Search

Background: Heart failure (HF) is a complex syndrome associated with high morbidity and mortality and increased health care use. Patient education is key to improving health outcomes, achieved by promoting self-management to optimize medical management. Newer digital tools like SMS text messaging and smartphone apps provide novel patient education approaches., Objective: This study aimed to partner with clinicians and people with lived experience of HF to identify the priority educational topic areas to inform the development and delivery of a bank of electronic-message driven tips (e-TIPS) to support HF self-management., Methods: We conducted 3 focus groups with cardiovascular clinicians, people with lived experience of HF, and their caregivers, which consisted of 2 stages: stage 1 (an exploratory qualitative study to identify the unmet educational needs of people living with HF; previously reported) and stage 2 (a co-design feedback session to identify educational topic areas and inform the delivery of e-TIPS). This paper reports the findings of the co-design feedback session., Results: We identified 5 key considerations in delivering e-TIPS and 5 relevant HF educational topics for their content. Key considerations in e-TIP delivery included (1) timing of the e-TIPS; (2) clear and concise e-TIPS; (3) embedding a feedback mechanism; (4) distinguishing actionable and nonactionable e-TIPS; and (5) frequency of e-TIP delivery. Relevant educational topic areas included the following: (1) cardiovascular risk reduction, (2) self-management, (3) food and nutrition, (4) sleep hygiene, and (5) mental health., Conclusions: The findings from this co-design case study have provided a foundation for developing a bank of e-TIPS. These will now be evaluated for usability in the BANDAIDS e-TIPS, a single-group, quasi-experimental study of a 24-week e-TIP program (personalized educational messages) delivered via SMS text messaging (ACTRN12623000644662)., (© Caleb Ferguson, Scott William, Sabine M Allida, Jordan Fulcher, Alicia J Jenkins, Jo-Dee Lattimore, L-J Loch, Anthony Keech. Originally published in JMIR Cardio (https://cardio.jmir.org).)

Background: Heart failure is a major burden in Australia in terms of morbidity, mortality and healthcare expenditure. Multiple evidence-based therapies are recommended for heart failure with reduced ejection fraction (HFrEF), but data on physician adherence to therapy guidelines are limited., Aim: To compare use of HFrEF therapies against current evidence-based guidelines in an Australian hospital inpatient population., Methods: A retrospective review of patients admitted with a principal diagnosis of HFrEF across six metropolitan hospitals in Sydney, Australia, between January 2015 and June 2016. Use of medical and device therapies was compared with guideline recommendations using individual patient indications/contraindications. Readmission and mortality data were collected for a 1-year period following the admission., Results: Of the 1028 HFrEF patients identified, 39 were being managed with palliative intent, leaving 989 patients for the primary analysis. Use of beta-blockers (87.7% actual use/93.6% recommended use) and diuretics (88.4%/99.3%) was high among eligible patients. There were large evidence-practice gaps for angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB; 66.4%/89.0%) and aldosterone antagonists (41.0%/77.1%). In absolute terms, use of these therapies each increased by over 11% from admission. Ivabradine (11.5%/21.2%), automated internal cardiac defibrillators (29.5%/66.1%) and cardiac resynchronisation therapy (13.1%/28.7%) were used in a minority of eligible patients. Over the 1-year follow-up period, the mortality rate was 14.8%, and 44.2% of patients were readmitted to hospital at least once., Conclusion: Hospitalisation is a key mechanism for initiation of HFrEF therapies. The large evidence-practice gaps for ACEI/ARB and aldosterone antagonists represent potential avenues for improved HFrEF management., (© 2022 Royal Australasian College of Physicians.)

Objectives: Patients with stable ischemic heart disease (SIHD) may present with a variety of symptoms including typical angina, angina equivalents such as dyspnea or no symptoms. We sought to determine whether symptom status affects periprocedural safety and long-term mortality in patients undergoing PCI., Methods: Prospectively enrolled consecutive patients undergoing PCI for SIHD at six hospitals in Australia between 2005 to 2018 as part of the Melbourne Interventional Group registry. Symptom status was recorded at the time of PCI and patients undergoing staged PCI were excluded., Results: Overall, 11,730 patients with SIHD were followed up for a median period of 5 years (maximum 14.0 years, interquartile range 2.2-9.0 years) with 1,317 (11.2%) being asymptomatic. Asymptomatic patients were older, and more likely to be male, have triple-vessel disease, with multiple comorbidities including renal failure, diabetes and heart failure (all P < .01). These patients had significantly higher rates of periprocedural complications and major adverse cardiovascular events at 30-days. Long-term mortality was significantly higher in asymptomatic patients (27.2% vs 18.0%, P < .001). On cox regression for long-term mortality, after adjustment for more important clinical variables, asymptomatic status was an independent predictor (Hazard ratio (HR) 1.39 95% CI 1.16-1.66, P < .001)., Conclusions: In a real-world cohort of patients undergoing revascularization for SIHD, absence of symptoms was associated with higher rates of periprocedural complications and, after adjustment for more important clinical variables, was an independent predictor of long-term mortality. As the primary goal of revascularization in SIHD remains angina relief, the appropriateness of PCI in the absence of symptoms warrants justification., (Copyright © 2021 Elsevier Inc. All rights reserved.)