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Arundel C, Sheriff HM, Lam PH, Mohammed SF, Jones LG, Jurgens CY, Morgan CJ, Faselis C, Allman RM, Fonarow GC, Ahmed A. Renin-Angiotensin Inhibition and Outcomes in Nursing Home Residents With Heart Failure. Am J Ther 2021; 27:e235-e242. [PMID: 30299270 PMCID: PMC10502912 DOI: 10.1097/mjt.0000000000000836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs-ARBs) improve outcomes in heart failure (HF). Less is known about this association in nursing home (NH) residents. METHODS Of the 8024 hospitalized HF patients, 542 were NH residents, of whom 250 received ACEIs-ARBs. We assembled a propensity score-matched cohort of 157 pairs of NH residents receiving and not receiving ACEIs-ARBs balanced on 29 baseline characteristics (mean age, 83 years, 74% women, 17% African American), in which we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with ACEI-ARB use. We then checked for interaction in a matched cohort of 5130 patients (378 were NH residents) assembled from the 8024 patients. RESULTS Among 314 matched NH residents, HRs (95% CIs) for 30-day all-cause readmission, HF readmission, and all-cause mortality were 0.78 (0.47-1.28), 0.68 (0.29-1.60), and 1.26 (0.70-2.27), respectively. Respective HRs (95% CIs) at 1 year were 0.76 (0.56-1.02), 0.68 (0.42-1.09), and 1.04 (0.78-1.38). Among 5130 matched patients, ACEI-ARB use was associated with a significantly lower risk of all outcomes at both times, with no significant interactions, except for 1-year mortality, which was only significant in the non-NH subgroup (P for interaction, 0.026). CONCLUSIONS We found no evidence that the use of ACEIs or ARBs is associated with improved outcomes in patients with HF in the NH setting. However, we also found no evidence that this association is different in NH residents with HF versus non-NH patients with HF. Future larger studies are needed to demonstrate effectiveness of these drugs in the NH setting.
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Affiliation(s)
- Cherinne Arundel
- Veterans Affairs Medical Center, Washington, DC
- George Washington University, Washington, DC
| | - Helen M. Sheriff
- Veterans Affairs Medical Center, Washington, DC
- George Washington University, Washington, DC
| | - Phillip H. Lam
- Veterans Affairs Medical Center, Washington, DC
- Georgetown University, Washington, DC
- MedStar Washington Hospital Center, Washington, DC
| | | | - Linda G. Jones
- Veterans Affairs Medical Center, Birmingham, AL
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Charles Faselis
- Veterans Affairs Medical Center, Washington, DC
- George Washington University, Washington, DC
| | - Richard M. Allman
- Geriatrics and Extended Care, Department of Veterans Affairs, Washington, DC
| | | | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC
- George Washington University, Washington, DC
- University of Alabama at Birmingham, Birmingham, AL
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Khan SU, Khan MZ, Alkhouli M. Trends of Clinical Outcomes and Health Care Resource Use in Heart Failure in the United States. J Am Heart Assoc 2020; 9:e016782. [PMID: 32628064 PMCID: PMC7660738 DOI: 10.1161/jaha.120.016782] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Heart failure (HF) imparts a significant clinical and economic burden on the health system in the United States. Methods and Results We used the National Inpatient Sample database between September 2002 and December 2016. We examined trends of comorbidities, inpatient mortality, and healthcare resource use in patients admitted with acute HF. Outcomes were adjusted for demographic variables, comorbidities, and inflation. A total of 11 806 679 cases of acute HF hospitalization were identified. The burden of coronary artery disease, peripheral vascular disease, valvular heart disease, diabetes mellitus, hypertension, anemia, cancer, depression, and chronic kidney disease among patients admitted with acute HF increased over time. The adjusted mortality decreased from 6.8% in 2002 to 4.9% in 2016 (P-trend<0.001; average annual decline, 1.99%), which was consistent across age, sex, and race. The adjusted mean length of stay decreased from 8.6 to 6.5 days (P<0.001), but discharge disposition to a long-term care facility increased from 20.8% to 25.6% (P<0.001). The adjusted mean cost of stay increased from $51 548 to $72 075 (P<0.001; average annual increase, 2.78%), which was partially explained by the higher proportion of procedures (echocardiogram, right heart catheterization, use of ventricular assist devices, coronary artery bypass grafting) and the higher incidence of HF complications (cardiogenic shock, respiratory failure, ventilator, and renal failure requiring dialysis). Conclusions This national data set showed that despite increasing medical complexities, there was significant reduction in inpatient mortality and length of stay. However, these measures were counterbalanced by a higher proportion of discharge disposition to long-term care facilities and expensive cost of care.
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Affiliation(s)
- Safi U Khan
- Department of Medicine West Virginia University Morgantown WV
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Young L, Gilbert C, Kim J, Seo Y, Wilson FA, Chen LW. Examining Characteristics of Hospitalizations in Heart Failure Patients: Results from the 2009 All-payer Data. JOURNAL OF FAMILY MEDICINE AND DISEASE PREVENTION 2016; 2:037. [PMID: 28736765 PMCID: PMC5517048 DOI: 10.23937/2469-5793/1510037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Heart failure (HF) is one of the most common chronic and disabling illnesses, resulting in high morbidity and mortality. Readmission rate, one key indicator of healthcare quality and healthcare utilization, is prevalent in HF patients. Inconsistent evidences exist about the impact of rural health disparities on HF patients' readmissions. The purpose of this explorative study was to examine the characteristics of hospitalized HF patients and factors related to readmissions in 2009. The results showed all-cause readmission rates were 13.6%, 23.6%, and 31.6% at 30-, 90- and 180-days respectively. The factors related readmissions included age, income, discharge/transfer status from index hospitalization, and comorbidity. Findings from this analysis suggested additional studies using multiple data sources are needed to have a comprehensive understanding of risk factors related HF patients' healthcare utilization.
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Affiliation(s)
| | - Carol Gilbert
- Department of Pediatrics, University of Nebraska Medical Center, USA
| | - Jungyoon Kim
- Department of Health Service Research and Administration, University of Nebraska Medical Center, USA
| | - Yaewon Seo
- College of Nursing, Augusta University, USA
| | - Fernando A Wilson
- Department of Health Service Research and Administration, University of Nebraska Medical Center, USA
| | - Li-Wu Chen
- Department of Health Service Research and Administration, University of Nebraska Medical Center, USA
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Nazir A, Smucker WD. Heart Failure in Post-Acute and Long-Term Care: Evidence and Strategies to Improve Transitions, Clinical Care, and Quality of Life. J Am Med Dir Assoc 2015; 16:825-31. [DOI: 10.1016/j.jamda.2015.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 12/12/2022]
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Orr NM, Forman DE, De Matteis G, Gambassi G. Heart Failure Among Older Adults in Skilled Nursing Facilities: More of a Dilemma Than Many Now Realize. CURRENT GERIATRICS REPORTS 2015; 4:318-326. [PMID: 27398289 DOI: 10.1007/s13670-015-0150-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Post-acute care, encompassing long-term care hospitals, home health, inpatient rehabilitation, and skilled nursing facilities, is increasingly employed as an integral part of management for more complicated patients, particularly as hospitals seek to maintain costs and decrease length of stay. Skilled nursing facilities (SNFs) in particular are progressively utilized for patients with complex medical processes, including today's growing population of older hospitalized heart failure (HF) patients who pose a prominent challenge due to their high risks of mortality, 30-day readmissions, and substantial aggregate cost burden to the healthcare system. Publications to date have largely grouped post-hospitalized HF patients together when reporting demographic or outcome data, without differentiating those at SNFs from those at traditional nursing homes or other post-acute care settings. SNF patients suffer distinctive vulnerabilities and needs, and understanding these distinctions has implications for determining goals of care. In this review we evaluate HF patients referred to SNFs, and discuss the characteristics, outcomes, and management challenges associated with this particular population.
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Affiliation(s)
- Nicole M Orr
- Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA; Post-Acute Cardiology Care, LLC, Wellesley, MA 02481, USA
| | - Daniel E Forman
- Section of Geriatric Cardiology, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 500, Pittsburgh, PA 15213, USA; Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Giuseppe De Matteis
- Department of Medical Sciences, Division of Internal Medicine and Angiology, Catholic University of Sacred Heart, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Giovanni Gambassi
- Department of Medical Sciences, Division of Internal Medicine and Angiology, Catholic University of Sacred Heart, Largo Agostino Gemelli 8, 00168 Rome, Italy
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Messinger-Rapport BJ, Gammack JK, Little MO, Morley JE. Clinical Update on Nursing Home Medicine: 2014. J Am Med Dir Assoc 2014; 15:786-801. [DOI: 10.1016/j.jamda.2014.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 12/18/2022]
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Hancock HC, Close H, Mason JM, Murphy JJ, Fuat A, Singh R, Wood E, de Belder M, Brennan G, Hussain N, Kumar N, Wilson D, Hungin APS. High prevalence of undetected heart failure in long-term care residents: findings from the Heart Failure in Care Homes (HFinCH) study. Eur J Heart Fail 2012; 15:158-65. [PMID: 23112002 PMCID: PMC3547366 DOI: 10.1093/eurjhf/hfs165] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIMS Diagnosis of heart failure in older people in long-term care is challenging because of co-morbidities, cognitive deficit, polypharmacy, immobility, and poor access to services. This study aimed to ascertain heart failure prevalence and clinical management in this population. METHODS AND RESULTS A total of 405 residents, aged 65-100 years, in 33 UK care facilities were prospectively enrolled between April 2009 and June 2010. The presence of heart failure was determined using European Society of Cardiology guidelines, modified where necessary for immobility. Evaluation of symptoms and signs, functional capacity, and quality of life, portable on-site echocardiography, and medical record review were completed in 399 cases. The point prevalence of heart failure was 22.8% [n = 91, 95% confidence interval (CI) 18.8-27.2%]; of these, 62.7% (n = 57, 95% CI 59.6-66.5%) had heart failure with preserved ejection fraction and 37.3% had left ventricular systolic dysfunction (n = 34, 95% CI 34.8-40.5%). A total of 76% (n = 61) of previous diagnoses of heart failure were not confirmed, and up to 90% (n = 82) of study cases were new. No symptoms or signs were reliable predictors of heart failure. CONCLUSION Heart failure was diagnosed in almost a quarter of residents: the prevalence was substantially higher than in other populations. The majority of heart failure cases were undiagnosed, while three-quarters of previously recorded cases were misdiagnosed. Common symptoms and signs appear to have little clinical utility in this population. Early, accurate differential diagnosis is key to the effective management of heart failure; this may be failing in long-term care facilities.
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Affiliation(s)
- Helen C Hancock
- Durham Clinical Trials Unit, School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, Wolfson Research Institute, University Boulevard, Stockton-on-Tees TS17 6BH, UK.
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Johnell K, Fastbom J. Comparison of Prescription Drug Use between Community-Dwelling and Institutionalized Elderly in Sweden. Drugs Aging 2012; 29:751-8. [DOI: 10.1007/s40266-012-0002-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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