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Hammond MM, Shen C, Li S, Kazi DS, Sabe MA, Garan AR, Markson LJ, Manning WJ, Klein AL, Nagueh SF, Strom JB. Retrospective evaluation of echocardiographic variables for prediction of heart failure hospitalization in heart failure with preserved versus reduced ejection fraction: A single center experience. PLoS One 2020; 15:e0244379. [PMID: 33351853 PMCID: PMC7755281 DOI: 10.1371/journal.pone.0244379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/08/2020] [Indexed: 01/28/2023] Open
Abstract
Background Limited data exist on the differential ability of variables on transthoracic echocardiogram (TTE) to predict heart failure (HF) readmission across the spectrum of left ventricular (LV) systolic function. Methods We linked 15 years of TTE report data (1/6/2003-5/3/2018) at Beth Israel Deaconess Medical Center to complete Medicare claims. In those with recent HF, we evaluated the relationship between variables on baseline TTE and HF readmission, stratified by LVEF. Results After excluding TTEs with uninterpretable diastology, 5,900 individuals (mean age: 76.9 years; 49.1% female) were included, of which 2545 individuals (41.6%) were admitted for HF. Diastolic variables augmented prediction compared to demographics, comorbidities, and echocardiographic structural variables (p < 0.001), though discrimination was modest (c-statistic = 0.63). LV dimensions and eccentric hypertrophy predicted HF in HF with reduced (HFrEF) but not preserved (HFpEF) systolic function, whereas LV wall thickness, NT-proBNP, pulmonary vein D- and Ar-wave velocities, and atrial dimensions predicted HF in HFpEF but not HFrEF (all interaction p < 0.10). Prediction of HF readmission was not different in HFpEF and HFrEF (p = 0.93). Conclusions In this single-center echocardiographic study linked to Medicare claims, left ventricular dimensions and eccentric hypertrophy predicted HF readmission in HFrEF but not HFpEF and left ventricular wall thickness predicted HF readmission in HFpEF but not HFrEF. Regardless of LVEF, diastolic variables augmented prediction of HF readmission compared to echocardiographic structural variables, demographics, and comorbidities alone. The additional role of medication adherence, readmission history, and functional status in differential prediction of HF readmission by LVEF category should be considered for future study.
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Affiliation(s)
- Michael M. Hammond
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - Changyu Shen
- Division of Cardiovascular Medicine, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Stephanie Li
- Harvard Medical School, Boston, MA, United States of America
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Dhruv S. Kazi
- Division of Cardiovascular Medicine, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Marwa A. Sabe
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - A. Reshad Garan
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Lawrence J. Markson
- Harvard Medical School, Boston, MA, United States of America
- Information Systems, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Warren J. Manning
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Allan L. Klein
- The Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States of America
| | - Sherif F. Nagueh
- Department of Cardiology, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX, United States of America
| | - Jordan B. Strom
- Division of Cardiovascular Medicine, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- * E-mail:
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Fabbri M, Finney Rutten LJ, Manemann SM, Boyd C, Wolff J, Chamberlain AM, Weston SA, Yost KJ, Griffin JM, Killian JM, Roger VL. Patient-centered communication and outcomes in heart failure. THE AMERICAN JOURNAL OF MANAGED CARE 2020; 26:425-430. [PMID: 33094937 PMCID: PMC7587036 DOI: 10.37765/ajmc.2020.88500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To measure the impact of patient-centered communication on mortality and hospitalization among patients with heart failure (HF). STUDY DESIGN This was a survey study of 6208 residents of 11 counties in southeast Minnesota with incident HF (first-ever International Classification of Diseases, Ninth Revision code 428 or International Classification of Diseases, Tenth Revision code I50) between January 1, 2013, and March 31, 2016. METHODS Perceived patient-centered communication was assessed with the health care subscale of the Chronic Illness Resources Survey and measured as a composite score on three 5-point scales. We divided our cohort into tertiles and defined them as having fair/poor (score < 12), good (score of 12 or 13), and excellent (score ≥ 14) patient-centered communication. The survey was returned by 2868 participants (response rate: 45%), and those with complete data were retained for analysis (N = 2398). Cox and Andersen-Gill models were used to determine the association of patient-centered communication with death and hospitalization, respectively. RESULTS Among 2398 participants (median age, 75 years; 54% men), 233 deaths and 1194 hospitalizations occurred after a mean (SD) follow-up of 1.3 (0.6) years. Compared with patients with fair/poor patient-centered communication, those with good (HR, 0.70; 95% CI, 0.51-0.97) and excellent (HR, 0.70; 95% CI, 0.51-0.96) patient-centered communication experienced lower risks of death after adjustment for various confounders (Ptrend = .020). Patient-centered communication was not associated with hospitalization. CONCLUSIONS Among community patients living with HF, excellent and good patient-centered communication is associated with a reduced risk of death. Patient-centered communication can be easily assessed, and consideration should be given toward implementation in clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
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Głogowska-Ligus J, Dąbek J, Piechota M, Gallert-Kopyto W, Lepich T, Korzeń D, Gąsior Z. Can the expression of the metalloproteinase 9 gene and its inhibitor be considered as markers of heart failure? Minerva Cardiol Angiol 2020; 69:172-177. [PMID: 32643898 DOI: 10.23736/s2724-5683.20.05202-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Heart failure (HF) is a major cause of mortality in developed countries. Its formation is associated with a change in the transcriptional activity of many genes. The aim of the study was to select, from the group of genes related to coronary atherosclerosis and heart failure, genes differentiating patients with coronary heart disease and heart failure on the basis of myocardial ischemia from healthy people, and then genes differentiating patients with various stages of heart failure. METHODS The study was carried out using the oligonucleotide microarray technique HG-U133A (Affymetrix, Santa Clara, CA, USA). Cluster analysis showed a homogeneous division of the study group into patients with heart failure and healthy patients with excluded coronary artery disease and patients with heart failure depending on the size of the left ventricle ejection fraction. RESULTS The study showed that genes differentiating the group of patients from healthy people were: TGF-β1, TIMP-1 and MMP-9. The analysis also showed that genes differentiated patients with advanced heart failure in the course of coronary disease and left ventricular ejection fraction (LVEF) 20% and patients from the group with 40% LVEF were MMP-9 and TIMP-1. CONCLUSIONS Extracting from the group of genes related to coronary atherosclerosis and cardiac failure: MMP-9, TGF-β1 and TIMP-1 differentiating patients with heart failure on the basis of myocardial ischemia in varying degrees of severity from healthy people may indicate their significant contribution to disease development. Also increased expression of the metalloproteinase gene 9 (MMP-9) with a simultaneous decrease in the expression of its tissue inhibitor 1 (TIMP-1) in the studied group of patients with ischemic heart failure differing in left ventricular ejection fraction LVEF makes them the markers of progression in failure.
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Affiliation(s)
- Joanna Głogowska-Ligus
- Department of Epidemiology, Faculty of Health Sciences in Bytom, Medical University of Silesia, Katowice, Poland -
| | - Józefa Dąbek
- Department of Cardiology, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | | | - Tomasz Lepich
- Department of Human Anatomy, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Dariusz Korzeń
- Department of Anesthesiology and Intensive Care with Cardiac Monitoring, Independent Public Clinical Hospital No.7, Upper Silesian Medical Center, Medical University of Silesia in Katowice, Poland
| | - Zbigniew Gąsior
- Department of Cardiology, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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Estudio poblacional de la primera hospitalización por insuficiencia cardiaca y la interacción entre los reingresos y la supervivencia. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.05.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Fernández-Gassó L, Hernando-Arizaleta L, Palomar-Rodríguez JA, Abellán-Pérez MV, Hernández-Vicente Á, Pascual-Figal DA. Population-based Study of First Hospitalizations for Heart Failure and the Interaction Between Readmissions and Survival. ACTA ACUST UNITED AC 2018; 72:740-748. [PMID: 30262426 DOI: 10.1016/j.rec.2018.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/25/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Disease progression in patients after a first hospitalization for heart failure (HF), in particular the interaction between survival and rehospitalizations, is not well established. METHODS We studied all patients with a first hospitalization and main diagnosis of HF from 2009 to 2013 by analyzing the Minimum Data Set of the Region of Murcia. Both incident and recurrent patients were studied, and the trend in hospitalization rates was calculated by joinpoint regression. Patients were followed-up through their health cards until the end of 2015. Mortality and readmissions, including causes and chronology in relation to the time of death, were assessed. RESULTS A total of 8258 incident patients were identified, with annual rates increasing (+2.3%, P <.05) up to 1.24 patients per 1000 inhabitants, representing 71% of hospitalized individuals and 57% of total discharges due to HF. In the first year, 22% were readmitted due to HF, 31% due to cardiovascular causes, and 54% due to any cause. Five-year survival was 40%, which was significantly lower than age- and sex-adjusted expected survival for the general population (76%) (P <.001). Among patients who died during follow-up, readmissions (1.5 per patient/y, 0.4 due to HF) showed a "J" pattern, with 48% of rehospitalizations being concentrated in the last 3 deciles of survival prior to death. CONCLUSIONS Rates of first hospitalization due to HF continue to increase, with high mortality and rehospitalizations during follow-up, which are concentrated mainly in the period prior to death.
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Affiliation(s)
- Lucía Fernández-Gassó
- Servicio de Cardiología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - Lauro Hernando-Arizaleta
- Servicio de Planificación Sanitaria y Financiación Sanitaria, Consejería de Salud de la Región de Murcia, Murcia, Spain
| | - Joaquín A Palomar-Rodríguez
- Servicio de Planificación Sanitaria y Financiación Sanitaria, Consejería de Salud de la Región de Murcia, Murcia, Spain
| | - María Victoria Abellán-Pérez
- Servicio de Planificación Sanitaria y Financiación Sanitaria, Consejería de Salud de la Región de Murcia, Murcia, Spain
| | - Álvaro Hernández-Vicente
- Servicio de Cardiología, Hospital Universidad Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
| | - Domingo A Pascual-Figal
- Servicio de Cardiología, Hospital Universidad Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Murcia, Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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Ballo P, Profili F, Policardo L, Roti L, Francesconi P, Zuppiroli A. Opposite trends in hospitalization and mortality after implementation of a chronic care model-based regional program for the management of patients with heart failure in primary care. BMC Health Serv Res 2018; 18:388. [PMID: 29848317 PMCID: PMC5975582 DOI: 10.1186/s12913-018-3164-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/30/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The chronic care model (CCM) is an established framework for the management of patients with chronic illness at the individual and population level. Its application has been previously shown to improve clinical outcome in several conditions, but the prognostic impact of CCM-based programs for the management of patients with chronic heart failure (HF) in primary care is still to be elucidated. METHODS We assessed the prognostic impact of a primary-care, CCM-based project applied in Tuscany, Italy, in 1761 patients with chronic HF enrolled in a retrospective matched cohort study. The project was based on predefined working teams including general practitioners and nurses, proactively scheduled regular follow-up visitations for each patient, counseling for therapy adherence and lifestyle modifications, appropriate diagnostic and therapeutic pathways according to international guidelines, and a key supporting role of the nurses, who were responsible for the practical coordination of the follow-up. A matched group of 3522 HF subjects assisted by general practitioners not involved in the project was considered as control group. The endpoints of this study were HF hospitalization and all-cause mortality. RESULTS Over a 4-year follow-up period, HF hospitalization rate was higher in the CCM group than the controls (12.1 vs 10.3 events/100 patient-years; incidence rate ratio 1.15[1.05-1.27], p = 0.0030). Mortality was lower in the CCM group than the controls (10.8 vs 12.6 events/100 patient-years; incidence rate ratio 0.82[0.75-0.91], p < 0.0001). In multivariable analysis, the CCM status was associated with a 34% higher risk of HF hospitalization and 18% lower risk of death (p < 0.0001 for both). The effect on HF hospitalization was mostly driven by a 50% higher rate of planned HF hospitalization. CONCLUSIONS Implementation of a CCM-based program for the management of HF patients in primary care led to reduced mortality and increased HF hospitalization. These findings support the hypothesis that the beneficial effects of CCM on survival might be extended to patients with chronic HF followed in primary care, but also support the need for further strategies aimed at improving the management of these patients in terms of hospitalizations.
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Affiliation(s)
- Piercarlo Ballo
- Cardiology Unit, S. Maria Annunziata Hospital, via dell’Antella 58, Florence, Italy
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Fernández Gassó ML, Hernando-Arizaleta L, Palomar Rodríguez JA, Pascual-Figal DA. Análisis de los ingresos hospitalarios por insuficiencia cardiaca en registros sanitarios de diferentes comunidades autónomas. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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8
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Fernández Gassó ML, Hernando-Arizaleta L, Palomar Rodríguez JA, Pascual-Figal DA. Analysis of Hospitalization Trends for Heart Failure in the Health Registries of Different Autonomous Communities. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2018; 71:128-129. [PMID: 29191781 DOI: 10.1016/j.rec.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 09/06/2017] [Indexed: 06/07/2023]
Affiliation(s)
- María L Fernández Gassó
- Servicio de Cardiología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain.
| | | | | | - Domingo A Pascual-Figal
- Servicio de Cardiología, Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina, Universidad de Murcia, Murcia, Spain
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9
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Fernández Gassó ML, Hernando-Arizaleta L, Palomar-Rodríguez JA, Soria-Arcos F, Pascual-Figal DA. Tendencia y características de la hospitalización por insuficiencia cardiaca en un marco poblacional durante el periodo 2003-2013. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.11.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fernández Gassó ML, Hernando-Arizaleta L, Palomar-Rodríguez JA, Soria-Arcos F, Pascual-Figal DA. Trends and Characteristics of Hospitalization for Heart Failure in a Population Setting From 2003 to 2013. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2017; 70:720-726. [PMID: 28363708 DOI: 10.1016/j.rec.2017.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 11/29/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Population-based studies in other countries have reported a reduction of standardized rates of hospitalization for heart failure (HF) but data from a well-defined population are lacking in Spain. METHODS All hospitalizations with a principal diagnosis of HF between 2003 and 2013 were obtained from the Minimum Basic Data Set, which includes all hospitals in the Region of Murcia. Health care episodes were identified by the individual health card (27 158 episodes). For each year, we studied the following parameters: crude, age-standardized and sex-standardized hospitalization rates for HF, length of stay, mortality, clinical variables, and the Elixhauser index. Time trends were analyzed using joinpoint regression. RESULTS Hospitalization rates increased by 76.7%, from 1.28‰ to 2.26‰ (crude) and 1.06‰ to 1.77‰ (standardized); the mean annual percentage of change (APC) was 8.2% until 2007 and was subsequently 1.9% (P < .05). Rates doubled in persons ≥ 75 years, reaching 19.9‰ in those aged 75 to 84 years (APC, 5.4%) and 32.5‰ in those aged ≥ 85 years (APC, 11.7%) but were unchanged in persons aged < 75 years. The hospitalization rate was 36% higher in women than in men but was equal after age-standardization and showed no temporal change. The Elixhauser comorbidity index increased by almost 1 point during the study period and episodes > 6 points increased by 2-fold. Length of stay and mortality were unchanged during the study period. CONCLUSIONS Between 2003 and 2013, there was a sustained increase in standardized rates of hospitalization for HF, which affected persons ≥ 75 years and was associated with a rise in comorbidity. There is a need for strategies focused on this population.
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Affiliation(s)
| | | | | | - Federico Soria-Arcos
- Servicio de Cardiología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - Domingo A Pascual-Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Facultad de Medicina, Universidad de Murcia, El Palmar, Murcia, Spain.
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Ventura HO, Silver MA. Observations and Reflections on the Burden of Hospitalizations for Heart Failure. Mayo Clin Proc 2017; 92:175-178. [PMID: 28160868 DOI: 10.1016/j.mayocp.2016.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, La; Department of Medicine and the Division of Medical Services, Advocate Christ Medical Center and University of Illinois at Chicago, Chicago, Ill.
| | - Marc A Silver
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, La; Department of Medicine and the Division of Medical Services, Advocate Christ Medical Center and University of Illinois at Chicago, Chicago, Ill
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12
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Trupp RJ, Penny L, Prasun MA. American Association of Heart Failure Nurses Position Paper on the Certified Heart Failure Nurse – Knowledge (CHFN-K) Certification. Heart Lung 2016; 45:291-2. [DOI: 10.1016/j.hrtlng.2016.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Reeder KM, Ercole PM, Peek GM, Smith CE. Symptom perceptions and self-care behaviors in patients who self-manage heart failure. J Cardiovasc Nurs 2015; 30:E1-7. [PMID: 24335834 PMCID: PMC4116472 DOI: 10.1097/jcn.0000000000000117] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with heart failure (HF) are at heightened risk for acute exacerbation requiring hospitalization. Although timely reporting of symptoms can expedite outpatient treatment and avoid the need for hospitalization, few patients recognize and respond to symptoms until acutely ill. OBJECTIVE The purpose of this study was to explore patients' perceptions of symptoms and self-care behaviors for symptom relief, leading up to a HF hospitalization. METHODS To examine prehospitalization symptom scenarios, semistructured interviews were conducted with 60 patients hospitalized for acute decompensated HF. RESULTS Thirty-seven patients (61.7%) said that they had a sense that "something just wasn't quite right" before their symptoms began but were unable to specify further. Signs and symptoms most often recognized by the patients were related to dyspnea (85%), fatigue (53.3%), and edema (41.7%). Few patients interpreted their symptoms as being related to worsening HF and most often attributed symptoms to changes in diet (18.3%) and medications (13.3%). Twenty-six patients (43.3%) used self-care strategies to relieve symptoms before hospital admission. More than 40% of the patients had symptoms at least 2 weeks before hospitalization. CONCLUSIONS Despite the wide dissemination of HF evidence-based guidelines, important components of symptom self-management remain suboptimal. Because most of HF self-management occurs in the postdischarge environment, research is needed that identifies how patients interpret symptoms of HF in the specific contexts in which patients self-manage their HF. These findings suggest the need for interventions that will help patients expeditiously recognize, accurately interpret, and use appropriate and safe self-care strategies for symptoms.
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Affiliation(s)
- Katherine M Reeder
- Katherine M. Reeder, PhD, RN Research Assistant Professor, Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri. Patrick M. Ercole, PhD, MPH Assistant Professor, Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri. Gina M. Peek, MSN, RN Assistant Professor, Newman Division of Nursing, Emporia State University, Kansas. Carol E. Smith, PhD, RN, FAAN Professor, School of Nursing & Preventive Medicine, Kansas University Medical Center, Kansas City
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DeMaria AN, Adler ED, Bax JJ, Ben-Yehuda O, Feld GK, Greenberg BH, Hall JL, Hlatky MA, Lew WYW, Lima JAC, Mahmud E, Maisel AS, Narayan SM, Nissen SE, Sahn DJ, Tsimikas S. Highlights of the year in JACC 2013. J Am Coll Cardiol 2014; 63:570-602. [PMID: 24524815 DOI: 10.1016/j.jacc.2014.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Eric D Adler
- Cardiology Division, UCSD Medical Center, San Diego, California
| | - Jeroen J Bax
- Leiden University Medical Center, Leiden, the Netherlands
| | | | - Gregory K Feld
- Cardiology Division, UCSD Medical Center, San Diego, California
| | | | | | | | | | | | - Ehtisham Mahmud
- Cardiology Division, UCSD Medical Center, San Diego, California
| | - Alan S Maisel
- Veterans Affairs Medical Center, San Diego, California
| | | | | | - David J Sahn
- Department of Pediatric Cardiology, Oregon Health and Science University, Portland, Oregon
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Blais C, Dai S, Waters C, Robitaille C, Smith M, Svenson LW, Reimer K, Casey J, Puchtinger R, Johansen H, Gurevich Y, Lix LM, Quan H, Tu K. Assessing the burden of hospitalized and community-care heart failure in Canada. Can J Cardiol 2013; 30:352-8. [PMID: 24565257 DOI: 10.1016/j.cjca.2013.12.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The surveillance of heart failure (HF) is currently conducted using either survey or hospital data, which have many limitations. Because Canada is collecting medical information in administrative health data, the present study seeks to propose methods for the national surveillance of HF using linked population-based data. METHODS Linked administrative data from 5 Canadian provinces were analyzed to estimate prevalence, incidence, and mortality rates for persons with HF between 1996/1997 and 2008/2009 using 2 case definitions: (1) 1 hospitalization with an HF diagnosis in any field (H_Any) and (2) 1 hospitalization in any field or at least 2 physician claims within a 1-year period (H_Any_2P). One hospitalization with an HF diagnosis code in the most responsible diagnosis field (H_MR) was also compared. Rates were calculated for individuals aged ≥ 40 years. RESULTS In 2008/2009, combining the 5 provinces (approximately 82% of Canada's total population), both age-standardized HF prevalence and incidence were underestimated by 39% and 33%, respectively, with H_Any when compared with H_Any_2P. Mortality was higher in patients with H_MR compared with H_Any. The degree of underestimation varied by province and by age, with older age groups presenting the largest differences. Prevalence estimates were stable over the years, especially for the H_Any_2P case definition. CONCLUSIONS The prevalence and incidence of HF using inpatient data alone likely underestimates the population rates by at least 33%. The addition of physician claims data is likely to provide a more inclusive estimate of the burden of HF in Canada.
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Affiliation(s)
- Claudia Blais
- Institut national de santé publique du Québec, Québec City, Québec, Canada; Faculté de pharmacie, Université Laval, Québec City, Québec, Canada
| | - Sulan Dai
- Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, Ontario, Canada.
| | - Chris Waters
- Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Cynthia Robitaille
- Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Mark Smith
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Lawrence W Svenson
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Health, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Kim Reimer
- BC Ministry of Health, Victoria, British Columbia, Canada
| | - Jill Casey
- Nova Scotia Health and Wellness, Halifax, Nova Scotia, Canada
| | - Rolf Puchtinger
- Saskatchewan Ministry of Health, Regina, Saskatchewan, Canada
| | - Helen Johansen
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Yana Gurevich
- Canadian Institute for Health Information, Toronto, Ontario, Canada
| | - Lisa M Lix
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Hude Quan
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karen Tu
- Institute for Clinical Evaluative Sciences; Department of Family and Community Medicine, University of Toronto; University Health Network, Toronto Western Hospital Family Health Team, Toronto, Ontario, Canada
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Abstract
Heart failure (HF) has been singled out as an epidemic and is a staggering clinical and public health problem, associated with significant mortality, morbidity, and healthcare expenditures, particularly among those aged ≥ 65 years. The case mix of HF is changing over time with a growing proportion of cases presenting with preserved ejection fraction for which there is no specific treatment. Despite progress in reducing HF-related mortality, hospitalizations for HF remain frequent and rates of readmissions continue to rise. To prevent hospitalizations, a comprehensive characterization of predictors of readmission in patients with HF is imperative and must integrate the impact of multimorbidity related to coexisting conditions. New models of patient-centered care that draw on community-based resources to support HF patients with complex coexisting conditions are needed to decrease hospitalizations.
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Affiliation(s)
- Véronique L Roger
- Department of Health Sciences Research and Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
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