Stewart Simon, Patel Sheila K, Lancefield Terase F, Sampaio Rodrigues Thalys, Doumtsis Nicholas, Moini Nasreen, Harley Ashleigh, Vaughan-Fowler Emily-Rose, Chan Yih-Kai, Chen Alexander, Chye David, Liew David Fl, McMaster Christopher, Ramchand Jay, Yates Paul A, Kwong Jason C, McDonald Christine F, Burrell Louise M
Institute for Health Research, University of Notre Dame, Fremantle, WA.
Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
Med J Aust. 2025 Jul 21;223(2):77-84. doi: 10.5694/mja2.52699. Epub 2025 Jun 24.
To investigate whether a multifaceted intervention for building resilience to external provocations to health reduced the number of all-cause hospital re-admissions and deaths of people hospitalised with multimorbid heart disease, compared with standard post-discharge management.
Single centre, prospective, open, randomised trial with blinded endpoint acquisition and adjudication (REsilience to Seasonal ILlness and Increased Emergency admissioNs CarE, RESILIENCE).
SETTING, PARTICIPANTS: Adults (aged 18 years or older) admitted as emergency medical patients with multimorbid heart disease to Austin Hospital, a tertiary hospital in Melbourne, 19 November 2020 - 28 July 2022, with planned discharge to home.
Standard post-discharge management, as well as the 12-month active management program: home visits by a nurse, specialist clinical review, and tailored recommendations for optimising clinical management and promoting resilience to external provocations; the nurse coordinated the additional care, provided individualised support, and arranged RESILIENCE physician reviews as required. The comparator group received standard post-discharge management only.
Proportion of days alive and out of hospital during follow-up (minimum, twelve months) with respect to the maximum number possible.
Of 203 participants (mean age, 75.7 years; standard deviation [SD], 10.2 years; 104 women), 103 were randomly allocated to the intervention group, 100 to the standard management group; median follow-up time was 600 days (interquartile range, 416-681 days). A total of 470 hospital admissions and 3874 days of hospital stay during follow-up were recorded for 138 of the 203 trial participants (68%); 38 people (19%) died during follow-up. The days alive and out of hospital proportion was 86.5% (SD, 25.3 percentage points) for the intervention group and 88.3% (SD, 23.5 percentage points) for the standard management group (adjusted difference, 2.04 percentage points; 95% CI, -4.97 to 8.56 percentage points).
A multifaceted intervention for reducing bio-behavioural vulnerability to external events was ineffective in increasing the proportion of days alive and out of hospital after hospital discharge for people admitted with multimorbid heart disease. However, the program could be modified to improve health outcomes for such people.
ClinicalTrials.gov, NCT04614428 (prospective).
与标准出院后管理相比，研究一项针对增强对健康外部诱因的恢复力的多方面干预措施是否能减少患有多种合并症心脏病的住院患者的全因再次入院人数和死亡人数。
单中心、前瞻性、开放、随机试验，采用盲法终点数据采集和判定（季节性疾病恢复力与增加急诊入院护理研究，RESILIENCE）。
设置、参与者：2020年11月19日至2022年7月28日期间，作为急诊患者入住墨尔本一家三级医院奥斯汀医院，患有多种合并症心脏病且计划出院回家的成年人（年龄18岁及以上）。
标准出院后管理，以及为期12个月的积极管理计划：护士家访、专科临床评估，以及为优化临床管理和增强对外部诱因的恢复力而量身定制的建议；护士协调额外护理，提供个性化支持，并根据需要安排RESILIENCE医生评估。对照组仅接受标准出院后管理。
随访（最短12个月）期间存活且未住院天数占最大可能天数的比例。
203名参与者（平均年龄75.7岁；标准差[SD]10.2岁；104名女性）中，103人被随机分配至干预组，100人被分配至标准管理组；中位随访时间为600天（四分位间距416 - 681天）。203名试验参与者中的138人（68%）在随访期间共记录到470次住院和3874天住院时间；38人（19%）在随访期间死亡。干预组存活且未住院天数比例为86.5%（SD 25.3个百分点），标准管理组为88.3%（SD 23.5个百分点）（调整差异2.04个百分点；95%CI -4.97至8.56个百分点）。
一项旨在降低生物行为对外界事件易感性的多方面干预措施，对于提高患有多种合并症心脏病的出院患者存活且未住院天数比例无效。然而，该计划可进行修改以改善此类患者的健康结局。
ClinicalTrials.gov，NCT04614428（前瞻性）
