251
|
Abstract
Multimorbidity is common among older adults with heart failure and creates diagnostic and management challenges. Diagnosis of heart failure may be difficult, as many conditions commonly found in older persons produce dyspnea, exercise intolerance, fatigue, and weakness; no singular pathognomonic finding or diagnostic test differentiates them from one another. Treatment may also be complicated, as multimorbidity creates high potential for drug-disease and drug-drug interactions in settings of polypharmacy. The authors suggest that management of multimorbid older persons with heart failure be patient, rather than disease-focused, to best meet patients' unique health goals and minimize risk from excessive or poorly-coordinated treatments.
Collapse
|
252
|
Freedland KE, Carney RM, Rich MW, Steinmeyer BC, Skala JA, Dávila-Román VG. Depression and Multiple Rehospitalizations in Patients With Heart Failure. Clin Cardiol 2016; 39:257-62. [PMID: 26840627 DOI: 10.1002/clc.22520] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/20/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There have been few studies of the effect of depression on rehospitalization in patients with heart failure (HF), and even fewer on its role in multiple rehospitalizations. HYPOTHESIS Depression is an independent risk factor for multiple readmissions in patients with HF. METHODS A cohort of 662 patients with HF who were discharged alive after hospitalization were interviewed to evaluate symptoms of depression and were followed for 1 year. All-cause readmissions were documented by chart review. A marginal proportional rates model was used to model the effect of depression on the rate of rehospitalization with adjustment for known predictors of HF outcomes. RESULTS Depression symptoms predicted multiple readmissions (adjusted hazard ratio [HR]: 1.08, 95% confidence interval [CI]: 1.03-1.13, P = 0.0008). Compared with patients without depression, those who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for major depression at index were at the highest risk for multiple rehospitalizations (HR: 1.51, 95% CI: 1.15-1.97, P = 0.003). CONCLUSIONS Depression is an independent risk factor for multiple all-cause readmissions in patients with HF.
Collapse
Affiliation(s)
- Kenneth E Freedland
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Robert M Carney
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Michael W Rich
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Brian C Steinmeyer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Judith A Skala
- Palliative Care Department, Veterans Administration Medical Center, St. Louis, Missouri
| | - Victor G Dávila-Román
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
253
|
Selan S, Hellström A, Fagerström C. Impact of Nutritional Status and Sleep Quality on Hospital Utilisation in the Oldest Old with Heart Failure. J Nutr Health Aging 2016; 20:170-7. [PMID: 26812513 DOI: 10.1007/s12603-015-0594-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe three-year trends in nutritional status and sleep quality and their impact on hospital utilisation in the oldest old (80 +) with heart failure (HF). DESIGN Single-centred longitudinal observational study. SETTING South-eastern Sweden. PARTICIPANTS 90 elderly (80+) with objectively verified HF. MEASUREMENTS Baseline data from the Mini Nutritional Assessment (MNA) and on sleep quality were collected through structured interviews following the HF diagnosis (n=90) and at a three-year follow-up (n=41). Data on hospital utilisation during the three years following the HF diagnosis were also collected. RESULTS Nineteen percent of the participants were found to have impaired nutritional status, a condition that increased hospital utilisation by four bed days per year. A majority (85%) had impaired sleep quality, but no impact on hospital utilisation was found. Nutritional status and sleep quality were stable over the three-year period. CONCLUSION In the oldest old with HF, impaired nutritional status and impaired sleep quality are already common at HF diagnosis. Impaired nutritional status increases hospital utilisation significantly. Therefore, it is of supreme importance to systematically evaluate nutritional status and sleep quality in the oldest old when they are diagnosed with HF, as well as to take action if impairments are present.
Collapse
Affiliation(s)
- S Selan
- Suzana Selan, Department of Health, Blekinge Institute of Technology, Telephone: +46 70-211 82 87. E-mail:
| | | | | |
Collapse
|
254
|
Ziaeian B, Fonarow GC. The Prevention of Hospital Readmissions in Heart Failure. Prog Cardiovasc Dis 2016; 58:379-85. [PMID: 26432556 PMCID: PMC4783289 DOI: 10.1016/j.pcad.2015.09.004] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 09/13/2015] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) is a growing healthcare burden and one of the leading causes of hospitalizations and readmission. Preventing readmissions for HF patients is an increasing priority for clinicians, researchers, and various stakeholders. The following review will discuss the interventions found to reduce readmissions for patients and improve hospital performance on the 30-day readmission process measure. While evidence-based therapies for HF management have proliferated, the consistent implementation of these therapies and development of new strategies to more effectively prevent readmissions remain areas for continued improvement.
Collapse
Affiliation(s)
- Boback Ziaeian
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Jonathan and Karin Fielding School of Public Health at UCLA, Los Angeles, CA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles Medical Center, Los Angeles, CA.
| |
Collapse
|
255
|
Abstract
Heart failure (HF) is a major public health problem affecting more than 23 million patients worldwide. Incidence and prevalence rates vary significantly according to the source of data, but both increase with advancing age reaching, in the very elderly, prevalence rates that represent a challenge for the organization of medical care systems. Even if evidence-based treatments have improved prognosis in some patients with HF, patients with HF still need to be carefully characterized, described, and treated. Hospitalizations for acute HF are frequent and costly accounting for the vast majority of HF-related costs.
Collapse
Affiliation(s)
- Francesco Orso
- Department of Medicine and Geriatrics, Section of Geriatric Medicine and Cardiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,ANMCO Research Center, Via La Marmora 34, 50121, Florence, Italy
| | - Gianna Fabbri
- ANMCO Research Center, Via La Marmora 34, 50121, Florence, Italy
| | | |
Collapse
|
256
|
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2015; 133:e38-360. [PMID: 26673558 DOI: 10.1161/cir.0000000000000350] [Citation(s) in RCA: 3740] [Impact Index Per Article: 415.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
257
|
Böhm M, Robertson M, Ford I, Borer JS, Komajda M, Kindermann I, Maack C, Lainscak M, Swedberg K, Tavazzi L. Influence of Cardiovascular and Noncardiovascular Co-morbidities on Outcomes and Treatment Effect of Heart Rate Reduction With Ivabradine in Stable Heart Failure (from the SHIFT Trial). Am J Cardiol 2015; 116:1890-7. [PMID: 26508709 DOI: 10.1016/j.amjcard.2015.09.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/19/2015] [Accepted: 09/19/2015] [Indexed: 12/19/2022]
Abstract
Incidence of chronic heart failure (HF) increases with age and cardiovascular (CV) morbidity. Co-morbidities increase hospitalization and mortality in HF, and non-CV co-morbidities may lead to preventable hospitalizations. We studied the impact of co-morbidities on mortality and morbidity in Systolic Heart Failure Treatment with the I(f) Inhibitor Ivabradine Trial, and investigated whether the impact of ivabradine was affected by co-morbidities. We analyzed the Systolic Heart Failure Treatment with the I(f) Inhibitor Ivabradine Trialpopulation, with moderate-to-severe HF and left ventricular dysfunction (in sinus rhythm with heart rate at rest ≥70 beats/min), according to co-morbidity: chronic obstructive pulmonary disease, diabetes mellitus, anemia, stroke, impaired renal function, myocardial infarction, hypertension, and peripheral artery disease. Co-morbidity load was classed as 0, 1, 2, 3, 4+ or 1 to 2 co-morbidities, or 3+ co-morbidities. Co-morbidities were evenly distributed between the placebo and ivabradine groups. Patients with more co-morbidities were likely to be older, women, had more advanced HF, were less likely to be on β blockers, with an even distribution on ivabradine 2.5, 5, or 7.5 mg bid and placebo at all co-morbidity loads. Number of co-morbidities was related to outcomes. Cardiovascular death or HF hospitalization events significantly increased (p <0.0001) with co-morbidity load, with the most events in patients with >3 co-morbidities for both, ivabradine and placebo. There was no interaction between co-morbidity load and the treatment effects of ivabradine. Hospitalization rate was lower at all co-morbidity loads for ivabradine. In conclusion, cardiac and noncardiac co-morbidities significantly affect CV outcomes, particularly if there are >3 co-morbidities. The effect of heart rate reduction with ivabradine is maintained at all co-morbidity loads.
Collapse
|
258
|
|
259
|
Galioto R, Fedor AF, Gunstad J. Possible neurocognitive benefits of exercise in persons with heart failure. Eur Rev Aging Phys Act 2015; 12:6. [PMID: 26865870 PMCID: PMC4745145 DOI: 10.1186/s11556-015-0151-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/30/2015] [Indexed: 01/08/2023] Open
Abstract
More than 6 million Americans have heart failure (HF) and more than 500,000 are diagnosed each year. In addition to its many adverse medical consequences, HF is also a significant risk factor for neurological disorders like Alzheimer's disease and associated with cognitive impairment long prior to the onset of these conditions. Converging bodies of literature suggest cognitive dysfunction in HF may be at least partially modifiable. One key mechanism for cognitive improvement is improved cerebral blood flow, which may be possible with exercise in patients with HF. This brief review provides a model for the likely neurocognitive benefits of exercise in HF and encourages further work in this area.
Collapse
Affiliation(s)
- Rachel Galioto
- Department of Psychology Sciences, Kent State University, Kent, OH 44242 USA
| | - Andrew F Fedor
- Department of Psychology Sciences, Kent State University, Kent, OH 44242 USA
| | - John Gunstad
- Department of Psychology Sciences, Kent State University, Kent, OH 44242 USA
| |
Collapse
|
260
|
Conde-Martel A, Hernández-Meneses M. [Prevalence and prognostic meaning of comorbidity in heart failure]. Rev Clin Esp 2015; 216:222-8. [PMID: 26455791 DOI: 10.1016/j.rce.2015.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/31/2015] [Indexed: 01/09/2023]
Abstract
Heart failure (HF) predominantly affects elderly individuals and has a significant impact on the health systems of developed countries. Comorbidities are present in most patients with HF by acting as the cause, the consequence or a mere coincidence. In addition to their high prevalence, they have considerable relevance because they can mask symptoms, impede the diagnosis and treatment, contribute to progression and negatively influence the prognosis of HF. Most of the associated comorbidities result in a greater number of hospitalisations, poorer quality of life and increased mortality. Given that many of these comorbidities are underdiagnosed, their detection could improve the outcome and quality of life of patients with HF. This article reviews the prevalence and prognostic meaning of the most prevalent comorbidities associated with HF.
Collapse
Affiliation(s)
- A Conde-Martel
- Servicio de Medicina Interna. Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, España; Universidad de Las Palmas de Gran Canaria, Las Palmas, España.
| | - M Hernández-Meneses
- Servicio de Medicina Interna. Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, España
| |
Collapse
|
261
|
Aranda JM. Strategies to Reduce Heart Failure Hospitalizations and Readmissions: How Low Can We Go? CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2015. [DOI: 10.15212/cvia.2015.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
262
|
Erez A, Klempfner R, Goldenberg I, Elis A. Short and long term survival following hospitalization with a primary versus non-primary diagnosis of acute heart failure. Eur J Intern Med 2015; 26:420-4. [PMID: 26021839 DOI: 10.1016/j.ejim.2015.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the short-term and long-term outcomes of patients hospitalized with a primary diagnosis of acute heart failure (AHF) versus AHF associated with an alternative principal diagnosis. METHODS The Israel nationwide Heart Failure (HF) survey examined prospectively 4102 consecutive HF patients admitted to all 25 public hospitals in the country. This study focused on 2302 patients hospitalized with a diagnosis of AHF. In 1594 patients, AHF was the principal diagnosis of hospitalization. In 708 patients, AHF was a secondary diagnosis with an alternative principal diagnosis of hospitalization. RESULTS Patients with secondary diagnosis of AHF were younger with an overall less comorbidities except for concomitant ischemic heart disease. Despite that, hospital duration was longer (median days (Q1-Q3), 4 (3-7), and 6(4-9), respectively, P<0.001) and in-hospital mortality was higher (7.2% vs. 4.9%, p-value=0.03) among patients with a secondary diagnosis of AHF. Consistently, the age and sex adjusted OR of secondary diagnosis of AHF for in-hospital mortality was 1.76 (C.I. 1.2-2.54; p-val=0.003). However, long-term follow-up showed a risk-reversal wherein the adjusted risk for 10-year mortality was significantly lower among those hospitalized with a secondary vs. primary diagnosis of AHF (HR=0.88, C.I. 0.79-0.99; p-val=0.04). CONCLUSIONS While hospitalization with secondary diagnosis of AHF is associated with a higher risk for in-hospital mortality in comparison to hospitalization with principal diagnosis of AHF, it is independently associated with a lower risk for 10-year mortality. These findings may have implications for short and long term risk stratification after AHF hospitalization.
Collapse
Affiliation(s)
- Aharon Erez
- Leviev Heart Center, Chaim Sheba Medical Center, Israel.
| | | | | | - Avishay Elis
- Department of Medicine, Beilinson Hospital, Rabin Medical Center, PetachTikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
263
|
Non-cardiovascular comorbidity, severity and prognosis in non-selected heart failure populations: A systematic review and meta-analysis. Int J Cardiol 2015; 196:98-106. [PMID: 26080284 PMCID: PMC4518480 DOI: 10.1016/j.ijcard.2015.05.180] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 04/13/2015] [Accepted: 05/26/2015] [Indexed: 01/14/2023]
Abstract
Background Non-cardiovascular comorbidities are recognised as independent prognostic factors in selected heart failure (HF) populations, but the evidence on non-selected HF and how comorbid disease severity and change impacts on outcomes has not been synthesised. We identified primary HF comorbidity follow-up studies to compare the impact of non-cardiovascular comorbidity, severity and change on the outcomes of quality of life, all-cause hospital admissions and all-cause mortality. Methods Literature databases (Jan 1990–May 2013) were screened using validated strategies and quality appraisal (QUIPS tool). Adjusted hazard ratios for the main HF outcomes were combined using random effects meta-analysis and inclusion of comorbidity in prognostic models was described. Results There were 68 primary HF studies covering nine non-cardiovascular comorbidities. Most were on diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD) and renal dysfunction (RD) for the outcome of mortality (93%) and hospital admissions (16%), median follow-up of 4 years. The adjusted associations between HF comorbidity and mortality were DM (HR 1.34; 95% CI 1.2, 1.5), COPD (1.39; 1.2, 1.6) and RD (1.52; 1.3, 1.7). Comorbidity severity increased mortality from moderate to severe disease by an estimated 78%, 42% and 80% respectively. The risk of hospital admissions increased up to 50% for each disease. Few studies or prognostic models included comorbidity change. Conclusions Non-cardiovascular comorbidity and severity significantly increases the prognostic risk of poor outcomes in non-selected HF populations but there is a major gap in investigating change in comorbid status over time. The evidence supports a step-change for the inclusion of comorbidity severity in new HF interventions to improve prognostic outcomes. We synthesise the prognosis evidence on non-CVD comorbidity and severity in non-selected HF Most studies focused on three comorbid diseases for mortality and admissions and none for QoL COPD, diabetes and CKD increased mortality and admission risk in non-selected HF Severity studies were few but where available, risk increased with disease severity Comorbidity severity is important but has yet to be included in HF prognostic models
Collapse
|
264
|
Gerber Y, Weston SA, Redfield MM, Chamberlain AM, Manemann SM, Jiang R, Killian JM, Roger VL. A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010. JAMA Intern Med 2015; 175:996-1004. [PMID: 25895156 PMCID: PMC4451405 DOI: 10.1001/jamainternmed.2015.0924] [Citation(s) in RCA: 550] [Impact Index Per Article: 61.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Heart failure (HF) is commonly referred to as an epidemic, posing major clinical and public health challenges. Yet, contemporary data on its magnitude and implications are scarce. OBJECTIVE To evaluate recent trends in HF incidence and outcomes overall and by preserved ejection fraction (HFpEF) or reduced ejection fraction (HFrEF). DESIGN, SETTING, AND PARTICIPANTS Incidence rates of HF in Olmsted County, Minnesota (population, approximately 144,248), between January 1, 2000, and December 31, 2010, were assessed. MAIN OUTCOMES AND MEASURES Patients identified with incident HF (n = 2762) (mean age, 76.4 years; 43.1% male) were followed up for all-cause and cause-specific hospitalizations (through December 2012) and death (through March 2014). RESULTS The age- and sex-adjusted incidence of HF declined substantially from 315.8 per 100,000 in 2000 to 219.3 per 100,000 in 2010 (annual percentage change, -4.6), equating to a rate reduction of 37.5% (95% CI, -29.6% to -44.4%) over the last decade. The incidence declined for both HF types but was greater (interaction P = .08) for HFrEF (-45.1%; 95% CI, -33.0% to -55.0%) than for HFpEF (-27.9%; 95% CI, -12.9% to -40.3%). Mortality was high (24.4% for age 60 years and 54.4% for age 80 years at 5 years of follow-up), frequently ascribed to noncardiovascular causes (54.3%), and did not decline over time. The risk of cardiovascular death was lower for HFpEF than for HFrEF (multivariable-adjusted hazard ratio, 0.79; 95% CI, 0.67-0.93), whereas the risk of noncardiovascular death was similar (1.07; 95% CI, 0.89-1.29). Hospitalizations were common (mean, 1.34; 95% CI, 1.25-1.44 per person-year), particularly among men, and did not differ between HFpEF and HFrEF. Most hospitalizations (63.0%) were due to noncardiovascular causes. Hospitalization rates for cardiovascular causes did not change over time, whereas those for noncardiovascular causes increased. CONCLUSIONS AND RELEVANCE Over the last decade, the incidence of HF declined substantially, particularly for HFrEF, contrasting with no apparent change in mortality. Noncardiovascular conditions have an increasing role in hospitalizations and remain the most frequent cause of death. These results underscore the need to augment disease-centric management approaches with holistic strategies to reduce the population burden of HF.
Collapse
Affiliation(s)
- Yariv Gerber
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota2Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Susan A Weston
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Margaret M Redfield
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Sheila M Manemann
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Ruoxiang Jiang
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Jill M Killian
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota3Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
265
|
Donal E, Lund LH, Oger E, Hage C, Persson H, Reynaud A, Ennezat PV, Bauer F, Drouet E, Linde C, Daubert C. New echocardiographic predictors of clinical outcome in patients presenting with heart failure and a preserved left ventricular ejection fraction: a subanalysis of the Ka (Karolinska) Ren (Rennes) Study. Eur J Heart Fail 2015; 17:680-8. [PMID: 26033771 DOI: 10.1002/ejhf.291] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 02/23/2015] [Accepted: 03/19/2015] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To identify electrocardiographic and echocardiographic predictors of mortality and hospitalizations for heart failure (HF) in the KaRen study. BACKGROUND KaRen is a prospective, observational study of the long-term outcomes of patients presenting with heart failure and a preserved ejection fraction (HFpEF). METHOD We identified 538 patients who presented with acute cardiac decompensation, a >100 pg/mL serum b-type natriuretic peptide (BNP) or >300 pg/mL N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration and a left ventricular ejection fraction (LVEF) >45%. After 4-8 weeks of standard treatment, 413 patients (mean age = 76 ± 9 years, 55.9% women) returned for analyses of their clinical status, laboratory screen, and detailed electrocardiographic and Doppler echocardiographic recordings. They were followed for a mean of 28 months thereafter. The primary study endpoint was time to death from all causes or first hospitalization for heart failure. RESULTS Mean LVEF was 62.4 ± 6.9% and median NT-proBNP 1410 pmol/L. PR interval >200 ms was present in 11.2% of patients and 14.9% had a >120 ms QRS duration, with left bundle branch block in only 6.3%. Over a mean follow-up of 28 months, 177 patients (42.9%) reached a primary study endpoint, including 61 deaths and 116 hospitalizations for heart failure. After adjustment for age, gender, New York Heart Association class, atrial fibrillation history, creatinine, sodium, BNP, ejection fraction, and right ventricular fractional shortening, only E/e' remained as a predictor, with a hazard ratio = 1.49 and P = 0.0012. CONCLUSION The incidence of hospitalizations for HF and deaths in KaRen was high and E/e' predicted adverse clinical outcomes. These observations should help in the risk stratification and therapy of HFpEF.
Collapse
Affiliation(s)
- Erwan Donal
- Cardiology department & CIC-IT U 804, Hôpital Pontchaillou-CHU Rennes, Rennes University Health Centre, rue Henri Le Guillou, 35000, Rennes, France.,LTSI, Rennes 1 University, INSERM 1099, Rennes, France
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Emmanuel Oger
- Clinical Investigation Center INSERM CIC-1414, CHU Rennes, France
| | - Camilla Hage
- Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Hans Persson
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | | | | | - Fabrice Bauer
- Cardiology Department, Rouen University Health Centre, Rouen, France
| | | | - Cecilia Linde
- Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Claude Daubert
- Cardiology department & CIC-IT U 804, Hôpital Pontchaillou-CHU Rennes, Rennes University Health Centre, rue Henri Le Guillou, 35000, Rennes, France.,LTSI, Rennes 1 University, INSERM 1099, Rennes, France
| | | |
Collapse
|
266
|
Roger VL. Cardiovascular diseases in populations: secular trends and contemporary challenges-Geoffrey Rose lecture, European Society of Cardiology meeting 2014. Eur Heart J 2015; 36:2142-6. [PMID: 25994744 DOI: 10.1093/eurheartj/ehv220] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 05/05/2015] [Indexed: 11/14/2022] Open
Abstract
Geoffrey Rose pioneered the concept that, to reduce the burden of disease, improving the population distribution of a risk factor was preferable to interventions that target high-risk individuals. Reflecting on this concept prompted us to ask if temporal trends in the burden of cardiovascular disease support this hypothesis. This perspective article summarizes the Geoffrey Rose lecture given at the European Society of Cardiology meeting in 2014 and examines how cardiovascular diseases have evolved over the past three decades focusing on temporal trends in myocardial infarction and heart failure.
Collapse
Affiliation(s)
- Véronique L Roger
- Department of Health Sciences Research and Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| |
Collapse
|
267
|
The Hospitalization Burden and Post-Hospitalization Mortality Risk in Heart Failure With Preserved Ejection Fraction: Results From the I-PRESERVE Trial (Irbesartan in Heart Failure and Preserved Ejection Fraction). JACC-HEART FAILURE 2015; 3:429-441. [PMID: 25982110 DOI: 10.1016/j.jchf.2014.12.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 12/09/2014] [Accepted: 12/23/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this study was to investigate prognosis in patients with heart failure (HF) with preserved ejection fraction and the causes of hospitalization and post-hospitalization mortality. BACKGROUND Although hospitalizations in patients with HF with preserved ejection fraction are common, there are limited data from clinical trials on the causes of admission and the influence of hospitalizations on subsequent mortality risk. METHODS Patients (n = 4,128) with New York Heart Association functional class II to IV HF and left ventricular ejection fractions >45% were enrolled in I-PRESERVE (Irbesartan in Heart Failure and Preserved Ejection Fraction). A blinded events committee adjudicated cardiovascular hospitalizations and all deaths using predefined and standardized definitions. The risk for death after HF, any-cause, or non-HF hospitalization was assessed using time-dependent Cox proportional hazard models. RESULTS A total of 2,278 patients had 5,863 hospitalizations during the 49 months of follow-up, of which 3,585 (61%) were recurrent hospitalizations. For any-cause hospitalizations, 26.5% of patients died during follow-up, with an incident mortality rate of 11.1 deaths per 100 patient-years (PYs) and an adjusted hazard ratio of 5.32 (95% confidence interval: 4.21 to 6.23). Overall, 53.6% of hospitalizations were classified as cardiovascular and 43.7% as noncardiovascular, with 2.7% not classifiable. HF was the largest single cause of initial (17.6%) and overall (21.1%) hospitalizations, although, after HF hospitalization, a substantially higher proportion of readmissions were due to primary HF causes (40%). HF hospitalization occurred in 685 patients, with 41% deaths during follow-up, an incident mortality rate of 19.3 deaths per 100 PYs. The adjusted hazard ratio was 2.93 (95% confidence interval: 2.40 to 3.57) relative to patients who were not hospitalized for HF and was greater in those with longer durations of hospitalization. There were 1,593 patients with only non-HF hospitalizations, 21% of whom died during follow-up, with an incident mortality rate of 8.7 deaths per 100 PYs and an adjusted hazard ratio of 4.25 (95% confidence interval: 3.27 to 5.32). The risk for death was highest in the first 30 days and declined over time for all hospitalization categories. Patients not hospitalized for HF or for any cause had observed incident mortality rates of 3.8 and 1.3 deaths per 100 PYs, respectively. CONCLUSIONS In I-PRESERVE, HFpEF patients hospitalized for any reason, and especially for HF, were at high risk for subsequent death, particularly early. The findings support the need for careful attention in the post-discharge time period including attention to comorbid conditions. Among those hospitalized for HF, the high mortality rate and increased proportion of readmissions due to HF (highest during the first 30 days), suggest that this group would be an appropriate target for investigation of new interventions.
Collapse
|
268
|
Kitzman DW, Upadhya B, Reeves G. Hospitalizations and Prognosis in Elderly Patients With Heart Failure and Preserved Ejection Fraction: Time to Treat the Whole Patient. JACC-HEART FAILURE 2015; 3:442-444. [PMID: 25982112 DOI: 10.1016/j.jchf.2015.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 01/27/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Dalane W Kitzman
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Bharthi Upadhya
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Gordon Reeves
- Division of Cardiology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
269
|
Varr BC, Maurer MS. Emerging role of serelaxin in the therapeutic armamentarium for heart failure. Curr Atheroscler Rep 2015; 16:447. [PMID: 25108571 DOI: 10.1007/s11883-014-0447-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Acute heart failure (AHF) remains a major cause of morbidity and mortality, with an increasing prevalence anticipated over the next few decades as the population ages, heightening already significant health and economic burdens to society. New therapies for AHF have stalled over the past decade for a multitude of reasons, principal among them the heterogeneous population of patients affected with potentially multiple operative pathophysiologic mechanisms making a single targeted therapy a challenge. Serelaxin, a recombinant form of human relaxin-2, mediates adaptive cardiovascular effects during pregnancy that could be beneficial in the AHF population, primarily through nitric oxide-mediated vasodilation. Serelaxin is a novel therapeutic agent that has shown promise in the treatment of AHF in predefined subpopulations, though studies powered for "hard" outcomes are still pending. In this review, we examine the clinical investigations to date involving serelaxin in patients with heart failure and its possible emerging role in the future therapy of AHF.
Collapse
Affiliation(s)
- Brandon C Varr
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA,
| | | |
Collapse
|
270
|
McNaughton CD, Cawthon C, Kripalani S, Liu D, Storrow AB, Roumie CL. Health literacy and mortality: a cohort study of patients hospitalized for acute heart failure. J Am Heart Assoc 2015; 4:jah3939. [PMID: 25926328 PMCID: PMC4599411 DOI: 10.1161/jaha.115.001799] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background More than 30% of patients hospitalized for heart failure are rehospitalized or die within 90 days of discharge. Lower health literacy is associated with mortality among outpatients with chronic heart failure; little is known about this relationship after hospitalization for acute heart failure. Methods and Results Patients hospitalized for acute heart failure and discharged home between November 2010 and June 2013 were followed through December 31, 2013. Nurses administered the Brief Health Literacy Screen at admission; low health literacy was defined as Brief Health Literacy Screen ≤9. The primary outcome was all-cause mortality. Secondary outcomes were time to first rehospitalization and, separately, time to first emergency department visit within 90 days of discharge. Cox proportional hazards models determined their relationships with health literacy, adjusting for age, gender, race, insurance, education, comorbidity, and hospital length of stay. For the 1379 patients, average age was 63.1 years, 566 (41.0%) were female, and 324 (23.5%) had low health literacy. Median follow-up was 20.7 months (interquartile range 12.8 to 29.6 months), and 403 (29.2%) patients died. Adjusted hazard ratio for death among patients with low health literacy was 1.34 (95% CI 1.04, 1.73, P=0.02) compared to Brief Health Literacy Screen >9. Within 90 days of discharge, there were 415 (30.1%) rehospitalizations and 201 (14.6%) emergency department visits, with no evident association with health literacy. Conclusions Lower health literacy was associated with increased risk of death after hospitalization for acute heart failure. There was no evident relationship between health literacy and 90-day rehospitalization or emergency department visits.
Collapse
Affiliation(s)
- Candace D McNaughton
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN (C.D.M.N., A.B.S.)
| | - Courtney Cawthon
- Department of Medicine, Vanderbilt University, Nashville, TN (C.C., S.K., C.L.R.)
| | - Sunil Kripalani
- Department of Medicine, Vanderbilt University, Nashville, TN (C.C., S.K., C.L.R.)
| | - Dandan Liu
- Department of Biostatistics, Vanderbilt University, Nashville, TN (D.L.)
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN (C.D.M.N., A.B.S.)
| | - Christianne L Roumie
- Department of Medicine, Vanderbilt University, Nashville, TN (C.C., S.K., C.L.R.) Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, Nashville, TN (C.L.R.)
| |
Collapse
|
271
|
Dominguez-Rodriguez A, Abreu-Gonzalez P, Jimenez-Sosa A, Gonzalez J, Caballero-Estevez N, Martin-Casanas FV, Lara-Padron A, Aranda JM. The impact of frailty in older patients with non-ischaemic cardiomyopathy after implantation of cardiac resynchronization therapy defibrillator. Europace 2015; 17:598-602. [DOI: 10.1093/europace/euu333] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
272
|
Dunlay SM, Redfield MM, Jiang R, Weston SA, Roger VL. Care in the last year of life for community patients with heart failure. Circ Heart Fail 2015; 8:489-96. [PMID: 25834184 DOI: 10.1161/circheartfailure.114.001826] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 03/19/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Healthcare utilization peaks at the end of life (EOL) in patients with heart failure. However, it is unclear what factors affect end of life utilization in patients with heart failure and if utilization has changed over time. METHODS AND RESULTS Southeastern Minnesota residents with heart failure were prospectively enrolled into a longitudinal cohort study from 2003 to 2011. Patients who died before December 31, 2012, were included in the analysis. Information on hospitalizations and outpatient visits in the last year of life was obtained using administrative sources. Negative binomial regression was used to assess the association between patient characteristics and utilization. The 698 decedents (47.3% men; 53.4% preserved ejection fraction) experienced 1528 hospitalizations (median 2 per person; range, 0-12; 37.6% because of cardiovascular causes) and 12 927 outpatient visits (median 14 per person; range, 0-119) in their last year of life. Most patients (81.5%) were hospitalized at least once and 28.4% died in the hospital. Patients who were older and those with dementia had lower utilization. Patients who were married, resided in a skilled nursing facility, and had more comorbidities had higher utilization. Patients with preserved ejection fraction had higher rates of noncardiovascular hospitalizations although other utilization was similar. Over time, rates of hospitalizations and outpatient visits decreased, whereas palliative care consults and enrollment in hospice increased. CONCLUSIONS Although patient factors remain associated with differential healthcare utilization at the end of life, utilization declined over time and use of palliative care services increased. These results are encouraging given the high resource use in patients with heart failure.
Collapse
Affiliation(s)
- Shannon M Dunlay
- From the Division of Cardiovascular Diseases, Department of Medicine (S.M.D., M.M.R., V.L.R.) and Department of Health Sciences Research (S.M.D., R.J., S.A.W., V.L.R.), Mayo Clinic, Rochester, MN.
| | - Margaret M Redfield
- From the Division of Cardiovascular Diseases, Department of Medicine (S.M.D., M.M.R., V.L.R.) and Department of Health Sciences Research (S.M.D., R.J., S.A.W., V.L.R.), Mayo Clinic, Rochester, MN
| | - Ruoxiang Jiang
- From the Division of Cardiovascular Diseases, Department of Medicine (S.M.D., M.M.R., V.L.R.) and Department of Health Sciences Research (S.M.D., R.J., S.A.W., V.L.R.), Mayo Clinic, Rochester, MN
| | - Susan A Weston
- From the Division of Cardiovascular Diseases, Department of Medicine (S.M.D., M.M.R., V.L.R.) and Department of Health Sciences Research (S.M.D., R.J., S.A.W., V.L.R.), Mayo Clinic, Rochester, MN
| | - Véronique L Roger
- From the Division of Cardiovascular Diseases, Department of Medicine (S.M.D., M.M.R., V.L.R.) and Department of Health Sciences Research (S.M.D., R.J., S.A.W., V.L.R.), Mayo Clinic, Rochester, MN
| |
Collapse
|
273
|
Abstract
Heart failure with preserved ejection fraction (HFPEF) is a common condition, and the prevalence is projected to increase further. Studies differ in the reported incidence and mortality associated with this condition, although there is agreement that between a third and one-half of all patients with heart failure have HFPEF. Although several consensus statements and guidelines have been published, some recent randomized clinical trials have reported low mortality, raising doubts about whether all patients diagnosed with HFPEF have HFPEF or whether the condition is heterogeneous in its cause and prognosis. The overall reported prognosis of patients with HFPEF remains poor.
Collapse
Affiliation(s)
- Charlotte Andersson
- Framingham Heart Study, Mt Wayte Avenue 73, Suite 2, Framingham, MA 01702-5827, USA; Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, 801 Massachusetts Avenue, Suite 470, Boston, MA 02118, USA; Department of Cardiology, Gentofte Hospital, Niels Andersens vej 65, Hellerup 2900, Denmark.
| | - Ramachandran S Vasan
- Framingham Heart Study, Mt Wayte Avenue 73, Suite 2, Framingham, MA 01702-5827, USA; Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, 801 Massachusetts Avenue, Suite 470, Boston, MA 02118, USA; Section of Cardiology, Boston University School of Medicine, 801 Massachussetts Avenue, Suite 470, Boston, MA 02118, USA
| |
Collapse
|
274
|
Böhm M, Borer JS, Camm J, Ford I, Lloyd SM, Komajda M, Tavazzi L, Talajic M, Lainscak M, Reil JC, Ukena C, Swedberg K. Twenty-four-hour heart rate lowering with ivabradine in chronic heart failure: insights from the SHIFT Holter substudy. Eur J Heart Fail 2015; 17:518-26. [DOI: 10.1002/ejhf.258] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 12/23/2014] [Accepted: 01/09/2015] [Indexed: 01/18/2023] Open
Affiliation(s)
- Michael Böhm
- Universitätsklinikum des Saarlandes; Klinik für Innere Medizin III Homburg/Saar Germany
| | - Jeffrey S. Borer
- Division of Cardiovascular Medicine; The Howard Gilman Institute for Heart Valve Diseases and the Schiavone Institute for Cardiovascular Translational Research; SUNY Downstate Medical Center Brooklyn and New York, NY USA
| | - John Camm
- Division of Clinical Sciences; St George's University of London; London UK
| | - Ian Ford
- Robertson Centre for Biostatistics; University of Glasgow; Glasgow UK
| | - Suzanne M. Lloyd
- Robertson Centre for Biostatistics; University of Glasgow; Glasgow UK
| | - Michel Komajda
- Groupe Hospitalier Pitie-Salpetriere; Faculte de medicine Paris France
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research; E.S. Health Science Foundation; Cotingola Italy
| | | | - Mitja Lainscak
- University Clinic Golnik; Division of Cardiology; Slovenia
| | - Jan-Christian Reil
- Universitätsklinikum des Saarlandes; Klinik für Innere Medizin III Homburg/Saar Germany
| | - Christian Ukena
- Universitätsklinikum des Saarlandes; Klinik für Innere Medizin III Homburg/Saar Germany
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy; University of Gothenburg, Sweden and National Heart and Lung Institute, Imperial College; London
| |
Collapse
|
275
|
Dunlay SM, Manemann SM, Chamberlain AM, Cheville AL, Jiang R, Weston SA, Roger VL. Activities of daily living and outcomes in heart failure. Circ Heart Fail 2015; 8:261-7. [PMID: 25717059 PMCID: PMC4366326 DOI: 10.1161/circheartfailure.114.001542] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic disease can contribute to functional disability, which can degrade quality of life. However, the prevalence of functional disability and its association with outcomes among patients with heart failure requires further study. METHODS AND RESULTS Southeastern Minnesota residents with heart failure were enrolled from September 2003 through January 2012 into a cohort study with follow-up through December 2012. Difficulty with 9 activities of daily living (ADLs) was assessed by a questionnaire. Patients were divided into 3 categories of ADL difficulty (no/minimal, moderate, severe). The associations of ADL difficulty with mortality and hospitalization were assessed using Cox and Andersen-Gill models. Among 1128 patients (mean age, 74.7 years; 49.2% female), a majority (59.4%) reported difficulty with one or more ADLs at enrollment, with 272 (24.1%) and 146 (12.9%) experiencing moderate and severe difficulty, respectively. After a mean (SD) follow-up of 3.2 (2.4) years, 614 patients (54.4%) had died. Mortality increased with increasing ADL difficulty; the hazard ratio (95% confidence interval) for death was 1.49 (1.22-1.82) and 2.26 (1.79-2.86) for those with moderate and severe difficulty, respectively, compared to those with no/minimal difficulty (Ptrend<0.001). Patients with moderate and severe difficulty were at an increased risk for all-cause and noncardiovascular hospitalization. In a second assessment, 17.7% of survivors reported more difficulty with ADLs and patients with persistently severe or worsening difficulty were at an increased risk for death (hazard ratio, 2.10; 95% confidence interval, 1.71-2.58; P<0.001) and hospitalization (hazard ratio, 1.51; 95% confidence interval, 1.31-1.74; P<0.001). CONCLUSIONS Functional disability is common in patients with heart failure, can progress over time, and is associated with adverse prognosis.
Collapse
Affiliation(s)
- Shannon M Dunlay
- From the Division of Cardiovascular Diseases, Department of Medicine (S.M.D., V.L.R.), Department of Health Sciences Research (S.M.D., S.M.M., A.M.C., R.J., S.A.W., V.L.R.), and Department of Physical Medicine and Rehabilitation (A.L.C.), Mayo Clinic, Rochester, MN.
| | - Sheila M Manemann
- From the Division of Cardiovascular Diseases, Department of Medicine (S.M.D., V.L.R.), Department of Health Sciences Research (S.M.D., S.M.M., A.M.C., R.J., S.A.W., V.L.R.), and Department of Physical Medicine and Rehabilitation (A.L.C.), Mayo Clinic, Rochester, MN
| | - Alanna M Chamberlain
- From the Division of Cardiovascular Diseases, Department of Medicine (S.M.D., V.L.R.), Department of Health Sciences Research (S.M.D., S.M.M., A.M.C., R.J., S.A.W., V.L.R.), and Department of Physical Medicine and Rehabilitation (A.L.C.), Mayo Clinic, Rochester, MN
| | - Andrea L Cheville
- From the Division of Cardiovascular Diseases, Department of Medicine (S.M.D., V.L.R.), Department of Health Sciences Research (S.M.D., S.M.M., A.M.C., R.J., S.A.W., V.L.R.), and Department of Physical Medicine and Rehabilitation (A.L.C.), Mayo Clinic, Rochester, MN
| | - Ruoxiang Jiang
- From the Division of Cardiovascular Diseases, Department of Medicine (S.M.D., V.L.R.), Department of Health Sciences Research (S.M.D., S.M.M., A.M.C., R.J., S.A.W., V.L.R.), and Department of Physical Medicine and Rehabilitation (A.L.C.), Mayo Clinic, Rochester, MN
| | - Susan A Weston
- From the Division of Cardiovascular Diseases, Department of Medicine (S.M.D., V.L.R.), Department of Health Sciences Research (S.M.D., S.M.M., A.M.C., R.J., S.A.W., V.L.R.), and Department of Physical Medicine and Rehabilitation (A.L.C.), Mayo Clinic, Rochester, MN
| | - Véronique L Roger
- From the Division of Cardiovascular Diseases, Department of Medicine (S.M.D., V.L.R.), Department of Health Sciences Research (S.M.D., S.M.M., A.M.C., R.J., S.A.W., V.L.R.), and Department of Physical Medicine and Rehabilitation (A.L.C.), Mayo Clinic, Rochester, MN
| |
Collapse
|
276
|
Short- and long-term mortality and hospital readmissions among patients with new hospitalization for heart failure: A population-based investigation from Italy. Int J Cardiol 2015; 181:81-7. [DOI: 10.1016/j.ijcard.2014.12.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/28/2014] [Accepted: 12/01/2014] [Indexed: 11/21/2022]
|
277
|
|
278
|
Chamberlain AM, St Sauver JL, Gerber Y, Manemann SM, Boyd CM, Dunlay SM, Rocca WA, Finney Rutten LJ, Jiang R, Weston SA, Roger VL. Multimorbidity in heart failure: a community perspective. Am J Med 2015; 128:38-45. [PMID: 25220613 PMCID: PMC4282820 DOI: 10.1016/j.amjmed.2014.08.024] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 08/13/2014] [Accepted: 08/13/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Comorbidities are a major concern in heart failure, leading to adverse outcomes, increased health care utilization, and excess mortality. Nevertheless, the epidemiology of comorbid conditions and differences in their occurrence by type of heart failure and sex are not well documented. METHODS The prevalence of 16 chronic conditions defined by the US Department of Health and Human Services was obtained among 1382 patients from Olmsted County, Minn. diagnosed with first-ever heart failure between 2000 and 2010. Heat maps displayed the pairwise prevalences of the comorbidities and the observed-to-expected ratios for occurrence of morbidity pairs by type of heart failure (preserved or reduced ejection fraction) and sex. RESULTS Most heart failure patients had 2 or more additional chronic conditions (86%); the most prevalent were hypertension, hyperlipidemia, and arrhythmias. The co-occurrence of other cardiovascular diseases was common, with higher prevalences of co-occurring cardiovascular diseases in men compared with women. Patients with preserved ejection fraction had one additional condition compared with those with reduced ejection fraction (mean 4.5 vs 3.7). The patterns of co-occurring conditions were similar between preserved and reduced ejection fraction; however, differences in the ratios of observed-to-expected co-occurrence were apparent by type of heart failure and sex. In addition, some psychological and neurological conditions co-occurred more frequently than expected. CONCLUSION Multimorbidity is common in heart failure, and differences in co-occurrence of conditions exist by type of heart failure and sex, highlighting the need for a better understanding of the clinical consequences of multiple chronic conditions in heart failure patients.
Collapse
Affiliation(s)
| | - Jennifer L St Sauver
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minn
| | - Yariv Gerber
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn; Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Sheila M Manemann
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Md
| | - Shannon M Dunlay
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Walter A Rocca
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn; Department of Neurology, Mayo Clinic, Rochester, Minn
| | - Lila J Finney Rutten
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minn
| | - Ruoxiang Jiang
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Susan A Weston
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minn; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.
| |
Collapse
|
279
|
Abstract
Heart failure (HF) is a clinical syndrome, which is becoming a major public health problem in recent decades, due to its increasing prevalence, especially in the developed countries, mostly due to prolonged lifespan of the general population as well as the increased of HF patients. The HF treatment, particularly, new pharmacological and non-pharmacological agents, has markedly improved clinical outcomes of patients with HF including increased life expectancy and improved quality of life. However, despite the facts that mortality in HF patients has decreased, it still remains unacceptably high. This review of summarizes the evidence to date about the mortality of HF patients. Despite the impressive achievements in the pharmacological and non-pharmacological treatment of HF patients which has undeniably improved the survival of these patients, the mortality still remains high particularly among elderly, male and African-American patients. Patients with HF and reduced ejection fraction have higher mortality rates, most commonly due to cardiovascular causes, compared with patients HF and preserved ejection fraction.
Collapse
Affiliation(s)
- Ibadete Bytyçi
- Clinic of Cardiology and Angiology, University Clinical Centre of Kosova; Prishtina-Republic of Kosovo.
| | | |
Collapse
|
280
|
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation 2014; 131:e29-322. [PMID: 25520374 DOI: 10.1161/cir.0000000000000152] [Citation(s) in RCA: 4464] [Impact Index Per Article: 446.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
281
|
Abstract
Heart failure (HF) is a major public health problem affecting more than five million Americans and more than 23 million patients worldwide. The epidemiology of HF is evolving. Data suggests that the incidence of HF peaked in the mid-1990s and has since declined. Survival after HF diagnosis has improved, leading to an increase in prevalence. The case mix is also changing, as a rising proportion of patients with HF have preserved ejection fraction and multimorbidity is increasingly common. After diagnosis, HF can have a profound associated morbidity. Hospitalizations in HF remain both frequent and costly, though they may be declining as a result of preventive efforts. The need for skilled nursing facility care in HF has risen. The role of palliative medicine in the care of patients with advanced HF is evolving as we learn how to best care for this population with a large symptom burden.
Collapse
Affiliation(s)
- Shannon M Dunlay
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Gonda 5, 200 First St. SW, Rochester, MN, 55905, USA,
| | | |
Collapse
|
282
|
Koifman E, Grossman E, Elis A, Dicker D, Koifman B, Mosseri M, Kuperstein R, Goldenberg I, Kamerman T, Levine-Tiefenbrun N, Klempfner R. Multidisciplinary rehabilitation program in recently hospitalized patients with heart failure and preserved ejection fraction: rationale and design of a randomized controlled trial. Am Heart J 2014; 168:830-7.e1. [PMID: 25458645 DOI: 10.1016/j.ahj.2014.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 08/02/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) comprises a large portion of heart failure patients and portends poor prognosis with similar outcome to heart failure with reduced ejection fraction (HFrEF). Thus far, no medical therapy has been shown to improve clinical outcome in this common condition. TRIAL DESIGN The study is a randomized-controlled, multicenter clinical trial aimed to determine whether early posthospitalization comprehensive cardiac rehabilitation (CR) including exercise training (ET) in recently hospitalized HFpEF patients reduces the composite end point of all-cause mortality and hospitalizations in comparison with usual care (UC). After undergoing baseline evaluation, patients are randomized to either UC or to ambulatory comprehensive CR program. Patients in the CR arm will participate in a 6-month biweekly ET program according to a predefined protocol, in addition to a complementary home exercise prescribed by a specialist in CR. Exercise training will include endurance and low-intensity resistance training. Patients in the UC arm will be followed up at the outpatient clinic, with management according to current heart failure guidelines. Physician follow-up visits will be conducted at 3, 6, and 12 months for assessment of adherence to therapy and ET, functional status, quality of life, and clinical events. Secondary end points will include quality-of-life questionnaire, economic end points, blood pressure, and hemoglobin A1C levels. CONCLUSIONS Cardiac rehabilitation and ET are relatively inexpensive and accessible and can be beneficial in HFpEF patients. Our trial is designed to evaluate the impact of early posthospitalization comprehensive rehabilitation program on clinical end points of mortality, hospitalization, and quality of life in HFpEF patients.
Collapse
|
283
|
McNallan SM, Singh M, Chamberlain AM, Kane RL, Dunlay SM, Redfield MM, Weston SA, Roger VL. Frailty and healthcare utilization among patients with heart failure in the community. JACC-HEART FAILURE 2014; 1:135-41. [PMID: 23956958 DOI: 10.1016/j.jchf.2013.01.002] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to determine the prevalence of frailty in a community cohort of patients with heart failure (HF) and to determine whether frailty is associated with healthcare utilization. BACKGROUND Frailty is associated with death in patients with HF, but its prevalence and impact on healthcare utilization in patients with HF are poorly characterized. METHODS Residents of Olmsted, Dodge, and Fillmore counties in Minnesota with HF between October 2007 and March 2011 were prospectively recruited to undergo frailty assessment. Frailty was defined as 3 or more of the following: unintentional weight loss, exhaustion, weak grip strength, and slowness and low physical activity measured by the SF-12 physical component score. Intermediate frailty was defined as 1 or 2 components. Negative binomial regression was used to examine the association between outpatient visits and frailty; Andersen-Gill models were used to determine if frailty predicted emergency department (ED) visits or hospitalizations. RESULTS Among 448 patients (mean age 73 ± 13 years, 57% men), 74% had some degree of frailty (19% frail, 55% intermediate frail). Over a mean follow-up period of 2.0 ± 1.1 years, 20,164 outpatient visits, 1,440 ED visits, and 1,057 hospitalizations occurred. After adjustment for potential confounders, frailty was associated with a 92% increased risk for ED visits and a 65% increased risk for hospitalizations. The population-attributable risk associated with any degree of frailty was 35% for ED visits and 19% for hospitalizations. CONCLUSIONS Frailty is common among community patients with HF and is a strong and independent predictor of ED visits and hospitalizations. Because frailty is potentially modifiable, it should be incorporated in the clinical evaluation of patients with HF.
Collapse
|
284
|
Desai AS, Claggett B, Pfeffer MA, Bello N, Finn PV, Granger CB, McMurray JJV, Pocock S, Swedberg K, Yusuf S, Solomon SD. Influence of hospitalization for cardiovascular versus noncardiovascular reasons on subsequent mortality in patients with chronic heart failure across the spectrum of ejection fraction. Circ Heart Fail 2014; 7:895-902. [PMID: 25326006 DOI: 10.1161/circheartfailure.114.001567] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Noncardiovascular (non-CV) comorbidities may contribute to hospitalizations in patients with heart failure (HF). We examined the incidence of mortality following hospitalization for cardiovascular (CV) versus non-CV reasons in the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program. METHODS AND RESULTS First hospitalizations for CV or non-CV reasons during the CHARM trial (N=7599) were related to subsequent risk of all-cause death using time-updated proportional hazards models. Over median 37.7 month follow-up, 2816 subjects (37.1%) were not hospitalized, 2893 (38.1%) were first hospitalized for CV reasons, and 1890 (24.9%) for non-CV reasons. The death rate (per 100 patient-years) among those not hospitalized was 2.8 compared with 17.8 after CV and 16.5 after non-CV hospitalization (both P<0.001 versus not hospitalized). Mortality at 30 days was higher after CV than non-CV hospitalization; however, among 30-day survivors of CV and non-CV hospitalization, rates of subsequent mortality were similar (14.5 versus 14.6 per 100 patient-years; P=0.62). Rates of CV hospitalization were higher for those with ejection fraction (EF) ≤40% than those with EF >40% (P<0.001), but rates of non-CV hospitalization did not vary by EF. Low EF patients had higher risk for mortality than preserved EF patients after any hospitalization, but within each EF subgroup, mortality in 30-day survivors of CV versus non-CV hospitalization was similar. CONCLUSIONS Non-CV hospitalization is frequent in patients with symptomatic heart failure and associated with risk of subsequent mortality similar to CV hospitalization across the spectrum of EF. These findings may have implications for developing strategies to prevent readmissions. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00634309 (CHARM-Added), NCT00634712 (CHARM-Preserved), NCT00634400 (CHARM-Alternative).
Collapse
Affiliation(s)
- Akshay S Desai
- From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.).
| | - Brian Claggett
- From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.)
| | - Marc A Pfeffer
- From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.)
| | - Natalie Bello
- From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.)
| | - Peter V Finn
- From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.)
| | - Christopher B Granger
- From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.)
| | - John J V McMurray
- From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.)
| | - Stuart Pocock
- From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.)
| | - Karl Swedberg
- From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.)
| | - Salim Yusuf
- From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.)
| | - Scott D Solomon
- From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.D., B.C., M.A.P., N.B., P.V.F., S.D.S.); Cardiology, Duke University, Durham, NC (C.B.G.); Cardiology, Western Infirmary, Glasgow, United Kingdom (J.J.V.M.); Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom (S.P.); Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden (K.S.); and Population Health Research Institute, McMaster University, Hamilton, ON, Canada (S.Y.)
| |
Collapse
|
285
|
Kauta SR, Keenan BT, Goldberg L, Schwab RJ. Diagnosis and treatment of sleep disordered breathing in hospitalized cardiac patients: a reduction in 30-day hospital readmission rates. J Clin Sleep Med 2014; 10:1051-9. [PMID: 25317084 DOI: 10.5664/jcsm.4096] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Sleep disordered breathing (SDB) is associated with significant cardiovascular sequelae and positive airway pressure (PAP) has been shown to improve heart failure and prevent the recurrence of atrial fibrillation in cardiac patients with sleep apnea. Patients who are hospitalized with cardiac conditions frequently have witnessed symptoms of SDB but often do not have a diagnosis of sleep apnea. We implemented a clinical paradigm to perform unattended sleep studies and initiate treatment with PAP in hospitalized cardiac patients with symptoms consistent with SDB. We hypothesized that PAP adherence in cardiac patients with SDB would reduce readmission rates 30 days after discharge. METHODS 106 consecutive cardiac patients hospitalized for heart failure, arrhythmias, and myocardial infarction and who reported symptoms of SDB were evaluated. Patients underwent a type III portable sleep study and those patients diagnosed with sleep apnea were started on PAP. Demographic data, SDB type, PAP adherence, and data regarding 30-day hospital readmission/ED visits were collected. RESULTS Of 106 patients, 104 had conclusive diagnostic studies using portable monitoring systems. Seventy-eight percent of patients (81/104) had SDB (AHI ≥ 5 events/h). Eighty percent (65/81) had predominantly obstructive sleep apnea, and 20% (16/81) had predominantly central sleep apnea. None of 19 patients (0%) with adequate PAP adherence, 6 of 20 (30%) with partial PAP use, and 5 of 17 (29%) of patients who did not use PAP were readmitted to the hospital or visited the emergency department (ED) for a cardiac issue within 30 days from discharge (p = 0.025). CONCLUSIONS Performing diagnostic unattended sleep studies and initiating PAP treatment in hospitalized cardiac patients was feasible and provided important clinical information. Our data indicate that hospital readmission and ED visits 30 days after discharge were significantly lower in patients with cardiac disease and SDB who adhered to PAP treatment than those who were not adherent. COMMENTARY A commentary on this article appears in this issue on page 1067.
Collapse
Affiliation(s)
- Shilpa R Kauta
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
| | - Brendan T Keenan
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
| | - Lee Goldberg
- Department of Cardiology, University of Pennsylvania, Philadelphia, PA
| | - Richard J Schwab
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
286
|
Bakal JA, McAlister FA, Liu W, Ezekowitz JA. Heart failure re-admission: measuring the ever shortening gap between repeat heart failure hospitalizations. PLoS One 2014; 9:e106494. [PMID: 25211034 PMCID: PMC4161342 DOI: 10.1371/journal.pone.0106494] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 08/07/2014] [Indexed: 11/24/2022] Open
Abstract
Many quality-of-care and risk prediction metrics rely on time to first rehospitalization even though heart failure (HF) patients may undergo several repeat hospitalizations. The aim of this study is to compare repeat hospitalization models. Using a population-based cohort of 40,667 patients, we examined both HF and all cause re-hospitalizations using up to five years of follow-up. Two models were examined: the gap-time model which estimates the adjusted time between hospitalizations and a multistate model which considered patients to be in one of four states; community-dwelling, in hospital for HF, in hospital for any reason, or dead. The transition probabilities and times were then modeled using patient characteristics and number of repeat hospitalizations. We found that during the five years of follow-up roughly half of the patients returned for a subsequent hospitalization for each repeat hospitalization. Additionally, we noted that the unadjusted time between hospitalizations was reduced ∼40% between each successive hospitalization. After adjustment each additional hospitalization was associated with a 28 day (95% CI: 22-35) reduction in time spent out of hospital. A similar pattern was seen when considering the four state model. A large proportion of patients had multiple repeat hospitalizations. Extending the gap between hospitalizations should be an important goal of treatment evaluation.
Collapse
Affiliation(s)
- Jeffrey A. Bakal
- Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, Edmonton, Alberta, Canada
- Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Finlay A. McAlister
- Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, Edmonton, Alberta, Canada
- Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Wei Liu
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Justin A. Ezekowitz
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
| |
Collapse
|
287
|
Anand IS, Win S, Rector TS, Cohn JN, Taylor AL. Effect of Fixed-Dose Combination of Isosorbide Dinitrate and Hydralazine on All Hospitalizations and on 30-Day Readmission Rates in Patients With Heart Failure. Circ Heart Fail 2014; 7:759-65. [DOI: 10.1161/circheartfailure.114.001360] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Inder S. Anand
- From the Medicine Service Line (I.S.A., S.W., J.N.C., A.L.T.) and Research Service Line (T.S.R.), VA Medical Center, Minneapolis, MN (I.S.A., T.S.R.); Department of Medicine, University of Minnesota, Minneapolis (I.S.A., S.W., T.S.R., J.N.C.); and Department of Medicine, Columbia University Medical Center, College of Physicians and Surgeons, New York, NY (A.L.T.)
| | - Sithu Win
- From the Medicine Service Line (I.S.A., S.W., J.N.C., A.L.T.) and Research Service Line (T.S.R.), VA Medical Center, Minneapolis, MN (I.S.A., T.S.R.); Department of Medicine, University of Minnesota, Minneapolis (I.S.A., S.W., T.S.R., J.N.C.); and Department of Medicine, Columbia University Medical Center, College of Physicians and Surgeons, New York, NY (A.L.T.)
| | - Thomas S. Rector
- From the Medicine Service Line (I.S.A., S.W., J.N.C., A.L.T.) and Research Service Line (T.S.R.), VA Medical Center, Minneapolis, MN (I.S.A., T.S.R.); Department of Medicine, University of Minnesota, Minneapolis (I.S.A., S.W., T.S.R., J.N.C.); and Department of Medicine, Columbia University Medical Center, College of Physicians and Surgeons, New York, NY (A.L.T.)
| | - Jay N. Cohn
- From the Medicine Service Line (I.S.A., S.W., J.N.C., A.L.T.) and Research Service Line (T.S.R.), VA Medical Center, Minneapolis, MN (I.S.A., T.S.R.); Department of Medicine, University of Minnesota, Minneapolis (I.S.A., S.W., T.S.R., J.N.C.); and Department of Medicine, Columbia University Medical Center, College of Physicians and Surgeons, New York, NY (A.L.T.)
| | - Anne L. Taylor
- From the Medicine Service Line (I.S.A., S.W., J.N.C., A.L.T.) and Research Service Line (T.S.R.), VA Medical Center, Minneapolis, MN (I.S.A., T.S.R.); Department of Medicine, University of Minnesota, Minneapolis (I.S.A., S.W., T.S.R., J.N.C.); and Department of Medicine, Columbia University Medical Center, College of Physicians and Surgeons, New York, NY (A.L.T.)
| |
Collapse
|
288
|
McCormick N, Lacaille D, Bhole V, Avina-Zubieta JA. Validity of heart failure diagnoses in administrative databases: a systematic review and meta-analysis. PLoS One 2014; 9:e104519. [PMID: 25126761 PMCID: PMC4134216 DOI: 10.1371/journal.pone.0104519] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/10/2014] [Indexed: 01/15/2023] Open
Abstract
Objective Heart failure (HF) is an important covariate and outcome in studies of elderly populations and cardiovascular disease cohorts, among others. Administrative data is increasingly being used for long-term clinical research in these populations. We aimed to conduct the first systematic review and meta-analysis of studies reporting on the validity of diagnostic codes for identifying HF in administrative data. Methods MEDLINE and EMBASE were searched (inception to November 2010) for studies: (a) Using administrative data to identify HF; or (b) Evaluating the validity of HF codes in administrative data; and (c) Reporting validation statistics (sensitivity, specificity, positive predictive value [PPV], negative predictive value, or Kappa scores) for HF, or data sufficient for their calculation. Additional articles were located by hand search (up to February 2011) of original papers. Data were extracted by two independent reviewers; article quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Using a random-effects model, pooled sensitivity and specificity values were produced, along with estimates of the positive (LR+) and negative (LR−) likelihood ratios, and diagnostic odds ratios (DOR = LR+/LR−) of HF codes. Results Nineteen studies published from1999–2009 were included in the qualitative review. Specificity was ≥95% in all studies and PPV was ≥87% in the majority, but sensitivity was lower (≥69% in ≥50% of studies). In a meta-analysis of the 11 studies reporting sensitivity and specificity values, the pooled sensitivity was 75.3% (95% CI: 74.7–75.9) and specificity was 96.8% (95% CI: 96.8–96.9). The pooled LR+ was 51.9 (20.5–131.6), the LR− was 0.27 (0.20–0.37), and the DOR was 186.5 (96.8–359.2). Conclusions While most HF diagnoses in administrative databases do correspond to true HF cases, about one-quarter of HF cases are not captured. The use of broader search parameters, along with laboratory and prescription medication data, may help identify more cases.
Collapse
Affiliation(s)
- Natalie McCormick
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Centre of Canada, Richmond, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Centre of Canada, Richmond, British Columbia, Canada
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Cardiovascular Committee of the Canadian Rheumatology Administrative Data Network, Richmond, British Columbia, Canada
| | - Vidula Bhole
- Arthritis Research Centre of Canada, Richmond, British Columbia, Canada
- EpiSolutions Consultancy Services, Thane, India
| | - J. Antonio Avina-Zubieta
- Arthritis Research Centre of Canada, Richmond, British Columbia, Canada
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Cardiovascular Committee of the Canadian Rheumatology Administrative Data Network, Richmond, British Columbia, Canada
- * E-mail:
| |
Collapse
|
289
|
Dunlay SM, Pack QR, Thomas RJ, Killian JM, Roger VL. Participation in cardiac rehabilitation, readmissions, and death after acute myocardial infarction. Am J Med 2014; 127:538-46. [PMID: 24556195 PMCID: PMC4035431 DOI: 10.1016/j.amjmed.2014.02.008] [Citation(s) in RCA: 180] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 02/05/2014] [Accepted: 02/05/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Participation in cardiac rehabilitation has been shown to decrease mortality after acute myocardial infarction, but its impact on readmissions requires examination. METHODS We conducted a population-based surveillance study of residents discharged from the hospital after their first-ever myocardial infarction in Olmsted County, Minnesota, from January 1, 1987, to September 30, 2010. Patients were followed up through December 31, 2010. Participation in cardiac rehabilitation after myocardial infarction was determined using billing data. We used a landmark analysis approach (cardiac rehabilitation participant vs not determined by attendance in at least 1 session of cardiac rehabilitation at 90 days post-myocardial infarction discharge) to compare readmission and mortality risk between cardiac rehabilitation participants and nonparticipants accounting for propensity to participate using inverse probability treatment weighting. RESULTS Of 2991 patients with incident myocardial infarction, 1569 (52.5%) participated in cardiac rehabilitation after hospital discharge. The cardiac rehabilitation participation rate did not change during the study period, but increased in the elderly and decreased in men and younger patients. After adjustment, cardiac rehabilitation participants had lower all-cause readmission (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.65-0.87; P < .001), cardiovascular readmission (HR, 0.80; 95% CI, 0.65-0.99; P = .037), noncardiovascular readmission (HR, 0.72; 95% CI, 0.61-0.85; P < .001), and mortality (HR, 0.58; 95% CI, 0.49-0.68; P < .001) risk. CONCLUSIONS Cardiac rehabilitation participation is associated with a markedly reduced risk of readmission and death after incident myocardial infarction. Improving cardiac rehabilitation participation rates may have a large impact on post-myocardial infarction healthcare resource use and outcomes.
Collapse
Affiliation(s)
- Shannon M Dunlay
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn; Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
| | - Quinn R Pack
- Division of Cardiology, Baystate Medical Center, Springfield, Mass
| | - Randal J Thomas
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Jill M Killian
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Véronique L Roger
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn; Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| |
Collapse
|
290
|
Chamberlain AM, Manemann SM, Dunlay SM, Spertus JA, Moser DK, Berardi C, Kane RL, Weston SA, Redfield MM, Roger VL. Self-rated health predicts healthcare utilization in heart failure. J Am Heart Assoc 2014; 3:e000931. [PMID: 24870937 PMCID: PMC4309095 DOI: 10.1161/jaha.114.000931] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Heart failure (HF) patients experience impaired functional status, diminished quality of life, high utilization of healthcare resources, and poor survival. Yet, the identification of patient‐centered factors that influence prognosis is lacking. Methods and Results We determined the association of 2 measures of self‐rated health with healthcare utilization and skilled nursing facility (SNF) admission in a community cohort of 417 HF patients prospectively enrolled between October 2007 and December 2010 from Olmsted County, MN. Patients completed a 12‐item Short Form Health Survey (SF‐12). Low self‐reported physical functioning was defined as a score ≤25 on the SF‐12 physical component. The first question of the SF‐12 was used as a measure of self‐rated general health. After 2 years, 1033 hospitalizations, 1407 emergency department (ED) visits, and 19,780 outpatient office visits were observed; 87 patients were admitted to a SNF. After adjustment for confounding factors, an increased risk of hospitalizations (1.52 [1.17 to 1.99]) and ED visits (1.48 [1.04 to 2.11]) was observed for those with low versus moderate‐high self‐reported physical functioning. Patients with poor and fair self‐rated general health also experienced an increased risk of hospitalizations (poor: 1.73 [1.29 to 2.32]; fair: 1.46 [1.14 to 1.87]) and ED visits (poor: 1.73 [1.16 to 2.56]; fair: 1.48 [1.13 to 1.93]) compared with good‐excellent self‐rated general health. No association between self‐reported physical functioning or self‐rated general health with outpatient visits and SNF admission was observed. Conclusion In community HF patients, self‐reported measures of physical functioning predict hospitalizations and ED visits, indicating that these patient‐reported measures may be useful in risk stratification and management in HF.
Collapse
Affiliation(s)
- Alanna M Chamberlain
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (A.M.C., S.M.M., S.M.D., C.B., S.A.W., R.)
| | - Sheila M Manemann
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (A.M.C., S.M.M., S.M.D., C.B., S.A.W., R.)
| | - Shannon M Dunlay
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (A.M.C., S.M.M., S.M.D., C.B., S.A.W., R.) Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.M.D., M.M.R., R.)
| | - John A Spertus
- Division of Cardiology, Department of Medicine, University of Missouri at Kansas City, Kansas City, MO (J.A.S.)
| | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, KY (D.K.M.)
| | - Cecilia Berardi
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (A.M.C., S.M.M., S.M.D., C.B., S.A.W., R.)
| | - Robert L Kane
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN (R.L.K.)
| | - Susan A Weston
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (A.M.C., S.M.M., S.M.D., C.B., S.A.W., R.)
| | - Margaret M Redfield
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.M.D., M.M.R., R.)
| | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN (A.M.C., S.M.M., S.M.D., C.B., S.A.W., R.) Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (S.M.D., M.M.R., R.)
| |
Collapse
|
291
|
Dunlay SM, Swetz KM, Redfield MM, Mueller PS, Roger VL. Resuscitation preferences in community patients with heart failure. Circ Cardiovasc Qual Outcomes 2014; 7:353-9. [PMID: 24823952 DOI: 10.1161/circoutcomes.113.000759] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Little is known about the resuscitation preferences of patients with heart failure, how they may change over the course of the disease, and their association with mortality. METHODS AND RESULTS We enrolled consecutive Southeastern Minnesota residents with heart failure from October 2007 through September 2011 into a longitudinal study. Information on resuscitation preferences (Full Code or do-not-resuscitate [DNR]) was obtained from medical records through April 1, 2013. Of 608 patients enrolled, 237 died during follow-up. At enrollment, most patients (73.4%) were Full Code, whereas at death, most (78.5%) were DNR. The independent predictors of DNR status at enrollment were advanced age, chronic obstructive pulmonary disease, previous malignancy, and decreased mobility. Patients who were DNR were at increased risk of death (unadjusted hazard ratio, 2.03; 95% confidence interval, 1.48-2.73; P<0.001), but this risk did not persist after adjusting for age, comorbidity, and self-perceived general health (hazard ratio, 0.97; 95% confidence interval, 0.74-1.30; P=0.83). Of 481 patients who were Full Code during follow-up, 22 (4.6%) received cardiopulmonary resuscitation for an in-hospital cardiac arrest. Eight patients survived to hospital discharge; only 2 (9.1% of those receiving cardiopulmonary resuscitation) made a complete recovery and returned home. The median time from a final decision to be DNR until death was only 37 (7,70) days. CONCLUSIONS The resuscitation preferences of patients with heart failure seem to be driven by the decline in clinical status that often accompanies advanced age and multimorbidity. Furthermore, these data suggest that electing DNR status does not independently affect a patient's risk of death.
Collapse
Affiliation(s)
- Shannon M Dunlay
- From the Divisions of Cardiovascular Diseases (S.M.D., M.M.R., V.L.R.) and General Internal Medicine (K.M.S., P.S.M.), Department of Medicine, and Department of Health Sciences Research (S.M.D., V.L.R.), Mayo Clinic, Rochester, MN.
| | - Keith M Swetz
- From the Divisions of Cardiovascular Diseases (S.M.D., M.M.R., V.L.R.) and General Internal Medicine (K.M.S., P.S.M.), Department of Medicine, and Department of Health Sciences Research (S.M.D., V.L.R.), Mayo Clinic, Rochester, MN
| | - Margaret M Redfield
- From the Divisions of Cardiovascular Diseases (S.M.D., M.M.R., V.L.R.) and General Internal Medicine (K.M.S., P.S.M.), Department of Medicine, and Department of Health Sciences Research (S.M.D., V.L.R.), Mayo Clinic, Rochester, MN
| | - Paul S Mueller
- From the Divisions of Cardiovascular Diseases (S.M.D., M.M.R., V.L.R.) and General Internal Medicine (K.M.S., P.S.M.), Department of Medicine, and Department of Health Sciences Research (S.M.D., V.L.R.), Mayo Clinic, Rochester, MN
| | - Véronique L Roger
- From the Divisions of Cardiovascular Diseases (S.M.D., M.M.R., V.L.R.) and General Internal Medicine (K.M.S., P.S.M.), Department of Medicine, and Department of Health Sciences Research (S.M.D., V.L.R.), Mayo Clinic, Rochester, MN
| |
Collapse
|
292
|
Effoe VS, Rodriguez CJ, Wagenknecht LE, Evans GW, Chang PP, Mirabelli MC, Bertoni AG. Carotid intima-media thickness is associated with incident heart failure among middle-aged whites and blacks: the Atherosclerosis Risk in Communities study. J Am Heart Assoc 2014; 3:e000797. [PMID: 24815496 PMCID: PMC4309069 DOI: 10.1161/jaha.114.000797] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Increased carotid intima‐media thickness (IMT) is associated with subclinical left ventricular myocardial dysfunction, suggesting a possible role of carotid IMT in heart failure (HF) risk determination. Methods and Results Mean far wall carotid IMT, measured by B‐mode ultrasound, was available for 13 590 Atherosclerosis Risk in Communities study participants aged 45 to 64 years and free of HF at baseline. HF was defined using ICD‐9 428 and ICD‐10 I‐50 codes from hospitalization records and death certificates. The association between carotid IMT and incident HF was assessed using Cox proportional hazards analysis with models adjusted for demographic variables, major CVD risk factors, and interim CHD. There were 2008 incident HF cases over a median follow‐up of 20.6 years (8.1 cases per 1000 person‐years). Mean IMT was higher in those with HF than in those without (0.81 mm±0.23 versus 0.71 mm±0.17, P<0.001). Unadjusted rate of HF for the fourth compared with the first quartile of IMT was 15.4 versus 3.9 per 1000 person‐years; P<0.001. In multivariable analysis, after adjustment, each standard deviation increase in IMT was associated with incident HF (HR 1.20 [95% CI: 1.16 to 1.25]). After adjustment, the top quartile of IMT was associated with HF (HR 1.60 [95% CI: 1.37 to 1.87]). Results were similar across race and gender groups. Conclusions Increasing carotid IMT is associated with incident HF in middle‐aged whites and blacks, beyond risks explained by major CVD risk factors and CHD. This suggests that carotid IMT may be associated with HF through mechanisms different from myocardial ischemia or infarction.
Collapse
Affiliation(s)
- Valery S Effoe
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | | | | | | | | | | | | |
Collapse
|
293
|
Corrao G, Ghirardi A, Ibrahim B, Merlino L, Maggioni AP. Burden of new hospitalization for heart failure: a population-based investigation from Italy. Eur J Heart Fail 2014; 16:729-36. [PMID: 24806352 DOI: 10.1002/ejhf.105] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 04/09/2014] [Accepted: 04/11/2014] [Indexed: 12/15/2022] Open
Abstract
AIMS Heart failure has been described as one of the emerging pandemics of the 21st century. This report aims to measure the burden of new hospitalization for heart failure in the population of an Italian region of nearly 10 million inhabitants. METHODS AND RESULTS Data were retrieved from healthcare utilization databases covering the population of the Italian region of Lombardy. We identified patients who were hospitalized for the first time with a primary diagnosis of heart failure (hospitalized heart failure, HHF) during 2011. Incident HHF cases were used for measuring incidence rates and exploring mortality, re-hospitalizations, and healthcare costs on the 1-year time horizon after the index hospitalization. Out-of-hospital mortality, hospitalizations, and healthcare costs were also measured in a referent cohort free from heart failure hospitalization and matched 1:1 by gender and age with the HHF cohort. The overall HHF incidence rate was 32 and 20 events per 10,000 person-years in men and women, respectively. The incidence increased steeply with age in both genders. Among newly hospitalized patients, 7% died during hospitalization. Among survivors, cumulative out-of-hospital mortality and hospital readmission were 24% and 59%, respectively. The average per capita cost was €11,000, the main cost being hospitalizations. Mortality, readmissions, and costs experienced by HHF patients of 88, 75, and 79%, respectively, exceeded those of the referent cohort. CONCLUSIONS The main burden associated with HHF is related to hospitalizations. Effective treatment options that decrease hospitalization rates could reduce patients' suffering and offer considerable cost savings.
Collapse
Affiliation(s)
- Giovanni Corrao
- Dipartimento di Statistica e Metodi Quantitativi, Sezione di Biostatistica, Epidemiologia e Sanità Pubblica, Università di Milano-Bicocca, Milan, Italy
| | | | | | | | | |
Collapse
|
294
|
Ogunneye O, Rothberg MB, Friderici J, Slawsky MT, Gadiraju VT, Stefan MS. The Association Between Skilled Nursing Facility Care Quality and 30-Day Readmission Rates After Hospitalization for Heart Failure. Am J Med Qual 2014; 30:205-13. [DOI: 10.1177/1062860614531069] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Mara T. Slawsky
- Baystate Medical Center, Springfield, MA
- Tufts University School of Medicine, Boston, MA
| | | | - Mihaela S. Stefan
- Baystate Medical Center, Springfield, MA
- Tufts University School of Medicine, Boston, MA
| |
Collapse
|
295
|
Abstract
The systemic effects and comorbidities of chronic respiratory disease such as COPD contribute substantially to its burden. Symptoms in COPD do not solely arise from the degree of airflow obstruction as exercise limitation is compounded by the specific secondary manifestations of the disease including skeletal muscle impairment, osteoporosis, mood disturbance, anemia, and hormonal imbalance. Pulmonary rehabilitation targets the systemic manifestations of COPD, the causes of which include inactivity, systemic inflammation, hypoxia and corticosteroid treatment. Comorbidities are common, including cardiac disease, obesity, and metabolic syndrome and should not preclude pulmonary rehabilitation as they may also benefit from similar approaches.
Collapse
Affiliation(s)
- Rachael A Evans
- Department of Respiratory Medicine, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Michael D L Morgan
- Department of Respiratory Medicine, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
| |
Collapse
|
296
|
Cubbon RM, Woolston A, Adams B, Gale CP, Gilthorpe MS, Baxter PD, Kearney LC, Mercer B, Rajwani A, Batin PD, Kahn M, Sapsford RJ, Witte KK, Kearney MT. Prospective development and validation of a model to predict heart failure hospitalisation. Heart 2014; 100:923-9. [PMID: 24647052 PMCID: PMC4033182 DOI: 10.1136/heartjnl-2013-305294] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Objective Acute heart failure syndrome (AHFS) is a major cause of hospitalisation and imparts a substantial burden on patients and healthcare systems. Tools to define risk of AHFS hospitalisation are lacking. Methods A prospective cohort study (n=628) of patients with stable chronic heart failure (CHF) secondary to left ventricular systolic dysfunction was used to derive an AHFS prediction model which was then assessed in a prospectively recruited validation cohort (n=462). Results Within the derivation cohort, 44 (7%) patients were hospitalised as a result of AHFS during 1 year of follow-up. Predictors of AHFS hospitalisation included furosemide equivalent dose, the presence of type 2 diabetes mellitus, AHFS hospitalisation within the previous year and pulmonary congestion on chest radiograph, all assessed at baseline. A multivariable model containing these four variables exhibited good calibration (Hosmer–Lemeshow p=0.38) and discrimination (C-statistic 0.77; 95% CI 0.71 to 0.84). Using a 2.5% risk cut-off for predicted AHFS, the model defined 38.5% of patients as low risk, with negative predictive value of 99.1%; this low risk cohort exhibited <1% excess all-cause mortality per annum when compared with contemporaneous actuarial data. Within the validation cohort, an identically applied model derived comparable performance parameters (C-statistic 0.81 (95% CI 0.74 to 0.87), Hosmer–Lemeshow p=0.15, negative predictive value 100%). Conclusions A prospectively derived and validated model using simply obtained clinical data can identify patients with CHF at low risk of hospitalisation due to AHFS in the year following assessment. This may guide the design of future strategies allocating resources to the management of CHF.
Collapse
Affiliation(s)
- R M Cubbon
- Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - A Woolston
- Centre of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
| | - B Adams
- Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - C P Gale
- Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK Centre of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
| | - M S Gilthorpe
- Centre of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
| | - P D Baxter
- Centre of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
| | - L C Kearney
- Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - B Mercer
- Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - A Rajwani
- Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - P D Batin
- Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - M Kahn
- Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | | | - K K Witte
- Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - M T Kearney
- Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| |
Collapse
|
297
|
Tuppin P, Cuerq A, de Peretti C, Fagot-Campagna A, Danchin N, Juillière Y, Alla F, Allemand H, Bauters C, Drici MD, Hagège A, Jondeau G, Jourdain P, Leizorovicz A, Paccaud F. Two-year outcome of patients after a first hospitalization for heart failure: A national observational study. Arch Cardiovasc Dis 2014; 107:158-68. [DOI: 10.1016/j.acvd.2014.01.012] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 01/20/2014] [Accepted: 01/30/2014] [Indexed: 11/26/2022]
|
298
|
McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Køber L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, McDonagh T, Sechtem U, Bonet LA, Avraamides P, Ben Lamin HA, Brignole M, Coca A, Cowburn P, Dargie H, Elliott P, Flachskampf FA, Guida GF, Hardman S, Iung B, Merkely B, Mueller C, Nanas JN, Nielsen OW, Ørn S, Parissis JT, Ponikowski P. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur J Heart Fail 2014; 14:803-69. [PMID: 22828712 DOI: 10.1093/eurjhf/hfs105] [Citation(s) in RCA: 1818] [Impact Index Per Article: 181.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
299
|
Rickenbacher P, Pfisterer M, Burkard T, Kiowski W, Follath F, Burckhardt D, Schindler R, Brunner-La Rocca HP. Why and how do elderly patients with heart failure die? Insights from the TIME-CHF study. Eur J Heart Fail 2014; 14:1218-29. [DOI: 10.1093/eurjhf/hfs113] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Peter Rickenbacher
- Division of Cardiology; University Hospital Basel; Switzerland
- Division of Cardiology; Internal Medicine University Department; Kantonsspital Bruderholz Switzerland
| | | | - Thilo Burkard
- Division of Cardiology; University Hospital Basel; Switzerland
| | | | | | | | - Ruth Schindler
- Division of Cardiology; University Hospital Basel; Switzerland
| | - Hans-Peter Brunner-La Rocca
- Division of Cardiology; University Hospital Basel; Switzerland
- Department of Cardiology; Maastricht University Medical Center; Maastricht The Netherlands
| | | |
Collapse
|
300
|
Chang PP, Chambless LE, Shahar E, Bertoni AG, Russell SD, Ni H, He M, Mosley TH, Wagenknecht LE, Samdarshi TE, Wruck LM, Rosamond WD. Incidence and survival of hospitalized acute decompensated heart failure in four US communities (from the Atherosclerosis Risk in Communities Study). Am J Cardiol 2014; 113:504-10. [PMID: 24342763 DOI: 10.1016/j.amjcard.2013.10.032] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 10/05/2013] [Accepted: 10/05/2013] [Indexed: 11/19/2022]
Abstract
Most population-based estimates of incident hospitalized heart failure (HF) have not differentiated acute decompensated heart failure (ADHF) from chronic stable HF nor included racially diverse populations. The Atherosclerosis Risk in Communities Study conducted surveillance of hospitalized HF events (age ≥55 years) in 4 US communities. We estimated hospitalized ADHF incidence and survival by race and gender. Potential 2005 to 2009 HF hospitalizations were identified by International Classification of Diseases, Ninth Revision, Clinical Modification, codes; 6,168 records were reviewed to validate ADHF cases. Population estimates were derived from US Census data; 50% of eligible hospitalizations were classified as ADHF, of which 63.6% were incident ADHF and 36.4% were recurrent ADHF. The average incidence of hospitalized ADHF was 11.6 per 1,000 persons, aged ≥55 years, per year, and recurrent hospitalized ADHF was 6.6 per 1,000 persons/yr. Age-adjusted annual ADHF incidence was highest for black men (15.7 per 1,000), followed by black women (13.3 per 1,000), white men (12.3 per 1,000), and white women (9.9 per 1,000). Of incident ADHF events with heart function assessment (89%), 53% had reduced the ejection fraction (heart failure with reduced ejection fraction [HFrEF]) and 47% had preserved ejection fraction (heart failure with preserved ejection fraction [HFpEF]). Black men had the highest proportion of acute HFrEF events (70%); white women had the highest proportion of acute HFpEF (59%). Age-adjusted 28-day and 1-year case fatality after an incident ADHF was 10.4% and 29.5%, respectively. Survival did not differ by race or gender. In conclusion, ADHF hospitalization and HF type varied by both race and gender, but case fatality rates did not. Further studies are needed to explain why black men are at higher risk of hospitalized ADHF and HFrEF.
Collapse
Affiliation(s)
- Patricia P Chang
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
| | - Lloyd E Chambless
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Eyal Shahar
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona
| | - Alain G Bertoni
- Department of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Stuart D Russell
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Hanyu Ni
- Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Maryland
| | - Max He
- Duke Clinical Research Institute, Durham, North Carolina
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Lynne E Wagenknecht
- Department of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Tandaw E Samdarshi
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Lisa M Wruck
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Wayne D Rosamond
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|