Multidisciplinary Group Clinic Appointments: The Self-Management and Care of Heart Failure (SMAC-HF) Trial

Background—This trial tested the effects of multidisciplinary group clinic appointments on the primary outcome of time to first heart failure (HF) rehospitalization or death. Methods and Results—HF patients (n=198) were randomly assigned to standard care or standard care plus multidisciplinary group clinics. The group intervention consisted of 4 weekly clinic appointments and 1 booster clinic at month 6, where multidisciplinary professionals engaged patients in HF self-management skills. Data were collected prospectively for 12 months beginning after completion of the first 4 group clinic appointments (2 months post randomization). The intervention was associated with greater adherence to recommended vasodilators (P=0.04). The primary outcome (first HF-related hospitalization or death) was experienced by 22 (24%) in the intervention group and 30 (28%) in standard care. The total HF-related hospitalizations, including repeat hospitalizations after the first time, were 28 in the intervention group and 45 among those receiving standard care. The effects of treatment on rehospitalization varied significantly over time. From 2 to 7 months post randomization, there was a significantly longer hospitalization-free time in the intervention group (Cox proportional hazard ratio=0.45 (95% confidence interval, 0.21–0.98; P=0.04). No significant difference between groups was found from month 8 to 12 (hazard ratio=1.7; 95% confidence interval, 0.7–4.1). Conclusions—Multidisciplinary group clinic appointments were associated with greater adherence to selected HF medications and longer hospitalization-free survival during the time that the intervention was underway. Larger studies will be needed to confirm the benefits seen in this trial and identify methods to sustain these benefits

Thinking infrastructures

International audienceThis volume introduces the notion of Thinking Infrastructures to explore a broad range of phenomena that structure attention, shape decision-making, and guide cognition: Thinking Infrastructures configure entities (via tracing, tagging), organise knowledge (via search engines), sort things out (via rankings and ratings), govern markets (via calculative practices, including algorithms), and configure preferences (via valuations such as recommender systems). Thus, Thinking Infrastructures, we collectively claim in this volume, inform and shape distributed and embodied cognition, including collective reasoning, structuring of attention and orchestration of decision-making.<br/

Thinking Infrastructures

International audienceThis volume introduces the notion of Thinking Infrastructures to explore a broad range of phenomena that structure attention, shape decision-making, and guide cognition: Thinking Infrastructures configure entities (via tracing, tagging), organise knowledge (via search engines), sort things out (via rankings and ratings), govern markets (via calculative practices, including algorithms), and configure preferences (via valuations such as recommender systems). Thus, Thinking Infrastructures, we collectively claim in this volume, inform and shape distributed and embodied cognition, including collective reasoning, structuring of attention and orchestration of decision-making.<br/