Medicine (Northwest Academic Centre) - Theses
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ItemAn Examination of Heart Failure Rehospitalisation in a Western Metropolitan Melbourne Population( 2020)Heart failure is a complex clinical syndrome, associated with a significant burden of morbidity and mortality, including a high rate of rehospitalisation. Reducing the burden of rehospitalisation among patients with heart failure is a recognised priority for healthcare systems. However, in order to optimize outcomes, contemporary studies have emphasized the need for better understanding of the clinical heterogeneity of heart failure populations. Extending beyond the understanding of pathophysiological heterogeneity, the elucidation of sociodemographic factors may also reveal greater opportunities for targeted optimisation. Moreover, utilising new methods by which rehospitalisation is assessed may lead greater insights than would otherwise be captured by conventional means. This project aims to expand the understanding of rehospitalisation burden in evolving heart failure populations. It evaluates the adverse impact of cultural and linguistic diversity on rehospitalisation outcomes in patients with heart failure. A discussion of important methodological concepts into researching culturally and linguistically diverse (CALD) patient groups is carried out. In doing so, a novel operational approach to defining CALD patients is presented. This thesis also explores the measures of which rehospitalisation is evaluated in heart failure patients. It described the added value of analysing all recurrent hospital admissions (events), an approach which is very seldom performed in heart failure research. An assessment of several modelling techniques for evaluating rehospitalisation burden is performed, specifically in relation to heart failure type (i.e. heart failure with preserved vs reduced ejection fraction). In doing so, demonstrate the analysis of recurrent hospitalisations, compared to traditionally utilised first-event statistical approaches, may be a more informative and clinically relevant measure when evaluating the burden of heart failure rehospitalisation. As the prevalence of heart failure is rising and patients are becoming more diverse and complex, there is an increasing need to better characterise and understand these evolving heart failure populations. Further elucidating the heterogeneity of heart failure populations will help guide improvements to existing management approaches, as well as the direct the development of new targeted approaches.