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Abstract
BACKGROUND General practitioners in the UK are financially incentivised, via the Quality Outcomes Framework, to maintain a record of all patients at their practice with heart failure and manage them appropriately. The prevalence of heart failure recorded in primary care registers (0.7-1.0%) is less than reported in epidemiological studies (3-5%). Using an audit of clinical practice, we set out to investigate if there are patients 'missing' from primary care heart failure registers and what the underlying mechanisms might be. DESIGN The design of this study was as an audit of clinical practice at a UK general practice ( n = 9390). METHODS Audit software (ENHANCE-HF) was used to identify patients who may have heart failure via a series of hierarchical searches of electronic records. Heart failure was then confirmed or excluded based on the electronic records by a heart failure specialist nurse and patients added to the register. Outcome data for patients without heart failure was collected after two years. RESULTS Heart failure prevalence was 0.63% at baseline and 1.12% after the audit. Inaccurate coding accounted for the majority of missing patients. Amongst patients without heart failure who were taking a loop diuretic, the rate of incident heart failure was 13% and the rate of death or hospitalization with heart failure was 25% respectively during two-year follow-up. CONCLUSION There are many patients missing from community heart failure registers which may detriment patient outcome and practice income. Patients without heart failure who take loop diuretics are at high risk of heart failure-related events.
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Affiliation(s)
| | | | | | - Andrew L Clark
- 1 Department of Academic Cardiology, Hull York Medical School, UK
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2
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Smeets CJ, Storms V, Vandervoort PM, Dreesen P, Vranken J, Houbrechts M, Goris H, Grieten L, Dendale P. A Novel Intelligent Two-Way Communication System for Remote Heart Failure Medication Uptitration (the CardioCoach Study): Randomized Controlled Feasibility Trial. JMIR Cardio 2018; 2:e8. [PMID: 31758773 PMCID: PMC6834244 DOI: 10.2196/cardio.9153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/19/2017] [Accepted: 01/02/2018] [Indexed: 12/16/2022] Open
Abstract
Background European Society of Cardiology guidelines for the treatment of heart failure (HF) prescribe uptitration of angiotensin-converting enzyme inhibitors (ACE-I) and β-blockers to the maximum-tolerated, evidence-based dose. Although HF prognosis can drastically improve when correctly implementing these guidelines, studies have shown that they are insufficiently implemented in clinical practice. Objective The aim of this study was to verify whether supplementing the usual care with the CardioCoach follow-up tool is feasible and safe, and whether the tool is more efficient in implementing the guideline recommendations for β-blocker and ACE-I. Methods A total of 25 HF patients were randomly assigned to either the usual care control group (n=10) or CardioCoach intervention group (n=15), and observed for 6 months. The CardioCoach follow-up tool is a two-way communication platform with decision support algorithms for semiautomatic remote medication uptitration. Remote monitoring sensors automatically transmit patient’s blood pressure, heart rate, and weight on a daily basis. Results Patients’ satisfaction and adherence for medication intake (10,018/10,825, 92.55%) and vital sign measurements (4504/4758, 94.66%) were excellent. However, the number of technical issues that arose was large, with 831 phone contacts (median 41, IQR 32-65) in total. The semiautomatic remote uptitration was safe, as there were no adverse events and no false positive uptitration proposals. Although no significant differences were found between both groups, a higher number of patients were on guideline-recommended medication dose in both groups compared with previous reports. Conclusions The CardioCoach follow-up tool for remote uptitration is feasible and safe and was found to be efficient in facilitating information exchange between care providers, with high patient satisfaction and adherence. Trial Registration ClinicalTrials.gov NCT03294811; https://clinicaltrials.gov/ct2/show/NCT03294811 (Archived by WebCite at http://www.webcitation.org/6xLiWVsgM)
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Affiliation(s)
- Christophe Jp Smeets
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Valerie Storms
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Pieter M Vandervoort
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Pauline Dreesen
- Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Julie Vranken
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | | | - Hanne Goris
- Department of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Lars Grieten
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Paul Dendale
- Department of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
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3
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Tran MW, Weiland TJ, Phillips GA. Psychosocial and nonclinical factors predicting hospital utilization in patients of a chronic disease management program: a prospective observational study. J Ambul Care Manage 2016; 38:77-86. [PMID: 25469581 DOI: 10.1097/jac.0b013e31829d9e81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Psychosocial factors such as marital status (odds ratio, 3.52; 95% confidence interval, 1.43-8.69; P = .006) and nonclinical factors such as outpatient nonattendances (odds ratio, 2.52; 95% confidence interval, 1.22-5.23; P = .013) and referrals made (odds ratio, 1.20; 95% confidence interval, 1.06-1.35; P = .003) predict hospital utilization for patients in a chronic disease management program. Along with optimizing patients' clinical condition by prescribed medical guidelines and supporting patient self-management, addressing psychosocial and nonclinical issues are important in attempting to avoid hospital utilization for people with chronic illnesses.
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Affiliation(s)
- Mark W Tran
- St Vincent's Hospital Melbourne, Fitzroy (Mr Tran, Dr Weiland, and Ms Phillips), and University of Melbourne, Parkville (Dr Weiland and Ms Phillips), Victoria, Australia
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Smith CE, Piamjariyakul U, Dalton KM, Russell C, Wick J, Ellerbeck EF. Nurse-Led Multidisciplinary Heart Failure Group Clinic Appointments: Methods, Materials, and Outcomes Used in the Clinical Trial. J Cardiovasc Nurs 2015; 30:S25-34. [PMID: 25774836 DOI: 10.1097/JCN.0000000000000255] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Self-management and Care of Heart Failure through Group Clinics Trial evaluated the effects of multidisciplinary group clinic appointments on self-care skills and rehospitalizations in high-risk heart failure (HF) patients. OBJECTIVE The purpose of this article is to (1) describe key Self-management and Care of Heart Failure through Group Clinics Trial group clinic interactive learning strategies, (2) describe resources and materials used in the group clinic appointment, and (3) present results supporting this patient-centered group intervention. METHODS This clinical trial included 198 HF patients (randomized to either group clinical appointments or to standard care). Data were collected from 72 group clinic appointments via patients' (1) group clinic session evaluations, (2) HF self-care behaviors skills, (3) HF-related discouragement and quality of life scores, and (4) HF-related reshopitalizations during the 12-month follow-up. Also, the costs of delivery of the group clinical appointments were tabulated. RESULTS Overall, patients rated group appointments as 4.8 of 5 on the "helpfulness" in managing HF score. The statistical model showed a 33% decrease in the rate of rehospitalizations (incidence rate ratio, 0.67) associated with the intervention over the 12-month follow-up period when compared with control patients (χ(2)1=3.9, P=.04). The total cost for implementing 5 group appointments was $243.58 per patient. CONCLUSION The intervention was associated with improvements in HF self-care knowledge and home care behavior skills and managing their for HF care. In turn, better self-care was associated with reductions in HF-related hospitalizations.
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Crissinger ME, Marchionda KM, Dunlap ME. Adherence to clinical guidelines in heart failure (HF) outpatients: Impact of an interprofessional HF team on evidence-based medication use. J Interprof Care 2015; 29:483-7. [PMID: 26091371 DOI: 10.3109/13561820.2015.1027334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Clinical systolic heart failure (HF) guidelines specify recommendations for ACE inhibitors (ACEI), angiotensin receptor blockers (ARB), and beta blockers according to doses used in clinical trials. However, many HF patients remain suboptimally treated. We sought to determine which provider type, between an interprofessional HF team, non-HF cardiologists, and primary care physicians (PCP), most optimally manages HF medications and doses. A retrospective chart review was performed on adult patients at an academic county hospital with an ejection fraction ≤40% and a diagnosis of HF, seen by a single provider type (HF team, cardiologist, or PCP) at least twice within a 12-month period. Utilization rates of any ACEI/ARB and any beta blocker were robust across provider types, though evidence-based ACEI/ARB and beta blocker were greatest from the HF team. Doses of evidence-based therapies dropped markedly in the non-HF team groups. The percent of patients prescribed optimal doses of an evidence-based ACEI/ARB AND beta blocker was 69%, 33%, and 25% for the HF team, cardiologists and PCPs, respectively (p < 0.0167). Patients followed by the HF team were more frequently prescribed evidence-based medications at optimal doses. This supports using specialized interprofessional HF teams to attain greater adherence to evidence-based recommendations in treating systolic HF.
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Marzluf BA, Reichardt B, Neuhofer LM, Kogler B, Wolzt M. Influence of drug adherence and medical care on heart failure outcome in the primary care setting in Austria. Pharmacoepidemiol Drug Saf 2015; 24:722-30. [PMID: 25980789 DOI: 10.1002/pds.3790] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 03/14/2015] [Accepted: 03/30/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE Guideline-recommended therapy has been proven beneficial in heart failure (HF), but general implementation remains poor. The aim of this study was to evaluate the adherence to drug therapy, quality of primary non-drug medical care (NDMC) and its impact on HF outcome. METHODS From 13 Austrian health insurance funds, we identified 36 829 patients (77.1 ± 10.8 years, 44.8% men) hospitalised for HF who survived more than 90 days after discharge in the period between April 2006 and June 2010. Drug adherence was analysed from prescriptions filled and NDMC from numbers of physician consultations and diagnostic tests relevant for HF per quarter of a year (medical care index (MedCI)) claimed from the insurance funds. Kaplan-Meier and multivariate Cox regression analyses were performed to identify the association of outcome (survival and death without further admission for HF, readmission for HF) with drug adherence and NDMC. RESULTS Readmission due to HF or death without prior readmission for HF occurred in 19.7% and 22.5%, respectively. Adherence to angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers, beta-blockers and aldosterone antagonists was 49.3%, 40.4% and 16.1%, respectively, and was associated with better survival by Kaplan-Meier analysis. NDMC was consumed less frequently by deceased (76.0%; MedCI 2.55 ± 3.04) than surviving (79.3%; 3.60 ± 3.81) or readmitted (78.4%; 3.80 ± 4.13) patients (p < 0.001 for deceased vs both other). Drug adherence and NDMC were independent factors associated with better survival by multivariate regression analysis. CONCLUSION Guideline-recommended drug therapy remains underutilised in Austria. Drug adherence and quality of NDMC are associated with better outcome in HF patients.
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Affiliation(s)
- Beatrice A Marzluf
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Lisa M Neuhofer
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Bernhard Kogler
- Main Association of Austrian Social Security Institutions, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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von Scheidt W, Zugck C, Pauschinger M, Hambrecht R, Bruder O, Hartmann A, Rauchhaus M, Zahn R, Brachmann J, Tebbe U, Neumann T, Strasser RH, Böhm M, Störk S, Hochadel M, Heidemann P, Senges J. Characteristics, management modalities and outcome in chronic systolic heart failure patients treated in tertiary care centers: results from the EVIdence based TreAtment in Heart Failure (EVITA-HF) registry. Clin Res Cardiol 2014; 103:1006-14. [PMID: 25052361 DOI: 10.1007/s00392-014-0743-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/15/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Limited data exist regarding baseline characteristics and management of heart failure with reduced ejection fraction (EF) in tertiary care facilities. METHODS EVITA-HF comprises web-based case report data on demography, comorbidities, diagnostic and therapy measures, quality of life, adverse events and 1-year follow-up of patients hospitalized for chronic heart failure and an ejection fraction of less than 40%. RESULTS Between February 2009 and June 2011, a total of 1,853 consecutive, hospitalized patients (pts) were included in 16 centers in Germany. Mean age was 70 years, 76% were male. Median EF was 30%, and 63% were in NYHA III/IV. Ischemic cardiomyopathy was present in 56%, history of hypertension in 76%, diabetes in 39%, impaired renal function in 33%, thyroid dysfunction in 12%, and malignoma in 7%. Sixty-eight percent of pts had a non-elective admission. Rhythm was sinus/atrial fibrillation or flutter/pacemaker in 64, 28 and 11%, respectively. Median heart rate amounted to 80 bpm, median blood pressure to 122/74 mmHg. LBBB was present in 26% of non-pacemaker pts. Eighteen percent had an ICD or CRT-D. Medication (admission vs. discharge) consisted of ACEI or ARB in 73 vs. 88%, β-blocker in 71 vs. 89%, mineral corticosteroid receptor antagonist (MRA) in 32 vs. 57%, diuretics in 68 vs. 83% (p < 0.001 for each). Forty-two percent of pts received a specific treatment procedure beyond pharmacotherapy, of these 48% revascularization, 39% device therapy, 14% electrical cardioversion, 5% ablation procedures, 9 % valvular procedures, 6% iv inotropes, 1.8% IABP or LVAD implantation. At discharge, 33% of survivors had ICD- or CRT-D implants. One-year mortality amounted to 16.8%, and death or rehospitalization to 56%. NYHA class III/IV was found in 30% (p < 0.001 vs. index admission), general health status was improved in 45% and unchanged in 36% of patients. Eighty-five percent of pts took ACEI or ARB, 86% β-blockers, 47% MRA, and 78% diuretics (p < 0.001 vs. index discharge for all). CONCLUSION Patients with chronic heart failure and low ejection fraction represent an elderly and multimorbid population. While hospitalized, they experience a significant optimization of prognosis-relevant medication, revascularization and device therapy. After 1 year, mortality is moderate; drug adherence is high and NYHA status favourable. The EVITA-HF registry is able to reflect coherently the real-world management, efforts and follow-up in heart failure pts managed in tertiary care facilities.
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Castelli G, Fornaro A, Ciaccheri M, Dolara A, Troiani V, Tomberli B, Olivotto I, Gensini GF. Improving Survival Rates of Patients With Idiopathic Dilated Cardiomyopathy in Tuscany Over 3 Decades. Circ Heart Fail 2013; 6:913-21. [DOI: 10.1161/circheartfailure.112.000120] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Gabriele Castelli
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Alessandra Fornaro
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Mauro Ciaccheri
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Alberto Dolara
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Vito Troiani
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Benedetta Tomberli
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Iacopo Olivotto
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Gian Franco Gensini
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
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Feldman DE, Huynh T, Des Lauriers J, Giannetti N, Frenette M, Grondin F, Michel C, Sheppard R, Montigny M, Lepage S, Nguyen V, Behlouli H, Pilote L. Gender and Other Disparities in Referral to Specialized Heart Failure Clinics Following Emergency Department Visits. J Womens Health (Larchmt) 2013; 22:526-31. [DOI: 10.1089/jwh.2012.4107] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Debbie Ehrmann Feldman
- Université de Montréal, Montreal, Quebec, Canada
- Public Health Department of Montreal, Montreal, Quebec, Canada
- Institut National de Santé Publique du Québec, Montréal, Québec, Canada
| | - Thao Huynh
- McGill University Health Centre, Montréal, Québec, Canada
| | | | | | - Marc Frenette
- Hôpital du Sacre Cœur de Montréal, Montréal, Québec, Canada
| | | | | | | | | | - Serge Lepage
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Viviane Nguyen
- McGill University Health Centre, Montréal, Québec, Canada
| | | | - Louise Pilote
- McGill University Health Centre, Montréal, Québec, Canada
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SHUKLA ASHISH, CURTIS ANNEB, MEHRA MANDEEPR, ALBERT NANCYM, GHEORGHIADE MIHAI, HEYWOOD JTHOMAS, LIU YANG, O'CONNOR CHRISTOPHERM, REYNOLDS DWIGHT, WALSH MARYNORINE, YANCY CLYDEW, FONAROW GREGGC. Factors Associated with Improvement in Utilization of Cardiac Resynchronization Therapy in Eligible Heart Failure Patients: Findings from IMPROVE HF. Pacing and Clinical Electrophysiology 2013; 36:433-43. [DOI: 10.1111/pace.12090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 10/27/2012] [Accepted: 11/24/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - MANDEEP R. MEHRA
- Brigham and Women's Hospital and Harvard Medical School; Boston; Massachusetts
| | | | - MIHAI GHEORGHIADE
- Northwestern University Feinberg School of Medicine; Chicago; Illinois
| | | | - YANG LIU
- Medtronic, Inc.; Mounds View; Minnesota
| | | | - DWIGHT REYNOLDS
- University of Oklahoma Health Sciences Center; Oklahoma City; Oklahoma
| | | | - CLYDE W. YANCY
- Northwestern University Feinberg School of Medicine; Chicago; Illinois
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Parissis JT, Mantziari L, Kaldoglou N, Ikonomidis I, Nikolaou M, Mebazaa A, Altenberger J, Delgado J, Vilas-Boas F, Paraskevaidis I, Anastasiou-Nana M, Follath F. Gender-related differences in patients with acute heart failure: management and predictors of in-hospital mortality. Int J Cardiol 2012; 168:185-9. [PMID: 23041090 DOI: 10.1016/j.ijcard.2012.09.096] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 07/06/2012] [Accepted: 09/15/2012] [Indexed: 11/15/2022]
Abstract
AIM AND METHODS Gender-related differences in clinical phenotype, in-hospital management and prognosis of acute heart failure (AHF) patients have been previously reported in European and US registries. The ALARM-HF survey is the first to include a cohort of 4953 patients hospitalized for AHF in 666 hospitals in 6 European countries, Mexico and Australia. RESULTS Women accounted for 37% of the study population, were older and had higher rates of de novo heart failure (45% vs 36%, p<0.001) than men. An acute coronary syndrome (ACS) was the predominant precipitating factor in both genders, but to a lesser extent in females (30% vs 42%, p<0.001). Between genders comparison showed higher incidence of atrial fibrillation, valvular heart disease, diabetes, obesity, anemia and depression in women (p<0.05). Similarly, women had higher left ventricular ejection fraction (LVEF) on admission (42 ± 15% vs 36 ± 13%, p<0.001) and systolic blood pressure (135 ± 40 mm Hg vs 131 ± 39 mm Hg, p=0.001) than men. On the other hand, men had more often coronary artery disease, renal failure and chronic obstructive pulmonary disease (p<0.05). Importantly, in-hospital mortality was similar in both genders (11.1% in females vs 10.5% in males, p=0.475), and its common predictors were: systolic blood pressure at admission, creatinine>1.5mg/dL and diabetes. Furthermore, recent ACS, valvular heart disease and dementia contributed to prognosis in women, while LVEF, hypertension and anemia were independent predictors in men. CONCLUSION Among patients with AHF, there are significant differences in co-morbidities, precipitating factors and predictors of in-hospital mortality between genders. Nevertheless, in-hospital mortality remains similar between genders.
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Affiliation(s)
- John T Parissis
- Second Cardiology Department, Attikon University Hospital, Athens, Greece.
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Zugck C, Franke J, Gelbrich G, Frankenstein L, Scheffold T, Pankuweit S, Duengen HD, Regitz-zagrosek V, Pieske B, Neumann T, Rauchhaus M, Angermann CE, Katus HA, Ertl GE, Störk S. Implementation of pharmacotherapy guidelines in heart failure: experience from the German Competence Network Heart Failure. Clin Res Cardiol 2012; 101:263-72. [DOI: 10.1007/s00392-011-0388-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 11/24/2011] [Indexed: 11/26/2022]
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13
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Franke J, Zugck C, Wolter JS, Frankenstein L, Hochadel M, Ehlermann P, Winkler R, Nelles M, Zahn R, Katus HA, Senges J. A decade of developments in chronic heart failure treatment: a comparison of therapy and outcome in a secondary and tertiary hospital setting. Clin Res Cardiol 2012; 101:1-10. [DOI: 10.1007/s00392-011-0348-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 07/12/2011] [Indexed: 11/27/2022]
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de Vries AE, de Jong RM, van der Wal MHL, Jaarsma T, van Dijk RB, Hillege HL. The value of INnovative ICT guided disease management combined with Telemonitoring in OUtpatient clinics for Chronic Heart failure patients. Design and methodology of the IN TOUCH study: a multicenter randomised trial. BMC Health Serv Res 2011; 11:167. [PMID: 21752280 PMCID: PMC3146411 DOI: 10.1186/1472-6963-11-167] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 07/13/2011] [Indexed: 11/27/2022] Open
Abstract
Background Although the value of telemonitoring in heart failure patients is increasingly studied, little is known about the value of the separate components of telehealth: ICT guided disease management and telemonitoring. The aim of this study is to investigate the value of telemonitoring added to ICT guided disease management (DM) on the quality and efficiency of care in patients with chronic heart failure (CHF) after a hospitalisation. Methods/Design The study is divided in two arms; a control arm (DM) and an intervention arm (DM+TM) in 10 hospitals in the Netherlands. In total 220 patients will be included after worsening of CHF (DM: N = 90, DM+TM: N = 130). Total follow-up will be 9 months. Data will be collected at inclusion and then after 2 weeks, 4.5 and 9 months. The primary endpoint of this study is a composite score of: 1: death from any cause during the follow-up of the study, 2: first readmission for HF and 3: change in quality of life compared to baseline, assessed by the Minnesota Living with Heart failure Questionnaire. The study has started in December 2009 and results are expected in 2012. Conclusions The IN TOUCH study is the first to investigate the effect of telemonitoring on top of ICT guided DM on the quality and efficiency of care in patients with worsening HF and will use a composite score as its primary endpoint. Trial registration Netherlands Trial Register (NTR): NTR1898
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Affiliation(s)
- Arjen E de Vries
- Thoraxcenter, Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands.
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Feldman DE, Ducharme A, Giannetti N, Frenette M, Michel C, Grondin F, Sheppard R, Lauriers JD, Behlouli H, Pilote L. Outcomes for Women and Men Who Attend a Heart Failure Clinic: Results of a 12-Month Longitudinal Study. J Card Fail 2011; 17:540-6. [DOI: 10.1016/j.cardfail.2011.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 03/01/2011] [Accepted: 03/03/2011] [Indexed: 11/26/2022]
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16
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Feldman DE, Ducharme A, Giannetti N, Frenette M, Michel C, Grondin F, Sheppard R, Lauriers JD, Behlouli H, Pilote L. Outcomes for Women and Men Who Attend a Heart Failure Clinic: Results of a 12-Month Longitudinal Study. J Card Fail 2011. [DOI: 10.1016/j.cardfail.2011.03.001
https://www.sciencedirect.com/science/article/pii/s1071916411001023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
The recent publication of the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF) has affirmed the important role of aldosterone-receptor antagonism across the spectrum of systolic heart failure. Previously restricted as therapy in patients with severe symptomatic or postinfarction heart failure, it now is being considered in less-sick patients. The precise mechanisms of benefit remain to be elucidated, in part due to the observed discrepancy between improved outcomes and the lack of reverse cardiac remodeling with aldosterone-receptor antagonists. With the probable increased use of spironolactone and eplerenone, there are concerns for increased complications, especially hyperkalemia. This risk must be balanced against the potential benefit for reduced mortality and morbidity in addition to effects of β-blockers and angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, and cardiac resynchronization therapy.
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Abstract
Heart failure is a chronic and debilitating disease responsible for high cardiac morbidity and mortality in the world and is associated with over 290 000 deaths in the United States each year. This article reviews palliative care and self-care, which are critical components of heart failure management that are inadequately defined in the current American College of Cardiology/American Heart Association Guidelines for the Diagnosis and Management of Heart Failure. Palliative care describes a multidisciplinary approach to the treatment of heart failure therapy that addresses both the symptomatic and psychosocial aspects of the disease. Self-care aims to maintain disease stability and prevent clinical decline through a variety of patient-based behavioral and lifestyle modifications.
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Affiliation(s)
- Keith A Thompson
- Cedars Sinai Heart Institute, Cedars Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
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Arnold JMO, Gula LJ. The Art and Science of Heart Failure. J Am Coll Cardiol 2010; 55:1811-1813. [DOI: 10.1016/j.jacc.2010.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 03/09/2010] [Indexed: 11/21/2022]
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