & M. Cohen, an Elsevier publication

Available at the Monash University bookshop at The Alfred.

  • The ONLY stand alone book to be short-listed for excellence in the 2009 National Prescribing Service review of world-wide English language resources about complementary medicines.
  • Recommended by the Royal Australian College of General Practitioners (RACGP), Australian Pharmacy Board and Pharmaceutical Society of Australia (PSA).

2010: Perioperative metabolic therapy improves redox status and outcomes in cardiac surgery patients: a randomized trial, by J-Y. Leong, J. van der Merwe, S. Pepe, M. Bailey, A. Perkins, R. Lymbury, D. Esmore, S. Marasco & F. Rosenfeldt, in Heart, Lung & Circulation

2007: The clinical application of metabolic therapy for cardiovascular disease, by A. Hadj, S. Pepe, F. Rosenfeldt, in Heart, Lung & Circulation

2006: Pre-operative preparation for cardiac surgery utilising and combination of metabolic, physical and mental therapy, by A. Hadj, D. Esmore, M. Rowland, S. Pepe, L. Schneider, J. Lewin & F. Rosenfeldt, in Heart, Lung & Circulation

2003:  The principles of metabolic therapy for heart disease, by A. Hadj, S. Pepe, S. Marasco & F. Rosenfeldt, in Heart, Lung & Circulation


Other publications of interest


A Guide to Evidence-based Integrative and Complementary Medicine, by Dr Vicki Kotsirilos, Associate Professor Luis Vitetta and Professor Avni Sali, 2011

  • an evidence based book designed for General Practitioners, specialists, medical students and health practitioners with an interest in integrative medicine

General Practice: The Integrative Approach, by Dr Kerryn Phelps and Dr Craig Hassed, 2010

  • a comprehensive text book for General Practitioners, with a contemporary, integrative approach to diagnosis, investigation and management of health issues and disease states encountered in the general practice environment. 

Complementary and Integrative Therapies for Cardiovascular Disease, by Prof William Frishman, Prof Michael Weintraub, Marc Micozzi, 2005

  • An evidence based book discussing integrative practices in various hospitals and clinics overseas. 

Recommended Information Resources: 

  1. Schmelzer C, Lindner I, Rimbach G, Niklowitz P, Menke T, Doring F. Functions of coenzyme Q10 in inflammation and gene expression. Biofactors 2008; 32:179-183.
  2. Calò L, Bianconi L, Colivicchi F, Lamberti F, Loricchio ML, de Ruvo E, Meo A, Pandozi C, Staibano M, Santini M. N-3 Fatty acids for the prevention of atrial fibrillation after coronary artery bypass surgery: a randomized, controlled trial. J Am Coll Cardiol 2005; 45(10):1723-1728.
  3. Rosenfeldt FL, Pepe S, Linnane A, Nagley P, Rowland M, Ou R, Marasco S, Lyon W, Esmore D. Coenzyme Q10 protects the aging heart against stress: studies in rats, human tissues, and patients. Ann N Y Acad Sci 2002; 959:355-359.
  4. Rosenfeldt F, Marasco S, Lyon W, Wowk M, Sheeran F, Bailey M, Esmore D, Davis B, Pick A, Rabinov M, Smith J, Nagley P, Pepe S. Coenzyme Q10 therapy before cardiac surgery improves mitochondrial function and in vitro contractility of myocardial tissue. J Thorac Cardiovasc Surg 2005; 129(1):25-32.
  5. Rosenfeldt FL, Pepe S, Linnane A, Nagley P, Rowland M, Ou R, Marasco S, Lyon W. The effects of ageing on the response to cardiac surgery: protective strategies for the ageing myocardium. Biogerontology 2002; 3(1-2):37-40.
  6. Rosenfeldt FL, Korchazhkina OV, Richards SM, Fisher JL, Tong S, Pisarenko OI. Aspartate improves recovery of the recently infarcted rat heart after cardioplegic arrest. Eur J Cardiothorac Surg 1998; 14(2):185-90.
  7. Munsch CM, Rosenfeldt FL, O'Halloran K, Langley LH, Conyers RA, Williams JF. The effect of orotic acid on the response of the recently infarcted rat heart to hypothermic cardioplegia. Eur J Cardiothorac Surg 1991; 5(2):82-92.
  8. Munsch C, Williams JF, Rosenfeldt FL. The impaired tolerance of the recently infarcted rat heart to cardioplegic arrest: the protective effect of orotic acid. J Mol Cell Cardiol 1989; 21(8):751-754.
  9. Rosenfeldt F, Miller F, Nagley P, Hadj A, Marasco S, Quick D, Sheeran F, Wowk M, Pepe S. Response of the senescent heart to stress: clinical therapeutic strategies and quest for mitochondrial predictors of biological age. Ann N Y Acad Sci 2004; 1019:78-84.
  10. Leong JY, Pepe S, Van der Merwe J, Calderone A, Esmore D, Krum H, Rosenfeldt FL. Preoperative Metabolic Therapy Improves Outcomes From Cardiac Surgery: A Prospective Randomised Clinical Trial. [Conference Abstract] Heart Lung Circ 2007; 16 (Suppl 2):S178.