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Mahmoudi Z, Chenaghlou M, Zare H, Safaei N, Yousefi M. Heart failure: a prevalence-based and model-based cost analysis. Front Cardiovasc Med 2023; 10:1239719. [PMID: 38107256 PMCID: PMC10722181 DOI: 10.3389/fcvm.2023.1239719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/08/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Heart failure (HF) imposes a heavy economic burden on patients, their families, and society as a whole. Therefore, it is crucial to quantify the impact and dimensions of the disease in order to prioritize and allocate resources effectively. Methods This study utilized a prevalence-based, bottom-up, and incidence-based Markov model to assess the cost of illness. A total of 502 HF patients (classes I-IV) were recruited from Madani Hospital in Tabriz between May and October 2022. Patients were followed up every two months for a minimum of two and a maximum of six months using a person-month measurement approach. The perspective of the study was societal, and both direct and indirect costs were estimated. Indirect costs were calculated using the Human Capital (HC) method. A two-part regression model, consisting of the Generalized Linear Model (GLM) and Probit model, was used to analyze the relationship between HF costs and clinical and demographic variables. Results The total cost per patient in one year was 261,409,854.9 Tomans (21,967.21 PPP). Of this amount, 207,147,805.8 Tomans (17,407.38 PPP) (79%) were indirect costs, while 54,262,049.09 Tomans (4,559.84 PPP) (21%) were direct costs. The mean lifetime cost was 2,173,961,178 Tomans. Premature death accounted for the highest share of lifetime costs (48%), while class III HF had the lowest share (2%). Gender, having basic insurance, and disease class significantly influenced the costs of HF, while comorbidity and age did not have a significant impact. The predicted amount closely matched the observed amount, indicating good predictive power. Conclusion This study revealed that HF places a significant economic burden on patients in terms of both direct and indirect costs. The substantial contribution of indirect costs, which reflect the impact of the disease on other sectors of the economy, highlights the importance of unpaid work. Given the significant variation in HF costs among assessed variables, social and financial support systems should consider these variations to provide efficient and fair support to HF patients.
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Affiliation(s)
- Zahra Mahmoudi
- Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Chenaghlou
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Naser Safaei
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmood Yousefi
- Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Verweij L, Petri ACM, MacNeil-Vroomen JL, Jepma P, Latour CHM, Peters RJG, Scholte op Reimer WJM, Buurman BM, Bosmans JE. The Cardiac Care Bridge transitional care program for the management of older high-risk cardiac patients: An economic evaluation alongside a randomized controlled trial. PLoS One 2022; 17:e0263130. [PMID: 35085361 PMCID: PMC8794155 DOI: 10.1371/journal.pone.0263130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/09/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the cost-effectiveness of the Cardiac Care Bridge (CCB) nurse-led transitional care program in older (≥70 years) cardiac patients compared to usual care. Methods The intervention group (n = 153) received the CCB program consisting of case management, disease management and home-based cardiac rehabilitation in the transition from hospital to home on top of usual care and was compared with the usual care group (n = 153). Outcomes included a composite measure of first all-cause unplanned hospital readmission or mortality, Quality Adjusted Life Years (QALYs) and societal costs within six months follow-up. Missing data were imputed using multiple imputation. Statistical uncertainty surrounding Incremental Cost-Effectiveness Ratios (ICERs) was estimated by using bootstrapped seemingly unrelated regression. Results No significant between group differences in the composite outcome of readmission or mortality nor in societal costs were observed. QALYs were statistically significantly lower in the intervention group, mean difference -0.03 (95% CI: -0.07; -0.02). Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective was 0.31 at a Willingness To Pay (WTP) of €0,00 and 0.14 at a WTP of €50,000 per composite outcome prevented and 0.32 and 0.21, respectively per QALY gained. Conclusion The CCB program was on average more expensive and less effective compared to usual care, indicating that the CCB program is dominated by usual care. Therefore, the CCB program cannot be considered cost-effective compared to usual care.
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Affiliation(s)
- Lotte Verweij
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Adrianne C. M. Petri
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Janet L. MacNeil-Vroomen
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Patricia Jepma
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Corine H. M. Latour
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Ron J. G. Peters
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wilma J. M. Scholte op Reimer
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Research Group Chronic Diseases, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Bianca M. Buurman
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Judith E. Bosmans
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Teimourizad A, Rezapour A, Sadeghian S, Tajdini M. Cost-effectiveness of cardiac resynchronization therapy plus an implantable cardioverter-defibrillator in patients with heart failure: a systematic review. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:31. [PMID: 34020661 PMCID: PMC8139093 DOI: 10.1186/s12962-021-00285-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Heart failure (HF) is an unusual heart function that causes reduction in cardiac or pulmonary output. Cardiac resynchronization therapy (CRT) is a mechanical device that helps to recover ventricular dysfunction by pacing the ventricles. This study planned to systematically review cost-effectiveness of CRT combined with an implantable cardioverter-defibrillator (ICD) versus ICD in patients with HF. METHODS We used five databases (NHS Economic Evaluation Database, Cochrane Library, Medline, PubMed, and Scopus) to systematically reviewed studies published in the English language on the cost-effectiveness of CRT with defibrillator (CRT-D) Vs. ICD in patients with HF over 2000 to 2020. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was applied to assess the quality of the selected studies. RESULTS Five studies reporting the cost-effectiveness of CRT-D vs ICD were finally identified. The results revealed that time horizon, direct medical costs, type of model, discount rate, and sensitivity analysis obviously mentioned in almost all studies. All studies used quality-adjusted life years (QALYs) as an effectiveness measurement. The highest and the lowest Incremental cost-effectiveness ratio (ICER) were reported in the USA ($138,649per QALY) and the UK ($41,787per QALY), respectively. CONCLUSION Result of the study showed that CRT-D compared to ICD alone was the most cost-effective treatment in patients with HF.
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Affiliation(s)
- Abedin Teimourizad
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Saeed Sadeghian
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masih Tajdini
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Fomin IV, Vinogradova NG, Polyakov DS, Pogrebetskaya VA. Experience of introducing a new form of organization of medical care for patients with heart failure in the Russian Federation. ACTA ACUST UNITED AC 2021; 61:42-51. [PMID: 33849418 DOI: 10.18087/cardio.2021.3.n1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/27/2021] [Indexed: 11/18/2022]
Abstract
Aim To present clinical characteristics of patients after hospitalization for acute decompensated heart failure (ADHF) and to analyze hemodynamic indexes and compliance with the treatment at two years depending on the conditions of outpatient follow-up.Material and methods The study included 942 patients with chronic heart failure (CHF) older than 18 years who had been hospitalized for ADHF. Based on patients' decisions, two groups were isolated: patients who continued the outpatient follow-up at the Center of CHF (CCHF) (group 1, n=510) and patients who continued the follow-up in outpatient multidisciplinary clinics (OMC) at their place of residence (group 2, n=432). The clinical portrait of patients was evaluated after ADHF, and hemodynamic parameters were evaluated on discharge from the hospital. Also, the patient compliance with the treatment was analyzed during two years of follow-up. Statistical analysis was performed with Statistica 7.0 for Windows.Results The leading causes for CHF included arterial hypertension, ischemic heart disease, atrial fibrillation, and type 2 diabetes mellitus. With the mean duration of hospitalization of 11 inpatient days, 88.1 % and 88.4 % of patients of groups 1 and 2 were discharged with complaints of shortness of breath; 62 % and 70.4 % complained of palpitations; and 73.6 % and 71.8 % complained of general weakness. On discharge from the hospital, the following obvious signs of congestion remained: peripheral edema in 54.3 % and 57.9 %; pulmonary rales in 28.8 % and 32.4 %; orthopnea in 21.4 % and 26.2 %; and cough in 16,5 % and 15.5 % of patients of groups 1 and 2, respectively. For the time of hospitalization, CHF patients did not achieve their targets of systolic BP (SBP), diastolic BP (DBP) and heart rate (HR). Patients of group 1 achieved the recommended values of SBP, DBP and HR already at one year of the follow-up at CCHF. Patients of group 2 had no significant changes in hemodynamic indexes. At one and two years of the follow-up, group 2 showed a considerable impairment of the compliance with the basis therapy for CHF compared to group 1.Conclusions During the short period of hospitalization (11 inpatient days), the patients retained pronounced symptoms of HF and clinical signs of congestion and did not achieve their hemodynamic targets. The patients who were followed up for a long time at CCHF were more compliant with the basis therapy, which resulted in improvement of hemodynamic indexes, compared to the patients who were managed in OMS at the place of residence.
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Affiliation(s)
- I V Fomin
- Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia
| | - N G Vinogradova
- Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia City Clinical Hospital #38, Nizhny Novgorod, Russia
| | - D S Polyakov
- Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia
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Vinogradova NG. [The prognosis of patients with chronic heart failure, depending on adherence to observation in a specialized heart failure treatment center]. ACTA ACUST UNITED AC 2019; 59:13-21. [PMID: 31876458 DOI: 10.18087/cardio.n613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/11/2019] [Indexed: 11/18/2022]
Abstract
Actuality. The risk of death of patients with chronic heart failure (CHF) after acute decompensation of heart failure (ADHF) is directly related to the quality of the treatment of CHF after discharge from the hospital. In order to achieve the maximum effect of therapy in patients with CHF, experts in Europe and the USA recommend the creation of centers of specialized medical care for patients with CHF. Objective: to determine the risks of general, cardiovascular mortality and death from ADHF in patients with CHF during two years of observation, depending on their adherence to observation in a specialized center for the treatment of chronic heart failure (center CHF). Materials and methods. The study consistently included 942 patients with CHF after ADHF. The adherence of patients to follow up in center CHF was analyzed and 4 groups were distinguished: group 1 (n = 313) included patients who were observed continuously for two years; group 2 (n = 382) included patients who, after discharge, had never been observed in the center CHF; group 3 (n = 197) consisted of patients who were monitored at center CHF during the first year and then discontinued, and group 4 (n = 49) united patients who, when included in the study, abandoned observation, but after a year began to be constantly observed during the second year center CHF. Results. Statistically significant differences in age were registered only between groups 1 and 2 (69.6+9.9 and 71.8+11 years, respectively, р1/2=0.006). The overall mortality over the 2 years of follow-up was significantly higher in group 2 (32.4%) versus group 1 (1.2%, OR=3.8, 95% CI 2.5-5.7; p1/2<0.001 ); compared with group 3 (9.1%, OR=4.8, 95% CI 2.8-8.1; p2/3<0.001) and group 4 (8,2%, OR = 5.4, 95% CI 1.9-15.3; p2/4=0.0005). Cardiovascular mortality (CVM) for 2 years of follow-up was significantly higher in group 2 versus group 1 (8.1% and 1.3% of cases, OR=6.8, 95% CI 2.4-19.5; p1/2<0.001), as well as in comparison with group 3 (CVM 3% for 2 years, OR=2.8, 95% CI 1.1-6.8; p2/3=0.02). CVM in group 4 (6.1%) was 5 times higher in comparison with group 1 (OR=5.0, 95% CI 1.1-23.2; p1/4=0.02). The risks of death from ADHF over the 2 years of follow-up were significantly higher in group 2 (16.4%) compared with all groups: with group 1 (6.4%) OR=2.9, 95% CI 1.7-4, 9, p1/2<0.001; with group 3 (5.1%) OR=3.7, 95% CI 1.8-7.3, p2/3<0.001; and with group 4 (2%) OR=9.5, 95% CI 1.3-69.7, p2/4= 0.008. The combined endpoint (CVM and death from ADHF in 2 years of follow-up) was also significantly higher in group 2 (24.5%) compared with all compared groups: group 1 (7.7%), OR=3.9, 95% CI 2.4-6.3, p1/2<0.001; group 3 (8.1%), OR=3.7, 95% CI 2.1-6.5, p2/3<0.001; and group 4 (8.2%), OR=3.7, 95% CI 1.3-10.4; p2/4=0.01. Conclusion. Surveillance of patients with CHF after an episode of ADHF in a specialized center CHF, both for a long time (two years) and partially during the first year of observation, reduces the risk of all-cause death, CVM and death from ADHF.
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Affiliation(s)
- N G Vinogradova
- Privolzhsky Research Medical University; Municipal Clinical Hospital #38
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6
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Vinogradova NG. City Center for the Treatment of Chronic Heart Failure: the organiza-tion of work and the effectiveness of treatment of patients with chronic heart failure. ACTA ACUST UNITED AC 2019; 59:31-39. [PMID: 30853011 DOI: 10.18087/cardio.2621] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 11/18/2022]
Abstract
Actuality. In the Russian Federation, there has been an increase in the number of patients with chronic heart failure (CHF) of the III-IV functional class, who are characterized by frequent development of acute decompensation of СHF and frequent repeated hospitalizations. This dictates the need to create a system of effective control over the conduct of drug therapy and physical rehabilitation after discharge from the hospital at the outpatient stage. OBJECTIVE to identify the differences between the two strategies for monitoringatients with CHF after decompensation and to determine the effectiveness of treatment, rehabilitation measures and life prognosis depending on the observation in the system of the specialized City Center for Treatment of CHF (Heart failure clinic) and in real outpatient practice. MATERIALS AND METHODS The study included 648 patients hospitalized with decompensation in the inpatient unit of the Center for Treatment CHF. Group 1 consisted of 412 patients who, after discharge, continued rehabilitation and follow-up in the outpatient department of the Center for Treatment CHF. Group 2-326 patients who, after discharge, preferred observation in another outpatient departments of Nizhny Novgorod. RESULTS After 1 year of observation, the overall mortality rate in group 2 was 14.83 %, and in group 1-4.13 %, (odds ratio (OR) = 4.0, 95 % confidence interval (CI) 2.2-7.4; p <0.001). Cardiovascular mortality was also higher in group 2: 11.4 % versus 3.3 % (OR = 3.8, 95 % CI 2.0-7.4; p <0.001), as well as mortality from decompensation: 7.6 % versus 2.1 % (OR = 3.8, 95 % CI 1.7-8.7; p <0.001). In group 2, non-fatal cardiovascular complications were more common: 5.1 % versus 1.6 % (OR = 3.2, 95 % CI 1.2-8.3; p = 0.01), as well as fatal and nonfatal stroke, pulmonary thromboembolism, venous thromboembolic complications - 6.3 % versus 1.4 % (OR = 4.4, 95 % CI 1, 7-11.6; p <0.001). An increase in the proportion of rehospitalized patients with CHF during the year in group 2 compared with group 1 was recorded: 50.3 % and 31.8 % of patients, respectively (OR = 2.2, 95 % CI 1.5-3.2; p<0.001). Physical activity of patients who were observed in Center for Treatment CHF the was significantly higher than among patients who were treated in another outpatient departments. CONCLUSION Management of patients with CHF after decompensation in Heart failure clinic showed better results in comparison with the standard approach: the risks of general, cardiovascular mortality and nonfatal cardiovascular complications were statistically significantly lower. Patients with CHF who refused to be seen at Heart failure clinic were more often hospitalized again during the year.
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Karamichalakis N, Parissis J, Bakosis G, Bistola V, Ikonomidis I, Sideris A, Filippatos G. Implantable devices to monitor patients with heart failure. Heart Fail Rev 2018; 23:849-857. [PMID: 30284661 DOI: 10.1007/s10741-018-9742-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Reducing heart failure hospitalizations represents a major challenge for modern clinicians. Early detection of congestion plays a key role in disease management strategy. Apart from traditional methods (patient reporting symptoms, body weight monitoring), novel home-care strategies allow guided adjustments in medical therapy through telemonitoring embedded in cardiac electronic implantable devices or through stand-alone diagnostic devices for hemodynamic monitoring. Wireless pulmonary artery pressure monitoring seems to reduce re-admission risk and is currently approved for this purpose in patients with heart failure. Multiparameter monitoring is also appealing and could be a valuable tool in managing these patients. However, invasive techniques face several safety concerns and cost-effectiveness issues. Therefore, quest for future research and emerging technologies is necessary.
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Affiliation(s)
| | - John Parissis
- Attikon General University Hospital, 1 Rimini Str, 122 43, Chaidari, Greece
| | - George Bakosis
- Attikon General University Hospital, 1 Rimini Str, 122 43, Chaidari, Greece
| | - Vasiliki Bistola
- Attikon General University Hospital, 1 Rimini Str, 122 43, Chaidari, Greece
| | | | - Antonios Sideris
- Evangelismos General Hospital, 45-47 Ipsilantou Str., 10676, Athens, Greece
| | - Gerasimos Filippatos
- Attikon General University Hospital, 1 Rimini Str, 122 43, Chaidari, Greece.,Medical School, University of Cyprus, University House "Anastasios G. Leventis", 1 Panepistimiou Avenue, 2109 Aglantzia, Nicosia, P.O. Box 20537, 1678, Nicosia, Cyprus
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Cost-effectiveness of a follow-up program for older patients with heart failure: a randomized controlled trial. Eur Geriatr Med 2018; 9:523-532. [PMID: 34674493 DOI: 10.1007/s41999-018-0074-y] [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: 02/16/2018] [Accepted: 05/28/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE To assess the cost-utility of adding a disease management program (DMP) delivered by geriatric day hospital (GDH) for older patients with heart failure (HF) after hospital discharge. METHODS 117 older HF patients discharged by a geriatric service were randomly assigned to DMP (n = 59) and usual care (UC) (n = 58) groups. The DMP group received health education, therapeutic control and monitoring through both telephone contacts and face-to-face visits at the GDH for 12 months. The UC group received standard health care. The main outcome measures were the costs from the health-care system and societal perspectives and quality-adjusted life-years (QALYs) using EuroQol (EQ-5D-3L). The cost-effectiveness analysis used the package ICEinfer in R 2.13.0. RESULTS The mean age was 85 years, and 73% of the patients were women. The mean values of QALYs after 12 months were - 0.083 in DMP and - 0.154 in UC. Each extra QALY gained by the DMP relative to usual care cost was €38,274 and €25,390 from health-care or societal perspective, respectively. An investment of €44,000/QALY (Spanish Health System Threshold) showed a 91 and 85% of probability to be cost-effective from health-care and societal perspectives. CONCLUSION The intervention was moderately cost-effective in delaying deaths and preserving the loss of health-related quality of life in older patients with HF. The study was internationally registered with the ISRCTN10823032.
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Smeets CJ, Storms V, Vandervoort PM, Dreesen P, Vranken J, Houbrechts M, Goris H, Grieten L, Dendale P. A Novel Intelligent Two-Way Communication System for Remote Heart Failure Medication Uptitration (the CardioCoach Study): Randomized Controlled Feasibility Trial. JMIR Cardio 2018; 2:e8. [PMID: 31758773 PMCID: PMC6834244 DOI: 10.2196/cardio.9153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/19/2017] [Accepted: 01/02/2018] [Indexed: 12/16/2022] Open
Abstract
Background European Society of Cardiology guidelines for the treatment of heart failure (HF) prescribe uptitration of angiotensin-converting enzyme inhibitors (ACE-I) and β-blockers to the maximum-tolerated, evidence-based dose. Although HF prognosis can drastically improve when correctly implementing these guidelines, studies have shown that they are insufficiently implemented in clinical practice. Objective The aim of this study was to verify whether supplementing the usual care with the CardioCoach follow-up tool is feasible and safe, and whether the tool is more efficient in implementing the guideline recommendations for β-blocker and ACE-I. Methods A total of 25 HF patients were randomly assigned to either the usual care control group (n=10) or CardioCoach intervention group (n=15), and observed for 6 months. The CardioCoach follow-up tool is a two-way communication platform with decision support algorithms for semiautomatic remote medication uptitration. Remote monitoring sensors automatically transmit patient’s blood pressure, heart rate, and weight on a daily basis. Results Patients’ satisfaction and adherence for medication intake (10,018/10,825, 92.55%) and vital sign measurements (4504/4758, 94.66%) were excellent. However, the number of technical issues that arose was large, with 831 phone contacts (median 41, IQR 32-65) in total. The semiautomatic remote uptitration was safe, as there were no adverse events and no false positive uptitration proposals. Although no significant differences were found between both groups, a higher number of patients were on guideline-recommended medication dose in both groups compared with previous reports. Conclusions The CardioCoach follow-up tool for remote uptitration is feasible and safe and was found to be efficient in facilitating information exchange between care providers, with high patient satisfaction and adherence. Trial Registration ClinicalTrials.gov NCT03294811; https://clinicaltrials.gov/ct2/show/NCT03294811 (Archived by WebCite at http://www.webcitation.org/6xLiWVsgM)
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Affiliation(s)
- Christophe Jp Smeets
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Valerie Storms
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Pieter M Vandervoort
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Pauline Dreesen
- Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Julie Vranken
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | | | - Hanne Goris
- Department of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Lars Grieten
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Paul Dendale
- Department of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
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Moertl D, Altenberger J, Bauer N, Berent R, Berger R, Boehmer A, Ebner C, Fritsch M, Geyrhofer F, Huelsmann M, Poelzl G, Stefenelli T. Disease management programs in chronic heart failure : Position statement of the Heart Failure Working Group and the Working Group of the Cardiological Assistance and Care Personnel of the Austrian Society of Cardiology. Wien Klin Wochenschr 2017; 129:869-878. [PMID: 29080104 PMCID: PMC5711993 DOI: 10.1007/s00508-017-1265-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 08/17/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Deddo Moertl
- Department of Internal Medicine 3, University Hospital St. Poelten, Karl Landsteiner Private University, St. Poelten, Austria.
- Institute for Research of Ischaemic Cardiac Diseases and Rhythmology, Karl Landsteiner Society, St. Pölten, Austria.
| | - Johann Altenberger
- Rehabilitation Center, Lehrkrankenhaus der PMU, Pensionsversicherung Grossgmain, Grossgmain, Austria
- Heart Failure Working Group, Austrian Society for Cardiology, Vienna, Austria
| | - Norbert Bauer
- Department of Internal Medicine, Hospital Hartberg, Hartberg, Styria, Austria
- Heart Failure Working Group, Austrian Society for Cardiology, Vienna, Austria
| | - Robert Berent
- Center for Cardiovascular Rehabilitation, Bad Ischl, Upper Austria, Austria
- Heart Failure Working Group, Austrian Society for Cardiology, Vienna, Austria
| | - Rudolf Berger
- Department for Internal Medicine I, Convent Hospital Barmherzige Brueder, Eisenstadt, Burgenland, Austria
- Heart Failure Working Group, Austrian Society for Cardiology, Vienna, Austria
| | - Armin Boehmer
- Department of Internal Medicine 1, University Clinic Krems, Krems, Lower Austria, Austria
- Heart Failure Working Group, Austrian Society for Cardiology, Vienna, Austria
| | - Christian Ebner
- Department of Internal Medicine 2, Convent Hospital Elisabethinen, Linz, Upper Austria, Austria
- Heart Failure Working Group, Austrian Society for Cardiology, Vienna, Austria
| | - Margarethe Fritsch
- Working Group for Preventive Medicine (AVOS), Salzburg, Austria
- Working Group of the Cardiological Assistance and Care Personnel, Austrian Society of Cardiology, Vienna, Austria
| | - Friedrich Geyrhofer
- Department of Internal Medicine 2, Convent Hospital Elisabethinen, Linz, Upper Austria, Austria
- Working Group of the Cardiological Assistance and Care Personnel, Austrian Society of Cardiology, Vienna, Austria
| | - Martin Huelsmann
- University Clinic of Internal Medicine II, Medical University Vienna, Vienna, Austria
- Heart Failure Working Group, Austrian Society for Cardiology, Vienna, Austria
| | - Gerhard Poelzl
- University Clinic of Internal Medicine III, Medical University Innsbruck, Innsbruck, Tyrol, Austria
- Heart Failure Working Group, Austrian Society for Cardiology, Vienna, Austria
| | - Thomas Stefenelli
- Department of Internal Medicine 1, Donauspital/SMZ Ost, Vienna, Austria
- Heart Failure Working Group, Austrian Society for Cardiology, Vienna, Austria
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Maru S, Byrnes JM, Carrington MJ, Stewart S, Scuffham PA. Long-term cost-effectiveness of home versus clinic-based management of chronic heart failure: the WHICH? study. J Med Econ 2017; 20:318-327. [PMID: 27841726 DOI: 10.1080/13696998.2016.1261031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The cost-effectiveness of a heart failure management intervention can be further informed by incorporating the expected benefits and costs of future survival. METHODS This study compared the long-term costs per quality-adjusted life year (QALY) gained from home-based (HBI) vs specialist clinic-based intervention (CBI) among elderly patients (mean age = 71 years) with heart failure discharged home (mean intervention duration = 12 months). Cost-utility analysis was conducted from a government-funded health system perspective. A Markov cohort model was used to simulate disease progression over 15 years based on initial data from a randomized clinical trial (the WHICH? study). Time-dependent hazard functions were modeled using the Weibull function, and this was compared against an alternative model where the hazard was assumed to be constant over time. Deterministic and probabilistic sensitivity analyses were conducted to identify the key drivers of cost-effectiveness and quantify uncertainty in the results. RESULTS During the trial, mortality was the highest within 30 days of discharge and decreased thereafter in both groups, although the declining rate of mortality was slower in CBI than HBI. At 15 years (extrapolated), HBI was associated with slightly better health outcomes (mean of 0.59 QALYs gained) and mean additional costs of AU$13,876 per patient. The incremental cost-utility ratio and the incremental net monetary benefit (vs CBI) were AU$23,352 per QALY gained and AU$15,835, respectively. The uncertainty was driven by variability in the costs and probabilities of readmissions. Probabilistic sensitivity analysis showed HBI had a 68% probability of being cost-effective at a willingness-to-pay threshold of AU$50,000 per QALY. CONCLUSION Compared with CBI (outpatient specialized HF clinic-based intervention), HBI (home-based predominantly, but not exclusively) could potentially be cost-effective over the long-term in elderly patients with heart failure at a willingness-to-pay threshold of AU$50,000/QALY, albeit with large uncertainty.
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Affiliation(s)
- Shoko Maru
- a Centre for Applied Health Economics, School of Medicine and Population & Social Health Research, Menzies Health Institute Queensland, Griffith University , Nathan , QLD , Australia
| | - Joshua M Byrnes
- a Centre for Applied Health Economics, School of Medicine and Population & Social Health Research, Menzies Health Institute Queensland, Griffith University , Nathan , QLD , Australia
| | - Melinda J Carrington
- b Centre for Primary Care and Prevention, Mary MacKillop Institute for Health Research, Australian Catholic University , Melbourne , Victoria , Australia
| | - Simon Stewart
- c Centre for Research Excellence to Reduce Inequality in Heart Disease, Mary MacKillop Institute for Health Research, Australian Catholic University , Melbourne Victoria , Australia
| | - Paul A Scuffham
- a Centre for Applied Health Economics, School of Medicine and Population & Social Health Research, Menzies Health Institute Queensland, Griffith University , Nathan , QLD , Australia
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Holst M, Willenheimer R, Mårtensson J, Lindholm M, Strömberg A. Telephone Follow-Up of Self-Care Behaviour after a Single Session Education of Patients with Heart Failure in Primary Health Care. Eur J Cardiovasc Nurs 2016; 6:153-9. [PMID: 16928469 DOI: 10.1016/j.ejcnurse.2006.06.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Revised: 06/26/2006] [Accepted: 06/28/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Improved self-care behaviour is a goal in educational programmes for patients with heart failure, especially in regard to daily self-weighing and salt and fluid restriction. AIMS The objectives of the present study were to: (1) describe self-care with special regard to daily self-weighing and salt and fluid restriction in patients with heart failure in primary health care, during one year of monthly telephone follow-up after a single session education, (2) to describe gender differences in regard to self-care and (3) to investigate if self-care was associated with health-related quality of life. METHODS The present analysis is a subgroup analysis of a larger randomised trial. After one intensive educational session, a primary health care nurse evaluated 60 patients (mean age 79 years, 52% males, 60% in New York Heart Association class III-IV) by monthly telephone follow-up during 12 months. RESULTS The intervention had no effect on quality of life measured by EuroQol 5D and no significant associations were found between quality of life and self-care behaviour. Self-care behaviour measured by The European Self-care Behaviour Scale remained unchanged throughout the study period. No significant gender differences were shown but women had a tendency to improve adherence to daily weight control between 3- and 12 months. CONCLUSION The self-care behaviour and quality of life in patients with heart failure did not change during one year of monthly telephone follow-up after a single session education and this indicates a need for more extensive interventions to obtain improved self-care behaviour in these patients.
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Affiliation(s)
- Marie Holst
- Malmö University School of Health and Society, Sweden.
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Banz K, Delnoy PP, Billuart JR. Exploratory cost-effectiveness analysis of cardiac resynchronization therapy with systematic device optimization vs. standard (non-systematic) optimization: a multinational economic evaluation. HEALTH ECONOMICS REVIEW 2015; 5:57. [PMID: 26160650 PMCID: PMC4498000 DOI: 10.1186/s13561-015-0057-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/02/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Recent studies provide evidence of improved clinical benefits associated with cardiac resynchronization therapy (CRT) optimization. Our analysis explores the cost-effectiveness of systematically optimized (SO, 3 times a year) vs. non-systematically optimized (NSO, less than 3 times a year) CRT, whatever the echo optimization method used (manual or SonR® automatic). A longitudinal cohort model was developed to predict clinical and economic outcomes for SO vs. NSO strategies over 5 years. The analysis was performed from the payer perspective. Data from CLEAR study post-hoc analysis was used with 199 pts with CRT pacemaker (CRT-P). The main economic outcome measure was incremental cost-effectiveness (ICER) expressed as cost per Quality Adjusted Life Years (QALY) gained. To assess the impact of data uncertainty, a sensitivity analysis was performed. The model also predicts outcomes for the two optimization strategies for CRT-D therapy vs. optimal medical treatment (OPT). RESULTS At 1 year, ICERs for SO CRT vs. NSO CRT-P range between <euro> 22,226 (Spain) and <euro> 26,977 (Italy). Therefore, on the basis of a Willingness-To-Pay of <euro>30,000 per QALY, the SO method develops into a cost effective strategy from 1 year, onwards. These favorable outcomes are supported by the sensitivity analysis. Systematic optimization of CRT-D might also improve the cost-effectiveness of this device therapy by 27 % to 30 % dependent on the country analyzed, at 5 years. CONCLUSIONS Our economic evaluation shows promising health economic benefits associated with SO CRT. These preliminary findings need further confirmation.
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Affiliation(s)
- Kurt Banz
- OUTCOMES International Ltd, Malzgasse 9 CH- 4052, Basel, Switzerland,
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Vuorinen AL, Leppänen J, Kaijanranta H, Kulju M, Heliö T, van Gils M, Lähteenmäki J. Use of home telemonitoring to support multidisciplinary care of heart failure patients in Finland: randomized controlled trial. J Med Internet Res 2014; 16:e282. [PMID: 25498992 PMCID: PMC4275484 DOI: 10.2196/jmir.3651] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/10/2014] [Accepted: 11/05/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Heart failure (HF) patients suffer from frequent and repeated hospitalizations, causing a substantial economic burden on society. Hospitalizations can be reduced considerably by better compliance with self-care. Home telemonitoring has the potential to boost patients' compliance with self-care, although the results are still contradictory. OBJECTIVE A randomized controlled trial was conducted in order to study whether the multidisciplinary care of heart failure patients promoted with telemonitoring leads to decreased HF-related hospitalization. METHODS HF patients were eligible whose left ventricular ejection fraction was lower than 35%, NYHA functional class ≥2, and who needed regular follow-up. Patients in the telemonitoring group (n=47) measured their body weight, blood pressure, and pulse and answered symptom-related questions on a weekly basis, reporting their values to the heart failure nurse using a mobile phone app. The heart failure nurse followed the status of patients weekly and if necessary contacted the patient. The primary outcome was the number of HF-related hospital days. Control patients (n=47) received multidisciplinary treatment according to standard practices. Patients' clinical status, use of health care resources, adherence, and user experience from the patients' and the health care professionals' perspective were studied. RESULTS Adherence, calculated as a proportion of weekly submitted self-measurements, was close to 90%. No difference was found in the number of HF-related hospital days (incidence rate ratio [IRR]=0.812, P=.351), which was the primary outcome. The intervention group used more health care resources: they paid an increased number of visits to the nurse (IRR=1.73, P<.001), spent more time at the nurse reception (mean difference of 48.7 minutes, P<.001), and there was a greater number of telephone contacts between the nurse and intervention patients (IRR=3.82, P<.001 for nurse-induced contacts and IRR=1.63, P=.049 for patient-induced contacts). There were no statistically significant differences in patients' clinical health status or in their self-care behavior. The technology received excellent feedback from the patient and professional side with a high adherence rate throughout the study. CONCLUSIONS Home telemonitoring did not reduce the number of patients' HF-related hospital days and did not improve the patients' clinical condition. Patients in the telemonitoring group contacted the Cardiology Outpatient Clinic more frequently, and on this way increased the use of health care resources. TRIAL REGISTRATION Clinicaltrials.gov NCT01759368; http://clinicaltrials.gov/show/NCT01759368 (Archived by WebCite at http://www.webcitation.org/6UFxiCk8Z).
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Ogah OS, Stewart S, Onwujekwe OE, Falase AO, Adebayo SO, Olunuga T, Sliwa K. Economic burden of heart failure: investigating outpatient and inpatient costs in Abeokuta, Southwest Nigeria. PLoS One 2014; 9:e113032. [PMID: 25415310 PMCID: PMC4240551 DOI: 10.1371/journal.pone.0113032] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/18/2014] [Indexed: 11/19/2022] Open
Abstract
Background: Heart failure (HF) is a deadly, disabling and often costly syndrome world-wide. Unfortunately, there is a paucity of data describing its economic impact in sub Saharan Africa; a region in which the number of relatively younger cases will inevitably rise. Methods: Heath economic data were extracted from a prospective HF registry in a tertiary hospital situated in Abeokuta, southwest Nigeria. Outpatient and inpatient costs were computed from a representative cohort of 239 HF cases including personnel, diagnostic and treatment resources used for their management over a 12-month period. Indirect costs were also calculated. The annual cost per person was then calculated. Results: Mean age of the cohort was 58.0±15.1 years and 53.1% were men. The total computed cost of care of HF in Abeokuta was 76, 288,845 Nigerian Naira (US$508, 595) translating to 319,200 Naira (US$2,128 US Dollars) per patient per year. The total cost of in-patient care (46% of total health care expenditure) was estimated as 34,996,477 Naira (about 301,230 US dollars). This comprised of 17,899,977 Naira- 50.9% ($US114,600) and 17,806,500 naira −49.1%($US118,710) for direct and in-direct costs respectively. Out-patient cost was estimated as 41,292,368 Naira ($US 275,282). The relatively high cost of outpatient care was largely due to cost of transportation for monthly follow up visits. Payments were mostly made through out-of-pocket spending. Conclusion: The economic burden of HF in Nigeria is particularly high considering, the relatively young age of affected cases, a minimum wage of 18,000 Naira ($US120) per month and considerable component of out-of-pocket spending for those affected. Health reforms designed to mitigate the individual to societal burden imposed by the syndrome are required.
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Affiliation(s)
- Okechukwu S. Ogah
- Division of cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria
- Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Simon Stewart
- Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Health and Medical research Council Centre of Research Excellence to Reduce, Inequality in Heart Disease, Melbourne, Australia
| | - Obinna E. Onwujekwe
- Department of Health Administration and Management, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu State, Nigeria
| | - Ayodele O. Falase
- Division of cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Taiwo Olunuga
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Karen Sliwa
- Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Hatter Institute for Cardiovascular Research in Africa and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Kamrani AAA, Foroughan M, Taraghi Z, Yazdani J, Kaldi AR, Ghanei N, Mokhtarpour R. Self care behaviors among elderly with chronic heart failure and related factors. Pak J Biol Sci 2014; 17:1161-1169. [PMID: 26027161 DOI: 10.3923/pjbs.2014.1161.1169] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Self Care Behaviors (SCB) is one of the most important challenges in controlling readmission and improving the elderly patients outcomes. The aims of this study were to describe the SCB among elderly with heart failure and to assess relationships between SCB, demographic characteristics, age-related characteristics and clinical characteristics. In this cross sectional study, 184 elderly (age 60) with heart failure were selected with convenience sampling from 4 teaching hospitals. To assess SCB, the European Heart Failure Self Care Behavior Scale was used. Its validity and reliability were confirmed (CVI = 0.97 and α = 0.74). Data was collected from patients' medical record and by interviews. The highest percentage of behaviors not performing properly (score > 2), were related to self reported exercise (96.2%), receiving a flu shot (89.7%) and weight monitoring (80.5%), respectively. There was significant relationship between SCB and cognitive impairment (p < 0.001), serum sodium level (p < 0.001), charlson co-morbidity Index (p = 0.001), ejection fraction (p = 0.002), visual impairment (p = 0.002), sleep disorders (p = 0.003), poly-pharmacy (p = 0.004), hearing impairment (p = 0.012) and systolic blood pressure (p = 0.049). Significant relationship between SCB and age-related characteristics suggests the need to design both supportive and preventive programs among elderly with heart failure.
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Agvall B, Paulsson T, Foldevi M, Dahlström U, Alehagen U. Resource use and cost implications of implementing a heart failure program for patients with systolic heart failure in Swedish primary health care. Int J Cardiol 2014; 176:731-8. [PMID: 25131925 DOI: 10.1016/j.ijcard.2014.07.105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 07/09/2014] [Accepted: 07/26/2014] [Indexed: 01/03/2023]
Abstract
AIM Heart failure (HF) is a common but serious condition which involves a significant economic burden on the health care economy. The purpose of this study was to evaluate cost and quality of life (QoL) implications of implementing a HF management program (HFMP) in primary health care (PHC). METHODS AND RESULTS This was a prospective randomized open-label study including 160 patients with a diagnosis of HF from five PHC centers in south-eastern Sweden. Patients randomized to the intervention group received information about HF from HF nurses and from a validated computer-based awareness program. HF nurses and physicians followed the patients intensely in order to optimize HF treatment according to current guidelines. The patients in the control group were followed by their regular general practitioner (GP) and received standard treatment according to local management routines. No significant changes were observed in NYHA class and quality-adjusted life years (QALY), implying that functional class and QoL were preserved. However, costs for hospital care (HC) and PHC were reduced by EUR 2167, or 33%. The total cost was EUR 4471 in the intervention group and EUR 6638 in the control group. CONCLUSIONS Introducing HFMP in Swedish PHC in patients with HF entails a significant reduction in resource utilization and costs, and maintains QoL. Based on these results, a broader implementation of HFMP in PHC may be recommended. However, results should be confirmed with extended follow-up to verify long-term effects.
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Affiliation(s)
- Björn Agvall
- Department of Medical and Health Sciences, Linkoping University, Department of Primary Health Care, Linkoping, County of Östergötland, Sweden.
| | - Thomas Paulsson
- Global Health Economics and Outcomes Research, Bristol-Myers Squibb, Belgium
| | - Mats Foldevi
- Department of Medical and Health Sciences, Linkoping University, Department of Primary Health Care, Linkoping, County of Östergötland, Sweden
| | - Ulf Dahlström
- Division of Cardiovascular Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Cardiology UHL, County Council of Östergötland, Linköping, Sweden
| | - Urban Alehagen
- Division of Cardiovascular Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Cardiology UHL, County Council of Östergötland, Linköping, Sweden
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Telemonitoring in heart failure: A state-of-the-art review. Rev Port Cardiol 2014; 33:229-39. [DOI: 10.1016/j.repc.2013.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 10/19/2013] [Indexed: 11/21/2022] Open
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Sousa C, Leite S, Lagido R, Ferreira L, Silva‐Cardoso J, Maciel MJ. Telemonitoring in heart failure: A state‐of‐the‐art review. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2013.10.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Patel H, Shafazand M, Ekman I, Höjgård S, Swedberg K, Schaufelberger M. Home care as an option in worsening chronic heart failure- A pilot study to evaluate feasibility, quality adjusted life years and cost-effectiveness. Eur J Heart Fail 2014; 10:675-81. [DOI: 10.1016/j.ejheart.2008.05.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2007] [Revised: 04/11/2008] [Accepted: 05/22/2008] [Indexed: 11/25/2022] Open
Affiliation(s)
- Harshida Patel
- Institute of Health and Care Sciences, Sahlgrenska Academy; Sweden
- The Vårdal Institute, Göteborg University; Göteborg Sweden
| | - Masoud Shafazand
- Departments of Emergency and Cardiovascular Medicine, Sahlgrenska Academy; Göteborg Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy; Sweden
| | - Sören Höjgård
- Swedish Institute for Food and Agricultural Economics; Sweden
| | - Karl Swedberg
- Departments of Emergency and Cardiovascular Medicine, Sahlgrenska Academy; Göteborg Sweden
| | - Maria Schaufelberger
- Departments of Emergency and Cardiovascular Medicine, Sahlgrenska Academy; Göteborg Sweden
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Ågren S, S Evangelista L, Davidson T, Strömberg A. Cost-effectiveness of a nurse-led education and psychosocial programme for patients with chronic heart failure and their partners. J Clin Nurs 2013; 22:2347-53. [PMID: 23829407 DOI: 10.1111/j.1365-2702.2012.04246.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES This randomised controlled trial was conducted to estimate the cost-effectiveness of a nurse-led education and psychosocial support programme for patients with heart failure (HF) and their partners. BACKGROUND There are few studies evaluating cost-effectiveness of interventions among HF patient-partner dyads. METHODS Dyads randomised to the experimental group received nurse-led counselling, computer-based education and written materials aimed at developing problem-solving skills at two, six and 12 weeks after hospitalisation with HF exacerbation. The dyads in the control group received usual care. A cost-effectiveness analysis that included costs associated with staff time to deliver the intervention and travel costs was conducted at 12 months. Quality-adjusted life-year (QALY) weights for patients and partners were estimated by SF-6D. RESULTS A total of 155 dyads were included. The intervention cost was €223 per patient. Participants in both groups showed improvements in QALY weights after 12 months. However, no significant difference in QALY weights was found between the patients in the two groups, nor among their partners. CONCLUSION The intervention was not proven cost-effective, neither for patients nor for partners. The intervention, however, had trends (but not significant) effects on the patient-partner dyads, and by analysing the QALY gained from the dyad, a reasonable mean cost-effectiveness ratio was achieved. RELEVANCE TO CLINICAL PRACTICE The study shows trends of a cost-effective education and psychosocial care of HF patient-partner dyads.
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Affiliation(s)
- Susanna Ågren
- Thoracic and Vascular Nursing, Department of Medicine and Health Sciences, Linköping University, Division of Nursing Sciences, Linköping University, Linköping, Sweden.
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Zatarain-Nicolás E, López-Díaz J, de la Fuente-Galán L, García-Pardo H, Recio-Platero A, San Román-Calvar JA. Tratamiento de la insuficiencia cardiaca descompensada con furosemida subcutánea mediante bombas elastoméricas: experiencia inicial. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.06.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Plasma extracellular vesicle protein content for diagnosis and prognosis of global cardiovascular disease. Neth Heart J 2013; 21:467-71. [PMID: 23975618 PMCID: PMC3776081 DOI: 10.1007/s12471-013-0462-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Cardiovascular disease is a major public health problem worldwide. Its growing burden is particularly ominous in Asia, due to increasing rates of major risk factors such as diabetes, obesity and smoking. There is an urgent need for early identification and treatment of individuals at risk of adverse cardiovascular events. Plasma extracellular vesicle proteins are novel biomarkers that have been shown to be useful in the diagnosis, risk stratification and prognostication of patients with cardiovascular disease. Ongoing parallel biobank initiatives in European (the Netherlands) and Asian (Singapore) populations offer a unique opportunity to validate these biomarkers in diverse ethnic groups.
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Subcutaneous infusion of furosemide administered by elastomeric pumps for decompensated heart failure treatment: initial experience. ACTA ACUST UNITED AC 2013; 66:1002-4. [PMID: 24774118 DOI: 10.1016/j.rec.2013.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 06/09/2013] [Indexed: 11/20/2022]
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Liu C, Zheng D, Zhao L, Li P, Li B, Murray A, Liu C. Elastic properties of peripheral arteries in heart failure patients in comparison with normal subjects. J Physiol Sci 2013; 63:195-201. [PMID: 23519698 PMCID: PMC10717337 DOI: 10.1007/s12576-013-0254-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 03/08/2013] [Indexed: 11/27/2022]
Abstract
Understanding the change in elastic properties of peripheral arteries in heart failure patients is of particular importance, especially when compared with normal subjects. To investigate factors associated with their difference, 40 normal subjects and 60 heart failure patients were studied. Electrocardiograms, carotid pulses and radial pulses were simultaneously recorded to determine carotid-radial pulse transit time (carotid-radial PTT), arm pulse wave velocity (PWV), and arterial volume distensibility. In comparison with normal subjects, carotid-radial PTT was lower by 8 ms in heart failure patients, arm PWV higher by 1.4 m/s, and peripheral arterial distensibility lower by 0.04 % per mmHg (all significant, P < 0.01). Peripheral arterial distensibility was significantly related to systolic blood pressure (SBP) and to left ventricular ejection fraction (LVEF) for heart failure patients (both P < 0.001), but the relationship for the normal group was not statistically significant (both 0.05 < P<0.1). Ageing had a significant inverse relationship with arterial distensibility in normal subjects (P < 0.05), but not in heart failure patients (P = 0.59). No subject in the normal group had an arterial distensibility lower than 0.1 % per mmHg, in comparison with 28 % (17/60) in the heart failure group. Peripheral arterial distensibility has been shown to be significantly lower in heart failure patients in comparison with normal subjects. High SBP and low LVEF were the main factors associated with low arterial distensibility in heart failure patients.
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Affiliation(s)
- Chengyu Liu
- School of Information Science and Engineering, Shandong University, 27 Shanda Nanlu, Jinan, 250100, China.
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Bertoldi EG, Rohde LE, Zimerman LI, Pimentel M, Polanczyk CA. Cost-effectiveness of cardiac resynchronization therapy in patients with heart failure: The perspective of a middle-income country's public health system. Int J Cardiol 2013; 163:309-315. [DOI: 10.1016/j.ijcard.2011.06.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 06/06/2011] [Indexed: 11/16/2022]
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Trends and predictors of hospitalization, readmissions and length of stay in ambulatory patients with heart failure. Rev Clin Esp 2013; 213:1-7. [DOI: 10.1016/j.rce.2012.10.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 09/25/2012] [Accepted: 10/10/2012] [Indexed: 11/18/2022]
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Frigola-Capell E, Comin-Colet J, Davins-Miralles J, Gich-Saladich I, Wensing M, Verdú-Rotellar J. Trends and predictors of hospitalization, readmissions and length of stay in ambulatory patients with heart failure. Rev Clin Esp 2013. [DOI: 10.1016/j.rceng.2012.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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COST-UTILITY ANALYSIS OF NT-PROBNP-GUIDED MULTIDISCIPLINARY CARE IN CHRONIC HEART FAILURE. Int J Technol Assess Health Care 2012; 29:3-11. [DOI: 10.1017/s0266462312000712] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives: A recent randomized, controlled trial in chronic heart failure patients showed that NT-proBNP-guided, intensive patient management (BMC) on top of multidisciplinary care reduced all-cause mortality and heart failure hospitalizations compared with multidisciplinary care (MC) or usual care (UC). We now performed a cost-utility analysis of these interventions from a payer's perspective.Methods: Costs related to hospitalizations, ambulatory physician and nurse visits, and NT-proBNP testing for the three management strategies were acquired for both Austria (€) and Canada ($) and combined with the survival and quality of life data from the clinical trial for cost-effectiveness analysis. Data on long-term survival, costs, and quality-adjusted life-years (QALY) were extrapolated for a 20-year time horizon using a Markov model, which simulated the progression of disease through beta-blocker use, hospitalizations, and mortality.Results: BMC was the most cost-effective strategy as it was dominant (cost-saving with improved health outcome) over both MC and UC based on both Austrian and Canadian costs. Incremental cost-effectiveness ratios for MC relative to UC were €3,746 and $5,554 per QALY gained for Austrian and Canadian costs, respectively. The probabilities for BMC being the most cost-effective strategy were 92 percent at a threshold value of Austrian €40,000 and 93 percent at a threshold value of Canadian $50,000.Conclusions: NT-proBNP-guided, intensive HF patient management in addition to multidisciplinary care not only reduces death and hospitalization but also proves to be cost-effective.
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Cameron J, Ski CF, Thompson DR. Screening for determinants of self-care in patients with chronic heart failure. Heart Lung Circ 2012; 21:806-8. [PMID: 22939110 DOI: 10.1016/j.hlc.2012.07.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 07/24/2012] [Accepted: 07/24/2012] [Indexed: 12/12/2022]
Abstract
Heart failure self-care is vital to achieving clinical stability and improved health outcomes. Yet despite the attention it has been given, in both research and clinical practice, effective self-care remains elusive. It is recognised that there are many patient factors that impact on attaining effective self-care skills. Systematic research is warranted to resolve the knowledge gap of how patients process information and develop the necessary self-care skills. In addition, sound screening tools are needed to assess factors that hinder the development of effective heart failure self-care skills. In this manner, education and support strategies can be applied on an individualised needs basis to enhance health outcomes.
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Affiliation(s)
- Jan Cameron
- Cardiovascular Research Centre, Australian Catholic University, Melbourne, Australia.
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Abstract
Heart failure , a syndrome associated with increasing prevalence, high mortality, and frequent hospital admissions, imposes a significant economic burden on western healthcare systems that is expected to further increase in the future due to the ageing population. Hospitalizations are responsible for the largest part of treatment costs and, thus, the main target for strategies aiming at cost reduction. Current literature suggests that evidence-based therapy with drugs, devices, and modern disease management programmes improves clinical outcomes of the large population of heart failure patients in a largely cost-effective manner. However, comprehensive knowledge about the cost of treatment is important to guide clinicians in the responsible allocation of today's limited health-care resources. This review provides information about the total cost of heart failure and the contribution of different treatment components to the overall costs.
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Affiliation(s)
- Frieder Braunschweig
- Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
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de Vries AE, de Jong RM, van der Wal MHL, Jaarsma T, van Dijk RB, Hillege HL. The value of INnovative ICT guided disease management combined with Telemonitoring in OUtpatient clinics for Chronic Heart failure patients. Design and methodology of the IN TOUCH study: a multicenter randomised trial. BMC Health Serv Res 2011; 11:167. [PMID: 21752280 PMCID: PMC3146411 DOI: 10.1186/1472-6963-11-167] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 07/13/2011] [Indexed: 11/27/2022] Open
Abstract
Background Although the value of telemonitoring in heart failure patients is increasingly studied, little is known about the value of the separate components of telehealth: ICT guided disease management and telemonitoring. The aim of this study is to investigate the value of telemonitoring added to ICT guided disease management (DM) on the quality and efficiency of care in patients with chronic heart failure (CHF) after a hospitalisation. Methods/Design The study is divided in two arms; a control arm (DM) and an intervention arm (DM+TM) in 10 hospitals in the Netherlands. In total 220 patients will be included after worsening of CHF (DM: N = 90, DM+TM: N = 130). Total follow-up will be 9 months. Data will be collected at inclusion and then after 2 weeks, 4.5 and 9 months. The primary endpoint of this study is a composite score of: 1: death from any cause during the follow-up of the study, 2: first readmission for HF and 3: change in quality of life compared to baseline, assessed by the Minnesota Living with Heart failure Questionnaire. The study has started in December 2009 and results are expected in 2012. Conclusions The IN TOUCH study is the first to investigate the effect of telemonitoring on top of ICT guided DM on the quality and efficiency of care in patients with worsening HF and will use a composite score as its primary endpoint. Trial registration Netherlands Trial Register (NTR): NTR1898
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Affiliation(s)
- Arjen E de Vries
- Thoraxcenter, Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands.
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Ferretto S, Dalla Valle C, Cukon Buttignoni S, Brugnaro L, Boffa GM. In-hospital management of heart failure: in 10 years we have improved, but not enough. Intern Emerg Med 2011; 6:235-9. [PMID: 21152996 DOI: 10.1007/s11739-010-0493-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2010] [Accepted: 11/10/2010] [Indexed: 12/01/2022]
Abstract
It is well recognized that the majority of patients with heart failure (HF) are admitted to General Medicine Departments (GMDs), and that the recommendations of the international guidelines for the treatment of HF are often incorrectly applied in hospital practice. We evaluated the treatment of patients with HF discharged from a single hospital over a period of 10 years. The study population comprised two series of patients who were discharged from six GMDs of a single hospital with the diagnosis of HF in the first 2 months of 1998 and 2008. The patients were also divided in two groups on the basis of the type of HF, systolic or diastolic. In 10 years, the number of patients who were discharged with the diagnosis of HF increased, the median age rose from 79 to 82 years and diastolic has become the more common type of HF. The prevalence of comorbidities rose significantly. There was an increased use of ACE-inhibitors and betablockers, and a reduction of digoxin and nitrates. The mortality decreased from 16.7% in 1998 to 9.6% in 2008 (p < 0.02) and hospitalizations became shorter (p < 0.05) considering patients with systolic HF (EF ≤ 45%) the median age rose from 74 to 79 years old (p < 0.01). We recorded an increasing use of betablockers, a reduction in the prescription of digoxin. The percentage of Diastolic HF rose from 55.7% in 1998 to 65.0% in 2008 (p < 0.001). The median age of these patients changed from 79 to 82 years old (p < 0.05). In 10 years, the clinical characteristics and management of HF patients who are hospitalized have changed. Pharmacological treatment has improved, but it still remains far from being adequately compliant with guideline recommendations.
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Affiliation(s)
- Sonia Ferretto
- Department of Cardiologic, Thoracic and Vascular Sciences, Director Prof. S. Iliceto, University of Padua, via Giustiniani 2, 35128, Padua, Italy.
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Pulignano G, Del Sindaco D, Di Lenarda A, Tarantini L, Cioffi G, Gregori D, Tinti MD, Monzo L, Minardi G. Usefulness of frailty profile for targeting older heart failure patients in disease management programs: a cost-effectiveness, pilot study. J Cardiovasc Med (Hagerstown) 2010; 11:739-47. [DOI: 10.2459/jcm.0b013e328339d981] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Telemedical support in patients with chronic heart failure: experience from different projects in Germany. Int J Telemed Appl 2010; 2010. [PMID: 20814594 PMCID: PMC2931371 DOI: 10.1155/2010/181806] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 03/22/2010] [Accepted: 06/28/2010] [Indexed: 12/14/2022] Open
Abstract
The great epidemiological significance and costs associated with chronic heart failure pose a challenge to health systems in Western industrial countries. In the past few years, controlled randomised studies have shown that patients with chronic heart failure benefit from telemedical monitoring; specifically, telemonitoring of various vital parameters combined with a review of the symptoms, drug compliance and patient education. In Germany, various telemedical monitoring projects for patients with chronic heart failure have been initiated in the past few years; seven of them are presented here. Currently 7220 patients are being monitored in the seven selected projects. Most patients (51.1%) are in NYHA stage II, 26.3% in NYHA stage III, 14.5% in NYHA stage I and only 6.6% in NYHA stage IV respectively. Most projects are primarily regional. Their structure of telemedical monitoring tends to be modular and uses stratification according to the NYHA stages. All projects include medical or health economics assessments. The future of telemedical monitoring projects for patients with chronic heart failure will depend on the outcome of these assessments. Only of there is statistical evidence for medical benefit to the individual patient as well as cost savings will these projects continue.
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Chen YH, Ho YL, Huang HC, Wu HW, Lee CY, Hsu TP, Cheng CL, Chen MF. Assessment of the clinical outcomes and cost-effectiveness of the management of systolic heart failure in Chinese patients using a home-based intervention. J Int Med Res 2010; 38:242-52. [PMID: 20233536 DOI: 10.1177/147323001003800129] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study was designed to assess the clinical effect of a home-based telephone intervention in Chinese heart failure patients. A total of 550 Chinese heart failure patients were enrolled into either (i) a group that received the usual standard of care (UC group); or (ii) a group that received a home-based heart failure centre management programme using nursing specialist-led telephone consultations (HFC group). The impact of the home-based intervention on admission rate, admission length and medical costs over 6 months was measured. Although the mean left ventricular ejection fraction in HFC patients was 29.3% compared with 34.8% in UC patients, the home-based intervention resulted in a significantly lower all-cause admission rate per person (HFC 0.60 +/- 0.77 times/person; UC 0.96 +/- 0.85 times/person), a shorter all-cause hospital stay (reduced by 8 days per person) and lower total 6-month medical costs (reduced by US$2682 per patient). These results suggest that the home-based intervention with nursing specialist-led telephone consultations may improve the clinical outcome and provide cost-savings for Chinese patients with heart failure.
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Affiliation(s)
- Y-H Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Relationship between pulse transit time and blood pressure is impaired in patients with chronic heart failure. Clin Res Cardiol 2010; 99:657-64. [DOI: 10.1007/s00392-010-0168-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 04/14/2010] [Indexed: 12/13/2022]
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Vanderheyden M, Houben R, Verstreken S, Ståhlberg M, Reiters P, Kessels R, Braunschweig F. Continuous monitoring of intrathoracic impedance and right ventricular pressures in patients with heart failure. Circ Heart Fail 2010; 3:370-7. [PMID: 20197559 DOI: 10.1161/circheartfailure.109.867549] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hemodynamic monitoring using implantable devices may provide early warning of volume overload in patients with heart failure (HF). This study was designed to prospectively compare information from intrathoracic impedance monitoring and continuous right ventricular pressure measurements in patients with HF. METHODS AND RESULTS Sixteen patients with HF (age, 63.5+/-13.8 years; left ventricular ejection fraction, 23.2+/-11.3%; New York Heart Association, II and III) and a previous HF decompensation received both a cardiac resynchronization therapy defibrillator providing a daily average of intrathoracic impedance and an implantable hemodynamic monitor providing an estimate of the pulmonary artery diastolic pressure. At the end of a 6-month investigator-blinded period, baseline reference hemodynamic values were determined over 4 weeks during which the patient was clinically stable. A major HF event was defined as HF decompensation requiring hospitalization, IV diuretic treatment, or leading to death. Sixteen major HF events occurred in 10 patients. Within 30 days and 14 days before a major HF event, impedance decreased by 0.12+/-0.21 Omega/d and 0.20+/-0.20 Omega/d, respectively, whereas estimated pulmonary arterial diastolic pressure increased by 0.10+/-0.20 mm Hg/d and 0.16+/-0.15 mm Hg/d, respectively. During these periods, impedance decreased by 3.8+/-5.4 Omega (P<0.02) and 4.9+/-6.1 Omega (P<0.007), respectively, whereas estimated pulmonary arterial diastolic pressure increased by 5.8+/-5.7 mm Hg (P<0.002) and 6.8+/-6.1 mm Hg (P<0.001), respectively, compared with baseline. In all patients, impedance and estimated pulmonary arterial diastolic pressure were inversely correlated (r = -0.48+/-0.25). Within 30 days preceding a major HF event, this correlation improved to r =-0.58+/-0.24. CONCLUSIONS Decompensated HF develops based on hemodynamic derangements and is preceded by significant changes in intrathoracic impedance and right ventricular pressures during the month prior to a major clinical event. Impedance and pressure changes are moderately correlated. Future research may establish the complementary contribution of both parameters to guide diagnosis and management of patients with HF by implantable devices.
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Affiliation(s)
- Marc Vanderheyden
- Department of Cardiology, Onze Lieve Vrouwe Ziekenhuis, Moorselbaan 164, Aalst, Belgium.
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Phelan D, Smyth L, Ryder M, Murphy N, O’Loughlin C, Conlon C, Ledwidge M, McDonald K. Can we reduce preventable heart failure readmissions in patients enrolled in a Disease Management Programme? Ir J Med Sci 2009; 178:167-71. [DOI: 10.1007/s11845-009-0332-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Accepted: 03/16/2009] [Indexed: 10/20/2022]
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Dixon DL, De Pasquale CG, De Smet HR, Klebe S, Orgeig S, Bersten AD. Reduced surface tension normalizes static lung mechanics in a rodent chronic heart failure model. Am J Respir Crit Care Med 2009; 180:181-7. [PMID: 19372252 DOI: 10.1164/rccm.200809-1506oc] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Chronic elevation of pulmonary microvascular pressure in chronic heart failure results in compensatory changes in the lung that reduce alveolar fluid filtration and protect against pulmonary microvascular rupture. OBJECTIVES To determine whether these compensatory responses may have maladaptive effects on lung function. METHODS Six weeks after myocardial infarction (chronic heart failure model) rat lung composition, both gross and histologic; air and saline mechanics; surfactant production; and immunological mediators were examined. MEASUREMENTS AND MAIN RESULTS An increase in dry lung weight, due to increased insoluble protein, lipid and cellular infiltrate, without pulmonary edema was found. Despite this, both forced impedance and air pressure-volume mechanics were normal. However, there was increased tissue stiffness in the absence of surface tension (saline pressure-volume curve) with a concurrent increase in both surfactant content and alveolar type II cell numbers, suggesting a novel homeostatic phenomenon. CONCLUSIONS These studies suggest a compensatory reduction in pulmonary surface tension that attenuates the effect of lung parenchymal remodeling on lung mechanics, hence work of breathing.
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Affiliation(s)
- Dani-Louise Dixon
- Intensive and Critical Care Unit, Flinders Medical Centre, Bedford Park, Adelaide, South Australia 5042, Australia.
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Juillière Y, Jourdain P, Roncalli J, Boireau A, Guibert H, Lambert H, Spinazze L, Jondeau G, Sonnier P, Rouanne C, Bidet A, Sandrin-Berthon B, Trochu JN. Therapeutic education unit for heart failure: Setting-up and difficulties. Initial evaluation of the I-CARE programme. Arch Cardiovasc Dis 2009; 102:19-27. [DOI: 10.1016/j.acvd.2008.10.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 10/20/2008] [Accepted: 10/20/2008] [Indexed: 11/28/2022]
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Guía de práctica clínica de la Sociedad Europea de Cardiología (ESC) para el diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica (2008). Rev Esp Cardiol 2008. [DOI: 10.1016/s0300-8932(08)75740-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Beich KR, Yancy C. The Heart Failure and Sodium Restriction Controversy: Challenging Conventional Practice. Nutr Clin Pract 2008; 23:477-86. [DOI: 10.1177/0884533608323429] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Katherine R. Beich
- From the Baylor Transplant Institute, and Baylor University Medical Center, Dallas, Texas
| | - Clyde Yancy
- From the Baylor Transplant Institute, and Baylor University Medical Center, Dallas, Texas
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Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJV, Ponikowski P, Poole-Wilson PA, Strömberg A, van Veldhuisen DJ, Atar D, Hoes AW, Keren A, Mebazaa A, Nieminen M, Priori SG, Swedberg K, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Tendera M, Auricchio A, Bax J, Bohm M, Corra U, della Bella P, Elliott PM, Follath F, Gheorghiade M, Hasin Y, Hernborg A, Jaarsma T, Komajda M, Kornowski R, Piepoli M, Prendergast B, Tavazzi L, Vachiery JL, Verheugt FWA, Zamorano JL, Zannad F. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 2008; 29:2388-442. [PMID: 18799522 DOI: 10.1093/eurheartj/ehn309] [Citation(s) in RCA: 1956] [Impact Index Per Article: 122.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Kenneth Dickstein
- University of Bergen, Cardiology Division, Stavanger University Hospital, Norway.
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ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 2008; 10:933-89. [PMID: 18826876 DOI: 10.1016/j.ejheart.2008.08.005] [Citation(s) in RCA: 1328] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Yu DSF, Lee DTF, Kwong ANT, Thompson DR, Woo J. Living with chronic heart failure: a review of qualitative studies of older people. J Adv Nurs 2008; 61:474-83. [PMID: 18261056 DOI: 10.1111/j.1365-2648.2007.04553.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper is a report of a systematic review of qualitative studies of how older people live with chronic heart failure. BACKGROUND Chronic heart failure is a global epidemic mainly affecting an ageing population. Understanding how older people live with this disease is important to help promote their adjustment to the distressing illness experience. DATA SOURCES Eligible studies published in 1997-2007 were identified from several databases (Medline, CINAHL, PsycINFO and Sociological Abstracts). A manual search was conducted of bibliographies of the identified studies and relevant journals. REVIEW METHODS Two researchers independently reviewed the studies and extracted the data. Key concepts from the papers were compared for similarities and differences. The transactional model of stress was used to guide data synthesis. FINDINGS Fourteen qualitative studies were identified. Most described the illness experiences of older people with chronic heart failure and associated coping strategies. There was some emerging work exploring the adjustment process. The findings indicated that living with chronic heart failure was characterized by distressing symptoms, compromised physical functioning, feelings of powerlessness and hopelessness, and social and role dysfunction. There were gender differences in the way the disease was conceived. Adjustment required patients to make sense of the illness experience, accept the prognosis, and get on with living with the condition. CONCLUSION Empowering older people to manage chronic heart failure, instilling hope and bolstering support system are means of promoting successful adjustment to the disease. Further research needs to explore the cultural differences in the adjustment process.
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Affiliation(s)
- Doris S F Yu
- Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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Chan DC, Heidenreich PA, Weinstein MC, Fonarow GC. Heart failure disease management programs: a cost-effectiveness analysis. Am Heart J 2008; 155:332-8. [PMID: 18215605 DOI: 10.1016/j.ahj.2007.10.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Accepted: 10/01/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Heart failure (HF) disease management programs have shown impressive reductions in hospitalizations and mortality, but in studies limited to short time frames and high-risk patient populations. Current guidelines thus only recommend disease management targeted to high-risk patients with HF. METHODS This study applied a new technique to infer the degree to which clinical trials have targeted patients by risk based on observed rates of hospitalization and death. A Markov model was used to assess the incremental life expectancy and cost of providing disease management for high-risk to low-risk patients. Sensitivity analyses of various long-term scenarios and of reduced effectiveness in low-risk patients were also considered. RESULTS The incremental cost-effectiveness ratio of extending coverage to all patients was $9700 per life-year gained in the base case. In aggregate, universal coverage almost quadrupled life-years saved as compared to coverage of only the highest quintile of risk. A worst case analysis with simultaneous conservative assumptions yielded an incremental cost-effectiveness ratio of $110,000 per life-year gained. In a probabilistic sensitivity analysis, 99.74% of possible incremental cost-effectiveness ratios were <$50,000 per life-year gained. CONCLUSIONS Heart failure disease management programs are likely cost-effective in the long-term along the whole spectrum of patient risk. Health gains could be extended by enrolling a broader group of patients with HF in disease management.
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Affiliation(s)
- David C Chan
- Brigham and Women's Hospital, Boston, MA 02115, USA.
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Bharmal M, Gemmen E, Zyczynski T, Linnstaedt A, Kenny D, Marelli C. Resource utilisation, charges and mortality following hospital inpatient admission for congestive heart failure among the elderly in the US. J Med Econ 2008; 11:397-414. [PMID: 19450095 DOI: 10.3111/13696990802193081] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study examined resource utilisation, charges and mortality among congestive heart failure (CHF) patients over the course of the first year following initial hospital discharge for CHF in the US. METHODS The Medicare Standard Analytic Files for the years 1998 through to 2001 were used for the analysis. The study sample included patients with an inpatient hospitalisation between the 1st January 1999 and the 31st December 2000 with a primary ICD-9 diagnosis code of CHF. Statistical analysis including univariate and multivariate regression analysis were conducted. RESULTS Within 1 year following initial CHF discharge, 50% of patients had at least one all-cause readmission and 20% had at least one CHF-related readmission. The mean total charges among all patients was $36,230 (SD $55,086). Of the patients 20% incurred more than $55,000 in medical charges during the year after discharge; 10% incurred charges exceeding $90,000. More than one-half of the CHF patients visited the emergency department within 3 months of hospital discharge, and within 1 year almost one-third of the CHF patients (31.4%) died. CONCLUSIONS The charges, morbidity and mortality associated with CHF patients are significant. Reducing these risks through more effective disease management offers the potential for substantial cost savings.
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Abstract
Heart failure (HF) is a serious public health problem worldwide. It has a high prevalence, affects mainly the elderly and causes high mortality or disability with high economic costs. The aim of the present study was to calculate the number of admissions for HF, the total in-hospital stay, the mean length of in-hospital stay and the in-hospital costs due to HF in Belgium. Retrospective analysis of data from the national hospital registration system provided the following results. In 2001, there were 19,398 admissions with HF as a primary diagnosis, with a total in-hospital stay of 286,938 days. The mean in-hospital stay for HF was 14.8 days. The total in-hospital cost of HF as a primary diagnosis was euro 94,113,827, representing 1.8% of the total hospital expenditure. The limitations of this study are its mere focus on admissions and their characteristics in 2001, and the use of a retrospective analysis. Nevertheless, it led to the conclusion that HF was responsible for a significant number of in-hospital days, with a significant impact on healthcare costs in Belgium.
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Affiliation(s)
- Neree Claes
- Faculty of Medicine, Chair 'De Onderlinge ziekenkas-Prevention', Hasselt University, Belgium
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