Susan Hales

Symptom patterns, duration and responses in newly diagnosed patients with heart failure

This study investigated the symptom patterns and duration and associated predictors occurring prior to first heart failure (HF) admission. Data from the Managing Cardiac Function (MACARF) program from January to December 2007 were reviewed in relation to preadmission symptoms and contacts with health professionals. Patients (n = 242) were aged 78.7 years (SD 12 years), male (54%) and married (45%). Patients experienced up to seven symptoms (Mean 2.7, SD 1.4) for a median of 4.47 days (range 1-7) before admission, most commonly increased dyspnoea on exertion (88%), and for the shortest duration chest discomfort. Less than half (48%) contacted a health professional before hospitalization, most often a general practitioner (37%). The duration patients experienced before presenting to hospital was increased if they presented during business hours (beta = 2.68) or the evening (beta = 1.88) (and therefore less from midnight to 8:30 am), or with a change in symptom (beta = 1.4), whereas duration was reduced by chest discomfort (beta = -2.01) and older age (beta = -0.07). There is a significant time window during which patients and health professionals may detect and act on worsening HF symptoms. Newly diagnosed patients with HF need support to recognize and respond to these symptoms to avoid hospital admission.

Quality of life, social support and cognitive impairment in heart failure patients without diagnosed dementia.

Improving health-related quality of life (HRQL) is an important goal for heart failure (HF) patients, and understanding the factors that influence HRQL is essential to this process. We investigated the influence of social support and cognitive impairment on HRQL in community dwelling HF patients (n = 104) without diagnosed dementia. Patients were aged mean 80.93 years (SD 11.01) and were classified as New York Heart Association Class 1/II (45%) or III/IV (53%). Age, social support and cognition had important independent effects. Younger people had the most negative effects of HF in all areas of HRQL: emotional (B = -0.32), physical (B = -0.44) and overall (B = -1). Well-supported patients (general social support) had the least negative effect from HF on HRQL: emotional domain (B = -4.62) and overall (B = -11.72). Patients with normal cognition had more negative impact of HF on HRQL: physical domain (B = 5.51) and overall HRQL (B = 10.42). A clearer understanding of the relationships between age, social support and cognition and the effect on the impact of HF on HRQL is needed before interventions can be appropriately developed.

Predictors of Frequent Readmissions in Patients With Heart Failure

BACKGROUND Patients with heart failure (HF) have a high incidence of hospital readmissions. However risk models that explore predictors of a single readmission may be less useful at identifying the patients with frequent readmissions who contribute to a disproportionately large proportion of morbidity and health care costs. METHODS A total of 6252 patients enrolled in the Management of Cardiac Failure Program (MACARF) in Northern Sydney Area Hospitals between 1998 and 2015 were randomly divided into derivation and validation cohorts to create and test a risk model for predictors of ≥2 readmissions or death within 1year of initial hospitalisation for HF. RESULTS Multivariate predictors of frequent (≥2) readmissions or death were a history of ischaemic heart disease and chronic kidney disease, being unmarried, having anaemia, low serum albumin, elevated creatinine, prolonged hospital stay (>7 days), and not receiving beta blockers on discharge. Event rates increased with a higher risk score (p<0.001) and the prediction was similar in the validation and derivation cohorts (p=0.588). The C-statistic was 0.65. CONCLUSIONS Our risk score may assist in focussing health care resources and interventions by identifying the subset of HF patients at increased risk for a disproportionately high burden of disease.

Titration of ACE Inhibitors and Beta Blockers in a Heart Failure Population

Background: Angiotensin converting enzyme (ACE) inhibitors and Beta blockers (BB) reduce hospitalisation and mortality in systolic heart failure (HF). While drug initiation has improved, titration to target doses remains suboptimal. Aims:We investigated the frequency and determinants of uptitration of ACE and (ARB) and BB 6 months postHF admission (January–June 2009) in the Management of Cardiac Function (MACARF) program patients. Methods: Of 155 patients, 116 (75%) were discharged on ACE/ARB and 98 (63%) on a BB. For this analysis, we excluded those at target dose at hospital discharge, EF> 40%, or those who died prior to 6 months.