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Savarese G, Lund LH, Dahlström U, Strömberg A. Nurse-Led Heart Failure Clinics Are Associated With Reduced Mortality but Not Heart Failure Hospitalization. J Am Heart Assoc 2020; 8:e011737. [PMID: 31094284 PMCID: PMC6585319 DOI: 10.1161/jaha.118.011737] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Follow-up in a nurse-led heart failure ( HF ) clinic is recommended in HF guidelines, but its association with outcomes remains controversial, with previous studies including few and highly selected patients. Thus, large analyses of "real-world" samples are needed. Aims were to assess: (1) independent predictors of and (2) prognosis associated with planned referral to nurse-led HF clinics. Methods and Results We analyzed data from the SwedeHF (Swedish HF Registry) using multivariable logistic regressions to identify independent predictors of planned referral to a nurse-led HF clinic and multivariable Cox regressions to test associations between planned referral and outcomes (all-cause death, HF hospitalization, and their composite). Of 40 992 patients, 39% were planned to be referred to a follow-up in a nurse-led HF clinic. Independent characteristics associated with planned referral were shorter duration of HF , clinical markers of more-severe HF, such as lower ejection fraction, higher New York Heart Association class and N-terminal pro-B-type natriuretic peptide, and lower blood pressure, as well as cohabitating versus living alone, male sex, fewer comorbidities, and more use of HF treatments. After adjustments, planned referral to a nurse-led HF clinic was associated with reduced mortality and mortality/ HF hospitalization, but not HF hospitalization alone. Conclusions In this nation-wide registry, 39% of our identified HF cohort was planned to be referred to a nurse-led HF clinic. Planned referral reflected more-severe HF , but also sex- and family-related factors, and it was independently associated with lower risk of death, but not of HF hospitalization.
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Affiliation(s)
- Gianluigi Savarese
- 1 Division of Cardiology Department of Medicine Karolinska Institutet Stockholm Sweden
| | - Lars H Lund
- 1 Division of Cardiology Department of Medicine Karolinska Institutet Stockholm Sweden.,2 Heart and Vascular Theme Karolinska University Hospital Stockholm Sweden
| | - Ulf Dahlström
- 3 Department of Medical and Health Sciences and Department of Cardiology Linköping University Linköping Sweden
| | - Anna Strömberg
- 3 Department of Medical and Health Sciences and Department of Cardiology Linköping University Linköping Sweden
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152
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Schumacher C, Jones A, Costa AP. Home Care Nursing Visits and Same-Day Emergency Department Use: Which Patients Are Most at Risk? Can J Nurs Res 2020; 53:376-383. [PMID: 32819144 DOI: 10.1177/0844562120949426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Home care patients are a growing group of community-dwelling older adults with complex care needs and high health service use. Adult home care patients are at high risk for emergency department (ED) visits, which is greater on the same day as a nursing visit. PURPOSE The purpose of this study was to examine whether common nursing indicators modified the association between nursing visits and same-day ED visits. METHODS A case-crossover design within a retrospective cohort of adult home care patients in Ontario. RESULTS A total of 11,840 home care nursing patients were analyzed. Home care patients who received a home nursing visit were more likely to go the ED afterhours on the same day with a stronger association for visits not admitted to the hospital. Having a urinary catheter increased the risk of a same-day ED visit (OR: 1.78 (95% CI 1.15-1.60) vs. 1.21 (95% CI 1.15-1.28)). No other clinical indicator modified the association. CONCLUSIONS The findings of this study can be used to inform care policies and practices for home care nurses in the management of indwelling urinary catheter complications. Further examination of system factors such as capacity and resources available to respond to catheter related complications in the community setting are recommended.
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Affiliation(s)
- Connie Schumacher
- BDG, McMaster University, Hamilton, Ontario, Canada.,Department of Nursing, Brock University, St. Catharines, Ontario, Canada
| | - Aaron Jones
- BDG, McMaster University, Hamilton, Ontario, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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153
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Eze ND, Mateus C, Cravo Oliveira Hashiguchi T. Telemedicine in the OECD: An umbrella review of clinical and cost-effectiveness, patient experience and implementation. PLoS One 2020; 15:e0237585. [PMID: 32790752 PMCID: PMC7425977 DOI: 10.1371/journal.pone.0237585] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Patients and policy makers alike have high expectations for the use of digital technologies as tools to improve health care service quality at a sustainable cost. Many countries within the Organisation for Economic Co-operation and Development (OECD) are investing in telemedicine initiatives, and a large and growing body of peer-reviewed studies on the topic has developed, as a consequence. Nonetheless, telemedicine is still not used at scale within the OECD. Seeking to provide a snapshot of the evidence on the use of telemedicine in the OECD, this umbrella review of systematic reviews summarizes findings on four areas of policy relevance: clinical and cost-effectiveness, patient experience, and implementation. Methods This review followed a prior written, unregistered protocol. Four databases (PubMed/Medline, CRD, and Cochrane Library) were searched for systematic reviews or meta-analyses published between January 2014 and February 2019. Based on the inclusion criteria, 98 systematic reviews were selected for analysis. Due to substantial heterogeneity, a meta-analysis was not conducted. The quality of included reviews was assessed using the AMSTAR 2 tool. Results Most reviews (n = 53) focused on effectiveness, followed by cost-effectiveness (n = 18), implementation (n = 17) and patient experience (n = 15). Eighty-three percent of clinical effectiveness reviews found telemedicine at least as effective as face-to-face care, and thirty-nine percent of cost-effectivenss reviews found telemedicine to be cost saving or cost-effective. Patients reported high acceptance of telemedicine and the most common barriers to implementation were usability and lack of reimbursement. However, the methodological quality of most reviews was low to critically low which limits generalizability and applicability of findings. Conclusion This umbrella review finds that telemedicine interventions can improve glycemic control in diabetic patients; reduce mortality and hospitalization due to chronic heart failure; help patients manage pain and increase their physical activity; improve mental health, diet quality and nutrition; and reduce exacerbations associated with respiratory diseases like asthma. In certain disease and specialty areas, telemedicine may be a less effective way to deliver care. While there is evidence that telemedicine can be cost-effective, generalizability is hindered by poor quality and reporting standards. This umbrella review also finds that patients report high levels of acceptance and satisfaction with telemedicine interventions, but that important barriers to wider use remain.
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Affiliation(s)
- Nkiruka D Eze
- Division of Health Research, Health Economics at Lancaster, Lancaster University, Lancaster, United Kingdom
| | - Céu Mateus
- Division of Health Research, Health Economics at Lancaster, Lancaster University, Lancaster, United Kingdom
| | - Tiago Cravo Oliveira Hashiguchi
- Health Division Organisation for Economic Co-operation and Development, Directorate for Employment, Labour and Social Affairs, Paris, France
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154
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Sterling MR, Kern LM, Safford MM, Jones CD, Feldman PH, Fonarow GC, Sheng S, Matsouaka RA, DeVore AD, Lytle B, Xu H, Allen LA, Deswal A, Yancy CW, Albert NM. Home Health Care Use and Post-Discharge Outcomes After Heart Failure Hospitalizations. JACC-HEART FAILURE 2020; 8:1038-1049. [PMID: 32800510 DOI: 10.1016/j.jchf.2020.06.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study compared the characteristics of Medicare beneficiaries who were hospitalized for heart failure (HF) and then discharged home who received home health care (HHC) to the characteristics of those who did not, and examined associations among HHC and readmission and mortality rates. BACKGROUND After hospitalization for HF, some patients receive HHC. However, the use of HHC over time, the factors associated with its use, and the post-discharge outcomes after receiving it are not well studied. METHODS This study used Get With The Guidelines-HF data, merged with Medicare fee-for-service claims. Propensity score matching and Cox proportional hazards models were used to evaluate the associations between HHC and post-discharge outcomes. RESULTS From 2005 to 2015, 95,531 patients were admitted for HF, and 32,697 (34.2%) received HHC after discharge. The rate of HHC increased over time from 31.4% to 36.1% (p < 0.001). HHC recipients were older, more likely to be female, and had more comorbidities. HHC was associated with a higher risk of all-cause 30-day readmission (hazard ratio [HR]: 1.25; 95% confidence interval [CI]: 1.20 to 1.30), HF-specific 30-day readmission (HR: 1.20; 95% CI: 1.13 to 1.28), all-cause 90-day readmission (HR: 1.23; 95% CI: 1.19 to 1.26), HF-specific 90-day readmission (HR: 1.16; 95% CI: 1.11 to 1.22), and all-cause 30-and 90-day mortality, respectively (HR: 1.70; 95% CI: 1.56 to 1.86) and HR: 1.49; 95% CI: 1.41 to 1.57) compared to those who did not receive HHC. CONCLUSIONS Use of HHC after HF hospitalization increased among Medicare beneficiaries. HHC recipients were older and sicker than non-HHC recipients. Although HHC was associated with a higher risk of readmissions and mortality, this finding should be interpreted cautiously, given the presence of unmeasured variables that could affect receipt of HHC. Research is needed to determine whether the results reflect appropriate health care use.
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Affiliation(s)
| | - Lisa M Kern
- Weill Cornell Medicine, New York, New York, USA
| | | | | | | | - Gregg C Fonarow
- University of California Los Angeles, Los Angeles, California, USA
| | - Shubin Sheng
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | | | | | - Haolin Xu
- Duke University, Durham, North Carolina, USA
| | - Larry A Allen
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Anita Deswal
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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155
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Dawson S, Kunonga P, Beyer F, Spiers G, Booker M, McDonald R, Cameron A, Craig D, Hanratty B, Salisbury C, Huntley A. Does health and social care provision for the community dwelling older population help to reduce unplanned secondary care, support timely discharge and improve patient well-being? A mixed method meta-review of systematic reviews. F1000Res 2020; 9:857. [PMID: 34621521 PMCID: PMC8482050 DOI: 10.12688/f1000research.25277.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 11/20/2022] Open
Abstract
Background: This study aimed to identify and examine systematic review evidence of health and social care interventions for the community-dwelling older population regarding unplanned hospital admissions, timely hospital discharge and patient well-being. Methods: A meta-review was conducted using Joanna Briggs and PRISMA guidance. A search strategy was developed: eight bibliographic medical and social science databases were searched, and references of included studies checked. Searches were restricted to OECD countries and to systematic reviews published between January 2013-March 2018. Data extraction and quality appraisal was undertaken by one reviewer with a random sample screened independently by two others. Results: Searches retrieved 21,233 records; using data mining techniques, we identified 8,720 reviews. Following title and abstract and full-paper screening, 71 systematic reviews were included: 62 quantitative, seven qualitative and two mixed methods reviews. There were 52 reviews concerned with healthcare interventions and 19 reviews concerned with social care interventions. This meta-review summarises the evidence and evidence gaps of nine broad types of health and social care interventions. It scrutinises the presence of research in combined health and social care provision, finding it lacking in both definition and detail given. This meta-review debates the overlap of some of the person-centred support provided by community health and social care provision. Research recommendations have been generated by this process for both primary and secondary research. Finally, it proposes that research recommendations can be delivered on an ongoing basis if meta-reviews are conducted as living systematic reviews. Conclusions: This meta-review provides evidence of the effect of health and social care interventions for the community-dwelling older population and identification of evidence gaps. It highlights the lack of evidence for combined health and social care interventions and for the impact of social care interventions on health care outcomes. Registration: PROSPERO ID CRD42018087534; registered on 15 March 2018.
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Affiliation(s)
- Shoba Dawson
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Patience Kunonga
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Fiona Beyer
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Gemma Spiers
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Matthew Booker
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Ruth McDonald
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Ailsa Cameron
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Dawn Craig
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, UK, Newcastle, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Alyson Huntley
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
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156
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Mutharasan RK. Transitioning Patients with Heart Failure to Outpatient Care. Heart Fail Clin 2020; 16:421-431. [PMID: 32888637 DOI: 10.1016/j.hfc.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The transition from hospitalization to outpatient care is a vulnerable time for patients with heart failure. This requires specific focus on the transitional care period. Here the authors propose a framework to guide process improvement in the transitional care period. The authors extend this framework by (1) examining the role new technology might play in transitional care, and (2) offering practical advice for teams building transitional care programs.
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Affiliation(s)
- R Kannan Mutharasan
- Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Arkes Pavilion, Suite 6-071, Chicago, IL 60611, USA.
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157
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Allida S, Du H, Xu X, Prichard R, Chang S, Hickman LD, Davidson PM, Inglis SC. mHealth education interventions in heart failure. Cochrane Database Syst Rev 2020; 7:CD011845. [PMID: 32613635 PMCID: PMC7390434 DOI: 10.1002/14651858.cd011845.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Heart failure (HF) is a chronic disease with significant impact on quality of life and presents many challenges to those diagnosed with the condition, due to a seemingly complex daily regimen of self-care which includes medications, monitoring of weight and symptoms, identification of signs of deterioration and follow-up and interaction with multiple healthcare services. Education is vital for understanding the importance of this regimen, and adhering to it. Traditionally, education has been provided to people with heart failure in a face-to-face manner, either in a community or a hospital setting, using paper-based materials or video/DVD presentations. In an age of rapidly-evolving technology and uptake of smartphones and tablet devices, mHealth-based technology (defined by the World Health Organization as mobile and wireless technologies to achieve health objectives) is an innovative way to provide health education which has the benefit of being able to reach people who are unable or unwilling to access traditional heart failure education programmes and services. OBJECTIVES To systematically review and quantify the potential benefits and harms of mHealth-delivered education for people with heart failure. SEARCH METHODS We performed an extensive search of bibliographic databases and registries (CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, IEEE Xplore, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) Search Portal), using terms to identify HF, education and mHealth. We searched all databases from their inception to October 2019 and imposed no restriction on language of publication. SELECTION CRITERIA We included studies if they were conducted as a randomised controlled trial (RCT), involving adults (≥ 18 years) with a diagnosis of HF. We included trials comparing mHealth-delivered education such as internet and web-based education programmes for use on smartphones and tablets (including apps) and other mobile devices, SMS messages and social media-delivered education programmes, versus usual HF care. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed risks of bias, and extracted data from all included studies. We calculated the mean difference (MD) or standardised mean difference (SMD) for continuous data and the odds ratio (OR) for dichotomous data with a 95% confidence interval (CI). We assessed heterogeneity using the I2 statistic and assessed the quality of evidence using GRADE criteria. MAIN RESULTS We include five RCTs (971 participants) of mHealth-delivered education interventions for people with HF in this review. The number of trial participants ranged from 28 to 512 participants. Mean age of participants ranged from 60 years to 75 years, and 63% of participants across the studies were men. Studies originated from Australia, China, Iran, Sweden, and The Netherlands. Most studies included participants with symptomatic HF, NYHA Class II - III. Three studies addressed HF knowledge, revealing that the use of mHealth-delivered education programmes showed no evidence of a difference in HF knowledge compared to usual care (MD 0.10, 95% CI -0.2 to 0.40, P = 0.51, I2 = 0%; 3 studies, 411 participants; low-quality evidence). One study assessing self-efficacy reported that both study groups had high levels of self-efficacy at baseline and uncertainty in the evidence for the intervention (MD 0.60, 95% CI -0.57 to 1.77; P = 0.31; 1 study, 29 participants; very low-quality evidence).Three studies evaluated HF self-care using different scales. We did not pool the studies due to the heterogenous nature of the outcome measures, and the evidence is uncertain. None of the studies reported adverse events. Four studies examined health-related quality of life (HRQoL). There was uncertainty in the evidence for the use of mHealth-delivered education on HRQoL (MD -0.10, 95% CI -2.35 to 2.15; P = 0.93, I2 = 61%; 4 studies, 942 participants; very low-quality evidence). Three studies reported on HF-related hospitalisation. The use of mHealth-delivered education may result in little to no difference in HF-related hospitalisation (OR 0.74, 95% CI 0.52 to 1.06; P = 0.10, I2 = 0%; 3 studies, 894 participants; low-quality evidence). We downgraded the quality of the studies due to limitations in study design and execution, heterogeneity, wide confidence intervals and fewer than 500 participants in the analysis. AUTHORS' CONCLUSIONS We found that the use of mHealth-delivered educational interventions for people with HF shows no evidence of a difference in HF knowledge; uncertainty in the evidence for self-efficacy, self-care and health-related quality of life; and may result in little to no difference in HF-related hospitalisations. The identification of studies currently underway and those awaiting classification indicate that this is an area of research from which further evidence will emerge in the short and longer term.
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Affiliation(s)
- Sabine Allida
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Huiyun Du
- School of Nursing and Midwifery, Flinders University, Bedford Park, Australia
| | - Xiaoyue Xu
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Roslyn Prichard
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Sungwon Chang
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Louise D Hickman
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | | | - Sally C Inglis
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
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158
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Psychometric Testing of the Hebrew Version of the European Heart Failure Self-Care Behaviour Scale. Heart Lung Circ 2020; 29:e121-e130. [DOI: 10.1016/j.hlc.2019.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/23/2019] [Accepted: 10/20/2019] [Indexed: 11/21/2022]
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159
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Corbalan R, Bassand JP, Illingworth L, Ambrosio G, Camm AJ, Fitzmaurice DA, Fox KAA, Goldhaber SZ, Goto S, Haas S, Kayani G, Mantovani LG, Misselwitz F, Pieper KS, Turpie AGG, Verheugt FWA, Kakkar AK. Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation: A Report From the GARFIELD-AF Registry. JAMA Cardiol 2020; 4:526-548. [PMID: 31066873 DOI: 10.1001/jamacardio.2018.4729] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes. Objective To assess the treatment strategies and 1-year clinical outcomes of antithrombotic and CHF therapies for patients with newly diagnosed AF with concomitant CHF stratified by etiology (ischemic cardiomyopathy [ICM] vs nonischemic cardiomyopathy [NICM]). Design, Setting, and Participants The GARFIELD-AF registry is a prospective, noninterventional registry. A total of 52 014 patients with AF were enrolled between March 2010 and August 2016. A total of 11 738 patients 18 years and older with newly diagnosed AF (≤6 weeks' duration) and at least 1 investigator-determined stroke risk factor were included. Data were analyzed from December 2017 to September 2018. Exposures One-year follow-up rates of death, stroke/systemic embolism, and major bleeding were assessed. Main Outcomes and Measures Event rates per 100 person-years were estimated from the Poisson model and Cox hazard ratios (HRs) and 95% confidence intervals. Results The median age of the population was 71.0 years, 22 987 of 52 013 were women (44.2%) and 31 958 of 52 014 were white (61.4%). Of 11 738 patients with CHF, 4717 (40.2%) had ICM and 7021 (59.8%) had NICM. Prescription of oral anticoagulant and antiplatelet drugs was not balanced between groups. Oral anticoagulants with or without antiplatelet drugs were used in 2753 patients with ICM (60.1%) and 5082 patients with NICM (73.7%). Antiplatelets were prescribed alone in 1576 patients with ICM (34.4%) and 1071 patients with NICM (15.5%). Compared with patients with NICM, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (72.6% [3439] vs 60.3% [4236]) and of β blockers (63.3% [2988] vs 53.2% [3737]) was higher in patients with ICM. Rates of all-cause and cardiovascular death per 100 patient-years were significantly higher in the ICM group (all-cause death: ICM, 10.2; 95% CI, 9.2-11.1; NICM, 7.0; 95% CI, 6.4-7.6; cardiovascular death: ICM, 5.1; 95% CI, 4.5-5.9; NICM, 2.9; 95% CI, 2.5-3.4). Stroke/systemic embolism rates tended to be higher in ICM groups compared with NICM groups (ICM, 2.0; 95% CI, 1.6-2.5; NICM, 1.5; 95% CI, 1.3-1.9). Major bleeding rates were significantly higher in the ICM group (1.1; 95% CI, 0.8-1.4) compared with the NICM group (0.7; 95% CI, 0.5-0.9). Conclusions and Relevance Patients with ICM received oral anticoagulants with or without antiplatelet drugs less frequently and antiplatelets alone more frequently than patients with NICM, but they received angiotensin-converting enzyme inhibitors/angiotensin receptor blockers more often than patients with NICM. All-cause and cardiovascular death rates were higher in patients with ICM than patients with NICM. Trial Registration ClinicalTrials.gov Identifier: NCT01090362.
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Affiliation(s)
- Ramon Corbalan
- Division of Cardiovascular Diseases, Catholic University School of Medicine, Santiago, Chile
| | - Jean-Pierre Bassand
- University of Besançon, Besançon, France.,Thrombosis Research Institute, London, England
| | | | | | - A John Camm
- St George's University of London, London, England
| | | | | | - Samuel Z Goldhaber
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Shinya Goto
- Tokai University School of Medicine, Kanagawa, Japan
| | - Sylvia Haas
- Formerly at Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Lorenzo G Mantovani
- Center for Public Health Research, University of Milan Bicocca, Monza, Italy
| | | | - Karen S Pieper
- Thrombosis Research Institute, London, England.,Duke Clinical Research Institute, Durham, North Carolina
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160
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Autonomous Walking Program and High-Intensity Inspiratory Muscle Training in Individuals With Heart Failure—A Feasibility Study. Cardiopulm Phys Ther J 2020. [DOI: 10.1097/cpt.0000000000000144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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161
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Feldman SF, Lesuffleur T, Olié V, Gastaldi-Ménager C, Juillière Y, Tuppin P. Outpatient healthcare utilization 30 days before and after hospitalization for heart failure in France: Contribution of the national healthcare database (Systèmenationaldesdonnéesdesanté). Arch Cardiovasc Dis 2020; 113:401-419. [PMID: 32473996 DOI: 10.1016/j.acvd.2019.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/22/2019] [Accepted: 11/22/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Guidelines have been published concerning patient management after hospitalization for heart failure. The French national healthcare database (Systèmenationaldesdonnéesdesanté; SNDS) can be used to compare these guidelines with real-life practice. AIMS To study healthcare utilization 30 days before and after hospitalization for heart failure, and the variations induced by the exclusion of institutionalized patients, who are less exposed to outpatient healthcare utilization. METHODS We identified the first hospitalization for heart failure in 2015 of adult beneficiaries of the health insurance schemes covering 88% of the French population, who were alive 30 days after hospitalization. Outpatient healthcare utilization rates during the 30 days after hospitalization and the median times to outpatient care, together with their interquartile ranges, were described for all patients, and for a subgroup excluding institutionalized patients. RESULTS Among the 104,984 patients included (mean age 79 years; 52% women), 74% were non-institutionalized (mean age 78 years; 47% women). The frequencies of at least one consultation after hospitalization and the median times to consultation were 69% (total sample) vs. 78% (subgroup excluding institutionalized patients) and 8 days (interquartile range 3; 16) vs. 7 days (3; 15) for general practitioners, 20% vs. 21% and 14 days (7; 23) vs. 16 days (9; 24) for cardiologists and 58% vs. 69% and 3 days (1; 9) vs. 2 days (1; 7) for nurses, with reimbursement of diuretics in 77% vs. 86%, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in 48% vs. 55% and beta-blockers in 55% vs. 63%. Departmental variations, excluding institutionalized patients, were large: general practice consultations (interquartile range 74%; 83%), cardiology consultations (11%; 23%) and nursing care (68%; 77%). CONCLUSIONS Low outpatient healthcare utilization rates, long intervals to first healthcare utilization and departmental variations indicate a mismatch between guidelines and real-life practice, which is accentuated when including institutionalized patients.
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Affiliation(s)
- Sarah F Feldman
- Caisse nationale de l'assurance maladie (CNAM), 75986 Paris, France
| | | | - Valérie Olié
- Santé publique France, 94410 Saint-Maurice, France
| | | | - Yves Juillière
- Cardiologie, Institut Lorrain du cœur et des vaisseaux Louis-Mathieu, 54500 Vandœuvre-lès-Nancy, France
| | - Philippe Tuppin
- Caisse nationale de l'assurance maladie (CNAM), 75986 Paris, France.
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162
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Virani SA, Clarke B, Ducharme A, Ezekowitz JA, Heckman GA, McDonald M, Mielniczuk LM, Swiggum E, Van Spall HGC, Zieroth S. Optimizing Access to Heart Failure Care in Canada During the COVID-19 Pandemic. Can J Cardiol 2020; 36:1148-1151. [PMID: 32405146 PMCID: PMC7217768 DOI: 10.1016/j.cjca.2020.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 01/07/2023] Open
Abstract
The traditional model of heart failure (HF) care in Canada, which relies upon a multidisciplinary team and clinic-based care processes, has been undermined as a result of the COVID-19 pandemic. As the pandemic continues, we will be challenged to improve or maintain the health status of those with HF by optimizing guideline-directed care despite physical distancing constraints and a reduction in the health care workforce. This will require development of new strategies specifically targeted at decreasing the risk of decompensation and resultant HF hospitalization. As such, we must quickly pivot to the adoption and application of novel technologies and revise usual care models, processes, and workflow. The unprecedented COVID-19 crisis has delivered the Canadian HF community a burning platform for the design and implementation of innovative approaches to support the vulnerable population we serve; born out of necessity, we now have the opportunity to explore innovative approaches that might inform the future of HF care delivery in Canada. Herein, we provide perspectives from leadership within the Canadian Heart Failure Society on how to optimize HF care during the COVID-19 pandemic.
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Affiliation(s)
- Sean A Virani
- University of British Columbia, Vancouver, British Columbia, Canada.
| | - Brian Clarke
- Libin Cardiovascular Institute and the University of Calgary, Calgary, Alberta, Canada
| | - Anique Ducharme
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Justin A Ezekowitz
- Canadian VIGOUR Centre and the University of Alberta, Edmonton, Alberta, Canada
| | | | - Michael McDonald
- Peter Munk Cardiac Centre and the University of Toronto, Toronto, Ontario, Canada
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163
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Mai Ba H, Son YJ, Lee K, Kim BH. Transitional Care Interventions for Patients with Heart Failure: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082925. [PMID: 32340346 PMCID: PMC7215305 DOI: 10.3390/ijerph17082925] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 12/15/2022]
Abstract
Heart failure (HF) is a life-limiting illness and presents as a gradual functional decline with intermittent episodes of acute deterioration and some recovery. In addition, HF often occurs in conjunction with other chronic diseases, resulting in complex comorbidities. Hospital readmissions for HF, including emergency department (ED) visits, are considered preventable. Majority of the patients with HF are often discharged early in the recovery period with inadequate self-care instructions. To address these issues, transitional care interventions have been implemented with the common objective of reducing the rate of hospital readmission, including ED visits. However, there is a lack of evidence regarding the benefits and adverse effects of transitional care interventions on clinical outcomes and patient-related outcomes of patients with HF. This integrative review aims to identify the components of transitional care interventions and the effectiveness of these interventions in improving health outcomes of patients with HF. Five databases were searched from January 2000 to December 2019, and 25 articles were included.
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Affiliation(s)
- Hai Mai Ba
- Department of Nursing, Gachon University Graduate School, Incheon 21936, Korea;
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea;
| | - Kyounghoon Lee
- College of Medicine, Division of Cardiology, Gachon University, Incheon 21565, Korea;
- Cardiovascular Research Institute, Gachon University, Incheon 21565, Korea
| | - Bo-Hwan Kim
- Cardiovascular Research Institute, Gachon University, Incheon 21565, Korea
- College of Nursing, Gachon University, Incheon 21936, Korea
- Correspondence: ; Tel.: +82-32-820-4213
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164
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Larina VN, Leonova MV, Bondarenkova AA, Larin VG. Patient compliance and physicians’ adherence to guidelines on heart failure with reduced ejection fraction. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- V. N. Larina
- N.I. Pirogov Russian National Research Medical University
| | | | | | - V. G. Larin
- N.I. Pirogov Russian National Research Medical University
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165
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Seferović PM, Piepoli MF, Lopatin Y, Jankowska E, Polovina M, Anguita‐Sanchez M, Störk S, Lainščak M, Miličić D, Milinković I, Filippatos G, Coats AJ. Heart Failure Association of the European Society of Cardiology Quality of Care Centres Programme: design and accreditation document. Eur J Heart Fail 2020; 22:763-774. [DOI: 10.1002/ejhf.1784] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 01/18/2020] [Accepted: 02/19/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Petar M. Seferović
- Faculty of Medicine University of Belgrade Belgrade Serbia
- Faculty of Medicine, Serbian Academy of Sciences and Arts Belgrade Serbia
| | - Massimo F. Piepoli
- Heart Failure Unit, Guglielmo da Saliceto Hospital Azienda Unità Sanitaria Locale di Piacenza and University of Parma Piacenza Italy
| | - Yuri Lopatin
- Volgograd Regional Cardiology Centre, Volgograd State Medical University Volgograd Russia
| | - Ewa Jankowska
- Department of Heart Disease Wroclaw Medical University, Centre for Heart Disease, Military Hospital Wroclaw Poland
| | - Marija Polovina
- Faculty of Medicine University of Belgrade Belgrade Serbia
- Department of Cardiology Clinical Centre of Serbia Belgrade Serbia
| | | | - Stefan Störk
- Department of Internal Medicine I and Comprehensive Heart Failure Centre University Hospital, University of Würzburg Würzburg Germany
- Department of Cardiology University of Würzburg Würzburg Germany
- Division of Cardiology General Hospital Murska Sobota Murska Sobota Slovenia
| | - Mitja Lainščak
- Faculty of Medicine University of Ljubljana Ljubljana Slovenia
| | - Davor Miličić
- Department of Cardiovascular Diseases University Hospital Centre Zagreb, University of Zagreb Zagreb Croatia
| | - Ivan Milinković
- Faculty of Medicine University of Belgrade Belgrade Serbia
- Department of Cardiology Clinical Centre of Serbia Belgrade Serbia
| | - Gerasimos Filippatos
- Second Department of Cardiology Attikon University Hospital, Medical School, National and Kapodistrian University of Athens Athens Greece
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166
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Virani SA, Zieroth S, Bray S, Ducharme A, Harkness K, Koshman SL, McDonald M, O'Meara E, Swiggum E, Chan M, Ezekowitz JA, Giannetti N, Grzeslo A, Heckman GA, Howlett JG, Lepage S, Mielniczuk L, Moe GW, Toma M, Abrams H, Al-Hesaye A, Cohen-Solal A, D'Astous M, De S, Delgado D, Desplantie O, Estrella-Holder E, Green L, Haddad H, Hernandez AF, Kouz S, LeBlanc MH, Lee D, Masoudi FA, Matteau S, McKelvie R, Parent MC, Rajda M, Ross HJ, Sussex B. The Status of Specialized Ambulatory Heart Failure Care in Canada: A Joint Canadian Heart Failure Society and Canadian Cardiovascular Society Heart Failure Guidelines Survey. CJC Open 2020; 2:151-160. [PMID: 32462129 PMCID: PMC7242502 DOI: 10.1016/j.cjco.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/04/2020] [Indexed: 12/31/2022] Open
Abstract
This joint Canadian Heart Failure Society and the CCS Heart Failure guidelines report has been developed to provide a pan-Canadian snapshot of the current state of clinic-based ambulatory heart failure (HF) care in Canada with specific reference to elements and processes of care associated with quality and high performing health systems. It includes the viewpoints of persons with lived experience, patient care providers, and administrators. It is imperative to build on the themes identified in this survey, through engaging all health care professionals, to develop integrated and shared care models that will allow better patient outcomes. Several patient and organizational barriers to care were identified in this survey, which must inform the development of regional care models and pragmatic solutions to improve transitions for this patient population. Unfortunately, we were unsuccessful in incorporating the perspectives of primary care providers and internal medicine specialists who provide the majority of HF care in Canada, which in turn limits our ability to comment on strategies for capacity building outside the HF clinic setting. These considerations must be taken into account when interpreting our findings. Engaging all HF care providers, to build on the themes identified in this survey, will be an important next step in developing integrated and shared care models known to improve patient outcomes.
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Affiliation(s)
| | - Sean A Virani
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sharon Bray
- Lived Experience Partner, Toronto, Ontario, Canada
| | - Anique Ducharme
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | | | - Michael McDonald
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Eileen O'Meara
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Elizabeth Swiggum
- Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, Canada
| | | | - Michael Chan
- University of Alberta, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | | | | | - Adam Grzeslo
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - George A Heckman
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - Jonathan G Howlett
- Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Serge Lepage
- Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Lisa Mielniczuk
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Mustafa Toma
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Sabe De
- London Health Sciences, Western University, London, Ontario, Canada
| | | | - Olivier Desplantie
- Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, Canada
| | | | - Lee Green
- University of Alberta, Edmonton, Alberta, Canada
| | - Haissam Haddad
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Simon Kouz
- Centre Intégré de Santé et de Services Sociaux de Lanaudière - Centre Hospitalier de Lanaudière, Joliette, Québec, Canada
| | - Marie-Hélène LeBlanc
- Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Université Laval, Québec, Québec, Canada
| | - Douglas Lee
- University Health Network, Toronto, Ontario, Canada
| | | | - Sylvain Matteau
- Université de Sherbrooke, Sherbrooke, Québec, Canada.,Chaleur Regional Hospital, Bathurst, New Brunswick, Canada
| | - Robert McKelvie
- St Joseph's Health Care, Western University, London, Ontario, Canada
| | - Marie-Claude Parent
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Miroslaw Rajda
- QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Heather J Ross
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Bruce Sussex
- Memorial University, St John's, Newfoundland, Canada
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167
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Scalvini S, Comini L, Bernocchi P. How can multidisciplinary management with remote monitoring improve the outcome of patients with chronic cardiac diseases? Expert Rev Med Devices 2020; 17:153-157. [DOI: 10.1080/17434440.2020.1720510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Care Continuity Unit and Telemedicine Service, Lumezzane, Italy
| | - Laura Comini
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Lumezzane, Italy
| | - Palmira Bernocchi
- Istituti Clinici Scientifici Maugeri IRCCS, Care Continuity Unit and Telemedicine Service, Lumezzane, Italy
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168
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Nuevas estrategias para evaluar la efectividad de servicios de insuficiencia cardiaca. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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169
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McKenna WJ, Montoro-López MN. Novel strategies to evaluate the effectiveness of heart failure services. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:200-204. [PMID: 31668638 DOI: 10.1016/j.rec.2019.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/12/2019] [Indexed: 06/10/2023]
Affiliation(s)
- William J McKenna
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar; Institute of Cardiovascular Science, University College London, London, United Kingdom; Section of Cardiovascular Diseases, Yale School of Medicine and YNHH Heart and Vascular Center, New Haven, CT, United States.
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170
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Güder G, Ertl G, Angermann CE. [Diagnostics and treatment of chronic heart failure : Update 2020]. Herz 2020:10.1007/s00059-019-04877-z. [PMID: 32016486 DOI: 10.1007/s00059-019-04877-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Heart failure is a systemic disease. As populations are aging worldwide, the prevalence and importance of comorbidities as major determinants of heart failure symptoms, disease progression and prognosis are increasing. Since the last version of the European Society of Cardiology guidelines for the diagnosis and treatment of heart failure was published in 2016, promising novel pharmacotherapies for chronic heart failure and its comorbidities and new device-based treatment and monitoring options have become available; however, the broad range of therapeutic options as well as the diagnostic and therapeutic implications of comorbidities render the treatment of heart failure increasingly more complex. This review aims to provide practical guidance for a rational up-to-date approach to the evidence-based management of heart failure.
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Affiliation(s)
- Gülmisal Güder
- Medizinische Klinik und Poliklinik I, Kardiologie, Universität Würzburg, Würzburg, Deutschland
- Deutsches Zentrum für Herzinsuffizienz, Universität und Universitätsklinikum Würzburg, Haus A 15, Am Schwarzenberg 15, 97078, Würzburg, Deutschland
| | - Georg Ertl
- Deutsches Zentrum für Herzinsuffizienz, Universität und Universitätsklinikum Würzburg, Haus A 15, Am Schwarzenberg 15, 97078, Würzburg, Deutschland
| | - Christiane E Angermann
- Deutsches Zentrum für Herzinsuffizienz, Universität und Universitätsklinikum Würzburg, Haus A 15, Am Schwarzenberg 15, 97078, Würzburg, Deutschland.
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171
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Variations in stepped-wedge cluster randomized trial design: Insights from the Patient-Centered Care Transitions in Heart Failure trial. Am Heart J 2020; 220:116-126. [PMID: 31805422 DOI: 10.1016/j.ahj.2019.08.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 08/26/2019] [Indexed: 11/21/2022]
Abstract
The stepped-wedge (SW) cluster randomized controlled trial, in which clusters cross over in a randomized sequence from control to intervention, is ideal for the implementation and testing of complex health service interventions. In certain cases however, implementation of the intervention may pose logistical challenges, and variations in SW design may be required. We examine the logistical and statistical implications of variations in SW design using the optimization of the Patient-Centered Care Transitions in Heart Failure trial for illustration. We review the following complete SW design variations: a typical SW design; an SW design with multiple clusters crossing over per period to achieve balanced cluster sizes at each step; hierarchical randomization to account for higher-level clustering effects; nested substudies to measure outcomes requiring a smaller sample size than the primary outcomes; and hybrid SW design, which combines parallel cluster with SW design to improve efficiency. We also reviewed 3 incomplete SW design variations in which data are collected in some but not all steps to ease measurement burden. These include designs with a learning period that improve fidelity to the intervention, designs with reduced measurements to minimize collection burden, and designs with early and late blocks to accommodate cluster readiness. Variations in SW design offer pragmatic solutions to logistical challenges but have implications to statistical power. Advantages and disadvantages of each variation should be considered before finalizing the design of an SW randomized controlled trial.
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172
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Leavitt MA, Hain DJ, Keller KB, Newman D. Testing the Effect of a Home Health Heart Failure Intervention on Hospital Readmissions, Heart Failure Knowledge, Self-Care, and Quality of Life. J Gerontol Nurs 2020; 46:32-40. [PMID: 31978237 DOI: 10.3928/00989134-20191118-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/06/2019] [Indexed: 01/26/2023]
Abstract
For older adults, heart failure (HF) has the highest 30-day hospital readmission rate of any chronic illness. Despite research into strategies to reduce readmissions, no single program has emerged as sustainable. The purpose of the current study was to test a researcher-developed home health nurse HF intervention (CareNavRN™) on 30-day readmission rates, HF knowledge, self-care, and quality of life (QOL) among 40 older adults transitioning home. Home health nurses received specialized HF training and visited patients once per week at home for 4 weeks. The control group (n = 21) had six readmissions (29%) and the intervention group (n = 19) had three readmissions (16%); however, the results were underpowered and statistically nonsignificant. Pre-/post-surveys demonstrated significant improvement in HF knowledge (p = 0.043), self-care confidence (p = 0.003), and QOL (p < 0.001) in the intervention group. CareNavRN is a promising approach to improve outcomes during transition from hospital to home for patients without access to a comprehensive disease management program. [Journal of Gerontological Nursing, 46(2), 32-40.].
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173
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Seto E, Ross H, Tibbles A, Wong S, Ware P, Etchells E, Kobulnik J, Chibber T, Poon S. A Mobile Phone-Based Telemonitoring Program for Heart Failure Patients After an Incidence of Acute Decompensation (Medly-AID): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e15753. [PMID: 32012116 PMCID: PMC7003117 DOI: 10.2196/15753] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/11/2019] [Accepted: 10/26/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Patients with heart failure (HF) are at the highest risk for hospital readmissions during the first few weeks after discharge when patients are transitioning from hospital to home. Telemonitoring (TM) for HF management has been found to reduce mortality risk and hospital readmissions if implemented appropriately; however, the impact of TM targeted for patients recently discharged from hospital, for whom TM might have the biggest benefit, is still unknown. Medly, a mobile phone-based TM system that is currently being used as a standard of care for HF at a large Canadian hospital, may be an effective tool for the management of HF in patients recently discharged from hospital. OBJECTIVE The objective of the Medly-After an Incidence of acute Decompensation (Medly-AID) trial is to determine the effect of Medly on the self-care and quality of life of patients with HF who have been recently discharged from hospital after an HF-related decompensation. METHODS A multisite multimethod randomized controlled trial (RCT) will be conducted at 2 academic hospitals and at least one community hospital to evaluate the impact of Medly-enabled HF management on the outcomes of patients with HF who had been hospitalized for HF-related decompensation and discharged during the 2 weeks before recruitment. The trial will include 144 participants with HF (74 in each control and intervention groups). Control patients will receive standard of care, whereas patients in the intervention group will receive standard of care and Medly. Specifically, patients in the intervention group will record daily weight, blood pressure, and heart rate and answer symptom-related questions via the Medly app. Medly will generate automated patient self-care messages such as to adjust diuretic medications, based on the rules-based algorithm personalized to the individual patient, and send real-time alerts to their health care providers as necessary. All patients will be followed for 3 months. Primary outcome measures are self-care and quality of life as measured through the validated questionnaires Self-Care of Heart Failure Index, EQ-5D-5L, and the Kansas City Cardiomyopathy Questionnaire-12. Secondary outcome measures for this study include cost of health care services used and health outcomes. RESULTS Patient recruitment began in November 2018 at the Sunnybrook Health Sciences Centre, with a total of 35 participants recruited by July 30, 2019 (17 in the intervention group and 18 in the control group). The final analysis is expected to occur in the fall of 2020. CONCLUSIONS This RCT will be the first to assess the effectiveness of the Medly TM system for use following discharge from hospital after a HF-related decompensation. TRIAL REGISTRATION ClinicalTrials.gov NCT03358303; https://clinicaltrials.gov/ct2/show/NCT03358303. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15753.
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Affiliation(s)
- Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Heather Ross
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Alana Tibbles
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Steven Wong
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Patrick Ware
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Edward Etchells
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada
| | - Jeremy Kobulnik
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Cardiology, University Health Network, Toronto, ON, Canada
- Department of Cardiology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Tamanna Chibber
- Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephanie Poon
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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174
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Chambers D, Cantrell A, Booth A. Implementation of interventions to reduce preventable hospital admissions for cardiovascular or respiratory conditions: an evidence map and realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BackgroundIn 2012, a series of systematic reviews summarised the evidence regarding interventions to reduce preventable hospital admissions. Although intervention effects were dependent on context, the reviews revealed a consistent picture of reduction across different interventions targeting cardiovascular and respiratory conditions. The research reported here sought to provide an in-depth understanding of how interventions that have been shown to reduce admissions for these conditions may work, with a view to supporting their effective implementation in practice.ObjectivesTo map the available evidence on interventions used in the UK NHS to reduce preventable admissions for cardiovascular and respiratory conditions and to conduct a realist synthesis of implementation evidence related to these interventions.MethodsFor the mapping review, six databases were searched for studies published between 2010 and October 2017. Studies were included if they were conducted in the UK, the USA, Canada, Australia or New Zealand; recruited adults with a cardiovascular or respiratory condition; and evaluated or described an intervention that could reduce preventable admissions or re-admissions. A descriptive summary of key characteristics of the included studies was produced. The studies included in the mapping review helped to inform the sampling frame for the subsequent realist synthesis. The wider evidence base was also engaged through supplementary searching. Data extraction forms were developed using appropriate frameworks (an implementation framework, an intervention template and a realist logic template). Following identification of initial programme theories (from the theoretical literature, empirical studies and insights from the patient and public involvement group), the review team extracted data into evidence tables. Programme theories were examined against the individual intervention types and collectively as a set. The resultant hypotheses functioned as synthesised statements around which an explanatory narrative referenced to the underpinning evidence base was developed. Additional searches for mid-range and overarching theories were carried out using Google Scholar (Google Inc., Mountain View, CA, USA).ResultsA total of 569 publications were included in the mapping review. The largest group originated from the USA. The included studies from the UK showed a similar distribution to that of the map as a whole, but there was evidence of some country-specific features, such as the prominence of studies of telehealth. In the realist synthesis, it was found that interventions with strong evidence of effectiveness overall had not necessarily demonstrated effectiveness in UK settings. This could be a barrier to using these interventions in the NHS. Facilitation of the implementation of interventions was often not reported or inadequately reported. Many of the interventions were diverse in the ways in which they were delivered. There was also considerable overlap in the content of interventions. The role of specialist nurses was highlighted in several studies. The five programme theories identified were supported to varying degrees by empirical literature, but all provided valuable insights.LimitationsThe research was conducted by a small team; time and resources limited the team’s ability to consult with a full range of stakeholders.ConclusionsOverall, implementation appears to be favoured by support for self-management by patients and their families/carers, support for services that signpost patients to consider alternatives to seeing their general practitioner when appropriate, recognition of possible reasons why patients seek admission, support for health-care professionals to diagnose and refer patients appropriately and support for workforce roles that promote continuity of care and co-ordination between services.Future workResearch should focus on understanding discrepancies between national and international evidence and the transferability of findings between different contexts; the design and evaluation of implementation strategies informed by theories about how the intervention being implemented might work; and qualitative research on decision-making around hospital referrals and admissions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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175
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Abstract
An effective discharge plan is associated with better outcomes in advanced heart failure (HF) patients. Furthermore, a patient-centred care planning can improve patients' satisfaction, quality of life, and enhance self-care. Telemedicine may allow optimized monitoring of advanced HF patients. Nevertheless, its implementation into clinical practice across European countries is still limited. This document reflects the key points discussed concerning effective management plans in advanced HF by a panel of experts during a Heart Failure Association meeting on physiological monitoring of the complex multimorbid HF patient.
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Affiliation(s)
- Loreena Hill
- Queen's University, Belfast, Northern Ireland, UK
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176
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Michael F, Whitelaw S, Van Spall HG. Transitional care quality indicators to assess quality of care following hospitalisation for chronic obstructive pulmonary disease and heart failure: a systematic review protocol. BMJ Open 2019; 9:e032764. [PMID: 31892659 PMCID: PMC6955556 DOI: 10.1136/bmjopen-2019-032764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The period following hospitalisation for chronic obstructive pulmonary disease (COPD) or heart failure (HF)-when patients transition between settings and clinicians-is one of high risk. Transitional care services that bridge the gap from hospital to home can improve outcomes, but there are no widely accepted indicators to assess their quality. METHODS AND ANALYSIS In this systematic review, we will summarise transitional care quality indicators, and describe their associations with clinical, patient-reported and cost outcomes. We will search MEDLINE, Embase, CINAHL and HealthSTAR, as well as grey literature and reference lists of included articles. We will screen all studies published between January 1990 and October 2019 that test an intervention that aims to improve the hospital-to-home transition for patients with COPD and/or HF; and measure at least one process (eg, medication errors), clinical (eg, hospital readmissions) or patient-reported (eg, health-related quality of life) outcome which will serve as a transitional care quality indicator . We will include randomised controlled trials, cohort studies, cross-sectional studies, interrupted time series studies and before-after studies. We will extract data in duplicate and classify transitional care quality indicators as structural, process-related or outcome-related. When possible, we will assess associations between transitional care quality indicators and clinical outcomes. In anticipation of conceptual and statistical heterogeneity, we will provide a qualitative synthesis and narrative review of the results. ETHICS AND DISSEMINATION This review will provide a list of transitional care quality indicators and their associations with clinical outcomes. These results can be used by hospitals, administrators and clinicians for assessing the quality of transitional care provided to patients with COPD and HF. The findings can also be used by policy-makers to assess and incentivise transitional care quality. We will disseminate results through publications, social media releases and presentations. PROSPERO REGISTRATION NUMBER This study is registered on PROSPERO.
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Affiliation(s)
- Faith Michael
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sera Whitelaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Harriette Gc Van Spall
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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177
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Ryan CJ, Bierle RS, Vuckovic KM. The Three Rs for Preventing Heart Failure Readmission: Review, Reassess, and Reeducate. Crit Care Nurse 2019; 39:85-93. [PMID: 30936132 DOI: 10.4037/ccn2019345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Despite improvements in heart failure therapies, hospitalization readmission rates remain high. Nationally, increasing attention has been directed toward reducing readmission rates and thus identifying patients with the highest risk for readmission. This article summarizes the evidence related to decreasing readmission for patients with heart failure within 30 days after discharge, focusing on the acute setting. Each patient requires an individualized plan for successful transition from hospital to home and preventing readmission. Nurses must review the patient's current plan of care and adherence to it and look for clues to failure of the plan that could lead to readmission to the hospital. In addition, nurses must reassess the current plan with the patient and family to ensure that the plan continues to meet the patient's needs. Finally, nurses must continually reeducate patients about their plan of care, their plan for self-management, and strategies to prevent hospital readmission for heart failure.
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Affiliation(s)
- Catherine J Ryan
- Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, and Director, Nursing Evidence Based Practice and Nursing Research, University of Illinois Hospital & Health Sciences System, Chicago. .,Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Regional Health Heart and Vascular Institute, Rapid City, South Dakota. .,Karen M. Vuckovic is an advanced practice nurse, Division of Cardiology, University of Illinois Hospital & Health Sciences System, and a clinical assistant professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago.
| | - Rebecca Schuetz Bierle
- Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, and Director, Nursing Evidence Based Practice and Nursing Research, University of Illinois Hospital & Health Sciences System, Chicago.,Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Regional Health Heart and Vascular Institute, Rapid City, South Dakota.,Karen M. Vuckovic is an advanced practice nurse, Division of Cardiology, University of Illinois Hospital & Health Sciences System, and a clinical assistant professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago
| | - Karen M Vuckovic
- Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, and Director, Nursing Evidence Based Practice and Nursing Research, University of Illinois Hospital & Health Sciences System, Chicago.,Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Regional Health Heart and Vascular Institute, Rapid City, South Dakota.,Karen M. Vuckovic is an advanced practice nurse, Division of Cardiology, University of Illinois Hospital & Health Sciences System, and a clinical assistant professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago
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178
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Xanthopoulos A, Butler J, Parissis J, Polyzogopoulou E, Skoularigis J, Triposkiadis F. Acutely decompensated versus acute heart failure: two different entities. Heart Fail Rev 2019; 25:907-916. [PMID: 31802377 DOI: 10.1007/s10741-019-09894-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Heart failure (HF) has been classified in chronic HF (CHF) and acute HF (AHF). The latter has been subdivided in acutely decompensated chronic HF (ADCHF) defined as the deterioration of preexisting CHF and de novo AHF defined as the rapid development of new symptoms and signs of HF that requires urgent medical attention. However, ADCHF and de novo AHF have fundamental pathophysiological differences. Most importantly, the typical illness trajectory of HF, which is similar to that of other chronic organ diseases including lung, renal, and liver failure, features a gradual decline, with acute episodes usually related to disease evolution followed by partial recovery. Thus, ADCHF should be considered part of the natural history of CHF and renamed CHF exacerbation (CHFE) in accordance with the appropriate terminology used in chronic obstructive pulmonary disease. AHF, in turn, should include only acute de novo HF. The clinical implications of this paradigm shift will be in CHFE the change in focus from in-hospital to optimal ambulatory CHF management aiming at primary and secondary CHFE prevention, while in AHF, the institution of measures for in-hospital limitation of cardiac injury and prevention or retardation of symptomatic CHF development.
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Affiliation(s)
- Andrew Xanthopoulos
- Department of Cardiology, Larissa University General Hospital, P.O. Box 1425, 411 10, Larissa, Greece
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - John Parissis
- Heart Failure Unit, Second Cardiology Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eftihia Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - John Skoularigis
- Department of Cardiology, Larissa University General Hospital, P.O. Box 1425, 411 10, Larissa, Greece
| | - Filippos Triposkiadis
- Department of Cardiology, Larissa University General Hospital, P.O. Box 1425, 411 10, Larissa, Greece.
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179
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Miró Ò, Padrosa J, Takagi K, Gayat É, Gil V, Llorens P, Martín-Sánchez FJ, Herrero-Puente P, Jacob J, Montero MM, Tost J, Díez MPL, Traveria L, Torres-Gárate R, Alonso MI, Agüera C, Valero A, Javaloyes P, Peacock WF, Bueno H, Mebazaa A, Fuentes M, Gil C, Alonso H, Garmila P, García GL, Yáñez-Palma MC, López SI, Escoda R, Xipell C, Sánchez C, Gaytan JM, Pérez-Durá MJ, Salvo E, Pavón J, Noval A, Torres JM, López-Grima ML, Valero A, Juan MÁ, Aguirre A, Morales JE, Masó SM, Alonso MI, Ruiz F, Franco JM, Mecina AB, Tost J, Sánchez S, Carbajosa V, Piñera P, Nicolás JAS, Garate RT, Alquezar A, Rizzi MA, Herrera S, Roset A, Cabello I, Richard F, Pérez JMÁ, Diez MPL, Álvarez JV, García BP, Sánchez González MGGYM, Javaloyes P, Marquina V, Jiménez I, Hernández N, Brouzet B, Ramos S, López A, Andueza JA, Romero R, Ruíz M, Calvache R, Lorca MT, Calderón L, Arriaga BA, Sierra B, Mojarro EM, Bécquer LT, Burillo G, García LL, LaSalle GC, Urbano CA, Soto ABG, Padial ED, Ferrer ES, Garrido M, Lucas FJ, Gaya R, Bibiano C, Mir M, Rodríguez B, Sánchez N, Carballo JL, Rodríguez-Adrada E, Rodríguez B. Influence of the length of hospitalisation in post-discharge outcomes in patients with acute heart failure: Results of the LOHRCA study. Eur J Intern Med 2019; 70:24-32. [PMID: 31451322 DOI: 10.1016/j.ejim.2019.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/04/2019] [Accepted: 08/09/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the relationship between length of hospitalisation (LOH) and post-discharge outcomes in acute heart failure (AHF) patients and to ascertain whether there are different patterns according to department of initial hospitalisation. METHODS Consecutive AHF patients hospitalised in 41 Spanish centres were grouped based on the LOH (<6/6-10/11-15/>15 days). Outcomes were defined as 90-day post-discharge all-cause mortality, AHF readmissions, and the combination of both. Hazard ratios (HRs), adjusted by chronic conditions and severity of decompensation, were calculated for groups with LOH >6 days vs. LOH <6 days (reference), and stratified by hospitalisation in cardiology, internal medicine, geriatrics, or short-stay units. RESULTS We included 8563 patients (mean age: 80 (SD = 10) years, 55.5% women), with a median LOH of 7 days (IQR 4-11): 2934 (34.3%) had a LOH <6 days, 3184 (37.2%) 6-10 days, 1287 (15.0%) 11-15 days, and 1158 (13.5%) >15 days. The 90-day post-discharge mortality was 11.4%, readmission 32.2%, and combined endpoint 37.4%. Mortality was increased by 36.5% (95%CI = 13.0-64.9) when LOH was 11-15 days, and by 72.0% (95%CI = 42.6-107.5) when >15 days. Conversely, no differences were found in readmission risk, and the combined endpoint only increased 21.6% (95%CI = 8.4-36.4) for LOH >15 days. Stratified analysis by hospitalisation departments rendered similar post-discharge outcomes, with all exhibiting increased mortality for LOH >15 days and no significant increments in readmission risk. CONCLUSIONS Short hospitalisations are not associated with worse outcomes. While post-discharge readmissions are not affected by LOH, mortality risk increases as the LOH lengthens. These findings were similar across hospitalisation departments.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, Barcelona; "Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain; The GREAT (Global REsearch in Acute Cardiovascular Conditions Team) Network, Rome, Italy.
| | - Joan Padrosa
- Emergency Department, Hospital Clínic, Barcelona; "Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Koji Takagi
- Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisière University Hospital, Université Paris Diderot, Paris, France
| | - Étienne Gayat
- Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisière University Hospital, Université Paris Diderot, Paris, France
| | - Víctor Gil
- Emergency Department, Hospital Clínic, Barcelona; "Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Pere Llorens
- Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain
| | - Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Madrid, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense de Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - María Mir Montero
- Emergency Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Josep Tost
- Emergency Department, Hospital de Terrassa, Barcelona, Catalonia, Spain
| | | | - Lissete Traveria
- Emergency Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Raquel Torres-Gárate
- Emergency Department, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | | | - Carmen Agüera
- Emergency Department, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Amparo Valero
- Emergency Department, Hospital Doctor Peset, València, Spain
| | - Patricia Javaloyes
- Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain
| | - W Frank Peacock
- The GREAT (Global REsearch in Acute Cardiovascular Conditions Team) Network, Rome, Italy; Emergency Department, Baylor College of Medicine, Ben Taub General Hospital, Houston, USA
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, Universidad Complutense, Hospital 12 de Octubre, Madrid, Spain
| | - Alexandre Mebazaa
- The GREAT (Global REsearch in Acute Cardiovascular Conditions Team) Network, Rome, Italy; Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisière University Hospital, Université Paris Diderot, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | - Eva Salvo
- Hospital Politénic La Fe de Valencia, Spain
| | - José Pavón
- Hospital Dr. Negrín de Las Palmas de Gran Canaria, Spain
| | - Antonio Noval
- Hospital Insular de Las Palmas de Gran Canaria, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Aitor Alquezar
- Hospital de la Santa Creu y Sant Pau de Barcelona, Spain
| | | | - Sergio Herrera
- Hospital de la Santa Creu y Sant Pau de Barcelona, Spain
| | - Alex Roset
- Hospital Universitari de Bellvitge de Barcelona, Spain
| | - Irene Cabello
- Hospital Universitari de Bellvitge de Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rut Gaya
- Hospital Juan XXIII de Tarragona, Spain
| | | | - María Mir
- Hospital Infanta Leonor de Madrid, Spain
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180
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Kadu M, Heckman GA, Stolee P, Perlman C. Risk of Hospitalization in Long-Term Care Residents Living with Heart Failure: a Retrospective Cohort Study. Can Geriatr J 2019; 22:171-181. [PMID: 31885757 PMCID: PMC6887138 DOI: 10.5770/cgj.22.366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Older adults living with heart failure (HF) in long-term care (LTC) experience frequent hospitalization. Using routinely available clinical information, we examined resident-level factors that precipitate hospitalization within 90 days of admission to LTC. METHODS This was a retrospective cohort study of older adults diagnosed with HF, who were admitted to LTC in Ontario, Canada, between 2011 and 2013. Multivariate logistic regression models using generalized estimating equations were developed to determine predictors of hospitalization in residents with HF. RESULTS Entry to LTC from a hospital was the strongest predictor of future hospitalization (OR: 8.1, 95% CI: 7.1-9.3), followed by a score of three or greater on the Changes in Health, End-stage Signs and Symptoms scale, a measure of moderate to severe medical instability (O.R 4.2, 95% CI: 3.1-5.9). Other variables that increased the likelihood of hospitalization included being flagged as a high risk for falls, two or more physician visits, and increased monitoring for acute medical illness within 14 days of admission. CONCLUSION Our findings highlight that health instability and transitions from acute to LTC will increase the likelihood of transitioning back into the hospital setting. The identified predisposing factors suggest the need for targeted prevention strategies for those in high-risk groups.
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Affiliation(s)
- Mudathira Kadu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - George A. Heckman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
- Schlegel-University of Waterloo Research Institute on Aging, Waterloo, ON, Canada
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Christopher Perlman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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181
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Tomasoni D, Adamo M, Lombardi CM, Metra M. Highlights in heart failure. ESC Heart Fail 2019; 6:1105-1127. [PMID: 31997538 PMCID: PMC6989277 DOI: 10.1002/ehf2.12555] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) remains a major cause of mortality, morbidity, and poor quality of life. It is an area of active research. This article is aimed to give an update on recent advances in all aspects of this syndrome. Major changes occurred in drug treatment of HF with reduced ejection fraction (HFrEF). Sacubitril/valsartan is indicated as a substitute to ACEi/ARBs after PARADIGM-HF (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.73 to 0.87 for sacubitril/valsartan vs. enalapril for the primary endpoint and Wei, Lin and Weissfeld HR 0.79, 95% CI 0.71-0.89 for recurrent events). Its initiation was then shown as safe and potentially useful in recent studies in patients hospitalized for acute HF. More recently, dapagliflozin and prevention of adverse-outcomes in DAPA-HF trial showed the beneficial effects of the sodium-glucose transporter type 2 inhibitor dapaglifozin vs. placebo, added to optimal standard therapy [HR, 0.74; 95% CI, 0.65 to 0.85;0.74; 95% CI, 0.65 to 0.85 for the primary endpoint]. Trials with other SGLT 2 inhibitors and in other patients, such as those with HF with preserved ejection fraction (HFpEF) or with recent decompensation, are ongoing. Multiple studies showed the unfavourable prognostic significance of abnormalities in serum potassium levels. Potassium lowering agents may allow initiation and titration of mineralocorticoid antagonists in a larger proportion of patients. Meta-analyses suggest better outcomes with ferric carboxymaltose in patients with iron deficiency. Drugs effective in HFrEF may be useful also in HF with mid-range ejection fraction. Better diagnosis and phenotype characterization seem warranted in HF with preserved ejection fraction. These and other burning aspects of HF research are summarized and reviewed in this article.
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Affiliation(s)
- Daniela Tomasoni
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaCardiothoracic DepartmentCivil HospitalsBresciaItaly
| | - Marianna Adamo
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaCardiothoracic DepartmentCivil HospitalsBresciaItaly
| | - Carlo Mario Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaCardiothoracic DepartmentCivil HospitalsBresciaItaly
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaCardiothoracic DepartmentCivil HospitalsBresciaItaly
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182
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Dacunka M, Sanchez S, Chapoutot L, Marchais A. [Impact of a Home Return Assistance Service (PRADO-IC) on the re-hospitalisation rate for heart failure patients]. Ann Cardiol Angeiol (Paris) 2019; 68:310-315. [PMID: 31471045 DOI: 10.1016/j.ancard.2019.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 07/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Heart failure is a public health problem. Since 2013, the National Insurance has been offering the PRADO-IC service for the return home of patients hospitalised for cardiac decompensation. The aim of this study was to assess the impact of PRADO on the rate of re-hospitalisation of patients with heart failure at the centre hospitalier de Troyes (CHT). MATERIAL AND METHODS This was a 26-month monocentric retrospective study. Patients who were hospitalised for congestive heart failure in the cardiology department of the Troyes Hospital Centre from January 1, 2017 to August 31, 2018, and discharged home with the PRADO-IC service were included in the study. The primary outcome was the assessment of the number of readmissions for heart failure, 6 months before and 6 months after inclusion in the program. Secondary outcomes were the evaluation of the number of all-cause readmissions, the average length of stay and the time to readmission. RESULTS The average number of hospitalisations for cardiac decompensation before inclusion in the PRADO decreased from 0.34 to 0.25 (P=0.53) at 6 months. The average number of all-cause hospitalisations before inclusion increased from 0.57 to 0.58 (P=0.50) at 6 months. There was no significant difference in average length of stay and time to re-admission. CONCLUSION We did not highlight the impact of PRADO on the rate of re-hospitalisation of heart failure patients.
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Affiliation(s)
- M Dacunka
- Pôle vasculaire, service de cardiologie, centre hospitalier de Troyes, 101, avenue Anatole-France, 10000 Troyes, France.
| | - S Sanchez
- Pôle information médicale évaluation performance (IMEP), centre hospitalier de Troyes, hôpitaux Champagne Sud, 101, avenue Anatole CS 10178, 10003 Troyes cedex, France.
| | - L Chapoutot
- Pôle vasculaire, service de cardiologie, centre hospitalier de Troyes, 101, avenue Anatole-France, 10000 Troyes, France.
| | - A Marchais
- Pôle vasculaire, service de cardiologie, centre hospitalier de Troyes, 101, avenue Anatole-France, 10000 Troyes, France.
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183
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Jaarsma T, Strömberg A. We told you so: 'knowledge is not enough to improve heart failure self-care behaviour'. Eur J Heart Fail 2019; 21:1443-1444. [PMID: 31452305 DOI: 10.1002/ejhf.1580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 07/13/2019] [Indexed: 01/16/2023] Open
Affiliation(s)
- Tiny Jaarsma
- Department of Nursing, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna Strömberg
- Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands
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184
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Wu Z, Kim MS, Broad JB, Zhang X, Bloomfield K, Connolly MJ. Association between post-discharge secondary care and risk of repeated hospital presentation, entry into long-term care and mortality in older people after acute hospitalization. Geriatr Gerontol Int 2019; 19:1048-1053. [PMID: 31475414 DOI: 10.1111/ggi.13766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/30/2019] [Accepted: 08/05/2019] [Indexed: 11/26/2022]
Abstract
AIM Hospitalizations are frequent among acutely ill older people, and might be reduced by post-discharge secondary care (PDSC). We aimed to determine the proportion of older patients planned to receive or attending PDSC after acute hospitalization and the association with undesirable outcomes. METHODS A retrospective observational study was carried out using an electronic health record system in two hospitals in New Zealand. Patients were aged ≥75 years, initially presented at an emergency department (ED) and were discharged from medical, surgical, geriatrics or orthopedics wards in three 2-week periods. Planned PDSC at discharge, attended PDSC, ED presentation, long-term care (LTC) admission and death in 90 days after discharge were obtained through the health record system. Proportional hazards regression assessed the associations of planned or attended PDSC with undesirable outcomes (ED presentation, LTC admission and death) within 90 days of discharge. RESULTS Clinical records for 1085 patients were extracted, 963 were eligible. Of these, 413 (42.9%) had planned PDSC in discharge summaries, and 573 (59.5%) actually attended in 90 days. Patients planned for PDSC had a similarly adjusted hazard of ED presentation (HR 0.99, P = 0.92), LTC admission (HR 0.73, P = 0.25) and death (HR 0.80, P = 0.34) within 90 days of discharge, compared with those not planned. Similar non-significant associations were observed between attended PDSC and undesirable outcomes. CONCLUSIONS In patients aged ≥75 years in New Zealand, we did not find "planned PDSC" at discharge or "attended PDSC" after an acute hospitalization to be associated with ED presentation, LTC admission and death within 90 days after discharge. Other potential benefits of planned or attended PDSC require further investigation. Geriatr Gerontol Int 2019; 19: 1048-1053.
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Affiliation(s)
- Zhenqiang Wu
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand
| | - Min Soo Kim
- Auckland District Health Board, Auckland, New Zealand
| | - Joanna B Broad
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand
| | - Xian Zhang
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand
| | - Katherine Bloomfield
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
| | - Martin J Connolly
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
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185
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Seferovic PM, Ponikowski P, Anker SD, Bauersachs J, Chioncel O, Cleland JGF, de Boer RA, Drexel H, Ben Gal T, Hill L, Jaarsma T, Jankowska EA, Anker MS, Lainscak M, Lewis BS, McDonagh T, Metra M, Milicic D, Mullens W, Piepoli MF, Rosano G, Ruschitzka F, Volterrani M, Voors AA, Filippatos G, Coats AJS. Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2019; 21:1169-1186. [PMID: 31129923 DOI: 10.1002/ejhf.1531] [Citation(s) in RCA: 418] [Impact Index Per Article: 83.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 12/15/2022] Open
Abstract
The European Society of Cardiology (ESC) has published a series of guidelines on heart failure (HF) over the last 25 years, most recently in 2016. Given the amount of new information that has become available since then, the Heart Failure Association (HFA) of the ESC recognized the need to review and summarise recent developments in a consensus document. Here we report from the HFA workshop that was held in January 2019 in Frankfurt, Germany. This expert consensus report is neither a guideline update nor a position statement, but rather a summary and consensus view in the form of consensus recommendations. The report describes how these guidance statements are supported by evidence, it makes some practical comments, and it highlights new research areas and how progress might change the clinical management of HF. We have avoided re-interpretation of information already considered in the 2016 ESC/HFA guidelines. Specific new recommendations have been made based on the evidence from major trials published since 2016, including sodium-glucose co-transporter 2 inhibitors in type 2 diabetes mellitus, MitraClip for functional mitral regurgitation, atrial fibrillation ablation in HF, tafamidis in cardiac transthyretin amyloidosis, rivaroxaban in HF, implantable cardioverter-defibrillators in non-ischaemic HF, and telemedicine for HF. In addition, new trial evidence from smaller trials and updated meta-analyses have given us the chance to provide refined recommendations in selected other areas. Further, new trial evidence is due in many of these areas and others over the next 2 years, in time for the planned 2021 ESC guidelines on the diagnosis and treatment of acute and chronic heart failure.
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Affiliation(s)
- Petar M Seferovic
- Serbian Academy of Sciences and Arts, Heart Failure Center, Faculty of Medicine, Belgrade University Medical Center, Belgrade, Serbia
| | - Piotr Ponikowski
- Centre for Heart Diseases, University Hospital, Wroclaw, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, and University of Medicine Carol Davila, Bucharest, Romania
| | - John G F Cleland
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, UK.,Robertson Centre for Biostatistics and Clinical Trials, Glasgow, UK
| | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein.,Division of Angiology, Swiss Cardiovascular Center, University Hospital Berne, Berne, Switzerland.,Drexel University College of Medicine, Philadelphia, PA, USA
| | - Tuvia Ben Gal
- Department of Cardiology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Tiny Jaarsma
- Department of Nursing, Faculty of Medicine and Health Sciences, University of Linköping, Linköping, Sweden
| | - Ewa A Jankowska
- Centre for Heart Diseases, University Hospital, Wroclaw, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology & Berlin Institute of Health Center for Regenerative Therapies (BCRT), DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Charité-Universitätsmedizin Berlin (CVK), Berlin, Germany.,Department of Cardiology, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Basil S Lewis
- Lady Davis Carmel Medical Center and Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
| | - Davor Milicic
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Croatia
| | | | - Massimo F Piepoli
- Heart Failure Unit, Cardiology, G. da Saliceto Hospital, Piacenza, Italy
| | - Giuseppe Rosano
- Cardiovascular Clinical Academic Group, St George's Hospitals NHS Trust University of London, London, UK.,IRCCS San Raffaele Pisana, Rome, Italy
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital, University Heart Center, Zurich, Switzerland
| | | | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerasimos Filippatos
- Heart Failure Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Greece.,School of Medicine, University of Cyprus, Nicosia, Cyprus
| | - Andrew J S Coats
- Department of Cardiology, IRCCS San Raffaele Pisana, Rome, Italy
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Abstract
PURPOSE OF REVIEW Heart failure clinical practice guidelines are fundamental and serve as framework for providers to deliver evidence-based care that correlates with enhanced patient outcomes. However, adherence, particularly to guideline-directed medical therapy, remains suboptimal for a multitude of reasons. RECENT FINDINGS Despite robust clinical trials, updated guidelines and an expert consensus statement from American Heart Association, American College of Cardiology, and Heart Failure Society of America registry data signal that heart failure patients do not receive appropriate pharmacotherapy and may receive an intracardiac device without prior initiation or optimization of medical therapy. Strategies to improve provider adherence to heart failure guidelines include multidisciplinary models and appropriate referral and care standardization. These approaches can improve morbidity, mortality, and quality of life in HF patients.
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187
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Bundgaard JS, Mogensen UM, Christensen S, Ploug U, Rørth R, Ibsen R, Kjellberg J, Køber L. The economic burden of heart failure in Denmark from 1998 to 2016. Eur J Heart Fail 2019; 21:1526-1531. [PMID: 31359583 DOI: 10.1002/ejhf.1577] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/26/2019] [Accepted: 07/09/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Heart failure (HF) imposes a large burden on both the individual and the society. The aim of this study was to investigate the economic burden (either direct or indirect costs) attributed to patients with HF before, at, and after time of diagnosis. METHODS AND RESULTS Using Danish nationwide registries we identified all patients > 18 years with a first-time diagnosis of HF from 1998-2016 and matched them 1:1 with a control group from the background population on age, gender, marital status, and educational level. The economic analysis of the total costs after diagnosis was based on direct costs including hospitalization, procedures, medication, and indirect costs including social welfare and lost productivity to estimate the annual cost of HF. A total of 176 067 HF patients with a median age of 76 (interquartile range 67-84) years and 55% male were included. Patients with HF incurred an average of €17 039 in total annual direct (€11 926) and indirect (€5113) healthcare costs peaking at year of diagnosis compared to €5936 in the control group with the majority attributable to inpatient admissions. The total annual net costs including public transfer after index HF were €11 957 higher in patients with HF compared to controls and the economic consequences were evident more than 2 years prior to the diagnosis of HF. CONCLUSION Patients with HF impose significantly higher total annual healthcare costs compared to a matched control group with findings evident more than 2 years prior to HF diagnosis.
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Affiliation(s)
- Johan S Bundgaard
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark
| | - Ulrik M Mogensen
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark.,Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | | | | | - Rasmus Rørth
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark
| | | | - Jakob Kjellberg
- Danish Institute for Health Services Research, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark
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188
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Teoh KW, Khan TM, Chaiyakunapruk N, Lee SWH. Examining the use of network meta-analysis in pharmacy services research: A systematic review. J Am Pharm Assoc (2003) 2019; 59:787-791.e1. [PMID: 31311758 DOI: 10.1016/j.japh.2019.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Pharmacists play an important role in supporting the health care needs of the public, and various studies have examined the impact of pharmacy services on patient care. This systematic review aimed to describe studies evaluating the impact of pharmacy services by means of network meta-analyses. DATA SOURCES A systematic literature review of network meta-analyses examining pharmacy services was performed on PubMed, Embase, International Pharmaceutical Abstracts, and Cochrane Database of Systematic Reviews from database inception to November 30, 2018. STUDY SELECTION Network meta-analyses that examined the comparative effectiveness of pharmacy services (where pharmacists provide patient care to optimize patient outcomes) in any population, country, or setting. DATA EXTRACTION Data were independently extracted by 2 authors with the use of a standardized extraction form. The methodologic quality of articles was assessed with the use of the Cochrane Risk of Bias in Systematic Reviews tool. RESULTS Two network meta-analysis studies were identified. The first study compared 53 randomized controlled trials evaluating the effectiveness of transitional care services among discharged patients with heart failure. The study found that pharmacist interventions such as medication reconciliation, patient education, and medication optimization had little impact on improving the all-cause mortality and readmission rate in these patients. The second report compared 43 randomized controlled trials examining the efficacy of pharmacist-based diabetes educational interventions with or without pharmaceutical care on people with type 2 diabetes. It was reported that pharmacy services were effective in reducing glycosylated hemoglobin among people with type 2 diabetes, with larger effect sizes observed when these services involved a combination of 2 or more pharmacy services. CONCLUSION This study demonstrated a paucity of studies using network meta-analysis techniques in evaluating pharmacist-provided services. This could be due to the lack of confidence in using this method, because network meta-analysis requires several additional assumptions that require careful consideration while performing the analysis.
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189
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Razavi AC, Monlezun DJ, Sapin A, Sarris L, Schlag E, Dyer A, Harlan T. Etiological Role of Diet in 30-Day Readmissions for Heart Failure: Implications for Reducing Heart Failure-Associated Costs via Culinary Medicine. Am J Lifestyle Med 2019; 14:351-360. [PMID: 33281513 DOI: 10.1177/1559827619861933] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background. Reducing the under-30-day readmission for heart failure (HF) patients is a modifiable quality-of-care measure, yet the role of diet in HF readmissions and cost-effective HF care remain ill-defined. Methods. Medical chart review was conducted to determine cause(s) for HF treatment failure. Randomized controlled trial-backed machine learning models were employed to assess the relationship of culinary medicine education with HF 30-day readmission rate and cost. Results. Of 1031 HF admissions, 130 occurred within 30 days of discharge (12.61%.) Nearly two-thirds of individuals were male (64.02%), while the mean age and median length of stay were 64.33 ± 14.02 and 2, respectively. Medication noncompliance (34.62%) was the most common etiology for 30-day readmissions, followed by dietary noncompliance (16.92%), comorbidity (16.92%), a combination of dietary and medication noncompliance (10%), HF exacerbation (10%), iatrogenic (10%), and drug abuse (1.54%). Medication noncompliance contributed to the highest gross charge by readmission, costing a total of $1 802 096. Compared with traditional care, culinary medicine education for HF patients would prevent 93 HF readmissions and save $3.9 million in an estimated 4-year period. Conclusion. Though pharmacological treatment remains a focal point of HF management, diet-based approaches may improve tertiary HF prevention and reduce HF-associated health care expenditures.
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Affiliation(s)
- Alexander C Razavi
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, Louisiana (ACR, DJM, AS, LS, ES, AD, TH).,Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana (ACR, DJM, AS, ES).,University of Texas M.D. Anderson Cancer Center, Houston, Texas (DJM)
| | - Dominique J Monlezun
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, Louisiana (ACR, DJM, AS, LS, ES, AD, TH).,Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana (ACR, DJM, AS, ES).,University of Texas M.D. Anderson Cancer Center, Houston, Texas (DJM)
| | - Alexander Sapin
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, Louisiana (ACR, DJM, AS, LS, ES, AD, TH).,Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana (ACR, DJM, AS, ES).,University of Texas M.D. Anderson Cancer Center, Houston, Texas (DJM)
| | - Leah Sarris
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, Louisiana (ACR, DJM, AS, LS, ES, AD, TH).,Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana (ACR, DJM, AS, ES).,University of Texas M.D. Anderson Cancer Center, Houston, Texas (DJM)
| | - Emily Schlag
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, Louisiana (ACR, DJM, AS, LS, ES, AD, TH).,Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana (ACR, DJM, AS, ES).,University of Texas M.D. Anderson Cancer Center, Houston, Texas (DJM)
| | - Amber Dyer
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, Louisiana (ACR, DJM, AS, LS, ES, AD, TH).,Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana (ACR, DJM, AS, ES).,University of Texas M.D. Anderson Cancer Center, Houston, Texas (DJM)
| | - Timothy Harlan
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, Louisiana (ACR, DJM, AS, LS, ES, AD, TH).,Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana (ACR, DJM, AS, ES).,University of Texas M.D. Anderson Cancer Center, Houston, Texas (DJM)
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190
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Evaluation of a nurse-led intervention program in heart failure: A randomized trial. Med Clin (Barc) 2019; 152:431-437. [DOI: 10.1016/j.medcli.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 08/22/2018] [Accepted: 08/28/2018] [Indexed: 01/29/2023]
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191
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McAlister FA. Improving Outcomes for Patients with Heart Failure After Discharge: Mind the Gap. J Card Fail 2019; 25:340-342. [PMID: 30936003 DOI: 10.1016/j.cardfail.2019.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 03/28/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Finlay A McAlister
- Division of General Internal Medicine and Heart Function Clinic, University of Alberta, Edmonton, Canada.
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192
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Akita K, Kohno T, Kohsaka S, Shiraishi Y, Nagatomo Y, Goda A, Mizuno A, Sujino Y, Fukuda K, Yoshikawa T. Prognostic Impact of Previous Hospitalization in Acute Heart Failure Patients. Circ J 2019; 83:1261-1268. [PMID: 30944274 DOI: 10.1253/circj.cj-18-1087] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The natural course of heart failure (HF) is typically associated with repeated hospitalizations, and subsequently, patient prognosis deteriorates. However, the precise relationship between repeated admissions for HF and long-term prognosis remains unknown. Methods and Results: We analyzed data from 1,730 consecutive acute HF patients registered in the West Tokyo Heart Failure (WET-HF) registry between June 2005 and April 2014 (median age, 76 years). Patients were divided into 3 groups according to the number of previous HF admissions at the time of the index admission (0, n=876 [55.4%]; 1, n=425 [26.9%]; ≥2, n=279 [17.7%] previous admissions). A history of multiple previous admissions was an independent predictor for all-cause death and HF readmission in reference to a history of a single previous admission (hazard ratio (HR), 1.53; 95% confidence interval (CI) 1.10-2.13; HR, 1.90 95% CI, 1.47-2.44, respectively) or no previous admissions (HR, 1.37, 95% CI, 1.01-1.85; HR, 2.83, 95% CI, 2.19-3.65, respectively). On the other hand, a history of a single previous admission was an independent predictor for HF readmission in reference to a history of no previous admissions (HR, 1.51, 95% CI, 1.18-1.92), but not for all-cause death (HR, 0.89, 95% CI, 0.66-1.20). CONCLUSIONS Based on a contemporary multicenter HF registry, a history of multiple previous HF admissions was revealed as an independent, strong risk factor of adverse events following the index admission. The number of hospitalizations could be a simple and important surrogate indicating subsequent adverse events in patients with HF.
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Affiliation(s)
- Keitaro Akita
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Takashi Kohno
- Division of Cardiology, Department of Medicine, Keio University School of Medicine
| | - Shun Kohsaka
- Division of Cardiology, Department of Medicine, Keio University School of Medicine
| | - Yasuyuki Shiraishi
- Division of Cardiology, Department of Medicine, Keio University School of Medicine
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College
| | - Ayumi Goda
- Department of Cardiology, Kyorin University School of Medicine
| | - Atsushi Mizuno
- Department of Cardiology, St. Lukes International Hospital
| | - Yasumori Sujino
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Keiichi Fukuda
- Division of Cardiology, Department of Medicine, Keio University School of Medicine
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193
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Transitional Care Interventions for Heart Failure: What Are the Mechanisms? Am J Med 2019; 132:278-280. [PMID: 30300627 DOI: 10.1016/j.amjmed.2018.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 09/17/2018] [Indexed: 01/10/2023]
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194
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Van Spall HGC, Lee SF, Xie F, Oz UE, Perez R, Mitoff PR, Maingi M, Tjandrawidjaja MC, Heffernan M, Zia MI, Porepa L, Panju M, Thabane L, Graham ID, Haynes RB, Haughton D, Simek KD, Ko DT, Connolly SJ. Effect of Patient-Centered Transitional Care Services on Clinical Outcomes in Patients Hospitalized for Heart Failure: The PACT-HF Randomized Clinical Trial. JAMA 2019; 321:753-761. [PMID: 30806695 PMCID: PMC6439867 DOI: 10.1001/jama.2019.0710] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE Health care services that support the hospital-to-home transition can improve outcomes in patients with heart failure (HF). OBJECTIVE To test the effectiveness of the Patient-Centered Care Transitions in HF transitional care model in patients hospitalized for HF. DESIGN, SETTING, AND PARTICIPANTS Stepped-wedge cluster randomized trial of 2494 adults hospitalized for HF across 10 hospitals in Ontario, Canada, from February 2015 to March 2016, with follow-up until November 2016. INTERVENTIONS Hospitals were randomized to receive the intervention (n = 1104 patients), in which nurse-led self-care education, a structured hospital discharge summary, a family physician follow-up appointment less than 1 week after discharge, and, for high-risk patients, structured nurse homevisits and heart function clinic care were provided to patients, or usual care (n = 1390 patients), in which transitional care was left to the discretion of clinicians. MAIN OUTCOMES AND MEASURES Primary outcomes were hierarchically ordered as composite all-cause readmission, emergency department (ED) visit, or death at 3 months; and composite all-cause readmission or ED visit at 30 days. Secondary outcomes were B-PREPARED score for discharge preparedness (range: 0 [most prepared] to 22 [least prepared]); the 3-Item Care Transitions Measure (CTM-3) for quality of transition (range: 0 [worst transition] to 100 [best transition]); the 5-level EQ-5D version (EQ-5D-5L) for quality of life (range: 0 [dead] to 1 [full health]); and quality-adjusted life-years (QALY; range: 0 [dead] to 0.5 [full health at 6 months]). RESULTS Among eligible patients, all 2494 (mean age, 77.7 years; 1258 [50.4%] women) completed the trial. There was no significant difference between the intervention and usual care groups in the first primary composite outcome (545 [49.4%] vs 698 [50.2%] events, respectively; hazard ratio [HR], 0.99 [95% CI, 0.83-1.19]) or in the second primary composite outcome (304 [27.5%] vs 408 [29.3%] events, respectively; HR, 0.93 [95% CI, 0.73-1.18]). There were significant differences between the intervention and usual care groups in the secondary outcomes of mean B-PREPARED score at 6 weeks (16.6 vs 13.9; difference, 2.65 [95% CI, 1.37-3.92]; P < .001); mean CTM-3 score at 6 weeks (76.5 vs 70.3; difference, 6.16 [95% CI, 0.90-11.43]; P = .02); and mean EQ-5D-5L score at 6 weeks (0.7 vs 0.7; difference, 0.06 [95% CI, 0.01 to 0.11]; P = .02) and 6 months (0.7 vs 0.6; difference, 0.06 [95% CI, 0.01-0.12]; P = .02). There was no significant difference in mean QALY between groups at 6 months (0.3 vs 0.3; difference, 0.00 [95% CI, -0.02 to 0.02]; P = .98). CONCLUSIONS AND RELEVANCE Among patients with HF in Ontario, Canada, implementation of a patient-centered transitional care model compared with usual care did not improve a composite of clinical outcomes. Whether this type of intervention could be effective in other health care systems or locations would require further research. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02112227.
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Affiliation(s)
- Harriette G. C. Van Spall
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Shun Fu Lee
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, Program for Health Economics and Outcome Measures, Hamilton, Ontario, Canada
| | - Urun Erbas Oz
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Richard Perez
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Peter R. Mitoff
- Department of Medicine, University of Toronto, Ontario, Canada
- Department of Medicine, St Joseph’s Health Centre, Toronto, Ontario, Canada
| | - Manish Maingi
- Cardiac Health Program, Trillium Health Partners, Mississauga, Ontario, Canada
| | | | - Michael Heffernan
- Department of Medicine, Halton Health Care Services, Oakville, Ontario, Canada
| | - Mohammad I. Zia
- Department of Medicine, University of Toronto, Ontario, Canada
- Department of Medicine, Michael Garron Hospital, Toronto, Ontario, Canada
| | - Liane Porepa
- Department of Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Mohamed Panju
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
| | - R. Brian Haynes
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dilys Haughton
- Hamilton Niagara Haldimand Brant Community Care Access Centre, Hamilton, Ontario, Canada
| | - Kim D. Simek
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Dennis T. Ko
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Stuart J. Connolly
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
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195
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Abstract
BACKGROUND Despite advances in treatment, the increasing and ageing population makes heart failure an important cause of morbidity and death worldwide. It is associated with high healthcare costs, partly driven by frequent hospital readmissions. Disease management interventions may help to manage people with heart failure in a more proactive, preventative way than drug therapy alone. This is the second update of a review published in 2005 and updated in 2012. OBJECTIVES To compare the effects of different disease management interventions for heart failure (which are not purely educational in focus), with usual care, in terms of death, hospital readmissions, quality of life and cost-related outcomes. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL for this review update on 9 January 2018 and two clinical trials registries on 4 July 2018. We applied no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) with at least six months' follow-up, comparing disease management interventions to usual care for adults who had been admitted to hospital at least once with a diagnosis of heart failure. There were three main types of intervention: case management; clinic-based interventions; multidisciplinary interventions. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Outcomes of interest were mortality due to heart failure, mortality due to any cause, hospital readmission for heart failure, hospital readmission for any cause, adverse effects, quality of life, costs and cost-effectiveness. MAIN RESULTS We found 22 new RCTs, so now include 47 RCTs (10,869 participants). Twenty-eight were case management interventions, seven were clinic-based models, nine were multidisciplinary interventions, and three could not be categorised as any of these. The included studies were predominantly in an older population, with most studies reporting a mean age of between 67 and 80 years. Seven RCTs were in upper-middle-income countries, the rest were in high-income countries.Only two multidisciplinary-intervention RCTs reported mortality due to heart failure. Pooled analysis gave a risk ratio (RR) of 0.46 (95% confidence interval (CI) 0.23 to 0.95), but the very low-quality evidence means we are uncertain of the effect on mortality due to heart failure. Based on this limited evidence, the number needed to treat for an additional beneficial outcome (NNTB) is 12 (95% CI 9 to 126).Twenty-six case management RCTs reported all-cause mortality, with low-quality evidence indicating that these may reduce all-cause mortality (RR 0.78, 95% CI 0.68 to 0.90; NNTB 25, 95% CI 17 to 54). We pooled all seven clinic-based studies, with low-quality evidence suggesting they may make little to no difference to all-cause mortality. Pooled analysis of eight multidisciplinary studies gave moderate-quality evidence that these probably reduce all-cause mortality (RR 0.67, 95% CI 0.54 to 0.83; NNTB 17, 95% CI 12 to 32).We pooled data on heart failure readmissions from 12 case management studies. Moderate-quality evidence suggests that they probably reduce heart failure readmissions (RR 0.64, 95% CI 0.53 to 0.78; NNTB 8, 95% CI 6 to 13). We were able to pool only two clinic-based studies, and the moderate-quality evidence suggested that there is probably little or no difference in heart failure readmissions between clinic-based interventions and usual care (RR 1.01, 95% CI 0.87 to 1.18). Pooled analysis of five multidisciplinary interventions gave low-quality evidence that these may reduce the risk of heart failure readmissions (RR 0.68, 95% CI 0.50 to 0.92; NNTB 11, 95% CI 7 to 44).Meta-analysis of 14 RCTs gave moderate-quality evidence that case management probably slightly reduces all-cause readmissions (RR 0.92, 95% CI 0.83 to 1.01); a decrease from 491 to 451 in 1000 people (95% CI 407 to 495). Pooling four clinic-based RCTs gave low-quality and somewhat heterogeneous evidence that these may result in little or no difference in all-cause readmissions (RR 0.90, 95% CI 0.72 to 1.12). Low-quality evidence from five RCTs indicated that multidisciplinary interventions may slightly reduce all-cause readmissions (RR 0.85, 95% CI 0.71 to 1.01); a decrease from 450 to 383 in 1000 people (95% CI 320 to 455).Neither case management nor clinic-based intervention RCTs reported adverse effects. Two multidisciplinary interventions reported that no adverse events occurred. GRADE assessment of moderate quality suggested that there may be little or no difference in adverse effects between multidisciplinary interventions and usual care.Quality of life was generally poorly reported, with high attrition. Low-quality evidence means we are uncertain about the effect of case management and multidisciplinary interventions on quality of life. Four clinic-based studies reported quality of life but we could not pool them due to differences in reporting. Low-quality evidence indicates that clinic-based interventions may result in little or no difference in quality of life.Four case management programmes had cost-effectiveness analyses, and seven reported cost data. Low-quality evidence indicates that these may reduce costs and may be cost-effective. Two clinic-based studies reported cost savings. Low-quality evidence indicates that clinic-based interventions may reduce costs slightly. Low-quality data from one multidisciplinary intervention suggested this may be cost-effective from a societal perspective but less so from a health-services perspective. AUTHORS' CONCLUSIONS We found limited evidence for the effect of disease management programmes on mortality due to heart failure, with few studies reporting this outcome. Case management may reduce all-cause mortality, and multidisciplinary interventions probably also reduce all-cause mortality, but clinic-based interventions had little or no effect on all-cause mortality. Readmissions due to heart failure or any cause were probably reduced by case-management interventions. Clinic-based interventions probably make little or no difference to heart failure readmissions and may result in little or no difference in readmissions for any cause. Multidisciplinary interventions may reduce the risk of readmission for heart failure or for any cause. There was a lack of evidence for adverse effects, and conclusions on quality of life remain uncertain due to poor-quality data. Variations in study location and time of occurrence hamper attempts to review costs and cost-effectiveness.The potential to improve quality of life is an important consideration but remains poorly reported. Improved reporting in future trials would strengthen the evidence for this patient-relevant outcome.
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Affiliation(s)
- Andrea Takeda
- University College LondonInstitute of Health Informatics ResearchLondonUK
| | - Nicole Martin
- University College LondonInstitute of Health Informatics ResearchLondonUK
| | - Rod S Taylor
- University of Exeter Medical SchoolInstitute of Health ResearchSouth Cloisters, St Luke's Campus, Heavitree RoadExeterUKEX2 4SG
| | - Stephanie JC Taylor
- Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonCentre for Primary Care and Public Health and Asthma UK Centre for Applied ResearchYvonne Carter Building58 Turner StreetLondonUKE1 2AB
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196
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Lee C, Beleznai T, Hassan S, Rawat A, Douglas H, Kanagala P, Sankaranarayanan R. Ambulatory management of acute decompensation in heart failure. Br J Hosp Med (Lond) 2019; 80:40-45. [DOI: 10.12968/hmed.2019.80.1.40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Cheuk Lee
- Cardiology Clinical Fellow, Department of Cardiology, Aintree University Hospitals NHS Foundation Trust, Liverpool
| | - Timea Beleznai
- Cardiology Clinical Fellow, Department of Cardiology, Aintree University Hospitals NHS Foundation Trust, Liverpool
| | - Salimah Hassan
- Cardiology Advanced Nurse Practitioner, Department of Cardiology, Aintree University Hospitals NHS Foundation Trust, Liverpool
| | - Anju Rawat
- Cardiology Advanced Nurse Practitioner, Department of Cardiology, Aintree University Hospitals NHS Foundation Trust, Liverpool
| | - Homeyra Douglas
- Consultant Cardiologist, Department of Cardiology, Aintree University Hospitals NHS Foundation Trust, Liverpool
| | - Prathap Kanagala
- Consultant Cardiologist, Department of Cardiology, Aintree University Hospitals NHS Foundation Trust, Liverpool
| | - Rajiv Sankaranarayanan
- Consultant Cardiologist, Department of Cardiology, Aintree University Hospitals NHS Foundation Trust, Liverpool L9 7AL
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197
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Piepoli MF. E-health in self-care of heart failure patients: promises become reality. Eur J Heart Fail 2018; 21:247-248. [PMID: 30592367 DOI: 10.1002/ejhf.1386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/13/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Massimo F Piepoli
- Heart Failure Unit, Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy
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198
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Dinatolo E, Sciatti E, Anker MS, Lombardi C, Dasseni N, Metra M. Updates in heart failure: what last year brought to us. ESC Heart Fail 2018; 5:989-1007. [PMID: 30570225 PMCID: PMC6300825 DOI: 10.1002/ehf2.12385] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Elisabetta Dinatolo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Edoardo Sciatti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Markus S. Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Berlin‐Brandenburg Center for Regenerative Therapies (BCRT), DZHK (German Centre for Cardiovascular Research), partner site BerlinCharité—Universitätsmedizin BerlinBerlinGermany
| | - Carlo Lombardi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Nicolò Dasseni
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
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199
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Wagenaar KP, Broekhuizen BDL, Jaarsma T, Kok I, Mosterd A, Willems FF, Linssen GCM, Agema WRP, Anneveldt S, Lucas CMHB, Mannaerts HFJ, Wajon EMCJ, Dickstein K, Cramer MJ, Landman MAJ, Hoes AW, Rutten FH. Effectiveness of the European Society of Cardiology/Heart Failure Association website 'heartfailurematters.org' and an e-health adjusted care pathway in patients with stable heart failure: results of the 'e-Vita HF' randomized controlled trial. Eur J Heart Fail 2018; 21:238-246. [PMID: 30485612 PMCID: PMC6607483 DOI: 10.1002/ejhf.1354] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 05/18/2018] [Accepted: 10/07/2018] [Indexed: 12/13/2022] Open
Abstract
Background Efficient incorporation of e‐health in patients with heart failure (HF) may enhance health care efficiency and patient empowerment. We aimed to assess the effect on self‐care of (i) the European Society of Cardiology/Heart Failure Association website ‘heartfailurematters.org’ on top of usual care, and (ii) an e‐health adjusted care pathway leaving out ‘in person’ routine HF nurse consultations in stable HF patients. Methods and results In a three‐group parallel‐randomized trial in stable HF patients from nine Dutch outpatient clinics, we compared two interventions (
heartfailurematters.org website and an e‐health adjusted care pathway) to usual care. The primary outcome was self‐care measured with the European Heart Failure Self‐care Behaviour Scale. Secondary outcomes were health status, mortality, and hospitalizations. In total, 450 patients were included. The mean age was 66.8 ± 11.0 years, 74.2% were male, and 78.8% classified themselves as New York Heart Association I or II at baseline. After 3 months of follow‐up, the mean score on the self‐care scale was significantly higher in the groups using the website and the adjusted care pathway compared to usual care (73.5 vs. 70.8, 95% confidence interval 0.6–6.2; and 78.2 vs. 70.8, 95% confidence interval 3.8– 9.4, respectively). The effect attenuated, until no differences after 1 year between the groups. Quality of life showed a similar pattern. Other secondary outcomes did not clearly differ between the groups. Conclusions Both the heartfailurematters.org website and an e‐health adjusted care pathway improved self‐care in HF patients on the short term, but not on the long term. Continuous updating of e‐health facilities could be helpful to sustain effects. Clinical Trial registration: ClinicalTrials.gov ID NCT01755988.
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Affiliation(s)
- Kim P Wagenaar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Berna D L Broekhuizen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Ilse Kok
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | | | | | | | | | | | | | | | | | - Kenneth Dickstein
- Stavanger University Hospital, University of Bergen, Stavanger, Norway
| | - Maarten J Cramer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Marcel A J Landman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
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200
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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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