None listed
Conditions
Brief summary
The ageing population and the success of treating previously fatal acute cardiac disease has led to an ongoing epidemic of heart failure. Given the status of this diagnosis as a component of overall health costs, controlling HF readmission represents a significant component of controlling hospital expenditure in the coming years. Furthermore, the lessons learned from a successful partnership approach to integration of hospital and community services will inform similar approaches to other chronic diseases including chronic lung disease and diabetes. In the current context, success of this program will have wide reaching implications for service delivery nationally and internationally. This randomized trial will provide the information with which to make evidence-based decisions about improved transfer of HF to community care and improved systems of community maintenance. This Partnership seeks to provide the necessary steps in system re-design to overcome identified problems. Specifically, the research-specific outcomes from this project will be to define where best to invest community resources for the management of heart failure, how to improve hospital and primary care integration in the management of this condition, how to identify early deteriorations and keep patients at home, reduce hospitalisations and save money.
Interventions
This approach will involve the following deviations from standard practice:
1. Pre-discharge
- 1a. Discussion and assessment of palliative care needs. This will be performed by the physician or nurse on the care team, prompted by study co-ordinator;
- 1b. Echocardiography (including pulmonary imaging) and/or BNP to ensure that the patient is as close as possible to euvolaemic before discharge. This will be performed by the physician or sonographer, prompted by study co-ordinator;
This approach will involve the following deviations from standard practice: 1. Pre-discharge - 1a. Discussion and assessment of palliative care needs. This will be performed by the physician or nurse on the care team, prompted by study co-ordinator; - 1b. Echocardiography (including pulmonary imaging) and/or BNP to ensure that the patient is as close as possible to euvolaemic before discharge. This will be performed by the physician or sonographer, prompted by study co-ordinator; - 1c. Assessment of risk based on clinical, cognitive and psychosocial factors. Clinical data will include patient history, medications, physical measurements, blood tests, and findings on echocardiography. Nonclinical data included age, sex, language background, marital status, living alone or with others, education, socioeconomic status, remoteness index (differentiating residence in a metropolitan, rural, or remote area of Australia), medical insurance, and any home health care services provided. Questionnaires used for data collection included the Montreal Cognitive Assessment (MoCA), Patient Health Questionnaire (PHQ-9), and Generalized Anxiety Disorder (GAD-7). This was obtained by the study co-ordinator and communicated to the heart failure nurse. 2. Transition care - A heart failure nurse who will follow the patient as both an inpatient and outpatient and act as a ’transition coach‘ to visit the patient in the hospital prior to discharge and ensure appropriate medication reconciliation, follow-up plans, and education. 3. Follow-up –The heart failure nurse will provide at least two calls (telephone and home visit) within the first 30 days to provide post-discharge support. Surveillance over the next year will involve calls and/or home visits, monthly over the 1st 3 months, with frequency determined by the risk and status of the patient thereafter. Telemonitoring of weight and vital signs if needed. Assistance will be provided to maximize the likelihood of up-titration of medications. 4. The heart failure nurse will be the first contact for changes in patient status and liaise with the cardiologists or Emergency Department (ED) if review rather than admission is needed; 5. Action plan - Provision of clear instructions to patients and caretakers regarding personalized actions to take when weight or symptoms change.
Sponsors
University of Tasmania
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Admission to hospital with heart failure
Exclusion criteria
- Unable to provide written informed consent to participate in this study - Participating in another clinical research trial where randomized treatment would be unacceptable - Moderate or worse primary mitral or aortic valve disease - Any HF admission within the last 6 months - Concomitant unstable angina, acute myocardial infarction - Device malfunction, endocarditis - Patients with LVAD - Potentially reversible LV dysfunction – post-partum, alcoholic cardiomyopathy, hyperthyroidism - Concomitant terminal non-cardiac illnesses that could influence 12 month prognosis (e.g. advanced malignancy), - Inability to acquire interpretable images (identified from baseline echo)
Outcome results
None listed