Recent trends in health assessments for older Australians.

Non-Indigenous older Australians (aged 75+ years) are encouraged to undertake an annual health assessment (75+HA) to identify overlooked medical conditions, holistically assess the management of current chronic conditions and highlight potential risk factors for poor health. Uptake in the 2000s has been previously reported to be slowly increasing, but still very low. This study aimed to identify the uptake of 75+HA between 2011 and 2019, comparing State and National trends over a 9-year period. The uptake of Medicare Items 701, 703, 705 and 707 between 2011 and 2019 was analysed. These results were incorporated with Australian Demographics data to present rate ratios by State and age groups. An increasing number of 75+HAs were performed between 2011 and 2019, and the 75+HAs performed were increasing in duration. Overall, the 75+HA uptake was still generally low, at approximately one-third of the eligible population; however, despite the low uptake, age-standardised figures showed upward trends. The 75+HA rate in the 85+ year group has now overtaken their younger (aged 75-84 years) counterparts. There were also clear variations between States. Given the low rates, strategies to improve uptake should be targeted so all eligible Australians receive an annual Medicare Benefits Schedule (MBS)-funded 75+HA.

Experienced general practitioners.

ObjectiveHealth assessments (HAs) are available annually for community-dwelling older people: the 75+HA for non-Indigenous Australians aged ≥75 years and the 55+IHA for Indigenous Australians aged ≥55 years. Medicare requires general practitioners (GPs) to cover the items within the relevant HA form. This study explored the views of experienced GPs and practice nurses (PNs) towards the older-person HA forms.MethodsThirty-nine experienced GPs and PNs responded to an online questionnaire.ResultsIn this study, experienced GPs and PNs suggested that current items within the 75+HA Medicare-provided guideline form need reviewing, such as those relating to psychological function, medication and exercise and falls. There were also recommendations to consider including items consistently across both the 55+IHA and 75+HA and to include new items, such as personal alarms, loneliness, support networks, spiritual health, musculoskeletal diseases, whether other screening is up to date and future planning. Many parts of the HA were deemed irrelevant or condescending to 'well' older Australians, so should be optional. Healthcare professionals also requested reintroducing conducting the HA at the community-dwelling patient's home. User-friendly integrated forms would improve healthcare professionals' time management and provide better communication with patients and carers, and create greater opportunities for multidisciplinary referral processes, as well as provide linkages to MyAgedCare and myHealthRecord.ConclusionCapturing the views of healthcare professionals towards older-person HA forms generated suggested improvements. The adoption of these suggestions would elicit more holistic health information for older Australians.What is known about the topic?Annual HAs are available for older Australians (75+HAs and 55+IHAs). Medicare requires GPs cover items within their prescribed HA form. The 75+HAs and 55+IHAs allow for the monitoring of health problems specific to community-dwelling older people, which may be difficult to address in the time frames of a standard GP consultation; however, there is very little research on the experiences of health professionals regarding the conditions required to be assessed within the HAs.What does this paper add?This study examined the views of experienced GPs and PNs to identify potential changes to the current procedures. Capturing the views of healthcare professionals towards older-person HA forms generated important suggested improvements, such as reviewing psychological function, medication, exercise and falls items. There were recommendations to include items across both the 55+IHA and 75+HA and new items, such as personal alarms, loneliness, support networks, spiritual health, musculoskeletal diseases assessments, future planning and whether the patient's screening is up to date.What are the implications for practitioners?The experienced GPs and PNs in this study suggested significant additions and revisions to the current HA forms. The incorporation of these suggestions should lead to permanent modifications of the current forms to make them more relevant and appropriate for older Australians, but the challenge for implementation is how these additional items would be funded.

Attitudes of general practitioners and practice nurses regarding older person health assessments.

Health assessments (HAs) are available for community-dwelling older people to receive annually from general practitioners (GPs), but have low uptake. Little is known regarding the views of GPs and practice nurses (PNs) towards older person HAs and whether this might contribute to the low uptake. The objective of this study was to explore the attitudes of GPs and PNs towards older person HAs. Fifty-eight participant responses to an online questionnaire were analysed through descriptive statistics and content analysis. Most participants (77%) found older person HAs to be useful. Participants felt HAs identified health problems that may otherwise be missed (n=21). The main barriers to delivery of HAs were patient refusal (n=25) and insufficient practitioner time (n=19). The most requested change to HAs was increased patient education and public awareness regarding older person HAs (n=10). Health professionals felt increased patient education and public awareness, particularly to address patient misconceptions regarding older person HAs, may improve HA uptake.

What is learned from an Australian older person health assessment?

Objective To examine what new health information is identified at a patient's most recent 75+HA compared with their standard GP consultations in the prior 24 months. Methods Parameters measured included newly identified chronic conditions, new management for previously diagnosed chronic conditions, medication management, referrals, vaccinations, and positive test results for the monitoring of previously diagnosed chronic conditions. A retrospective patient record study collecting data from two GP clinics in metropolitan and regional Victoria was undertaken. A total of 195 75+HA recipients were included. Results No significant difference was found in the number of new chronic conditions recorded at patients' most recent 75+HA compared with standard GP consultations in the prior 24 months. However, significant differences in the types of conditions were noted, with 75+HAs significantly more likely to record elevated lipids (P<0.001), vitamin D deficiencies (P=0.004), eye/vision-related (P=0.011), diabetes (P=0.019), and hearing conditions (P=0.045) compared with standard GP consultations. Significantly more referrals (P<0.001) and new management for previously diagnosed conditions (P=0.009) occurred at 75+HA than at standard GP consultations. Patients who were receiving their first 75+HA were significantly more likely to receive vaccinations than those receiving a subsequent 75+HA (P=0.022). Conclusion 75+HAs fulfil a role in addressing chronic health problems otherwise overlooked during standard GP consultations. What is known about the topic? Since their introduction in 1999, uptake of 75+HAs has been low. Two studies from 2001 to 2002 have suggested benefits of conducting 75+HAs to identify new health problems. What does this paper add? When compared with standard GP consultations, 75+HAs identify different types of new health problems, including elevated lipids, vitamin D deficiencies, eye/vision-related conditions, diabetes, and hearing conditions. Furthermore, more referrals and new management of previously identified problems occur at 75+HA. What are the implications for practitioners? 75+HAs fulfil a role in identifying and addressing chronic health problems in older patients that may otherwise have been overlooked at standard GP consultations. Suggestions of additions to the 75+HA template are made based on common chronic conditions detected in standard consultations but not included currently within the 75+HA.

Maternal iodine dietary supplements and neonatal thyroid stimulating hormone in Gippsland, Australia.

BACKGROUND AND OBJECTIVES: Pregnant women are at particular risk of iodine deficiency due to their higher iodine requirements. Iodine is known to be essential for normal growth and brain development, therefore neonatal outcomes in mildly iodine deficient areas, such as Gippsland, are a critical consideration. This study aimed to investigate whether iodine supplementation prevented iodine insufficiency as determined by neonatal thyroid stimulating hormone (TSH) screening criteria. METHODS AND STUDY DESIGN: Gippsland-based women aged >=18 years, in their third trimester of pregnancy, provided self-reported information regarding their iodine supplement use and consent to access their offspring's neonatal TSH screening data. 126 women consented to participate, with 111 women completing all components of this study. RESULTS: Only 18.9% of participants followed the National Health and Medical Research Council (NHMRC) recommendation of 150 µg/day iodine supplement, with 42.3% of participants not taking any supplements, or taking supplements with no iodine or insufficient iodine. The remaining women (38.7%) were taking supplements with doses of iodine much higher (200-300 µg) than the NHMRC recommended dose or were taking multiple supplements containing iodine. When correlating iodine intake to their neonates' TSH, no correlation was found. When iodine supplementation usage was categorised as below, equal to, or above NHMRC recommendations there was no significant difference in neonatal TSH. CONCLUSION: This study found that iodine supplementation appeared to prevent maternal iodine insufficiency when measured against neonatal TSH screening criteria.

Conversation Maps and Diabetes Education Groups: An Evaluation at an Australian Rural Health Service.

Objective. The rural Central Gippsland Health Service (CGHS) assists patients with diabetes through the provision of diabetes education. The purpose of this study was to compare and evaluate the CGHS 5-week didactic program and a modified group-participatory Conversation Maps diabetes education program. Method. A pre- and post-program survey was conducted of clients who attended the two different diabetes education programs. The survey consisted of a self-constructed demographic questionnaire, the Diabetes Knowledge Test, the Diabetes Empowerment Scale, and the Diabetes Self-Care Activities Measure. Results. For the CGHS program, there were no differences between pre- and post-program surveys in knowledge scores (11.05 ± 3.56 vs. 12.75 ± 4.19, P = 0.0883, n = 20), self-care activities (4.46 ± 1.11 vs. 4.83 ± 0.68, P = 0.0832, n = 12), or empowerment scores (7.16 ± 1.60 vs. 7.92 ± 1.26, P = 0.0540, n = 17). For the modified Conversation Maps program, there were significant improvements between pre- and post-program surveys in knowledge scores (12.42 ± 4.15 vs. 15.54 ± 3.79, P = 0.0004, n = 26), self-care activities (4.74 ± 1.09 vs. 5.32 ± 0.80, P = 0.0139, n = 24), and empowerment scores (6.56 ± 2.19 vs. 8.11 ± 1.46, P = 0.0016, n = 21). The greatest difference between the two programs was observed in knowledge gain (P = 0.0178). Overall, participants were satisfied with both programs, with no difference seen in satisfaction levels (P = 0.9763). A1C results improved in both programs to a mean of 6.7% (P = 0.0071 for CGHS and P = 0.0092 for Conversation Maps). Conclusion. The modified Conversation Maps program resulted in significant improvements for rural participants.

Educators' expectations of roles, employability and career pathways of registered and enrolled nurses in Australia.

In Australia, like other countries, two levels of nurse are registered for entry to practice. Educational changes for second level nurses in Australia have led to questions regarding roles and career options. This paper reports on interviews with nursing course coordinators to examine educator expectations of roles and career pathways of registered and enrolled nurses. Coordinators of eight degree (registered) and diploma (enrolled) nursing programs were interviewed to determine their opinions on roles and careers that students were prepared for. Transcripts were thematically analysed. Educators reported similar graduate roles, although high acuity care was primarily the role of registered nurses. Career expectations differed with enrolled nurses having limited advancement opportunity, and registered nurses greater career options. Health organisations were unprepared to accommodate increased practice scope of enrolled nurses and limited work practice through policies stipulating who could perform procedures. Organisational health policies need to accommodate increased enrolled nurse skill base. Education of practising nurses is necessary regarding increased scope of enrolled nurse practice to ensure they are used to their full potential. Increasing patient acuity requires more registered nurses, as enrolled nurses are unprepared to care for complex or deteriorating patients.

The changing skill mix in nursing: considerations for and against different levels of nurse.

AIM: To investigate the current literature to gain an understanding of skill mix, why it is being manipulated and how it affects patient care and health-care costs. BACKGROUND: Due to workforce shortages, economic constraints and increasing patient acuity, employers are looking at methods of providing patient care whilst maintaining costs. Registered nurses make up a large percentage of the health-care budget. The manipulation of skill mix (i.e. the percentage of registered nurses available for patient care) is seen as one method of managing the increasing cost whilst still ensuring patient care. EVALUATION: Research literature was used to determine the current use of skill mix and its impact on patient care and health-care costs. KEY ISSUE: The use of a higher proportion of registered nurses is associated with better health outcomes, shorter length of stay and reduced patient morbidity. CONCLUSION: Economic savings from substituting registered nurses with other health professionals may be offset by increased patient length of stay in hospital and increased patient mortality. IMPLICATIONS FOR NURSING MANAGEMENT: When evaluating nursing skill mix, a higher percentage of registered nurses may result in health-care facility cost savings by providing a shorter length of stay and decreased patient complications.

Similarities and differences in educational preparation of registered and enrolled nurses in Australia: An examination of curricula content.

Abstract Background: Variations exist internationally in the types and numbers of nurses registered to practice. Whilst the United Kingdom has phased out second level nurses, countries such as Australia, New Zealand, Singapore and the United States have maintained a two level system. In Australia, the two levels of nurse authorised to practice are the registered nurse whom complete an undergraduate nursing degree, and enrolled nurse whom complete either a certificate or diploma program. Recent changes to educational preparation and resulting scope of practice for enrolled nurses have resulted in increased confusion between roles and expectations of the different levels. Aim: This paper reports on findings of a study aimed at identifying differences in educational preparation of the different levels of nurse in Australia. Method: Course coordinators from nine organisations offering pre-registration nursing programs completed self-reporting questionnaires designed to obtain information on types and lengths of courses, and details of curricula including course objectives, teaching and assessment methods and content areas. Results: Comparative analysis of survey responses identified similarities and differences between registered and enrolled nurse programs. Common areas included teaching and assessment methods, core theoretical units and general nursing skills. The diploma and degree programs appear aligned in most theory and clinical skills. The main difference identified existed between skills taught in the two enrolled nurse programs. Conclusions: Findings further add to confusion regarding registered and enrolled nurses in Australia. Further research is required to determine expectations of employers and other major stakeholders with regard to the differences.

Comparisons of the educational preparation of registered and enrolled nurses in Australia: the educators' perspectives.

Similar to the U.S.A., New Zealand and Singapore, Australia registers two levels of nurse, the degree or postgraduate entry prepared registered nurse and diploma or certificate-prepared enrolled nurse. Over the past decade, significant changes have occurred in educational preparation of enrolled nurses. This has resulted in enrolled nurses undertaking many roles and responsibilities previously undertaken only by registered nurses. An exploratory qualitative research study using interviews with educators of both registered and enrolled nurses was undertaken to investigate differences in educational preparation of registered and enrolled nurses in Australia. This paper describes perceptions around how participants viewed educational approaches and different cohorts, types and levels of students. Similarities included topics covered and the majority skills taught, although high acuity skills remain a difference between the levels of nurse. Differences were also found in type of student, educational background and teaching methods.

Senior nurse role expectations of graduate registered and enrolled nurses on commencement to practice.

OBJECTIVE: This paper reports on a project to examine the expectations of senior nurses regarding graduate roles of registered and enrolled nurses educated in Victoria, Australia. METHODS: Participants completed an online survey to indicate whether predetermined competencies were in the roles of graduate enrolled or registered nurses or not in the role of either nurse. Chi-squared analysis was used to identify differences between participant groups. RESULTS: Participants expressed variations in role expectations for the different level of graduate nurse. Although basic nursing care was undertaken by both graduate enrolled and registered nurses, no specific role was identified for enrolled nurses. Differences were found in the opinions of senior nurses over the roles of graduate nurses, demonstrating considerable variation in expectations. Management, education and research roles were not identified as the role of either nurse on graduation. Differences were found in the expectations of the different senior nurse groups regarding the roles of the enrolled nurse, particularly in the new skills taught in the enrolled nurse diploma program. CONCLUSIONS: Confusion exists regarding the roles of both types of nurse on graduation. Further research across Australia is required to clarify the roles of the different level of nurse in different practice contexts.

Similarities and differences in educational preparation of registered and enrolled nurses in Australia: An examination of curricula content.

UNLABELLED: Abstract Background: Variations exist internationally in the types and numbers of nurses registered to practice. Whilst the United Kingdom has phased out second level nurses, countries such as Australia, New Zealand, Singapore and the United States have maintained a two level system. In Australia, the two levels of nurse authorised to practice are the registered nurse whom complete an undergraduate nursing degree, and enrolled nurse (EN) whom complete either a certificate or diploma programme. Recent changes to educational preparation and resulting scope of practice for ENs have resulted in increased confusion between roles and expectations of the different levels. AIM: This paper reports on findings of a study aimed at identifying differences in educational preparation of the different levels of nurse in Australia. METHOD: Course coordinators from nine organisations offering pre-registration nursing programmes completed self-reporting questionnaires designed to obtain information on types and lengths of courses, and details of curricula including course objectives, teaching and assessment methods and content areas. RESULTS: Comparative analysis of survey responses identified similarities and differences between registered and EN programmes. Common areas included teaching and assessment methods, core theoretical units and general nursing skills. The diploma and degree programmes appear aligned in most theory and clinical skills. The main difference identified existed between skills taught in the two EN programmes. CONCLUSIONS: Findings further add to confusion regarding registered and ENs in Australia. Further research is required to determine expectations of employers and other major stakeholders with regard to the differences.

Senior nurse role expectations of graduate registered and enrolled nurses in Australia: Content analysis of open-ended survey questions.

Abstract Changes to educational preparation and scope of practice for enrolled nurses (ENs) in Australia have impacted on role expectations. This paper reports results of a survey of senior nurses in Victoria, Australia, regarding opinions of the differences in role expectation and scope of practice for graduate registered and ENs. Content analysis of open-ended survey questions was used to identify themes in the written data. Results identified education, skill level and responsibility as differences between the levels of graduate nurses despite many respondents perceiving there to be no or little difference in graduate roles.

Learning styles of first-year undergraduate nursing and midwifery students: a cross-sectional survey utilising the Kolb Learning Style Inventory.

It is important that educators understand their students' learning styles. In this study we investigate the learning styles of first-year undergraduate nursing and midwifery university students and whether these learning styles are influenced by student demographic characteristics. A cross-sectional survey including demographic questions and the Kolb Learning Style Inventory was utilised. There was a 78% response rate (n=345). The majority of first-year students investigated in this study were divergers (29.5%), followed by assimilators (28.8%), accommodators (23.9%) and convergers (17.9%). Female students had a higher reflective observation (RO) score than male students (p=0.0078). Those with English as first language showed a higher active experimentation score (p=0.0543) and a lower concrete experience (CE) score (p=0.0038). Australian citizens and permanent residents had a higher RO score (p=0.0560) and a lower CE score (p=0.0100) than migrants and international students. Nursing/arts students had a higher abstract conceptualisation (AC) score than nursing students (p=0.0013). Students enrolled in 4-5 subject units had a higher AC score than those enrolled in 1-2 units (p=0.0244). Nursing and midwifery students are mainly of the diverger and assimilating learning styles. Some student demographic characteristics show a significant influence on learning styles. This study has teaching and research implications.

Compulsory medical rural placements: senior student opinions of early-year experiential learning.

OBJECTIVE: The aim of this study was to determine senior medical student (year 3-5) opinions of their early-year (year 1-2) rural placement. DESIGN: We assessed the impact of MBBS early-year rural placements through a follow up of this cohort in their later years using a cross-sectional questionnaire. SETTING: The questionnaire was administered to year 3-5 medical students at their clinical school. PARTICIPANTS: There were 97 participants (49% response rate) in the study. Twenty-nine per cent were male and 71% were female; 44% were from a rural background and 56% were from a metropolitan background; 48% were year 3 students, 32% were year 4 students and 20% were year 5 students; and 59% of the students were, at the time, situated at a rural clinical school and 41% were at a metropolitan clinical school. MAIN OUTCOME MEASURE: Closed-ended questions were quantified and statistically analysed. Open-ended responses were thematically analysed to determine what their experience of early-year rural placements were like. RESULTS: Seventy-nine per cent of students considered the year 1 placement length as 'about right'. Overall, most students found year 1 rural placements positive and grasped the placement aims and objectives. Most students were also pleased with year 2 rural placements, mainly due to the clinical aspects. CONCLUSIONS: Medical students appear to prefer shorter early-year rural placements and understand the benefits and importance of such placements. They also have a desire for greater clinical exposure during these early-year placements.

Learning preferences of first year nursing and midwifery students: utilising VARK.

The diversity of first year students is increasing with new schemes promoting access to higher education courses. It is important to assess the learning styles of students in order to cater for their differing learning needs. The aim of this study was to profile first year nursing/midwifery students at two campuses of Australian Catholic University, to investigate their learning preferences and the effect demographic background has on these preferences. We designed a survey to collect demographic data and incorporated the VARK (visual, aural, read-write and kinaesthetic) questionnaire to investigate the students' preferred learning modes. The kinaesthetic score of our students was the highest (7.34 ± 2.67), significantly differing from the other three modes (p<0.001). Demographic factors such as gender and age group did not influence mean scores of each sensory modality. The predominant preference was quadmodal utilising all four learning styles. The distribution of students preferring to learn by unimodal, bimodal, trimodal and quadmodal styles varied between demographic groupings. The rural students had significantly higher visual and kinaesthetic scores compared to their metropolitan counterparts. Students attending the rural campus had higher visual and read-write scores. Visual and aural scores were significantly lower for students from non-English speaking backgrounds. These findings have significant teaching and research implications.

Chronic type 1 diabetes in spontaneously hypertensive rats leads to exacerbated cardiac fibrosis.

INTRODUCTION: Diabetes in human subjects is often associated with hypertension. The aim of this study was to examine the development of cardiac fibrosis following induction of type 1 diabetes in genetically hypertensive rats. METHODS: Diabetes was induced by streptozotocin (STZ) injection in 8-week-old normotensive Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHRs) for a duration of 16 or 24 weeks. Aged-matched, nondiabetic WKY and SHRs were used as controls. At termination of treatment, the rats were anaesthetized, hearts arrested in diastole and perfusion fixed. A comprehensive examination of cardiac fibrosis throughout the right and left ventricles was undertaken in picrosirius red-stained sections, using image analysis and by undertaking collagen type I and type III immunohistochemistry. RESULTS: Induction of diabetes in the SHRs led to a marked increase in the levels of interstitial fibrosis in the left ventricle plus septum (LV+S) at both 16 and 24 weeks duration (59% and 43% increase, respectively) and also in the right ventricle after 24 weeks duration of diabetes (35% increase compared to the nondiabetic SHR). Exacerbated perivascular fibrosis was also observed in the LV+S in the diabetic-hypertensive rats at the later time point. These effects of induction of diabetes were not observed in the normotensive strain. CONCLUSIONS/INTERPRETATION: Our findings clearly demonstrate elevations in cardiac fibrosis when type 1 diabetes is combined with hypertension. Our findings thus stress the importance of closely monitoring both blood pressure and glucose levels in type 1 diabetic patients in order to prevent myocardial collagen deposition.

Angiotensin II type 2 receptor antagonizes angiotensin II type 1 receptor-mediated cardiomyocyte autophagy.

Autophagy has emerged as an important process in the pathogenesis of cardiovascular diseases, but the proximal triggers for autophagy are unknown. Angiotensin II plays a central role in the pathogenesis of cardiac hypertrophy and heart failure. In this study, we used angiotensin II type 1 (AT(1)) and type 2 (AT(2)) receptor-expressing adenoviruses in cultured neonatal cardiomyocytes to provide the first demonstration that neonatal cardiomyocyte autophagic activity is differentially modulated by AT(1) and AT(2) receptor subtypes. Angiotensin II stimulation (48 hours) of neonatal cardiomyocytes expressing the AT(1) receptor alone (Ad-AT(1); 10 multiplicities of infection) induced a significant increase in the number of HcRed-LC3 autophagosomes per cell (17.3+/-1.6 versus 33.3+/-4.1 autophagosomes per cell; P<0.05). Coexpression of a high ratio of AT(2):AT(1) (Ad-AT(2):Ad-AT(1) multiplicity of infection ratio: 20:5) receptors completely abrogated the AT(1)-mediated increase in autophagy (9.3+/-1.4 versus 33.3+/-4.1 autophagosomes per cell; P<0.05). Treatment with the AT(2) receptor antagonist PD123319 did not reverse the AT(2)-mediated antiautophagic effect. AT(1)- and AT(2)-mediated autophagic responses were also assessed in cardiomyocytes from a genetic model that exhibits neonatal myocardial growth suppression. In these neonate myocyte cultures, AT(1) receptor activation induced a marked increase in the number of myocytes containing cytoplasmic vacuoles compared with the control (22.7+/-4.1% versus 1.1+/-0.6%; P<0.001) and was characterized by a nonapoptotic autophagic phenotype. The incidence of cardiomyocyte autophagic vacuolization in this myocyte population decreased dramatically to only 0.4+/-0.2% in myocytes infected with a high ratio of Ad-AT(2):Ad-AT(1). This study provides the first description of reciprocal regulation of cardiomyocyte autophagic induction by the AT(1) and AT(2) receptor subtypes.

The angiotensin II type 2 receptor causes constitutive growth of cardiomyocytes and does not antagonize angiotensin II type 1 receptor-mediated hypertrophy.

Angiotensin II (Ang II) has important actions on the heart via type 1 (AT1) and type 2 (AT2) receptors. The link between AT1 receptor activation and the hypertrophy of cardiomyocytes is accepted, whereas the contribution of the AT2 receptor, which reportedly antagonizes the AT1 receptor, is contentious. This ambiguity is primarily based on in vivo approaches, in which the direct effect of the AT2 receptor and its modulation of the AT1 receptor (at the level of the cardiomyocyte) are difficult to establish. In this study, we used adenoviruses encoding AT1 and AT2 to coexpress these receptors in isolated cardiomyocytes, allowing a direct examination of the consequence of varying AT1/AT2 stoichiometry on cardiomyocyte hypertrophy. In myocytes expressing only the AT1 receptor, Ang II stimulation promoted robust hypertrophy (increased protein:DNA ratio and phenotypic changes) via activation of mitogen-activated protein kinases (MAPKs). Titration of the AT2 receptor against the AT1 receptor did not inhibit Ang II-mediated cardiomyocyte hypertrophy. Instead, basal and Ang II-mediated hypertrophy was increased in line with the amplified expression of the AT2 receptor, indicating a capacity for the AT2 receptor to enhance basal cardiomyocyte growth. Indeed, expression of the AT2 receptor alone resulted in hypertrophy; remarkably, this was unaffected by Ang II stimulation or the AT2 receptor-specific ligands PD123319 and CGP42112. Although previous studies have indicated that the AT2 receptor can antagonize MAPK activation via the AT1 receptor, we found no evidence for this in cardiomyocytes. Thus, the AT2 receptor promotes ligand-independent, constitutive cardiomyocyte hypertrophy and does not directly antagonize the AT1 receptor in this setting.