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Cordwin DJ, Guidi J, Alhashimi L, Hummel SL, Koelling TM, Dorsch MP. Differences in provider approach to initiating and titrating guideline directed medical therapy in heart failure with reduced ejection fraction. BMC Cardiovasc Disord 2024; 24:247. [PMID: 38730379 PMCID: PMC11087241 DOI: 10.1186/s12872-024-03911-1] [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: 08/21/2023] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Despite the strong evidence supporting guideline-directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF), prescription rates in clinical practice are still lacking. METHODS A survey containing 20 clinical vignettes of patients with HFrEF was answered by a national sample of 127 cardiologists and 68 internal/family medicine physicians. Each vignette had 4-5 options for adjusting GDMT and the option to make no medication changes. Survey respondents could only select one option. For analysis, responses were dichotomized to the answer of interest. RESULTS Cardiologists were more likely to make GDMT changes than general medicine physicians (91.8% vs. 82.0%; OR 1.84 [1.07-3.19]; p = 0.020). Cardiologists were more likely to initiate beta-blockers (46.3% vs. 32.0%; OR 2.38 [1.18-4.81], p = 0.016), angiotensin receptor blocker/neprilysin inhibitor (ARNI) (63.8% vs. 48.1%; OR 1.76 [1.01-3.09], p = 0.047), and hydralazine and isosorbide dinitrate (HYD/ISDN) (38.2% vs. 23.7%; OR 2.47 [1.48-4.12], p < 0.001) compared to general medicine physicians. No differences were found in initiating angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARBs), initiating mineralocorticoid receptor antagonist (MRA), sodium-glucose transporter protein 2 (SGLT2) inhibitors, digoxin, or ivabradine. CONCLUSIONS Our results demonstrate cardiologists were more likely to adjust GDMT than general medicine physicians. Future focus on improving GDMT prescribing should target providers other than cardiologists to improve care in patients with HFrEF.
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Affiliation(s)
- David J Cordwin
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Jessica Guidi
- Medical School, University of Michigan, Ann Arbor, MI, USA
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Lana Alhashimi
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Scott L Hummel
- Medical School, University of Michigan, Ann Arbor, MI, USA
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Health System, Ann Arbor, MI, USA
| | - Todd M Koelling
- Medical School, University of Michigan, Ann Arbor, MI, USA
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Michael P Dorsch
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA.
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA.
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Marzinski S, Melrose D, Moynihan T, Hlebichuk J, Liao Y, Hook M. Knowing the Patient: Understanding Readmission Reasons in Complex Heart Failure. J Cardiovasc Nurs 2023:00005082-990000000-00154. [PMID: 38015045 DOI: 10.1097/jcn.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND Heart failure (HF) is a complex problem characterized by frequent hospitalizations and high 30-day readmission rates. Researchers studying HF readmission report that patients and clinicians have different perspectives on readmission and preventability when unadjusted for disease severity. OBJECTIVE The aim of this study was to gather patient, caregiver, nurse, and physician subjective reason(s) for 30-day HF readmission and perceptions of preventability with contextual factors to evaluate differences. METHODS A convergent, parallel, mixed-methods design was used with interviews and chart reviews to evaluate contextual factors from the current and index hospital stay. Adults readmitted within 30 days of a previous inpatient stay with a coded HF diagnosis were enrolled and interviewed, followed by interviews with associated caregivers, attending physicians, and assigned nurses. RESULTS Interviews were conducted with patients (n = 44), caregivers (n = 6), physicians (n = 24), and nurses (n = 44). Readmissions were emergent/urgent (95%) and occurred within 14.9 days (SD, 8.1; 2-28 days) on average after discharge. Index stay coding revealed that most patients (73%) had a high severity of illness (73%) and risk of mortality (68%). Heart failure stage was inconsistently documented. Patients reported acute symptomatic reasons, with only 32% describing readmission as preventable. Physicians reported diagnostic reasons, 38% of which were preventable. Nurses reported behavioral reasons, with 59% being preventable. Patient/clinician agreement on readmission reason was low (30%). CONCLUSIONS Patient/clinician perspectives on readmission varied among the patients with complex HF. Care planning based on HF stage and other contextual factors is needed to ensure a shared understanding of disease severity and a tailored symptom management approach to prevent readmission.
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Liu S, Xiong XY, Chen H, Liu MD, Wang Y, Yang Y, Zhang MJ, Xiang Q. Transitional Care in Patients with Heart Failure: A Concept Analysis Using Rogers' Evolutionary Approach. Risk Manag Healthc Policy 2023; 16:2063-2076. [PMID: 37822727 PMCID: PMC10563773 DOI: 10.2147/rmhp.s427495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023] Open
Abstract
Objective The purpose of this study was to clarify the concept of transitional care in patients with heart failure. Background Transitional care is increasingly being applied in patients with heart failure, but the concept of transitional care in heart failure patients is not uniform and confused with other definitions, which limits further research and practice on transitional care for these patients. Design Rodgers' evolutionary concept analysis. Methods A comprehensive literature search was conducted using the PUBMED, EMBASE, EBSCO, Chinese Biological Medicine (CBM), CNKI, and WANFANG databases (up to January 26, 2023). We used Rodgers' evolutionary concept analysis method to identify related concepts, attributes, antecedents, and consequences of transitional care in patients with heart failure. Results A total of 33 articles were included. The following attributes belonging to transitional care in patients with heart failure were extracted from the literature: self-care, multidisciplinary collaboration, and information transmission. The antecedents were patients' health status, the health literacy of patients and caregivers, the role functions of the main implementer and social and medical resources. Consequences were separated into two categories: patient-centered health outcomes (all-cause mortality, health-related quality of life, discharge preparedness, self-care behaviors, satisfaction of patients) and healthcare utilization outcomes (hospital readmission, length of hospital stay, emergency department visits). Conclusion This study found that transitional care in heart failure patients is a systemic care process during a vulnerable period that improves patient self-management and coordination between hospital resources and social support systems for continuous management to promote smooth patient transitions between different locations. This concept analysis will inform healthcare providers in designing evidence-based interventions and quality improvement strategies to ensure that transition processes lead to desired outcomes. In addition, this study will also be helpful for developing specific assessment tools to identify patients with HF who need transitional care.
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Affiliation(s)
- Si Liu
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
- Nursing Department, the Second Affiliated Hospital of Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Xiao-yun Xiong
- Nursing Department, the Second Affiliated Hospital of Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Hua Chen
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Meng-die Liu
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Ying Wang
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Ying Yang
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Mei-jun Zhang
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Qin Xiang
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
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Sharma V, Joon T, Kulkarni V, Samanani S, Simpson SH, Voaklander D, Eurich D. Predicting 30-day risk from benzodiazepine/Z-drug dispensations in older adults using administrative data: A prognostic machine learning approach. Int J Med Inform 2023; 178:105177. [PMID: 37591010 DOI: 10.1016/j.ijmedinf.2023.105177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/11/2023] [Accepted: 08/06/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To develop a machine-learning (ML) model using administrative data to estimate risk of adverse outcomes within 30-days of a benzodiazepine (BZRA) dispensation in older adults for use by health departments/regulators. DESIGN, SETTING AND PARTICIPANTS This study was conducted in Alberta, Canada during 2018-2019 in Albertans 65 years of age and older. Those with any history of malignancy or palliative care were excluded. EXPOSURE Each BZRA dispensation from a community pharmacy served as the unit of analysis. MAIN OUTCOMES AND MEASURES ML algorithms were developed on 2018 administrative data to predict risk of any-cause hospitalization, emergency department visit or death within 30-days of a BZRA dispensation. Validation on 2019 administrative data was done using XGBoost to evaluate discrimination, calibration and other relevant metrics on ranked predictions. Daily and quarterly predictions were simulated on 2019 data. RESULTS 65,063 study participants were included which represented 633,333 BZRA dispensation during 2018-2019. The validation set had 314,615 dispensations linked to 55,928 all-cause outcomes representing a pre-test probability of 17.8%. C-statistic for the XGBoost model was 0.75. Measuring risk at the end of 2019, the top 0.1 percentile of predicted risk had a LR + of 40.31 translating to a post-test probability of 90%. Daily and quarterly classification simulations resulted in uninformative predictions with positive likelihood ratios less than 10 in all risk prediction categories. Previous history of admissions was ranked highest in variable importance. CONCLUSION Developing ML models using only administrative health data may not provide health regulators with sufficient informative predictions to use as decision aids for potential interventions, especially if considering daily or quarterly classifications of BZRA risks in older adults. ML models may be informative for this context if yearly classifications are preferred. Health regulators should have access to other types of data to improve ML prediction.
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Affiliation(s)
- Vishal Sharma
- 2-040 Li Ka Shing Center for Health Research Innovation, School of Public Health, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - Tanya Joon
- OKAKI Health Intelligence, Edmonton, Alberta, Canada
| | | | | | - Scot H Simpson
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - Don Voaklander
- School of Public Health, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - Dean Eurich
- 2-040 Li Ka Shing Center for Health Research Innovation, School of Public Health, University of Alberta, Edmonton, Alberta T6G 2E1, Canada.
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Brüning J, Yevtushenko P, Schlief A, Jochum T, van Gijzen L, Meine S, Romberg J, Kuehne T, Arndt A, Goubergrits L. In-silico enhanced animal study of pulmonary artery pressure sensors: assessing hemodynamics using computational fluid dynamics. Front Cardiovasc Med 2023; 10:1193209. [PMID: 37745132 PMCID: PMC10517052 DOI: 10.3389/fcvm.2023.1193209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/17/2023] [Indexed: 09/26/2023] Open
Abstract
To assess whether in-silico models can be used to predict the risk of thrombus formation in pulmonary artery pressure sensors (PAPS), a chronic animal study using pigs was conducted. Computed tomography (CT) data was acquired before and immediately after implantation, as well as one and three months after the implantation. Devices were implanted into 10 pigs, each one in the left and right pulmonary artery (PA), to reduce the required number of animal experiments. The implantation procedure aimed at facilitating optimal and non-optimal positioning of the devices to increase chances of thrombus formation. Eight devices were positioned non-optimally. Three devices were positioned in the main PA instead of the left and right PA. Pre-interventional PA geometries were reconstructed from the respective CT images, and the devices were virtually implanted at the exact sites and orientations indicated by the follow-up CT after one month. Transient intra-arterial hemodynamics were calculated using computational fluid dynamics. Volume flow rates were modelled specifically matching the animals body weights. Wall shear stresses (WSS) and oscillatory shear indices (OSI) before and after device implantation were compared. Simulations revealed no relevant changes in any investigated hemodynamic parameters due to device implantation. Even in cases, where devices were implanted in a non-optimal manner, no marked differences in hemodynamic parameters compared to devices implanted in an optimal position were found. Before implantation time and surface-averaged WSS was 2.35 ± 0.47 Pa, whereas OSI was 0.08 ± 0.17 , respectively. Areas affected by low WSS magnitudes were 2.5 ± 2.7 cm2 , whereas the areas affected by high OSI were 18.1 ± 6.3 cm2 . After device implantation, WSS and OSI were 2.45 ± 0.49 Pa and 0.08 ± 0.16 , respectively. Surface areas affected by low WSS and high OSI were 2.9 ± 2.7 cm2 , and 18.4 ± 6.1 cm2 , respectively. This in-silico study indicates that no clinically relevant differences in intra-arterial hemodynamics are occurring after device implantation, even at non-optimal positioning of the sensor. Simultaneously, no embolic events were observed, suggesting that the risk for thrombus formation after device implantation is low and independent of the sensor position.
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Affiliation(s)
- Jan Brüning
- Institute of Computer-assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Pavlo Yevtushenko
- Institute of Computer-assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Adriano Schlief
- Institute of Computer-assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | - Titus Kuehne
- Institute of Computer-assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Leonid Goubergrits
- Institute of Computer-assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center Digital Future, Berlin, Germany
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Sharma V, Kulkarni V, Joon T, Eurich DT, Simpson SH, Voaklander D, Wright B, Samanani S. Predicting falls-related admissions in older adults in Alberta, Canada: a machine-learning falls prevention tool developed using population administrative health data. BMJ Open 2023; 13:e071321. [PMID: 37607796 PMCID: PMC10445355 DOI: 10.1136/bmjopen-2022-071321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/26/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE To construct a machine-learning (ML) model for health systems with organised falls prevention programmes to identify older adults at risk for fall-related admissions. DESIGN This prognostic study used population-level administrative health data to develop an ML prediction model. SETTING This study took place in Alberta, Canada during 2018-2019. PARTICIPANTS Albertans aged 65 and older with at least one prior admission. Those with palliative conditions or emigrated out of Alberta were excluded. EXPOSURE Unit of analysis was the individual person. MAIN OUTCOMES/MEASURES We identified fall-related admissions. A CatBoost model was developed on 2018 data to predict risk of fall-related emergency department visits or hospitalisations. Temporal validation was done using 2019 data to evaluate model performance. We reported discrimination, calibration and other relevant metrics measured at the end of 2019 on both ranked predictions and predicted probability thresholds. A cost-savings simulation was performed using 2019 data. RESULTS Final number of study participants was 224 445. The validation set had 203 584 participants with 19 389 fall-related events (9.5% pretest probability) and an ML model c-statistic of 0.70. The highest ranked predictions had post-test probabilities ranging from 40% to 50%. Net benefit analysis presented mixed results with some net benefit using the ML model in the 6%-30% range. The top 50 percentile of predicted risks represented nearly $C60 million in health system costs related to falls. Intervening on the top 25 or 50 percentiles of predicted risk could realise substantial (up to $C16 million) savings. CONCLUSION ML prediction models based on population-level administrative data can assist health systems with fall prevention programmes identify older adults at risk of fall-related admissions and reduce costs. ML predictions based on ranked predictions or probability thresholds could guide subsequent interventions to mitigate fall risks. Increased access to diverse forms of data could improve ML performance and further reduce costs.
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Affiliation(s)
- Vishal Sharma
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Scot H Simpson
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Don Voaklander
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Bruce Wright
- Island Medical Program, University of Victoria, Victoria, British Columbia, Canada
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Meraz R, Osteen K, McGee JS, Noblitt P, Viejo H. Applying Stress and Coping Theory to Understand Diuretic Adherence Experiences in Persons with Heart Failure. West J Nurs Res 2023; 45:67-77. [PMID: 35711104 DOI: 10.1177/01939459221106122] [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: 11/15/2022]
Abstract
Despite the benefits of diuretics for treating the symptoms of heart failure (HF), patients may report side effects and intentionally not adhere to diuretic regimens. Positive internal motivators, such as positive emotions, may benefit individuals in their adaptation to medication-related stress. However, there has been limited study of these potential motivators in those with HF. Using a descriptive qualitative approach, 82 adults taking diuretics for HF were interviewed. This study applied stress and coping theory to understand the diuretic-taking experiences of patients with HF. Data analysis revealed three themes: (a) diuretics are bothersome, (b) staying positive in the mid of hardship, and (c) adapting to endure. Findings suggest that adherent participants stayed positive amid the perceived hardship, maintaining resilient and grateful attitudes. Adherent participants adapted to bothersome diuretic effects and utilized creative strategies. More research is needed to understand the relationships between resilience, adaptive coping, and diuretic adherence.
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Affiliation(s)
- Rebecca Meraz
- Baylor University Louise Herrington School of Nursing, Dallas, TX, USA
| | - Kathryn Osteen
- Baylor University Louise Herrington School of Nursing, Dallas, TX, USA
| | | | - Paul Noblitt
- Baylor Scott & White Medical Center, Irving, TX, USA
| | - Henry Viejo
- Baylor Scott & White Heart and Vascular Hospital, Fort Worth, TX, USA
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Keeney T, Lee MK, Basford JR, Cheville A. Association of Function, Symptoms, and Social Support Reported in Standardized Outpatient Clinic Questionnaires With Subsequent Hospital Discharge Disposition and 30-Day Readmissions. Arch Phys Med Rehabil 2022; 103:2383-2390. [PMID: 35803330 DOI: 10.1016/j.apmr.2022.06.004] [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: 01/31/2022] [Revised: 05/23/2022] [Accepted: 06/02/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine whether patient-reported information, routinely collected in an outpatient setting, is associated with readmission within 30 days of discharge and/or the need for post-acute care after a subsequent hospital admission. DESIGN Retrospective cohort study. Six domains of patient-reported information collected in the outpatient setting (psychological distress, respiratory symptoms, musculoskeletal pain, family support, mobility, and activities of daily living [ADLs]) were linked to electronic health record hospitalization data. Mixed effects logistic regression models with random intercepts were used to identify the association between the 6 domains and outcomes. SETTING Outpatient clinics and hospitals in a Midwestern health system. PARTICIPANTS 7671 patients who were hospitalized 11,445 times between May 2004 and May 2014 (N=7671). INTERVENTION None. MAIN OUTCOME MEASURES 30-day hospital readmission and discharge home vs facility. RESULTS Domains were significantly associated with 30-day readmission and placement in a facility. Specifically, mobility (odds ratio [OR]=1.30; 95% confidence interval [CI], 1.16, 1.46), ADLs (OR=1.27; 95% CI, 1.13, 1.42), respiratory symptoms (OR=1.26; 95% CI, 1.12, 1.41), and psychological distress (OR=1.20; 95% CI, 1.07, 1.35) had the strongest associations with 30-day readmission. The ADL (OR=2.52; 95% CI, 2.26, 2.81), mobility (OR=2.35; 95% CI, 2.10, 2.63), family support (OR=2.28; 95% CI, 1.98, 2.62), and psychological distress (OR=1.38; 95% CI, 1.25, 1.52) domains had the strongest associations with discharge to an institution. CONCLUSIONS Patient-reported function, symptoms, and social support routinely collected in outpatient clinics are associated with future 30-day readmission and discharge to an institutional setting. Whether these data can be leveraged to guide interventions to address patient needs and improve outcomes requires further research.
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Affiliation(s)
- Tamra Keeney
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Center for Aging and Serious Illness, Mongan Institute, Massachusetts General Hospital, Boston, MA; Department of Health Services, Policy & Practice, Brown University, School of Public Health, Providence, RI.
| | - Minji K Lee
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Jeffrey R Basford
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Andrea Cheville
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
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Stubbs D, Bashford T, Gilder F, Nourallah B, Ercole A, Levy N, Clarkson J. Can process mapping and a multisite Delphi of perioperative professionals inform our understanding of system-wide factors that may impact operative risk? BMJ Open 2022; 12:e064105. [PMID: 36368764 PMCID: PMC9660566 DOI: 10.1136/bmjopen-2022-064105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To examine whether the use of process mapping and a multidisciplinary Delphi can identify potential contributors to perioperative risk. We hypothesised that this approach may identify factors not represented in common perioperative risk tools and give insights of use to future research in this area. DESIGN Multidisciplinary, modified Delphi study. SETTING Two centres (one tertiary, one secondary) in the UK during 2020 amidst coronavirus pressures. PARTICIPANTS 91 stakeholders from 23 professional groups involved in the perioperative care of older patients. Key stakeholder groups were identified via process mapping of local perioperative care pathways. RESULTS Response rate ranged from 51% in round 1 to 19% in round 3. After round 1, free text suggestions from the panel were combined with variables identified from perioperative risk scores. This yielded a total of 410 variables that were voted on in subsequent rounds. Including new suggestions from round two, 468/519 (90%) of the statements presented to the panel reached a consensus decision by the end of round 3. Identified risk factors included patient-level factors (such as ethnicity and socioeconomic status), and organisational or process factors related to the individual hospital (such as policies, staffing and organisational culture). 66/160 (41%) of the new suggestions did not feature in systematic reviews of perioperative risk scores or key process indicators. No factor categorised as 'organisational' is currently present in any perioperative risk score. CONCLUSIONS Through process mapping and a modified Delphi we gained insights into additional factors that may contribute to perioperative risk. Many were absent from currently used risk stratification scores. These results enable an appreciation of the contextual limitations of currently used risk tools and could support future research into the generation of more holistic data sets for the development of perioperative risk assessment tools.
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Affiliation(s)
- Daniel Stubbs
- Healthcare Design Group, Department of Engineering, University of Cambridge, Cambridge, UK
- Division of Anaesthesia, University of Cambridge Department of Medicine, Cambridge, UK
| | - Tom Bashford
- Healthcare Design Group, Department of Engineering, University of Cambridge, Cambridge, UK
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Fay Gilder
- Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Basil Nourallah
- Department of Anaesthesia, West Suffolk Hospital, Bury Saint Edmunds, UK
| | - Ari Ercole
- Division of Anaesthesia, University of Cambridge Department of Medicine, Cambridge, UK
| | - Nicholas Levy
- Department of Anaesthesia, West Suffolk Hospital, Bury Saint Edmunds, UK
| | - John Clarkson
- Healthcare Design Group, Department of Engineering, University of Cambridge, Cambridge, UK
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Improved 30-Day Heart Failure Readmissions Following Implementation of an Advanced Cardiovascular Education (ACE) Academy. J Nurs Care Qual 2022; 37:300-306. [DOI: 10.1097/ncq.0000000000000631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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The Palliative Approach and Terminal Heart Failure Admissions - Are We Getting it Right? Heart Lung Circ 2022; 31:841-848. [PMID: 35153151 DOI: 10.1016/j.hlc.2022.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/11/2021] [Accepted: 01/02/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chronic heart failure has a high mortality and early provision of palliative care supports complex decision-making and improves quality of life. AIM To explore whether and when a palliative approach was adopted during the last 12 months of life in patients who experienced an in-hospital death from heart failure. DESIGN Retrospective medical record review of all deaths from chronic heart failure (January 2010 to December 2019). PARTICIPANTS Admissions with chronic heart failure resulting in death were analysed from an Australian tertiary referral centre. RESULTS The cohort (n=517) were elderly (median age 83.8 years IQR=77.6-88.7) and male (55.1%). Common comorbidities were ischaemic heart disease (n=293 56.7%) and atrial fibrillation (n=289 55.9%). Life sustaining interventions occurred in 97 (18.8%) patients. In 31 (6.0%) patients referral to specialist palliative care occurred prior to, and in 263 (50.9%) during, the terminal admission. Opioids were prescribed to 440 (85.1%) patients. Comfort care was the documented goal in 158 patients (30.6%). A palliative approach was significantly associated with prior admission in the preceding 12 months (OR=1.5 95% CI=1.0-2.1 p<0.043), receiving outpatient care (OR=2.6 95% CI=1.6-4.1 p<0.01), and admissions in the latter half of the decade (OR=1.5 95% CI=1.0-2.0 p<0.038). CONCLUSION Despite greater adoption of a palliative approach in the terminal admission over the last decade, a significant proportion of patients receive palliative care late, just prior to death.
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Denfeld QE, Camacho SA, Dieckmann N, Hiatt SO, Davis MR, Cramer DV, Rupert A, Habecker BA, Lee CS. Background and Design of the Biological and Physiological Mechanisms of Symptom Clusters in Heart Failure (BIOMES-HF) Study. J Card Fail 2022; 28:973-981. [PMID: 35045322 DOI: 10.1016/j.cardfail.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Symptoms, which often cluster together, are a significant problem in heart failure (HF). There is considerable heterogeneity in symptom burden, particularly in the vulnerable transition period after a hospitalization for HF, and the biological underpinnings of symptom during transitions are unclear. The purpose of this paper is to describe the background and design of a study that addresses these knowledge gaps, entitled "Biological and Physiological Mechanisms of Symptom Clusters in Heart Failure" (BIOMES-HF). STUDY DESIGN AND METHODS BIOMES-HF is a prospective gender- and age-balanced longitudinal study of 240 adults during the 6-month transition period after a HF hospitalization. The aims are to: 1) identify clusters of change in physical symptoms, 2) quantify longitudinal associations between biomarkers and physical symptoms, and 3) quantify longitudinal associations between physical frailty and physical symptoms among adults with heart failure. We will measure multiple symptoms, biomarkers, and physical frailty at discharge and then at 1 week and 1, 3, and 6 months post-hospitalization. We will use growth mixture modeling and longitudinal mediation modeling to examine changes in symptoms, biomarkers, and physical frailty post-HF hospitalization and associations therein. CONCLUSIONS This innovative study will advance HF symptom science by utilizing a multi-biomarker panel and the physical frailty phenotype to capture the multifaceted nature of HF. Using advanced quantitative modeling, we will characterize heterogeneity and identify potential mechanisms of symptoms in HF. As a result, this research will pinpoint amenable targets for intervention to provide better, individualized treatment to improve symptom burden in HF. BRIEF LAY SUMMARY Adults with heart failure may have significant symptom burden. This study is designed to shed light on our understanding of the role of biological and physiological mechanisms in explaining heart failure symptoms, particularly groups of co-occurring symptoms, over time. We will explore how symptoms, biomarkers, and physical frailty changes after a heart failure hospitalization. The knowledge generated from this study will be used to guide the management and self-care for adults with heart failure.
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Affiliation(s)
- Quin E Denfeld
- Oregon Health & Science University School of Nursing, Portland, OR, USA; Oregon Health & Science University Knight Cardiovascular Institute Portland, OR, USA.
| | - S Albert Camacho
- Oregon Health & Science University Knight Cardiovascular Institute Portland, OR, USA
| | - Nathan Dieckmann
- Oregon Health & Science University School of Nursing, Portland, OR, USA; Oregon Health & Science University School of Medicine Division of Psychology, Portland, OR
| | - Shirin O Hiatt
- Oregon Health & Science University School of Nursing, Portland, OR, USA
| | | | - Daniela V Cramer
- Oregon Health & Science University School of Nursing, Portland, OR, USA
| | - Allissah Rupert
- Oregon Health & Science University School of Nursing, Portland, OR, USA
| | - Beth A Habecker
- Oregon Health & Science University Knight Cardiovascular Institute Portland, OR, USA; Oregon Health & Science University Department of Chemical Physiology & Biochemistry, Portland, OR, USA
| | - Christopher S Lee
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA; Australian Catholic University, Melbourne, Australia
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13
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Davis J, Olazo K, Sierra M, Tarver ME, Caldwell B, Saha A, Lisker S, Lyles C, Sarkar U. Do patient-reported outcome measures measure up? A qualitative study to examine perceptions and experiences with heart failure proms among diverse, low-income patients. J Patient Rep Outcomes 2022; 6:6. [PMID: 35032226 PMCID: PMC8760874 DOI: 10.1186/s41687-022-00410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a Patient-Reported Outcome Measure (PROM) used to evaluate the health status of patients with heart failure (HF) but has predominantly been tested in settings serving predominately white, male, and economically well-resourced populations. We sought to examine the acceptability of the shorter version of the KCCQ (KCCQ-12) among racially and ethnically diverse patients receiving care in an urban, safety-net setting.
Methods We conducted cognitive interviews with a diverse population of patients with heart failure in a safety net system to assess their perceptions of the KCCQ-12. We conducted a thematic analysis of the qualitative data then mapped themes to the Capability, Opportunity, Motivation Model of Behavior framework. Results We interviewed 18 patients with heart failure and found that patients broadly endorsed the concepts of the KCCQ-12 with minor suggestions to improve the instrument’s content and appearance. Although patients accepted the KCCQ-12, we found that the instrument did not adequately measure aspects of health care and quality of life that patients identified as being important components of managing their heart failure. Patient-important factors of heart failure management coalesced into three main themes: social support, health care environment, and mental health. Conclusions Patients from this diverse, low-income, majority non-white population experience unique challenges and circumstances that impact their ability to manage disease. In this study, patients were receptive to the KCCQ-12 as a tool but perceived that it did not adequately capture key health components such as mental health and social relationships that deeply impact their ability to manage HF. Further study on the incorporation of social determinants of health into PROMs could make them more useful tools in evaluating and managing HF in diverse, underserved populations. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00410-9.
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Affiliation(s)
- Jonathan Davis
- Division of Cardiology, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, 1001 Potrero Avenue, 94110, San Francisco, CA, USA
| | - Kristan Olazo
- Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, Building 10, Ward 13, San Francisco, CA, 94110, USA.,Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco, CA, USA
| | - Maribel Sierra
- Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, Building 10, Ward 13, San Francisco, CA, 94110, USA.,Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco, CA, USA
| | - Michelle E Tarver
- Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, MD, USA
| | - Brittany Caldwell
- Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, MD, USA
| | - Anindita Saha
- Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, MD, USA
| | - Sarah Lisker
- Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, Building 10, Ward 13, San Francisco, CA, 94110, USA.,Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco, CA, USA
| | - Courtney Lyles
- Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, Building 10, Ward 13, San Francisco, CA, 94110, USA.,Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Urmimala Sarkar
- Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, Building 10, Ward 13, San Francisco, CA, 94110, USA. .,Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco, CA, USA. .,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
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14
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Predicting 30-day readmissions in patients with heart failure using administrative data: a machine learning approach. J Card Fail 2021; 28:710-722. [PMID: 34936894 DOI: 10.1016/j.cardfail.2021.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/02/2021] [Accepted: 12/09/2021] [Indexed: 12/23/2022]
Abstract
AIMS To develop machine-learning (ML) models trained on administrative data which predict risk of readmission in heart failure (HF) patients; evaluate and compare the ML model with the currently used LaCE score using clinically informative metrics. METHODS AND RESULTS This prognostic study was conducted in Alberta, Canada on 9,845 patients with confirmed HF admitted to hospital between 2012-2019. The outcome was unplanned all-cause hospital readmission within 30-days of discharge. 80% of the data was used for ML model development and 20% for independent validation. We reported, using the validation set, c-statistics (AUROCs)and performance metrics (likelihood ratio [LR], positive predictive values [PPV]) for the XGBoost model and a modified LaCE score within their respective predictive thresholds. Boosted tree-based classifiers had higher AUROCs (0.65 for XGBoost) compared to others (0.58 for Neural Network) and 0.57 for the modified LaCE. Within the predicted threshold range of the XGBoost classifier, the positive LR was 1.00 at the low end of predicted risk and 6.12 at the high end, resulting in a PPV (post-test probability) range of 21-62%; the pre-test probability of readmission was 20.9% using prevalence. The corresponding positive LRs and PPVs across LaCE score thresholds were 1.00-1.20 and 21-24%, respectively. CONCLUSION Despite predicting readmissions better than the LaCE, even the best ML model trained on administrative health data (XGBoost) did not provide substantially informative prediction performance as it only generated a moderate shift from pre to post-test probability. Health systems wishing to deploy such a tool should consider training ML models with additional data. Adding other techniques like Natural Language Processing, along with ML, to use other clinical information (like chart notes) might improve prediction performance.
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15
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Dorsch MP, Farris KB, Rowell BE, Hummel SL, Koelling TM. The Effects of the ManageHF4Life Mobile App on Patients With Chronic Heart Failure: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e26185. [PMID: 34878990 PMCID: PMC8693200 DOI: 10.2196/26185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/28/2021] [Accepted: 10/29/2021] [Indexed: 01/27/2023] Open
Abstract
Background The successful management of heart failure (HF) involves guideline-based medical therapy as well as self-management behavior. As a result, the management of HF is moving toward a proactive real-time technological model of assisting patients with monitoring and self-management. Objective The aim of this paper was to evaluate the efficacy of enhanced self-management via a mobile app intervention on health-related quality of life, self-management, and HF readmissions. Methods A single-center randomized controlled trial was performed. Participants older than 45 years and admitted for acute decompensated HF or recently discharged in the past 4 weeks were included. The intervention group (“app group”) used a mobile app, and the intervention prompted daily self-monitoring and promoted self-management. The control group (“no-app group”) received usual care. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score from baseline to 6 and 12 weeks. Secondary outcomes were the Self-Care Heart Failure Index (SCHFI) questionnaire score and recurrent HF admissions. Results A total of 83 participants were enrolled and completed all baseline assessments. Baseline characteristics were similar between the groups except for the prevalence of ischemic HF. The app group had a reduced MLHFQ at 6 weeks (mean 37.5, SD 3.5 vs mean 48.2, SD 3.7; P=.04) but not at 12 weeks (mean 44.2, SD 4 vs mean 45.9, SD 4; P=.78), compared to the no-app group. There was no effect of the app on the SCHFI at 6 or 12 weeks. The time to first HF readmission was not statistically different between the app group and the no-app group (app group 11/42, 26% vs no-app group 12/41, 29%; hazard ratio 0.89, 95% CI 0.39-2.02; P=.78) over 12 weeks. Conclusions The adaptive mobile app intervention, which focused on promoting self-monitoring and self-management, improved the MLHFQ at 6 weeks but did not sustain its effects at 12 weeks. No effect was seen on HF self-management measured by self-report. Further research is needed to enhance engagement in the app for a longer period and to determine if the app can reduce HF readmissions in a larger study. Trial Registration ClinicalTrials.gov NCT03149510; https://clinicaltrials.gov/ct2/show/NCT03149510
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Affiliation(s)
- Michael P Dorsch
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, United States.,Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States
| | - Karen B Farris
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Brigid E Rowell
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Scott L Hummel
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States.,Division of Cardiovascular Medicine, Medical School, University of Michigan, Ann Arbor, MI, United States.,Ann Arbor Veterans Affairs Health System, Ann Arbor, MI, United States
| | - Todd M Koelling
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States.,Division of Cardiovascular Medicine, Medical School, University of Michigan, Ann Arbor, MI, United States
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16
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Goh KH, Wang L, Yeow AYK, Ding YY, Au LSY, Poh HMN, Li K, Yeow JJL, Tan GYH. Prediction of Readmission in Geriatric Patients From Clinical Notes: Retrospective Text Mining Study. J Med Internet Res 2021; 23:e26486. [PMID: 34665149 PMCID: PMC8564665 DOI: 10.2196/26486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/30/2021] [Accepted: 07/27/2021] [Indexed: 12/30/2022] Open
Abstract
Background Prior literature suggests that psychosocial factors adversely impact health and health care utilization outcomes. However, psychosocial factors are typically not captured by the structured data in electronic medical records (EMRs) but are rather recorded as free text in different types of clinical notes. Objective We here propose a text-mining approach to analyze EMRs to identify older adults with key psychosocial factors that predict adverse health care utilization outcomes, measured by 30-day readmission. The psychological factors were appended to the LACE (Length of stay, Acuity of the admission, Comorbidity of the patient, and Emergency department use) Index for Readmission to improve the prediction of readmission risk. Methods We performed a retrospective analysis using EMR notes of 43,216 hospitalization encounters in a hospital from January 1, 2017 to February 28, 2019. The mean age of the cohort was 67.51 years (SD 15.87), the mean length of stay was 5.57 days (SD 10.41), and the mean intensive care unit stay was 5% (SD 22%). We employed text-mining techniques to extract psychosocial topics that are representative of these patients and tested the utility of these topics in predicting 30-day hospital readmission beyond the predictive value of the LACE Index for Readmission. Results The added text-mined factors improved the area under the receiver operating characteristic curve of the readmission prediction by 8.46% for geriatric patients, 6.99% for the general hospital population, and 6.64% for frequent admitters. Medical social workers and case managers captured more of the psychosocial text topics than physicians. Conclusions The results of this study demonstrate the feasibility of extracting psychosocial factors from EMR clinical notes and the value of these notes in improving readmission risk prediction. Psychosocial profiles of patients can be curated and quantified from text mining clinical notes and these profiles can be successfully applied to artificial intelligence models to improve readmission risk prediction.
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Affiliation(s)
- Kim Huat Goh
- Nanyang Business School, Nanyang Technological University, Singapore, Singapore
| | - Le Wang
- City University of Hong Kong, Hong Kong, Hong Kong
| | | | - Yew Yoong Ding
- Tan Tock Seng Hospital, Singapore, Singapore.,Geriatric Education and Research Institute, Singapore, Singapore
| | | | | | - Ke Li
- Medical Informatics, National University Health System, Singapore, Singapore
| | | | - Gamaliel Yu Heng Tan
- Ng Teng Fong General Hospital, Singapore, Singapore.,Medical Informatics, National University Health System, Singapore, Singapore
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17
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Pieteraerens W. Previous healthcare experiences are important in explaining the care-seeking behaviour in heart failure patients. Evid Based Nurs 2021; 24:125. [PMID: 32796002 DOI: 10.1136/ebnurs-2020-103306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
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18
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Austin RC, Schoonhoven L, Clancy M, Richardson A, Kalra PR, May CR. Do chronic heart failure symptoms interact with burden of treatment? Qualitative literature systematic review. BMJ Open 2021; 11:e047060. [PMID: 34330858 PMCID: PMC8327846 DOI: 10.1136/bmjopen-2020-047060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Explore the interaction between patient experienced symptoms and burden of treatment (BoT) theory in chronic heart failure (CHF). BoT explains how dynamic patient workload (self-care) and their capacity (elements influencing capability), impacts on patients' experience of illness. DESIGN Review of qualitative research studies. DATA SOURCES CINAHL, EMBASE, MEDLINE, PsycINFO, Scopus and Web of Science were searched between January 2007 and 2020. ELIGIBILITY CRITERIA Journal articles in English, reporting qualitative studies on lived experience of CHF. RESULTS 35 articles identified related to the lived experience of 720 patients with CHF. Symptoms with physical and emotional characteristics were identified with breathlessness, weakness, despair and anxiety most prevalent. Identifying symptoms' interaction with BoT framework identified three themes: (1) Symptoms appear to infrequently drive patients to engage in self-care (9.2% of codes), (2) symptoms appear to impede (70.5% of codes) and (3) symptoms form barriers to self-care engagement (20.3% of codes). Symptoms increase illness workload, making completing tasks more difficult; simultaneously, symptoms alter a patient's capacity, through a reduction in their individual capabilities and willingness to access external resources (ie, hospitals) often with devasting impact on patients' lives. CONCLUSIONS Symptoms appear to be integral in the patient experience of CHF and BoT, predominately acting to impede patients' efforts to engage in self-care. Symptoms alter illness workload, increasing complexity and hardship. Patients' capacity is reduced by symptoms, in what they can do and their willingness to ask for help. Symptoms can lower their perceived self-value and roles within society. Symptoms appear to erode a patient's agency, decreasing self-value and generalised physical deconditioning leading to affective paralysis towards self-care regimens. Together describing a state of overwhelming BoT which is thought to be a contributor to poor engagement in self-care and may provide new insights into the perceived poor adherence to self-care in the CHF population. PROSPERO REGISTRATION NUMBER CRD42017077487.
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Affiliation(s)
- Rosalynn C Austin
- Department of Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, UK
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institite for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK
| | - Lisette Schoonhoven
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institite for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mike Clancy
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, Hampshire, UK
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
| | - Alison Richardson
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institite for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK
| | - Paul R Kalra
- Department of Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, UK
- Faculty of Health and Science, University of Portsmouth, Portsmouth, Hampshire, UK
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health Research (NIHR), Applied Research Collaboration (ARC) North Thames, London, UK
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19
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Chou A, Euloth T, Matcho B, Pastva AM, Bilderback A, Freburger JK. Is Discordance Between Recommended and Actual Postacute Discharge Setting a Risk Factor for Readmission in Patients With Congestive Heart Failure? J Am Heart Assoc 2021; 10:e020425. [PMID: 34320844 PMCID: PMC8475711 DOI: 10.1161/jaha.120.020425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Readmissions in patients with congestive heart failure are common and often preventable. Limited data suggest that patients discharged to a less intensive postacute care setting than recommended are likely to readmit. We examined whether postacute setting discordance (discharge to a less intensive postacute setting than recommended by a physical and occupational therapist) was associated with hospital readmission in patients with congestive heart failure. We also assessed sociodemographic and clinical predictors of setting discordance. Methods and Results Retrospective analysis of administrative claims and electronic health record data was conducted on 25 500 adults with a discharge diagnosis of congestive heart failure from 12 acute care hospitals in Western Pennsylvania. Generalized linear mixed models were estimated to examine the association between postacute setting discordance and 30‐day hospital readmission and to identify predictors of setting discordance. The 30‐day readmission and postacute setting discordance rates were high (23.7%, 20.6%). While controlling for demographic and clinical covariates, patients in discordant postacute settings were more likely to be readmitted within 30 days (adjusted odds ratio [OR], 1.12; 95% CI, 1.04–1.20). The effect was also seen in the subgroup of patients with low mobility scores (adjusted OR, 1.20; 95% CI, 1.08–1.33). Factors associated with setting discordance were lower‐income, higher comorbidity burden, therapist recommendation disagreement, and midrange mobility limitations. Conclusions Postacute setting discordance was associated with an increased readmission risk in patients hospitalized with congestive heart failure. Maximizing concordance between therapist recommended and actual postacute discharge setting may decrease readmissions. Understanding factors associated with post‐acute setting discordance can inform strategies to improve the quality of the discharge process.
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Affiliation(s)
- Aileen Chou
- Department of Physical Therapy University of Pittsburgh PA
| | | | | | - Amy M Pastva
- Department of Orthopaedic Surgery Division of Physical Therapy, and Duke Claude D. Pepper Older Americans Independence Center Duke University School of Medicine Durham NC
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20
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Sethares KA, Chin E. Age and gender differences in physical heart failure symptom clusters. Heart Lung 2021; 50:832-837. [PMID: 34311226 DOI: 10.1016/j.hrtlng.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Gender differences exist in structure and function of the heart resulting in HF symptom variation. Previous HF symptom cluster research described symptom clusters that were linked to functional status, mortality, quality of life and rehospitalization. Age and gender differences between cluster groups were described in one study. OBJECTIVES Identify physical HF symptom clusters and explore age and gender differences between clusters. METHODS Secondary analysis study of adults with HF. Cluster analysis was conducted using hierarchical agglomerative clustering techniques. A pictorial dendrogram output displays clusters. RESULTS Three symptom clusters were identified in this sample of 133 older HF patients that differed by gender (p = 0.04), age (p = 0.00) and beta blocker use (p = 0.01). Symptom clusters were consistent with worsening HF, acute HF and chronic HF. CONCLUSION Symptom clusters differ by age and gender. Education should be directed at increasing patient awareness of their individual symptom clusters.
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Affiliation(s)
- Kristen A Sethares
- Department of Adult Nursing, College of Nursing and Health Sciences, University of Massachusetts Dartmouth, 285 Old Westport Rd. North Dartmouth 02747, MA, United States.
| | - Elizabeth Chin
- Department of Adult Nursing, College of Nursing and Health Sciences, University of Massachusetts Dartmouth, 285 Old Westport Rd. North Dartmouth 02747, MA, United States
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21
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Medication Nonadherence or Self-care? Understanding the Medication Decision-Making Process and Experiences of Older Adults With Heart Failure. J Cardiovasc Nurs 2021; 35:26-34. [PMID: 31567510 PMCID: PMC6903380 DOI: 10.1097/jcn.0000000000000616] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND More than half of all patients with heart failure (HF) do not take medications as prescribed, resulting in negative health outcomes. Research has shown that medication adherence may be intentional rather than the ability to follow prescribed regimens, yet very little is known about medication-taking decisions in older patients with HF. OBJECTIVE The purpose of this qualitative study was to gain insight into the decision-making processes and experiences of older patients with HF by exploring the different aspects in choosing to take or not take medications as prescribed in the community setting. METHODS Using a narrative inquiry approach, the personal narratives of 11 adults 65 years or older who took at least 2 daily medications for HF were gathered using in-depth, semistructured interviews. The data in this study were organized and analyzed using Riessman's framework for narrative analysis. RESULTS Participants made intentional decisions to take particular medications differently than prescribed. A worrisome symptom prompted a naturalistic decision-making process. When a medication interfered with attaining a personal goal, participants coped by individualizing their medication regimen. Participants did not consider taking a medication differently than prescribed as nonadherence but a necessary aspect of maintaining a personal level of health, which could be seen as self-care. CONCLUSIONS The older patient with HF should be carefully assessed for nonadherence. The development of interventions that are patient specific, target medications with the greatest potential for nonadherence, and use easy-to-access resources may promote decisions for medication adherence. More research is needed to develop interventions that promote decisions for medication adherence.
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22
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Readmitted Patients With Heart Failure Sick, Tired, and Symptomatic: A Qualitative Descriptive Study From a Quaternary Academic Medical Center. J Cardiovasc Nurs 2021; 37:248-256. [PMID: 33591059 DOI: 10.1097/jcn.0000000000000791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Heart failure (HF) readmissions will continue to grow unless we have a better understanding of why patients with HF are readmitted. Our purpose was to gain an understanding, from the patients' perspective, of how patients with HF viewed their discharge instructions and how they felt when they got home and were then readmitted in less than 30 days. METHODS AND RESULTS We used a qualitative descriptive approach using semistructured interviews with 22 patients with HF. Most participants had multimorbidities, were classified as New York Heart Association class III (n = 13) with reduced ejection fraction (n = 20), and were on home inotrope therapy (n = 13). The overarching theme that emerged was that these participants were sick, tired, and symptomatic. Additional categories within this theme highlight discharge instructions as being clear and easily understood; rich descriptions of physical, emotional, and other symptoms leading up to readmission; and reports of daily activities including what "good" and "not good" days looked like. Moreover, when participants experienced an exacerbation of their HF symptoms, they were sick enough to be readmitted to the hospital. CONCLUSION Our findings confirm ongoing challenges with a complex group of sick patients with HF, with the majority on home inotropes with reduced ejection fraction, who developed an unavoidable progression of their illness and subsequent hospital readmission.
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23
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Chestnut VM, Vadyak K, McCambridge MM, Weiss MJ. The Impact of Telephonic Follow-Up Within 2 Business Days Postdischarge on 30-Day Readmissions for Patients With Heart Failure. J Dr Nurs Pract 2021; 14:JDNP-D-19-00079. [PMID: 33468613 DOI: 10.1891/jdnp-d-19-00079] [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: 11/25/2022]
Abstract
BACKGROUND Heart failure (HF) is a chronic condition associated with high rates of hospital readmissions. The prevalence and costs of HF are expected to rise dramatically by 2030 (Heidenreich,et al., 2013). OBJECTIVE A 24-month, retrospective study was conducted using electronic medical record (EMR) chart review, seeking to identify if postdischarge follow-up phone calls decreased 30-day readmissions in individuals with HF. METHODS The study included 705 adult participants who were admitted to the hospital for HF. Some received a postdischarge call within 2 business days of discharge, and some did not. RESULTS Participants who received the postdischarge call were less likely to be readmitted (20.1%) than participants who did not receive a postdischarge call (28.8%; p = .007). Participants who received the postdischarge call were more likely to have a follow-up visit within 14 days (70.1%) than participants who did not receive a postdischarge call (30.2%; p < .001). CONCLUSIONS The findings from this study may help to drive future transitional care strategies for individuals diagnosed with HF. IMPLICATIONS FOR NURSING Nurse-led transitional care interventions offer potential solutions to ensure safe, effective hospital discharges.
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Affiliation(s)
- Victoria M Chestnut
- Care Transitions and Navigations-Lehigh Valley Health Network, Allentown, PA
| | - Karen Vadyak
- Patient Care Services-Lehigh Valley Reilly Children's Hospital, Allentown, PA
| | - Matthew M McCambridge
- Chief Quality and Patient Safety Officer-Lehigh Valley Health Network, Allentown, PA
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24
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Vuckovic KM, Bierle RS, Ryan CJ. Navigating Symptom Management in Heart Failure: The Crucial Role of the Critical Care Nurse. Crit Care Nurse 2021; 40:55-63. [PMID: 32236426 DOI: 10.4037/ccn2020685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
High-acuity, progressive care, and critical care nurses often provide care for patients with heart failure during an exacerbation of acute disease or at the end of life. Identifying and managing heart failure symptoms is complex and requires early recognition and early intervention. Because symptoms of heart failure are not disease specific, patients may not respond to them appropriately, resulting in treatment delays. This article reviews the complexities and issues surrounding the patient's ability to recognize heart failure symptoms and the critical care nurse's role in facilitating early intervention. It outlines the many barriers to symptom recognition and response, including multimorbidities, age, symptom intensity, symptom escalation, and health literacy. The influence of self-care on heart failure management is also described. The critical care nurse plays a crucial role in teaching heart failure patients to identify and respond appropriately to their symptoms, thus promoting early intervention.
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Affiliation(s)
- Karen M Vuckovic
- Karen M. Vuckovic is an advanced practice registered nurse, Division of Cardiology, University of Illinois Hospital and Health Sciences System, and a clinical associate professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois. Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Monument Health Heart and Vascular Institute, Rapid City, South Dakota. Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago
| | - Rebecca Schuetz Bierle
- Karen M. Vuckovic is an advanced practice registered nurse, Division of Cardiology, University of Illinois Hospital and Health Sciences System, and a clinical associate professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois. Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Monument Health Heart and Vascular Institute, Rapid City, South Dakota. Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago
| | - Catherine J Ryan
- Karen M. Vuckovic is an advanced practice registered nurse, Division of Cardiology, University of Illinois Hospital and Health Sciences System, and a clinical associate professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois. Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Monument Health Heart and Vascular Institute, Rapid City, South Dakota. Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago
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25
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Mutharasan RK. Transitioning Patients with Heart Failure to Outpatient Care. Heart Fail Clin 2020; 16:421-431. [PMID: 32888637 DOI: 10.1016/j.hfc.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The transition from hospitalization to outpatient care is a vulnerable time for patients with heart failure. This requires specific focus on the transitional care period. Here the authors propose a framework to guide process improvement in the transitional care period. The authors extend this framework by (1) examining the role new technology might play in transitional care, and (2) offering practical advice for teams building transitional care programs.
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Affiliation(s)
- R Kannan Mutharasan
- Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Arkes Pavilion, Suite 6-071, Chicago, IL 60611, USA.
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26
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Sentell TL, Seto TB, Quensell ML, Malabed JM, Guo M, Vawer MD, Braun KL, Taira DA. Insights in Public Health: Outpatient Care Gaps for Patients Hospitalized with Ambulatory Care Sensitive Conditions in Hawai'i: Beyond Access and Continuity of Care. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2020; 79:91-97. [PMID: 32190842 PMCID: PMC7061028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Ambulatory care sensitive conditions (ACSCs) are conditions that can generally be managed in community-based healthcare settings, and, if managed well, should not require hospital admission. A 5-year, mixed methods study was recently concluded that (1) documented disparities in hospitalizations for ACSCs in Hawai'i through quantitative analysis of state-wide hospital discharge data; and (2) identified contributing factors for these hospitalizations through patient interviews. This Public Health Insights article provides deeper context for, and consideration of, a striking study finding: the differences between typical measures of access to care and the quality of patient/provider interactions as reported by study participants. The themes that emerged from the patients' stories of their own potentially preventable hospital admissions shed light on the importance of being heard, trust, communication, and health knowledge in their relationships with their providers. We conclude that improving the quality of the relationship and level of engagement between the patient and community/outpatient providers may help reduce hospitalizations for ACSCs in Hawai'i and beyond. These interpersonal-level goals should be supported by systems-level efforts to improve health care delivery and address health disparities.
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Affiliation(s)
- Tetine L Sentell
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (TLS,KLB)
| | - Todd B Seto
- The Queen's Medical Center, Honolulu, HI (TBS, MDV)
| | - Michelle L Quensell
- School of Nursing and Dental Hygiene, University of Hawai'i at Manoa, Honolulu, HI (MLQ, MG)
| | - Jhon Michael Malabed
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (JMM)
| | - Mary Guo
- School of Nursing and Dental Hygiene, University of Hawai'i at Manoa, Honolulu, HI (MLQ, MG)
| | - May D Vawer
- The Queen's Medical Center, Honolulu, HI (TBS, MDV)
| | - Kathryn L Braun
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (TLS,KLB)
| | - Deborah A Taira
- Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (DAT)
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27
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Ryan CJ, Bierle RS, Vuckovic KM. The Three Rs for Preventing Heart Failure Readmission: Review, Reassess, and Reeducate. Crit Care Nurse 2019; 39:85-93. [PMID: 30936132 DOI: 10.4037/ccn2019345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Despite improvements in heart failure therapies, hospitalization readmission rates remain high. Nationally, increasing attention has been directed toward reducing readmission rates and thus identifying patients with the highest risk for readmission. This article summarizes the evidence related to decreasing readmission for patients with heart failure within 30 days after discharge, focusing on the acute setting. Each patient requires an individualized plan for successful transition from hospital to home and preventing readmission. Nurses must review the patient's current plan of care and adherence to it and look for clues to failure of the plan that could lead to readmission to the hospital. In addition, nurses must reassess the current plan with the patient and family to ensure that the plan continues to meet the patient's needs. Finally, nurses must continually reeducate patients about their plan of care, their plan for self-management, and strategies to prevent hospital readmission for heart failure.
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Affiliation(s)
- Catherine J Ryan
- Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, and Director, Nursing Evidence Based Practice and Nursing Research, University of Illinois Hospital & Health Sciences System, Chicago. .,Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Regional Health Heart and Vascular Institute, Rapid City, South Dakota. .,Karen M. Vuckovic is an advanced practice nurse, Division of Cardiology, University of Illinois Hospital & Health Sciences System, and a clinical assistant professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago.
| | - Rebecca Schuetz Bierle
- Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, and Director, Nursing Evidence Based Practice and Nursing Research, University of Illinois Hospital & Health Sciences System, Chicago.,Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Regional Health Heart and Vascular Institute, Rapid City, South Dakota.,Karen M. Vuckovic is an advanced practice nurse, Division of Cardiology, University of Illinois Hospital & Health Sciences System, and a clinical assistant professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago
| | - Karen M Vuckovic
- Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, and Director, Nursing Evidence Based Practice and Nursing Research, University of Illinois Hospital & Health Sciences System, Chicago.,Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Regional Health Heart and Vascular Institute, Rapid City, South Dakota.,Karen M. Vuckovic is an advanced practice nurse, Division of Cardiology, University of Illinois Hospital & Health Sciences System, and a clinical assistant professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago
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28
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Trinacty CM, LaWall E, Ashton M, Taira D, Seto TB, Sentell T. Adding Social Determinants in the Electronic Health Record in Clinical Care in Hawai'i: Supporting Community-Clinical Linkages in Patient Care. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2019; 78:46-51. [PMID: 31285969 PMCID: PMC6603884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Social and behavioral determinants of health, such as poverty, homelessness, and limited social support, account for an estimated 40% of health burdens and predict critical health outcomes. Many clinical-community linkages specifically focus on addressing such challenges. Given its distinctive history, culture, and location, Hawai'i has unique social factors impacting population health. Local health systems are striving to address these issues to meet their patients' health needs. Yet the evidence on precisely how health care systems and communities may work together to achieve these goals are limited both generally and specifically in the Hawai'i context. This article describes real-world efforts by 3 local health care delivery systems that integrate the identification of social needs into clinical care using the electronic health record (EHR). One health care system collects and assesses social challenges and interpersonal needs to improve the care for its frail seniors (aged 65 and older). Another system added key data fields around social support and inpatient mobility in the EHR to identify whether patients needed additional help during hospitalization and post-discharge. A third added a social needs screening tool (eg, housing instability, food insecurity, transportation needs) to its EHR to ensure that patient-specific needs can be appropriately addressed by the care team. Successful integration of this information into the EHR can identify, direct, and support clinical-community linkages and integrate such relationships into the care team. Many lessons can be learned from the implementation of these programs, including the importance of clinical relevance and ensuring capacity for social work liaisons trained for this work to address identified needs.
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Affiliation(s)
| | | | | | - Deborah Taira
- Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (DT)
| | - Todd B Seto
- The Queen's Medical Center, Honolulu, HI (TBS)
| | - Tetine Sentell
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu HI (TS)
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Soucier RJ, Miller PE, Ingrassia JJ, Riello R, Desai NR, Ahmad T. Essential Elements of Early Post Discharge Care of Patients with Heart Failure. Curr Heart Fail Rep 2019; 15:181-190. [PMID: 29700697 DOI: 10.1007/s11897-018-0393-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW Heart failure is associated with an enormous burden on both patients and health care systems in the USA. Several national policy initiatives have focused on improving the quality of heart failure care, including reducing readmissions following hospitalization, which are common, costly, and, at least in part, preventable. The transition from inpatient to ambulatory care setting and the immediate post-hospitalization period present an opportunity to further optimize guideline concordant medical therapy, identify reversible issues related to worsening heart failure, and evaluate prognosis. It can also provide opportunities for medication reconciliation and optimization, consideration of device-based therapies, appropriate management of comorbidities, identification of individual barriers to care, and a discussion of goals of care based on prognosis. RECENT FINDINGS Recent studies suggest that attention to detail regarding patient comorbidities, barriers to care, optimization of both diuretic and neurohormonal therapies, and assessment of prognosis improve patient outcomes. Despite the fact that the transition period appears to be an optimal time to address these issues in a comprehensive manner, most patients are not referred to programs specializing in this approach post hospital discharge. The objective of this review is to provide an outline for early post discharge care that allows clinicians and other health care providers to care for these heart failure patients in a manner that is both firmly rooted in the guidelines and patient-centered. Data regarding which intervention is most likely to confer benefit to which subset of patients with this disease is lacking and warrants further study.
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Affiliation(s)
- Richard J Soucier
- Sections of Cardiovascular Medicine, Yale University School of Medicine, 135 College Street, Suite 230, New Haven, CT, 06520, USA
| | - P Elliott Miller
- Sections of Cardiovascular Medicine, Yale University School of Medicine, 135 College Street, Suite 230, New Haven, CT, 06520, USA
| | - Joseph J Ingrassia
- Division of Cardiology, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, 06032, USA
| | - Ralph Riello
- Division of Pharmacy, Yale University School of Medicine, New Haven, CT, USA
| | - Nihar R Desai
- Sections of Cardiovascular Medicine, Yale University School of Medicine, 135 College Street, Suite 230, New Haven, CT, 06520, USA.,Center for Outcomes Research and Evaluation, Yale New Haven Health System, Yale New Haven Hospital, New Haven, CT, USA
| | - Tariq Ahmad
- Sections of Cardiovascular Medicine, Yale University School of Medicine, 135 College Street, Suite 230, New Haven, CT, 06520, USA.
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Liljeroos M, Strömberg A. Introducing nurse-led heart failure clinics in Swedish primary care settings. Eur J Heart Fail 2018; 21:103-109. [PMID: 30338881 DOI: 10.1002/ejhf.1329] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/02/2018] [Accepted: 09/10/2018] [Indexed: 12/28/2022] Open
Abstract
AIM According to clinical guidelines, it is recommended that patients with heart failure (HF) receive structured multidisciplinary care at nurse-led HF clinics in order to optimise treatment and avoid preventable readmissions. Today, there are HF clinics with specialist-trained nurses at almost all Swedish hospitals, but HF clinics remain scarce in primary care (PC). The aim of this study was two-fold: firstly, to evaluate the effects of systematically implementing nurse-led HF clinics in PC settings with regard to hospital healthcare utilisation and evidence-based HF treatment, and secondly to explore patients' experiences of HF clinics in PC. METHODS AND RESULTS The study had a pre-post design. Annual measurement were done between 2010-2017 regarding in-hospital healthcare consumption and medical treatment. Data from 2011-2017 after the implementation of HF clinics in PC in one county council Sweden were compared with baseline data collected before the implementation in 2010. The implementation of HF clinics in PC significantly reduced the number of HF-related hospital admissions by 27% (P < 0.001), HF hospital days by 27.3% (P < 0.001) and HF emergency room visits by 24% (P < 0.001). Further, patients were to a higher extent medically treated according to guidelines and satisfied with the care they received at the PC HF clinic. CONCLUSION Nurse-led HF clinics in PC seem to be effective in reducing the need for in-hospital care and provide high quality person-centred care.
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Affiliation(s)
- Maria Liljeroos
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Anna Strömberg
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden.,Sue & Bill Gross School of Nursing, University of California Irvine, CA, USA
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31
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Krittanawong C, Johnson KW, Hershman SG, Tang WW. Big data, artificial intelligence, and cardiovascular precision medicine. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2018. [DOI: 10.1080/23808993.2018.1528871] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Chayakrit Krittanawong
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kipp W. Johnson
- Institute for Next Generation Healthcare, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven G. Hershman
- Department of Medicine, Stanford University, Stanford, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - W.H. Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland, OH, USA
- Center for Clinical Genomics, Cleveland Clinic, Cleveland, OH, USA
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32
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Heart Failure Home Management Challenges and Reasons for Readmission: a Qualitative Study to Understand the Patient's Perspective. J Gen Intern Med 2018; 33:1700-1707. [PMID: 29992429 PMCID: PMC6153210 DOI: 10.1007/s11606-018-4542-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 01/30/2018] [Accepted: 06/11/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Heart failure patients have high 30-day hospital readmission rates. Interventions designed to prevent readmissions have had mixed success. Understanding heart failure home management through the patient's experience may reframe the readmission "problem" and, ultimately, inform alternative strategies. OBJECTIVE To understand patient and caregiver challenges to heart failure home management and perceived reasons for readmission. DESIGN Observational qualitative study. PARTICIPANTS Heart failure patients were recruited from two hospitals and included those who were hospitalized for heart failure at least twice within 30 days and those who had been recently discharged after their first heart failure admission. APPROACH Open-ended, semi-structured interviews. Conclusions vetted using focus groups. KEY RESULTS Semi-structured interviews with 31 patients revealed a combination of physical and socio-emotional influences on patients' home heart failure management. Major themes identified were home management as a struggle between adherence and adaptation, and hospital readmission as a rational choice in response to distressing symptoms. Patients identified uncertainty regarding recommendations, caused by unclear instructions and temporal incongruence between behavior and symptom onset. This uncertainty impaired their competence in making routine management decisions, resulting in a cycle of limit testing and decreasing adherence. Patients reported experiencing hopelessness and frustration in response to perceiving a deteriorating functional status. This led some to a cycle of despair characterized by worsening adherence and negative emotions. As these cycles progressed and distressing symptoms worsened, patients viewed the hospital as the safest place for recovery and not a "negative" outcome. CONCLUSION Cycles of limit testing and despair represent important patient-centered struggles in managing heart failure. The resulting distress and fear make readmission a rational choice for patients rather than a negative outcome. Interventions (e.g., palliative care) that focus on methods to address these patient-centered factors should be further studied rather than methods to reduce hospital readmissions.
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Identifying and targeting patients with predicted 30-day hospital readmissions using the revised LACE index score and early postdischarge intervention. INT J EVID-BASED HEA 2018; 16:174-181. [DOI: 10.1097/xeb.0000000000000142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Säfström E, Jaarsma T, Strömberg A. Continuity and utilization of health and community care in elderly patients with heart failure before and after hospitalization. BMC Geriatr 2018; 18:177. [PMID: 30103688 PMCID: PMC6090801 DOI: 10.1186/s12877-018-0861-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/11/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The period after hospitalization due to deteriorated heart failure (HF) is characterized as a time of high generalized risk. The transition from hospital to home is often problematic due to insufficient coordination of care, leading to a fragmentation of care rather than a seamless continuum of care. The aim was to describe health and community care utilization prior to and 30 days after hospitalization, and the continuity of care in patients hospitalized due to de novo or deteriorated HF from the patients' perspective and from a medical chart review. METHODS This was a cross-sectional study with consecutive inclusion of patients hospitalized at a county hospital in Sweden due to deteriorated HF during 2014. Data were collected by structured telephone interviews and medical chart review and analyzed with the Spearman's rank correlation coefficient and Chi square. A P value of 0.05 was considered significant. RESULTS A total of 121 patients were included in the study, mean age 82.5 (±6.8) and 49% were women. Half of the patients had not visited any health care facility during the month prior to the index hospital admission, and 79% of the patients visited the emergency room (ER) without a referral. Among these elderly patients, a total of 40% received assistance at home prior to hospitalization and 52% after discharge. A total of 86% received written discharge information, one third felt insecure after hospitalization and lacked knowledge of which health care provider to consult with and contact in the event of deterioration or complications. Health care utilization increased significantly after hospitalization. CONCLUSION Most patients had not visited any health care facility within 30 days before hospitalization. Health care utilization increased significantly after hospitalization. Flaws in the continuity of care were found; even though most patients received written information at discharge, one third of the patients lacked knowledge about which health care provider to contact in the event of deterioration and felt insecure at home after discharge.
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Affiliation(s)
- Emma Säfström
- Sörmland County Council, Nyköping Hospital, Nyköping, Sweden
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Anna Strömberg
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University, Linköping, Sweden
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Treece J, Ghouse M, Rashid S, Arikapudi S, Sankhyan P, Kohli V, O’Neill L, Addo-Yobo E, Bhattad V, Baumrucker SJ. The Effect of Hospice on Hospital Admission and Readmission Rates: A Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2018. [DOI: 10.1177/1084822318761105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Symptom control may become challenging for terminally ill patients as they near the end of life. Patients often seek hospital admission to address symptoms, such as pain, nausea, vomiting, and restlessness. Alternatively, palliative medicine focuses on the control and mitigation of symptoms, while allowing patients to maintain their quality of life, whether in an outpatient or inpatient setting. Hospice care provides, in addition to inpatient care at a hospice facility or in a hospital, the option for patients to receive symptom management at home. This option for symptom control in the outpatient setting is essential to preventing repeated and expensive hospital readmissions. This article discusses the impact of hospice care on hospital readmission rates.
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Affiliation(s)
| | | | - Saima Rashid
- East Tennessee State University, Johnson City, TN, USA
| | | | | | - Varun Kohli
- East Tennessee State University, Johnson City, TN, USA
| | - Luke O’Neill
- East Tennessee State University, Johnson City, TN, USA
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Pedersen SS, Skovbakke SJ, Wiil UK, Schmidt T, dePont Christensen R, Brandt CJ, Sørensen J, Vinther M, Larroudé CE, Melchior TM, Riahi S, Smolderen KGE, Spertus JA, Johansen JB, Nielsen JC. Effectiveness of a comprehensive interactive eHealth intervention on patient-reported and clinical outcomes in patients with an implantable cardioverter defibrillator [ACQUIRE-ICD trial]: study protocol of a national Danish randomised controlled trial. BMC Cardiovasc Disord 2018; 18:136. [PMID: 29969990 PMCID: PMC6029360 DOI: 10.1186/s12872-018-0872-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Denmark and other countries, there has been a shift in the management of patients with an implantable cardioverter defibrillator (ICD) with remote device monitoring largely replacing in-hospital visits. Less patient-nurse and patient-physician interaction may lead to gaps in patients' quality of care and impede patients' adaptation to living successfully with the ICD. A comprehensive eHealth intervention that include goal-setting, monitoring of symptoms of depression, anxiety, and quality of life, psychological treatment, information provision, supportive tools, online dialogues with nursing staff and access to an online community network, may help fill these gaps and be particularly beneficial to patients who suffer from anxiety and depression. This study will evaluate the effectiveness of the ACQUIRE-ICD care innovation, a comprehensive and interactive eHealth intervention, on patient-reported and clinical outcomes. METHODS The ACQUIRE-ICD study is a multicenter, prospective, two-arm, unblinded randomised controlled superiority trial that will enroll 478 patients implanted with a first-time ICD or ICD with cardiac synchronisation therapy (CRT-D) from the six implanting centers in Denmark. The trial will evaluate the clinical effectiveness and cost-effectiveness of the ACQUIRE-ICD care innovation, as add-on to usual care compared with usual care alone. The primary endpoint, device acceptance, assessed with the Florida Patient Acceptance Survey, is evaluated at 12 months' post implant. Secondary endpoints, evaluated at 12 and 24 months' post implant, include patient-reported outcomes, return to work, time to first ICD therapy and first hospitalisation, mortality and cost-effectiveness. DISCUSSION The effectiveness of a comprehensive and interactive eHealth intervention that relies on patient-centred and personalised tools offered via a web-based platform targeted to patients with an ICD has not been assessed so far. The ACQUIRE-ICD care innovation promotes and facilitates that patients become active participants in the management of their disease, and as such addresses the need for a more patient-centered disease-management approach. If the care innovation proves to be beneficial to patients, it may not only increase patient empowerment and quality of life but also free up time for clinicians to care for more patients. TRIAL REGISTRATION The trial has been registered on https://clinicaltrials.gov/ct2/show/NCT02976961 on November 30, 2016 with registration number [ NCT02976961 ].
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Affiliation(s)
- Susanne S. Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- OPEN, Odense Patient data Explorative Networ, Odense University Hospital, Odense, Denmark
| | - Søren J. Skovbakke
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Uffe K. Wiil
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Thomas Schmidt
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | | | | | - Jan Sørensen
- Danish Center for Health Economics (DaCHE), University of Southern Denmark, Odense, Denmark
| | - Michael Vinther
- Department of Cardiology B, Rigshospitalet, Copenhagen, Denmark
| | | | - Thomas M. Melchior
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kim G. E. Smolderen
- Saint Luke’s Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, MO USA
| | - John A. Spertus
- Saint Luke’s Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, MO USA
| | - Jens B. Johansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jens C. Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Overactive Bladder is a Distress Symptom in Heart Failure. Int Neurourol J 2018; 22:77-82. [PMID: 29991228 PMCID: PMC6059908 DOI: 10.5213/inj.1836120.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/07/2018] [Indexed: 12/24/2022] Open
Abstract
The prevalence of Heart failure (HF) is expected to increase worldwide with the aging population trend. The numerous symptoms of and repeated hospitalizations for HF negatively affect the patient’s quality of life and increase the patient’s economic burden. Up to 50% of patients with HF suffer from urinary incontinence (UI) and an overactive bladder (OAB). However, there are limited data about the relationship between UI, OAB, and HF. The association between HF and urinary symptoms may be directly attributable to worsening HF pathophysiology. A comprehensive literature review was conducted for all publications between January 2000 and November 2017 using the PubMed, Embase, and Cochrane databases. HF represents a major and growing public health problem, with an increased risk of UI and an OAB as comorbidities. Possible effects of HF on urinary problems may be mediated by the prescription of medications for symptomatic relief. Although diuretics are typically used to relieve congestion, and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers improve survival, these classes of drugs have been suggested to worsen urinary symptoms in the presence of HF. Further research is required to understand the impact of UI and an OAB on the HF illness trajectory.
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Ahmad FS, French B, Bowles KH, Sevilla-Cazes J, Jaskowiak-Barr A, Gallagher TR, Kangovi S, Goldberg LR, Barg FK, Kimmel SE. Incorporating patient-centered factors into heart failure readmission risk prediction: A mixed-methods study. Am Heart J 2018; 200:75-82. [PMID: 29898852 DOI: 10.1016/j.ahj.2018.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 03/03/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Capturing and incorporating patient-centered factors into 30-day readmission risk prediction after hospitalized heart failure (HF) could improve the modest performance of current models. METHODS Using a mixed-methods approach, we developed a patient-centered survey and evaluated the additional predictive utility of the survey compared to a traditional readmission risk model (the Krumholz et al. model). Area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow goodness-of-fit statistic quantified the performance of both models. We measured the amount of model improvement with the addition of patient-centered factors to the Krumholz et al. model with the integrated discrimination improvement (IDI). In an exploratory analysis, we used hierarchical clustering algorithms to identify groups with similar survey responses and tested for differences between clusters using standard descriptive statistics. RESULTS From 3/24/2014 to 3/12/2015, 183 patients hospitalized with HF were enrolled from an urban, academic health system and followed for 30days after discharge. The Krumholz et al. plus patient-centered factors model had similar-to-slightly lower performance (AUC [95%CI]:0.62 [0.52, 0.71]; goodness-of-fit P=.10) than the Krumholz et al. model (AUC [95%CI]:0.66 [0.57, 0.76]; goodness-of-fit P=.19). The IDI (95%CI) was 0.003 (-0.014,0.020). We identified three patient clusters based on patient-centered survey responses. The clusters differed with respect to gender, self-rated health, employment status, and prior hospitalization frequency (all P<.05). CONCLUSIONS The addition of patient-centered factors did not improve 30-day readmission model performance. Rather than designing interventions based on predicted readmission risk, tailoring interventions to all patients, based on their characteristics, could inform the design of targeted, readmission reduction strategies.
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Copeland LA, Zeber JE, Thibodeaux LV, McIntyre RT, Stock EM, Hochhalter AK. Postdischarge Correlates of Health Literacy Among Medicaid Inpatients. Popul Health Manag 2018; 21:493-500. [PMID: 29596034 DOI: 10.1089/pop.2017.0095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Health literacy may represent a target for intervention to improve hospital transitions. This study analyzed the association of health literacy with postdischarge utilization among Medicaid patients treated in an integrated health care system. Discharged inpatients covered by Medicaid (N = 112) participated in this observational study set in a single 600-bed hospital in a private, nonprofit, integrated health care system in the southwestern United States. Participants completed surveys within 15 days of discharge, self-reporting demographics, self-care behaviors, and 2 measures of health literacy (REALM-SF [Short Form of the Rapid Estimate of Adult Literacy in Medicine] and Chew [health literacy screen from Chew et al]). Electronic medical records data were incorporated to determine occurrence of 30-day/90-day postdischarge emergency visits and readmission. Half the respondents (54%) scored at the high-school grade equivalent on REALM-SF, while 46% scored adequate health literacy on the Chew. Forty percent (40%) experienced either emergency care or readmission within 90 days post discharge. Patients who were younger, female, or living with children had relatively better health literacy. Health literacy itself was not associated with readmission or postdischarge emergency care, although African American race was. Although Medicaid patients varied considerably on health literacy, this factor was not associated with adverse health care outcomes. Future work should better identify individuals requiring supportive transition services to reduce problems following hospital discharge.
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Affiliation(s)
- Laurel A Copeland
- 1 Center for Applied Health Research , Baylor Scott & White Health, Temple, Texas
- 2 VA Central Western Massachusetts Healthcare , Leeds, Massachusetts
- 3 Department of Psychiatry, UT Health , San Antonio, Texas
| | - John E Zeber
- 1 Center for Applied Health Research , Baylor Scott & White Health, Temple, Texas
- 3 Department of Psychiatry, UT Health , San Antonio, Texas
- 4 Central Texas Veterans Health Care System , Temple, Texas
| | | | | | - Eileen M Stock
- 6 VA Maryland Health Care System , Perry Point, Maryland
| | - Angela K Hochhalter
- 5 Baylor Scott & White Health , Temple, Texas
- 7 Texas A&M Health Science Center , Temple, Texas
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Fivecoat HC, Sayers SL, Riegel B. Social support predicts self-care confidence in patients with heart failure. Eur J Cardiovasc Nurs 2018. [PMID: 29533083 DOI: 10.1177/1474515118762800] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Self-care for patients with heart failure includes engaging in behaviours that maintain medical stability and manage problematic symptoms, as well as the confidence in one's ability to carry out such behaviours. Given the social context of self-care behaviours in heart failure, there has been increasing interest in social support as a predictor of self-care. AIM The goal of the present study was to examine the role of social support in self-care across time for persons with heart failure. METHODS Using data from an observational study of patients with chronic heart failure ( n = 280), we examined the role of three types of support - instrumental support, emotional support and assistance with self-care - in the longitudinal course of self-care maintenance, management and confidence. Self-report questionnaire data were collected at baseline and at three and six months later. RESULTS We found that instrumental and emotional support predicted better self-care confidence on average and that self-care confidence improved at a faster rate for those with less instrumental support. Emotional support was positively associated with self-care management and self-care confidence, and assistance with self-care was positively associated with self-care maintenance. CONCLUSION These findings highlight the contribution of social support to self-care in heart failure and provide guidance for future family-based interventions to improve self-care.
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Affiliation(s)
- Hayley C Fivecoat
- 1 Mental Illness Research, Education and Clinical Center, Corporal Michael J Crescenz VA Medical Center, Philadelphia, USA.,2 Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Steven L Sayers
- 1 Mental Illness Research, Education and Clinical Center, Corporal Michael J Crescenz VA Medical Center, Philadelphia, USA.,2 Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Barbara Riegel
- 3 School of Nursing, University of Pennsylvania, Philadelphia, USA
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Pennathur PR, Ayres BS. A qualitative investigation of healthcare workers' strategies in response to readmissions. BMC Health Serv Res 2018; 18:138. [PMID: 29482531 PMCID: PMC5827983 DOI: 10.1186/s12913-018-2945-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 02/19/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Readmission of a patient to a hospital is typically associated with significant clinical changes in the patient's condition, but it is unknown how healthcare workers modify their provision of care when considering these changes. The purpose of the present study was to determine how healthcare workers shift their care strategies when treating readmitted patients. METHODS A typical case sampling study of healthcare workers was conducted using the grounded theory approach. The study setting comprised several patient care units at an academic center and tertiary-care hospital. We purposively sampled 34 healthcare workers (19 women, 15 men) to participate in individual interviews, either face-to-face or by telephone. We asked the participants semi structured questions regarding their thoughts on readmissions and how they altered their process and behavior for readmitted patients. Interviews were audio-recorded and transcribed. We used a qualitative data analyses based on an inductive approach to generate themes about how healthcare workers shift their strategies for readmitted patients. RESULTS Healthcare workers' shifts in strategy for readmissions were reflected in three major themes: clinical assessment, use and management of information, and communication patterns. Participants reported that they became more conservative in their assessment of the clinical condition of a readmitted patient. The participants also indicated that readmitted patients would be treated in a similar way to normal admission based on care requirements; however, somewhat paradoxically, they also expressed that having access to prior patient information changed the way they treated a readmitted patient. CONCLUSIONS Although healthcare workers may exhibit a tendency to become more conservative with readmissions, readily available patient information from the previous admission played a large part in guiding their thinking. A more conservative approach with a readmitted patient, on its own, does not necessarily lead to improved documentation or better patient care.
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Affiliation(s)
| | - Brennan S. Ayres
- Department of Mechanical and Industrial Engineering, University of Iowa, Iowa City, 52242 USA
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Lim SL, Chan SP, Lee KY, Ching A, Holden RJ, Miller KF, Storrow AB, Lam CS, Collins SP. An East-West comparison of self-care barriers in heart failure. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 8:615-622. [PMID: 29283270 DOI: 10.1177/2048872617744352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Barriers in heart failure self-care contribute to heart failure hospitalizations, but geographic differences have not been well-studied. We aimed to compare self-care barriers in heart failure patients managed at tertiary centers in an Eastern (Singapore) versus a Western (USA) nation. METHODS Acute heart failure patients were prospectively assessed with a standardized instrument comprising of 47 distinct self-care barriers. The multi-equation generalized structural equation model was used to evaluate for geographic differences in barriers experienced, and association of barriers with outcomes. RESULTS Patient-related factors accounted for six out of 10 most prevalent self-care barriers among the 90 patients, with a median number of 11 barriers reported per patient. The Western patients reported a higher level of barriers when compared with their Eastern counterparts (median (interquartile range) 15 (9-24) versus 9 (4-16), p=0.001), after adjusting for demographics and co-morbidities. Many of these differences could be explained by geographic differences between the countries. There was no significant difference identified in all-cause mortality (19.4% versus 10.2%) and heart failure re-hospitalization (41.9% versus 45.8%) at six months between the groups. CONCLUSIONS Self-care barriers are highly prevalent among acute heart failure patients, and differ substantially between East and West, but were not associated with geographic differences in outcomes.
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Affiliation(s)
- Shir Lynn Lim
- Department of Cardiology, National University Heart Center, Singapore
| | - Siew Pang Chan
- Department of Medicine, National University of Singapore, Singapore.,Cardiovascular Research Institute, National University Heart Center, Singapore
| | - Kim Yee Lee
- Department of Cardiology, National University Heart Center, Singapore
| | - Anne Ching
- Department of Cardiology, National University Heart Center, Singapore
| | - Richard J Holden
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, USA.,Indiana University Center for Aging Research, USA
| | | | | | - Carolyn Sp Lam
- Department of Cardiology, National Heart Center, Singapore.,Duke-NUS Graduate Medical School, Singapore
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Borkenhagen LS, McCoy RG, Havyer RD, Peterson SM, Naessens JM, Takahashi PY. Symptoms Reported by Frail Elderly Adults Independently Predict 30-Day Hospital Readmission or Emergency Department Care. J Am Geriatr Soc 2017; 66:321-326. [PMID: 29231962 DOI: 10.1111/jgs.15221] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the degree to which self-reported symptoms predict unplanned readmission or emergency department (ED) care within 30 days of high-risk, elderly adults enrolled in a posthospitalization care transition program (CTP). DESIGN Retrospective cohort study. SETTING Posthospitalization CTP at Mayo Clinic, Rochester, Minnesota, from January 1, 2013, through March 3, 2015. PARTICIPANTS Frail, elderly adults (N = 230; mean age 83.5 ± 8.3, 46.5% male). MEASUREMENTS Charlson Comorbidity Index (CCI) and self-reported symptoms, measured using the Edmonton Symptom Assessment System (ESAS), were ascertained upon CTP enrollment. RESULTS Mean CCI was 3.9 ± 2.3. Of 51 participants returning to the hospital within 30 days of discharge, 13 had ED visits, and 38 were readmitted. Age, sex, and CCI were not significantly different between returning and nonreturning participants, but returning participants were significantly more likely to report shortness of breath (P = .004), anxiety (P = .02), depression (P = .02), and drowsiness (P = .01). Overall ESAS score was also a significant predictor of hospital return (P = .01). CONCLUSION Four self-reported symptoms and overall ESAS score, but not CCI, ascertained after hospital discharge were strong predictors of hospital return within 30 days. Including symptoms in risk stratification of high-risk elderly adults may help target interventions and reduce readmissions.
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Affiliation(s)
- Lynn S Borkenhagen
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rozalina G McCoy
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota.,Division of Health Care Policy & Research, Mayo Clinic, Rochester, Minnesota
| | - Rachel D Havyer
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Stephanie M Peterson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - James M Naessens
- Division of Health Care Policy & Research, Mayo Clinic, Rochester, Minnesota
| | - Paul Y Takahashi
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Disdier Moulder MP, Larock JM, Garofoli A, Foley DA. Family Help With Medication Management: A Predictive Marker for Early Readmission. Mayo Clin Proc Innov Qual Outcomes 2017; 1:211-218. [PMID: 30225419 PMCID: PMC6132200 DOI: 10.1016/j.mayocpiqo.2017.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVES To identify aspects of medication management that are associated with a greater risk of hospital readmission. PATIENTS AND METHODS We conducted a prospective cohort study, with a thorough medication history and reconciliation performed at admission and discharge. Patients 18 years or older (N=258) were prospectively enrolled on admission to a cardiology service at a tertiary care hospital from September 1, 2011, through July 31, 2012. All patients received their hospital and outpatient care within our institution, which minimized loss to follow-up. Readmission rates within 30 days and 6 months after discharge were recorded and used to investigate associations with specific characteristics related to medication regimen and management. Nominal logistic fit tests were used to establish associations with risk factors. RESULTS A higher risk of readmission within 30 days after discharge was seen with heart failure diagnosis (P=.003) and with increased severity of comorbid conditions based on Charlson score (P=.02). Patients whose family managed their medications entirely had a higher risk of readmission at 30 days (odds ratio, 2.92; 95% CI, 1.25-5.6; P=.01) and at 6 months (odds ratio, 3.54; 95% CI, 1.70-7.65; P<.001). These findings were independent of the presence of heart failure. CONCLUSION Patients requiring family member support with medication management should be considered at increased risk for readmission. Increased focus on these patients at discharge may help decrease readmissions.
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Affiliation(s)
| | | | | | - David A. Foley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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46
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Riegel B, Moser DK, Buck HG, Dickson VV, Dunbar SB, Lee CS, Lennie TA, Lindenfeld J, Mitchell JE, Treat-Jacobson DJ, Webber DE. Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association. J Am Heart Assoc 2017; 6:e006997. [PMID: 28860232 PMCID: PMC5634314 DOI: 10.1161/jaha.117.006997] [Citation(s) in RCA: 260] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Self-care is defined as a naturalistic decision-making process addressing both the prevention and management of chronic illness, with core elements of self-care maintenance, self-care monitoring, and self-care management. In this scientific statement, we describe the importance of self-care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self-care behaviors such as diet and exercise, barriers to self-care, and the effectiveness of self-care in improving outcomes is reviewed, as is the evidence supporting various individual, family-based, and community-based approaches to improving self-care. Although there are many nuances to the relationships between self-care and outcomes, there is strong evidence that self-care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self-care in evidence-based guidelines.
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47
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Breathett K, D'Amico R, Adesanya TMA, Hatfield S, Willis S, Sturdivant RX, Foraker RE, Smith S, Binkley P, Abraham WT, Peterson PN. Patient Perceptions on Facilitating Follow-Up After Heart Failure Hospitalization. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.004099. [PMID: 28615367 DOI: 10.1161/circheartfailure.117.004099] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 05/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Timely follow-up after hospitalization for heart failure (HF) is recommended. However, follow-up is suboptimal, especially in lower socioeconomic groups. Patient-centered solutions for facilitating follow-up post-HF hospitalization have not been extensively evaluated. METHODS AND RESULTS Face-to-face surveys were conducted between 2015 and 2016 among 83 racially diverse adult patients (61% African American, 34% Caucasian, and 5% Other) hospitalized for HF at a university hospital centered in a low-income area of Columbus, Ohio. Patient perceptions of methods to facilitate follow-up post-HF hospitalization and likelihood of using interventions were investigated using a Likert scale: 1=very much to 5=not at all. Results were analyzed by Wilcoxon signed-rank test with Bonferroni correction. The response rate was 82%. The annual household income was <$35 000 for 49% of patients. An appointment near the patient's home was the most desired intervention (77%), followed by reminder message (73%), transportation to appointment (63%), and elimination of copayment (59%). Interventions most likely to be used if provided were similarly ranked: reminder message (48%), appointment near home (46%), elimination of copay (46%), and transportation to appointment (39%). There were significant differences (P=0.001) in high-ranking interventions related to location (appointment near home, transportation, home appointment) and reminder for visit compared with low-ranking interventions related to time (weekend appointment, appointment after 5 pm) and telemedicine. CONCLUSIONS Among this cohort of racially diverse low-income patients hospitalized with HF, an appointment near the patient's home and a reminder message were the most desired interventions to facilitate follow-up. Further study of similar populations nationwide is warranted.
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Affiliation(s)
- Khadijah Breathett
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.).
| | - Rachel D'Amico
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - T M Ayodele Adesanya
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Stefanie Hatfield
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Shannon Willis
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Rodney X Sturdivant
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Randi E Foraker
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Sakima Smith
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Philip Binkley
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - William T Abraham
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
| | - Pamela N Peterson
- From the Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora (K.B., P.N.P.); School of Medicine (R.D., T.M.A.A.), Division of Biostatistics (R.X.S.), and Division of Epidemiology (R.E.F.), Ohio State University, Columbus; Ohio State University Hospital East, Columbus (S.H.); Department of Medicine, Gwinnett Medical Center, Lawrenceville, GA (S.W.); Division of Biostatistics, Azusa Pacific University, CA (R.X.S.); Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (S.S., P.B., W.T.A.); and Division of Cardiology, Denver Health Medical Center, CO (P.N.P.)
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Pedersen SS, Schmidt T, Skovbakke SJ, Wiil UK, Egstrup K, Smolderen KG, Spertus JA. A Personalized and Interactive Web-Based Health Care Innovation to Advance the Quality of Life and Care of Patients With Heart Failure (ACQUIRE-HF): A Mixed Methods Feasibility Study. JMIR Res Protoc 2017; 6:e96. [PMID: 28536092 PMCID: PMC5461421 DOI: 10.2196/resprot.7110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/31/2017] [Accepted: 04/08/2017] [Indexed: 12/16/2022] Open
Abstract
Background Heart failure (HF) is a progressive, debilitating, and complex disease, and due to an increasing incidence and prevalence, it represents a global health and economic problem. Hence, there is an urgent need to evaluate alternative care modalities to current practice to safeguard a high level of care for this growing population. Objective Our goal was to examine the feasibility of engaging patients to use patient-centered and personalized tools coupled with a Web-based, shared care and interactive platform in order to empower and enable them to live a better life with their disease. Methods We used a mixed methods, single-center, pre-post design. Patients with HF and reduced left ventricular ejection fraction (n=26) were recruited from the outpatient HF clinic at Odense University Hospital (Svendborg Hospital), Denmark, between October 2015 and March 2016. Patients were asked to monitor their health status via the platform using the standardized, disease-specific measure, the Kansas City Cardiomyopathy Questionnaire (KCCQ), and to register their weight. A subset of patients and nursing staff were interviewed after 3-month follow-up about their experiences with the platform. Results Overall, patients experienced improvement in patient-reported health status but deterioration in self-care behavior between baseline and 3-month follow-up. The mean score reflecting patient expectations toward use prior to start of the study was lower (16 [SD 5]) than their actual experiences with use of the platform (21 [SD 5]) after 3-month follow-up. Of all patients, 19 completed both a baseline and follow-up KCCQ. A total of 9 experienced deterioration in their health status (range from 3-34 points), while 10 experienced an improvement (range from 1-23 points). The qualitative data indicated that the majority of patients found the registration and monitoring on the platform useful. Both nursing staff and patients indicated that such monitoring could be a useful tool to engage and empower patients, in particular when patients are just diagnosed with HF. Conclusions The use of patient tracking and monitoring of health status in HF using a standardized and validated measure seems feasible and may lead to insights that will help educate, empower, and engage patients more in their own disease management, although it is not suitable for all patients. Nursing staff found the patient-centered tool beneficial as a communication tool with patients but were more reticent with respect to using it as a replacement for the personal contact in the outpatient clinic.
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Affiliation(s)
- Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Thomas Schmidt
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | | | - Uffe Kock Wiil
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Kenneth Egstrup
- Department of Medical Research, Odense University Hospital, Svendborg, Denmark
| | - Kim G Smolderen
- Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City, MO, United States
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City, MO, United States
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Lloyd T, Buck H, Foy A, Black S, Pinter A, Pogash R, Eismann B, Balaban E, Chan J, Kunselman A, Smyth J, Boehmer J. The Penn State Heart Assistant: A pilot study of a web-based intervention to improve self-care of heart failure patients. Health Informatics J 2017; 25:292-303. [DOI: 10.1177/1460458217704247] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Tom Lloyd
- Department of Public Health Sciences, Penn State College of Medicine, USA
| | - Harleah Buck
- College of Nursing, University of South Florida, USA
| | | | - Sara Black
- Heart and Vascular Institute, Penn State Health, USA
| | - Antony Pinter
- Penn State College of Information Sciences and Technology, USA
| | - Rosanne Pogash
- Department of Public Health Sciences, Penn State College of Medicine, USA
| | | | | | | | - Allen Kunselman
- Department of Public Health Sciences, Penn State College of Medicine, USA
| | - Joshua Smyth
- College of Health and Human Development, Penn State University, USA
| | - John Boehmer
- Heart and Vascular Institute, Penn State Health, USA
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Rates and predictive factors of return to the emergency department following an initial release by the emergency department for acute heart failure. CAN J EMERG MED 2017; 20:222-229. [PMID: 28367768 DOI: 10.1017/cem.2017.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Following release by emergency department (ED) for acute heart failure (AHF), returns to ED represent important adverse health outcomes. The objective of this study was to document relapse events and factors associated with return to ED in the 14-day period following release by ED for patients with AHF. METHODS The primary outcome was the number of return to ED for patients who were release by ED after the initial visit, for any related medical problem within 14 days of this initial ED visit. RESULTS Return visits to the EDs occurred in 166 (20%) patients. Of all patients who returned to ED within the 14-day period, 77 (47%) were secondarily admitted to the hospital. The following factors were associated with return visits to ED: past medical history of percutaneous coronary intervention or coronary artery bypass graft (aOR=1.51; 95% CIs [1.01-2.24]), current use of antiarrhythmics medications (1.96 [1.05-3.55]), heart rate above 80 /min (1.89 [1.28-2.80]), systolic blood pressure below 140 mm Hg (1.67[1.14-2.47]), oxygen saturation (SaO2) above 96% (1.58 [1.08-2.31]), troponin above the upper reference limit of normal (1.68 [1.15-2.45]), and chest X-ray with pleural effusion (1.52 [1.04-2.23]). CONCLUSIONS Many heart failure patients (i.e. 1 in 5 patients) are released from the ED and then suffer return to ED. Patients with multiple medical comorbidities, and those with abnormal initial vital signs are at increased risk for return to ED and should be identified.
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