Promoting resilience to weather-related and seasonal provocations to health in people with multimorbid heart disease: a prospective pragmatic, randomised trial

Abstract

Objective: 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.

Study design: 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.

Intervention: 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.

Major outcome measure: Proportion of days alive and out of hospital during follow-up (minimum, twelve months) with respect to the maximum number possible.

Results: 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).

Conclusion: 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.

Trial registration: ClinicalTrials.gov, NCT04614428 (prospective).

Keywords: Climate change.