ABSTRACT
Background: Australia is experiencing ever more frequent weather/environmental challenges, including extreme heatwaves and bushfires. There are no proven interventions to reduce seasonal challenges to the cardiovascular health of vulnerable individuals. The REsilience to Seasonal ILlness and Increased Emergency admissioNs CarE (RESILIENCE) Trial will test the hypothesis that an individually-tailored intervention program will reduce re-hospitalisation risk and mortality in vulnerable individuals. Methods: We will recruit 300 medical patients admitted to the Austin Hospital (Melbourne, Australia), with chronic heart disease and multimorbidity and randomise (1:1) to standard care or the RESILIENCE program (RP). Applying a COVID-19 adapted protocol, the RP group will have their bio-behavioural profile and home environment assessed to determine their vulnerability to seasonal events. An individualised case-management program, including virtual clinic review with a nurse and physician, will be applied to promote seasonal resilience. The primary endpoint is all-cause days alive out of hospital during 12-month follow-up. Trial registered at ClinicalTrials.gov NCT04614428. Results: To date, 27 patients have been recruited and randomised. The mean age was 76±9 years and 11 (40%) were female. The most common comorbidities were hypertension (76 %), coronary artery disease (52 %), heart failure (52 %) and chronic kidney disease (52 %). Ten patients (37 %) have had a post-discharge home visit by the RP nurse and 5 (18 %) have attended the clinic. Conclusion: Recruitment is ongoing, and in the absence of further COVID-19 related lockdowns, all patients will be recruited over the next 12 months. Funding: MRFF-Keeping Australians Out of Hospital Grant
ABSTRACT
Objective: Australia is experiencing ever more frequent/provocative weather and environmental challenges, including more extreme heatwaves and catastrophic bushfires. Concurrently, the annual challenge of wintry conditions to a population adapted to warmer conditions persists. Remarkably, however, there are no proven interventions to reduce seasonal challenges to the cardiovascular health of vulnerable individuals. In a world-first, the REsilience to Seasonal ILlness and Increased Emergency admissioNs CarE (RESILIENCE) Trial will test the hypothesis that an individually tailored, intervention program will reduce the risk of re-hospitalisation and mortality in vulnerable individuals. Design and method: 300 adult patients admitted to the Austin Hospital in Melbourne, Australia with heart disease and multimorbidity will be recruited and randomised (1:1) to standard care (SC) or the RESILIENCE program (RP) over 12-months. Applying a COVID-19 adapted protocol, the RP group will have their bio-behavioural profile and home environment assessed post-discharge, to determine their vulnerability to seasonal events. An individualised case-management program, including a virtual clinic review with a dedicated RP cardiac nurse and physician, will be applied to promote seasonal resilience. The primary end-point is all-cause days alive out of hospital (DAOH) during 12-month follow-up. Results: With study recruitment delayed due to COVID-19 restrictions, virtual screening of medical in-patients has confirmed the need and potential for the RP. Of 630 potential participants identified over a 6 week period, 196 patients (31%) met eligibility criteria-85 women and 79 men, mean (±SD) age 79 ± 11 years. Non-eligibility was largely due to non-chronic form of heart disease (34%), no comorbidity (23 %), and inability to give informed consent (15%). Conclusions: Preliminary data suggest that once commenced, we will rapidly recruit the requisite number of trial participants and depending on the results, we will be able to determine the cost-effectiveness of the RP to reduce seasonallyinduced admissions and mortality.