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.

Territoriality and Migration in a Divided Society: Lay Theories of Citizenship and Place in Northern Ireland

The study of citizenship has increasingly focused on the ways in which spatialized understandings of the concept can be used to marginalise and exclude social groups: exclusive constructions of national boundaries, local neighbourhoods and public spaces can deny marginalised groups their social and political rights. Less attention has been paid to how constructions of place can accommodate different groups’ rights and promote peaceful coexistence. This is particularly important in locations where migration disrupts existing understandings (‘lay theories’) of the relationship between residency, identity and collective rights. The present research examines how spatialized understandings of citizenship shape perceptions of intergroup mixing in previously segregated areas of a post-conflict society. Critical Discursive Social Psychological (CDSP) analysis of 30 interviews with long-term residents and recent migrants to increasingly mixed areas of Belfast shows that, while all pa
rticipants acknowledged Northern Ireland’s territorialisation, different lay theories of citizenship underpin the possibility and desirability of intergroup coexistence. Long-term residents drew upon understandings of the negative citizenry of the outgroup to argue against the possibility of peaceful coexistence within their locale, while recent incomers gave evidence of their own experiences of good citizenship within the shared spaces of neighbourhood to demonstrate that this could and should be achieved. The implications of lay theories of citizenship for the study of residential migration and mixing are discussed

Desistance from Sexual Offending: Do the Mainstream Theories Apply?

The literature on desistance from crime has become well established in recent years with strong bodies of evidence supporting the role of factors such as employment, relationships and identity change in this process. However, the relevance of this literature to individuals convicted of sexual crimes is not known as such individuals are almost always excluded from this research. This article presents the results from one of the first empirical studies on desistance from sexual offending based on 32 in-depth life story interviews with adult males previously convicted of child sex offences. In this analysis we explore the significance of work, the role of relationships, and changes in imagined selves in the self-identities of individuals successfully desisting from sexual offending. The findings provide support for all three factors in helping to sustain desistance from sex offending, but also suggest clear differences between desistance from sex offending and other types of crime in these regards.

STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail Adults with Limited Life Expectancy): Consensus Validation

Background: To validate STOPPFrail, a list of explicit criteria for potentially inappropriate medications (PIMs) in frailer older adults with limited life expectancy. A Delphi consensus survey of an expert panel (n = 17) comprising specialists in geriatric medicine, clinical pharmacology, palliative care, psychiatry of old age, clinical pharmacy and general practice.
Methods: STOPPFrail criteria was initially created by the authors based on clinical
experience and appraisal of the available literature. Criteria were organised according to physiological system. Each criterion was accompanied by an explanation. Panellists ranked their agreement with each criterion on a 5-point Likert scale and invited to provide written feedback. Criteria with a median Likert response of 4/5 (agree/strongly agree) and a 25th centile of ≥4 were included in the final criteria.
Results: Three Delphi rounds were required. All panellists completed all rounds. Thirty criteria were proposed for inclusion; 26 were accepted. No new criteria were added. The first two criteria suggest deprescribing medications with no indication or where compliance is poor. The remaining 24 criteria include lipid-lowering therapies, alpha-blockers for hypertension, anti-platelets, neuroleptics, proton pump inhibitors, H-2 receptor antagonists, anti-spasmodics, theophylline, leukotriene antagonists, calcium supplements, bone anti-resorptive therapy, selective oestrogen receptor modulators, non-steroidal antiinflammatories, corticosteroids, 5-alpha reductase inhibitors, alpha-1 selective blockers, muscarinic antagonists, oral diabetic agents, ACE-inhibitors, angiotensin receptor blockers, systemic oestrogens, multivitamins, nutritional supplements and prophylactic antibiotics. Anticoagulants and anti-depressants were excluded. Despite incorporation of panellists’ suggestions, memantine and acetyl-cholinesterase inhibitors remained inconclusive.
Conclusion: STOPPFrail comprises 26 criteria, which have been judged by broad consensus, to be potentially inappropriate in frailer older patients with limited life expectancy. STOPPFrail may assist in deprescribing medications in these patients.