1
|
Educational inequalities in heart failure mortality and the cycles of the internal armed conflict in Colombia: An observational panel study of ecological data, 1999-2017. Heliyon 2023; 9:e13050. [PMID: 36785819 PMCID: PMC9918747 DOI: 10.1016/j.heliyon.2023.e13050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Heart failure (HF) is a significant clinical problem and an important public health issue due to the morbidity and mortality that it causes, especially in a population that is aging and affected by social stressors such as armed conflict. We aim to describe the inequalities and trends of HF mortality by educational level in Colombia between 1999 and 2017 compared with the cycles of the internal armed conflict during the same period. An observational study of ecological data panels, with aggregates at the national level, was conducted. Information from death certificates with HF as the basic cause of death (COD) was used. Variables of the year of death, sex, age, department of residence, and educational level were considered. Mortality rates adjusted for age were calculated. A joinpoint regression was used to model the trend of rates by educational level. We found that both men and women with primary education had the highest adjusted mortality rates: among men, RR_primary = 19.06 deaths/100,000 inhabitants, SE = 0.13 vs. RR_tertiary = 4.85, SE = 0.17, and similar differences among women. Mortality rates tended to decrease at all educational levels, with a greater reduction in people with higher educational levels. In both sexes, the behavior of the relative index of inequality showed significant inequality, albeit with a strong reduction during the last decade. Mortality due to HF in Colombia shows inequalities by educational level. In the prevention of HF, education should be considered a structural social determinant. In addition, we analyzed the potential role of the Colombian long-term armed conflict in the observed trends. We highlighted the role of the health sector, together with other sectors (education, work, and housing), in developing intersectoral public policies that contribute to the reduction of cardiovascular mortality disparities.
Collapse
|
2
|
Assessment of health-related quality of life in patients with heart failure: a cross-sectional study in Saudi Arabia. Health Qual Life Outcomes 2022; 20:128. [PMID: 36042486 PMCID: PMC9425984 DOI: 10.1186/s12955-022-02040-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 08/22/2022] [Indexed: 11/27/2022] Open
Abstract
Background As a precarious clinical condition and a public health problem, heart failure (HF) is associated with a significant burden of morbidity, mortality, and health care costs. As almost all of the published research has been conducted in Western countries, there is a need for culturally relevant studies in Saudi Arabia. This is the first study to investigate health-related quality of life (HRQoL) and its associated factors among Saudi patients with HF in the Qassim region.
Methods A cross-sectional study was conducted at the only tertiary care hospital in the Qassim region of Saudi Arabia during the period from November 2020 to July 2021. The participants were interviewed face-to-face by trained interviewers using the standard validated 36-item Short-Form Health Survey (SF-36) questionnaire for HRQoL assessment. The data were analyzed using STATA version 16. Results The participants included 246 HF patients whose mean (SD) age was 56.7 (10.9) years. A majority of the respondents (80%, n = 197) were male, and 49% (n = 121) had an education level of less than secondary school. The median scores were high for the domains of social functioning (100 points) and bodily pain (75 points) and low for role-physical functioning (25 points). In general, the median scores for the physical and mental component summaries were 58.1 and 63.7, respectively. Patients with an education level less than secondary school were more likely to have a low physical component summary score (aOR 3.00, 95% CI 1.46–6.17), while female patients were more likely to have a low mental component summary score (aOR 2.67, 95% CI 1.38–5.16). Conclusions Health-related quality of life was found to be moderate among these HF patients. Periodic HRQoL assessment is recommended for HF patients to minimize their physical and psychological concerns, particularly for patients with low education levels and female patients.
Collapse
|
3
|
Vanzella LM, Oh P, Pakosh M, Ghisi GLDM. Barriers and facilitators to virtual education in cardiac rehabilitation: a systematic review of qualitative studies. Eur J Cardiovasc Nurs 2021; 21:414-429. [PMID: 34941993 PMCID: PMC9383179 DOI: 10.1093/eurjcn/zvab114] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/04/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022]
Abstract
Background Due to restrictions imposed by the severe acute respiratory syndrome coronavirus 2 pandemic much attention has been given to virtual education in cardiac rehabilitation (CR). Despite growing evidence that virtual education is effective in teaching patients how to better self-manage their conditions, there is very limited evidence on barriers and facilitators of CR patients in the virtual world. Aims To identify barriers and facilitators to virtual education participation and learning in CR. Methods A systematic review of peer-reviewed literature was conducted. Medline, Embase, Emcare, CINAHL, PubMed, and APA PsycInfo were searched from inception through April 2021. Following the PRISMA checklist, only qualitative studies were considered. Theoretical domains framework (TDF) was used to guide thematic analysis. The Critical Appraisal Skills Program was used to assess the quality of the studies. Results Out of 6662 initial citations, 12 qualitative studies were included (58% ‘high’ quality). A total of five major barriers and facilitators were identified under the determinants of TDF. The most common facilitator was accessibility, followed by empowerment, technology, and social support. Format of the delivered material was the most common barrier. Technology and social support also emerged as barriers. Conclusion This is the first systematic review, to our knowledge, to provide a synthesis of qualitative studies that identify barriers and facilitators to virtual education in CR. Cardiac rehabilitation patients face multiple barriers to virtual education participation and learning. While 12 qualitative studies were found, future research should aim to identify these aspects in low-income countries, as well as during the pandemic, and methods of overcoming the barriers described.
Collapse
Affiliation(s)
- Lais Manata Vanzella
- University Health Network, Toronto Rehabilitation Institute, 347 Rumsey Road, Toronto, Ontario M4G 2R6, Canada
| | - Paul Oh
- University Health Network, Toronto Rehabilitation Institute, 347 Rumsey Road, Toronto, Ontario M4G 2R6, Canada
| | - Maureen Pakosh
- Library & Information Services, University Health Network, Toronto Rehabilitation Institute, 347 Rumsey Road, Toronto, Ontario M4G 2R6, Canada
| | - Gabriela Lima de Melo Ghisi
- University Health Network, Toronto Rehabilitation Institute, 347 Rumsey Road, Toronto, Ontario M4G 2R6, Canada
| |
Collapse
|
4
|
Socioeconomic Gradients in Mortality Following HF Hospitalization in a Country With Universal Health Care Coverage. JACC-HEART FAILURE 2020; 8:917-927. [DOI: 10.1016/j.jchf.2020.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/11/2020] [Indexed: 12/19/2022]
|
5
|
Koirala B, Dennison Himmelfarb CR, Budhathoki C, Davidson PM. Heart failure self-care, factors influencing self-care and the relationship with health-related quality of life: A cross-sectional observational study. Heliyon 2020; 6:e03412. [PMID: 32149197 PMCID: PMC7031642 DOI: 10.1016/j.heliyon.2020.e03412] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 10/31/2019] [Accepted: 02/10/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Self-care helps maintain health, prevents complications and improves the quality of life of patients living with heart failure (HF). Self-care is critical to HF management but has received limited attention in Nepal. Identification of the sociodemographic and clinical characteristics associated with self-care is crucial to tailoring appropriate self-care programs to improve health outcomes including patients' quality of life. AIMS The aims of this study were to describe self-care including the factors influencing self-care and the relationship between self-care and health-related quality of life in patients living with HF in Kathmandu, Nepal. METHODS We used a cross-sectional observational study design to measure self-care maintenance, self-care management, and self-care confidence using the Nepali Self-Care of Heart Failure Index. To analyze data, we used descriptive statistics, bivariate associations and regression modeling. RESULTS We recruited 221 patients with HF: mean age 57.5 ± 15.76 years, 62% male. The results in this sample indicated poor self-care maintenance (38.5 ± 11.56), management (45.7 ± 15.14), and confidence (40.9 ± 16.31). Patients with higher education were associated with higher self-care maintenance and management. Living alone and a better New York Heart Association functional classification for HF were related to higher self-care confidence. Higher social support was associated with better self-care. Self-care confidence was an independent predictor of self-care maintenance, management and health-related quality of life on adjusted analyses. CONCLUSION Self-care was limited among patients living with HF in Nepal yet was associated with better quality of life. The study identified various sociodemographic and clinical factors related to self-care, which could be crucial while developing self-care interventions.
Collapse
Affiliation(s)
- Binu Koirala
- School of Nursing, Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD 21205 United States
| | - Cheryl R. Dennison Himmelfarb
- School of Nursing, Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD 21205 United States
- Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, 2024 E Monument St, Baltimore, MD 21205 United States
| | - Chakra Budhathoki
- School of Nursing, Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD 21205 United States
| | - Patricia M. Davidson
- School of Nursing, Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD 21205 United States
| |
Collapse
|
6
|
Ahmad K, Chen EW, Nazir U, Cotts W, Andrade A, Trivedi AN, Erqou S, Wu W. Regional Variation in the Association of Poverty and Heart Failure Mortality in the 3135 Counties of the United States. J Am Heart Assoc 2019; 8:e012422. [PMID: 31480884 PMCID: PMC6818020 DOI: 10.1161/jaha.119.012422] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/05/2019] [Indexed: 12/30/2022]
Abstract
Background There is significant geographical variation in heart failure (HF) mortality across the United States. County socioeconomic factors that influence these outcomes are unknown. We studied the association between county socioeconomic factors and HF mortality and compared it with coronary heart disease (CHD) mortality. Methods and Results This is a cross-sectional analysis of socioeconomic factors and mortality in HF and CHD across 3135 US counties from 2010 to 2015. County-level poverty, education, income, unemployment, health insurance status, and cause-specific mortality rates were collected from the Centers for Disease Control and Prevention and US Census Bureau databases. Poverty had the strongest correlation with both HF and CHD mortality, disproportionately higher for HF (r=0.48) than CHD (r=0.24). HF mortality increased by 5.2 deaths/100 000 for each percentage increase in county poverty prevalence in a frequency-weighted, demographic-adjusted, multivariate regression model. The greatest attenuation in the poverty regression coefficient (66.4%) was seen after adjustment for prevalence of diabetes mellitus and obesity. Subgroup analysis by census region showed that this relationship was the strongest in the South and weakest in the Northeast (6.1 versus 1.4 deaths/100 000 per 1% increase in county poverty in a demographics-adjusted model). Conclusions County poverty is the strongest socioeconomic factor associated with HF and CHD mortality, an association that is stronger with HF than with CHD and varied by census region. Over half of the association was explained by differences in the prevalence of diabetes mellitus and obesity across the counties. Health policies targeting improvement in these risk factors may address and possibly minimize health disparities caused by socioeconomic factors.
Collapse
Affiliation(s)
- Khansa Ahmad
- Division of Cardiology, Providence Veterans Affairs Medical Center and the Warren Alpert Medical School at Brown UniversityProvidenceRI
| | - Edward W. Chen
- Division of Cardiology, Providence Veterans Affairs Medical Center and the Warren Alpert Medical School at Brown UniversityProvidenceRI
| | - Umair Nazir
- Division of Cardiology, Providence Veterans Affairs Medical Center and the Warren Alpert Medical School at Brown UniversityProvidenceRI
| | - William Cotts
- Division of Cardiology, Providence Veterans Affairs Medical Center and the Warren Alpert Medical School at Brown UniversityProvidenceRI
| | - Ambar Andrade
- Division of Cardiology, Providence Veterans Affairs Medical Center and the Warren Alpert Medical School at Brown UniversityProvidenceRI
| | - Amal N. Trivedi
- Division of Cardiology, Providence Veterans Affairs Medical Center and the Warren Alpert Medical School at Brown UniversityProvidenceRI
| | - Sebhat Erqou
- Division of Cardiology, Providence Veterans Affairs Medical Center and the Warren Alpert Medical School at Brown UniversityProvidenceRI
| | - Wen‐Chih Wu
- Division of Cardiology, Providence Veterans Affairs Medical Center and the Warren Alpert Medical School at Brown UniversityProvidenceRI
| |
Collapse
|
7
|
Andersen J, Gerds TA, Gislason G, Schou M, Torp-Pedersen C, Hlatky MA, Møller S, Madelaire C, Strandberg-Larsen K. Socioeconomic position and one-year mortality risk among patients with heart failure: A nationwide register-based cohort study. Eur J Prev Cardiol 2019; 27:79-88. [DOI: 10.1177/2047487319865946] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Aims We sought to determine whether socioeconomic position affects the survival of patients with heart failure treated in a national healthcare system. Methods We linked national Danish registers, identified 145,690 patients with new-onset heart failure between 2000 and 2015, and obtained information on education and income levels. We analysed differences in survival by income quartile and educational level using multiple Cox regression, stratified by sex. We standardised one-year mortality risks according to income level by age, year of diagnosis, cohabitation status, educational level, comorbidities and medical treatment of all patients. We standardised one-year mortality risk according to educational level by age and year of diagnosis. Results One-year mortality was inversely related to income. In women the standardised average one-year mortality risk was 28.0% in the lowest income quartile and 24.3% in the highest income quartile, a risk difference of −3.8% (95% confidence interval (CI) −4.9% to −2.6%). In men the standardised one-year mortality risk was 26.1% in the lowest income quartile and 20.2% in the highest income quartile, a risk difference of −5.8% (95% CI −6.8% to −4.9%). Similar gradients in standardised mortality were present between the highest and lowest educational levels: −6.6% (95% CI −9.6% to −3.5%) among women and −5.0% (95% CI −6.3% to −3.7%) among men. Conclusions Income and educational level affect the survival of patients with heart failure, even in a national health system. Research is needed to investigate how socioeconomic differences affect survival.
Collapse
Affiliation(s)
- Julie Andersen
- Department of Research, Danish Heart Foundation, Denmark
| | - Thomas Alexander Gerds
- Department of Research, Danish Heart Foundation, Denmark
- Department of Public Health, University of Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Research, Danish Heart Foundation, Denmark
- Department of Cardiology, Herlev and Gentofte University Hospital, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Denmark
- Department of Cardiology, Aalborg University Hospital, Denmark
| | - Mark A Hlatky
- Department of Health Research and Policy, Campus Drive, Stanford University School of Medicine, Stanford, CA, USA
| | - Sidsel Møller
- Department of Cardiology, Herlev and Gentofte University Hospital, Denmark
| | | | | |
Collapse
|
8
|
Lovell J, Pham T, Noaman SQ, Davis MC, Johnson M, Ibrahim JE. Self-management of heart failure in dementia and cognitive impairment: a systematic review. BMC Cardiovasc Disord 2019; 19:99. [PMID: 31035921 PMCID: PMC6489234 DOI: 10.1186/s12872-019-1077-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/11/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The cornerstone of effective management in heart failure (HF) is the ability to self-care. Aims include i) To determine factors influencing self-care in HF patients with cognitive impairment (CI) and ii) to determine the influence of cognitive domains on self-care in patients with HF and CI. METHODS MEDLINE, CINAHL, EMBASE, EBSCOHost, PsychINFO, ProQuest Research Library, Health Technology Assessment Database, The Cochrane Library, Web of Science and Scopus databases were systematically searched. Original research describing the relationship between cognition and HF self-care in community-dwelling older persons with dementia/CI in English, published in a peer-reviewed journal from 1stJanuary(2000)-22ndMarch(2016) was identified. Study and population characteristics, data sources, self-care processes, methods of cognitive assessment, cognitive domains affected, study outcomes, impact of impairment, and other risk factors of self-care impairment were abstracted by two reviewers. RESULTS Of 10,688 studies identified, 14 met the inclusion criteria. Patients with HF and CI ranged from 14 to 73%. Where reported, self-care maintenance adequacy ranged from 50 to 61%; self-care management adequacy ranged from 14 to 36% and self-care confidence adequacy ranged from 0 to 44% on the Self-care of Heart Failure Index (SCHFI). All but one study predicted poor self-care ability according to poor outcome on cognitive testing. Additionally, specific cognitive domain deficits impaired self-care. Subjects with lower cognitive scores were less likely to seek assistance while subjects with depression had poor self-care abilities. CONCLUSIONS Clinicians must consider the type and severity of impairments in cognitive domains to tailor management. Awareness of depression, self-confidence and support access may modulate self-care ability.
Collapse
Affiliation(s)
- Janaka Lovell
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia.
| | - Tony Pham
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| | - Samer Q Noaman
- Department of Cardiology, Alfred Health, Victoria, 3004, Australia
| | | | - Marilyn Johnson
- Institute of Transport Studies, Monash University, Victoria, 3800, Australia
| | - Joseph E Ibrahim
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria, 3006, Australia
| |
Collapse
|
9
|
Khaing W, Vallibhakara SA, Attia J, McEvoy M, Thakkinstian A. Effects of education and income on cardiovascular outcomes: A systematic review and meta-analysis. Eur J Prev Cardiol 2017; 24:1032-1042. [PMID: 28406328 DOI: 10.1177/2047487317705916] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objective Previous studies have reported discrepancy effects of education and income on cardiovascular diseases. This systematic review and meta-analysis was therefore conducted which aimed to summarize effects of education and income on cardiovascular diseases. Methods Studies were identified from Medline and Scopus until July 2016. Cohorts were eligible if they assessed associations between education/income and cardiovascular diseases, had at least one outcome including coronary artery diseases, cardiovascular events, strokes and cardiovascular deaths. A multivariate meta-analysis was applied to pool risk effects of these social determinants. Results Among 72 included cohorts, 39, 19, and 14 were studied in Europe, USA, and Asia. Pooled risk ratios of low and medium versus high education were 1.36 (95% confidence interval: 1.11-1.66) and 1.21 (1.06-1.40) for coronary artery diseases, 1.50 (1.17-1.92) and 1.27 (1.09-1.48) for cardiovascular events, 1.23 (1.06-1.43) and 1.17 (1.01-1.35) for strokes, and 1.39 (1.26-1.54) and 1.21 (1.12-1.30) for cardiovascular deaths. The effects of education on all cardiovascular diseases were still present in US and Europe settings, except in Asia this was present only for cardiovascular deaths. Effects of low and medium income versus high on these corresponding cardiovascular diseases were 1.49 (1.16-1.91) and 1.27 (1.10-1.47) for coronary artery diseases, 1.17 (0.96-1.44) and 1.05 (0.98-1.13) for cardiovascular events, 1.30 (0.99-1.72) and 1.24 (1.00-1.53) for strokes, and 1.76 (1.45-2.14) and 1.34 (1.17-1.54) for cardiovascular deaths. Conclusion Social determinants are risk factors of cardiovascular diseases in developed countries, although high heterogeneity in pooling. Data in Asia countries are still needed to update pooling.
Collapse
Affiliation(s)
- Win Khaing
- 1 Section for Clinical Epidemiology and Biostatistics, Mahidol University, Thailand.,2 Department of Preventive and Social Medicine, University of Medicine, Mandalay, Myanmar
| | - Sakda A Vallibhakara
- 1 Section for Clinical Epidemiology and Biostatistics, Mahidol University, Thailand
| | - John Attia
- 3 The School of Medicine and Public Health, the University of Newcastle, Newcastle, NSW, Australia
| | - Mark McEvoy
- 3 The School of Medicine and Public Health, the University of Newcastle, Newcastle, NSW, Australia
| | - Ammarin Thakkinstian
- 1 Section for Clinical Epidemiology and Biostatistics, Mahidol University, Thailand
| |
Collapse
|
10
|
Pierre-Louis B, Rodriques S, Gorospe V, Guddati AK, Aronow WS, Ahn C, Wright M. Clinical factors associated with early readmission among acutely decompensated heart failure patients. Arch Med Sci 2016; 12:538-45. [PMID: 27279845 PMCID: PMC4889688 DOI: 10.5114/aoms.2016.59927] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 02/01/2015] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Congestive heart failure (CHF) is a common cause of hospital readmission. MATERIAL AND METHODS A retrospective study was conducted at Harlem Hospital in New York City. Data were collected for 685 consecutive adult patients admitted for decompensated CHF from March, 2009 to December, 2012. Variables including patient demographics, comorbidities, laboratory studies, and medical therapy were compared between CHF patient admissions resulting in early CHF readmission and not resulting in early CHF readmission. RESULTS Clinical factors found to be independently significant for early CHF readmission included chronic obstructive pulmonary disease (odds ratio (OR) = 6.4), HIV infection (OR = 3.4), African-American ethnicity (OR = 2.2), systolic heart failure (OR = 1.9), atrial fibrillation (OR = 2.3), renal disease with glomerular filtration rate < 30 ml/min (OR = 2.7), evidence of substance abuse (OR = 1.7), and absence of angiotensin-converting enzyme inhibitors or angiotensin receptor blocker therapy after discharge (OR = 1.8). The ORs were used to develop a scoring system regarding the risk for early readmission. CONCLUSIONS Identifying patients with clinical factors associated with early CHF readmission after an index hospitalization for CHF using the proposed scoring system would allow for an early CHF readmission risk stratification protocol to target particularly high-risk patients.
Collapse
Affiliation(s)
- Bredy Pierre-Louis
- Columbia University Medical Center, Harlem Hospital Center, New York, NY, USA
| | | | | | | | - Wilbert S. Aronow
- Westchester Medical Center/New York Medical College, Valhalla, NY, USA
| | - Chul Ahn
- Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - Maurice Wright
- Columbia University Medical Center, Harlem Hospital Center, New York, NY, USA
| |
Collapse
|
11
|
Hu X, Hu X, Su Y, Qu M, Dolansky MA. The changes and factors associated with post-discharge self-care behaviors among Chinese patients with heart failure. Patient Prefer Adherence 2015; 9:1593-601. [PMID: 26635468 PMCID: PMC4646583 DOI: 10.2147/ppa.s88431] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Self-care behavior is essential for achieving good outcomes among patients with heart failure. Understanding the factors associated with self-care over time is important for the provision of appropriate and targeted interventions. However, little is known regarding the changes and factors associated with post-discharge self-care behaviors among Chinese patients with heart failure. OBJECTIVE To investigate the changes and factors of self-care behaviors during the first 3 months following discharge among patients with heart failure in the People's Republic of China. METHODS A descriptive design with a convenience sample was utilized in this study. Patients (N=128) from two hospitals, West China Hospital and Angjin Hospital, in Chengdu, People's Republic of China, were recruited from June 2013 to June 2014. The instruments used in the study included the following: the Social Support Rating Scale, the Hospital Anxiety and Depression Scale, the Self-Efficacy for Managing Chronic Disease 6-Item Scale, and the European Heart Failure Self-Care Behaviour Scale. Multivariate linear regression analyses were used to identify the factors related to self-care behaviors at baseline, 1 month, and 3 months following discharge. RESULTS Patients' self-care behaviors were poor and decreased significantly over time (F=4.09, P<0.05). The factors associated with self-care behaviors at baseline included the following: education level, comorbidities, and social support. The factors related to self-care behaviors at 1 and 3 months following discharge included the following: education level, comorbidities, social support, and self-efficacy. The variances in self-care behaviors attributed to these factors were 43%, 46%, and 42% at baseline, 1 month, and 3 months following discharge, respectively. CONCLUSION Additional support should be provided to patients with heart failure with low educational levels and patients with multiple comorbidities. Follow-up, continuity of care, and family caregiver integration following discharge are necessary for the said patients to improve their self-care behaviors and obtain better outcomes.
Collapse
Affiliation(s)
- Xiaolin Hu
- Department of Nursing, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Xiuying Hu
- Department of Nursing, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yonglin Su
- Department of Rehabilitation Medicine, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Moying Qu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Mary A Dolansky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
12
|
Ghisi GLDM, Britto R, Motamedi N, Grace SL. Disease-related knowledge in cardiac rehabilitation enrollees: correlates and changes. PATIENT EDUCATION AND COUNSELING 2015; 98:533-539. [PMID: 25577470 DOI: 10.1016/j.pec.2014.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 11/16/2014] [Accepted: 12/21/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To describe (1) patients' disease-related knowledge at cardiac rehabilitation (CR) entry; (2) correlates of this knowledge; (3) whether CR completion is related to knowledge; and (4) behavioral correlates of knowledge. METHODS For this prospective, observational study, a convenience sample of new CR patients was approached at 3 programs to complete a survey. It consisted of sociodemographic items, heart-health behavior surveys, and the CADE-Q. Patients were provided a similar survey 6 months later. RESULTS 214 patients completed the CADE-Q at both points, with scores demonstrating "acceptable" to "good" knowledge. Higher knowledge at CR entry was significantly associated with greater education, being married, greater English-language proficiency, and history of percutaneous coronary intervention (p≤0.05). The 118 (55.1%) patients that completed CR demonstrated significantly higher knowledge than non-enrollees at post-test (p≤0.05). There was a significant positive association between knowledge and physical activity (p≤0.01) and nutrition (p≤0.05) at post-test, but no association with smoking or medication adherence. CONCLUSIONS CR adherence ensures patients sustain knowledge needed to optimize their disease management, and perhaps ultimately their health outcomes. PRACTICE IMPLICATIONS CR completion should be promoted so patients remain educated about their disease management, and the health behaviors observed will be practiced in a greater proportion of patients.
Collapse
Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Cardiac Rehabilitation and Prevention Program, University Health Network, Toronto, Canada; Exercise Sciences Department, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Canada.
| | - Raquel Britto
- Physical Therapy Department, Federal University of Minas Gerais, Belo Horizonte, Brazil; School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Nickan Motamedi
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Sherry L Grace
- Cardiac Rehabilitation and Prevention Program, University Health Network, Toronto, Canada; School of Kinesiology and Health Science, York University, Toronto, Canada
| |
Collapse
|
13
|
Cowie MR, Anker SD, Cleland JGF, Felker GM, Filippatos G, Jaarsma T, Jourdain P, Knight E, Massie B, Ponikowski P, López-Sendón J. Improving care for patients with acute heart failure: before, during and after hospitalization. ESC Heart Fail 2015; 1:110-145. [PMID: 28834628 DOI: 10.1002/ehf2.12021] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Acute heart failure (AHF) is a common and serious condition that contributes to about 5% of all emergency hospital admissions in Europe and the USA. Here, we present the recommendations from structured discussions among an author group of AHF experts in 2013. The epidemiology of AHF and current practices in diagnosis, treatment, and long-term care for patients with AHF in Europe and the USA are examined. Available evidence indicates variation in the quality of care across hospitals and regions. Challenges include the need for rapid diagnosis and treatment, the heterogeneity of precipitating factors, and the typical repeated episodes of decompensation requiring admission to hospital for stabilization. In hospital, care should involve input from an expert in AHF and auditing to ensure that guidelines and protocols for treatment are implemented for all patients. A smooth transition to follow-up care is vital. Patient education programmes could have a dramatic effect on improving outcomes. Information technology should allow, where appropriate, patient telemonitoring and sharing of medical records. Where needed, access to end-of-life care and support for all patients, families, and caregivers should form part of a high-quality service. Eight evidence-based consensus policy recommendations are identified by the author group: optimize patient care transitions, improve patient education and support, provide equity of care for all patients, appoint experts to lead AHF care across disciplines, stimulate research into new therapies, develop and implement better measures of care quality, improve end-of-life care, and promote heart failure prevention.
Collapse
Affiliation(s)
- Martin R Cowie
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
| | - Stefan D Anker
- Charité-University Medical Centre, Campus Virchow-Klinikum, Berlin, Germany
| | - John G F Cleland
- National Heart and Lung Institute, Imperial College London and Harefield Hospital, London, UK.,University of Hull, Hull, UK
| | | | | | - Tiny Jaarsma
- Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Patrick Jourdain
- René Dubos Hospital, Pontoise, France.,Paris Descartes University, Paris, France
| | | | - Barry Massie
- San Francisco Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | | | - José López-Sendón
- Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
| |
Collapse
|
14
|
D'Addario M, Cappelletti E, Sarini M, Greco A, Monzani D, Pancani L, Steca P. Communication and disease management: a qualitative study on coronary disease. Health Psychol Behav Med 2015. [DOI: 10.1080/21642850.2015.1026823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
15
|
Ghisi GLDM, Abdallah F, Grace SL, Thomas S, Oh P. A systematic review of patient education in cardiac patients: do they increase knowledge and promote health behavior change? PATIENT EDUCATION AND COUNSELING 2014; 95:160-74. [PMID: 24529720 DOI: 10.1016/j.pec.2014.01.012] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 12/20/2013] [Accepted: 01/18/2014] [Indexed: 05/26/2023]
Abstract
OBJECTIVE (1) To investigate the impact of education on patients' knowledge; (2) to determine if educational interventions are related to health behavior change in cardiac patients; and (3) to describe the nature of educational interventions. METHODS A literature search of several electronic databases was conducted for published articles from database inception to August 2012. Eligible articles included cardiac patients, and described delivery of educational interventions by a healthcare provider. Outcomes were knowledge, smoking, physical activity, dietary habits, response to symptoms, medication adherence, and psychosocial well-being. Articles were reviewed by 2 authors independently. RESULTS Overall, 42 articles were included, of which 23 (55%) were randomized controlled trials, and 16 (38%) were considered "good" quality. Eleven studies (26%) assessed knowledge, and 10 showed a significant increase with education. With regard to outcomes, educational interventions were significantly and positively related to physical activity, dietary habits, and smoking cessation. The nature of interventions was poorly described and most frequently delivered post-discharge, by a nurse, and in groups. CONCLUSIONS Findings support the benefits of educational interventions in CHD, though increase in patients' knowledge and behavior change. PRACTICE IMPLICATIONS Future reporting of education interventions should be more explicitly characterized, in order to be reproducible and assessed.
Collapse
Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Exercise Sciences Department, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Canada; Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - Flavia Abdallah
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Sherry L Grace
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Scott Thomas
- Exercise Sciences Department, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Canada
| | - Paul Oh
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| |
Collapse
|
16
|
de Melo Ghisi GL, Grace SL, Thomas S, Evans MF, Sawula H, Oh P. Healthcare providers' awareness of the information needs of their cardiac rehabilitation patients throughout the program continuum. PATIENT EDUCATION AND COUNSELING 2014; 95:143-150. [PMID: 24457175 DOI: 10.1016/j.pec.2013.12.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/22/2013] [Accepted: 12/26/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To (1) describe cardiac rehabilitation (CR) participant information needs, (2) investigate whether CR providers are cognizant of patient's information needs and preferred delivery formats, and (3) investigate whether patient information needs change over the course of CR. METHODS In this cross-sectional study, 306 CR patients and 28 CR providers completed a survey. The survey consisted of the Information Needs in CR (INCR) questionnaire, and items about preferred education delivery formats. RESULTS Low-income CR participants had significantly greater information needs than high-income participants. CR providers were cognizant of patient information needs, except patients did desire more information on diagnosis and treatment than providers perceived (p<0.01). Books, lectures and discussion were identified as the preferred delivery formats by both patients and providers. There were some significant differences in patient information needs over the course of the program, particularly in relation to concerns and risk factors. CONCLUSION CR patients desire information in many areas, particularly regarding emergency/safety and diagnosis/treatment. CR providers were highly cognizant of patient information needs; however, these do change over time. PRACTICE IMPLICATIONS These findings could inform evaluation and improvement of CR education programming, to ensure programs are meeting patient information needs across all stages of recovery.
Collapse
Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Exercise Sciences Department, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Canada; Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - Sherry L Grace
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Scott Thomas
- Exercise Sciences Department, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Canada
| | | | - Heather Sawula
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Paul Oh
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| |
Collapse
|
17
|
Deedwania P, Patel K, Fonarow GC, Desai RV, Zhang Y, Feller MA, Ovalle F, Love TE, Aban IB, Mujib M, Ahmed MI, Anker SD, Ahmed A. Prediabetes is not an independent risk factor for incident heart failure, other cardiovascular events or mortality in older adults: findings from a population-based cohort study. Int J Cardiol 2013; 168:3616-22. [PMID: 23731526 DOI: 10.1016/j.ijcard.2013.05.038] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 04/24/2013] [Accepted: 05/04/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Whether prediabetes is an independent risk factor for incident heart failure (HF) in non-diabetic older adults remains unclear. METHODS Of the 4602 Cardiovascular Health Study participants, age≥65 years, without baseline HF and diabetes, 2157 had prediabetes, defined as fasting plasma glucose (FPG) 100-125 mg/dL. Propensity scores for prediabetes, estimated for each of the 4602 participants, were used to assemble a cohort of 1421 pairs of individuals with and without prediabetes, balanced on 44 baseline characteristics. RESULTS Participants had a mean age of 73 years, 57% were women, and 13% African American. Incident HF occurred in 18% and 20% of matched participants with and without prediabetes, respectively (hazard ratio {HR} associated with prediabetes, 0.90; 95% confidence interval {CI}, 0.76-1.07; p=0.239). Unadjusted and multivariable-adjusted HRs (95% CIs) for incident HF associated with prediabetes among 4602 pre-match participants were 1.22 (95% CI, 1.07-1.40; p=0.003) and 0.98 (95% CI, 0.85-1.14; p=0.826), respectively. Among matched individuals, prediabetes had no independent association with incident acute myocardial infarction (HR, 1.02; 95% CI, 0.81-1.28; p=0.875), angina pectoris (HR, 0.93; 95% CI, 0.77-1.12; p=0.451), stroke (HR, 0.86; 95% CI, 0.70-1.06; p=0.151) or all-cause mortality (HR, 0.99; 95% CI, 0.88-1.11; p=0.840). CONCLUSIONS We found no evidence that prediabetes is an independent risk factor for incident HF, other cardiovascular events or mortality in community-dwelling older adults. These findings question the wisdom of routine screening for prediabetes in older adults and targeted interventions to prevent adverse outcomes in older adults with prediabetes.
Collapse
|
18
|
Betihavas V, Newton PJ, Frost SA, Macdonald PS, Davidson PM. Patient, provider and system factors influencing rehospitalisation in adults with heart failure: a literature review. Contemp Nurse 2012. [DOI: 10.5172/conu.2012.2772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
19
|
Hawkins NM, Jhund PS, McMurray JJV, Capewell S. Heart failure and socioeconomic status: accumulating evidence of inequality. Eur J Heart Fail 2012; 14:138-46. [PMID: 22253454 DOI: 10.1093/eurjhf/hfr168] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Socioeconomic status (SES) is a powerful predictor of incident coronary disease and adverse cardiovascular outcomes. Understanding the impact of SES on heart failure (HF) development and subsequent outcomes may help to develop effective and equitable prevention, detection, and treatment strategies METHODS AND RESULTS A systematic literature review of electronic databases including PubMed, EMBASE, CINAHL, and the Cochrane Library, restricted to human subjects, was carried out. The principal outcomes were incidence, prevalence, hospitalizations, mortality, and treatment of HF. Socioeconomic measures included education, occupation, employment relations, social class, income, housing characteristics, and composite and area level indicators. Additional studies were identified from bibliographies of relevant articles and reviews. Twenty-eight studies were identified. Lower SES was associated with increased incidence of HF, either in the community or presenting to hospital. The adjusted risk of developing HF was increased by ∼30-50% in most reports. Readmission rates following hospitalization were likewise greater in more deprived patients. Although fewer studies examined mortality, lower SES was associated with poorer survival. Evidence defining the equity of medical treatment of patients with HF was scarce and conflicting. CONCLUSIONS Socioeconomic deprivation is a powerful independent predictor of HF development and adverse outcomes. However, the precise mechanisms accounting for this risk remain elusive. Heart failure represents the endpoint of numerous different pathophysiological processes and 'chains of events', each modifiable throughout the disease trajectories. The interaction between SES and HF is accordingly complex. Disentangling the many and varied life course processes is challenging. A better understanding of these issues may help attenuate the health inequalities so clearly evident among patients with HF.
Collapse
Affiliation(s)
- Nathaniel M Hawkins
- Institute of Cardiovascular Medicine & Science, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK.
| | | | | | | |
Collapse
|
20
|
Tung HH, Chen SC, Yin WH, Cheng CH, Wang TJ, Wu SF. Self care behavior in patients with heart failure in Taiwan. Eur J Cardiovasc Nurs 2012; 11:175-82. [PMID: 21382750 DOI: 10.1016/j.ejcnurse.2011.02.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to describe the self-care behaviors and associated demographic factors affecting such behaviors in the heart failure population in Taiwan. METHODS A descriptive, cross-sectional, correlational design was used in this study and 86 heart failure patients were sampled by convenience sampling. Demographic questionnaire and Self-Care of Heart Failure Index, V. 6 were used to collect these data. Descriptive statistic, correlation coefficient and multiple regression were used to analyze the data. RESULTS The result indicated a low level of self-care maintenance and management although self-care confidence was adequate. Patients who were married had better self-care maintenance and self-care confidence than those who were single. Self-care confidence was a determinant of self-care maintenance. CONCLUSION This study provided detailed information on self-care behavior status in heart failure patients in Taiwan.
Collapse
Affiliation(s)
- Heng-Hsin Tung
- National Taipei University of Nursing and Health Science, 365 Ming Te Road PeiTou, Taipei 112, Taiwan, ROC.
| | | | | | | | | | | |
Collapse
|
21
|
Zhang Y, Kilgore ML, Arora T, Mujib M, Ekundayo OJ, Aban IB, Feller MA, Desai RV, Love TE, Allman RM, Fonarow GC, Ahmed A. Design and rationale of studies of neurohormonal blockade and outcomes in diastolic heart failure using OPTIMIZE-HF registry linked to Medicare data. Int J Cardiol 2011; 166:230-5. [PMID: 22119116 DOI: 10.1016/j.ijcard.2011.10.089] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/04/2011] [Accepted: 10/18/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Heart failure (HF) is the leading cause of hospitalization for Medicare beneficiaries. Nearly half of all HF patients have diastolic HF or HF with preserved ejection fraction (HF-PEF). Because these patients were excluded from major randomized clinical trials of neurohormonal blockade in HF there is little evidence about their role in HF-PEF. METHODS The aims of the American Recovery & Reinvestment Act-funded National Heart, Lung, and Blood Institute-sponsored "Neurohormonal Blockade and Outcomes in Diastolic Heart Failure" are to study the long-term effects of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and aldosterone antagonists in four separate propensity-matched populations of HF-PEF patients in the OPTIMIZE-HF (Organized Program to Initiate Life-Saving Treatment in Hospitalized Patients with Heart Failure) registry. Of the 48,612 OPTIMIZE-HF hospitalizations occurring during 2003-2004 in 259 U.S. hospitals, 20,839 were due to HF-PEF (EF ≥40%). For mortality and hospitalization we used Medicare national claims data through December 31, 2008. RESULTS Using a two-step (hospital-level and hospitalization-level) probabilistic linking approach, we assembled a cohort of 11,997 HF-PEF patients from 238 OPTIMIZE-HF hospitals. These patients had a mean age of 75 years, mean EF of 55%, were 62% women, 15% African American, and were comparable with community-based HF-PEF cohorts in key baseline characteristics. CONCLUSIONS The assembled Medicare-linked OPTIMIZE-HF cohort of Medicare beneficiaries with HF-PEF with long-term outcomes data will provide unique opportunities to study clinical effectivenss of various neurohormonal antagonists with outcomes in HF-PEF using propensity-matched designs that allow outcome-blinded assembly of balanced cohorts, a key feature of randomized clinical trials.
Collapse
Affiliation(s)
- Yan Zhang
- University of Alabama at Birmingham, Birmingham, AL 35294–2041, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Weidner G, Zahn D, Mendell NR, Smits JMA, Deng MC, Zittermann A, Spaderna H. Patients' sex and emotional support as predictors of death and clinical deterioration in the waiting for a new heart study: results from the 1-year follow-up. Prog Transplant 2011. [PMID: 21736238 DOI: 10.7182/prtr.21.2.j779w1q6k61k0jk4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Little is known about the role of patient's sex and emotional support in the prognosis of heart transplant candidates. OBJECTIVE To examine patient's sex and emotional support as predictors of outcomes in the Waiting for a New Heart Study. DESIGN, SETTING, AND PARTICIPANTS The Waiting for a New Heart Study is a prospective observational study of 318 patients (18% female) newly added to the waiting list for a heart transplant. Demographic, medical, psychosocial characteristics (including social support [ENRICHD Social Support Index; high vs. low support]) were assessed at the time of wait-listing. Main Outcomes-Time until death/delisting due to deteriorated tealth, considering competing outcomes (e.g., transplantation) during the first 12 months after wait-listing were analyzed via cause-specific Cox proportional hazard models. RESULTS By 12 months, 32 men (12%) and 10 women (17%) had died/deteriorated. Medical risk was comparable across sexes. More men than women reported low emotional support (20.4% vs. 8.6%) and being a past or current smoker (80.4% vs. 56.9%). More women than men had low vocational level (93.1% vs. 69.6%; all P values < .05). With medical risk and other confounding variables controlled for, female sex significantly increased risk of death/deterioration (hazard ratio, 2.30; 95% confidence interval, 1.04-5.12; P = .04); low emotional support further tended to increase the risk for this outcome (P = .07). As none of the 5 women with low emotional support had reached this end point, analyses were performed in the male sample and revealed that men with low emotional support were more than twice as likely to die/deteriorate than were men with high support (hazard ratio, 2.23; 95% confidence interval, 1.04-4.82; P = .04). CONCLUSION Women had worse survival while awaiting a heart transplant than men had, independent of confounding variables. Even though emotional support may be an important buffer for men, protective factors for women warrant further investigation with larger samples and/or longer follow-ups.
Collapse
Affiliation(s)
- Gerdi Weidner
- Department of Biology, Romberg Tiburon Center, San Francisco State University, 3150 Paradise Drive, Tiburon, CA 94920, USA.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Weidner G, Zahn D, Mendell NR, Smits JMA, Deng MC, Zittermann A, Spaderna H. Patients' Sex and Emotional Support as Predictors of Death and Clinical Deterioration in the Waiting for a New Heart Study: Results from the 1-Year Follow-up. Prog Transplant 2011; 21:106-14. [DOI: 10.1177/152692481102100204] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Context Little is known about the role of patient's sex and emotional support in the prognosis of heart transplant candidates. Objective To examine patient's sex and emotional support as predictors of outcomes in the Waiting for a New Heart Study. Design, Setting, and Participants The Waiting for a New Heart Study is a prospective observational study of 318 patients (18% female) newly added to the waiting list for a heart transplant. Demographic, medical, psychosocial characteristics (including social support [ENRICHD Social Support Index; high vs low support]) were assessed at the time of wait-listing. Main Outcomes Time until death/delisting due to deteriorated health, considering competing outcomes (eg, transplantation) during the first 12 months after wait-listing were analyzed via cause-specific Cox proportional hazard models. Results—By 12 months, 32 men (12%) and 10 women (17%) had died/deteriorated. Medical risk was comparable across sexes. More men than women reported low emotional support (20.4% vs 8.6%) and being a past or current smoker (80.4% vs 56.9%). More women than men had low vocational level (93.1% vs 69.6%; all P values < .05). With medical risk and other confounding variables controlled for, female sex significantly increased risk of death/deterioration (hazard ratio, 2.30; 95% confidence interval, 1.04–5.12; P = .04); low emotional support further tended to increase the risk for this outcome ( P = .07). As none of the 5 women with low emotional support had reached this end point, analyses were performed in the male sample and revealed that men with low emotional support were more than twice as likely to die/deteriorate than were men with high support (hazard ratio, 2.23; 95% confidence interval, 1.04–4.82; P = .04). Conclusion Women had worse survival while awaiting a heart transplant than men had, independent of confounding variables. Even though emotional support may be an important buffer for men, protective factors for women warrant further investigation with larger samples and/or longer follow-ups.
Collapse
Affiliation(s)
- Gerdi Weidner
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | - Daniela Zahn
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | - Nancy R. Mendell
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | - Jacqueline M. A. Smits
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | - Mario C. Deng
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | - Armin Zittermann
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | - Heike Spaderna
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | | |
Collapse
|
24
|
Barbareschi G, Sanderman R, Leegte IL, van Veldhuisen DJ, Jaarsma T. Educational Level and the Quality of Life of Heart Failure Patients: A Longitudinal Study. J Card Fail 2011; 17:47-53. [DOI: 10.1016/j.cardfail.2010.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 08/09/2010] [Accepted: 08/11/2010] [Indexed: 11/16/2022]
|
25
|
Aguado O, Morcillo C, Delàs J, Rennie M, Bechich S, Schembari A, Fernández F, Rosell F. Long-term implications of a single home-based educational intervention in patients with heart failure. Heart Lung 2010; 39:S14-22. [DOI: 10.1016/j.hrtlng.2010.04.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 04/07/2010] [Accepted: 04/14/2010] [Indexed: 10/19/2022]
|
26
|
Smeulders ESTF, van Haastregt JCM, Ambergen T, Stoffers HEJH, Janssen-Boyne JJJ, Uszko-Lencer NHKM, Gorgels APM, Lodewijks-van der Bolt CLB, van Eijk JTM, Kempen GIJM. Heart failure patients with a lower educational level and better cognitive status benefit most from a self-management group programme. PATIENT EDUCATION AND COUNSELING 2010; 81:214-221. [PMID: 20153132 DOI: 10.1016/j.pec.2010.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 12/30/2009] [Accepted: 01/09/2010] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The Chronic Disease Self-Management Programme (CDSMP)was recently evaluated among patients with congestive heart failure (CHF) in a randomized controlled trial (n = 317) with twelve months of follow-up after the start of the programme. That trial demonstrated short-term improvements in cardiac-specific quality of life. The current study assessed which of the patients participating in this trial benefited most from the CDSMP with respect to cardiac-specific quality of life. METHODS Subgroup analyses were conducted using mixed-effects linear regression models to assess the relationship between patient characteristics and the effects of the CDSMP on cardiac-specific quality of life. RESULTS In the short term, patients with better cognitive status benefited more from the CDSMP than their poorer functioning counterparts. In addition, lower educated patients benefited more from the CDSMP than their higher educated counterparts during total follow-up. CONCLUSION Subgroup effects were found for cognitive status and educational level. Future research should be performed to validate current findings and further explore the conditions under which CHF patients may benefit more from the programme. PRACTICE IMPLICATIONS These results indicate that lower educated patients, in particular, should be encouraged to participate in the CDSMP. In addition, healthcare practitioners are recommended to take into account potential cognitive impairments of patients.
Collapse
Affiliation(s)
- Esther S T F Smeulders
- Department of Health Care and Nursing Science, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Outcomes in younger and older adults with chronic advanced systolic heart failure: a propensity-matched study. Int J Cardiol 2010; 154:128-33. [PMID: 20947188 DOI: 10.1016/j.ijcard.2010.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 07/03/2010] [Accepted: 09/05/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Older age is an independent predictor of all-cause mortality in patients with mild to moderate heart failure (HF). Whether older age is also an independent predictor of mortality in patients with more advanced HF is unknown. METHODS Of the 2707 Beta-Blocker Evaluation of Survival Trial (BEST) participants with ambulatory chronic HF (New York Heart Association class III/IV and left ventricular ejection fraction <35%), 1091 were elderly (≥ 65 years). Propensity scores for older age, estimated for each of the 2707 patients, were used to assemble a cohort of 603 pairs of younger and older patients, balanced on 66 baseline characteristics. RESULTS All-cause mortality occurred in 33% and 36% of younger and older matched patients respectively during 4 years of follow-up (hazard ratio {HR} associated with age ≥ 65 years, 1.05; 95% confidence interval {CI}, 0.87-1.27; P=0.614). HF hospitalization occurred in 38% and 40% of younger and older matched patients respectively (HR, 1.01; 95% CI, 0.84-1.21; P=0.951). Among 603 pairs of unmatched and unbalanced patients, all-cause mortality occurred in 28% and 36% of younger and older patients respectively (HR, 1.34; 95% CI, 1.10-1.64; P=0.004) and HF hospitalization occurred in 34% and 40% of younger and older unmatched patients respectively (HR, 1.24; 95% CI, 1.03-1.50; P=0.024). CONCLUSION Significant bivariate associations suggest that older age is a useful marker of poor outcomes in patients with advanced chronic systolic HF. However, lack of significant independent associations suggests that older age per se has no intrinsic effect on outcomes in these patients.
Collapse
|
28
|
Higher levels of education may be a marker of higher disease-specific knowledge in patients with chronic heart failure. Int J Cardiol 2010. [DOI: 10.1016/j.ijcard.2009.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
29
|
Lainscak M, Farkas J, Jaarsma T. Education, knowledge, and self-management strategies in patients with chronic heart failure. Int J Cardiol 2010; 144:92-3; author reply 93-4. [DOI: 10.1016/j.ijcard.2008.12.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 12/14/2008] [Indexed: 10/21/2022]
|
30
|
Gheorghiade M, Flaherty JD, Fonarow GC, Desai RV, Lee R, McGiffin D, Love TE, Aban I, Eichhorn EJ, Bonow RO, Ahmed A. Coronary artery disease, coronary revascularization, and outcomes in chronic advanced systolic heart failure. Int J Cardiol 2010; 151:69-75. [PMID: 20554334 DOI: 10.1016/j.ijcard.2010.04.092] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Revised: 04/20/2010] [Accepted: 04/28/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Associations between coronary artery disease (CAD) and outcomes in systolic heart failure (HF) and that between coronary artery bypass graft (CABG) surgery and outcomes in patients with HF and CAD have not been examined using propensity-matched designs. METHODS Of the 2707 patients with advanced chronic systolic HF in the Beta-Blocker Evaluation of Survival Trial (BEST), 1593 had a history of CAD, of whom 782 had prior CABG. Using propensity scores for CAD we assembled a cohort of 458 pairs of CAD and no-CAD patients. Propensity scores for prior CABG in those with CAD were used to assemble 500 pairs of patients with and without CABG. Matched patients were balanced on 68 baseline characteristics. RESULTS All-cause mortality occurred in 33% and 24% of matched patients with and without CAD respectively, during 26 months of median follow-up (hazard ratio {HR} when CAD was compared with no-CAD, 1.41; 95% confidence interval {CI}, 1.11-1.81; P=0.006). HR's (95% CIs) for CAD-associated cardiovascular mortality, HF mortality, and sudden cardiac death (SCD) were 1.53 (1.17-2.00; P=0.002), 1.44 (0.92-2.25; P=0.114) and 1.76 (1.21-2.57; P=0.003) respectively. CAD had no association with hospitalization. Among matched patients with HF and CAD, all-cause mortality occurred in 32% and 39% of those with and without prior CABG respectively (HR for CABG, 0.77; 95% CI, 0.62-0.95; P=0.015). CONCLUSIONS In patients with advanced chronic systolic HF, CAD is associated with increased mortality, and in those with CAD, prior CABG seems to be associated with reduced all-cause mortality but not SCD.
Collapse
|
31
|
Bowling CB, Pitt B, Ahmed MI, Aban IB, Sanders PW, Mujib M, Campbell RC, Love TE, Aronow WS, Allman RM, Bakris GL, Ahmed A. Hypokalemia and outcomes in patients with chronic heart failure and chronic kidney disease: findings from propensity-matched studies. Circ Heart Fail 2010; 3:253-60. [PMID: 20103777 DOI: 10.1161/circheartfailure.109.899526] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about the effects of hypokalemia on outcomes in patients with chronic heart failure (HF) and chronic kidney disease. METHODS AND RESULTS Of the 7788 patients with chronic HF in the Digitalis Investigation Group trial, 2793 had chronic kidney disease, defined as estimated glomerular filtration rate <60 mL/min per 1.73 m(2). Of these, 527 had hypokalemia (serum potassium <4 mEq/L; mild) and 2266 had normokalemia (4 to 4.9 mEq/L). Propensity scores for hypokalemia were used to assemble a balanced cohort of 522 pairs of patients with hypokalemia and normokalemia. All-cause mortality occurred in 48% and 36% of patients with hypokalemia and normokalemia, respectively, during 57 months of follow-up (matched hazard ratio when hypokalemia was compared with normokalemia, 1.56; 95% CI, 1.25 to 1.95; P<0.0001). Matched hazard ratios (95% CIs) for cardiovascular and HF mortalities and all-cause, cardiovascular, and HF hospitalizations were 1.65 (1.29 to 2.11; P<0.0001), 1.82 (1.28 to 2.57; P<0.0001), 1.16 (1.00 to 1.35; P=0.036), 1.27 (1.08 to 1.50; P=0.004), and 1.29 (1.05 to 1.58; P=0.014), respectively. Among 453 pairs of balanced patients with HF and chronic kidney disease, all-cause mortality occurred in 47% and 38% of patients with mild hypokalemia (3.5 to 3.9 mEq/L) and normokalemia, respectively (matched hazard ratio, 1.31; 95% CI, 1.03 to 1.66; P=0.027). Among 169 pairs of balanced patients with estimated glomerular filtration rate <45 mL/min per 1.73 m(2), all-cause mortality occurred in 57% and 47% of patients with hypokalemia (<4 mEq/L; mild) and normokalemia, respectively (matched hazard ratio, 1.53; 95% CI, 1.07 to 2.19; P=0.020). CONCLUSIONS In patients with HF and chronic kidney disease, hypokalemia (serum potassium <4 mEq/L) is common and associated with increased mortality and hospitalization.
Collapse
|
32
|
Ahmed MI, Lainscak M, Mujib M, Love TE, Aban I, Piña IL, Aronow WS, Bittner V, Ahmed A. Gender-related dissociation in outcomes in chronic heart failure: reduced mortality but similar hospitalization in women. Int J Cardiol 2009; 148:36-42. [PMID: 19939481 DOI: 10.1016/j.ijcard.2009.10.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 09/13/2009] [Accepted: 10/18/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND The impact of gender on major natural history endpoints in heart failure (HF) has not been examined in a propensity-matched study. METHODS Of the 7788 chronic systolic and diastolic HF patients in the Digitalis Investigation Group trial 1926 were women. Propensity scores for female gender were used to assemble a cohort of 1669 pairs of men and women who were well-balanced on 32 measured baseline characteristics. Matched hazard ratios (HR) and 95% confidence intervals (CI) for outcomes associated with female gender were calculated using stratified Cox regression models. RESULTS All-cause mortality occurred in 36% (rate, 1256/10,000 person-years) and 30% (rate, 1008/10,000 person-years) of matched men and women respectively during 5 years of follow up (HR when women were compared with men, 0.82, 95% CI, 0.72-0.94, P=0.004). Female gender was also associated with reduced cardiovascular mortality (matched HR, 0.85; 95% CI, 0.73-0.99, P=0.037) and a trend toward reduced non-cardiovascular mortality (matched HR, 0.73; 95% CI, 0.53-1.00; P=0.053). All-cause hospitalization occurred in 67% (rate, 4003/10,000 person-years) and 65% (rate, 3762/10,000 person-years) matched male and female patients respectively (HR for women, 1.03, 95% CI, 0.93-1.15, P=0.538). Female gender was not associated with cardiovascular or HF hospitalization but was associated with hospitalization due to unstable angina pectoris (matched HR, 1.38; 95%CI, 1.11-1.72; P=0.003) and stroke (matched HR, 0.65; 95%CI, 0.46-0.92; P=0.014). CONCLUSIONS In patients with chronic HF, female gender has a significant independent association with improved survival but has no association with all-cause, cardiovascular, or HF hospitalizations.
Collapse
Affiliation(s)
- Mustafa I Ahmed
- University of Alabama at Birmingham, Birmingham, AL 35294-2041, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Wahle C, Adamopoulos C, Ekundayo OJ, Mujib M, Aronow WS, Ahmed A. A propensity-matched study of outcomes of chronic heart failure (HF) in younger and older adults. Arch Gerontol Geriatr 2008; 49:165-71. [PMID: 18692914 DOI: 10.1016/j.archger.2008.06.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Revised: 06/24/2008] [Accepted: 06/26/2008] [Indexed: 10/21/2022]
Abstract
The majority of heart failure (HF) patients are older adults and most HF-related adverse events occur in these patients. However, the independent association of age and outcomes in HF is not clearly determined. We categorized 7788 ambulatory HF patients who participated in the Digitalis Investigation Group (DIG) trial as younger (< 65 years) and older (> or = 65 years). Propensity scores for older age were calculated for each patient and used to match 2381 pairs of younger and older patients. The associations of older age with mortality and hospitalization during a median 40 months of follow-up were assessed using matched Cox regression models. All-cause mortality occurred in 877 older patients versus 688 younger patients (hazard ratio when older age was compared with younger age (HR)=1.26; 95% confidence interval (CI)=1.12-1.41; p<0.0001). Older patients, when compared with propensity-matched younger patients, also had significantly higher mortality rates due to cardiovascular causes (HR=1.14; 95% CI=1.00-1.30; p=0.044) and worsening heart failure causes (HR=1.32; 95% CI=1.07-1.62; p=0.009). No significant association was found between age and hospitalization due to all causes (HR=1.08; 95% CI=0.99-1.18; p=0.084) and cardiovascular causes (HR=1.03; 95% CI=0.93-1.13; p=0.622). However, hospitalization due to HF was significantly increased in older patients (HR=1.14; 95% CI=1.01-1.28; p=0.041). In ambulatory HF patients, older age although associated with increased mortality, was not associated with increased hospitalizations except for those due to worsening HF.
Collapse
Affiliation(s)
- Christy Wahle
- University of Alabama at Birmingham, 1530 3rd Avenue South, CH-19, Ste-219, Birmingham, AL 35294-2041, USA
| | | | | | | | | | | |
Collapse
|
34
|
Alper AB, Campbell RC, Anker SD, Bakris G, Wahle C, Love TE, Hamm LL, Mujib M, Ahmed A. A propensity-matched study of low serum potassium and mortality in older adults with chronic heart failure. Int J Cardiol 2008; 137:1-8. [PMID: 18691778 DOI: 10.1016/j.ijcard.2008.05.047] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 05/08/2008] [Accepted: 05/10/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Most HF patients are older adults, yet the associations of low serum potassium and outcomes in these patients are unknown. We studied the effect of low serum potassium in a propensity-matched population of elderly HF patients. METHODS Of the 7788 patients in the Digitalis Investigation Group trial, 4036 were >or=65 years. Of these, 3598 had data on baseline serum potassium and 324 with potassium >or=5 mEq/L were excluded. Remaining patients were categorized into low (<4 mEq/L; n=590) and normal (4-4.9 mEq/L; n=2684) potassium groups. Propensity scores for low-potassium, calculated for each patient, were used to match 561 low-potassium and 1670 normal-potassium patients. Association of low potassium and outcomes were assessed using matched Cox regression analyses. RESULTS Patients had a mean (+/-SD) age of 72 (+/-6) years, 29% were women and 12% were non-whites. Of the 561 low-potassium patients, 500 had low-normal (3.5-3.9 mEq/L) potassium. All-cause mortality occurred in 37% (rate, 1338/10,000 person-years) normal-potassium and 43% (rate, 1594/10,000 person-years) low-potassium patients (hazard ratio {HR} for low-potassium, 1.22; 95% confidence interval {CI}, 1.04-1.44; p=0.014). Low-normal (3.5-3.9 mEq/L) potassium levels had a similar association with mortality (HR, 1.19, 95% CI, 1.00-1.41, p=0.049). Low (HR, 1.10; 95% CI, 0.96-1.25; p=0.175) or low-normal (HR=1.09, 95% CI=0.95-1.25, p=0.229) serum potassium levels were not associated with all-cause hospitalization. CONCLUSIONS In a propensity-matched population of elderly ambulatory chronic HF patients, well-balanced in all measured baseline covariates, low and low-normal serum potassium were associated with increased mortality but had no association with hospitalization.
Collapse
|