The Wider Considerations in Closing Chronic Disease Gaps - Focus on Heart Failure and Implementation

Pupalan Iyngkaran; Charlotte Hespe; Fahad Hanna; John D Horowitz; Malcolm Battersby; Craig Nelson; Sharon Andrew; Maximilian P de Courten

doi:10.2174/1573403X18666220512160737

The Wider Considerations in Closing Chronic Disease Gaps - Focus on Heart Failure and Implementation

Curr Cardiol Rev. 2023;19(2):e120522204690. doi: 10.2174/1573403X18666220512160737.

Authors

Pupalan Iyngkaran¹, Charlotte Hespe², Fahad Hanna³, John D Horowitz⁴, Malcolm Battersby⁵, Craig Nelson⁶, Sharon Andrew⁷, Maximilian P de Courten⁸

Affiliations

¹ Heart Failure & Cardiac Imaging, University of Notre Dame, Werribee Mercy Sub School, School of Medicine Sydney; Research Fellow Mitchell Institute, Victoria University, Victoria, Australia.
² General Practice and Primary Care Research, School of Medicine, Sydney, The University of Notre Dame Australia, 160 Oxford St, Darlinghurst, NSW 2010, PO Box 944 Broadway, NSW 2007, Australia.
³ Program of Public Health, Department of Health, Torrens University Australia, Australia.
⁴ Cardiology University of Adelaide, Adelaide, Australia.
⁵ College of Medicine and Public Health, Flinders University Mental Health Program Lead, Flinders Health and Medical Research Institute, Southern Adelaide Local Health Network Mental Health Service, Melbourne, Australia.
⁶ Division of Chronic and Complex Care and the Director of Nephrology, Melbourne, Australia.
⁷ Adjunct Professor of Nursing, Institute Health and Sport, Victoria University, PO Box 14428 Melbourne, Victoria 8001, Australia.
⁸ Mitchell Institute for Education and Health Policy, Victoria University, 300 Queen St, Melbourne 3000, Australia.

Abstract

Background: Heart failure (HF) is predominately a chronic disease. There are overlaps in HF and chronic disease research and care. Chronic disease and HF research are conducted with multiple goals. The overarching goal is "optimized patient outcomes at maximum costeffectiveness". However, observations on patients can come with many variables; thus, we see differences in clinical translation. This document discusses an argument for three important gaps common to HF and chronic disease, i.e., screening, self-management, and patient-reported outcomes (PRO), and provides a glance of how it could fit into the evidence tree. Pertinent arguments for a framework for health services and models of care are provided as a prelude to future consensus.

Methodology: 1) A preliminary literature review to identify a taxonomy for cardiovascular research, and 2) a review of the published literature describing the translation of research studies into clinical practice for cardiovascular disorders. A spectrum from observational to large randomized controlled trials to post-marketing studies were identified.

Discussion: A brief discussion on traditional research and differences focusing on screening, mixed methods research concepts, and chronic diseases models of care. Six steps to facilitate this: 1) Research design; 2) Research application (translation) i. routine ii. challenges; 3. Transforming research to translational level; 4. Funding and infrastructure; 5. Clinical Centres of Research Excellence (CCRE) and collaboration; 6. Governance and cost-effectiveness.

Conclusion: Implementation research that aims to link research findings to improved patient outcomes in an efficient and effective way is a neglected area. Skills required to perform implementation research are complex. Ways to maximize translational impacts for chronic disease research to clinical practice are described in a HF context.

Keywords: Chronic disease; clinical translation; health policy; heart failure; patient-reported outcomes; screening.

Publication types

Review

MeSH terms

Chronic Disease
Heart Failure* / therapy
Humans