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Hill L, McNulty A, McMahon J, Mitchell G, Farrell C, Uchmanowicz I, Castiello T. Heart Failure Nurses within the Primary Care Setting. Card Fail Rev 2024; 10:e01. [PMID: 38464555 PMCID: PMC10918528 DOI: 10.15420/cfr.2023.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/27/2023] [Indexed: 03/12/2024] Open
Abstract
Cardiology services within primary care often focus on disease prevention, early identification of illness and prompt referral for diagnosis and specialist treatment. Due to advances in pharmaceuticals, implantable cardiac devices and surgical interventions, individuals with heart failure are living longer, which can place a significant strain on global healthcare resources. Heart failure nurses in a primary care setting offer a wealth of clinical knowledge and expertise across all phases of the heart failure trajectory and are able to support patients, family members and other community services, including general practitioners. This review examines the recently published evidence on the current and potential future practice of heart failure nurses within primary care.
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Affiliation(s)
- Loreena Hill
- School of Nursing and Midwifery, Queen's University BelfastBelfast, UK
- College of Nursing and Midwifery, Mohammed Bin Rashid UniversityDubai, United Arab Emirates
| | - Anne McNulty
- School of Nursing and Midwifery, Queen's University BelfastBelfast, UK
| | - James McMahon
- School of Nursing and Midwifery, Queen's University BelfastBelfast, UK
| | - Gary Mitchell
- School of Nursing and Midwifery, Queen's University BelfastBelfast, UK
| | - Cathy Farrell
- Errigal Chronic Disease Management Hub, LetterkennyDonegal, Ireland
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Wrocław Medical UniversityWrocław, Poland
- Institute of Heart Diseases, University HospitalWrocław, Poland
| | - Teresa Castiello
- Department of Cardiovascular Imaging, King's College LondonLondon, UK
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Ramamurthy S, Steven Brown L, Agostini M, Alick Lindstorm S, Dave H, Dieppa M, Ding K, Doyle A, Hays R, Harvey J, Perven G, Podkorytova I, Zepeda R, Das RR. Emergency department visits and readmissions in patients with psychogenic nonepileptic seizures (PNES) at a safety net hospital. Epilepsy Behav 2021; 122:108225. [PMID: 34352667 DOI: 10.1016/j.yebeh.2021.108225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Readmissions and emergency department (ED) visits after an index admission have been become a quality measure due to associations with poor outcomes and increased healthcare costs. Readmissions and ED encounters have been studied in a variety of conditions including epilepsy but have not been examined exclusively in psychogenic nonepileptic seizures (PNES). In this study we examined the rate of readmissions and ED visits after a discharge from an Epilepsy Monitoring Unit (EMU) in a safety net hospital. We also determined patient phenotypes that are associated with readmissions. MATERIAL AND METHODS This was a retrospective chart review study with index admission being a discharge from an EMU between January 1 and December 31 2016 with follow-up until August 31 2020. We obtained data regarding demographics, medical and psychiatric history, and social history and treatment interventions. Our outcome variables were both all-cause and seizure-related hospital readmissions and ED visits 30 days following the index discharge and readmissions and ED visits 30 days thereafter. RESULTS Eleven of 122 patients (9%) had a non-seizure-related ED visit and/or hospitalization within 30 days of index discharge while 45 (37%) had re-contact with the health system thereafter for non-seizure-related issues. Seven of 122 patients (6%) had a seizure-related ED visit or hospital readmission within 30 days of discharge. Twenty-eight (23%) had a seizure-related readmission or ED visit after 30 days. Of these 28, 4 patients had been to an ER within 7 days of EMU discharge. The majority of subsequent encounters with the healthcare system were through the ED (n = 38) as compared to hospital (n = 10) and EMU readmissions (n = 9). On bivariate statistical analysis, charity or self-pay insurance status (p < 0.01), homelessness (p < 0.01), emergent EMU admission on index admission (p < 0.01), history of a psychiatric diagnosis (p < 0.02), and ED encounters 12 months prior to admission (p < 0.01) were significantly associated with readmission; however, on multivariate analysis only charity insurance status was a significant predictor. CONCLUSIONS In this study of readmissions and ED visits after discharge with a diagnosis of PNES at a safety net hospital, we found a seizure-related readmission rate of approximately 6% in 30 days and 23% thereafter with the majority of re-contact with the hospital being in the ED. On multi-variate analysis insurance status was a significant factor associated with readmission and ED visits. Our future research directions include examining referrals and treatment completion at the hospital's PNES clinic as well as creating a risk score to better identify patients with PNES at risk of readmission.
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Affiliation(s)
- Swetha Ramamurthy
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd E1.202, Dallas, TX 75390, United States.
| | - L Steven Brown
- Biostatistics, Parkland Health and Hospital System, 5200 Harry Hines Blvd, Dallas, TX 75235, United States.
| | - Mark Agostini
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd E1.202, Dallas, TX 75390, United States.
| | - Sasha Alick Lindstorm
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd E1.202, Dallas, TX 75390, United States.
| | - Hina Dave
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd E1.202, Dallas, TX 75390, United States.
| | - Marisara Dieppa
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd E1.202, Dallas, TX 75390, United States.
| | - Kan Ding
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd E1.202, Dallas, TX 75390, United States.
| | - Alexander Doyle
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd E1.202, Dallas, TX 75390, United States.
| | - Ryan Hays
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd E1.202, Dallas, TX 75390, United States.
| | - Jay Harvey
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd E1.202, Dallas, TX 75390, United States.
| | - Ghazala Perven
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd E1.202, Dallas, TX 75390, United States.
| | - Irina Podkorytova
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd E1.202, Dallas, TX 75390, United States.
| | - Rodrigo Zepeda
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd E1.202, Dallas, TX 75390, United States.
| | - Rohit R Das
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd E1.202, Dallas, TX 75390, United States.
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