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Simon Stewart

Publications and source records attributed to Simon Stewart.

At least 55 records · Page 3Linked to original sources
PubMed2002

A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study.

PURPOSE: To describe the effect of atrial fibrillation on long-term morbidity and mortality. SUBJECTS AND METHODS: The Renfrew/Paisley Study surveyed 7052 men and 8354 women aged 45-64 years between 1972 and 1976. All hospitalizations and deaths occurring during the subsequent 20 years were analyzed by the presence or absence of atrial fibrillation at baseline. Lone atrial fibrillation was defined in the absence of other cardiovascular signs or symptoms. Cox proportional hazards models were used to adjust for age and cardiovascular conditions. RESULTS: After 20 years, 42 (89%) of the 47 women with atrial fibrillation had a cardiovascular event (death or hospitalization), compared with 2276 (27%) of the 8307 women without this arrhythmia. Among men, 35 (66%) of 53 with atrial fibrillation had an event, compared with 3151 (45%) of 6999 without atrial fibrillation. In women, atrial fibrillation was an independent predictor of cardiovascular events (rate ratio [RR] = 3.0; 95% confidence interval [CI]: 2.1-4.2), fatal or nonfatal strokes (RR = 3.2; 95% CI: 1.0-5.0), and heart failure (RR = 3.4; 95% CI: 1.9-6.2). The rate ratios among men were 1.8 (95% CI: 1.3-2.5) for cardiovascular events, 2.5 (95% CI: 1.3-4.8) for strokes, and 3.4 (95% CI: 1.7-6.8) for heart failure. Atrial fibrillation was an independent predictor of all-cause mortality in women (RR = 2.2; 95% CI: 1.5-3.2) and men (RR = 1.5; 95% CI: 1.2-2.2). However, lone atrial fibrillation (which occurred in 15 subjects) was not associated with a statistically significant increase in either cardiovascular events (RR = 1.5; 95% CI: 0.6-3.6) or mortality (RR = 1.8; 95% CI: 0.9-3.8). CONCLUSIONS: Atrial fibrillation is associated with an increased long-term risk of stroke, heart failure, and all-cause mortality, especially in women.

Atrial Fibrillation↗
PubMed2002

Home-based intervention in congestive heart failure: long-term implications on readmission and survival.

BACKGROUND: It is not known to what extent initially observed benefits of postdischarge programs of care for patients with chronic congestive heart failure (CHF) in respect to event-free survival, readmissions, and healthcare costs persist in the long term. Methods and Results- We prospectively studied the long-term effects of a multidisciplinary home-based intervention (HBI) in a cohort of CHF patients randomly allocated to either to HBI (n=149) or usual care (n=148). During a median of 4.2 years of follow-up, there were significantly fewer primary end points (unplanned readmission or death) in the HBI versus usual care group: a mean of 0.21 versus 0.37 primary events per patient per month (P<0.01). Median event-free survival was more prolonged in the HBI than usual care group (7 versus 3 months; P<0.01). Fewer HBI patients died (56% versus 65%; P=0.06) and had more prolonged survival (a median of 40 versus 22 months; P<0.05) compared with usual care. Assignment to HBI was both an independent predictor of event-free survival (RR 0.70; P<0.01) and survival alone (RR 0.72; P<0.05). Overall, HBI patients had 78 fewer unplanned readmissions compared with usual care (0.17 versus 0.29 readmissions per patient per month; P<0.05). The median cost of these readmissions was $A325 versus $A660/month per HBI and usual care patient (P<0.01). CONCLUSIONS: The beneficial effects of HBI in reducing frequency of unplanned readmissions in CHF patients persist in the long term and are associated with prolongation of survival.

Aftercare↗
PubMed2002

Heart failure in a cold climate. Seasonal variation in heart failure-related morbidity and mortality.

OBJECTIVES: This study was done to determine whether seasonal variation exists in hospitalizations and deaths due to heart failure (HF) and to examine possible contributors to such variability. BACKGROUND: Although seasonal variation in the incidence of acute myocardial infarction and sudden death is well recognized, it is less well documented in HF. METHODS: We used the linked Scottish Morbidity Record scheme, which provides individualized morbidity and mortality data for the entire Scottish population. RESULTS: Between 1990 and 1996, there were a total of 75,452 male and 81,269 female hospitalizations related to HF in Scotland, with an average rate of admissions per 100,000 population of 8.4 and 8.5 per day, respectively. Significantly more admissions occurred in winter compared to summer (p < 0.0001). In women, the peak rate of admission occurred in December (12% more than average) and the lowest rate in July (7% less than average) (odds ratio [OR] 1.14, p < 0.001). The respective figures for men were 6% more, 8% less (OR 1.16, p < 0.001). In both genders, the greatest variation occurred in those aged >75 years---peak winter rates being 15% to 18% higher than average. There was also a winter peak in concomitantly coded respiratory disease; this seasonal excess accounted for approximately one-fifth of the winter increment in HF hospitalizations. Seasonal variation in mortality was also seen in these patients. The number of male deaths in December was 16% higher, and in July 7% lower, than average (OR 1.25, p < 0.001). In women, the equivalent figures were 21% higher (January) and 14% lower (July) (OR 1.21, p < 0.001). Again, the greatest variation occurred in those aged >75 years---peak rates being 23% to 35% higher than average. CONCLUSIONS: There is substantial seasonal variation in HF hospitalizations and deaths, particularly in the elderly. Approximately one-fifth of the winter excess in admissions is attributable to respiratory disease. Extra vigilance in patients with HF is advisable in winter, as is immunization against pneumococcus and influenza.

Age Distribution↗
PubMed2002

Effective nurse-led interventions in heart disease.

Nurses are increasingly being involved in initiatives to improve the co-ordination, delivery and eventual outcomes of health care. Key components of these initiatives include application of evidence-based treatments, ensuring individualised follow-up and the provision of "seamless" care overall. There is evidence in key areas that nurse-led interventions for patients with heart disease are effective, and that they are likely to work in other areas if properly supported and appropriate structures and systems are put in place to promote such practice. Given the promising results to date, it would be disappointing if these issues remain unresolved and the potential value of this type of interventions unfulfilled.

Heart Diseases↗
PubMed2002

The current cost of heart failure to the National Health Service in the UK.

We have recently shown that heart failure admission rates continue to increase in the UK -- particularly in older age groups. As hospital activity represents the major cost component of health care expenditure related to heart failure, this study evaluated the current cost of this syndrome to the National Health Service (NHS) in the UK. We applied contemporary estimates of health care activity associated with heart failure to the whole UK population on an age and sex-specific basis to calculate its cost to the NHS for the year 1995. Direct components of health care included in these estimates were hospital admissions associated with a principal diagnosis of heart failure, associated outpatient consultations, general practice consultations and prescribed drug therapy. We also calculated the cost of nursing-home care following a primary heart failure admission and the cost of hospitalisations associated with a secondary diagnosis of heart failure. Adjusting for probable increases in hospital activity and the progressive ageing of the UK population, we have also projected the cost of heart failure to the NHS for the year 2000. We estimated that there were 988000 individuals requiring treatment for heart failure in the UK during 1995. The 'direct' cost of health care for these patients was estimated to be pound 716 million, or 1.83% of total NHS expenditure. Hospitalisations and drug prescriptions accounted for 69 and 18% of this expenditure, respectively. The additional costs associated with long-term nursing home care and secondary heart failure admissions accounted for a further pound 751 million (2.0% of total NHS expenditure). By the year 2000, we estimated that the combined total direct cost of heart failure would have risen to pound 905 million -- equivalent to 1.91% of total NHS expenditure. Using well-validated sets of data, these findings re-confirm the importance of heart failure as a major public health problem in the UK. The annual direct cost of heart failure to the NHS in 2000 is likely to be of the order of 1.9% of total expenditure -- the predominant cost component being hospitalisation.

Aged↗
PubMed2002

Detecting early clinical deterioration in chronic heart failure patients post-acute hospitalisation-a critical component of multidisciplinary, home-based intervention?

AIMS: To firstly describe the prevalence, characteristics and consequences of early clinical deterioration (ECD) in chronic heart failure (CHF) patients discharged from acute hospital care and, secondly, to examine the potential benefits of a multidisciplinary, home-based intervention (HBI) in limiting the common sequelae of such deterioration. METHODS: This phenomenon was studied in 90 CHF patients assigned to the intervention arm of a randomised study of HBI. ECD was defined as death, unplanned re-admission or clinical instability (detected at a home visit) within 14 days of hospital discharge. Multivariate analysis was used to determine the independent correlates of ECD. Using these data, a 1:1 case-control ratio of patients assigned to the usual care arm of the study was selected to match those patients exhibiting non-fatal ECD and subject to HBI. Subsequent morbidity and mortality rates were then compared on the basis of the presence or absence of non-fatal ECD and/or HBI. RESULTS: Of the 90 patients assigned to HBI, two died suddenly, five required an unplanned re-admission to hospital and 28 were found to be clinically unstable at a planned home visit, within 14 days of discharge from the index admission. The combined prevalence of ECD this cohort was therefore 39% (35 of 90 patients) and was independently correlated with greater age (OR=1.1 per yearly increment; P<0.001) and comorbidity (OR=2.0 per incremental Charlson index of comorbidity score; P<0.001). Patients who exhibited clinical instability at the home visit were significantly more likely to be non-adherent to prescribed treatment (10 of 28 vs. 9 of 55; P<0.05). Compared to the remainder of the cohort also subject to HBI, despite remedial intervention, patients who exhibited non-fatal ECD had reduced event-free survival (11 of 33 vs. 38 of 55; P<0.001), more frequent unplanned re-admission (0.2 vs. 0.1 admissions/patient/month; P<0.01), and more prolonged hospital stay (1.6 vs. 0.5 days/patient/month; P<0.001) in the subsequent 6-month period. However, compared to case-controls, these patients (n=33 in both groups) had fewer days of hospitalisation (1.6 vs. 3.6 days/patient/month; P=0.05) and, most significantly, were more likely to survive to 6 months (6 vs. 13 died; P<0.05). CONCLUSION: ECD is a common phenomenon in older CHF patients discharged from acute hospital care and is associated with poorer health outcomes in the longer-term. Post-discharge HBI is an important means for identifying and addressing ECD. Although HBI conveys benefits incremental to usual care, these data also provide a sound basis for increasing its effectiveness by applying earlier home visits in selected 'high-risk' patients.

Acute Disease↗
PubMed2002

Optimising stroke outcomes through evidence-based nursing practice: an Australian perspective.

Stroke is the third leading cause of death of people in the world today and the highest cause of disability and handicap, producing a huge burden on individuals and society more broadly. Yet unlike its counterpart acute myocardial infarction (AMI), little has been done to promote early intervention in evolving strokes. Recommendations from the American Heart Association and more recently the European Stroke Initiative are available; however, in Australia (as with many other countries) practice guidelines are scarce and clinicians largely operate in an ad hoc manner with little awareness of 'best practice'. The controversial role of thrombolysis with limitations in respect to selecting appropriate patients, in addition to a small window of opportunity for therapeutic beneficial effects and a high risk for haemorrhage, has inhibited its widespread application. As such, emergent stroke management clearly lags behind that of AMI-both with respect to the range of treatment options and the application of best practice. This paper reviews the literature regarding best practice management of evolving stroke and the crucial role of nurses in triaging and managing patients to deliver optimal outcomes within the Australian context.

Australia↗
PubMedDate not supplied

Epidemiology and economic impact of atrial fibrillation.

The clinical and public health importance of detecting and treating atrial fibrillation (AF), a predominantly chaotic and fast cardiac dysrhythmia that disrupts cardiac output and increases the probability of intracardiac and systemic thrombosis, is increasingly being recognized. This article describes the epidemiology and economic health burden of AF and reviews the evidence to suggest that an epidemic of AF will persist for the foreseeable future.

Age Distribution↗
PubMedDate not supplied

A new solution for an old problem? Effects of a nurse-led, multidisciplinary, home-based intervention on readmission and mortality in patients with chronic atrial fibrillation.

BACKGROUND: Atrial fibrillation (AF), the most common chronic cardiac dysrhythmia, is an important cause of cardiovascular morbidity and mortality. However, there is a paucity of studies examining the potential benefits of optimizing the postdischarge management of patients with chronic AF. RESEARCH OBJECTIVE: To examine the effects of a nurse-led, multidisciplinary, home-based intervention (HBI) on the pattern of recurrent hospitalization and mortality in patients with chronic AF in the presence and absence of chronic heart failure (HF). PATIENT COHORT AND METHODS: Health outcomes in a total of 152 hospitalized patients (53% male) with a mean age of 73 +/- 9 years and a diagnosis of chronic AF who were randomly allocated to either HBI (n = 68) or usual postdischarge care (UC: n = 84) were examined. Specifically, the pattern of unplanned hospitalization and all-cause mortality during 5-year follow-up were compared on the basis of the presence (n = 87) and absence (n = 65) of HF at baseline. RESULTS: Patients with concurrent HF exposed to HBI (n = 37) had fewer readmissions (2.9 vs 3.4/patient), days of associated hospital stay (22.7 vs 30.5: P = NS) and fatal events (51 % vs 66%) relative to UC (n = 50): P = NS for all comparisons. In the absence of HF, morbidity and mortality rates were significantly lower but still substantial during 5-year follow-up. In these patients, HBI was associated with a trend towards prolonged event-free survival (adjusted RR = 0.70; P = .12) and fewer fatal events (29% vs 53%, adjusted RR = 0.49; P = .08). HBI patients (n = 31) also had fewer readmissions (2.1 vs 2.6/patient) and days of associated hospital stay (16.3 vs 20.3/patient), although this did not reach statistical significance. On the basis of these data, it was calculated that a randomized study of an AF-specific HBI would require 250 patients followed for a median of 3 years to detect a 25% variation in recurrent hospital stay relative to UC. CONCLUSIONS: These unique data provide sufficient preliminary evidence to support the hypothesis that the benefits of HBI in relation to the management of HF may extend to "high risk" patients with chronic AF in whom morbidity and mortality rates are also unacceptably high. Further, appropriately powered studies are required to confirm these benefits.

Aftercare↗