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Roubille F, Mercier G, Lancman G, Pasche H, Alami S, Delval C, Bessou A, Vadel J, Rey A, Duret S, Abraham E, Chatellier G, Durand Zaleski I. Weight telemonitoring of heart failure versus standard of care in a real-world setting: Results on mortality and hospitalizations in a 6-month nationwide matched cohort study. Eur J Heart Fail 2024; 26:1201-1214. [PMID: 38450858 DOI: 10.1002/ejhf.3191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024] Open
Abstract
AIMS Evaluating the benefit of telemonitoring in heart failure (HF) management in real-world settings is crucial for optimizing the healthcare pathway. The aim of this study was to assess the association between a 6-month application of the telemonitoring solution Chronic Care Connect™ (CCC) and mortality, HF hospitalizations, and associated costs compared with standard of care (SOC) in patients with a diagnosis of HF. METHODS AND RESULTS From February 2018 to March 2020, a retrospective cohort study was conducted using the largest healthcare insurance system claims database in France (Système National des Données de Santé) linked to the CCC telemonitoring database of adult patients with an ICD-10-coded diagnosis of HF. Patients from the telemonitoring group were matched with up to two patients from the SOC group based on their high-dimensional propensity score, without replacement, using the nearest-neighbour method. A total of 1358 telemonitored patients were matched to 2456 SOC patients. The cohorts consisted of high-risk patients with median times from last HF hospitalization to index date of 17.0 (interquartile range: 7.0-66.0) days for the telemonitoring group and 27.0 (15.0-70.0) days for the SOC group. After 6 months, telemonitoring was associated with mortality risk reduction (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.56-0.89), a higher risk of first HF hospitalization (HR 1.81, 95% CI 1.55-2.13), and higher HF healthcare costs (relative cost 1.38, 95% CI 1.26-1.51). Compared with the SOC group, the telemonitoring group experienced a shorter average length of overnight HF hospitalization and fewer emergency visits preceding HF hospitalizations. CONCLUSION The results of this nationwide cohort study highlight a valuable role for telemonitoring solutions such as CCC in the management of high-risk HF patients. However, for telemonitoring solutions based on weight and symptoms, consideration should be given to implement additional methods of assessment to recognize imminent worsening of HF, such as impedance changes, as a way to reduce mortality risk and the need for HF hospitalizations. Further studies are warranted to refine selection of patients who could benefit from a telemonitoring system and to confirm long-term benefits in high-risk and stable HF patients.
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Affiliation(s)
- François Roubille
- Cardiology Department, Hôpital Lapeyronie, PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU, INI-CRT, Montpellier, France
| | - Grégoire Mercier
- Economic Evaluation Unit (URME), University Hospital of Montpellier, Montpellier, France
- IDESP, Université de Montpellier, INSERM, Montpellier, France
| | | | | | - Sarah Alami
- Air Liquide Santé International, Bagneux, France
| | | | | | | | | | | | | | - Gilles Chatellier
- Department of Statistics Informatics and Public Health, Université Paris-Cité, Paris, France
- Clinical Research Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Isabelle Durand Zaleski
- Université de Paris, CRESS, INSERM, INRA, URCEco, AP-HP, Hôpital de l'Hôtel Dieu, Paris, France
- Santé Publique Hôpital Henri Mondor, Créteil, France
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Bonilla-Palomas JL, Anguita-Sánchez M, Fernández-Pérez C, Bernal-Sobrino JL, García M, Prado N, Rosillo N, Pérez-Villacastín J, Gómez-Doblas JJ, Elola-Somoza FJ. [Hospital admissions and outcomes for systolic and diastolic heart failure in Spain between 2016 and 2019: A population-based study]. Med Clin (Barc) 2024; 162:213-219. [PMID: 37981482 DOI: 10.1016/j.medcli.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/04/2023] [Accepted: 10/07/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND AND PURPOSE In Spain there is a lack of population data that specifically compare hospitalization for systolic and diastolic heart failure (HF). We assessed clinical characteristics, in-hospital mortality and 30-day cardiovascular readmission rates differentiating by HF type. METHODS We conducted a retrospective observational study of patients discharged with the principal diagnosis of HF from The National Health System' acute hospital during 2016-2019, distinguishing between systolic and diastolic HF. The source of the data was the Minimum Basic Data Set. The risk-standardized in-hospital mortality ratio and risk-standardized 30-day cardiovascular readmission ratio were calculated using multilevel risk adjustment models. RESULTS The 190,200 episodes of HF were selected. Of these, 163,727 (86.1%) were classified as diastolic HF and were characterized by older age, higher proportion of women, diabetes mellitus, dementia and renal failure than those with systolic HF. In the multilevel risk adjustment models, diastolic HF was a protective factor for both in-hospital mortality (odds ratio [OR]: 0.79; 95% confidence interval [CI]: 0.75-0.83; P<.001) and 30-day cardiovascular readmission versus systolic HF (OR: 0.93; 95% CI: 0.88-0.97; P=.002). CONCLUSIONS In Spain, between 2016 and 2019, hospitalization episodes for HF were mostly due to diastolic HF. According to the multilevel risk adjustment models, diastolic HF compared to systolic HF was a protective factor for both in-hospital mortality and 30-day cardiovascular readmission.
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Affiliation(s)
| | | | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, España; Departamento de Medicina Preventiva, Área Sanitaria de Santiago de Compostela y Barbanza, Instituto de Investigación de Santiago, Santiago de Compostela, La Coruña, España
| | - José Luis Bernal-Sobrino
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, España; Departamento de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, España
| | - María García
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, España
| | - Náyade Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, España
| | - Nicolás Rosillo
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, España
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Daubert C. Heart failure: A major public health problem. Presse Med 2024; 53:104224. [PMID: 38340897 DOI: 10.1016/j.lpm.2024.104224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
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Ketabi M, Andishgar A, Fereidouni Z, Sani MM, Abdollahi A, Vali M, Alkamel A, Tabrizi R. Predicting the risk of mortality and rehospitalization in heart failure patients: A retrospective cohort study by machine learning approach. Clin Cardiol 2024; 47:e24239. [PMID: 38402566 PMCID: PMC10894620 DOI: 10.1002/clc.24239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/17/2024] [Accepted: 02/09/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Heart failure (HF) is a global problem, affecting more than 26 million people worldwide. This study evaluated the performance of 10 machine learning (ML) algorithms and chose the best algorithm to predict mortality and readmission of HF patients by using The Fasa Registry on Systolic HF (FaRSH) database. HYPOTHESIS ML algorithms may better identify patients at increased risk of HF readmission or death with demographic and clinical data. METHODS Through comprehensive evaluation, the best-performing model was used for prediction. Finally, all the trained models were applied to the test data, which included 20% of the total data. For the final evaluation and comparison of the models, five metrics were used: accuracy, F1-score, sensitivity, specificity and Area Under Curve (AUC). RESULTS Ten ML algorithms were evaluated. The CatBoost (CAT) algorithm uses a series of decision tree models to create a nonlinear model, and this CAT algorithm performed the best of the 10 models studied. According to the three final outcomes from this study, which involved 2488 participants, 366 (14.7%) of the patients were readmitted to the hospital, 97 (3.9%) of the patients died within 1 month of the follow-up, and 342 (13.7%) of the patients died within 1 year of the follow-up. The most significant variables to predict the events were length of stay in the hospital, hemoglobin level, and family history of MI. CONCLUSIONS The ML-based risk stratification tool was able to assess the risk of 5-year all-cause mortality and readmission in patients with HF. ML could provide an explicit explanation of individualized risk prediction and give physicians an intuitive understanding of the influence of critical features in the model.
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Affiliation(s)
- Marzieh Ketabi
- Student Research CommitteeFasa University of Medical SciencesFasaIran
| | | | - Zhila Fereidouni
- Department of Medical Surgical NursingFasa University of Medical ScienceFarsIran
| | | | - Ashkan Abdollahi
- School of MedicineShiraz University of Medical SciencesShirazIran
| | - Mohebat Vali
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Abdulhakim Alkamel
- Noncommunicable Diseases Research CenterFasa University of Medical ScienceFasaIran
| | - Reza Tabrizi
- Noncommunicable Diseases Research CenterFasa University of Medical ScienceFasaIran
- Clinical Research Development UnitFasa University of Medical SciencesFasaIran
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Dacunka M, Sanchez S, Raoul F, Chapoutot L, Maillier B, Marchais A. [Republication of: Evaluation of the implementation of the 2021 guidelines of the European Society of Cardiology for heart failure with reduced ejection fraction in patients aged over 75]. Ann Cardiol Angeiol (Paris) 2023; 72:101680. [PMID: 37839136 DOI: 10.1016/j.ancard.2023.101680] [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: 10/17/2023]
Abstract
INTRODUCTION Heart failure is a frequent pathology with a poor prognosis which mainly concerns elderly patients. The recommandations concerning the pharmagical treatment in heart failure with LVEF are reduced on randomized trials carried out on a young population. The aim of this work is to evaluate their application on a population aged ≥ 75. MATERIALS AND METHODS This is a retrospective, bicentric cohort, concerning patients hospitalized between September 1, 2021 and March 31, 2023, at the hospital centers of Troyes and Romilly sur Seine. The primary endpoint was a composite endpoint combining rehospitalisation rate or all-cause death rate at 6 months. RESULTS A group of 81 patients was included in the study. The average number of treatments is associated with a significant reduction in the rate of hospitalisations ord deaths at 6 months (p = 0,005); as it concerns the level of titration, the analysing comparing the "therapeutic inertia" group and the "current titration/maximum tolerated dose" group did not reveal any significant difference (p = 0,169). CONCLUSION Our study highlighted the potential positive impact of the application of the latest ESC recommendations concerning first-line drug treatment on the rate of rehospitalisation or death from all causes, in patients with heart failure reduced LVEF aged over 75.
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Affiliation(s)
- Marianne Dacunka
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
| | - Stéphane Sanchez
- Pôle territoriale Santé Publique et Performance, Centre Hospitalier de Troyes, Troyes France; Vieillissement fragilité, Université de Reims Champagne-Ardenne, Reims, EA3797 France.
| | - Florian Raoul
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
| | - Laurent Chapoutot
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
| | - Bruno Maillier
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
| | - Aurélie Marchais
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
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Chemouni F, Nishikawa TC, Groyer H, Diaby O, Chollet J, Ittah D. Hospital Resource Utilization and Costs in Patients with Heart Failure in France. PHARMACOECONOMICS - OPEN 2023; 7:927-940. [PMID: 37713172 PMCID: PMC10721763 DOI: 10.1007/s41669-023-00431-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Heart failure (HF) is one of the leading causes of morbidity and mortality, and economic burden on the healthcare system. The aim of this study was to estimate the current hospital resource utilization and costs for HF patients in France. METHODS This retrospective cohort study included adult HF patients hospitalized in France between January 1, 2019 and December 31, 2019. Data related to sociodemographic characteristics, number and duration of hospital stays, use of medical procedures or expensive and innovative drugs/medical devices included in the "liste-en-sus", and comorbidities were retrieved from the French national hospital discharge database. Data were further stratified based on the presence or absence of cardiac decompensation, comorbidities, ejection fraction (EF) status, and incident/prevalent patients. RESULTS In 2019, a total of 430,544 patients were hospitalized in France with HF as a primary or associated diagnosis, with 51.9% male and 48.1% female and a mean age of 79.0 years. More than 75% of the study population was composed of prevalent HF patients. About 3.1% of patients were diagnosed with at least one event of cardiac decompensation during follow-up. Also, 20.2% and 9.9% of patients were identified with preserved and reduced EFs, respectively. The average number and length of hospital stays were 1.7 per patient and 10.4 days per patient, respectively. The annual cost of hospitalization for HF was €8341.3 per patient. Presence of cardiac decompensation at index date or during follow-up, reduced EF, and comorbidities were associated with numerically higher frequency and length of hospitalization, and hospitalization cost. For hospitalization and 'liste-en-sus' medical devices, higher cost was observed in incident than prevalent HF patients, while for 'liste-en-sus' drugs, higher cost was reported in prevalent than incident HF patients. CONCLUSION This study highlighted the high economic hospital burden of HF in France. More studies investigating different HF patient profiles must be conducted to help determine the main factors of hospital cost for HF.
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Affiliation(s)
- Frank Chemouni
- Grand Hôpital de l'Est Francilien, site de Marne-la-Vallée, 2-4 Cours de la Gondoire, 77600, Jossigny, France
| | | | - Harinala Groyer
- Boehringer Ingelheim France, 100-104 avenue de France, 75013, Paris, France
| | - Oumou Diaby
- IQVIA, Real World Solutions France, 17 bis Place des Reflets, 92026, Courbevoie, France
| | - Julien Chollet
- Boehringer Ingelheim France, 100-104 avenue de France, 75013, Paris, France
| | - Deborah Ittah
- Boehringer Ingelheim France, 100-104 avenue de France, 75013, Paris, France
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Dacunka M, Sanchez S, Raoul F, Chapoutot L, Maillier B, Marchais A. [Evaluation of the implementation of the 2021 guidelines of the European Society of Cardiology for heart failure with reduced ejection fraction in patients aged over 75]. Ann Cardiol Angeiol (Paris) 2023; 72:101646. [PMID: 37689044 DOI: 10.1016/j.ancard.2023.101646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/04/2023] [Accepted: 08/16/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION Heart failure is a frequent pathology with a poor prognosis which mainly concerns elderly patients. The recommandations concerning the pharmagical treatment in heart failure with LVEF are reduced on randomized trials carried out on a young population. The aim of this work is to evaluate their application on a population aged ≥ 75. MATERIALS AND METHODS This is a retrospective, bicentric cohort, concerning patients hospitalized between September 1, 2021 and March 31, 2023, at the hospital centers of Troyes and Romilly sur Seine. The primary endpoint was a composite endpoint combining rehospitalisation rate or all-cause death rate at 6 months. RESULTS A group of 81 patients was included in the study. The average number of treatments is associated with a significant reduction in the rate of hospitalisations ord deaths at 6 months (p = 0,005); as it concerns the level of titration, the analysing comparing the "therapeutic inertia" group and the "current titration/maximum tolerated dose" group did not reveal any significant difference (p = 0,169). CONCLUSION Our study highlighted the potential positive impact of the application of the latest ESC recommendations concerning first-line drug treatment on the rate of rehospitalisation or death from all causes, in patients with heart failure reduced LVEF aged over 75.
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Affiliation(s)
- Marianne Dacunka
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
| | - Stéphane Sanchez
- Pôle territoriale Santé Publique et Performance, Centre Hospitalier de Troyes, Troyes France; Vieillissement fragilité, Université de Reims Champagne-Ardenne, Reims, EA3797 France.
| | - Florian Raoul
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
| | - Laurent Chapoutot
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
| | - Bruno Maillier
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
| | - Aurélie Marchais
- Service de cardiologie, Centre Hospitalier de Troyes, Troyes France.
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Alami S, Courouve L, Lancman G, Gomis P, Al-Hamoud G, Laurelli C, Pasche H, Chatellier G, Mercier G, Roubille F, Delval C, Durand-Zaleski I. Organisational Impact of a Remote Patient Monitoring System for Heart Failure Management: The Experience of 29 Cardiology Departments in France. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4366. [PMID: 36901372 PMCID: PMC10002348 DOI: 10.3390/ijerph20054366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Remote patient monitoring (RPM) for the management of patients with chronic heart failure (CHF) has been widely studied from clinical and health-economic points of view. In contrast, data on the organisational impact of this type of RPM are scarce. The objective of the present study of cardiology departments (CDs) in France was to describe the organisational impact of the Chronic Care ConnectTM (CCCTM) RPM system for CHF. An organisational impact map for health technology assessment was used to identify and define the criteria evaluated in the present survey, including the care process, equipment, infrastructure, training, skill transfers, and the stakeholders' abilities to implement the care process. In April 2021, an online questionnaire was sent to 31 French CDs that were using CCCTM for CHF management: 29 (94%) completed the questionnaire. The survey results showed that CDs progressively modified their organisational structures upon or shortly after the implementation of the RPM device. Twenty-four departments (83%) had created a dedicated team, sixteen (55%) had provided dedicated outpatient consultations for patients with an emergency alert, and twenty-five (86%) admitted patients directly (i.e., avoiding the need to attend the emergency department). The present survey is the first to have assessed the organisational impact of the implementation of the CCCTM RPM device for CHF management. The results highlighted the variety of organisational structures, which tended to structure with the use of the device.
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Affiliation(s)
- Sarah Alami
- ALSI, Air Liquide Santé International, 92220 Bagneux, France
| | | | - Guila Lancman
- ALSI, Air Liquide Santé International, 92220 Bagneux, France
| | | | | | | | - Hélène Pasche
- ALSI, Air Liquide Santé International, 92220 Bagneux, France
| | - Gilles Chatellier
- Department of Statistics Informatics and Public Health, Université Paris-Cité, 75006 Paris, France
- Clinical Research Unit, Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France
| | - Grégoire Mercier
- Economic Evaluation Unit (URME), University Hospital of Montpellier, 34295 Montpellier, France
- IDESP, Université de Montpellier, INSERM, 34000 Montpellier, France
| | - François Roubille
- Cardiology Department, Hôpital Lapeyronie, PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU, INI-CRT, 34090 Montpellier, France
| | - Cécile Delval
- ALSI, Air Liquide Santé International, 92220 Bagneux, France
| | - Isabelle Durand-Zaleski
- Université de Paris, CRESS, INSERM, INRA, URCEco, AP-HP, Hôpital de l’Hôtel Dieu, 75004 Paris, France
- Santé Publique Hôpital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny F, 94010 Créteil, France
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Lecoeur E, Domengé O, Fayol A, Jannot AS, Hulot JS. Epidemiology of heart failure in young adults: a French nationwide cohort study. Eur Heart J 2023; 44:383-392. [PMID: 36452998 PMCID: PMC9890267 DOI: 10.1093/eurheartj/ehac651] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/24/2022] [Accepted: 10/30/2022] [Indexed: 12/05/2022] Open
Abstract
AIMS Heart failure (HF) in young adults is uncommon, and changes in its incidence and prognosis in recent years are poorly described. METHODS AND RESULTS The incidence and prognosis of HF in young adults (1850 years) were characterized using nationwide medico-administrative data from the French National Hospitalization Database (period 20132018). A total of 1,486 877 patients hospitalized for incident HF were identified, including 70 075 (4.7) patients aged 1850 years (estimated incidence of 0.44 for this age group). During the study period, the overall incidence of HF tended to decrease in the overall population but significantly increased by 0.041 in young adults (P 0.001). This increase was notably observed among young men (from 0.51 to 0.59, P 0.001), particularly those aged 3650 years. In these young men, ischaemic heart disease (IHD) was the most frequently reported cause of HF, whereas non-ischaemic HF was mainly observed in patients 35 years old. In contrast to non-ischaemic HF, the incidence of IHD increased over the study period, which suggests that IHD-related HF is progressively affecting younger patients. Concordantly, young HF patients presented with high rates of traditional IHD risk factors, including obesity, smoking, hypertension, dyslipidaemia, or diabetes. Lastly, the rates of re-hospitalization (for HF or for any cause) within two years after the first HF event and in-hospital mortality were high in all groups, indicating a poor-prognosis population. CONCLUSION Strategies for the prevention of HF risk factors should be strongly considered for patients under 50 years old.
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Affiliation(s)
- Emmanuel Lecoeur
- Department of Medical Informatics and Public Health, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | - Orianne Domengé
- Université de Paris Cité, INSERM, PARCC, Heart failure translational laboratory, F-75015, Paris, France
- CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | - Antoine Fayol
- Université de Paris Cité, INSERM, PARCC, Heart failure translational laboratory, F-75015, Paris, France
- CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | - Anne-Sophie Jannot
- Department of Medical Informatics and Public Health, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
| | - Jean-Sébastien Hulot
- Université de Paris Cité, INSERM, PARCC, Heart failure translational laboratory, F-75015, Paris, France
- CIC1418 and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, F-75015, Paris, France
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Varlot J, Popovic B, Soudant M, Thilly N, Agrinier N. Prognostic factors of readmission and mortality after first heart failure hospitalization: results from EPICAL2 cohort. ESC Heart Fail 2022; 10:965-974. [PMID: 36480482 PMCID: PMC10053266 DOI: 10.1002/ehf2.14246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/03/2022] [Accepted: 11/08/2022] [Indexed: 12/13/2022] Open
Abstract
AIMS We aimed to identify prognostic individual factors in patients with first acute heart failure (HF) hospitalization, considering both death and readmission as part of the natural history of HF. METHODS AND RESULTS We used data from the observational, prospective, multicentre EPICAL2 cohort study from which we selected incident cases of acute HF alive at discharge. We relied on an illness-death model to identify prognostic factors on first readmission and on mortality before and after readmission. In 451 patients hospitalized for first acute HF, we observed within the year after discharge, 23 (5.1%) deaths before readmission and 270 (59.9%) first readmissions, of which 60 (22.2%) were followed by death of any cause. First, among patient characteristics, only Charlson index ≥ 8 was associated with first readmission [adjusted hazard ratio (aHR) = 1.6, 95% confidence interval (CI) (1.1-2.3), P = 0.011]. Second, Charlson index ≥ 8 [aHR = 4.2, 95% CI (1.2-14.8), P = 0.025], low blood pressure (BP) [aHR = 12.2, 95% CI (1.9-79.6), P = 0.009], high BP [aHR = 6.9, 95% CI (1.3-36.4), P = 0.023], and prescription of recommended dual or triple HF therapy at index discharge [aHR = 0.2, 95% CI (0.1-0.7), P = 0.014] were associated with mortality before any readmission. Third, Charlson index ≥ 8 [aHR = 2.4, 95% CI (1.1-5.6), P = 0.037] and the time to first readmission (per 30 days additional) [aHR = 1.2; 95% CI (1.1-1.4), P = 0.007] were associated with mortality after readmission. CONCLUSIONS Regardless of the prognostic state considered, we showed that comorbidities are of critical prognostic value in a real-world cohort of incident HF cases. This argues in favour of multidisciplinary care in HF.
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Affiliation(s)
- Jeanne Varlot
- Département de Cardiologie Université de Lorraine, CHRU Nancy Nancy France
| | - Batric Popovic
- Département de Cardiologie Université de Lorraine, CHRU Nancy Nancy France
| | - Marc Soudant
- CIC‐EC, Epidémiologie Clinique Université de Lorraine, CHRU Nancy, INSERM F‐54000 Nancy France
| | - Nathalie Thilly
- Département Méthodologie, Promotion, Investigation Université de Lorraine, CHRU Nancy Nancy France
- APEMAC Université de Lorraine Nancy France
| | - Nelly Agrinier
- CIC‐EC, Epidémiologie Clinique Université de Lorraine, CHRU Nancy, INSERM F‐54000 Nancy France
- APEMAC Université de Lorraine Nancy France
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Canepa M, Leporatti L, Persico L, Ameri P, Porto I, Ansaldi F, Montefiori M. Frequency, characteristics and prognostic impact of hospital readmissions in elderly patients with heart failure: A population study from 2013 to 2017 in Liguria, Northern Italy. Int J Cardiol 2022; 363:111-118. [PMID: 35728700 DOI: 10.1016/j.ijcard.2022.06.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/24/2022] [Accepted: 06/16/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Hospital readmissions are a key determinant of prognosis in elderly patients with heart failure (HF). We investigated their frequency, predictors and prognostic impact using a large administrative database from Liguria, the oldest region of Italy. METHODS Patients aged ≥18 years with at least one hospitalization with HF and being prescribed a diuretic medication between January 2013 and December 2017 were included in the analysis. Their demographics and Charlson comorbidity index (CCI) were collected. Patients were grouped by number of readmissions, and negative binomial and Cox proportional hazard models were used to explore independent predictors of readmissions and mortality, respectively. RESULTS There were 207,130 hospital admissions from 35,316 patients (mean age 81.6 years, 43.7% ≥85 years of age, 47.2% male, mean CCI 1.7, overall mortality 52.8%). About a quarter of patients (8.878, 25.1%) had more than eight readmissions during follow-up, for a total of 108.146 admissions (52.2% of admissions). Male gender, lower educational level and higher CCI were independently associated with increased number of readmissions and increased mortality. There was an independent inverse relationship between number of admissions and survival, with patients hospitalized 8 or more times displaying a 3-fold increase in mortality, and a significant interaction between older age and readmissions on mortality. CONCLUSION A quarter of older comorbid HF patients contributed to more than half of HF hospital readmissions recorded over a 5-year period in Liguria, with a dismal impact on prognosis. Aging societies should pay greater attention to this matter and personalized disease-management programs should be implemented.
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Affiliation(s)
- Marco Canepa
- Department of Internal Medicine, University of Genoa, Italy; Cardiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Lucia Leporatti
- Department of Economics, Study and Research Centre Aphec, University of Genoa, Genoa, Italy
| | - Luca Persico
- Department of Economics, Study and Research Centre Aphec, University of Genoa, Genoa, Italy
| | - Pietro Ameri
- Department of Internal Medicine, University of Genoa, Italy; Cardiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Italo Porto
- Department of Internal Medicine, University of Genoa, Italy; Cardiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Filippo Ansaldi
- A.Li.Sa. (Azienda Sanitaria Regione Liguria), Genoa, Italy; Department of Health Science, University of Genoa, Genoa, Italy
| | - Marcello Montefiori
- Department of Economics, Study and Research Centre Aphec, University of Genoa, Genoa, Italy
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Hariharaputhiran S, Peng Y, Ngo L, Ali A, Hossain S, Visvanathan R, Adams R, Chan W, Ranasinghe I. Long-term survival and life expectancy following an acute heart failure hospitalization in Australia and New Zealand. Eur J Heart Fail 2022; 24:1519-1528. [PMID: 35748124 PMCID: PMC9804480 DOI: 10.1002/ejhf.2595] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 01/05/2023] Open
Abstract
AIMS Contemporary long-term survival following a heart failure (HF) hospitalization is uncertain. We evaluated survival up to 10 years after a HF hospitalization using national data from Australia and New Zealand, identified predictors of survival, and estimated the attributable loss in life expectancy. METHODS AND RESULTS Patients hospitalized with a primary diagnosis of HF from 2008-2017 were identified and all-cause mortality assessed by linking with Death Registries. Flexible parametric survival models were used to estimate survival, predictors of survival and loss in life expectancy. A total of 283 048 patients with HF were included (mean age 78.2 ± 12.3 years, 50.8% male). Of these, 48.3% (48.1-48.5) were surviving by 3 years, 34.1% (33.9-34.3) by 5 years and 17.1% (16.8-17.4) by 10 years (median survival 2.8 years). Survival declined with age with 53.4% of patients aged 18-54 years and 6.2% aged ≥85 years alive by 10 years (adjusted hazard ratio [aHR] for mortality 4.84, 95% confidence interval [CI] 4.65-5.04 for ≥85 years vs. 18-54 years) and was worse in male patients (aHR 1.14, 95% CI 1.13-1.15). Prior HF (aHR 1.20, 95% CI 1.18-1.22), valvular and rheumatic heart disease (aHR 1.11, 95% CI 1.10-1.13) and vascular disease (aHR 1.07, 95% CI 1.04-1.09) were cardiovascular comorbidities most strongly associated with long-term death. Non-cardiovascular comorbidities and geriatric syndromes were common and associated with higher mortality. Compared with the general population, HF was associated with a loss of 7.3 years in life expectancy (or 56.6% of the expected life expectancy) and reached 20.5 years for those aged 18-54 years. CONCLUSION Less than one in five patients hospitalized for HF were surviving by 10 years with patients experiencing almost 60% loss in life expectancy compared with the general population, highlighting the considerable persisting societal burden of HF. Concerted multidisciplinary efforts are needed to improve post-hospitalization outcomes of HF.
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Affiliation(s)
| | - Yang Peng
- Department of CardiologyThe Prince Charles HospitalBrisbaneQLDAustralia,School of Clinical MedicineThe University of QueenslandBrisbaneQLDAustralia
| | - Linh Ngo
- Department of CardiologyThe Prince Charles HospitalBrisbaneQLDAustralia,School of Clinical MedicineThe University of QueenslandBrisbaneQLDAustralia
| | - Anna Ali
- Discipline of MedicineUniversity of AdelaideAdelaideSAAustralia
| | - Sadia Hossain
- School of Public HealthUniversity of AdelaideAdelaideSAAustralia,Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical SchoolUniversity of AdelaideAdelaideSAAustralia
| | - Renuka Visvanathan
- College of Medicine and Public HealthFlinders UniversityAdelaideSAAustralia,Aged & Extended Care Services, Queen Elizabeth Hospital and Basil Hetzel InstituteCentral Adelaide Local Health NetworkAdelaideSAAustralia,National Health and Medical Research Council, Centre of Research Excellence in Frailty and Healthy AgeingUniversity of AdelaideAdelaideSAAustralia
| | - Robert Adams
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical SchoolUniversity of AdelaideAdelaideSAAustralia
| | - Wandy Chan
- Department of CardiologyThe Prince Charles HospitalBrisbaneQLDAustralia,School of Clinical MedicineThe University of QueenslandBrisbaneQLDAustralia
| | - Isuru Ranasinghe
- Department of CardiologyThe Prince Charles HospitalBrisbaneQLDAustralia,School of Clinical MedicineThe University of QueenslandBrisbaneQLDAustralia
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13
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Pathak A, Levy P, Roubille F, Chatellier G, Mercier G, Alami S, Lancman G, Pasche H, Laurelli C, Delval C, Ramirez‐Gil JF, Galinier M. Healthcare costs of a telemonitoring programme for heart failure: indirect deterministic data linkage analysis. ESC Heart Fail 2022; 9:3888-3897. [PMID: 35950267 PMCID: PMC9773639 DOI: 10.1002/ehf2.14072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/01/2022] [Accepted: 06/21/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS We aim to evaluate the costs associated with healthcare resource consumption for chronic heart failure (HF) management in patients allocated to telemonitoring versus standard of care (SC). METHODS AND RESULTS OSICAT-ECO involved 745 patients from the OSICAT trial (NCT02068118) who were successfully linked to the French national healthcare database through an indirect deterministic data linkage approach. OSICAT compared a telemonitoring programme with SC follow-up in adults hospitalized for acute HF ≤ 12 months. Healthcare resource costs included those related to hospital and ambulatory expenditure for HF and were restricted to direct costs determined from the French health data system over 18 months of follow-up. Most of the total costs (69.4%) were due to hospitalization for HF decompensation, followed by ambulatory nursing fees (11.8%). During 18-month follow-up, total costs were 2% lower in the telemonitoring versus the SC group, due primarily to a 21% reduction in nurse fees. Among patients with NYHA class III/IV, a 15% reduction in total costs (€3131 decrease) was observed over 18-month follow-up in the telemonitoring versus the SC group, with the highest difference in hospital expenditure during the first 6 months, followed by a shift in costs from hospital to ambulatory at 12 months. CONCLUSIONS HF hospitalization and ambulatory nursing fees represented most of the costs related to HF. No benefit was observed for telemonitoring versus SC with regard to cost reductions over 18 months. Patients with severe HF showed a non-significant 15% reduction in costs, largely related to hospitalization for HF decompensation, nurse fees, and medical transport.
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Affiliation(s)
- Atul Pathak
- Department of Cardiovascular MedicinePrincess Grace HospitalMonacoPrincipality of Monaco
| | - Pierre Levy
- LEDa – LEGOS, Université Paris DauphinePSL Research UniversityParisFrance
| | - François Roubille
- Cardiology Department, INI‐CRT, CHU de Montpellier, PhyMedExpUniversité de Montpellier, INSERM, CNRSMontpellierFrance
| | - Gilles Chatellier
- Clinical Research Unit and CIC 1418 INSERMGeorge‐Pompidou European HospitalParisFrance
| | - Grégoire Mercier
- Economic Evaluation Unit (URME), University Hospital of MontpellierMontpellier UniversityMontpellierFrance,IDESPUniv Montpellier, INSERMMontpellierFrance
| | - Sarah Alami
- Air Liquide Santé InternationalBagneuxFrance
| | | | | | | | | | | | - Michel Galinier
- Cardiology DepartmentRangueil University HospitalToulouseFrance,Faculty of MedicineUniversity of Paul Sabatier‐Toulouse IIIToulouseFrance
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14
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Sabatier R, Legallois D, Jodar M, Courouve L, Donio V, Boudevin F, De Chalus T, Hauchard K, Belin A, Milliez P. Impact of patient engagement in a French telemonitoring programme for heart failure on hospitalization and mortality. ESC Heart Fail 2022; 9:2886-2898. [PMID: 35715956 DOI: 10.1002/ehf2.13978] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/20/2022] [Accepted: 05/08/2022] [Indexed: 12/21/2022] Open
Abstract
AIMS Management of patients with recently decompensated heart failure by hospital services is expensive, complicated to plan, and not always effective. Telemedicine programmes in heart failure may improve the quality of care, but their effectiveness is poorly documented in real-world settings. The study aims to evaluate the impact of patient engagement in home-based telemonitoring for heart failure (SCAD programme) on rehospitalization and mortality rates. METHODS AND RESULTS A retrospective observational study was performed in 659 SCAD participants. SCAD is a patient-oriented service of home-based interactive telemonitoring offered to heart failure patients during hospitalization who agree to participate in a therapeutic education programme. Patients were telemonitored for at least 3 months, and rehospitalization and mortality were documented at 12 months and 5 years. During the telemonitoring period, patients provided daily information on health and lifestyle through an internet-based interface. Data were linked on a patient-by-patient basis between the SCAD database and the French national health insurance database (Système National des Données de Santé). Outcomes were compared as a function of use of the programme. Low, intermediate, and high users were classified by tercile of data return during telemonitoring. Patients were followed for a median of 32.9 months. Rehospitalization rates for cardiovascular disease decreased from 79.4% in the year preceding enrolment to 41.1% in the following year and from 52.8% to 18.8% for hospitalizations for heart failure. The 12 month mortality rate was 11.2%. Significant associations were observed between level of use of the SCAD programme and all-cause rehospitalization (P = 0.0085), rehospitalization for cardiovascular disease (P = 0.0010), rehospitalization for heart failure (27.8% in low users, 12.9% in intermediate users, and 13.5% in high users; P < 0.0001), and mortality (26.8%, 15.2%, and 15.9% respectively; P = 0.0157) in the 12 months following enrolment. The mean number of days alive outside hospital were 279 ± 111 in low users, 312 ± 90 in intermediate users, and 304 ± 100 in high users (P = 0.0022). CONCLUSIONS Educational home telemonitoring of patients with heart failure following hospitalization provides long-term clinical benefits in terms of rehospitalization and death in real-world settings, according to the level of use of the programme by the patient. These benefits would be expected to have a major impact on the burden of this disease. Low engagement in telemonitoring could be used as a signal of poor prognosis and taken into account in the management strategy.
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Affiliation(s)
- Rémi Sabatier
- Service de Cardiologie et de Pathologie Vasculaire, CHU Caen Normandie, Avenue Côte de Nacre, 14000, Caen, France
| | - Damien Legallois
- Service de Cardiologie et de Pathologie Vasculaire, CHU Caen Normandie, Avenue Côte de Nacre, 14000, Caen, France
| | - Mouna Jodar
- Service de Cardiologie et de Pathologie Vasculaire, CHU Caen Normandie, Avenue Côte de Nacre, 14000, Caen, France
| | | | | | | | | | | | - Annette Belin
- Service de Cardiologie et de Pathologie Vasculaire, CHU Caen Normandie, Avenue Côte de Nacre, 14000, Caen, France
| | - Paul Milliez
- Service de Cardiologie et de Pathologie Vasculaire, CHU Caen Normandie, Avenue Côte de Nacre, 14000, Caen, France
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15
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Janwanishstaporn S, Karaketklang K, Krittayaphong R. National trend in heart failure hospitalization and outcome under public health insurance system in Thailand 2008-2013. BMC Cardiovasc Disord 2022; 22:203. [PMID: 35488204 PMCID: PMC9052701 DOI: 10.1186/s12872-022-02629-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background There are limited data on the burden, characteristics, and outcomes of hospitalized heart failure (HF) patients in Thailand. The aim of this study was to investigate national trend in HF hospitalization rate, in-hospital and 1-year mortality rate, and rehospitalization rate in Thailand. Methods We analyzed the claims data of hospitalized patients obtained from the three major Thailand public health reimbursement systems between 2008 and 2013. Patients aged ≥ 18 years with a principal diagnosis of HF by the International Classification of Diseases, Tenth Revision, Thai modification were included. Comorbidities were identified by secondary diagnosis codes. The annual rate of HF hospitalization was calculated per 100,000 beneficiaries. Records of subsequent hospitalization of discharged patients were retrieved. For 1-year mortality rate, vital status of each patient was obtained from Thai Civil Registration of Death database. All outcomes were tested for linear trends across calendar years. Results Between 2008 and 2013, 434,933 HF hospitalizations were identified. The mean age was 65.3 years (SD 14.6), and 58.1% were female. The HF hospitalization rate increased from 138 in 2008 to 168 per 100,000 beneficiaries in 2013 (P for trend < 0.001). Nearly half (47.4%) had had a prior HF admission within 1 year. A small proportion of patients (7.4%) received echocardiography during hospitalization. The median length of hospital stay was 3 days. In-hospital mortality declined from 4.4 to 3.8% (P for trend < 0.001). The overall 30-day and 1-year rehospitalization rates were 34 and 73%, respectively, without significant trends over the study period. Most common cause of 30-day rehospitalization was HF (42%). One-year mortality decreased from 31.8% in 2008 to 28.5% in 2012 (P for trend < 0.001). Conclusion Between 2008 and 2013, HF hospitalization rate in Thailand increased. The in-hospital and 1-year mortality rates decreased slightly. However, the rehospitalization rate remained high mainly due to recurrent HF hospitalization. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02629-2.
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Affiliation(s)
- Satit Janwanishstaporn
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. .,Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road Bangkoknoi, Bangkok, 10700, Thailand.
| | - Khemajira Karaketklang
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rungroj Krittayaphong
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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16
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Sauer F, Riou M, Charles AL, Meyer A, Andres E, Geny B, Talha S. Pathophysiology of Heart Failure: A Role for Peripheral Blood Mononuclear Cells Mitochondrial Dysfunction? J Clin Med 2022; 11:jcm11030741. [PMID: 35160190 PMCID: PMC8836880 DOI: 10.3390/jcm11030741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) is a leading cause of hospitalization in patients aged more than 65 years and is associated with high mortality rates. A better comprehension of its physiopathology is still needed, and, in addition to neurohormonal systems and sodium glucose co-transporter 2 modulations, recent studies focus on the mitochondrial respiration of peripheral blood circulating cells (PBMCs). Thus, cardiovascular metabolic risk factors and cellular switch with an increased neutrophil/lymphocytes ratio might favor the decreased PBMC mitochondrial respiration observed in relation with HF severity. PBMCs are implicated in the immune system function and mitochondrial dysfunction of PBMC, potentially induced by their passage through a damaged heart and by circulating mitoDAMPs, which can lead to a vicious circle, thus sustaining negative cardiac remodeling during HF. This new approach of HF complex pathophysiology appears to be a promising field of research, and further studies on acute and chronic HF with reduced or preserved LVEF are warranted to better understand whether circulating PBMC mitochondrial function and mitoDAMPs follow-ups in HF patients might show diagnosis, prognosis or therapeutic usefulness.
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Affiliation(s)
- François Sauer
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- University Hospital of Strasbourg, Physiology and Functional Exploration Service, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Marianne Riou
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- University Hospital of Strasbourg, Physiology and Functional Exploration Service, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Anne-Laure Charles
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- University Hospital of Strasbourg, Physiology and Functional Exploration Service, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Alain Meyer
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- University Hospital of Strasbourg, Physiology and Functional Exploration Service, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Emmanuel Andres
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- Internal Medicine, Diabete and Metabolic Diseases Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, France
| | - Bernard Geny
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- University Hospital of Strasbourg, Physiology and Functional Exploration Service, 1 Place de l’Hôpital, 67091 Strasbourg, France
- Correspondence:
| | - Samy Talha
- University of Strasbourg, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 “Mitochondria, Oxidative Stress and Muscle Protection”, 11 rue Humann, 67000 Strasbourg, France; (F.S.); (M.R.); (A.-L.C.); (A.M.); (E.A.); (S.T.)
- University Hospital of Strasbourg, Physiology and Functional Exploration Service, 1 Place de l’Hôpital, 67091 Strasbourg, France
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17
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Abdoul Carime N, Cottenet J, Clerfond G, Eschalier R, Quilliot D, Eicher JC, Joly B, Quantin C. Impact of nutritional status on heart failure mortality: a retrospective cohort study. Nutr J 2022; 21:2. [PMID: 34991613 PMCID: PMC8734339 DOI: 10.1186/s12937-021-00753-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/21/2021] [Indexed: 12/19/2022] Open
Abstract
Background Chronic heart failure (CHF) is one of the most common causes of mortality in industrialized countries despite regular therapeutic advances. Numerous factors influence mortality in CHF patients, including nutritional status. It is known that malnutrition is a risk factor for mortality, whereas obesity may play a protective role, a phenomenon dubbed the “obesity paradox”. However, the effect of the obesity-malnutrition association on mortality has not been previously studied for CHF. Our aim was to study the effect of nutritional status on overall mortality in CHF patients. Methods This retrospective, multicenter study was based on a French nationwide database (PMSI). We included all CHF patients aged ≥18 years admitted to all public and private hospitals between 2012 and 2016 and performed a survival analysis over 1 to 4 years of follow-up. Results Malnutrition led to a significant decrease in life expectancy in CHF patients when compared with normal nutritional status (aHR=1.16 [1.14-1.18] at one year and aHR=1.04 [1.004-1.08] at four years), obese, and obese-malnutrition groups. In contrast, obesity led to a significant increase in life expectancy compared with normal nutritional status (aHR=0.75 [0.73-0.78] at one year and aHR=0.85 [0.81-0.90] at four years), malnutrition, and obese-malnutrition groups. The mortality rate was similar in patients presenting both malnutrition and obesity and patients with normal nutritional status. Conclusions Our results indicate that the protective effect on mortality observed in obese CHF patients seems to be linked to fat massincrease. Furthermore, malnourished obese and normal nutritional status patients had similar mortality rates. Further studies should be conducted to confirm our results and to explore the physiopathological mechanisms behind these effects. Supplementary Information The online version contains supplementary material available at 10.1186/s12937-021-00753-x.
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Affiliation(s)
- Nafiz Abdoul Carime
- Biostatistics and Bioinformatics department (DIM), Dijon University Hospital, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics department (DIM), Dijon University Hospital, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France
| | - Guillaume Clerfond
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France and Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France and F-CRIN, INI-CRCT, Nancy, France
| | - Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France and Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France and F-CRIN, INI-CRCT, Nancy, France
| | - Didier Quilliot
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, 1 Allée du Morvan, 54511 Vandoeuvre-lès-Nancy, France; Nutritional Assistance Department, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | | | - Bertrand Joly
- CHPCB Paray-le-Monial General Hospital, Paray-le-Monial, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics department (DIM), Dijon University Hospital, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France. .,Inserm, CIC 1432, Dijon, France; Dijon University Hospital, Clinical Investigation Center, clinical epidemiology/ clinical trials unit, Dijon, France. .,Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France.
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18
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Bonilla-Palomas JL, Anguita-Sánchez MP, Elola-Somoza FJ, Bernal-Sobrino JL, Fernández-Pérez C, Ruiz-Ortíz M, Jiménez-Navarro M, Bueno-Zamora H, Cequier-Fillat Á, Marín-Ortuño F. Thirteen-year trends in hospitalization and outcomes of patients with heart failure in Spain. Eur J Clin Invest 2021; 51:e13606. [PMID: 34076253 DOI: 10.1111/eci.13606] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/06/2021] [Accepted: 05/14/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Heart failure is one of the most pressing current public health concerns. However, in Spain there is a lack of population data. We aimed to examine thirteen-year nationwide trends in heart failure hospitalization, in-hospital mortality and 30-day readmission rates in Spain. METHODS We conducted a retrospective observational study of patients discharged with the principal diagnosis of heart failure from The National Health System' acute hospitals during 2003-2015. The source of the data was the Minimum Basic Data Set. Temporal trends were modelled using Poisson regression analysis. The risk-standardized in-hospital mortality ratio was calculated using a multilevel risk adjustment logistic regression model. RESULTS A total of 1 254 830 episodes of heart failure were selected. Throughout 2003-2015, the number of hospital discharges with principal diagnosis of heart failure increased by 61%. Discharge rates weighted by age and sex increased during the period [incidence rate ratio (IRR): 1.03; 95% confidence interval (95% CI): 1.03-1.03; P < .001)], although this increase was motivated by the increase in older age groups (≥75 years old). The crude mortality rate diminished (IRR: 0.99; 95% CI: 0.98-1, P < .001), but 30-day readmission rate increased (IRR: 1.05; 95% CI: 1.04-1.06; P < .001). The risk-standardized in-hospital mortality ratio did not change throughout the study period (IRR: 0.997; 95% CI: 0.992-1; P = .32). CONCLUSIONS From 2003 to 2015, heart failure admission rates increased significantly in Spain as a consequence of the sustained increase of hospitalization in the population ≥75 years. 30-day readmission rates increased, but the risk-standardized in-hospital mortality ratio did not significantly change for the same period.
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Affiliation(s)
| | | | | | - José L Bernal-Sobrino
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain.,Servicio de Control de Gestión, University Hospital 12 de Octubre, Madrid, Spain
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Skipina TM, Upadhya B, Soliman EZ. Secondhand Smoke Exposure is Associated with Prevalent Heart Failure: Longitudinal Examination of the National Health and Nutrition Examination Survey. Nicotine Tob Res 2021; 23:1512-1517. [PMID: 34213549 DOI: 10.1093/ntr/ntab047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 03/16/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Serum cotinine is a sensitive and specific biomarker for tobacco exposure including second-hand smoke exposure (SHS). We sought to examine whether SHS is associated with heart failure (HF) among non-hospitalized adults. METHODS This analysis included 11 219 non-smokers (age 48.4 ± 20.5 years, 55.9% women, 70.5% whites) from the United States Third National Health and Nutrition Examination (NHANES) years 1988-1994. SHS was defined as serum cotinine ≥1 ng/mL. To assess dose-response, cut-points of serum cotinine ≥3 ng/mL and ≥6 ng/mL were used. Multivariable logistic regression was used to examine the association between SHS and HF. The consistency of this association was tested among subgroups stratified by race, gender, and comorbidities. NHANES years 2003-2006 were examined for longitudinal comparison. RESULTS 18.9% (n = 2125) of participants had SHS exposure while 3.7% (n = 416) had HF. After adjusting for covariates, SHS was associated with a 35% increased odds of HF with a dose-response relationship between levels of serum cotinine and HF. This association was stronger in males than females (interaction p-value = 0.03) and those with a history of CVD versus those without (interaction p-value < 0.001). This association persisted in the NHANES 2003-2006 analysis. CONCLUSION There is a dose-response relationship between SHS and HF with possible effect modification by gender and prior CVD. This is a novel finding that underscores the harmful effects of passive smoking on the cardiovascular system and highlights the needs for further prohibition of smoking in public areas and a personalized risk assessment among high-risk groups, especially in regions with less-stringent public health policies. IMPLICATIONS This study showed a novel association between secondhand smoke exposure and prevalent heart failure among non-smokers, adding to the list of harmful cardiovascular manifestations of secondhand smoke exposure. This was more apparent in men and those with a prior history of cardiovascular disease. Heart failure is a debilitating disease process, so this finding has important policy implications in low-income countries and poor communities with less-stringent health policies because they are known to have the highest levels of exposure. Smoke-free policies targeting these regions would thus yield substantial public health benefits.
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Affiliation(s)
- T M Skipina
- Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - B Upadhya
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - E Z Soliman
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, American University in Cairo, New Cairo, Egypt
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Walsh ME, Cronin S, Boland F, Ebell MH, Fahey T, Wallace E. Geographical variation of emergency hospital admissions for ambulatory care sensitive conditions in older adults in Ireland 2012-2016. BMJ Open 2021; 11:e042779. [PMID: 33952537 PMCID: PMC8103372 DOI: 10.1136/bmjopen-2020-042779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Ambulatory care sensitive (ACS) conditions are those for which intensified primary care management could potentially prevent emergency admissions. This study aimed to quantify geographical variation in emergency admissions with ACS conditions in older adults and explore factors influencing variation. DESIGN Repeated cross-sectional study. SETTING 34 public hospitals in the Ireland. PARTICIPANTS Adults aged ≥65 years hospitalised for seven ACS conditions between 2012 and 2016 (chronic obstructive pulmonary disease, congestive heart failure (CHF), diabetes, angina, pyelonephritis/urinary tract infections (UTIs), dehydration and pneumonia). PRIMARY OUTCOME MEASURE Age and sex standardised emergency admission rates (SARs) per 1000 older adults. ANALYSIS Age and sex SARs were calculated for 21 geographical areas. Extremal quotients and systematic components of variance (SCV) quantified variation. Spatial regression analyses was conducted for SARs with unemployment, urban population proportion, hospital turnover, supply of general practitioners (GPs), and supply of hospital-based specialists as explanatory variables. RESULTS Over time, an increase in UTI/pyelonephritis SARs was seen while SARs for angina and CHF decreased. Geographic variation was moderate overall and high for dehydration and angina (SCV=11.7-50.0). For all conditions combined, multivariable analysis showed lower urban population (adjusted coefficient: -2.2 (-3.4 to -0.9, p<0.01)), lower GP supply (adjusted coefficient: -5.5 (-8.2 to -2.9, p<0.01)) and higher geriatrician supply (adjusted coefficient: 3.7 (0.5 to 6.9, p=0.02)) were associated with higher SARs. CONCLUSIONS Future research should evaluate methods of preventing admissions for ACS conditions among older adults, including how resources are allocated at a local level.
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Affiliation(s)
- Mary E Walsh
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sinead Cronin
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiona Boland
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mark H Ebell
- Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USA
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Emma Wallace
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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21
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Chan DZL, Kerr AJ, Doughty RN. Temporal trends in the burden of heart failure. Intern Med J 2021; 51:1212-1218. [PMID: 33650267 DOI: 10.1111/imj.15253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/13/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
Heart failure is a common healthcare problem associated with high morbidity and mortality. The burden of heart failure is changing; increases secondary to an ageing population may be offset by improved primary cardiovascular prevention and advances in heart failure therapies. In this review, we evaluate recent international trends in heart failure incidence, morbidity and mortality. Although the age-standardised incidence of heart failure has been decreasing since 2000, the incidence in those age groups <55 years is increasing with patients being diagnosed at younger ages. Despite improvements in therapies for heart failure, prognosis still remains poor with up to one-third of patients not surviving beyond 1 year following diagnosis and no improvements in mortality over the past 10 years. The case-mix of heart failure patients is changing with a greater proportion having non-ischaemic aetiology and preserved ejection fraction, and a higher prevalence of non-cardiovascular comorbidity and mortality.
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Affiliation(s)
- Daniel Z L Chan
- Department of Cardiology, Counties Manukau District Health Board, Auckland, New Zealand
| | - Andrew J Kerr
- Department of Cardiology, Counties Manukau District Health Board, Auckland, New Zealand.,School of Population Health, University of Auckland, Auckland, New Zealand
| | - Rob N Doughty
- Department of Medicine, University of Auckland, Auckland, New Zealand.,Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
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22
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Chioncel O, Ambrosy AP, Maggioni AP. Temporal trends in the outcomes of acute heart failure: between consolatory evidences and real progress. Eur J Heart Fail 2021; 23:432-435. [PMID: 33599362 DOI: 10.1002/ejhf.2130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania.,University of Medicine Carol Davila, Bucharest, Romania
| | - Andrew P Ambrosy
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Aldo P Maggioni
- ANMCO Research Center, Florence, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
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23
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Hanon O, Belmin J, Benetos A, Chassagne P, De Decker L, Jeandel C, Krolak-Salmon P, Nourhashemi F, Paccalin M. Consensus of experts from the French Society of Geriatrics and Gerontology on the management of heart failure in very old subjects. Arch Cardiovasc Dis 2021; 114:246-259. [PMID: 33455889 DOI: 10.1016/j.acvd.2020.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 02/08/2023]
Abstract
The prevalence of heart failure increases with age. In France, the 1-year mortality rate is 35% in subjects aged 80-89 years with heart failure, and 50% after the age of 90 years. In octogenarians, heart failure is associated with high rates of cardiovascular and non-cardiovascular events, and is one of the main causes of hospitalization and disability. The prevalence of frailty increases in elderly subjects with heart failure, and the co-occurrence of heart failure and frailty increases the risk of mortality in patients with heart failure. In the elderly, the presence of frailty must be evaluated using a comprehensive geriatric assessment to manage geriatric syndromes, such as cognitive disorders, malnutrition, falls, depression, polypharmacy, disability and social isolation. The objective of heart failure therapy in octogenarians is to reduce symptoms, mortality and hospitalizations, but also to improve quality of life. In the absence of specific studies involving very old subjects, most recommendations are extrapolated from evidence-based data from younger populations. Overall, the epidemiological studies in patients with heart failure aged>80 years highlight the underprescription of recommended drugs. This underprescription may be related to comorbidity, a fear of side-effects and the lack of specific recommendations for drug prescription in heart failure with preserved ejection fraction, which is common in this very old population. The benefit/risk ratio related to heart failure treatment and comorbidity should be carefully weighed and reassessed on a regular basis. Consideration of disease prognosis according to factors that predict mortality can help to better define the care plan and promote palliative and supportive care when needed.
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Affiliation(s)
- Olivier Hanon
- Service de gériatrie, hôpital Broca, AP-HP, 75013 Paris, France; EA 4468, gérontopôle d'Île-de-France, université de Paris, 75013 Paris, France.
| | - Joël Belmin
- Service de gériatrie, hôpital Charles-Foix, 94200 Ivry-sur-Seine, France; Faculté de médecine, Sorbonne université, 75103 Paris, France
| | - Athanase Benetos
- Service de médecine interne gériatrique, CHRU plurithématiques-Nancy, 54035 Nancy, France; UMR_S 1116, Inserm, université de Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - Philippe Chassagne
- Service de médecine interne gériatrique, CHU de Rouen, 76000 Rouen, France
| | - Laure De Decker
- Service de gérontologie clinique, CHU de Nantes, 44093 Nantes, France
| | - Claude Jeandel
- Centre Antonin-Balmès, CHU de Montpellier, 34090 Montpellier, France
| | - Pierre Krolak-Salmon
- Institut du vieillissement, hôpital des Charpennes, hospices civils de Lyon, 69002 Lyon, France; Inserm 1048, université de Lyon, 69675 Bron, France
| | - Fati Nourhashemi
- Gérontopôle, CHU de Toulouse, 31059 Toulouse, France; Inserm 1027, 31000 Toulouse, France
| | - Marc Paccalin
- Pôle de Gériatrie, CHU La Milétrie, 86021 Poitiers, France; CIC 1402, Inserm, centre hospitalier universitaire de Poitiers, université de Poitiers, 86000 Poitiers, France
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24
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Scailteux LM, Lacroix C, Bergeron S, Despas F, Sassier M, Triquet L, Picard S, Oger E, Polard E. [Adverse drug reactions profiles for abiraterone and enzalutamide: A pharmacovigilance descriptive analysis]. Therapie 2020; 76:455-465. [PMID: 33376005 DOI: 10.1016/j.therap.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to describe the profile of adverse drug reactions (ADRs) observed with abiraterone and enzalutamide, based on cases registered in the French regional pharmacovigilance centres to identify potential pharmacovigilance signals. METHODS We extracted from the French pharmacovigilance database all cases of ADRs or drug interactions involving abiraterone or enzalutamide from the time they market authorization date until December 31st, 2017. Signal detection results have been transmitted by the French Agency for Health Products (ANSM). The data were compared with those of the risk management plans for each drug and the literature. RESULTS Among the 233 observations analyzed, nearly 62% involved abiraterone as a suspect drug and 38% involved enzalutamide; only 1 case involved both drugs. The ADRs profile is different between the drugs. Abiraterone is mostly associated with expected cardiac diseases (heart failure, and QT prolongation), expected with the drug. Also described, several cases of hepatotoxicity have been reported, however some cases with fatal outcome suggest that despite a follow-up of the liver function tests, it is difficult to anticipate this risk. Signals concerning acute renal failure and ischemic stroke have arisen. Enzalutamide is more particularly associated with various neurological disorders (convulsions, hallucinations, fatigue, and memory impairment) expected with the drug. While ischemic heart disease is also expected, signals of heart failure and atrial fibrillation have arisen. A potential hepatotoxicity of the molecule is discussed because of cases of cholestatic hepatitis. CONCLUSION The analysis of the French pharmacovigilance database cases allows to confirm an expected and monitored risk profile in the risk management plan for both drugs. Several signals have arisen, some of which will be investigated through a pharmacoepidemiology study.
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Affiliation(s)
- Lucie-Marie Scailteux
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, CHU de Rennes, rue Henri Le Guilloux, 35000 Rennes, France; EA 7449 REPERES, université Rennes, 35000 Rennes, France.
| | - Clémence Lacroix
- Service de pharmacologie clinique, centre régional de pharmacovigilance, Inserm, institut de neuroscience des systèmes UMR 1106, Aix Marseille université, AP-HM, 13005 Marseille, France
| | - Sandrine Bergeron
- UMR-S1172, degenerative and vascular cognitive disorders, Lille neuroscience and cognition, Inserm, CHU de Lille, université Lille, 59000 Lille, France
| | - Fabien Despas
- Service de pharmacologie médicale et clinique, Inserm 1027, facultés de médecine, CHU, université Paul-Sabatier, 31000 Toulouse, France
| | - Marion Sassier
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, CHU de Caen, 14000 Caen, France
| | - Louise Triquet
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, CHU de Rennes, rue Henri Le Guilloux, 35000 Rennes, France
| | - Sylvie Picard
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, CHU de Rennes, rue Henri Le Guilloux, 35000 Rennes, France
| | - Emmanuel Oger
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, CHU de Rennes, rue Henri Le Guilloux, 35000 Rennes, France; EA 7449 REPERES, université Rennes, 35000 Rennes, France
| | - Elisabeth Polard
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, CHU de Rennes, rue Henri Le Guilloux, 35000 Rennes, France; EA 7449 REPERES, université Rennes, 35000 Rennes, France
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25
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Wang T, Huang S, Wang C, Lin F, Chen H, Hsiao F. Nationwide trends in incidence, healthcare utilization, and mortality in hospitalized heart failure patients in Taiwan. ESC Heart Fail 2020; 7:3653-3666. [PMID: 32924330 PMCID: PMC7755001 DOI: 10.1002/ehf2.12892] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/28/2020] [Accepted: 06/24/2020] [Indexed: 12/30/2022] Open
Abstract
AIMS The objective of this study was to estimate the nationwide annual incidence, healthcare utilization, and mortality among hospitalized heart failure (HF) patients in Taiwan. METHODS AND RESULTS People aged 20 years or older and having been newly admitted for HF between 2010 and 2015 were identified from Taiwan's National Health Insurance Research Database. For 124 816 patients with incident HF hospitalizations between 2010 and 2012, we further analysed their treatment patterns, healthcare utilizations, and mortality during index hospitalization and within 3 years following discharge from the index hospitalization. The age-stratified incidences were declined by 10-20% in people aged 55 years or older, but increased by ~4% among people younger than 44 years old between 2010 and 2015. For all incident hospitalized HF patients, the percentages of patients visiting the emergency room, were rehospitalized, and treated with guideline-directed medical therapy were highest in the first year. Approximately two-thirds of subsequent hospitalizations were due to non-HF and non-cardiovascular causes. The all-cause mortality rate during index hospitalization was 8.5%, whereas the mortality rates at 30 days, 90 days, 180 days, 1 year, 2 years, and 3 years following discharge were 3.5%, 8.9%, 14.4%, 22.5%, 33.9%, and 42.8%, respectively, for those surviving index HF hospitalization. Non-cardiovascular disease-related deaths accounted for nearly 60% of all deaths. CONCLUSIONS Our study reveals that, in contemporary Taiwan, the >10% annual mortality following the first year of hospitalization, 30% deaths occurring outside the hospital, and 60% non-cardiovascular-related deaths, along with the decreasing use of guideline-directed medical therapy, highlight sectors requiring more attention.
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Affiliation(s)
- Tzung‐Dau Wang
- Cardiovascular Center and Division of Cardiology, Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Shih‐Tsung Huang
- Graduate Institute of Clinical Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- School of Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Chen‐Yu Wang
- Graduate Institute of Clinical Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- School of Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Fang‐Ju Lin
- Graduate Institute of Clinical Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- School of Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- Department of PharmacyNational Taiwan University HospitalTaipeiTaiwan
| | - Ho‐Min Chen
- Health Data Research CenterNational Taiwan UniversityTaipeiTaiwan
| | - Fei‐Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- School of Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- Department of PharmacyNational Taiwan University HospitalTaipeiTaiwan
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Sierpiński R, Sokolska JM, Suchocki T, Koń B, Urbański F, Kruk M, Sokolski M, Ponikowski P, Jankowska EA. 10 year trends in hospitalization rates due to heart failure and related in-hospital mortality in Poland (2010-2019). ESC Heart Fail 2020; 7:3365-3373. [PMID: 33089965 PMCID: PMC7754958 DOI: 10.1002/ehf2.13060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/16/2020] [Accepted: 09/29/2020] [Indexed: 01/14/2023] Open
Abstract
Aims Heart failure (HF) remains a major public health challenge worldwide. Contemporary epidemiological data on HF hospitalization rates and related in‐hospital mortality are scarce also in Poland. The aim of the study was to determine the trends in hospitalization rates due to HF and related in‐hospital mortality in Poland in the recent decade. Methods and results Data on HF hospitalizations and in‐hospital mortality in patients aged >17 years in Poland between 2010 and 2019 were obtained from the central database of the Polish National Health Fund. Hospitalizations with either primary or secondary diagnosis of HF were identified using the 10th revision of the International Statistical Classification of Diseases and Related Health Problems codes (I50, I42, J81 with extensions, and R57.0). There were 4 259 698 HF hospitalizations and 608 577 in‐hospital deaths (14% in‐hospital mortality) reported during 2010–2019 in Poland. During this period, there was a steady increase in the number of HF hospitalizations per 1000 inhabitants in subsequent years, being more pronounced in men than in women (in 2019: 16 and 13 HF hospitalizations per 1000 inhabitants in men and women, respectively). The relative risk of HF hospitalization was higher in men than in women, and this gender‐related difference steadily increased from 9% in 2010 to 25% in 2019. During 2010–2019, there was an increase in the number of HF hospitalizations per 1000 inhabitants in subsequent age groups, with a trend being more pronounced in men than in women (129 and 99 HF hospitalizations per 1000 inhabitants in men and women aged ≥80 years, respectively). During this period, there was a slight increase in in‐hospital mortality during HF hospitalization in subsequent years, being more pronounced in women than in men (in 2019: 16% and 14% of in‐hospital mortality in women and men, respectively). The relative risk of in‐hospital mortality during HF hospitalization was higher in women than in men, and this gender‐related difference steadily increased from 8% in 2010 to 18% in 2019. During this period, in‐hospital mortality during HF hospitalization was ~12% for women and men aged 18–29 years, whereas the highest values of in‐hospital mortality reached ~19% for patients aged ≥80 years. Conclusions We have observed steady growing trends in HF hospitalization rates and related in‐hospital mortality in Poland over the last decade. Both age and gender have differentiated the reported epidemiological patterns.
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Affiliation(s)
- Radosław Sierpiński
- Medical Research AgencyWarsawPoland
- University of Cardinal Wyszynski in WarsawWarsawPoland
| | - Justyna M. Sokolska
- Department of Heart DiseasesWrocław Medical UniversityWroclawPoland
- Department of Cardiology, University Heart CenterUniversity Hospital ZurichZurichSwitzerland
| | - Tomasz Suchocki
- Biostatistics Group, Department of GeneticsWroclaw University of Environmental and Life SciencesWroclawPoland
| | | | | | | | - Mateusz Sokolski
- Department of Heart DiseasesWrocław Medical UniversityWroclawPoland
- Centre for Heart DiseasesUniversity HospitalWroclawPoland
| | - Piotr Ponikowski
- Department of Heart DiseasesWrocław Medical UniversityWroclawPoland
- Centre for Heart DiseasesUniversity HospitalWroclawPoland
| | - Ewa A. Jankowska
- Department of Heart DiseasesWrocław Medical UniversityWroclawPoland
- Centre for Heart DiseasesUniversity HospitalWroclawPoland
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27
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Son YJ, Choi J, Lee HJ. Effectiveness of Nurse-Led Heart Failure Self-Care Education on Health Outcomes of Heart Failure Patients: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186559. [PMID: 32916907 PMCID: PMC7560014 DOI: 10.3390/ijerph17186559] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 12/20/2022]
Abstract
Poor self-care behaviors can lead to an increase in the risk of adverse health outcomes among patients with heart failure. Although a number of studies have investigated the effectiveness of nurse-led self-care education, the evidence regarding the effects of nurse-led intervention in heart failure remains uncertain. This study aimed to evaluate evidence on the effectiveness of nurse-led heart failure self-care education on health outcomes in patients with heart failure. To identify studies testing nurse-led education designed to improve self-care among heart failure patients, comprehensive search methods were used between January 2000 and October 2019 to systematically search six electronic databases: PubMed, CINAHL, Embase, Cochrane library, Web of Science, and SCOPUS. All the eligible study data elements were independently assessed and analyzed using random-effects meta-analysis methods. Of 612 studies, eight articles were eligible for this study. Nurse-led heart failure self-care education significantly reduced the risk of all-cause readmission (risk ratio (RR) = 0.75, 95% confidence interval (CI) = 0.66–0.85), heart failure specific readmission (RR = 0.60, 95% CI = 0.42–0.85), and all-cause mortality or readmission (RR = 0.71, 95% CI = 0.61–0.82). However, nurse-led heart failure self-care education was not associated with improvements in the quality of life and heart failure knowledge. Studies on the effectiveness of nurse-led heart failure self-care education mostly report only the positive effects on patients’ health outcomes, whereas evidence of the effectiveness of the nurse-led approach is still limited. Therefore, high quality randomized controlled trials with detailed and explicit descriptions on the components of the interventions are needed.
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Affiliation(s)
- Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea;
| | - JiYeon Choi
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul 03722, Korea;
| | - Hyeon-Ju Lee
- Department of Nursing, Tongmyoung University, Busan 48520, Korea
- Correspondence: ; Tel.: +82-51-629-2687
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28
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Constantinou P, Pelletier-Fleury N, Olié V, Gastaldi-Ménager C, JuillÈre Y, Tuppin P. Patient stratification for risk of readmission due to heart failure by using nationwide administrative data. J Card Fail 2020; 27:266-276. [PMID: 32801005 DOI: 10.1016/j.cardfail.2020.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/27/2020] [Accepted: 07/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Identifying patients with heart failure (HF) who are most at risk of readmission permits targeting adapted interventions. The use of administrative data enables regulators to support the implementation of such interventions. METHODS AND RESULTS In a French nationwide cohort of patients aged 65 years or older, surviving an index hospitalization for HF in 2015 (N = 70,657), we studied HF readmission predictors available in administrative data, distinguishing HF severity from overall morbidity and taking into account the competing mortality risk, over a 1-year follow-up period. We also computed cumulative incidences and daily rates of HF readmission for patient groups defined according to HF severity and overall morbidity. Of the patients, 31.8% (n = 22,475) were readmitted at least once for HF, and 17.6% (n = 12,416) died without any readmission for HF. HF severity and overall morbidity were the strongest readmission predictors were the strongest readmission predictors (subdistribution hazard ratios 2.66 [95% CI: 2.52-2.81] and 1.37 [1.30-1.45], respectively, when comparing extreme categories). Overall morbidity and age were more strongly associated with the rate of death without HF readmission (cause-specific hazard ratios). The difference in observed HF readmission between patient risk groups was approximately 40% (21.9%, n = 2144/9,786 vs 60.4%, n = 618/1023). CONCLUSIONS Segmentation of HF patients into readmission risk groups is possible by using administrative data, and it enables the targeting of preventive interventions.
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Affiliation(s)
- Panayotis Constantinou
- Center for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud; French National Health Insurance (Cnam), Paris, France.
| | - Nathalie Pelletier-Fleury
- Center for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud
| | - Valérie Olié
- French Public Health Agency (Santé Publique France), Saint-Maurice, France
| | | | - Yves JuillÈre
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-les-Nancy, France
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29
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Cui X, Thunström E, Dahlström U, Zhou J, Ge J, Fu M. Trends in cause-specific readmissions in heart failure with preserved vs. reduced and mid-range ejection fraction. ESC Heart Fail 2020; 7:2894-2903. [PMID: 32729678 PMCID: PMC7524131 DOI: 10.1002/ehf2.12899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/03/2020] [Accepted: 06/24/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS The aim of this study was to investigate whether the readmission of heart failure (HF) patients has decreased over time and how it differs among HF with preserved ejection fraction (EF) (HFpEF) vs. reduced EF (HFrEF) and mid-range EF (HFmrEF). METHODS AND RESULTS We evaluated HF patients index hospitalized from January 2004 to December 2011 in the Swedish Heart Failure Registry with 1 year follow-up. Outcome measures were the first occurring all-cause, cardiovascular (CV), and HF readmissions. A total of 20 877 HF patients (11 064 HFrEF, 4215 HFmrEF, and 5562 HFpEF) were included in the study. All-cause readmission was the highest in patients with HFpEF, whereas CV and HF readmissions were the highest in HFrEF. From 2004 to 2011, HF readmission rates within 6 months (from 22.3% to 17.3%, P = 0.003) and 1 year (from 27.7% to 23.4%, P = 0.019) in HFpEF declined, and the risk for 1 year HF readmission in HFpEF was reduced by 7% after adjusting for age and sex (P = 0.022). Likewise, risk factors for HF readmission in HFpEF changed. However, no significant changes were observed in all-cause or CV readmission rates in HFpEF, and no significant changes in cause-specific readmissions were observed in HFrEF. Time to the first readmission did not change significantly from 2004 to 2011, regardless of EF subgroup (all P-values > 0.05). CONCLUSIONS Declining temporal trend in HF readmission rates was found in HFpEF, but all-cause readmission still remained the highest in HFpEF vs. HFrEF and HFmrEF. More efforts are needed to reduce the non-HF-related readmission in patients with HFpEF.
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Affiliation(s)
- Xiaotong Cui
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Thunström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Dahlström
- Department of Cardiology, Linköping University, Linköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jingmin Zhou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Galinier M, Roubille F, Berdague P, Brierre G, Cantie P, Dary P, Ferradou JM, Fondard O, Labarre JP, Mansourati J, Picard F, Ricci JE, Salvat M, Tartière L, Ruidavets JB, Bongard V, Delval C, Lancman G, Pasche H, Ramirez-Gil JF, Pathak A. Telemonitoring versus standard care in heart failure: a randomised multicentre trial. Eur J Heart Fail 2020; 22:985-994. [PMID: 32438483 DOI: 10.1002/ejhf.1906] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022] Open
Abstract
AIMS The aim was to assess the effect of a telemonitoring programme vs. standard care (SC) in preventing all-cause deaths or unplanned hospitalisations in heart failure (HF) at 18 months. METHODS AND RESULTS OSICAT was a randomised, multicentre, open-label French study in 937 patients hospitalised for acute HF ≤12 months before inclusion. Patients were randomised to telemonitoring (daily body weight measurement, daily recording of HF symptoms, and personalised education) (n = 482) or to SC (n = 455). Mean ± standard deviation number of events for the primary outcome was 1.30 ± 1.85 for telemonitoring and 1.46 ± 1.98 for SC [rate ratio 0.97, 95% confidence interval (CI) 0.77-1.23; P = 0.80]. In New York Heart Association (NYHA) class III or IV HF, median time to all-cause death or first unplanned hospitalisation was 82 days in the telemonitoring group and 67 days in the SC group (P = 0.03). After adjustment for known predictive factors, telemonitoring was associated with a 21% relative risk reduction in first unplanned hospitalisation for HF [hazard ratio (HR) 0.79, 95% CI 0.62-0.99; P = 0.044); the relative risk reduction was 29% in patients with NYHA class III or IV HF (HR 0.71, 95% CI 0.53-0.95; P = 0.02), 38% in socially isolated patients (HR 0.62, 95% CI 0.39-0.98; P = 0.043), and 37% in patients who were ≥70% adherent to body weight measurement (HR 0.63, 95% CI 0.45-0.88; P = 0.006). CONCLUSION Telemonitoring did not result in a significantly lower rate of all-cause deaths or unplanned hospitalisations in HF patients. The pre-specified subgroup results suggest the telemonitoring approach improves clinical outcomes in selected populations but need further confirmation.
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Affiliation(s)
- Michel Galinier
- Cardiology, Toulouse Rangueil University Hospital (CHU), Toulouse, France.,UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Toulouse, France.,Faculty of Medicine, University of Paul Sabatier-Toulouse III, Toulouse, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Philippe Berdague
- Beziers Hospital Centre, Beziers, France.,MSP Beziers, Beziers, France
| | - Gilles Brierre
- Intercommunal Hospital Centre des Vallées de l'Ariege, Foix, France
| | - Philippe Cantie
- Intercommunal Hospital Centre Castres-Mazamet, Castres, France
| | - Patrick Dary
- Private Practice, Saint Yrieix La Perche, France
| | - Jean-Marc Ferradou
- Cardiology Aftercare and Rehabilitation Centre, Beaumont de Lomagne, France
| | | | | | | | - François Picard
- Unité d'Insuffisance Cardiaque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | | | | | | | | | - Cécile Delval
- Air Liquide Santé International, Loges en Josas, France
| | - Guila Lancman
- Air Liquide Santé International, Loges en Josas, France
| | - Hélène Pasche
- Air Liquide Santé International, Loges en Josas, France
| | | | - Atul Pathak
- Department of Cardiovascular Medicine, Princess Grace Hospital, Monaco, Monaco
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31
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Loncar G, Cvetinovic N, Lainscak M, Isaković A, von Haehling S. Bone in heart failure. J Cachexia Sarcopenia Muscle 2020; 11:381-393. [PMID: 32087616 PMCID: PMC7113538 DOI: 10.1002/jcsm.12516] [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] [Received: 04/28/2019] [Revised: 10/10/2019] [Accepted: 10/17/2019] [Indexed: 12/12/2022] Open
Abstract
There is an increasing interest in osteoporosis and reduced bone mineral density affecting not only post-menopausal women but also men, particularly with coexisting chronic diseases. Bone status in patients with stable chronic heart failure (HF) has been rarely studied so far. HF and osteoporosis are highly prevalent aging-related syndromes that exact a huge impact on society. Both disorders are common causes of loss of function and independence, and of prolonged hospitalizations, presenting a heavy burden on the health care system. The most devastating complication of osteoporosis is hip fracture, which is associated with high mortality risk and among those who survive, leads to a loss of function and independence often necessitating admission to long-term care. Current HF guidelines do not suggest screening methods or patient education in terms of osteoporosis or osteoporotic fracture. This review may serve as a solid base to discuss the need for bone health evaluation in HF patients.
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Affiliation(s)
- Goran Loncar
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg-August University, Goettingen, Germany
| | - Natasa Cvetinovic
- Department of Cardiology, University Clinical Hospital Center 'Dr. Dragisa Misovic-Dedinje', Belgrade, Serbia
| | - Mitja Lainscak
- Department of Internal Medicine, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg-August University, Goettingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
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32
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Homar V, Mirosevic S, Svab I, Lainscak M. Natriuretic peptides for heart failure screening in nursing homes: a systematic review. Heart Fail Rev 2020; 26:1131-1140. [PMID: 32200491 DOI: 10.1007/s10741-020-09944-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The high burden of heart failure in nursing-home populations is due to advanced age and comorbidities. Heart failure is often undiagnosed or misdiagnosed in this population and therefore remains untreated. We review the use of natriuretic peptide biomarkers for screening heart failure in nursing-home residents. The study was performed in accordance with recommendations from the Cochrane Collaboration using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) and is registered in PROSPERO Register of Systematic Reviews. Databases PubMed, Embase, and Trip were searched from 2000 to March 2019, supplemented by hand-searching of references. Studies investigating the nursing-home population were included. The prevalence of heart failure among nursing-home residents was higher than in the general population of comparable age (23% vs 10%, respectively). The rate of misdiagnosis in nursing homes ranged from 25 to 76%. NT-proBNP was the most commonly used natriuretic peptide biomarker for heart failure screening. The mean value of NT-proBNP was significantly higher in residents with heart failure than in residents overall (pooled means of 2409 pg/mL vs 1074 pg/mL, respectively). In comparison with current guidelines, the proposed cut-off values for ruling out heart failure were higher in the analyzed studies, with ranges of 230-760 pg/mL for NT-proBNP and 50-115 pg/mL for BNP. NT-proBNP and BNP are used for screening heart failure in the nursing-home population. The current screening cut-off values are probably too low for use in nursing homes. Our most conservative estimation for ruling out heart failure is an NT-proBNP cut-off value of 230 pg/mL.
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Affiliation(s)
- Vesna Homar
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, 56 Poljanski nasip, 1000, Ljubljana, Slovenia. .,Community Health Centre Vrhnika, Vrhnika, Slovenia.
| | - Spela Mirosevic
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, 56 Poljanski nasip, 1000, Ljubljana, Slovenia
| | - Igor Svab
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, 56 Poljanski nasip, 1000, Ljubljana, Slovenia
| | - Mitja Lainscak
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, 56 Poljanski nasip, 1000, Ljubljana, Slovenia.,Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia
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33
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Lhermitte C, Viallet A, Rosset E, Godreuil C. [Assessing the educational needs of patients with heart failure]. SOINS; LA REVUE DE RÉFÉRENCE INFIRMIÈRE 2020; 64:12-17. [PMID: 31864504 DOI: 10.1016/j.soin.2019.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Heart failure is a chronic pathology resulting in repeated hospitalisations and has a significant impact on the patient's quality of life. Therapeutic patient education (TPE) forms part of patients' global care to improve their health status. A study was carried out at Bégin military teaching hospital of hospitalised patients with heart failure to identify their educational needs and create a TPE programme which best meets their expectations.
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Affiliation(s)
- Chloé Lhermitte
- Service de pharmacie à usage intérieur, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
| | - Alice Viallet
- Service de pharmacie à usage intérieur, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - Emmanuelle Rosset
- Service d'hôpital médical de jour et de réadaptation cardiaque, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - Christian Godreuil
- Service d'hôpital médical de jour et de réadaptation cardiaque, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
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Hasanpour-Dehkordi A, Yadollahi M, Tali S, Gheshlagh R. Effect of exercise training on dimensions of quality of life and fatigue in people with congestive heart failure class II and III: A randomized controlled trial. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2020. [DOI: 10.4103/injms.injms_43_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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35
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Bocquillon V, Destors M, Guzun R, Doutreleau S, Pépin JL, Tamisier R. [Cardiac dysfunction and the obstructive sleep apnoea syndrome]. Rev Mal Respir 2019; 37:161-170. [PMID: 31866122 DOI: 10.1016/j.rmr.2019.07.011] [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: 12/06/2018] [Accepted: 07/04/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Cardiac insufficiency affects nearly 2% of the population with increased morbidity/mortality despite advances in therapeutic management. The sleep apnoea syndrome (SAS) is a risk factor for, and cause of aggravation of, myocardial dysfunction. BACKGROUND SAS is found in 70% of patients with chronic cardiac failure, 65% of patients with refractory hypertension, 60% of patients with cerebro-vascular accidents and 50% of patients with atrial fibrillation. The associated cardiovascular mortality is multiplied by a factor of 2 to 3. The pathophysiological mechanisms are intermittent nocturnal hypoxia, variations in CO2 levels, variations in intrathoracic pressure and repeated arrousals from sleep, concurrent with sympathetic hyperactivity, endothelial dysfunction and systemic inflammation. CONCLUSIONS SAS and cardiological management in patients presenting with myocardial dysfunction should be combined. It is necessary to pursue the scientific investigations with the aim of determining a precise care pathway and the respective places of each of the cardiological and pulmonary measures.
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Affiliation(s)
- V Bocquillon
- Inserm 1042, laboratoire HP2, Université Grenoble-Alpes, 38000 Grenoble, France; Pôle thorax et vaisseaux, clinique de physiologie sommeil et exercice, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - M Destors
- Inserm 1042, laboratoire HP2, Université Grenoble-Alpes, 38000 Grenoble, France; Pôle thorax et vaisseaux, clinique de physiologie sommeil et exercice, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - R Guzun
- Inserm 1042, laboratoire HP2, Université Grenoble-Alpes, 38000 Grenoble, France; Pôle thorax et vaisseaux, clinique de physiologie sommeil et exercice, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - S Doutreleau
- Inserm 1042, laboratoire HP2, Université Grenoble-Alpes, 38000 Grenoble, France; Pôle thorax et vaisseaux, clinique de physiologie sommeil et exercice, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - J L Pépin
- Inserm 1042, laboratoire HP2, Université Grenoble-Alpes, 38000 Grenoble, France; Pôle thorax et vaisseaux, clinique de physiologie sommeil et exercice, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - R Tamisier
- Inserm 1042, laboratoire HP2, Université Grenoble-Alpes, 38000 Grenoble, France; Pôle thorax et vaisseaux, clinique de physiologie sommeil et exercice, CHU de Grenoble-Alpes, 38000 Grenoble, France.
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Dacunka M, Sanchez S, Chapoutot L, Marchais A. [Impact of a Home Return Assistance Service (PRADO-IC) on the re-hospitalisation rate for heart failure patients]. Ann Cardiol Angeiol (Paris) 2019; 68:310-315. [PMID: 31471045 DOI: 10.1016/j.ancard.2019.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 07/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Heart failure is a public health problem. Since 2013, the National Insurance has been offering the PRADO-IC service for the return home of patients hospitalised for cardiac decompensation. The aim of this study was to assess the impact of PRADO on the rate of re-hospitalisation of patients with heart failure at the centre hospitalier de Troyes (CHT). MATERIAL AND METHODS This was a 26-month monocentric retrospective study. Patients who were hospitalised for congestive heart failure in the cardiology department of the Troyes Hospital Centre from January 1, 2017 to August 31, 2018, and discharged home with the PRADO-IC service were included in the study. The primary outcome was the assessment of the number of readmissions for heart failure, 6 months before and 6 months after inclusion in the program. Secondary outcomes were the evaluation of the number of all-cause readmissions, the average length of stay and the time to readmission. RESULTS The average number of hospitalisations for cardiac decompensation before inclusion in the PRADO decreased from 0.34 to 0.25 (P=0.53) at 6 months. The average number of all-cause hospitalisations before inclusion increased from 0.57 to 0.58 (P=0.50) at 6 months. There was no significant difference in average length of stay and time to re-admission. CONCLUSION We did not highlight the impact of PRADO on the rate of re-hospitalisation of heart failure patients.
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Affiliation(s)
- M Dacunka
- Pôle vasculaire, service de cardiologie, centre hospitalier de Troyes, 101, avenue Anatole-France, 10000 Troyes, France.
| | - S Sanchez
- Pôle information médicale évaluation performance (IMEP), centre hospitalier de Troyes, hôpitaux Champagne Sud, 101, avenue Anatole CS 10178, 10003 Troyes cedex, France.
| | - L Chapoutot
- Pôle vasculaire, service de cardiologie, centre hospitalier de Troyes, 101, avenue Anatole-France, 10000 Troyes, France.
| | - A Marchais
- Pôle vasculaire, service de cardiologie, centre hospitalier de Troyes, 101, avenue Anatole-France, 10000 Troyes, France.
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15-Year Trends in Patients Hospitalised With Heart Failure and Enrolled in an Australian Heart Failure Management Program. Heart Lung Circ 2019; 28:1646-1654. [DOI: 10.1016/j.hlc.2018.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 08/12/2018] [Accepted: 10/08/2018] [Indexed: 11/19/2022]
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Long B, Koyfman A, Gottlieb M. Diagnosis of Acute Heart Failure in the Emergency Department: An Evidence-Based Review. West J Emerg Med 2019; 20:875-884. [PMID: 31738714 PMCID: PMC6860389 DOI: 10.5811/westjem.2019.9.43732] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 09/09/2019] [Indexed: 01/01/2023] Open
Abstract
Heart failure is a common presentation to the emergency department (ED), which can be confused with other clinical conditions. This review provides an evidence-based summary of the current ED evaluation of heart failure. Acute heart failure is the gradual or rapid decompensation of heart failure, resulting from either fluid overload or maldistribution. Typical symptoms can include dyspnea, orthopnea, or systemic edema. The physical examination may reveal pulmonary rales, an S3 heart sound, or extremity edema. However, physical examination findings are often not sensitive or specific. ED assessments may include electrocardiogram, complete blood count, basic metabolic profile, liver function tests, troponin, brain natriuretic peptide, and a chest radiograph. While often used, natriuretic peptides do not significantly change ED treatment, mortality, or readmission rates, although they may decrease hospital length of stay and total cost. Chest radiograph findings are not definitive, and several other conditions may mimic radiograph findings. A more reliable modality is point-of-care ultrasound, which can facilitate the diagnosis by assessing for B-lines, cardiac function, and inferior vena cava size. These modalities, combined with clinical assessment and gestalt, are recommended.
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Affiliation(s)
- Brit Long
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| | - Alex Koyfman
- University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas
| | - Michael Gottlieb
- Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois
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Sulo G, Igland J, Øverland S, Egeland GM, Roth GA, Vollset SE, Tell GS. Heart failure in Norway, 2000-2014: analysing incident, total and readmission rates using data from the Cardiovascular Disease in Norway (CVDNOR) Project. Eur J Heart Fail 2019; 22:241-248. [PMID: 31646725 DOI: 10.1002/ejhf.1609] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/10/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022] Open
Abstract
AIMS To examine trends in heart failure (HF) hospitalization rates and risk of readmissions following an incident HF hospitalization. METHODS AND RESULTS During 2000-2014, we identified in the Cardiovascular Disease in Norway Project 142 109 hospitalizations with HF as primary diagnosis. Trends of incident and total (incident and recurrent) HF hospitalization rates were analysed using negative binomial regression models. Changes over time in 30-day and 3-year risk of HF recurrences or cardiovascular disease (CVD)-related readmissions were analysed using Fine and Grey competing risk regression, with death as competing events. Age-standardized rates declined on average 1.9% per year in men and 1.8% per year in women for incident HF hospitalizations (both Ptrend < 0.001) but did not change significantly in either men or women for total HF hospitalizations. In men surviving the incident HF hospitalization, 30-day and 3-year risk of a HF recurrent event increased 1.7% and 1.2% per year, respectively. Similarly, 30-day and 3-year risk of a CVD-related hospitalization increased 1.5% and 1.0% per year, respectively (all Ptrend < 0.001). No statistically significant changes in the risk of HF recurrences or CVD-related readmissions were observed among women. In-hospital mortality for a first and recurrent HF episode declined over time in both men and women. CONCLUSIONS Incident HF hospitalization rates declined in Norway during 2000-2014. An increase in the risk of recurrences in the context of reduced in-hospital mortality following an incident and recurrent HF hospitalization led to flat trends of total HF hospitalization rates.
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Affiliation(s)
- Gerhard Sulo
- Centre for Disease Burden, Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway.,Oral Health Centre of Expertise in Western Norway, Bergen, Norway
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Simon Øverland
- Centre for Disease Burden, Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway.,Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Grace M Egeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Divisions of Health Data and Digitalization and Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, WA, USA
| | - Stein E Vollset
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, WA, USA
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
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40
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Estudio poblacional de la primera hospitalización por insuficiencia cardiaca y la interacción entre los reingresos y la supervivencia. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.05.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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41
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Lainscak M, Omersa D, Sedlar N, Anker SD, Farkas J. Heart failure prevalence in the general population: SOBOTA-HF study rationale and design. ESC Heart Fail 2019; 6:1077-1084. [PMID: 31347289 PMCID: PMC6816073 DOI: 10.1002/ehf2.12496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/02/2019] [Accepted: 06/25/2019] [Indexed: 12/28/2022] Open
Abstract
Aims Epidemiological heart failure (HF) data in the era of natriuretic peptides and echocardiography are scarce. The primary aim of this study is to evaluate the HF prevalence in the general population. We will also investigate natriuretic peptide cut‐off for diagnosis of HF. Finally, we will be able to identify left ventricular function phenotypes and study relations between cardiac function, clinical presentation, and health‐related quality of life. Methods and results Screening Of adult urBan pOpulation To diAgnose Heart Failure (SOBOTA‐HF) is a cross‐sectional prevalence study in a representative sample of Murska Sobota residents aged 55 years or more. Individuals will be invited to attend screening visit with point‐of‐care N‐terminal pro‐b‐type natriuretic peptide (NT‐proBNP) testing. All subjects with NT‐proBNP ≥ 125 pg/mL will be invited for a diagnostic visit that will include history and physical examination, electrocardiogram, echocardiography, blood and urine sampling, ankle brachial index, pulmonary function tests, body composition measurement, physical performance tests, and questionnaires. To validate the screening procedure, a control group (NT‐proBNP < 125 pg/mL) will undergo the same diagnostic evaluation. An external centre will validate echocardiography results, and the HF diagnosis will be adjudicated within an international HF expert panel. Overall and age‐specific HF prevalence will be calculated in individuals ≥ 55 years and extrapolated to the whole population. Conclusions The SOBOTA‐HF study will test the latest HF guideline diagnostic criteria in the general population sample. Next to HF prevalence, it will provide insight into left ventricular function and general patient phenotype; we will also extend current understanding of natriuretic peptides for HF screening.
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Affiliation(s)
- Mitja Lainscak
- General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, Rakican, SI-9000, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Daniel Omersa
- General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, Rakican, SI-9000, Murska Sobota, Slovenia.,General Hospital Jesenice, Jesenice, Slovenia
| | - Natasa Sedlar
- National Institute of Public Health, Ljubljana, Slovenia
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jerneja Farkas
- General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, Rakican, SI-9000, Murska Sobota, Slovenia.,National Institute of Public Health, Ljubljana, Slovenia
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42
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Méndez-Bailón M, Jiménez-García R, Hernández-Barrera V, Comín-Colet J, Esteban-Hernández J, de Miguel-Díez J, de Miguel-Yanes JM, Muñoz-Rivas N, Lorenzo-Villalba N, López-de-Andrés A. Significant and constant increase in hospitalization due to heart failure in Spain over 15 year period. Eur J Intern Med 2019; 64:48-56. [PMID: 30827807 DOI: 10.1016/j.ejim.2019.02.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/05/2019] [Accepted: 02/23/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND To examine trends in the incidence, characteristics, and in-hospital outcomes of heart failure (HF) hospitalizations from 2001 to 2015 in Spain. METHODS Using the Spanish National Hospital Discharge Database (SNHDD) we selected admissions with a primary or secondary diagnosis of HF. The primary end points were trends in the incidence of hospitalizations and in-hospital mortality (IHM). Trends with primary and secondary diagnosis of HF were evaluated separately. RESULTS The incidence of HF coding increased significantly from 466.16 cases per 100,000 inhabitants in 2001-03 to 780.4 in 2013-15 (p < .001). Age increased over time (76.33 ± 10.92 years in 2001-03 vs. 79.4 ± 10.78 years in 2013-15; p < .001). We found a decrease in the percentage of women over the study period (53.07% vs. 52%; p < .001). We detected a significant increase in comorbidity according to the Charlson Comorbidity Index over time (mean 2.17 ± 0.98 in 2001-03 vs. 2.46 ± 1.04 in 2013-15). The most common associated comorbidities were atrial fibrillation (42.23%), hypertension (38.87%) and type 2 diabetes (34.3%). For the total time period, IHM was 12.79%. IHM decreased significantly over time from 13.47% in 2001-03 to 12.30% in 2013-15. Patients with HF coded as a secondary diagnosis have 66% higher risk of dying in the hospital that those with HF coded as a primary diagnosis. CONCLUSIONS This research shows an increase of hospitalizations due to HF in Spain, particularly in patients with HF as a secondary diagnosis. Advance age and comorbidity in acute HF has increased in the recent years. However, IHM is decreasing while readmissions remain stable.
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Affiliation(s)
- Manuel Méndez-Bailón
- Internal Medicine Department, Clínico San Carlos University Hospital, Medicine Department, Complutense University of Madrid (UCM), Clínico San Carlos Hospital Biomedical Research Institute (IdISSC), Madrid, Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Josep Comín-Colet
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain, Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Jesús Esteban-Hernández
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Javier de Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - José M de Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Spain
| | - Nuria Muñoz-Rivas
- Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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Bricard D, Or Z. Impact of early primary care follow-up after discharge on hospital readmissions. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:611-623. [PMID: 30600468 DOI: 10.1007/s10198-018-1022-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 12/11/2018] [Indexed: 06/09/2023]
Abstract
Reducing repeated hospitalizations of patients with chronic conditions is a policy objective for improving system efficiency. We test the hypothesis that the risk of readmission is associated with the timing and intensity of primary care follow-up after discharge, focusing on patients hospitalized for heart failure in France. We propose a discrete-time model which takes into account that primary care treatments have a lagged and cumulative effect on readmission risk, and an instrumental variable approach, exploiting geographical differences in availability of generalists. We show that the early consultations with a GP after discharge can reduce the 28-day readmission risk by almost 50%, and that patients with higher ambulatory care utilization have smaller odds of readmission. Furthermore, geographical disparities in primary care affect indirectly the readmission risk. These results suggest that interventions which strengthen communication between hospitals and generalists are elemental for reducing readmissions and for developing effective strategies at the hospital level, it is also necessary to consider primary care resources that are available to patients.
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Affiliation(s)
- Damien Bricard
- Institut de Recherche et de Documentation en Economie de la Santé (IRDES), 117 bis rue Manin, 75019, Paris, France.
| | - Zeynep Or
- Institut de Recherche et de Documentation en Economie de la Santé (IRDES), 117 bis rue Manin, 75019, Paris, France
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Abstract
Heart failure (HF) is a clinical syndrome that associates clinical signs in people over 80 years of age, an increase in natriuretic peptides and abnormal cardiac structures that result from cardiac aging in many cases. The most common symptoms are grouped according to the acronym "EPOF" (shortness of breath, weight gain, edema, fatigue). Over the age of 80, comorbidities must be taken into account. The incidence and prevalence of HF significantly increases with age and makes HF the most common reason for hospitalization for people over 80, and an important health expense. The management of HF, necessarily multidisciplinary with a geriatric evaluation, has improved over time due to effective targeted treatment, but mortality, hospitalization and readmission rates remain high. Therapeutic education and patient follow-up for treatment optimization are needed.
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45
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Simonet D. Technocratic recentralization in the French health care system: A critical evaluation. Int J Health Plann Manage 2018; 34:824-835. [PMID: 30680793 DOI: 10.1002/hpm.2740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 11/10/2022] Open
Abstract
The French health care system implemented several corporate management recipes such as diagnostic-related groups (DRGs), benchmarking, and activity-based management in a bid to restore fiscal discipline and to "reassert the center." The government also regrouped health policy decisions with the Regional Health Agencies and opted for a top-down line of command to ensure policy implementation. Though reforms emphasized evidenced-based policy and outputs measurement, outcomes were below expectations in many areas and led to a shift in values. Professional autonomy and patient engagement receded. This leads us to a critical evaluation of the French audit society.
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Affiliation(s)
- Daniel Simonet
- School of Business and Public Administration, American University of Sharjah, Sharjah, UAE
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46
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Dinatolo E, Sciatti E, Anker MS, Lombardi C, Dasseni N, Metra M. Updates in heart failure: what last year brought to us. ESC Heart Fail 2018; 5:989-1007. [PMID: 30570225 PMCID: PMC6300825 DOI: 10.1002/ehf2.12385] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Elisabetta Dinatolo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Edoardo Sciatti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Markus S. Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Berlin‐Brandenburg Center for Regenerative Therapies (BCRT), DZHK (German Centre for Cardiovascular Research), partner site BerlinCharité—Universitätsmedizin BerlinBerlinGermany
| | - Carlo Lombardi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Nicolò Dasseni
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
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47
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Niedziela JT, Parma Z, Pawlowski T, Rozentryt P, Gasior M, Wojakowski W. Secular trends in first-time hospitalization for heart failure with following one-year readmission and mortality rates in the 3.8 million adult population of Silesia, Poland between 2010 and 2016. The SILCARD database. Int J Cardiol 2018; 271:146-151. [DOI: 10.1016/j.ijcard.2018.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/22/2018] [Accepted: 05/08/2018] [Indexed: 10/28/2022]
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48
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Xu XR, Meng XC, Wang X, Hou DY, Liang YH, Zhang ZY, Liu JM, Zhang J, Xu L, Wang H, Zhao WS, Zhang L. A severity index study of long-term prognosis in patients with chronic heart failure. Life Sci 2018; 210:158-165. [DOI: 10.1016/j.lfs.2018.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/31/2018] [Accepted: 09/02/2018] [Indexed: 11/24/2022]
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49
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Fernández-Gassó L, Hernando-Arizaleta L, Palomar-Rodríguez JA, Abellán-Pérez MV, Hernández-Vicente Á, Pascual-Figal DA. Population-based Study of First Hospitalizations for Heart Failure and the Interaction Between Readmissions and Survival. ACTA ACUST UNITED AC 2018; 72:740-748. [PMID: 30262426 DOI: 10.1016/j.rec.2018.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/25/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Disease progression in patients after a first hospitalization for heart failure (HF), in particular the interaction between survival and rehospitalizations, is not well established. METHODS We studied all patients with a first hospitalization and main diagnosis of HF from 2009 to 2013 by analyzing the Minimum Data Set of the Region of Murcia. Both incident and recurrent patients were studied, and the trend in hospitalization rates was calculated by joinpoint regression. Patients were followed-up through their health cards until the end of 2015. Mortality and readmissions, including causes and chronology in relation to the time of death, were assessed. RESULTS A total of 8258 incident patients were identified, with annual rates increasing (+2.3%, P <.05) up to 1.24 patients per 1000 inhabitants, representing 71% of hospitalized individuals and 57% of total discharges due to HF. In the first year, 22% were readmitted due to HF, 31% due to cardiovascular causes, and 54% due to any cause. Five-year survival was 40%, which was significantly lower than age- and sex-adjusted expected survival for the general population (76%) (P <.001). Among patients who died during follow-up, readmissions (1.5 per patient/y, 0.4 due to HF) showed a "J" pattern, with 48% of rehospitalizations being concentrated in the last 3 deciles of survival prior to death. CONCLUSIONS Rates of first hospitalization due to HF continue to increase, with high mortality and rehospitalizations during follow-up, which are concentrated mainly in the period prior to death.
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Affiliation(s)
- Lucía Fernández-Gassó
- Servicio de Cardiología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - Lauro Hernando-Arizaleta
- Servicio de Planificación Sanitaria y Financiación Sanitaria, Consejería de Salud de la Región de Murcia, Murcia, Spain
| | - Joaquín A Palomar-Rodríguez
- Servicio de Planificación Sanitaria y Financiación Sanitaria, Consejería de Salud de la Región de Murcia, Murcia, Spain
| | - María Victoria Abellán-Pérez
- Servicio de Planificación Sanitaria y Financiación Sanitaria, Consejería de Salud de la Región de Murcia, Murcia, Spain
| | - Álvaro Hernández-Vicente
- Servicio de Cardiología, Hospital Universidad Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
| | - Domingo A Pascual-Figal
- Servicio de Cardiología, Hospital Universidad Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Murcia, Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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50
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Camplain R, Kucharska-Newton A, Keyserling TC, Layton JB, Loehr L, Heiss G. Incidence of Heart Failure Observed in Emergency Departments, Ambulatory Clinics, and Hospitals. Am J Cardiol 2018; 121:1328-1335. [PMID: 29576231 PMCID: PMC5972069 DOI: 10.1016/j.amjcard.2018.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/29/2018] [Accepted: 02/06/2018] [Indexed: 12/29/2022]
Abstract
Reports on the burden of heart failure (HF) have largely omitted HF diagnosed in outpatient settings. We quantified annual incidence rates ([IR] per 1,000 person years) of HF identified in ambulatory clinics, emergency departments (EDs), and during hospital stays in a national probability sample of Medicare beneficiaries from 2008 to 2014, by age and race/ethnicity. A 20% random sample of Medicare beneficiaries ages ≥65 years with continuous Medicare Parts A, B, and D coverage was used to estimate annual IRs of HF identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Of the 681,487 beneficiaries with incident HF from 2008 to 2014, 283,451 (41%) presented in ambulatory clinics, 76,919 (11%) in EDs, and 321,117 (47%) in hospitals. Overall, incidence of HF in ambulatory clinics decreased from 2008 (IR 22.2, 95% confidence interval [CI] 22.0, 22.4) to 2014 (IR 15.0, 95% CI 14.8, 15.1). Similarly, incidence of HF-related ED visits without an admission to the hospital decreased somewhat from 2008 (IR 5.5, 95% CI 5.4, 5.6) to 2012 (IR 4.2, 95% CI 4.1, 4.3) and stabilized from 2013 to 2014. Similar to previous reports, HF hospitalizations, both International Classification of Diseases, Ninth Revision, Clinical Modification code 428.x in the primary and any position, decreased over the study period. More than half of all new cases of HF in Medicare beneficiaries presented in an ambulatory clinic or ED. The overall incidence of HF decreased from 2008 to 2014, regardless of health-care setting. In conclusion, consideration of outpatient HF is warranted to better understand the burden of HF and its temporal trends.
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Affiliation(s)
- Ricky Camplain
- Northern Arizona University, Center for Health Equity Research, Flagstaff, Arizona; The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina.
| | - Anna Kucharska-Newton
- The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina
| | - Thomas C Keyserling
- The University of North Carolina at Chapel Hill, Department of Medicine, Chapel Hill, North Carolina
| | - J Bradley Layton
- The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina; RTI Health Solutions, Research Triangle Park, North Carolina
| | - Laura Loehr
- The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina
| | - Gerardo Heiss
- The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina
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