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Driscoll A, Meagher S, Kennedy R, Hare DL, Johnson DF, Asker K, Farouque O, Romaniuk H, Orellana L. Impact of a heart failure nurse practitioner service on rehospitalizations, emergency presentations, and survival in patients hospitalized with acute heart failure. Eur J Cardiovasc Nurs 2023; 22:701-708. [PMID: 36413653 DOI: 10.1093/eurjcn/zvac108] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/09/2022] [Accepted: 11/13/2022] [Indexed: 10/12/2023]
Abstract
AIMS Heart failure nurse practitioners (HF NPs) are an emerging component of the heart failure (HF) specialist workforce but their impact in an inpatient setting is untested. The aim of this paper is to explore the impact of an inpatient HF NP service on 12-month all-cause rehospitalizations, emergency department (ED) presentations, and mortality in patients hospitalized with HF compared with usual hospital care. METHODS AND RESULTS Retrospective, two-group comparative design involving patients (n = 408) admitted via ED with acute HF to a metropolitan quaternary hospital between January 2013 and August 2017. Doubly robust estimation with augmented inverse probability weighting (DR-AIPW) was used to account for the non-random allocation of patients to usual hospital care or the HF NP service in addition to usual in-hospital care. Among 408 patients (186 usual care and 222 HF NP service) admitted with acute HF, the mean age was 76.5 [standard deviation (SD) 12.0] years and 56.4% (n = 230) were male. After IPW adjustment, patients seen by the HF NP service had a lower risk of 12-month rehospitalization (61.3 vs. 78.3% usual care; difference -16.9%, 95% CI: -26.4%, -6.6%) and ED presentations (12.6 vs. 22.0%; difference -9.4%, 95% CI: -17.3%, -1.4%) with no difference in 6- or 12-month mortality. The HF NP service improved referrals to a home visiting programme that was available to HF patients (64.4 vs. 45.4%; difference 19%, 95% CI: 8.8%, 28.8%). CONCLUSION Additional support by an inpatient HF NP service has the potential to significantly reduce rehospitalizations and ED presentations over 12 months. Further evidence from a multicentre randomized control trial is warranted.
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Affiliation(s)
- Andrea Driscoll
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
| | - Sharon Meagher
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - Rhoda Kennedy
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - David L Hare
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | - Douglas F Johnson
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
- The Royal Melbourne Hospital, Department of General Medicine, Grattan St, Parkville, VIC 3050, Australia
| | - Kristina Asker
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
| | - Omar Farouque
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | - Helena Romaniuk
- Biostatistics Unit, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - Liliana Orellana
- Biostatistics Unit, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
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Nishi M, Shikuma A, Seki T, Horiguchi G, Matoba S. In-hospital mortality and cardiovascular treatment during hospitalization for heart failure among patients with schizophrenia: a nationwide cohort study. Epidemiol Psychiatr Sci 2023; 32:e62. [PMID: 37849318 PMCID: PMC10594642 DOI: 10.1017/s2045796023000744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/06/2023] [Accepted: 09/17/2023] [Indexed: 10/19/2023] Open
Abstract
AIMS Schizophrenia is associated with cardiovascular disease (CVD) risk, and patients with schizophrenia are more likely to receive suboptimal care for CVD. However, there is limited knowledge regarding in-hospital prognosis and quality of care for patients with schizophrenia hospitalized for heart failure (HF). This study sought to elucidate the association between schizophrenia and in-hospital mortality, as well as cardiovascular treatment in patients hospitalized with HF. METHODS Using the nationwide cardiovascular registry data in Japan, a total of 704,193 patients hospitalized with HF from 2012 to 2019 were included and stratified by age: young age, > 18 to 45 years (n = 20,289); middle age, >45 to 65 years (n = 114,947); and old age, >65 to 85 years (n = 568,957). All and 30-day in-hospital mortality as well as prescription of cardiovascular medications were assessed. After multiple imputation for missing values, mixed-effect multivariable logistic regression analysis was performed using patient and hospital characteristics with hospital identifier as a variable with random effects. RESULTS Patients with schizophrenia were more likely to experience prolonged hospital stays, and incur higher hospitalization costs. In-hospital mortality for non-elderly patients with schizophrenia was significantly worse than for those without schizophrenia: the mortality rate was 7.6% vs 3.5% and the adjusted odds ratio (OR) was 1.96 (95% confidence interval (CI): 1.24-3.10, P = 0.0037) in young adult patients; 6.2% vs 4.0% and 1.49 (95% CI: 1.17-1.88, P < 0.001) in middle-aged patients. Thirty-day in-hospital mortality was significantly worse in middle-aged patients: the mortality rate was 4.7% vs 3.0% and an adjusted OR was 1.40 (95% CI: 1.07-1.83, P = 0.012). In-hospital mortality in elderly patients did not differ between those with and without schizophrenia. Prescriptions of beta-blockers and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers were significantly lower in patients with schizophrenia across all age groups. CONCLUSION Schizophrenia was identified as a risk factor for in-hospital mortality and reduced prescription of cardioprotective medications in non-elderly patients hospitalized with HF. These findings highlight the necessity for differentiated care and management of HF in patients with severe mental illnesses.
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Affiliation(s)
- Masahiro Nishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akira Shikuma
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomotsugu Seki
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Go Horiguchi
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Olson M, Thompson Z, Xie L, Nair A. Broadening Heart Failure Care Beyond Cardiology: Challenges and Successes Within the Landscape of Multidisciplinary Heart Failure Care. Curr Cardiol Rep 2023; 25:851-861. [PMID: 37436647 DOI: 10.1007/s11886-023-01907-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE OF REVIEW Heart failure (HF) is a growing public health concern that impairs the quality of life and is associated with significant mortality. As the prevalence of heart failure increases, multidisciplinary care is essential to provide comprehensive care to individuals. RECENT FINDINGS The challenges of implementing an effective multidisciplinary care team can be daunting. Effective multidisciplinary care begins at the initial diagnosis of heart failure. The transition of care from the inpatient to the outpatient setting is critically important. The use of home visits, case management, and multidisciplinary clinics has been shown to decrease mortality and heart failure hospitalizations, and major society guidelines endorse multidisciplinary care for heart failure patients. Expanding heart failure care beyond cardiology entails incorporating primary care, advanced practice providers, and other disciplines. Patient education and self-management are fundamental to multidisciplinary care, as is a holistic approach to effectively address comorbid conditions. Ongoing challenges include navigating social disparities within heart failure care and limiting the economic burden of the disease.
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Affiliation(s)
- Michael Olson
- Baylor College of Medicine, 7200 Cambridge St, Ste 6C, Houston, TX, 77030, USA
| | - Zachary Thompson
- Baylor College of Medicine, 7200 Cambridge St, Ste 6C, Houston, TX, 77030, USA
| | - Lola Xie
- Baylor College of Medicine, 7200 Cambridge St, Ste 6C, Houston, TX, 77030, USA
- The Texas Heart Institute, Cardiology, Houston, TX, 77030, USA
| | - Ajith Nair
- Baylor College of Medicine, 7200 Cambridge St, Ste 6C, Houston, TX, 77030, USA.
- The Texas Heart Institute, Cardiology, Houston, TX, 77030, USA.
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Nishi M, Seki T, Shikuma A, Kawamata H, Horiguchi G, Matoba S. Association between patient volume to cardiologist, process of care, and clinical outcomes in heart failure. ESC Heart Fail 2023. [PMID: 37075756 PMCID: PMC10375098 DOI: 10.1002/ehf2.14385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/07/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023] Open
Abstract
AIMS The impact of hospital volume on clinical performance has been investigated by many researchers to date and thought that it is associated with quality of care and outcome for patients with heart failure (HF). This study sought to determine whether annual admissions of HF per cardiologist are associated with process of care, mortality, and readmission. METHODS AND RESULTS Among the nationwide registry 'Japanese registry of all cardiac and vascular diseases - diagnostics procedure combination' data collected from 2012 to 2019, a total of 1 127 113 adult patients with HF and 1046 hospitals were included in the study. Primary outcome was in-hospital mortality, and secondary outcome was 30 day in-hospital mortality and readmission at 30 days and 6 months. Hospital and patient characteristics and process of care measures were also assessed. Mixed-effect logistic regression and Cox proportional-hazards model was used for multivariable analysis, and adjusted odds ratio and hazard ratio were evaluated. Process of care measures had inverse trends for annual admissions of HF per cardiologist (P < 0.01 for all measures: prescription rate of beta-blocker, angiotensin converting enzyme inhibitor or angiotensin II receptor blocker, mineralocorticoid receptor antagonist, and anticoagulant for atrial fibrillation). Adjusted odds ratio for in-hospital mortality was 1.04 (95% confidence interval (CI): 1.04-1.08, P = 0.04) and 30 day in-hospital mortality was 1.05 (95% CI: 1.01-1.09, P = 0.01) for interval of 50 annual admissions of HF per cardiologist. Adjusted hazard ratio for 30 day readmission was 1.05 (95% CI: 1.02-1.08, P < 0.01) and 6 month readmission was 1.07 (95% CI: 1.03-1.11, P < 0.01). Plots of the adjusted odds indicated 300 as the threshold of annual admissions of HF per cardiologist for substantial increase of in-hospital mortality risk. CONCLUSIONS Our findings demonstrated that annual admissions of HF per cardiologist are associated with worse process of care, mortality, and readmission with the threshold for mortality risk increased, emphasizing the optimal proportion of patients admitted with HF to cardiologist for better clinical performance.
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Affiliation(s)
- Masahiro Nishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomotsugu Seki
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akira Shikuma
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hirofumi Kawamata
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Go Horiguchi
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Dai L, Dorje T, Gootjes J, Shah A, Dembo L, Rankin J, Hillis G, Robinson S, Atherton JJ, Jacques A, Reid CM, Maiorana A. Primary care Adherence To Heart Failure guidelines IN Diagnosis, Evaluation and Routine management (PATHFINDER): a randomised controlled trial protocol. BMJ Open 2023; 13:e063656. [PMID: 36972959 PMCID: PMC10069547 DOI: 10.1136/bmjopen-2022-063656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 02/06/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION General practitioners (GPs) routinely provide care for patients with heart failure (HF); however, adherence to management guidelines, including titrating medication to optimal dose, can be challenging in this setting. This study will evaluate the effectiveness of a multifaceted intervention to support adherence to HF management guidelines in primary care. METHODS AND ANALYSIS We will undertake a multicentre, parallel-group, randomised controlled trial of 200 participants with HF with reduced ejection fraction. Participants will be recruited during a hospital admission due to HF. Following hospital discharge, the intervention group will have follow-up with their GP scheduled at 1 week, 4 weeks and 3 months with the provision of a medication titration plan approved by a specialist HF cardiologist. The control group will receive usual care. The primary endpoint, assessed at 6 months, will be the difference between groups in the proportion of participants being prescribed five guideline-recommended treatments; (1) ACE inhibitor/angiotensin receptor blocker/angiotensin receptor neprilysin inhibitor at least 50% of target dose, (2) beta-blocker at least 50% of target dose, (3) mineralocorticoid receptor antagonist at any dose, (4) anticoagulation for patients diagnosed with atrial fibrillation, (5) referral to cardiac rehabilitation. Secondary outcomes will include functional capacity (6-minute walk test); quality of life (Kansas City Cardiomyopathy Questionnaire); depressive symptoms (Patient Health Questionnaire-2); self-care behaviour (Self-Care of Heart Failure Index). Resource utilisation will also be assessed. ETHICS AND DISSEMINATION Ethical approval was granted by the South Metropolitan Health Service Ethics Committee (RGS3531), with reciprocal approval at Curtin University (HRE2020-0322). Results will be disseminated via peer-reviewed publications and conferences. TRIAL REGISTRATION NUMBER ACTRN12620001069943.
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Affiliation(s)
- Liying Dai
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Tashi Dorje
- Department of Cardiology, Mount Hospital, Perth, Western Australia, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Cardiology, Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - Jan Gootjes
- WA Cardiology, Perth, Western Australia, Australia
| | - Amit Shah
- Department of Cardiology and Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Lawrence Dembo
- Department of Cardiology and Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Jamie Rankin
- Department of Cardiology and Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Graham Hillis
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Suzanne Robinson
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Deakin Health Economics, Deakin University, Melbourne, Western Australia, Australia
| | - John J Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Angela Jacques
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Christopher M Reid
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew Maiorana
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Department of Allied Health, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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Amuthan R, Curtis AB. From background to solutions: Eliminating sex gaps in clinical electrophysiology practice. Heart Rhythm O2 2022; 3:817-826. [PMID: 36588992 PMCID: PMC9795315 DOI: 10.1016/j.hroo.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Sex, a biological construct, and gender, a sociocultural construct, both influence the epidemiology and outcomes of various cardiac arrhythmias, leading to disparities that have been observed in clinical practice. Addressing disparities is crucial to improve the quality of clinical care. We recognize gender equality as the ultimate goal to ensuring equitable health care and propose the following strategies to achieve the goal: sex- and gender-stratified research, quality improvement initiatives, implicit bias training, promotion of women into leadership positions in cardiology, peer support, and shared decision-making to help mitigate disparities. However, further research on how to improve the widespread adoption and implementation of such strategies in the clinical setting is required.
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Affiliation(s)
| | - Anne B. Curtis
- Address reprint requests and correspondence: Dr Anne B. Curtis, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High St, D2-76, Buffalo, NY 14203.
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e895-e1032. [PMID: 35363499 DOI: 10.1161/cir.0000000000001063] [Citation(s) in RCA: 710] [Impact Index Per Article: 355.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2022; 79:e263-e421. [PMID: 35379503 DOI: 10.1016/j.jacc.2021.12.012] [Citation(s) in RCA: 824] [Impact Index Per Article: 412.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. STRUCTURE Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Development of the International Cardiac Rehabilitation Registry Including Variable Selection and Definition Process. Glob Heart 2022; 17:1. [PMID: 35174042 PMCID: PMC8757385 DOI: 10.5334/gh.1091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/15/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: The International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) is developing a registry (ICRR) specifically for low-resource settings, where the burden of cardiovascular diseases is greatest and the need for program development highest. Herein we describe the development process, including the variable selection process. Method: Following a literature search on registry best practices, a stepwise model for ICRR development was identified. Then, based on recommendations by Core Outcome Set-STAndards for Development (COS-STAD), we underwent a process to identify variables. All available CR registries were contacted to request their data dictionaries, reviewed CR quality indicators and guideline recommendations, and searched for common data elements and core outcome sets; 35 unique variables (including patient-reported outcomes) were selected for potential inclusion. Twenty-one purposively-identified stakeholders and experts agreed to serve on a Delphi panel. Panelists rated the variables in an online survey, and suggested potential additional variables; A webcall was held to reach consensus on which to include/exclude. Next, panelists provided input to finalize each variable definition, and rated which associated indicators should be used for benchmarking in registry dashboards and a patient lay summary; a second consensus call was held. A 1-month public comment period ensued. Results: First, registry objectives and governance were approved by ICCPR, including data quality and access policies. The protocol was developed, for public posting. For variable selection, the overall mean rating was 6.1 ± 0.3/7; 12 were excluded, some of which were moved to a program survey, and others were revised. Two variables were added in an annual follow-up, resulting in 13 program and 16 patient-reported variables. Legal advice was sought to finalize ICRR agreements. Ethics approvals were obtained. Usability testing is now being initiated. Conclusion: It is hoped this will serve to harmonize CR assessment internationally and enable quality improvement in CR delivery in low-resource settings.
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Izumo M. Value of Echocardiography in the Treatment of Patients With Acute Heart Failure. Front Cardiovasc Med 2021; 8:740439. [PMID: 34869645 PMCID: PMC8634439 DOI: 10.3389/fcvm.2021.740439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/14/2021] [Indexed: 11/25/2022] Open
Abstract
Heart failure (HF) is a burden in pandemic medicine resulting in high mortality and morbidity. Because acute HF is a life-threatening event, its diagnosis and choice of optimal treatment are important to improve outcomes. Furthermore, understanding the cause and hemodynamics of acute HF is important in selecting the optimal treatment for these patients. Echocardiography is widely used in daily clinical practice because of its non-invasive nature and excellent portability to understand cardiac function and hemodynamics. Echocardiography is highly recommended by guidelines in the practice of HF, but evidence is limited. In this review, I would like to share clinical value of echocardiography in the treatment of patients with acute HF and discuss the usefulness of echocardiography.
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Affiliation(s)
- Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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Arjunan P, D'Souza MS. Efficacy of nurse-led cardiac rehabilitation on health care behaviours in adults with chronic heart failure: An experimental design. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Zhang J, Hao JY, Jing R, Liu JJ, Di CY, Lu YJ, Gao P, Wang YJ, Yang RF, Lin WH. Current trends in optimal medical therapy after PCI and its influence on clinical outcomes in China. BMC Cardiovasc Disord 2021; 21:258. [PMID: 34039268 PMCID: PMC8157424 DOI: 10.1186/s12872-021-02052-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 04/22/2021] [Indexed: 11/22/2022] Open
Abstract
Background Limited data were available on the current trends in optimal medical therapy (OMT) after PCI and its influence on clinical outcomes in China. We aimed to evaluate the utilization and impact of OMT on the main adverse cardiovascular and cerebrovascular events (MACCEs) in post-PCI patients and analyzed the factors predictive of OMT after discharge. Methods We collected data from 3812 individuals from 2016.10 to 2017.09 at TEDA International Cardiovascular Hospital. They were classified into an OMT group and a non-OMT group according to their OMT status, which was defined as the combination of dual antiplatelet therapy, statins, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers after PCI. Multivariable Cox regression models were developed to assess the association between OMT and MACCEs, defined as all-cause mortality, nonfatal myocardial infarction, stroke, and target vessel revascularization. A logistic regression model was established to analyze the factors predictive of OMT. Results Our results revealed that the proportion of patients receiving OMT and its component drugs decreased over time. A total of 36.0% of patients were still adherent to OMT at the end of follow-up. Binary logistic regression analysis revealed that baseline OMT (P < 0.001, OR = 52.868) was the strongest predictor of OMT after PCI. The Cox hazard model suggested that smoking after PCI was associated with the 1-year risk of MACCE (P = 0.001, HR = 2.060, 95% CI 1.346–3.151), while OMT (P = 0.001, HR = 0.486, 95% CI 0.312–0.756) was an independent protective factor against postoperative MACCEs. Conclusions There was still a gap between OMT utilization after PCI and the recommendations in the evidence-based guidelines. Sociodemographic and clinical factors influence the application of OMT. The management of OMT and smoking cessation after PCI should be emphasized.
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Affiliation(s)
- Jian Zhang
- Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Jing-Yan Hao
- College of Clinical Cardiovascular Disease, Tianjin Medical University, Tianjin, China
| | - Rui Jing
- Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Jing-Jing Liu
- Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Cheng-Ye Di
- Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Yu-Jie Lu
- Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Peng Gao
- Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Ya-Jie Wang
- Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Rui-Fei Yang
- Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
| | - Wen-Hua Lin
- Department of Cardiology I, TEDA International Cardiovascular Hospital, Tianjin, 300457, China.
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13
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Wadhera RK, Vaduganathan M, Jiang GY, Song Y, Xu J, Shen C, Bhatt DL, Yeh RW, Fonarow GC. Performance in Federal Value-Based Programs of Hospitals Recognized by the American Heart Association and American College of Cardiology for High-Quality Heart Failure and Acute Myocardial Infarction Care. JAMA Cardiol 2021; 5:515-521. [PMID: 32074242 DOI: 10.1001/jamacardio.2020.0001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Importance The US Centers for Medicare & Medicaid Services have implemented national value-based programs that incentivize hospitals to deliver better cardiovascular care. However, it is unclear how hospitals recognized for high-quality cardiovascular care by American Heart Association (AHA) and American College of Cardiology (ACC) national quality improvement initiatives (termed award hospitals) have performed under value-based programs. Objective To determine if hospitals that received awards for high-quality cardiovascular care from the AHA/ACC were less likely to be penalized under the Hospital Readmissions Reduction Program (HRRP) and the Hospital Value-Based Purchasing Program (VBP) compared with other hospitals. Design, Setting, and Participants This national cross-sectional study included data from short-term acute care hospitals in the United States that were participating in the HRRP or VBP in fiscal year 2018. Exposures Recognition awards for high-quality care from the AHA's Get With The Guidelines-Heart Failure and ACC's Chest Pain-MI (myocardial infarction) Registry national quality improvement initiatives. Main Outcomes and Measures Proportion of hospitals that received a financial penalty or financial reward under the HRRP or VBP, median payment adjustments, and hospital-level 30-day mortality rates. Results This study included 3175 hospitals participating in the HRRP and 2781 hospitals participating in the VBP in fiscal year 2018. Under the HRRP, a higher proportion of award hospitals received financial penalties compared with other hospitals (419 [85.5%] vs 2112 [78.7%]; P < .001), although payment reductions were similar (median, 0.39% [interquartile range (IQR), 0.08%-0.84%] vs 0.33% [IQR, 0.03%-0.89%]; P = .17). Under the VBP, a higher proportion of award hospitals received penalties compared with other hospitals (250 [51.7%] vs 950 [41.4%]; P < .001), and fewer award hospitals received financial rewards (234 [48.4%] vs 1347 [58.6%]; P < .001). Median payment reductions were higher for award hospitals than other hospitals (0.01% [IQR, 0.00%-0.38%] vs 0.0% [IQR, 0.00%-0.28%]; P < .001), and median payment increases were lower (0.0% [IQR, 0.00%-0.34%] vs 0.13% [IQR, 0.00%-0.60%]; P < .001). Thirty-day mortality at award hospitals was similar (acute myocardial infarction, 13.2% vs 13.2%; P = .76) or slightly lower (heart failure, 11.3% vs 11.7%; P = .001) compared with other hospitals. Conclusions and Relevance Hospitals that received awards for high-quality cardiovascular care from the AHA/ACC were more likely to be penalized and less likely to be financially rewarded by federal value-based programs. These findings highlight the potential need to standardize measurement of cardiovascular care quality.
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Affiliation(s)
- Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Division of Cardiology, Harvard Medical School, Boston, Massachusetts
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Ginger Y Jiang
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Division of Cardiology, Harvard Medical School, Boston, Massachusetts
| | - Yang Song
- Baim Institute for Clinical Research, Boston, Massachusetts
| | - Jiaman Xu
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Division of Cardiology, Harvard Medical School, Boston, Massachusetts
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Division of Cardiology, Harvard Medical School, Boston, Massachusetts
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Division of Cardiology, Harvard Medical School, Boston, Massachusetts
| | - Gregg C Fonarow
- David Geffen School of Medicine, Division of Cardiology, University of California, Los Angeles Medical Center, Los Angeles.,Associate Editor for Health Care Quality and Guidelines
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14
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Eschenroeder LW, Nguyen VP, Neradilek MB, Li S, Dardas TF. Patterns of Hospital Bypass and Interhospital Transfer Among Patients With Heart Failure. J Card Fail 2020; 26:762-768. [DOI: 10.1016/j.cardfail.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 04/03/2020] [Accepted: 04/22/2020] [Indexed: 11/30/2022]
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15
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The Effect of Transitional Care on 30-Day Outcomes in Patients Hospitalised With Acute Heart Failure. Heart Lung Circ 2020; 29:1347-1355. [DOI: 10.1016/j.hlc.2020.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/01/2020] [Accepted: 03/01/2020] [Indexed: 01/10/2023]
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16
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Wirtz HS, Sheer R, Honarpour N, Casebeer AW, Simmons JD, Kurtz CE, Pasquale MK, Globe G. Real-World Analysis of Guideline-Based Therapy After Hospitalization for Heart Failure. J Am Heart Assoc 2020; 9:e015042. [PMID: 32805181 PMCID: PMC7660806 DOI: 10.1161/jaha.119.015042] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Patients hospitalized with heart failure (HF) with reduced ejection fraction have high risk of rehospitalization or death. Despite guideline recommendations based on high-quality evidence, a substantial proportion of patients with HF with reduced ejection fraction receive suboptimal care and/or do not comply with optimal care following hospitalization. Methods and Results This retrospective observational study identified 17 106 patients with HF with reduced ejection fraction with an incident HF-related hospitalization using the Humana Medicare Advantage database (2008-2016). HF medication classes (beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor neprilysin inhibitors, or mineralocorticoid receptor antagonists) received in the year after hospitalization were recorded, and categorized by treatment intensity (ie, number of concomitant medication classes received: none [23% of patients; n=3987], monotherapy [22%; n=3777], dual therapy [41%; n=7056], or triple therapy [13%; n=2286]). Compared with no medication, risk of primary outcome (composite of death or rehospitalization) was significantly reduced (hazard ratio [95% CI]) with monotherapy (0.68 [0.64-0.71]), dual therapy (0.56 [0.53-0.59]), and triple therapy (0.45 [0.41-0.50]). Nearly half (46%) of patients who received post-discharge medication had no dose escalation. Overall, 59% of patients had follow-up with a primary care physician within 14 days of discharge, and 23% had follow-up with a cardiologist. Conclusions In real-world clinical practice, increasing treatment intensity reduced risk of death and rehospitalization among patients hospitalized for HF, though the use of guideline-recommended dual and triple HF therapy remained low. There are opportunities to improve post-discharge medical management for patients with HF with reduced ejection fraction such as optimizing dose titration and improving post-discharge follow-up with providers.
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17
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Impact of Individual Patient Profiles on Adherence to Guideline Directed Medical Therapy in Heart Failure With Reduced Ejection Fraction: VCOR-HF Study. Heart Lung Circ 2020; 29:1782-1789. [PMID: 32646638 DOI: 10.1016/j.hlc.2020.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/30/2020] [Accepted: 04/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Multiple co-morbidities complicate initiation of medical therapy in patients with heart failure with reduced ejection fraction (HFrEF). Adherence to guidelines based on individual patient profiles is not well described. This paper examines the effect of individual patient profiles on guideline recommended therapies for HFrEF. METHODS This was a prospective, observational, non-randomised study of hospitalised HFrEF patients over 30 days, from 2014 to 2017 in 16 hospitals. A previously developed algorithm-based guideline adherence score was used to determine adherence to key performance indicators: prescribing of beta blockers, angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), mineralocorticoid-receptor antagonist (MRAs) for HFrEF patients and early outpatient and heart failure (HF) disease management program review. Patients were classified as low, moderate and excellent adherence to medical therapy. RESULTS Of the 696 HFrEF patients, 69.1% (n=481) were male with an average age of 73.15 years (SD±14.5 years). At discharge, 64.6% (n=427) were prescribed an ACEI/ARB, 78.7% (n=525) a beta blocker and 45.3% (n=302) prescribed MRA. Based on individual patient profiles, 18.2% (n=107) of eligible patients received an outpatient clinic and HF disease management program review within 30 days and 41.5% (n=71) were prescribed triple therapy. Based on individual profiles, 13% (n=21) of patients received an excellent guideline adherence score. CONCLUSION Individual patient profiles impact on adherence to guideline recommendations. Review in transitional care and prescribing of triple pharmacotherapy is suboptimal. Translational strategies to facilitate the implementation of guideline recommended therapies is warranted.
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18
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Khera R, Tang Y, Link MS, Krumholz HM, Girotra S, Chan PS. Association Between Hospital Recognition for Resuscitation Guideline Adherence and Rates of Survival for In-Hospital Cardiac Arrest. Circ Cardiovasc Qual Outcomes 2020; 12:e005429. [PMID: 30871337 DOI: 10.1161/circoutcomes.118.005429] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hospitals participating in the national Get With The Guidelines-Resuscitation registry receive an award for high rates of adherence to quality metrics for in-hospital cardiac arrest. We sought to evaluate whether awards based on these quality metrics can be considered a proxy for performance on cardiac arrest survival. Methods and Results Among 195 hospitals with continuous participation in Get With The Guidelines-Resuscitation between 2012 and 2015, we identified 78 that received an award (Gold or Silver) for ≥85% compliance for all 4 metrics for in-hospital cardiac arrest-time to chest compressions, ≤1 minute; time to defibrillation, ≤2 minutes; device confirmation of endotracheal tube placement; and a monitored/witnessed arrest-for at least 12 consecutive months during 2014 to 2015. Award hospitals had higher cardiac arrest volumes than nonaward hospitals but otherwise had similar site characteristics. During 2014 to 2015, award hospitals had higher rates of return of spontaneous circulation for in-hospital cardiac arrest than nonaward hospitals (median [interquartile range], 71% [64%-77%] versus 66% [59%-74%]; Spearman ρ, 0.19; P=0.009). However, rates of risk-standardized survival to discharge at award hospitals (median, 25% [interquartile range, 22%-30%]) were similar to nonaward hospitals (median, 24% [interquartile range, 12%-27%]; Spearman ρ, 0.13; P=0.06). Among hospitals in the best tertile for survival to discharge in 2014 to 2015, 55.4% (36/65) did not receive an award, with poor discrimination of high-performing hospitals by award status (C statistic, 0.53). Similarly, there was only a weak association between hospitals' award status in 2014 to 2015 and their rates of survival to discharge in the preceding 2-year period (Spearman ρ, 0.16; P=0.03). Conclusions The current recognition mechanism within a national registry for in-hospital cardiac arrest captures hospital performance on return of spontaneous circulation but is not well correlated with survival to discharge. This suggests that current awards for resuscitation quality may not adequately capture hospital performance on overall survival-the outcome of greatest interest to patients.
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Affiliation(s)
- Rohan Khera
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (R.K., M.S.L.)
| | - Yuanyuan Tang
- Saint Luke's Mid America Heart Institute, Kansas City, MO (Y.T., P.S.C.)
| | - Mark S Link
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (R.K., M.S.L.)
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (H.M.K.).,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Saket Girotra
- Division of Cardiology, Department of Internal Medicine, University of Iowa (S.G.)
| | - Paul S Chan
- Saint Luke's Mid America Heart Institute, Kansas City, MO (Y.T., P.S.C.).,Division of Cardiology, Department of Internal Medicine, University of Missouri-Kansas City (P.S.C.)
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Taniguchi FP, Bernardez-Pereira S, Silva SA, Ribeiro ALP, Morgan L, Curtis AB, Taubert K, Albuquerque DCD, Weber B, Chrispim PPM, Toth CPP, Morosov EDM, Fonarow GC, Smith SC, Paola AAVD. Implementation of a Best Practice in Cardiology (BPC) Program Adapted from Get With The Guidelines®in Brazilian Public Hospitals: Study Design and Rationale. Arq Bras Cardiol 2020; 115:92-99. [PMID: 32187286 PMCID: PMC8384317 DOI: 10.36660/abc.20190393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/14/2019] [Indexed: 01/04/2023] Open
Abstract
Fundamento Existem grandes oportunidades de melhoria da qualidade do cuidado cardiovascular em países em desenvolvimento por meio da implementação de um programa de qualidade. Objetivo Avaliar o efeito de um programa de Boas Práticas em Cardiologia (BPC) nos indicadores de desempenho e desfechos clínicos dos pacientes relacionados à insuficiência cardíaca, fibrilação atrial e síndromes coronarianas agudas em um subconjunto de hospitais públicos brasileiros. Métodos O programa Boas Práticas em Cardiologia (BPC) foi adaptado do programa Get With The Guidelines (GWTG) da American Heart Association (AHA) para ser utilizado no Brasil. O programa está sendo iniciado em três domínios de cuidado simultaneamente (síndrome coronariana aguda, fibrilação atrial e insuficiência cardíaca), o que consiste em uma abordagem nunca testada no GWTG. Existem seis eixos de intervenções utilizadas pela literatura sobre tradução do conhecimento que abordará barreiras locais identificadas por meio de entrevistas estruturadas e reuniões regulares para auditoria e feedback. Planeja-se incluir no mínimo 10 hospitais e 1500 pacientes por doença cardíaca. O desfecho primário inclui as taxas de adesão às medidas de cuidado recomendadas pelas diretrizes. Desfechos secundários incluem o efeito do programa sobre o tempo de internação, mortalidade global e específica, taxas de readmissão, qualidade de vida, percepção do paciente sobre saúde e adesão dos pacientes às intervenções prescritas. Resultados Espera-se, nos hospitais participantes, uma melhoria e a manutenção das taxas de adesão as recomendações baseadas em evidência e dos desfechos dos pacientes. Este é o primeiro programa em melhoria da qualidade a ser realizado na América do Sul, que fornecerá informações importantes de como programas de sucesso originados em países desenvolvidos como os Estados Unidos podem ser adaptados às necessidades de países com economias em desenvolvimento como o Brasil. Um programa bem sucedido dará informações valiosas para o desenvolvimento de programas de melhoria da qualidade em outros países em desenvolvimento. Conclusões Este estudo de mundo real proverá informações para a avaliação e aumento da adesão às diretrizes de cardiologia no Brasil, bem como a melhora dos processos assistenciais. (Arq Bras Cardiol. 2020; 115(1):92-99)
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Gregg C Fonarow
- University of California Los Angeles, Los Angeles, Califórnia, EUA
| | - Sidney C Smith
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, EUA
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20
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Yu Y, Gupta A, Wu C, Masoudi FA, Du X, Zhang J, Krumholz HM, Li J. Characteristics, Management, and Outcomes of Patients Hospitalized for Heart Failure in China: The China PEACE Retrospective Heart Failure Study. J Am Heart Assoc 2019; 8:e012884. [PMID: 31431117 PMCID: PMC6755852 DOI: 10.1161/jaha.119.012884] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/05/2019] [Indexed: 12/11/2022]
Abstract
Background Heart failure (HF) is an emerging epidemic in China and accounts for significant healthcare resource utilization in the inpatient setting. To create evidence-based, life-saving, and cost-saving hospitalization systems, the first step is to characterize the contemporary national landscape of inpatient HF care. Methods and Results In the China PEACE 5r-HF study (China Patient-centered evaluative Assessment of Cardiac Events Retrospective Study of Heart Failure), we used 2-stage random sampling to create a nationally representative cohort of 10 004 admissions for HF from 189 hospitals in 2015 in China. Data on patient characteristics, management, and outcomes were obtained through centralized medical record abstraction. The median age of the cohort was 73 years (interquartile range, 65-80), and 48.9% were women. More than half (56.2%) of the patients were hospitalized in rural areas. Prevalence of ejection fraction ≥50%, 40% to 50%, and <40% was 60.3%, 17.7%, and 22.0%, respectively. We identified substantial gaps in care, including underutilization of diagnostic tests such as echocardiograms (63.6%), chest imaging (75.2%), and biomarker testing (56.4%), low prescription rates of guideline-recommended medications during hospitalization and at discharge, suboptimal rates of follow-up appointments (24.3%), and widespread utilization of traditional Chinese medicine (74.8%). The combined rate of in-hospital mortality and treatment withdrawal in our study was 3.5%, and median length-of-stay was 9 days (interquartile range, 7-13). Conclusions Patients admitted with acute HF in China have distinctive epidemiology and receive substandard care, but have low inpatient mortality despite long length of stay. These findings provide opportunities for streamlining efficiencies while improving quality of inpatient HF care in China. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02877914.
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Affiliation(s)
- Yuan Yu
- The China PEACE Collaborative Group: NHC Key Laboratory of Clinical Research for Cardiovascular MedicationsNational Clinical Research Center of Cardiovascular DiseasesFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Central China Subcenter of the National Center for Cardiovascular DiseasesHenanPeople's Republic of China
| | - Aakriti Gupta
- Division of Cardiovascular MedicineColumbia University Medical CenterNew YorkNY
- Center for Outcomes Research and EvaluationYale‐New Haven HospitalNew HavenCT
| | - Chaoqun Wu
- The China PEACE Collaborative Group: NHC Key Laboratory of Clinical Research for Cardiovascular MedicationsNational Clinical Research Center of Cardiovascular DiseasesFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Central China Subcenter of the National Center for Cardiovascular DiseasesHenanPeople's Republic of China
| | | | - Xue Du
- The China PEACE Collaborative Group: NHC Key Laboratory of Clinical Research for Cardiovascular MedicationsNational Clinical Research Center of Cardiovascular DiseasesFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Central China Subcenter of the National Center for Cardiovascular DiseasesHenanPeople's Republic of China
| | - Jian Zhang
- State Key Laboratory of Cardiovascular DiseaseFuwai HospitalHeart Failure CenterChinese Academy of Medical Sciences and Peking Union Medical CollegeNational Center for Cardiovascular DiseasesBeijingPeople's Republic of China
| | - Harlan M. Krumholz
- Center for Outcomes Research and EvaluationYale‐New Haven HospitalNew HavenCT
- Section of Cardiovascular MedicineDepartment of Internal MedicineYale University School of MedicineNew HavenCT
- Department of Health Policy and ManagementYale School of Public HealthNew HavenCT
| | - Jing Li
- The China PEACE Collaborative Group: NHC Key Laboratory of Clinical Research for Cardiovascular MedicationsNational Clinical Research Center of Cardiovascular DiseasesFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Central China Subcenter of the National Center for Cardiovascular DiseasesHenanPeople's Republic of China
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Optimal Medical Therapy Prescribing Patterns and Disparities Identified in Patients with Acute Coronary Syndromes at an Academic Medical Center in an Area with High Coronary Heart Disease-Related Mortality. Am J Cardiovasc Drugs 2019; 19:185-193. [PMID: 30414088 DOI: 10.1007/s40256-018-0308-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Coronary heart disease (CHD)-related mortality is high in the southern United States. A five-drug pharmacotherapy regimen for acute coronary syndromes (ACS), defined as optimal medical therapy (OMT), can decrease CHD-related mortality. Studies have indicated that OMT is prescribed 50-60% of the time. Assessment of prescribing could provide insight into the potential etiology of disparate mortality. OBJECTIVE The aim was to evaluate prescribing of OMT at discharge in patients presenting with an ACS event at an academic medical center and identify patients at risk of not receiving OMT. METHODS A single-center, retrospective cohort of patients with ACS diagnosis between July 2013 and July 2015 was investigated, and a multivariable regression analysis conducted to identify populations at risk of not receiving OMT. RESULTS A total of 864 patients were identified by International Classification of Diseases, Ninth Revision (ICD-9) codes, with 533 excluded and 331 analyzed. OMT was prescribed in 69.79%. Patients ≥ 75 years of age [p = 0.003; odds ratio (OR) 0.30; 95% confidence interval (CI) 0.136-0.673], unstable angina presentation (p = 0.042; OR 0.55; 95% CI 0.307-0.977), and surgical management (p = 0.001; OR 0.22; 95% CI 0.095-0.519) were less likely to receive OMT. CONCLUSIONS The percentage of patients prescribed OMT exceeded the reported global percentage of prescribed OMT. However, disparities exist among specific populations.
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Nakano A, Vinter N, Egstrup K, Svendsen ML, Schjødt I, Johnsen SP. Association between process performance measures and 1-year mortality among patients with incident heart failure: a Danish nationwide study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:28-34. [PMID: 30204858 DOI: 10.1093/ehjqcco/qcy041] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 09/10/2018] [Indexed: 12/28/2022]
Abstract
Aims To examine the association between fulfilment of performance measures supported by clinical guidelines recommendations and 1-year mortality among patients with incident heart failure (HF) in Denmark. Methods and results A nationwide population-based follow-up study based on the Danish Heart Failure Registry. All Danish hospital departments caring for patients with HF. We identified 24 308 in- and outpatients diagnosed with HF from 2003 to 2010. Quality of care was defined as receiving the guideline recommended processes of care: use of echocardiography, New York Heart Association classification, treatment with angiotensin-converting-enzyme inhibitors/angiotensin-II-receptor blocker, beta blockers, physical training, and patient education. Main outcome measure is 1-year mortality. We used multiple imputation and multivariable Cox proportional hazard regression to compute hazard ratios (HRs) for 1-year mortality adjusted for potential confounding factors. Within 1 year, 17.1% of the patients died and the adjusted HRs ranged from 0.61 [95% confidence interval (CI) 0.55-0.67] for patient education to 0.99 (95% CI 0.90-1.10) for beta blocker therapy. The association between meeting more performance measures and 1-year mortality appeared to follow a dose-response pattern: using 0-25% of fulfilled measures as reference, patients who fulfilled 76-100% of the performance measures had an adjusted HR of 0.43 (95% CI 0.38-0.48), while the adjusted HR was 0.96 (95% CI 0.86-1.07) for patients who fulfilled between 26% and 50% of the performance measures. Conclusion Meeting process performance measures, which reflect care in concordance with clinical guideline recommendations, was associated with substantially lower 1-year mortality among patients with incident HF.
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Affiliation(s)
- Anne Nakano
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Olof Palmes Allé 43, Denmark.,Department of The Danish Clinical Registers, Audit Unit West, Olof Palmes Allé 15, Aarhus N, Denmark
| | - Nicklas Vinter
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Region Hospital, Falkevej 1G, Silkeborg, Denmark.,Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Mølleparkvej 10, Aalborg, Denmark
| | - Kenneth Egstrup
- Department of Cardiology, Odense University Hospital, Svendborg Hospital, Baagøes Allé 15, Svendborg, Denmark
| | - Marie Louise Svendsen
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Olof Palmes Allé 43, Denmark.,Data & Documentation, DEFACTUM, Olof Palmes Allé 17, Aarhus N, Denmark
| | - Inge Schjødt
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Søren Paaske Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Olof Palmes Allé 43, Denmark.,Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Mølleparkvej 10, Aalborg, Denmark
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23
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Luo N, Lippmann SJ, Mentz RJ, Greiner MA, Hammill BG, Hardy NC, Laskey WK, Heidenreich PA, Chang C, Hernandez AF, Curtis LH, Peterson PN, Fonarow GC, O'Brien EC. Relationship Between Hospital Characteristics and Early Adoption of Angiotensin-Receptor/Neprilysin Inhibitor Among Eligible Patients Hospitalized for Heart Failure. J Am Heart Assoc 2019; 8:e010484. [PMID: 30712431 PMCID: PMC6405590 DOI: 10.1161/jaha.118.010484] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 12/12/2018] [Indexed: 12/11/2022]
Abstract
Background The angiotensin-receptor/neprilysin inhibitor ( ARNI ) sacubitril/valsartan reduces hospitalization and mortality for patients with heart failure with reduced ejection fraction. However, adoption of ARNI into clinical practice has been slow. Factors influencing use of ARNI have not been fully elucidated. Using data from the Get With The Guidelines-Heart Failure registry, Hospital Compare, Dartmouth Atlas, and the American Hospital Association Survey, we sought to identify hospital characteristics associated with patient-level receipt of an ARNI prescription. Methods and Results We analyzed patients with heart failure with reduced ejection fraction who were eligible for ARNI prescription (ejection fraction≤40%, no contraindications) and hospitalized from October 1, 2015 through December 31, 2016. We used logistic regression to estimate the associations between hospital characteristics and patient ARNI prescription at hospital discharge, accounting for clustering of patients within hospitals using generalized estimating equation methods and adjusting for patient-level covariates. Of 16 674 eligible hospitalizations from 210 hospitals, 1020 patients (6.1%) were prescribed ARNI at discharge. The median hospital-level proportion of patients prescribed ARNI was 3.3% (Q1, Q3: 0%, 12.6%). After adjustment for patient-level covariates, for-profit hospitals had significantly higher odds of ARNI prescription compared with not-for-profit hospitals (odds ratio, 2.53; 95% CI , 1.05-6.10; P=0.04), and hospitals located in the Western United States had lower odds of ARNI prescription compared with those in the Northeast (odds ratio, 0.33; 95% CI , 0.13-0.84; P=0.02). Conclusions Relatively few hospital characteristics were associated with ARNI prescription at hospital discharge, in contrast to what has been observed in early adoption in other disease areas. Additional evaluation of barriers to implementing new evidence into heart failure practice is needed.
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Affiliation(s)
- Nancy Luo
- Division of Cardiovascular MedicineUniversity of California—Davis Medical CenterSacramentoCA
| | - Steven J. Lippmann
- Department of Population Health SciencesDuke University School of MedicineDurhamNC
| | - Robert J. Mentz
- Department of MedicineDuke University School of MedicineDurhamNC
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNC
| | - Melissa A. Greiner
- Department of Population Health SciencesDuke University School of MedicineDurhamNC
| | - Bradley G. Hammill
- Department of Population Health SciencesDuke University School of MedicineDurhamNC
| | - N. Chantelle Hardy
- Department of Population Health SciencesDuke University School of MedicineDurhamNC
| | - Warren K. Laskey
- Division of CardiologyUniversity of New Mexico School of MedicineAlbuquerqueNM
| | - Paul A. Heidenreich
- Department of MedicineVeterans Affairs Palo Alto Health Care SystemPalo AltoCA
| | - Chun‐Lan Chang
- US Health Economics & Outcomes ResearchNovartis Pharmaceuticals CorporationEast HanoverNJ
| | - Adrian F. Hernandez
- Department of MedicineDuke University School of MedicineDurhamNC
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNC
| | - Lesley H. Curtis
- Department of Population Health SciencesDuke University School of MedicineDurhamNC
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNC
| | - Pamela N. Peterson
- Department of Medicine Denver Health Medical CenterDenverCO
- Anschutz Medical CenterUniversity of ColoradoAuroraCO
| | - Gregg C. Fonarow
- Ahmanson‐UCLA Cardiomyopathy CenterUniversity of CaliforniaLos AngelesCA
| | - Emily C. O'Brien
- Department of Population Health SciencesDuke University School of MedicineDurhamNC
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNC
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Kojima S, Hiraoka E, Arai J, Homma Y, Norisue Y, Takahashi O, Soma T, Suzuki T, Noguchi M, Shibayama K, Obunai K, Watanabe H. Effect of a do-not-resuscitate order on the quality of care in acute heart failure patients: a single-center cohort study. Int J Gen Med 2018; 11:405-412. [PMID: 30410386 PMCID: PMC6198884 DOI: 10.2147/ijgm.s173253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background A do-not-resuscitate (DNR) order is reportedly associated with a decrease in performance measures, but it should not be applied to noncardiopulmonary resuscitation procedures. Good performance measures are associated with improvement in heart failure outcomes. Aim To analyze the influence of DNR order on performance measures of heart failure at our hospital, where lectures on DNR order are held every 3 months. Design Retrospective cohort study. Methods The medical report of patients with acute heart failure who were admitted between April 2013 and March 2015 were retrospectively analyzed. We collected demographic data, information on the presence or absence of DNR order within 24 hours of admission, and inhospital mortality. Performance measures of heart failure, including assessment of cardiac function and discharge prescription of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker and beta-blocker for left ventricular systolic dysfunction and anticoagulant for atrial fibrillation, were collected and compared between groups with and without DNR orders. Results In 394 total patients and 183 patients with left ventricular systolic dysfunction, 114 (30%) and 44 (24%) patients, respectively, had a DNR order. Patients with a DNR order had higher inhospital mortality. There were no significant differences between the two groups in terms of the four quality measures (left ventricular function assessment, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, beta-blocker, and anticoagulant). Conclusion DNR orders did not affect performance measures, but they were associated with higher inhospital mortality among acute heart failure patients.
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Affiliation(s)
| | | | | | | | - Yasuhiro Norisue
- Department of Critical Care and Pulmonary Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Todaijima, Urayasu-city, Chiba 279-0001, Japan
| | - Osamu Takahashi
- Department of Internal Medicine, St Luke's International Hospital, Chuo-ku, Tokyo 104-8560, Japan
| | | | | | - Masahiko Noguchi
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Todaijima, Urayasu-city, Chiba 279-0001, Japan
| | - Kentaro Shibayama
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Todaijima, Urayasu-city, Chiba 279-0001, Japan
| | - Kotaro Obunai
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Todaijima, Urayasu-city, Chiba 279-0001, Japan
| | - Hiroyuki Watanabe
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Todaijima, Urayasu-city, Chiba 279-0001, Japan
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Abstract
PURPOSE OF REVIEW Describe the global burden of cardiovascular disease (CVD), highlight barriers to evidence-based care and propose effective interventions based on identified barriers. RECENT FINDINGS The global burden of CVD is increasing worldwide. This trend is steeper in lower income countries, where CVD incidence and fatality remains high. Risk factor control, around the world, remains poor, especially in lower and middle-income countries. Barriers at the patient, healthcare provider and health system have been identified. The use of multifaceted interventions that target identified contextual barriers to care, including increasing awareness of CVD and related risk, improving health policy (i.e. taxation of tobacco), improving the availability and affordability of fixed-dose combined medications and task-shifting of healthcare responsibilities are potential solutions to improve the global burden of CVD. SUMMARY There is a need to address identified barriers using evidence-based and multifaceted interventions. Global initiatives, led by the World Heart Federation and the WHO, to facilitate the implementation of such interventions are underway.
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Pope CA, Davis BH, Wine L, Nemeth LS, Axon RN. A Triangulated Qualitative Study of Veteran Decision-Making to Seek Care During Heart Failure Exacerbation: Implications of Dual Health System Use. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2018; 55:46958017751506. [PMID: 29482411 PMCID: PMC5833170 DOI: 10.1177/0046958017751506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 07/21/2017] [Accepted: 11/17/2017] [Indexed: 11/17/2022]
Abstract
Among Veterans, heart failure (HF) contributes to frequent emergency department visits and hospitalization. Dual health care system use (dual use) occurs when Veterans Health Administration (VA) enrollees also receive care from non-VA sources. Mounting evidence suggests that dual use decreases efficiency and patient safety. This qualitative study used constructivist grounded theory and content analysis to examine decision making among 25 Veterans with HF, for similarities and differences between all-VA users and dual users. In general, all-VA users praised specific VA providers, called services helpful, and expressed positive capacity for managing HF. In addition, several Veterans who described inadvertent one-time non-VA health care utilization in emergent situations more closely mirrored all-VA users. By contrast, committed dual users more often reported unmet needs, nonresponse to VA requests, and faster services in non-VA facilities. However, a primary trigger for dual use was VA telephone referral for escalating symptoms, instead of care coordination or primary/specialty care problem-solving.
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Affiliation(s)
- Charlene A. Pope
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, USA
| | - Boyd H. Davis
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- University of North Carolina at Charlotte, USA
| | - Leticia Wine
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | | | - Robert N. Axon
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, USA
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27
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Sauser Zachrison K, Levine DA, Fonarow GC, Bhatt DL, Cox M, Schulte P, Smith EE, Suter RE, Xian Y, Schwamm LH. Timely Reperfusion in Stroke and Myocardial Infarction Is Not Correlated: An Opportunity for Better Coordination of Acute Care. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003148. [PMID: 28283469 DOI: 10.1161/circoutcomes.116.003148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 02/01/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Timely reperfusion is critical in acute ischemic stroke (AIS) and ST-segment-elevation myocardial infarction (STEMI). The degree to which hospital performance is correlated on emergent STEMI and AIS care is unknown. Primary objective of this study was to determine whether there was a positive correlation between hospital performance on door-to-balloon (D2B) time for STEMI and door-to-needle (DTN) time for AIS, with and without controlling for patient and hospital differences. METHODS AND RESULTS Prospective study of all hospitals in both Get With The Guidelines-Stroke and Get With The Guidelines-Coronary Artery Disease from 2006 to 2009 and treating ≥10 patients. We compared hospital-level DTN time and D2B time using Spearman rank correlation coefficients and hierarchical linear regression modeling. There were 43 hospitals with 1976 AIS and 59 823 STEMI patients. Hospitals' DTN times for AIS did not correlate with D2B times for STEMI (ρ=-0.09; P=0.55). There was no correlation between hospitals' proportion of eligible patients treated within target time windows for AIS and STEMI (median DTN time <60 minutes: 21% [interquartile range, 11-30]; median D2B time <90 minutes: 68% [interquartile range, 62-79]; ρ=-0.14; P=0.36). The lack of correlation between hospitals' DTN and D2B times persisted after risk adjustment. We also correlated hospitals' DTN time and D2B time data from 2013 to 2014 using Get With The Guidelines (DTN time) and Hospital Compare (D2B time). From 2013 to 2014, hospitals' DTN time performance in Get With The Guidelines was not correlated with D2B time performance in Hospital Compare (n=546 hospitals). CONCLUSIONS We found no correlation between hospitals' observed or risk-adjusted DTN and D2B times. Opportunities exist to improve hospitals' performance of time-critical care processes for AIS and STEMI in a coordinated approach.
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Affiliation(s)
- Kori Sauser Zachrison
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.).
| | - Deborah A Levine
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.)
| | - Gregg C Fonarow
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.)
| | - Deepak L Bhatt
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.)
| | - Margueritte Cox
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.)
| | - Phillip Schulte
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.)
| | - Eric E Smith
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.)
| | - Robert E Suter
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.)
| | - Ying Xian
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.)
| | - Lee H Schwamm
- From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.)
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28
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O'Donnell TFX, Deery SE, Darling JD, Shean KE, Mittleman MA, Yee GN, Dernbach MR, Schermerhorn ML. Adherence to lipid management guidelines is associated with lower mortality and major adverse limb events in patients undergoing revascularization for chronic limb-threatening ischemia. J Vasc Surg 2017; 66:572-578. [PMID: 28506476 PMCID: PMC5843377 DOI: 10.1016/j.jvs.2017.03.416] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/03/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The 2013 American College of Cardiology/American Heart Association lipid management guidelines recommend high-intensity statins for all patients ≤75 years old with chronic limb-threatening ischemia (CLTI) and moderate-intensity statins for CLTI patients >75 years old without contraindications or on dialysis, but these recommendations are based primarily on coronary and stroke data. We aimed to validate these guidelines in patients with CLTI and to assess current adherence to these recommendations. METHODS We identified all patients with CLTI who underwent first-time revascularization (endovascular or surgical) at Beth Israel Deaconess Medical Center from 2005 to 2014. Patients were classified as taking high-intensity, moderate-intensity, low-intensity, or no statin postoperatively. Outcomes included death and major adverse limb event (MALE). Propensity scores were calculated for the probability of receiving guideline-recommended intensity of statin therapy to account for nonrandom assignment of treatments. Cox regression models were constructed and adjusted for the propensity scores and further adjusted for strong potential confounders. RESULTS After excluding patients on hemodialysis (n = 252), we identified 1019 limbs from 931 patients with a median follow-up of 380 days. Patients discharged on the recommended statin intensity had higher rates of preoperative statin use, coronary artery disease, chronic kidney disease, stroke, atrial fibrillation, congestive heart failure, and coronary artery bypass grafting; they had lower smoking rates and were less likely to be ambulatory preoperatively. Overall, only 35% were taking the recommended statin dosage: 55% of those >75 years old and 20% of those ≤75 years old. In multivariable analysis including propensity scores where appropriate, discharge on any statin was associated with lower mortality (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.60-0.90; P < .01). Discharge on the recommended intensity of statin therapy was associated with lower mortality (HR, 0.73; 95% CI, 0.60-0.99; P < .05) and lower MALE rate (HR, 0.71; 95% CI, 0.51-0.97; P < .05). Patients >75 years old and ≤75 years old accrued similar benefit. In patients >75 years old, moderate-intensity statin therapy was associated with lower rates of death and MALE compared with high-intensity therapy but did not reach statistical significance. CONCLUSIONS Use of the recommended intensity of statin therapy in compliance with 2013 American College of Cardiology/American Heart Association lipid management guidelines is associated with significantly improved survival and lower MALE rate in patients undergoing revascularization for CLTI. Adherence to current guidelines is an appealing target for quality improvement.
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Affiliation(s)
- Thomas F X O'Donnell
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Sarah E Deery
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Jeremy D Darling
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Katie E Shean
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Murray A Mittleman
- Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Gabrielle N Yee
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Matthew R Dernbach
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.
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Calculating the 30-day Survival Rate in Acute Myocardial Infarction: Should we Use the Treatment Chain or the Hospital Catchment Model? Heart Int 2017; 12:10.5301_heartint.5000238. [PMID: 30263101 PMCID: PMC6159709 DOI: 10.5301/heartint.5000238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction Acute myocardial infarction (AMI) is a potentially deadly disease and
significant efforts have been concentrated on improving hospital
performance. A 30-day survival rate has become a key quality of care
indicator. In Northern Norway, some patients undergoing AMI are directly
transferred to the Regional Cardiac Intervention Center at the University
Hospital of North Norway in Tromsø. Here, coronary angiography and
percutaneous coronary intervention is performed. Consequently, local
hospitals may be bypassed in the treatment chain, generating differences in
case mix, and making the treatment chain model difficult to interpret. We
aimed to compare the treatment chain model with an alternative based on
patients’ place of living. Methods Between 2013 and 2015, a total of 3,155 patients were registered in the
Norwegian Patient Registry database. All patients were categorized according
to their local hospital's catchment area. The method of Guo-Romano, with an
indifference interval of 0.02, was used to test whether a hospital was an
outlier or not. We adjusted for age, sex, comorbidity, and number of prior
hospitalizations. Conclusions We revealed the 30-day AMI survival figure ranging between 88.0% and 93.5%
(absolute difference 5.5%) using the hospital catchment method. The
treatment chain rate ranged between 86.0% and 94.0% (absolute difference
8.0%). The latter figure is the one published as the National Quality of
Care Measure in Norway. Local hospitals may get negative attention even
though their catchment area is well served. We recommend the hospital
catchment method as the first choice when measuring equality of care.
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Rajadurai J, Tse HF, Wang CH, Yang NI, Zhou J, Sim D. Understanding the Epidemiology of Heart Failure to Improve Management Practices: An Asia-Pacific Perspective. J Card Fail 2017; 23:327-339. [PMID: 28111226 DOI: 10.1016/j.cardfail.2017.01.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/13/2016] [Accepted: 01/18/2017] [Indexed: 01/08/2023]
Abstract
Heart failure (HF) is a major global healthcare problem with an estimated prevalence of approximately 26 million. In Asia-Pacific regions, HF is associated with a significant socioeconomic burden and high rates of hospital admission. Epidemiological data that could help to improve management approaches to address this burden in Asia-Pacific regions are limited, but suggest patients with HF in the Asia-Pacific are younger and have more severe signs and symptoms of HF than those of Western countries. However, local guidelines are based largely on the European Society of Cardiology and American College of Cardiology Foundation/American Heart Association guidelines, which draw their evidence from studies where Western patients form the major demographic and patients from the Asia-Pacific region are underrepresented. Furthermore, regional differences in treatment practices likely affect patient outcomes. In the following review, we examine epidemiological data from existing regional registries, which indicate that these patients represent a distinct subpopulation of patients with HF. In addition, we highlight that patients with HF are under-treated in the region despite the existence of local guidelines. Finally, we provide suggestions on how data can be enriched throughout the region, which may positively affect local guidelines and improve management practices.
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Affiliation(s)
- Jeyamalar Rajadurai
- Department of Cardiology, Subang Jaya Medical Centre, Subang Jaya, Malaysia.
| | - Hung-Fat Tse
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Chao-Hung Wang
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ning-I Yang
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jingmin Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - David Sim
- Department of Cardiology, National Heart Centre Singapore, Singapore
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31
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Patel DB, Shah RM, Bhatt DL, Liang L, Schulte PJ, DeVore AD, Hernandez AF, Heidenreich PA, Yancy CW, Fonarow GC. Guideline-Appropriate Care and In-Hospital Outcomes in Patients With Heart Failure in Teaching and Nonteaching Hospitals: Findings From Get With The Guidelines-Heart Failure. Circ Cardiovasc Qual Outcomes 2016; 9:757-766. [PMID: 27780849 DOI: 10.1161/circoutcomes.115.002542] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 09/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite increasing awareness regarding evidence-based guidelines, considerable gaps exist for heart failure (HF) quality of care at teaching hospitals (TH) and nonteaching hospitals (NTH). We analyzed data from Get With The Guidelines (GWTG)-HF to compare the rates and trends of guideline-recommended care at TH and NTH for patients with HF. METHOD AND RESULTS Baseline patient characteristics, performance measures, and in-hospital outcomes were compared between 197 187 HF patients admitted to TH and 106 924 patients admitted to NTH between 2005 and 2014. Patients treated in TH were younger and were more likely to be black and uninsured. Defect-free care (defined as 100% compliance with performance measures) was similar in both group of hospitals (crude rates: 88% at TH versus 86% at NTH, adjusted odds ratio 0.99, 95% confidence interval 0.73-1.34) as were individual performance measures: discharge instruction, documentation of ejection fraction, use of angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists, use of β-blocker, and smoking cessation counseling. During the study period, there was improvement in adherence with performance measures over time, with no significant difference at TH (adjusted odds ratio 1.20, 95% confidence interval 1.11-1.30; P<0.01) and NTH (adjusted odds ratio 1.09, 95% confidence interval 1.02-1.17; P=0.01; interaction P value 0.07). CONCLUSIONS Data from the GWTG-HF program suggest that there was improving and comparable adherence with HF performance measures and use of guideline-recommended therapies irrespective of hospital teaching status.
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Affiliation(s)
- Dhavalkumar B Patel
- From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Rachit M Shah
- From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Deepak L Bhatt
- From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Li Liang
- From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Phillip J Schulte
- From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Adam D DeVore
- From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Adrian F Hernandez
- From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Paul A Heidenreich
- From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Clyde W Yancy
- From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Gregg C Fonarow
- From the Virginia Commonwealth University, Richmond, VA (D.B.P., R.M.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Duke University School of Medicine, Durham, NC and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.L., P.J.S., A.D.D., A.F.H.); VA Palo Alto Health Care System, Palo Alto, CA (P.A.H.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.).
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Driscoll A, Meagher S, Kennedy R, Hay M, Banerji J, Campbell D, Cox N, Gascard D, Hare D, Page K, Nadurata V, Sanders R, Patsamanis H. What is the impact of systems of care for heart failure on patients diagnosed with heart failure: a systematic review. BMC Cardiovasc Disord 2016; 16:195. [PMID: 27729027 PMCID: PMC5057466 DOI: 10.1186/s12872-016-0371-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 09/28/2016] [Indexed: 12/25/2022] Open
Abstract
Background Hospital admissions for heart failure are predicted to rise substantially over the next decade placing increasing pressure on the health care system. There is an urgent need to redesign systems of care for heart failure to improve evidence-based practice and create seamless transitions through the continuum of care. The aim of the review was to examine systems of care for heart failure that reduce hospital readmissions and/or mortality. Method Electronic databases searched were: Ovid MEDLINE, EMBASE, CINAHL, grey literature, reviewed bibliographies and Cochrane Central Register of Controlled Trials for randomised controlled trials, non-randomised trials and cohort studies from 1st January 2008 to 4th August 2015. Inclusion criteria for studies were: English language, randomised controlled trials, non-randomised trials and cohort studies of systems of care for patients diagnosed with heart failure and aimed at reducing hospital readmissions and/or mortality. Three reviewer authors independently assessed articles for eligibility based on title and abstract and then full-text. Quality of evidence was assessed using Newcastle-Ottawa Scale for non-randomised trials and GRADE rating tool for randomised controlled trials. Results We included 29 articles reporting on systems of care in the workforce, primary care, in-hospital, transitional care, outpatients and telemonitoring. Several studies found that access to a specialist heart failure team/service reduced hospital readmissions and mortality. In primary care, a collaborative model of care where the primary physician shared the care with a cardiologist, improved patient outcomes compared to a primary physician only. During hospitalisation, quality improvement programs improved the quality of inpatient care resulting in reduced hospital readmissions and mortality. In the transitional care phase, heart failure programs, nurse-led clinics, and early outpatient follow-up reduced hospital readmissions. There was a lack of evidence as to the efficacy of telemonitoring with many studies finding conflicting evidence. Conclusion Redesigning systems of care aimed at improving the translation of evidence into clinical practice and transitional care can potentially improve patient outcomes in a cohort of patients known for high readmission rates and mortality.
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Affiliation(s)
- Andrea Driscoll
- Deakin University, Locked Bag 20000, Geelong, VIC, 3220, Australia.
| | - Sharon Meagher
- Deakin University, Locked Bag 20000, Geelong, VIC, 3220, Australia
| | - Rhoda Kennedy
- Deakin University, Locked Bag 20000, Geelong, VIC, 3220, Australia
| | - Melanie Hay
- Heart Foundation (Victoria), Level 12, 500 Collins st, Melbourne, 3000, Australia
| | - Jayant Banerji
- School of Rural Health, Monash University, Bendigo, Victoria, Australia
| | | | - Nicholas Cox
- Cardiology Department, Western Health, Gordon Street, Footscray, 3011, Melbourne, Australia
| | - Debra Gascard
- Monash Health, Monash Health Community, Dandenong, Melbourne, Australia
| | - David Hare
- Department of Cardiology, University of Melbourne and Austin Health, Burgundy St Heidelberg, 3081, Melbourne, Australia
| | - Karen Page
- Deakin University, Locked Bag 20000, Geelong, VIC, 3220, Australia
| | | | - Rhonda Sanders
- St Vincent's Hospital, Victoria parade, Melbourne, Australia
| | - Harry Patsamanis
- Heart Foundation (Victoria), Level 12, 500 Collins st, Melbourne, 3000, Australia
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Bazzano LAL, Marshall MK, Harrold R, Pak KJ, van Driel ML. Interventions to improve evidence-based prescribing in heart failure. Hippokratia 2016. [DOI: 10.1002/14651858.cd011253.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Lydia AL Bazzano
- Ochsner Health System; Internal Medicine Residency/Dept of Hospital Medicine-Ochsner; 1514 Jefferson Hwy New Orleans Louisiana USA 70121
| | - Marilyn K Marshall
- University of Queensland Ochsner Clinical School at Ochsner Medical Center; School of Medicine; 1415 Jefferson Hwy New Orleans Louisiana USA 70121
| | - Robert Harrold
- University of Queensland Ochsner Clinical School at Ochsner Medical Center; School of Medicine; 1415 Jefferson Hwy New Orleans Louisiana USA 70121
| | - Kirk J Pak
- Ochsner Clinic Foundation; Department of Internal Medicine; 1514 Jefferson Hwy New Orleans Louisiana USA 70121
| | - Mieke L van Driel
- The University of Queensland; Discipline of General Practice, School of Medicine; Brisbane Queensland Australia 4029
- Ghent University; Department of Family Medicine and Primary Health Care; 1K3, De Pintelaan 185 Ghent Belgium 9000
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Mathews R, Fonarow GC, Li S, Peterson ED, Rumsfeld JS, Heidenreich PA, Roe MT, Oetgen WJ, Jollis JG, Cannon CP, de Lemos JA, Wang TY. Comparison of performance on Hospital Compare process measures and patient outcomes between hospitals that do and do not participate in Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines. Am Heart J 2016; 175:1-8. [PMID: 27179718 DOI: 10.1016/j.ahj.2016.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 01/20/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines (ACTION Registry-GWTG) was designed to measure and improve the treatment and outcomes of patients with acute myocardial infarction (AMI), yet it is unknown whether performance of Medicare Hospital Compare metrics and outcomes differ between hospitals participating versus those not participating in the registry. METHODS Using 2007 to 2010 Hospital Compare data, we matched participating to nonparticipating hospitals based on teaching status, size, percutaneous coronary intervention capability, and baseline (2007) Hospital Compare AMI process measure performance. We used linear mixed modeling to compare 2010 Hospital Compare process measure adherence, 30-day risk-adjusted mortality, and readmission rates. We repeated these analyses after stratification according to baseline performance level. RESULTS Compared with nonparticipating hospitals, those participating were larger (median 288 vs 139 beds, P < .0001), more often teaching hospitals (18.8% vs 6.3%, P < .0001), and more likely had interventional catheterization lab capabilities (85.7% vs 34.0%, P < .0001). Among 502 matched pairs of participating and nonparticipating hospitals, we found high levels of process measure adherence in both 2007 and 2010, with minimal differences between them. Rates of 30-day mortality and readmission in 2010 were also similar between both groups. Results were consistent across strata of baseline performance level. CONCLUSIONS In this observational analysis, there were no significant differences in the performance of Hospital Compare process measures or outcomes between hospitals in Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines and other hospitals not in the registry. However, baseline performance on the Hospital Compare process measures was very high in both groups, suggesting the need for new quality improvement foci to further improve patient outcomes.
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Dual health care system use is associated with higher rates of hospitalization and hospital readmission among veterans with heart failure. Am Heart J 2016; 174:157-63. [PMID: 26995383 DOI: 10.1016/j.ahj.2015.09.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/26/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Heart failure (HF) frequently causes hospital admission and readmission. Patients receiving care from multiple providers and facilities (dual users) may risk higher health care utilization and worse health outcomes. METHODS To determine rates of emergency department (ED) visits, hospitalizations, and hospital readmissions relative to dual use among HF patients, we analyzed a retrospective cohort of 13,977 veterans with HF hospitalized at the Veterans Affairs (VA) or non-VA facilities from 2007 to 2011; we analyzed rates of acute health care utilization using zero-inflated negative binomial regression. RESULTS Compared to VA-only users and dual users, individuals receiving all of their ED and hospital care outside the VA tended to be older, more likely to be non-Hispanic white and married, and less likely to have high levels of service connected disability. Compared to VA-only users, dual users had significantly higher rates of ED visits for HF as a primary diagnosis (adjusted rate ratio 1.15, 95% CI 1.04-1.27), hospitalization for HF (adjusted rate ratio 1.4, 95% CI 1.26-1.56), hospital readmission after HF hospitalization (all cause) (1.46, 95% CI 1.30-1.65), and HF-specific hospital readmission after HF hospitalization (1.46, 95% CI 1.31-1.63). With the exception of hospitalization for any primary diagnosis, non-VA-only users had significantly lower rates of ED visits, hospitalization, and readmission compared to VA-only users. CONCLUSIONS Dual use is associated with higher rates of health care utilization among patients with HF. Interventions should be devised to encourage continuity of care where possible and to improve the effectiveness and safety of dual use in instances where it is necessary or desired.
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Abstract
Atrial fibrillation (AF) is a major risk factor for ischemic stroke. Guidelines recommend anticoagulation for patients with intermediate and high stroke risk (CHA2DS2-VASc score ≥ 2). Underuse of anticoagulants among eligible patients remains a persistent problem. Evidence demonstrates that the psychology of the fear of causing harm (omission bias) results in physicians' hesitancy to initiate anticoagulation and an inaccurate estimation of stroke risk. The American Heart Association (AHA) initiated the Get With The Guidelines-AFIB (GWTG-AFIB) module in June 2013 to enhance guideline adherence for treatment and management of AF. Better quality of care for AF patients can be provided by increasing adherence to anticoagulation guidelines and improving patient compliance with anticoagulation therapy through education and established protocols. Nonvitamin K antagonist oral anticoagulants may facilitate better patient adherence due to ease of administration and reduced monitoring burden. In this review, we discuss the reasons for underuse, omission bias contributing to underuse, and different strategies to address this issue.
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Affiliation(s)
- Ajay Vallakati
- a Division of Cardiovascular Diseases , Metrohealth Medical Center , Cleveland , OH , USA
| | - William R Lewis
- a Division of Cardiovascular Diseases , Metrohealth Medical Center , Cleveland , OH , USA
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Papadimitriou L, Georgiopoulou VV, Kort S, Butler J, Kalogeropoulos AP. Echocardiography in Acute Heart Failure: Current Perspectives. J Card Fail 2016; 22:82-94. [DOI: 10.1016/j.cardfail.2015.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/18/2015] [Accepted: 08/04/2015] [Indexed: 01/08/2023]
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Bhatt DL, Drozda JP, Shahian DM, Chan PS, Fonarow GC, Heidenreich PA, Jacobs JP, Masoudi FA, Peterson ED, Welke KF. ACC/AHA/STS Statement on the Future of Registries and the Performance Measurement Enterprise. J Am Coll Cardiol 2015; 66:2230-2245. [DOI: 10.1016/j.jacc.2015.07.010] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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López-Sendón J, González-Juanatey JR, Pinto F, Cuenca Castillo J, Badimón L, Dalmau R, González Torrecilla E, López-Mínguez JR, Maceira AM, Pascual-Figal D, Pomar Moya-Prats JL, Sionis A, Zamorano JL. Indicadores de calidad en cardiología. Principales indicadores para medir la calidad de los resultados (indicadores de resultados) y parámetros de calidad relacionados con mejores resultados en la práctica clínica (indicadores de práctica asistencial). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): Declaración de posicionamiento de consenso de SEC/SECTCV. CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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López-Sendón J, González-Juanatey JR, Pinto F, Cuenca Castillo J, Badimón L, Dalmau R, González Torrecilla E, López-Mínguez JR, Maceira AM, Pascual-Figal D, Pomar Moya-Prats JL, Sionis A, Zamorano JL. Indicadores de calidad en cardiología. Principales indicadores para medir la calidad de los resultados (indicadores de resultados) y parámetros de calidad relacionados con mejores resultados en la práctica clínica (indicadores de práctica asistencial). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): Declaración de posicionamiento de consenso de SEC/SECTCV. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Bhatt DL, Drozda JP, Shahian DM, Chan PS, Fonarow GC, Heidenreich PA, Jacobs JP, Masoudi FA, Peterson ED, Welke KF, Heidenreich PA, Albert NM, Chan PS, Curtis LH, Bruce Ferguson T, Fonarow GC, Michael Ho P, Jurgens C, O’Brien S, Russo AM, Thomas RJ, Ting HH, Varosy PD. ACC/AHA/STS Statement on the Future of Registries and the Performance Measurement Enterprise. Circ Cardiovasc Qual Outcomes 2015; 8:634-48. [DOI: 10.1161/hcq.0000000000000013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bhatt DL, Drozda JP, Shahian DM, Chan PS, Fonarow GC, Heidenreich PA, Jacobs JP, Masoudi FA, Peterson ED, Welke KF. ACC/AHA/STS Statement on the Future of Registries and the Performance Measurement Enterprise: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and The Society of Thoracic Surgeons. Ann Thorac Surg 2015; 100:1926-41. [PMID: 26438978 DOI: 10.1016/j.athoracsur.2015.07.078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 07/28/2015] [Accepted: 07/28/2015] [Indexed: 11/24/2022]
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Sato Y. Multidisciplinary management of heart failure just beginning in Japan. J Cardiol 2015; 66:181-8. [DOI: 10.1016/j.jjcc.2015.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/13/2015] [Accepted: 01/16/2015] [Indexed: 01/11/2023]
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López-Sendón J, González-Juanatey JR, Pinto F, Cuenca Castillo J, Badimón L, Dalmau R, González Torrecilla E, López-Mínguez JR, Maceira AM, Pascual-Figal D, Pomar Moya-Prats JL, Sionis A, Zamorano JL. Quality Markers in Cardiology. Main Markers to Measure Quality of Results (Outcomes) and Quality Measures Related to Better Results in Clinical Practice (Performance Metrics). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): A SEC/SECTCV Consensus Position Paper. ACTA ACUST UNITED AC 2015; 68:976-995.e10. [PMID: 26315766 DOI: 10.1016/j.rec.2015.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/21/2015] [Indexed: 02/06/2023]
Abstract
Cardiology practice requires complex organization that impacts overall outcomes and may differ substantially among hospitals and communities. The aim of this consensus document is to define quality markers in cardiology, including markers to measure the quality of results (outcomes metrics) and quality measures related to better results in clinical practice (performance metrics). The document is mainly intended for the Spanish health care system and may serve as a basis for similar documents in other countries.
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Affiliation(s)
- José López-Sendón
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain.
| | - José Ramón González-Juanatey
- Sociedad Española de Cardiología, Madrid, Spain; Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Fausto Pinto
- European Society of Cardiology; Department of Cardiology, University Hospital Santa Maria, Lisbon, Portugal
| | - José Cuenca Castillo
- Sociedad Española de Cirugía Torácica-Cardiovascular; Servicio de Cirugía Cardiaca, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Lina Badimón
- Centro de Investigación Cardiovascular (CSIC-ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Regina Dalmau
- Unidad de Rehabilitación Cardiaca, Servicio de Cardiología, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - Esteban González Torrecilla
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - José Ramón López-Mínguez
- Unidad de Cardiología intervencionista, Servicio de Cardiología, Hospital Infanta Crsitina, Badajoz, Spain
| | - Alicia M Maceira
- Unidad de Imagen Cardiaca, Servicio de Cardiología, ERESA Medical Center, Valencia, Spain
| | - Domingo Pascual-Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Alessandro Sionis
- Unidad de Cuidados Intensivos Cardiológicos, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José Luis Zamorano
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Affiliation(s)
- Fasiha Kanwal
- Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas.
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Heidenreich PA, Zhao X, Hernandez AF, Yancy CW, Schwamm LH, Albert NM, Fonarow GC. Impact of an expanded hospital recognition program for heart failure quality of care. J Am Heart Assoc 2014; 3:e000950. [PMID: 25208954 PMCID: PMC4323821 DOI: 10.1161/jaha.114.000950] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background In 2009, the Get With The Guidelines–Heart Failure program enhanced the standard recognition of hospitals by offering additional recognition if hospitals performed well on certain quality measures. We sought to determine whether initiation of this enhanced recognition opportunity led to acceleration in quality of care for all hospitals participating in the program. Methods and Results We examined hospital‐level performance on 9 quality‐of‐care (process) measures that were added to an existing recognition program (based on existing published performance measures). The rate of increase in use over time 6 months to 2 years after the start of the program was compared with the rate of increase in use for the measures during the 18‐month period prior to the start of the program. Use increased for all 9 new quality measures from 2008 to 2011. Among 4 measures with baseline use near or lower than 50%, a statistically significant greater increase in use during the program was seen for implantable cardioverter defibrillator use (program versus preprogram use: odds ratio 1.14, 95% CI 1.06 to 1.23). Among the 5 measures for which baseline use was 50% or higher, the increase in influenza vaccination rates actually slowed. There was no evidence of adverse impact on the 4 established quality measures, a composite of which actually increased faster during the expanded program (adjusted odds ratio 1.08, 95% CI 1.01 to 1.15). Conclusions A program providing expanded hospital recognition for heart failure had mixed results in accelerating the use of 9 quality measures.
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Affiliation(s)
| | - Xin Zhao
- Duke Clinical Research Institute, Durham, NC (X.Z., A.F.H.)
| | | | - Clyde W Yancy
- Bluhm Cardiovascular Institute Northwestern University, Northwestern Memorial Hospital, Chicago, IL (C.W.Y.)
| | | | | | - Gregg C Fonarow
- University of California Los Angeles, Los Angeles, CA (G.C.F.)
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Lewis WR, Piccini JP, Turakhia MP, Curtis AB, Fang M, Suter RE, Page RL, Fonarow GC. Get With The Guidelines AFIB. Circ Cardiovasc Qual Outcomes 2014; 7:770-7. [DOI: 10.1161/circoutcomes.114.001263] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It is a cause of stroke, heart failure, and death. Guideline-based treatment can improve outcomes in AF. Unfortunately, adherence to these guidelines is low. Get With The Guidelines is a hospital-based performance initiative, which has been shown to improve adherence over time. Get With The Guidelines-AFIB is a novel quality improvement registry designed to improve adherence to AF guidelines.
Methods and Results—
Hospitals will be recruited by regional American Heart Association staff and key stakeholders. Inpatients or observed patients with AF or atrial flutter will be enrolled. Data collected will include demographic, medical history, and clinical characteristics including laboratory values and treatments. Decision support will guide adherence to achievement and quality measures designed to improve adherence to anticoagulation, heart rate control, safe antiarrhythmic drug use, and patient education and follow-up. Increased adherence to guidelines will be facilitated using rapid-cycle quality improvement, site-specific reporting including national and regional benchmarks and hospital recognition for achievement. Primary analyses will include adherence to American Heart Association/American College of Cardiology performance measures and guidelines. Secondary analyses will include processes of care, risk stratification, treatment of special conditions or populations and use of particular treatment techniques.
Conclusions—
AF is common clinical problem with significant morbidity and mortality. Get With The Guidelines-AFIB is a national hospital-based AF quality improvement program designed to increase adherence to evidence-based guidelines for AF.
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Affiliation(s)
- William R. Lewis
- From the Division of Cardiology, Department of Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, OH (W.R.L.); Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC (J.P.P.); VA Palo Alto Health Care System, Palo Alto, CA (M.P.T.); Department of Medicine, Stanford University School of Medicine, Stanford, CA (M.P.T.); Department of Medicine, University at Buffalo, Buffalo, NY (A.B.C.); Division of Hospital Medicine, Department of Medicine, University
| | - Jonathan P. Piccini
- From the Division of Cardiology, Department of Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, OH (W.R.L.); Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC (J.P.P.); VA Palo Alto Health Care System, Palo Alto, CA (M.P.T.); Department of Medicine, Stanford University School of Medicine, Stanford, CA (M.P.T.); Department of Medicine, University at Buffalo, Buffalo, NY (A.B.C.); Division of Hospital Medicine, Department of Medicine, University
| | - Mintu P. Turakhia
- From the Division of Cardiology, Department of Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, OH (W.R.L.); Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC (J.P.P.); VA Palo Alto Health Care System, Palo Alto, CA (M.P.T.); Department of Medicine, Stanford University School of Medicine, Stanford, CA (M.P.T.); Department of Medicine, University at Buffalo, Buffalo, NY (A.B.C.); Division of Hospital Medicine, Department of Medicine, University
| | - Anne B. Curtis
- From the Division of Cardiology, Department of Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, OH (W.R.L.); Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC (J.P.P.); VA Palo Alto Health Care System, Palo Alto, CA (M.P.T.); Department of Medicine, Stanford University School of Medicine, Stanford, CA (M.P.T.); Department of Medicine, University at Buffalo, Buffalo, NY (A.B.C.); Division of Hospital Medicine, Department of Medicine, University
| | - Margaret Fang
- From the Division of Cardiology, Department of Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, OH (W.R.L.); Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC (J.P.P.); VA Palo Alto Health Care System, Palo Alto, CA (M.P.T.); Department of Medicine, Stanford University School of Medicine, Stanford, CA (M.P.T.); Department of Medicine, University at Buffalo, Buffalo, NY (A.B.C.); Division of Hospital Medicine, Department of Medicine, University
| | - Robert E. Suter
- From the Division of Cardiology, Department of Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, OH (W.R.L.); Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC (J.P.P.); VA Palo Alto Health Care System, Palo Alto, CA (M.P.T.); Department of Medicine, Stanford University School of Medicine, Stanford, CA (M.P.T.); Department of Medicine, University at Buffalo, Buffalo, NY (A.B.C.); Division of Hospital Medicine, Department of Medicine, University
| | - Robert L. Page
- From the Division of Cardiology, Department of Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, OH (W.R.L.); Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC (J.P.P.); VA Palo Alto Health Care System, Palo Alto, CA (M.P.T.); Department of Medicine, Stanford University School of Medicine, Stanford, CA (M.P.T.); Department of Medicine, University at Buffalo, Buffalo, NY (A.B.C.); Division of Hospital Medicine, Department of Medicine, University
| | - Gregg C. Fonarow
- From the Division of Cardiology, Department of Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, OH (W.R.L.); Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC (J.P.P.); VA Palo Alto Health Care System, Palo Alto, CA (M.P.T.); Department of Medicine, Stanford University School of Medicine, Stanford, CA (M.P.T.); Department of Medicine, University at Buffalo, Buffalo, NY (A.B.C.); Division of Hospital Medicine, Department of Medicine, University
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48
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Filippatos G, Farmakis D, Bistola V, Karavidas A, Mebazaa A, Maggioni AP, Parissis JT. Temporal trends in epidemiology, clinical presentation and management of acute heart failure: results from the Greek cohorts of the Acute Heart Failure Global Registry of Standard Treatment and the European Society of Cardiology-Heart Failure pilot survey. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2014:2048872614527012. [PMID: 24595245 DOI: 10.1177/2048872614527012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Temporal trends of epidemiological data on acute heart failure (AHF) are limited. We sought to assess changes in epidemiology, clinical presentation and management of AHF in Greece using data from two international registries conducted three years apart. METHODS AND RESULTS The Acute Heart Failure Global Registry of Standard Treatment (ALARM-HF) and the European Society of Cardiology-Heart Failure (ESC-HF) pilot survey were conducted during 2006-2007 and 2009-2010, respectively. A total of 432 AHF patients were recruited by Greek sites in the two registries (255 in ALARM-HF and 177 in ESC-HF pilot survey). About 60% of patients in both registries presented with acutely decompensated chronic HF and 40% with de novo AHF. The use of life-prolonging, guideline-recommended medications increased over time (pre-admission use of angiotensin-converting enzyme (ACE) inhibitors/ angiotensin receptor blockers (ARBs) from 47% to 60%, beta-blockers from 31% to 65%, aldosterone antagonists from 18% to 45%). Those therapies also increased during hospitalisation in both registries. Patients were treated by cardiologists in >90% of cases during hospitalisation; the main intravenous therapies in both registries were diuretics (94% and 97%), followed by vasodilators (47% and 22%) and inotropes (31% and 20%). The length of hospitalisation remained similar (6-7 days in both registries), while in-hospital mortality dropped from 8.5% in the ALARM-HF to 4.5% in the ESC-HF pilot survey. CONCLUSIONS A temporal increase in the use of life-prolonging therapies along with an improvement of in-hospital mortality was observed. Clinical profiles, in-hospital management and outcome of AHF patients in Greece were similar to other European countries, despite regional differences in healthcare systems.
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Affiliation(s)
- Gerasimos Filippatos
- Department of Cardiology, Attikon University Hospital, University of Athens Medical School, Greece
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49
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Fleming LM, Kociol RD. Interventions for Heart Failure Readmissions: Successes and Failures. Curr Heart Fail Rep 2014; 11:178-87. [DOI: 10.1007/s11897-014-0192-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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50
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Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M, Nodari S, Lam CSP, Sato N, Shah AN, Gheorghiade M. The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol 2014; 63:1123-1133. [PMID: 24491689 DOI: 10.1016/j.jacc.2013.11.053] [Citation(s) in RCA: 1461] [Impact Index Per Article: 146.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/22/2013] [Accepted: 11/12/2013] [Indexed: 12/11/2022]
Abstract
Heart failure is a global pandemic affecting an estimated 26 million people worldwide and resulting in more than 1 million hospitalizations annually in both the United States and Europe. Although the outcomes for ambulatory HF patients with a reduced ejection fraction (EF) have improved with the discovery of multiple evidence-based drug and device therapies, hospitalized heart failure (HHF) patients continue to experience unacceptably high post-discharge mortality and readmission rates that have not changed in the last 2 decades. In addition, the proportion of HHF patients classified as having a preserved EF continues to grow and may overtake HF with a reduced EF in the near future. However, the prognosis for HF with a preserved EF is similar and there are currently no available disease-modifying therapies. HHF registries have significantly improved our understanding of this clinical entity and remain an important source of data shaping both public policy and research efforts. The authors review global HHF registries to describe the patient characteristics, management, outcomes and their predictors, quality improvement initiatives, regional differences, and limitations of the available data. Moreover, based on the lessons learned, they also propose a roadmap for the design and conduct of future HHF registries.
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Affiliation(s)
- Andrew P Ambrosy
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California
| | - Javed Butler
- Division of Cardiology, Emory University, Atlanta, Georgia
| | - Ovidiu Chioncel
- Institute of Emergency for Cardiovascular Diseases Prof. C.C. Iliescu, Cardiology 1, Bucharest, Romania
| | - Stephen J Greene
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Muthiah Vaduganathan
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Savina Nodari
- Department of Cardiology, University of Brescia, Brescia, Italy
| | | | - Naoki Sato
- Internal Medicine, Cardiology, and Intensive Care Medicine, Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan
| | - Ami N Shah
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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