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Vulnerability to environmental and climatic health provocations among women and men hospitalised with chronic heart disease : Insights from the RESILIENCE TRIAL cohort
Stewart, Simon Patel, Sheila K. Lancefield, Terase F. Rodrigues, Thalys S. Doumtsis, Nicolas Jess, Ashleigh Vaughan-Fowler, Emily-Rose Chan, Yih Kai Ramchand, Jay Yates, Paul A.
Stewart, Simon
Patel, Sheila K.
Lancefield, Terase F.
Rodrigues, Thalys S.
Doumtsis, Nicolas
Jess, Ashleigh
Vaughan-Fowler, Emily-Rose
Chan, Yih Kai
Ramchand, Jay
Yates, Paul A.
Abstract
Aims
We aimed to recruit a representative cohort of women and men with multi-morbid chronic heart disease as part of a trial testing an innovative, nurse-co-ordinated, multi-faceted intervention to lower rehospitalization and death by addressing areas of vulnerability to external challenges to their health.
Methods and results
The prospective, randomized open, blinded end-point RESILIENCE Trial recruited 203 hospital inpatients (mean age 75.7 ± 10.2 years) of whom 51% were women and 94% had combined coronary artery disease, heart failure, and/or atrial fibrillation. Levels of concurrent multi-morbidity were high (mean Charlson Index of Comorbidity Score 6.5 ± 2.7), and 8.9% had at least mild frailty according to the Rockwood Clinical Frailty Scale. Including the index admission, 19–20% of women and men had a pre-existing pattern of seasonally linked hospitalization (seasonality). Detailed phenotyping revealed that 48% of women and 40% of men had ≥3 physiological factors, and 15% of women and 16% of men had ≥3 behavioural factors likely to increase their vulnerability to external provocations to their health. Overall, 61–62% of women and men had ≥4 combined factors indicative of such vulnerability. Additional factors such as reliance on the public health system (63 vs. 49%), lower education (30 vs. 14%), and living alone (48 vs. 29%) were more prevalent in women.
Conclusion
We successfully recruited women and men with multi-morbid chronic heart disease and bio-behavioural indicators of vulnerability to external provocations to their health. Once completed, the RESILIENCE TRIAL will provide important insights on the impact of addressing such vulnerability (promoting resilience) on subsequent health outcomes.
Registration
ClinicalTrials.org: NCT04614428.
Keywords
Disease management, Heart failure, Mortality, Seasons, Secondary prevention, Weather
Date
2023
Type
Journal article
Journal
European Journal of Cardiovascular Nursing
Book
Volume
23
Issue
3
Page Range
278-286
Article Number
ACU Department
Mary MacKillop Institute for Health Research
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Event URL
Open Access Status
License
All rights reserved
File Access
Controlled
Notes
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved.