Self Managing Heart Failure in Remote Australia - Translating Concepts into Clinical Practice

Abstract

Congestive heart failure (CHF) is an ambulatory health care condition characterized by episodes of decompensation and is usually without cure. It is a leading cause for morbidity and mortality and the lead cause for hospital admissions in older patients in the developed world. The long-term requirement for medical care and pharmaceuticals contributes to significant health care costs. CHF management follows a hierarchy from physician prescription to allied health, predominately nurse-led, delivery of care. Health services are easier to access in urban compared to rural settings. The differentials for more specialized services could be even greater. Remote Australia is thus faced with unique challenges in delivering CHF best practice. Chronic disease self-management programs (CDSMP) were designed to increase patient participation in their health and alleviate stress on health systems. There have been CDSMP successes with some diseases, although challenges still exist for CHF. These challenges are amplified in remote Australia due to geographic and demographic factors, increased burden of disease, and higher incidence of comorbidities. In this review we explore CDSMP for CHF and the challenges for our region.

A Delphi Study to Prioritize Evidence-Based Strategies for Cardiovascular Disease Care in India

“…Therefore, more studies on the feasibility and effectiveness of training strategies are needed in low resource settings. The group problem solving strategy of goal setting and the adaptation of the Stanford Chronic Disease Self-Management Program (Iyngkaran et al, 2016 ; Liddy et al, 2016 ) was rated well for priority (1.80), but poorly on technical complexity (3.10) and capital intensity (3.10). This discordance likely indicates a higher perceived value for such strategy, but uncertainty around its implementation.…”

Contextualising evidence based medicine in determining the key root for translational effectiveness for chronic disease self-management and heart failure

“…These points are quite relevant for the example we explore in this perspective. CDSM and HF evidence has been downgraded and there appears little coherence as to what CDSM could look like in daily practice [2,20]. Our team have published and argued that as the HF guidelines are established, the question of CDSM is thus one of helping achieve GDMT.…”

Rethinking heart failure care and health technologies from early COVID-19 experiences - A narrative review

“…Selfmanagement successes are measured by the levels of selfefficacy and self-tailoring achieved. CDSMP comprise of three key components [25]:…”

“…Anecdotally, self-management capacities of self-isolating patients would have increased, unfortunately there are no data on its impact on worsening HF. None the less in all the studies and trials to date, for HF, while there have been positive findings, no health system to date has successfully translated a viable model of CDSMP that impacts on major adverse events, outcomes or cost effectiveness [25][26][27][28][29]. The foundations of managing readmissions in health services around self-management is also proving difficult largely because there is no standardised model that traverses the boundaries of patients' journeys.…”