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Kim AR, Hyun J, Lee SE, Hong JA, Kang PJ, Jung SH, Kim MS. Prognosis of Venoarterial Extracorporeal Membrane Oxygenation in Mixed, Cardiogenic and Septic Shock. ASAIO J 2023; 69:658-664. [PMID: 37018827 DOI: 10.1097/mat.0000000000001933] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Mixed cardiogenic-septic shock (MS), defined as the combination of cardiogenic (CS) and septic (SS) shock, is often encountered in cardiac intensive care units. Herein, the authors compared the impact of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in MS, CS, and SS. Of 1,023 patients who received VA-ECMO from January 2012 to February 2020 at a single center, 211 with pulmonary embolism, hypovolemic shock, aortic dissection, and unknown causes of shock were excluded. The remaining 812 patients were grouped based on the cause of shock at VA-ECMO application: i) MS (n = 246, 30.3%), ii) CS (n = 466, 57.4%), iii) SS (n = 100, 12.3%). The MS group was younger and had lower left ventricular ejection fraction than the CS or SS group did. The 30 day and 1 year mortalities were the highest in SS (30 day mortality: 50.4% vs. 43.3% vs. 69.0%, p < 0.001 for MS versus CS versus SS, respectively; 1 year mortality: 67.5% vs. 53.2% vs. 81.0%, p < 0.001 for MS versus CS versus SS, respectively). Posthoc analysis showed that the 30 day mortality of MS was not different from CS, while the 1 year mortality of MS was worse than CS but better than SS. Venoarterial extracorporeal membrane oxygenation application for MS may help improve survival and should therefore be considered if indicated.
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Affiliation(s)
- Ah-Ram Kim
- From the Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Junho Hyun
- From the Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Eun Lee
- From the Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Ae Hong
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Pil-Je Kang
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min-Seok Kim
- From the Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Kimchi A, Aronow HU, Ni YM, Ong MK, Mirocha J, Black JT, Auerbach AD, Ganiats TG, Greenfield S, Romano PS, Kedan I. Postdischarge Noninvasive Telemonitoring and Nurse Telephone Coaching Improve Outcomes in Heart Failure Patients With High Burden of Comorbidity. J Card Fail 2023; 29:774-783. [PMID: 36521727 PMCID: PMC10175121 DOI: 10.1016/j.cardfail.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 10/06/2022] [Accepted: 11/11/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Noninvasive telemonitoring and nurse telephone coaching (NTM-NTC) is a promising postdischarge strategy in heart failure (HF). Comorbid conditions and disease burden influence health outcomes in HF, but how comorbidity burden modulates the effectiveness of NTM-NTC is unknown. This study aims to identify patients with HF who may benefit from postdischarge NTM-NTC based on their burden of comorbidity. METHODS AND RESULTS In the Better Effectiveness After Transition - Heart Failure trial, patients hospitalized for acute decompensated HF were randomized to postdischarge NTM-NTC or usual care. In this secondary analysis of 1313 patients with complete data, comorbidity burden was assessed by scoring complication and coexisting diagnoses from index admissions. Clinical outcomes included 30-day and 180-day readmissions, mortality, days alive, and combined days alive and out of the hospital. Patients had a mean of 5.7 comorbidities and were stratified into low (0-2), moderate (3-8), and high comorbidity (≥9) subgroups. Increased comorbidity burden was associated with worse outcomes. NTM-NTC was not associated with readmission rates in any comorbidity subgroup. Among high comorbidity patients, NTM-NTC was associated with significantly lower mortality at 30 days (hazard ratio 0.25, 95% confidence interval 0.07-0.90) and 180 days (hazard ratio 0.51, 95% confidence interval 0.27-0.98), as well as more days alive (160.1 vs 140.3, P = .029) and days alive out of the hospital (152.0 vs 133.2, P = .044) compared with usual care. CONCLUSIONS Postdischarge NTM-NTC improved survival among patients with HF with a high comorbidity burden. Comorbidity burden may be useful for identifying patients likely to benefit from this management strategy.
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Affiliation(s)
- Asher Kimchi
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Harriet U Aronow
- Nursing Research, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yu-Ming Ni
- Department of Cardiology, Scripps Memorial Hospital La Jolla, La Jolla, California
| | - Michael K Ong
- Department of Medicine, UCLA, Los Angeles, California
| | - James Mirocha
- Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jeanne T Black
- Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Theodore G Ganiats
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, California
| | | | - Patrick S Romano
- Department of Medicine and Pediatrics, UC Davis, Sacramento, California
| | - Ilan Kedan
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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Lecoeur E, Domengé O, Fayol A, Jannot AS, Hulot JS. Epidemiology of heart failure in young adults: a French nationwide cohort study. Eur Heart J 2023; 44:383-392. [PMID: 36452998 PMCID: PMC9890267 DOI: 10.1093/eurheartj/ehac651] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/24/2022] [Accepted: 10/30/2022] [Indexed: 12/05/2022] Open
Abstract
AIMS Heart failure (HF) in young adults is uncommon, and changes in its incidence and prognosis in recent years are poorly described. METHODS AND RESULTS The incidence and prognosis of HF in young adults (1850 years) were characterized using nationwide medico-administrative data from the French National Hospitalization Database (period 20132018). A total of 1,486 877 patients hospitalized for incident HF were identified, including 70 075 (4.7) patients aged 1850 years (estimated incidence of 0.44 for this age group). During the study period, the overall incidence of HF tended to decrease in the overall population but significantly increased by 0.041 in young adults (P 0.001). This increase was notably observed among young men (from 0.51 to 0.59, P 0.001), particularly those aged 3650 years. In these young men, ischaemic heart disease (IHD) was the most frequently reported cause of HF, whereas non-ischaemic HF was mainly observed in patients 35 years old. In contrast to non-ischaemic HF, the incidence of IHD increased over the study period, which suggests that IHD-related HF is progressively affecting younger patients. Concordantly, young HF patients presented with high rates of traditional IHD risk factors, including obesity, smoking, hypertension, dyslipidaemia, or diabetes. Lastly, the rates of re-hospitalization (for HF or for any cause) within two years after the first HF event and in-hospital mortality were high in all groups, indicating a poor-prognosis population. CONCLUSION Strategies for the prevention of HF risk factors should be strongly considered for patients under 50 years old.
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Affiliation(s)
- Emmanuel Lecoeur
- Department of Medical Informatics and Public Health, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | - Orianne Domengé
- Université de Paris Cité, INSERM, PARCC, Heart failure translational laboratory, F-75015, Paris, France
- CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | - Antoine Fayol
- Université de Paris Cité, INSERM, PARCC, Heart failure translational laboratory, F-75015, Paris, France
- CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | - Anne-Sophie Jannot
- Department of Medical Informatics and Public Health, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | - Jean-Sébastien Hulot
- Université de Paris Cité, INSERM, PARCC, Heart failure translational laboratory, F-75015, Paris, France
- CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
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López-Vilella R, Marqués-Sulé E, Sánchez-Lázaro I, Laymito Quispe R, Martínez Dolz L, Almenar Bonet L. Creatinine and NT-ProBNP levels could predict the length of hospital stay of patients with decompensated heart failure. Acta Cardiol 2021; 76:1100-1107. [PMID: 33480331 DOI: 10.1080/00015385.2020.1871264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Heart failure (HF) is a clinical syndrome that causes high morbidity and mortality with a high number of admissions and sometimes prolonged admissions. This study aimed at assessing whether parameters detected during the first 24 h of admission may predict a prolonged hospital stay in patients admitted to hospital for decompensated HF. METHODS From January 2016 to December 2019, 2359 admissions of decompensated HF were recorded. In-hospital transfers, de novo HF, deaths and scheduled admissions were discarded to homogenise the sample. Finally, 1196 patients were included. The sample was divided into two groups: (a) non-prolonged admission (n = 643, admission ≤7 days) or (b) prolonged admission (n = 553, admission >7 days). Clinical, analytical, electrocardiographic and echocardiographic variables obtained during the first 24 h of admission were analysed. RESULTS Univariate differences were found at admission in NT-ProBNP, creatinine, history of cardiac surgery, smoking and alcoholism, left and right ventricular ejection fraction, systolic blood pressure and heart rate. The ROC analysis showed significant areas under the curve for the NT-ProBNP (AUC: 0.63, 95% CI: 0.60-0.67; p < 0.001) and creatinine (AUC: 0.69, 95% CI: 0.66-0.72; p < 0.0001). The variables associated with prolonged hospital admission were NT-ProBNP (OR: 1, 95% CI: 1-1; p < 0.001), creatinine (OR: 2.2, 95% CI: 1.8-2.7; p < 0.0001) and previous smoking (OR: 1.5, 95% CI: 0.4-1; p < 0.02). CONCLUSIONS Variables such as creatinine and NT-ProBNP at hospital admission may define a subgroup of patients who will probably have a long hospital stay. Therefore, the planning of hospital care and transition to discharge may be enhanced.
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Affiliation(s)
- Raquel López-Vilella
- Unit of Heart Failure and Transplant, La Fe University and Polytechnic Hospital, Valencia, Spain
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Ignacio Sánchez-Lázaro
- Unit of Heart Failure and Transplant, La Fe University and Polytechnic Hospital, Valencia, Spain
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- CIBERCV, Valencia, Spain
| | - Rocío Laymito Quispe
- Unit of Heart Failure and Transplant, La Fe University and Polytechnic Hospital, Valencia, Spain
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Luis Martínez Dolz
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- CIBERCV, Valencia, Spain
| | - Luis Almenar Bonet
- Unit of Heart Failure and Transplant, La Fe University and Polytechnic Hospital, Valencia, Spain
- Cardiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- CIBERCV, Valencia, Spain
- Faculty of Medicine, University of Valencia, Valencia, Spain
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Estudio poblacional de la primera hospitalización por insuficiencia cardiaca y la interacción entre los reingresos y la supervivencia. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.05.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Iyngkaran P, Liew D, Neil C, Driscoll A, Marwick TH, Hare DL. Moving From Heart Failure Guidelines to Clinical Practice: Gaps Contributing to Readmissions in Patients With Multiple Comorbidities and Older Age. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2018; 12:1179546818809358. [PMID: 30618487 PMCID: PMC6299336 DOI: 10.1177/1179546818809358] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 09/14/2018] [Indexed: 12/20/2022]
Abstract
This feature article for the thematic series on congestive heart failure (CHF) readmissions aims to outline important gaps in guidelines for patients with multiple comorbidities and the elderly. Congestive heart failure diagnosis manifests as a 3-phase journey between the hospital and community, during acute, chronic stable, and end-of-life (palliative) phases. This journey requires in variable intensities a combination of multidisciplinary care within tertiary hospital or ambulatory care from hospital outpatients or primary health services, within the general community. Management goals are uniform, ie, to achieve the lowest New York Heart Association class possible, with improvement in ejection fraction, by delivering gold standard therapies within a CHF program. Comorbidities are an important common denominator that influences outcomes. Comorbidities include diabetes mellitus, chronic obstructive airways disease, chronic renal impairment, hypertension, obesity, sleep apnea, and advancing age. Geriatric care includes the latter as well as syndromes such as frailty, falls, incontinence, and confusion. Many systems still fail to comprehensively achieve all aspects of such programs. This review explores these factors.
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Affiliation(s)
- Pupalan Iyngkaran
- Northern Territory Medical Program, Flinders University, Darwin, NT, Australia
- Pupalan Iyngkaran, Yellow Building 4 Cnr University Drive North & University Drive West Charles Darwin University, Casuarina, NT 0815, Australia.
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christopher Neil
- Department of Medicine—Western Precinct, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrea Driscoll
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
- Austin Health, Melbourne, VIC, Australia
| | | | - David L Hare
- Cardiovascular Research, The University of Melbourne, Melbourne, VIC, Australia
- Heart Failure Services, Austin Health, Melbourne, VIC, Australia
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7
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Niedziela JT, Parma Z, Pawlowski T, Rozentryt P, Gasior M, Wojakowski W. Secular trends in first-time hospitalization for heart failure with following one-year readmission and mortality rates in the 3.8 million adult population of Silesia, Poland between 2010 and 2016. The SILCARD database. Int J Cardiol 2018; 271:146-151. [DOI: 10.1016/j.ijcard.2018.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/22/2018] [Accepted: 05/08/2018] [Indexed: 10/28/2022]
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8
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Fernández-Gassó L, Hernando-Arizaleta L, Palomar-Rodríguez JA, Abellán-Pérez MV, Hernández-Vicente Á, Pascual-Figal DA. Population-based Study of First Hospitalizations for Heart Failure and the Interaction Between Readmissions and Survival. ACTA ACUST UNITED AC 2018; 72:740-748. [PMID: 30262426 DOI: 10.1016/j.rec.2018.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/25/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Disease progression in patients after a first hospitalization for heart failure (HF), in particular the interaction between survival and rehospitalizations, is not well established. METHODS We studied all patients with a first hospitalization and main diagnosis of HF from 2009 to 2013 by analyzing the Minimum Data Set of the Region of Murcia. Both incident and recurrent patients were studied, and the trend in hospitalization rates was calculated by joinpoint regression. Patients were followed-up through their health cards until the end of 2015. Mortality and readmissions, including causes and chronology in relation to the time of death, were assessed. RESULTS A total of 8258 incident patients were identified, with annual rates increasing (+2.3%, P <.05) up to 1.24 patients per 1000 inhabitants, representing 71% of hospitalized individuals and 57% of total discharges due to HF. In the first year, 22% were readmitted due to HF, 31% due to cardiovascular causes, and 54% due to any cause. Five-year survival was 40%, which was significantly lower than age- and sex-adjusted expected survival for the general population (76%) (P <.001). Among patients who died during follow-up, readmissions (1.5 per patient/y, 0.4 due to HF) showed a "J" pattern, with 48% of rehospitalizations being concentrated in the last 3 deciles of survival prior to death. CONCLUSIONS Rates of first hospitalization due to HF continue to increase, with high mortality and rehospitalizations during follow-up, which are concentrated mainly in the period prior to death.
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Affiliation(s)
- Lucía Fernández-Gassó
- Servicio de Cardiología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - Lauro Hernando-Arizaleta
- Servicio de Planificación Sanitaria y Financiación Sanitaria, Consejería de Salud de la Región de Murcia, Murcia, Spain
| | - Joaquín A Palomar-Rodríguez
- Servicio de Planificación Sanitaria y Financiación Sanitaria, Consejería de Salud de la Región de Murcia, Murcia, Spain
| | - María Victoria Abellán-Pérez
- Servicio de Planificación Sanitaria y Financiación Sanitaria, Consejería de Salud de la Región de Murcia, Murcia, Spain
| | - Álvaro Hernández-Vicente
- Servicio de Cardiología, Hospital Universidad Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
| | - Domingo A Pascual-Figal
- Servicio de Cardiología, Hospital Universidad Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Murcia, Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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9
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Tsao CW, Lyass A, Enserro D, Larson MG, Ho JE, Kizer JR, Gottdiener JS, Psaty BM, Vasan RS. Temporal Trends in the Incidence of and Mortality Associated With Heart Failure With Preserved and Reduced Ejection Fraction. JACC-HEART FAILURE 2018; 6:678-685. [PMID: 30007560 DOI: 10.1016/j.jchf.2018.03.006] [Citation(s) in RCA: 257] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This study aimed to determine temporal trends in the incidence of and mortality associated with heart failure (HF) and its subtypes (heart failure with reduced ejection fraction [HFrEF] and heart rate with preserved ejection fraction [HFpEF]) in the community. BACKGROUND Major shifts in cardiovascular disease risk factor prevalence and advances in therapies may have influenced HF incidence and mortality. METHODS In the FHS (Framingham Heart Study) and CHS (Cardiovascular Health Study), for participants who were ≥60 years of age and free of HF (n = 15,217; 60% women; 2,524 incident HF cases; 115,703 person-years of follow-up), we estimated adjusted incidence rate ratios of HF, HFrEF, and HFpEF from 1990 to 1999 and 2000 to 2009. We compared the cumulative incidence of and mortality associated with HFrEF versus HFpEF within and between decades. RESULTS Across the 2 decades, HF incidence rate ratio was similar (p = 0.13). The incidence rate ratio of HFrEF declined (p = 0.0029), whereas HFpEF increased (p < 0.001). Although HFrEF incidence declined more in men than in women, men had a higher incidence of HFrEF than women in each decade (p < 0.001). The incidence of HFpEF significantly increased over time in both men and women (p < 0.001 and p = 0.02, respectively). During follow-up after HF, 1,701 individuals died (67.4%; HFrEF, n = 557 [33%]; HFpEF, n = 474 [29%]). There were no significant differences in mortality rates (overall, cardiovascular disease, and noncardiovascular disease) across decades within HF subtypes or between HFrEF and HFpEF within decade. CONCLUSIONS In several U.S. community-based samples from 1990 to 2009, we observed divergent trends of decreasing HFrEF and increasing HFpEF incidence, with stable overall HF incidence and high risk for mortality. Our findings highlight the need to elucidate factors contributing to these observations.
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Affiliation(s)
- Connie W Tsao
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts.
| | - Asya Lyass
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
| | - Danielle Enserro
- Department of Mathematics and Statistics, Boston University, Boston, Massachusetts; Roswell Park Cancer Institute, Buffalo, New York
| | - Martin G Larson
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
| | - Jennifer E Ho
- Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jorge R Kizer
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - John S Gottdiener
- Division of Cardiology, Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington; Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - Ramachandran S Vasan
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Sections of Cardiology and Preventative Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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10
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Risk and predictors of readmission for heart failure following a myocardial infarction between 2004 and 2013: A Swedish nationwide observational study. Int J Cardiol 2017; 248:221-226. [DOI: 10.1016/j.ijcard.2017.05.086] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/07/2017] [Accepted: 05/20/2017] [Indexed: 11/17/2022]
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Multi-state modelling of heart failure care path: A population-based investigation from Italy. PLoS One 2017; 12:e0179176. [PMID: 28591172 PMCID: PMC5462433 DOI: 10.1371/journal.pone.0179176] [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] [Received: 02/08/2017] [Accepted: 05/24/2017] [Indexed: 11/19/2022] Open
Abstract
Background How different risk profiles of heart failure (HF) patients can influence multiple readmissions and outpatient management is largely unknown. We propose the application of two multi-state models in real world setting to jointly evaluate the impact of different risk factors on multiple hospital admissions, Integrated Home Care (IHC) activations, Intermediate Care Unit (ICU) admissions and death. Methods and findings The first model (model 1) concerns only hospitalizations as possible events and aims at detecting the determinants of repeated hospitalizations. The second model (model 2) considers both hospitalizations and ICU/IHC events and aims at evaluating which profiles are associated with transitions in intermediate care with respect to repeated hospitalizations or death. Both are characterized by transition specific covariates, adjusting for risk factors. We identified 4,904 patients (4,129 de novo and 775 worsening heart failure, WHF) hospitalized for HF from 2009 to 2014. 2,714 (55%) patients died. Advanced age and higher morbidity load increased the rate of dying and of being rehospitalized (model 1), decreased the rate of being discharged from hospital (models 1 and 2) and increased the rate of inactivation of IHC (model 2). WHF was an important risk factor associated with hospital readmission. Conclusion Multi-state models enable a better identification of two patterns of HF patients. Once adjusted for age and comorbidity load, the WHF condition identifies patients who are more likely to be readmitted to hospital, but does not represent an increasing risk factor for activating ICU/IHC. This highlights different ways to manage specific patients’ patterns of care. These results provide useful healthcare support to patients’ management in real world context. Our study suggests that the epidemiology of the considered clinical characteristics is more nuanced than traditionally presented through a single event.
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12
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Stewart S. Caring for Older Patients with Chronic Cardiac Disease: An Increasing Challenge for Cardiac Nurses in the 21st Century. Eur J Cardiovasc Nurs 2016; 1:11-3. [PMID: 14622860 DOI: 10.1016/s1474-5151(01)00003-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Simon Stewart
- NHF of Australia Ralph Reader Fellow, Adelaide University and University of South Australia, South Australia, Australia.
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13
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Omersa D, Farkas J, Erzen I, Lainscak M. National trends in heart failure hospitalization rates in Slovenia 2004-2012. Eur J Heart Fail 2016; 18:1321-1328. [DOI: 10.1002/ejhf.617] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Daniel Omersa
- National Institute of Public Health; Ljubljana Slovenia
| | | | - Ivan Erzen
- National Institute of Public Health; Ljubljana Slovenia
| | - Mitja Lainscak
- Department of Cardiology, Department of Research and Education; General Hospital Celje; Celje Slovenia
- Faculty of Medicine; University of Ljubljana; Ljubljana Slovenia
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14
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Stergren J, McMurray JJV. Angiotensin receptor blockers in heart failure. J Renin Angiotensin Aldosterone Syst 2016; 4:171-5. [PMID: 14608522 DOI: 10.3317/jraas.2003.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Collectively, a series of large, prospective randomised outcome trials has now shown that angiotensin receptor blockers (ARBs) are of clinical value in a broad spectrum of patients with symptomatic heart failure, regardless of background therapy and ventricular function. There is a clear benefit of ARBs in patients unable to tolerate an angiotensin-converting enzyme (ACE) inhibitor and this benefit is of a similar magnitude to that obtained with an ACE inhibitor (ACE-I). Both Val-HeFT and, particularly, CHARM-Added, also show that symptoms, morbidity and mortality are further reduced if an ARB is added to an ACE-I. This benefit is not only statistically significant but clinically important. CHARM-Preserved showed that candesartan can reduce hospital admission for heart failure in patients with preserved systolic function though more definitive outcome data are needed in this group.
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McKee SP, Leslie SJ, LeMaitre JP, Webb DJ, Denvir MA. Physician Opinions on the Implementation of the Sign Guideline for Heart Failure. Scott Med J 2016; 49:10-3. [PMID: 15012045 DOI: 10.1177/003693300404900103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Aims: To assess physician opinion of, and attitudes to, the Scottish Intercollegiate Guideline Network (SIGN) guideline for chronic heart failure (CHF) due to left ventricular systolic dysfunction. Methods and Results: A questionnaire examining physicians' attitudes and their use of the SIGN guideline for CHF was distributed to 158 physicians in two teaching hospitals within one NHS trust. 65% of recipients responded. More cardiologists had read the guideline compared to non-cardiologists (91 vs 56%, p < 0.05). The majority of cardiologists and non-cardiologists agreed that it was applicable to their patients (92 vs 79%, p > 0.1) and that implementation may reduce hospital admissions (65 vs 59%, p > 0.5). In general, compliance was thought to be a problem in only a minority of patients in both groups for angiotensin converting enzyme inhibitors (8 vs 19%), diuretics (12 vs 29%) and digoxin (17 vs 19%, all p > 0.1). Beta-blocker compliance was identified as a problem by both groups (50 vs 53%, p > 0.5) while fewer cardiologists reported compliance as a problem with spironolactone (4 vs 25%, p < 0.05). More cardiologists felt that there was a need for a community based CHF nurse specialist (100 vs 57%, p < 0.001), and that this strategy would reduce hospital admissions (92 vs 57%, p < 0.01). Conclusions: Differences exist between cardiologist and non-cardiologist physicians' awareness of the SIGN guideline for CHF. Furthermore, we have shown differences in reported implementation of the guideline and perceived difficulties with specific drug therapies. This is in spite of high levels of agreement in both groups with the treatment suggested by the guideline and the anticipated benefits resulting from its implementation.
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Affiliation(s)
- S P McKee
- Cardiology Unit, Department of Medical Sciences, The University of Edinburgh, Western General Hospital, Edinburgh
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16
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Stewart S. Atrial Fibrillation in the 21st Century: The New Cardiac ‘Cinderella’ and New Horizons for Cardiovascular Nursing? Eur J Cardiovasc Nurs 2016. [DOI: 10.1016/s1474-51510200010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Simon Stewart
- Centre for Research into Nursing and Health Care/School of Nursing and Midwifery, 4th Floor Centenary Building, City East Campus, University of South Australia, Frome Road, Adelaide 5000, Australia
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17
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Abstract
Stroke is the third leading cause of death of people in the world today and the highest cause of disability and handicap, producing a huge burden on individuals and society more broadly. Yet unlike its counterpart acute myocardial infarction (AMI), little has been done to promote early intervention in evolving strokes. Recommendations from the American Heart Association and more recently the European Stroke Initiative are available; however, in Australia (as with many other countries) practice guidelines are scarce and clinicians largely operate in an ad hoc manner with little awareness of ‘best practice’. The controversial role of thrombolysis with limitations in respect to selecting appropriate patients, in addition to a small window of opportunity for therapeutic beneficial effects and a high risk for haemorrhage, has inhibited its widespread application. As such, emergent stroke management clearly lags behind that of AMI–both with respect to the range of treatment options and the application of best practice. This paper reviews the literature regarding best practice management of evolving stroke and the crucial role of nurses in triaging and managing patients to deliver optimal outcomes within the Australian context.
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Carter P, Reynolds J, Carter A, Potluri S, Uppal H, Chandran S, Potluri R. The impact of psychiatric comorbidities on the length of hospital stay in patients with heart failure. Int J Cardiol 2016; 207:292-6. [DOI: 10.1016/j.ijcard.2016.01.132] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 12/11/2015] [Accepted: 01/05/2016] [Indexed: 11/25/2022]
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Abstract
The hospitalized heart failure (HF) population is becoming a significant economic burden to Asian countries because of the growing elderly population, increased prevalence of HF, and recurrent rehospitalization. A targeted treatment strategy is needed with prognostic factors that can reduce mortality or rehospitalization after discharge. The accepted prognostic factors include age, low systolic blood pressure, ischemic heart disease, reduced left ventricular function, hyponatremia, and renal dysfunction. Prognostic factors for clinical outcomes in hospitalized patients with HF may be different in Asian people. Further research leading to better understanding of the characteristics of Asian patients hospitalized with HF is warranted.
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Affiliation(s)
- Seok-Min Kang
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Chan Cho
- Cardiology Division, Department of Internal Medicine, College of Medicine, Chungbuk National University, 776 Sunhwan-1-Ro, Seowon-Gu, Cheongju 362-711, Korea.
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20
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Honma M, Tanaka F, Sato K, Onoda T, Sakai T, Nishiyama O, Matsumoto T, Onodera M, Sakata K, Nakamura M. Sex-specific temporal trends in the incidence and prevalence of hospitalized patients with preserved versus reduced left ventricular ejection fraction heart failure: A Japanese community-wide study. IJC HEART & VASCULATURE 2015; 9:15-21. [PMID: 28785700 PMCID: PMC5497324 DOI: 10.1016/j.ijcha.2015.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/07/2015] [Accepted: 07/25/2015] [Indexed: 02/01/2023]
Abstract
Background Sex specific temporal trends in the incidence and prevalence of hospitalization for heart failure (HF), particularly in conjunction with reduced and preserved left ventricular ejection fraction (EF) remain unclear, especially in Asian general populations. Methods We conducted a community based HF registration study over a 10 year period in an aging cohort of the Japanese general population. Results A total of 2598 cases of hospitalized HF were registered during the survey period. Of these 1413 cases (55%) were initial admissions for HF (incident case). The study period was divided into five 2-year terms (T1, 2003–2004; T2, 2005–2006; T3, 2007–2008; T4, 2009–2010; T5, 2011–2012), and data were compared among the terms. Age adjusted incidence of HF (per 105 person-year) remained stable in men, but decreased significantly by 25% in women (from 104 at T1 to 79 at T5; p for trend < 0.05). Among incident cases who underwent echocardiography (≈ 90%), the proportion of HF with preserved EF increased in men (from 32% at T1 to 43% at T5; p for trend < 0.05), and was relatively high and remained stable throughout the study period in women (from 52% at T1 to 58% at T5; p for trend; NS). Conclusion Although the incidence of HF has declined especially in women between 2003 and 2012 in the study population, the proportion of HF with preserved EF has increased over time. These trends suggest a future prevalence of HF with preserved EF rather than HF with reduced EF in aging Asian populations.
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Affiliation(s)
- Miho Honma
- Dept Internal Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan
- Iwate Prefecture Ninohe Hospital, Iwate, Japan
| | - Fumitaka Tanaka
- Dept Internal Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan
| | - Kenyu Sato
- Dept Internal Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan
| | - Toshiyuki Onoda
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Iwate, Japan
| | | | | | | | | | - Kiyomi Sakata
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Iwate, Japan
| | - Motoyuki Nakamura
- Dept Internal Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Japan
- Corresponding author at: Division of Cardioangiology, Department of Internal Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan.
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21
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Korajkic A, Poole SG, MacFarlane LM, Bergin PJ, Dooley MJ. Impact of a Pharmacist Intervention on Ambulatory Patients with Heart Failure: A Randomised Controlled Study. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2011.tb00679.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | - Michael J Dooley
- Alfred Health, Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Parkville Victoria
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22
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Short- and long-term mortality and hospital readmissions among patients with new hospitalization for heart failure: A population-based investigation from Italy. Int J Cardiol 2015; 181:81-7. [DOI: 10.1016/j.ijcard.2014.12.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/28/2014] [Accepted: 12/01/2014] [Indexed: 11/21/2022]
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Abstract
Heart failure (HF) is a major public health problem affecting more than five million Americans and more than 23 million patients worldwide. The epidemiology of HF is evolving. Data suggests that the incidence of HF peaked in the mid-1990s and has since declined. Survival after HF diagnosis has improved, leading to an increase in prevalence. The case mix is also changing, as a rising proportion of patients with HF have preserved ejection fraction and multimorbidity is increasingly common. After diagnosis, HF can have a profound associated morbidity. Hospitalizations in HF remain both frequent and costly, though they may be declining as a result of preventive efforts. The need for skilled nursing facility care in HF has risen. The role of palliative medicine in the care of patients with advanced HF is evolving as we learn how to best care for this population with a large symptom burden.
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Affiliation(s)
- Shannon M Dunlay
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Gonda 5, 200 First St. SW, Rochester, MN, 55905, USA,
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24
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Ambrosy AP, Gheorghiade M, Chioncel O, Mentz RJ, Butler J. Global Perspectives in Hospitalized Heart Failure: Regional and Ethnic Variation in Patient Characteristics, Management, and Outcomes. Curr Heart Fail Rep 2014; 11:416-27. [DOI: 10.1007/s11897-014-0221-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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25
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Guppy-Coles KB, Prasad SB, Smith KC, Hillier S, Lo A, Atherton JJ. Evaluation of training nurses to perform semi-automated three-dimensional left ventricular ejection fraction using a customised workstation-based training protocol. J Clin Nurs 2014; 24:1479-88. [DOI: 10.1111/jocn.12666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Kristyan B Guppy-Coles
- Department of Cardiology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
- University of Queensland School of Medicine; Brisbane Qld Australia
| | - Sandhir B Prasad
- Department of Cardiology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
- University of Queensland School of Medicine; Brisbane Qld Australia
- Mater Adult Hospital; Brisbane Qld Australia
| | - Kym C Smith
- Department of Cardiology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - Samuel Hillier
- Department of Cardiology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - Ada Lo
- Department of Cardiology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - John J Atherton
- Department of Cardiology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
- University of Queensland School of Medicine; Brisbane Qld Australia
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26
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Guha K, McDonagh T. Heart failure epidemiology: European perspective. Curr Cardiol Rev 2014; 9:123-7. [PMID: 23597298 PMCID: PMC3682396 DOI: 10.2174/1573403x11309020005] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/19/2012] [Accepted: 12/12/2012] [Indexed: 11/22/2022] Open
Abstract
Heart failure poses an increasing problem for global healthcare systems. The epidemiological data which has been accrued over the last thirty years has predominantly been accumulated from experience within North America and Europe. Initial large cohort, prospective longitudinal studies produced the first publications; however latterly the focus has shifted onto epidemiological data governing hospitalisation and mortality. The emphasis behind this shift has been the resource implications with regards to repetitive, costly and prolonged hospitalisation. The European experience in heart failure, though similar to North America has recently demonstrated differences in hospitalisation which may underlie the differences between healthcare system configuration. Heart failure however remains an increasing global problem and the endpoint of a variety of cardiovascular diseases. Allied with the fact of increasingly elderly populations and prior data demonstrating a steep rise in prevalent cases within more elderly populations, it is likely that the increasing burden of disease will continue to pose challenges for modern healthcare. Despite the predicted increase in the number of patients affected by heart failure, over the last thirty years, a clear management algorithm has evolved for the use of pharmacotherapies (neuro-hormonal antagonists), device based therapies (Implantable Cardioverting Defibrillator (ICD) and Cardiac Resynchronisation Therapy (CRT)) and mechanical therapies including left ventricular assist devices and cardiac transplantation. Though the management of such patients has been clearly delineated in national and international guidelines, the underuse of all available and appropriate therapies remains a significant problem. When comparing various epidemiological studies from different settings and timepoints, it should be remembered that rates of prevalence and incidence may vary depending upon the definition used, methods of accumulating information (with the possibility of bias) and the chosen cut point of defining left ventricular systolic dysfunction (LVSD).
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Affiliation(s)
- K Guha
- Division of Heart Failure, Dept of Cardiology, Royal Brompton Hospital, Chelsea, London, UK.
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27
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de Peuter OR, Lip GY, Souverein PC, Klungel OH, de Boer A, Büller HR, Kamphuisen PW. Time-trends in treatment and cardiovascular events in patients with heart failure: a pharmacosurveillance study. Eur J Heart Fail 2014; 13:489-95. [DOI: 10.1093/eurjhf/hfq228] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Olav R. de Peuter
- Department of Vascular Medicine; Academic Medical Centre; PO Box 22660 1100DD Amsterdam The Netherlands
| | - Gregory Y.H. Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital; Birmingham UK
| | - Patrick C. Souverein
- Pharmacoepidemiology and pharmacotherapy; Utrecht Institute for Pharmaceutical Sciences; Utrecht The Netherlands
| | - Olaf H. Klungel
- Pharmacoepidemiology and pharmacotherapy; Utrecht Institute for Pharmaceutical Sciences; Utrecht The Netherlands
| | - Anthonius de Boer
- Pharmacoepidemiology and pharmacotherapy; Utrecht Institute for Pharmaceutical Sciences; Utrecht The Netherlands
| | - Harry R. Büller
- Department of Vascular Medicine; Academic Medical Centre; PO Box 22660 1100DD Amsterdam The Netherlands
| | - Pieter W. Kamphuisen
- Department of Vascular Medicine; Academic Medical Centre; PO Box 22660 1100DD Amsterdam The Netherlands
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28
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Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M, Nodari S, Lam CSP, Sato N, Shah AN, Gheorghiade M. The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol 2014; 63:1123-1133. [PMID: 24491689 DOI: 10.1016/j.jacc.2013.11.053] [Citation(s) in RCA: 1425] [Impact Index Per Article: 142.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/22/2013] [Accepted: 11/12/2013] [Indexed: 12/11/2022]
Abstract
Heart failure is a global pandemic affecting an estimated 26 million people worldwide and resulting in more than 1 million hospitalizations annually in both the United States and Europe. Although the outcomes for ambulatory HF patients with a reduced ejection fraction (EF) have improved with the discovery of multiple evidence-based drug and device therapies, hospitalized heart failure (HHF) patients continue to experience unacceptably high post-discharge mortality and readmission rates that have not changed in the last 2 decades. In addition, the proportion of HHF patients classified as having a preserved EF continues to grow and may overtake HF with a reduced EF in the near future. However, the prognosis for HF with a preserved EF is similar and there are currently no available disease-modifying therapies. HHF registries have significantly improved our understanding of this clinical entity and remain an important source of data shaping both public policy and research efforts. The authors review global HHF registries to describe the patient characteristics, management, outcomes and their predictors, quality improvement initiatives, regional differences, and limitations of the available data. Moreover, based on the lessons learned, they also propose a roadmap for the design and conduct of future HHF registries.
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Affiliation(s)
- Andrew P Ambrosy
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California
| | - Javed Butler
- Division of Cardiology, Emory University, Atlanta, Georgia
| | - Ovidiu Chioncel
- Institute of Emergency for Cardiovascular Diseases Prof. C.C. Iliescu, Cardiology 1, Bucharest, Romania
| | - Stephen J Greene
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Muthiah Vaduganathan
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Savina Nodari
- Department of Cardiology, University of Brescia, Brescia, Italy
| | | | - Naoki Sato
- Internal Medicine, Cardiology, and Intensive Care Medicine, Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan
| | - Ami N Shah
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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29
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Iversen KK, Kjaergaard J, Akkan D, Kober L, Torp-Pedersen C, Hassager C, Vestbo J, Kjoller E. The prognostic importance of lung function in patients admitted with heart failure. Eur J Heart Fail 2014; 12:685-91. [DOI: 10.1093/eurjhf/hfq050] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Jesper Kjaergaard
- The Heart Centre; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Dilek Akkan
- The Heart Centre; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Lars Kober
- The Heart Centre; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology; Copenhagen University Hospital, Gentofte Hospital; Copenhagen Denmark
| | - Christian Hassager
- The Heart Centre; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Jorgen Vestbo
- Department of Cardiology and Respiratory Medicine; Copenhagen University Hospital, Hvidovre Hospital; Hvidovre Denmark
- School of Translational Medicine; University of Manchester, Wythenshawe Hospital; Manchester UK
| | - Erik Kjoller
- Department of Cardiology S105; Copenhagen University Hospital, Herlev Hospital; Herlev Ringvej 75, DK-2730 Herlev Copenhagen Denmark
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30
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Wu JR, DeWalt DA, Baker DW, Schillinger D, Ruo B, Bibbins-Domingo K, Macabasco-O'Connell A, Holmes GM, Broucksou KA, Erman B, Hawk V, Cene CW, Jones CD, Pignone M. A single-item self-report medication adherence question predicts hospitalisation and death in patients with heart failure. J Clin Nurs 2013; 23:2554-64. [PMID: 24355060 DOI: 10.1111/jocn.12471] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2013] [Indexed: 10/25/2022]
Abstract
AIMS AND OBJECTIVES To determine whether a single-item self-report medication adherence question predicts hospitalisation and death in patients with heart failure. BACKGROUND Poor medication adherence is associated with increased morbidity and mortality. Having a simple means of identifying suboptimal medication adherence could help identify at-risk patients for interventions. DESIGN We performed a prospective cohort study in 592 participants with heart failure within a four-site randomised trial. METHODS Self-report medication adherence was assessed at baseline using a single-item question: 'Over the past seven days, how many times did you miss a dose of any of your heart medication?' Participants who reported no missing doses were defined as fully adherent, and those missing more than one dose were considered less than fully adherent. The primary outcome was combined all-cause hospitalisation or death over one year and the secondary endpoint was heart failure hospitalisation. Outcomes were assessed with blinded chart reviews, and heart failure outcomes were determined by a blinded adjudication committee. We used negative binomial regression to examine the relationship between medication adherence and outcomes. RESULTS Fifty-two percent of participants were 52% male, mean age was 61 years, and 31% were of New York Heart Association class III/IV at enrolment; 72% of participants reported full adherence to their heart medicine at baseline. Participants with full medication adherence had a lower rate of all-cause hospitalisation and death (0·71 events/year) compared with those with any nonadherence (0·86 events/year): adjusted-for-site incidence rate ratio was 0·83, fully adjusted incidence rate ratio 0·68. Incidence rate ratios were similar for heart failure hospitalisations. CONCLUSION A single medication adherence question at baseline predicts hospitalisation and death over one year in heart failure patients. RELEVANCE TO CLINICAL PRACTICE Medication adherence is associated with all-cause and heart failure-related hospitalisation and death in heart failure. It is important for clinicians to assess patients' medication adherence on a regular basis at their clinical follow-ups.
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Affiliation(s)
- Jia-Rong Wu
- The School of Nursing, University of North Carolina, Chapel Hill, NC, USA
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31
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Abstract
Heart failure (HF) has been singled out as an epidemic and is a staggering clinical and public health problem, associated with significant mortality, morbidity, and healthcare expenditures, particularly among those aged ≥ 65 years. The case mix of HF is changing over time with a growing proportion of cases presenting with preserved ejection fraction for which there is no specific treatment. Despite progress in reducing HF-related mortality, hospitalizations for HF remain frequent and rates of readmissions continue to rise. To prevent hospitalizations, a comprehensive characterization of predictors of readmission in patients with HF is imperative and must integrate the impact of multimorbidity related to coexisting conditions. New models of patient-centered care that draw on community-based resources to support HF patients with complex coexisting conditions are needed to decrease hospitalizations.
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Affiliation(s)
- Véronique L Roger
- Department of Health Sciences Research and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
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32
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Barasa A, Schaufelberger M, Lappas G, Swedberg K, Dellborg M, Rosengren A. Heart failure in young adults: 20-year trends in hospitalization, aetiology, and case fatality in Sweden. Eur Heart J 2013; 35:25-32. [PMID: 23900697 PMCID: PMC3877433 DOI: 10.1093/eurheartj/eht278] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To describe trends in incidence and case fatality among younger (18-54 years) and older (55-84 years) Swedish patients with heart failure (HF). METHODS AND RESULTS Through linking the Swedish national hospital discharge and the cause-specific death registries, we identified patients aged 18-84 years that were discharged 1987-2006 with a diagnosis of HF. Age-specific mean incidence rates per 100 000 person-years were calculated in four 5-year periods. Kaplan-Meier survival curves were plotted up to 3 years. From 1987 to 2006, there were 443 995 HF hospitalizations among adults 18-84 years. Of these, 4660 (1.0%) and 13 507 (3.0%) occurred in people aged 18-44 and 45-54 years (31.6% women), respectively. From the first to the last 5-year period, HF incidence increased by 50 and 43%, among people aged 18-34 and 35-44 years, respectively. Among people ≥45 years, incidence peaked in the mid-1990s and then decreased. Heart failure in the presence of cardiomyopathy increased more than two-fold among all age groups. Case fatality decreased for all age groups until 2001, after which no further significant decrease <55 years was observed. CONCLUSION Increasing HF hospitalization in young adults in Sweden opposes the general trend seen in older patients, a finding which may reflect true epidemiological changes. Cardiomyopathy accounted for a substantial part of this increase. High case fatality and lack of further case fatality reduction after 2001 are causes for concern.
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Affiliation(s)
- Anders Barasa
- Corresponding author. Anders Barasa, Tel: +46 313434000, Fax: +46 31191416,
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Brettell R, Soljak M, Cecil E, Cowie MR, Tuppin P, Majeed A. Reducing heart failure admission rates in England 2004-2011 are not related to changes in primary care quality: national observational study. Eur J Heart Fail 2013; 15:1335-42. [PMID: 23845798 PMCID: PMC3834843 DOI: 10.1093/eurjhf/hft107] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Heart failure (HF) is an important clinical problem. Expert consensus has defined HF as a primary care-sensitive condition for which the risk of unplanned admissions may be reduced by high quality primary care, but there is little supporting evidence. We analysed time trends in HF admission rates in England and risk and protective factors for admission. METHODS AND RESULTS We used Hospital Episodes Statistics to produce indirectly standardized HF admission counts by general practice for 2004-2011. Clustered negative binomial regression analysis produced admission risk ratios and assessed the significance of potential explanatory covariates. These included population factors (deprivation; HF, coronary heart disease, and smoking prevalence), primary care resourcing [access; general practitioner (GP) supply], and primary care quality ('Quality and Outcomes Framework' indicator.) There were 327,756 HF admissions of patients registered with 8405 practices over the study period. There was a significant reduction in admissions over time, from 6.96/100,000 in 2004 to 5.60/100,000 in 2010 (P < 0.001). Deprivation and HF prevalence were risk factors for admission. GP supply and access protected against admission. However, these effects were small and did not explain the large and highly significant annual trend in falling admission rates. CONCLUSIONS The observed fall in admissions over time cannot be explained by the primary care covariates we included. This analysis suggests that the potential for further significant reduction in emergency HF admissions by improving clinical quality of primary care (as currently measured) may be limited. Further work is required to identify the reasons for the reduction in admissions.
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Affiliation(s)
- Rachel Brettell
- Department of Primary Care Health Sciences, University of Oxford, UK
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34
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Trends and predictors of hospitalization, readmissions and length of stay in ambulatory patients with heart failure. Rev Clin Esp 2013; 213:1-7. [DOI: 10.1016/j.rce.2012.10.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 09/25/2012] [Accepted: 10/10/2012] [Indexed: 11/18/2022]
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Frigola-Capell E, Comin-Colet J, Davins-Miralles J, Gich-Saladich I, Wensing M, Verdú-Rotellar J. Trends and predictors of hospitalization, readmissions and length of stay in ambulatory patients with heart failure. Rev Clin Esp 2013. [DOI: 10.1016/j.rceng.2012.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Daamen MA, Hamers JPH, Gorgels APM, Brunner-la Rocca HP, Tan FES, van Dieijen-Visser MP, Schols JMGA. The prevalence and management of heart failure in Dutch nursing homes; design of a multi-centre cross-sectional study. BMC Geriatr 2012; 12:29. [PMID: 22686685 PMCID: PMC3462700 DOI: 10.1186/1471-2318-12-29] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 05/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heart failure is likely to be particularly prevalent in the nursing home population, but reliable data about the prevalence of heart failure in nursing homes are lacking. Therefore the aims of this study are to investigate (a) the prevalence and management of heart failure in nursing home residents and (b) the relation between heart failure and care dependency as well as heart failure and quality of life in nursing home residents. METHODS/DESIGN Nursing home residents in the southern part of the Netherlands, aged over 65 years and receiving long-term somatic or psychogeriatric care will be included in the study. A panel of two cardiologists and a geriatrician will diagnose heart failure based on data collected from actual clinical examinations (including history, physical examination, ECG, cardiac markers and echocardiography), patient records and questionnaires. Care dependency will be measured using the Care Dependency Scale. To measure the quality of life of the participating residents, the Qualidem will be used for psychogeriatric residents and the SF-12 and VAS for somatic residents. CONCLUSION The study will provide an insight into the actual prevalence and management of heart failure in nursing home residents as well as their quality of life and care dependency. TRIAL REGISTRATION Dutch trial register NTR2663.
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Affiliation(s)
- Mariëlle Amj Daamen
- Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
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Boyne JJJ, Vrijhoef HJM, Crijns HJGM, De Weerd G, Kragten J, Gorgels APM. Tailored telemonitoring in patients with heart failure: results of a multicentre randomized controlled trial. Eur J Heart Fail 2012; 14:791-801. [PMID: 22588319 DOI: 10.1093/eurjhf/hfs058] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Recent increases in heart failure tend to overload the healthcare system. Consequently, there is a need for innovative strategies to reduce heart failure hospitalizations. METHODS AND RESULTS A multicentre randomized controlled trial was carried out to test the hypothesis that telemonitoring reduces heart failure hospitalizations during 1 year follow-up. The mean age of the 382 participating patients was 71.5 (32-93) years; the mean left ventricular ejection fraction was 0.38, and in 61% it was ≤0.45%. Mean time to first heart failure-related hospitalization was 161 days for the intervention group and 139 days for the usual-care group; hospitalizations occurred in 18 (9.1%) compared with 25 (13.5%) patients, with a total number of 24 and 43 hospitalizations, respectively [Kaplan-Meier P = 0.151, hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.35-1.17]. Subgroup analysis of the primary endpoint showed benefits for three subgroups: duration of heart failure, having a pacemaker, and co-habiting. The combined endpoint of heart failure admission and all-cause mortality was similar for both groups (Kaplan-Meier P = 0.641, HR 0.89, 95% CI 0.69-1.83). No differences were found regarding secondary endpoints, except for the reduced number of face to face contacts with the heart failure nurse (Mann-Whitney P < 0.001). Mortality was 18 (9.1%) in the intervention group and 12 (6.5%) in the usual-care group (Mann-Whitney P = 0.34, Cox regression analysis P = 0.82). CONCLUSION No significant differences were found regarding the primary endpoint, possibly caused by a relative underpowering of the population combined with well-treated study groups. However, telemonitoring tends to reduce heart failure (re)admissions and significantly decreases contacts with specialized nurses. Further research with pre-specified groups, as found in the subgroup analysis, is needed. TRIAL REGISTRATION NCT00502255.
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Affiliation(s)
- Josiane J J Boyne
- Department of Patient & Care, Maastricht University Medical Centre, & CAPHRI, The Netherlands.
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Al Suwaidi J, Asaad N, Al-Qahtani A, El-Menyar A, Al-Mulla AW, Singh R, AlBinali HA. Effect of Age on Outcome on Patients Hospitalized With Heart Failure: From a 20-Year Registry in a Middle-Eastern Country (1991-2010). ACTA ACUST UNITED AC 2012; 18:320-6. [DOI: 10.1111/j.1751-7133.2012.00290.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rodríguez-Gázquez MDLÁ, Arredondo-Holguín E. Validity and Reliability of a Scale for Rating Self-care in Persons with Heart Failure. AQUICHAN 2012. [DOI: 10.5294/aqui.2012.12.1.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: determinar la validez y confiabilidad, en el contexto colombiano, de la Escala de valoración de comportamientos de autocuidadoen personas con falla cardiaca (FC) diseñada por Nancy Artinian. Método: estudio de validación de la escala Revised HeartFailure Self Care Behavior. Se realizó validación cultural (n = 13 enfermeros expertos en cuidado cardiovascular y 12 pacientes con FC),validación factorial y análisis de la confiabilidad (n = 206 pacientes con FC). Resultados: la validación cultural de la escala fue adecuada. La validación factorial mostró que la versión en español tenía cuatro dominios (solicitud de ayuda, adaptación a vivir con la enfermedad,adherencia al tratamiento farmacológico y adherencia al tratamiento no farmacológico) que explicaron el 34,2% de la varianza del constructolatente en la escala. Se eliminaron siete ítems por explicar menos del 0,2% de la varianza, quedando la escala final reducida a 21ítems. El coeficiente de confiabilidad alfa de Cronbach para la escala total fue aceptable (0,75). Conclusión: la nueva versión de la escalatiene adecuadas propiedades psicométricas en términos de confiabilidad y validez, lo que permitirá su utilización por enfermeros en ladetección de cambios de comportamientos de autocuidado clínicamente importantes en los pacientes con FC.
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Suwaidi JA, Asaad N, Al-Qahtani A, Al-Mulla AW, Singh R, Albinali HA. Prevalence and outcome of Middle-eastern Arab and South Asian patients hospitalized with heart failure: insight from a 20-year registry in a Middle-eastern country (1991–2010). ACTA ACUST UNITED AC 2012; 14:81-9. [DOI: 10.3109/17482941.2012.655298] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Atherton JJ. Chronic heart failure: we are fighting the battle, but are we winning the war? SCIENTIFICA 2012; 2012:279731. [PMID: 24278681 PMCID: PMC3820562 DOI: 10.6064/2012/279731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 10/31/2012] [Indexed: 05/04/2023]
Abstract
Heart failure represents an end-stage phenotype of a number of cardiovascular diseases and is generally associated with a poor prognosis. A number of organized battles fought over the last two to three decades have resulted in considerable advances in treatment including the use of drugs that interfere with neurohormonal activation and device-based therapies such as implantable cardioverter defibrillators and cardiac resynchronization therapy. Despite this, the prevalence of heart failure continues to rise related to both the aging population and better survival in patients with cardiovascular disease. Registries have identified treatment gaps and variation in the application of evidenced-based practice, including the use of echocardiography and prescribing of disease-modifying drugs. Quality initiatives often coupled with multidisciplinary, heart failure disease management promote self-care and minimize variation in the application of evidenced-based practice leading to better long-term clinical outcomes. However, to address the rising prevalence of heart failure and win the war, we must also turn our attention to disease prevention. A combined approach is required that includes public health measures applied at a population level and screening strategies to identify individuals at high risk of developing heart failure in the future.
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Affiliation(s)
- John J. Atherton
- Cardiology Department, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4006, Australia
- School of Medicine, University of Queensland, Brisbane, QLD 4006, Australia
- *John J. Atherton:
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Edner M, Ring M, Henriksson P. Pre-implant right ventricular function might be an important predictor of the response to cardiac resynchronization therapy. Cardiovasc Ultrasound 2011; 9:28. [PMID: 22029550 PMCID: PMC3215970 DOI: 10.1186/1476-7120-9-28] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 10/26/2011] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Cardiac resynchronization therapy is proven efficacious in patients with heart failure (HF). Presence of biventricular HF is associated with a worse prognosis than having only left ventricular (LV) HF and pacing might deteriorate heart function. The aim of the study was to assess a possible significance of right ventricular (RV) pre-implant systolic function to predict response to CRT. DESIGN We studied 22 HF-patients aged 72 ± 11 years, QRS-duration 155 ± 20 ms and with an LV ejection fraction (EF) of 26 ± 6% before and four weeks after receiving a CRT-device. RESULTS There were no changes in LV diameters or end systolic volume (ESV) during the study. However, end diastolic volume (EDV) decreased from 226 ± 71 to 211 ± 64 ml (p = 0.02) and systolic maximal velocities (SMV) increased from 2.2 ± 0.4 to 2.6 ± 0.9 cm/s (p = 0.04). Pre-implant RV-SMV (6.2 ± 2.6 cm/s) predicted postoperative increase in LV contractility, p = 0.032. CONCLUSIONS Pre-implant decreased RV systolic function might be an important way to predict a poor response to CRT implicating that other treatments should be considered. Furthermore we found that 3D- echocardiography and Tissue Doppler Imaging were feasible to detect short-term changes in LV function.
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Affiliation(s)
- Magnus Edner
- Karolinska Institutet, Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Margareta Ring
- Karolinska Institutet, Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Peter Henriksson
- Karolinska Institutet, Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
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Biagi P, Gussoni G, Iori I, Nardi R, Mathieu G, Mazzone A, Panuccio D, Scanelli G, Cicatello C, Rinollo C, Muriago M, Galasso D, Bonizzoni E, Vescovo G. Clinical profile and predictors of in-hospital outcome in patients with heart failure: The FADOI “CONFINE” Study. Int J Cardiol 2011; 152:88-94. [DOI: 10.1016/j.ijcard.2011.02.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 01/05/2011] [Accepted: 02/07/2011] [Indexed: 01/18/2023]
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Ekman I, Wolf A, Olsson LE, Taft C, Dudas K, Schaufelberger M, Swedberg K. Effects of person-centred care in patients with chronic heart failure: the PCC-HF study. Eur Heart J 2011; 33:1112-9. [PMID: 21926072 PMCID: PMC3751966 DOI: 10.1093/eurheartj/ehr306] [Citation(s) in RCA: 226] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aims Person-centred care (PCC) emphasizes a partnership in care between patients and healthcare professionals and is advocated by WHO as a key component of quality health care. We evaluated outcomes of PCC in hospitalized patients with chronic heart failure (CHF) with respect to the length of hospital stay (LOS), activities of daily living (ADL), health-related quality of life (HRQL) and 6-month readmission rate. Methods and results During 2008–2010, 248 consecutive patients hospitalized for symptoms of worsening CHF were enrolled in a controlled before and after designed study. A Usual care group (n= 123) was recruited according to pre-defined criteria to map usual CHF care and assess outcomes at five designated hospital wards. Based on the mapping, a panel of in-house clinicians and researchers developed measures aimed at aligning usual care with basic PCC principles. These measures were incorporated into a study protocol to guide care procedures at the same five wards. Person-centred care was then implemented at these wards and evaluated in 125 patients. Both length of hospital stay and 6-month readmission were extracted from patient records. Activities of daily living were evaluated at baseline and discharge and HRQL was evaluated at baseline and after 3 months. In the analysis of all patients, the LOS was reduced by 1 day (P= 0.16) while retaining ADL (P= 0.07). When PCC was fully implemented (per protocol analysis), LOS was reduced by 2.5 days (P= 0.01) and the ADL-level better preserved (P= 0.04). Health-related quality of life and time-to-first readmission did not differ. Conclusion In this proof-of-concept study, our findings suggest that a fully implemented PCC approach shortens hospital stay and maintains functional performance in patients hospitalized for worsening CHF, without increasing risk for readmission or jeopardizing patients' HRQL.
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Affiliation(s)
- Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, Gothenburg 40530, Sweden
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Natriuretic peptide testing in EDs for managing acute dyspnea: a meta-analysis. Am J Emerg Med 2011; 29:757-67. [DOI: 10.1016/j.ajem.2010.02.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 02/25/2010] [Accepted: 02/25/2010] [Indexed: 02/03/2023] Open
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Giubbini R, Milan E, Bertagna F, Mut F, Metra M, Rodella C, Dondi M. Nuclear cardiology and heart failure. Eur J Nucl Med Mol Imaging 2011; 36:2068-80. [PMID: 19672592 DOI: 10.1007/s00259-009-1246-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 07/26/2009] [Indexed: 01/07/2023]
Abstract
The prevalence of heart failure in the adult population is increasing. It varies between 1% and 2%, although it mainly affects elderly people (6-10% of people over the age of 65 years will develop heart failure). The syndrome of heart failure arises as a consequence of an abnormality in cardiac structure, function, rhythm, or conduction. Coronary artery disease is the leading cause of heart failure and it accounts for this disorder in 60-70% of all patients affected. Nuclear techniques provide unique information on left ventricular function and perfusion by gated-single photon emission tomography (SPECT). Myocardial viability can be assessed by both SPECT and PET imaging. Finally, autonomic dysfunction has been shown to increase the risk of death in patients with heart disease and this may be applicable to all patients with cardiac disease regardless of aetiology. MIBG scanning has a very promising prognostic value in patients with heart failure.
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Affiliation(s)
- Raffaele Giubbini
- Department of Nuclear Medicine, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
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Brachmann J, Böhm M, Rybak K, Klein G, Butter C, Klemm H, Schomburg R, Siebermair J, Israel C, Sinha AM, Drexler H. Fluid status monitoring with a wireless network to reduce cardiovascular-related hospitalizations and mortality in heart failure: rationale and design of the OptiLink HF Study (Optimization of Heart Failure Management using OptiVol Fluid Status Monitoring and CareLink). Eur J Heart Fail 2011; 13:796-804. [PMID: 21555324 PMCID: PMC3125124 DOI: 10.1093/eurjhf/hfr045] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Aims The Optimization of Heart Failure Management using OptiVol Fluid Status Monitoring and CareLink (OptiLink HF) study is designed to investigate whether OptiVol fluid status monitoring with an automatically generated wireless CareAlert notification via the CareLink Network can reduce all-cause death and cardiovascular hospitalizations in an HF population, compared with standard clinical assessment. Methods Patients with newly implanted or replacement cardioverter-defibrillator devices with or without cardiac resynchronization therapy, who have chronic HF in New York Heart Association class II or III and a left ventricular ejection fraction ≤35% will be eligible to participate. Following device implantation, patients are randomized to either OptiVol fluid status monitoring through CareAlert notification or regular care (OptiLink ‘on' vs. ‘off'). The primary endpoint is a composite of all-cause death or cardiovascular hospitalization. It is estimated that 1000 patients will be required to demonstrate superiority of the intervention group to reduce the primary outcome by 30% with 80% power. Conclusion The OptiLink HF study is designed to investigate whether early detection of congestion reduces mortality and cardiovascular hospitalization in patients with chronic HF. The study is expected to close recruitment in September 2012 and to report first results in May 2014. ClinicalTrials.gov Identifier: NCT00769457
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Affiliation(s)
- Johannes Brachmann
- Department of Cardiology, Angiology and Pneumology, Klinikum Coburg GmbH, II, Medizinische Klinik, Coburg, Germany.
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Abstract
Heart failure (HF) is a major public health issue, with a prevalence of over 5.8 million in the USA, and over 23 million worldwide, and rising. The lifetime risk of developing HF is one in five. Although promising evidence shows that the age-adjusted incidence of HF may have plateaued, HF still carries substantial morbidity and mortality, with 5-year mortality that rival those of many cancers. HF represents a considerable burden to the health-care system, responsible for costs of more than $39 billion annually in the USA alone, and high rates of hospitalizations, readmissions, and outpatient visits. HF is not a single entity, but a clinical syndrome that may have different characteristics depending on age, sex, race or ethnicity, left ventricular ejection fraction (LVEF) status, and HF etiology. Furthermore, pathophysiological differences are observed among patients diagnosed with HF and reduced LVEF compared with HF and preserved LVEF, which are beginning to be better appreciated in epidemiological studies. A number of risk factors, such as ischemic heart disease, hypertension, smoking, obesity, and diabetes, among others, have been identified that both predict the incidence of HF as well as its severity. In this Review, we discuss key features of the epidemiology and risk profile of HF.
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Stewart S, Ekman I, Ekman T, Odén A, Rosengren A. Population Impact of Heart Failure and the Most Common Forms of Cancer. Circ Cardiovasc Qual Outcomes 2010; 3:573-80. [DOI: 10.1161/circoutcomes.110.957571] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The contemporary impact of heart failure (HF) versus the most common forms of cancer as reflected by related first-ever hospitalizations and subsequent case-fatality rates is unknown.
Methods and Results—
Using a national registry in Sweden, we compared the rate of first-ever hospitalization and associated short- and long-term survival for HF, acute myocardial infarction (AMI), and the most common forms of cancer on an age and sex-specific basis during 1988 to 2004 in 949 733 Swedish patients (1 162 309 hospital admissions in total). Annual incidence of first-ever hospitalization for HF, AMI, and cancer in Sweden were 484, 424, and 373 (lung, colorectal, prostate, and bladder cancer combined) per 100 000 men and 470, 280, and 350 (lung, colorectal, bladder, breast, and ovarian cancer combined) per 100 000 women age >20 years. The ratio of individual cases of HF to cancer was 1.37:1 (465 998 versus 340 738). Despite improvements in 30-day and 5-year survival (adjusted 7% and 6% increase per calendar year for men and women, respectively), HF was associated with unadjusted case-fatality rate of 59% within 5 years and 196 400 deaths versus 58% and 131 000 deaths in patients with cancer. During 10-year follow-up, HF was associated with 66 318 versus 55 364 premature life-years lost than all common forms of cancer in men. In women, the equivalent figures were 59 535 versus 64 533 premature life-years lost.
Conclusions—
These data confirm that, like most common forms of cancer combined, HF exerts a major health burden in respect to age-adjusted rates of first hospitalization, poor overall survival, and premature life-years lost.
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Affiliation(s)
- Simon Stewart
- From the Preventative Health, Baker IDI Heart and Diabetes Institute (S.S.), Melbourne, Australia; the Institute for Health and Care Sciences (I.E.), the Sahlgrenska Academy at Goteborg, Sweden; the Department of Oncology (T.E.), Sahlgrenska University Hospital, Goteborg, Sweden; the Department of Mathematical Sciences (A.O.), Chalmers University of Technology, Goteborg, Sweden; and the Department of Acute and Cardiovascular Medicine (A.R.), Sahlgrenska University Hospital/Ostra, Goteborg, Sweden
| | - Inger Ekman
- From the Preventative Health, Baker IDI Heart and Diabetes Institute (S.S.), Melbourne, Australia; the Institute for Health and Care Sciences (I.E.), the Sahlgrenska Academy at Goteborg, Sweden; the Department of Oncology (T.E.), Sahlgrenska University Hospital, Goteborg, Sweden; the Department of Mathematical Sciences (A.O.), Chalmers University of Technology, Goteborg, Sweden; and the Department of Acute and Cardiovascular Medicine (A.R.), Sahlgrenska University Hospital/Ostra, Goteborg, Sweden
| | - Tor Ekman
- From the Preventative Health, Baker IDI Heart and Diabetes Institute (S.S.), Melbourne, Australia; the Institute for Health and Care Sciences (I.E.), the Sahlgrenska Academy at Goteborg, Sweden; the Department of Oncology (T.E.), Sahlgrenska University Hospital, Goteborg, Sweden; the Department of Mathematical Sciences (A.O.), Chalmers University of Technology, Goteborg, Sweden; and the Department of Acute and Cardiovascular Medicine (A.R.), Sahlgrenska University Hospital/Ostra, Goteborg, Sweden
| | - Anders Odén
- From the Preventative Health, Baker IDI Heart and Diabetes Institute (S.S.), Melbourne, Australia; the Institute for Health and Care Sciences (I.E.), the Sahlgrenska Academy at Goteborg, Sweden; the Department of Oncology (T.E.), Sahlgrenska University Hospital, Goteborg, Sweden; the Department of Mathematical Sciences (A.O.), Chalmers University of Technology, Goteborg, Sweden; and the Department of Acute and Cardiovascular Medicine (A.R.), Sahlgrenska University Hospital/Ostra, Goteborg, Sweden
| | - Annika Rosengren
- From the Preventative Health, Baker IDI Heart and Diabetes Institute (S.S.), Melbourne, Australia; the Institute for Health and Care Sciences (I.E.), the Sahlgrenska Academy at Goteborg, Sweden; the Department of Oncology (T.E.), Sahlgrenska University Hospital, Goteborg, Sweden; the Department of Mathematical Sciences (A.O.), Chalmers University of Technology, Goteborg, Sweden; and the Department of Acute and Cardiovascular Medicine (A.R.), Sahlgrenska University Hospital/Ostra, Goteborg, Sweden
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Butler J, Chirovsky D, Phatak H, McNeill A, Cody R. Renal Function, Health Outcomes, and Resource Utilization in Acute Heart Failure. Circ Heart Fail 2010; 3:726-45. [DOI: 10.1161/circheartfailure.109.920298] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Javed Butler
- From the Cardiology Division (J.B.), Emory University, Atlanta, Ga; the Department of Health Policy and Management (D.C.), University of North Carolina at Chapel Hill, Chapel Hill, NC; Global Outcomes Research and Reimbursement (H.P.), Merck & Co, Inc, Whitehouse Station, NJ; the Epidemiology Department, Merck & Co, Inc (A.M.), Upper Gwynedd, Pa; and Global Scientific Affairs (R.C.), Merck & Co, Inc, Whitehouse Station, NJ
| | - Diana Chirovsky
- From the Cardiology Division (J.B.), Emory University, Atlanta, Ga; the Department of Health Policy and Management (D.C.), University of North Carolina at Chapel Hill, Chapel Hill, NC; Global Outcomes Research and Reimbursement (H.P.), Merck & Co, Inc, Whitehouse Station, NJ; the Epidemiology Department, Merck & Co, Inc (A.M.), Upper Gwynedd, Pa; and Global Scientific Affairs (R.C.), Merck & Co, Inc, Whitehouse Station, NJ
| | - Hemant Phatak
- From the Cardiology Division (J.B.), Emory University, Atlanta, Ga; the Department of Health Policy and Management (D.C.), University of North Carolina at Chapel Hill, Chapel Hill, NC; Global Outcomes Research and Reimbursement (H.P.), Merck & Co, Inc, Whitehouse Station, NJ; the Epidemiology Department, Merck & Co, Inc (A.M.), Upper Gwynedd, Pa; and Global Scientific Affairs (R.C.), Merck & Co, Inc, Whitehouse Station, NJ
| | - Anne McNeill
- From the Cardiology Division (J.B.), Emory University, Atlanta, Ga; the Department of Health Policy and Management (D.C.), University of North Carolina at Chapel Hill, Chapel Hill, NC; Global Outcomes Research and Reimbursement (H.P.), Merck & Co, Inc, Whitehouse Station, NJ; the Epidemiology Department, Merck & Co, Inc (A.M.), Upper Gwynedd, Pa; and Global Scientific Affairs (R.C.), Merck & Co, Inc, Whitehouse Station, NJ
| | - Robert Cody
- From the Cardiology Division (J.B.), Emory University, Atlanta, Ga; the Department of Health Policy and Management (D.C.), University of North Carolina at Chapel Hill, Chapel Hill, NC; Global Outcomes Research and Reimbursement (H.P.), Merck & Co, Inc, Whitehouse Station, NJ; the Epidemiology Department, Merck & Co, Inc (A.M.), Upper Gwynedd, Pa; and Global Scientific Affairs (R.C.), Merck & Co, Inc, Whitehouse Station, NJ
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