2
|
Camplain R, Kucharska-Newton A, Keyserling TC, Layton JB, Loehr L, Heiss G. Incidence of Heart Failure Observed in Emergency Departments, Ambulatory Clinics, and Hospitals. Am J Cardiol 2018; 121:1328-1335. [PMID: 29576231 PMCID: PMC5972069 DOI: 10.1016/j.amjcard.2018.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/29/2018] [Accepted: 02/06/2018] [Indexed: 12/29/2022]
Abstract
Reports on the burden of heart failure (HF) have largely omitted HF diagnosed in outpatient settings. We quantified annual incidence rates ([IR] per 1,000 person years) of HF identified in ambulatory clinics, emergency departments (EDs), and during hospital stays in a national probability sample of Medicare beneficiaries from 2008 to 2014, by age and race/ethnicity. A 20% random sample of Medicare beneficiaries ages ≥65 years with continuous Medicare Parts A, B, and D coverage was used to estimate annual IRs of HF identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Of the 681,487 beneficiaries with incident HF from 2008 to 2014, 283,451 (41%) presented in ambulatory clinics, 76,919 (11%) in EDs, and 321,117 (47%) in hospitals. Overall, incidence of HF in ambulatory clinics decreased from 2008 (IR 22.2, 95% confidence interval [CI] 22.0, 22.4) to 2014 (IR 15.0, 95% CI 14.8, 15.1). Similarly, incidence of HF-related ED visits without an admission to the hospital decreased somewhat from 2008 (IR 5.5, 95% CI 5.4, 5.6) to 2012 (IR 4.2, 95% CI 4.1, 4.3) and stabilized from 2013 to 2014. Similar to previous reports, HF hospitalizations, both International Classification of Diseases, Ninth Revision, Clinical Modification code 428.x in the primary and any position, decreased over the study period. More than half of all new cases of HF in Medicare beneficiaries presented in an ambulatory clinic or ED. The overall incidence of HF decreased from 2008 to 2014, regardless of health-care setting. In conclusion, consideration of outpatient HF is warranted to better understand the burden of HF and its temporal trends.
Collapse
Affiliation(s)
- Ricky Camplain
- Northern Arizona University, Center for Health Equity Research, Flagstaff, Arizona; The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina.
| | - Anna Kucharska-Newton
- The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina
| | - Thomas C Keyserling
- The University of North Carolina at Chapel Hill, Department of Medicine, Chapel Hill, North Carolina
| | - J Bradley Layton
- The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina; RTI Health Solutions, Research Triangle Park, North Carolina
| | - Laura Loehr
- The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina
| | - Gerardo Heiss
- The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina
| |
Collapse
|
3
|
Miró Ò, Gil V, Xipell C, Sánchez C, Aguiló S, Martín-Sánchez FJ, Herrero P, Jacob J, Mebazaa A, Harjola VP, Llorens P. IMPROV-ED study: outcomes after discharge for an episode of acute-decompensated heart failure and comparison between patients discharged from the emergency department and hospital wards. Clin Res Cardiol 2016; 106:369-378. [PMID: 28005170 DOI: 10.1007/s00392-016-1065-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/15/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To define the short- and mid-term outcomes of patients discharged after an episode of acute-decompensated heart failure (ADHF) and evaluate the differences between patients discharged directly from the emergency department (ED) and those discharged after hospitalization. METHODS We performed a prospective, multicenter, cohort-designed study, including consecutive patients diagnosed with ADHF in 27 Spanish EDs. Thirty-four variables on epidemiology, comorbidity, baseline status, vital signs, signs of congestion, laboratory tests, and treatment were collected in every patient. The primary outcome was a combined endpoint of ED revisit (without hospitalization) or hospitalization due to ADHF, or all-cause death. Secondary outcomes were each of these three events individually. Outcomes were obtained by survival analysis at different timepoints in the entire cohort, and crude and adjusted comparisons were carried out between patients discharged directly from the ED and after hospitalization. RESULTS Of the 3233 patients diagnosed with ADHF during a 2-month period, we analyzed 2986 patients discharged alive: 787 (26.4%) discharged from the ED and 2199 (73.6%) after hospitalization. The cumulative percentages of events for the whole cohort (at 7/30/180 days) for the combined endpoint were 7.8/24.7/57.8; for ED revisit 2.5/9.4/25.5; for hospitalization 4.6/15.3/40.7; and for death 0.9/4.3/16.8. After adjustment for patient profile and center, significant increases were found in the hazard ratios for ED- compared to hospital-discharged patients in the combined endpoint, ED revisit and hospitalization, being higher at short-term [at 7 days, 2.373 (1.678-3.355), 2.069 (1.188-3.602), and 3.071 (1.915-4.922), respectively] than at mid-term [at 180 days, 1.368 (1.160-1.614), 1.642 (1.265-2.132), and 1.302 (1.044-1.623), respectively]. No significant differences were found in death. CONCLUSIONS Patients with ADHF discharged from the ED have worse outcomes, especially at short term, than those discharged after hospitalization. The definition and implementation of effective strategies to improve patient selection for direct ED discharge are needed.
Collapse
Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Catalonia, Spain. .,"Emergencies: Processes and Pathologies" Research Group, IDIBAPS, Villarroel 170, 08036, Barcelona, Catalonia, Spain.
| | - Víctor Gil
- Emergency Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Catalonia, Spain. .,"Emergencies: Processes and Pathologies" Research Group, IDIBAPS, Villarroel 170, 08036, Barcelona, Catalonia, Spain.
| | - Carolina Xipell
- Emergency Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Catalonia, Spain.,"Emergencies: Processes and Pathologies" Research Group, IDIBAPS, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Carolina Sánchez
- Emergency Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Catalonia, Spain.,"Emergencies: Processes and Pathologies" Research Group, IDIBAPS, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Sira Aguiló
- Emergency Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Catalonia, Spain.,"Emergencies: Processes and Pathologies" Research Group, IDIBAPS, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Francisco J Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Madrid, Universidad Complutense de Madrid, Madrid, Spain
| | - Pablo Herrero
- Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care Medicine, Hospital Lariboisière, U942 Inserm, Université Paris Diderot, Paris, France
| | - Veli-Pekka Harjola
- Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University, Helsinki University Hospital, Helsinki, Finland
| | - Pere Llorens
- Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain
| | | |
Collapse
|
4
|
Linn AC, Azzolin K, Souza END. Associação entre autocuidado e reinternação hospitalar de pacientes com insuficiência cardíaca. Rev Bras Enferm 2016; 69:500-6. [DOI: 10.1590/0034-7167.2016690312i] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 12/26/2015] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: verificar associação entre o autocuidado e o número de reinternações hospitalares de pacientes com diagnóstico de insuficiência cardíaca (IC) descompensada, bem como testar a aplicabilidade de dois instrumentos de avaliação de autocuidado. Estudo longitudinal, realizado em um hospital de referência cardiológica do sul do Brasil. Método: foram incluídos 82 pacientes, com idade média de 61,85±12,33 anos, 57,3% do sexo masculino. O escore médio da avaliação de autocuidado encontrado pelas escalas European Heart Failure Self-care Behavior Scale e a Escala de Autocuidado para Pacientes com Insuficiência Cardíaca foi insatisfatório. Resultados: foi verificada uma média de 2,57±1,66 reinternações hospitalares no último ano por descompensação da IC. Houve correlação entre os escores de autocuidado com número de reinternações hospitalares por IC descompensada. Escolaridade e idade mostraram-se associadas ao autocuidado dos pacientes com IC. Conclusão: ambas as escalas avaliam o autocuidado de forma relevante, sendo correlacionados os seus índices.
Collapse
Affiliation(s)
| | - Karina Azzolin
- Fundação Universitária de Cardiologia do Rio Grande do Sul, Brasil; Universidade Federal do Rio Grande do Sul, Brazil
| | - Emiliane Nogueira de Souza
- Fundação Universitária de Cardiologia do Rio Grande do Sul, Brasil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| |
Collapse
|
5
|
de Souza EN, Rohde LE, Ruschel KB, Mussi CM, Beck-da-Silva L, Biolo A, Clausell N, Rabelo-Silva ER. A nurse-based strategy reduces heart failure morbidity in patients admitted for acute decompensated heart failure in Brazil: the HELEN-II clinical trial. Eur J Heart Fail 2014; 16:1002-8. [DOI: 10.1002/ejhf.125] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/02/2014] [Accepted: 05/28/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Emiliane Nogueira de Souza
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences; Federal University of Rio Grande do Sul; Porto Alegre RS Brazil
- Instituto de Cardiologia-Fundação Universitária de Cardiologia; Porto Alegre RS Brazil
| | - Luis Eduardo Rohde
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences; Federal University of Rio Grande do Sul; Porto Alegre RS Brazil
- Heart Failure and Transplant Group; Cardiovascular Division, Hospital de Clínicas de Porto Alegre; Porto Alegre RS Brazil
| | - Karen Brasil Ruschel
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences; Federal University of Rio Grande do Sul; Porto Alegre RS Brazil
| | - Cláudia Mota Mussi
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences; Federal University of Rio Grande do Sul; Porto Alegre RS Brazil
- Heart Failure and Transplant Group; Cardiovascular Division, Hospital de Clínicas de Porto Alegre; Porto Alegre RS Brazil
| | - Luis Beck-da-Silva
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences; Federal University of Rio Grande do Sul; Porto Alegre RS Brazil
- Heart Failure and Transplant Group; Cardiovascular Division, Hospital de Clínicas de Porto Alegre; Porto Alegre RS Brazil
| | - Andréia Biolo
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences; Federal University of Rio Grande do Sul; Porto Alegre RS Brazil
- Heart Failure and Transplant Group; Cardiovascular Division, Hospital de Clínicas de Porto Alegre; Porto Alegre RS Brazil
| | - Nadine Clausell
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences; Federal University of Rio Grande do Sul; Porto Alegre RS Brazil
- Heart Failure and Transplant Group; Cardiovascular Division, Hospital de Clínicas de Porto Alegre; Porto Alegre RS Brazil
| | - Eneida Rejane Rabelo-Silva
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences; Federal University of Rio Grande do Sul; Porto Alegre RS Brazil
- Heart Failure and Transplant Group; Cardiovascular Division, Hospital de Clínicas de Porto Alegre; Porto Alegre RS Brazil
- Nursing School of the Federal University of Rio Grande Do Sul; Porto Alegre RS Brazil
| |
Collapse
|
7
|
Pöss J, Link A, Böhm M. Pharmacological treatment of acute heart failure: current treatment and new targets. Clin Pharmacol Ther 2013; 94:499-508. [PMID: 23863875 DOI: 10.1038/clpt.2013.136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 07/07/2013] [Indexed: 01/11/2023]
Abstract
Acute heart failure (AHF) is defined as the rapid onset of, or changes in, the symptoms and signs of heart failure (HF). It is a life-threatening situation in which diagnosis and initiation of therapy are crucial. The treatment aims are to stabilize the patient, improve clinical symptoms, and increase long-term survival rates. Few treatments have been investigated in clinical trials. This review summarizes the principles of pharmacologic treatment, the underlying clinical trials, and new pharmacologic targets.
Collapse
Affiliation(s)
- J Pöss
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Homburg/Saar, Germany
| | | | | |
Collapse
|
9
|
Abstract
Acute decompensated heart failure (ADHF) is a major public health problem throughout the world and its importance is continuing to grow. This article reviews the epidemiology of ADHF and the profile of patients suffering from this condition. It describes factors used in assessing prognosis and presents treatment options. Although no currently available treatments have been shown to favorably affect long-term outcomes, there are a variety of strategies and approaches to management that are expected to reduce morbidity and mortality following discharge after ADHF hospitalization. In particular, the clinician is alerted to the need to identify factors that trigger decompensation as well as to optimize treatments for chronic heart failure. The importance of the transition from hospital to the outpatient setting is described. Particular attention should be focused on providing health education to the patient and their family at an appropriate level of medical literacy as well as ensuring early follow-up evaluation after hospital discharge.
Collapse
Affiliation(s)
- Barry Greenberg
- Advanced Heart Failure Treatment Program, Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California at San Diego, CA 92093, USA.
| |
Collapse
|