Establishing a pragmatic framework to optimise health outcomes in heart failure and multimorbidity (ARISE-HF): A multidisciplinary position statement

Stewart, Simon; Riegel, Bárbara; Boyd, Cynthia M.; Ahamed, Yasmin; Thompson, David R.; Burrell, Louise M.; Carrington, M.; Coats, Andrew J.S.; Granger, Bradi B.; Hides, Julie; Weintraub, William S.; Moser, Debra K.; Dickson, Victoria Vaughan; McDermott, Cressida J.; Keates, Ashley K.; Rich, Michael W.

doi:10.1016/j.ijcard.2016.03.001

Cited by 45 publications

(42 citation statements)

References 123 publications

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“…The themes that emerged from users’ experiences, such as reassurance, confirm the benefits of using home monitoring as articulated in [11]. The lesson learned about the importance of individualized care especially for patients with comorbidities in this study supports [20] which highlighted the need to acknowledge, routinely profile, identify personal goals, support individualized case management, and include the patients’ perspective and overall outcomes in evaluation [20]. Refining a system design to be personal has also been demonstrated by Triantafyllidis et al [18].…”

Section: Discussionsupporting

confidence: 72%

Design and Usability of a Heart Failure mHealth System: A Pilot Study

et al. 2017

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BackgroundDespite the advances in mobile health (mHealth) systems, little is known about patients’ and providers’ experiences using a new mHealth system design.ObjectiveThis study aimed to understand challenges and provide design considerations for a personalized mHealth system that could effectively support heart failure (HF) patients after they transition into the home environment.MethodsFollowing exploratory interviews with nurses and preventive care physicians, an mHealth system was developed. Patients were asked to measure their weight, blood pressure, and blood glucose (if they had diabetes). They were also instructed to enter symptoms, view notifications, and read messages on a mobile app that we developed. A Bluetooth-enabled weight scale, blood pressure monitor, glucometer, and mobile phone was provided after an introductory orientation and training session. HF nurses used a dashboard to view daily measurements for each patient and received text and email alerts when risk was indicated. Observations of usage, cases of deterioration, readmissions, and metrics related to system usability and quality of life outcomes were used to determine overall effectiveness of the system, whereas focus group sessions with patients were conducted to elicit participants’ feedback on the system’s design.ResultsA total of 8 patients with HF participated over a 6-month period. Overall, the mean users’ satisfaction with the system ranked 73%, which was above average. Quality of life improvement was 3.6. Patients and nurses used the system on a regular basis and were able to successfully identify and manage 8 health deteriorations, of which 5 were completely managed remotely. Focus groups revealed that, on one hand, the system was beneficial and helped patients with: recording and tracking readings; receiving encouragement and reassurance from nurses; spotting and solving problems; learning from past experiences; and communication. On the other hand, findings also highlighted design issues and recommendations for future systems such as the need to communicate via other media, personalize symptom questions and messages, integrate other health tracking technologies, and provide additional methods to analyze and visualize their data.ConclusionsUnderstanding users’ experiences provides important design considerations that could complement existing design recommendations from the literature, and, when combined with physician and nurse requirements, have the potential to yield a feasible telehealth system that is effective in supporting HF self-care. Future studies will include these guidelines and use a larger sample size to validate the outcomes.

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Section: Discussionsupporting

confidence: 72%

Design and Usability of a Heart Failure mHealth System: A Pilot Study

et al. 2017

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“…HF subjects typically suffer from a number of coexisting diseases that may influence the outcomes of care [2,3,15]. To the best of our knowledge, this is the first study (i) investigating a comprehensive search of comorbidities based on administrative data, (ii) assessing their impact on short-term survival, and (iii) trying to disentangle between mortality associated with HF from that due to all other causes through a relative survival approach.…”

Section: Discussionmentioning

confidence: 99%

Comorbidity-adjusted relative survival in newly hospitalized heart failure patients: A population-based study

Baldi

Azzolina

Berchialla

et al. 2017

International Journal of Cardiology

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of patients with heart failure"). Conflicts of Interest:The authors report no relationships that could be construed as a conflict of interest. 2 AbstractBackground. This study aims to identify comorbidities through various sources and to assess their short-term impact on relative survival in a cohort of Heart Failure (HF) patients. Methods.Newly hospitalized HF patients were identified from hospital discharge abstracts ( Results. The cohort consisted of 51,061 HF patients (53% women; median age 80 years). After integrating information from all sources, the prevalence of diabetes, chronic pulmonary disease and renal disease raised up to 27.6%, 26.2% and 14.2%, respectively.Survival in the HF cohort was inferior to that in the reference population and decreased with increasing number of comorbidities. Notably, the overall performance of the relative survival models was similar regardless of which strategy was used to ascertain comorbidity. Conclusions.The effort required to implement a comprehensive search method for comorbidities is worth the potential benefit when the aim is to assess the comorbidity burden. On the contrary, a search method limited to HDA can reasonably be used to determine a comorbidity profile for mortality risk adjustment purposes.

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“…A multidisciplinary position statement identified five key steps (ARISE-HF) that could potentially improve clinical outcomes if applied in a systematic manner:124 Acknowledge multimorbidity as a clinical syndrome that is associated with poor health outcomesRoutinely profile (using a standardized protocol – adapted to the local health care system) all patients hospitalized with HF to determine the extent of concurrent multimorbidityIdentify individualized priorities and person-centered goals on the extent of concurrent multimorbiditySupport individualized, home-based, multidisciplinary, case management to supplement standard HF management, andEvaluate health outcomes well beyond acute hospitalization and encompass all-cause events and a person-centered perspective in affected individuals.…”

Section: Conclusion: the Place Of Ivabradine In Hf Therapymentioning

confidence: 99%

Advances in the management of heart failure: the role of ivabradine

Müller‐Werdan

Stöckl

Werdan

2016

VHRM

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A high resting heart rate (≥70–75 b.p.m.) is a risk factor for patients with heart failure (HF) with reduced ejection fraction (EF), probably in the sense of accelerated atherosclerosis, with an increased morbidity and mortality. Beta-blockers not only reduce heart rate but also have negative inotropic and blood pressure-lowering effects, and therefore, in many patients, they cannot be given in the recommended dose. Ivabradine specifically inhibits the pacemaker current (funny current, If) of the sinoatrial node cells, resulting in therapeutic heart rate lowering without any negative inotropic and blood pressure-lowering effect. According to the European Society of Cardiology guidelines, ivabradine should be considered to reduce the risk of HF hospitalization and cardiovascular death in symptomatic patients with a reduced left ventricular EF ≤35% and sinus rhythm ≥70 b.p.m. despite treatment with an evidence-based dose of beta-blocker or a dose below the recommended dose (recommendation class “IIa” = weight of evidence/opinion is in favor of usefulness/efficacy: “should be considered”; level of evidence “B” = data derived from a single randomized clinical trial or large nonrandomized studies). Using a heart rate cutoff of ≥ 75 b.p.m., as licensed by the European Medicines Agency, treatment with ivabradine 5–7.5 mg b.i.d. reduces cardiovascular mortality by 17%, HF mortality by 39% and HF hospitalization rate by 30%. A high resting heart rate is not only a risk factor in HF with reduced EF but also at least a risk marker in HF with preserved EF, in acute HF and also in special forms of HF. In this review, we discuss the proven role of ivabradine in the validated indication “HF with reduced EF” together with interesting preliminary findings, and the potential role of ivabradine in further, specific forms of HF.

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Establishing a pragmatic framework to optimise health outcomes in heart failure and multimorbidity (ARISE-HF): A multidisciplinary position statement

Cited by 45 publications

References 123 publications

Design and Usability of a Heart Failure mHealth System: A Pilot Study

Design and Usability of a Heart Failure mHealth System: A Pilot Study

Comorbidity-adjusted relative survival in newly hospitalized heart failure patients: A population-based study

Advances in the management of heart failure: the role of ivabradine

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