1
|
Peterson G, Kranker K, Pu J, Magid D, Blue L, McCall N, Markovitz A, Concannon T, Stewart K, Markovich P. Impacts of the Million Hearts® Cardiovascular Disease Risk Reduction Model on Medications, Heart Attacks and Strokes, and Medicare Spending after Two Years: A Cluster‐Randomized Trial. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - K. Kranker
- Mathematica Policy Research Princeton NJ United States
| | - J. Pu
- Mathematica Oakland CA United States
| | - D. Magid
- Kaiser Permanente Colorado Denver CO United States
| | - L. Blue
- Mathematica Washington DC United States
| | - N. McCall
- Mathematica Washington DC United States
| | | | | | | | - P. Markovich
- CMS Innovation Center Silver Spring MD United States
| |
Collapse
|
2
|
Bishawi M, Bell S, Cai L, Landford W, Arif S, McLarty A, Blue L, Phillips B, Nicoara A, Patel C, Milano C. Antibiotic Prophylaxis Strategies in LVAD Implantation and LVAD Infections: A Systematic Review of the Literature. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.640] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
3
|
Kennedy S, Blue L, Smith LN. 027 Reflections on hospital admission for chronic heart failure using patient and carer anecdotes. Heart 2010. [DOI: 10.1136/hrt.2010.195958.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
4
|
Kennedy S, Blue L, Smith L. 139 Oral Reflections on Hospital Admission for Chronic Heart Failure Using Patient and Carer Anecdotes. Eur J Cardiovasc Nurs 2010. [DOI: 10.1016/s1474-5151(10)60102-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/29/2022]
Affiliation(s)
- S. Kennedy
- University of Glasgow, Glasgow, United Kingdom
| | - L. Blue
- British Heart Foundation, Glasgow, United Kingdom
| | - L.N. Smith
- University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
5
|
Petrucci R, Rogers J, Blue L, Gallagher C, Russell S, Dordunoo D, Jaski B, Chillcott S, Sun B, Yanssens T. 138: Neurocognitive Evaluation of Destination Therapy Pateints Receiving Continuous Flow Left Ventricular Assist Devices. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.147] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
6
|
Pal J, Alexander B, Lodge A, Blue L, Milano C. 51: Successful Management of Pump Pocket Infections in Patients with Implanted Left Ventricular Assist Devices. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.728] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
7
|
Felker M, Milano C, Yager J, Hernandez A, Blue L, Higginbotham M, Lodge A, Russell S. Outcomes of an alternate list strategy for heart transplantation. J Heart Lung Transplant 2005. [DOI: 10.1016/j.healun.2004.12.083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
8
|
Fisher C, Berry C, Blue L, Morton JJ, McMurray J. N-terminal pro B type natriuretic peptide, but not the new putative cardiac hormone relaxin, predicts prognosis in patients with chronic heart failure. Heart 2003; 89:879-81. [PMID: 12860863 PMCID: PMC1767758 DOI: 10.1136/heart.89.8.879] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To determine whether the plasma concentration of the putative new cardiac hormone relaxin is predictive of clinical outcome in patients with chronic heart failure (CHF). DESIGN Plasma relaxin and N-terminal pro B type natriuretic peptide (NT pro BNP) concentrations were measured in 87 patients admitted in an emergency with CHF caused by left ventricular systolic dysfunction. These were related to death and death or readmission with CHF over the following year. SETTING Western Infirmary, Glasgow, UK. MAIN OUTCOME MEASURES Plasma concentrations of relaxin and NT pro BNP; time to death or hospitalisation caused by heart failure. RESULTS Plasma concentrations of both relaxin and NT pro BNP were greatly increased. Of the 43 patients with NT pro BNP above the group median concentration, 23 (53%) died and 30 (70%) died or were hospitalised with CHF. Among the 44 with concentrations below the median, these numbers were 5 (11%) and 12 (27%), respectively (p < 0.0001 and p < 0.0001, respectively). Plasma NT pro BNP concentration remained an independent predictor of an adverse clinical outcome in a multivariate analysis. Of the 42 patients with a relaxin concentration above the median, 13 (31%) died and 20 (48%) died or were hospitalised. Below the median, these numbers were 15 of 45 (33%) and 22 of 45 (49%) (p = 0.76 and p = 0.84, respectively). CONCLUSIONS NT pro BNP is a powerful and independent predictor of outcome in CHF, whereas relaxin, also secreted by the heart in increased amounts in CHF, is not.
Collapse
Affiliation(s)
- C Fisher
- Department of Cardiology, Western Infirmary, Glasgow, UK
| | | | | | | | | |
Collapse
|
9
|
Stewart S, Blue L, Walker A, Morrison C, McMurray JJV. An economic analysis of specialist heart failure nurse management in the UK; can we afford not to implement it? Eur Heart J 2002; 23:1369-78. [PMID: 12191748 DOI: 10.1053/euhj.2001.3114] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS Hospital activity represents the major component of health care expenditure related to heart failure. This study evaluated the economic impact of applying specialist nurse management programmes that limit heart failure-related hospital readmissions within a whole population. METHODS Using a reliable and validated estimate of the current level and cost of heart failure-related hospital activity in the U.K., we determined the thresholds at which the actual cost of establishing and applying a national service based on three different models of specialist nurse management would be equal to the 'cost' of bed utilization associated with preventable hospital readmissions in the year 2000. The three models of care examined were home-based, clinic-based or a combination of home plus clinic-based, post-discharge follow-up. The potential impact of this service was based on a U.K.-wide caseload of 122,000 patients discharged to home with a discharge diagnosis of congestive heart failure in that year. RESULTS Based on heart failure-specific patterns of hospital activity, we estimate that 47,000 of these 122,000 patients would normally accumulate a total of 594000 days of associated hospital stay from 49,000 readmissions (for any reason) within 1 year of hospital discharge. The cost of these admissions to the National Health Service was calculated at 166.2 million pounds sterling. Taking into account other costs associated with such hospital activity (e.g. general practice and hospital outpatient visits) each 10% reduction in recurrent bed utilization would be associated with 18.0 million ponds sterling in cost savings. Alternatively, the cost of applying a U.K.-wide programme of home-, clinic- or home plus clinic-based follow-up was calculated to be 69.4 pounds sterling, 73.1 pounds sterling and 72.5 million pounds sterling per annum, respectively. The relative thresholds at which generated 'cost-savings' would equal the cost of applying these programmes of care would therefore be a 38.5%, 40.6% and 40.3% reduction in recurrent bed utilization, respectively. If, as expected, a home-based programme of specialist nurse management reduced recurrent bed utilization by 50% or more, annual savings equivalent to 169,000 pounds sterling per 1000 patients treated would be generated. CONCLUSIONS This is the first study to examine the economic consequences of applying a specialist nurse-mediated, post-discharge management service for heart failure within a whole population. Our findings suggest that such a service will not only improve quality of life and reduce readmissions in patients with congestive heart failure, but also reduce costs and improve the efficiency of the health care system in doing so.
Collapse
Affiliation(s)
- S Stewart
- Department of Cardiology, The Queen Elizabeth Hospital/University of Adelaide, Australia
| | | | | | | | | |
Collapse
|
10
|
Blue L, Lang E, McMurray JJ, Davie AP, McDonagh TA, Murdoch DR, Petrie MC, Connolly E, Norrie J, Round CE, Ford I, Morrison CE. Randomised controlled trial of specialist nurse intervention in heart failure. BMJ 2001; 323:715-8. [PMID: 11576977 PMCID: PMC56888 DOI: 10.1136/bmj.323.7315.715] [Citation(s) in RCA: 374] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine whether specialist nurse intervention improves outcome in patients with chronic heart failure. DESIGN Randomised controlled trial. SETTING Acute medical admissions unit in a teaching hospital. PARTICIPANTS 165 patients admitted with heart failure due to left ventricular systolic dysfunction. The intervention started before discharge and continued thereafter with home visits for up to 1 year. MAIN OUTCOME MEASURES Time to first event analysis of death from all causes or readmission to hospital with worsening heart failure. RESULTS 31 patients (37%) in the intervention group died or were readmitted with heart failure compared with 45 (53%) in the usual care group (hazard ratio=0.61, 95% confidence interval 0.33 to 0.96). Compared with usual care, patients in the intervention group had fewer readmissions for any reason (86 v 114, P=0.018), fewer admissions for heart failure (19 v 45, P<0.001) and spent fewer days in hospital for heart failure (mean 3.43 v 7.46 days, P=0.0051). CONCLUSIONS Specially trained nurses can improve the outcome of patients admitted to hospital with heart failure.
Collapse
Affiliation(s)
- L Blue
- Department of Cardiology, Western Infirmary, Dumbarton Road, Glasgow G12 6NT
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Stewart S, Blue L, Capewell S, Horowitz JD, McMurray JJ. Poles apart, but are they the same? A comparative study of Australian and Scottish patients with chronic heart failure. Eur J Heart Fail 2001; 3:249-55. [PMID: 11246064 DOI: 10.1016/s1388-9842(00)00144-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
This paper reports on an international comparison of the characteristics, treatment and health outcomes of chronic heart failure (CHF) patients discharged from acute hospital care in Australia and Scotland. The baseline characteristics and treatment of 200 CHF patients recruited to a randomised study of a non-pharmacological intervention in Australia and 157 CHF patients concurrently recruited to a similar study in Scotland were compared. Subsequent health outcomes (including survival and readmission) within 3 months of discharge in those patients who received usual post-discharge care in Australia (n=100) and Scotland (n=75) were also compared. Individuals in both countries were predominantly old and frail with significant comorbidity likely to complicate treatment. Similar proportions of Australian and Scottish patients were prescribed either a 'high' (20 vs. 18%) or medium (64 vs. 66%) dose of an angiotensin-converting enzyme inhibitor. Proportionately more Australian patients were prescribed a long-acting nitrate, digoxin and/or a beta-blocker. At 3 months post-discharge, 57 of the 100 (57%: 95% CI 47--67%) Australian and 37 of the 75 (49%: 95% CI 38--61%) Scottish patients assigned to 'usual care' remained event-free (NS). Similarly, 15 vs. 12% required > or =2 unplanned readmission (NS) and 16 vs. 19% of Australian and Scottish patients, respectively, died (NS). Australian and Scottish patients accumulated a median of 0.6 vs. 0.9 days, respectively, of hospitalisation/patient/month (NS). On multivariate analysis (including country of origin), unplanned readmission or death was independently correlated with severe renal impairment (adjusted odds ratio 4.4, P<0.05), a previous hospitalisation for CHF (2.3, P<0.05), longer index hospitalisation (2.7 for >10 days, P<0.05) and greater comorbidity (1.3 for each incremental unit of the Charlson Index, P=0.05). Health outcomes among predominantly old and frail CHF patients appear to be independent of the health-care system in which the patient is managed and more likely to be dependent on the syndrome itself.
Collapse
Affiliation(s)
- S Stewart
- Department of Cardiology, The Queen Elizabeth Hospital/University of Adelaide, Adelaide, Australia
| | | | | | | | | |
Collapse
|
12
|
Riley J, Blue L. Assessing and managing chronic heart failure. Prof Nurse 2001; 16:1112-5. [PMID: 12029913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Patients with chronic heart failure have a reduced quality of life. Symptoms can be managed, but there is no cure. Heart failure nurses can offer advice, education and support to patients. This article reviews the common causes of heart failure and the nursing interventions that can help manage the symptoms.
Collapse
Affiliation(s)
- J Riley
- Thames Valley University, Royal Brompton Hospital, London
| | | |
Collapse
|
13
|
Stewart S, Blue L, Capewell S, Horowitz J, McMurray J. Poles apart, but are they the same? A comparative study of Australian and Scottish patients with chronic heart failure. Eur J Heart Fail 2000. [DOI: 10.1016/s1388-9842(00)80388-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/15/2022] Open
Affiliation(s)
- S. Stewart
- CRI in Heart Failure, University of Glasgow; Glasgow United Kingdom
| | - L. Blue
- CRI in Heart Failure, University of Glasgow; Glasgow United Kingdom
| | - S. Capewell
- Department of Public Health; University of Glasgow; Glasgow United Kingdom
| | - J.D. Horowitz
- Cardiology, University of Adelaide; Adelaide Australia
| | - J.J. McMurray
- CRI in Heart Failure, University of Glasgow; Glasgow United Kingdom
| |
Collapse
|
14
|
Murdoch DR, McDonagh TA, Byrne J, Blue L, Farmer R, Morton JJ, Dargie HJ. Titration of vasodilator therapy in chronic heart failure according to plasma brain natriuretic peptide concentration: randomized comparison of the hemodynamic and neuroendocrine effects of tailored versus empirical therapy. Am Heart J 1999; 138:1126-32. [PMID: 10577444 DOI: 10.1016/s0002-8703(99)70079-7] [Citation(s) in RCA: 172] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Most patients with chronic heart failure (CHF) receive the same dose of angiotensin-converting enzyme (ACE) inhibitors because there is currently no measure of treatment efficacy. We sought to determine whether titration of vasodilator therapy according to plasma brain natriuretic peptide (BNP) concentration may be of value in the individual optimization of vasodilator therapy in CHF. METHODS AND RESULTS Twenty patients with mild to moderate CHF receiving stable conventional therapy including an ACE inhibitor were randomly assigned to titration of ACE inhibitor dosage according to serial measurement of plasma BNP concentration (BNP group) or optimal empirical ACE inhibitor therapy (clinical group) for 8 weeks. Only the BNP-driven approach was associated with significant reductions in plasma BNP concentration throughout the duration of the study and a significantly greater suppression when compared with empiric therapy after 4 weeks [-42.1% (-58.2, -19.7) vs -12.0% (-31.8, 13.8), P =.03]. Both treatment strategies were well tolerated and associated with favorable neurohormonal and hemodynamic effects; however, in comparison between groups, mean heart rate fell (P =.02) and plasma renin activity rose (P =.03) in the BNP group when compared with the clinical group. CONCLUSIONS Plasma BNP concentration may be chronically reduced by tailored vasodilator therapy in CHF. Furthermore, titration of vasodilator therapy according to plasma BNP was associated with more profound inhibition of the renin-angiotensin-aldosterone system and significant fall in heart rate when compared with empiric therapy.
Collapse
Affiliation(s)
- D R Murdoch
- Clinical Research Initiative in Heart Failure, West Medical Building, University of Glasgow, Scotland.
| | | | | | | | | | | | | |
Collapse
|
15
|
Watkins L, Blue L, Cator K, Miller S, Roberts S, Suneson J. Dietitians and a clinical ladder program: a successful combination. J Am Diet Assoc 1994; 94:1038-1039. [PMID: 8071487 DOI: 10.1016/0002-8223(94)92200-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- L Watkins
- Baylor University Medical Center, Transplant Services Department, Dallas, TX 75246
| | | | | | | | | | | |
Collapse
|