title: Establishing a pragmatic framework to optimise health outcomes in heart failure and multimorbidity (ARISE-HF): A multidisciplinary position statement.
abstract: BACKGROUND
  Multimorbidity in heart failure (HF), defined as HF of any aetiology and multiple concurrent conditions that require active management, represents an emerging problem within the ageing HF patient population worldwide.
  
  
  METHODS
  To inform this position paper, we performed: 1) an initial review of the literature identifying the ten most common conditions, other than hypertension and ischaemic heart disease, complicating the management of HF (anaemia, arrhythmias, cognitive dysfunction, depression, diabetes, musculoskeletal disorders, renal dysfunction, respiratory disease, sleep disorders and thyroid disease) and then 2) a review of the published literature describing the association between HF with each of the ten conditions. From these data we describe a clinical framework, comprising five key steps, to potentially improve historically poor health outcomes in this patient population.
  
  
  RESULTS
  We identified five key steps (ARISE-HF) that could potentially improve clinical outcomes if applied in a systematic manner: 1) Acknowledge multimorbidity as a clinical syndrome that is associated with poor health outcomes, 2) Routinely profile (using a standardised protocol - adapted to the local health care system) all patients hospitalised with HF to determine the extent of concurrent multimorbidity, 3) Identify individualised priorities and person-centred goals based on the extent and nature of multimorbidity, 4) Support individualised, home-based, multidisciplinary, case management to supplement standard HF management, and 5) Evaluate health outcomes well beyond acute hospitalisation and encompass all-cause events and a person-centred perspective in affected individuals.
  
  
  CONCLUSIONS
  We propose ARISE-HF as a framework for improving typically poor health outcomes in those affected by multimorbidity in HF.
authors.affiliation: Mary MacKillop Institute for Health Research Centre of Research Excellence in Health Service Research to Reduce Inequality in Heart Disease, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia. Electronic address: Simon.Stewart@acu.edu.au.
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
authors.affiliation: University of Pennsylvania School of Nursing, Room 335 Fagin Hall, 418 Curie Blvd.,Philadelphia, PA 19104-4217, USA. Electronic address: briegel@nursing.upenn.edu.
authors.forename: Barbara
authors.initials: B
authors.lastname: Riegel
authors.affiliation: Center on Aging and Health, John Hopkins University, Mason F. Lord Building, 7th Floor, Center Tower, 5200 Eastern Avenue, Baltimore, MD 21224, USA. Electronic address: cboyd@jhsph.edu.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Boyd
authors.affiliation: Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia. Electronic address: Yasmin.Ahamed@acu.edu.au.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Ahamed
authors.affiliation: Mary MacKillop Institute for Health Research, Centre for the Heart and Mind, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia. Electronic address: David.Thompson@acu.edu.au.
authors.forename: David R
authors.initials: DR
authors.lastname: Thompson
authors.affiliation: The University of Melbourne, Department of Medicine, Austin Health, Level 7, Room 10, Lance Townsend Building, Austin Health , Heidelberg, Victoria 3084, Melbourne, Australia. Electronic address: l.burrell@unimelb.edu.au.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Burrell
authors.affiliation: Mary MacKillop Institute for Health Research, Centre for Primary Care and Prevention, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia. Electronic address: Melinda.Carrington@acu.edu.au.
authors.forename: Melinda J
authors.initials: MJ
authors.lastname: Carrington
authors.affiliation: Monash and Warwick Universities, Monash Warwick Alliance Office, Building 3A, Clayton Campus, Wellington Road, Victoria 3800, Australia. Electronic address: ajscoats@aol.com.
authors.forename: Andrew
authors.initials: A
authors.lastname: Coats
authors.affiliation: Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA. Electronic address: grang004@mc.duke.edu.
authors.forename: Bradi B
authors.initials: BB
authors.lastname: Granger
authors.affiliation: Mary MacKillop Institute for Health Research, Centre for Musculoskeletal Research, Australian Catholic University, Level 1, 631 Stanley Street, Woolloongabba, Queensland 4102, Australia. Electronic address: Julie.Hides@acu.edu.au.
authors.forename: Julie
authors.initials: J
authors.lastname: Hides
authors.affiliation: Jefferson University, Christiana Care Health Services, Center for Heart & Vascular Health, Suite 1070, 4755 Ogletown-Stanton Road, Newark, DE 19713, USA. Electronic address: WWeintraub@Christianacare.org.
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
authors.affiliation: University of Kentucky, Center for Biobehavioral Research in Self-Management of Cardiopulmonary Diseases, College of Nursing, 527 College of Nursing Building, Lexington, KY 40536-0232, USA. Electronic address: debra.moser@uky.edu.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
authors.affiliation: New York University, College of Nursing, 433 First Ave Room 742, New York, NY 10010, USA. Electronic address: vdickson@nyu.edu.
authors.forename: Victoria Vaughan
authors.initials: VV
authors.lastname: Dickson
authors.affiliation: Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia. Electronic address: Cressida.McDermott@acu.edu.au.
authors.forename: Cressida J
authors.initials: CJ
authors.lastname: McDermott
authors.affiliation: Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia. Electronic address: Kimberley.Keates@acu.edu.au.
authors.forename: Ashley K
authors.initials: AK
authors.lastname: Keates
authors.affiliation: Washington University School of Medicine, Cardiovascular Division, 660 S. Euclid Ave, Campus Box 8086, St. Louis, MO 63110, USA. Electronic address: mrich@wustl.edu.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Rich
mesh_terms: D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015897:Comorbidity; D003695:Delivery of Health Care / Q000379:methods* / Q000592:standards / Q000639:trends; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D033183:Interdisciplinary Communication; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005791:Patient Care / Q000379:methods* / Q000592:standards / Q000639:trends; D016896:Treatment Outcome
keywords: Heart failure; Multidisciplinary management; Multimorbidity; Person-centred perspective