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Suo E, Driscoll A, Dinh D, Brennan A, Kaye DM, Stub D, Lefkovits J, Reid CM, Hopper I. Comparison of Characteristics and Outcomes in Patients With Acute Decompensated Heart Failure Admitted Under General Medicine and Cardiology Units. Heart Lung Circ 2024; 33:983-989. [PMID: 38458933 DOI: 10.1016/j.hlc.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/12/2023] [Accepted: 01/11/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Acute decompensated heart failure (ADHF) is a leading cause of cardiovascular disease hospitalisations associated with significant morbidity and mortality. In hospitals, HF patients are typically managed by cardiology or physician teams, with differences in patient demographics and clinical outcomes. This study utilises contemporary HF registry data to compare patient characteristics and outcomes in those with ADHF admitted into General Medicine and Cardiology units. METHODS The Victorian Cardiac Outcomes Registry was utilised to identify patients hospitalised with ADHF 30-day period in each of four consecutive years. We compared patient characteristics, pharmacological management and outpatient follow-up of patients admitted to General Medicine and Cardiology units. Primary outcome measures included in-hospital mortality, 30-day readmission, and 30-day mortality. RESULTS Between 2014 and 2017, a total of 1,253 patients with ADHF admissions were registered, with 53% admitted in General Medicine units and 47% in Cardiology units. General Medicine patients were more likely to be older (82 vs 71 years; p<0.001), female (51% vs 34%; p<0.001), and have higher prevalence of comorbidities and preserved left ventricular function (p<0.001). There were no differences in primary outcome measures between General Medicine and Cardiology in terms of: in-hospital mortality (5.0% vs 3.9%; p=0.35), 30-day readmission (23.4% vs 23.6%; p=0.93), and 30-day mortality (10.0% vs 8.0%; p=0.21). CONCLUSIONS Hospitalised patients with HF continue to have high mortality and rehospitalisation rates. The choice of treatment by General Medicine or Cardiology units, based on the particular medical profile and individual needs of the patients, provides equivalent outcomes.
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Affiliation(s)
| | - Andrea Driscoll
- Deakin University, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Diem Dinh
- Monash University, Melbourne, Vic, Australia
| | | | - David M Kaye
- The Alfred Hospital, Melbourne, Vic, Australia; Baker IDI Heart Diabetes Institute, Melbourne, Vic, Australia
| | - Dion Stub
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia; Baker IDI Heart Diabetes Institute, Melbourne, Vic, Australia
| | - Jeffrey Lefkovits
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia; The Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Christopher M Reid
- Monash University, Melbourne, Vic, Australia; Curtin University, Perth, WA, Australia
| | - Ingrid Hopper
- The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia.
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Lu DY, Kanduri J, Yeo I, Goyal P, Krishnan U, Horn EM, Karas MG, Sobol I, Majure DT, Naka Y, Minutello RM, Cheung JW, Uriel N, Kim LK. Impact of Advanced Therapy Centers on Characteristics and Outcomes of Heart Failure Admissions. Circ Heart Fail 2024; 17:e011115. [PMID: 38456308 DOI: 10.1161/circheartfailure.123.011115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 01/08/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Although much attention has been paid to admission and transfer patterns for cardiogenic shock, contemporary data are lacking on decompensated heart failure (HF) admissions and transfers and the impact of advanced therapy centers (ATCs) on outcomes. METHODS HF hospitalizations were obtained from the Nationwide Readmissions Database 2016 to 2019. Centers performing at least 1 heart transplant or left ventricular assist device were classified as ATCs. Patient characteristics, outcomes, and procedural volume were compared among 3 cohorts: admissions to non-ATCs, admissions to ATCs, and transfers to ATCs. A secondary analysis evaluated outcomes for severe HF hospitalizations (cardiogenic shock, cardiac arrest, and mechanical ventilation). Multivariable logistic regression was performed to adjust for the presence of HF decompensations and significant clinical variables during univariate analysis. RESULTS A total of 2 331 690 hospitalizations (81.2%) were admissions to non-ATCs (94.5% of centers), 525 037 (18.3%) were admissions to ATCs (5.5% of centers), and 15 541 (0.5%) were transferred to ATCs. Patients treated at ATCs (especially those transferred) had higher rates of HF decompensations, procedural frequency, lengths of stay, and costs. Unadjusted mortality was 2.6% at non-ATCs and was higher at ATCs, both for directly admitted (2.9%, P<0.001) and transferred (11.2%, P<0.001) patients. However, multivariable-adjusted mortality was significantly lower at ATCs, both for directly admitted (odds ratio, 0.82 [95% CI, 0.78-0.87]; P<0.001) and transferred (odds ratio, 0.66 [95% CI, 0.57-0.78]; P<0.001) patients. For severe HF admissions, unadjusted mortality was 37.2% at non-ATCs and was lower at ATCs, both for directly admitted (25.3%, P<0.001) and transferred (25.2%, P<0.001) patients, with similarly lower multivariable-adjusted mortality. CONCLUSIONS Patients with HF treated at ATCs were sicker but associated with higher procedural volume and lower adjusted mortality.
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Affiliation(s)
- Daniel Y Lu
- Division of Cardiology, Department of Medicine (D.Y.L., J.K., I.Y., P.G., U.K., E.M.H., M.G.K., I.S., D.T.M., R.M.M., J.W.C., L.K.K.), Weill Cornell Medical College, New York Presbyterian Hospital, New York
- Weill Cornell Cardiovascular Outcomes Research Group, Weill Cornell Medical College, New York (D.Y.L., I.Y., U.K., J.W.C., L.K.K.)
| | - Jaya Kanduri
- Division of Cardiology, Department of Medicine (D.Y.L., J.K., I.Y., P.G., U.K., E.M.H., M.G.K., I.S., D.T.M., R.M.M., J.W.C., L.K.K.), Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Ilhwan Yeo
- Division of Cardiology, Department of Medicine (D.Y.L., J.K., I.Y., P.G., U.K., E.M.H., M.G.K., I.S., D.T.M., R.M.M., J.W.C., L.K.K.), Weill Cornell Medical College, New York Presbyterian Hospital, New York
- Weill Cornell Cardiovascular Outcomes Research Group, Weill Cornell Medical College, New York (D.Y.L., I.Y., U.K., J.W.C., L.K.K.)
| | - Parag Goyal
- Division of Cardiology, Department of Medicine (D.Y.L., J.K., I.Y., P.G., U.K., E.M.H., M.G.K., I.S., D.T.M., R.M.M., J.W.C., L.K.K.), Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Udhay Krishnan
- Division of Cardiology, Department of Medicine (D.Y.L., J.K., I.Y., P.G., U.K., E.M.H., M.G.K., I.S., D.T.M., R.M.M., J.W.C., L.K.K.), Weill Cornell Medical College, New York Presbyterian Hospital, New York
- Weill Cornell Cardiovascular Outcomes Research Group, Weill Cornell Medical College, New York (D.Y.L., I.Y., U.K., J.W.C., L.K.K.)
| | - Evelyn M Horn
- Division of Cardiology, Department of Medicine (D.Y.L., J.K., I.Y., P.G., U.K., E.M.H., M.G.K., I.S., D.T.M., R.M.M., J.W.C., L.K.K.), Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Maria G Karas
- Division of Cardiology, Department of Medicine (D.Y.L., J.K., I.Y., P.G., U.K., E.M.H., M.G.K., I.S., D.T.M., R.M.M., J.W.C., L.K.K.), Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Irina Sobol
- Division of Cardiology, Department of Medicine (D.Y.L., J.K., I.Y., P.G., U.K., E.M.H., M.G.K., I.S., D.T.M., R.M.M., J.W.C., L.K.K.), Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - David T Majure
- Division of Cardiology, Department of Medicine (D.Y.L., J.K., I.Y., P.G., U.K., E.M.H., M.G.K., I.S., D.T.M., R.M.M., J.W.C., L.K.K.), Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Yoshifumi Naka
- Department of Cardiac Surgery (Y.N.), Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Robert M Minutello
- Division of Cardiology, Department of Medicine (D.Y.L., J.K., I.Y., P.G., U.K., E.M.H., M.G.K., I.S., D.T.M., R.M.M., J.W.C., L.K.K.), Weill Cornell Medical College, New York Presbyterian Hospital, New York
| | - Jim W Cheung
- Division of Cardiology, Department of Medicine (D.Y.L., J.K., I.Y., P.G., U.K., E.M.H., M.G.K., I.S., D.T.M., R.M.M., J.W.C., L.K.K.), Weill Cornell Medical College, New York Presbyterian Hospital, New York
- Weill Cornell Cardiovascular Outcomes Research Group, Weill Cornell Medical College, New York (D.Y.L., I.Y., U.K., J.W.C., L.K.K.)
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Columbia University, New York Presbyterian Hospital, New York (N.U.)
| | - Luke K Kim
- Division of Cardiology, Department of Medicine (D.Y.L., J.K., I.Y., P.G., U.K., E.M.H., M.G.K., I.S., D.T.M., R.M.M., J.W.C., L.K.K.), Weill Cornell Medical College, New York Presbyterian Hospital, New York
- Weill Cornell Cardiovascular Outcomes Research Group, Weill Cornell Medical College, New York (D.Y.L., I.Y., U.K., J.W.C., L.K.K.)
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Amin K, Bethel G, Jackson LR, Essien UR, Sloan CE. Eliminating Health Disparities in Atrial Fibrillation, Heart Failure, and Dyslipidemia: A Path Toward Achieving Pharmacoequity. Curr Atheroscler Rep 2023; 25:1113-1127. [PMID: 38108997 PMCID: PMC11044811 DOI: 10.1007/s11883-023-01180-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE OF REVIEW Pharmacoequity refers to the goal of ensuring that all patients have access to high-quality medications, regardless of their race, ethnicity, gender, or other characteristics. The goal of this article is to review current evidence on disparities in access to cardiovascular drug therapies across sociodemographic subgroups, with a focus on heart failure, atrial fibrillation, and dyslipidemia. RECENT FINDINGS Considerable and consistent disparities to life-prolonging heart failure, atrial fibrillation, and dyslipidemia medications exist in clinical trial representation, access to specialist care, prescription of guideline-based therapy, drug affordability, and pharmacy accessibility across racial, ethnic, gender, and other sociodemographic subgroups. Researchers, health systems, and policy makers can take steps to improve pharmacoequity by diversifying clinical trial enrollment, increasing access to inpatient and outpatient cardiology care, nudging clinicians to increase prescription of guideline-directed medical therapy, and pursuing system-level reforms to improve drug access and affordability.
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Affiliation(s)
- Krunal Amin
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Garrett Bethel
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Larry R Jackson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Utibe R Essien
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Center for the Study of Healthcare Innovation, Implementation & Policy, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
| | - Caroline E Sloan
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.
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Zhang DT, Onyebeke C, Nahid M, Balkan L, Musse M, Pinheiro LC, Sterling MR, Durant RW, Brown TM, Levitan EB, Safford MM, Goyal P. Social Determinants of Health and Cardiologist Involvement in the Care of Adults Hospitalized for Heart Failure. JAMA Netw Open 2023; 6:e2344070. [PMID: 37983029 PMCID: PMC10660170 DOI: 10.1001/jamanetworkopen.2023.44070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/10/2023] [Indexed: 11/21/2023] Open
Abstract
Importance Involvement of a cardiologist in the care of adults during a hospitalization for heart failure (HF) is associated with reduced rates of in-hospital mortality and hospital readmission. However, not all patients see a cardiologist when they are hospitalized for HF. Objective To determine whether social determinants of health (SDOH) are associated with cardiologist involvement in the management of adults hospitalized for HF. Design, Setting, and Participants This retrospective cohort study used data from the Reasons for Geographic and Racial Difference in Stroke (REGARDS) cohort. Participants included adults who experienced an adjudicated hospitalization for HF between 2009 and 2017 in all 48 contiguous states in the US. Data analysis was performed from November 2022 to January 2023. Exposures A total of 9 candidate SDOH, aligned with the Healthy People 2030 conceptual model, were examined: Black race, social isolation, social network and/or caregiver availability, educational attainment less than high school, annual household income less than $35 000, living in rural area, living in a zip code with high poverty, living in a Health Professional Shortage Area, and living in a state with poor public health infrastructure. Main Outcomes and Measures The primary outcome was cardiologist involvement, defined as involvement of a cardiologist as the primary responsible clinician or as a consultant. Bivariate associations between each SDOH and cardiologist involvement were examined using Poisson regression with robust SEs. Results The study included 1000 participants (median [IQR] age, 77.8 [71.5-84.0] years; 479 women [47.9%]; 414 Black individuals [41.4%]; and 492 of 876 with low income [56.2%]) hospitalized at 549 unique US hospitals. Low annual household income (<$35 000) was the only SDOH with a statistically significant association with cardiologist involvement (relative risk, 0.88; 95% CI, 0.82-0.95). In a multivariable analysis adjusting for age, race, sex, HF characteristics, comorbidities, and hospital characteristics, low income remained inversely associated with cardiologist involvement (relative risk, 0.89; 95% CI, 0.82-0.97). Conclusions and Relevance This cohort study found that adults with low household income were 11% less likely than adults with higher incomes to have a cardiologist involved in their care during a hospitalization for HF. These findings suggest that socioeconomic status may bias the care provided to patients hospitalized for HF.
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Affiliation(s)
- David T. Zhang
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - Musarrat Nahid
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Lauren Balkan
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Mahad Musse
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Laura C. Pinheiro
- Department of Health Policy and Management, Weill Cornell Medicine, New York, New York
| | | | - Raegan W. Durant
- Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Todd M. Brown
- Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Emily B. Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham
| | | | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York
- Program for the Care and Study of the Aging Heart, Weill Cornell Medicine, New York, New York
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Osuagwu C, Khinkar RM, Zheng A, Wien M, Decopain J, Desai S, McElrath E, Hinchey E, Mueller SK, Schnipper JL, Boxer R, Shannon EM. A Public Health Critical Race Praxis Informed Congestive Heart Failure Quality Improvement Initiative on Inpatient General Medicine. J Gen Intern Med 2023; 38:2236-2244. [PMID: 36849864 PMCID: PMC9970115 DOI: 10.1007/s11606-023-08086-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Prior evaluation at our hospital demonstrated that, compared to White patients, Black and Latinx patients with congestive heart failure (CHF) were less likely to be admitted to the cardiology service rather than the general medicine service (GMS). Patients admitted to GMS (compared to cardiology) had inferior rates of cardiology follow-up and 30-day readmission. OBJECTIVE To develop and test the feasibility and impacts of using quality improvement (QI) methods, in combination with the Public Health Critical Race Praxis (PHCRP) framework, to engage stakeholders in developing an intervention for ensuring guideline-concordant inpatient CHF care across all patient groups. METHODS We compared measures for all patients admitted with CHF to GMS between September 2019 and March 2020 (intervention group) to CHF patients admitted to GMS in the previous year (pre-intervention group) and those admitted to cardiology during the pre-intervention and intervention periods (cardiology group). Our primary measures were 30-day readmissions and 14- and 30-day post-discharge cardiology follow-up. RESULTS There were 79 patients admitted with CHF to GMS during the intervention period, all of whom received the intervention. There were similar rates of Black and Latinx patients across the three groups. Compared to pre-intervention, intervention patients had a significantly lower 30-day readmission rate (18.9% vs. 24.8%; p=0.024), though the cardiology group also had a decrease in 30-day readmissions from the pre-intervention to intervention period. Compared to pre-intervention, intervention patients had significantly higher 14-day and 30-day post-discharge follow-up visits scheduled with cardiology (36.7% vs. 24.8%, p=0.005; 55.7% vs. 42.3%, p=0.0029), but no improvement in appointment attendance. CONCLUSION This study provides a first test of applying the PHCRP framework within a stakeholder-engaged QI initiative for improving CHF care across races and ethnicities. Our study design cannot evaluate causation. However, the improvements in 30-day readmission, as well as in processes of care that may affect it, provide optimism that inclusion of a racism-conscious framework in QI initiatives is feasible and may enhance QI measures.
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Affiliation(s)
- Chidinma Osuagwu
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Roaa M Khinkar
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amy Zheng
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew Wien
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Jennifer Decopain
- School of Nursing, MGH Institute of Health Professions, Charlestown, MA, USA
| | - Sonali Desai
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Quality and Safety, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Erin McElrath
- Department of Medicine, Brigham and Woman's Hospital, Boston, MA, USA
| | - Emily Hinchey
- Department of Medicine, Brigham and Woman's Hospital, Boston, MA, USA
| | - Stephanie K Mueller
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jeffrey L Schnipper
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Robert Boxer
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Evan Michael Shannon
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Room, Los Angeles, CA, 812, USA.
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Bazmpani MA, Papanastasiou CA, Giampatzis V, Kamperidis V, Zegkos T, Zebekakis P, Savopoulos C, Karvounis H, Efthimiadis GK, Ziakas A, Karamitsos TD. Differences in Demographics, in-Hospital Management and Short-Term Prognosis in Admissions for Acutely Decompensated Heart Failure to Cardiology vs. Internal Medicine Departments: A Prospective Study. J Cardiovasc Dev Dis 2023; 10:315. [PMID: 37623328 PMCID: PMC10455388 DOI: 10.3390/jcdd10080315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Heart failure (HF) is among the leading causes of unplanned hospital admissions worldwide. Patients with HF carry a high burden of comorbidities; hence, they are frequently admitted for non-cardiac conditions and managed in Internal Medicine Departments (IMD). The aim of our study was to investigate differences in demographics, in-hospital management, and short-term outcomes of HF patients admitted to IMD vs. cardiology departments (CD). A prospective cohort study enrolling consecutive patients with acutely decompensated HF either as primary or as secondary diagnosis during the index hospitalization was conducted. Our primary endpoint was a combined endpoint of in-hospital mortality and 30-day rehospitalization for HF. A total of 302 patients participated in the study, with 45% of them admitted to IMD. Patients managed by internists were older with less pronounced HF symptoms on admission. In-hospital mortality was higher for patients admitted to IMD vs. CD (21% vs. 6%, p < 0.001). The composite endpoint of in-hospital death and heart failure hospitalizations at 30 days post-discharge was higher for patients admitted to IMD both in univariate [OR: 3.2, 95% CI (1.8-5.7); p < 0.001] and in multivariate analysis [OR 3.74, 95% CI (1.72-8.12); p = 0.001]. In addition, the HF rehospitalization rate at 6 months after discharge was higher in IMD patients [HR 1.65, 95% CI (1.1, 2.4), p = 0.01]. Overall, HF patients admitted to IMD have worse short-term outcomes compared to patients admitted to CD.
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Affiliation(s)
- Maria-Anna Bazmpani
- First Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece; (M.-A.B.); (C.A.P.); (V.K.); (T.Z.); (H.K.); (G.K.E.); (A.Z.)
| | - Christos A. Papanastasiou
- First Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece; (M.-A.B.); (C.A.P.); (V.K.); (T.Z.); (H.K.); (G.K.E.); (A.Z.)
| | - Vasilios Giampatzis
- Cardiology Department, General Hospital of Kavala, 65500 Thessaloniki, Greece;
| | - Vasileios Kamperidis
- First Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece; (M.-A.B.); (C.A.P.); (V.K.); (T.Z.); (H.K.); (G.K.E.); (A.Z.)
| | - Thomas Zegkos
- First Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece; (M.-A.B.); (C.A.P.); (V.K.); (T.Z.); (H.K.); (G.K.E.); (A.Z.)
| | - Pantelis Zebekakis
- Fisrt Department of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece;
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece;
| | - Haralambos Karvounis
- First Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece; (M.-A.B.); (C.A.P.); (V.K.); (T.Z.); (H.K.); (G.K.E.); (A.Z.)
| | - Georgios K. Efthimiadis
- First Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece; (M.-A.B.); (C.A.P.); (V.K.); (T.Z.); (H.K.); (G.K.E.); (A.Z.)
| | - Antonios Ziakas
- First Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece; (M.-A.B.); (C.A.P.); (V.K.); (T.Z.); (H.K.); (G.K.E.); (A.Z.)
| | - Theodoros D. Karamitsos
- First Cardiology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece; (M.-A.B.); (C.A.P.); (V.K.); (T.Z.); (H.K.); (G.K.E.); (A.Z.)
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López-Díez MP, Alquézar-Arbé A, Jacob J, Llorens P, Llauger L, Herrero P, Gil V, Núñez J, Martín-Sánchez FJ, Miró Ò. Hospital development of heart failure follow-up units and short-term prognosis after acute decompensation in Spain. Int J Cardiol 2023; 378:64-70. [PMID: 36804513 DOI: 10.1016/j.ijcard.2023.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To investigate whether the existence of heart failure units (HFU) and link nurse units (LNU) in the hospital improve short-term outcomes of acute heart failure (AHF) episodes. METHODS Patients with AHF diagnosed in 45 Spanish emergency departments were analysed according to whether the hospital had a complete development of follow-up units (HFU + LNU), partial (HFU or LNU) or none. The outcomes were: 30-day mortality, hospitalization, in-hospital mortality, >7 days admission, and adverse event (death, rehospitalisation, or reconsultation to the emergency department) at 30 days post-discharge. Outcomes were adjusted for baseline and AHF episode characteristics. RESULTS 19,947 patients were included, median age was 82 years (IQR 76--87), women were 55%. It was 20% of patients attended in hospitals with null development, 28% with partial development and 52% with complete development. Mortality at 30 days was 10.1% (null/partial/complete development: 10.5%/9.5%/10.4%; p=0.880), hospitalization 74.6% (72.7%/72.7%/75.7%; p<0.001), in-hospital mortality 7.4% (7.6%/7.0%/7.5%; p=0.995), prolonged hospitalization 47.4% (51.1%/52.4%/43.5%; p<0.001) and adverse events 30 days post-hospitalization 30.3% (36.2%/28.9%/30.3%; p < 0.001). In the adjusted analysis, hospital with complete development of follow-up units was not associated with mortality, but with increased hospitalization (OR= 1.172; 95%CI 1.069-1.285) and lower prolonged hospitalization (OR = 0.725; 95%CI 0.660-0.797) and adverse events at 30 days post-discharge (OR=0.831; 95%CI 0.755-0.916). Partial development was only associated with decreased post-discharge adverse events (OR= 0.782; 95%CI 0.702-0.871). CONCLUSION The development of follow-up units is not associated with 30-day mortality, but is associated with less prolonged hospitalization and fewer post-discharge adverse events in patients with AHF.
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Affiliation(s)
| | | | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Pere Llorens
- Emergency Department, Short Stay Unit and Hospital at Home, Hospital Doctor Balmis, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Miguel Hernández University, Alicante, Spain
| | - Lluís Llauger
- Emergency Department, Hospital Universitari de Vic, Barcelona, Spain
| | - Pablo Herrero
- Emergency Department, Hospital Central Asturia, Oviedo, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico de Valencia, Valencia, Spain
| | | | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
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8
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Nishi M, Seki T, Shikuma A, Kawamata H, Horiguchi G, Matoba S. Association between patient volume to cardiologist, process of care, and clinical outcomes in heart failure. ESC Heart Fail 2023. [PMID: 37075756 PMCID: PMC10375098 DOI: 10.1002/ehf2.14385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/07/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023] Open
Abstract
AIMS The impact of hospital volume on clinical performance has been investigated by many researchers to date and thought that it is associated with quality of care and outcome for patients with heart failure (HF). This study sought to determine whether annual admissions of HF per cardiologist are associated with process of care, mortality, and readmission. METHODS AND RESULTS Among the nationwide registry 'Japanese registry of all cardiac and vascular diseases - diagnostics procedure combination' data collected from 2012 to 2019, a total of 1 127 113 adult patients with HF and 1046 hospitals were included in the study. Primary outcome was in-hospital mortality, and secondary outcome was 30 day in-hospital mortality and readmission at 30 days and 6 months. Hospital and patient characteristics and process of care measures were also assessed. Mixed-effect logistic regression and Cox proportional-hazards model was used for multivariable analysis, and adjusted odds ratio and hazard ratio were evaluated. Process of care measures had inverse trends for annual admissions of HF per cardiologist (P < 0.01 for all measures: prescription rate of beta-blocker, angiotensin converting enzyme inhibitor or angiotensin II receptor blocker, mineralocorticoid receptor antagonist, and anticoagulant for atrial fibrillation). Adjusted odds ratio for in-hospital mortality was 1.04 (95% confidence interval (CI): 1.04-1.08, P = 0.04) and 30 day in-hospital mortality was 1.05 (95% CI: 1.01-1.09, P = 0.01) for interval of 50 annual admissions of HF per cardiologist. Adjusted hazard ratio for 30 day readmission was 1.05 (95% CI: 1.02-1.08, P < 0.01) and 6 month readmission was 1.07 (95% CI: 1.03-1.11, P < 0.01). Plots of the adjusted odds indicated 300 as the threshold of annual admissions of HF per cardiologist for substantial increase of in-hospital mortality risk. CONCLUSIONS Our findings demonstrated that annual admissions of HF per cardiologist are associated with worse process of care, mortality, and readmission with the threshold for mortality risk increased, emphasizing the optimal proportion of patients admitted with HF to cardiologist for better clinical performance.
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Affiliation(s)
- Masahiro Nishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomotsugu Seki
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akira Shikuma
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hirofumi Kawamata
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Go Horiguchi
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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9
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Zhang DT, Onyebeke C, Nahid M, Balkan L, Musse M, Pinheiro LC, Sterling MR, Durant RW, Brown TM, Levitan EB, Safford MM, Goyal P. Social Determinants of Health and Cardiologist Involvement in the Care of Adults Hospitalized for Heart Failure. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.23.23287671. [PMID: 36993687 PMCID: PMC10055565 DOI: 10.1101/2023.03.23.23287671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Introduction The involvement of a cardiologist in the care of adults during a hospitalization for heart failure (HF) is associated with reduced rates of in-hospital mortality and hospital readmission. However, not all patients see a cardiologist when they are hospitalized for HF. Since reasons for this are not entirely clear, we sought to determine whether social determinants of health (SDOH) are associated with cardiologist involvement in the management of adults hospitalized for HF. We hypothesized that SDOH would be inversely associated with cardiologist involvement in the care of adults hospitalized for HF. Methods We included adult participants from the national REasons for Geographic And Racial Difference in Stroke (REGARDS) cohort, who experienced an adjudicated hospitalization for HF between 2009 and 2017. We excluded participants who were hospitalized at institutions that lacked cardiology services (n=246). We examined nine candidate SDOH, which align with the Healthy People 2030 conceptual model: Black race, social isolation (0-1 visits from a family or friend in the past month), social network/caregiver availability (having someone to care for them if ill), educational attainment < high school, annual household income < $35,000, living in rural areas, living in a zip code with high poverty, living in a Health Professional Shortage Area, and residing in a state with poor public health infrastructure. The primary outcome was cardiologist involvement, a binary variable which was defined as involvement of a cardiologist as the primary responsible clinician or as a consultant, collected via chart review. We examined associations between each SDOH and cardiologist involvement using Poisson regression with robust standard errors. Candidate SDOH with statistically significant associations (p<0.10) were retained for multivariable analysis. Potential confounders/covariates for the multivariable analysis included age, race, sex, HF characteristics, comorbidities, and hospital characteristics. Results We examined 876 participants hospitalized at 549 unique US hospitals. The median age was 77.5 years (IQR 71.0-83.7), 45.9% were female, 41.4% were Black, and 56.2% had low income. Low household income (<$35,000/year) was the only SDOH that had a statistically significant association with cardiologist involvement in a bivariate analysis (RR: 0.88 [95% CI: 0.82-0.95]). After adjusting for potential confounders, low income remained inversely associated (RR: 0.89 [95% CI: 0.82-0.97]). Conclusions Adults with low household income were 11% less likely to have a cardiologist involved in their care during a hospitalization for HF. This suggests that socioeconomic status may implicitly bias the care provided to patients hospitalized for HF.
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Affiliation(s)
- David T. Zhang
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Musarrat Nahid
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Lauren Balkan
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Mahad Musse
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Laura C. Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Madeline R. Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Raegan W. Durant
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Todd M. Brown
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Emily B. Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Parag Goyal
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY
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10
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Enard KR, Coleman AM, Yakubu RA, Butcher BC, Tao D, Hauptman PJ. Influence of Social Determinants of Health on Heart Failure Outcomes: A Systematic Review. J Am Heart Assoc 2023; 12:e026590. [PMID: 36695317 PMCID: PMC9973629 DOI: 10.1161/jaha.122.026590] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Prior research suggests an association between clinical outcomes in heart failure (HF) and social determinants of health (SDoH). Because providers should identify and address SDoH in care delivery, we evaluated how SDoH have been defined, measured, and evaluated in studies that examine HF outcomes. Methods and Results Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, databases were searched for observational or interventional studies published between 2009 and 2021 that assessed the influence of SDoH on outcomes. Selected articles were assessed for quality using a validated rating scheme. We identified 1373 unique articles for screening; 104 were selected for full-text review, and 59 met the inclusion criteria, including retrospective and prospective cohort, cross-sectional, and intervention studies. The majority examined readmissions and hospitalizations (k=33), mortality or survival (k=29), and success of medical devices and transplantation (k=8). SDoH examined most commonly included race, ethnicity, age, sex, socioeconomic status, and education or health literacy. Studies used a range of 1 to 9 SDoH as primary independent variables and 0 to 7 SDoH as controls. Multiple data sources were employed and frequently were electronic medical records linked with national surveys and disease registries. The effects of SDoH on HF outcomes were inconsistent because of the heterogeneity of data sources and SDoH constructs. Conclusions Our systematic review reveals shortcomings in measurement and deployment of SDoH variables in HF care. Validated measures need to be prospectively and intentionally collected to facilitate appropriate analysis, reporting, and replication of data across studies and inform the design of appropriate, evidence-based interventions that can ameliorate significant HF morbidity and societal costs.
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Affiliation(s)
- Kimberly R. Enard
- College for Public Health and Social JusticeSaint Louis UniversitySaint LouisMO
| | - Alyssa M. Coleman
- College for Public Health and Social JusticeSaint Louis UniversitySaint LouisMO
| | - R. Aver Yakubu
- College for Public Health and Social JusticeSaint Louis UniversitySaint LouisMO
| | | | - Donghua Tao
- Medical Center LibrarySaint Louis UniversitySaint LouisMO
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11
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Jiménez-Méndez C, Díez-Villanueva P, Bonanad C, Ortiz-Cortés C, Barge-Caballero E, Goirigolzarri J, Esteban-Fernández A, Pérez-Rivera Á, Cobo M, López J, Sanz-García A, Guerrero C, Pardo HG, Robles C, Iglesias D, Pinilla JMG, Rodríguez LL, Formiga F, Martín-Sánchez FJ, Vidán MT, Ariza A, Martínez-Sellés M, Alfonso F. Frailty and prognosis of older patients with chronic heart failure. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:1011-1019. [PMID: 35718066 DOI: 10.1016/j.rec.2022.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is prevalent in advanced ages. Our objective was to assess the impact of frailty on 1-year mortality in older patients with ambulatory HF. METHODS Our data come from the FRAGIC study (Spanish acronym for "Study of the impact of frailty and other geriatric syndromes on the clinical management and prognosis of elderly outpatients with heart failure"), a multicenter prospective registry conducted in 16 Spanish hospitals including outpatients ≥ 75 years with HF followed up by cardiology services in Spain. RESULTS We included 499 patients with a mean age of 81.4±4.3 years, of whom 193 (38%) were women. A total of 268 (54%) had left ventricular ejection fraction <40%, and 84.6% was in NYHA II functional class. The FRAIL scale identified 244 (49%) pre-frail and 111 (22%) frail patients. Frail patients were significantly older, were more frequently female (both, P <.001), and had higher comorbidity according to the Charlson index (P=.017) and a higher prevalence of geriatric syndromes (P <.001). During a median follow-up of 371 [361-387] days, 58 patients (11.6%) died. On multivariate analysis (Cox regression model), frailty detected with the FRAIL scale was marginally associated with mortality (HR=2.35; 95%CI, 0.96-5.71; P=.059), while frailty identified by the visual mobility scale was an independent predictor of mortality (HR=2.26; 95%CI, 1.16-4.38; P=.015); this association was maintained after adjustment for confounding variables (HR=2.13; 95%CI, 1.08-4.20; P=.02). CONCLUSIONS In elderly outpatients with HF, frailty is independently associated with mortality at 1 year of follow-up. It is essential to identify frailty as part of the comprehensive approach to elderly patients with HF.
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Affiliation(s)
| | | | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Carolina Ortiz-Cortés
- Servicio de Cardiología, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
| | - Eduardo Barge-Caballero
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Josebe Goirigolzarri
- Servicio de Cardiología, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | - Ángel Pérez-Rivera
- Servicio de Cardiología, Hospital Universitario de Burgos, Burgos, Spain
| | - Marta Cobo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Javier López
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ancor Sanz-García
- Unidad de Análisis de Datos, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, Madrid, Spain
| | - Carmen Guerrero
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Héctor García Pardo
- Servicio de Cardiología, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Carolina Robles
- Servicio de Cardiología, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Diego Iglesias
- Servicio de Cardiología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - José Manuel García Pinilla
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain
| | | | - Francesc Formiga
- Servicio de Medicina Interna, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - María Teresa Vidán
- Servicio de Geriatría, Hospital Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Spain
| | - Albert Ariza
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain; Servicio de Cardiología, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
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12
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Sharma Y, Horwood C, Hakendorf P, Thompson C. Characteristics and outcomes of patients with heart failure discharged from different speciality units in Australia: an observational study. QJM 2022; 115:727-734. [PMID: 35176164 DOI: 10.1093/qjmed/hcac051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Previous studies have reported differing clinical outcomes among hospitalized heart failure (HF) patients admitted under cardiology and general medicine (GM) without consideration of patients' frailty. AIMS To explore outcomes in patients admitted under the two specialities after taking into account their frailty and other characteristics. METHODS This retrospective study included all HF patients ≥18 years admitted between 1 January 2013 and 31 December 2019 at two Australian tertiary hospitals. Frailty was determined by use of the Hospital Frailty Risk Score (HFRS) and patients with HFRS ≥ 5 were classified as frail. Propensity score matching (PSM) was used to match 11 variables between the two specialities. The primary outcomes included the days-alive-and-out-of-hospital (DAOH90) at 90 days of discharge, 30-day mortality and readmissions. RESULTS Of 4913 HF patients, mean age 76.2 (14.1) years, 51% males, 2653 (54%) were admitted under cardiology compared to 2260 (46%) under GM. Patients admitted under GM were more likely to be older females, with a higher Charlson index and poor renal function than those admitted under cardiology. Overall, 23.8% patients were frail and frail patients were more likely to be admitted under GM than cardiology (33.6% vs. 15.3%, P < 0.001). PSM created 1532 well-matched patients in each group. After PSM, the DAOH90 was not significantly different among patients admitted in GM when compared to cardiology (coefficient -5.36, 95% confidence interval -11.73 to 1.01, P = 0.099). Other clinical outcomes were also similar between the two specialities. CONCLUSIONS Clinical characteristics of HF patients differ between GM and cardiology; however, clinical outcomes were not significantly different after taking into account frailty and other variables.
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Affiliation(s)
- Y Sharma
- From the College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, SA 5042, Australia
- Division of Medicine, Cardiac and Critical Care, Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042, Australia
| | - C Horwood
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, SA 5042, Australia
| | - P Hakendorf
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, SA 5042, Australia
| | - C Thompson
- Discipline of Medicine, The University of Adelaide, Adelaide, SA 5005, Australia
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13
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Canepa M, Kapelios CJ, Benson L, Savarese G, Lund LH. Temporal Trends of Heart Failure Hospitalizations in Cardiology Versus Noncardiology Wards According to Ejection Fraction: 16-Year Data From the SwedeHF Registry. Circ Heart Fail 2022; 15:e009462. [PMID: 35938444 DOI: 10.1161/circheartfailure.121.009462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients hospitalized for acute heart failure (AHF) may receive different care depending on type of ward. We describe temporal changes in triage of HF patients with preserved, mildly reduced, and reduced ejection fraction (HFpEF, HFmrEF, and HFrEF) hospitalized for AHF to cardiology versus noncardiology wards in Sweden. METHODS We analyzed temporal changes in ward type for AHF for HFrEF versus HFmrEF versus HFpEF between 2000 and 2016. RESULTS Among 37 918 patients with AHF, 19 777 (52%) had HFrEF, 7712 (20%) had HFmrEF, and 10 429 (28%) had HFpEF. Overall, 19 646 (52%) were hospitalized in cardiology and 18 272 (48%) in noncardiology. The proportions hospitalized in noncardiology in 2000 to 2004 versus in 2013 to 2016 were for HFrEF: 45 versus 47%, for HFmrEF: 52 versus 56%, and for HFpEF: 46 versus 64%, respectively. The overall proportion of HFrEF in 2000 to 2004 versus in 2013 to 2016 decreased (60% versus 49%) especially in noncardiology (58% versus 41%), whereas the overall proportion of HFpEF increased (20% versus 30%) especially in noncardiology (21% versus 37%). The average age and prevalence of comorbidities also increased over time, with older patients with multiple comorbidities being more frequently admitted to noncardiology wards. CONCLUSIONS Over time, AHF hospitalization for HFpEF occurred increasingly in noncardiology, whereas for HFrEF and HFmrEF the proportions of patients treated in cardiology versus noncardiology were substantially unchanged over time. This may have implications for implementation of emerging HFpEF therapy.
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Affiliation(s)
- Marco Canepa
- Cardiology Unit, Department of Internal Medicine, University of Genoa, Italy (M.C.)
- Ospedale Policlinico San Martino IRCCS, Genoa, Italy (M.C.)
| | - Chris J Kapelios
- Cardiology Department, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (C.J.K.)
| | - Lina Benson
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (L.B.)
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden (G.S., L.H.L.)
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden (G.S., L.H.L.)
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14
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Zhao HL, Gao XL, Liu YH, Li SL, Zhang Q, Shan WC, Zheng Q, Zhou J, Liu YZ, Liu L, Guo N, Tian HS, Wei QM, Hu XT, Cui YK, Geng X, Wang Q, Cui W. Validation and derivation of short-term prognostic risk score in acute decompensated heart failure in China. BMC Cardiovasc Disord 2022; 22:307. [PMID: 35799104 PMCID: PMC9264535 DOI: 10.1186/s12872-022-02743-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Few prognostic risk scores (PRSs) have been routinely used in acute decompensated heart failure (ADHF). We, therefore, externally validated three published PRSs (3A3B, AHEAD, and OPTIME-CHF) and derived a new PRS to predict the short-term prognosis in ADHF. Methods A total of 4550 patients from the Heb-ADHF registry in China were randomly divided into the derivation and validation cohorts (3:2). Discrimination of each PRS was assessed by the area under the receiver operating characteristic curve (AUROC). Logistic regression was exploited to select the predictors and create the new PRS. The Hosmer–Lemeshow goodness-of-fit test was used to assess the calibration of the new PRS. Results The AUROCs of the 3A3B, AHEAD, and OPTIME-CHF score in the derivation cohort were 0.55 (95% CI 0.53–0.57), 0.54 (95% CI 0.53–0.56), and 0.56 (95% CI 0.54–0.57), respectively. After logistic regression analysis, the new PRS computed as 1 × (diastolic blood pressure < 80 mmHg) + 2 × (lymphocyte > 1.11 × 109/L) + 1 × (creatinine > 80 μmol/L) + 2 × (blood urea nitrogen > 21 mg/dL) + 1 × [BNP 500 to < 1500 pg/mL (NT-proBNP 2500 to < 7500 pg/mL)] or 3 × [BNP ≥ 1500 (NT-proBNP ≥ 7500) pg/mL] + 3 × (QRS fraction of electrocardiogram < 55%) + 4 × (ACEI/ARB not used) + 1 × (rhBNP used), with a better AUROC of 0.67 (95% CI 0.64–0.70) and a good calibration (Hosmer–Lemeshow χ2 = 3.366, P = 0.186). The results in validation cohort verified these findings. Conclusions The short-term prognostic values of 3A3B, AHEAD, and OPTIME-CHF score in ADHF patients were all poor, while the new PRS exhibited potential predictive ability. We demonstrated the QRS fraction of electrocardiogram as a novel predictor for the short-term outcomes of ADHF for the first time. Our findings might help to recognize high-risk ADHF patients.
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Affiliation(s)
- Hong-Liang Zhao
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China.,Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei province, China
| | - Xiao-Li Gao
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Renqiu, 062552, Hebei Province, China
| | - Ying-Hua Liu
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Renqiu, 062552, Hebei Province, China
| | - Sen-Lin Li
- Department of Cardiology, Zhangjiakou First Hospital, Zhangjiakou, 075000, Hebei Province, China
| | - Qi Zhang
- Department of Cardiology, Baoding First Central Hospital, Baoding, 071000, Hebei Province, China
| | - Wei-Chao Shan
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, 067000, Hebei Province, China
| | - Qun Zheng
- Department of Cardiology, Hengshui People's Hospital, Hengshui, 053000, Hebei Province, China
| | - Jiang Zhou
- Department of Cardiology, Chengde Central Hospital, Chengde, 067024, Hebei Province, China
| | - Yong-Zheng Liu
- Department of Cardiology, Qinhuangdao First Hospital, Qinhuangdao, 066099, Hebei Province, China
| | - Li Liu
- Department of Cardiology, Qinhuangdao First Hospital, Qinhuangdao, 066099, Hebei Province, China
| | - Nan Guo
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, 061011, Hebei Province, China
| | - Hong-Sen Tian
- Department of Cardiology, Handan Central Hospital, Handan, 056000, Hebei Province, China
| | - Qing-Min Wei
- Department of Cardiology, Xingtai People's Hospital, Xingtai, 054001, Hebei Province, China
| | - Xi-Tian Hu
- Department of Cardiology, Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei Province, China
| | - Ying-Kai Cui
- Department of Cardiology, The 252nd Hospital of People's Liberation Army, Baoding, 071000, Hebei Province, China
| | - Xue Geng
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China
| | - Qian Wang
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China
| | - Wei Cui
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China.
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15
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Fragilidad y pronóstico de los pacientes mayores con insuficiencia cardiaca. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.04.019] [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]
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16
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González-Franco Á, Cerqueiro González J, Arévalo-Lorido J, Álvarez-Rocha P, Carrascosa-García S, Armengou A, Guzmán-García M, Trullàs J, Montero-Pérez-Barquero M, Manzano L. Beneficios de un modelo asistencial integral en pacientes ancianos con insuficiencia cardíaca y elevada comorbilidad: programa UMIPIC. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Kapelios CJ, Canepa M, Benson L, Hage C, Thorvaldsen T, Dahlström U, Savarese G, Lund LH. Non-cardiology vs. cardiology care of patients with heart failure and reduced ejection fraction is associated with lower use of guideline-based care and higher mortality: Observations from The Swedish Heart Failure Registry. Int J Cardiol 2021; 343:63-72. [PMID: 34517016 DOI: 10.1016/j.ijcard.2021.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/19/2021] [Accepted: 09/07/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Patients with heart failure (HF) are often cared for by non-cardiologists. The implications are unknown. METHODS In a nationwide HF cohort with reduced ejection fraction (HFrEF), we compared demographics, clinical characteristics, guideline-based therapy use and outcomes in non-cardiology vs. cardiology in-patient and out-patient care. RESULTS Between 2000 and 2016, 36,076 patients with HFrEF were enrolled in the Swedish HF registry (19,337 [54%] in-patients overall), with 44% of in-patients and 45% of out-patients managed in non-cardiology settings. Predictors of treatment in non-cardiology were age > 75 years (adjusted odds ratio for non-cardiology 1.20; 95% confidence interval 1.14-1.27), lower education level (0.71; 0.66-0.76 for university vs. compulsory), valve disease (1.24; 1.18-1.31) and systolic blood pressure (SBP) >120 mmHg (1.05; 1.00-1.10). Non-cardiology care was significantly associated with lower use of beta-blockers (0.80; 0.74-0.86) and devices (intracardiac defibrillator [ICD] and/or cardiac resynchronization therapy [CRT]: 0.63; 0.56-0.71), and less frequent specialist follow-up (0.61; 0.57-0.65). Over 1-year follow-up the risk of all-cause mortality (adjusted hazard ratio 1.09; 1.03-1.15) was higher but the risk of first HF (re-) hospitalization was lower (0.93; 0.89-0.97) in non-cardiology vs. cardiology care. CONCLUSIONS In HFrEF, non-cardiology care was independently associated with older ageand lower education. After covariate adjustment, non-cardiology care was associated with lower use of beta-blockers and devices, higher mortality, and lower risk of HF hospitalization. Access to cardiology care may not be equitable and this may have implications for use of guideline-based care and outcomes.
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Affiliation(s)
| | - Marco Canepa
- Cardiology Unit, Department of Internal Medicine, University of Genoa, Italy; Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Lina Benson
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Sweden
| | - Camilla Hage
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Tonje Thorvaldsen
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Dahlström
- Department of Cardiology, Linkoping University, Linkoping, Sweden; Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Gianluigi Savarese
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Lars H Lund
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
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18
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González-Franco Á, Cerqueiro González JM, Arévalo-Lorido JC, Álvarez-Rocha P, Carrascosa-García S, Armengou A, Guzmán-García M, Trullàs JC, Montero-Pérez-Barquero M, Manzano L. Morbidity and mortality in elderly patients with heart failure managed with a comprehensive care model vs. usual care: The UMIPIC program. Rev Clin Esp 2021; 222:123-130. [PMID: 34615617 DOI: 10.1016/j.rceng.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Elderly patients with heart failure (HF) have a high degree of comorbidity which leads to fragmented care, with frequent hospitalizations and high mortality. This study evaluated the benefit of a comprehensive continuous care model (UMIPIC program) in elderly HF patients. METHODS AND RESULTS We prospectively analyzed data from the RICA registry on 2862 patients with HF treated in internal medicine departments. They were divided into two groups: one monitored in the UMIPIC program (UMIPIC group, n: 809) and another which received conventional care (RICA group, n: 2.053). We evaluated HF readmissions during 12 months of follow-up and total mortality after episodes of HF hospitalization. UMIPIC patients were older with higher rates of comorbidity and preserved ejection fraction than the RICA group. However, the UMIPIC group had a lower rate of HF readmissions (17% vs. 26%, p < .001) and mortality (16% vs. 27%, respectively; p < .001). In addition, we selected 370 propensity score-matched patients from each group and the differences in HF readmissions (15% UMIPIC vs. 30% RICA; hazard ratio [HR] = 0.44; 95% confidence interval [CI] 0.32-0.60; p < .001) and mortality (17% UMIPIC vs. 28% RICA; hazard ratio = 0.58; 95% CI 0.42-0.79; p = .001) were maintained. CONCLUSIONS The implementation of the UMIPIC program, based on comprehensive continuous care of elderly patients with HF and high comorbidity, markedly reduce HF readmissions and total mortality.
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Affiliation(s)
- Á González-Franco
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | | | - J C Arévalo-Lorido
- Servicio de Medicina Interna, Hospital Comarcal de Zafra, Zafra, Badajoz, Spain
| | - P Álvarez-Rocha
- Servicio de Medicina Interna y Cardiología, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
| | - S Carrascosa-García
- Servicio de Medicina Interna, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - A Armengou
- Servicio de Medicina Interna, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - M Guzmán-García
- Servicio de Medicina Interna, Hospital San Juan de la Cruz, Jaén, Spain
| | - J C Trullàs
- Servicio de Medicina Interna, Hospital d'Olot i comarcal de la Garrotxa, Girona, Spain; Laboratori de Reparació i Regeneració Tissular (TR2Lab), Facultat de Medicina, Universitat de Vic - Universitat Central de Catalunya, Vic, Barcelona, Spain
| | - M Montero-Pérez-Barquero
- Servicio de Medicina Interna, IMIBIC/Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, Spain
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19
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Maggioni AP, Andreotti F. Closing the Gap Between Populations Enrolled in Traditional Randomized Controlled Trials and Patients Encountered in Clinical Practice: The Case of Heart Failure. Circ Heart Fail 2021; 14:e008840. [PMID: 34407640 DOI: 10.1161/circheartfailure.121.008840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy (A.P.M.)
| | - Felicita Andreotti
- Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy (F.A.)
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20
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Negassa A, Ahmed S, Zolty R, Patel SR. Prediction Model Using Machine Learning for Mortality in Patients with Heart Failure. Am J Cardiol 2021; 153:86-93. [PMID: 34246419 DOI: 10.1016/j.amjcard.2021.05.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 01/03/2023]
Abstract
Heart Failure (HF) is a major cause of morbidity and mortality in the US. With aging of the US population, the public health burden of HF is enormous. We aimed to develop an ensemble prediction model for 30-day mortality after discharge using machine learning. Using an electronic medical records (EMR) database, all patients with a non-elective HF admission over 10 years (January 2001 - December 2010) within the Montefiore Medical Center (MMC) health system, in the Bronx, New York, were included. We developed an ensemble model for 30-day mortality after discharge and employed discrimination, range of prediction, Brier index and explained variance as metrics in assessing model performance. A total of 7,516 patients were included. The discrimination achieved by the ensemble model was higher 0.83 (95% CI: 0.80 to 0.87) compared to the benchmark model 0.79 (95% CI: 0.75 to 0.84). The ensemble model also exhibited a better range of prediction as well as a favorable profile with respect to the other metrics employed. In conclusion, an ensemble machine learning approach exhibited an improvement in performance compared to the benchmark logistic model in predicting all-cause mortality among HF patients within 30-days of discharge. Machine learning is a promising alternative approach for risk profiling of HF patients, and it enhances individualized patient management.
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21
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Berthelot E, Broussier A, Damy T, Donadio C, Cosson S, Rovani X, Salengro E, Billebeau G, Megbemado R, Rekik N, Godreuil C, Richard K, Shourick J, Assayag P, Belmin J, David JP, Hittinger L. Good performance in the management of acute heart failure in cardiogeriatric departments: the ICREX-94 experience. BMC Geriatr 2021; 21:288. [PMID: 33933023 PMCID: PMC8088705 DOI: 10.1186/s12877-021-02210-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
CONTEXT A growing number of elderly patients hospitalized for Acute Heart Failure (AHF) are being managed in cardiogeriatrics departments, but their characteristics and prognosis are poorly known. This study aimed to investigate the profile and outcome (rehospitalization at 90 days) of patients hospitalized for AHF in cardiogeriatrics departments in the Val-de-Marne area in the suburbs of Paris, and to compare them to AHF patients hospitalized in cardiology departments in the same area. METHODS Observational study, ICREX-94, conducted in seven cardiology departments in France and three specific cardiogeriatrics departments in Val-de-Marne. RESULTS A total of 308 patients were hospitalized for AHF between October 2017 and January 2019. During the 90 days following discharge, 29.6% patients were readmitted to the hospital. Compared with patients hospitalized in cardiology departments, patients in cardiogeriatrics departments were older (p < 0.001), less independent (living more often alone or in an institution) (p < 0.001), more often depressed (p < 0.001), had more often major neurocognitive disorder (p < 0.001), had a higher Human Development Index (HDI, p < 0.001), and were less often diagnosed with amyloidosis (p < 0.001). There was no difference in outcome whether patients were discharged from cardiology or cardiogeriatrics departments. The most frequent precipitating factors underlying AHF decompensation between the first and second hospitalization were arrhythmia and infection. CONCLUSION AHF patients discharged from cardiogeriatrics departments, compared to cardiology departments, showed clinical differences but had the same prognosis regarding AHF rehospitalization at 90 days.
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Affiliation(s)
- Emmanuelle Berthelot
- Université Paris Sud, Le Kremlin-Bicêtre, France.
- APHP, Department of Cardiology, Hopital Bicêtre, 78, rue du général Leclerc, 94270, Le Kremlin Bicêtre, France.
| | - Amaury Broussier
- Université Paris Est, Créteil, INSERM, IMRB, Equipe CEpiA, F-94010, Créteil, France
- Department of Geriatrics, AP-HP, Henri-Mondor/Emile-Roux hospitals, F-94456, Limeil-Brevannes, France
| | - Thibaud Damy
- Université Paris Est, Créteil, INSERM, IMRB, Equipe CEpiA, F-94010, Créteil, France
- Department of Cardiology, heart failure and amyloidosis unit, Referral Center For Cardiac Amyloidosis, AP-HP, Henri-Mondor/Albert-Chenevier hospitals, F-94010, Créteil, France
| | - Cristiano Donadio
- Université Paris Sud, Le Kremlin-Bicêtre, France
- APHP, Department of Cardiology, Hopital Bicêtre, 78, rue du général Leclerc, 94270, Le Kremlin Bicêtre, France
- Department of geriatrics, AP-HP, Hôpital Charles Foix and Sorbonne Université, F-94200, Ivry-sur-Seine, France
| | - Stephane Cosson
- Hôpital privé Paul Dégine, 4 avenue Marx Dormoy, F-94500, Champigny-sur-Marne, France
| | - Xavier Rovani
- Hôpital privé Paul Dégine, 4 avenue Marx Dormoy, F-94500, Champigny-sur-Marne, France
| | - Emmanuel Salengro
- Centre Hospitalier de Villeneuve St Georges, 40 allée de la Source, F-94190, Villeneuve-Saint-Georges, France
| | - Gilles Billebeau
- Centre Hospitalier de Villeneuve St Georges, 40 allée de la Source, F-94190, Villeneuve-Saint-Georges, France
| | - Richard Megbemado
- Hôpital Sainte Camille, 2 rue des Pères Camilliens, F-94360, Bry-sur-Marne, France
| | - Noomen Rekik
- Hôpital Sainte Camille, 2 rue des Pères Camilliens, F-94360, Bry-sur-Marne, France
| | - Christian Godreuil
- Hôpital d'Instruction des Armées Bégin, 69 avenue de Paris, F-94160, Saint-Mandé, France
| | - Kevin Richard
- AP-HP Centre hospitalier Chenevier, 40 rue de Mesly, F-94000, Créteil, France
| | | | - Patrick Assayag
- Université Paris Sud, Le Kremlin-Bicêtre, France
- APHP, Department of Cardiology, Hopital Bicêtre, 78, rue du général Leclerc, 94270, Le Kremlin Bicêtre, France
| | - Joel Belmin
- Department of geriatrics, AP-HP, Hôpital Charles Foix and Sorbonne Université, F-94200, Ivry-sur-Seine, France
| | - Jean Philippe David
- Université Paris Est, Créteil, INSERM, IMRB, Equipe CEpiA, F-94010, Créteil, France
- Department of Internal Medicine and Geriatrics, AP-HP, Henri Mondor hospitals, F-94010, Créteil, France
| | - Luc Hittinger
- Université Paris Est, Créteil, INSERM, IMRB, Equipe CEpiA, F-94010, Créteil, France
- Department of Cardiology, heart failure and amyloidosis unit, Referral Center For Cardiac Amyloidosis, AP-HP, Henri-Mondor/Albert-Chenevier hospitals, F-94010, Créteil, France
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22
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Maymon SL, Moravsky G, Marcus G, Shuvy M, Pereg D, Epstein D, Litovchik I, Fuchs S, Minha S. Disparities in the characteristics and outcomes of patients hospitalized with acute decompensated heart failure admitted to internal medicine and cardiology departments: a single-centre, retrospective cohort study. ESC Heart Fail 2020; 8:390-398. [PMID: 33232585 PMCID: PMC7835581 DOI: 10.1002/ehf2.13084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/08/2020] [Accepted: 10/14/2020] [Indexed: 12/28/2022] Open
Abstract
Aims Efforts are constantly made to decrease the rates of readmission after acute decompensated heart failure (ADHF). ADHF admissions to internal medicine departments (IMD) were previously associated with higher risk for readmission compared with those admitted to cardiology departments (CD). It is unknown if the earlier still applies after recent advancement in care over the last decade. This contemporary cohort compares characteristics and outcomes of ADHF patients admitted to IMD with those admitted to CD. Methods and results The data for this single‐centre, retrospective study utilized a cohort of 8332 ADHF patients admitted between 2007 and 2017. We compared patients' baseline characteristics and clinical and laboratory indices of patients admitted to CD and IMD with the outcome defined as 30 day readmission rate. In comparison with those admitted to CD, patients admitted to IMD (89.5% of patients) were older (79 [70–86] vs. 69 [60–78] years; P < 0.001) and had a higher incidence of co‐morbidities and a higher ejection fraction. Readmission rates at 30 days were significantly lower in patients admitted to CD (15.9% vs. 19.6%; P = 0.01). Conflicting results of three statistical models failed to associate between the admitting department and 30 day readmission (odds ratio for 30 day readmission in CD: forced and backward stepwise logistic regression 0.8, 95% confidence interval 0.65–0.97, P = 0.02; stabilized inverse probability weights model odds ratio 1.0, confidence interval 0.75–1.37, P = 0.96). Conclusions This contemporary analysis of ADHF patient cohort demonstrates significant differences in the characteristics and outcomes of patients admitted to IMD and CD. Thus, focusing strategies for readmission prevention in patients admitted to IMD may be beneficial.
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Affiliation(s)
- Shiri Lea Maymon
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Gil Moravsky
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Cardiology, Shamir Medical Center, Be'er Yaakov, Zerifin, 70300, Israel
| | - Gil Marcus
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Cardiology, Shamir Medical Center, Be'er Yaakov, Zerifin, 70300, Israel
| | - Mony Shuvy
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel
| | - David Pereg
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Cardiology, Meir Medical Centre, Kfar Saba, Israel
| | - Danny Epstein
- Department of Internal Medicine 'B', Rambam Medical Center, Haifa, Israel
| | - Ilya Litovchik
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Cardiology, Shamir Medical Center, Be'er Yaakov, Zerifin, 70300, Israel
| | - Shmuel Fuchs
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Cardiology, Shamir Medical Center, Be'er Yaakov, Zerifin, 70300, Israel
| | - Sa'ar Minha
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Cardiology, Shamir Medical Center, Be'er Yaakov, Zerifin, 70300, Israel
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23
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Ricciardi E, La Malfa G, Guglielmi G, Cenni E, Micali M, Corsello LM, Lopena P, Manco L, Pontremoli R, Moscatelli P, Murdaca G, Musso N, Montecucco F, Ameri P, Porto I, Pende A, Canepa M. Characteristics of current heart failure patients admitted to internal medicine vs. cardiology hospital units: the VASCO study. Intern Emerg Med 2020; 15:1219-1229. [PMID: 32172459 DOI: 10.1007/s11739-020-02304-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/26/2020] [Indexed: 12/17/2022]
Abstract
The majority of patients hospitalized for heart failure (HF) are admitted to internal medicine (IM) rather than to cardiology (CA) units, but to date few studies have analyzed the characteristics of these two populations. In this snapshot survey, we compared consecutive patients admitted for HF in six IM units vs. one non-intensive CA unit. During the 6-month survey period, 467 patients were enrolled (127 in CA, 27.2% vs. 340 in IM, 72.8%). IM patients were almost 10 years older (CA 75 ± 10, IM 82 ± 8 years; p < 0.001), more frequently female (CA 39%, IM 55%; p = 0.002) and living at home alone (CA 12%, IM 21%; p = 0.017). The leading cause of hospitalization in both groups was acute worsening of HF (CA 42%, IM 53%; p = 0.031), followed by atrial fibrillation (CA 29%, IM 12%; p < 0.001) and infections (CA 24%, IM 27%; p = 0.563). Ischemic (CA 43%, IM 30%; p = 0.008) and dilated cardiomyopathy patients (CA 21%, IM 12%; p < 0.001) were primarily admitted to CA unit, whereas those with hypertensive heart disease to IM (CA 3%, IM 39%; p < 0.001). Left ventricular ejection fraction (LVEF) was available in 96% of CA patients, but only in 60% of IM patients (p = 0.001). Among patients with LVEF measured, those with LVEF < 40% were predominantly admitted to CA (CA 60%, IM 14%; p < 0.001), whereas those with LVEF ≥ 50% were admitted to IM (CA 21%, IM 33%; p = 0.019); 26% of IM patients were discharged without a known LVEF. Medical treatments also significantly differed, according to patients' clinical and instrumental characteristics in each unit. This study demonstrates important differences between HF patients hospitalized in CA vs. IM, and the need for a greater interaction between these two medical specialties for a better care of HF patients.
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Affiliation(s)
- Elisa Ricciardi
- Clinica di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giovanni La Malfa
- Clinica di Malattie dell'Apparato Cardiovascolare con UTIC, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Giulia Guglielmi
- Clinica di Malattie dell'Apparato Cardiovascolare con UTIC, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Elisabetta Cenni
- Divisione di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Micali
- Clinica di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Moisio Corsello
- Clinica di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Patrizia Lopena
- Clinica di Medicina Interna 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Manco
- Clinica di Medicina Interna 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Roberto Pontremoli
- Clinica di Medicina Interna 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Moscatelli
- Divisione di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giuseppe Murdaca
- Clinica di Medicina Interna ad Orientamento Immunologico, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Natale Musso
- Clinica Endocrinologica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fabrizio Montecucco
- Clinica di Medicina Interna 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pietro Ameri
- Clinica di Malattie dell'Apparato Cardiovascolare con UTIC, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Italo Porto
- Clinica di Malattie dell'Apparato Cardiovascolare con UTIC, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Aldo Pende
- Clinica di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Canepa
- Clinica di Malattie dell'Apparato Cardiovascolare con UTIC, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
- Department of Internal Medicine, University of Genova, Genoa, Italy.
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24
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Eberly LA, Richterman A, Beckett AG, Wispelwey B, Marsh RH, Cleveland Manchanda EC, Chang CY, Glynn RJ, Brooks KC, Boxer R, Kakoza R, Goldsmith J, Loscalzo J, Morse M, Lewis EF, Abel S, Adams A, Anaya J, Andrews EH, Atkinson B, Avutu V, Bachorik A, Badri O, Bailey M, Baird K, Bakshi S, Balaban D, Barshop K, Baumrin E, Bayomy O, Beamesderfer J, Becker N, Berg DD, Berman AN, Blum SM, Boardman AP, Boden K, Bonacci RA, Brown S, Campbell K, Case S, Cetrone E, Charrow A, Chiang D, Clark D, Cohen AJ, Cooper A, Cordova T, Cuneo CN, de Feria AA, Deffenbacher K, DeFilippis EM, DeGregorio G, Deutsch AJ, Diephuis B, Divakaran S, Dorschner P, Downing N, Drescher C, D'Silva KM, Dunbar P, Duong D, Earp S, Eckhardt C, Elman SA, England R, Everett K, Fedotova N, Feingold-Link T, Ferreira M, Fisher H, Foo P, Foote M, Franco I, Gilliland T, Greb J, Greco K, Grewal S, Grin B, Growdon ME, Guercio B, Hahn CK, Hasselfeld B, Haydu EJ, Hermes Z, Hildick-Smith G, Holcomb Z, Holroyd K, Horton L, Huang G, Jablonski S, Jacobs D, Jain N, Japa S, Joseph R, Kalashnikova M, Kalwani N, Kang D, Karan A, Katz JT, Kellner D, Kidia K, Kim JH, Knowles SM, Kolbe L, Kore I, Koullias Y, Kuye I, Lang J, Lawlor M, Lechner MG, Lee K, Lee S, Lee Z, Limaye N, Lin-Beckford S, Lipsyc M, Little J, Loewenthal J, Logaraj R, Lopez DM, Loriaux D, Lu Y, Ma K, Marukian N, Matias W, Mayers JR, McConnell I, McLaughlin M, Meade C, Meador C, Mehta A, Messenger E, Michaelidis C, Mirsky J, Mitten E, Mueller A, Mullur J, Munir A, Murphy E, Nagami E, Natarajan A, Nsahlai M, Nze C, Okwara N, Olds P, Paez R, Pardo M, Patel S, Petersen A, Phelan L, Pimenta E, Pipilas D, Plovanich M, Pong D, Powers BW, Rao A, Ramirez Batlle H, Ramsis M, Reichardt A, Reiger S, Rengarajan M, Rico S, Rome BN, Rosales R, Rotenstein L, Roy A, Royston S, Rozansky H, Rudder M, Ryan CE, Salgado S, Sanchez P, Schulte J, Sekar A, Semenkovich N, Shannon E, Shaw N, Shorten AB, Shrauner W, Sinnenberg L, Smithy JW, Snyder G, Sreekrishnan A, Stabenau H, Stavrou E, Stergachis A, Stern R, Stone A, Tabrizi S, Tanyos S, Thomas C, Thun H, Torres-Lockhart K, Tran A, Treasure C, Tsai FD, Tsaur S, Tschirhart E, Tuwatananurak J, Venkateswaran RV, Vishnevetsky A, Wahl L, Wall A, Wallace F, Walsh E, Wang P, Ward HB, Warner LN, Weeks LD, Weiskopf K, Wengrod J, Williams JN, Winkler M, Wong JL, Worster D, Wright A, Wunsch C, Wynter JS, Yarbrough C, Yau WY, Yazdi D, Yeh J, Yialamas MA, Yozamp N, Zambrotta M, Zon R. Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center. Circ Heart Fail 2019; 12:e006214. [PMID: 31658831 DOI: 10.1161/circheartfailure.119.006214] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Racial inequities for patients with heart failure (HF) have been widely documented. HF patients who receive cardiology care during a hospital admission have better outcomes. It is unknown whether there are differences in admission to a cardiology or general medicine service by race. This study examined the relationship between race and admission service, and its effect on 30-day readmission and mortality Methods: We performed a retrospective cohort study from September 2008 to November 2017 at a single large urban academic referral center of all patients self-referred to the emergency department and admitted to either the cardiology or general medicine service with a principal diagnosis of HF, who self-identified as white, black, or Latinx. We used multivariable generalized estimating equation models to assess the relationship between race and admission to the cardiology service. We used Cox regression to assess the association between race, admission service, and 30-day readmission and mortality. RESULTS Among 1967 unique patients (66.7% white, 23.6% black, and 9.7% Latinx), black and Latinx patients had lower rates of admission to the cardiology service than white patients (adjusted rate ratio, 0.91; 95% CI, 0.84-0.98, for black; adjusted rate ratio, 0.83; 95% CI, 0.72-0.97 for Latinx). Female sex and age >75 years were also independently associated with lower rates of admission to the cardiology service. Admission to the cardiology service was independently associated with decreased readmission within 30 days, independent of race. CONCLUSIONS Black and Latinx patients were less likely to be admitted to cardiology for HF care. This inequity may, in part, drive racial inequities in HF outcomes.
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Affiliation(s)
- Lauren A Eberly
- University of Pennsylvania, Department of Medicine, Division of Cardiovascular Medicine, Philadelphia, PA (L.A.E.)
| | - Aaron Richterman
- Department of Medicine (A.R., A.G.B., B.W., K.C.B., R.K., J.L., M.M.), Brigham and Women's Hospital, Boston, MA
| | - Anne G Beckett
- Department of Medicine (A.R., A.G.B., B.W., K.C.B., R.K., J.L., M.M.), Brigham and Women's Hospital, Boston, MA
| | - Bram Wispelwey
- Department of Medicine (A.R., A.G.B., B.W., K.C.B., R.K., J.L., M.M.), Brigham and Women's Hospital, Boston, MA
| | - Regan H Marsh
- Department of Emergency Medicine (R.H.M., E.C.C.M., C.Y.C), Brigham and Women's Hospital, Boston, MA
| | | | - Cindy Y Chang
- Department of Emergency Medicine (R.H.M., E.C.C.M., C.Y.C), Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA (C.Y.C)
| | - Robert J Glynn
- Division of Preventive Medicine, Department of Medicine (R.J.G.), Brigham and Women's Hospital, Boston, MA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (R.J.G)
| | - Katherine C Brooks
- Department of Medicine (A.R., A.G.B., B.W., K.C.B., R.K., J.L., M.M.), Brigham and Women's Hospital, Boston, MA
| | - Robert Boxer
- Division of General Internal Medicine, Department of Medicine (R.B.), Brigham and Women's Hospital, Boston, MA
| | - Rose Kakoza
- Department of Medicine (A.R., A.G.B., B.W., K.C.B., R.K., J.L., M.M.), Brigham and Women's Hospital, Boston, MA
| | - Jennifer Goldsmith
- Division of Global Health Equity, Department of Medicine (J.G., M.M.), Brigham and Women's Hospital, Boston, MA
| | - Joseph Loscalzo
- Department of Medicine (A.R., A.G.B., B.W., K.C.B., R.K., J.L., M.M.), Brigham and Women's Hospital, Boston, MA
| | - Michelle Morse
- Department of Medicine (A.R., A.G.B., B.W., K.C.B., R.K., J.L., M.M.), Brigham and Women's Hospital, Boston, MA.,Division of Global Health Equity, Department of Medicine (J.G., M.M.), Brigham and Women's Hospital, Boston, MA
| | - Eldrin F Lewis
- Division of Cardiovascular Medicine, and Department of Medicine (E.F..L.), Brigham and Women's Hospital, Boston, MA
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Lenzi J, Avaldi VM, Molinazzi D, Descovich C, Urbinati S, Cappelli V, Fantini MP. Are degree of urbanisation and travel times to healthcare services associated with the processes of care and outcomes of heart failure? A retrospective cohort study based on administrative data. PLoS One 2019; 14:e0223845. [PMID: 31658280 PMCID: PMC6816546 DOI: 10.1371/journal.pone.0223845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/30/2019] [Indexed: 12/28/2022] Open
Abstract
A few studies have found that patients with heart failure (HF) living in less densely populated areas have reduced use of services and poorer outcomes. However, there is a lack of evidence regarding transport accessibility measured as the actual distance between the patient's home and the healthcare facility. The aim of this study was to investigate if different urbanisation levels and travel times to healthcare services are associated with the processes of care and the outcomes of HF. This retrospective cohort study included patients residing in the Local Healthcare Authority of Bologna (2915 square kilometres) who were discharged from hospital with a diagnosis of HF between 1 January and 31 December 2017. Six-month study outcomes included both process (cardiology follow-up visits) and outcome measures (all-cause readmissions, emergency room visits, all-cause mortality). Of the 2022 study patients, 963 (47.6%) lived in urban areas, 639 (31.6%) in intermediate density areas, and 420 (20.8%) in rural communities. Most patients lived ≤30 minutes away from the nearest healthcare facility, either inpatient or outpatient. After controlling for a number of individual factors, no significant association between travel times and outcomes was present. However, rural patients as opposed to urban patients were more likely to see a cardiologist during follow-up (OR 1.42, 99% CI 1.03-1.96). These follow-up visits were associated with reduced mortality within 6 months of discharge (OR 0.53, 99% CI 0.32-0.87). We also found that multidisciplinary interventions for HF were more common in rural than in urban settings (18.8% vs. 4.0%). In conclusion, travel times had no impact on the quality of care for patients with HF. Differences between urban and rural patients were possibly mediated by more proximal factors, some of which are potential targets for intervention such as the availability and utilisation of follow-up cardiology services and multidisciplinary models of care.
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Affiliation(s)
- Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – University of Bologna, Bologna, Italy
| | - Vera Maria Avaldi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – University of Bologna, Bologna, Italy
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
- * E-mail:
| | - Dario Molinazzi
- Department of Management Control and Administrative Data, Bologna Local Healthcare Authority, Bologna, Italy
| | - Carlo Descovich
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
| | | | - Veronica Cappelli
- Directorate of Assistance, Technology and Rehabilitation, Bologna Local Healthcare Authority, Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – University of Bologna, Bologna, Italy
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Piña IL. If It Is Not Health Care Access or Insurance Coverage, Then Why Do Racial Disparities Persist? JACC-HEART FAILURE 2019; 6:421-423. [PMID: 29724364 DOI: 10.1016/j.jchf.2018.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Ileana L Piña
- Division of Cardiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
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Wilkinson C, Thomas H, McMeekin P, Price C. PROCESS AND SYSTEMS: A cohort study to evaluate the impact of service centralisation for emergency admissions with acute heart failure. Future Healthc J 2019; 6:41-46. [PMID: 31098585 PMCID: PMC6520079 DOI: 10.7861/futurehosp.6-1-41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The aim of our study was to describe the impact of emergency care centralisation on unscheduled admissions with a primary discharge diagnosis of acute heart failure (HF). We carried out a retrospective cohort study of HF admissions 1 year before and 1 year after centralisation of three accident and emergency departments into one within a single large NHS trust. Outcomes included mortality, length of stay, readmissions, specialist inpatient input and follow-up, and prescription rates of stabilising medication. Baseline characteristics were similar for 211 patients before and for 307 following reconfiguration. Median length of stay decreased from 8 to 6 days (p=0.020) without an increase in readmissions (4.7% versus 4.2%, p=0.813). The proportion with specialist follow-up increased (60% to 72%, p=0.036). There was a trend towards decreased mortality (32.2% versus 27.7% at 90 days; p=0.266). Contact with the cardiology team was associated with decreased mortality. In conclusion, centralisation of specialist emergency care was associated with greater service efficiency and a trend towards reduced mortality.
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Affiliation(s)
- Chris Wilkinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Northern Deanery, Northumbria NHS Foundation Trust, UK
| | | | - Peter McMeekin
- School of Health, Community and Education Studies, Northumbria University, Newcastle upon Tyne, UK
| | - Chris Price
- Northumbria NHS Foundation Trust, UK
- NIHR Newcastle Biomedical Research Centre and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne
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Kwak MY, Lee SM, Lee TH, Eun SJ, Lee JY, Kim Y. Accessibility of Prenatal Care Can Affect Inequitable Health Outcomes of Pregnant Women Living in Obstetric Care Underserved Areas: a Nationwide Population-Based Study. J Korean Med Sci 2019; 34:e8. [PMID: 30618515 PMCID: PMC6318447 DOI: 10.3346/jkms.2019.34.e8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 10/11/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND As of 2011, among 250 administrative districts in Korea, 54 districts did not have obstetrics and gynecology clinics or hospitals providing prenatal care and delivery services. The Korean government designated 38 regions among 54 districts as "Obstetric Care Underserved Areas (OCUA)." However, little is known there are any differences in pregnancy, prenatal care, and outcomes of women dwelling in OCUA compared to women in other areas. The purposes of this study were to compare the pregnancy related indicators (PRIs) and adequacy of prenatal care between OCUA region and non-OCUA region. METHODS Using National Health Insurance database in Korea from January 1, 2012 to December 31, 2014, we constructed the whole dataset of women who terminated pregnancy including delivery and abortion. We assessed incidence rate of 17 PRIs and adequacy of prenatal care. All indicators were compared between OCUA group and non-OCUA group. RESULTS The women dwelling in OCUA regions were more likely to get abortion (4.6% in OCUA vs. 3.6% in non-OCUA) and receive inadequate prenatal care (7.2% vs. 4.4%). Regarding abortion rate, there were significant regional differences in abortion rate. The highest abortion rate was 10.3% and the lowest region was 1.2%. Among 38 OCUA regions, 29 regions' abortion rates were higher than the national average of abortion rate (3.56%) and there were 10 regions in which abortion rates were higher than 7.0%. In addition, some PRIs such as acute pyelonephritis and transfusion in obstetric hemorrhage were more worse in OCUA regions compared to non-OCUA regions. CONCLUSION PRIs are different according to the regions where women are living. The Korean government should make an effort reducing these gaps of obstetric cares between OCUA and non-OCUA.
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Affiliation(s)
- Mi Young Kwak
- Center for Public Health, National Medical Center, Seoul, Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Ho Lee
- Center for Public Health, National Medical Center, Seoul, Korea
| | - Sang Jun Eun
- Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin Yong Lee
- Public Health Medical Service, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea
| | - Yoon Kim
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
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29
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Breathett K, Liu WG, Allen LA, Daugherty SL, Blair IV, Jones J, Grunwald GK, Moss M, Kiser TH, Burnham E, Vandivier RW, Clark BJ, Lewis EF, Mazimba S, Battaglia C, Ho PM, Peterson PN. African Americans Are Less Likely to Receive Care by a Cardiologist During an Intensive Care Unit Admission for Heart Failure. JACC. HEART FAILURE 2018; 6:413-420. [PMID: 29724363 PMCID: PMC5940011 DOI: 10.1016/j.jchf.2018.02.015] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/22/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study sought to determine whether the likelihood of receiving primary intensive care unit (ICU) care by a cardiologist versus a noncardiologist was greater for Caucasians than for African Americans admitted to an ICU for heart failure (HF). The authors further evaluated whether primary ICU care by a cardiologist is associated with higher in-hospital survival, irrespective of race. BACKGROUND Increasing data demonstrate an association between better HF outcomes and care by a cardiologist. It is unclear if previously noted racial differences in cardiology care persist in an ICU setting. METHODS Using the Premier database, adult patients admitted to an ICU with a primary discharge diagnosis of HF from 2010 to 2014 were included. Hierarchical logistic regression models were used to determine the association between race and primary ICU care by a cardiologist, adjusting for patient and hospital variables. Cox regression with inverse probability weighting was used to assess the association between cardiology care and in-hospital mortality. RESULTS Among 104,835 patients (80.3% Caucasians, 19.7% African Americans), Caucasians had higher odds of care by a cardiologist than African Americans (adjusted odds ratio: 1.42; 95% confidence interval: 1.34 to 1.51). Compared with a noncardiologist, primary ICU care by a cardiologist was associated with higher in-hospital survival (adjusted hazard ratio: 1.20, 95% confidence interval: 1.11 to 1.28). The higher likelihood of survival did not differ by patient race (interaction p = 0.32). CONCLUSIONS Among patients admitted to an ICU for HF, African Americans were less likely than Caucasians to receive primary care by a cardiologist. Primary care by a cardiologist was associated with higher survival for both Caucasians and African Americans.
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Affiliation(s)
- Khadijah Breathett
- Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson, Arizona.
| | - Wenhui G Liu
- Veteran Affairs Eastern Colorado Health Care System, Denver, Colorado
| | - Larry A Allen
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Stacie L Daugherty
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Irene V Blair
- Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado
| | | | - Gary K Grunwald
- Veteran Affairs Eastern Colorado Health Care System, Denver, Colorado; Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Marc Moss
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, University of Colorado, Aurora, Colorado
| | - Tyree H Kiser
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, University of Colorado, Aurora, Colorado; Department of Clinical Pharmacy, University of Colorado, Aurora, Colorado
| | - Ellen Burnham
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, University of Colorado, Aurora, Colorado
| | - R William Vandivier
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, University of Colorado, Aurora, Colorado
| | - Brendan J Clark
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, University of Colorado, Aurora, Colorado
| | - Eldrin F Lewis
- Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sula Mazimba
- Division of Cardiology, University of Virginia Health System, Charlottesville, Virginia
| | - Catherine Battaglia
- Veteran Affairs Eastern Colorado Health Care System, Denver, Colorado; University of Colorado School of Public Health, Denver, Colorado
| | - P Michael Ho
- Veteran Affairs Eastern Colorado Health Care System, Denver, Colorado; Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, University of Colorado, Aurora, Colorado
| | - Pamela N Peterson
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Division of Cardiology, Denver Health Medical Center, Denver, Colorado
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The day of the week and acute heart failure admissions: Relationship with acute myocardial infarction, 30-day readmission rate and in-hospital mortality. Int J Cardiol 2017; 249:292-300. [DOI: 10.1016/j.ijcard.2017.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 08/05/2017] [Accepted: 09/02/2017] [Indexed: 11/20/2022]
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Avaldi VM, Lenzi J, Urbinati S, Molinazzi D, Descovich C, Campagna A, Taglioni M, Fioritti A, Fantini MP. Effect of cardiologist care on 6-month outcomes in patients discharged with heart failure: results from an observational study based on administrative data. BMJ Open 2017; 7:e018243. [PMID: 29101146 PMCID: PMC5695401 DOI: 10.1136/bmjopen-2017-018243] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/08/2017] [Accepted: 09/29/2017] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To evaluate the effect of cardiologist care on adherence to evidence-based secondary prevention medications, mortality and readmission within 6 months of discharge in patients with heart failure (HF). DESIGN Retrospective observational study based on administrative data. SETTING Local Healthcare Authority (LHA) of Bologna, one of the largest LHAs of Italy with ~870 000 inhabitants. PARTICIPANTS All patients residing in the LHA of Bologna discharged from hospital with a diagnosis of HF between 1 January 2015 and 31 December 2015. PRIMARY AND SECONDARY OUTCOME MEASURES Multivariable regression analysis was used to assess the association of inpatient and outpatient cardiologist care with adherence to evidence-based medications, all-cause mortality and hospital readmission (including emergency room visits) within 6 months of discharge. RESULTS The study population included 2650 patients (mean age 82.3 years). 340 (12.8%) patients were discharged from cardiology wards, while 635 (24.0%) were seen by a cardiologist during follow-up. Inpatient and outpatient cardiologist care was associated with an increased likelihood of adherence to ACE inhibitors/angiotensin receptor blockers (ACEIs/ARBs), β-blockers and aldosterone antagonists after discharge. The risk of mortality was significantly lower among patients adherent to ACEIs/ARBs and/or β-blockers (-53% and -28%, respectively); the risk of hospital readmission was significantly lower among patients adherent to ACEIs/ARBs (-28%). CONCLUSIONS Compared with non-specialist care, cardiologist care improves patient adherence to evidence-based medications and might thus favourably affect mortality and readmission following HF.
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Affiliation(s)
- Vera Maria Avaldi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Stefano Urbinati
- Department of Cardiology, Bellaria Hospital, Bologna, Emilia-Romagna, Italy
| | - Dario Molinazzi
- Department of Management Control and Administrative Data, Bologna Local Healthcare Authority, Bologna, Emilia-Romagna, Italy
| | - Carlo Descovich
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Emilia-Romagna, Italy
| | - Anselmo Campagna
- Regional Agency for Health and Social Care of Emilia-Romagna, Bologna, Emilia-Romagna, Italy
| | - Martina Taglioni
- Department of Clinical Governance and Quality, St Orsola-Malpighi Hospital, Bologna, Emilia-Romagna, Italy
| | - Angelo Fioritti
- Medical Directorate, Bologna Local Healthcare Authority, Bologna, Emilia-Romagna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Emilia-Romagna, Italy
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Prabakaran S, Gongora Nieto MC, Lundberg G. Atrial Fibrillation in Women: Risks and Management. J Womens Health (Larchmt) 2017; 27:107-114. [PMID: 29028452 DOI: 10.1089/jwh.2016.6282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Atrial fibrillation (AF) is one of the most commonly occurring arrhythmias and a major modifiable risk factor for stroke, especially in women. While its prevalence is similar in both men and women, women unfortunately face a greater intrinsic AF-related risk of stroke than men do. This is likely one of the reasons that more women than men die from strokes, in addition to experiencing more new and recurrent strokes. Therefore, in women especially, it is imperative to diagnose and treat AF as early as possible. While its unreliable symptom profile and possible intermittent nature can make AF difficult to detect, proactive identification of risk factors and improved detection methods can help. Additionally, the use of risk stratification schemes for anticoagulant therapy, along with the efficacy of nonvitamin K antagonist anticoagulants can enable appropriate therapy to prevent stroke occurrence.
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Affiliation(s)
- Sindhu Prabakaran
- 1 Clinical Research Intern, Emory Women's Heart Center , Atlanta, Georgia .,2 Georgetown University School of Medicine , Washington, District of Columbia
| | - Maria Carolina Gongora Nieto
- 3 Division of Cardiology, Emory University School of Medicine , Atlanta, Georgia .,4 Emory Women's Heart Center, Atlanta, Georgia
| | - Gina Lundberg
- 3 Division of Cardiology, Emory University School of Medicine , Atlanta, Georgia .,4 Emory Women's Heart Center, Atlanta, Georgia
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Treating Specialty and Outcomes in Newly Diagnosed Atrial Fibrillation: From the TREAT-AF Study. J Am Coll Cardiol 2017; 70:78-86. [PMID: 28662810 DOI: 10.1016/j.jacc.2017.04.054] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/13/2017] [Accepted: 04/28/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) occurs in many clinical contexts and is diagnosed and treated by clinicians across many specialties. This approach has resulted in treatment variations. OBJECTIVES The goal of this study was to evaluate the association between treating specialty and AF outcomes among patients newly diagnosed with AF. METHODS Using data from the TREAT-AF (Retrospective Evaluation and Assessment of Therapies in AF) study from the Veterans Health Administration, patients with newly diagnosed, nonvalvular AF between 2004 and 2012 were identified who had at least 1 outpatient encounter with primary care or cardiology within 90 days of the AF diagnosis. Cox proportional hazards regression was used to evaluate the association between treating specialty and AF outcomes. RESULTS Among 184,161 patients with newly diagnosed AF (age 70 ± 11 years; 1.7% women; CHA2DS2-VASc score 2.6 ± 1.7), 40% received cardiology care and 60% received primary care only. After adjustment for covariates, cardiology care was associated with reductions in stroke (hazard ratio [HR]: 0.91; 95% confidence interval [CI]: 0.86 to 0.96; p < 0.001) and death (HR: 0.89; 95% CI: 0.88 to 0.91; p < 0.0001) and increases in hospitalizations for AF/supraventricular tachycardia (HR: 1.38; 95% CI: 1.35 to 1.42; p < 0.0001) and myocardial infarction (HR: 1.03; 95% CI: 1.00 to 1.05; p < 0.04). The propensity-matched cohort had similar results. In mediation analysis, oral anticoagulation prescription within 90 days of diagnosis may have mediated reductions in stroke but did not mediate reductions in survival. CONCLUSIONS In patients with newly diagnosed AF, cardiology care was associated with improved outcomes, potentially mediated by early prescription of oral anticoagulation therapy. Although hypothesis-generating, these data warrant serious consideration and study of health care system interventions at the time of new AF diagnosis.
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Vicent L, Ayesta A, Vidán MT, Miguel-Yanes JMD, García J, Tamargo M, Gómez V, Véliz S, Fernández-Avilés F, Martínez-Sellés M. [Profile of heart failure according to the department of admission. Implications for multidisciplinary management]. Rev Esp Geriatr Gerontol 2017; 52:182-187. [PMID: 28010940 DOI: 10.1016/j.regg.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 11/06/2016] [Accepted: 11/08/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Population aging has led to notable changes in heart failure admissions. The aim of this study was to analyse the characteristics, comorbidity, management, and outcomes of this patient population in three hospital departments. METHODS An analysis was made of a prospective register that included all patients admitted due to heart failure in Internal Medicine, Cardiology, and Geriatrics over a period of 45 days. RESULTS Of a total of 235 patients, 124 (52.7%) were admitted to Internal Medicine, 83 (35.3%) to Cardiology, and 28 (11.9%) to Geriatrics. Mean age was 77.0±20.2 years (Cardiology 71.5±13.5; Internal Medicine 79.2±21.1; Geriatrics 89.9±5.1; p<.001). Preserved ejection fraction was found in 121 (51.5%) patients, and this rate was higher in Internal Medicine (62.5%) and Geriatrics (70.0%) than in Cardiology (31.3%), p<.001. Comorbidity was frequent, especially atrial fibrillation (126; 53.6%), renal disease (89; 37.8%), and chronic obstructive pulmonary disease (65; 27.6%). Infections were the most common decompensating trigger in Internal Medicine (56; 45.2%), and there was often no trigger in Cardiology (45; 54.2%) and Geriatrics (14; 50.0%), p<.0001. The use of renin-angiotensin system inhibitors, beta-blockers, and spironolactone in patients with systolic dysfunction was higher in Cardiology. During the 45 days follow-up, 23 patients (9.9%) were readmitted, which was more frequent in Internal Medicine than in Cardiology (odds ratio 3.0 [95% confidence interval: 1.1 - 8.6], p=.03), with no other significant comparisons. CONCLUSIONS Patients admitted due to decompensated heart failure are elderly and often have comorbidities. There are major differences between departments as regards age and clinical profile.
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Affiliation(s)
- Lourdes Vicent
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - Ana Ayesta
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense, Madrid, España
| | | | - Jorge García
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - María Tamargo
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - Víctor Gómez
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - Samuel Véliz
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - Francisco Fernández-Avilés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España; Facultad de Medicina, Universidad Complutense, Madrid, España
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España; Facultad de Medicina, Universidad Complutense, Madrid, España; Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, España.
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Amir O, Ben-Gal T, Weinstein JM, Schliamser J, Burkhoff D, Abbo A, Abraham WT. Evaluation of remote dielectric sensing (ReDS) technology-guided therapy for decreasing heart failure re-hospitalizations. Int J Cardiol 2017; 240:279-284. [PMID: 28341372 DOI: 10.1016/j.ijcard.2017.02.120] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 02/12/2017] [Accepted: 02/24/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We tested whether remote dielectric sensing (ReDS)-directed fluid management reduces readmissions in patients recently hospitalized for heart failure (HF). BACKGROUND Pulmonary congestion is the most common cause of worsening HF leading to hospitalization. Accurate remote monitoring of lung fluid volume may guide optimal treatment and prevent re-hospitalization. ReDS technology is a quantitative non-invasive method for measuring absolute lung fluid volume. METHODS Patients hospitalized for acute decompensated HF were enrolled during their index admission and followed at home for 90days post-discharge. Daily ReDS readings were obtained using a wearable vest, and were used as a guide to optimizing HF therapy, with a goal of maintaining normal lung fluid content. Comparisons of the number of HF hospitalizations during ReDS-guided HF therapy were made, both to the 90days prior to enrollment and to the 90days following discontinuation of ReDS monitoring. RESULTS Fifty patients were enrolled, discharged, and followed at home for 76.9±26.2days. Patients were 73.8±10.3years old, 40% had LVEF above 40%, and 38% were women. Compared to the pre- and post-ReDS periods, there were 87% and 79% reductions in the rate of HF hospitalizations, respectively, during ReDS-guided HF therapy. The hazard ratio between the ReDS and the pre-ReDS period was 0.07 (95% CI [0.01-0.54] p=0.01), and between the ReDS and the post-ReDS period was 0.11 (95% CI [0.014-0.88] p=0.037). CONCLUSIONS These findings suggest that ReDS-guided management has the potential to reduce HF readmissions in acute decompensated HF patients recently discharged from the hospital.
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Affiliation(s)
- Offer Amir
- Cardio-Vascular Institute, Baruch Padeh Medical Center, Poriya, Israel; Faculty of Medicine in the Galilee, Bar Ilan University, Tiberias, Israel
| | - Tuvia Ben-Gal
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | | | | | | | - Aharon Abbo
- Sensible Medical Innovations Ltd., Netanya, Israel
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, OH, USA.
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The Role of Cardiologists in the Management of Patients with Heart Failure. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1067:133-144. [PMID: 29188455 DOI: 10.1007/5584_2017_120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Heart failure is a complex clinical syndrome with a remarkable impact on health care systems in terms of patients' morbidity and mortality, as well as direct and indirect costs. It is essential to redesign models of care for patients with heart failure that are tailored on personalized health care needs and carried out in the most appropriate setting. There is some debate about the role of cardiologists in the management of patients with heart failure. Indeed, results regarding the inclination of cardiologists' patients to achieve better outcomes are controversial, given the heterogeneity of studies in terms of study design, population, setting and variables considered. The aim of this chapter is to describe and synthesize the current state of knowledge about the role of specialists in the management of patient with heart failure, and to assess whether there is a type of patients for which cardiologists demonstrate the greatest value or a setting of care where they add more benefit.
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Moffett BS, Humlicek TJ, Rossano JW, Price JF, Cabrera AG. Readmissions for Heart Failure in Children. J Pediatr 2016; 177:153-158.e3. [PMID: 27372394 DOI: 10.1016/j.jpeds.2016.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 04/01/2016] [Accepted: 06/02/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the frequency of inpatient 30-day readmission for heart failure in children with cardiomyopathy discharged after an admission for heart failure and the impact of discharge pharmacotherapy on readmissions. STUDY DESIGN The Pediatric Health Information System Database was queried for patients ≤18 years of age with an International Classification of Diseases, Ninth Revision code for heart failure (428.xx) or cardiomyopathy (425.xx) discharged from 2004 to 2013. Patients were excluded if they had congenital heart disease, expired on the initial admission, or underwent cardiac surgery. Patient admission characteristics were documented and discharge medications were captured. Frequency of 30-day readmission for heart failure was identified, and mixed effects multivariable logistic regression analysis was performed to determine factors significant for readmission. RESULTS A total of 2386 patients met study criteria (52.1% male, median age 8.1 years [IQR 1.2-14.6 years]). Vasoactive medications were used in 70.3% of patients on initial admission, the most common of which was milrinone (62.8%). Angiotensin converting enzyme inhibitors and beta-blockers were given at discharge to 67.4% and 35.9%, respectively. Frequency of 30-day readmission for heart failure was 12.9%. Duration of milrinone or beta-blocker use at discharge and institutional heart failure patient volume were associated with a greater odds of 30-day readmission, whereas mechanical ventilation on initial admission was associated with decreased odds of readmission. CONCLUSIONS Pediatric patients with cardiomyopathy and heart failure have a high frequency of heart failure-related 30-day readmission. Outpatient pharmacotherapy at discharge does not appear to influence readmission.
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Affiliation(s)
- Brady S Moffett
- Department of Pharmacy, Texas Children's Hospital, Houston, TX; Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Houston, TX.
| | - Timothy J Humlicek
- Department of Pharmacy, Texas Children's Hospital, Houston, TX; Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Houston, TX
| | - Joseph W Rossano
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jack F Price
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Houston, TX
| | - Antonio G Cabrera
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Houston, TX
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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.
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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
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Yang CJ, Yang J, Yang J, Fan ZX. Arginine vasopressin antagonist tolvaptan in the treatment of heart failure: a meta-analysis of randomized controlled trials. Int J Clin Exp Med 2015; 8:22117-22128. [PMID: 26885186 PMCID: PMC4729972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 12/11/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Tolvaptan can promote water clearance without a deterioration of serum electrolytes in HF patients, but its efficacy and safety were unclear. We performed a meta-analysis of randomized controlled trials (RCTs) to investigate the efficacy and safety of tolvaptan in the treatment of patients hospitalized for heart failure (HF). METHODS In Oct 2014, a literature search was started and found all studies conducted from 2000 to 2014. We systematically searched the literature through the MEDLINE database and EMBASE database. Quality assessments were evaluated with Jadad quality scale. Data were extracted considering the characteristics of efficacy and safety designs. RESULT Eight RCTs enrolling 13453 participants satisfying the inclusion criteria were finally analyzed. There were significant decreases of body weight (MD=-0.87, 95% CI=-0.94 to -0.80, P<0.001) among all subgroups. Significant increase of serum sodium was found between tolvaptan and placebo groups at day 1 (MD=2.93, 95% CI=2.70 to 3.16, P<0.001) and at day 7 or discharge (MD=3.10, 95% CI=2.78 to 3.42, P<0.001). There were significant differences between the day 1 subgroup and day 7 or discharge subgroup (MD=2.99, 95% CI=2.80 to 3.18, P<0.001). A statistical significant improve in dyspnea (RR=1.10, 95% CI=1.07 to 1.13, P<0.001) and edema (RR=1.05, 95% CI=1.02 to 1.08, P<0.001) occurred, whereas there was no difference in rales (RR=2.38, 95% CI=0.89 to 6.38, P=0.08) and pulmonary congestion (RR=1.02, 95% CI=0.71 to 1.45, P=0.93). Pooled effect measure in the outcome of common adverse event (RR=1.08, 95% CI=0.99 to 1.18, P=0.08) and serious adverse (RR=0.96, 95% CI=0.88 to 1.04, P=0.29) event both show no significant occurrence. CONCLUSION Tolvaptan decreases body weight, increases serum sodium, and improves congestion without significant increasing adverse events in HF patients.
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Affiliation(s)
- Chao-Jun Yang
- Department of Cardiology, The First College of Clinical Medical Sciences, China Three Gorges UniversityYichang 443000, Hubei Province, China
- Institute of Cardiovascular Diseases, China Three Gorges UniversityYichang 443000, Hubei Province, China
| | - Jun Yang
- Department of Cardiology, The First College of Clinical Medical Sciences, China Three Gorges UniversityYichang 443000, Hubei Province, China
- Institute of Cardiovascular Diseases, China Three Gorges UniversityYichang 443000, Hubei Province, China
| | - Jian Yang
- Department of Cardiology, The First College of Clinical Medical Sciences, China Three Gorges UniversityYichang 443000, Hubei Province, China
- Institute of Cardiovascular Diseases, China Three Gorges UniversityYichang 443000, Hubei Province, China
| | - Zhi-Xing Fan
- Department of Cardiology, The First College of Clinical Medical Sciences, China Three Gorges UniversityYichang 443000, Hubei Province, China
- Institute of Cardiovascular Diseases, China Three Gorges UniversityYichang 443000, Hubei Province, China
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