Optimising Transitional Care Following a Heart Failure Hospitalisation in Australia.

Hospitalisations for heart failure (HF) are associated with high rates of readmission and death, the most vulnerable period being within the first few weeks post-hospital discharge. Effective transition of care from hospital to community settings for patients with HF can help reduce readmission and mortality over the vulnerable period, and improve long-term outcomes for patients, their family or carers, and the healthcare system. Planning and communication underpin a seamless transition of care, by ensuring that the changes to patients' management initiated in hospital continue to be implemented following discharge and in the long term.

Healthcare services use by patients with heart failure in Australia: Findings from the SHAPE study.

Background And Objectives: General practitioners (GPs) play a central role in healthcare, serving as the first point of contact, making appropriate referrals and coordinating care for chronic conditions such as heart failure (HF). We sought to determine healthcare use by people with HF in primary care.

Method: In this Study of Heart failure in the Australian Primary carE setting (SHAPE), we analysed records of 1.

Consensus statement on the current pharmacological prevention and management of heart failure.

Introduction: This consensus statement of Australian clinicians provides new recommendations for the pharmacological management of heart failure based on studies reported since the publication of the 2018 Australian heart failure guidelines.

Main Recommendations: ▪Use of sodium-glucose cotransporter 2 (SGLT2) inhibitors to prevent hospitalisation for heart failure in type 2 diabetes mellitus can be extended to patients with multiple cardiovascular risk factors, albuminuric chronic kidney disease, or atherosclerotic cardiovascular disease. ▪New evidence supports the use of a mineralocorticoid receptor antagonist (finerenone) to prevent heart failure in type 2 diabetes mellitus associated with albuminuric chronic kidney disease.

Guideline-based audit of the hospital management of heart failure with reduced ejection fraction.

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.

Clinical characteristics of people with heart failure in Australian general practice: results from a retrospective cohort study.

Aims: Heart failure (HF) causes significant morbidity and mortality, but the rates and characteristics of people with HF in Australia are not well studied. SHAPE set out to describe the characteristics of HF patients seen in the real-world setting.

Methods: We analysed anonymized patient data extracted from the clinical software of 43 participating GP clinics for the 5 year period from 1 July 2013 to 30 June 2018.

Epidemiology of heart failure: Study of Heart failure in the Australian Primary carE setting (SHAPE).

Aims: At present, there is no robust information on the prevalence and incidence of heart failure (HF) in the general Australian community. The present study of primary care data sought to estimate the prevalence and incidence of HF in the community and to describe the demographic and clinical profile of Australians with HF.

Methods And Results: We undertook a retrospective cohort study based on analysis of anonymized medical records of adult patients cared for at 43 Australian general practices between 1 July 2013 and 30 June 2018.

The epidemiology of heart failure in the general Australian community - study of heart failure in the Australian primary carE setting (SHAPE): methods.

Background: There is a paucity of information on the epidemiology of heart failure (HF) in Australia. The Study of Heart failure in the Australian Primary carE setting (SHAPE) study aims to estimate the prevalence and annual incidence of HF in the general Australian community and to describe the demographic and key clinical profile of Australians with HF.

Methods: We undertook a retrospective cohort study based on analysis of non-identifiable medical records of adult patients cared for at 43 general practices between 1 July 2013 and 30 June 2018.

Cost-Effectiveness of Ivabradine in the Treatment of Chronic Heart Failure.

Background: In the Systolic Heart failure treatment with the I inhibitor Trial (SHIFT) randomised placebo-controlled trial, ivabradine was shown to reduce hospital admissions for worsening heart failure (HF) and deaths due to HF in patients with symptomatic systolic HF and an elevated resting heart rate (HR). This analysis evaluates the cost effectiveness of adding ivabradine to optimal standard HF treatment in patients with a HR≥77 bpm.

Methods: A Markov model was developed to assess the impact of ivabradine on mean survival and quality of life over a patient's lifetime (10 years).

The prognostic impact of chest pain in 1306 patients presenting with confirmed acute pulmonary embolism.

Background: The prognostic influence of chest pain in patients presenting with pulmonary embolism has not been well defined. We investigated whether the presence of chest pain at presentation affected the mortality of patients with acute pulmonary embolism.

Methods: Retrospective cohort study of consecutive patients admitted to a tertiary hospital with confirmed acute pulmonary embolism from 2000 to 2012, with study outcomes tracked using a state-wide death registry.

High mortality in patients presenting with acute pulmonary embolism and elevated INR not on anticoagulant therapy.

The prognostic significance of patients presenting with pulmonary embolism (PE) and elevated International Normalised Ratio (INR) not on anticoagulant therapy has not been described. We investigated whether these patients had higher mortality compared to patients with normal INR. A retrospective study of patients admitted to a tertiary hospital with acute PE from 2000 to 2012 was undertaken, with study outcomes tracked using a state-wide death registry.

Iron Deficiency in Heart Failure: Looking Beyond Anaemia.

Iron is an essential micronutrient in many cellular processes. Iron deficiency, with or without anaemia, is common in patients with chronic heart failure. Observational studies have shown iron deficiency to be associated with worse clinical outcomes and mortality.

Cardiac electronic implantable devices in the treatment of heart failure.

Heart failure is a condition which has an increasing incidence as the population ages, leading to increasing prevalence globally and in Australia. This condition also carries very high morbidity and mortality rates, attributed in part to electrical conduction disturbances which lead to sudden cardiac death or pathophysiological cardiac changes due to delayed activation of the left free wall and mechanical dyssynchrony. Current pharmacologic therapy has made impressive advances in improving survival rates in this population, but morbidity and mortality rates still remain high.

Management and outcomes following an acute coronary event in patients with chronic heart failure 1999-2007.

Aim: The outcome of patients with chronic heart failure (CHF) following an ischaemic event is poorly understood. We evaluated the management and outcomes of CHF patients presenting with an acute coronary syndrome (ACS) and explored changes in outcomes over time.

Method And Results: A total of 5556 patients enrolled in the Australia-New Zealand population of the Global Registry of Acute Coronary Events (GRACE) between 1999 and 2007 were included.

Impact of sleep disordered breathing severity on hemodynamics, autonomic balance and cardiopulmonary functional status in chronic heart failure.

Background: Despite advances in medical therapy, sleep disordered breathing (SDB) remains highly prevalent in chronic heart failure (CHF). The impact of severity of SDB on sympathovagal balance, central hemodynamic responses and cardiopulmonary functional status in these patients is uncertain.

Methods: Thirteen patients with stable CHF (mean age+/-10 years; 12 NYHA Class II, 1 Class III) identified with SDB (apnoea-hypopnoea index [AHI] >or=5) by polysomnography underwent echocardiography, standard hemodynamic and functional assessment, heart rate variability analysis and treadmill cardiopulmonary testing.

Differences in management and outcome of ischemic and non-ischemic cardiomyopathy.

Background: Ischemic and non-ischemic cardiomyopathy (ICM and NICM) both cause heart failure, but the different etiologies may result in differences in management and outcome, which were explored in this study.

Methods: Cohort study of 168 consecutive patients (90 ICM, 78 NICM) recruited from a tertiary referral heart failure clinic followed for 40+/-19 months.

Results: Patients with ICM were older than NICM with worse NYHA functional state but similar left ventricular ejection fraction (LVEF) and dimensions at baseline.

Autonomic abnormalities in congestive heart failure patients with sleep-disordered breathing.

Background: The increasing prevalence of chronic heart failure is affecting patients' longevity, quality of life, and health resources, despite advances in management. Recognizing and treating comorbid illnesses is critical. Risk factors such as hypertension and diabetes are treated, but less importance is placed on the role of sleep apnea in heart failure.

Impact of gender on outcomes in chronic systolic heart failure.

Background And Aim: Understanding the influence of gender in heart failure allows for better treatment. This study described the gender differences in heart failure patients and their response to therapy.

Methods: Consecutive patients (116 men vs.

Barriers to participation in and adherence to cardiac rehabilitation programs: a critical literature review.

Despite the documented evidence of the benefits of cardiac rehabilitation (CR) in enhancing recovery and reducing mortality following a myocardial infarction, only about one third of patients participate in such programs. Adherence to these programs is an even bigger problem, with only about one third maintaining attendance in these programs after 6 months. This review summarizes research that has investigated barriers to participation and adherence to CR programs.