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

Driscoll, Andrea, Tonkin, Andrew, Stewart, Andrew, Worrall-Carter, Linda, Thompson, David R., Riegel, Barbara, Hare, David L., Davidson, Patricia M, Mulvany, Christine and Stewart, Simon 2013, Complexity of management and health outcomes in a prospective cohort study of 573 heart failure patients in Australia : does more equal less?, Journal of clinical nursing, vol. 22, no. 11-12, pp. 1629-1638, doi: 10.1111/jocn.12073.

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Title Complexity of management and health outcomes in a prospective cohort study of 573 heart failure patients in Australia : does more equal less?
Author(s) Driscoll, AndreaORCID iD for Driscoll, Andrea
Tonkin, Andrew
Stewart, Andrew
Worrall-Carter, Linda
Thompson, David R.
Riegel, Barbara
Hare, David L.
Davidson, Patricia M
Mulvany, Christine
Stewart, Simon
Journal name Journal of clinical nursing
Volume number 22
Issue number 11-12
Start page 1629
End page 1638
Total pages 10
Publisher Wiley
Place of publication Oxford, England
Publication date 2013-06
ISSN 0962-1067
Keyword(s) disease management
heart failure
hart failure programmes
quality score
Summary 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.
Language eng
DOI 10.1111/jocn.12073
Field of Research 110201 Cardiology (incl Cardiovascular Diseases)
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2013, Wiley
Persistent URL

Document type: Journal Article
Collection: School of Nursing and Midwifery
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Created: Tue, 21 May 2013, 13:38:48 EST by Jane Moschetti

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