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dc.contributor.authorZisis, G
dc.contributor.authorHuynh, Q
dc.contributor.authorYang, Y
dc.contributor.authorNeil, C
dc.contributor.authorCarrington, MJ
dc.contributor.authorBall, J
dc.contributor.authorMaguire, G
dc.contributor.authorMarwick, TH
dc.date.accessioned2020-11-17T03:29:08Z
dc.date.available2020-11-17T03:29:08Z
dc.date.issued2020-07-22
dc.identifier.citationZisis, G., Huynh, Q., Yang, Y., Neil, C., Carrington, M. J., Ball, J., Maguire, G. & Marwick, T. H. (2020). Rationale and design of a risk-guided strategy for reducing readmissions for acute decompensated heart failure: the Risk-HF study. ESC HEART FAILURE, 7 (5), pp.3151-3160. https://doi.org/10.1002/ehf2.12897.
dc.identifier.issn2055-5822
dc.identifier.urihttp://hdl.handle.net/11343/251515
dc.description.abstractAIMS: Heart failure (HF) readmission commonly arises owing to insufficient patient knowledge and failure of recognition of the early stages of recurrent fluid congestion. In previous work, we developed a score to predict short-term hospital readmission and showed that higher-risk patients benefit most from a disease management programme (DMP) that included enhancing knowledge and education by a nurse. We aim to evaluate the effectiveness of a novel, nurse-led HF DMP in selected patients at high risk of short-term hospital readmission, using ultrasound-guided diuretic management and artificial intelligence to enhance HF knowledge in an outpatient setting. METHODS AND RESULTS: Risk-HF is a prospective multisite randomized controlled trial that will allocate 404 patients hospitalized with acute decompensated HF, and ≥33% risk of readmission and/or death at 30 days, into risk-guided nurse intervention (DMP-Plus group) compared with usual care. Intervention elements include (i) fluid management with a handheld ultrasound (HHU) device at point of care; (ii) post-discharge follow-up; (iii) optimal programmed drug titration; (iv) better transition of care; (v) intensive self-care education via an avatar-based 'digital health coach'; and (vi) exercise guidance through the digital coach. Usual care involves standard post-discharge hospital care. The primary outcome is reduced death and/or hospital readmissions at 30 days post-discharge, and secondary outcomes include quality of life, fluid management efficacy, and feasibility and patient engagement. Assuming that our intervention will reduce readmissions and/or deaths by 50%, with a 1:1 ratio of intervention vs. usual care, we plan to randomize 404 patients to show a difference at a statistical power of 80%, using a two-sided alpha of 0.05. We anticipate this recruitment will be achieved by screening 2020 hospitalized HF patients for eligibility. An 8 week pilot programme of our digital health coach in 21 HF patients, age > 75 years, showed overall improvements in quality of life (13 of 21), self-care (12 of 21), and HF knowledge (13 of 21). A pilot of the use of HHU by nurses showed that it was feasible and accurate. CONCLUSIONS: The Risk-HF trial will evaluate the effectiveness of a risk-guided intervention to improve HF outcomes and will evaluate the efficacy of trained HF nurses delivering a fluid management protocol that is guided by lung ultrasound with an HHU at point of care.
dc.languageEnglish
dc.publisherWILEY PERIODICALS, INC
dc.titleRationale and design of a risk-guided strategy for reducing readmissions for acute decompensated heart failure: the Risk-HF study
dc.typeJournal Article
dc.identifier.doi10.1002/ehf2.12897
melbourne.affiliation.departmentMedicine and Radiology
melbourne.source.titleESC Heart Failure
melbourne.source.volume7
melbourne.source.issue5
melbourne.source.pages3151-3160
dc.rights.licenseCC BY-NC
melbourne.elementsid1458776
melbourne.contributor.authorNeil, Christopher
melbourne.contributor.authorMarwick, Thomas
dc.identifier.eissn2055-5822
melbourne.accessrightsOpen Access


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