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Lee CY, Lee J, Seo HH, Shin S, Kim SW, Lee S, Lim S, Hwang KC. TAK733 attenuates adrenergic receptor-mediated cardiomyocyte hypertrophy via inhibiting ErkThr188 phosphorylation. Clin Hemorheol Microcirc 2019; 72:179-187. [PMID: 30714951 DOI: 10.3233/ch-180476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cardiac hypertrophy is an important risk factor for heart failure. The MEK-ERK axis has been reported as a major regulator in controlling cardiac hypertrophy. TAK733 is a potent and selective MEK inhibitor that suppresses cell growth in a broad range of cell lines. OBJECTIVE Therefore, we aimed to investigate the anti-hypertrophic effect of TAK733 in cardiomyocytes. METHODS Cardiomyocyte hypertrophy was induced with norepinephrine (NE) or phenylepinephrine (PE) using H9c2 cells. To confirm the cardiomyocyte hypertrophy, cell size and protein synthesis were measured and hypertrophy-related gene expression was estimated by reverse transcription polymerase chain reaction. To identify the signaling pathway involved, immunoblot analysis were performed. RESULTS We observed that NE activated MEK-ERK signaling and increased ANP and BNP expression, resulting in cardiomyocyte hypertrophy. TAK733 significantly reduced cardiomyocyte hypertrophy by regulating NE-induced ERK1/2 and ERKThr188 activation, hypertrophy marker expression, and cardiomyocyte hypertrophy through depression of MEK activity. In addition, we examined that PE-induced cardiomyocyte hypertrophy was also attenuated by TAK733. CONCLUSIONS Here, we report that TAK733 suppressed NE- or PE-induced cardiomyocyte hypertrophy by repressing a crucial component of cardiac hypertrophy-related pathways. These results suggest that TAK733 may be a useful therapeutics for cardiac hypertrophy and warrants further in vivo studies.
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Affiliation(s)
- Chang Youn Lee
- Department of Integrated Omics for Biomedical Sciences, Yonsei University, Seoul, Republic of Korea
| | - Jiyun Lee
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, Republic of Korea
| | - Hyang-Hee Seo
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, Republic of Korea
| | - Sunhye Shin
- Department of Integrated Omics for Biomedical Sciences, Yonsei University, Seoul, Republic of Korea
| | - Sang Woo Kim
- Institute for Bio-Medical Convergence, College of Medicine, Catholic Kwandong University, Gangneung, Gangwon-do, Republic of Korea
| | - Seahyoung Lee
- Institute for Bio-Medical Convergence, College of Medicine, Catholic Kwandong University, Gangneung, Gangwon-do, Republic of Korea
| | - Soyeon Lim
- Institute for Bio-Medical Convergence, College of Medicine, Catholic Kwandong University, Gangneung, Gangwon-do, Republic of Korea
| | - Ki-Chul Hwang
- Institute for Bio-Medical Convergence, College of Medicine, Catholic Kwandong University, Gangneung, Gangwon-do, Republic of Korea
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Adena MA, Hamann G, Sindone AP. Cost-Effectiveness of Ivabradine in the Treatment of Chronic Heart Failure. Heart Lung Circ 2019; 28:414-422. [DOI: 10.1016/j.hlc.2018.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/28/2017] [Accepted: 01/07/2018] [Indexed: 12/31/2022]
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Al‐Omary MS, Khan AA, Davies AJ, Fletcher PJ, Mcivor D, Bastian B, Oldmeadow C, Sverdlov AL, Attia JR, Boyle AJ. Outcomes following heart failure hospitalization in a regional Australian setting between 2005 and 2014. ESC Heart Fail 2018; 5:271-278. [PMID: 29265710 PMCID: PMC5880667 DOI: 10.1002/ehf2.12239] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/27/2017] [Accepted: 11/07/2017] [Indexed: 12/25/2022] Open
Abstract
AIMS The aim of the current study is to examine 10 year trends in mortality and readmission following heart failure (HF) hospitalization in metropolitan and regional Australian settings. METHODS AND RESULTS We identified all index HF hospitalizations in the Hunter New England region from 2005 to 2014, using a 10 year 'look back' period. The primary endpoint was a composite of all-cause mortality or all-cause readmission at 1 year. Secondary endpoints included all-cause mortality, all-cause readmission, and HF readmission at 30 days and 1 year. We used logistic regression to explore the predictors of the composite outcome of either all-cause death or readmission at 1 year. There were 12 114 patients admitted with a first episode of HF between 2005 and 2014, followed up until death or the end of 2015. The mean age was 78 ± 12 years and 49% (n = 5906) were male. A total of 4831 (40%) resided in regional areas and the remainder in metropolitan areas. One hundred sixty-eight patients (1.4%) were Aboriginal. Approximately 69% of patients had either died or been readmitted for any cause within 12 months of their index event. The 30 day and 1 year all-cause mortality rates were 13% and 32%, respectively, with no change in the trend over the study period. Age, socio-economic disadvantage, ischaemic heart disease, renal failure, and chronic lower respiratory disease were predictors of the primary endpoint. CONCLUSIONS Heart failure hospitalizations are followed by high rates of death or readmission. There was no change in this composite endpoint over the 10 year study period.
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Affiliation(s)
- Mohammed S. Al‐Omary
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
- The University of NewcastleNewcastleNSWAustralia
- Hunter Medical Research InstituteNewcastleNSWAustralia
| | - Arshad A. Khan
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
| | - Allan J. Davies
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
| | - Peter J. Fletcher
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
- The University of NewcastleNewcastleNSWAustralia
| | - Dawn Mcivor
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
| | - Bruce Bastian
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
| | - Christopher Oldmeadow
- The University of NewcastleNewcastleNSWAustralia
- Hunter Medical Research InstituteNewcastleNSWAustralia
| | - Aaron L. Sverdlov
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
- The University of NewcastleNewcastleNSWAustralia
- Hunter Medical Research InstituteNewcastleNSWAustralia
| | - John R. Attia
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
- The University of NewcastleNewcastleNSWAustralia
- Hunter Medical Research InstituteNewcastleNSWAustralia
| | - Andrew J. Boyle
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
- The University of NewcastleNewcastleNSWAustralia
- Hunter Medical Research InstituteNewcastleNSWAustralia
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A physician targeted intervention improves prescribing in chronic heart failure in general medical units. BMC Health Serv Res 2018; 18:206. [PMID: 29566753 PMCID: PMC5865296 DOI: 10.1186/s12913-018-3009-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 03/15/2018] [Indexed: 01/19/2023] Open
Abstract
Background Despite strong evidence for beta-blockers and angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) in chronic heart failure (CHF), they have been under-utilised especially in general medical units. We aim to evaluate the effectiveness and feasibility of a physician-targeted quality improvement intervention with education and feedback on the prescription of beta-blockers and ACEI/ARB for CHF management in an inpatient setting. Methods We conducted an interrupted time series study between January 2009 and February 2012. A two-stage intervention was implemented. Between November 2009 and January 2011, a structured physician-oriented education program was undertaken. From February 2011, quarterly performance feedback was provided to each medical unit by a senior clinician. Medical notes of patients admitted with CHF under general medical units before and during the intervention were prospectively audited. Main outcomes were beta-blockers and ACEI/ARB prescription rates, and 180-day readmission rates for CHF. Results Four hundred and sixty-eight patients were included in this study. Structured education program was associated with a significant rise in beta-blockers prescription rates from a baseline of 60 to 92% (p = 0.003), but a non-sustained rise in ACEI/ARB prescription. Regular performance feedback resulted in a further sustained increase in ACEI/ARB prescription rates from 62 to 93% (p = 0.028) and a positive trend for beta-blockers with rates maintained at 89%. There was a reduction in 180-day readmission rates that correlated with the improvements in beta-blocker (p = 0.030) and ACEI/ARB (p = 0.035) prescription. Conclusion Implementation of a structured education program with regular performance feedback was durable and was associated with improvements in appropriate prescribing and an observed decrease in CHF-related readmissions.
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Mortality and Readmission Following Hospitalisation for Heart Failure in Australia: A Systematic Review and Meta-Analysis. Heart Lung Circ 2018. [PMID: 29519691 DOI: 10.1016/j.hlc.2018.01.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Heart failure (HF) is a common, costly condition with an increasing burden on Australian health care system resources. Knowledge of the burden of HF on patients and on the health system is important for resource allocation. This study is the first systematic review to estimate the mortality and readmission rates after hospitalisation for HF in the Australian population. METHODS We searched for studies of HF hospitalisation in Australia published between January 1990 and May 2016, using a systematic search of PubMed, Medline, Scopus, Web of Science, EMBASE and Cochrane Library databases. Studies reporting 30-day and/or 1-year outcomes for mortality or readmission following hospitalisation were eligible and included in this study. RESULTS Out of 2889 articles matching the initial search criteria, a total of 13 studies representing 67,255 patients were included in the final analysis. The pooled mean age of heart failure patients was 76.3 years and 51% were male (n=34,271). The pooled estimated 30-day and 1-year all-cause mortality were 8% and 25% respectively. The pooled estimated 30-day and 1-year all-cause readmission rates were 20% and 56% respectively. There is a high prevalence of comorbidities in heart failure patients. There were limited data on readmission and mortality in rural patients and Indigenous people. CONCLUSIONS Heart failure hospitalisations in Australia are followed by substantial readmission and mortality rates.
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Heart Failure Hospitalisations in the Hunter New England Area Over 10 years. A Changing Trend. Heart Lung Circ 2017; 26:627-630. [DOI: 10.1016/j.hlc.2016.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 11/24/2022]
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Abstract
Heart failure (HF) is a global pandemic affecting at least 26 million people worldwide and is increasing in prevalence. HF health expenditures are considerable and will increase dramatically with an ageing population. Despite the significant advances in therapies and prevention, mortality and morbidity are still high and quality of life poor. The prevalence, incidence, mortality and morbidity rates reported show geographic variations, depending on the different aetiologies and clinical characteristics observed among patients with HF. In this review we focus on the global epidemiology of HF, providing data about prevalence, incidence, mortality and morbidity worldwide.
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Affiliation(s)
- Gianluigi Savarese
- Division of Cardiology, Department of Medicine,Karolinska Insitutet, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital,Stockholm, Sweden
| | - Lars H Lund
- Division of Cardiology, Department of Medicine,Karolinska Insitutet, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital,Stockholm, Sweden
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Weeks KL, Bernardo BC, Ooi JYY, Patterson NL, McMullen JR. The IGF1-PI3K-Akt Signaling Pathway in Mediating Exercise-Induced Cardiac Hypertrophy and Protection. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1000:187-210. [PMID: 29098623 DOI: 10.1007/978-981-10-4304-8_12] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Regular physical activity or exercise training can lead to heart enlargement known as cardiac hypertrophy. Cardiac hypertrophy is broadly defined as an increase in heart mass. In adults, cardiac hypertrophy is often considered a poor prognostic sign because it often progresses to heart failure. Heart enlargement in a setting of cardiac disease is referred to as pathological cardiac hypertrophy and is typically characterized by cell death and depressed cardiac function. By contrast, physiological cardiac hypertrophy, as occurs in response to chronic exercise training (i.e. the 'athlete's heart'), is associated with normal or enhanced cardiac function. The following chapter describes the morphologically distinct types of heart growth, and the key role of the insulin-like growth factor 1 (IGF1) - phosphoinositide 3-kinase (PI3K)-Akt signaling pathway in regulating exercise-induced physiological cardiac hypertrophy and cardiac protection. Finally we summarize therapeutic approaches that target the IGF1-PI3K-Akt signaling pathway which are showing promise in preclinical models of heart disease.
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Affiliation(s)
- Kate L Weeks
- Baker Heart & Diabetes Institute, P.O. Box 6492, Melbourne, VIC, 3004, Australia.
| | - Bianca C Bernardo
- Baker Heart & Diabetes Institute, P.O. Box 6492, Melbourne, VIC, 3004, Australia
| | - Jenny Y Y Ooi
- Baker Heart & Diabetes Institute, P.O. Box 6492, Melbourne, VIC, 3004, Australia
| | - Natalie L Patterson
- Baker Heart & Diabetes Institute, P.O. Box 6492, Melbourne, VIC, 3004, Australia
| | - Julie R McMullen
- Baker Heart & Diabetes Institute, P.O. Box 6492, Melbourne, VIC, 3004, Australia.
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Iyngkaran P, Liew D, McDonald P, Thomas MC, Reid C, Chew D, Hare DL. Phase 4 Studies in Heart Failure - What is Done and What is Needed? Curr Cardiol Rev 2016; 12:216-30. [PMID: 27280303 PMCID: PMC5011189 DOI: 10.2174/1573403x12666160606121458] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/18/2015] [Accepted: 01/11/2016] [Indexed: 02/07/2023] Open
Abstract
Congestive heart failure (CHF) therapeutics is generated through a well-described evidence generating process. Phases 1 - 3 of this process are required prior to approval and widespread clinical use. Phase 3 in almost all cases is a methodologically sound randomized controlled trial (RCT). After this phase it is generally accepted that the treatment has a significant, independent and prognostically beneficial effect on the pathophysiological process. A major criticism of RCTs is the population to whom the result is applicable. When this population is significantly different from the trial cohort the external validity comes into question. Should the continuation of the evidence generating process continue these problems might be identified. Post marketing surveillance through phase 4 and comparative effectiveness studies through phase 5 trials are often underperformed in comparison to the RCT. These processes can help identify remote adverse events and define new hypotheses for community level benefits. This review is aimed at exploring the post-marketing scene for CHF therapeutics from an Australian health system perspective. We explore the phases of clinical trials, the level of evidence currently available and options for ensuring greater accountability for community level CHF clinical outcomes.
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Affiliation(s)
- Pupalan Iyngkaran
- Cardiologist & Senior Lecturer NT Medical School, Flinders University, Australia.
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10
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Iyngkaran P, Kangaharan N, Zimmet H, Arstall M, Minson R, Thomas MC, Bergin P, Atherton J, MacDonald P, Hare DL, Horowitz JD, Ilton M. Heart Failure in Minority Populations - Impediments to Optimal Treatment in Australian Aborigines. Curr Cardiol Rev 2016; 12:166-79. [PMID: 27280307 PMCID: PMC5011191 DOI: 10.2174/1573403x12666160606115034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/18/2015] [Accepted: 01/11/2016] [Indexed: 01/30/2023] Open
Abstract
Chronic heart failure (CHF) among Aboriginal/Indigenous Australians is endemic. There are also grave concerns for outcomes once acquired. This point is compounded by a lack of prospective and objective studies to plan care. To capture the essence of the presented topic it is essential to broadly understand Indigenous health. Key words such as ‘worsening’, ‘gaps’, ‘need to do more’, ‘poorly studied’, or ‘future studies should inform’ occur frequently in contrast to CHF research for almost all other groups. This narrative styled opinion piece attempts to discuss future directions for CHF care for Indigenous Australians. We provide a synopsis of the problem, highlight the treatment gaps, and define the impediments that present hurdles in optimising CHF care for Indigenous Australians.
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Affiliation(s)
- Pupalan Iyngkaran
- Cardiologist and Senior Lecturer NT Medical School, Flinders University, Tiwi, NT 0811, Australia.
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Chan YK, Tuttle C, Ball J, Teng THK, Ahamed Y, Carrington MJ, Stewart S. Current and projected burden of heart failure in the Australian adult population: a substantive but still ill-defined major health issue. BMC Health Serv Res 2016; 16:501. [PMID: 27654659 PMCID: PMC5031369 DOI: 10.1186/s12913-016-1748-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 06/18/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Comprehensive epidemiological data to describe the burden of heart failure (HF) in Australia remain lacking despite its importance as a major health issue. Herewith, we estimate the current and future burden of HF in Australia using best available data. METHODS Australian-specific and the most congruent international epidemiological and health utilisation data were applied to the Australian population (adults aged ≥ 45 years, 8.9 of 22.7 million total population in 2014) on an age and sex-specific basis. We estimated the current incident and prevalent cases of clinically overt/symptomatic HF (predominately those with reduced ejection fraction), hospital activity (diagnosis of HF as a primary or secondary reason for admission) and health care costs in 2014 and future prevalence and burden of HF projected to 2030. RESULTS We estimated that over 61,000 (6.9 per 1000 person-years) adult Australians aged ≥ 45 years (58 % women) are diagnosed with HF with clinically overt signs and symptoms every year. On a conservative basis, 480,000 (6.3 %, 95 % CI 2.6 to 10.0 %) Australians (66 % men) are now affected by the syndrome with > 150,000 hospitalisations in excess of 1 million days in hospital per annum. The annual cost of managing HF in the community is approximately $900 million and nearly $2.7 billion ($1.5 versus $1.2 billion, men versus women) when considering the additional cost of in-patient care. We predict that the prevalence and future burden of HF will continue to increase over the next 10-15 years to nearly 750,000 people with an estimated annual health care cost of $3.8 billion. CONCLUSIONS Australia is not immune to the growing magnitude and implications of a sustained epidemic of HF in an ageing population. However, its public health and economic burden will remain ill-defined until more definitive Australian-specific data are generated.
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Affiliation(s)
- Yih-Kai Chan
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Camilla Tuttle
- Baker IDI Central Australia, Alice Springs, Northern Territory, 0870, Australia
| | - Jocasta Ball
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Tiew-Hwa Katherine Teng
- Western Australian Centre for Rural Health, University of Western Australia, Perth, Australia
| | - Yasmin Ahamed
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Melinda Jane Carrington
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Simon Stewart
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia.
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12
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Wong CC, Ng AC, Kritharides L, Sindone AP. Iron Deficiency in Heart Failure: Looking Beyond Anaemia. Heart Lung Circ 2016; 25:209-16. [DOI: 10.1016/j.hlc.2015.06.827] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/14/2015] [Indexed: 12/30/2022]
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13
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Sahle BW, Owen AJ, Mutowo MP, Krum H, Reid CM. Prevalence of heart failure in Australia: a systematic review. BMC Cardiovasc Disord 2016; 16:32. [PMID: 26852410 PMCID: PMC4744379 DOI: 10.1186/s12872-016-0208-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the absence of a systematic collection of data pertaining to heart failure, summarizing the data available from individual studies provides an opportunity to estimate the burden of heart failure. The present study systematically reviewed the literature to estimate the incidence and prevalence rates of heart failure in Australia. METHODS Studies reporting on prevalence or incidence of heart failure published between 1990 and 2015 were identified through a systematic search of Embase, PubMed, Ovid Medline, MeSH, Scopus and websites of the Australian Institute of Health, and Welfare and Australian Bureau of Statistics. RESULTS The search yielded a total of 4978 records, of which thirteen met the inclusion criteria. There were no studies reporting on the incidence of heart failure. The prevalence of heart failure in the Australian population ranged between 1.0% and 2.0%, with a significant proportion of cases being previously undiagnosed. The burden of heart failure was higher among Indigenous than non-Indigenous Australians (age-standardized prevalence rate ratio of 1.7). Heart failure was prevalent in women than men, and in rural and remote regions than in the metropolitan and capital territories. CONCLUSION This systematic review highlights the limited available data on the epidemiology of heart failure in Australia. Population level studies, using standardized approaches, are needed in order to precisely describe the burden of HF in the population.
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Affiliation(s)
- Berhe W Sahle
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Vic, 3004, Australia.
- School of Public Health, Mekelle University, Mekelle, Ethiopia.
| | - Alice J Owen
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Vic, 3004, Australia.
| | - Mutsa P Mutowo
- School of Public Health, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Henry Krum
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Vic, 3004, Australia.
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Vic, 3004, Australia.
- School of Public Health, Curtin University, Perth, Australia.
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Chang S, Davidson PM, Newton PJ, Macdonald P, Carrington MJ, Marwick TH, Horowitz JD, Krum H, Reid CM, Chan YK, Scuffham PA, Sibbritt D, Stewart S. Composite outcome measures in a pragmatic clinical trial of chronic heart failure management: A comparative assessment. Int J Cardiol 2015; 185:62-8. [PMID: 25791092 DOI: 10.1016/j.ijcard.2015.03.071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/03/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND A number of composite outcomes have been developed to capture the perspective of the patient, clinician and objective measures of health in assessing heart failure outcomes. To date there has been a limited examination in the composition of these outcomes. METHODS AND RESULTS Three commonly used scoring systems in heart failure trials: Packer's composite, Patient Journey and the African American Heart Failure Trial (A-HeFT) scores were compared in assessing outcomes from the Which heart failure intervention is most cost-effective & consumer friendly in reducing hospital care (WHICH(?)) Trial. Comparability and interpretability of these outcomes and the influence of each component to the final outcome were examined. Despite all three composite outcomes incorporating mortality, hospitalisation and quality of life (QoL), the contribution of each individual component to the final outcomes differed. The component with the most influence in deteriorating condition for the Packer's composite was hospitalisation (67.7%), while in Patient Journey it was QoL (61.5%) and for A-HeFT composite score it was mortality (45.4%). CONCLUSIONS The contribution made by each component varied in subtle, but important ways. This study emphasises the importance of understanding the value system of the composite outcomes to enable meaningful interpretation of results.
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Affiliation(s)
| | | | | | - Peter Macdonald
- St Vincent's Hospital and Victor Chang Cardiac Research Institute, Sydney, Australia
| | | | | | | | - Henry Krum
- Monash Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Australia
| | - Christopher M Reid
- Monash Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Australia
| | - Yih Kai Chan
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Paul A Scuffham
- Griffith Health Institute, Griffith University, Logan, Australia
| | | | - Simon Stewart
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Hayward C, Jansz P. Mechanical circulatory support for the failing heart – progress, pitfalls and promises. Heart Lung Circ 2015; 24:527-31. [PMID: 25797325 DOI: 10.1016/j.hlc.2015.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Christopher Hayward
- Heart Failure and Transplant Unit, St Vincent's Hospital and Victor Chang Cardiac Research Institute, Sydney.
| | - Paul Jansz
- Heart Failure and Transplant Unit, St Vincent's Hospital and Victor Chang Cardiac Research Institute, Sydney
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Are all outcomes in chronic heart failure rated equally? An argument for a patient-centred approach to outcome assessment. Heart Fail Rev 2014; 19:153-62. [PMID: 23238990 DOI: 10.1007/s10741-012-9369-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Chronic heart failure (CHF) is a multi-dimensional and complex syndrome. Outcome measures are important for determining both the efficacy and quality of care and capturing the patient's perspective in evaluating the outcomes of health care delivery. Capturing the patient's perspective via patient-reported outcomes is increasingly important; however, including objective measures such as mortality would provide more complete account of outcomes important to patients. Currently, no single measure for CHF outcomes captures all dimensions of the quality of care from the patient's perspective. To describe the role of outcome measures in CHF from the perspective of patients, a structured literature review was undertaken. This review discusses the concepts and methodological issues related to measurement of CHF outcomes. Outcome assessment at the level of the patient, provider and health care system were identified as being important. The perspectives of all stakeholders should be considered when developing an outcomes measurement suite to inform CHF health care. This paper recommends that choice of outcome measures should depend on their ability to provide a comprehensive, comparable, meaningful and accurate assessment that are important to patient.
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Inglis SC, Clark RA, Shakib S, Wong DT, Molaee P, Wilkinson D, Stewart S. Hot summers and heart failure: Seasonal variations in morbidity and mortality in Australian heart failure patients (1994-2005). Eur J Heart Fail 2014; 10:540-9. [DOI: 10.1016/j.ejheart.2008.03.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 02/29/2008] [Accepted: 03/26/2008] [Indexed: 10/22/2022] Open
Affiliation(s)
- Sally C. Inglis
- Schools of Medicine and Nursing; University of Queensland; Brisbane Australia
| | - Robyn A. Clark
- Department of Clinical Pharmacology; Royal Adelaide Hospital and Faculty of Health Sciences, University of South Australia; Adelaide Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology; Royal Adelaide Hospital; Adelaide Australia
| | - Denis T. Wong
- Department of Cardiology; Royal Adelaide Hospital; Adelaide Australia
| | - Payman Molaee
- Cardiovascular Research Centre, Royal Adelaide Hospital; Adelaide Australia
| | - David Wilkinson
- School of Medicine, University of Queensland; Brisbane Australia
| | - Simon Stewart
- Preventative Cardiology, Baker Heart Research Institute; Melbourne Australia
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Corcoran KJ, Jowsey T, Leeder SR. One size does not fit all: the different experiences of those with chronic heart failure, type 2 diabetes and chronic obstructive pulmonary disease. AUST HEALTH REV 2013; 37:19-25. [PMID: 23158955 DOI: 10.1071/ah11092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 02/12/2012] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The Australian federal government is developing a policy response to chronic disease in Australia. The Serious and Continuing Illness Policy and Practice Study examined the experience of individuals with chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) or type 2 diabetes mellitus (diabetes) in the Australian Capital Territory (ACT) and Western Sydney. This paper describes the disease-specific experiences of people interviewed. METHODS We conducted semi-structured interviews with 40 individuals aged 45-85 years with CHF, COPD or diabetes in 2008. Interviews were recorded and transcribed. Qualitative content analysis was performed, assisted by QSR Nvivo 8 qualitative data software. RESULTS Participants with CHF (n=9) came to terms with the prospect of unpredictable sudden death. Participants with COPD (n=15) were angry about limitations it imposed on their lives. Participants with diabetes (n=16) experienced a steep learning curve in self-management of their condition surrounded by high levels of uncertainty. CONCLUSION Although people with chronic illness share many experiences, a person's overall experience of living with chronic illness is significantly shaped by the nature of their specific dominant disease. Policies for patient-centred care must take account of both generic and disease-specific elements.
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Robertson J, McElduff P, Pearson SA, Henry DA, Inder KJ, Attia JR. The health services burden of heart failure: an analysis using linked population health data-sets. BMC Health Serv Res 2012; 12:103. [PMID: 22533631 PMCID: PMC3413515 DOI: 10.1186/1472-6963-12-103] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 04/25/2012] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The burden of patients with heart failure on health care systems is widely recognised, although there have been few attempts to quantify individual patterns of care and differences in health service utilisation related to age, socio-economic factors and the presence of co-morbidities. The aim of this study was to assess the typical profile, trajectory and resource use of a cohort of Australian patients with heart failure using linked population-based, patient-level data. METHODS Using hospital separations (Admitted Patient Data Collection) with death registrations (Registry of Births, Deaths and Marriages) for the period 2000-2007 we estimated age- and gender-specific rates of index admissions and readmissions, risk factors for hospital readmission, mean length of stay (LOS), median survival and bed-days occupied by patients with heart failure in New South Wales, Australia. RESULTS We identified 29,161 index admissions for heart failure. Admission rates increased with age, and were higher for males than females for all age groups. Age-standardised rates decreased over time (256.7 to 237.7/100,000 for males and 235.3 to 217.1/100,000 for females from 2002-3 to 2006-7; p = 0.0073 adjusted for gender). Readmission rates (any cause) were 27% and 73% at 28-days and one year respectively; readmission rates for heart failure were 11% and 32% respectively. All cause mortality was 10% and 28% at 28 days and one year. Increasing age was associated with more heart failure readmissions, longer LOS and shorter median survival. Increasing age, increasing Charlson comorbidity score and male gender were risk factors for hospital readmission. Cohort members occupied 954,888 hospital bed-days during the study period (any cause); 383,646 bed-days were attributed to heart failure admissions. CONCLUSIONS The rates of index admissions for heart failure decreased significantly in both males and females over the study period. However, the impact on acute care hospital beds was substantial, with heart failure patients occupying almost 200,000 bed-days per year in NSW over the five year study period. The strong age-related trends highlight the importance of stabilising elderly patients before discharge and community-based outreach programs to better manage heart failure and reduce readmissions.
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Affiliation(s)
- Jane Robertson
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
- Clinical Pharmacology, Calvary Mater Hospital, The University of Newcastle, Clinical Sciences Building, Waratah, NSW, 2298, Australia
| | - Patrick McElduff
- Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - Sallie-Anne Pearson
- UNSW Cancer Research Centre, University of New South Wales and Prince of Wales Clinical School, Sydney, Australia
| | - David A Henry
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
- Institute for Clinical Evaluative Sciences and Department of Medicine, University of Toronto, Toronto, Canada
| | - Kerry J Inder
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - John R Attia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
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Effects of Treatment on Exercise Tolerance, Cardiac Function, and Mortality in Heart Failure With Preserved Ejection Fraction. J Am Coll Cardiol 2011; 57:1676-86. [DOI: 10.1016/j.jacc.2010.10.057] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Revised: 10/19/2010] [Accepted: 10/28/2010] [Indexed: 11/23/2022]
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Teng THK, Hung J, Finn J. The effect of evidence-based medication use on long-term survival in patients hospitalised for heart failure in Western Australia. Med J Aust 2010; 192:306-10. [PMID: 20230346 DOI: 10.5694/j.1326-5377.2010.tb03528.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Accepted: 09/15/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine trends and predictors of prescription medications on discharge after first (index) hospitalisation for heart failure (HF), and the effect on all-cause mortality of evidence-based therapy. DESIGN A retrospective multicentre cohort study, with medical record review. SETTING Three tertiary-care hospitals in Perth, Western Australia. PATIENTS WA Hospital Morbidity Data were used to identify a random sample of 1006 patients with an index admission to hospital for HF between 1996 and 2006. MAIN OUTCOME MEASURES Proportion of patients prescribed evidence-based therapy for HF on discharge from hospital; and 1-year all-cause mortality. RESULTS Among 944 patients surviving to hospital discharge, the prescription rate of angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) (74.3%) and loop diuretics (85.5%) remained high over the study period, whereas that of beta-blockers and spironolactone increased (10.5% to 51.3% and 1.4% to 23.3%, respectively), and digoxin prescription decreased (38.1% to 20.7%). The temporal trends in use of beta-blockers, spironolactone and digoxin were in line with clinical trial evidence. Age > or = 75 years was a significant, negative predictor of beta-blocker and spironolactone prescription. In-hospital echocardiography, performed in 53% of patients, was associated with a significantly greater likelihood of treatment with ACE inhibitors/ARBs, beta-blockers and spironolactone. Both ACE inhibitors/ARBs and beta-blockers prescribed on discharge were associated with a lower adjusted hazard ratio (HR) for mortality at 1-year (HR, 0.71; P = 0.003; and HR, 0.68; P = 0.002, respectively). CONCLUSION ACE inhibitors/ARBs and beta-blockers, prescribed during initial hospitalisation for HF, are associated with improved long-term survival. Therapy became more evidence based over the study period, but echocardiography, an important predictor of evidence-based therapy, was underutilised.
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Selig SE, Levinger I, Williams AD, Smart N, Holland DJ, Maiorana A, Green DJ, Hare DL. Exercise & Sports Science Australia Position Statement on exercise training and chronic heart failure. J Sci Med Sport 2010; 13:288-94. [DOI: 10.1016/j.jsams.2010.01.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 01/18/2010] [Accepted: 01/19/2010] [Indexed: 12/31/2022]
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Cameron J, Worrall-Carter L, Page K, Riegel B, Lo SK, Stewart S. Does cognitive impairment predict poor self-care in patients with heart failure? Eur J Heart Fail 2010; 12:508-15. [PMID: 20354031 DOI: 10.1093/eurjhf/hfq042] [Citation(s) in RCA: 206] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Cognitive impairment occurs often in patients with chronic heart failure (CHF) and may contribute to sub-optimal self-care. This study aimed to test the impact of cognitive impairment on self-care. METHODS AND RESULTS In 93 consecutive patients hospitalized with CHF, self-care (Self-Care of Heart Failure Index) was assessed. Multiple regression analysis was used to test a model of variables hypothesized to predict self-care maintenance, management, and confidence. Variables in the model were mild cognitive impairment (MCI; Mini-Mental State Exam and Montreal Cognitive Assessment), depressive symptoms (Cardiac Depression Scale), age, gender, social isolation, education level, new diagnosis, and co-morbid illnesses. Sixty-eight patients (75%) were coded as having MCI and had significantly lower self-care management (eta(2)= 0.07, P < 0.01) and self-confidence scores (eta(2)= 0.05, P < 0.05). In multivariate analysis, MCI, co-morbidity index, and NYHA class III or IV explained 20% of the variance in self-care management (P < 0.01); MCI made the largest contribution explaining 9% of the variance. Increasing age and symptoms of depression explained 13% of the variance in self-care confidence scores (P < 0.01). CONCLUSION Cognitive impairment, a hidden co-morbidity, may impede patients' ability to make appropriate self-care decisions. Screening for MCI may alert health professionals to those at greater risk of failed self-care.
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Affiliation(s)
- Jan Cameron
- School of Nursing & Midwifery (Victoria), Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia.
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Riegel B, Driscoll A, Suwanno J, Moser DK, Lennie TA, Chung ML, Wu JR, Dickson VV, Carlson B, Cameron J. Heart failure self-care in developed and developing countries. J Card Fail 2009; 15:508-16. [PMID: 19643362 PMCID: PMC2745342 DOI: 10.1016/j.cardfail.2009.01.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 01/21/2009] [Accepted: 01/26/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heart failure (HF) self-care is poor in developed countries like the United States, but little is known about self-care in developing countries. METHODS AND RESULTS A total of 2082 adults from 2 developed (United States and Australia) and 2 developing countries (Thailand and Mexico) were studied in a descriptive, comparative study. Self-care was measured using the Self-Care of HF Index, which provided scores on self-care maintenance, management, and confidence. Data were analyzed using regression analysis after demographic (age, gender, education), clinical (functional status, experience with the diagnosis, comorbid conditions), and setting of enrollment (hospital or clinic) differences were controlled. When adequate self-care was defined as a standardized score >or=70%, self-care was inadequate in most scales in most groups. Self-care maintenance was highest in the Australian sample and lowest in the Thai sample (P < .001). Self-care management was highest in the US sample and lowest in the Thai sample (P < .001). Self-care confidence was highest in the Mexican sample and lowest in the Thai sample (P < .001). Determinants differed for the three types of self-care (eg, experience with HF was associated only with self-care maintenance). CONCLUSION Interventions aimed at improving self-care are greatly needed in both the developed and the developing countries studied.
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Affiliation(s)
- Barbara Riegel
- University of Pennsylvania School of Nursing, Philadelphia, PA 19104-4217, USA.
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25
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Newton PJ, Betihavas V, Macdonald P. The role of b-type natriuretic peptide in heart failure management. Aust Crit Care 2009; 22:117-23. [DOI: 10.1016/j.aucc.2009.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 06/04/2009] [Indexed: 10/20/2022] Open
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Davidson PM, Stewart S. Heart failure nursing in Australia: Past, present and future. Aust Crit Care 2009; 22:108-10. [DOI: 10.1016/j.aucc.2009.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Accepted: 06/22/2009] [Indexed: 11/16/2022] Open
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Clark RA, Driscoll A. Access and quality of heart failure management programs in Australia. Aust Crit Care 2009; 22:111-6. [PMID: 19586780 DOI: 10.1016/j.aucc.2009.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 06/04/2009] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/AIM In response to the high burden of disease associated with chronic heart failure (CHF), in particular the high rates of hospital admissions, dedicated CHF management programs (CHF-MP) have been developed. Over the past five years there has been a rapid growth of CHF-MPs in Australia. Given the apparent mismatch between the demand for, and availability of CHF-MPs, this paper has been designed to discuss the accessibility to and quality of current CHF-MPs in Australia. METHODS The data presented in this report has been combined from the research of the co-authors, in particular a review of the inequities in access to chronic heart failure which utilised geographical information systems (GIS) and the survey of heterogeneity in quality and service provision in Australian. RESULTS Of the 62 CHF-MPs surveyed in this study 93% (58) centres had been located areas that are rated as Highly Accessible. This result indicated that most of the CHF-MPs have been located in capital cities or large regional cities. Six percent (4 CHF-MPs) had been located in Accessible areas which were country towns or cities. No CHF-MPs had been established outside of cities to service the estimated 72,000 individuals with CHF living in rural and remote areas. 16% of programs recruited NYHA Class I patients and of these 20% lacked confirmation (echocardiogram) of their diagnosis. CONCLUSION Overall, these data highlight the urgent need to provide equitable access to CHF-MP's. When establishing CHF-MPs consideration of current evidence based models to ensure quality in practice.
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Affiliation(s)
- Robyn A Clark
- Sanson Institiute, City East Campus, University of South Australia, Adelaide, SA, Australia.
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Boyde M, Tuckett A, Peters R, Thompson DR, Turner C, Stewart S. Learning style and learning needs of heart failure patients (The Need2Know-HF patient study). Eur J Cardiovasc Nurs 2009; 8:316-22. [PMID: 19520614 DOI: 10.1016/j.ejcnurse.2009.05.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 05/12/2009] [Accepted: 05/15/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Heart failure management programs which include education are the gold standard for management of patients with heart failure. Identifying the learning styles and learning needs of heart failure patients is an essential step in developing effective education strategies within these programs. AIM To investigate the learning style and learning needs of heart failure patients. METHODS Patients diagnosed with heart failure at a large tertiary referral hospital completed a Heart Failure Learning Style and Needs Inventory. RESULTS From the total of 55 patients who completed the questionnaire 64% reported a preference for multimodal learning style, 18% preferred read/write, 11% preferred auditory, and 7% preferred kinesthetic. In relation to educational topics, signs and symptoms was ranked as the most important topic to learn about followed by prognosis. CONCLUSION This study provides a poignant snap-shot into the world of chronic disease. In essence, the patients' educational needs for living with heart failure can be summed up as "Never better, getting worse, unpredictable". The results indicate that these groups of patients need to know (Need2Know) about information regarding their signs and symptoms as well as wanting to elicit the significance of their disease and whether it can be cured.
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Affiliation(s)
- Mary Boyde
- Princess Alexandra Hospital, The University of Queensland, School of Nursing and Midwifery, Second Floor, Building 15, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, QLD 4102, Australia.
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Feasibility of a group-based self-management program among congestive heart failure patients. Heart Lung 2009; 38:499-512. [PMID: 19944874 DOI: 10.1016/j.hrtlng.2009.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 12/30/2008] [Accepted: 01/28/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study assessed the feasibility of the Chronic Disease Self-Management Program (CDSMP) among patients with congestive heart failure (CHF). The program emphasizes patients' central role and responsibility in managing their illness. METHODS Patients were randomly assigned to the program, which was led by a cardiac nurse specialist and a CHF patient. Data on performance according to protocol, adherence, and opinion about the program were collected among 186 patients and 18 leaders. RESULTS Eighty percent of the group sessions were carried out largely according to protocol. Three fourths of the patients attended at least 4 of the 6 sessions. Female sex and lower New York Heart Association classification predicted good attendance. CONCLUSION Directly after the program and at 12-month follow-up, approximately three fourths of the patients stated that they had benefited from the program. Recommendations mainly concerned spending more time on several program topics and specifying patient-selection criteria in more detail. The program was considered feasible.
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Teng THK, Finn J, Hung J, Geelhoed E, Hobbs M. A validation study: how effective is the Hospital Morbidity Data as a surveillance tool for heart failure in Western Australia? Aust N Z J Public Health 2008; 32:405-7. [PMID: 18959540 DOI: 10.1111/j.1753-6405.2008.00269.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the accuracy of the hospital discharge coding of heart failure (HF) in the Western Australian (WA) Hospital Morbidity Data (HMD). METHODS A retrospective medical chart review of a sample of 1,006 patients with a principal diagnosis code indicating HF in the WA HMD was undertaken. Validation was reported against a written diagnosis of HF in the medical chart and using Boston criteria score as a gold standard. RESULTS The positive predictive value (PPV) of the HMD coding of HF as the principal diagnosis was 99.5% when compared to the medical chart diagnosis and 92.4% when compared to the Boston score criteria for 'definite' HF and 98.8% for a combined 'possible' and 'definite' HF Boston score. CONCLUSIONS With the high predictive accuracy, the WA HMD can be used with confidence to monitor trends in the epidemiology of in-hospital HF patients.
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Affiliation(s)
- Tiew-Hwa Katherine Teng
- School of Population Heath, University of Western Australia, Crawley, Western Australia, Australia.
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Barnett AG, de Looper M, Fraser JF. The seasonality in heart failure deaths and total cardiovascular deaths. Aust N Z J Public Health 2008; 32:408-13. [PMID: 18959541 DOI: 10.1111/j.1753-6405.2008.00270.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To examine the seasonal pattern in heart failure (HF) and cardiovascular disease (CVD) by climate and cause of death in Australia. METHODS A retrospective analysis of a national database of deaths in the eight Australian State and Territory capitals between January 1997 and November 2004. We examined the seasonal pattern in HF and CVD deaths, we identified variations in the pattern by: sex, age, time, climate and cause of death (for total CVD using seven groups determined by ICD-10 code). RESULTS Deaths in all seven groups of CVD significantly increased in winter. The largest increase in mortality rates was 23.5% observed for HF. The magnitude of this increase varied greatly between cities, with the lowest winter mortality rates in the coldest (Hobart) and warmest (Darwin) cities. The pattern in CVD deaths showed a clearer correlation with climate than HF deaths. CONCLUSION AND IMPLICATIONS Winters in Australia are mild but winter increases in HF and CVD are a significant problem. Increased blood pressure and lack of vitamin D in winter are the most likely causes of the increase. Reducing exposure to cold, particularly in the elderly, should reduce the number of winter CVD deaths in Australia.
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Affiliation(s)
- Adrian G Barnett
- Institute of Health and Biomedical Innovation and School of Public Health, Queensland University of Technology, Queensland.
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Driscoll A, Currey J, Worrall-Carter L, Stewart S. Ethical dilemmas of a large national multi-centre study in Australia: time for some consistency. J Clin Nurs 2008; 17:2212-20. [PMID: 18705740 DOI: 10.1111/j.1365-2702.2007.02219.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To examine the impact and obstacles that individual Institutional Research Ethics Committee (IRECs) had on a large-scale national multi-centre clinical audit called the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study. BACKGROUND Multi-centre research is commonplace in the health care system. However, IRECs continue to fail to differentiate between research and quality audit projects. METHODS The National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes study used an investigator-developed questionnaire concerning a clinical audit for heart failure programmes throughout Australia. Ethical guidelines developed by the National governing body of health and medical research in Australia classified the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study as a low risk clinical audit not requiring ethical approval by IREC. RESULTS Fifteen of 27 IRECs stipulated that the research proposal undergo full ethical review. None of the IRECs acknowledged: national quality assurance guidelines and recommendations nor ethics approval from other IRECs. Twelve of the 15 IRECs used different ethics application forms. Variability in the type of amendments was prolific. Lack of uniformity in ethical review processes resulted in a six- to eight-month delay in commencing the national study. CONCLUSIONS Development of a national ethics application form with full ethical review by the first IREC and compulsory expedited review by subsequent IRECs would resolve issues raised in this paper. IRECs must change their ethics approval processes to one that enhances facilitation of multi-centre research which is now normative process for health services. RELEVANCE TO CLINICAL PRACTICE The findings of this study highlight inconsistent ethical requirements between different IRECs. Also highlighted are the obstacles and delays that IRECs create when undertaking multi-centre clinical audits. However, in our clinical practice it is vital that clinical audits are undertaken for evaluation purposes. The findings of this study raise awareness of inconsistent ethical processes and highlight the need for expedient ethical review for clinical audits.
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Affiliation(s)
- Andrea Driscoll
- Department of Epidemiology and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
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Esmore DS, Kaye D, Salamonsen R, Buckland M, Begg JR, Negri J, Ayre P, Woodard J, Rosenfeldt FL. Initial clinical experience with the VentrAssist left ventricular assist device: the pilot trial. J Heart Lung Transplant 2008; 27:479-85. [PMID: 18442712 DOI: 10.1016/j.healun.2008.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Revised: 01/31/2008] [Accepted: 02/06/2008] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The VentrAssist (VA) is a novel, continuous flow left ventricular assist device (LVAD). The purpose of this trial was to investigate the safety and efficacy of the VA in elderly patients with end-stage heart failure. METHODS In this prospective trial, patients requiring circulatory support either as destination therapy (DT) or as a bridge to transplant (BTT) were implanted with a VA device. RESULTS Between June 2003 and August 2006, 9 elderly patients (mean age 65 years) were implanted. The median support time was 454 (range 73 to 977) days for the DT and 35 (range 26 to 508) days for the BTT cohort. All patients survived implantation; 30-day mortality was 22% (n = 2). The adverse event profile was encouraging, with no embolic neurologic events and minimal sepsis. Cumulative trial support time was 7.3 patient-years. CONCLUSIONS The VentrAssist shows promise as a safe and reliable "third-generation" VAD. Having demonstrated potential as a DT and prolonged BTT device, extended clinical trials are warranted.
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Affiliation(s)
- Donald S Esmore
- Department of Cardiothoracic Surgery, Alfred Hospital, Prahran, Victoria, Australia.
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Clark RA, Yallop JJ, Piterman L, Croucher J, Tonkin A, Stewart S, Krum H. Adherence, adaptation and acceptance of elderly chronic heart failure patients to receiving healthcare via telephone-monitoring. Eur J Heart Fail 2007; 9:1104-11. [DOI: 10.1016/j.ejheart.2007.07.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Revised: 05/27/2007] [Accepted: 07/16/2007] [Indexed: 10/22/2022] Open
Affiliation(s)
- Robyn A. Clark
- National Heart Foundation South Australian Branch; Australia
- Faculty of Health Sciences; University of South Australia; Australia
| | - Julie J. Yallop
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences; Monash University; Prahran Victoria Australia
- Department of General Practice & Primary Health Care; The University of Auckland; New Zealand
| | - Leon Piterman
- School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences; Monash University; East Bentleigh Vic Australia
| | - Joanne Croucher
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences; Monash University; Prahran Victoria Australia
| | - Andrew Tonkin
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences; Monash University; Prahran Victoria Australia
| | - Simon Stewart
- Department of Preventative Cardiology; Baker Heart Research Institute; Prahran Victoria Australia
| | - Henry Krum
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences; Monash University; Prahran Victoria Australia
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McMullen JR, Jennings GL. Differences between pathological and physiological cardiac hypertrophy: novel therapeutic strategies to treat heart failure. Clin Exp Pharmacol Physiol 2007; 34:255-62. [PMID: 17324134 DOI: 10.1111/j.1440-1681.2007.04585.x] [Citation(s) in RCA: 245] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
1. In general, cardiac hypertrophy (an increase in heart mass) is a poor prognostic sign. Cardiac enlargement is a characteristic of most forms of heart failure. Cardiac hypertrophy that occurs in athletes (physiological hypertrophy) is a notable exception. 2. Physiological cardiac hypertrophy in response to exercise training differs in its structural and molecular profile to pathological hypertrophy associated with pressure or volume overload in disease. Physiological hypertrophy is characterized by normal organization of cardiac structure and normal or enhanced cardiac function, whereas pathological hypertrophy is commonly associated with upregulation of fetal genes, fibrosis, cardiac dysfunction and increased mortality. 3. It is now clear that several signalling molecules play unique roles in the regulation of pathological and physiological cardiac hypertrophy. 4. The present review discusses the possibility of targeting cardioprotective signalling pathways and genes activated in the athlete's heart to treat or prevent heart failure.
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Affiliation(s)
- Julie R McMullen
- Baker Heart Research Institute, Melbourne, Victoria 8008, Australia.
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Clark RA, Eckert KA, Stewart S, Phillips SM, Yallop JJ, Tonkin AM, Krum H. Rural and urban differentials in primary care management of chronic heart failure: new data from the CASE study. Med J Aust 2007; 186:441-5. [PMID: 17484704 DOI: 10.5694/j.1326-5377.2007.tb00993.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 12/11/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether primary care management of chronic heart failure (CHF) differed between rural and urban areas in Australia. DESIGN A cross-sectional survey stratified by Rural, Remote and Metropolitan Areas (RRMA) classification. The primary source of data was the Cardiac Awareness Survey and Evaluation (CASE) study. SETTING Secondary analysis of data obtained from 341 Australian general practitioners and 23 845 adults aged 60 years or more in 1998. MAIN OUTCOME MEASURES CHF determined by criteria recommended by the World Health Organization, diagnostic practices, use of pharmacotherapy, and CHF-related hospital admissions in the 12 months before the study. RESULTS There was a significantly higher prevalence of CHF among general practice patients in large and small rural towns (16.1%) compared with capital city and metropolitan areas (12.4%) (P < 0.001). Echocardiography was used less often for diagnosis in rural towns compared with metropolitan areas (52.0% v 67.3%, P < 0.001). Rates of specialist referral were also significantly lower in rural towns than in metropolitan areas (59.1% v 69.6%, P < 0.001), as were prescribing rates of angiotensin-converting enzyme inhibitors (51.4% v 60.1%, P < 0.001). There was no geographical variation in prescribing rates of beta-blockers (12.6% [rural] v 11.8% [metropolitan], P = 0.32). Overall, few survey participants received recommended "evidence-based practice" diagnosis and management for CHF (metropolitan, 4.6%; rural, 3.9%; and remote areas, 3.7%). CONCLUSIONS This study found a higher prevalence of CHF, and significantly lower use of recommended diagnostic methods and pharmacological treatment among patients in rural areas.
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Affiliation(s)
- Robyn A Clark
- Faculty of Health Sciences, University of South Australia, Adelaide, SA, Australia
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Cameron J, Worrall-Carteris L, Driscoll A, New G, Stewart S. Extent of heart failure self-care as an endpoint to patient education: A literature review. ACTA ACUST UNITED AC 2007. [DOI: 10.12968/bjca.2007.2.4.23455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jan Cameron
- School of Nursing, Deakin University, Melbourne, Australia
| | | | | | - Gishel New
- Box Hill Hospital and Associate Professor of Medicine, Monash University, Melbourne Australia
| | - Simon Stewart
- Baker Heart Research Institute, Melbourne, Australia
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Clark RA, Driscoll A, Nottage J, McLennan S, Coombe DM, Bamford EJ, Wilkinson D, Stewart S. Inequitable provision of optimal services for patients with chronic heart failure: a national geo-mapping study. Med J Aust 2007; 186:169-73. [PMID: 17309416 DOI: 10.5694/j.1326-5377.2007.tb00855.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Accepted: 12/05/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the location and accessibility of current Australian chronic heart failure (CHF) management programs and general practice services with the probable distribution of the population with CHF. DESIGN AND SETTING Data on the prevalence and distribution of the CHF population throughout Australia, and the locations of CHF management programs and general practice services from 1 January 2004 to 31 December 2005 were analysed using geographic information systems (GIS) technology. OUTCOME MEASURES Distance of populations with CHF to CHF management programs and general practice services. RESULTS The highest prevalence of CHF (20.3-79.8 per 1000 population) occurred in areas with high concentrations of people over 65 years of age and in areas with higher proportions of Indigenous people. Five thousand CHF patients (8%) discharged from hospital in 2004-2005 were managed in one of the 62 identified CHF management programs. There were no CHF management programs in the Northern Territory or Tasmania. Only four CHF management programs were located outside major cities, with a total case load of 80 patients (0.7%). The mean distance from any Australian population centre to the nearest CHF management program was 332 km (median, 163 km; range, 0.15-3246 km). In rural areas, where the burden of CHF management falls upon general practitioners, the mean distance to general practice services was 37 km (median, 20 km; range, 0-656 km). CONCLUSION There is an inequity in the provision of CHF management programs to rural Australians.
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Affiliation(s)
- Robyn A Clark
- Faculty of Health Sciences, University of South Australia, Adelaide, SA.
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Fatkin D. Guidelines for the Diagnosis and Management of Familial Dilated Cardiomyopathy. Heart Lung Circ 2007; 16:19-21. [PMID: 17188933 DOI: 10.1016/j.hlc.2006.10.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Accepted: 10/25/2006] [Indexed: 11/20/2022]
Affiliation(s)
- Diane Fatkin
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia.
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Krum H, Jelinek MV, Stewart S, Sindone A, Atherton JJ, Hawkes AL. Guidelines for the prevention, detection and management of people with chronic heart failure in Australia 2006. Med J Aust 2007; 185:549-57. [PMID: 17115967 DOI: 10.5694/j.1326-5377.2006.tb00690.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2006] [Accepted: 09/26/2006] [Indexed: 11/17/2022]
Abstract
Chronic heart failure (CHF) is found in 1.5%-2.0% of Australians. Considered rare in people aged less than 45 years, its prevalence increases to over 10% in people aged >/= 65 years. CHF is one of the most common reasons for hospital admission and general practitioner consultation in the elderly (>/= 70 years). Common causes of CHF are ischaemic heart disease (present in > 50% of new cases), hypertension (about two-thirds of cases) and idiopathic dilated cardiomyopathy (around 5%-10% of cases). Diagnosis is based on clinical features, chest x-ray and objective measurement of ventricular function (eg, echocardiography). Plasma levels of B-type natriuretic peptide (BNP) may have a role in diagnosis, primarily as a test for exclusion. Diagnosis may be strengthened by a beneficial clinical response to treatment(s) directed towards amelioration of symptoms. Management involves prevention, early detection, amelioration of disease progression, relief of symptoms, minimisation of exacerbations, and prolongation of survival.
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Affiliation(s)
- Henry Krum
- NHMRC Centre of Clinical Research Excellence in Therapeutics, Department of Epidemiology and Preventive Medicine, and Department of Medicine, Monash University, Alfred Hospital, Melbourne, VIC, Australia
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McLean AS, Eslick GD, Coats AJS. The epidemiology of heart failure in Australia. Int J Cardiol 2006; 118:370-4. [PMID: 17046084 DOI: 10.1016/j.ijcard.2006.07.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 07/13/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND The epidemiology of heart failure is poorly understood. Australia has one of the highest rates of cardiovascular disease in the world with heart failure representing a large proportion of this group, yet there is minimal data on the incidence or prevalence. AIMS To determine the epidemiological impact of heart failure in Australia by assessing mortality and morbidity data. METHODS Data were obtained from National and State health organisations in terms of morbidity and mortality of heart failure. Data were obtained from several sources so as to provide a comprehensive picture of the available epidemiological data on heart failure. RESULTS The mortality rates associated with heart failure have been decreasing substantially over the last 20 years. However, there appears to be a stabilisation of heart failure presentations over the last decade, both nationally and in the state of New South Wales. Extrapolation of the data to assess prevalence of heart failure in the community was not possible. CONCLUSIONS Currently, mortality rates for heart failure are decreasing in Australia, while there does not appear to be any real increase in the numbers of patients admitted to hospital with a subsequent diagnosis of heart failure over a 10 year period.
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Affiliation(s)
- Anthony S McLean
- Department of Intensive Care Medicine, Nepean Hospital, The University of Sydney, Penrith, New South Wales, Australia
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Smeulders ESTF, van Haastregt JCM, van Hoef EFM, van Eijk JT, Kempen GIJM. Evaluation of a self-management programme for congestive heart failure patients: design of a randomised controlled trial. BMC Health Serv Res 2006; 6:91. [PMID: 16857049 PMCID: PMC1569834 DOI: 10.1186/1472-6963-6-91] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2006] [Accepted: 07/20/2006] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Congestive heart failure (CHF) has a substantial impact on care utilisation and quality of life. It is crucial for patients to cope with CHF adequately, if they are to live an acceptable life. Self-management may play an important role in this regard. Previous studies have shown the effectiveness of the 'Chronic Disease Self-Management Program' (CDSMP), a group-based cognitive behavioural programme for patients with various chronic conditions. However, the programme's effectiveness has not yet been studied specifically among CHF patients. This paper presents the design of a randomised controlled trial to evaluate the effects of the CDSMP on psychosocial attributes, health behaviour, quality of life, and health care utilisation of CHF patients. METHODS/DESIGN The programme is being evaluated in a two-group randomised controlled trial. Patients were eligible if they had been diagnosed with CHF and experienced slight to marked limitation of physical activity. They were selected from the Heart Failure and/or Cardiology Outpatient Clinics of six hospitals. Eligible patients underwent a baseline assessment and were subsequently allocated to the intervention or control group. Patients allocated to the intervention group were invited to attend the self-management programme consisting of six weekly sessions, led by a CHF nurse specialist and a CHF patient. Those allocated to the control group received care as usual. Follow-up measurements are being carried out immediately after the intervention period, and six and twelve months after the start of the intervention. An effect evaluation and a process evaluation are being conducted. The primary outcomes of the effect evaluation are self-efficacy expectancies, perceived control, and cognitive symptom management. The secondary outcome measures are smoking and drinking behaviour, Body Mass Index (BMI), physical activity level, self-care behaviour, health-related quality of life, perceived autonomy, symptoms of anxiety and depression, and health care utilisation. The programme's feasibility is assessed by measuring compliance with the protocol, patients' attendance and adherence, and the opinions about the programme. DISCUSSION A total number of 318 patients were included in the trial. At present, follow-up data are being collected. The results of the trial become clear after completion of the data collection in January 2007. TRIAL REGISTRATION Trialregister (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=467) ISRCTN88363287.
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Affiliation(s)
- Esther STF Smeulders
- Maastricht University, Faculty of Health Sciences, Department of Health Care Studies, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Jolanda CM van Haastregt
- Maastricht University, Faculty of Health Sciences, Department of Health Care Studies, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Elisabeth FM van Hoef
- Maastricht University, Faculty of Health Sciences, Department of Health Care Studies, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Jacques ThM van Eijk
- Maastricht University, Faculty of Health Sciences, Department of Health Care Studies, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Gertrudis IJM Kempen
- Maastricht University, Faculty of Health Sciences, Department of Health Care Studies, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Jelinek H, Warner P, King S, De Jong B. Opportunistic screening for cardiovascular problems in rural and remote health settings. J Cardiovasc Nurs 2006; 21:217-22. [PMID: 16699362 DOI: 10.1097/00005082-200605000-00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death in Australia and the United States. It is not known if routine electrocardiogram (ECG) assessment at the community level could identify a significant proportion of people with clinically relevant ECG anomalies who could benefit from intervention. PURPOSE This study aimed to elucidate the use of 3-lead ECG assessment by community nurses in rural and remote health settings. We report the findings obtained from 20-minute, lead II ECG recordings of 71 people who participated in a diabetes screening study. RESULTS Seven participants reported cardiac anomalies before screening. One or more ECG abnormalities were found in 45 participants. Of these, nine people who were otherwise asymptomatic showed abnormal ECG characteristics that warranted further investigation. CONCLUSION Although further research is needed, incorporating routine 3-lead ECG testing in rural and remote communities may improve general health in the community by providing early recognition of cardiac anomalies in otherwise asymptomatic individuals who may be amenable to treatment. This study has implications for community nurses on two levels: opportunistic screening, monitoring and evaluation.
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Affiliation(s)
- Herbert Jelinek
- School of Community Health, Charles Sturt University, Albury, NSW, Australia.
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Driscoll A, Worrall-Carter L, McLennan S, Dawson A, O'Reilly J, Stewart S. Heterogeneity of heart failure management programs in Australia. Eur J Cardiovasc Nurs 2005; 5:75-82. [PMID: 16216559 DOI: 10.1016/j.ejcnurse.2005.08.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Revised: 06/16/2005] [Accepted: 08/22/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Heart Failure Management Programs (HFMPs) have proven to be cost-effective in minimising recurrent hospitalisations, morbidity and mortality. However, variability between the programs exists which could translate into variable health outcomes. OBJECTIVE To survey the characteristics of HFMPs throughout Australia and to identify potential heterogeneity in their organisation and structure. METHOD Thirty-nine post-discharge HFMPs were identified from a systematic search of the Australian health-care system in 2002. A comprehensive 19-item questionnaire specifically examining characteristics of HFMPs was sent to co-ordinators of identified programs in early 2003. RESULTS All participants responded with six institutions (15%) indicating that their HFMP had ceased operations due to a lack of funding. The survey revealed an uneven distribution of the 33 active HFMPs operating throughout Australia. Overall, 4450 post-discharge HF patients (median: 74; IQR: 24-147) were managed via these programs, representing only 11% of the potential caseload for an Australia-wide network of HFMPs. Heterogeneity of these programs existed in respect to the model of care applied within the program (70% applied a home-based program and 18% a specialist HF clinic) and applied interventions (30% of programs had no discharge criteria and 45% of programs prevented nurses administering/titrating medications). Sustained funding was available to only 52% of the active HFMPs. CONCLUSION Inequity of access to HFMPs in Australia is evident in relation to locality and high service demand, further complicated by inadequate funding. Heterogeneity between these programs is substantial. The development of national benchmarks for evidence-based HFMPs is required to address program variability and funding issues to realise their potential to improve health outcomes.
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