Simon Stewart

Short-term and long-term outcomes in 133 429 emergency patients admitted with angina or myocardial infarction in Scotland, 1990-2000: Population-based cohort study

Publisher: BMJ

Date: 11-2006

DOI: 10.1136/HRT.2005.085399

The causes, treatment, and outcome of pulmonary hypertension in Africa: Insights from the Pan African Pulmonary Hypertension Cohort (PAPUCO) Registry

Publisher: Elsevier BV

Date: 10-2016

DOI: 10.1016/J.IJCARD.2016.06.242

Abstract: Epidemiology, aetiology, management and outcome data for various forms of pulmonary hypertension (PH) in Africa are scarce. A prospective, multinational cohort registry of 220 consecutive patients (97% of African descent) from 9 specialist centres in 4 African countries. The antecedents, characteristics and management of newly diagnosed PH plus 6-month survival were studied. There were 209 adults (median age 48years [IQR 35, 64]) and 11 children (age range 1 to 17years). Most adults had advanced disease - 66% WHO Functional Class III-IV, median 6-minute walk test distance of 252m (IQR 120, 350) and median right ventricular systolic pressure 58mmHg (IQR 49, 74). Adults comprised 16% pulmonary arterial hypertension, 69% PH due to left heart disease, 11% PH due to lung disease and/or hypoxia, 2% chronic thromboembolic pulmonary hypertension, and 2% PH with unclear multifactorial mechanism. At 6-months, 21% of adults with follow-up data had died. On an adjusted basis (independent of sub-groups) mortality was associated with increasing functional impairment (p=0.021 overall - WHO Class IV versus I, OR 1.68 [95% CI 0.13, 4.36]) and presence of combined right atrial and ventricular hypertrophy (46% - OR 2.88, 95% CI 1.45, 5.72). Children commonly presented with dyspnoea, fatigue, cough, and palpitations with six and three children, respectively diagnosed with concurrent PH associated congenital heart disease and left heart disease. These data provide new insights into PH from an African perspective, with clear opportunities to improve its prevention, treatment and outcomes. ClinicalTrials.gov (NCT02265887).

The National Echocardiography Database Australia (NEDA): Rationale and methodology

Publisher: Elsevier BV

Date: 10-2018

DOI: 10.1016/J.AHJ.2018.07.001

Abstract: The National Echocardiography Database Australia (NEDA) is a new echocardiography database collecting digital measurements on both a retrospective and prospective basis. To date, echocardiographic data from 435,133 in iduals (aged 61.6 ± 17.9 years) with linkage to 59,725 all-cause deaths during a median of 40 months follow-up have been collected. These data will inform a number of initial analyses focusing on pulmonary hypertension, aortic stenosis and the role of artificial intelligence to facilitate accurate diagnoses of cardiac abnormalities.

Impact of nurse-mediated management on achieving blood pressure goal levels in primary care: Insights from the Valsartan Intensified Primary carE Reduction of Blood Pressure Study

Publisher: Oxford University Press (OUP)

Date: 09-07-2016

DOI: 10.1177/1474515115591901

Abstract: Blood pressure targets in in iduals treated for hypertension in primary care remain difficult to attain. To assess the role of practice nurses in facilitating intensive and structured management to achieve ideal BP levels. We analysed outcome data from the Valsartan Intensified Primary carE Reduction of Blood Pressure Study. Patients were randomly allocated (2:1) to the study intervention or usual care. Within both groups, a practice nurse mediated the management of blood pressure for 439 patients with endpoint blood pressure data (n=1492). Patient management was categorised as: standard usual care (n=348, 23.3%) practice nurse-mediated usual care (n=156, 10.5%) standard intervention (n=705, 47.3%) and practice nurse-mediated intervention (n=283, 19.0%). Blood pressure goal attainment at 26-week follow-up was then compared. Mean age was 59.3±12.0 years and 62% were men. Baseline blood pressure was similar in practice nurse-mediated (usual care or intervention) and standard care management patients (150 ± 16/88 ± 11 vs. 150 ± 17/89 ± 11 mmHg, respectively). Practice nurse-mediated patients had a stricter blood pressure goal of ⩽125/75 mmHg (33.7% vs. 27.3%, p=0.026). Practice nurse-mediated intervention patients achieved the greatest blood pressure falls and the highest level of blood pressure goal attainment (39.2%) compared with standard intervention (35.0%), practice nurse-mediated usual care (32.1%) and standard usual care (25.3% p<0.001). Practice nurse-mediated intervention patients were almost two-fold more likely to achieve their blood pressure goal compared with standard usual care patients (adjusted odds ratio 1.92, 95% confidence interval 1.32 to 2.78 p=0.001). There is greater potential to achieve blood pressure targets in primary care with practice nurse-mediated hypertension management.

Bringing order to chaos: The case for integrated management of atrial fibrillation

Publisher: BMJ

Date: 06-07-2017

DOI: 10.1136/HEARTJNL-2017-311519

Effective nurse-led interventions in heart disease

Publisher: Elsevier BV

Date: 06-2002

DOI: 10.1016/S0167-5273(02)00064-5

Abstract: Nurses are increasingly being involved in initiatives to improve the co-ordination, delivery and eventual outcomes of health care. Key components of these initiatives include application of evidence-based treatments, ensuring in idualised follow-up and the provision of "seamless" care overall. There is evidence in key areas that nurse-led interventions for patients with heart disease are effective, and that they are likely to work in other areas if properly supported and appropriate structures and systems are put in place to promote such practice. Given the promising results to date, it would be disappointing if these issues remain unresolved and the potential value of this type of interventions unfulfilled.

Measuring national accessibility to cardiac services using geographic information systems

Publisher: Elsevier BV

Date: 05-2012

DOI: 10.1016/J.APGEOG.2012.01.007

Heterogeneity of heart failure management programs in Australia

Publisher: Oxford University Press (OUP)

Date: 03-2006

DOI: 10.1016/J.EJCNURSE.2005.08.001

Abstract: 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. To survey the characteristics of HFMPs throughout Australia and to identify potential heterogeneity in their organisation and structure. 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. 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. 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.

Vulnerability to environmental and climatic health provocations among women and men hospitalized with chronic heart disease: insights from the RESILIENCE TRIAL cohort

Publisher: Oxford University Press (OUP)

Date: 25-08-2023

DOI: 10.1093/EURJCN/ZVAD076

Abstract: We aimed to recruit a representative cohort of women and men with multimorbid chronic heart disease as part of a trial testing an innovative, nurse-coordinated, multi-faceted intervention to lower rehospitalisation and death by addressing areas of vulnerability to external challenges to their health. The prospective, randomised open, blinded end-point RESILIENCE Trial recruited 203 hospital inpatients (mean age 75.7 ± 10.2 years) of whom 51% were women and 94% had combined coronary artery disease, heart failure and/or atrial fibrillation. Levels of concurrent multimorbidity were high (mean Charlson Index of Comorbidity Score 6.3 ± 2.7), and 8.9% had at least mild frailty according to the Rockwood Clinical Frailty Scale. Including the index admission, 19-20% of women and men had a pre-existing pattern of seasonally-linked hospitalisation (seasonality). Detailed phenotyping revealed that 48% of women and 40% of men had ≥3 physiological factors, and 15% of women and 16% of men had ≥3 behavioural factors likely to increase their vulnerability to external provocations to their health. Overall, 61-62% of women and men had ≥4 combined factors indicative of such vulnerability. Additional factors such as reliance on the public health system (63% versus 49%), lower education (30% versus 14%) and living alone (48% versus 29%) were more prevalent in women. We successfully recruited women and men with multimorbid chronic heart disease and bio-behavioural indicators of vulnerability to external provocations to their health. Once completed, the RESILIENCE TRIAL will provide important insights on the impact of addressing such vulnerability (promoting resilience) on subsequent health outcomes.

Comparison of contemporaneous responses for EQ-5D-3L and Minnesota Living with Heart Failure; a case for disease specific multiattribute utility instrument in cardiovascular conditions

Publisher: Elsevier BV

Date: 2017

DOI: 10.1016/J.IJCARD.2016.11.030

Abstract: The EQ-5D-3L, a generic multi-attribute utility instrument (MAUI), is widely employed to assist in economic evaluations in health care. The EQ-5D-3L lacks sensitivity when used in conditions such as cardiovascular disease (CVD). Although there are number of CVD specific quality of life instruments, currently, there are no CVD specific MAUIs. The aim of this study is to investigate the discriminative ability and responsiveness of the EQ-5D-3L and the Minnesota Living with Heart Failure Questionnaire (MLHF), a CVD specific quality of life instrument in a group of heart failure patients. The psychometric performance of the EQ-5D-3L and the MLHF was assessed using data from a randomised trial for a heart failure management intervention. The two instruments were compared for discrimination, responsiveness and agreement. The severity groups were defined using New York Heart Association functional classes. The effect sizes for severe classes were generally similar showing good discrimination. The MLHF recorded better responsiveness between the time points than the EQ-5D-3L which was indicated by higher effect sizes and standardised response means. The change in MLHF summary scores between the time points was significant (p<0.005 paired t-test). The overall agreement between the two measures was low. The low correlation indicates that the two classification systems cover different aspects of health space. Comparison of CVD specific instruments with other generic MAUIs such as EQ-5D-3L and AQOL-8D is recommended for further research.

Elevated risk factors but low burden of heart disease in urban African primary care patients: A fundamental role for primary prevention

Publisher: Elsevier BV

Date: 07-2012

DOI: 10.1016/J.IJCARD.2011.01.022

Abstract: Few data describe the case burden of heart disease and cardiovascular risk factors relative to other conditions in urban Africans seeking primary health care. A clinical registry captured data on 1311 consecutive primary care patients (99% African) from two primary care clinics in Soweto, South Africa. Those with suspected sub-clinical heart disease had more advanced cardiologic assessment. Overall, 862 women (66%, 41 ± 16 years) and 449 men (38 ± 14 years) were studied. Whilst more men were smokers (47% vs. 14% OR 5.23, 95% CI 4.01-6.82), more women were obese (42% vs. 14% OR 4.54, 95% CI 3.33-5.88) blood glucose levels doubling with age in obese women. Although 33% were hypertensive, only 4.9% had type 2 diabetes (n=45), heart disease (n=10) and/or cerebrovascular disease (n=12). Overall, 16% (n=205) had an abnormal 12-lead ECG with more men than women showing a major abnormality (24% vs. 11% OR 2.63, 95% CI 1.89-3.46). Of 99 cases (7.6%) subject to advanced cardiologic assessment, 29 (2.2%) had newly diagnosed heart disease: including hypertensive heart failure (13 women vs. 2 men, OR 4.51 95% CI 1.00-21.2), coronary artery disease (n=3), valve disease (n=3), dilated cardiomyopathy (n=3) and 2 cases of acute myocarditis. These data demonstrate a relatively low burden of heart disease in urban African patients seeking primary health care. Alternatively, high antecedent risk, particularly among obese women, highlights a key role for enhanced primary prevention.

Substantial between-hospital variation in outcome following first emergency admission for heart failure

Publisher: Oxford University Press (OUP)

Date: 04-2002

DOI: 10.1053/EUHJ.2001.2890

Different lipid profiles according to ethnicity in the Heart of Soweto study cohort of de novo presentations of heart disease : cardiovascular topics

Publisher: Clinics Cardive Publishing

Date: 12-08-2012

DOI: 10.5830/CVJA-2012-036

Mapping the emergence of heart disease in a black, urban population in Africa: The Heart of Soweto Study

Publisher: Elsevier BV

Date: 03-2006

DOI: 10.1016/J.IJCARD.2006.01.001

Abstract: There is increasing evidence that many populations in the developing world are in "epidemiologic transition" with the subsequent emergence of more "affluent" disease states. The "Heart of Soweto Study" will systematically investigate the emergence of heart disease (HD) in a large urban population in South Africa. Part of the conurbation of Johannesburg, South Africa, Soweto is a predominantly Black African community of 1 million in iduals. During an initial two year period, all in iduals presenting to the local Baragwanath Hospital (3500 beds) with any form of HD will be studied. Demographic and diagnostic coding data in those with pre-established HD will form an abbreviated clinical registry of >12,000 "prevalent" cases. Similarly, socio-demographic, clinical and diagnostic data (e.g. echocardiography and ECG) in newly diagnosed patients will form a more detailed clinical registry of >5000 "incident" cases. Sub-studies of the relationship between HIV status and HD and the optimal management of chronic heart failure will also be performed. These data will provide a unique insight into the causes and consequences of a broad spectrum of HD-related conditions in a "developing world" community in epidemiologic transition. Initially documented population rates, in addition to detailed examinations of the underlying risk factors and causes of HD-related morbidity/mortality will provide an important platform for future stages of the study: a community-based, population screening program and culturally specific primary and secondary programs of care. There is an urgent need to systematically track the emergence of HD in the developing world. Initially involving more than 15,000 in iduals, the unique Heart of Soweto Study has the potential to provide a wealth of information in this regard.

A Self‐Fulfilling Prophecy: Building a Successful Career in Health Research

Publisher: Wiley

Date: 30-03-2007

DOI: 10.1002/9780470777855

A population study of the long-term consequences of Rose angina: 20-Year follow-up of the Renfrew-Paisley study

Publisher: BMJ

Date: 12-2006

DOI: 10.1136/HRT.2006.090118

Nurse-directed services: How can they be made more effective?

Publisher: Oxford University Press (OUP)

Date: 02-2002

DOI: 10.1016/S1474-5151(01)00006-8

Utility of the Oswestry Disability Index for studies of back pain related disability in nurses: Evaluation of psychometric and measurement properties

Publisher: Elsevier BV

Date: 05-2010

DOI: 10.1016/J.IJNURSTU.2009.10.013

Abstract: Disability due to back pain in nurses results in reduced productivity, work absenteeism and attrition from the nursing workforce internationally. Consistent use of outcome measures is needed in intervention studies to enable meta-analyses that determine efficacy of back pain preventive programs. This study investigated the psychometric and measurement properties of the Oswestry Disability Index (ODI) in nursing students to determine its suitability for assessing back pain related disability in intervention studies. Bachelor of Nursing students were recruited. Test-retest reliability and the ability of the ODI to discriminate between in iduals with serious and non-serious back pain were investigated. The measurement error of the ODI was examined with the minimal detectable change at the 90% confidence level (MDC(90)). Student nurses (n=214) had a low mean ODI score of 8.8+/-7.4%. Participants with serious back pain recorded higher scores than the rest of the cohort (p<0.05). Test-retest reliability examined in 33 in iduals was ICC=0.88 (95%CI 0.77-0.94). The MDC(90)=6%, and 36% of nursing students scored below the MDC(90) indicating the tool had limited ability to detect longitudinal change in disability in this population. Data from this and previous studies demonstrate that the measurement properties of the ODI are inappropriate for studying back pain related disability in nurses. The ODI is not recommended for back pain intervention studies in the nursing population and an alternative tool that is sensitive to lower levels of disability must be determined.

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)

Publisher: Elsevier BV

Date: 06-2013

DOI: 10.1016/J.IJCARD.2011.10.065

Abstract: 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. 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 in idually 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. With study recruitment to be completed in early 2012, the results of this study will be available in early 2014. If positive, SAFETY will represent a potentially cost-effective and readily applicable strategy to improve health outcomes in high risk in iduals discharged from hospital with chronic AF.

Characteristics of Bicuspid Aortic Valve Disease and Stenosis: The National Echo Database of Australia

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 07-09-2021

DOI: 10.1161/JAHA.121.020785

Abstract: Bicuspid aortic valve (BAV) is the most common congenital heart disease in adults but is clinically heterogeneous. We aimed to describe the echocardiographic characteristics of BAV and compare patients with BAV with moderate‐to‐severe aortic stenosis (AS) with those with tricuspid aortic valve (TAV) stenosis. Using the National Echo Database of Australia, patients in whom BAV was identified were studied. Those with moderate‐to‐severe AS (mean gradient mm Hg [BAV‐AS]) were compared with those with TAV and moderate‐to‐severe AS (TAV‐AS). Of 264 159 adults whose aortic valve morphology was specified, 4783 (1.8%) had confirmed BAV (aged 49.6±17.4 years, 69% men). Of these, 42% had no AS, and 46% had no aortic regurgitation. Moderate‐to‐severe AS was detected in a greater proportion of patients with BAV with a recorded mean gradient (n=1112, 34%) compared with those with TAV (n=4377, 4% P .001). Patients with BAV‐AS were younger (aged 55.3±16.7 years versus 77.3±11.0 years P .001), and where measured had larger ascending aortic diameters (37±8 mm versus 35±5 mm P .001). Age and sex‐adjusted mortality risk was significantly lower in patients with BAV‐AS (hazard ratio, 0.53 95% CI, 0.45–0.63 P .001). In this large study of patients across the spectrum of BAV disease, the largest proportion had no significant valvulopathy or aortopathy. Compared with those with TAV‐AS, patients with BAV were more likely to have moderate‐to‐severe AS, have larger ascending aortas, and were over 2 decades younger at the time of AS diagnosis. Despite this, patients with BAV appear to have a more favorable prognosis when AS develops, compared with those with TAV‐AS. URL: www.anzctr.org.au/ Unique identifier: ACTRN12617001387314.

Heart of Africa: Clinical Profile of an Evolving Burden of Heart Disease in Africa

Publisher: Wiley

Date: 13-05-2016

DOI: 10.1002/9781119097136

The burden of heart failure

Publisher: Elsevier BV

Date: 12-2004

DOI: 10.1016/S1520-765X(04)80002-6

The effect of noise artefacts on gravitational-wave searches for neutron star post-merger remnants

Publisher: Oxford University Press (OUP)

Date: 23-05-2023

DOI: 10.1093/MNRAS/STAD1556

Abstract: Gravitational waves from binary neutron star post-merger remnants have the potential to uncover the physics of the hot nuclear equation of state. These gravitational-wave signals are high frequency (∼kHz) and short-lived ($\\mathcal {O}(10\\, \\mathrm{ms})$), which introduces potential problems for data analysis algorithms due to the presence of non-stationary and non-Gaussian noise artefacts in gravitational-wave observatories. We quantify the degree to which these noise features in LIGO data may affect our confidence in identifying post-merger gravitational-wave signals. We show that the combination of vetoing data with non-stationary glitches and the application of the Allen χ2 veto (usually reserved for long-lived lower frequency gravitational-wave signals), allows one to confidently detect post-merger signals with signal-to-noise ratio ρ ≳ 8. We discuss the need to incorporate the data quality checks and vetoes into realistic post-merger gravitational-wave searches, and describe their relevance to calculating realistic false-alarm and false-dismissal rates.

Acute hyperglycemia impairs vascular function in healthy and cardiometabolic diseased subjects: Systematic review and meta-analysis

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 09-2015

DOI: 10.1161/ATVBAHA.115.305530

Abstract: Controversy exists over the effect of acute hyperglycemia on vascular function. In this systematic review, we compared the effect of acute hyperglycemia on endothelial and vascular smooth muscle functions across healthy and cardiometabolic diseased subjects. A systematic search of MEDLINE, EMBASE, and Web of Science from inception until July 2014 identified articles evaluating endothelial or vascular smooth muscle function during acute hyperglycemia and normoglycemia. Meta-analyses compared the standardized mean difference (SMD) in endothelial and vascular smooth muscle functions between acute hyperglycemia and normoglycemia. Subgroup analyses and metaregression identified sources of heterogeneity. Thirty-nine articles (525 healthy and 540 cardiometabolic subjects) were analyzed. Endothelial function was decreased (39 studies n=1065 SMD, −1.25 95% confidence interval, −1.52 to −0.98 P .01), whereas vascular smooth muscle function was preserved (6 studies n=144 SMD, −0.07 95% confidence interval, −0.30 to 0.16 P =0.55) during acute hyperglycemia compared with normoglycemia. Significant heterogeneity was detected among endothelial function studies ( P .01). A subgroup analysis revealed that endothelial function was decreased in the macrocirculation (30 studies n=884 SMD, −1.40 95% confidence interval, −1.68 to −1.12 P .01) but not in the microcirculation (9 studies n=181 SMD, −0.63 95% confidence interval, −1.36 to 0.11 P =0.09). Similar results were observed according to health status. Macrovascular endothelial function was inversely associated with age, blood pressure, and low-density lipoprotein cholesterol and was positively associated with the postocclusion interval of vascular assessment. To our knowledge, this is the first systematic review and meta-analysis of its kind. In healthy and diseased subjects, we found evidence for macrovascular but not microvascular endothelial dysfunction during acute hyperglycemia.

Effect of socioeconomic deprivation on the population risk of incident heart failure hospitalisation: An analysis of the Renfrew/Paisley Study

Publisher: Wiley

Date: 29-11-2006

DOI: 10.1016/J.EJHEART.2006.02.008

Abstract: There are few data describing the effect of socioeconomic deprivation on the risk of developing heart failure (HF). To examine the relationship between socioeconomic deprivation and hospitalisation with HF over 20 years. Between 1972 and 1976, 15,402 in iduals, aged 45-64 years, residing in two towns in Scotland, underwent cardiovascular screening. We report hospitalisations with HF over the subsequent 20 years according to Carstairs deprivation category and Social Class. Following screening, 628 men and women (4.1%) were hospitalised with a primary diagnosis of HF. There was a gradient in the risk of HF hospitalisation with increasing socioeconomic deprivation (P=0.003). Of the most deprived in iduals, 6.4% were hospitalised for HF compared to 3.5% of the most affluent group. Cox-proportional Hazard models showed that independent of age, sex and baseline risk factors for cardio-respiratory status, greater socioeconomic deprivation increased the risk of HF admission (P<0.001, overall). The adjusted risk of admission for HF was 39% greater in the most versus least deprived subjects (RR 1.39 95% CI 1.04-2.01 P=0.04). These data show a link between social deprivation and the risk of developing HF, irrespective of baseline cardio-respiratory status and cardiovascular risk factors.

Nurse-Led Care of Heart Failure: Will it Work in Remote Settings?

Publisher: Elsevier BV

Date: 10-2012

DOI: 10.1016/J.HLC.2012.07.004

Abstract: This paper reviews the role of predominantly nurse-led, multidisciplinary, chronic heart failure management programs as part of the gold-standard management of patients discharged from hospital with this syndrome. It discusses the various options for applying these evidence-based programs and how they apply to the management of those living in rural/remote Australia. Specifically, it describes the challenges of applying CHF management in remote settings and how face-to-face, family based programs of care might be particularly effective from an Indigenous perspective. Finally, it describes ongoing research to determine the best approach to CHF management in remote settings.

The WHICH? trial: rationale and design of a pragmatic randomized, multicentre comparison of home- vs. clinic-based management of chronic heart failure patients

Publisher: Wiley

Date: 08-2011

DOI: 10.1093/EURJHF/HFR048

Abstract: To describe the rationale and design of the Which Heart failure Intervention is most Cost-effective & consumer friendly in reducing Hospital care (WHICH?) trial. WHICH? is a pragmatic, multicentre, randomized controlled trial that seeks to determine if multidisciplinary management of chronic heart failure (CHF) patients post-acute hospitalization delivered in a patient's own home is superior to care delivered via a specialist CHF outpatient clinic. The composite primary endpoint is all-cause, unplanned recurrent hospitalization or death during 12-18 months of follow-up. Of 688 eligible patients, 280 patients (73% male and 66% principal diagnosis of CHF) with a mean age of 71 ± 14 years have been randomized to home- (n = 143) or clinic-based (n = 137) post-discharge management. This will provide 80% power (two-sided alpha of 0.05) to detect a 15% absolute difference in both the primary end-point and rate of all-cause hospital stay. Preliminary data suggest that the two groups are well matched in nearly all baseline socio-economic and clinical parameters. The majority of patients have significant co-morbidity, including hypertension (63%), coronary artery disease (55%), and atrial fibrillation (53%) with an accordingly high Charlson Index of Comorbidity Score (6.1 ± 2.4). Despite its relatively small size, the WHICH? trial is well placed to examine the relative impact of two of the most commonly applied forms of face-to-face management designed to reduce recurrent hospitalization and prolong survival in CHF patients.

Undertaking Nursing Interventions Throughout Europe: Research Activities of the Working Group on Cardiovascular Nursing of the European Society of Cardiology

Publisher: Oxford University Press (OUP)

Date: 10-2002

DOI: 10.1016/S1474-5151(02)00036-1

Abstract: The working Group on Cardiovascular Nursing is actively involved in international research though the UNITE (Undertaking Nursing Research Throughout Europe) research program, a new initiative for the WGCN. A group of cardiovascular nursing researchers from a number of different European countries committed themselves to a research group that is designed to promulgate international research in the field of cardiac nursing. The first study was a survey on coronary risk factors in a cohort of cardiac nurses from Europe. At this moment four additional studies are planned aimed at the development of the nursing profession in Europe and improvement of care for patients with chronic cardiac disease. If, as hoped, these studies prove to be successful, it will provide the seed for other international collaborations of this type.

Trends in case-fatality in 22 968 patients admitted for the first time with atrial fibrillation in Scotland, 1986–1995

Publisher: Elsevier BV

Date: 03-2002

DOI: 10.1016/S0167-5273(01)00626-X

Abstract: Although atrial fibrillation (AF) is an important cause of cardiovascular morbidity and mortality there is a paucity of data describing hospitalisation rates and case-fatality associated with this common arrhythmia. This study examines recent trends in first-ever hospitalisations for AF in Scotland. Using the linked Scottish Morbidity Record Scheme, we identified all 22968 patients admitted to Scottish hospitals for the first time with a principal diagnosis of AF between 1986 and 1995. For each calendar year we calculated short (30-day) and medium (31 day to 2 years) case-fatality rates. Adjusting for each patient's age, sex, deprivation status, concurrent diagnoses and prior hospitalisation status, we examined whether case-fatality rates had significantly improved during this 10-year period. Between 1986 and 1995 the number of men hospitalised for the first time with AF increased by 926 (125%) to 1730 per annum and the number of women and by 875 (105%) to 1712 (both P<0.001). Hospitalisation rates increased from 0.31 to 0.70/1000 men and from 0.32 to 0.65/1000 women (both P<0.001). By the end of this period the proportion of men had increased from 48 to 50%. In both sexes, the median age of patients rose--in men from 66 to 68 years and in women from 74 to 75 years (both P<0.01). Despite the increasing age of patients and greater comorbidity, short-term (30-day) case-fatality declined from 4.0 to 3.1% in men (P<0.001) and 4.1 to 3.8% (P<0.01) in women. Similarly, medium-term (31-day to 2-year) case-fatality fell from 25 to 22% in men and 27 to 25% (both P<0.001) in women. Adjusting for the age, sex, extent of deprivation, secondary diagnoses and prior hospitalisation of hospitalised patients, we found that the risk of short-term case-fatality in the 1995 male and female cohort significantly declined by 21% (P<0.05) and 24% (P<0.05), respectively, in comparison to the 1986 cohort. The adjusted risk of case-fatality in the medium term also declined significantly in men by 30% (P<0.05) over this period and by 20% (P<0.05) in women relative to 1986. The number of first-ever hospitalisations for AF has increased twofold during the 10-year period 1986-1995. Although the age of patients has progressively increased during this period, short and medium case-fatality rates have declined, especially in men. This may partly reflect better treatment of AF. However, changing admission thresholds and other factors could also have led to an apparent improvement in prognosis. Nevertheless, medium-term case fatality remains substantial after a first ever admission to hospital with AF.

Threshold of Pulmonary Hypertension Associated With Increased Mortality

Publisher: Elsevier BV

Date: 06-2019

DOI: 10.1016/J.JACC.2019.03.482

Abstract: There is increasing evidence that current thresholds for diagnosing pulmonary hypertension (PHT) underestimate the prognostic impact of PHT. The aim of this study was to determine the prognostic impact of increasing pulmonary pressures within the National Echocardiography Database of Australia cohort (n = 313,492). The distribution of estimated right ventricular systolic pressure (eRVSP) was examined in 157,842 men and women. All had data linkage to long-term survival during median follow-up of 4.2 years (interquartile range: 2.2 to 7.5 years). The cohort comprised 74,405 men and 83,437 women 65.6 ± 17.7 years of age. Overall, 17,955 (11.4%), 7,016 (4.4%), and 4,515 (2.9%) subjects had eRVSP levels indicative of mild (40 to 49 mm Hg), moderate (50 to 59 mm Hg), or severe (≥60 mm Hg) PHT, respectively, assuming a right atrial pressure of 5 mm Hg. These subjects were more likely to die during long-term follow up (for severe PHT, adjusted hazard ratio: 9.73 95% confidence interval: 8.60 to 11.0 p < 0.001). After adjustment for age, sex, and evidence of left heart disease, those subjects with eRVSP levels within the third (28.05 to 32.0 mm Hg hazard ratio: 1.410 95% confidence interval: 1.310 to 1.517) and fourth (32.05 to 38.83 mm Hg hazard ratio: 1.979 95% confidence interval: 1.853 to 2.114) quintiles had significantly higher mortality (p 30.0 mm Hg) indicative of PHT was identified. (A Longitudinal Cohort Study of Echocardiograms From Public and Private Echocardiography Laboratories From Around Australia, Linked With the National Deaths Index ACTRN12617001387314).

Impact of body mass index on mortality and hospitalisation of patients with atrial fibrillation

Publisher: Oxford University Press (OUP)

Date: 17-04-2018

DOI: 10.1177/1474515118772446

Abstract: Atrial fibrillation represents a substantial clinical and public health issue. The definitive impact of body mass index on prognosis of patients with chronic (persistent or permanent) atrial fibrillation remains undetermined. The purpose of this study was to investigate the association of body mass index with health outcomes (mortality and re-hospitalisation) of patients with chronic atrial fibrillation. Using data from the Standard versus Atrial Fibrillation spEcific managemenT strategY (SAFETY) trial (a randomised controlled trial of home-based, atrial fibrillation-specific disease management), we performed post-hoc analyses of mortality and re-hospitalisation outcomes during minimum 24-month follow-up according to baseline body mass index profile. Of 297 participants (mean age 71±11 years, 47% female, mean body mass index 29.6±6.7 kg/m 2 ), 35.0% of participants were overweight (body mass index 25.0–29.9 kg/m 2 ) and 43.1% were obese (body mass index≥30 kg/m 2 ). During follow-up, n=42 died including 16/65 (24.6%) classified as normal body mass index, 16/104 (15.4%) classified as overweight and 10/128 (7.8%) classified as obese. Increasing body mass index was not associated with increased mortality but was associated with re-hospitalisation due to cardiovascular disease with greater length-of-stay (odds ratio 1.05 95% confidence interval 1.00–1.09, p=0.032). Obese in iduals experienced increased unplanned admissions compared to overweight in iduals (incidence rate ratio 0.71 95% confidence interval 0.53–0.96, p=0.028), and increased cardiovascular-related (incidence rate ratio 0.58 95% confidence interval 0.39–0.86, p=0.007) and all-cause admissions (incidence rate ratio 0.63 95% confidence interval 0.45–0.89, p=0.008) compared to those classified as normal body mass index. Overweight and obesity were not associated with survival in patients with chronic atrial fibrillation but were associated with more frequent hospital care and prolonged stay.

Does comedy kill? A retrospective, longitudinal cohort, nested case-control study of humour and longevity in 53 British comedians

Publisher: Elsevier BV

Date: 02-2015

DOI: 10.1016/J.IJCARD.2014.11.152

Abstract: This work aims to test the hypothesis that the funniest comedians are most at risk of a premature death and reduced longevity compared to their relatively less funny counterparts. A retrospective longitudinal cohort study with a nested case-control analysis of longevity of 53 male British comedians born between 1900 and 1954 was conducted. All comedians were given a subjective score from 1 (relatively funny) to 10 (hilariously funny) by the study investigators. The survival profile of all comedians was then examined adjusting for decade of birth, whether they worked in a comedy team and their comedy score. A nested case-control analysis examined the longevity of those comedians working in teams according to their pre-specified status within the team (straight/less funny versus funny team member). On an adjusted basis, there was no correlation between the decade of birth (HR 0.94, 95% 0.65 to 1.38 per incremental decade p=0.763) and comedy team status (HR 1.13, 95% 0.51 to 2.48 versus independent comedian p=0.761) with longevity. However, an increasingly funny comedy score was associated with increased mortality (HR 1.24, 95% CI 1.06 to 1.44 per unit funny score p=0.006). Of the 23 comedians adjudged to be very funny (score 8-10), 18 (78%) had died versus 12 (40%) of the rest mean age at death 63.3±12.2 versus 72.3±14.7 (p=0.079). Within comedy teams, those identified as the funnier member(s) of the partnership were, on an adjusted basis, more than three times more likely to die prematurely when compared to their more serious comedy partners (HR 3.52, 95% CI 1.22, 10.1 p=0.020). These data suggest that elite comedians are at increased risk of premature death compared to their less funny counterparts. Mental health issues and personality characteristics that help shape their comedic talent and success may well explain their reduced longevity and raises serious issues for identifying and mitigating their risk of a premature death.

Mild cognitive impairment in high-risk patients with chronic atrial fibrillation: A forgotten component of clinical management?

Publisher: BMJ

Date: 12-01-2013

DOI: 10.1136/HEARTJNL-2012-303182

Abstract: We examined cognitive function in older hospitalised patients with chronic atrial fibrillation (AF). A prospective substudy of a multicentre randomised trial of an AF-specific disease management intervention (the Standard versus Atrial Fibrillation spEcific managemenT studY SAFETY). Three tertiary referral hospitals within Australia. A total of 260 patients with chronic AF: mean age 72±11 years, 53% men, mean CHA2DS2-VASc score 4±2. Cognitive function was assessed at baseline (during inpatient stay) using the Montreal Cognitive Assessment (MoCA). The extent of mild cognitive impairment (MCI-defined as a MoCA score <26) in AF patients and identification of independent predictors of MCI. Overall, 169 patients (65%, 95% CI 59% to 71%) were found to have MCI at baseline (mean MoCA score 21±3). Multiple deficits in cognitive domains were identified, most notably in executive functioning, visuospatial abilities and short-term memory. Predictors of MCI (age and sex-adjusted) were lower education level (technical/trade school level OR 6.00, 95% CI 2.07 to 17.42 <8 years school education OR 5.29, 95% CI 1.95 to 14.36 vs 8-13 years), higher CHA2DS2-VASc score (OR 1.46, 95% CI 1.23 to 1.74) and prescribed digoxin (OR 2.19, 95% CI 1.17 to 4.10). MCI is highly prevalent amongst typically older high-risk patients hospitalised with AF. Routine assessment of cognitive function with adjustment of clinical management is indicated for this patient group.

Post-discharge electrocardiogram Holter monitoring in recently hospitalised individuals with chronic atrial fibrillation to enhance therapeutic monitoring and identify potentially predictive phenotype

Publisher: Oxford University Press (OUP)

Date: 14-08-2016

DOI: 10.1177/1474515114547650

Abstract: Atrial fibrillation (AF) is the most common cardiac arrhythmia managed in clinical practice. Maintenance of intended rate or rhythm control following hospitalisation is a key therapeutic goal. The purpose of this study was to assess post-discharge maintenance of intended AF control and classify potentially predictive heart rate (HR) phenotypes via electrocardiogram (ECG) Holter monitoring. In a sub-study of a multicentre randomised controlled trial comparing AF-specific management with usual care, 24-hour ECG Holter monitoring was undertaken in 133 patients 7-14 days post-discharge. Intended rate and rhythm control were compared to Holter data. Analysis of the frequency distribution of mean hour-to-hour differences identified those with labile HRs. Mean age was 71 ± 10 years, 67 (50%) were male and mean HR was 72 ± 14 bpm. Most (89%) had persistent AF (median time in AF=39% (IQR 0-100%)). Uncontrolled HR (>90 bpm for >10% of recording) occurred in 35 (26%) patients and 49 (37%) patients did not achieve their intended rate (n=26) or rhythm control (n=23). Patients in the upper quartile of mean hour-to-hour HR variability were identified as persistently labile (n=33). A further group (n=22) with periodically labile HRs was identified. Those with coronary artery disease (OR 0.34 95% CI 0.13-0.91, p=0.033) or renal disease/dysfunction (OR 0.24 95% CI 0.06-0.98, p=0.047) were less likely to demonstrate HR stability (n=78). Post-discharge ECG Holter monitoring of AF patients represents a valuable tool to identify deviations in intended rhythm/rate control and adjust therapeutic management accordingly. It may also identify in iduals who demonstrate labile HRs.

Contribution of the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic to de novo presentations of heart disease in the Heart of Soweto Study cohort

Publisher: Oxford University Press (OUP)

Date: 11-2011

DOI: 10.1093/EURHEARTJ/EHR398

A systematic approach to chronic heart failure care: A consensus statement

Publisher: AMPCo

Date: 08-2014

DOI: 10.5694/MJA14.00032

Abstract: The National Heart Foundation of Australia assembled an expert panel to provide guidance on policy and system changes to improve the quality of care for people with chronic heart failure (CHF). The recommendations have the potential to reduce emergency presentations, hospitalisations and premature death among patients with CHF. Best-practice management of CHF involves evidence-based, multidisciplinary, patient-centred care, which leads to better health outcomes. A CHF care model is required to achieve this. Although CHF management programs exist, ensuring access for everyone remains a challenge. This is particularly so for Aboriginal and Torres Strait Islander peoples, those from non-metropolitan areas and lower socioeconomic backgrounds, and culturally and linguistically erse populations. Lack of data and inadequate identification of people with CHF prevents efficient patient monitoring, limiting information to improve or optimise care. This leads to ineffectiveness in measuring outcomes and evaluating the CHF care provided. Expanding current cardiac registries to include patients with CHF and developing mechanisms to promote data linkage across care transitions are essential. As the prevalence of CHF rises, the demand for multidisciplinary workforce support will increase. Workforce planning should provide access to services outside of large cities, one of the main challenges it is currently facing. To enhance community-based management of CHF, general practitioners should be empowered to lead care. Incentive arrangements should favour provision of care for Aboriginal and Torres Strait Islander peoples, those from lower socioeconomic backgrounds and rural areas, and culturally and linguistically erse populations. Ongoing research is vital to improving systems of care for people with CHF. Future research activity needs to ensure the translation of valuable knowledge and high-quality evidence into practice.

Malignant and benign phenotypes of multimorbidity in heart failure: Implications for clinical practice

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 05-2019

DOI: 10.1097/JCN.0000000000000557

National survey of the prevalence, incidence, primary care burden, and treatment of heart failure in Scotland

Publisher: BMJ

Date: 10-2004

DOI: 10.1136/HRT.2003.029553

Standard vs. intensified management of heart failure to reduce healthcare costs: Results of a multicentre, randomized controlled trial

Publisher: Oxford University Press (OUP)

Date: 20-05-2017

DOI: 10.1093/EURHEARTJ/EHX259

Incidence and characteristics of newly diagnosed rheumatic heart disease in Urban African adults: insights from the Heart of Soweto Study

Publisher: Oxford University Press (OUP)

Date: 07-12-2009

DOI: 10.1093/EURHEARTJ/EHP530

Abstract: Little is known on the incidence and clinical characteristics of newly diagnosed rheumatic heart disease (RHD) in adulthood from urban African communities in epidemiologic transition. Chris Hani Baragwanath Hospital services the black African community of 1.1 million people in Soweto, South Africa. A prospective, clinical registry captured data from all de novo cases of structural and functional valvular heart disease (VHD) presenting to the Cardiology Unit during 2006/07. We describe in detail all cases with newly diagnosed RHD. There were 4005 de novo presentations in 2006/07 and 960 (24%) had a valvular abnormality. Of these, 344 cases (36%) were diagnosed with RHD. Estimated incidence of new cases of RHD for those aged >14 years in the region was 23.5 cases/100 000 per annum. Most were black African females (n = 234-68%) with a similar age profile to males [median 41 (interquartile range 30-55) years vs. 42 (interquartile range 31-55) years]. The predominant valvular lesion (n = 204, 59%) was mitral regurgitation (MR), with 48 (14%) and 43 (13%) cases, respectively, having combination lesions of aortic plus MR and mixed mitral VHD. Impaired systolic function was found in 28/204 cases (14%) of predominant MR and in 23/126 cases (18%) with predominant aortic regurgitation. Elevated right ventricular systolic pressure >35 mmHg (62 cases), atrial fibrillation (34 cases), and anaemia (27 cases) were found in 18, 10, and 8% of 344 RHD cases, respectively. Subsequent valve replacement/repair was performed in 75 patients (22%). A total of 90 cases (26%) were admitted within 30 months of initial diagnosis for suspected bacterial endocarditis. These data reveal a high incidence of newly diagnosed RHD within an adult urban African community. These data argue strongly for the first episode of RHD to be made a notifiable condition in high burden countries in order to ensure control of the disease through register-based secondary prophylaxis programmes.

Platelet Nitric Oxide Responsiveness

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 12-2005

DOI: 10.1161/01.ATV.0000193622.77294.57

Abstract: Objectives— Nitric oxide (NO) is critically important in the regulation of vascular tone and the inhibition of platelet aggregation. We have shown previously that patients with acute coronary syndromes (ACS) or stable angina pectoris have impaired platelet responses to NO donors when compared with normal subjects. We tested the hypotheses that platelet hyporesponsiveness to NO is a predictor of (1) cardiovascular readmission and/or death and (2) all-cause mortality in patients with ACS (unstable angina pectoris or non–Q-wave myocardial infarction). Methods and Results— Patients (n=51) with ACS had evaluation of platelet aggregation within 24 hours of coronary care unit admission using impedance aggregometry. Patients were categorized as having “normal” (≥32% inhibition of ADP-induced aggregation with the NO donor sodium nitroprusside 10 μmol/L n=18) or “impaired” ( % inhibition of ADP-induced aggregation n=33) NO responses. We then compared the incidence of cardiovascular readmission and death during a median of 7 years of follow-up in these 2 groups. Using a Cox proportional hazards model adjusting for age, sex, index event, postdischarge medical treatment, revascularization status, left ventricular systolic dysfunction, concurrent disease states, and cardiac risk factors, impaired NO responsiveness was associated with an increased risk of the combination of cardiovascular readmission and/or death (relative risk, 2.7 95% CI, 1.03 to 7.10 P =0.041) and all-cause mortality (relative risk, 6.3 95% CI, 1.09 to 36.7 P =0.033). Conclusions— Impaired platelet NO responsiveness is a novel, independent predictor of increased mortality and cardiovascular morbidity in patients with high-risk ACS.

Is fenofibrate a cost-saving treatment for middle-aged individuals with type II diabetes? An economic analysis of the FIELD Study

Publisher: Elsevier BV

Date: 06-2008

DOI: 10.1016/J.IJCARD.2007.04.040

Abstract: The aim of this study was to determine the impact of fenofibrate therapy on health care costs in middle-aged patients with type II diabetes at high risk of future cardiovascular events. We undertook an economic analysis of the FIELD study conducted from the perspective of the third party payer (direct costs) with all "within trial" health care costs derived from reported clinical outcomes using pooled data from all 9795 study participants. All analyses were performed on an intention-to-treat-basis and items of expenditure were derived from 2001/2002 health economic data: comparing Diagnostic Related Groupings (DRG) costs of major morbid events from an average of unit costs derived from three European countries (UK, France and Germany). Despite the additional cost of applying fenofibrate therapy, that was off-set slightly by a reduced need for supplementary lipid-lowering therapy (a net cost increase of 20,495 Euros per 1000 person years to apply combined lipid-lowering therapy), fenofibrate was associated with a net saving of 23,607 Euros in health care costs per 1000 person years of follow-up. This represents an approximate 10% net saving in health care costs (total of 227,111 versus 203,415 Euros for the placebo and treatment groups, respectively). As such, based on the 95% CI calculated for observed event rates per 1000 person years at risk, the cost impact of fenofibrate therapy ranged from a 24% net saving to a 4% net increase in health care costs relative to treatment with placebo. When the highest compared to lowest DRG unit costs were applied to observed event rates, the cost impact of fenofibrate therapy varied from a 5% to 12% net saving (low versus high cost health care models) in health care costs relative to usual care. The robust nature of these analyses suggest potential cost advantages in the longer-term by applying fenofibrate in this type of patient cohort (quite possibly in combination with statin therapy) via a marked reduction in costly cardiac events and procedures.

Systematic review of model-based analyses reporting the cost-effectiveness and cost-utility of cardiovascular disease management programs

Publisher: Oxford University Press (OUP)

Date: 16-05-2015

DOI: 10.1177/1474515114536093

Abstract: The reported cost effectiveness of cardiovascular disease management programs (CVD-MPs) is highly variable, potentially leading to different funding decisions. This systematic review evaluates published modeled analyses to compare study methods and quality. Articles were included if an incremental cost-effectiveness ratio (ICER) or cost-utility ratio (ICUR) was reported, it is a multi-component intervention designed to manage or prevent a cardiovascular disease condition, and it addressed all domains specified in the American Heart Association Taxonomy for Disease Management. Nine articles (reporting 10 clinical outcomes) were included. Eight cost-utility and two cost-effectiveness analyses targeted hypertension (n=4), coronary heart disease (n=2), coronary heart disease plus stoke (n=1), heart failure (n=2) and hyperlipidemia (n=1). Study perspectives included the healthcare system (n=5), societal and fund holders (n=1), a third party payer (n=3), or was not explicitly stated (n=1). All analyses were modeled based on interventions of one to two years' duration. Time horizon ranged from two years (n=1), 10 years (n=1) and lifetime (n=8). Model structures included Markov model (n=8), 'decision analytic models' (n=1), or was not explicitly stated (n=1). Considerable variation was observed in clinical and economic assumptions and reporting practices. Of all ICERs/ICURs reported, including those of subgroups (n=16), four were above a US$50,000 acceptability threshold, six were below and six were dominant. The majority of CVD-MPs was reported to have favorable economic outcomes, but 25% were at unacceptably high cost for the outcomes. Use of standardized reporting tools should increase transparency and inform what drives the cost-effectiveness of CVD-MPs.

Uncovering the treatable burden of severe aortic stenosis in the UK

Publisher: BMJ

Date: 2022

DOI: 10.1136/OPENHRT-2021-001783

Abstract: To estimate the population prevalence and treatable burden of severe aortic stenosis (AS) in the UK. We adapted a contemporary model of the population profile of symptomatic and asymptomatic severe AS in Europe and North America to estimate the number of people aged ≥55 years in the UK who might benefit from surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). With a point prevalence of 1.48%, we estimate that 291 448 men and women aged ≥55 years in the UK had severe AS in 2019. Of these, 68.3% (199 059, 95% CI 1 77 201 to 221 355 people) would have been symptomatic and, therefore, more readily treated according to their surgical risk profile the remaining 31.7% of cases (92 389, 95% CI 70 093 to 144 247) being asymptomatic. Based on historical patterns of intervention, 58.4% (116 251, 95% CI 106 895 to 1 25 606) of the 199 059 symptomatic cases would qualify for SAVR, with 7208 (95% CI 7091 to 7234) being assessed as being in a high, preoperative surgical risk category. Among the remaining 41.6% (82 809, 95% CI 73 453 to 92 164) of cases potentially unsuitable for SAVR, an estimated 61.7% (51 093, 95% CI 34 780 to 67 655) might be suitable for TAVI. We estimate that 172 859 out of 291 448 prevalent cases of severe AS (59.3%) will subsequently die within 5 years without proactive management. These data suggest a high burden of severe AS in the UK requiring surgical or transcatheter intervention that challenges the ongoing capacity of the National Health Service to meet the needs of those affected.

Prevalence and profile of “seasonal frequent flyers” with chronic heart disease: Analysis of 1598 patients and 4588 patient-years follow-up

Publisher: Elsevier BV

Date: 03-2019

DOI: 10.1016/J.IJCARD.2018.12.060

Abstract: Peaks and troughs in cardiovascular events correlated with seasonal change is well established from an epidemiological perspective but not a clinical one. Retrospective analysis of the recruitment, baseline characteristics and outcomes during minimum 12-month exposure to all four seasons in 1598 disease-management trial patients hospitalised with chronic heart disease. Seasonality was prospectively defined as ≥4 hospitalisations (all-cause) AND >45% of related bed-days occurring in any one season during median 988 (IQR 653, 1394) days follow-up. Patients (39% female) were aged 70 ± 12 years and had a combination of coronary artery disease (58%), heart failure (54%), atrial fibrillation (50%) and multimorbidity. Overall, 29.9% of patients displayed a pattern of seasonality. Independent correlates of seasonality were female gender (adjusted OR 1.27, 95% CI 1.01-1.61 p = 0.042), mild cognitive impairment (adjusted OR 1.51, 95% CI 1.16-1.97 p = 0.002), greater multimorbidity (OR 1.20, 95% CI 1.15-1.26 per Charlson Comorbidity Index Score p < 0.001), higher systolic (OR 1.01, 95%CI 1.00-1.01 per 1 mmHg p = 0.002) and lower diastolic (OR 0.99, 95% CI 0.98-1.00 per 1 mmHg p = 0.002) blood pressure. These patients were more than two-fold more likely to die (adjusted HR 2.16, 95% CI 1.60-2.90 p < 0.001) with the highest and lowest number of deaths occurring during spring (31.7%) and summer (19.9%), respectively. Despite high quality care and regardless of their diagnosis, we identified a significant proportion of "seasonal frequent flyers" with concurrent poor survival in this real-world cohort of patients with chronic heart disease.

Pressure points in primary care: Blood pressure and management of hypertension in 532 050 patients from 2005 to 2010

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 06-2013

DOI: 10.1097/HJH.0B013E3283606BC7

Telephone Support to Rural and Remote Patients with Heart Failure: The Chronic Heart Failure Assessment by Telephone (CHAT) study

Publisher: Wiley

Date: 18-07-2013

DOI: 10.1111/1755-5922.12009

Abstract: Heart failure (HF) remains a condition with high morbidity and mortality. We tested a telephone support strategy to reduce major events in rural and remote Australians with HF, who have limited healthcare access. Telephone support comprised an interactive telecommunication software tool (TeleWatch) with follow-up by trained cardiac nurses. Patients with a general practice (GP) diagnosis of HF were randomized to usual care (UC) or UC and telephone support intervention (UC+I) using a cluster design involving 143 GPs throughout Australia. Patients were followed up for 12 months. The primary endpoint was the Packer clinical composite score. Secondary endpoints included hospitalization for any cause, death or hospitalization, as well as HF hospitalization. Four hundred and five patients were randomized to CHAT. Patients were well matched at baseline for key demographic variables. The primary endpoint of the Packer score was not different between the two groups (P = 0.98), although more patients improved with UC+I. There were fewer patients hospitalized for any cause (74 vs. 114, adjusted HR 0.67 [95% CI 0.50-0.89], P = 0.006) and who died or were hospitalized (89 vs. 124, adjusted HR 0.70 [95% CI 0.53-0.92], P = 0.011), in the UC+I vs. UC group. HF hospitalizations were reduced with UC+I (23 vs. 35, adjusted HR 0.81 [95% CI 0.44-1.38]), although this was not significant (P = 0.43). There were 16 deaths in the UC group and 17 in the UC+I group (P = 0.43). Although no difference was observed in the primary endpoint of CHAT (Packer composite score), UC+I significantly reduced the number of HF patients hospitalized among a rural and remote cohort. These data suggest that telephone support may be an efficacious approach to improve clinical outcomes in rural and remote HF patients.

Is there an association between sleeping patterns and other environmental factors with obesity and blood pressure in an Urban African population?

Publisher: Public Library of Science (PLoS)

Date: 08-10-2015

DOI: 10.1371/JOURNAL.PONE.0131081

Validity of the Montreal Cognitive Assessment (MoCA) as a screening test for Mild Cognitive Impairment (MCI) in a cardiovascular population

Publisher: SAGE Publications

Date: 14-12-2011

DOI: 10.1177/0891988710390813

Abstract: While rates of mild cognitive impairment (MCI) are relatively high in populations with cardiovascular diseases and risk factors, screening tests for MCI have not been evaluated in this patient group. This study investigated the sensitivity and specificity of the Montreal Cognitive Assessment (MoCA) tool for detecting MCI in 110 patients (mean age 67.9 + 11.7 years 60% female) recruited from hospital cardiovascular outpatient clinics. Mean MoCA performance was relatively low (22.8 + 3.8) in this group, with 72.1% of participants scoring below the recommended cutoff for cognitive impairment ( ). The presence of MCI was determined using the Neuropsychological Assessment Battery Screening Module (NAB-SM). Both amnestic MCI and multiple-domain MCI were identified. The optimum MoCA cutoff for detecting MCI in this group was . At this cutoff, the MoCA’s sensitivity for detecting amnestic MCI was 100% and for multiple-domain MCI it was 83.3%. Specificity rates for amnestic MCI and multiple-domain MCI were 50.0% and 52% respectively. The poor specificity of the MoCA suggests that it will have limited value as a screening test for MCI in settings where the overall prevalence of MCI is low.

Kidney age - chronological age difference (KCD) score provides an age-adapted measure of kidney function

Publisher: Springer Science and Business Media LLC

Date: 26-04-2021

DOI: 10.1186/S12882-021-02324-Y

Abstract: Given the age-related decline in glomerular filtration rate (GFR) in healthy in iduals, we examined the association of all-cause death or cardiovascular event with the Kidney age - Chronological age Difference (KCD) score, whereby an in idual’s kidney age is estimated from their estimated GFR (eGFR) and the age-dependent eGFR decline reported for healthy living potential kidney donors. We examined the association between death or cardiovascular event and KCD score, age-dependent stepped eGFR criteria (eGFRstep), and eGFR 60 ml/min/1.73 m 2 (eGFR60) in a community-based high cardiovascular risk cohort of 3837 in iduals aged ≥60 (median 70, interquartile range 65, 75) years, followed for a median of 5.6 years. In proportional hazards analysis, KCD score ≥ 20 years (KCD20) was associated with increased risk of death or cardiovascular event in unadjusted analysis and after adjustment for age, sex and cardiovascular risk factors. Addition of KCD20, eGFRstep or eGFR60 to a cardiovascular risk factor model did not improve area under the curve for identification of in iduals who experienced death or cardiovascular event in receiver operating characteristic curve analysis. However, addition of KCD20 or eGFR60, but not eGFRstep, to a cardiovascular risk factor model improved net reclassification and integrated discrimination. KCD20 identified in iduals who experienced death or cardiovascular event with greater sensitivity than eGFRstep for all participants, and with greater sensitivity than eGFR60 for participants aged 60–69 years, with similar sensitivities for men and women. In this high cardiovascular risk cohort aged ≥60 years, the KCD score provided an age-adapted measure of kidney function that may assist patient education, and KCD20 provided an age-adapted criterion of eGFR-related increased risk of death or cardiovascular event. Further studies that include the full age spectrum are required to examine the optimal KCD score cut point that identifies increased risk of death or cardiovascular event, and kidney events, associated with impaired kidney function, and whether the optimal KCD score cut point is similar for men and women. ClinicalTrials.gov NCT00400257 , NCT00604006 , and NCT01581827 .

MCL-1 inhibition provides a new way to suppress breast cancer metastasis and increase sensitivity to dasatinib

Publisher: Springer Science and Business Media LLC

Date: 12-2016

DOI: 10.1186/S13058-016-0781-6

Amino-terminal-pro-B-type natriuretic peptide levels and low diastolic blood pressure: Potential relevance to the diastolic J-curve

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 11-2014

DOI: 10.1097/HJH.0000000000000320

Rationale and design of the pan African pulmonary hypertension cohort (PAPUCO) study: implementing a contemporary registry on pulmonary hypertension in Africa

Publisher: BMJ

Date: 10-2014

DOI: 10.1136/BMJOPEN-2014-005950

Abstract: Pulmonary hypertension (PH) is a devastating, progressive disease with increasingly debilitating symptoms and usually shortened overall life expectancy due to a narrowing of the pulmonary vasculature and consecutive right heart failure. Little is known about PH in Africa, but limited reports suggest that PH is more prevalent in Africa compared with developed countries due to the high prevalence of risk factors in the region. A multinational multicentre registry-type cohort study was established and tailored to resource-constraint settings to describe disease presentation, disease severity and aetiologies of PH, comorbidities, diagnostic and therapeutic management, and the natural course of PH in Africa. PH will be diagnosed by specialist cardiologists using echocardiography (right ventricular systolic pressure mm Hg, absence of pulmonary stenosis and acute right heart failure), usually accompanied by shortness of breath, fatigue, peripheral oedema and other cardiovascular symptoms, ECG and chest X-ray changes in keeping with PH as per guidelines (European Society of Cardiology and European Respiratory Society (ESC/ERS) guidelines). Additional investigations such as a CT scan, a ventilation erfusion scan or right heart catheterisation will be performed at the discretion of the treating physician. Functional tests include a 6 min walk test and the Karnofsky Performance Score. The WHO classification system for PH will be applied to describe the different aetiologies of PH. Several substudies have been implemented within the registry to investigate specific types of PH and their outcome at up to 24 months. Data will be analysed by an independent institution following a data analyse plan. All local ethics committees of the participating centres approved the protocol. The data will be disseminated through peer-reviewed journals at national and international conferences and public events at local care providers.

Anaemia and renal function in heart failure due to idiopathic dilated cardiomyopathy

Publisher: Wiley

Date: 24-03-2007

DOI: 10.1016/J.EJHEART.2006.10.013

Abstract: Anaemia and renal dysfunction are common in patients with heart failure (HF). Most studies involve western cohorts with ischaemic aetiology receiving treatment likely to impair renal function. To investigate the frequency of anaemia and renal dysfunction and the relationship between the two within a cohort of 163 newly diagnosed Black African idiopathic cardiomyopathy patients prior to commencing HF treatments and compare those findings to those of western HF cohorts. Single-centre retrospective analysis. Anaemia defined as haemoglobin concentration<13.0 g/dL for males (n=85) and <12 g/dL for females (n=78). Probable renal dysfunction defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m2, using serum creatinine concentrations. The mean age was 48+/-11 years, 52% were male. Overall, 13.5% of patients were anaemic and 11.8% had evidence of renal dysfunction, while 1.2% had both. Renal dysfunction was significantly more common in older patients (mean age 58+/-13 vs. 47+/-10 years: p<0.001). The frequency of anaemia and renal dysfunction in this cohort was lower than that reported in western HF cohorts. These data infer a more limited relationship between HF, anaemia and renal dysfunction in patients without atherothrombotic disease hence extrapolation of HF data from the western world to other populations should be interpreted cautiously.

Impact of home versus clinic-based management of chronic heart failure: The WHICH? (Which heart failure intervention is most cost-effective & consumer friendly in reducing hospital care) multicenter, randomized trial

Publisher: Elsevier BV

Date: 10-2012

DOI: 10.1016/J.JACC.2012.06.025

Abstract: The goal of this study was to make a head-to-head comparison of 2 common forms of multidisciplinary chronic heart failure (CHF) management. Although direct patient contact appears to be best in delivering CHF management overall, the precise form to optimize health outcomes is less clear. This prospective, multicenter randomized controlled trial with blinded endpoint adjudication comprised 280 hospitalized CHF patients (73% male, age 71 ± 14 years, and 73% with left ventricular ejection fraction ≤45%) randomized to home-based intervention (HBI) or specialized CHF clinic-based intervention (CBI). The primary endpoint was all-cause, unplanned hospitalization or death during 12- to 18-month follow-up. Secondary endpoints included type/duration of hospitalization and healthcare costs. The primary endpoint occurred in 102 of 143 (71%) HBI versus 104 of 137 (76%) CBI patients (adjusted hazard ratio [HR]: 0.97 [95% confidence interval (CI): 0.73 to 1.30], p = 0.861): 96 (67.1%) HBI versus 95 (69.3%) CBI patients had an unplanned hospitalization (p = 0.887), and 31 (21.7%) versus 38 (27.7%) died (p = 0.252). The median duration of each unplanned hospitalization was significantly less in the HBI group (4.0 [interquartile range (IQR): 2.0 to 7.0] days vs. 6.0 [IQR: 3.5 to 13] days p = 0.004). Overall, 75% of all hospitalization was attributable to 64 (22.9%) patients, of whom 43 (67%) were CBI patients (adjusted odds ratio: 2.55 [95% CI: 1.37 to 4.73], p = 0.003). HBI was associated with significantly fewer days of all-cause hospitalization (-35% p = 0.003) and from cardiovascular causes (-37% p = 0.025) but not for CHF (-24% p = 0.218). Consequently, healthcare costs ($AU3.93 vs. $AU5.53 million) were significantly less for the HBI group (median: $AU34 [IQR: 13 to 81] per day vs. $AU52 [17 to 140] per day p = 0.030). HBI was not superior to CBI in reducing all-cause death or hospitalization. However, HBI was associated with significantly lower healthcare costs, attributable to fewer days of hospitalization. (Which Heart failure Intervention is most Cost-effective & consumer friendly in reducing Hospital care [WHICH?] ACTRN12607000069459).

Atrial fibrillation: Profile and burden of an evolving epidemic in the 21st century

Publisher: Elsevier BV

Date: 09-2013

DOI: 10.1016/J.IJCARD.2012.12.093

Abstract: Atrial fibrillation (AF) represents an increasing public health challenge with profound social and economic implications. A comprehensive synthesis and review of the AF literature was performed. Overall, key findings from 182 studies were used to describe the indicative scope and impact of AF from an in idual to population perspective. There are many pathways to AF including advancing age, cardiovascular disease and increased levels of obesity/metabolic disorders. The reported population prevalence of AF ranges from 2.3%-3.4% and historical trends reflect increased AF incidence. Estimated life-time risk of AF is around 1 in 4. Primary care contacts reflect whole population trends: AF-related case-presentations increase from less than 0.5% in those aged 40 years or less to 6-12% for those aged 85 years or more. Globally, AF-related hospitalisations (primary or secondary diagnosis) showed an upward trend (from ~35 to over 100 admissions/10,000 persons) during 1996 to 2006. The estimated cost of AF is greater than 1% of health care expenditure and rising with hospitalisations the largest contributor. For affected in iduals, quality of life indices are poor and AF confers an independent 1.5 to 2.0-fold probability of death in the longer-term. AF is also closely linked to ischaemic stroke (3- to 5-fold risk), chronic heart failure (up to 50% develop AF) and acute coronary syndromes (up to 25% develop AF) with consistently worse outcomes reported with concurrent AF. Future projections predict at least a doubling of AF cases by 2050. AF represents an evolving, global epidemic providing considerable challenges to minimise its impact from an in idual to whole society perspective.

Trends in out-of-hospital deaths due to coronary heart disease in Sweden (1991 to 2006)

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 2011

DOI: 10.1161/CIRCULATIONAHA.110.964999

Abstract: Case fatality associated with a first coronary event is often underestimated when only those who survive to reach a hospital are considered. Few studies have examined long-term trends in case fatality associated with a major coronary event that occurs out of the hospital. Record linkage documented all case subjects 35 to 84 years of age in Sweden during 1991 to 2006 with a first major coronary event (out-of-hospital coronary death or hospitalization for acute myocardial infarction). Of the 384 597 cases identified, 111 319 (28.9%) died out of the hospital, and another 36 552 (9.5%) died in the hospital or within 28 days of hospitalization. From 1991 to 2006, out-of hospital deaths as a proportion of all major coronary events declined from 30.5% to 25.6% (adjusted mean annual decrease 2.2%, 95% confidence interval 2.1% to 2.4%), however, with a larger decline in 28-day case fatality in hospitalized cases (adjusted mean annual decrease 5.8%, 95% confidence interval 5.5% to 6.0%). As a result of the faster decline in in-hospital deaths, the relative contribution of out-of-hospital deaths to overall case fatality increased, particularly among younger in iduals (eg, among those 35 to 54 years of age, no more than 10.8% of all deaths occurred in hospitalized cases during 2003–2006). Although female sex (odds ratio 0.85, 95% confidence interval 0.83 to 0.87) and older age (odds ratio 0.972, 95% confidence interval 0.971 to 0.974 per year) were associated with lower risk for initial out-of-hospital death, each successive calendar year was associated with increased risk (odds ratio 1.041, 95% confidence interval 1.038 to 1.044). The great majority of all fatal coronary events occur outside the hospital, and this proportion is increasing, particularly among younger in iduals.

Consistency in size and asymmetry of the psoas major muscle among elite footballers

Publisher: BMJ

Date: 26-05-2009

DOI: 10.1136/BJSM.2009.058909

Abstract: To determine, using magnetic resonance imaging (MRI), the cross-sectional area (CSA) of the psoas major (PM) muscle across multiple vertebral levels, to examine any asymmetry of the PM muscle and investigate the consistency across vertebral levels, and to determine whether a relationship exists between low back pain (LBP) and the size or asymmetry of the PM muscle among elite Australian Rules football (AFL) players. Observational cross-sectional study. Assessments and MRI examinations were carried out in a hospital setting. Thirty-one male elite AFL players aged between 20 and 32 years participated in the study. The independent factors in the study were "asymmetry" (coded as ipsilateral or contralateral to kicking leg) and "group" (current LBP versus no current LBP). The dependent variable in the study was the CSA of the PM muscle. The PM muscle was larger on the side of the dominant kicking leg at all four vertebral levels measured (F = 7.28, p = 0.012). Participants who reported current LBP had larger PM muscles than the remainder of the players (F = 4.63, p = 0.041). Additional investigation into the underlying mechanisms of the observed differences in PM muscle size could help to develop treatment and rehabilitation programmes aimed at reducing the incidence of LBP among AFL players. Furthermore, asymmetry of the PM muscle was observed at multiple vertebral levels and therefore future studies may only need to take single-level measurements to assess for asymmetry.

Change in ejection fraction and long-term mortality in adults referred for echocardiography

Publisher: Wiley

Date: 04-2021

DOI: 10.1002/EJHF.2161

Abstract: We investigated long‐term mortality associated with changes in left ventricular ejection fraction (LVEF) in a large, real‐world patient cohort. A total of 117 275 adults (63 ± 16 years, 46% women) had LVEF quantified by the same method ≥6 months apart. This included 17 343 cases (66 ± 15 years, 48% women) being initially investigated for heart failure (HF). During 3.3 [interquartile range (IQR) 1.7–6.0] years from first to last echocardiogram, median change in LVEF was −1 (IQR −8 to +5) units from a baseline of 62% (IQR 54–69%). During subsequent 7.6 (IQR 4.3–10.1) years of follow‐up, 11 397 (9.7%) and 34 101 (29.1%) cases died from cardiovascular disease and all causes, respectively. Actual 5‐year, all‐cause mortality increased from 12% to 29% among those with the smallest to the largest decrease in LVEF (from units to units) the adjusted risk of cardiovascular‐related mortality increased two‐ to eightfold beyond a ‐unit decline in LVEF (vs. minimal change P 0.001 for all comparisons). Among those initially investigated for HF (32% with initial LVEF %), the adjusted hazard ratio for cardiovascular‐related mortality ranged from 0.35 [95% confidence interval (CI) 0.28–0.49] to 4.21 (95% CI 3.30–5.22) for a ‐unit increase to ‐unit decline in LVEF (vs. minimal change P 0.001 for both comparisons). A distinctive, bi‐directional plateau of improved vs. worsening mortality was evident around a final LVEF of 50% to 55%. These data, derived from a large, heterogeneous cohort of adults being followed up with echocardiography, suggest that modest LVEF changes (particularly around an LVEF of 50–55%) may be of clinical significance.

The Deleterious Effects of Hyperglycemia on Platelet Function in Diabetic Patients With Acute Coronary Syndromes

Publisher: Elsevier BV

Date: 2007

DOI: 10.1016/J.JACC.2006.08.053

Abstract: This study sought to assess the determinants of platelet nitric oxide (NO) responsiveness in diabetic patients admitted with acute coronary syndromes (ACS) and the short-term effects of aggressive glycemic control on these factors. Hyperglycemia is an independent risk factor for mortality in both diabetic patients and nondiabetic patients with ACS. The mechanism(s) underlying this observation and potential benefit from its correction remain uncertain. Although a reduction in NO bioavailability has been proposed, this remains untested in the ACS setting. A total of 76 diabetic patients with ACS were studied. Putative correlations between admission blood sugar level (BSL), inhibition of platelet aggregation by the NO donor sodium nitroprusside (SNP), and superoxide (O2-) were assessed. Hyperglycemic patients (n = 60) were randomized to acute glycemic control with intravenous versus subcutaneous insulin, and changes in the aforementioned parameters were compared. Plasma levels of the endogenous inhibitor of NO synthase asymmetric dimethylarginine (ADMA) were also monitored. There was an inverse correlation between admission BSL and both platelet SNP response (p = 0.007) and ADMA levels (p = 0.045), and a positive correlation with O2- generation (p < 0.001). Intravenous insulin infusion resulted in a greater reduction (p < 0.001) in BSL, differentially improved platelet responsiveness to SNP (p = 0.049), and decreased O2- (p < 0.001) and ADMA levels (p = 0.049). A component of platelet dysfunction in diabetic patients with ACS is impaired responsiveness to the anti-aggregatory effects of NO, probably reflecting increased NO clearance by O2-. This phenomenon is reversed by acute aggressive glycemic control. These findings provide a further rationale for use of insulin therapy in acute myocardial infarction and suggest its extension to ACS patients.

Pattern of blood pressure in Australian adults: Results from a National Blood Pressure Screening Day of 13,825 adults

Publisher: Elsevier BV

Date: 12-2010

DOI: 10.1016/J.IJCARD.2009.06.003

Abstract: Recent national data of cardiovascular disease (CVD) risk factors in Australia are limited. Therefore this study sought to gain a contemporary snapshot of the blood pressure (BP) profile of Australian adults. We established 100 metropolitan and regional screening sites. Using a standardized protocol and the same automated, validated BP monitor, Registered Nurses recorded the BP and other risk factors for CVD of self-selected volunteers on a single day. A total of 13,825 subjects (55% female, aged 48±16 years) were assessed. Mean systolic and diastolic BP was 131±18 and 79±12 mm Hg. Overall, 34% had an elevated BP while 10% being treated for hypertension (HT) were normotensive (combined total 44%). Elevated BP was more common in older in iduals, men (42% versus 27% of women), regional dwelling residents (40% versus 32% of metropolitan) and people from lower socio-economic backgrounds (39% versus 30% of higher). Overall, 50% of subjects with a history of HT had elevated BP compared to 30% without a history of HT. Adjusting for age and sex, elevated BP was independently associated with obesity (OR: 1.77, 95% CI 1.52-2.06), regional location (OR: 1.32, 95% CI 1.19-1.45) and modifiable risk factors (OR: 1.28, 95% CI 1.21-1.35) those being treated for CVD or diabetes are less likely to have high BP. In the largest study of its kind in Australia, the findings highlight the need for continued vigilance to detect, monitor and prevent elevated BP within an ageing population in whom metabolic disorders are becoming more frequent.

Prolonged effects of a home-based intervention in patients with chronic illness

Publisher: American Medical Association (AMA)

Date: 27-03-2006

DOI: 10.1001/ARCHINTE.166.6.645

Abstract: Data on the long-term benefits of nonspecific disease management programs are limited. We performed a long-term follow-up of a previously published randomized trial. We compared all-cause mortality and recurrent hospitalization during median follow-up of 7.5 years in a heterogeneous cohort of patients with chronic illness initially exposed to a multidisciplinary, home-based intervention (HBI) (n = 260) or to usual postdischarge care (n = 268). During follow-up, HBI had no impact on all-cause mortality (relative risk, 1.04 95% confidence interval, 0.80-1.35) or event-free survival from death or unplanned hospitalization (relative risk, 1.03 95% confidence interval, 0.86-1.24). Initial analysis suggested that HBI had only a marginal impact in reducing unplanned hospitalization, with 677 readmissions vs 824 for the usual care group (mean +/- SD rate, 0.72 +/- 0.96 vs 0.84 +/- 1.20 readmissions atient per year P = .08). When accounting for increased hospital activity in HBI patients with chronic obstructive pulmonary disease during follow-up for 2 years, post hoc analyses showed that HBI reduced readmissions by 14% within 2 years in patients without this condition (mean +/- SD rate, 0.54 +/- 0.72 vs 0.63 +/- 0.88 readmission atient per year P = .04) and by 21% in all surviving patients within 3 to 8 years (mean +/- SD rate, 0.64 +/- 1.26 vs 0.81 +/- 1.61 readmissions atient per year P = .03). Overall, recurrent hospital costs were significantly lower (14%) in the HBI group (mean +/- SD, 823 dollars +/- 1642 dollars vs 960 dollars +/- 1376 dollars per patient per year P = .045). This unique study suggests that a nonspecific HBI provides long-term cost benefits in a range of chronic illnesses, except for chronic obstructive pulmonary disease.

Ejection fraction and mortality: a nationwide register-based cohort study of 499 153 women and men

Publisher: Wiley

Date: 26-11-2021

DOI: 10.1002/EJHF.2047

Abstract: We investigated the sex‐based risk of mortality across the spectrum of left ventricular ejection fraction (LVEF) in a large cohort of patients in Australia. Quantified levels of LVEF from 237 046 women (48.1%) and 256 109 men undergoing first‐time, routine echocardiography (2000–2019) were linked to 119 232 deaths (median 5.6 years of follow‐up). Overall, 17.6% of men vs. 8.3% of women had an LVEF %. An LVEF % was associated with the highest crude cardiovascular‐related and all‐cause mortality at 5 years (∼20–30% and ∼ 40–50%, respectively). Thereafter, actual cardiovascular‐related and all‐cause mortality at 5 years in both sexes steeply improved to a nadir LVEF of 65.0–69.9% (reference group). Below this LVEF level, the adjusted hazard ratio (HR) for cardiovascular‐related mortality for a LVEF of 55.0–59.9% was 1.36 [95% confidence interval (CI) 1.16–1.59 P 0.001] in women and 1.21 (95% CI 1.05–1.39 P = 0.008) in men. In women, an LVEF of 60.0–64.9% was also associated with a HR 1.33 (95% CI 1.16–1.52 P 0.001) for cardiovascular‐related mortality. These associations were most striking in women and men aged years and were replicated in those with suspected heart failure (32 403 cases aged 65.2 ± 16.1 years, 57.0% women). For pre‐existing heart failure (33 738 cases aged 67.6 ± 16.9 years, 46.5% women), the specific threshold of increased mortality was at and below 50.0–54.9%. Among patients investigated for suspected or established cardiovascular disease, we found clinically relevant sex‐based differences in the distribution and mortality associated with an LVEF .0–69.9%. Specifically, they suggest a greater risk of mortality at higher LVEF levels among women.

Use of a nurse-led intervention to optimize beta-blockade for reducing cardiac events after major noncardiac surgery

Publisher: Elsevier BV

Date: 04-2009

DOI: 10.1016/J.AHJ.2008.09.014

Abstract: Although guidelines recommend the use of beta-adrenoceptor blocking drugs to reduce cardiac events (CEs) after major noncardiac surgery, trial results have varied between showing benefit, ineffectiveness, and harm. We sought whether optimizing beta-blockade (BB) delivery could make them more effective. Intermediate risk patients undergoing major noncardiac surgery (n = 400) were randomized to 2 strategies of BB therapy: universal BB (UBB n = 197) comprising an algorithm-based, nurse-led strategy to optimize dosing and adherence to bisoprolol titration over > or =1 week preoperatively versus usual care (UC n = 203), whereby BB are continued in those already taking them or prescribed for patients identified as high risk based on ischemia (new or inducible wall motion abnormalities) at dobutamine echocardiography (DbE). Daily electrocardiogram and troponin levels were obtained on 3 postoperative days. The primary end point was a major CE (cardiac death or myocardial infarction) within 30 days. There were 25 major CEs (6.3%), occurring in 13 (6.6%) of 197 UBB and 12 (5.9%) of 203 UC patients (OR 1.12, 95% CI 0.52-2.39). Independent predictors of CEs were baseline systolic blood pressure (beta 1.02, P = .005) and postoperative hypotension (beta 1.02, P = .03) but not treatment strategy. Those randomized to UBB had significantly better heart rate control perioperatively, at the cost of bradycardia and hypotension. The negative predictive value of DbE in this study was 95%. These data confirm a persistent CE rate after major noncardiac surgery despite nurse-led dose titration of bisoprolol. Cardiac events were equivalent to a UC strategy based on DbE results.

Measuring Self-care in Chronic Heart Failure:A Review of the Psychometric Properties of Clinical Instruments

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 11-2009

DOI: 10.1097/JCN.0B013E3181B5660F

Pilot testing of a self-care education intervention for patients with heart failure

Publisher: Oxford University Press (OUP)

Date: 11-01-2013

DOI: 10.1177/1474515111430881

Abstract: A key component of the structured approach to the management of chronic heart failure (CHF) is effective patient education. Patient education is a precursor to performing appropriate health-related behaviours that can decrease rehospitalizations. To pilot test an educational intervention and to determine the efficacy of a self-care manual combined with a DVD for patients with CHF. Outcomes of interest included heart failure-related knowledge and self-care behaviours. This pilot study enrolled a s le of 38 patients with CHF. A pre-test ost-test design was conducted to assess changes in knowledge and self-care abilities. Knowledge was assessed with the Dutch Heart Failure Knowledge Scale and self-care behaviours were assessed using the Self-Care of Heart Failure Index. Of the 38 participants 71% were male, 50% were aged between 65 and 74 years, and 31.6% had not completed Year 10 education. There was a statistically significantly difference in the pre- and post-test scores for knowledge (p < 0.0001). Self-care showed positive improvement between pre- and post-test scores maintenance (p = 0.027), management (p < 0.0001) and confidence (p = 0.051). This pilot study has indicated that a patient-centred self-care manual combined with a DVD is beneficial and is associated with an improvement in patients' knowledge and self-care abilities. Healthcare professionals should utilize multimedia educational resources specifically designed to meet the learning needs of patients with CHF.

Economic implications of cardiovascular disease management programs: moving beyond one-off experiments

Publisher: Informa UK Limited

Date: 14-05-2015

DOI: 10.1586/14737167.2015.1046842

Abstract: Substantial variation in economic analyses of cardiovascular disease management programs hinders not only the proper assessment of cost-effectiveness but also the identification of heterogeneity of interest such as patient characteristics. The authors discuss the impact of reporting and methodological variation on the cost-effectiveness of cardiovascular disease management programs by introducing issues that could lead to different policy or clinical decisions, followed by the challenges associated with net intervention effects and generalizability. The authors conclude with practical suggestions to mitigate the identified issues. Improved transparency through standardized reporting practice is the first step to advance beyond one-off experiments (limited applicability outside the study itself). Transparent reporting is a prerequisite for rigorous cost-effectiveness analyses that provide unambiguous implications for practice: what type of program works for whom and how.

Uncovering a hidden epidemic: A study of the current burden of heart failure in Australia

Publisher: Elsevier BV

Date: 09-2004

DOI: 10.1016/J.HLC.2004.06.007

Abstract: Australia, like other countries, is experiencing an epidemic of heart failure (HF). However, given the lack of national and population-based datasets collating detailed cardiovascular-specific morbidity and mortality outcomes, quantifying the specific burden imposed by HF has been difficult. Australian Bureau of Statistics (ABS data) for the year 2000 were used in combination with contemporary, well-validated population-based epidemiologic data to estimate the number of in iduals with symptomatic and asymptomatic HF related to both preserved (diastolic dysfunction) and impaired left ventricular systolic (dys)function (LVSD) and rates of HF-related hospitalisation. In 2000, we estimate that around 325,000 Australians (58% male) had symptomatic HF associated with both LVSD and diastolic dysfunction and an additional 214,000 with asymptomatic LVSD. 140,000 (26%) live in rural and remote regions, distal to specialist health care services. There was an estimated 22,000 incidents of admissions for congestive heart failure and approximately 100,000 admissions associated with this syndrome overall. Australia is in the midst of a HF epidemic that continues to grow. Overall, it probably contributes to over 1.4 million days of hospitalization at a cost of more than 1 billion dollars. A national response to further quantify and address this enormous health problem is required.

Differential patterns of disease and injury in Mozambique: New perspectives from a pragmatic, multicenter, surveillance study of 7809 emergency presentations

Publisher: Public Library of Science (PLoS)

Date: 10-07-2019

DOI: 10.1371/JOURNAL.PONE.0219273

Preface

Publisher: Wiley

Date: 13-05-2016

DOI: 10.1002/9781119097136.FMATTER

Differential impact of malnutrition on health outcomes among indigenous and non-indigenous adults admitted to hospital in regional australia—a prospective cohort study

Publisher: MDPI AG

Date: 19-05-2018

DOI: 10.3390/NU10050644

Chronic Cardiac Care: A Practical Guide to Specialist Nurse Management

Publisher: Wiley

Date: 2007

DOI: 10.1002/9780470750599

Congenital Heart Disease Requires a Lifetime Continuum of Care: A Call for a Regional Registry

Publisher: Elsevier BV

Date: 08-2016

DOI: 10.1016/J.HLC.2016.03.018

Trends in stroke incidence after hospitalization for atrial fibrillation in Sweden 1987 to 2006

Publisher: Elsevier BV

Date: 08-2013

DOI: 10.1016/J.IJCARD.2012.03.057

Abstract: To investigate recent trends in incidence of hemorrhagic and non-hemorrhagic strokes in patients with atrial fibrillation (AF). The Swedish Hospital Discharge and Cause of Death Registries were linked to provide outcome data. 321,276 patients 35 to 84 years (56.5% male, mean age 71.5 years) free of prior stroke with a first AF diagnosis during 1987-2006 were included. Over 3 year follow-up 24,733 patients (7.7%) were diagnosed with ischemic stroke and 2292 (0.7%) with hemorrhagic stroke. The 3-year incidence of ischemic stroke decreased from 8.7% for patients diagnosed in 1987-1991 to 6.6% for those diagnosed in 2002 to 2006. The corresponding incidence of hemorrhagic stroke increased from 0.38% for patients diagnosed in 1987-1991 to 0.57% for those diagnosed in 2002 to 2006. Covariable-adjusted risk of ischemic stroke was significantly reduced (HR 0.65 0.63-0.68) while risk of hemorrhagic stroke was significantly increased (HR 1.19 1.05-1.36). Compared to the general population, total stroke risk decreased more among AF patients. We found a considerable decrease in risk of ischemic stroke in Sweden in patients without prior stroke and with a first hospital diagnosis of AF. There was an increased risk of hemorrhagic stroke, but because hemorrhagic stroke represented only a small proportion of all strokes, the overall risk of stroke declined.

Optimising management of hypertension in primary care: The Valsartan Intensified Primary Care Reduction of Blood Pressure (Viper-Bp) Study

Publisher: Elsevier BV

Date: 12-2011

DOI: 10.1016/J.IJCARD.2010.12.055

Abstract: The Valstartan Intensified Primary CarE Reduction of Blood Pressure Study (VIPER-BP) Study is an open-label, randomised controlled trial comparing usual primary care management with an intensive BP management strategy using three forms of valsartan-based therapy (mono-therapy, thiazide diuretic or calcium channel blocker combinations) to achieve in idualised BP control. To identify the features of General Practitioner (GP) management of hypertension in Australia, we analyse the response to a case scenario-based survey of 500 GPs. We subsequently recruited a national cohort of GP Investigators to enrol up to 2500 patients into the VIPER-BP Study. GP responses clearly demonstrated that, compared to the VIPER-BP intervention, a heterogeneous approach to the primary care management of hypertension persists in Australia. By November 2010, 2157 hypertensive patients from 272 actively recruiting GP Investigators were enrolled into the study. Of these, 1965 (91%) patients were entered into a standardised "run-in" phase of 28 days of valsartan 80 mg/day. Subsequently, 1285 patients were randomised to usual care (n=435) or the VIPER-BP intervention (n=850). There was a predominance of males (62%), whilst 55% had pre-existing diabetes or cardiovascular disease and 63% had been previously treated for hypertension. Mean systolic and diastolic BP on randomisation for men and women, respectively, was 148 ± 15/88 ± 11 and 148 ± 18/87 ± 10 mm Hg. In contrast to typical primary care management of hypertension, VIPER-BP combines more intensive and aggressive therapies with structured management to more rapidly attain and sustain in idualised BP targets in hypertensive patients.

Risk factors for asymptomatic echocardiographic abnormalities that predict symptomatic heart failure

Publisher: Wiley

Date: 30-11-2022

DOI: 10.1002/EHF2.13695

Abstract: Risk factors for asymptomatic echocardiographic abnormalities that predict symptomatic heart failure (HF) may provide insight into early mechanisms of HF pathogenesis. We examined risk factors associated with asymptomatic echocardiographic structural, systolic, and diastolic abnormalities, separately and in combination, and interactions between risk factors, in the prospective community‐based SCReening Evaluation of the Evolution of New HF (SCREEN‐HF) Study cohort of 3190 participants at increased risk of cardiovascular disease. Inclusion criteria were age ≥ 60 years with one or more of hypertension, diabetes, ischaemic heart disease, valvular heart disease, abnormal heart rhythm, cerebrovascular disease, or renal impairment. Exclusion criteria were known HF, ejection fraction 50%, or mild valve abnormality. Structural, systolic, and diastolic echocardiographic abnormalities were defined according to the Atherosclerosis Risk in Communities study criteria, and risk factors for asymptomatic structural, systolic, and diastolic abnormalities were identified using logistic regression analysis. In multivariable analysis, increased body mass index (BMI), non‐steroidal anti‐inflammatory drug therapy, and alcohol intake were risk factors for isolated structural abnormality, whereas male gender, increased heart rate, atrial fibrillation (AF), angiotensin‐converting enzyme inhibitor therapy, and obstructive sleep apnoea were associated with a lower risk. Moreover, male gender, smoking, increased systolic blood pressure, and physical inactivity were risk factors for isolated systolic abnormality, whereas increased pulse pressure and antihypertensive therapy were associated with a lower risk. Furthermore, increased age, blood pressure, amino‐terminal pro‐B‐type natriuretic peptide level, and warfarin therapy (associated with AF) were risk factors for isolated diastolic abnormality, whereas increased heart rate and triglyceride level (associated with BMI) were associated with a lower risk. The association of increased heart rate with lower risk of structural and diastolic abnormalities was independent of β‐blocker therapy. Interactions between risk factors differed for structural, systolic, and diastolic abnormalities. The different risk factors for asymptomatic structural, systolic, and diastolic abnormalities that predict symptomatic HF, and the interactions between risk factors, illustrate how these structural, systolic, and diastolic abnormalities represent unique trajectories that lead to symptomatic HF. Improved understanding of these trajectories may assist in the design of HF prevention strategies.

Development and Test-Retest Reliability of an Extended Version of the Nordic Musculoskeletal Questionnaire (NMQ-E): A Screening Instrument for Musculoskeletal Pain

Publisher: Elsevier BV

Date: 05-2009

DOI: 10.1016/J.JPAIN.2008.11.008

Abstract: The Nordic Musculoskeletal Questionnaire (NMQ) quantifies musculoskeletal pain and activity prevention in 9 body regions. The purpose of this study was to develop an extended NMQ (NMQ-E) to collect greater information regarding musculoskeletal pain, examine test-retest reliability and the reproducibility of alternate administration methods. Reliability was examined using observed proportion of agreement for all (P(o)), positive (P(pos)) and negative (P(neg)) responses, kappa (kappa), proportion of maximum kappa achieved (kappa/kappa(max)), intra-class correlation coefficient (ICC) and standard error of measurement (SEM). The NMQ-E was self-administered by 59 Bachelor of Nursing students at a 24-h interval with mean P(o) = 0.88-0.98 and kappa/kappa(max) = 0.71-0.96 for 10 dichotomous questions and mean ICC((2,1)) = 0.97 and SEM = 1.05 years for the age at symptom onset question. The NMQ-E was completed via self and interview administration by 31 student nurses at a 0.97 +/- 1.14 day interval with mean P(o) = 0.92-0.98 and kappa/kappa(max) = 0.76-1.00 for binary questions and mean ICC((2,1)) = 0.90 and SEM = 1.51 years for age at symptom onset data. In both sub-studies, mean P(pos) was lower than mean P(neg) and low prevalence reduced kappa in many instances. The NMQ-E collects reliable information regarding the onset, prevalence, and consequences of musculoskeletal pain and can be administered by self-completion and personal interview. This study presents an NMQ-E that collects reliable information regarding the onset, prevalence, and consequences of musculoskeletal pain in 9 body regions. The NMQ-E can be utilized in descriptive studies or longitudinal studies of disease outcome and can be administered via self-completion and personal interview.

Cardiovascular Effects of Indoor Air Pollution from Solid Fuel: Relevance to Sub-Saharan Africa

Publisher: Springer Science and Business Media LLC

Date: 17-05-2019

DOI: 10.1007/S40572-019-00234-8

Abstract: This research aims to summarize evidence on the cardiovascular effects of indoor air pollution (IAP) from solid fuel and identify areas for research and policy for low- and middle-income countries. IAP affects people from low socioeconomic status in Latin America, Asia, and Africa, who depend upon biomass as a fuel for cooking, heating, and lighting. In these settings, IAP disproportionately affects women, children, the elderly, and people with cardiopulmonary disease. The health effects of IAP include acute respiratory infections, chronic obstructive pulmonary disease, pneumoconiosis, cataract and blindness, pulmonary tuberculosis, adverse effects to pregnancy, cancer, and cardiovascular and cerebrovascular disease. New methods for assessing in idual IAP exposure, exposing pathways of IAP-related cardiovascular disease, and performing qualitative research focusing on population preferences regarding strategies to reduce IAP exposure have been the most important developments in tackling the burden of IAP. Unfortunately, major disparities exist regarding research into the cardiovascular effects of IAP, with only few studies coming from sub-Saharan Africa, despite this region having the highest proportion of households using solid fuels. Premature cardiovascular deaths and disability can be averted in low-middle income countries by addressing biomass fuel usage by the most disadvantaged settings. While research is needed to uncover the mechanisms involved in cardiovascular outcomes linked to IAP, immediate action is needed to educate the most affected populations on IAP health hazards and to reduce their exposure to this environmental risk through promoting improved housing and better ventilation, as well as increasing access to affordable clean cooking energy.

Evidence-based chronic heart failure management programs: Reality or myth?

Publisher: BMJ

Date: 12-2009

DOI: 10.1136/QSHC.2008.028035

Abstract: Chronic heart failure management programmes (CHF-MPs) have become part of standard care for patients with chronic heart failure (CHF). To investigate whether programmes had applied evidence-based expert clinical guidelines to optimise patient outcomes. Prospective cross-sectional survey was used to conduct a national audit. Community setting of CHF-MPs for patients after discharge. All CHF-MPs operating during 2005-2006 (n = 55). 10-50 consecutive patients from 48 programmes were also recruited (n = 1157). (1) Characteristics and interventions used within each CHF-MP and (2) characteristics of patients enrolled into these programmes. Overall, there was a disproportionate distribution of CHF-MPs across Australia. Only 6.3% of hospitals nationally provided a CHF-MP. A total of 8000 post-discharge CHF patients (median, 126 IQR, 26-260) were managed via CHF-MPs representing only 20% of the potential national case load. Significantly, 16% of the case load comprised patients in functional New York Heart Association class I with no evidence of these patients having had previous echocardiography to confirm a diagnosis of CHF. Heterogeneity of CHF-MPs in applied models of care was evident with 70% of CHF-MPs offering a hybrid model (a combination of heart failure outpatient clinics and home visits), 20% conducting home visits and 16% an extended rehabilitation model of care. Less than half (44%) allowed heart failure nurses to titrate medications. The main medications that were titrated in these programmes were diuretics (n = 23, 96%), beta-blockers (n = 17, 71%), ACE inhibitors (n = 14, 58%) and spironolactone (n = 9, 38%). CHF-MPs are being implemented rapidly throughout Australia. However, many of these programmes do not adhere to expert clinical guidelines for the management of patients with CHF. This poor translation of evidence into practice highlights the inconsistency and questions the quality of health-related outcomes for these patients.

Effect of Nurse-Implemented Transitional Care for Chinese Individuals with Chronic Heart Failure in Hong Kong: A Randomized Controlled Trial

Publisher: Wiley

Date: 08-2015

DOI: 10.1111/JGS.13533

Evidence-based chronic heart-failure management programmes: reality or myth?

Publisher: BMJ

Date: 2011

DOI: 10.1136/BMJQS.2008.028035

Abstract: Chronic heart-failure management programmes (CHF-MPs) have become part of standard care for patients with chronic heart failure (CHF). To investigate whether programmes had applied evidence-based expert clinical guidelines to optimise patient outcomes. A prospective cross-sectional survey was used to conduct a national audit. Community setting of CHF-MPs for patients postdischarge. All CHF-MPs operating during 2005-2006 (n=55). Also 10-50 consecutive patients from 48 programmes were recruited (n=1157). (1) Characteristics and interventions used within each CHF-MP and (2) characteristics of patients enrolled into these programmes. Overall, there was a disproportionate distribution of CHF-MPs across Australia. Only 6.3% of hospitals nationally provided a CHF-MP. A total of 8000 postdischarge CHF patients (median: 126 IQR: 26-260) were managed via CHF-MPs, representing only 20% of the potential national case load. Significantly, 16% of the caseload comprised patients in functional New York Heart Association Class I with no evidence of these patients having had previous echocardiography to confirm a diagnosis of CHF. Heterogeneity of CHF-MPs in applied models of care was evident, with 70% of CHF-MPs offering a hybrid model (a combination of heart-failure outpatient clinics and home visits), 20% conducting home visits and 16% conducting an extended rehabilitation model of care. Less than half (44%) allowed heart-failure nurses to titrate medications. The main medications that were titrated in these programmes were diuretics (n=23, 96%), β-blockers (n=17, 71%), ACE inhibitors (ACEIs) (n=14, 58%) and spironolactone (n=9, 38%). CHF-MPs are being implemented rapidly throughout Australia. However, many of these programmes do not adhere to expert clinical guidelines for the management of patients with CHF. This poor translation of evidence into practice highlights the inconsistency and questions the quality of health-related outcomes for these patients.

Prediction of right ventricular and posterior wall ST elevation by coronary care nurses: The 12-lead electrocardiograph versus the 18-lead electrocardiograph

Publisher: Elsevier BV

Date: 1996

DOI: 10.1016/S0147-9563(96)80007-0

Abstract: To determine the value of routine versus selective use of the 18-lead electrocardiogram in determining the size of an acute inferior myocardial infarction (MI). Prospective, quasi-experimental, random assignment. The coronary care unit (CCU) of a major teaching hospital in South Australia. Fifty-two patients admitted to the CCU with acute evolving inferior MI. Correlation and comparison of the predictions of the right ventricular (RV) and posterior wall (PW) lead ST elevation with prospectively chosen markers on the 12-lead electrocardiogram--ST elevation in lead III > II and precordial ST depression, and the predictions by coronary care nurses. The results of 18-lead electrocardiograms of 52 consecutive patients admitted to the CCU with acute evolving inferior MI were classified according to prospectively chosen criteria. Coronary care nurses were randomly assigned four 12-lead electrocardiograms and asked to "blindly" predict ST elevation in the concurrent RV and PW leads. ST elevation in lead III > II demonstrated a sensitivity and positive predictive accuracy of 86% to 1 mm of ST elevation in the RV leads. ST depression in V1, V2, and V3 similarly demonstrated a 75% sensitivity and 89% positive predictive accuracy to 1 mm of ST elevation in the PW leads. In comparison, coronary care nurses proved to be as accurate in their predictions of additional PW ST elevation (p = 0.73), but were significantly less able to predict RV ST elevation (p = 0.049). These predictions were independent of the level of experience and qualifications. Discriminating between smaller and larger types of inferior MIs has the potential to alter patient management: Thirty-two percent of patients in the study demonstrated additional ST elevation in both the RV and PW leads. Both of the 12-lead electrocardiogram markers used in this study proved reasonably accurate in predicting additional ST elevation in the leads that normally comprise the 18-lead electrocardiogram. Recognition of these markers has the potential to expedite the need for the additional 18-lead electrocardiogram when rapid assessment of infarction size is required. However, the routine use of the 18-lead electrocardiogram is supported by this study.

Nurse led, multidisciplinary intervention in chronic heart failure: Editorial

Publisher: BMJ

Date: 11-1998

DOI: 10.1136/HRT.80.5.430

Age, sex, and social trends in out-of-hospital cardiac deaths in Scotland 1986–95: a retrospective cohort study

Publisher: Elsevier BV

Date: 10-2001

DOI: 10.1016/S0140-6736(01)06343-7

Multidisciplinary strategies for the management of heart failure patients at high risk for admission

Publisher: Elsevier BV

Date: 08-2004

DOI: 10.1016/J.JACC.2004.05.055

Cardiometabolic risk and disease in Indigenous Australians: The heart of the heart study

Publisher: Elsevier BV

Date: 02-2014

DOI: 10.1016/J.IJCARD.2013.12.026

Abstract: This study assessed the burden and determinants of cardiovascular and metabolic risk in a community s le of high risk Indigenous Australians. Indigenous Australians are over-represented in the most disadvantaged strata of Australian society. The role of psychosocial and socioeconomic factors in patterning cardiometabolic disease in this population is unclear. The Heart of the Heart Study was a cross sectional study of 436 Aboriginal adults from remote, urban and peri-urban communities around Alice Springs (Northern Territory, Australia). Participants underwent detailed assessments of socio-demographic, psychosocial, cardiovascular and metabolic status. In iduals with depression were twice as likely to have cardiovascular disease (OR 2.03 1.07-3.88 p<0.05). Chronic kidney disease (39.7%, 37.2% and 18.2%) and diabetes (28.4%, 34.0% and 19.2%) were more common in peri-urban and remote compared to urban communities. Cardiovascular disease did not vary across locations (p=0.069), but coronary artery disease did (p=0.035 for trend). Unemployed in iduals were more likely to have cardiovascular disease (OR 2.32 1.33-4.06 p<0.001). Socioeconomic gradients in coronary artery disease, all cardiovascular disease and diabetes, as measured by income, operated differentially across locations (p for location/socioeconomic status interactions 0.002 0.01 and 0.04 respectively). Participants had high rates of pre-existing cardiovascular disease, diabetes and chronic kidney disease. Cardiovascular risk in these communities was associated with psychosocial factors and socioeconomic indicators. However, gradients operated differentially across location. These data provide a strong foundation for better understanding key drivers of increased levels of cardiovascular and other common forms of non-communicable disease in Indigenous people.

Assessing cutaneous microvascular function with iontophoresis: Avoiding non-specific vasodilation

Publisher: Elsevier BV

Date: 09-2017

DOI: 10.1016/J.MVR.2017.04.006

Abstract: Iontophoresis of vasoactive agents is commonly used to assess cutaneous microvascular reactivity. However, it is known that iontophoresis can be limited by confounding non-specific vasodilatory effects. Despite this, there is still no standardization of protocols or data expression. Therefore, this study evaluated commonly used protocols of iontophoresis by assessing each for evidence of non-specific vasodilatory effects and examined the reproducibility of those protocols that are free of non-specific responses. Twelve healthy participants were administered doses of acetylcholine (ACh) 1-2% and sodium nitroprusside (SNP) 1%, diluted in sodium chloride 0.9% or deionized water, and insulin 100U/mL in a sterile diluent using iontophoresis coupled with laser speckle contrast imaging (LSCI). Increases in blood flux at a control electrode, containing the diluent only, indicated a non-specific response. Reproducibility of iontophoresis protocols that were free of non-specific vasodilatory effects were subsequently compared to that of post-occlusive reactive hyperemia (PORH), used as a standard, in 20 healthy participants. Iontophoresis of ACh or SNP in sodium choloride (0.02mA for 200 and 400s, respectively) and ACh in deionized water (0.1mA for 30s) mediated the least non-specific vasodilatory effects. Microvascular responses to insulin were mediated mainly by non-specific effects. Compared to PORH, the intraday and interday reproducibility for iontophoresis of ACh and SNP (0.02mA for 200 and 400s, respectively) with LSCI was weaker, but still deemed good to excellent when data was expressed, in perfusion units or cutaneous vascular conductance, as the absolute peak blood flux response to the vascular reactivity test or as the change in blood flux between peak and baseline values. This study provides updated recommendations for assessing cutaneous microvascular function with iontophoresis.

The burden and nature of malnutrition among patients in regional hospital settings: A cross-sectional survey

Publisher: Elsevier BV

Date: 02-2018

DOI: 10.1016/J.CLNESP.2017.12.010

Abstract: Indigenous people experience a higher burden of nutrition-related conditions and are more likely to experience food insecurity compared to non-Indigenous people. Consequently, they remain at increased risk of malnutrition particularly when residing in regional or remote areas. This study aims to compare and characterise the burden and nature of malnutrition among a representative cohort of Indigenous and non-Indigenous Australians admitted to regional hospitals for medical inpatient care. This was a cross-sectional survey conducted in three regional hospitals in the Northern Territory and Far North Queensland of Australia from February 2015 to September 2015. A total of 1606 adult medical inpatients were screened for eligibility. Of these, 608 eligible patients were screened for malnutrition using the validated Malnutrition Screening Tool and assessed for malnutrition using the Subjective Global Assessment. Socio-economic and health-related variables and anthropometric measurements were collected to identify the correlates of malnutrition. Of the 271 Indigenous patients and 337 non-Indigenous patients screened and assessed for malnutrition, 250/608 (41.7%, 95% CI 40.1-52.3%) were found to be malnourished. Significantly higher rates of malnutrition (46.1%, 95% CI 40.1-52.3% versus 37.1%, 95% CI 31.9-42.5%) were found in Indigenous patients compared to non-Indigenous patients (P = 0.024). Higher rates of malnutrition were observed in Indigenous patients residing in Central Australia (56.7%, 95% CI 46.7-66.4%) than in the Top End of the Northern Territory (40.7%, 95% CI 31.7-50.1%) and in Far North Queensland (36.7%, 95% CI 23.4-51.7%). Factors independently predictive of malnutrition for both Indigenous and non-Indigenous participants included residence in Central Australia (OR 4.31, 95% CI 2.63-7.90, P < 0.001) an increased Charlson Comorbidity Index prognostic score (OR 1.37 [per incremental score], 95% CI 1.19-1.59, P < 0.001) and an underweight Body Mass Index (OR 29.97, 95% CI 3.68-244.0, P < 0.001). Of the 250/608 patients who were malnourished, the positive predictor value (PPV) for malnourished patients who were underweight was 96.6% (95% CI 88.3-99.6%) for Indigenous Australians who were malnourished and underweight, the PPV was 100%. A mid-upper arm circumference of less than 23 cm demonstrated a strong PPV for all patients who were malnourished (96.1%, 95% CI 89.0-99.2%). This is the first study to characterise malnutrition in adult Indigenous Australians in a hospital inpatient setting. Compared to non-Indigenous patients the burden and pattern of malnutrition was both higher and markedly different among Indigenous patients. These data highlight the critical importance for actively screening for and responding to malnutrition in this vulnerable patient population in regional and remote settings.

Incident aortic stenosis in 49 449 men and 42 229 women investigated with routine echocardiography

Publisher: BMJ

Date: 25-08-2022

DOI: 10.1136/HEARTJNL-2021-319697

Abstract: We addressed the paucity of data describing the characteristics and consequences of incident aortic stenosis (AS). Adults undergoing echocardiography with a native aortic valve (AV) and no AS were studied. Subsequent age-specific and sex-specific incidence of AS were derived from echocardiograms conducted a median of 2.8 years apart. Progressive AV dysfunction and in idually linked mortality were examined per AS category. 49 449 men (53.9%, 60.9±15.8 years) and 42 229 women (61.6±16.9 years) with no initial evidence of AS were identified. Subsequently, 6293 (6.9%) developed AS—comprising 5170 (5.6%), 636 (0.7%), 339 (0.4%) and 148 (0.2%) cases of mild, moderate, severe low-gradient and severe high-gradient AS, respectively. Age-adjusted incidence rates of all grades of AS were 17.5 cases per 1000 men/annum and 18.7 cases per 1000 women/annum: rising from ~5 to ~40 cases per 1000/annum in those aged years vs years. Median peak AV velocity increased by +0.57 (+0.36 to +0.80) m/s in mild AS compared with +2.75 (+2.40 to +3.19) m/s in severe high-gradient AS cases between first and last echocardiograms. During subsequent median 7.7 years follow-up, 24 577 of 91 678 cases (26.8%) died. Compared with no AS, the adjusted risk of all-cause mortality was 1.42-fold higher in mild AS, 1.92-fold higher in moderate AS, 1.95-fold higher in severe low-gradient AS and 2.27-fold higher in severe, high-gradient AS cases (all p .001). New onset AS is a common finding among older patients followed up with echocardiography. Any grade of AS is associated with higher mortality, reinforcing the need for proactive vigilance.

Standard versus atrial fibrillation-specific management strategy (SAFETY) to reduce recurrent admission and prolong survival: pragmatic, multicentre, randomised controlled trial

Publisher: Elsevier BV

Date: 02-2015

DOI: 10.1016/S0140-6736(14)61992-9

Socioeconomic Status and Heart Failure in Sydney

Publisher: Elsevier BV

Date: 04-2014

DOI: 10.1016/J.HLC.2013.10.056

Abstract: Socioeconomic disadvantage is associated with an increased risk of developing heart failure and with inferior health outcomes following diagnosis. Data for hospitalisations and deaths due to heart failure in the Sydney metropolitan region were extracted from New South Wales hospital records and Australian Bureau of Statistics databases for 1999-2003. Standardised rates were analysed according to patients' residential local government area and correlated with an index of socioeconomic disadvantage. Eight of the 13 local government areas with standardised separation rate ratios significantly higher than all NSW, and those with the six highest standardised separation rate ratios, were in Greater Western Sydney. Rates of heart failure hospitalisations per local government area were inversely correlated with level of socioeconomic status. Higher rates of heart failure hospitalisations among residents of socioeconomically disadvantaged regions within Sydney highlight the need for strategies to lessen the impact of disadvantage and strategies to improve cardiovascular health.

Predisposing factors and incidence of newly diagnosed atrial fibrillation in an urban African community: insights from the Heart of Soweto Study

Publisher: BMJ

Date: 09-11-2010

DOI: 10.1136/HRT.2010.206938

Abstract: Little is known about the incidence and clinical characteristics of newly diagnosed atrial fibrillation/flutter (AF) in urban Africans in epidemiological transition. This observational cohort study was carried out in the Chris Hani Baragwanath Hospital in Soweto South Africa. A clinical registry captured detailed clinical data on all de novo cases of AF presenting to the Cardiology Unit during the period 2006-2008. Overall, 246 of 5328 cardiac cases (4.6%) presented with AF (estimated 5.6 cases/100 000 population/annum). Mean age was 59±18 years and the majority were of African descent (n=211, 86%) and/or female (n=150, 61%). Men were more than twice as likely to smoke (OR 2.88, 95% CI 1.92 to 4.04) than women, but women were twice as likely to be obese (OR 1.80, 95% CI 1.28 to 2.52) than men. Lone AF occurred in 22 (8.9%) cases, while concurrent valve disease and/or functional valvular abnormality occurred in 107 cases (44%). Overall, 171 cases (70%) presented with uncontrolled AF (ventricular rate >90 beats/min) with no sex-based differences. Common co-morbidities were any form of heart failure (56%) and rheumatic heart disease (21%). Women with AF were more likely to present with hypertensive heart failure (OR 2.37, 95% CI 1.24 to 4.54) but less likely to present with a dilated cardiomyopathy (OR 0.42, 95% CI 0.23 to 0.76) or coronary artery disease (OR 0.38, 95% CI 0.14 to 1.02) than men. Mean overall CHADS(2) score (in 195 non-rheumatic cases) was 1.51±0.91 and, despite a similar age profile, women had higher scores than men (1.73±0.94 vs 1.24±0.78 p<0.0001). These unique data suggest that urban Africans in Soweto develop AF at a relatively young age. Conventional strategies used to manage and treat AF need to be carefully evaluated in this setting.

Excess mortality at Christmas due to cardiovascular disease in the HUNT study prospective population-based cohort in Norway

Publisher: Springer Science and Business Media LLC

Date: 20-03-2021

DOI: 10.1186/S12889-021-10503-7

Abstract: Although it is known that winter inclusive of the Christmas holiday period is associated with an increased risk of dying compared to other times of the year, very few studies have specifically examined this phenomenon within a population cohort subject to baseline profiling and prospective follow-up. In such a cohort, we sought to determine the specific characteristics of mortality occuring during the Christmas holidays. Baseline profiling and outcome data were derived from a prospective population-based cohort with longitudinal follow-up in Central Norway - the Trøndelag Health (HUNT) Study. From 1984 to 1986 , 88% of the target population comprising 39,273 men and 40,353 women aged 48 ± 18 and 50 ± 18 years, respectively, were profiled. We examined the long-term pattern of mortality to determine the number of excess (all-cause and cause-specific) deaths that occurred during winter overall and, more specifically, the Christmas holidays. During 33.5 (IQR 17.1–34.4) years follow-up, 19,879 (50.7%) men and 19,316 (49.3%) women died at age-adjusted rate of 5.3 and 4.6 deaths per 1000/annum, respectively. Overall, 1540 (95% CI 43–45 deaths/season) more all-cause deaths occurred in winter (December to February) versus summer (June to August), with 735 (95% CI 20–22 deaths per season) of these cardiovascular-related. December 25th–27th was the deadliest 3-day period of the year being associated with 138 (95% CI 96–147) and 102 (95% CI 72–132) excess all-cause and cardiovascular-related deaths, respectively. Accordingly, compared to 1st–21st December (equivalent winter conditions), the incidence rate ratio of all-cause mortality increased to 1.22 (95% CI 1.16–1.27) and 1.17 (95% 1.11–1.22) in men and women, respectively, during the next 21 days (Christmas/New Year holidays). All observed differences were highly significant ( P 0.001). A less pronounced pattern of mortality due to respiratory illnesses (but not cancer) was also observed. Beyond a broader pattern of seasonally-linked mortality characterised by excess winter deaths, the deadliest time of year in Central Norway coincides with the Christmas holidays. During this time, the pattern and frequency of cardiovascular-related mortality changes markedly contrasting with a more stable pattern of cancer-related mortality. Pending confirmation in other populations and climates, further research to determine if these excess deaths are preventable is warranted.

Overcoming the tyranny of distance: An analysis of outreach visits to optimise secondary prevention of cardiovascular disease in high-risk individuals living in Central Australia

Publisher: Wiley

Date: 19-08-2016

DOI: 10.1111/AJR.12222

Abstract: We examined the logistical challenges of conducting an outreach, secondary prevention program for adults discharged from Alice Springs Hospital following an acute presentation of cardiovascular disease. This represents a sub-study of the Central Australian Heart Protection Study (CAHPS). Clinical, logistic and demographic data were used to examine the characteristics of outreach visits in the intervention arm of the study. Fifty subjects initially allocated to the intervention arm of the trial were studied. Completion of scheduled, plus additional outreach visits according to the intervention protocol. The majority of subjects presented with an acute coronary syndrome (44/50 (88%)) and 31 (62%) were of Indigenous ethnicity. However, Indigenous subjects being younger (53.1 ± 11.1 versus 58.0 ± 11.0 years non-Indigenous) had a more complex risk factor and co-morbid profile, with significantly more diabetes (77% versus 26% P < 0.001), hypertension (81% versus 53% P = 0.04) and renal failure (52% versus 21% P = 0.03). Community of origin of Indigenous subjects was 230 ± 208 km from the hospital versus 61 ± 150 km for non-Indigenous subjects (P = 0.004). Indigenous subjects missed a significantly higher number of scheduled visits at six months (1.39 ± 2.14 versus 0.16 ± 0.50 visits P = 0.02). However, multivariate analyses suggested that distance did not influence successful completion of visits. These early findings from CAHPS are invaluable to understanding and improving the feasibility of secondary prevention programs for Indigenous adults living with heart disease in remote communities.

Targeted LOWering of Central Blood Pressure in patients with hypertension: Baseline recruitment, rationale and design of a randomized controlled trial (The LOW CBP study)

Publisher: Elsevier BV

Date: 11-2017

DOI: 10.1016/J.CCT.2017.08.010

Abstract: High blood pressure (BP) is the most common modifiable cause of death from cardiovascular disease. Lowering BP with medication improves patient outcomes, but even in populations with normal upper arm (brachial) BP there remains considerable residual risk for cardiovascular disease and this may be due to persistently elevated central BP. There has never been a trial to determine the value of targeted central BP lowering among patients with hypertension, and this was the aim of this study. This is a multi-centre, randomized, open-label, blinded endpoint trial among 308 patients treated for uncomplicated hypertension with controlled brachial BP (<140/90mmHg) but elevated central BP (≥0.5SD above age- and sex-specific normal values). Baseline recruitment has been completed. Participants were randomized to intervention with spironolactone (25mg/d) or usual care and are being followed over 24months, with the primary outcome being left ventricular mass index (using cardiac magnetic resonance imaging). Brachial and central BP will be measured in the clinic, at home over 7-days and by 24-h ambulatory monitoring. Aortic stiffness will be assessed by carotid-to-femoral pulse wave velocity. Primary (intention to treat) analysis will determine the role of central versus brachial BP for predicting changes in left ventricular mass index. Compared with control, intervention is expected to significantly lower left ventricular mass index, and this effect is expected to be independently correlated with central BP lowering. These findings would support the concept of central BP as an important therapeutic target in hypertension management. Results are expected in 2018.

Composite outcome measures in a pragmatic clinical trial of chronic heart failure management: A comparative assessment

Publisher: Elsevier BV

Date: 04-2015

DOI: 10.1016/J.IJCARD.2015.03.071

Abstract: 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. 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 in idual 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%). 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.

Pulmonary hypertension: Prevalence and mortality in the Armadale echocardiography cohort

Publisher: BMJ

Date: 03-07-2012

DOI: 10.1136/HEARTJNL-2012-301992

The thrombotic profile of treatment-naive HIV-positive black South Africans with acute coronary syndromes

Publisher: SAGE Publications

Date: 11-05-2011

DOI: 10.1177/1076029609358883

Abstract: Background: Patients with human immunodeficiency virus (HIV) infection on protease inhibitors (PIs) have a heightened risk of arterial thrombosis but little is known about treatment-naive patients. Methods/Results: Prospective study from South Africa comparing thrombotic profiles of HIV-positive and -negative patients with acute coronary syndrome (ACS). A total of 30 treatment-naive HIV-positive patients with ACS were compared to 30 HIV-negative patients with ACS. Patients with HIV were younger and besides smoking (73% vs 33%) and low high-density lipoprotein (HDL 0.8 ± 0.3 vs 1.1 ± 0.4), they had fewer risk factors. Thrombophilia was more common in HIV-positive patients with lower protein C (PC 82 ± 22 vs 108 ± 20) and higher factor VIII levels (201 ± 87 vs 136 ± 45). Patients with HIV had higher frequencies of anticardiolipin (aCL 47% vs 10%) and antiprothrombin antibodies (87% vs 21%). Conclusion: Treatment-naive HIV-positive patients with ACS are younger, with fewer traditional risk factors but a greater degree of thrombophilia compared with HIV-negative patients.

Interventions to prevent back pain and back injury in nurses: A systematic review

Publisher: BMJ

Date: 25-01-2007

DOI: 10.1136/OEM.2006.030643

Uncovering a multitude of sins: Medication management in the home post acute hospitalisation among the chronically ill

Publisher: Wiley

Date: 04-1999

DOI: 10.1111/J.1445-5994.1999.TB00687.X

Abstract: Sub-optimal use of prescribed medication is often associated with unplanned hospitalisation among the chronically ill. To examine the extent of sub-optimal use of prescribed medication in a 'high risk' patient cohort recently discharged from acute hospital care. Chronically ill patients discharged from acute hospital care (n = 342) were studied. At one week post discharge a home visit was performed by a nurse and a pharmacist during which medication management (including compliance and medication-related knowledge) was assessed. During the majority of home visits at least one medication-related problem was detected: approximately half of the cohort subject to a 'reliable' pill-count were found to be mal-compliant and almost all demonstrated inadequate medication-related knowledge. Mal-compliance was correlated with > or = five prescribed medications (Odds ratio [OR] 2.6: p 75 years (OR 2.2: p < 0.001), exacerbation of a pre-existing chronic illness (OR 2.7: p = 0.044) and < or = six years formal education (OR 1.9: p = 0.004). Neither were modulated by extent of in-hospital counselling. Other previously unknown problems detected during the home visit included hoarding of previously prescribed medication (35%) and reducing medication intake to minimise costs (21%). Management of prescribed medications among chronically ill patients recently discharged from acute hospital care is often sub-optimal. Assessment of medication management in the home provides an invaluable opportunity to detect and address problems likely to result in poorer health outcomes.

Prolonged Beneficial Effects of a Home-Based Intervention on Unplanned Readmissions and Mortality Among Patients With Congestive Heart Failure

Publisher: American Medical Association (AMA)

Date: 08-02-1999

DOI: 10.1001/ARCHINTE.159.3.257

Abstract: A single home-based intervention (HBI) applied immediately after hospital discharge in a cohort of "high-risk" patients with congestive heart failure has been shown to decrease numbers of unplanned readmissions plus out-of-hospital deaths during a period of 6 months. The duration of this beneficial effect remains uncertain. Hospitalized patients with congestive heart failure who had been randomly assigned to receive either usual care (n=48) or HBI 1 week after discharge (n=49) were subject to an extended follow-up of 18 months. The primary end point of the study was frequency of unplanned readmissions plus out-of-hospital deaths. Secondary end points included total hospital stay, frequency of multiple readmissions, cost of hospital-based care, and total mortality. During 18-month follow-up, HBI patients had fewer unplanned readmissions (64 vs 125 P=.02) and out-of-hospital deaths (2 vs 9 P=.02), representing 1.4+/-1.3 vs 2.7+/-2.8 events per HBI and usual-care patient, respectively (P=.03). The HBI patients also had fewer days of hospitalization (2.5+/-2.7 vs 4.5+/-4.8 per patient P=.004) and, once readmitted, were less likely to experience 4 or more readmissions (3/31 vs 12/38 P=.03). Hospital-based costs were significantly lower among HBI patients (Aust $5100 vs Aust $10600 per patient P=.02). Unplanned readmission was positively correlated with 14 days or more of unplanned readmission in the 6 months before study entry (odds ratio [OR], 5.4 P=.006). Positive correlates of death were (1) non-English speaking (OR, 4.9 P=.008), (2) 14 days or more of unplanned readmission in the 6 months before study entry (OR, 4.9 P=.008), and (3) left ventricular ejection fraction of 40% or less (OR, 3.0 P=.03) conversely, assignment to HBI was a negative correlate (OR, 0.3 P=.02). In this controlled study, among a cohort of high-risk patients with congestive heart failure, beneficial effects of a postdischarge HBI were sustained for at least 18 months, with a significant reduction in unplanned readmissions, total hospital stay, hospital-based costs, and mortality.

Beyond the numbers: The individual challenges of combating consistently poor survival in heart failure

Publisher: Elsevier BV

Date: 02-2008

DOI: 10.1016/J.AHJ.2007.11.006

Electrical cardioversion for atrial fibrillation: outcomes in ‘real-life’ clinical practice

Publisher: Elsevier BV

Date: 11-2001

DOI: 10.1016/S0167-5273(01)00522-8

Abstract: There is currently considerable debate with regard to the optimal management of atrial fibrillation/flutter (AF), including the long-term success of electrical cardioversion and the duration of anti-coagulation thereafter. The aim of this study was to investigate the current management and outcomes of electrical cardioversion in unselected patients in ordinary clinical practice. A prospective, observational study of 111 consecutive patients with AF who had been referred for electrical cardioversion was undertaken in a large teaching hospital. After cardioversion, patients were followed-up for 12 months or until death if this occurred earlier. Sinus rhythm was restored immediately in 96 of 111 (86%) patients. Only 54 of 88 (61%) patients in sinus rhythm at discharge remained in this rhythm at 1 month. Of these 54, a further 21 (39%) had relapsed into AF by 12 months. Independent predictors of sinus rhythm at discharge were younger age (for a difference of 5 years, odds ratio=1.54 95% confidence interval 1.04 to 1.16 P=0.002) and absence of hypertension (1.73, 1.22-1.91 P=0.015). The presence of sinus rhythm at discharge (6.4, 1.6-25.3 P=0.007) was an independent predictor of sinus rhythm at 1 month, whereas older age was a negative predictor (0.96, 0.92-1.0 P=0.05). Health-related quality of life improved at 1 and 12 months in those patients who remained in sinus rhythm compared to those who remained in AF. Though electrical cardioversion for AF has a high initial success rate only a minority of patients remained in sinus rhythm 1 year. The common practice of discontinuing anticoagulant treatment in patients in sinus rhythm at 1 month may be unsafe. Long-term maintenance of sinus rhythm is, however, associated with better health-related quality of life.

Incremental Value of Global Longitudinal Strain in the Long-Term Prediction of Heart Failure among Patients with Coronary Artery Disease

Publisher: Elsevier BV

Date: 02-2022

DOI: 10.1016/J.ECHO.2021.09.003

Abstract: 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. 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 in iduals at risk of incident HF. Long-term (9 years) follow-up was obtained via data linkage. Analysis was performed using a competing-risk model. 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). 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.

Addressing the conundrum of multimorbidity in heart failure: Do we need a more strategic approach to improve health outcomes?

Publisher: Oxford University Press (OUP)

Date: 11-09-2016

DOI: 10.1177/1474515115604794

Abstract: There is clear evidence across the globe that the clinical complexity of patients presenting to hospital with the syndrome of heart failure is increasing - not only in terms of the presence of concurrent disease states, but with additional socio-demographic risk factors that complicate treatment. Management strategies that treat heart failure as the main determinant of health outcomes ignores the multiple and complex issues that will inevitably erode the efficacy and efficiency of current heart failure management programmes. This complex problem (or conundrum) requires a different way of thinking around the complex interactions that underpin poor outcomes in heart failure. In this context, we present the COordinated NUrse-led inteNsified Disease management for continuity of caRe for mUltiMorbidity in Heart Failure (CONUNDRUM-HF) matrix that may well inform future research and models of care to achieve better health outcomes in this rapidly increasing patient population.

Managing patients with acute myocardial ischemia and reperfusion injury with N-acetylcysteine.

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 05-1997

DOI: 10.1097/00003465-199705000-00002

Abstract: Previously administered in cases of acetaminophen toxicity, N-Acetylcysteine (NAC) is now also being used in the management of acute myocardial ischemia and reperfusion injury. NAC potentiates the beneficial effects of nitrates such as nitroglycerin and reduces oxidative stress on the heart. The critical care nurse plays an important role in optimizing the therapeutic benefits of NAC and minimizing its potential harmful effects.

Trends in long-term cardiovascular mortality and morbidity in men and women with heart failure of ischemic versus non-ischemic aetiology in Western Australia between 1990 and 2005

Publisher: Elsevier BV

Date: 07-2012

DOI: 10.1016/J.IJCARD.2011.01.061

Abstract: It is uncertain if improvements in long-term cardiovascular (CV) mortality have occurred in both men and women with ischemic and non-ischemic forms of heart failure (HF). The Western Australia Hospital Morbidity Database was used to identify all index (first-ever) hospitalizations for HF between 1990 and 2005. Patients were followed until death attributed to cardiovascular causes or censored on December 31, 2006 to determine 5-year survival. Cox proportional hazards models were used to compare the adjusted mortality hazard ratio (HR) during the study follow-up (4-year periods). A total of 21,507 patients (mean age 73.9 years, 49.1% women) were identified. Women were significantly older than men, and less likely to have ischemic HF (38.8% versus 46.1%). Over the period, age-standardized incidence of first HF hospitalization declined but with the least decline in women with non-ischemic HF (-13.3%) compared to other subgroups. Risk-adjusted 5-year CV mortality declined over the study period, with HR 0.64 (95% CI 0.60-0.68) for patients admitted in 1998-2001 compared to 1990-1993, with significant improvement in both forms of HF, and in both sexes and across age groups. However, overall total HF hospitalizations increased (+26.7%) over the period, particularly for non-ischemic HF (+43.7%), of which elderly women formed the predominant group. Risk-adjusted long-term survival improved similarly in men and women, including the elderly, with ischemic and non-ischemic forms of HF during 1990-2005 in Western Australia. However, there was a growing burden of HF hospitalizations particularly for HF of non-ischemic aetiology.

Pattern and Outcome of Heart Failure–Related Hospitalization Over 5 Years in a Remote Australian Population: A Retrospective Administrative Data Cohort of 617 Indigenous and non-Indigenous Cases

Publisher: Elsevier BV

Date: 10-2017

DOI: 10.1016/J.CARDFAIL.2017.06.002

Abstract: The aim of this work was to understand the pattern and outcomes for heart failure (HF)-related hospitalization among Indigenous and non-Indigenous patients living in Central Australia. A retrospective analysis of administrative data for patients presenting with a primary or secondary diagnosis of HF to Central Australia's Alice Springs Hospital during 2008-2012 was performed. The population rate of admission and subsequent outcomes (including mortality and readmission) during the 5-year study period were examined. A total of 617 patients, aged 55.8 ± 17.5 years and 302 (49%) female constituted the study cohort. The 446 Indigenous patients (72%) were significantly younger (50.8 ± 15.9 vs 68.7 ± 14.9 P < .001) and clinically more complex compared with the non-Indigenous patients. Annual prevalence of any HF hospitalization was markedly higher in the Indigenous population (1.9%, 95% CI 1.7-2.1) compared with the non-Indigenous population (0.5%, 95% CI 0.4-0.6) the greatest difference being for women. Overall, non-Indigenous patients had poorer outcomes and were significantly more likely to die (P < .0001), but this was largely driven by age differences. Alternatively, Indigenous patients were significantly more likely to have a higher number of hospitalizations, although indigeneity was not a predictor for 30- or 365-day rehospitalization from the index admission. The pattern of HF among Indigenous Australians in Central Australia is characterized by a younger population with more clinically complex cases and greater health care utilization.

Refractory to Medical Treatment But not to Nursing Care: Can We Do More for Patients with Chronic Angina Pectoris?

Publisher: Oxford University Press (OUP)

Date: 09-2003

DOI: 10.1016/S1474-5151(03)00067-7

New onset atrial fibrillation is associated with elevated galectin-3 levels

Publisher: Elsevier BV

Date: 11-2016

DOI: 10.1016/J.IJCARD.2016.08.172

A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study

Publisher: Elsevier BV

Date: 10-2002

DOI: 10.1016/S0002-9343(02)01236-6

Abstract: To describe the effect of atrial fibrillation on long-term morbidity and mortality. The Renfrew/Paisley Study surveyed 7052 men and 8354 women aged 45-64 years between 1972 and 1976. All hospitalizations and deaths occurring during the subsequent 20 years were analyzed by the presence or absence of atrial fibrillation at baseline. Lone atrial fibrillation was defined in the absence of other cardiovascular signs or symptoms. Cox proportional hazards models were used to adjust for age and cardiovascular conditions. After 20 years, 42 (89%) of the 47 women with atrial fibrillation had a cardiovascular event (death or hospitalization), compared with 2276 (27%) of the 8307 women without this arrhythmia. Among men, 35 (66%) of 53 with atrial fibrillation had an event, compared with 3151 (45%) of 6999 without atrial fibrillation. In women, atrial fibrillation was an independent predictor of cardiovascular events (rate ratio [RR] = 3.0 95% confidence interval [CI]: 2.1-4.2), fatal or nonfatal strokes (RR = 3.2 95% CI: 1.0-5.0), and heart failure (RR = 3.4 95% CI: 1.9-6.2). The rate ratios among men were 1.8 (95% CI: 1.3-2.5) for cardiovascular events, 2.5 (95% CI: 1.3-4.8) for strokes, and 3.4 (95% CI: 1.7-6.8) for heart failure. Atrial fibrillation was an independent predictor of all-cause mortality in women (RR = 2.2 95% CI: 1.5-3.2) and men (RR = 1.5 95% CI: 1.2-2.2). However, lone atrial fibrillation (which occurred in 15 subjects) was not associated with a statistically significant increase in either cardiovascular events (RR = 1.5 95% CI: 0.6-3.6) or mortality (RR = 1.8 95% CI: 0.9-3.8). Atrial fibrillation is associated with an increased long-term risk of stroke, heart failure, and all-cause mortality, especially in women.

Adherence, adaptation and acceptance of elderly chronic heart failure patients to receiving healthcare via telephone-monitoring

Publisher: Wiley

Date: 11-2007

DOI: 10.1016/J.EJHEART.2007.07.018

Abstract: Although the potential to reduce hospitalisation and mortality in chronic heart failure (CHF) is well reported, the feasibility of receiving healthcare by structured telephone support or telemonitoring is not. To determine adherence, adaptation and acceptability to a national nurse-coordinated telephone-monitoring CHF management strategy. The Chronic Heart Failure Assistance by Telephone Study (CHAT). Triangulation of descriptive statistics, feedback surveys and qualitative analysis of clinical notes. Cohort comprised of standard care plus intervention (SC+I) participants who completed the first year of the study. 30 GPs (70% rural) randomised to SC+I recruited 79 eligible participants, of whom 60 (76%) completed the full 12 month follow-up period. During this time 3619 calls were made into the CHAT system (mean 45.81 SD+/-79.26, range 0-369), Overall there was an adherence to the study protocol of 65.8% (95% CI 0.54-0.75 p=0.001) however, of the 60 participants who completed the 12 month follow-up period the adherence was significantly higher at 92.3% (95% CI 0.82-0.97, p<or=0.001). Only 3% of this elderly group (mean age 74.7+/-9.3 years) were unable to learn or competently use the technology. Participants rated CHAT with a total acceptability rate of 76.45%. This study shows that elderly CHF patients can adapt quickly, find telephone-monitoring an acceptable part of their healthcare routine, and are able to maintain good adherence for a least 12 months.

Prolonged impact of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort

Publisher: Elsevier BV

Date: 07-2014

DOI: 10.1016/J.IJCARD.2014.04.164

Abstract: We compared the longer-term impact of the two most commonly applied forms of post-discharge management designed to minimize recurrent hospitalization and prolong survival in typically older patients with chronic heart failure (CHF). We followed a multi-center randomized controlled trial cohort of Australian patients hospitalized with CHF and initially allocated to home-based or specialized CHF clinic-based intervention for 1368 ± 216 days. Blinded endpoints included event-free survival from all-cause emergency hospitalization or death, all-cause mortality and rate of all-cause hospitalization and stay. 280 patients (73% male, aged 71 ± 14 years and 73% left ventricular systolic dysfunction) were initially randomized to home-based (n=143) or clinic-based (n=137) intervention. During extended follow-up (complete for 274 patients), 1139 all-cause hospitalizations (7477 days of hospital stay) and 121 (43.2%) deaths occurred. There was no difference in the primary endpoint 20 (14.0%) home-based versus 13 (7.4%) clinic-based patients remained event-free (adjusted HR 0.89, 95% CI 0.70 to 1.15 p=0.378). Significantly fewer home-based (51/143, 35.7%) than clinic-based intervention (71/137, 51.8%) patients died (adjusted HR 0.62, 95% CI 0.42 to 0.90: p=0.012). Home-based versus clinic-based intervention patients accumulated 592 and 547 all-cause hospitalizations (p=0.087) associated with 3067 (median 4.0, IQR 2.0 to 6.8) versus 4410 (6.0, IQR 3.0 to 12.0) days of hospital stay (p<0.01 for rate and duration of hospital stay). Relative to clinic-based intervention, home-based intervention was not associated with prolonged event-free survival. Home-based intervention was, however, associated with significantly fewer all-cause deaths and significantly fewer days of hospital stay in the longer-term. Australian New Zealand Clinical Trials Registry number 12607000069459 (www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=81803).

Risk factors for incident heart failure with preserved or reduced ejection fraction, and valvular heart failure, in a community-based cohort

Publisher: BMJ

Date: 07-2018

DOI: 10.1136/OPENHRT-2018-000782

Abstract: The lack of effective therapies for heart failure with preserved ejection fraction (HFpEF) reflects an incomplete understanding of its pathogenesis. We analysed baseline risk factors for incident HFpEF, heart failure with reduced ejection fraction (HFrEF) and valvular heart failure (VHF) in a community-based cohort. We recruited 2101 men and 1746 women ≥60 years of age with hypertension, diabetes, ischaemic heart disease (IHD), abnormal heart rhythm, cerebrovascular disease or renal impairment. Exclusion criteria were known heart failure, left ventricular ejection fraction % or valve abnormality mild in severity. Median follow-up was 5.6 (IQR 4.6–6.3) years. Median time to heart failure diagnosis in 162 participants was 4.5 (IQR 2.7–5.4) years, 73 with HFpEF, 53 with HFrEF and 36 with VHF. Baseline age and amino-terminal pro-B-type natriuretic peptide levels were associated with HFpEF, HFrEF and VHF. Pulse pressure, IHD, waist circumference, obstructive sleep apnoea and pacemaker were associated with HFpEF and HFrEF atrial fibrillation (AF) and warfarin therapy were associated with HFpEF and VHF and peripheral vascular disease and low platelet count were associated with HFrEF and VHF. Additional risk factors for HFpEF were body mass index (BMI), hypertension, diabetes, renal dysfunction, low haemoglobin, white cell count and β-blocker, statin, loop diuretic, non-steroidal anti-inflammatory and clopidogrel therapies, for HFrEF were male gender and cigarette smoking and for VHF were low diastolic blood pressure and alcohol intake. BMI, diabetes, low haemoglobin, white cell count and warfarin therapy were more strongly associated with HFpEF than HFrEF, whereas male gender and low platelet count were more strongly associated with HFrEF than HFpEF. Our data suggest a major role for BMI, hypertension, diabetes, renal dysfunction, and inflammation in HFpEF pathogenesis strategies directed to prevention of these risk factors may prevent a sizeable proportion of HFpEF in the community. NCT00400257 , NCT00604006 and NCT01581827 .

Cardiovascular Risk in Urban and Rural African Settings

Publisher: Wiley

Date: 13-05-2016

DOI: 10.1002/9781119097136.CH4

Predominance of heart failure in the heart of Soweto study cohort: Emerging challenges for urban African communities

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 02-12-2008

DOI: 10.1161/CIRCULATIONAHA.108.786244

Abstract: Background— There is a paucity of data to describe the clinical characteristics of heart failure (HF) in urban African communities in epidemiological transition. Methods and Results— Chris Hani Baragwanath Hospital services the 1.1 million black African community of Soweto, South Africa. Of 1960 cases of HF and related cardiomyopathies in 2006, we prospectively collected detailed demographic and clinical data from all 844 de novo presentations (43%). Mean age was 55±16 years, and women (479 [57%]) and black Africans (739 [88%]) predominated. Most (761 [90%]) had ≥1 cardiovascular risk. Mean left ventricular ejection fraction was 45±18%. Overall, 180 patients (23%) had isolated diastolic dysfunction, 234 (28%) tricuspid regurgitation, 121 (14%) isolated right HF, and 100 (12%) mitral regurgitation. The most common diagnoses were hypertensive HF (281 [33%]), idiopathic dilated cardiomyopathy (237 [28%]), and, surprisingly, right HF (225 [27%]). Black Africans had less ischemic cardiomyopathy (adjusted odds ratio, 0.12 95% CI, 0.07 to 0.20) but more idiopathic and other causes of cardiomyopathy (adjusted odds ratio, 4.80 95% CI, 2.57 to 8.93). Concurrent renal dysfunction, anemia, and atrial fibrillation were found in 172 (25%), 72 (10%), and 53 (6.3%) cases, respectively. Conclusions— These contemporary data highlight the multiple challenges of preventing and managing an increasing and complex burden of HF in urban Africa. In addition to tackling antecedent hypertension, a predominance of young women and a large component of right HF predicate the development of tailored therapeutic strategies.

Specialist Nurse Management Programmes

Publisher: Springer Science and Business Media LLC

Date: 2003

DOI: 10.2165/00019053-200321040-00001

Abstract: Chronic heart failure (CHF) is a modern-day epidemic in most developed countries. As such, it is both common and costly. Contrary to the impression given by clinical trial data, CHF mainly affects older in iduals with approximately equal numbers of men and women and concurrent disease profiles likely to complicate or even prohibit the application of proven treatments. It is within this context that there has been an increasing interest in specific CHF-management programmes designed to limit costly hospital use in typically older in iduals at high risk for poor quality of life, recurrent readmissions and premature death. This paper examines the evidence to suggest that CHF programmes involving in idualised multidisciplinary post-discharge healthcare, with a major focus on specialist nurse management to ensure that the patient receives optimal treatment, are clinically and economically effective in reducing the typical burden imposed by CHF. These programmes appear to be most effective in 'high-risk' patients who typically have recurrent readmissions in high-cost units. Overall, the literature suggests that these programmes are able to reduce recurrent hospital stay by 30-50% relative to usual care (even in the presence of gold-standard treatment) in the short to medium term with comparable cost benefits. Recent data from a management programme involving a cohort of typically older and fragile patients with CHF in Australia showed that at 3 years post index admission, hospital utilisation costs were reduced by one-third relative to usual care. The potential for enormous cost benefits (both in terms of absolute cost savings and in terms of facilitating a more efficient healthcare system) if a specialist nurse programme of care was applied in the form of a UK-wide heart failure service was also recently examined. Based on year 2000 activity levels, it was found that for each specialist heart failure nurse appointed in the UK (with a caseload of 200-250 patients per annum), nominal savings of pound 49 000 per annum could be generated in order to make the healthcare system more efficient.

Cardiovascular disease prevention via a nurse-facilitated intervention clinic in a regional setting: The Protecting Healthy Hearts Program

Publisher: Oxford University Press (OUP)

Date: 20-05-2015

DOI: 10.1177/1474515114537022

Abstract: Regional-dwelling adults have higher levels of cardiovascular disease (CVD) risk. To determine the potential benefits of a nurse-led, self-management intervention program to reduce CVD and diabetes risk. A six-month pre ost observational study was conducted in a high risk, under-serviced regional community. A nurse-led heart health clinic was established and 530 self-selected adult in iduals (mean age 54±14 years, 62% female) were subject to standardized screening. In idual targets and multidisciplinary strategies to reduce risk factors were in idually tailored according to the Green Amber Red Delineation of rIsk And Need (GARDIAN) system. Changes in participants' CVD risk factors and lifestyle behaviors were compared and independent correlates of improvements in blood pressure (BP), total cholesterol, weight and absolute CVD risk were evaluated. Baseline risk factors for CVD were highly prevalent. Participants required low (43%), moderate (34%) or high (23%) levels of surveillance and management according to GARDIAN criteria. Clinically significant changes in 326 (76%) participants were observed. Average BP decreased by 4 mmHg (systolic) and 1 mmHg (diastolic), weight by almost 1 kg, total cholesterol by 0.6 mmol/l and body mass index (BMI) by 0.3 kg/m(2). A change in absolute CVD risk scores of -0.4% was observed. Primary physician attendance independently predicted improvements in BP (odds ratio (OR) 1.67 95% confidence interval (CI) 1.08-2.58, p=0.022) whereas GARDIAN status, age, physical activity and nurse guidance positively influenced cholesterol, absolute CVD risk and weight outcomes. The feasibility and short-term benefits of a dedicated "heart health" service for high risk regional-dwelling in iduals was shown.

The Spectrum of Heart Disease in Urban Africans: The Heart of Soweto Study

Publisher: Wiley

Date: 13-05-2016

DOI: 10.1002/9781119097136.CH6

Northern Territory Heart Failure Initiative -Clinical Audit (NTHFI-CA)-a prospective database on the quality of care and outcomes for acute decompensated heart failure admission in the Northern Territory: Study design and rationale

Publisher: BMJ

Date: 2014

DOI: 10.1136/BMJOPEN-2013-004137

Rheumatic Heart Disease

Publisher: Wiley

Date: 13-05-2016

DOI: 10.1002/9781119097136.CH7

Mild cognitive impairment is associated with subclinical diastolic dysfunction in patients with chronic heart disease

Publisher: Oxford University Press (OUP)

Date: 07-08-2018

DOI: 10.1093/EHJCI/JEX169

Abstract: 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). 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 in idual 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). 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.

Population Screening for Heart Disease in Vulnerable Populations: Lessons from the Heart of Soweto Study

Publisher: Elsevier BV

Date: 04-2009

DOI: 10.1016/J.HLC.2009.01.003

Abstract: This article reviews the progress of the largest study of heart disease in Africa to date - the Heart of Soweto Study. Moreover, it discusses the relevance of this study in respect to population screening in vulnerable populations. This includes Indigenous Australians living in communities that are remote from mainstream health care services.

Human Immunodeficiency Virus-Related Heart Disease

Publisher: Wiley

Date: 13-05-2016

DOI: 10.1002/9781119097136.CH9

Recognising the “other half” of the heart failure equation: are we doing enough for family caregivers?

Publisher: Wiley

Date: 28-05-2005

DOI: 10.1016/J.EJHEART.2004.07.021

Evidence of improving prognosis in heart failure: Trends in case fatality in 66 547 patients hospitalized between 1986 and 1995

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 05-09-2000

DOI: 10.1161/01.CIR.102.10.1126

Abstract: Background —Contemporary survival in unselected patients with heart failure and the population impact of newer therapies have not been widely studied. Therefore, we have documented case-fatality rates (CFRs) over a recent 10-year period. Methods and Results —In Scotland, all hospitalizations and deaths are captured on a single database. We have studied case fatality in all patients admitted with a principal diagnosis of heart failure from 1986 to 1995. A total of 66 547 patients (47% male) were studied. Median age was 72 years in men and 78 years in women. Crude CFRs at 30 days and at 1, 5, and 10 years were 19.9%, 44.5%, 76.5%, and 87.6%, respectively. Median survival was 1.47 years in men and 1.39 years in women (2.47 and 2.36 years, respectively, in those surviving 30 days). Age had a powerful effect on survival, and sex, comorbidity, and deprivation had modest effects. One-year CF was 24.2% in those aged years and 58.1% in those aged years. After adjustment, 30-day CFRs fell between 1986 and 1995, by 26% (95% CI 15 to 35, P .0001) in men and 17% (95% CI 6 to 26, P .0001) in women. Longer term CFRs fell by 18% (95% CI 13 to 24, P .0001) in men and 15% (95% CI 10 to 20, P .0001) in women. Median survival increased from 1.23 to 1.64 years. Conclusions —Heart failure CF is much higher in the general population than in clinical trials, especially in the elderly. Although survival has increased significantly over the last decade, there is still much room for improvement.

Nurse Specialists in Adult Congenital Heart Disease: The Current Status in Europe

Publisher: Oxford University Press (OUP)

Date: 03-2006

DOI: 10.1016/J.EJCNURSE.2005.10.010

Abstract: Recommendations for the management of adults with congenital heart disease indicate that specialist referral centres should employ nurse specialists who are trained and educated in the care for these patients. We surveyed the involvement, education and activities of nurse specialists in the care for adults with congenital cardiac anomalies in Europe. The Euro Heart Survey on Adult Congenital Heart Disease has previously showed that 20 out of 48 specialist centres (42%) have nurse specialists affiliated with their programme. Fifteen of these 20 centres (75%) validly completed a web-based survey tool. Specialist centres had a median number of 2 nurse specialists on staff, corresponding with 1 full-time equivalent. In most centres, the nurse specialists were also affiliated with other cardiac care programmes, in addition to congenital heart disease. The involvement of nurse specialists was not related to the caseload of inpatients and outpatient visits. Physical examination was the most prevalent activity undertaken by nurse specialists (93.3%), followed by telephone accessibility (86.7%), patient education (86.7%), co-ordination of care (73.3%), and follow-up after discharge (73.3%). Patient education covered mainly prevention and prophylaxis of endocarditis (100%), cardiovascular risk factors (92.3%), sport activities (92.3%), the type and characteristics of the heart defect (92.3%), the definition and aetiology of endocarditis (84.6%), cardiac risk in case of pregnancy (84.6%), and heredity (84.6%). Two third of the nurse specialists were involved in research. This survey revealed gaps in the provision of care for these patients in Europe and demonstrated that there is room for improvement in order to provide adequate chronic disease management. The results of this study can be used by in idual hospitals for benchmarking.

Poor Survival with Impaired Valvular Hemodynamics After Aortic Valve Replacement: The National Echo Database Australia Study

Publisher: Elsevier BV

Date: 09-2020

DOI: 10.1016/J.ECHO.2020.04.024

Impact of nurse-led, multidisciplinary home-based intervention on event-free survival across the spectrum of chronic heart disease

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 10-05-2016

DOI: 10.1161/CIRCULATIONAHA.116.020730

Abstract: 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. 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 in idual trial cohorts) and with a Charlson Comorbidity Index Score of 5 to 8 (36%–61%). 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. URL: www.anzctr.org.au . Unique identifiers: 12610000221055, 12608000022369, 12607000069459.

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: The Young at Heart Study

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 07-2013

DOI: 10.1161/CIRCOUTCOMES.111.000006

Abstract: We examined the impact of a prolonged secondary prevention program on recurrent hospitalization in cardiac patients with private health insurance. 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] atient 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). 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. Australian New Zealand Clinical Trials Registry Unique Identifier: 12608000014358. URL: www.anzctr.org.au/trial_view.aspx?id=82509 .

Australia: A report on the international conference on medicinal drug policies, the way forward. Sydney, Australia, October, 1995

Publisher: Wiley

Date: 03-1996

DOI: 10.1111/J.1440-172X.1996.TB00022.X

Pediatric Mortality Due to Inborn Errors of Metabolism in Victoria, Australia: A Population-Based Study

Publisher: American Medical Association (AMA)

Date: 08-09-2010

DOI: 10.1001/JAMA.2010.1259

A study of unplanned readmissions to a coronary care unit

Publisher: Elsevier BV

Date: 05-1997

DOI: 10.1016/S0147-9563(97)90056-X

Abstract: To determine the cause and frequency of unplanned readmissions to a coronary care unit (CCU) after initial transfer to a general cardiac unit, but before hospital discharge. Analysis of 1776 admissions to a CCU during a 16-month period. The CCU of a major teaching hospital in South Australia. All patients admitted to the CCU during the 16-month period. CCU readmissions before hospital discharge were categorized as either "planned" or "unplanned." The latter were investigated for determination of casualty and variations in patient characteristics (including age, sex, initial diagnosis, pharmacotherapy, and duration of stay in the CCU). Of the 1776 CCU admissions examined, 44 (2.5% of total) were unplanned readmissions before hospital discharge. Most of these (39 of 44) were related to "reactivation" of acute myocardial ischemia. Patients whose initial diagnosis was acute myocardial infarction or unstable angina pectoris were more likely to require a further unplanned CCU admission (p < 0.05) those with unstable angina pectoris had a second stay in CCU significantly longer than their first (p < 0.05). Six patients were readmitted within 6 hours of cessation of a heparin infusion (4 of the 6 without aspirin administration), and 11 patients had not received antiplatelet therapy after their initial CCU stay. Overall, a disproportionate number of men were readmitted to CCU (p < 0.05). In the current study, unplanned readmissions to the CCU: (1) were relatively infrequent, (2) were more protracted than initial stays in CCU, (3) may have been prevented in 15 of the 44 cases with more appropriate pharmacotherapy, and (4) involved a disproportionate number of male patients.

Reply: Poor Outcomes in Patients With Moderate Aortic Stenosis: Let's Review the Data

Publisher: Elsevier BV

Date: 02-2020

DOI: 10.1016/J.JACC.2019.12.014

Hot summers and heart failure: Seasonal variations in morbidity and mortality in Australian heart failure patients (1994-2005)

Publisher: Wiley

Date: 06-2008

DOI: 10.1016/J.EJHEART.2008.03.008

Abstract: There are minimal reports of seasonal variations in chronic heart failure (CHF)-related morbidity and mortality beyond the northern hemisphere. We examined potential seasonal variations with respect to morbidity and all-cause mortality over more than a decade in a cohort of 2961 patients with CHF from a tertiary referral hospital in South Australia subject to mild winters and hot summers. Seasonal variation across all event-types was observed. CHF-related morbidity peaked in winter (July) and was lowest in summer (February): 70 (95% CI: 65 to 76) vs. 33 (95% CI: 30 to 37) admissions/1000 at risk (p<0.005). All-cause admissions (113 (95% CI: 107 to 120) vs. 73 (95% CI 68 to 79) admissions/1000 at risk, p<0.001) and concurrent respiratory disease (21% vs. 12%, p<0.001) were consistently higher in winter. 2010 patients died, mortality was highest in August relative to February: 23 (95% CI: 20 to 27) vs. 12 (95% CI: 10 to 15) deaths per 1000 at risk, p<0.001. Those aged 75 years or older were most at risk of seasonal variations in morbidity and mortality. Seasonal variations in CHF-related morbidity and mortality occur in the hot climate of South Australia, suggesting that relative (rather than absolute) changes in temperature drive this global phenomenon.

Association of aortic stenosis with platelet hyperaggregability and impaired responsiveness to nitric oxide

Publisher: Elsevier BV

Date: 03-2029

DOI: 10.1016/S0002-9149(02)02536-5

The 12-lead ECG in peripartum cardiomyopathy

Publisher: Clinics Cardive Publishing

Date: 18-07-2012

DOI: 10.5830/CVJA-2012-006

Failing ageing hearts

Publisher: Oxford University Press (OUP)

Date: 11-2001

DOI: 10.1053/EUHJ.2000.2558

Moderate aortic stenosis: culprit or bystander?

Publisher: BMJ

Date: 2022

DOI: 10.1136/OPENHRT-2021-001743

Abstract: Non-rheumatic aortic stenosis (AS) is among the most common valvular diseases in the developed world. Current guidelines support aortic valve replacement (AVR) for severe symptomatic AS, which carries high morbidity and mortality when left untreated. In contrast, moderate AS has historically been thought to be a benign diagnosis for which the potential benefits of AVR are outweighed by the procedural risks. However, emerging data demonstrating the substantial mortality risk in untreated moderate AS and substantial improvements in periprocedural and perioperative mortality with AVR have challenged the traditional risk/benefit paradigm. As such, an appraisal of the contemporary data on morbidity and mortality associated with moderate AS and appropriate timing of valvular intervention in AS is warranted. In this review, we discuss the current understanding of moderate AS, including the epidemiology, current surveillance and management guidelines, clinical outcomes, and future studies.

Gender-specific secondary prevention? Differential psychosocial risk factors for major cardiovascular events

Publisher: BMJ

Date: 04-2016

DOI: 10.1136/OPENHRT-2015-000356

Does cognitive impairment predict poor self‐care in patients with heart failure?

Publisher: Wiley

Date: 21-04-2010

DOI: 10.1093/EURJHF/HFQ042

Abstract: 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. 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). 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.

Cost-effectiveness of a home based intervention for secondary prevention of readmission with chronic heart disease

Publisher: Public Library of Science (PLoS)

Date: 10-12-2015

DOI: 10.1371/JOURNAL.PONE.0144545

A national survey of the prevalence, incidence, primary care burden and treatment of atrial fibrillation in Scotland

Publisher: BMJ

Date: 05-2007

DOI: 10.1136/HRT.2006.107573

Association of traditional risk factors with carotid intima-media thickness and carotid plaque in asymptomatic individuals with a family history of premature cardiovascular disease

Publisher: Springer Science and Business Media LLC

Date: 03-11-2022

DOI: 10.1007/S10554-021-02459-X

Carvedilol reduces the costs of medical care in severe heart failure: An economic analysis of the COPERNICUS study applied to the United Kingdom

Publisher: Elsevier BV

Date: 04-2005

DOI: 10.1016/J.IJCARD.2004.12.003

Abstract: The aim of this study was to determine the effects of carvedilol on the costs related to the treatment of severe chronic heart failure (CHF). Costs for the treatment for heart failure within the National Health Service (NHS) in the United Kingdom (UK) were applied to resource utilisation data prospectively collected in all patients randomized into the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) Study. Unit-specific, per diem (hospital bed day) costs were used to calculate expenditures due to hospitalizations. We also included costs of carvedilol treatment, general practitioner surgery/office visits, hospital out-patient clinic visits and nursing home care based on estimates derived from validated patterns of clinical practice in the UK. The estimated cost of carvedilol therapy and related ambulatory care for the 1156 patients assigned to active treatment was pound530,771 ( pound44.89 per patient/month of follow-up). However, patients assigned to carvedilol were hospitalised less often and accumulated fewer and less expensive days of admission. Consequently, the total estimated cost of hospital care was pound3.49 million in the carvedilol group compared with pound4.24 million for the 1133 patients in the placebo arm. The cost of post-discharge care was also less in the carvedilol than in the placebo group ( pound479,200 vs. pound548,300). Overall, the cost per patient treated in the carvedilol group was pound3948 compared to pound4279 in the placebo group. This equated to a cost of pound385.98 vs. pound434.18, respectively, per patient/month of follow-up: an 11.1% reduction in health care costs in favour of carvedilol. These findings suggest that not only can carvedilol treatment increase survival and reduce hospital admissions in patients with severe CHF but that it can also cut costs in the process.

Resource utilization and costs in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme

Publisher: Oxford University Press (OUP)

Date: 24-10-2006

DOI: 10.1093/EURHEARTJ/EHL016

Abstract: More treatments are needed to improve clinical outcomes in chronic heart failure (HF). It is, however, important that treatments for a condition as common as HF are affordable. We have carried out a prospective economic analysis of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme. Patients with NYHA class II-IV HF and LVEF 0.40 were randomized in CHARM-Preserved. Each trial compared the effect of candesartan to placebo on the primary outcome of cardiovascular death or HF hospitalization. Detailed information was prospectively collected on hospital admissions, procedures/operations and drugs. A cost-consequence analysis was performed for France, Germany and the UK for CHARM-Overall and a cost-effectiveness analysis for the low LVEF trials. The cost of candesartan was substantially offset by a reduction in hospital admissions, especially for HF. In the cost-consequence analysis, candesartan was cost-saving in most scenarios for CHARM-Alternative and Added but the marginal annual net cost per patient was upto 372 euros per year in CHARM-Preserved, in which candesartan did not reduce the primary outcome significantly. In the cost-effectiveness analysis of patients with a LVEF < or = 0.40, candesartan was cost-saving in some scenarios and in the others the maximum cost per life year gained was 3881 euros. Candesartan improves functional class, reduces the risk of hospital admission, and increases survival in patients with a HF and a LVEF < or =0.40 at an acceptable cost.

Establishing a pragmatic framework to optimise health outcomes in heart failure and multimorbidity (ARISE-HF): A multidisciplinary position statement

Publisher: Elsevier BV

Date: 06-2016

DOI: 10.1016/J.IJCARD.2016.03.001

Seasonal variations in cardiovascular disease

Publisher: Springer Science and Business Media LLC

Date: 18-05-2017

DOI: 10.1038/NRCARDIO.2017.76

Abstract: Cardiovascular disease (CVD) follows a seasonal pattern in many populations. Broadly defined winter peaks and clusters of all subtypes of CVD after 'cold snaps' are consistently described, with corollary peaks linked to heat waves. In iduals living in milder climates might be more vulnerable to seasonality. Although seasonal variation in CVD is largely driven by predictable changes in weather conditions, a complex interaction between ambient environmental conditions and the in idual is evident. Behavioural and physiological responses to seasonal change modulate susceptibility to cardiovascular seasonality. The heterogeneity in environmental conditions and population dynamics across the globe means that a definitive study of this complex phenomenon is unlikely. However, given the size of the problem and a range of possible targets to reduce seasonal provocation of CVD in vulnerable in iduals, scope exists for both greater recognition of the problem and application of multifaceted interventions to attenuate its effects. In this Review, we identify the physiological and environmental factors that contribute to seasonality in nearly all forms of CVD, highlight findings from large-scale population studies of this phenomenon across the globe, and describe the potential strategies that might attenuate peaks in cardiovascular events during cold and hot periods of the year.

Stopping heart failure in its tracks

Publisher: Wiley

Date: 02-2007

DOI: 10.1016/J.EJHEART.2006.09.004

Nursing and midwifery: Time for an amicable divorce?

Publisher: Elsevier BV

Date: 05-2007

DOI: 10.1016/J.IJNURSTU.2007.03.002

Long‐term tolerance and efficacy of adjunctive exenatide therapy on glycaemic control and bodyweight in type 2 diabetes: a retrospective study from a specialist diabetes outpatient clinic

Publisher: Wiley

Date: 04-2014

DOI: 10.1111/IMJ.12377

Abstract: Weight gain and hypoglycaemia are common adverse effects associated with anti-diabetic treatments. Our aim was to evaluate the long-term effects of adjunctive exenatide therapy on weight loss and glycaemic control in patients with type 2 diabetes. A review of medical records in a specialist diabetes clinic over 5 years identified 446 patients who were prescribed exenatide therapy. We examined change in glycosylated haemoglobin (HbA1c), weight, albumin-creatinine ratio and hypoglycaemic medication during 24 months follow up. Subjects were aged 59 ± 10 years (49% women) and received exenatide in combination with oral agents and insulin (47%). During an average of 17 ± 14 months follow up, 51% (more women than men odds ratio 1.69, 95% confidence interval 1.14–2.49) remained on treatment. Lack of efficacy (33%) and/or gastrointestinal (27%) side-effects were the main reasons for treatment cessation. At 24 months, there was a reduction in HbA1c of 0.7 ± 1.2% and weight loss of 4.3 ± 5.2 kg. Change in HbA1c was similar regardless of concurrent insulin therapy, yet insulin was associated with greater weight reduction (4.8 ± 5.3 vs 3.8 ± 5.1 kg, P = 0.016). Independent predictors of HbA1c response were higher baseline HbA1c, longer duration of diabetes and use of insulin or sulfonylureas at study end. Predictors of weight response were baseline use of insulin or thiazolidinediones, increased age, female sex and sulfonylurea or thiazolidinediones at study end. Longer exenatide treatment duration was favourable for reducing HbA1c and weight. Exenatide is effective in reducing HbA1c and weight, regardless of concurrent insulin, and in a specialist diabetes outpatient clinic, is recommended for use in clinical practice.

Long-term trends in first hospitalization for heart failure and subsequent survival between 1986 and 2003. A population study of 5.1 million people

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 03-02-2009

DOI: 10.1161/CIRCULATIONAHA.108.812172

Abstract: Background— We examined whether population-level hospitalization rates for heart failure (HF) and subsequent survival have continued to improve since the turn of the century. We also examined trends in the prescribing of evidence-based pharmacological treatment for HF. Methods and Results— All patients in Scotland hospitalized with a first episode of HF between 1986 and 2003 were followed up until death or the end of 2004. Prescriptions of evidence-based treatments issued from 1997 to 2003 by a s le of primary care practices were also examined. A total of 116 556 in iduals (52.6% women) had a first hospital discharge for HF. Age-adjusted first hospitalization rates for HF (per 100 000 95% CI in parentheses) rose from 124 (119 to 129) in 1986 to 162 (157 to 168) in 1994 and then fell to 105 (101 to 109) in 2003 in men in women, they rose from 128 (123 to 132) in 1986 to 160 (155 to 165) in 1993, falling to 101 (97 to 105) in 2003. Case-fatality rates fell steadily over the period. Adjusted 30-day case-fatality rates fell after discharge (adjusted odds [2003 versus 1986] 0.59 [95% CI 0.45 to 0.63] in men and 0.77 [95% CI 0.67 to 0.88] in women). Adjusted 1- and 5-year survival improved similarly. Median survival increased from 1.33 to 2.34 years in men and from 1.32 to 1.79 years in women. Age-adjusted prescribing rates for angiotensin-converting enzyme inhibitors, β-blockers, and spironolactone increased from 1997 to 2003 (all P .0001 for trend). Conclusions— After rising between 1986 and 1994, rates of first hospitalization for HF declined. Case-fatality rates also fell. Prescribing rates for HF therapies increased from 1997 to 2003. These findings suggest that improvements in the prevention and treatment of HF may have had progressive, sustained effects on outcomes at the population level however, prognosis remains poor in HF.

Which components of heart failure programmes are effective? A systematic review and meta‐analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic

Publisher: Wiley

Date: 09-2011

DOI: 10.1093/EURJHF/HFR039

Abstract: Telemonitoring (TM) and structured telephone support (STS) have the potential to deliver specialized management to more patients with chronic heart failure (CHF), but their efficacy is still to be proven. The aim of this meta-analysis was to review randomized controlled trials (RCTs) of TM or STS for all-cause mortality and all-cause and CHF-related hospitalizations in patients with CHF, as a non-invasive remote model of a specialized disease-management intervention. We searched all relevant electronic databases and search engines, hand-searched bibliographies of relevant studies, systematic reviews, and meeting abstracts. Two reviewers independently extracted all data. Randomized controlled trials comparing TM or STS to usual care in patients with CHF were included. Studies that included intensified management with additional home or clinic-visits were excluded. Primary outcomes (mortality and hospitalizations) were analysed secondary outcomes (cost, length of stay, and quality of life) were tabulated. Thirty RCTs of STS and TM were identified (25 peer-reviewed publications (n= 8323) and five abstracts (n= 1482)). Of the 25 peer-reviewed studies, 11 evaluated TM (2710 participants), 16 evaluated STS (5613 participants) with two testing both STS and TM in separate intervention arms compared with usual care. Telemonitoring reduced all-cause mortality {risk ratio (RR) 0.66 [95% confidence interval (CI) 0.54-0.81], P< 0.0001 }and STS showed a similar, but non-significant trend [RR 0.88 (95% CI 0.76-1.01), P= 0.08]. Both TM [RR 0.79 (95% CI 0.67-0.94), P= 0.008], and STS [RR 0.77 (95% CI 0.68-0.87), P< 0.0001] reduced CHF-related hospitalizations. Both interventions improved quality of life, reduced costs, and were acceptable to patients. Improvements in prescribing, patient-knowledge and self-care, and functional class were observed. Telemonitoring and STS both appear effective interventions to improve outcomes in patients with CHF. Systematic Review Number: Cochrane Database of Systematic Reviews. 2008:Issue 3. Art. No.: CD007228. DOI: 10.1002/14651858.CD007228.

Caring for Older Patients with Chronic Cardiac Disease: An Increasing Challenge for Cardiac Nurses in the 21st Century

Publisher: Oxford University Press (OUP)

Date: 02-2002

DOI: 10.1016/S1474-5151(01)00003-2

Cohort Profile: The Nurses and Midwives e-Cohort Study--A Novel Electronic Longitudinal Study

Publisher: Oxford University Press (OUP)

Date: 17-01-2008

DOI: 10.1093/IJE/DYM294

European cardiac nurses’ current practice and knowledge on anticoagulation therapy

Publisher: Oxford University Press (OUP)

Date: 27-05-2013

DOI: 10.1177/1474515113491658

Abstract: Successful management of warfarin, new anti-thrombotic agents and self-monitoring devices requires that health care professionals effectively counsel and educate patients. Previous studies indicate that health care professionals do not always have the knowledge to provide patients with the correct information. The purpose of this study was to investigate European cardiovascular nurses' knowledge on the overall management of anticoagulation therapy and examine if this knowledge was influenced by level of education and years in clinical practice. A questionnaire including 47 items on practice patterns and knowledge on warfarin, new anticoagulants, warfarin-drug and warfarin-food interactions, and self-management of International Normalized Ratio (INR) was distributed to the attendants at a European conference in 2012. The response rate was 32% (n=206), of whom 84% reported having direct patient contact. Warfarin was the most common used oral anticoagulation in daily practice. One third offered their patients both patient self-testing and patient self-management of INR. The mean total score on the knowledge questions was 28±6 (maximum possible score 53). Nurses in direct patient care had a higher mean score (p=0.011). Knowledge on warfarin and medication-interactions were low, but knowledge on warfarin-diet interactions and how to advise patients on warfarin as somewhat better. European cardiac nurses need to improve their knowledge and practice patterns on oral anticoagulation therapy. This area of knowledge is important in order to deliver optimal care to cardiac patients and to minimise adverse effects of the treatment.

Prevalence and Cost of Managing Paediatric Cardiac Disease in Queensland

Publisher: Elsevier BV

Date: 02-2021

DOI: 10.1016/J.HLC.2020.06.002

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

Publisher: Elsevier BV

Date: 2012

DOI: 10.1016/J.IJCARD.2010.08.071

Abstract: Disease management programs have been shown to improve health outcomes in high risk in iduals in many but not all health care systems. 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 in idual'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. 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. The Young @ Heart intervention is a well accepted and potentially effective intervention to reduce recurrent hospital stay in privately insured cardiac patients in Australia.

A multidisciplinary, home based intervention reduced deaths and readmissions in patients with chronic congestive heart failure

Publisher: BMJ

Date: 05-2000

DOI: 10.1136/EBM.5.3.84

Hemodynamics in pulmonary arterial hypertension (PAH): Do they explain long-term clinical outcomes with PAH-specific therapy?

Publisher: Springer Science and Business Media LLC

Date: 22-02-2010

DOI: 10.1186/1471-2261-10-9

Abstract: Pulmonary arterial hypertension (PAH) has witnessed dramatic treatment advances over the past decade. However, with the exception of epoprostenol, data from short-term randomized controlled trials (RCTs) have not shown a benefit of these drugs on survival. There remains a need to differentiate between available therapies and current endpoint responses which in turn, could be used to guide treatment selection and provide long-term prognostic information for patients. We performed a systematic literature search of MEDLINE and EMBASE databases for RCTs of PAH-specific therapy published between January 1980 and May 2009. Articles were selected if they contained a placebo comparator and described hemodynamic changes from baseline. We applied the weighted mean change in hemodynamic variables to the equation developed by the National Institutes of Health (NIH) Registry to estimate long-term survival with each therapy. Ten RCTs involving 1,635 patients met the inclusion criteria. Suitable hemodynamic data were identified for bosentan, sitaxentan, sildenafil, epoprostenol, beraprost and treprostinil. 77.6% of patients were female and the mean (SD) age was 46.5 ± 4.9 years. 55.5% of patients had idiopathic PAH (iPAH), 23.9% PAH related to connective tissue disease, and 18.2% PAH related to congenital heart disease. Based on the effects observed in short-term trials and, relative to placebo, all analyzed therapies improved survival. The estimated 1-year survival was 78.4%, 77.8%, 76.1%, 75.8%, 75.2%, and 74.1% for epoprostenol, bosentan, treprostinil, sitaxentan, sildenafil, and beraprost, respectively. These estimates are considerably lower than the 1-year observed survival reported in several open-label and registry studies with PAH-specific therapies: 88% - 97%. When applied to the NIH Registry equation, hemodynamic changes from baseline appear to underestimate the survival benefits observed with long-term PAH therapy.

Diastolic dysfunction and mortality in 436 360 men and women: the National Echo Database Australia (NEDA)

Publisher: Oxford University Press (OUP)

Date: 03-11-2020

DOI: 10.1093/EHJCI/JEAA253

Abstract: To examine the characteristics rognostic impact of diastolic dysfunction (DD) according to 2016 American Society of Echocardiography (ASE) and European Society of Cardiovascular Imaging (ESCVI) guidelines, and in idual parameters of DD. Data were derived from a large multicentre mortality-linked echocardiographic registry comprising 436 360 adults with ≥1 diastolic function measurement linked to 100 597 deaths during 2.2 million person-years follow-up. ASE/European Association of Cardiovascular Imaging (EACVI) algorithms could be applied in 392 009 (89.8%) cases comprising 11.4% of cases with ‘reduced’ left ventricular ejection fraction (LVEF & 50%) and 88.6% with ‘preserved’ LVEF (≥50%). Diastolic function was indeterminate in 21.5% and 62.2% of ‘preserved’ and ‘reduced’ LVEF cases, respectively. Among preserved LVEF cases, the risk of adjusted 5-year cardiovascular-related mortality was elevated in both DD [odds ratio (OR) 1.31, 95% confidence interval (CI) 1.22–1.42 P & 0.001] and indeterminate status cases (OR 1.11, 95% CI 1.04–1.18 P & 0.001) vs. no DD. Among impaired LVEF cases, the equivalent risk of cardiovascular-related mortality was 1.51 (95% CI 1.15–1.98, P & 0.001) for increased filling pressure vs. 1.25 (95% CI 0.96–1.64, P = 0.06) for indeterminate status. Mitral E velocity, septal e’ velocity, E:e’ ratio, and LAVi all correlated with mortality. On adjusted basis, pivot-points of increased risk for cardiovascular-related mortality occurred at 90 cm/s for E wave velocity, 9 cm/s for septal e’ velocity, an E:e’ ratio of 9, and an LAVi of 32 mL/m2. ASE/EACVI-classified DD is correlated with increased mortality. However, many cases remain ‘indeterminate’. Importantly, when analysed in idually, mitral E velocity, septal e’ velocity, E:e’ ratio, and LAVi revealed clear pivot-points of increased risk of cardiovascular-related mortality.

Metabolic therapeutics in angina pectoris: History revisited with perhexiline

Publisher: Oxford University Press (OUP)

Date: 06-2006

DOI: 10.1016/J.EJCNURSE.2006.01.001

Abstract: The ever-increasing burden of ischaemic heart disease and its common manifestation chronic angina pectoris calls for the exploration of other treatment options for those patients who despite the maximum conventional pharmacological and surgical interventions continue to suffer. Such exploration has led to the increasing use of new metabolically acting antianginal agents and the re-emergence of an old and somewhat forgotten pharmacological agent, perhexiline maleate. This review aims to update the cardiac nurse with knowledge to manage the care a patient receiving perhexiline maleate treatment and provide a brief review of three new metabolic agents: trimetazidine, ranolazine and etomoxir.

Stable angina and acute coronary syndromes are associated with nitric oxide resistance in platelets

Publisher: Elsevier BV

Date: 06-2001

DOI: 10.1016/S0735-1097(01)01238-4

Abstract: The study examined possible clinical determinants of platelet resistance to nitric oxide (NO) donors in patients with stable angina pectoris (SAP) and acute coronary syndromes (ACS), relative to nonischemic patients and normal subjects. We have shown previously that platelets from patients with SAP are resistant to the antiaggregating effects of nitroglycerin (NTG) and sodium nitroprusside (SNP). Extent of adenosine diphosphate (1 micromol/liter)-induced platelet aggregation (impedance aggregometry in whole blood) and inhibition of aggregation by NTG (100 micromol/liter) and SNP (10 micromol/liter) were compared in normal subjects (n = 43), nonischemic patients (those with chest pain but no fixed coronary disease, (n = 35) and patients with SAP (n = 82) or ACS (n = 153). Association of NO resistance with coronary risk factors, coronary artery disease (CAD), intensity of angina and current medication was examined by univariate and multivariate analyses. In patients with SAP and ACS as distinct from nonischemic patients and normal subjects, platelet aggregability was increased (both p < 0.01), and inhibition of aggregation by NTG and SNP was decreased (both p < 0.01). Multivariate analysis revealed that NO resistance occurred significantly more frequently with ACS than with SAP (odds ratio [OR] 2.3:1), and was less common among patients treated with perhexiline (OR 0.3:1) or statins (OR 0.45:1). Therapy with other antianginal drugs, extent of CAD, intensity of angina and coronary risk factors were not associated with variability in platelet responsiveness to NO donor. Patients with symptomatic ischemic heart disease, especially ACS, exhibit increased platelet aggregability and decreased platelet responsiveness to the antiaggregatory effects of NO donors. The extent of NO resistance in platelets is not correlated with coronary risk factors. Pharmacotherapy with perhexiline and/or statins may improve platelet responsiveness to NO.

Trends from 1996 to 2007 in incidence and mortality outcomes of heart failure after acute myocardial infarction: a population-based study of 20,812 patients with first acute myocardial infarction in Western Australia.

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 26-09-2013

DOI: 10.1161/JAHA.113.000172

Abstract: Advances in treatment for acute myocardial infarction ( AMI ) are likely to have had a beneficial impact on the incidence of and deaths attributable to heart failure ( HF ) complicating AMI , although limited data are available to support this contention. W estern A ustralian linked administrative health data were used to identify 20 812 consecutive patients, aged 40 to 84 years, without prior HF hospitalized with an index (first) AMI between 1996 and 2007. We assessed the temporal incidence of and adjusted odds ratio/hazard ratio for death associated with HF concurrent with AMI admission and within 1 year after discharge. Concurrent HF comprised 75% of incident HF cases. Between the periods 1996–1998 and 2005–2007, the prevalence of HF after AMI declined from 28.1% to 16.5%, with an adjusted odds ratio of 0.50 (95% CI , 0.44 to 0.55). The crude 28‐day case‐fatality rate for patients with concurrent HF declined marginally from 20.5% to 15.9% ( P .05) compared with those without concurrent HF , in whom the case‐fatality rate declined from 11.0% to 4.8% ( P .001). Concurrent HF was associated with a multivariate‐adjusted odds ratio of 2.2 for 28‐day mortality and a hazard ratio of 2.2 for 1‐year mortality in 28‐day survivors. Occurrence of HF within 90 days of the index AMI was associated with an adjusted hazard ratio of 2.7 for 1‐year mortality in 90‐day survivors. Despite encouraging declines in the incidence of HF complicating AMI , it remains a common problem with high mortality. Increased attention to these high‐risk patients is needed given the lack of improvement in their long‐term prognosis.

Age-specific diastolic dysfunction improves prediction of symptomatic heart failure by Stage B heart failure

Publisher: Wiley

Date: 15-05-2019

DOI: 10.1002/EHF2.12449

Comprehensive care in heart failure: Where to from here?

Publisher: Elsevier BV

Date: 12-2005

DOI: 10.1016/J.EHBC.2005.09.010

Determinants of achieving early blood pressure control with monotherapy in a primary care setting

Publisher: Wiley

Date: 16-07-2013

DOI: 10.1111/JCH.12164

Age‐related longitudinal change in cardiac structure and function in adults at increased cardiovascular risk

Publisher: Wiley

Date: 07-04-2020

DOI: 10.1002/EHF2.12687

Prevalence, incidence, risk factors and treatment of atrial fibrillation in Australia: The Australian Diabetes, Obesity and Lifestyle (AusDiab) longitudinal, population cohort study

Publisher: Elsevier BV

Date: 02-2016

DOI: 10.1016/J.IJCARD.2015.12.013

Abstract: We sought to describe the prevalence, incidence, risk factors and treatment (according to stroke risk) of atrial fibrillation (AF) in the national, population-based Australian Diabetes, Obesity and Lifestyle (AusDiab) study cohort. ECG data were available from 8273/11,247 participants of AusDiab study in 1999/2000 and from 5422 participants in 2004/2005. Minnesota coding was used to identify prevalent and incident cases of AF. 90 prevalent cases of AF (14.1 per 1000) comprising 56 men (mean age 70.5 ± 1.9 years) and 34 women (aged 78.3 ± 1.2 years) were identified in 1999-2000. AF prevalence was associated with sedentary behaviour versus physically active (PR 2.0, 95% CI 1.2-3.6). 53 incident cases of AF (2.0, 95%, CI 1.5-2.6 per 1000 person-year) were subsequently identified in 2004-2005. Increased risk of incident AF was associated with male sex, obesity, history of angina, myocardial infarction and stroke. Both increased weight gain and increased weight loss appeared to be associated with increased risks of developing AF in women, while no obvious association was observed in men. Despite their high risk for stroke, anti-thrombotic therapy was observed in only 39.3% of participants with CHA2DS2-VASC scores ≥ 2. This study contributes to a better understanding of the AF burden. With the ageing population, coordinated efforts will be needed to anticipate the future health care costs related to AF and its impacts on the health care system. This will include appropriate application of anti-thrombotic therapy according to risk of thrombo-embolic events.

Incident pulmonary hypertension in 13 488 cases investigated with repeat echocardiography: a clinical cohort study

Publisher: European Respiratory Society (ERS)

Date: 06-07-2023

DOI: 10.1183/23120541.00082-2023

Abstract: We addressed the paucity of data describing the characteristics and natural history of incident pulmonary hypertension (PHT). Adults (n=13 448) undergoing routine echocardiography without initial evidence of PHT (estimated right ventricular systolic pressure, eRVSP .0 mmHg) or left heart disease (LHD) were studied. Incident PHT (eRVSP ≥30.0 mmHg) was detected on repeat echocardiogram a median of 4.1 years apart. Mortality was examined according to increasing eRVSP levels (30.0–39.9, 40.0–49.9 and ≥50.0 mmHg) indicative of mild-to-severe PHT. A total of 6169 men (45.9%, aged 61.4±16.7 years) and 7279 women (60.8±16.9 years) without evidence of PHT were identified (first echo). Subsequently, 5412 (40.2%) developed evidence of PHT, comprising 4125 (30.7%), 928 (6.9%), and 359 (2.7%) cases with an eRVSP of 30.0–39.9 mmHg, 40.0–49.9 mmHg, and ≥50.0 mmHg, respectively (incidence being 94.0 and 90.9 cases per 1000 men and women/year). Median eRVSP increased by +0.0 (IQR −2.27 to +2.67) mmHg and +30.68 (+26.03 to +37.31) mmHg among those with eRVSP .0 mmHg versus ≥50.0 mmHg. During median 8.1 years follow-up, 2776 (20.6%) died from all-causes. Compared to those with eRVSP .0 mmHg, the adjusted risk of all-cause mortality was 1.30-fold higher in 30.0–39.9 mmHg, 1.82-fold higher in 40.0–49.9 mmHg and 2.11-fold higher in ≥50.0 mmHg groups (all p .001 ). New onset PHT, as indicated by elevated eRVSP, is a common finding among older patients without LHD followed-up with echocardiography. This phenomenon is associated with an increased morality risk even among those with mildly elevated eRVSP.

Transient endothelial dysfunction induced by sugar-sweetened beverage consumption may be attenuated by a single bout of aerobic exercise

Publisher: Elsevier BV

Date: 2018

DOI: 10.1016/J.MVR.2017.07.003

Abstract: This study assessed whether aerobic exercise would attenuate microvascular endothelial dysfunction induced by commercial sugar-sweetened beverage (SSB) consumption. Eleven healthy males participated in this randomized, single-blind crossover study. Cutaneous microvascular endothelial function was assessed using laser speckle contrast imaging coupled with post-occlusive reactive hyperemia before and after a) consumption of water b) consumption of a commercial SSB c) 30min of aerobic exercise followed by water consumption and d) 30 minutes of aerobic exercise followed by SSB consumption. Blood glucose and arterial pressure responses were also monitored. Volumes of water and SSB consumed (637.39±29.15 mL) were in idualized for each participant, ensuring SSB consumption delivered 1 g of sucrose per kg of body weight. Exercise was performed at 75% of the maximal oxygen uptake heart rate. Compared to water consumption, the commercial SSB elevated blood glucose concentrations in both sedentary (4.69±0.11 vs. 7.47±0.28 mmol/L, P<0.05) and exercised states (4.95±0.13 vs. 7.93±0.15 mmol/L, P<0.05). However, the decrease in microvascular endothelial function observed following sedentary SSB consumption, expressed as the percentage increase from baseline (208.60±22.40 vs. 179.83±15.80%, P=0.01) and the change in peak hyperemic blood flux from basal to post-intervention assessments (-0.04±0.03 vs. -0.12±0.02 ΔCVC, P=0.01), was attenuated following 30min of aerobic exercise. To our knowledge, this is the first study to provide evidence that a single bout of aerobic exercise may prevent transient SSB-mediated microvascular endothelial dysfunction.

Lower levels of high-density lipoprotein cholesterol in urban Africans presenting with communicable versus non-communicable forms of heart disease: The 'Heart of Soweto' hospital registry study

Publisher: BMJ

Date: 14-07-2014

DOI: 10.1136/BMJOPEN-2014-005069

Better Indigenous Risk stratification for Cardiac Health study (BIRCH) protocol: Rationale and design of a cross-sectional and prospective cohort study to identify novel cardiovascular risk indicators in Aboriginal Australian and Torres Strait Islander adults

Publisher: Springer Science and Business Media LLC

Date: 23-08-2017

DOI: 10.1186/S12872-017-0662-7

What works in chronic care management: The case of heart failure

Publisher: Health Affairs (Project Hope)

Date: 2009

DOI: 10.1377/HLTHAFF.28.1.179

Abstract: The evidence base of what works in chronic care management programs is underdeveloped. To fill the gap, we pooled and reanalyzed data from ten randomized clinical trials of heart failure care management programs to discern how program delivery methods contribute to patient outcomes. We found that patients enrolled in programs using multi-disciplinary teams and in programs using in-person communication had significantly fewer hospital readmissions and readmission days than routine care patients had. Our study offers policymakers and health plan administrators important guideposts for developing an evidence base on which to build effective policy and programmatic initiatives for chronic care management.

Beneficial clinical effects of perhexiline in patients with stable angina pectoris and acute coronary syndromes are associated with potentiation of platelet responsiveness to nitric oxide

Publisher: Oxford University Press (OUP)

Date: 15-12-2002

DOI: 10.1053/EUHJ.2002.3296

Abstract: To examine whether the prophylactic antianginal agent perhexiline potentiates platelet responsiveness to nitric oxide (NO) in patients with stable angina pectoris (SAP) and acute coronary syndromes (ACS: unstable angina pectoris or non-Q-wave myocardial infarction). Blood s les were obtained from patients before and after initiation of treatment with perhexiline. ADP-induced platelet aggregation and its inhibition by the NO donor sodium nitroprusside (SNP) were determined via impedance aggregometry in whole blood (WB) and platelet-rich plasma (PRP). Intraplatelet cGMP content was assayed by RIA, and superoxide (O(2)(-)) level by lucigenin-derived chemiluminescence. In patients with ACS not receiving perhexiline (n=12), platelet responsiveness to SNP did not vary significantly over the first 3 days post admission to hospital. Therapy with perhexiline for 3 days was associated with increases in SNP-induced inhibition of aggregation from 29+/-2% to 43+/-4% (n=50,P <0.001) in WB and from 20+/-5% to 42+/-7% (n=12, P<0.01) in PRP. Resolution of symptomatic ischaemia (n=39) was associated with significantly greater (P<0.01) increases than non-resolution (n=11). Similar increases in SNP responsiveness (P<0.001) occurred following institution of perhexiline therapy in patients with SAP (n=30), associated with a 85% decrease in anginal frequency. Treatment with perhexiline potentiated the cGMP-elevating effects of SNP in platelets (n=9,P =0.03). Although perhexiline did not alter whole blood O(2)(-) concentration ex vivo, it inhibited (P<0.01) O(2)(-) release from neutrophils in vitro. Perhexiline potentiates platelet responsiveness to NO both in SAP and ACS patients in the latter group this improvement was predictive of resolution of ischaemic symptoms. The predominant mechanism of perhexiline effect is an increase in platelet cGMP responsiveness. Perhexiline also may reduce the potential for NO clearance by neutrophil-derived O(2)(-).

Mild pulmonary hypertension and premature mortality among 154956 men and women undergoing routine echocardiography

Publisher: European Respiratory Society (ERS)

Date: 28-05-2022

DOI: 10.1183/13993003.00832-2021

Impaired platelet nitric oxide response in patients with new onset atrial fibrillation

Publisher: Elsevier BV

Date: 2015

DOI: 10.1016/J.IJCARD.2014.10.137

Abstract: Clinical factors associated with thromboembolic risk in AF patients are well characterized and include new onset AF. Biochemically, AF is associated with inflammatory activation and impairment of nitric oxide (NO) signalling, which may also predispose to thromboembolism: the bases for variability in these anomalies have not been identified. We therefore sought to identify correlates of impaired platelet NO signalling in patients hospitalized with atrial fibrillation (AF), and to evaluate the impact of acuity of AF. 87 patients hospitalized with AF were evaluated. Platelet aggregation, and its inhibition by the NO donor sodium nitroprusside, was evaluated using whole blood impedance aggregometry. Correlates of impaired NO response were examined and repeated in a "validation" cohort of acute cardiac illnesses. Whilst clinical risk scores were not significantly correlated with integrity of NO signalling, new onset AF was associated with impaired NO response (6 ± 5% inhibition versus 25 ± 4% inhibition for chronic AF, p<0.01). New onset AF was a multivariate correlate (p<0.01) of impaired NO signalling, along with platelet ADP response (p<0.001), whereas the associated tachycardia was not. Platelet ADP response was predicted by elevation of plasma thrombospondin-1 concentrations (p<0.01). Validation cohort evaluations confirmed that acute AF was associated with significant (p<0.05) impairment of platelet NO response, and that neither acute heart failure nor acute coronary syndromes were associated with similar impairment. Recent onset of AF is associated with marked impairment of platelet NO response. These findings may contribute to thromboembolic risk in such patients.

Symptom clusters in adults with chronic atrial fibrillation

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 05-2017

DOI: 10.1097/JCN.0000000000000344

Clinical Features and Outcomes of Peripartum Cardiomyopathy in Nigeria

Publisher: Elsevier BV

Date: 11-2020

DOI: 10.1016/J.JACC.2020.09.540

Characteristics of symptoms and symptom change across different heart failure subtypes: a sex-stratified analysis

Publisher: Oxford University Press (OUP)

Date: 27-10-2023

DOI: 10.1093/EURJCN/ZVAC099

Abstract: To examine sex-stratified differences in the association of left ventricular ejection fraction-based heart failure (HF) subtypes and the characteristics and correlates of self-reported changes in HF symptoms. We report a secondary data analysis from 528 hospitalized in iduals diagnosed with HF characterised by a reduced, mildly reduced, or preserved ejection fraction [HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF), or HF with preserved ejection fraction (HFpEF)] who completed 12-month follow-up within a multicentre disease management trial. There were 302 men (71.1 ± 11.9 years, 58% with HFrEF) and 226 women (77.1 ± 10.6 years, 49% with HFpEF). The characteristics of self-reported symptoms measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) at baseline and 12-month were analysed. At baseline, shortness of breath and fatigue predominated with key differences according to HF subtypes in bilateral ankle oedema (both sexes), walking problems (women) and depressive symptoms (men). At 12-month follow-up, most KCCQ scores had not significantly changed. However, 25% of in iduals reported worse symptom. In women, those with HFpEF had worse symptoms than those with HFmrEF/HFrEF (P = 0.025). On an adjusted basis, women [odds ratios (OR): 1.78, 95% confidence interval (CI): 1.00–3.16 vs. men], those with coronary artery disease (OR: 2.01, 95% CI: 1.21–3.31) and baseline acute pulmonary oedema (OR: 1.67, 95% CI: 1.02–2.75) were most likely to report worsening symptoms. Among men, worsening symptoms correlated with a history of hypertension (OR: 2.16, 95% CI: 1.07–4.35) and a non-English-speaking background (OR: 2.30, 95% CI: 1.02–5.20). We found significant heterogeneity (with potential clinical implications) in the symptomatic characteristics and subsequent symptom trajectory according to the sex and HF subtype of those hospitalized with the syndrome. ANZCTR12613000921785

Short message service (SMS) as an educational tool during pregnancy: A literature review

Publisher: SAGE Publications

Date: 28-07-2016

DOI: 10.1177/0017896915607910

Abstract: In many low- and middle-income countries, access to health information during pregnancy is poor. The rapid adoption of mobile phones in these countries has created new opportunities for disseminating such information. This paper reviews existing information on the use of short message services (SMSs) as a feasible tool to transmit health education information. The PubMed, Cochrane library, EMBASE and Google scholar databases were searched for studies in which mobile phone SMSs were used to promote health education during pregnancy. Studies of adult women, from any setting, who received SMS health education messages during their pregnancy, were included, irrespective of study design. The analysis of results followed a narrative synthesis approach, a textual approach involving a synthesis of findings from multiple studies. The synthesis was developed manually, based on the extraction of data. All studies demonstrated use or interest in SMS technology to facilitate health information messaging. Findings from several studies showed that pregnant women were both receptive and willing to use SMS technology to enhance their health. In Zanzibar, the effect of SMS on skilled delivery rates and access to emergency healthcare was assessed. The effects SMS alerts had on hospital deliveries and SMS interventions had on facility use during pregnancy were assessed in Rwanda. The review highlights the practicality and willingness of utilising SMS technology to promote or enhance health education.

Caring for patients with acute myocardial ischaemia: The perhexiline maleate experience

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 05-1995

DOI: 10.1097/00003465-199505000-00002

Abstract: Perhexiline Maleate (Px) is a potent, oxygen-sparing agent used in the management of patients with acute myocardial ischaemia that is resistant to conventional pharmacological therapy. The critical care nurse plays an integral role in (1) maximizing the therapeutic benefits of Px and (2) ensuring that the patient reaches the point of correctional intervention with the minimum of ischaemic damage.

Commentary: Review: Routine changes of IV administration sets (not containing lipids or blood products) at intervals ≤96 hours do not affect infusate or catheter related bloodstream infection

Publisher: BMJ

Date: 07-2006

DOI: 10.1136/EBN.9.3.81

Author reply

Publisher: Wiley

Date: 09-2013

DOI: 10.1111/IMJ.12242

You'll Never Walk Alone: Key challenges for the profession of cardiovascular nursing

Publisher: Oxford University Press (OUP)

Date: 03-2007

DOI: 10.1016/J.EJCNURSE.2007.01.098

Commentary

Publisher: Elsevier BV

Date: 09-2004

DOI: 10.1016/J.EBCM.2004.06.045

Cardiovascular Risk Estimation by Professionally Active Cardiovascular Nurses: Results from the Basel 2005 Nurses Cohort∗

Publisher: Oxford University Press (OUP)

Date: 12-2006

DOI: 10.1016/J.EJCNURSE.2006.06.007

Abstract: Nurses play a key role in the prevention of cardiovascular disease (CVD) and one would, therefore, expect them to have a heightened awareness of the need for systematic screening and their own CVD risk profile. The aim of this study was to examine personal awareness of CVD risk among a cohort of cardiovascular nurses attending a European conference. Of the 340 delegates attending the 5th annual Spring Meeting on Cardiovascular Nursing (Basel, Switzerland, 2005), 287 (83%) completed a self-report questionnaire to assess their own risk factors for CVD. Delegates were also asked to give an estimation of their absolute total risk of experiencing a fatal CVD event in the next 10 years. Level of agreement between self-reported CVD risk estimation and their actual risk according to the SCORE risk assessment system was compared by calculating weighted Kappa (kappa(w)). Overall, 109 responders (38%) self-reported having either pre-existing CVD (only 2%), one or more markedly raised CVD risk factors, a high total risk of fatal CVD (> or =5% in 10 years) or a strong family history of CVD. About half of this cohort (53%) did not know their own total cholesterol level. Less than half (45%) reported having a 10-year risk of fatal CVD of or =5%. Based on the SCORE risk function, the estimated 10-year risk of a fatal CVD event was or =5% risk of such an event. Overall, less than half (46%) of this cohort's self-reported CVD risk corresponded with that calculated using the SCORE risk function (kappa(w)=0.27). Most cardiovascular nurses attending a European conference in 2005 poorly understood their own CVD risk profile, and the agreement between their self-reported 10-year risk of a fatal CVD and their CVD risk using SCORE was only fair. Given the specialist nature of this conference, our findings clearly demonstrate a need to improve overall nursing awareness of the role and importance of systematic CVD risk assessment.

Continuous ST-segment monitoring: A non-invasive method of assessing myocardial perfusion in acute myocardial infarction

Publisher: Oxford University Press (OUP)

Date: 02-2002

DOI: 10.1016/S1474-5151(01)00015-9

Cardiac Damage Staging Classification Predicts Prognosis in All the Major Subtypes of Severe Aortic Stenosis: Insights from the National Echo Database Australia

Publisher: Elsevier BV

Date: 11-2021

DOI: 10.1016/J.ECHO.2021.05.017

Abstract: There are currently no established prognostic models for "low-gradient" severe aortic stenosis (AS), including those with low-flow, low-gradient (LFLG) or normal-flow, low-gradient (NFLG) severe AS. The "cardiac damage staging classification" has been validated as a clinically useful prognostic tool for high-gradient severe AS but not yet for these other common subtypes of severe AS, LFLG and NFLG. The authors analyzed data from the National Echo Database of Australia, a large national, multicenter registry with in idual data linkage to mortality. Of 192,060 adults (mean age, 62.8 ± 17.8 years) with comprehensive ultrasound profiling of the native aortic valve studied between 2000 and 2019, 12,013 (6.3%) had severe AS. On the basis of standard echocardiographic parameters, 5,601 patients with high-gradient, 611 with classical and 959 with paradoxical LFLG, and 911 with NFLG severe AS were identified. Mean follow-up was 88 ± 45 months. All-cause and cardiovascular-related mortality were assessed for each group on an adjusted basis (age and sex) and analyzed by cardiac damage stage. Patients with LFLG AS had greater associated cardiac damage at diagnosis (stages 3 and 4 in 34% of those with classical LFLG, 22.5% of those with paradoxical LFLG, 15.5% of those with NFLG, and 14% of those with high-gradient AS P < .001). For all four major subtypes of severe AS, there was a progressive increase in 1- and 5-year mortality with increasing cardiac damage score. For ex le, for paradoxical LFLG severe AS, compared with stage 0 patients, adjusted 1-year all-cause mortality was 22% higher in stage 1 patients, 55% higher in stage 2 patients (P = .095), and 155% higher in stage 3 and 4 patients (P < .001). Among patients with classical LFLG severe AS, compared with stage 1 patients, adjusted 1-year all-cause mortality was 55% higher in stage 2 patients (P = .018) and 100% higher in stage 3 and 4 patients (P < .001). Regardless of severe AS subtype, increasing severity denoted by the cardiac damage staging classification is strongly associated with increasing mortality risk.

The Rise (And Fall?) of Coronary Care Nurses

Publisher: Oxford University Press (OUP)

Date: 09-2004

DOI: 10.1016/J.EJCNURSE.2004.08.002

Application of Geographic Modeling Techniques to Quantify Spatial Access to Health Services Before and After an Acute Cardiac Event: The Cardiac Accessibility and Remoteness Index for Australia (ARIA) Project

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 24-04-2012

DOI: 10.1161/CIRCULATIONAHA.111.083394

Abstract: Access to cardiac services is essential for appropriate implementation of evidence-based therapies to improve outcomes. The Cardiac Accessibility and Remoteness Index for Australia (Cardiac ARIA) aimed to derive an objective, geographic measure reflecting access to cardiac services. An expert panel defined an evidence-based clinical pathway. Using Geographic Information Systems (GIS), the team developed a numeric/alphabetic index at 2 points along the continuum of care. The acute category (numeric) measured the time from the emergency call to arrival at an appropriate medical facility via road ambulance. The aftercare category (alphabetic) measured access to 4 basic services (family doctor, pharmacy, cardiac rehabilitation, and pathology services) when a patient returned to his or her community. The numeric index ranged from 1 (access to principal referral center with cardiac catheterization service ≤1 hour) to 8 (no ambulance service, hours to medical facility, air transport required). The alphabetic index ranged from A (all 4 services available within a 1-hour drive-time) to E (no services available within 1 hour). The panel found that 13.9 million Australians (71%) resided within Cardiac ARIA 1A locations (hospital with cardiac catheterization laboratory and all aftercare within 1 hour). Those outside Cardiac 1A were overrepresented by people years of age (32%) and indigenous people (60%). The Cardiac ARIA index demonstrated substantial inequity in access to cardiac services in Australia. This methodology can be used to inform cardiology health service planning and could be applied to other common disease states within other regions of the world.

An Absolute Risk Prediction Model to Determine Unplanned Cardiovascular Readmissions for Adults with Chronic Heart Failure

Publisher: Elsevier BV

Date: 11-2015

DOI: 10.1016/J.HLC.2015.04.168

Abstract: Frequent readmissions are a hallmark of chronic heart failure (CHF). We sought to develop an absolute risk prediction model for unplanned cardiovascular readmissions following hospitalisation for CHF. An inception cohort was obtained from the WHICH? trial, a prospective, multi-centre randomised controlled trial which was a head-to-head comparison of the efficacy of a home-based intervention versus clinic-based intervention for adults with CHF. A Cox's proportional hazards model (taking into account the competing risk of death) was used to develop a prediction model. Bootstrap methods were used to identify factors for the final model. Based on these data a nomogram was developed. Of the 280 participants in the WHICH? trial 37 (13%) were readmitted for a cardiovascular event (including CHF) within 28 days, and a further 149 (53%) were readmitted within 18 months for a cardiovascular event. In the proposed competing risk model, factors associated with an increased risk of hospitalisation for CHF were: age (HR 1.07, 95% CI 0.90-1.26) for each 10-year increase in age living alone (HR 1.09, 95% CI 0.74-1.59) those with a sedentary lifestyle (HR 1.44, 95% CI, 0.92-2.25) and the presence of multiple co-morbid conditions (HR 1.69, 95% CI 0.38-7.58) for five or more co-morbid conditions (compared to in iduals with one documented co-morbidity). The C-statistic of the final model was 0.80. We have developed a practical model for in idualising the risk of short-term readmission for CHF. This model may provide additional information for targeting and tailoring interventions and requires future prospective evaluation.

Heart failure nursing in Australia: Challenges, strengths, and opportunities

Publisher: Wiley

Date: 11-2008

DOI: 10.1111/J.1751-7117.2008.00017.X

Effects of Sugar-Sweetened Beverage Consumption on Microvascular and Macrovascular Function in a Healthy Population

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 06-2017

DOI: 10.1161/ATVBAHA.116.308010

Abstract: To assess vascular function during acute hyperglycemia induced by commercial sugar-sweetened beverage (SSB) consumption and its effect on underlying mechanisms of the nitric oxide pathway. In a randomized, single-blind, crossover trial, 12 healthy male participants consumed 600 mL (20 oz.) of water or a commercial SSB across 2 visits. Endothelial and vascular smooth muscle functions were assessed in the microcirculation using laser speckle contrast imaging coupled with iontophoresis and in the macrocirculation using brachial artery ultrasound with flow- and nitrate-mediated dilation. Compared with water, SSB consumption impaired microvascular and macrovascular endothelial function as indicated by a decrease in the vascular response to acetylcholine iontophoresis (208.3±24.3 versus 144.2±15.7%, P .01) and reduced flow-mediated dilation (0.019±0.002 versus 0.014±0.002%/s, P .01), respectively. Systemic vascular smooth muscle remained preserved. Similar decreases in endothelial function were observed during acute hyperglycemia in an in vivo rat model. However, function was fully restored by treatment with the antioxidants, N -acetylcysteine and apocynin. In addition, ex vivo experiments revealed that although the production of reactive oxygen species was increased during acute hyperglycemia, the bioavailability of nitric oxide in the endothelium was decreased, despite no change in the activation state of endothelial nitric oxide synthase. To our knowledge, this is the first study to assess the vascular effects of acute hyperglycemia induced by commercial SSB consumption alone. These findings suggest that SSB-mediated endothelial dysfunction is partly due to increased oxidative stress that decreases nitric oxide bioavailability. URL: www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366442& isReview=true . Australian New Zealand Clinical Trials Registry Number: ACTRN12614000614695.

More rigorous protocol adherence to intensive structured management improves blood pressure control in primary care: results from the Valsartan Intensified Primary carE Reduction of Blood Pressure study.

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 06-2014

DOI: 10.1097/HJH.0000000000000180

Extending the Horizon in Chronic Heart Failure

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 05-12-2006

DOI: 10.1161/CIRCULATIONAHA.106.638122

Abstract: Background— The long-term impact of chronic heart failure management programs over the typical life span of affected in iduals is unknown. Methods and Results— The effects of a nurse-led, multidisciplinary, home-based intervention (HBI) in a typically elderly cohort of patients with chronic heart failure initially randomized to either HBI (n=149) or usual postdischarge care (UC) (n=148) after a short-term hospitalization were studied for up to 10 years of follow-up (minimum 7.5 years of follow-up). Study end points were all-cause mortality, event-free survival (event was defined as death or unplanned hospitalization), recurrent hospital stay, and cost per life-year gained. Median survival in the HBI cohort was almost twice that of UC (40 versus 22 months P .001), with fewer deaths overall (HBI, 77% versus 89% adjusted relative risk, 0.74 95% CI, 0.53 to 0.80 P .001). HBI was associated with prolonged event-free survival (median, 7 versus 4 months P .01). HBI patients had more unplanned readmissions (560 versus 550) but took 7 years to overtake UC the rates of readmission (2.04±3.23 versus 3.66±7.62 admissions P .05) and related hospital stay (14.8±23.0 versus 28.4±53.4 days per patient per year P .05) were significantly lower in the HBI group. HBI was associated with 120 more life-years per 100 patients treated compared with UC (405 versus 285 years) at a cost of $1729 per additional life-year gained when we accounted for healthcare costs including the HBI. Conclusions— In altering the natural history of chronic heart failure relative to UC (via prolonged survival and reduced frequency of recurrent hospitalization), HBI is a remarkably cost- and time-effective strategy over the longer term.

Hypertension: A global perspective

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 21-06-2011

DOI: 10.1161/CIRCULATIONAHA.110.992362

A low-cost solar-powered blood-pressure device

Publisher: Elsevier BV

Date: 08-2011

DOI: 10.1016/S0140-6736(11)60131-1

Older and more complicated heart failure patients: an increasing challenge to the health care system!

Publisher: Elsevier BV

Date: 08-2001

DOI: 10.1054/CHEC.2001.0115

Platelet Reactivity Is Independent of Left Atrial Wall Deformation in Patients with Atrial Fibrillation

Publisher: Hindawi Limited

Date: 2016

DOI: 10.1155/2016/9754808

Abstract: It has been documented recently that left atrial (LA) deformation in AF patients (while in AF) is predictive of subsequent stroke risk. Additionally, diminished LA deformation during AF correlates with the presence of LA blood stasis. Given that endothelial function is dependent on laminar blood flow, the present study sought to investigate the effect of diminished LA deformation (during AF) on platelet reactivity and inflammation in AF patients. Patients ( n = 17 ) hospitalised with AF underwent echocardiography (while in AF) for determination of peak positive LA strain (LASp). Whole blood impedance aggregometry was used to measure extent of ADP-induced aggregation and subsequent inhibitory response to the nitric oxide (NO) donor, sodium nitroprusside. Platelet thioredoxin-interacting protein (Txnip) content was determined by immunohistochemistry. LASp tended ( p = 0.078 ) to vary inversely with CHA 2 DS 2 VASc scores. However, mediators of inflammation (C-reactive protein, Txnip) did not correlate significantly with LASp nor did extent of ADP-induced platelet aggregation or platelet NO response. These results suggest that the thrombogenic risk associated with LA stasis is independent of secondary effects on platelet aggregability or inflammation.

Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis

Publisher: BMJ

Date: 10-04-2007

DOI: 10.1136/BMJ.39156.536968.55

Hypertension and hypertensive heart disease in African women

Publisher: Springer Science and Business Media LLC

Date: 28-01-2014

DOI: 10.1007/S00392-014-0660-Z

Abstract: Hypertension and hypertensive heart disease is one of the main contributors to a growing burden of non-communicable forms of cardiovascular disease around the globe. The recently published global burden of disease series showed a 33 % increase of hypertensive disorders in pregnancy in the past two decades with long-term consequences. Africans, particularly younger African women, appear to be bearing the brunt of this increasing public health problem. Hypertensive heart disease is particularly problematic in pregnancy and is an important contributor to maternal case-fatality. European physicians increasingly need to attend to patients from African decent and need to know about unique aspects of disease presentation and pharmacological as well as non-pharmacological care. Reductions in salt consumption, as well as timely detection and treatment of hypertension and hypertensive heart disease remain a priority for effective primary and secondary prevention of CVD (particularly stroke and CHF) in African women. This article reviews the pattern, potential causes and consequences and treatment of hypertension and hypertensive heart disease in African women, identifying the key challenges for effective primary and secondary prevention in this regard.

Short-term outcomes after hospital discharge in patients admitted with heart failure in Abeokuta, Nigeria: Data from the Abeokuta Heart Failure Registry

Publisher: Clinics Cardive Publishing

Date: 04-11-2014

DOI: 10.5830/CVJA-2014-040

Challenge impairment with atrial fibrillation remains a reply: Diagnosing vascular mild cognitive

Publisher: BMJ

Date: 12-04-2013

DOI: 10.1136/HEARTJNL-2013-303965

Bridging the gap in heart failure prevention: Rationale and design of the Nurse-led Intervention for Less Chronic Heart Failure (NIL-CHF) Study

Publisher: Wiley

Date: 18-12-2010

DOI: 10.1093/EURJHF/HFP161

Abstract: The primary objective of the Nurse-led Intervention for Less Chronic Heart Failure (NIL-CHF) Study is to develop a programme of care that cost-effectively prevents the development of chronic heart failure (CHF). Methods NIL-CHF is a randomized controlled trial of a hybrid, home- and clinic-based, nurse-led multidisciplinary intervention targeting hospitalized patients at risk of developing CHF. A target of 750 patients aged >/=45 years will be exposed to usual post-discharge care or the NIL-CHF intervention. The composite primary endpoint is all-cause mortality or CHF-related admission during 3-5 years of follow-up. After 12 months recruitment, approximately 300 eligible patients (40% of target) have been randomized. Overall, 73% are male and the mean age is 65 +/- 10 years. The most common antecedents for CHF thus far are hypertension (70%, 95% CI, 64-75%), coronary artery disease (51%, 95% CI, 31-41%), and type 2 diabetes (26%, 95% CI, 21-31%), whereas 76% (95% CI, 69-82%) of patients have diastolic dysfunction, 29% (95% CI, 23-36%) left ventricular hypertrophy, 71% (95% CI, 64-78%) mitral valve dysfunction, and 7% (95% CI, 4-12%) have a left ventricular ejection fraction </=45%. As one of the largest randomized studies of its kind, NIL-CHF will ultimately provide important insights into the potential to prevent CHF via prolonged and intensive disease management.

Access to Cardiac Rehabilitation Does Not Equate to Attendance

Publisher: Oxford University Press (OUP)

Date: 17-04-2014

DOI: 10.1177/1474515113486376

Abstract: Timely access to appropriate cardiac care is critical for optimizing positive outcomes after a cardiac event. Attendance at cardiac rehabilitation (CR) remains less than optimal (10%-30%). Our aim was to derive an objective, comparable, geographic measure reflecting access to cardiac services after a cardiac event in Australia. An expert panel defined a single patient care pathway and a hierarchy of the minimum health services for CR and secondary prevention. Using geographic information systems a numeric/alpha index was modelled to describe access before and after a cardiac event. The aftercare phase was modelled into five alphabetical categories: from category A (access to medical service, pharmacy, CR, pathology within 1 h) to category E (no services available within 1 h). Approximately 96% or 19 million people lived within 1 h of the four basic services to support CR and secondary prevention, including 96% of older Australians and 75% of the indigenous population. Conversely, 14% (64,000) indigenous people resided in population locations that had poor access to health services that support CR after a cardiac event. Results demonstrated that the majority of Australians had excellent 'geographic' access to services to support CR and secondary prevention. Therefore, it appears that it is not the distance to services that affects attendance. Our 'geographic' lens has identified that more research on socioeconomic, sociological or psychological aspects to attendance is needed.

Research in cardiovascular nursing in Europe: toward a UNITED approach. Undertaking Nursing Interventions Throughout Europe Research Group.

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 10-2001

DOI: 10.1097/00005082-200110000-00009

Abstract: This article describes the efforts of a recent initiative of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. The Undertaking Nursing Interventions Throughout Europe (UNITE) Research Group represents a truly international team of nurses who collaborate on a number of research studies. The major focus of the group is to provide better care to patients in whom modern day treatment has proven to be ineffectual such as patients with chronic, intractable angina.

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

Publisher: Oxford University Press (OUP)

Date: 23-11-2018

DOI: 10.1177/1474515117743979

Abstract: 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). 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. 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%. 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.

Assessment of care provision for hypertension at the emergency Department of an Urban Hospital in Mozambique

Publisher: Springer Science and Business Media LLC

Date: 12-2019

DOI: 10.1186/S12913-019-4820-8

Abstract: Management of hypertension in Mozambique is poor, and rates of control are amongst the lowest in the world. Health system related factors contribute at least partially to this situation, particularly in settings where there is scarcity of resources to address the double burden of infectious and non-communicable diseases. This study aimed to assess the management of hypertension in an emergency department (ED). During a pragmatic and prospective 30-day snapshot study (with 24 h surveillance) and random profiling of one-in-five presentations to the ED of Hospital Geral de Mavalane, Maputo, we assessed patient’s flow and care, as well as health facility’s infrastructure and resources through direct observation. Reports from pharmacy and laboratory stocks were used to assess availability of diagnostics and medicines needed for hypertension management. The 1911 hypertensive patients included in the study had several stops during their journey inside the health facility and followed a non-standardized care flow. No clinical protocols or algorithms for risk stratification of hypertension were available. Stock-outs of basic diagnostic tools for risk stratification and medicines were registered. The availability of medicines was 28% on average. Critical gaps in health facility readiness to address arterial hypertension seen in ED were uncovered, including lack of clinical protocols, insufficient availability of diagnostics and essential medicines, as well as low affordability of the families to guaranty continuum of care. Innovative financing mechanisms are needed to support the health system to address hypertension.

Clinical algorithm to screen for cardiopulmonary disease in low-income settings

Publisher: Springer Science and Business Media LLC

Date: 16-09-2019

DOI: 10.1038/S41569-019-0268-0

The role of ST-segment monitoring in assessment of acute myocardial infarction

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 09-1999

DOI: 10.1097/00003465-199909000-00002

Abstract: Continuous ST-segment analysis is an accurate and noninvasive tool for monitoring coronary artery patency in patients with acute myocardial infarction. This type of monitoring also is easy to use and cost-effective. The critical care nurse plays a pivotal role in initiating ST-segment monitoring, promptly detecting ST-segment changes, and rapidly intervening to achieve myocardial reperfusion.

Comparison of the EQ-5D-3L and the SF-6D (SF-12) contemporaneous utility scores in patients with cardiovascular disease

Publisher: Springer Science and Business Media LLC

Date: 08-2017

DOI: 10.1007/S11136-017-1666-6

Abstract: Multi-attribute utility instruments (MAUIs) are widely used to measure utility weights. This study sought to compare utility weights of two popular MAUIs, the EQ-5D-3L and the SF-6D, and inform researchers in the selection of generic MAUI for use with cardiovascular (CVD) patients. Data were collected in the Young@Heart study, a randomised controlled trial of a nurse-led multidisciplinary home-based intervention compared to standard usual care. Participants (n = 598) completed the EQ-5D-3L and the SF-12v2, from which the SF-6D can be constructed, at baseline and at 24-month follow-up. This study examined discrimination, responsiveness, correlation and differences across the two instruments. Both MAUIs were able to discriminate between the NYHA severity classes and recorded similar changes between the two time points although only SF-6D differences were significant. Correlations between the dimensions of the two MAUIs were low. There were significant differences between the two instruments in mild conditions but they were similar in severe conditions. Substantial ceiling and floor effects were observed. Our findings indicate that the EQ-5D and the SF-6D cover different spaces in health due to their classification systems. Both measures were capable of discriminating between severity groups and responsive to quality of life changes in the follow-up. It is recommended to use the EQ-5D-3L in severe and the SF-6D in mild CVD conditions.

Enhanced Diagnosis of Severe Aortic Stenosis Using Artificial Intelligence: A Proof-of-Concept Study of 530,871 Echocardiograms

Publisher: Elsevier BV

Date: 04-2020

DOI: 10.1016/J.JCMG.2019.10.013

Telemonitoring for Patients With Chronic Heart Failure: A Systematic Review

Publisher: Elsevier BV

Date: 02-2007

DOI: 10.1016/J.CARDFAIL.2006.09.001

Threshold body mass index and sex-specific waist circumference for increased risk of heart failure with preserved ejection fraction

Publisher: Oxford University Press (OUP)

Date: 19-05-2019

DOI: 10.1177/2047487319851298

Abstract: Body mass index † Deceased. (BMI) is a risk factor for heart failure with preserved ejection fraction (HFpEF). We investigated the threshold BMI and sex-specific waist circumference associated with increased HFpEF incidence in the SCReening Evaluation of the Evolution of New Heart Failure (SCREEN-HF) study, a cohort study of a community-based population at increased cardiovascular disease risk. Inclusion criteria were age ≥60 years with one or more of self-reported hypertension, diabetes, heart disease, abnormal heart rhythm, cerebrovascular disease or renal impairment. Exclusion criteria were known heart failure, ejection fraction % or more than mild valve abnormality. Among 3847 SCREEN-HF participants, 73 were diagnosed with HFpEF at a median of 4.5 (interquartile range: 2.9–5.5) years after enrolment. HFpEF incidence rates were higher for BMI ≥27.5 kg/m 2 than for BMI 25 kg/m 2 , and for waist circumference cm (men) or 90 cm (women) than for waist circumference ≤94 cm (men) or ≤ 83 cm (women) in Poisson regression analysis. Semiparametric proportional hazards analyses confirmed these BMI and waist circumference thresholds, and exceeding these thresholds was associated with an attributable risk of HFpEF of 44–49%. Both central obesity and overweight were associated with increased HFpEF incidence. Although a randomised trial of weight control would be necessary to establish a causal relationship between obesity/overweight and HFpEF incidence, these data suggest that maintenance of BMI and waist circumference below these thresholds in a community similar to that of the SCREEN-HF cohort may reduce the HFpEF incidence rate by as much as 50%.

Pharmacological Treatment and Perceived Health Status During 1-Year Follow Up in Patients Diagnosed with Coronary Artery Disease, But Ineligible for Revascularization: Results from the Euro Heart Surv

Publisher: Oxford University Press (OUP)

Date: 06-2006

DOI: 10.1016/J.EJCNURSE.2006.01.003

Abstract: It has been recognized that a clinically significant portion of patients with coronary artery disease (CAD) continue to experience anginal and other related symptoms that are refractory to the combination of medical therapy and revascularization. The Euro Heart Survey on Revascularization (EHSCR) provided an opportunity to assess pharmacological treatment and outcome in patients with proven CAD who were ineligible for revascularization. We performed a secondary analysis of EHS-CR data. After excluding patients with ST-elevation myocardial infarction and those in whom revascularization was not indicated, 4409 patients remained in the analyses. We selected two groups: (1) patients in whom revascularization was the preferred treatment option (n = 3777, 86%), and (2) patients who were considered ineligible for revascularization (n = 632, 14%). Patient ineligible for revascularization had a worse risk profile, more often had a total occlusion (59% vs. 37%, p < 0.001), were treated more often with ACE-inhibitors (65% vs. 55%, p < 0.001) but less likely with aspirin (83% vs. 88%, p < 0.001). Overall, they had higher case-fatality at 1-year (7.0% vs. 3.7%, p < 0.001). Regarding self-perceived health status, measured via the EuroQol 5D (EQ-5D) questionnaire, these same patients reported more problems on all dimensions of the EQ-5D. Furthermore, in the revascularization group we observed an increase between discharge and 1-year follow up (utility score from 0.85 to 1.00) whereas patients ineligible for revascularization did not improve over time (utility score remained 0.80) In this large cohort of European patients with CAD, those considered ineligible for revascularization had more co-morbidities and risk factors, and scored worse on self-perceived health status as compared to revascularized patients in the revascularization group. With the exception of ACE-inhibitors and aspirin, there were no major differences regarding drug treatment between the two groups. Given these clinically significant observations, there appears to be a role for nurse-led, multidisciplinary, rehabilitation teams that target clinically vulnerable patients whose symptoms remain refractory to standard medical care.

Socio‐economic inequalities in diabetes prevalence in the Kingdom of Saudi Arabia

Publisher: Wiley

Date: 28-08-2020

DOI: 10.1002/HPM.2899

Contemporary profile of acute heart failure in Southern Nigeria: Data from the abeokuta heart failure clinical registry

Publisher: Elsevier BV

Date: 06-2014

DOI: 10.1016/J.JCHF.2013.12.005

Abstract: The aim of this study was to determine the contemporary profile, clinical characteristics, and intrahospital outcomes of acute heart failure (AHF) in an African urban community. There are limited data on the current burden and characteristics of AHF in Nigerian Africans. Comprehensive and detailed clinical and sociodemographic data were prospectively collected from 452 consecutive patients presenting with AHF to the only tertiary hospital in Abeokuta, Nigeria (population about 1 million) over a 2-year period. The mean age was 56.6 ± 15.3 years (57.3 ± 13.4 years for men, 55.7 ± 17.1 years for women), and 204 patients (45.1%) were women. Overall, 415 subjects (91.8%) presented with de novo AHF. The most common risk factor for heart failure was hypertension (pre-existing in 64.3% of patients). Type 2 diabetes mellitus was present in 41 patients (10.0%). Hypertensive heart failure was the most common etiological cause of heart failure, responsible for 78.5% of cases. Dilated cardiomyopathy (7.5%), cor pulmonale (4.4%), pericardial disease (3.3%), rheumatic heart disease (2.4%), and ischemic heart disease were less common (0.4%) causes. The majority of subjects (71.2%) presented with left ventricular dysfunction (mean left ventricular ejection fraction 43.9 ± 9.0%), with valvular dysfunction and abnormal left ventricular geometry frequently documented. The mean duration of hospital stay was 11.4 ± 9.1 days, and intrahospital mortality was 3.8%. Compared with those in high-income countries, patients presenting with AHF in Abeokuta, Nigeria, are relatively younger and still of working age. It is also more common in men and associated with severe symptoms because of late presentation. Intrahospital mortality is similar to that in other parts of the world.

A Survey of Coronary Risk Factors and B-Type Natriuretic Peptide Concentrations in Cardiac Nurses from Europe: Do Nurses Still Practice what they Preach?

Publisher: Oxford University Press (OUP)

Date: 04-2004

DOI: 10.1016/J.EJCNURSE.2004.01.005

NT-proB natriuretic peptide, risk factors and asymptomatic left ventricular dysfunction: Results of the SCReening Evaluation of the Evolution of New Heart Failure Study (SCREEN-HF)

Publisher: Elsevier BV

Date: 10-2013

DOI: 10.1016/J.IJCARD.2013.08.089

Abstract: We assessed left ventricular dysfunction in a population at high risk for heart failure (HF), and explored associations between ventricular function, HF risk factors and NT-proB natriuretic peptide (NT-proBNP). 3550 subjects at high risk for incident HF (≥60 years plus ≥1 HF risk factor), but without pre-existing HF or left ventricular dysfunction, were recruited. Anthropomorphic data, medical history and blood for NT-proBNP were collected. Participants at highest risk (n = 664) (NT-proBNP highest quintile >30.0 pmol/L) and a s le (n = 51) from the lowest NT-proBNP quintile underwent echocardiography. Participants in the highest NT-proBNP quintile, compared to the lowest, were older (74 years vs. 67 years p < 0.001) and more likely to have coronary artery disease, stroke or renal impairment. In the top NT-proBNP quintile (n = 664), left ventricular systolic impairment was observed in 6.6% (95% CI: 4 to 8%) of participants and was associated with male gender, coronary artery disease, hypertension and NT-proBNP. At least moderate diastolic dysfunction was observed in 24% (95% CI 20 to 27%) of participants and was associated with diabetes and NT-proBNP. In this high risk population, NT-proBNP was associated with left ventricular systolic impairment (p < 0.001) and moderate to severe diastolic dysfunction (p < 0.001) after adjustment for age, gender, coronary artery disease, diabetes, hypertension and obesity. A high burden of ventricular dysfunction was observed in this high risk group. Combining NT-proBNP and HF risk factors may identify those with ventricular dysfunction. This would allow resources to be focused on those at greatest risk of progression to overt HF.

Trends in hospital activity, morbidity and case fatality related to atrial fibrillation in Scotland, 1986-1996

Publisher: Oxford University Press (OUP)

Date: 15-04-2001

DOI: 10.1053/EUHJ.2000.2511

Integrated care and optimal management of pulmonary arterial hypertension

Publisher: Informa UK Limited

Date: 05-2009

DOI: 10.2147/JMDH.S3085

Economic burden of heart failure: Investigating outpatient and inpatient costs in Abeokuta, Southwest Nigeria

Publisher: Public Library of Science (PLoS)

Date: 21-11-2014

DOI: 10.1371/JOURNAL.PONE.0113032

Heart failure in a cold climate

Publisher: Elsevier BV

Date: 03-2002

DOI: 10.1016/S0735-1097(02)01685-6

Abstract: This study was done to determine whether seasonal variation exists in hospitalizations and deaths due to heart failure (HF) and to examine possible contributors to such variability. Although seasonal variation in the incidence of acute myocardial infarction and sudden death is well recognized, it is less well documented in HF. We used the linked Scottish Morbidity Record scheme, which provides in idualized morbidity and mortality data for the entire Scottish population. Between 1990 and 1996, there were a total of 75,452 male and 81,269 female hospitalizations related to HF in Scotland, with an average rate of admissions per 100,000 population of 8.4 and 8.5 per day, respectively. Significantly more admissions occurred in winter compared to summer (p < 0.0001). In women, the peak rate of admission occurred in December (12% more than average) and the lowest rate in July (7% less than average) (odds ratio [OR] 1.14, p < 0.001). The respective figures for men were 6% more, 8% less (OR 1.16, p 75 years---peak winter rates being 15% to 18% higher than average. There was also a winter peak in concomitantly coded respiratory disease this seasonal excess accounted for approximately one-fifth of the winter increment in HF hospitalizations. Seasonal variation in mortality was also seen in these patients. The number of male deaths in December was 16% higher, and in July 7% lower, than average (OR 1.25, p < 0.001). In women, the equivalent figures were 21% higher (January) and 14% lower (July) (OR 1.21, p 75 years---peak rates being 23% to 35% higher than average. There is substantial seasonal variation in HF hospitalizations and deaths, particularly in the elderly. Approximately one-fifth of the winter excess in admissions is attributable to respiratory disease. Extra vigilance in patients with HF is advisable in winter, as is immunization against pneumococcus and influenza.

Atrial fibrillation is associated with cognitive decline in stroke-free subjects: the Tromsø Study

Publisher: Wiley

Date: 28-09-2017

DOI: 10.1111/ENE.13445

Abstract: Previous studies have shown associations between atrial fibrillation (AF) and cognitive decline. We investigated this association in a prospective population study, focusing on whether stroke risk factors modulated this association in stroke-free women and men. We included 4983 participants (57% women) from the fifth survey of the Tromsø Study (Tromsø 5, 2001), of whom 2491 also participated in the sixth survey (Tromsø 6, 2007-2008). Information about age, education, blood pressure, body mass index, lipids, smoking, coffee consumption, physical activity, depression, coronary and valvular heart disease, heart failure and diabetes was obtained at baseline. AF status was based on hospital records. The outcome was change in cognitive score from Tromsø 5 to Tromsø 6, measured by the verbal memory test, the digit-symbol coding test and the tapping test. Mean age at baseline was 65.4 years. The mean reduction in the tapping test scores was significantly larger in participants with AF (5.3 taps/10 s 95% CI: 3.9, 6.7) compared with those without AF (3.8 taps/10 s 95% CI: 3.5, 4.1). These estimates were unchanged when adjusted for other risk factors and were similar for both sexes. AF was not associated with change in the digit-symbol coding or the verbal memory tests. Atrial fibrillation in stroke-free participants was independently associated with cognitive decline as measured with the tapping test.

Investing in the future of cardiovascular nursing as a research based profession: an international perspective.

Publisher: Wiley

Date: 2000

DOI: 10.1111/J.0889-7204.2000.80388.X

Abstract: While we all face problems with promoting research even at a local level we must not lose sight of how much there is to gain from learning from each other. Together, on an international basis, we can make more progress in alleviating the suffering of our patients. The "head in the sand" approach (even on a nice warm beach in Australia or California) will be of little benefit to our patients or ourselves in the future. We must do more to take the good, but rare, ex les of international collaboration in cardiovascular nursing and make them commonplace!

Prognostic impact of pulmonary arterial hypertension: A population-based analysis

Publisher: Elsevier BV

Date: 02-2008

DOI: 10.1016/J.IJCARD.2006.12.045

Abstract: Although pulmonary arterial hypertension (PAH) is widely accepted as deadly, if not a rare disease, its prognostic impact beyond reports from specialist centres is unknown. Using the unique Scottish Morbidity Record Scheme and linked survival data, we tracked the survival of all Scottish adults aged < or =65 years admitted for the first time during the period of 1986 to 2001 with a probable diagnosis of Idiopathic PAH and a PAH related to connective tissue disorders (Connective PAH) and congenital abnormalities (Congenital PAH) - the three most common forms of PAH. Overall, 374 Scottish men and women were discharged from the hospital with incident PAH during the period 1986 to 2001. On an unadjusted basis, Congenital PAH (40-45%) was associated with the lowest case fatality at 5 years in both men and women. In both sexes, Idiopathic PAH and Connective PAH were associated with high initial one-year case fatality (20-30%) with a steady accumulation of fatal events in the four years thereafter (60-75% case fatality at 5 years). Overall, the adjusted risk of dying within one year in the period 1986 to 1989 was 2.22-fold greater (OR 95% CI, 1.27 to 3.85) than in 1998 to 2001 (P<0.001). The greatest falls in one year case fatality were seen in those with Connective PAH (18-fold increased risk of dying in 1986 to 1989 versus 1998 to 2001: P=0.013). Similarly, women (adjusted OR 1.38, 95% CI 1.16 to 1.63: P<0.001) and the most deprived in iduals (OR 2.38, 95% CI 1.17 to 4.82: P<0.05) were at greater risk of dying within 5 years. Alternatively, those patients discharged in 1997 were less likely to die during this period compared to their 1986 counterparts, although this difference did not quite reach statistical significance (OR 0.45, 95% CI 0.22 to 1.06: P=0.056). This population-based study has confirmed the deadly impact of the three most common forms of PAH. Overall, there are encouraging trends in relation to one and five year adjusted survival rates particularly in relation to PAH related to connective tissue disorders.

Long-term cardiovascular consequences of obesity: 20-Year follow-up of more than 15 000 middle-aged men and women (the Renfrew-Paisley study)

Publisher: Oxford University Press (OUP)

Date: 23-09-2006

DOI: 10.1093/EURHEARTJ/EHI506

Abstract: To examine the long-term cardiovascular consequences of obesity and project the cardiovascular consequences of the recent increase in prevalence of obesity. Between 1972 and 1976, 15 402 in iduals aged 45-64, living in two towns in the west of Scotland underwent comprehensive cardiovascular screening. We analysed all deaths and hospitalizations for cardiovascular reasons occurring over the subsequent 20 years according to baseline body mass index (BMI) category. Compared with normal weight in iduals (BMI 18.5-24.9), obesity (BMI > or =30) was associated with an increased adjusted risk of coronary heart disease (hazard ratio for death or hospital admission: 1.60, 95% CI 1.45-1.78), heart failure (2.09, 1.68-2.59), stroke (1.41, 1.21-1.65), venous thrombo-embolism (2.29, 1.60-3.30), and atrial fibrillation (1.75, 1.17-2.65). Obesity was associated with nine additional cardiovascular deaths and 36 additional cardiovascular hospital admissions for every 100 affected middle-aged men over the subsequent 20 years (seven deaths and 28 admissions in women). Assuming no change in cardiovascular risk profile and outcomes related to obesity, the increase in prevalence in 1998, when compared with 1972, is projected to lead to an additional four cardiovascular deaths and 14 admissions per 100 middle-aged men and women over the next 20 years. Obesity is associated with an increase in a broad range of fatal and non-fatal cardiovascular events. Consideration of only coronary, only fatal, and only first events greatly underestimates the cardiovascular consequences of obesity.

Preserved ejection fraction and structural heart disease in 446 848 patients investigated with echocardiography

Publisher: Wiley

Date: 22-12-2021

DOI: 10.1002/EHF2.13149

Abstract: Sex‐specific differences in left ventricular ejection fraction (LVEF) and responses to neurohormonal modulating therapies are relevant to clinical trials of treatment for heart failure with preserved ejection fraction (HFpEF). This study aimed to identify the proportion and characteristics of patients presenting with possible or confirmed HFpEF within the National Echo Database of Australia. A total of 237 046 women (48.1%) and 256 019 men (aged 61.0 ± 18.3 vs. 60.6 ± 17.1 years, respectively) had sex‐specific distributions of LVEF: 94.3% of women had LVEF ≥ 45% (mean LVEF 66.0 ± 8.6%), compared with 87.2% of men (mean LVEF 63.4 ± 8.7%). The presence of structural heart disease (SHD) according to the PARAGON‐HF criteria could be calculated in 93.8% of women and 93.4% of men with an LVEF ≥ 45%. Of these, 64 502 (30.8%) women and 104 344 (50.0%) of men had left ventricular hypertrophy, and 78 948 (35.3%) and 95 846 (42.9%), respectively, had left atrial enlargement. As a result, the proportion of women vs. men fulfilling echocardiographic criteria for HFpEF was very different: 111 497 (53.2%) vs. 146 359 (70.1%). SHD markedly increased with age, associated with a greater increase in women than men. The same signal was observed in those referred for suspected or previously confirmed HFpEF. Double the number of men than women had LVEF 45%, and the distribution of SHD had was highly sex specific. Left ventricular hypertrophy and left atrial enlargement were more common in men and becoming more frequent in women with advancing age. The echocardiographic SHD distribution was similar in those referred with suspected or confirmed HFpEF. The findings are relevant to sex‐specific recruitment criteria for future clinical trials.

The conundrum of detecting stable angina pectoris in the community setting

Publisher: Springer Science and Business Media LLC

Date: 22-12-2010

DOI: 10.1038/NRCARDIO.2009.226

Abstract: In iduals with undetected stable angina pectoris (SAP) as a consequence of undiagnosed coronary artery disease are at high risk of poor quality of life and a premature fatal event (for ex le, sudden cardiac death out of hospital). If the extent and distribution of SAP are accurately identified at the population level, clinical screening could potentially be targeted and evaluated to optimize the management and secondary prevention of underlying coronary artery disease. Common measures of SAP in populations have important limitations. Measures chosen to identify such cases should reflect their validity as measures of undiagnosed SAP, currently symptomatic angina or lifetime diagnosis of angina.

Open Data from the Third Observing Run of LIGO, Virgo, KAGRA, and GEO

Publisher: American Astronomical Society

Date: 28-07-2023

DOI: 10.3847/1538-4365/ACDC9F

Abstract: The global network of gravitational-wave observatories now includes five detectors, namely LIGO Hanford, LIGO Livingston, Virgo, KAGRA, and GEO 600. These detectors collected data during their third observing run, O3, composed of three phases: O3a starting in 2019 April and lasting six months, O3b starting in 2019 November and lasting five months, and O3GK starting in 2020 April and lasting two weeks. In this paper we describe these data and various other science products that can be freely accessed through the Gravitational Wave Open Science Center at gwosc.org . The main data set, consisting of the gravitational-wave strain time series that contains the astrophysical signals, is released together with supporting data useful for their analysis and documentation, tutorials, as well as analysis software packages.

Left Ventricular Dysfunction and Exercise Capacity Trajectory: Implications for Subclinical Heart Failure Staging Criteria

Publisher: Elsevier BV

Date: 05-2019

DOI: 10.1016/J.JCMG.2017.10.023

Abstract: This study aimed to determine the association of stage B heart failure (SBHF) and its constituent left ventricular (LV) abnormalities with trajectory of exercise capacity over time, and assess whether this association is modified by reversion of these LV abnormalities to normal. The LV abnormalities of SBHF may coincide with a reduction in exercise capacity that precedes the overt exercise intolerance of clinical heart failure (HF). Determining the predictive capacity of established and novel SBHF criteria for exercise capacity decline may improve HF risk stratification. LV structure/function (echocardiography) and exercise capacity (6-min walk distance [6MWD]) were assessed at baseline and 3-year follow-up in 268 patients from the NIL-CHF (Nurse-led Intervention for Less Chronic Heart Failure) study (all stage A [SAHF] or SBHF). Changes (Δ) in 6MWD were compared between SAHF and SBHF and across each of 4 constituent components of SBHF: LV hypertrophy, regional wall motion abnormality(ies) (RWMA), left ventricular systolic dysfunction (LVSD) (ejection fraction 0.10). Elevated E/e' is associated with a similar degree of exercise capacity decline to LVSD, supporting that both LV functional criteria be considered in distinguishing SBHF from SAHF. That reversion of either manifestation of LV dysfunction was associated with preserved exercise capacity advocates targeting of these factors by HF preventive interventions.

Multimorbidity and the Risk of All-Cause 30-Day Readmission in the Setting of Multidisciplinary Management of Chronic Heart Failure: A Retrospective Analysis of 830 Hospitalized Patients in Australia

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 09-2018

DOI: 10.1097/JCN.0000000000000391

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

Publisher: Oxford University Press (OUP)

Date: 29-06-2013

DOI: 10.1177/1474515112451702

Abstract: A sustained epidemic of cardiovascular disease and related risk factors is a global phenomenon contributing significantly to premature deaths and costly morbidity. Preventative strategies across the full continuum of life, from a population to in idual perspective, are not optimally applied. This paper describes a simple and adaptable 'traffic-light' system we have developed to systematically perform in idual risk and need delineation in order to 'titrate' the intensity and frequency of healthcare intervention in a cost-effective manner. The GARDIAN (Green Amber Red Delineation of Risk and Need) system is an in idual assessment of risk and need that modulates the frequency and intensity of future healthcare intervention. In idual assessment of risk and need for ongoing intervention and support is determined with reference to three domains: (1) clinical stability, (2) gold-standard management, and (3) a broader, holistic assessment of in idual circumstance. This can be applied from a primary prevention, secondary prevention, or chronic disease management perspective. Our experience with applying and validating GARDIAN to titrate healthcare resources according to need has been extensive to date, with >5000 in iduals profiled in a host of clinical settings. A series of clinical randomized trials will determine the impact of the GARDIAN system on important indices of healthcare utilization and health status. The GARDIAN model to delineating risk and need for varied intensity of management shows strong potential to cost effectively improve health outcomes for both in iduals at risk of heart disease and those with established heart disease.

An epidemiological study of stroke hospitalizations in maputo, mozambique: A high burden of disease in a resource-poor country

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 11-2010

DOI: 10.1161/STROKEAHA.110.594275

Abstract: Background and Purpose— Already a major cause of death and disability in high-income countries, the burden of stroke in sub-Saharan Africa is also expected to be high. However, specific stroke data are scarce from resource-poor countries. We studied the incidence, characteristics, and short-term consequences of hospitalizations for stroke in Maputo, Mozambique. Methods— Over 12 months, comprehensive data from all local patients admitted to any hospital in Maputo with a new stroke event were prospectively captured according to the World Health Organization’s STEPwise approach to stroke surveillance program. Disability levels (pre- and posthospital discharge) and short-term case-fatality (in-hospital and 28 days) were also studied. Results— Overall, 651 new stroke events (mean age 59.1±13.2 years and 53% men) were captured by the registry with 601 confirmed by CT scan (83.4%) or necropsy (8.9%). Crude and adjusted (world reference population) annual incidence rates of stroke were 148.7 per 100 000 and 260.1 per 100 000 aged ≥25 years, respectively. Of these, 531 (81.6%) represented a first-ever stroke event comprising 254 ischemic (42.0%) and 217 (36.1%) an intracerebral hemorrhage. Before admission, 561 patients (86.2%) had hypertension and 271 (41.6%) had symptoms for hours. In-hospital and 28-day case-fatality were 33.3% and 49.6% (72.3% for hemorrhagic stroke), respectively. From almost no preadmission disability, 64.4% of 370 survivors at 28 days had moderate-to-severe disability. Conclusions— The burden of disease associated with stroke is high in Maputo, emphasizing the importance of primary prevention and improvement of the standards of care in a developing country under epidemiological transition.

Injury surveillance of an Australian community netball club

Publisher: Elsevier BV

Date: 07-2020

DOI: 10.1016/J.PTSP.2020.04.004

Prognostic importance of cognitive impairment in chronic heart failure patients: Does specialist management make a difference?

Publisher: Wiley

Date: 08-2006

DOI: 10.1016/J.EJHEART.2005.11.013

Abstract: Cognitive impairment is common among chronic heart failure (CHF) patients. To determine the prognostic significance of cognitive impairment in patients participating in a randomized study of a CHF management program (CHF-MP). CHF patients were randomized to a CHF-MP (n=100) or usual care (n=100). Baseline cognition was assessed using the Mini Mental Status Examination (MMSE). Five-year all-cause mortality, and combined death-or-readmission, were compared on the basis of the presence (MMSE 19-26) or absence (MMSE >26) of cognitive impairment. 27 patients (13.5%) had cognitive impairment and, on an adjusted basis, were more likely to die (96.3% versus 68.2%. RR 2.19, 95% CI 1.41 to 3.39: P<0.001) and/or experience an unplanned hospitalization (100% versus 94%. RR 1.44, 95% CI 1.06 to 1.95: P=0.019). Cognitively impaired patients had a similar (non-significant) adjusted risk of death-or-readmission in both the CHF-MP (RR 1.40, 95% CI 0.63 to 3.11: P=0.403) and in usual care (RR 1.38, 95% CI 0.75 to 2.53: P=0.305). In the usual care cohort, cognitive impairment was associated with a greater (non-significant), adjusted risk of death (RR 1.61, 95% CI 1.10 to 4.92: P=0.122). In the CHF-MP, adjusted risk of death was significantly higher for cognitively impaired patients (RR 2.33, 95% CI 1.10 to 4.92: P=0.027). These data suggest that "mild" cognitive impairment is of prognostic importance in CHF: even when a CHF-MP has been applied.

What are the factors in risk prediction models for rehospitalisation for adults with chronic heart failure?

Publisher: Elsevier BV

Date: 02-2012

DOI: 10.1016/J.AUCC.2011.07.004

Abstract: Risk prediction models can assist in identifying in iduals at risk of adverse events and also the judicious allocation of scare resources. Our objective was to describe risk prediction models for the rehospitalisation of in iduals with chronic heart failure (CHF) and identify the elements contributing to these models. The electronic data bases MEDLINE, PsychINFO, Ovid Evidence-Based Medicine Reviews and Scopus (1950-2010), were searched for studies that describe models to predict all-cause hospital readmission for in iduals with CHF. Search terms included: patient readmission risk chronic heart failure, congestive heart failure and heart failure. We excluded non-English studies, pediatric studies, and publications without original data. Only 1 additional model was identified since the review undertaken by Ross and colleagues in 2008. All models were derived from data sets collected in the United States and patients were followed from 60 days to 18 months. The only common predictors of re-hospitalisation in the models identified by Ross and colleagues were a history of diabetes mellitus and a history of prior hospitalisation. The additional model extends its scope to include the non clinical factors of social instability and socioeconomic status as predictors of rehospitalisation. In spite of the burden of hospitalisation in CHF, there are limited tools to assist clinicians in assessing risk. Developing risk prediction models, based on patient, provider and system characteristics may assist in identifying in iduals in the community at greatest risk and in need of targeted interventions to improve outcomes.

The current cost of heart failure to the National Health Service in the UK

Publisher: Wiley

Date: 06-2002

DOI: 10.1016/S1388-9842(01)00198-2

Abstract: We have recently shown that heart failure admission rates continue to increase in the UK -- particularly in older age groups. As hospital activity represents the major cost component of health care expenditure related to heart failure, this study evaluated the current cost of this syndrome to the National Health Service (NHS) in the UK. We applied contemporary estimates of health care activity associated with heart failure to the whole UK population on an age and sex-specific basis to calculate its cost to the NHS for the year 1995. Direct components of health care included in these estimates were hospital admissions associated with a principal diagnosis of heart failure, associated outpatient consultations, general practice consultations and prescribed drug therapy. We also calculated the cost of nursing-home care following a primary heart failure admission and the cost of hospitalisations associated with a secondary diagnosis of heart failure. Adjusting for probable increases in hospital activity and the progressive ageing of the UK population, we have also projected the cost of heart failure to the NHS for the year 2000. We estimated that there were 988000 in iduals requiring treatment for heart failure in the UK during 1995. The 'direct' cost of health care for these patients was estimated to be pound 716 million, or 1.83% of total NHS expenditure. Hospitalisations and drug prescriptions accounted for 69 and 18% of this expenditure, respectively. The additional costs associated with long-term nursing home care and secondary heart failure admissions accounted for a further pound 751 million (2.0% of total NHS expenditure). By the year 2000, we estimated that the combined total direct cost of heart failure would have risen to pound 905 million -- equivalent to 1.91% of total NHS expenditure. Using well-validated sets of data, these findings re-confirm the importance of heart failure as a major public health problem in the UK. The annual direct cost of heart failure to the NHS in 2000 is likely to be of the order of 1.9% of total expenditure -- the predominant cost component being hospitalisation.

Antiphospholipid antibodies in black south africans with hiv and acute coronary syndromes: Prevalence and clinical correlates

Publisher: Springer Science and Business Media LLC

Date: 04-10-2011

DOI: 10.1186/1756-0500-4-379

Effects of Home‐Based Intervention on Unplanned Readmissions and Out‐of‐Hospital Deaths

Publisher: Wiley

Date: 02-1998

DOI: 10.1111/J.1532-5415.1998.TB02535.X

Abstract: To determine the effect of a home-based intervention (HBI) on the frequency of unplanned readmission and out-of-hospital death among patients discharged home from acute hospital care. A randomized controlled trial comparing HBI with usual care (UC). A tertiary referral hospital servicing the northwestern region of Adelaide, South Australia. Medical and surgical patients (n = 762) discharged home after hospitalization. Home-based intervention (n = 381) consisted of counseling of all patients before discharge followed by a single home visit (by a nurse and pharmacist) to those patients considered to be at high risk of readmission (n = 314) in order to optimize compliance with and knowledge of the treatment regimen, identify early clinical deterioration, and intensify follow-up of such patients where appropriate. The primary endpoint was the number of unplanned readmissions plus out-of-hospital deaths over a 6-month follow-up period. During the study follow-up, the major endpoint occurred most commonly in the UC group (217 vs 155 episodes: P < .001). Overall, the HBI group demonstrated fewer unplanned readmissions (154 vs 197: P = .022), out-of-hospital deaths (1 vs. 20: P < .001), total deaths (12 vs. 29: P = .006), emergency department attendances (236 vs 314: P < .001), and total days of hospitalization (1452 vs 1766: P < .001). There was a disproportionate reduction in multiple events among HBI patients (P = .035). Hospital-based costs of health care during study follow-up tended to be lower in the HBI group ($A2190 vs $A2680 per patient: P = .102). Mean cost of HBI was $A190 per patient visited, whereas other community-based health care costs were similar for both groups. Among high-risk patients discharged from acute hospital care, HBI is beneficial in limiting unplanned readmissions and reducing risk of out-of-hospital death. It may be particularly cost-effective if applied selectively to patients with a history of frequent unplanned hospital admission.

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

Publisher: Oxford University Press (OUP)

Date: 20-08-2023

DOI: 10.1093/EURJCN/ZVAC036

Abstract: 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. 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. 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.

Poor Long-Term Survival in Patients With Moderate Aortic Stenosis

Publisher: Elsevier BV

Date: 10-2019

DOI: 10.1016/J.JACC.2019.08.004

Abstract: Historical data suggesting poor survival in patients with aortic stenosis (AS) who do not undergo treatment are largely confined to patients with severe AS. This study sought to determine the prognostic impact of all levels of native valvular AS. Severity of AS was characterized by convention and by statistical distribution in 122,809 male patients (mean age 61 ± 17 years) and 118,494 female patients (mean age 62 ± 19 years), with measured aortic valve (AV) mean gradient, peak velocity, and/or area. The relationship between AS severity and survival was then examined during median 1,208 days (interquartile range: 598 to 2,177 days) of follow-up. Patients with previous aortic valve intervention were excluded. Overall, 16,129 (6.7%), 3,315 (1.4%), and 6,383 (2.6%) patients had mild, moderate, and severe AS, respectively. On an adjusted basis (vs. no AS 5-year mortality 19%), patients with mild to severe AS had an increasing risk of long-term mortality (adjusted hazard ratio: 1.44 to 2.09 p < 0.001 for all comparisons). The 5-year mortality was 56% and 67%, respectively, in those with moderate AS (mean gradient 20.0 to 39.0 mm Hg eak velocity 3.0 to 3.9 m/s) and severe AS (≥40.0 mm Hg, ≥4.0 m/s, or AV area <1.0 cm These data confirm that when left untreated, severe AS is associated with poor long-term survival. Moreover, they also suggest poor survival rates in patients with moderate AS. (National Echocardiographic Database of Australia [NEDA] ACTRN12617001387314).

Seasonal Variation in AF-related Admissions to a Coronary Care Unit in a “Hot” Climate

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 03-2004

DOI: 10.1097/00005082-200403000-00008

Abstract: Seasonal variations in atrial fibrillation (AF)-related morbidity and mortality have been demonstrated in "cold" northern European climates, but there are few data describing such a phenomenon in a "hot" climate. To examine the pattern of AF-related admissions to a coronary care unit (CCU) in South Australia operating within a Mediterranean climate, and to determine potential differences according to mean daily temperatures. PATIENT COHORT AND METHODS: A total of 144 admissions to the CCU during the 30 hottest and coldest days (60 days in total) during the calendar year 2001 were analyzed in respect to the absolute number of admissions and the profile of those admitted during "hot" and "cold" days. Overall, there were significantly more admissions to the CCU on "cold" as opposed to "hot" days (90 vs 54 patients in 30 days, P < or = .001). Of the 24 patients found to be in AF on presentation to hospital, 18 (75%) were admitted on cold days (P < .05). Alternatively, during "hot" days, patients were more likely to be diagnosed with unstable angina rather than acute myocardial infarction (46% vs 30%, P = .07) with proportionately fewer patients in AF at the time (11% vs 20%, P = NS). These preliminary data suggest that the phenomenon of seasonal variations in AF-related morbidity extend beyond colder climates to hotter climates with sufficiently large relative (as opposed to absolute) changes in ambient temperatures during the year.

Current theories and therapies relating to acute myocardial infarction and reperfusion injury

Publisher: Elsevier BV

Date: 06-1992

DOI: 10.1016/0964-3397(92)90039-M

Abstract: Acute myocardial infarction (AMI) was previously treated with conservative strategies that allowed the process of ischaemia to proceed uninterrupted. The resultant myocardial necrosis and reduced ventricular function were accepted outcomes. The emergence of thrombolytic agents such as streptokinase and tissue plasminogen activator (tPA) revolutionised the management of coronary artery occlusion, yet the spectre of further myocardial necrosis and ventricular dysfunction remains. The concept of 'reperfusion injury', an acute process described as occurring after thrombolysis of a coronary artery occlusion and referring to an unexpected loss of ventricular function, has been extensively researched. Current research papers describing the mechanisms involved appear either to emphasise those processes that occur within the actual myocytes, or those events within the coronary vasculature. In most papers however, oxygen free radicals (OFRs) are accepted as mediators of cellular injury despite the debate surrounding their primary source. Efforts to minimise the effects of primary ischaemia and subsequent 'reperfusion injury', appear to be focused upon restoring cardioprotection against the increased levels of these damaging molecules. Scavenging agents such as N-acetylcysteine (NAC) which can also assist in dilating coronary vessels as well as preventing further platelet aggregation, when combined with glyceryl trinitrate (GTN), are being closely scrutinised. Despite the advances made, the processes within the myocardium remain somewhat a mystery and the search continues for more effective strategies to ensure myocardial viability and long-term function. Critical care nurses need not only to be aware of the aim of these new strategies, but should also be conscious of their effect on the patients receiving them.

What Is the Optimal Place for Heart Failure Treatment and Care: Home or Hospital?

Publisher: Springer Science and Business Media LLC

Date: 25-06-2013

DOI: 10.1007/S11897-013-0144-X

Abstract: This article examines the role of home versus hospital clinic-based management of heart failure to achieve the best outcomes for affected in iduals and their carer/families. It also considers the role of remote management strategies. Overall, the evidence in favor of home-based strategies is quite compelling. However, persistently high levels of heart-failure-related morbidity and mortality, combined with inconsistent application of key components of care, mandate greater efforts to develop more standardized and cost-effective forms of heart failure support services.

Ethnic-Specific Normative Reference Values for Echocardiographic LA and LV Size, LV Mass, and Systolic Function

Publisher: Elsevier BV

Date: 06-2015

DOI: 10.1016/J.JCMG.2015.02.014

Abstract: This study sought to derive age-, sex-, and ethnic-appropriate adult reference values for left atrial (LA) and left ventricular (LV) dimensions and volumes, LV mass, fractional shortening, and ejection fraction (EF) derived from geographically erse population studies. The current recommended reference values for measurements from echocardiography may not be suitable to the erse world population to which they are now applied. Population-based datasets of echocardiographic measurements from 22,404 adults without clinical cardiovascular or renal disease, hypertension, or diabetes were combined in an in idual person data meta-analysis. Quantile regression was used to derive reference values at the 95th percentile (upper reference value [URV]) and fifth percentile (lower reference value [LRV]) of each measurement against age (treated as linear), separately within sex and ethnic groups. The URVs for left ventricular end-diastolic volume (LVEDV), LV end-systolic volume, and LV stroke volume (SV) were highest in Europeans and lowest in South Asians. Important sex and ethnic differences remained after indexation by body surface area or height for these measurements, as well as for the LRV for SV. LVEDV and SV decreased with increasing age for all groups. Importantly, the LRV for EF differed by ethnicity there was a clear apparent difference between Europeans and Asians. The URVs for LV end-diastolic diameter and LV end-systolic diameter were higher for Europeans than those for East Asian, South Asian, and African people, particularly among men. Similarly, the URVs for LA diameter and volume were highest for Europeans. Sex- and/or ethnic-appropriate echocardiographic reference values are indicated for many measurements of LA and LV size, LV mass, and EF. Reference values for LV volumes and mass also differ across the age range.

A not-so-rare form of heart failure in urban black Africans: Pathways to right heart failure in the Heart of Soweto Study cohort

Publisher: Wiley

Date: 10-2011

DOI: 10.1093/EURJHF/HFR108

Abstract: Preliminary data suggest that right heart failure (RHF) may be more common in urban Africans than first suspected. We examined the characteristics and pathways to RHF in the Heart of Soweto cohort. A clinical registry captured data from 5328 de novo presentations of heart disease to the Cardiology Unit, Chris Hani Baragwanath Hospital in Soweto, South Africa during 2006-08. Of 2505 cases of HF (47% of total cohort), 697 (28%) were diagnosed with RHF (50% primary diagnosis). Despite more females than males (379 vs. 318 cases), proportionately more men presented with RHF [15 vs. 12% of cases odds ratios (OR) 1.27, 95% confidence intervals (CI) 1.08-1.49] and Africans predominated overall (n= 642, 92%). Apart from concurrent left-sided heart disease (213 cases, 31%) there were many pathways to RHF including chronic lung disease (179 cases, 26% including COPD and tuberculosis) and 141 cases (20%) of pulmonary arterial hypertension (PAH). On an adjusted basis, women were almost two-fold more likely to present with PAH (OR 1.72, 95% CI 1.17-2.55 P= 0.006) while those with low levels of education (OR 0.69, 95% CI 0.47-1.01 P= 0.054) and originating from Soweto (OR 0.64, 95% CI 0.42-0.96 P= 0.029) were less likely to present with PAH compared with the rest of the cohort. These data suggest cases of RHF and related PAH are relatively common among urban Africans presenting with de novo heart disease.

Commentary: Review: Multidisciplinary interventions reduce hospital admission and all cause mortality in heart failure

Publisher: BMJ

Date: 2006

DOI: 10.1136/EBN.9.1.23

Hypertensive heart failure in nigerian africans: Insights from the abeokuta heart failure registry

Publisher: Wiley

Date: 16-02-2015

DOI: 10.1111/JCH.12496

Atrial fibrillation in the 21st century: the new cardiac 'Cinderella' and new horizons for cardiovascular nursing?

Publisher: Oxford University Press (OUP)

Date: 06-2002

DOI: 10.1016/S1474-5151(02)00010-5

B‐Type natriuretic peptide suppression of neutrophil superoxide generation: mechanistic studies in normal subjects

Publisher: Wiley

Date: 10-2014

DOI: 10.1111/1440-1681.12291

Abstract: Many acute cardiovascular disease states are associated with neutrophil infiltration of myocardium and subsequent release of superoxide (O2 (-) ) and myeloperoxidase (MPO), which contribute to inflammatory reactions. B-Type natriuretic peptide (BNP) is known to exert anti-inflammatory and antifibrotic effects, but it is not known whether these may include interactions with neutrophils. In neutrophils isolated from 20 healthy subjects, we assessed the effect of BNP on the 'neutrophil burst' (O2 (-) production and MPO release) stimulated by phorbol myristate acetate (PMA) and N-formyl-methionyl-leucyl-phenylalanine (fMLP), respectively. Effects of BNP on cGMP accumulation, and the effects of the cell-permeable cGMP analogue 8-(4-chlorophenylthio) guanosine-cGMP (8-p-CPT-cGMP) and protein kinase G (PKG) inhibition with KT5823 on the neutrophil-BNP interaction were also evaluated. B-Type natriuretic peptide suppressed O2 (-) release from neutrophils by 23 ± 6% (P < 0.001) and 24 ± 8% (P < 0.05) following PMA and fMLP stimulation, respectively. Although BNP did not significantly increase cGMP formation, 8-p-CPT-cGMP suppressed both PMA- and fMLP-induced neutrophil O2 (-) release by 16% and 28%, respectively (P < 0.05). The PKG inhibitor KT5823 attenuated the effects of BNP on both fMLP- and PMA-associated O2 (-) production. Neither BNP nor 8-p-CPT-cGMP significantly affected MPO release from neutrophils. Suppression of O2 (-) release from neutrophils by BNP may contribute to its anti-inflammatory and antifibrotic actions.

Home-Based Intervention in Congestive Heart Failure

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 18-06-2002

DOI: 10.1161/01.CIR.0000019067.99013.67

Abstract: Background — It is not known to what extent initially observed benefits of postdischarge programs of care for patients with chronic congestive heart failure (CHF) in respect to event-free survival, readmissions, and healthcare costs persist in the long term. Methods and Results — We prospectively studied the long-term effects of a multidisciplinary home-based intervention (HBI) in a cohort of CHF patients randomly allocated to either to HBI (n=149) or usual care (n=148). During a median of 4.2 years of follow-up, there were significantly fewer primary end points (unplanned readmission or death) in the HBI versus usual care group: a mean of 0.21 versus 0.37 primary events per patient per month ( P .01). Median event-free survival was more prolonged in the HBI than usual care group (7 versus 3 months P .01). Fewer HBI patients died (56% versus 65% P =0.06) and had more prolonged survival (a median of 40 versus 22 months P .05) compared with usual care. Assignment to HBI was both an independent predictor of event-free survival (RR 0.70 P .01) and survival alone (RR 0.72 P .05). Overall, HBI patients had 78 fewer unplanned readmissions compared with usual care (0.17 versus 0.29 readmissions per patient per month P .05). The median cost of these readmissions was $A325 versus $A660/month per HBI and usual care patient ( P .01). Conclusions — The beneficial effects of HBI in reducing frequency of unplanned readmissions in CHF patients persist in the long term and are associated with prolongation of survival.

Population impact of heart failure and the most common forms of cancer: A study of 1 162 309 hospital cases in Sweden (1988 to 2004)

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 11-2010

DOI: 10.1161/CIRCOUTCOMES.110.957571

Abstract: The contemporary impact of heart failure (HF) versus the most common forms of cancer as reflected by related first-ever hospitalizations and subsequent case-fatality rates is unknown. Using a national registry in Sweden, we compared the rate of first-ever hospitalization and associated short- and long-term survival for HF, acute myocardial infarction (AMI), and the most common forms of cancer on an age and sex-specific basis during 1988 to 2004 in 949 733 Swedish patients (1 162 309 hospital admissions in total). Annual incidence of first-ever hospitalization for HF, AMI, and cancer in Sweden were 484, 424, and 373 (lung, colorectal, prostate, and bladder cancer combined) per 100 000 men and 470, 280, and 350 (lung, colorectal, bladder, breast, and ovarian cancer combined) per 100 000 women age years. The ratio of in idual cases of HF to cancer was 1.37:1 (465 998 versus 340 738). Despite improvements in 30-day and 5-year survival (adjusted 7% and 6% increase per calendar year for men and women, respectively), HF was associated with unadjusted case-fatality rate of 59% within 5 years and 196 400 deaths versus 58% and 131 000 deaths in patients with cancer. During 10-year follow-up, HF was associated with 66 318 versus 55 364 premature life-years lost than all common forms of cancer in men. In women, the equivalent figures were 59 535 versus 64 533 premature life-years lost. These data confirm that, like most common forms of cancer combined, HF exerts a major health burden in respect to age-adjusted rates of first hospitalization, poor overall survival, and premature life-years lost.

Prevention: Convergent communicable and noncommunicable heart disease

Publisher: Springer Science and Business Media LLC

Date: 22-11-2012

DOI: 10.1038/NRCARDIO.2011.180

Platelet hyperaggregability in patients with atrial fibrillation

Publisher: Springer Science and Business Media LLC

Date: 02-07-2015

DOI: 10.1007/S00059-015-4335-Y

Abstract: Atrial fibrillation (AF) is a condition where platelet hyperaggregability is commonly present. We examined potential physiological bases for platelet hyperaggregability in a cohort of patients with acute and chronic AF. In particular, we sought to identify the impact of inflammation [myeloperoxidase (MPO) and C-reactive protein (CRP)] and impaired nitric oxide (NO) signaling. Clinical and biochemical determinants of adenosine diphosphate (ADP)-induced platelet aggregation were sought in patients (n = 106) hospitalized with AF via univariate and multivariate analysis. Hyper-responsiveness of platelets to ADP was directly (r = 0.254, p < 0.01) correlated with plasma concentrations of thrombospondin-1 (TSP-1), a matricellular protein that impairs NO responses and contributes to development of oxidative stress. In turn, plasma TSP-1 concentrations were directly correlated with MPO concentrations (r = 0.221, p < 0.05), while MPO concentrations correlated with those of asymmetric dimethylarginine (ADMA, r = 0.220, p < 0.05), and its structural isomer symmetric dimethylarginine (SDMA, r = 0.192, p = 0.05). Multivariate analysis identified TSP-1 (β = 0.276, p < 0.05) concentrations, as well as female sex (β = 0.199, p < 0.05), as direct correlates of platelet aggregability, and SDMA concentrations (β = - 0.292, p < 0.05) as an inverse correlate. We conclude that platelet hyperaggregability, where present in the context of AF, may be engendered by impaired availability of NO, as well as via MPO-related inflammatory activation.

Levels of and changes in socioeconomic inequality in delivery care service: A decomposition analysis using Bangladesh Demographic Health Surveys

Publisher: Public Library of Science (PLoS)

Date: 30-11-2020

DOI: 10.1371/JOURNAL.PONE.0242325

Abstract: Socioeconomic inequality in maternity care is well-evident in many developing countries including Bangladesh, but there is a paucity of research to examine the determinants of inequality and the changes in the factors of inequality over time. This study examines the factors accounting for the levels of and changes in wealth-related inequality in three outcomes of delivery care service: health facility delivery, skilled birth attendance, and C-section delivery in Bangladesh. This study uses from the Bangladesh Demographic and Health Survey of 2011 and 2014. We apply logistic regression models to examine the association between household wealth status and delivery care measures, controlling for a wide range of sociodemographic variables. The Erreygers normalised concentration index is used to measure the level of inequalities and decomposition method is applied to disentangle the determinants contributing to the levels of and changes in the observed inequalities. We find a substantial inequality in delivery care service utilisation favouring woman from wealthier households. The extent of inequality increased in health facility delivery and C-section delivery in 2014 while increase in skilled birth attendance was not statistically significant. Wealth and education were the main factors explaining both the extent of and the increase in the degree of inequality between 2011 and 2014. Four or more antenatal care (ANC4+) visits accounted for about 8% to 14% of the observed inequality, but the contribution of ANC4+ visits declined in 2014. This study reveals no progress in equity gain in the use of delivery care services in this decade compared to a declining trend in inequity in the last decade in Bangladesh. Policies need to focus on improving the provision of delivery care services among women from poorer socioeconomic groups. In addition, policy initiatives for promoting the completion of quality education are important to address the stalemate of equity gain in delivery care services in Bangladesh.

Long-term cost-effectiveness of a disease management program for patients with atrial fibrillation compared to standard care – a multi-state survival model based on a randomized controlled trial

Publisher: Informa UK Limited

Date: 2021

DOI: 10.1080/13696998.2020.1860371

Long-term cost-effectiveness of home versus clinic-based management of chronic heart failure: the WHICH? study

Publisher: Informa UK Limited

Date: 12-2017

DOI: 10.1080/13696998.2016.1261031

Abstract: The cost-effectiveness of a heart failure management intervention can be further informed by incorporating the expected benefits and costs of future survival. This study compared the long-term costs per quality-adjusted life year (QALY) gained from home-based (HBI) vs specialist clinic-based intervention (CBI) among elderly patients (mean age = 71 years) with heart failure discharged home (mean intervention duration = 12 months). Cost-utility analysis was conducted from a government-funded health system perspective. A Markov cohort model was used to simulate disease progression over 15 years based on initial data from a randomized clinical trial (the WHICH? study). Time-dependent hazard functions were modeled using the Weibull function, and this was compared against an alternative model where the hazard was assumed to be constant over time. Deterministic and probabilistic sensitivity analyses were conducted to identify the key drivers of cost-effectiveness and quantify uncertainty in the results. During the trial, mortality was the highest within 30 days of discharge and decreased thereafter in both groups, although the declining rate of mortality was slower in CBI than HBI. At 15 years (extrapolated), HBI was associated with slightly better health outcomes (mean of 0.59 QALYs gained) and mean additional costs of AU$13,876 per patient. The incremental cost-utility ratio and the incremental net monetary benefit (vs CBI) were AU$23,352 per QALY gained and AU$15,835, respectively. The uncertainty was driven by variability in the costs and probabilities of readmissions. Probabilistic sensitivity analysis showed HBI had a 68% probability of being cost-effective at a willingness-to-pay threshold of AU$50,000 per QALY. Compared with CBI (outpatient specialized HF clinic-based intervention), HBI (home-based predominantly, but not exclusively) could potentially be cost-effective over the long-term in elderly patients with heart failure at a willingness-to-pay threshold of AU$50,000/QALY, albeit with large uncertainty.

SCReening Evaluation of the Evolution of New Heart Failure Study (SCREEN-HF): Early detection of chronic heart failure in the workplace

Publisher: CSIRO Publishing

Date: 2017

DOI: 10.1071/AH15107

Abstract: Objective The aim of the present study was to determine whether asymptomatic heart failure (HF) in the workplace is subject to the health worker effect, making screening using conventional risk factors combined with a cardiac biomarker, namely N-terminal pro B-type natriuretic peptide (NT-proBNP), as useful as in the general population. Methods Between June 2007 and December 2009 a ‘well’ population deemed at high risk for development of HF was identified through health insurance records. Blood was collected from volunteer participants for analysis of urea, electrolytes and creatinine, a full blood count and NT-proBNP. An echocardiogram was performed on selected participants based on high NT-proBNP concentrations. Results The mean left ventricular ejection fraction (LVEF) was significantly reduced in participants with the highest compared with the lowest NT-proBNP quintile. In multivariate analysis, log-transformed NT-proBNP was independently associated with impaired LVEF and with moderate to severe diastolic dysfunction after adjustment for age, sex, coronary artery disease, diabetes, hypertension and obesity. Conclusions A large burden of asymptomatic left ventricular dysfunction (AVLD) was observed in subjects aged 60 and over with plasma NT-proBNP in the top quintile that was independent of conventional risk factors and work status. HWE does not appear to operate in AVLD. NT-proBNP testing in a population with HF risk factors may cost-effectively identify those at greatest risk of developing HF in a working population and facilitate early diagnosis, treatment and maintenance of work capacity. What is known about the topic? Chronic heart failure (CHF) has several causes, the most common being hypertension and coronary ischaemia. CHF is a major health problem of increasing prevalence that severely impacts quality of life, shortens lives and reduces worker productivity. It is often not diagnosed early enough to take full advantage of ameliorating medication. What does this paper add? Population screening for CHF is not currently advocated. This may be because conventional risk factors must be used in combination and there is no useful biomarker available. Yet evidence (SOLVD (Studies of Left Ventricular Dysfunction trials) recommends early diagnosis. We believe the work place is an area of potential screening where there is little supporting evidence. This paper provides evidence that the biomarker NT-proBNP is a useful new tool that improves cost-effectiveness of screening in a selected population. Specifically, the paper recommends CHF screening in the population with the highest potential health gain (i.e. the working population) by the sector with the highest economic gain (i.e. employers). What are the implications for practitioners? The paper presents important health screening recommendations for medical and health and safety practitioners within a selected population of workers. We feel practitioners should consider screening for incipient heart failure, particularly within Australia’s working population, to save lives, provide economic benefit and extend working longevity.

Handmaiden or right-hand man: Is the relationship between doctors and nurses still therapeutic?

Publisher: Elsevier BV

Date: 05-2007

DOI: 10.1016/J.IJCARD.2006.05.073

Seasonal variation in morbidity and mortality related to atrial fibrillation

Publisher: Elsevier BV

Date: 11-2004

DOI: 10.1016/J.IJCARD.2004.03.041

Cost-effectiveness of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort — The WHICH? study (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care)

Publisher: Elsevier BV

Date: 12-2015

DOI: 10.1016/J.IJCARD.2015.08.066

Abstract: To assess the long-term cost-effectiveness of two multidisciplinary management programs for elderly patients hospitalized with chronic heart failure (CHF) and how it is influenced by patient characteristics. A trial-based analysis was conducted alongside a randomized controlled trial of 280 elderly patients with CHF discharged to home from three Australian tertiary hospitals. Two interventions were compared: home-based intervention (HBI) that involved home visiting with community-based care versus specialized clinic-based intervention (CBI). Bootstrapped incremental cost-utility ratios were computed based on quality-adjusted life-years (QALYs) and total healthcare costs. Cost-effectiveness acceptability curves were constructed based on incremental net monetary benefit (NMB). We performed multiple linear regression to explore which patient characteristics may impact patient-level NMB. During median follow-up of 3.2 years, HBI was associated with slightly higher QALYs (+0.26 years per person p=0.078) and lower total healthcare costs (AU$ -13,100 per person p=0.025) mainly driven by significantly reduced duration of all-cause hospital stay (-10 days p=0.006). At a willingness-to-pay threshold of AU$ 50,000 per additional QALY, the probability of HBI being better-valued was 96% and the incremental NMB of HBI was AU$ 24,342 (discounted, 5%). The variables associated with increased NMB were HBI (vs. CBI), lower Charlson Comorbidity Index, no hyponatremia, fewer months of HF, fewer prior HF admissions <1 year and a higher patient's self-care confidence. HBI's net benefit further increased in those with fewer comorbidities, a lower self-care confidence or no hyponatremia. Compared with CBI, HBI is likely to be cost-effective in elderly CHF patients with significant comorbidity.

Persistently misunderstood and malignant: the case of heart failure vs. cancer

Publisher: Wiley

Date: 19-06-2017

DOI: 10.1002/EJHF.908

Poles apart, but are they the same? A comparative study of Australian and Scottish patients with chronic heart failure

Publisher: Wiley

Date: 03-2001

DOI: 10.1016/S1388-9842(00)00144-6

Abstract: This paper reports on an international comparison of the characteristics, treatment and health outcomes of chronic heart failure (CHF) patients discharged from acute hospital care in Australia and Scotland. The baseline characteristics and treatment of 200 CHF patients recruited to a randomised study of a non-pharmacological intervention in Australia and 157 CHF patients concurrently recruited to a similar study in Scotland were compared. Subsequent health outcomes (including survival and readmission) within 3 months of discharge in those patients who received usual post-discharge care in Australia (n=100) and Scotland (n=75) were also compared. In iduals in both countries were predominantly old and frail with significant comorbidity likely to complicate treatment. Similar proportions of Australian and Scottish patients were prescribed either a 'high' (20 vs. 18%) or medium (64 vs. 66%) dose of an angiotensin-converting enzyme inhibitor. Proportionately more Australian patients were prescribed a long-acting nitrate, digoxin and/or a beta-blocker. At 3 months post-discharge, 57 of the 100 (57%: 95% CI 47--67%) Australian and 37 of the 75 (49%: 95% CI 38--61%) Scottish patients assigned to 'usual care' remained event-free (NS). Similarly, 15 vs. 12% required > or =2 unplanned readmission (NS) and 16 vs. 19% of Australian and Scottish patients, respectively, died (NS). Australian and Scottish patients accumulated a median of 0.6 vs. 0.9 days, respectively, of hospitalisation atient/month (NS). On multivariate analysis (including country of origin), unplanned readmission or death was independently correlated with severe renal impairment (adjusted odds ratio 4.4, P<0.05), a previous hospitalisation for CHF (2.3, P 10 days, P<0.05) and greater comorbidity (1.3 for each incremental unit of the Charlson Index, P=0.05). Health outcomes among predominantly old and frail CHF patients appear to be independent of the health-care system in which the patient is managed and more likely to be dependent on the syndrome itself.

Improving research supervision in nursing

Publisher: Elsevier BV

Date: 05-2005

DOI: 10.1016/J.NEDT.2005.01.011

Abstract: In this paper, four experienced researchers from the UK, China and Australia offer guidance in research supervision based on their experiences and the recent document, Improving standards in postgraduate research degree programmes [Higher Education Funding Council for England, 2003. Improving standards in postgraduate research degree programmes. Formal consultation. Department for Employment and Learning, Northern Ireland, Higher Education Funding Council for England, Higher Education Funding Council for Wales, Scottish Higher Education Funding Council, HEFCE, London]. Supervision is an important aspect of not only the development of the neophyte researcher, but of academic staff and research activity in general. With increased academic accountability, good supervision should be an integral component of a quality research governance framework and resourced as such. Recommendations include: adoption of these standards rigorous selection of research students and supervisors and development of projects development of departmental procedures for monitoring, feedback and intellectual property and transparency, rigour and fairness in examination procedures.

Heart failure nursing in Australia: Past, present and future

Publisher: Elsevier BV

Date: 08-2009

DOI: 10.1016/J.AUCC.2009.06.006

Fear of movement, passive coping, manual handling, and severe or radiating pain increase the likelihood of sick leave due to low back pain

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 07-2011

DOI: 10.1016/J.PAIN.2011.02.041

Abstract: Sick leave due to low back pain (LBP-SL) is costly and compromises workforce productivity. The fear-avoidance model asserts that maladaptive pain-related cognitions lead to avoidance and disuse, which can perpetuate ongoing pain. Staying home from work is an avoidant behavior, and hence pain-related psychological features may help explain LBP-SL. We examined the relative contribution of pain catastrophizing, fear of movement, and pain coping (active and passive) in LBP-SL in addition to pain characteristics and other psychosocial, occupational, general health, and demographic factors. Two-way interactions between age and gender and candidate exposures were also considered. Our s le comprised 2164 working nurses and midwives with low back pain in the preceding year. Binary logistic regression was performed on cross-sectional data by manual backward stepwise elimination of nonsignificant terms to generate a parsimonious multivariable model. From an extensive array of exposures assessed, fear of movement (women, odds ratio [OR]=1.05, 95% confidence interval [CI] 1.02-1.08 men, OR=1.17, 95% CI 1.05-1.29), passive coping (OR=1.07, 95% CI 1.04-1.11), pain severity (OR=1.61, 95% CI 1.50-1.72), pain radiation (women, OR=1.45, 95% CI 1.10-1.92 men, OR=4.13, 95% CI 2.15-7.95), and manual handling frequency (OR=1.03, 95% CI 1.01-1.05) increased the likelihood of LBP-SL in the preceding 12 months. Administrators and managers were less likely to report LBP-SL (OR=0.44, 95% CI 0.27-0.71), and age had a protective effect in in iduals in a married or de facto relationship (OR=0.97, 95% CI 0.95-0.98). In summary, fear of movement, passive coping, frequent manual handling, and severe or radiating pain increase the likelihood of LBP-SL. Gender-specific responses to pain radiation and fear of movement are evident.

Prevalence and Outcomes of Low‐Gradient Severe Aortic Stenosis—From the National Echo Database of Australia

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 16-11-2021

DOI: 10.1161/JAHA.121.021126

Abstract: The prevalence and outcomes of the different subtypes of severe low‐gradient aortic stenosis (AS) in routine clinical cardiology practice have not been well characterized. Data were derived from the National Echocardiography Database of Australia. Of 192 060 adults (aged 62.8±17.8 [mean±SD] years) with native aortic valve profiling between 2000 and 2019, 12 013 (6.3%) had severe AS. Of these, 5601 patients (47%) had high‐gradient and 6412 patients (53%) had low‐gradient severe AS. The stroke volume index was documented in 2741 (42.7%) patients with low gradient 1750 patients (64%) with low flow, low gradient (LFLG) and 991 patients with normal flow, low gradient. Of the patients with LFLG, 1570 (89.7%) had left ventricular ejection fraction recorded 959 (61%) had paradoxical LFLG (preserved left ventricular ejection fraction), and 611 (39%) had classical LFLG (reduced left ventricular ejection fraction). All‐cause and cardiovascular‐related mortality were assessed in the 8162 patients with classifiable severe AS subtype during a mean±SD follow‐up of 88±45 months. Actual 1‐year and 5‐year all‐cause mortality rates varied across these groups and were 15.8% and 49.2% among patients with high‐gradient severe AS, 11.6% and 53.6% in patients with normal‐flow, low‐gradient severe AS, 16.9% and 58.8% in patients with paradoxical LFLG severe AS, and 30.5% and 72.9% in patients with classical LFLG severe AS. Compared with patients with high‐gradient severe AS, the 5‐year age‐adjusted and sex‐adjusted mortality risk hazard ratios were 0.94 (95% CI, 0.85–1.03) in patients with normal‐flow, low‐gradient severe AS 1.01 (95% CI, 0.92–1.12) in patients with paradoxical LFLG severe AS and 1.65 (95% CI, 1.48–1.84) in patients with classical LFLG severe AS. Approximately half of those patients with echocardiographic features of severe AS in routine clinical practice have low‐gradient hemodynamics, which is associated with long‐term mortality comparable with or worse than high‐gradient severe AS. The poorest survival was associated with classical LFLG severe AS.

Search for Gravitational Waves Associated with Fast Radio Bursts Detected by CHIME/FRB during the LIGO–Virgo Observing Run O3a

Publisher: American Astronomical Society

Date: 28-09-2023

DOI: 10.3847/1538-4357/ACD770

Cost of an emerging epidemic: An economic analysis of atrial fibrillation in the UK (Heart (2004) 90, (286-292))

Publisher: BMJ

Date: 11-2007

DOI: 10.1136/HRT.2002.008748CORR1

The Indigenous Australian Malnutrition Project: the burden and impact of malnutrition in Aboriginal Australian and Torres Strait Islander hospital inpatients, and validation of a malnutrition screening tool for use in hospitals—study rationale and protocol

Publisher: Springer Science and Business Media LLC

Date: 08-08-2016

DOI: 10.1186/S40064-016-2943-5

Frailty and Seasonality

Publisher: Springer Science and Business Media LLC

Date: 17-04-2020

DOI: 10.1007/S12603-020-1367-7

The role of mobile consumers in lake nutrient cycles: a brief review

Publisher: Springer Science and Business Media LLC

Date: 04-04-2018

DOI: 10.1007/S10750-018-3603-2

Current and projected burden of heart failure in the Australian adult population: A substantive but still ill-defined major health issue

Publisher: Springer Science and Business Media LLC

Date: 21-09-2016

DOI: 10.1186/S12913-016-1748-0

Spectrum of heart disease and risk factors in a black urban population in South Africa (the Heart of Soweto Study): a cohort study

Publisher: Elsevier BV

Date: 03-2008

DOI: 10.1016/S0140-6736(08)60417-1

Is the last “man” standing in comedy the least funny? A retrospective cohort study of elite stand-up comedians versus other entertainers

Publisher: Elsevier BV

Date: 10-2016

DOI: 10.1016/J.IJCARD.2016.06.284

Abstract: This study aimed to confirm, in a large, erse cohort of elite Stand-up Comedians and other entertainers, that there is an inverse association between comedic ability and longevity. This retrospective cohort study included 200 Stand-up Comedians (13% women), 113 Comedy Actors (17.5% women), and 184 Dramatic Actors (29.3% women) listed in the top 200 in each category in a popular online ranking website. Longevity within each group was examined adjusting for life expectancy by year of birth and within-group ranking score. Stand-up Comedians were younger than Comedy Actors (median birth year 1962 versus 1947: p<0.001) and Dramatic Actors (1962 versus 1946: p<0.001). Overall, 36/200 (18.0%), 33/114 (29.0%) and 56/184 (30.9%) of Stand-up Comedians, Comedy Actors and Dramatic Actors, respectively, had died (p=0.011). There was a significant gradient (p=0.011) in the age of death, with Stand-up Comedians dying at a younger age (67.1±21.3years) than their Comedy Actor (68.9±15.4years) and Dramatic Actor (70.7±16.6years) counterparts. Stand-up Comedians (38.9% versus 19.6%) were more likely to die prematurely compared to Dramatic Actors p=0.043, OR 1.98 95% CI 1.01 to 3.87). Independent of year of birth, for Stand-up Comedians alone, higher comedy rank was associated with shorter longevity (hazard ratio 0.938, 95% CI 0.880 to 0.999 for a 10-rank difference p=0.045). These data reaffirm an adverse relationship between comedic ability and longevity, with elite Stand-up Comedians more highly rated by the public more likely to die prematurely.

Welcome on behalf of the Editors!

Publisher: Oxford University Press (OUP)

Date: 02-2002

DOI: 10.1016/S1474-5151(01)00008-1

The clinical consequences and challenges of hypertension in urban-dwelling black Africans: Insights from the Heart of Soweto Study

Publisher: Elsevier BV

Date: 2011

DOI: 10.1016/J.IJCARD.2009.05.061

Abstract: There is a paucity of data to describe advanced forms of cardiovascular disease (CVD) in urban black Africans with hypertension (HT). Chris Hani Baragwanath Hospital services the black African community of 1.1 million people in Soweto, South Africa. We prospectively collected detailed demographic and clinical data from all de novo presentations to the hospital's Cardiology Unit in 2006. Overall, 761 black African patients (56% of de novo cases) presented with a diagnosis of HT with more women (63%, aged 58.5±14.9 years) than men (aged 58.0±15.6 years). On presentation, 396 women (82%) versus 187 men (67%) had dizziness, palpitations and/or chest pain (OR 1.23, 95% 1.12-1.34: p<0.0001). HT was the primary diagnosis in 266 cases (35%). In the rest (n=495), non-ischaemic forms of heart failure were common (54% of total) while only 6.2% had coronary artery disease. Concurrent left ventricular hypertrophy, renal dysfunction and anaemia were present in 39%, 24% and 11% of cases, respectively, with a similar age-adjusted pattern of co-morbidity according to sex. However, men were more likely to present with impaired systolic function (OR 2.13, 95% CI 1.50 to 3.00 p<0.0001). In the absence of effective primary and secondary prevention strategies, these unique data highlight the potentially devastating impact of advanced forms of hypertensive heart disease in urban black African communities with more women than men affected.

Trends in mortality after first hospitalization with Atrial Fibrillation diagnosis in Sweden 1987 to 2006

Publisher: Elsevier BV

Date: 12-2013

DOI: 10.1016/J.IJCARD.2013.10.028

Abstract: To examine trends in 3-year mortality after a first hospitalization with diagnosed atrial fibrillation in a large cohort with and without important comorbidities. The Swedish Hospital Discharge and Cause of Death Registries were linked to investigate trends in mortality for all patients 35 to 84 years hospitalized for the first time with a discharge diagnosis (principal or contributory) of atrial fibrillation in Sweden during 1987 to 2006.We performed an analysis of temporal trends in mortality stratified for presence or absence of co-morbidities affecting survival. Exactly 376,000 patients (56% male, mean age 72 years) with a first diagnosis of atrial fibrillation during 1987–2006 were identified and followed for 3 years. Patients with one or more of the prespecified comorbidities had the highest mortality and the largest absolute decline in mortality, but patients without these comorbidities had a slightly larger relative decline (absolute risk reduction in 3-year mortality (AAR) from 42.5 to 34.7%, Hazard Ratio (HR) 0.76 95% confidence interval (95% CI) 0.74 to 0.77 versus ARR 16.2% to 11.7%, HR 0.71 0.68 to 0.74. In patients aged below 65 years,with no comorbidities, there was minimal change inmortality, and they still had a 2 times increased mortality compared to the general population (SMR 1.95 1.84-2.06). Survival after a first hospitalization with a diagnosis of atrial fibrillation improved regardless comorbidities. Patients aged < 65 years old without diagnosed comorbidities still had a poor prognosis compared to the general population.

Constraints on the Cosmic Expansion History from GWTC–3

Publisher: American Astronomical Society

Date: 06-2023

DOI: 10.3847/1538-4357/AC74BB

Abstract: We use 47 gravitational wave sources from the Third LIGO–Virgo–Kamioka Gravitational Wave Detector Gravitational Wave Transient Catalog (GWTC–3) to estimate the Hubble parameter H ( z ), including its current value, the Hubble constant H 0 . Each gravitational wave (GW) signal provides the luminosity distance to the source, and we estimate the corresponding redshift using two methods: the redshifted masses and a galaxy catalog. Using the binary black hole (BBH) redshifted masses, we simultaneously infer the source mass distribution and H ( z ). The source mass distribution displays a peak around 34 M ⊙ , followed by a drop-off. Assuming this mass scale does not evolve with the redshift results in a H ( z ) measurement, yielding H 0 = 68 − 8 + 12 km s − 1 Mpc − 1 (68% credible interval) when combined with the H 0 measurement from GW170817 and its electromagnetic counterpart. This represents an improvement of 17% with respect to the H 0 estimate from GWTC–1. The second method associates each GW event with its probable host galaxy in the catalog GLADE+ , statistically marginalizing over the redshifts of each event’s potential hosts. Assuming a fixed BBH population, we estimate a value of H 0 = 68 − 6 + 8 km s − 1 Mpc − 1 with the galaxy catalog method, an improvement of 42% with respect to our GWTC–1 result and 20% with respect to recent H 0 studies using GWTC–2 events. However, we show that this result is strongly impacted by assumptions about the BBH source mass distribution the only event which is not strongly impacted by such assumptions (and is thus informative about H 0 ) is the well-localized event GW190814.

Patient preferences for the delivery of disease management in chronic heart failure: A qualitative study

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 05-2012

DOI: 10.1097/JCN.0B013E31821ABF22

Relationship between plasma perhexiline concentration and symptomatic status during short-term perhexiline therapy

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 12-1996

DOI: 10.1097/00007691-199612000-00002

Abstract: We tested the hypothesis that resolution versus persistence of symptomatic ischaemia and/or development of nausea/dizziness on the third day of loading with perhexiline maleate (PM), is correlated with perhexiline plasma concentrations after the standard loading phase in patients with acute coronary syndromes. Forty consecutive patients with either unstable angina pectoris or non-Q-wave myocardial infarction with persistent angina pectoris, despite maximal pharmacological therapy (other than PM), were studied. All patients received PM 400 mg/day for 3 days and 200 mg/day thereafter. On days 2 and 3 observers blinded to the 72-96 h plasma perhexiline concentration assessed the patient regarding episodes of angina and/or nausea/dizziness. On the third day of loading with PM, 12 patients experienced angina and 11 patients had nausea and/or dizziness. Plasma perhexiline concentrations at 72-96 h varied widely: mean 0.46 +/- 0.26 (range 0.11-1.77) microgram/ml. There was a relationship of borderline statistical significance between resolution of anginal symptoms and plasma perhexiline concentration > 0.15 microgram/ml (p = 0.055). There was a close relationship between emergence of nausea/dizziness with plasma perhexiline concentration > 0.06 microgram/ml (p < 0.01). We conclude that this study (a) suggests that PM exerts incremental antianginal effects over those of other antiischaemic agents in patients with acute coronary syndromes and (b) establishes that the development of nausea and/or dizziness in such patients is strongly predictive of accumulation of perhexiline beyond the therapeutic range of the drug.

Commentary: Tuberculosis, diabetes and smoking: A burden greater than the sum of its parts

Publisher: Oxford University Press (OUP)

Date: 02-2013

DOI: 10.1093/IJE/DYS217

Is health-related quality of life among older, chronically ill patients associated with unplanned readmission to hospital?

Publisher: Wiley

Date: 10-1999

DOI: 10.1111/J.1445-5994.1999.TB01618.X

Abstract: Assessment of health-related quality of life (HRQL) is being used increasingly to assess the impact of treatment. To determine if HRQL, assessed shortly after acute hospitalisation, is associated with readmission to hospital. In a prospective, longitudinal study, 163 chronically ill, medical and surgical patients (mean age 67.0+/-16.3 years) discharged to home following acute hospitalisation were studied. HRQL was assessed at one month post-hospital discharge using the MOS 36-Item Short-Form Health Survey (SF-36). Patients were followed-up for six months thereafter to determine subsequent incidence of unplanned readmission. HRQL as measured by the eight health dimensions of the SF-36, for the entire cohort, was lower relative to age and gender matched norms for the local population (p<0.01). During study follow-up, 47 (35%) patients had an unplanned readmission and one patient died. Patients who had an unplanned readmission demonstrated both significantly lower physical (32.2+/-9.8 vs 38.6+/-10.1: p<0.001) and mental (45.1+/-12.7 vs 49.9+/-12.3: p=0.03) health component scores in comparison to the remainder of the cohort. On multivariate analysis, independent correlates of unplanned readmission were: 1) presence of formal home assistance (OR 6.4: p or =five prescribed medications (OR 2.4: p=0.04), 3) > or =two admissions in the six months before follow-up (OR 4.3: p<0.01) and 4) an SF-36 physical component score of < or =40 (OR 2.2: p=0.05). In this cohort of predominantly older and chronically ill patients recently discharged from acute hospital care, relatively lower SF-36 physical health component scores were independently associated with an increased risk of subsequent unplanned readmission.

Gender and survival: a population-based study of 201,114 men and women following a first acute myocardial infarction

Publisher: Elsevier BV

Date: 09-2001

DOI: 10.1016/S0735-1097(01)01465-6

Abstract: We tested the hypotheses that the effect of gender on short-term case fatality following a first admission for acute myocardial infarction (AMI) varies with age, and that this effect is offset by differences in the proportion of men and women who survive to reach hospital. Evidence is conflicting regarding the effect of gender on prognosis after AMI. All 201,114 first AMIs between 1986 and 1995 were studied. Both 30-day and 1-year case fatality were analyzed for the 117,749 patients hospitalized and for all first AMIs, including deaths before hospitalization. The effect of gender and its interaction with age on survival was examined using multivariate modeling. Gender-based differences in survival varied according to age in hospitalized patients, with younger women having higher 30-day case fatality than men (e.g., <55 years, women 6.5% vs. 4.8% men, p < 0.0001). When deaths from first AMI before hospitalization were included in 30-day case fatality, women were less likely to die (adjusted odds ratio 0.9, confidence interval 0.89 to 0.93). Gender was not an independent predictor of one-year survival (p = 0.16). Female gender increases the probability of surviving to reach hospital, and this outweighs the excess risk of death occurring in younger women following hospitalization. Overall, men have a higher 30-day case fatality than women. Women do not fare worse than men after AMI when age and other factors are taken into account. However, men are more likely to die before hospitalization.

Out with the Old and In with the New: Primary Care Management of Heart Failure with Preserved Ejection Fraction

Publisher: Radcliffe Media Media Ltd

Date: 17-02-2022

DOI: 10.15420/CFR.2021.27

Abstract: Primary care plays an integral role in the management of complex, chronic disease states such as heart failure. However, there is a disconnect between the characteristics of those recruited into clinical trials and those managed in the real world, which means the contribution and consideration of primary care in current guidelines is suboptimal. In this article, the authors explore key issues in the diagnosis and management of heart failure that need to be addressed from a primary care perspective. This article focuses on the issue of heart failure with preserved ejection fraction and the integration of new clinical epidemiology and trial evidence into clinical practice. In response, the authors advocate for dedicated guidelines for the primary care management of heart failure, the development of strategies to facilitate communications between health professionals in acute and community care and a renewed focus on researching optimal models of heart failure care in the community.

Have Traditional Heart Failure Management Programs Reached Their “Use by” Date? Time to Apply More Nuanced Care

Publisher: Springer Science and Business Media LLC

Date: 20-03-2019

DOI: 10.1007/S11897-019-00426-1

Abstract: To determine the current evidence supporting the otherwise proven heart failure management programs (HFMPs) in the setting of an increasingly older and more complex patient population. Attempts to replace proven face-to-face, multidisciplinary management of HF with remote management techniques (including telemedicine and implantable remote monitoring devices) have yielded mixed results. This may well reflect the clinical cascade effect of greater surveillance paradoxically leading to worse health outcomes as well as a narrow focus on HF alone in patients with clinically significant multimorbidity. Concurrently, there is preliminary evidence that the increasing phenomenon of HF and multimorbidity in older patients is undermining the otherwise positive impact of "traditional" HFMPs. A more nuanced approach to determining who would benefit from what form of HF management, including the integration of remote surveillance techniques, is required.

Testing a model of patient characteristics, psychologic status, and cognitive function as predictors of self-care in persons with chronic heart failure

Publisher: Elsevier BV

Date: 09-2009

DOI: 10.1016/J.HRTLNG.2008.11.004

Abstract: Self-care is a key component in the management of chronic heart failure (CHF). Yet there are many barriers that interfere with a patient's ability to undertake self-care. The primary aim of the study was to test a conceptual model of determinants of CHF self-care. Specifically, we hypothesized that cognitive function and depressive symptoms would predict CHF self-care. Fifty consecutive patients hospitalized with CHF were assessed for self-care (Self-Care of Heart Failure Index), cognitive function (Mini Mental State Exam), and depressive symptoms (Cardiac Depression Scale) during their index hospital admission. Other factors thought to influence self-care were tested in the model: age, gender, social isolation, self-care confidence, and comorbid illnesses. Multiple regression was used to test the model and to identify significant in idual determinants of self-care maintenance and management. The model of 7 variables explained 39% (F [7, 42] 3.80 P = .003) of the variance in self-care maintenance and 38% (F [7, 42] 3.73 P = .003) of the variance in self-care management. Only 2 variables contributed significantly to the variance in self-care maintenance: age (P < .01) and moderate-to-severe comorbidity (P < .05). Four variables contributed significantly to the variance in self-care management: gender (P < .05), moderate-to-severe comorbidity (P < .05), depression (P < .05), and self-care confidence (P < .01). When cognitive function was removed from the models, the model explained less of the variance in self-care maintenance (35%) (F [6, 43] 3.91 P = .003) and management (34%) (F [6, 43] 3.71 P = .005). Although cognitive function added to the model in predicting both self-care maintenance and management, it was not a significant predictor of CHF self-care compared with other modifiable and nonmodifiable factors. Depression explained only self-care management.

Streptokinase-induced transient aggravation of myocardial injury

Publisher: Elsevier BV

Date: 06-1995

DOI: 10.1016/0167-5273(95)93679-M

Complexity of management and health outcomes in a prospective cohort study of 573 heart failure patients in Australia: Does more equal less?

Publisher: Wiley

Date: 07-02-2013

DOI: 10.1111/JOCN.12073

Abstract: To compare the efficacy of chronic heart failure management programmes (CHF-MPs) according to a scoring algorithm used to quantify the level of applied interventions-the Heart Failure Intervention Score (HF-IS). The overall efficacy of heart failure programmes has been proven in several meta-analyses. However, the debate continues as to which components are essential in a heart failure programme to improve patient outcomes. Prospective cohort study of patients participating in heart failure programmes. Forty-eight of 62 (77%) programmes in Australia participating in a national register of CHF-MPs were evaluated using the HF-IS: derived from a summed and weighted score of each intervention applied by the CHF-MP (27 interventions overall). The CHF-MPs were prospectively categorised as relatively low (HF-IS < 190 - n = 39 programmes & 407 patients) or high (HF-IS ≥ 190 - n = 9 programmes & 166 patients) in complexity. Six-month morbidity and mortality rates in 573 consecutively recruited patients with systolic dysfunction and in New York Heart Association Class II-IV were prospectively examined. Patients exposed to CHF-MPs with a high HF-IS had a lower rate of unplanned, all-cause hospitalisation (n = 24, 14% vs. n = 102, 25%) compared with CHF-MPs with a low HF-IS within six months. On an adjusted basis, CHF-MPs with a high HF-IS were associated with a reduced risk of unplanned hospitalisation and/or death within six months and remained event-free longer. High complexity CHF-MPs applying more evidence-based interventions are associated with a higher event-free survival over six months. The HF-IS is an easy-to-use evidence-based tool to assist programme coordinators to improve the quality of their heart failure programme which may also improve patient outcomes.

Chronic cardiovascular disease management: How can it be improved?

Publisher: Oxford University Press (OUP)

Date: 02-2008

DOI: 10.1097/HJR.0B013E3282F4F98F

Predictors of rehospitalization in patients admitted with heart failure in Abeokuta, Nigeria: Data from the Abeokuta heart failure registry

Publisher: Elsevier BV

Date: 11-2014

DOI: 10.1016/J.CARDFAIL.2014.08.012

Abstract: We sought, for the first time, to examine the rate and predictors of hospital readmission in patients discharged after an episode of heart failure (HF) in Nigeria. This was a hospital-based, prospective, observational study that used the data from the Abeokuta HF Registry. Overall, 1.53% (95% confidence interval [CI] 0.58-4.02) and 12.2% (95% CI 8.88-16.8) of patients were re-hospitalized at least once within 30 days and 6 months, respectively (5.3% had multiple readmissions) the latter comprised 21/138 men (15.2%) and 11/124 (8.9%) women. A total of 11 (4.2%) died (all of whom had been rehospitalized). Worsening HF (24 cases, 75%) was the commonest reason for readmission. Among others, factors associated with rehospitalization included presence of mitral regurgitation (odds ratio [OR] 2.37, 95% CI 1.26-4.46), age ≥ 60 years (OR 2.04, 95% CI 0.96-3.29), presence of tricuspid regurgitation (OR 1.77, 95% CI 0.86-3.61), and presence of atrial fibrillation (OR 1.34, 95% CI 0.59-3.03). However, on an adjusted basis, only female sex (adjusted OR 0.33, 95% CI 0.14-0.79 P = .014 vs male) and body mass index <19 kg/m² (adjusted OR 3.74, 95% CI 1.15-12.16 P = .028 vs ≥ 19 kg/m²) were independent correlates of readmission during 6 months' follow-up. HF rehospitalization within 6 months' follow-up occurred in ∼12% of our cohort living an environment where HF etiology is predominately nonischemic and the HF population is relatively younger. Higher rates of readmission were noted in those with older age, lower body mass index, low literacy, lower serum sodium level, and presence of atrial fibrillation, renal dysfunction, and valvular dysfunction.

Standing at the crossroads between new and historically prevalent heart disease: Effects of migration and socio-economic factors in the Heart of Soweto cohort study

Publisher: Oxford University Press (OUP)

Date: 16-12-2011

DOI: 10.1093/EURHEARTJ/EHQ439

Abstract: Migration, urbanization, and change in socio-economic factors have potentially profound effects on heart disease in low-to-middle income countries. Chris Hani Baragwanath Hospital in Soweto, South Africa, provides health care to >1 million Africans. We systematically captured data from all de novo presentations of suspected heart disease (focusing on 'new' vs. historically prevalent forms) during 2006-2008. There were 3168 female (52 ± 18 years) vs. 2160 male (53 ± 17 years) cases. Overall, 999 (19%) presented with uncomplicated hypertension (n = 988) or type II diabetes, 1862 cases (35%) 'new' heart disease (1146 and 581 cases of hypertensive heart failure and coronary artery disease), and 2092 cases (39%) of historically prevalent heart disease (including 724 with primary valve disease and 502 idiopathic dilated cardiomyopathies). Level of education and non-communicable risk factors were important correlates of advanced disease. The rate of historically prevalent cases was higher in those aged 20-49 years (19-60 cases/100,000 population/annum) whilst being higher for "new" heart disease in those aged >50 years (155-343 cases opulation/annum). Historically prevalent heart disease cases were younger [adjusted odds ratio (OR) 0.98, 95% 0.97-0.99 per year], more likely to be African (OR 4.59, 95% 2.76-7.60) while being less likely to originate from Soweto (OR 0.87, 95% 0.75-1.00) and be female (OR 0.67, 95% 0.49-0.92). Dynamic socio-economic and lifestyle factors characteristic of epidemiological transition appear to have positioned the urban, mainly African community of Soweto at the crossroads between historically prevalent and 'new' forms of heart disease.

An epidemiological study of pulmonary arterial hypertension

Publisher: European Respiratory Society (ERS)

Date: 14-03-2007

DOI: 10.1183/09031936.00092306

Abstract: All hospitalisations for pulmonary arterial hypertension (PAH) in the Scottish population were examined to determine the epidemiological features of PAH. These data were compared with expert data from the Scottish Pulmonary Vascular Unit (SPVU). Using the linked Scottish Morbidity Record scheme, data from all adults aged 16-65 yrs admitted with PAH (idiopathic PAH, pulmonary hypertension associated with congenital heart abnormalities and pulmonary hypertension associated with connective tissue disorders) during the period 1986-2001 were identified. These data were compared with the most recent data in the SPVU database (2005). Overall, 374 Scottish males and females aged 16-65 yrs were hospitalised with incident PAH during 1986-2001. The annual incidence of PAH was 7.1 cases per million population. On December 31, 2002, there were 165 surviving cases, giving a prevalence of PAH of 52 cases per million population. Data from the SPVU were available for 1997-2006. In 2005, the last year with a complete data set, the incidence of PAH was 7.6 cases per million population and the corresponding prevalence was 26 cases per million population. Hospitalisation data from the Scottish Morbidity Record scheme gave higher prevalences of pulmonary arterial hypertension than data from the expert centres (Scotland and France). The hospitalisation data may overestimate the true frequency of pulmonary arterial hypertension in the population, but it is also possible that the expert centres underestimate the true frequency.

Disparities in clinical features and outcomes of peripartum cardiomyopathy in high versus low prevalent regions in Nigeria

Publisher: Wiley

Date: 17-06-2021

DOI: 10.1002/EHF2.13463

Abstract: The prospective, multicentre Peripartum Cardiomyopathy in Nigeria (PEACE) registry originally demonstrated a high prevalence of peripartum cardiomyopathy (PPCM) among patients originating from Kano, North‐West Nigeria. In a post hoc analysis, we sought to determine if this phenomenon was characterized by a differential case profile and outcome among PPCM cases originating elsewhere. Overall, 199 (81.6%) of a total 244 PPCM patients were recruited from three sites in Kano, compared with 45 patients (18.4%) from 11 widely dispersed centres across Nigeria. Presence and extent of ventricular myocardial remodelling during follow‐up, relative to baseline status, were assessed by echocardiography. During median 17 months follow‐up, Kano patients demonstrated significantly better myocardial reverse remodelling than patients from other sites. Overall, 50.6% of patients from Kano versus 28.6% from other regions were asymptomatic ( P = 0.029) at study completion, with an accompanying difference in all‐cause mortality (17.6% vs. 22.2% respectively, P = 0.523) not reaching statistical significance. Alternatively, 135/191 (84.9%) of Kano patients had selenium deficiency ( μg/L), and 46/135 (34.1%) of them received oral selenium supplementation. Critically, those that received selenium supplementation demonstrated better survival (6.5% vs. 21.2% P = 0.025), but the supplement did not have significant impact on myocardial remodelling. This study has shown important non‐racial regional disparities in the clinical features and outcomes of PPCM patients in Nigeria, that might partly be explained by selenium supplementation.

Influence of socioeconomic deprivation on the primary care burden and treatment of patients with a diagnosis of heart failure in general practice in Scotland: population based study

Publisher: BMJ

Date: 23-04-2004

DOI: 10.1136/BMJ.38043.414074.EE

A New Solution for an Old Problem? Effects of a Nurse-led, Multidisciplinary, Home-based Intervention on Readmission and Mortality in Patients With Chronic Atrial Fibrillation

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 03-2004

DOI: 10.1097/00005082-200403000-00006

Abstract: Atrial fibrillation (AF), the most common chronic cardiac dysrhythmia, is an important cause of cardiovascular morbidity and mortality. However, there is a paucity of studies examining the potential benefits of optimizing the postdischarge management of patients with chronic AF. To examine the effects of a nurse-led, multidisciplinary, home-based intervention (HBI) on the pattern of recurrent hospitalization and mortality in patients with chronic AF in the presence and absence of chronic heart failure (HF). PATIENT COHORT AND METHODS: Health outcomes in a total of 152 hospitalized patients (53% male) with a mean age of 73 +/- 9 years and a diagnosis of chronic AF who were randomly allocated to either HBI (n = 68) or usual postdischarge care (UC: n = 84) were examined. Specifically, the pattern of unplanned hospitalization and all-cause mortality during 5-year follow-up were compared on the basis of the presence (n = 87) and absence (n = 65) of HF at baseline. Patients with concurrent HF exposed to HBI (n = 37) had fewer readmissions (2.9 vs 3.4 atient), days of associated hospital stay (22.7 vs 30.5: P = NS) and fatal events (51 % vs 66%) relative to UC (n = 50): P = NS for all comparisons. In the absence of HF, morbidity and mortality rates were significantly lower but still substantial during 5-year follow-up. In these patients, HBI was associated with a trend towards prolonged event-free survival (adjusted RR = 0.70 P = .12) and fewer fatal events (29% vs 53%, adjusted RR = 0.49 P = .08). HBI patients (n = 31) also had fewer readmissions (2.1 vs 2.6 atient) and days of associated hospital stay (16.3 vs 20.3 atient), although this did not reach statistical significance. On the basis of these data, it was calculated that a randomized study of an AF-specific HBI would require 250 patients followed for a median of 3 years to detect a 25% variation in recurrent hospital stay relative to UC. These unique data provide sufficient preliminary evidence to support the hypothesis that the benefits of HBI in relation to the management of HF may extend to "high risk" patients with chronic AF in whom morbidity and mortality rates are also unacceptably high. Further, appropriately powered studies are required to confirm these benefits.

A chair in cardiovascular nursing: nice title but really necessary?

Publisher: Oxford University Press (OUP)

Date: 06-2002

DOI: 10.1016/S1474-5151(02)00015-4

Epidemiology and economic impact of atrial fibrillation

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 03-2004

DOI: 10.1097/00005082-200403000-00003

Abstract: The clinical and public health importance of detecting and treating atrial fibrillation (AF), a predominantly chaotic and fast cardiac dysrhythmia that disrupts cardiac output and increases the probability of intracardiac and systemic thrombosis, is increasingly being recognized. This article describes the epidemiology and economic health burden of AF and reviews the evidence to suggest that an epidemic of AF will persist for the foreseeable future.

Learning style and learning needs of heart failure patients (The Need2Know-HF patient study)

Publisher: Oxford University Press (OUP)

Date: 12-2009

DOI: 10.1016/J.EJCNURSE.2009.05.003

Abstract: 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. To investigate the learning style and learning needs of heart failure patients. Patients diagnosed with heart failure at a large tertiary referral hospital completed a Heart Failure Learning Style and Needs Inventory. 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. 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.

Suppression of neutrophil superoxide generation by BNP is attenuated in acute heart failure: a case for ‘BNP resistance’

Publisher: Wiley

Date: 11-02-2015

DOI: 10.1002/EJHF.242

Abstract: The release of the B-type natriuretic peptide (BNP) is increased in heart failure (HF), a condition associated with oxidative stress. BNP is known to exert anti-inflammatory effects including suppression of neutrophil superoxide (O2(-)) release. However, BNP-based restoration of homeostasis in HF is inadequate, and the equivocal clinical benefit of a recombinant BNP, nesiritide, raises the possibility of attenuated response to BNP. We therefore tested the hypothesis that BNP-induced suppression of neutrophil O2(-) generation is impaired in patients with acute HF. We have recently characterized suppression of neutrophil O2(-) generation (PMA- or fMLP-stimulated neutrophil burst) by BNP as a measure of its physiological activity. In the present study, BNP response was compared in neutrophils of healthy subjects (n = 29) and HF patients (n = 45). Effects of BNP on fMLP-induced phosphorylation of the NAD(P)H oxidase subunit p47phox were also evaluated. In acute HF patients, the suppressing effect of BNP (1 µmol/L) on O2(-) generation was attenuated relative to that in healthy subjects (P < 0.05 for both PMA and fMLP). Analogously, BNP inhibited p47phox phosphorylation in healthy subjects but not in HF patients (P < 0.05). However, O2(-)-suppressing effects of the cell-permeable cGMP analogue (8-pCPT-cGMP) were preserved in acute HF. Conventional HF treatment for 5 weeks partially restored neutrophil BNP responsiveness (n = 25, P < 0.05), despite no significant decrease in plasma NT-proBNP levels. BNP inhibits neutrophil O2(-) generation by suppressing NAD(P)H oxidase assembly. This effect is impaired in acute HF patients, with partial recovery during treatment.

Variable littoral-pelagic coupling as a food-web response to seasonal changes in pelagic primary production

Publisher: Wiley

Date: 29-10-2017

DOI: 10.1111/FWB.13046

Heart Failure Management Programs Reduce Readmissions and Prolong Survival

Publisher: American Medical Association (AMA)

Date: 13-06-2005

DOI: 10.1001/ARCHINTE.165.11.1311-A

New-onset atrial fibrillation and thromboembolic risk: Cardiovascular syzygy?

Publisher: Elsevier BV

Date: 06-2016

DOI: 10.1016/J.HRTHM.2015.12.010

Abstract: Atrial fibrillation (AF) is a condition that confers increased thromboembolic risk. Oral anticoagulant (OAC) therapy can attenuate this risk. However, use of OAC therapy is determined largely by the presence of additional clinical factors (encapsulated by the CHA2DS2VASc score) that incrementally elevate stroke risk. Currently, there is no specific recommendation regarding urgency of initiation of OAC therapy in the presence of new-onset AF, except where cardioversion is being considered. Recently, it has become increasingly apparent that there is a period immediately following the onset of AF of particularly accentuated thromboembolic risk (with respect to chronic AF): the physiological bases for this risk are as yet incompletely understood. However, given that both inflammation and impaired nitric oxide signaling are pivotally involved in the pathogenesis of AF, these factors may also mediate thrombotic risk in the context of new-onset AF. Advances in OAC therapy have recently been achieved, with development of agents that are comparable or superior to warfarin for mitigation of stroke risk, but with a safety profile similar to aspirin therapy. Thus, the incremental increase in thromboembolic risk experienced by new-onset AF patients constitutes a previously widely neglected case in favor of the rapid application of OAC therapy to such in iduals. This review seeks to summarize the thromboembolic risk observed in new-onset AF and the emerging understanding of the physiological bases for this risk.

Cognitive impairment predicts functional capacity in dementia-free patients with cardiovascular disease

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 09-2010

DOI: 10.1097/JCN.0B013E3181DAE445

Learning for heart failure patients (The L-HF patient study)

Publisher: Wiley

Date: 05-06-2009

DOI: 10.1111/J.1365-2702.2008.02716.X

Abstract: To investigate the learning style and preferences for information delivery of heart failure patients for the purpose of informing the design of educational resources. Patient education is a vital component of heart failure management programmes however the content and delivery of education varies in each programme. Traditionally education programmes for patients have focussed on educational needs as identified by health care providers however research has shown there are discrepancies between patients' and nurses' perceptions of the learning needs of heart failure patients. There is no evidence that educational programmes for heart failure patients are based on identification of patients learning needs or their preferred learning style. Qualitative. A purposive s le of 12 participants, diagnosed with heart failure and enrolled in a heart failure management programme, participated in semi-structured interviews. Four themes emerged: knowledge quest (L-loading), barriers to learning (L-inhibitors), facilitators for learning (L-agonists), and meeting educational needs (L-titration). Integral to these themes was the participant's relationship with health care professionals. This study provides unique information regarding the preferred learning modality of heart failure patients and, as such, serves to inform the development of appropriate education resources specifically tailored for this population. The development of effective modes of education is likely to further enhance heart failure management programmes service organisation and delivery and improve health outcomes for heart failure patients.

Weather Trumps Festivity? More Cardiovascular Disease Events Occur in Winter than in December Holidays in Queensland, Australia

Publisher: MDPI AG

Date: 27-09-2021

DOI: 10.3390/IJERPH181910158

Abstract: Objective: Cardiovascular disease (CVD) is the leading cause of hospitalisations and deaths in Australia. This study estimates the excess CVD hospitalisations and deaths across seasons and during the December holidays in Queensland, Australia. Methods: The study uses retrospective, longitudinal, population-based cohort data from Queensland, Australia from January 2010 to December 2015. The outcomes were hospitalisations and deaths categorised as CVD-related. CVD events were grouped according to when they occurred in the calendar year. Excess hospitalisations and deaths were estimated using the multivariate ordinary least squares method after adjusting for confounding effects. Results: More CVD hospitalisations and deaths occurred in winter than in summer, with 7811 (CI: 1353, 14,270 p 0.01) excess hospitalisations and 774 (CI: 35, 1513 p 0.01) deaths compared to summer. During the coldest month (July), there was an excess of 42 hospitalisations and 7 deaths per 1000 patients. Fewer CVD hospitalisations (−20 (CI: −29, −9 p 0.01)) occurred during the December holidays than any other period during the calendar year. Non-CVD events were mostly not statistically significant different between periods. Conclusion: Most CVD events in Queensland occurred in winter rather than during the December holidays. Potentially cost-effective initiatives should be explored such as encouraging patients with CVD conditions to wear warmer clothes during cold temperatures and/or insulating the homes of CVD patients who cannot otherwise afford to.

Development of an evidence-based scoring system (HF-IS) to assess the quality of heart failure programmes for patients postdischarge from hospital

Publisher: Wiley

Date: 18-05-2011

DOI: 10.1111/J.1365-2702.2010.03687.X

Abstract: Aim. The aim of this study was to develop a potential scoring algorithm for interventions in a chronic heart failure management programme – the Heart Failure Intervention Score – to facilitate quality improvement and programme auditing. Background. The overall efficacy of chronic heart failure management programmes has been demonstrated in several meta‐analyses. However, meta‐analyses did not determine in idual interventions in a programme that resulted in beneficial patient outcomes. Design. A prospective cross‐sectional survey design. Method. All chronic heart failure management programmes in Australia ( n = 62), identified by a national register, were surveyed to determine programme characteristics and interventions. Results. Of the 62 national chronic heart failure management programmes, 48 (77%) completed the survey and 27 in idual interventions were identified. Variability in the use of the key interventions was common among the programmes. Each intervention was given an arbitrary weighted score according to the level of supportive evidence available and a total score calculated. Programmes were then categorised into low or high complexity based on several interventions implemented and their weighted score. A total score of ≥190 (median = 178, interquartile range 176–195) was used to ide programmes into two groups. Nine programmes were categorised into high Heart Failure Intervention Score group and majority of these were based in the acute hospital setting (78%). In the low Heart Failure Intervention Score group, there were 39 programmes of which there were a higher proportion of community‐based programmes (38%) and programmes in small community hospitals (10%). Conclusion. The Heart Failure Intervention Score provides a potential evidence‐based quality improvement tool through which a set of minimum standards can be developed. Implementation of the Heart Failure Intervention Score provides guidance to programme coordinators to enable monitoring of standards of heart failure programmes, which may potentially result in better patient outcomes. Relevance to clinical practice. The Heart Failure Intervention Score is an evidence‐based tool that can be easily used by heart failure programme coordinators to ensure that their programme is evidence‐based, which will improve the quality of their programme and potentially programme outcomes.

Broadening the reach of cardiac rehabilitation to rural and remote Australia

Publisher: Oxford University Press (OUP)

Date: 04-2004

DOI: 10.1016/J.EJCNURSE.2003.10.002

Living With, and Caring for, Congenital Heart Disease in Australia: Insights From the Congenital Heart Alliance of Australia and New Zealand Online Survey

Publisher: Elsevier BV

Date: 02-2020

DOI: 10.1016/J.HLC.2018.12.009

Abstract: There is a paucity of data describing the day-to-day experiences of adult Australians personally living with or caring for a child born with congenital heart disease (CHD). Such data would be of great practical importance to inform health care initiatives to improve outcomes. 588 men (38.3 ± 11.9 years) and women (39.6 ± 12.6 years, 78% of respondent patients) living with CHD and 1,091 adult carers (93% mothers) of children with CHD (median age 7.3 [IQR 3.5-13.3 years], 54% male), representing all Australian states and territories, responded to a comprehensive online survey designed and hosted by the Congenital Heart Alliance of Australia and New Zealand. Data on demographic factors, the nature of underlying CHD, interactions with health care services, psychological wellbeing and wider impacts of CHD were collected. Most respondents were able to identify the type of CHD they (29% with a simple lesion such atrial septal defect, 17% tetralogy of Fallot) or their child had (21% with a simple lesion, 15% tetralogy of Fallot), whilst 90% cases of CHD had undergone cardiac surgery. Patients with CHD were mostly employed (70%) or studying (8.8%), whilst 9.1% were receiving disability benefits. In terms of transition care, 52% of adult patients had been referred by a paediatric to adult cardiologist with 84% still actively managed by a specialist. Overall, 31% of patients with CHD sought emergency care and required >10 days sick leave in the past 12 months. Moreover, 71% and 55% of patients, respectively, reported recent feelings of anxiety/worry or depressive thoughts related to their CHD (61% sought professional assistance). Consistent with high levels of disruption to daily living, 59% of carer respondents (24%>10 days) had taken carer's leave in the past 12 months. These contemporary, self-reported, Australian data reveal the burden of living and caring for CHD from an adult's perspective. Survey respondents highlighted the potential disconnect between paediatric and adult CHD services and suggest an important, unmet need for dedicated health services/community care to cost-effectively manage high levels of health care utilisation coupled with associated psychological distress.

Mild cognitive impairment impacts health outcomes of patients with atrial fibrillation undergoing a disease management intervention

Publisher: BMJ

Date: 02-2018

DOI: 10.1136/OPENHRT-2017-000755

Beyond competition: A new paradigm for collaborative cardiovascular research in Australia

Publisher: Oxford University Press (OUP)

Date: 09-2005

DOI: 10.1016/J.EJCNURSE.2005.07.001

Estimating the current and future prevalence of atrial fibrillation in the Australian adult population

Publisher: AMPCo

Date: 2015

DOI: 10.5694/MJA14.00238

Abstract: To estimate the current and future prevalence of atrial fibrillation (AF) in the Australian adult population according to age and sex. Application of international AF prevalence statistics to Australian adult population data (for people ≥ 55 years) to estimate population prevalence use of population projections to estimate potential future prevalence of AF. Estimated prevalence of AF in 2014 and future prevalence projected to 2034. We estimated that at 30 June 2014 there would be 328,562 cases of AF among people aged ≥ 55 years (a prevalence of 5.35% 95% CI, 3.79%-7.53%), comprising 174,986 men (prevalence, 5.97% 95% CI, 4.11%-8.54%) and 153,576 women (prevalence, 4.79% 95% CI, 3.50%-6.60%). Without significant changes to the natural history of AF, by 2034 this figure is projected to rise to over 600,000 (prevalence, 6.39% 95% CI, 4.56%-8.90%), with a prevalence of 7.22% among men (95% CI, 4.99%-10.28%) and 5.64% (95% CI, 4.18%-7.64%) among women. The greatest projected regional increase in prevalence between 2014 and 2034 is expected in Queensland, with a likely twofold increase (from 61,613 cases to 123,142 cases), although New South Wales cases will remain predominant, with a 1.7-fold increase (from 110 892 to 191 578). We also predicted that between 2014 and 2034 the number of AF cases would double among older age groups (from 200 638 to 414 377 in iduals aged ≥ 75 years) and would increase 2.5-fold among men aged ≥ 85 years (from 29 370 to 71 582). These data are indicative of a largely underappreciated AF prevalence in Australia. They mandate a more systematic effort to both understand and respond to an evolving AF burden.

Systematic review of trial-based analyses reporting the economic impact of heart failure management programs compared with usual care

Publisher: Oxford University Press (OUP)

Date: 16-10-2016

DOI: 10.1177/1474515114556031

Abstract: The cost-effectiveness of heart failure management programs (HF-MPs) is highly variable. We explored intervention and clinical characteristics likely to influence cost outcomes. A systematic review of economic analyses alongside randomized clinical trials comparing HF-MPs and usual care. Electronic databases were searched for English peer-reviewed articles published between 1990 and 2013. Of 511 articles identified, 34 comprising 35 analyses met the inclusion criteria. Eighteen analyses (51%) reported a HF-MP as more effective and less costly four analyses (11%), and five analyses (14%) also reported they were more effective but with no significant or an increased cost difference, respectively. Alternatively, five analyses (14%) reported no statistically significant difference in effects or costs, and one analysis (3%) reported no statistically significant effect difference but was less costly. Finally, two analyses (6%) reported no statistically significant effect difference but were more costly. Interventions that reduced hospital admissions tended to result in favorable cost outcomes, moderated by increased resource use, intervention cost and/or the durability of the intervention effect. The reporting quality of economic evaluation assessed by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist varied substantially between 5% and 91% (median 45% 34 articles) of the checklist criteria adequately addressed. Overall, none of the study, patient or intervention characteristics appeared to independently influence the cost-effectiveness of a HF-MP. The extent that HF-MPs reduce hospital readmissions appears to be associated with favorable cost outcomes. The current evidence does not provide a sufficient evidence base to explain what intervention or clinical attributes may influence the cost implications.

Cardiac tachyarrhythmias and patient values and preferences for their management: the European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacif

Publisher: Oxford University Press (OUP)

Date: 24-06-2015

DOI: 10.1093/EUROPACE/EUV233

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

Publisher: Wiley

Date: 21-04-2015

DOI: 10.1002/EJHF.272

Abstract: The aim of this study was to determine the effectiveness of a long-term, nurse-led, multidisciplinary programme of home/clinic visits in preventing progressive cardiac dysfunction in in iduals at risk of developing de novo chronic heart failure (CHF). A pragmatic, single-centre (tertiary-referral hospital with specialist cardiological services), open-label, randomized controlled trial with blinded endpoint adjudication was carried out. In total, 624 cardiac inpatients (66 ± 11 years, 71% male, and 70% with CAD) were randomly allocated (1:1) to standard care or the study intervention. The intention-to-treat cohort comprised 310 standard care and 301 intervention participants. During 51.0 ± 8.2 months follow-up, 38/310 (12%) standard care [mean event-free survival 1865 days, 95% confidence interval (CI) 1817-1913 days] vs. 41/301 (14%) intervention participants (1855 days, 95% CI 1804-1906 days) experienced the primary composite endpoint of de novo CHF hospitalization or all-cause mortality (P = 0.574). Although there were no statistically significant differences in the rate of cardiovascular-related and emergency hospitalizations, the NIL-CHF (Nurse-led Intervention for Less Chronic Heart Failure) group accumulated 478 (0.214 ± 0.70 vs. 0.095 ± 0.284 days articipant/month P = 0.052) and 1097 fewer days of hospital stay (0.391 ± 1.80 vs. 0.199 ± 0.47 days articipant/month P = 0.023), respectively, compared with standard care. The intervention group also showed better cardiac recovery on echocardiography at 3 years [81/226 (35.8%) vs. 56/225 (24.9%), odds ratio 1.44, 95% CI 1.08-1.92, P = 0.011]. Relative to a high level of standard care, the NIL-CHF intervention was ineffective in preventing CHF and rehospitalization. On the other hand, it was associated with reduced hospital stay and improved cardiac function over the long term. Australian New Zealand Clinical Trials Registry (No. 12608000022369).

Optimising stroke outcomes through evidence-based nursing practice: an Australian perspective

Publisher: Oxford University Press (OUP)

Date: 12-2002

DOI: 10.1016/S1474-5151(02)00042-7

Abstract: Stroke is the third leading cause of death of people in the world today and the highest cause of disability and handicap, producing a huge burden on in iduals and society more broadly. Yet unlike its counterpart acute myocardial infarction (AMI), little has been done to promote early intervention in evolving strokes. Recommendations from the American Heart Association and more recently the European Stroke Initiative are available however, in Australia (as with many other countries) practice guidelines are scarce and clinicians largely operate in an ad hoc manner with little awareness of 'best practice'. The controversial role of thrombolysis with limitations in respect to selecting appropriate patients, in addition to a small window of opportunity for therapeutic beneficial effects and a high risk for haemorrhage, has inhibited its widespread application. As such, emergent stroke management clearly lags behind that of AMI-both with respect to the range of treatment options and the application of best practice. This paper reviews the literature regarding best practice management of evolving stroke and the crucial role of nurses in triaging and managing patients to deliver optimal outcomes within the Australian context.

Detecting early clinical deterioration in chronic heart failure patients post‐acute hospitalisation—a critical component of multidisciplinary, home‐based intervention?

Publisher: Wiley

Date: 06-2002

DOI: 10.1016/S1388-9842(02)00019-3

Abstract: To firstly describe the prevalence, characteristics and consequences of early clinical deterioration (ECD) in chronic heart failure (CHF) patients discharged from acute hospital care and, secondly, to examine the potential benefits of a multidisciplinary, home-based intervention (HBI) in limiting the common sequelae of such deterioration. This phenomenon was studied in 90 CHF patients assigned to the intervention arm of a randomised study of HBI. ECD was defined as death, unplanned re-admission or clinical instability (detected at a home visit) within 14 days of hospital discharge. Multivariate analysis was used to determine the independent correlates of ECD. Using these data, a 1:1 case-control ratio of patients assigned to the usual care arm of the study was selected to match those patients exhibiting non-fatal ECD and subject to HBI. Subsequent morbidity and mortality rates were then compared on the basis of the presence or absence of non-fatal ECD and/or HBI. Of the 90 patients assigned to HBI, two died suddenly, five required an unplanned re-admission to hospital and 28 were found to be clinically unstable at a planned home visit, within 14 days of discharge from the index admission. The combined prevalence of ECD this cohort was therefore 39% (35 of 90 patients) and was independently correlated with greater age (OR=1.1 per yearly increment P<0.001) and comorbidity (OR=2.0 per incremental Charlson index of comorbidity score P<0.001). Patients who exhibited clinical instability at the home visit were significantly more likely to be non-adherent to prescribed treatment (10 of 28 vs. 9 of 55 P<0.05). Compared to the remainder of the cohort also subject to HBI, despite remedial intervention, patients who exhibited non-fatal ECD had reduced event-free survival (11 of 33 vs. 38 of 55 P<0.001), more frequent unplanned re-admission (0.2 vs. 0.1 admissions atient/month P<0.01), and more prolonged hospital stay (1.6 vs. 0.5 days atient/month P<0.001) in the subsequent 6-month period. However, compared to case-controls, these patients (n=33 in both groups) had fewer days of hospitalisation (1.6 vs. 3.6 days atient/month P=0.05) and, most significantly, were more likely to survive to 6 months (6 vs. 13 died P<0.05). ECD is a common phenomenon in older CHF patients discharged from acute hospital care and is associated with poorer health outcomes in the longer-term. Post-discharge HBI is an important means for identifying and addressing ECD. Although HBI conveys benefits incremental to usual care, these data also provide a sound basis for increasing its effectiveness by applying earlier home visits in selected 'high-risk' patients.

Are all doctorates equal or are some “more equal than others”? An examination of which ones should be offered by schools of nursing

Publisher: Elsevier BV

Date: 03-2007

DOI: 10.1016/J.NEPR.2006.06.006

Abstract: This paper examines the typical and varying routes to doctoral degrees in the UK and other developed countries. It raises the important question of whether university schools of nursing should offer a whole range of options with the potential for sub-optimal higher degree training and therefore "mediocre" academics, or resist the "path of least resistance" and offer more limited pathways that ensure that only the highest quality training and candidates are associated with what should be the pinnacle of the profession. As such, it seeks to clarify which of the commonly offered routes to doctoral degrees might be most suited to the academic integrity and value of the profession to our patients and the health care system.

Reduced between-hospital variation in short term survival after acute myocardial infarction: the result of improved cardiac care?

Publisher: BMJ

Date: 06-2005

DOI: 10.1136/HRT.2004.042929

Most individuals with treated blood pressures above target receive only one or two antihypertensive drug classes

Publisher: Wiley

Date: 2013

DOI: 10.1111/J.1445-5994.2012.02927.X

Abstract: A significant proportion of in iduals taking antihypertensive therapies fail to achieve blood pressures <140/90 mmHg. In order to develop strategies for improved treatment of blood pressure, we examined the association of blood pressure control with antihypertensive therapies and clinical and lifestyle factors in a cohort of adults at increased cardiovascular risk. A cross-sectional study of 3994 adults from Melbourne and Shepparton, Australia enrolled in the SCReening Evaluation of the Evolution of New Heart Failure (SCREEN-HF) study. Inclusion criteria were age ≥60 years with one or more of self-reported ischaemic or other heart disease, atrial fibrillation, cerebrovascular disease, renal impairment or treatment for hypertension or diabetes for ≥2 years. Exclusion criteria were known heart failure or cardiac abnormality on echocardiography or other imaging. The main outcome measures were the proportion of participants receiving antihypertensive therapy with blood pressures ≥140/90 mmHg and the association of blood pressure control with antihypertensive therapies and clinical and lifestyle factors. Of 3623 participants (1975 men and 1648 women) receiving antihypertensive therapy, 1867 (52%) had blood pressures ≥140/90 mmHg. Of these 1867 participants, 1483 (79%) were receiving only one or two antihypertensive drug classes. Blood pressures ≥140/90 mmHg were associated with increased age, male sex, waist circumference and log amino-terminal-pro-B-type natriuretic peptide levels. Most in iduals with treated blood pressures above target receive only one or two antihypertensive drug classes. Prescribing additional antihypertensive drug classes and lifestyle modification may improve blood pressure control in this population of in iduals at increased cardiovascular risk.

Patient Preferences and Willingness-To-Pay for a Home or Clinic Based Program of Chronic Heart Failure Management: Findings from the Which? Trial

Publisher: Public Library of Science (PLoS)

Date: 07-03-2013

DOI: 10.1371/JOURNAL.PONE.0058347

Self-care behaviours and heart failure: Does experience with symptoms really make a difference?

Publisher: Oxford University Press (OUP)

Date: 06-2010

DOI: 10.1016/J.EJCNURSE.2009.10.004

Abstract: There are many reasons to explain why achievement of optimal self-care can be difficult for many patients with chronic heart failure (CHF). To investigate differences in self-care skills between patients with and without experience of CHF symptoms. On the basis of a confirmed diagnosis and treatment for CHF 2 months, patients were prospectively designated as "novices" or "experienced". Administration of the Self-Care Heart Failure Index assessed 3 self-care skills: maintenance, management and confidence. A score >70% in each scale is considered adequate self care. Hierarchal regression models were built to test three hypotheses. In 143 elderly patients hospitalised with CHF, novices had lower self-care maintenance (63+/-16 vs. 71+/-14, p=0.05) and self-care management scores (48+/-17 vs. 58+/-19, p=0.003) than experienced patients. Novices were less likely to have adequate self-care maintenance (OR, 0.73 95% CI 0.5 to 0.9, LR<0.02) and management (OR, 0.3 95% CI, 0.1 to 0.8, p=0.02). Patients experienced with CHF had similar confidence levels (66+/-17 vs. 64+/-17, p=0.40) to novices. Level of experience is a determinant of self-care skills suggesting this factor should be considered in determining an in idual education plan.

Home is where the heart is when it comes to transitional care in heart failure, but is it the only way to improve health outcomes?

Publisher: Wiley

Date: 10-09-2017

DOI: 10.1002/EJHF.835

Preventing CVD in resource-poor areas: Perspectives from the ‘real-world’

Publisher: Springer Science and Business Media LLC

Date: 07-2009

DOI: 10.1038/NRCARDIO.2009.79

Abstract: An evolving epidemic of cardiovascular disease (CVD) is having a profound effect on the health of vulnerable populations in low-to-middle income countries with limited resources. Despite some encouraging signs (particularly initiatives from the WHO), global and regional apathy towards noncommunicable forms of CVD adds to the complexity of issues to consider when establishing cost-effective prevention programs. We present our perspective on overcoming the myriad of barriers to providing cost-effective measures for CVD prevention in a resource-poor environment through the 'prism' of our experiences in establishing the Heart of Soweto Study in South Africa.

More ‘malignant’ than cancer? Five‐year survival following a first admission for heart failure

Publisher: Wiley

Date: 06-2001

DOI: 10.1016/S1388-9842(00)00141-0

Abstract: The prognostic impact of heart failure relative to that of 'high-profile' disease states such as cancer, within the whole population, is unknown. All patients with a first admission to any Scottish hospital in 1991 for heart failure, myocardial infarction or the four most common types of cancer specific to men and women were identified. Five-year survival rates and associated loss of expected life-years were then compared. In 1991, 16224 men had an initial hospitalisation for heart failure (n=3241), myocardial infarction (n=6932) or cancer of the lung, large bowel, prostate or bladder (n=6051). Similarly, 14842 women were admitted for heart failure (n=3606), myocardial infarction (n=4916), or cancer of the breast, lung, large bowel or ovary (n=6320). With the exception of lung cancer, heart failure was associated with the poorest 5-year survival rate (approximately 25% for both sexes). On an adjusted basis, heart failure was associated with worse long-term survival than bowel cancer in men (adjusted odds ratio, 0.89 95% CI, 0.82-0.97 P<0.01) and breast cancer in women (odds ratio, 0.59 95% CI, 0.55-0.64 P<0.001). The overall population rate of expected life-years lost due to heart failure in men was 6.7 years/1000 and for women 5.1 years/1000. With the notable exception of lung cancer, heart failure is as 'malignant' as many common types of cancer and is associated with a comparable number of expected life-years lost.

A time bomb of cardiovascular risk factors in South Africa: Results from the Heart of Soweto Study Heart Awareness Days

Publisher: Elsevier BV

Date: 02-2009

DOI: 10.1016/J.IJCARD.2007.11.067

Abstract: There is strong anecdotal evidence that many urban communities in Sub-Saharan Africa are in epidemiologic transition with the subsequent emergence of more affluent causes of heart disease. However, data to describe the risk factor profile of affected communities is limited. During 9 community screening days undertaken in the predominantly Black African community of Soweto, South Africa (population 1 to 1.5 million) in 2006-2007, we examined the cardiovascular risk factor profile of volunteers. Screening comprised a combination of self-reported history and a clinical assessment that included calculation of body mass index (BMI), blood pressure and random blood glucose and total cholesterol levels. In total, we screened a total of 1691 subjects (representing almost 0.2% of the total population). The majority (99%) were Black African, there were more women (65%) than men and the mean age was 46+/-14 years. Overall, 78% of subjects were found to have >or=1 major risk factor for heart disease. By far the most prevalent risk factor overall was obesity (43%) with significantly more obese women than men (23% versus 55%: OR 1.76 95% CI 1.62 to 1.91: p<0.001). A further 33% of subjects had high blood pressures (systolic or diastolic) and 13% an elevated (non-fasting) total blood cholesterol level: no statistically significant differences between the sexes were found. There was a positive correlation between increasing BMI and other risk factors including elevated systolic (r(2)=0.046, p<0.001) and diastolic blood pressure (r(2)=0.032, p<0.001) with overweight subjects three times more likely to have concurrent hypercholesterolemia (OR 3.3, 95% CI 2.1 to 5.3: p<0.01). These unique pilot data strongly suggest a high prevalence of related risk factors for heart disease in this urban black African population in epidemiologic transition. Further research is needed to confirm our findings and to determine their true causes and potential consequences.

Rationale and design of the national benchmarking and evidence-based national clinical guidelines for chronic heart failure management programs study

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 07-2006

DOI: 10.1097/00005082-200607000-00007

Abstract: The National Benchmarks and Evidence-Based National Clinical Guidelines for Heart Failure Management Programs Study is a national, multicenter study designed to determine the nature, range, and effect of interventions applied by chronic heart failure management programs (CHF-MPs) throughout Australia on patient outcomes. Its primary objective is to use these data to develop national benchmarks and evidence-based clinical guidelines and optimize their cost-effective application by reducing quality and outcome variability. Primary data will be collected from CHF-MP coordinators and CHF patients enrolled in these programs on a national basis. Secondary outcome data will be collected from a national morbidity record and from patients' medical records. Stage I of the study involves a prospective clinical audit of all CHF-MPs throughout Australia (n = 45) to determine the extent of variability in programs currently. Stage II is a prospective cross-sectional survey design enrolling 1,500 patients (average of 40 patients per program) to firstly determine the typical profile of patients being managed via a CHF-MP in Australia and, secondly, the subsequent morbidity and mortality during the 6-month follow-up. Outcome data will be subject to multivariate analysis to determine the key components of care in this regard. All study data will be then examined in the final stage of the study (III) to develop national benchmarks for the application and auditing of CHF-MPs in Australia. Variability in patient outcomes is a product of heterogeneity among CHF-MPs. The development of national benchmarks will minimize such heterogeneity and will provide a greater level of evidence for their cost-effective application.

Effect of intensive structured care on individual blood pressure targets in primary care: multicentre randomised controlled trial

Publisher: BMJ

Date: 20-11-2012

DOI: 10.1136/BMJ.E7156

Winter Peaks in Heart Failure: An Inevitable or Preventable Consequence of Seasonal Vulnerability?

Publisher: Radcliffe Group Ltd

Date: 24-05-2019

DOI: 10.15420/CFR.2018.40.2

Abstract: Climate change is a major contributor to annual winter peaks in cardiovascular events across the globe. However, given the paradoxical observation that cardiovascular seasonality is observed in relatively mild as well as cold climates, global warming may not be as positive for the syndrome of heart failure (HF) as some predict. In this article, we present our Model of Seasonal Flexibility to explain the spectrum of in idual responses to climatic conditions. We have identified distinctive phenotypes of resilience and vulnerability to explain why winter peaks in HF occur. Moreover, we identify how better identification of climatic vulnerability and the use of multifaceted interventions focusing on modifiable bio-behavioural factors may improve HF outcomes.

Heart Failure Management Programmes in Europe

Publisher: Oxford University Press (OUP)

Date: 09-2006

DOI: 10.1016/J.EJCNURSE.2006.04.002

Abstract: The ESC guidelines recommend that an organised system of specialist heart failure (HF) care should be established to improve outcomes of HF patients. The aim of this study was therefore to identify the number and the content of HF management programmes in Europe. A two-phase descriptive study was conducted: an initial screening to identify the existence of HF management programmes and a survey to describe the content in countries where at least 30% of the hospitals had a programme. Of the 43 European countries approached, 26 (60%) estimated the percentage of HF management programmes. Seven countries reported that they had such programmes in more than 30% of their hospitals. Of the 673 hospitals responding to the questionnaire, 426 (63%) had a HF management programme. Half of the programmes (n = 205) were located in an outpatient clinic. In the UK a combination of hospital and home-based programmes was common (75%). The most programmes included physical examination, telephone consultation, patient education, drug titration and diagnostic testing. Most (89%) programmes involved nurses and physicians. Multi-disciplinary teams were active in 56% of the HF programmes. The most prominent differences between the 7 countries were the degree of collaboration with home care and GP's, the role in palliative care and the funding. Only a few European countries have a large number of organised programmes for HF care and follow up. To improve outcomes of HF patients throughout Europe more effort should be taken to increase the number of these programmes in all countries.

Structured telephone support or telemonitoring programs for patients with chronic heart failure

Publisher: John Wiley & Sons, Ltd

Date: 16-07-2008

DOI: 10.1002/14651858.CD007228

Financial aspects of heart failure programs of care

Publisher: Wiley

Date: 17-02-2005

DOI: 10.1016/J.EJHEART.2005.01.001

Abstract: As suggested by studies that have examined the economic burden imposed by heart failure and, more specifically where the greatest expenditure occurs, the key to cost-effectively minimising the impact of a sustained heart failure epidemic is to minimise recurrent hospital use--even at the expense of increasing levels of community-based care and prescribed pharmacotherapy. This paper examines the potential cost-benefits of applying specialist heart failure programs of care and the range of financial issues that need to be considered when establishing a formal heart failure service.

Australia's health care reform agenda: Implications for the nurses' role in chronic heart failure management

Publisher: Elsevier BV

Date: 08-2011

DOI: 10.1016/J.AUCC.2010.08.003

Abstract: The importance of the nursing role in chronic heart failure (CHF) management is increasingly recognised. With the recent release of the National Health and Hospitals Reform Commission (NHHRC) report in Australia, a review of nursing roles in CHF management is timely and appropriate. This paper aims to discuss the implications of the NHHRC report and nursing roles in the context of CHF management in Australia. The electronic databases, Thomson Rheuters Web of Knowledge, Scopus and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), were searched using keywords including "heart failure", "management", "Australia" and "nursing". In addition policy documents were reviewed including statements and reports from key professional organisations and Government Departments to identify issues impacting on nursing roles in CHF management. There is a growing need for the prevention and control of chronic conditions, such as CHF. This involves an increasing emphasis on specialist cardiovascular nurses in community based settings, both in outreach and inreach health service models. This review has highlighted the need to base nursing roles on evidence based principles and identify the importance of the nursing role in coordinating and managing CHF care in both independent and collaborative practice settings. The importance of the nursing role in early chronic disease symptom recognition and implementing strategies to prevent further deterioration of in iduals is crucial to improving health outcomes. Consideration should be given to ensure that evidence based principles are adopted in models of nursing care.

Enhanced detection of severe aortic stenosis via artificial intelligence: a clinical cohort study

Publisher: BMJ

Date: 07-2023

DOI: 10.1136/OPENHRT-2023-002265

Abstract: We developed an artificial intelligence decision support algorithm (AI-DSA) that uses routine echocardiographic measurements to identify severe aortic stenosis (AS) phenotypes associated with high mortality. 631 824 in iduals with 1.08 million echocardiograms were randomly spilt into two groups. Data from 442 276 in iduals (70%) entered a Mixture Density Network (MDN) model to train an AI-DSA to predict an aortic valve area cm 2 , excluding all left ventricular outflow tract velocity or dimension measurements and then using the remainder of echocardiographic measurement data. The optimal probability threshold for severe AS detection was identified at the f1 score probability of 0.235. An automated feature also ensured detection of guideline-defined severe AS. The AI-DSA’s performance was independently evaluated in 184 301 (30%) in iduals. The area under receiver operating characteristic curve for the AI-DSA to detect severe AS was 0.986 (95% CI 0.985 to 0.987) with 4622/88 199 (5.2%) in iduals (79.0±11.9 years, 52.4% women) categorised as ‘high-probability’ severe AS. Of these, 3566 (77.2%) met guideline-defined severe AS. Compared with the AI-derived low-probability AS group (19.2% mortality), the age-adjusted and sex-adjusted OR for actual 5-year mortality was 2.41 (95% CI 2.13 to 2.73) in the high probability AS group (67.9% mortality)—5-year mortality being slightly higher in those with guideline-defined severe AS (69.1% vs 64.4% age-adjusted and sex-adjusted OR 1.26 (95% CI 1.04 to 1.53), p=0.021). An AI-DSA can identify the echocardiographic measurement characteristics of AS associated with poor survival (with not all cases guideline defined). Deployment of this tool in routine clinical practice could improve expedited identification of severe AS cases and more timely referral for therapy.

The challenge of an expanded therapeutic window in pulmonary hypertension

Publisher: Springer Science and Business Media LLC

Date: 16-01-2020

DOI: 10.1038/S41569-020-0332-9

A predominance of hypertensive heart failure in the Abuja Heart Study cohort of urban Nigerians: A prospective clinical registry of 1515 de novo cases

Publisher: Wiley

Date: 08-2013

DOI: 10.1093/EURJHF/HFT061

Abstract: Even though cardiovascular disease is gradually becoming the major cause of morbidity and mortality in sub-Saharan Africa, there are very few data on the pattern of heart disease in this part of the world. We therefore decided to determine the pattern of heart disease in Abuja, which is one of the fastest growing and most westernized cities in Nigeria, and compare our findings with those of the Heart of Soweto Study in South Africa. Detailed clinical data were consecutively captured from 1515 subjects of African descent, residing in Abuja, and equivalent Soweto data from 4626 subjects were available for comparison. In Abuja, male subjects were on average, ∼2 years older than female subjects. Hypertension was the primary diagnosis in 45.8% of the cohort, comprising more women than men [odds ratio (OR) 1.96, 95% confidence interval (CI) 1.26-2.65], and hypertensive heart failure (HF) was the most common form of HF in 61% of cases. On an age- and sex-adjusted basis, compared with the Soweto cohort, the Abuja cohort were more likely to present with a primary diagnosis of hypertension (adjusted OR 2.10, 95% CI 1.85-2.42) or hypertensive heart disease/failure (OR 2.48, 95% CI 2.18-2.83) P < 0.001 for both. They were, however, far less likely to present with CAD (OR 0.04, 95% CI 0.02-0.11) and right heart failure (2.5% vs. 27%). As in Soweto, but more so, hypertension is the most common cause of de novo HF presentations in Abuja, Nigeria.

Spectrum of Cardiovascular Risk and Heart Disease in sub-Saharan Africa

Publisher: Wiley

Date: 13-05-2016

DOI: 10.1002/9781119097136.PART3

Resolution of ST-segment elevation following intravenous administration of nitroglycerin and verapamil

Publisher: Elsevier BV

Date: 02-2002

DOI: 10.1016/S0002-9149(01)02268-8

The Alice Springs Hospital Readmission Prevention Project (ASHRAPP): a randomised control trial

Publisher: Springer Science and Business Media LLC

Date: 20-02-2017

DOI: 10.1186/S12913-017-2077-7

Cholesterol complacency in Australia: time to revisit the basics of cardiovascular disease prevention

Publisher: Wiley

Date: 12-02-2009

DOI: 10.1111/J.1365-2702.2008.02507.X

Abstract: Community awareness of the importance of hypercholesterolemia and the need for appropriate therapy is an important part of global efforts to reduce the population burden of cardiovascular disease. The aim of this study was to assess the knowledge and attitudes about cholesterol and to determine adherence to taking cholesterol-lowering medication among patients at high risk for cardiovascular events. In spite of the availability of lifestyle and medical treatments for lipid management, an estimated 50% of adult Australians (6.4 million) remain at risk for a cardiovascular-related event because they have total blood cholesterol levels which exceed recommended limits. It is within this context that a significant gap remains in meeting cholesterol goals, despite easy to meet targets with readily available therapeutic options. A two-page national self-report postal survey was conducted from August-October 2006. A total of 508 Australian adults previously treated for hypercholesterolemia were surveyed to determine their understanding about cholesterol and their adherence to treatment. The mean age of participants was 67 (SD 10) years (72% male). Many participants (72%) were at risk of a cardiovascular event based on a prior history and 18% had type II diabetes. Participants had been prescribed lipid-lowering therapy (94% statin therapy) for an average of 10 years and visited their general practitioner on average three times per year. For those who knew their most recent cholesterol reading (67%), the total cholesterol was on average 4.5 (SD 1.1) mmol/l. This level was above the recommended limits for 40% of participants. Overall, 85% of participants reported knowing that there was high- and low-density lipoprotein forms of cholesterol, but only 56% and 38%, respectively, said that they understood or showed signs of clearly understanding the different types of cholesterol when their knowledge was assessed further. On the whole, therefore, participants had a limited understanding about cholesterol and its potential impact on cardiovascular events. Moreover, 25% of participants admitted to being non-compliant in taking their medication and only 51% correctly identified modifiable risk factors as most important for heart disease. Encouragingly, despite 85% of participants finding lifestyle changes challenging, most still identified their potential benefits. This study highlights that there are many unresolved issues in relation to educating high-risk patients who regularly visit their general practitioner to learn about and optimise their cholesterol levels via appropriate treatment and monitoring. There is a need for urgent public education and management by in iduals and the health community. Strategies to address 'cholesterol complacency', in the sense of a willingness to accept sub-optimal standards of cholesterol control at both the patient and healthcare system levels (general practitioners in particular), are urgently needed to truncate an anticipated rising tide of cardiovascular disease in Australia.

Assessing cardiovascular risk in regional areas: The Healthy Hearts - Beyond City Limits program

Publisher: Springer Science and Business Media LLC

Date: 03-09-2012

DOI: 10.1186/1472-6963-12-296

Abstract: Cardiovascular disease (CVD) is more prevalent in regional and remote Australia compared to metropolitan areas. The aim of Healthy Hearts was to determine age and sex specific CVD risk factor levels and the potential value of national risk clinics. Healthy Hearts was an observational research study conducted in four purposefully selected higher risk communities in regional Victoria, Australia. The main outcome measures were the proportion of participants with CVD risk factors with group comparisons to determine the adjusted likelihood of elevated risk factor levels. Trained personnel used a standardized protocol over four weeks per community to measure CVD risk factor levels, estimate absolute CVD risk and provide feedback and advice. A total of 2125 self-selected participants were assessed (mean age 58 ± 15 years, 57% women). Overall, CVD risk factors were highly prevalent. More men than women had ≥ 2 modifiable CVD risk factors (76% vs. 68%, p .001), pre-existing CVD (20 vs. 15%, p .01) and a major ECG abnormality requiring follow-up (15% vs. 7%, p .001) . Less men reported depressive symptoms compared to women (28% vs. 22%, p .01). A higher proportion of women were obese (adjusted OR 1.36, 95% CI 1.13 to 1.63), and physically inactive (adjusted OR 1.32, 95% CI 1.07 to 1.63). High CVD risk factor levels were confirmed for regional Victoria. Close engagement with in iduals and communities provides scope for the application of regional risk management clinics to reduce the burden of CVD risk in regional Australia.

Trends in hospitalization for heart failure in Scotland, 1990-1996. An epidemic that has reached its peak?

Publisher: Oxford University Press (OUP)

Date: 02-2001

DOI: 10.1053/EUHJ.2000.2291

Heart Failure

Publisher: Wiley

Date: 13-05-2016

DOI: 10.1002/9781119097136.PART6

Prediction of incident heart failure by serum amino-terminal pro-B-type natriuretic peptide level in a community-based cohort

Publisher: Wiley

Date: 18-01-2019

DOI: 10.1002/EJHF.1381

Abstract: We investigated which serum amino-terminal pro-B-type-natriuretic peptide (NT-proBNP) levels inform heart failure (HF) risk in a community-based population at increased cardiovascular disease (CVD) risk. Inclusion criteria were age ≥ 60 years with one or more of self-reported hypertension, diabetes, heart disease, abnormal heart rhythm, cerebrovascular disease, or renal impairment. Exclusion criteria were known HF, ejection fraction (EF) 76% and specificities of 47-69% for 5-year prediction of total HF in men and women in all three age groups. Sensitivities were ≥ 75% in most subgroups according to body mass index, estimated glomerular filtration rate, and the presence or absence of atrial fibrillation, pacemaker, or CVD, and for the prediction of HFpEF, HFrEF and VHF. Age-specific serum NT-proBNP levels inform prognosis, and hence therapeutic decisions, regarding HF risk in in iduals at increased CVD risk.

Time from symptoms to definitive diagnosis of idiopathic pulmonary arterial hypertension: The delay study

Publisher: Wiley

Date: 2013

DOI: 10.4103/2045-8932.109919

Abstract: Survival rates for patients with idiopathic pulmonary arterial hypertension (IPAH) have improved with the introduction of PAH‐specific therapies. However, the time between patient‐reported onset of symptoms and a definitive diagnosis of IPAH is consistently delayed. We conducted a retrospective, multi‐center, descriptive investigation in order to (a) understand what factors contribute to persistent diagnostic delays, and (b) examine the time from initial symptom onset to a definitive diagnosis of IPAH. Between January 2007 and December 2008, we enrolled consecutively diagnosed adults with IPAH from four tertiary referral centers in Australia. Screening of patient records and “one‐on‐one” interviews were used to determine the time from patient‐described initial symptoms to a diagnosis of IPAH, confirmed by right heart catheterization (RHC). Thirty‐two participants (69% female) were studied. Mean age at symptom onset was 56 ± 16.4 years and 96% reported exertional dyspnea. Mean time from symptom onset to diagnosis was 47 ± 34 months with patients subsequently aged 60 ± 17.3 years. Patients reported 5.3 ± 3.8 GP visits and 3.0 ± 2.1 specialist reviews before being seen at a pulmonary hypertension (PH) center. Advanced age, number of general practitioner (GP) visits, heart rate, and systolic blood pressure at the time of diagnosis were significantly associated with the observed delay. We found a significant delay of 3.9 years from symptom onset to a diagnosis of IPAH in Australia. Exertional dyspnea is the most common presenting symptom. Current practice within Australia does not appear to have the specific capacity for timely, multi‐factorial evaluation of breathlessness and potential IPAH.

Preventing heart failure: a position paper of the Heart Failure Association in collaboration with the European Association of Preventive Cardiology.

Publisher: Wiley

Date: 2022

DOI: 10.1002/EJHF.2351

Abstract: The heart failure epidemic is growing and its prevention, in order to reduce associated hospital readmission rates and its clinical and economic burden, is a key issue in modern cardiovascular medicine. The present position paper aims to provide practical evidence-based information to support the implementation of effective preventive measures. After reviewing the most common risk factors, an overview of the population attributable risks in different continents is presented, to identify potentially effective opportunities for prevention and to inform preventive strategies. Finally, potential interventions that have been proposed and have been shown to be effective in preventing heart failure are listed.

Within trial cost-utility analysis of disease management program for patients hospitalized with atrial fibrillation: Results from the SAFETY trial

Publisher: Informa UK Limited

Date: 04-07-2019

DOI: 10.1080/13696998.2019.1631831

Research in cardiovascular care: A position statement of the Council on Cardiovascular Nursing and Allied Professionals of the European Society of Cardiology

Publisher: Oxford University Press (OUP)

Date: 23-10-2013

DOI: 10.1177/1474515113509761

Abstract: To deliver optimal patient care, evidence-based care is advocated and research is needed to support health care staff of all disciplines in deciding which options to use in their daily practice. Due to the increasing complexity of cardiac care across the life span of patients combined with the increasing opportunities and challenges in multidisciplinary research, the Science Committee of the Council on Cardiovascular Nursing and Allied Professionals (CCNAP) recognised the need for a position statement to guide researchers, policymakers and funding bodies to contribute to the advancement of the body of knowledge that is needed to further improve cardiovascular care. In this paper, knowledge gaps in current research related to cardiovascular patient care are identified, upcoming challenges are explored and recommendations for future research are given.

Effects of a nurse-led, clinic and home-based intervention on recurrent hospital use in chronic heart failure

Publisher: Wiley

Date: 17-02-2005

DOI: 10.1016/J.EJHEART.2004.10.008

Abstract: Few studies have examined the potential benefits of specialist nurse-led programs of care involving home and clinic-based follow-up to optimise the post-discharge management of chronic heart failure (CHF). To determine the effectiveness of a hybrid program of clinic plus home-based intervention (C+HBI) in reducing recurrent hospitalisation in CHF patients. CHF patients with evidence of left ventricular systolic dysfunction admitted to two hospitals in Northern England were assigned to a C+HBI lasting 6 months post-discharge (n=58) or to usual, post-discharge care (UC: n=48) via a cluster randomization protocol. The co-primary endpoints were death or unplanned readmission (event-free survival) and rate of recurrent, all-cause readmission within 6 months of hospital discharge. During study follow-up, more UC patients had an unplanned readmission for any cause (44% vs. 22%: P=0.019, OR 1.95 95% CI 1.10-3.48) whilst 7 (15%) versus 5 (9%) UC and C+HBI patients, respectively, died (P=NS). Overall, 15 (26%) C+HBI versus 21 (44%) UC patients experienced a primary endpoint. C+HBI was associated with a non-significant, 45% reduction in the risk of death or readmission when adjusting for potential confounders (RR 0.55, 95% CI 0.28-1.08: P=0.08). Overall, C+HBI patients accumulated significantly fewer unplanned readmissions (15 vs. 45: P<0.01) and days of recurrent hospital stay (108 vs. 459 days: P<0.01). C+HBI was also associated with greater uptake of beta-blocker therapy (56% vs. 18%: P<0.001) and adherence to Na restrictions (P<0.05) during 6-month follow-up. This is the first randomised study to specifically examine the impact of a hybrid, C+HBI program of care on hospital utilisation in patients with CHF. Its beneficial effects on recurrent readmission and event-free survival are consistent with those applying either a home or clinic-based approach.

Sustainability of healthcare professionals’ adherence to clinical practice guidelines in primary care

Publisher: Springer Science and Business Media LLC

Date: 03-2022

DOI: 10.1186/S12875-022-01641-X

Abstract: Sustainability of adherence to clinical practice guidelines (CPGs) represents an important indicator of the successful implementation in the primary care setting. To explore the sustainability of primary care providers’ adherence to CPGs after receiving planned guideline implementation strategies, activities, or programmes. Cochrane Central Register of Controlled Trials (CENTRAL) Cumulative Index to Nursing and Allied Health Literature (CINAHL) EMBase Joanna Briggs Institute Journals@Ovid Medline PsycoINFO PubMed, and Web of Science were searched from January 2000 through May 2021 to identify relevant studies. Studies evaluating the sustainability of primary care providers’ (PCPs’) adherence to CPGs in primary care after any planned guideline implementation strategies, activities, or programmes were included. Two reviewers extracted data from the included studies and assessed methodological quality independently. Narrative synthesis of the findings was conducted. Eleven studies were included. These studies evaluated the sustainability of adherence to CPGs related to drug prescribing, disease management, cancer screening, and hand hygiene in primary care. Educational outreach visits, teaching sessions, reminders, audit and feedback, and printed materials were utilized in the included studies as guideline implementation strategies. None of the included studies utilized purpose-designed measurements to evaluate the extent of sustainability. Three studies showed positive sustainability results, three studies showed mixed sustainability results, and four studies reported no significant changes in the sustainability of adherence to CPGs. Overall, it was difficult to quantify the extent to which CPG-based healthcare behaviours were fully sustained based on the variety of results reported in the included studies. Current guideline implementation strategies may potentially improve the sustainability of PCPs’ adherence to CPGs. However, the literature reveals a limited body of evidence for any given guideline implementation strategy. Further research, including the development of a validated purpose-designed sustainability tool, is required to address this important clinical issue. The study protocol has been registered at PROSPERO (No. CRD42021259748 ).

The continuums of impairment in vascular reactivity across the spectrum of cardiometabolic health: A systematic review and network meta‐analysis

Publisher: Wiley

Date: 18-03-2019

DOI: 10.1111/OBR.12831

Abstract: This study aimed to assess, for the first time, the change in vascular reactivity across the full spectrum of cardiometabolic health. Systematic searches were conducted in MEDLINE and EMBASE databases from their inception to March 13, 2017, including studies that assessed basal vascular reactivity in two or more of the following health groups (aged ≥18 years old): healthy, overweight, obesity, impaired glucose tolerance, metabolic syndrome, or type 2 diabetes with or without complications. Direct and indirect comparisons of vascular reactivity were combined using a network meta-analysis. Comparing data from 193 articles (7226 healthy subjects and 19344 patients), the network meta-analyses revealed a progressive impairment in vascular reactivity (flow-mediated dilation data) from the clinical onset of an overweight status (-0.41%, 95% CI, -0.98 to 0.15) through to the development of vascular complications in those with type 2 diabetes (-4.26%, 95% CI, -4.97 to -3.54). Meta-regressions revealed that for every 1 mmol/l increase in fasting blood glucose concentration, flow-mediated dilation decreased by 0.52%. Acknowledging that the time course of disease may vary between patients, this study demonstrates multiple continuums of vascular dysfunction where the severity of impairment in vascular reactivity progressively increases throughout the pathogenesis of obesity and/or insulin resistance, providing information that is important to enhancing the timing and effectiveness of strategies that aim to improve cardiovascular outcomes.

Effects of a Home-Based Intervention Among Patients With Congestive Heart Failure Discharged From Acute Hospital Care

Publisher: American Medical Association (AMA)

Date: 25-05-1998

DOI: 10.1001/ARCHINTE.158.10.1067

Abstract: We examined the effect of a home-based intervention (HBI) on readmission and death among "high-risk" patients with congestive heart failure discharged home from acute hospital care. Hospitalized patients with congestive heart failure and impaired systolic function, intolerance to exercise, and a history of 1 or more hospital admissions for acute heart failure were randomized to either usual care (n=48) or HBI at 1 week after discharge (n=49). Home-based intervention comprised a single home visit (by a nurse and pharmacist) to optimize medication management, identify early clinical deterioration, and intensify medical follow-up and caregiver vigilance as appropriate. The primary end point of the study was frequency of unplanned readmissions plus out-of-hospital deaths within 6 months of discharge. Secondary end points included duration of hospital stay and overall mortality. During follow-up, patients in the HBI group had fewer unplanned readmissions (36 vs 63 P=.03) and fewer out-of-hospital deaths (1 vs 5 P=.11): 0.8+/-0.9 vs 1.4+/-1.8 (mean +/- SD) events per patient assigned to HBI and usual care, respectively (P=.03). Patients in the HBI group also had fewer days of hospitalization (261 vs 452 P=.05) and fewer total deaths (6 vs 12 P=.11). Patients assigned to usual care were more likely to experience 3 or more readmissions for acute heart failure (P=.02). Predictors of unplanned readmission were (1) 14 days or more of unplanned readmission during the 6 months before study entry (odds ratio [OR], 5.2 95% confidence interval [CI], 1.8-16.2), (2) previous admission for acute myocardial ischemia (OR, 3.3 95% CI, 1.2-9.1), and (3) an albumin plasma concentration of 38 g/L or less (OR, 2.4 95% CI, 1.2-6.0). Home-based intervention was also associated with a trend toward reduced risk of unplanned readmission (OR, 0.4 95% CI, 0.2-1.1). Among a cohort of high-risk patients with congestive heart failure, HBI was associated with reduced frequency of unplanned readmissions plus out-of-hospital deaths within 6 months of discharge from the hospital.

Self-care management of heart failure: Practical recommendations from the patient care committee of the heart failure association of the European society of cardiology

Publisher: Wiley

Date: 02-2011

DOI: 10.1093/EURJHF/HFQ219

Abstract: Guidelines on heart failure (HF) stress the importance of lifestyle advice, although there is little evidence that such recommendations improve symptoms or prognosis. Patients experience symptoms of different intensities which impair their daily activities and reduce the quality-of-life. To cope with their clinical condition, many patients seek advice about lifestyle and self-management strategies when in contact with medical care providers, particularly specialized HF services. Self-care management is an important part of HF treatment, thus health professionals working with patients with HF have recognized the need for more specific recommendations on lifestyle advice. The present paper summarizes the available evidence, promotes self-care management, and aims to provide practical advice for health professionals delivering care to HF patients. It also defines avenues of research to optimize self-care strategies in a number of key areas to derive further benefits.

Adverse Prognostic Impact of Even Mild or Moderate Tricuspid Regurgitation: Insights from the National Echocardiography Database of Australia

Publisher: Elsevier BV

Date: 08-2022

DOI: 10.1016/J.ECHO.2022.04.003

Abstract: The prevalence and prognostic impact of tricuspid regurgitation (TR) remain incompletely characterized. The distribution of TR severity was analyzed in 439,558 adults (mean age, 62.1 ± 17.8 years 51.5% men) being investigated for heart disease, from 2000 to 2019, by 25 centers contributing to the National Echocardiography Database of Australia. Survival status and cause of death were ascertained in all adults from the National Death Index of Australia. The relationship between TR severity and mortality was examined. Of those studied, 311,604 (70.9%) had no/trivial TR 94,172 (21.4%), mild TR 26,056 (5.9%), moderate TR and 7,726 (1.8%), severe TR. During a median 4.1 years (interquartile range, 2.2-7.0 years) of follow-up, 109,004 died (49% from cardiovascular causes). Moderate or greater TR was associated with older age and female sex (P < .001). In iduals with moderate and severe TR had a 2.0- to 3.2-fold increased risk of all-cause long-term mortality after adjustment for age and sex compared with those with no/trivial TR (P < .001 for both comparisons). Even those with mild TR had a significantly increased risk for mortality (hazard ratio [HR] = 1.29 95% CI, 1.27-1.31). In fully adjusted models, including for RV systolic pressure, atrial fibrillation, and significant left heart disease, there remained a 1.24- to 2.65-fold increased risk of mortality with mild (HR = 1.24 95% CI, 1.23-1.26), moderate (HR = 1.72 95% CI, 1.68-1.75), or severe TR (HR = 2.65 95% CI, 2.57-2.73), compared with those with no/trivial TR (P < .001 for all). Tricuspid regurgitation is a common condition in adults referred for echocardiography. Moreover, even in the presence of other cardiac disease, increasing grades of TR are independently associated with increasing risks of cardiovascular and all-cause mortality. Furthermore, we show that even mild TR is independently associated with a significant increase in mortality.

Screening for mild cognitive impairment in patients with heart failure: Montreal Cognitive Assessment versus Mini Mental State Exam

Publisher: Oxford University Press (OUP)

Date: 18-04-2013

DOI: 10.1177/1474515111435606

Abstract: Cognitive impairments occur frequently in patients with chronic heart failure (CHF), resulting in worse health outcomes than expected. These impairments can remain undetected unless specifically screened. There are limited sensitive screening measures available in nursing practice to identify mild cognitive impairment (MCI). To compare the Montreal Cognitive Assessment (MoCA) with the Mini Mental State Exam (MMSE) in screening for MCI in CHF patients. The MMSE and MoCA were administered to 93 hospitalized CHF patients (70±11 years), without a history of neurocognitive problems. Patients with low MoCA scores (<26) were compared to those with low MMSE scores (<27). Two different parameters were examined between the MoCA and the MMSE: level of MCI agreement (Kappa coefficient) and task errors on assessed cognitive domains (χ2 test). Statistically more patients had low MoCA scores compared with low MMSE scores (66 vs. 30, p=0.02). The MoCA classified 38 (41%) patients as cognitively impaired that were not classified by the MMSE. A significantly low level of agreement was found (κ=0.25, p=0.001) between the MMSE and MoCA in identifying patients with scores suggestive of MCI. More task errors were observed on the MoCA cognitive domains compared with the MMSE cognitive domains. In 68% of patients with low cognitive scores, visuospatial task errors were observed on tasks from the MoCA compared with 22% on a similar task of the MMSE. The MoCA, a screening tool for MCI, identified subtle but potentially clinically relevant cognitive dysfunctions with greater frequency than MMSE.

SARS-CoV 2 infection (covid-19) and cardiovascular disease in Africa: Health care and socio-economic implications

Publisher: Ubiquity Press, Ltd.

Date: 2021

DOI: 10.5334/GH.829

Chilling findings: The need for winter vigilance in heart failure

Publisher: Elsevier BV

Date: 03-2006

DOI: 10.1016/J.CARDFAIL.2005.12.004

Acute Coronary Syndromes in Treatment-Naïve Black South Africans with Human Immunodeficiency Virus Infection

Publisher: Wiley

Date: 02-2010

DOI: 10.1111/J.1540-8183.2009.00520.X

Abstract: HIV patients on protease inhibitors have greater risk of acute coronary syndromes (ACS) but little is known about treatment-naïve patients. Authors conducted a prospective single-center study from Soweto, South Africa, comparing the clinical and angiographic features of treatment-naïve HIV positive and negative patients with ACS. Between March 2004 and February 2008, 30 consecutive treatment-naïve HIV patients with ACS were compared to the next HIV-negative patient as a 1:1 control. HIV patients were younger (43 +/- 7 vs. 54 +/- 13, P = 0.004) and, besides smoking (73% vs. 33%, P = 0.002), had fewer risk factors than the control group with less hypertension (23% vs. 77%, P = 0.0001), diabetes (3% vs. 23%, P = 0.05), LDL hyperlipidemia (2.2 +/- 0.9 vs. 3.0 +/- 1.2, P = 0.006), and other coronary risk factors (7% vs. 53%, P = 0.0001). HDL was lower in the HIV group (0.8 +/- 0.3 vs. 1.1 +/- 0.4, P = 0.001). Atherosclerotic burden was lower in the HIV group with more normal infarct-related arteries (47% vs. 13%, P = 0.005) but a higher degree of large thrombus burden (43% vs. 17%, P = 0.02). Stents were used to a similar degree in HIV and control patients (30% vs. 37%, P = 0.78) with more target lesion revascularization in the HIV group (56% vs. 0%, P = 0.008). Treatment-naïve HIV patients with ACS are younger and have fewer traditional risk factors than HIV-negative patients. HIV patients have less atherosclerotic but higher thrombotic burden which may imply a prothrombotic state in the pathogenesis of ACS in these patients.

Ethical dilemmas of a large national multi-centre study in Australia: Time for some consistency

Publisher: Wiley

Date: 25-07-2008

DOI: 10.1111/J.1365-2702.2007.02219.X

Abstract: To examine the impact and obstacles that in idual 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. Multi-centre research is commonplace in the health care system. However, IRECs continue to fail to differentiate between research and quality audit projects. 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. 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. 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. 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.

Feeding the emergence of advanced heart disease in Soweto : a nutritional survey of black African patients with heart failure

Publisher: Clinics Cardive Publishing

Date: 12-06-2012

DOI: 10.5830/CVJA-2011-021

Palliative care for non-malignant disease?

Publisher: Therapeutic Guidelines Limited

Date: 10-2003

DOI: 10.18773/AUSTPRESCR.2003.072

Economic evaluation of the impact of nicorandil in angina (IONA) trial

Publisher: BMJ

Date: 05-2006

DOI: 10.1136/HRT.2003.026385

Cardiovascular disease in Africa: Epidemiological profile and challenges

Publisher: Springer Science and Business Media LLC

Date: 23-02-2017

DOI: 10.1038/NRCARDIO.2017.19

Abstract: From a global perspective, the large and erse African population is disproportionately affected by cardiovascular disease (CVD). The historical balance between communicable and noncommunicable pathways to CVD in different African regions is dependent on external factors over the life course and at a societal level. The future risk of noncommunicable forms of CVD (predominantly driven by increased rates of hypertension, smoking, and obesity) is a growing public health concern. The incidence of previously rare forms of CVD such as coronary artery disease will increase, in concert with historically prevalent forms of disease, such as rheumatic heart disease, that are yet to be optimally prevented or treated. The success of any strategies designed to reduce the evolving and increasing burden of CVD across the heterogeneous communities living on the African continent will be dependent upon accurate and up-to-date epidemiological data on the cardiovascular profile of every major populace and region. In this Review, we provide a contemporary picture of the epidemiology of CVD in Africa, highlight key regional discrepancies among populations, and emphasize what is currently known and, more importantly, what is still unknown about the CVD burden among the >1 billion people living on the continent.

Early repolarization patterns associated with increased arrhythmic risk are common in young non-Caucasian Australian males and not influenced by athletic status

Publisher: Elsevier BV

Date: 07-2015

DOI: 10.1016/J.HRTHM.2015.03.060

Abstract: Early repolarization (ER) with a horizontal ST segment (ST-h) and high- litude J waves in the inferior leads is associated with an increased risk of cardiac arrhythmic death. The effect of ethnicity and athletic status on this increased-risk ER pattern has not been established. Aboriginal Australian/Torres Strait Islander and Pacific Islander/Maori (non-Caucasian [non-C]) subjects are well represented in Australian sport however, the patterns and prevalence of ER in these populations are unknown. The purpose of this study was to assess the prevalence and effect of athletic activity on ER patterns in young non-C and Caucasian (C) subjects. Twelve-lead ECGs of 726 male athletes (23.8% non-C) and 170 male controls (45.9% non-C) aged 16-40 years were analyzed for the presence of ER, defined as J-point elevation (J wave, QRS slur, or discrete ST elevation) ≥0.1 mV in ≥2 inferior (II, III, aVF) or lateral (I, aVL,V4-V6) leads. ST morphology was coded as horizontal (ST-h) or ascending (ST-a). "Increased-risk ER" was defined as inferior ER with ST-h and J waves >2 mV. Regardless of athletic status, ER and increased-risk ER were more prevalent in non-C than in C subjects (53.8% vs 32% and 7.6% vs 1.2%, respectively, P <.0001). Whereas lower heart rate, larger QRS voltage, and shorter QRS duration were predictors of ER, non-C ethnicity was the only independent predictor of increased-risk ER (odds ratio 17.621, 95% confidence interval 4.98-62.346, P < .0001). ER patterns associated with increased arrhythmic risk are more common in young non-C than C subjects and were not influenced by athletic status. The long-term clinical significance of ER in these populations is yet to be determined.

Educational Interventions for Patients With Heart Failure:A Systematic Review of Randomized Controlled Trials

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 07-2011

DOI: 10.1097/JCN.0B013E3181EE5FB2

An economic analysis of specialist heart failure nurse management in the U.K. Can we afford not to implement it?

Publisher: Oxford University Press (OUP)

Date: 09-2002

DOI: 10.1053/EUHJ.2001.3114

Abstract: Hospital activity represents the major component of health care expenditure related to heart failure. This study evaluated the economic impact of applying specialist nurse management programmes that limit heart failure-related hospital readmissions within a whole population. Using a reliable and validated estimate of the current level and cost of heart failure-related hospital activity in the U.K., we determined the thresholds at which the actual cost of establishing and applying a national service based on three different models of specialist nurse management would be equal to the 'cost' of bed utilization associated with preventable hospital readmissions in the year 2000. The three models of care examined were home-based, clinic-based or a combination of home plus clinic-based, post-discharge follow-up. The potential impact of this service was based on a U.K.-wide caseload of 122,000 patients discharged to home with a discharge diagnosis of congestive heart failure in that year. Based on heart failure-specific patterns of hospital activity, we estimate that 47,000 of these 122,000 patients would normally accumulate a total of 594000 days of associated hospital stay from 49,000 readmissions (for any reason) within 1 year of hospital discharge. The cost of these admissions to the National Health Service was calculated at 166.2 million pounds sterling. Taking into account other costs associated with such hospital activity (e.g. general practice and hospital outpatient visits) each 10% reduction in recurrent bed utilization would be associated with 18.0 million ponds sterling in cost savings. Alternatively, the cost of applying a U.K.-wide programme of home-, clinic- or home plus clinic-based follow-up was calculated to be 69.4 pounds sterling, 73.1 pounds sterling and 72.5 million pounds sterling per annum, respectively. The relative thresholds at which generated 'cost-savings' would equal the cost of applying these programmes of care would therefore be a 38.5%, 40.6% and 40.3% reduction in recurrent bed utilization, respectively. If, as expected, a home-based programme of specialist nurse management reduced recurrent bed utilization by 50% or more, annual savings equivalent to 169,000 pounds sterling per 1000 patients treated would be generated. This is the first study to examine the economic consequences of applying a specialist nurse-mediated, post-discharge management service for heart failure within a whole population. Our findings suggest that such a service will not only improve quality of life and reduce readmissions in patients with congestive heart failure, but also reduce costs and improve the efficiency of the health care system in doing so.

Time to get anxious about the broken hearted?

Publisher: Elsevier BV

Date: 11-2010

DOI: 10.1016/J.IJCARD.2009.10.055

Tackling heart disease at the global level: Implications of the united nations' statement on the prevention and control of noncommunicable disease

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 11-2011

DOI: 10.1161/CIRCOUTCOMES.111.963678

Angina and intermittent claudication in 7403 participants of the 2003 Scottish Health Survey: Impact on general and mental health, quality of life and five-year mortality

Publisher: Elsevier BV

Date: 09-2013

DOI: 10.1016/J.IJCARD.2012.05.099

Abstract: Angina and intermittent claudication impair function and mobility and reduce health-related quality of life. Both symptoms have similar etiology, yet the physical and psychological impacts of these symptoms are rarely studied in community-based cohorts or in in iduals with isolated symptoms. The 2003 Scottish Health Survey was a cross-sectional survey which enrolled a random s le of in iduals aged 16-95 years living in Scotland. The Rose Angina Questionnaire, the Edinburgh Claudication Questionnaire, the Short Form-12 (SF-12) and the General Health Questionnaire were completed. Self-assessed general health was reported. Survey results were linked to national death records and mortality at five years was calculated. Subjects with isolated angina or intermittent claudication and neither symptom were compared (22 participants with both symptoms were excluded) 7403 participants (aged ≥ 16 years) were included. Participants with angina (n=205 60 ± 15 years 45% male) rated their general health worse and were more likely to have a potential mental-health problem than those with intermittent claudication (n=173 61 ± 15 years 41% male). Mean (standard deviation) physical and mental component scores on the SF-12 were higher for participants with intermittent claudication relative to those with angina (physical component score: 42.3 (10.6) vs. 35.0 (11.7), p<0.001 mental component score: 52.3 (8.5) vs. 46.5 (11.7), p=0.001). There was an observed absolute difference in five-year mortality of 4.8% (angina 12.3%, 95% CI 8.5-17.6 intermittent claudication 7.5%, 95% CI 4.4-12.6) although not statistically significant (p=0.16). Both intermittent claudication and angina adversely impact general and mental health and survival, even in a relatively young, community-based cohort.

Women Versus Men with Chronic Atrial Fibrillation: Insights from the Standard Versus Atrial Fibrillation spEcific managemenT studY (SAFETY)

Publisher: Public Library of Science (PLoS)

Date: 29-05-2013

DOI: 10.1371/JOURNAL.PONE.0065795

Cardiovascular Nursing at the Crossroads: Are We Demanding the Highest Academic Standards?

Publisher: Oxford University Press (OUP)

Date: 10-2002

DOI: 10.1016/S1474-5151(02)00039-7

Effects of a multidisciplinary, home-based intervention on planned readmissions and survival among patients with chronic congestive heart failure: a randomised controlled study

Publisher: Elsevier BV

Date: 09-1999

DOI: 10.1016/S0140-6736(99)03428-5

Abstract: Hospital admissions among patients with congestive heart failure (CHF) are a major contributor to health-care costs. Previous investigations suggest that the therapeutic efficacy of pharmacotherapy in CHF may be improved by strategies incorporating home visits to identify and address factors precipitating deterioration and resultant readmission. Chronic CHF patients discharged home after acute hospital admission were randomly assigned usual care (n=100) or a multidisciplinary, home-based intervention (n=100), consisting of a home visit by a cardiac nurse 7-14 days after discharge. The primary endpoint of the study was frequency of unplanned readmission plus out-of-hospital death within 6 months. During 6 months' follow-up there were 129 primary endpoint events in the usual-care group and 77 in the intervention group (p=0.02). More intervention-group than usual-care patients remained event-free (38 vs 51 p=0.04). Overall, there were fewer unplanned readmissions (68 vs 118 p=0.03) and associated days in hospital (460 vs 1173 p=0.02) among intervention-group patients. Hospital-based costs were Australian $490,300 for the intervention group and A$922,600 for the usual-care group (p=0.16) the mean cost of the intervention was A$350 per patient, and other community-based costs were similar for both groups. A home-based intervention has the potential to decrease the rate of unplanned readmissions and associated health-care costs, prolong event-free and total survival, and improve quality of life among patients with chronic CHF.

Heart failure, ventricular dysfunction and risk factor prevalence in Australian Aboriginal peoples: the Heart of the Heart Study

Publisher: BMJ

Date: 11-08-2012

DOI: 10.1136/HEARTJNL-2012-302229

Abstract: Limited strategies have been developed to evaluate and address the alarming discrepancy in early mortality between Indigenous and non-Indigenous populations. To assess heart failure (HF), HF risk factors and document cardiac characteristics in an Australian Aboriginal population. Adults were enrolled across six Aboriginal communities in Central Australia. They undertook comprehensive cardiovascular assessments, including echocardiography, to determine HF status, asymptomatic ventricular dysfunction and underlying risk factor profile. Of 436 participants (mean age 44±14 years 64% women) enrolled, 5.3% (95% CI 3.2% to 7.5%) were diagnosed with HF, only 35% of whom had a pre-existing HF diagnosis. Asymptomatic left ventricular dysfunction (ALVD) was seen in 13% (95% CI 9.4% to 15.7%) of the population. Estimates of HF risk factor prevalence were as follows: body mass index (BMI) ≥30 kg/m(2) 42%, hypertension 41%, diabetes mellitus 40%, coronary artery disease (CAD) 7% and history of acute rheumatic fever or rheumatic heart disease 7%. In logistic regression analysis (after adjustment for age and gender), HF was associated with CAD (OR=9.6, p<0.001), diabetes (OR=5.4, p=0.002), hypertension (OR=4.8, p=0.006), BMI ≥30 kg/m(2) (OR=2.9, p=0.02), acute rheumatic fever or rheumatic heart disease (OR=5.6, p=0.001) and B-type natriuretic peptide (OR=1.02, p<0.001). The burden of HF, ALVD and risk factors in this population was extremely high. This study highlights potentially modifiable targets on which to focus resources and screening strategies to prevent HF in this high-risk Indigenous population.

Implementing guideline based heart failure care in the Northern territory: challenges and solutions

Publisher: Elsevier BV

Date: 05-2014

DOI: 10.1016/J.HLC.2013.12.005

University Of Glasgow

Location: United Kingdom of Great Britain and Northern Ireland

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University Of Cape Town

Location: South Africa

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University Of Adelaide

Location: Australia

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Universidade Eduardo Mondlane

Location: Mozambique

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Charles Darwin University

Location: Australia

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Torrens University Australia

Location: Australia

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University Of Notre Dame Australia

Location: Australia

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Baker IDI Heart And Diabetes Institute

Location: Australia

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University Of South Australia

Location: Australia

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Monash University

Location: Australia

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Flinders University

Location: Australia

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Queen Elizabeth Hospital / University Of Adelaide

Location: Australia

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Queen Elizabeth Hospital

Location: Australia

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Mozambique Institute For Health Research

Location: Mozambique

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Mary MacKillop Institute For Health Research, Australian Catholic University

Location: Australia

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Griffith University Menzies Health Institute Queensland

Location: Australia

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University Of The Witwatersrand

Location: South Africa

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University Of Notre Dame Australia

Location: No location found

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Charles Darwin University

Location: No location found

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University Of Cape Town

Location: No location found

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Develop And Pilot An E-cohort Research Technique For Longitudinal Studies Using Multiple International Cohorts

Start Date: 2005

End Date: 2006

Funder: Australian Research Council

Recruitment And Retention Of The Australian Medical Practitioner Workforce - A Longitudinal Electronic Cohort Study

Start Date: 2007

End Date: 2011

Funder: Australian Research Council

Optimising Heart Disease Prevention And Management

Start Date: 2014

End Date: 2018

Funder: National Health and Medical Research Council

Improving Care Of The Dying With Chronic Heart Failure

Start Date: 2002

End Date: 2005

Funder: National Health and Medical Research Council

MOZART Disease Surveillance Study

Start Date: 2017

End Date: 2018

Funder: Pfizer

CARDIAC-ARIA : Measuring The Accessibility To Cardiovascular Services In Rural And Remote Australia Via Applied Geographical Spatial Technology (GIS)

Start Date: 2007

End Date: 2009

Funder: Australian Research Council

Factors Associated With The Recruitment And Retention Of The Current And Future Nursing Workforce - A Longitudinal E-cohort Study

Start Date: 2005

End Date: 2010

Funder: Australian Research Council

The Management To Optimise Diabetes And Metabolic Syndrome Risk Reduction Via Nurse-led Intervention (MODERN) Study

Start Date: 2014

End Date: 2017

Funder: National Health and Medical Research Council

NHMRC Senior Principal Research Fellowship

Start Date: 2019

End Date: 2023

Funder: National Health and Medical Research Council

NHMRC Principal Research Fellow

Start Date: 2013

End Date: 2017

Funder: National Health and Medical Research Council

Innovative Health Programs To Reduce Inequality In Heart Disease

Start Date: 2018

End Date: 2022

Funder: National Health and Medical Research Council

Detection And Management Of Depression In General Practice Patients With Chronic Manifestations Of Ischaemic Heart Disea

Start Date: 2005

End Date: 2008

Funder: National Health and Medical Research Council

Which Heart Failure Intervention Is Most Cost-effective & Consumer Friendly In Reducing Hospital Care: The WHICH? Study

Start Date: 2007

End Date: 2011

Funder: National Health and Medical Research Council

The WHICH? Trial Of Standard Versus Intensified Heart Failure Care

Start Date: 2013

End Date: 2016

Funder: National Health and Medical Research Council

NIL-CHF Study

Start Date: 2008

End Date: 2012

Funder: National Health and Medical Research Council

Integration Of Risk Evaluation In Cardiovascular Disease Management Programs

Start Date: 2009

End Date: 2013

Funder: National Health and Medical Research Council

REDUCING INEQUALITY IN HEART DISEASE

Start Date: 2012

End Date: 2017

Funder: National Health and Medical Research Council

Linkage Projects - Grant ID: LP0562608

Start Date: 12-2005

End Date: 06-2008

Amount: $130,000.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP0774868

Start Date: 06-2007

End Date: 06-2012

Amount: $340,000.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP0775217

Start Date: 08-2007

End Date: 12-2012

Amount: $158,688.00

Funder: Australian Research Council

Special Research Initiatives - Grant ID: SR0566924

Start Date: 09-2005

End Date: 09-2006

Amount: $52,825.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP0562102

Start Date: 01-2006

End Date: 12-2010

Amount: $650,000.00

Funder: Australian Research Council