Life expectancy for community-based patients with heart failure from time of diagnosis

AIMS: Heart failure has been demonstrated in previous studies to have a dismal prognosis. However, the modern-day prognosis of patients with new onset heart failure diagnosed in the community managed within a disease management programme is not known. The purpose of this study is to report on prognosis of patients presenting with new onset heart failure in the community who are subsequently followed in a disease management program.

METHODS AND RESULTS: A review of patients referred to a rapid access heart failure diagnostic clinic between 2002 and 2012 was undertaken. Details of diagnosis, demographics, medical history, medications, investigations and mortality data were analysed. A total of 733 patients were seen in Rapid Access Clinic for potential new diagnosis of incident of heart failure. 38.9% (n=285) were diagnosed with heart failure, 40.7% (n=116) with HF-REF and 59.3% (n=169) with HF-PEF. There were 84 (29.5%) deaths in the group of patients diagnosed with heart failure; 41 deaths (35.3%) occurred in patients with HF-REF and 43 deaths (25.4%) occurred in patients with HF-PEF. In patients with heart failure, 52.4% (n=44) died from cardiovascular causes. 63.8% of HF patients were alive after 5 years resulting on average in a month per year loss of life expectancy over that period compared with aged matched simulated population.

CONCLUSIONS: In this community-based cohort, the prognosis of heart failure was better than reported in previous studies. This is likely due to the impact of prompt diagnosis, the improvement in therapies and care within a disease management structure.

Shadow policing: the boundaries of community-based ‘policing’ in Northern Ireland

The intention of this article is to provide a structural and operational analysis of policing beyond the police in Northern Ireland. While the polity enjoys low levels of ‘officially’ recorded crime as part of its post-conflict status, little empirical analysis exists as to the epistemological roots of security production outside that of the Police Service of Northern Ireland. The empirical evidence presented seeks to establish that beyond more prominent analyses related to paramilitary ‘policing’, the country is in fact replete with a substantial reservoir of legitimate civil society policing – the collective mass of which contributes to policing, community safety and quality of life issues. While such non-state policing at the level of locale was recognised by the Independent Commission for Policing, structured understandings have rarely permeated governmental or academic discourse beyond anecdotal contentions. Thus, the present argument provides an empirical assessment of the complex, non-state policing landscape beyond the formal state apparatus; examines definitions and structures of such community-based policing activities; and explores issues related to co-opting this non-state security ‘otherness’ into more formal relations with the state.

Policing, Terrorism and the Conundrum of 'Community': A Northern Ireland Perspective

The book chapter examines the conundrums and contradictions for PSNI in delivering their community policing agenda within a post-conflict environment which simultaneously demands the delivery of counter-terrorism policing in view of the current dissident terrorist threat.