Martin A Denvir

Publications (72) View all

• Source

  Available from: Scott Murray

  Article: The Authors' reply.

  Martin A Denvir, Kristin Haga, Scott Murray
  Heart (British Cardiac Society) 08/2012; 98(20):1538. · 4.22 Impact Factor
• Source

  Available from: Scott Murray

  Article: Identifying community based chronic heart failure patients in the last year of life: a comparison of the Gold Standards Framework Prognostic Indicator Guide and the Seattle Heart Failure Model.

  Kristin Haga, Scott Murray, Janet Reid, Andrea Ness, Maureen O'Donnell, Diane Yellowlees, Martin A Denvir
  [show abstract] [hide abstract]
  ABSTRACT: To assess the clinical utility of the Gold Standards Framework Prognostic Indicator Guide (GSF) and the Seattle Heart Failure Model (SHF) to identify patients with chronic heart failure (CHF) in the last year of life. An observational cohort study of 138 community based ambulatory patients with New York Heart Association (NYHA) class III and IV CHF managed by a specialist heart failure nursing team. 12 month mortality, and sensitivity and specificity of GSF and SHF. 138 CHF patients with NYHA class III and IV symptoms were identified from a population of 368 ambulatory CHF patients. 119 (86%) met GSF criteria for end of life care. The SHF model identified six (4.3%) patients with a predicted life expectancy of 1 year or less. At the 12 month follow-up, 43 (31%) patients had died. The sensitivity and specificity for GSF and SHF in predicting death were 83% and 22%, and 12% and 99%, respectively. Receiver operator characteristic analysis of SHF revealed a C index of 0.68±0.05 (95% CI 0.58 to 0.77). Chronic kidney disease (serum creatinine ≥140 μmol/l) was a strong univariate predictor of 12 month mortality, with a sensitivity of 56% and specificity of 72%. Neither the GSF nor the SHF accurately predicted which patients were in the last year of life. The poor prognostic ability of these models highlights one of the barriers to providing timely palliative care in CHF.
  Heart (British Cardiac Society) 04/2012; 98(7):579-83. · 4.22 Impact Factor
• Source

  Available from: Martin A Denvir

  Article: Identifying acute coronary syndrome patients approaching end-of-life.

  Stephen Fenning, Rebecca Woolcock, Kristin Haga, Javaid Iqbal, Keith A Fox, Scott A Murray, Martin A Denvir
  [show abstract] [hide abstract]
  ABSTRACT: Acute coronary syndrome (ACS) is common in patients approaching the end-of-life (EoL), but these patients rarely receive palliative care. We compared the utility of a palliative care prognostic tool (Gold Standards Framework (GSF)) and the Global Registry of Acute Coronary Events (GRACE) score, to help identify patients approaching EoL. 172 unselected consecutive patients with confirmed ACS admitted over an eight-week period were assessed using prognostic tools and followed up for 12 months. GSF criteria identified 40 (23%) patients suitable for EoL care while GRACE identified 32 (19%) patients with ≥ 10% risk of death within 6 months. Patients meeting GSF criteria were older (p = 0.006), had more comorbidities (1.6 ± 0.7 vs. 1.2 ± 0.9, p = 0.007), more frequent hospitalisations before (p = 0.001) and after (0.0001) their index admission, and were more likely to die during follow-up (GSF+ 20% vs GSF- 7%, p = 0.03). GRACE score was predictive of 12-month mortality (C-statistic 0.75) and this was improved by the addition of previous hospital admissions and previous history of stroke (C-statistic 0.88). This study has highlighted a potentially large number of ACS patients eligible for EoL care. GSF or GRACE could be used in the hospital setting to help identify these patients. GSF identifies ACS patients with more comorbidity and at increased risk of hospital readmission.
  PLoS ONE 01/2012; 7(4):e35536. · 4.09 Impact Factor
• Article: Social deprivation and poor prognosis after cardiac surgery.

  Martin A Denvir, Vipin Zamvar
  BMJ (Clinical research ed.). 02/2009; 338:b721.
• Article: Best practice for chronic heart failure patients--writing guidelines is not enough.

  Martin A Denvir, Stephen J Leslie
  European Heart Journal 08/2008; 29(14):1706-8. · 10.48 Impact Factor