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Garg N, Johnson J, Patel V, Pekmezaris R, Seepersaud H, Kumar P, Thomesen R, Luknauth H, Amlicke M, Ruelle M, Becker L. Understanding social risk factors in patients presenting to the emergency Department for Acute Heart Failure: A pilot study. Am J Emerg Med 2024; 84:7-14. [PMID: 39047343 DOI: 10.1016/j.ajem.2024.07.012] [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: 04/02/2024] [Revised: 06/30/2024] [Accepted: 07/06/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The standard of care for congestive heart failure (CHF) aims to slow disease progression and maximize patient function, however there is an increase in emergency department (ED) revisits and readmissions. Social risk factors play a role in the disease management and prognosis of CHF. There is a gap in the identification of low-risk CHF patient who would be safely discharged using an initial social risk factor stratification. OBJECTIVES To generate a social risk profile for patients presenting to the ED with acute CHF exacerbation and identify variables that may increase the risk of 7-day and overall mortality, 30-day ED revisit, and readmission. METHODS We conducted a pilot prospective survey-based study among adult patients presenting to the ED with acute CHF exacerbation. The combination of a self-report questionnaire and retrospective chart review was used to generate a CHF risk profile. RESULTS A total of 62 patients were recruited in the pilot study with a mean age of 69.5 years. The preliminary data indicated that prior to this ED visit, 21% of patients were not aware of a previous CHF diagnosis; 64.5% of patients rated their sleep quality as poor or very poor; 72.6% reported orthopnea; and 43.5% reported recent weight gain. 37.1% of patients did not adhere to dietary recommendations and some patients did not adhere to their medication regime 100%. CONCLUSION This study suggests establishing a social risk profile for patients presenting to the ED with CHF can help formulate a CHF-specific care plan and optimize multidisciplinary management to reduce ED revisits and readmissions.
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Affiliation(s)
- Nidhi Garg
- South Shore University Hospital, Bayshore, New York, USA, Northwell Health, Department of Emergency Medicine.
| | - Jennifer Johnson
- North Shore University Hospital, Manhasset, NY, USA, Northwell Health, Department of Emergency Medicine.
| | - Vidhi Patel
- Department of Internal Medicine, Manhasset, NY, Northwell Health, USA.
| | - Renee Pekmezaris
- Department of Internal Medicine, Manhasset, NY, Northwell Health, USA.
| | | | | | | | - Harshani Luknauth
- New York Institute of Technology College of Osteopathic Medicine, Glen Head, NY, USA.
| | - Maire Amlicke
- Long Island Jewish Medical Center, New Hyde Park, NY, Northwell Health, Department of Emergency Medicine, USA.
| | - Marianne Ruelle
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA.
| | - Lance Becker
- Long Island Jewish Medical Center, New Hyde Park, NY, Northwell Health.
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2
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Lorenzo M, de la Espriella R, Miñana G, Núñez G, Carratalá A, Rodríguez E, Santas E, Valls N, Villar S, Donoso V, Bayés-Genís A, Sanchis J, Núñez J. Role of spot urinary sodium in outpatients with heart failure. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00234-2. [PMID: 39038750 DOI: 10.1016/j.rec.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/03/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION AND OBJECTIVES Spot determination of urinary sodium (UNa+) has emerged as a useful tool for monitoring diuretic response in patients with acute heart failure (AHF). However, the evidence in outpatients is scarce. We aimed to examine the relationship between spot UNa+ levels and the risk of mortality and worsening heart failure (WHF) events in individuals with chronic HF. METHODS This observational and ambispective study included 1145 outpatients with chronic HF followed in a single center specialized HF clinic. UNa+ assessment was carried out 1-5 days before each visit. The endpoints of the study were the association between UNa+ and risk of a) long-term death and b) AHF-hospitalization and total WHF events (including AHF-hospitalization, emergency department visits or parenteral loop-diuretic administration in HF clinic), assessed by multivariate Cox and negative binomial regressions. RESULTS The mean±standard deviation of age was 73±11 years, 670 (58.5%) were men, 902 (78.8%) were on stable NYHA class II, and 595 (52%) had LFEF ≥50%. The median (interquartile range) UNa+ was 72 (51-94) mmol/L. Over a median follow-up of 2.63 (1.70-3.36) years, there were 293 (25.6%) deaths and 382 WHF events (244 AHF-admissions) in 233 (20.3%) patients. After multivariate adjustment, baseline UNa+ was inverse and linearly associated with the risk of total WHF (IRR, 1.07; 95%CI, 1.02-1.12; P=.007) and AHF-admissions (IRR, 1.08; 95%CI, 1.02-1.14; P=.012) and borderline associated with all-cause mortality (HR, 1.04; 95%CI, 0.99-1.09; P=.068). CONCLUSIONS In outpatients with chronic HF, lower UNa+ was associated with a higher risk of recurrent WHF events.
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Affiliation(s)
- Miguel Lorenzo
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Rafael de la Espriella
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; Facultad de Medicina, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Gonzalo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Arturo Carratalá
- Laboratorio de Bioquímica Clínica y Patología Molecular, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Enrique Rodríguez
- Laboratorio de Bioquímica Clínica y Patología Molecular, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; Facultad de Medicina, Universitat de València, Valencia, Spain
| | - Neus Valls
- Servicio de Urgencias Médicas, Hospital General Universitario de Valencia, Valencia, Spain
| | - Sandra Villar
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Víctor Donoso
- Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; Facultad de Medicina, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; Facultad de Medicina, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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Davoudi A, Chae S, Evans L, Sridharan S, Song J, Bowles KH, McDonald MV, Topaz M. Fairness gaps in Machine learning models for hospitalization and emergency department visit risk prediction in home healthcare patients with heart failure. Int J Med Inform 2024; 191:105534. [PMID: 39106773 DOI: 10.1016/j.ijmedinf.2024.105534] [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: 12/21/2023] [Revised: 06/24/2024] [Accepted: 06/28/2024] [Indexed: 08/09/2024]
Abstract
OBJECTIVES This study aims to evaluate the fairness performance metrics of Machine Learning (ML) models to predict hospitalization and emergency department (ED) visits in heart failure patients receiving home healthcare. We analyze biases, assess performance disparities, and propose solutions to improve model performance in diverse subpopulations. METHODS The study used a dataset of 12,189 episodes of home healthcare collected between 2015 and 2017, including structured (e.g., standard assessment tool) and unstructured data (i.e., clinical notes). ML risk prediction models, including Light Gradient-boosting model (LightGBM) and AutoGluon, were developed using demographic information, vital signs, comorbidities, service utilization data, and the area deprivation index (ADI) associated with the patient's home address. Fairness metrics, such as Equal Opportunity, Predictive Equality, Predictive Parity, and Statistical Parity, were calculated to evaluate model performance across subpopulations. RESULTS Our study revealed significant disparities in model performance across diverse demographic subgroups. For example, the Hispanic, Male, High-ADI subgroup excelled in terms of Equal Opportunity with a metric value of 0.825, which was 28% higher than the lowest-performing Other, Female, Low-ADI subgroup, which scored 0.644. In Predictive Parity, the gap between the highest and lowest-performing groups was 29%, and in Statistical Parity, the gap reached 69%. In Predictive Equality, the difference was 45%. DISCUSSION AND CONCLUSION The findings highlight substantial differences in fairness metrics across diverse patient subpopulations in ML risk prediction models for heart failure patients receiving home healthcare services. Ongoing monitoring and improvement of fairness metrics are essential to mitigate biases.
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Affiliation(s)
- Anahita Davoudi
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA.
| | - Sena Chae
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Lauren Evans
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Sridevi Sridharan
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Jiyoun Song
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Kathryn H Bowles
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA; Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Maxim Topaz
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA; School of Nursing, Columbia University, New York City, NY, USA; Data Science Institute, Columbia University, New York City, New York, USA
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Kazory A. Contemporary Decongestive Strategies in Acute Heart Failure. Semin Nephrol 2024; 44:151512. [PMID: 38702211 DOI: 10.1016/j.semnephrol.2024.151512] [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: 05/06/2024]
Abstract
Congestion is the primary driver of hospital admissions in patients with heart failure and the key determinant of their outcome. Although intravenous loop diuretics remain the predominant agents used in the setting of acute heart failure, the therapeutic response is known to be variable, with a significant subset of patients discharged from the hospital with residual hypervolemia. In this context, urinary sodium excretion has gained attention both as a marker of response to loop diuretics and as a marker of prognosis that may be a useful clinical tool to guide therapy. Several decongestive strategies have been explored to improve diuretic responsiveness and removal of excess fluid. Sequential nephron blockade through combination diuretic therapy is one of the most used methods to enhance natriuresis and counter diuretic resistance. In this article, I provide an overview of the contemporary decongestive approaches and discuss the clinical data on the use of add-on diuretic therapy. I also discuss mechanical removal of excess fluid through extracorporeal ultrafiltration with a brief review of the results of landmark studies. Finally, I provide a short overview of the strategies that are currently under investigation and may prove helpful in this setting.
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Affiliation(s)
- Amir Kazory
- Division of Nephrology, Hypertension, and Renal Transplantation, College of Medicine, University of Florida, Gainesville, FL.
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5
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Ivynian SE, Ferguson C, Newton PJ, DiGiacomo M. The role of illness perceptions in delayed care-seeking in heart failure: A mixed-methods study. Int J Nurs Stud 2024; 150:104644. [PMID: 38016267 DOI: 10.1016/j.ijnurstu.2023.104644] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/30/2023] [Accepted: 11/04/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Unclear illness perceptions are common in heart failure. The self-regulation model of illness behaviour highlights factors that may impact how people with chronic illness choose to cope with or manage their condition and has been used to study pre-hospital delay for stroke and acute myocardial infarction. The principles of self-regulation can be applied in heart failure to help illuminate the link between unclear illness perceptions and sub-optimal symptom self-management. OBJECTIVE Informed by the self-regulation model of illness behaviour, this study examines the role of illness perceptions in coping responses that lead to delayed care-seeking for heart failure symptoms. DESIGN Mixed-methods phenomenological study. SETTING(S) Quaternary referral hospital - centre of excellence for cardiovascular care and heart transplantation. PARTICIPANTS Seventy-two symptomatic patients with heart failure participated in a survey assessing illness perceptions. A subset of fifteen individuals was invited to participate in semi-structured interviews. METHODS Illness perceptions were assessed using the Brief Illness Perception Questionnaire. In-depth semi-structured interviews were conducted to elicit previous care-seeking experiences and decision-making that led to a passive, or active coping response to worsening symptoms. Descriptive statistics were used to report questionnaire findings, and open-ended responses were grouped into descriptive categories. Interpretative phenomenological analysis was undertaken on interview transcripts. RESULTS Participants perceived little personal control over their condition and mostly attributed heart failure to lifestyle factors such as diet and lack of activity. Cognitive dissonance between perceived self-identity and heart failure-identity led to a highly emotional response which drove coping towards avoidance strategies and denial. CONCLUSIONS This study demonstrates the use of the principles of self-regulation in heart failure and offers a framework to understand how patient representations and emotional responses can inform behaviour in illness. Findings highlight the value of empowering patients to take control of their health and the need to help align values (e.g. independence) with behaviours (e.g. actively addressing problems) to facilitate optimal symptom self-management.
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Affiliation(s)
- Serra E Ivynian
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Australia.
| | - Caleb Ferguson
- School of Nursing, University of Wollongong and Centre for Chronic & Complex Care, Blacktown Hospital, Western Sydney Local Health District, NSW, Australia
| | - Phillip J Newton
- School of Nursing & Midwifery, University of Newcastle, Australia
| | - Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Australia
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Kim J, Jiang J, Shen S, Setoguchi S. Trends in cardiac rehabilitation rates among patients admitted for acute heart failure in Japan, 2009-2020. PLoS One 2023; 18:e0294844. [PMID: 38015991 PMCID: PMC10684100 DOI: 10.1371/journal.pone.0294844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES To describe inpatient and outpatient cardiac rehabilitation (CR) utilization patterns over time and by subgroups among patients admitted for acute heart failure (AHF) in Japan. BACKGROUND Cardiac rehabilitation (CR) is a crucial secondary prevention strategy for patients with heart failure. While the number of older patients with AHF continues to rise, trends in inpatient and outpatient CR participation following AHF in Japan have not been described to date. METHODS We conducted a retrospective cohort study of adult patients hospitalized for AHF in Japan between April 2008 and December 2020. Using data from the Medical Data Vision database, we measured trends in inpatient and outpatient CR participation following AHF. Descriptive analyses and summary statistics for AHF patients by CR participation status were reported. RESULTS The analytic cohort included 88,052 patients. Among these patients, 37,810 (42.9%) participated in inpatient and/or outpatient CR. Of those, 36,431 (96.4%) participated in inpatient CR only and 1,277 (3.4%) participated in both inpatient and outpatient CR. Rates of inpatient CR rose more than 6-fold over the study period, from 9% in 2009 to 55% in 2020, whereas rates of outpatient CR were consistently low. CONCLUSIONS The rate of inpatient CR participation among AHF patients in Japan rose dramatically over a 12-year period, whereas outpatient CR following AHF was vastly underutilized. Further study is needed to assess the clinical effectiveness of inpatient CR and to create infrastructure and incentives to support and encourage outpatient CR.
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Affiliation(s)
- Junghyun Kim
- Institute for Health, Health Care Policy and Aging Research, Center for Pharmacoepidemiology and Treatment Science, Rutgers University, New Brunswick, New Jersey, United States of America
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea
| | - Jenny Jiang
- Center for Observational Research and Data Science, Bristol Myers Squibb, Lawrenceville, New Jersey, United States of America
| | - Sophie Shen
- Worldwide Patient Safety, Epidemiology, Bristol Myers Squibb, Princeton, New Jersey, United States of America
| | - Soko Setoguchi
- Institute for Health, Health Care Policy and Aging Research, Center for Pharmacoepidemiology and Treatment Science, Rutgers University, New Brunswick, New Jersey, United States of America
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States of America
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Gálvez-Barrón C, Pérez-López C, Villar-Álvarez F, Ribas J, Formiga F, Chivite D, Boixeda R, Iborra C, Rodríguez-Molinero A. Machine learning for the development of diagnostic models of decompensated heart failure or exacerbation of chronic obstructive pulmonary disease. Sci Rep 2023; 13:12709. [PMID: 37543661 PMCID: PMC10404284 DOI: 10.1038/s41598-023-39329-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/24/2023] [Indexed: 08/07/2023] Open
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are two chronic diseases with the greatest adverse impact on the general population, and early detection of their decompensation is an important objective. However, very few diagnostic models have achieved adequate diagnostic performance. The aim of this trial was to develop diagnostic models of decompensated heart failure or COPD exacerbation with machine learning techniques based on physiological parameters. A total of 135 patients hospitalized for decompensated heart failure and/or COPD exacerbation were recruited. Each patient underwent three evaluations: one in the decompensated phase (during hospital admission) and two more consecutively in the compensated phase (at home, 30 days after discharge). In each evaluation, heart rate (HR) and oxygen saturation (Ox) were recorded continuously (with a pulse oximeter) during a period of walking for 6 min, followed by a recovery period of 4 min. To develop the diagnostic models, predictive characteristics related to HR and Ox were initially selected through classification algorithms. Potential predictors included age, sex and baseline disease (heart failure or COPD). Next, diagnostic classification models (compensated vs. decompensated phase) were developed through different machine learning techniques. The diagnostic performance of the developed models was evaluated according to sensitivity (S), specificity (E) and accuracy (A). Data from 22 patients with decompensated heart failure, 25 with COPD exacerbation and 13 with both decompensated pathologies were included in the analyses. Of the 96 characteristics of HR and Ox initially evaluated, 19 were selected. Age, sex and baseline disease did not provide greater discriminative power to the models. The techniques with S and E values above 80% were the logistic regression (S: 80.83%; E: 86.25%; A: 83.61%) and support vector machine (S: 81.67%; E: 85%; A: 82.78%) techniques. The diagnostic models developed achieved good diagnostic performance for decompensated HF or COPD exacerbation. To our knowledge, this study is the first to report diagnostic models of decompensation potentially applicable to both COPD and HF patients. However, these results are preliminary and warrant further investigation to be confirmed.
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Affiliation(s)
- César Gálvez-Barrón
- Research Area, Consorci Sanitari Alt Penedès i Garraf, Sant Pere de Ribes-Barcelona, Barcelona, Spain.
| | - Carlos Pérez-López
- Research Area, Consorci Sanitari Alt Penedès i Garraf, Sant Pere de Ribes-Barcelona, Barcelona, Spain
| | | | - Jesús Ribas
- Department of Pneumology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Francesc Formiga
- Geriatric Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - David Chivite
- Geriatric Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Ramón Boixeda
- Department of Internal Medicine, Hospital de Mataró, Mataró-Barcelona, Spain
| | - Cristian Iborra
- Department of Cardiology, IIS Fundación Jiménez Díaz, Madrid, Spain
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Rahman MS, Rahman HR, Prithula J, Chowdhury MEH, Ahmed MU, Kumar J, Murugappan M, Khan MS. Heart Failure Emergency Readmission Prediction Using Stacking Machine Learning Model. Diagnostics (Basel) 2023; 13:diagnostics13111948. [PMID: 37296800 DOI: 10.3390/diagnostics13111948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Heart failure is a devastating disease that has high mortality rates and a negative impact on quality of life. Heart failure patients often experience emergency readmission after an initial episode, often due to inadequate management. A timely diagnosis and treatment of underlying issues can significantly reduce the risk of emergency readmissions. The purpose of this project was to predict emergency readmissions of discharged heart failure patients using classical machine learning (ML) models based on Electronic Health Record (EHR) data. The dataset used for this study consisted of 166 clinical biomarkers from 2008 patient records. Three feature selection techniques were studied along with 13 classical ML models using five-fold cross-validation. A stacking ML model was trained using the predictions of the three best-performing models for final classification. The stacking ML model provided an accuracy, precision, recall, specificity, F1-score, and area under the curve (AUC) of 89.41%, 90.10%, 89.41%, 87.83%, 89.28%, and 0.881, respectively. This indicates the effectiveness of the proposed model in predicting emergency readmissions. The healthcare providers can intervene pro-actively to reduce emergency hospital readmission risk and improve patient outcomes and decrease healthcare costs using the proposed model.
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Affiliation(s)
- Md Sohanur Rahman
- Department of Electrical and Electronics Engineering, University of Dhaka, Dhaka 1000, Bangladesh
| | - Hasib Ryan Rahman
- Department of Electrical and Electronics Engineering, University of Dhaka, Dhaka 1000, Bangladesh
| | - Johayra Prithula
- Department of Electrical and Electronics Engineering, University of Dhaka, Dhaka 1000, Bangladesh
| | | | - Mosabber Uddin Ahmed
- Department of Electrical and Electronics Engineering, University of Dhaka, Dhaka 1000, Bangladesh
| | - Jaya Kumar
- Department of Physiology, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - M Murugappan
- Intelligent Signal Processing (ISP) Research Lab, Department of Electronics and Communication Engineering, Kuwait College of Science and Technology, Block 4, Doha 13133, Kuwait
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Sheridan WS, Wetterling F, Testani JM, Borlaug BA, Fudim M, Damman K, Gray A, Gaines P, Poloczek M, Madden S, Tucker J, Buxo T, Gaul R, Corcoran L, Sweeney F, Burkhoff D. Safety and performance of a novel implantable sensor in the inferior vena cava under acute and chronic intravascular volume modulation. Eur J Heart Fail 2023; 25:754-763. [PMID: 36891760 DOI: 10.1002/ejhf.2822] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/10/2023] [Accepted: 02/27/2023] [Indexed: 03/10/2023] Open
Abstract
AIMS The management of congestion is one of the key treatment targets in heart failure. Assessing congestion is, however, difficult. The purpose of this study was to investigate the safety and dynamic response of a novel, passive, inferior vena cava (IVC) sensor in a chronic ovine model. METHODS AND RESULTS A total of 20 sheep divided into three groups were studied in acute and chronic in vivo settings. Group I and Group II included 14 sheep in total with 12 sheep receiving the sensor and two sheep receiving a control device (IVC filter). Group III included an additional six animals for studying responses to volume challenges via infusion of blood and saline solutions. Deployment was 100% successful with all devices implanted; performing as expected with no device-related complications and signals were received at all observations. At similar volume states no significant differences in IVC area normalized to absolute area range were measured (55 ± 17% on day 0 and 62 ± 12% on day 120, p = 0.51). Chronically, the sensors were completely integrated with a thin, reendothelialized neointima with no loss of sensitivity to infused volume. Normalized IVC area changed significantly from 25 ± 17% to 43 ± 11% (p = 0.007) with 300 ml infused. In contrast, right atrial pressure required 1200 ml of infused volume prior to a statistically significant change from 3.1 ± 2.6 mmHg to 7.5 ± 2.0 mmHg (p = 0.02). CONCLUSION In conclusion, IVC area can be measured remotely in real-time using a safe, accurate, wireless, and chronic implantable sensor promising to detect congestion with higher sensitivity than filling pressures.
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Affiliation(s)
| | | | - Jeffrey Moore Testani
- Section of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Marat Fudim
- Duke Clinical Research Institute, Durham, NC, USA
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Kevin Damman
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Alastair Gray
- Department of Cardiology, Craigavon Area Hospital, Craigavon, UK
| | | | - Martin Poloczek
- Department of Internal Medicine and Cardiology, University Hospital Brno and Faculty of Medicine of Masaryk University, Brno, Czech Republic
| | - Stephen Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - James Tucker
- FIRE1, Foundry Innovation and Research 1 Ltd, Dublin, Ireland
| | - Teresa Buxo
- FIRE1, Foundry Innovation and Research 1 Ltd, Dublin, Ireland
| | - Robert Gaul
- FIRE1, Foundry Innovation and Research 1 Ltd, Dublin, Ireland
| | - Louise Corcoran
- FIRE1, Foundry Innovation and Research 1 Ltd, Dublin, Ireland
| | - Fiachra Sweeney
- FIRE1, Foundry Innovation and Research 1 Ltd, Dublin, Ireland
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10
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Anderson A, Mukashev N, Zhou D, Bigler W. The Costs Of Disparities In Preventable Heart Failure Hospitalizations In The US South, 2015-17. Health Aff (Millwood) 2023; 42:693-701. [PMID: 37126750 DOI: 10.1377/hlthaff.2022.01314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Black Americans in the US South have high rates of preventable heart failure hospitalizations, which reflects systemic inequities that also produce economic costs. We measured the direct medical costs of disparities in preventable heart failure admissions (that is, excess admissions) among Medicare beneficiaries living in six states in the US South (Kentucky, Arkansas, Florida, Georgia, Mississippi, and North Carolina). We used 2015-17 data from the Healthcare Cost and Utilization Project and constructed negative binomial models with state-level fixed effects to calculate adjusted admission rates with heart failure as the principal diagnosis. We calculated the number of these admissions that would have been avoided if Black, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native Medicare beneficiaries had the same admission rates as White beneficiaries. We found 28,213 excess admissions (48 percent excess) with $60,845,855 annual costs among Black beneficiaries, 3,499 (14 percent excess) with $8,179,381 annual costs among Hispanic beneficiaries, and 550 (51 percent excess) with $1,093,472 in annual costs among American Indian/Alaska Native beneficiaries. Failure to address heart failure treatment inequities in the community has a high opportunity cost.
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Dudek M, Kałużna-Oleksy M, Migaj J, Sawczak F, Krysztofiak H, Lesiak M, Straburzyńska-Migaj E. sST2 and Heart Failure-Clinical Utility and Prognosis. J Clin Med 2023; 12:3136. [PMID: 37176577 PMCID: PMC10179304 DOI: 10.3390/jcm12093136] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
New parameters and markers are constantly being sought to help better assess patients with heart failure (HF). ST2 protein has gained interest as a potential biomarker in cardiovascular disease. It is known that the IL-33/ST2L system belongs to the cardioprotective pathway, which prevents the fibrosis, hypertrophy, and apoptosis of cardiomyocytes and also inhibits the inflammatory response. Soluble ST2 (sST2) is involved in the immune response and secreted in response to the mechanical overload of the myocardium, thus providing information on the processes of myocardial remodeling and fibrosis. A total of 110 hospitalized patients diagnosed with heart failure with reduced ejection fraction (HFrEF) were included in the study. Clinical and biochemical parameters were studied. During the follow-up, 30.9% patients died and 57.3% patients reached the composite endpoint. Using ROC curves, the reference cut-off point for sST2 was determined to be 45.818 pg/mL for all-cause deaths. Significantly higher concentrations of inflammatory parameters and natriuretic peptides were found in the group of patients with higher sST2 concentrations. sST2 protein is an independent risk factor for all-cause deaths of patients with HFrEF.
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Affiliation(s)
- Magdalena Dudek
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznań, Poland
| | - Marta Kałużna-Oleksy
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznań, Poland
| | - Jacek Migaj
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznań, Poland
| | - Filip Sawczak
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznań, Poland
| | - Helena Krysztofiak
- Department of Cardiology, University Hospital in Opole, 45-401 Opole, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznań, Poland
| | - Ewa Straburzyńska-Migaj
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznań, Poland
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12
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Giamouzis G, Xanthopoulos A, Boudoulas KD, Karagiannis G, Skoularigis J, Triposkiadis F. Editorial: Novel and emerging therapies in heart failure. Front Cardiovasc Med 2023; 10:1179352. [PMID: 37034331 PMCID: PMC10079209 DOI: 10.3389/fcvm.2023.1179352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/10/2023] [Indexed: 04/11/2023] Open
Affiliation(s)
- Grigorios Giamouzis
- Cardiology Department, General University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Andrew Xanthopoulos
- Cardiology Department, General University Hospital of Larissa, Larissa, Greece
| | | | - Georgios Karagiannis
- Transplant Department, Harefield Hospital and Cardiology Department, Hillingdon Hospital, London, United Kingdom
| | - John Skoularigis
- Cardiology Department, General University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Filippos Triposkiadis
- Cardiology Department, General University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Ullah MI, Tamanna S, Bhagat R. High nocturnal periodic breathing reported by PAP adherence data predicts decompensation of heart failure. J Clin Sleep Med 2023; 19:431-441. [PMID: 36310394 PMCID: PMC9978441 DOI: 10.5664/jcsm.10346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 03/03/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) often coexists with heart failure (HF) and is commonly treated with positive airway pressure (PAP) therapy. Periodic breathing (PB) may be present in HF and is an indicator of poor prognosis, but there is no easy way to detect PB in an outpatient setting. However, it can be detected by analyzing PAP usage data. The study aimed to assess if high PB% detected by PAP machine could predict impending HF exacerbation and if better PAP adherence is associated with reduced hospitalization and mortality. METHODS We retrospectively reviewed medical records of 115 patients with OSA from the sleep clinic of our VA Medical Center. The cross-sectional data on demographics, labs, PAP adherence, PB% in the previous 30 days, echocardiogram in the previous 6 months, and hospitalizations and mortality in the subsequent 180 days were extracted. Based on left ventricular ejection fraction (LVEF), patients were classified into (1) HF with normal-midrange LVEF (LVEF ≥40%, n = 74) and (2) HF with reduced LVEF (LVEF < 40%, n = 41). Pairwise correlation and linear regressions were done to assess predictors of PB%. Binomial and logistic regressions assessed the relationship of PB% and PAP adherence with hospitalization from HF and all-cause mortality. RESULTS In the HF with reduced LVEF group, the mean PB% was 2.6 times higher (P < .001) and PAP adherence was 29% lower (P < .001). PB% positively correlated with brain natriuretic peptide level (r = .447, P < .01) and number of hospitalizations (r = .331, P < .01). Higher PB% negatively correlated with LVEF (r = -.423, P < .01) and estimated glomerular filtration rate (r = -.246, P < .01). Every 10% increase in PAP adherence decreased odds of hospitalization by 0.78 times (P < .001) and odds of death by 0.86 (P = .043). CONCLUSIONS High PB% detected by PAP machine data is a predictor of impending HF exacerbation and hospitalization. Improved PAP adherence and optimization of medical therapy may reduce hospitalization and all-cause mortality. CITATION Ullah MI, Tamanna S, Bhagat R. High nocturnal periodic breathing reported by PAP adherence data predicts decompensation of heart failure. J Clin Sleep Med. 2023;19(3):431-441.
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Affiliation(s)
- Mohammad I. Ullah
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Sadeka Tamanna
- Department of Medicine, G.V. (Sonny) Montgomery VA Medical Center, Jackson, Mississippi
| | - Rajesh Bhagat
- Department of Medicine, G.V. (Sonny) Montgomery VA Medical Center, Jackson, Mississippi
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Ardekani A, Fereidooni R, Heydari ST, Ghahramani S, Shahabi S, Bagheri Lankarani K. The association of patient-reported social determinants of health and hospitalization rate: A scoping review. Health Sci Rep 2023; 6:e1124. [PMID: 36846535 PMCID: PMC9944244 DOI: 10.1002/hsr2.1124] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction The interplay between social determinants of health (SDOH) and hospitalization is significant as targeted interventions can improve the social status of the individuals. This interrelation has been historically overlooked in health care. In the present study, we reviewed studies in which the association between patient-reported social risks and hospitalization rate was assessed. Method We performed a scoping literature review of articles published until September 1, 2022 without time limit. We searched PubMed, Embase, Web of Science, Scopus, and Google Scholar to find relevant studies using terms representing "social determinants of health" and "hospitalization." Forward and backward reference checking was done for the included studies. All studies that used patient-reported data as a proxy of social risks to determine the association between social risks and hospitalization rates were included. The screening and data extraction processes were done independently by two authors. In case of disagreement, senior authors were consulted. Results Our search process retrieved a total of 14,852 records. After the duplicate removal and screening process, eight studies met the eligibility criteria, all of which were published from 2020 to 2022. The sample size of the studies ranged from 226 to 56,155 participants. All eight studies investigated the impact of food security on hospitalization, and six investigated economic status. In three studies, latent class analysis was applied to divide participants based on their social risks. Seven studies found a statistically significant association between social risks and hospitalization rates. Conclusion Individuals with social risk factors are more susceptible to hospitalization. There is a need for a paradigm shift to meet these needs and reduce the number of preventable hospitalizations.
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Affiliation(s)
- Ali Ardekani
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Reza Fereidooni
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Sulmaz Ghahramani
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Saeed Shahabi
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
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15
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Zhao K, Zhou J, Guo JT, Wu CH, Li SL, Zhang Q, Tian X, Shan WC, Ding ZJ, Yuan LS, Zheng Q, Gao XL, Guo N, Tian HS, Wei QM, Hu XT, Cui YK, Geng X, Wang Q, Cui W. Association between tricuspid annular systolic velocity and poor short-term prognosis in patients with acute decompensated heart failure. Ann Med 2022; 54:2898-2908. [PMID: 36259612 PMCID: PMC9624254 DOI: 10.1080/07853890.2022.2134585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND There is scant data on the association of the Pulsed wave-Doppler tissue imaging (PW-DTI)-derived tricuspid lateral annular peak systolic velocity (S') and poor short-term prognosis of patients with acute decompensated heart failure (ADHF). PATIENTS AND METHODS A total number of 732 participants from the Heb-ADHF registry in China were divided into three groups according to the corresponding status of tricuspid S'. Demographic characteristics, comorbidities, physical examinations, lab tests, and medications were compared among the different groups. Different logistic regression models were utilized to gauge the relationship between S' and the risk of a composite of short-term all-cause mortality or 30-day heart failure (HF)-related rehospitalization. RESULTS The number of composite outcome events identified in the study population was 85, with the short-term all-cause death coupled with 30-day HF readmission events reaching 23 and 62, respectively. As per the multivariable adjusted analysis, S' was inversely related to the risk of a composite outcome [<10 cm/s odds ratios (OR) 2.90, 95% confidence interval (CI):1.33-6.31; 10-11 cm/s OR 2.18, 95% CI: 1.10-4.33; p for trend = 0.006] in comparison with S' at >11 cm/s. When S' was analysed as a continuous variable, per 1 cm/s increase, the OR (95% CI) for a composite outcome was [0.87 (0.77-0.99), p = 0.028]. Area under curve (AUC) of S' for predicting outcome of ADHF was 0.631 (95%CI: 0.573-0.690, p < 0.01). Significant inverse association was also observed in left ventricular ejection fraction (LVEF) ≥40% subgroup. CONCLUSIONS Inspite of the potential confounders, a more impaired tricuspid annular peak systolic velocity is associated with a poorer short-term prognosis of patients with ADHF.
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Affiliation(s)
- Kai Zhao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiang Zhou
- Department of Cardiology, Chengde Central Hospital, Chengde, China
| | - Jing Tao Guo
- Department of Cardiology, Chengde Central Hospital, Chengde, China
| | - Cai Hong Wu
- Department of Cardiology, First Hospital of Zhangjiakou, Zhangjiakou, China
| | - Sen Lin Li
- Department of Cardiology, First Hospital of Zhangjiakou, Zhangjiakou, China
| | - Qi Zhang
- Department of Cardiology, First Central Hospital of Baoding, Baoding, China
| | - Xiang Tian
- Department of Cardiology, First Central Hospital of Baoding, Baoding, China
| | - Wei Chao Shan
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Zhen Jiang Ding
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Lan Suo Yuan
- Department of Cardiology, Hengshui People's Hospital, Hengshui, China
| | - Qun Zheng
- Department of Cardiology, Hengshui People's Hospital, Hengshui, China
| | - Xiao Li Gao
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Cangzhou, China
| | - Nan Guo
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, China
| | - Hong Sen Tian
- Department of Cardiology, Handan Central Hospital, Handan, China
| | - Qing Min Wei
- Department of Cardiology, Xingtai People's Hospital, Xingtai, China
| | - Xi Tian Hu
- Department of Cardiology, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Ying Kai Cui
- Department of Cardiology, The 252nd Hospital of People's Liberation Army, Baoding, China
| | - Xue Geng
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qian Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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16
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Xu R, Tian Q, Wei J, Ye Y, Li Y, Lin Q, Wang Y, Liu L, Shi C, Xia W, Liu Y. Short-term exposure to ambient air pollution and readmissions for heart failure among 3660 post-discharge patients with hypertension in older Chinese adults. J Epidemiol Community Health 2022; 76:984-990. [PMID: 36198486 DOI: 10.1136/jech-2022-219676] [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: 08/08/2022] [Accepted: 09/21/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite ambient air pollution being associated with various adverse cardiovascular outcomes, the acute effects of ambient air pollution on hospital readmissions for heart failure (HF) among post-discharge patients with hypertension remain less understood. METHODS We conducted a time-stratified case-crossover study among 3660 subjects 60 years or older who were admitted to hospital for HF after discharge for hypertension in Guangzhou, China during 2016-2019. For each subject, individualised residential exposures to ambient particulate matter with an aerodynamic diameter ≤1 µm (PM1), ≤2.5 µm (PM2.5), ≤10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) and ozone were extracted from our validated grid dataset. RESULTS An IQR increase of lag 04-day exposure to PM1 (IQR: 11.6 μg/m3), PM2.5 (IQR 21.9 μg/m3), PM10 (IQR 35.0 μg/m3), SO2 (IQR 4.4 μg/m3), NO2 (IQR 23.3 μg/m3) and CO (IQR 0.25 mg/m3) was significantly associated with a 9.77% (95% CI 2.21% to 17.89%), 8.74% (95% CI 1.05% to 17.00%), 13.93% (95% CI 5.36% to 23.20%), 10.81% (95% CI 1.82% to 20.60%), 14.97% (95% CI 8.05% to 22.34%) and 7.37% (95% CI 0.98% to 14.16%) increase in odds of HF readmissions, respectively. With adjustment for other pollutants, the association for NO2 exposure remained stable, while the associations for PM1, PM2.5, PM10, SO2 and CO exposures became insignificant. Overall, an estimated 19.86% of HF readmissions were attributable to NO2 exposure, while reducing NO2 exposure to the WHO and China air quality standards would avoid 12.87% and 0.54% of readmissions, respectively. No susceptible populations were observed by sex, age or season. CONCLUSION Short-term exposure to ambient NO2 was significantly associated with an increased odds of HF readmissions among post-discharge patients with hypertension in older Chinese adults.
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Affiliation(s)
- Ruijun Xu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qi Tian
- Department of Statistics, Guangzhou Health Technology Identification and Human Resources Assessment Center, Guangzhou, Guangdong, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland at College Park, College Park, Maryland, USA
| | - Yunshao Ye
- Department of Statistics, Guangzhou Health Technology Identification and Human Resources Assessment Center, Guangzhou, Guangdong, China
| | - Yingxin Li
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qiaoxuan Lin
- Department of Statistics, Guangzhou Health Technology Identification and Human Resources Assessment Center, Guangzhou, Guangdong, China
| | - Yaqi Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Likun Liu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chunxiang Shi
- Meteorological Data Laboratory, National Meteorological Information Center, Beijing, China
| | - Wenhao Xia
- Department of Hypertension and Vascular Disease, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Yuewei Liu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
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Posada-Martinez EDITHL, COX ZACHARYL, CANO-NIETO MARIANAM, IBARRA-MARQUEZ NIKEIND, MORENO-VILLAGOMEZ JULIETA, GUDIÑO-BRAVO PEDRO, ARIAS-GODINEZ JOSEA, LOPEZ-GIL SALVADOR, MADERO MAGDALENA, RAO VEENAS, MEBAZAA ALEXANDRE, BURKHOFF DANIEL, COWIE MARTINR, FUDIM MARAT, DAMMAN KEVIN, BORLAUG BARRYA, TESTANI JEFFREYM, IVEY-MIRANDA JUANB. Changes in the Inferior Vena Cava Are More Sensitive Than Venous Pressure During Fluid Removal: A Proof-of-Concept Study. J Card Fail 2022; 29:463-472. [PMID: 36243338 DOI: 10.1016/j.cardfail.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/29/2022] [Accepted: 09/10/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Congestion is central to the pathophysiology of heart failure (HF); thus, tracking congestion is crucial for the management of patients with HF. In this study we aimed to compare changes in inferior vena cava diameter (IVCD) with venous pressure following manipulation of volume status during ultrafiltration in patients with cardiac dysfunction. METHODS AND RESULTS Patients with stable hemodialysis and with systolic or diastolic dysfunction were studied. Central venous pressure (CVP) and peripheral venous pressure (PVP) were measured before and after hemodialysis. IVCD and PVP were measured simultaneously just before dialysis, 3 times during dialysis and immediately after dialysis. Changes in IVCD and PVP were compared at each timepoint with ultrafiltration volumes. We analyzed 30 hemodialysis sessions from 20 patients. PVP was validated as a surrogate for CVP. Mean ultrafiltration volume was 2102 ± 667 mL. IVCD discriminated better ultrafiltration volumes ≤ 500 mL or ≤ 750 mL than PVP (AUC 0.80 vs 0.62, and 0.80 vs 0.56, respectively; both P< 0.01). IVCD appeared to track better ultrafiltration volume (P< 0.01) and hemoconcentration (P< 0.05) than PVP. Changes in IVCD were of greater magnitude than those of PVP (average change from predialysis: -58 ± 30% vs -28 ± 21%; P< 0.001). CONCLUSIONS In patients undergoing ultrafiltration, changes in IVCD tracked changes in volume status better than venous pressure.
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18
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Al-Omary MS, Majeed T, Al-Khalil H, Sugito S, Clapham M, Ngo DTM, Attia JR, Boyle AJ, Sverdlov AL. Patient characteristics, short-term and long-term outcomes after incident heart failure admissions in a regional Australian setting. Open Heart 2022; 9:e001897. [PMID: 35641098 PMCID: PMC9157343 DOI: 10.1136/openhrt-2021-001897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/11/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS This study aims to (1) define the characteristics of patients with a first admission for heart failure (HF), stratified by type (reduced (HFrEF) vs preserved (HFpEF) ejection fraction) in a regional Australian setting; (2) compare the outcomes in terms of mortality and rehospitalisation and (3) assess adherence to the treatment guidelines. METHODS We identified all index hospitalisations with HF to John Hunter Hospital and Tamworth Rural Referral Hospital in the Hunter New England Local Health District over a 12 months. We used the recent Australian HF guidelines to classify HFrEF and HFpEF and assess adherence to guideline-directed therapy. The primary outcome of the study was to compare short-term (1 year) and long-term all-cause mortality and the composite of all-cause hospitalisation or all-cause mortality of patients with HFrEF and HFpEF. RESULTS There were 664 patients who had an index HF admission to John Hunter and Tamworth hospitals in 2014. The median age was 80 years, 47% were female and 22 (3%) were Aboriginal. In terms of HF type, 29% had HFrEF, 37% had HFpEF, while the remainder (34%) did not have an echocardiogram within 1 year of admission and could not be classified. The median follow-up was 3.3 years. HFrEF patients were predominantly male (64%) and in 48% the aetiology was ischaemic heart disease. The 1-year all-cause mortality was 23% in HFpEF subgroup and 29% in HFrEF subgroup (p=0.15). Five-year mortality was 61% in HFpEF and HFrEF patients. Of the HFrEF patients, only 61% were on renin-angiotensin-aldosterone blockers, 74% were on β-blockers and 39% were on aldosterone antagonist. CONCLUSION HF patients are elderly and about evenly split between HFrEF and HFpEF. In this regional cohort, both HF types are associated with similar 1-year and 5-year mortality following incident HF hospitalisation. Echocardiography and guideline-directed therapies were underused.
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Affiliation(s)
- Mohammed S Al-Omary
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
| | - Tazeen Majeed
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Hafssa Al-Khalil
- John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Stuart Sugito
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Mathew Clapham
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Doan T M Ngo
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - John R Attia
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Andrew J Boyle
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Aaron L Sverdlov
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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19
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Flores-Álvarez FJ, Sillero-Herrera A, Cuesta-Gaviño J, Fernández-Sánchez ML, Vega-Sánchez J, López-Fe JL, Gamboa-Antiñolo FM, Utrilla-Ayala D, Aguirre-Palacio A, De Villar-Conde E, Vergara-López S. Frailty as a predictor of clinical problems and events that require elderly patients with heart failure to use health resources. Arch Gerontol Geriatr 2022; 101:104698. [PMID: 35390571 DOI: 10.1016/j.archger.2022.104698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/15/2022] [Accepted: 03/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The clinical management of elderly patients with heart failure (HF) is not firmly established. Decision-making should be individualized depending on the biological deterioration of each patient, from aggressive management to a palliative approach. Frailty can serve as the basis for this comprehensive individualized management. Our objective was to evaluate the importance of the main clinical problems, as well as the events that required the use of health resources, based the degree of frailty, in elderly patients with HF. METHODS AND RESULTS Retrospective observational cohort study. Frailty was defined according to the deficit accumulation construct. A total of 546 patients hospitalized for acute HF were included. The median age (Q1-Q3) was 82 (78-86) years. A total of 454 patients (83%) showed some degree of frailty: 221 (48.7%) mild, 207 (45.6%) moderate and 26 (5.7%) advanced. There was a significant tendency towards polypharmacy from no to severe frailty. Hospital events were recorded for 4 (1-6) patients with mild frailty, 4 (2-6) patients with moderate frailty and 2 ((1-4) patients with advanced frailty (p = 0.045). A total of 204 patients (37.4%) died during follow-up. The median time to death was 11.4 (4-16.8), 6.7 (3.3-11.6), 6.5 (3.4-12.2) and 4.1 (0.8-7.7) months for patients with no, mild, moderate, or advanced frailty, respectively (p = 0.006). CONCLUSIONS Frailty due to deficit accumulation is a good predictor of clinical problems and events that require the use of health resources; therefore, it can serve as a basis for the management of HF in the elderly.
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Affiliation(s)
- F J Flores-Álvarez
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - A Sillero-Herrera
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - J Cuesta-Gaviño
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | | | - J Vega-Sánchez
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - J L López-Fe
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - F M Gamboa-Antiñolo
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - D Utrilla-Ayala
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - A Aguirre-Palacio
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - E De Villar-Conde
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - S Vergara-López
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain).
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Tamaki S, Yamada T, Watanabe T, Morita T, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Kayama K, Sakamoto D, Ueda K, Kogame T, Tamura Y, Fujita T, Nishigaki K, Fukuda Y, Kokubu Y, Fukunami M. Usefulness of the 2-year iodine-123 metaiodobenzylguanidine-based risk model for post-discharge risk stratification of patients with acute decompensated heart failure. Eur J Nucl Med Mol Imaging 2022; 49:1906-1917. [PMID: 34997293 DOI: 10.1007/s00259-021-05663-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/15/2021] [Indexed: 01/02/2023]
Abstract
PURPOSE A four-parameter risk model that included cardiac iodine-123 metaiodobenzylguanidine (MIBG) imaging and readily available clinical parameters was recently developed for prediction of 2-year cardiac mortality risk in patients with chronic heart failure. We sought to validate the ability of this risk model to predict post-discharge clinical outcomes in patients with acute decompensated heart failure (ADHF) and to compare its prognostic value with that of the Acute Decompensated Heart Failure National Registry (ADHERE) and Get With The Guidelines-Heart Failure (GWTG-HF) risk scores. METHODS We studied 407 consecutive patients who were admitted for ADHF and survived to discharge, with definitive 2-year outcomes (death or survival). Cardiac MIBG imaging was performed just before discharge. The 2-year cardiac mortality risk was calculated using four parameters, namely age, left ventricular ejection fraction, New York Heart Association functional class, and cardiac MIBG heart-to-mediastinum ratio on delayed images. Patients were stratified into three groups based on the 2-year cardiac mortality risk: low- (< 4%), intermediate- (4-12%), and high-risk (> 12%) groups. The ADHERE and GWTG-HF risk scores were also calculated. RESULTS There was a significant difference in the incidence of cardiac death among the three groups stratified using the 2-year cardiac mortality risk model (p < 0.0001). The 2-year cardiac mortality risk model had a higher C-statistic (0.732) for the prediction of cardiac mortality than the ADHERE and GWTG-HF risk scores. CONCLUSION The 2-year MIBG-based cardiac mortality risk model is useful for predicting post-discharge clinical outcomes in patients with ADHF. TRIAL REGISTRATION NUMBER UMIN000015246, 25 September 2014.
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Affiliation(s)
- Shunsuke Tamaki
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan.
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Tetsuya Watanabe
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Takashi Morita
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Masato Kawasaki
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Atsushi Kikuchi
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Tsutomu Kawai
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Masahiro Seo
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Jun Nakamura
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Kiyomi Kayama
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Daisuke Sakamoto
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Kumpei Ueda
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Takehiro Kogame
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Yuto Tamura
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Takeshi Fujita
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Keisuke Nishigaki
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Yuto Fukuda
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Yuki Kokubu
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Masatake Fukunami
- Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
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Cruz IO, Costa S, Teixeira R, Franco F, Gonçalves L. Telemonitoramento da Insuficiência Cardíaca – A Experiência de um Centro. Arq Bras Cardiol 2021; 118:599-604. [PMID: 35137786 PMCID: PMC8959025 DOI: 10.36660/abc.20201264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
Fundamento A evolução natural da insuficiência cardíaca é uma pior progressiva e internações hospitalares recorrentes. São necessárias estratégias para se detectar descompensações em tempo hábil. O uso do telemonitoramento da insuficiência cardíaca é inconsistente. Objetivos Este estudo tem o objetivo de avaliar o impacto desse programa de telemonitoramento (PTM) em internações hospitalares e admissões em serviços de emergência. Métodos Este é um estudo retrospectivo observacional que analisou dados de todos os pacientes que se cadastraram no PTM de janeiro a 2018 a dezembro de 2019. Foram coletados dados demográficos, clínicos e relacionados ao PTM. O número de internações hospitalares e admissões em serviços de emergência do ano anterior e posterior ao cadastro foram comparados, utilizando-se o teste de Wilcoxon. Um p-valor bilateral de <0,05 foi considerado significativo. Resultados Um total de 39 pacientes foram cadastrados, com uma média de idade de 62,1 ± 14 anos e predominância de pacientes do sexo masculino (90%). As causas mais comuns de insuficiência cardíaca foram cardiomiopatia isquêmica e dilatada. A fração de ejeção média foi de 30% e o tempo mediano da duração da doença foi de 84 meses (FIQ 33-144). Pacientes que foram cadastrados por menos de um mês foram excluídos, com um total de 34 pacientes analisados. Os pacientes foram acompanhados no PTM por um período mediano de 320 dias. O número de admissões em serviços de emergência foi reduzido em 66% (p<0,001) e o número de internações hospitalares por insuficiência cardíaca foi reduzido em 68% (p<0,001). O PTM não teve impacto no número de internações hospitalares por outras causas. Conclusões Este estudo sugere que o PTM poderia reduzir a utilização de serviços de saúde em pacientes com insuficiência cardíaca.
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22
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Lan T, Liao YH, Zhang J, Yang ZP, Xu GS, Zhu L, Fan DM. Mortality and Readmission Rates After Heart Failure: A Systematic Review and Meta-Analysis. Ther Clin Risk Manag 2021; 17:1307-1320. [PMID: 34908840 PMCID: PMC8665875 DOI: 10.2147/tcrm.s340587] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/18/2021] [Indexed: 12/29/2022] Open
Abstract
Objective The current work aimed to examine the rates of and risk factors for mortality and readmission after heart failure (HF). Setting A systematic search was carried out in PubMed, the Cochrane Library, and EMBASE to identify eligible reports. The random-effects model was utilized to evaluate the pooled results. Participants A total of 27 studies with 515,238 participants were finally meta-analysed. The HF patients had an average age of 76.3 years, with 51% of the sample being male, in the pooled analysis. Primary and Secondary Outcome Measures The outcome measures were 30-day and 1-year readmission rates, mortality, and risk factors for readmission and mortality. Results The effect sizes for readmission and mortality were estimated as the mean and 95% confidence interval (CI). The estimated 30-day and 1-year all-cause readmission rates were 0.19 (95% CI 0.14-0.23) and 0.53 (95% CI 0.46-0.59), respectively, while the all-cause mortality rates were 0.14 (95% CI 0.10-0.18) and 0.29 (95% CI 0.25-0.33), respectively. Comorbidities were highly prevalent in individuals with HF. Conclusion Heart failure hospitalization is followed by high readmission and mortality rates.
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Affiliation(s)
- Tian Lan
- Department of Health Care Management and Medical Education, The School of Military Preventive Medicine, Air Force Medical University, Xi'an, People's Republic of China.,Department of Health Care Management, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Yan-Hui Liao
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Jian Zhang
- Department of Health Care Management, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Zhi-Ping Yang
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, People's Republic of China
| | - Gao-Si Xu
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Liang Zhu
- Department of Health Care Management and Medical Education, The School of Military Preventive Medicine, Air Force Medical University, Xi'an, People's Republic of China
| | - Dai-Ming Fan
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, People's Republic of China
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23
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Ivey-Miranda JB, Wetterling F, Gaul R, Sheridan S, Asher JL, Rao VS, Maulion C, Mahoney D, Mebazaa A, Gray AP, Burkhoff D, Cowie MR, Cox ZL, Butler J, Fudim M, McDonald K, Damman K, Borlaug BA, Testani JM. Changes in inferior vena cava area represent a more sensitive metric than change in filling pressures during experimental manipulation of intravascular volume and tone. Eur J Heart Fail 2021; 24:455-462. [PMID: 34837447 PMCID: PMC9306514 DOI: 10.1002/ejhf.2395] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/30/2021] [Accepted: 11/16/2021] [Indexed: 12/05/2022] Open
Abstract
Aims Remote monitoring of pulmonary artery pressure has reduced heart failure (HF) hospitalizations in chronic HF as elevation of pulmonary artery pressure provides information that can guide treatment. The venous system is characterized by high capacitance, thus substantial increases in intravascular volume can occur before filling pressures increase. The inferior vena cava (IVC) is a highly compliant venous conduit and thus a candidate for early detection of change in intravascular volume. We aimed to compare IVC cross‐sectional area using a novel sensor with cardiac filling pressures during experimental manipulation of volume status, vascular tone, and cardiac function. Methods and results Experiments were conducted in sheep to manipulate volume status (colloid infusion), vascular tone (nitroglycerin infusion) and cardiac function (rapid cardiac pacing). A wireless implantable IVC sensor was validated ex‐vivo and in‐vivo, and then used to measure the cross‐sectional area of the IVC. Right‐ and left‐sided cardiac filling pressures were obtained via right heart catheterization. The IVC sensor provided highly accurate and precise measurements of cross‐sectional area in ex‐vivo and in‐vivo validation. IVC area changes were more sensitive than the corresponding changes in cardiac filling pressures during colloid infusion (p < 0.001), vasodilatation (p < 0.001) and cardiac dysfunction induced by rapid pacing (p ≤ 0.02). Conclusions Inferior vena cava area can be remotely and accurately measured in real time with a wireless implantable sensor. Changes in IVC area are more sensitive than corresponding changes in filling pressures following experimental volume loading and fluid redistribution. Additional research is warranted to understand if remote monitoring of the IVC may have advantages over pressure‐based monitors in HF.
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Affiliation(s)
- Juan B Ivey-Miranda
- Department of Internal Medicine, Section of Cardiology, Yale University School of Medicine, New Haven, CT, USA.,Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | | | | | - Jennifer L Asher
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Veena S Rao
- Department of Internal Medicine, Section of Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Christopher Maulion
- Department of Internal Medicine, Section of Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Devin Mahoney
- Department of Internal Medicine, Section of Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Alexandre Mebazaa
- Université de Paris, Inserm 942 MASCOT, Department of Anesthesia and Critical Care, Hôpital Lariboisière, DMU Parabol, APHP Nord, Paris, France
| | - Alastair P Gray
- . Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Martin R Cowie
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Zachary L Cox
- Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Marat Fudim
- Duke Clinical Research Institute, Durham, NC, USA.,Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | | | - Kevin Damman
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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24
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Rao VS, Maulion C, Asher JL, Ivey-Miranda JB, Cox ZL, Moreno-Villagomez J, Mahoney D, Turner JM, Wilson FP, Wilcox CS, Testani JM. Renal negative pressure treatment as a novel therapy for heart failure-induced renal dysfunction. Am J Physiol Regul Integr Comp Physiol 2021; 321:R588-R594. [PMID: 34405731 DOI: 10.1152/ajpregu.00115.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Congestion is the primary pathophysiological lesion in most heart failure (HF) hospitalizations. Renal congestion increases renal tubular pressure, reducing glomerular filtration rate (GFR) and diuresis. Because each nephron is a fluid-filled column, renal negative pressure therapy (rNPT) applied to the urinary collecting system should reduce tubular pressure, potentially improving kidney function. We evaluated the renal response to rNPT in congestive HF. Ten anesthetized ∼80-kg pigs underwent instrumentation with bilateral renal pelvic JuxtaFlow catheters. GFR was determined by iothalamate clearance (mGFR) and renal plasma flow (RPF) by para-aminohippurate clearance. Each animal served as its own control with randomization of left versus right kidney to -30 mmHg rNPT or no rNPT. mGFR and RPF were measured simultaneously from the rNPT and no rNPT kidney. Congestive HF was induced via cardiac tamponade maintaining central venous pressure at 20-22.5 mmHg throughout the experiment. Before HF induction, rNPT increased natriuresis, diuresis, and mGFR compared with the control kidney (P < 0.001 for all). Natriuresis, diuresis, and mGFR decreased following HF (P < 0.001 for all) but were higher in rNPT kidney versus control (P < 0.001 for all). RPF decreased during HF (P < 0.001) without significant differences between rNPT treatments. During HF, the rNPT kidney had similar diuresis and natriuresis (P > 0.5 for both) and higher fractional excretion of sodium (P = 0.001) compared with the non-rNPT kidney in the no HF period. In conclusion, rNPT resulted in significantly increased diuresis, natriuresis, and mGFR, with or without experimental HF. rNPT improved key renal parameters of the congested cardiorenal phenotype.
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Affiliation(s)
- Veena S Rao
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Christopher Maulion
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jennifer L Asher
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Juan B Ivey-Miranda
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.,Hospital de Cardiologia, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Zachary L Cox
- Department of Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, Tennessee.,Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julieta Moreno-Villagomez
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.,Facultad de Estudios Superiores Iztacala, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Devin Mahoney
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey M Turner
- Department of Medicine, Division of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - F Perry Wilson
- Clinical and translational research accelerator, Yale University School of Medicine, New Haven, Connecticut
| | - Christopher S Wilcox
- Division of Nephrology and Hypertension Center, Georgetown University, Washington, District of Columbia
| | - Jeffrey M Testani
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
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25
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Madanat L, Saleh M, Maraskine M, Halalau A, Bukovec F. Congestive Heart Failure 30-Day Readmission: Descriptive Study of Demographics, Co-morbidities, Heart Failure Knowledge, and Self-Care. Cureus 2021; 13:e18661. [PMID: 34786247 PMCID: PMC8579470 DOI: 10.7759/cureus.18661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 11/21/2022] Open
Abstract
Background Congestive heart failure (CHF) readmissions are associated with substantial financial and medical implications. We performed a descriptive study to determine demographic, clinical, and behavioral factors associated with 30-day readmission. Materials and methods Patients hospitalized with CHF at William Beaumont Hospital in Royal Oak, MI, from March 2019-May 2019 were studied. Response to heart failure knowledge and self-care questionnaires along with the patients' demographic and clinical factors were collected. Thirty-day readmission to any of the eight hospitals in the Beaumont Health System was documented. Results One-hundred ninety-six (196) patients were included. The all-cause 30-day readmission rate was 23%. A numerical higher rate of readmissions was observed among males (23.7% vs 22.2%), current smokers (27.3% vs 22.9%), and patients with peripheral vascular disease (PVD; 28.9% vs 21.2%), diabetes mellitus (DM; 26.4% vs 18.9%), hypertension (HTN; 26.4% vs 10%), coronary artery disease (CAD; 24.6% vs 19%), and prior history of cerebrovascular accident (CVA; 28.9% vs 21.2%) (p>0.05). Reduced left ventricular ejection fraction (LVEF) was associated with higher readmissions (24.4% vs 20.5%, p=0.801). Patients with the highest reported questionnaire scores corresponding to better heart failure knowledge and self-care behaviors at home were readmitted at a similar rate compared to those scoring in the lowest interval (25%, p=0.681). Conclusion Though statistically insignificant due to the limitations of sample size, a higher percentage of readmissions was observed in male patients, current smokers, reduced LVEF, and higher comorbidity burden. Better reported patient self-care behavior, medication compliance, and heart failure knowledge did not correlate with reduced readmission rates. While the impact of medical comorbidities on 30-day readmissions is better established, the role of socioeconomic factors remains unclear and might suggest a focus for future work.
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Affiliation(s)
- Luai Madanat
- Internal Medicine, Beaumont Hospital, Royal Oak, USA
| | - Monique Saleh
- Internal Medicine, Beaumont Hospital, Royal Oak, USA
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26
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Halatchev IG, Wu WC, Heidenreich PA, Djukic E, Balasubramanian S, Ohlms KB, McDonald JR. Inpatient versus outpatient intravenous diuresis for the acute exacerbation of chronic heart failure. IJC HEART & VASCULATURE 2021; 36:100860. [PMID: 34485679 PMCID: PMC8391052 DOI: 10.1016/j.ijcha.2021.100860] [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: 06/09/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND We established an IV outpatient diuresis (IVOiD) clinic and conducted a quality improvement project to evaluate safety, effectiveness and costs associated with outpatient versus inpatient diuresis for patients presenting with acute decompensated heart failure (ADHF) to the emergency department (ED). METHODS Patients who were clinically diagnosed with ADHF in the ED, but did not have high-risk features, were either diuresed in the hospital or in the outpatient IVOiD clinic. The dose of IV diuretic was based on their home maintenance diuretic dose. The outcomes measured were the effects of diuresis (urine output, weight, hemodynamic and laboratory abnormalities), 30-90 day readmissions, 30-90 day death and costs. RESULTS In total, 36 patients (22 inpatients and 14 outpatients) were studied. There were no significant differences in the baseline demographics between groups. The average inpatient stay was six days and the average IVOiD clinic days were 1.2. There was no significant difference in diuresis per day of treatment (1159 vs. 944 ml, p = 0.46). There was no significant difference in adverse outcomes, 30-90 day readmissions or 30-90 day deaths. There was a significantly lower cost in the IVOiD group compared to the inpatient group ($839.4 vs. $9895.7, p=<0.001). CONCLUSIONS Outpatient IVOiD clinic diuresis may be a viable alternative to accepted clinical practice of inpatient diuresis for ADHF. Further studies are needed to validate this in a larger cohort and in different sites.
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Affiliation(s)
- Ilia G. Halatchev
- Veterans Affairs St. Louis Health Care System, John Cochran Division, St. Louis, MO, United States
- Washington University School of Medicine, St. Louis, MO, United States
| | - Wen-Chin Wu
- Veterans Affairs Providence Health Care System, Providence Medical Center, Providence, Rhode Island, United States
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, United States
| | | | - Elma Djukic
- Veterans Affairs St. Louis Health Care System, John Cochran Division, St. Louis, MO, United States
| | - Sumitra Balasubramanian
- Clinical Research and Epidemiology Workgroup at Veterans Affairs St. Louis Health Care System, John Cochran Division, St. Louis, MO, United States
| | - Kelly B. Ohlms
- Clinical Research and Epidemiology Workgroup at Veterans Affairs St. Louis Health Care System, John Cochran Division, St. Louis, MO, United States
| | - Jay R. McDonald
- Veterans Affairs St. Louis Health Care System, John Cochran Division, St. Louis, MO, United States
- Washington University School of Medicine, St. Louis, MO, United States
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27
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Deka P, Almenar L, Pathak D, Klompstra L, López-Vilella R, Marques-Sule E. Depression mediates physical activity readiness and physical activity in patients with heart failure. ESC Heart Fail 2021; 8:5259-5265. [PMID: 34523268 PMCID: PMC8712809 DOI: 10.1002/ehf2.13609] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 12/28/2022] Open
Abstract
Aims Although physical activity (PA) and exercise are essential for patients with heart failure (HF), adherence to the recommended guidelines is low. Not much is known about the mediating effect of HF patients' mental state with their readiness for PA and reported activity levels. The purpose of this study is to investigate the mediatory effect of depression on PA readiness (physical limitation and psychological readiness) and self‐reported PA in patients with HF. Methods and results In this cross‐sectional study, 163 New York Heart Association Class I and II HF patients, during their clinic visit, reported on their physical limitation (PAR‐Q) and psychological readiness [self‐efficacy (ESES) and motivation (RM 4‐FM)] for PA, depression (HADS‐D), and PA (s‐IPAQ). Mediation analysis was performed to test the mediating effect of depression on PA readiness (physical limitation and psychological readiness) and self‐reported PA following the steps described by Baron and Kenny (1986). Hierarchical regression models were tested for their effects. The Self‐Efficacy Theory and Self‐Determination theory provided the theoretical platform for the study. Depression completely mediated the effect of physical limitation (βdep = 268.57; P < 0.0001) and partially mediated the effect of self‐efficacy on PA (βdep = 344.16; P < 0.0001). Both intrinsic (P < .0001) and extrinsic motivation (P < .0001) for PA had an independent and significant effect on PA, not mediated by depression. Conclusions Patients with HF should be screened for depression throughout the trajectory of the disease as it can impact their physical and psychological readiness to perform PA.
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Affiliation(s)
- Pallav Deka
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Luis Almenar
- Heart Failure and Transplants Unit, Department of Cardiology, Universitary and Politecnic La Fe Hospital, Valencia, Spain.,CIBERCV, University of Valencia, Valencia, Spain
| | - Dola Pathak
- Department of Statistics and Probability, Michigan State University, East Lansing, MI, USA
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Raquel López-Vilella
- Heart Failure and Transplants Unit, Department of Cardiology, Universitary and Politecnic La Fe Hospital, Valencia, Spain
| | - Elena Marques-Sule
- Heart Failure and Transplants Unit, Department of Cardiology, Universitary and Politecnic La Fe Hospital, Valencia, Spain.,Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
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28
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Negassa A, Ahmed S, Zolty R, Patel SR. Prediction Model Using Machine Learning for Mortality in Patients with Heart Failure. Am J Cardiol 2021; 153:86-93. [PMID: 34246419 DOI: 10.1016/j.amjcard.2021.05.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 01/03/2023]
Abstract
Heart Failure (HF) is a major cause of morbidity and mortality in the US. With aging of the US population, the public health burden of HF is enormous. We aimed to develop an ensemble prediction model for 30-day mortality after discharge using machine learning. Using an electronic medical records (EMR) database, all patients with a non-elective HF admission over 10 years (January 2001 - December 2010) within the Montefiore Medical Center (MMC) health system, in the Bronx, New York, were included. We developed an ensemble model for 30-day mortality after discharge and employed discrimination, range of prediction, Brier index and explained variance as metrics in assessing model performance. A total of 7,516 patients were included. The discrimination achieved by the ensemble model was higher 0.83 (95% CI: 0.80 to 0.87) compared to the benchmark model 0.79 (95% CI: 0.75 to 0.84). The ensemble model also exhibited a better range of prediction as well as a favorable profile with respect to the other metrics employed. In conclusion, an ensemble machine learning approach exhibited an improvement in performance compared to the benchmark logistic model in predicting all-cause mortality among HF patients within 30-days of discharge. Machine learning is a promising alternative approach for risk profiling of HF patients, and it enhances individualized patient management.
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Kazemi Majd F, Gavgani VZ, Golmohammadi A, Jafari-Khounigh A. Effect of physician prescribed information on hospital readmission and death after discharge among patients with health failure: A randomized controlled trial. Health Informatics J 2021; 27:1460458221996409. [PMID: 33657912 DOI: 10.1177/1460458221996409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In order to understand if a physician prescribed medical information changes, the number of hospital readmission, and death among the heart failure patients. A 12-month randomized controlled trial was conducted (December 2013-2014). Totally, 120 patients were randomly allocated into two groups of intervention (n = 60) and control (n = 60). Accordingly, the control group was given the routine oral information by the nurse or physician, and the intervention group received the Information Prescription (IP) prescribed by the physician as well as the routine oral information. The data was collected via telephone interviews with the follow-up intervals of 6 and 12 months, and also for 1 year after the discharge. The patients with the median age of (IQR) 69.5 years old (19.8) death upon adjusting a Cox survival model, [RR = 0.67, 95%CI: 0.46-0.97]. Few patients died during 1 year in the intervention group compared to the controls (7 vs 15) [RR = 0.47, 95%CI: 0.20-1.06]. During a period of 6-month follow-up there was not statistically significant on death and readmission between two groups. Physician prescribed information was clinically and statistically effective on the reduction of death and hospital readmission rates among the HF patients in long term follow-up.
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Huang X, Liu J, Hu S, Zhang L, Miao F, Tian A, Li J. Systolic blood pressure at admission and long-term clinical outcomes in patients hospitalized for heart failure. ESC Heart Fail 2021; 8:4007-4017. [PMID: 34374229 PMCID: PMC8497357 DOI: 10.1002/ehf2.13521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/03/2021] [Accepted: 07/05/2021] [Indexed: 12/28/2022] Open
Abstract
Aims The study sought to investigate the association between admission systolic blood pressure (SBP) and 1‐year clinical outcomes in patients hospitalized for heart failure (HF) and in subgroups. Methods This study was based on the China Patient‐centred Evaluative Assessment of Cardiac Events Prospective Heart Failure Study, which prospectively enrolled patients hospitalized for HF in 52 hospitals from 20 provinces in China between August 2016 and May 2018. Patients were divided into four groups according to the quartiles of SBP at admission. The multivariable Cox proportional hazards regression models were fitted to examine the association between admission SBP and all‐cause death and HF readmission within 1 year after the index hospitalization. Restricted cubic splines were used to explore the non‐linear association between SBP and the clinical outcomes. Results Among 4896 patients, those with lower admission SBP were younger, more likely to be male, have left ventricular ejection fraction <40%, and receive β‐blockers, aldosterone antagonists, and diuretics. After adjustment for potential confounders, lower admission SBP was significantly associated with higher all‐cause death and there is no threshold, while we only observed such an association with HF readmission when admission SBP was lower than 120 mmHg. Compared with the 4th SBP quartile, patients in the 1st SBP quartile had higher risk of all‐cause death (hazard ratio, 1.85; 95% confidence interval 1.48–2.33; P < 0.001) and HF readmission (hazard ratio, 1.40; 95% confidence interval 1.19–1.65, P < 0.001). These associations were consistent in most subgroups, such as age, sex, and left ventricular ejection fraction. Conclusions In patients hospitalized for HF, lower admission SBP portends an increased risk of 1 year all‐cause death and HF readmission, and these associations were consistent among subgroups.
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Affiliation(s)
- Xinghe Huang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Jiamin Liu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Shuang Hu
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Lihua Zhang
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Fengyu Miao
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Aoxi Tian
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Jing Li
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China.,Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
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Cavalcante VN, Cavalcanti ACD, Tinoco JDMVP, Figueiredo LDS, Mesquita ET. Effectiveness of Mindfulness Meditation Programs in the Promotion of Quality of Life in Patients with Heart Failure: A Systematic Review. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Polsook R, Aungsuroch Y. A cross-sectional study of factors predicting readmission in Thais with coronary artery disease. J Res Nurs 2021; 26:293-304. [PMID: 35251254 PMCID: PMC8894994 DOI: 10.1177/1744987120946792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Coronary artery disease is a major cause of morbidity and mortality with high readmission rates. Hospital readmissions for coronary artery disease contribute to rising healthcare costs and are a marker of quality of care. Despite this, prior studies have found that readmission rates vary widely. AIMS This study aims to determine the impact of social support, depression, comorbidities, symptom severity, quality of life and readmission among coronary artery disease patients in Thailand. METHODS A total of 321 coronary artery disease patients from tertiary care hospitals across all regions of Thailand were recruited for this study. Data were analysed using multiple regression analysis. RESULTS The coefficient for social support (beta = -0.22) was found to be significant (p < 0.05), whereas comorbidity, symptom severity, depression and quality of life were not significant. Thus, social support was found to be the most significant predictive factor for readmission. CONCLUSIONS Accordingly, when designing effective nursing interventions, nurses should promote social support interventions for coronary artery disease patients to improve the quality of care, decrease readmission rates and improve patients' quality of life.
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Affiliation(s)
- Rapin Polsook
- Rapin Polsook, Faculty of Nursing, Chulalongkorn University, Floor 11, Boromarajonani Srisatapat Building, Rama 1 Road, Patumwan, Bangkok 10330, Thailand.
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Aronson D. Environmental factors, winter respiratory infections and the seasonal variation in heart failure admissions. Sci Rep 2021; 11:11292. [PMID: 34050240 PMCID: PMC8163784 DOI: 10.1038/s41598-021-90790-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/18/2021] [Indexed: 12/02/2022] Open
Abstract
Seasonal cycles of AHF are causally attributed to the seasonal pattern of respiratory tract infections. However, this assumption has never been formally validated. We aimed to determine whether the increase in winter admissions for acute heart failure (AHF) can be explained by seasonal infectious diseases. We studied 12,147 patients admitted for AHF over a period of 11 years (2005–2015). Detailed virology and bacteriology data were collected on each patient. Meteorological information including daily temperature and relative humidity was obtained for the same period. The peak-to-low ratio, indicating the intensity of seasonality, was calculated using negative binomial regression-derived incidence rate ratios (IRR). AHF admissions occurred with a striking annual periodicity, peaking in winter (December-February) and were lowest in summer (June–August), with a seasonal amplitude (January vs. August) of 2.00 ([95% CI 1.79–2.24]. Occurrence of confirmed influenza infections was low (1.59%). Clinical diagnoses of respiratory infections, confirmed influenza infections, and influenza-like infections also followed a strong seasonal pattern (P < 0.0001; Peak/low ratio 2.42 [95% CI 1.394–3.03]). However, after exclusion of all respiratory infections, the seasonal variation in AHF remained robust (Peak/low ratio January vs. August, 1.81 [95% CI 1.60–2.05]; P < 0.0001). There was a strong inverse association between AHF admissions and average monthly temperature (IRR 0.95 per 1℃ increase; 95% CI 0.94 to 0.96). In conclusion, these is a dominant seasonal modulation of AHF admissions which is only partly explained by the incidence of winter respiratory infections. Environmental factors modify the susceptibility of heart failure patients to decompensation.
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Affiliation(s)
- Doron Aronson
- Department of Cardiology, Rambam Medical Center, POB 9602, 31096, Haifa, Israel. .,B. Rappaport Faculty of Medicine, Technion Medical School, Haifa, Israel.
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Heo S, Moser DK, Lennie TA, Kim J, Turrise S, Troyan PJ, Kang J, Jones HJ. Self-care strategies and interventions needed in patients with heart failure: from patient perspectives-a qualitative study. Eur J Cardiovasc Nurs 2021; 20:540-546. [PMID: 34008023 DOI: 10.1093/eurjcn/zvaa033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/29/2020] [Accepted: 12/11/2020] [Indexed: 11/13/2022]
Abstract
AIMS Most patients with heart failure (HF) have symptoms. Poor self-care has been associated with the development or worsening symptoms. Thus, to improve HF symptoms, it may be critical to understand self-care and interventions targeting improvements in HF symptoms needed from patients' perspectives. To explore patients' perceptions of self-care strategies of individual symptoms, HF symptom improvement, and interventions needed to improve HF symptoms in patients with HF. METHODS AND RESULTS Qualitative data were collected from 20 patients with HF using a semi-structured open-ended interview guide. Data were analysed using content analysis. Five themes appeared: (i) use of a variety of strategies with some knowledge deficit and inefficiency, (ii) uncertainty in symptom improvement, (iii) consideration of several possible self-care strategies, (iv) use of situation-specific strategies in seeking treatment, and (v) willingness to receive comprehensive and realistic interventions. Patients used a variety of self-care strategies, including taking medication, reducing activities, and changing diet and position, but many reported having a lack of knowledge and multiple HF symptoms. Several patients were uncertain whether symptoms could be improved, but all patients reported that they would participate in comprehensive and realistic intervention sessions to gain knowledge about their symptoms and management strategies, and to receive emotional support from healthcare providers and peer patients. CONCLUSION Patients with HF used several self-care strategies with the hope of symptom improvements but were uncertain about the effectiveness. More effective, comprehensive, and realistic interventions need to be delivered to patients with HF to enhance their ability to manage their symptoms.
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Affiliation(s)
- Seongkum Heo
- Mercer University, Georgia Baptist College of Nursing, 3001 Mercer University Drive, Atlanta, GA 30341, USA
| | - Debra K Moser
- University of Kentucky, College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Terry A Lennie
- University of Kentucky, College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - JinShil Kim
- Gachon University, 191 Hambakmeoro, Yeonsu-gu, Incheon 21936, South Korea
| | - Stephanie Turrise
- University of North Carolina, Wilmington, School of Nursing, 601 S. College Road, Wilmington, NC 28403, USA
| | - Pattie J Troyan
- Mercer University, Georgia Baptist College of Nursing, 3001 Mercer University Drive, Atlanta, GA 30341, USA
| | - JungHee Kang
- University of Kentucky, College of Nursing, 2201 Regency Rd, Suite, 403, Lexington, KY 40503, USA
| | - Holly J Jones
- University of Cincinnati, College of Nursing, P.O. Box 210038, Cincinnati, OH 45221-0038, USA
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Directly Measured Adherence to Treatment in Chronic Heart Failure: LEVEL-CHF Registry. Am J Med Sci 2021; 361:491-498. [PMID: 33781390 DOI: 10.1016/j.amjms.2020.12.004] [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: 04/10/2020] [Revised: 11/08/2020] [Accepted: 12/04/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Currently, most available data on the medication adherence of patients with chronic heart failure are based on indirect methods. We examined the level of adherence to medical therapy using a direct method - serum drug level testing. METHODS We carried out a prospective single-centre registry of patients with chronic heart failure (LEVEL-CHF registry), in whom we analysed serum levels of the medications prescribed for the treatment of heart failure: angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists. We labelled a patient as non-adherent if at least one serum level of a prescribed drug was unmeasurable (below the detection limit). Patients with all tested drugs identifiable in serum were labelled as adherent. We enrolled 274 patients (208 men and 66 women) mean age 62 years. RESULTS 82.5% of patients were adherent and 17.5% non-adherent to prescribed medications. 3.6% were completely non-adherent without any detectable drugs in serum. Patients aged <60 years were more likely to be non-adherent than older patients (OR 2.15). No other clinical or laboratory parameters predicted non-adherence. CONCLUSIONS A significant proportion of outpatients with chronic heart failure were non-adherent to treatment when assessed by a direct method of serum drug level testing. Non-adherence was more likely in younger patients.
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Polsook R, Aungsuroch Y. Factors influencing readmission among Thais with myocardial infarction. BELITUNG NURSING JOURNAL 2021; 7:15-23. [PMID: 37469799 PMCID: PMC10353658 DOI: 10.33546/bnj.1234] [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: 10/27/2020] [Revised: 11/11/2020] [Accepted: 01/07/2021] [Indexed: 07/21/2023] Open
Abstract
Background Readmission among patients with myocardial infarction is costly, and it has become a marker of quality of care. Therefore, factors related to readmission warrant examination. Objective This study aimed at examining factors influencing readmission in Thai with myocardial infarction. Methods This was a cross-sectional study with 200 participants randomly selected from five regional hospitals in Thailand. All research tools used indicated acceptable validity and reliability. Linear Structural Relationship version 8.72 was used for the data analysis. Results The findings showed that the hypothesized model with social support, depression, symptom severity, comorbidity, and quality of life could explain 4% (R2 = 0.04) of the variance in readmission (χ2 = 1.39, df = 2, p < 0.50, χ2/df = 0.69, GIF = 1.00, RMSEA = 0.00, SRMR = 0.01, and AGFI = 0.98). Symptom severity was the most influential factor that had a positive and direct effect on the readmission rate (0.06, p < 0.05). Conclusion These findings serve as an input to decrease readmission in patients with myocardial infarction by reducing the symptom severity and comorbidity and promoting a better quality of life.
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Affiliation(s)
- Rapin Polsook
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
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Zhang Z, Bai J, Huang Y. The efficacy of a nursing care and follow-up program for patients with heart failure: Study protocol for a randomized controlled trial. Medicine (Baltimore) 2020; 99:e23380. [PMID: 33285722 PMCID: PMC7717929 DOI: 10.1097/md.0000000000023380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/28/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Heart failure (HF) is one of the primary causes of the increasing public health costs, incidence rate and mortality of heart disease. As treatment options for the HF have evolved, people have a better understanding of overall burden of HF, resulting a more centralized method for the treatment of these patients with chronic diseases. At present, with the rapid progress of medical technology, the nursing mode must be updated accordingly. The objective of this trial is to investigate the effects of the program of nursing care and follow-up on life quality, self-care, and the rehospitalization of patients with HF. METHOD This is a randomized controlled study to be carried out from November 2020 to March 2021 and was granted through the Ethics Committee of Changshan County People's Hospital (CCPH002376). The patients meet the following criteria will be included: the age of the patients is 18 years and above, and the functional classification is NYHA II or NYHA III. The patients with the following criteria will be excluded: patients who have received the by-pass surgery in the last 6 months; cancer patients are given radiotherapy or chemotherapy; patients with severe renal failure requiring dialysis; patients with chronic obstructive pulmonary disease who need ventilation; and patients with hearing or visual impairment. In our experiment, patient information scale, the life quality scale (The Left Ventricular Dysfunction Scale) and Self-Care of HF Index are utilized for the assessment. All the analyses are implemented with SPSS for Windows Version 20.0. RESULTS Impact of experimental programs on outcomes will be illustrated in the Table. CONCLUSION We hypothesize that the nursing care conducted for the HF patients may improve the life quality and self-care. TRIAL REGISTRATION NUMBER researchregistry 6129.
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Affiliation(s)
| | | | - Yongmei Huang
- Department of Nursing, Changshan County People's Hospital, Zhejiang, China
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Balderston JR, Sternberg ME, Joyce JM, Evans DP, Gertz ZM. Focused Cardiac Ultrasound in Dyspnea of Unclear Etiology in the Emergency Department: Utility of the FLUID Score. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2211-2217. [PMID: 32395861 DOI: 10.1002/jum.15332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES We evaluated the utility of focused cardiac ultrasound to predict the length of stay in patients presenting to the emergency department with dyspnea of unclear etiology. METHODS Patients with focused cardiac ultrasound examinations performed in the emergency department for dyspnea over a 34-month period were retrospectively identified. Patients were excluded if they had a prior diagnosis of heart failure, dialysis requirement, or an etiology of dyspnea unrelated to the volume status. Left ventricular function was categorized as normal or reduced, and the inferior vena cava was categorized as normal or increased volume. A fast limited ultrasound to investigate dyspnea (FLUID) score was calculated by adding 1 point for reduced left ventricular function and 1 point for increased volume, producing a score of 0, 1, or 2. RESULTS There were 123 patients included. There was a significant correlation between the FLUID score and length of stay, with longer stays for higher scores (FLUID score 0, 7.4 hours median; FLUID score 1, 2.34 days; FLUID score 2, 5.56 days; analysis of variance P < .001). Of the other variables collected, only age, hypertension, diabetes, heart rate, and brain natriuretic peptide were significantly correlated with the length of stay. A multivariate analysis including those variables and the FLUID score showed that the FLUID score was the strongest independent predictor of the length of stay. CONCLUSIONS Focused cardiac ultrasound and calculation of a FLUID score for patients with undifferentiated dyspnea can be a powerful tool to predict the hospital length of stay.
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Affiliation(s)
- Jessica R Balderston
- Departments of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Michael E Sternberg
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - J Michael Joyce
- Departments of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - David P Evans
- Departments of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Zachary M Gertz
- Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia, USA
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Boodoo C, Zhang Q, Ross HJ, Alba AC, Laporte A, Seto E. Evaluation of a Heart Failure Telemonitoring Program Through a Microsimulation Model: Cost-Utility Analysis. J Med Internet Res 2020; 22:e18917. [PMID: 33021485 PMCID: PMC7576467 DOI: 10.2196/18917] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a major public health issue in Canada that is associated with high prevalence, morbidity, and mortality rates and high financial and social burdens. Telemonitoring (TM) has been shown to improve all-cause mortality and hospitalization rates in patients with HF. The Medly program is a TM intervention integrated as standard of care at a large Canadian academic hospital for ambulatory patients with HF that has been found to improve patient outcomes. However, the cost-effectiveness of the Medly program is yet to be determined. OBJECTIVE This study aims to conduct a cost-utility analysis of the Medly program compared with the standard of care for HF in Ontario, Canada, from the perspective of the public health care payer. METHODS Using a microsimulation model, individual patient data were simulated over a 25-year time horizon to compare the costs and quality-adjusted life years (QALYs) between the Medly program and standard care for patients with HF treated in the ambulatory care setting. Data were sourced from a Medly Program Evaluation study and literature to inform model parameters, such as Medly's effectiveness in reducing mortality and hospitalizations, health care and intervention costs, and model transition probabilities. Scenario analyses were conducted in relation to HF severity and TM deployment models. One-way deterministic effectiveness analysis and probabilistic sensitivity analysis were performed to explore the impact on the results of uncertainty in model parameters. RESULTS The Medly program was associated with an average total cost of Can $102,508 (US $77,626) per patient and total QALYs of 5.51 per patient compared with the average cost of Can $97,497 (US $73,831) and QALYs of 4.95 per patient in the Standard Care Group. This led to an incremental cost of Can $5011 (US $3794) and incremental QALY of 0.566, resulting in an incremental cost-effectiveness ratio of Can $8850 (US $6701)/QALY. Cost-effectiveness improved in relation to patients with advanced HF and with deployment models in which patients used their own equipment. Baseline and alternative scenarios consistently showed probabilities of cost-effectiveness greater than 85% at a willingness-to-pay threshold of Can $50,000 (US $37,718). Although the results showed some sensitivity to assumptions about effectiveness parameters, the intervention was found to remain cost-effective. CONCLUSIONS The Medly program for patients with HF is cost-effective compared with standard care using commonly reported willingness-to-pay thresholds. This study provides evidence for decision makers on the use of TM for HF, supports the use of a nurse-led model of TM that embeds clinically validated algorithms, and informs the use of economic modeling for future evaluations of early-stage health informatics technology.
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Affiliation(s)
- Chris Boodoo
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Qi Zhang
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Heather J Ross
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Ana Carolina Alba
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Canadian Centre for Health Economics, Toronto, ON, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
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Cox ZL, Fleming J, Ivey-Miranda J, Griffin M, Mahoney D, Jackson K, Hodson DZ, Thomas D, Gomez N, Rao VS, Testani JM. Mechanisms of Diuretic Resistance Study: design and rationale. ESC Heart Fail 2020; 7:4458-4464. [PMID: 32893505 PMCID: PMC7754741 DOI: 10.1002/ehf2.12949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/08/2020] [Accepted: 07/14/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Diuretic resistance is a common complication impairing decongestion during hospitalization for acute decompensated heart failure (ADHF). The current understanding of diuretic resistance mechanisms in ADHF is based upon extrapolations from other disease states and healthy volunteers. However, accumulating evidence suggests that the dominant mechanisms in other populations have limited influence on diuretic response in ADHF. Additionally, the ability to rapidly and reliably diagnose diuretic resistance is inadequate using currently available tools. AIMS The Mechanisms of Diuretic Resistance (MDR) Study is designed to rigorously investigate the mechanisms of diuretic resistance and develop tools to rapidly predict diuretic response in a prospective cohort hospitalized with ADHF. METHODS Study assessments occur serially during the ADHF hospitalization and after discharge. Each assessment includes a supervised 6-hour urine collection with baseline blood and timed spot urine collections following loop diuretic administration. Patient characteristics, medications, physical exam findings, and both in-hospital and post-discharge HF outcomes are collected. Patients with diuretic resistance are eligible for a randomized sub-study comparing an increased loop diuretic dose with combination diuretic therapy of loop diuretic plus chlorothiazide. CONCLUSIONS The Mechanisms of Diuretic Resistance Study will establish a prospective patient cohort and biorepository to investigate the mechanisms of diuretic resistance and urine biomarkers to rapidly predict loop diuretic resistance.
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Affiliation(s)
- Zachary L Cox
- Department of Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, TN, USA.,Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James Fleming
- Yale University School of Medicine, New Haven, CT, USA
| | - Juan Ivey-Miranda
- Yale University School of Medicine, New Haven, CT, USA.,Hospital de Cardiologia, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Devin Mahoney
- Yale University School of Medicine, New Haven, CT, USA
| | | | | | - Daniel Thomas
- Yale University School of Medicine, New Haven, CT, USA
| | - Nicole Gomez
- Yale University School of Medicine, New Haven, CT, USA
| | - Veena S Rao
- Yale University School of Medicine, New Haven, CT, USA
| | - Jeffrey M Testani
- Yale University School of Medicine, New Haven, CT, USA.,Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
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Haukilahti MAE, Kenttä TV, Tikkanen JT, Anttonen O, Aro AL, Kerola T, Rissanen H, Knekt P, Junttila MJ, Huikuri HV. Electrocardiographic Risk Markers for Heart Failure in Women Versus Men. Am J Cardiol 2020; 130:70-77. [PMID: 32684284 DOI: 10.1016/j.amjcard.2020.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
Heart failure (HF) is one of the leading causes of hospitalization in the Western world. Women have a lower HF hospitalization rate and mortality compared with men. The role of electrocardiography as a risk marker of future HF in women is not well known. We studied association of electrocardiographic (ECG) risk factors for HF hospitalization in women from a large middle-aged general population with a long-term follow-up and compared the risk profile to men. Standard 12-lead ECG markers were analyzed from 10,864 subjects (49% women), and their predictive value for HF hospitalization was analyzed. During the follow-up (30 ± 11 years), a total of 1,743 subjects had HF hospitalization; of these, 861 were women (49%). Several baseline characteristics, such as age, body mass index, blood pressure, and history of previous cardiac disease predicted the occurrence of HF both in women and men (p <0.001 for all). After adjusting for baseline variables, ECG sign of left ventricular hypertrophy (LVH) (p <0.001), and atrial fibrillation (p <0.001) were the only baseline ECG variables that predicted future HF in women. In men, HF was predicted by fast heart rate (p = 0.008), T wave inversions (p <0.001), abnormal Q-waves (p = 0.002), and atrial fibrillation (p <0.001). Statistically significant gender interactions in prediction of HF were observed in ECG sign of LVH, inferolateral T wave inversions, and heart rate. In conclusion, ECG sign of LVH predicts future HF in middle-aged women, and T wave inversions and elevated heart rate are associated with HF hospitalization in men.
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Schjødt I, Liljeroos M, Larsen P, Johnsen SP, Strömberg A, Løgstrup BB. Risk factors for hospital readmission in adult patients with heart failure with reduced ejection fraction: a systematic review. JBI Evid Synth 2020; 18:1641-1700. [PMID: 32898362 DOI: 10.11124/jbisrir-d-19-00203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review was to identify and synthesize evidence on risk factors associated with hospital readmission within the first year after heart failure hospitalization among patients with heart failure with reduced left ventricular ejection fraction. INTRODUCTION Heart failure is associated with a high risk of hospital readmission. Readmissions are associated with higher mortality and health care costs. It is a high health care priority to identify vulnerable patients with heart failure who may potentially benefit from targeted personalized care interventions aiming to reduce readmissions. INCLUSION CRITERIA This review considered studies including adult patients who had heart failure with a reduced left ventricular ejection fraction ≤ 40% who were discharged after a heart failure hospitalization. The authors included studies with experimental and observational designs evaluating risk factors for i) all-cause hospital readmission, ii) heart failure hospital readmission, and iii) composite outcomes within seven, 15, 30, 60, 90, 180, and 365 days after hospital discharge. Composite outcomes included end points where all-cause readmission and/or heart failure readmission were part of a defined end point (i.e. all-cause readmission or mortality; heart failure readmission or mortality; cardiovascular readmission; cardiovascular readmission or mortality; and readmission, mortality, or cardiac transplant). Studies reporting all-cause readmission and/or heart failure readmission as a primary outcome, secondary outcome, or part of a composite outcome were included. METHODS PubMed, Embase, CINAHL, Cochrane CENTRAL, PsycINFO, OpenGrey, MedNar, DART-Europe, ProQuest Dissertations and Theses, and the Grey Literature Report in Public Health were searched to find both published and unpublished studies in English, Swedish, Norwegian, or Danish from 2000 to June 2018. Study selection, critical appraisal, data extraction, and data synthesis followed the JBI approach for systematic reviews. Statistical pooling was not possible due to clinical and methodological heterogeneity of the studies included and the lack of risk factors reported more than once. A narrative summary of the findings was performed. RESULTS Fifty-two studies, including one randomized controlled trial and 51 cohort studies with a total of 128,186 participants, were included. Risk factors for readmission were reported for 30-day outcome in 16 studies, 60-day in three studies, 90-day in 15 studies, 180-day in 12 studies, and 365-day outcome in 15 studies. Based on multivariable analyses from 43 cohort studies and results from one randomized controlled trial, the authors identified several factors associated with higher risk of all-cause readmission, heart failure readmission, and composite outcomes (e.g. readmission or death) within 30, 60, 90, 180, and 365 days after discharge for a heart failure hospitalization. CONCLUSIONS This review provides a comprehensive overview of factors associated with a clinical outcome after a heart failure hospitalization in patients with heart failure with left ventricular ejection fraction ≤ 40%. Owing to the heterogeneity of variables investigated and the lack of comparability of findings, the clinical impact of the identified risk factors remains uncertain. This review highlights research gaps and the need for a standardized way to define and measure all-cause readmission, heart failure readmission, and composite end points in clinical research to improve study quality and enable comparison of findings between studies.
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Affiliation(s)
- Inge Schjødt
- 1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark 2Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden 3Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden 4Health Sciences Research Center, University College Lillebælt, Odense, Denmark 5Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark 6Department of Cardiology, Linköping University Hospital, Linköping, Sweden 7Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Sadeq A, Sadeq A, Sadeq A, Alkhidir IY, Aburuz S, Mellal AA, Al Najjar MS, Elnour AA. Risk factors for hospital readmission of patients with heart failure: A cohort study. J Pharm Bioallied Sci 2020; 12:335-343. [PMID: 33100794 PMCID: PMC7574751 DOI: 10.4103/jpbs.jpbs_323_20] [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: 05/13/2020] [Revised: 05/16/2020] [Accepted: 05/30/2020] [Indexed: 11/25/2022] Open
Abstract
Aim: The aim of this study was to develop a risk factor model for hospital readmission in patients with heart failure. Background: Identification of risk factors and predictors of readmission to hospital in patients with heart failure is very crucial for improved clinical outcomes. Objective: The objective of the current study was to investigate and delineate the risk factors that may be implicated in putting a patient at greater risk of readmission due to uncontrolled heart failure. Materials and Methods: This is a prospective follow-up cohort study of 170 patients with heart failure at a tertiary hospital in Al Ain city in the United Arab Emirates. We have developed a risk factor model based on the recommendations of validated published data. We have used univariate and multivariate logistic regression analyses on structured steps based on the published data. The main outcome was the risk factors for readmission to hospital due to heart failure. Results: A final predictive model (10 variables) was produced for unplanned readmission of patients with heart failure. The risk factors identified in the final model with their odds ratios (ORs) and confidence intervals (CIs) were as follows: four or more prescribed medicines (OR = 4.13; CI = 3.5–4.1; P = 0.003), more than twice daily dosing regimen (OR = 2.34; CI = 1.0–5.0; P = 0.023), poor knowledge of prescribed medications (OR = 4.24; CI = 1.213–14.781; P = 0.006), diabetes mellitus (OR = 3.78; CI = 1.6–8.7; P = 0.006), edema (OR = 2.64; CI = 1.2–5.6; P = 0.011), being house bound (OR = 2.77; CI = 1.2–6.2; P = 0.014), and being prescribed diuretics (OR = 3.69; CI = 1.4–9.2; P = 0.042). Conclusion: The specificity of the developed risk prediction model was 82.2%, the sensitivity was 74.3%, and the overall accuracy was 72.9%. The model can be emulated in population with similar characteristics to prevent early readmission of patient with heart failure.
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Affiliation(s)
- Adel Sadeq
- Clinical Pharmacy Program, College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates
| | - Ahmed Sadeq
- Shaikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates
| | - Asil Sadeq
- Pharmacy Practice, College of Pharmacy, Trinity University, Dublin, Republic of Ireland
| | - Israa Yousif Alkhidir
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Omdurman Islamic University, Khartoum, Sudan
| | - Salahedin Aburuz
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Abdullah Abu Mellal
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Munther S Al Najjar
- Clinical Pharmacy Program, College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates
| | - Asim Ahmed Elnour
- Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
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Lazareva NV, Oshchepkova EV, Orlovsky AA, Tereschenko SN. [Clinical characteristics and quality assessment of the treatment of patients with chronic heart failure with diabetes mellitus]. TERAPEVT ARKH 2020; 92:37-44. [PMID: 32598696 DOI: 10.26442/00403660.2020.04.000474] [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: 05/18/2020] [Indexed: 01/10/2023]
Abstract
AIM A study of the clinical and instrumental characteristics and quality of treatment of patients with chronic heart failure (CHF) with diabetes mellitus. MATERIALS AND METHODS The study was conducted by using the CHF register method, which is a computer program with remote access, which allows on-line data collection on patients who have been examined and treated in primary care and in hospitals. The study included 8272 patients with CHF IIIV FC (functional class) (New York Heart Association NYHA); among them 62% of patients were treated in hospital. RESULTS The study showed that the frequency of diabetes was 21%. The main causes of CHF in diabetic patients are coronary artery disease, myocardial infarction (in anamnesis) and hypertension. These patients are more often diagnosed with III and IV CHF FC according to (NYHA) and retained LV (left ventricular) ejection fraction. The reduced ejection fraction was observed in 6.8% of cases, and the frequency of the intermediate LV was significantly higher than among patients with CHF and with diabetes and accounted for 18.9%. At patients with CHF with diabetes in comparison with patients with CHF without diabetes, atherosclerosis of the peripheral arteries, stroke (in anamnesis) and chronic kidney disease of stage III and IV were significantly more common. CONCLUSION Under the treatment, patients with CHF with diabetes have higher levels of SBP (systolic blood pressure), lipids and glucose in the blood plasma, indicating a lack of quality of treatment and, accordingly, the doctors are not optimally performing the clinical guidelines on treating this category of patients.
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Kennedy R. Baseline heart failure symptoms have a direct and predictive mediator effect on health-related quality of life in patients with heart failure. Evid Based Nurs 2020; 24:ebnurs-2020-103270. [PMID: 32398267 DOI: 10.1136/ebnurs-2020-103270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Rachel Kennedy
- Coronary Care Unit, University Hospital Limerick, Limerick, Ireland
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46
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Bansal N, Zelnick L, Bhat Z, Dobre M, He J, Lash J, Jaar B, Mehta R, Raj D, Rincon-Choles H, Saunders M, Schrauben S, Weir M, Wright J, Go AS. Burden and Outcomes of Heart Failure Hospitalizations in Adults With Chronic Kidney Disease. J Am Coll Cardiol 2020; 73:2691-2700. [PMID: 31146814 DOI: 10.1016/j.jacc.2019.02.071] [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: 11/23/2018] [Revised: 02/19/2019] [Accepted: 02/26/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Data on rates of heart failure (HF) hospitalizations, recurrent hospitalizations, and outcomes related to HF hospitalizations in chronic kidney disease (CKD) are limited. OBJECTIVES This study examined rates of HF hospitalizations and re-hospitalizations within a large CKD population and evaluated the burden of HF hospitalizations with the risk of subsequent CKD progression and death. METHODS The prospective CRIC (Chronic Renal Insufficiency Cohort) study measured the estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (ACR) at baseline. The crude rates and rate ratios of HF hospitalizations and 30-day HF re-hospitalizations were calculated using Poisson regression models. Cox regression was used to assess the association of the frequency of HF hospitalizations within the first 2 years of follow-up with risk of subsequent CKD progression and death. RESULTS Among 3,791 participants, the crude rate of HF admissions was 5.8 per 100 person-years (with higher rates of HF with preserved ejection fraction vs. HF with reduced ejection fraction). The adjusted rate of HF was higher with a lower eGFR (vs. eGFR >45 ml/min/1.73 m2); the rate ratios were 1.7 and 2.2 for eGFR 30 to 44 and <30 ml/min/1.73 m2 (vs. >45 ml/min/1.73 m2), respectively. Similarly, the adjusted rates of HF hospitalization were significantly higher in those with higher urine ACR (vs. urine ACR <30 mg/g); the rate ratios were 1.9 and 2.6 for urine ACR 30 to 299 and ≥300 mg/g, respectively. Overall, 20.6% of participants had a subsequent HF re-admission within 30 days. HF hospitalization within 2 years of study entry was associated with greater adjusted risks for CKD progression (1 hospitalization: hazard ratio [HR]: 1.93; 95% confidence interval [CI]: 1.40 to 2.67; 2+ hospitalizations: HR: 2.14; 95% CI: 1.30 to 3.54) and all-cause death (1 hospitalization: HR: 2.20; 95% CI: 1.71 to 2.84; 2+ hospitalizations: HR: 3.06; 95% CI: 2.23 to 4.18). CONCLUSIONS Within a large U.S. CKD population, the rates of HF hospitalizations and re-hospitalization were high, with even higher rates across categories of lower eGFR and higher urine ACR. Patients with CKD hospitalized with HF had greater risks of CKD progression and death. HF prevention and treatment should be a public health priority to improve CKD outcomes.
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Affiliation(s)
- Nisha Bansal
- Department of Medicine, University of Washington, Seattle, Washington.
| | - Leila Zelnick
- Department of Medicine, University of Washington, Seattle, Washington
| | - Zeenat Bhat
- Department of Medicine, Wayne State University, Detroit, Michigan
| | - Mirela Dobre
- Department of Medicine, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Jiang He
- Department of Medicine, Tulane University, New Orleans, Louisiana
| | - James Lash
- Department of Medicine, Jesse Brown VAMC and University of Illinois Hospital and Health Sciences Center, Chicago, Illinois
| | - Bernard Jaar
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Rupal Mehta
- Department of Medicine, Northwestern University, Evanston, Illinois
| | - Dominic Raj
- Department of Medicine, George Washington University, Washington, DC
| | | | - Milda Saunders
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Sarah Schrauben
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Weir
- Department of Medicine, University of Maryland, College Park, Maryland
| | - Julie Wright
- Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Alan S Go
- Department of Medicine, Kaiser Permanente Northern California, Division of Research, Oakland, California; Department of Medicine, University of California-San Francisco, San Francisco, California; Department of Medicine, Stanford University School of Medicine, Palo Alto, California
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Abstract
Acute heart failure (AHF) is a syndrome defined as the new onset (de novo heart failure (HF)) or worsening (acutely decompensated heart failure (ADHF)) of symptoms and signs of HF, mostly related to systemic congestion. In the presence of an underlying structural or functional cardiac dysfunction (whether chronic in ADHF or undiagnosed in de novo HF), one or more precipitating factors can induce AHF, although sometimes de novo HF can result directly from the onset of a new cardiac dysfunction, most frequently an acute coronary syndrome. Despite leading to similar clinical presentations, the underlying cardiac disease and precipitating factors may vary greatly and, therefore, the pathophysiology of AHF is highly heterogeneous. Left ventricular diastolic or systolic dysfunction results in increased preload and afterload, which in turn lead to pulmonary congestion. Fluid retention and redistribution result in systemic congestion, eventually causing organ dysfunction due to hypoperfusion. Current treatment of AHF is mostly symptomatic, centred on decongestive drugs, at best tailored according to the initial haemodynamic status with little regard to the underlying pathophysiological particularities. As a consequence, AHF is still associated with high mortality and hospital readmission rates. There is an unmet need for increased individualization of in-hospital management, including treatments targeting the causative factors, and continuation of treatment after hospital discharge to improve long-term outcomes.
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Affiliation(s)
- Mattia Arrigo
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Mariell Jessup
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wilfried Mullens
- Ziekenhuis Oost Limburg, Genk, Belgium
- University of Hasselt, Hasselt, Belgium
| | - Nosheen Reza
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ajay M Shah
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre, London, UK
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, Department of Medicine and Cardiology, University of Cape Town, Cape Town, South Africa
| | - Alexandre Mebazaa
- Université de Paris, MASCOT, Inserm, Paris, France.
- Department of Anesthesia, Burn and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France.
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Ryan CJ, Bierle RS, Vuckovic KM. The Three Rs for Preventing Heart Failure Readmission: Review, Reassess, and Reeducate. Crit Care Nurse 2019; 39:85-93. [PMID: 30936132 DOI: 10.4037/ccn2019345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Despite improvements in heart failure therapies, hospitalization readmission rates remain high. Nationally, increasing attention has been directed toward reducing readmission rates and thus identifying patients with the highest risk for readmission. This article summarizes the evidence related to decreasing readmission for patients with heart failure within 30 days after discharge, focusing on the acute setting. Each patient requires an individualized plan for successful transition from hospital to home and preventing readmission. Nurses must review the patient's current plan of care and adherence to it and look for clues to failure of the plan that could lead to readmission to the hospital. In addition, nurses must reassess the current plan with the patient and family to ensure that the plan continues to meet the patient's needs. Finally, nurses must continually reeducate patients about their plan of care, their plan for self-management, and strategies to prevent hospital readmission for heart failure.
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Affiliation(s)
- Catherine J Ryan
- Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, and Director, Nursing Evidence Based Practice and Nursing Research, University of Illinois Hospital & Health Sciences System, Chicago. .,Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Regional Health Heart and Vascular Institute, Rapid City, South Dakota. .,Karen M. Vuckovic is an advanced practice nurse, Division of Cardiology, University of Illinois Hospital & Health Sciences System, and a clinical assistant professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago.
| | - Rebecca Schuetz Bierle
- Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, and Director, Nursing Evidence Based Practice and Nursing Research, University of Illinois Hospital & Health Sciences System, Chicago.,Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Regional Health Heart and Vascular Institute, Rapid City, South Dakota.,Karen M. Vuckovic is an advanced practice nurse, Division of Cardiology, University of Illinois Hospital & Health Sciences System, and a clinical assistant professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago
| | - Karen M Vuckovic
- Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, and Director, Nursing Evidence Based Practice and Nursing Research, University of Illinois Hospital & Health Sciences System, Chicago.,Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Regional Health Heart and Vascular Institute, Rapid City, South Dakota.,Karen M. Vuckovic is an advanced practice nurse, Division of Cardiology, University of Illinois Hospital & Health Sciences System, and a clinical assistant professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago
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Thirugnanam K, Cossette SM, Lu Q, Chowdhury SR, Harmann LM, Gupta A, Spearman AD, Sonin DL, Bordas M, Kumar SN, Pan AY, Simpson PM, Strande JL, Bishop E, Zou M, Ramchandran R. Cardiomyocyte-Specific Snrk Prevents Inflammation in the Heart. J Am Heart Assoc 2019; 8:e012792. [PMID: 31718444 PMCID: PMC6915262 DOI: 10.1161/jaha.119.012792] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/15/2019] [Indexed: 01/06/2023]
Abstract
Background The SNRK (sucrose-nonfermenting-related kinase) enzyme is critical for cardiac function. However, the underlying cause for heart failure observed in Snrk cardiac conditional knockout mouse is unknown. Methods and Results Previously, 6-month adult mice knocked out for Snrk in cardiomyocytes (CMs) displayed left ventricular dysfunction. Here, 4-month adult mice, on angiotensin II (Ang II) infusion, show rapid decline in cardiac systolic function, which leads to heart failure and death in 2 weeks. These mice showed increased expression of nuclear factor κ light chain enhancer of activated B cells (NF-κB), inflammatory signaling proteins, proinflammatory proteins in the heart, and fibrosis. Interestingly, under Ang II infusion, mice knocked out for Snrk in endothelial cells did not show significant systolic or diastolic dysfunction. Although an NF-κB inflammation signaling pathway was increased in Snrk knockout endothelial cells, this did not lead to fibrosis or mortality. In hearts of adult mice knocked out for Snrk in CMs, we also observed NF-κB pathway activation in CMs, and an increased presence of Mac2+ macrophages was observed in basal and Ang II-infused states. In vitro analysis of Snrk knockdown HL-1 CMs revealed similar upregulation of the NF-κB signaling proteins and proinflammatory proteins that was exacerbated on Ang II treatment. The Ang II-induced NF-κB pathway-mediated proinflammatory effects were mediated in part through protein kinase B or AKT, wherein AKT inhibition restored the proinflammatory signaling protein levels to baseline in Snrk knockdown HL-1 CMs. Conclusions During heart failure, SNRK acts as a cardiomyocyte-specific repressor of cardiac inflammation and fibrosis.
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Affiliation(s)
- Karthikeyan Thirugnanam
- Division of NeonatologyDepartment of PediatricsDevelopmental Vascular Biology Program, Children's Research InstituteMedical College of WisconsinMilwaukeeWI
| | - Stephanie M. Cossette
- Division of NeonatologyDepartment of PediatricsDevelopmental Vascular Biology Program, Children's Research InstituteMedical College of WisconsinMilwaukeeWI
| | - Qiulun Lu
- Center for Molecular and Translational MedicineGeorgia State UniversityAtlantaGA
| | - Shreya R. Chowdhury
- Obstetrics and GynecologyDevelopmental Vascular Biology Program, Children's Research InstituteMedical College of WisconsinMilwaukeeWI
| | - Leanne M. Harmann
- Division of Cardiovascular MedicineDepartment of Cell Biology, Neurobiology and AnatomyCardiovascular CenterClinical and Translational Science InstituteMedical College of WisconsinMilwaukeeWI
| | - Ankan Gupta
- Division of NeonatologyDepartment of PediatricsDevelopmental Vascular Biology Program, Children's Research InstituteMedical College of WisconsinMilwaukeeWI
| | - Andrew D. Spearman
- Division of Cardiology, Department of Pediatrics,
Developmental Vascular Biology Program, Children's Research InstituteMedical College of WisconsinMilwaukeeWI
| | - Dmitry L. Sonin
- Almazov National Medical Research CentreSt.‐PetersburgRussia
| | - Michelle Bordas
- Division of NeonatologyDepartment of PediatricsDevelopmental Vascular Biology Program, Children's Research InstituteMedical College of WisconsinMilwaukeeWI
| | - Suresh N. Kumar
- Division of Pediatric PathologyDepartment of PathologyMedical College of WisconsinMilwaukeeWI
| | - Amy Y. Pan
- Quantitative Health SciencesDepartment of PediatricsMedical College of WisconsinMilwaukeeWI
| | - Pippa M. Simpson
- Quantitative Health SciencesDepartment of PediatricsMedical College of WisconsinMilwaukeeWI
| | - Jennifer L. Strande
- Division of Cardiovascular MedicineDepartment of Cell Biology, Neurobiology and AnatomyCardiovascular CenterClinical and Translational Science InstituteMedical College of WisconsinMilwaukeeWI
| | - Erin Bishop
- Obstetrics and GynecologyDevelopmental Vascular Biology Program, Children's Research InstituteMedical College of WisconsinMilwaukeeWI
| | - Ming‐Hui Zou
- Center for Molecular and Translational MedicineGeorgia State UniversityAtlantaGA
| | - Ramani Ramchandran
- Division of NeonatologyDepartment of PediatricsDevelopmental Vascular Biology Program, Children's Research InstituteMedical College of WisconsinMilwaukeeWI
- Obstetrics and GynecologyDevelopmental Vascular Biology Program, Children's Research InstituteMedical College of WisconsinMilwaukeeWI
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50
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Tian J, Yan J, Zhang Q, Yang H, Chen X, Han Q, Han R, Ren J, Zhang Y, Han Q. Analysis Of Re-Hospitalizations For Patients With Heart Failure Caused By Coronary Heart Disease: Data Of First Event And Recurrent Event. Ther Clin Risk Manag 2019; 15:1333-1341. [PMID: 31814728 PMCID: PMC6861516 DOI: 10.2147/tcrm.s218694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 10/24/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The re-hospitalization rate of patients with heart failure remains at a high level, and studies of the subject have focused mainly on event-time outcomes. In addition to using re-hospitalization data with the outcomes of the event-time-count, this study introduces the conditional frailty model, which could help obtain more reasonable results. MATERIALS AND METHODS This prospective observational cohort study enrolled 1484 patients with heart failure caused by coronary heart disease. The outcomes of heart failure readmissions and the case report form data were collected. Based on the traditional Cox model with event-time outcomes, the mixed effects of a conditional frailty model were added to analyze the event-time-count longitudinal data. RESULTS The Cox regression model showed that non-manual work, diastolic dysfunction, and better medical compensation increased the risk of heart failure readmission, whereas treatment with beta-blockers decreased the risk. The conditional frailty model further revealed that age, female sex, non-manual work, better medical compensation, longer QRS duration, and treatment with percutaneous coronary intervention increased the risk of heart failure readmission. CONCLUSION This study obtained more reliable, reasonable results based on longitudinal data and a mixed model. The results could provide more clinical epidemiological evidence for the management of heart failure.
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Affiliation(s)
- Jing Tian
- Department of Cardiology, The 1st Hospital of Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
| | - Jingjing Yan
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
| | - Qing Zhang
- Department of Cardiology, The 1st Hospital of Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
| | - Hong Yang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
| | - Xinlong Chen
- Department of Cardiology, The 1st Hospital of Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
| | - Qiang Han
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
| | - Rui Han
- Department of Cardiology, The 1st Hospital of Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
| | - Jia Ren
- Department of Cardiology, The 1st Hospital of Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
| | - Yanbo Zhang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
- Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Taiyuan, Shanxi Province030001, People’s Republic of China
| | - Qinghua Han
- Department of Cardiology, The 1st Hospital of Shanxi Medical University, Taiyuan, Shanxi Province030001, People’s Republic of China
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