1
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Sterling MR, Espinosa CG, Spertus D, Shum M, McDonald MV, Ryvicker MB, Barrón Y, Tobin JN, Kern LM, Safford MM, Banerjee S, Goyal P, Ringel JB, Rajan M, Arbaje AI, Jones CD, Dodson JA, Cené C, Bowles KH. Improving TRansitions ANd outcomeS for heart FailurE patients in home health CaRe (I-TRANSFER-HF): a type 1 hybrid effectiveness-implementation trial: study protocol. BMC Health Serv Res 2024; 24:1160. [PMID: 39354472 PMCID: PMC11443790 DOI: 10.1186/s12913-024-11584-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 09/12/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Some of the most promising strategies to reduce hospital readmissions in heart failure (HF) is through the timely receipt of home health care (HHC), delivered by Medicare-certified home health agencies (HHAs), and outpatient medical follow-up after hospital discharge. Yet national data show that only 12% of Medicare beneficiaries receive these evidence-based practices, representing an implementation gap. To advance the science and improve outcomes in HF, we will test the effectiveness and implementation of an intervention called Improving TRansitions ANd OutcomeS for Heart FailurE Patients in Home Health CaRe (I-TRANSFER-HF), comprised of early and intensive HHC nurse visits combined with an early outpatient medical visit post-discharge, among HF patients receiving HHC. METHODS This study will use a Hybrid Type 1, stepped wedge randomized trial design, to test the effectiveness and implementation of I-TRANSFER-HF in partnership with four geographically diverse dyads of hospitals and HHAs ("hospital-HHA" dyads) across the US. Aim 1 will test the effectiveness of I-TRANSFER-HF to reduce 30-day readmissions (primary outcome) and ED visits (secondary outcome), and increase days at home (secondary outcome) among HF patients who receive timely follow-up compared to usual care. Hospital-HHA dyads will be randomized to cross over from a baseline period of no intervention to the intervention in a randomized sequential order. Medicare claims data from each dyad and from comparison dyads selected within the national dataset will be used to ascertain outcomes. Hypotheses will be tested with generalized mixed models. Aim 2 will assess the determinants of I-TRANSFER-HF's implementation using a mixed-methods approach and is guided by the Consolidated Framework for Implementation Research 2.0 (CFIR 2.0). Qualitative interviews will be conducted with key stakeholders across the hospital-HHA dyads to assess acceptability, barriers, and facilitators of implementation; feasibility and process measures will be assessed with Medicare claims data. DISCUSSION As the first pragmatic trial of promoting timely HHC and outpatient follow-up in HF, this study has the potential to dramatically improve care and outcomes for HF patients and produce novel insights for the implementation of HHC nationally. TRIAL REGISTRATION This trial has been registered on ClinicalTrials.Gov (#NCT06118983). Registered on 10/31/2023, https://clinicaltrials.gov/study/NCT06118983?id=NCT06118983&rank=1 .
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Affiliation(s)
- Madeline R Sterling
- Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-357, New York, 10065, NY, USA.
| | - Cisco G Espinosa
- Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-357, New York, 10065, NY, USA
| | - Daniel Spertus
- Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-357, New York, 10065, NY, USA
| | - Michelle Shum
- Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-357, New York, 10065, NY, USA
| | | | - Miriam B Ryvicker
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | - Yolanda Barrón
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | | | - Lisa M Kern
- Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-357, New York, 10065, NY, USA
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-357, New York, 10065, NY, USA
| | - Samprit Banerjee
- Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-357, New York, 10065, NY, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-357, New York, 10065, NY, USA
| | - Joanna Bryan Ringel
- Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-357, New York, 10065, NY, USA
| | - Mangala Rajan
- Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-357, New York, 10065, NY, USA
| | - Alicia I Arbaje
- Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christine D Jones
- University of Colorado Denver - Anschutz Medical Campus, and Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | | | - Crystal Cené
- UC San Diego School of Medicine, San Diego, CA, USA
| | - Kathryn H Bowles
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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2
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Mace M, Lidströmer N. Current approaches to preventing heart failure readmissions and decompensated disease. Minerva Cardiol Angiol 2024; 72:535-543. [PMID: 37405713 DOI: 10.23736/s2724-5683.23.06284-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Heart failure is a resource-intensive condition to manage and typically involves a multi-disciplinary and multi-modality approach leading to an expensive treatment paradigm. It is worth noting that hospital admissions constitute over 80% of heart failure management costs. In the past two decades, healthcare systems have developed new ways of following patients remotely to prevent them from being readmitted to the hospital. However, despite these efforts, hospital admissions have still increased. Many successful readmission reduction programs prioritize education and self-care to increase patients' awareness of their disease and promote lasting lifestyle changes. While socioeconomic factors impact success, interventions tend to be effective when medication adherence and guideline-directed medical therapy are emphasized. Monitoring intracardiac pressure can improve resource allocation efficiency and has demonstrated significant reductions in readmissions with improved quality of life in outpatient and remote settings. Data from several studies focused on remote monitoring devices strongly suggest that understanding congestion using physiological biomarkers is an effective management strategy. Since most cases of heart failure are first presented in acute hospitalization settings, immediate access to intracardiac pressure for treatment and decision-making purposes could result in substantial management improvements. However, a notable technology gap needs to be addressed to enable this at a low cost with less reliability on scarce specialist care resources. Contemporary evidence is conclusive that direct hemodynamic are the vital signs in heart failure with the highest clinical utility. Therefore, future ability to obtain these insights reliably using non-invasive methods will be a paradigm-changing technology.
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Affiliation(s)
- Matthew Mace
- Academy for Healthcare Science (AHCS), Lutterworth, UK -
- Acorai AB, Stockholm, Sweden -
| | - Niklas Lidströmer
- Acorai AB, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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3
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Hoevelmann J, Volterrani M, Emrich IE. Barriers to the implementation of heart failure therapy in the elderly: Let's accept the challenge! Eur J Heart Fail 2024. [PMID: 39317962 DOI: 10.1002/ejhf.3449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Accepted: 08/20/2024] [Indexed: 09/26/2024] Open
Affiliation(s)
- Julian Hoevelmann
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Maurizio Volterrani
- IRCCS San Raffaele Roma, Rome, Italy
- San Raffaele Open University in Rome, Rome, Italy
| | - Insa E Emrich
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany
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4
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Akinterinwa OE, Singh M, Vemuri S, Tyagi SC. A Need to Preserve Ejection Fraction during Heart Failure. Int J Mol Sci 2024; 25:8780. [PMID: 39201469 PMCID: PMC11354382 DOI: 10.3390/ijms25168780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/20/2024] [Accepted: 08/07/2024] [Indexed: 09/02/2024] Open
Abstract
Heart failure (HF) is a significant global healthcare burden with increasing prevalence and high morbidity and mortality rates. The diagnosis and management of HF are closely tied to ejection fraction (EF), a crucial parameter for evaluating disease severity and determining treatment plans. This paper emphasizes the urgent need to maintain EF during heart failure, highlighting the distinct phenotypes of HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). It discusses the complexities of HFrEF pathophysiology and its negative impact on patient outcomes, stressing the importance of ongoing research and the development of effective therapeutic interventions to slow down the progression from preserved to reduced ejection fraction. Additionally, it explores the potential role of renal denervation in preserving ejection fraction and its implications for HFrEF management. This comprehensive review aims to offer valuable insights into the critical role of EF preservation in enhancing outcomes for patients with heart failure.
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Affiliation(s)
- Oluwaseun E. Akinterinwa
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Mahavir Singh
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY 40202, USA
- Center for Predictive Medicine (CPM) for Biodefense and Emerging Infectious Diseases, University of Louisville, Louisville, KY 40202, USA
| | - Sreevatsa Vemuri
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Suresh C. Tyagi
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY 40202, USA
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Espinosa CG, Vergez S, McDonald MV, Safford MM, Cho J, Tobin JN, Mourad O, Marcus R, Joanna Bryan Ringel J, Banerjee S, Dell N, Feldman P, Sterling MR. Leveraging home health aides to improve outcomes in heart failure: A pilot study protocol. Contemp Clin Trials 2024; 143:107570. [PMID: 38740297 PMCID: PMC11283941 DOI: 10.1016/j.cct.2024.107570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/07/2023] [Accepted: 05/10/2024] [Indexed: 05/16/2024]
Abstract
Heart failure (HF) affects six million people in the U.S., is associated with high morbidity, mortality, and healthcare utilization.(1, 2) Despite a decade of innovation, the majority of interventions aimed at reducing hospitalization and readmissions in HF have not been successful.(3-7) One reason may be that most have overlooked the role of home health aides and attendants (HHAs), who are often highly involved in HF care.(8-13) Despite their contributions, studies have found that HHAs lack specific HF training and have difficulty reaching their nursing supervisors when they need urgent help with their patients. Here we describe the protocol for a pilot randomized control trial (pRCT) assessing a novel stakeholder-engaged intervention that provides HHAs with a) HF training (enhanced usual care arm) and b) HF training plus a mobile health application that allows them to chat with a nurse in real-time (intervention arm). In collaboration with the VNS Health of New York, NY, we will conduct a single-site parallel arm pRCT with 104 participants (HHAs) to evaluate the feasibility, acceptability, and effectiveness (primary outcomes: HF knowledge; HF caregiving self-efficacy) of the intervention among HHAs caring for HF patients. We hypothesize that educating and better integrating HHAs into the care team can improve their ability to provide support for patients and outcomes for HF patients as well (exploratory outcomes include hospitalization, emergency department visits, and readmission). This study offers a novel and potentially scalable way to leverage the HHA workforce and improve the outcomes of the patients for whom they care. Clinical trial.gov registration: NCT04239911.
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Affiliation(s)
| | - Sasha Vergez
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | | | | | - Jacklyn Cho
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Jonathan N Tobin
- Clinical Directors Network (CDN) and The Rockefeller University Center for Clinical and Translational Science, New York, NY, USA
| | - Omar Mourad
- Weill Cornell Medicine- Qatar, Qatar Foundation - Education City, Doha, Qatar
| | - Rosa Marcus
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
| | | | | | | | - Penny Feldman
- Center for Home Care Policy & Research, VNS Health, New York, NY, USA
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6
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Vohra AS, Moghtaderi A, Luo Q, Magid DJ, Black B, Masoudi FA, Kini V. Trends in Mortality After Incident Hospitalization for Heart Failure Among Medicare Beneficiaries. JAMA Netw Open 2024; 7:e2428964. [PMID: 39158909 PMCID: PMC11333983 DOI: 10.1001/jamanetworkopen.2024.28964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 06/24/2024] [Indexed: 08/20/2024] Open
Abstract
Importance Despite advances in treatment and care quality for patients hospitalized with heart failure (HF), minimal improvement in mortality has been observed after HF hospitalization since 2010. Objective To evaluate trends in mortality rates across specific intervals after hospitalization. Design, Setting, and Participants This cohort study evaluated a random sample of Medicare fee-for-service beneficiaries with incident HF hospitalization from January 1, 2008, to December 31, 2018. Data were analyzed from February 2023 to May 2024. Main Outcomes and Measures Unadjusted mortality rates were calculated by dividing the number of all-cause deaths by the number of patients with incident HF hospitalization for the following periods: in-hospital, 30 days (0-30 days after hospital discharge), short term (31 days to 1 year after discharge), intermediate term (1-2 years after discharge), and long term (2-3 years after discharge). Each period was considered separately (ie, patients who died during one period were not counted in subsequent periods). Annual unadjusted and risk-adjusted mortality ratios were calculated (using logistic regression to account for differences in patient characteristics), defined as observed mortality divided by expected mortality based on 2008 rates. Results A total of 1 256 041 patients (mean [SD] age, 83.0 [7.6] years; 56.0% female; 86.0% White) were hospitalized with incident HF. There was a substantial decrease in the mortality ratio for the in-hospital period (unadjusted ratio, 0.77; 95% CI, 0.67-0.77; risk-adjusted ratio, 0.74; 95% CI, 0.71-0.76). For subsequent periods, mortality ratios increased through 2013 and then decreased through 2018, resulting in no reductions in unadjusted postdischarge mortality during the full study period (30-day mortality ratio, 0.94; 95% CI, 0.82-1.06; short-term mortality ratio, 1.02; 95% CI, 0.87-1.17; intermediate-term mortality ratio, 0.99; 95% CI, 0.79-1.19; and long-term mortality ratio, 0.96; 95% CI, 0.76-1.16) and small reductions in risk-adjusted postdischarge mortality during the full study period (30-day mortality ratio, 0.88; 95% CI, 0.86-0.90; short-term mortality ratio, 0.94; 95% CI, 0.94-0.95; intermediate-term mortality ratio, 0.94; 95% CI, 0.92-0.95; and long-term mortality ratio, 0.95; 95% CI, 0.93-0.96). Conclusions and Relevance In this study of Medicare fee-for-service beneficiaries, there was a substantial decrease in in-hospital mortality for patients hospitalized with incident HF from 2008 to 2018, but little to no reduction in mortality for subsequent periods up to 3 years after hospitalization. These results suggest opportunities to improve longitudinal outpatient care for patients with HF after hospital discharge.
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Affiliation(s)
- Adam S. Vohra
- Division of Cardiology, Weill Cornell Medical College, New York, New York
| | - Ali Moghtaderi
- Department of Health Policy and Management, George Washington University, Washington, DC
| | - Qian Luo
- Department of Health Policy and Management, George Washington University, Washington, DC
| | - David J. Magid
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Englewood
| | - Bernard Black
- Pritzker School of Law and Kellogg School of Management, Northwestern University, Chicago, Illinois
| | | | - Vinay Kini
- Division of Cardiology, Weill Cornell Medical College, New York, New York
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7
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Kambalapalli S, Baral N, Paul TK, Upreti P, Talaei F, Ayad S, Ibrahim M, Aggarwal V, Kumar G, Alraies C, Mitchell J. Thirty-day hospital readmission in females with acute heart failure and breast cancer: A retrospective cohort study from national readmission database. PLoS One 2024; 19:e0301596. [PMID: 39042606 PMCID: PMC11265691 DOI: 10.1371/journal.pone.0301596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/19/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Breast Cancer and cardiovascular diseases are amongst the two leading causes of mortality in the United States, and the two conditions are connected in part because of recognized cardiotoxicity of cancer treatments. The aim of this study is to investigate the predictors risk factors for thirty-day readmission in female breast cancer survivors presenting with acute heart failure. METHODS This is a retrospective cohort study of acute heart failure (AHF) hospitalization in female patients with breast cancer in 2019 using the National Readmission Database (NRD), which is the largest publicly available all-payer inpatient readmission database in the United States. Our study sample included adult female patients aged 18 years and older. The primary outcome of interest was the rate of 30- day readmission. RESULTS In 2019, there were 8332 total index admissions for AHF in females with breast cancer and 7776 patients were discharged alive. The mean age was 74.4 years (95% CI: 74, 74.7). The percentage of readmission at 30 days among those discharged alive was 21.8% (n = 1699). Hypertensive heart disease with chronic kidney disease accounted for the majority of readmission in AHF with breast cancer followed by sepsis, acute kidney injury, respiratory failure, pneumonia, and atrial fibrillation. Demographic factors including higher burden of comorbidities predict readmission. The total in-hospital mortality in index admission was 6.67% (n = 556) and for readmitted patients was 8.77% (n = 149). The mean length of stay for index admission was 7.5 days (95% CI: 7.25, 7.75). CONCLUSIONS Readmission of female breast cancer survivors presenting with AHF is common and largely be attributed to high burden of comorbidities including hypertension, and chronic kidney disease. A focus on close outpatient follow-up will be beneficial in lowering readmissions.
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Affiliation(s)
- Soumya Kambalapalli
- Department of Internal Medicine, McLaren Flint/Michigan State University College of Human Medicine, Flint, MI, United States of America
| | - Nischit Baral
- Department of Cardiology, Mount Sinai Medical Center Miami, Columbia University, Miami, Florida, United States of America
| | - Timir K. Paul
- Department of Cardiovascular Medicine, Ascension Saint Thomas Hospital, University of Tennessee College of Medicine, Nashville, Tennessee, United States of America
| | - Prakash Upreti
- Rochester General Hospital, Rochester, NY, United States of America
| | - Fahimeh Talaei
- Department of Internal Medicine, McLaren Flint/Michigan State University College of Human Medicine, Flint, MI, United States of America
| | - Sarah Ayad
- Department of Internal Medicine, Hurley Medical Center/Michigan State University College of Human Medicine, Flint, MI, United States of America
| | - Mahmoud Ibrahim
- Department of Internal Medicine, McLaren Flint/Michigan State University College of Human Medicine, Flint, MI, United States of America
| | - Vikas Aggarwal
- Division of Cardiology, University of Michigan, Ann Arbor, MI, United States of America
| | - Gautam Kumar
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Chadi Alraies
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI, United States of America
| | - Joshua Mitchell
- Division of Cardiology, Washington University, St. Louis, MO, United States of America
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8
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Luque GC, Picchio ML, Daou B, Lasa-Fernandez H, Criado-Gonzalez M, Querejeta R, Filgueiras-Ramas D, Prato M, Mecerreyes D, Ruiz-Cabello J, Alegret N. Printable Poly(3,4-ethylenedioxythiophene)-Based Conductive Patches for Cardiac Tissue Remodeling. ACS APPLIED MATERIALS & INTERFACES 2024; 16:34467-34479. [PMID: 38936818 DOI: 10.1021/acsami.4c03784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Myocardial cardiopathy is one of the highest disease burdens worldwide. The damaged myocardium has little intrinsic repair ability, and as a result, the distorted muscle loses strength for contraction, producing arrhythmias and fainting, and entails a high risk of sudden death. Permanent implantable conductive hydrogels that can restore contraction strength and conductivity appear to be promising candidates for myocardium functional recovery. In this work, we present a printable cardiac hydrogel that can exert functional effects on networks of cardiac myocytes. The hydrogel matrix was designed from poly(vinyl alcohol) (PVA) dynamically cross-linked with gallic acid (GA) and the conductive polymer poly(3,4-ethylenedioxythiophene) (PEDOT). The resulting patches exhibited excellent electrical conductivity, elasticity, and mechanical and contractile strengths, which are critical parameters for reinforcing weakened cardiac contraction and impulse propagation. Furthermore, the PVA-GA/PEDOT blend is suitable for direct ink writing via a melting extrusion. As a proof of concept, we have proven the efficiency of the patches in propagating the electrical signal in adult mouse cardiomyocytes through in vitro recordings of intracellular Ca2+ transients during cell stimulation. Finally, the patches were implanted in healthy mouse hearts to demonstrate their accommodation and biocompatibility. Magnetic resonance imaging revealed that the implants did not affect the essential functional parameters after 2 weeks, thus showing great potential for treating cardiomyopathies.
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Affiliation(s)
- Gisela C Luque
- Center for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), Paseo de Miramón 194, Donostia-San Sebastián 20014, Spain
- Instituto de Desarrollo Tecnológico para la Industria Química (INTEC) CONICET, Güemes 3450, Santa Fe 3000, Argentina
| | - Matías L Picchio
- POLYMAT University of the Basque Country UPV/EHU, Joxe Mari Korta Center, Avda. Tolosa 72, Donostia-San Sebastián 20018, Spain
| | - Bahaa Daou
- Instituto de Desarrollo Tecnológico para la Industria Química (INTEC) CONICET, Güemes 3450, Santa Fe 3000, Argentina
- IIS Biodonostia, Neurosciences Area, Group of Neuromuscular Diseases, Paseo Dr. Begiristain s/n, San Sebastian 20014, Spain
| | - Haizpea Lasa-Fernandez
- Center for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), Paseo de Miramón 194, Donostia-San Sebastián 20014, Spain
| | - Miryam Criado-Gonzalez
- POLYMAT University of the Basque Country UPV/EHU, Joxe Mari Korta Center, Avda. Tolosa 72, Donostia-San Sebastián 20018, Spain
| | - Ramon Querejeta
- Servicio de Cardiología, Hospital Universitario Donostia, San Sebastián, Gipuzkoa 20014, España
| | - David Filgueiras-Ramas
- Centro Nacional de Investigaciones Cardiovasculares; CIBER de Enfermedades Cardiovasculares, Hospital Clínico Universitario San Carlos, Madrid 28029, Spain
| | - Maurizio Prato
- Center for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), Paseo de Miramón 194, Donostia-San Sebastián 20014, Spain
- Department of Chemical and Pharmaceutical Sciences, INSTM Unit of Trieste, University of Trieste, Via L. Giorgieri 1, Trieste 34127, Italy
- Ikerbasque, Basque Foundation for Science, Bilbao 48013, Spain
| | - David Mecerreyes
- POLYMAT University of the Basque Country UPV/EHU, Joxe Mari Korta Center, Avda. Tolosa 72, Donostia-San Sebastián 20018, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao 48013, Spain
| | - Jesús Ruiz-Cabello
- Center for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), Paseo de Miramón 194, Donostia-San Sebastián 20014, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao 48013, Spain
- Ciber Enfermedades Respiratorias (Ciberes), Madrid 28029, Spain
- NMR and Imaging in Biomedicine Group, Department of Chemistry in Pharmaceutical Sciences, Pharmacy School, University Complutense Madrid, Madrid 28040, Spain
| | - Nuria Alegret
- Center for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), Paseo de Miramón 194, Donostia-San Sebastián 20014, Spain
- POLYMAT University of the Basque Country UPV/EHU, Joxe Mari Korta Center, Avda. Tolosa 72, Donostia-San Sebastián 20018, Spain
- IIS Biodonostia, Neurosciences Area, Group of Neuromuscular Diseases, Paseo Dr. Begiristain s/n, San Sebastian 20014, Spain
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9
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Chen C, Porter R, Zhou X, Snozek CL, Yang EH, Wang S. Microfluidic Digital Immunoassay for Point-of-Care Detection of NT-proBNP from Whole Blood. Anal Chem 2024; 96:10569-10576. [PMID: 38877973 DOI: 10.1021/acs.analchem.4c01046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
The high prevalence and economic burden of heart failure remain a challenge to global health. This lifelong disease leads to a buildup of permanent heart damage, making early detection and frequent monitoring crucial for effective treatment. N-terminal proBNP (NT-proBNP) is an important biomarker for monitoring the disease state, but current commercial and research NT-proBNP assays require phlebotomy and bulky equipment or do not satisfy clinical requirements such as sensitivity and detection thresholds. Here, we report a point-of-care (POC) compatible microfluidic digital immunoassay that can quantify the NT-proBNP concentration in a small volume of whole blood. Our automated microfluidic device takes whole blood samples mixed with biotinylated detection antibodies and passes through a plasma filter to react with a capture antibody-functionalized sensor surface. Streptavidin-coated gold nanoparticles (GNPs) are then released to mark the surface-bound single NT-proBNP immunocomplexes and recorded with bright-field microscopy. NT-proBNP concentrations in the sample are quantified via a hybrid digital/analog calibration curve. Digital counts of bound GNPs are used as readout signal at low concentrations for high sensitivity detection, and GNP pixel occupancies are used at high concentrations for extended dynamic range. With this approach, we detected NT-proBNP in the range of 8.24-10 000 pg/mL from 7 μL of whole blood in 10 min, with a limit of detection of 0.94 pg/mL. Finally, the method was validated with 15 clinical serum samples, showing excellent linear correlation (r = 0.998) with Roche's Elecsys proBNP II assay. This evidence indicates that this method holds promise for decentralized monitoring of heart failure.
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Affiliation(s)
- Chao Chen
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona 85287, United States
- Center for Biosensors and Bioelectronics, The Biodesign Institute, Arizona State University, Tempe, Arizona 85287, United States
| | - Ryan Porter
- Center for Biosensors and Bioelectronics, The Biodesign Institute, Arizona State University, Tempe, Arizona 85287, United States
- School of Electrical, Computer and Energy Engineering, Arizona State University, Tempe, Arizona 85287, United States
| | - Xiaoyan Zhou
- Center for Biosensors and Bioelectronics, The Biodesign Institute, Arizona State University, Tempe, Arizona 85287, United States
- School of Electrical, Computer and Energy Engineering, Arizona State University, Tempe, Arizona 85287, United States
| | - Christine Lh Snozek
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, Arizona 85054, United States
| | - Eric H Yang
- Department of Cardiovascular Disease, Mayo Clinic Arizona, Phoenix, Arizona 85054, United States
| | - Shaopeng Wang
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona 85287, United States
- Center for Biosensors and Bioelectronics, The Biodesign Institute, Arizona State University, Tempe, Arizona 85287, United States
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Skoll D, Abarca P, Pham V, Das A, Mantini C, Tun H, Van Herle H, Vaidya A, Wolfson AM, Fong MW. Accuracy and correlation of bed and standing scale weights in monitoring volume status in heart failure patients. Future Cardiol 2024; 20:389-393. [PMID: 38708909 PMCID: PMC11457616 DOI: 10.1080/14796678.2024.2340919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/05/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction: Accurate volume status monitoring is crucial for effective diuretic therapy in patients with acute decompensated heart failure (ADHF). While guidelines recommend daily standing body weight measurement as an indicator of volume status, bed scales are commonly used in healthcare facilities.Methods: A method-comparison design was used to compare bed and standing scale weights among adults hospitalized with ADHF at Los Angeles County-University of Southern California Medical Center between March and April 2023.Results & Conclusion: Among 51 weight pairs from 43 participants, a clinically significant mean difference of 1.42 ± 1.18 kg was observed, exceeding the recommended threshold. Inaccuracies, with 71% showing differences >0.6 kg, highlight potential fluid management errors when relying on bed scales in ADHF hospitalizations.
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Affiliation(s)
- Devin Skoll
- Keck School of Medicine of USC, Los Angeles, CA92121, USA
| | | | - Vu Pham
- LAC+USC Medical Center, Los Angeles, CA90033, USA
| | - Anushka Das
- Keck School of Medicine of USC, Los Angeles, CA92121, USA
| | - Clark Mantini
- University of Southern California, Los Angeles, CA92626, USA
| | - Han Tun
- Keck School of Medicine of USC, Los Angeles, CA92121, USA
| | - Helga Van Herle
- Department of Cardiology, Keck Medical Center of USC, Los Angeles, CA90033, USA
| | - Ajay Vaidya
- Department of Cardiology, Keck Medical Center of USC, Los Angeles, CA90033, USA
| | - Aaron M Wolfson
- Department of Cardiology, Keck Medical Center of USC, Los Angeles, CA90033, USA
| | - Michael W Fong
- Department of Cardiology, Keck Medical Center of USC, Los Angeles, CA90033, USA
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11
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Trochez RJ, Barrett JB, Shi Y, Schildcrout JS, Rick C, Nair D, Welch SA, Kumar AA, Bell SP, Kripalani S. Vulnerability to functional decline is associated with noncardiovascular cause of 90-day readmission in hospitalized patients with heart failure. J Hosp Med 2024; 19:386-393. [PMID: 38402406 DOI: 10.1002/jhm.13316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Hospital readmission is common among patients with heart failure. Vulnerability to decline in physical function may increase the risk of noncardiovascular readmission for these patients, but the association between vulnerability and the cause of unplanned readmission is poorly understood, inhibiting the development of effective interventions. OBJECTIVES We examined the association of vulnerability with the cause of readmission (cardiovascular vs. noncardiovascular) among hospitalized patients with acute decompensated heart failure. DESIGNS, SETTINGS, AND PARTICIPANTS This prospective longitudinal study is part of the Vanderbilt Inpatient Cohort Study. MAIN OUTCOME AND MEASURES The primary outcome was the cause of unplanned readmission (cardiovascular vs. noncardiovascular). The primary independent variable was vulnerability, measured using the Vulnerable Elders Survey (VES-13). RESULTS Among 804 hospitalized patients with acute decompensated heart failure, 315 (39.2%) experienced an unplanned readmission within 90 days of discharge. In a multinomial logistic model with no readmission as the reference category, higher vulnerability was associated with readmission for noncardiovascular causes (relative risk ratio [RRR] = 1.36, 95% confidence interval [CI]: 1.06-1.75) in the first 90 days after discharge. The VES-13 score was not associated with readmission for cardiovascular causes (RRR = 0.94, 95% CI: 0.75-1.17). CONCLUSIONS Vulnerability to functional decline predicted noncardiovascular readmission risk among hospitalized patients with heart failure. The VES-13 is a brief, validated, and freely available tool that should be considered in planning care transitions. Additional work is needed to examine the efficacy of interventions to monitor and mitigate noncardiovascular concerns among vulnerable patients with heart failure being discharged from the hospital.
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Affiliation(s)
- Ricardo J Trochez
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer B Barrett
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yaping Shi
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan S Schildcrout
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chelsea Rick
- Department of Medicine, Division of Geriatric Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Devika Nair
- Department of Medicine, Division of Nephrology & Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah A Welch
- Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Veterans Affairs, Geriatric Research Education and Clinical Center(GRECC), Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Anupam A Kumar
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan P Bell
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sunil Kripalani
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Section of Hospital Medicine, Department of Medicine, Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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12
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Silva-Cardoso J, Santos J, Araújo I, Andrade A, Morais Sarmento P, Santos P, Moura B, Marques I, Peres M, Ferreira JP, Agostinho J, Pimenta J. conTemporary reflectiOns regarding heart failure manaGEmenT - How to ovERcome the PorTuguese barriers (TOGETHER-PT). Rev Port Cardiol 2024; 43:225-235. [PMID: 37689388 DOI: 10.1016/j.repc.2023.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/11/2023] [Accepted: 05/02/2023] [Indexed: 09/11/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is a complex clinical syndrome that is a significant burden in hospitalisations, morbidity, and mortality. Although a significant effort has been made to better understand its consequences and current barriers in its management, there are still several gaps to address. The present work aimed to identify the views of a multidisciplinary group of health care professionals on HF awareness and literacy, diagnosis, treatment and organization of care, identifying current challenges and providing insights into the future. METHODS A steering committee was established, including members of the Heart Failure Study Group of the Portuguese Society of Cardiology (GEIC-SPC), the Heart Failure Study Group of the Portuguese Society of Internal Medicine (NEIC-SPMI) and the Cardiovascular Study Group (GEsDCard) of the Portuguese Association of General and Family Medicine (APMGF). This steering committee produced a 16-statement questionnaire regarding different HF domains that was answered to by a diversified group of 152 cardiologists, internists, general practitioners, and nurses with an interest or dedicated to HF using a five-level Likert scale. Full agreement was defined as ≥80% of level 5 (fully agree) responses. RESULTS Globally, consensus was achieved in all but one of the 16 statements. Full agreement was registered in seven statements, namely 3 of 4 statements for patient education and HF awareness and 2 in 4 statements of both HF diagnosis and healthcare organization, with proportions of fully agree responses ranging from 82.9% to 96.7%. None of the HF treatment statements registered full agreement but 3 of 4 achieved ≥80% of level 4 (agree) responses. CONCLUSION This document aims to be a call-to-action to improve HF patients' quality of life and prognosis, by promoting a change in HF care in Portugal.
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Affiliation(s)
- José Silva-Cardoso
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal; RISE - Health Research Network, Portugal.
| | - Jonathan Santos
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal; ARS Norte, ACES Vale Sousa Norte, USF Torrão, Portugal
| | - Inês Araújo
- Clínica de Insuficiência Cardíaca, Serviço de Medicina III, Hospital S. Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Aurora Andrade
- Serviço de Cardiologia, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Pedro Morais Sarmento
- Departamento de Medicina Interna e Hospital de Dia de Insuficiência Cardíaca do Hospital da Luz de Lisboa, Lisboa, Portugal
| | - Paulo Santos
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal; RISE - Health Research Network, Portugal; MEDCIDS, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Brenda Moura
- Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Irene Marques
- Serviço de Medicina Interna, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica - Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Marisa Peres
- Serviço de Cardiologia, Hospital de Santarém, Santarém, Portugal
| | - João Pedro Ferreira
- Unic@RISE, Serviço de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Université de Lorraine, Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Joao Agostinho
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Joana Pimenta
- Serviço de Medicina Interna, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; UnIC@RISE, Departamento de Medicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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13
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Sharieff GQ, Uejo C. Sprint Team Approach Yields Rapid Improvement in Leapfrog Quality Indicators. J Healthc Manag 2024; 69:156-163. [PMID: 38467028 DOI: 10.1097/jhm-d-22-00223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
GOAL Patient safety and quality care are two critical areas that every healthcare organization strives to grow and improve upon. At Scripps Health, specific efforts reviewed for this article were implemented to reduce hospital-acquired conditions and hospital readmissions that are components of Centers for Medicare & Medicaid Services programs and Leapfrog Hospital Survey scores. METHODS Sprint teams, a novel approach to rapidly develop a checklist for lower-performing care improvement areas, were implemented after an internal review of existing tools and an evidence-based literature review. These areas included catheter-associated urinary tract infections (CAUTIs), central-line associated bloodstream infections (CLABSIs), Clostridioides difficile (C. diff.) and methicillin-resistant Staphylococcus aureus (MRSA) infections, chronic obstructive pulmonary disease (COPD) and heart failure readmissions, surgical site infections and handwashing, bar coding, and the computerized physician order entry components of Leapfrog scoring. The checklist for each area served as a teaching tool for staff and a guideline for case review to ensure that standard work was routinely performed. PRINCIPAL FINDINGS The sprint teams showed dramatic results in the initial focus areas. From a baseline standardized infection ratio (SIR) of 1.141 for CLABSIs, the sprint team reduced the SIR to 0.885 in Year 1 of the program and to 0.687 in Year 2. For CAUTIs, the SIR decreased from a baseline of 1.391 in Year 1 to 0.720 in Year 2. C. diff. infections fell from 0.422 to 0.315 in Year 1 and to 0.260 in Year 2. While the MRSA SIR did not improve during the first year, the MRSA reduction sprint team showed success in Year 2 with a decrease in the SIR from 0.537 to 0.245. Readmission reduction sprint teams focused on heart failure, COPD, and total hip and knee complications. The teams also achieved positive results in reducing readmissions by following checklists and reviewing each readmission case for justification. PRACTICAL APPLICATIONS Rapid change can be safely and effectively implemented with multidisciplinary sprint teams. Developed with an evidence-based, case review approach, sprint team checklists can help to standardize processes for the review of any infections or readmissions that occur in the inpatient arena.
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Cunningham JW, Singh P, Reeder C, Claggett B, Marti-Castellote PM, Lau ES, Khurshid S, Batra P, Lubitz SA, Maddah M, Philippakis A, Desai AS, Ellinor PT, Vardeny O, Solomon SD, Ho JE. Natural Language Processing for Adjudication of Heart Failure in a Multicenter Clinical Trial: A Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiol 2024; 9:174-181. [PMID: 37950744 PMCID: PMC10640703 DOI: 10.1001/jamacardio.2023.4859] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/29/2023] [Indexed: 11/13/2023]
Abstract
Importance The gold standard for outcome adjudication in clinical trials is medical record review by a physician clinical events committee (CEC), which requires substantial time and expertise. Automated adjudication of medical records by natural language processing (NLP) may offer a more resource-efficient alternative but this approach has not been validated in a multicenter setting. Objective To externally validate the Community Care Cohort Project (C3PO) NLP model for heart failure (HF) hospitalization adjudication, which was previously developed and tested within one health care system, compared to gold-standard CEC adjudication in a multicenter clinical trial. Design, Setting, and Participants This was a retrospective analysis of the Influenza Vaccine to Effectively Stop Cardio Thoracic Events and Decompensated Heart Failure (INVESTED) trial, which compared 2 influenza vaccines in 5260 participants with cardiovascular disease at 157 sites in the US and Canada between September 2016 and January 2019. Analysis was performed from November 2022 to October 2023. Exposures Individual sites submitted medical records for each hospitalization. The central INVESTED CEC and the C3PO NLP model independently adjudicated whether the cause of hospitalization was HF using the prepared hospitalization dossier. The C3PO NLP model was fine-tuned (C3PO + INVESTED) and a de novo NLP model was trained using half the INVESTED hospitalizations. Main Outcomes and Measures Concordance between the C3PO NLP model HF adjudication and the gold-standard INVESTED CEC adjudication was measured by raw agreement, κ, sensitivity, and specificity. The fine-tuned and de novo INVESTED NLP models were evaluated in an internal validation cohort not used for training. Results Among 4060 hospitalizations in 1973 patients (mean [SD] age, 66.4 [13.2] years; 514 [27.4%] female and 1432 [72.6%] male]), 1074 hospitalizations (26%) were adjudicated as HF by the CEC. There was good agreement between the C3PO NLP and CEC HF adjudications (raw agreement, 87% [95% CI, 86-88]; κ, 0.69 [95% CI, 0.66-0.72]). C3PO NLP model sensitivity was 94% (95% CI, 92-95) and specificity was 84% (95% CI, 83-85). The fine-tuned C3PO and de novo NLP models demonstrated agreement of 93% (95% CI, 92-94) and κ of 0.82 (95% CI, 0.77-0.86) and 0.83 (95% CI, 0.79-0.87), respectively, vs the CEC. CEC reviewer interrater reproducibility was 94% (95% CI, 93-95; κ, 0.85 [95% CI, 0.80-0.89]). Conclusions and Relevance The C3PO NLP model developed within 1 health care system identified HF events with good agreement relative to the gold-standard CEC in an external multicenter clinical trial. Fine-tuning the model improved agreement and approximated human reproducibility. Further study is needed to determine whether NLP will improve the efficiency of future multicenter clinical trials by identifying clinical events at scale.
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Affiliation(s)
- Jonathan W. Cunningham
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Cardiovascular Disease Initiative, Broad Institute of Harvard University and the Massachusetts Institute of Technology, Cambridge
| | - Pulkit Singh
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge
| | - Christopher Reeder
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Emily S. Lau
- Cardiovascular Disease Initiative, Broad Institute of Harvard University and the Massachusetts Institute of Technology, Cambridge
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Shaan Khurshid
- Cardiovascular Disease Initiative, Broad Institute of Harvard University and the Massachusetts Institute of Technology, Cambridge
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston
| | - Puneet Batra
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge
| | - Steven A. Lubitz
- Cardiovascular Disease Initiative, Broad Institute of Harvard University and the Massachusetts Institute of Technology, Cambridge
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston
| | - Mahnaz Maddah
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge
| | - Anthony Philippakis
- Data Sciences Platform, Broad Institute of Harvard and the Massachusetts Institute of Technology, Cambridge
| | - Akshay S. Desai
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Patrick T. Ellinor
- Cardiovascular Disease Initiative, Broad Institute of Harvard University and the Massachusetts Institute of Technology, Cambridge
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston
| | - Orly Vardeny
- Minneapolis VA Hospital, University of Minnesota, Minneapolis
| | - Scott D. Solomon
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jennifer E. Ho
- Cardiovascular Disease Initiative, Broad Institute of Harvard University and the Massachusetts Institute of Technology, Cambridge
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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15
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Zheng S, Li L, Jiang C, He L, Lai Y, Li W, Zhao X, Wang X, Li L, Du X, Ma C, Dong J. Association between performance measures and clinical outcomes in patients with heart failure in China: Results from the HERO study. Clin Cardiol 2024; 47:e24233. [PMID: 38375935 PMCID: PMC10877660 DOI: 10.1002/clc.24233] [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: 01/02/2024] [Accepted: 01/30/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND There is great heterogeneity in the quality of care among hospitals in China, but studies on the performance measures and prognosis of patients with heart failure (HF) are still deficient. HYPOTHESIS Performance measures have been used as a guideline to clinicans, however, the association between them and outcomes among HF patients in China remains unclear. METHODS We analyzed 4497 patients with HF from the Heart Failure Registry of Patient Outcomes study. Performance measures were determined according to the guidelines, and the patients were divided into four groups based on a composite performance score. Multiple imputation and Cox proportional-hazard regression models were used to assess the association between the performance measures and clinical outcomes. RESULTS Overall, only 12.5% of patients met the top 25% of the performance measures, whereas 33.5% of patients met the bottom 25% of the measures. A total of 992 (22.2%) patients died within 1 year, involving a larger proportion of patients who had met only the bottom 25% of the performance measures than had met the top 25% (27.0% vs. 16.3%, respectively). The patients who met the top 25% of the measures had a lower 1-year mortality rate (adjusted hazard ratio: 0.78, 95% confidence interval: 0.61-0.98). CONCLUSIONS The association between performance measures and mortality appeared to follow a dose-response pattern with a larger degree of compliance with performance measures being associated with a lower mortality rate in patients with HF. Accordingly, the quality of care for patients with HF in China needs to be further improved.
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Affiliation(s)
- Shiyue Zheng
- Department of Cardiology, Beijing AnZhen HospitalCapital Medical UniversityBeijingChina
| | - Li Li
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Chao Jiang
- Department of Cardiology, Beijing AnZhen HospitalCapital Medical UniversityBeijingChina
| | - Liu He
- Department of Cardiology, Beijing AnZhen Hospital, National Clinical Research Centre for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data‐Based Precision Medicine for Cardiovascular DiseasesCapital Medical UniversityBeijingChina
| | - Yiwei Lai
- Department of Cardiology, Beijing AnZhen HospitalCapital Medical UniversityBeijingChina
| | - Wenjie Li
- Department of Cardiology, Beijing AnZhen HospitalCapital Medical UniversityBeijingChina
| | - Xiaoyan Zhao
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Xiaofang Wang
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Ling Li
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Xin Du
- Department of Cardiology, Beijing AnZhen HospitalCapital Medical UniversityBeijingChina
| | - Changsheng Ma
- Department of Cardiology, Beijing AnZhen HospitalCapital Medical UniversityBeijingChina
| | - Jianzeng Dong
- Department of Cardiology, Beijing AnZhen HospitalCapital Medical UniversityBeijingChina
- Department of CardiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
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Wang Q, Yu F, Su H, Liu Z, Hu K, Wu G, Yan J, Chen K, Yang D. Recurrent heart failure hospitalizations in heart failure with preserved ejection fraction: an analysis of TOPCAT trial. ESC Heart Fail 2024; 11:475-482. [PMID: 38054211 PMCID: PMC10804151 DOI: 10.1002/ehf2.14570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/02/2023] [Accepted: 10/03/2023] [Indexed: 12/07/2023] Open
Abstract
AIMS Recurrent heart failure hospitalization (HFH) is an important feature of the progression of heart failure (HF). In the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, we analysed risk factors for recurrent HFH events in HF patients with preserved ejection fraction (HFpEF) and developed a risk prediction model for recurrent HFH. METHODS AND RESULTS This analysis focused on the subset of TOPCAT participants enrolled in the Americas (n = 1767). Recurrent HFH was defined as two or more hospitalizations for HF during the follow-up period. Lasso regression and multivariate logistic regression were used to screen the risk factors, and the risk prediction model of recurrent HFH was established. During a median follow-up period of 3.4 (95% confidence interval: 3.3-3.6) years, 72.2% (542 of 751 total hospitalizations) of HFH events occurred in 9.4% (n = 163) of patients with recurrent HFHs. Patients in the recurrent HFH group had higher cardiovascular mortality rate [6.2 per 100 patient-years (PY) vs. 3.8 per 100 PY, P = 0.016] and all-cause mortality rate (10.0 per 100 PY vs. 6.8 per 100 PY, P = 0.015) than those in the non-recurrent HFH group. The model consisting of nine predictors has moderate predictive power for recurrent HFH events in patients with HFpEF (AUC = 0.75, Brier score = 0.08). Decision curve analysis showed a net clinical benefit from the application of the prediction model. CONCLUSIONS In patients with HFpEF, the majority of HFHs occur in a small proportion of patients with repeated hospitalizations, who typically have more comorbidities and are at higher risk of death. The predictive model developed in this study helps to identify patients at high risk of recurrent HFH.
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Affiliation(s)
- Qi Wang
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Fei Yu
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Hao Su
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Zhiquan Liu
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Kai Hu
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Guohong Wu
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Ji Yan
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Kangyu Chen
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
| | - Dongmei Yang
- Department of Echocardiography, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiChina
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Harris S, Paynter K, Guinn M, Fox J, Moore N, Maddox TM, Lyons PG. Post-hospitalization remote monitoring for patients with heart failure or chronic obstructive pulmonary disease in an accountable care organization. BMC Health Serv Res 2024; 24:69. [PMID: 38218820 PMCID: PMC10787416 DOI: 10.1186/s12913-023-10496-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/19/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Post-hospitalization remote patient monitoring (RPM) has potential to improve health outcomes for high-risk patients with chronic medical conditions. The purpose of this study is to determine the extent to which RPM for patients with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) is associated with reductions in post-hospitalization mortality, hospital readmission, and ED visits within an Accountable Care Organization (ACO). METHODS Nonrandomized prospective study of patients in an ACO offered enrollment in RPM upon hospital discharge between February 2021 and December 2021. RPM comprised of vital sign monitoring equipment (blood pressure monitor, scale, pulse oximeter), tablet device with symptom tracking software and educational material, and nurse-provided oversight and triage. Expected enrollment was for at least 30-days of monitoring, and outcomes were followed for 6 months following enrollment. The co-primary outcomes were (a) the composite of death, hospital admission, or emergency care visit within 180 days of eligibility, and (b) time to occurrence of this composite. Secondary outcomes were each component individually, the composite of death or hospital admission, and outpatient office visits. Adjusted analyses involved doubly robust estimation to address confounding by indication. RESULTS Of 361 patients offered remote monitoring (251 with CHF and 110 with COPD), 140 elected to enroll (106 with CHF and 34 with COPD). The median duration of RPM-enrollment was 54 days (IQR 34-85). Neither the 6-month frequency of the co-primary composite outcome (59% vs 66%, FDR p-value = 0.47) nor the time to this composite (median 29 vs 38 days, FDR p-value = 0.60) differed between the groups, but 6-month mortality was lower in the RPM group (6.4% vs 17%, FDR p-value = 0.02). After adjustment for confounders, RPM enrollment was associated with nonsignificantly decreased odds for the composite outcome (adjusted OR [aOR] 0.68, 99% CI 0.25-1.34, FDR p-value 0.30) and lower 6-month mortality (aOR 0.41, 99% CI 0.00-0.86, FDR p-value 0.20). CONCLUSIONS RPM enrollment may be associated with improved health outcomes, including 6-month mortality, for selected patient populations.
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Affiliation(s)
- Samantha Harris
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Julie Fox
- BJC Medical Group, St. Louis, MO, USA
| | | | | | - Patrick G Lyons
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
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18
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Gupta K, Mastoris I, Sauer AJ. Remote Monitoring Devices and Heart Failure. Heart Fail Clin 2024; 20:1-13. [PMID: 37953016 DOI: 10.1016/j.hfc.2023.05.002] [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] [Indexed: 11/14/2023]
Abstract
Remote patient monitoring (RPM) in patients with heart failure (HF) involves transmitting physiological data from devices to a health-care provider via a wireless connection with targeted interventions when values exceed the preset threshold. Devices used in telemonitoring range from weighing scales, blood pressure cuffs, and pulse oximeters to devices used to measure cardiac filling pressure and intrathoracic impedance using cardiac implantable electronic devices and wearables. Accordingly, RPM devices can potentially engage patients in their cardiovascular care and reduce the burden of HF in society.
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Affiliation(s)
- Kashvi Gupta
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Ioannis Mastoris
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew J Sauer
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA.
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19
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Amdani S, Lopez R, Schold JD, Tang WHW. 30- and 60-Day Readmission Rates for Children With Heart Failure in the United States. JACC. HEART FAILURE 2024; 12:83-96. [PMID: 37943220 DOI: 10.1016/j.jchf.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/07/2023] [Accepted: 08/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Studies on readmission for pediatric heart failure (HF) patients is sparse. OBJECTIVES This study evaluated 30- and 60-day readmission rates in pediatric HF patients from 2010 to 2019. METHODS The authors used data from the Nationwide Readmission Database to evaluate trends in 30- and 60-day hospital readmissions among pediatric patients with HF and compare them with adults with HF. Readmissions were also stratified by sex, diagnosis, neighborhood income, and hospital volume. RESULTS There were 84,731 hospital admissions for HF. Compared with children without HF, those with HF were older, had Medicare/Medicaid insurance, and resided in micropolitan areas and low-income neighborhoods. The 30- (19.5% vs 3.1%) and 60-day (27.5% vs 4.3%) all-cause readmission rates were higher for children with HF compared with those without HF. Compared with children without HF, lengths of stay, deaths, and costs related to their readmission were higher for children readmitted with HF (P < 0.05 for all). There was no significant decline in pediatric HF-related 30- or 60- day readmissions during the study period overall, or for those with congenital heart disease (P > 0.05), unlike adult HF readmissions (P < 0.01). Infants were at highest risk, and readmission rates for teenagers are rising. CONCLUSIONS The 30- and 60-day readmission rates for pediatric patients with HF in the current era is high (∼20% and 30%, respectively). Unlike adult HF, pediatric HF readmission rates have not declined. Pediatric HF patients readmitted to the hospital have higher death rates and greater resource utilization than patients without HF. National measures to decrease readmissions for pediatric patients with HF is warranted.
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Affiliation(s)
- Shahnawaz Amdani
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio, USA.
| | - Rocio Lopez
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jesse D Schold
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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20
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Kim MJ, Aseltine RH, Tabtabai SR. Understanding the Burden of 30-Day Readmission in Patients With Both Primary and Secondary Diagnoses of Heart Failure: Causes, Timing, and Impact of Co-Morbidities. Am J Cardiol 2024; 210:76-84. [PMID: 37858595 DOI: 10.1016/j.amjcard.2023.09.086] [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: 05/15/2023] [Revised: 09/11/2023] [Accepted: 09/21/2023] [Indexed: 10/21/2023]
Abstract
Although efforts to reduce 30-day readmission rates have mainly focused on patients with heart failure (HF) as a primary diagnosis at index hospitalization, patients with HF as a secondary diagnosis remain common, costly, and understudied. This study aimed to determine the incidence, etiology, and patterns of 30-day readmissions after discharge for HF as a primary and secondary diagnosis and investigate the impact of co-morbidities on HF readmission. The National Readmission Database from 2014 to 2016 was used to identify HF patients with a linked 30-day readmission. Patient and hospital characteristics, admission features, and Elixhauser-related co-morbidities were compared between the 2 groups. Readmitted patients in both groups were younger, male, with lower household income, higher mortality risk, and higher hospitalization costs. Over 60% of readmissions were for reasons other than HF, and greater than 1/3 had more than 2 readmissions within 30 days, with a median time to readmission of 12 days. Both cohorts had high readmission rates and high rates of readmission for causes other than HF. Our findings suggest that efforts to reduce 30-day readmission rates should be extended to patients with secondary HF diagnosis, with surveillance extending to 2 weeks postdischarge to identify patients at risk.
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Affiliation(s)
- Min-Jung Kim
- Department of Medicine, Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut; Center for Population Health, UConn Health, Farmington, Connecticut
| | - Robert H Aseltine
- Division of Behavioral Sciences and Community Health, Farmington, Connecticut; Center for Population Health, UConn Health, Farmington, Connecticut
| | - Sara R Tabtabai
- Heart Failure and Population Health, Trinity Health of New England, Hartford, Connecticut; Women's Heart Program, Saint Francis Hospital, Hartford, Connecticut.
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21
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Yazdanyar A. Garnering Insight from Claims-Based Databases on the Association between Loop Diuretics and Heart Failure Outcomes. Am J Cardiol 2024; 210:283-284. [PMID: 37839461 DOI: 10.1016/j.amjcard.2023.09.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Ali Yazdanyar
- Associate Professor of Clinical Medicine, Division of Hospital Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104.
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22
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Helberg J, Bensimhon D, Katsadouros V, Schmerge M, Smith H, Peck K, Williams K, Winfrey W, Nanavati A, Knapp J, Schmidt M, Curran L, McCarthy M, Sawulski M, Harbrecht L, Santos I, Masoudi E, Narendra N. Heart failure management at home: a non-randomised prospective case-controlled trial (HeMan at Home). Open Heart 2023; 10:e002371. [PMID: 38065589 PMCID: PMC10711907 DOI: 10.1136/openhrt-2023-002371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND/OBJECTIVES Heart failure (HF) is a growing clinical and economic burden for patients and health systems. The COVID-19 pandemic has led to avoidance and delay in care, resulting in increased morbidity and mortality among many patients with HF. The increasing burden of HF during the COVID-19 pandemic led us to evaluate the quality and safety of the Hospital at Home (HAH) for patients presenting to their community providers or emergency department (ED) with symptoms of acute on chronic HF (CHF) requiring admission. DESIGN/OUTCOMES A non-randomised prospective case-controlled of patients enrolled in the HAH versus admission to the hospital (usual care, UC). Primary outcomes included length of stay (LOS), adverse events, discharge disposition and patient satisfaction. Secondary outcomes included 30-day readmission rates, 30-day ED usage and ED dwell time. RESULTS Sixty patients met inclusion/exclusion criteria and were included in the study. Of the 60 patients, 40 were in the HAH and 20 were in the UC group. Primary outcomes demonstrated that HAH patients had slightly longer LOS (6.3 days vs 4.7 days); however, fewer adverse events (12.5% vs 35%) compared with the UC group. Those enrolled in the HAH programme were less likely to be discharged with postacute services (skilled nursing facility or home health). HAH was associated with increased patient satisfaction compared with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score in North Carolina. Secondary outcomes of 30-day readmission and ED usage were similar between HAH and UC. CONCLUSIONS The HAH pilot programme was shown to be a safe and effective alternative to hospitalisation for the appropriately selected patient presenting with acute on CHF.
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Affiliation(s)
- Justin Helberg
- Internal Medicine Teaching Service, Cone Health, Greensboro, North Carolina, USA
| | | | - Vasili Katsadouros
- Internal Medicine Teaching Service, Cone Health, Greensboro, North Carolina, USA
| | - Michelle Schmerge
- Remote Health Services, PLLC, Greensboro, North Carolina, USA
- Remote Health Services, PLLC, Greensboro, North Carolina, USA
| | - Heather Smith
- Remote Health Services, PLLC, Greensboro, North Carolina, USA
| | - Kelly Peck
- Triad Healthcare Network, Greensboro, North Carolina, USA
| | - Kim Williams
- Remote Health Services, PLLC, Greensboro, North Carolina, USA
| | - William Winfrey
- Internal Medicine Teaching Service, Cone Health, Greensboro, North Carolina, USA
| | | | - Jon Knapp
- Cone Health, Greensboro, North Carolina, USA
| | | | - Lisa Curran
- Cone Health, Greensboro, North Carolina, USA
| | | | | | - Lawrence Harbrecht
- Internal Medicine Teaching Service, Cone Health, Greensboro, North Carolina, USA
| | - Idalys Santos
- Internal Medicine Teaching Service, Cone Health, Greensboro, North Carolina, USA
| | - Ellie Masoudi
- Internal Medicine Teaching Service, Cone Health, Greensboro, North Carolina, USA
| | - Nischal Narendra
- Internal Medicine Teaching Service, Cone Health, Greensboro, North Carolina, USA
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Twohig PA, Scholten K, Schissel M, Brittan K, Barbaretta J, Samson K, Smith L, Mailliard M, Peeraphatdit TB. Mortality Increased Among Hospitalized Patients with Cirrhosis Before and Following Different Waves of the COVID-19 Pandemic. Dig Dis Sci 2023; 68:4381-4388. [PMID: 37864739 DOI: 10.1007/s10620-023-08105-x] [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: 03/30/2023] [Accepted: 08/30/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) pandemic disrupted patient care and worsened the morbidity and mortality of some chronic diseases. The impact of the COVID-19 pandemic on hospitalizations and outcomes in patients with cirrhosis both before and during different time periods of the pandemic has not been evaluated. AIMS Describe characteristics of hospitalized patients with cirrhosis and evaluate inpatient mortality and 30-day readmission before and after the start of the COVID-19 pandemic. METHODS Retrospective single-center cohort study of all hospitalized patients with cirrhosis from 2018 to 2022. Time periods within the COVID-19 pandemic were defined using reference data from the World Health Organization and Centers for Disease Control. Adjusted odds ratios from logistic regression were used to assess differences between periods. RESULTS 33,926 unique hospitalizations were identified. Most patients were over age 60 years across all time periods of the pandemic. More Hispanic patients were hospitalized during COVID-19 than before COVID-19. Medicare and Medicaid are utilized less frequently during COVID-19 than before COVID-19. After controlling for age and gender, inpatient mortality was significantly higher during all COVID-19 periods except Omicron compared to before COVID-19. The odds of experiencing a 30-day readmission were 1.2 times higher in the pre-vaccination period compared to the pre-COVID-19 period. CONCLUSION Inpatient mortality among patients with cirrhosis has increased during the COVID-19 pandemic compared to before COVID-19. Although COVID-19 infection may have had a small direct pathologic effect on the natural history of cirrhotic liver disease, it is more likely that other factors are impacting this population.
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Affiliation(s)
- Patrick A Twohig
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE, 68198, USA.
| | - Kyle Scholten
- Department of Internal Medicine, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE, 68198, USA
| | - Makayla Schissel
- Department of Biostatistics, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Kevin Brittan
- Department of Internal Medicine, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE, 68198, USA
| | - Jason Barbaretta
- Department of Internal Medicine, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE, 68198, USA
| | - Kaeli Samson
- Department of Biostatistics, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Lynette Smith
- Department of Biostatistics, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Mark Mailliard
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE, 68198, USA
| | - Thoetchai Bee Peeraphatdit
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE, 68198, USA
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24
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Parikh RV, Axelrod AW, Ambrosy AP, Tan TC, Bhatt AS, Fitzpatrick JK, Lee KK, Adatya S, Vasadia JV, Dinh HH, Go AS. Association Between Participation in a Heart Failure Telemonitoring Program and Health Care Utilization and Death Within an Integrated Health Care Delivery System. J Card Fail 2023; 29:1642-1654. [PMID: 37220825 DOI: 10.1016/j.cardfail.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The clinical usefulness of remote telemonitoring to reduce postdischarge health care use and death in adults with heart failure (HF) remains controversial. METHODS AND RESULTS Within a large integrated health care delivery system, we matched patients enrolled in a postdischarge telemonitoring intervention from 2015 to 2019 to patients not receiving telemonitoring at up to a 1:4 ratio on age, sex, and calipers of a propensity score. Primary outcomes were readmissions for worsening HF and all-cause death within 30, 90, and 365 days of the index discharge; secondary outcomes were all-cause readmissions and any outpatient diuretic dose adjustments. We matched 726 patients receiving telemonitoring to 1985 controls not receiving telemonitoring, with a mean age of 75 ± 11 years and 45% female. Patients receiving telemonitoring did not have a significant reduction in worsening HF hospitalizations (adjusted rate ratio [aRR] 0.95, 95% confidence interval [CI] 0.68-1.33), all-cause death (adjusted hazard ratio 0.60, 95% CI 0.33-1.08), or all-cause hospitalization (aRR 0.82, 95% CI 0.65-1.05) at 30 days, but did have an increase in outpatient diuretic dose adjustments (aRR 1.84, 95% CI 1.44-2.36). All associations were similar at 90 and 365 days postdischarge. CONCLUSIONS A postdischarge HF telemonitoring intervention was associated with more diuretic dose adjustments but was not significantly associated with HF-related morbidity and mortality.
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Affiliation(s)
- Rishi V Parikh
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California
| | - Amir W Axelrod
- Department of Cardiology, Kaiser Permanente Vallejo Medical Center, Vallejo, California
| | - Andrew P Ambrosy
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Thida C Tan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Ankeet S Bhatt
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Jesse K Fitzpatrick
- Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Keane K Lee
- Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Sirtaz Adatya
- Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Jitesh V Vasadia
- Department of Cardiology, Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, California
| | - Howard H Dinh
- Department of Cardiology, Kaiser Permanente South Sacramento Medical Center, Sacramento, California
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California; Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, California; Department of Medicine (Nephrology), Stanford University School of Medicine, Palo Alto, California.
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25
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Kim MJ, Tabtabai SR, Aseltine RH. Predictors of 30-Day Readmission in Patients Hospitalized With Heart Failure as a Primary Versus Secondary Diagnosis. Am J Cardiol 2023; 207:407-417. [PMID: 37782972 DOI: 10.1016/j.amjcard.2023.08.111] [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: 05/18/2023] [Revised: 08/11/2023] [Accepted: 08/20/2023] [Indexed: 10/04/2023]
Abstract
Short-term rehospitalizations are common, costly, and detrimental to patients with heart failure (HF). Current research and policy have focused primarily on 30-day readmissions for patients with HF as a primary diagnosis at index hospitalization, whereas a much larger population of patients are admitted with HF as a secondary diagnosis. This study aims to compare patients initially hospitalized for HF as either a primary or a secondary diagnosis, and to identify the most important factors in predicting 30-day readmission. Patients admitted with HF between 2014 and 2016 in the Nationwide Readmissions Database were included and divided into 2 cohorts: those admitted with a primary and secondary diagnosis of HF. Multivariable logistic regression was performed to predict 30-day readmission. Statistically significant predictors in multivariable logistic regression were used for dominance analysis to rank these factors by relative importance. Co-morbidities were the major driver of increased risk of 30-day readmission in both groups. Individual Elixhauser co-morbidities and the Elixhauser co-morbidity indexes were significantly associated with an increase in 30-day readmission. The 5 most important predictors of 30-day readmission according to dominance analysis were age, Elixhauser co-morbidity indexes of co-morbidity complications and readmission, number of diagnoses, and renal failure. These 5 factors accounted for 68% of the 30-day readmission risk. Measures of patient co-morbidities were among the strongest predictors of readmission risk. This study highlights the importance of expanding predictive models to include a broader set of clinical measures to create better-performing models of readmission risk for HF patients.
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Affiliation(s)
- Min-Jung Kim
- Department of Medicine, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut; Center for Population Health, UConn Health, Farmington, Connecticut
| | - Sara R Tabtabai
- Heart Failure and Population Health, Trinity Health of New England, Hartford, Connecticut; Women's Heart Program, Saint Francis Hospital, Hartford, Connecticut
| | - Robert H Aseltine
- Division of Behavioral Sciences and Community Health; Center for Population Health, UConn Health, Farmington, Connecticut.
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26
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Cowger JA, Basir MB, Baran DA, Hayward CS, Rangaswami J, Walton A, Tita C, Minear S, Hakemi E, Klein L, Cheng R, Wu R, Mohanty BD, Heuring JJ, Neely E, Shah P. Safety and Performance of the Aortix Device in Acute Decompensated Heart Failure and Cardiorenal Syndrome. JACC. HEART FAILURE 2023; 11:1565-1575. [PMID: 37804307 DOI: 10.1016/j.jchf.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Cardiorenal syndrome (CRS) complicates 33% of acute decompensated heart failure (ADHF) admissions, and patients with persistent congestion at discharge have high 30-day event rates. OBJECTIVES The purpose of this study was to evaluate a novel catheter-deployed intra-aortic entrainment pump (IAEP) in patients with ADHF with CRS and persistent congestion. METHODS A multicenter (n = 14), nonrandomized, single-arm, safety and feasibility study of IAEP therapy was conducted. Within patient changes (post-pre IAEP therapy) in fluid loss, hemodynamics, patient-reported dyspnea, and serum biomarkers were assessed using Wilcoxon signed-rank testing. RESULTS Of 21 enrolled patients, 18 received Aortix therapy. Mean ± SD patient age was 60.3 ± 7.9 years. The median left ventricular ejection fraction was 22.5% (25th-75th percentile: 10.0%-53.5%); 27.8% had a left ventricular ejection fraction ≥50%. Pre-therapy, patients received 8.7 ± 4.1 days of loop diuretic agents and 44% were on inotropes. Pump therapy averaged 4.6 ± 1.6 days, yielding net fluid losses of 10.7 ± 6.5 L (P < 0.001) and significant (P < 0.01) reductions in central venous pressure (change from baseline: -8.5 mm Hg [25th-75th percentile: -3.5 to -10.0 mm Hg]), pulmonary capillary wedge pressure (-11.0 mm Hg [25th-75th percentile: -5.0 to -14.0 mm Hg]), and serum creatinine (-0.2 mg/dL [25th-75th percentile: -0.1 to -0.5 mg/dL]) with improved estimated glomerular filtration rate (+5.0 mL/min/1.73 m2 [25th-75th percentile: 2.0-9.0 mL/min/1.73 m2]) and patient-reported dyspnea score (+16 [25th-75th percentile: 3-37]). Dyspnea scores, natriuretic peptides, and renal function improvements persisted through 30 days. CONCLUSIONS This pilot study of patients with ADHF, persistent congestion, and worsening renal function due to CRS supports the potential for safely achieving decongestion using IAEP therapy. These initial promising results provide the basis for future randomized clinical trials of this novel pump. (An Evaluation of the Safety and Performance of the Aortix System for Intra-Aortic Mechanical Circulatory Support in Patients with Cardiorenal Syndrome [The Aortix CRS Pilot Study]; NCT04145635).
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Affiliation(s)
- Jennifer A Cowger
- Henry Ford Health Heart and Vascular Institute, Detroit, Michigan, USA
| | - Mir B Basir
- Henry Ford Health Heart and Vascular Institute, Detroit, Michigan, USA
| | | | - Christopher S Hayward
- St. Vincent's Hospital, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia
| | | | | | - Cristina Tita
- Henry Ford Health Heart and Vascular Institute, Detroit, Michigan, USA
| | | | - Emad Hakemi
- Cleveland Clinic Florida, Weston, Florida, USA
| | - Liviu Klein
- University of California San Francisco, San Francisco, California, USA
| | - Richard Cheng
- University of California San Francisco, San Francisco, California, USA
| | - Robby Wu
- Tampa General Hospital and University of South Florida Heart and Vascular Institute, Tampa, Florida, USA
| | - Bibhu D Mohanty
- Tampa General Hospital and University of South Florida Heart and Vascular Institute, Tampa, Florida, USA
| | | | | | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA.
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27
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Chae S, Davoudi A, Song J, Evans L, Hobensack M, Bowles KH, McDonald MV, Barrón Y, Rossetti SC, Cato K, Sridharan S, Topaz M. Predicting emergency department visits and hospitalizations for patients with heart failure in home healthcare using a time series risk model. J Am Med Inform Assoc 2023; 30:1622-1633. [PMID: 37433577 PMCID: PMC10531127 DOI: 10.1093/jamia/ocad129] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/24/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVES Little is known about proactive risk assessment concerning emergency department (ED) visits and hospitalizations in patients with heart failure (HF) who receive home healthcare (HHC) services. This study developed a time series risk model for predicting ED visits and hospitalizations in patients with HF using longitudinal electronic health record data. We also explored which data sources yield the best-performing models over various time windows. MATERIALS AND METHODS We used data collected from 9362 patients from a large HHC agency. We iteratively developed risk models using both structured (eg, standard assessment tools, vital signs, visit characteristics) and unstructured data (eg, clinical notes). Seven specific sets of variables included: (1) the Outcome and Assessment Information Set, (2) vital signs, (3) visit characteristics, (4) rule-based natural language processing-derived variables, (5) term frequency-inverse document frequency variables, (6) Bio-Clinical Bidirectional Encoder Representations from Transformers variables, and (7) topic modeling. Risk models were developed for 18 time windows (1-15, 30, 45, and 60 days) before an ED visit or hospitalization. Risk prediction performances were compared using recall, precision, accuracy, F1, and area under the receiver operating curve (AUC). RESULTS The best-performing model was built using a combination of all 7 sets of variables and the time window of 4 days before an ED visit or hospitalization (AUC = 0.89 and F1 = 0.69). DISCUSSION AND CONCLUSION This prediction model suggests that HHC clinicians can identify patients with HF at risk for visiting the ED or hospitalization within 4 days before the event, allowing for earlier targeted interventions.
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Affiliation(s)
- Sena Chae
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Anahita Davoudi
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Jiyoun Song
- Columbia University School of Nursing, New York City, New York, USA
| | - Lauren Evans
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Mollie Hobensack
- Columbia University School of Nursing, New York City, New York, USA
| | - Kathryn H Bowles
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | | | - Yolanda Barrón
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Sarah Collins Rossetti
- Columbia University School of Nursing, New York City, New York, USA
- Department of Biomedical Informatics, Columbia University, New York City, New York, USA
| | - Kenrick Cato
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Sridevi Sridharan
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Maxim Topaz
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
- Columbia University School of Nursing, New York City, New York, USA
- Data Science Institute, Columbia University, New York City, New York, USA
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28
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Verma A, Fonarow GC, Hsu JJ, Jackevicius CA, Mody FV, Nguyen A, Amidi O, Goldberg S, Vetrivel R, Upparapalli D, Theodoropoulos K, Gregorio S, Chang DS, Bostrom K, Althouse AD, Ziaeian B. DASH-HF Study: A Pragmatic Quality Improvement Randomized Implementation Trial for Patients With Heart Failure With Reduced Ejection Fraction. Circ Heart Fail 2023; 16:e010278. [PMID: 37494051 PMCID: PMC10524378 DOI: 10.1161/circheartfailure.122.010278] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/12/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Heart failure is a prevailing diagnosis of hospitalization and readmission within 6 months, and nearly a quarter of these patients die within a year. Guideline-directed medication therapies reduce risk of mortality by 73% over 2 years; however, the implementation of these therapies to their target dose in clinical practice continues to be challenging. In 2020, the Veterans Affairs (VA) Health Care System developed a HF dashboard to monitor and improve outpatient HF management. The DASH-HF (Dashboard Activated Services and Telehealth for Heart Failure) study is a randomized, pragmatic clinical trial to evaluate proactive dashboard-directed telehealth clinics to improve the use and dosing of guideline-directed medication therapy for patients with heart failure with reduced ejection fraction not on optimal guideline-directed medication therapy within the VA. METHODS Three hundred veterans with heart failure with reduced ejection fraction met inclusion criteria with an optimization potential score (OPS) of 5 or less out of 10, representing nonoptimal guideline-directed medication therapy. The primary outcome was a composite score of guideline-directed medical therapy, the OPS, 6 months after the end of the intervention. Secondary outcomes included active prescriptions for each individual guideline-directed medical therapy class, HF-related hospitalizations, deaths, and clinician time per patient during the intervention clinics. RESULTS There was no significant difference between the intervention arm and usual care group in the primary outcome (OPS, 2.9; SD=2.1 versus OPS, 2.6, SD=2.1); adjusted mean difference 0.3 (95% CI, -0.1 to 0.7) or in the prespecified secondary outcomes for hospitalization and all-cause mortality for the intervention of proactive dashboard-based clinics. CONCLUSIONS A dashboard-based clinic intervention did not improve the OPS or secondary outcomes of hospitalization and all-cause mortality. There remains a larger opportunity to better target patients and provide more intensive follow-up to further evaluate the utility of proactive dashboard-based clinics for HF management and quality improvement. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT05001165.
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Affiliation(s)
- Aradhana Verma
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Gregg C. Fonarow
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jeffrey J. Hsu
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Division of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Cynthia A. Jackevicius
- Department of Pharmacy Practice and Administration, Western University of Health Sciences, Pomona, CA; Department of Pharmacy, VA Greater Los Angeles Healthcare System; ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | - Amanda Nguyen
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Omid Amidi
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sarah Goldberg
- Division of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Reeta Vetrivel
- Division of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Deepti Upparapalli
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Stephanie Gregorio
- Department of Pharmacy, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Donald S. Chang
- Division of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Kristina Bostrom
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Division of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | | | - Boback Ziaeian
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Division of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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Achury Saldaña DM, Rodríguez Parrado IY, González RA. Cardio SEM: A Novel Approach for a Traffic Light System for Heart Failure Warning Signs. Comput Inform Nurs 2023; 41:673-678. [PMID: 37165833 DOI: 10.1097/cin.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Existing literature on the follow-up of heart failure patients with warning signs shows that it is necessary to increase patients' knowledge and of seeking help in a timely manner. This suggests an opportunity to implement strategies that integrate technology to visualize the risk of decompensation. This article studies the acceptance of Cardio Sem, a traffic light system mobile application for patients with heart failure. A descriptive, observational pilot study was performed with 23 outpatients belonging to a heart failure program. For 4 weeks, patients used Cardio Sem, which allows visualizing the risk of decompensation through a series of questions that patients must answer daily and provides guidance for managing signs and symptoms of decompensation. A technology acceptance questionnaire was applied to all patients, resulting in acceptance of the application, especially in the dimensions that emphasized perceived usefulness (100%), social influence (100%), and behavioral intent (99.8%). Cardio Sem is useful for early detection of symptoms that allow for early response to complications. Acceptance of the application by patients and its ease of use present the possibility to implement it as a complementary tool to promote self-care and effective management of symptoms.
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Affiliation(s)
- Diana Marcela Achury Saldaña
- Author Affiliations : School of Nursing, Pontificia Universidad Javeriana (Ms Achury Saldaña); Clínica Palermo (Ms Parrado); and Engineering Faculty, Pontificia Universidad Javeriana (Dr González), Bogotá, Colombia
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Schmaderer MS, Struwe L, Loecker C, Lier L, Lundgren SW, Pozehl B, Zimmerman L. Feasibility, Acceptability, and Intervention Description of a Mobile Health Intervention in Patients With Heart Failure. J Cardiovasc Nurs 2023; 38:481-491. [PMID: 36288470 DOI: 10.1097/jcn.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Mobile health (mHealth) is used to encourage and support self-management skills in patients with heart failure. The purpose of the study was to describe the feasibility, fidelity, usability, and acceptability of mHealth interventions. This pilot study used a randomized 3-group (enhanced usual care, mHealth, and mHealth plus, which included a nurse practitioner and community health worker) repeated-measure design to determine the feasibility of using a self-management behavior app and a Bluetooth-enabled scale for daily self-monitoring of weights and medications. In the 2 mHealth groups, of the 48 patients, 38 (79%) engaged partially in recording daily weights and medications, and of the 74 patients in the sample, we obtained partial to complete data on 63 (85%) of the patients during follow-up outcome phone calls. Most patients found the intervention to be feasible, usable, and acceptable, and (93%) patients in the mHealth group and 100% of patients in the mHealth plus group agreed or strongly agreed that they learned how to self-manage their heart failure using the app. The intervention was reasonable to implement and provided insight for future intervention improvements.
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Zangger G, Bricca A, Liaghat B, Juhl CB, Mortensen SR, Andersen RM, Damsted C, Hamborg TG, Ried-Larsen M, Tang LH, Thygesen LC, Skou ST. Benefits and Harms of Digital Health Interventions Promoting Physical Activity in People With Chronic Conditions: Systematic Review and Meta-Analysis. J Med Internet Res 2023; 25:e46439. [PMID: 37410534 PMCID: PMC10359919 DOI: 10.2196/46439] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/20/2023] [Accepted: 05/25/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Digital health interventions for managing chronic conditions have great potential. However, the benefits and harms are still unclear. OBJECTIVE This systematic review and meta-analysis aimed to investigate the benefits and harms of digital health interventions in promoting physical activity in people with chronic conditions. METHODS We searched the MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials databases from inception to October 2022. Eligible randomized controlled trials were included if they used a digital component in physical activity promotion in adults with ≥1 of the following conditions: depression or anxiety, ischemic heart disease or heart failure, chronic obstructive pulmonary disease, knee or hip osteoarthritis, hypertension, or type 2 diabetes. The primary outcomes were objectively measured physical activity and physical function (eg, walk or step tests). We used a random effects model (restricted maximum likelihood) for meta-analyses and meta-regression analyses to assess the impact of study-level covariates. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation. RESULTS Of 14,078 hits, 130 randomized controlled trials were included. Compared with usual care or minimal intervention, digital health interventions increased objectively measured physical activity (end of intervention: standardized mean difference [SMD] 0.29, 95% CI 0.21-0.37; follow-up: SMD 0.17, 95% CI 0.04-0.31) and physical function (end of intervention: SMD 0.36, 95% CI 0.12-0.59; follow-up: SMD 0.29, 95% CI 0.01-0.57). The secondary outcomes also favored the digital health interventions for subjectively measured physical activity and physical function, depression, anxiety, and health-related quality of life at the end of the intervention but only subjectively measured physical activity at follow-up. The risk of nonserious adverse events, but not serious adverse events, was higher in the digital health interventions at the end of the intervention, but no difference was seen at follow-up. CONCLUSIONS Digital health interventions improved physical activity and physical function across various chronic conditions. Effects on depression, anxiety, and health-related quality of life were only observed at the end of the intervention. The risk of nonserious adverse events is present during the intervention, which should be addressed. Future studies should focus on better reporting, comparing the effects of different digital health solutions, and investigating how intervention effects are sustained beyond the end of the intervention. TRIAL REGISTRATION PROSPERO CRD42020189028; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189028.
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Affiliation(s)
- Graziella Zangger
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Alessio Bricca
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Behnam Liaghat
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Centre for Evidence-Based Orthopedics (CEBO), Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark
| | - Carsten B Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, University Hospital of Copenhagen, Herlev and Gentofte, Denmark
| | - Sofie Rath Mortensen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rune Martens Andersen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Camma Damsted
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Trine Grønbek Hamborg
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
| | - Mathias Ried-Larsen
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Centre for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Hermann Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Min D, Lee J, Ahn JA. A Qualitative Study on the Self-Care Experiences of People with Heart Failure. West J Nurs Res 2023; 45:646-652. [PMID: 37085988 DOI: 10.1177/01939459231169102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
We aimed to explore in-depth experiences and emotions of people with heart failure within the context of self-care. A qualitative descriptive study was conducted using semi-structured interviews. Ten patients were recruited from an outpatient clinic at a university-affiliated hospital in South Korea between September and November 2019. Data were analyzed using a thematic content analysis approach. Participants were 68-86 years old, and 80% were men. Five themes of the self-care experiences of persons with heart failure were identified: "Suddenly diagnosed with heart failure," "Unpredictable symptoms and unprepared for self-care," "Dependent on caring family on a heartbreaking uphill," "Self-care efforts with apprehension," and "Continued self-care efforts with expert help." Programs to support self-care for people with heart failure are needed and should be developed by incorporating patients' needs and reflecting their uncertainty and vulnerability.
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Affiliation(s)
- Deulle Min
- Department of Nursing, College of Medicine, Wonkwang University, Iksan, Jeonbuk, Korea
| | - Jungeun Lee
- College of Nursing, University of Rhode Island, Kingston, RI, USA
| | - Jeong-Ah Ahn
- College of Nursing and Research Institute of Nursing Science, Ajou University, Suwon, Korea
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Khodneva Y, Levitan EB, Arora P, Presley CA, Oparil S, Cherrington AL. Disparities in Postdischarge Ambulatory Care Follow-Up Among Medicaid Beneficiaries With Diabetes, Hospitalized for Heart Failure. J Am Heart Assoc 2023; 12:e029094. [PMID: 37284763 PMCID: PMC10356027 DOI: 10.1161/jaha.122.029094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/18/2023] [Indexed: 06/08/2023]
Abstract
Background Ambulatory follow-up for all patients with heart failure (HF) is recommended within 7 to 14 days after hospital discharge to improve HF outcomes. We examined postdischarge ambulatory follow-up of patients with comorbid diabetes and HF from a low-income population in primary and specialty care. Methods and Results Adults with diabetes and first hospitalizations for HF, covered by Alabama Medicaid in 2010 to 2019, were included and the claims analyzed for ambulatory care use (any, primary care, cardiology, or endocrinology) within 60 days after discharge using restricted mean survival time regression and negative binomial regression. Among 9859 Medicaid-covered adults with diabetes and first hospitalization for HF (mean age, 53.7 years; SD, 9.2 years; 47.3% Black; 41.8% non-Hispanic White; 10.9% Hispanic/Other [Other included non-White Hispanic, American Indian, Pacific Islander and Asian adults]; 65.4% women, 34.6% men), 26.7% had an ambulatory visit within 0 to 7 days, 15.2% within 8 to 14 days, 31.3% within 15 to 60 days, and 26.8% had no visit; 71% saw a primary care physician and 12% a cardiology physician. Black and Hispanic/Other adults were less likely to have any postdischarge ambulatory visit (P<0.0001) or the visit was delayed (by 1.8 days, P=0.0006 and by 2.8 days, P=0.0016, respectively) and were less likely to see a primary care physician than non-Hispanic White adults (adjusted incidence rate ratio, 0.96 [95% CI, 0.91-1.00] and 0.91 [95% CI, 0.89-0.98]; respectively). Conclusions More than half of Medicaid-covered adults with diabetes and HF in Alabama did not receive guideline-concordant postdischarge care. Black and Hispanic/Other adults were less likely to receive recommended postdischarge care for comorbid diabetes and HF.
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Affiliation(s)
- Yulia Khodneva
- Department of Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Emily B. Levitan
- Department of Epidemiology, School of Public HealthUniversity of Alabama at BirminghamBirminghamALUSA
| | - Pankaj Arora
- Department of Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Caroline A. Presley
- Department of Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Suzanne Oparil
- Department of Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Andrea L. Cherrington
- Department of Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
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Akinlonu AA, Alonso A, Mene-Afejuku TO, Lopez P, Kansara T, Ola O, Mushiyev S, Pekler G. The Impact of Cocaine Use and the Obesity Paradox in Patients With Heart Failure With Reduced Ejection Fraction Due to Non-ischemic Cardiomyopathy. Cureus 2023; 15:e40298. [PMID: 37448382 PMCID: PMC10337646 DOI: 10.7759/cureus.40298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/15/2023] Open
Abstract
Background Obesity and illicit drugs are independent risk factors for developing heart failure (HF). However, recent studies have suggested that patients who already have HF and are obese have better clinical outcomes. We aim to study the effect of cocaine use on this obesity paradox phenomenon as it pertains to HF readmissions. Methodology In a retrospective chart analysis, we reviewed patients with a diagnosis of HF with reduced ejection fraction (HFrEF) admitted to Metropolitan Hospital in New York. We studied the association between body mass index (BMI) categories, namely, non-obese (<30 kg/m2) and obese (≥30 kg/m2), cocaine use, and the primary outcome (time to readmission for HF within 30 days after discharge). The interaction between cocaine and obesity status and its association with the primary outcome was also assessed. Results A total of 261 patients were identified. Non-obese status and cocaine use were associated with an increased hazard of readmission in 30 days (hazard ratio (HR) = 2.28, p = 0.049 and HR = 3.12, p = 0.004, respectively). Furthermore, cocaine users who were non-obese were over six times more likely to be re-admitted in 30 days compared to non-cocaine users who were obese (HR = 6.45, p = 0.0002). Conclusions Non-obese status and continued use of cocaine have a negative additive effect in impacting HF readmissions.
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Affiliation(s)
- Adedoyin A Akinlonu
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, USA
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA
| | - Alvaro Alonso
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, USA
| | - Tuoyo O Mene-Afejuku
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, USA
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA
| | - Persio Lopez
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA
| | - Tikal Kansara
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA
| | - Olatunde Ola
- Hospital Medicine, Mayo Clinic Health System, La Crosse, USA
| | - Savi Mushiyev
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA
| | - Gerald Pekler
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA
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Predictors of Hospital Readmission After Motor Vehicle Crash: Prospective Cohort Study. J Trauma Nurs 2023; 30:83-91. [PMID: 36881699 DOI: 10.1097/jtn.0000000000000707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Motor vehicle crash (MVC) is a major public health problem worldwide and contributes to a large burden of death, disability, and economic loss. OBJECTIVE To identify the predictors of hospital readmission in victims of MVC within 1 year after discharge. METHODS A prospective cohort study conducted with individuals who suffered MVC admitted to a regional hospital and who were followed up for 12 months after discharge. Predictors of hospital readmission were verified by means of Poisson regression models with robust variance, using a hierarchical conceptual model. RESULTS Of the 241 patients followed up, 200 were contacted and comprised the population of this study. Of these, 50 (25.0%) reported hospital readmission during the 12-month period after discharge. It was evidenced that being male (relative risk [RR] = 0.58; 95% CI [0.36, 0.95], p = .033) was a protective factor, whereas occurrences of greater severity (RR = 1.77; 95% CI [1.03, 3.02], p = .036), not receiving pre-hospital care (RR = 2.14; 95% CI [1.24, 3.69], p = .006), the occurrence of postdischarge infection (RR = 2.14; 95% CI [1.37, 3.36], p = .001), and having access to rehabilitation treatment (RR = 1.64; 95% CI [1.03, 2.62], p≤ .001) are configured as risk factors for hospital readmission in individuals who have suffered these events. CONCLUSION It was found that gender, trauma severity, pre-hospital care, postdischarge infection, and rehabilitation treatment variables predict hospital readmission in MVC victims within 1 year after discharge.
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Thandra A, Balakrishna AM, Walters RW, Alugubelli N, Koripalli VS, Alla VM. Trends in and predictors of multiple readmissions following heart failure hospitalization: A National wide analysis from the United States. Am J Med Sci 2023; 365:145-151. [PMID: 36152813 DOI: 10.1016/j.amjms.2022.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 05/23/2022] [Accepted: 09/12/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Readmission following Heart failure (HF) hospitalization is common: 25% are readmitted within a month of discharge and ≈50% within 6 months. A small proportion of these patients can have multiple readmissions within this period, adding disproportionately to the health care costs. In this study, we assessed the trends, predictors and costs associated with multiple readmissions using National readmissions database (NRD). METHODS We queried NRD for HF hospitalizations from 2010 to 2018 using ICD-9/10-CM codes. Multinomial logistic regression was used to compare readmission cohorts, with the multivariable model adjusting for other factors. All analyses accounted for the NRD sampling design were conducted using SAS v. 9.4 with p < 0.05 used to indicate statistical significance. RESULTS Within the study period, an estimated 6,763,201 HF hospitalizations were identified. Of these, 58% had no readmission; 26% had 1 readmission; and 16% had ≥2 readmissions within 90 days of index hospitalization. There was no statistically significant change in readmission rates during the observation period. Multiple readmissions which accounted for 37% of all readmissions contributed to 57% of readmission costs. Younger age was identified as a predictor of multiple readmissions while sex, comorbidities and the type of insurance were not significantly different from those with single readmission. CONCLUSIONS Multiple readmissions in HF are common (16%), have remained unchanged between 2010 and 2018 and impose a significant health care cost burden. Future research should focus on identifying these patients for targeted intervention that may minimize excessive readmissions particularly in those patients who are in the palliation phase of HF.
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Affiliation(s)
- Abhishek Thandra
- Department of Medicine, Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, United States.
| | | | - Ryan W Walters
- Department of Medicine, Division of Clinical Research and Evaluative Sciences, Creighton University School of Medicine, Omaha, NE, United States
| | - Navya Alugubelli
- Department of Medicine, Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, United States
| | | | - Venkata M Alla
- Department of Medicine, Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, United States
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Chen S, Hu W, Yang Y, Cai J, Luo Y, Gong L, Li Y, Si A, Zhang Y, Liu S, Mi B, Pei L, Zhao Y, Chen F. Predicting Six-Month Re-Admission Risk in Heart Failure Patients Using Multiple Machine Learning Methods: A Study Based on the Chinese Heart Failure Population Database. J Clin Med 2023; 12:jcm12030870. [PMID: 36769515 PMCID: PMC9918116 DOI: 10.3390/jcm12030870] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/29/2022] [Accepted: 01/19/2023] [Indexed: 01/25/2023] Open
Abstract
Since most patients with heart failure are re-admitted to the hospital, accurately identifying the risk of re-admission of patients with heart failure is important for clinical decision making and management. This study plans to develop an interpretable predictive model based on a Chinese population for predicting six-month re-admission rates in heart failure patients. Research data were obtained from the PhysioNet portal. To ensure robustness, we used three approaches for variable selection. Six different machine learning models were estimated based on selected variables. The ROC curve, prediction accuracy, sensitivity, and specificity were used to evaluate the performance of the established models. In addition, we visualized the optimized model with a nomogram. In all, 2002 patients with heart failure were included in this study. Of these, 773 patients experienced re-admission and a six-month re-admission incidence of 38.61%. Based on evaluation metrics, the logistic regression model performed best in the validation cohort, with an AUC of 0.634 (95%CI: 0.599-0.646) and an accuracy of 0.652. A nomogram was also generated. The established prediction model has good discrimination ability in predicting. Our findings are helpful and could provide useful information for the allocation of healthcare resources and for improving the quality of survival of heart failure patients.
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Affiliation(s)
- Shiyu Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Weiwei Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Yuhui Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Jiaxin Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Yaqi Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Department of Nursing, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Lingmin Gong
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Yemian Li
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Aima Si
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Yuxiang Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Sitong Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Baibing Mi
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Leilei Pei
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Yaling Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
| | - Fangyao Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
- Department of Radiology, First Affiliate Hospital of Xi’an Jiaotong University, Xi’an 710061, China
- Correspondence: ; Tel.: +86-29-82655104-202
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Exploring Health Literacy Categories in Patients With Heart Failure: A Latent Class Analysis. J Cardiovasc Nurs 2023; 38:13-22. [PMID: 36508237 DOI: 10.1097/jcn.0000000000000889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although a growing number of studies have demonstrated that patients' health literacy is associated with health outcomes, the exact relationship between them is not clear. AIMS AND OBJECTIVES The aim of this study was to explore latent classes of health literacy in patients with heart failure and analyze the differences among different groups. DESIGN AND METHODS This is a cross-sectional survey. Patients diagnosed with heart failure were selected from 3 tertiary hospitals in Tianjin, China, from March 2019 to November 2019. We measured patients' health literacy using the Health Literacy Scale for Chronic Patients. Latent class analysis was carried out based on the patients' Health Literacy Scale for Chronic Patients scores. Multinomial logistic regression was used to identify the predictive indicators of the latent classes. RESULTS The health literacy of patients with heart failure was divided into 3 different latent classes, named "high health literacy group," "low literacy high dependence group," and "moderate literacy high willingness group." There were statistically significant differences in gender, age, smoking history, marital status, education level, household income level, and quality of life among different health literacy classes. Low education level and household income level predicted poor health literacy. CONCLUSION There were 3 latent classes for the health literacy of patients with heart failure. Different health literacy classes exhibited their own distinctive characteristics. Patients in the "moderate literacy high willingness group" had the worst quality of life. Understanding the specific types of health literacy in patients with heart failure facilitates targeted nursing interventions to improve their quality of life.
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Davidge J, Ashfaq A, Ødegaard KM, Olsson M, Costa-Scharplatz M, Agvall B. Clinical characteristics and mortality of patients with heart failure in Southern Sweden from 2013 to 2019: a population-based cohort study. BMJ Open 2022; 12:e064997. [PMID: 36526318 PMCID: PMC9764664 DOI: 10.1136/bmjopen-2022-064997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To describe clinical characteristics and prognosis related to heart failure (HF) phenotypes in a community-based population by applying a novel algorithm to obtain ejection fractions (EF) from electronic medical records. DESIGN Retrospective population-based cohort study. SETTING Data were collected for all patients with HF in Southwest Sweden. The region consists of three acute care hospitals, 40 inpatient wards, 2 emergency departments, 30 outpatient specialty clinics and 48 primary healthcare. PARTICIPANTS 8902 patients had an HF diagnosis based on the International Classification of Diseases, Tenth Revision during the study period. Patients <18 years as well as patients declining to participate were excluded resulting in a study population of 8775 patients. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was distribution of HF phenotypes by echocardiography. The secondary outcome measures were 1 year all-cause mortality and HR for all-cause mortality using Cox regression models. RESULTS Out of 8775 patients with HF, 5023 (57%) had a conclusive echocardiography distributed into HF with reduced EF (35%), HF with mildly reduced EF (27%) and HF with preserved EF (38%). A total of 43% of the cohort did not have a conclusive echocardiography, and therefore no defined phenotype (HF-NDP). One-year all-cause mortality was 42% within the HF-NDP group and 30% among those with a conclusive EF. The HR of all-cause mortality in the HF-NDP group was 1.27 (95% CI 1.17 to 1.37) when compared with the confirmed EF group. There was no significant difference in survival within the HF phenotypes. CONCLUSIONS This population-based study showed a distribution of HF phenotypes that varies from those in selected HF registries, with fewer patients with HF with reduced EF and more patients with HF with preserved EF. Furthermore, 1-year all-cause mortality was significantly higher among patients with HF who had not undergone a conclusive echocardiography at diagnosis, highlighting the importance of correct diagnostic procedure to improve treatment strategies and outcomes.
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Affiliation(s)
- Jason Davidge
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Capio Vårdcentral Halmstad, Capio AB, Halmstad, Sweden
| | - Awais Ashfaq
- Center for Applied Intelligent Systems Research (CAISR), Halmstad University, Halmstad, Sweden
| | | | - Mattias Olsson
- Center for Applied Intelligent Systems Research (CAISR), Halmstad University, Halmstad, Sweden
| | | | - Björn Agvall
- Department of Research and Development, Region Halland, Halmstad, Sweden
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Introduction of specialized heart failure nurses in primary care and its impact on readmissions. Prim Health Care Res Dev 2022; 23:e78. [PMID: 36484241 PMCID: PMC9817084 DOI: 10.1017/s1463423622000676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Heart failure (HF) has a 2% prevalence in the population and is a major cause of morbidity and mortality. Multiple efforts have been made worldwide to improve quality of care and decrease unplanned readmissions for HF patients, one of which has been the introduction of specialist HF nurses (HFN) in primary health care. The present evidence on the benefits of HFN is contradicting. This study aims to evaluate the impact of a quality improvement intervention, availability of a HFN in Swedish primary care, on hospital readmissions. METHODS All patients over the age of 65 with a HF diagnosis and with complete information on availability of a HFN were included in this retrospective register-based study. Using propensity score matching (PSM) techniques, two comparable groups of 128 patients each were created according to the exposure status, availability or no availability of a HFN. The rate of readmission was compared between the groups. RESULTS Using PSM, 256 patients were matched, 128 in the HFN group and 128 in the no-HFN group. A total of 50% and 46.09% of patients in the HFN and no-HFN groups were readmitted, respectively. Mean number of readmissions per patient was 1.19 (SD 0.61) in the HFN group and 1.10 (SD 0.44) in the no-HFN group. Patients in the HFN had 17.6% higher odds of being readmitted during the study period, OR: 1.176 (CI: 0.716-1.932), and 3.8% lower odds of being readmitted within 30 days, OR: 0.962 (CI: 0.528-1.750). CONCLUSIONS Availability of a HFN in primary care was not significantly associated with reduced readmissions for the patients included in this study. Further investigations are warranted looking at the impacts of availability and access to a HFN in primary care on readmissions and other patient outcomes.
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Di Tanna GL, Angell B, Urbich M, Lindgren P, Gaziano TA, Globe G, Stollenwerk B. A Proposal of a Cost-Effectiveness Modeling Approach for Heart Failure Treatment Assessment: Considering the Short- and Long-Term Impact of Hospitalization on Event Rates. PHARMACOECONOMICS 2022; 40:1095-1105. [PMID: 35960435 DOI: 10.1007/s40273-022-01174-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The rate of events such as recurrent heart failure (HF) hospitalization and death are known to dramatically increase directly after HF hospitalization. Furthermore, the number of HF hospitalizations is associated with irreversible long-term disease progression, which is in turn associated with increased event rates. However, cost-effectiveness models of HF treatments commonly fail to capture both the short- and long-term association between HF hospitalization and events. OBJECTIVE The aim of this study was to provide a decision-analytic model that reflects the short- and long-term association between HF hospitalization and event rates. Furthermore, we assess the impact of omitting these associations. METHODS We developed a life-time Markov cohort model to evaluate HF treatments, and modeled the short-term impact of HF hospitalization on event rates via a sequence of tunnel states, with transition probabilities following a parametric survival curve. The corresponding long-term impact was modeled via hazard ratios per HF hospitalization. We obtained baseline event rates and utilities from published literature. Subsequently, we assessed, for a hypothetical HF treatment, how omitting the modeled associations (through a simple two-state model) affects incremental quality-adjusted life-years (QALYs). RESULTS We developed a model that incorporates both short- and long-term impacts of HF hospitalizations. Based on an assumed treatment effect of a 20% risk reduction for HF hospitalization (and associated reductions in all-cause mortality of 15%), omitting the short-term, the long-term, or both associations resulted in a 5%, 1%, and 22% decrease in QALYs gained, respectively. CONCLUSION For both modeling components, i.e., the short- and long-term implications of HF hospitalization, the impact on incremental outcomes associated with treatment was substantial. Considering these aspects as proposed within this modeling approach better reflects the natural course of this progressive condition and will enhance the evaluation of future HF treatments.
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Affiliation(s)
- Gian Luca Di Tanna
- University of New South Wales, Sydney, NSW, Australia.
- The George Institute for Global Health, Level 5, 1 King St, Newtown, NSW, 2042, Australia.
| | - Blake Angell
- The George Institute for Global Health, Level 5, 1 King St, Newtown, NSW, 2042, Australia
| | | | - Peter Lindgren
- Karolinska Institutet, Stockholm, Sweden
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Thomas A Gaziano
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gary Globe
- Cerevel Therapeutics, Cambridge, MA, USA
| | - Björn Stollenwerk
- Amgen (Europe) GmbH, Economic Modeling Center of Excellence, Rotkreuz, Switzerland
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Abassade P, Cohen L, Fels A, Chatellier G, Sacco E, Beaussier H, Fleury L, Komajda M, Cador R. [Impact of Home Return Assistance Service in Heart Failure (PRADO-IC) on the one year re-hospitalisation and mortality in a heart failure hospitalized population of patients]. Ann Cardiol Angeiol (Paris) 2022; 71:267-275. [PMID: 35940973 DOI: 10.1016/j.ancard.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Congestive heart failure (CHF) is associated with prolonged and recurrent hospitalizations; the prognosis remains poor. Since 2013, the Caisse Primaire d'Assurance Maladie (CPAM) has set up a support program PRADO-IC (support program for returning home after hospitalisation for heart failure). The aim of this study was to evaluate the impact of PRADO-IC on the heart failure readmission rate and death rate at one year. METHODS From September 2016 to September 2018, all patients hospitalized for heart failure at Saint-Joseph Hospital were included in an observational study. The inclusion in PRADO-IC program was at physician's discretion. Two groups were compared according to the inclusion in PRADO-IC or not (T). The primary endpoints were the comparison of one-year mortality and heart failure readmission rate between the two groups. RESULTS Six hundred and thirty-three patients were included, 262 in the PRADO-IC group and 371 in the non-PRADO group. Patients in the PRADO-IC cohort more frequently present severity criteria (age, weight, BNP level, arrhythmia, anemia, renal failure). Mortality at one year (19.5% vs 16.2%, p = 0.28) are equivalent in both groups. There were no significant differences in one-year rehospitalization rate for heart failure (HF) (35.1% in PRADO cohort vs 28% in T group, p = 0.06), the time to first hospitalization (74.5 days in PRADO vs 54.5 days in T, p = 0.55) and the length of hospitalization (6.0 days in PRADO vs 7.0 days in T, p = 0.29) between the two groups. Age, hyponatremia, anemia, cancer, HF re-hospitalization were variables linked to a risk of mortality, in a multivariable analysis. CONCLUSION Our study shows that the PRADO-IC program concerned to the most severe patients. Despite this, the one-year mortality and the HF readmission rate are similar between the two groups.
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Affiliation(s)
- Philippe Abassade
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75014, Paris, France.
| | - Léa Cohen
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75014, Paris, France
| | - Audrey Fels
- Département de Recherche Clinique, Groupe Hospitalier Paris Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France
| | - Gilles Chatellier
- Département de Recherche Clinique, Groupe Hospitalier Paris Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France
| | - Emmanuelle Sacco
- Département de Recherche Clinique, Groupe Hospitalier Paris Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France
| | - Hélène Beaussier
- Département de Recherche Clinique, Groupe Hospitalier Paris Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France
| | - Laetitia Fleury
- Direction Régionale du Service Médical (DRSM) d'Île de France, 17 Place de l'Argonne 75019, Paris, France
| | - Michel Komajda
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75014, Paris, France
| | - Romain Cador
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75014, Paris, France
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de Carvalho Costa IMNB, Silva DGD, Oliveira JLM, Silva JRS, Pereira LMC, Alves LVS, de Andrade FA, Góes Jorge JD, Oliveira LMSMD, Almeida RRD, Oliveira VB, Martins LS, Costa JO, de Souza MFC, Voci SM, Almeida-Santos MA, Abreu VV, Aidar FJ, Baumworcel L, Sousa ACS. Adherence to secondary prevention measures after acute coronary syndrome in patients associated exclusively with the public and private healthcare systems in Brazil. Prev Med Rep 2022; 29:101973. [PMID: 36161134 PMCID: PMC9502285 DOI: 10.1016/j.pmedr.2022.101973] [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: 04/22/2022] [Revised: 07/28/2022] [Accepted: 08/27/2022] [Indexed: 11/24/2022] Open
Abstract
Adherence to secondary prevention measures after acute coronary syndrome (ACS) is essential to prevent disease recurrence. In Brazil, the Brazilian Unified Health System (SUS, in Portuguese), and the private healthcare system (PHCS) coexist. We aimed to evaluate the adherence to secondary prevention in patients with ACS who were assisted by either SUS or PHCS. In this longitudinal prospective study, patients with ACS were admitted to the four cardiological reference hospitals of Sergipe, three of which assisted PHCS users, and one, SUS users. We analyzed the two patient care models with multiple logistic regression models for adherence to physical activity, pharmacotherapy, and smoking cessation. We enrolled 581 volunteers in this study: 44.1 % from SUS and 55.9 % from PHCS. PHCS users showed greater adherence to pharmacotherapy at both 30 and 180 (p = 0.001) days after ACS with better results in all classes of medications (p < 0.05) than SUS users did. They also showed better adherence to physical activity (p = 0.047). There was no distinction between the groups regarding smoking cessation. The secondary prevention measures after ACS were more effective in PHCS users than in SUS users due to better adherence, especially to pharmacotherapy and regular physical activity.
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Affiliation(s)
| | - Danielle Góes da Silva
- Program of Post-Graduation in Nutrition Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Joselina Luzia Meneses Oliveira
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Department of Medicine, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- São Lucas Clinic and Hospital / Rede D Or São Luiz, Aracaju, Sergipe, Brazil
- Division of Cardiology, University Hospital, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - José Rodrigo Santos Silva
- Department of Statistics and Actuarial Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Luciana Vieira Sousa Alves
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Juliana de Góes Jorge
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Department of Physiotherapy, Tiradentes University, Aracaju, Sergipe, Brazil
| | | | - Rebeca Rocha de Almeida
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Victor Batista Oliveira
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Larissa Santos Martins
- Program of Post-Graduation in Nutrition Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Jamille Oliveira Costa
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Silvia Maria Voci
- Program of Post-Graduation in Nutrition Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Marcos Antonio Almeida-Santos
- São Lucas Clinic and Hospital / Rede D Or São Luiz, Aracaju, Sergipe, Brazil
- Postgraduate Program in Health and Environment, Tiradentes University, Aracaju, Sergipe, Brazil
| | - Victoria Vieira Abreu
- Program of Post-Graduation in Nutrition Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Felipe J. Aidar
- Group of Studies and Research in Performance, Sport, Health and Paralympic Sports – GEPEPS, Federal University of Sergipe (UFS), São Cristóvão, Sergipe, Brazil
| | - Leonardo Baumworcel
- São Lucas Clinic and Hospital / Rede D Or São Luiz, Aracaju, Sergipe, Brazil
| | - Antônio Carlos Sobral Sousa
- Program of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Department of Medicine, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- São Lucas Clinic and Hospital / Rede D Or São Luiz, Aracaju, Sergipe, Brazil
- Division of Cardiology, University Hospital, Federal University of Sergipe, Aracaju, Sergipe, Brazil
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Iacovoni A, Palmieri VI, Abete R, Vecchi AL, Mortara A, Gori M, Tomasoni D, De Ponti R, Senni M. Right and left ventricular structures and functions in acute HFpEF: comparing the hypertensive pulmonary edema and worsening heart failure phenotypes. J Cardiovasc Med (Hagerstown) 2022; 23:663-671. [PMID: 36099073 DOI: 10.2459/jcm.0000000000001366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Limited data are available on right (RV) and left (LV) ventricular structures and functions in acute heart failure with preserved ejection fraction (AHF-pEF) presenting with hypertensive pulmonary edema (APE) versus predominant peripheral edema (peHF). METHODS AND RESULTS In a prospective study of consecutive patients with AHF-pEF, 80 patients met inclusion and not exclusion criteria, and underwent echocardiographic and laboratory examination in the emergency ward. The survived (94%) were re-evaluated at the discharge. At admission, systolic, diastolic, pulse blood pressure (BP), and high sensitivity troponin I were higher (all P < 0.05) with APE than with peHF while brain-type natriuretic peptide (BNP), hemoglobin and estimated glomerular filtration rate (eGFR) did not differ between the two phenotypes. LV volumes and EF were comparable between APE and peHF, but APE showed lower relative wall thickness (RWT), smaller left atrial (LA) volume, higher pulse pressure/stroke volume (PP/SV), and higher ratio between the peak velocities of the early diastolic waves sampled by traditional and tissue Doppler modality (mitral E/e', all P < 0.05). Right ventricular and atrial (RA) areas were smaller, tricuspid anular plane systolic excursion (TAPSE) and estimated pulmonary artery peak systolic pressure (sPAP) were higher with APE than with peHF (all P < 0.05) while averaged degree of severity of tricuspid insufficiency was greater with peHF than with APE. At discharge, PP/SV, mitral E/e', sPAP, RV sizes were reduced from admission in both phenotypes (all P < 0.05) and did not differ anymore between phenotypes, whereas LV EF and TAPSE did not show significant changes over time and treatments. CONCLUSION In AHF-pEF, at comparable BNP and LV EF, hypertensive APE showed eccentric LV geometry but smaller RV and RA sizes, and higher RV systolic function, increased LV ventricular filling and systemic arterial loads. AHF resolution abolished the differences in PP/SV and LV diastolic load between APE and peHF whereas APE remained associated with more eccentric RV and higher TAPSE.
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Affiliation(s)
- Attilio Iacovoni
- Cardiology Division, Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII Hospital, Bergamo
| | - VIttorio Palmieri
- Department of Cardiac Surgery and Transplantation, AORN dei Colli Monaldi-Cotugno-CTO Naples
| | - Raffaele Abete
- Cardiology Division, Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII Hospital, Bergamo
| | - Andrea Lorenzo Vecchi
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation, University of Insubria, Varese
| | - Andrea Mortara
- Department of Clinical Cardiology, Policlinico di Monza, Monza, Italy
| | - Mauro Gori
- Cardiology Division, Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII Hospital, Bergamo
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Roberto De Ponti
- Department of Cardiac Surgery and Transplantation, AORN dei Colli Monaldi-Cotugno-CTO Naples
| | - Michele Senni
- Cardiology Division, Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII Hospital, Bergamo
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Diamond J, DeVore AD. New Strategies to Prevent Rehospitalizations for Heart Failure. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2022; 24:199-212. [PMID: 36164396 PMCID: PMC9493159 DOI: 10.1007/s11936-022-00969-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/24/2022]
Abstract
Purpose of review Heart failure (HF) hospitalizations are common, costly, associated with poor outcomes and potentially avoidable. Reducing HF hospitalizations is therefore a major objective of US healthcare. This review aims to outline causes for HF hospitalizations and provides actionable strategies for HF hospitalization prevention. Recent findings Heart failure hospitalizations often have multifactorial and diverse etiologies associated with medical and social patient factors leading to increased congestion. The most recently updated American Heart Association/American College of Cardiology/Heart Failure Society of America Guidelines for the Management of HF were published in 2022 and utilize high-quality evidence to offer a framework for analyzing and preventing HF hospitalizations. Summary Prevention of hospitalizations can be achieved by optimizing guideline-directed medical therapies, incorporating appropriate device-based technologies, and utilizing systems-based practices. By identifying treatment gaps and opportunities for improved HF care, this review comprehensively defines the challenges associated with HF rehospitalizations as well as potential solutions.
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Affiliation(s)
- Jamie Diamond
- Division of Cardiology and Department of Medicine, Duke University School of Medicine, 200 Trent Drive, 4th FloorRoom #4225, Orange ZoneDurham, NC 27710 USA
| | - Adam D DeVore
- Division of Cardiology and Department of Medicine, Duke University School of Medicine, 200 Trent Drive, 4th FloorRoom #4225, Orange ZoneDurham, NC 27710 USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC USA
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Verma A, Fonarow GC, Hsu JJ, Jackevicius CA, Mody FV, Amidi O, Goldberg S, Upparapalli D, Theodoropoulos K, Gregorio S, Chang DS, Bostrom K, Althouse AD, Ziaeian B. The design of the Dashboard Activated Services and Telehealth for Heart Failure (DASH-HF) study: A pragmatic quality improvement randomized implementation trial for patients with heart failure with reduced ejection fraction. Contemp Clin Trials 2022; 120:106895. [PMID: 36028192 PMCID: PMC9635621 DOI: 10.1016/j.cct.2022.106895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/14/2022] [Accepted: 08/20/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Gaps in the receipt and dosing of guideline-directed medical therapy (GDMT) persist for patients with heart failure with reduced ejection fraction (HFrEF) [1]. In 2020, the Veterans Affairs (VA) developed a heart failure (HF) specific population dashboard to monitor care quality and performance on standard HFrEF performance measures [2]. METHODS The Dashboard Activated Services and Telehealth for HF (DASH-HF) study is a pragmatic randomized quality improvement study designed to evaluate the utility of proactive population management clinics using the VA's HF dashboard to optimize GDMT for patients with HFrEF. Panel management telemedicine clinics incorporated multidisciplinary clinicians to perform chart review and impromptu telephone encounters to evaluate current HFrEF management and opportunities to optimize GDMT. The study will evaluate the efficacy of proactive panel management to usual care at 6 months as quantified by the GDMT optimization potential score. Secondary outcomes include hospitalizations, mortality, and clinician time per intervention. The study completed enrollment and randomization of 300 participants. The intervention was performed from September to December 2021. CONCLUSION DASH-HF will contribute to the literature by evaluating use of the existing VA dashboard to identify HF patients with the lowest adherence to GDMT and proactively target this group for the intervention. REGISTRATION https://clinicaltrials.gov/. Unique identifier: NCT05001165.
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Affiliation(s)
- Aradhana Verma
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Jeffrey J Hsu
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Division of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Cynthia A Jackevicius
- Department of Pharmacy Practice and Administration, Western University of Health Sciences, Pomona, CA, Department of Pharmacy, VA Greater Los Angeles Healthcare System, ICES, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Freny Vaghaiwalla Mody
- Division of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Omid Amidi
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Sarah Goldberg
- Division of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Deepti Upparapalli
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Kleanthis Theodoropoulos
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Stephanie Gregorio
- Department of Pharmacy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Donald S Chang
- Division of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Kristina Bostrom
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Division of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Andrew D Althouse
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Boback Ziaeian
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Division of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America.
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Hariharaputhiran S, Peng Y, Ngo L, Ali A, Hossain S, Visvanathan R, Adams R, Chan W, Ranasinghe I. Long-term survival and life expectancy following an acute heart failure hospitalization in Australia and New Zealand. Eur J Heart Fail 2022; 24:1519-1528. [PMID: 35748124 PMCID: PMC9804480 DOI: 10.1002/ejhf.2595] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 01/05/2023] Open
Abstract
AIMS Contemporary long-term survival following a heart failure (HF) hospitalization is uncertain. We evaluated survival up to 10 years after a HF hospitalization using national data from Australia and New Zealand, identified predictors of survival, and estimated the attributable loss in life expectancy. METHODS AND RESULTS Patients hospitalized with a primary diagnosis of HF from 2008-2017 were identified and all-cause mortality assessed by linking with Death Registries. Flexible parametric survival models were used to estimate survival, predictors of survival and loss in life expectancy. A total of 283 048 patients with HF were included (mean age 78.2 ± 12.3 years, 50.8% male). Of these, 48.3% (48.1-48.5) were surviving by 3 years, 34.1% (33.9-34.3) by 5 years and 17.1% (16.8-17.4) by 10 years (median survival 2.8 years). Survival declined with age with 53.4% of patients aged 18-54 years and 6.2% aged ≥85 years alive by 10 years (adjusted hazard ratio [aHR] for mortality 4.84, 95% confidence interval [CI] 4.65-5.04 for ≥85 years vs. 18-54 years) and was worse in male patients (aHR 1.14, 95% CI 1.13-1.15). Prior HF (aHR 1.20, 95% CI 1.18-1.22), valvular and rheumatic heart disease (aHR 1.11, 95% CI 1.10-1.13) and vascular disease (aHR 1.07, 95% CI 1.04-1.09) were cardiovascular comorbidities most strongly associated with long-term death. Non-cardiovascular comorbidities and geriatric syndromes were common and associated with higher mortality. Compared with the general population, HF was associated with a loss of 7.3 years in life expectancy (or 56.6% of the expected life expectancy) and reached 20.5 years for those aged 18-54 years. CONCLUSION Less than one in five patients hospitalized for HF were surviving by 10 years with patients experiencing almost 60% loss in life expectancy compared with the general population, highlighting the considerable persisting societal burden of HF. Concerted multidisciplinary efforts are needed to improve post-hospitalization outcomes of HF.
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Affiliation(s)
| | - Yang Peng
- Department of CardiologyThe Prince Charles HospitalBrisbaneQLDAustralia,School of Clinical MedicineThe University of QueenslandBrisbaneQLDAustralia
| | - Linh Ngo
- Department of CardiologyThe Prince Charles HospitalBrisbaneQLDAustralia,School of Clinical MedicineThe University of QueenslandBrisbaneQLDAustralia
| | - Anna Ali
- Discipline of MedicineUniversity of AdelaideAdelaideSAAustralia
| | - Sadia Hossain
- School of Public HealthUniversity of AdelaideAdelaideSAAustralia,Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical SchoolUniversity of AdelaideAdelaideSAAustralia
| | - Renuka Visvanathan
- College of Medicine and Public HealthFlinders UniversityAdelaideSAAustralia,Aged & Extended Care Services, Queen Elizabeth Hospital and Basil Hetzel InstituteCentral Adelaide Local Health NetworkAdelaideSAAustralia,National Health and Medical Research Council, Centre of Research Excellence in Frailty and Healthy AgeingUniversity of AdelaideAdelaideSAAustralia
| | - Robert Adams
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical SchoolUniversity of AdelaideAdelaideSAAustralia
| | - Wandy Chan
- Department of CardiologyThe Prince Charles HospitalBrisbaneQLDAustralia,School of Clinical MedicineThe University of QueenslandBrisbaneQLDAustralia
| | - Isuru Ranasinghe
- Department of CardiologyThe Prince Charles HospitalBrisbaneQLDAustralia,School of Clinical MedicineThe University of QueenslandBrisbaneQLDAustralia
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Lauffenburger JC, Lu Z, Mahesri M, Kim E, Tong A, Kim SC. Using Data-Driven Approaches to Classify and Predict Health Care Spending in Patients With Gout Using Urate-Lowering Therapy. Arthritis Care Res (Hoboken) 2022; 75:1300-1310. [PMID: 36039962 DOI: 10.1002/acr.25008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/17/2022] [Accepted: 08/25/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Despite increasing overall health care spending over the past several decades, little is known about long-term patterns of spending among US patients with gout. Current approaches to assessing spending typically focus on composite measures or patients agnostic to disease state; in contrast, examining spending using longitudinal measures may better discriminate patients and target interventions to those in need. We used a data-driven approach to classify and predict spending patterns in patients with gout. METHODS Using insurance claims data from 2017-2019, we used group-based trajectory modeling to classify patients ages 40 years or older diagnosed with gout and treated with urate-lowering therapy (ULT) by their total health care spending over 2 years. We assessed the ability to predict membership in each spending group using logistic and generalized boosted regression with split-sample validation. Models were estimated using different sets of predictors and evaluated using C statistics. RESULTS In 57,980 patients, the mean ± SD age was 71.0 ± 10.5 years, and 17,194 patients (29.7%) were female. The best-fitting model included the following groups: minimal spending (13.2%), moderate spending (37.4%), and high spending (49.4%). The ability to predict groups was high overall (e.g., boosted C statistics with all predictors: minimal spending [0.89], moderate spending [0.78], and high spending [0.90]). Although average adherence was relatively high in the population, for the high-spending group, the most influential predictors were greater gout medication adherence and diabetes melllitus diagnosis. CONCLUSION We identified distinct long-term health care spending patterns in patients with gout using ULT with high accuracy. Several clinical predictors could be key areas for intervention, such as gout medication use or diabetes melllitus.
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Affiliation(s)
| | - Zhigang Lu
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mufaddal Mahesri
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Erin Kim
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Angela Tong
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Seoyoung C Kim
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Poon S, Leis B, Lambert L, MacFarlane K, Anderson K, Blais C, Demers C, Ezekowitz JA, Hawkins NM, Lee DS, Moe G, Sandhu RK, Virani SA, Wilton S, Zieroth S, McKelvie R. The State of Heart Failure Care in Canada: Minimal Improvement in Readmissions Over Time Despite an Increased Number of Evidence-Based Therapies. CJC Open 2022; 4:667-675. [PMID: 36035740 PMCID: PMC9402962 DOI: 10.1016/j.cjco.2022.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/01/2022] Open
Abstract
Background Methods Results Conclusions
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50
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Rizzuto N, Charles G, Knobf MT. Decreasing 30-Day Readmission Rates in Patients With Heart Failure. Crit Care Nurse 2022; 42:13-19. [PMID: 35908767 DOI: 10.4037/ccn2022417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Heart failure affects approximately 6.2 million adults in the United States and has an estimated national cost of $30.7 billion annually. Despite advances in treatment, heart failure is a leading cause of hospital readmissions. Nonadherence to treatment plans, lack of education, and lack of access to care contribute to poorer outcomes. LOCAL PROBLEM For patients with heart failure, the mean readmission rate is 21% nationally and 23% in New York State. Before the pilot heart failure program began, the 30-day readmission rate in the study institution was 28.6%. METHODS A multidisciplinary team created a heart failure self-care pilot program that was implemented on a hospital telemetry unit with 47 patients. Patients received education on their disease process, medications, diet, exercise, and early symptom recognition. Patients received a follow-up telephone call 48 to 72 hours after discharge and were seen by a cardiologist within a week of discharge. RESULTS The 30-day readmission rate for heart failure decreased by 16.6% after implementation of the pilot program, which improved patient adherence to their medication and treatment plan and resulted in a reduction of readmissions. DISCUSSION Patients in the pilot program represented diverse backgrounds. Socioeconomic factors such as the lack of affordable, healthy food choices and easy access to resources were associated with worse outcomes. CONCLUSIONS The evidence-based heart failure program improved knowledge, early symptom recognition, lifestyle modification, and adherence to medication, treatment plan, and follow-up appointments. The multidisciplinary team approach to the heart failure program reduced gaps in care and improved coordination and transition of care.
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Affiliation(s)
- Nancy Rizzuto
- Nancy Rizzuto is an adult nurse practitioner and the Director of Nursing, Critical Care, and Cardiology Services, Brookdale University Hospital, Brooklyn, New York
| | - Greg Charles
- Greg Charles is a program director for Cardiology Services and an angioplasty specialist, Brookdale University Hospital
| | - M Tish Knobf
- M. Tish Knobf is a professor of nursing, Yale University School of Nursing, Orange, Connecticut
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