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Hofmarcher T, Cabrales Alin D, Linde C. Cost effectiveness of implementing ESC guidelines for treatment of iron deficiency in heart failure in the Nordic countries. SCAND CARDIOVASC J 2019; 52:348-355. [DOI: 10.1080/14017431.2018.1546894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Thomas Hofmarcher
- Department of Economics, Lund University, Lund, Sweden
- IHE – The Swedish Institute for Health Economics, Lund, Sweden
| | | | - Cecilia Linde
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
- Karolinska Institutet, Stockholm, Sweden
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102
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Tschöpe C, Kherad B, Klein O, Lipp A, Blaschke F, Gutterman D, Burkhoff D, Hamdani N, Spillmann F, Van Linthout S. Cardiac contractility modulation: mechanisms of action in heart failure with reduced ejection fraction and beyond. Eur J Heart Fail 2019; 21:14-22. [PMID: 30485591 PMCID: PMC6607484 DOI: 10.1002/ejhf.1349] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/04/2018] [Accepted: 08/20/2018] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is responsible for substantial morbidity and mortality and is increasing in prevalence. Although there has been remarkable progress in the treatment of HF with reduced ejection fraction (HFrEF), morbidity and mortality are still substantial. Cardiac contractility modulation (CCM) signals, consisting of biphasic high-voltage bipolar signals delivered to the right ventricular septum during the absolute refractory period, have been shown to improve symptoms, exercise tolerance and quality of life and reduce the rate of HF hospitalizations in patients with ejection fractions (EF) between 25% and 45%. CCM therapy is currently approved in the European Union, China, India, Australia and Brazil for use in symptomatic HFrEF patients with normal or slightly prolonged QRS duration. CCM is particularly beneficial in patients with baseline EF between 35% and 45%, which includes half the range of HF patients with mid-range EFs (HFmrEF). At the cellular level, CCM has been shown in HFrEF patients to improve calcium handling, to reverse the foetal myocyte gene programme associated with HF, and to facilitate reverse remodelling. This review highlights the preclinical and clinical literature related to CCM in HFrEF and HFmrEF and outlines the potential of CCM for HF with preserved EF, concluding that CCM may fill an important unmet need in the therapeutic approach to HF across the range of EFs.
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Affiliation(s)
- Carsten Tschöpe
- Department of CardiologyUniversitätsmedizin Berlin, Campus Virchow Klinikum (CVK)BerlinGermany
- Berlin Center for Regenerative Therapies (BCRT), Campus Virchow Klinikum (CVK)Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site BerlinBerlinGermany
| | - Behrouz Kherad
- Department of CardiologyUniversitätsmedizin Berlin, Campus Virchow Klinikum (CVK)BerlinGermany
| | - Oliver Klein
- Department of CardiologyUniversitätsmedizin Berlin, Campus Virchow Klinikum (CVK)BerlinGermany
- Berlin Center for Regenerative Therapies (BCRT), Campus Virchow Klinikum (CVK)Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site BerlinBerlinGermany
| | - Axel Lipp
- Department of NeurologyUniversitätsmedizin Berlin, CVKBerlinGermany
| | - Florian Blaschke
- Department of CardiologyUniversitätsmedizin Berlin, Campus Virchow Klinikum (CVK)BerlinGermany
| | | | | | - Nazha Hamdani
- Department of Cardiovascular PhysiologyRuhr University BochumBochumGermany
| | - Frank Spillmann
- Department of CardiologyUniversitätsmedizin Berlin, Campus Virchow Klinikum (CVK)BerlinGermany
| | - Sophie Van Linthout
- Department of CardiologyUniversitätsmedizin Berlin, Campus Virchow Klinikum (CVK)BerlinGermany
- Berlin Center for Regenerative Therapies (BCRT), Campus Virchow Klinikum (CVK)Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site BerlinBerlinGermany
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103
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Keane C, McClelland S, Gallagher J, O'Reilly O, Fawsitt R, Ledwidge M, McDonald K. The Heart Failure Virtual Consultation - a powerful tool for the delivery of specialist care and the democratization of knowledge in the community. Eur J Heart Fail 2018; 21:255-256. [DOI: 10.1002/ejhf.1390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/30/2018] [Accepted: 11/19/2018] [Indexed: 12/30/2022] Open
Affiliation(s)
- Ciara Keane
- Heart Failure Unit, St. Vincent's University Hospital; School of Medicine, University College Dublin; Dublin Ireland
| | - Sarah McClelland
- Heart Failure Unit, St. Vincent's University Hospital; School of Medicine, University College Dublin; Dublin Ireland
| | - Joe Gallagher
- Irish College of General Practicioners; Dublin Ireland
| | - Orlaith O'Reilly
- Integrated Care Programme for the Prevention and Management of Chronic Disease, Health Service Executive; Dublin Ireland
| | | | - Mark Ledwidge
- Heart Failure Unit, St. Vincent's University Hospital; School of Medicine, University College Dublin; Dublin Ireland
| | - Ken McDonald
- Heart Failure Unit, St. Vincent's University Hospital; School of Medicine, University College Dublin; Dublin Ireland
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104
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Iyngkaran P, Liew D, Neil C, Driscoll A, Marwick TH, Hare DL. Moving From Heart Failure Guidelines to Clinical Practice: Gaps Contributing to Readmissions in Patients With Multiple Comorbidities and Older Age. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2018; 12:1179546818809358. [PMID: 30618487 PMCID: PMC6299336 DOI: 10.1177/1179546818809358] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 09/14/2018] [Indexed: 12/20/2022]
Abstract
This feature article for the thematic series on congestive heart failure (CHF) readmissions aims to outline important gaps in guidelines for patients with multiple comorbidities and the elderly. Congestive heart failure diagnosis manifests as a 3-phase journey between the hospital and community, during acute, chronic stable, and end-of-life (palliative) phases. This journey requires in variable intensities a combination of multidisciplinary care within tertiary hospital or ambulatory care from hospital outpatients or primary health services, within the general community. Management goals are uniform, ie, to achieve the lowest New York Heart Association class possible, with improvement in ejection fraction, by delivering gold standard therapies within a CHF program. Comorbidities are an important common denominator that influences outcomes. Comorbidities include diabetes mellitus, chronic obstructive airways disease, chronic renal impairment, hypertension, obesity, sleep apnea, and advancing age. Geriatric care includes the latter as well as syndromes such as frailty, falls, incontinence, and confusion. Many systems still fail to comprehensively achieve all aspects of such programs. This review explores these factors.
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Affiliation(s)
- Pupalan Iyngkaran
- Northern Territory Medical Program, Flinders University, Darwin, NT, Australia
- Pupalan Iyngkaran, Yellow Building 4 Cnr University Drive North & University Drive West Charles Darwin University, Casuarina, NT 0815, Australia.
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christopher Neil
- Department of Medicine—Western Precinct, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrea Driscoll
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
- Austin Health, Melbourne, VIC, Australia
| | | | - David L Hare
- Cardiovascular Research, The University of Melbourne, Melbourne, VIC, Australia
- Heart Failure Services, Austin Health, Melbourne, VIC, Australia
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105
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Favilli S, Prandstraller D, Spaziani G, Calabri GB, Lombardi M, Balducci A, Vairo U. Age-related issues: From fetus to adolescent. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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106
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Wändell P, Carlsson AC, Li X, Gasevic D, Ärnlöv J, Holzmann MJ, Sundquist J, Sundquist K. Heart failure in immigrant groups: a cohort study of adults aged 45 years and over in Sweden. SCAND CARDIOVASC J 2018; 52:292-300. [PMID: 30445882 DOI: 10.1080/14017431.2018.1546892] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE An increased risk of being diagnosed with coronary heart disease or atrial fibrillation has been shown among different immigrant groups. However, less is known on the risk of being diagnosed with congestive heart failure (CHF). DESIGN We studied CHF in immigrants including all adults ≥45 years in Sweden (n = 3,274,119) from 1998 to 2012. CHF was defined as at the first event registered in the National Patient Register. Risk of incident CHF in immigrant groups compared to the Swedish-born population was assessed by Cox regression, stratified by sex, adjusting for age, socio-demographic status, and co-morbidities. RESULTS During a mean follow-up of 14 years in total, a total of 302,340 (9.2%) events of CHF were registered. We found the following: higher incidence in men from Bosnia, Iraq, Lebanon, Russia and Africa; among women from Bosnia, Iraq, Lebanon, Turkey, Central Europe and Finland; lower incidence in men from Iceland, Latin America, Southern Europe, Norway and Western Europe; and among women from Iceland, Southern Europe, Norway, Denmark and Western Europe. CONCLUSION It is important to be aware of the increased incidence of CHF in some immigrant groups, especially from countries and areas where the immigrants have been refugees, in order to enable for a timely diagnosis, treatment of and prevention of CHF and its debilitating complications.
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Affiliation(s)
- Per Wändell
- a Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society , Karolinska Institutet , Huddinge , Sweden
| | - Axel C Carlsson
- a Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society , Karolinska Institutet , Huddinge , Sweden
| | - Xinjun Li
- b Center for Primary Health Care Research , Lund University , Malmö , Sweden
| | - Danijela Gasevic
- c Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine , University of Edinburgh , Edinburgh , UK.,d School of Public Health and Preventive Medicine , Monash University , Melbourne , Australia
| | - Johan Ärnlöv
- a Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society , Karolinska Institutet , Huddinge , Sweden.,e School of Health and Social Studies , Dalarna University , Falun , Sweden
| | - Martin J Holzmann
- f Functional Area of Emergency Medicine , Karolinska University Hospital , Stockholm , Sweden.,g Department of Internal Medicine Solna , Karolinska Institutet , Stockholm , Sweden
| | - Jan Sundquist
- b Center for Primary Health Care Research , Lund University , Malmö , Sweden.,h Department of Family Medicine and Community Health, Department of Population Health Science and Policy , Icahn School of Medicine at Mount Sinai , New York , NY , USA.,i Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine , Shimane University , Matsue , Japan
| | - Kristina Sundquist
- b Center for Primary Health Care Research , Lund University , Malmö , Sweden.,h Department of Family Medicine and Community Health, Department of Population Health Science and Policy , Icahn School of Medicine at Mount Sinai , New York , NY , USA.,i Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine , Shimane University , Matsue , Japan
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107
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Liljeroos M, Strömberg A. Introducing nurse-led heart failure clinics in Swedish primary care settings. Eur J Heart Fail 2018; 21:103-109. [PMID: 30338881 DOI: 10.1002/ejhf.1329] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/02/2018] [Accepted: 09/10/2018] [Indexed: 12/28/2022] Open
Abstract
AIM According to clinical guidelines, it is recommended that patients with heart failure (HF) receive structured multidisciplinary care at nurse-led HF clinics in order to optimise treatment and avoid preventable readmissions. Today, there are HF clinics with specialist-trained nurses at almost all Swedish hospitals, but HF clinics remain scarce in primary care (PC). The aim of this study was two-fold: firstly, to evaluate the effects of systematically implementing nurse-led HF clinics in PC settings with regard to hospital healthcare utilisation and evidence-based HF treatment, and secondly to explore patients' experiences of HF clinics in PC. METHODS AND RESULTS The study had a pre-post design. Annual measurement were done between 2010-2017 regarding in-hospital healthcare consumption and medical treatment. Data from 2011-2017 after the implementation of HF clinics in PC in one county council Sweden were compared with baseline data collected before the implementation in 2010. The implementation of HF clinics in PC significantly reduced the number of HF-related hospital admissions by 27% (P < 0.001), HF hospital days by 27.3% (P < 0.001) and HF emergency room visits by 24% (P < 0.001). Further, patients were to a higher extent medically treated according to guidelines and satisfied with the care they received at the PC HF clinic. CONCLUSION Nurse-led HF clinics in PC seem to be effective in reducing the need for in-hospital care and provide high quality person-centred care.
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Affiliation(s)
- Maria Liljeroos
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Anna Strömberg
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden.,Sue & Bill Gross School of Nursing, University of California Irvine, CA, USA
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108
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Schmidt-Mende K, Wettermark B, Andersen M, Elsevier M, Carrero JJ, Shemeikka T, Hasselström J. Prevalence of renally inappropriate medicines in older people with renal impairment - A cross-sectional register-based study in a large primary care population. Basic Clin Pharmacol Toxicol 2018; 124:256-265. [PMID: 30328682 DOI: 10.1111/bcpt.13127] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/04/2018] [Indexed: 12/21/2022]
Abstract
The aim of this population-based, cross-sectional study was to analyse the prevalence of renally inappropriate medicines (RIMs) in older people with renal impairment. We included 30 372 people aged ≥65 years with chronic kidney disease (CKD) stage 3, and 2161 with stage 4 attending primary care in Stockholm, Sweden. We used data derived from SCREAM, a database linking patient-specific data on demography, morbidity, healthcare consumption and dispensed drugs to creatinine measurements. Estimated glomerular filtration rate was calculated with CKD-EPI based on the first non-hospital serum creatinine in 2010. RIMs were defined as medicines needing dose adjustment or being contra-indicated in CKD stage 3 or 4 with reference to Swedish "Janusmed Drugs and Renal function." Dispensed prescription drugs were analysed during 1 year after creatinine assessment. Drug doses were considered as excessive if their mean volume dispensed per day exceeded the recommended dose. Contra-indicated medicines were regarded as inappropriate if dispensed at least once during 1 year. Excessive dosing was present in 42.5% of older people with CKD stage 3 and in 58.1% with stage 4. The prevalence of contra-indicated medicines was 9.4% and 38.0%, respectively. A limited number of RIMs accounted for the majority of excessive dosing, such as drugs acting on the renin-angiotensin-aldosterone system, betablockers and opioids. Commonly dispensed contra-indicated substances were NSAIDs and antidiabetics. We conclude that the prevalence of RIMs in older people with renal impairment is considerably high. Still, RIM use may be manageable as only a limited number of RIMs are frequently used.
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Affiliation(s)
- Katharina Schmidt-Mende
- Academic Primary Health Care Centre, Stockholm County Council, Stockholm, Sweden.,Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
| | - Björn Wettermark
- Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden.,Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Morten Andersen
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.,Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Monique Elsevier
- Heymans Institute of Clinical Pharmacology, University Hospital Gent, Gent, Belgium
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Tero Shemeikka
- Department of Digital Health and Care, Public Healthcare Services Administration, Stockholm County Council, Stockholm, Sweden
| | - Jan Hasselström
- Academic Primary Health Care Centre, Stockholm County Council, Stockholm, Sweden.,Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
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109
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Ivanova I, Elseviers M, Wettermark B, Schmidt Mende K, Vander Stichele R, Christiaens T. Electronic assessment of cardiovascular potentially inappropriate medications in an administrative population database. Basic Clin Pharmacol Toxicol 2018; 124:62-73. [DOI: 10.1111/bcpt.13095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/08/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Ivana Ivanova
- Clinical Pharmacology Research Unit; Heymans Institute of Pharmacology; Ghent University; Ghent Belgium
| | - Monique Elseviers
- Clinical Pharmacology Research Unit; Heymans Institute of Pharmacology; Ghent University; Ghent Belgium
- Centre For Research and Innovation in Care (CRIC); University of Antwerp; Wilrijk Belgium
| | - Bjorn Wettermark
- Public Healthcare Services Committee Administration; Stockholm County Council; Stockholm Sweden
- Department of Medicine; Unit for Clinical Epidemiology; Centre for Pharmacoepidemiology; Karolinska Institutet; Stockholm Sweden
| | - Katharina Schmidt Mende
- Academic Primary Health Care Center; Stockholm County Council; Huddinge Sweden
- Department of Neurobiology, Care Sciences and Society; Division of Family Medicine; Karolinska Institute; Huddinge Sweden
| | - Robert Vander Stichele
- Clinical Pharmacology Research Unit; Heymans Institute of Pharmacology; Ghent University; Ghent Belgium
| | - Thierry Christiaens
- Clinical Pharmacology Research Unit; Heymans Institute of Pharmacology; Ghent University; Ghent Belgium
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110
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Säfström E, Jaarsma T, Strömberg A. Continuity and utilization of health and community care in elderly patients with heart failure before and after hospitalization. BMC Geriatr 2018; 18:177. [PMID: 30103688 PMCID: PMC6090801 DOI: 10.1186/s12877-018-0861-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/11/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The period after hospitalization due to deteriorated heart failure (HF) is characterized as a time of high generalized risk. The transition from hospital to home is often problematic due to insufficient coordination of care, leading to a fragmentation of care rather than a seamless continuum of care. The aim was to describe health and community care utilization prior to and 30 days after hospitalization, and the continuity of care in patients hospitalized due to de novo or deteriorated HF from the patients' perspective and from a medical chart review. METHODS This was a cross-sectional study with consecutive inclusion of patients hospitalized at a county hospital in Sweden due to deteriorated HF during 2014. Data were collected by structured telephone interviews and medical chart review and analyzed with the Spearman's rank correlation coefficient and Chi square. A P value of 0.05 was considered significant. RESULTS A total of 121 patients were included in the study, mean age 82.5 (±6.8) and 49% were women. Half of the patients had not visited any health care facility during the month prior to the index hospital admission, and 79% of the patients visited the emergency room (ER) without a referral. Among these elderly patients, a total of 40% received assistance at home prior to hospitalization and 52% after discharge. A total of 86% received written discharge information, one third felt insecure after hospitalization and lacked knowledge of which health care provider to consult with and contact in the event of deterioration or complications. Health care utilization increased significantly after hospitalization. CONCLUSION Most patients had not visited any health care facility within 30 days before hospitalization. Health care utilization increased significantly after hospitalization. Flaws in the continuity of care were found; even though most patients received written information at discharge, one third of the patients lacked knowledge about which health care provider to contact in the event of deterioration and felt insecure at home after discharge.
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Affiliation(s)
- Emma Säfström
- Sörmland County Council, Nyköping Hospital, Nyköping, Sweden
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Anna Strömberg
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University, Linköping, Sweden
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111
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Ergatoudes C, Thunström E, Hansson PO, Morales D, Mandalenakis Z, Rosengren A, Zhong Y, Caidahl K, Fu M. Natriuretic and Inflammatory Biomarkers as Risk Predictors of Heart Failure in Middle-Aged Men From the General Population: A 21-Year Follow-Up. J Card Fail 2018; 24:594-600. [PMID: 30048772 DOI: 10.1016/j.cardfail.2018.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 07/03/2018] [Accepted: 07/13/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although several biomarkers, including natriuretic peptides and inflammatory biomarkers, have proven to be useful prognostic predictors in patients with heart failure (HF), their predictive value for incident HF has not been extensively studied. METHODS AND RESULTS The "Study of Men Born in 1943" is a longitudinal, prospective study of men living in the city of Gothenburg, Sweden. A panel of biomarkers consisting of interleukin-6 (IL-6), cystatin C, high-sensitivity C-reactive protein (hs-CRP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) was analyzed from blood samples collected in 1993 in men aged 50 years. Incident HF was recorded from multiple sources, including an echocardiographic assessment in 2014. A total of 747 (94%) of the 798 participants with no previous history of HF were included. Of these 747 participants, 85 (11.4%) developed HF over a 21-year follow-up. After adjustment for body mass index (BMI) and hypertension at baseline, NT-proBNP ≥25 ng/L was associated with a higher risk of HF (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.30-3.36; P = .0024), as was hs-CRP >3 mg/L (OR 2.61, 95% CI 1.59-4.29; P = .0002). In a multivariable model, the expected probability of HF was 0.33 (95% CI 0.23-0.45) in hypertensive patients with hs-CRP >3 mg/L, NT-proBNP ≥25 ng/L, and BMI ≥25 kg/m2, compared with a probability of 0.04 (95% CI 0.02-0.07) in nonhypertensive patients with hs-CRP ≤3 mg/L, NT-proBNP <25 ng/L, and BMI <25 kg/m.2 CONCLUSIONS: NT-proBNP ≥25 ng/L and elevated hs-CRP levels in men aged 50 years were predictive biomarkers for HF over a 2one year follow-up.
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Affiliation(s)
- Constantinos Ergatoudes
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Erik Thunström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - David Morales
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - You Zhong
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Kenneth Caidahl
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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112
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Andersson L, Nordgren L. Heart Failure Patients' Perceptions of Received and Wanted Information: A Cross-Sectional Study. Clin Nurs Res 2018; 28:340-355. [PMID: 29986617 DOI: 10.1177/1054773818787196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate heart failure patients' perceptions of received and wanted information and to identify differences regarding received and wanted information in relation to sociodemographic variables. A cross-sectional descriptive design was used. Patients with heart failure ( n = 192) were recruited from six primary health care centers in Sweden. Data were collected by a postal questionnaire. A majority of the respondents had received information about the condition and the medication. Within primary health care, most respondents had been informed about medication. The respondents wanted more information about continued care and treatment, medication, and the condition. There were significant differences between sociodemographic groups concerning what information they wanted. Clinical nurses can support patients with heart failure by using evidence-based methods that strengthen the patients' self-efficacy and by individualized information that increases patients' knowledge and improves their self-care behaviors. Future studies are needed to identify informational needs of particular fragile groups of patients.
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Affiliation(s)
- Lena Andersson
- 1 Vårdcentralen Centrum Flen, Sweden.,2 Research and Development Centre, Sörmland County Council/Centre for Clinical Research Sörmland, Uppsala University, Sweden
| | - Lena Nordgren
- 2 Research and Development Centre, Sörmland County Council/Centre for Clinical Research Sörmland, Uppsala University, Sweden.,3 Department of Public Health and Caring Sciences, Uppsala University, Sweden
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113
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Karlsson Lind L, Komen J, Wettermark B, von Euler M, Tomson T. Valproic acid utilization among girls and women in Stockholm: Impact of regulatory restrictions. Epilepsia Open 2018; 3:357-363. [PMID: 30187006 PMCID: PMC6119758 DOI: 10.1002/epi4.12228] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2018] [Indexed: 11/11/2022] Open
Abstract
Objective In November 2014, the European Medicines Agency (EMA) strengthened restrictions on the use of valproic acid in girls and women of childbearing potential. The objective of this study was to determine whether there has been a change in initiations of valproic acid treatment to females after the regulatory restrictions and to assess if such changes differed between indications (epilepsy and psychiatric disorder). Methods An interrupted time-series analysis was conducted using all initiations of valproic acid in Stockholm, Sweden. from January 2011 to June 2017. Female and male patients aged 0-45 years with a recorded diagnosis of epilepsy and/or a psychiatric disorder were compared. Results Before the EMA warning, a decline in trend of valproic acid initiations was seen in patients with epilepsy. After the warning, a significant decrease of valproic acid initiations was seen in women with a psychiatric disorder, but not in women with epilepsy. Significance The regulatory warning appeared to have significantly influenced valproic acid initiations in women of childbearing age with a psychiatric disorder. No effect was seen in women with epilepsy, probably because the decline had started long before.
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Affiliation(s)
- Linnéa Karlsson Lind
- Health and Medical Care Administration Stockholm County Council Stockholm Sweden.,Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Joris Komen
- Department of Pharmaceutical Sciences Utrecht University Utrecht The Netherlands
| | - Björn Wettermark
- Health and Medical Care Administration Stockholm County Council Stockholm Sweden.,Department of Medicine Solna Centre for Pharmacoepidemiology Karolinska Institutet Karolinska University Hospital Stockholm Sweden
| | - Mia von Euler
- Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden.,Clinical Pharmacology Karolinska University Hospital, Solna Stockholm Sweden.,Department of Medicine, Solna Karolinska Institutet Stockholm Sweden
| | - Torbjörn Tomson
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
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114
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Lymphocyte-to-white blood cells ratio in older patients experiencing a first acute heart failure hospitalization. Eur Geriatr Med 2018; 9:365-370. [PMID: 34654238 DOI: 10.1007/s41999-018-0051-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/24/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Low lymphocyte counts are related to poor health results in heart failure (HF) patients. We assess whether a low lymphocyte-to-white blood cells ratio (LWR) is related to 1-year mortality in older patients experiencing a first hospitalization for acute HF. METHODS We evaluated 859 patients > 75 years of age admitted within a 33-month period because of a first episode of acute HF. Patients were divided into four groups according to LWR quartiles. RESULTS Patients' mean age was 83.5 ± 5.5 years and their median LWR was 16.7%. After 1 year of follow-up 270 patients (31.43%) died. Mean LWR values were significatively lower in the group of patients who died (15.1 vs. 17.4%; p = 0.001). Mortality rates were significantly higher in the lower LWR quartile either at 1 month, 3 months, and 1 year after the index acute HF episode. The univariate logistic regression analysis identified the LWR (either as quartiles or continuous variable) to be independently associated with higher risk of 1-year post-discharge mortality. Multivariate analysis confirmed this association (HR for LWR as a quartiles variable 1.525; 95% CI 1.161-2.003 and for LWR as a continuous variable 1.145; 95% CI 1.069-1854) besides older age, a higher comorbidity and higher admission potassium. CONCLUSIONS As is the case in other HF scenarios, a simple routine admission laboratory test such as lymphocyte count can independently predict 1-year mortality for older patients hospitalized for first time due to acute HF.
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115
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Eriksson B, Wändell P, Dahlström U, Näsman P, Lund LH, Edner M. Comorbidities, risk factors and outcomes in patients with heart failure and an ejection fraction of more than or equal to 40% in primary care- and hospital care-based outpatient clinics. Scand J Prim Health Care 2018; 36:207-215. [PMID: 29633886 PMCID: PMC6066291 DOI: 10.1080/02813432.2018.1459654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The aim of this study is to describe patients with heart failure and an ejection fraction (EF) of more than or equal to 40%, managed in both Primary- and Hospital based outpatient clinics separately with their prognosis, comorbidities and risk factors. Further to compare the heart failure medication in the two groups. DESIGN We used the prospective Swedish Heart Failure Registry to include 9654 out-patients who had HF and EF ≥40%, 1802 patients were registered in primary care and 7852 in hospital care. Descriptive statistical tests were used to analyze base line characteristics in the two groups and multivariate logistic regression analysis to assess mortality rate in the groups separately. SETTING The prospective Swedish Heart Failure Registry. SUBJECTS Patients with heart failure and an ejection fraction (EF) of more than or equal to 40%. MAIN OUTCOME MEASURES Comorbidities, risk factors and mortality. RESULTS Mean-age was 77.5 (primary care) and 70.3 years (hospital care) p < 0.0001, 46.7 vs. 36.3% women respectively (p < 0.0001) and EF ≥50% 26.1 vs. 13.4% (p < 0.0001). Co-morbidities were common in both groups (97.2% vs. 92.3%), the primary care group having more atrial fibrillation, hypertension, ischemic heart disease and COPD. According to the multivariate logistic regression analysis smoking, COPD and diabetes were the most important independent risk factors in the primary care group and valvular disease in the hospital care group. All-cause mortality during mean follow-up of almost 4 years was 31.5% in primary care and 27.8% in hospital care. One year-mortality rates were 7.8%, and 7.0% respectively. CONCLUSION Any co-morbidity was noted in 97% of the HF-patients with an EF of more than or equal to 40% managed at primary care based out-patient clinics and these patients had partly other independent risk factors than those patients managed in hospital care based outpatients clinics. Our results indicate that more attention should be payed to manage COPD in the primary care group. KEY POINTS 97% of heart failure patients with an ejection fraction of more than or equal to 40% managed at primary care based out-patient clinics had any comorbidity. Patients in primary care had partly other independent risk factors than those in hospital care. All-cause mortality during mean follow-up of almost 4 years was higher in primary care compared to hospital care. In matched HF-patients RAS-antagonists, beta-blockers as well as the combination of the two drugs were more seldom prescribed when managed in primary care compared with hospital care.
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Affiliation(s)
- B. Eriksson
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden;
- CONTACT Björn Eriksson Gustavsbergs VCOdelbergs väg 19 13440 Gustavsberg, Stockholm, Sweden
| | - P. Wändell
- Division of Family Medicine, NVS, Karolinska Institutet, Sweden;
| | - U. Dahlström
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, SwedenLinköping;
| | - P. Näsman
- Centre for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden;
| | - L. H. Lund
- Karolinska Institutet, Department of Medicine, Unit of Cardiology, Karolinska University Hospital, Stockholm, Sweden;
| | - M. Edner
- Cardiology Unit, N3: 06, Department of Medicine, Karolinska Institute and University Hospital, Stockholm, Sweden
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116
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Ballo P, Profili F, Policardo L, Roti L, Francesconi P, Zuppiroli A. Opposite trends in hospitalization and mortality after implementation of a chronic care model-based regional program for the management of patients with heart failure in primary care. BMC Health Serv Res 2018; 18:388. [PMID: 29848317 PMCID: PMC5975582 DOI: 10.1186/s12913-018-3164-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/30/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The chronic care model (CCM) is an established framework for the management of patients with chronic illness at the individual and population level. Its application has been previously shown to improve clinical outcome in several conditions, but the prognostic impact of CCM-based programs for the management of patients with chronic heart failure (HF) in primary care is still to be elucidated. METHODS We assessed the prognostic impact of a primary-care, CCM-based project applied in Tuscany, Italy, in 1761 patients with chronic HF enrolled in a retrospective matched cohort study. The project was based on predefined working teams including general practitioners and nurses, proactively scheduled regular follow-up visitations for each patient, counseling for therapy adherence and lifestyle modifications, appropriate diagnostic and therapeutic pathways according to international guidelines, and a key supporting role of the nurses, who were responsible for the practical coordination of the follow-up. A matched group of 3522 HF subjects assisted by general practitioners not involved in the project was considered as control group. The endpoints of this study were HF hospitalization and all-cause mortality. RESULTS Over a 4-year follow-up period, HF hospitalization rate was higher in the CCM group than the controls (12.1 vs 10.3 events/100 patient-years; incidence rate ratio 1.15[1.05-1.27], p = 0.0030). Mortality was lower in the CCM group than the controls (10.8 vs 12.6 events/100 patient-years; incidence rate ratio 0.82[0.75-0.91], p < 0.0001). In multivariable analysis, the CCM status was associated with a 34% higher risk of HF hospitalization and 18% lower risk of death (p < 0.0001 for both). The effect on HF hospitalization was mostly driven by a 50% higher rate of planned HF hospitalization. CONCLUSIONS Implementation of a CCM-based program for the management of HF patients in primary care led to reduced mortality and increased HF hospitalization. These findings support the hypothesis that the beneficial effects of CCM on survival might be extended to patients with chronic HF followed in primary care, but also support the need for further strategies aimed at improving the management of these patients in terms of hospitalizations.
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Affiliation(s)
- Piercarlo Ballo
- Cardiology Unit, S. Maria Annunziata Hospital, via dell’Antella 58, Florence, Italy
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Norberg H, Bergdahl E, Lindmark K. Eligibility of sacubitril-valsartan in a real-world heart failure population: a community-based single-centre study. ESC Heart Fail 2018; 5:337-343. [PMID: 29345425 PMCID: PMC5880656 DOI: 10.1002/ehf2.12251] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/23/2017] [Accepted: 11/23/2017] [Indexed: 12/11/2022] Open
Abstract
AIMS This study aims to investigate the eligibility of the Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor (ARNI) with ACE inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) study to a real-world heart failure population. METHODS AND RESULTS Medical records of all heart failure patients living within the catchment area of Umeå University Hospital were reviewed. This district consists of around 150 000 people. Out of 2029 patients with a diagnosis of heart failure, 1924 (95%) had at least one echocardiography performed, and 401 patients had an ejection fraction of ≤35% at their latest examination. The major PARADIGM-HF criteria were applied, and 95 patients fulfilled all enrolment criteria and thus were eligible for sacubitril-valsartan. This corresponds to 5% of the overall heart failure population and 24% of the population with ejection fraction ≤ 35%. The eligible patients were significantly older (73.2 ± 10.3 vs. 63.8 ± 11.5 years), had higher blood pressure (128 ± 17 vs. 122 ± 15 mmHg), had higher heart rate (77 ± 17 vs. 72 ± 12 b.p.m.), and had more atrial fibrillation (51.6% vs. 36.2%) than did the PARADIGM-HF population. CONCLUSIONS Only 24% of our real-world heart failure and reduced ejection fraction population was eligible for sacubitril-valsartan, and the real-world heart failure and reduced ejection fraction patients were significantly older than the PARADIGM-HF population. The lack of data on a majority of the patients that we see in clinical practice is a real problem, and we are limited to extrapolation of results on a slightly different population. This is difficult to address, but perhaps registry-based randomized clinical trials will help to solve this issue.
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Affiliation(s)
- Helena Norberg
- Department of Pharmacology and Clinical NeuroscienceUmeå UniversityS‐901 87UmeåSweden
- Department of Public Health and Clinical MedicineUmeå UniversityS‐901 87UmeåSweden
| | - Ellinor Bergdahl
- Department of Public Health and Clinical MedicineUmeå UniversityS‐901 87UmeåSweden
| | - Krister Lindmark
- Department of Public Health and Clinical MedicineUmeå UniversityS‐901 87UmeåSweden
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118
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Vitamin D deficiency was common in all patients at a Swedish primary care centre, but more so in patients born outside of Europe. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2018; 26:649-652. [PMID: 30524936 PMCID: PMC6245030 DOI: 10.1007/s10389-018-0910-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 03/13/2018] [Indexed: 12/31/2022]
Abstract
Background Vitamin D is associated with extra-skeletal processes, and vitamin D deficiency might contribute to the development of chronic diseases. Aim To investigate vitamin D levels in an unselected patient population at a Swedish suburban primary care centre. Methods Vitamin D levels were assessed in 102 patients aged 20 to 65 years visiting the primary care centre, independent of cause of visit, during 2 weeks in January 2014. The difference in vitamin D levels between patients born in Europe and patients born outside Europe was calculated using linear regression, adjusting for gender and age. The difference in prevalence of vitamin D deficiency (< 25 nmol/l) was calculated using logistic regression adjusting for gender, age, vitamin D supplement, and sun exposure. Results Patients born outside Europe (n = 66) had 15 nmol/l [95% confidence interval (CI) 9.17–20.84] lower levels of vitamin D than patients born in Europe. Vitamin D deficiency was more common in patients born outside Europe (50%) than in patients born in Europe (11%, odds ratio 8.20 95% CI 2.49–26.98, p < 0.001). Conclusion Lower levels of vitamin D and the prevalence of vitamin D deficiency were more common in patients born outside Europe compared to patients born in Europe.
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119
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Becher PM, Hinrichs S, Fluschnik N, Hennigs JK, Klingel K, Blankenberg S, Westermann D, Lindner D. Role of Toll-like receptors and interferon regulatory factors in different experimental heart failure models of diverse etiology: IRF7 as novel cardiovascular stress-inducible factor. PLoS One 2018. [PMID: 29538462 PMCID: PMC5851607 DOI: 10.1371/journal.pone.0193844] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Heart failure (HF) is a leading cause of morbidity and mortality in the western world. Although optimal medical care and treatment is widely available, the prognosis of patients with HF is still poor. Toll-like receptors (TLRs) are important compartments of the innate immunity. Current studies have identified TLRs as critical mediators in cardiovascular diseases. In the present study, we investigated the involvement of TLRs and interferon (IFN) regulatory factors (IRFs) in different experimental HF models including viral myocarditis, myocardial ischemia, diabetes mellitus, and cardiac hypertrophy. In addition, we investigated for the first time comprehensive TLR and IRF gene and protein expression under basal conditions in murine and human cardiac tissue. We found that Tlr4, Tlr9 and Irf7 displayed highest gene expression under basal conditions, indicating their significant role in first-line defense in the murine and human heart. Moreover, induction of TLRs and IRFs clearly differs between the various experimental HF models of diverse etiology and the concomitant inflammatory status. In the HF model of acute viral-induced myocarditis, TLR and IRF activation displayed the uppermost gene expression in comparison to the remaining experimental HF models, indicating the highest amount of myocardial inflammation in myocarditis. In detail, Irf7 displayed by far the highest gene expression during acute viral infection. Interestingly, post myocardial infarction TLR and IRF gene expression was almost exclusively increased in the infarct zone after myocardial ischemia (Tlr2, Tlr3, Tlr6, Tlr7, Tlr9, Irf3, Irf7). With one exception, Irf3 showed a decreased gene expression in the remote zone post infarction. Finally, we identified Irf7 as novel cardiovascular stress-inducible factor in the pathologically stressed heart. These findings on TLR and IRF function in the inflamed heart highlight the complexity of inflammatory immune response and raise more interesting questions for future investigation.
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Affiliation(s)
- Peter Moritz Becher
- Department for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- * E-mail:
| | - Svenja Hinrichs
- Department for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Nina Fluschnik
- Department for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Jan K. Hennigs
- Section Pneumology, Department of Medicine II, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Stefan Blankenberg
- Department for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Dirk Westermann
- Department for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Diana Lindner
- Department for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
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120
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Bastholm-Rahmner P, Gustafsson LL, Aggefors K, Ateva K, Elfving S, Eriksen J, Jirlow M, Juhasz-Haverinen M, Malmström RE, Nikpour-Ardaly M, Röjvall M, Vallin M, Andersén-Karlsson E, Ovesjö ML. Patients' knowledge and attitudes to the Wise List - a drug formulary from the Stockholm Drug and Therapeutic committee. BMC Health Serv Res 2018. [PMID: 29530028 PMCID: PMC5848508 DOI: 10.1186/s12913-018-2968-2] [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] [Indexed: 11/17/2022] Open
Abstract
Background Involving patients in decisions about their pharmacotherapy is crucial for a satisfactory treatment outcome. Information and opinions about medicines are available from a variety of sources. The Wise List is the drug formulary of recommended essential medicines for the Stockholm healthcare region and is issued by the Drug and Therapeutics Committee (DTC). To inform the public about treatment for common diseases and the concept of recommended medicines, a patient edition of the Wise List was developed. The aim of this study was to explore patients’ knowledge, needs and attitudes to the Wise List, DTC and information about medicines in general. Methods To examine patient knowledge about recommended medicines a survey (n = 312) was carried out at four large primary healthcare centres in Stockholm, Sweden. To further elucidate the patients’ needs of the information on recommended medicines and medicines in general, three focus group discussions (FGDs) were performed. Results Of the respondents 57% did not recognise the Wise List, 26% recognised but did not use it and 17% used it. A total of 63% reported that they search for information about medicines. The most common information source was “asking their doctor” (36%) followed by searching the internet (31%). The FGDs revealed that the patients were not interested in medicines in general, only in the medicines they use themselves. They did not understand the aim of the Wise List or how they could benefit from information about recommended medicines. The patients expressed a wish to access all information they need about their own care as well as public healthcare information at one location. Conclusion The intended aim of the DTC with providing information to the public was not achieved as the patients have difficulties to understand the information and how they should use it. The patients were not interested in medicines in general, they wanted information tailored to their specific needs. The findings highlight the importance of creating tools for patients in collaboration with them and evaluate the concept continuously.
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Affiliation(s)
- Pia Bastholm-Rahmner
- Medical Management Centre, LIME, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.
| | - Lars L Gustafsson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
| | - Kristina Aggefors
- Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | - Kristina Ateva
- Stockholm Drug and Therapeutics Committee, Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | - Susanne Elfving
- Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | - Jaran Eriksen
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
| | - Malena Jirlow
- Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | | | - Rickard E Malmström
- Clinical Pharmacology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Solna, Sweden
| | | | - Magnus Röjvall
- Stockholm Drug and Therapeutics Committee, Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | - Martina Vallin
- Karolinska Institutet, Department of Public Health Sciences, Tomtebodavägen 18A, Stockholm, Sweden
| | - Eva Andersén-Karlsson
- Department of Clinical Science and Education, Södersjukhuset, Internal Medicine, Karolinska Institutet, 118 83, Stockholm, Sweden
| | - Marie-Louise Ovesjö
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
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Luo H, Xu Y, Yue F, Zhang C, Chen C. Quality of inclusion criteria in the registered clinical trials of heart failure with preserved ejection fraction: Is it time for a change? Int J Cardiol 2018; 254:210-214. [DOI: 10.1016/j.ijcard.2017.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 12/01/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
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Stamp KD, Prasun M, Lee CS, Jaarsma T, Piano MR, Albert NM. Nursing research in heart failure care: a position statement of the american association of heart failure nurses (AAHFN). Heart Lung 2018; 47:169-175. [PMID: 29397988 DOI: 10.1016/j.hrtlng.2018.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Heart Failure (HF) is a public health problem globally affecting approximately 6 million in the United States. OBJECTIVES A tailored position statement was developed by the American Association of Heart Failure Nurses (AAHFN) and their Research Consortium to assist researchers, funding institutions and policymakers with improving HF clinical advancements and outcomes. METHODS A comprehensive review was conducted using multiple search terms in various combinations to describe gaps in HF nursing science. Based on gaps described in the literature, the AAHFN made recommendations for future areas of research in HF. RESULTS Nursing has made positive contributions through disease management interventions, however, quality, rigorous research is needed to improve the lives of patients and families while advancing nursing science. CONCLUSIONS Advancing HF science is critical to managing and improving patient outcomes while promoting the nursing profession. Based on this review, the AAHFN is putting forth a call to action for research designs that promote validity, sustainability, and funding of future nursing research.
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Affiliation(s)
- Kelly D Stamp
- School of Nursing University of North Carolina at Greensboro, 218 Moore Building, P.O. Box 26170, Greensboro, NC 27420, USA.
| | - Marilyn Prasun
- Heart Failure Disease Management Program, Memorial Medical Center & Clinical Associate Professor, University of Illinois at Chicago, Chicago, IL, USA
| | - Christopher S Lee
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Tiny Jaarsma
- Department of Nursing, Linkoping University, Linkoping, Sweden
| | - Mariann R Piano
- School of Nursing, Vanderbilt University, Nashville, TN, USA
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Conrad N, Judge A, Tran J, Mohseni H, Hedgecott D, Crespillo AP, Allison M, Hemingway H, Cleland JG, McMurray JJV, Rahimi K. Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. Lancet 2018; 391:572-580. [PMID: 29174292 PMCID: PMC5814791 DOI: 10.1016/s0140-6736(17)32520-5] [Citation(s) in RCA: 743] [Impact Index Per Article: 123.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/06/2017] [Accepted: 08/09/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Large-scale and contemporary population-based studies of heart failure incidence are needed to inform resource planning and research prioritisation but current evidence is scarce. We aimed to assess temporal trends in incidence and prevalence of heart failure in a large general population cohort from the UK, between 2002 and 2014. METHODS For this population-based study, we used linked primary and secondary electronic health records of 4 million individuals from the Clinical Practice Research Datalink (CPRD), a cohort that is representative of the UK population in terms of age and sex. Eligible patients were aged 16 years and older, had contributed data between Jan 1, 2002, and Dec 31, 2014, had an acceptable record according to CPRD quality control, were approved for CPRD and Hospital Episodes Statistics linkage, and were registered with their general practice for at least 12 months. For patients with incident heart failure, we extracted the most recent measurement of baseline characteristics (within 2 years of diagnosis) from electronic health records, as well as information about comorbidities, socioeconomic status, ethnicity, and region. We calculated standardised rates by applying direct age and sex standardisation to the 2013 European Standard Population, and we inferred crude rates by applying year-specific, age-specific, and sex-specific incidence to UK census mid-year population estimates. We assumed no heart failure for patients aged 15 years or younger and report total incidence and prevalence for all ages (>0 years). FINDINGS From 2002 to 2014, heart failure incidence (standardised by age and sex) decreased, similarly for men and women, by 7% (from 358 to 332 per 100 000 person-years; adjusted incidence ratio 0·93, 95% CI 0·91-0·94). However, the estimated absolute number of individuals with newly diagnosed heart failure in the UK increased by 12% (from 170 727 in 2002 to 190 798 in 2014), largely due to an increase in population size and age. The estimated absolute number of prevalent heart failure cases in the UK increased even more, by 23% (from 750 127 to 920 616). Over the study period, patient age and multi-morbidity at first presentation of heart failure increased (mean age 76·5 years [SD 12·0] to 77·0 years [12·9], adjusted difference 0·79 years, 95% CI 0·37-1·20; mean number of comorbidities 3·4 [SD 1·9] vs 5·4 [2·5]; adjusted difference 2·0, 95% CI 1·9-2·1). Socioeconomically deprived individuals were more likely to develop heart failure than were affluent individuals (incidence rate ratio 1·61, 95% CI 1·58-1·64), and did so earlier in life than those from the most affluent group (adjusted difference -3·51 years, 95% CI -3·77 to -3·25). From 2002 to 2014, the socioeconomic gradient in age at first presentation with heart failure widened. Socioeconomically deprived individuals also had more comorbidities, despite their younger age. INTERPRETATION Despite a moderate decline in standardised incidence of heart failure, the burden of heart failure in the UK is increasing, and is now similar to the four most common causes of cancer combined. The observed socioeconomic disparities in disease incidence and age at onset within the same nation point to a potentially preventable nature of heart failure that still needs to be tackled. FUNDING British Heart Foundation and National Institute for Health Research.
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Affiliation(s)
- Nathalie Conrad
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK; Bristol National Institute for Health Research Biomedical Research Centre, Musculoskeletal Research Unit, Southmead Hospital, University of Bristol, Bristol, UK; Medical Research Council Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Jenny Tran
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Hamid Mohseni
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Deborah Hedgecott
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | | | - Moira Allison
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Harry Hemingway
- The Farr Institute of Health Informatics Research, University College London, London, UK; The National Institute for Health Research, Biomedical Research Centre, University College London Hospitals NHS Foundation Trust/University College London, London, UK
| | - John G Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK; National Heart & Lung Institute, Imperial College London, London, UK
| | - John J V McMurray
- Institute for Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kazem Rahimi
- The George Institute for Global Health, University of Oxford, Oxford, UK; Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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Riedel O, Ohlmeier C, Enders D, Elsässer A, Vizcaya D, Michel A, Eberhard S, Schlothauer N, Berg J, Garbe E. The contribution of comorbidities to mortality in hospitalized patients with heart failure. Clin Res Cardiol 2018; 107:487-497. [PMID: 29404680 DOI: 10.1007/s00392-018-1210-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/01/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Heart failure (HF) with reduced ejection fraction (HFrEF) has a worse prognosis than HF with preserved EF (HFpEF). The study aimed to evaluate whether different comorbidity profiles of HFrEF- and HFpEF-patients or HF-specific mechanisms contribute to a greater extent to this difference. METHODS We linked data from two health insurances to data from a cardiology clinic hospital information system. Patients with a hospitalization with HF in 2005-2011, categorized as HFrEF (EF < 45%) or HFpEF (EF ≥ 45%), were propensity score (PS) matched to controls without HF on comorbidites and medication to assure similar comorbidity profiles of patients and their respective controls. The balance of the covariates in patients and controls was compared via the standardized difference (SDiff). Age-standardized 1-year mortality rates (MR) with 95% confidence intervals (CI) were calculated. RESULTS 777 HFrEF-patients (1135 HFpEF-patients) were PS-matched to 3446 (4832) controls. Balance between patients and controls was largely achieved with a SDiff < 0.1 on most variables considered. The age-standardized 1-year MRs per 1000 persons in HFrEF-patients and controls were 267.8 (95% CI 175.9-359.8) and 86.1 (95% CI 70.0-102.3). MRs in HFpEF-patients and controls were 166.2 (95% CI 101.5-230.9) and 61.5 (95% CI 52.9-70.1). Thus, differences in MRs between patients and their controls were higher for HFrEF (181.7) than for HFpEF (104.7). CONCLUSIONS Given the similar comorbidity profiles between HF-patients and controls, the higher difference in mortality rates between HFrEF-patients and controls points more to HF-specific mechanisms for these patients, whereas for HFpEF-patients a higher contribution of comorbidity is suggested by our results.
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Affiliation(s)
- Oliver Riedel
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359, Bremen, Germany.
| | - C Ohlmeier
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359, Bremen, Germany
- IGES Institut GmbH, Berlin, Germany
| | - D Enders
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359, Bremen, Germany
| | - A Elsässer
- Department of Cardiology, Klinikum Oldenburg, AöR, Oldenburg, Germany
| | - D Vizcaya
- Epidemiology, Bayer AG, Berlin, Germany
| | - A Michel
- Epidemiology, Bayer AG, Berlin, Germany
| | | | - N Schlothauer
- Hausarztpraxis Dr. Stephan Spiekermann&Partner im Gesundheitszentrum, Delmenhorst, Germany
| | - J Berg
- AOK Bremen/Bremerhaven, Bremerhaven, Germany
| | - E Garbe
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359, Bremen, Germany
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Abstract
Heart failure (HF) represents a global pandemic health problem with a high impact on health-care costs, affecting about 26 million adults worldwide. The overall HF prevalence and incidence are ~2% and ~0.2% per year, respectively, in Western countries, with half of the HF population with reduced ejection fraction (HFpEF) and half with preserved (HFpEF) or mid-range ejection fraction (HFmrEF). Sex differences may exist in HF. More males have HFrEF or HFmrEF and an ischemic etiology, whereas more females have HFpEF and hypertension, diastolic dysfunction, and valvular pathologies as HF etiologies. Females are generally older, have a higher EF, higher frequency of HF-related symptoms, and lower NYHA functional status. Generally, it is observed that female HF patients tend to have more comorbidities such as atrial fibrillation, diabetes, hypertension, anemia, iron deficiency, renal disease, arthritis, frailty, depression, and thyroid abnormalities. However, overall, females have better prognosis in terms of mortality and hospitalization risk compared with men, regardless of EF. Potential sex differences in HF characteristics may be underestimated because of the underrepresentation of females in cardiovascular research and, in particular, the sex imbalance in clinical trial enrollment may avoid to identify sex-specific differences in treatments' benefit.
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127
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Martini E, Stirparo GG, Kallikourdis M. Immunotherapy for cardiovascular disease. J Leukoc Biol 2017; 103:493-500. [PMID: 29345361 DOI: 10.1002/jlb.5mr0717-306r] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/16/2017] [Accepted: 11/24/2017] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF), the final stage of pathological cardiac hypertrophy, is a major cause of hospitalization and mortality. The role of inflammation in the pathogenesis of HF has been extensively studied, with great emphasis on proinflammatory cytokines. Yet, clinical trials targeting these cytokines failed to become a credible therapeutic strategy for HF. More recent studies are increasingly highlighting an active role for T cells in the progression of HF pathology. As a result, a number of novel immunotherapy strategies are emerging for the treatment of HF and other cardiovascular diseases, via the targeting of adaptive immunity. Here we provide an overview of the background, details, and expected outcomes of these attempts.
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Affiliation(s)
- Elisa Martini
- Adaptive Immunity Laboratory, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, Milan, Italy
| | - Giuliano Giuseppe Stirparo
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, Milan, Italy
| | - Marinos Kallikourdis
- Adaptive Immunity Laboratory, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, Milan, Italy.,Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
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128
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van den Dorpel MMP, Heinonen I, Snelder SM, Vos HJ, Sorop O, van Domburg RT, Merkus D, Duncker DJ, van Dalen BM. Early detection of left ventricular diastolic dysfunction using conventional and speckle tracking echocardiography in a large animal model of metabolic dysfunction. Int J Cardiovasc Imaging 2017; 34:743-749. [PMID: 29234934 PMCID: PMC5889412 DOI: 10.1007/s10554-017-1287-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/01/2017] [Indexed: 11/26/2022]
Abstract
Left ventricular (LV) diastolic dysfunction is one of the important mechanisms responsible for symptoms in patients with heart failure. The aim of the current study was to identify parameters that may be used to detect early signs of LV diastolic dysfunction in diabetic pigs on a high fat diet, using conventional and speckle tracking echocardiography. The study population consisted of 16 healthy Göttingen minipigs and 18 minipigs with experimentally induced metabolic dysfunction. Echocardiography measurements were performed at baseline and 3-month follow-up. The ratio of peak early (E) and late filling velocity (E/A ratio) and the ratio of E and the velocity of the mitral annulus early diastolic wave (E/Em ratio) did not change significantly in both groups. Peak untwisting velocity decreased in the metabolic dysfunction group (- 30.1 ± 18.5 vs. - 23.4 ± 15.5 °/ms) but not in controls (- 38.1 ± 23.6 vs. - 42.2 ± 23.0 °/ms), being significantly different between the groups at the 3-month time point (p < 0.05). In conclusion, whereas E/A ratio and E/Em ratio did not change significantly after 3 months of metabolic dysfunction, peak untwisting velocity was significantly decreased. Hence, peak untwisting velocity may serve as an important marker to detect early changes of LV diastolic dysfunction.
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Affiliation(s)
- Mark M P van den Dorpel
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Ilkka Heinonen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, University of Turku, Turku, Finland
| | - Sanne M Snelder
- Department of Cardiology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Hendrik J Vos
- Division of Biomedical Engineering, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Oana Sorop
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Ron T van Domburg
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Daphne Merkus
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Dirk J Duncker
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Bas M van Dalen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
- Department of Cardiology, Franciscus Gasthuis, Rotterdam, The Netherlands.
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129
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Wallentin F, Wettermark B, Kahan T. Drug treatment of hypertension in Sweden in relation to sex, age, and comorbidity. J Clin Hypertens (Greenwich) 2017; 20:106-114. [DOI: 10.1111/jch.13149] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/07/2017] [Accepted: 08/17/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Fredrik Wallentin
- Karolinska Institutet; Department of Clinical Sciences; Danderyd Hospital; Division of Cardiovascular Medicine; Stockholm Sweden
| | - Björn Wettermark
- Karolinska Institutet; Department of Medicine/Solna; Centre for Pharmacoepidemiology; Stockholm Sweden
- Public Healthcare Services Committee; Stockholm County Council; Stockholm Sweden
| | - Thomas Kahan
- Karolinska Institutet; Department of Clinical Sciences; Danderyd Hospital; Division of Cardiovascular Medicine; Stockholm Sweden
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Wändell P, Carlsson AC, Holzmann MJ, Ärnlöv J, Sundquist J, Sundquist K. Comparison of Mortality and Nonfatal Cardiovascular Events in Adults With Atrial Fibrillation With Versus Without Levothyroxine Treatment. Am J Cardiol 2017; 120:1974-1979. [PMID: 28941600 DOI: 10.1016/j.amjcard.2017.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 01/15/2023]
Abstract
Levothyroxine has been suggested to be cardiotoxic, but previous studies on the risk of cardiovascular events associated with levothyroxine treatment have been inconclusive. We aimed to study the association between levothyroxine treatment and all-cause mortality as well as cardiovascular events. Study population included all adults (n = 12,283) ≥ 45 years diagnosed with atrial fibrillation (AF) at 75 primary care centers in Sweden in 2001 to 2007, with (n = 1,189; 283 men and 906 women) or without (n = 11,094) levothyroxine treatment. Outcome was defined as all-cause mortality and cardiovascular events, that is, myocardial infarction, ischemic stroke, and congestive heart failure until December 31, 2010. During a mean 5.8 years (standard deviation 2.4 years) of follow-up, a total of 3,954 patients died (32.2%), among whom 92 men (32.5%) and 266 women (29.4%) were treated with levothyroxine. In fully adjusted Cox regression models (age, co-morbidity, socioeconomic factors, and warfarin treatment), a significant association between levothyroxine treatment and lower mortality was found among women (hazard ratio 0.78, 95% confidence interval 0.68 to 0.91), but not among men (hazard ratio 0.87, 95% confidence interval 0.69 to 1.10). In the secondary analysis, levothyroxine treatment was not associated with the risk of myocardial infarction, ischemic stroke, or congestive heart failure (p > 0.05). In conclusion, in a large representative cohort, we found that levothyroxine treatment decreased the mortality risk in women with AF, which suggests that such treatment could be of benefit in this setting.
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131
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Risk and predictors of readmission for heart failure following a myocardial infarction between 2004 and 2013: A Swedish nationwide observational study. Int J Cardiol 2017; 248:221-226. [DOI: 10.1016/j.ijcard.2017.05.086] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/07/2017] [Accepted: 05/20/2017] [Indexed: 11/17/2022]
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132
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Giezeman M, Arne M, Theander K. Adherence to guidelines in patients with chronic heart failure in primary health care. Scand J Prim Health Care 2017; 35:336-343. [PMID: 29105550 PMCID: PMC5730031 DOI: 10.1080/02813432.2017.1397253] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To describe adherence to international guidelines for chronic heart failure (CHF) management concerning diagnostics, pharmacological treatment and self-care behaviour in primary health care. DESIGN A cross-sectional descriptive study of patients with CHF, using data obtained from medical records and a postal questionnaire. SETTING Three primary health care centres in Sweden. SUBJECTS Patients with a CHF diagnosis registered in their medical record. MAIN OUTCOME MEASURES Adherence to recommended diagnostic tests and pharmacological treatment by the European Society of Cardiology guidelines and self-care behaviour, using the European Heart Failure Self-care Behaviour Scale (EHFScBS-9). RESULTS The 155 participating patients had a mean age of 79 (SD9) years and 89 (57%) were male. An ECG was performed in all participants, 135 (87%) had their NT-proBNP measured, and 127 (82%) had transthoracic echocardiography performed. An inhibitor of the renin angiotensin system (RAS) was prescribed in 120 (78%) patients, however only 45 (29%) in target dose. More men than women were prescribed RAS-inhibition. Beta blockers (BBs) were prescribed in 117 (76%) patients, with 28 (18%) at target dose. Mineralocorticoidreceptor antagonists were prescribed in 54 (35%) patients and daily diuretics in 96 (62%). The recommended combination of RAS-inhibitors and BBs was prescribed to 92 (59%), but only 14 (9%) at target dose. The mean score on the EHFScBS-9 was 29 (SD 6) with the lowest adherence to daily weighing and consulting behaviour. CONCLUSION Adherence to guidelines has improved since prior studies but is still suboptimal particularly with regards to medication dosage. There is also room for improvement in patient education and self-care behaviour.
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Affiliation(s)
- Maaike Giezeman
- School of Medical Sciences, Örebro University, Örebro, Sweden
- Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden
- CONTACT Maaike Giezeman Centre for Clinical Research, Hus 73 plan 3, 65185 Karlstad, Sweden
| | - Mats Arne
- Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Kersti Theander
- Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden
- Department of Nursing, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden
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Nordgren L, Söderlund A. Social support, self-rated health and low mood in people on sick leave due to heart failure: a cross-sectional study. Scand J Public Health 2017; 46:606-612. [PMID: 29160157 DOI: 10.1177/1403494817718070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS The aim of this study was to investigate social support in relation to self-rated health and the prevalence of low mood in people on sick leave due to heart failure. METHODS A cross-sectional design was used, and 590 individuals on sick leave due to heart failure in Sweden responded to the postal questionnaire. The questions therein concerned received and needed functional and structural support from managers, work colleagues, families and friends. Multivariate analyses were conducted. RESULTS The variables of income and needed support from family contributed significantly and negatively to self-rated health. Those who perceived that they needed more support from their manager reported experiencing low mood more frequently. CONCLUSIONS The results showed a negative relation between manager support and low mood. Thus, support from managers and perceptions of low mood during sick leave are negatively associated, however, we do not know anything about the causality of this association. The results also indicated that needed support from family was negatively associated with self-rated health. The results also highlighted a multidimensional frailty in people with heart failure that needs to be recognized in future research as well as in clinical practice.
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Affiliation(s)
- Lena Nordgren
- 1 Centre for Clinical Research Sörmland, Uppsala University, Sweden.,2 Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Anne Söderlund
- 3 School of Health, Care and Social Welfare, Mälardalen University, Sweden
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Formiga F, Moreno-Gonzalez R, Chivite D, Franco J, Montero A, Corbella X. High comorbidity, measured by the Charlson Comorbidity Index, associates with higher 1-year mortality risks in elderly patients experiencing a first acute heart failure hospitalization. Aging Clin Exp Res 2017; 30:927-933. [PMID: 29124524 DOI: 10.1007/s40520-017-0853-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/04/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Comorbidity is related to poor health results in chronic heart failure (HF). AIMS The purpose of the study was to assess whether a high Charlson Comorbidity Index score (CCI) relates to 1 year mortality after a first hospitalization for acute HF (AHF). METHODS We reviewed the medical records of 897 patients > 65 years of age admitted within a two-year period because of a first episode of AHF. We analyzed two groups: low (CCI ≤ 2) and high (CCI > 2) comorbidity. RESULTS Patients' mean CCI was 2.2 ± 1.7; 344 patients (38.35%) had a CCI > 2. 1-year all-cause mortality rate in the high comorbidity group was 32.6%, worse than that among low comorbidity group patients (23.7%, p = 0.002). Cox multivariate analysis identified a CCI > 2 as an independent risk factor for 1-year mortality (p = 0.002; HR: 1.525; CI 95% 1.161-2.003), along with older age, history of arterial hypertension, and higher admission heart rate and serum potassium values. Analyzing CCI as a continuous variable, the association remained is also significant (p = 0.0001; HR 1.145; CI 95% 1.069-1.854). CONCLUSIONS Higher global comorbidity (CCI > 2) at the time of a first hospitalization because of AHF is an independent predictor of mid-term post-discharge mortality among elderly HF patients.
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Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Department, Universitary Hospital Bellvitge-IDIBELL, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Rafael Moreno-Gonzalez
- Geriatric Unit, Internal Medicine Department, Universitary Hospital Bellvitge-IDIBELL, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - David Chivite
- Geriatric Unit, Internal Medicine Department, Universitary Hospital Bellvitge-IDIBELL, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jonathan Franco
- Internal Medicine Service, Hospital Universitari Quiron Dexeus, Barcelona, Spain
| | - Abelardo Montero
- Geriatric Unit, Internal Medicine Department, Universitary Hospital Bellvitge-IDIBELL, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Geriatric Unit, Internal Medicine Department, Universitary Hospital Bellvitge-IDIBELL, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- Hestia Chair in Integrated Health and Social Care, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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135
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Wong CM, Hawkins NM, Ezekowitz JA, Jhund PS, Savu A, MacDonald MR, Kristensen SL, Petrie MC, McMurray JJ, McAlister FA, Kaul P. Heart Failure in Young Adults Is Associated With High Mortality: A Contemporary Population-Level Analysis. Can J Cardiol 2017; 33:1472-1477. [DOI: 10.1016/j.cjca.2017.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/07/2017] [Accepted: 05/12/2017] [Indexed: 10/19/2022] Open
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137
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Basic C, Rosengren A, Lindström S, Schaufelberger M. High validity of cardiomyopathy diagnoses in western Sweden (1989-2009). ESC Heart Fail 2017; 5:233-240. [PMID: 29024504 PMCID: PMC5880670 DOI: 10.1002/ehf2.12224] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 08/07/2017] [Accepted: 09/01/2017] [Indexed: 01/21/2023] Open
Abstract
Aim Hospital discharges with a diagnosis of cardiomyopathy have more than doubled in Sweden since 1987. We validated the cardiomyopathy diagnoses over this time period to investigate that the increase was real and not a result of improved recognition of the diagnosis and better diagnostic methods. Methods and results Every fifth year from 1989 to 2009, records for all patients with a cardiomyopathy diagnosis were identified by searching the local registers in three hospitals in Västra Götaland, Sweden. The diagnoses were validated according to criteria defined by the European Society of Cardiology from 2008. The population comprised 611 cases with cardiomyopathy diagnoses [mean age 58.9 (SD 15.5) years, 68.2% male], divided into three major groups: dilated, hypertrophic, and other cardiomyopathies. Hypertrophic cardiomyopathy and hypertrophic obstructive cardiomyopathy were analysed as a group. Cardiomyopathies for which there were few cases, such as restrictive, arrhythmogenic right ventricular, left ventricular non‐compaction, takotsubo, and peripartum cardiomyopathies, were analysed together and defined as ‘other cardiomyopathies’. Relevant co‐morbidities were registered. The use of echocardiography was 99.7%, of which 94.6% was complete echocardiography reports. The accuracy rates of the diagnoses dilated cardiomyopathy, hypertrophic cardiomyopathy, and other cardiomyopathies were 85.5%, 87.5%, and 100%, respectively, with no differences between the three hospitals or years studied; nor did the prevalence of co‐morbidities differ. Conclusions The accuracy rate of the cardiomyopathy diagnoses from in‐hospital records from >600 patients in western Sweden during a 20 year period was 86.6%, with no significant trend over time, strengthening epidemiological findings that this is likely due to an actual increase in cardiomyopathy diagnoses rather than changes in coding practices. The use of echocardiography was high, and there was no significant difference in co‐morbidities during the study period. The accuracy rate of the cardiomyopathy diagnoses during the 20 year period was high. The use of diagnostic tools did not increase under the study period, and once cardiomyopathy diagnoses were suspected, echocardiography was performed in almost all cases. In this study, the occurrence of cardiomyopathy was increasing over time without significant increase of co‐morbidity, supporting that an actual increase of cardiomyopathy has occurred.
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Affiliation(s)
- Carmen Basic
- Section of Emergency and Cardiovascular Medicine, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Annika Rosengren
- Section of Emergency and Cardiovascular Medicine, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Sandra Lindström
- Department of Obstetrics and Gynaecology, Ryhov County Hospital, Jönköping, Sweden
| | - Maria Schaufelberger
- Section of Emergency and Cardiovascular Medicine, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
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138
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Klatte DCF, Gasparini A, Xu H, de Deco P, Trevisan M, Johansson ALV, Wettermark B, Ärnlöv J, Janmaat CJ, Lindholm B, Dekker FW, Coresh J, Grams ME, Carrero JJ. Association Between Proton Pump Inhibitor Use and Risk of Progression of Chronic Kidney Disease. Gastroenterology 2017; 153:702-710. [PMID: 28583827 DOI: 10.1053/j.gastro.2017.05.046] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/24/2017] [Accepted: 05/29/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Proton pump inhibitors (PPI) have been associated with acute kidney injury and recent studies suggest that they may be associated with the risk of chronic kidney disease (CKD). METHODS We performed a retrospective analysis using the Stockholm creatinine measurements database, which contains information on diagnoses, dispensation claims, and laboratory test results for all citizens in the Stockholm region from 2007 through 2010. We identified new users of PPIs (n = 105,305) and new users of H2 blockers (H2B; n = 9578); data on renal outcomes were collected for a median 2.7 years. The primary outcome was progression CKD, defined as doubling of creatinine or decrease in estimated glomerular filtration rate of 30% or more. Secondary outcomes were end-stage renal disease and acute kidney injury. Complete collection of repeated PPI and H2B dispensations at pharmacies in Sweden allowed modeling the time-dependent risk associated with cumulative PPI exposure. RESULTS Users of PPIs, compared with users of H2Bs, had an increased risk for doubled levels of creatinine (1985 events; adjusted hazard ratio [HR], 1.26; 95% CI, 1.05-1.51) and decrease in estimated glomerular filtration rate of 30% or more (11,045 events; 1.26; 95% CI, 1.16-1.36). PPI use also associated with development of end-stage renal disease (HR, 2.40; 95% CI, 0.76-7.58) and acute kidney injury (HR, 1.30; 95% CI, 1.00-1.69). There was a graded association between cumulative exposure to PPIs and risk of CKD progression. This was not the case for cumulative H2B use. CONCLUSIONS Initiation of PPI therapy and cumulative PPI exposure is associate with increased risk of CKD progression in a large, North European healthcare system. Although consistent, the association was modest in magnitude, and cannot exclude residual confounding.
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Affiliation(s)
- Derk C F Klatte
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Hong Xu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pietro de Deco
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Marco Trevisan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Björn Wettermark
- Public Healthcare Services committee, Stockholm County Council, Stockholm, Sweden; Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Ärnlöv
- School of Health and Social Studies, Dalarna University, Falun, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
| | - Cynthia J Janmaat
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bengt Lindholm
- Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Juan J Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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139
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Koudstaal S, Pujades‐Rodriguez M, Denaxas S, Gho JM, Shah AD, Yu N, Patel RS, Gale CP, Hoes AW, Cleland JG, Asselbergs FW, Hemingway H. Prognostic burden of heart failure recorded in primary care, acute hospital admissions, or both: a population-based linked electronic health record cohort study in 2.1 million people. Eur J Heart Fail 2017; 19:1119-1127. [PMID: 28008698 PMCID: PMC5420446 DOI: 10.1002/ejhf.709] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 10/25/2016] [Accepted: 11/04/2016] [Indexed: 12/11/2022] Open
Abstract
AIMS The prognosis of patients hospitalized for worsening heart failure (HF) is well described, but not that of patients managed solely in non-acute settings such as primary care or secondary outpatient care. We assessed the distribution of HF across levels of healthcare, and assessed the prognostic differences for patients with HF either recorded in primary care (including secondary outpatient care) (PC), hospital admissions alone, or known in both contexts. METHODS AND RESULTS This study was part of the CALIBER programme, which comprises linked data from primary care, hospital admissions, and death certificates for 2.1 million inhabitants of England. We identified 89 554 patients with newly recorded HF, of whom 23 547 (26%) were recorded in PC but never hospitalized, 30 629 (34%) in hospital admissions but not known in PC, 23 681 (27%) in both, and 11 697 (13%) in death certificates only. The highest prescription rates of ACE inhibitors, beta-blockers, and mineralocorticoid receptor antagonists was found in patients known in both contexts. The respective 5-year survival in the first three groups was 43.9% [95% confidence interval (CI) 43.2-44.6%], 21.7% (95% CI 21.1-22.2%), and 39.8% (95% CI 39.2-40.5%), compared with 88.1% (95% CI 87.9-88.3%) in the age- and sex-matched general population. CONCLUSION In the general population, one in four patients with HF will not be hospitalized for worsening HF within a median follow-up of 1.7 years, yet they still have a poor 5-year prognosis. Patients admitted to hospital with worsening HF but not known with HF in primary care have the worst prognosis and management. Mitigating the prognostic burden of HF requires greater consistency across primary and secondary care in the identification, profiling, and treatment of patients. TRIAL REGISTRATION NCT02551016.
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Affiliation(s)
- Stefan Koudstaal
- Farr Institute of Health Informatics ResearchLondonUK
- UCL Institute of Health InformaticsUniversity College LondonLondonUK
- Department of CardiologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Mar Pujades‐Rodriguez
- Farr Institute of Health Informatics ResearchLondonUK
- UCL Institute of Health InformaticsUniversity College LondonLondonUK
| | - Spiros Denaxas
- Farr Institute of Health Informatics ResearchLondonUK
- UCL Institute of Health InformaticsUniversity College LondonLondonUK
| | - Johannes M.I.H. Gho
- Department of CardiologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Anoop D. Shah
- Farr Institute of Health Informatics ResearchLondonUK
- UCL Institute of Health InformaticsUniversity College LondonLondonUK
| | - Ning Yu
- Farr Institute of Health Informatics ResearchLondonUK
- UCL Institute of Health InformaticsUniversity College LondonLondonUK
| | - Riyaz S. Patel
- Farr Institute of Health Informatics ResearchLondonUK
- UCL Institute of Health InformaticsUniversity College LondonLondonUK
- UCL Institute of Cardiovascular SciencesUniversity College LondonLondonUK
| | - Chris P. Gale
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Arno W. Hoes
- Julius Centre for Health Sciences and Primary CareUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - John G. Cleland
- Faculty of Medicine, National Heart & Lung InstituteImperial College LondonLondonUK
| | - Folkert W. Asselbergs
- Farr Institute of Health Informatics ResearchLondonUK
- UCL Institute of Health InformaticsUniversity College LondonLondonUK
- Department of CardiologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Harry Hemingway
- Farr Institute of Health Informatics ResearchLondonUK
- UCL Institute of Health InformaticsUniversity College LondonLondonUK
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140
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Abstract
Heart failure is the quintessential cardiovascular syndrome of aging that results from common cardiovascular conditions in older adults in conjunction with age-associated changes in cardiovascular structure and function. To a large extent, heart failure is a geriatric syndrome in much the same way that dementia, falls, and frailty are geriatric syndromes. The incidence and prevalence of heart failure increase strikingly with age and make heart failure the most common reason for hospitalization among older adults. Although outcomes for older adults with heart failure have improved over time, mortality, hospitalization, and rehospitalization rates remain high.
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Affiliation(s)
- Kumar Dharmarajan
- Section of Cardiovascular Medicine, Department of Internal Medicine, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Yale University School of Medicine, 1 Church Street, Suite 200, New Haven, CT 06510, USA.
| | - Michael W Rich
- Division of Cardiology, Department of Internal Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St Louis, MO 63110, USA
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141
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Schmidt-Mende K, Andersen M, Wettermark B, Hasselström J. Educational intervention on medication reviews aiming to reduce acute healthcare consumption in elderly patients with potentially inappropriate medicines-A pragmatic open-label cluster-randomized controlled trial in primary care. Pharmacoepidemiol Drug Saf 2017; 26:1347-1356. [PMID: 28799226 DOI: 10.1002/pds.4263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 05/08/2017] [Accepted: 06/15/2017] [Indexed: 11/10/2022]
Abstract
PURPOSE Potentially inappropriate medicines (PIMs) may cause 10% of unplanned admissions in elderly people. We performed an educational intervention in primary care to reduce acute health care consumption and PIMs through the promotion of medication reviews (MRs) in elderly patients. METHODS This cluster-randomized controlled trial was conducted in the context of an official campaign promoting rational drug use in elderly people. Sixty-nine primary health care practices with 119,910 patients aged older than or equal to 65 were randomized, with 1 dropout in the intervention group. The intervention consisted of educational outreach visits with feedback on prescribing and the development of a working procedure on MRs. Follow-up was 9 months. Outcomes were assessed in an administrative health care database. The combined primary outcome was unplanned hospital admission and/or emergency department visit. Secondary outcomes were among other PIMs and rates of MRs. The risk differences in outcomes between intervention and control group were estimated by using regression models. RESULTS During follow-up, 22.8% of patients in the intervention and 22.0% in the control group were admitted unplanned to hospital and/or experienced at least 1 emergency department (nonsignificant risk difference 0.8%, 95% CI -0.7% to 2.4%). There were no significant differences regarding secondary outcomes such as PIMs or MRs. CONCLUSIONS No changes were seen in acute health care consumption, PIMs, and MRs in elderly patients after an educational intervention in primary care. The reasons for the lack of effect could be a suboptimal intervention, limitations in outcome measures, and the use of administrative data to monitor outcomes.
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Affiliation(s)
- K Schmidt-Mende
- Academic Primary Health Care Centre, Stockholm County Council and Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
| | - M Andersen
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.,Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - B Wettermark
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.,Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden
| | - J Hasselström
- Academic Primary Health Care Centre, Stockholm County Council and Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
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142
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Störk S, Handrock R, Jacob J, Walker J, Calado F, Lahoz R, Hupfer S, Klebs S. Epidemiology of heart failure in Germany: a retrospective database study. Clin Res Cardiol 2017; 106:913-922. [PMID: 28748265 PMCID: PMC5655572 DOI: 10.1007/s00392-017-1137-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/17/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic heart failure (HF) is associated with significant healthcare expenditure, morbidity, and mortality. This study investigated the epidemiology of HF in Germany. METHODS This retrospective study used anonymous healthcare claims data from the German Health Risk Institute on individuals with statutory health insurance. Patients with uninterrupted data from 1 January 2009 to 31 December 2013 or death (whichever occurred first), and ≥2 recorded HF-related diagnoses in 2011, were included. Patients with newly diagnosed HF were identified. Patients were followed up for 2 years from first diagnosis. RESULTS Of 3,132,337 eligible patients, 123,925 (55.0% women; mean age 76.2 years) had HF: a prevalence of 3.96%. Of these, 26,368 had newly diagnosed HF: an incidence of 655/100,000 persons at risk. Incidence increased with age and was similar regardless of sex. During follow-up, there were 48,159 hospital admissions among newly diagnosed patients (1.8 hospitalizations/patient/2 years); HF accounted for 6% of these. Additionally, 20,148 patients (16.3%) overall and 5983 newly diagnosed patients (22.7%) died. Most new cases of HF were diagnosed by office-based physicians (63.2%); new cases among hospital inpatients were predominantly diagnosed by internal medicine specialists (70.7%). Overall, 94.0% received their initial prescription for HF treatment from a family practitioner. CONCLUSIONS The high prevalence and incidence observed in this representative sample emphasize the burden of HF in Germany. Substantial hospitalization rates and mortality highlight the need for early diagnosis and appropriate treatment, and for close cooperation between physician specialties and healthcare sectors.
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Affiliation(s)
- Stefan Störk
- Comprehensive Heart Failure Centre Würzburg and Department of Internal Medicine I, University and University Hospital Würzburg, Würzburg, Germany. .,Deutsches Zentrum für Herzinsuffizienz Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany.
| | | | - Josephine Jacob
- Elsevier Health Analytics, Berlin, Germany.,Health Risk Institute, Berlin, Germany
| | - Jochen Walker
- Elsevier Health Analytics, Berlin, Germany.,Health Risk Institute, Berlin, Germany
| | | | | | | | - Sven Klebs
- Novartis Pharma GmbH, Nuremberg, Germany
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143
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Roversi S, Fabbri LM, Sin DD, Hawkins NM, Agustí A. Chronic Obstructive Pulmonary Disease and Cardiac Diseases. An Urgent Need for Integrated Care. Am J Respir Crit Care Med 2017; 194:1319-1336. [PMID: 27589227 DOI: 10.1164/rccm.201604-0690so] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a global health issue with high social and economic costs. Concomitant chronic cardiac disorders are frequent in patients with COPD, likely owing to shared risk factors (e.g., aging, cigarette smoke, inactivity, persistent low-grade pulmonary and systemic inflammation) and add to the overall morbidity and mortality of patients with COPD. The prevalence and incidence of cardiac comorbidities are higher in patients with COPD than in matched control subjects, although estimates of prevalence vary widely. Furthermore, cardiac diseases contribute to disease severity in patients with COPD, being a common cause of hospitalization and a frequent cause of death. The differential diagnosis may be challenging, especially in older and smoking subjects complaining of unspecific symptoms, such as dyspnea and fatigue. The therapeutic management of patients with cardiac and pulmonary comorbidities may be similarly challenging: bronchodilators may have cardiac side effects, and, vice versa, some cardiac medications should be used with caution in patients with lung disease. The aim of this review is to summarize the evidence of the relationship between COPD and the three most frequent and important cardiac comorbidities in patients with COPD: ischemic heart disease, heart failure, and atrial fibrillation. We have chosen a practical approach, first summarizing relevant epidemiological and clinical data, then discussing the diagnostic and screening procedures, and finally evaluating the impact of lung-heart comorbidities on the therapeutic management of patients with COPD and heart diseases.
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Affiliation(s)
- Sara Roversi
- 1 Department of Metabolic Medicine, University of Modena and Reggio Emilia and Sant'Agostino Estense Hospital, Modena, Italy
| | - Leonardo M Fabbri
- 1 Department of Metabolic Medicine, University of Modena and Reggio Emilia and Sant'Agostino Estense Hospital, Modena, Italy
| | | | - Nathaniel M Hawkins
- 3 Division of Cardiology, Department of Medicine, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Alvar Agustí
- 4 Thorax Institute, Hospital Clinic in Barcelona, University of Barcelona, Barcelona, Spain
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144
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Cars T, Lindhagen L, Malmström RE, Neovius M, Schwieler J, Wettermark B, Sundström J. Effectiveness of Drugs in Routine Care: A Model for Sequential Monitoring of New Medicines Using Dronedarone as Example. Clin Pharmacol Ther 2017; 103:493-501. [DOI: 10.1002/cpt.751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/01/2017] [Accepted: 05/16/2017] [Indexed: 12/27/2022]
Affiliation(s)
- T Cars
- Department of Medical Sciences; Uppsala University; Uppsala Sweden
- Public Healthcare Services Committee Administration; Stockholm County Council; Stockholm Sweden
| | - L Lindhagen
- Uppsala Clinical Research Center; Uppsala University; Uppsala Sweden
| | - RE Malmström
- Clinical Pharmacology; Karolinska University Hospital, Deptartment of Medicine Solna, Karolinska Institutet; Stockholm Sweden
| | - M Neovius
- Clinical Epidemiology Unit; Department of Medicine, Karolinska Institutet; Stockholm Sweden
| | - J Schwieler
- Department of Cardiology; Karolinska Institutet; Stockholm Sweden
| | - B Wettermark
- Public Healthcare Services Committee Administration; Stockholm County Council; Stockholm Sweden
- Centre for Pharmacoepidemiology; Department of Medicine, Karolinska Institutet; Stockholm Sweden
| | - J Sundström
- Department of Medical Sciences; Uppsala University; Uppsala Sweden
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145
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Persson CE, Björck L, Lagergren J, Lappas G, Giang KW, Rosengren A. Risk of Heart Failure in Obese Patients With and Without Bariatric Surgery in Sweden-A Registry-Based Study. J Card Fail 2017; 23:530-537. [PMID: 28506731 DOI: 10.1016/j.cardfail.2017.05.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/18/2017] [Accepted: 05/10/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obesity is a known risk factor for heart failure. The prevalence of both conditions has increased in Sweden during the past several decades. Obesity surgery has been shown to improve cardiac function. We therefore investigated whether the risk of heart failure was lower in obese patients after bariatric surgery compared with obese patients without surgical intervention. METHODS AND RESULTS From the Swedish National Patient Registry. we created a cohort including 47,859 patients aged 18-74 years with a primary diagnosis of obesity from 2000 to 2011. Of these, 22,295 (46.6%) underwent bariatric surgery (mean age 40.7 (standard deviation [SD] 10.7) years, 75.9% female). There were 25,564 (53.4%) nonsurgical obese patients (mean age 44.3 (SD 13.2) years, 66.8% female). Patients who underwent bariatric surgery had a markedly reduced risk of heart failure compared with nonsurgical obese patients (age- and sex-adjusted hazard ratio [HR] 0.37, 95% confidence interval [CI] 0.29-0.46). The lower risk persisted after further adjustment for baseline differences in known risk factors for heart failure (HR 0.37, 95% CI 0.30-0.46). CONCLUSION Patients who underwent bariatric surgery had a reduced risk of heart failure after surgery compared with nonsurgical obese patients.
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Affiliation(s)
- Christina E Persson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Lena Björck
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, NS 67, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Section of Gastrointestinal Cancer, Division of Cancer Studies, King's College London, Strand, London, United Kingdom
| | - Georgios Lappas
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kok Wai Giang
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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146
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Mamas MA, Sperrin M, Watson MC, Coutts A, Wilde K, Burton C, Kadam UT, Kwok CS, Clark AB, Murchie P, Buchan I, Hannaford PC, Myint PK. Do patients have worse outcomes in heart failure than in cancer? A primary care-based cohort study with 10-year follow-up in Scotland. Eur J Heart Fail 2017; 19:1095-1104. [PMID: 28470962 DOI: 10.1002/ejhf.822] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/05/2017] [Accepted: 02/26/2017] [Indexed: 12/16/2022] Open
Abstract
AIMS This study was designed to evaluate whether survival rates in patients with heart failure (HF) are better than those in patients with diagnoses of the four most common cancers in men and women, respectively, in a contemporary primary care cohort in the community in Scotland. METHODS AND RESULTS Data were obtained from the Primary Care Clinical Informatics Unit from a database of 1.75 million people registered with 393 general practices in Scotland. Sex-specific survival modelling was undertaken using Cox proportional hazards models, adjusted for potential confounders. A total of 56 658 subjects were eligible for inclusion in the study. These represented a total of 147 938 person-years of follow-up (median follow-up: 2.04 years). In men, HF (reference group; 5-year survival: 55.8%) had worse mortality outcomes than prostate cancer [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.57-0.65; 5-year survival: 68.3%], and bladder cancer (HR 0.88, 95% CI 0.81-0.96; 5-year survival: 57.3%), but better outcomes than lung cancer (HR 3.86, 95% CI 3.65-4.07; 5-year survival: 8.4%) and colorectal cancer (HR 1.23, 95% CI 1.16-1.31; 5-year survival: 48.9%). In women, HF (reference group; 5-year survival: 49.5%) had worse mortality outcomes than breast cancer (HR 0.55, 95% CI 0.51-0.59; 5-year survival 77.7%), but better outcomes than colorectal cancer (HR 1.21, 95% CI 1.13-1.29; 5-year survival 51.5%), lung cancer (HR 3.82, 95% CI 3.60-4.05; 5-year survival 10.4%), and ovarian cancer (HR 1.98, 95% CI 1.80-2.17; 5-year survival 38.2%). CONCLUSIONS Despite advances in management, HF remains as 'malignant' as some of the common cancers in both men and women.
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Affiliation(s)
- Mamas A Mamas
- Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK.,Academic Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, UK.,Farr Institute, University of Manchester, Manchester, UK
| | | | - Margaret C Watson
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Alasdair Coutts
- Research Applications and Data Management Team, IT Services, University of Aberdeen, Aberdeen, UK
| | - Katie Wilde
- Research Applications and Data Management Team, IT Services, University of Aberdeen, Aberdeen, UK
| | - Christopher Burton
- Academic Unit of Primary Medical Care, Northern General Hospital, Sheffield, UK
| | - Umesh T Kadam
- Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, UK
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK.,Academic Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, UK.,Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Allan B Clark
- Norwich Research Park Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Iain Buchan
- Farr Institute, University of Manchester, Manchester, UK
| | - Philip C Hannaford
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Phyo K Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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147
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Danielsen R, Thorgeirsson G, Einarsson H, Ólafsson Ö, Aspelund T, Harris TB, Launer L, Gudnason V. Prevalence of heart failure in the elderly and future projections: the AGES-Reykjavík study. SCAND CARDIOVASC J 2017; 51:183-189. [PMID: 28366010 DOI: 10.1080/14017431.2017.1311023] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To assess the prevalence of heart failure (HF) in a randomly selected study population of elderly individuals representing the general population of Iceland. Furthermore, to project the number of individuals likely to have HF in the future. DESIGN Baseline characteristics and clinical data from 5706 individuals who participated in the population based AGES-Reykjavik Study and gave their informed consent were used. Their age range was 66-98 years (mean age 77.0 ± 5.9 years), 57.6% were females. HF-diagnoses were established by review of hospital records and adjudicated according to prespecified criteria. Data from the 'Statistics Iceland' institution on the current size, age and sex distribution of the population and its prediction into the sixth decade were also used. RESULTS The prevalence of HF was 3.6% in the sexes combined, but higher in men (5.1%) than women (2.7%) (p < .001). The prevalence of HF per age groups ≤69, 70-74, 75-79, 80-84 and ≥85 years was 1.7%, 1.5%, 3.7%, 5.2% and 7.2%, respectively. The number of individuals ≥70 years with HF will increase considerably in the future. Thus, a calculation based on the projected age distribution and increase in the number of elderly ≥70 years in the coming decades, demonstrated that the number of patients with HF will have increased 2.3-fold by the year 2040 and tripled by the year 2060. CONCLUSIONS This study, in a cohort of elderly participants representative of the general population in a Nordic country, predicts that HF will be a major and increasing health problem in the coming decades.
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Affiliation(s)
- Ragnar Danielsen
- a The Department of Cardiology , Landspítali University Hospital , Reykjavík , Iceland.,c The University of Iceland , Reykjavík , Iceland
| | - Gudmundur Thorgeirsson
- a The Department of Cardiology , Landspítali University Hospital , Reykjavík , Iceland.,b The Icelandic Heart Association Research Institute , Kópavogur , Iceland.,c The University of Iceland , Reykjavík , Iceland
| | - Haukur Einarsson
- a The Department of Cardiology , Landspítali University Hospital , Reykjavík , Iceland
| | - Örn Ólafsson
- b The Icelandic Heart Association Research Institute , Kópavogur , Iceland
| | - Thor Aspelund
- b The Icelandic Heart Association Research Institute , Kópavogur , Iceland.,c The University of Iceland , Reykjavík , Iceland
| | - Tamara B Harris
- d Laboratory of Epidemiology and Population Sciences, National Institute of Aging , Bethesda , MD , USA
| | - Lenore Launer
- d Laboratory of Epidemiology and Population Sciences, National Institute of Aging , Bethesda , MD , USA
| | - Vilmundur Gudnason
- b The Icelandic Heart Association Research Institute , Kópavogur , Iceland.,c The University of Iceland , Reykjavík , Iceland
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148
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Taylor CJ, Ryan R, Nichols L, Gale N, Hobbs FR, Marshall T. Survival following a diagnosis of heart failure in primary care. Fam Pract 2017; 34:161-168. [PMID: 28137979 PMCID: PMC6192063 DOI: 10.1093/fampra/cmw145] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Heart failure is a common long term condition affecting around 900 000 people in the UK and patients commonly present to primary care. The prognosis of patients with a code of heart failure in their primary care record is unknown. OBJECTIVE The study sought to determine the overall survival rates for patients with heart failure in a primary care population from the time of diagnosis. METHODS Survival analysis was carried out using UK primary care records from The Health Improvement Network (THIN) between 1 January 1998 and 31 December 2012. Patients age 45 or over with a first diagnostic label of heart failure were matched by age, sex and practice to people without heart failure. Outcome was death in the heart failure and no heart failure cohorts. Kaplan-Meier curves were used to compare survival. Age-specific survival rates at 1, 5 and 10 years were determined for men and women with heart failure. Survival rates by year of diagnosis and case definition were also calculated. RESULTS During the study period, 54313 patients had a first diagnostic code of heart failure. Overall survival rates for the heart failure group were 81.3% (95%CI 80.9-81.6), 51.5% (95%CI 51.0-52.0) and 29.5% (95%CI 28.9-30.2) at 1, 5 and 10 years respectively and did not change over time. CONCLUSIONS In a primary care population, the survival of patients diagnosed with heart failure did not improved over time. Further research is needed to explain these trends and to find strategies to improve outlook.
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Affiliation(s)
- Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ronan Ryan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Linda Nichols
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola Gale
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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149
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Old-and With Severe Heart Failure: Telemonitoring by Using Digital Pen Technology in Specialized Homecare: System Description, Implementation, and Early Results. Comput Inform Nurs 2017; 34:360-8. [PMID: 27223309 DOI: 10.1097/cin.0000000000000252] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Telehealth programs for heart failure have been studied using a variety of techniques. Because currently a majority of the elderly are nonusers of computers and Internet, we developed a home telehealth system based on digital pen technology. Fourteen patients (mean age, 84 years [median, 83 years]) with severe heart failure participated in a 13-month pilot study in specialized homecare. Participants communicated patient-reported outcome measures daily using the digital pen and health diary forms, submitting a total of 3 520 reports. The reports generated a total of 632 notifications when reports indicated worsening health. Healthcare professionals reviewed reports frequently, more than 4700 times throughout the study, and acted on the information provided. Patients answered questionnaires and were observed in their home environment when using the system. Results showed that the technology was accepted by participants: patients experienced an improved contact with clinicians; they felt more compliant with healthcare professionals' advice, and they felt more secure and more involved in their own care. Via the system, the healthcare professionals detected heart failure-related deteriorations at an earlier stage, and as a consequence, none of the patients were admitted into hospital care during the study.
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150
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Piccinni C, Antonazzo IC, Simonetti M, Mennuni MG, Parretti D, Cricelli C, Colombo D, Nica M, Cricelli I, Lapi F. The Burden of Chronic Heart Failure in Primary Care in Italy. High Blood Press Cardiovasc Prev 2017; 24:171-178. [DOI: 10.1007/s40292-017-0193-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/15/2017] [Indexed: 12/12/2022] Open
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