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Zhang X, Yao Y, Zhang Y, Jiang S, Li X, Wang X, Li Y, Yang W, Zhao Y, Zang X. Prognostic value of patient-reported outcomes in predicting 30 day all-cause readmission among older patients with heart failure. ESC Heart Fail 2022; 9:2840-2850. [PMID: 35686326 DOI: 10.1002/ehf2.13991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/05/2022] [Accepted: 05/08/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Previous prediction studies for 30 day readmission in patients with heart failure were built mainly based on electronic medical records and rarely involved patient-reported outcomes. This study aims to develop and validate a nomogram including patient-reported outcomes to predict the possibility of 30 day all-cause readmission in older patients with heart failure and to explore the value of patient-reported outcomes in prediction model. METHODS AND RESULTS This was a prospective cohort study. The nomogram was developed and internally validated by Logistic regression analysis based on 381 patients in training group from March to December 2019. The nomogram was externally validated based on 170 patients from July to October 2020. Receiver operating characteristic curves, calibration plots and decision-curve analysis were used to evaluate the performance of the nomogram. A total of 381 patients' complete data were analysed in the training group and 170 patients were enrolled in the external validation group. In the training group, 14.4% (n = 55) patients were readmitted to hospitals within 30 days of discharge and 15.9% (n = 27) patients were readmitted in the external validation group. The nomogram included six factors: history of surgery, changing the type of medicine by oneself, information acquisition ability, subjective support, depression level, quality of life, all of which were significantly associated with 30 day readmission in older patients with heart failure. The areas under the receiver operating characteristic curves of nomogram were 0.949 (95% CI: 0.925, 0.973, sensitivity: 0.873, specificity: 0.883) and 0.804 (95% CI: 0.691, 0.917, sensitivity: 0.778, specificity: 0.832) respectively in the training and external validation groups, which indicated that the nomogram had better discrimination ability. The calibration plots demonstrated favourable coordination between predictive probability of 30 day readmission and observed probability. Decision-curve analysis showed that the net benefit of the nomogram was better between threshold probabilities of 0-85%. CONCLUSIONS A novel and easy-to-use nomogram is constructed and demonstrated which emphasizes the important role of patient-reported outcomes in predicting studies. The performance of the nomogram drops in the external validation cohort and the nomogram must be validated in a wide prospective cohort of HF patients before its clinical relevance can be demonstrated. All these findings in this study can assist professionals in identifying the needs of HF patients so as to reduce 30 day readmission.
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Affiliation(s)
- Xiaonan Zhang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Ying Yao
- Department of Emergency, Tianjin Medical University General Hospital, Tianjin, China
| | - Yanwen Zhang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Sixuan Jiang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xuedong Li
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaobing Wang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yanting Li
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Weiling Yang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xiaoying Zang
- School of Nursing, Tianjin Medical University, Tianjin, China
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e895-e1032. [PMID: 35363499 DOI: 10.1161/cir.0000000000001063] [Citation(s) in RCA: 671] [Impact Index Per Article: 335.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2022; 79:e263-e421. [PMID: 35379503 DOI: 10.1016/j.jacc.2021.12.012] [Citation(s) in RCA: 775] [Impact Index Per Article: 387.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. STRUCTURE Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Chowdhury M, Buttar R, Rai D, Tahir MW, Tan BEX, Thakkar S, Ali H, Patel HP, Bhatt DL, Depta JP. Same-day discharge after transcatheter mitral valve repair using MitraClip in a tertiary community hospital: a case series. Eur Heart J Case Rep 2021; 5:ytab397. [PMID: 34693199 PMCID: PMC8522429 DOI: 10.1093/ehjcr/ytab397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/03/2021] [Accepted: 09/27/2021] [Indexed: 12/15/2022]
Abstract
Background Due to the current Coronavirus Disease 2019 (COVID-19) pandemic, there is a realization for innovation in procedures and protocols to minimize hospital stay and at the same time ensure continued evidence-based treatment delivered to the patients. We present a same-day discharge protocol for transcatheter mitral valve repair (TMVR) using MitraClip under general anaesthesia in a six-patient case series. This protocol aims to reduce the length of hospital stay, thereby minimizing potential for nosocomial COVID-19 infections and to promote safe discharge with cautious follow-up. Case summary Six patients with severe symptomatic mitral valve (MV) regurgitation underwent successful transfemoral MV repair using standard procedures. Following repair, patients were monitored on telemetry in the recovery area for 3 h, ambulated to assess vascular access stability and underwent post-procedural transthoracic echocardiogram to assess for any pericardial effusion or post-procedural prosthetic mitral stenosis. Conclusion Same-day discharge after TMVR is possible when done cautiously with close follow-up, can minimize hospital stay, improve resource utilization, and reduce risk of nosocomial COVID-19 infection.
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Affiliation(s)
- Medhat Chowdhury
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Rupinder Buttar
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Devesh Rai
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | | | - Bryan E-Xin Tan
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | | | - Hammad Ali
- Department of Internal Medicine, Detroit Medical Center/Wayne State University, Detroit, MI, USA
| | - Harsh P Patel
- Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, IL, USA
| | - Deepak L Bhatt
- Deparment of Cardiology, Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
- Corresponding authors. Tel: +1 857 307 1992, (D.L.B.); Tel: 585-922-4000, (J.P.D.)
| | - Jeremiah P Depta
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, 1425 Portland Avenue, Rochester, NY 14621, USA
- Corresponding authors. Tel: +1 857 307 1992, (D.L.B.); Tel: 585-922-4000, (J.P.D.)
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Zhang B, Li M, Kang Y, Xing L, Zhang Y. Comparison of different transcatheter interventions for treatment of mitral regurgitation: A protocol for a network meta-analysis. Medicine (Baltimore) 2020; 99:e23623. [PMID: 33327338 PMCID: PMC7738030 DOI: 10.1097/md.0000000000023623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The arrival of transcatheter mitral valve therapies has provided feasible and safe alternatives to medical and surgical treatments for mitral regurgitation. The aim of this study is to estimate the relative efficacy and safety of different transcatheter mitral valve therapies for mitral regurgitation patients through network meta-analysis. METHODS A systematic search will be performed using PubMed, EMBASE, the Cochrane Library, Web of Science, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure to include random controlled trials and nonrandom controlled trials comparing the efficacy and safety of different transcatheter mitral valve techniques. The risk of bias for the included nonrandom controlled studies will be evaluated according to Risk of Bias in Non-randomized Studies - of Interventions. For random controlled trials, we will use Cochrane Handbook version 5.1.0 as the risk of bias tool. A Bayesian network meta-analysis will be conducted using R-4.0.3 software. Grading of recommendations assessment, development, and evaluation will be used to assess the quality of evidence. RESULTS The results of this network meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION This study will provide broad evidence of efficacy and safety of different transcatheter mitral valve therapies for treatment of mitral regurgitation and provide suggestions for clinical practice and future research. PROTOCOL REGISTRATION NUMBER INPLASY2020110034.
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Affiliation(s)
- Bowen Zhang
- Department of Cardiothoracic Surgery, Wuwei People's Hospital, Gansu
| | - Muyang Li
- The Second Clinical Medical College of Lanzhou University
| | - Yingying Kang
- School of Basic Medical Sciences, Lanzhou University
| | - Lina Xing
- School of Basic Medical Sciences, Lanzhou University
| | - Yu Zhang
- Department of Thoracic Surgery, First Hospital of Lanzhou University, Lanzhou, China
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Sawalha K, Al-Akchar M, Ibrahim A, Buhnerkempe M, Koester C, Salih M, Bhattarai M, Tandan N, Bhatt DL, Hafiz AM. Impact of chronic kidney disease on in-hospital outcomes and readmission rate after edge-to-edge transcatheter mitral valve repair. Catheter Cardiovasc Interv 2020; 97:E569-E579. [PMID: 32969155 DOI: 10.1002/ccd.29188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/06/2020] [Accepted: 07/19/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Transcatheter mitral valve repair (TMVR) is a treatment option for patients with 3+ or greater mitral regurgitation who cannot undergo mitral valve surgery. Outcomes in patients with chronic kidney disease (CKD) and end stage renal disease (ESRD) are unclear. We sought to evaluate the TMVR in-hospital outcomes, readmission rates and its impact on kidney function. METHODS Data from 2016 National Readmission Database was used to obtain all patients who underwent TMVR. Patients were classified by their CKD status: no CKD, CKD, or ESRD. The primary outcomes were: in-hospital mortality, 30- and 90-day readmission rate, and change in CKD status on readmission. Multivariable logistic regression analysis was used to assess in-hospital, readmission outcomes and kidney function stage. RESULTS A total of 4,645 patients were assessed (mean age 78.5 ± 10.3 years). In-hospital mortality was higher in patients with CKD (4.0%, odds ratio [OR]:2.01 [95% CI, confidence interval: 1.27-3.18]) and ESRD (6.6%, OR: 6.38 [95% CI: 1.49-27.36]) compared with non-CKD (2.4%). 30-day readmission rate was higher in ESRD versus non-CKD patients (17.8% vs. 10.4%, OR: 2.24 [95% CI: 1.30-3.87]) as was 90-day readmission (41.2% vs. 21% OR: 2.51 [95% CI:1.70-3.72]). Kidney function improved in 25% of patients with CKD stage 3 and in 50% with CKD stage 4-5 at 30-and 90-day readmission. Incidence of AKI, major bleeding, and respiratory failure were higher in CKD group. CONCLUSIONS Patients with CKD and ESRD have worse outcomes and higher readmission rate after TMVR. In patients who were readmitted after TMVR, renal function improved in some patients, suggesting that TMVR could potentially improve CKD stage.
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Affiliation(s)
- Khalid Sawalha
- Department of Internal Medicine, University of Massachusetts Medical School- Baystate Medical Center, Springfield, Massachusetts
| | - Mohammad Al-Akchar
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Abdisamad Ibrahim
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Michael Buhnerkempe
- Department of Internal Medicine, Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Cameron Koester
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Mohsin Salih
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Mukul Bhattarai
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Nitin Tandan
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Deepak L Bhatt
- Cardiovascular Division, Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Abdul Moiz Hafiz
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
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