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Bayoumi E, Lam PH, Enders R, Arundel C, Sheriff HM, Brar V, Jurgens CY, Deedwania P, Faselis C, Allman RM, Fonarow GC, Ahmed A. Beta-Blocker Use and Outcomes in Nursing Home Residents with Heart Failure with Reduced Ejection Fraction. Am J Med 2022; 135:607-614. [PMID: 34861195 DOI: 10.1016/j.amjmed.2021.11.004] [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] [Received: 10/22/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Beta-blockers improve clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF). Less is known about their role in older nursing home residents with HFrEF. METHODS From the combined OPTIMIZE-HF and Alabama Heart Failure Project data sets, we assembled a propensity score-matched balanced cohort of 6494 hospitalized patients ≥65 years with HFrEF (ejection fraction ≤40%). In our primary approach, hazard ratios (HRs) and 95% confidence intervals (CI)s for outcomes associated with discharge prescriptions for beta- blockers were estimated, examining for heterogeneity by admission from nursing homes. In our sensitivity approach, we examined these associations in a separately assembled propensity score-matched cohort of 122 patients admitted from nursing homes. RESULTS In the matched primary cohort of 6494 patients, HRs (95% CIs) for 12-month all-cause mortality and heart failure readmission were 0.80 (0.74-0.87) and 0.94 (0.86-1.02), respectively. Respective HRs (95% CIs) in the nursing home and non-nursing home subgroups were 0.77 (0.51-1.16) and 0.81 (0.74-0.87) for all-cause mortality (interaction P: 0.653) and 1.06 (0.53-2.12) and 0.89 (0.82-0.96) for heart failure readmission (interaction P: 0.753). In the matched sensitivity cohort of 122 patients admitted from nursing homes, HRs (95% CIs) for 12-month all-cause mortality and heart failure readmission were 0.86 (0.55-1.35) and 1.07 (0.52-2.22), respectively. Similar associations were observed for 30-day outcomes. CONCLUSIONS Beta-blocker use was associated with a lower risk of all-cause mortality but not of heart failure readmission in older patients with HFrEF, which were similar for patients admitted and not admitted from nursing homes.
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Affiliation(s)
- Essraa Bayoumi
- Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; MedStar Washington Hospital Center, Washington, DC
| | - Phillip H Lam
- Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; MedStar Washington Hospital Center, Washington, DC
| | | | - Cherinne Arundel
- Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; George Washington University, Washington, DC
| | - Helen M Sheriff
- Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC
| | - Vijaywant Brar
- Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; MedStar Washington Hospital Center, Washington, DC
| | - Corrine Y Jurgens
- Boston College, Chestnut Hill, MA; Stony Brook University School of Nursing, Stony Brook, NY
| | | | - Charles Faselis
- Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC; Uniformed Services University, Washington, DC
| | - Richard M Allman
- George Washington University, Washington, DC; University of Alabama at Birmingham, Birmingham
| | | | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; George Washington University, Washington, DC.
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Lamppu PJ, Laakkonen ML, Finne-Soveri H, Kautiainen H, Laurila JV, Pitkälä KH. Training Staff in Long-Term Care Facilities-Effects on Residents' Symptoms, Psychological Well-Being, and Proxy Satisfaction. J Pain Symptom Manage 2021; 62:e4-e12. [PMID: 33794303 DOI: 10.1016/j.jpainsymman.2021.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/15/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
CONTEXT Long-term care facility (LTCF) residents have unmet needs in end-of-life and symptom care. OBJECTIVES This study examines the effects of an end-of-life care staff training intervention on LTCF residents' pain, symptoms, and psychological well-being and their proxies' satisfaction with care. METHODS We report findings from a single-blind, cluster randomized controlled trial featuring 324 residents with end-of-life care needs in 20 LTCF wards in Helsinki. The training intervention included four 4-hour educational workshops on palliative care principles (advance care planning, adverse effects of hospitalizations, symptom management, communication, supporting proxies, challenging situations). Training was provided to all members of staff in small groups. Education was based on constructive learning methods and included participants' own resident cases, role-plays, and small-group discussions. During a 12-month follow-up we assessed residents' symptoms with the Edmonton Symptom Assessment Scale (ESAS), pain with the PAINAD instrument and psychological well-being using a PWB questionnaire. Proxies' satisfaction with care was assessed using the SWC-EOLD. RESULTS The change in ESAS symptom scores from baseline to 6 months favored the intervention group compared with the control group. However, the finding was diluted at 12 months. PAINAD, PWB, and SWC-EOLD scores remained unaffected by the intervention. All follow-up analyses were adjusted for age, gender, do-not-resuscitate order, need for help, and clustering. CONCLUSION Our rigorous randomized controlled trial on palliative care training intervention demonstrated mild effects on residents' symptoms and no robust effects on psychological well-being or on proxies' satisfaction with care.
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Affiliation(s)
- Pauli J Lamppu
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Department of Social Services and Health Care, Helsinki Hospital, Geriatric Clinic, Helsinki, Finland.
| | - Marja-Liisa Laakkonen
- Department of Social Services and Health Care, Helsinki Hospital, Geriatric Clinic, Helsinki, Finland
| | | | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Jouko V Laurila
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Kaisu H Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
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Boxer RS, Dolansky MA, Chaussee EL, Campbell JD, Daddato AE, Page RL, Fairclough DL, Gravenstein S. A Randomized Controlled Trial of Heart Failure Disease Management vs Usual Care in Skilled Nursing Facilities. J Am Med Dir Assoc 2021; 23:359-366. [PMID: 34146521 DOI: 10.1016/j.jamda.2021.05.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 05/14/2021] [Accepted: 05/19/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Patients discharged from the hospital to a skilled nursing facility (SNF) are not typically part of a heart failure disease management program (HF-DMP). The objective of this study is to determine if an HF-DMP in SNF improves outcomes for patients with HF. DESIGN Cluster-randomized controlled trial. PARTICIPANTS The trial was conducted in 47 SNFs, and 671 patients were enrolled (329 HF-DMP; 342 to usual care). METHODS The HF-DMP included documentation of ejection fraction, symptoms, weights, diet, medication optimization, education, and 7-day visit post SNF discharge. The composite outcome was all-cause hospitalization, emergency department visits, or mortality at 60 days. Secondary outcomes included the composite endpoint at 30 days, change in the Kansas City Cardiomyopathy Questionnaire and the Self-care of HF Index at 60 days. Rehospitalization and mortality rates were calculated as an exploratory outcome. RESULTS Mean age of the patients was 79 ± 10 years, 58% were women, and the mean ejection fraction was 51% ± 16%. At 30 and 60 days post SNF admission, the composite endpoint was not significant between DMP (29%) and usual care (32%) at 30 days and 60 days (43% vs 47%, respectively). The Kansas City Cardiomyopathy Questionnaire significantly improved in the HF-DMP vs usual care for the Physical Limitation (11.3 ± 2.9 vs 20.8 ± 3.6; P = .039) and Social Limitation subscales (6.0 ± 3.1 vs 17.9 ± 3.8; P = .016). Self-care of HF Index was not significant. The total number of events (composite endpoint) totaled 517 (231 in HF-DMP and 286 in usual care). Differences in the 60-day hospitalization rate [mean HF-DMP rate 0.43 (SE 0.03) vs usual care 0.54 (SE 0.05), P = .04] and mortality rate (HF-DMP 5.2% vs usual care 10.8%, P < .001) were significant. CONCLUSIONS AND IMPLICATIONS The composite endpoint was high for patients with HF in SNF regardless of group. Rehospitalization and mortality rates were reduced by the HF-DMP. HF-DMPs in SNFs may be beneficial to the outcomes of patients with HF. SNFs should consider structured HF-DMPs for their patients.
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Affiliation(s)
- Rebecca S Boxer
- Institute for Health Research, Kaiser Permanente, Aurora, CO, USA; Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Mary A Dolansky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Erin L Chaussee
- Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA; Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jon D Campbell
- Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Andrea E Daddato
- Institute for Health Research, Kaiser Permanente, Aurora, CO, USA; Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert L Page
- Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Diane L Fairclough
- Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA; Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stefan Gravenstein
- Alpert Medical School of Brown University, Providence, RI, USA; Brown School of Public Health, Providence, RI, USA; Providence Veterans Administration Medical Center, Providence, RI, USA
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Kaufman BG, Granger BB, Sun JL, Sanders G, Taylor DH, Mark DB, Warraich H, Fiuzat M, Steinhauser K, Tulsky JA, Rogers JG, O'Connor C, Mentz RJ. The Cost-Effectiveness of Palliative Care: Insights from the PAL-HF Trial. J Card Fail 2021; 27:662-669. [PMID: 33731305 DOI: 10.1016/j.cardfail.2021.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In a randomized control trial, Palliative Care in Heart Failure (PAL-HF) improved heart failure-related quality of life, though cost-effectiveness remains unknown. The aim of this study was to evaluate the cost-effectiveness of the PAL-HF trial, which provided outpatient palliative care to patients with advanced heart failure. METHODS AND RESULTS Outcomes for usual care and PAL-HF strategies were compared using a Markov cohort model over 36 months from a payer perspective. The model parameters were informed by PAL-HF trial data and supplemented with meta-analyses and Medicare administrative data. Outcomes included hospitalization, place of death, Medicare expenditures, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios. Simulated mortality rates were the same for PAL-HF and usual care cohorts, at 89.7% at 36 months. In the base case analysis, the PAL-HF intervention resulted in an incremental gain of 0.03 QALYs and an incremental cost of $964 per patient for an incremental cost-effectiveness ratio of $29,041 per QALY. In 1-way sensitivity analyses, an intervention cost of up to $140 per month is cost effective at $50,000 per QALY. Of 1000 simulations, the PC intervention had a 66.1% probability of being cost effective at a $50,000 willingness-to-pay threshold assuming no decrease in hospitalization. In a scenario analysis, PAL-HF decreased payer spending through reductions in noncardiovascular hospitalizations. CONCLUSIONS These results from this single-center trial are encouraging that palliative care for advanced heart failure is an economically attractive intervention. Confirmation of these findings in larger multicenter trials will be an important part of developing the evidence to support more widespread implementation of the PAL-HF palliative care intervention.
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Affiliation(s)
- Brystana G Kaufman
- Margolis Center for Health Policy, Duke University, Durham, North Carolina.
| | - Bradi B Granger
- Margolis Center for Health Policy, Duke University, Durham, North Carolina; School of Nursing, Duke University, Durham, North Carolina
| | - Jie-Lena Sun
- Duke Clinical Research Institute, Durham, North Carolina
| | - Gillian Sanders
- Margolis Center for Health Policy, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Donald H Taylor
- Margolis Center for Health Policy, Duke University, Durham, North Carolina; Sanford School of Public Policy, Duke University, Durham, North Carolina
| | - Daniel B Mark
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Mona Fiuzat
- Duke University School of Medicine, Durham, North Carolina
| | | | - James A Tulsky
- Duke Clinical Research Institute, Durham, North Carolina
| | | | | | - Robert J Mentz
- Duke Clinical Research Institute, Durham, North Carolina
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Arundel C, Sheriff HM, Lam PH, Mohammed SF, Jones LG, Jurgens CY, Morgan CJ, Faselis C, Allman RM, Fonarow GC, Ahmed A. Renin-Angiotensin Inhibition and Outcomes in Nursing Home Residents With Heart Failure. Am J Ther 2021; 27:e235-e242. [PMID: 30299270 PMCID: PMC10502912 DOI: 10.1097/mjt.0000000000000836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs-ARBs) improve outcomes in heart failure (HF). Less is known about this association in nursing home (NH) residents. METHODS Of the 8024 hospitalized HF patients, 542 were NH residents, of whom 250 received ACEIs-ARBs. We assembled a propensity score-matched cohort of 157 pairs of NH residents receiving and not receiving ACEIs-ARBs balanced on 29 baseline characteristics (mean age, 83 years, 74% women, 17% African American), in which we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with ACEI-ARB use. We then checked for interaction in a matched cohort of 5130 patients (378 were NH residents) assembled from the 8024 patients. RESULTS Among 314 matched NH residents, HRs (95% CIs) for 30-day all-cause readmission, HF readmission, and all-cause mortality were 0.78 (0.47-1.28), 0.68 (0.29-1.60), and 1.26 (0.70-2.27), respectively. Respective HRs (95% CIs) at 1 year were 0.76 (0.56-1.02), 0.68 (0.42-1.09), and 1.04 (0.78-1.38). Among 5130 matched patients, ACEI-ARB use was associated with a significantly lower risk of all outcomes at both times, with no significant interactions, except for 1-year mortality, which was only significant in the non-NH subgroup (P for interaction, 0.026). CONCLUSIONS We found no evidence that the use of ACEIs or ARBs is associated with improved outcomes in patients with HF in the NH setting. However, we also found no evidence that this association is different in NH residents with HF versus non-NH patients with HF. Future larger studies are needed to demonstrate effectiveness of these drugs in the NH setting.
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Affiliation(s)
- Cherinne Arundel
- Veterans Affairs Medical Center, Washington, DC
- George Washington University, Washington, DC
| | - Helen M. Sheriff
- Veterans Affairs Medical Center, Washington, DC
- George Washington University, Washington, DC
| | - Phillip H. Lam
- Veterans Affairs Medical Center, Washington, DC
- Georgetown University, Washington, DC
- MedStar Washington Hospital Center, Washington, DC
| | | | - Linda G. Jones
- Veterans Affairs Medical Center, Birmingham, AL
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Charles Faselis
- Veterans Affairs Medical Center, Washington, DC
- George Washington University, Washington, DC
| | - Richard M. Allman
- Geriatrics and Extended Care, Department of Veterans Affairs, Washington, DC
| | | | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC
- George Washington University, Washington, DC
- University of Alabama at Birmingham, Birmingham, AL
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Patient Characteristics Are Not Associated With Documentation of Weight and Heart Failure Related Sign and Symptom Assessment in Skilled Nursing Facilities. J Am Med Dir Assoc 2020; 22:1265-1270.e1. [PMID: 33071159 DOI: 10.1016/j.jamda.2020.08.033] [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: 12/26/2019] [Revised: 08/13/2020] [Accepted: 08/24/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Monitoring body weight and signs and symptoms related to heart failure (HF) can alert clinicians to a patient's worsening condition but the degree to which these practices are performed in skilled nursing facilities (SNFs) is unknown. This study analyzed the frequency of these monitoring practices in SNFs and explored associated factors at both the patient and SNF level. DESIGN An observational study of data from the usual care arm of the SNF Connect Trial, a randomized cluster trial of a HF disease management intervention. The data extracted from charts were combined with publicly available facility data. A linear regression model was estimated to evaluate the frequency of HF disease management conditional on patient and facility covariates. SETTING Data from 28 SNFs in Colorado. PARTICIPANTS Patients discharged from hospital to SNFs with a primary or secondary diagnosis of HF. MEASUREMENTS Patient-level covariates included demographics, New York Heart Association class, type of HF, and Charlson comorbidity index. Facility-level covariates were from Nursing Home Compare. RESULTS The sample (n = 320) was majority female (66%), white (93%), with mean age 80 ± 10 years and a Charlson comorbidity index of 3.2 ± 1.5. Seventy percent had HF with preserved ejection fraction, mean ejection fraction of 50 ± 16% and 40% with a New York Heart Association class III-IV. On average, patients were weighed 40% of their days in the SNF and had documentation of at least 1 HF-related sign or symptom 70% of their days in the SNF. Patient-level factors were not associated with frequency of documenting weight and assessments of HF-related signs/symptoms. Health Inspection Star Rating was positively associated with weight monitoring (P < .05) but not associated with symptom assessment. CONCLUSIONS AND IMPLICATIONS Patient-level factors are not meaningfully associated with the documentation of weight tracking or sign/symptom assessment. Monitoring weight was instead associated with the Health Inspection Star Rating.
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El Hadidi S, Rosano G, Tamargo J, Agewall S, Drexel H, Kaski JC, Niessner A, Lewis BS, Coats AJS. Potentially Inappropriate Prescriptions in Heart Failure with Reduced Ejection Fraction (PIP-HFrEF). EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 8:187-210. [PMID: 32941594 DOI: 10.1093/ehjcvp/pvaa108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/12/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) is a chronic debilitating and potentially life-threatening condition. Heart Failure patients are usually at high risk of polypharmacy and consequently, potentially inappropriate prescribing leading to poor clinical outcomes. Based on the published literature, a comprehensive HF-specific prescribing review tool is compiled to avoid medications that may cause HF or harm HF patients and to optimize the prescribing practice of HF guideline-directed medical therapies. Recommendations are made in line with the last versions of ESC guidelines, ESC position papers, scientific evidence, and experts' opinions.
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Affiliation(s)
- Seif El Hadidi
- Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt, New Cairo, Egypt
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy.,Cardiovascular Clinical Academic Group, St George's Hospitals NHS Trust University of London, London, UK
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Heinz Drexel
- VIVIT Institute, Landeskrankenhaus Feldkirch, Austria
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria
| | - Basil S Lewis
- Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel
| | - Andrew J S Coats
- Centre of Clinical and Experimental Medicine, IRCCS San Raffaele Pisana, Rome, Italy
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Abstract
PURPOSE Exercise training has been shown to reduce combined cardiovascular mortality and hospitalizations in patients with chronic heart failure (CHF) with reduced ejection fraction (HFrEF). Whereas there are extensive data on exercise training for individuals with HFrEF in a research setting, the experience of delivering cardiac rehabilitation (CR) services in the clinical setting has not been well described. With little knowledge regarding the number of qualifying patients with HFrEF in the United States, we described our 18-month experience recruiting hospitalized inpatients and stable outpatients into phase 2 CR. METHODS Patients hospitalized with CHF HFrEF were tracked for enrollment in CR. Exercise training response was described for patients identified as inpatients and for stable HFrEF outpatients referred from cardiology clinic or heart failure clinic. RESULTS The cohort included 83 patients hospitalized with CHF and 36 outpatients. Only 17% (14/83) of eligible HFrEF inpatients enrolled in CR following CHF hospitalization compared with 97% (35/36) outpatient referrals. Improvements in aerobic capacity for the total cohort were observed whether expressed as estimated metabolic equivalents (n = 19, 4.6 ± 1.6 to 6.2 ± 2.4, P < .0001) or (Equation is included in full-text article.)O2peak (n = 14, 14.4 ± 3.5 to 16.4 ± 4.6 mL/kg/min, P = .02) for those who completed CR. CONCLUSION Significant barriers to recruiting and enrolling patients with HFrEF were observed and only 17% of inpatients attended CR. Systematic in-hospital referral with close followup in the outpatient setting has the potential to capture more eligible patients. The participation of referred stable outpatients with HFrEF was much higher. Regardless of the referral source, patients with HFrEF completing CR can expect improvements in aerobic capacity, muscle strength, and depressive symptoms.
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Chronic Heart Failure: Impact of the Current Guidelines. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2018.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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10
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Symptoms, Nutrition, Pressure Ulcers, and Return to Community Among Older Women With Heart Failure at Skilled Nursing Facilities: A Pilot Study. J Cardiovasc Nurs 2018; 33:22-29. [PMID: 29200058 DOI: 10.1097/jcn.0000000000000422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mortality rate is high for older women with heart failure (HF) who are discharged to skilled nursing facilities (SNFs) after hospitalization, but little is known about their symptoms, nutritional factors, and pressure ulcer status and whether these variables predict the women's return to the community. OBJECTIVES The aims of this study are to characterize symptoms (ie, dyspnea, cognitive dysfunction, depression, and pain) and nutritional and pressure ulcer status, evaluate relationships among symptoms, and examine predictors of return to the community among older women with HF admitted to SNFs. METHODS In this pilot observational study, data were collected retrospectively from the electronic medical records and the Minimum Data Set 3.0. RESULTS Data were obtained for 45 women with HF (mean age, 84.8 years). Frequency of symptoms was dyspnea 18%, cognitive dysfunction 20%, depression 5%, and pain 78%. Mean body mass index (BMI) was 29.8 kg/m. Frequency of pressure ulcer risk was 85% and 18% had pressure ulcers. The 4 symptoms were not significantly related. Younger age (odds ratio, 0.90; P = .023) and BMI of 25 kg/m or greater (odds ratio, 5.31; P = .017) predicted return to the community. CONCLUSIONS The women in this study had frequent pain, moderately frequent cognitive dysfunction, and high pressure ulcer risk. Surprisingly, few women had dyspnea or depression. Women who were younger with higher BMI were more likely to return to the community. The study needs to be replicated in a larger more diverse group of older patients with HF.
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Barriers to Beta-Blocker Use and Up-Titration Among Patients with Heart Failure with Reduced Ejection Fraction. Cardiovasc Drugs Ther 2018; 31:559-564. [PMID: 29181610 DOI: 10.1007/s10557-017-6764-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE For patients with heart failure with reduced ejection fraction (HFrEF), guidelines recommend use of beta-blockers with gradual up-titration. However, many patients with HFrEF do not use beta-blockers and up-titration is rare. Our purpose was to identify and rank barriers to beta-blocker use and up-titration from the perspective of primary care physicians. METHODS We conducted 4 moderated, structured group discussions among 19 primary care physicians using the nominal group technique; 16 participants also completed a survey. Participants generated lists of barriers to beta-blocker use and up-titration among patients with HFrEF. Each participant had six votes with three votes assigned to the item ranked most important, two to the second most important item, and one to the third most important item. Investigators characterized items into themes. The percentage of available votes was calculated for each theme. RESULTS Fifteen of 16 participating primary care physicians who completed the survey reported that management of beta-blockers was their responsibility. Treatment/side effects, particularly hypotension, were identified as the most important barrier for beta-blocker use (72% of available votes) followed by polypharmacy (11%), healthcare system barriers (10%), and comorbidities (6%). Barriers to up-titration included treatment/side effects (49% of available votes), patient communication/buy-in (21%), polypharmacy (13%), and healthcare system barriers (8%). CONCLUSIONS Many barriers to guideline concordant use of beta-blockers among patients with HFrEF identified by primary care providers are not readily modifiable. Addressing these barriers may require development, testing, and dissemination of protocols for beta-blocker initiation and up-titration that are safe and appropriate in primary care.
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12
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Akyar I, Dionne-Odom JN, Bakitas MA. Using Patients and Their Caregivers Feedback to Develop ENABLE CHF-PC: An Early Palliative Care Intervention for Advanced Heart Failure. J Palliat Care 2018; 34:103-110. [PMID: 29952216 DOI: 10.1177/0825859718785231] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE: Models of early, community-based palliative care for individuals with New York Heart Association (NYHA) class III/IV heart failure and their families are lacking. We used the Medical Research Council process of developing complex interventions to conduct a formative evaluation study to translate an early palliative care intervention from cancer to heart failure. METHOD: One component of the parent formative evaluation pilot study was qualitative satisfaction interviews with 8 patient-caregiver dyad participants who completed Educate, Nurture, Advise, Before Life Ends Comprehensive Heartcare For Patient and Caregivers (ENABLE CHF-PC) intervention. The ENABLE CHF-PC consists of an in-person palliative care assessment, weekly telehealth coaching sessions, and monthly follow-up. Subsequent to completing the coaching sessions, patient and caregiver participants were interviewed to elicit their experiences with ENABLE CHF-PC. Digitally recorded interviews were transcribed and analyzed using a thematic approach. RESULTS: Patients (n = 8) mean age was 67.3, 62.5% were female, 75% were married/living with a partner; caregivers (n = 8) mean age was 56.8, and 87.5% were female. Four themes related to experiences with ENABLE CHF-PC included "allowed me to vent," "gained perspective," "helped me plan," and "gained illness management and decision-making skills." Recommendations for intervention modification included (1) start program at diagnosis, (2) maintain phone-based approach, and (3) expand topics and modify format. CONCLUSION: Patients and caregivers unanimously found the intervention to be helpful and acceptable. After incorporating modifications, ENABLE CHF-PC is currently undergoing efficacy testing in a large randomized controlled trial.
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Affiliation(s)
- Imatullah Akyar
- 1 Faculty of Nursing, Hacettepe University, Ankara, Turkey.,2 School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J Nicholas Dionne-Odom
- 2 School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.,3 Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of Alabama at Birmingham Center for Palliative and Supportive Care, Birmingham, AL, USA
| | - Marie A Bakitas
- 2 School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.,3 Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of Alabama at Birmingham Center for Palliative and Supportive Care, Birmingham, AL, USA
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Orr NM, Jones CD, Daddato AE, Boxer RS. Post-acute Care for Patients with Heart Failure. CURRENT CARDIOVASCULAR RISK REPORTS 2018. [DOI: 10.1007/s12170-018-0583-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Athilingam P, Jenkins BA, Zumpano H, Labrador MA. "Mobile technology to improve heart failure outcomes: A proof of concept paper". Appl Nurs Res 2018; 39:26-33. [PMID: 29422170 DOI: 10.1016/j.apnr.2017.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 09/23/2017] [Accepted: 10/15/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Heart failure (HF) causes significant symptom burden and human suffering with considerable economic burden due to hospital readmissions. Targeted interventions to encourage and support self-management behavior is warranted. AIM To test the proof of concept of a mobile application (HeartMapp) in improving self-care management of patients with heart failure. METHOD An exploratory inquiry used a field study strategy with purposeful sampling and constant comparative analysis to test the proof of concept of HeartMapp using The Business Model Canvas framework. RESULTS A total of 125 individuals, who were identified as potential candidates to use the HeartMapp completed the interview over a seven-week period in 2016. Constant comparative analysis indicated themes that Skilled Nursing Facilities had increased readmissions. Participants from Skilled Nursing Facilities reported concern on lack of staffing, star rating, and malpractice claims. Two types of patients were identified as early adapters of technology and those in denial. Health care facilities reported challenges on transitional care, nurses struggle with engagement of patients on self-care management. To avoid readmission penalty, hospitals task home care agencies to keep the patients home for 30-days. While home care agencies rely on remote telemonitoring reported that current telemonitoring devices are costly to maintain, thus exploring novel technology. CONCLUSION The Business Model Canvas provided directions for future testing of HeartMapp for its usability as an adjunct device in home health setting to improve self-management and enhance communication with providers, and ultimately reduce readmissions.
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Affiliation(s)
- Ponrathi Athilingam
- College of Nursing, University of South Florida, Tampa, FL 33612, United States.
| | - Bradlee A Jenkins
- College of Nursing, University of South Florida, Entrepreneurial Lead for the NSF I-Corps Project, United States; Society of Acute Care Nurse Practitioner Students at USF, United States.
| | - Heather Zumpano
- IMST Telehealth Consulting, Dunedin, FL 34698, United States.
| | - Miguel A Labrador
- Professor, College of Computer Science and Engineering, USF, Tampa 33612, United States.
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Li L, Jesdale BM, Hume A, Gambassi G, Goldberg RJ, Lapane KL. Pharmacotherapy Use in Older Patients With Heart Failure and Reduced Ejection Fraction After a Skilled Nursing Facility Stay. J Card Fail 2017; 23:843-851. [DOI: 10.1016/j.cardfail.2017.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 09/10/2017] [Accepted: 09/15/2017] [Indexed: 12/13/2022]
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Daddato A, Wald HL, Horney C, Fairclough DL, Leister EC, Coors M, Capell WH, Boxer RS. A randomized trial of heart failure disease management in skilled nursing facilities (SNF Connect): Lessons learned. Clin Trials 2017; 14:308-313. [PMID: 28135830 DOI: 10.1177/1740774517690529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIMS Conducting clinical trials in skilled nursing facilities is particularly challenging. This manuscript describes facility and patient recruitment challenges and solutions for clinical research in skilled nursing facilities. METHODS Lessons learned from the SNF Connect Trial, a randomized trial of a heart failure disease management versus usual care for patients with heart failure receiving post-acute care in skilled nursing facilities, are discussed. Description of the trial design and barriers to facility and patient recruitment along with regulatory issues are presented. RESULTS The recruitment of Denver-metro skilled nursing facilities was facilitated by key stakeholders of the skilled nursing facilities community. However, there were still a number of barriers to facility recruitment including leadership turnover, varying policies regarding research, fear of litigation and of an increased workload. Engagement of facilities was facilitated by their strong interest in reducing hospital readmissions, marketing potential to hospitals, and heart failure management education for their staff. Recruitment of patients proved difficult and there were few facilitators. Identified patient recruitment challenges included patients being unaware of their heart failure diagnosis, patients overwhelmed with their illness and care, and frequently there was no available proxy for cognitively impaired patients. Flexibility in changing the recruitment approach and targeting skilled nursing facilities with higher rates of admissions helped to overcome some barriers. CONCLUSION Recruitment of skilled nursing facilities and patients in skilled nursing facilities for clinical trials is challenging. Strategies to attract both facilities and patients are warranted. These include aligning study goals with facility incentives and flexible recruitment protocols to work with patients in "transition crisis."
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Affiliation(s)
- Andrea Daddato
- GRECC Denver VA Eastern Colorado Health System and Division of Geriatric Medicine, Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Heidi L Wald
- GRECC Denver VA Eastern Colorado Health System and Division of Geriatric Medicine, Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Carolyn Horney
- GRECC Denver VA Eastern Colorado Health System and Division of Geriatric Medicine, Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Diane L Fairclough
- GRECC Denver VA Eastern Colorado Health System and Division of Geriatric Medicine, Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Erin C Leister
- GRECC Denver VA Eastern Colorado Health System and Division of Geriatric Medicine, Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Marilyn Coors
- GRECC Denver VA Eastern Colorado Health System and Division of Geriatric Medicine, Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Warren H Capell
- GRECC Denver VA Eastern Colorado Health System and Division of Geriatric Medicine, Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Rebecca S Boxer
- GRECC Denver VA Eastern Colorado Health System and Division of Geriatric Medicine, Department of Internal Medicine, School of Medicine, University of Colorado, Aurora, CO, USA
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Rong X, Peng Y, Yu HP, Li D. Cultural factors influencing dietary and fluid restriction behaviour: perceptions of older Chinese patients with heart failure. J Clin Nurs 2016; 26:717-726. [PMID: 27532343 DOI: 10.1111/jocn.13515] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Xiaoshan Rong
- Nursing Department; Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine; Shanghai China
| | - Youqing Peng
- Department of Nursing; Shanghai East Hospital; Tongji University School of Medicine; Shanghai China
| | - Hai-Ping Yu
- Nursing Department; Shanghai East Hospital; Tongji University School of Medicine; Shanghai China
| | - Dan Li
- Nursing Department; Shanghai East Hospital; Tongji University School of Medicine; Shanghai China
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18
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Orr NM, Boxer RS, Dolansky MA, Allen LA, Forman DE. Skilled Nursing Facility Care for Patients With Heart Failure: Can We Make It "Heart Failure Ready?". J Card Fail 2016; 22:1004-1014. [PMID: 27769909 PMCID: PMC7245613 DOI: 10.1016/j.cardfail.2016.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/06/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
Abstract
Skilled nursing facilities (SNFs) have emerged as an integral component of care for older adults with heart failure (HF). Despite their prominent role, poor clinical outcomes for the medically complex patients with HF managed in SNFs are common. Barriers to providing quality care include poor transitional care during hospital-to-SNF and SNF-to-community discharges, lack of HF training among SNF staff, and a lack of a standardized care process among SNF facilities. Although no evidence-based practice standards have been established, various measures and tools designed to improve HF management in SNFs are being investigated. In this review, we discuss the challenges of HF care in SNFs as well as potential targets and recommendations that can help improve care with respect to transitions, HF management within SNFs, and modifiable factors within facilities. Policy considerations that might help catalyze improvements in SNF-based HF management are also discussed.
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Affiliation(s)
- Nicole M Orr
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, Massachusetts; Post-Acute Cardiology Care, Wellesley, Massachusetts.
| | - Rebecca S Boxer
- Eastern Colorado (Denver) Veterans Association GRECC, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado
| | | | - Larry A Allen
- University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel E Forman
- Geriatric Cardiology Section, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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Kheirbek RE, Fokar A, Moore HJ. A 108-Year-Old Centenarian Survivor of Acute Decompensated Heart Failure and Acute Kidney Injury. J Am Med Dir Assoc 2016; 17:757-9. [PMID: 27324810 DOI: 10.1016/j.jamda.2016.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Raya Elfadel Kheirbek
- Veterans Affairs Medical Center, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Ali Fokar
- Veterans Affairs Medical Center, Washington, DC
| | - Hans J Moore
- Veterans Affairs Medical Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
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Dolansky MA, Capone L, Leister E, Boxer RS. Targeting heart failure rehospitalizations in a skilled nursing facility: A case report. Heart Lung 2016; 45:392-6. [PMID: 27340005 DOI: 10.1016/j.hrtlng.2016.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/08/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We report on a skilled nursing facility (SNF) that added designated heart failure (HF) beds and created a patient registry to track the number and reasons for rehospitalization. BACKGROUND Targeting the reduction of rehospitalizations from SNFs is an important goal and patients with HF are particularly vulnerable for rehospitalizations as HF disease management programs in SNFs are rare. METHODS A case study of a local quality improvement initiative. RESULTS The data from the registry revealed, that compared to patients without HF, patients with HF were more often rehospitalized for cardiopulmonary symptoms and less often for infection. In addition, patients with HF were most often rehospitalized during the first 7 days of their SNF stay and if they had a primary hospital discharge diagnosis of HF. CONCLUSION We highlight the benefits of a patient registry to guide future quality improvement initiatives to reduce patient rehospitalization rates.
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Affiliation(s)
| | | | - Erin Leister
- University of Colorado School of Public Health, Department of Biostatistics and Informatics, USA
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Rojas Sánchez LZ, Hernández Vargas JA, Trujillo Cáceres SJ, Roa Díaz ZM, Jurado Arenales AM, Toloza Pérez YG. Usefulness of the Diagnosis "Decreased Cardiac Output (00029)" in Patients With Chronic Heart Failure. Int J Nurs Knowl 2016; 28:192-198. [PMID: 27245262 DOI: 10.1111/2047-3095.12148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 04/23/2016] [Accepted: 05/06/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine the clinical and construct validity of the nursing diagnosis "decreased cardiac output" (DCO) in patients with chronic heart failure. METHODS Cross-sectional study. RESULTS A total of 200 people were studied. The defining characteristics with the highest prevalence were as follows: arrhythmia (62.5%) and fatigue (61.5%). Adjustment measures such as infit and outfit were maintained between 0.50 and 1.56 and the total variance explained by the measures was 29.3%. CONCLUSIONS This study determined the clinical validity of the nursing diagnosis DCO. Regarding construct validity, adjustment of the defining characteristics to the Rasch model was observed. IMPLICATIONS FOR NURSING PRACTICE This study improves the evidence-based practice of nursing and strengthened the role of the nurse who leads care to this population. OBJETIVO Determinar la validez clínica y de constructo del diagnóstico de enfermería "Disminución del Gasto Cardíaco" en pacientes con falla cardíaca crónica. MÉTODOS: Estudio de corte transversal. RESULTADOS Un total de 200 pacientes fueron estudiados. Las características definitorias con las mayores prevalencias fueron: arritmia (62.5%) y fatiga (61.5%). Medidas de ajuste como el infit y outfit se mantuvieron entre 0.50 y 1.56. El total de la varianza explicada por las medidas fue de 29.3%. CONCLUSIONES Este estudio determinó la validez clínica del diagnóstico de enfermería "Disminución del Gasto Cardíaco". En cuanto a la validez de constructo, se observó que 19 de las 21 características definitorias se ajustaron al modelo Rasch. IMPLICACIONES PARA LA PRÁCTICA DE ENFERMERÍA: Este estudio mejora la práctica basada en la evidencia de enfermería y fortalece el rol de las enfermeras que lideran el cuidado en esta población.
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Affiliation(s)
- Lyda Zoraya Rojas Sánchez
- Lyda Zoraya Rojas Sánchez, MSc, RN, Master in Epidemiology, is an Epidemiologist, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia, and Assistant Professor, School of Nursing-Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
| | | | - Silvia Juliana Trujillo Cáceres
- Silvia Juliana Trujillo Cáceres, RN, is a Young Researcher, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia
| | - Zayne Milena Roa Díaz
- Zayne Milena Roa Díaz, RN, Master in Epidemiology, is an Epidemiologist, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia, and Assistant Professor, School of Nursing-Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
| | - Adriana Milena Jurado Arenales
- Adriana Milena Jurado Arenales, RN, is a Nurse, Clinic of Heart Failure and Cardiac Transplantation, Department of Cardiology, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia
| | - Yesith Guillermo Toloza Pérez
- Yesith Guillermo Toloza Pérez, RN, is a Graduate of the School of Nursing-Universidad Industrial de Santander, Bucaramanga, Santander, Colombia. All authors belong to the Group of Research and Knowledge Development in Nursing, Research Institute, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia
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Forman DE, Alexander K, Brindis RG, Curtis AB, Maurer M, Rich MW, Sperling L, Wenger NK. Improved Cardiovascular Disease Outcomes in Older Adults. F1000Res 2016; 5. [PMID: 26918183 PMCID: PMC4755414 DOI: 10.12688/f1000research.7088.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2016] [Indexed: 12/11/2022] Open
Abstract
Longevity is increasing and the population of older adults is growing. The biology of aging is conducive to cardiovascular disease (CVD), such that prevalence of coronary artery disease, heart failure, valvular heart disease, arrhythmia and other disorders are increasing as more adults survive into old age. Furthermore, CVD in older adults is distinctive, with management issues predictably complicated by multimorbidity, polypharmacy, frailty and other complexities of care that increase management risks (e.g., bleeding, falls, and rehospitalization) and uncertainty of outcomes. In this review, state-of-the-art advances in heart failure, acute coronary syndromes, transcatheter aortic valve replacement, atrial fibrillation, amyloidosis, and CVD prevention are discussed. Conceptual benefits of treatments are considered in relation to the challenges and ambiguities inherent in their application to older patients.
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Affiliation(s)
- Daniel E Forman
- Geriatric Cardiology Section, University of Pittsburgh Medical Center, Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Karen Alexander
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Ralph G Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Anne B Curtis
- Department of Medicine, University at Buffalo, Buffalo, New York, USA
| | - Mathew Maurer
- Department of Medicine, Columbia University Medical Center, New York, USA
| | - Michael W Rich
- Washington University School of Medicine, St Louis, MO, USA
| | - Laurence Sperling
- Emory University School of Medicine and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, GA, USA
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Nazir A, Smucker WD. Heart Failure in Post-Acute and Long-Term Care: Evidence and Strategies to Improve Transitions, Clinical Care, and Quality of Life. J Am Med Dir Assoc 2015; 16:825-31. [DOI: 10.1016/j.jamda.2015.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 12/12/2022]
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Orr NM, Forman DE, De Matteis G, Gambassi G. Heart Failure Among Older Adults in Skilled Nursing Facilities: More of a Dilemma Than Many Now Realize. CURRENT GERIATRICS REPORTS 2015; 4:318-326. [PMID: 27398289 DOI: 10.1007/s13670-015-0150-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Post-acute care, encompassing long-term care hospitals, home health, inpatient rehabilitation, and skilled nursing facilities, is increasingly employed as an integral part of management for more complicated patients, particularly as hospitals seek to maintain costs and decrease length of stay. Skilled nursing facilities (SNFs) in particular are progressively utilized for patients with complex medical processes, including today's growing population of older hospitalized heart failure (HF) patients who pose a prominent challenge due to their high risks of mortality, 30-day readmissions, and substantial aggregate cost burden to the healthcare system. Publications to date have largely grouped post-hospitalized HF patients together when reporting demographic or outcome data, without differentiating those at SNFs from those at traditional nursing homes or other post-acute care settings. SNF patients suffer distinctive vulnerabilities and needs, and understanding these distinctions has implications for determining goals of care. In this review we evaluate HF patients referred to SNFs, and discuss the characteristics, outcomes, and management challenges associated with this particular population.
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Affiliation(s)
- Nicole M Orr
- Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA; Post-Acute Cardiology Care, LLC, Wellesley, MA 02481, USA
| | - Daniel E Forman
- Section of Geriatric Cardiology, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 500, Pittsburgh, PA 15213, USA; Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Giuseppe De Matteis
- Department of Medical Sciences, Division of Internal Medicine and Angiology, Catholic University of Sacred Heart, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Giovanni Gambassi
- Department of Medical Sciences, Division of Internal Medicine and Angiology, Catholic University of Sacred Heart, Largo Agostino Gemelli 8, 00168 Rome, Italy
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Early Rehabilitation in the Intensive Care Unit. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0094-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Thinking Outside the Box: Treating Acute Heart Failure Outside the Hospital to Improve Care and Reduce Admissions. J Card Fail 2015; 21:667-73. [DOI: 10.1016/j.cardfail.2015.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 05/12/2015] [Accepted: 05/15/2015] [Indexed: 01/16/2023]
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Colvin M, Sweitzer NK, Albert NM, Krishnamani R, Rich MW, Stough WG, Walsh MN, Westlake Canary CA, Allen LA, Bonnell MR, Carson PE, Chan MC, Dickinson MG, Dries DL, Ewald GA, Fang JC, Hernandez AF, Hershberger RE, Katz SD, Moore S, Rodgers JE, Rogers JG, Vest AR, Whellan DJ, Givertz MM. Heart Failure in Non-Caucasians, Women, and Older Adults: A White Paper on Special Populations From the Heart Failure Society of America Guideline Committee. J Card Fail 2015; 21:674-93. [DOI: 10.1016/j.cardfail.2015.05.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/21/2015] [Accepted: 05/26/2015] [Indexed: 01/11/2023]
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