Medicine (Northwest Academic Centre) - Theses

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Type: Masters Research thesis × Author: Mulligan, Andrew David ×

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    The management of acute decompensated heart failure in a geriatric population: evaluation of novel strategies in a contemporary hospital setting
    Mulligan, Andrew David ( 2020)
    Heart failure is a heterogeneous complex disease, with increasing prevalence in the elderly. It is a morbid disease characterized by high mortality and frequent hospital re-admissions, responsible for a significant burden to the patient and to healthcare services. This thesis will examine unique approaches to the hospital system care of acute decompensated elderly heart failure patients by two main projects. Project one is an evaluation of Western Health’s implementation of a ‘cardio-geriatric ’unit and its effect on length of stay and readmission compared to previous routine practice. This found that the intervention did not change length of stay or readmission, however uniquely described a complex group and explores reasons why it may be difficult to achieve these outcomes. Project two explores the significance of anemia and iron deficiency, and the effect on treatment of iron deficiency, a significant comorbidity in heart failure in an elderly population. It demonstrates the prevalence and patterns of iron use in this group of patients. This thesis adds to the literature an exploration of the care provided to elderly comorbid heart failure patients in the hospital setting. It demonstrates the medical complexity of this group of patients and the difficulty in curbing outcomes in this group of patients. It allows for future research to develop alternative models of care or intervention or perhaps induce a paradigm change in the approach to care for the elderly comorbid heart failure patients.