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Rajamohan M, Jayhoon Z, Gomez B, Tankel F, Clarke N, Foskett S, Baumann A, Quilty S, Kozor R, Wong CX. Heart failure among Indigenous and non-Indigenous Australians in remote Central Australia. Intern Med J 2024; 54:755-763. [PMID: 37929803 DOI: 10.1111/imj.16256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND There is a paucity of data on the burden of heart failure (HF) in Central Australia, the most populous Indigenous region in the country. AIMS To characterize Indigenous and non-Indigenous Australians with HF in Central Australia. METHODS Consecutive patients with HF and reduced ejection fraction <50% were included for the period 2019 to 2021. Clinical, echocardiographic and major adverse cardiovascular events (MACE) data were collected. RESULTS Four hundred twenty-four patients with HF were included (70% Indigenous, 59% male; follow-up 2.2 ± 0.5 years). Indigenous Australians were younger (53 ± 15 vs 68 ± 13 years, P < 0.001) with higher rates of rheumatic heart disease (18% vs 1%, P < 0.001), diabetes (63% vs 33%, P < 0.001) and severe chronic kidney disease (CKD; 32% vs 7%, P < 0.001). HF was more prevalent among Indigenous (138 [95% confidence interval (CI), 123-155] per 10 000) compared with non-Indigenous Australians (53 [95% CI, 44-63] per 10 000), particularly among younger individuals and females. There were similar HF aetiologies between groups. Guideline-directed medical therapy (GDMT) was suboptimal and similar between the groups: angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (64% vs 67%, P = 0.47) and β-blockers (68% vs 71%, P = 0.47). Indigenous Australians had a significantly higher rate of MACE (54% vs 28%, P < 0.001) and death from any cause (24% vs 13%, P = 0.013). CONCLUSIONS HF is more than two times as prevalent among Indigenous Central Australians, particularly among younger individuals and females. Despite similar HF aetiologies and GDMT, MACE and mortality outcomes are higher in Indigenous individuals with HF. These data have implications for efforts to close the Indigenous gap in morbidity and mortality.
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Affiliation(s)
- Manoj Rajamohan
- Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- Faculty of Medicine and Health, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | | | - Benjamin Gomez
- Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Fraser Tankel
- Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Nicholas Clarke
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sheena Foskett
- Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Angus Baumann
- Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Simon Quilty
- Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Rebecca Kozor
- Faculty of Medicine and Health, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Christopher X Wong
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Ye S, Corbett C, Dennis ASM, Jape D, Patel H, Zentner D, Hopper I. Palliative Care Utilisation and Outcomes in Patients Admitted for Heart Failure in a Victorian Healthcare Service. Heart Lung Circ 2024:S1443-9506(24)00052-0. [PMID: 38461106 DOI: 10.1016/j.hlc.2024.01.022] [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: 09/14/2023] [Revised: 12/22/2023] [Accepted: 01/11/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Heart failure (HF) has high mortality and healthcare utilisation. It has a complex and unpredictable trajectory, which is often interpreted as a barrier to guideline recommended early integration of palliative care (PC). In particular, lack of referral criteria and misconceptions around PC affect inpatient specialist PC referrals. AIMS The main objective was to characterise the pattern and predictors of referral of HF patients to the specialist inpatient PC consultative service at our healthcare service. METHODS A retrospective, single-centre cohort study was performed on consecutive patients admitted across the hospital with HF over a 12-month period (July 2019-June 2020). Mortality data were checked against state death registry data. RESULTS The 502 patients admitted for HF were elderly (mean age 78±14 years), had high dependency (54% Australian-modified Karnofsky Performance Status (AKPS) 50-70, 29% AKPS 10-40), and high mortality (53% within median 32 months at death registry data linkage). Seven per cent (7%) were referred to inpatient specialist PC. AKPS 10-40 (62% of those referred vs 26% not referred, p<0.01), reliance on carers (65% vs 36%, p<0.01), and New York Heart Association (NYHA) class III-IV symptoms (86% vs 42%, p<0.01) were associated with referral, but two or more admissions in the last 12 months for HF were not (16% vs 10%, p=0.21). Many PC domains, such as symptom burden, distress, and preferred care, were not adequately assessed. CONCLUSIONS Referral to inpatient specialist PC in hospitalised HF patients is low relative to the morbidity and mortality in these patients.
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Affiliation(s)
- Sylvia Ye
- Department of General Medicine, Alfred Hospital, Melbourne, Vic, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
| | - Cathy Corbett
- Department of General Medicine, Alfred Hospital, Melbourne, Vic, Australia; Department of Palliative Care, Alfred Hospital, Melbourne, Vic, Australia
| | | | - Dylan Jape
- Department of General Medicine, Alfred Hospital, Melbourne, Vic, Australia
| | - Hitesh Patel
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Dominica Zentner
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Ingrid Hopper
- Department of General Medicine, Alfred Hospital, Melbourne, Vic, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
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Ranasinghe MP, Koh Y, Vogrin S, Nelson CL, Cohen ND, Voskoboinik A, Nanayakkara S, Haikerwal D, Mateevici C, Wharton J, Casey E, Papapostolou S, Costello B. Early Discharge to Clinic-Based Therapy of Patients Presenting With Decompensated Heart Failure (EDICT-HF): Study Protocol for a Multi-Centre Randomised Controlled Trial. Heart Lung Circ 2024; 33:78-85. [PMID: 38158264 DOI: 10.1016/j.hlc.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Acute decompensated heart failure involves a high rate of mortality and complications. Management typically involves a multi-day hospital admission. However, patients often lose part of their function with each successive admission, and are at a high risk for hospital-associated complications such as nosocomial infection. This study aims to determine the safety and efficacy of the management of patients presenting with acute decompensated heart failure to clinic-based therapy vs usual inpatient care using a reproducible management pathway. METHOD An investigator-initiated, prospective, non-inferiority, 1:1 randomised-controlled trial, stratified by left ventricular ejection fraction including 460 patients with a minimum follow-up of 7 days. This is a multi-centre study to be performed in centres across Victoria, Australia. Participants will be patients with either heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF), admitted for acute decompensation of heart failure. INTERVENTION Early discharge to an outpatient-based Heart Failure Rapid Access Clinical Review (RACER) in addition to frequent medical/nursing at-home review for patients admitted with decompensated heart failure. RESULTS The primary endpoint will be a non-inferiority assessment of re-hospitalisation at 30 days. Secondary outcomes include superiority assessment of hospitalisation at 30 days, a composite clinical endpoint of major adverse cardiac and cerebrovascular event (MACCE), hospital re-admission or mortality at 3 months, achievement of guideline-directed medical therapy, patient assessment of symptoms (visual-analogue scale quantified as area under curve and Kansas City Cardiomyopathy Questionnaire-12 [KCCQ-12]), attendance at 3-month outpatient follow-up, number of bed stays/clinics attended, proportion of patients free from congestion, change in serum creatinine level, treatment for electrolyte disturbances, time to transition from intravenous to oral diuretics, and health economics analysis (cost-benefit analysis, cost-utility analysis, incremental cost-effectiveness ratio). CONCLUSIONS The Early Discharge to Clinic-Based Therapy of Patients Presenting with Decompensated Heart Failure (EDICT-HF) trial will help determine whether earlier discharge to out-of-hospital care is non-inferior to the usual practice of inpatient care, in patients with heart failure admitted to hospital for acute decompensation, as an alternative model of care.
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Affiliation(s)
- Mark P Ranasinghe
- Western Health, Department of Cardiology, Melbourne, Vic, Australia; The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Vic, Australia
| | - Youlin Koh
- Western Health, Department of Cardiology, Melbourne, Vic, Australia
| | - Sara Vogrin
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Vic, Australia
| | - Craig L Nelson
- Western Health, Division of Chronic and Complex Care, Melbourne, Vic, Australia; Western Health, Department of Nephrology, Melbourne, Vic, Australia
| | - Neale D Cohen
- Baker Heart and Diabetes Institute, Diabetes Clinical Research, Melbourne, Vic, Australia
| | - Aleksandr Voskoboinik
- Western Health, Department of Cardiology, Melbourne, Vic, Australia; Heart Centre, The Alfred Hospital, Melbourne, Vic, Australia
| | | | - Deepak Haikerwal
- Western Health, Department of Cardiology, Melbourne, Vic, Australia
| | - Cristina Mateevici
- Western Health, Ambulatory Care Unit, Melbourne, Vic, Australia; Western Health, Department of Infectious Diseases, Melbourne, Vic, Australia
| | - James Wharton
- Western Health, Ambulatory Care Unit, Melbourne, Vic, Australia
| | - Erin Casey
- Western Health, Division of Chronic and Complex Care, Melbourne, Vic, Australia
| | - Stavroula Papapostolou
- Western Health, Department of Cardiology, Melbourne, Vic, Australia; Heart Centre, The Alfred Hospital, Melbourne, Vic, Australia
| | - Ben Costello
- Western Health, Department of Cardiology, Melbourne, Vic, Australia.
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Vakhshoori M, Bondariyan N, Sabouhi S, Kiani K, Alaei Faradonbeh N, Emami SA, Shakarami M, Khanizadeh F, Sanaei S, Motamedi N, Shafie D. The impact of platelet-to-lymphocyte ratio on clinical outcomes in heart failure: a systematic review and meta-analysis. Ther Adv Cardiovasc Dis 2024; 18:17539447241227287. [PMID: 38305256 PMCID: PMC10838041 DOI: 10.1177/17539447241227287] [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] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Inflammation has been suggested to play a role in heart failure (HF) pathogenesis. However, the role of platelet-to-lymphocyte ratio (PLR), as a novel biomarker, to assess HF prognosis needs to be investigated. We sought to evaluate the impact of PLR on HF clinical outcomes. METHODS English-published records in PubMed/Medline, Scopus, and Web-of-science databases were screened until December 2023. Relevant articles evaluated PLR with clinical outcomes (including mortality, rehospitalization, HF worsening, and HF detection) were recruited, with PLR difference analysis based on death/survival status in total and HF with reduced ejection fraction (HFrEF) patients. RESULTS In total, 21 articles (n = 13,924) were selected. The total mean age was 70.36 ± 12.88 years (males: 61.72%). Mean PLR was 165.54 [95% confidence interval (CI): 154.69-176.38]. In total, 18 articles (n = 10,084) reported mortality [either follow-up (PLR: 162.55, 95% CI: 149.35-175.75) or in-hospital (PLR: 192.83, 95% CI: 150.06-235.61) death rate] and the mean PLR was 166.68 (95% CI: 154.87-178.50). Further analysis revealed PLR was significantly lower in survived HF patients rather than deceased group (152.34, 95% CI: 134.01-170.68 versus 194.73, 95% CI: 175.60-213.85, standard mean difference: -0.592, 95% CI: -0.857 to -0.326, p < 0.001). A similar trend was observed for HFrEF patients. PLR failed to show any association with mortality risk (hazard ratio: 1.02, 95% CI: 0.99-1.05, p = 0.289). Analysis of other aforementioned outcomes was not possible due to the presence of few studies of interest. CONCLUSION PLR should be used with caution for prognosis assessment in HF sufferers and other studies are necessary to explore the exact association.
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Affiliation(s)
- Mehrbod Vakhshoori
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Hezar Jarib Avenue, Isfahan, Iran
| | - Niloofar Bondariyan
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sadeq Sabouhi
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Keivan Kiani
- Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nazanin Alaei Faradonbeh
- Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sayed Ali Emami
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrnaz Shakarami
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Shahin Sanaei
- Department of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Davood Shafie
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Khosravirad Z, Rostamzadeh M, Azizi S, Khodashenas M, Khodadoustan Shahraki B, Ghasemi F, ghorbanzadeh M. The Efficacy of Self-care Behaviors, Educational Interventions, and Follow-up Strategies on Hospital Readmission and Mortality Rates in Patients with Heart Failure. Galen Med J 2023; 12:1-7. [PMID: 38774856 PMCID: PMC11108665 DOI: 10.31661/gmj.v12i.3116] [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: 07/11/2023] [Indexed: 05/24/2024] Open
Abstract
Heart failure (HF), a worldwide epidemic with significant morbidity and mortality risks, is frequently secondary to cardiovascular disorders and probably is the common final way to survive patients. Almost 25% of hospitalized patients with acute HF are expected to be readmitted within 30 days post-discharge, and the rates of rehospitalization increase to almost one-third at 60 days and 60 percent within one year of discharge. Although care planning for patients with heart failure is complex, multidisciplinary, and resource-dependent, optimal self-care management along with appropriate educational intervention and follow-up strategy could be able to reduce readmissions, decline the duration of hospitalization, increase life expectancy, decrease the rates of mortality, and reduce costs of healthcare services for patients with HF. However, there are contradictions in previous reports about the efficacy of self-care, mainly due to patients' non-adherence to self-care behaviors. Therefore, the current study aimed to review the investigations on the effectiveness of self-care of HF patients in reducing hospital readmissions and increasing quality of life, and discuss novel approaches for predischarge educational interventions and postdischarge follow-up strategies.
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Affiliation(s)
| | - Mohammad Rostamzadeh
- Department of Cardiology, School of Medicine, Ardabil University of Medical
Sciences, Ardabil, Iran
| | - Shiva Azizi
- Department of Nursing, School of Nursing, North Khorasan University of Medical
Sciences, Bojnurd, Iran
| | | | | | - Farangis Ghasemi
- Department of Biology, Jahrom Branch, Islamic Azad University, Jahrom, Iran
| | - Maryam ghorbanzadeh
- Department of Nursing, School of Nursing, North Khorasan University of Medical
Sciences, Bojnurd, Iran
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Chapman-Goetz J, Packham N, Yu K, Gabb G, Potts C, Prosser A, Arstall MA, Burdeniuk C, Chan A, Wilson T, Hotham E, Suppiah V. NPS MedicineWise application in supporting medication adherence in chronic heart failure: an acceptability and feasibility pilot study. Front Digit Health 2023; 5:1274355. [PMID: 38034908 PMCID: PMC10684918 DOI: 10.3389/fdgth.2023.1274355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Heart failure (HF) is an increasing global concern. Despite evidence-based pharmacotherapy, associated morbidity and mortality remain high. This study aimed to assess the acceptability, feasibility, and value of the NPS MedicineWise dose reminder app in a tiered, pharmacist-led intervention to address medication non-adherence in patients with HF. Methods This prospective, single-blinded, randomised controlled trial recruited 55 patients with HF between September 2019 and October 2020. Participants were randomly assigned to either the intervention or control arms. Intervention participants used the app which prompted medication administration at each dosing interval. Control participants received standard care and remained blinded to the app throughout the study. Treatment non-adherence prompted a tiered, pharmacist-led intervention. Comparison of the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) at baseline and 6-months measured the app's value in supporting medication adherence. Secondary outcome measures included self-reported medication knowledge, health-related quality of life, psychological wellbeing, and signs and symptoms of HF. Data were analysed using standard statistical tests with significance set at α 0.05. Results Approximately half of respondents reported managing HF and medications better by using the MedicineWise app (Tier 1). Most respondents expressed satisfaction with the in-app messages (Tier 2) and pharmacists' phone calls (Tier 3). The intervention participants demonstrated a significant improvement in the SEAMS between baseline and 6-months follow-up. Discussion It is feasible and potentially of value to use the MedicineWise app with a tiered, pharmacist-led intervention to support medication adherence in patients with HF. Our findings provide clinicians with "real-world" information on the practicality and potential value of using mobile health to support treatment adherence in patients with HF. Trial registration number Australian New Zealand Clinical Trials Registry Clinical trial registration number: ACTRN12619000289112p (http://www.ANZCTR.org.au/ACTRN12619000289112p.aspx).
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Affiliation(s)
- Jessica Chapman-Goetz
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Nerida Packham
- Consumer Medicines Information Services, NPS MedicineWise, Surry Hills, NSW, Australia
| | - Kitty Yu
- e-Health, NPS MedicineWise, Melbourne, VIC, Australia
| | - Genevieve Gabb
- Department of Cardiology, Noarlunga GP Plus Super Clinic, Adelaide, SA, Australia
| | - Cassandra Potts
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Adaire Prosser
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Margaret A. Arstall
- Department of Cardiology, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Christine Burdeniuk
- Department of Cardiology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Alicia Chan
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Teena Wilson
- Integrated Cardiovascular Clinical Network, Country Health South Australia, Adelaide, SA, Australia
| | - Elizabeth Hotham
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Vijayaprakash Suppiah
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
- Australian Centre for Precision Health, University of South Australia, Adelaide, SA, Australia
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7
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Chung Y, Garden FL, Marks GB, Vedam H. Causes of hypercapnic respiratory failure: a population-based case-control study. BMC Pulm Med 2023; 23:347. [PMID: 37710243 PMCID: PMC10503117 DOI: 10.1186/s12890-023-02639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVE There are no population-based data on the relative importance of specific causes of hypercapnic respiratory failure (HRF). We sought to quantify the associations between hospitalisation with HRF and potential antecedent causes including chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, and congestive cardiac failure. We used data on the prevalence of these conditions to estimate the population attributable fraction for each cause. METHODS A case-control study was conducted among residents aged ≥ 40 years from the Liverpool local government area in Sydney, Australia. Cases were identified from hospital records based on PaCO2 > 45 mmHg. Controls were randomly selected from the study population using a cluster sampling design. We collected self-reported data on medication use and performed spirometry, limited-channel sleep studies, venous sampling for N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, and sniff nasal inspiratory pressure (SNIP) measurements. Logistic regression analyses were performed using directed acyclic graphs to identify covariates. RESULTS We recruited 42 cases and 105 controls. HRF was strongly associated with post-bronchodilator airflow obstruction, elevated NT-proBNP levels, reduced SNIP measurements and self-reported opioid medication use. There were no differences in the apnoea-hypopnea index or oxygen desaturation index between groups. COPD had the highest population attributable fraction (42%, 95% confidence interval 18% to 59%). CONCLUSIONS COPD, congestive cardiac failure, and self-reported use of opioid medications, but not obstructive sleep apnea, are important causes of HRF among adults over 40 years old. No single cause accounts for the majority of cases based on the population attributable fraction.
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Affiliation(s)
- Yewon Chung
- School of Clinical Medicine, South Western Sydney Clinical Campuses, Discipline of Medicine, UNSW Sydney, Sydney, Australia.
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Locked Bag 7103 Liverpool, Liverpool, Sydney, NSW, BC 1871, Australia.
- Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia.
| | - Frances L Garden
- School of Clinical Medicine, South Western Sydney Clinical Campuses, Discipline of Medicine, UNSW Sydney, Sydney, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia
| | - Guy B Marks
- School of Clinical Medicine, South Western Sydney Clinical Campuses, Discipline of Medicine, UNSW Sydney, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Locked Bag 7103 Liverpool, Liverpool, Sydney, NSW, BC 1871, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia
| | - Hima Vedam
- School of Clinical Medicine, South Western Sydney Clinical Campuses, Discipline of Medicine, UNSW Sydney, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Locked Bag 7103 Liverpool, Liverpool, Sydney, NSW, BC 1871, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia
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8
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Chai R, Ye Z, Xue W, Shi S, Wei Y, Hu Y, Wu H. Tanshinone IIA inhibits cardiomyocyte pyroptosis through TLR4/NF-κB p65 pathway after acute myocardial infarction. Front Cell Dev Biol 2023; 11:1252942. [PMID: 37766966 PMCID: PMC10520722 DOI: 10.3389/fcell.2023.1252942] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Tanshinone IIA, derived from Radix Salviae Miltiorrhizae (Salvia miltiorrhiza Bunge), constitutes a significant component of this traditional Chinese medicine. Numerous studies have reported positive outcomes regarding its influence on cardiac function. However, a comprehensive comprehension of the intricate mechanisms responsible for its cardioprotective effects is still lacking. Methods: A rat model of heart failure (HF) induced by acute myocardial infarction (AMI) was established via ligation of the left anterior descending coronary artery. Rats received oral administration of tanshinone IIA (1.5 mg/kg) and captopril (10 mg/kg) for 8 weeks. Cardiac function was assessed through various evaluations. Histological changes in myocardial tissue were observed using staining techniques, including Hematoxylin and Eosin (HE), Masson, and transmission electron microscopy. Tunel staining was used to detect cell apoptosis. Serum levels of NT-pro-BNP, IL-1β, and IL-18 were quantified using enzyme-linked immunosorbent assay (ELISA). Expression levels of TLR4, NF-κB p65, and pyroptosis-related proteins were determined via western blotting (WB). H9C2 cardiomyocytes underwent hypoxia-reoxygenation (H/R) to simulate ischemia-reperfusion (I/R) injury, and cell viability and apoptosis were assessed post treatment with different tanshinone IIA concentrations (0.05 μg/ml, 0.1 μg/ml). ELISA measured IL-1β, IL-18, and LDH expression in the cell supernatant, while WB analysis evaluated TLR4, NF-κB p65, and pyroptosis-related protein levels. NF-κB p65 protein nuclear translocation was observed using laser confocal microscopy. Results: Tanshinone IIA treatment exhibited enhanced cardiac function, mitigated histological cardiac tissue damage, lowered serum levels of NT-pro-BNP, IL-1β, and IL-18, and suppressed myocardial cell apoptosis. Moreover, tanshinone IIA downregulated the expression of TLR4, NF-κB p65, IL-1β, pro-IL-1β, NLRP3, Caspase-1, and GSDMD-N pyroptosis-related proteins in myocardial tissue. Additionally, it bolstered H/R H9C2 cardiomyocyte viability, curbed cardiomyocyte apoptosis, and reduced the levels of TLR4, NF-κB p65, IL-1β, pro-IL-1β, NLRP3, Caspase-1, and GSDMD-N pyroptosis-related proteins in H/R H9C2 cells. Furthermore, it hindered NF-κB p65 protein nuclear translocation. Conclusion: These findings indicate that tanshinone IIA enhances cardiac function and alleviates myocardial injury in HF rats following AMI. Moreover, tanshinone IIA demonstrates potential suppression of cardiomyocyte pyroptosis. These effects likely arise from the inhibition of the TLR4/NF-κB p65 signaling pathway, presenting a promising therapeutic target.
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Affiliation(s)
| | | | | | | | - Yi Wei
- Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuanhui Hu
- Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huaqin Wu
- Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Shahim B, Kapelios CJ, Savarese G, Lund LH. Global Public Health Burden of Heart Failure: An Updated Review. Card Fail Rev 2023; 9:e11. [PMID: 37547123 PMCID: PMC10398425 DOI: 10.15420/cfr.2023.05] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/10/2023] [Indexed: 08/08/2023] Open
Abstract
Heart failure (HF) is a rapidly growing public health issue with an estimated prevalence of 64 million people globally. Although the incidence of HF has stabilised worldwide and seems to be declining in developed countries, the prevalence is increasing due to the ageing of the population, improved survival after MI and improved treatment and survival of patients with HF. Yet, HF remains associated with high mortality and morbidity, poor quality of life and functional capacity, and confers a substantial burden to the healthcare system. The prevalence, incidence, mortality and morbidity rates reported show geographical variations, depending on the different aetiologies and clinical characteristics observed among patients with HF. In this review, we provide an overview of the global epidemiology of HF with updated data on prevalence, incidence, mortality and morbidity worldwide.
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Affiliation(s)
- Bahira Shahim
- Division of Cardiology, Department of Medicine, Karolinska InstitutetStockholm, Sweden
- Heart and Vascular Theme, Karolinska University HospitalStockholm, Sweden
| | - Chris J Kapelios
- Department of Cardiovascular Medicine, University of Utah Health Sciences CenterSalt Lake City, UT, US
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska InstitutetStockholm, Sweden
- Heart and Vascular Theme, Karolinska University HospitalStockholm, Sweden
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska InstitutetStockholm, Sweden
- Heart and Vascular Theme, Karolinska University HospitalStockholm, Sweden
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NAJAFI-VOSOUGH ROYA, FARADMAL JAVAD, HOSSEINI SEYEDKIANOOSH, MOGHIMBEIGI ABBAS, MAHJUB HOSSEIN. Longitudinal machine learning model for predicting systolic blood pressure in patients with heart failure. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2023; 64:E226-E231. [PMID: 37654862 PMCID: PMC10468193 DOI: 10.15167/2421-4248/jpmh2023.64.2.2887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/22/2023] [Indexed: 09/02/2023]
Abstract
Objective Systolic blood pressure (SBP) strongly indicates the prognosis of heart failure (HF) patients, as it is closely linked to the risk of death and readmission. Hence, maintaining control over blood pressure is a vital factor in the management of these patients. In order to determine significant variables associated with changes in SBP over time and assess the effectiveness of classical and machine learning models in predicting SBP, this study aimed to conduct a comparative analysis between the two. Methods This retrospective cohort study involved the analysis of data from 483 patients with HF who were admitted to Farshchian Heart Center located in Hamadan in the west of Iran, and hospitalized at least two times between October 2015 and July 2019. To predict SBP, we utilized a linear mixed-effects model (LMM) and mixed-effects least-square support vector regression (MLS-SVR). The effectiveness of both models was evaluated based on the mean absolute error and root mean squared error. Results The LMM analysis revealed that changes in SBP over time were significantly associated with sex, body mass index (BMI), sodium, time, and history of hypertension (P-value < 0.05). Furthermore, according to the MLS-SVR analysis, the four most important variables in predicting SBP were identified as history of hypertension, sodium, BMI, and triglyceride. In both the training and testing datasets, MLS-SVR outperformed LMM in terms of performance. Conclusions Based on our results, it appears that MLS-SVR has the potential to serve as a viable alternative to classical longitudinal models for predicting SBP in patients with HF.
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Affiliation(s)
- ROYA NAJAFI-VOSOUGH
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - JAVAD FARADMAL
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - SEYED KIANOOSH HOSSEINI
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - ABBAS MOGHIMBEIGI
- Department of Biostatistics and Epidemiology, Faculty of Health, Alborz University of Medical Sciences, Karaj, Iran
- Research Center for Health, Safety and Environment, Alborz University of Medical Sciences, Karaj, Iran
| | - HOSSEIN MAHJUB
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
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11
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Ahmed KY, Allan J, Dalton H, Sleigh A, Seubsman SA, Ross AG. Reviewing Publicly Available Reports on Child Health Disparities in Indigenous and Remote Communities of Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5959. [PMID: 37297562 PMCID: PMC10253029 DOI: 10.3390/ijerph20115959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
Developing programs that ensure a safe start to life for Indigenous children can lead to better health outcomes. To create effective strategies, governments must have accurate and up-to-date information. Accordingly, we reviewed the health disparities of Australian children in Indigenous and remote communities using publicly available reports. A thorough search was performed on Australian government and other organisational websites (including the Australian Bureau of Statistics [ABS] and the Australian Institute of Health and Welfare [AIHW]), electronic databases [MEDLINE] and grey literature sites for articles, documents and project reports related to Indigenous child health outcomes. The study showed Indigenous dwellings had higher rates of crowding when compared to non-Indigenous dwellings. Smoking during pregnancy, teenage motherhood, low birth weight and infant and child mortality were higher among Indigenous and remote communities. Childhood obesity (including central obesity) and inadequate fruit consumption rates were also higher in Indigenous children, but Indigenous children from remote and very remote areas had a lower rate of obesity. Indigenous children performed better in physical activity compared to non-Indigenous children. No difference was observed in vegetable consumption rates, substance-use disorders or mental health conditions between Indigenous and non-Indigenous children. Future interventions for Indigenous children should focus on modifiable risk factors, including unhealthy housing, perinatal adverse health outcomes, childhood obesity, poor dietary intake, physical inactivity and sedentary behaviours.
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Affiliation(s)
- Kedir Y. Ahmed
- Rural Health Research Institute, Charles Sturt University, Orange, NSW 2800, Australia
| | - Julaine Allan
- Rural Health Research Institute, Charles Sturt University, Orange, NSW 2800, Australia
| | - Hazel Dalton
- Rural Health Research Institute, Charles Sturt University, Orange, NSW 2800, Australia
| | - Adrian Sleigh
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Sam-ang Seubsman
- School of Human Ecology, Sukhothai Thammathirat Open University, Nonthaburi 11120, Thailand
| | - Allen G. Ross
- Rural Health Research Institute, Charles Sturt University, Orange, NSW 2800, Australia
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12
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McGee M, Shephard L, Sugito S, Baker D, Brienesse S, Al-Omary M, Nathan-Marsh R, Ngo DTM, Oakley P, Boyle AJ, Garvey G, Sverdlov AL. Mind The Gap, Aboriginal and Torres Strait Islander Cardiovascular Health: A Narrative Review. Heart Lung Circ 2023; 32:136-142. [PMID: 36336616 DOI: 10.1016/j.hlc.2022.09.017] [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: 03/27/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
Australia's First Nations Peoples, Aboriginal and Torres Strait Islanders, have reduced life expectancy compared to the wider community. Cardiovascular diseases, mainly driven by ischaemic heart disease, are the leading contributors to this disparity. Despite over a third of First Nations Peoples living in New South Wales, the bulk of the peer-reviewed literature is from Central Australia and Far North Queensland. Regardless of the site of publication, First Nations Peoples are significantly younger at disease onset and have higher rates of comorbidities, in turn driving adverse health events. On top of this, very few First Nations Peoples specific cardiovascular interventions or programs have been shown to improve outcomes. The traditional biomedical model of care is less efficacious and non-traditional models of communication such as clinical yarning may benefit both clinicians and patients. The key purpose of this review is to highlight the deficiencies of our knowledge of cardiovascular burden of disease for First Nations Peoples; and to serve as a catalyst for more dedicated research. We need to have relationships with communities and concentrate on community improvement and partnerships. By involving First Nations Peoples researchers in collaboration with local communities in all levels of health care design and intervention will improve outcomes.
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Affiliation(s)
- Michael McGee
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Lauren Shephard
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Stuart Sugito
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - David Baker
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Stephen Brienesse
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Mohammed Al-Omary
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Rhian Nathan-Marsh
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Doan T M Ngo
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia. https://twitter.com/DoanNgo4
| | - Patrick Oakley
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia; Aboriginal Health Unit, Hunter New England Health, Wallsend Health Campus, Newcastle, NSW, Australia; General Medicine Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Andrew J Boyle
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Gail Garvey
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Aaron L Sverdlov
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia.
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13
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Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res 2023; 118:3272-3287. [PMID: 35150240 DOI: 10.1093/cvr/cvac013] [Citation(s) in RCA: 493] [Impact Index Per Article: 493.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/08/2022] [Indexed: 01/25/2023] Open
Abstract
Heart Failure (HF) is a multi-faceted and life-threatening syndrome characterized by significant morbidity and mortality, poor functional capacity and quality of life, and high costs. HF affects more than 64 million people worldwide. Therefore, attempts to decrease its social and economic burden have become a major global public health priority. While the incidence of HF has stabilized and seems to be declining in industrialized countries, the prevalence is increasing due to the ageing of the population, improved treatment of and survival with ischaemic heart disease, and the availability of effective evidence-based therapies prolonging life in patients with HF. There are geographical variations in HF epidemiology. There is substantial lack of data from developing countries, where HF exhibits different features compared with that observed in the Western world. In this review, we provide a contemporary overview on the global burden of HF, providing updated estimates on prevalence, incidence, outcomes, and costs worldwide.
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Affiliation(s)
- Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Moritz Becher
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Giuseppe M C Rosano
- St George's Hospital Medical School, London, UK.,IRCCS San Raffaele Roma, Rome, Italy
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14
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Cardona M, Sav A, Michaleff ZA, Thomas ST, Dobler CC. Alignment of Doctors' Understanding of Treatment Burden Priorities and Chronic Heart Failure Patients' Experiences: A Nominal Group Technique Consultation. Patient Prefer Adherence 2023; 17:153-165. [PMID: 36713974 PMCID: PMC9880013 DOI: 10.2147/ppa.s385911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/18/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To identify and rank areas of treatment burden in chronic heart failure (CHF), including solutions, that should be discussed during the clinical encounter from a patient, and doctors' perspective. PATIENTS AND METHODS Patients with CHF and clinicians managing heart failure were invited. Nominal group technique sessions held either face to face or online in 2021-2022, with individual identification of priorities and voting on ranking. RESULTS Four patient groups (N=22) and one doctor group (N=5) were held. For patients with heart failure, in descending order of priority Doctor-patient communication, Inefficiencies of the healthcare system, Healthcare access issues, Cost implications of treatment, Psychosocial impacts on patients and their families, and Impact of treatment work were the most important treatment burdens. Priorities independently identified by the doctors aligned with the patients' but ranking differed. Patient solutions ranged from involvement of nurses or pharmacists to enhance understanding of discharge planning, through to linkage between health information systems, and maintaining strong family or social support networks. Doctors' solutions covered timing medicines with activities of daily living, patient education on the importance of compliance, medication reviews to overcome clinical inertia, and routine clinical audits. CONCLUSION The top treatment burden priorities for CHF patients were related to interaction with clinicians and health system inefficiencies, whereas doctors were generally aware of patients' treatment burden but tended to focus on the complexity of the direct treatment work. Addressing the priority issues identified here can commence with clinicians becoming aware of the issues that matter to patients and proactively discussing feasible immediate and longer-term solutions during clinical encounters.
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Affiliation(s)
- Magnolia Cardona
- Institute for Evidence Based Healthcare, Bond University, Robina, Queensland, Australia
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Correspondence: Magnolia Cardona, Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine Level 4, HSM Building 5, Bond University, Robina, Queensland, 4226, Australia, Tel +61 7 5595 0170, Email
| | - Adem Sav
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Zoe A Michaleff
- Institute for Evidence Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Sarah T Thomas
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Claudia C Dobler
- Institute for Evidence Based Healthcare, Bond University, Robina, Queensland, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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15
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Ben Ismail E, Jaana M, Sherrard H, MacPhee E. IVR System Use by Patients with Heart Failure: Compliance and Services Utilization Patterns. J Med Syst 2022; 46:69. [PMID: 36104511 PMCID: PMC9474272 DOI: 10.1007/s10916-022-01847-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/16/2022] [Accepted: 07/25/2022] [Indexed: 10/25/2022]
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16
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Davies P, Smith S, Wilcox R, Stewart JD, Davis TJ, McKenna K, Hanson J. Examination of the independent contribution of rheumatic heart disease and congestive cardiac failure to the development and outcome of melioidosis in Far North Queensland, tropical Australia. PLoS Negl Trop Dis 2022; 16:e0010604. [PMID: 35849581 PMCID: PMC9292120 DOI: 10.1371/journal.pntd.0010604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/23/2022] [Indexed: 11/19/2022] Open
Abstract
Background Patients with rheumatic heart disease (RHD) and congestive cardiac failure (CCF) are believed to have an increased risk of melioidosis and are thought to be more likely to die from the infection. This study was performed to confirm these findings in a region with a high incidence of all three conditions. Principal findings Between January 1998 and December 2021 there were 392 cases of melioidosis in Far North Queensland, tropical Australia; 200/392 (51.0%) identified as an Indigenous Australian, and 337/392 (86.0%) had a confirmed predisposing comorbidity that increased risk for the infection. Overall, 46/392 (11.7%) died before hospital discharge; the case fatality rate declining during the study period (p for trend = 0.001). There were only 3/392 (0.8%) with confirmed RHD, all of whom had at least one other risk factor for melioidosis; all 3 survived to hospital discharge. Among the 200 Indigenous Australians in the cohort, 2 had confirmed RHD; not statistically greater than the prevalence of RHD in the local general Indigenous population (1.0% versus 1.2%, p = 1.0). RHD was present in only 1/193 (0.5%) cases of melioidosis diagnosed after October 2016, a period which coincided with prospective data collection. There were 26/392 (6.6%) with confirmed CCF, but all 26 had another traditional risk factor for melioidosis. Patients with CCF were more likely to also have chronic lung disease (OR (95% CI: 4.46 (1.93–10.31), p<0.001) and chronic kidney disease (odds ratio (OR) (95% confidence interval (CI): 2.98 (1.22–7.29), p = 0.01) than those who did not have CCF. Two patients with melioidosis and CCF died before hospital discharge; both were elderly (aged 81 and 91 years) and had significant comorbidity. Conclusions In this region of tropical Australia RHD and CCF do not appear to be independent risk factors for melioidosis and have limited prognostic utility. Melioidosis, a disease caused by Burkholderia pseudomallei, rarely develops in the absence of well-described predisposing conditions that include diabetes mellitus, hazardous alcohol intake, chronic kidney disease, chronic lung disease, malignancy, and immunosuppression. These comorbidities are also strongly linked to patients’ short and long-term outcomes. In the large Darwin Prospective Melioidosis Study (DPMS) performed in Australia’s Northern Territory, the presence of rheumatic heart disease (RHD) and/or congestive cardiac failure (CCF) were independently associated with pulmonary melioidosis and independently predicted death. Indeed, patients with RHD and/or CCF and melioidosis had the highest case-fatality rate in the DPMS cohort. The prevalence of RHD and/or CCF in cases of melioidosis in this study in Far North Queensland (FNQ), was similar to that seen in the Northern Territory. However, every patient had at least one other traditional risk factor for the disease. Furthermore, pulmonary involvement and mortality were not higher in patients with RHD and/or CCF. In FNQ, RHD and CCF are not independent risk factors for melioidosis and have limited prognostic utility. The high prevalence of these cardiac diseases in patients with melioidosis may be, at least partly, explained by the confounding presence of socioeconomic disadvantage that increases the incidence of all three conditions.
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Affiliation(s)
- Phoebe Davies
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Rob Wilcox
- Tropical Public Health Service, Cairns, Queensland, Australia
| | - James D. Stewart
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Tania J. Davis
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Kylie McKenna
- Tropical Public Health Service, Cairns, Queensland, Australia
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
- Kirby Institute, University of New South Wales, Sydney, Australia
- * E-mail:
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17
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Chai R, Xue W, Shi S, Zhou Y, Du Y, Li Y, Song Q, Wu H, Hu Y. Cardiac Remodeling in Heart Failure: Role of Pyroptosis and Its Therapeutic Implications. Front Cardiovasc Med 2022; 9:870924. [PMID: 35509275 PMCID: PMC9058112 DOI: 10.3389/fcvm.2022.870924] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/31/2022] [Indexed: 12/17/2022] Open
Abstract
Pyroptosis is a kind of programmed cell death closely related to inflammation. The pathways that mediate pyroptosis can be divided into the Caspase-1-dependent canonical pathway and the Caspase4/5/11-dependent non-canonical pathway. The most significant difference from other cell death is that pyroptosis rapidly causes rupture of the plasma membrane, cell expansion, dissolution and rupture of the cell membrane, the release of cell contents and a large number of inflammatory factors, and send pro-inflammatory signals to adjacent cells, recruit inflammatory cells and induce inflammatory responses. Cardiac remodeling is the basic mechanism of heart failure (HF) and the core of pathophysiological research on the underlying mechanism. A large number of studies have shown that pyroptosis can cause cardiac fibrosis, cardiac hypertrophy, cardiomyocytes death, myocardial dysfunction, excessive inflammation, and cardiac remodeling. Therefore, targeting pyroptosis has a good prospect in improving cardiac remodeling in HF. In this review, the basic molecular mechanism of pyroptosis is summarized, the relationship between pyroptosis and cardiac remodeling in HF is analyzed in-depth, and the potential therapy of targeting pyroptosis to improve adverse cardiac remodeling in HF is discussed, providing some ideas for improving the study of adverse cardiac remodeling in HF.
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Affiliation(s)
- Ruoning Chai
- Department of Cardiovascular, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wenjing Xue
- Department of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Shuqing Shi
- Department of Internal Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yu Zhou
- Department of Clinical Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yihang Du
- Department of Cardiovascular, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuan Li
- Department of Clinical Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Qingqiao Song
- Department of Internal Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huaqin Wu
- Department of Cardiovascular, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Huaqin Wu
| | - Yuanhui Hu
- Department of Cardiovascular, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Yuanhui Hu
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Jones JL, Lumsden NG, Simons K, Ta'eed A, de Courten MP, Wijeratne T, Cox N, Neil CJA, Manski-Nankervis JA, Hamblin PS, Janus ED, Nelson CL. Using electronic medical record data to assess chronic kidney disease, type 2 diabetes and cardiovascular disease testing, recognition and management as documented in Australian general practice: a cross-sectional analysis. Fam Med Community Health 2022; 10:fmch-2021-001006. [PMID: 35177470 PMCID: PMC8860071 DOI: 10.1136/fmch-2021-001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives To evaluate the capacity of general practice (GP) electronic medical record (EMR) data to assess risk factor detection, disease diagnostic testing, diagnosis, monitoring and pharmacotherapy for the interrelated chronic vascular diseases—chronic kidney disease (CKD), type 2 diabetes (T2D) and cardiovascular disease. Design Cross-sectional analysis of data extracted on a single date for each practice between 12 April 2017 and 18 April 2017 incorporating data from any time on or before data extraction, using baseline data from the Chronic Disease early detection and Improved Management in PrimAry Care ProjecT. Deidentified data were extracted from GP EMRs using the Pen Computer Systems Clinical Audit Tool and descriptive statistics used to describe the study population. Setting Eight GPs in Victoria, Australia. Participants Patients were ≥18 years and attended GP ≥3 times within 24 months. 37 946 patients were included. Results Risk factor and disease testing/monitoring/treatment were assessed as per Australian guidelines (or US guidelines if none available), with guidelines simplified due to limitations in data availability where required. Risk factor assessment in those requiring it: 30% of patients had body mass index and 46% blood pressure within guideline recommended timeframes. Diagnostic testing in at-risk population: 17% had diagnostic testing as per recommendations for CKD and 37% for T2D. Possible undiagnosed disease: Pathology tests indicating possible disease with no diagnosis already coded were present in 6.7% for CKD, 1.6% for T2D and 0.33% familial hypercholesterolaemia. Overall prevalence: Coded diagnoses were recorded in 3.8% for CKD, 6.6% for T2D, 4.2% for ischaemic heart disease, 1% for heart failure, 1.7% for ischaemic stroke, 0.46% for peripheral vascular disease, 0.06% for familial hypercholesterolaemia and 2% for atrial fibrillation. Pharmaceutical prescriptions: the proportion of patients prescribed guideline-recommended medications ranged from 44% (beta blockers for patients with ischaemic heart disease) to 78% (antiplatelets or anticoagulants for patients with ischaemic stroke). Conclusions Using GP EMR data, this study identified recorded diagnoses of chronic vascular diseases generally similar to, or higher than, reported national prevalence. It suggested low levels of extractable documented risk factor assessments, diagnostic testing in those at risk and prescription of guideline-recommended pharmacotherapy for some conditions. These baseline data highlight the utility of GP EMR data for potential use in epidemiological studies and by individual practices to guide targeted quality improvement. It also highlighted some of the challenges of using GP EMR data.
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Affiliation(s)
- Julia L Jones
- Nephrology, Western Health, Melbourne, Victoria, Australia .,Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Western Health Chronic Disease Alliance, Melbourne, Victoria, Australia
| | - Natalie G Lumsden
- Nephrology, Western Health, Melbourne, Victoria, Australia.,Western Health Chronic Disease Alliance, Melbourne, Victoria, Australia.,General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Koen Simons
- Western Health Chronic Disease Alliance, Melbourne, Victoria, Australia.,Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Anis Ta'eed
- Nephrology, Western Health, Melbourne, Victoria, Australia
| | - Maximilian P de Courten
- Mitchell Institute for Education and Health Policy, Melbourne, Victoria, Australia.,Chronic Disease Prevention and Management, Victoria University, Melbourne, Victoria, 3011
| | - Tissa Wijeratne
- Western Health Chronic Disease Alliance, Melbourne, Victoria, Australia.,La Trobe University, Melbourne, Victoria, Australia.,Neurology, Western Health, Melbourne, Victoria, Australia
| | - Nicholas Cox
- Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Western Health Chronic Disease Alliance, Melbourne, Victoria, Australia.,Cardiology, Western Health, Melbourne, Victoria, Australia
| | - Christopher J A Neil
- Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Western Health Chronic Disease Alliance, Melbourne, Victoria, Australia.,Cardiology, Western Health, Melbourne, Victoria, Australia
| | | | - Peter Shane Hamblin
- Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Western Health Chronic Disease Alliance, Melbourne, Victoria, Australia.,Endocrinology and Diabetes, Western Health, Melbourne, Victoria, Australia
| | - Edward D Janus
- Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Western Health Chronic Disease Alliance, Melbourne, Victoria, Australia.,Medicine, Western Health, Melbourne, Victoria, Australia
| | - Craig L Nelson
- Nephrology, Western Health, Melbourne, Victoria, Australia.,Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Western Health Chronic Disease Alliance, Melbourne, Victoria, Australia
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19
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Chapman-Goetz J, Packham N, Gabb G, Potts C, Yu K, Prosser A, Hotham E, Suppiah V. Acceptability and feasibility of the NPS MedicineWise mobile phone application in supporting medication adherence in patients with chronic heart failure: Protocol for a pilot study. PLoS One 2022; 17:e0263284. [PMID: 35120174 PMCID: PMC8815969 DOI: 10.1371/journal.pone.0263284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/21/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Heart failure (HF) is an increasing global concern. Despite evidence-based pharmacotherapy, morbidity and mortality remain high in HF. Medication non-adherence is a crucial factor in optimising clinical outcomes. A growing number of smartphone applications (apps) assist management. While evidence support their use to promote treatment adherence, apps alone may not be the solution. The objective of this pilot study is to assess the acceptability and feasibility of a tiered intervention added to the NPS MedicineWise dose reminder app (MedicineWise app) in supporting medication adherence in HF. METHODS AND ANALYSIS This prospective, single-blinded, randomised controlled trial will recruit 55 Australian patients with HF to be randomly assigned to either intervention (MedicineWise app + usual care) or control (usual care alone) arm. Control participants will remain unaware of the intervention throughout the study. At baseline, intervention participants will be instructed in the MedicineWise app. A reminder will then prompt medication administration at each dosing interval. If non-adherence is suggested from 24 hourly reports (critical medications) or 72 hours (non-critical medications), the individual/s will be escalated through a tiered, pharmacist-led intervention. The primary outcome will be the acceptability and feasibility of this approach in supporting adherence. Between-group comparison of the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) at baseline, 3 and 6 months will be used to measure the app's value in supporting adherence. Secondary outcome measures include self-reported medication adherence and knowledge, health-related quality of life, psychological wellbeing, signs and symptoms of HF, and medication and HF knowledge. ETHICS AND DISSEMINATION The protocol received ethics approval from Central Adelaide Clinical Human Research Ethics Committee (Protocol number R20190302) and University of South Australia Human Research Ethics Committee (Protocol number 202450). Findings will be disseminated through peer-reviewed journals. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry Clinical trial number: ACTRN12619000289112p (http://www.ANZCTR.org.au/ACTRN12619000289112p.aspx).
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Affiliation(s)
| | - Nerida Packham
- Consumer Medicines Information Services, NPS Medicine Wise, Sydney, Australia
| | - Genevieve Gabb
- Department of Cardiology, Noarlunga GP Plus Super Clinic, Adelaide, Australia
| | | | - Kitty Yu
- e-Health, NPS Medicine Wise, Melbourne, Australia
| | - Adaire Prosser
- SA Pharmacy, Flinders Medical Centre, Adelaide, Australia
| | - Elizabeth Hotham
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Vijayaprakash Suppiah
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
- Australian Centre for Precision Health, University of South Australia, Adelaide, Australia
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20
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Heidarpour M, Sourani Z, Vakhshoori M, Bondariyan N, Emami SA, Fakhrolmobasheri M, Seyedhossaini S, Shafie D. Prognostic utility of shock index and modified shock index on long-term mortality in acute decompensated heart failure; Persian Registry of cardioVascular diseasE/Heart Failure (PROVE/HF) study. Acta Cardiol 2022; 78:217-226. [PMID: 35098893 DOI: 10.1080/00015385.2022.2030554] [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: 11/01/2022]
Abstract
BACKGROUND Shock index (SI) and modified SI (MSI) are used for prognosis in patients with cardiovascular diseases (CVDs), especially myocardial infarction. However, the utility of these indices in heart failure(HF) is less frequently investigated. We aimed to evaluate the long-term prognostic capability of SI and MSI among Iranian HF patients. METHODS This retrospective cohort study was implemented in the context of the Persian Registry Of cardioVascular diseasE/HF (PROVE/HF). A total of 3896 acute decompensated HF (ADHF) patients were enrolled from March 2016 to March 2020. SI and MSI were assessed at admission. Receiver operating characteristic (ROC) and Kaplan-Meier curves were used to define optimum SI and MSI cut-off points and depict mortality during follow-up, respectively. The association of CVD death according to different SI and MSI cut-off points and quartiles was assessed through univariate and multivariate regression hazard models. RESULTS Mean age of participants was 70.22 ± 12.65 years (males: 62.1%). We found 0.66 (sensitivity:62%, specificity: 51%) and 0.87 (sensitivity: 61%, specificity: 51%) as optimised cut-off points for SI and MSI, respectively. Mean follow-up was 10.26 ± 7.5 months and 1110 (28.5%) deaths occurred during this time. Multivariate adjusted models revealed patients had SI ≥ 0.66 or within the third and fourth quartiles had higher likelihood of mortality compared to reference group (hazard ratio(HR): 1.58, 95%CI: 1.39-1.80, p < 0.001, HR: 1.38,95%CI:1.14-1.66, p = 0.001 and HR:2.00,95%CI:1.68-2.38, p < 0.001, respectively). MSI outcomes were similar (MSI ≥ 0.87: HR: 1.52,95%CI: 1.34-1.72, p < 0.001, third quartile (0.89 ≤ MSI < 1.00):HR:1.23,95%CI:1.009-1.50, p = 0.041, fourth quartile (MSI ≥ 1.00): HR: 1.80,95%CI: 1.53-2.13, p < 0.001). Kaplan-Meier curves showed patients with higher SI and MSI cut-off values and quartiles had lower survival rates. CONCLUSION Higher SI and MSI values were associated with increased mortality risk, and these two bedside indices could be appropriately considered for long-term prognosis in ADHF patients.
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Affiliation(s)
- Maryam Heidarpour
- Department of Endocrinology, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Sourani
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrbod Vakhshoori
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Niloofar Bondariyan
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sayed Ali Emami
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Fakhrolmobasheri
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Davood Shafie
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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21
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Kaviarasan V, Mohammed V, Veerabathiran R. Genetic predisposition study of heart failure and its association with cardiomyopathy. Egypt Heart J 2022; 74:5. [PMID: 35061126 PMCID: PMC8782994 DOI: 10.1186/s43044-022-00240-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/12/2022] [Indexed: 12/12/2022] Open
Abstract
Heart failure (HF) is a clinical condition distinguished by structural and functional defects in the myocardium, which genetic and environmental factors can induce. HF is caused by various genetic factors that are both heterogeneous and complex. The incidence of HF varies depending on the definition and area, but it is calculated to be between 1 and 2% in developed countries. There are several factors associated with the progression of HF, ranging from coronary artery disease to hypertension, of which observed the most common genetic cause to be cardiomyopathy. The main objective of this study is to investigate heart failure and its association with cardiomyopathy with their genetic variants. The selected novel genes that have been linked to human inherited cardiomyopathy play a critical role in the pathogenesis and progression of HF. Research sources collected from the human gene mutation and several databases revealed that numerous genes are linked to cardiomyopathy and thus explained the hereditary influence of such a condition. Our findings support the understanding of the genetics aspect of HF and will provide more accurate evidence of the role of changing disease accuracy. Furthermore, a better knowledge of the molecular pathophysiology of genetically caused HF could contribute to the emergence of personalized therapeutics in future.
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Affiliation(s)
- Vaishak Kaviarasan
- Human Cytogenetics and Genomics Laboratory, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamilnadu, 603103, India
| | - Vajagathali Mohammed
- Human Cytogenetics and Genomics Laboratory, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamilnadu, 603103, India
| | - Ramakrishnan Veerabathiran
- Human Cytogenetics and Genomics Laboratory, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamilnadu, 603103, India.
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22
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Emmons-Bell S, Johnson C, Roth G. Prevalence, incidence and survival of heart failure: a systematic review. Heart 2022; 108:1351-1360. [PMID: 35042750 PMCID: PMC9380485 DOI: 10.1136/heartjnl-2021-320131] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/22/2021] [Indexed: 12/12/2022] Open
Abstract
Studies of the epidemiology of heart failure in the general population can inform assessments of disease burden, research, public health policy and health system care delivery. We performed a systematic review of prevalence, incidence and survival for all available population-representative studies to inform the Global Burden of Disease 2020. We examined population-based studies published between 1990 and 2020 using structured review methods and database search strings. Studies were sought in which heart failure was defined by clinical diagnosis using structured criteria such as the Framingham or European Society of Cardiology criteria, with studies using alternate case definitions identified for comparison. Study results were extracted with descriptive characteristics including age range, location and case definition. Search strings identified 42 360 studies over a 30-year period, of which 790 were selected for full-text review and 125 met criteria for inclusion. 45 sources reported estimates of prevalence, 41 of incidence and 58 of mortality. Prevalence ranged from 0.2%, in a Hong Kong study of hospitalised heart failure patients in 1997, to 17.7%, in a US study of Medicare beneficiaries aged 65+ from 2002 to 2013. Collapsed estimates of incidence ranged from 0.1%, in the EPidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine (EPICAL) study of acute heart failure in France among those aged 20-80 years in 1994, to 4.3%, in a US study of Medicare beneficiaries 65+ from 1994 to 2003. One-year heart failure case fatality ranged from 4% to 45% with an average of 33% overall and 24% for studies across all adult ages. Diagnostic criteria, case ascertainment strategy and demographic breakdown varied widely between studies. Prevalence, incidence and survival for heart failure varied widely across countries and studies, reflecting a range of study design. Heart failure remains a high prevalence disease among older adults with a high risk of death at 1 year.
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Affiliation(s)
- Sophia Emmons-Bell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Catherine Johnson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Gregory Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA .,Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
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23
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Kwan T, Chua B, Pires D, Feng O, Edmiston N, Longman J. A qualitative analysis of the barriers and enablers faced by Australian rural general practitioners in the non-pharmacological management of congestive heart failure in community dwelling patients. BMC Health Serv Res 2022; 22:5. [PMID: 34974834 PMCID: PMC8722034 DOI: 10.1186/s12913-021-07383-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Congestive heart failure (CHF) is a significant health problem in Australia, and disproportionately affects rural Australians. Management of CHF in Australia is heavily centred around the general practitioner (GP). Australian and international literature indicates there is a gap between current and best practice in CHF management. There is little known about the non-pharmacological aspects of management, or CHF management in a rural Australian context. This study aimed to identify what Australian GPs practicing in the Northern Rivers Region of New South Wales, Australia, perceived were the barriers and enablers in the non-pharmacological management of CHF amongst community dwelling patients, to inform healthcare access, resourcing and delivery in Australian rural environments. METHODS Qualitative study involving a realist thematic analysis of data collected from semi-structured face-to-face interviews. RESULTS Fifteen GPs and GP trainees participated. Four interlinked key themes underpinning GPs' experiences with non-pharmacological management of CHF were interpreted from the interview data: (1) resources, (2) complexity of heart failure, (3) relationships, and (4) patient demographics, priorities and views affect how patients engage with non-pharmacological management of CHF. CONCLUSION Rural Australian GPs face considerable barriers to non-pharmacological management of CHF. The data suggests that increased rural Australian health services and community transportation, multidisciplinary management, and stronger professional networks have the potential to be invaluable enablers of CHF management. Further research exploring non-pharmacological management of CHF in other rural contexts may provide additional insights to better inform rural healthcare access and resourcing.
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Affiliation(s)
- Trevor Kwan
- Western Sydney University, Penrith, New South Wales, Australia.
| | - Benjamin Chua
- Western Sydney University, Penrith, New South Wales, Australia
| | - David Pires
- Western Sydney University, Penrith, New South Wales, Australia
| | - Olivia Feng
- Western Sydney University, Penrith, New South Wales, Australia
| | - Natalie Edmiston
- Western Sydney University, Penrith, New South Wales, Australia
- University Centre for Rural Health, Lismore, New South Wales, Australia
| | - Jo Longman
- University Centre for Rural Health, Lismore, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
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24
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Sicras-Mainar A, Sicras-Navarro A, Palacios B, Varela L, Delgado JF. Epidemiología y tratamiento de la insuficiencia cardiaca en España: estudio PATHWAYS-HF. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2020.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Niu XN, Wen H, Sun N, Zhao R, Wang T, Li Y. Exploring risk factors of short-term readmission in heart failure patients: A cohort study. Front Endocrinol (Lausanne) 2022; 13:1024759. [PMID: 36518258 PMCID: PMC9742544 DOI: 10.3389/fendo.2022.1024759] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/09/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The risk of all-cause mortality in patients with heart failure (HF) has been studied previously. Readmission risk of HF patients was rarely explored. Thus, we aimed to explore early warning factors that may influence short-term readmission of HF patients. METHODS The data of this study came from an HF database in China. It was a retrospective single-center observational study that collected characteristic data on Chinese HF patients by integrating electronic medical records and follow-up outcome data. Eventually, 1,727 patients with HF were finally included in our study. RESULTS In our study, the proportion of HF patients with New York Heart Association (NYHA) class II, III, and IV HF were 17.20%, 52.69%, and 30.11%, respectively. The proportion of patients with readmission within 6 months and readmission within 3 months was 38.33% and 24.20%, respectively. Multivariate logistic regression showed that NYHA class (p III = 0.028, p IV < 0.001), diabetes (p = 0.002), Cr (p = 0.003), and RDW-SD (p = 0.039) were risk factors for readmission within 6 months of HF patients. NYHA class (p III = 0.038, p IV < 0.001), CCI (p = 0.033), Cr (p = 0.012), UA (p = 0.042), and Na (p = 0.026) were risk factors for readmission within 3 months of HF patients. CONCLUSIONS Our study implied risk factors of short-term readmission risk in patients with HF, which may provide policy guidance for the prognosis of patients with HF.
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Affiliation(s)
| | | | | | | | - Ting Wang
- *Correspondence: Yan Li, ; Ting Ting Wang,
| | - Yan Li
- *Correspondence: Yan Li, ; Ting Ting Wang,
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26
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Lan T, Liao YH, Zhang J, Yang ZP, Xu GS, Zhu L, Fan DM. Mortality and Readmission Rates After Heart Failure: A Systematic Review and Meta-Analysis. Ther Clin Risk Manag 2021; 17:1307-1320. [PMID: 34908840 PMCID: PMC8665875 DOI: 10.2147/tcrm.s340587] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/18/2021] [Indexed: 12/29/2022] Open
Abstract
Objective The current work aimed to examine the rates of and risk factors for mortality and readmission after heart failure (HF). Setting A systematic search was carried out in PubMed, the Cochrane Library, and EMBASE to identify eligible reports. The random-effects model was utilized to evaluate the pooled results. Participants A total of 27 studies with 515,238 participants were finally meta-analysed. The HF patients had an average age of 76.3 years, with 51% of the sample being male, in the pooled analysis. Primary and Secondary Outcome Measures The outcome measures were 30-day and 1-year readmission rates, mortality, and risk factors for readmission and mortality. Results The effect sizes for readmission and mortality were estimated as the mean and 95% confidence interval (CI). The estimated 30-day and 1-year all-cause readmission rates were 0.19 (95% CI 0.14-0.23) and 0.53 (95% CI 0.46-0.59), respectively, while the all-cause mortality rates were 0.14 (95% CI 0.10-0.18) and 0.29 (95% CI 0.25-0.33), respectively. Comorbidities were highly prevalent in individuals with HF. Conclusion Heart failure hospitalization is followed by high readmission and mortality rates.
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Affiliation(s)
- Tian Lan
- Department of Health Care Management and Medical Education, The School of Military Preventive Medicine, Air Force Medical University, Xi'an, People's Republic of China.,Department of Health Care Management, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Yan-Hui Liao
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Jian Zhang
- Department of Health Care Management, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Zhi-Ping Yang
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, People's Republic of China
| | - Gao-Si Xu
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Liang Zhu
- Department of Health Care Management and Medical Education, The School of Military Preventive Medicine, Air Force Medical University, Xi'an, People's Republic of China
| | - Dai-Ming Fan
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, People's Republic of China
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27
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Najafi-Vosough R, Faradmal J, Hosseini SK, Moghimbeigi A, Mahjub H. Predicting Hospital Readmission in Heart Failure Patients in Iran: A Comparison of Various Machine Learning Methods. Healthc Inform Res 2021; 27:307-314. [PMID: 34788911 PMCID: PMC8654329 DOI: 10.4258/hir.2021.27.4.307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/23/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives Heart failure (HF) is a common disease with a high hospital readmission rate. This study considered class imbalance and missing data, which are two common issues in medical data. The current study’s main goal was to compare the performance of six machine learning (ML) methods for predicting hospital readmission in HF patients. Methods In this retrospective cohort study, information of 1,856 HF patients was analyzed. These patients were hospitalized in Farshchian Heart Center in Hamadan Province in Western Iran, from October 2015 to July 2019. The support vector machine (SVM), least-square SVM (LS-SVM), bagging, random forest (RF), AdaBoost, and naïve Bayes (NB) methods were used to predict hospital readmission. These methods’ performance was evaluated using sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Two imputation methods were also used to deal with missing data. Results Of the 1,856 HF patients, 29.9% had at least one hospital readmission. Among the ML methods, LS-SVM performed the worst, with accuracy in the range of 0.57–0.60, while RF performed the best, with the highest accuracy (range, 0.90–0.91). Other ML methods showed relatively good performance, with accuracy exceeding 0.84 in the test datasets. Furthermore, the performance of the SVM and LS-SVM methods in terms of accuracy was higher with the multiple imputation method than with the median imputation method. Conclusions This study showed that RF performed better, in terms of accuracy, than other methods for predicting hospital readmission in HF patients.
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Affiliation(s)
- Roya Najafi-Vosough
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Javad Faradmal
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Kianoosh Hosseini
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Moghimbeigi
- Department of Biostatistics and Epidemiology, Faculty of Health, Alborz University of Medical Sciences, Karaj, Iran.,Research Center for Health, Safety and Environment, Alborz University of Medical Sciences, Karaj, Iran
| | - Hossein Mahjub
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
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28
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Chan RK, Dinh DT, Hare DL, Lockwood S, Neil C, Prior D, Brennan A, Lefkovits J, Carruthers H, Reid CM, Driscoll A. Management of Acute Decompensated Heart Failure in Rural Versus Metropolitan Settings: An Australian Experience. Heart Lung Circ 2021; 31:491-498. [PMID: 34740540 DOI: 10.1016/j.hlc.2021.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/13/2021] [Accepted: 08/22/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Acute decompensated heart failure (ADHF) is the most common cause of hospital admission in patients over 65, with poorer outcomes demonstrated in rural versus metropolitan areas. The aim of this study was to compare the in-hospital and post-discharge management of ADHF patients admitted to rural versus metropolitan hospitals in Victoria. METHODS Data from the Victorian Cardiac Outcomes Registry, Heart Failure (VCOR-HF) project was used. This was a prospective, observational, non-randomised study of consecutive patients admitted to participating hospitals in Victoria, Australia, with ADHF as their primary diagnosis over four 30-day periods during consecutive years. All patients were followed up for 30 days post discharge. RESULTS 1,357 patients (1,260 metropolitan, 97 rural) were admitted to study hospitals with ADHF during the study periods. Cohorts were similar in age (average 76.87±13.12 years) and percentage of male gender (56.4% overall). Metropolitan patients were more likely to have diabetes (44.4% vs 34.0%, p=0.046), kidney disease (65.8% vs 37.1%, p<0.01) and anaemia (31.9% vs 19.6%, p=0.01). There was no significant difference in length of stay between metropolitan and rural patients (7.49 vs 6.37 days, p=0.12). There was no significant difference between metropolitan and rural patients in 30-day rehospitalisations (19.1% vs 11.6%, p=0.07, respectively) and all-cause 30-day mortality (8.2% vs 4.1%, p=0.15, respectively). Metropolitan patients were significantly more likely to have seen their general practitioner (GP) (68.1% vs 53.2%, p<0.01) or attend an outpatient clinic (35.9% vs 10.6%, p<0.01) by 30 days. There was no significant difference in number of days to follow-up of any kind between groups. Referrals to a heart failure home visiting program remained low overall (19.9%). CONCLUSION There was no significant difference in 30-day rehospitalisations or mortality between patients admitted to rural versus metropolitan hospitals. Geographical discrepancies were noted in follow-up by 30 days, with significantly more metropolitan patients having seen a doctor by 30 days post-discharge. Overall follow-up rates remain suboptimal.
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Affiliation(s)
- R Kimberley Chan
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia.
| | - Diem T Dinh
- Monash University, Melbourne, Vic, Australia
| | - David L Hare
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia
| | | | - Chris Neil
- University of Melbourne, Melbourne, Vic, Australia; Western Health, Melbourne, Vic, Australia
| | | | | | | | | | | | - Andrea Driscoll
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia; Deakin University, Melbourne, Vic, Australia
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29
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Multimorbidity and multiple causes of death in heart failure. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01223-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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30
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Meng X, Wang Y, Tang X, Gu J, Fu Y. Self-management on heart failure: A meta-analysis. Diabetes Metab Syndr 2021; 15:102176. [PMID: 34186372 DOI: 10.1016/j.dsx.2021.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS Heart failure (HF) is a severe public health problem all over the World. Self-management is an effective method to progress self-care ability. However, the role of self-management in heart failure has not been thoroughly elucidated. METHODS The research articles related to heart failure were searched by the PubMed, Embase, Cochrane databases, and China National Knowledge Database on articles published through March 2020. The average 95% of confidence intervals (CIs) were used to calculate using random-effects or fixed-effects. Review Manager (version 5.2) was adopted for meta-analysis, sensitivity analysis, and bias analysis. RESULTS Eight (8) eligible studies with 1707 patients with HF were included in this analysis. In the Meta-analysis showed significant differences for Self-management (SM) groups in Dutch Heart Failure Knowledge Scale (DHFK) (MD = 1.36, 95%CI [-0.03, 2.75], P = 0.04; I2 = 83%), in Self-Care of Heart Failure Index (SCHFI) (MD = 5.51, 95%CI [0.62, 10.40], P = 0.03; I2 = 70%), and in Self-Efficacy for Managing Chronic Disease Scale (SEMCDI) (I2 = 47%, Z = 5.43, P of over effect < 0.0001) than control groups. One bias is detected as attrition bias, and another one is reporting bias. Sensitivity analysis satisfied the stability of the results. CONCLUSION Self-management was associated with significant outcomes in patients with HF through knowledge, attitude, and practice (KAP).
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Affiliation(s)
- Xianghong Meng
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China
| | - Yuping Wang
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China
| | - Xiaowen Tang
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China
| | - Jianfang Gu
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China
| | - Yonghua Fu
- Department of Cardiology, Shanghai Pudong Hospital, Fudan University, 2800 Gongwei Road, Shanghai, 201399, China.
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31
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Leach MJ, Gillam M, Gonzalez-Chica DA, Walsh S, Muyambi K, Jones M. Health care need and health disparities: Findings from the Regional South Australia Health (RESONATE) survey. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:905-917. [PMID: 32767700 DOI: 10.1111/hsc.13124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 05/05/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
Regional South Australia has some of the highest rates of psychological distress, chronic disease and multimorbidity of any Australian State or Territory. Yet, the healthcare needs of this population are still not completely understood. To better understand the healthcare needs of regional South Australians, we invited adults living in the region to complete the 44-item consumer utilisation, expectations and experiences of healthcare instrument (CONVERSATIONS), online or in hard-copy. The survey was conducted between April 2017 and March 2018. A multi-modal recruitment campaign was utilised to promote the survey. We examined associations between study outcomes and remoteness area, and drew comparisons between our findings and other surveys reporting pertinent outcomes in the urban SA population. The questionnaire was completed by 3,926 adults (52.5% females; 37.6% aged 60 + years). Among the 264 distinct health conditions reported by participants, the most prevalent were hypertension (31.6%), depression (25.7%), anxiety (23.5%) and hypercholesterolaemia (22.9%). The lifetime prevalence of these conditions among participants exceeded rates reported in urban SA. The largest regional-urban health disparities were observed for eczema/dermatitis, skin cancer, other cancer types and cataracts, where prevalence rates were 2075%, 400%, 373% and 324% higher, respectively, than that reported in urban SA. Participants also reported higher levels of multimorbidity (37.7% higher) relative to urban South Australians. By contrast, participants appeared to be exposed to fewer lifestyle risk behaviours (e.g. smoking, alcohol, inadequate fruit or vegetable intake) than their urban counterparts. In summary, there was a high level of healthcare need, and considerable health disparity among participants when compared with urban settings (particularly for skin and eye conditions). These findings highlight the need for a more targeted approach to delivering health services and health promotion activities in regional areas.
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Affiliation(s)
- Matthew J Leach
- National Centre for Naturopathic Medicine, Southern Cross University, East Lismore, NSW, Australia
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
| | | | - Sandra Walsh
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
| | - Kuda Muyambi
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
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Chan DZL, Kerr AJ, Doughty RN. Temporal trends in the burden of heart failure. Intern Med J 2021; 51:1212-1218. [PMID: 33650267 DOI: 10.1111/imj.15253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/13/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
Heart failure is a common healthcare problem associated with high morbidity and mortality. The burden of heart failure is changing; increases secondary to an ageing population may be offset by improved primary cardiovascular prevention and advances in heart failure therapies. In this review, we evaluate recent international trends in heart failure incidence, morbidity and mortality. Although the age-standardised incidence of heart failure has been decreasing since 2000, the incidence in those age groups <55 years is increasing with patients being diagnosed at younger ages. Despite improvements in therapies for heart failure, prognosis still remains poor with up to one-third of patients not surviving beyond 1 year following diagnosis and no improvements in mortality over the past 10 years. The case-mix of heart failure patients is changing with a greater proportion having non-ischaemic aetiology and preserved ejection fraction, and a higher prevalence of non-cardiovascular comorbidity and mortality.
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Affiliation(s)
- Daniel Z L Chan
- Department of Cardiology, Counties Manukau District Health Board, Auckland, New Zealand
| | - Andrew J Kerr
- Department of Cardiology, Counties Manukau District Health Board, Auckland, New Zealand.,School of Population Health, University of Auckland, Auckland, New Zealand
| | - Rob N Doughty
- Department of Medicine, University of Auckland, Auckland, New Zealand.,Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
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Biomedical, Socioeconomic and Demographic Predictors of Heart Failure Readmissions: A Systematic Review. Heart Lung Circ 2021; 30:817-836. [PMID: 33541820 DOI: 10.1016/j.hlc.2020.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/30/2020] [Accepted: 11/22/2020] [Indexed: 11/20/2022]
Abstract
AIMS To identify the biomedical, socioeconomic and demographic predictors of heart failure (HF) related readmissions in adult patients with HF. METHODS This systematic review was conducted in March 2020 using the databases EMBASE, CINAHL and Medline to identify publications between 2015-2020. The resulting articles were systematically reviewed according to the PRISMA guidelines. RESULTS Eighteen (18) studies were included in this review. Unemployment (HR=1.09; 95%CI=1.05-1.14; p=0.03) was the only socioeconomic factor predictive of HF-readmissions. Socio-Economic Indexes for Areas (SEIFA) scores did not predict HF readmissions in adults with HF (p>0.05). All patients included in the studies had pre-existing HF. Based on the included studies, Indigenous status was identified as a risk factor for HF readmissions in 1 study (p<0.05), and age or sex did not affect HF readmission patterns (p>0.05). New York Heart Association (NYHA) class, brain natriuretic peptide (BNP) levels, and heart rate were also predictive of HF readmission (p<0.05). Left ventricular ejection fraction and blood pressure, however, were non-significant risk factors of HF readmissions (p>0.05). CONCLUSIONS This review identified unemployment, Indigenous status, NYHA class, heart rate, and BNP levels to predict HF related readmissions in adult patients with HF. Adding demographic and socioeconomic variables to readmission risk models has the potential to more accurately target patients at risk of readmissions.
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Epidemiology and treatment of heart failure in Spain: the HF-PATHWAYS study. ACTA ACUST UNITED AC 2020; 75:31-38. [PMID: 33380382 DOI: 10.1016/j.rec.2020.09.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND OBJECTIVES To describe the epidemiology and treatment of a large contemporary cohort of patients with heart failure (HF). METHODS Observational, retrospective, population-based study using the BIG-PAC database, which includes people aged ≥ 18 years seeking care for HF between 2017 and 2019. The main variables were the prevalence/annual incidence rate, comorbidities, clinical variables, and medication administered. RESULTS We identified 19 762 patients with HF from a total of 1 189 003 persons seeking medical attention from 2017 to 2019 (2019: mean age, 78.3 years; 53.0% men). Distribution by type of left ventricular ejection fraction (LVEF) was as follows: 51.7% reduced, 40.2% preserved, and 8.1% mid-range. In 2019, the prevalence was 1.89% (95%CI, 1.70-2.08), with an incidence rate of 2.78 new cases per 1000 persons/y. No statistically significant differences were observed in prevalence and/or incidence from 2017 to 2019. Among patients with HF with reduced ejection fraction (HFrEF), 64% received beta-blockers, 80.5% angiotensin-converting enzyme inhibitor/angiotensin receptor blockers or sacubitril-valsartan, and 29.8% an aldosterone antagonist. In addition, from the diagnosis (baseline) to 24 months of follow-up, there was discreet treatment optimization, which was notable in the first 3 to 6 months. CONCLUSIONS Epidemiological data on HF remained stable during the study period, with a lower prevalence than that reported in non-population-based studies. There is wide room for improvement in the optimization of medical treatment of HFrEF.
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Dashwood A, Vale C, Laher S, Chui F, Rheault H, Gan J, Wong YW. Impact of Patient and Model of Care Factors on Titration and Tolerability of Sacubitril/Valsartan: An Early Australian Real-World Experience. Heart Lung Circ 2020; 29:1688-1695. [DOI: 10.1016/j.hlc.2020.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/29/2020] [Accepted: 03/10/2020] [Indexed: 12/29/2022]
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Dashwood A, Cheesman E, Beard N, Haqqani H, Wong YW, Molenaar P. Understanding How Phosphorylation and Redox Modifications Regulate Cardiac Ryanodine Receptor Type 2 Activity to Produce an Arrhythmogenic Phenotype in Advanced Heart Failure. ACS Pharmacol Transl Sci 2020; 3:563-582. [PMID: 32832863 DOI: 10.1021/acsptsci.0c00003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Indexed: 12/17/2022]
Abstract
Heart failure (HF) is a global pandemic with significant mortality and morbidity. Despite current medications, 50% of individuals die within 5 years of diagnosis. Of these deaths, 30-50% will be a result of sudden cardiac death from ventricular arrhythmias. This review discusses two stress-induced mechanisms, phosphorylation from chronic β-adrenoceptor (β-AR) stimulation and thiol modifications from oxidative stress, and how they modulate the cardiac ryanodine receptor type 2 (RyR2) and foster an arrhythmogenic phenotype. Calcium (Ca2+) is the ubiquitous secondary messenger of excitation-contraction coupling and provides a common pathway for contractile dysfunction and arrhythmia genesis. In a healthy heart, Ca2+ is released from the sarcoplasmic reticulum (SR) by RyR2. The open probability of RyR2 is under the dynamic influence of co-proteins, ions, and kinases that are in strict balance to ensure normal physiological functioning. In HF, chronic β-AR activity and production of reactive oxygen species and reactive nitrogen species provide two stress-induced mechanisms uncoupling RyR2 control, resulting in pathological diastolic SR Ca2+ leak. This increased cytosolic [Ca2+] promotes Ca2+ extrusion via the local Na+/Ca2+ exchanger, resulting in net sarcolemmal depolarization, delayed after depolarization and ventricular arrhythmia. Experimental models researching oxidative stress and phosphorylation have aimed to identify how post-translational modifications to the RyR2 macromolecular complex, and the associated Na+/Ca2+ cycling proteins, result in pathological Ca2+ handling and diastolic leak. However, the causative molecular changes remain controversial and undefined. Through understanding the molecular mechanisms that produce an arrhythmic phenotype, novel therapeutic targets to treat HF and prevent its malignant course can be identified.
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Affiliation(s)
- Alexander Dashwood
- Heart Lung Institute, The Prince Charles Hospital, Chermside, Brisbane, Queensland 4032, Australia.,Cardio-Vascular Molecular & Therapeutics Translational Research Group, Northside Clinical School of Medicine, Faculty of Medicine, University of Queensland, Brisbane, Queensland 4032, Australia.,Griffith University, Southport, Queensland 4215, Australia
| | - Elizabeth Cheesman
- Cardio-Vascular Molecular & Therapeutics Translational Research Group, Northside Clinical School of Medicine, Faculty of Medicine, University of Queensland, Brisbane, Queensland 4032, Australia
| | - Nicole Beard
- Queensland University of Technology (QUT), School of Biomedical Sciences, Institute of Health and Biomedical Innovation, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia.,Faculty of Science and Technology, University of Canberra, Bruce, Australian Capital Territory 2617, Australia
| | - Haris Haqqani
- Heart Lung Institute, The Prince Charles Hospital, Chermside, Brisbane, Queensland 4032, Australia.,Cardio-Vascular Molecular & Therapeutics Translational Research Group, Northside Clinical School of Medicine, Faculty of Medicine, University of Queensland, Brisbane, Queensland 4032, Australia
| | - Yee Weng Wong
- Heart Lung Institute, The Prince Charles Hospital, Chermside, Brisbane, Queensland 4032, Australia.,Cardio-Vascular Molecular & Therapeutics Translational Research Group, Northside Clinical School of Medicine, Faculty of Medicine, University of Queensland, Brisbane, Queensland 4032, Australia
| | - Peter Molenaar
- Cardio-Vascular Molecular & Therapeutics Translational Research Group, Northside Clinical School of Medicine, Faculty of Medicine, University of Queensland, Brisbane, Queensland 4032, Australia.,Queensland University of Technology (QUT), School of Biomedical Sciences, Institute of Health and Biomedical Innovation, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia
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Shepel RN, Drapkina OM. Angiogenesis in Patients with Chronic Heart Failure: Focus on Endothelial Vascular Growth Factor, Pentraxin-3 and Transforming Growth Factor Beta. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-05-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chronic heart failure (CHF) is considered the leading cause of death in patients with established cardiovascular (CVD) and metabolic diseases. Although the current treatment strategy has improved survival and clinical outcomes, the prevalence of CHF shows an increase. Current clinical guidelines for the treatment and prevention of CVD note the role of biological markers as a fairly simple and powerful tool for diagnosing, stratifying risk and predicting CHF. However, it is unclear whether all of these biological markers are equally capable of predicting cardiovascular mortality and heart failure related outcomes in patients with acute and chronic heart failure, as well as in different phenotypes of heart failure. However, the results of numerous studies demonstrate scientific interest in the processes of angiogenesis among patients with CHF. There is an impressive body of evidence linking CHF to the level of markers such as vascular endothelial growth factor, pentraxin-3, and transforming growth factor beta. The review presents the data of domestic and foreign clinical studies devoted to the study of the level of angiogenesis markers among patients with CHF.
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Affiliation(s)
- R. N. Shepel
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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38
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Leach MJ, Walsh S, Muyambi K, Gillam M, Jones M. Expressed Demand for Health Care Services in Regional South Australia: A Cross-sectional Study. J Rural Health 2020; 37:645-654. [PMID: 32602978 DOI: 10.1111/jrh.12472] [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] [Indexed: 11/28/2022]
Abstract
PURPOSE Accessibility and availability of health care services/providers is an increasing concern for many regional communities, particularly regional South Australia. Assessing the level of health service/provider utilization within a region (ie, expressed demand) can be useful in determining health care need and health service/workforce demand. METHODS The regional South Australia health (RESONATE) survey aimed to determine the expressed demand for health care services and the health workforce in a regional South Australian population. The study was open to adults living in regional South Australia and was promoted using a comprehensive multimodal recruitment campaign. Data were collected between April 2017 and March 2018 using the consumer utilization, expectations and experiences of healthcare instrument. FINDINGS A total of 3,926 adults completed the questionnaire. Participants reported using 47 different health care providers in the previous 12 months. Whilst almost all (92.9%) participants had seen a general practitioner in the past 12 months, yoga instructors, chiropractors, pharmacists, and physiotherapists were visited most frequently. Proportionally fewer participants in more remote locations received conventional services/treatments, though a significantly greater proportion of those in more remote locations had received complementary medicine services/treatments (relative to inner regional areas). CONCLUSIONS Findings of the RESONATE survey point to a high level of expressed demand for conventional and complementary health care services among study participants, possibly higher than that reported in the general population. Examining the extent to which the health needs of this and other regional populations are met should be the focus of further research to better inform future health workforce/services planning.
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Affiliation(s)
- Matthew J Leach
- National Centre for Naturopathic Medicine, Southern Cross University, East Lismore, New South Wales, Australia.,Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Sandra Walsh
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Kuda Muyambi
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
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Groenewegen A, Rutten FH, Mosterd A, Hoes AW. Epidemiology of heart failure. Eur J Heart Fail 2020; 22:1342-1356. [PMID: 32483830 PMCID: PMC7540043 DOI: 10.1002/ejhf.1858] [Citation(s) in RCA: 832] [Impact Index Per Article: 208.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022] Open
Abstract
The heart failure syndrome has first been described as an emerging epidemic about 25 years ago. Today, because of a growing and ageing population, the total number of heart failure patients still continues to rise. However, the case mix of heart failure seems to be evolving. Incidence has stabilized and may even be decreasing in some populations, but alarming opposite trends have been observed in the relatively young, possibly related to an increase in obesity. In addition, a clear transition towards heart failure with a preserved ejection fraction has occurred. Although this transition is partially artificial, due to improved recognition of heart failure as a disorder affecting the entire left ventricular ejection fraction spectrum, links can be made with the growing burden of obesity‐related diseases and with the ageing of the population. Similarly, evidence suggests that the number of patients with heart failure may be on the rise in low‐income countries struggling under the double burden of communicable diseases and conditions associated with a Western‐type lifestyle. These findings, together with the observation that the mortality rate of heart failure is declining less rapidly than previously, indicate we have not reached the end of the epidemic yet. In this review, the evolving epidemiology of heart failure is put into perspective, to discern major trends and project future directions.
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Affiliation(s)
- Amy Groenewegen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arend Mosterd
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Arno W Hoes
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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40
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Hospitalized patients with heart failure: the impact of anxiety, fatigue, and therapy adherence on quality of life. ARCHIVES OF MEDICAL SCIENCES. ATHEROSCLEROTIC DISEASES 2020; 4:e268-e279. [PMID: 32368682 PMCID: PMC7191938 DOI: 10.5114/amsad.2019.90257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/12/2019] [Indexed: 01/25/2023]
Abstract
Introduction Heart failure (HF) is a major global health problem associated with increased morbidity and mortality and reduced quality of life (QoL). The aim of the study was to assess the impact of anxiety, fatigue and adherence to therapeutic guidelines on HF patients' QoL. Material and methods A hundred and twenty hospitalized HF patients were enrolled in the study. Data collection was performed by completion of the Minnesota Living With Heart Failure Questionnaire (MLHFQ), the Greek version of the Modified Fatigue Impact Scale (MFIS-Greek), the Zung Self-Rating Anxiety Scale (SAS) and a questionnaire that measured adherence to therapeutic guidelines. Results Data analysis showed moderate levels of anxiety and high levels of adherence to therapeutic guidelines as well as moderate to large effects of HF on patients' fatigue and QoL. A statistically significant positive linear association was observed between anxiety and QoL (rho > 0.6) as well as fatigue and QoL (rho > 0.3). An increase in the anxiety or fatigue score indicated an increase also in the QoL score, meaning that the more anxiety and fatigue a patient felt the worse the QoL also was. Moreover, a statistically significant negative linear association was observed between adherence to therapeutic guidelines and QoL (rho < -0.2). An increase in adherence score indicated a decrease in QoL score, meaning that the more adherent a patient was the better was the QoL. Conclusions The present findings suggest that QoL may be improved when adherence to therapy is increased and fatigue and anxiety are alleviated.
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41
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Leach MJ. Determinants of Complementary Medicine Service Utilization in a Regional South Australian Population: A Cross-Sectional Study. J Rural Health 2020; 37:69-80. [PMID: 32150311 DOI: 10.1111/jrh.12421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The dearth of accessible and appropriate conventional health care services in regional areas may drive many people to seek care provided by complementary medicine (CM) practitioners. Understanding the drivers of CM service use in this population may help inform future health services planning. This study set out to examine the determinants of CM service utilization in a regional South Australian population. METHODS Adults residing in regional South Australia between April 2017 and March 2018 were invited to complete the 44-item consumer utilization, expectations, and experiences of health care instrument. The questionnaire was available in print and online, and was promoted using a multimodal recruitment campaign. Independent predictors of CM service use were determined using multivariate logistic regression. FINDINGS Completing the questionnaire were 3,926 adults (56.7% aged 50+ years; 52.5% females). Forty-seven percent of participants reported using a CM service within the last 12 months. Univariate analyses revealed a statistically significant association between 13 factors and CM service use. When these factors were forced into a multivariate logistic regression model, the number of predictors of CM service utilization was reduced to 10, which included 6 predisposing factors, 3 enabling factors, and 1 personal health practice. This model was able to explain 23.1% (Nagelkerke R2 = 0.231) of the variation in CM service use in this sample. CONCLUSIONS A high level of CM service use was reported among participants living in regional South Australia. The findings highlight the degree to which the appropriateness of health services impacts health-seeking behavior in regional communities.
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Affiliation(s)
- Matthew J Leach
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia.,Patarina Institute, Adelaide, South Australia.,National Centre for Naturopathic Medicine, Southern Cross University, East Lismore, New South Wales
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42
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Shabu S, Jayasekara R. Effectiveness of cognitive behavior therapy for patients with heart failure and depression: A systematic review protocol. Nurs Health Sci 2020; 22:14-19. [PMID: 31499596 DOI: 10.1111/nhs.12646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/08/2019] [Accepted: 08/11/2019] [Indexed: 08/31/2023]
Abstract
The objective of this review is to determine the effectiveness of cognitive behavior therapy for patients with heart failure and depression, aged ≥18 years, in institutionalized healthcare settings. More specifically, the review aims to identify which cognitive behavior therapy strategy/strategies, including the method of delivery, is the most effective for the management of depression in hospitalized patients with heart failure. The review question is as follows: Is cognitive behavior therapy effective in reducing symptoms of depression in patients with heart failure? This systematic review will be conducted in accordance with the Joanna Briggs Institute methodology for systematic reviews of effectiveness evidence. This review only includes randomized controlled trials assessing the effectiveness of cognitive behavior therapy as a treatment for depression in adults (aged ≥18 years) with heart failure, compared with usual care, which might include medications.
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Affiliation(s)
- Shancy Shabu
- Cardiac Step Down Ward, The Queen Elizabeth Hospital, Adelaid, South Australia, Australia
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Rasika Jayasekara
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
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Duggan KA, Hodge G, Chen J, Hunter T. Vasoactive intestinal peptide infusion reverses existing myocardial fibrosis in the rat. Eur J Pharmacol 2019; 862:172629. [PMID: 31449808 DOI: 10.1016/j.ejphar.2019.172629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 11/17/2022]
Abstract
Congestive cardiac failure has become one of the major health challenges of the 21st century and new therapies are needed to address this problem. The concentration of vasoactive intestinal peptide (VIP) in the heart has been shown to decrease as fibrosis (the pathology leading to heart failure) increases and to become undetectable in end stage cardiomyopathy. We sought to determine whether replenishment of myocardial VIP might treat myocardial fibrosis and therefore represent a new therapeutic target. Wistar Kyoto rats on a high (4.4%) salt diet were randomised to zero time control, 4 week infusion of VIP (5 pmol/kg/min) or vehicle control infusion. Myocardial VIP concentration was measured by radioimmunoassay, fibrosis was quantitated by computerised histomorphometry and changes in pro-fibrotic mediators were measured by quantitative rt-PCR. Myocardial VIP increased significantly in VIP treated rats compared with vehicle treated controls (P < 0.01) while fibrosis in the VIP treated rats was significantly lower than in both the zero time control (P < 0.05) and the vehicle infused control (P < 0.0005). Although all six profibrotic mediators which were measured increased over the 4 week experimental period VIP infusion only affected angiotensinogen (Agt) and angiotensin receptor type 1a (AT1a) expression. In both instances VIP caused a significant decrease in messenger rna expression (Agt P < 0.01 and At1a P < 0.01) compared with vehicle infused controls. We conclude that VIP infusion increased myocardial VIP concentration and was able to reverse existing myocardial fibrosis suggesting a possible therapeutic role for a VIP based therapy in cardiac failure.
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Dunn JL, Nusem E, Straker K, Gregory S, Wrigley C. Human Factors and User Experience Issues with Ventricular Assist Device Wearable Components: A Systematic Review. Ann Biomed Eng 2019; 47:2431-2488. [PMID: 31342334 DOI: 10.1007/s10439-019-02303-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/07/2019] [Indexed: 01/24/2023]
Abstract
Ventricular Assist Devices (VADs) provide continuous mechanical circulatory support during in- and out-of-hospital care. However, limitations of the external wearable components influence patient quality of life. There is insufficient understanding of the issues with such components that combines a holistic viewpoint from both human factors and user (including patient and caregiver) experience perspectives. This paper comprehensively details the issues with VAD wearable systems and proposes a way for human-centered design to bridge the gap, addressing such issues synergistically. Through the review the authors investigated: the user issues caused by wearable components of VADs, and how human factors issues correlate to the VAD user experience. A Boolean search ("ventricular assist" AND "human factors" AND "experience") for peer-reviewed studies published between 2008 and 2018 returned 338 titles, with 35 relevant studies selected using a PRISMA process for inclusion in cross-study analysis and synthesis. This paper provides design recommendations for the issues found in the literature. Four key focus areas to inform the future design of VAD wearable components were identified-'Power Supply', 'Wearability and Travel Freedom', 'The Female Experience' and 'Intuitive Handling'. Using design to drive innovation could result in VAD wearable components which better meet or exceed users' quality of life goals.
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Affiliation(s)
- Jessica Lea Dunn
- School of Architecture, Design and Planning, University of Sydney, Sydney, NSW, Australia.
| | - Erez Nusem
- School of Architecture, Design and Planning, University of Sydney, Sydney, NSW, Australia
| | - Karla Straker
- School of Architecture, Design and Planning, University of Sydney, Sydney, NSW, Australia
| | - Shaun Gregory
- Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Cara Wrigley
- School of Architecture, Design and Planning, University of Sydney, Sydney, NSW, Australia
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Toukhsati SR, Jaarsma T, Babu AS, Driscoll A, Hare DL. Self-Care Interventions That Reduce Hospital Readmissions in Patients With Heart Failure; Towards the Identification of Change Agents. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2019; 13:1179546819856855. [PMID: 31217696 PMCID: PMC6563392 DOI: 10.1177/1179546819856855] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/17/2019] [Indexed: 12/12/2022]
Abstract
Unplanned hospital readmissions are the most important, preventable cost in heart failure (HF) health economics. Current professional guidelines recommend that patient self-care is an important means by which to reduce this burden. Patients with HF should be engaged in their care such as by detecting, monitoring, and managing their symptoms. A variety of educational and behavioural interventions have been designed and implemented by health care providers to encourage and support patient self-care. Meta-analyses support the use of self-care interventions to improve patient self-care and reduce hospital readmissions; however, efficacy is variable. The aim of this review was to explore methods to achieve greater clarity and consistency in the development and reporting of self-care interventions to enable ‘change agents’ to be identified. We conclude that advancement in this field requires more explicit integration and reporting on the behaviour change theories that inform the design of self-care interventions and the selection of behaviour change techniques. The systematic application of validated checklists, such as the Theory Coding Scheme and the CALO-RE taxonomy, will improve the systematic testing and refinement of interventions to enable ‘change agent/s’ to be identified and optimised.
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Affiliation(s)
- S R Toukhsati
- School of Health and Life Sciences, Psychology, Federation University Australia, Berwick, VIC, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia.,Department of Cardiology, Austin Health, Heidelberg, VIC, Australia
| | - T Jaarsma
- Faculty of Health Sciences, University of Linköping, Linköping, Sweden.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - A S Babu
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia.,Department of Cardiology, Austin Health, Heidelberg, VIC, Australia.,Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India
| | - A Driscoll
- Department of Cardiology, Austin Health, Heidelberg, VIC, Australia.,School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
| | - D L Hare
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia.,Department of Cardiology, Austin Health, Heidelberg, VIC, Australia
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Woods LS, Duff J, Roehrer E, Walker K, Cummings E. Patients' Experiences of Using a Consumer mHealth App for Self-Management of Heart Failure: Mixed-Methods Study. JMIR Hum Factors 2019; 6:e13009. [PMID: 31045504 PMCID: PMC6521216 DOI: 10.2196/13009] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/04/2019] [Accepted: 03/21/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND To support the self-management of heart failure, a team of hospital clinicians, patients, and family caregivers have co-designed the consumer mobile health app, Care4myHeart. OBJECTIVE This research aimed to determine patient experiences of using the app to self-manage heart failure. METHODS Patients with heart failure used the app for 14 days on their own smart device in a home setting, following which a mixed-methods evaluation was performed. Eight patients were recruited, of whom six completed the Mobile Application Rating Scale and attended an interview. RESULTS The overall app quality score was "acceptable" with 3.53 of 5 points, with the aesthetics (3.83/5) and information (3.78/5) subscales scoring the highest. The lowest mean score was in the app-specific subscale representing the perceived impact on health behavior change (2.53/5). Frequently used features were weight and fluid restriction tracking, with graphical representation of data particularly beneficial for improved self-awareness and ongoing learning. The use of technology for self-management will fundamentally differ from current practices and require a change in daily routines. However, app use was correlated with potential utility for daily management of illness with benefits of accurate recording and review of personal health data and as a communication tool for doctors to assist with care planning, as all medical information is available in one place. Technical considerations included participants' attitudes toward technology, functionality and data entry issues, and relatively minor suggested changes. CONCLUSIONS The findings from this usability study suggest that a significant barrier to adoption is the lack of integration of technology into everyday life in the context of already established disease self-management routines. Future studies should explore the barriers to adoption and sustainability of consumer mobile health interventions for chronic conditions, particularly whether introducing such apps is more beneficial at the commencement of a self-management regimen.
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Affiliation(s)
- Leanna Sarah Woods
- School of Nursing, University of Tasmania, Darlinghurst, Australia.,St Vincent's Private Hospital Sydney, Darlinghurst, Australia
| | - Jed Duff
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
| | - Erin Roehrer
- School of Technology, Environments and Design, University of Tasmania, Hobart, Australia
| | - Kim Walker
- School of Nursing, University of Tasmania, Darlinghurst, Australia
| | - Elizabeth Cummings
- School of Nursing, University of Tasmania, Darlinghurst, Australia.,School of Health Information Science, University of Victoria, Victoria, BC, Canada
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COMBINING INSTITUTIONAL AND ADMINISTRATIVE DATA TO ASSESS HOSPITAL COSTS FOR PATIENTS RECEIVING VENTRICULAR ASSIST DEVICES. Int J Technol Assess Health Care 2019; 34:555-566. [PMID: 30595135 DOI: 10.1017/s0266462318003586] [Citation(s) in RCA: 2] [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 The aim of this study was to describe patient level costing methods and develop a database of healthcare resource use and cost in patients with AHF receiving ventricular assist device (VAD) therapy. METHODS Patient level micro-costing was used to identify documented activity in the years preceding and following VAD implantation, and preceding heart transplant for a cohort of seventy-seven consecutive patients listed for heart transplantation (2009-12). Clinician interviews verified activity, established time resource required for each activity, and added additional undocumented activities. Costs were sourced from the general ledger, salary, stock price, pharmacy formulary data, and from national medical benefits and prostheses lists. Linked administrative data analyses of activity external to the implanting institution, used National Weighted Activity Units (NWAU), 2014 efficient price, and admission complexity cost weights and were compared with micro-costed data for the implanting admission. RESULTS The database produced includes patient level activity and costs associated with the seventy-seven patients across thirteen resource areas including hospital activity external to the implanting center. The median cost of the implanting admission using linked administrative data was $246,839 (interquartile range [IQR] $246,839-$271,743), versus $270,716 (IQR $211,740-$378,482) for the institutional micro-costing (p = .08). CONCLUSIONS Linked administrative data provides a useful alternative for imputing costs external to the implanting center, and combined with institutional data can illuminate both the pathways to transplant referral and the hospital activity generated by patients experiencing the terminal phases of heart failure in the year before transplant, cf-VAD implant, or death.
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Iyngkaran P, Liew D, Neil C, Driscoll A, Marwick TH, Hare DL. Moving From Heart Failure Guidelines to Clinical Practice: Gaps Contributing to Readmissions in Patients With Multiple Comorbidities and Older Age. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2018; 12:1179546818809358. [PMID: 30618487 PMCID: PMC6299336 DOI: 10.1177/1179546818809358] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 09/14/2018] [Indexed: 12/20/2022]
Abstract
This feature article for the thematic series on congestive heart failure (CHF) readmissions aims to outline important gaps in guidelines for patients with multiple comorbidities and the elderly. Congestive heart failure diagnosis manifests as a 3-phase journey between the hospital and community, during acute, chronic stable, and end-of-life (palliative) phases. This journey requires in variable intensities a combination of multidisciplinary care within tertiary hospital or ambulatory care from hospital outpatients or primary health services, within the general community. Management goals are uniform, ie, to achieve the lowest New York Heart Association class possible, with improvement in ejection fraction, by delivering gold standard therapies within a CHF program. Comorbidities are an important common denominator that influences outcomes. Comorbidities include diabetes mellitus, chronic obstructive airways disease, chronic renal impairment, hypertension, obesity, sleep apnea, and advancing age. Geriatric care includes the latter as well as syndromes such as frailty, falls, incontinence, and confusion. Many systems still fail to comprehensively achieve all aspects of such programs. This review explores these factors.
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Affiliation(s)
- Pupalan Iyngkaran
- Northern Territory Medical Program, Flinders University, Darwin, NT, Australia
- Pupalan Iyngkaran, Yellow Building 4 Cnr University Drive North & University Drive West Charles Darwin University, Casuarina, NT 0815, Australia.
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christopher Neil
- Department of Medicine—Western Precinct, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrea Driscoll
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
- Austin Health, Melbourne, VIC, Australia
| | | | - David L Hare
- Cardiovascular Research, The University of Melbourne, Melbourne, VIC, Australia
- Heart Failure Services, Austin Health, Melbourne, VIC, Australia
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Palmer K, Bowles KA, Paton M, Jepson M, Lane R. Chronic Heart Failure and Exercise Rehabilitation: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2018; 99:2570-2582. [DOI: 10.1016/j.apmr.2018.03.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/26/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
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50
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How to Manage Heart Failure: New Guidelines 2018. Heart Lung Circ 2018; 27:1267-1269. [DOI: 10.1016/j.hlc.2018.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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