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Lawson CA, Benson L, Squire I, Zaccardi F, Ali M, Hand S, Kadam U, Tay WT, Dahlstrom U, Lund LH, Savarese G, Lam CS, Khunti K, Strömberg A. Changing health related quality of life and outcomes in heart failure by age, sex and subtype. EClinicalMedicine 2023; 64:102217. [PMID: 37745020 PMCID: PMC10514432 DOI: 10.1016/j.eclinm.2023.102217] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/26/2023] Open
Abstract
Background There are calls to integrate serial recordings of health related quality of life (HRQoL) into routine care, clinical trials and prognosis. Little is known about the relationship between change in HRQoL and outcomes in heart failure (HF) patients by age, sex and HF subtype. Method From the Swedish Heart Failure Registry (SwedeHF; 2008-2019), patients were categorised by reduced (<40%, HFrEF), mildly-reduced (40-49%, HFmrEF) and preserved (≥50%, HFpEF) ejection fraction. HRQoL was measured using Euro-QoL-5D visual analogue scale (EQ5D-vas), collected at baseline and 1-year. Baseline EQ5D-vas scores were categorised by: "best" (76-100), "good" (51-75), "bad" (26-50), and "worst" (0-25). Change in EQ5D-vas was categorised as 'no significant change' (<5 points increase/decrease); some worsening (5-9 points decrease); considerable worsening (≥10 points decrease); some improvement (5-9 points increase); considerable improvement (≥10 points increase). Associations with admission and death were estimated and interactions with patient sub-groups tested. Findings Among 23,553 patients (median age 74 [66-81] years, 8000 [34%] female), baseline EQ5D-vas was worse in older patients, women, and those with HFpEF compared to their respective counterparts. Compared to patients with the "best" EQ5D-vas, the adjusted associations for admission for those with "good", "bad" and "worst" EQ5D-vas were, respectively: HR 1.09 (1.04, 1.14), 1.27 (1.21, 1.33) and 1.39 (1.28, 1.51). Compared to no significant change in EQ5D-vas, the adjusted estimates for admission following some improvement, considerable improvement, some worsening and considerable worsening were, respectively: HR 0.91 (0.82, 1.01), 0.75 (0.70, 0.81), 1.04 (0.92, 1.16) and 1.25 (1.16, 1.35). Results were similar amongst groups and for HF admission and death. Interpretation Change in HRQoL was an independent indicator of risk of admission and death in people with all HF subtypes, irrespective of age and sex. Funding NIHR.
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Affiliation(s)
- Claire A. Lawson
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
- NIHR Leicester Biomedical Research Centre –Cardiology, Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Leicestershire, United Kingdom
| | | | - Iain Squire
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
- NIHR Leicester Biomedical Research Centre –Cardiology, Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Leicestershire, United Kingdom
- Karolinska Institutet, Stockholm, Sweden
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, University of Leicester, Leicestershire, United Kingdom
- Diabetes Centre, University of Leicester, Leicestershire, United Kingdom
- National Institute for Health Research (NIHR) Applied Research Collaboration - East Midlands (ARC-EM), University of Leicester, Leicestershire, United Kingdom
| | - Mohammad Ali
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
- NIHR Leicester Biomedical Research Centre –Cardiology, Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Leicestershire, United Kingdom
| | - Simon Hand
- Health Sciences, University of Leicester, Leicestershire, United Kingdom
| | - Umesh Kadam
- Health Sciences, University of Leicester, Leicestershire, United Kingdom
| | | | - Ulf Dahlstrom
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Lars H. Lund
- Karolinska Institutet, Stockholm, Sweden
- Duke-National University of Singapore, Singapore
| | | | | | - Kamlesh Khunti
- Leicester Real World Evidence Unit, University of Leicester, Leicestershire, United Kingdom
- Diabetes Centre, University of Leicester, Leicestershire, United Kingdom
- National Institute for Health Research (NIHR) Applied Research Collaboration - East Midlands (ARC-EM), University of Leicester, Leicestershire, United Kingdom
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, and Department of Cardiology, Linkoping University, Sweden
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Lawson CA, Tay WT, Richards M, Zaccardi F, Tromp J, Teng THK, Hung CL, Chandramouli C, Wander GS, Ouwerkerk W, Teramoto K, Ali M, Kadam U, Hand S, Harrison M, Anand I, Naik A, Squire I, Khunti K, Stromberg A, Lam CS. Patient-Reported Status and Heart Failure Outcomes in Asia by Sex, Ethnicity, and Socioeconomic Status. JACC. ASIA 2023; 3:349-362. [PMID: 37323861 PMCID: PMC10261894 DOI: 10.1016/j.jacasi.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 06/17/2023]
Abstract
Background In heart failure (HF), symptoms and health-related quality of life (HRQoL) are known to vary among different HF subgroups, but evidence on the association between changing HRQoL and outcomes has not been evaluated. Objectives The authors sought to investigate the relationship between changing symptoms, signs, and HRQoL and outcomes by sex, ethnicity, and socioeconomic status (SES). Methods Using the ASIAN-HF (Asian Sudden Cardiac Death in Heart Failure) Registry, we investigated associations between the 6-month change in a "global" symptoms and signs score (GSSS), Kansas City Cardiomyopathy Questionnaire overall score (KCCQ-OS), and visual analogue scale (VAS) and 1-year mortality or HF hospitalization. Results In 6,549 patients (mean age: 62 ± 13 years], 29% female, 27% HF with preserved ejection fraction), women and those in low SES groups had higher symptom burden but lower signs and similar KCCQ-OS to their respective counterparts. Malay patients had the highest GSSS (3.9) and lowest KCCQ-OS (58.5), and Thai/Filipino/others (2.6) and Chinese patients (2.7) had the lowest GSSS scores and the highest KCCQ-OS (73.1 and 74.6, respectively). Compared to no change, worsening of GSSS (>1-point increase), KCCQ-OS (≥10-point decrease) and VAS (>1-point decrease) were associated with higher risk of HF admission/death (adjusted HR: 2.95 [95% CI: 2.14-4.06], 1.93 [95% CI: 1.26-2.94], and 2.30 [95% CI: 1.51-3.52], respectively). Conversely, the same degrees of improvement in GSSS, KCCQ-OS, and VAS were associated with reduced rates (HR: 0.35 [95% CI: 0.25-0.49], 0.25 [95% CI: 0.16-0.40], and 0.64 [95% CI: 0.40-1.00], respectively). Results were consistent across all sex, ethnicity, and SES groups (interaction P > 0.05). Conclusions Serial measures of patient-reported symptoms and HRQoL are significant and consistent predictors of outcomes among different groups with HF and provide the potential for a patient-centered and pragmatic approach to risk stratification.
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Affiliation(s)
- Claire A. Lawson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
- Leicester Real World Evidence Unit, Leicester, United Kingdom
- NIHR Applied Research Collaboration–East Midlands, University of Leicester, Leicester, United Kingdom
| | | | - Mark Richards
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
- National University Heart Centre, Singapore
| | - Francesco Zaccardi
- NIHR Applied Research Collaboration–East Midlands, University of Leicester, Leicester, United Kingdom
- Diabetes Research Centre, Leicester, United Kingdom
| | - Jasper Tromp
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- School of Allied Health, University of Western Australia, Australia
| | - Chung-Lieh Hung
- Department of Cardiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chanchal Chandramouli
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Gurpreet S. Wander
- Department of Cardiology, Hero Dayanand Medical College Heart Institute, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore
- Department of Dermatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
| | | | - Mohammad Ali
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Umesh Kadam
- Diabetes Research Centre, Leicester, United Kingdom
- Department of Health Sciences, University of Leicester, Leicestershire, United Kingdom
| | - Simon Hand
- Department of Health Sciences, University of Leicester, Leicestershire, United Kingdom
| | - Mary Harrison
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Inder Anand
- Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ajay Naik
- Care Institute of Medical Sciences, Ahmedabad, India
| | - Iain Squire
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Leicester, United Kingdom
- NIHR Applied Research Collaboration–East Midlands, University of Leicester, Leicester, United Kingdom
- Diabetes Research Centre, Leicester, United Kingdom
| | - Anna Stromberg
- Department of Health, Medicine and Caring Sciences, and Department of Cardiology, Linkoping University, Sweden
| | - Carolyn S.P. Lam
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- George Institute for Global Health, Sydney, Australia
- Department of Cardiology, University of Groningen, Groningen, the Netherlands
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Prediction of 7-Day Readmission Risk for Pediatric Trauma Patients. J Surg Res 2020; 253:254-261. [PMID: 32388388 DOI: 10.1016/j.jss.2020.03.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/18/2020] [Accepted: 03/26/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pediatric patients admitted for trauma may have unique risk factors of unplanned readmission and require condition-specific models to maximize accuracy of prediction. We used a multicenter data set on trauma admissions to study risk factors and predict unplanned 7-day readmissions with comparison to the 30-day metric. METHODS Data from 28 hospitals in the United States consisting of 82,532 patients (95,158 encounters) were retrieved, and 75% of the data were used for building a random intercept, mixed-effects regression model, whereas the remaining were used for evaluating model performance. The variables included were demographics, payer, current and past health care utilization, trauma-related and other diagnoses, medications, and surgical procedures. RESULTS Certain conditions such as poisoning and medical/surgical complications during treatment of traumatic injuries are associated with increased odds of unplanned readmission. Conversely, trauma-related conditions, such as trauma to the thorax, knee, lower leg, hip/thigh, elbow/forearm, and shoulder/upper arm, are associated with reduced odds of readmission. Additional predictors include the current and past health care utilization and the number of medications. The corresponding 7-day model achieved an area under the receiver operator characteristic curve of 0.737 (0.716, 0.757) on an independent test set and shared similar risk factors with the 30-day version. CONCLUSIONS Patients with trauma-related conditions have risk of readmission modified by the type of trauma. As a result, additional quality of care measures may be required for patients with trauma-related conditions that elevate their risk of readmission.
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Quercioli C, Nisticò F, Troiano G, Maccari M, Messina G, Barducci M, Carriero G, Golinelli D, Nante N. Developing a new predictor of health expenditure: preliminary results from a primary healthcare setting. Public Health 2018; 163:121-127. [PMID: 30142482 DOI: 10.1016/j.puhe.2018.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 06/13/2018] [Accepted: 07/10/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Risk adjustment is a widely used tool for health expenditure prediction and control. Early approaches for estimating health expenditure were based on patient demographic variables alone, whereas more recent models incorporate patient information, such as chronic medical conditions, clinical diagnoses, and self-reported health status. Many studies have investigated the health expenditure predictive capacity of single demographic, morbidity, or health-related quality of life measures, but the best models prove to be those that include them all. The aim of this study was to develop an index that combines measures of perceived health and disease severity and to compare its efficacy in predicting health expenditure with that of the measures taken individually. STUDY DESIGN This is a linked cross-sectional study. METHODS In 2009 and 2010, the health-related quality of life questionnaire SF-36 (8 scales, two indices: Physical Component Summary [PCS] and Mental Component Summary [MCS]) was distributed to 886 patients of general practitioners in the Province of Siena, Italy. Severity of diseases was calculated for each patient using the Charlson Index (CH-I) and Cumulative Illness Rating Scale Severity Index (CIRS-SI). Siena Local Health Unit 2012 data on health expenditure were obtained for each patient. Multivariate linear regression was applied to test the performance of severity (CH-I, CIRS-SI) and perceived health (PCS and MCS) measures in predicting health expenditure. The indexes that predicted health expenditure best were then combined in a new tool, and its expenditure predictive capacity was tested. RESULTS The best health expenditure predictors proved to be PCS and SI (R2 = 0.15 and R2 = 0.17, respectively). When combined in a new index (PCS-SI), better predictive capacity of health expenditure was obtained than with the two single measures separately (R2 = 0.19). CONCLUSIONS A multidimensional indicator proved to be a better predictor of healthcare expenditure than single health measures.
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Affiliation(s)
- C Quercioli
- Postgraduate School of Public Health, University of Siena, Via Aldo Moro, 53100, Siena, Italy; Healthcare Management - Local Health Unit 7, Piazza Rosselli 26, 53100, Siena, Italy.
| | - F Nisticò
- Postgraduate School of Public Health, University of Siena, Via Aldo Moro, 53100, Siena, Italy
| | - G Troiano
- Postgraduate School of Public Health, University of Siena, Via Aldo Moro, 53100, Siena, Italy
| | - M Maccari
- Healthcare Management - Local Health Unit 7, Piazza Rosselli 26, 53100, Siena, Italy
| | - G Messina
- Postgraduate School of Public Health, University of Siena, Via Aldo Moro, 53100, Siena, Italy; Department of Molecular and Developmental Medicine, University of Siena, Via Aldo Moro, 53100, Siena, Italy
| | - M Barducci
- Postgraduate School of Public Health, University of Siena, Via Aldo Moro, 53100, Siena, Italy
| | - G Carriero
- General Practice - Local Health Unit 7, Piazza Rosselli 26, 53100, Siena, Italy
| | - D Golinelli
- Postgraduate School of Public Health, University of Siena, Via Aldo Moro, 53100, Siena, Italy
| | - N Nante
- Postgraduate School of Public Health, University of Siena, Via Aldo Moro, 53100, Siena, Italy; Department of Molecular and Developmental Medicine, University of Siena, Via Aldo Moro, 53100, Siena, Italy
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Boisvert S, Proulx-Belhumeur A, Gonçalves N, Doré M, Francoeur J, Gallani MC. An integrative literature review on nursing interventions aimed at increasing self-care among heart failure patients. Rev Lat Am Enfermagem 2017; 23:753-68. [PMID: 26444179 PMCID: PMC4623739 DOI: 10.1590/0104-1169.0370.2612] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze and summarize knowledge concerning critical components of interventions that have been proposed and implemented by nurses with the aim of optimizing self-care by heart failure patients. METHODS PubMed and CINAHL were the electronic databases used to search full peer-reviewed papers, presenting descriptions of nursing interventions directed to patients or to patients and their families and designed to optimize self-care. Forty-two studies were included in the final sample (n=4,799 patients). RESULTS this review pointed to a variety and complexity of nursing interventions. As self-care encompasses several behaviors, interventions targeted an average of 3.6 behaviors. Educational/counselling activities were combined or not with cognitive behavioral strategies, but only about half of the studies used a theoretical background to guide interventions. Clinical assessment and management were frequently associated with self-care interventions, which varied in number of sessions (1 to 30); length of follow-up (2 weeks to 12 months) and endpoints. CONCLUSIONS these findings may be useful to inform nurses about further research in self-care interventions in order to propose the comparison of different modalities of intervention, the use of theoretical background and the establishment of endpoints to evaluate their effectiveness.
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Affiliation(s)
- Sophie Boisvert
- Faculté des sciences infirmières, Université Laval, Québec, QC, CA
| | | | - Natalia Gonçalves
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BR
| | - Michel Doré
- Faculté des sciences infirmières, Université Laval, Québec, QC, CA
| | - Julie Francoeur
- Institut universitaire de cardiologie et pneumologie de Québec, Québec, QC, CA
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Chung ES, Casey DE, Snow R. Redefining Hospital Readmissions to Better Reflect Clinical Course of Care for Heart Failure Patients. Am J Med Qual 2016; 22:98-102. [PMID: 17395965 DOI: 10.1177/1062860606298245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The prevailing definition of a hospital readmission is a hospital admission that occurs within a specified time frame after discharge from the first or index admission. This definition may be questionable for studies with long or indefinite time frames during which the effect of interventions in the index admission will likely wane, making it less appropriate to classify a later hospitalization as a readmission. The current study proposes an alternative definition of readmission and compares the new definition to the traditional one. The comparison shows that the new method is more conceptually correct because it takes into account the waning effect of the index admission. It can identify readmissions regardless of when they occur. It increases a readmission sample size and thus statistical power.
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Wu JR, Moser DK, DeWalt DA, Rayens MK, Dracup K. Health Literacy Mediates the Relationship Between Age and Health Outcomes in Patients With Heart Failure. Circ Heart Fail 2016; 9:e002250. [PMID: 26721913 DOI: 10.1161/circheartfailure.115.002250] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have linked frequent rehospitalizations for heart failure (HF) and increased mortality with older age, higher severity of HF, lack of an evidence-based medication regimen, and inadequate health literacy. However, the pathway between age and health outcomes in patients with HF remains unknown. Therefore, the purpose of this study was to test whether the association between age and health outcomes can be explained by severity of HF, evidence-based medication use, and health literacy in patients with HF. METHODS AND RESULTS This was a longitudinal study of 575 rural patients with HF recruited from outpatient clinics and hospitals. Demographics, clinical data, and health literacy were collected at baseline. HF readmissions and cardiac mortality were followed for 2 years; 57% of patients were ≥ 65 years of age. Older patients with HF were more likely to have low health literacy and less likely to be prescribed angiotensin-converting enzyme inhibitors or β-blockers. Using Kaplan-Meier survival curves with log-rank tests, health outcomes were significantly worse in patients who were ≥ 65 years and in those with low health literacy. Separate Cox regressions revealed that age and health literacy predicted worse health outcomes (P = 0.006 and < 0.001, respectively). When health literacy was entered into the model, the hazard ratio for age changed from 1.49 to 1.29 (a 41% reduction); age was no longer a significant predictor of health outcomes, but health literacy remained significant (P < 0.001), demonstrating mediation. CONCLUSIONS Health literacy mediates the relationship between age and health outcomes in adults with HF. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00415545.
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Affiliation(s)
- Jia-Rong Wu
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.).
| | - Debra K Moser
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.)
| | - Darren A DeWalt
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.)
| | - Mary Kay Rayens
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.)
| | - Kathleen Dracup
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.)
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Evans RS, Benuzillo J, Horne BD, Lloyd JF, Bradshaw A, Budge D, Rasmusson KD, Roberts C, Buckway J, Geer N, Garrett T, Lappé DL. Automated identification and predictive tools to help identify high-risk heart failure patients: pilot evaluation. J Am Med Inform Assoc 2016; 23:872-8. [PMID: 26911827 DOI: 10.1093/jamia/ocv197] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/20/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Develop and evaluate an automated identification and predictive risk report for hospitalized heart failure (HF) patients. METHODS Dictated free-text reports from the previous 24 h were analyzed each day with natural language processing (NLP), to help improve the early identification of hospitalized patients with HF. A second application that uses an Intermountain Healthcare-developed predictive score to determine each HF patient's risk for 30-day hospital readmission and 30-day mortality was also developed. That information was included in an identification and predictive risk report, which was evaluated at a 354-bed hospital that treats high-risk HF patients. RESULTS The addition of NLP-identified HF patients increased the identification score's sensitivity from 82.6% to 95.3% and its specificity from 82.7% to 97.5%, and the model's positive predictive value is 97.45%. Daily multidisciplinary discharge planning meetings are now based on the information provided by the HF identification and predictive report, and clinician's review of potential HF admissions takes less time compared to the previously used manual methodology (10 vs 40 min). An evaluation of the use of the HF predictive report identified a significant reduction in 30-day mortality and a significant increase in patient discharges to home care instead of to a specialized nursing facility. CONCLUSIONS Using clinical decision support to help identify HF patients and automatically calculating their 30-day all-cause readmission and 30-day mortality risks, coupled with a multidisciplinary care process pathway, was found to be an effective process to improve HF patient identification, significantly reduce 30-day mortality, and significantly increase patient discharges to home care.
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Affiliation(s)
- R Scott Evans
- Medical Informatics, Intermountain Healthcare Biomedical Informatics, University of Utah
| | - Jose Benuzillo
- Intermountain Healthcare Cardiovascular Clinical Program
| | - Benjamin D Horne
- Intermountain Heart Institute, Intermountain Medical Center Genetic Epidemiology Division, Department of Internal Medicine, University of Utah
| | | | | | - Deborah Budge
- Intermountain Heart Institute, Intermountain Medical Center
| | | | | | | | - Norma Geer
- McKay Dee Hospital Cardiovascular Program
| | | | - Donald L Lappé
- Intermountain Healthcare Cardiovascular Clinical Program Intermountain Heart Institute, Intermountain Medical Center
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Functional Status and Hospital Readmissions Using the Medical Expenditure Panel Survey. J Gen Intern Med 2015; 30:965-72. [PMID: 25691236 PMCID: PMC4471038 DOI: 10.1007/s11606-014-3170-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/19/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hospital readmissions are expensive and they may signal poor quality of care. Whether functional status is related to hospital readmissions using a representative U.S sample remains unexplored . OBJECTIVE We aimed to assess the relationship between functional status and all-cause 30-day hospital readmissions using a representative sample of the US population. DESIGN This was a retrospective observational study (2003-2011). PATIENTS The study included 3,772 patients who completed the SF-12 before being hospitalized. Three hundred and eighteen (8.4%) were readmitted within 30 days after being discharged. MEASUREMENTS The Medical Expenditure Panel Survey (MEPS) was employed. Functional status was measured with the Short-Form 12-Item Health Survey Version 2® (SF-12). The probability of being readmitted was estimated using a logistic model controlling for demographic characteristics, comorbid conditions, insurance coverage, physical (PCS) and mental (MCS) summaries of the SF-12, reason for hospitalization, length of hospital stay, region, and residential area. RESULTS A one-unit difference in PCS reduced the odds of readmission by 2% (odds ratio 0.98 [95% CI, 0.97 to 0.99]; p < 0.001), which implies an 18% reduction in the odds of readmissions for a ten-unit difference (one standard deviation) in PCS. The c-statistic of the model was 0.72. CONCLUSION Baseline physical function is associated with hospital readmissions. The SF-12 improves the ability to identify patients at high risk of hospital readmission.
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Biering K, Frydenberg M, Hjollund NH. Self-reported health following percutaneous coronary intervention: results from a cohort followed for 3 years with multiple measurements. Clin Epidemiol 2014; 6:441-9. [PMID: 25506246 PMCID: PMC4259550 DOI: 10.2147/clep.s65476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective Improvements in the treatment of coronary heart disease have increased the number of patients living with a chronic heart disease. Patient-reported outcomes are required to adequately describe prognosis. We report self-rated health in a population-based cohort of patients with coronary heart disease treated with percutaneous coronary intervention (PCI). Methods Over 3 years, we followed 1,726 patients under 65 years treated with PCI with eight repetitive questionnaires. With the use of multiple imputation, we described the course of self-rated health using the short form 12-item survey’s mental component summary (MCS) and physical component summary (PCS) and analyzed adjusted differences by sex, age, educational level, indication for PCI, and left ventricular ejection fraction along with an analysis of decrease in health status. Results MCS scores increased during follow-up, while PCS scores were stable over time. Men rated higher in MCS and PCS than women, and older patients rated higher in MCS than younger. Other differences were negligible. Younger age was identified as a risk factor for marked decrease in mental health over time. Conclusion In a complete population-based cohort of PCI patients with multiple measurements, we found improvements in mental, but not physical health over time. Demographic differences in health were larger than disease-related differences.
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Affiliation(s)
- Karin Biering
- Department of Occupational Medicine, Regional Hospital West Jutland, Herning, Denmark ; Danish Ramazzini Centre, Regional Hospital West Jutland, Herning, Denmark
| | - Morten Frydenberg
- Section of Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Niels Henrik Hjollund
- WestChronic, Regional Hospital West Jutland, Herning, Denmark ; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Berg J, Lindgren P, Kahan T, Schill O, Persson H, Edner M, Mejhert M. Health-related quality of life and long-term morbidity and mortality in patients hospitalised with systolic heart failure. JRSM Cardiovasc Dis 2014; 3:2048004014548735. [PMID: 25396054 PMCID: PMC4228927 DOI: 10.1177/2048004014548735] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Health-related quality of life has been shown to impact prognosis in chronic heart failure, however with limited long-term follow-up. We analysed data spanning 8–12 years to assess the impact of health-related quality of life using the Nottingham Health Profile on first hospitalisation and mortality, for cardiovascular and all causes. Methods We included 208 patients aged ≥60 years with New York Heart Association class II–IV and left ventricular systolic dysfunction hospitalised in Stockholm during 1996–99. Data on hospital admissions, discharge diagnoses and date and cause of death were collected from administrative databases and medical records until 2007. Cox proportional hazard models were employed to analyse the time to event for mortality and hospitalisations. Results Mean age was 76 years, 58% were male and mean ejection fraction was 34%. Median survival was 4.6 years (range 6 days–11.9 years); 148 patients died. All-cause and cardiovascular mortality were determined by physical mobility (by Nottingham Health Profile), age, gender, diuretic dose and haemoglobin level. Glomerular filtration rate was significant for all-cause mortality, while atrioventricular plane displacement was predictive of cardiovascular mortality. Median time to first all-cause and cardiovascular hospitalisation was 5.7 and 11.2 months, respectively. Time to first all-cause hospitalisation was determined by physical mobility, emotional reactions, age, gender and haemoglobin level, while only physical mobility and diuretic dose predicted time to first cardiovascular hospitalisation. Conclusions In conclusion, in patients with systolic chronic heart failure, physical mobility as part of health-related quality of life is an independent prognostic marker for cardiovascular and all-cause readmissions and mortality over 12 years.
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Affiliation(s)
- Jenny Berg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ; OptumInsight, Stockholm, Sweden
| | - Peter Lindgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden ; IVBAR, Stockholm, Sweden
| | - Thomas Kahan
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Owe Schill
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Hans Persson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Edner
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Märit Mejhert
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden ; Department of Medicine, Ersta Hospital, Stockholm, Sweden
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12
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Hebert C, Shivade C, Foraker R, Wasserman J, Roth C, Mekhjian H, Lemeshow S, Embi P. Diagnosis-specific readmission risk prediction using electronic health data: a retrospective cohort study. BMC Med Inform Decis Mak 2014; 14:65. [PMID: 25091637 PMCID: PMC4136398 DOI: 10.1186/1472-6947-14-65] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 07/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Readmissions after hospital discharge are a common occurrence and are costly for both hospitals and patients. Previous attempts to create universal risk prediction models for readmission have not met with success. In this study we leveraged a comprehensive electronic health record to create readmission-risk models that were institution- and patient- specific in an attempt to improve our ability to predict readmission. METHODS This is a retrospective cohort study performed at a large midwestern tertiary care medical center. All patients with a primary discharge diagnosis of congestive heart failure, acute myocardial infarction or pneumonia over a two-year time period were included in the analysis.The main outcome was 30-day readmission. Demographic, comorbidity, laboratory, and medication data were collected on all patients from a comprehensive information warehouse. Using multivariable analysis with stepwise removal we created three risk disease-specific risk prediction models and a combined model. These models were then validated on separate cohorts. RESULTS 3572 patients were included in the derivation cohort. Overall there was a 16.2% readmission rate. The acute myocardial infarction and pneumonia readmission-risk models performed well on a random sample validation cohort (AUC range 0.73 to 0.76) but less well on a historical validation cohort (AUC 0.66 for both). The congestive heart failure model performed poorly on both validation cohorts (AUC 0.63 and 0.64). CONCLUSIONS The readmission-risk models for acute myocardial infarction and pneumonia validated well on a contemporary cohort, but not as well on a historical cohort, suggesting that models such as these need to be continuously trained and adjusted to respond to local trends. The poor performance of the congestive heart failure model may suggest that for chronic disease conditions social and behavioral variables are of greater importance and improved documentation of these variables within the electronic health record should be encouraged.
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Affiliation(s)
- Courtney Hebert
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
- Division of Infectious Diseases, The Ohio State University, Columbus, OH, USA
| | - Chaitanya Shivade
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, USA
| | - Randi Foraker
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Jared Wasserman
- College of Public Health, The Ohio State University, Columbus, OH, USA
- The Dartmouth Institute of Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Caryn Roth
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Hagop Mekhjian
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University, Columbus, OH, USA
| | - Stanley Lemeshow
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Peter Embi
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
- Division of Immunology and Rheumatology, The Ohio State University, Columbus, OH, USA
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13
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Agvall B, Paulsson T, Foldevi M, Dahlström U, Alehagen U. Resource use and cost implications of implementing a heart failure program for patients with systolic heart failure in Swedish primary health care. Int J Cardiol 2014; 176:731-8. [PMID: 25131925 DOI: 10.1016/j.ijcard.2014.07.105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 07/09/2014] [Accepted: 07/26/2014] [Indexed: 01/03/2023]
Abstract
AIM Heart failure (HF) is a common but serious condition which involves a significant economic burden on the health care economy. The purpose of this study was to evaluate cost and quality of life (QoL) implications of implementing a HF management program (HFMP) in primary health care (PHC). METHODS AND RESULTS This was a prospective randomized open-label study including 160 patients with a diagnosis of HF from five PHC centers in south-eastern Sweden. Patients randomized to the intervention group received information about HF from HF nurses and from a validated computer-based awareness program. HF nurses and physicians followed the patients intensely in order to optimize HF treatment according to current guidelines. The patients in the control group were followed by their regular general practitioner (GP) and received standard treatment according to local management routines. No significant changes were observed in NYHA class and quality-adjusted life years (QALY), implying that functional class and QoL were preserved. However, costs for hospital care (HC) and PHC were reduced by EUR 2167, or 33%. The total cost was EUR 4471 in the intervention group and EUR 6638 in the control group. CONCLUSIONS Introducing HFMP in Swedish PHC in patients with HF entails a significant reduction in resource utilization and costs, and maintains QoL. Based on these results, a broader implementation of HFMP in PHC may be recommended. However, results should be confirmed with extended follow-up to verify long-term effects.
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Affiliation(s)
- Björn Agvall
- Department of Medical and Health Sciences, Linkoping University, Department of Primary Health Care, Linkoping, County of Östergötland, Sweden.
| | - Thomas Paulsson
- Global Health Economics and Outcomes Research, Bristol-Myers Squibb, Belgium
| | - Mats Foldevi
- Department of Medical and Health Sciences, Linkoping University, Department of Primary Health Care, Linkoping, County of Östergötland, Sweden
| | - Ulf Dahlström
- Division of Cardiovascular Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Cardiology UHL, County Council of Östergötland, Linköping, Sweden
| | - Urban Alehagen
- Division of Cardiovascular Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Cardiology UHL, County Council of Östergötland, Linköping, Sweden
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14
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Ho JC, Ghosh J, Steinhubl SR, Stewart WF, Denny JC, Malin BA, Sun J. Limestone: high-throughput candidate phenotype generation via tensor factorization. J Biomed Inform 2014; 52:199-211. [PMID: 25038555 DOI: 10.1016/j.jbi.2014.07.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 05/14/2014] [Accepted: 07/02/2014] [Indexed: 12/22/2022]
Abstract
The rapidly increasing availability of electronic health records (EHRs) from multiple heterogeneous sources has spearheaded the adoption of data-driven approaches for improved clinical research, decision making, prognosis, and patient management. Unfortunately, EHR data do not always directly and reliably map to medical concepts that clinical researchers need or use. Some recent studies have focused on EHR-derived phenotyping, which aims at mapping the EHR data to specific medical concepts; however, most of these approaches require labor intensive supervision from experienced clinical professionals. Furthermore, existing approaches are often disease-centric and specialized to the idiosyncrasies of the information technology and/or business practices of a single healthcare organization. In this paper, we propose Limestone, a nonnegative tensor factorization method to derive phenotype candidates with virtually no human supervision. Limestone represents the data source interactions naturally using tensors (a generalization of matrices). In particular, we investigate the interaction of diagnoses and medications among patients. The resulting tensor factors are reported as phenotype candidates that automatically reveal patient clusters on specific diagnoses and medications. Using the proposed method, multiple phenotypes can be identified simultaneously from data. We demonstrate the capability of Limestone on a cohort of 31,815 patient records from the Geisinger Health System. The dataset spans 7years of longitudinal patient records and was initially constructed for a heart failure onset prediction study. Our experiments demonstrate the robustness, stability, and the conciseness of Limestone-derived phenotypes. Our results show that using only 40 phenotypes, we can outperform the original 640 features (169 diagnosis categories and 471 medication types) to achieve an area under the receiver operator characteristic curve (AUC) of 0.720 (95% CI 0.715 to 0.725). Moreover, in consultation with a medical expert, we confirmed 82% of the top 50 candidates automatically extracted by Limestone are clinically meaningful.
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Affiliation(s)
- Joyce C Ho
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX 78712, United States.
| | - Joydeep Ghosh
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX 78712, United States
| | - Steve R Steinhubl
- Scripps Translational Science Institute, Scripps Health, La Jolla, CA 92037, United States
| | - Walter F Stewart
- Sutter Health Research, Development, and Dissemination Team, Sutter Health, Walnut Creek, CA 94598, United States
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN 37232, United States; Department of Medicine, Vanderbilt University, Nashville, TN 37232, United States
| | - Bradley A Malin
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN 37232, United States; Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37232, United States
| | - Jimeng Sun
- School of Computational Science and Engineering at College of Computing, Georgia Institute of Technology, Atlanta, GA 30332, United States
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15
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Chamberlain AM, Manemann SM, Dunlay SM, Spertus JA, Moser DK, Berardi C, Kane RL, Weston SA, Redfield MM, Roger VL. Self-rated health predicts healthcare utilization in heart failure. J Am Heart Assoc 2014; 3:e000931. [PMID: 24870937 PMCID: PMC4309095 DOI: 10.1161/jaha.114.000931] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Heart failure (HF) patients experience impaired functional status, diminished quality of life, high utilization of healthcare resources, and poor survival. Yet, the identification of patient‐centered factors that influence prognosis is lacking. Methods and Results We determined the association of 2 measures of self‐rated health with healthcare utilization and skilled nursing facility (SNF) admission in a community cohort of 417 HF patients prospectively enrolled between October 2007 and December 2010 from Olmsted County, MN. Patients completed a 12‐item Short Form Health Survey (SF‐12). Low self‐reported physical functioning was defined as a score ≤25 on the SF‐12 physical component. The first question of the SF‐12 was used as a measure of self‐rated general health. After 2 years, 1033 hospitalizations, 1407 emergency department (ED) visits, and 19,780 outpatient office visits were observed; 87 patients were admitted to a SNF. After adjustment for confounding factors, an increased risk of hospitalizations (1.52 [1.17 to 1.99]) and ED visits (1.48 [1.04 to 2.11]) was observed for those with low versus moderate‐high self‐reported physical functioning. Patients with poor and fair self‐rated general health also experienced an increased risk of hospitalizations (poor: 1.73 [1.29 to 2.32]; fair: 1.46 [1.14 to 1.87]) and ED visits (poor: 1.73 [1.16 to 2.56]; fair: 1.48 [1.13 to 1.93]) compared with good‐excellent self‐rated general health. No association between self‐reported physical functioning or self‐rated general health with outpatient visits and SNF admission was observed. Conclusion In community HF patients, self‐reported measures of physical functioning predict hospitalizations and ED visits, indicating that these patient‐reported measures may be useful in risk stratification and management in HF.
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Affiliation(s)
- Alanna M Chamberlain
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (A.M.C., S.M.M., S.M.D., C.B., S.A.W., R.)
| | - Sheila M Manemann
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (A.M.C., S.M.M., S.M.D., C.B., S.A.W., R.)
| | - Shannon M Dunlay
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (A.M.C., S.M.M., S.M.D., C.B., S.A.W., R.) Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.M.D., M.M.R., R.)
| | - John A Spertus
- Division of Cardiology, Department of Medicine, University of Missouri at Kansas City, Kansas City, MO (J.A.S.)
| | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, KY (D.K.M.)
| | - Cecilia Berardi
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (A.M.C., S.M.M., S.M.D., C.B., S.A.W., R.)
| | - Robert L Kane
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN (R.L.K.)
| | - Susan A Weston
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (A.M.C., S.M.M., S.M.D., C.B., S.A.W., R.)
| | - Margaret M Redfield
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.M.D., M.M.R., R.)
| | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (A.M.C., S.M.M., S.M.D., C.B., S.A.W., R.) Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.M.D., M.M.R., R.)
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16
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Johansson P, Broström A, Dahlström U, Alehagen U. Global perceived health and ten-year cardiovascular mortality in elderly primary care patients with possible heart failure. Eur J Heart Fail 2014; 10:1040-7. [DOI: 10.1016/j.ejheart.2008.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 05/24/2008] [Accepted: 07/01/2008] [Indexed: 10/21/2022] Open
Affiliation(s)
- Peter Johansson
- Department of Cardiology; Linköping University Hospital; S-58185 Linköping Sweden
- Department of Medicine and Care; Faculty of Health Sciences Linköping University; S-58185 Linköping Sweden
| | - Anders Broström
- Department of Medicine and Care; Faculty of Health Sciences Linköping University; S-58185 Linköping Sweden
- Division of Clinical Neurophysiology; Linköping University Hospital; S-58185 Linköping Sweden
| | - Ulf Dahlström
- Department of Cardiology; Linköping University Hospital; S-58185 Linköping Sweden
- Department of Medicine and Care; Faculty of Health Sciences Linköping University; S-58185 Linköping Sweden
| | - Urban Alehagen
- Department of Cardiology; Linköping University Hospital; S-58185 Linköping Sweden
- Department of Medicine and Care; Faculty of Health Sciences Linköping University; S-58185 Linköping Sweden
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17
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Patient Health Questionnaire-9 score and adverse cardiac outcomes in patients hospitalized for acute cardiac disease. J Psychosom Res 2013; 75:409-13. [PMID: 24182627 DOI: 10.1016/j.jpsychores.2013.08.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/01/2013] [Accepted: 08/02/2013] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The Patient Health Questionnaire-9 (PHQ-9) is increasingly used as a depression assessment tool in cardiac patients. However, in contrast to older depression instruments, there is little data linking PHQ-9 scores to adverse cardiac outcomes. Our goal was to evaluate whether higher PHQ-9 scores were predictive of subsequent cardiac readmissions among depressed patients hospitalized for an acute cardiac event. METHODS Patients diagnosed with depression during hospitalization for acute coronary syndrome, heart failure, or arrhythmia were enrolled in a randomized depression management trial. Participants were administered PHQ-9 at enrollment, and data was collected regarding cardiac readmissions and mortality over the next 6months. To evaluate the independent association of PHQ-9 score with subsequent cardiac readmission, Cox regression analysis that included relevant sociodemographic and medical covariates was used. Survival analysis examining time to first event, stratified by quartile of initial PHQ-9 score, was performed using Kaplan-Meier curves and log-rank test for trend. Analyses were then repeated using a composite (cardiac readmission or mortality) outcome. RESULTS Among 172 subjects, 62 (36.0%) had a cardiac-related rehospitalization. Higher initial PHQ-9 score predicted cardiac-related rehospitalization, independent of multiple relevant covariates (hazard ratio 1.09 [95% confidence interval=1.02-1.17]; p=0.015). On survival analysis, log-rank test for trend revealed a significant rise in event rates across increasing PHQ-9 quartiles (χ(2)=6.36; p=0.012). Findings were similar (p<.05) for the composite outcome. CONCLUSION In depressed cardiac patients, each additional point on the PHQ-9 was independently associated with a 9% greater risk of cardiac readmission over the subsequent 6months.
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18
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Chamberlain AM, McNallan SM, Dunlay SM, Spertus JA, Redfield MM, Moser DK, Kane RL, Weston SA, Roger VL. Physical health status measures predict all-cause mortality in patients with heart failure. Circ Heart Fail 2013; 6:669-75. [PMID: 23625946 DOI: 10.1161/circheartfailure.112.000291] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Physical health status measures have been shown to predict death in heart failure (HF); however, few studies found significant associations after adjustment for confounders, and most were not representative of all HF patients. METHODS AND RESULTS HF patients from southeastern MN were prospectively enrolled between 10/2007 and 12/2010, completed a 12-item Short Form Health Survey (SF-12) and a 6-minute walk, and were followed through 2011 for death from any cause. Scores ≤ 25 on the SF-12 physical component indicated low self-reported physical functioning, and the first question of the SF-12 measured self-rated general health. Low functional exercise capacity was defined as ≤ 300 m walked during a 6-minute walk. Over a mean follow-up of 2.3 years, 86 deaths occurred among the 352 participants. A 1.6-fold (95% confidence interval, 1.0-2.7) and 1.8-fold (95% confidence interval, 1.1-2.9) increased risk of death was observed among patients with low self-reported physical functioning and low functional exercise capacity, respectively. Poor self-rated general health corresponded to a 2.7-fold (95% confidence interval, 1.5-4.9) increased risk of death compared with good to excellent general health. All measures equally discriminated between who would die and who would survive (C-statistics: 0.729, 0.750, and 0.740 for self-reported physical functioning, self-rated general health, and functional exercise capacity, respectively). CONCLUSIONS Three physical health status measures, captured by the SF-12 and a 6-minute walk, equally predict death among community HF patients. Therefore, the first question of the SF-12, which is the least burdensome to administer, may be sufficient to identify HF patients at greatest risk of death.
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19
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Mejhert M, Lindgren P, Schill O, Edner M, Persson H, Kahan T. Long term health care consumption and cost expenditure in systolic heart failure. Eur J Intern Med 2013; 24:260-5. [PMID: 23269392 DOI: 10.1016/j.ejim.2012.11.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/26/2012] [Accepted: 11/21/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND The prevalence, health care consumption, and mortality increase in elderly patients with heart failure. This study aimed to analyse long term cost expenditure and predictors of health care consumption in these patients. METHODS We included 208 patients aged 60 years or older and hospitalised with heart failure (NYHA class II-IV and left ventricular systolic dysfunction); 58% were men, mean age 76 years, and mean ejection fraction 0.34. Data on all hospital admissions, discharge diagnoses, lengths of stay, and outpatient visits were collected from the National Board of Health and Welfare. We obtained data of all health care consumption for each individual. RESULTS After 8-12 years of prospective follow up 72% were dead (median survival 4.6 years). Main drivers of health care expenditure were non-cardiac (40%) and cardiac (29%) hospitalizations, and visits to primary care centres (16%), and hospital outpatient clinics (15%). On average, health care expenditures were € 36,447 per patient during follow up. The average yearly cost per patient was about 5,700€, in contrast to the estimated consumption of primary and hospital care in the general population: € 1,956 in 65-74 year olds and € 2,701 in 75-84 year olds. Poor quality of life (Nottingham Health Profile) was the strongest independent predictor of total health care consumption and costs (p<0.001; by multivariate analyses). CONCLUSION Health care costs in chronic systolic heart failure are at least two-fold higher than in the general population. Quality of life is a strong independent predictor of health care consumption.
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Affiliation(s)
- Märit Mejhert
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden.
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20
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Biering K, Nielsen TT, Rasmussen K, Niemann T, Hjollund NH. Return to work after percutaneous coronary intervention: the predictive value of self-reported health compared to clinical measures. PLoS One 2012; 7:e49268. [PMID: 23173052 PMCID: PMC3500279 DOI: 10.1371/journal.pone.0049268] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 10/08/2012] [Indexed: 11/18/2022] Open
Abstract
AIMS Coronary heart disease is prevalent in the working-age population. Traditional outcome measures like mortality and readmission are of importance to evaluate the prognosis but are hardly sufficient. Ability to work is an additional outcome of clinical and societal significance. We describe trends and predictors of Return To Work (RTW) after PCI and describe a possible benefit using patient-reported measures in risk stratification of RTW. METHODS A total of 1585 patients aged less than 67 years treated with PCI in 2006-2008 at the Aarhus University Hospital were enrolled. Clinical information was provided through the West Denmark Heart Registry, and 4 weeks after PCI we mailed a questionnaire regarding self-rated health (response rate 83.5%). RTW was defined at weekly basis using extensive register data on transfer payments. Predictors of RTW were analysed as time to event. ROC curves constructed by logistic regression of predicting variables were evaluated by the c-statistic. RESULTS Four weeks before PCI 50% of the patients were working; the corresponding figures were 25% after 4 weeks, 36% after 12 weeks, and 43% after one year. The patients' self-rated health one month after the procedure was a significant better predictor of RTW compared to other variables including LVEF, both at short (12 weeks) and long (one year) term. CONCLUSIONS The patient's self-rated health four weeks after the procedure was a stronger predictor than left ventricular ejection fraction (LVEF), and consequently useful when patients seek medical advice with respect to RWT.
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Affiliation(s)
- Karin Biering
- Department of Occupational Medicine, Regional Hospital West Jutland, Herning, Denmark.
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21
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Hoekstra T, Jaarsma T, van Veldhuisen DJ, Hillege HL, Sanderman R, Lesman-Leegte I. Quality of life and survival in patients with heart failure. Eur J Heart Fail 2012; 15:94-102. [PMID: 22989869 DOI: 10.1093/eurjhf/hfs148] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AIMS To examine whether self-rated disease-specific and generic quality of life predicts long-term mortality, independent of brain natriuretic peptide (BNP) levels, and to explore factors related to low quality of life in a well-defined heart failure (HF) population. METHODS AND RESULTS A cohort of 661 patients (62% male; age 71 years; left ventricular ejection fraction 34%) was followed prospectively for 3 years. Quality of life questionnaires (Ladder of Life, RAND36, and Minnesota Living with Heart Failure Questionnaire) and BNP levels were assessed at discharge after a hospital admission for HF. Three-year mortality was 42%. After adjustment for demographic variables, clinical variables, and BNP levels, poor quality of life scores predicted higher mortality; per 10 units on the physical functioning [hazard ratio (HR) 1.08, 95% confidence interval (CI) 1.02-1.14] and general health (HR 1.08, 95% CI 1.01-1.16) dimensions of the RAND36. Patients with low scores on these dimensions were more likely to be in New York Heart Association class III-IV, diagnosed with co-morbidities, have suffered longer from HF, have lower estimated glomerular filtration rates, and have fewer beta-blocker prescriptions. CONCLUSION Quality of life was independently related to survival in a cohort of hospitalized patients with HF. TRIAL REGISTRATION NCT 98675639.
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Affiliation(s)
- Tialda Hoekstra
- Department of Cardiology, University Medical Center Groningen (UMCG), University of Groningen, RB Groningen, The Netherlands.
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22
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Franzén-Dahlin A, Karlsson MR, Mejhert M, Laska AC. Quality of life in chronic disease: a comparison between patients with heart failure and patients with aphasia after stroke. J Clin Nurs 2011; 19:1855-60. [PMID: 20920012 DOI: 10.1111/j.1365-2702.2010.03219.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study aimed to describe the impact of heart failure and of stroke with aphasia on quality of life (QoL) and to compare the different domains of QoL in these groups. BACKGROUND The prevalence of chronic conditions has increased during the last decades, and chronic diseases such as stroke and heart failure may have a great impact on QoL. DESIGN Comparative study of patients from two randomised controlled studies. METHOD Seventy-nine patients with heart failure and 70 patients with aphasia after stroke were evaluated concerning the severity of their disease and by QoL, as measured with the Nottingham Health Profile, in the acute phase and after six months. RESULTS The severity of the disease improved between baseline and six month for both groups. Correlations between New York Heart Association (NYHA) class and all QoL domains were seen in patients with heart failure after six months. The degree of aphasia correlated to mobility, social, emotional and total score after six month. QoL in patients with heart failure was more affected in the domains of sleep and energy in the acute phase and in the energy domain at six months. CONCLUSION Although low energy is more frequent among patients with heart failure, both groups report poor QoL. Improvement in severity of the disease is not necessarily accompanied by improvement in QoL. RELEVANCE TO CLINICAL PRACTICE Nottingham Health Profile can easily be used as a screening instrument, aiming to identify patients at risk for adverse effects on QoL. A better understanding of the subjective QoL of patients with chronic disease is fundamental for health care professionals to be able to identify and support vulnerable patients.
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Affiliation(s)
- Asa Franzén-Dahlin
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden.
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Giamouzis G, Kalogeropoulos A, Georgiopoulou V, Laskar S, Smith AL, Dunbar S, Triposkiadis F, Butler J. Hospitalization Epidemic in Patients With Heart Failure: Risk Factors, Risk Prediction, Knowledge Gaps, and Future Directions. J Card Fail 2011; 17:54-75. [DOI: 10.1016/j.cardfail.2010.08.010] [Citation(s) in RCA: 182] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Revised: 08/03/2010] [Accepted: 08/16/2010] [Indexed: 01/17/2023]
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Kalra AD, Fisher RS, Axelrod P. Decreased length of stay and cumulative hospitalized days despite increased patient admissions and readmissions in an area of urban poverty. J Gen Intern Med 2010; 25:930-5. [PMID: 20429040 PMCID: PMC2917661 DOI: 10.1007/s11606-010-1370-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 02/03/2010] [Accepted: 04/08/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Length of stay at US acute care hospitals has been steadily decreasing since 1960, and there is ongoing concern that increasing financial pressures on hospitals with high proportions of Medicaid patients may be causing unduly short lengths of stay. OBJECTIVE To study temporal trends in hospital utilization on internal medicine services at Temple University Hospital, which has the highest percentage of Medicaid and uninsured patients in the state of Pennsylvania. DESIGN Examination of temporal changes in hospital practice over three time periods spanning 13 years. MEASUREMENTS Numbers of discharges, 1- and 12-month re-admission rates, and lengths of stay. US census data from 1990 to 2000 were examined for the eight major zip codes in which hospitalized patients live. MAIN RESULTS The number of internal medicine admissions increased from 1991 (117/month) to 2004 (455/month); p < 0.0001. Mean length of stay for the index admission decreased from 8.7 to 4.9 days; p < 0.001. The percentage of patients readmitted within 12 months of the discharge date of the index admission increased from 42.3% to 49.5%; p = 0.045. Mean cumulative length of stay over 12 months, including readmissions, decreased significantly (15.8 to 12.5 days; p = 0.031). Compared to all US hospitals, our hospital had a greater increase in admissions and a greater decrease in length of stay. During this time period, in surrounding zip codes, there were decreases in total population and total number of persons living in poverty, but also multiple closures of area hospitals that served poor patients. CONCLUSION During the 13-year study period, despite increased readmission rates, the overall number of hospitalized days per year on the internal medicine inpatient service decreased. As local hospitals serving this inner city low income area have closed, our hospital had atypically high increases in numbers of admissions and decreases in length of stay. This raises questions about current adequacy of hospital care in inner city areas of poverty.
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Affiliation(s)
- Amit D Kalra
- Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
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25
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Škodová Z, van Dijk JP, Nagyová I, Rosenberger J, Ondušová D, Middel B, Reijneveld SA. Psychosocial predictors of change in quality of life in patients after coronary interventions. Heart Lung 2010; 40:331-9. [PMID: 20561888 DOI: 10.1016/j.hrtlng.2009.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 11/20/2009] [Accepted: 12/10/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Health-related quality of life (HRQOL) after coronary interventions (coronary artery bypass grafting, percutaneous transluminal coronary angioplasty) usually improves in patients, but not in all patients. Some patients actually show a significant decline in HRQOL. Our aim was to explore the potential of psychologic well-being (anxiety, depression), vital exhaustion, Type D personality, and socioeconomic position as predictors of HRQOL in patients with coronary disease. METHODS A total of 106 patients scheduled for coronary angiography were interviewed before (baseline) and 12 to 24 months after coronary angiography. Socioeconomic status was evaluated by education. The General Health Questionnaire 28 was used for measuring psychologic well-being (anxiety, depression), the Maastricht interview was used for measuring vital exhaustion, and the Type D questionnaire was used for measuring personality. HRQOL was assessed using the Short Form-36 (physical and mental components) questionnaire. Functional status was assessed with a combination of New York Heart Association and Canadian Cardiovascular Society classifications. Linear regressions were used to analyze data. RESULTS A change in physical HRQOL was predicted by baseline psychologic well-being (β = -.39; 95% confidence interval [CI], -1.00 to -.16) and baseline HRQOL (β = -.61; 95% CI, -.83 to -.34). A change in mental HRQOL was predicted by (baseline) psychologic well-being (β = -.37; 95% CI, -.99 to -.09), vital exhaustion (β = -.21; 95% CI, -.69 to -.03), and baseline HRQOL (β = -.76; 95% CI, -1.03 to -.44). Ejection fraction did not significantly predict HRQOL. CONCLUSION Psychosocial factors (psychologic well-being, vital exhaustion) seem to be more important predictors of change in HRQOL compared with some objective medical indicators (ejection fraction) among patients with coronary disease.
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Affiliation(s)
- Zuzana Škodová
- University of PJ Safarik, KISH-Kosice Institute for Society and Health, Kosice, Slovakia.
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26
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Quality of life predicts outcome in a heart failure disease management program. Int J Cardiol 2010; 139:60-7. [DOI: 10.1016/j.ijcard.2008.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 06/26/2008] [Accepted: 09/02/2008] [Indexed: 11/22/2022]
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Moser DK, Yamokoski L, Sun JL, Conway GA, Hartman KA, Graziano JA, Binanay C, Stevenson LW. Improvement in health-related quality of life after hospitalization predicts event-free survival in patients with advanced heart failure. J Card Fail 2009; 15:763-9. [PMID: 19879462 DOI: 10.1016/j.cardfail.2009.05.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Revised: 04/30/2009] [Accepted: 05/04/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) is a major clinical outcome for heart failure (HF) patients. We aimed to determine the frequency, durability, and prognostic significance of improved HRQOL after hospitalization for decompensated HF. METHODS AND RESULTS We analyzed HRQOL, measured serially using the Minnesota Living with Heart Failure Questionnaire (MLHFQ), for 425 patients who survived to discharge in a multicenter randomized clinical trial of pulmonary artery catheter versus clinical assessment to guide therapy for patients with advanced HF. All patients enrolled had 1 or more prior HF hospitalizations or chronic high diuretic doses and 1 or more symptom and 1 sign of fluid overload at admission. Improvement, defined as a decrease of more than 5 points in MLHFQ total score, occurred in 68% of patients by 1 month and stabilized. The degree of 1-month improvement differed (P < .0001 group x time interaction) between 6-month survivors and non-survivors. In a Cox regression model, after adjustment for traditional risk factors for HF morbidity and mortality, improvement in HRQOL by 1 month compared to worsening at 1 month or no change predicted time to subsequent event-free survival (P=.013). CONCLUSIONS In patients hospitalized with severe HF decompensation, HRQOL is seriously impaired but improves substantially within 1 month for most patients and remains improved for 6 months. Patients for whom HRQOL does not improve by 1 month after hospital admission merit specific attention both to improve HRQOL and to address high risk for poor event-free survival.
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Affiliation(s)
- Debra K Moser
- University of Kentucky, Lexington, KY 40536-0232, USA.
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28
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Gustafsson F, Schou M, Videbaek L, Dridi N, Ryde H, Handberg J, Hildebrandt PR. Incidence and predictors of hospitalization or death in patients managed in multidisciplinary heart failure clinics. Eur J Heart Fail 2009; 11:413-9. [DOI: 10.1093/eurjhf/hfp025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Finn Gustafsson
- Department of Cardiology B; The Heart Centre, Rigshospitalet; Blegdamsvej 9 DK-2100 Copenhagen Denmark
| | - Morten Schou
- Department of Cardiology and Endocrinology; Frederiksberg Hospital; Frederiksberg Denmark
| | - Lars Videbaek
- Department of Cardiology; Odense University Hospital; Odense Denmark
| | - Nadia Dridi
- Department of Internal Medicine; Amager Hospital; Copenhagen Denmark
| | - Henrik Ryde
- Department of Internal Medicine; Slagelse Sygehus; Slagelse Denmark
| | - Jens Handberg
- Department of Cardiology and Endocrinology Hillerød Sygehus; Hillerød Denmark
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Margoto G, Colombo RCR, Gallani MCBJ. Características clínicas e psicossociais do paciente com insuficiência cardíaca que interna por descompensação clínica. Rev Esc Enferm USP 2009; 43:44-53. [PMID: 19437853 DOI: 10.1590/s0080-62342009000100006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Este estudo teve como objetivo identificar perfil sociodemográfico e clínico, história de hospitalizações por Insuficiência Cardíaca (IC) e seguimento (consultas regulares, tratamento medicamentoso, fatores facilitadores e dificultadores do seguimento) do paciente internado por quadro de descompensação clínica. Foram entrevistados 61 pacientes com idade média de 58,1 (± 15,9) anos, 3,5 (± 4,4) anos de estudo e renda individual de 1,3 (± 2,4) salários-mínimos. A maioria dos sujeitos se encontrava em classe funcional III ou IV da New York Heart Association, tendo como causa mais freqüente de hospitalização, os sinais/sintomas da forma congestiva da IC. 75,4% dos sujeitos relataram acompanhamento clínico, porém de periodicidade irregular. Constatou-se utilização de terapêutica medicamentosa em proporção inferior à recomendada pela literatura. Os achados devem auxiliar a identificação dos pacientes com maior risco de descompensação da IC e assim, desenhar e implementar intervenções específicas visando a redução das re-hospitalizações por IC.
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Mommersteeg PMC, Denollet J, Spertus JA, Pedersen SS. Health status as a risk factor in cardiovascular disease: a systematic review of current evidence. Am Heart J 2009; 157:208-18. [PMID: 19185627 DOI: 10.1016/j.ahj.2008.09.020] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 09/26/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patient-perceived health status is receiving increased recognition as a patient-centered outcome in chronic heart failure (CHF) and coronary artery disease (CAD), but poor health status is also associated with adverse prognosis. In this systematic review, we examined current evidence on the influence of health status on prognosis in CHF and CAD. METHODS We conducted a search of PubMed using a set of a priori-defined search terms, the Web of Science for newly cited articles, and the reference lists of eligible articles, resulting in 34 articles. RESULTS Poor physical health status was a significant predictor for adverse health outcomes in patients with CHF and CAD. In CHF, poor physical health status seemed to be a stronger predictor of hospitalization than mortality. Little evidence was found that poor mental health status is associated with adverse prognosis in CHF and CAD. A disease-specific measure was a better predictor in CHF, but not in CAD. The majority of studies adjusted for an objective measure of disease severity. Neither the index event nor time to follow-up appeared to influence the predictive value of health status. CONCLUSIONS Poor physical health status is associated with adverse CAD and CHF prognosis. Heterogeneity across studies makes definitive conclusions difficult as to which components of health status may be detrimental to patients' health, and how health status as a potential risk factor should be assessed, monitored, and intervened upon in clinical practice.
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Affiliation(s)
- Paula M C Mommersteeg
- Center of Research on Psychology in Somatic Diseases, Tilburg University, The Netherlands
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31
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Prediction of early readmission in medical inpatients using the Probability of Repeated Admission instrument. Nurs Res 2008; 57:406-15. [PMID: 19018215 DOI: 10.1097/nnr.0b013e31818c3e06] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the absence of an instrument to predict risk of early readmission, examination of the well-validated probability of repeated admission (Pra) for this new purpose is indicated. OBJECTIVE The objective of this study was to examine the use of the Pra in accurately identifying and predicting adult medical inpatients at risk of early readmission. METHODS Over 20 months, 1,077 consecutively admitted medical patients were enrolled in this prospective cohort study at a Midwestern tertiary care medical center. Pra score values were calculated within 2 days of discharge. Databases at the index medical center and other institutions were queried to identify readmission within 41 days. RESULTS Prevalence of readmission was 14% (confidence interval = 12.4%-15.6%). Pra score values ranged from .16 to .75. Indices to identify and predict readmission for a range of cut points were reported to minimize loss of information. The likelihood ratio for patients with a Pra score value > or = .53 was 1.67. Using a Pra cut point of > or = .45, readmission of patients with a high Pra was 2.3 times more likely than that of patients with a low Pra (p < .001, confidence interval = 1.63-3.27). Comparisons between cohorts indicated that differences existed with four of the eight variables used to calculate the Pra score: diabetes (p = .01), self-rated health status (p = .007), and number of doctor visits (p < .001) and hospitalizations (p < .001) in the past year. DISCUSSION Within this heterogeneous sample, prediction of readmission using the Pra was better than chance. These findings may facilitate development of a better predictive model by combining select Pra variables with other variables associated with early readmission.
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Thombs BD, Ziegelstein RC, Stewart DE, Abbey SE, Parakh K, Grace SL. Physical health status assessed during hospitalization for acute coronary syndrome predicts mortality 12 months later. J Psychosom Res 2008; 65:587-93. [PMID: 19027449 DOI: 10.1016/j.jpsychores.2008.06.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 05/19/2008] [Accepted: 06/03/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Self-report measures of health status predict mortality in several groups of patients with cardiovascular disease, although overlap with symptoms of depression may reduce or eliminate this relationship. The association between self-reported health status and mortality has not been examined in patients hospitalized for acute coronary syndrome (ACS). The objective was to investigate whether the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the SF-12 predicted 12-month all-cause mortality after controlling for cardiac risk factors and symptoms of depression. METHODS The SF-12 and Beck Depression Inventory were administered 2-5 days after admission to 800 ACS patients from 12 coronary care units. Logistic regression was used to assess the relationship of the PCS and MCS with mortality 12 months later, controlling for age, sex, cardiac diagnosis (acute myocardial infarction vs. unstable angina), Killip class, history of myocardial infarction, and in-hospital depressive symptoms. RESULTS Lower scores on the SF-12 PCS (worse health) were associated with a significantly higher risk of mortality [odds ratio (OR)=0.94, 95% confidence interval (CI)=0.92-0.97, P<.001]. MCS scores failed to reach significance (OR=0.98, CI=0.95-1.00, P=.053). The PCS significantly predicted mortality even after controlling for other cardiac risk factors and depressive symptoms (OR=0.96, CI=0.93-0.99, P=.008), equivalent to a 34% increase in risk per 10-point (1 SD) decrement in PCS scores. CONCLUSION The brief SF-12 PCS presents an attractive option for improving risk stratification among hospitalized ACS patients.
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Affiliation(s)
- Brett D Thombs
- Department of Psychiatry, McGill University and Sir Mortimer B. Davis-Jewish General Hospital, Quebec, Canada.
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Johansson P, Broström A, Dahlström U, Alehagen U. Global Perceived Health and Health-Related Quality of Life in Elderly Primary Care Patients with Symptoms of Heart Failure. Eur J Cardiovasc Nurs 2008; 7:269-76. [DOI: 10.1016/j.ejcnurse.2007.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Revised: 12/03/2007] [Accepted: 12/05/2007] [Indexed: 11/29/2022]
Abstract
Background: The aim was to examine whether a single question about global perceived health (GPH) is associated with the domains of health-related quality of life (HR-QoL) as assessed by the SF-36, and whether the scores in these domains differ from the different scores of the GPH in relation to left ventricular ejection fraction (LVEF). Method: The study included 412 elderly outpatients with symptoms of heart failure (HF). Echocardiography was used to determine their LVEF, and GPH was assessed by the first question on the SF-36. Results: The correlations between GPH and the different domains in SF-36 ranged from 0.33 to 0.64 in patients with LVEF ≥ 50% and was between 0.29 and 0.59 in patients with LVEF < 40%. Regression analyses revealed GPH to be the strongest predictor of HR-QoL. Patients with LVEF < 40% rating poor GPH differed significantly ( p < 0.05) from those with good or moderate GPH in six of the eight HR-QoL domains. Conclusion: One question about GPH gives a good general description of HR-QoL and may therefore be used as a simple tool to assess HR-QoL in elderly outpatients with clinical symptoms of HF.
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Affiliation(s)
- Peter Johansson
- Department of Cardiology, Linköping University Hospital, S-58185 Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, S-58185 Linköping, Sweden
| | - Anders Broström
- Department of Medical and Health Sciences, Linköping University, S-58185 Linköping, Sweden
- Division of Clinical Neurophysiology, Linköping University Hospital, S-58185 Linköping, Sweden
| | - Ulf Dahlström
- Department of Cardiology, Linköping University Hospital, S-58185 Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, S-58185 Linköping, Sweden
| | - Urban Alehagen
- Department of Cardiology, Linköping University Hospital, S-58185 Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, S-58185 Linköping, Sweden
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Pedersen SS, Theuns DAMJ, Muskens-Heemskerk A, Erdman RAM, Jordaens L. Type-D personality but not implantable cardioverter-defibrillator indication is associated with impaired health-related quality of life 3 months post-implantation. ACTA ACUST UNITED AC 2007; 9:675-80. [PMID: 17434891 DOI: 10.1093/europace/eum041] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS Little is known about the impact of ICD indication (primary vs. secondary) on health-related quality of life (HRQL). Indication may also interact with psychological factors, such as personality. Using a prospective design, we examined whether ICD indication and type-D personality (i.e. experiencing increased negative emotions paired with emotional non-expression) serve as modulators of HRQL at baseline and 3 months post-implantation. METHODS AND RESULTS Consecutively implanted ICD patients (n = 154) completed the Type-D Scale (DS14) at baseline and the Short-Form Health Survey 36 (SF-36) at baseline and 3 months. Of all patients, 82 (53%) received an ICD due to prophylactic reasons; the prevalence of type-D was 23%. Indication had no influence on HRQL (P = 0.75). Further stratification by personality showed a main effect for type-D personality (P < 0.001), with type-D patients generally experiencing poorer HRQL; there was no main effect for indication (P = 0.45) nor was the interaction effect indication by type-D significant (P = 0.22). There was a significant improvement in HRQL over time (P = 0.001). Type-D remained an independent predictor of impaired HRQL, adjusting for clinical factors and shocks during follow-up (P < 0.001). However, in adjusted analysis there was no longer a significant change in HRQL over time (P = 0.099). CONCLUSION Type-D personality but not ICD indication was associated with impaired HRQL at the time of implantation and at 3 months. In the quest for enhancing risk stratification in clinical practice, personality factors, such as type-D, should not be ignored, as both type-D and poor HRQL have been associated with increased risk of mortality in cardiac patients.
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Affiliation(s)
- Susanne S Pedersen
- CoRPS, Department of Medical Psychology, Center of Research on Psychology in Somatic diseases, Room P503a, Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE Tilburg, The Netherlands.
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