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Ali S, Tyerman J. Palliative Care for the Elderly With Heart Diseases in Tertiary Health care: A Concept Analysis. Am J Hosp Palliat Care 2024; 41:1061-1075. [PMID: 37963548 PMCID: PMC11318222 DOI: 10.1177/10499091231213606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The increasing incidence of heart failure (HF) in the elderly leads to increased mortality, hospitalization, length of hospital stay, and health care costs. Older adults often face multiple drug treatments, comorbidities, frailty, and cognitive problems, which require early palliative care. However, these patients do not receive adequate palliative care. OBJECTIVE This concept analysis aimed to develop an in-depth understanding of palliative care for elderly patients with cardiac diseases in tertiary care. DESIGN The analysis was guided by Walker and Avant's method, and databases were searched using keywords, such as palliative care, tertiary care, elderly, and heart. Covidence was used to review the results using the inclusion and exclusion criteria. RESULTS The World Health Organisation's definition of palliative care is widely accepted. Palliative care for older adults with heart disease in tertiary care is preceded by chronic illness, polypharmacy, symptom burden, physical and cognitive decline, comorbidities, and psychosocial/spiritual issues. The main attributes of palliative care for this population include health care professionals and patient education, holistic patient/family-centered care, symptom management, shared decision-making, early integration, advanced care planning, and a multidisciplinary approach. Palliative care improves elderly cardiac patients' and their family satisfaction while reducing readmission, hospital stays, and unnecessary invasive procedures. CONCLUSION Collaboration between hospitals, community organizations, transitional palliative care services, and research has the potential to improve early palliative care and the well-being of the elderly cardiac population. Advanced Practice Nurses (APNs) competencies play a crucial role in promoting palliative care in the elderly HF population.
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Affiliation(s)
- Sana Ali
- School of Nursing, Faculty of Health Sciences, The University of Ottawa, Ottawa, ON, Canada
| | - Jane Tyerman
- School of Nursing, Faculty of Health Sciences, The University of Ottawa, Ottawa, ON, Canada
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Boureau A, Annweiler C, Belmin J, Bouleti C, Chacornac M, Chuzeville M, David J, Jourdain P, Krolak‐Salmon P, Lamblin N, Paccalin M, Sebbag L, Hanon O. Practical management of frailty in older patients with heart failure: Statement from a panel of multidisciplinary experts on behalf the Heart Failure Working Group of the French Society of Cardiology and on behalf French Society of Geriatrics and Gerontology. ESC Heart Fail 2022; 9:4053-4063. [PMID: 36039817 PMCID: PMC9773761 DOI: 10.1002/ehf2.14040] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/02/2022] [Accepted: 06/09/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS The heart failure (HF) prognosis in older patients remains poor with a high 5-years mortality rate more frequently attributed to noncardiovascular causes. The complex interplay between frailty and heart failure contribute to poor health outcomes of older adults with HF independently of ejection fraction. The aim of this position paper is to propose a practical management of frailty in older patients with heart failure. METHODS A panel of multidisciplinary experts on behalf the Heart Failure Working Group of the French Society of Cardiology and on behalf French Society of Geriatrics and Gerontology conducted a systematic literature search on the interlink between frailty and HF, met to propose an early frailty screening by non-geriatricians and to propose ways to implement management plan of frailty. Statements were agreed by expert consensus. RESULTS Clinically relevant aspects of interlink between frailty and HF have been reported to identify the population eligible for screening and the most suitable screening test(s). The frailty screening program proposed focuses on frailty model defined by an accumulation of deficits including geriatric syndromes, comorbidities, for older patients with HF in different settings of care. The management plan of frailty includes optimization of HF pharmacological treatments and non-surgical device treatment as well as optimization of a global patient-centred biopsychosocial blended collaborative care pathway. CONCLUSION The current manuscript provides practical recommendations on how to screen and optimize frailty management in older patients with heart failure.
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Affiliation(s)
- Anne‐Sophie Boureau
- Department of Geriatrics, University Hospital, Nantes, France; Institut du ThoraxUniversity HospitalNantesFrance
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers; UPRES EA 4638, University of Angers; Gérontopôle Autonomie Longévité des Pays de la Loire; Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and DentistryUniversity of Western OntarioLondonONCanada
| | - Joël Belmin
- Hôpital Charles Foix et Sorbonne UniversitéIvry‐sur‐SeineFrance
| | - Claire Bouleti
- Cardiology, University of Poitiers, Clinical Investigation Center (CIC) INSERM 1402Poitiers University HospitalPoitiersFrance
| | | | - Michel Chuzeville
- Geriatric Cardiology Department, Edouard Herriot HospitalHospices Civils de LyonLyonFrance
| | - Jean‐Philippe David
- INSERM‐ U955, IMRB, CEpiA team, Department of Geriatric Medicine, AP‐HP, Hôpitaux Henri‐MondorUniv Paris Est CreteilCreteilFrance
| | - Patrick Jourdain
- DMU COREVE, GHU Paris Saclay, APHP, Paris, France; INSERM UMR S 999IHU TORINO (thorax Innovation)TurinItaly
| | - Pierre Krolak‐Salmon
- Clinical and Research Memory Center of Lyon, Lyon Institute For Elderly, Hospices Civils de Lyon, Villeurbanne, France; University of Lyon, Lyon, France; Neuroscience Research Centre of Lyon, INSERM 1048CNRSLyonFrance
| | - Nicolas Lamblin
- Institut Cœur Poumon, CHU de Lille, Inserm U1167, Institut Pasteur de LilleUniversité de LilleLilleFrance
| | - Marc Paccalin
- Department of GeriatricsCHU La Milétrie, CIC‐1402PoitiersFrance
| | - Laurent Sebbag
- Service Insuffisance Cardiaque et Transplantation Hospices Civils de Lyon Hôpital Louis PradelBronFrance
| | - Olivier Hanon
- Department of GeriatricsUniversité de Paris, EA 4468, APHP, Hôpital BrocaParisFrance
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Duong MH, Gnjidic D, McLachlan AJ, Sakiris MA, Goyal P, Hilmer SN. The Prevalence of Adverse Drug Reactions and Adverse Drug Events from Heart Failure Medications in Frail Older Adults: A Systematic Review. Drugs Aging 2022; 39:631-643. [PMID: 35761118 PMCID: PMC9355931 DOI: 10.1007/s40266-022-00957-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 12/14/2022]
Abstract
Introduction Frailty is highly prevalent in heart failure populations and a major risk factor for adverse drug reactions (ADRs) and adverse drug events (ADEs). This review aimed to describe the prevalence, causality and severity of ADRs or ADEs from heart failure medications among frail compared with non-frail older adults. Methods A systematic search of CENTRAL, MEDLINE, Embase, Ageline, CINAHL, International Pharmaceutical Abstracts, PsychInfo, Scopus, registries and citations prior to 18 May 2021 was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist. Risk of bias and quality of evidence were assessed. Eligible studies included randomised controlled trials (RCTs) and observational studies of people diagnosed with heart failure, aged ≥ 65 years, with frailty defined by an objective measurement, and reported ADRs/ADEs from/with heart failure medications. Results Two reviewers screened 2419 articles; interrater reliability kappa = 0.88. Three observational studies (n = 2596), a secondary analysis of two RCTs (n = 2098) and two cohort studies (n = 498) were included in a narrative synthesis. Frail patients in randomised trials of sacubitril/valsartan, aliskiren, or enalapril had twice the risk of mortality (hazard ratio [HR] 2.09, 1.62–2.71) and hospitalisations (HR 1.82, 1.37–2.41) compared with robust patients, which may reflect responsiveness to medications and/or factors unrelated to medication use. Hospitalisations from falls, tiredness and nausea were probably attributable to digoxin and possibly preventable according to the Naranjo and Hallas scales, respectively. Conclusion The potential harms from heart failure medications in frail older people are poorly studied and understood. Clinical trials and pharmacovigilance studies should include frailty as a covariate to inform medication optimisation for this vulnerable and growing population. Registration Prospero registration number: CRD 42021253762. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40266-022-00957-8.
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Affiliation(s)
- Mai H Duong
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia. .,Department of Clinical Pharmacology and Aged Care, Kolling Institute, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Danijela Gnjidic
- Faculty of Medicine and Health, Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Andrew J McLachlan
- Faculty of Medicine and Health, Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Marissa A Sakiris
- Department of Pharmacy, Royal North Shore Hospital, Sydney, NSW, Australia
| | | | - Sarah N Hilmer
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.,Department of Clinical Pharmacology and Aged Care, Kolling Institute, Royal North Shore Hospital, Sydney, NSW, Australia
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Flores-Álvarez FJ, Sillero-Herrera A, Cuesta-Gaviño J, Fernández-Sánchez ML, Vega-Sánchez J, López-Fe JL, Gamboa-Antiñolo FM, Utrilla-Ayala D, Aguirre-Palacio A, De Villar-Conde E, Vergara-López S. Frailty as a predictor of clinical problems and events that require elderly patients with heart failure to use health resources. Arch Gerontol Geriatr 2022; 101:104698. [PMID: 35390571 DOI: 10.1016/j.archger.2022.104698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/15/2022] [Accepted: 03/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The clinical management of elderly patients with heart failure (HF) is not firmly established. Decision-making should be individualized depending on the biological deterioration of each patient, from aggressive management to a palliative approach. Frailty can serve as the basis for this comprehensive individualized management. Our objective was to evaluate the importance of the main clinical problems, as well as the events that required the use of health resources, based the degree of frailty, in elderly patients with HF. METHODS AND RESULTS Retrospective observational cohort study. Frailty was defined according to the deficit accumulation construct. A total of 546 patients hospitalized for acute HF were included. The median age (Q1-Q3) was 82 (78-86) years. A total of 454 patients (83%) showed some degree of frailty: 221 (48.7%) mild, 207 (45.6%) moderate and 26 (5.7%) advanced. There was a significant tendency towards polypharmacy from no to severe frailty. Hospital events were recorded for 4 (1-6) patients with mild frailty, 4 (2-6) patients with moderate frailty and 2 ((1-4) patients with advanced frailty (p = 0.045). A total of 204 patients (37.4%) died during follow-up. The median time to death was 11.4 (4-16.8), 6.7 (3.3-11.6), 6.5 (3.4-12.2) and 4.1 (0.8-7.7) months for patients with no, mild, moderate, or advanced frailty, respectively (p = 0.006). CONCLUSIONS Frailty due to deficit accumulation is a good predictor of clinical problems and events that require the use of health resources; therefore, it can serve as a basis for the management of HF in the elderly.
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Affiliation(s)
- F J Flores-Álvarez
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - A Sillero-Herrera
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - J Cuesta-Gaviño
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | | | - J Vega-Sánchez
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - J L López-Fe
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - F M Gamboa-Antiñolo
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - D Utrilla-Ayala
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - A Aguirre-Palacio
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - E De Villar-Conde
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - S Vergara-López
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain).
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Clinical Characteristics and Predictors of In-Hospital Mortality among Older Patients with Acute Heart Failure. J Clin Med 2022; 11:jcm11020439. [PMID: 35054133 PMCID: PMC8781633 DOI: 10.3390/jcm11020439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/17/2022] Open
Abstract
Acute Heart Failure (AHF)-related hospitalizations and mortality are still high in western countries, especially among older patients. This study aimed to describe the clinical characteristics and predictors of in-hospital mortality of older patients hospitalized with AHF. We conducted a retrospective study including all consecutive patients ≥65 years who were admitted for AHF at a single academic medical center between 1 January 2008 and 31 December 2018. The primary outcome was all-cause, in-hospital mortality. We also analyzed deaths due to cardiovascular (CV) and non-CV causes and compared early in-hospital events. The study included 6930 patients, mean age 81 years, 51% females. The overall mortality rate was 13%. Patients ≥85 years had higher mortality and early death rate than younger patients. Infections were the most common condition precipitating AHF in our cohort, and pneumonia was the most frequent of these. About half of all hospital deaths were due to non-CV causes. After adjusting for confounding factors other than NYHA class at admission, infections were associated with an almost two-fold increased risk of mortality, HR 1.74, 95% CI 1.10-2.71 in patients 65-74 years (p = 0.014); HR 1.83, 95% CI 1.34-2.49 in patients 75-84 years (p = 0.001); HR 1.74, 95% CI 1.24-2.19 in patients ≥85 years (p = 0.001). In conclusion, among older patients with AHF, in-hospital mortality rates increased with increasing age, and infections were associated with an increased risk of in-hospital mortality. In contemporary patients with AHF, along with the treatment of the CV conditions, management should be focused on timely diagnosis and appropriate treatment of non-CV factors, especially pulmonary infections.
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Goldstein A, Antoine A, Ray P. [EDS and diagnosis of cardiogenic pulmonary oedema]. SOINS. GERONTOLOGIE 2021; 26:24-27. [PMID: 34462108 DOI: 10.1016/j.sger.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Acute cardiogenic pulmonary oedema in the elderly does not differ fundamentally from that seen in the young patient. Appropriate pathways must be established, with regular nursing follow-up, to enable rapid detection and treatment of episodes of acute heart failure. The paramedical team plays an essential role in liaising with families, providing nursing care and listening to the patient at the bedside.
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Affiliation(s)
- Adrien Goldstein
- Service d'accueil des urgences-Service d'aide médicale d'urgence- Structures mobiles d'urgence et de réanimation, centre hospitalier universitaire Dijon Bourgogne, 14 rue Paul-Gaffarel, F-21000 Dijon, France; UFR des sciences de santé Dijon, université de Bourgogne et Franche-Comté, site Dijon, Maison de l'Université, esplanade Erasme, 21078 Dijon, France
| | - Aymeric Antoine
- Service d'accueil des urgences-Service d'aide médicale d'urgence- Structures mobiles d'urgence et de réanimation, centre hospitalier universitaire Dijon Bourgogne, 14 rue Paul-Gaffarel, F-21000 Dijon, France
| | - Patrick Ray
- Service d'accueil des urgences-Service d'aide médicale d'urgence- Structures mobiles d'urgence et de réanimation, centre hospitalier universitaire Dijon Bourgogne, 14 rue Paul-Gaffarel, F-21000 Dijon, France; UFR des sciences de santé Dijon, université de Bourgogne et Franche-Comté, site Dijon, Maison de l'Université, esplanade Erasme, 21078 Dijon, France.
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Tersalvi G, Gasperetti A, Schiavone M, Dauw J, Gobbi C, Denora M, Krul JD, Cioffi GM, Mitacchione G, Forleo GB. Acute heart failure in elderly patients: a review of invasive and non-invasive management. J Geriatr Cardiol 2021; 18:560-576. [PMID: 34404992 PMCID: PMC8352772 DOI: 10.11909/j.issn.1671-5411.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Acute heart failure (AHF) is a major cause of unplanned hospitalisations in the elderly and is associated with high mortality. Its prevalence has grown in the last years due to population aging and longer life expectancy of chronic heart failure patients. Although international societies have provided guidelines for the management of AHF in the general population, scientific evidence for geriatric patients is often lacking, as these are underrepresented in clinical trials. Elderly have a different risk profile with more comorbidities, disability, and frailty, leading to increased morbidity, longer recovery time, higher readmission rates, and higher mortality. Furthermore, therapeutic options are often limited, due to unfeasibility of invasive strategies, mechanical circulatory support and cardiac transplantation. Thus, the in-hospital management of AHF should be tailored to each patient's clinical situation, cardiopulmonary condition and geriatric assessment. Palliative care should be considered in some cases, in order to avoid unnecessary diagnostics and/or treatments. After discharge, a strict follow-up through outpatient clinic or telemedicine is can improve quality of life and reduce rehospitalisation rates. The aim of this review is to offer an insight on current literature and provide a clinically oriented, patient-tailored approach regarding assessment, treatment and follow-up of elderly patients admitted for AHF.
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Affiliation(s)
- Gregorio Tersalvi
- Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Alessio Gasperetti
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Marco Schiavone
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Cecilia Gobbi
- Institut Cardiovasculaire de Caen, Hôpital Privé Saint Martin, Caen, France
| | - Marialessia Denora
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Joel Daniel Krul
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Giacomo Maria Cioffi
- Division of Cardiology, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Gianfranco Mitacchione
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Giovanni B. Forleo
- Cardiology Unit, ASST-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
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Pan Y, Shao C, Zhang L, He Y, Yang J, Fu W, Yang J, Wan H. The effect of Guanxin Shutong capsule on alleviating the myocardial fibrosis in heart failure rats. JOURNAL OF ETHNOPHARMACOLOGY 2021; 275:114169. [PMID: 33932513 DOI: 10.1016/j.jep.2021.114169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Guanxin Shutong (GXST) capsule is a renowned traditional Chinese medicine widely used for the treatment of cardiovascular diseases in the clinic. However, no pharmacological experimental studies of GXST has been reported on the treatment of pressure overload-induced heart failure. This study aimed to investigate the effects of GXST capsule on ameliorating myocardial fibrosis conditions in pressure overload-induced heart failure rats. MATERIAL AND METHODS Rats were randomly divided into 6 groups: Normal group, Model group, GXST-treated group at a dose of 0.5 g/kg, 1 g/kg, 2 g/kg, respectively, and digoxin positive control group at a dose of 1 mg/kg. After 4 weeks of administration, cardiac function was evaluated by echocardiography. Cardiac injury and fibrotic conditions were evaluated by H&E staining, Masson staining, and Sirius Red staining. Myocardial fibrosis was evaluated by immunohistochemistry staining and Western blot. RESULTS GXST significantly inhibited cardiac fibrosis, reduced the excessive deposition of collagen, and finally improved cardiac function. GXST reversed ventricular remodeling might be through the TGF-β/Smad3 pathway. CONCLUSION GXST capsule demonstrated a strong anti-fibrosis effect in heart failure rats by inhibiting the TGF-β/Smad3 signaling pathway.
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Affiliation(s)
- Yuming Pan
- Zhejiang Chinese Medical University, Hangzhou, 310053, China.
| | - Chongyu Shao
- Zhejiang Chinese Medical University, Hangzhou, 310053, China.
| | - Ling Zhang
- Zhejiang Chinese Medical University, Hangzhou, 310053, China.
| | - Yu He
- Zhejiang Chinese Medical University, Hangzhou, 310053, China.
| | - Jintao Yang
- Zhejiang Chinese Medical University, Hangzhou, 310053, China.
| | - Wei Fu
- Department of Cardiac-Cerebral Diseases, Yinchuan Cardiac-Cerebral Treatment Internet Hospital, Yinchuan, China.
| | - Jiehong Yang
- Zhejiang Chinese Medical University, Hangzhou, 310053, China.
| | - Haitong Wan
- Zhejiang Chinese Medical University, Hangzhou, 310053, China.
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Despins LA, Guidoboni G, Skubic M, Sala L, Enayati M, Popescu M, Deroche CB. Using Sensor Signals in the Early Detection of Heart Failure: A Case Study. J Gerontol Nurs 2021; 46:41-46. [PMID: 32598000 DOI: 10.3928/00989134-20200605-07] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Early detection of heart failure in older adults will be a significant issue for the foreseeable future. The current article presents a case study to describe how monitoring ballistocardiogram (BCG) waveforms captured non-invasively using sensors placed under a bed mattress can detect early heart failure changes. Heart and respiratory rates obtained from the bed sensor of a female older adult who was hospitalized with acute mixed congestive heart failure, clinic notes, and data from computer simulations reflecting increasing diastolic dysfunction were analyzed. Mean heart and respiratory rate trends obtained from her bed sensor in the prior 2 months did not indicate heart failure. BCG waveforms resulting from the simulations demonstrated changes associated with decreasing cardiac output as diastolic function worsened. Developing new methods for clinically interpreting BCG waveforms presents a significant opportunity for improving early heart failure detection. [Journal of Gerontological Nursing, 46(7), 41-46.].
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Clinical Impact of Worsening Renal Function in Elderly Patients with Acute Decompensated Heart Failure. INTERNATIONAL JOURNAL OF HEART FAILURE 2021; 3:128-137. [PMID: 36262877 PMCID: PMC9536691 DOI: 10.36628/ijhf.2020.0050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/28/2021] [Accepted: 02/25/2021] [Indexed: 01/08/2023]
Abstract
Background and Objectives The clinical significance of worsening renal function (WRF) in elderly patients with acute decompensated heart failure (ADHF) is not completely understood. We compared the clinical conditions between younger and elderly patients with ADHF after the appearance of WRF to establish its prognostic influence. Methods We included 654 consecutive patients (37% women) admitted for ADHF. We divided the patients into four groups according to their age (<80 years, under-80, n=331; ≥80 years, over-80, n=323) and to their WRF statuses (either WRF or non-WRF group). We defined WRF as an increase in serum creatinine level ≥0.3 mg/dL or ≥150% within 48 hours after hospital arrival (under-80, n=62; over-80, n=75). The primary endpoint was a composite of cardiac events within 1 year. Results The survival analyses revealed that the WRF group had significantly more cardiac events than the non-WRF group in patients in the over-80 group (log-rank p=0.025), but not in those of the under-80 group (log-rank p=0.50). The patients in the over-80, WRF group presented more significant mean blood pressure (MBP) drops than those in the over-80 non-WRF group (p=0.003). Logistic regression analyses revealed that higher MBP at admission was a significant predictor of WRF. Conclusions WRF is a predictor of poor outcomes in elderly patients with ADHF.
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Freund Y, Cachanado M, Delannoy Q, Laribi S, Yordanov Y, Gorlicki J, Chouihed T, Féral-Pierssens AL, Truchot J, Desmettre T, Occelli C, Bobbia X, Khellaf M, Ganansia O, Bokobza J, Balen F, Beaune S, Bloom B, Simon T, Mebazaa A. Effect of an Emergency Department Care Bundle on 30-Day Hospital Discharge and Survival Among Elderly Patients With Acute Heart Failure: The ELISABETH Randomized Clinical Trial. JAMA 2020; 324:1948-1956. [PMID: 33201202 PMCID: PMC7672513 DOI: 10.1001/jama.2020.19378] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Clinical guidelines for the early management of acute heart failure in the emergency department (ED) setting are based on only moderate levels of evidence, with subsequent low adherence to these guidelines. OBJECTIVE To test the effect of an early guideline-recommended care bundle on short-term prognosis in older patients with acute heart failure in the ED. DESIGN, SETTING, AND PARTICIPANTS Stepped-wedge cluster randomized trial in 15 EDs in France of 503 patients 75 years and older with a diagnosis of acute heart failure in the ED from December 2018 to September 2019 and followed up for 30 days until October 2019. INTERVENTIONS A care bundle that included early intravenous nitrate boluses; management of precipitating factors, such as acute coronary syndrome, infection, or atrial fibrillation; and moderate dose of intravenous diuretics (n = 200). In the control group, patient care was left to the discretion of the treating emergency physician (n = 303). Each center was randomized to the order in which they switched to the "intervention period." After the initial 4-week control period for all centers, 1 center entered in the intervention period every 2 weeks. MAIN OUTCOMES AND MEASURES The primary end point was the number of days alive and out of hospital at 30 days. Secondary outcomes included 30-day all-cause mortality, 30-day cardiovascular mortality, unscheduled readmission, length of hospital stay, and kidney impairment. RESULTS Among 503 patients who were randomized (median age, 87 years; 298 [59%] women), 502 were analyzed. In the intervention group, patients received a median (interquartile range) of 27.0 (9-54) mg of intravenous nitrates in the first 4 hours vs 4.0 (2.0-6.0) mg in the control group (adjusted difference, 23.8 [95% CI, 13.5-34.1]). There was a significantly higher percentage of patients in the intervention group treated for their precipitating factors than in the control group (58.8% vs 31.9%; adjusted difference, 31.1% [95% CI, 14.3%-47.9%]). There was no statistically significant difference in the primary end point of the number of days alive and out of hospital at 30 days (median [interquartile range], 19 [0- 24] d in both groups; adjusted difference, -1.9 [95% CI, -6.6 to 2.8]; adjusted ratio, 0.88 [95% CI, 0.64-1.21]). At 30 days, there was no significant difference between the intervention and control groups in mortality (8.0% vs 9.7%; adjusted difference, 4.1% [95% CI, -17.2% to 25.3%]), cardiovascular mortality (5.0% vs 7.4%; adjusted difference, 2.1% [95% CI, -15.5% to 19.8%]), unscheduled readmission (14.3% vs 15.7%; adjusted difference, -1.3% [95% CI, -26.3% to 23.7%]), median length of hospital stay (8 d in both groups; adjusted difference, 2.5 [95% CI, -0.9 to 5.8]), and kidney impairment (1% in both groups). CONCLUSIONS AND RELEVANCE Among older patients with acute heart failure, use of a guideline-based comprehensive care bundle in the ED compared with usual care did not result in a statistically significant difference in the number of days alive and out of the hospital at 30 days. Further research is needed to identify effective treatments for acute heart failure in older patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03683212.
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Affiliation(s)
- Yonathan Freund
- Sorbonne Université, Improving Emergency Care FHU, Paris, France
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris (APHP), Paris, France
| | - Marine Cachanado
- Clinical Research Platform (URC-CRC-CRB), Hôpital Saint-Antoine, APHP, Paris, France
| | - Quentin Delannoy
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris (APHP), Paris, France
| | - Said Laribi
- Emergency Department, Hôpital Bretonneau, Tours, France
| | - Youri Yordanov
- Sorbonne Université, Improving Emergency Care FHU, Paris, France
- Emergency Department, Hôpital Saint Antoine, APHP, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, Paris, France
| | - Judith Gorlicki
- Emergency Department, Hôpital Avicenne, APHP, Bobigny, France
| | - Tahar Chouihed
- Emergency Department, Hôpital CHRU Nancy, INSERM U1116, Université de Lorraine, Vandoeuvre les Nancy, France
| | | | | | | | | | | | - Mehdi Khellaf
- Emergency Department, Hôpital Henri Mondor, APHP, Université Paris Est – INSERM U955, Créteil, France
| | - Olivier Ganansia
- Emergency Department, Hôpital Paris Saint Joseph, Groupe Hospitalier Paris Saint Joseph
| | - Jérôme Bokobza
- Emergency Department, Hôpital Cochin, APHP, Paris, France
| | - Frédéric Balen
- Emergency Department, Centre hospitalier Universitaire de Toulouse, Toulouse, France
| | - Sebastien Beaune
- Emergency Department, Hôpital Ambroise-Paré, APHP, Boulogne, Inserm U1144, Université de Paris, France
| | - Ben Bloom
- Emergency Department, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Tabassome Simon
- Sorbonne Université, Improving Emergency Care FHU, Paris, France
- Clinical Research Platform (URC-CRC-CRB), Hôpital Saint-Antoine, APHP, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesia, Burn and Critical Care, Hôpitaux Universitaires Saint Louis Lariboisière, FHU PROMICE INI-CRCT, AP-HP, France
- Université de Paris, Paris, France
- U942 – MASCOT- Inserm, Paris, France
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12
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Yuan Y, Huang F, Deng C, Zhu P. The Additional Prognostic Value of Ghrelin for Mortality and Readmission in Elderly Patients with Acute Heart Failure. Clin Interv Aging 2020; 15:1353-1363. [PMID: 32848376 PMCID: PMC7429106 DOI: 10.2147/cia.s259889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/20/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose To evaluate the prognostic value of ghrelin, a growth hormone-releasing peptide, for mortality and readmission in elderly patients with acute heart failure (AHF). Patients and Methods We measured plasma ghrelin and pro B-type natriuretic peptide (NT-proBNP) levels upon emergency admission in 241 prospectively recruited elderly AHF patients (61.0% men). The outcomes were all-cause mortality and/or readmission due to heart failure (HF). Multivariate Cox proportional hazards regression analyses were used to evaluate the prognostic value of ghrelin. Discrimination, calibration, and reclassification indices were compared between models, with or without ghrelin. Results During 1.2 years of follow-up, we observed 90 events (57 deaths and 33 readmissions due to HF). Plasma ghrelin levels were significantly elevated in elderly AHF patients, when compared to healthy control subjects (P < 0.001). Patients with events had significantly higher baseline ghrelin levels, when compared to those without (P < 0.001). Ghrelin levels were positively correlated with NT-proBNP levels and HF severity, whereas they were negatively correlated with nutritional status (all P < 0.05). Log transformed ghrelin levels were independently associated with AHF events (hazard ratio = 2.64, 95% confidence interval = 1.11–6.25, P = 0.028). The incorporation of ghrelin into the reference model, or reference with the NT-proBNP model, both improved C-statistics (from 0.742–0.780 and 0.836–0.857; P = 0.074 and 0.044, respectively), resulting in an improvement in net reclassification index (14.42% and 10.45%, P = 0.020 and 0.025, respectively), and integrated discrimination index (5.64% and 3.60%, both P < 0.001). Patients who displayed the above NT-proBNP and ghrelin median levels had a markedly higher risk of AHF adverse events (P < 0.001). Conclusion Plasma ghrelin is an independent predictor of adverse events in elderly AHF patients. Ghrelin may provide additional value to clinical parameters or NT-proBNP for prognostic risk stratification in AHF.
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Affiliation(s)
- Yin Yuan
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Feng Huang
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, Fujian, People's Republic of China.,Fujian Provincial Institute of Clinical Geriatrics, Fuzhou, Fujian, People's Republic of China.,Fujian Provincial Key Laboratory of Geriatrics, Fuzhou, Fujian, People's Republic of China
| | - Chaochao Deng
- Fujian Provincial Institute of Clinical Geriatrics, Fuzhou, Fujian, People's Republic of China
| | - Pengli Zhu
- The Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, Fujian, People's Republic of China
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13
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Clinical Predictors Influencing the Length of Stay in Emergency Department Patients Presenting with Acute Heart Failure. ACTA ACUST UNITED AC 2020; 56:medicina56090434. [PMID: 32867269 PMCID: PMC7558979 DOI: 10.3390/medicina56090434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022]
Abstract
Background and objectives: Acute heart failure is a common problem encountered in the emergency department (ED). More than 80% of the patients with the condition subsequently require lengthy and repeated hospitalization. In a setting with limited in-patient capacity, the patient flow is often obstructed. Appropriate disposition decisions must be made by emergency physicians to deliver effective care and alleviate ED overcrowding. This study aimed to explore clinical predictors influencing the length of stay (LOS) in patients with acute heart failure who present to the ED. Materials and Methods: We conducted prognostic factor research with a retrospective cohort design. Medical records of patients with acute heart failure who presented to the ED of Ramathibodi Hospital from January to December 2015 were assessed for eligibility. Thirteen potential clinical predictors were selected as candidates for statistical modeling based on previous reports. Multivariable Poisson regression was used to estimate the difference in LOS between patients with and without potential predictors. Results: A total of 207 patients were included in the analysis. Most patients were male with a mean age of 74.2 ± 12.5 years. The median LOS was 54.6 h (Interquartile range 17.5, 149.3 h). From the multivariable analysis, four clinical characteristics were identified as independent predictors with an increase in LOS. These were patients with New York Heart Association (NYHA) functional class III/IV (+72.9 h, 95%Confidence interval (CI) 23.9, 121.8, p = 0.004), respiratory rate >24 per minute (+80.7 h, 95%CI 28.0, 133.3, p = 0.003), hemoglobin level <10 mg/dL (+60.4 h, 95%CI 8.6, 112.3, p = 0.022), and serum albumin <3.5 g/dL (+52.8 h, 95%CI 3.6, 102.0, p = 0.035). Conclusions: Poor NYHA functional class, tachypnea, anemia, and hypoalbuminemia are significant clinical predictors of patients with acute heart failure who required longer LOS.
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14
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Miyajima I, Yatabe T, Kuroiwa H, Tamura T, Yokoyama M. Influence of nutrition support therapy on readmission among patients with acute heart failure in the intensive care unit: A single-center observational study. Clin Nutr 2020; 39:174-179. [DOI: 10.1016/j.clnu.2019.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 12/12/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
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15
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The evolution of geriatric neurology. HANDBOOK OF CLINICAL NEUROLOGY 2019. [PMID: 31753157 DOI: 10.1016/b978-0-12-804766-8.00032-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
The founders of neurology in the late 19th century and early 20th century laid the foundation for modern geriatric neurology by detailed observations, in their patients, of the clinical expressions of aging of the nervous system. Further advances in clinical manifestations of aging and more detailed examination of disease states in the elderly accelerated in the last quarter of the 20th century. Basic, translational, and clinical research support of geriatric neurology studies expanded and advanced during this period and into the 21st century. The size and sophistication of this movement was stimulated by a number of factors: the successful development of geriatrics as a specialty in primary care, internal medicine, and psychiatry; the projected growth of the geriatric population; and the projections of the number of people with Alzheimer's disease. However, there were and continue to be inadequate numbers of trained geriatric neurologists available to care for the "silver tsunami" of elderly patients with age-related diseases that will present in the next 3 decades. The combination of massive investment in dementia/Alzheimer's research in the past decade, widespread awareness among researchers and trainees of the opportunities to do research in age-related diseases, and the need for further knowledge of neurodegenerative diseases led to a broad expansion of research efforts. Longitudinal clinical studies of the elderly and the advent of sophisticated neuroimaging, genetics, and laboratory techniques are advancing the field. The initiation of therapeutic interventions has led to cautious optimism about the ability to ameliorate suffering in these patients and diminish the burdens of central nervous system aging.
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16
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Xie YZ, Ni JM, Zhang SJ, Ding GR, Feng JF. Efficacy of urapidil for the treatment of patients with senile hypertension and acute heart failure. Medicine (Baltimore) 2019; 98:e17352. [PMID: 31593086 PMCID: PMC6799376 DOI: 10.1097/md.0000000000017352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Previous clinical studies have reported that urapidil can effectively treat patients with senile hypertension (SH) and acute heart failure (AHF). However, no studies have systematically assessed the efficacy and safety of urapidil for patients with SH and AHF. Thus, this study will investigate the efficacy and safety of urapidil for SH and AHF. METHODS In this study, we will search the following electronic databases from inception to the June 30, 2019: MEDLINE, EMBASE, Cochrane Library, Google scholar, Springer, WANGFANG, and China Knowledge Resource Integrated Database. We will search all these electronic databases without language limitations. We will also search grey records to avoid missing potential literature. In this study, only randomized controlled trials on assessing efficacy and safety of urapidil for SH and AHF will be considered. We will use RevMan 5.3 software and STATA 15.0 software to carry out statistical analysis. RESULTS This study will evaluate the efficacy and safety of urapidil for SH and AHF by assessing all-cause mortality, change in body weight, urine output, change in serum sodium; and incidence of all adverse events. CONCLUSION This study will provide latest evidence of the efficacy and safety of urapidil for patients with SH and AHF. DISSEMINATION AND ETHICS This study will only analyze published data; therefore, no ethical approval is needed. The findings of this study will be published at peer-reviewed journals. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019139344.
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Affiliation(s)
| | | | | | | | - Jun-Fei Feng
- Department of Respiratory Medicine, Hangzhou Fuyang Hospital of Traditional Chinese Medicine, Hangzhou, China
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17
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Xavier SDO, Ferretti-Rebustini REDL. Clinical characteristics of heart failure associated with functional dependence at admission in hospitalized elderly. Rev Lat Am Enfermagem 2019; 27:e3137. [PMID: 31038631 PMCID: PMC6528626 DOI: 10.1590/1518-8345.2869-3137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 12/16/2018] [Indexed: 01/27/2023] Open
Abstract
Objective to identify which clinical features of heart failure are associated with a
greater chance of functional dependence for the basic activities of daily
living in hospitalized elderly. Method cross-sectional study conducted with elderly hospitalized patients. The
clinical characteristics of heart failure were assessed by self-report,
medical records and scales. Dependency was assessed by the Katz Index. The
Fisher’s Exact Test was used to analyze associations between the nominal
variables, and logistic regression to identify factors associated with
dependence. Results the sample consisted of 191 cases. The prevalence of functional dependence
was 70.2%. Most of the elderly were partially dependent (66.6%). Clinical
characteristics associated with dependence at admission were dyspnea (Odds
Ratio 8.5, Confidence Interval 95% 2.668-27.664, p <0.001), lower limb
edema (Odds Ratio 5.7, 95% Confidence Interval 2.148-15.571, p <0.001);
cough (Odds Ratio 9.0, 95% confidence interval 1.053-76.938, p <0.045);
precordial pain (Odds Ratio 4.5, 95% confidence interval 1.125-18.023, p
<0.033), and pulmonary crackling (Odds Ratio 4.9, 95% Confidence Interval
1.704-14.094, p <0.003). Conclusion functional dependence in admitted elderly patients with heart failure is more
associated with congestive signs and symptoms.
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18
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Freund Y, Gorlicki J, Cachanado M, Salhi S, Lemaître V, Simon T, Mebazaa A. Early and comprehensive care bundle in the elderly for acute heart failure in the emergency department: study protocol of the ELISABETH stepped-wedge cluster randomized trial. Trials 2019; 20:95. [PMID: 30704508 PMCID: PMC6357377 DOI: 10.1186/s13063-019-3188-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/09/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Acute heart failure (AHF) is one of the most common diagnoses for elderly patients in the emergency department (ED), with an admission rate above 80% and 1-month mortality around 10%. The European guidelines for the management of AHF are based on moderate levels of evidence, due to the lack of randomized controlled trials and the scarce evidence of any clinical added value of a specific treatment to improve outcomes. Recent reports suggest that the very early administration of full recommended therapy may decrease mortality. However, several studies have highlighted that elderly patients often received suboptimal treatment. Our hypothesis is that an early care bundle that comprises early and comprehensive management of symptoms, along with prompt detection and treatment of precipitating factors should improve AHF outcome in elderly patients. METHODS/DESIGN ELISABETH is a stepped-wedge, cluster randomized controlled, clinical trial in 15 emergency departments in France recruiting all patients aged 75 years and older with a diagnosis of AHF. The tested intervention is a care bundle with a checklist that mandates detection and early treatment of AHF precipitating factors, early and intensive treatment of congestion with intravenously administered nitrate boluses, and application of other recommended treatment (low-dose diuretics, non-invasive ventilation when indicated, and preventive low-molecular-weight heparin). Each center is randomized to the order in which they will switch from a "control period" to an "intervention period." All centers begin the trials with the control period for 2 weeks, then after each 2-week step a new center will enter the intervention period. At the end of the trial, all clusters will receive the intervention regimen. The primary outcome is the number of days alive and out of the hospital at 30 days. DISCUSSION If our hypothesis is confirmed, this trial will strengthen the level of evidence of AHF guidelines and stress the importance of the associated early and comprehensive treatment of precipitating factors. This trial could be the first to report a reduction in short-term morbidity and mortality in elderly AHF patients. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03683212. Prospectively registered on 25 September 2018.
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Affiliation(s)
- Yonathan Freund
- Sorbonne Université, Paris, France
- Emergency Department, Hôpital Pitié-Salpêtrière, Paris, France
- Service d’accueil des urgences, Hôpital Pitié-Salpêtrière, 83 boulevard de l’hôpital, 75013 Paris, France
| | - Judith Gorlicki
- Emergency Department, Hôpital Avicenne, Université Paris 13, Sorbonne Paris Cité, Bobigny, France
| | - Marine Cachanado
- Clinical Research Platform, Hôpital Saint-Antoine, Paris, France
| | - Sarah Salhi
- Clinical Research Platform, Hôpital Saint-Antoine, Paris, France
| | - Vanessa Lemaître
- Clinical Research Platform, Hôpital Saint-Antoine, Paris, France
| | - Tabassome Simon
- Sorbonne Université, Paris, France
- Clinical Research Platform, Hôpital Saint-Antoine, Paris, France
| | - Alexandre Mebazaa
- Department of Anaesthesiology and Critical Care Medicine, Saint Louis and Lariboisière University Hospitals and INSERM UMR-S 942, Paris, France
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19
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Palazzuoli A, Evangelista I, Ruocco G, Lombardi C, Giovannini V, Nuti R, Ghio S, Ambrosio G. Early readmission for heart failure: An avoidable or ineluctable debacle? Int J Cardiol 2018; 277:186-195. [PMID: 30262226 DOI: 10.1016/j.ijcard.2018.09.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 08/30/2018] [Accepted: 09/10/2018] [Indexed: 12/18/2022]
Abstract
Early hospital readmission after an episode of Acute Decompensated Heart Failure (ADHF) is an emerging issue that is causing a relevant clinical and economic burden. Although there might be several reasons for early readmissions, in many cases these might be effectively prevented by a more adequate post-discharge management, including recommendations on lifestyle and rehabilitation programs. However, almost half of hospitalizations are unrelated to specific cardiac causes and thus increases the difficulty in analyzing risks prediction. Many episodes are related to social environment, poor familiar assistance and inadequate followup program. In addition, the national and insurance companies constantly quest for a reduction of costs that could lead to inappropriately shortened hospital stays. Therefore, the suitability of early re-hospitalization as a correct target for good medical practice is highly debated. Nevertheless, the post-discharge phase after episodes of ADHF remains poorly analyzed in clinical trials and specific investigations should be considered during the transition period from acute to chronic status. A validated program, which focuses on an appropriate risk algorithm including cardiac and extracardiac precipitating factors is lacking. This is a necessary and it should become one of the most important targets to aim for in HF management and strategy.
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Affiliation(s)
- Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Internal Medicine, University of Siena, Siena, Italy.
| | - Isabella Evangelista
- Cardiovascular Diseases Unit, Department of Internal Medicine, University of Siena, Siena, Italy
| | - Gaetano Ruocco
- Cardiovascular Diseases Unit, Department of Internal Medicine, University of Siena, Siena, Italy
| | - Carlo Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Valtere Giovannini
- Azienda Ospedaliera Universitaria Senese, Le Scotte Hospital, Siena, Italy
| | - Ranuccio Nuti
- Cardiovascular Diseases Unit, Department of Internal Medicine, University of Siena, Siena, Italy
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
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20
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Dai Z, Zhang Y, Ye H, Zhang G, Jin H, Chen Z, Yao Y, Tian X, Zhou J, Li P, Liang X, Xie H, Ge S, Zhang Z. Adiponectin is valuable in the diagnosis of acute heart failure with renal insufficiency. Exp Ther Med 2018; 16:2725-2734. [PMID: 30210613 DOI: 10.3892/etm.2018.6511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 03/27/2018] [Indexed: 01/06/2023] Open
Abstract
Acute heart failure (AHF) is a major public health issue due to its high incidence and poor prognosis; thus, efficient and timely diagnosis is critical for improving the prognosis and lowering the mortality rate. Amino-terminal pro-brain natriuretic peptide (NT-proBNP) is widely used in the diagnosis of AHF; however, its efficacy is controversial in diagnosing AHF with renal insufficiency. There were numerous studies reporting the association of adiponectin (ADPN) and heart diseases. Therefore, the present study aimed to investigate whether ADPN is helpful in identifying AHF with renal insufficiency. A total of 407 participants (218 AHF patients and 189 controls) were enrolled into the current study. The plasma levels of ADPN and NT-proBNP were measured using a sandwich enzyme-linked immunosorbent assay and an electrochemiluminescence immunoassay, respectively. In addition, these levels were compared among the various New York Health Association classes, as well as the ischemic and non-ischemic AHF cases. The correlation between the two biomarkers and the renal function was analyzed by Spearman's correlation, while the diagnostic efficiency of ADPN and NT-proBNP was evaluated in AHF patients with and without renal insufficiency. The results revealed that NT-proBNP exhibited a higher diagnostic efficiency as compared with ADPN in patients without renal insufficiency [area under the receiver operating characteristic curve (AUC), 0.905 vs. 0.775]. By contrast, the ADPN presented a better diagnostic value in comparison with NT-proBNP in AHF with renal insufficiency (AUC, 0.872 vs. 0.828). Therefore, a combination of these two biomarkers may provide an excellent efficacy in the diagnosis of AHF with renal insufficiency (AUC, 0.904; sensitivity, 71.2%; specificity, 98.3%). In conclusion, ADPN is a valuable biomarker for diagnosing AHF, particularly in patients with impaired renal function.
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Affiliation(s)
- Zhang Dai
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Yan Zhang
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Huiming Ye
- State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian 361002, P.R. China.,Department of Clinical Laboratory, Xiamen Maternal and Child Health Hospital, Teaching Hospital of Medical College Xiamen University, Xiamen, Fujian 361003, P.R. China
| | - Guoqiang Zhang
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Hongwei Jin
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Ziming Chen
- Department of Reagent Research, Xiamen Innovax Biotech Co., Ltd., Xiamen, Fujian 361022, P.R. China
| | - Yihui Yao
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Xuebing Tian
- Department of Clinical Laboratory, Xiamen Cardiovascular Hospital, Medical College Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Jianfeng Zhou
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Peihua Li
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Xianming Liang
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Huabing Xie
- Department of Clinical Laboratory, Xiamen Cardiovascular Hospital, Medical College Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Shengxiang Ge
- State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian 361002, P.R. China
| | - Zhongying Zhang
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China.,State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian 361002, P.R. China.,Department of Clinical Laboratory, Zhongshan Teaching Hospital, Fujian Medical University, Xiamen, Fujian 361001, P.R. China
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21
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Abstract
Acute heart failure (AHF) is a life-threatening condition requiring immediate treatment. The initial therapy should take into account the clinical presentation, pathophysiology at play, precipitating factors and underlying cardiac pathology. Particular attention should be given to polymorbidity and the avoidance of potential iatrogenic harm. Patient preferences and ethical issues should be integrated into the treatment plan at an early stage. The average survival of AHF patients is 2 years and the most vulnerable period is the 3-month time window directly after discharge. Reducing both persistent subclinical congestion and underutilisation of disease-modifying heart failure therapies as well as ensuring optimal transitions of care after hospital discharge are essential in improving outcomes for AHF patients.
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Affiliation(s)
- Mattia Arrigo
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Petra Nijst
- Department of Cardiology, Ziekenhuis Oost Limburg Genk, Genk, Belgium
| | - Alain Rudiger
- Cardiosurgical Intensive Care Unit, University Hospital Zurich, Zurich, Switzerland
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