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Williams TB, Crump A, Garza MY, Parker N, Simmons S, Lipschitz R, Sexton KW. Care delivery team composition effect on hospitalization risk in African Americans with congestive heart failure. PLoS One 2023; 18:e0286363. [PMID: 37319230 PMCID: PMC10270633 DOI: 10.1371/journal.pone.0286363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
The care delivery team (CDT) is critical to providing care access and equity to patients who are disproportionately impacted by congestive heart failure (CHF). However, the specific clinical roles that are associated with care outcomes are unknown. The objective of this study was to examine the extent to which specific clinical roles within CDTs were associated with care outcomes in African Americans (AA) with CHF. Deidentified electronic medical record data were collected on 5,962 patients, representing 80,921 care encounters with 3,284 clinicians between January 1, 2014 and December 31, 2021. Binomial logistic regression assessed associations of specific clinical roles and the Mann Whitney-U assessed racial differences in outcomes. AAs accounted for only 26% of the study population but generated 48% of total care encounters, the same percentage of care encounters generated by the largest racial group (i.e., Caucasian Americans; 69% of the study population). AAs had a significantly higher number of hospitalizations and readmissions than Caucasian Americans. However, AAs had a significantly higher number of days at home and significantly lower care charges than Caucasian Americans. Among all CHF patients, patients with a Registered Nurse on their CDT were less likely to have a hospitalization (i.e. 30%) and a high number of readmissions (i.e., 31%) during the 7-year study period. When stratified by heart failure phenotype, the most severe patients who had a Registered Nurse on their CDT were 88% less likely to have a hospitalization and 50% less likely to have a high number of readmissions. Similar decreases in the likelihood of hospitalization and readmission were also found in less severe cases of heart failure. Specific clinical roles are associated with CHF care outcomes. Consideration must be given to developing and testing the efficacy of more specialized, empirical models of CDT composition to reduce the disproportionate impact of CHF.
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Affiliation(s)
- Tremaine B. Williams
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Alisha Crump
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Maryam Y. Garza
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Nadia Parker
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Simeon Simmons
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Riley Lipschitz
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Kevin Wayne Sexton
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
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De Keyzer E, Hossein A, Rabineau J, Morissens M, Almorad A, van de Borne P. Non-invasive cardiac kinetic energy distribution: a new marker of heart failure with impaired ejection fraction (KINO-HF). Front Cardiovasc Med 2023; 10:1096859. [PMID: 37200972 PMCID: PMC10185762 DOI: 10.3389/fcvm.2023.1096859] [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: 11/12/2022] [Accepted: 04/10/2023] [Indexed: 05/20/2023] Open
Abstract
Background Heart failure (HF) remains a major cause of mortality, morbidity, and poor quality of life. 44% of HF patients present impaired left ventricular ejection fraction (LVEF). Kinocardiography (KCG) technology combines ballistocardiography (BCG) and seismocardiography (SCG). It estimates myocardial contraction and blood flow through the cardiac chambers and major vessels through a wearable device. Kino-HF sought to evaluate the potential of KCG to distinguish HF patients with impaired LVEF from a control group. Methods Successive patients with HF and impaired LVEF (iLVEF group) were matched and compared to patients with normal LVEF ≥ 50% (control). A 60 s KCG acquisition followed cardiac ultrasound. The kinetic energy from KCG signals was computed in different phases of the cardiac cycle (i K s y s t o l i c ; Δ i K d i a s t o l i c ) as markers of cardiac mechanical function. Results Thirty HF patients (67 [59; 71] years, 87% male) were matched with 30 controls (64.5 [49; 73] years, 87% male). SCG Δ i K d i a s t o l i c , BCG i K s y s t o l i c , BCG Δ i K d i a s t o l i c were lower in HF than controls (p < 0.05), while SCG i K s y s t o l i c was similar. Furthermore, a lower SCG i K s y s t o l i c was associated with an increased mortality risk during follow-up. Conclusions KINO-HF demonstrates that KCG can distinguish HF patients with impaired systolic function from a control group. These favorable results warrant further research on the diagnostic and prognostic capabilities of KCG in HF with impaired LVEF.Clinical Trial Registration: NCT03157115.
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Affiliation(s)
- Eva De Keyzer
- Department of Cardiology, Brugmann Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Amin Hossein
- Laboratoray of Physics and Physiology, Université Libre de Bruxelles, Brussels, Belgium
| | - Jeremy Rabineau
- Laboratoray of Physics and Physiology, Université Libre de Bruxelles, Brussels, Belgium
| | - Marielle Morissens
- Department of Cardiology, Brugmann Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Almorad
- Department of Cardiology, Brugmann Hospital, Université Libre de Bruxelles, Brussels, Belgium
- Heart Rhythm Management Centre, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Philippe van de Borne
- Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Witting C, Zheng J, Tisdale RL, Shannon E, Kohsaka S, Lewis EF, Heidenreich P, Sandhu A. Treatment Differences in Medical Therapy for Heart Failure With Reduced Ejection Fraction Between Sociodemographic Groups. JACC. HEART FAILURE 2023; 11:161-172. [PMID: 36647925 PMCID: PMC10069379 DOI: 10.1016/j.jchf.2022.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND There are sociodemographic disparities in outcomes of heart failure with reduced ejection fraction (HFrEF), but disparities in guideline-directed medical therapy (GDMT) remain poorly characterized. OBJECTIVES This study aimed to analyze GDMT treatment rates in eligible patients with recently diagnosed HFrEF, and to determine how rates vary by sociodemographic characteristics. METHODS This retrospective cohort study included patients diagnosed with HFrEF at Veterans Affairs (VA) hospitals from 2013 to 2019. The authors analyzed GDMT treatment rates and doses, excluding patients with contraindications. Therapies of interest were evidence-based beta-blockers (BBs), renin-angiotensin system inhibitors (RASIs), angiotensin receptor-neprilysin inhibitors (ARNIs), and mineralocorticoid antagonists (MRAs). The authors compared adjusted treatment rates by race and ethnicity, neighborhood social vulnerability, rurality, distance to medical care, and sex. RESULTS The cohort comprised 126,670 VA patients with recently diagnosed HFrEF. The study found that racial and ethnic minorities had similar or higher treatment rates than White patients. Patients residing in socially vulnerable neighborhoods had 3.4% lower ARNI (95% CI: 1.9%-5.0%) treatment rates. Patients residing farther from specialty care had similar rates of GDMT therapy overall, but were less likely to be taking at least 50% of the target doses of either BBs (4.0% less likely; 95% CI: 3.1%-5.0%) or RASIs (5.0% less likely; 95% CI: 4.1%-6.0%) compared with those closer to care. CONCLUSIONS Among VA patients with recently diagnosed HFrEF, the authors did not find that racial and ethnic minority patients were less likely to receive GDMT. However, appropriate dose up-titration may occur less frequently in more remote patients.
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Affiliation(s)
- Celeste Witting
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Jimmy Zheng
- School of Medicine, Stanford University, Stanford, California, USA
| | - Rebecca L Tisdale
- VA Palo Alto Health Care System, Palo Alto, California, USA; Department of Health Policy, Stanford University, Stanford, California, USA
| | - Evan Shannon
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, California, USA
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Eldrin F Lewis
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Paul Heidenreich
- Department of Medicine, Stanford University, Stanford, California, USA; VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Alexander Sandhu
- Department of Medicine, Stanford University, Stanford, California, USA; VA Palo Alto Health Care System, Palo Alto, California, USA.
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Kobo O, Raisi-Estabragh Z, Gevaert S, Rana JS, Van Spall HGC, Roguin A, Petersen SE, Ky B, Mamas MA. Impact of cancer diagnosis on distribution and trends of cardiovascular hospitalizations in the USA between 2004 and 2017. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:787-797. [PMID: 35913736 PMCID: PMC9603542 DOI: 10.1093/ehjqcco/qcac045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIMS There is limited data on temporal trends of cardiovascular hospitalizations and outcomes amongst cancer patients. We describe the distribution, trends of admissions, and in-hospital mortality associated with key cardiovascular diseases among cancer patients in the USA between 2004 and 2017. METHODS Using the Nationwide Inpatient Sample we, identified admissions with five cardiovascular diseases of interest: acute myocardial infarction (AMI), pulmonary embolism (PE), ischaemic stroke, heart failure, atrial fibrillation (AF) or atrial flutter, and intracranial haemorrhage. Patients were stratified by cancer status and type. We estimated crude annual rates of hospitalizations and annual in-hospital all-cause mortality rates. RESULTS From >42.5 million hospitalizations with a primary cardiovascular diagnosis, 1.9 million (4.5%) had a concurrent record of cancer. Between 2004 and 2017, cardiovascular admission rates increased by 23.2% in patients with cancer, whilst decreasing by 10.9% in patients without cancer. The admission rate increased among cancer patients across all admission causes and cancer types except prostate cancer. Patients with haematological (9.7-13.5), lung (7.4-8.9), and GI cancer (4.6-6.3) had the highest crude rates of cardiovascular hospitalizations per 100 000 US population. Heart failure was the most common reason for cardiovascular admission in patients across all cancer types, except GI cancer (crude admission rates of 13.6-16.6 per 100 000 US population for patients with cancer). CONCLUSIONS In contrast to declining trends in patients without cancer, primary cardiovascular admissions in patients with cancer is increasing. The highest admission rates are in patients with haematological cancer, and the most common cause of admission is heart failure.
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Affiliation(s)
- Ofer Kobo
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, Newcastle ST5 5BG, UK
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera 38100, Israel
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Centre for Advanced Cardiovascular Imaging, Queen Mary University London, ondon E1 4NS, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Sofie Gevaert
- Department of Cardiology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
| | - Jamal S Rana
- Department of Cardiology, Permanente Medical Group, Oakland, CA 94612, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Harriette G C Van Spall
- Department of Medicine, Department of Health Research Methods, Evidence, and Impact, Population Health Research Institute, Research Institute of St. Joe's, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera 38100, Israel
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Centre for Advanced Cardiovascular Imaging, Queen Mary University London, London E1 4NS, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Health Data Research UK, London NW1 2BE, UK
- Alan Turing Institute, London NW1 2DB, UK
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, Newcastle ST5 5BG, UK
- Institute of Population Health, University of Manchester, Manchester M13 9PL, UK
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Lin CY, Dracup K, Pelter MM, Biddle MJ, Moser DK. Association of psychological distress with reasons for delay in seeking medical care in rural patients with worsening heart failure symptoms. J Rural Health 2022; 38:713-720. [PMID: 33783853 PMCID: PMC10106011 DOI: 10.1111/jrh.12573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The impact of depressive symptoms and anxiety on rural patients' decisions to seek care for worsening heart failure (HF) symptoms remains unknown. The purposes of this study were (1) to describe rural patients' reasons for delay in seeking care for HF, and (2) to determine whether depressive symptoms or anxiety was associated with patients' reasons for delay in seeking medical care for worsening symptoms. METHODS A total of 611 rural HF patients were included. Data on reasons for patient delay in seeking medical care (The Reasons for Delay Questionnaire), depressive symptoms (PHQ-9), and anxiety (BSI-ANX) were collected. Statistical analyses included chi-square and multiple regression. RESULTS A total of 85.4% of patients reported at least 1 reason for delay. Patients with higher levels of depressive symptoms were more likely to cite embarrassment, problems with transportation, and financial concerns as a reason for delay. Patients with anxiety not only cited nonsymptom-related reasons but also reported symptom-related reasons for delay in seeking care (ie, symptoms seemed vague, not sure of symptoms, symptoms didn't seem to be serious enough, and symptoms were different from the last episode). In multiple regression, patients with greater depressive symptoms and anxiety had a greater number of reasons for delay in seeking care (P = .003 and P = .023, respectively). CONCLUSIONS Our findings suggest that enhancement of patients' symptom appraisal abilities and improvement in psychological distress may result in a reduction in delay in seeking medical care for worsening symptoms in rural patients with HF.
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Affiliation(s)
- Chin-Yen Lin
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Kathleen Dracup
- School of Nursing, University of California, San Francisco, California
| | - Michele M. Pelter
- School of Nursing, University of California, San Francisco, California
| | | | - Debra K. Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky
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Adrianzen-Herrera D, Sparks AD, Shastri A, Zakai NA, Littenberg B. Geographic disparities in cardiovascular mortality among patients with myelodysplastic syndromes: A population-based analysis. Cancer Epidemiol 2022; 80:102238. [PMID: 35970010 DOI: 10.1016/j.canep.2022.102238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/30/2022] [Accepted: 08/07/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Clonal hematopoiesis, a precursor to myelodysplastic syndromes (MDS), constitutes a novel cardiovascular disease (CVD) risk factor, causing growing interest in cardiovascular outcomes in MDS. Rurality is associated with increased CVD but studies on cardiovascular geographic disparities in MDS are lacking. METHODS Using the U.S. Surveillance, Epidemiology, and End Results (SEER) registry, we identified 52,750 MDS patients between 2001 and 2016. Rurality was defined using Rural-Urban Continuum Codes. Cox regression estimated the association of rurality and cardiovascular death. RESULTS MDS incidence was equal in urban and rural populations (6.7 per 100,000). Crude probability of cardiovascular death was higher among rural MDS patients. Adjusting for age, sex, race/ethnicity, marital status, insurance, and MDS risk (defined from histology), rural patients had 12% increased risk of CVD death compared to urban patients (HR=1.12, 95%CI 1.03-1.21). HR for CVD death was 1.22 (95%CI 1.01-1.5) in patients from the most rural areas (less than 2500 urban population). Among MDS patients younger than 65 years, rurality was associated with 25% increased risk of CVD death (HR=1.25, 95%CI 1.01-1.59). DISCUSSION This population-based analysis suggests that rural residence is linked to higher burden of cardiovascular death in patients with MDS. The disparity is not explained by demographic factors or MDS risk. Interventions targeting CVD may improve outcomes in rural MDS patients.
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Affiliation(s)
- Diego Adrianzen-Herrera
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
| | - Andrew D Sparks
- Biomedical Statistics Research Core, University of Vermont, Burlington, VT, USA
| | - Aditi Shastri
- Department of Oncology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Neil A Zakai
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Benjamin Littenberg
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
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Minhas AMK, Sheikh AB, Ijaz SH, Mostafa A, Nazir S, Khera R, Loccoh EC, Warraich HJ. Rural-Urban Disparities in Heart Failure and Acute Myocardial Infarction Hospitalizations. Am J Cardiol 2022; 175:164-169. [PMID: 35577603 DOI: 10.1016/j.amjcard.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/01/2022]
Abstract
Substantial gaps in clinical outcomes exist in rural and urban hospitals in the United States. We used the National Inpatient Sample to examine trends in hospitalizations, in-hospital mortality, length of stay, and inflation-adjusted cost of adults admitted for heart failure (HF) and acute myocardial infarction (AMI) in rural and urban hospitals between 2004 and 2018. From 2004 to 2013 and 2014, there was an initial decrease in age-adjusted HF hospitalizations in both urban (annual percent change [APC] -3.9 [95% confidence interval [CI] -4.3 to -3.5] p <0.001) and rural hospitals (APC -5.9 [95% CI -6.4 to -5.3] p <0.001), after which hospitalizations for HF increased in urban areas (APC 4.2 [95% CI 3.2 to 5.3] p <0.001) and remained stable in rural areas (APC 0.2 [95% CI -2.1 to 2.6] p = 0.863). Urban AMI hospitalizations decreased between 2004 and 2010 (APC -4.4 [95% CI -5.3 to -3.3] p <0.001) and subsequently remained stable (APC 0.2 [95% CI -0.5 to 0.9] p = 0.552), whereas rural AMI hospitalizations had a consistent decrease throughout the study period (APC -4.2 [95% CI -5.0 to -3.4] p <0.001). Overall, urban hospitals had lower in-hospital mortality for HF and AMI than rural hospitals (3.1% vs 3.5%, p <0.001% and 5.4% vs 6.5%, p <0.001), respectively. Initially, in-hospital mortality was higher in rural hospitals; however, the rural-urban hospital mortality gap decreased during the study period for both HF and AMI. Rural hospitals had a shorter mean length of stay for HF and AMI (4.4 vs 5.5 days, p <0.001 and 3.9 vs 4.7 days, p <0.001) and lower inflation-adjusted costs for both HF and AMI ($8,897.1 vs $13,420.8, p <0.001 and $15,301.6 vs $22,943.7, p <0.001) when compared with urban hospitals. In conclusion, a consistent decrease in the in-hospital mortality gap in rural and urban hospitals for HF and AMI suggests improvement in inpatient rural cardiovascular care during the study period. Continued healthcare policy reforms are warranted to alleviate the disparities in rural-urban cardiovascular outcomes.
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The Situation-Specific Theory of Heart Failure Self-care: An Update on the Problem, Person, and Environmental Factors Influencing Heart Failure Self-care. J Cardiovasc Nurs 2022; 37:515-529. [PMID: 35482335 PMCID: PMC9561231 DOI: 10.1097/jcn.0000000000000919] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Many studies of heart failure (HF) self-care have been conducted since the last update of the situation-specific theory of HF self-care.
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Petitte TM, Li J, Fang W, Shafique S, Piamjariyakul U. Modifiable Risk Factors Associated With Heart Failure Readmissions: 1-Year Follow-up. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Miftode RS, Costache II, Cianga P, Petris AO, Cianga CM, Maranduca MA, Miftode IL, Constantinescu D, Timpau AS, Crisan A, Mitu O, Haba MSC, Stafie CS, Șerban IL. The Influence of Socioeconomic Status on the Prognosis and Profile of Patients Admitted for Acute Heart Failure during COVID-19 Pandemic: Overestimated Aspects or a Multifaceted Hydra of Cardiovascular Risk Factors? Healthcare (Basel) 2021; 9:healthcare9121700. [PMID: 34946426 PMCID: PMC8700988 DOI: 10.3390/healthcare9121700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/04/2021] [Accepted: 12/05/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Heart failure (HF) is a complex clinical syndrome that represents a great burden on public health systems due to its increased prevalence, disability and mortality rates. There are multiple triggers that can induce or aggravate a preexisting HF, socioeconomic status (SES) emerging as one of the most common modifiable risk factors. Our study aimed to analyze the influence of certain SES indicators on the outcome, clinical aspects and laboratory parameters of patients with HF in North-Eastern Romania, as well as their relationship with other traditional cardiovascular risk factors. Methods: We conducted a prospective, single-center study comprising 120 consecutively enrolled patients admitted for acute HF. The evaluation of individual SES was based upon a standard questionnaire and evidence from official documents. Results: the patients’ age ranged between 18 and 94 years; Out of 120 patients, 49 (40.8%) were women and 71 (59.2%) were men, residing in rural 59 (49.2%) or urban 61 (50.8%) areas. 14.2% were university graduates, while 15.8% had only attended primary school. The majority of the patients are or were employed in the service sector (54.5%), followed by industry (29.2%) and agriculture (20%). The mean monthly income was 306.1 ± 177.4 euro, while the mean hospitalization cost was 2471.8 ± 2073.8 euro per patient. The individual income level was positively correlated with urban area of residence, adequate household sanitation facilities and healthcare access, and negatively associated with advanced age and previous hospitalizations due to HF. However, the individual financial situation was also positively correlated with the increased prevalence of certain cardiovascular risk factors, such as arterial hypertension, anemia or obesity, but not with total cholesterol or male gender. Concerning the direct impact of a poor economic status upon prognosis in the setting of acute HF, our results showed no statistically significant differences concerning the in-hospital or at 1-month follow-up mortality rates. Rather than inducing a direct impact on the short-term outcome, these findings concerning SES indicators are meant to enhance the implementation of policies aimed to provide adequate healthcare for people from all social layers, with a primary focus on modifiable cardiovascular risk factors.
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Affiliation(s)
- Radu-Stefan Miftode
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania or (R.-S.M.); (A.-S.T.); (A.C.); (O.M.); (M.S.C.H.)
| | - Irina-Iuliana Costache
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania or (R.-S.M.); (A.-S.T.); (A.C.); (O.M.); (M.S.C.H.)
- Correspondence: (I.-I.C.); (A.O.P.)
| | - Petru Cianga
- Department of Immunology, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (P.C.); (C.-M.C.); (D.C.)
| | - Antoniu Octavian Petris
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania or (R.-S.M.); (A.-S.T.); (A.C.); (O.M.); (M.S.C.H.)
- Correspondence: (I.-I.C.); (A.O.P.)
| | - Corina-Maria Cianga
- Department of Immunology, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (P.C.); (C.-M.C.); (D.C.)
| | - Minela-Aida Maranduca
- Department of Morpho-Functional Sciences (II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (M.-A.M.); (I.-L.Ș.)
| | - Ionela-Larisa Miftode
- Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
| | - Daniela Constantinescu
- Department of Immunology, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (P.C.); (C.-M.C.); (D.C.)
| | - Amalia-Stefana Timpau
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania or (R.-S.M.); (A.-S.T.); (A.C.); (O.M.); (M.S.C.H.)
| | - Adrian Crisan
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania or (R.-S.M.); (A.-S.T.); (A.C.); (O.M.); (M.S.C.H.)
| | - Ovidiu Mitu
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania or (R.-S.M.); (A.-S.T.); (A.C.); (O.M.); (M.S.C.H.)
| | - Mihai Stefan Cristian Haba
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania or (R.-S.M.); (A.-S.T.); (A.C.); (O.M.); (M.S.C.H.)
| | - Celina-Silvia Stafie
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
| | - Ionela-Lacramioara Șerban
- Department of Morpho-Functional Sciences (II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (M.-A.M.); (I.-L.Ș.)
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Chan RK, Dinh DT, Hare DL, Lockwood S, Neil C, Prior D, Brennan A, Lefkovits J, Carruthers H, Reid CM, Driscoll A. Management of Acute Decompensated Heart Failure in Rural Versus Metropolitan Settings: An Australian Experience. Heart Lung Circ 2021; 31:491-498. [PMID: 34740540 DOI: 10.1016/j.hlc.2021.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/13/2021] [Accepted: 08/22/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Acute decompensated heart failure (ADHF) is the most common cause of hospital admission in patients over 65, with poorer outcomes demonstrated in rural versus metropolitan areas. The aim of this study was to compare the in-hospital and post-discharge management of ADHF patients admitted to rural versus metropolitan hospitals in Victoria. METHODS Data from the Victorian Cardiac Outcomes Registry, Heart Failure (VCOR-HF) project was used. This was a prospective, observational, non-randomised study of consecutive patients admitted to participating hospitals in Victoria, Australia, with ADHF as their primary diagnosis over four 30-day periods during consecutive years. All patients were followed up for 30 days post discharge. RESULTS 1,357 patients (1,260 metropolitan, 97 rural) were admitted to study hospitals with ADHF during the study periods. Cohorts were similar in age (average 76.87±13.12 years) and percentage of male gender (56.4% overall). Metropolitan patients were more likely to have diabetes (44.4% vs 34.0%, p=0.046), kidney disease (65.8% vs 37.1%, p<0.01) and anaemia (31.9% vs 19.6%, p=0.01). There was no significant difference in length of stay between metropolitan and rural patients (7.49 vs 6.37 days, p=0.12). There was no significant difference between metropolitan and rural patients in 30-day rehospitalisations (19.1% vs 11.6%, p=0.07, respectively) and all-cause 30-day mortality (8.2% vs 4.1%, p=0.15, respectively). Metropolitan patients were significantly more likely to have seen their general practitioner (GP) (68.1% vs 53.2%, p<0.01) or attend an outpatient clinic (35.9% vs 10.6%, p<0.01) by 30 days. There was no significant difference in number of days to follow-up of any kind between groups. Referrals to a heart failure home visiting program remained low overall (19.9%). CONCLUSION There was no significant difference in 30-day rehospitalisations or mortality between patients admitted to rural versus metropolitan hospitals. Geographical discrepancies were noted in follow-up by 30 days, with significantly more metropolitan patients having seen a doctor by 30 days post-discharge. Overall follow-up rates remain suboptimal.
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Affiliation(s)
- R Kimberley Chan
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia.
| | - Diem T Dinh
- Monash University, Melbourne, Vic, Australia
| | - David L Hare
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia
| | | | - Chris Neil
- University of Melbourne, Melbourne, Vic, Australia; Western Health, Melbourne, Vic, Australia
| | | | | | | | | | | | - Andrea Driscoll
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia; Deakin University, Melbourne, Vic, Australia
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12
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Association between Residence Location and Pre-Hospital Delay in Patients with Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126679. [PMID: 34205798 PMCID: PMC8296403 DOI: 10.3390/ijerph18126679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/17/2022]
Abstract
Rural residents with heart failure (HF) face more challenges than their urban counterparts in taking action when their symptoms worsen due to limited healthcare resources in rural areas. This may contribute to rural residents’ pre-hospital delay in seeking medical care. However, few studies have investigated the relationship between residence locations and pre-hospital delay among patients with HF. Therefore, this study determined whether living in rural areas is associated with pre-hospital delay in patients with HF. A retrospective electronic medical record review was conducted using the data of patients discharged with worsening HF from an academic medical center. Data on postal codes of the patients’ residences and their experiences before seeking medical care were obtained. Pre-hospital delay was calculated from the onset of HF symptoms to hospital arrival. A multivariate linear regression analysis was performed to determine the relationship between residence location and pre-hospital delay. The median pre-hospital delay time of all patients was 72 h (N = 253). About half of the patients did nothing to relieve their symptoms before seeking medical care. Living in urban areas was associated with a shorter pre-hospital delay. Patients with HF waited several days after first experiencing worsening of symptoms before getting admitted to a hospital, which may be related to inappropriate interpretation and responses to the worsening of symptoms. Furthermore, we found that rural residents were more vulnerable to pre-hospital delay than their urban counterparts.
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13
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Hutchinson RN, Han PKJ, Lucas FL, Black A, Sawyer D, Fairfield K. Rural disparities in end-of-life care for patients with heart failure: Are they due to geography or socioeconomic disparity? J Rural Health 2021; 38:457-463. [PMID: 34043838 DOI: 10.1111/jrh.12597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The impact of rurality and socioeconomic deprivation on end-of-life (EOL) care for patients with heart failure (HF) is unknown. We analyzed claims to describe the prevalence and predictors of EOL health care utilization for patients dying with HF in a predominantly rural state. METHODS We used the MaineHealth Data Organization's All-Payer Claims Data to identify 15,168 patients ≥35 who died with HF between 2012 and 2017. The primary outcome was health care utilization during the last 180 days of life (EOL definition for this analysis), including emergency department (ED) visits, hospitalizations, intensive care unit (ICU) admissions, and hospice utilization. Patient characteristics analyzed included age, gender, comorbidities, area deprivation index (ADI), and rurality. FINDINGS Among 15,168 patients ≥35 who died with HF, 48% had ≥2 hospitalizations, 72% had ≥2 ED visit, 29% had an ICU stay, 2% initiated dialysis during EOL, and 64% received hospice. Rural patients were more likely to have an ICU admission and have ≥2 hospitalizations. Patients residing in areas with higher ADI were more likely to be hospitalized, admitted to the ICU, and started on dialysis. Both rural patients and those living in higher ADI areas were less likely to receive hospice. After multivariable adjustment, rurality and ADI were independently associated with a decreased likelihood of receiving hospice (OR 0.62 [95% CI: 0.53-0.72] for the most rural patients and OR 0.64 [95% CI: 0.57-0.72] for the highest ADI). CONCLUSION Both rurality and local area deprivation drive disparities in EOL care for patients dying with heart failure.
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Affiliation(s)
- Rebecca N Hutchinson
- Division of Palliative Medicine, Maine Medical Center, Portland, Maine, USA.,Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine, USA
| | - Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine, USA
| | - F Lee Lucas
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine, USA
| | - Adam Black
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine, USA
| | - Douglas Sawyer
- Division of Academic Affairs, Maine Medical Center, Portland, Maine, USA
| | - Kathleen Fairfield
- Department of Internal Medicine, Maine Medical Center, Portland, Maine, USA
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14
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Manemann SM, St Sauver J, Henning-Smith C, Finney Rutten LJ, Chamberlain AM, Fabbri M, Weston SA, Jiang R, Roger VL. Rurality, Death, and Healthcare Utilization in Heart Failure in the Community. J Am Heart Assoc 2021; 10:e018026. [PMID: 33533260 PMCID: PMC7955348 DOI: 10.1161/jaha.120.018026] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Prior reports indicate that living in a rural area may be associated with worse health outcomes. However, data on rurality and heart failure (HF) outcomes are scarce. Methods and Results Residents from 6 southeastern Minnesota counties with a first-ever code for HF (International Classification of Diseases, Ninth Revision [ICD-9], code 428, and International Classification of Diseases, Tenth Revision [ICD-10] code I50) between January 1, 2013 and December 31, 2016, were identified. Resident address was classified according to the rural-urban commuting area codes. Rurality was defined as living in a nonmetropolitan area. Cox regression was used to analyze the association between living in a rural versus urban area and death; Andersen-Gill models were used for hospitalization and emergency department visits. Among 6003 patients with HF (mean age 74 years, 48% women), 43% lived in a rural area. Rural patients were older and had a lower educational attainment and less comorbidity compared with patients living in urban areas (P<0.001). After a mean (SD) follow-up of 2.8 (1.7) years, 2440 deaths, 20 506 emergency department visits, and 11 311 hospitalizations occurred. After adjustment, rurality was independently associated with an increased risk of death (hazard ratio [HR], 1.18; 95% CI, 1.09-1.29) and a reduced risk of emergency department visits (HR, 0.89; 95% CI, 0.82-0.97) and hospitalizations (HR, 0.78; 95% CI, 0.73-0.84). Conclusions Among patients with HF, living in a rural area is associated with an increased risk of death and fewer emergency department visits and hospitalizations. Further study to identify and address the mechanisms through which rural residence influences mortality and healthcare utilization in HF is needed in order to reduce disparities in rural health.
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Affiliation(s)
| | | | - Carrie Henning-Smith
- Division of Health Policy and Management University of Minnesota School of Public Health Minneapolis MN
| | | | | | - Matteo Fabbri
- Department of Health Sciences Research Mayo Clinic Rochester MN
| | - Susan A Weston
- Department of Health Sciences Research Mayo Clinic Rochester MN
| | - Ruoxiang Jiang
- Department of Health Sciences Research Mayo Clinic Rochester MN
| | - Véronique L Roger
- Department of Health Sciences Research Mayo Clinic Rochester MN.,Division of Cardiovascular Diseases Mayo Clinic Rochester MN
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15
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Hwang B, Pelter MM, Moser DK, Dracup K. Effects of an educational intervention on heart failure knowledge, self-care behaviors, and health-related quality of life of patients with heart failure: Exploring the role of depression. PATIENT EDUCATION AND COUNSELING 2020; 103:1201-1208. [PMID: 31964579 PMCID: PMC7253326 DOI: 10.1016/j.pec.2020.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 12/20/2019] [Accepted: 01/13/2020] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To test effects of an educational intervention on patient-reported outcomes among rural heart failure (HF) patients and to examine whether effects differed between patients with and without depression. METHODS Patients (N = 614) were randomized to usual care (UC) or 1 of 2 intervention groups. Both intervention groups received face-to-face education, followed by either 2 phone calls (LITE) or biweekly calls until they demonstrated content competency (PLUS). Follow-up lasted 24 months. Statistical analyses included linear mixed models and subgroup analyses by depression status. RESULTS Both intervention groups showed improvement in HF knowledge at 3 months (LITE-UC, p = 0.003; PLUS-UC, p < 0.001). Improvement lasted 24 months only in the PLUS group. Compared to UC, both intervention groups exhibited better self-care at 3 months (LITE-UC, p < 0.001; PLUS-UC, p < 0.001) and 12 months (LITE-UC, p = 0.001; PLUS-UC, p = 0.002). There were no differences in health-related quality of life (HRQOL) among groups. In subgroup analyses, similar effects were found among non-depressed, but not among depressed patients. CONCLUSION The educational intervention improved HF knowledge and self-care, but not HRQOL. No intervention effects were observed in patients with depressive symptoms. PRACTICE IMPLICATIONS The simple educational intervention is promising to improve HF knowledge and self-care. Additional strategies are needed for depressed patients.
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Affiliation(s)
- Boyoung Hwang
- College of Nursing & Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea.
| | | | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, USA
| | - Kathleen Dracup
- School of Nursing, University of California, San Francisco, USA
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16
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Brandstetter C, Winter T, Weidinger F, Stöllberger C. The attitude towards disease management programs in Austrian heart failure patients: a pilot study comparing rural and urban patients. Minerva Cardioangiol 2020; 68:209-215. [PMID: 32100981 DOI: 10.23736/s0026-4725.20.05082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Disease Management Programs (DMPs) for heart failure (HF) patients have been developed to better control patients' well-being as well as their daily drug intake. DMPs for HF are not always accepted by the patients, and the reasons for this phenomenon are largely unknown. We hypothesized that patients from rural areas accept a DMP more likely than patients living in a big city. Thus, a pilot study investigated differences in the attitude towards DMPs between HF-patients in one rural and one urban hospital in Austria. METHODS Patients admitted because of HF to 2 hospitals, one with rural and one with urban populations, were included prospectively by using a questionnaire. RESULTS Included were 60 patients, 43% females with a mean age of 76 years, in each hospital 30 patients. Rural patients were more interested in a nurse-based DMP than urban (N.=30) (P=0.029). After discharge, urban patients planned more often to attend a specialist than rural (P=0.005). No differences were found regarding gender, age, willingness to be included into a telenursing-based program and estimation of knowledge about HF. CONCLUSIONS Structures of the health care system and patients' attitudes must be considered when planning DMPs. Development of DMPs which are accepted by urban patients will be relevant for the future.
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Affiliation(s)
- Clara Brandstetter
- Department of Internal Medicine, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - Thomas Winter
- Department of Internal Medicine, Krankenhaus Barmherzige Schwestern Ried, Ried, Austria
| | - Franz Weidinger
- Department of Internal Medicine, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - Claudia Stöllberger
- Department of Internal Medicine, Krankenanstalt Rudolfstiftung, Vienna, Austria -
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17
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Biddle MJ, Moser DK, Pelter MM, Robinson S, Dracup K. Predictors of Adherence to Self-Care in Rural Patients With Heart Failure. J Rural Health 2019; 36:120-129. [PMID: 31840332 DOI: 10.1111/jrh.12405] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The common reality of not following a recommended course of treatment is a major cause of poor health outcomes in patients with heart failure (HF). The purpose of this study was to identify predictors of adherence to HF self-care recommendations in rural HF patients who received an intervention to promote symptom management and self-care. METHODS Data from 349 rural HF patients (42% female, 90% Caucasian) randomized to the intervention arms of the study were used. Adherence was measured using the European Heart Failure Self-Care Scale questionnaire, a brief measure that asks patients to report their adherence to a variety of recommended HF symptom management behaviors (ie, daily weight monitoring, when to call the physician, medications, diet, and exercise). The following predictors were tested: age, gender, marital status, education level, depression score (measured using PHQ-9), anxiety score (measured with the Brief Symptom Inventory), and level of perceived control (measured using Control Attitudes Scale-R). Multivariate linear regression was used to test the model. RESULTS The model to predict adherence was significant (P < .0001). Of the covariates tested in the regression model, being a male (P = .009), having less anxiety (P = .018), not being depressed (P = .017), and having higher perceived control (P = .003) were predictors of improved self-care score at 3 months. CONCLUSION Adherence is a multifaceted and a challenging behavior based on the assumption that the patient agrees with self-care recommendations. These data suggest interventions designed to promote adherence behaviors should include an assessment of gender, anxiety, depression, and perceived control for optimal outcomes.
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Affiliation(s)
- Martha J Biddle
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Michele M Pelter
- School of Nursing, University of California, San Francisco, California
| | - Susan Robinson
- School of Nursing, University of California, San Francisco, California
| | - Kathleen Dracup
- School of Nursing, University of California, San Francisco, California
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18
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Lenzi J, Avaldi VM, Molinazzi D, Descovich C, Urbinati S, Cappelli V, Fantini MP. Are degree of urbanisation and travel times to healthcare services associated with the processes of care and outcomes of heart failure? A retrospective cohort study based on administrative data. PLoS One 2019; 14:e0223845. [PMID: 31658280 PMCID: PMC6816546 DOI: 10.1371/journal.pone.0223845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/30/2019] [Indexed: 12/28/2022] Open
Abstract
A few studies have found that patients with heart failure (HF) living in less densely populated areas have reduced use of services and poorer outcomes. However, there is a lack of evidence regarding transport accessibility measured as the actual distance between the patient's home and the healthcare facility. The aim of this study was to investigate if different urbanisation levels and travel times to healthcare services are associated with the processes of care and the outcomes of HF. This retrospective cohort study included patients residing in the Local Healthcare Authority of Bologna (2915 square kilometres) who were discharged from hospital with a diagnosis of HF between 1 January and 31 December 2017. Six-month study outcomes included both process (cardiology follow-up visits) and outcome measures (all-cause readmissions, emergency room visits, all-cause mortality). Of the 2022 study patients, 963 (47.6%) lived in urban areas, 639 (31.6%) in intermediate density areas, and 420 (20.8%) in rural communities. Most patients lived ≤30 minutes away from the nearest healthcare facility, either inpatient or outpatient. After controlling for a number of individual factors, no significant association between travel times and outcomes was present. However, rural patients as opposed to urban patients were more likely to see a cardiologist during follow-up (OR 1.42, 99% CI 1.03-1.96). These follow-up visits were associated with reduced mortality within 6 months of discharge (OR 0.53, 99% CI 0.32-0.87). We also found that multidisciplinary interventions for HF were more common in rural than in urban settings (18.8% vs. 4.0%). In conclusion, travel times had no impact on the quality of care for patients with HF. Differences between urban and rural patients were possibly mediated by more proximal factors, some of which are potential targets for intervention such as the availability and utilisation of follow-up cardiology services and multidisciplinary models of care.
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Affiliation(s)
- Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – University of Bologna, Bologna, Italy
| | - Vera Maria Avaldi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – University of Bologna, Bologna, Italy
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
- * E-mail:
| | - Dario Molinazzi
- Department of Management Control and Administrative Data, Bologna Local Healthcare Authority, Bologna, Italy
| | - Carlo Descovich
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
| | | | - Veronica Cappelli
- Directorate of Assistance, Technology and Rehabilitation, Bologna Local Healthcare Authority, Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – University of Bologna, Bologna, Italy
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19
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Gutman SJ, Costello BT, Papapostolou S, Iles L, Ja J, Hare JL, Ellims A, Marwick TH, Taylor AJ. Impact of sex, socio-economic status, and remoteness on therapy and survival in heart failure. ESC Heart Fail 2019; 6:944-952. [PMID: 31618531 PMCID: PMC6816230 DOI: 10.1002/ehf2.12481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/26/2019] [Accepted: 05/30/2019] [Indexed: 01/28/2023] Open
Abstract
Aims This study aims to determine if traditional markers of disadvantage [female sex, low socio‐economic status (SES), and remoteness] are associated with lower prescription of evidence‐based therapy and higher mortality among patients with moderate–severe heart failure with reduced ejection fraction. Methods and results We recruited 452 consecutive class II–III heart failure with reduced ejection fraction patients. Baseline clinical data were recorded prospectively. The primary outcome was the association of female sex on overall survival. Secondary outcomes included association between evidence‐based therapy delivery and sex and association of SES and remoteness on heart failure therapy and survival. The Australian Bureau of Statistics generated all indices. Median follow‐up was 37.9 months. One hundred and nine patients (24.3%) were women. There was no difference in overall survival based on sex (hazard ratio = 1.19, 95% confidence interval: 0.74–1.92, 0.48). There was no difference in prescription of beta‐blockers [χ2(1) = 0.91, 0.66], angiotensin‐converting enzyme inhibitors [χ2(1) = 0.001, 0.97], nor aldosterone antagonists [χ2(1) = 2.71, 0.10]. There was no difference in rates of primary prevention implantable cardioverter‐defibrillator implantation in men compared with women [χ2(1) = 0.35, 0.56]. Neither higher SES nor inner city residence conferred an overall survival benefit. Conclusions In this Australian cohort of heart failure patients, delivery of care and likelihood of death are comparable between the sexes, SES groups, and rural vs. city residents.
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Affiliation(s)
- Sarah J Gutman
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Ben T Costello
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Stavroula Papapostolou
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Leah Iles
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Johnson Ja
- The Alfred Hospital, Melbourne, Victoria, Australia
| | - James L Hare
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Andris Ellims
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Thomas H Marwick
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Andrew J Taylor
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
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20
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Hovland-Tånneryd A, Melin M, Hägglund E, Hagerman I, Persson HE. From randomised controlled trial to real world implementation of a novel home-based heart failure tool: pooled and comparative analyses of two clinical controlled trials. Open Heart 2019; 6:e000954. [PMID: 31217992 PMCID: PMC6546184 DOI: 10.1136/openhrt-2018-000954] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/21/2019] [Accepted: 05/06/2019] [Indexed: 01/17/2023] Open
Abstract
Objectives A home-based tool for heart failure (HF) patients, was evaluated in a specialist setting as a randomised controlled trial (RCT) and also in a validation cohort in a primary care setting in a clinical controlled trial (CCT). The tool provides education, symptom monitoring and titration of diuretics. The aim of this study was thus to extend validity of the previous RCT findings in order to describe applicability of the tool in clinical practice. Methods Data from both trials were analysed separately, as well as a pooled data set (n=172). Data were analysed with respect to HF related in-hospital days, self-care behaviour and system adherence, during a 6-month intervention. The analysis of in-hospital days for the pooled data was adjusted for baseline differences between the two study cohorts, relating to disease state. Results In the RCT (n=72) the intervention group (IG) consisted of 32 patients and the control group (CG) of 40 patients. The risk ratio (RR) for in-hospital days was RR: 0.72, 95% CI 0.61 to 0.84, p<0.05 in favour of the IG. In the CCT (n=100) both the IG and the CG consisted of 50 patients and the IG had fewer in-hospitals days, comparable to the RCT findings with RR: 0.67; 95% CI 0.45 to 0.99; p<0.05. For the pooled data set made up of 172 patients, the groups were well balanced but with a higher prevalence of hypertension in the CG. The RR relating to in-hospital days for the pooled data set was 0.71; 95% CI 0.61 to 0.82; p<0.05 in favour of the IG. There was a statistically significant improvement in self-care by 27% and the median system adherence was 94%. Conclusions These analyses suggest that the evaluated tool might reduce HF related in-hospital days in the general HF population, which adds to the external validity of previous findings. Clinical Trial Registration NCT03655496.
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Affiliation(s)
| | - Michael Melin
- Heart and Vascular Theme, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Ewa Hägglund
- Heart and Vascular Theme, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Inger Hagerman
- Heart and Vascular Theme, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Hans E Persson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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21
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Tankumpuan T, Asano R, Koirala B, Dennison-Himmelfarb C, Sindhu S, Davidson PM. Heart failure and social determinants of health in Thailand: An integrative review. Heliyon 2019; 5:e01658. [PMID: 31193015 PMCID: PMC6513778 DOI: 10.1016/j.heliyon.2019.e01658] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/10/2018] [Accepted: 05/01/2019] [Indexed: 12/26/2022] Open
Abstract
Background Heart failure is a highly burdensome syndrome and is rapidly increasing in prevalence in low and middle-income countries and outcomes are influenced at the level of the patient, provider and health system. Understanding heart failure beyond a biomedical perspective and the relationship between health outcomes and social determinants of health is critical for informing policy development and improving health outcomes. Aim To identify the social determinants of health for improving health outcomes for individuals with heart failure in Thailand. Method This integrative review included studies published between January 1, 2008, and March 31, 2016 in both the Thai and English language identified through searching Scopus, PubMed, and CINAHL. Results Six experimental, eight descriptive and two qualitative studies were identified met the inclusion and exclusion criteria. The majority of study participants were elderly, female, had low-education and income levels, were participating in a universal coverage scheme and living in a rural setting. All interventions were delivered at the level of the individual, focusing on education to improve knowledge, self-care, and functional status. Findings showed an improvement in health outcomes which were moderated by social determinants of health such as gender and income. Conclusion As the burden of heart failure increases in Thailand and other emerging economies, developing culturally appropriate, affordable and acceptable models of intervention considering social determinants of health is necessary.
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Affiliation(s)
| | - Reiko Asano
- The Johns Hopkins University School of Nursing, United States
| | - Binu Koirala
- The Johns Hopkins University School of Nursing, United States
| | | | | | - Patricia M Davidson
- The Johns Hopkins University School of Nursing, United States.,University of Technology Sydney, Australia
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22
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Iyngkaran P, Liew D, Neil C, Driscoll A, Marwick TH, Hare DL. Moving From Heart Failure Guidelines to Clinical Practice: Gaps Contributing to Readmissions in Patients With Multiple Comorbidities and Older Age. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2018; 12:1179546818809358. [PMID: 30618487 PMCID: PMC6299336 DOI: 10.1177/1179546818809358] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 09/14/2018] [Indexed: 12/20/2022]
Abstract
This feature article for the thematic series on congestive heart failure (CHF) readmissions aims to outline important gaps in guidelines for patients with multiple comorbidities and the elderly. Congestive heart failure diagnosis manifests as a 3-phase journey between the hospital and community, during acute, chronic stable, and end-of-life (palliative) phases. This journey requires in variable intensities a combination of multidisciplinary care within tertiary hospital or ambulatory care from hospital outpatients or primary health services, within the general community. Management goals are uniform, ie, to achieve the lowest New York Heart Association class possible, with improvement in ejection fraction, by delivering gold standard therapies within a CHF program. Comorbidities are an important common denominator that influences outcomes. Comorbidities include diabetes mellitus, chronic obstructive airways disease, chronic renal impairment, hypertension, obesity, sleep apnea, and advancing age. Geriatric care includes the latter as well as syndromes such as frailty, falls, incontinence, and confusion. Many systems still fail to comprehensively achieve all aspects of such programs. This review explores these factors.
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Affiliation(s)
- Pupalan Iyngkaran
- Northern Territory Medical Program, Flinders University, Darwin, NT, Australia
- Pupalan Iyngkaran, Yellow Building 4 Cnr University Drive North & University Drive West Charles Darwin University, Casuarina, NT 0815, Australia.
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christopher Neil
- Department of Medicine—Western Precinct, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrea Driscoll
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
- Austin Health, Melbourne, VIC, Australia
| | | | - David L Hare
- Cardiovascular Research, The University of Melbourne, Melbourne, VIC, Australia
- Heart Failure Services, Austin Health, Melbourne, VIC, Australia
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23
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Vermeulin T, Lucas M, Marini H, Di Fiore F, Loeb A, Lottin M, Daubert H, Gray C, Guisier F, Sefrioui D, Michel P, de Mil R, Czernichow P, Merle V. Totally implanted venous access-associated adverse events in oncology: Results from a prospective 1-year surveillance programme. Bull Cancer 2018; 105:1003-1011. [PMID: 30322697 DOI: 10.1016/j.bulcan.2018.09.005] [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: 08/01/2018] [Revised: 09/10/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION During the last decade, most studies on totally implanted venous access-associated adverse events (TIVA-AE) were conducted retrospectively and/or were based on a limited sample size. The aim of our survey was two-fold: to estimate the incidence of TIVA-AE and to identify risk factors in patients with cancer. METHODS Data from our routine surveillance of TIVA-AE were collected prospectively between October 2009 and January 2011 in two oncology referral centers in Northern France. The open cohort under surveillance during the same time period was reconstituted retrospectively using data from the hospital information systems. Incidences of first TIVA-AE per 1000 TIVA-days were calculated. Risk factors were identified using multivariate logistic regressions. RESULTS We included 2286 cancer patients, corresponding to 582,347 TIVA-days. Among the 133 first TIVA-AE observed (incidence 0.23 per 1000 TIVA-days [0.19-0.27]), there were 50 infectious AE (incidence 0.09 [0.06-0.11]) and 83 non-infectious AE (incidence 0.14 [0.11-0.17]). Compared to non-metastatic solid cancers, metastatic cancers (aOR=2.3 [0.9-6.0]), and hematologic malignancies (aOR=3.2 [1.1-8.8]) tended to be associated with a higher risk of infectious TIVA-AE (P=0.087). Solid cancer type was associated with non-infectious TIVA-AE (P=0.030), especially digestive cancers. DISCUSSION We report accurate estimations of TIVA-AE incidences in one of the largest populations among previously published studies. As in previous studies, metastatic cancers and hematologic malignancies tended to be associated with a higher risk of infectious TIVA-AE. Further studies are warranted to confirm the effect of digestive cancers.
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Affiliation(s)
- Thomas Vermeulin
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France.
| | - Mélodie Lucas
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France
| | - Hélène Marini
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France
| | - Frédéric Di Fiore
- Rouen University Hospital, Department of Hepatogastroenterology, 1, rue de Germont, 76031 Rouen cedex, France
| | - Agnès Loeb
- Comprehensive Cancer Center Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France
| | - Marion Lottin
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France
| | - Hervé Daubert
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France
| | - Christian Gray
- Comprehensive Cancer Center Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France
| | - Florian Guisier
- Rouen University Hospital, Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care, CIC Inserm U 1404, 1, rue de Germont, 76031 Rouen cedex, France
| | - David Sefrioui
- Rouen University Hospital, Department of Hepatogastroenterology, 1, rue de Germont, 76031 Rouen cedex, France
| | - Pierre Michel
- Rouen University Hospital, Department of Hepatogastroenterology, 1, rue de Germont, 76031 Rouen cedex, France
| | - Rémy de Mil
- Normandie Université, UNICAEN, Inserm U 1086, 3, avenue Général-Harris, 14076 Caen, France
| | - Pierre Czernichow
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France
| | - Véronique Merle
- Rouen University Hospital, Research Group "Dynamics and Events of Care Pathways", 1, rue de Germont, 76031 Rouen cedex, France
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Abstract
Atrial fibrillation (AF) and heart failure (HF) are evolving epidemics, together responsible for substantial human suffering and health-care expenditure. Ageing, improved cardiovascular survival, and epidemiological transition form the basis for their increasing global prevalence. Although we now have a clear picture of how HF promotes AF, gaps remain in our knowledge of how AF exacerbates or even causes HF, and how the development of HF affects the outcome of patients with AF. New data regarding HF with preserved ejection fraction and its unique relationship with AF suggest a possible role for AF in its aetiology, possibly as a trigger for ventricular fibrosis. Deciding on optimal treatment strategies for patients with both AF and HF is increasingly difficult, given that results from trials of pharmacological rhythm control are arguably obsolete in the age of catheter ablation. Restoring sinus rhythm by catheter ablation seems successful in the medium term and improves HF symptoms, functional capacity, and left ventricular function. Long-term studies to examine the effect on rates of stroke and death are ongoing. Guidelines continue to evolve to keep pace with this rapidly changing field.
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