1
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Hill L, Prager Geller T, Baruah R, Beattie JM, Boyne J, de Stoutz N, Di Stolfo G, Lambrinou E, Skibelund AK, Uchmanowicz I, Rutten FH, Čelutkienė J, Piepoli MF, Jankowska EA, Chioncel O, Ben Gal T, Seferovic PM, Ruschitzka F, Coats AJS, Strömberg A, Jaarsma T. Integration of a palliative approach into heart failure care: a European Society of Cardiology Heart Failure Association position paper. Eur J Heart Fail 2020; 22:2327-2339. [PMID: 32892431 DOI: 10.1002/ejhf.1994] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/18/2022] Open
Abstract
The Heart Failure Association of the European Society of Cardiology has published a previous position paper and various guidelines over the past decade recognizing the value of palliative care for those affected by this burdensome condition. Integrating palliative care into evidence-based heart failure management remains challenging for many professionals, as it includes the identification of palliative care needs, symptom control, adjustment of drug and device therapy, advance care planning, family and informal caregiver support, and trying to ensure a 'good death'. This new position paper aims to provide day-to-day practical clinical guidance on these topics, supporting the coordinated provision of palliation strategies as goals of care fluctuate along the heart failure disease trajectory. The specific components of palliative care for symptom alleviation, spiritual and psychosocial support, and the appropriate modification of guideline-directed treatment protocols, including drug deprescription and device deactivation, are described for the chronic, crisis and terminal phases of heart failure.
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Affiliation(s)
- Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Tal Prager Geller
- Palliative Care Ward at Dorot Health Centre, Heart Failure Unit at Rabin Medical Center, Netanya, Israel
| | - Resham Baruah
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - James M Beattie
- Cicely Saunders Institute, King's College London, London, UK
| | - Josiane Boyne
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Giuseppe Di Stolfo
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | | | - Izabella Uchmanowicz
- Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Massimo Francesco Piepoli
- Heart Failure Unit, Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy.,University of Parma, Parma, Italy
| | - Ewa A Jankowska
- Centre for Heart Diseases, University Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania.,University of Medicine Carol Davila, Bucharest, Romania
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Petar M Seferovic
- Cardiology Department, Clinical Centre Serbia, Medical School Belgrade, Belgrade, Serbia
| | - Frank Ruschitzka
- Clinic for Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
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2
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Zhang ZH, Meng FQ, Hou XF, Qian ZY, Wang Y, Qiu YH, Jiang ZY, Du AJ, Qin CT, Zou JG. Clinical characteristics and long-term prognosis of ischemic and non-ischemic cardiomyopathy. Indian Heart J 2020; 72:93-100. [PMID: 32534695 PMCID: PMC7296233 DOI: 10.1016/j.ihj.2020.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/22/2020] [Accepted: 04/19/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives The different etiology of HF has different prognostic risk factors. Prognosis assessment of ICM and NICM has important clinical value. This study is aimed to explore the predicting factors for ICM and NICM. Methods 1082 HFrEF patients were retrospectively enrolled from Jan. 01, 2016 to Dec. 31, 2017. On Jan. 31, 2019, 873 patients were enrolled for analysis excluding incomplete, unfollowed, and unexplained data. The patients were divided into ischemic and non-ischemic group. The differences in clinical characteristics and long-term prognosis between the two groups were analyzed, and multivariate Cox analysis was used to predict the respective all-cause mortality, SCD and rehospitalization of CHF. Results 873 patients aged 64(53,73) were divided into two groups: ICM (403, 46.16%) and NICM. At the end, 203 died (111 in ICM, 54.68%), of whom 87 had SCD (53 in ICM, 60.92%) and 269 had rehospitalization for HF(134 in ICM, 49.81%). Independent risk factors affecting all-cause mortality in ICM: DM, previous hospitalization of HF, age, eGFR, LVEF; for SCD: PVB, eGFR, Hb, revascularization; for readmission of HF: low T3 syndrome, PVB, DM, previous hospitalization of HF, eGFR. Otherwise; factors affecting all-cause mortality in NICM: NYHA III-IV, paroxysmal AF/AFL, previous hospitalization of HF, β-blocker; for SCD: low T3 syndrome, PVB, nitrates, sodium, β-blocker; for rehospitalization of HF: paroxysmal AF/AFL, previous admission of HF, LVEF. Conclusions Both all-cause mortality and SCD in ICM is higher than that in NICM. Different etiologies of CHF have different risk factors affecting the prognosis.
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Affiliation(s)
- Zhi-Hua Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China; Department of Cardiology, Jiangning Hospital Affiliated to Nanjing Medical University, Jiangsu, China
| | - Fan-Qi Meng
- Department of Cardiology, Xiamen Cardiovascular Disease Hospital, Xiamen, China
| | - Xiao-Feng Hou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Zhi-Yong Qian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Yao Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Yuan-Hao Qiu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Zhe-Yu Jiang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - An-Jie Du
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Chao-Tong Qin
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Jian-Gang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu, China.
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3
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Meng F, Zhang Z, Hou X, Qian Z, Wang Y, Chen Y, Wang Y, Zhou Y, Chen Z, Zhang X, Yang J, Zhang J, Guo J, Li K, Chen L, Zhuang R, Jiang H, Zhou W, Tang S, Wei Y, Zou J. Machine learning for prediction of sudden cardiac death in heart failure patients with low left ventricular ejection fraction: study protocol for a retroprospective multicentre registry in China. BMJ Open 2019; 9:e023724. [PMID: 31101692 PMCID: PMC6530409 DOI: 10.1136/bmjopen-2018-023724] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Left ventricular ejection fraction (LVEF) ≤35%, as current significant implantable cardioverter-defibrillator (ICD) indication for primary prevention of sudden cardiac death (SCD) in heart failure (HF) patients, has been widely recognised to be inefficient. Improvement of patient selection for low LVEF (≤35%) is needed to optimise deployment of ICD. Most of the existing prediction models are not appropriate to identify ICD candidates at high risk of SCD in HF patients with low LVEF. Compared with traditional statistical analysis, machine learning (ML) can employ computer algorithms to identify patterns in large datasets, analyse rules automatically and build both linear and non-linear models in order to make data-driven predictions. This study is aimed to develop and validate new models using ML to improve the prediction of SCD in HF patients with low LVEF. METHODS AND ANALYSIS We will conduct a retroprospective, multicentre, observational registry of Chinese HF patients with low LVEF. The HF patients with LVEF ≤35% after optimised medication at least 3 months will be enrolled in this study. The primary endpoints are all-cause death and SCD. The secondary endpoints are malignant arrhythmia, sudden cardiac arrest, cardiopulmonary resuscitation and rehospitalisation due to HF. The baseline demographic, clinical, biological, electrophysiological, social and psychological variables will be collected. Both ML and traditional multivariable Cox proportional hazards regression models will be developed and compared in the prediction of SCD. Moreover, the ML model will be validated in a prospective study. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics Committee of the First Affiliated Hospital of Nanjing Medical University (2017-SR-06). All results of this study will be published in international peer-reviewed journals and presented at relevant conferences. TRIAL REGISTRATION NUMBER ChiCTR-POC-17011842; Pre-results.
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Affiliation(s)
- Fanqi Meng
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Zhihua Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Cardiology, Jiangning Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaofeng Hou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhiyong Qian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yao Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yanhong Chen
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Yilian Wang
- Department of Cardiology, The Second People’s Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Ye Zhou
- Department of Cardiology, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Zhen Chen
- Department of Cardiology, Taixing People’s Hospital, Taixing, Jiangsu, China
| | - Xiwen Zhang
- Department of Cardiology, The First People’s Hospital of Huaian, Huaian, Jiangsu, China
| | - Jing Yang
- Department of Cardiology, The First People’s Hospital of Huaian, Huaian, Jiangsu, China
| | - Jinlong Zhang
- Department of Cardiology, The First People’s Hospital of Yancheng, Yancheng, Jiangsu, China
| | - Jianghong Guo
- Department of Cardiology, Rugao People’s Hospital, Rugao, Jiangsu, China
| | - Kebei Li
- Department of Cardiology, The First People’s Hospital of Zhangjiagang, Zhangjiagang, Jiangsu, China
| | - Lu Chen
- Department of Cardiology, The Third People’s Hospital of Suzhou, Suzhou, Jiangsu, China
| | - Ruijuan Zhuang
- Department of Cardiology, The Third People’s Hospital of Wuxi, Wuxi, Jiangsu, China
| | - Hai Jiang
- Department of Cardiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Weihua Zhou
- School of Computing, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Shaowen Tang
- Department of Epidemiology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yongyue Wei
- Department of Biostatistics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiangang Zou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
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Scrutinio D, Guida P, Passantino A, Ammirati E, Oliva F, Lagioia R, Raimondo R, Venezia M, Frigerio M. Acutely decompensated heart failure with chronic obstructive pulmonary disease: Clinical characteristics and long-term survival. Eur J Intern Med 2019; 60:31-38. [PMID: 30446355 DOI: 10.1016/j.ejim.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/30/2018] [Accepted: 11/06/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is among the most common comorbidities in patients hospitalized with heart failure and is generally associated with poor outcomes. However, the results of previous studies with regard to increased mortality and risk trajectories were not univocal. We sought to assess the prognostic impact of COPD in patients admitted for acutely decompensated heart failure (ADHF) and investigate the association between use of β-blockers at discharge and mortality in patients with COPD. METHODS We studied 1530 patients. The association of COPD with mortality was examined in adjusted Fine-Gray proportional hazard models where heart transplantation and ventricular assist device implantation were treated as competing risks. The primary outcome was 5-year all-cause mortality. RESULTS After adjusting for establisked risk markers, the subdistribution hazard ratios (SHR) of 5-year mortality for COPD patients compared with non-COPD patients was 1.25 (95% confidence intervals [CIs] 1.06-1.47; p = .007). The relative risk of death for COPD patients increased steeply from 30 to 180 days, and remained noticeably high throughout the entire follow-up. Among patients with comorbid COPD, the use of β-blockers at discharge was associated with a significantly reduced risk of 1-year post-discharge mortality (SHR 0.66, 95%CIs 0.53-0.83; p ≤.001). CONCLUSIONS Our data indicate that ADHF patients with comorbid COPD have a worse long-term survival than those without comorbid COPD. Most of the excess mortality occurred in the first few months following hospitalization. Our data also suggest that the use of β-blockers at discharge is independently associated with improved survival in ADHF patients with COPD.
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Affiliation(s)
| | - Pietro Guida
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Italy
| | | | | | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Rocco Lagioia
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Italy
| | - Rosa Raimondo
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Italy
| | - Mario Venezia
- Istituti Clinici Scientifici Maugeri, I.R.C.C.S., Italy
| | - Maria Frigerio
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
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5
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Johnson MJ, Gadoud A. Palliative Care for People with Chronic Heart Failure: When is it Time? J Palliat Care 2018. [DOI: 10.1177/082585971102700107] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Miriam J. Johnson
- MJ Johnson (corresponding author) Hull York Medical School, University of Hull, UK, and St. Catherine's Hospice, Throxenby Lane, Scarborough, North Yorkshire, UK YO12
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6
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Gallego González E, Ortiz Alonso FJ, Vidán Astiz MT, Soria Felix S, García Cárdenas V, Omonte Guzmán J, Abizanda P, Valadés Malagón MI, Oreja Sevilla S, Serra Rexach JA. Development and validation of a prognostic index for 6- and 12-month mortality in hospitalized older adults. Arch Gerontol Geriatr 2017; 73:269-278. [PMID: 28869885 DOI: 10.1016/j.archger.2017.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/16/2017] [Accepted: 07/17/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND/AIM Estimation of mortality in elderly patients is difficult yet very important when planning care. Previous tools are complicated or do no take into account some major determinants of mortality (i.e., frailty). We designed a simple, accurate, and non-disease-specific tool to predict individual mortality risk after hospital discharge in older adults. METHODS Patients admitted to the Acute Geriatric Unit were assessed at adission and at discharge and contacted 6 and 12 months later. Determinants of mortality were obtained. Using multivariable analysis, beta coeffcicients were calculated to build 2 scores able to predict mortality at 6 and 12 months after discharge. The scores were tested on a sample comprising 75% of the patients, who were randomly selected; they were validated using the remaining 25%. Discrimination was assessed using ROC curves. Scores were calculated for each patient and divided into tertiles. Survival analysis was performed. RESULTS Determinants of mortality at 6 months were dependent ambulation at baseline, full dependence at discharge, length of stay, pluripatology, pressure ulcers, low grip strength, malignacy, and male gender. At 12 months the determinants were: dependent amblation at baseline, full dependence at discharge, pluripatology, low BMI, low grip strength, heart failure, malignacy, and male gender. Discrimination and calibration were excellent. Survival analysis demonstrated different survival trajectories (p<0.001) for each tertile in both scores. CONCLUSIONS Our incices provide accurate prognostic information in elderly patients after discharge. They can be calculated easily, quickly and do not require technical or laboratory support, thus endorsing their value in dalily clinical practice.
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Affiliation(s)
- Eva Gallego González
- Hospital Universitario de Canarias, Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERFES, Madrid, Spain.
| | - Francisco Javier Ortiz Alonso
- Instituto de Investigación Sanitaria Gregorio Marañón, CIBERFES, Madrid, Spain; Geriatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Maria Teresa Vidán Astiz
- Instituto de Investigación Sanitaria Gregorio Marañón, CIBERFES, Madrid, Spain; Geriatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, CIBERFES, Spain.
| | - Selene Soria Felix
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | | | - John Omonte Guzmán
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Pedro Abizanda
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, CIBERFES, Albacete, Spain.
| | | | - Silvia Oreja Sevilla
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - José Antonio Serra Rexach
- Instituto de Investigación Sanitaria Gregorio Marañón, CIBERFES, Madrid, Spain; Geriatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, CIBERFES, Spain.
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7
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Treece J, Chemchirian H, Hamilton N, Jbara M, Gangadharan V, Paul T, Baumrucker SJ. A Review of Prognostic Tools in Heart Failure. Am J Hosp Palliat Care 2017; 35:514-522. [PMID: 28554221 DOI: 10.1177/1049909117709468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A minority of patients with end-stage disease are referred to palliative medicine for consultation in advanced heart failure. Educating stakeholders, including primary care, cardiology, and critical care of the benefits of hospice and palliative medicine for patients with poor prognosis, may increase appropriately timed referrals and improve quality of life for these patients. This article reviews multiple tools useful in prognostication in the setting of advanced heart failure.
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Affiliation(s)
- Jennifer Treece
- 1 Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Hrak Chemchirian
- 2 Department of Cardiology, Charleston Area Medical Center, Charleston, WV, USA
| | - Neil Hamilton
- 1 Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Manar Jbara
- 3 Department of Cardiology, ETSU College of Medicine, Johnson City, TN, USA
| | | | - Timir Paul
- 3 Department of Cardiology, ETSU College of Medicine, Johnson City, TN, USA
| | - Steven J Baumrucker
- 5 Department of Hospice and Palliative Medicine, Wellmont Health System, Kingsport, TN, USA
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8
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Khafaji HAR, Sulaiman K, Singh R, Alhabib KF, Asaad N, Alsheikh-Ali A, Al-Jarallah M, Bulbanat B, Almahmeed W, Ridha M, Bazargani N, Amin H, Al-Motarreb A, Faleh HA, Elasfar A, Panduranga P, Suwaidi JA. Chronic obstructive airway disease among patients hospitalized with acute heart failure; clinical characteristics, precipitating factors, management and outcome: Observational report from the Middle East. ACTA ACUST UNITED AC 2016; 17:55-66. [DOI: 10.1080/17482941.2016.1203438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Hadi A. R. Khafaji
- Department of Cardiology, Saint Michael's Hospital, Toronto University, Toronto, Canada
| | - Kadhim Sulaiman
- Biostatistics Section, Department of Cardiology, Royal Hospital, Muscat, Oman
| | - Rajvir Singh
- Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khalid F. Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Nidal Asaad
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Alawi Alsheikh-Ali
- Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | | | - Bassam Bulbanat
- Department of Cardiology, Sabah Al-Ahmed Cardiac Center, Kuwait City, Kuwait
| | - Wael Almahmeed
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mustafa Ridha
- Department of Cardiology, Adan Hospital, Hadiya, Kuwait
| | - Nooshin Bazargani
- Department of Cardiology, Dubai Hospital, Dubai, United Arab Emirates
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Center, Manamah, Bahrain
| | - Ahmed Al-Motarreb
- Department of Cardiology, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | - Husam Al Faleh
- Department of Cardiology and Cardiovascular Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Abdelfatah Elasfar
- Department of Cardiology, Prince Salman Heart Center, King Fahad Medical City, Saudi Arabia
| | | | - Jassim Al Suwaidi
- Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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9
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Sajgalik P, Grupper A, Edwards BS, Kushwaha SS, Stulak JM, Joyce DL, Joyce LD, Daly RC, Kara T, Schirger JA. Current Status of Left Ventricular Assist Device Therapy. Mayo Clin Proc 2016; 91:927-40. [PMID: 27378038 DOI: 10.1016/j.mayocp.2016.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 04/22/2016] [Accepted: 05/03/2016] [Indexed: 02/05/2023]
Abstract
Congestive heart failure (HF) remains a serious burden in the Western World. Despite advances in pharmacotherapy and resynchronization, many patients have progression to end-stage HF. These patients may be candidates for heart transplant or left ventricular assist device (LVAD) therapy. Heart transplants are limited by organ shortages and in some cases by patient comorbidities; therefore, LVAD therapy is emerging as a strategy of bridge to transplant or as a destination therapy in patients ineligible for transplant. Patients initially ineligible for a transplant may, in certain cases, become eligible for transplant after physiologic improvement with LVAD therapy, and a small number of patients with an LVAD may have sufficient recovery of myocardial function to allow device explantation. This clinically oriented review will describe (1) the most frequently used pump types and aspects of the continuous-flow physiology and (2) the clinical indications for and the shift toward the use of LVADs in less sick patients with HF. Additionally, we review complications of LVAD therapy and project future directions in this field. We referred to the Interagency Registry for Mechanically Assisted Circulatory Support, landmark trials, and results from recently published studies as major sources in obtaining recent outcomes, and we searched for related published literature via PubMed. This review focuses primarily on clinical practice for primary care physicians and non-HF cardiologists in the United States.
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Affiliation(s)
- Pavol Sajgalik
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Department of Internal Medicine, Cardioangiology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Avishay Grupper
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Brook S Edwards
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - John M Stulak
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - David L Joyce
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Lyle D Joyce
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Richard C Daly
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Tomas Kara
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Department of Internal Medicine, Cardioangiology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - John A Schirger
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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10
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Szyguła-Jurkiewicz B, Nadziakiewicz P, Zakliczynski M, Szczurek W, Chraponski J, Zembala M, Gasior M. Predictive Value of Hepatic and Renal Dysfunction Based on the Models for End-Stage Liver Disease in Patients With Heart Failure Evaluated for Heart Transplant. Transplant Proc 2016; 48:1756-60. [DOI: 10.1016/j.transproceed.2016.01.079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 01/21/2016] [Indexed: 12/28/2022]
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11
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Cardiovascular medicine heart failure (CVM-HF) index as prognostic model for candidates to MitraClip therapy. Heart Vessels 2015; 31:1633-42. [PMID: 26694720 DOI: 10.1007/s00380-015-0772-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 11/20/2015] [Indexed: 01/06/2023]
Abstract
Transcatheter MitraClip repair is a new tool for the management of severe mitral regurgitation in patients at very high risk for conventional surgery. Aim of our study was reporting one-year clinical outcomes in candidates to MitraClip procedures, divided into three groups according to the cardiovascular medicine heart failure (CVM-HF) index. The study population consists of 46 consecutive patients, divided, in accordance with CVM-HF index, as follows: one patient in the low-risk category (group A); 27 patients in the medium-risk (group B) and 18 patients in high-risk category (group C). The primary study endpoint was a combined of all-cause mortality and re-hospitalization rate. Secondary endpoints were all-cause mortality and cardiac mortality. Patients of group B and group C were compared. Regarding the primary endpoint, patients in group C had significantly poorer outcomes than patients in group B, with a 12-month survival freedom from events of 44.4 and 74.1 %, respectively (log-rank test, p = 0.039); survival freedom from cardiac mortality was 100 and 83.3 % in group B and C, respectively (log-rank test, p = 0.027). One-year survival free from re-hospitalization was 74.1 % in group B and 39.9 % in group C (log-rank test; p = 0.036). Survival free from all-cause of mortality was 92.6 and 77.8 %, respectively (log-rank test; p = 0.129). In our initial experience the CVM-HF index showed to be valuable for understanding if the patient with advanced heart failure and functional mitral regurgitation can really benefit by MitraClip therapy.
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Non-cardiovascular comorbidity, severity and prognosis in non-selected heart failure populations: A systematic review and meta-analysis. Int J Cardiol 2015; 196:98-106. [PMID: 26080284 PMCID: PMC4518480 DOI: 10.1016/j.ijcard.2015.05.180] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 04/13/2015] [Accepted: 05/26/2015] [Indexed: 01/14/2023]
Abstract
Background Non-cardiovascular comorbidities are recognised as independent prognostic factors in selected heart failure (HF) populations, but the evidence on non-selected HF and how comorbid disease severity and change impacts on outcomes has not been synthesised. We identified primary HF comorbidity follow-up studies to compare the impact of non-cardiovascular comorbidity, severity and change on the outcomes of quality of life, all-cause hospital admissions and all-cause mortality. Methods Literature databases (Jan 1990–May 2013) were screened using validated strategies and quality appraisal (QUIPS tool). Adjusted hazard ratios for the main HF outcomes were combined using random effects meta-analysis and inclusion of comorbidity in prognostic models was described. Results There were 68 primary HF studies covering nine non-cardiovascular comorbidities. Most were on diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD) and renal dysfunction (RD) for the outcome of mortality (93%) and hospital admissions (16%), median follow-up of 4 years. The adjusted associations between HF comorbidity and mortality were DM (HR 1.34; 95% CI 1.2, 1.5), COPD (1.39; 1.2, 1.6) and RD (1.52; 1.3, 1.7). Comorbidity severity increased mortality from moderate to severe disease by an estimated 78%, 42% and 80% respectively. The risk of hospital admissions increased up to 50% for each disease. Few studies or prognostic models included comorbidity change. Conclusions Non-cardiovascular comorbidity and severity significantly increases the prognostic risk of poor outcomes in non-selected HF populations but there is a major gap in investigating change in comorbid status over time. The evidence supports a step-change for the inclusion of comorbidity severity in new HF interventions to improve prognostic outcomes. We synthesise the prognosis evidence on non-CVD comorbidity and severity in non-selected HF Most studies focused on three comorbid diseases for mortality and admissions and none for QoL COPD, diabetes and CKD increased mortality and admission risk in non-selected HF Severity studies were few but where available, risk increased with disease severity Comorbidity severity is important but has yet to be included in HF prognostic models
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Ferrero P, Iacovoni A, D'Elia E, Vaduganathan M, Gavazzi A, Senni M. Prognostic scores in heart failure - Critical appraisal and practical use. Int J Cardiol 2015; 188:1-9. [PMID: 25880571 DOI: 10.1016/j.ijcard.2015.03.154] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 03/05/2015] [Accepted: 03/15/2015] [Indexed: 12/25/2022]
Abstract
Survival in patients with heart failure in the last two decades has significantly improved, owing to availability of new drugs, devices, and technologies. However, these new therapeutic tools are often costly and not without attendant risks. Thus, accurate and reproducible risk stratification is required to assess appropriateness of therapy. Although a growing body of evidence has characterized various predictors of poor outcomes, the application of comprehensive prognostic models in clinical practice remains limited. Herein, we critically evaluate the utility of prognostic scores in heart failure, discussing the strategies to select the most efficient and appropriate risk estimator in the individual patient.
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Affiliation(s)
- Paolo Ferrero
- Dipartimento Cardiovascolare, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Attilio Iacovoni
- Dipartimento Cardiovascolare, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Emilia D'Elia
- Dipartimento Cardiovascolare, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; Internal Medicine Department, Pavia University, Pavia
| | - Muthiah Vaduganathan
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Antonello Gavazzi
- FROM Fondazione per la Ricerca, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Senni
- Dipartimento Cardiovascolare, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
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Low health-related quality of life is a predictor of major adverse cardiovascular events in patients with chronic nonischemic heart failure. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 11:283-8. [PMID: 26336436 PMCID: PMC4283881 DOI: 10.5114/kitp.2014.45678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 03/04/2014] [Accepted: 03/12/2014] [Indexed: 11/17/2022]
Abstract
Introduction The need to indentify patients with chronic heart failure (CHF) at a higher risk of major adverse cardiovascular events (MACEs) has become increasingly important; therefore, new parameters, such as health-related quality of life (HRQoL), are gaining ground. The aim of this study The aim of this study was to determine the risk factors for MACEs, with a special emphasis on HRQoL in chronic non-ischemic heart failure (NIHF) patients. Material and methods This prospective study enrolled 271 hospitalized patients with heart failure symptoms (NYHA II and III), without neoplastic disease, diabetes, hepatic cirrhosis or chronic kidney disease, who had been receiving optimal medical treatment. In all the patients, laboratory examinations, electrocardiography, echocardiography, a 6-minute walking test, invasive right heart pressure measurements and coronary angiography were performed. HRQoL assessment was conducted with the Short-Form Health Survey (SF-36). Clinical observation commenced on admission to the hospital and lasted 3 years. Data concerning MACE incidence (death, transplantation, circulatory support, hospitalization) were obtained during outpatient visits. Results The final analysis enrolled 202 patients, while 17 patients were lost to follow up. The MACE incidence was 42.1%. Major adverse cardiovascular events risk factors in multiple factor analysis were: alkaline phosphatase (hazard ratio [HR] = 1.01; p < 0.05); right ventricular end-diastolic diameter (HR = 1.08; p < 0.001); hsCRP (HR = 1.04; p < 0.05); and the following HRQoL indices: Bodily Pain (HR = 0.98; p < 0.05) and Mental Health (HR = 0.97; p < 0.01). Conclusions Low values for HRQoL parameters (Bodily Pain and Mental Health), right ventricular end-diastolic diameter, serum concentration of hsCRP and alkaline phosphatase are prognostic factors in NIHF patients.
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The Model for End-Stage Liver Disease (MELD) can predict outcomes in ambulatory patients with advanced heart failure who have been referred for cardiac transplantation evaluation. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 11:178-81. [PMID: 26336418 PMCID: PMC4283859 DOI: 10.5114/kitp.2014.43847] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 03/19/2014] [Accepted: 04/01/2014] [Indexed: 12/28/2022]
Abstract
Risk stratification in heart failure (HF) patients is an important element for management. There are several risk stratification models that can be used to predict the prognosis of patients with HF, such as Aaronson's scale, CVM-HF (CardioVascular Medicine Heart Failure), the Seattle Heart Failure Model (SHFM) and the Munich score. These models fail to adequately address the impact of multiorgan dysfunction on prognosis. The classical Model for End-Stage Liver Disease (MELD) score consists of: total bilirubin, INR (international normalized ratio) and creatinine level. There are some modifications of the MELD scale: MELD-XI, which excludes the INR score; the mod-MELD score, in which INR is replaced with albumin levels; and MELD-Na, which consists of the bilirubin and creatinine levels, INR ratio and the sodium level. Therefore, the MELD score systems are markers of multisystem dysfunction (renal, cardiac, hepatic). It is important that they are composed of routinely collected laboratory measures which are easy to use.
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Rodriguez-Pascual C, Paredes-Galan E, Vilches-Moraga A, Ferrero-Martinez AI, Torrente-Carballido M, Rodriguez-Artalejo F. Comprehensive Geriatric Assessment and 2-Year Mortality in Elderly Patients Hospitalized for Heart Failure. Circ Cardiovasc Qual Outcomes 2014; 7:251-8. [DOI: 10.1161/circoutcomes.113.000551] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carlos Rodriguez-Pascual
- From the Departments of Geriatric Medicine (C.R.-P., A.V.-M., A.I.F.-M., M.T.-C.) and Cardiology (E.P.-G.), Hospital Meixoeiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigación Biomédica de Vigo (IBIV), Vigo, Spain (C.R.-P.); Department of Medicine, School of Medicine, Universidad de Santiago de Compostela, Santiago de Compostela, Spain (C.R.-P.); and Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz,
| | - Emilio Paredes-Galan
- From the Departments of Geriatric Medicine (C.R.-P., A.V.-M., A.I.F.-M., M.T.-C.) and Cardiology (E.P.-G.), Hospital Meixoeiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigación Biomédica de Vigo (IBIV), Vigo, Spain (C.R.-P.); Department of Medicine, School of Medicine, Universidad de Santiago de Compostela, Santiago de Compostela, Spain (C.R.-P.); and Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz,
| | - Arturo Vilches-Moraga
- From the Departments of Geriatric Medicine (C.R.-P., A.V.-M., A.I.F.-M., M.T.-C.) and Cardiology (E.P.-G.), Hospital Meixoeiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigación Biomédica de Vigo (IBIV), Vigo, Spain (C.R.-P.); Department of Medicine, School of Medicine, Universidad de Santiago de Compostela, Santiago de Compostela, Spain (C.R.-P.); and Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz,
| | - Ana Isabel Ferrero-Martinez
- From the Departments of Geriatric Medicine (C.R.-P., A.V.-M., A.I.F.-M., M.T.-C.) and Cardiology (E.P.-G.), Hospital Meixoeiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigación Biomédica de Vigo (IBIV), Vigo, Spain (C.R.-P.); Department of Medicine, School of Medicine, Universidad de Santiago de Compostela, Santiago de Compostela, Spain (C.R.-P.); and Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz,
| | - Marta Torrente-Carballido
- From the Departments of Geriatric Medicine (C.R.-P., A.V.-M., A.I.F.-M., M.T.-C.) and Cardiology (E.P.-G.), Hospital Meixoeiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigación Biomédica de Vigo (IBIV), Vigo, Spain (C.R.-P.); Department of Medicine, School of Medicine, Universidad de Santiago de Compostela, Santiago de Compostela, Spain (C.R.-P.); and Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz,
| | - Fernando Rodriguez-Artalejo
- From the Departments of Geriatric Medicine (C.R.-P., A.V.-M., A.I.F.-M., M.T.-C.) and Cardiology (E.P.-G.), Hospital Meixoeiro, Complejo Hospitalario Universitario de Vigo, Vigo, Spain; Instituto de Investigación Biomédica de Vigo (IBIV), Vigo, Spain (C.R.-P.); Department of Medicine, School of Medicine, Universidad de Santiago de Compostela, Santiago de Compostela, Spain (C.R.-P.); and Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz,
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TNM-like classification: a new proposed method for heart failure staging. ScientificWorldJournal 2013; 2013:175925. [PMID: 24376377 PMCID: PMC3859030 DOI: 10.1155/2013/175925] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 09/29/2013] [Indexed: 11/18/2022] Open
Abstract
Heart Failure (HF) is an acute or chronic syndrome, that causes a lot of damaging effects to every system. The involvement of different systems is variably related to age and others comorbidities. The severity of organ damage is often proportional to the duration of heart failure. The typology of HF and the duration determine which organs will be affected and vice versa the severity of organ damage supplies precious information about prognosis and outcome of patients with heart failure. Moreover, a classification based not only on symptomatic and syndromic typical features of heart failure, but also on functional data of each system, could allow us to apply the most appropriate therapies, to obtain a more accurate prognosis, and to employ necessary and not redundant human and financial resources. With an eye on the TNM staging used in oncology, we drawn up a classification that will consider the different involvement of organs such as lungs, kidneys, and liver in addition to psychological pattern and quality of life in HF patients. For all these reasons, it is our intention to propose a valid and more specific classification available for the clinical staging of HF that takes into account pathophysiological and structural changes that can remark prognosis and management of HF.
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Senni M, Parrella P, De Maria R, Cottini C, Böhm M, Ponikowski P, Filippatos G, Tribouilloy C, Di Lenarda A, Oliva F, Pulignano G, Cicoira M, Nodari S, Porcu M, Cioffi G, Gabrielli D, Parodi O, Ferrazzi P, Gavazzi A. Predicting heart failure outcome from cardiac and comorbid conditions: The 3C-HF score. Int J Cardiol 2013; 163:206-11. [DOI: 10.1016/j.ijcard.2011.10.071] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 10/18/2011] [Indexed: 10/26/2022]
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Salpeter SR, Luo EJ, Malter DS, Stuart B. Systematic review of noncancer presentations with a median survival of 6 months or less. Am J Med 2012; 125:512.e1-6. [PMID: 22030293 DOI: 10.1016/j.amjmed.2011.07.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 05/28/2011] [Accepted: 07/09/2011] [Indexed: 12/22/2022]
Abstract
PURPOSE We report on clinical indicators of 6-month mortality in advanced noncancer illnesses and the effect of treatment on survival. METHODS The MEDLINE database was searched comprehensively to find studies evaluating survival for common advanced noncancer illnesses. We retrieved and evaluated studies that reported a median survival of ≤1 year and evaluated prognostic factors or effect of treatment on survival. We extracted data on presentations with median survivals of ≤6 months for heart failure, chronic obstructive pulmonary disease, dementia, geriatric failure to thrive, cirrhosis, and end-stage renal failure. Independent risk factors for survival were combined and included if their combination was associated with a 6-month mortality of ≥50%. RESULTS The search identified 1000 potentially relevant studies, of which 475 were retrieved and evaluated, and 74 were included. We report the common clinical presentations that are consistently associated with a 6-month median survival. Even though advanced noncancer syndromes differ clinically, a universal set of prognostic factors signals progression to terminal disease, including poor performance status, advanced age, malnutrition, comorbid illness, organ dysfunction, and hospitalization for acute decompensation. Generally, a 6-month median survival is associated with the presence of 2-4 of these factors. With few exceptions, these terminal presentations are quite refractory to treatment. CONCLUSION This systematic review summarizes prognostic factors common to advanced noncancer illness. There is little evidence at present that treatment prolongs survival at these terminal stages.
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Maharaj R. Diastolic dysfunction and heart failure with a preserved ejection fraction: Relevance in critical illness and anaesthesia. J Saudi Heart Assoc 2012; 24:99-121. [PMID: 23960679 DOI: 10.1016/j.jsha.2012.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 01/22/2012] [Accepted: 01/23/2012] [Indexed: 01/19/2023] Open
Abstract
Epidemiological and clinical studies suggest that HF with a preserved ejection fraction will become the more common form of HF which clinicians will encounter. The spectrum of diastolic disease extends from the asymptomatic phase to fulminant cardiac failure. These patients are commonly encountered in operating rooms and critical care units. A clearer understanding of the underlying pathophysiology and clinical implications of HF with a preserved ejection fraction is fundamental to directing further research and to evaluate interventions. This review highlights the impact of diastolic dysfunction and HF with a preserved ejection fraction during the perioperative period and during critical illness.
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Affiliation(s)
- R Maharaj
- Department of Intensive Care Medicine, Kings College Hospital, London SE5 9RS, UK
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22
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Ahluwalia SC, Gross CP, Chaudhry SI, Leo-Summers L, Van Ness PH, Fried TR. Change in comorbidity prevalence with advancing age among persons with heart failure. J Gen Intern Med 2011; 26:1145-51. [PMID: 21573881 PMCID: PMC3181289 DOI: 10.1007/s11606-011-1725-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 03/04/2011] [Accepted: 04/12/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Comorbidity-a condition that co-exists with a primary illness-is common among older persons with heart failure and can complicate the overall management of this population. OBJECTIVES To determine the relationship between advancing age and the prevalence and patterns of comorbidity among older persons with heart failure. DESIGN Retrospective longitudinal cohort study PARTICIPANTS A total of 201,130 Medicare beneficiaries with heart failure stratified into three age strata in 2001: 66-75, 76-85, and 86+ years, and followed over 5 years. MEASUREMENTS (1) Prevalence of 19 conditions as identified by the Chronic Conditions Warehouse from Medicare claims data, characterized as concordant (related to heart failure) or discordant (unrelated to heart failure), and (2) overall comorbidity burden, defined as count of conditions. RESULTS The median number of comorbidities rose from four (IQR: 2-5) to five (IQR: 4-7) among the young-old, and from 4 (IQR: 3-6) to 6 (IQR: 5-8) among the middle-old and oldest-old between 2001 and 2006. In 2001, the majority of concordant conditions were more prevalent among the youngest than oldest beneficiaries (e.g., diabetes 46.2% vs 26.9%; kidney disease 21.8% vs 18.4%), while the majority of discordant conditions were more prevalent among the oldest-old than youngest-old beneficiaries (e.g., dementia 39.6% vs 9.9%; hip fracture 9.5% vs 1.9%). Discordant conditions increased in prevalence faster among the oldest than youngest beneficiaries (e.g., dementia 13% points versus 9% points). CONCLUSION Among older Medicare beneficiaries with heart failure, there is a higher overall burden of comorbidity and greater prevalence of discordant comorbidity among the oldest old. Comorbidity prevalence increases over time, with discordant comorbidity increasing at the fastest rate among the oldest old. This comorbidity burden highlights the challenge of effectively treating heart failure while simultaneously managing co-existing and unrelated conditions.
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Foraker RE, Rose KM, Suchindran CM, Chang PP, McNeill AM, Rosamond WD. Socioeconomic status, Medicaid coverage, clinical comorbidity, and rehospitalization or death after an incident heart failure hospitalization: Atherosclerosis Risk in Communities cohort (1987 to 2004). Circ Heart Fail 2011; 4:308-16. [PMID: 21430286 DOI: 10.1161/circheartfailure.110.959031] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Among patients with heart failure (HF), early readmission or death and repeat hospitalizations may be indicators of poor disease management or more severe disease. METHODS AND RESULTS We assessed the association of neighborhood median household income (nINC) and Medicaid status with rehospitalization or death in the Atherosclerosis Risk in Communities cohort study (1987 to 2004) after an incident HF hospitalization in the context of individual socioeconomic status and evaluated the relationship for modification by demographic and comorbidity factors. We used generalized linear Poisson mixed models to estimate rehospitalization rate ratios and 95% CIs and Cox regression to estimate hazard ratios (HRs) and 95% CIs of rehospitalization or death. In models controlling for race and study community, sex, age at HF diagnosis, body mass index, hypertension, educational attainment, alcohol use, and smoking, patients with a high burden of comorbidity who were living in low-nINC areas at baseline had an elevated hazard of all-cause rehospitalization (HR, 1.40; 95% CI, 1.10 to 1.77), death (HR, 1.36; 95% CI, 1.02 to 1.80), and rehospitalization or death (HR, 1.36; 95% CI, 1.08 to 1.70) as well as increased rates of hospitalization compared to those with a high burden of comorbidity living in high-nINC areas. Medicaid recipients with a low level of comorbidity had an increased hazard of all-cause rehospitalization (HR, 1.19; 95% CI, 1.05 to 1.36) and rehospitalization or death (HR, 1.21; 95% CI, 1.07 to 1.37) and a higher rate of repeat hospitalizations compared to non-Medicaid recipients. CONCLUSIONS Comorbidity burden appears to influence the association among nINC, Medicaid status, and rehospitalization and death in patients with HF.
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Affiliation(s)
- Randi E Foraker
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, USA.
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Tanaka K, Kodama M, Ito M, Hoyano M, Mitsuma W, Ramadan MM, Kashimura T, Hirono S, Okura Y, Kato K, Hanawa H, Aizawa Y. Force-frequency relationship as a predictor of long-term prognosis in patients with heart diseases. Heart Vessels 2010; 26:153-9. [PMID: 20978893 DOI: 10.1007/s00380-010-0040-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 03/11/2010] [Indexed: 10/18/2022]
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Increasing Palliative Consults for Heart Failure Inpatients Using the Seattle Heart Failure Model. J Hosp Palliat Nurs 2010. [DOI: 10.1097/njh.0b013e3181e0866b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baggish AL, van Kimmenade RRJ, Pinto Y, Richards AM, Lainchbury J, Bayes-Genis A, Santaló M, Ordonez-Llanos J, Januzzi JL. New York Heart Association class versus amino-terminal pro-B type natriuretic peptide for acute heart failure prognosis. Biomarkers 2010; 15:307-14. [PMID: 20370326 DOI: 10.3109/13547501003632580] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The prognostic value of the New York Heart Association classification (NYHAC) in acutely decompensated heart failure (ADHF) is unknown. OBJECTIVES We sought to determine the relative value of NYHAC among patients with concomitantly measured amino-terminal pro-B type natriuretic peptide (NT-proBNP) at presentation with ADHF. MATERIALS AND METHODS NYHAC was determined for 720 patients with ADHF and 1-year mortality status was examined. Cox-proportional hazards analysis compared the prognostic accuracy of NYHAC with other ADHF risk measures. RESULTS NYHAC had a significant univariate association with 1-year mortality status (HR 1.41, 95% confidence interval (CI) 1.03-1.94; p = 0.03) but was not a significant predictor of death in a multivariable model that included NT-proBNP (HR 2.14; 95% CI 1.65-2.81, p < 0.001). CONCLUSIONS In contrast to objective measures such as NT-proBNP, the NYHAC appears to provide limited prognostic information among individuals with ADHF.
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Affiliation(s)
- Aaron L Baggish
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Metra M, Felker GM, Zacà V, Bugatti S, Lombardi C, Bettari L, Voors AA, Gheorghiade M, Dei Cas L. Acute heart failure: multiple clinical profiles and mechanisms require tailored therapy. Int J Cardiol 2010; 144:175-9. [PMID: 20537739 DOI: 10.1016/j.ijcard.2010.04.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 04/02/2010] [Indexed: 11/16/2022]
Abstract
Acute heart failure (HF) is the most common diagnosis at discharge in patients aged >65years. It carries a dismal prognosis with a high in-hospital mortality and very high post-discharge mortality and re-hospitalization rates. It is a complex clinical syndrome that cannot be described as a single entity as it varies widely with respect to underlying pathophysiologic mechanisms, clinical presentations and, likely, treatments. It is the aim of this paper to describe some of the main clinical presentations of acute HF. Amongst them, we will consider de novo HF versus acutely decompensated chronic HF, HF caused, and/or worsened, by myocardial ischemia, acute HF with low, normal, or high systolic blood pressure, acute HF caused by lung congestion or fluid retention or fluid redistribution to the lungs, and acute HF with comorbidities (diabetes, anemia, renal insufficiency, etc.). Different pathophysiologic mechanisms and clinical presentations may coexist in the same patient. Identification and, whenever possible, treatment of underlying pathophysiologic mechanisms may become important for acute HF management.
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Affiliation(s)
- Marco Metra
- Cardiology, Department of Experimental and Applied Medicine, University of Brescia, Italy.
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Paredes S, Rocha T, de Carvalho P, Henriques J, Harris M, Morais J. Cardiovascular risk and status assessment. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:2872-2876. [PMID: 21095709 DOI: 10.1109/iembs.2010.5626069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This work focuses on the development of models to support the assessment of a patient's global cardiovascular condition. Three types of models, based on different types of information, have been developed: long term cardiovascular risk models, that evaluate the risk of occurring of cardiovascular event within a long period of time (years); short term cardiovascular risk models, to assess the risk of death within a short period of time (months); cardiovascular status assessment models, to estimate the current cardiovascular condition of a patient. Three major drawbacks of current cardiovascular tools are addressed: reduced number of risk factors considered by each individual tool, inappropriateness of these tools to incorporate empirical clinical expertise and incapacity of these tools to deal with incomplete information. Methodologies and preliminary results, obtained under FP7 HeartCycle project, as well as future directions of research are also presented in this paper.
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Affiliation(s)
- S Paredes
- Instituto Politécnico de Coimbra, Departamento de Engenharia, Informática e de Sistemas, Rua Pedro Nunes, 3030-199, Portugal.
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Peterson PN, Rumsfeld JS, Liang L, Albert NM, Hernandez AF, Peterson ED, Fonarow GC, Masoudi FA. A validated risk score for in-hospital mortality in patients with heart failure from the American Heart Association get with the guidelines program. Circ Cardiovasc Qual Outcomes 2009; 3:25-32. [PMID: 20123668 DOI: 10.1161/circoutcomes.109.854877] [Citation(s) in RCA: 410] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Effective risk stratification can inform clinical decision-making. Our objective was to derive and validate a risk score for in-hospital mortality in patients hospitalized with heart failure using American Heart Association Get With the Guidelines-Heart Failure (GWTG-HF) program data. METHODS AND RESULTS A cohort of 39 783 patients admitted January 1, 2005, to June 26, 2007, to 198 hospitals participating in GWTG-HF was divided into derivation (70%, n=27 850) and validation (30%, n=11 933) samples. Multivariable logistic regression identified predictors of in-hospital mortality in the derivation sample from candidate demographic, medical history, and laboratory variables collected at admission. In-hospital mortality rate was 2.86% (n=1139). Age, systolic blood pressure, blood urea nitrogen, heart rate, sodium, chronic obstructive pulmonary disease, and nonblack race were predictive of in-hospital mortality. The model had good discrimination in the derivation and validation datasets (c-index, 0.75 in each). Effect estimates from the entire sample were used to generate a mortality risk score. The predicted probability of in-hospital mortality varied more than 24-fold across deciles (range, 0.4% to 9.7%) and corresponded with observed mortality rates. The model had the same operating characteristics among those with preserved and impaired left ventricular systolic function. The morality risk score can be calculated on the Web-based calculator available with the GWTG-HF data entry tool. CONCLUSIONS The GWTG-HF risk score uses commonly available clinical variables to predict in-hospital mortality and provides clinicians with a validated tool for risk stratification that is applicable to a broad spectrum of patients with heart failure, including those with preserved left ventricular systolic function.
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Diabetes Mellitus and Long-Term Outcome in Heart Failure Patients After Surgical Ventricular Restoration. Ann Thorac Surg 2009; 88:1451-6. [DOI: 10.1016/j.athoracsur.2009.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 06/29/2009] [Accepted: 07/02/2009] [Indexed: 11/19/2022]
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Jaarsma T, Beattie JM, Ryder M, Rutten FH, McDonagh T, Mohacsi P, Murray SA, Grodzicki T, Bergh I, Metra M, Ekman I, Angermann C, Leventhal M, Pitsis A, Anker SD, Gavazzi A, Ponikowski P, Dickstein K, Delacretaz E, Blue L, Strasser F, McMurray J. Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2009; 11:433-43. [PMID: 19386813 DOI: 10.1093/eurjhf/hfp041] [Citation(s) in RCA: 362] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Heart failure is a serious condition and equivalent to malignant disease in terms of symptom burden and mortality. At this moment only a comparatively small number of heart failure patients receive specialist palliative care. Heart failure patients may have generic palliative care needs, such as refractory multifaceted symptoms, communication and decision making issues and the requirement for family support. The Advanced Heart Failure Study Group of the Heart Failure Association of the European Society of Cardiology organized a workshop to address the issue of palliative care in heart failure to increase awareness of the need for palliative care. Additional objectives included improving the accessibility and quality of palliative care for heart failure patients and promoting the development of heart failure-orientated palliative care services across Europe. This document represents a synthesis of the presentations and discussion during the workshop and describes recommendations in the area of delivery of quality care to patients and families, education, treatment coordination, research and policy.
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Affiliation(s)
- Tiny Jaarsma
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJV. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Fail 2009; 11:130-9. [PMID: 19168510 PMCID: PMC2639415 DOI: 10.1093/eurjhf/hfn013] [Citation(s) in RCA: 375] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 08/31/2008] [Accepted: 11/03/2008] [Indexed: 11/12/2022] Open
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are global epidemics incurring significant morbidity and mortality. The combination presents many diagnostic challenges. Clinical symptoms and signs frequently overlap. Evaluation of cardiac and pulmonary function is often problematic and occasionally misleading. Echocardiography and pulmonary function tests should be performed in every patient. Careful interpretation is required to avoid misdiagnosis and inappropriate treatment. Airflow obstruction, in particular, must be demonstrated when clinically euvolaemic. Very high and very low concentrations of natriuretic peptides have high positive and negative predictive values for diagnosing HF in those with both conditions. Intermediate values are less informative. Both conditions are systemic disorders with overlapping pathophysiological processes. In patients with HF, COPD is consistently an independent predictor of death and hospitalization. However, the impact on ischaemic and arrhythmic events is unknown. Greater collaboration is required between cardiologists and pulmonologists to better identify and manage concurrent HF and COPD. The resulting symptomatic and prognostic benefits outweigh those attainable by treating either condition alone.
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Affiliation(s)
- Nathaniel Mark Hawkins
- Aintree Cardiac Centre, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK.
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Russo MJ, Gelijns AC, Stevenson LW, Sampat B, Aaronson KD, Renlund DG, Ascheim DD, Hong KN, Oz MC, Moskowitz AJ, Rose EA, Miller LW. The cost of medical management in advanced heart failure during the final two years of life. J Card Fail 2008; 14:651-8. [PMID: 18926436 DOI: 10.1016/j.cardfail.2008.06.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 05/27/2008] [Accepted: 06/02/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine patterns of resource use and the cost of care for patients with advanced heart failure treated with medical management (MM) during the final 2 years of life. METHODS AND RESULTS The study population (n=47, mean age 70.4 years+/-7.06) included patients randomized to the MM arm of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure trial. Inpatient and outpatient use data were obtained from the clinical dataset and Centers for Medicare and Medicaid Services (beginning January 1, 1998). Cost and resource use were tracked from the date of death (t(d)) backward in 3-month intervals (eg, t(d-1), t(d-2)). In the primary analysis, costs were summed across intervals. The mean cost of MM in the final 2 years of life was $156,169, with 50.5% ($78,880.39) expended in the final 6 months. The mean quarterly cost increased (P < .01) 4.9-fold from t(d-8) ($8,816 +/- $14,270) to t(d-1) ($42,836 +/- $41,407). The number of inpatient days increased (P < .01) 6.6-fold from 3.8+/-4.7 days to 22.2+/-23.5 days during the same time intervals. CONCLUSION This current economic analysis extends on previous findings by demonstrating that medical therapy in advanced and end-stage heart failure is associated with significant costs and resource consumption; these costs and resource consumption increase significantly as death approaches.
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Rusinaru D, Saaidi I, Godard S, Mahjoub H, Battle C, Tribouilloy C. Impact of chronic obstructive pulmonary disease on long-term outcome of patients hospitalized for heart failure. Am J Cardiol 2008; 101:353-8. [PMID: 18237599 DOI: 10.1016/j.amjcard.2007.08.046] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Revised: 08/24/2007] [Accepted: 08/24/2007] [Indexed: 11/19/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a frequently neglected co-morbidity in patients with heart failure (HF). The aim of this study was to evaluate the prognostic impact of COPD in patients hospitalized for HF. Consecutive patients (n=799) admitted for a first episode of HF in all healthcare establishments of the Somme department (France) during 2000 were prospectively enrolled. Baseline characteristics and long-term prognosis were compared according to COPD status. COPD was diagnosed in 156 patients (19.5%). Compared with the no-COPD group, patients with COPD were predominantly men, more often smokers, and had lower discharge prescription rates of beta blockers (6% vs 27%, p<0.001). Five-year survival rate in patients with COPD was significantly lower than that of the no-COPD group (31% vs 42%, p=0.03). Compared with the expected survival of the age- and gender-matched general population, the 5-year survival rate in patients with COPD was dramatically lower (31% vs 71%). On multivariable analysis, COPD was a strong predictor of poorer outcome (hazard ratio 1.53, 95% confidence interval 1.21 to 1.94, p<0.001). COPD was an independent predictor of mortality in patients with preserved left ventricular ejection fraction and in patients with reduced ejection fraction. In conclusion, patients with HF and associated COPD have a poor prognosis with an impressive excess mortality compared to HF patients without COPD and the general population. Beta-blocker prescription rates remain deceptively low in this category of patients with HF.
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Affiliation(s)
- Dan Rusinaru
- INSERM, ERI 12 and University Hospital Amiens, Amiens, France
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Bibliography. Current world literature. Cardiovascular medicine. Curr Opin Pediatr 2007; 19:601-6. [PMID: 17885483 DOI: 10.1097/mop.0b013e3282f12851] [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: 11/25/2022]
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