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Chan YK, Stickland N, Stewart S. An inevitable or modifiable trajectory towards heart failure in high-risk individuals: insights from the nurse-led intervention for less chronic heart failure (NIL-CHF) study. Eur J Cardiovasc Nurs 2023; 22:33-42. [PMID: 35986905 DOI: 10.1093/eurjcn/zvac036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 01/20/2023]
Abstract
AIMS We extended follow-up of a heart failure (HF) prevention study to determine if initially positive findings of improved cardiac recovery were translated into less de novo HF and/or all-cause mortality (primary endpoint) in the longer term. METHODS AND RESULTS The Nurse-led Intervention for Less Chronic HF (NIL-CHF) study was a single-centre randomized trial of nurse-led prevention involving cardiac inpatients without HF. At 3 years, 454 survivors (aged 66 ± 11 years, 71% men and 68% coronary artery disease) had the following: (i) a normal echocardiogram (128 cases/28.2%), (ii) structural heart disease (196/43.2%), or (iii) left ventricular diastolic dysfunction/left ventricular systolic dysfunction (LVDD/LVSD: 130/28.6%). Outcomes were examined during median 8.3 (interquartile range 7.8-8.8) years according to these hierarchal groups and change in cardiac status from baseline to 3 years. Overall, 109 (24.0%) participants had a de novo HF admission or died while accumulating 551 cardiovascular-related admissions/3643 days of hospital stay. Progressively worse cardiac status correlated with increased hospitalizations (P < 0.001). The mean rate (95% confidence interval) of cardiovascular admissions/days of hospital stay being 0.09 (0.05-0.12) admissions/0.33 (0.13-0.54) days vs. 0.27 (0.20-0.34) admissions/2.20 (1.36-3.04) days per annum for those with a normal echocardiogram vs. LVDD/LVSD at 3 years. With progressively higher event rates, the adjusted hazard ratio for a de novo HF admission and/or death associated with a structural abnormality (24.5% of cases) and LVDD/LVSD (36.2%) at 3 years was 1.57 (0.82-3.01; P = 0.173) and 2.07 (1.05-4.05; P = 0.035) compared with a normal echocardiogram (10.9%). Mortality also mirrored the direction/extent of cardiac status/trajectory. CONCLUSIONS These data suggest the positive initial effects of NIL-CHF intervention on cardiac recovery contributed to better long-term outcomes among patients at high risk of HF. However, prevention of HF remains challenging.
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Affiliation(s)
- Yih-Kai Chan
- Mary MacKillop Institute for Health Research, The Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Nerolie Stickland
- Mary MacKillop Institute for Health Research, The Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Simon Stewart
- Center for Cardiopulmonary Health, Torrens University Australia, Adelaide, SA 5000, Australia.,Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA 6160, Australia
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Gomez del Pulgar M, Cuevas-Budhart MA, Hernández-Iglesias S, Kappes M, Riquelme Contreras VA, Rodriguez-Lopez E, De Almeida Souza AM, Gonzalez Jurado MA, Crespo Cañizares A. Best Nursing Intervention Practices to Prevent Non-Communicable Disease: A Systematic Review. Public Health Rev 2022; 43:1604429. [PMID: 36189187 PMCID: PMC9516617 DOI: 10.3389/phrs.2022.1604429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/19/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives: To explore nursing health education interventions for non-communicable disease patients. Methods: The design was a systematic review of research work published between 2008 and 2018. The data sources included the Web of Science, PubMed, Scopus, COCHRANE, and LILACS. The studies that met the inclusion were assessed, and the analysis for methodological quality through the recommended tools CASPe, and JADAD. Results: Fifteen original studies from eight counties were included in the review; Findings revealed 13 studies with randomized samples and six used power analysis. Nurses’ interventions included house calls, home care, and individual and group health education. Conclusion: Nursing interventions showed 76.4% the effectiveness of results in patient outcomes to promote and improve healthier lifestyles and quality of life of non-communicable disease patients. This review discloses the significant impact of nursing health education interventions. Nursing leadership and political decision-makers should consider providing programs to enhance health education knowledge and abilities. All of this can favor the sustainability of the global economy by changing the life style of thousands of people worldwide. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42020208809.
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Affiliation(s)
- Mercedes Gomez del Pulgar
- Centro de Educación Superior Hygiea, Madrid, Spain
- Coordination of the Center for Advanced Clinical Simulation of the Nursing Degree, Universidad Francisco de Vitoria, Posuelo de Alarcon, Madrid, España
| | - Miguel Angel Cuevas-Budhart
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Instituto Mexicano del Seguro Social (IMSS), Mexico City, México
- *Correspondence: Miguel Angel Cuevas-Budhart, , ,
| | - Sonsoles Hernández-Iglesias
- Institutional Relations and Health Practices of Health Sciences, Faculty of the Nursing Degree, Universidad Francisco de Vitoria, Pozuelo de Alarcon, Madrid, España
| | - Maria Kappes
- College of Health Care Sciences, Nursing School, Universidad San Sebastián, Puerto Montt, Chile
| | | | | | | | | | - Almudena Crespo Cañizares
- Clinical Practices of the Degree in Nursing, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
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Haji K, Huynh Q, Wong C, Stewart S, Carrington M, Marwick TH. Improving the Characterization of Stage A and B Heart Failure by Adding Global Longitudinal Strain. JACC Cardiovasc Imaging 2022; 15:1380-1387. [DOI: 10.1016/j.jcmg.2022.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 12/16/2022]
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Haji K, Marwick TH, Stewart S, Carrington M, Chan YK, Chan W, Huynh Q, Neil C, Wong C. Incremental Value of Global Longitudinal Strain in the Long-Term Prediction of Heart Failure among Patients with Coronary Artery Disease. J Am Soc Echocardiogr 2021; 35:187-195. [PMID: 34508839 DOI: 10.1016/j.echo.2021.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Heart failure (HF) remains a common complication for patients with coronary artery disease (CAD), especially after acute myocardial infarction. Although left ventricular ejection fraction (LVEF) is conventionally used to assess cardiac function for risk stratification, it has been shown in other settings to underestimate the risk of HF compared with global longitudinal strain (GLS). Moreover, most evidence pertains to early-onset HF. We sought the clinical and myocardial predictors for late-onset HF in patients with CAD. METHODS We analyzed echocardiograms (including GLS) in 334 patients with CAD (ages 65 ± 11 years, 77% male) who were enrolled in the Nurse-Led Intervention for Less Chronic Heart Failure trial, a prospective, randomized controlled trial that compared standard care with nurse-led intervention to prevent HF in individuals at risk of incident HF. Long-term (9 years) follow-up was obtained via data linkage. Analysis was performed using a competing-risk model. RESULTS Baseline LVEF values were normal or mildly impaired (LVEF ≥ 40%) in all subjects. After a median of 9 years of follow-up, 50 (15%) of the 334 patients had new HF admissions, and 68 (20%) died. In a competing-risk model, HF was associated with GLS (hazard ratio = 1.15 [1.05-1.25], P = .001), independent of estimated glomerular filtration rate (hazard ratio = 0.98 [0.97-0.99], P = .045), Charlson comorbidity score (hazard ratio = 1.64 [1.25-2.15], P < .001), or E/e' (hazard ratio = 1.08 [1.02-1.14], P = .01). Global longitudinal strain-but not conventional echocardiographic measures-added incremental value to a clinical model based on age, gender, and Charlson score (area under the curve, 0.78-0.83, P = .01). Global longitudinal strain was still associated with HF development in patients taking baseline angiotensin convertase enzyme inhibitors (hazard ratio = 1.21 [1.11-1.31], P < .01) and baseline beta-blockers (1.17 [1.09, 1.26]; P < .01). Mortality was associated with older men, risk factors (hypertension or diabetes), and comorbidities (AF and chronic kidney disease). CONCLUSIONS Global longitudinal strain is independently associated with risk of incident HF in patients admitted with CAD and provides incremental prognostic value to standard markers. Identifying an at-risk subgroup using GLS may be the focus of future randomized controlled trails to enable targeted therapeutic intervention.
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Affiliation(s)
- Kawa Haji
- Baker Heart and Diabetes Institute, Melbourne, Australia; Cardiology Department, Western Health, Melbourne, Australia; Department of Medicine; and University of Melbourne, Melbourne, Australia.
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia; Cardiology Department, Western Health, Melbourne, Australia; Department of Medicine; and University of Melbourne, Melbourne, Australia
| | - Simon Stewart
- Torrens University Australia, Adelaide, Australia; University of Glasgow, Glasgow, Scotland
| | | | - Yih-Kai Chan
- Australian Catholic University, Melbourne, Australia
| | - William Chan
- Cardiology Department, Western Health, Melbourne, Australia; Department of Medicine; and University of Melbourne, Melbourne, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Christopher Neil
- Cardiology Department, Western Health, Melbourne, Australia; Department of Medicine; and University of Melbourne, Melbourne, Australia
| | - Chiew Wong
- Department of Medicine; and University of Melbourne, Melbourne, Australia; Cardiology Department, Northern Health, Melbourne, Australia
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Sacre JW, Wong C, Chan YK, Carrington MJ, Stewart S, Kingwell BA. Left Ventricular Dysfunction and Exercise Capacity Trajectory. JACC Cardiovasc Imaging 2019; 12:798-806. [DOI: 10.1016/j.jcmg.2017.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 10/06/2017] [Accepted: 10/12/2017] [Indexed: 01/23/2023]
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Sacre JW, Ball J, Wong C, Chan YK, Stewart S, Kingwell BA, Carrington MJ. Mild cognitive impairment is associated with subclinical diastolic dysfunction in patients with chronic heart disease. Eur Heart J Cardiovasc Imaging 2019; 19:285-292. [PMID: 28954294 DOI: 10.1093/ehjci/jex169] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/23/2017] [Indexed: 11/12/2022] Open
Abstract
Background To examine mild cognitive impairment and its associations with subclinical cardiac dysfunction in patients with chronic heart disease yet to develop the clinical syndrome of chronic heart failure (CHF). Methods and results Patients from the Nurse-led Intervention for Less Chronic Heart Failure Study (n = 373 with chronic heart disease other than CHF; 64 ± 11 years, 69% men) were screened for mild cognitive impairment [Montreal cognitive assessment (MoCA) score <26] and underwent echocardiographic/clinical profiling. We investigated associations of mild cognitive impairment and MoCA cognitive domain subscores with global cardiac status ('normal' vs. 'diastolic dysfunction' vs. 'other cardiac abnormality') and individual echocardiographic parameters. Patients with mild cognitive impairment (n = 161; 43%) demonstrated a higher age-adjusted prevalence of diastolic dysfunction (37% vs. 24%; P < 0.05). Multivariate logistic regression (adjusted for age, sex, and other relevant clinical factors) indicated that the odds of mild cognitive impairment were two-times higher with diastolic dysfunction (P = 0.030) and 1.7-times higher with 'other cardiac abnormalities' (P = 0.082) vs. normal cardiac status. In turn, mild cognitive impairment was predicted by left-ventricular (LV) filling pressure (based on the ratio of early diastolic filling and annular velocities; adjusted odds ratio 1.07 per unit increase, P = 0.022), but not LV structural parameters. Specific deficits in the cognitive domains of executive functioning and visuo-constructional abilities were also independently predicted by diastolic dysfunction (P < 0.05). Conclusion Mild cognitive impairment is prevalent in patients with subclinical chronic heart disease at high-risk of CHF. Independent associations with LV diastolic dysfunction suggest a link between cardiac and cognitive functioning beyond shared risk factors.
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Affiliation(s)
- Julian W Sacre
- Metabolic and Vascular Physiology Laboratory, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Jocasta Ball
- Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Chiew Wong
- Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Grattan St, Parkville, Victoria 3010, Australia
| | - Yih-Kai Chan
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring St, Melbourne, Victoria 3000, Australia
| | - Simon Stewart
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring St, Melbourne, Victoria 3000, Australia
| | - Bronwyn A Kingwell
- Metabolic and Vascular Physiology Laboratory, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia
| | - Melinda J Carrington
- Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring St, Melbourne, Victoria 3000, Australia
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Maru S, Byrnes J, Carrington MJ, Chan YK, Stewart S, Scuffham PA. Economic evaluation of a nurse-led home and clinic-based secondary prevention programme to prevent progressive cardiac dysfunction in high-risk individuals: The Nurse-led Intervention for Less Chronic Heart Failure (NIL-CHF) randomized controlled study. Eur J Cardiovasc Nurs 2017; 17:439-445. [PMID: 29166769 DOI: 10.1177/1474515117743979] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to assess the cost-effectiveness of a long-term, nurse-led, multidisciplinary programme of home/clinic visits in preventing progressive cardiac dysfunction in patients at risk of developing de novo chronic heart failure (CHF). METHODS A trial-based analysis was conducted alongside a pragmatic, single-centre, open-label, randomized controlled trial of 611 patients (mean age: 66 years) with subclinical cardiovascular diseases (without CHF) discharged to home from an Australian tertiary referral hospital. A nurse-led home and clinic-based programme (NIL-CHF intervention, n = 301) was compared with standard care ( n=310) in terms of life-years, quality-adjusted life-years (QALYs) and healthcare costs. The uncertainty around the incremental cost and QALYs was quantified by bootstrap simulations and displayed on a cost-effectiveness plane. RESULTS During a median follow-up of 4.2 years, there were no significant between-group differences in life-years (-0.056, p=0.488) and QALYs (-0.072, p=0.399), which were lower in the NIL-CHF group. The NIL-CHF group had slightly lower all-cause hospitalization costs (AUD$2943 per person; p=0.219), cardiovascular-related hospitalization costs (AUD$1142; p=0.592) and a more pronounced reduction in emergency/unplanned hospitalization costs (AUD$4194 per person; p=0.024). When the cost of intervention was added to all-cause, cardiovascular and emergency-related readmissions, the reductions in the NIL-CHF group were AUD$2742 ( p=0.313), AUD$941 ( p=0.719) and AUD$3993 ( p=0.046), respectively. At a willingness-to-pay threshold of AUD$50,000/QALY, the probability of the NIL-CHF intervention being better-valued was 19%. CONCLUSIONS Compared with standard care, the NIL-CHF intervention was not a cost-effective strategy as life-years and QALYs were slightly lower in the NIL-CHF group. However, it was associated with modest reductions in emergency/unplanned readmission costs.
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Affiliation(s)
- Shoko Maru
- 1 Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
| | - Joshua Byrnes
- 1 Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
| | - Melinda J Carrington
- 2 Centre for Primary Care and Prevention, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.,4 Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Yih-Kai Chan
- 2 Centre for Primary Care and Prevention, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Simon Stewart
- 3 Centre for Research Excellence to Reduce Inequality in Heart Disease, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Paul A Scuffham
- 1 Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
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Abstract
UNLABELLED Introduction The adult CHD population is increasing and ageing and remains at high risk for morbidity and mortality. In a retrospective single-centre study, we conducted a comprehensive review of non-elective hospitalisations of adults with CHD and explored factors associated with length of stay. METHODS We identified adults (⩾18 years) with CHD admitted during a 12-month period and managed by the adult CHD service. Data regarding demographics, cardiac history, hospital admission, resource utilisation, and length of stay were extracted. RESULTS There were 103 admissions of 91 patients (age 37±10 years; 52% female). Of 91 patients, 96% had moderate or complex defects. Of 103 admissions, 45% were through the emergency department. The most common reasons for admission were arrhythmia (37%) and heart failure (28%); 29% of admissions included a stay in the ICU. The mean number of consultations by other services was 2.0. Electrophysiology and anaesthesiology departments were most frequently consulted. After removing outliers, the mean length of stay was 7.9±7.4 days (median=5 days). The length of stay was longer for patients admitted for heart failure (12.2±10.3 days; p=0.001) and admitted directly to the ward (9.6±8.9 days; p=0.009). CONCLUSIONS Among non-electively hospitalised adults with CHD in a tertiary-care centre, management often entails an interdisciplinary approach, and the length of stay is longest for patients admitted with heart failure. The healthcare system must ensure optimal resources to maintain high-quality care for this expanding patient population.
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Stewart S, Wiley JF, Ball J, Chan YK, Ahamed Y, Thompson DR, Carrington MJ. Impact of Nurse-Led, Multidisciplinary Home-Based Intervention on Event-Free Survival Across the Spectrum of Chronic Heart Disease: Composite Analysis of Health Outcomes in 1226 Patients From 3 Randomized Trials. Circulation 2016; 133:1867-77. [PMID: 27083509 PMCID: PMC4857795 DOI: 10.1161/circulationaha.116.020730] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/11/2016] [Indexed: 12/19/2022]
Abstract
Background— We sought to determine the overall impact of a nurse-led, multidisciplinary home-based intervention (HBI) adapted to hospitalized patients with chronic forms of heart disease of varying types. Methods and Results— Prospectively planned, combined, secondary analysis of 3 randomized trials (1226 patients) of HBI were compared with standard management. Hospitalized patients presenting with heart disease but not heart failure, atrial fibrillation but not heart failure, and heart failure, as well, were recruited. Overall, 612 and 614 patients, respectively, were allocated to a home visit 7 to 14 days postdischarge by a cardiac nurse with follow-up and multidisciplinary support according to clinical need or standard management. The primary outcome of days-alive and out-of-hospital was examined on an intention-to-treat basis. During 1371 days (interquartile range, 1112–1605) of follow-up, 218 patients died and 17 917 days of hospital stay were recorded. In comparison with standard management, HBI patients achieved significantly prolonged event-free survival (90.1% [95% confidence interval, 88.2–92.0] versus 87.2% [95% confidence interval, 85.1–89.3] days-alive and out-of-hospital; P=0.020). This reflected less all-cause mortality (adjusted hazard ratio, 0.67; 95% confidence interval, 0.50–0.88; P=0.005) and unplanned hospital stay (median, 0.22 [interquartile range, 0–1.3] versus 0.36 [0–2.1] days/100 days follow-up; P=0.011). Analyses of the differential impact of HBI on all-cause mortality showed significant interactions (characterized by U-shaped relationships) with age (P=0.005) and comorbidity (P=0.041); HBI was most effective for those aged 60 to 82 years (59%–65% of individual trial cohorts) and with a Charlson Comorbidity Index Score of 5 to 8 (36%–61%). Conclusions— These data provide further support for the application of postdischarge HBI across the full spectrum of patients being hospitalized for chronic forms of heart disease. Clinical Trial Registration— URL: http://www.anzctr.org.au. Unique identifiers: 12610000221055, 12608000022369, 12607000069459.
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Affiliation(s)
- Simon Stewart
- From Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
| | - Joshua F Wiley
- From Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Jocasta Ball
- From Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Yih-Kai Chan
- From Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Yasmin Ahamed
- From Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - David R Thompson
- From Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Melinda J Carrington
- From Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
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Stewart S, Chan YK, Wong C, Jennings G, Scuffham P, Esterman A, Carrington M. Impact of a nurse-led home and clinic-based secondary prevention programme to prevent progressive cardiac dysfunction in high-risk individuals: the Nurse-led Intervention for Less Chronic Heart Failure (NIL-CHF) randomized controlled study. Eur J Heart Fail 2015; 17:620-30. [DOI: 10.1002/ejhf.272] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 03/11/2015] [Accepted: 03/16/2015] [Indexed: 01/22/2023] Open
Affiliation(s)
- Simon Stewart
- Mary MacKillop Institute for Health Research; Australian Catholic University; Melbourne Australia
| | - Yih-Kai Chan
- Mary MacKillop Institute for Health Research; Australian Catholic University; Melbourne Australia
| | - Chiew Wong
- Non-intervention Cardiology; Western Health; Melbourne Australia
| | - Garry Jennings
- Baker IDI Heart and Diabetes Institute; Melbourne Australia
| | - Paul Scuffham
- Centre for Applied Health Economics & Menzies Health Institute Queensland; Griffith University; Brisbane Australia
| | - Adrian Esterman
- University of South Australia, Adelaide, Australia and Centre for Research Excellence in Chronic Disease Prevention; James Cook University; Cairns Australia
| | - Melinda Carrington
- Mary MacKillop Institute for Health Research; Australian Catholic University; Melbourne Australia
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Yang H, Negishi K, Otahal P, Marwick TH. Clinical prediction of incident heart failure risk: a systematic review and meta-analysis. Open Heart 2015; 2:e000222. [PMID: 25893103 PMCID: PMC4395833 DOI: 10.1136/openhrt-2014-000222] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/15/2015] [Accepted: 03/17/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Early treatment may alter progression to overt heart failure (HF) in asymptomatic individuals with stage B HF (SBHF). However, the identification of patients with SBHF is difficult. This systematic review sought to examine the strength of association of clinical factors with incident HF, with the intention of facilitating selection for HF screening. METHODS Electronic databases were systematically searched for studies reporting risk factors for incident HF. Effect sizes, typically HRs, of each risk variable were extracted. Pooled crude and adjusted HRs with 95% CIs were computed for each risk variable using a random-effects model weighted by inverse variance. RESULTS Twenty-seven clinical factors were identified to be associated with risk of incident HF in 15 observational studies in unselected community populations which followed 456 850 participants over 4-29 years. The strongest independent associations for incident HF were coronary artery disease (HR=2.94; 95% CI 1.36 to 6.33), diabetes mellitus (HR=2.00; 95% CI 1.68 to 2.38), age (HR (per 10 years)=1.80; 95% CI 1.13 to 2.87) followed by hypertension (HR=1.61; 95% CI 1.33 to 1.96), smoking (HR=1.60; 95% CI 1.45 to 1.77), male gender (HR=1.52; 95% CI 1.24 to 1.87) and body mass index (HR (per 5 kg/m(2))=1.15; 95% CI 1.06 to 1.25). Atrial fibrillation (HR=1.88; 95% CI 1.60 to 2.21), left ventricular hypertrophy (HR=2.46; 95% CI 1.71 to 3.53) and valvular heart disease (HR=1.74; 95% CI 1.07 to 2.84) were also strongly associated with incident HF but were not examined in sufficient papers to provide pooled hazard estimates. CONCLUSIONS Prediction of incident HF can be calculated from seven common clinical variables. The risk associated with these may guide strategies for the identification of high-risk people who may benefit from further evaluation and intervention.
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Affiliation(s)
- Hong Yang
- Menzies Institute for Medical Research , Hobart, Tasmania , Australia
| | - Kazuaki Negishi
- Menzies Institute for Medical Research , Hobart, Tasmania , Australia
| | - Petr Otahal
- Menzies Institute for Medical Research , Hobart, Tasmania , Australia
| | - Thomas H Marwick
- Menzies Institute for Medical Research , Hobart, Tasmania , Australia
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Stewart S, Carrington MJ, Marwick T, Davidson PM, Macdonald P, Horowitz J, Krum H, Newton PJ, Reid C, Scuffham PA. The WHICH? trial: rationale and design of a pragmatic randomized, multicentre comparison of home- vs. clinic-based management of chronic heart failure patients. Eur J Heart Fail 2014; 13:909-16. [DOI: 10.1093/eurjhf/hfr048] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Simon Stewart
- Department of Preventative Health; Baker IDI Heart and Diabetes Institute; Melbourne Australia
| | - Melinda J. Carrington
- Department of Preventative Health; Baker IDI Heart and Diabetes Institute; Melbourne Australia
| | - Thomas Marwick
- Cardiovascular Imaging Research Unit (CIRCUS); School of Medicine, The University of Queensland, Princess Alexandra Hospital; Brisbane Australia
| | - Patricia M. Davidson
- The Centre for Cardiovascular and Chronic Care; Curtin Health Innovative Research Institute, University of Technology/Curtin University, St Vincent's and Mater Health,; Sydney Australia
| | - Peter Macdonald
- St Vincent's Hospital and Victor Chang Cardiac Research Institute; Sydney Australia
| | - John Horowitz
- The Queen Elizabeth Hospital and University of Adelaide; Adelaide Australia
| | - Henry Krum
- Monash Centre of Cardiovascular Research and Education in therapeutics; School of Public Health & Preventive Medicine, Monash University; Melbourne Victoria Australia
| | - Phillip J. Newton
- The Centre for Cardiovascular and Chronic Care; Curtin Health Innovative Research Institute, University of Technology/Curtin University, St Vincent's and Mater Health; Sydney Australia
| | - Christopher Reid
- Monash Centre of Cardiovascular Research and Education in therapeutics; School of Public Health & Preventive Medicine, Monash University; Melbourne Victoria Australia
| | - Paul A. Scuffham
- Department of Health Economics, Centre for Applied Health Economics; School of Medicine, Griffith University; Logan Australia
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de Waure C, Lauret GJ, Ricciardi W, Ferket B, Teijink J, Spronk S, Myriam Hunink MG. Lifestyle interventions in patients with coronary heart disease: a systematic review. Am J Prev Med 2013; 45:207-16. [PMID: 23867029 DOI: 10.1016/j.amepre.2013.03.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 02/14/2013] [Accepted: 03/22/2013] [Indexed: 11/18/2022]
Abstract
CONTEXT Coronary heart disease (CHD) is responsible for about 15% of all deaths worldwide and is identified as a top priority for decision makers. Both primary and secondary prevention are considered key strategies in the prevention of CHD. The aim of this study was to assess the efficacy of nonpharmacologic interventions with multiple lifestyle components in patients with established CHD in comparison to usual care. For this reason, a systematic review and meta-analysis of RCTs were performed. EVIDENCE ACQUISITION The Cochrane Library, MEDLINE, and EMBASE databases were examined until March 31, 2012 (without start date) in order to identify studies addressing patient-tailored multifactorial lifestyle interventions aimed at reducing more than one cardiovascular risk factor in patients with established CHD. Primary endpoints were fatal and nonfatal cardiovascular events. Secondary outcomes were overall mortality and cardiovascular disease-associated hospital readmissions. EVIDENCE SYNTHESIS The search strategy yielded 14 unique RCTs, which were considered in the qualitative analysis. Nine of them contributed to the meta-analysis. A random effects model was used to pool the data. The meta-analysis showed a significant risk reduction of 18% (relative risk 0.82, 95% CI=0.69, 0.98) of fatal cardiovascular events in patients undergoing multifactorial lifestyle interventions. Further, a nonsignificant reduction of nonfatal events, overall mortality and hospital readmissions was found. CONCLUSIONS Multifactorial lifestyle interventions aimed at improving modifiable risk factors in patients with established CHD reduce the risk for fatal cardiovascular events. Therefore, they may have added value in secondary prevention of CHD.
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Affiliation(s)
- Chiara de Waure
- Institute of Public Health, Catholic University of the Sacred Heart, Rome, Italy.
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14
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Carrington MJ, Chan YK, Calderone A, Scuffham PA, Esterman A, Goldstein S, Stewart S. A Multicenter, Randomized Trial of a Nurse-Led, Home-Based Intervention for Optimal Secondary Cardiac Prevention Suggests Some Benefits for Men but Not for Women. Circ Cardiovasc Qual Outcomes 2013; 6:379-89. [DOI: 10.1161/circoutcomes.111.000006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
We examined the impact of a prolonged secondary prevention program on recurrent hospitalization in cardiac patients with private health insurance.
Methods and Results—
The Young at Heart multicenter, randomized, controlled trial compared usual postdischarge care (UC) with nurse-led, home-based intervention (HBI). The primary end point was rate of all-cause hospital stay (31.5±7.5 months follow-up). In total, 602 patients (aged 70±10 years, 72% men) were randomized to UC (n=296) or HBI (n=306, 96% received ≥1 home visit). Overall, 42 patients (7.0%) died, and 492 patients (82%) accumulated 2397 all-cause hospitalizations associated with 10 258 hospital days costing >$17 million. There were minimal group differences (HBI versus UC) in the primary end point of all-cause hospital stay (5405 versus 4853 days; median [interquartile range], 0.08 [0.03–0.17] versus 0.07 [0.03–0.13]/patient per month). There were similar trends with respect to all hospitalizations (1197 versus 1200;
P
=0.802) and associated costs ($8.66 versus $8.58 million;
P
=0.375). At 2 years, however, more HBI versus UC (39% versus 27%; odds ratio, 1.67; 95% confidence interval, 1.15–2.41;
P
=0.007) patients were assessed as stable and optimally managed. For women, HBI outcomes were predominantly worse than UC outcomes. In men, HBI was associated with reduced risk of cardiovascular hospitalization (adjusted hazard ratio, 0.68; 95% confidence interval, 0.46–0.99;
P
=0.044) with less cardiovascular hospitalizations (192 versus 269;
P
=0.054) and costs ($2.49 versus $3.53 million;
P
=0.046).
Conclusions—
HBI did not reduce recurrent all-cause hospitalization compared with UC in privately insured cardiac patients overall. However, it did convey some benefits in cardiac outcomes for men.
Clinical Trial Registration—
Australian New Zealand Clinical Trials Registry Unique Identifier: 12608000014358. URL:
http://www.anzctr.org.au/trial_view.aspx?id=82509
.
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Affiliation(s)
- Melinda J. Carrington
- From the Preventative Health and NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease (M.J.C., Y.K.C., A.C., S.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; School of Medicine, Griffith University, Brisbane, Australia (P.A.S.); Division of Health Sciences, University of South Australia, Adelaide, Australia (A.E.); and School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia (S.G.)
| | - Yih-Kai Chan
- From the Preventative Health and NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease (M.J.C., Y.K.C., A.C., S.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; School of Medicine, Griffith University, Brisbane, Australia (P.A.S.); Division of Health Sciences, University of South Australia, Adelaide, Australia (A.E.); and School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia (S.G.)
| | - Alicia Calderone
- From the Preventative Health and NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease (M.J.C., Y.K.C., A.C., S.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; School of Medicine, Griffith University, Brisbane, Australia (P.A.S.); Division of Health Sciences, University of South Australia, Adelaide, Australia (A.E.); and School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia (S.G.)
| | - Paul A. Scuffham
- From the Preventative Health and NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease (M.J.C., Y.K.C., A.C., S.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; School of Medicine, Griffith University, Brisbane, Australia (P.A.S.); Division of Health Sciences, University of South Australia, Adelaide, Australia (A.E.); and School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia (S.G.)
| | - Adrian Esterman
- From the Preventative Health and NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease (M.J.C., Y.K.C., A.C., S.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; School of Medicine, Griffith University, Brisbane, Australia (P.A.S.); Division of Health Sciences, University of South Australia, Adelaide, Australia (A.E.); and School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia (S.G.)
| | - Stan Goldstein
- From the Preventative Health and NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease (M.J.C., Y.K.C., A.C., S.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; School of Medicine, Griffith University, Brisbane, Australia (P.A.S.); Division of Health Sciences, University of South Australia, Adelaide, Australia (A.E.); and School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia (S.G.)
| | - Simon Stewart
- From the Preventative Health and NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease (M.J.C., Y.K.C., A.C., S.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; School of Medicine, Griffith University, Brisbane, Australia (P.A.S.); Division of Health Sciences, University of South Australia, Adelaide, Australia (A.E.); and School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia (S.G.)
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15
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Carrington MJ, Kok S, Jansen K, Stewart S. The Green, Amber, Red Delineation of Risk and Need (GARDIAN) management system: a pragmatic approach to optimizing heart health from primary prevention to chronic disease management. Eur J Cardiovasc Nurs 2012; 12:337-45. [DOI: 10.1177/1474515112451702] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Simone Kok
- Hogeschool van Amsterdam, Amsterdam, The Netherlands
| | - Kiki Jansen
- Hogeschool van Amsterdam, Amsterdam, The Netherlands
| | - Simon Stewart
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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16
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Carrington MJ, Ball J, Horowitz JD, Marwick TH, Mahadevan G, Wong C, Abhayaratna WP, Haluska B, Thompson DR, Scuffham PA, Stewart S. Navigating the fine line between benefit and risk in chronic atrial fibrillation: rationale and design of the Standard versus Atrial Fibrillation spEcific managemenT studY (SAFETY). Int J Cardiol 2011; 166:359-65. [PMID: 22079383 DOI: 10.1016/j.ijcard.2011.10.065] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 10/18/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Health outcomes associated with atrial fibrillation (AF) continue to be poor and standard management often does not provide clinical stability. The Standard versus Atrial Fibrillation spEcific managemenT studY (SAFETY) compares the efficacy of a post-discharge, nurse-led, multi-disciplinary programme to optimise AF management with usual care. METHODS SAFETY is a prospective, multi-centre, randomised controlled trial with blinded-endpoint adjudication. A target of 320 hospitalised patients with a chronic form of AF will be randomised (stratified by "rate" versus "rhythm" control) to usual post-discharge care or the SAFETY Intervention (SI). The SI involves home-based assessment, extensive clinical profiling and the application of optimal gold-standard pharmacology which is individually tailored according to a "traffic light" framework based on clinical stability, risk profile and therapeutic management. The primary endpoint is event-free survival from all-cause death or unplanned readmission during 18-36 months follow-up. Secondary endpoints include rate of recurrent hospital stay, treatment success (i.e. maintenance of rhythm or rate control and/or application of anti-thrombotic therapy without a bleeding event) and cost-efficacy. RESULTS With study recruitment to be completed in early 2012, the results of this study will be available in early 2014. CONCLUSIONS If positive, SAFETY will represent a potentially cost-effective and readily applicable strategy to improve health outcomes in high risk individuals discharged from hospital with chronic AF.
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Affiliation(s)
- Melinda J Carrington
- Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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17
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Chan YK, Stewart S, Calderone A, Scuffham P, Goldstein S, Carrington MJ. Exploring the potential to remain "Young @ Heart": initial findings of a multi-centre, randomised study of nurse-led, home-based intervention in a hybrid health care system. Int J Cardiol 2010; 154:52-8. [PMID: 20888653 DOI: 10.1016/j.ijcard.2010.08.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 08/27/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND Disease management programs have been shown to improve health outcomes in high risk individuals in many but not all health care systems. METHODS Young @ Heart is a multi-centre, randomised controlled study of a nurse-led, home-based intervention (HBI) program vs. usual care (UC) in privately insured patients in Australia aged ≥ 45 years following an acute cardiac admission. Intensity of HBI is tailored to an individual's clinical stability, management and risk profile. The primary endpoint is the rate of all-cause stay during a mean of 2.5 years follow-up. RESULTS A target of 602 adults (72% men) were randomised to HBI (n=306) or UC (n=296); their initial profiles being well matched. At baseline, 71% were overweight (body mass index 29.7 ± 3.9 kg/m(2)) and 66% had an elevated blood pressure (153 ± 18/89 ± 7 mm Hg). Over half had a history of smoking and 39% had a sub-optimal total cholesterol level >4 mmol/L. Overall, 62% (376 cases) were treated for coronary artery disease (27% with multi-vessel disease and 39% underwent cardiac revascularisation). A further 20% (120 cases) were treated for a cardiac arrhythmia (predominantly atrial fibrillation) and 19% type 2 diabetes mellitus. At 7-14 days post-discharge, 293 (96%) HBI patients received a home visit triggering urgent clinical review and/or enhanced clinical management in many patients. CONCLUSIONS The Young @ Heart intervention is a well accepted and potentially effective intervention to reduce recurrent hospital stay in privately insured cardiac patients in Australia.
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Affiliation(s)
- Yih-Kai Chan
- Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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