Effect of the optimize heart failure care program on clinical and patient outcomes – The pilot implementation in Vietnam

Background: The Ho-Chi-Minh-city Heart Institute in Vietnam took part in the Optimize Heart Failure (OHF) Care Program, designed to improve outcomes following heart failure (HF) hospitalization by increasing patient awareness and optimizing HF treatment. Methods: HF patients hospitalized with left ventricular ejection-fraction (LVEF) <50% were included. Patients received guideline-recommended HF treatment and education. Clinical signs, treatments and outcomes were assessed at admission, discharge, 2 and 6 months (M2, M6). Patients’ knowledge and practice were assessed at M6 by telephone survey. Results: 257 patients were included. Between admission and M2 and M6, heart rate decreased significantly, and clinical symptoms improved significantly. LVEF increased significantly from admission to M6. 85% to 99% of patients received education. At M6, 45% to 78% of patients acquired knowledge and adhered to practice regarding diet, exercise, weight control, and detection of worsening symptoms. High use of renin-angiotensin-aldosterone-system inhibitors (91%), mineralocorticoid-receptor-antagonists (77%) and diuretics (85%) was noted at discharge. Beta-blocker and ivabradine use was less frequent at discharge but increased significantly at M6 (from 33% to 51% and from 9% to 20%, respectively, p < 0.001). There were no in-hospital deaths. Readmission rates at 30 and 60 days after discharge were 8.3% and 12.5%, respectively. Mortality rates at 30 days, 60 days and 6 months were 1.2%, 2.5% and 6.4%, respectively. Conclusions: The OHF Care Program could be implemented in Vietnam without difficulty and was associated with high usage of guideline-recommended drug therapy. Although education was delivered, patient knowledge and practice could be further improved at M6 after discharge

Geographic isolation and physiological mechanisms underpinning species distributions at the range limit hotspot of South Georgia

In order to allocate quotas for sustainable harvests, that account for climate warming, it is important to incorporate species vulnerabilities that will underlie likely changes in population dynamics. Hotspots, regions with rapidly changing climate, are important locations for rapid advances in mechanistic understanding of the factors driving these changes, particularly if they coincide with regions with a high incidence of range limits, such as the sub-Antarctic Island of South Georgia. This archipelago is at the Northern limit of the Southern Ocean and therefore the northern distribution limit for many Southern Ocean shallow water marine species, which are amongst the most sensitive fauna to increasing temperature. At range limits species may either be living close to their physiological limits, or they may have more resistant phenotypes. In case studies, the northern range limit population of the gastropod limpet, Nacella concinna, has greater physiological plasticity at South Georgia than those from further south, allowing them to cope better with the warmer and more variable seasonal temperatures. Bivalve species, however, alter their depth distributions at South Georgia, to avoid the warmer water masses, indicating that they may not be able to cope with the warmer temperatures. Mackerel icefish, Champsocephalus gunnari, has a unique Antarctic trait, the loss of haemoglobin. A combination of temperature driven change in food web structure, and this extreme physiological cold adaptation, may explain why rapid warming at its northern range limit of South Georgia, has prevented stocks fully recovering from over fishing in the 1980s, despite highly conservative management strategies

Climate velocity and the future global redistribution of marine biodiversity

Anticipating the effect of climate change on biodiversity, in particular on changes in community composition, is crucial for adaptive ecosystem management but remains a critical knowledge gap. Here, we use climate velocity trajectories, together with information on thermal tolerances and habitat preferences, to project changes in global patterns of marine species richness and community composition under IPCC Representative Concentration Pathways (RCPs) 4.5 and 8.5. Our simple, intuitive approach emphasizes climate connectivity, and enables us to model over 12 times as many species as previous studies. We find that range expansions prevail over contractions for both RCPs up to 2100, producing a net local increase in richness globally, and temporal changes in composition, driven by the redistribution rather than the loss of diversity. Conversely, widespread invasions homogenize present-day communities across multiple regions. High extirpation rates are expected regionally (for example, Indo-Pacific), particularly under RCP8.5, leading to strong decreases in richness and the anticipated formation of no-analogue communities where invasions are common. The spatial congruence of these patterns with contemporary human impacts highlights potential areas of future conservation concern. These results strongly suggest that the millennial stability of current global marine diversity patterns, against which conservation plans are assessed, will change rapidly over the course of the century in response to ocean warming. © 2015 Macmillan Publishers Limited

Thermal biases and vulnerability to warming in the world’s marine fauna

A critical assumption underlying projections of biodiversity change associated with global warming is that ecological communities comprise balanced mixes of warm-affinity and cool-affinity species which, on average, approximate local environmental temperatures. Nevertheless, here we find that most shallow water marine species occupy broad thermal distributions that are aggregated in either temperate or tropical realms. These distributional trends result in ocean-scale spatial thermal biases, where communities are dominated by species with warmer or cooler affinity than local environmental temperatures. We use community-level thermal deviations from local temperatures as a form of sensitivity to warming, and combine these with projected ocean warming data to predict warming-related loss of species from present-day communities over the next century. Large changes in local species composition appear likely, and proximity to thermal limits, as inferred from present-day species’ distributional ranges, outweighs spatial variation in warming rates in contributing to predicted rates of local species loss