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.

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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, 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
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 http://hdl.handle.net/10536/DRO/DU:30052571

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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