1
|
Fröhlich H, Rosenfeld N, Täger T, Goode K, Kazmi S, Hole T, Katus HA, Atar D, Cleland JGF, Agewall S, Clark AL, Frankenstein L, Grundtvig M. Epidemiology and long-term outcome in outpatients with chronic heart failure in Northwestern Europe. Heart 2019; 105:1252-1259. [PMID: 30792238 DOI: 10.1136/heartjnl-2018-314256] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/22/2019] [Accepted: 02/02/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To describe the epidemiology, long-term outcomes and temporal trends in mortality in ambulatory patients with chronic heart failure (HF) with reduced (HFrEF), mid-range (HFmrEF) or preserved ejection fraction (HFpEF) from three European countries. METHODS We identified 10 312 patients from the Norwegian HF Registry and the HF registries of the universities of Heidelberg, Germany, and Hull, UK. Patients were classified according to baseline left ventricular ejection fraction (LVEF) and time of enrolment (period 1: 1995-2005 vs period 2: 2006-2015). Predictors of mortality were analysed by use of univariable and multivariable Cox regression analyses. RESULTS Among 10 312 patients with stable HF, 7080 (68.7%), 2086 (20.2%) and 1146 (11.1%) were classified as having HFrEF, HFmrEF or HFpEF, respectively. A total of 4617 (44.8%) patients were included in period 1, and 5695 (55.2%) patients were included in period 2. Baseline characteristics significantly differed with respect to type of HF and time of enrolment. During a median follow-up of 66 (33-105) months, 5297 patients (51.4%) died. In multivariable analyses, survival was independent of LVEF category (p>0.05), while mortality was lower in period 2 as compared with period 1 (HR 0.81, 95% CI 0.72 to 0.91, p<0.001). Significant predictors of all-cause mortality regardless of HF category were increasing age, New York Heart Association functional class, N-terminal pro-brain natriuretic peptide and use of loop diuretics. CONCLUSION Ambulatory patients with HF stratified by LVEF represent different phenotypes. However, after adjusting for a wide range of covariates, long-term survival is independent of LVEF category. Outcome significantly improved during the last two decades irrespective from type of HF.
Collapse
Affiliation(s)
- Hanna Fröhlich
- Department of Cardiology, Angiology and Pulmonology, University of Heidelberg, Heidelberg, Germany
| | - Niklas Rosenfeld
- Department of Cardiology, Angiology and Pulmonology, University of Heidelberg, Heidelberg, Germany
| | - Tobias Täger
- Department of Cardiology, Angiology and Pulmonology, University of Heidelberg, Heidelberg, Germany
| | - Kevin Goode
- Health Technology, University of Hull, Kingston-upon-Hull, UK
| | - Syed Kazmi
- Academic Cardiology, University of Hull, Kingston-upon-Hull, UK
| | - Torstein Hole
- Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hugo A Katus
- Cardiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - John G F Cleland
- Royal Brompton & Harefield Hospitals, Imperial College, London, UK
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | | | - Lutz Frankenstein
- Department of Cardiology, Angiology and Pulmonology, University of Heidelberg, Heidelberg, Germany
| | | |
Collapse
|
2
|
Fonseca C, Brás D, Araújo I, Ceia F. Heart failure in numbers: Estimates for the 21st century in Portugal. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|
3
|
Insuficiência cardíaca em números: estimativas para o século XXI em Portugal. Rev Port Cardiol 2018; 37:97-104. [DOI: 10.1016/j.repc.2017.11.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 11/11/2017] [Indexed: 12/27/2022] Open
|
4
|
Characteristics and outcomes of heart failure hospitalization before implementation of a heart failure clinic: The PRECIC study. Rev Port Cardiol 2017; 36:431-438. [DOI: 10.1016/j.repc.2016.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 10/04/2016] [Accepted: 10/11/2016] [Indexed: 11/24/2022] Open
|
5
|
Characteristics and outcomes of heart failure hospitalization before implementation of a heart failure clinic: The PRECIC study. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
6
|
Nazário Leão R, Marques da Silva P. Diastolic dysfunction in hypertension. HIPERTENSION Y RIESGO VASCULAR 2017; 34:128-139. [PMID: 28268171 DOI: 10.1016/j.hipert.2017.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/26/2017] [Indexed: 12/21/2022]
Abstract
Hypertension and coronary heart disease, often coexisting, are the most common risk factors for heart failure. The progression of hypertensive heart disease involves myocardial fibrosis and alterations in the left ventricular geometry that precede the functional change, initially asymptomatic. The left ventricular diastolic dysfunction is part of this continuum being defined by the presence of left ventricular diastolic dysfunction without signs or symptoms of heart failure or poor left ventricular systolic function. It is highly prevalent in hypertensive patients and is associated with increased cardiovascular morbidity and mortality. Despite its growing importance in clinical practice it remains poorly understood. This review aims to present the epidemiological fundamentals and the latest developments in the pathophysiology, diagnosis and treatment of left ventricular diastolic dysfunction.
Collapse
Affiliation(s)
- R Nazário Leão
- Unidade Funcional Medicina 2, Hospital São José, Centro Hospitalar Lisboa Central - EPE, Lisboa, Portugal; Nova Medical School, Lisboa, Portugal.
| | - P Marques da Silva
- Nova Medical School, Lisboa, Portugal; Núcleo de Investigação Arterial, Unidade Funcional Medicina 4, Hospital Santa Marta, Centro Hospitalar Lisboa Central - EPE, Lisboa, Portugal
| |
Collapse
|
7
|
Sajeev CG, Rajan Nair S, George B, Rajesh GN, Krishnan MN. Demographical and clinicopathological characteristics in heart failure and outcome predictors: a prospective, observational study. ESC Heart Fail 2017; 4:16-22. [PMID: 28217308 PMCID: PMC5292640 DOI: 10.1002/ehf2.12119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/22/2016] [Accepted: 08/25/2016] [Indexed: 01/22/2023] Open
Abstract
AIMS The aims of the study were to study the demographical and clinicopathological characteristics of patients presenting with heart failure and evaluate the 1 year outcomes and to identify risk predictors if any. METHODS AND RESULTS A prospective observational study was conducted in consecutive patients of systolic heart failure. The study was divided into two parts-an initial 6 month enrolment phase followed up for 1 year for major adverse cardiovascular events. All patients were treated according to the Institutional Heart Failure Protocol. Demographical and clinicopathophysiological characteristics were studied, and results were analysed. A total of 143 patients were enrolled. The mean age of subjects was 56.4 years with male subjects constituting almost two-thirds of the study population. The commonest aetiology of heart failure was ischemic with valvular heart disease being the commonest cause of non-ischemic heart failure. Bendopnea, a recently described symptom of heart failure, was found in a significant number of subjects. By univariate analysis, male sex (P = 0.042) and cardiomegaly (P = 0.035) were predictors of rehospitalization, whereas the univariate predictors of mortality were ischemic aetiology (P = 0.000), age > 50 years (P = 0.007), hypertension (P = 0.012), worsening NYHA class (P = 0.003), diabetes mellitus (P = 0.009), and hypokalaemia (P = 0.006). Multivariate analysis performed showed age > 50 years [P = 0.007; OR (CI) = 13.547 (2.034-90.238)], NYHA class [P = 0.002; OR (CI) = 32.300 (3.733-276.532)], and hypokalaemia [P = 0.031; OR (CI) = 7.524 (1.208-46.862)] as significant predictors of mortality during long-term follow-up. CONCLUSIONS The study will definitely help us to throw more light in identifying risk predictors of heart failure and help in improving clinical outcomes.
Collapse
Affiliation(s)
| | | | - Biju George
- Department of Community MedicineGovernment Medical CollegeCalicutIndia
| | | | | |
Collapse
|
8
|
Laribi S, Aouba A, Nikolaou M, Lassus J, Cohen-Solal A, Plaisance P, Pavillon G, Jois P, Fonarow GC, Jougla E, Mebazaa A. Trends in death attributed to heart failure over the past two decades in Europe. Eur J Heart Fail 2014; 14:234-9. [DOI: 10.1093/eurjhf/hfr182] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Said Laribi
- INSERM UMR-S 942, Hôpital Lariboisière; Paris France
- Paris Diderot University, Sorbonne Paris Cité; France
- AP-HP, Department of Emergency Medicine; Hôpital Lariboisière; Paris France
- The GREAT network ( http://www.greatnetwork.org )
| | - Albertine Aouba
- Center of Epidemiology for Medical Causes of Death (INSERM, CépiDc, Kremlin-Bicêtre); France
| | - Maria Nikolaou
- INSERM UMR-S 942, Hôpital Lariboisière; Paris France
- The GREAT network ( http://www.greatnetwork.org )
| | - Johan Lassus
- INSERM UMR-S 942, Hôpital Lariboisière; Paris France
- The GREAT network ( http://www.greatnetwork.org )
| | - Alain Cohen-Solal
- INSERM UMR-S 942, Hôpital Lariboisière; Paris France
- Paris Diderot University, Sorbonne Paris Cité; France
- The GREAT network ( http://www.greatnetwork.org )
| | - Patrick Plaisance
- Paris Diderot University, Sorbonne Paris Cité; France
- AP-HP, Department of Emergency Medicine; Hôpital Lariboisière; Paris France
- The GREAT network ( http://www.greatnetwork.org )
| | - Gérard Pavillon
- Center of Epidemiology for Medical Causes of Death (INSERM, CépiDc, Kremlin-Bicêtre); France
| | - Preeti Jois
- Department of Emergency Medicine; University of Florida; Gainesville FL USA
| | - Gregg C. Fonarow
- Department of Medicine; University of California-Los Angeles Medical Center; Los Angeles CA USA
| | - Eric Jougla
- Center of Epidemiology for Medical Causes of Death (INSERM, CépiDc, Kremlin-Bicêtre); France
| | - Alexandre Mebazaa
- INSERM UMR-S 942, Hôpital Lariboisière; Paris France
- Paris Diderot University, Sorbonne Paris Cité; France
- AP-HP, Department of Anesthesiology and Critical Care; Hôpital Lariboisière; Paris France
- The GREAT network ( http://www.greatnetwork.org )
| | | |
Collapse
|
9
|
Dzudie A, Kengne AP, Mbahe S, Menanga A, Kenfack M, Kingue S. Chronic heart failure, selected risk factors and co-morbidities among adults treated for hypertension in a cardiac referral hospital in Cameroon. Eur J Heart Fail 2014; 10:367-72. [DOI: 10.1016/j.ejheart.2008.02.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Revised: 11/25/2007] [Accepted: 02/04/2008] [Indexed: 11/27/2022] Open
Affiliation(s)
- Anastase Dzudie
- Heart failure and transplantation Unit; Louis Pradel's Cardiovascular Hospital; Lyon France
- Department of Internal medicine and subspecialties; University of Yaoundé I; Cameroon
| | - Andre Pascal Kengne
- The George Institute For International Health; University of Sydney; Australia
| | - Salomon Mbahe
- Department of Internal medicine and subspecialties; University of Yaoundé I; Cameroon
| | - Alain Menanga
- Cardiology Unit, Service of Internal Medicine B; Yaoundé General Hospital; Cameroon
| | - Monique Kenfack
- Department of Internal medicine and subspecialties; University of Yaoundé I; Cameroon
| | - Samuel Kingue
- Department of Internal medicine and subspecialties; University of Yaoundé I; Cameroon
- Cardiology Unit, Service of Internal Medicine B; Yaoundé General Hospital; Cameroon
| |
Collapse
|
10
|
Rushton CA, Strömberg A, Jaarsma T, Kadam UT. Multidrug and optimal heart failure therapy prescribing in older general practice populations: a clinical data linkage study. BMJ Open 2014; 4:e003698. [PMID: 24384895 PMCID: PMC3902310 DOI: 10.1136/bmjopen-2013-003698] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/15/2013] [Accepted: 11/22/2013] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To investigate multidrug therapy in the cardiovascular disease (CVD) population and whether it was associated with suboptimal drug prescribing in heart failure (HF). DESIGN A population-based cross-sectional clinical data linkage study. SETTING The clinical database populations were registered with three general practices in North Staffordshire that are part of a research network. PARTICIPANTS 3155 patients aged 50 years and over were selected on the basis of a CVD-related prescription and a CVD consultation code applied to their electronic medical record in a 2-year time period. All available diagnostic data were linked to all drugs prescribed data during this time period. Two study groups were: (1) HF and (2) non-HF CVD (reference group). EXPOSURE A standard drug formulary system was used to define four multidrug count categories based on the number of different British National Formulary drug chapters prescribed at the same time. PRIMARY AND SECONDARY OUTCOME MEASURES Optimal HF therapy was defined as the prescribing of ACE inhibitor (ACEi) or a combination of ACEi and β-blocker in the 2-year time window. An additional three specific CVD drug categories that are indicated in HF were also measured. RESULTS The HF group, compared with the reference group, had higher non-CVD multidrug therapy (26% with 7 or more counts compared with 14% in the non-HF CVD reference group). For the first-choice optimal drug treatment for HF with ACEi (64%) or ACEi and β-blocker combined therapy (23%), the multidrug-adjusted associations between the HF group and the reference group were OR 3.89; 95% CI 2.8 to 5.5 and 1.99; 1.4 to 2.9, respectively. These estimates were not influenced by adjustment for sociodemographic factors and multidrug counts. CONCLUSIONS Multidrug therapy prescribing is much higher in the HF group than in a comparable CVD group but did not influence optimal drug prescribing.
Collapse
Affiliation(s)
- Claire A Rushton
- School of Nursing and Midwifery, Keele University, Stoke-on-Trent, UK
| | - Anna Strömberg
- Department of Medical and Health Sciences, Linköping University and Department of Cardiology, County Council of Östergötland, Linkoping, Sweden
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Linkoping, Sweden
| | - Umesh T Kadam
- Health Services Research Unit, Keele University, Newcastle-under-Lyme, UK
| |
Collapse
|
11
|
Velasco J, Nielsen A. Calidad de la atención a los pacientes con insuficiencia cardiaca crónica en atención primaria. Semergen 2012. [DOI: 10.1016/j.semerg.2011.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
12
|
Krüger K, Strand L, Geitung JT, Eide GE, Grimsmo A. Can electronic tools help improve nursing home quality? ISRN NURSING 2011; 2011:208142. [PMID: 22013540 PMCID: PMC3191730 DOI: 10.5402/2011/208142] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 08/03/2011] [Indexed: 11/23/2022]
Abstract
Background. Nursing homes face challenges in the coming years due to the increased number of elderly. Quality will be under pressure, expectations of the services will rise, and clinical complexity will grow. New strategies are needed to meet this situation. Modern clinical information systems with decision support may be part of that. Objectives. To study the impact of introducing an electronic patient record system with decision support on the use of warfarin, neuroleptics and weighing of patients, in nursing homes. Methods. A prevalence study was performed in seven nursing homes with 513 subjects. A before-after study with internal controls was performed. Results. The prevalence of atrial fibrillation in the seven nursing homes was 18.8%. After intervention, the proportion of all patients taking warfarin increased from 3.0% to 9.8% (P = 0.0086), neuroleptics decreased from 33.0% to 21.5% (P = 0.0121), and the proportion not weighed decreased from 72.6% to 16.0% (P < 0.0001). The internal controls did not change significantly. Conclusion. Statistics and management data can be continuously produced to monitor the quality of work processes. The electronic health record system and its system for decision support can improve drug therapy and monitoring of treatment policy.
Collapse
Affiliation(s)
- Kjell Krüger
- Løvåsen Teaching Nursing Home, Municipality of Bergen, Løvåsen 26, 5145 Fyllingsdalen, Norway
| | | | | | | | | |
Collapse
|
13
|
Ferreira S, Marinho A, Patacho M, Santa-Clara E, Carrondo C, Winck J, Bettencourt P. Prevalence and characteristics of sleep apnoea in patients with stable heart failure: Results from a heart failure clinic. BMC Pulm Med 2010; 10:9. [PMID: 20199687 PMCID: PMC2841101 DOI: 10.1186/1471-2466-10-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Accepted: 03/03/2010] [Indexed: 02/01/2023] Open
Abstract
Background Heart failure (HF) and sleep apnoea (SA) association has been recognized but whether it results from confounding factors (hypertension, ischaemia, obesity) remains unclear. We aimed to determine the prevalence of SA in HF and to identify potential risk factors for SA in HF population. Methods We prospectively evaluated 103 patients with stable HF on optimized therapy. In-laboratory polysomnography was performed. Type and severity of SA were defined according international criteria. Demographic, anthropometric and clinical characteristics were collected. Continuous data are expressed as median and interquartile range. Results SA was found in 72.8%, moderate to severe in a significant proportion (apnoea-hypopnoea index ≥ 15- 44.7% of all patients) and predominantly obstructive (60.0% of patients with SA). Most patients were non-sleepy (Epworth < 10- 66%). SA patients were predominantly men (85.3 vs 60.7%, p-0.015), had larger neck (38.0 (35.0-42.0) vs 35.0 (33.2-38.0) cm, p-0.003), severe systolic dysfunction, (63.9 vs 33.3%, p-0.018), left ventricle (LV) hypertrophy (16.2 vs 0.0%, p-0.03), LV and left atria (LA) dilatation (49.0 (44.0-52.0) vs 42.0 (38.0-48.0) mm, p < 0.001; 60.0 (54.0-65.0) vs 56.0 (52.0-59.0) mm, p-0.01). However, only LA diameter was an independent predictor of SA. Higher body-mass index (BMI) was associated with moderate to severe SA. Patients with obstructive SA had larger neck and a trend for higher BMI, snoring and sleepiness. Hypocapnia was not associated with central SA. Conclusions In our HF population, SA was prevalent, frequently asymptomatic and without characteristic risk factors. Unlike previously reported, obstructive SA was the predominant type. These results suggest that SA is underdiagnosed in HF and there is a possible correlation between them, independent of confounding factors. Recent advances in HF therapy might influence prevalence and type of SA in this population.
Collapse
Affiliation(s)
- Susana Ferreira
- Internal Medicine Department, São João Hospital, Oporto Medical University, Cardiovascular Research Unit, Alameda Professor Doutor Hernâni Monteiro, 4200-319 Porto, Portugal.
| | | | | | | | | | | | | |
Collapse
|
14
|
Barrio Ruiz C, Parellada Esquius N, Alvarado Montesdeoca C, Moll Casamitjana D, Muñoz Segura MD, Romero Menor C. [Heart failure: a view from primary care]. Aten Primaria 2010; 42:134-40. [PMID: 19818536 PMCID: PMC7024420 DOI: 10.1016/j.aprim.2009.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 06/22/2009] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Our aim was to find out the situation of heart failure (HF) in primary care. DESIGN Cross-sectional multicentre study. SETTING Four primary health care centres and a hospital in an urban area of Barcelona. PARTICIPANTS From a registered population of 35,212 inhabitants older than 45 years, we studied all patients (333) diagnosed with HF in 2006 in primary care. MEASUREMENTS A standardised questionnaire was used to record demographic, clinical and treatment data. RESULTS There were 61.4% females. Mean age was 74.5 (standard deviation [SD]: 10) for men and 79 (SD: 9.8) for women. A total of 46% of patients had HF for <5 years. The comorbidity diagnosis and at the beginning of the study were: hypertension 65.4% and 73%, diabetes 33.6% and 40%, dyslipaemia 40% and 53%, coronary disease 30% and 27%, and valvular disease 23.7% and 27%, respectively. A total of 64% of patients had registered New York Heart Association functional class (48% class II, 30% III and 6.6% IV). Blood pressure was controlled in 36% men and 20.5% women (P=0.002); 75.4% had an electrocardiogram, 57% X-ray; 58% of men and 46% of women (P=0.02) had echocardiography. The most prescribed drugs were diuretics 85.3%, the least, beta blockers 27%. CONCLUSIONS Patients with HF in primary care are elderly females with a lot of comorbidities. We must be concerned by the suboptimal use of basic investigations (electrocardiogram and X-ray) and beta blocker treatments.
Collapse
|
15
|
van Lieshout J, Wensing M, Grol R. Improvement of primary care for patients with chronic heart failure: a pilot study. BMC Health Serv Res 2010; 10:8. [PMID: 20064198 PMCID: PMC2820039 DOI: 10.1186/1472-6963-10-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 01/08/2010] [Indexed: 11/10/2022] Open
Abstract
Background Many patients with chronic heart failure (CHF) receive treatment in primary care, but data have shown that the quality of care for these patients needs to be improved. We aimed to evaluate the impact and feasibility of a programme for improving primary care for patients with CHF. Methods An observational study was performed in 19 general practices in the south-eastern part of the Netherlands, evaluation involving 15 general practitioners and 77 CHF patients. The programme for improvement comprised educational and organizational components and was delivered by a trained practice visitor to the practices. The evaluation was based on case registration forms completed by health professionals and telephone interviews. Results Management relating to diet and physical exercise seemed to have improved as eight patients were referred to dieticians and five to physiotherapists. The seasonal influenza vaccination rate increased from 94% to 97% (75/77). No impact on smoking was observed. Pharmaceutical treatment was adjusted according to guideline recommendations in 12% of the patients (9/77); 7 patients started recommended medication and 2 patients received dosage adjustments. General practitioners perceived the programme to be feasible. Clinical task delegation to nurses and assistants increased in some practices, but collaboration with other healthcare providers remained limited. Conclusions The improvement programme proved to have moderate impact on patient care. Its effectiveness should be tested in a larger rigorous evaluation study using modifications based on the pilot experiences.
Collapse
Affiliation(s)
- Jan van Lieshout
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, 114 IQ healthcare, 6500 HB Nijmegen, The Netherlands.
| | | | | |
Collapse
|
16
|
Jurgens CY, Moser DK, Armola R, Carlson B, Sethares K, Riegel B. Symptom clusters of heart failure. Res Nurs Health 2009; 32:551-60. [PMID: 19650069 PMCID: PMC3234105 DOI: 10.1002/nur.20343] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients with heart failure (HF) report multiple symptoms. Change in symptoms is an indicator of HF decompensation. Patients have difficulty differentiating HF symptoms from comorbid illness or aging. The study purpose was to identify the number, type, and combination of symptoms in hospitalized HF patients and test relationships with comorbid illness and age. A secondary analysis from a HF registry (N = 687) was conducted. The sample was 51.7% female, mean age 71 +/- 12.5 years. The theory of unpleasant symptoms informed the study regarding the multidimensional nature of symptoms. Factor analysis of nine items from the Minnesota Living with HF Questionnaire resulted in three factors, acute and chronic volume overload and emotional distress. Clusters occurred more frequently in older patients, but caused less impact.
Collapse
Affiliation(s)
- Corrine Y Jurgens
- School of Nursing, Stony Brook University, HSC L2-223, Stony Brook, NY 11794-8240, USA
| | | | | | | | | | | |
Collapse
|
17
|
Dahlstrom U, Hakansson J, Swedberg K, Waldenstrom A. Adequacy of diagnosis and treatment of chronic heart failure in primary health care in Sweden. Eur J Heart Fail 2009; 11:92-8. [DOI: 10.1093/eurjhf/hfn006] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Karl Swedberg
- Department of emergency and cardiovascular medicine; Sahlgrenska Academy, University of Gothenburg; Gothenburg Sweden
| | | |
Collapse
|
18
|
Otero-Raviña F, Grigorian-Shamagian L, Fransi-Galiana L, Názara-Otero C, Fernández-Villaverde JM, del Álamo-Alonso A, Nieto-Pol E, de Santiago-Boullón M, López-Rodríguez I, Cardona-Vidal JM, Varela-Román A, González-Juanatey JR. Estudio gallego de insuficiencia cardiaca en atención primaria (estudio GALICAP). Rev Esp Cardiol 2007. [DOI: 10.1157/13101641] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
19
|
Otero-Raviña F, Grigorian-Shamagian L, Fransi-Galiana L, Názara-Otero C, Fernández-Villaverde JM, del Álamo-Alonso A, Nieto-Pol E, de Santiago-Boullón M, López-Rodríguez I, Cardona-Vidal JM, Varela-Román A, González-Juanatey JR. Galician Study of Heart Failure in Primary Care (GALICAP Study). ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1885-5857(07)60170-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
20
|
Abstract
Heart failure is becoming an increasing concern to healthcare worldwide. It is the only cardiovascular disorder that continues to increase in both prevalence and incidence, and as the population continues to age, it is expected that the prevalence of this disease will continue to rise. Guidelines on diagnosis and treatment of heart failure are to be met. Most patients with heart failure will present themselves in general practice. Therefore, the community management of heart failure has become increasingly important and the role of General Practitioners even more crucial. Improving the reliability of diagnosis in primary care is essential since determining the aetiology and stage of heart failure leads to different management choices to improve symptoms, quality of life and disease prognosis. Furthermore, early diagnosis is needed, when there may be no symptoms, since treatment can delay or reverse disease progression. Diagnostic methods may therefore need to encompass screening strategies, as well as symptomatic case identification, in the future. General Practitioners must make correct decisions regarding appropriate further investigation, treatment and referral. A correct diagnosis is the cornerstone leading to effective management. The aim of this paper is to review the role of symptoms and signs and diagnostic tests, such as, chest X-ray, ECG, natriuretic peptides and echocardiography, for diagnosing heart failure in the primary care setting. Improving diagnostic skills remains a continuous challenge for clinicians. Simple and reliable diagnostic procedures are crucial to comply with Guidelines and reduce healthcare utilisation and costs.
Collapse
Affiliation(s)
- Cândida Fonseca
- São Francisco Xavier Hospital, Medical Sciences School, New University of Lisbon, Portugal.
| |
Collapse
|
21
|
Riegel B, Carlson B, Glaser D, Romero T. Randomized Controlled Trial of Telephone Case Management in Hispanics of Mexican Origin With Heart Failure. J Card Fail 2006; 12:211-9. [PMID: 16624687 DOI: 10.1016/j.cardfail.2006.01.005] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Revised: 12/18/2005] [Accepted: 01/09/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Disease management is effective in the general population, but it has not been tested prospectively in a sample of solely Hispanics with heart failure (HF). We tested the effectiveness of telephone case management in decreasing hospitalizations and improving health-related quality of life (HRQL) and depression in Hispanics of Mexican origin with HF. METHODS AND RESULTS Hospitalized Hispanics with chronic HF (n = 134) were enrolled and randomized to intervention (n = 69) or usual care (n = 65). The sample was elderly (72 +/- 11 years), New York Heart Association class III/IV (81.3%), and poorly educated (78.4% less than high school education). Most (55%) were unacculturated into US society. Bilingual/bicultural Mexican-American registered nurses provided 6 months of standardized telephone case management. Data on hospitalizations were collected from automated systems at 1, 3, and 6 months after the index hospital discharge. Health-related quality of life and depression were measured by self-report at enrollment, 3, and 6 months. Intention to treat analysis was used. No significant group differences were found in HF hospitalizations, the primary outcome variable (usual care: 0.49 +/- 0.81 [CI 0.25-0.73]; intervention: 0.55 +/- 1.1 [CI 0.32-0.78] at 6 months). No significant group differences were found in HF readmission rate, HF days in the hospital, HF cost of care, all-cause hospitalizations or cost, mortality, HRQL, or depression. CONCLUSION These results have important implications because of the current widespread enthusiasm for disease management. Although disease management is effective in the mainstream HF patient population, in Hispanics this ill, elderly, and poorly educated, a different approach may be needed.
Collapse
Affiliation(s)
- Barbara Riegel
- School of Nursing and Leonard Davis Institute, University of Pennsylvania, Philadelphia, 19104-6096, USA
| | | | | | | |
Collapse
|
22
|
Reibis R, Dovifat C, Dissmann R, Ehrlich B, Schulz S, Stolze K, Wegscheider K, Völler H. Implementation of evidence–based therapy in patients with systolic heart failure from 1998–2000. Clin Res Cardiol 2006; 95:154-61. [PMID: 16598528 DOI: 10.1007/s00392-006-0348-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Accepted: 11/02/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND In recent years, the incidence of systolic heart failure has increased. Besides a complete revascularization, guideline-based medication represents the most effective therapeutic approach. AIM Analysis of adherence of guideline-recommended and actual medication during inpatient cardiac rehabilitation as well as under subsequent outpatient conditions. METHODS From 01/1998 to 12/ 2000, 1346 consecutive patients (64 +/- 10 years, 73% male, LVEF 36.3 +/- 8%, 88% ischemic, 6.7% valvular cardiomyopathy, 5.3% other causes, 11.8% atrial fibrillation) were included in a singlecenter prospective register. Medication was recorded at discharge and after the follow-up period of 731 +/- 215 days. Trends in prescription rates were analyzed based on nonparametric correlations (Spearman's-Rho). Changes in medication from in- to outpatient settings were analyzed using exact McNemar test. RESULTS At discharge 75.3% (67.9%/68.9%/ 86.6% in 1998/1999/2000, p <0.001) of the patients were treated as recommended. This rate dropped to 68.3% at followup (p <0.0001). Mortality within the follow-up period was low (12.6%). CONCLUSION It could be shown that from 1998 to 2000 inpatient guideline conformity was implementable adequately. Outpatient conformity was significantly lower. Although a high proportion of correctly prescribed CHF medication could be demonstrated, a further effort to improve guideline adherence in the management of heart failure patients is desirable.
Collapse
Affiliation(s)
- R Reibis
- Klinik am See Ruedersdorf/Berlin, Seebad 84, 15562, Ruedersdorf/Berlin, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Fonseca C, Mota T, Morais H, Matias F, Costa C, Oliveira AG, Ceia F. The value of the electrocardiogram and chest X-ray for confirming or refuting a suspected diagnosis of heart failure in the community. Eur J Heart Fail 2004; 6:807-12, 821-2. [PMID: 15542421 DOI: 10.1016/j.ejheart.2004.09.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2004] [Accepted: 09/08/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is a common assumption that a normal ECG or a normal heart size on chest X-ray virtually rules out a diagnosis of heart failure. AIMS To assess the value of the electrocardiogram and chest X-ray in identifying patients with chronic heart failure in the community. METHODS AND RESULTS This study was a secondary analysis of data prospectively collected at the time of patient's enrollment in the EPICA study, an epidemiological study of the prevalence of heart failure in Portugal. A total of 6300 subjects were clinically evaluated. Patients who presented with symptoms or signs of heart failure, and/or were receiving diuretics for chronic heart failure (CHF) had a chest X-ray, ECG, and echocardiogram. The diagnosis of heart failure was confirmed in 551 cases. Patients with right atrial enlargement, atrial flutter, atrial fibrillation, 2nd degree-Mobitz I atrioventricular block, 1st degree atrioventricular block, left bundle branch block, lung interstitial oedema, and bilateral pleural effusion were more likely to be diagnosed with heart failure. For the diagnosis of heart failure, in the Portuguese population aged over 25 years, an abnormal electrocardiogram had an estimated sensitivity of 81%, and negative predictive value of 75%; an abnormal chest X-ray had an estimated sensitivity of 57%, and negative predictive value of 83%. Twenty five percent of patients with CHF had a normal ECG or chest X-ray. CONCLUSION Our results show that electrocardiographic and roentgenographic features are not sufficient to allow heart failure to be reliably predicted in the community and support the recommendation that all patients with suspected heart failure should undergo echocardiography.
Collapse
Affiliation(s)
- Cândida Fonseca
- Department of Internal Medicine, Medical Sciences School, New University of Lisbon, Lisbon, Portugal.
| | | | | | | | | | | | | |
Collapse
|
24
|
|