Screening, referral and treatment of depression by Australian cardiologists
- Authors: Hare, David , Stewart, Andrew , Driscoll, Andrea , Mathews, Stephanie , Toukhsati, Samia
- Date: 2020
- Type: Text , Journal article
- Relation: Heart Lung and Circulation Vol. 29, no. 3 (2020), p. 401-404
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- Description: Background: Depression is common in cardiovascular disease (CVD). Clinical practice guidelines recommend routine depression screening by cardiologists. The aim of the study was to undertake a national survey of Australian cardiologists’ clinical practice behaviours in relation to depression screening, referral, and treatment. Methods: The Cardiovascular Disease and Depression Questionnaire was sent to 827 eligible cardiologist members of Cardiac Society of Australia and New Zealand, of which a total of 524 were returned (63%). Results: Most Australian cardiologists do not routinely ask their patients about depression and only 3% routinely use depression screening instruments. Most cardiologists (>70%) think that General Practitioners (Primary Care Physicians) are primarily responsible for identifying and treating depression in CVD. Cardiologists, who understand the prognostic risks of depression in CVD and feel confident to identify and treat depression, were more likely to screen, refer and/or treat patients for depression. Conclusions: Australian cardiologists rarely use validated depression screening measures. Several brief instruments are available for use and can be easily integrated into routine patient care without taking additional consultation time. © 2019
- Description: This work was supported by the Beyond Blue Victorian Centre of Excellence in Depression and Anxiety. Prof Andrea Driscoll was supported by a Heart Foundation Future Leader fellowship 100472 from the National Heart Foundation of Australia.
Self-care interventions that reduce hospital readmissions in patients with heart failure; towards the identification of change agents
- Authors: Toukhsati, Samia , Jaarsma, Tiny , Babu, Abraham , Driscoll, Andrea , Hare, David
- Date: 2019
- Type: Text , Journal article , Review
- Relation: Clinical Medicine Insights: Cardiology Vol. 13, no. (2019), p. 1-8
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- Description: Unplanned hospital readmissions are the most important, preventable cost in heart failure (HF) health economics. Current professional guidelines recommend that patient self-care is an important means by which to reduce this burden. Patients with HF should be engaged in their care such as by detecting, monitoring, and managing their symptoms. A variety of educational and behavioural interventions have been designed and implemented by health care providers to encourage and support patient self-care. Meta-analyses support the use of self-care interventions to improve patient self-care and reduce hospital readmissions; however, efficacy is variable. The aim of this review was to explore methods to achieve greater clarity and consistency in the development and reporting of self-care interventions to enable ‘change agents’ to be identified. We conclude that advancement in this field requires more explicit integration and reporting on the behaviour change theories that inform the design of self-care interventions and the selection of behaviour change techniques. The systematic application of validated checklists, such as the Theory Coding Scheme and the CALO-RE taxonomy, will improve the systematic testing and refinement of interventions to enable ‘change agent/s’ to be identified and optimised.
Higher long-term adherence to statins in rural patients at high atherosclerotic risk
- Authors: Peverelle, Matthew , Baradi, Arul , Paleri, Sarang , Lee, Yun , Sultani, Rohullah , Toukhsati, Samia , Hare, David , Janus, Edward , Wilson, Andrew
- Date: 2019
- Type: Text , Journal article
- Relation: Journal of Clinical Lipidology Vol. 13, no. 1 (2019), p. 163-169
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- Description: Background: Rural patients with atherosclerotic cardiovascular disease (ASCVD) experience greater cardiovascular morbidity and mortality than their urban counterparts. Statin therapy is a key component of ASCVD treatment. The extent to which there may be regional differences in long-term adherence to statins is unknown. Objective: To assess long-term rates of adherence to statins in a high-risk ASCVD cohort, and whether regional differences exist between rural and urban patients. Methods: Follow-up was conducted in patients who underwent coronary angiography at a single tertiary center between 2009 and 2013. Adherence was defined as consumption of prescribed statin ≥6 days per week. Patients were divided into remoteness areas (RAs), classified as RA1 (major city), RA2 (inner regional), and RA3 (outer regional) based on the Australian Standard Geographical Classification. Results: Five hundred twenty-five patients (69% male, mean age 64 ± 11 years) were followed-up after a median of 5.3 years. Baseline characteristics were similar between RAs. Overall adherence was 83%; however, rural patients were significantly more adherent to their statin therapy (80% in RA1, 83% in RA2, and 93% in RA3, P =.04). Living in RA3 independently predicted greater statin adherence than living in RA1 (odds ratio: 2.75, 95% CI: 1.1–7.8, P =.03). All-cause mortality was significantly higher in RA3 than other regional areas (6% RA1, 12% RA2, and 18% RA3, P =.01). Conclusions: Despite higher all-cause mortality, rural patients with ASCVD demonstrate significantly greater long-term adherence to statins than urban patients. Other factors, such as reduced access to health care and delayed diagnosis may explain the gap in outcomes between rural and urban patients.
Confirming a beneficial effect of the six-minute walk test on exercise confidence in patients with heart failure
- Authors: Toukhsati, Samia , Mathews, Stephanie , Sheed, A. , Freijah, Isabella , Moncur, L. , Cropper, P , Ha, F. , Hare, David
- Date: 2020
- Type: Text , Journal article
- Relation: European Journal of Cardiovascular Nursing Vol. 19, no. 2 (2020), p.165-171
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- Description: Background: Low confidence to exercise is a barrier to engaging in exercise in heart failure patients. Participating in low to moderate intensity exercise, such as the six-minute walk test, may increase exercise confidence. Aim: To compare the effects of a six-minute walk test with an educational control condition on exercise confidence in heart failure patients. Methods: This was a prospective, quasi-experimental design whereby consecutive adult patients attending an out-patient heart failure clinic completed the Exercise Confidence Scale prior to and following involvement in the six-minute walk test or an educational control condition. Results: Using a matched pairs, mixed model design (n=60; 87% male; Mage=58.87±13.16), we identified a significantly greater improvement in Total exercise confidence (F(1,54)=4.63, p=0.036, partial η2=0.079) and Running confidence (F(1,57)=4.21, p=0. 045, partial η2=0.069) following the six-minute walk test compared to the educational control condition. These benefits were also observed after adjustment for age, gender, functional class and depression. Conclusion: Heart failure patients who completed a six-minute walk test reported greater improvement in exercise confidence than those who read an educational booklet for 10 min. The findings suggest that the six-minute walk test may be used as a clinical tool to improve exercise confidence. Future research should test these results under randomized conditions and examine whether improvements in exercise confidence translate to greater engagement in exercise behavior. © The European Society of Cardiology 2019.