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Valk MJM, Hoes AW, Mosterd A, Landman MA, Zuithoff NPA, Broekhuizen BDL, Rutten FH. Training general practitioners to improve evidence-based drug treatment of patients with heart failure: a cluster randomised controlled trial. Neth Heart J 2020; 28:604-612. [PMID: 32997300 PMCID: PMC7596131 DOI: 10.1007/s12471-020-01487-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aims To assess whether a single training session for general practitioners (GPs) improves the evidence-based drug treatment of heart failure (HF) patients, especially of those with HF with reduced ejection fraction (HFrEF). Methods and results A cluster randomised controlled trial was performed for which patients with established HF were eligible. Primary care practices (PCPs) were randomised to care-as-usual or to the intervention group in which GPs received a half-day training session on HF management. Changes in HF medication, health status, hospitalisation and survival were compared between the two groups. Fifteen PCPs with 200 HF patients were randomised to the intervention group and 15 PCPs with 198 HF patients to the control group. Mean age was 76.9 (SD 10.8) years; 52.5% were female. On average, the patients had been diagnosed with HF 3.0 (SD 3.0) years previously. In total, 204 had HFrEF and 194 HF with preserved ejection fraction (HFpEF). In participants with HFrEF, the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers decreased in 6 months in both groups [5.2%; (95% confidence interval (CI) 2.0–10.0)] and 5.6% (95% CI 2.8–13.4)], respectively [baseline-corrected odds ratio (OR) 1.07 (95% CI 0.55–2.08)], while beta-blocker use increased in both groups by 5.2% (95% CI 2.0–10.0) and 1.1% (95% CI 0.2–6.3), respectively [baseline-corrected OR 0.82 (95% CI 0.42–1.61)]. For health status, hospitalisations or survival after 12–28 months there were no significant differences between the two groups, also not when separately analysed for HFrEF and HFpEF. Conclusion A half-day training session for GPs does not improve drug treatment of HF in patients with established HF. Electronic supplementary material The online version of this article (10.1007/s12471-020-01487-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M J M Valk
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - A W Hoes
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Mosterd
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands
| | | | - N P A Zuithoff
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - B D L Broekhuizen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - F H Rutten
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
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2
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Hedrick R, Korouri S, Tadros E, Darwish T, Cortez V, Triay D, Pasini M, Olanisa L, Herrera N, Hanna S, Kimchi A, Hamilton M, Danovitch I, IsHak WW. The impact of antidepressants on depressive symptom severity, quality of life, morbidity, and mortality in heart failure: a systematic review. Drugs Context 2020; 9:2020-5-4. [PMID: 32788920 PMCID: PMC7398616 DOI: 10.7573/dic.2020-5-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/05/2020] [Accepted: 06/12/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The purpose of this paper is to review the literature on the impact of antidepressants on depressive symptom severity, quality of life (QoL), morbidity, and mortality in patients with heart failure (HF). METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies published from December 1969 to December 2019 that pertain to depression and HF were identified through the use of the PubMed and PsycINFO databases, using the keywords: 'antidepressant*' and 'heart failure.' Two authors independently conducted a focused analysis and reached a final consensus on 17 studies that met the specific selection criteria and passed the study quality checks. RESULTS Studies varied in types of antidepressants used as well as in study designs. Ten studies were analyzed for the impact of antidepressant medications on depressive symptom severity. Five of these were randomized controlled trials (RCTs), out of which sertraline and paroxetine showed a significant reduction in depressive symptoms despite the small samples utilized. Four of the 17 studies addressed QoL as part of their outcomes showing no difference for escitalopram (RCT), significantly greater improvements for paroxetine controlled release (RCT), statistical significance for sertraline compared to control (pilot study), and showing significant improvement before and after treatment (open-label trial) for nefazodone. Thirteen of the 17 studies included measures of morbidity and mortality. Although early analyses have pointed to an association of antidepressant use and mortality particularly with fluoxetine, the reviewed studies showed no increase in mortality for antidepressants, and secondary analyses showed improved mortality in patients who achieved remission of depressive symptoms. CONCLUSION Out of the various antidepressants studied, which included sertraline, paroxetine, escitalopram, citalopram, bupropion, nefazodone, and nortriptyline, selective serotonin reuptake inhibitors seem to be a safe treatment option for patients with depression and HF. However, due to the variety of study designs as well as the mixed results for each antidepressant, more information for reducing depression severity, morbidity, and mortality and improving quality of life in patients with HF should be examined using robust large sample RCTs.
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Affiliation(s)
- Rebecca Hedrick
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Samuel Korouri
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Emile Tadros
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tarneem Darwish
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Veronica Cortez
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Desiree Triay
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mia Pasini
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Linda Olanisa
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nathalie Herrera
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sophia Hanna
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Asher Kimchi
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michele Hamilton
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Waguih William IsHak
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Psychiatry, David Geffen School of Medicine, Los Angeles, CA, USA
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3
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Abstract
Heart failure is the major cause of morbidity and mortality in the United States. Stage D heart failure has a greater mortality rate than many cancers and has equivalent symptom burden and severity. There has been a paradigm shift in our understanding of the pathophysiology of heart failure. Progressive heart failure is associated with ventricular remodeling and a maladaptive neurohumoral response. Drug classes have evolved that curtail ventricular remodeling, and blunt neurohumoral responses reduce morbidity and mortality. Despite combination drug and device therapies, the management of Stage D heart failure includes palliation. Both cardiology and palliative specialists need to learn from one another in order to palliate these highly symptomatic patients. Such collaboration will enhance care and are the basis for well-conceived research trials.
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Affiliation(s)
- Mellar P Davis
- The Harry R Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio, USA
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4
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Type D personality and depressive symptoms are independent predictors of impaired health status in chronic heart failure☆. Eur J Heart Fail 2014; 10:802-10. [PMID: 18614397 DOI: 10.1016/j.ejheart.2008.06.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 05/28/2008] [Accepted: 06/23/2008] [Indexed: 01/16/2023] Open
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5
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Effectiveness of a Self-Care Program in Improving Symptom Distress and Quality of Life in Congestive Heart Failure Patients. J Nurs Res 2011; 19:257-66. [DOI: 10.1097/jnr.0b013e318237f08d] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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6
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A randomized study of transendocardial injection of autologous bone marrow mononuclear cells and cell function analysis in ischemic heart failure (FOCUS-HF). Am Heart J 2011; 161:1078-87.e3. [PMID: 21641354 DOI: 10.1016/j.ahj.2011.01.028] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 01/13/2011] [Indexed: 01/12/2023]
Abstract
BACKGROUND Autologous bone marrow mononuclear cell (ABMMNC) therapy has shown promise in patients with heart failure (HF). Cell function analysis may be important in interpreting trial results. METHODS In this prospective study, we evaluated the safety and efficacy of the transendocardial delivery of ABMMNCs in no-option patients with chronic HF. Efficacy was assessed by maximal myocardial oxygen consumption, single photon emission computed tomography, 2-dimensional echocardiography, and quality-of-life assessment (Minnesota Living with Heart Failure and Short Form 36). We also characterized patients' bone marrow cells by flow cytometry, colony-forming unit, and proliferative assays. RESULTS Cell-treated (n = 20) and control patients (n = 10) were similar at baseline. The procedure was safe; adverse events were similar in both groups. Canadian Cardiovascular Society angina score improved significantly (P = .001) in cell-treated patients, but function was not affected. Quality-of-life scores improved significantly at 6 months (P = .009 Minnesota Living with Heart Failure and P = .002 physical component of Short Form 36) over baseline in cell-treated but not control patients. Single photon emission computed tomography data suggested a trend toward improved perfusion in cell-treated patients. The proportion of fixed defects significantly increased in control (P = .02) but not in treated patients (P = .16). Function of patients' bone marrow mononuclear cells was severely impaired. Stratifying cell results by age showed that younger patients (≤60 years) had significantly more mesenchymal progenitor cells (colony-forming unit fibroblasts) than patients >60 years (20.16 ± 14.6 vs 10.92 ± 7.8, P = .04). Furthermore, cell-treated younger patients had significantly improved maximal myocardial oxygen consumption (15 ± 5.8, 18.6 ± 2.7, and 17 ± 3.7 mL/kg per minute at baseline, 3 months, and 6 months, respectively) compared with similarly aged control patients (14.3 ± 2.5, 13.7 ± 3.7, and 14.6 ± 4.7 mL/kg per minute, P = .04). CONCLUSIONS ABMMNC therapy is safe and improves symptoms, quality of life, and possibly perfusion in patients with chronic HF.
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7
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Hargraves TL, Bennett AA, Brien JAE. Evaluating outpatient pharmacy services: a literature review of specialist heart failure services. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/ijpp.14.1.0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objective
To identify appropriate methods to evaluate a specialist pharmacy service for heart failure patients in an ambulatory care setting.
Method
An extensive literature review was undertaken to identify the published data on evaluative studies of specialist pharmacy services, including those directed at heart failure patients in an ambulatory care model of service provision.
Key findings
Six studies were identified evaluating outpatient pharmacy services for heart failure. The pharmacy services provided in these settings were not well defined. The impact of the pharmacist was compared to ‘usual care’, that is care delivered without a pharmacist, by either a prospective randomised controlled trial (RCT), or before and after studies. In most cases the service was delivered by one pharmacist at one site. Services were primarily targeted at patients and focused on medication and lifestyle education, adverse drug reaction monitoring, and compliance/adherence. In all studies, there was a trend for improvement in the outcomes measured. Different study endpoints were examined, including process indicators such as compliance and outcome measures such as morbidity (clinical), quality of life (humanistic), and hospital admissions (economic). The ideal evaluative study would be an adequately powered, prospective, randomised controlled trial, comparing the effect of the pharmacist service to usual care (without the specified pharmacy service). Appropriate study endpoints including process indicators and outcome measures are needed. Identification of specific components and the extent of the service that would provide the most benefit to selected patient groups would be of interest.
Conclusions
Specialist ambulatory care pharmacy services have not been well defined or evaluated in the literature. Limited randomised controlled data exist.
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Affiliation(s)
| | - Alexandra A Bennett
- Therapeutics Centre, St Vincent's Hospital, Sydney, Australia
- Faculty of Pharmacy, University of Sydney, Australia
| | - Jo-anne E Brien
- Therapeutics Centre, St Vincent's Hospital, Sydney, Australia
- Faculty of Pharmacy, University of Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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8
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Schiffer AA, Pedersen SS, Widdershoven JW, Denollet J. Type D personality and depressive symptoms are independent predictors of impaired health status in chronic heart failure. Eur J Heart Fail 2009; 10:922-30. [PMID: 18942177 DOI: 10.1016/j.ejheart.2008.07.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To examine whether Type D personality exerts a stable, independent effect on health status in CHF over time, adjusted for depressive symptoms. SUBJECTS CHF outpatients (n = 166; 75% men; mean age 66 years) completed the Type D Scale and Beck Depression Inventory (baseline) and the Minnesota Living with Heart Failure Questionnaire and Short-Form Health Survey (baseline and 12 months). RESULTS There was a general improvement in disease-specific physical (p = .029) and mental (p < .001) health over time, but Type D patients scored significantly lower on both outcomes (p < or = .001). The interaction effects Type D x time were not significant, indicating stability of the personality effect. Type D patients also scored significantly lower on all generic physical (p values between .001 and .04) and mental (all p values < or = .01) health status subdomains; these effects were also stable over time. Type D was an independent predictor of disease-specific mental health (p < .001), social functioning (p = .04), role emotional functioning (p < .001), bodily pain (p = .05), and general health (p = .04), adjusted for depressive symptoms, baseline health status and clinical characteristics. Depressive symptoms was an independent predictor of role physical functioning and bodily pain. CONCLUSIONS Type D personality and depressive symptoms were independent predictors of impaired health status in CHF.
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Affiliation(s)
- Angélique A Schiffer
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
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9
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Wlodarczyk JH, Keogh A, Smith K, McCosker C. CHART: congestive cardiac failure in hospitals, an Australian review of treatment. Heart Lung Circ 2008; 12:94-102. [PMID: 16352115 DOI: 10.1046/j.1444-2892.2003.00197.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Despite strong evidence supporting the use of angiotensin-converting enzyme inhibitors (ACED, beta-blockers, and spironolactone in heart failure, evidence suggests these drugs are under-used and under-dosed. The aim of the present study was to determine the impact of hospitalisation on heart failure pharmacotherapy in patients with congestive heart failure (CHF). A retrospective study was conducted, based on 300 consecutive admissions with the medical record diagnosis of heart failure, in each of seven grade one teaching hospitals. At admission, 49.5% of patients were treated with ACEI, 19.2% with beta-blockers and 8.1% with spironolactone. Twenty-six per cent of untreated patients started ACEI treatment during their hospital stay, and 9.4% started beta-blockers The main determinants of treatment with ACEI at discharge were a primary diagnosis of heart failure (odds ratio (OR) = 1.886) and the presence of a potential contraindication (high creatinine OR = 0.458, cough OR = 0.187, renal artery stenosis OR = 0.309). Patients were less likely to be discharged on beta-blockers if greater than 85 years of age (OR = 0.545), or there was mention of airways disease (OR = 0.347), asthma (OR = 0.238) or type 2 diabetes (OR = 0.721) on the medical record. Patients admitted by a cardiologist were more likely to be discharged on beta-blockers (OR = 3.207). Spironolactone was more likely used in patients with primary diagnosis of heart failure (OR = 1.549), aged less than 85 years (OR = 0.319), and/or admitted by a cardiologist (OR = 1.827). The substantial number of patients admitted to hospital with a secondary diagnosis of heart failure should be targeted for therapeutic optimisation.
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Affiliation(s)
- John H Wlodarczyk
- John Wlodarczyk Consulting Services, New Lambton, New South Wales, Australia
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10
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Heo S, Moser DK, Lennie TA, Zambroski CH, Chung ML. A comparison of health-related quality of life between older adults with heart failure and healthy older adults. Heart Lung 2007; 36:16-24. [PMID: 17234473 DOI: 10.1016/j.hrtlng.2006.06.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 03/14/2006] [Accepted: 06/13/2006] [Indexed: 11/15/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) in older adults with heart failure may be affected by a variety of variables including aging. It is important to determine the unique impact of heart failure to more effectively improve HRQOL in this population. OBJECTIVE The purpose of this study was to compare HRQOL and physical, psychologic, clinical, and sociodemographic status in older adults with and without heart failure. METHODS The HRQOL of 90 older adults with heart failure and 116 healthy older adults was compared. The factors best associated with HRQOL in each group were determined using multiple regression model. RESULTS HRQOL was substantially worse among older adults with heart failure than among healthy older adults. Older adults with heart failure had more severe physical and emotional symptoms, poorer functional status, and worse health perceptions. Physical symptom status was the strongest predictor of HRQOL in both groups. In addition, in older adults with heart failure, physical symptom status, age, and anxiety were related to HRQOL. CONCLUSION The poor HRQOL seen in patients with heart failure is not just a reflection of aging. Comprehensive interventions targeted toward the factors that specifically negatively impact HRQOL are essential in older adults with heart failure.
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Affiliation(s)
- Seongkum Heo
- University of Kentucky, College of Nursing, Lexington, Kentucky 40536-0232, USA
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11
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McLean AS, Eslick GD, Coats AJS. The epidemiology of heart failure in Australia. Int J Cardiol 2006; 118:370-4. [PMID: 17046084 DOI: 10.1016/j.ijcard.2006.07.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 07/13/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND The epidemiology of heart failure is poorly understood. Australia has one of the highest rates of cardiovascular disease in the world with heart failure representing a large proportion of this group, yet there is minimal data on the incidence or prevalence. AIMS To determine the epidemiological impact of heart failure in Australia by assessing mortality and morbidity data. METHODS Data were obtained from National and State health organisations in terms of morbidity and mortality of heart failure. Data were obtained from several sources so as to provide a comprehensive picture of the available epidemiological data on heart failure. RESULTS The mortality rates associated with heart failure have been decreasing substantially over the last 20 years. However, there appears to be a stabilisation of heart failure presentations over the last decade, both nationally and in the state of New South Wales. Extrapolation of the data to assess prevalence of heart failure in the community was not possible. CONCLUSIONS Currently, mortality rates for heart failure are decreasing in Australia, while there does not appear to be any real increase in the numbers of patients admitted to hospital with a subsequent diagnosis of heart failure over a 10 year period.
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Affiliation(s)
- Anthony S McLean
- Department of Intensive Care Medicine, Nepean Hospital, The University of Sydney, Penrith, New South Wales, Australia
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12
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Linné AB, Liedholm H. Effects of an interactive CD-program on 6 months readmission rate in patients with heart failure - a randomised, controlled trial [NCT00311194]. BMC Cardiovasc Disord 2006; 6:30. [PMID: 16796760 PMCID: PMC1526456 DOI: 10.1186/1471-2261-6-30] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 06/24/2006] [Indexed: 01/10/2023] Open
Abstract
Background Disease-management programmes including patient education have promoted improvement in outcome for patients with heart failure. However, there is sparse evidence concerning which component is essential for success, and very little is known regarding the validity of methods or material used for the education. Methods Effects of standard information to heart failure patients given prior to discharge from hospital were compared with additional education by an interactive program on all-cause readmission or death within 6 months. As a secondary endpoint, patients' general knowledge of heart failure and its treatment was tested after 2 months. Results Two hundred and thirty patients were randomised to standard information (S) or additional CD-ROM education (E). In (S) 52 % reached the endpoint vs. 49 % in (E). This difference was not significant. Of those who completed the questionnaire (37 %), patients in (E) achieved better knowledge and a marginally better outcome. Conclusion The lack of effect on the readmission rate could be due to an insufficient sample size but might also indicate that in pharmacologically well-treated patients there is little room for altering the course of the condition. As there was some indication that patients who knew more about their condition might fare better, the place for intensive education and support of heart failure patients has yet to be determined.
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Affiliation(s)
- Agneta Björck Linné
- Drug and Therapeutics Committee, Malmö University Hospital, MFC, Ing 59, S-205 02 Malmoe, Sweden
| | - Hans Liedholm
- Drug and Therapeutics Committee, Malmö University Hospital, MFC, Ing 59, S-205 02 Malmoe, Sweden
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13
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Clark RA, McLennan S, Dawson A, Wilkinson D, Stewart S. Uncovering a hidden epidemic: a study of the current burden of heart failure in Australia. Heart Lung Circ 2006; 13:266-73. [PMID: 16352206 DOI: 10.1016/j.hlc.2004.06.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Australia, like other countries, is experiencing an epidemic of heart failure (HF). However, given the lack of national and population-based datasets collating detailed cardiovascular-specific morbidity and mortality outcomes, quantifying the specific burden imposed by HF has been difficult. METHODS Australian Bureau of Statistics (ABS data) for the year 2000 were used in combination with contemporary, well-validated population-based epidemiologic data to estimate the number of individuals with symptomatic and asymptomatic HF related to both preserved (diastolic dysfunction) and impaired left ventricular systolic (dys)function (LVSD) and rates of HF-related hospitalisation. RESULTS In 2000, we estimate that around 325,000 Australians (58% male) had symptomatic HF associated with both LVSD and diastolic dysfunction and an additional 214,000 with asymptomatic LVSD. 140,000 (26%) live in rural and remote regions, distal to specialist health care services. There was an estimated 22,000 incidents of admissions for congestive heart failure and approximately 100,000 admissions associated with this syndrome overall. CONCLUSION Australia is in the midst of a HF epidemic that continues to grow. Overall, it probably contributes to over 1.4 million days of hospitalization at a cost of more than 1 billion dollars. A national response to further quantify and address this enormous health problem is required.
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Affiliation(s)
- Robyn A Clark
- Cardiovascular Nursing, School of Nursing and Midwifery, University of South Australia, City East Campus, Adelaide 5000, Australia
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14
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Wolfe R, Worrall-Carter L, Foister K, Keks N, Howe V. Assessment of cognitive function in heart failure patients. Eur J Cardiovasc Nurs 2005; 5:158-64. [PMID: 16359923 DOI: 10.1016/j.ejcnurse.2005.10.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2005] [Revised: 09/26/2005] [Accepted: 10/11/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Research on the cognitive capacity of heart failure patients is limited, with a paucity of benchmark information available for this population. It is highly likely that cognitive deficits affect patients' understanding of disease and treatment requirements, as well as limiting their functional capacity and ability to implement treatment plans, and undertake self-care. AIMS The purpose of this study was to establish a comprehensive neurocognitive profile of the heart failure patient through systematic neurocognitive assessment and to determine whether an association existed between severity of heart failure and cognitive abilities. METHODS Thirty-eight patients were recruited from the heart failure patient databases of two metropolitan hospitals in Melbourne, Australia. Participants were individually assessed using four standardised, internationally recognised neuropsychological tests that examined current and premorbid intelligence, memory and executive functioning. RESULTS Although there was no significant decline from premorbid general intellectual function, other specific areas of deficit, including impaired memory and executive functioning, were identified. There were no significant correlations between heart failure severity and the neurocognitive measures used. CONCLUSION The results support the need to recognise cognitive impairment in people with heart failure and to develop an abbreviated method of assessing cognitive function that can be easily implemented in the clinical setting. Identifying cognitive deficits in this population will be useful in guiding the content and nature of treatment plans to maximise adherence and minimise worsening of heart failure symptoms.
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Affiliation(s)
- Rachel Wolfe
- Box Hill Hospital, Nelson Road, Box Hill, Vic, 3125, Australia
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15
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Croom KF, Plosker GL. Eplerenone : a pharmacoeconomic review of its use in patients with post-myocardial infarction heart failure. PHARMACOECONOMICS 2005; 23:1057-72. [PMID: 16235978 DOI: 10.2165/00019053-200523100-00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Eplerenone (Inspra) is a selective aldosterone blocker. When added to standard medical therapy, eplerenone significantly improved morbidity and mortality in patients with left ventricular (LV) systolic dysfunction and clinical evidence of heart failure following acute myocardial infarction (MI), in a well designed, placebo-controlled trial known as EPHESUS (Eplerenone Post-acute myocardial infarction Heart failure Efficacy and SUrvival Study). Although eplerenone was generally well tolerated, it was associated with a higher incidence of hyperkalaemia than placebo.Cost-effectiveness analyses based on this trial have been performed in the US, The Netherlands, Germany, France and Spain. Direct medical costs were analysed based on prospectively collected resource-use data with local costs applied; modelling was conducted to calculate incremental costs per life-year or QALY gained, with survival curves assumed to remain parallel after treatment ended. Eplerenone was associated with a gain of 0.0304 life-years (approximately 11 days) compared with placebo during the study period. Based on these analyses, eplerenone was cost effective compared with placebo in patients with LV systolic dysfunction and heart failure after an MI when added to standard therapy for 16 months. The incremental cost per life-year gained for eplerenone versus placebo (for a range of three different life-expectancy projections) was 10,402-21,876 US dollars in the US (year 2001 costs, except for eplerenone [2004]) [equivalent to 12,274-25,814 euro; mid-2001 exchange rate], 5,365-12,795 euro for The Netherlands (year 2003 costs), 6,956-14,628 euro for Germany, 5,432-11,423 euro for France and 8,626-18,141 euro for Spain (year of costing not reported). The US, Dutch, French and Spanish analyses estimated that >90% of observations for incremental cost per life-year gained were below a threshold of 50,000 US dollars or 50,000 euro. Incremental costs per QALY gained for eplerenone versus placebo in the US, Dutch, French and Spanish analyses were 15,330-32,405 US dollars (18,089-38,238 euro), 12,148, 8,005-16,922 euro and 12,713-26, 873 euro, respectively. Clinical and pharmacoeconomic data comparing eplerenone with another active drug, such as spironolactone, in this patient population are not available. In conclusion, when added to standard therapy in patients with LV systolic dysfunction and heart failure after an acute MI, eplerenone was associated with significant reductions in mortality and morbidity compared with placebo. Despite some inherent limitations, available pharmacoeconomic data from Europe and the US indicate that eplerenone is a cost-effective treatment compared with placebo in terms of incremental cost per life-year gained in this patient population.
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Halcomb E, Davidson P, Daly J, Yallop J, Tofler G. Australian nurses in general practice based heart failure management: implications for innovative collaborative practice. Eur J Cardiovasc Nurs 2004; 3:135-47. [PMID: 15234318 DOI: 10.1016/j.ejcnurse.2004.02.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2003] [Revised: 12/05/2003] [Accepted: 02/11/2004] [Indexed: 11/27/2022]
Abstract
BACKGROUND The growing global burden of heart failure (HF) necessitates the investigation of alternative methods of providing co-ordinated, integrated and client-focused primary care. Currently, the models of nurse-coordinated care demonstrated to be effective in randomized controlled trials are only available to a relative minority of clients and their families with HF. This current gap in service provision could prove fertile ground for the expansion of practice nursing [The Nurse in Family Practice: Practice Nurses and Nurse Practitioners in primary health care. 1988, Scutari Press, London: Impact of rural living on the experience of chronic illness. Australian Journal of Rural Health, 2001. 9: 235-240]. AIM This paper aims to review the published literature describing the current and potential role of the practice nurse in HF management in Australia. METHODS Searches of electronic databases, the reference lists of published materials and the internet were conducted using key words including 'Australia', 'practice nurse', 'office nurse', 'nurs*', 'heart failure', 'cardiac' and 'chronic illness'. Inclusion criteria for this review were English language literature; nursing interventions for heart failure (HF) and the role of practice nurses in primary care. RESULTS There is currently a paucity of data evaluating the potential role for practice nurses in a reconfigured, collaborative health care system. Those studies that were identified were, largely, of a descriptive nature. In addition to identifying the practice nurse as a largely unexplored resource, key themes that emerged from the review include: (1) current general practice services face significant barriers to the implementation of evidence-based HF practice; (2) there is considerable variation in the practice nurse role between general practices; (3) there are significant barriers to the expansion of the practice nurse role; (4) multidisciplinary interventions can effectively deliver secondary prevention strategies; (5) practice nurses can potentially facilitate these multidisciplinary interventions; and (6) practice nurses are favorably perceived by consumers although there is some confusion about the nature of their role. CONCLUSION On the basis of this literature review, practice nurses represent a potentially useful adjunct to current models of service provision in HF management. Further research needs to comprehensively investigate the role of the practice nurse in the Australian context with a view to developing effective and sustainable frameworks for clinical practice. In particular, high-level evidence is required to evaluate the efficacy of the practice nurse role compared to current disease management strategies.
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Affiliation(s)
- Elizabeth Halcomb
- School of Nursing, Family and Community Health (SNFCH), College of Social and Health Sciences (CSHS), University of Western Sydney, Locked Bag 1797, Penrith DC 1797, NSW, Sydney, Australia.
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Ansari MZ, Henderson T, Ackland M, Cicuttini F, Sundararajan V. Congestive cardiac failure: urban and rural perspectives in Victoria. Aust J Rural Health 2004; 11:266-70. [PMID: 14678408 DOI: 10.1111/j.1440-1584.2003.00532.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Effective and timely care for congestive cardiac failure (CCF) should reduce the risks of hospitalisation. The purpose of this study is to describe variations in rates of hospital admissions for CCF in Victoria as an indicator of the adequacy of primary care services. Detailed analyses identify trends in hospitalisations, urban/rural differentials and variations by the Primary Care Partnerships (PCP). SETTING Acute care hospitals in Victoria. DESIGN Routine analyses of age and sex standardised admission rates of CCF in Victoria using the Victorian Admitted Episodes Dataset from 1993-1994 to 2000-2001. SUBJECTS All patients admitted to acute care hospitals in Victoria with the principal diagnosis of CCF between 1993-1994 and 2000-2001. RESULTS There were 8359 admissions for CCF in Victoria with an average of 7.37 bed days in 2000-2001. There was a significantly higher admission rate for CCF in rural areas compared to metropolitan in 2000/200--(2.53/1000 (2.44-2.62) and 1.80/1000 (1.75-1.85))--respectively. Small area analyses identified 17 PCP (14 of which were rural) with significantly higher admission rate ratios of CCF compared to Victoria. CONCLUSION Small area analyses of CCF have identified significant gaps in the management of CCF in the community. This may be a reflection of deficit in primary care availability, accessibility, or appropriateness. Detailed studies may be needed to determine the relative importance of these factors in Victoria for targeting specific interventions at the PCP level.
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Affiliation(s)
- Mohammad Z Ansari
- Health Surveillance and Evaluation Section, Department of Human Services, Monash University, Melbourne, Victoria, Australia.
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Bosworth HB, Steinhauser KE, Orr M, Lindquist JH, Grambow SC, Oddone EZ. Congestive heart failure patients' perceptions of quality of life: the integration of physical and psychosocial factors. Aging Ment Health 2004; 8:83-91. [PMID: 14690872 DOI: 10.1080/13607860310001613374] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Congestive heart failure (CHF) lowers survival and worsens the quality of life (QOL) of over four million older Americans. Both clinicians and standardized instruments used to assess the QOL of patients with CHF focus primarily on physical symptoms rather than capturing the full range of psychosocial concerns. The purpose of this study was to gather descriptions of the components of QOL as understood by patients living with CHF. Focus groups were conducted with patients with known CHF, New York Heart Association (NYHA) class I-IV, and left ventricular fraction of <40%. Focus groups were audiotaped, transcribed, and reviewed for common and recurrent themes using the methods of constant comparisons. We conducted three focus groups (n = 15) stratified by NYHA stage with male patients ranging in age from 47-82 years of age. Five patients were classified with NYHA stage III/IV and ten with NYHA stage I/II. Thirty attributes of QOL were identified which fell into five broad domains: symptoms, role loss, affective response, coping, and social support. Expectedly, patients reported the importance of physical symptoms; however, participants also identified concern for family, the uncertainty of prognosis, and cognitive function as dimensions of QOL. Changes in patients' lives attributed to CHF were not always considered deficiencies; rather, methods of coping with CHF were identified as important attributes representing possible opportunities for personal growth. Clinicians must understand the full range of concerns affecting the QOL of their older patients with CHF. The findings suggest that psychosocial aspects and patient uncertainty about their prognosis are important components of QOL among CHF patients.
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Affiliation(s)
- H B Bosworth
- Center for Health Service Research in Primary Care, Durham Veterans Affairs Medical Center, NC 27705, USA.
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De Smet HR, Menadue MF, Oliver JR, Phillips PA. Increased thirst and vasopressin secretion after myocardial infarction in rats. Am J Physiol Regul Integr Comp Physiol 2003; 285:R1203-11. [PMID: 14557239 DOI: 10.1152/ajpregu.00098.2003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Impaired regulation of salt and water balance in left ventricular dysfunction and heart failure can lead to pulmonary and peripheral edema and hyponatremia. Previous studies of disordered water regulation in heart failure have used models of low cardiac output with normal cardiac function (e.g., inferior vena cava ligation). We investigated thirst and vasopressin (AVP) secretion in a rat myocardial infarction model of chronic left ventricular dysfunction/heart failure in response to a 24-h water deprivation period. Thirst (implied from water drunk), hematocrit, plasma renin activity, and plasma AVP concentrations increased with water deprivation vs. ad libitum water access. Thirst and plasma AVP concentrations were significantly positively correlated with infarct size after 24-h water deprivation but not under ad libitum water access conditions. The mechanism by which this occurs is unclear but could involve increased osmoreceptor sensitivity, altered stimulation of baroreceptors, the renin-angiotensin system, or altered central neural control.
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Affiliation(s)
- H R De Smet
- Dept. of Medicine, Flinders Medical Centre, Bedford Park, South Australia 5042, Australia
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Riegel B, Carlson B, Glaser D, Romero T. Changes over 6-months in health-related quality of life in a matched sample of Hispanics and non-Hispanics with heart failure. Qual Life Res 2003; 12:689-98. [PMID: 14516178 DOI: 10.1023/a:1025132623647] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Hispanics are a growing ethnic minority in the United States and one at significant risk for heart failure. Health-related quality of life (HRQL) is poor in individuals with heart failure, especially during and immediately following hospitalization. No prior research into the HRQL of Hispanics with heart failure was located. A sample of 80 individuals with heart failure, evenly divided by primary language and matched on functional status using the New York Heart Association classification system and age, was studied for 6 months following hospital discharge. Data on HRQL were collected using Spanish and English versions of the Minnesota Living with Heart Failure Questionnaire. Scores improved over time in both groups but significantly more so in the Hispanics when compared to the non-Hispanics. Group differences in HRQL could not be explained by demographics, clinical characteristics, treatment received, perceived support, or instrument response characteristics. Further exploration of this naturally occurring phenomenon may provide insight into how HRQL can be improved in the general heart failure population.
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Affiliation(s)
- Barbara Riegel
- University of Pennsylvania, School of Nursing, Philadelphia, PA 19104-6096, USA.
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Abstract
Heart failure prevalence is increasing because of the ageing of the population and the longer survival of people experiencing myocardial infarction and heart failure. The lifetime risk of developing heart failure in Western countries is about 20%. The increasing prevalence of overweight, obesity and diabetes is likely to accelerate heart failure incidence. While there have been major advances in treating heart failure, a preventive approach promises greater benefit to a larger proportion of the community. The medical strategy for heart failure prevention, based on calculation of individual risk, is focused on the minority of individuals who exceed an arbitrary risk threshold. A public health strategy targeting the whole population offers a greater prospect of reducing the incidence of heart failure and other cardiovascular disease. A multitiered approach, encompassing environmental determinants of lifestyle, legislation, and education about healthy lifestyles throughout life, in addition to aggressive control of risk factors in high-risk individuals, is likely to have the greatest impact.
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Affiliation(s)
- Duncan J Campbell
- St Vincent's Institute of Medical Research, and Department of Medicine, University of Melbourne, Fitzroy, VIC 3065.
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Juenger J, Schellberg D, Kraemer S, Haunstetter A, Zugck C, Herzog W, Haass M. Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables. Heart 2002; 87:235-41. [PMID: 11847161 PMCID: PMC1767036 DOI: 10.1136/heart.87.3.235] [Citation(s) in RCA: 512] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To assess health related quality of life of patients with congestive heart failure; to compare their quality of life with the previously characterised general population and in those with other chronic diseases; and to correlate the different aspects of quality of life with relevant somatic variables. SETTING University hospital. PATIENTS AND DESIGN A German version of the generic quality of life measure (SF-36) containing eight dimensions was administered to 205 patients with congestive heart failure and systolic dysfunction. Cardiopulmonary evaluation included assessment of New York Heart Association (NYHA) functional class, left ventricular ejection fraction, peak oxygen uptake, and the distance covered during a standardised six minute walk test. RESULTS Quality of life significantly decreased with NYHA functional class (linear trend: p < 0.0001). In NYHA class III, the scores of five of the eight quality of life domains were reduced to around one third of those in the general population. The pattern of reduction was different in patients with chronic hepatitis C and major depression, and similar in patients on chronic haemodialysis. Multiple regression analysis showed that only the NYHA functional class was consistently and closely associated with all quality of life scales. The six minute walk test and peak oxygen uptake added to the explanation of the variance in only one of the eight quality of life domains (physical functioning). Left ventricular ejection fraction, duration of disease, and age showed no clear association with quality of life. CONCLUSIONS In congestive heart failure, quality of life decreases as NYHA functional class worsens. Though NYHA functional class was the most dominant predictor among the somatic variables studied, the major determinants of reduced quality of life remain unknown.
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Affiliation(s)
- J Juenger
- Departments of General Internal and Psychosomatic Medicine, University of Heidelberg, Heidelberg, Germany.
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Najib MM, Goldberg Arnold RJ, Kaniecki DJ, Pettit KG, Roth D, Antell L, Xuan J. Medical resource use and costs of congestive heart failure after carvedilol use. HEART DISEASE (HAGERSTOWN, MD.) 2002; 4:70-7. [PMID: 11975837 DOI: 10.1097/00132580-200203000-00003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A retrospective cohort study based on claims and medical chart data was conducted to compare healthcare use and costs in congestive heart failure patients with and without carvedilol. Adult patients with a minimum of two claims with a valid congestive heart failure diagnosis from 1997 to 1999 were included. Patients receiving continuous carvedilol treatment for at least 4 months were considered study case patients. Case patients were matched based on age, gender, race, and concomitant medication. Healthcare use and costs were compared between the case and control groups. A total of 128 case and 147 control patients were identified. There were no significant differences in demographic characteristics, concomitant medication, or New York Heart Association classification between these two groups. Analysis of variance and chi-square analyses were conducted for continuous and categorical variables, respectively. Statistical adjustments were made using a multivariate model. Carvedilol had a significant economic reduction in the overall expenditures by approximately $14,530. Facility expenditures were approximately $9,000 lower for the carvedilol group than for the control group. Carvedilol-treated patients had less frequent hospital admissions and shorter lengths of stay compared with patients not receiving carvedilol. Congestive heart failure patients receiving carvedilol have significantly less healthcare use and costs than patients not receiving carvedilol.
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Affiliation(s)
- Mohammad M Najib
- Health Care Research and New Business Development, Pharmacon International, New York, New York 10018, USA.
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Hunsaker FG, Cioffi DA, Amadio PC, Wright JG, Caughlin B. The American academy of orthopaedic surgeons outcomes instruments: normative values from the general population. J Bone Joint Surg Am 2002; 84:208-15. [PMID: 11861726 DOI: 10.2106/00004623-200202000-00007] [Citation(s) in RCA: 519] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The collection of population-based normative data is a necessary step in the process of standardization of eleven American Academy of Orthopaedic Surgeons (AAOS) musculoskeletal outcomes measures. These data serve as comparative normative scores with which to assess the effectiveness of treatment regimens in clinical practice settings and to study the clinical outcomes of treatment in musculoskeletal research. METHODS With use of a panel mail methodology, self-reported data on the eleven AAOS musculoskeletal outcomes measures were collected from the general population of the United States. RESULTS The overall response rate of 67.4% for the various surveys met study expectations. For the eleven measures, the range of the confidence intervals for the surveys was +/-1.6% to +/-2.3%, exceeding the +/-3% set a priori. With use of the Multitrait/Multi-Item Analysis Program, all of the scales within each of eleven measures exhibited high internal reliability as well as discriminant and convergent validity. Items within each of the scales contributed roughly equal proportions of information to the total scale scores. CONCLUSIONS All eleven instruments met study expectations for providing reliable and valid normative data for use in clinical and research settings.
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Harjai KJ, Cameron AC, Shah M, Stapleton D. Length of hospital stay in patients with decompensated heart failure from moderate to severe left ventricular systolic dysfunction. Am J Cardiol 2001; 88:909-11, A8. [PMID: 11676962 DOI: 10.1016/s0002-9149(01)01906-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- K J Harjai
- Department of Cardiology, Ochsner Clinic, New Orleans, Louisiana, USA.
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Rubenstein LM, DeLeo A, Chrischilles EA. Economic and health-related quality of life considerations of new therapies in Parkinson's disease. PHARMACOECONOMICS 2001; 19:729-752. [PMID: 11548910 DOI: 10.2165/00019053-200119070-00003] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The progressive disability of Parkinson's disease results in substantial burdens for patients, their families and society in terms of increased health resource use, poorer quality of life, caregiver burden, disrupted family relationships, decreases in social and leisure activities, deteriorating emotional well-being, and direct and indirect costs of illness. Health-related quality of life (HR-QOL) measures have been used successfully in cross-sectional studies to identify and characterise these burdens; however, there is not yet substantial evidence that these instruments will be responsive to changes in patients over time and that the results will provide patients and health professionals with clinically meaningful information useful in making decisions about treatment strategies. The few studies documenting direct and indirect costs indicate increased use of ancillary health and community services, significant adaptations in home and transportation, increased use of mobility and self-care aids, and lack of access to appropriate healthcare providers. Patients with Parkinson's disease incur higher hospital expenses, have increased number of prescriptions, and experience earnings loss; the latter also applies to family caregivers. The choice, intensity and timing of therapy are determined by a variety of factors: presenting symptoms, age, employment status, comorbidity, cognitive impairment and level of functional impairment. Choices must be individually tailored to a patient's physical and personal needs. To be useful for patients with Parkinson's disease in clinical practice, clinicians should be able to use HR-QOL measures to identify appropriate medical interventions or socio-behavioural modifications to modify the HR-QOL deficits. However, while the interplay of interventions and clinical outcomes are often well understood, the effects of interventions on HR-QOL outcomes have not been studied extensively. Little research has been done that explicitly links the signs and symptoms of Parkinson's disease to the HR-QOL outcomes. The only Parkinson's disease cost-effectiveness study as yet performed indicated higher costs for patients receiving pramipexole than for those not taking the drug, but additional quality life-years were gained. Longer term effectiveness of many treatment strategies, and the usefulness of HR-QOL instruments to assess these treatments for individual patients over time, are critical areas for future research.
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Affiliation(s)
- L M Rubenstein
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, 52242, USA.
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Plasma amino-terminal pro-brain natriuretic peptide: A novel approach to the diagnosis of cardiac dysfunction. J Card Fail 2000. [DOI: 10.1016/s1071-9164(00)90015-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Linné AB, Liedholm H, Israelsson B. Effects of systematic education on heart failure patients' knowledge after 6 months. A randomised, controlled trial. Eur J Heart Fail 1999; 1:219-27. [PMID: 10935668 DOI: 10.1016/s1388-9842(99)00041-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Many procedures for patient education are introduced in clinical practice without proper evaluation in randomised trials. AIMS To compare systematic nurse and pharmacist led education including an interactive Kodak Photo-CD Portfolio technique with conventional information regarding heart failure patients' knowledge. METHODS One hundred and thirty heart failure patients discharged from hospital were randomised to receive either conventional information or additional structured education with a follow-up of 6 months. Difference in knowledge was tested by questionnaire after 6 months. RESULTS At the end of the study there was a significant difference in the intervention group (n = 50) compared to the control group (n = 58) regarding knowledge as tested by a questionnaire. Of maximal 28 points the intervention group attained 17.2 points (mean) and the control group 14.3 points (mean), 95% confidence interval for difference 1.0-4.7 points (P = 0.0051). CONCLUSIONS Two to 3 hours of systematic education improved heart failure patients' knowledge on essential issues. High age does not preclude the introduction of a new technique for patient education.
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Affiliation(s)
- A B Linné
- B Pharm Department of Community Medicine, Malmö University Hospital, Sweden.
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Snow L, O'Brien E, Saltman DC, Ahern M. When Should We Measure Functioning? A Comparison of Serial Measurement of the MOS SF-36 in an Australian Hospital Sample with Australian Norms. Australas J Ageing 1999. [DOI: 10.1111/j.1741-6612.1999.tb00088.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Increase in arterial stiffness with age causes elevation of systolic blood pressure, which is the most common antecedent of heart failure in older people. Heart failure results from systolic and diastolic dysfunction; in either case, reducing mechanical load is the basis for preventing and treating heart failure.
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Affiliation(s)
- P S Macdonald
- Department of Cardiology, St Vincent's Hospital, Sydney, NSW.
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Lowe JM, Candlish PM, Henry DA, Wlodarcyk JH, Heller RF, Fletcher PJ. Management and outcomes of congestive heart failure: a prospective study of hospitalised patients. Med J Aust 1998; 168:115-8. [PMID: 9484328 DOI: 10.5694/j.1326-5377.1998.tb126744.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To characterise the morbidity, mortality and patterns of care for patients hospitalised with congestive heart failure (CHF). DESIGN Prospective cohort study with one-year follow-up. PATIENTS 409 patients aged 60 years and over admitted to hospital with congestive heart failure between 1 May and 30 November 1993. SETTING John Hunter Hospital (tertiary referral for cardiology) and Mater Hospital (non-tertiary referral for cardiology), Newcastle, New South Wales. OUTCOME MEASURES Length of hospital stay (LOS); unplanned readmissions; mortality at 28 days and one year; and relationship between outcomes and patient and disease characteristics determined by multivariate analysis. RESULTS Annual hospitalisation rate for CHF in the 60 years and over age group was 783/100,000, with CHF accounting for 10.9% of patients in this age group. Median LOS was eight days, and varied significantly between hospitals. ACE inhibitors were being taken by 66% of subjects at discharge. Rate of unplanned readmissions within 28 days was 20%. Mortality was 12.5% at 28 days and 33% at one year. For a first admission for CHF, 28-day mortality was lower than for readmissions (odds ratio, 0.25; 95% confidence interval, 0.1-0.62), and average LOS was 17% lower. Increasing age and renal impairment were significantly associated with higher one-year mortality. Greater comorbidity was associated significantly with longer LOS and non-significantly with higher 28-day and one-year mortality. CONCLUSIONS CHF is a common reason for admission, often results in unplanned readmissions, and has a high mortality. Undertreatment with ACE inhibitors continues. The importance of avoiding recurrent admissions was clear. A program of intensive case management may reduce the burden attributable to CHF.
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Affiliation(s)
- J M Lowe
- Department of General Medicine, John Hunter Hospital, Newcastle, NSW.
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