The FRAilty MEasurement in Heart Failure (FRAME-HF) Project

University of Technology Sydney. Faculty of Health.Frailty is a complex, multifaceted syndrome frequently experienced by older people and those living with chronic disease, such as HF. The presence of frailty is a robust predictive indicator of worse outcomes in people with HF, including rehospitalisation and mortality. Despite increasing interest in assessing frailty over the last decade, there is an absence of consensus regarding the universal definition of frailty and the optimal means of assessment for this population. The FRAME-HF project aims to determine the most suitable and clinically relevant frailty instrument(s) for use in adults living with heart failure (HF). Setting and participants: The FRAME-HF project was undertaken at St Vincent’s Hospital, Sydney, Australia. This project included: 1) Individuals ≥ 18 years and older with a confirmed diagnosis of HF and 2) Cardiovascular clinicians. Design: Deductive sequential mixed methods project comprising three interrelated yet discrete studies: a systematic review (Study 1); a cross-sectional study (Study 2); and a prospective cohort study (Study 3). Study 1: A systematic review identified seven different frailty instruments used to identify frailty in HF studies to date, none of which were validated for use in patients living with HF. Study 2: A cross-sectional study of the association between subjective clinician estimates of frailty and a formal frailty assessment. Thirty-nine clinicians completed frailty estimates, and 75 patients had their frailty formally assessed, producing 194 paired frailty assessments. This study revealed that correlation and inter-rater agreement between pooled clinician-estimated frailty and the formal frailty assessment was fair (rs= 0.52; κ= 0.33, CI: 0.23 – 0.43), confirming that subjective clinician estimates of frailty are not a reliable replacement for formal frailty assessment in adults living with HF. Study 3: Part A evaluated the convergent and discriminant validity of three physical frailty instruments. Of the three instruments compared, the SHARE-FI and the St Vincent’s Frailty instrument displayed stronger validity than the Frailty Phenotype in this cohort. Part B revealed the six frailty instruments potentially relevant for use in adults living with HF displayed adequate predictive performance (C-statistic 0.71-0.73) and sensitivity (88-92%). Further work is needed to confirm these results in a larger cohort. A validated frailty instrument for use in adults with HF is needed, one that is quick and easy to use in a resource-restricted clinical environment. Frailty assessment needs to be incorporated into cardiovascular clinicians' daily practice and universally accepted as an integral part of HF clinical management

Hospital service use in the last year of life by Indigenous Australians who died of heart failure or cardiomyopathy : a linked data study

Background: Aboriginal and Torres Strait Islander peoples experience disproportionate rates of heart failure. However, information regarding their use of hospital services in the last year of life is poorly delineated to inform culturally appropriate end-of-life health services. Objectives: To quantify hospital service use in the last year of life of Aboriginal and Torres Strait Islander peoples who died of heart failure or cardiomyopathy in Queensland, Australia. Methods: A subgroup analysis of a larger retrospective linkage study using administrative health data in Queensland, Australia. Individuals that identified as an Aboriginal and Torres Strait Islander person from their first hospital admission in the last year of life, who died of heart failure or cardiomyopathy from 2008 to 2018, were included. Results: There were 99 individuals, with emergency department presentation/s recorded for 85 individuals. Over 50% of individuals presenting to the Emergency Department were from regional areas (n = 43, 51%). The 99 individuals had a total of 472 hospital admissions, excluding same day admissions for haemodialysis, and 70% (n = 70) died in hospital. Most admissions were coded as acute care (n = 442, 94%), and fewer were coded as palliative care (n = 19, 4%). Median comorbidities or factors that led to hospital contact = 5 (interquartile range 3–9). Conclusion: Acute care hospital admissions in the last year of life by this population are common for those who died of heart failure or cardiomyopathy. Multimorbidity is prevalent in the last year of life, underscoring the importance of primary health care, provided by nurses and Indigenous health workers

Risk of organism acquisition from prior room occupants: An updated systematic review

Background Evidence from a previous systematic review indicates that patients admitted to a room where the previous occupant had a multidrug-resistant bacterial infection resulted in an increased risk of subsequent colonisation and infection with the same organism for the next room occupant. In this paper, we have sought to expand and update this review. Methods A systematic review and meta-analysis was undertaken. A search using Medline/PubMed, Cochrane and CINHAL databases was conducted. Risk of bias was assessed by the ROB-2 tool for randomised control studies and ROBIN-I for non-randomised studies. Results From 5175 identified, 12 papers from 11 studies were included in the review for analysis. From 28,299 patients who were admitted into a room where the prior room occupant had any of the organisms of interest, 651 (2.3%) were shown to acquire the same species of organism. In contrast, 981,865 patients were admitted to a room where the prior occupant did not have an organism of interest, 3818 (0.39%) acquired an organism(s). The pooled acquisition odds ratio (OR) for all the organisms across all studies was 2.45 (95% CI: 1.53–3.93]. There was heterogeneity between the studies (I2 89%, P < 0.001). Conclusion The pooled OR for all the pathogens in this latest review has increased since the original review. Findings from our review provide some evidence to help inform a risk management approach when determining patient room allocation. The risk of pathogen acquisition appears to remain high, supporting the need for continued investment in this area

Clinical practices for defining, detecting, and diagnosing postoperative atrial fibrillation after coronary revascularization surgery – A scoping review

Objectives: This scoping review was undertaken to understand the degree of variation in clinical practices associated with postoperative atrial fibrillation (POAF), following coronary revascularization surgery by collating and synthesising key concepts from current published literature. Review methods and data sources: This scoping review was conducted following the framework outlined by Askey and O\u27Malley. Reporting of this scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Initial searches were completed in September 2020 and updated in January 2023. Comprehensive searches to identify relevant published literature were carried out within CINAHL, MEDLINE, and ProQuest databases. All searches were limited to full-text papers published in English with human adult participants. Deductive content analysis using NVivo software was performed to synthesise the data. Results: A total of 692 studies were identified during the database searches. After the deletion of duplicates and the application of the inclusion and exclusion criteria, 73 studies were included in the scoping review. The included studies were published between 2001 and 2022 and included a total of 24,833 participants. Forty-six studies included a definition of POAF, with four of these citing a peak-body definition. A total of 24 included studies reported on electrocardiogram diagnostic criteria for POAF, with 13/24 [54%] describing these characteristics within their definition. The time-based diagnostic criteria ranged from a minimum duration of greater than 30 seconds to greater than 1 hour. The most frequently reported minimum-time thresholds were ≥30 seconds, reported in 12 of 51 (24%) studies and ≥5 min, reported in 13 of 51 (25%) studies. Conclusions: There is a lack of consistency in clinical practice for defining, detecting, and diagnosing POAF, following coronary revascularization surgery. Consensus and standardisation of clinical practices are urgently needed

Barriers and facilitators to using feedback systems from clinical quality registries among health care providers

This systematic scoping review aims to explore the barriers and enablers to using feedback systems from clinical quality registries in hospital-based registries. Databases an

Clinical outcomes of nurse-coordinated interventions for frail older adults discharged from hospital: A systematic review and meta-analysis

Aim: To determine the effects of nurse-coordinated interventions in improving readmissions, cumulative hospital stay, mortality, functional ability and quality of life for frail older adults discharged from hospital. Design: Systematic review with meta-analysis. Methods: A systematic search using key search terms of ‘frailty’, ‘geriatric’, ‘hospital’ and ‘nurse’. Covidence was used to screen individual studies. Studies were included that addressed frail older adults, incorporated a significant nursing role in the intervention and were implemented during hospital admission with a focus on transition from hospital to home. Data Sources: This review searched MEDLINE (Ovid), CINAHL (EBSCO), PubMed (EBSCO), Scopus, Embase (Ovid) and Cochrane library for studies published between 2000 and September 2023. Results: Of 7945 abstracts screened, a total 16 randomised controlled trials were identified. The 16 randomised controlled trials had a total of 8795 participants, included in analysis. Due to the heterogeneity of the outcome measures used meta-analysis could only be completed on readmission (n = 13) and mortality (n = 9). All other remaining outcome measures were reported through narrative synthesis. A total of 59 different outcome measure assessments and tools were used between studies. Meta-analysis found statistically significant intervention effect at 1-month readmission only. No other statistically significant effects were found on any other time point or outcome. Conclusion: Nurse-coordinated interventions have a significant effect on 1-month readmissions for frail older adults discharged from hospital. The positive effect of interventions on other health outcomes within studies were mixed and indistinct, this is attributed to the large heterogeneity between studies and outcome measures. Relevance to Clinical Practice: This review should inform policy around transitional care recommendations at local, national and international levels. Nurses, who constitute half of the global health workforce, are ideally situated to provide transitional care interventions. Nurse-coordinated models of care, which identify patient needs and facilitate the continuation of care into the community improve patient outcomes. Implications for the Profession and/or Patient Care: Review findings will be useful for key stakeholders, clinicians and researchers to learn more about the essential elements of nurse-coordinated transitional care interventions that are best targeted to meet the needs of frail older adults. Impact: When frail older adults experience transitions in care, for example discharging from hospital to home, there is an increased risk of adverse events, such as institutionalisation, hospitalisation, disability and death. Nurse-coordinated transitional care models have shown to be a potential solution to support adults with specific chronic diseases, but there is more to be known about the effectiveness of interventions in frail older adults. This review demonstrated the positive impact of nurse-coordinated interventions in improving readmissions for up to 1 month post-discharge, helping to inform future transitional care interventions to better support the needs of frail older adults. Reporting Method: This systematic review was reported in accordance with the Referred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Patient or Public Contribution: No Patient or Public Contribution

Strategies for improving diversity, equity, and inclusion in cardiovascular research: a primer

This paper aims to empower cardiovascular (CV) researchers by promoting diversity, equity, and inclusion (DE&I) principles throughout the research cycle. It defines DE&I and introduces practical strategies for implementation in recruitment, retention, and team dynamics within CV research. Evidence-based approaches supporting underrepresented populations’ participation are outlined for each research phase. Emphasizing the significance of inclusive research environments, the paper offers guidance and resources. We invite CV researchers to actively embrace DE&I principles, enhancing research relevance and addressing longstanding CV health disparities

The prototype of a frailty learning health system: The HARMONY Model

Introduction: Rapid translation of research findings into clinical practice through innovation is critical to improve health systems and patient outcomes. Access to efficient systems of learning underpinned with real-time data are the future of healthcare. This type of health system will decrease unwarranted clinical variation, accelerate rapid evidence translation, and improve overall healthcare quality. Methods: This paper aims to describe The HARMONY model (acHieving dAta-dRiven quality iMprovement to enhance frailty Outcomes using a learNing health sYstem), a new frailty learning health system model of implementation science and practice improvement. The HARMONY model provides a prototype for clinical quality registry infrastructure and partnership within health care. Results: The HARMONY model was applied to the Western Sydney Clinical Frailty Registry as the prototype exemplar. The model networks longitudinal frailty data into an accessible and useable format for learning. Creating local capability that networks current data infrastructures to translate and improve quality of care in real-time. Conclusion: This prototype provides a model of registry data feedback and quality improvement processes in an inpatient aged care and rehabilitation hospital setting to help reduce clinical variation, enhance research translation capacity, and improve care quality