Effectiveness of the Pharmacist-Involved Multidisciplinary Management of Heart Failure to Improve Hospitalizations and Mortality Rates in 4630 Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: There is evidence that heart failure (HF) patients who receive pharmacist care have better clinical outcomes. METHODS AND RESULTS: English-language peer-reviewed randomized controlled trials comparing the pharmacist-involved multidisciplinary intervention with usual care were included. We searched PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, and the Cochrane Library from inception through March 2017. Cochrane method for risk of bias was used to assess within and between studies. 18 RCTs (n = 4630) were included for systematic review, and 16 (n = 4447) for meta-analysis. Meta-analysis showed a significant reduction in HF hospitalizations {odds ratio (OR) 0.72 [95% confidence interval (CI) 0.55-0.93], P = .01, I2  =  39%} but no effect on HF mortality. Similarly, a significant reduction in all-cause hospitalizations [OR 0.76, 95% CI (0.60-0.96), P = .02, I2  =  52%] but no effect on all-cause mortality was revealed. The overall trend was an improvement in medication adherence. There were significant improvements in HF knowledge (P<.05), but no significant improvements were found on health care costs and self-care. CONCLUSIONS: The pharmacist is a vital member of a multidisciplinary team in HF management to improve clinical outcomes. There was a great deal of variability about which specific intervention is most effective in improving clinical outcomes.

Role of the Pharmacist for Improving Self-care and Outcomes in Heart Failure.

PURPOSE OF REVIEW: This review highlights the current and emerging approaches for the role of the pharmacist for improving self-care and outcomes in heart failure management. RECENT FINDINGS: Pharmacists are contributing to heart failure management in a variety of settings, including hospitals, clinics, and communities. Different interventions which may be mediated by the pharmacist include drug adherence, discharge counseling, medication reconciliation, telephone follow-up, and recommendation of evidence-based medicines. Pharmacist engagement in heart failure management has demonstrated improved drug adherence, readmission rates, medication management, self-care ability, patient satisfaction, and heart failure knowledge. Some findings are mixed, especially for readmission rates. Improved medication management was reported in nearly all studies, despite significant heterogeneity in the models of care, patient populations, and study designs. This review highlights the requirement for large randomized trials with extended follow-up to confirm the impact of the role of the pharmacist in HF self-care, particularly through multidisciplinary-based interventions.

External validation of the Health Care Homes hospital admission risk stratification tool in the Aboriginal Australian population of the Northern Territory.

Objective This study aimed to externally validate the Commonwealth's Health Care Homes (HCH) algorithm for Aboriginal Australians living in the Northern Territory (NT). Methods A retrospective cohort study design using linked primary health care (PHC) and hospital data was used to analyse the performance of the HCH algorithm in predicting the risk of hospitalisation for the NT study population. The study population consisted of Aboriginal Australians residing in the NT who have visited a PHC clinic at one of the 54 NT Government clinics at least once between 1 January 2013 and 31 December 2017. Predictors of hospitalisation included demographics, patient observations, medications, diagnoses, pathology results and previous hospitalisation. Results There were a total of 3256 (28.5%) emergency attendances or preventable hospitalisations during the study period. The HCH algorithm had an area under the receiver operating characteristic curve (AUC) of 0.58 for the NT remote Aboriginal population, compared with 0.66 in the Victorian cohort. A refitted model including 'previous hospitalisation' had an AUC of 0.72, demonstrating better discrimination than the HCH algorithm. Calibration was also improved in the refitted model, with an intercept of 0.00 and a slope of 1.00, compared with an intercept of 1.29 and a slope of 0.55 in the HCH algorithm. Conclusion The HCH algorithm performed poorly on the NT cohort compared with the Victorian cohort, due to differences in population demographics and burden of disease. A population-specific hospitalisation risk algorithm is required for the NT.

Comparison of general and cardiac care-specific indices of spatial access in Australia.

OBJECTIVE: To identity differences between a general access index (Accessibility/ Remoteness Index of Australia; ARIA+) and a specific acute and aftercare cardiac services access index (Cardiac ARIA). RESEARCH DESIGN AND METHODS: Exploratory descriptive design. ARIA+ (2011) and Cardiac ARIA (2010) were compared using cross-tabulations (chi-square test for independence) and map visualisations. All Australian locations with ARIA+ and Cardiac ARIA values were included in the analysis (n = 20,223). The unit of analysis was Australian locations. RESULTS: Of the 20,223 locations, 2757 (14% of total) had the highest level of acute cardiac access coupled with the highest level of general access. There were 1029 locations with the poorest access (5% of total). Approximately two thirds of locations in Australia were classed as having the highest level of cardiac aftercare. Locations in Major Cities, Inner Regional Australia, and Outer Regional Australia accounted for approximately 98% of this category. There were significant associations between ARIA+ and Cardiac ARIA acute (χ2 = 25250.73, df = 28, p<0.001, Cramer's V = 0.559, p<0.001) and Cardiac ARIA aftercare (χ2 = 17204.38, df = 16, Cramer's V = 0.461, p<0.001). CONCLUSIONS: Although there were significant associations between the indices, ARIA+ and Cardiac ARIA are not interchangeable. Systematic differences were apparent which can be attributed largely to the underlying specificity of the Cardiac ARIA (a time critical index that uses distance to the service of interest) compared to general accessibility quantified by the ARIA+ model (an index that uses distance to population centre). It is where the differences are located geographically that have a tangible impact upon the communities in these locations-i.e. peri-urban areas of the major capital cities, and around the more remote regional centres. There is a strong case for specific access models to be developed and updated to assist with efficient deployment of resources and targeted service provision. The reasoning behind the differences highlighted will be generalisable to any comparison between general and service-specific access models.

Correction: Comparison of general and cardiac care-specific indices of spatial access in Australia.

[This corrects the article DOI: 10.1371/journal.pone.0219959.].

Recommendations and practices for the screening of depression and anxiety in acute coronary syndrome: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to identify and map current recommendations and practices for the screening of depression and anxiety in acute coronary syndrome patients in the acute care setting.Specifically, the review questions are.

Adherence to activity monitoring devices or smartphone applications for improving physical activity in adults with cardiovascular disease: a systematic review protocol.

REVIEW QUESTION: The question of this review is: what is the adherence to the use of activity monitoring devices or applications to improve physical activity in adults with cardiovascular disease?Specifically, the review objectives are.

Heart failure following blood cancer therapy in pediatric and adult populations.

AIM: The link between chemotherapy treatment and cardiotoxicity is well established, particularly for adults with blood cancers. However, it is less clear for children. This analysis aimed to compare the trajectory and mortality of children and adults who received chemotherapy for blood cancers and were subsequently hospitalized for heart failure. METHODS: Linked data from the Queensland Cancer Registry, Death Registry and Hospital Administration records for initial chemotherapy and later heart failure were reviewed (1996-2009). Of all identified blood cancer patients (N = 23 434), 8339 received chemotherapy, including 817 children (aged ≤18 years at time of cancer diagnosis) and 7522 adults. Time-varying Cox proportional hazards regression models were used to compare the characteristics and survival between the two groups. RESULTS: Of those who were subsequently hospitalized for heart failure, 70% of children and 46% of adults had the index admission within 12 months of their cancer diagnosis. Of these, 53% of the pediatric heart failure population and 71% of the adult heart failure population died within the study period. Following adjustment for age, sex and chemotherapy admissions, children with heart failure had an increased mortality risk compared to their non-heart failure counterparts, a difference which was much greater than that between the adult groups. CONCLUSION: The impact of heart failure on children previously treated for blood cancer is more severe than for adults, with earlier morbidity and greater mortality. Improved strategies are needed for the prevention and management of cardiotoxicity in this population.

Effectiveness of discharge education on outcomes in acute coronary syndrome patients: a systematic review protocol.

REVIEW QUESTION: The question of this review is what is the effectiveness of discharge education on outcomes in acute coronary syndrome patients?

Overweight and obesity in 4-year-old South Australian children and the stability of IOTF cut points in this age group.

OBJECTIVE: To assess the validity of internationally accepted mid-year cut points for overweight and obesity in children and their application for ongoing surveillance. DATA: A large (n = 114,925) state wide administrative data set of preschool children (aged 48-60 months) in South Australia including measured height and weight, collected at various points in the fifth year of life by the Children, Youth and Women's Health Service (CYWHS) between 1995 and 2003. METHODS: Prevalence of overweight and obesity were calculated for each year of the data set between 1995 and 2003. The international mid-year cut points were compared to cut points for each month of age throughout the fifth year of life. RESULTS: The prevalence of overweight and obesity in this age group has increased significantly over the period for both males and females. The estimates of overweight and obesity prevalence for both males and females calculated using the mid-year cut points were not significantly different to cut points for each month of age in both genders. CONCLUSIONS: The body mass index of children does not vary significantly through the fifth year of life and prevalence estimates can be obtained at any point in the fifth or sixth year of age for surveillance purposes.