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DE Albuquerque DC, DE Barros E Silva PGM, Lopes RD, Hoffmann-Filho CR, Nogueira PR, Reis H, Nishijuka FA, Martins SM, DE Figueiredo Neto JA, Pavanello R, DE Souza Neto JD, Danzmann LC, Gemelli JR, Rohde LEP, Hernandes ME, Rivera MAM, Simões MVIN, Dos Santos ES, Canesin MF, Zilli AC, Santos RHN, Jesuino IDEA, Mourilhe-Rocha R, Moura LZ, Marcondes-Braga FG, Mesquita ET. In-Hospital Management and Long-term Clinical Outcomes and Adherence in Patients With Acute Decompensated Heart Failure: Primary Results of the First Brazilian Registry of Heart Failure (BREATHE). J Card Fail 2024; 30:639-650. [PMID: 37648061 DOI: 10.1016/j.cardfail.2023.08.014] [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: 10/06/2022] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Heart failure (HF), a common cause of hospitalization, is associated with poor short-term clinical outcomes. Little is known about the long-term prognoses of patients with HF in Latin America. METHODS BREATHE was the first nationwide prospective observational study in Brazil that included patients hospitalized due to acute heart failure (HF). Patients were included during 2 time periods: February 2011-December 2012 and June 2016-July 2018 In-hospital management, 12-month clinical outcomes and adherence to evidence-based therapies were evaluated. RESULTS A total of 3013 patients were enrolled at 71 centers in Brazil. At hospital admission, 83.8% had clear signs of pulmonary congestion. The main cause of decompensation was poor adherence to HF medications (27.8%). Among patients with reduced ejection fraction, concomitant use of beta-blockers, renin-angiotensin-aldosterone inhibitors and spironolactone decreased from 44.5% at hospital discharge to 35.2% at 3 months. The cumulative incidence of mortality at 12 months was 27.7%, with 24.3% readmission at 90 days and 44.4% at 12 months. CONCLUSIONS In this large national prospective registry of patients hospitalized with acute HF, rates of mortality and readmission were higher than those reported globally. Poor adherence to evidence-based therapies was common at hospital discharge and at 12 months of follow-up.
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Affiliation(s)
| | - Pedro Gabriel Melo DE Barros E Silva
- Hcor-Hospital do Coração, São Paulo, Brazil; Hospital Samaritano Paulista, São Paulo, Brazil; Brazilian Clinical Research Institute, São Paulo, Brazil
| | - Renato D Lopes
- Brazilian Clinical Research Institute, São Paulo, Brazil; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Centro de Pesquisa da Clínica Médica e Cardiologia da UNIFESP, São Paulo, Brazil.
| | | | | | - Helder Reis
- Hospital de Clínicas Gaspar Viana, Paró, Brazil
| | | | | | | | | | | | - Luiz Claudio Danzmann
- Hospital São Lucas-PUCRS, Rio Grande do Sul, Brazil; Universidade Luterana do Brasil-Hospital Universitório de Canoas (RS), Rio Grande do Sul, Brazil
| | | | - Luis Eduardo Paim Rohde
- Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento-HMV, Rio Grande do Sul, Brazil
| | | | | | - Marcus VINíCIUS Simões
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | - Ricardo Mourilhe-Rocha
- Hospital Universitório Pedro Ernesto, Rio de Janeiro, Brazil; Complexo Hospitalar Américas- Vitória e Samaritano Barra, Rio de Janeiro, Brazil
| | | | - Fabiana G Marcondes-Braga
- Departamento de Insuficiência Cardíaca-DEIC-SBC, Rio de Janeiro, Brazil; Instituto do Coração (inCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Evandro Tinoco Mesquita
- Departamento de Insuficiência Cardíaca-DEIC-SBC, Rio de Janeiro, Brazil; Universidade Federal Fluminense, Rio de Janeiro, Brazil
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Chai PR, Kaithamattam JJ, Chung M, Tom JJ, Goodman GR, Hasdianda MA, Carnes TC, Vaduganathan M, Scirica BM, Schnipper JL. Formative Perceptions of a Digital Pill System to Measure Adherence to Heart Failure Pharmacotherapy: Mixed Methods Study. JMIR Cardio 2024; 8:e48971. [PMID: 38358783 PMCID: PMC10905352 DOI: 10.2196/48971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/19/2023] [Accepted: 12/22/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Heart failure (HF) affects 6.2 million Americans and is a leading cause of hospitalization. The mainstay of the management of HF is adherence to pharmacotherapy. Despite the effectiveness of HF pharmacotherapy, effectiveness is closely linked to adherence. Measuring adherence to HF pharmacotherapy is difficult; most clinical measures use indirect strategies such as calculating pharmacy refill data or using self-report. While helpful in guiding treatment adjustments, indirect measures of adherence may miss the detection of suboptimal adherence and co-occurring structural barriers associated with nonadherence. Digital pill systems (DPSs), which use an ingestible radiofrequency emitter to directly measure medication ingestions in real-time, represent a strategy for measuring and responding to nonadherence in the context of HF pharmacotherapy. Previous work has demonstrated the feasibility of using DPSs to measure adherence in other chronic diseases, but this strategy has yet to be leveraged for individuals with HF. OBJECTIVE We aim to explore through qualitative interviews the facilitators and barriers to using DPS technology to monitor pharmacotherapy adherence among patients with HF. METHODS We conducted individual, semistructured qualitative interviews and quantitative assessments between April and August 2022. A total of 20 patients with HF who were admitted to the general medical or cardiology service at an urban quaternary care hospital participated in this study. Participants completed a qualitative interview exploring the overall acceptability of and willingness to use DPS technology for adherence monitoring and perceived barriers to DPS use. Quantitative assessments evaluated HF history, existing medication adherence strategies, and attitudes toward technology. We analyzed qualitative data using applied thematic analysis and NVivo software (QSR International). RESULTS Most participants (12/20, 60%) in qualitative interviews reported a willingness to use the DPS to measure HF medication adherence. Overall, the DPS was viewed as useful for increasing accountability and reinforcing adherence behaviors. Perceived barriers included technological issues, a lack of need, additional costs, and privacy concerns. Most were open to sharing adherence data with providers to bolster clinical care and decision-making. Reminder messages following detected nonadherence were perceived as a key feature, and customization was desired. Suggested improvements are primarily related to the design and usability of the Reader (a wearable device). CONCLUSIONS Overall, individuals with HF perceived the DPS to be an acceptable and useful tool for measuring medication adherence. Accurate, real-time ingestion data can guide adherence counseling to optimize adherence management and inform tailored behavioral interventions to support adherence among patients with HF.
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Affiliation(s)
- Peter R Chai
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, United States
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States
- The Fenway Institute, Boston, MA, United States
| | - Jenson J Kaithamattam
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Michelle Chung
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Jeremiah J Tom
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Georgia R Goodman
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
- The Fenway Institute, Boston, MA, United States
| | | | | | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Benjamin M Scirica
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Jeffrey L Schnipper
- Division of Hospital Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
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3
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Tah S, Valderrama M, Afzal M, Iqbal J, Farooq A, Lak MA, Gostomczyk K, Jami E, Kumar M, Sundaram A, Sharifa M, Arain M. Heart Failure With Preserved Ejection Fraction: An Evolving Understanding. Cureus 2023; 15:e46152. [PMID: 37900404 PMCID: PMC10613100 DOI: 10.7759/cureus.46152] [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: 08/23/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome in which patients have signs and symptoms of HF due to high left ventricular (LV) filling pressure despite normal or near normal LV ejection fraction. It is more common than HF with reduced ejection fraction (HFrEF), and its diagnosis and treatment are more challenging than HFrEF. Although hypertension is the primary risk factor, coronary artery disease and other comorbidities, such as atrial fibrillation (AF), diabetes, chronic kidney disease (CKD), and obesity, also play an essential role in its formation. This review summarizes current knowledge about HFpEF, its pathophysiology, clinical presentation, diagnostic challenges, current treatments, and promising novel treatments. It is essential to continue to be updated on the latest treatments for HFpEF so that patients always receive the most therapeutic treatments. The use of GnRH agonists in the management of HFpEF, infusion of Apo a-I nanoparticle, low-level transcutaneous vagal stimulation (LLTS), and estrogen only in post-menopausal women are promising strategies to prevent diastolic dysfunction and HFpEF; however, there is still no proven curative treatment for HFpEF yet.
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Affiliation(s)
- Sunanda Tah
- Surgery, Beckley Appalachian Regional Healthcare (ARH) Hospital, Beckley, USA
- Surgery, Saint James School of Medicine, Arnos Vale, VCT
| | | | - Maham Afzal
- Medicine, Fatima Jinnah Medical University, Lahore, PAK
| | | | - Aisha Farooq
- Internal Medicine, Dr. Ruth Pfau Hospital, Karachi, PAK
| | | | - Karol Gostomczyk
- Medicine, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, POL
| | - Elhama Jami
- Internal Medicine, Herat Regional Hospital, Herat, AFG
| | | | | | | | - Mustafa Arain
- Internal Medicine, Civil Hospital Karachi, Karachi, PAK
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4
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Jasińska-Stroschein M, Waszyk-Nowaczyk M. Multidimensional Interventions on Supporting Disease Management for Hospitalized Patients with Heart Failure: The Role of Clinical and Community Pharmacists. J Clin Med 2023; 12:3037. [PMID: 37109373 PMCID: PMC10142526 DOI: 10.3390/jcm12083037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/13/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND existing trials on the role of clinical pharmacists in managing chronic disease patients have focused on variety of interventions, including preparing patients for the transition from hospital to home. However, little quantitative evidence is available regarding the effect of multidimensional interventions on supporting disease management for hospitalized patients with heart failure (HF). The present paper reviews the effects of inpatient, discharge and/or after-discharge interventions performed on hospitalized HF patients by multidisciplinary teams, including pharmacists. METHODS articles were identified through search engines in three electronic databases following the PRISMA Protocol. Randomized controlled trials (RCTs) or non-randomized intervention studies conducted in the period 1992-2022 were included. In all studies, baseline characteristics of patients as well as study end-points were described in relation to a control group i.e., usual care and a group of subjects that received care from a clinical and/or community pharmacist, as well as other health professionals (Intervention). Study outcomes included all-cause hospital 30-day re-admission or emergency room (ER) visits, all-cause hospitalization within >30 days after discharge, specific-cause hospitalization rates, medication adherence and mortality. The secondary outcomes included adverse events and quality of life. Quality assessment was carried out using RoB 2 Risk of Bias Tool. Publication bias across studies was determined using the funnel plot and Egger's regression test. RESULTS a total of 34 protocols were included in the review, while the data from 33 trials were included in further quantitative analyses. The heterogeneity between studies was high. Pharmacist-led interventions, usually performed within interprofessional care teams, reduced the rates of 30-day all-cause hospital re-admission (odds ratio, OR = 0.78; 95% CI 0.62-0.98; p = 0.03) and all-cause hospitalization >30 days after discharge (OR = 0.73; 95% CI 0.63-0.86; p = 0.0001). Subjects hospitalized primarily due to heart failure demonstrated reduced risk of hospital admission within longer periods, i.e., from 60 to 365 days after discharge (OR = 0.64; 95% CI 0.51-0.81; p = 0.0002). The rate of all-cause hospitalization was reduced by multidimensional interventions taken by pharmacists: reviews of medicine lists and/or their reconciliation at discharge (OR = 0.63; 95% CI 0.43-0.91; p = 0.014), as well as interventions that were based mainly on patient education and counseling (OR = 0.65; 95% CI 0.49-0.88; p = 0.0047). In conclusion, given that HF patients often have complex treatment regimens and multiple comorbid conditions, our findings highlight the need for greater involvement from skilled clinical and community pharmacists in disease management.
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Affiliation(s)
| | - Magdalena Waszyk-Nowaczyk
- Pharmacy Practice Division, Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznan, Poland
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Bezati S, Velliou M, Ventoulis I, Simitsis P, Parissis J, Polyzogopoulou E. Infection as an under-recognized precipitant of acute heart failure: prognostic and therapeutic implications. Heart Fail Rev 2023:10.1007/s10741-023-10303-8. [PMID: 36897491 PMCID: PMC9999079 DOI: 10.1007/s10741-023-10303-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
As the prevalence of heart failure (HF) continues to rise, prompt diagnosis and management of various medical conditions, which may lead to HF exacerbation and result in poor patient outcomes, are of paramount importance. Infection has been identified as a common, though under-recognized, precipitating factor of acute heart failure (AHF), which can cause rapid development or deterioration of HF signs and symptoms. Available evidence indicates that infection-related hospitalizations of patients with AHF are associated with higher mortality, protracted length of stay, and increased readmission rates. Understanding the intricate interaction of both clinical entities may provide further therapeutic strategies to prevent the occurrence of cardiac complications and improve prognosis of patients with AHF triggered by infection. The purpose of this review is to investigate the incidence of infection as a causative factor in AHF, explore its prognostic implications, elucidate the underlying pathophysiological mechanisms, and highlight the basic principles of the initial diagnostic and therapeutic interventions in the emergency department.
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Affiliation(s)
- Sofia Bezati
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, Chaidari, 12462, Athens, Greece.
| | - Maria Velliou
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, Ptolemaida, 50200, Greece
| | - Panagiotis Simitsis
- National and Kapodistrian University of Athens, 2nd Department of Cardiology, Heart Failure Unit, Attikon University Hospital, Athens, Greece
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, Chaidari, 12462, Athens, Greece.,Emergency Medicine Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, Chaidari, 12462, Athens, Greece.,Emergency Medicine Department, National and Kapodistrian University of Athens, Athens, Greece
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6
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Bendary A, Hassanein M, Bendary M, Smman A, Hassanin A, Elwany M. The predictive value of precipitating factors on clinical outcomes in hospitalized patients with decompensated heart failure: insights from the Egyptian cohort in the European Society of Cardiology Heart Failure long-term registry. Egypt Heart J 2023; 75:16. [PMID: 36884155 PMCID: PMC9995627 DOI: 10.1186/s43044-023-00342-9] [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: 11/22/2022] [Accepted: 02/25/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Knowledge of the frequency of precipitating factors for acute heart failure (AHF) is important (either new-onset heart failure [NOHF] or worsening heart failure [WHF]), as this can guide strategies for prevention and treatment. Most data come only from Western Europe and North America; nevertheless, geographic differences do exist. We set out to study the prevalence of precipitating factors of AHF and their connection to patient characteristics and in-hospital and long-term mortality in patients from Egypt hospitalized for decompensated HF. Using the ESC-HF-LT Registry which is a prospective, multicenter, observational study of patients confessed to cardiology centers in the nations of Europe and the Mediterranean, patients presenting with AHF were recruited from 20 centers all over Egypt. Enrolling physicians were requested to report possible precipitants from among several predefined reasons. RESULTS We included 1515 patients (mean age 60 ± 12 years, 69% males). The mean LVEF was 38 ± 11%. Seventy-seven percent of the total population had HFrEF, 9.8% had HFmrEF, and 13.3% had HFpEF. The commonly reported precipitating factors for AHF hospitalization among study population were as follows (in decreasing order of frequency): infection in 30.3% of patients, acute coronary syndrome/myocardial ischemia (ACS/MI) in 26%, anemia in 24.3%, uncontrolled hypertension in 24.2%, atrial fibrillation (AF) in 18.3%, renal dysfunction in 14.6%, and non-compliance in 6.5% of patients. HFpEF patients had significantly higher rates of AF, uncontrolled hypertension, and anemia as precipitants for acute decompensation. ACS/MI were significantly more frequent in patients with HFmrEF. WHF patients had significantly higher rates of infection and non-compliance, whereas new-onset HF patients showed significantly higher rates of ACS/MI and uncontrolled hypertension. One-year follow-up revealed that patients with HFrEF had a significantly higher rate of mortality compared to patients with HFmrEF and HFpEF (28.3%, 19.5, and 19.4%, P = 0.004). Patients with WHF had a significantly higher rates of 1-year mortality when compared to those with NOHF (30.0% vs. 20.3%, P < 0.001). Renal dysfunction, anemia, and infection were independently connected to worse long-term survival. CONCLUSIONS Precipitating factors of AHF are frequent and substantially influence outcomes after hospitalization. They should be considered goals for avoiding AHF hospitalization and depicting those at highest risk for short-term mortality.
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Affiliation(s)
- Ahmed Bendary
- Cardiology Department, Faculty of Medicine, Benha University, Benha, Egypt.
| | | | - Mohamed Bendary
- Biostatistics Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Smman
- Alexandria University Students' Hospital, Alexandria, Egypt
| | - Ahmed Hassanin
- Division of Cardiology, University of Arkansas for Medical Sciences, Arkansas, NY, USA
| | - Mostafa Elwany
- Cardiology Department, Alexandria University, Alexandria, Egypt
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7
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Yoon HJ, Kim KH, Lee N, Park H, Kim HY, Cho JY, Ahn Y, Jeong MH. Sex-Specific Predictors of Long-Term Mortality in Elderly Patients with Ischemic Cardiomyopathy. J Clin Med 2023; 12:jcm12052012. [PMID: 36902797 PMCID: PMC10003953 DOI: 10.3390/jcm12052012] [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: 01/30/2023] [Revised: 02/22/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Ischemic heart failure (HF) is one of the most common causes of morbidity and mortality in the world-wide, but sex-specific predictors of mortality in elderly patients with ischemic cardiomyopathy (ICMP) have been poorly studied. A total of 536 patients with ICMP over 65 years-old (77.8 ± 7.1 years, 283 males) were followed for a mean of 5.4 years. The development of death during clinical follow up was evaluated, and predictors of mortality were compared. Death was developed in 137 patients (25.6%); 64 females (25.3%) vs. 73 males (25.8%). Low-ejection fraction was only an independent predictor of mortality in ICMP, regardless of sex (HR 3.070 CI = 1.708-5.520 in female, HR 2.011, CI = 1.146-3.527 in male). Diabetes (HR 1.811, CI = 1.016-3.229), elevated e/e' (HR 2.479, CI = 1.201-5.117), elevated pulmonary artery systolic pressure (HR 2.833, CI = 1.197-6.704), anemia (HR 1.860, CI = 1.025-3.373), beta blocker non-use (HR2.148, CI = 1.010-4.568), and angiotensin receptor blocker non-use (HR 2.100, CI = 1.137-3.881) were bad prognostic factors of long term mortality in female, whereas hypertension (HR 1.770, CI = 1.024-3.058), elevated Creatinine (HR 2.188, CI = 1.225-3.908), and statin non-use (HR 3.475, CI = 1.989-6.071) were predictors of mortality in males with ICMP independently. Systolic dysfunction in both sexes, diastolic dysfunction, beta blocker and angiotensin receptor blockers in female, and statins in males have important roles for long-term mortality in elderly patients with ICMP. For improving long-term survival in elderly patients with ICMP, it may be necessary to approach sex specifically.
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Incidence of Respiratory Pathogens in Naval Special Warfare Sea, Air, and Land Team Candidates With Swimming-Induced Pulmonary Edema. Chest 2022; 163:1185-1192. [PMID: 36427538 DOI: 10.1016/j.chest.2022.11.023] [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: 06/08/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Swimming-induced pulmonary edema (SIPE) is a respiratory condition frequently seen among Naval Special Warfare (NSW) trainees. The incidence of positive respiratory panel (RP) findings in trainees with a diagnosis of SIPE currently is unknown. RESEARCH QUESTION Does a significant difference exist in the incidence of respiratory pathogens in nasopharyngeal samples of NSW candidates with SIPE and a control group? STUDY DESIGN AND METHODS Retrospective analysis of clinical information from NSW Sea, Air, and Land (SEAL) team candidates with a diagnosis of SIPE over a 12-month period. Candidates who demonstrated the common signs and symptoms of SIPE underwent a nasopharyngeal swab and RP test for common respiratory pathogens. SIPE diagnoses were supported by two-view chest radiography. RP tests were obtained for a selected control group of first-phase trainees without SIPE. RESULTS Forty-five of 1,048 SEAL team candidates received a diagnosis of SIPE (4.3%). Five had superimposed pneumonia. Thirty-six of 45 showed positive results for at least one microorganism on the RP (80%). In the study group, human rhinovirus/enterovirus (RV/EV) was the most frequently detected organism (37.8%), followed by coronavirus OC43 (17.8%), and parainfluenza virus type 3 (17.8%). Sixteen of 68 candidates from the control group showed positive RP (24%) findings. Patients with SIPE and positive RP results reported dyspnea (94%), pink frothy sputum (44%), and hemoptysis (22%) more frequently than the control participants with positive RP results. Those who reported respiratory infection symptoms in both the study and control groups showed higher incidences of positive RP results (P = .046). INTERPRETATION We observed that 80% of trainees with a diagnosis of SIPE showed positive results on a point-of-care RP. This positivity rate was significantly higher than that of RP test results from the control cohort. These findings suggest an association between colonization with a respiratory pathogen and the development of SIPE in NSW candidates.
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Shamaa TM, Kitajima T, Ivanics T, Shimada S, Yeddula S, Mohamed A, Rizzari M, Collins K, Yoshida A, Abouljoud M, Nagai S. Can Weather Be a Factor in Liver Transplant Waitlist and Posttransplant Outcomes? Analysis of United Network for Organ Sharing Registry. Transplant Proc 2022; 54:2254-2262. [DOI: 10.1016/j.transproceed.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/08/2022] [Accepted: 08/26/2022] [Indexed: 11/07/2022]
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10
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Ambrosy AP, Malik UI, Leong TK, Allen AR, Sung SH, Go AS. Food security, diet quality, nutritional knowledge, and attitudes towards research in adults with heart failure during the COVID-19 pandemic. Clin Cardiol 2022; 45:180-188. [PMID: 35106780 PMCID: PMC8860486 DOI: 10.1002/clc.23761] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/26/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The impact of the novel coronavirus disease 2019 (COVID-19) pandemic on diet and nutrition among older adults with chronic medical conditions have not been well-described. METHODS We conducted a survey addressing (1) food access, (2) diet quality and composition, (3) nutritional understanding, and (4) attitudes towards research among adults with heart failure (HF) within an integrated health system. Adults (≥18 years) with diagnosed HF and at least one prior hospitalization for HF within the last 12 months were approached to complete the survey electronically or by mail. Outcomes included all-cause and HF-specific hospitalizations and all-cause death was ascertained via the electronic health record. RESULTS Among 1212 survey respondents (32.5% of eligible patients) between May 18, 2020 and September 30, 2020, mean ± SD age was 77.9 ± 11.4 years, 50.1% were women, and median (25th-75th) left ventricular ejection fraction was 55% (40%-60%). Overall, 15.1% of respondents were food insecure, and only 65% of participants answered correctly more than half of the items assessing nutritional knowledge. Although most respondents were willing to participate in future research, that number largely declined for studies requiring blood draws (32.2%), study medication (14.4%), and/or behavior change (27.1%). Food security, diet quality, and nutritional knowledge were not independently associated with outcomes at 90 or 180 days. CONCLUSION In a cohort of older adults with HF and multiple comorbidities, a significant proportion reported issues with food access, diet quality, and nutritional knowledge during the COVID-19 pandemic. Future research should evaluate interventions targeting these domains in at-risk individuals.
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Affiliation(s)
- Andrew P Ambrosy
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Umar I Malik
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Thomas K Leong
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Amanda R Allen
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Alan S Go
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.,Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco, California, USA.,Department of Medicine, Stanford University, Palo Alto, California, USA
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11
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Tromp J, Beusekamp JC, Ouwerkerk W, Meer P, Cleland JG, Angermann CE, Dahlstrom U, Ertl G, Hassanein M, Perrone SV, Ghadanfar M, Schweizer A, Obergfell A, Filippatos G, Dickstein K, Collins SP, Lam CS. Regional Differences in Precipitating Factors of Hospitalization for Acute Heart Failure: Insights from the
REPORT‐HF
Registry. Eur J Heart Fail 2022; 24:645-652. [PMID: 35064730 PMCID: PMC9106888 DOI: 10.1002/ejhf.2431] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/05/2022] [Accepted: 01/14/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS Few prior studies have investigated differences in precipitants leading to hospitalizations for acute heart failure (AHF) in a cohort with global representation. METHODS AND RESULTS We analysed the prevalence of precipitants and their association with outcomes in 18 553 patients hospitalized for AHF in REPORT-HF (prospective international REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure) according to left ventricular ejection fraction subtype (reduced [HFrEF] and preserved ejection fraction [HFpEF]) and presentation (new-onset vs. decompensated chronic heart failure [DCHF]). Patients were enrolled from 358 centres in 44 countries stratified according to Latin America, North America, Western Europe, Eastern Europe, Eastern Mediterranean and Africa, Southeast Asia, and Western Pacific. Precipitants were pre-with mutually exclusive categories and selected according to the local investigator's discretion. Outcomes included in-hospital and 1-year mortality. The median age was 67 (interquartile range 57-77) years, and 39% were women. Acute coronary syndrome (ACS) was the most common precipitant in patients with new-onset heart failure in all regions except for North America and Western Europe, where uncontrolled hypertension and arrhythmia, respectively, were the most common precipitants, independent of confounders. In patients with DCHF, non-adherence to diet/medication was the most common precipitant regardless of region. Uncontrolled hypertension was a more likely precipitant in HFpEF, non-adherence to diet/medication, and ACS were more likely precipitants in HFrEF. Patients admitted due to worsening renal function had the worst in-hospital (5%) and 1-year post-discharge (30%) mortality rates, regardless of region, heart failure subtype and admission type (pinteraction >0.05 for all). CONCLUSION Data on global differences in precipitants for AHF highlight potential regional differences in targets for preventing hospitalization for AHF and identifying those at highest risk for early mortality.
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Affiliation(s)
- Jasper Tromp
- Saw Swee Hock School of Public Health National University of Singapore and National University Health System Singapore
- Duke‐NUS Medical School Singapore
| | - Joost C. Beusekamp
- University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Wouter Ouwerkerk
- National Heart Centre Singapore Singapore
- Dept of Dermatology Amsterdam UMC, University of Amsterdam, Amsterdam Infection & Immunity Institute Amsterdam The Netherlands
| | - Peter Meer
- University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - John G.F. Cleland
- Robertson Centre for Biostatistics and Clinical Trials, Institute of Health & Well‐Being, University of Glasgow and National Heart & Lung Institute, Imperial College London
| | - Christiane E. Angermann
- Comprehensive Heart Failure Centre, University Hospital and University of Würzburg Würzburg Germany
| | - Ulf Dahlstrom
- Department of Cardiology and Department of Health, Medicine and Caring Sciences Linkoping University Linkoping Sweden
| | - Georg Ertl
- Comprehensive Heart Failure Centre, University Hospital and University of Würzburg Würzburg Germany
| | - Mahmoud Hassanein
- Alexandria University, Faculty of Medicine, Cardiology Department Alexandria Egypt
| | - Sergio V. Perrone
- El Cruce Hospital by Florencio Varela, Lezica Cardiovascular Institute, Sanctuary of the Trinidad Miter Buenos Aires Argentina
| | | | | | | | - Gerasimos Filippatos
- University of Cyprus, School of Medicine & National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology Attikon University Hospital Athens Greece
| | | | - Sean P Collins
- Vanderbilt University Medical Center, Department of Emergency Medicine Nashville TN USA
| | - Carolyn S.P. Lam
- Duke‐NUS Medical School Singapore
- University of Groningen, University Medical Center Groningen Groningen The Netherlands
- National Heart Centre Singapore Singapore
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12
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Wu JR, Moser DK. Health-Related Quality of Life Is a Mediator of the Relationship Between Medication Adherence and Cardiac Event-Free Survival in Patients with Heart Failure. J Card Fail 2021; 27:848-856. [PMID: 34364662 DOI: 10.1016/j.cardfail.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/25/2021] [Accepted: 03/05/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) is an important patient-reported outcome that is related to medication adherence, hospitalization and death. The nature of the relationships among medication adherence, HRQOL, and hospitalization and death is unknown. We sought to determine the relationships among medication adherence, HRQOL, and cardiac event-free survival in patients with heart failure. METHODS AND RESULTS We enrolled 218 patients with heart failure. Patients' medication adherence was measured objectively using the Medication Event Monitoring System. HRQOL was assessed using the Minnesota Living with Heart Failure Questionnaire. Patients were followed for up to 3.5 years to collect hospitalization and mortality data. Mediation analysis was used to determine the nature of the relationships among the variables. Patients with better medication adherence had better HRQOL (P = .014). Medication adherence and HRQOL were associated with cardiac event-free survival (both P < .05). Patients with medication nonadherence were 1.86 times more likely to experience a cardiac event than those with better medication adherence (P = .038). Medication adherence was not associated with cardiac event-free survival after entering HRQOL in the model (P = .118), indicating mediation by HRQOL of the relationship between medication adherence and cardiac event-free survival. CONCLUSIONS HRQOL mediated the relationship between medication adherence and cardiac event-free survival. It is important to assess medication adherence and HRQOL regularly and develop interventions to improve medication adherence and HRQOL to decrease hospitalization and mortality in patients with heart failure.
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Affiliation(s)
- Jia-Rong Wu
- College of Nursing, University of Kentucky, Lexington, Kentucky.
| | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky
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13
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Medication as a risk factor for hospitalization due to heart failure and shock: a series of case-crossover studies in Swiss claims data. Eur J Clin Pharmacol 2020; 76:979-989. [PMID: 32270213 PMCID: PMC7306029 DOI: 10.1007/s00228-020-02835-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/20/2020] [Indexed: 01/06/2023]
Abstract
Purpose Heart failure is among the leading causes for hospitalization in Europe. In this study, we evaluate potential precipitating factors for hospitalization for heart failure and shock. Methods Using Swiss claims data (2014–2015), we evaluated the association between hospitalization for heart failure and shock, and prescription of oral potassium supplements, non-steroidal anti-inflammatory drugs (NSAIDs), and amoxicillin/clavulanic acid. We conducted case-crossover analyses, where exposure was compared for the hazard period and the primary control period (e.g., 1–30 days before hospitalization vs. 31–60 days, respectively). Conditional logistic regression was applied and subsequently adjusted for addressing potential confounding by disease progression. Sensitivity analyses were conducted and stratification for co-medication was performed. Results We identified 2185 patients hospitalized with heart failure or shock. Prescription of potassium supplements, NSAIDs, and amoxicillin/clavulanic acid was significantly associated with an increased risk for hospitalization for heart failure and shock with crude odds ratios (OR) of 2.04 for potassium (95% CI 1.24–3.36, p = 0.005, 30 days), OR 1.8 for NSAIDs (95% CI 1.39–2.33, p < 0.0001, 30 days), and OR 3.25 for amoxicillin/clavulanic acid (95% CI 2.06–5.14, p < 0.0001, 15 days), respectively. Adjustment attenuated odds ratios, while the significant positive association remained (potassium OR 1.70 (95% CI 1.01–2.86, p = 0.046), NSAIDs OR 1.50 (95% CI 1.14–1.97, p = 0.003), and amoxicillin/clavulanic acid OR 2.26 (95% CI 1.41–3.62, p = 0.001). Conclusion Prescription of potassium supplements, NSAIDs, and amoxicillin/clavulanic acid is associated with increased risk for hospitalization. Underlying conditions such as pain, electrolyte imbalances, and infections are likely contributing risk factors. Physicians may use this knowledge to better identify patients at risk and adapt patient management. Electronic supplementary material The online version of this article (10.1007/s00228-020-02835-x) contains supplementary material, which is available to authorized users.
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14
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Terner Z, Long A, Reviriego-Mendoza M, Larkin JW, Usvyat LA, Kotanko P, Maddux FW, Wang Y. Seasonal and Secular Trends of Cardiovascular, Nutritional, and Inflammatory Markers in Patients on Hemodialysis. KIDNEY360 2020; 1:93-105. [PMID: 35372910 PMCID: PMC8809101 DOI: 10.34067/kid.0000352019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/13/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND All life on earth has adapted to the effects of changing seasons. The general and ESKD populations exhibit seasonal rhythms in physiology and outcomes. The ESKD population also shows secular trends over calendar time that can convolute the influences of seasonal variations. We conducted an analysis that simultaneously considered both seasonality and calendar time to isolate these trends for cardiovascular, nutrition, and inflammation markers. METHODS We used data from adult patients on hemodialysis (HD) in the United States from 2010 through 2014. An additive model accounted for variations over both calendar time and time on dialysis. Calendar time trends were decomposed into seasonal and secular trends. Bootstrap procedures and likelihood ratio methods tested if seasonal and secular variations exist. RESULTS We analyzed data from 354,176 patients on HD at 2436 clinics. Patients were 59±15 years old, 57% were men, and 61% had diabetes. Isolated average secular trends showed decreases in pre-HD systolic BP (pre-SBP) of 2.6 mm Hg (95% CI, 2.4 to 2.8) and interdialytic weight gain (IDWG) of 0.35 kg (95% CI, 0.33 to 0.36) yet increases in post-HD weight of 2.76 kg (95% CI, 2.58 to 2.97). We found independent seasonal variations of 3.3 mm Hg (95% CI, 3.1 to 3.5) for pre-SBP, 0.19 kg (95% CI, 0.17 to 0.20) for IDWG, and 0.62 kg (95% CI, 0.46 to 0.79) for post-HD weight as well as 0.12 L (95% CI, 0.11 to 0.14) for ultrafiltration volume, 0.41 ml/kg per hour (95% CI, 0.37 to 0.45) for ultrafiltration rates, and 3.30 (95% CI, 2.90 to 3.77) hospital days per patient year, which were higher in winter versus summer. CONCLUSIONS Patients on HD show marked seasonal variability of key indicators. Secular trends indicate decreasing BP and IDWG and increasing post-HD weight. These methods will be of importance for independently determining seasonal and secular trends in future assessments of population health.
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Affiliation(s)
- Zachary Terner
- Department of Statistics and Applied Probability, University of California-Santa Barbara, Santa Barbara, California
| | - Andrew Long
- Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts
| | | | - John W. Larkin
- Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts
| | - Len A. Usvyat
- Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts
| | - Peter Kotanko
- Research Division, Renal Research Institute, New York, New York; and
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | | | - Yuedong Wang
- Department of Statistics and Applied Probability, University of California-Santa Barbara, Santa Barbara, California
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Shoemaker MJ, Dias KJ, Lefebvre KM, Heick JD, Collins SM. Physical Therapist Clinical Practice Guideline for the Management of Individuals With Heart Failure. Phys Ther 2020; 100:14-43. [PMID: 31972027 DOI: 10.1093/ptj/pzz127] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/15/2019] [Accepted: 06/10/2019] [Indexed: 12/12/2022]
Abstract
The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular and Pulmonary Section of APTA, have commissioned the development of this clinical practice guideline to assist physical therapists in their clinical decision making when managing patients with heart failure. Physical therapists treat patients with varying degrees of impairments and limitations in activity and participation associated with heart failure pathology across the continuum of care. This document will guide physical therapist practice in the examination and treatment of patients with a known diagnosis of heart failure. The development of this clinical practice guideline followed a structured process and resulted in 9 key action statements to guide physical therapist practice. The level and quality of available evidence were graded based on specific criteria to determine the strength of each action statement. Clinical algorithms were developed to guide the physical therapist in appropriate clinical decision making. Physical therapists are encouraged to work collaboratively with other members of the health care team in implementing these action statements to improve the activity, participation, and quality of life in individuals with heart failure and reduce the incidence of heart failure-related re-admissions.
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Affiliation(s)
- Michael J Shoemaker
- Department of Physical Therapy, Grand Valley State University, 301 Michigan NE, Suite 200, Grand Rapids, MI 49503 (USA). Dr Shoemaker is a board-certified clinical specialist in geriatric physical therapy
| | - Konrad J Dias
- Physical Therapy Program, Maryville University of St Louis, St Louis, Missouri. Dr Dias is a board-certified clinical specialist in cardiovascular and pulmonary physical therapy
| | - Kristin M Lefebvre
- Department of Physical Therapy, Concordia University St Paul, St Paul, Minnesota. Dr Lefebvre is a board-certified clinical specialist in cardiovascular and pulmonary physical therapy
| | - John D Heick
- Department of Physical Therapy, Northern Arizona University, Flagstaff, Arizona. Dr Heick is a board-certified clinical specialist in orthopaedic physical therapy, neurologic physical therapy, and sports physical therapy
| | - Sean M Collins
- Physical Therapy Program, Plymouth State University, Plymouth, New Hampshire
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Post-Discharge Services for Different Diagnoses Than Index Hospitalization Predict Decreased 30-Day Readmissions Among Medicare Beneficiaries. J Gen Intern Med 2019; 34:1766-1774. [PMID: 31228052 PMCID: PMC6712241 DOI: 10.1007/s11606-019-05115-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/05/2018] [Accepted: 05/01/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Efforts to reduce hospital readmissions include post-discharge interventions related to the illness treated during the index hospitalization (IH). These efforts may be inadequate because readmissions are precipitated by a wide range of health conditions unrelated to the primary diagnosis of the IH. OBJECTIVE To investigate the relationship between post-discharge health services utilization for the same or a different diagnosis than the IH and unplanned 30-day readmission. DESIGN AND PARTICIPANTS The study sample included 583,199 all-cause IHs among 2014 Medicare fee-for-service beneficiaries. For all-cause IH, as well as individually for heart failure, myocardial infarction, and pneumonia IH, we used multivariable logistic regressions to investigate the association between post-discharge services utilization and readmission. MAIN MEASURES The outcome was unplanned 30-day readmission. Primary independent variables were post-discharge services utilization, including institutional outpatient, office-based primary care, office-based specialist, office-based non-physician practitioner, emergency department, home health care, and skilled nursing facility providers. KEY RESULTS Among all-cause IH, 11.7% resulted in unplanned 30-day readmissions, and only 18.1% of readmissions occurred for the same primary diagnosis as IH. A substantial majority of post-discharge health services were utilized for a primary diagnosis differing from IH. Compared with no visit, institutional outpatient visits for the same primary diagnosis as IH (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.31-0.34) and for a different primary diagnosis than IH (OR, 0.36; 95% CI, 0.35-0.37) were similarly strongly associated with decreased unplanned 30-day readmission. Primary care physician, specialist, non-physician practitioner, and home health care showed similar patterns. IH for heart failure, myocardial infarction, and pneumonia manifested similar patterns to all-cause IH both in terms of post-discharge services utilization and in terms of its impact on readmission. CONCLUSIONS To reduce unplanned 30-day readmission more effectively, discharge planning should include post-discharge services to address health conditions beyond the primary cause of the IH.
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Tsuyuki RT, Lockwood EE, Shibata MC, Simpson SH, Tweden KL, Gutierrez R, Reddy MC, Rowe BH, Villa-Roel C, Fradette M. A Randomized Trial of Video-based Education in Patients With Heart Failure: The Congestive Heart Failure Outreach Program of Education (COPE). CJC Open 2019; 1:62-68. [PMID: 32159085 PMCID: PMC7063627 DOI: 10.1016/j.cjco.2018.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 12/12/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Heart failure (HF) exacerbations often relate to poor self-care. Education programs improve outcomes, but are resource-intensive. We developed a video-based educational intervention and evaluated it in patients with HF. METHODS Congestive Heart Failure Outreach Program of Education was a pragmatic multicenter randomized trial. We included subjects with HF if they were hospitalized, seen in the emergency department (ED), or high-risk outpatients, and randomized them to intervention or control. Intervention included a 20-minute video, supplementary booklet, and 3 bimonthly newsletters focusing on salt and fluid restriction, daily weights, and medications. Subjects watched the video and were encouraged to review it at home, along with the booklet/newsletters. Control subjects received the booklet only. The primary outcome was the difference in cardiovascular hospitalizations or ED visits between groups at 6 months. Secondary outcomes included clinical events and in-hospital days. RESULTS We recruited 539 subjects from 22 centers in Canada and the United States. Baseline characteristics were similar in both groups: 64% were male and had a mean age of 66 (± 13) years, mean ejection fraction 31% (± 13.5), and 65% New York Heart Association Functional Classification III/IV. The primary outcome occurred in 57 subjects (21%) in the intervention group compared with 61 subjects (23%) in the control group (P = 0.66). There were no significant differences in prespecified secondary outcomes; however, death occurred in 18 subjects (7%) in the intervention group and 33 subjects (12%) in the control group (P = 0.03). CONCLUSION Video education on self-care did not reduce hospitalizations or ED visits in patients with HF. Of note, mortality was lower in the intervention group.
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Affiliation(s)
- Ross T. Tsuyuki
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- EPICORE Centre, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Evan E. Lockwood
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- EPICORE Centre, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Cardiology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Marcelo C. Shibata
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- EPICORE Centre, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Cardiology, Misericordia Hospital, Edmonton, Alberta, Canada
| | - Scot H. Simpson
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | | | - Rosa Gutierrez
- Capital Health Authority/Alberta Health Services, Edmonton, Alberta, Canada (now retired)
| | - Maria C. Reddy
- Capital Health Authority/Alberta Health Services, Edmonton, Alberta, Canada (now retired)
| | - Brian H. Rowe
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Cristina Villa-Roel
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Miriam Fradette
- EPICORE Centre, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Perceptions and Acceptability of Receiving SMS Self-care Messages in Chinese Patients With Heart Failure: An Inpatient Survey. J Cardiovasc Nurs 2018; 32:357-364. [PMID: 27617565 DOI: 10.1097/jcn.0000000000000349] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Self-care is critical for postdischarge heart failure (HF) patients. Short message service (SMS) is a promising way to promote HF self-care. OBJECTIVE The aim of this study is to investigate knowledge status in Chinese HF patients, as well as the acceptance of SMS as a way to improve self-care. METHODS A survey using a self-developed questionnaire was conducted in patients with decompensated HF 2 days before discharge. RESULTS A total of 540 patients completed the survey. Among them, only 69.8% and 63.3% of patients were aware of their HF status and medication regimen, respectively. A total of 95.6% patients were willing to receive SMS. Patient himself/herself, caregiver, or both patient and caregiver were almost equally selected as the preferred receiver of SMS. Educational and/or reminder SMS was considered "very helpful" by 50.2% of the patients as a way of promoting self-care, similar to that of telephone education and brochure education. "Take your medicine", "avoid getting flu," and "keep follow-up" were regarded as the most important self-care contents, whereas "weigh yourself every day" and "restrict fluid intake" were considered the least important. CONCLUSION As a way of promoting HF self-care, SMS intervention combining educational and reminder function might be well accepted by HF patients in China. The status of HF, medication, weight control, and fluid restriction should be emphasized during the practice. Caution should be drawn as the survey was not tested elsewhere. Further clinical trials would be conducted to examine the effect of SMS intervention on self-care behaviors and outcomes of HF patients.
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Gustafsson M, Sjölander M, Pfister B, Schneede J, Lövheim H. Effects of Pharmacists' Interventions on Inappropriate Drug Use and Drug-Related Readmissions in People with Dementia-A Secondary Analysis of a Randomized Controlled Trial. PHARMACY 2018; 6:pharmacy6010007. [PMID: 29337859 PMCID: PMC5874546 DOI: 10.3390/pharmacy6010007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 12/15/2022] Open
Abstract
Age-associated physiological changes and extensive drug treatment including use of potentially inappropriate medications (PIMs) pose a significant risk of drug-drug interactions and adverse drug events among elderly people with dementia. This study aimed at analysing the effects of clinical pharmacists' interventions on use of PIMs, risk of emergency department visits, and time to institutionalization. Furthermore, a descriptive analysis was conducted of circumstances associated with drug-related readmissions. This is a secondary analysis of data from a randomized controlled intervention study conducted in two hospitals in Northern Sweden. The study included patients (n = 460) 65 years or older with dementia or cognitive impairment. The intervention consisted of comprehensive medication reviews conducted by clinical pharmacists as part of a healthcare team. There was a larger decrease in PIMs in the intervention group compared with the control group (p = 0.011). No significant difference was found in time to first all-cause emergency department visits (HR = 0.994, 95% CI = 0.755-1.307 p = 0.963, simple Cox regression) or time to institutionalization (HR = 0.761, 95% CI = 0.409-1.416 p = 0.389, simple Cox regression) within 180 days. Common reasons for drug-related readmissions were negative effects of sedatives, opioids, antidepressants, and anticholinergic agents, resulting in confusion, falling, and sedation. Drug-related readmissions were associated with living at home, heart failure, and diabetes. Pharmacist-provided interventions were able to reduce PIMs among elderly people with dementia and cognitive impairment.
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Affiliation(s)
- Maria Gustafsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187 Umeå, Sweden.
| | - Maria Sjölander
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187 Umeå, Sweden.
| | - Bettina Pfister
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187 Umeå, Sweden.
| | - Jörn Schneede
- Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187 Umeå, Sweden.
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-90187 Umeå, Sweden.
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Kapoor JR, Kapoor R, Ju C, Heidenreich PA, Eapen ZJ, Hernandez AF, Butler J, Yancy CW, Fonarow GC. Precipitating Clinical Factors, Heart Failure Characterization, and Outcomes in Patients Hospitalized With Heart Failure With Reduced, Borderline, and Preserved Ejection Fraction. JACC-HEART FAILURE 2017; 4:464-72. [PMID: 27256749 DOI: 10.1016/j.jchf.2016.02.017] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 02/05/2016] [Accepted: 02/07/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study assessed the comparative frequency of precipitating clinical factors leading to hospitalization among heart failure (HF) patients with reduced, borderline, and preserved ejection fraction (EF) BACKGROUND: There are few data assessing the comparative frequency of clinical factors leading to HF among hospitalized among patients with reduced, borderline, and preserved EF. METHODS We analyzed the factors potentially contributing to HF hospitalization among 99,825 HF admissions from 305 hospitals in the Get With The Guidelines-HF (GWTG-HF) database between January 2005 and September 2013 and assessed their association with length of stay and in-hospital mortality. RESULTS Mean patient age was 72.6 ± 14.2 years, 49% were female, and mean EF was 39.3 ± 17.2%. Common factors included pneumonia/respiratory process (28.2%), arrhythmia (21.7%), medication noncompliance (15.8%), worsening renal failure (14.7%), and uncontrolled hypertension (14.5%). In patients with borderline EF (EF 40% to 49%), pneumonia was associated with longer hospital stay, whereas dietary and medication noncompliance were associated with reduced length of stay. In patients with preserved EF (EF ≥50% or qualitative assessment of normal or mild dysfunction), pneumonia, weight gain, and worsening renal function were independently associated with longer lengths of stay. Worsening renal function and pneumonia were independently associated with higher in-hospital mortality in all HF groups, and acute pulmonary edema was associated with higher mortality in reduced EF. Dietary noncompliance (14.7%) was associated with reduced mortality for all groups but reached statistical significance in the subgroups of reduced (odds ratio [OR]: 0.65; 95% confidence interval [CI]: 0.46 to 0.91) and preserved systolic function (OR: 0.52; 95% CI: 0.33 to 0.83). Patients presenting with ischemia had a higher mortality rate (OR: 1.31; 95% CI: 1.02 to 1.69; and 1.72; 95% CI: 1.27 to 2.33, respectively, in the 2 groups). CONCLUSIONS Potential precipitating factors among patients hospitalized with HF vary by EF group and are independently associated with clinical outcomes.
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Affiliation(s)
| | | | - Christine Ju
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Zubin J Eapen
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Javed Butler
- Division of Cardiology, Stony Brook University, Stony Brook, New York
| | | | - Gregg C Fonarow
- Division of Cardiology, University of California Los Angeles, Los Angeles, California
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Obi Y, Kalantar-Zadeh K, Streja E, Rhee CM, Reddy UG, Soohoo M, Wang Y, Ravel V, You AS, Jing J, Sim JJ, Nguyen DV, Gillen DL, Saran R, Robinson B, Kovesdy CP. Seasonal variations in transition, mortality and kidney transplantation among patients with end-stage renal disease in the USA. Nephrol Dial Transplant 2017; 32:ii99-ii105. [PMID: 28201764 DOI: 10.1093/ndt/gfw379] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 09/22/2016] [Indexed: 12/22/2022] Open
Abstract
Background Seasonal variations may exist in transitioning to dialysis, kidney transplantation and related outcomes among end-stage renal disease (ESRD) patients. Elucidating these variations may have major clinical and healthcare policy implications for better resource allocation across seasons. Methods Using the United States Renal Data System database from 1 January 2000 to 31 December 2013, we calculated monthly counts of transitioning to dialysis or first transplantation and deaths. Crude monthly transition fraction was defined as the number of new ESRD patients divided by all ESRD patients on the first day of each month. Similar fractions were calculated for all-cause and cause-specific mortality and transplantation. Results The increasing trend of the annual transition to ESRD plateaued during 2009-2012 (n = 126 264), and dropped drastically in 2013 (n = 117 372). Independent of secular trends, monthly transition to ESRD was lowest in July (1.65%) and highest in January (1.97%) of each year. All-cause, cardiovascular and infectious mortalities were lowest in July or August (1.32, 0.58 and 0.15%, respectively) and highest in January (1.56, 0.71 and 0.19%, respectively). Kidney transplantation was highest in June (0.33%), and this peak was mainly attributed to living kidney transplantation in summer months. Transplant failure showed a similar seasonal variation to naïve transition, peaking in January (0.65%) and nadiring in September (0.56%). Conclusions Transitioning to ESRD and adverse events among ESRD people were more frequent in winter and less frequent in summer, whereas kidney transplantation showed the reverse trend. The potential causes and implications of these consistent seasonal variations warrant more investigation.
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Affiliation(s)
- Yoshitsugu Obi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA
- Fielding School of Public Health at UCLA, Los Angeles, CA, USA
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA
| | - Uttam G Reddy
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA
| | - Yaping Wang
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA
| | - Vanessa Ravel
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA
| | - Amy S You
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA
| | - Jennie Jing
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA, USA
| | - John J Sim
- Kaiser Permanente of Southern California, Los Angeles, CA, USA
| | - Danh V Nguyen
- Biostatistics, Epidemiology & Research Design Unit, Institute for Clinical and Translational Science, University of California Irvine, Irvine, CA, USA
| | - Daniel L Gillen
- Deptartment of Statistics, Program in Public Health, University of California Irvine, Irvine, CA, USA
| | - Rajiv Saran
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI, USA
| | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA
- Nephrology Section, Memphis VA Medical Center, Memphis, TN, USA
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22
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Abstract
Purpose To determine if the inclusion of a clinical pharmacist (CP) in a heart failure (HF) multidisciplinary team could lead to a reduction in the number of hospital admissions and additionally decrease the clinical signs and symptoms of HF patients with either Medicaid or no medical insurance. Methods Longitudinal study to determine the impact of a pharmaceutical-care service program to HF patients by comparing the 9-month period before (pre-intervention) and the 9-month period after (post-intervention) implementation of the program. The intervention of the CP was directed in two complementary functions. The first was direct patient contact and the second was to provide drug information to the medical clinicians. Results Twenty-nine outpatients completed the study. Over 9 months, the CP made a total of 216 interventions and had three in-person, follow-up contacts and three telephone contacts per patient. At post-intervention, there was a statistically significant reduction in the total number of hospitalizations (50 vs 23; P < 0.018) and length of stay (LOS) (263 days vs 108 days; P < 0.03). However, there was an insignificant reduction in HF hospitalizations, LOS, and total number of HF signs and symptoms. Conclusions Addition of a CP to an outpatient HF clinic can lead to fewer hospital admissions and a reduction in the LOS in patients with either Medicaid or no medical insurance.
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Affiliation(s)
- Devada Singh-Franco
- Nova Southeastern University; Ambulatory Care, Broward General Medical Center
| | - Leanne Li
- Pharmacy Administration, Nova Southeastern University
| | - Stan Hannah
- Applied Research, Nova Southeastern University
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23
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Ragbaoui Y, Nouamou I, Hammiri AE, Habbal R. [Predictive factors of medication adherence in patients with chronic heart failure: Morocco's experience]. Pan Afr Med J 2017; 26:115. [PMID: 28533838 PMCID: PMC5429467 DOI: 10.11604/pamj.2017.26.115.11471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/02/2017] [Indexed: 11/24/2022] Open
Abstract
L’adhésion médicamenteuse chez les patients ayant une insuffisance cardiaque chronique est reconnue comme l’un des problèmes majeurs dans la gestion de cette pathologie. L’état démographique et socioéconomique des pays africains peut avoir un impact sur l’adhésion au traitement de l’insuffisance cardiaque chronique. Nous avons réalisé une étude transversale de Septembre 2014 à Janvier 2015 portant sur les patients en insuffisance cardiaque chronique suivis au centre d’insuffisance cardiaque du département de cardiologie du centre hospitalier universitaire IBN ROCHD à Casablanca au Maroc. La mesure de l’adhésion médicamenteuse était basée sur un questionnaire: questionnaire CARDIA. Les informations relatifs aux facteurs prédictifs d’adhésion médicamenteuse était dérivés du model d’adhésion multidimensionnel. Nous avons inclus dans cette étude 147 patients insuffisants cardiaques chroniques. Le pourcentage de l’adhésion médicamenteuse était de 83.6% selon CARDIA-Questionary. Les facteurs prédictifs qui influencent significativement l’adhésion médicamenteuse était: La dépression (p=0.034), le niveau de support social (p=0.03) et la prise de médicaments par le patient lui-même (p=0.0001). Comme dans plusieurs régions au monde, l’adhésion médicamenteuse chez les patients ayant une insuffisance cardiaque chronique reste un problème de santé au Maroc. Les différentes stratégies qui agissent sur les facteurs prédictifs pourraient améliorer l’adhésion médicamenteuse.
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Affiliation(s)
- Yassine Ragbaoui
- Service de Cardiologie, Centre Hospitalier Universitaire IBN ROCHD, Casablanca, Maroc
| | - Imad Nouamou
- Service de Cardiologie, Centre Hospitalier Universitaire IBN ROCHD, Casablanca, Maroc
| | - Ayoub El Hammiri
- Service de Cardiologie, Centre Hospitalier Universitaire IBN ROCHD, Casablanca, Maroc
| | - Rachida Habbal
- Service de Cardiologie, Centre Hospitalier Universitaire IBN ROCHD, Casablanca, Maroc
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24
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Alemzadeh-Ansari MJ, Ansari-Ramandi MM, Naderi N. Chronic Pain in Chronic Heart Failure: A Review Article. J Tehran Heart Cent 2017; 12:49-56. [PMID: 28828019 PMCID: PMC5558055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Heart failure (HF) is one of the main causes of death and disability in the world. The prevalence of HF in developed countries is between 1% and 2% of the adult population and approximately between 6% and 10% in the elderly, giving rise to high costs of care and treatment. Indeed, in the United States, the direct and indirect costs exceeded 23 billion dollars in 2002. HF is typically characterized by periods of acute symptoms followed by returns to nearly asymptomatic periods. As dyspnea and fatigue are considered the signature symptoms of HF, other symptoms such as pain go unnoticed. Awareness of the burden of pain, however, is growing in patients with chronic HF. The past 2 decades have witnessed remarkable technical headway in cardiology and many patients have survived despite the progressive impairment of their cardiovascular function. It is, therefore, of great value to investigate the prevalence and management of pain in patients with HF. To that end, we undertook a comprehensive search using the MEDLINE database for studies and guidelines on the subject of pain and HF and the complications and considerations and finally selected 65 studies for review.
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Affiliation(s)
| | | | - Nasim Naderi
- Corresponding Author: Nasim Naderi, Associate Professor of Cardiology, Rajaie Cardiovascular, Medical and Research Center, Vali-Asr Avenue, Niyayesh Boulevard, Tehran, Iran. 1996911151. Tel: +98 21 23922115. Fax: +98 21 22055594.
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25
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Caballero A, Pinilla MI, Mendoza ICS, Peña JRA. [Hospital readmission rate and associated factors among health services enrollees in Colombia]. CAD SAUDE PUBLICA 2017; 32:S0102-311X2016000705009. [PMID: 27462855 DOI: 10.1590/0102-311x00146014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 02/18/2016] [Indexed: 11/22/2022] Open
Abstract
Hospital readmissions are common and expensive, and there is little information on the problem in Colombia. The objective was to determine the frequency of 30-day all-cause hospital readmissions and associated factors. This was a retrospective analytical cohort study of 64,969 hospitalizations from January 2008 to January 2009 in 47 Colombian cities. 6,573 hospital readmissions, prevalence: 10.1% (men 10.9%, women 9.5%), 44.7% > 65 years of age. Hospital readmissions was associated with higher mortality (5.8% vs. 1.8%). There was an increase in the Hospital readmissions rate in patients with diseases of the circulatory system. Hospital readmissions was more likely in hematological diseases and neoplasms. Mean length of stay during the first readmission was 7 days in patients that were readmitted and 4.5 in those without readmission. Greater total cost of hospital readmissions (USA 21,998,275): 15.8% of the total cost of hospitalizations. Higher prevalence rates in referred patients (18.8%) and patients from the outpatient clinic (13.7%). Hospital readmissions is common and is associated with longer length of hospital stay and higher mortality and cost. Increased risk of hospital readmissions in men > 65 years, patients referred from other institutions, and in hematological diseases and neoplasms.
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26
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Huynh-Hohnbaum ALT, Marshall L, Villa VM, Lee G. Self-Management of Heart Disease in Older Adults. Home Health Care Serv Q 2017; 34:159-72. [PMID: 26566582 DOI: 10.1080/01621424.2015.1092909] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The American Heart Association estimates that 81% of people who die of coronary heart disease are 65 years old or older. The leading risk health behaviors include physical inactivity, poor diet, smoking, and binge drinking. Using the 2011-2012 California Health Interview Survey (CHIS), this study looked at how self-management, which includes a plan developed by a medical professional and the confidence to manage one's disease, may decrease negative risk behaviors in older adults. The presence of a plan and increased self-efficacy decreased engagement in negative dietary behaviors and low physical activity. Implications for strategies that address heart disease and self-management are discussed.
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Affiliation(s)
- Anh-Luu T Huynh-Hohnbaum
- a School of Social Work , California State University , Los Angeles, Los Angeles , California , USA
| | - Lia Marshall
- b Luskin School of Public Affairs , University of California , Los Angeles, Los Angeles , California , USA
| | - Valentine M Villa
- c School of Social Work, and Applied Gerontology Institute , California State University , Los Angeles, Los Angeles , California , USA
| | - Gi Lee
- a School of Social Work , California State University , Los Angeles, Los Angeles , California , USA
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27
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Khafaji HAR, Sulaiman K, Singh R, Alhabib KF, Asaad N, Alsheikh-Ali A, Al-Jarallah M, Bulbanat B, Almahmeed W, Ridha M, Bazargani N, Amin H, Al-Motarreb A, Faleh HA, Elasfar A, Panduranga P, Suwaidi JA. Chronic obstructive airway disease among patients hospitalized with acute heart failure; clinical characteristics, precipitating factors, management and outcome: Observational report from the Middle East. ACTA ACUST UNITED AC 2016; 17:55-66. [DOI: 10.1080/17482941.2016.1203438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Hadi A. R. Khafaji
- Department of Cardiology, Saint Michael's Hospital, Toronto University, Toronto, Canada
| | - Kadhim Sulaiman
- Biostatistics Section, Department of Cardiology, Royal Hospital, Muscat, Oman
| | - Rajvir Singh
- Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khalid F. Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Nidal Asaad
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Alawi Alsheikh-Ali
- Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | | | - Bassam Bulbanat
- Department of Cardiology, Sabah Al-Ahmed Cardiac Center, Kuwait City, Kuwait
| | - Wael Almahmeed
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mustafa Ridha
- Department of Cardiology, Adan Hospital, Hadiya, Kuwait
| | - Nooshin Bazargani
- Department of Cardiology, Dubai Hospital, Dubai, United Arab Emirates
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Center, Manamah, Bahrain
| | - Ahmed Al-Motarreb
- Department of Cardiology, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | - Husam Al Faleh
- Department of Cardiology and Cardiovascular Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Abdelfatah Elasfar
- Department of Cardiology, Prince Salman Heart Center, King Fahad Medical City, Saudi Arabia
| | | | - Jassim Al Suwaidi
- Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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28
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Moulton PJ, McGrane AM, Beck TL, Holland NL, Christopher MA. Utilization of Home Health Care Services by Elderly Patients with Heart Failure. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2016. [DOI: 10.1177/089780189801000414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Heart failure is one of the most common reasons for admission to home health care among older adults Patients with heart failure present complex challenges for home health care agency staff, given the chronic yet variable nature of the disease and the importance of behavioral factors in long-term management of heart failure. The purpose of this study was to examine the patterns of health service utilization and outcomes of home care among elderly home care patients with heart failure. The sample included 104 patients with a primary or secondary diagnosis of heart failure admitted to a large Medicare-certified home care agency. Finding from the study revealed that subjects received an average of 11 skilled nursing visits over a 37-day period. Twelve percent of the subjects were rehospitalized before their home care treatment plans were completed. Although the percentage of patients rehospitalized in this study was relatively low, additional research is needed that will investigate the relationship between home care nurses' interventions and the patient outcomes associated with these interventions.
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29
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Leventhal MJE, Riegel B, Carlson B, De Geest S. Negotiating Compliance in Heart Failure: Remaining Issues and Questions. Eur J Cardiovasc Nurs 2016; 4:298-307. [PMID: 15893959 DOI: 10.1016/j.ejcnurse.2005.04.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2004] [Revised: 03/30/2005] [Accepted: 04/04/2005] [Indexed: 11/26/2022]
Abstract
Living with heart failure (HF) means living with a chronic illness characterized by periods of acute decompensation alternating with periods of relative stability. Improved medical care for patients with cardiovascular diseases, coupled with the aging of the populations in the developed world, has resulted in a steadily increasing prevalence of HF. Rehospitalization rates are high for this patient population. In 20–64% of the cases, poor compliance by patients with the prescribed HF treatment is a contributing factor to hospitalization. This article uses a review of the literature on HF non-compliance, including the prevalence, barriers, consequences, and the long-term outcomes of non-compliance with HF therapy, to illustrate remaining issues and questions. Original studies published in English or German between 1966 and June 2004 identified by combining patient compliance, non-compliance, adherence, self-care, rehospitalization, patient education, and management programs, with heart failure in the search strategy are included. Creative approaches to achieving a true partnership between providers and patients are needed if clinical outcomes are to improve.
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Affiliation(s)
- Marcia J E Leventhal
- Institute of Nursing Science, University of Basel, Division of Clinical Nursing Science, University Hospital of Basel, CH-4056 Basel, Switzerland
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30
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Bos-Touwen I, Jonkman N, Westland H, Schuurmans M, Rutten F, de Wit N, Trappenburg J. Tailoring of self-management interventions in patients with heart failure. Curr Heart Fail Rep 2016; 12:223-35. [PMID: 25929690 PMCID: PMC4424272 DOI: 10.1007/s11897-015-0259-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The effectiveness of heart failure (HF) self-management interventions varies within patients suggesting that one size does not fit all. It is expected that effectiveness can be optimized when interventions are tailored to individual patients. The aim of this review was to synthesize the literature on current use of tailoring in self-management interventions and patient characteristics associated with self-management capacity and success of interventions, as building blocks for tailoring. Within available trials, the degree to which interventions are explicitly tailored is marginal and often limited to content. We found that certain patient characteristics that are associated with poor self-management capacity do not influence effectiveness of a given intervention (i.e., age, gender, ethnicity, disease severity, number of comorbidities) and that other characteristics (low: income, literacy, education, baseline self-management capacity) in fact are indicators of patients with a high likelihood for success. Increased scientific efforts are needed to continue unraveling success of self-management interventions and to validate the modifying impact of currently known patient characteristics.
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Affiliation(s)
- Irene Bos-Touwen
- />Department Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Nini Jonkman
- />Department Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Heleen Westland
- />Department Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Marieke Schuurmans
- />Department Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Frans Rutten
- />Julius Center, Department of General Practice, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Niek de Wit
- />Julius Center, Department of General Practice, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Jaap Trappenburg
- />Department Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
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31
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Wu JR, Moser DK. Type D personality predicts poor medication adherence in patients with heart failure in the USA. Int J Behav Med 2015; 21:833-42. [PMID: 24198039 DOI: 10.1007/s12529-013-9366-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Type D (distressed) personality and medication nonadherence have been associated with poor health outcomes. Type D personality is associated with poor medication adherence in patients with coronary artery disease. However, the relationship between type D personality and medication adherence in patients with heart failure (HF) remains unknown. PURPOSE Therefore, the goal of this study was to examine the association between type D personality and medication adherence in patients with HF. METHOD This was a sub-analysis of baseline data from a randomized controlled trial with 84 patients with HF in the USA. Demographic, clinical, and psychological data were collected at baseline by interview, questionnaires, and medical record review. Type D personality was assessed using the Type D Personality Scale (DS14). Medication adherence was measured using both objective (Medication Event Monitoring System, MEMS) and self-reported (Morisky Medication Adherence Scale, MMAS-4) measures. Patients started medication adherence monitoring with the MEMS bottle at baseline and is used continuously for a month. Multiple regressions were used to explore the relationships between type D personality and medication adherence while adjusting for demographic, clinical, and psychological factors. RESULTS Patients with type D personality were more likely to have poor medication adherence. Type D personality was associated with medication adherence before and after adjusting for covariates when it was analyzed as a categorical variable. However, type D personality was not associated with medication adherence when analyzed as a dimensional construct. Negative affectivity, a component of type D personality, was associated with medication adherence. CONCLUSION As a dimensional construct, type D personality may not reflect the components of the personality associated with poor outcomes. Negative affectivity was associated with medication adherence in patients with HF. Interventions aiming to improving/enhancing medication adherence need to take into account patients with the negative affectivity component of type D personality who are at higher risk for poor medication adherence, which may lead to adverse health outcomes.
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Affiliation(s)
- Jia-Rong Wu
- School of Nursing, University of North Carolina at Chapel Hill, 435 Carrington Hall, CB# 7460, Chapel Hill, NC, 27599-7460, USA,
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de Albuquerque DC, de Souza JD, Bacal F, Rohde LEP, Bernardez-Pereira S, Berwanger O, Almeida DR. I Brazilian Registry of Heart Failure - Clinical Aspects, Care Quality and Hospitalization Outcomes. Arq Bras Cardiol 2015; 104:433-42. [PMID: 26131698 PMCID: PMC4484675 DOI: 10.5935/abc.20150031] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/07/2015] [Accepted: 01/07/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Heart failure (HF) is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. OBJECTIVE Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. METHODS Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. RESULTS A total of 1,263 patients (64±16 years, 60% women) were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%), dyslipidemia (36.7%) and diabetes (34%). Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. CONCLUSION The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence.
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Affiliation(s)
| | | | - Fernando Bacal
- Instituto do Coração (InCor) do Hospital das Clínicas da
Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Otavio Berwanger
- Instituto de Pesquisa, Hospital do Coração, São Paulo, SP,
Brazil
| | - Dirceu Rodrigues Almeida
- Universidade Federal de São Paulo, UNIFESP, São Paulo, SP;
Sociedade Brasileira de Cardiologia - Departamento de Insuficiência Cardíaca (DEIC) -
Brazil
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33
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Hargraves TL, Bennett AA, Brien JAE. Developing an Outpatient Heart Failure Pharmacy Service. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2008.tb00812.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Tracey-Lea Hargraves
- Pharmacy Department; St Vincent's Hospital
- Faculty of Pharmacy; University of Sydney
| | - Alexandra A Bennett
- Pharmacy Department; St Vincent's Hospital
- Faculty of Pharmacy; University of Sydney
| | - Jo-anne E Brien
- Pharmacy Department; St Vincent's Hospital
- Faculty of Pharmacy; University of Sydney
- Faculty of Medicine; University of New South Wales; Kensington New South Wales
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34
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Blennerhassett JD, Cusack BM, Smith CD, Green L, Tribe KL. A Novel Medicines Management Pathway. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2006.tb00601.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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35
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Ghisi GLDM, Britto R, Motamedi N, Grace SL. Disease-related knowledge in cardiac rehabilitation enrollees: correlates and changes. PATIENT EDUCATION AND COUNSELING 2015; 98:533-539. [PMID: 25577470 DOI: 10.1016/j.pec.2014.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 11/16/2014] [Accepted: 12/21/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To describe (1) patients' disease-related knowledge at cardiac rehabilitation (CR) entry; (2) correlates of this knowledge; (3) whether CR completion is related to knowledge; and (4) behavioral correlates of knowledge. METHODS For this prospective, observational study, a convenience sample of new CR patients was approached at 3 programs to complete a survey. It consisted of sociodemographic items, heart-health behavior surveys, and the CADE-Q. Patients were provided a similar survey 6 months later. RESULTS 214 patients completed the CADE-Q at both points, with scores demonstrating "acceptable" to "good" knowledge. Higher knowledge at CR entry was significantly associated with greater education, being married, greater English-language proficiency, and history of percutaneous coronary intervention (p≤0.05). The 118 (55.1%) patients that completed CR demonstrated significantly higher knowledge than non-enrollees at post-test (p≤0.05). There was a significant positive association between knowledge and physical activity (p≤0.01) and nutrition (p≤0.05) at post-test, but no association with smoking or medication adherence. CONCLUSIONS CR adherence ensures patients sustain knowledge needed to optimize their disease management, and perhaps ultimately their health outcomes. PRACTICE IMPLICATIONS CR completion should be promoted so patients remain educated about their disease management, and the health behaviors observed will be practiced in a greater proportion of patients.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Cardiac Rehabilitation and Prevention Program, University Health Network, Toronto, Canada; Exercise Sciences Department, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Canada.
| | - Raquel Britto
- Physical Therapy Department, Federal University of Minas Gerais, Belo Horizonte, Brazil; School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Nickan Motamedi
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Sherry L Grace
- Cardiac Rehabilitation and Prevention Program, University Health Network, Toronto, Canada; School of Kinesiology and Health Science, York University, Toronto, Canada
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Carthon JMB, Lasater KB, Sloane DM, Kutney-Lee A. The quality of hospital work environments and missed nursing care is linked to heart failure readmissions: a cross-sectional study of US hospitals. BMJ Qual Saf 2015; 24:255-63. [PMID: 25672342 DOI: 10.1136/bmjqs-2014-003346] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Threats to quality and patient safety may exist when necessary nursing care is omitted. Empirical research is needed to determine how missed nursing care is associated with patient outcomes. AIM The aim of this study was to examine the relationship between missed nursing care and hospital readmissions. METHODS Cross-sectional examination, using three linked data sources-(1) nurse survey, (2) patient discharge data from three states (California, New Jersey and Pennsylvania) and (3) administrative hospital data- from 2005 to 2006. We explored the incidence of 30-day readmission for 160 930 patients with heart failure in 419 acute care hospitals in the USA. Logistic regression was used to assess the effect of missed care on the odds of readmission, adjusting for patient and hospital characteristics. RESULTS The most frequently missed nursing care activities across all hospitals in our sample included talking to and comforting patients (42.0%), developing and updating care plans (35.8%) and educating patients and families (31.5%). For 4 of the 10 studied care activities, each 10 percentage-point increase in the number of nurses reporting having missed the activity was associated with an increase in the odds of readmission by 2-8% after adjusting for patient and hospital characteristics. However, missed nursing care was no longer a significant predictor of readmission once adjusting for the nurse work environment, except in the case of the delivery of treatments and procedures (OR 1.08, 95% CI 1.02 to 1.14). CONCLUSIONS Missed care is an independent predictor of heart failure readmissions. However, once adjusting for the quality of the nurse work environment, this relationship is attenuated. Improvements in nurses' working conditions may be one strategy to reduce care omissions and improve patient outcomes.
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Affiliation(s)
- J Margo Brooks Carthon
- Center for Health Outcomes & Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karen B Lasater
- Center for Health Outcomes & Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Douglas M Sloane
- Center for Health Outcomes & Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ann Kutney-Lee
- Center for Health Outcomes & Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Karbasi Afshar R, Ramezani Binabaj M, Rezaee Zavareh MS, Saburi A, Ajudani R. Efficacy of cardiac resynchronization with defibrillator insertion in patients undergone coronary artery bypass graft: a cohort study of cardiac function. Ann Card Anaesth 2015; 18:34-8. [PMID: 25566709 PMCID: PMC4900314 DOI: 10.4103/0971-9784.148319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) is a proven therapeutic method in selected patients with heart failure and systolic dysfunction which increases left ventricular function and patient survival. We designed a study that included patients undergoing coronary artery bypass graft (CABG), with and without CRT-defibrillator (CRT-D) inserting and then measured its effects on these two groups. PATIENTS AND METHODS Between 2010 and 2013, we conducted a prospective cohort study on 100 coronary artery disease patients where candidate for CABG. Then based on the receiving CRT-D, the patients were categorized in two groups; Group 1 ( n = 48, with CRT-D insertion before CABG) and Group 2 ( n = 52 without receiving CRT-D). Thereafter both of these groups were followed-up at 1-3 months after CABG for mortality, hospitalization, atrial fibrillation (AF), echocardiographic assessment, and New York Heart Association (NYHA) class level. RESULTS The mean age of participants in Group 1 (48 male) and in Group 2 (52 male) was 58 ± 13 and 57 ± 12 respectively. Difference between Groups 1 and 2 in cases of mean left ventricular ejection fraction (LVEF) changes and NYHA class level was significant ( P > 0.05). Hospitalization ( P = 0.008), mortality rate ( P = 0.007), and AF were significantly different between these two groups. CONCLUSIONS The results showed that the increase in LVEF and patient's improvement according to NYHA-class was significant in the first group, and readmission, mortality rate and AF was increased significantly in the second group.
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Wu JR, DeWalt DA, Baker DW, Schillinger D, Ruo B, Bibbins-Domingo K, Macabasco-O'Connell A, Holmes GM, Broucksou KA, Erman B, Hawk V, Cene CW, Jones CD, Pignone M. A single-item self-report medication adherence question predicts hospitalisation and death in patients with heart failure. J Clin Nurs 2013; 23:2554-64. [PMID: 24355060 DOI: 10.1111/jocn.12471] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2013] [Indexed: 10/25/2022]
Abstract
AIMS AND OBJECTIVES To determine whether a single-item self-report medication adherence question predicts hospitalisation and death in patients with heart failure. BACKGROUND Poor medication adherence is associated with increased morbidity and mortality. Having a simple means of identifying suboptimal medication adherence could help identify at-risk patients for interventions. DESIGN We performed a prospective cohort study in 592 participants with heart failure within a four-site randomised trial. METHODS Self-report medication adherence was assessed at baseline using a single-item question: 'Over the past seven days, how many times did you miss a dose of any of your heart medication?' Participants who reported no missing doses were defined as fully adherent, and those missing more than one dose were considered less than fully adherent. The primary outcome was combined all-cause hospitalisation or death over one year and the secondary endpoint was heart failure hospitalisation. Outcomes were assessed with blinded chart reviews, and heart failure outcomes were determined by a blinded adjudication committee. We used negative binomial regression to examine the relationship between medication adherence and outcomes. RESULTS Fifty-two percent of participants were 52% male, mean age was 61 years, and 31% were of New York Heart Association class III/IV at enrolment; 72% of participants reported full adherence to their heart medicine at baseline. Participants with full medication adherence had a lower rate of all-cause hospitalisation and death (0·71 events/year) compared with those with any nonadherence (0·86 events/year): adjusted-for-site incidence rate ratio was 0·83, fully adjusted incidence rate ratio 0·68. Incidence rate ratios were similar for heart failure hospitalisations. CONCLUSION A single medication adherence question at baseline predicts hospitalisation and death over one year in heart failure patients. RELEVANCE TO CLINICAL PRACTICE Medication adherence is associated with all-cause and heart failure-related hospitalisation and death in heart failure. It is important for clinicians to assess patients' medication adherence on a regular basis at their clinical follow-ups.
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Affiliation(s)
- Jia-Rong Wu
- The School of Nursing, University of North Carolina, Chapel Hill, NC, USA
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Lowrie R, Johansson L, Forsyth P, Bryce SL, McKellar S, Fitzgerald N. Experiences of a community pharmacy service to support adherence and self-management in chronic heart failure. Int J Clin Pharm 2013; 36:154-62. [PMID: 24293306 DOI: 10.1007/s11096-013-9889-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 11/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Heart failure (HF) is common, disabling and deadly. Patients with HF often have poor self-care and medicines non-adherence, which contributes to poor outcomes. Community pharmacy based cognitive services have the potential to help, but we do not know how patients view community-pharmacist-led services for patients with HF. OBJECTIVE We aimed to explore and portray in detail, the perspectives of patients receiving, and pharmacists delivering an enhanced, pay for performance community pharmacy HF service. SETTING Community pharmacies and community-based patients in Greater Glasgow and Clyde, Scotland. METHODS Focus groups with pharmacists and semi-structured interviews with individual patients by telephone. Cross sectional thematic analysis of qualitative data used Normalization Process Theory to understand and describe patient's reports. MAIN OUTCOME MEASURE Experiences of receiving and delivering an enhanced HF service. RESULTS Pharmacists voiced their confidence in delivering the service and highlighted valued aspects including the structured consultation and repeated contacts with patients enabling the opportunity to improve self care and medicines adherence. Discussing co-morbidities other than HF was difficult and persuading patients to modify behaviour was challenging. Patients were comfortable discussing symptoms and medicines with pharmacists; they identified pharmacists as fulfilling roles that were needed but not currently addressed. Patients reported the service helped them to enact HF medicines and HF self care management strategies. CONCLUSION Both patients receiving and pharmacists delivering a cognitive HF service felt that it addressed a shortfall in current care. There may be a clearly defined role for pharmacists in supporting patients to address the burden of understanding and managing their condition and treatment, leading to better self management and medicines adherence. This study may inform the development of strategies or policies to improve the process of care for patients with HF and has implications for the development of other extended role services.
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Affiliation(s)
- Richard Lowrie
- Research and Development, Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, Victoria Infirmary, Langside Road, Glasgow, G42 9TT, UK,
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Psotka MA, Teerlink JR. Strategies to Prevent Postdischarge Adverse Events Among Hospitalized Patients with Heart Failure. Heart Fail Clin 2013; 9:303-20, vi. [DOI: 10.1016/j.hfc.2013.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Freund T, Campbell SM, Geissler S, Kunz CU, Mahler C, Peters-Klimm F, Szecsenyi J. Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions. Ann Fam Med 2013; 11:363-70. [PMID: 23835823 PMCID: PMC3704497 DOI: 10.1370/afm.1498] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 10/04/2012] [Accepted: 10/25/2012] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are seen as potentially avoidable with optimal primary care. Little is known, however, about how primary care physicians rate these hospitalizations and whether and how they could be avoided. This study explores the complex causality of such hospitalizations from the perspective of primary care physicians. METHODS We conducted semistructured interviews with 12 primary care physicians from 10 primary care clinics in Germany regarding 104 hospitalizations of 81 patients with ACSCs at high risk of rehospitalization. RESULTS Participating physicians rated 43 (41%) of the 104 hospitalizations to be potentially avoidable. During the interviews the cause of hospitalization fell into 5 principal categories: system related (eg, unavailability of ambulatory services), physician related (eg, suboptimal monitoring), medical (eg, medication side effects), patient related (eg, delayed help-seeking), and social (eg, lack of social support). Subcategories frequently associated with physicians' rating of hospitalizations for ACSCs as potentially avoidable were after-hours absence of the treating physician, failure to use ambulatory services, suboptimal monitoring, patients' fearfulness, cultural background and insufficient language skills of patients, medication errors, medication nonadherence, and overprotective caregivers. Comorbidities and medical emergencies were frequent causes attributed to ACSC-based hospitalizations that were rated as being unavoidable. CONCLUSIONS Primary care physicians rated a significant proportion of hospitalizations for ACSCs to be potentially avoidable. Strategies to avoid these hospitalizations may target after-hours care, optimal use of ambulatory services, intensified monitoring of high-risk patients, and initiatives to improve patients' willingness and ability to seek timely help, as well as patients' medication adherence.
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Affiliation(s)
- Tobias Freund
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
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Matthias AT, Ekanayaka R. Precipitant profile of acute heart failure: experience of a tertiary level cardiac centre in Sri Lanka. HEART ASIA 2013; 5:86-91. [PMID: 27326091 DOI: 10.1136/heartasia-2013-010250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/16/2013] [Accepted: 05/05/2013] [Indexed: 11/04/2022]
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is a common cause of hospitalisation in most countries. Data on acute precipitants of HF and hospitalisation is not available in Sri Lanka. BACKGROUND AND METHODS A prospective study of 100 sequential admissions with HF to the cardiology unit (National Hospital of Sri Lanka) to describe the precipitants and clinical outcome of HF. RESULTS Fifty-eight male and 42 female admissions were studied. Mean age was 60.66 years. Mean hospital stay was 5.5(SD 4.6) days. Sixty had de novo HF and 40 had pre-existing HF. The most common identifiable precipitants were acute ischaemia 37 (37%), anaemia 41 (41%), respiratory tract infection 10 (10%), arrhythmia 11 (11%), worsening renal function 11 (11%) and alcohol 5 (5.7%). Non-adherence to medication 4 (4.6%), smoking 3 (3.9%), exposure to environmental stress 3 (3.4%) and uncontrolled hypertension 1 (1%) were also observed as precipitants. The most common arrhythmia was atrial fibrillation. Out of 34 patients in whom angiotensin-converting enzyme inhibitors or angiotensin-converting enzyme receptor blockers were indicated, 11% were not on the drug. Among 29 patients in whom spironolactone was indicated, seven patients were not on the drug. CONCLUSIONS Most precipitating factors of HF are preventable. Early identification and prevention of anaemia, preventing respiratory tract infection by vaccination, aggressive revascularisation for patients with ischaemia, monitoring of renal functions, and patient education regarding drug and diet compliance, would reduce the number of admissions.
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Affiliation(s)
| | - Ruvan Ekanayaka
- Cardiology Unit , National Hospital of Sri Lanka , Colombo , Sri Lanka
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Borke JA, Wyer PC. Eating a larger number of high-salt foods is not associated with short-term risk of acute decompensation in patients with chronic heart failure. J Emerg Med 2012; 44:36-45. [PMID: 23103068 DOI: 10.1016/j.jemermed.2012.02.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 08/30/2011] [Accepted: 02/26/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Risk factors for exacerbation of congestive heart failure have not been consistently validated. OBJECTIVE Our objective was to examine the role of short-term dietary sodium intake in acute decompensated heart failure. METHODS Patients with chronic congestive heart failure presenting to the Emergency Department for either acute decompensated heart failure (cases) or for other reasons (controls) were included in a case-control study. Cases and controls were compared with respect to age, smoking, recent sodium intake, medication nonadherence, coronary artery disease, and hypertension. A food frequency questionnaire was utilized to estimate recent sodium intake, defined as the number of food types consumed in the previous 3 days from the 12 highest-sodium food categories. RESULTS There were 182 patients enrolled. One patient was excluded due to uncertainty about the primary diagnosis. When adjusted for age, smoking, medication nonadherence, coronary artery disease, and hypertension, acute decompensated heart failure was not associated with short-term dietary sodium intake. The odds ratio for acute decompensated heart failure for each increase in the number of high-sodium food types consumed was 1.1 (95% confidence interval 0.9-1.3; p = 0.3). Acute decompensated heart failure was associated with medication nonadherence, with an odds ratio for decompensation of 2.5 (95% confidence interval 1.2-5.1; p = 0.01). CONCLUSIONS Patients with chronic congestive heart failure who presented to the Emergency Department with acute decompensated heart failure were no more likely to report consuming a greater number of high-sodium foods in the 3 days before than were patients with chronic congestive heart failure who presented with unrelated symptoms. On the other hand, those who presented with acute decompensated heart failure were significantly more likely to report nonadherence with medications.
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Affiliation(s)
- Jesse A Borke
- Advocate Christ Medical Center, Oak Lawn, Illinois 60453, USA
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Betihavas V, Newton PJ, Frost SA, Macdonald PS, Davidson PM. Patient, provider and system factors influencing rehospitalisation in adults with heart failure: a literature review. Contemp Nurse 2012. [DOI: 10.5172/conu.2012.2772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wu JR, Frazier SK, Rayens MK, Lennie TA, Chung ML, Moser DK. Medication adherence, social support, and event-free survival in patients with heart failure. Health Psychol 2012; 32:637-46. [PMID: 22746258 DOI: 10.1037/a0028527] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Medication adherence and perceived social support (PSS) are independent predictors of mortality in patients with heart failure (HF). However, the predictive power of the combination of medication adherence and PSS for hospitalization and death has not been investigated in patients with HF. The purpose of the study was to explore the combined influence of medication adherence and PSS for prediction of cardiac event-free survival in patients with HF. METHOD A total of 218 HF patients monitored medication adherence for 1-3 months and completed the Multidimensional Perceived Social Support Scale (MPSSS) at baseline. Medication adherence was measured using a valid and objective measure, the Medication Event Monitoring System (MEMS). Patients were followed for up to 3.5 years to collect data about cardiac event-free survival (i.e., cardiac emergency department visits, hospitalizations, and death). To test the association of the combination of medication adherence and PSS with outcomes, the interaction term of medication adherence and PSS was first entered in a Cox regression to predict outcomes. Second, patients were grouped using an evidence-based cutpoint of 88% for medication adherence from the MEMS data and a median score 71 of the MPSSS. Kaplan-Meier and Cox proportional hazards models were used to compare cardiac event-free survival among groups. RESULT Medication adherence and PSS were independent predictors of cardiac event-free survival (p = .006 and .021, respectively). Patients with medication nonadherence and lower PSS had a 3.5 times higher risk of cardiac events than those who were adherent and had higher PSS. CONCLUSION Medication adherence mediated the relationship between PSS and cardiac event-free survival in this sample. Moreover, medication adherence and social support independently, and in combination, predicted cardiac event-free survival in patients with HF. Interventions to improve clinical outcomes should address medication adherence and social support.
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Affiliation(s)
- Jia-Rong Wu
- Department of Adult/Geriatric Health, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460, USA
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Taylor DM, Fui MNT, Chung AR, Gani L, Zajac JD, Burrell LM. A comparison of precipitants and mortality when acute decompensated heart failure occurs in the community and hospital settings. Heart Lung Circ 2012; 21:439-43. [PMID: 22578760 DOI: 10.1016/j.hlc.2012.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 04/04/2012] [Accepted: 04/14/2012] [Indexed: 11/18/2022]
Abstract
AIM We aimed to compare the precipitants of acute decompensated heart failure (ADHF) among patients admitted with diagnoses inclusive of ADHF (community patients) and patients admitted without ADHF but who developed it during their stay (hospital patients). METHODS This was a prospective, analytical, observational study undertaken in the Austin Hospital, a major metropolitan teaching hospital (September 2008-February 2010). Consecutive patients admitted to a general medicine unit, and diagnosed and treated for ADHF were enrolled. The unit medical staff completed a specifically designed data collection document. RESULTS Three hundred and fifty-nine patients were enrolled (42.9% male, mean age 81.9 years). The community (n=312) and hospital (n=47) patient groups did not differ in age, gender, risk variables (living alone, cognitive impairment, multiple medications, compliance), cardiac failure medication use or cause of known heart failure (ischaemia, hypertension, valve dysfunction, 'other') (p>0.05). The ADHF precipitants comprised infection (39.8% patients), myocardial ischaemia (17.3%), tachyarrhythmia (16.2%), non-compliance with fluid and salt restriction (9.2%), non-compliance with medication (6.7%), renal failure (5.8%), medication reduction (5.0%), intravenous fluid complication (3.9%) and 'other' causes (13.9%). Significantly more hospital patients had their ADHF precipitated by intravenous fluid complications (25.5% versus 0.6%, p<0.001). Hospital patients also had a significantly greater death rate (25.5% versus 9.3%, p<0.01). CONCLUSION Acute decompensated heart failure precipitated in hospital is a dangerous condition with a high mortality. While infection and myocardial ischaemia are the common precipitants, complications of intravenous fluid use, an iatrogenic condition, may be considerable and are potentially avoidable.
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Affiliation(s)
- D McD Taylor
- Emergency Department, Austin Health, Melbourne, Victoria, Australia.
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Velazquez EJ, Williams JB, Yow E, Shaw LK, Lee KL, Phillips HR, O'Connor CM, Smith PK, Jones RH. Long-term survival of patients with ischemic cardiomyopathy treated by coronary artery bypass grafting versus medical therapy. Ann Thorac Surg 2012; 93:523-30. [PMID: 22269720 DOI: 10.1016/j.athoracsur.2011.10.064] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 10/19/2011] [Accepted: 10/25/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND We prospectively applied the Surgical Treatment of Ischemic Cardiomyopathy trial entry criteria to an observational database to determine whether coronary artery bypass grafting (CABG) decreases mortality compared with medical therapy (MED) for patients with coronary artery disease and depressed left ventricular ejection fraction. METHODS This was a retrospective, observational, cohort study of prospectively collected data from the Duke Databank for Cardiovascular Disease. Long-term mortality was the main outcome measure. Between January 1, 1995, and July 31, 2009, 86,874 patients underwent cardiac catheterization for suspected ischemic heart disease and were evaluated for inclusion in the analysis. RESULTS A total of 2,624 patients were found to have left ventricular ejection fraction less than 0.35, coronary artery disease amenable to CABG, and no left main stenosis of greater than 50%. After exclusions including ongoing Canadian Cardiovascular Society class III angina and acute myocardial infarction, 763 patients were included for propensity score analysis, including 624 who received MED and 139 who underwent CABG. Adjusted mortality curves were constructed for those patients in the three quintiles most likely to receive CABG. The curves diverged early, with risk-adjusted mortality rates at 5 years of 46% for MED versus 29% for CABG, and the survival benefit of CABG over MED continued through 10 years of follow-up (hazard ratio, 0.63; 95% confidence interval, 0.45 to 0.88). CONCLUSIONS Among a propensity-matched, risk-adjusted, observational cohort of patients with coronary artery disease, left ventricular ejection fraction less than 0.35, and no left main disease of greater than 50%, CABG is associated with a survival advantage over MED through 10 years of follow-up.
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Affiliation(s)
- Eric J Velazquez
- Division of Cardiovascular Medicine, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina 27715, USA.
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Damen NL, Pelle AJ, Szabó BM, Pedersen SS. Symptoms of anxiety and cardiac hospitalizations at 12 months in patients with heart failure. J Gen Intern Med 2012; 27:345-50. [PMID: 21892660 PMCID: PMC3286556 DOI: 10.1007/s11606-011-1843-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 06/01/2011] [Accepted: 08/09/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Heart failure (HF) is a leading cause of hospitalization. Clinical and socio-demographic factors have been associated with cardiac admissions, but little is known about the role of anxiety. We examined whether symptoms of anxiety were associated with cardiac hospitalizations at 12 months in HF patients. METHODS HF outpatients (N = 237) completed the Hospital Anxiety and Depression Scale (HADS) at baseline (i.e., inclusion into the study). A cutoff ≥8 was used to indicate probable clinical levels of anxiety and depression. At 12 months, a medical chart abstraction was performed to obtain information on cardiac hospitalizations. RESULTS The prevalence of symptoms of anxiety was 24.9% (59/237), and 27.0% (64/237) of patients were admitted for cardiac reasons at least once during the 12-month follow-up period. Symptoms of anxiety were neither significantly associated with cardiac hospitalizations in univariable logistic analysis [OR = 1.13, 95% CI (0.59-2.17), p = 0.72] nor in multivariable analysis [OR = 0.94, 95% CI (0.38-2.31), p = 0.89]. New York Heart Association (NYHA) functional class III [OR = 3.00, 95% CI (1.08-8.12), p = 0.04] and a history of HF-related hospitalizations [OR = 1.18, 95% CI (1.01-1.38), p = 0.03] were independently associated with 12-month cardiac admissions. CONCLUSIONS The current study found no significant association between symptoms of anxiety and cardiac hospitalizations at 12 months in HF patients. In contrast, clinical indicators (i.e., NYHA class III and a history of HF-related hospitalizations) were significantly associated with admissions due to a cardiac cause. Future studies are warranted to investigate the importance of symptoms of anxiety in HF using a larger sample size and a longer follow-up duration.
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Affiliation(s)
- Nikki L Damen
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical Psychology, Tilburg University, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands
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Informal caregivers' experiences of caring for patients with chronic heart failure: systematic review and metasynthesis of qualitative studies. J Cardiovasc Nurs 2012; 26:386-94. [PMID: 21263337 DOI: 10.1097/jcn.0b013e3182076a69] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increasing evidence suggests that family support for patients with chronic heart failure (CHF) contributes greatly to the disease management of CHF. In addition, the quality of the CHF patient's close personal relationships can influence CHF outcomes. However, caregivers cannot provide care alone and need guidance, support, and skills to manage care that is often complex. In this article, we provide a review of studies that have explicitly investigated these issues of informal caregivers to CHF patients. OBJECTIVE The objective of this study was to explore informal caregivers' views and experiences of caring for patients with CHF. METHODS This is a systematic review and synthesis of qualitative studies describing informal caregivers' experiences in home-based care. Data sources were published literature written in English from electronic databases: PubMed, CINAHL (1982-2009), PsycINFO (1967-2009), EMBASE (1980-2009), and the Cochrane Library Database. Ten primary studies met the inclusion criteria. RESULTS A number of themes emerged. Five key themes were identified from synthesis of the studies: sharing of caring, suffering from anxiety, being isolated, enjoying a good relationship, and searching for support. CONCLUSIONS Caring for persons with CHF can affect the well-being of their informal caregivers, which may ultimately have consequences for the CHF patient's health. Further studies are needed to clarify these issues and to examine the role of informal caregivers in the management of CHF.
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