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

Driscoll, A; Tonkin, A; Stewart, A; Worrall-Carter, L; Thompson, DR; Riegel, B; Hare, DL; Davidson, PM; Mulvany, C; Stewart, S

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

Driscoll, A Tonkin, A Stewart, A Worrall-Carter, L Thompson, DR Riegel, B Hare, DL Davidson, PM

Mulvany, C Stewart, S

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Publication Type:: Journal Article
Citation:: Journal of Clinical Nursing, 2013, 22 (11-12), pp. 1629 - 1638
Issue Date:: 2013-06-01

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Field	Value	Language
dc.contributor.author	Driscoll, A	en_US
dc.contributor.author	Tonkin, A	en_US
dc.contributor.author	Stewart, A	en_US
dc.contributor.author	Worrall-Carter, L	en_US
dc.contributor.author	Thompson, DR	en_US
dc.contributor.author	Riegel, B	en_US
dc.contributor.author	Hare, DL	en_US
dc.contributor.author	Davidson, PM https://orcid.org/0000-0003-2050-1534	en_US
dc.contributor.author	Mulvany, C	en_US
dc.contributor.author	Stewart, S	en_US
dc.date.available	2012-09-06	en_US
dc.date.issued	2013-06-01	en_US
dc.identifier.citation	Journal of Clinical Nursing, 2013, 22 (11-12), pp. 1629 - 1638	en_US
dc.identifier.issn	0962-1067	en_US
dc.identifier.uri	http://hdl.handle.net/10453/27647
dc.description.abstract	Aims and objectives: To compare the efficacy of chronic heart failure management programmes (CHF-MPs) according to a scoring algorithm used to quantify the level of applied interventions-the Heart Failure Intervention Score (HF-IS). Background: The overall efficacy of heart failure programmes has been proven in several meta-analyses. However, the debate continues as to which components are essential in a heart failure programme to improve patient outcomes. Design: Prospective cohort study of patients participating in heart failure programmes. Method: Forty-eight of 62 (77%) programmes in Australia participating in a national register of CHF-MPs were evaluated using the HF-IS: derived from a summed and weighted score of each intervention applied by the CHF-MP (27 interventions overall). The CHF-MPs were prospectively categorised as relatively low (HF-IS < 190 - n = 39 programmes & 407 patients) or high (HF-IS ≥ 190 - n = 9 programmes & 166 patients) in complexity. Six-month morbidity and mortality rates in 573 consecutively recruited patients with systolic dysfunction and in New York Heart Association Class II-IV were prospectively examined. Results: Patients exposed to CHF-MPs with a high HF-IS had a lower rate of unplanned, all-cause hospitalisation (n = 24, 14% vs. n = 102, 25%) compared with CHF-MPs with a low HF-IS within six months. On an adjusted basis, CHF-MPs with a high HF-IS were associated with a reduced risk of unplanned hospitalisation and/or death within six months and remained event-free longer. Conclusion: High complexity CHF-MPs applying more evidence-based interventions are associated with a higher event-free survival over six months. Relevance to clinical practice: The HF-IS is an easy-to-use evidence-based tool to assist programme coordinators to improve the quality of their heart failure programme which may also improve patient outcomes. © 2013 Blackwell Publishing Ltd.	en_US
dc.relation.ispartof	Journal of Clinical Nursing	en_US
dc.relation.isbasedon	10.1111/jocn.12073	en_US
dc.subject.classification	Nursing	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Registries	en_US
dc.subject.mesh	Prospective Studies	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Aged, 80 and over	en_US
dc.subject.mesh	Middle Aged	en_US
dc.subject.mesh	Australia	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Heart Failure	en_US
dc.title	Complexity of management and health outcomes in a prospective cohort study of 573 heart failure patients in Australia: Does more equal less?	en_US
dc.type	Journal Article
utslib.citation.volume	11-12	en_US
utslib.citation.volume	22	en_US
utslib.for	1110 Nursing	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	1701 Psychology	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Nursing
utslib.copyright.status	closed_access
pubs.issue	11-12	en_US
pubs.publication-status	Published	en_US
pubs.volume	22	en_US

Abstract:

Aims and objectives: To compare the efficacy of chronic heart failure management programmes (CHF-MPs) according to a scoring algorithm used to quantify the level of applied interventions-the Heart Failure Intervention Score (HF-IS). Background: The overall efficacy of heart failure programmes has been proven in several meta-analyses. However, the debate continues as to which components are essential in a heart failure programme to improve patient outcomes. Design: Prospective cohort study of patients participating in heart failure programmes. Method: Forty-eight of 62 (77%) programmes in Australia participating in a national register of CHF-MPs were evaluated using the HF-IS: derived from a summed and weighted score of each intervention applied by the CHF-MP (27 interventions overall). The CHF-MPs were prospectively categorised as relatively low (HF-IS < 190 - n = 39 programmes & 407 patients) or high (HF-IS ≥ 190 - n = 9 programmes & 166 patients) in complexity. Six-month morbidity and mortality rates in 573 consecutively recruited patients with systolic dysfunction and in New York Heart Association Class II-IV were prospectively examined. Results: Patients exposed to CHF-MPs with a high HF-IS had a lower rate of unplanned, all-cause hospitalisation (n = 24, 14% vs. n = 102, 25%) compared with CHF-MPs with a low HF-IS within six months. On an adjusted basis, CHF-MPs with a high HF-IS were associated with a reduced risk of unplanned hospitalisation and/or death within six months and remained event-free longer. Conclusion: High complexity CHF-MPs applying more evidence-based interventions are associated with a higher event-free survival over six months. Relevance to clinical practice: The HF-IS is an easy-to-use evidence-based tool to assist programme coordinators to improve the quality of their heart failure programme which may also improve patient outcomes. © 2013 Blackwell Publishing Ltd.

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http://hdl.handle.net/10453/27647