1
|
Cerqueiro-González JM, González-Franco A, Fernández-Rodríguez JM, Martínez-Litago E, Pérez-Silvestre J, Salamanca-Bautista P, Morales-Rull L, Conde-Martel A, Casado J, Manzano-Espinosa L, Aramburu-Bodas O. Basic action protocol for the outpatient management of chronic heart failure of the Spanish society of internal medicine. Rev Clin Esp 2024:S2254-8874(24)00113-9. [PMID: 39216808 DOI: 10.1016/j.rceng.2024.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Chronic heart failure (CHF) represents a challenge for the healthy system due to its high prevalence, high burden of morbidity and mortality, and high consumption of health resources. To address this problem, it is necessary to develop efficient management strategies that include both hospital care and outpatient care. The primary objective is to stabilize the patient and prevent decompensation, with the consequent improvement in quality of life, reduction in hospital admissions and emergency department care, and, consequently, reduction in healthcare costs. In this context, the heart failure and atrial fibrilation working group of the Spanish Society of Internal Medicine has developed a protocol for the management of outpatient CHF, that addresses, from the perspective of Internal medicine, all the problems suffered by the patient with CHF. This protocol aims to optimize pharmacological treatment, control cardiovascular risk factors and various comorbidities, educate the patient and their environment about the disease, promote adherence to treatment and stablish follow-up adapted to their condition.
Collapse
Affiliation(s)
| | - A González-Franco
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - E Martínez-Litago
- Servicio de Medicina Interna, Hospital Santa Bárbara de Puertollano, Spain
| | | | - P Salamanca-Bautista
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Macarena, Universidad de Sevilla, Spain
| | - L Morales-Rull
- Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Spain
| | - A Conde-Martel
- Servicio de Medicina Interna, Hospital Universitario de Gran Canaria Doctor Negrín, Spain
| | - J Casado
- Servicio de Medicina Interna, Hospital Universitario de Getafe, Madrid, Spain
| | - L Manzano-Espinosa
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - O Aramburu-Bodas
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Macarena, Universidad de Sevilla, Spain
| |
Collapse
|
2
|
Silva-Cardoso J, Santos J, Araújo I, Andrade A, Morais Sarmento P, Santos P, Moura B, Marques I, Peres M, Ferreira JP, Agostinho J, Pimenta J. conTemporary reflectiOns regarding heart failure manaGEmenT - How to ovERcome the PorTuguese barriers (TOGETHER-PT). Rev Port Cardiol 2024; 43:225-235. [PMID: 37689388 DOI: 10.1016/j.repc.2023.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/11/2023] [Accepted: 05/02/2023] [Indexed: 09/11/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is a complex clinical syndrome that is a significant burden in hospitalisations, morbidity, and mortality. Although a significant effort has been made to better understand its consequences and current barriers in its management, there are still several gaps to address. The present work aimed to identify the views of a multidisciplinary group of health care professionals on HF awareness and literacy, diagnosis, treatment and organization of care, identifying current challenges and providing insights into the future. METHODS A steering committee was established, including members of the Heart Failure Study Group of the Portuguese Society of Cardiology (GEIC-SPC), the Heart Failure Study Group of the Portuguese Society of Internal Medicine (NEIC-SPMI) and the Cardiovascular Study Group (GEsDCard) of the Portuguese Association of General and Family Medicine (APMGF). This steering committee produced a 16-statement questionnaire regarding different HF domains that was answered to by a diversified group of 152 cardiologists, internists, general practitioners, and nurses with an interest or dedicated to HF using a five-level Likert scale. Full agreement was defined as ≥80% of level 5 (fully agree) responses. RESULTS Globally, consensus was achieved in all but one of the 16 statements. Full agreement was registered in seven statements, namely 3 of 4 statements for patient education and HF awareness and 2 in 4 statements of both HF diagnosis and healthcare organization, with proportions of fully agree responses ranging from 82.9% to 96.7%. None of the HF treatment statements registered full agreement but 3 of 4 achieved ≥80% of level 4 (agree) responses. CONCLUSION This document aims to be a call-to-action to improve HF patients' quality of life and prognosis, by promoting a change in HF care in Portugal.
Collapse
Affiliation(s)
- José Silva-Cardoso
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal; RISE - Health Research Network, Portugal.
| | - Jonathan Santos
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal; ARS Norte, ACES Vale Sousa Norte, USF Torrão, Portugal
| | - Inês Araújo
- Clínica de Insuficiência Cardíaca, Serviço de Medicina III, Hospital S. Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Aurora Andrade
- Serviço de Cardiologia, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Pedro Morais Sarmento
- Departamento de Medicina Interna e Hospital de Dia de Insuficiência Cardíaca do Hospital da Luz de Lisboa, Lisboa, Portugal
| | - Paulo Santos
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal; RISE - Health Research Network, Portugal; MEDCIDS, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Brenda Moura
- Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Irene Marques
- Serviço de Medicina Interna, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica - Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Marisa Peres
- Serviço de Cardiologia, Hospital de Santarém, Santarém, Portugal
| | - João Pedro Ferreira
- Unic@RISE, Serviço de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Université de Lorraine, Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Joao Agostinho
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Joana Pimenta
- Serviço de Medicina Interna, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; UnIC@RISE, Departamento de Medicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| |
Collapse
|
3
|
Bonilla-Palomas JL, Anguita-Sánchez M, Fernández-Pérez C, Bernal-Sobrino JL, García M, Prado N, Rosillo N, Pérez-Villacastín J, Gómez-Doblas JJ, Elola-Somoza FJ. [Hospital admissions and outcomes for systolic and diastolic heart failure in Spain between 2016 and 2019: A population-based study]. Med Clin (Barc) 2024; 162:213-219. [PMID: 37981482 DOI: 10.1016/j.medcli.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/04/2023] [Accepted: 10/07/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND AND PURPOSE In Spain there is a lack of population data that specifically compare hospitalization for systolic and diastolic heart failure (HF). We assessed clinical characteristics, in-hospital mortality and 30-day cardiovascular readmission rates differentiating by HF type. METHODS We conducted a retrospective observational study of patients discharged with the principal diagnosis of HF from The National Health System' acute hospital during 2016-2019, distinguishing between systolic and diastolic HF. The source of the data was the Minimum Basic Data Set. The risk-standardized in-hospital mortality ratio and risk-standardized 30-day cardiovascular readmission ratio were calculated using multilevel risk adjustment models. RESULTS The 190,200 episodes of HF were selected. Of these, 163,727 (86.1%) were classified as diastolic HF and were characterized by older age, higher proportion of women, diabetes mellitus, dementia and renal failure than those with systolic HF. In the multilevel risk adjustment models, diastolic HF was a protective factor for both in-hospital mortality (odds ratio [OR]: 0.79; 95% confidence interval [CI]: 0.75-0.83; P<.001) and 30-day cardiovascular readmission versus systolic HF (OR: 0.93; 95% CI: 0.88-0.97; P=.002). CONCLUSIONS In Spain, between 2016 and 2019, hospitalization episodes for HF were mostly due to diastolic HF. According to the multilevel risk adjustment models, diastolic HF compared to systolic HF was a protective factor for both in-hospital mortality and 30-day cardiovascular readmission.
Collapse
Affiliation(s)
| | | | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, España; Departamento de Medicina Preventiva, Área Sanitaria de Santiago de Compostela y Barbanza, Instituto de Investigación de Santiago, Santiago de Compostela, La Coruña, España
| | - José Luis Bernal-Sobrino
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, España; Departamento de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, España
| | - María García
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, España
| | - Náyade Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, España
| | - Nicolás Rosillo
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, España
| | | | | | | |
Collapse
|
4
|
Capdevila Aguilera C, Vela Vallespín E, Clèries Escayola M, Yun Viladomat S, Fernández Solana C, Alcober Morte L, Monterde Prat D, Hidalgo Quirós E, Calero Molina E, José Bazán N, Moliner Borja P, Piera Jiménez J, Ruiz Muñoz M, Corbella Virós X, Jiménez-Marrero S, Garay Melero A, Ramos Polo R, Alcoberro Torres L, Pons Riverola A, Enjuanes Grau C, Comín-Colet J. Population-based evaluation of the impact of socioeconomic status on clinical outcomes in patients with heart failure in integrated care settings. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:803-812. [PMID: 36963612 DOI: 10.1016/j.rec.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/07/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION AND OBJECTIVES Low socioeconomic status (SES) is associated with poor outcomes in patients with heart failure (HF). We aimed to examine the influence of SES on health outcomes after a quality of care improvement intervention for the management of HF integrating hospital and primary care resources in a health care area of 209 255 inhabitants. METHODS We conducted a population-based pragmatic evaluation of the implementation of an integrated HF program by conducting a natural experiment using health care data. We included all individuals consecutively admitted to hospital with at least one ICD-9-CM code for HF as the primary diagnosis and discharged alive in Catalonia between January 1, 2015 and December 31, 2019. We compared outcomes between patients exposed to the new HF program and those in the remaining health care areas, globally and stratified by SES. RESULTS A total of 77 554 patients were included in the study. Death occurred in 37 469 (48.3%), clinically-related hospitalization in 41 709 (53.8%) and HF readmission in 29 755 (38.4%). On multivariate analysis, low or very low SES was associated with an increased risk of all-cause death and clinically-related hospitalization (all Ps <.05). The multivariate models showed a significant reduction in the risk of all-cause death (HR, 0.812; 95%CI, 0.723-0.912), clinically-related hospitalization (HR, 0.886; 95%CI, 0.805-0.976) and HF hospitalization (HR, 0.838; 95%CI, 0.745-0.944) in patients exposed to the new HF program compared with patients exposed to the remaining health care areas and this effect was independent of SES. CONCLUSIONS An intensive transitional HF management program improved clinical outcomes, both overall and across SES strata.
Collapse
Affiliation(s)
- Cristina Capdevila Aguilera
- Departamento de Gerencia, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Departamento de Ciencias Clínicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, Spain
| | - Emili Vela Vallespín
- Unidad de Información y Conocimiento, Servicio Catalán de la Salud (CatSalut), Barcelona, Spain; Digitalización para la Sostenibilidad del Sistema Sanitario DS3-IDIBELL, Servicio Catalán de la Salud (CatSalut), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montse Clèries Escayola
- Unidad de Información y Conocimiento, Servicio Catalán de la Salud (CatSalut), Barcelona, Spain; Digitalización para la Sostenibilidad del Sistema Sanitario DS3-IDIBELL, Servicio Catalán de la Salud (CatSalut), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Yun Viladomat
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Medicina Interna, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Coral Fernández Solana
- Servicio de Atención Primaria, Delta del Llobregat e IDIAP, Barcelona, Spain; Servicio de Atención Primaria, Instituto Catalán de la Salud, Barcelona, Spain
| | - Laia Alcober Morte
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Atención Primaria, Delta del Llobregat e IDIAP, Barcelona, Spain; Servicio de Atención Primaria, Instituto Catalán de la Salud, Barcelona, Spain
| | - David Monterde Prat
- Digitalización para la Sostenibilidad del Sistema Sanitario DS3-IDIBELL, Servicio Catalán de la Salud (CatSalut), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Atención Primaria, Instituto Catalán de la Salud, Barcelona, Spain
| | - Encarna Hidalgo Quirós
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Atención Primaria, Delta del Llobregat e IDIAP, Barcelona, Spain; Servicio de Atención Primaria, Instituto Catalán de la Salud, Barcelona, Spain
| | - Esther Calero Molina
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria José Bazán
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Moliner Borja
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Piera Jiménez
- Digitalización para la Sostenibilidad del Sistema Sanitario DS3-IDIBELL, Servicio Catalán de la Salud (CatSalut), L'Hospitalet de Llobregat, Barcelona, Spain; Facultad de Informática, Multimedia y Telecomunicaciones, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Marta Ruiz Muñoz
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella Virós
- Grupo de investigación en Enfermedades Sistémicas, Vasculares y Envejecimiento (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Facultad de Medicina, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Santiago Jiménez-Marrero
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alberto Garay Melero
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Raúl Ramos Polo
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lidia Alcoberro Torres
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alexandra Pons Riverola
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Enjuanes Grau
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Josep Comín-Colet
- Departamento de Ciencias Clínicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, Spain; Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain.
| |
Collapse
|
5
|
Recio-Mayoral A, Morgado García de Polavieja JI. Implementing clinical practice guidelines in the real world: a common-sense approach. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:757-758. [PMID: 37544593 DOI: 10.1016/j.rec.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 08/08/2023]
|
6
|
López-García L, Lorenzo-Villalba N, Molina-Puente JI, Kishta A, Sanchez-Sauce B, Aguilar-Rodriguez F, Bernanbeu-Wittel M, Muñoz-Rivas N, Soler-Rangel L, Fernández-Carmena L, Andrès E, Deodati F, Trapiello-Valbuena F, Casasnovas-Rodríguez P, López-Reboiro ML, Méndez-Bailon M. Clinical Characteristics and Prognostic Impact of Short Physical Performance Battery in Hospitalized Patients with Acute Heart Failure-Results of the PROFUND-IC Registry. J Clin Med 2023; 12:5974. [PMID: 37762915 PMCID: PMC10531733 DOI: 10.3390/jcm12185974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Most patients diagnosed with heart failure (HF) are older adults with multiple comorbidities. Multipathological patients constitute a population with common characteristics: greater clinical complexity and vulnerability, frailty, mortality, functional deterioration, polypharmacy, and poorer health-related quality of life with more dependency. OBJECTIVES To evaluate the clinical characteristics of hospitalized patients with acute heart failure and to determine the prognosis of patients with acute heart failure according to the Short Physical Performance Battery (SPPB) scale. METHODS Observational, prospective, and multicenter cohort study conducted from September 2020 to May 2022 in patients with acute heart failure as the main diagnosis and NT-ProBNP > 300 pg. The cohort included patients admitted to internal medicine departments in 18 hospitals in Spain. Epidemiological variables, comorbidities, cardiovascular risk factors, cardiovascular history, analytical parameters, and treatment during admission and discharge of the patients were collected. Level of frailty was assessed by the SPPB scale, and dependence, through the Barthel index. A descriptive analysis of all the variables was carried out, expressed as frequencies and percentages. A bivariate analysis of the SPPB was performed based on the score obtained (SPPB ≤ 5 and SPPB > 5). For the overall analysis of mortality, HF mortality, and readmission of patients at 30 days, 6 months, and 1 year, Kaplan-Meier survival curves were used, in which the survival experience among patients with an SPPB > 5 and SPPB ≤ 5 was compared. RESULTS A total of 482 patients were divided into two groups according to the SPPB with a cut-off point of an SPPB < 5. In the sample, 349 patients (77.7%) had an SPPB ≤ 5 and 100 patients (22.30%) had an SPPB > 5. Females (61%) predominated in the group with an SPPB ≤ 5 and males (61%) in those with an SPPB > 5. The mean age was higher in patients with an SPPB ≤ 5 (85.63 years). Anemia was more frequent in patients with an SPPB ≤ 5 (39.5%) than in patients with an SPPB ≥ 5 (29%). This was also seen with osteoarthritis (32.7%, p = 0.000), diabetes (49.6%, p = 0.001), and dyslipidemia (69.6%, p = 0.011). Patients with an SPPB score > 5 had a Barthel index < 60 in only 4% (n = 4) of cases; the remainder of the patients (96%, n = 96) had a Barthel index > 60. Patients with an SPPB > 5 showed a higher probability of survival at 30 days (p = 0.029), 6 months (p = 0.031), and 1 year (p = 0.007) with (OR = 7.07; 95%CI (1.60-29.80); OR: 3.9; 95%CI (1.30-11.60); OR: 6.01; 95%CI (1.90-18.30)), respectively. No statistically significant differences were obtained in the probability of readmission at 30 days, 6 months, and 1 year (p > 0.05). CONCLUSIONS Patients admitted with acute heart failure showed a high frequency of frailty as assessed by the SPPB. Patients with an SPPB ≤ 5 had greater comorbidities and greater functional limitations than patients with an SPPB > 5. Patients with heart failure and a Barthel index > 60 frequently presented an SPPB < 5. In daily clinical practice, priority should be given to performing the SPPB in patients with a Barthel index > 60 to assess frailty. Patients with an SPPB ≤ 5 had a higher risk of mortality at 30 days, 6 months, and 1 year than patients with an SPPB ≤ 5. The SPPB is a valid tool for identifying frailty in acute heart failure patients and predicting 30-day, 6-month, and 1-year mortality.
Collapse
Affiliation(s)
- Lidia López-García
- Facultad de Enfermería, Universidad Complutense, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Noel Lorenzo-Villalba
- Service de Médecine Interne, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Juan Igor Molina-Puente
- Servicio de Medicina Interna, Complejo Hospitalario de Ávila, 05004 Avila, Spain; (J.I.M.-P.); (A.K.)
| | - Aladin Kishta
- Servicio de Medicina Interna, Complejo Hospitalario de Ávila, 05004 Avila, Spain; (J.I.M.-P.); (A.K.)
| | - Beatriz Sanchez-Sauce
- Servicio de Medicina Interna, Hospital Universitario Fundación de Alcorcón, 28922 Madrid, Spain
| | | | | | - Nuria Muñoz-Rivas
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Llanos Soler-Rangel
- Servicio de Medicina Interna, Hospital Infanta Sofia, 28702 San Sebastián de los Reyes, Spain
| | | | - Emmanuel Andrès
- Service de Médecine Interne, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Francesco Deodati
- Servicio de Medicina Interna, Hospital Infanta Cristina, 28981 Parla, Spain
| | | | | | | | - Manuel Méndez-Bailon
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| |
Collapse
|
7
|
Esteban-Fernández A, Anguita-Sánchez M, Bonilla-Palomas JL, Anguita-Gámez M, Rosillo N, Del Prado N, Bernal JL, Fernández-Pérez C, Fernández-Rozas I, Gómez-Doblas JJ, Pérez-Villacastin J, Elola FJ. One-year readmissions for circulatory diseases and in-hospital mortality after an index episode of heart failure in elderly patients. A nationwide data from public hospitals in Spain between 2016 and 2018. Clin Res Cardiol 2023:10.1007/s00392-023-02202-7. [PMID: 37041378 DOI: 10.1007/s00392-023-02202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/06/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Heart failure (HF) is one of the leading causes of hospitalization and death in elderly patients. However, there is limited evidence on readmission and mortality 1-year after discharge for HF. METHODS Retrospective analysis of the Minimum Basic Data Set, including HF episodes, discharged from Spanish hospitals between 2016 and 2018 in ≥ 75 years. We calculated: (a) the rate of readmissions due to circulatory system diseases (CSD) 365 days after index episode; (b) in-hospital mortality in readmissions; and (c) predictors of mortality and readmission. RESULTS We included 178,523 patients (59.2% women) aged 85.1 ± 5.5 years. The most frequent comorbidities were arrhythmias (56.0%) and renal failure (39.5%). During the follow-up, 48,932 patients (27.4%) had at least one readmission for CSD and a crude rate of 40.2%, the most frequent one HF (52.8%). The median between the date of readmission and discharge from the last admission was 70 days [IQI 24; 171] for the first readmission. The most relevant predictors of the number of readmissions were valvular heart disease and myocardial ischemia. During the readmissions, 26,757 patients (79.1%) died, representing a cumulative in-hospital mortality of 47,945 (26.9%). The factors in the index episode predictors of mortality during readmissions were cardio-respiratory failure and stroke. The number of readmissions was a risk factor for in-hospital mortality (OR 1.13; 95% CI 1.11-1.14). CONCLUSIONS The readmission rate for CSD 1-year after the index episode of HF in patients ≥ 75 years was 28.4%. The cumulative in-hospital mortality rate during the readmissions was 26.9%, and the number of rehospitalizations was identified as one of the main predictors of mortality.
Collapse
Affiliation(s)
- Alberto Esteban-Fernández
- Cardiology Service, Hospital Universitario Severo Ochoa, Calle Orellana S/N, 28911, Leganés, Madrid, Spain.
| | - Manuel Anguita-Sánchez
- Cardiology Service, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides para la Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | | | | | - Nicolás Rosillo
- Institute for the Improvement of Health Care (IMAS Foundation), Madrid, Spain
| | - Náyade Del Prado
- Institute for the Improvement of Health Care (IMAS Foundation), Madrid, Spain
| | - José Luis Bernal
- Management Control Service, Hospital Universitario 12 de Octubre, Madrid, Spain
- Preventive Medicine Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cristina Fernández-Pérez
- Institute for the Improvement of Health Care (IMAS Foundation), Madrid, Spain
- Preventive Medicine Department, Área Sanitaria de Santiago de Compostela y Barbanza, Instituto de Investigación de Santiago, Santiago de Compostela, Spain
| | - Inmaculada Fernández-Rozas
- Cardiology Service, Hospital Universitario Severo Ochoa, Calle Orellana S/N, 28911, Leganés, Madrid, Spain
| | | | | | | |
Collapse
|
8
|
Revisando Conceptos de Acceso, Trayectorias, Participación y Conocimiento Tácito en Investigaciones Sobre Pacientes y Cobertura en Salud. Value Health Reg Issues 2023; 33:42-48. [PMID: 36228530 DOI: 10.1016/j.vhri.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/13/2022] [Accepted: 08/24/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This study aimed to characterize 5 approaches that have been developed in research on patients and health coverage, which reveal information from the perspective of patients: (1) access to healthcare, (2) therapeutic trajectories, (3) social participation in decision making on health coverage, (4) tacit knowledge, and (5) communities of practice. METHODS This is a narrative literature review, based on searches performed in PubMed/MEDLINE and Web of Science, between August and December 2021. A total of 45 scientific articles were selected for analysis, which were complemented by a gray literature search that provided 6 additional manuscripts. RESULTS Improving access to health services requires an understanding of the meaning of the concept of access from the users themselves. The patient trajectory approach contributes by emphasizing that the focus of analysis must adopt the patient's perspective, given that it provides valuable information for the decision making on health coverage. In addition, the role that social participation has in the process to grant trust and legitimacy is described. Tacit knowledge makes explicit the importance of revealing it as a source of information that adds value to the decision-making process. Finally, communities of practice are described as spaces where new ways of experiencing the disease originate, as well as ways of relating to the health system and its actors. CONCLUSIONS The article raises the relevance that various social actors know these approaches, as well as strategies to integrate them into the assessment processes in terms of health coverage.
Collapse
|
9
|
Piña IL, Gibson GT, Zieroth S, Kataria R. Reflecting on the advancements of HFrEF therapies over the last two decades and predicting what is yet to come. Eur Heart J Suppl 2022; 24:L2-L9. [PMID: 36545229 PMCID: PMC9762889 DOI: 10.1093/eurheartjsupp/suac112] [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] [Indexed: 12/23/2022]
Abstract
What was once considered a topic best avoided, managing heart failure with reduced ejection fraction (HFrEF) has become the focus of many drug and device therapies. While the four pillars of guideline-directed medical therapies have successfully reduced heart failure hospitalizations, and some have even impacted cardiovascular mortality in randomized controlled trials (RCTs), patient-reported outcomes have emerged as important endpoints that merit greater emphasis in future studies. The prospect of an oral inotrope seems more probable now as targets for drug therapies have moved from neurohormonal modulation to intracellular mechanisms and direct cardiac myosin stimulation. While we have come a long way in safely providing durable mechanical circulatory support to patients with advanced HFrEF, several percutaneous device therapies have emerged, and many are under investigation. Biomarkers have shown promise in not only improving our ability to diagnose incident heart failure but also our potential to implicate specific pathophysiological pathways. The once-forgotten concept of discordance between pressure and volume, the forgotten splanchnic venous and lymphatic compartments, have all emerged as promising targets for diagnosing and treating heart failure in the not-so-distant future. The increase in heart failure-related cardiogenic shock (CS) has revived interest in defining optimal perfusion targets and designing RCTs in CS. Rapid developments in remote monitoring, telemedicine, and artificial intelligence promise to change the face of heart failure care. In this state-of-the-art review, we reminisce about the past, highlight the present, and predict what might be the future of HFrEF therapies.
Collapse
Affiliation(s)
- Ileana L Piña
- Division of Cardiology, Thomas Jefferson University, 4201 Henry Ave, Philadelphia, PA 19144, USA
| | - Gregory T Gibson
- Division of Cardiology, Thomas Jefferson University, 4201 Henry Ave, Philadelphia, PA 19144, USA
| | - Shelley Zieroth
- Section of Cardiology, Max Rady College of Medicine, University of Manitoba, 750 Bannatyne Ave, Winnipeg, MB R3E 0W2, Canada
| | - Rachna Kataria
- Division of Cardiology, Warren Alpert Medical School of Brown University, Lifespan Cardiovascular Institute, Rhode Island Hospital, 2 Dudley Street, Providence, RI 02905, USA
| |
Collapse
|
10
|
Cerqueiro-González J, González-Franco Á, Carrascosa-García S, Soler-Rangel L, Ruiz-Laiglesia F, Epelde-Gonzalo F, Dávila-Ramos M, Casado-Cerrada J, Casariego-Vales E, Manzano L. Beneficios de un modelo asistencial integral en pacientes con insuficiencia cardíaca y fracción de eyección preservada: Programa UMIPIC. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
11
|
Girerd N, Mewton N, Tartière JM, Guijarro D, Jourdain P, Damy T, Lamblin N, Bayes-Génis A, Pellicori P, Januzzi J, Rossignol P, Roubille F. Practical outpatient management of worsening chronic heart failure. Eur J Heart Fail 2022; 24:750-761. [PMID: 35417093 PMCID: PMC9325366 DOI: 10.1002/ejhf.2503] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/04/2022] [Accepted: 04/10/2022] [Indexed: 11/12/2022] Open
Abstract
Management of worsening heart failure (WHF) has traditionally been hospital‐based, but with the rising burden of heart failure (HF), the pressure on healthcare systems exerted by this disease necessitates a different strategy than long (and costly) hospital stays. A strategy for outpatient intravenous (IV) diuretic treatment of WHF has been developed in certain American centres in the past 10 years, whereas European centres have been mostly favouring ‘classic’ in‐hospital management of WHF. Embracing novel, outpatient approaches for treating WHF could substantially reduce the burden on healthcare systems while improving patient's satisfaction and quality of life. The present article is intended to provide essential knowledge and practical guidelines aimed at helping clinicians implement these new ambulatory approaches using day hospital and/or at‐home hospitalization. The topics addressed by our group of HF experts include the pathophysiological background of diuretic therapy, the most suitable profile of WHF that may be managed in an ambulatory setting, the pharmacological protocols that can be used, as well as a detailed description of healthcare structures that can be proposed to deliver these ambulatory care interventions. The practical aspects of day hospital and hospital‐at‐home IV diuretic administration are specifically emphasized. The algorithm provided along with the practical IV diuretic protocols should assist HF clinicians in implementing this new approach in their local clinical setting.
Collapse
Affiliation(s)
- Nicolas Girerd
- Université de Lorraine, Centre d'Investigation Clinique- Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Nathan Mewton
- Hôpital Cardiovasculaire Louis Pradel Hospices Civils de Lyon Heart Failure Department Clinical Investigation Center Inserm 1407 CarMeN Inserm 1060, University Claude Bernard Lyon 1 28 Avenue Doyen Lépine 69500, Bron
| | | | - Damien Guijarro
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, F-44000, France
| | - Patrick Jourdain
- Covidom regional telemedicine platform, Assistance Publique-Hôpitaux de Paris, Paris, France; Cardiology Department, University Hospital of Bicêtre, Assistance Publique-Hôpitaux de Paris, Kremlin Bicêtre, France
| | - Thibaud Damy
- Réseau cardiogen, Department of Cardiology, centre français de référence de l'amylose cardiaque (CRAC), CHU d'Henri-Mondor, AP-HP, 94000, Créteil, France
| | - Nicolas Lamblin
- Department of Cardiology, Université de Lille, 59000, Lille, France
| | - Antoni Bayes-Génis
- CIBERCV; Servicio de Cardiología. Hospital Germans Trias i Pujol. Universitat Autònoma de Barcelona. Barcelona., Spain
| | - Pierpaolo Pellicori
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - James Januzzi
- Cardiology Division, Massachusetts General Hospital, Baim Institute for Clinical Research, Harvard Medical School, Boston, MA, USA
| | - Patrick Rossignol
- Université de Lorraine, Centre d'Investigation Clinique- Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy Brabois, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Cardiology Department, CHU de Montpellier, France
| |
Collapse
|
12
|
Ilieșiu AM, Hodorogea AS, Balahura AM, Bădilă E. Non-Invasive Assessment of Congestion by Cardiovascular and Pulmonary Ultrasound and Biomarkers in Heart Failure. Diagnostics (Basel) 2022; 12:962. [PMID: 35454010 PMCID: PMC9024731 DOI: 10.3390/diagnostics12040962] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Worsening chronic heart failure (HF) is responsible for recurrent hospitalization and increased mortality risk after discharge, irrespective to the ejection fraction. Symptoms and signs of pulmonary and systemic congestion are the most common cause for hospitalization of acute decompensated HF, as a consequence of increased cardiac filling pressures. The elevated cardiac filling pressures, also called hemodynamic congestion, may precede the occurrence of clinical congestion by days or weeks. Since HF patients often have comorbidities, dyspnoea, the main symptom of HF, may be also caused by respiratory or other illnesses. Recent studies underline the importance of the diagnosis and treatment of hemodynamic congestion before HF symptoms worsen, reducing hospitalization and improving prognosis. In this paper we review the role of integrated evaluation of biomarkers and imaging technics, i.e., echocardiography and pulmonary ultrasound, for the diagnosis, prognosis and treatment of congestion in HF patients.
Collapse
Affiliation(s)
- Adriana Mihaela Ilieșiu
- Cardiology and Internal Medicine Department, Theodor Burghele Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Andreea Simona Hodorogea
- Cardiology and Internal Medicine Department, Theodor Burghele Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Ana-Maria Balahura
- Internal Medicine Department, Bucharest Clinical Emergency Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.B.); (E.B.)
| | - Elisabeta Bădilă
- Internal Medicine Department, Bucharest Clinical Emergency Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.B.); (E.B.)
| |
Collapse
|
13
|
González-Franco Á, Cerqueiro González J, Arévalo-Lorido J, Álvarez-Rocha P, Carrascosa-García S, Armengou A, Guzmán-García M, Trullàs J, Montero-Pérez-Barquero M, Manzano L. Beneficios de un modelo asistencial integral en pacientes ancianos con insuficiencia cardíaca y elevada comorbilidad: programa UMIPIC. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
14
|
Cerqueiro-González J, González-Franco Á, Carrascosa-García S, Soler-Rangel L, Ruiz-Laiglesia F, Epelde-Gonzalo F, Dávila-Ramos M, Casado-Cerrada J, Casariego-Vales E, Manzano L. Benefits of a comprehensive care model in patients with heart failure and preserved ejection fraction: The UMIPIC program. Rev Clin Esp 2022; 222:339-347. [DOI: 10.1016/j.rceng.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/14/2021] [Indexed: 01/10/2023]
|
15
|
Bonilla-Palomas JL, Anguita-Sánchez MP, Elola-Somoza FJ, Bernal-Sobrino JL, Fernández-Pérez C, Ruiz-Ortíz M, Jiménez-Navarro M, Bueno-Zamora H, Cequier-Fillat Á, Marín-Ortuño F. Thirteen-year trends in hospitalization and outcomes of patients with heart failure in Spain. Eur J Clin Invest 2021; 51:e13606. [PMID: 34076253 DOI: 10.1111/eci.13606] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/06/2021] [Accepted: 05/14/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Heart failure is one of the most pressing current public health concerns. However, in Spain there is a lack of population data. We aimed to examine thirteen-year nationwide trends in heart failure hospitalization, in-hospital mortality and 30-day readmission rates in Spain. METHODS We conducted a retrospective observational study of patients discharged with the principal diagnosis of heart failure from The National Health System' acute hospitals during 2003-2015. The source of the data was the Minimum Basic Data Set. Temporal trends were modelled using Poisson regression analysis. The risk-standardized in-hospital mortality ratio was calculated using a multilevel risk adjustment logistic regression model. RESULTS A total of 1 254 830 episodes of heart failure were selected. Throughout 2003-2015, the number of hospital discharges with principal diagnosis of heart failure increased by 61%. Discharge rates weighted by age and sex increased during the period [incidence rate ratio (IRR): 1.03; 95% confidence interval (95% CI): 1.03-1.03; P < .001)], although this increase was motivated by the increase in older age groups (≥75 years old). The crude mortality rate diminished (IRR: 0.99; 95% CI: 0.98-1, P < .001), but 30-day readmission rate increased (IRR: 1.05; 95% CI: 1.04-1.06; P < .001). The risk-standardized in-hospital mortality ratio did not change throughout the study period (IRR: 0.997; 95% CI: 0.992-1; P = .32). CONCLUSIONS From 2003 to 2015, heart failure admission rates increased significantly in Spain as a consequence of the sustained increase of hospitalization in the population ≥75 years. 30-day readmission rates increased, but the risk-standardized in-hospital mortality ratio did not significantly change for the same period.
Collapse
Affiliation(s)
| | | | | | - José L Bernal-Sobrino
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain.,Servicio de Control de Gestión, University Hospital 12 de Octubre, Madrid, Spain
| | | | | | | | | | | | | |
Collapse
|
16
|
González-Franco Á, Cerqueiro González JM, Arévalo-Lorido JC, Álvarez-Rocha P, Carrascosa-García S, Armengou A, Guzmán-García M, Trullàs JC, Montero-Pérez-Barquero M, Manzano L. Morbidity and mortality in elderly patients with heart failure managed with a comprehensive care model vs. usual care: The UMIPIC program. Rev Clin Esp 2021; 222:123-130. [PMID: 34615617 DOI: 10.1016/j.rceng.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Elderly patients with heart failure (HF) have a high degree of comorbidity which leads to fragmented care, with frequent hospitalizations and high mortality. This study evaluated the benefit of a comprehensive continuous care model (UMIPIC program) in elderly HF patients. METHODS AND RESULTS We prospectively analyzed data from the RICA registry on 2862 patients with HF treated in internal medicine departments. They were divided into two groups: one monitored in the UMIPIC program (UMIPIC group, n: 809) and another which received conventional care (RICA group, n: 2.053). We evaluated HF readmissions during 12 months of follow-up and total mortality after episodes of HF hospitalization. UMIPIC patients were older with higher rates of comorbidity and preserved ejection fraction than the RICA group. However, the UMIPIC group had a lower rate of HF readmissions (17% vs. 26%, p < .001) and mortality (16% vs. 27%, respectively; p < .001). In addition, we selected 370 propensity score-matched patients from each group and the differences in HF readmissions (15% UMIPIC vs. 30% RICA; hazard ratio [HR] = 0.44; 95% confidence interval [CI] 0.32-0.60; p < .001) and mortality (17% UMIPIC vs. 28% RICA; hazard ratio = 0.58; 95% CI 0.42-0.79; p = .001) were maintained. CONCLUSIONS The implementation of the UMIPIC program, based on comprehensive continuous care of elderly patients with HF and high comorbidity, markedly reduce HF readmissions and total mortality.
Collapse
Affiliation(s)
- Á González-Franco
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | | | - J C Arévalo-Lorido
- Servicio de Medicina Interna, Hospital Comarcal de Zafra, Zafra, Badajoz, Spain
| | - P Álvarez-Rocha
- Servicio de Medicina Interna y Cardiología, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
| | - S Carrascosa-García
- Servicio de Medicina Interna, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - A Armengou
- Servicio de Medicina Interna, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - M Guzmán-García
- Servicio de Medicina Interna, Hospital San Juan de la Cruz, Jaén, Spain
| | - J C Trullàs
- Servicio de Medicina Interna, Hospital d'Olot i comarcal de la Garrotxa, Girona, Spain; Laboratori de Reparació i Regeneració Tissular (TR2Lab), Facultat de Medicina, Universitat de Vic - Universitat Central de Catalunya, Vic, Barcelona, Spain
| | - M Montero-Pérez-Barquero
- Servicio de Medicina Interna, IMIBIC/Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, Spain
| | | |
Collapse
|
17
|
Hinch BK, Staffileno BA. Implementing a Heart Failure Transition Program to Reduce 30-Day Readmissions. J Healthc Qual 2021; 43:110-118. [PMID: 32516164 DOI: 10.1097/jhq.0000000000000268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Thirty-day readmissions for heart failure (HF) patients are often considered avoidable and linked to inadequate treatment and poor coordination of services and discharge plans. PROBLEM Lack of coordinated transitional care services and high 30-day readmissions prompted the interdisciplinary team to develop an HF Transition Program (HFTP). METHODS This quality improvement initiative used monthly trend data before and after HFTP implementation. INTERVENTIONS The American Heart Association Guidelines for HF Transitions served as a framework for developing the HFTP. RESULTS Over an 11-month period, 466 patients were enrolled into the HFTP, resulting in 18.2% (n = 82/450) 30-day cumulative readmission rate that is lower than the 21.9% national average. Sixteen patients did not code for HF after discharge. Heart Failure Transition Program calls to patients and families within the first week home were consistently high at 92.3% (430/466). CONCLUSIONS These data show that care coordination and transitional care are important strategies to decrease 30-day HF readmissions.
Collapse
|
18
|
Gheno J, Weis AH. CARE TRANSTION IN HOSPITAL DISCHARGE FOR ADULT PATIENTS: INTEGRATIVE LITERATURE REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2021-0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to summarize and analyze the scientific production on care transition in the hospital discharge of adult patients. Method: integrative review, conducted from May to July 2020, in four relevant databases in the health area: Public Medline (PubMed); Scientific Electronic Library Online (SciELO); Scopus and Virtual Health Library (VHL). The analysis of the results occurred descriptively and was organized into thematic categories that emerged according to the similarity of the contents extracted from the articles. Results: 46 articles from national and international journals, with a predominance of descriptive/non-experimental studies or qualitative studies, met the inclusion criteria. Five categories were identified: discharge and post-discharge process; Continuity of post-discharge care; Benefits of care transition; Role of nurses in care transition and Experiences of patients on care transition. Hospital discharge and care transitions are interconnected processes as transitions qualify the dehospitalization process. Different strategies for continuity of care should be adopted, as they offer greater safety to the patient. Studies have shown that nurses play a fundamental role in transitions and, in Brazil, this activity still needs to gain more space. Reduced hospitalizations, mortality, hospital costs and patient satisfaction are benefits of transitions. Conclusion: care transition is an effective strategy for the care provided to the patient being discharged. It points out the need for integration between the care network and assists services in decision-making about the continuity of care on discharge.
Collapse
Affiliation(s)
- Jociele Gheno
- Grupo Hospitalar Conceição, Brasil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil
| | | |
Collapse
|
19
|
Greene SJ, Adusumalli S, Albert NM, Hauptman PJ, Rich MW, Heidenreich PA, Butler J. Building a Heart Failure Clinic: A Practical Guide from the Heart Failure Society of America. J Card Fail 2020; 27:2-19. [PMID: 33289664 DOI: 10.1016/j.cardfail.2020.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/13/2020] [Indexed: 01/09/2023]
Abstract
Heart failure (HF) remains a leading cause of mortality and morbidity and a primary driver of health care resource use in the United States. As such, there continues to be much interest in the development and refinement of HF clinics that manage patients with HF in a guideline-directed, technology-enabled, and coordinated approach. Optimization of resource use and maintenance of collaboration with other providers are also important themes when considering implementation of HF clinics. Through this document, the Heart Failure Society of America aims to provide a contemporary, practical guide to creating and sustaining a HF clinic. The guide discusses (1) patient care considerations for delivering guideline-directed and patient-centered care, and (2) operational considerations including development of a HF clinic business plan, setting goals, leadership support, triggers for patient referral and patient follow-up, patient population served, optimal clinic staffing models, relationships with subspecialists, and continuous quality improvement. This document was developed to empower providers and clinicians who wish to build and sustain community-based, successful HF clinics.
Collapse
Affiliation(s)
- Stephen J Greene
- Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Srinath Adusumalli
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nancy M Albert
- Nursing Institute and Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio USA
| | - Paul J Hauptman
- University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Michael W Rich
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Javed Butler
- University of Mississippi Medical Center, Jackson, Mississippi, USA.
| | | |
Collapse
|
20
|
Follow-up results in a specialised consultation after discharge for heart failure. Rev Clin Esp 2020; 220:323-330. [PMID: 31757406 DOI: 10.1016/j.rce.2019.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/29/2019] [Accepted: 08/06/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite advances in the diagnosis and treatment of heart failure (HF), the condition still has high morbidity and mortality. Health education and the treatment of comorbidities have been shown to be effective, as has multidisciplinary care in specialised units, although this involves organisational and structural efforts that are not always feasible. We present the results of a simple outpatient consultation, focused on the specialised care of HF. PATIENTS AND METHODS The consultation included patients discharged after hospitalisation (index hospitalisation) for decompensated HF from an internal medicine department. The follow-up was conducted by internists especially dedicated (not exclusively) to HF and a nurse partially dedicated to HF. The follow-up consisted of fixed visits 1, 3, 6 and 12 months after the discharge, with more visits on demand if needed. RESULTS A total of 250 patients were included with a minimum follow-up of 1 year. The reduction in hospitalisations and emergency department visits was 56% and 61% (P<.05), respectively, for HF and 46% and 40% (P<.05), respectively, for any cause. Treatment optimisation was also achieved, with a significant increase in the evidence-based drug prescription rate and the reduction of other drugs, such as calcium antagonists. CONCLUSION A simple model based on a specialised care consultation for HF is effective in reducing readmissions and optimising the treatment. The lack of healthcare resources should not be an obstacle for specialised care for patients with HF.
Collapse
|
21
|
Amores Arriaga B, Josa Laorden C, Garcés Horna V, Sánchez Marteles M, Sampériz Legarre P, Ruiz Laiglesia F, Rubio Gracia J, Torres Cabrero R, Nadal Ibor M, Pérez Calvo J. Follow-up results in a specialized consultation after discharge for heart failure. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
22
|
Barge-Caballero E, Barge-Caballero G, Couto-Mallón D, Paniagua-Martín MJ, Marzoa-Rivas R, Naya-Leira C, Riveiro-Rodríguez CM, Grille-Cancela Z, Blanco-Canosa P, Muñiz J, Vázquez-Rodríguez JM, Crespo-Leiro MG. Comparación de mortalidad pronosticada y mortalidad observada en pacientes con insuficiencia cardiaca tratados en una unidad clínica especializada. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
23
|
Barge-Caballero E, Barge-Caballero G, Couto-Mallón D, Paniagua-Martín MJ, Marzoa-Rivas R, Naya-Leira C, Riveiro-Rodríguez CM, Grille-Cancela Z, Blanco-Canosa P, Muñiz J, Vázquez-Rodríguez JM, Crespo-Leiro MG. Comparison of predicted and observed mortality in patients with heart failure treated at a specialized unit. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:652-659. [PMID: 31980398 DOI: 10.1016/j.rec.2019.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/16/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION AND OBJECTIVES To analyze survival in heart failure (HF) patients treated at a specialized unit. METHODS Prospective cohort-based study of HF patients treated at a specialized unit from 2011 to 2017. Observed 1- and 3-year mortality rates were compared with those predicted by the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score. RESULTS We studied 1280 patients, whose median MAGGIC risk score was 19 [interquartile range, 13-24]. Prescription rates of beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, mineralocorticoid receptor antagonists, and sacubitril-valsartan were 93%, 67%, 22%, 73%, and 16%, respectively. The MAGGIC risk score showed good discrimination for mortality at 1 year (c-statistic=0.71) and 3 years (c-statistic=0.76). Observed mortality was significantly lower than predicted mortality, both at 1 year (6.2% vs 10.9%; observed/predicted ratio=0.57; P<.001) and at 3 years (16.7% vs 27.7%; observed/predicted ratio=0.60; P<.001). This discrepancy was found in several subgroups, except in patients aged> 70 years (29.9% vs 34.7%; observed/predicted ratio=0.86; P=.126) and in patients with ejection fraction> 40% (19.6% vs 20.7%; observed/predicted ratio=0.95; P=.640). CONCLUSIONS Mortality in HF patients treated at a specialized clinic was significantly lower than that predicted by the MAGGIC risk score.
Collapse
Affiliation(s)
- Eduardo Barge-Caballero
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - Gonzalo Barge-Caballero
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - David Couto-Mallón
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - María J Paniagua-Martín
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Raquel Marzoa-Rivas
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Carmen Naya-Leira
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Cristina M Riveiro-Rodríguez
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Zulaika Grille-Cancela
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Paula Blanco-Canosa
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Javier Muñiz
- Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña (UDC), A Coruña, Spain
| | - José Manuel Vázquez-Rodríguez
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - María G Crespo-Leiro
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña (UDC), A Coruña, Spain
| |
Collapse
|
24
|
Nall RW, Herndon BB, Mramba LK, Vogel-Anderson K, Hagen MG. An Interprofessional Primary Care-Based Transition of Care Clinic to Reduce Hospital Readmission. Am J Med 2020; 133:e260-e268. [PMID: 31877267 DOI: 10.1016/j.amjmed.2019.10.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/22/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hospital readmission is a major burden for patients, caregivers, and health systems. Some readmissions may be avoided through timely follow-up in a transition clinic with an interprofessional approach to care. METHODS We prospectively evaluated a cohort of adults >18 years, n = 203, who are patients of an affiliated academic internal medicine clinic with University of Florida Health and discharged from the hospital between November 1, 2016, and May 1, 2017. We sought to determine if follow-up in an interprofessional transition-of-care (TCM) clinic after discharge was associated with a reduction in hospital readmission when compared to standard follow-up at 30, 60, and 90 days. RESULTS Follow-up in the TCM clinic was associated with reduced odds of hospital readmission at 90 days by 60%, (odds ratio [OR]: 0.40, P = 0.044, 95% confidence interval [CI] 0.16-0.97). Although the clinic failed to demonstrate a statistically significant association between clinic follow-up and in readmission at 30 (OR: 0.66, P = 0.36, 95% CI 0.27-1.59) and 60 days (OR: 0.67, P = 0.31, 95% CI 0.31-1.47), fewer readmissions were seen in patients seen by the TCM clinic. CONCLUSIONS A primary care nested interprofessional transition-of-care clinic was associated with a reduction in hospital readmission.
Collapse
Affiliation(s)
- Ryan W Nall
- University of Florida, College of Medicine, Gainesville.
| | | | - Lazarus K Mramba
- University of Kansas, Department of Biostatistics and Data Science, Kansas City, KS
| | | | | |
Collapse
|
25
|
Mai Ba H, Son YJ, Lee K, Kim BH. Transitional Care Interventions for Patients with Heart Failure: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082925. [PMID: 32340346 PMCID: PMC7215305 DOI: 10.3390/ijerph17082925] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 12/15/2022]
Abstract
Heart failure (HF) is a life-limiting illness and presents as a gradual functional decline with intermittent episodes of acute deterioration and some recovery. In addition, HF often occurs in conjunction with other chronic diseases, resulting in complex comorbidities. Hospital readmissions for HF, including emergency department (ED) visits, are considered preventable. Majority of the patients with HF are often discharged early in the recovery period with inadequate self-care instructions. To address these issues, transitional care interventions have been implemented with the common objective of reducing the rate of hospital readmission, including ED visits. However, there is a lack of evidence regarding the benefits and adverse effects of transitional care interventions on clinical outcomes and patient-related outcomes of patients with HF. This integrative review aims to identify the components of transitional care interventions and the effectiveness of these interventions in improving health outcomes of patients with HF. Five databases were searched from January 2000 to December 2019, and 25 articles were included.
Collapse
Affiliation(s)
- Hai Mai Ba
- Department of Nursing, Gachon University Graduate School, Incheon 21936, Korea;
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea;
| | - Kyounghoon Lee
- College of Medicine, Division of Cardiology, Gachon University, Incheon 21565, Korea;
- Cardiovascular Research Institute, Gachon University, Incheon 21565, Korea
| | - Bo-Hwan Kim
- Cardiovascular Research Institute, Gachon University, Incheon 21565, Korea
- College of Nursing, Gachon University, Incheon 21936, Korea
- Correspondence: ; Tel.: +82-32-820-4213
| |
Collapse
|
26
|
Agostinho JR, Gonçalves I, Rigueira J, Aguiar-Ricardo I, Nunes-Ferreira A, Santos R, Guimarães T, Alves P, Cunha N, Rodrigues T, André ŃZ, Pedro M, Veiga F, Pinto FJ, Brito D. Protocol-based follow-up program for heart failure patients: Impact on prognosis and quality of life. Rev Port Cardiol 2020; 38:755-764. [PMID: 32005587 DOI: 10.1016/j.repc.2019.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 03/08/2019] [Accepted: 03/31/2019] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Heart failure is associated with high rates of readmission and mortality, and there is a need for measures to improve outcomes. This study aims to assess the impact of the implementation of a protocol-based follow-up program for heart failure patients on readmission and mortality rates and quality of life. METHODS A quasi-experimental study was performed, with a prospective registry of 50 consecutive patients discharged after hospitalization for acute heart failure. The study group was followed by a cardiologist at days 7-10 and the first, third, sixth and 12th month after discharge, with predefined procedures. The control group consisted of patients hospitalized for heart failure prior to implementation of the program and followed on a routine basis. RESULTS No significant differences were observed between the two groups regarding mean age (67.1±11.2 vs. 65.8±13.4 years, p=0.5), NYHA functional class (p=0.37), or median left ventricular ejection fraction (27% [19.8-35.3] vs. 29% [23.5-40]; p=0.23) at discharge. Mean follow-up after discharge was similar (11±5.3 vs. 10.9±5.5 months, p=0.81). The protocol-based follow-up program was associated with a significant reduction in all-cause readmission (26% vs. 60%, p=0.003), heart failure readmission (16% vs. 36%, p=0.032), and mortality (4% vs. 20%, p=0.044). In the study group there was a significant improvement in all quality of life measures (p<0.001). CONCLUSION A protocol-based follow-up program for patients with heart failure led to a significant reduction in readmission and mortality rates, and was associated with better quality of life.
Collapse
Affiliation(s)
- João R Agostinho
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal.
| | - Inês Gonçalves
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Joana Rigueira
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Inês Aguiar-Ricardo
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Afonso Nunes-Ferreira
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Rafael Santos
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Tatiana Guimarães
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Pedro Alves
- Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Nelson Cunha
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Tiago Rodrigues
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - ŃZinga André
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Mónica Pedro
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Fátima Veiga
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Fausto J Pinto
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Dulce Brito
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | | |
Collapse
|
27
|
Rivas-Lasarte M, Álvarez-García J, Mirabet S, Sionis A, Roig E, Cinca J. Is lung ultrasound monitoring really useful for impacting rehospitalization and mortality in worsening heart failure? Reply. Eur J Heart Fail 2020; 22:386-387. [PMID: 31919952 DOI: 10.1002/ejhf.1719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 11/09/2022] Open
|
28
|
Lupón J, Bayés-Genís A. Mortalidad y reingresos por insuficiencia cardiaca: la necesidad de un registro oficial completo, abierto y homologable. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
29
|
Lupón J, Bayés-Genís A. Mortality and Heart Failure Hospitalizations. The Need for an Exhaustive, Official, and Standardized Registry. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2019; 72:988-990. [PMID: 31378684 DOI: 10.1016/j.rec.2019.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/08/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Josep Lupón
- Unitat d'Insuficiència Cardíaca, Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
| | - Antoni Bayés-Genís
- Unitat d'Insuficiència Cardíaca, Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
30
|
Protocol-based follow-up program for heart failure patients: Impact on prognosis and quality of life. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
|
31
|
Abstract
Heart failure-related recurrent hospitalizations are widely recognized as a source of burden to both patients and the health system. Hospital discharges represent a transition of care and can often become a catalyst for readmission. One strategy in reducing this burden is the implementation of dedicated heart failure clinics. We conducted a retrospective review of all patients discharged from an inner city safety-net public hospital with a discharge diagnosis of heart failure. Patients followed in the Heart Clinic (HC) were compared to those with standard follow-up. All included cases were followed for 30 days after discharge to determine whether an all-cause readmission occurred. There were 258 patient discharges with an overall sicker population in the HC cohort. The HC group had a better event-free survival with a 67.1% reduction in readmission (log rank *p < .05). In concluding, a dedicated heart failure clinic reduced 30-day readmissions for patients who were discharged after having an acute exacerbation of heart failure.
Collapse
|
32
|
Continuity of care interventions for preventing hospital readmission of older people with chronic diseases: A meta-analysis. Int J Nurs Stud 2019; 101:103396. [PMID: 31698168 DOI: 10.1016/j.ijnurstu.2019.103396] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/01/2019] [Accepted: 08/06/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hospital readmission after discharge is a frequent, burdensome and costly event, particularly frequent in older people with multiple chronic conditions. Few literature reviews have analysed studies of continuity of care interventions to reduce readmissions of older inpatients discharged home over the short and long term. OBJECTIVE To evaluate the effectiveness of continuity of care interventions in older people with chronic diseases in reducing short and long term hospital readmission after hospital discharge. DESIGN Meta-analysis of randomized controlled trials. DATA SOURCES A comprehensive literature search on the databases PubMed, Medline, CINAHL and EMBASE was performed on 27 January 2019 with no language and time limits. REVIEW METHODS RCTs on continuity of care interventions on older people discharged from hospital having hospital readmission as outcome, were included. Two reviewers independently screened the studies and assessed methodological quality using the Cochrane Risk of Bias tool. Selected outcome data were combined and pooled using a Mantel-Haenszel random-effects model. RESULTS Thirty RCTs, representing 8920 patients were included. Results were stratified by time of readmissions. At 1 month from discharge, the continuity interventions were associated with lower readmission rates in 207/1595 patients in the experimental group (12.9%), versus 264/1645 patients in the control group (16%) (Relative Risk [RR], 0.84 [95% CI, 0.71-0.99]). From 1 to 3 months, readmission rates were lower in 325/1480 patients in the experimental group (21.9%), versus 455/1523 patients in the control group (29.8%) (RR 0.74 [95% CI, 0.65-0.84]). A subgroup analysis showed that this positive effect was stronger when the interventions addressed all of the continuity dimensions. After 3 months this impact became inconclusive with moderate/high statistical heterogeneity. CONCLUSIONS Continuity of care interventions prevent short term hospital readmission in older people with chronic diseases. However, there is inconclusive evidence about the effectiveness of continuity interventions aiming to reduce long term readmission, and it is suggested that stronger focus on it is needed.
Collapse
|
33
|
Peterson PN, Allen LA, Heidenreich PA, Albert NM, Piña IL. The American Heart Association Heart Failure Summit, Bethesda, April 12, 2017. Circ Heart Fail 2019; 11:e004957. [PMID: 30354400 DOI: 10.1161/circheartfailure.118.004957] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The American Heart Association convened a meeting to summarize the changing landscape of heart failure (HF), anticipate upcoming challenges and opportunities to achieve coordinated identification and treatment, and to recommend areas in need of focused efforts. The conference involved representatives from clinical care organizations, governmental agencies, researchers, patient advocacy groups, and public and private healthcare partners, demonstrating the breadth of stakeholders interested in improving care and outcomes for patients with HF. The main purposes of this meeting were to foster dialog and brainstorm actions to close gaps in identifying people with or at risk for HF and reduce HF-related morbidity, mortality, and hospitalizations. This report highlights the key topics covered during the meeting, including (1) identification of patients with or at risk for HF, (2) tracking patients once diagnosed, (3) application of population health approaches to HF, (4) improved strategies for reducing HF hospitalization (not just rehospitalization), and (5) promoting HF self-management.
Collapse
Affiliation(s)
- Pamela N Peterson
- Department of Medicine, Denver Health Medical Center, CO (P.N.P.).,Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (P.N.P., L.A.A.)
| | - Larry A Allen
- Department of Medicine, Denver Health Medical Center, CO (P.N.P.)
| | - Paul A Heidenreich
- Department of Medicine, Stanford University, Palo Alto, CA (P.A.H.).,Veteran Affairs Palo Alto Healthcare System, CA (P.A.H.)
| | - Nancy M Albert
- Nursing Institute and Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, OH (N.M.A.)
| | - Ileana L Piña
- Department of Cardiology, Albert Einstein College of Medicine, Montefiore Einstein Heart and Vascular Institute, Bronx, New York (I.L.P.)
| | | |
Collapse
|
34
|
Murninkas D, Itzhaki Ben Zadok O, Iakobishvili Z, Jino H, Yohananov E, Birkenfeld S, Hasdai D. Comparison of 18-Month Outcomes of Ambulatory Patients With Reduced (≤40%) Left Ventricular Ejection Fraction Treated in a Community-Based, Dedicated Heart Failure Clinic Versus Treated Elsewhere. Am J Cardiol 2019; 123:1101-1108. [PMID: 30658921 DOI: 10.1016/j.amjcard.2018.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/14/2018] [Accepted: 12/19/2018] [Indexed: 11/30/2022]
Abstract
We sought to examine the management and outcomes of ambulatory patients with heart failure and reduced ejection fraction in a community-based, dedicated clinic. Patients with left ventricular ejection fraction (LVEF) ≤40% were actively solicited to attend a community-based, dedicated clinic. Eligible patients who chose to decline constituted our control group. Of 552 patients with LVEF ≤40% (median age 73 years and median LVEF 35%), 304 (55%) agreed to attend the clinic. Patients with worse New York Heart Association class were more likely to attend the clinic (odds ratio 2.07 [1.45, 2.95], p <0.001), whereas women were more likely to decline (odds ratio 0.63 [0.42, 0.93], p <0.022). During 18 months of follow-up, patients in the dedicated clinic significantly improved their functional capacity (56% New York Heart Association 3 to 4 at baseline vs 27% at follow-up, p <0.001) and LVEF (35% [interquartile range 25, 35] at baseline vs 35% (interquartile range 30, 40) at follow-up, p <0.001). In comparison with patients managed routinely, patients treated in a dedicated clinic achieved better guideline-recommended pharmacological treatment (65% vs 85% receiving β blockers, p <0.001, 65% vs 82% receiving renin-angiotensin inhibitors, p = 0.0006, 31% vs 45% receiving mineralocorticoid receptor antagonists, p <0.001). During follow-up, electrical device implantation was similar (6% vs 7% of dedicated-HF-clinic patients, p = 0.700). Furthermore, overall survival was better in patients treated in the clinic (log rank p = 0.0006), even after censoring the first 4 months to account for potential bias (log rank p = 0.0232). In conclusion, management in a community-based, dedicated clinic compared with routine management was associated with augmented guideline-recommended treatment and improved survival.
Collapse
Affiliation(s)
- Daniel Murninkas
- Clalit Health Services, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Itzhaki Ben Zadok
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.
| | - Zaza Iakobishvili
- Clalit Health Services, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Henri Jino
- Clalit Health Services, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ester Yohananov
- Clalit Health Services, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Birkenfeld
- Clalit Health Services, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Hasdai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| |
Collapse
|
35
|
Pacho C, Domingo M, Núñez R, Lupón J, Vela E, Bayes-Genis A. An Early Post-discharge Intervention Planned to Reduce 30-day Readmissions in old and Frail Heart Failure Patients Remains Beneficial at 1 Year. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2019; 72:261-263. [PMID: 29482982 DOI: 10.1016/j.rec.2018.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/19/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Cristina Pacho
- Servei de Medicina Interna-Unitat de Geriatria d'Aguts, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Domingo
- Servei de Cardiologia-Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Raquel Núñez
- Servei de Medicina Interna-Unitat de Geriatria d'Aguts, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Josep Lupón
- Servei de Cardiologia-Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Emili Vela
- Divisió d'Anàlisi de la demanda i d'Activitat, CatSalut, Barcelona, Spain
| | - Antoni Bayes-Genis
- Servei de Cardiologia-Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
| |
Collapse
|
36
|
Pacho C, Domingo M, Núñez R, Lupón J, Vela E, Bayes-Genis A. Una intervención precoz para reducir reingresos a los 30 días en pacientes ancianos frágiles con insuficiencia cardiaca mantiene su beneficio al año. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
37
|
Domingo C, Aros F, Otxandategi A, Beistegui I, Besga A, Latorre PM. [Efficacy of a multidisciplinary care management program for patients admitted at hospital because of heart failure (ProMIC)]. Aten Primaria 2019; 51:142-152. [PMID: 29496299 PMCID: PMC6836999 DOI: 10.1016/j.aprim.2017.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 09/22/2017] [Accepted: 09/26/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the efficacy of the ProMIC, multidisciplinary program for patients admitted at hospital because of heart failure (HF) programme, in reducing the HF-related readmission rate. DESING Quasi-experimental research with control group. SETTINGS Twelve primary health care centres and 3 hospitals from the Basque Country. PARTICIPANTS Aged 40 years old or above patients admitted for HF with a New York Heart Association functional class II to IV. INTERVENTIONS Patients in the intervention group carried out the ProMIC programme, a structured clinical intervention based on clinical guidelines and on the chronic care model. Control group received usual care. MAIN MEASUREMENTS The rate of readmission for HF and health-related quality of life RESULTS: One hundred fifty five patients were included in ProMIC group and 129 in control group. 45 rehospitalisation due to heart failure happened in ProMIC versus 75 in control group (adjusted hazard ratio=0.59, CI 95%: 0.36-0.98; P=.049). There were significant differences in specific quality of life al 6 months. No significant differences were found in rehospitalisation due to all causes, due to cardiovascular causes, visits to emergency room, mortality, the combined variable of these events, the functional capacity or quality of life at 12 months of follow up. CONCLUSIONS ProMIC reduces significantly heart failure rehospitalisation and improve quality of life al 6 months of follow up. No significant differences were found in the rests of variables.
Collapse
Affiliation(s)
- Cristina Domingo
- Medicina Familiar y Comunitaria, Gerencia de Atención Primaria del Servicio Cántabro de Salud, Santander, España.
| | - Fernando Aros
- Hospital Universitario de Araba, Osakidetza, Araba, España; Centro de Investigación Biomédica en Red Fisiopatologia de la Obesidad y de la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España
| | - Agurtzane Otxandategi
- Equipo de atención primaria, Centro de Salud Galdakao, Galdakao, Bizkaia, España; OSI Barrualde, Osakidetza, Galdakao, Bizkaia, España
| | - Idoia Beistegui
- Servicio de Cardiología, Hospital Universitario de Araba, Sede Santiago, Osakidetza, Araba, España
| | | | - Pedro María Latorre
- Medicina Familiar y Comunitaria, Unidad de investigación de Atención Primaria de Bizkaia, Osakidetza, Bilbao, Bizkaia, España; BioCruces Health Resarch Institute, Barakaldo, España
| |
Collapse
|
38
|
Bagudá JDJ, Jiménez JFD. Primary and Specialized Care: a necessary relationship for the implementation of a Heart Failure program. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2018; 30:265-267. [PMID: 30449402 DOI: 10.1016/j.arteri.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Javier de Juan Bagudá
- Programa Transversal de Insuficiencia Cardiaca. Hospital Universitario 12 de Octubre, CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid.
| | - Juan F Delgado Jiménez
- Programa Transversal de Insuficiencia Cardiaca. Hospital Universitario 12 de Octubre, CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid
| |
Collapse
|
39
|
Hollinger A, Cerlinskaite K, Bastian K, Mebazaa A. Biomarkers of increased intraventricular pressure: are we ready? Eur Heart J Suppl 2018. [DOI: 10.1093/eurheartj/suy025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Alexa Hollinger
- Department of Anaesthesiology, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 rue A. Paré, Paris, France
- Inserm 942 Paris, Biomarqueurs et maladies cardiaques, Hôpital Lariboisière - Bâtiment Viggo Petersen, 41, boulevard de la Chapelle, Paris Cedex 10, France
- Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Kamile Cerlinskaite
- Department of Anaesthesiology, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 rue A. Paré, Paris, France
- Inserm 942 Paris, Biomarqueurs et maladies cardiaques, Hôpital Lariboisière - Bâtiment Viggo Petersen, 41, boulevard de la Chapelle, Paris Cedex 10, France
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Santariškių g. 2, Vilnius, Lithuania
| | - Kathleen Bastian
- Department of Anaesthesiology, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 rue A. Paré, Paris, France
- Inserm 942 Paris, Biomarqueurs et maladies cardiaques, Hôpital Lariboisière - Bâtiment Viggo Petersen, 41, boulevard de la Chapelle, Paris Cedex 10, France
- Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Alexandre Mebazaa
- Department of Anaesthesiology, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, 2 rue A. Paré, Paris, France
- Inserm 942 Paris, Biomarqueurs et maladies cardiaques, Hôpital Lariboisière - Bâtiment Viggo Petersen, 41, boulevard de la Chapelle, Paris Cedex 10, France
- University Paris Diderot, 5 rue Thomas Mann, Paris, France
| |
Collapse
|
40
|
Pacho C, Domingo M, Núñez R, Lupón J, Núñez J, Barallat J, Moliner P, de Antonio M, Santesmases J, Cediel G, Roura S, Pastor MC, Tor J, Bayes-Genis A. Predictive biomarkers for death and rehospitalization in comorbid frail elderly heart failure patients. BMC Geriatr 2018; 18:109. [PMID: 29743019 PMCID: PMC5944009 DOI: 10.1186/s12877-018-0807-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/03/2018] [Indexed: 12/12/2022] Open
Abstract
Background Heart failure (HF) is associated with a high rate of readmissions within 30 days post-discharge and in the following year, especially in frail elderly patients. Biomarker data are scarce in this high-risk population. This study assessed the value of early post-discharge circulating levels of ST2, NT-proBNP, CA125, and hs-TnI for predicting 30-day and 1-year outcomes in comorbid frail elderly patients with HF with mainly preserved ejection fraction (HFpEF). Methods Blood samples were obtained at the first visit shortly after discharge (4.9 ± 2 days). The primary endpoint was the composite of all-cause mortality or HF-related rehospitalization at 30 days and at 1 year. All-cause mortality alone at one year was also a major endpoint. HF-related rehospitalizations alone were secondary end-points. Results From February 2014 to November 2016, 522 consecutive patients attending the STOP-HF Clinic were included (57.1% women, age 82 ± 8.7 years, mean Barthel index 70 ± 25, mean Charlson comorbidity index 5.6 ± 2.2). The composite endpoint occurred in 8.6% patients at 30 days and in 38.5% at 1 year. In multivariable analysis, ST2 [hazard ratio (HR) 1.53; 95% CI 1.19–1.97; p = 0.001] was the only predictive biomarker at 30 days; at 1 year, both ST2 (HR 1.34; 95% CI 1.15–1.56; p < 0.001) and NT-proBNP (HR 1.19; 95% CI 1.02–1.40; p = 0.03) remained significant. The addition of ST2 and NT-proBNP into a clinical predictive model increased the AUC from 0.70 to 0.75 at 30 days (p = 0.02) and from 0.71 to 0.74 at 1 year (p < 0.05). For all-cause death at 1 year, ST2 (HR 1.50; 95% CI 1.26–1.80; p < 0.001), and CA125 (HR 1.41; 95% CI 1.21–1.63; p < 0.001) remained independent predictors in multivariable analysis. The addition of ST2 and CA125 into a clinical predictive model increased the AUC from 0.74 to 0.78 (p = 0.03). For HF-related hospitalizations, ST2 was the only predictive biomarker in multivariable analyses, both at 30 days and at 1 year. Conclusions In a comorbid frail elderly population with HFpEF, ST2 outperformed NT-proBNP for predicting the risk of all-cause mortality or HF-related rehospitalization. ST2, a surrogate marker of inflammation and fibrosis, may be a better predictive marker in high-risk HFpEF. Electronic supplementary material The online version of this article (10.1186/s12877-018-0807-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Cristina Pacho
- Servei de Medicina Interna i Unitat de Geriatria d'Aguts, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Department de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Domingo
- Servei de Cardiologia i Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Raquel Núñez
- Servei de Medicina Interna i Unitat de Geriatria d'Aguts, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Josep Lupón
- Servei de Cardiologia i Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Department de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Julio Núñez
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Department, Hospital Clínico Universitario, INCLIVA Valencia, Valencia, Spain.,Departamento de Medicina, Universidad de Valencia, Valencia, Spain
| | - Jaume Barallat
- Servei de Bioquímica i Anàlisis clíniques, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Pedro Moliner
- Servei de Cardiologia i Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Marta de Antonio
- Servei de Cardiologia i Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Javier Santesmases
- Servei de Medicina Interna i Unitat de Geriatria d'Aguts, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Department de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Germán Cediel
- Servei de Cardiologia i Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Santiago Roura
- ICREC Research Program, Germans Trias i Pujol Health Science Research Institute, Badalona, Spain
| | - M Cruz Pastor
- Servei de Bioquímica i Anàlisis clíniques, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jordi Tor
- Servei de Medicina Interna i Unitat de Geriatria d'Aguts, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.,Department de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antoni Bayes-Genis
- Servei de Cardiologia i Unitat d'Insuficiència Cardíaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. .,Department de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain. .,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain. .,ICREC Research Program, Germans Trias i Pujol Health Science Research Institute, Badalona, Spain.
| |
Collapse
|
41
|
Zapatero-Gaviria A, Barba-Martín R, Canora Lebrato J, Fernández-Pérez C, Gómez-Huelgas R, Bernal-Sobrino J, Díez-Manglano J, Marco-Martínez J, Elola-Somoza F. RECALMIN II. Eight years of hospitalization in Internal Medicine Units (2007–2014). What has changed? Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
42
|
Zapatero-Gaviria A, Barba-Martín R, Canora Lebrato J, Fernández-Pérez C, Gómez-Huelgas R, Bernal-Sobrino JL, Díez-Manglano J, Marco-Martínez J, Elola-Somoza FJ. RECALMIN II. Eight years of hospitalisation in Internal Medicine Units (2007-2014). What has changed? Rev Clin Esp 2017; 217:446-453. [PMID: 28851485 DOI: 10.1016/j.rce.2017.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 07/20/2017] [Accepted: 07/22/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To analyse the evolution of care provided by the internal medicine units (IMU) of the Spanish National Health System from 2007 to 2014. MATERIAL AND METHODS We analysed all discharges from the IMU of the Spanish National Health System in 2007 and 2014, using the Minimum Basic Data Set. We compared the risk factors by episode, mortality and readmissions between the two periods. We prepared specific fits for the risk for mortality and readmissions in heart failure, pneumonia and chronic obstructive pulmonary disease, as well as the Charlson index for all activity. RESULTS Discharges from the IMU between the two periods increased 14%. The average patient age increased by 2.8 years (71.2±17.1 vs. 74±16.2; p<.001), with a marked increase in comorbidity (Charlson index, 4±3.7 vs. 4.7±3.9; p<.001; 24% increase in risk factors per episode). The adjusted mortality rates decreased slight but significantly, with a slight increase in readmissions. CONCLUSIONS During the analysed period, there was an increase of almost 3 years in the mean age of patients treated in the IMU of the Spanish National Health System, with a marked increase in comorbidity. These results should lead to a more appropriate assignment of nurse workloads and an increased implementation of good practices in clinical management.
Collapse
Affiliation(s)
- A Zapatero-Gaviria
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Madrid, España.
| | - R Barba-Martín
- Servicio de Medicina Interna, Hospital Universitario Rey Juan Carlos Móstoles, Madrid, España
| | - J Canora Lebrato
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Madrid, España
| | - C Fernández-Pérez
- Servicio de Medicina Preventiva, Hospital Clínico Universitario San Carlos, Madrid, España
| | - R Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Universitario Regional de Málaga, Málaga, España
| | - J L Bernal-Sobrino
- Unidad de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, España
| | - J Díez-Manglano
- Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Marco-Martínez
- Servicio de Medicina Interna, Hospital Clínico Universitario San Carlos, Madrid, España
| | - F J Elola-Somoza
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, España
| |
Collapse
|
43
|
Anguita Sánchez M, Castillo Domínguez JC. Do All Patients With Heart Failure Benefit From a Program for Early Follow-up After Hospital Discharge? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2017; 70:624-625. [PMID: 28363706 DOI: 10.1016/j.rec.2017.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 01/19/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Manuel Anguita Sánchez
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain.
| | - Juan C Castillo Domínguez
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| |
Collapse
|
44
|
Anguita Sánchez M, Castillo Domínguez JC. Seguimiento mediante programas específicos de consulta precoz tras el alta de un episodio de insuficiencia cardiaca: ¿en todos los pacientes? Rev Esp Cardiol (Engl Ed) 2017. [DOI: 10.1016/j.recesp.2017.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|