Vulnerability to environmental and climatic health provocations among women and men hospitalised with chronic heart disease: Insights from the RESILIENCE TRIAL cohort.

Abstract

We aimed to recruit a representative cohort of women and men with multimorbid chronic heart disease as part of a trial testing an innovative, nurse-coordinated, multi-faceted intervention to lower rehospitalisation and death by addressing areas of vulnerability to external challenges to their health. The prospective, randomised open, blinded end-point RESILIENCE Trial recruited 203 hospital inpatients (mean age 75.7 ± 10.2 years) of whom 51% were women and 94% had combined coronary artery disease, heart failure and/or atrial fibrillation. Levels of concurrent multimorbidity were high (mean Charlson Index of Comorbidity Score 6.3 ± 2.7), and 8.9% had at least mild frailty according to the Rockwood Clinical Frailty Scale. Including the index admission, 19-20% of women and men had a pre-existing pattern of seasonally-linked hospitalisation (seasonality). Detailed phenotyping revealed that 48% of women and 40% of men had ≥3 physiological factors, and 15% of women and 16% of men had ≥3 behavioural factors likely to increase their vulnerability to external provocations to their health. Overall, 61-62% of women and men had ≥4 combined factors indicative of such vulnerability. Additional factors such as reliance on the public health system (63% versus 49%), lower education (30% versus 14%) and living alone (48% versus 29%) were more prevalent in women. We successfully recruited women and men with multimorbid chronic heart disease and bio-behavioural indicators of vulnerability to external provocations to their health. Once completed, the RESILIENCE TRIAL will provide important insights on the impact of addressing such vulnerability (promoting resilience) on subsequent health outcomes.