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Cordwin DJ, Guidi J, Alhashimi L, Hummel SL, Koelling TM, Dorsch MP. Differences in provider approach to initiating and titrating guideline directed medical therapy in heart failure with reduced ejection fraction. BMC Cardiovasc Disord 2024; 24:247. [PMID: 38730379 PMCID: PMC11087241 DOI: 10.1186/s12872-024-03911-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Despite the strong evidence supporting guideline-directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF), prescription rates in clinical practice are still lacking. METHODS A survey containing 20 clinical vignettes of patients with HFrEF was answered by a national sample of 127 cardiologists and 68 internal/family medicine physicians. Each vignette had 4-5 options for adjusting GDMT and the option to make no medication changes. Survey respondents could only select one option. For analysis, responses were dichotomized to the answer of interest. RESULTS Cardiologists were more likely to make GDMT changes than general medicine physicians (91.8% vs. 82.0%; OR 1.84 [1.07-3.19]; p = 0.020). Cardiologists were more likely to initiate beta-blockers (46.3% vs. 32.0%; OR 2.38 [1.18-4.81], p = 0.016), angiotensin receptor blocker/neprilysin inhibitor (ARNI) (63.8% vs. 48.1%; OR 1.76 [1.01-3.09], p = 0.047), and hydralazine and isosorbide dinitrate (HYD/ISDN) (38.2% vs. 23.7%; OR 2.47 [1.48-4.12], p < 0.001) compared to general medicine physicians. No differences were found in initiating angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARBs), initiating mineralocorticoid receptor antagonist (MRA), sodium-glucose transporter protein 2 (SGLT2) inhibitors, digoxin, or ivabradine. CONCLUSIONS Our results demonstrate cardiologists were more likely to adjust GDMT than general medicine physicians. Future focus on improving GDMT prescribing should target providers other than cardiologists to improve care in patients with HFrEF.
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Affiliation(s)
- David J Cordwin
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Jessica Guidi
- Medical School, University of Michigan, Ann Arbor, MI, USA
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Lana Alhashimi
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Scott L Hummel
- Medical School, University of Michigan, Ann Arbor, MI, USA
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Health System, Ann Arbor, MI, USA
| | - Todd M Koelling
- Medical School, University of Michigan, Ann Arbor, MI, USA
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Michael P Dorsch
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA.
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA.
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Vester M, Beeres S, Lucas C, van Pol P, Schalij M, Bonten T, van Dijkman P, Tops L. Chronic care for heart failure patients: Who to refer back to the general practitioner?-Experiences of the Dutch integrated heart failure care model. J Eval Clin Pract 2024; 30:209-216. [PMID: 37897173 DOI: 10.1111/jep.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE The number of patients with heart failure (HF) and corresponding burden of the healthcare system will increase significantly. The Dutch integrated model, 'Transmural care of HF Patients' was based on the European Society of Cardiology (ESC) guidelines and initiated to manage the increasing prevalence of HF patients in primary and secondary care and stimulate integrated care. It is unknown how many HF patients are eligible for back-referral to general practitioners (GPs), which is important information for the management of chronic HF care. This study aims to evaluate clinical practice of patients for whom chronic HF care can be referred from the cardiologist to the GP based on the aforementioned chronic HF care model. DESIGN AND METHODS A retrospective case record-based study was conducted, which included all chronic HF patients registered in the cardiology information systems of two different hospitals. Subsequently, 200 patients were randomly selected for evaluation. The following patients were considered eligible for referral to the GP: 1/Stable HF patients with reduced left ventricular ejection fraction (LVEF), 2/Stable HF patients with a recovered LVEF and 3/Stable HF patients with a preserved LVEF, 4/HF, palliative setting. RESULTS Of the 200 patients, 17% was considered eligible for referral to the GP. This group consisted of 5% patients with a reduced LVEF, 10.5% patients with recovered LVEF and 1.5% patients with a preserved LVEF. Main indicators for HF care by cardiologists were active cardiac disease other than HF (39.5%), recent admission for HF (29.5%) or a recent adjustment in HF medication (7.5%). CONCLUSION Applying the chronic HF care model of the 'Transmural care of HF patients' and the ESC-guidelines, results in an important opportunity to further optimise HF integrated care and to deal with the increasing number of HF patients referred to the hospital.
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Affiliation(s)
- Marijke Vester
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Saskia Beeres
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Carolien Lucas
- Department of Cardiology, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Petra van Pol
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Martin Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tobias Bonten
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul van Dijkman
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Laurens Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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3
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Muk B, Bánfi-Bacsárdi F, Vámos M, Pilecky D, Majoros Z, Török GM, Vágány D, Polgár B, Solymossi B, Borsányi TD, Andréka P, Duray GZ, Kiss RG, Dékány M, Nyolczas N. The Impact of Specialised Heart Failure Outpatient Care on the Long-Term Application of Guideline-Directed Medical Therapy and on Prognosis in Heart Failure with Reduced Ejection Fraction. Diagnostics (Basel) 2024; 14:131. [PMID: 38248008 PMCID: PMC10814730 DOI: 10.3390/diagnostics14020131] [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: 10/29/2023] [Revised: 01/03/2024] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
(1) Background: Besides the use of guideline-directed medical therapy (GDMT), multidisciplinary heart failure (HF) outpatient care (HFOC) is of strategic importance in HFrEF. (2) Methods: Data from 257 hospitalised HFrEF patients between 2019 and 2021 were retrospectively analysed. Application and target doses of GDMT were compared between HFOC and non-HFOC patients at discharge and at 1 year. 1-year all-cause mortality (ACM) and rehospitalisation (ACH) rates were compared using the Cox proportional hazard model. The effect of HFOC on GDMT and on prognosis after propensity score matching (PSM) of 168 patients and the independent predictors of 1-year ACM and ACH were also evaluated. (3) Results: At 1 year, the application of RASi, MRA and triple therapy (TT: RASi + βB + MRA) was higher (p < 0.05) in the HFOC group, as was the proportion of target doses of ARNI, βB, MRA and TT. After PSM, the composite of 1-year ACM or ACH was more favourable with HFOC (propensity-adjusted HR = 0.625, 95% CI = 0.401-0.974, p = 0.038). Independent predictors of 1-year ACM were age, systolic blood pressure, application of TT and HFOC, while 1-year ACH was influenced by the application of TT. (4) Conclusions: HFOC may positively impact GDMT use and prognosis in HFrEF even within the first year of its initiation.
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Affiliation(s)
- Balázs Muk
- Department of Adult Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Fanni Bánfi-Bacsárdi
- Department of Adult Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Máté Vámos
- Cardiac Electrophysiology Division, Cardiology Center, Internal Medicine Clinic, University of Szeged, 6720 Szeged, Hungary
| | - Dávid Pilecky
- Department of Adult Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Zsuzsanna Majoros
- Department of Cardiology, Central Hospital of Northern Pest—Military Hospital, 1134 Budapest, Hungary
| | - Gábor Márton Török
- Department of Cardiology, Central Hospital of Northern Pest—Military Hospital, 1134 Budapest, Hungary
| | - Dénes Vágány
- Department of Cardiology, Central Hospital of Northern Pest—Military Hospital, 1134 Budapest, Hungary
| | - Balázs Polgár
- Department of Cardiology, Central Hospital of Northern Pest—Military Hospital, 1134 Budapest, Hungary
| | - Balázs Solymossi
- Department of Adult Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Tünde Dóra Borsányi
- Department of Cardiology, Central Hospital of Northern Pest—Military Hospital, 1134 Budapest, Hungary
| | - Péter Andréka
- Department of Adult Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Gábor Zoltán Duray
- Department of Cardiology, Central Hospital of Northern Pest—Military Hospital, 1134 Budapest, Hungary
| | - Róbert Gábor Kiss
- Department of Cardiology, Central Hospital of Northern Pest—Military Hospital, 1134 Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Miklós Dékány
- Department of Cardiology, Central Hospital of Northern Pest—Military Hospital, 1134 Budapest, Hungary
| | - Noémi Nyolczas
- Department of Adult Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
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4
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Liljeroos M, Agvall B, Eek D, Fu M. Experiences of Heart Failure and the Treatment Journey: A Mixed-Methods Study Among Patients with Heart Failure in Sweden. Patient Prefer Adherence 2023; 17:1935-1947. [PMID: 37581194 PMCID: PMC10423575 DOI: 10.2147/ppa.s418760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023] Open
Abstract
Purpose Qualitative studies that highlight the patient perspective of heart failure (HF) and its impact on the lives of patients are limited. Our study objective was to describe the patient's perspective on HF, including the diagnosis, treatment journey and healthcare interactions, and how HF impacts patients' lives and specifically their health-related quality of life (HRQoL) and work capacity. Patients and Methods This cross-sectional, non-interventional, mixed-methods patient experience study comprised: (i) a quantitative online survey with study-specific questions and assessments of HRQoL and work impairment among 101 patients with HF in Sweden and (ii) 35 qualitative interviews to gain in-depth understanding of the patients' experiences. Results Patients were found to experience a highly symptomatic and detrimental impact of HF on their HRQoL and work capacity. Fatigue was the most frequently reported symptom, and it was detrimental to all areas of patients' lives limiting them mentally, socially, and physically. Two-thirds of patients were not aware of the type of HF they had, one-third did not check their body weight regularly, and around half did not increase their physical exercise as recommended by both guidelines and healthcare practitioners. Patients preferred specialist to primary care, desired greater access to healthcare, and continuity in whom they interact with in primary care. Conclusion Patients with HF experience a highly symptomatic burden that affects them physically, mentally, and socially. Our study highlights a major gap in patients' knowledge about HF and HF-related healthcare. These results demonstrate a challenge for the Swedish healthcare system particularly as regards providing patients with continuity, accessibility, and proximity to primary care.
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Affiliation(s)
- Maria Liljeroos
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Björn Agvall
- Department of Research and Development, Region Halland, Halmstad, Sweden
| | - Daniel Eek
- Cardiovascular, Renal and Metabolism, Medical Department, BioPharmaceuticals, AstraZeneca, Stockholm, Sweden
| | - Michael Fu
- Section of Cardiology, Department of Medicine, Geriatrics and Emergency Medicine Sahlgrenska University Hospital-Östra Hospital, Gothenburg, Sweden
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5
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Malmborg M, Assad Turky Al-Kahwa A, Kober L, Torp-Pedersen C, Butt JH, Zahir D, Tuxen CD, Poulsen MK, Madelaire C, Fosbol E, Gislason G, Hildebrandt P, Andersson C, Gustafsson F, Schou M. Specialized heart failure clinics versus primary care: Extended registry-based follow-up of the NorthStar trial. PLoS One 2023; 18:e0286307. [PMID: 37289772 PMCID: PMC10249840 DOI: 10.1371/journal.pone.0286307] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 05/03/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Whether continued follow-up in specialized heart failure (HF) clinics after optimization of guideline-directed therapy improves long-term outcomes in patients with HF with reduced ejection fraction (HFrEF) is unknown. METHODS AND RESULTS 921 medically optimized HFrEF patients enrolled in the NorthStar study were randomly assigned to follow up in a specialized HF clinic or primary care and followed for 10 years using Danish nationwide registries. The primary outcome was a composite of HF hospitalization or cardiovascular death. We further assessed the 5-year adherence to prescribed neurohormonal blockade in 5-year survivors. At enrollment, the median age was 69 years, 24,7% were females, and the median NT-proBNP was 1139 pg/ml. During a median follow-up time of 4.1 (Q1-Q3 1.5-10.0) years, the primary outcome occurred in 321 patients (69.8%) randomized to follow-up in specialized HF clinics and 325 patients (70.5%) randomized to follow-up in primary care. The rate of the primary outcome, its individual components, and all-cause death did not differ between groups (primary outcome, hazard ratio 0.96 [95% CI, 0.82-1.12]; cardiovascular death, 1.00 [0.81-1.24]; HF hospitalization, 0.97 [0.82-1.14]; all-cause death, 1.00 [0.83-1.20]). In 5-year survivors (N = 660), the 5-year adherence did not differ between groups for angiotensin-converting enzyme inhibitors (p = 0.78), beta-blockers (p = 0.74), or mineralocorticoid receptor antagonists (p = 0.47). CONCLUSIONS HFrEF patients on optimal medical therapy did not benefit from continued follow-up in a specialized HF clinic after initial optimization. Development and implementation of new monitoring strategies are needed.
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Affiliation(s)
| | | | - Lars Kober
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Research and Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jawad H. Butt
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Deewa Zahir
- Department of Cardiology, Herlev and Gentofte Hospital, Herlev, Hellerup, Denmark
| | - Christian D. Tuxen
- Department of Cardiology, Bispebjerg-Frederiksberg Hospital, Frederiksberg, DK, Denmark
| | - Mikael K. Poulsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Christian Madelaire
- Department of Cardiology, Herlev and Gentofte Hospital, Herlev, Hellerup, Denmark
| | - Emil Fosbol
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Gunnar Gislason
- Danish Heart Foundation, Copenhagen, Denmark
- Department of Cardiology, Herlev and Gentofte Hospital, Herlev, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Per Hildebrandt
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- Frederiksberg Heart Clinic, Frederiksberg, Denmark
| | - Charlotte Andersson
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States of America
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, Herlev, Hellerup, Denmark
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6
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Su J, Barasa A, Andersson C, Abdulla J. Clinical course and therapy optimization of patients after discharge from a specialized heart failure clinic. Future Cardiol 2023; 19:271-282. [PMID: 37334820 DOI: 10.2217/fca-2022-0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Aim: We aimed to describe the clinical course of patients with heart failure with reduced ejection fraction (HFrEF) after discharge from the heart failure clinics (HFC). Patients & methods: We reviewed the hospital's records of 610 patients that were discharged between 2013 and 2018 from the HFC at a single centre. Patients with no recurrent contact to ambulatory cardiac care were invited to an echocardiographic assessment. Results: Of the survivors, 72% were re-referred after discharge. Nearly 30% of the patients with no recurrent contact with ambulatory cardiac care had persistent HFrEF and further therapeutical optimizations were indicated in half of them. Conclusion: This highlights the importance to identify high-risk patients that would benefit from extended management in the HFC.
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Affiliation(s)
- Junjing Su
- Department of Medicine, Section of Cardiology, Glostrup Hospital, Glostrup 2600, Copenhagen, Denmark
| | - Anders Barasa
- Department of Medicine, Section of Cardiology, Glostrup Hospital, Glostrup 2600, Copenhagen, Denmark
| | - Charlotte Andersson
- Department of Medicine, Section of Cardiology, Boston Medical Center, Boston University School of Medicine, MA 02118, USA
| | - Jawdat Abdulla
- Department of Medicine, Section of Cardiology, Glostrup Hospital, Glostrup 2600, Copenhagen, Denmark
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7
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Auener SL, Jeurissen PPT, Lok DJA, van Duijn HJ, van Pol PEJ, Westert GP, van Dulmen SA. Use of regional transmural agreements to support the right care in the right place for patients with chronic heart failure-a qualitative study. Neth Heart J 2023; 31:109-116. [PMID: 36507945 PMCID: PMC9742644 DOI: 10.1007/s12471-022-01740-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chronic heart failure (CHF) poses a major challenge for healthcare systems. As these patients' needs vary over time in intensity and complexity, the coordination of care between primary and secondary care is critical for them to receive the right care in the right place. To support the continuum of care needed, Dutch regional transmural agreements (RTAs) between healthcare providers have been developed. However, little is known about how the stakeholders have experienced the development and use of these RTAs. The aim of this study was to gain insight into how stakeholders have experienced the development and use of RTAs for CHF and explore which factors affected this. METHODS We interviewed 25 stakeholders from 9 Dutch regions based on the Measurement Instrument for Determinants of Innovations framework. Interview recordings were transcribed verbatim and analysed through open thematic coding. RESULTS In most cases, the RTA development was considered relatively easy. However, the participants noted that sustainable use of the RTAs faced different complexities and influencing factors. These barriers concerned the following themes: education of primary care providers, referral process, patients' willingness, relationships between healthcare providers, reimbursement by health insurance companies, electronic health record (EHR) systems and outcomes. CONCLUSION Some complexities, such as reimbursement and EHR systems, are likely to benefit from specialised support or a national approach. On a regional level, interregional learning can improve stakeholders' experiences. Future research should focus on quantitative effects of RTAs on outcomes and potential financing models for projects that aim to transition care from one setting to another.
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Affiliation(s)
- Stefan L. Auener
- grid.10417.330000 0004 0444 9382Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
| | - Patrick P. T. Jeurissen
- grid.10417.330000 0004 0444 9382Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
| | - Dirk J. A. Lok
- grid.413649.d0000 0004 0396 5908Department of Cardiology, Deventer Hospital, Deventer, The Netherlands
| | | | - Petra E. J. van Pol
- grid.440209.b0000 0004 0501 8269Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Gert P. Westert
- grid.10417.330000 0004 0444 9382Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
| | - Simone A. van Dulmen
- grid.10417.330000 0004 0444 9382Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
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8
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Hafkamp FJ, Tio RA, Otterspoor LC, de Greef T, van Steenbergen GJ, van de Ven ART, Smits G, Post H, van Veghel D. Optimal effectiveness of heart failure management - an umbrella review of meta-analyses examining the effectiveness of interventions to reduce (re)hospitalizations in heart failure. Heart Fail Rev 2022; 27:1683-1748. [PMID: 35239106 PMCID: PMC8892116 DOI: 10.1007/s10741-021-10212-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) is a major health concern, which accounts for 1-2% of all hospital admissions. Nevertheless, there remains a knowledge gap concerning which interventions contribute to effective prevention of HF (re)hospitalization. Therefore, this umbrella review aims to systematically review meta-analyses that examined the effectiveness of interventions in reducing HF-related (re)hospitalization in HFrEF patients. An electronic literature search was performed in PubMed, Web of Science, PsycInfo, Cochrane Reviews, CINAHL, and Medline to identify eligible studies published in the English language in the past 10 years. Primarily, to synthesize the meta-analyzed data, a best-evidence synthesis was used in which meta-analyses were classified based on level of validity. Secondarily, all unique RCTS were extracted from the meta-analyses and examined. A total of 44 meta-analyses were included which encompassed 186 unique RCTs. Strong or moderate evidence suggested that catheter ablation, cardiac resynchronization therapy, cardiac rehabilitation, telemonitoring, and RAAS inhibitors could reduce (re)hospitalization. Additionally, limited evidence suggested that multidisciplinary clinic or self-management promotion programs, beta-blockers, statins, and mitral valve therapy could reduce HF hospitalization. No, or conflicting evidence was found for the effects of cell therapy or anticoagulation. This umbrella review highlights different levels of evidence regarding the effectiveness of several interventions in reducing HF-related (re)hospitalization in HFrEF patients. It could guide future guideline development in optimizing care pathways for heart failure patients.
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Affiliation(s)
| | - Rene A. Tio
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Luuk C. Otterspoor
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Tineke de Greef
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | | | - Arjen R. T. van de Ven
- Netherlands Heart Network, Veldhoven, The Netherlands
- St. Anna Hospital, Geldrop, The Netherlands
| | - Geert Smits
- Netherlands Heart Network, Veldhoven, The Netherlands
- Primary care group Pozob, Veldhoven, The Netherlands
| | - Hans Post
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Dennis van Veghel
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
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9
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Meregalli P. Thoughts on the usefulness of a new scoring system for heart failure. Neth Heart J 2022; 30:400-401. [PMID: 35960439 PMCID: PMC9402825 DOI: 10.1007/s12471-022-01715-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- P Meregalli
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.
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10
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An updated systematic review on heart failure treatments for patients with renal impairment: the tide is not turning. Heart Fail Rev 2022; 27:1761-1777. [DOI: 10.1007/s10741-022-10216-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 12/11/2022]
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11
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Gingele AJ, Brandts L, Brunner-La Rocca HP, Cleuren G, Knackstedt C, Boyne JJJ. Introduction of a new scoring tool to identify clinically stable heart failure patients. Neth Heart J 2022; 30:402-410. [PMID: 34988879 PMCID: PMC9402836 DOI: 10.1007/s12471-021-01654-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Heart failure (HF) poses a burden on specialist care, making referral of clinically stable HF patients to primary care a desirable goal. However, a structured approach to guide patient referral is lacking. Methods The Maastricht Instability Score—Heart Failure (MIS-HF) questionnaire was developed to objectively stratify the clinical status of HF patients: patients with a low MIS-HF (0–2 points, indicating a stable clinical condition) were considered for treatment in primary care, whereas high scores (> 2 points) indicated the need for specialised care. The MIS-HF was evaluated in 637 consecutive HF patients presenting between 2015 and 2018 at Maastricht University Medical Centre. Results Of the 637 patients, 329 (52%) had a low score and 205 of these 329 (62%) patients were referred to primary care. The remaining 124 (38%) patients remained in secondary care. Of the 308 (48%) patients with a high score (> 2 points), 265 (86%) remained in secondary care and 41 (14%) were referred to primary care. The primary composite endpoint (mortality, cardiac hospital admissions) occurred more frequently in patients with a high compared to those with a low MIS-HF after 1 year of follow-up (29.2% vs 10.9%; odds ratio (OR) 3.36, 95% confidence interval (CI) 2.20–5.14). No significant difference in the composite endpoint (9.8% vs 12.9%; OR 0.73, 95% CI 0.36–1.47) was found between patients with a low MIS-HF treated in primary versus secondary care. Conclusion The MIS-HF questionnaire may improve referral policies, as it helps to identify HF patients that can safely be referred to primary care. Supplementary Information The online version of this article (10.1007/s12471-021-01654-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A J Gingele
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - L Brandts
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - H P Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - G Cleuren
- Department of Patient and Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - C Knackstedt
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - J J J Boyne
- Department of Patient and Care, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, The Netherlands
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12
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de Boer AR, Vaartjes I, Gohar A, Valk MJM, Brugts JJ, Boonman-de Winter LJM, van Riet EE, van Mourik Y, Brunner-La Rocca HP, Linssen GCM, Hoes AW, Bots ML, den Ruijter HM, Rutten FH. Heart failure with preserved, mid-range, and reduced ejection fraction across health care settings: an observational study. ESC Heart Fail 2021; 9:363-372. [PMID: 34889076 PMCID: PMC8787985 DOI: 10.1002/ehf2.13742] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/12/2021] [Indexed: 11/10/2022] Open
Abstract
AIMS This study aimed to assess the sex-specific distribution of heart failure (HF) with preserved, mid-range, and reduced ejection fraction across three health care settings. METHODS AND RESULTS In this descriptive observational study, we retrieved the distribution of HF types [with reduced ejection fraction (HFrEF), mid-range ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF)] for men and women between 65 and 79 years of age in three health care settings from a single country: (i) patients with screening-detected HF in the high-risk community (i.e. those with shortness of breath, frailty, diabetes mellitus, and chronic obstructive pulmonary disease) from four screening studies, (ii) patients with confirmed HF from primary care derived from a single observational study, and (iii) patients with confirmed HF from outpatient cardiology clinics participating in a registry. Among 1407 patients from the high-risk community, 288 had screen-detected HF (15% HFrEF, 12% HFmrEF, 74% HFpEF), and 51% of the screen-detected HF patients were women. In both women (82%) and men (65%), HFpEF was the most prevalent HF type. In the routine general practice population (30 practices, 70 000 individuals), among the 160 confirmed HF cases, 35% had HFrEF, 23% HFmrEF, and 43% HFpEF, and in total, 43% were women. In women, HFpEF was the most prevalent HF type (52%), while in men, this was HFrEF (41%). In outpatient cardiology clinics (n = 34), of the 4742 HF patients (66% HFrEF, 15% HFmrEF, 20% HFpEF), 36% were women. In both women (56%) and men (71%), HFrEF was the most prevalent HF type. CONCLUSIONS Both HF types and sex distribution vary considerably in HF patients of 65-79 years of age among health care settings. From the high-risk community through to general practice to the cardiology outpatient setting, there is a shift in HF type from HFpEF to HFrEF and a decrease in the proportion of HF patients that are women.
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Affiliation(s)
- Annemarijn R de Boer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.,Dutch Heart Foundation, The Hague, The Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.,Dutch Heart Foundation, The Hague, The Netherlands
| | - Aisha Gohar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Mark J M Valk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Evelien E van Riet
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Yvonne van Mourik
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | | | - Gerard C M Linssen
- Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, The Netherlands
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Hester M den Ruijter
- Experimental Cardiology, Division Heart & Lung Disease, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
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13
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Zheng C, Han L, Tian J, Li J, He H, Han G, Wang K, Yang H, Yan J, Meng B, Han Q, Zhang Y. Hierarchical management of chronic heart failure: a perspective based on the latent structure of comorbidities. ESC Heart Fail 2021; 9:595-605. [PMID: 34779142 PMCID: PMC8788137 DOI: 10.1002/ehf2.13708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/11/2021] [Accepted: 10/29/2021] [Indexed: 12/21/2022] Open
Abstract
AIMS Chronic heart failure (CHF) has an increasing burden of comorbidities, which affect clinical outcomes. Few studies have focused on the clustering and hierarchical management of patients with CHF based on comorbidity. This study aimed to explore the cluster model of CHF patients based on comorbidities and to verify their relationship with clinical outcomes. METHODS AND RESULTS Electronic health records of patients hospitalized with CHF from January 2014 to April 2019 were collected, and 12 common comorbidities were included in the latent class analysis. The Fruchterman-Reingold layout was used to draw the comorbidity network, and analysis of variance was used to compare the weighted degrees among them. The incidence of clinical outcomes among different clusters was presented on Kaplan-Meier curves and compared using the log-rank test, and the hazard ratio was calculated using the Cox proportional risk model. Sensitivity analysis was performed according to the left ventricular ejection fraction. Four different clinical clusters from 4063 total patients were identified: metabolic, ischaemic, high comorbidity burden, and elderly-atrial fibrillation. Compared with the metabolic cluster, patients in the high comorbidity burden cluster had the highest adjusted risk of combined outcome and all-cause mortality {1.67 [95% confidence interval (CI), 1.40-1.99] and 2.87 [95% CI, 2.17-3.81], respectively}, followed by the elderly-atrial fibrillation and ischaemic clusters. The adjusted readmission risk of patients with ischaemic, high comorbidity burden, and elderly-atrial fibrillation clusters were 1.35 (95% CI, 1.08-1.68), 1.39 (95% CI, 1.13-1.72), and 1.42 (95% CI, 1.14-1.77), respectively. The comorbidity network analysis found that patients in the high comorbidity burden cluster had more and higher comorbidity correlations than those in other clusters. Sensitivity analysis revealed that patients in the high comorbidity burden cluster had the highest risk of combined outcome and all-cause mortality (P < 0.05). CONCLUSIONS The difference in adverse outcomes among clusters confirmed the heterogeneity of CHF and the importance of hierarchical management. This study can provide a basis for personalized treatment and management of patients with CHF, and provide a new perspective for clinical decision making.
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Affiliation(s)
- Chu Zheng
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Linai Han
- Department of Cardiology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jing Tian
- Department of Cardiology, The First Hospital of Shanxi Medical University, Taiyuan, China.,Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Taiyuan, China
| | - Jing Li
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Hangzhi He
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Gangfei Han
- Department of Cardiology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ke Wang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Hong Yang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jingjing Yan
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Bingxia Meng
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Qinghua Han
- Department of Cardiology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yanbo Zhang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China.,Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Taiyuan, China
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14
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Abstract
Cardiovascular disease is the leading cause of death globally. While pharmacological advancements have improved the morbidity and mortality associated with cardiovascular disease, non-adherence to prescribed treatment remains a significant barrier to improved patient outcomes. A variety of strategies to improve medication adherence have been tested in clinical trials, and include the following categories: improving patient education, implementing medication reminders, testing cognitive behavioral interventions, reducing medication costs, utilizing healthcare team members, and streamlining medication dosing regimens. In this review, we describe specific trials within each of these categories and highlight the impact of each on medication adherence. We also examine ongoing trials and future lines of inquiry for improving medication adherence in patients with cardiovascular diseases.
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Affiliation(s)
- Steven T Simon
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Vinay Kini
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew E Levy
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Cardiology, Denver Health Medical Center, Denver, CO, USA
| | - P Michael Ho
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Cardiology Section, VA Eastern Colorado Health Care System, Aurora, CO, USA
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15
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Valk MJM, Hoes AW, Mosterd A, Landman MA, Zuithoff NPA, Broekhuizen BDL, Rutten FH. Training general practitioners to improve evidence-based drug treatment of patients with heart failure: a cluster randomised controlled trial. Neth Heart J 2020; 28:604-612. [PMID: 32997300 PMCID: PMC7596131 DOI: 10.1007/s12471-020-01487-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aims To assess whether a single training session for general practitioners (GPs) improves the evidence-based drug treatment of heart failure (HF) patients, especially of those with HF with reduced ejection fraction (HFrEF). Methods and results A cluster randomised controlled trial was performed for which patients with established HF were eligible. Primary care practices (PCPs) were randomised to care-as-usual or to the intervention group in which GPs received a half-day training session on HF management. Changes in HF medication, health status, hospitalisation and survival were compared between the two groups. Fifteen PCPs with 200 HF patients were randomised to the intervention group and 15 PCPs with 198 HF patients to the control group. Mean age was 76.9 (SD 10.8) years; 52.5% were female. On average, the patients had been diagnosed with HF 3.0 (SD 3.0) years previously. In total, 204 had HFrEF and 194 HF with preserved ejection fraction (HFpEF). In participants with HFrEF, the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers decreased in 6 months in both groups [5.2%; (95% confidence interval (CI) 2.0–10.0)] and 5.6% (95% CI 2.8–13.4)], respectively [baseline-corrected odds ratio (OR) 1.07 (95% CI 0.55–2.08)], while beta-blocker use increased in both groups by 5.2% (95% CI 2.0–10.0) and 1.1% (95% CI 0.2–6.3), respectively [baseline-corrected OR 0.82 (95% CI 0.42–1.61)]. For health status, hospitalisations or survival after 12–28 months there were no significant differences between the two groups, also not when separately analysed for HFrEF and HFpEF. Conclusion A half-day training session for GPs does not improve drug treatment of HF in patients with established HF. Electronic supplementary material The online version of this article (10.1007/s12471-020-01487-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M J M Valk
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - A W Hoes
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Mosterd
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands
| | | | - N P A Zuithoff
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - B D L Broekhuizen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - F H Rutten
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
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16
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Tini G, Bertero E, Signori A, Sormani MP, Maack C, De Boer RA, Canepa M, Ameri P. Cancer Mortality in Trials of Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2020; 9:e016309. [PMID: 32862764 PMCID: PMC7726990 DOI: 10.1161/jaha.119.016309] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background The burden of cancer in heart failure with reduced ejection fraction is apparently growing. Randomized controlled trials (RCTs) may help understanding this observation, since they span decades of heart failure treatment. Methods and Results We assessed cancer, cardiovascular, and total mortality in phase 3 heart failure RCTs involving ≥90% individuals with left ventricular ejection fraction <45%, who were not acutely decompensated and did not represent specific patient subsets. The pooled odds ratios (ORs) of each type of death for the control and treatment arms were calculated using a random‐effects model. Temporal trends and the impact of patient and RCT characteristics on mortality outcomes were evaluated by meta‐regression analysis. Cancer mortality was reported for 15 (25%) of 61 RCTs, including 33 709 subjects, and accounted for 6% to 14% of all deaths and 17% to 67% of noncardiovascular deaths. Cancer mortality rate was 0.58 (95% CI, 0.46–0.71) per 100 patient‐years without temporal trend (P=0.35). Cardiovascular (P=0.001) and total (P=0.001) mortality rates instead decreased over time. Moreover, cancer mortality was not influenced by treatment (OR, 1.08; 95% CI, 0.92–1.28), unlike cardiovascular (OR, 0.88; 95% CI, 0.79–0.98) and all‐cause (OR, 0.91; 95% CI, 0.84–0.99) mortality. Meta‐regression did not reveal significant sources of heterogeneity. Possible reasons for excluding patients with malignancy overlapped among RCTs with and without published cancer mortality, and malignancy was an exclusion criterion only for 4 (8.7%) of the RCTs not reporting cancer mortality. Conclusions Cancer is a major, yet overlooked cause of noncardiovascular death in heart failure with reduced ejection fraction, which has become more prominent with cardiovascular mortality decline.
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Affiliation(s)
- Giacomo Tini
- Cardiovascular Disease Unit IRCCS Ospedale Policlinico San MartinoIRCCS Italian Cardiovascular Network Genova Italy.,Department of Internal Medicine University of Genova Italy
| | - Edoardo Bertero
- Comprehensive Heart Failure Center (CHFC) University Clinic Würzburg Würzburg Germany
| | - Alessio Signori
- Department of Health Sciences Section of Biostatistics University of Genova Italy
| | - Maria Pia Sormani
- Department of Health Sciences Section of Biostatistics University of Genova Italy
| | - Christoph Maack
- Comprehensive Heart Failure Center (CHFC) University Clinic Würzburg Würzburg Germany
| | - Rudolf A De Boer
- Department of Cardiology University of GroningenUniversity Medical Center Groningen Groningen The Netherlands
| | - Marco Canepa
- Cardiovascular Disease Unit IRCCS Ospedale Policlinico San MartinoIRCCS Italian Cardiovascular Network Genova Italy.,Department of Internal Medicine University of Genova Italy
| | - Pietro Ameri
- Cardiovascular Disease Unit IRCCS Ospedale Policlinico San MartinoIRCCS Italian Cardiovascular Network Genova Italy.,Department of Internal Medicine University of Genova Italy
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17
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Abstract
Heart failure is associated with a range of comorbidities that have the potential to impair both quality of life and clinical outcome. Unfortunately, noncardiac diseases are underrepresented in large randomized clinical trials, and their management remains poorly understood. In clinical practice, the prevalence of comorbidities in heart failure is high. Although the prognostic impact of comorbidities is well known, their prevalence and impact in specific heart failure settings have been overlooked. Many studies have described specific single noncardiac conditions, but few have examined their overall burden and grading in patients with multiple comorbidities. The risk of comorbidities in patients with heart failure rises with more advanced disease, older age, and increased frailty-three conditions that are poorly represented in clinical trials. The pathogenic links between comorbidities and heart failure involve many pathways and include neurohormonal overdrive, inflammatory activation, oxidative stress, and endothelial dysfunction. Such interactions may worsen prognoses, but details of these relationships are still under investigation. We propose a shift from cardiac-focused care to a more systemic approach that considers all noncardiac diseases and related medications. Some new drugs class such as ARNI or SGLT2 inhibitors could change prognosis by acting directly or indirectly on metabolic disorders and related vascular consequences.
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18
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Cross AJ, Elliott RA, Petrie K, Kuruvilla L, George J. Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications. Cochrane Database Syst Rev 2020; 5:CD012419. [PMID: 32383493 PMCID: PMC7207012 DOI: 10.1002/14651858.cd012419.pub2] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Older people taking multiple medications represent a large and growing proportion of the population. Managing multiple medications can be challenging, and this is especially the case for older people, who have higher rates of comorbidity and physical and cognitive impairment than younger adults. Good medication-taking ability and medication adherence are necessary to ensure safe and effective use of medications. OBJECTIVES To evaluate the effectiveness of interventions designed to improve medication-taking ability and/or medication adherence in older community-dwelling adults prescribed multiple long-term medications. SEARCH METHODS We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, CINAHL Plus, and International Pharmaceutical Abstracts from inception until June 2019. We also searched grey literature, online trial registries, and reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs. Eligible studies tested interventions aimed at improving medication-taking ability and/or medication adherence among people aged ≥ 65 years (or of mean/median age > 65 years), living in the community or being discharged from hospital back into the community, and taking four or more regular prescription medications (or with group mean/median of more than four medications). Interventions targeting carers of older people who met these criteria were also included. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed abstracts and full texts of eligible studies, extracted data, and assessed risk of bias of included studies. We conducted meta-analyses when possible and used a random-effects model to yield summary estimates of effect, risk ratios (RRs) for dichotomous outcomes, and mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes, along with 95% confidence intervals (CIs). Narrative synthesis was performed when meta-analysis was not possible. We assessed overall certainty of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Primary outcomes were medication-taking ability and medication adherence. Secondary outcomes included health-related quality of life (HRQoL), emergency department (ED)/hospital admissions, and mortality. MAIN RESULTS We identified 50 studies (14,269 participants) comprising 40 RCTs, six cluster-RCTs, and four quasi-RCTs. All included studies evaluated interventions versus usual care; six studies also reported a comparison between two interventions as part of a three-arm RCT design. Interventions were grouped on the basis of their educational and/or behavioural components: 14 involved educational components only, 7 used behavioural strategies only, and 29 provided mixed educational and behavioural interventions. Overall, our confidence in results regarding the effectiveness of interventions was low to very low due to a high degree of heterogeneity of included studies and high or unclear risk of bias across multiple domains in most studies. Five studies evaluated interventions for improving medication-taking ability, and 48 evaluated interventions for improving medication adherence (three studies evaluated both outcomes). No studies involved educational or behavioural interventions alone for improving medication-taking ability. Low-quality evidence from five studies, each using a different measure of medication-taking ability, meant that we were unable to determine the effects of mixed interventions on medication-taking ability. Low-quality evidence suggests that behavioural only interventions (RR 1.22, 95% CI 1.07 to 1.38; 4 studies) and mixed interventions (RR 1.22, 95% CI 1.08 to 1.37; 12 studies) may increase the proportions of people who are adherent compared with usual care. We could not include in the meta-analysis results from two studies involving mixed interventions: one had a positive effect on adherence, and the other had little or no effect. Very low-quality evidence means that we are uncertain of the effects of educational only interventions (5 studies) on the proportions of people who are adherent. Low-quality evidence suggests that educational only interventions (SMD 0.16, 95% CI -0.12 to 0.43; 5 studies) and mixed interventions (SMD 0.47, 95% CI -0.08 to 1.02; 7 studies) may have little or no impact on medication adherence assessed through continuous measures of adherence. We excluded 10 studies (4 educational only and 6 mixed interventions) from the meta-analysis including four studies with unclear or no available results. Very low-quality evidence means that we are uncertain of the effects of behavioural only interventions (3 studies) on medication adherence when assessed through continuous outcomes. Low-quality evidence suggests that mixed interventions may reduce the number of ED/hospital admissions (RR 0.67, 95% CI 0.50 to 0.90; 11 studies) compared with usual care, although results from six further studies that we were unable to include in meta-analyses indicate that the intervention may have a smaller, or even no, effect on these outcomes. Similarly, low-quality evidence suggests that mixed interventions may lead to little or no change in HRQoL (7 studies), and very low-quality evidence means that we are uncertain of the effects on mortality (RR 0.93, 95% CI 0.67 to 1.30; 7 studies). Moderate-quality evidence shows that educational interventions alone probably have little or no effect on HRQoL (6 studies) or on ED/hospital admissions (4 studies) when compared with usual care. Very low-quality evidence means that we are uncertain of the effects of behavioural interventions on HRQoL (1 study) or on ED/hospital admissions (2 studies). We identified no studies evaluating effects of educational or behavioural interventions alone on mortality. Six studies reported a comparison between two interventions; however due to the limited number of studies assessing the same types of interventions and comparisons, we are unable to draw firm conclusions for any outcomes. AUTHORS' CONCLUSIONS Behavioural only or mixed educational and behavioural interventions may improve the proportion of people who satisfactorily adhere to their prescribed medications, but we are uncertain of the effects of educational only interventions. No type of intervention was found to improve adherence when it was measured as a continuous variable, with educational only and mixed interventions having little or no impact and evidence of insufficient quality to determine the effects of behavioural only interventions. We were unable to determine the impact of interventions on medication-taking ability. The quality of evidence for these findings is low due to heterogeneity and methodological limitations of studies included in the review. Further well-designed RCTs are needed to investigate the effects of interventions for improving medication-taking ability and medication adherence in older adults prescribed multiple medications.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Rohan A Elliott
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
- Pharmacy Department, Austin Health, Heidelberg, Australia
| | - Kate Petrie
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Lisha Kuruvilla
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
- Pharmacy Department, Barwon Health, North Geelong, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
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19
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Seferović PM, Piepoli MF, Lopatin Y, Jankowska E, Polovina M, Anguita‐Sanchez M, Störk S, Lainščak M, Miličić D, Milinković I, Filippatos G, Coats AJ. Heart Failure Association of the European Society of Cardiology Quality of Care Centres Programme: design and accreditation document. Eur J Heart Fail 2020; 22:763-774. [DOI: 10.1002/ejhf.1784] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 01/18/2020] [Accepted: 02/19/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Petar M. Seferović
- Faculty of Medicine University of Belgrade Belgrade Serbia
- Faculty of Medicine, Serbian Academy of Sciences and Arts Belgrade Serbia
| | - Massimo F. Piepoli
- Heart Failure Unit, Guglielmo da Saliceto Hospital Azienda Unità Sanitaria Locale di Piacenza and University of Parma Piacenza Italy
| | - Yuri Lopatin
- Volgograd Regional Cardiology Centre, Volgograd State Medical University Volgograd Russia
| | - Ewa Jankowska
- Department of Heart Disease Wroclaw Medical University, Centre for Heart Disease, Military Hospital Wroclaw Poland
| | - Marija Polovina
- Faculty of Medicine University of Belgrade Belgrade Serbia
- Department of Cardiology Clinical Centre of Serbia Belgrade Serbia
| | | | - Stefan Störk
- Department of Internal Medicine I and Comprehensive Heart Failure Centre University Hospital, University of Würzburg Würzburg Germany
- Department of Cardiology University of Würzburg Würzburg Germany
- Division of Cardiology General Hospital Murska Sobota Murska Sobota Slovenia
| | - Mitja Lainščak
- Faculty of Medicine University of Ljubljana Ljubljana Slovenia
| | - Davor Miličić
- Department of Cardiovascular Diseases University Hospital Centre Zagreb, University of Zagreb Zagreb Croatia
| | - Ivan Milinković
- Faculty of Medicine University of Belgrade Belgrade Serbia
- Department of Cardiology Clinical Centre of Serbia Belgrade Serbia
| | - Gerasimos Filippatos
- Second Department of Cardiology Attikon University Hospital, Medical School, National and Kapodistrian University of Athens Athens Greece
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20
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How to develop a national heart failure clinics network: a consensus document of the Hellenic Heart Failure Association. ESC Heart Fail 2020; 7:15-25. [PMID: 32100972 PMCID: PMC7083479 DOI: 10.1002/ehf2.12558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/01/2019] [Accepted: 10/31/2019] [Indexed: 12/26/2022] Open
Abstract
Heart failure (HF) is rapidly growing, conferring considerable mortality, morbidity, and costs. Dedicated HF clinics improve patient outcomes, and the development of a national HF clinics network aims at addressing this need at national level. Such a network should respect the existing health care infrastructures, and according to the capacities of hosting facilities, it can be organized into three levels. Establishing the continuous communication and interaction among the components of the network is crucial, while supportive actions that can enhance its efficiency include involvement of multidisciplinary health care professionals, use of structured HF‐specific documents, such as discharge notes, patient information leaflets, and patient booklets, and implementation of an HF‐specific electronic health care record and database platform.
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21
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Liljeroos M, Kato NP, van der Wal MH, Brons M, Luttik ML, van Veldhuisen DJ, Strömberg A, Jaarsma T. Trajectory of self-care behaviour in patients with heart failure: the impact on clinical outcomes and influencing factors. Eur J Cardiovasc Nurs 2020; 19:421-432. [PMID: 31992064 PMCID: PMC7272123 DOI: 10.1177/1474515120902317] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Patients' self-care behaviour is still suboptimal in many heart failure (HF) patients and underlying mechanisms on how to improve self-care need to be studied. AIMS (1) To describe the trajectory of patients' self-care behaviour over 1 year, (2) to clarify the relationship between the trajectory of self-care and clinical outcomes, and (3) to identify factors related to changes in self-care behaviour. METHODS In this secondary analysis of the COACH-2 study, 167 HF patients (mean age 73 years) were included. Self-care behaviour was assessed at baseline and after 12 months using the European Heart Failure Self-care Behaviour scale. The threshold score of ⩾70 was used to define good self-care behaviour. RESULTS Of all patients, 21% had persistent poor self-care behaviour, and 27% decreased from good to poor. Self-care improved from poor to good in 10%; 41% had a good self-care during both measurements. Patients who improved self-care had significantly higher perceived control than those with persistently good self-care at baseline. Patients who decreased their self-care had more all-cause hospitalisations (35%) and cardiovascular hospitalisations (26%) than patients with persistently good self-care (2.9%, p < 0.05). The prevalence of depression increased at 12 months in both patients having persistent poor self-care (0% to 21%) and decreasing self-care (4.4% to 22%, both p < 0.05). CONCLUSION Perceived control is a positive factor to improve self-care, and a decrease in self-care is related to worse outcomes. Interventions to reduce psychological distress combined with self-care support could have a beneficial impact on patients decreasing or persistently poor self-care behaviour.
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Affiliation(s)
- Maria Liljeroos
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Centre for Clinical Research, Sörmland County Council, Uppsala University, Eskilstuna, Sweden
| | - Naoko P Kato
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Martje Hl van der Wal
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Maaike Brons
- Department of Cardiology, University Medical Centre Utrecht, The Netherlands
| | - Marie Louise Luttik
- Research Group Nursing Diagnostics, School of Nursing, University of Applied Sciences Groningen, The Netherlands
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Agostinho JR, Gonçalves I, Rigueira J, Aguiar-Ricardo I, Nunes-Ferreira A, Santos R, Guimarães T, Alves P, Cunha N, Rodrigues T, André ŃZ, Pedro M, Veiga F, Pinto FJ, Brito D. Protocol-based follow-up program for heart failure patients: Impact on prognosis and quality of life. Rev Port Cardiol 2020; 38:755-764. [PMID: 32005587 DOI: 10.1016/j.repc.2019.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 03/08/2019] [Accepted: 03/31/2019] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Heart failure is associated with high rates of readmission and mortality, and there is a need for measures to improve outcomes. This study aims to assess the impact of the implementation of a protocol-based follow-up program for heart failure patients on readmission and mortality rates and quality of life. METHODS A quasi-experimental study was performed, with a prospective registry of 50 consecutive patients discharged after hospitalization for acute heart failure. The study group was followed by a cardiologist at days 7-10 and the first, third, sixth and 12th month after discharge, with predefined procedures. The control group consisted of patients hospitalized for heart failure prior to implementation of the program and followed on a routine basis. RESULTS No significant differences were observed between the two groups regarding mean age (67.1±11.2 vs. 65.8±13.4 years, p=0.5), NYHA functional class (p=0.37), or median left ventricular ejection fraction (27% [19.8-35.3] vs. 29% [23.5-40]; p=0.23) at discharge. Mean follow-up after discharge was similar (11±5.3 vs. 10.9±5.5 months, p=0.81). The protocol-based follow-up program was associated with a significant reduction in all-cause readmission (26% vs. 60%, p=0.003), heart failure readmission (16% vs. 36%, p=0.032), and mortality (4% vs. 20%, p=0.044). In the study group there was a significant improvement in all quality of life measures (p<0.001). CONCLUSION A protocol-based follow-up program for patients with heart failure led to a significant reduction in readmission and mortality rates, and was associated with better quality of life.
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Affiliation(s)
- João R Agostinho
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal.
| | - Inês Gonçalves
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Joana Rigueira
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Inês Aguiar-Ricardo
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Afonso Nunes-Ferreira
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Rafael Santos
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Tatiana Guimarães
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Pedro Alves
- Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Nelson Cunha
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Tiago Rodrigues
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - ŃZinga André
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Mónica Pedro
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Fátima Veiga
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Fausto J Pinto
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Dulce Brito
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
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Hsieh V, Paull G, Hawkshaw B. Heart Failure Integrated Care Project: overcoming barriers encountered by primary health care providers in heart failure management. AUST HEALTH REV 2020; 44:451-458. [DOI: 10.1071/ah18251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 08/01/2019] [Indexed: 01/07/2023]
Abstract
ObjectiveHeart failure (HF) is associated with increased morbidity and mortality. A significant proportion of HF patients will have repeated hospital presentations. Effective integration between general practice and existing HF management programs may address some of the challenges in optimising care for this complex patient population. The Heart Failure Integrated Care Project (HFICP) investigated the barriers encountered by primary healthcare providers in providing care to patients with HF in the community.
MethodsFive general practices in the St George and Sutherland regions (NSW, Australia) that employed practice nurses (PNs) were enrolled in the project. Participants responded to a printed survey that asked about their perceived role in the management of HF patients and their current knowledge and confidence in managing this condition. Participants also took part in a focus group meeting and were asked to identify barriers to improving HF patient management in general practice, and to offer suggestions about how the project could assist them to overcome those barriers.
ResultsBarriers to effective delivery of HF management in general practice included clinical factors (consultation time limitations, underutilisation of patient management systems, identifying patients with HF, lack of patient self-care materials), professional factors (suboptimal hospital discharge summary letters, underutilisation of PNs), organisation factors (difficulties in communication with hospital staff, lack of education regarding HF management) and system issues (no Medicare rebate for B-type natriuretic peptide testing, insufficient Medicare rebate for using PN in chronic disease management).
ConclusionsThe HFICP identified several barriers to improving integrated management for HF patients in the Australian setting. These findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between hospitals and primary care providers in delivering better care to HF patients.
What is known about the topic?Multidisciplinary HF programs are heterogeneous in their structures, they have low patient participation rates and a significant proportion of HF patients have further presentations to hospital with HF. Integrating the care of HF patients into the primary care system following hospital admission remains challenging.
What does this paper add?This paper identified several factors that hinder the effective delivery of care by primary care providers to patients with HF.
What are the implications for practitioners?The findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between tertiary health facilities and primary care providers in delivering better care to HF patients.
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Protocol-based follow-up program for heart failure patients: Impact on prognosis and quality of life. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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25
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Groenewegen A, Rutten FH. Decelerating trends in heart failure survival. Eur J Heart Fail 2019; 21:1326-1328. [DOI: 10.1002/ejhf.1626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Amy Groenewegen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht Utrecht The Netherlands
| | - Frans H. Rutten
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht Utrecht The Netherlands
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26
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Vinogradova NG, Polyakov DS, Fomin IV, Solovyova EV. [Stability of chronic heart failure from the position of a doctor and a patient: in search of contact points]. ACTA ACUST UNITED AC 2019; 59:33-40. [PMID: 31340747 DOI: 10.18087/cardio.2667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 11/18/2022]
Abstract
Actuality. The results of the EPOCH study showed that in 16 years in the Russian Federation the number of patients with chronic heart failure (CHF) of I-IV FC increased significantly. The main objectives of the treatment of CHF are the stabilization of the patient's condition and the reduction of the risks of cardiovascular mortality, decompensation and repeated hospitalizations for heart failure. But a single concept of "stable" CHF does not exist either in Russian or in foreign recommendations. OBJECTIVE To assess how ofen the subjective assessment of a doctor regarding the stability of a patient with CHF coincides with the subjective opinion of the patient with CHF regarding the stability of his condition; and to identify those parametrs that have a leading influence on the assessment of the stability of the state from the point of view of the physician and the patient. MATERIALS AND METHODS Data collection was carried out in the form of interviews among general practitioners and cardiologists in outpatient clinics (OC) of Nizhny Novgorod, which were randomly selected by the method of blind envelopes. In parallel, a survey was conducted of patients with CHF who applied for outpatient medical care about this syndrome to this OC, which the doctors were not informed about, because patient interviews were conducted after the end of outpatient admission in a separate room. Answers of doctors about a patient with CHF were compared with the answers of the corresponding patient; for this, a single code was assigned to both questionnaires. The study included 211 patients with CHF of any etiology older than 18 years. The study involved 25 doctors. The study was conducted from 11/01/17 to 11/30/17. RESULTS Analysis of the data suggests that the doctor is more likely to consider the patient more stable in cases when the patient notes a decrease in the severity of shortness of breath, weakness and does not detect edema, while the fact of therapy with loop diuretics (LD) or an increase in them did not affect assessment of stability from the point of view of the doctor. From the point of view of the patient, the absence of the first three signs also testifies to the stability of the condition, however, unlike doctors, patients more often (p <0.001) considered themselves unstable in those cases when they needed LD therapy or an increase in LD dose. A logit regression analysis and ROC analysis based on selected signs and symptoms of CHF confirmed that a model that combines questions about persistent weakness and edema is best suited to predict the patient's subjective assessment of patient's stability from a doctor's point of view (61.8% of the results can be correctly predicted), and at the cutoff threshold of 0.5, it has the highest sensitivity of 64.9%. To predict the subjective assessment of stability in relation to the patient, the optimal model turned out to be the one that includes answers to the questions of "shortness of breath", "weakness" and "intake of loop diuretics", which allows to predict 66.7% of the results correctly at the cut‑off threshold 0, 5 has a better balance of sensitivity and specificity (54.9 and 78.6, respectively). CONCLUSION Reducing the severity of dyspnea, weakness and lack of edema of the lower extremities are important signs of the stability of the condition, both in the opinion of the doctor and in the opinion of the patient. Unlike the doctor, the patient is more likely to be classified as unstable in those cases when he is forced to receive therapy with loop diuretics at the outpatient stage or to increase their dose. The model for assessing the stability of a patient with CHF from the point of view of a physician more often allows one to confirm the patient's stable condition, while the model used by patients more often allows to identify patient instability and worsening of the course of CHF.
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Affiliation(s)
| | | | - I V Fomin
- Privolzhsky Research Medical University
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Healy L, Ledwidge M, Gallagher J, Watson C, McDonald K. Developing a disease management program for the improvement of heart failure outcomes: the do's and the don'ts. Expert Rev Cardiovasc Ther 2019; 17:267-273. [PMID: 30916595 DOI: 10.1080/14779072.2019.1596798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Heart failure is a highly prevalent condition affecting approximately 2% of people worldwide. Heart failure disease management programs (DMP) have shown a reduction in mortality and reduced hospitalization and are an established part of clinical guidelines; however, their presence is not widespread. Focusing on the application of proven therapies, patient education, diagnosis with work up of cause and easy access for clinical deterioration should be fundamental to the structure of the DMP. Multidisciplinary team care with early and timely recognition of potentially critical patients is essential, along with the inclusion of patients diagnosed in hospital as well as the community. Areas covered: The fundamental structure of a DMP along with the current gaps in evidence is outlined. Current challenges with the heart failure condition along with the current best evidence are covered. Articles were searched using MEDLINE containing the keywords; Chronic Heart Failure, Disease Management Program. We have also provided clinical opinion. Expert opinion: A multidisciplinary approach to disease management programs is essential to providing adequate care to patients. DMPs are an established part of current guidelines and should be a benchmark of treatment. Future resources should be focused on identifying patients at risk and early prevention.
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Affiliation(s)
- Liam Healy
- a Healthcare Group , St. Vincent's University Hospital , Dublin , Ireland
| | - Mark Ledwidge
- a Healthcare Group , St. Vincent's University Hospital , Dublin , Ireland
| | - Joe Gallagher
- b School of Medicine and Medical Science , University College Dublin , Dublin , Ireland
| | - Chris Watson
- a Healthcare Group , St. Vincent's University Hospital , Dublin , Ireland
| | - Kenneth McDonald
- a Healthcare Group , St. Vincent's University Hospital , Dublin , Ireland
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Abstract
BACKGROUND Despite advances in treatment, the increasing and ageing population makes heart failure an important cause of morbidity and death worldwide. It is associated with high healthcare costs, partly driven by frequent hospital readmissions. Disease management interventions may help to manage people with heart failure in a more proactive, preventative way than drug therapy alone. This is the second update of a review published in 2005 and updated in 2012. OBJECTIVES To compare the effects of different disease management interventions for heart failure (which are not purely educational in focus), with usual care, in terms of death, hospital readmissions, quality of life and cost-related outcomes. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL for this review update on 9 January 2018 and two clinical trials registries on 4 July 2018. We applied no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) with at least six months' follow-up, comparing disease management interventions to usual care for adults who had been admitted to hospital at least once with a diagnosis of heart failure. There were three main types of intervention: case management; clinic-based interventions; multidisciplinary interventions. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Outcomes of interest were mortality due to heart failure, mortality due to any cause, hospital readmission for heart failure, hospital readmission for any cause, adverse effects, quality of life, costs and cost-effectiveness. MAIN RESULTS We found 22 new RCTs, so now include 47 RCTs (10,869 participants). Twenty-eight were case management interventions, seven were clinic-based models, nine were multidisciplinary interventions, and three could not be categorised as any of these. The included studies were predominantly in an older population, with most studies reporting a mean age of between 67 and 80 years. Seven RCTs were in upper-middle-income countries, the rest were in high-income countries.Only two multidisciplinary-intervention RCTs reported mortality due to heart failure. Pooled analysis gave a risk ratio (RR) of 0.46 (95% confidence interval (CI) 0.23 to 0.95), but the very low-quality evidence means we are uncertain of the effect on mortality due to heart failure. Based on this limited evidence, the number needed to treat for an additional beneficial outcome (NNTB) is 12 (95% CI 9 to 126).Twenty-six case management RCTs reported all-cause mortality, with low-quality evidence indicating that these may reduce all-cause mortality (RR 0.78, 95% CI 0.68 to 0.90; NNTB 25, 95% CI 17 to 54). We pooled all seven clinic-based studies, with low-quality evidence suggesting they may make little to no difference to all-cause mortality. Pooled analysis of eight multidisciplinary studies gave moderate-quality evidence that these probably reduce all-cause mortality (RR 0.67, 95% CI 0.54 to 0.83; NNTB 17, 95% CI 12 to 32).We pooled data on heart failure readmissions from 12 case management studies. Moderate-quality evidence suggests that they probably reduce heart failure readmissions (RR 0.64, 95% CI 0.53 to 0.78; NNTB 8, 95% CI 6 to 13). We were able to pool only two clinic-based studies, and the moderate-quality evidence suggested that there is probably little or no difference in heart failure readmissions between clinic-based interventions and usual care (RR 1.01, 95% CI 0.87 to 1.18). Pooled analysis of five multidisciplinary interventions gave low-quality evidence that these may reduce the risk of heart failure readmissions (RR 0.68, 95% CI 0.50 to 0.92; NNTB 11, 95% CI 7 to 44).Meta-analysis of 14 RCTs gave moderate-quality evidence that case management probably slightly reduces all-cause readmissions (RR 0.92, 95% CI 0.83 to 1.01); a decrease from 491 to 451 in 1000 people (95% CI 407 to 495). Pooling four clinic-based RCTs gave low-quality and somewhat heterogeneous evidence that these may result in little or no difference in all-cause readmissions (RR 0.90, 95% CI 0.72 to 1.12). Low-quality evidence from five RCTs indicated that multidisciplinary interventions may slightly reduce all-cause readmissions (RR 0.85, 95% CI 0.71 to 1.01); a decrease from 450 to 383 in 1000 people (95% CI 320 to 455).Neither case management nor clinic-based intervention RCTs reported adverse effects. Two multidisciplinary interventions reported that no adverse events occurred. GRADE assessment of moderate quality suggested that there may be little or no difference in adverse effects between multidisciplinary interventions and usual care.Quality of life was generally poorly reported, with high attrition. Low-quality evidence means we are uncertain about the effect of case management and multidisciplinary interventions on quality of life. Four clinic-based studies reported quality of life but we could not pool them due to differences in reporting. Low-quality evidence indicates that clinic-based interventions may result in little or no difference in quality of life.Four case management programmes had cost-effectiveness analyses, and seven reported cost data. Low-quality evidence indicates that these may reduce costs and may be cost-effective. Two clinic-based studies reported cost savings. Low-quality evidence indicates that clinic-based interventions may reduce costs slightly. Low-quality data from one multidisciplinary intervention suggested this may be cost-effective from a societal perspective but less so from a health-services perspective. AUTHORS' CONCLUSIONS We found limited evidence for the effect of disease management programmes on mortality due to heart failure, with few studies reporting this outcome. Case management may reduce all-cause mortality, and multidisciplinary interventions probably also reduce all-cause mortality, but clinic-based interventions had little or no effect on all-cause mortality. Readmissions due to heart failure or any cause were probably reduced by case-management interventions. Clinic-based interventions probably make little or no difference to heart failure readmissions and may result in little or no difference in readmissions for any cause. Multidisciplinary interventions may reduce the risk of readmission for heart failure or for any cause. There was a lack of evidence for adverse effects, and conclusions on quality of life remain uncertain due to poor-quality data. Variations in study location and time of occurrence hamper attempts to review costs and cost-effectiveness.The potential to improve quality of life is an important consideration but remains poorly reported. Improved reporting in future trials would strengthen the evidence for this patient-relevant outcome.
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Affiliation(s)
- Andrea Takeda
- University College LondonInstitute of Health Informatics ResearchLondonUK
| | - Nicole Martin
- University College LondonInstitute of Health Informatics ResearchLondonUK
| | - Rod S Taylor
- University of Exeter Medical SchoolInstitute of Health ResearchSouth Cloisters, St Luke's Campus, Heavitree RoadExeterUKEX2 4SG
| | - Stephanie JC Taylor
- Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonCentre for Primary Care and Public Health and Asthma UK Centre for Applied ResearchYvonne Carter Building58 Turner StreetLondonUKE1 2AB
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Groenewegen A, Rutten FH. Near-home heart failure care. Eur J Heart Fail 2018; 21:110-111. [PMID: 30520538 DOI: 10.1002/ejhf.1345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Amy Groenewegen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Liljeroos M, Strömberg A. Introducing nurse-led heart failure clinics in Swedish primary care settings. Eur J Heart Fail 2018; 21:103-109. [PMID: 30338881 DOI: 10.1002/ejhf.1329] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/02/2018] [Accepted: 09/10/2018] [Indexed: 12/28/2022] Open
Abstract
AIM According to clinical guidelines, it is recommended that patients with heart failure (HF) receive structured multidisciplinary care at nurse-led HF clinics in order to optimise treatment and avoid preventable readmissions. Today, there are HF clinics with specialist-trained nurses at almost all Swedish hospitals, but HF clinics remain scarce in primary care (PC). The aim of this study was two-fold: firstly, to evaluate the effects of systematically implementing nurse-led HF clinics in PC settings with regard to hospital healthcare utilisation and evidence-based HF treatment, and secondly to explore patients' experiences of HF clinics in PC. METHODS AND RESULTS The study had a pre-post design. Annual measurement were done between 2010-2017 regarding in-hospital healthcare consumption and medical treatment. Data from 2011-2017 after the implementation of HF clinics in PC in one county council Sweden were compared with baseline data collected before the implementation in 2010. The implementation of HF clinics in PC significantly reduced the number of HF-related hospital admissions by 27% (P < 0.001), HF hospital days by 27.3% (P < 0.001) and HF emergency room visits by 24% (P < 0.001). Further, patients were to a higher extent medically treated according to guidelines and satisfied with the care they received at the PC HF clinic. CONCLUSION Nurse-led HF clinics in PC seem to be effective in reducing the need for in-hospital care and provide high quality person-centred care.
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Affiliation(s)
- Maria Liljeroos
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Anna Strömberg
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Cardiology, Linköping University, Linköping, Sweden.,Sue & Bill Gross School of Nursing, University of California Irvine, CA, USA
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Säfström E, Jaarsma T, Strömberg A. Continuity and utilization of health and community care in elderly patients with heart failure before and after hospitalization. BMC Geriatr 2018; 18:177. [PMID: 30103688 PMCID: PMC6090801 DOI: 10.1186/s12877-018-0861-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/11/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The period after hospitalization due to deteriorated heart failure (HF) is characterized as a time of high generalized risk. The transition from hospital to home is often problematic due to insufficient coordination of care, leading to a fragmentation of care rather than a seamless continuum of care. The aim was to describe health and community care utilization prior to and 30 days after hospitalization, and the continuity of care in patients hospitalized due to de novo or deteriorated HF from the patients' perspective and from a medical chart review. METHODS This was a cross-sectional study with consecutive inclusion of patients hospitalized at a county hospital in Sweden due to deteriorated HF during 2014. Data were collected by structured telephone interviews and medical chart review and analyzed with the Spearman's rank correlation coefficient and Chi square. A P value of 0.05 was considered significant. RESULTS A total of 121 patients were included in the study, mean age 82.5 (±6.8) and 49% were women. Half of the patients had not visited any health care facility during the month prior to the index hospital admission, and 79% of the patients visited the emergency room (ER) without a referral. Among these elderly patients, a total of 40% received assistance at home prior to hospitalization and 52% after discharge. A total of 86% received written discharge information, one third felt insecure after hospitalization and lacked knowledge of which health care provider to consult with and contact in the event of deterioration or complications. Health care utilization increased significantly after hospitalization. CONCLUSION Most patients had not visited any health care facility within 30 days before hospitalization. Health care utilization increased significantly after hospitalization. Flaws in the continuity of care were found; even though most patients received written information at discharge, one third of the patients lacked knowledge about which health care provider to contact in the event of deterioration and felt insecure at home after discharge.
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Affiliation(s)
- Emma Säfström
- Sörmland County Council, Nyköping Hospital, Nyköping, Sweden
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Anna Strömberg
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University, Linköping, Sweden
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32
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El Hadidi S, Darweesh E, Byrne S, Bermingham M. A tool for assessment of heart failure prescribing quality: A systematic review and meta-analysis. Pharmacoepidemiol Drug Saf 2018; 27:685-694. [PMID: 29659109 DOI: 10.1002/pds.4430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 02/13/2018] [Accepted: 02/25/2018] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Heart failure (HF) guidelines aim to standardise patient care. Internationally, prescribing practice in HF may deviate from guidelines and so a standardised tool is required to assess prescribing quality. A systematic review and meta-analysis were performed to identify a quantitative tool for measuring adherence to HF guidelines and its clinical implications. METHODS Eleven electronic databases were searched to include studies reporting a comprehensive tool for measuring adherence to prescribing guidelines in HF patients aged ≥18 years. Qualitative studies or studies measuring prescription rates alone were excluded. Study quality was assessed using the Good ReseArch for Comparative Effectiveness Checklist. RESULTS In total, 2455 studies were identified. Sixteen eligible full-text articles were included (n = 14 354 patients, mean age 69 ± 8 y). The Guideline Adherence Index (GAI), and its modified versions, was the most frequently cited tool (n = 13). Other tools identified were the Individualised Reconciled Evidence Recommendations, the Composite Heart Failure Performance, and the Heart Failure Scale. The meta-analysis included the GAI studies of good to high quality. The average GAI-3 was 62%. Compared to low GAI, high GAI patients had lower mortality rate (7.6% vs 33.9%) and lower rehospitalisation rates (23.5% vs 24.5%); both P ≤ .05. High GAI was associated with reduced risk of mortality (hazard ratio = 0.29, 95% confidence interval, 0.06-0.51) and rehospitalisation (hazard ratio = 0.64, 95% confidence interval, 0.41-1.00). No tool was used to improve prescribing quality. CONCLUSION The GAI is the most frequently used tool to assess guideline adherence in HF. High GAI is associated with improved HF outcomes.
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Affiliation(s)
- Seif El Hadidi
- School of Pharmacy, University College Cork, Cork, Ireland.,Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt, New Cairo, Cairo, Egypt
| | - Ebtissam Darweesh
- Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt, New Cairo, Cairo, Egypt
| | - Stephen Byrne
- School of Pharmacy, University College Cork, Cork, Ireland
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Ferrari R, Bueno H, Chioncel O, Cleland JG, Stough WG, Lettino M, Metra M, Parissis JT, Pinto F, Ponikowski P, Ruschitzka F, Tavazzi L. Acute heart failure: lessons learned, roads ahead. Eur J Heart Fail 2018. [DOI: 10.1002/ejhf.1169] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Roberto Ferrari
- Department of Cardiology and LTTA Centre; University Hospital of Ferrara; Ferrara Italy
- Maria Cecilia Hospital, GVM Care & Research; E.S. Health Science Foundation; Cotignola Italy
| | - Héctor Bueno
- Department of Cardiology; Hospital 12 de Octubre; Madrid Spain
| | - Ovidiu Chioncel
- University of Medicine Carol Davila Bucuresti; Institutul de Urgente Boli Cardiovasculare CC; Iliescu Romania
| | - John G. Cleland
- National Heart & Lung Institute; Harefield Hospital, Imperial College; London UK
| | - Wendy Gattis Stough
- Departments of Pharmacy Practice and Clinical Research; Campbell University College of Pharmacy and Health Sciences; Cary NC USA
| | | | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health; University of Brescia; Brescia Italy
| | | | - Fausto Pinto
- Departamento de Cardiologia, CCUL, CAML, Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - Piotr Ponikowski
- Medical University, Centre for Heart Disease; Clinical Military Hospital; Wroclaw Poland
| | - Frank Ruschitzka
- Department of Cardiology; University Heart Center; Zürich Switzerland
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research; E.S. Health Science Foundation; Cotignola Italy
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34
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Krueger K, Griese-Mammen N, Schubert I, Kieble M, Botermann L, Laufs U, Kloft C, Schulz M. In search of a standard when analyzing medication adherence in patients with heart failure using claims data: a systematic review. Heart Fail Rev 2017; 23:63-71. [DOI: 10.1007/s10741-017-9656-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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35
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Ducharme A. Do Heart Failure Clinics Have to Reinvent Themselves to Remain Germane? Can J Cardiol 2017; 33:1212-1214. [DOI: 10.1016/j.cjca.2017.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 07/11/2017] [Accepted: 07/11/2017] [Indexed: 10/19/2022] Open
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36
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Multidisciplinary Heart Failure Clinics Are Associated With Lower Heart Failure Hospitalization and Mortality: Systematic Review and Meta-analysis. Can J Cardiol 2017; 33:1237-1244. [DOI: 10.1016/j.cjca.2017.05.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 05/16/2017] [Accepted: 05/16/2017] [Indexed: 11/15/2022] Open
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37
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De Regge M, De Pourcq K, Meijboom B, Trybou J, Mortier E, Eeckloo K. The role of hospitals in bridging the care continuum: a systematic review of coordination of care and follow-up for adults with chronic conditions. BMC Health Serv Res 2017; 17:550. [PMID: 28793893 PMCID: PMC5551032 DOI: 10.1186/s12913-017-2500-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 08/02/2017] [Indexed: 12/19/2022] Open
Abstract
Background Multiple studies have investigated the outcome of integrated care programs for chronically ill patients. However, few studies have addressed the specific role hospitals can play in the downstream collaboration for chronic disease management. Our objective here is to provide a comprehensive overview of the role of the hospitals by synthesizing the advantages and disadvantages of hospital interference in the chronic discourse for chronically ill patients found in published empirical studies. Method Systematic literature review. Two reviewers independently investigated relevant studies using a standardized search strategy. Results Thirty-two articles were included in the systematic review. Overall, the quality of the included studies is high. Four important themes were identified: the impact of transitional care interventions initiated from the hospital’s side, the role of specialized care settings, the comparison of inpatient and outpatient care, and the effect of chronic care coordination on the experience of patients. Conclusion Our results show that hospitals can play an important role in transitional care interventions and the coordination of chronic care with better outcomes for the patients by taking a leading role in integrated care programs. Above that, the patient experiences are positively influenced by the coordinating role of a specialist. Specialized care settings, as components of the hospital, facilitate the coordination of the care processes. In the future, specialized care centers and primary care could play a more extensive role in care for chronic patients by collaborating.
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Affiliation(s)
- Melissa De Regge
- Faculty of Economics and Business Administration, Department of Innovation, Entrepreneurship, and Service Management, Ghent University, Tweekerkenstraat 2, B-9000, Ghent, Belgium. .,Department of Strategic Policy Cell, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Kaat De Pourcq
- Faculty of Economics and Business Administration, Department of Innovation, Entrepreneurship, and Service Management, Ghent University, Tweekerkenstraat 2, B-9000, Ghent, Belgium
| | - Bert Meijboom
- Faculty of Economics, Department of Management, Tilburg University, Tilburg, The Netherlands.,Department Tranzo, Tilburg University, Tilburg, The Netherlands
| | - Jeroen Trybou
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Ghent, Belgium
| | - Eric Mortier
- Faculty of Medicine and Health Sciences, Department of Anaesthesiology, Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Kristof Eeckloo
- Department of Strategic Policy Cell, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Ghent, Belgium
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38
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Rutten FH, Gallagher J. What the General Practitioner Needs to Know About Their Chronic Heart Failure Patient. Card Fail Rev 2017; 2:79-84. [PMID: 28785457 DOI: 10.15420/cfr.2016:18:1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In this article we highlight what general practitioners (GPs) need to know about heart failure (HF). We pay attention to its definition, diagnosis - with risks of under- and over-diagnosis - and the role natriuretic peptides, electrocardiography, echocardiography, but also spirometry. We stress the role of the GP in case finding and risk stratification with optimisation of cardiovascular drug use in high-risk groups. Epidemiological data are provided, followed by discussion of the management aspects and possibilities of cooperative care of patients with chronic HF, focussing on pharmacological treatment, comorbidities and end-of-life care. This article highlights the experience and clinical practice of the authors: specifics of local heart failure management, and the role of the GP, will naturally vary.
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Affiliation(s)
- Frans H Rutten
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | - Joe Gallagher
- Department of General Practice, Health Research Group, University College Dublin, Dublin, Ireland
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Gallagher J, James S, Keane C, Fitzgerald A, Travers B, Quigley E, Hecht C, Zhou S, Watson C, Ledwidge M, McDonald K. Heart Failure Virtual Consultation: bridging the gap of heart failure care in the community - A mixed-methods evaluation. ESC Heart Fail 2017; 4:252-258. [PMID: 28772044 PMCID: PMC5542774 DOI: 10.1002/ehf2.12163] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/04/2017] [Accepted: 03/09/2017] [Indexed: 12/11/2022] Open
Abstract
Aims We undertook a mixed‐methods evaluation of a Web‐based conferencing service (virtual consult) between general practitioners (GPs) and cardiologists in managing patients with heart failure in the community to determine its effect on use of specialist heart failure services and acceptability to GPs. Methods and results All cases from June 2015 to October 2016 were recorded using a standardized recording template, which recorded patient demographics, medical history, medications, and outcome of the virtual consult for each case. Quantitative surveys and qualitative interviewing of 17 participating GPs were also undertaken. During this time, 142 cases were discussed—68 relating to a new diagnosis of heart failure, 53 relating to emerging deterioration in a known heart failure patient, and 21 relating to therapeutic issues. Only 17% required review in outpatient department following the virtual consultation. GPs reported increased confidence in heart failure management, a broadening of their knowledge base, and a perception of overall better patient outcomes. Conclusions These data from an initial experience with Heart Failure Virtual Consultation present a very positive impact of this strategy on the provision of heart failure care in the community and acceptability to users. Further research on the implementation and expansion of this strategy is warranted.
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Affiliation(s)
- Joseph Gallagher
- Heart Failure Unit, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Stephanie James
- Heart Failure Unit, St Vincent's University Hospital, Dublin, Ireland.,St Vincent's University Hospital Group, Dublin, Ireland
| | - Ciara Keane
- Heart Failure Unit, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Annie Fitzgerald
- Heart Failure Unit, St Vincent's University Hospital, Dublin, Ireland.,St Vincent's University Hospital Group, Dublin, Ireland
| | - Bronagh Travers
- Heart Failure Unit, St Vincent's University Hospital, Dublin, Ireland.,St Vincent's University Hospital Group, Dublin, Ireland
| | - Etain Quigley
- Heart Failure Unit, St Vincent's University Hospital, Dublin, Ireland.,Applied Research for Connected Health, NexusUCD, Dublin, Ireland
| | - Christina Hecht
- Heart Failure Unit, St Vincent's University Hospital, Dublin, Ireland.,Applied Research for Connected Health, NexusUCD, Dublin, Ireland
| | - Shuaiwei Zhou
- Heart Failure Unit, St Vincent's University Hospital, Dublin, Ireland.,Heartbeat Trust, Dun Laoghaire, Dublin, Ireland
| | - Chris Watson
- Heart Failure Unit, St Vincent's University Hospital, Dublin, Ireland.,Queen's University, Belfast, UK
| | - Mark Ledwidge
- Heart Failure Unit, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,Heartbeat Trust, Dun Laoghaire, Dublin, Ireland
| | - Kenneth McDonald
- Heart Failure Unit, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,St Vincent's University Hospital Group, Dublin, Ireland.,Heartbeat Trust, Dun Laoghaire, Dublin, Ireland
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Morbach C, Wagner M, Güntner S, Malsch C, Oezkur M, Wood D, Kotseva K, Leyh R, Ertl G, Karmann W, Heuschmann PU, Störk S. Heart failure in patients with coronary heart disease: Prevalence, characteristics and guideline implementation - Results from the German EuroAspire IV cohort. BMC Cardiovasc Disord 2017; 17:108. [PMID: 28476146 PMCID: PMC5420109 DOI: 10.1186/s12872-017-0543-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 04/28/2017] [Indexed: 01/10/2023] Open
Abstract
Background Adherence to pharmacotherapeutic treatment guidelines in patients with heart failure (HF) is of major prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Our aim was to investigate prevalence and characteristics of HF in patients with coronary heart disease (CHD), and to assess the adherence to current HF guidelines in patients with HF stage C, thus identifying potential targets for the optimization of guideline implementation. Methods Patients from the German sample of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EuroAspire) IV survey with a hospitalization for CHD within the previous six to 36 months providing valid data on echocardiography as well as on signs and symptoms of HF were categorized into stages of HF: A, prevalence of risk factors for developing HF; B, asymptomatic but with structural heart disease; C, symptomatic HF. A Guideline Adherence Indicator (GAI-3) was calculated for patients with reduced (≤40%) left ventricular ejection fraction (HFrEF) as number of drugs taken per number of drugs indicated; beta-blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, and mineralocorticoid receptor antagonists (MRA) were considered. Results 509/536 patients entered analysis. HF stage A was prevalent in n = 20 (3.9%), stage B in n = 264 (51.9%), and stage C in n = 225 (44.2%) patients; 94/225 patients were diagnosed with HFrEF (42%). Stage C patients were older, had a longer duration of CHD, and a higher prevalence of arterial hypertension. Awareness of pre-diagnosed HF was low (19%). Overall GAI-3 of HFrEF patients was 96.4% with a trend towards lower GAI-3 in patients with lower LVEF due to less thorough MRA prescription. Conclusions In our sample of CHD patients, prevalence of HF stage C was high and a sizable subgroup suffered from HFrEF. Overall, pharmacotherapy was fairly well implemented in HFrEF patients, although somewhat worse in patients with more reduced ejection fraction. Two major targets were identified possibly suited to further improve the implementation of HF guidelines: 1) increase patients´ awareness of diagnosis and importance of HF; and 2) disseminate knowledge about the importance of appropriately implementing the use of mineralocorticoid receptor antagonists. Trial registration This is a cross-sectional analysis of a non-interventional study. Therefore, it was not registered as an interventional trial.
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Affiliation(s)
- Caroline Morbach
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Department of Medicine I, University Hospital of Würzburg, Wuerzburg, Germany
| | - Martin Wagner
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Wuerzburg, Germany
| | - Stefan Güntner
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Department of Medicine I, University Hospital of Würzburg, Wuerzburg, Germany
| | - Carolin Malsch
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Wuerzburg, Germany
| | - Mehmet Oezkur
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Department of Cardiovascular Surgery, University Hospital Würzburg, Wuerzburg, Germany
| | - David Wood
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Kornelia Kotseva
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.,Department of Public Health, University of Ghent, Ghent, Belgium
| | - Rainer Leyh
- Department of Cardiovascular Surgery, University Hospital Würzburg, Wuerzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Department of Medicine I, University Hospital of Würzburg, Wuerzburg, Germany
| | - Wolfgang Karmann
- Department of Medicine, Klinik Kitzinger Land, Kitzingen, Germany
| | - Peter U Heuschmann
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Wuerzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany. .,Department of Medicine I, University Hospital of Würzburg, Wuerzburg, Germany.
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Sionis A, Sionis Green A, Manito Lorite N, Bueno H, Coca Payeras A, Díaz Molina B, González Juanatey JR, Ruilope Urioste LM, Zamorano Gómez JL, Almenar Bonet L, Ariza Solé A, Bover Freire R, Lambert Rodríguez JL, López de Sá E, López Fernández S, Martín Asenjo R, Mirabet Pérez S, Pascual Figal D, Segovia Cubero J, Varela Román A, San Román Calvar JA, Alfonso Manterola F, Arribas Ynsaurriaga F, Evangelista Masip A, Ferreira González I, Jiménez Navarro M, Marin Ortuño F, Pérez de Isla L, Rodríguez Padial L, Sánchez Fernández PL, Sionis Green A, Vázquez García R. Comments on the 2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure. ACTA ACUST UNITED AC 2017; 69:1119-1125. [PMID: 27894486 DOI: 10.1016/j.rec.2016.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 09/26/2016] [Indexed: 12/20/2022]
Affiliation(s)
- A Sionis
- Departamento de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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42
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McDonald K, Gallagher J. The practice gap in heart failure-the elephant in the room. Eur J Heart Fail 2017; 19:301-303. [DOI: 10.1002/ejhf.734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/22/2016] [Accepted: 11/16/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- Kenneth McDonald
- Heart Failure Unit; St Vincent's University Hospital; Elm Park Dublin 4 Ireland
| | - Joe Gallagher
- School of Medicine; University College Dublin; Ireland
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Abstract
Large-scale randomised controlled trials (RCTs) have demonstrated that angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and beta-blockers decrease mortality and hospitalisation in patients with heart failure (HF) associated with a reduced left ventricular ejection fraction. This has led to high prescription rates; however, these drugs are generally prescribed at much lower doses than the doses achieved in the RCTs. A number of strategies have been evaluated to improve medication titration in HF, including forced medication up-titration protocols, point-of-care decision support and extended scope of clinical practice for nurses and pharmacists. Most successful strategies have been multifaceted and have adapted existing multidisciplinary models of care. Furthermore, given the central role of general practitioners in long-term monitoring and care coordination in HF patients, these strategies should engage with primary care to facilitate the transition between the acute and primary healthcare sectors.
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Affiliation(s)
- John J Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital,Brisbane, Queensland, Australia.,School of Medicine, University of Queensland,Brisbane, Queensland, Australia
| | - Annabel Hickey
- Advanced Heart Failure and Cardiac Transplant Unit, The Prince Charles Hospital,Brisbane, Queensland, Australia
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44
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Riley JP, Masters J. Practical multidisciplinary approaches to heart failure management for improved patient outcome. Eur Heart J Suppl 2016. [DOI: 10.1093/eurheartj/suw046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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45
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Sionis A, Sionis Green A, Manito Lorite N, Bueno H, Coca Payeras A, Díaz Molina B, González Juanatey JR, Ruilope Urioste LM, Zamorano Gómez JL, Almenar Bonet L, Ariza Solé A, Bover Freire R, Lambert Rodríguez JL, López de Sá E, López Fernández S, Martín Asenjo R, Mirabet Pérez S, Pascual Figal D, Segovia Cubero J, Varela Román A, San Román Calvar JA, Alfonso Manterola F, Arribas Ynsaurriaga F, Evangelista Masip A, Ferreira González I, Jiménez Navarro M, Marin Ortuño F, Pérez de Isla L, Rodríguez Padial L, Sánchez Fernández PL, Sionis Green A, Vázquez García R. Comentarios a la guía ESC 2016 sobre el diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.09.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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46
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Hickey A, Suna J, Marquart L, Denaro C, Javorsky G, Munns A, Mudge A, Atherton JJ. Improving medication titration in heart failure by embedding a structured medication titration plan. Int J Cardiol 2016; 224:99-106. [DOI: 10.1016/j.ijcard.2016.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/19/2016] [Accepted: 09/01/2016] [Indexed: 11/28/2022]
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47
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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48
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- awyx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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49
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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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50
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37:2129-2200. [PMID: 27206819 DOI: 10.1093/eurheartj/ehw128] [Citation(s) in RCA: 8876] [Impact Index Per Article: 1109.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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