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Sindone AP, Driscoll A, Audehm R, Sverdlov AL, McVeigh J, Alicia Chan WP, Hickey A, Hopper I, Chang T, Maiorana A, Atherton JJ. Optimising Transitional Care Following a Heart Failure Hospitalisation in Australia. Heart Lung Circ 2024:S1443-9506(24)00193-8. [PMID: 38692982 DOI: 10.1016/j.hlc.2023.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 11/18/2023] [Accepted: 11/26/2023] [Indexed: 05/03/2024]
Abstract
Hospitalisations for heart failure (HF) are associated with high rates of readmission and death, the most vulnerable period being within the first few weeks post-hospital discharge. Effective transition of care from hospital to community settings for patients with HF can help reduce readmission and mortality over the vulnerable period, and improve long-term outcomes for patients, their family or carers, and the healthcare system. Planning and communication underpin a seamless transition of care, by ensuring that the changes to patients' management initiated in hospital continue to be implemented following discharge and in the long term. This evidence-based guide, developed by a multidisciplinary group of Australian experts in HF, discusses best practice for achieving appropriate and effective transition of patients hospitalised with HF to community care in the Australian setting. It provides guidance on key factors to address before and after hospital discharge, as well as practical tools that can be used to facilitate a smooth transition of care.
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Affiliation(s)
- Andrew P Sindone
- Heart Failure Unit and Department of Cardiology, Concord Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
| | - Andrea Driscoll
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; School of Nursing and Midwifery, Centre for Quality and Patient Safety, Faculty of Health, Deakin University, Geelong, Vic, Australia
| | - Ralph Audehm
- Department of General Practice and Primary Health Care, The University of Melbourne, Melbourne, Vic, Australia
| | - Aaron L Sverdlov
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - James McVeigh
- Heart Failure Service, The Prince of Wales Hospital, Randwick, NSW, Australia
| | | | | | - Ingrid Hopper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology and General Medicine Unit, Alfred Health, Melbourne, Vic, Australia
| | - Tim Chang
- Fiona Stanley Hospital, Perth, WA, Australia
| | - Andrew Maiorana
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia; Allied Health Department and Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Perth, WA, Australia
| | - John J Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia; Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia; Faculty of Science, Health, Education and Engineering, University of Sunshine Coast, Sunshine Coast, Qld, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
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Jahandideh S, Hutchinson AF, Bucknall TK, Considine J, Driscoll A, Manias E, Phillips NM, Rasmussen B, Vos N, Hutchinson AM. Using machine learning models to predict falls in hospitalised adults. Int J Med Inform 2024; 187:105436. [PMID: 38583216 DOI: 10.1016/j.ijmedinf.2024.105436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/09/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Identifying patients at high risk of falling is crucial in implementing effective fall prevention programs. While the integration of information systems is becoming more widespread in the healthcare industry, it poses a significant challenge in analysing vast amounts of data to identify factors that could enhance patient safety. OBJECTIVE To determine fall-associated factors and develop high-performance prediction tools for at-risk patients in acute and sub-acute care services in Australia. METHODS A retrospective study of 672,400 patients admitted to acute and sub-acute care services within a large metropolitan tertiary health service in Victoria, Australia, between January 1, 2019, and December 31, 2021. Data were obtained from four sources: the Department of Health Victorian Admitted Episodes Dataset, RiskManTM, electronic health records, and the health workforce dataset. Machine learning techniques, including Random Forest and Deep Neural Network models, were used to analyse the data, predict patient falls, and identify the most important risk factors for falls in this population. Model performance was evaluated using accuracy, F1-score, precision, recall, specificity, Matthew's correlation coefficient, and the area under the receiver operating characteristic curve (AUC). RESULTS The deep neural network and random forest models were highly accurate in predicting hospital patient falls. The deep neural network model achieved an accuracy of 0.988 and a specificity of 0.999, while the RF achieved an accuracy of 0.989 and a specificity of 1.000. The top 20 variables impacting falls were compared across both models, and 12 common factors were identified. These factors can be broadly classified into three categories: patient-related factors, staffing-related factors, and admission-related factors. Although not all factors are modifiable, they must be considered when planning fall prevention interventions. CONCLUSION The study demonstrated machine learning's potential to predict falls and identify key risk factors. Further validation across diverse populations and settings is essential for broader applicability.
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Affiliation(s)
- S Jahandideh
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - A F Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; Epworth HealthCare, Richmond, Victoria, Australia
| | - T K Bucknall
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; Alfred Health, Prahran, Victoria, Australia
| | - J Considine
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; Eastern Health, Box Hill, Victoria, Australia
| | - A Driscoll
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - E Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - N M Phillips
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - B Rasmussen
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; Western Health, Sunshine, Victoria, Australia
| | - N Vos
- Monash Health, Clayton, Victoria, Australia
| | - A M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; Barwon Health, Geelong, Victoria, Australia.
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Suo E, Driscoll A, Dinh D, Brennan A, Kaye DM, Stub D, Lefkovits J, Reid CM, Hopper I. Comparison of Characteristics and Outcomes in Patients With Acute Decompensated Heart Failure Admitted Under General Medicine and Cardiology Units. Heart Lung Circ 2024:S1443-9506(24)00046-5. [PMID: 38458933 DOI: 10.1016/j.hlc.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/12/2023] [Accepted: 01/11/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Acute decompensated heart failure (ADHF) is a leading cause of cardiovascular disease hospitalisations associated with significant morbidity and mortality. In hospitals, HF patients are typically managed by cardiology or physician teams, with differences in patient demographics and clinical outcomes. This study utilises contemporary HF registry data to compare patient characteristics and outcomes in those with ADHF admitted into General Medicine and Cardiology units. METHODS The Victorian Cardiac Outcomes Registry was utilised to identify patients hospitalised with ADHF 30-day period in each of four consecutive years. We compared patient characteristics, pharmacological management and outpatient follow-up of patients admitted to General Medicine and Cardiology units. Primary outcome measures included in-hospital mortality, 30-day readmission, and 30-day mortality. RESULTS Between 2014 and 2017, a total of 1,253 patients with ADHF admissions were registered, with 53% admitted in General Medicine units and 47% in Cardiology units. General Medicine patients were more likely to be older (82 vs 71 years; p<0.001), female (51% vs 34%; p<0.001), and have higher prevalence of comorbidities and preserved left ventricular function (p<0.001). There were no differences in primary outcome measures between General Medicine and Cardiology in terms of: in-hospital mortality (5.0% vs 3.9%; p=0.35), 30-day readmission (23.4% vs 23.6%; p=0.93), and 30-day mortality (10.0% vs 8.0%; p=0.21). CONCLUSIONS Hospitalised patients with HF continue to have high mortality and rehospitalisation rates. The choice of treatment by General Medicine or Cardiology units, based on the particular medical profile and individual needs of the patients, provides equivalent outcomes.
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Affiliation(s)
| | - Andrea Driscoll
- Deakin University, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Diem Dinh
- Monash University, Melbourne, Vic, Australia
| | | | - David M Kaye
- The Alfred Hospital, Melbourne, Vic, Australia; Baker IDI Heart Diabetes Institute, Melbourne, Vic, Australia
| | - Dion Stub
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia; Baker IDI Heart Diabetes Institute, Melbourne, Vic, Australia
| | - Jeffrey Lefkovits
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia; The Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Christopher M Reid
- Monash University, Melbourne, Vic, Australia; Curtin University, Perth, WA, Australia
| | - Ingrid Hopper
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia.
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Driscoll A, Clayden S, Lowe G. Call for the development and use of nurse practitioner sensitive outcome measures. Eur J Cardiovasc Nurs 2024:zvae008. [PMID: 38306407 DOI: 10.1093/eurjcn/zvae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/04/2024]
Affiliation(s)
- Andrea Driscoll
- School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Suzie Clayden
- Deakin Rural Health, Deakin University, Warrnambool, VIC 3280, Australia
| | - Grainne Lowe
- School of Nursing, Federation University, 72-100 Clyde Road, Berwick, VIC 3806, Australia
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Driscoll A, Meagher S, Kennedy R, Currey J. Effect of Intensive Nurse-Led Optimization of Heart Failure Medications in Patients With Heart Failure: A Meta-analysis of Randomized Controlled Trials. J Cardiovasc Nurs 2024:00005082-990000000-00166. [PMID: 38227630 DOI: 10.1097/jcn.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Prescribing of recommended medications for heart failure (HF) is suboptimal, leaving patients at a high risk of death or rehospitalization post discharge. Nurse-led titration (NLT) clinics are one strategy that could potentially improve the prescription of these medications. OBJECTIVE The aim of this article was to determine the effect of NLT clinics on all-cause mortality, all-cause or HF rehospitalizations, and adverse effects in patients with HF. METHODS We searched MEDLINE, EMBASE, Cochrane CENTRAL, International Clinical Trials Registry Platform, and ClinicalTrials.gov to identify randomized controlled trials comparing NLT of β-blocking agents, angiotensin receptor-neprilysin inhibitors, angiotensin-converting enzyme inhibitors, and/or angiotensin receptor blockers to optimization by another health professional in patients with HF. We used the fixed-effects Mantel-Haenszel method or meta-analyses. We assessed heterogeneity between studies using χ2 and I2. RESULTS Eight studies with 2025 participants were included. Participants in the NLT group experienced a lower rate of all-cause rehospitalizations (relative risk, 0.76, 95% confidence interval, 0.68-0.85; moderate quality of evidence) and less HF-related rehospitalizations (relative risk, 0.47; 95% confidence interval, 0.33-0.66; high quality of evidence) compared with the usual care group. All-cause mortality was lower in the NLT group (relative risk, 0.67; 95% confidence interval, 0.48-0.92; moderate quality of evidence) compared with the usual care group. Authors of one study reported no adverse events, and another study found one adverse event. CONCLUSION This meta-analysis indicates that NLT clinics may improve optimization of guideline-recommended medications with the potential to reduce rehospitalization and improve survival in a cohort of patients known for their poor outcomes.
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Driscoll A, Watts JJ, Meagher S, Kennedy R, Mar R, Johnson D, Hare DL, Faourque O, Gao L. Cost-effectiveness of an inpatient nurse practitioner in heart failure. Eur J Cardiovasc Nurs 2024; 23:33-41. [PMID: 37067006 DOI: 10.1093/eurjcn/zvad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/18/2023]
Abstract
AIMS Heart failure (HF) nurse practitioners (NPs) are an important part of the HF specialist team, and their impact on the cost-effectiveness of their role is unknown. The aim of this study was to determine the cost-effectiveness of a HF NP inpatient service compared with current practice of no HF NP service from a health system perspective at 12 months and 3 years. METHODS AND RESULTS We developed a Markov model to estimate costs, effects, and cost-effectiveness for hospitalized HF patients and seen by a HF NP service compared with usual care at 12 months and 3 years. Costs and effects were taken from a retrospective observational cohort study. Transition probabilities and utilities were derived from published studies. A total of 500 patients were included (250 patients in the HF NP service vs. 250 patients in usual care). Average age was 77.7 ± 11 years, and 54% were male. At 12 months, the HF NP group was cheaper and more effective compared with no HF NP [$23 031 vs. $25 111 (AUD), respectively; quality-adjusted life years (QALYs) were 0.68 in HF NP group compared with 0.66 in usual care]. The incremental cost-effectiveness ratio showed a savings of $109 474 per QALY gained at 12 months and a savings of $270 667 per QALY gained at 3 years in favour of the HF NP service. CONCLUSION The HF NP service was cost-effective with lower costs and higher QALYs compared with no HF NP service. Economic evaluations alongside randomized controlled trials are warranted.
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Affiliation(s)
- Andrea Driscoll
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Jennifer J Watts
- School of Health Economics, Deakin University, Burwood, Australia
| | - Sharon Meagher
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Rhoda Kennedy
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Ronald Mar
- Clinical Costing Department, Austin Health, Melbourne, Australia
| | - Doug Johnson
- Department of General Medicine, Melbourne Health, Melbourne, Australia
- School of Medicine, University of Melbourne, Parkville, Australia
| | - David L Hare
- Department of Cardiology, Austin Health, Melbourne, Australia
- School of Medicine, University of Melbourne, Parkville, Australia
| | - Omar Faourque
- Department of Cardiology, Austin Health, Melbourne, Australia
- School of Medicine, University of Melbourne, Parkville, Australia
| | - Lan Gao
- School of Health Economics, Deakin University, Burwood, Australia
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Le Grande MR, Murphy B, Kerr D, Beauchamp A, Driscoll A, Jackson AC. Barriers and enablers to screening, management and referral of sleep disorders in patients attending cardiac rehabilitation: A qualitative descriptive study. J Adv Nurs 2024; 80:136-149. [PMID: 37401808 DOI: 10.1111/jan.15765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/30/2023] [Accepted: 06/21/2023] [Indexed: 07/05/2023]
Abstract
AIMS To examine healthcare professional's knowledge about assessment and management of sleep disorders for cardiac patients and to describe the barriers to screening and management in cardiac rehabilitation settings. DESIGN A qualitative descriptive study. Data were collected via semi-structured interviews. METHODS In March 2022, a total of seven focus groups and two interviews were conducted with healthcare professionals who currently work in cardiac rehabilitation settings. Participants included 17 healthcare professionals who had undertaken cardiac rehabilitation training within the past 5 years. The study adheres to the consolidated criteria for reporting qualitative research guidelines. An inductive thematic analysis approach was utilized. RESULTS Six themes and 20 sub-themes were identified. Non-validated approaches to identify sleep disorders (such as asking questions) were often used in preference to validated instruments. However, participants reported positive attitudes regarding screening tools provided they did not adversely affect the therapeutic relationship with patients and benefit to patients could be demonstrated. Participants indicated minimal training in sleep issues, and limited knowledge of professional guidelines and recommended that more patient educational materials are needed. CONCLUSION Introduction of screening for sleep disorders in cardiac rehabilitation settings requires consideration of resources, the therapeutic relationship with patients and the demonstrated clinical benefit of extra screening. Awareness and familiarity of professional guidelines may improve confidence for nurses in the management of sleep disorders for patients with cardiac illness. IMPACTS The findings from this study address healthcare professionals' concerns regarding introduction of screening for sleep disorders for patients with cardiovascular disease. The results indicate concern for therapeutic relationships and patient management and have implications for nursing in settings such as cardiac rehabilitation and post-cardiac event counselling. REPORTING METHOD Adherence to COREQ guidelines was maintained. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution as this study explored health professionals' experiences only.
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Affiliation(s)
- Michael R Le Grande
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Barbara Murphy
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Debra Kerr
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Alison Beauchamp
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- School of Rural Health, Monash University, Warragul, Victoria, Australia
| | - Andrea Driscoll
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Alun C Jackson
- Australian Centre for Heart Health, North Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Centre on Behavioural Health, Hong Kong University, Pok Fu Lam, Hong Kong
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Kleissl-Muir S, Owen A, Rasmussen B, Zinn C, Driscoll A. Effects of a low carbohydrate diet on heart failure symptoms and quality of life in patients with diabetic cardiomyopathy: A randomised controlled trial pilot study. Nutr Metab Cardiovasc Dis 2023; 33:2455-2463. [PMID: 37798235 DOI: 10.1016/j.numecd.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/06/2023] [Accepted: 08/21/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND AIMS Heart failure, insulin resistance and/or type 2 diabetes mellitus coexist in the syndrome that is diabetic cardiomyopathy. Patients with diabetic cardiomyopathy experience high symptom burden and poor quality of life. We tested the hypothesis that a low carbohydrate diet improves heart failure symptoms and quality of life in patients with diabetic cardiomyopathy. METHODS AND RESULTS We conducted a 16-week randomised controlled pilot trial comparing the effects of a low carbohydrate diet (LC) to usual care (UC) in 17 adult patients with diabetic cardiomyopathy. New York Heart Association classification, weight, thirst distress and quality of life scores as well as blood pressure and biochemical data were assessed at baseline and at 16 weeks. Thirteen (n = 8 LC; n = 5 UC) patients completed the trial. The low carbohydrate diet induced significant weight loss in completers (p = 0.004). There was a large between-group difference in systolic blood pressure at the end of the study (Hedges's g 0.99[-014,2.08]). There were no significant differences in thirst or quality of life between groups. CONCLUSION This is the first clinical trial utilising the low carbohydrate dietary approach in patients with diabetic cardiomyopathy in an outpatient setting. A low carbohydrate diet can lead to significant weight loss in patients with diabetic cardiomyopathy. Future clinical trials with larger samples and that focus on fluid and sodium requirements of patients with diabetic cardiomyopathy who engage in a low carbohydrate diet are warranted. CLINICAL TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry (ANZCTR): ACTRN12620001278921. DATE OF REGISTRATION 26th November 2020.
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Affiliation(s)
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Bodil Rasmussen
- Deakin University School of Nursing and Midwifery, Geelong, VIC, Australia; Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand; School of Nursing and Midwifery, Centre for Quality and Patient Safety, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia; The Centre for Quality and Patient Safety, Institute of Health Transformation -Western Health Partnership, Western Health, St Albans, VIC, Australia; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Centre, Odense M, Denmark
| | - Caryn Zinn
- Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Andrea Driscoll
- Deakin University School of Nursing and Midwifery, Geelong, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Cardiology, Austin Health, Heidelberg, VIC, Australia; School of Nursing and Midwifery, Centre for Quality and Patient Safety, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
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Driscoll A, Meagher S, Kennedy R, Hare DL, Johnson DF, Asker K, Farouque O, Romaniuk H, Orellana L. Impact of a heart failure nurse practitioner service on rehospitalizations, emergency presentations, and survival in patients hospitalized with acute heart failure. Eur J Cardiovasc Nurs 2023; 22:701-708. [PMID: 36413653 DOI: 10.1093/eurjcn/zvac108] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/09/2022] [Accepted: 11/13/2022] [Indexed: 10/12/2023]
Abstract
AIMS Heart failure nurse practitioners (HF NPs) are an emerging component of the heart failure (HF) specialist workforce but their impact in an inpatient setting is untested. The aim of this paper is to explore the impact of an inpatient HF NP service on 12-month all-cause rehospitalizations, emergency department (ED) presentations, and mortality in patients hospitalized with HF compared with usual hospital care. METHODS AND RESULTS Retrospective, two-group comparative design involving patients (n = 408) admitted via ED with acute HF to a metropolitan quaternary hospital between January 2013 and August 2017. Doubly robust estimation with augmented inverse probability weighting (DR-AIPW) was used to account for the non-random allocation of patients to usual hospital care or the HF NP service in addition to usual in-hospital care. Among 408 patients (186 usual care and 222 HF NP service) admitted with acute HF, the mean age was 76.5 [standard deviation (SD) 12.0] years and 56.4% (n = 230) were male. After IPW adjustment, patients seen by the HF NP service had a lower risk of 12-month rehospitalization (61.3 vs. 78.3% usual care; difference -16.9%, 95% CI: -26.4%, -6.6%) and ED presentations (12.6 vs. 22.0%; difference -9.4%, 95% CI: -17.3%, -1.4%) with no difference in 6- or 12-month mortality. The HF NP service improved referrals to a home visiting programme that was available to HF patients (64.4 vs. 45.4%; difference 19%, 95% CI: 8.8%, 28.8%). CONCLUSION Additional support by an inpatient HF NP service has the potential to significantly reduce rehospitalizations and ED presentations over 12 months. Further evidence from a multicentre randomized control trial is warranted.
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Affiliation(s)
- Andrea Driscoll
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
| | - Sharon Meagher
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - Rhoda Kennedy
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - David L Hare
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | - Douglas F Johnson
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
- The Royal Melbourne Hospital, Department of General Medicine, Grattan St, Parkville, VIC 3050, Australia
| | - Kristina Asker
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
| | - Omar Farouque
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | - Helena Romaniuk
- Biostatistics Unit, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - Liliana Orellana
- Biostatistics Unit, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
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Kleissl-Muir S, Rasmussen B, Owen A, Zinn C, Driscoll A. A low-carbohydrate diet in place of SGLT2i therapy in a patient with diabetic cardiomyopathy. Endocrinol Diabetes Metab Case Rep 2023; 2023:23-0086. [PMID: 38103377 PMCID: PMC10762572 DOI: 10.1530/edm-23-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Summary In patients with diabetes mellitus, the toxic milieu caused by abnormal glucose and free fatty acid handling can lead to heart failure (HF). Referred to as diabetic cardiomyopathy (DMCM), this syndrome often exists in the absence of conventional risk factors for HF such as history of myocardial infarction or hypertension. Low-carbohydrate diets (LCDs) have recently been endorsed as an efficacious therapeutic dietary approach to prevent and reverse cardiometabolic disease including type 2 diabetes mellitus (T2DM). LCDs improve systemic insulin resistance (IR), reverses cardiac remodelling in a rodent model and downregulates the expression of sodium-glucose co-transporter 2 (SGLT2) receptors in the kidney. It is therefore conceivable that a lifestyle approach such as adopting an LCD can be offered to patients with DMCM. The reported case is that of a 45-year-old man with a 15-year history of non-ischaemic cardiomyopathy, T2DM and obesity. The patient volunteered to engage in a 16-week low-carbohydrate dietary intervention trial and then self-selected to remain on this diet for 1 year. The whole-food LCD was based on simple 'traffic light' style food lists and not designed to restrict calories, protein, fat or salt. After 1 year, the patient had lost 39 kg and his cardiometabolic markers had significantly improved. LCDs present a potentially beneficial approach for patients with DMCM and could be considered as a lifestyle intervention before SGLT2i therapy is commenced. Learning points Diabetic cardiomyopathy (DMCM) is a syndrome precipitated mainly by the detrimental effects of glucose metabolism disorders such as insulin resistance and diabetes. Low-carbohydrate diets (LCD) mimic many effects of sodium-glucose co-transporter 2 inhibitors (SGLT2i). LCDs are a dietary pattern which can have significant and beneficial effects on metabolic and anthropometric markers in patients with DMCM. LCDs and SGLT2i therapy could be combined and may achieve better clinical outcomes for patients with DMCM. Combination therapy may be carried out under close supervision as the real risk for diabetic ketoacidosis remains.
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Affiliation(s)
- Sabine Kleissl-Muir
- Deakin University School of Nursing and Midwifery, Geelong, Victoria, Australia
| | - Bodil Rasmussen
- Deakin University School of Nursing and Midwifery, Geelong, Victoria, Australia
- School of Nursing and Midwifery, Centre for Quality and Patient Safety, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- The Centre for Quality and Patient Safety, Institute of Health Transformation -Western Health Partnership, Western Health, St Albans, Victoria, Australia
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Centre, Odense M, Denmark
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Caryn Zinn
- Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Andrea Driscoll
- Deakin University School of Nursing and Midwifery, Geelong, Victoria, Australia
- School of Nursing and Midwifery, Centre for Quality and Patient Safety, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
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11
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Amin M, Kerr D, Atiase Y, Yakub Y, Driscoll A. Understanding Physical Activity Behavior in Ghanaian Adults with Type 2 Diabetes: A Qualitative Descriptive Study. J Funct Morphol Kinesiol 2023; 8:127. [PMID: 37754960 PMCID: PMC10532145 DOI: 10.3390/jfmk8030127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023] Open
Abstract
Despite a relatively low prevalence rate, sub-Saharan Africa bears a substantial diabetes burden. Physical activity (PA) plays a crucial role in managing type 2 diabetes mellitus (T2DM). However, PA levels among this population remain suboptimal. This study aimed to explore patients' perspectives on the barriers and facilitators to PA participation among Ghanaian adults with T2DM. Thirteen adults with T2DM were recruited from Korle-Bu Teaching Hospital, Ghana, for this qualitative descriptive study. Semi-structured interviews were conducted, and the data were analyzed using thematic analysis. Two overarching themes (personal factors and socio-structural factors) and 10 sub-themes relating to PA barriers and facilitators were identified. Participants had limited awareness of the recommended PA guidelines for T2DM management. Chronic illness-related factors hindered exercise participation. Difficulty differentiating between PA and exercise impeded the achievement of PA targets. Socio-structural barriers include concerns about social ridicule or embarrassment, safety during outdoor activities, a lack of culturally appropriate exercise facilities, and high social and work demands. Despite these barriers, participants were motivated by their understanding of the health benefits of PA. They emphasized integrating PA into daily routines through walking, work-related tasks, and household chores. Motivation and PA education from healthcare professionals are valued supports in achieving PA targets. Our findings showed that PA behaviour in Ghanaian adults with T2DM is influenced by both personal and external factors. Tailored PA interventions for this population should address identified barriers while leveraging facilitators to implement successful PA programs.
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Affiliation(s)
- Mohammed Amin
- Centre for Quality and Patient Safety, Institute for Health Transformation, Faculty of Health, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Melbourne, VIC 3125, Australia; (D.K.); (A.D.)
| | - Debra Kerr
- Centre for Quality and Patient Safety, Institute for Health Transformation, Faculty of Health, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Melbourne, VIC 3125, Australia; (D.K.); (A.D.)
| | - Yacoba Atiase
- National Diabetes Management and Research Centre, Korle-Bu Teaching Hospital, University of Ghana Medical School, Accra P.O. Box GP 4236, Ghana;
| | - Yusif Yakub
- Faculty of Medicine and Health, The University of Sydney, Science Road, Sydney, NSW 2050, Australia;
| | - Andrea Driscoll
- Centre for Quality and Patient Safety, Institute for Health Transformation, Faculty of Health, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Melbourne, VIC 3125, Australia; (D.K.); (A.D.)
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Kleissl-Muir S, Driscoll A, Owen A, Zinn C, Rasmussen B. Exploring the Barriers and Enablers to Implementing a 16-Week Low-Carbohydrate Diet for Patients With Diabetic Cardiomyopathy. J Cardiovasc Nurs 2023:00005082-990000000-00114. [PMID: 37550835 DOI: 10.1097/jcn.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
AIMS Cardiac dysfunction in patients with diabetes, referred to as diabetic cardiomyopathy, is primarily precipitated by dysregulations in glucose and lipid metabolism. Diet and lifestyle changes are considered crucial for successful heart failure and diabetes management and are often difficult to achieve. Low-carbohydrate diets (LCDs) have gained popularity for the management of metabolic diseases. Although quantitative research in this field is evolving, little is known about the personal experience of patients with diabetic cardiomyopathy on specific diets. The aim of this qualitative study was to identify enablers and barriers of patients with diabetic cardiomyopathy who engage in an LCD. It further explored patients' perception of dietary education and dietary support received while in hospital. METHODS AND RESULTS Participants who previously consented to a 16-week LCD trial were invited to share their experiences. Nine patients agreed to be interviewed. Semistructured interviews and a focus group interview were conducted, which were transcribed verbatim. Data were analyzed by using the 6-step approach for thematic analysis. Four themes were identified: (1) nutrition literacy (2) disease-related health benefits, (3) balancing commitments, and (4) availability of resources and support. CONCLUSION Improvements in disease-related symptoms acted as strong enablers to engage in an LCD. Barriers such as access to resources and time constraints were identified. These challenges may be overcome with efficient communication and ongoing dietary support. More research exploring the experience of patients with diabetic cardiomyopathy on an LCD are warranted.
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Amin M, Kerr D, Atiase Y, Yakub Y, Driscoll A. Expert Opinions about Barriers and Facilitators to Physical Activity Participation in Ghanaian Adults with Type 2 Diabetes: A Qualitative Descriptive Study. Sports (Basel) 2023; 11:123. [PMID: 37505610 PMCID: PMC10383987 DOI: 10.3390/sports11070123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023] Open
Abstract
Most adults with type 2 diabetes mellitus (T2DM) do not meet their physical activity (PA) goals despite its importance in improving their health outcomes. Our study aim was to explore the opinions of healthcare professionals regarding barriers and facilitators to PA participation in Ghanaian adults with T2DM. Using qualitative descriptive design, data were collected through semi-structured interviews with 13 healthcare professionals experienced in diabetes management in Ghana. Three main themes relating to PA barriers and facilitators were identified in a thematic analysis: health system-related factors, healthcare practitioner factors, and patient factors. Inadequate accessibility to physical therapists and therapy centres hindered the provision of PA programs. Nurses and doctors lacked sufficient knowledge and training on effective PA interventions for individuals with T2DM. Time constraints during patient consultations limited discussions on PA, while the cost associated with accessing physical therapy posed a significant challenge. Patients often disregarded PA advice from physical therapists due to their reliance on doctors, and some perceived PA as irrelevant for diabetes treatment. Despite these barriers, healthcare professionals expressed belief in PA facilitators, including integrating physical therapists and diabetes educators into diabetes care, providing structured exercise resources, improving curriculum planning to emphasise PA in health science education, and addressing knowledge gaps and misconceptions. Overall, this study highlights patient-related and healthcare system-related factors that influence PA behaviour in Ghanaian adults with T2DM. Findings from this study should inform the development of tailored PA programs for this population.
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Affiliation(s)
- Mohammed Amin
- Centre for Quality and Patient Safety, Institute for Health Transformation, Faculty of Health, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Debra Kerr
- Centre for Quality and Patient Safety, Institute for Health Transformation, Faculty of Health, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Yacoba Atiase
- National Diabetes Management and Research Centre, Korle-Bu Teaching Hospital, University of Ghana Medical School, Accra P.O. Box GP 4236, Ghana
| | - Yusif Yakub
- Faculty of Medicine and Health, The University of Sydney, Science Rd., Camperdown, NSW 2050, Australia
| | - Andrea Driscoll
- Centre for Quality and Patient Safety, Institute for Health Transformation, Faculty of Health, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
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14
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Pollock M, Hutchinson AM, Ockerby C, Driscoll A. Is Transcatheter Aortic Valve Implantation Effective in Improving Quality of Life?: A Systematic Review. J Cardiovasc Nurs 2023:00005082-990000000-00101. [PMID: 37306426 DOI: 10.1097/jcn.0000000000001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Aortic stenosis (AS) without surgical intervention is associated with morbidity and mortality and is the most common valvular disease in the western world. Transcatheter aortic valve implantation (TAVI) is a minimally invasive surgical option that has become a common treatment for people unable to undergo open aortic valve replacement; despite the increase in TAVI offerings in the last decade, patient quality of life (QoL) outcomes postoperatively are poorly understood. OBJECTIVE The aim of this review was to determine whether TAVI is effective in improving QoL. METHOD A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted, and the protocol was registered on PROSPERO (CRD42019122753). MEDLINE, CINAHL, EMBASE, and PsycINFO were searched for studies published between 2008 and 2021. Search terms included "transcatheter aortic valve replacement" and "quality of life" and their synonyms. Included studies were evaluated, dependent on study design, using either the Risk of Bias-2 or the Newcastle-Ottawa Scale. Seventy studies were included in the review. RESULTS Authors of the studies used a wide variety of QoL assessment instruments and follow-up durations; authors of most studies identified an improvement in QoL, and a small number identified a decline in QoL or no change from baseline. CONCLUSION Although authors of the vast majority of studies identified an improvement in QoL, there was very little consistency in instrument choice or follow-up duration; this made analysis and comparison difficult. A consistent approach to measuring QoL for patients who undergo TAVI is needed to enable comparison of outcomes. A richer, more nuanced understanding of QoL outcomes after TAVI could help clinicians support patient decision making and evaluate outcomes.
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15
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Amin M, Kerr D, Atiase Y, Aldwikat RK, Driscoll A. Effect of Physical Activity on Metabolic Syndrome Markers in Adults with Type 2 Diabetes: A Systematic Review and Meta-Analysis. Sports (Basel) 2023; 11:sports11050101. [PMID: 37234057 DOI: 10.3390/sports11050101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/24/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023] Open
Abstract
People with Type 2 diabetes mellitus (T2DM) are reported to have a high prevalence of metabolic syndrome (MetS), which increases their risk of cardiovascular events. Our aim was to determine the effect of physical activity (PA) on metabolic syndrome markers in people with T2DM. The study design was a systematic review and meta-analysis of randomised controlled trials evaluating the effect of PA on MetS in adults with T2DM. Relevant databases including SPORTdiscus, Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, PsycINFO, EMBASE, SocINDEX were searched up to August 2022. Primary endpoints were changes in MetS markers (blood pressure, triglyceride, high-density lipoprotein, fasting blood sugar, and waist circumference) after an exercise intervention. Using a random effect model with 95% confidence interval (CI), the mean difference between intervention groups and control groups were calculated. Twenty-six articles were included in the review. Overall, aerobic exercise had a significant effect on waist circumference (Mean Difference: -0.34 cm, 95% CI: -0.84, -0.05; effect size: 2.29, I2 = 10.78%). The effect sizes on blood pressure, triglyceride, high-density lipoprotein, fasting blood sugar were not statistically significant. No significant differences were found between exercise and control group following resistance training. Our findings suggest that aerobic exercise can improve waist circumference in people with T2DM and MetS. However, both aerobic and resistance exercise produced no significant difference in the remaining MetS markers. Larger and higher-quality studies are required to determine the full effects of PA on MetS markers in this population.
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Affiliation(s)
- Mohammed Amin
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Debra Kerr
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Yacoba Atiase
- National Diabetes Management and Research Centre, Korle-Bu Teaching Hospital, University of Ghana Medical School, Accra P.O. Box GP 4236, Ghana
| | - Rami Kamel Aldwikat
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
- School of Nursing and Midwifery, Monash University, 35 Rainforest Walk, Clayton, VIC 3800, Australia
| | - Andrea Driscoll
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
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16
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Amin M, Kerr D, Atiase Y, Samir MM, Driscoll A. Improving Metabolic Syndrome in Ghanaian Adults with Type 2 Diabetes through a Home-Based Physical Activity Program: A Feasibility Randomised Controlled Trial. Int J Environ Res Public Health 2023; 20:ijerph20085518. [PMID: 37107801 PMCID: PMC10138586 DOI: 10.3390/ijerph20085518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
There is a high prevalence of metabolic syndrome (MetS) among people with type 2 diabetes mellitus (T2DM). Physical activity has the potential to improve health outcomes for individuals with type 2 diabetes. Our study aim was to determine the effect of a 12-week culturally appropriate home-based physical activity program on metabolic syndrome markers and quality of life in Ghanaian adults with T2DM. A secondary objective was to examine the feasibility of implementing the PA program. A feasibility randomised controlled trial (RCT) was conducted. A purposive sample of 87 adults with T2DM at the Korle-Bu Teaching Hospital, Ghana, were randomized into either the control group (CG) (n = 43) or the intervention group (IG) (n = 44). Participants in the IG received the physical activity program in addition to their usual diabetes care; those in the CG received their usual diabetes care. Measurements for feasibility, MetS markers, and quality of life (SF-12) were performed at baseline and 12-week follow-up. Following the 12-week program, participants in the IG showed a significant improvement in fasting blood glucose (2.4% vs. 0.4%, p < 0.05), waist circumference (5.4% vs. 0.4%, p < 0.05), and systolic blood pressure (9.8% vs. 1.5%, p < 0.05). There were no statistical differences between the IG and CG regarding high-density lipoprotein, triglycerides, and diastolic blood pressure at the 12-week follow-up. Classification of MetS were reduced in the IG compared to the CG (51.2% vs. 83.3%, p < 0.05). The MetS severity score improved in the IG compared to the CG (8.8% vs. 0.5%, p < 0.05). The IG improved in two of the eight SF-12 dimensions (physical function and vitality, p < 0.05) compared to the CG. Thirty-two (72.7%) participants completed all 36 exercise sessions. Another 11 (25%) participants completed 80% of the exercise sessions. No adverse events were reported. In conclusion, a 12-week home-based physical activity program is feasible and safe. The intervention has the potential to improve MetS and quality of life in Ghanaian adults with T2DM. The preliminary findings of this study need to be confirmed in a large-scale multi-centre RCT.
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Affiliation(s)
- Mohammed Amin
- Centre for Quality and Patient Safety, Institute for Health Transformation, Faculty of Health, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
- Correspondence: ; Tel.: +61-4-52074801
| | - Debra Kerr
- Centre for Quality and Patient Safety, Institute for Health Transformation, Faculty of Health, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Yacoba Atiase
- University of Ghana School of Medicine and Dentistry, National Diabetes Management and Research Centre, Korle-Bu Teaching Hospital, Accra P.O. Box GP4236, Ghana
| | | | - Andrea Driscoll
- Centre for Quality and Patient Safety, Institute for Health Transformation, Faculty of Health, School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
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Driscoll A, Tori K, Jennings N, Schiftan D, Lowe G. Statewide Mapping of Nurse Practitioner Models of Practice Throughout Victoria. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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18
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Ganes A, Davis JA, Virtanen JK, Voutilainen A, Tuomainen TP, Atherton JJ, Amerena J, Driscoll A, Hare DL, Wittert G, Ruusunen A, Marx W, Mohebbi M, O’Neil A. Urinary sodium concentration predicts time to major adverse coronary events and all-cause mortality in men with heart failure over a 28–33-year period: a prospective cohort study. BMC Cardiovasc Disord 2022; 22:391. [PMID: 36056320 PMCID: PMC9438140 DOI: 10.1186/s12872-022-02830-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Lower urinary sodium concentrations (UNa) may be a biomarker for poor prognosis in chronic heart failure (HF). However, no data exist to determine its prognostic association over the long-term. We investigated whether UNa predicted major adverse coronary events (MACE) and all-cause mortality over 28–33 years.
Methods
One hundred and eighty men with chronic HF from the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) were included. Baseline data was collected between 1984 and 1989. MACE and all-cause outcomes were obtained using hospital linkage data (1984–2017) with a follow-up of 28–33 years. Cox proportional hazards models were generated using 24-h UNa tertiles at baseline (1 ≤ 173 mmol/day; 2 = 173-229 mmol/day; 3 = 230-491 mmol/day) as a predictor of time-to-MACE outcomes, adjusted for relevant covariates.
Results
Overall, 63% and 83% of participants (n = 114 and n = 150) had a MACE event (median 10 years) and all-cause mortality event (median 19 years), respectively. On multivariable Cox Model, relative to the lowest UNa tertile, no significant difference was noted in MACE outcome for individuals in tertiles 2 and 3 with events rates of 28% (HR:0.72; 95% CI: 0.46–1.12) and 21% (HR 0.79; 95% CI: 0.5–1.25) respectively.. Relative to the lowest UNa tertile, those in tertile 2 and 3 were 39% (HR: 0.61; 95% CIs: 0.41, 0.91) and 10% (HR: 0.90; 95% CIs: 0.62, 1.33) less likely to experience to experience all-cause mortality. The multivariable Cox model had acceptable prediction precision (Harrell's C concordance measure 0.72).
Conclusion
UNa was a significant predictor of all-cause mortality but not MACE outcomes over 28–33 years with 173–229 mmol/day appearing to be the optimal level. UNa may represent an emerging long-term prognostic biomarker that warrants further investigation.
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Cartledge S, Driscoll A, Dinh D, O'Neil A, Thomas E, Brennan AL, Liew D, Lefkovits J, Stub D. Trends and Predictors of Cardiac Rehabilitation Referral Following Percutaneous Coronary Intervention: A Prospective, Multi-Site Study of 41,739 Patients From the Victorian Cardiac Outcomes Registry (2017-2020). Heart Lung Circ 2022; 31:1247-1254. [PMID: 35643797 DOI: 10.1016/j.hlc.2022.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/30/2022] [Accepted: 04/07/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Following percutaneous coronary intervention (PCI), outpatient cardiac rehabilitation (CR) is essential for secondary prevention. However uptake of CR is suboptimal, despite strong evidence demonstrating benefits. The aim of this study was to identify contemporary trends and predictors of CR referral of PCI patients in Victoria. METHODS A prospective, observational study using data extracted from the Victorian Cardiac Outcomes Registry was undertaken. A total of 41,739 patients were discharged following PCI over the study period (2017-2020) and included for analysis. RESULTS Cardiac rehabilitation referral was 85%, with an increasing trend over time (p<0.001). Multivariable modelling identifying the independent predictors of CR referral included hospitals with high volumes of ST-elevation myocardial infarction patients (STEMI) (OR 4.89, 95% CI 4.41-5.20), STEMI diagnosis (OR 1.90, 95% CI 1.69-2.14), or treatment in a private hospital (OR 1.45, 95% CI 1.33-1.57). Predictors of non-referral included cardiogenic shock (OR 0.54, 95% CI 0.41-0.71), aged over 75 years (OR 0.62, 95% CI 0.57-0.68) and previous PCI (OR 0.66, 95% CI 0.62-0.70). Percutaneous coronary intervention patients with an acute coronary syndrome who were referred to CR were also more likely to be prescribed four or more major preventive pharmacotherapies, compared to those who were not referred (90% vs 82.1%, p<0.001). CONCLUSION Our contemporary multicentre analysis showed generally high CR referral rates which have increased over time. However, more effort is needed to target patients treated in the public sector, low volume STEMI hospitals or with short lengths of stay.
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Affiliation(s)
- Susie Cartledge
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia.
| | - Andrea Driscoll
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; School of Nursing and Midwifery, Deakin University, Geelong, Vic, Australia; Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Diem Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Adrienne O'Neil
- Food and Mood Centre, IMPACT Institute, Deakin University, Geelong, Vic, Australia
| | - Emma Thomas
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Brisbane, Qld, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Western Health, Melbourne, Vic, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Vic, Australia; Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
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Kleissl-Muir S, Rasmussen B, Owen A, Zinn C, Driscoll A. Low Carbohydrate Diets for Diabetic Cardiomyopathy: A Hypothesis. Front Nutr 2022; 9:865489. [PMID: 35529461 PMCID: PMC9069235 DOI: 10.3389/fnut.2022.865489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Elevated blood glucose levels, insulin resistance (IR), hyperinsulinemia and dyslipidemia the key aspects of type 2 diabetes mellitus (T2DM), contribute to the development of a certain form of cardiomyopathy. This cardiomyopathy, also known as diabetic cardiomyopathy (DMCM), typically occurs in the absence of overt coronary artery disease (CAD), hypertension or valvular disease. DMCM encompasses a variety of pathophysiological processes impacting the myocardium, hence increasing the risk for heart failure (HF) and significantly worsening outcomes in this population. Low fat (LF), calorie-restricted diets have been suggested as the preferred eating pattern for patients with HF. However, LF diets are naturally higher in carbohydrates (CHO). We argue that in an insulin resistant state, such as in DMCM, LF diets may worsen glycaemic control and promote further insulin resistance (IR), contributing to a physiological and functional decline in DMCM. We postulate that CHO restriction targeting hyperinsulinemia may be able to improve tissue and systemic IR. In recent years low carbohydrate diets (LC) including ketogenic diets (KD), have emerged as a safe and effective tool for the management of various clinical conditions such as T2DM and other metabolic disorders. CHO restriction achieves sustained glycaemic control, lower insulin levels and successfully reverses IR. In addition to this, its pleiotropic effects may present a metabolic stress defense and facilitate improvement to cardiac function in patients with HF. We therefore hypothesize that patients who adopt a LC diet may require less medications and experience improvements in HF-related symptom burden.
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Affiliation(s)
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- The Centre for Quality and Patient Safety, Institute of Health Transformation -Western Health Partnership, Western Health, St Albans, VIC, Australia
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Centre, Odense, Denmark
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Caryn Zinn
- Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Andrea Driscoll
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Cardiology, Austin Health, Heidelberg, VIC, Australia
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Giuliano C, Vicendese D, Vogrin S, Lane R, Driscoll A, Dinh D, Palmer K, Levinger I, Neil C. Predictors of Referral to Cardiac Rehabilitation in Patients following Hospitalisation with Heart Failure: A Multivariate Regression Analysis. J Clin Med 2022; 11:jcm11051232. [PMID: 35268323 PMCID: PMC8910897 DOI: 10.3390/jcm11051232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: This exploratory observational case−control study investigated the rate of referral to cardiac rehabilitation (CR) among patients hospitalised with heart failure (HF) and identified factors associated with referral. Methods: Patients hospitalised with HF as identified by the Victorian Cardiac Outcomes Registry HF study were included. Factors found to be univariately associated with referral were selected for multivariate logistic regression. Results: Among 1281 patients (mean age: 76.9 years; 32.8% HFrEF and 33.9% HfpEF), 125 (9.8%) were referred to CR. Patients referred were younger (73.6 (2.7, 81.5) vs. 80.2 (71.1, 86.5) p < 0.001) and were more likely to be men (72%, p < 0.001). Factors associated with referral included inpatient percutaneous coronary intervention (OR, 3.31; 95% CI, 1.04−10.48; p = 0.04), an aetiology of ischaemic or rhythm-related cardiomyopathy, and anticoagulants prescribed on discharge. Factors that lowered the likelihood of referral included older age, female, receiving inpatient oxygen therapy, and the presence of chronic obstructive pulmonary disease (COPD) or anaemia. Conclusions: The rate of referral to CR following hospitalisation with HF is low. Shortfalls are particularly evident among females, older patients, and in those with COPD or anaemia. Future studies should focus on improving referral processes and translating proven strategies that increase referrals to CR into practice.
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Affiliation(s)
- Catherine Giuliano
- Institute for Health and Sport, Victoria University, Melbourne, VIC 8001, Australia; (R.L.); (I.L.); (C.N.)
- Department of Cardiology, Western Health, Sunshine Hospital, Melbourne, VIC 3021, Australia
- Correspondence:
| | - Don Vicendese
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia;
- Department of Mathematics and Statistics, La Trobe University, Melbourne, VIC 3086, Australia
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC 3021, Australia;
| | - Rebecca Lane
- Institute for Health and Sport, Victoria University, Melbourne, VIC 8001, Australia; (R.L.); (I.L.); (C.N.)
- College of Health and Biomedicine, Victoria University, Melbourne, VIC 8001, Australia
| | - Andrea Driscoll
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Geelong, VIC 3216, Australia;
- Department of Cardiology, Austin Health, Melbourne, VIC 3084, Australia
| | - Diem Dinh
- Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
| | - Katie Palmer
- Department of Physiotherapy, Monash Health, Melbourne, VIC 3175, Australia;
- School of Primary and Allied Health Care, Monash University, Frankston, VIC 3199, Australia
| | - Itamar Levinger
- Institute for Health and Sport, Victoria University, Melbourne, VIC 8001, Australia; (R.L.); (I.L.); (C.N.)
- Department of Cardiology, Western Health, Sunshine Hospital, Melbourne, VIC 3021, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC 3021, Australia;
| | - Christopher Neil
- Institute for Health and Sport, Victoria University, Melbourne, VIC 8001, Australia; (R.L.); (I.L.); (C.N.)
- Department of Cardiology, Western Health, Sunshine Hospital, Melbourne, VIC 3021, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC 3021, Australia;
- Department of Medicine, Western Health, The University of Melbourne, Melbourne, VIC 3010, Australia
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Affiliation(s)
- A Driscoll
- School of Nursing and Midwifery, Deakin University, Geelong; Department of Cardiology, Austin Health, Heidelberg Melbourne, Victoria.
| | - S Cartledge
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Heart Centre, ALfred Health, Melbourne, Victoria
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Cartledge S, Driscoll A, Dinh D, O'Neil A, Thomas E, Brennan A, Lefkovits J, Stub D. High Risk PCI Patients Still Missing Out on Cardiac Rehabilitation Referral – a Prospective, Multisite Study of 41,739 Patients From the Victorian Cardiac Outcomes Registry. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Driscoll A, Romaniuk H, Dinh D, Amerena J, Brennan A, Hare DL, Kaye D, Lefkovits J, Lockwood S, Neil C, Prior D, Reid CM, Orellana L. Clinical risk prediction model for 30-day all-cause re-hospitalisation or mortality in patients hospitalised with heart failure. Int J Cardiol 2021; 350:69-76. [PMID: 34979149 DOI: 10.1016/j.ijcard.2021.12.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/18/2021] [Accepted: 12/28/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study aimed to develop a risk prediction model (AUS-HF model) for 30-day all-cause re-hospitalisation or death among patients admitted with acute heart failure (HF) to inform follow-up after hospitalisation. The model uses routinely collected measures at point of care. METHODS We analyzed pooled individual-level data from two cohort studies on acute HF patients followed for 30-days after discharge in 17 hospitals in Victoria, Australia (2014-2017). A set of 58 candidate predictors, commonly recorded in electronic medical records (EMR) including demographic, medical and social measures were considered. We used backward stepwise selection and LASSO for model development, bootstrap for internal validation, C-statistic for discrimination, and calibration slopes and plots for model calibration. RESULTS The analysis included 1380 patients, 42.1% female, median age 78.7 years (interquartile range = 16.2), 60.0% experienced previous hospitalisation for HF and 333 (24.1%) were re-hospitalised or died within 30 days post-discharge. The final risk model included 10 variables (admission: eGFR, and prescription of anticoagulants and thiazide diuretics; discharge: length of stay>3 days, systolic BP, heart rate, sodium level (<135 mmol/L), >10 prescribed medications, prescription of angiotensin converting enzyme inhibitors or angiotensin receptor blockers, and anticoagulants prescription. The discrimination of the model was moderate (C-statistic = 0.684, 95%CI 0.653, 0.716; optimism estimate = 0.062) with good calibration. CONCLUSIONS The AUS-HF model incorporating routinely collected point-of-care data from EMRs enables real-time risk estimation and can be easily implemented by clinicians. It can predict with moderate accuracy risk of 30-day hospitalisation or mortality and inform decisions around the intensity of follow-up after hospital discharge.
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Affiliation(s)
- A Driscoll
- Deakin University, School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, VIC 3220, Australia; Austin Health, Dept of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia.
| | - H Romaniuk
- Deakin University, Biostatistics Unit, Faculty of Health, 1 Gheringhap Street, Geelong, VIC 3220, Australia.
| | - D Dinh
- Monash University, School of Medicine and Preventive Health, Commercial Rd, Prahran, VIC 3121, Australia.
| | - J Amerena
- University Hospital Geelong, Cardiology Research Department, PO Box 281, Geelong 3220, Australia.
| | - A Brennan
- Monash University, School of Medicine and Preventive Health, Commercial Rd, Prahran, VIC 3121, Australia
| | - D L Hare
- Austin Health, Dept of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia; University of Melbourne, School of Medicine, Swanson St, Melbourne, VIC 3001, Australia.
| | - D Kaye
- Baker Heart and Diabetes Institute, Commercial Rd, Prahran, VIC 3121, Australia; Alfred Health, Department of Cardiology, Commercial Rd, Prahran, VIC 3121, Australia.
| | - J Lefkovits
- Monash University, School of Medicine and Preventive Health, Commercial Rd, Prahran, VIC 3121, Australia
| | - S Lockwood
- University Hospital Geelong, Cardiology Research Department, PO Box 281, Geelong 3220, Australia; Monash Health, Department of Cardiology, 246 Clayton Rd, Clayton, VIC 3168, Australia.
| | - C Neil
- University Hospital Geelong, Cardiology Research Department, PO Box 281, Geelong 3220, Australia; Western Health, Department of Cardiology, 160 Gordon St, Footscray, VIC 3011, Australia.
| | - D Prior
- St Vincents Hospital, Department of Cardiology, 41 Fitzroy Parade, Fitzroy, VIC 3065, Australia.
| | - C M Reid
- Curtin University, School of Public Health, NHMRC Centre for Research Excellence in Cardiovascular Outcomes Improvement, Kent St, Bentley, WA 6102, Australia.
| | - L Orellana
- Deakin University, Biostatistics Unit, Faculty of Health, 1 Gheringhap Street, Geelong, VIC 3220, Australia
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Tan C, Dinh D, Brennan A, Hare DL, Kaye D, Lefkovits J, Lockwood S, Neil C, Prior D, Nasis A, Wilson A, Reid CM, Stub D, Driscoll A. Characteristics and Clinical Outcomes in Patients With Heart Failure With Preserved Ejection Fraction Compared to Heart Failure With Reduced Ejection Fraction: Insights From the VCOR Heart Failure Snapshot. Heart Lung Circ 2021; 31:623-628. [PMID: 34742643 DOI: 10.1016/j.hlc.2021.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 06/12/2021] [Accepted: 09/16/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Heart failure is increasing in prevalence, creating a greater public health and economic burden on our health care system. With a rising proportion of hospitalisations for heart failure with preserved ejection fraction (HFpEF) compared to heart failure with reduced ejection fraction (HFrEF) and lack of proven therapies for HFpEF, patient characterisation and defining clinical outcomes are important in determining optimal management of heart failure patients. There is scarce Australian-specific data with regards to the burden of disease of patients with HFpEF which further limits our ability to appropriately manage this syndrome. AIM To determine the characteristics, management practices and outcomes of patients with HFpEF compared to patients diagnosed with HFrEF. METHOD Data was sourced from the Victorian Cardiac Outcomes Registry-Heart Failure (VCOR-HF) snapshot of patients admitted with acute heart failure to one of 16 Victorian health services between 2014-2017 over one consecutive month annually. Outcomes measured were in-hospital mortality, and 30-day readmission and mortality. RESULTS Of the 1,132 HF patients, 436 patients were diagnosed with HFpEF and were more likely to be female (59%) and older (81.5±9.8 vs 73.2±14.5 years). They were also more likely to have hypertension (80%), atrial fibrillation (59.9%), chronic obstructive airways disease (36.2%) and chronic kidney disease (68.8%). Patients with HFrEF were more likely to have ischaemic heart disease with a history of previous myocardial infarction (36.6%), percutaneous coronary intervention and cardiac bypass surgery (35.2%). There were no significant differences in 30-day mortality between HFpEF and HFrEF (10.2% vs 7.8%; p=0.19, respectively) and 30-day readmission rates (22.1% vs 25.9%; p=0.15, respectively). CONCLUSION VCOR-HF Snapshot data provides important insight into the burden of acute heart failure. Whilst patients with HFpEF and HFrEF have differing clinical profiles, morbidity, mortality and re-admission rates are similar.
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Affiliation(s)
| | - Diem Dinh
- Monash University, Melbourne, Vic, Australia
| | | | - David L Hare
- Austin Health, Melbourne, Vic, Australia; Melbourne University, Melbourne, Vic, Australia
| | - David Kaye
- The Alfred Hospital, Melbourne, Vic, Australia; Baker IDI Heart Diabetes Institute, Melbourne, Vic, Australia
| | - Jeffrey Lefkovits
- Monash University, Melbourne, Vic, Australia; The Royal Melbourne Hospital, Melbourne, Vic, Australia
| | | | - Christopher Neil
- Melbourne University, Melbourne, Vic, Australia; Western Health, Melbourne, Vic, Australia
| | - David Prior
- St Vincent's Hospital, Melbourne, Vic, Australia
| | - Arthur Nasis
- Monash Health, Melbourne, Vic, Australia; Safer Care Victoria, Department of Health and Human Services, Melbourne, Vic, Australia
| | - Andrew Wilson
- St Vincent's Hospital, Melbourne, Vic, Australia; Safer Care Victoria, Department of Health and Human Services, Melbourne, Vic, Australia
| | - Christopher M Reid
- Monash University, Melbourne, Vic, Australia; Curtin University, Perth, WA, Australia
| | - Dion Stub
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia; Baker IDI Heart Diabetes Institute, Melbourne, Vic, Australia
| | - Andrea Driscoll
- Monash University, Melbourne, Vic, Australia; Austin Health, Melbourne, Vic, Australia; Deakin University, Melbourne, Vic, Australia.
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Chan RK, Dinh DT, Hare DL, Lockwood S, Neil C, Prior D, Brennan A, Lefkovits J, Carruthers H, Reid CM, Driscoll A. Management of Acute Decompensated Heart Failure in Rural Versus Metropolitan Settings: An Australian Experience. Heart Lung Circ 2021; 31:491-498. [PMID: 34740540 DOI: 10.1016/j.hlc.2021.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/13/2021] [Accepted: 08/22/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Acute decompensated heart failure (ADHF) is the most common cause of hospital admission in patients over 65, with poorer outcomes demonstrated in rural versus metropolitan areas. The aim of this study was to compare the in-hospital and post-discharge management of ADHF patients admitted to rural versus metropolitan hospitals in Victoria. METHODS Data from the Victorian Cardiac Outcomes Registry, Heart Failure (VCOR-HF) project was used. This was a prospective, observational, non-randomised study of consecutive patients admitted to participating hospitals in Victoria, Australia, with ADHF as their primary diagnosis over four 30-day periods during consecutive years. All patients were followed up for 30 days post discharge. RESULTS 1,357 patients (1,260 metropolitan, 97 rural) were admitted to study hospitals with ADHF during the study periods. Cohorts were similar in age (average 76.87±13.12 years) and percentage of male gender (56.4% overall). Metropolitan patients were more likely to have diabetes (44.4% vs 34.0%, p=0.046), kidney disease (65.8% vs 37.1%, p<0.01) and anaemia (31.9% vs 19.6%, p=0.01). There was no significant difference in length of stay between metropolitan and rural patients (7.49 vs 6.37 days, p=0.12). There was no significant difference between metropolitan and rural patients in 30-day rehospitalisations (19.1% vs 11.6%, p=0.07, respectively) and all-cause 30-day mortality (8.2% vs 4.1%, p=0.15, respectively). Metropolitan patients were significantly more likely to have seen their general practitioner (GP) (68.1% vs 53.2%, p<0.01) or attend an outpatient clinic (35.9% vs 10.6%, p<0.01) by 30 days. There was no significant difference in number of days to follow-up of any kind between groups. Referrals to a heart failure home visiting program remained low overall (19.9%). CONCLUSION There was no significant difference in 30-day rehospitalisations or mortality between patients admitted to rural versus metropolitan hospitals. Geographical discrepancies were noted in follow-up by 30 days, with significantly more metropolitan patients having seen a doctor by 30 days post-discharge. Overall follow-up rates remain suboptimal.
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Affiliation(s)
- R Kimberley Chan
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia.
| | - Diem T Dinh
- Monash University, Melbourne, Vic, Australia
| | - David L Hare
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia
| | | | - Chris Neil
- University of Melbourne, Melbourne, Vic, Australia; Western Health, Melbourne, Vic, Australia
| | | | | | | | | | | | - Andrea Driscoll
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia; Deakin University, Melbourne, Vic, Australia
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van Gulik N, Hutchinson A, Considine J, Driscoll A, Malathum K, Botti M. Perceived roles and barriers to nurses' engagement in antimicrobial stewardship: A Thai qualitative case study. Infect Dis Health 2021; 26:218-227. [PMID: 33994163 DOI: 10.1016/j.idh.2021.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Antimicrobial stewardship is the practice of ensuring the optimal use of antibiotics to prevent antimicrobial resistance. A multidisciplinary approach is considered best practice; however, little is known about nurses' contribution. OBJECTIVES To explore how organisational multidisciplinary leaders and clinical nurses perceive nurses' roles in AMS in a single organisational site case study based in Thailand, within the current governance, educational and practice context, and the barriers to nurses' engagement in AMS. METHODS A qualitative descriptive study using thematic analysis approach was conducted in a 1000-bed university hospital in Bangkok, Thailand. The combined number of organisational leaders and nurses was 33 including 15 individual organisational leader interviews and three focus groups involving 18 nurses. RESULTS Nurses currently participate in AMS by supporting system processes, monitoring safety and optimal antibiotic use and patient education. A lack of clear articulation of nurses' role and traditional professional hierarchies limits active participation. Inconsistent engagement was perceived as due to a failure to prioritise AMS activities, a lack of formal policies and a need for further education. CONCLUSION Nurses do engage in AMS but there are significant governance, hierarchical and educational impediments. These gaps need to be addressed before clearly defined nurse roles in AMS can be developed and embedded into clinical practice.
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Affiliation(s)
- Nantanit van Gulik
- Ramathibodi School of Nursing, Mahidol University, Bangkok 10400, Thailand; Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
| | - Ana Hutchinson
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC 3220, Australia; Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Richmond, VIC 3121, Australia
| | - Julie Considine
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC 3220, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, VIC 3128, Australia
| | - Andrea Driscoll
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC 3220, Australia; Austin Health, Heidelberg, VIC 3084, Australia
| | - Kumthorn Malathum
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Mari Botti
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC 3220, Australia; Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Richmond, VIC 3121, Australia
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Lowe G, Tori K, Jennings N, Schiftan D, Driscoll A. Nurse practitioner work patterns: A cross-sectional study. Nurs Open 2021; 8:966-974. [PMID: 33434388 PMCID: PMC7877128 DOI: 10.1002/nop2.705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/16/2020] [Accepted: 10/28/2020] [Indexed: 11/18/2022] Open
Abstract
AIM The aim was to determine how nurse practitioner (NP) roles are translated into clinical practice across Victoria, Australia. This paper reports details about NP work patterns and scopes of practice across multiple clinical settings and geographic locations. DESIGN A quantitative survey design was used. A data abstraction tool, based on previous work, was adapted for this study. METHODS All NPs in one state of Australia were eligible to participate in the study and invited to complete an online survey about their NP practice. A previously developed data collection tool, capturing practice patterns of NPs, was adapted for online use in REDCAP. The data were exported, and descriptive statistics were analysed using SPSS. RESULTS Participants were mostly female, with males accounting for 25%. Findings indicate several NPs working in outpatient settings, community settings and forensic care. Patterns of practice-prescribing and ordering diagnostics-are associated with clinical context and model of care of the NP work.
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Affiliation(s)
- Grainne Lowe
- School of Nursing & MidwiferyCentre for Quality and Patient Safety ResearchDeakin UniversityBurwoodVic.Australia
| | | | | | - Dan Schiftan
- Department of Health and Human ServicesMelbourneVic.Australia
| | - Andrea Driscoll
- School of Nursing & MidwiferyCentre for Quality and Patient Safety ResearchDeakin UniversityBurwoodVic.Australia
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Le Grande MR, Jackson AC, Beauchamp A, Kerr D, Driscoll A. Diagnostic accuracy and suitability of instruments that screen for obstructive sleep apnoea, insomnia and sleep quality in cardiac patients: a meta-analysis. Sleep Med 2021; 86:135-160. [PMID: 33674192 DOI: 10.1016/j.sleep.2021.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/29/2021] [Accepted: 02/08/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND A number of clinical guidelines recommend that all cardiac rehabilitation patients should be screened for potential sleep disorders with a validated screening instrument. There is currently no consensus on what specific tools should be used. OBJECTIVE To identify tools that are practical to use in the clinical environment and have high diagnostic accuracy. METHODS We systematically searched online databases to identify patient reported outcome instruments that have been used in published research studies to assess the likelihood of obstructive sleep apnoea (OSA) in cardiac patients. In studies that provided diagnostic data, these data were extracted and verified via an evidence-based diagnostic calculator. Where sufficient numbers of studies were available, a meta-analysis was conducted to determine pooled estimates of specificity, sensitivity and diagnostic odds ratios. Selected papers were qualitatively assessed using the Standards for Reporting Diagnostic accuracy studies (STARD). RESULTS Of the 21 instruments identified, six detected likelihood of OSA, two assessed daytime sleepiness, five assessed insomnia and eight examined sleep quality. A meta-analysis of 14 studies that assessed diagnostic accuracy of moderate OSA, revealed moderate sensitivity for the Berlin Questionnaire, Sens = 0.49 (95% CI 0.45-0.52) and good sensitivity for the Stop-BANG, Sens = 0.93 (95% CI 0.87-0.96) but poor specificity at standard cut-off criteria. CONCLUSION There are promising practical tools available to screen patients with OSA and other sleep disorders in cardiac rehabilitation settings, but specificity could be improved. Additional assessment of sleep quality may enhance prognostic ability with both OSA and insomnia screening.
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Affiliation(s)
- Michael R Le Grande
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia; Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia; Melbourne Centre for Behaviour Change, School of Psychological Sciences, The University of Melbourne, Parkville, VIC, 3052, Australia.
| | - Alun C Jackson
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia; Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia; Centre on Behavioural Health, Hong Kong University, Pakfulam, Hong Kong
| | - Alison Beauchamp
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia; Department of Medicine - Western Health, The University of Melbourne, VIC, 3052, Australia; Australian Institute for Musculoskeletal Science (AIMSS), St. Albans, VIC, 3021, Australia; School of Rural Health, Monash University, Newborough, VIC, 3825, Australia
| | - Debra Kerr
- Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia
| | - Andrea Driscoll
- Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia; Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, VIC, 3220, Australia
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Mullan L, Wynter K, Driscoll A, Rasmussen B. Implementation strategies to overcome barriers to diabetes-related footcare delivery in primary care: a qualitative study. Aust J Prim Health 2021; 27:328-337. [PMID: 34229831 DOI: 10.1071/py20241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/05/2021] [Indexed: 11/23/2022]
Abstract
The aim of this study is to identify, from the perspectives of key health policy decision-makers, strategies that address barriers to diabetes-related footcare delivery in primary care, and outline key elements required to support implementation into clinical practice. The study utilised a qualitative design with inductive analysis approach. Seven key health policy decisions-makers within Australia were interviewed. Practical strategies identified to support provision and delivery of foot care in primary care were: (a) building on current incentivisation structures through quality improvement projects; (b) enhancing education and community awareness; (c) greater utilisation and provision of resources and support systems; and (d) development of collaborative models of care and referral pathways. Key elements reported to support effective implementation of footcare strategies included developing and implementing strategies based on co-design, consultation, collaboration, consolidation and co-commissioning. To the authors' knowledge, this is the first Australian study to obtain information from key health policy decision-makers, identifying strategies to support footcare delivery in primary care. Implementation of preventative diabetes-related footcare strategies into 'routine' primary care clinical practice requires multiparty co-design, consultation, consolidation, collaboration and co-commissioning. The basis of strategy development will influence implementation success and thus improve outcomes for people living with diabetes.
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Affiliation(s)
- Leanne Mullan
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Corresponding author.
| | - Karen Wynter
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Western Health Partnership, 176 Furlong Road, St Albans, Vic. 3021, Australia
| | - Andrea Driscoll
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia
| | - Bodil Rasmussen
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Western Health Partnership, 176 Furlong Road, St Albans, Vic. 3021, Australia; and Faculty of Health and Medical Sciences, Blegdamsvej 3B, 2200 Copenhagen, Denmark; and Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Campusvej 55, DK-5230 Odense M, Denmark
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Chan K, Dinh D, Hare D, Lockwood S, Neil C, Prior D, Brennan A, Lefkovits J, Carruthers H, Reid C, Driscoll A. Management of Acute Decompensated Heart Failure in Rural vs Metropolitan Settings: A Victorian Experience. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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32
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Mullan L, Wynter K, Driscoll A, Rasmussen B. Barriers and enablers to providing preventative and early intervention diabetes-related foot care: a qualitative study of primary care healthcare professionals' perceptions. Aust J Prim Health 2021; 27:319-327. [PMID: 33857402 DOI: 10.1071/py20235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/04/2021] [Indexed: 01/12/2023]
Abstract
This study explored the perceived healthcare system and process barriers and enablers experienced by GPs and Credentialled Diabetes Educators (CDEs) in Australian primary care, in the delivery of preventative and early intervention foot care to people with diabetes. A qualitative design with inductive analysis approach was utilised and reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ). Semi-structured interviews were conducted with two GPs and 14 CDEs from rural, urban and metropolitan areas of Australia. Participants were from New South Wales, South Australia, Victoria, Western Australia, the Northern Territory and Queensland. Barriers to providing foot care constituted five broad themes: (1) lack of access to footcare specialists and services; (2) education and training insufficiencies; (3) human and physical resource limitations related to funding inadequacies; (4) poor care integration such as inadequate communication and feedback across services and disciplines, and ineffectual multidisciplinary care; and (5) deficient footcare processes and guidelines including ambiguous referral pathways. Enablers to foot care were found at opposing ends of the same spectra as the identified barriers or were related to engaging in mentorship programs and utilising standardised assessment tools. This is the first Australian study to obtain information from GPs and CDEs about the perceived barriers and enablers influencing preventative and early intervention diabetes-related foot care. Findings offer an opportunity for the development and translation of effective intervention strategies across health systems, policy, funding, curriculum and clinical practice, in order to improve outcomes for people with diabetes.
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Affiliation(s)
- Leanne Mullan
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Corresponding author.
| | - Karen Wynter
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Western Health Partnership, 176 Furlong Road, St Albans, Burwood, Vic. 3021, Australia
| | - Andrea Driscoll
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia
| | - Bodil Rasmussen
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Western Health Partnership, 176 Furlong Road, St Albans, Burwood, Vic. 3021, Australia; and Faculty of Health and Medical Sciences, Blegdamsvej 3B, 2200 Copenhagen, Denmark; and Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Campusvej 55, DK-5230 Odense M, Denmark
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Driscoll A, Hinde S, Harrison A, Bojke L, Doherty P. Estimating the health loss due to poor engagement with cardiac rehabilitation in Australia. Int J Cardiol 2020; 317:7-12. [PMID: 32376418 DOI: 10.1016/j.ijcard.2020.04.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/07/2020] [Accepted: 04/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) programs are effective in reducing cardiovascular mortality and readmissions. However, most patients are denied the benefits of CR due to low referral rates. Of those patients referred, commencement rates vary from 28.4% to 60%. This paper quantifies the scale of health loss in Australia due to poor engagement with the program, and estimates how much public funding can be justifiably reallocated to address the problem. METHODS Economic decision modelling was undertaken to estimate the expected lifetime health loss and costs to Medicare. Key parameters were derived from Australian databases, CR registries and meta-analyses. Population health gains associated with uptake rates of 60%, and 85% were calculated. RESULTS CR was associated with a 99.9% probability of being cost-effective, even at a cost-effectiveness threshold lower than conventionally applied. Importantly, an average of 0.52 years of life expectancy are lost due to national uptake being below 60% achieved in some best performing programs in Australia, equivalent to 0.28 quality adjusted life years. The analysis indicates that $12.9 million/year could be justifiably reallocated from public funds to achieve a national uptake rate of 60%, while maintaining cost-effectiveness of CR due to the large health gains that would be expected. CONCLUSION CR is a cost-effective service for patients with coronary heart disease. In Australia, less than a third of patients commence CR, potentially resulting in avoidable patient harm. Additional investment in CR is vital and should be a national priority as the health gains for patients far outweigh the costs.
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Affiliation(s)
- A Driscoll
- Deakin University, School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, VIC 3220, Australia.; Austin Health, Dept of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia.
| | - S Hinde
- University of York, Centrefor Health Economics, Alcuin A Block, Heslington, York, YO105DD, UK
| | - A Harrison
- University of York, Department of Health Sciences, Seebohm Rowntree Building, Heslington, York YO105DD, UK
| | - L Bojke
- University of York, Centrefor Health Economics, Alcuin A Block, Heslington, York, YO105DD, UK
| | - P Doherty
- University of York, Department of Health Sciences, Seebohm Rowntree Building, Heslington, York YO105DD, UK
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Mullan L, Wynter K, Driscoll A, Rasmussen B. Prioritisation of diabetes-related footcare amongst primary care healthcare professionals. J Clin Nurs 2020; 29:4653-4673. [PMID: 32956503 DOI: 10.1111/jocn.15506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/09/2020] [Indexed: 01/22/2023]
Abstract
AIMS AND OBJECTIVES To assess primary healthcare professionals' priority for managing diabetic foot disease (DFD) over the progressive course of the condition compared to other aspects of diabetes care. BACKGROUND DFD affects up to 60 million people globally. Evidence suggests that comprehensive preventative footcare may reduce serious complications of DFD, such as amputation. DESIGN A cross-sectional quantitative study reported according to STROBE statement. METHODS General Practitioners (GPs) and Credentialled Diabetes Educators (CDEs) working within Australian primary care were invited to complete an online survey, to obtain information about preventative and early intervention footcare priorities and practices. Ten GPs and 84 CDEs completed the survey. RESULTS On diagnosis of type 2 diabetes, haemoglobin A1c (HbA1c) review was identified to be one of the top three priorities of care by 57 (61%) of participants whilst at 20-year history of diabetes 73 (78%) participants indicated its priority. Foot assessments became a priority for 78% (n = 73) of participants and podiatry referrals a priority for 53% (n = 50) of participants only when a "foot concern" was raised. Referrals to specialist high-risk foot podiatrists or services were a first priority for 56% (n = 53), when the person had significant amputation risk factors. CONCLUSION Diabetes-related preventative footcare assessments and management remain a low priority amongst primary healthcare professionals. Preventative care for asymptomatic complications, such as DFD, may be overlooked in favour of monitoring HbA1c or medication management. Limited prioritisation of footcare in primary care is concerning given the risks for amputation associated with DFD. RELEVANCE TO CLINICAL PRACTICE This study reveals the need for primary healthcare decision makers and clinicians to ensure preventative footcare is a focused priority earlier in the diabetes care continuum. Collaborative and widespread promotion of the importance of proactive rather than reactive footcare practices is required to support prevention of foot ulcers and amputation.
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Affiliation(s)
- Leanne Mullan
- Deakin University School of Nursing and Midwifery, Geelong, Vic., Australia
| | - Karen Wynter
- Deakin University School of Nursing and Midwifery, Geelong, Vic., Australia.,Centre for Quality and Patient Safety, Deakin University, Geelong, Australia.,Western Health Partnership, St. Albans, Vic., Australia
| | - Andrea Driscoll
- Deakin University School of Nursing and Midwifery, Geelong, Vic., Australia.,Centre for Quality and Patient Safety, Deakin University, Geelong, Australia
| | - Bodil Rasmussen
- Deakin University School of Nursing and Midwifery, Geelong, Vic., Australia.,Centre for Quality and Patient Safety, Deakin University, Geelong, Australia.,Western Health Partnership, St. Albans, Vic., Australia.,Faculty of Health and Medical Sciences, Copenhagen, Denmark.,Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Odense, Denmark
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Inglis SC, Naismith C, White K, Hendriks JM, Bray J, Hickman LD, Aldridge C, Bardsley K, Cameron J, Candelaria D, Cartledge S, Du H, Ferguson C, Martin L, Selkow T, Xu X, Wynne R, Driscoll A, Gallagher R, Clark R, Davidson PM. CSANZ COVID-19 Cardiovascular Nursing Care Consensus Statement: Executive Summary. Heart Lung Circ 2020; 29:1263-1267. [PMID: 32859539 PMCID: PMC7413197 DOI: 10.1016/j.hlc.2020.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Sally C Inglis
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Carolyn Naismith
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | | | - Jeroen M Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University; Centre for Heart Rhythm Disorders, University of Adelaide; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Janet Bray
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Louise D Hickman
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Chris Aldridge
- Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | | | - Jan Cameron
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Dion Candelaria
- Susan Wakil School of Nursing and Midwifery, & Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Susie Cartledge
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Huiyun Du
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Caleb Ferguson
- Western Sydney Nursing & Midwifery Research Centre, Western Sydney University & Western Sydney Local Health District, Blacktown Hospital, Sydney, NSW, Australia
| | - Lorelle Martin
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | | | - Xiaoyue Xu
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Rochelle Wynne
- Western Sydney Nursing & Midwifery Research Centre, Western Sydney University & Western Sydney Local Health District, Blacktown Hospital, Sydney, NSW, Australia; Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Geelong, Vic, Australia
| | - Andrea Driscoll
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Geelong, Vic, Australia; Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery, & Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Robyn Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Toner L, Koshy AN, Ko J, Driscoll A, Farouque O. Clinical Characteristics and Trends in Heart Failure Hospitalizations: An Australian Experience During the COVID-19 Lockdown. JACC Heart Fail 2020; 8:872-875. [PMID: 33004116 PMCID: PMC7418698 DOI: 10.1016/j.jchf.2020.05.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 12/04/2022]
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White-Williams C, Rossi LP, Bittner VA, Driscoll A, Durant RW, Granger BB, Graven LJ, Kitko L, Newlin K, Shirey M. Addressing Social Determinants of Health in the Care of Patients With Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e841-e863. [DOI: 10.1161/cir.0000000000000767] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Heart failure is a clinical syndrome that affects >6.5 million Americans, with an estimated 550 000 new cases diagnosed each year. The complexity of heart failure management is compounded by the number of patients who experience adverse downstream effects of the social determinants of health (SDOH). These patients are less able to access care and more likely to experience poor heart failure outcomes over time. Many patients face additional challenges associated with the cost of complex, chronic illness management and must make difficult decisions about their own health, particularly when the costs of medications and healthcare appointments are at odds with basic food and housing needs. This scientific statement summarizes the SDOH and the current state of knowledge important to understanding their impact on patients with heart failure. Specifically, this document includes a definition of SDOH, provider competencies, and SDOH assessment tools and addresses the following questions: (1) What models or frameworks guide healthcare providers to address SDOH? (2) What are the SDOH affecting the delivery of care and the interventions addressing them that affect the care and outcomes of patients with heart failure? (3) What are the opportunities for healthcare providers to address the SDOH affecting the care of patients with heart failure? We also include a case study (
Data Supplement
) that highlights an interprofessional team effort to address and mitigate the effects of SDOH in an underserved patient with heart failure.
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Le Grande MR, Beauchamp A, Driscoll A, Jackson AC. Prevalence of obstructive sleep apnoea in acute coronary syndrome patients: systematic review and meta-analysis. BMC Cardiovasc Disord 2020; 20:147. [PMID: 32209053 PMCID: PMC7092582 DOI: 10.1186/s12872-020-01430-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 03/12/2020] [Indexed: 12/26/2022] Open
Abstract
Background Obstructive Sleep Apnoea (OSA) has been recognised as a risk factor for cardiovascular diseases such as hypertension and cardiovascular events such as acute coronary syndrome (ACS). Since it is also known to reduce exercise tolerance, it is important to establish the prevalence of OSA in ACS patients, particularly in those who are commencing cardiac rehabilitation (CR) programs. Methods Using PRISMA guidelines a systematic search was conducted in order to identify studies that objectively measured (using polysomnography or portable monitoring) the prevalence of OSA in ACS patients following hospital admission. A data extraction table was used to summarise study characteristics and the quality of studies were independently assessed using the Joanna Briggs Institute Prevalence Critical Appraisal Tool. Meta-analysis of the selected studies was conducted in order to estimate OSA prevalence as a function of the two main methods of measurement, the severity of OSA, and timing of the OSA assessment following ACS hospital admission. Results Pooled prevalence estimates of OSA using the “gold standard” polysomnography ranged from 22% for severe OSA to 70% for mild OSA, at any time after hospital admission. Similar prevalence estimates were obtained using portable monitoring, but interpretation of these results are limited by the significant heterogeneity observed among these studies. Conclusions Prevalence of OSA following ACS is high and likely to be problematic upon patient entry into CR programs. Routine screening for OSA upon program entry may be necessary to optimise effectiveness of CR for these patients.
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Affiliation(s)
- Michael R Le Grande
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia. .,Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia. .,Melbourne Centre for Behaviour Change, School of Psychological Sciences, The University of Melbourne, Parkville, VIC, 3052, Australia.
| | - Alison Beauchamp
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia.,Department of Medicine -Western Health, The University of Melbourne, Parkville, VIC, 3052, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), St.Albans, VIC, 3021, Australia.,School of Rural Health, Monash University, Newborough, VIC, 3825, Australia
| | - Andrea Driscoll
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, VIC, 3220, Australia
| | - Alun C Jackson
- Australian Centre for Heart Health, 75 Chetwynd Street, North Melbourne, VIC, 3051, Australia.,Faculty of Health, Deakin University, Burwood, VIC, 3216, Australia.,Centre on Behavioural Health, Hong Kong University, Pakfulam, Hong Kong
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Hare DL, Stewart AG, Driscoll A, Mathews S, Toukhsati SR. Screening, Referral and Treatment of Depression by Australian Cardiologists. Heart Lung Circ 2020; 29:401-404. [DOI: 10.1016/j.hlc.2019.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/06/2019] [Indexed: 01/13/2023]
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Wynne R, McTier L, Kerr D, Rowe C, Abbs M, Driscoll A. 633 A Multi-Site Australian Study of Adult Cardiac Surgical Patients’ Health Literacy. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mullan L, Wynter K, Driscoll A, Rasmussen B. Preventative and early intervention diabetes-related foot care practices in primary care. Aust J Prim Health 2020; 26:161-172. [DOI: 10.1071/py19183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/01/2019] [Indexed: 01/11/2023]
Abstract
The aim of this study was to identify current preventative and early intervention diabetes-related foot care practices among Australian primary care healthcare professionals. A survey was developed to obtain information about preventative and early intervention foot care actions, priorities of care, access and referral to expert multidisciplinary foot care teams and adherence to best-practice diabetes-related foot care recommendations. The survey was distributed to GPs and Credentialled Diabetes Educators (CDEs). Surveys were completed by 10 GPs and 84 CDEs. Only 45% of all respondents reported removing the shoes and socks of their patients with diabetes at a consultation. Eighty-one percent of participants reported having access to specialist multidisciplinary foot care teams. Those in urban settings were significantly more likely to report access than those in rural areas (P=0.04). Median scores indicated that participants did not often utilise specialist teams to refer patients with diabetes-related foot ulceration and Charcot’s neuroarthropathy. Only 16% of participants reported having access to specialist foot care telehealth services; patients with diabetes-related foot ulceration and Charcot’s neuroarthropathy were rarely referred to these services. This study is the first Australian study to elicit information about preventative and early intervention diabetes-related foot care practices by GPs and CDEs working in Australian primary care. In the presence of acute diabetes-related foot complications, primary healthcare practitioners are not always adhering to best practice foot care recommendations. Further studies are required to understand the reasons for this and ensure evidence-based best practice foot care delivery to people with diabetes.
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Wynne R, McTier L, Rowe C, Kerr D, Driscoll A. 639 Patient Control Preferences Prior to Discharge After Cardiac Surgery. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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O'Neil A, Davis J, Mohebbi M, Voutilainen A, Virtanen J, Tuomainen T, Atherton J, Amerena J, Driscoll A, Hare D, Wittert G. 190 Urinary Sodium Concentration Predicts Time-to-Event Outcomes in Men With Heart Failure Over a 33-Year Period. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Currey J, Sprogis SK, Orellana L, Chander A, Meagher S, Kennedy R, Driscoll A. Specialty cardiac nurses' work satisfaction is influenced by the type of coronary care unit: A mixed methods study. BMC Nurs 2019; 18:42. [PMID: 31516383 PMCID: PMC6729056 DOI: 10.1186/s12912-019-0367-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 08/27/2019] [Indexed: 11/21/2022] Open
Abstract
Background Many dedicated Coronary Care Units (CCUs) in Victoria, Australia, have been decommissioned and replaced with larger combined generic medical/cardiac precincts called hybrid units. Hybrid units are staffed with a low proportion of specialist critical care nurses. These changes may pose risks to nurse satisfaction and retention, and quality of patient care. The aims of this study were to explore specialist cardiac nurses’ perceived work satisfaction across four CCUs, and differences in satisfaction between dedicated and hybrid CCUs. Methods This concurrent mixed methods study comprised two Phases in four Victorian CCUs (2 dedicated, 2 hybrid). In Phase 1, 74 specialist cardiac nurses completed the Professional Practice Environment (PPE) Scale. In Phase 2, 17 specialist cardiac nurses were interviewed to further explore elements of the PPE subscales. Descriptive, inferential (Phase 1), and content analyses (Phase 2) were performed. Results Survey participants’ median age was 38 years (IQR 30, 45). The median PPE Scale score was 3.10 (IQR 2.90, 3.10) indicating high levels of satisfaction with their workplaces. Specialist cardiac nurses in one hybrid unit were significantly less satisfied compared with each of the other three units (p < 0.05). There were no significant differences in overall satisfaction or in any subscale of the PPE Scale between dedicated and hybrid units. Qualitative data revealed nurses in hybrid units felt they had less control over practice, lacked autonomy, had poor relationships with physicians, and experienced inadequate nurse leadership. Conclusions Specialist cardiac nurses’ workplace satisfaction overall is high, with no significant differences between dedicated and hybrid CCUs. However, the structure of specialist cardiac units and NUM leadership skill level can impact nurses’ satisfaction with their workplace and collegial relationships. Strong nursing leadership that is respectful of nursing expertise and places patient safety foremost positively impacts nurses’ satisfaction. Further studies should assess the impact of the types of CCUs and NUM leadership on workforce factors such as nurse retention rates and patient outcomes such as adverse events.
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Affiliation(s)
- Judy Currey
- 1School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220 Australia.,2Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220 Australia.,3Deakin Learning Futures, Office of the Deputy Vice Chancellor (Education), Deakin University, 1 Gheringhap Street, Geelong, VIC 3220 Australia
| | - Stephanie K Sprogis
- 1School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220 Australia.,Centre for Quality and Patient Safety Research - Eastern Health Partnership, 2/5 Arnold Street, Box Hill, VIC 3128 Australia
| | - Liliana Orellana
- 5Biostatistics Unit, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220 Australia
| | - Anusha Chander
- 1School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220 Australia
| | - Sharon Meagher
- 1School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220 Australia
| | - Rhoda Kennedy
- 1School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220 Australia
| | - Andrea Driscoll
- 1School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220 Australia.,2Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220 Australia
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Gonzalez Garcia M, Fatehi F, Bashi N, Varnfield M, Iyngkaran P, Driscoll A, Neil C, Hare DL, Oldenburg B. A Review of Randomized Controlled Trials Utilizing Telemedicine for Improving Heart Failure Readmission: Can a Realist Approach Bridge the Translational Divide? Clin Med Insights Cardiol 2019; 13:1179546819861396. [PMID: 31316270 PMCID: PMC6620724 DOI: 10.1177/1179546819861396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/04/2019] [Indexed: 12/28/2022]
Abstract
Background: Telemedicine and digital health technologies hold great promise for improving clinical care of heart failure. However, inconsistent and contradictory findings from randomized controlled trials have so far discouraged widespread adoption of digital health in routine clinical practice. We undertook this review study to summarize the study outcomes of the use of exploring the evidence for telemedicine in the clinical care of patients with heart failure and readmissions. Methods: We inspected the references of guidelines and searched PubMed for randomized controlled trials published over the past 10 years on the use of telemedicine for reducing readmission in heart failure. We utilized a modified realist review approach to identify the underlying contextual mechanisms for the intervention(s) in each randomized controlled trial, evaluating outcomes of the intervention and understanding how and under what conditions they worked. To provide uniformity, all extracted data were synthesized using adapted domains from the taxonomy for disease management created by the Disease Management Taxonomy Writing Group. Results: A total of 12 papers were eligible, 6 of them supporting and 6 others undermining the use of telemedicine for improving heart failure readmission. In general terms, those studies not supporting the use of telemedicine were multicentre, publicly funded, with large amount of participants, and long duration. The patients had also better rates of treatment with angiotensin-converting enzyme inhibitors/angiotensin II receptor blocker and beta-blockers, and telemonitoring and automatic transmission of vital signs were less utilized, in comparison with the studies in which telemedicine use was supported. The analysis of the environment, intensity, content of interventions, method of communication, quality of the underlying model of care and the ability, capability, and interest from health workers can help us to envisage probabilities of success of telemedicine use. Conclusions: A realist lens may aid to understand whom and in which circumstances the use of telemedicine can add any substantial value to traditional models of care. Wider outcome criteria beyond major adverse cardiovascular events, for example, cost efficacy, should also be considered as appropriate for effecting guidelines on care delivery when robust prognostic therapeutics already exist.
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Affiliation(s)
- Manuel Gonzalez Garcia
- Australian eHealth Research Centre, CSIRO, Brisbane, QLD, Australia.,Heart Centre, University Hospital of Umeå, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Farhad Fatehi
- Australian eHealth Research Centre, CSIRO, Brisbane, QLD, Australia.,Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Tehran University of Medical Sciences, Tehran, Iran
| | - Nazli Bashi
- Australian eHealth Research Centre, CSIRO, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | | | | | - Andrea Driscoll
- School of Nursing and Midwifery, Deakin University and Austin Health, Geelong, VIC, Australia
| | - Christopher Neil
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, VIC, Australia
| | - David L Hare
- The University of Melbourne, Austin Health, Melbourne, VIC, Australia
| | - Brian Oldenburg
- WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
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Toukhsati SR, Jaarsma T, Babu AS, Driscoll A, Hare DL. Self-Care Interventions That Reduce Hospital Readmissions in Patients With Heart Failure; Towards the Identification of Change Agents. Clin Med Insights Cardiol 2019; 13:1179546819856855. [PMID: 31217696 PMCID: PMC6563392 DOI: 10.1177/1179546819856855] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/17/2019] [Indexed: 12/12/2022]
Abstract
Unplanned hospital readmissions are the most important, preventable cost in heart failure (HF) health economics. Current professional guidelines recommend that patient self-care is an important means by which to reduce this burden. Patients with HF should be engaged in their care such as by detecting, monitoring, and managing their symptoms. A variety of educational and behavioural interventions have been designed and implemented by health care providers to encourage and support patient self-care. Meta-analyses support the use of self-care interventions to improve patient self-care and reduce hospital readmissions; however, efficacy is variable. The aim of this review was to explore methods to achieve greater clarity and consistency in the development and reporting of self-care interventions to enable ‘change agents’ to be identified. We conclude that advancement in this field requires more explicit integration and reporting on the behaviour change theories that inform the design of self-care interventions and the selection of behaviour change techniques. The systematic application of validated checklists, such as the Theory Coding Scheme and the CALO-RE taxonomy, will improve the systematic testing and refinement of interventions to enable ‘change agent/s’ to be identified and optimised.
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Affiliation(s)
- S R Toukhsati
- School of Health and Life Sciences, Psychology, Federation University Australia, Berwick, VIC, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia.,Department of Cardiology, Austin Health, Heidelberg, VIC, Australia
| | - T Jaarsma
- Faculty of Health Sciences, University of Linköping, Linköping, Sweden.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - A S Babu
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia.,Department of Cardiology, Austin Health, Heidelberg, VIC, Australia.,Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India
| | - A Driscoll
- Department of Cardiology, Austin Health, Heidelberg, VIC, Australia.,School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
| | - D L Hare
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia.,Department of Cardiology, Austin Health, Heidelberg, VIC, Australia
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Driscoll A, Dinh D, Wong J, Toogood G, Hopper I, Zimmet H, Brennan A, Lefkovits J, Carruthers H, Mariani J, Connor H, Reid C. Adherence to Guideline Directed Medical Therapy of Patients Admitted to Hospital with Acute Heart Failure. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mullan L, Driscoll A, Wynter K, Rasmussen B. Barriers and enablers to delivering preventative and early intervention footcare to people with diabetes: a scoping review of healthcare professionals' perceptions. Aust J Prim Health 2019; 25:517-525. [DOI: 10.1071/py19115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/04/2019] [Indexed: 11/23/2022]
Abstract
The aim of this study is to examine barriers and enablers to delivering preventative and early intervention footcare to people with diabetes, from the perspective of healthcare professionals within primary care. MEDLINE, CINAHL and Scopus databases, as well as Google Scholar, were searched in September 2018. Inclusion criteria included: English language, qualitative and quantitative studies, since 1998, reporting on barriers or enablers, as reported by primary care health professionals, to delivering preventative or early intervention footcare to people with diabetes. In total, 339 studies were screened. Eight studies met criteria. Perceived barriers to providing footcare included: geographical, administrative and communication factors; referral and care guideline availability and implementation challenges; limited availability of specialists and high-risk foot services; and limited resources including time and funding. Enablers to footcare were: implementation of footcare programs; education; clear definition of staff roles; development of foot assessment reminder systems; and reminders for people with diabetes to remove their shoes at appointments. Barriers and enablers to footcare are multifaceted. Healthcare professionals are affected by health system and individual factors. By implementing strategies to address barriers to footcare delivery, it is possible to improve outcomes for people with diabetes, thus reducing the effect of diabetes-related foot disease.
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Iyngkaran P, Liew D, Neil C, Driscoll A, Marwick TH, Hare DL. Moving From Heart Failure Guidelines to Clinical Practice: Gaps Contributing to Readmissions in Patients With Multiple Comorbidities and Older Age. Clin Med Insights Cardiol 2018; 12:1179546818809358. [PMID: 30618487 PMCID: PMC6299336 DOI: 10.1177/1179546818809358] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 09/14/2018] [Indexed: 12/20/2022]
Abstract
This feature article for the thematic series on congestive heart failure (CHF) readmissions aims to outline important gaps in guidelines for patients with multiple comorbidities and the elderly. Congestive heart failure diagnosis manifests as a 3-phase journey between the hospital and community, during acute, chronic stable, and end-of-life (palliative) phases. This journey requires in variable intensities a combination of multidisciplinary care within tertiary hospital or ambulatory care from hospital outpatients or primary health services, within the general community. Management goals are uniform, ie, to achieve the lowest New York Heart Association class possible, with improvement in ejection fraction, by delivering gold standard therapies within a CHF program. Comorbidities are an important common denominator that influences outcomes. Comorbidities include diabetes mellitus, chronic obstructive airways disease, chronic renal impairment, hypertension, obesity, sleep apnea, and advancing age. Geriatric care includes the latter as well as syndromes such as frailty, falls, incontinence, and confusion. Many systems still fail to comprehensively achieve all aspects of such programs. This review explores these factors.
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Affiliation(s)
- Pupalan Iyngkaran
- Northern Territory Medical Program, Flinders University, Darwin, NT, Australia
- Pupalan Iyngkaran, Yellow Building 4 Cnr University Drive North & University Drive West Charles Darwin University, Casuarina, NT 0815, Australia.
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christopher Neil
- Department of Medicine—Western Precinct, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrea Driscoll
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
- Austin Health, Melbourne, VIC, Australia
| | | | - David L Hare
- Cardiovascular Research, The University of Melbourne, Melbourne, VIC, Australia
- Heart Failure Services, Austin Health, Melbourne, VIC, Australia
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Wressell JA, Rasmussen B, Driscoll A. Exploring the workplace violence risk profile for remote area nurses and the impact of organisational culture and risk management strategy. Collegian 2018. [DOI: 10.1016/j.colegn.2018.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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