Objective: Australia is experiencing ever more frequent/provocative weather and environmental challenges, including more extreme heatwaves and catastrophic bushfires Concurrently, the annual challenge of wintry conditions to a population adapted to warmer conditions persists Remarkably, however, there are no proven interventions to reduce seasonal challenges to the cardiovascular health of vulnerable individuals In a world-first, the REsilience to Seasonal ILlness and Increased Emergency admissioNs CarE (RESILIENCE) Trial will test the hypothesis that an individually tailored, intervention program will reduce the risk of re-hospitalisation and mortality in vulnerable individuals Design and method: 300 adult patients admitted to the Austin Hospital in Melbourne, Australia with heart disease and multimorbidity will be recruited and randomised (1:1) to standard care (SC) or the RESILIENCE program (RP) over 12-months Applying a COVID-19 adapted protocol, the RP group will have their bio-behavioural profile and home environment assessed post-discharge, to determine their vulnerability to seasonal events An individualised case-management program, including a virtual clinic review with a dedicated RP cardiac nurse and physician, will be applied to promote seasonal resilience The primary end-point is all-cause days alive out of hospital (DAOH) during 12-month follow-up Results: With study recruitment delayed due to COVID-19 restrictions, virtual screening of medical in-patients has confirmed the need and potential for the RP Of 630 potential participants identified over a 6 week period, 196 patients (31%) met eligibility criteria-85 women and 79 men, mean (±SD) age 79 ± 11 years Non-eligibility was largely due to non-chronic form of heart disease (34%), no comorbidity (23 %), and inability to give informed consent (15%) Conclusions: Preliminary data suggest that once commenced, we will rapidly recruit the requisite number of trial participants and depending on the results, we will be able to determine the cost-effectiveness of the RP to reduce seasonallyinduced admissions and mortality
Conducting an rct in the COVID-19 pandemic: Targeting vulnerability to seasonal and acute weather changes to keep australians with cardiovascular disease out of hospital-the res