Bronagh Travers

Elimination of early rehospitalization in a randomized, controlled trial of multidisciplinary care in a high-risk, elderly heart failure population: the potential contributions of specialist care, clinical stability and optimal angiotensin-converting enzyme inhibitor dose at discharge.

Despite a growing body of data demonstrating the benefits of multidisciplinary care in heart failure, persistently high rates of readmission, especially within the first month of discharge, continue to be documented.

Is multidisciplinary care of heart failure cost‐beneficial when combined with optimal medical care?

Multidisciplinary care (MDC) of heart failure (HF) can significantly reduce rates of unplanned hospitalisation, the major cost component of HF care.

Heart failure care in a hospital unit: a comparison of standard 3-month and extended 6-month programs.

We have previously shown that a structured in‐hospital and outpatient heart failure (HF) program reduces clinical events over a 3‐month period following hospital discharge.

Specialist care of heart failure improves appropriate pharmacotherapy at the expense of greater polypharmacy and drug-interactions.

There is growing concern at the nature and extent of polypharmacy in heart failure (HF), which may be associated with increased drug interactions, adverse drug effects and a poor understanding of and compliance with therapy.

Can individualized weight monitoring using the HeartPhone algorithm improve sensitivity for clinical deterioration of heart failure

Previous studies have demonstrated poor sensitivity of guideline weight monitoring in predicting clinical deterioration of heart failure (HF). This study aimed to evaluate patterns of remotely transmitted daily weights in a high‐risk HF population and also to compare guideline weight monitoring and an individualized weight monitoring algorithm.

Specialist Nurse Supervised In-Hospital Titration to Target Dose ACE Inhibitor – Is It Safe and Feasible in a Community Heart Failure Population?

BACKGROUND: Recently published guidelines from the ESC and practical recommendations from an international group of experts support the up-titration of ACE inhibitors at 1- to 2-week intervals. Observance of these guidelines could contribute to the under-dosing of ACE inhibitors at discharge in patients admitted with heart failure. Specialist heart failure nurse supervision of ACE inhibitor titration during the in-hospital stay could be a safe and effective means of avoiding this problem. OBJECTIVE: This observational study examines the feasibility of specialist heart failure nurse supervised rapid titration of ACE inhibition to at least target dose in sequential, class IV heart failure patients admitted to the cardiology service with left ventricular failure and not previously treated with an ACE inhibitor. METHODS: Fifty-two patients (mean age 71.9±11.6 years) were initiated on perindopril and titrated to maximally tolerated dose during the in-hospital phase. Indices of renal function (creatinine, urea, potassium) and systolic blood pressure were observed at baseline and at discharge from hospital and at 3 months. Lengths of stay and titration intervals were recorded. RESULTS: The mean length of stay was 10.3±7.7 days and 98% of patients achieved at least target dose of perindopril before discharge. The average time to titration to final dose was 5.5±4.2 days. Systolic blood pressure decreased significantly from 132±28 mmHg on admission to 117±18 mmHg on discharge. Mean baseline urea, creatinine and potassium did not change from admission to discharge (urea 8.4±2.5 to 9.2±3.9 mmol/l, P=0.15; creatinine 122.7±30.3 to 122.4±35.4 μmol/l, P=0.93; potassium 4.0±0.5 to 4.0±0.3 mEq/l, P=0.86). No significant changes were observed in these parameters at 12 weeks. There were no recorded incidences of symptomatic hypotension or progressive renal dysfunction even in patients (n=25) with evidence of chronic renal impairment (creatinine >120 μmol/l). CONCLUSIONS: Specialist heart failure nurse supervised initiation and rapid in-hospital titration of ACE inhibitor to at least target dose is feasible and safe in a severe heart failure population admitted with class IV heart failure. Routine application of this approach may help avoid under-dosing of ACE inhibitors without increasing length of hospital stay, and may reduce outpatient visits to heart failure clinics for titration.

Multidisciplinary Care of Heart Failure: What Have We Learned and Where Can We Improve?

The last two decades have witnessed significant advances in the management of heart failure. Patients enrolled in the active arms of clinical trials of vasodilator therapy, ACE inhibitors, beta blockers, spironolactone and devices such as Automatic Implantable Cardioverter Defibrilators and biventricular pacing units have experienced significant improvements in morbidity and yor mortality w1–3x. However, translation of these benefits into the routine heart failure community remains a major problem. As a result, two distinct populations of heart failure patients have emerged: a trial population showing ever-increasing benefits of improved therapy and the much larger community population where therapy is ineffectively prescribed, patient understanding is poor and follow-up is unstructured w4x. In short, the improved understanding of the pathophysiology of heart failure has not been mirrored by the development of the necessary care structures for this problem.

The St Vincent's potentially inappropriate medicines study: development of a disease-specific consensus list and its evaluation in ambulatory heart failure care

Heart failure (HF) patients may be at risk of prescription of potentially inappropriate medicines (PIMs) yet no disease‐specific list is available to assess PIM use in this population. A Consensus Potentially Inappropriate Medicines in Heart Failure (PIMHF) list was developed, assessed, and compared with an established, general tool in an ambulatory HF population.

Heart Failure Virtual Consultation: bridging the gap of heart failure care in the community ‐ A mixed‐methods evaluation

We undertook a mixed‐methods evaluation of a Web‐based conferencing service (virtual consult) between general practitioners (GPs) and cardiologists in managing patients with heart failure in the community to determine its effect on use of specialist heart failure services and acceptability to GPs.

Heart Failure Virtual Consultation: bridging the gap of heart failure care in the community - A mixed-methods evaluation: Virtual heart failure consultation

We undertook a mixed‐methods evaluation of a Web‐based conferencing service (virtual consult) between general practitioners (GPs) and cardiologists in managing patients with heart failure in the community to determine its effect on use of specialist heart failure services and acceptability to GPs.