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Development of a holistic patient-centred intervention to improve outcomes of older people living with frailty and chronic heart failure (CHF) – a multi-centre study


   Cardiovascular Sciences

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  Dr Shirley Sze, Prof I Squire  No more applications being accepted  Funded PhD Project (Students Worldwide)

About the Project

Project Highlights:

  1. Frailty is common in patients with heart failure (HF) and predisposes to poor clinical outcomes and quality of life; yet there are no effective management strategies for this at-risk population. 
  2. This project aims to develop, pilot and evaluate a novel complex intervention incorporating an individualised exercise programme, dietary support and regular medication review to optimise care and improve outcomes of HF patients with frailty.
  3. The student will co-design and produce the intervention with HF patients and their carers, as well as a multidisciplinary team of healthcare professionals, using a mixture of qualitative and quantitative methods. 

Project Overview

CHF and frailty are complex syndromes with significant overlap, both of which are associated with poor prognosis. Our previous work demonstrated that frailty is extremely common in older CHF patients and underpins recurrent hospital admissions and death; yet it is often under-recognised. Furthermore, older patients with frailty are often excluded from clinical trials for HF, so it remains unclear how we should manage these patients.

Current HF care focuses on medical management; many non-medical issues are neglected. Moreover, existing HF rehabilitation programmes are not individualised and only emphasise an exercise component. In order to address the various care needs of CHF patients living with frailty, including physical function, medication, dietary, psychological, and social needs, this project aims to design a novel intervention adopting a patient-centred approach and involving multidisciplinary input. The intervention will include an individualised exercise training programme designed by physiotherapists/rehabilitation specialists; nutritional support from dieticians, regular medication review by specialist nurses/pharmacists and co-management of comorbidities involving relevant specialists.

Through the intervention, we aim to improve participants’ physical function, QoL and reduce hospital admissions. On a wider level, we aim to create a reproducible frailty intervention, which can be adopted by HF teams across the country to improve care and outcomes of CHF patients.

This study is funded by the British Heart Foundation and the British Society of Heart Failure. We have commenced study set-up, including ethics approval and protocol development. The study is due to run over a period of 27 months.

 The PhD student will be supported to:

  1. Conduct a systematic review +/- meta-analysis to identify effective interventions for patients living with frailty
  2. Interact and work with stakeholders using a mixture of qualitative and quantitative methods, to co-design and co-produce a complex intervention and implementation guide targeting frail patients with HF, specifically addressing when, who, where, what and how to implement the intervention within the existing HF service
  3. Evaluate the feasibility and efficacy of the intervention at two hospital sites
  4. Attend training courses on complex intervention development
  5. Produce high-impact publications and present study results at scientific conferences

Methodology 

The project has 3 stages:

  Research to inform intervention

  • Systematic review +/- meta-analysis to evaluate the effectiveness of available interventions targeting older people with frailty
  • Process mapping to understand current HF pathway
  • Qualitative research in the form of interviews, focus groups and surveys to explore the experiences of stakeholders on how the current HF pathway can be altered to address the complex care needs of frail patients with HF

 Design the intervention

  • Hospital-Wide Comprehensive Geriatric Assessment (HoW-CGA) self-assessment tool will guide intervention development to ensure key service-level competences are fulfilled
  • Context, Mechanism and Outcome evaluation framework to identify the contextual factors within HF pathways with the greatest scope of change, propose ways to deliver the change mechanism and identify relevant outcome/ process measures to evaluate change

Pilot the intervention in two centres (N=75), obtain feedback from stakeholders and refine the intervention using Plan-Do-Study-Act methodology

Entry Requirements:

Applicants are required to hold/or expect to obtain a UK Bachelor Degree 2:1 or better in a relevant subject or overseas equivalent.  The University of Leicester English language requirements may apply

How To Apply  

Please refer to our How to Apply information at https://le.ac.uk/study/research-degrees/funded-opportunities/cvs-sze-cls and apply online

With your application, please include:

  • CV
  • Personal statement explaining, briefly, your interest in the project and your experience
  • Degree Certificates and Transcripts of study already completed and if possible transcript to date of study currently being undertaken
  • Evidence of English language proficiency, if applicable
  • In the reference section please enter the contact details of your two academic referees in the boxes provided or upload letters of reference if already available.

In the Funding Section: Enter CVS Sze CLS  


Funding Notes

College of Life Sciences funding for 3.5 years to include:
• Tuition fees at UK rate
• Stipend at UKRI rates (2022/3 stipend is £16,062 per year)
International students must be able to demonstrate that they can fund the difference between UK and International fees for the duration of their study. The difference in fees payable is £16,404 per year of study.

References

1: Sze S, Pellicori P, Zhang J, Weston J, Squire IB, Clark AL. Effect of frailty on treatment, hospitalisation and death in patients with chronic heart failure. Clin Res Cardiol. 2021 Aug;110(8):1249-1258.
2: Sze S, Pellicori P, Zhang J, Weston J, Clark AL. The impact of malnutrition on short-term morbidity and mortality in ambulatory patients with heart failure. Am J Clin Nutr. 2020: nqaa311.
3: Sze S, Pellicori P, Zhang J, Weston J, Clark AL. Agreement and classification performance of malnutrition tools in patients with chronic heart failure. Curr Dev Nutr. 2020;4(6):nzaa071.
4: Sze S, Pellicori P, Zhang J, Weston J, Clark AL. Identification of Frailty in Chronic Heart Failure. JACC Heart Fail. 2019;7(4):291-302.
5: Sze S, Pellicori P, Kazmi S, Rigby A, Cleland JGF, Wong K, Clark AL.
Prevalence and Prognostic Significance of Malnutrition Using 3 Scoring Systems Among Outpatients With Heart Failure: A Comparison With Body Mass Index. JACC Heart Fail. 2018;6:476-486.
6: Sze S, Zhang J, Pellicori P, Morgan D, Hoye A, Clark AL. Prognostic value of simple frailty and malnutrition screening tools in patients with acute heart failure due to left ventricular systolic dysfunction. Clin Res Cardiol. 2017;106:533-541.
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