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Cui YH, Wu CR, Xu D, Tang JG. Exploration of neuron heterogeneity in human heart failure with dilated cardiomyopathy through single-cell RNA sequencing analysis. BMC Cardiovasc Disord 2024; 24:86. [PMID: 38310240 PMCID: PMC10838417 DOI: 10.1186/s12872-024-03739-9] [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: 03/15/2023] [Accepted: 01/19/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVE We aimed to explore the heterogeneity of neurons in heart failure with dilated cardiomyopathy (DCM). METHODS Single-cell RNA sequencing (scRNA-seq) data of patients with DCM and chronic heart failure and healthy samples from GSE183852 dataset were downloaded from NCBI Gene Expression Omnibus, in which neuron data were extracted for investigation. Cell clustering analysis, differential expression analysis, trajectory analysis, and cell communication analysis were performed, and highly expressed genes in neurons from patients were used to construct a protein-protein interaction (PPI) network and validated by GSE120895 dataset. RESULTS Neurons were divided into six subclusters involved in various biological processes and each subcluster owned its specific cell communication pathways. Neurons were differentiated into two branches along the pseudotime, one of which was differentiated into mature neurons, whereas another tended to be involved in the immune and inflammation response. Genes exhibited branch-specific differential expression patterns. FLNA, ITGA6, ITGA1, and MDK interacted more with other gene-product proteins in the PPI network. The differential expression of FLNA between DCM and control was validated. CONCLUSION Neurons have significant heterogeneity in heart failure with DCM, and may be involved in the immune and inflammation response to heart failure.
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Affiliation(s)
- Yu-Hui Cui
- Department of Trauma-Emergency & Critical Care Medicine Center, Shanghai Fifth People's Hospital, Fudan University, No.801 Heqing Road, Minhang District, Shanghai, 200240, China
| | - Chun-Rong Wu
- Department of Trauma-Emergency & Critical Care Medicine Center, Shanghai Fifth People's Hospital, Fudan University, No.801 Heqing Road, Minhang District, Shanghai, 200240, China
| | - Dan Xu
- Department of Trauma-Emergency & Critical Care Medicine Center, Shanghai Fifth People's Hospital, Fudan University, No.801 Heqing Road, Minhang District, Shanghai, 200240, China
| | - Jian-Guo Tang
- Department of Trauma-Emergency & Critical Care Medicine Center, Shanghai Fifth People's Hospital, Fudan University, No.801 Heqing Road, Minhang District, Shanghai, 200240, China.
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Rubini A, Vilaplana-Prieto C, Vázquez-Jarén E, Hernández-González M, Félix-Redondo FJ, Fernández-Bergés D. Analysis and prediction of readmissions for heart failure in the first year after discharge with INCA score. Sci Rep 2023; 13:22477. [PMID: 38110472 PMCID: PMC10728208 DOI: 10.1038/s41598-023-49390-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023] Open
Abstract
To determine the readmissions trends and the comorbidities of patients with heart failure that most influence hospital readmission rates. Heart failure (HF) is one of the most prevalent health problems as it causes loss of quality of life and increased health-care costs. Its prevalence increases with age and is a major cause of re-hospitalisation within 30 days after discharge. INCA study had observational and ambispective design, including 4,959 patients from 2000 to 2019, with main diagnosis of HF in Extremadura (Spain). The variables examined were collected from discharge reports. To develop the readmission index, capable of discriminating the population with higher probability of re-hospitalisation, a Competing-risk model was generated. Readmission rate have increased over the period under investigation. The main predictors of readmission were: age, diabetes mellitus, presence of neoplasia, HF without previous hospitalisation, atrial fibrillation, anaemia, previous myocardial infarction, obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). These variables were assigned values with balanced weights, our INCA index showed that the population with values greater than 2 for men and women were more likely to be re-admitted. Previous HF without hospital admission, CKD, and COPD appear to have the greatest effect on readmission. Our index allowed us to identify patients with different risks of readmission.
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Affiliation(s)
- Alessia Rubini
- PhD Programme in Economics (DEcIDE), International Doctorate School of the National University of Distance Education (EIDUNED), 28015, Madrid, Spain.
- Research Unit of Don Benito-Villanueva de la Serena Health Area, 06700, Villanueva de la Serena, Spain.
| | | | - Elena Vázquez-Jarén
- Research Unit of Don Benito-Villanueva de la Serena Health Area, 06700, Villanueva de la Serena, Spain
- University Institute for Biosanitary Research of Extremadura (INUBE), 06080, Badajoz, Spain
| | - Miriam Hernández-González
- Research Unit of Don Benito-Villanueva de la Serena Health Area, 06700, Villanueva de la Serena, Spain
| | - Francisco Javier Félix-Redondo
- Research Unit of Don Benito-Villanueva de la Serena Health Area, 06700, Villanueva de la Serena, Spain
- University Institute for Biosanitary Research of Extremadura (INUBE), 06080, Badajoz, Spain
- Villanueva Norte Health Centre, Extremadura Health Service, 06700, Villanueva de la Serena, Spain
| | - Daniel Fernández-Bergés
- Research Unit of Don Benito-Villanueva de la Serena Health Area, 06700, Villanueva de la Serena, Spain
- University Institute for Biosanitary Research of Extremadura (INUBE), 06080, Badajoz, Spain
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3
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S. Jarab A, Al-Qerem WA, Hamam H, Abu Heshmeh S, Al-Azzam S, L. Mukattash T, Alefishat EA. Glycemic control and its associated factors among diabetic heart failure outpatients at two major hospitals in Jordan. PLoS One 2023; 18:e0285142. [PMID: 37796848 PMCID: PMC10553218 DOI: 10.1371/journal.pone.0285142] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/14/2023] [Indexed: 10/07/2023] Open
Abstract
Patients with heart failure (HF) are generally at higher risk of developing type 2 diabetes and having uncontrolled blood glucose. Furthermore, the prevalence of uncontrolled blood glucose in patients with HF is largely unknown. Identifying the factors associated with poor blood glucose control is a preliminary step in the development of effective intervention programs. The current cross-sectional study was conducted at two major hospitals to explore the factors associated with blood glucose control among patients with heart failure and type 2 diabetes. In addition to sociodemographic, medical records were used to collect medical information and a validated questionnaire was used to evaluate medication adherence. Regression analysis showed that poor medication adherence (OR = 0.432; 95%CI 0.204-0.912; P<0.05) and increased white blood cells count (OR = 1.12; 95%CI 1.033-1.213; P<0.01) were associated with poor glycemic control. For enhancing blood glucose control among patients with HF and diabetes, future intervention programs should specifically target patients who have high WBC counts and poor medication.
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Affiliation(s)
- Anan S. Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Walid A. Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Hanan Hamam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Shrouq Abu Heshmeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Sayer Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Tareq L. Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Eman A. Alefishat
- Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
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Kolovos S, Bellanca L, Groyer H, Rosano G, Gaultney J, Linden S. Cost-effectiveness of empagliflozin in heart failure patients irrespective of ejection fraction in England. J Cardiovasc Med (Hagerstown) 2023; 24:758-764. [PMID: 37577867 PMCID: PMC10481921 DOI: 10.2459/jcm.0000000000001532] [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: 10/28/2022] [Revised: 05/12/2023] [Accepted: 06/24/2023] [Indexed: 08/15/2023]
Abstract
AIMS Heart failure (HF) is a complex syndrome commonly categorized into two main phenotypes [left ventricular ejection fraction (LVEF) below or above 40%], and although empagliflozin is the first approved medication with proven clinical effectiveness for both phenotypes, its cost-effectiveness of treating the entire HF population remains unknown. METHODS The analysis was performed utilizing two preexisting, LVEF phenotype-specific cost-effectiveness models to estimate the cost-effectiveness of empagliflozin in adults for the treatment of symptomatic chronic HF, irrespective of ejection fraction (EF). The results of the phenotype-specific models were combined using a population-weighted approach to estimate the deterministic and probabilistic incremental cost-effectiveness ratios (ICERs). RESULTS Based on combined results, empagliflozin + standard of care (SoC) is associated with 6.13 life-years (LYs) and 3.92 quality-adjusted life-years (QALYs) compared with 5.98 LYs and 3.76 QALYs for SoC alone over a lifetime, resulting in an incremental difference of 0.15 LYs and 0.16 QALYs, respectively. Total lifetime healthcare costs per patient are £15 246 for empagliflozin + SoC and £13 982 for SoC giving an incremental difference of £1264. The ICER is £7757/QALY, which is substantially lower than the willingness-to-pay (WTP) of £30 000 per QALY used by NICE. The results of the probabilistic sensitivity analyses are in line with the deterministic results. CONCLUSION Empagliflozin is the first efficacious, approved, and cost-effective treatment option for all HF patients, irrespective of EF. The combined ICER was consistently below the WTP threshold. Therefore, empagliflozin offers value for money for the treatment of the full HF population in England.
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Affiliation(s)
| | | | | | | | | | - Stephan Linden
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
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5
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Jarab AS, Hamam HW, Al-Qerem WA, Heshmeh SRA, Mukattash TL, Alefishat EA. Health-related quality of life and its associated factors among outpatients with heart failure: a cross-sectional study. Health Qual Life Outcomes 2023; 21:73. [PMID: 37443053 DOI: 10.1186/s12955-023-02142-w] [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: 11/22/2022] [Accepted: 06/03/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Heart Failure (HF) is a chronic disease associated with life-limiting symptoms that could negatively impact patients' health-related quality of life (HRQOL). This study aimed to evaluate HRQOL and explore the factors associated with poor HRQOL among patients with HF in Jordan. METHODS This cross-sectional study used the validated Arabic version of the Minnesota Living with Heart Failure Questionnaire to assess HRQOL in outpatients with HF visiting cardiology clinics at two public hospitals in Jordan. Variables were collected from medical records and custom-designed questionnaires, including socio-demographics, biomedical variables, and disease and medication characteristics. Ordinal regression analysis was used to explore variables associated with poor HRQOL among HF patients. RESULTS Ordinal regression analysis showed that the number of HF medications (P < 0.05) and not taking a loop diuretic (P < 0.05) significantly increased HRQOL, while the number of other chronic diseases (P < 0.05), stage III/IV of HF (P < 0.01), low monthly income (P < 0.05), and being unsatisfied with the prescribed medications (P < 0.05) significantly decreased HRQOL of HF patients. CONCLUSIONS Although the current study demonstrated low HRQOL among patients with HF in Jordan, HRQOL has a considerable opportunity for improvement in those patients. Variables identified in the present study, including low monthly income, higher New York Heart Association (NYHA) classes, a higher number of comorbidities, and/or taking a loop diuretic, should be considered in future intervention programs, aiming to improve HRQOL in patients with HF.
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Affiliation(s)
- Anan S Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
- College of Pharmacy, Al Ain University, Abu Dhabi, UAE
| | - Hanan W Hamam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Walid A Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P.O. Box 130, Amman, 11733, Jordan
| | - Shrouq R Abu Heshmeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Tareq L Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Eman A Alefishat
- Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates.
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, 11942, Jordan.
- Center For Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates.
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Benito-Lozano M, López-Ayala P, Rodríguez S, Llorens P, Domínguez-Rodríguez A, Aguirre A, Alquézar A, Jacob J, Gil V, Martín-Sánchez FJ, Mir M, Andueza JA, Burillo-Putze G, Miró Ò. Analysis of the relationship between ambient air pollution and the severity of heart failure decompensations in two Spanish metropolises (Barcelona and Madrid). Med Clin (Barc) 2023:S0025-7753(23)00143-4. [PMID: 37055253 DOI: 10.1016/j.medcli.2023.02.016] [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: 12/19/2022] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVES To analyze whether the high levels of air pollutants are related to a greater severity of decompensated heart failure (HF). METHOD Patients diagnosed with decompensated HF in the emergency department of 4 hospitals in Barcelona and 3 in Madrid were included. Clinical data (age, sex, comorbidities, baseline functional status), atmospheric (temperature, atmospheric pressure) and pollutant data (SO2, NO2, CO, O3, PM10, PM2.5) were collected in the city on the day of emergency care. The severity of decompensation was estimated using 7-day mortality (primary indicator) and the need for hospitalization, in-hospital mortality, and prolonged hospitalization (secondary indicators). The association adjusted for clinical, atmospheric and city data between pollutant concentration and severity was investigated using linear regression (linearity assumption) and restricted cubic spline curves (no linearity assumption). RESULTS A total of 5292 decompensations were included, with a median age of 83 years (IQR=76-88) and 56% women. The medians (IQR) of the daily pollutant averages were: SO2=2.5μg/m3 (1.4-7.0), NO2=43μg/m3 (34-57), CO=0.48mg/m3 (0.35-0.63), O3=35μg/m3 (25-48), PM10=22μg/m3 (15-31) and PM2.5=12μg/m3 (8-17). Mortality at 7 days was 3.9%, and hospitalization, in-hospital mortality, and prolonged hospitalization were 78.9, 6.9, and 47.5%, respectively. SO2 was the only pollutant that showed a linear association with the severity of decompensation, since each unit of increase implied an OR for the need for hospitalization of 1.04 (95% CI 1.01-1.08). The restricted cubic spline curves study also did not show clear associations between pollutants and severity, except for SO2 and hospitalization, with OR of 1.55 (95% CI 1.01-2.36) and 2.71 (95% CI 1.13-6.49) for concentrations of 15 and 24μg/m3, respectively, in relation to a reference concentration of 5μg/m3. CONCLUSION Exposure to ambient air pollutants, in a medium to low concentration range, is generally not related to the severity of HF decompensations, and only NO2 may be associated with an increased need for hospitalization.
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Affiliation(s)
| | - Pedro López-Ayala
- Cardiovascular Research Institute Basel (CRIB) and Cardiology Department, University Hospital Basel, University of Basel, Basel, Suiza
| | - Sergio Rodríguez
- Instituto de Productos Naturales y Agrobiología (IPNA), CSIC, La Laguna, Santa Cruz de Tenerife, España
| | - Pere Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, España
| | | | - Alfons Aguirre
- Servicio de Urgencias, Hospital del Mar, Barcelona, España
| | - Aitor Alquézar
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Víctor Gil
- Área de Urgencias, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, España
| | | | - María Mir
- Servicio de Urgencias, Hospital Universitario Infanta Leonor, Madrid, España
| | - Juan Antonio Andueza
- Servicio de Urgencias, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Guillermo Burillo-Putze
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Tenerife, España.
| | - Òscar Miró
- Área de Urgencias, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, España
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Yousefi S, Ahangar H, Bahrami M, Kamalinejad M, Yaghoubi A, Azizi H. Effectiveness of "Centaurea behen" root on quality of life in patients with systolic heart failure: A randomized clinical trial. J Cardiovasc Thorac Res 2023; 15:22-29. [PMID: 37342665 PMCID: PMC10278197 DOI: 10.34172/jcvtr.2023.31619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/10/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction: The effect of Centaurea behen (Cb) on patients with systolic heart failure is not known academically. This study was conducted to evaluate the effect of Cb on improving the quality of life (QoL) and echocardiographic and biochemical blood parameters in patients with systolic heart failure. Methods: This study was a parallel double-blind, placebo-controlled randomized trial of 60 patients with systolic heart failure, was conducted from May 2018 up to August 2019. Intervention group received 150 mg twice daily Cb capsules for two months + Guideline directed medical therapy (GDMT), and control group received GDMT + placebo capsules for two months. The main aim of the present study were to assess the QoL based on the 6-minute walk test (6MWT) and the Minnesota living with heart failure questionnaire (MLHFQ). Independent T-test, paired T-test, and ANOVA were used for the analysis. Results: At the beginning of the present study there were no significant differences between study groups in terms of QoL and clinical results. After treatment, the average values of QoL based on MLHFQ and 6MWT instruments were significantly improved 15.5 and 36.18, respectively (P<0.05). Conclusion: Based on the MLHFQ, and 6MWT tests, the consumption of Centaurea behen root extract was associated with significant improvement in the quality of life of patients with systolic heart failure.
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Affiliation(s)
- Saeid Yousefi
- Department of Iranian Traditional Medicine, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hassan Ahangar
- Department of Cardiology, Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mohsen Bahrami
- Department of Iranian Traditional Medicine, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mohammad Kamalinejad
- Department of Pharmacognosy, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Yaghoubi
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hosein Azizi
- Research Center of Psychiatry and Behavirol Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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Al-Sadawi M, Aslam F, Tao M, Fan R, Singh A, Rashba E. Association of Late-Gadolinium Enhancement in Cardiac Magnetic Resonance with Mortality, Ventricular Arrhythmias, and Heart Failure in Patients with Non-Ischemic Cardiomyopathy: A Systematic Review and Meta-Analysis. Heart Rhythm O2 2023; 4:241-250. [PMID: 37124560 PMCID: PMC10134398 DOI: 10.1016/j.hroo.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Late gadolinium enhancement (LGE) on cardiac magnetic resonance is a predictor of adverse events in patients with nonischemic cardiomyopathy (NICM). Objective This meta-analysis evaluated the correlation between LGE and mortality, ventricular arrhythmias (VAs) and sudden cardiac death (SCD), and heart failure (HF) outcomes. Methods A literature search was conducted for studies reporting the association between LGE in NICM and the study endpoints. The primary endpoint was mortality. Secondary endpoints included VA and SCD, HF hospitalization, improvement in left ventricular ejection fraction (LVEF) to >35%, and heart transplantation referral. The search was not restricted to time or publication status. The minimum follow-up duration was 1 year. Results A total of 46 studies and 10,548 NICM patients (4610 with LGE, 5938 without LGE) were included; mean follow-up was 3 years (range 13-71 months). LGE was associated with increased mortality (odds ratio [OR] 2.9; 95% confidence interval [CI] 2.3-3.8; P < .01) and VA and SCD (OR 4.6; 95% CI 3.5-6.0; P < .01). LGE was associated with an increased risk of HF hospitalization (OR 3.4; 95% CI 2.3-5.0; P < .01), referral for transplantation (OR 5.1; 95% CI 2.5-10.4; P < .01), and decreased incidence of LVEF improvement to >35% (OR 0.2; 95% CI 0.03-0.85; P = .03). Conclusion LGE in NICM patients is associated with increased mortality, VA and SCD, and HF hospitalization and heart transplantation referral during long-term follow up. Given these competing risks of mortality and HF progression, prospective randomized controlled trials are required to determine if LGE is useful for guiding prophylactic implantable cardioverter-defibrillator placement in NICM patients.
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Affiliation(s)
| | | | | | | | | | - Eric Rashba
- Address reprint requests and correspondence: Dr Eric Rashba, Stony Brook Heart Rhythm Center, Stony Brook Medicine, 101 Nicolls Road, Stony Brook, NY 11794.
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Yang P, Guan Q, Ma M, Fan Y. Positive experiences of family caregivers of patients with chronic heart failure: protocol for a qualitative systematic review and meta-synthesis. BMJ Open 2022; 12:e063880. [PMID: 36600394 PMCID: PMC9743386 DOI: 10.1136/bmjopen-2022-063880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Previous studies have highlighted the experiences of caregivers for patients with chronic heart failure (CHF), specifically focusing on their negative experiences. There are few systematic reviews on the topic to synthesise the positive experiences of family caregivers for patients with CHF. This study will examine how experiences such as developing new skills, strengthening their relationships (between caregivers and recipients) and receiving appreciation from the care recipient assist to improve caregivers' perception of their circumstances. METHODS AND ANALYSIS This review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for qualitative systematic reviews. Qualitative and mixed methods studies related to the positive experiences of family caregivers for patients with CHF, reported in English or Chinese and published from inception in the following databases will be included: PubMed, MEDLINE, Embase, Cochrane Library, Web of Science, PsycINFO, CINAHL, Wan Fang Data, China National Knowledge Infrastructure, Chongqing VIP, Chinese Biomedical Literature Database, Open Grey and Deep Blue Library databases. The standard JBI Critical Appraisal Checklist for Qualitative Research will be used by two independent reviewers to appraise the quality of the included studies, and the standardised JBI Qualitative Data Extraction Tool for Qualitative Research will be applied to extract data. The final synthesised findings will be graded according to the ConQual approach for establishing confidence in the output of qualitative research synthesis. ETHICS AND DISSEMINATION Ethical approval is not required as no primary data are being collected. The results will be made available through a peer-reviewed publication. PROSPERO REGISTRATION NUMBER CRD42021282159.
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Affiliation(s)
- Panpan Yang
- Nursing, Binzhou Medical University-Yantai Campus, Yantai, Shandong, China
| | - Qingyi Guan
- Nursing, Binzhou Medical University-Yantai Campus, Yantai, Shandong, China
| | - Mengzhen Ma
- Nursing, Binzhou Medical University-Yantai Campus, Yantai, Shandong, China
| | - Yanyan Fan
- Nursing, Binzhou Medical University-Yantai Campus, Yantai, Shandong, China
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10
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Sigutova R, Evin L, Stejskal D, Ploticova V, Svagera Z. Specific microRNAs and heart failure: time for the next step toward application? Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2022; 166:359-368. [PMID: 35726831 DOI: 10.5507/bp.2022.028] [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: 04/07/2022] [Accepted: 06/09/2022] [Indexed: 12/15/2022] Open
Abstract
A number of microRNAs are involved in the pathophysiological events associated with heart disease. In this review, we discuss miR-21, miR-1, miR-23a, miR-142-5p, miR-126, miR-29, miR-195, and miR-499 because they are most often mentioned as important specific indicators of myocardial hypertrophy and fibrosis leading to heart failure. The clinical use of microRNAs as biomarkers and for therapeutic interventions in cardiovascular diseases appears highly promising. However, there remain many unresolved details regarding their specific actions in distinct pathological phenomena. The introduction of microRNAs into routine practice, as part of the cardiovascular examination panel, will require additional clinically relevant and reliable data. Thus, there remains a need for additional research in this area, as well as the optimization and standardization of laboratory procedures which could significantly shorten the determination time, and make microRNA analysis simpler and more affordable. In this review, we aim to summarize the current knowledge about selected microRNAs related to heart failure, including their potential use in diagnosis, prognosis, and treatment, and options for their laboratory determination.
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Affiliation(s)
- Radka Sigutova
- Institute of Laboratory Medicine, Department of Clinical Biochemistry, University Hospital Ostrava and Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Lukas Evin
- Department of Internal Medicine and Cardiology, Department of Cardiovascular, University Hospital Ostrava, Ostrava, Czech Republic
| | - David Stejskal
- Institute of Laboratory Medicine, Department of Clinical Biochemistry, University Hospital Ostrava and Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Vera Ploticova
- Institute of Laboratory Medicine, Department of Clinical Biochemistry, University Hospital Ostrava and Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Zdenek Svagera
- Institute of Laboratory Medicine, Department of Clinical Biochemistry, University Hospital Ostrava and Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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Wierda E, van Maarschalkerwaart W(W, van Seumeren E, Dickhoff C, Montanus I, de Boer D, Kop E, de Mol BA, Schroeder‐Tanka JM, van Heerbeek L. Outpatient treatment of worsening heart failure with intravenous diuretics: first results from a multicentre 2-year experience. ESC Heart Fail 2022; 10:594-600. [PMID: 36377206 PMCID: PMC9871674 DOI: 10.1002/ehf2.14168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 09/11/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022] Open
Abstract
AIMS The aim of this study is to examine the safety and efficacy of outpatient treatment of worsening heart failure (WHF) with intravenous diuretics. METHODS AND RESULTS This is a multicentre retrospective observational research study. Patients with all types of heart failure (HF) were included: heart failure with reduced ejection fraction (HFrEF), heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFpEF). Patients included in this study were 18 years or older, had symptoms of WHF, had weight gain of more than 2 kg, and were not responding to uptitrating of oral diuretic therapy. Patients were treated for one or more days at the outpatient department with administration of intravenous loop diuretics with or without a bolus. In this study, 259 patients were included (mean age of 76 years, mean left ventricular ejection fraction of 41%). Rehospitalization rates for HF were 30.5% and 53.3%, respectively, at 30 days and 1 year. All-cause mortality was 5.8% and 26.3%, respectively, at 30 days and 1 year. Rehospitalization rates for HF and all-cause mortality were highest in patients with HFrEF. In a total of 322 individual outpatient treatments with intravenous diuretics, only one adverse event was registered. CONCLUSIONS Outpatient treatment with intravenous diuretics of patients with WHF is a safe alternative strategy compared with the same treatment in hospitalized patients. However, only non-randomized data are available and rehospitalization rates for this group with WHF are high. No data are available on the best selection criteria and the cost-effectiveness of outpatient treatment with intravenous diuretics.
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Affiliation(s)
- Eric Wierda
- Department of CardiologyDijklander ZiekenhuisHoornThe Netherlands
| | | | | | | | | | | | - Esther Kop
- Department of CardiologyOLVGAmsterdamThe Netherlands
| | - Bas A.J.M. de Mol
- Department of Cardiothoracic SurgeryAmsterdam University Medical CenterAmsterdamThe Netherlands
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12
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Yan B. Actuators for Implantable Devices: A Broad View. MICROMACHINES 2022; 13:1756. [PMID: 36296109 PMCID: PMC9610948 DOI: 10.3390/mi13101756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/12/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
The choice of actuators dictates how an implantable biomedical device moves. Specifically, the concept of implantable robots consists of the three pillars: actuators, sensors, and powering. Robotic devices that require active motion are driven by a biocompatible actuator. Depending on the actuating mechanism, different types of actuators vary remarkably in strain/stress output, frequency, power consumption, and durability. Most reviews to date focus on specific type of actuating mechanism (electric, photonic, electrothermal, etc.) for biomedical applications. With a rapidly expanding library of novel actuators, however, the granular boundaries between subcategories turns the selection of actuators a laborious task, which can be particularly time-consuming to those unfamiliar with actuation. To offer a broad view, this study (1) showcases the recent advances in various types of actuating technologies that can be potentially implemented in vivo, (2) outlines technical advantages and the limitations of each type, and (3) provides use-specific suggestions on actuator choice for applications such as drug delivery, cardiovascular, and endoscopy implants.
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Affiliation(s)
- Bingxi Yan
- Department of Electrical and Computer Engineering, Ohio State University, Columbus, OH 43210, USA
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13
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Wideqvist M, Rosengren A, Schaufelberger M, Pivodic A, Fu M. Ten year age- and sex-specific temporal trends in incidence and prevalence of heart failure in Västra Götaland, Sweden. ESC Heart Fail 2022; 9:3931-3941. [PMID: 35957620 PMCID: PMC9773728 DOI: 10.1002/ehf2.14103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/02/2022] [Accepted: 07/28/2022] [Indexed: 01/19/2023] Open
Abstract
AIM Heart failure (HF) is predominantly a disorder of the elderly. During the last decades, cardiovascular primary and secondary prevention and life expectancy have improved. Accordingly, trends in incidence and prevalence of HF are dynamic and may differ over time by age and gender. We aim to investigate the overall and age-specific and sex-specific trends, in incidence, prevalence, and the proportion with co-morbidities of HF over a 10 year period in Region Västra Götaland, Sweden. METHODS AND RESULTS The VEGA database is an administrative database of all patients managed in hospital and/or in primary care (private and public) living in Region Västra Götaland. All patients with a main or contributory diagnosis of HF (I50) aged 18 years or older between 2008 and 2017 were included. Incidence and prevalence of HF were calculated based on the entire adult population of Region Västra Götaland. The adult population in Region Västra Götaland increased by 8% from 2008 (n = 1 234 609) to 2017 (n = 1 338 906). Half the population was female and 69% < 60 years of age, both constant over time. In total, 62 228 incident cases of HF were identified. In 2008, we identified 6464 cases, mean age 78.7 (11.5) years, and 49.8% (n = 3222) men, while in 2017, 5727 cases were identified, mean age 78.3 (11.8) years, and 52.5% (n = 3006) men. The overall yearly incidence rate of HF decreased by 3%, RR 0.97 (95% CI 0.96-0.97) per year, P < 0.0001, mainly driven by the age categories >75 years. A constantly higher incidence of HF was seen for men compared with women in all age categories, RR 1.46 (95% CI 1.44-1.49), P < 0.0001. During the same period, we observed a steady increase in overall prevalence from 1.8% for women and 2.0% for men in 2008, to 2.4% in women and 2.8% in men in 2017, particularly in those >85 years of age who had a prevalence of 16.5% (men) and 14.6% (women) in 2008 and 23.5% (men) and 21.5% (women) in 2017. The overall 1 year mortality rate was 22.7%. When adjusted for age, women had a lower risk for death by 13% compared with men [hazard ratio 0.87 (95% CI 0.84-0.90, P < 0.0001)]. CONCLUSION We saw a decrease in overall incidence, but incidence of HF remains high, particularly in the oldest age groups. Prevalence of HF keeps increasing particularly in those aged >85 years. Our findings emphasize the need for implementation of effective preventive strategies for HF.
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Affiliation(s)
- Maria Wideqvist
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of CardiologySahlgrenska University HospitalGothenburgSweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Medicine, Geriatrics and Emergency MedicineSahlgrenska University HospitalGothenburgSweden
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Medicine, Geriatrics and Emergency MedicineSahlgrenska University HospitalGothenburgSweden
| | - Aldina Pivodic
- Statistiska konsultgruppenGothenburgSweden,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Medicine, Geriatrics and Emergency MedicineSahlgrenska University HospitalGothenburgSweden
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14
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Lindberg F, Lund LH, Benson L, Schrage B, Edner M, Dahlström U, Linde C, Rosano G, Savarese G. Patient profile and outcomes associated with follow-up in specialty vs. primary care in heart failure. ESC Heart Fail 2022; 9:822-833. [PMID: 35170237 PMCID: PMC8934918 DOI: 10.1002/ehf2.13848] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/09/2022] [Accepted: 02/04/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS Factors influencing follow-up referral decisions and their prognostic implications are poorly investigated in patients with heart failure (HF) with reduced (HFrEF), mildly reduced (HFmrEF), and preserved (HFpEF) ejection fraction (EF). We assessed (i) the proportion of, (ii) independent predictors of, and (iii) outcomes associated with follow-up in specialty vs. primary care across the EF spectrum. METHODS AND RESULTS We analysed 75 518 patients from the large and nationwide Swedish HF registry between 2000-2018. Multivariable logistic regression models were fitted to identify the independent predictors of planned follow-up in specialty vs. primary care, and multivariable Cox models to assess the association between follow-up type and outcomes. In this nationwide registry, 48 115 (64%) patients were planned for follow-up in specialty and 27 403 (36%) in primary care. The median age was 76 [interquartile range (IQR) 67-83] years and 27 546 (36.5%) patients were female. Key independent predictors of planned follow-up in specialty care included optimized HF care, that is follow-up in a nurse-led HF clinic [odds ratio (OR) 4.60, 95% confidence interval (95% CI) 4.41-4.79], use of HF devices (OR 3.99, 95% CI 3.62-4.40), beta-blockers (OR 1.39, 95% CI 1.32-1.47), renin-angiotensin system/angiotensin-receptor-neprilysin inhibitors (OR 1.21, 95% CI 1.15-1.27), and mineralocorticoid receptor antagonists (OR 1.31, 95% CI 1.26-1.37); and more severe HF, that is higher NT-proBNP (OR 1.13, 95% CI 1.06-1.20) and NYHA class (OR 1.13, 95% CI 1.08-1.19). Factors associated with lower likelihood of follow-up in specialty care included older age (OR 0.29, 95% CI 0.28-0.30), female sex (OR 0.89, 95% CI 0.86-0.93), lower income (OR 0.79, 95% CI 0.76-0.82) and educational level (OR 0.77, 95% CI 0.73-0.81), higher EF [HFmrEF (OR 0.65, 95% CI 0.62-0.68) and HFpEF (OR 0.56, 95% CI 0.53-0.58) vs. HFrEF], and higher comorbidity burden, such as presence of kidney disease (OR 0.91, 95% CI 0.87-0.95), atrial fibrillation (OR 0.85, 95% CI 0.81-0.89), and diabetes mellitus (OR 0.92, 95% CI 0.88-0.96). A planned follow-up in specialty care was independently associated with lower risk of all-cause [hazard ratio (HR) 0.78, 95% CI 0.76-0.80] and cardiovascular death (HR 0.76, 95% CI 0.73-0.78) across the EF spectrum, but not of HF hospitalization (HR 1.06, 95% CI 1.03-1.10). CONCLUSIONS In a large nationwide HF population, referral to specialty care was linked with male sex, younger age, lower EF, lower comorbidity burden, better socioeconomic environment and optimized HF care, and associated with better survival across the EF spectrum. Our findings highlight the need for greater and more equal access to HF specialty care and improved quality of primary care.
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Affiliation(s)
- Felix Lindberg
- Division of Cardiology, Department of MedicineKarolinska Institutet, Karolinska University HospitalSolnavägen 1:02Stockholm171 76Sweden
| | - Lars H. Lund
- Division of Cardiology, Department of MedicineKarolinska Institutet, Karolinska University HospitalSolnavägen 1:02Stockholm171 76Sweden
- Heart and Vascular ThemeKarolinska University HospitalStockholmSweden
| | - Lina Benson
- Division of Cardiology, Department of MedicineKarolinska Institutet, Karolinska University HospitalSolnavägen 1:02Stockholm171 76Sweden
| | - Benedikt Schrage
- Division of Cardiology, Department of MedicineKarolinska Institutet, Karolinska University HospitalSolnavägen 1:02Stockholm171 76Sweden
- Department of CardiologyUniversity Heart and Vascular Center Hamburg, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/KielHamburgGermany
| | - Magnus Edner
- Division of Family Medicine, Department of NeurobiologyCare Sciences and Society (NVS), Karolinska InstitutetStockholmSweden
| | - Ulf Dahlström
- Department of Cardiology and Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Cecilia Linde
- Division of Cardiology, Department of MedicineKarolinska Institutet, Karolinska University HospitalSolnavägen 1:02Stockholm171 76Sweden
- Heart and Vascular ThemeKarolinska University HospitalStockholmSweden
| | | | - Gianluigi Savarese
- Division of Cardiology, Department of MedicineKarolinska Institutet, Karolinska University HospitalSolnavägen 1:02Stockholm171 76Sweden
- Heart and Vascular ThemeKarolinska University HospitalStockholmSweden
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15
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Dou W, Malhi M, Zhao Q, Wang L, Huang Z, Law J, Liu N, Simmons CA, Maynes JT, Sun Y. Microengineered platforms for characterizing the contractile function of in vitro cardiac models. MICROSYSTEMS & NANOENGINEERING 2022; 8:26. [PMID: 35299653 PMCID: PMC8882466 DOI: 10.1038/s41378-021-00344-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/12/2021] [Accepted: 12/03/2021] [Indexed: 05/08/2023]
Abstract
Emerging heart-on-a-chip platforms are promising approaches to establish cardiac cell/tissue models in vitro for research on cardiac physiology, disease modeling and drug cardiotoxicity as well as for therapeutic discovery. Challenges still exist in obtaining the complete capability of in situ sensing to fully evaluate the complex functional properties of cardiac cell/tissue models. Changes to contractile strength (contractility) and beating regularity (rhythm) are particularly important to generate accurate, predictive models. Developing new platforms and technologies to assess the contractile functions of in vitro cardiac models is essential to provide information on cell/tissue physiologies, drug-induced inotropic responses, and the mechanisms of cardiac diseases. In this review, we discuss recent advances in biosensing platforms for the measurement of contractile functions of in vitro cardiac models, including single cardiomyocytes, 2D monolayers of cardiomyocytes, and 3D cardiac tissues. The characteristics and performance of current platforms are reviewed in terms of sensing principles, measured parameters, performance, cell sources, cell/tissue model configurations, advantages, and limitations. In addition, we highlight applications of these platforms and relevant discoveries in fundamental investigations, drug testing, and disease modeling. Furthermore, challenges and future outlooks of heart-on-a-chip platforms for in vitro measurement of cardiac functional properties are discussed.
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Affiliation(s)
- Wenkun Dou
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8 Canada
- Program in Molecular Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8 Canada
| | - Manpreet Malhi
- Program in Molecular Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8 Canada
- Department of Biochemistry, University of Toronto, Toronto, ON M5S 1A8 Canada
| | - Qili Zhao
- Institute of Robotics and Automatic Information System and the Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin, 300350 China
| | - Li Wang
- School of Mechanical & Automotive Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan, 250353 China
| | - Zongjie Huang
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8 Canada
| | - Junhui Law
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8 Canada
| | - Na Liu
- School of Mechatronics Engineering and Automation, Shanghai University, Shanghai, 200444 China
| | - Craig A. Simmons
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8 Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9 Canada
- Translational Biology & Engineering Program, Ted Rogers Centre for Heart Research, Toronto, ON M5G 1M1 Canada
| | - Jason T. Maynes
- Program in Molecular Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8 Canada
- Department of Biochemistry, University of Toronto, Toronto, ON M5S 1A8 Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON M5S 1A8 Canada
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8 Canada
| | - Yu Sun
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8 Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9 Canada
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON M5S 3G4 Canada
- Department of Computer Science, University of Toronto, Toronto, ON M5T 3A1 Canada
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16
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Le N, Rahman T, Kapralik JL, Ibrahim Q, Lear SA, Van Spall HG. The Hospital at Home Model vs Routine Hospitalization for Acute Heart Failure: A Survey of Patients’ Preferences. CJC Open 2021; 4:263-270. [PMID: 35386130 PMCID: PMC8978061 DOI: 10.1016/j.cjco.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/15/2021] [Indexed: 10/31/2022] Open
Abstract
Background Methods Results Conclusions
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17
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Auener SL, Remers TEP, van Dulmen SA, Westert GP, Kool RB, Jeurissen PPT. The Effect of Noninvasive Telemonitoring for Chronic Heart Failure on Health Care Utilization: Systematic Review. J Med Internet Res 2021; 23:e26744. [PMID: 34586072 PMCID: PMC8515232 DOI: 10.2196/26744] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/18/2021] [Accepted: 06/30/2021] [Indexed: 12/20/2022] Open
Abstract
Background Chronic heart failure accounts for approximately 1%-2% of health care expenditures in most developed countries. These costs are primarily driven by hospitalizations and comorbidities. Telemonitoring has been proposed to reduce the number of hospitalizations and decrease the cost of treatment for patients with heart failure. However, the effects of telemonitoring on health care utilization remain unclear. Objective This systematic review aims to study the effect of telemonitoring programs on health care utilization and costs in patients with chronic heart failure. We assess the effect of telemonitoring on hospitalizations, emergency department visits, length of stay, hospital days, nonemergency department visits, and health care costs. Methods We searched PubMed, Embase, and Web of Science for randomized controlled trials and nonrandomized studies on noninvasive telemonitoring and health care utilization. We included studies published between January 2010 and August 2020. For each study, we extracted the reported data on the effect of telemonitoring on health care utilization. We used P<.05 and CIs not including 1.00 to determine whether the effect was statistically significant. Results We included 16 randomized controlled trials and 13 nonrandomized studies. Inclusion criteria, population characteristics, and outcome measures differed among the included studies. Most studies showed no effect of telemonitoring on health care utilization. The number of hospitalizations was significantly reduced in 38% (9/24) of studies, whereas emergency department visits were reduced in 13% (1/8) of studies. An increase in nonemergency department visits (6/9, 67% of studies) was reported. Health care costs showed ambiguous results, with 3 studies reporting an increase in health care costs, 3 studies reporting a reduction, and 4 studies reporting no significant differences. Health care cost reductions were realized through a reduction in hospitalizations, whereas increases were caused by the high costs of the telemonitoring program or increased health care utilization. Conclusions Most telemonitoring programs do not show clear effects on health care utilization measures, except for an increase in nonemergency outpatient department visits. This may be an unwarranted side effect rather than a prerequisite for effective telemonitoring. The consequences of telemonitoring on nonemergency outpatient visits should receive more attention from regulators, payers, and providers. This review further demonstrates the high clinical and methodological heterogeneity of telemonitoring programs. This should be taken into account in future meta-analyses aimed at identifying the effective components of telemonitoring programs.
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Affiliation(s)
- Stefan L Auener
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Toine E P Remers
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Simone A van Dulmen
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gert P Westert
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rudolf B Kool
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Patrick P T Jeurissen
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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18
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Alghamdi A, Algarni E, Balkhi B, Altowaijri A, Alhossan A. Healthcare Expenditures Associated with Heart Failure in Saudi Arabia: A Cost of Illness Study. Healthcare (Basel) 2021; 9:healthcare9080988. [PMID: 34442125 PMCID: PMC8391138 DOI: 10.3390/healthcare9080988] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 11/16/2022] Open
Abstract
Heart failure (HF) is considered to be a global health problem that generates a significant economic burden. Despite the growing prevalence in Saudi Arabia, the economic burden of HF is not well studied. The aim of this study was to estimate the health care expenditures associated with HF in Saudi Arabia from a social perspective. We conducted a multicenter cost of illness (COI) study in two large governmental centers in Riyadh, Saudi Arabia using 369 HF patients. A COI model was developed in order to estimate the direct medical costs associated with HF. The indirect costs of HF were estimated based on a human capital approach. Descriptive and inferential statistics were analyzed. The direct medical cost per HF patient was $9563. Hospitalization costs were the major driver in total spending, followed by medication and diagnostics costs. The cost significantly increased in line with the disease progression, ranging from $3671 in class I to $16,447 in class IV. The indirect costs per working HF patient were $4628 due to absenteeism, and $6388 due to presenteeism. The economic burden of HF is significantly high in Saudi Arabia. Decision makers need to focus on allocating resources towards strategies that prevent frequent hospitalizations and improve HF management and patient outcomes in order to lower the growing economic burden.
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Affiliation(s)
- Ahmed Alghamdi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (B.B.); (A.A.)
- Correspondence: ; Tel.: +966-114-677-479
| | - Eman Algarni
- Prince Sultan Cardiac Center, Prince Sultan Military Medical City, Riyadh 12233, Saudi Arabia;
| | - Bander Balkhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (B.B.); (A.A.)
| | - Abdulaziz Altowaijri
- Program for Health Assurance and Purchasing, Vision Realization Office, Ministry of Health, Riyadh 13315, Saudi Arabia;
| | - Abdulaziz Alhossan
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (B.B.); (A.A.)
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19
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Perera R, Stevens R, Aronson JK, Banerjee A, Evans J, Feakins BG, Fleming S, Glasziou P, Heneghan C, Hobbs FDR, Jones L, Kurtinecz M, Lasserson DS, Locock L, McLellan J, Mihaylova B, O’Callaghan CA, Oke JL, Pidduck N, Plüddemann A, Roberts N, Schlackow I, Shine B, Simons CL, Taylor CJ, Taylor KS, Verbakel JY, Bankhead C. Long-term monitoring in primary care for chronic kidney disease and chronic heart failure: a multi-method research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Long-term monitoring is important in chronic condition management. Despite considerable costs of monitoring, there is no or poor evidence on how, what and when to monitor. The aim of this study was to improve understanding, methods, evidence base and practice of clinical monitoring in primary care, focusing on two areas: chronic kidney disease and chronic heart failure.
Objectives
The research questions were as follows: does the choice of test affect better care while being affordable to the NHS? Can the number of tests used to manage individuals with early-stage kidney disease, and hence the costs, be reduced? Is it possible to monitor heart failure using a simple blood test? Can this be done using a rapid test in a general practitioner consultation? Would changes in the management of these conditions be acceptable to patients and carers?
Design
Various study designs were employed, including cohort, feasibility study, Clinical Practice Research Datalink analysis, seven systematic reviews, two qualitative studies, one cost-effectiveness analysis and one cost recommendation.
Setting
This study was set in UK primary care.
Data sources
Data were collected from study participants and sourced from UK general practice and hospital electronic health records, and worldwide literature.
Participants
The participants were NHS patients (Clinical Practice Research Datalink: 4.5 million patients), chronic kidney disease and chronic heart failure patients managed in primary care (including 750 participants in the cohort study) and primary care health professionals.
Interventions
The interventions were monitoring with blood and urine tests (for chronic kidney disease) and monitoring with blood tests and weight measurement (for chronic heart failure).
Main outcome measures
The main outcomes were the frequency, accuracy, utility, acceptability, costs and cost-effectiveness of monitoring.
Results
Chronic kidney disease: serum creatinine testing has increased steadily since 1997, with most results being normal (83% in 2013). Increases in tests of creatinine and proteinuria correspond to their introduction as indicators in the Quality and Outcomes Framework. The Chronic Kidney Disease Epidemiology Collaboration equation had 2.7% greater accuracy (95% confidence interval 1.6% to 3.8%) than the Modification of Diet in Renal Disease equation for estimating glomerular filtration rate. Estimated annual transition rates to the next chronic kidney disease stage are ≈ 2% for people with normal urine albumin, 3–5% for people with microalbuminuria (3–30 mg/mmol) and 3–12% for people with macroalbuminuria (> 30 mg/mmol). Variability in estimated glomerular filtration rate-creatinine leads to misclassification of chronic kidney disease stage in 12–15% of tests in primary care. Glycaemic-control and lipid-modifying drugs are associated with a 6% (95% confidence interval 2% to 10%) and 4% (95% confidence interval 0% to 8%) improvement in renal function, respectively. Neither estimated glomerular filtration rate-creatinine nor estimated glomerular filtration rate-Cystatin C have utility in predicting rate of kidney function change. Patients viewed phrases such as ‘kidney damage’ or ‘kidney failure’ as frightening, and the term ‘chronic’ was misinterpreted as serious. Diagnosis of asymptomatic conditions (chronic kidney disease) was difficult to understand, and primary care professionals often did not use ‘chronic kidney disease’ when managing patients at early stages. General practitioners relied on Clinical Commissioning Group or Quality and Outcomes Framework alerts rather than National Institute for Health and Care Excellence guidance for information. Cost-effectiveness modelling did not demonstrate a tangible benefit of monitoring kidney function to guide preventative treatments, except for individuals with an estimated glomerular filtration rate of 60–90 ml/minute/1.73 m2, aged < 70 years and without cardiovascular disease, where monitoring every 3–4 years to guide cardiovascular prevention may be cost-effective. Chronic heart failure: natriuretic peptide-guided treatment could reduce all-cause mortality by 13% and heart failure admission by 20%. Implementing natriuretic peptide-guided treatment is likely to require predefined protocols, stringent natriuretic peptide targets, relative targets and being located in a specialist heart failure setting. Remote monitoring can reduce all-cause mortality and heart failure hospitalisation, and could improve quality of life. Diagnostic accuracy of point-of-care N-terminal prohormone of B-type natriuretic peptide (sensitivity, 0.99; specificity, 0.60) was better than point-of-care B-type natriuretic peptide (sensitivity, 0.95; specificity, 0.57). Within-person variation estimates for B-type natriuretic peptide and weight were as follows: coefficient of variation, 46% and coefficient of variation, 1.2%, respectively. Point-of-care N-terminal prohormone of B-type natriuretic peptide within-person variability over 12 months was 881 pg/ml (95% confidence interval 380 to 1382 pg/ml), whereas between-person variability was 1972 pg/ml (95% confidence interval 1525 to 2791 pg/ml). For individuals, monitoring provided reassurance; future changes, such as increased testing, would be acceptable. Point-of-care testing in general practice surgeries was perceived positively, reducing waiting time and anxiety. Community heart failure nurses had greater knowledge of National Institute for Health and Care Excellence guidance than general practitioners and practice nurses. Health-care professionals believed that the cost of natriuretic peptide tests in routine monitoring would outweigh potential benefits. The review of cost-effectiveness studies suggests that natriuretic peptide-guided treatment is cost-effective in specialist settings, but with no evidence for its value in primary care settings.
Limitations
No randomised controlled trial evidence was generated. The pathways to the benefit of monitoring chronic kidney disease were unclear.
Conclusions
It is difficult to ascribe quantifiable benefits to monitoring chronic kidney disease, because monitoring is unlikely to change treatment, especially in chronic kidney disease stages G3 and G4. New approaches to monitoring chronic heart failure, such as point-of-care natriuretic peptide tests in general practice, show promise if high within-test variability can be overcome.
Future work
The following future work is recommended: improve general practitioner–patient communication of early-stage renal function decline, and identify strategies to reduce the variability of natriuretic peptide.
Study registration
This study is registered as PROSPERO CRD42015017501, CRD42019134922 and CRD42016046902.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard Stevens
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jeffrey K Aronson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
| | - Julie Evans
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Benjamin G Feakins
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Susannah Fleming
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - FD Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louise Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Milena Kurtinecz
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Daniel S Lasserson
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Julie McLellan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Borislava Mihaylova
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Jason L Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Pidduck
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annette Plüddemann
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, Knowledge Centre, University of Oxford, Oxford, UK
| | - Iryna Schlackow
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Brian Shine
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Claire L Simons
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kathryn S Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jan Y Verbakel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- National Institute for Health Research (NIHR) Community Healthcare MedTech and In Vitro Diagnostics Co-operative (MIC), Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clare Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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20
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Yamanoglu A, Celebi Yamanoglu NG, Ozturk S, Cakmak S, Akay S, Akyol PY, Sogut O. The value of the inferior vena cava ultrasound in the decision to hospitalise in patients with acute decompensated heart failure; the best sonographic measurement method? Acta Cardiol 2021; 76:245-257. [PMID: 32189575 DOI: 10.1080/00015385.2020.1740422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The primary aim of this study was to determine the value of the inferior vena cava (IVC) ultrasound in the decision to hospitalise acute decompensated heart failure (ADHF) patients. Our secondary aim was to find the most successful IVC measurement method in monitoring volume status. METHODS ADHF patients were accepted over a 1-year period in this study. Patients' vital signs, laboratory tests and IVC measurements measured by six methods (in B- and M-mode; maximum, minimum diameter and caval index) performed on an hourly basis were recorded. The presence of any statistically significant difference between the IVC measurement methods, laboratory tests and vital parameters between the hospitalised and discharged patients was calculated. ROC curves were produced in order to determine the ability of parameters to differentiate two groups. Spearman's correlation test was used to investigate correlation between the IVC measurement methods and patients' urine outputs. RESULTS A total of 71 patients were included in the study; 42 of these were hospitalised and 29 were discharged. Potassium, brain natriuretic peptide, respiration rate, urine output, maximum and minimum IVC diameters differed significantly between the two groups. Minimum IVC diameter measured in M-mode was identified as a weak marker with 65% sensitivity and 64% specificity (+PPV: 73%; -NPV:54%) for hospitalisation. Change in maximum IVC diameter measured in B-mode exhibited a high degree of correlation with change in body fluid (cc: 0.802). CONCLUSION IVC ultrasound may have a limited value in the decision to hospitalise ADHF patients. But Maximum IVC diameter may be an ideal method for monitoring hypervolemic patients' volume status. CLINICAL TRIALS IDENTIFIER NCT02725151.
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Affiliation(s)
- Adnan Yamanoglu
- Department of Emergency Medicine, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Nalan Gokce Celebi Yamanoglu
- Department of Emergency Medicine, Izmir Bozyaka Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Semi Ozturk
- Department of Cardiology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sumeyye Cakmak
- Department of Emergency Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Serhat Akay
- Department of Emergency Medicine, Izmir Bozyaka Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Pınar Yesim Akyol
- Department of Emergency Medicine, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Ozgur Sogut
- Department of Emergency Medicine, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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21
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Massaro AR. Neurological complications of heart failure. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:77-89. [PMID: 33632459 DOI: 10.1016/b978-0-12-819814-8.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Heart failure (HF) is a major global cause of death with increasing absolute worldwide numbers of HF patients. HF results from the interaction between cardiovascular aging with specific risk factors, comorbidities, and disease modifiers. The failing heart and neuronal injury have a bidirectional interaction requiring specific management strategies. Decreased cardiac output has been associated with lower brain volumes. Cerebral blood flow (CBF) may normalize following heart transplantation among severe HF patients. Stroke and cognitive impairment remain the main neurologic conditions associated with HF. However, HF patients may also suffer from chronic cerebral hypoperfusion. It seems likely that HF-related ischemic strokes are primarily the result of cardiac embolism. Atrial fibrillation (AF) is present in half of stroke patient with HF. The increased risk of hemorrhagic strokes is less well characterized and likely multifactorial, but may in part reflect a higher use of long-term antithrombotic therapy. The steady improvement of neuroimaging techniques has demonstrated an increased prevalence of silent ischemic lesions among HF patients. The populations most likely to benefit from long-term anticoagulant therapy are HF patients with AF. Cognitive impairment in HF can have a variety of clinical manifestations from mild memory problems to dementia.
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22
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Reduction of mortality by catheter ablation in real-world atrial fibrillation patients with heart failure. Sci Rep 2021; 11:4694. [PMID: 33633286 PMCID: PMC7907229 DOI: 10.1038/s41598-021-84256-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 01/27/2021] [Indexed: 12/19/2022] Open
Abstract
Whether catheter ablation for atrial fibrillation (AF) improves survival and affects other outcomes in real-world heart failure (HF) patients is unclear. This study aimed to evaluate whether ablation reduces death, and other outcomes in real-world AF patients with HF. Among 834,735 patients with AF from 2006 to 2015 in the Korean National Health Insurance Service database, 3173 HF patients underwent AF ablation. Propensity score weighting was used to correct for differences between the groups. During median 54 months follow-up, the risk of all-cause death in ablated patients was less than half of that in patients with medical therapy (2.8 vs. 6.2 per 100 person-years; hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.27–0.65, p < 0.001). Ablation was related with lower risk of cardiovascular death (HR 0.38, 95% CI 0.32–0.62, p < 0.001), HF admission (HR 0.39, 95% CI 0.33–0.46, p < 0.001) and stroke/systemic embolism (HR 0.44, 95% CI 0.37–0.53, p < 0.001). In subgroup analysis, the risk of all-cause death was reduced in most subgroups except in the elderly (≥ 75 years) and strictly anticoagulated patients. Ablation may be associated with reduced risk of all-cause death and cardiovascular death in real-world AF patients with HF, supporting the role of AF ablation in patients with HF.
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23
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Wideqvist M, Cui X, Magnusson C, Schaufelberger M, Fu M. Hospital readmissions of patients with heart failure from real world: timing and associated risk factors. ESC Heart Fail 2021; 8:1388-1397. [PMID: 33599109 PMCID: PMC8006673 DOI: 10.1002/ehf2.13221] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/18/2020] [Accepted: 01/06/2021] [Indexed: 12/11/2022] Open
Abstract
AIMS This study aims to investigate hospital readmissions and timing, as well as risk factors in a real world heart failure (HF) population. METHODS AND RESULTS All patients discharged alive in 2016 from Sahlgrenska University Hospital/Östra, Gothenburg, Sweden, with a primary diagnosis of HF were consecutively included. Patient characteristics, type of HF, treatment, and follow-up were registered. Time to first all-cause or HF readmission, as well as number of 1 year readmissions from discharge were recorded. In total, 448 patients were included: 273 patients (mean age 78 ± 11.8 years) were readmitted for any cause within 1 year (readmission rate of 60.9%), and 175 patients (mean age 76.6 ± 13.7) were never readmitted. Among readmissions, 60.1% occurred during the first quarter after index hospitalization, giving a 3 month all-cause readmission rate of 36.6%. HF-related 1 year readmission rate was 38.4%. Patients who were readmitted had significantly more renal dysfunction (52.4% vs. 36.6%, P = 0.001), pulmonary disease (25.6% vs. 15.4%, P = 0.010), and psychiatric illness (24.9% vs. 12.0%, P = 0.001). Number of co-morbidities and readmissions were significantly associated (P < 0.001 for all cause readmission rate and P = 0.012 for 1 year HF readmission rate). Worsening HF constituted 63% of all-cause readmissions. Psychiatric disease was an independent risk factor for 1 month and 1 year all-cause readmissions. Poor compliance to medication was an independent risk factor for 1 month and 1 year HF readmission. CONCLUSIONS In our real world cohort of HF patients, frequent hospital readmissions occurred in the early post-discharge period and were mainly driven by worsening HF. Co-morbidity was one of the most important factors for readmission.
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Affiliation(s)
- Maria Wideqvist
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Xiaotong Cui
- Department of cardiology Zhongshan Hospital, Fudan University, Shanghai, China
| | - Charlotte Magnusson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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24
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Zhigalov K, Van den Eynde J, Chrosch T, Goerdt L, Sá MPBO, Zubarevich A, Papathanasiou M, Wendt D, Luedike P, Pizanis N, Koch A, Schmack B, Rassaf T, Kamler M, Ruhparwar A, Weymann A. Outcomes of left ventricular assist device implantation for advanced heart failure in critically ill patients (INTERMACS 1 and 2): A retrospective study. Artif Organs 2021; 45:706-716. [PMID: 33350481 DOI: 10.1111/aor.13897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/27/2020] [Accepted: 12/17/2020] [Indexed: 12/29/2022]
Abstract
The use of left ventricular assist devices (LVADs) for advanced heart failure is becoming increasingly common. However, optimal timing and patient selection remain controversial. The aim of this study was to investigate outcomes of LVAD implantation for advanced heart failure in critically ill patients (INTERMACS 1 and 2). Between August 2010 and January 2020, 207 consecutive patients underwent LVAD implantation. Overall survival, major adverse events, and laboratory parameters were compared between patients in INTERMACS 1-2 (n = 107) and INTERMACS 3-5 (n = 100). Preoperative white blood cells, C-reactive protein, procalcitonin, bilirubin, alanine transaminase, and lactate dehydrogenase were all significantly higher in INTERMACS 1-2 when compared to INTERMACS 3-5 (P < .05). During hospitalization following LVAD implantation, patients in INTERMACS 1-2 were more likely to develop major infections (41.1% vs. 23.0%, P = .005), respiratory failure (57.9% vs. 25.0%, P < .001), mild (20.6% vs. 8.0%, P = .010), and moderate (31.8% vs. 7.0%, P < .001) right heart failure, and acute renal dysfunction (56.1% vs. 6.0%, P < .001). During a median follow-up of 2.00 years (interquartile range (IQR) 0.24-3.39 years), they had a higher incidence of thoracic (15.9% vs. 4.0%, P = .005) and gastrointestinal bleeding (21.5% vs. 11.0%, P = .042), as well as right heart failure (18.7% vs. 1%, P < .001). Risk of death was significantly higher in the INTERMACS 1-2 group (hazards ratio (HR) 1.64, 95% CI 1.12-2.40, P = .011). LVAD implantation in critically ill patients is associated with increased morbidity and mortality. Our results suggest that decision for LVAD should be not be delayed until INTERMACS 1 and 2 levels whenever possible.
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Affiliation(s)
- Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.,International Thoracic and Cardiovascular Research Association (ITCVR)
| | - Jef Van den Eynde
- International Thoracic and Cardiovascular Research Association (ITCVR).,Department of Cardiovascular Sciences, Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Chrosch
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Lukas Goerdt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Michel Pompeu Barros Oliveira Sá
- International Thoracic and Cardiovascular Research Association (ITCVR).,Department of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Maria Papathanasiou
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Peter Luedike
- Department of Cardiothoracic Surgery, Heart Center Essen Huttrop, University Hospital Essen, Essen, Germany
| | - Nikolaus Pizanis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Achim Koch
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.,International Thoracic and Cardiovascular Research Association (ITCVR)
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Markus Kamler
- Department of Cardiothoracic Surgery, Heart Center Essen Huttrop, University Hospital Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.,International Thoracic and Cardiovascular Research Association (ITCVR)
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.,International Thoracic and Cardiovascular Research Association (ITCVR)
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25
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Uyar H, Yesil E, Karadeniz M, Orscelik O, Ozkan B, Ozcan T, Cicek Yilmaz D, Celik A. The Effect of High Lactate Level on Mortality in Acute Heart Failure Patients With Reduced Ejection Fraction Without Cardiogenic Shock. Cardiovasc Toxicol 2021; 20:361-369. [PMID: 32048133 DOI: 10.1007/s12012-020-09563-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND We aimed to determine the effect of blood lactate levels on cardiovascular (CV) death and hospitalization for heart failure (HF) in acute HF patients with reduced left ventricular ejection fraction (EF). METHODS Eighty-five acute HF patients with reduced ejection fraction were divided into two groups according to admission blood lactate levels. 48 of them had low blood lactate levels (< 2 mmol/l) and 37 of them had high blood lactate levels (≥ 2 mmol/l). Patients with acute coronary syndrome, cardiogenic shock, sepsis and low blood pressure at admission were excluded from the study. Primary endpoint is the composite of cardiovascular (CV) death and hospitalization for heart failure (HHF) in 6-month follow-up. Secondary endpoint is the change in NT-proBNP levels from admission to 72 h. RESULTS Baseline characteristics of patients were similar in two groups. On baseline echocardiographic evaluation; patients with high lactate revealed a higher mitral E/A ratio (2.34 [0.43-3.31], p = 0.008) and a lower TAPSE ratio (14 [10-27], p = 0.008) than patients with low lactate levels. Over a median follow-up period of 6 months, the primary end point occurred in 28 (75.7%) of 37 patients assigned to high lactate group and in 20 (41.7%) of 48 patients assigned to low lactate group (p = 0.006). High lactate levels significantly increased the risk of CV death and HHF at 6 months by nearly 5.35-fold in acute HF patients with reduced EF. The change in NT-proBNP levels at 72nd hour after admission were similar between two groups. CONCLUSION Higher lactate levels at admission related with higher HHF at 6 months and may be related with higher risk of CV death in acute HF patients with reduced EF.
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Affiliation(s)
- Hakan Uyar
- Department of Cardiology, Mersin University Medical Faculty, 33343, Mersin, Turkey
| | - Emrah Yesil
- Department of Cardiology, Toros State Hospital, Mersin, Turkey
| | - Muzaffer Karadeniz
- Department of Cardiology, Mersin University Medical Faculty, 33343, Mersin, Turkey
| | - Ozcan Orscelik
- Department of Cardiology, Mersin University Medical Faculty, 33343, Mersin, Turkey
| | - Bugra Ozkan
- Department of Cardiology, Mersin University Medical Faculty, 33343, Mersin, Turkey
| | - Turkay Ozcan
- Department of Cardiology, Mersin University Medical Faculty, 33343, Mersin, Turkey
| | - Dilek Cicek Yilmaz
- Department of Cardiology, Mersin University Medical Faculty, 33343, Mersin, Turkey
| | - Ahmet Celik
- Department of Cardiology, Mersin University Medical Faculty, 33343, Mersin, Turkey.
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26
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Higenamine Improves Cardiac and Renal Fibrosis in Rats With Cardiorenal Syndrome via ASK1 Signaling Pathway. J Cardiovasc Pharmacol 2021; 75:535-544. [PMID: 32168151 DOI: 10.1097/fjc.0000000000000822] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The pathogenesis of cardiorenal syndrome (CRS) is very complex, and currently there is no effective treatment for CRS. Higenamine (HI) has been shown to improve cardiac function in rats with heart failure. However, the role of higenamine in CRS remains unknown. Here, in vitro, higenamine treatment markedly reduced neonatal rat cardiac fibroblast collagen synthesis and inhibited neonatal rat cardiac myocyte hypertrophy. In our study, a rat model of type 2 CRS was induced by left anterior descending coronary artery ligation combined with 5/6 subtotal nephrectomy (STNx). Higenamine treatment decreased serum creatinine (Scr), blood urea nitrogen, and brain natriuretic peptide levels and was capable of improving left ventricular remodeling and systolic function in CRS rats, accompanied with decreased expression of transforming growth factor-β1 (TGF-β1), α-smooth muscle actin (α-SMA) and collagen I (Col1A1). Moreover, higenamine significantly inhibited the protein expression of phosphorylated apoptosis signal-regulated kinase 1 (p-ASK1) and downstream mitogen-activated protein kinases (MAPK) (ERK, P38)/NF-κB in cardiorenal tissues of CRS rats and neonatal rat cardiac fibroblast/neonatal rat cardiac myocyte cells. Our study demonstrated that higenamine improved cardiorenal function in CRS rats and attenuated heart and kidney fibrosis possibly via targeting ASK1/MAPK (ERK, P38)/NF-κB signaling pathway. This finding extends our knowledge on the role of higenamine in cardiorenal fibrosis, providing a potential target to prevent the progression of CRS.
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27
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Hospitalizations and emergency department visits in heart failure patients after bariatric surgery. Surg Obes Relat Dis 2020; 17:489-497. [PMID: 33376053 DOI: 10.1016/j.soard.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/18/2020] [Accepted: 11/10/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Heart failure is a disease with significant healthcare utilization and a prioritized target for readmission prevention. Although obesity is related to heart failure morbidity, the effects of bariatric surgery in obese patients with heart failure are not well studied. OBJECTIVES To evaluate the impact of bariatric surgery on hospital-based healthcare utilization for patients with heart failure. SETTING Administrative statewide database. METHODS The New York Statewide Planning and Research Cooperative System database was used to identify patients with obesity and heart failure who underwent bariatric surgery from 2005 to 2015. Emergency department (ED) visits and hospitalization records from 1 year presurgery and up to 2 years postsurgery were compared. RESULTS Our study identified 899 patients with heart failure who underwent bariatric surgery. In the year presurgery, 11.48% of patients had any ED visit or hospitalization with a primary diagnosis of heart failure. The rate decreased drastically in the first year after surgery, with only 3.70% of patients having any heart failure-related hospital visits. The rate of heart failure-related visits was also lower in the second year postsurgery (3.44%) compared with the year before surgery. The risk of heart failure-related hospital visits was lower in both the first year (odds ratio [OR], .29; 95% confidence interval [CI], .19-.43) and second year postsurgery (OR, .26; 95% CI, .17-.41; P < .0001) than in the year before surgery. CONCLUSIONS These findings suggest that bariatric interventions might be associated with decreased risks of ED visits or hospitalizations due to heart failure exacerbations in obese patients with preexisting heart failure.
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28
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Zhang H, Huang T, Shen W, Xu X, Yang P, Zhu D, Fang H, Wan H, Wu T, Wu Y, Wu Q. Efficacy and safety of sacubitril-valsartan in heart failure: a meta-analysis of randomized controlled trials. ESC Heart Fail 2020; 7:3841-3850. [PMID: 32977362 PMCID: PMC7754944 DOI: 10.1002/ehf2.12974] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/10/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022] Open
Abstract
Aims Sacubitril‐valsartan has been shown to have superior effects over angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers in patients with heart failure (HF) and hypertension. The efficacy and safety of sacubitril‐valsartan in patients with HF are controversial. We performed a meta‐analysis of randomized controlled trials to assess and compare the effect and adverse events of sacubitril‐valsartan, valsartan, and enalapril in patients with HF. Methods and results We conducted a systematic search using PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov. Randomized controlled trials involving the use of sacubitril‐valsartan in patients with HF were included. We assessed the pooled odds ratio (OR) of all‐cause mortality, cardiovascular mortality, and hospitalization for HF in fixed‐effects models and the pooled risk ratio (RR) of symptomatic hypotension, worsening renal function, and hyperkalaemia in fixed‐effects models. Of the 315 identified records, six studies involving 14 959 patients were eligible for inclusion. Sacubitril‐valsartan reduced the endpoints of all‐cause mortality and cardiovascular mortality in patients with HF with reduced ejection fraction (HFrEF) in three trials with pooled ORs of 0.83 (P = 0.0006) and 0.78 (P < 0.0001), respectively. Regarding the composite outcome of hospitalization for HF in five trials, the pooled OR was 0.79 (P < 0.00001). Compared with enalapril or valsartan, sacubitril‐valsartan was associated with a high risk of symptomatic hypotension (RR 1.47, P < 0.00001), low risk of worsening renal function (RR 0.81, P = 0.005), and low rate of serious hyperkalaemia (≥6.0 mmol/L) (RR 0.76, P = 0.0007) in all six trials. Conclusions Compared with angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers, sacubitril‐valsartan significantly decreased the risk of death from all causes or cardiovascular causes in HFrEF and hospitalization for HF in both patients with HFrEF and HF with preserved ejection fraction. Sacubitril‐valsartan reduced the risk of renal dysfunction and serious hyperkalaemia but was associated with more symptomatic hypotension.
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Affiliation(s)
- Hongzhou Zhang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, China
| | - Tieqiu Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, China
| | - Wen Shen
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, China
| | - Xiuxiu Xu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, China
| | - Pingping Yang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, China
| | - Dan Zhu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, China
| | - Haiyang Fang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, China
| | - Hongbing Wan
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, China
| | - Tao Wu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, China
| | - Yanqing Wu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, China
| | - Qinghua Wu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, China
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Alotaibi AS, Alabdan N, Alotaibi AM, Aljaafary H, Alqahtani M. The Utilization of Spironolactone in Heart Failure Patients at a Tertiary Hospital in Saudi Arabia. Cureus 2020; 12:e10032. [PMID: 32983725 PMCID: PMC7515793 DOI: 10.7759/cureus.10032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Heart failure (HF) has high morbidity and mortality rates. Spironolactone has shown a 30% reduction in all-cause mortality, reduction in hospitalizations, and sudden death. However, data shows low use of spironolactone in HF patients. We aim to assess spironolactone utilization in HF reduced Ejection Fraction (HFrEF) patients and to identify the factors affecting its prescribing. METHODS A retrospective cross-sectional study of patients diagnosed with HF from January 2016 to January 2017 conducted at King Abdulaziz Medical City-Riyadh. INCLUSION CRITERIA all adult HFrEF <40% who are eligible for spironolactone with New York Heart Association (NYHA) class II-IV. Serum creatinine should be <2.5 mg/dL in men or <2.0 mg/dL in women, or estimated glomerular filtration rate (eGFR) >30 mL/min/1.73m2 and potassium <5.0 mEq/L. EXCLUSION CRITERIA pediatrics, end-stage renal disease, primary aldosteronism, and allergy to spironolactone. RESULTS We screened around 5000 HF patients, of whom 368 were included. Among 195 patients who were not on spironolactone, 121 patients were eligible to use it; however, they did not receive it. One hundred seventy-three patients were on spironolactone, of whom 30 received the drug although they did not meet the eligibility criteria. The mean age of patients on spironolactone was 61±14 and the mean age of patients not on spironolactone was 66.6±15.6. Two hundred seventy-seven patients in the study population were male. Regarding comorbidities, 265 patients were diabetic. As for laboratory findings, the mean potassium for patients on spironolactone was 4.3 mEq/L; the creatinine and eGFR for patients on spironolactone were 82 umol/L (0.9 mg/dl) and 88 mL/min/1.73m2 while those not on spironolactone had higher creatinine at 93 umol/L (1 mg/dl) and eGFR 80 mL/min/1.73m2. Using multivariate regression, we found many factors affecting spironolactone utilization, including EF before spironolactone, serum creatinine, angiotensin-converting enzyme inhibitors (ACEI), angiotensin-II receptor antagonists (ARBs), furosemide, statin, and stroke. CONCLUSIONS Spironolactone for HFrEF is underutilized. EF before spironolactone, serum creatinine, ACEI, ARBs, furosemide, statin, and stroke significantly affect spironolactone utilization. Further studies are warranted to identify barriers affecting spironolactone utilization in HF patients from prescribers' perspectives.
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Affiliation(s)
- Abdulmalik S Alotaibi
- Pharmaceutical Care, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences/King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Numan Alabdan
- Pharmaceutical Care, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences/King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Abdullah M Alotaibi
- Medicine, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences/King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Haifa Aljaafary
- Pharmaceutical Care, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences/King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Mohammed Alqahtani
- Medicine, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences/King Abdulaziz Medical City - Ministry of National Guard Health Affairs, Riyadh, SAU
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Ng DLC, Chai CS, Tan KL, Chee KH, Tung YZ, Wai SY, Teo WTJ, Ang BT, Lim MA, Tan SB. The Efficacy of a Single Session of 20-Minute Mindful Breathing in Reducing Dyspnea Among Patients With Acute Decompensated Heart Failure: A Randomized Controlled Trial. Am J Hosp Palliat Care 2020; 38:246-252. [DOI: 10.1177/1049909120934743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Heart failure is the leading cause of morbidity and mortality worldwide. Standard treatment for heart failure includes pharmacotherapy and cardiac device implants. However, supportive approaches in managing dyspnea in heart failure are limited. This study aimed to test the efficacy of 20-minute mindful breathing in reducing dyspnea among patients admitted for acute decompensated heart failure. We conducted a parallel-group, non-blinded, randomized controlled trial of a single session of 20-minute mindful breathing plus standard care versus standard care alone among patients admitted for moderate to severe dyspnea due to acute decompensated heart failure, using the dyspnea score based on the Edmonton Symptom Assessment System (ESAS), at the Cardiology Unit of University Malaya Medical Centre in Malaysia. Thirty participants were randomly assigned to a single session of 20-minute mindful breathing plus standard care (n = 15) or standard care alone (n = 15), with no difference in their demographic and clinical characteristics. There was statistically significant reduction in dyspnea in the intervention group compared to the control group at minute 20 (U = 49.5, n1 = 15, n2 =15, median reduction in ESAS dyspnea score 1 = 2, median reduction in ESAS dyspnea score 2 = 0, mean rank 1 = 11.30, mean rank 2 = 19.70, z = −2.692, r = 0.4, P = 0.007). Our results provided evidence that a single session of 20-minute mindful breathing was efficacious in reducing dyspnea for patients admitted for acute decompensated heart failure.
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Affiliation(s)
- Diana Leh-Ching Ng
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Chee-Shee Chai
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Kok-Leng Tan
- Department of Medicine, Faculty of Medicine, University Sains Malaysia, Kelantan, Malaysia
| | - Kok-Han Chee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yu-Zhen Tung
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Suet-Yen Wai
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wei-Ting Joyce Teo
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Bin-Ting Ang
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Min-Ai Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Seng-Beng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Wierda E, Dickhoff C, Handoko ML, Oosterom L, Kok WE, de Rover Y, de Mol BAJM, van Heerebeek L, Schroeder-Tanka JM. Outpatient treatment of worsening heart failure with intravenous and subcutaneous diuretics: a systematic review of the literature. ESC Heart Fail 2020; 7:892-902. [PMID: 32159279 PMCID: PMC7261522 DOI: 10.1002/ehf2.12677] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 01/20/2020] [Accepted: 02/18/2020] [Indexed: 12/15/2022] Open
Abstract
Aims In the coming decade, heart failure (HF) represents a major global healthcare challenge due to an ageing population and rising prevalence combined with scarcity of medical resources and increasing healthcare costs. A transitional care strategy within the period of clinical worsening of HF before hospitalization may offer a solution to prevent hospitalization. The outpatient treatment of worsening HF with intravenous or subcutaneous diuretics as an alternative strategy for hospitalization has been described in the literature. Methods and results In this systematic review, the available evidence for the efficacy and safety of outpatient treatment with intravenous or subcutaneous diuretics of patients with worsening HF is analysed. A search was performed in the electronic databases MEDLINE and EMBASE. Of the 11 included studies 10 were single‐centre, using non‐randomized, observational registries of treatment with intravenous or subcutaneous diuretics for patients with worsening HF with highly variable selection criteria, baseline characteristics, and treatment design. One study was a randomized study comparing subcutaneous furosemide with intravenous furosemide. In a total of 984 unique individual patients treated in the reviewed studies, only a few adverse events were reported. Re‐hospitalization rates for HF at 30 and 180 days were 28 and 46%, respectively. All‐cause re‐hospitalization rates at 30 and 60 days were 18–37 and 22%, respectively. The highest HF re‐hospitalization was 52% in 30 days in the subcutaneous diuretic group and 42% in 30 days in the intravenous diuretic group. Conclusions The reviewed studies present practice‐based results of treatment of patients with worsening HF with intravenous or subcutaneous diuretics in an outpatient HF care unit and report that it is effective by relieving symptoms with a low risk of adverse events. The studies do not provide satisfactory evidence for reduction in rates of re‐hospitalization or improvement in mortality or quality of life. The conclusions drawn from these studies are limited by the quality of the individual studies. Prospective randomized studies are needed to determine the safety and effectiveness of outpatient intravenous or subcutaneous diuretic treatment for patient with worsening HF.
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Affiliation(s)
- Eric Wierda
- Department of Cardiology, Dijklander Ziekenhuis, Hoorn, The Netherlands
| | | | - Martin Louis Handoko
- Department of Cardiology, Amsterdam University Medical Center, location VU University Medical Center, Amsterdam, The Netherlands
| | - Liane Oosterom
- Department of Cardiology, Dijklander Ziekenhuis, Purmerend, The Netherlands
| | - Wouter Emmanuel Kok
- Department of Cardiology, Amsterdam University Medical Center, location Academic Medical Center, Amsterdam, The Netherlands
| | - Y de Rover
- Department of Medical Library, Dijklander Ziekenhuis, Hoorn, The Netherlands
| | - B A J M de Mol
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Loek van Heerebeek
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Dewilde S, Carroll K, Nivelle E, Sawyer J. Evaluation of the cost-effectiveness of dexrazoxane for the prevention of anthracycline-related cardiotoxicity in children with sarcoma and haematologic malignancies: a European perspective. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:7. [PMID: 32063753 PMCID: PMC7011276 DOI: 10.1186/s12962-020-0205-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/04/2020] [Indexed: 12/18/2022] Open
Abstract
Background Anthracycline-treated childhood cancer survivors are at higher risk of cardiotoxicity, especially with cumulative doses received above 250 mg/m2. Dexrazoxane is the only option recommended for cardiotoxicity prevention in high-risk patients supported by randomised trials but its cost-effectiveness in paediatric cancer patients has not been established. Methods A cost-effectiveness model applicable to different national healthcare system perspectives, which simulates 10,000 patients with either sarcoma or haematologic malignancies, based upon baseline characteristics including gender, age at diagnosis, cumulative anthracycline dose and exposure to chest irradiation. Risk equations for developing congestive heart failure and death from recurrence of the original cancer, secondary malignant neoplasms, cardiac death, pulmonary death, and death from other causes were derived from published literature. These are applied to the individual simulated patients and time until development of these events was determined. The treatment effect of dexrazoxane on the risk of CHF or death was based upon a meta-analysis of randomised and non-randomised dexrazoxane studies in each tumour type. The model includes country specific data for drug and administration costs, all aspects of heart failure diagnosis and management, and death due to different causes for each of the five countries considered; France, Germany, the UK, Italy, and Spain. Results Dexrazoxane treatment resulted in a mean QALY benefit across the five countries ranging from 0.530 to 0.683 per dexrazoxane-treated patient. Dexrazoxane was cost-effective for paediatric patients receiving anthracycline treatment for sarcoma and for haematologic malignancies, irrespective of the cumulative anthracycline dose received. The Incremental Cost Effectiveness Ratio (ICER) was favourable in all countries irrespective of anthracycline dose for both sarcoma and haematological malignancies (range: dominant to €2196). Individual ICER varied considerably according to country with dominance demonstrated for dexrazoxane in Spain and Italy and ratios approximately double the European average in the UK and Germany. Conclusions Dexrazoxane is a highly cost-effective therapy for the prevention of anthracycline cardiotoxicity in paediatric patients with sarcoma or haematological malignancies in Europe, irrespective of the healthcare system in which they receive treatment. These benefits persist when patients who receive doses of anthracycline > 250 mg/m2 are included in the model.
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Affiliation(s)
| | | | | | - James Sawyer
- Prism Ideas Ltd, Morston House, Beam Heath Way, Nantwich, CW5 6GD UK
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Ivynian SE, Newton PJ, DiGiacomo M. Patient preferences for heart failure education and perceptions of patient–provider communication. Scand J Caring Sci 2020; 34:1094-1101. [DOI: 10.1111/scs.12820] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/25/2019] [Accepted: 01/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Serra E. Ivynian
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT) Faculty of Health University of Technology Sydney Ultimo NSW Australia
| | | | - Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT) Faculty of Health University of Technology Sydney Ultimo NSW Australia
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Weeda ER, Su Z, Taber DJ, Bian J, Morinelli TA, Casey M, DuBay DA. Costs and factors associated with heart failure following kidney transplantation - a single-center retrospective cohort study. Transpl Int 2020; 33:414-422. [PMID: 31930584 DOI: 10.1111/tri.13571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/28/2019] [Accepted: 01/05/2020] [Indexed: 01/08/2023]
Abstract
The number of adults with heart failure (HF) will increase by ~50% between 2012 and 2030. Among kidney transplant recipients, HF accounts for 16% of all post-transplant admissions. We describe the burden of HF and predictors of healthcare utilization following kidney transplantation. We retrospectively identified adults who underwent kidney transplantation at our institution (01/2007-12/2017). Data were acquired from electronic health records, with healthcare utilization obtained from a statewide database. The HF incidence rate and prevalence were estimated for each year, total charges for HF and non-HF patients were compared, and logistic regression was employed for a 3-year predictive model of healthcare utilization associated with HF. Among 1731 kidney transplant recipients, the post-transplant HF incidence rate ranged from 1.91 (year 3) to 6.80 (year 10) per 100 person-years, while the prevalence increased from 31.7% (year 1) to 48.1% (year 10). Median charges were $75 837 (HF) compared to $42 940 (non-HF) per person-year (P < 0.001). Pretransplant HF [odds ratio (OR) = 3.12] and an eGFR < 45 (OR = 4.73) were the strongest predictors of HF encounters (P < 0.05 for both). We observed a high and increasing prevalence of HF, which was associated with twice the costs. Kidney transplant recipients would benefit from interventions aimed at mitigating HF risk factors.
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Affiliation(s)
- Erin R Weeda
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Zemin Su
- Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC, USA
| | - David J Taber
- Department of Pharmacy, Ralph H Johnson VAMC, Charleston, SC, USA.,Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - John Bian
- Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Thomas A Morinelli
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Michael Casey
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Derek A DuBay
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
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Porumb M, Iadanza E, Massaro S, Pecchia L. A convolutional neural network approach to detect congestive heart failure. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2019.101597] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Financial burden of heart failure in a developing country: cost analysis from Manipal Heart Failure Registry, India. J Public Health (Oxf) 2019. [DOI: 10.1007/s10389-019-01141-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Lassnig A, Rienmueller T, Kramer D, Leodolter W, Baumgartner C, Schroettner J. A novel hybrid modeling approach for the evaluation of integrated care and economic outcome in heart failure treatment. BMC Med Inform Decis Mak 2019; 19:229. [PMID: 31752819 PMCID: PMC6868721 DOI: 10.1186/s12911-019-0944-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 10/21/2019] [Indexed: 11/18/2022] Open
Abstract
Background Demographic changes, increased life expectancy and the associated rise in chronic diseases pose challenges to public health care systems. Optimized treatment methods and integrated concepts of care are potential solutions to overcome increasing financial burdens and improve quality of care. In this context modeling is a powerful tool to evaluate potential benefits of different treatment procedures on health outcomes as well as health care budgets. This work presents a novel modeling approach for simulating different treatment procedures of heart failure patients based on extensive data sets from outpatient and inpatient care. Methods Our hybrid heart failure model is based on discrete event and agent based methodologies and facilitates the incorporation of different therapeutic procedures for outpatient and inpatient care on patient individual level. The state of health is modeled with the functional classification of the New York Heart Association (NYHA), strongly affecting discrete state transition probabilities alongside age and gender. Cooperation with Austrian health care and health insurance providers allowed the realization of a detailed model structure based on clinical data of more than 25,000 patients. Results Simulation results of conventional care and a telemonitoring program underline the unfavorable prognosis for heart failure and reveal the correlation of NYHA classes with health and economic outcomes. Average expenses for the treatment of NYHA class IV patients of €10,077 ± €165 were more than doubled compared to other classes. The selected use case of a telemonitoring program demonstrated potential cost savings within two years of application. NYHA classes II and III revealed most potential for additional treatment measures. Conclusion The presented model allows performing extensive simulations of established treatment procedures for heart failure patients and evaluating new holistic methods of care and innovative study designs. This approach offers health care providers a unique, adaptable and comprehensive tool for decision making in the complex and socioeconomically challenging field of cardiovascular diseases.
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Wammes JJG, Auener S, van der Wees PJ, Tanke MAC, Bellersen L, Westert GP, Atsma F, Jeurissen PPT. Characteristics and health care utilization among patients with chronic heart failure: a longitudinal claim database analysis. ESC Heart Fail 2019; 6:1243-1251. [PMID: 31556246 PMCID: PMC6989283 DOI: 10.1002/ehf2.12512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 07/28/2019] [Accepted: 08/12/2019] [Indexed: 12/03/2022] Open
Abstract
AIMS This study aimed to determine the characteristics of patients with heart failure and high costs (top 1% and top 2-5% highest costs in perspective of the general population) and to explore the longitudinal health care utilization and persistency of high costs. METHODS AND RESULTS Longitudinal observational study using claims data from 2006 to 2014 in the Netherlands. We identified all patients that received a hospital treatment for chronic heart failure between 1 January 2008 and 31 December 2010. Of each selected patient, all claims from the Dutch curative health system and with a starting date between 1 January 2006 and 31 December 2014 were extracted. Pharmaceutical and hospital claims were used to establish characteristics and indicators for health care utilization. Descriptive analyses and generalized estimating equation models were used to analyse characteristics, longitudinal health care utilization and to identify factors associated with high costs. Our findings revealed that the difference in costs between top 1%, top 2-5%, and bottom 95% patients with heart failure was mainly driven by hospital costs; and the top 1% group experienced a remarkable increase of mental health costs. Top 1% and top 2-5% patients with heart failure differed from lower cost patients in their higher rate of chronic conditions, excessive polypharmacy, hospital admissions, and heart-related surgeries. Heart-related surgeries contributed to the incidental high costs in 54% of top 1% patients, and the costs of the remaining top 1% patients were driven by mental health and pharmaceuticals use and rates of chronic conditions and multimorbidity. Top 1% patients were relatively young. Anaemia, dementia, diseases of arteries, veins and lymphatic vessels, influenza, and kidney failure were significantly associated with high costs. The end-of-life period was predictive of top 1% and top 5% costs. More than 90% of the population incurred at least one top 5% year during follow-up, and 31.8% incurred at least one top 1% year. Fifty-seven per cent incurred multiple top 5% years whereas only 8.6% incurred multiple top 1% years. Top 5% years were more frequently consecutive than top 1% years. CONCLUSIONS Top 1% utilization occurs predominantly incidentally and among less than a third of patients with heart failure, whereas almost all patients with heart failure experience at least one top 5% year, and more than half experience two or more top 5% years. Both medical and psychiatric/psychosocial needs contribute to high costs in heart failure patients. Comprehensive and integrated efforts are needed to further improve quality of care and reduce unnecessary costs.
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Affiliation(s)
- Joost Johan Godert Wammes
- Scientific Center for Quality of Healthcare, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Stefan Auener
- Scientific Center for Quality of Healthcare, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Philip J van der Wees
- Scientific Center for Quality of Healthcare, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Marit A C Tanke
- Scientific Center for Quality of Healthcare, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Louise Bellersen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gert P Westert
- Scientific Center for Quality of Healthcare, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Femke Atsma
- Scientific Center for Quality of Healthcare, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Patrick P T Jeurissen
- Scientific Center for Quality of Healthcare, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
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Cost-utility analysis of an implantable cardioverterdefibrillator for the treatment of patients with ischemic or non-ischemic New York Heart Association class II or III heart failure in Colombia. BIOMÉDICA 2019; 39:502-512. [PMID: 31584764 PMCID: PMC7357361 DOI: 10.7705/biomedica.4235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Indexed: 11/21/2022]
Abstract
Introduction: The use of an implantable cardioverter-defibrillator reduces the probability of sudden cardiac death in patients with heart failure.Objective: To determine the cost-utility relationship of an implantable cardioverter-defibrillator compared to optimal pharmacological therapy for patients with ischemic or non-ischemic New York Heart Association class II or III (NYHA II-III) heart failure in Colombia.Materials and methods: We developed a Markov model including costs, effectiveness, and quality of life from the perspective of the Colombian health system. For the baseline case, we adopted a time horizon of 10 years and discount rates of 3% for costs and 3.5% for benefits.The transition probabilities were obtained from a systematic review of the literature. The outcome used was the quality-adjusted life years. We calculated the costs by consulting with the manufacturers of the device offered in the Colombian market and using national-level pricing manuals. We conducted probabilistic and deterministic sensitivity analyses.Results: In the base case, the incremental cost-effectiveness ratio for the implantable cardioverter-defibrillator was USD$ 13,187 per quality-adjusted life year gained. For a willingness-to-pay equivalent to three times the gross domestic product per capita as a reference (USD$ 19,139 in 2017), the device would be a cost-effective strategy for the Colombian health system. However, the result may change according to the time horizon, the probability of death, and the price of the device.Conclusions: The use of an implantable cardioverter-defibrillator for preventing sudden cardiac death in patients with heart failure would be a cost-effective strategy for Colombia. The results should be examined considering the uncertainty.
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Chen S, Pürerfellner H, Meyer C, Acou WJ, Schratter A, Ling Z, Liu S, Yin Y, Martinek M, Kiuchi MG, Schmidt B, Chun KRJ. Rhythm control for patients with atrial fibrillation complicated with heart failure in the contemporary era of catheter ablation: a stratified pooled analysis of randomized data. Eur Heart J 2019; 41:2863-2873. [DOI: 10.1093/eurheartj/ehz443] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/05/2019] [Accepted: 06/04/2019] [Indexed: 01/23/2023] Open
Abstract
Abstract
Aims
The optimal treatment for patients with atrial fibrillation (AF) and heart failure (HF) has been a subject of debate for years. We aimed to evaluate the efficacy and safety of rhythm control strategy in patients with AF complicated with HF regarding hard clinical endpoints.
Methods and results
Up-to-date randomized data comparing rhythm control using antiarrhythmic drugs (AADs) vs. rate control (Subset A) or rhythm control using catheter ablation vs. medical therapy (Subset B) in AF and HF patients were pooled. The primary outcomes were all-cause mortality, re-hospitalization, stroke, and thromboembolic events. A total of 11 studies involving 3598 patients were enrolled (Subset A: 2486; Subset B: 1112). As compared with medical rate control, the AADs rhythm control was associated with similar all-cause mortality [odds ratio (OR): 0.96, P = 0.65], significantly higher rate of re-hospitalization (OR: 1.25, P = 0.01), and similar rate of stroke and thromboembolic events (OR: 0.91, P = 0.76,); however, as compared with medical therapy, catheter ablation rhythm control was associated with significantly lower all-cause mortality (OR: 0.51, P = 0.0003), reduced re-hospitalization rate (OR: 0.44, P = 0.003), similar rate of stroke events (OR: 0.59, P = 0.27), greater improvement in left ventricular ejection fraction [weighted mean difference (WMD): 6.8%, P = 0.0004], lower arrhythmia recurrence (29.6% vs. 80.1%, OR: 0.04, P < 0.00001), and greater improvement in quality of life (Minnesota Living with Heart Failure Questionnaire score) (WMD: −9.1, P = 0.007).
Conclusion
Catheter ablation as rhythm control strategy substantially improves survival rate, reduces re-hospitalization, increases the maintenance rate of sinus rhythm, contributes to preserve cardiac function, and improves quality of life for AF patients complicated with HF.
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Affiliation(s)
- Shaojie Chen
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhelm-Epstein Straße 4, Frankfurt am Main 60431, Germany
| | - Helmut Pürerfellner
- Department für Elektrophysiologie, Akademisches Lehrkrankenhaus, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Christian Meyer
- Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herzzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany
| | | | - Alexandra Schratter
- Medizinische Abteilung mit Kardiologie, Krankenhaus Hietzing Wien, Vienna, Austria
| | - Zhiyu Ling
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Shaowen Liu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuehui Yin
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Martin Martinek
- Department für Elektrophysiologie, Akademisches Lehrkrankenhaus, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Marcio G Kiuchi
- School of Medicine-Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Boris Schmidt
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhelm-Epstein Straße 4, Frankfurt am Main 60431, Germany
| | - K R Julian Chun
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhelm-Epstein Straße 4, Frankfurt am Main 60431, Germany
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41
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Schmickl CN, Heckman E, Owens RL, Thomas RJ. The Respiratory Signature: A Novel Concept to Leverage Continuous Positive Airway Pressure Therapy as an Early Warning System for Exacerbations of Common Diseases such as Heart Failure. J Clin Sleep Med 2019; 15:923-927. [PMID: 31138387 DOI: 10.5664/jcsm.7852] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 04/16/2019] [Indexed: 01/18/2023]
Abstract
ABSTRACT Each night millions of patients use continuous positive airway pressure (CPAP) to treat obstructive sleep apnea (OSA). To facilitate monitoring of treatment success, modern CPAP machines routinely record and analyze the respiratory signal in near real-time and submit some of these data to the manufacturer's centralized cloud server. Some of the conditions frequently associated with OSA such as heart failure or chronic obstructive pulmonary disease result in characteristic changes of the respiratory signal ("signatures"), especially during exacerbations. Thus, this infrastructure could be leveraged to detect changes in patients' health status facilitating early interventions. To illustrate this concept, we present and discuss the case of a patient with OSA who showed abrupt changes in his breathing pattern (increase in periodic breathing and machine-detected obstructive apneas) from 10 days prior until 8 days after a hospitalization for acute heart failure exacerbation.
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Affiliation(s)
- Christopher N Schmickl
- University of California San Diego, San Diego, California.,Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Eric Heckman
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Robert L Owens
- University of California San Diego, San Diego, California
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42
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Affiliation(s)
- Mohamed S. Anwar
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Alan G. Japp
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Nicholas L. Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
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43
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Registry based analysis of cost-of-illness study among stage C heart failure patients at Hospital Queen Elizabeth II, Sabah, Malaysia. HEALTH POLICY AND TECHNOLOGY 2019. [DOI: 10.1016/j.hlpt.2019.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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44
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Abstract
The aim of this study is to perform a systematic review of the costing methodological approaches adopted by published cost-of-illness (COI) studies. A systematic review was performed to identify cost-of-illness studies of heart failure published between January 2003 and September 2015 via computerized databases such as Pubmed, Wiley Online, Science Direct, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Costs reported in the original studies were converted to 2014 international dollars (Int$). Thirty five out of 4972 studies met the inclusion criteria. Nineteen out of the 35 studies reported the costs as annual cost per patient, ranging from Int$ 908.00 to Int$ 84,434.00, while nine studies reported costs as per hospitalization, ranging from Int$ 3780.00 to Int$ 34,233.00. Cost of heart failure increased as condition of heart failure worsened from New York Heart Association (NYHA) class I to NYHA class IV. Hospitalization cost was found to be the main cost driver to the total health care cost. The annual cost of heart failure ranges from Int$ 908 to Int$ 40,971 per patient. The reported cost estimates were inconsistent across the COI studies, mainly due to the variation in term of methodological approaches such as disease definition, epidemiological approach of study, study perspective, cost disaggregation, estimation of resource utilization, valuation of unit cost components, and data sources used. Such variation will affect the reliability, consistency, validity, and relevance of the cost estimates across studies.
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Affiliation(s)
- Asrul Akmal Shafie
- Discipline of Social Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia.
| | - Yui Ping Tan
- Discipline of Social Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
| | - Chin Hui Ng
- Discipline of Social Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
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45
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González-Costello J, Comín-Colet J, Lupón J, Enjuanes C, de Antonio M, Fuentes L, Moliner-Borja P, Farré N, Zamora E, Manito N, Pujol R, Bayés-Genis A. Importance of iron deficiency in patients with chronic heart failure as a predictor of mortality and hospitalizations: insights from an observational cohort study. BMC Cardiovasc Disord 2018; 18:206. [PMID: 30382817 PMCID: PMC6211465 DOI: 10.1186/s12872-018-0942-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022] Open
Abstract
Background Iron deficiency (ID) in patients with chronic heart failure (CHF) is considered an adverse prognostic factor. We aimed to evaluate if ID in patients with CHF is associated with increased mortality and hospitalizations. Methods We evaluated ID in patients with CHF at 3 university hospitals. ID was defined as absolute (ferritin < 100 μg/L) or functional (transferrin Saturation index < 20% and ferritin between 100 and 299 μg/L). We excluded patients who received treatment with intravenous Iron or Erythropoietin during follow-up. We evaluated if ID was a predictor of death or hospitalization due to heart failure or any cause using univariate and multivariate cox regression analysis. Results We included 1684 patients, 65% males, 38% diabetics, median age of 72 years, 37% in functional class III-IV and 30% of patients with a left ventricular ejection fraction > 45%. Patients were well treated, with 87% and 88% of patients receiving renin-angiotensin inhibitors and beta-blockers, respectively. Median transferrin saturation index was 20%, median ferritin 155 ng/mL and median haemoglobin 13 g/dL. ID was present in 53% of patients; in 35% it was absolute and in 18% functional. Median follow-up was 20 months. ID was a predictor of death, hospitalization due to heart failure or to any cause in univariate analysis but not after multivariate analysis. No differences were found between absolute or functional ID regarding prognosis. Conclusion In a real life population of patients with CHF and a high prevalence of heart failure with preserved ejection fraction, ID did not predict mortality or hospitalizations after adjustment for comorbidities, functional class and neurohormonal treatment.
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Affiliation(s)
- José González-Costello
- Area de Enfermedades del Corazón, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Feixa Llarga SN, 08907, Barcelona, Spain.
| | - Josep Comín-Colet
- Area de Enfermedades del Corazón, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Feixa Llarga SN, 08907, Barcelona, Spain
| | - Josep Lupón
- Unidad de Insuficiencia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Cristina Enjuanes
- Servicio de Cardiología, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta de Antonio
- Unidad de Insuficiencia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Lara Fuentes
- Area de Enfermedades del Corazón, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Feixa Llarga SN, 08907, Barcelona, Spain
| | - Pedro Moliner-Borja
- Servicio de Cardiología, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Farré
- Servicio de Cardiología, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elisabet Zamora
- Unidad de Insuficiencia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
| | - Nicolás Manito
- Area de Enfermedades del Corazón, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Feixa Llarga SN, 08907, Barcelona, Spain
| | - Ramón Pujol
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antoni Bayés-Genis
- Unidad de Insuficiencia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
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46
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Liu J, Lu JJ, Zhou K, Wan J, Li Y, Cui XY, Gao Q, Huang YC, Li SN, Dong QZ, Lin Q. Comparison of the efficacy and acceptability of Chinese herbal medicine in adult patients with heart failure and reduced ejection fraction: study protocol for a systematic review and network meta-analysis. BMJ Open 2018; 8:e015678. [PMID: 29921675 PMCID: PMC6020971 DOI: 10.1136/bmjopen-2016-015678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Heart failure with reduced ejection fraction (HFrEF) is defined as the clinical diagnosis of heart failure (HF) and ejection fraction (EF) ≤40%, which is a severe public healthcare issue and brings a heavy social and economic burden for patients with HFrEF. Chinese herbal medicine (CHM) has a long history in treating HF. Questions concerning the efficacy and acceptability of CHM-related interventions in adult patients with HFrEF led us to use the method of systematic review and network meta-analysis to integrate direct and indirect evidence to create hierarchies for all CHM. METHODS AND ANALYSIS Nine medical databases, including PubMed, EMBASE (OVID), the Cochrane Library, Google Scholar, Web of Science, CNKI, VIP, Wanfang Database and CBM will be searched from the date of database inception to June 2015 (updated to March 2017) without language and publication status restriction. Completely randomised controlled trials (RCTs) comparing CHM or CHM plus routine treatment with CHM, CHM plus routine treatment, routine treatment, no treatment or placebo for adults with HFrEF will be examined. Our primary outcomes will include all-cause mortality, HF-related death, all-cause rehospitalisation, HF-related rehospitalisation and acceptability (discontinuation due to any adverse events during treatment). Secondary outcomes will include response rate, mean value or mean difference from baseline of surrogate indexes. We will perform the Bayesian network meta-analyses (NMA) for the most frequently reported primary or secondary outcome and the acceptability outcome, if available. Meta-regression, subgroup analyses and sensitivity analyses will be conducted based on prespecified effect modifiers to assess the robustness of the findings. DISSEMINATION The results of this NMA will provide useful information about the effectiveness and acceptability of CHM in adults with HFrEF, which will also have implications for clinical practice and further research. Findings will be disseminated through peer-reviewed journal publication and conference presentations. PROSPERO REGISTRATION NUMBER CRD42016053854.
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Affiliation(s)
- Jing Liu
- Beijing University of Chinese Medicine, BeiJing, China
| | - Jin-Jin Lu
- Cardiovascular Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Kun Zhou
- Department of Scientific Research, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jie Wan
- Intensive Care Unit, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yan Li
- Cardiovascular Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-Yun Cui
- Cardiovascular Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qun Gao
- Beijing University of Chinese Medicine, BeiJing, China
| | | | - Si-Nai Li
- Beijing Institute of Traditional Chinese Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Qiao-Zhi Dong
- Department of Education, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qian Lin
- Cardiovascular Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
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47
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Lesyuk W, Kriza C, Kolominsky-Rabas P. Cost-of-illness studies in heart failure: a systematic review 2004-2016. BMC Cardiovasc Disord 2018; 18:74. [PMID: 29716540 PMCID: PMC5930493 DOI: 10.1186/s12872-018-0815-3] [Citation(s) in RCA: 257] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 04/20/2018] [Indexed: 12/18/2022] Open
Abstract
Background Heart failure is a major and growing medical and economic problem worldwide as 1–2% of the healthcare budget are spent for heart failure. The prevalence of heart failure has increased over the past decades and it is expected that there will be further raise due to the higher proportion of elderly in the western societies. In this context cost-of-illness studies can significantly contribute to a better understanding of the drivers and problems which lead to the increasing costs in heart failure. The aim of this study was to perform a systematic review of published cost-of-illness studies related to heart failure to highlight the increasing cost impact of heart failure. Methods A systematic review was conducted from 2004 to 2016 to identify cost-of-illness studies related to heart failure, searching PubMed (Medline), Cochrane, Science Direct (Embase), Scopus and CRD York Database. Results Of the total of 16 studies identified, 11 studies reported prevalence-based estimates, 2 studies focused on incidence-based data and 3 articles presented both types of cost data. A large variation concerning cost components and estimates can be noted. Only three studies estimated indirect costs. Most of the included studies have shown that the costs for hospital admission are the most expensive cost element. Estimates for annual prevalence-based costs for heart failure patients range from $868 for South Korea to $25,532 for Germany. The lifetime costs for heart failure patients have been estimated to $126.819 per patient. Conclusions Our review highlights the considerable and growing economic burden of heart failure on the health care systems. The cost-of-illness studies included in this review show large variations in methodology used and the cost results vary consequently. High quality data from cost-of-illness studies with a robust methodology applied can inform policy makers about the major cost drivers of heart failure and can be used as the basis of further economic evaluations. Electronic supplementary material The online version of this article (10.1186/s12872-018-0815-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wladimir Lesyuk
- Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany. .,National Leading-Edge Cluster Medical Technologies 'Medical Valley EMN', Erlangen, Bavaria, Germany.
| | - Christine Kriza
- Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,National Leading-Edge Cluster Medical Technologies 'Medical Valley EMN', Erlangen, Bavaria, Germany
| | - Peter Kolominsky-Rabas
- Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,National Leading-Edge Cluster Medical Technologies 'Medical Valley EMN', Erlangen, Bavaria, Germany
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48
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Čerlinskaitė K, Hollinger A, Mebazaa A, Cinotti R. Finding the balance between costs and quality in heart failure: a global challenge. Eur J Heart Fail 2018; 20:1175-1178. [PMID: 29673007 DOI: 10.1002/ejhf.1195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/07/2018] [Accepted: 03/08/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Kamilė Čerlinskaitė
- Inserm UMR-S 942, Paris, France.,Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique des Hopitaux de Paris, Paris, France.,Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Alexa Hollinger
- Inserm UMR-S 942, Paris, France.,Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique des Hopitaux de Paris, Paris, France.,Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Alexandre Mebazaa
- Inserm UMR-S 942, Paris, France.,Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique des Hopitaux de Paris, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Raphaël Cinotti
- Inserm UMR-S 942, Paris, France.,Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisière, Assistance Publique des Hopitaux de Paris, Paris, France.,Department of Anesthesia and Critical Care, University Hospital of Nantes, Nantes Cedex, France
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49
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Direction of the Relationship Between Acceptance of Illness and Health-Related Quality of Life in Chronic Heart Failure Patients. J Cardiovasc Nurs 2018; 32:348-356. [PMID: 27685859 DOI: 10.1097/jcn.0000000000000365] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study provides an in-depth insight into the relationships between illness acceptance and health-related quality of life (HRQoL) of chronic heart failure (CHF) patients. Although HRQoL is a well-established endpoint in CHF, little is known on illness acceptance in this group. AIMS The aim of this study is to critically reconsider the direction of a relationship between HRQoL and illness acceptance in CHF patients. METHODS The study included 204 patients (160 men and 44 women; mean age, 63 ± 11 years) with at least 6-month clinical evidence of CHF corresponding to New York heart Association (NYHA) classes I to IV. All the patients were examined with the Minnesota Living With Heart Failure Questionnaire (MLHFQ) and Acceptance of Illness Scale (AIS). RESULTS Univariate analysis showed that the level of illness acceptance correlated inversely with patient age, and the level of HRQoL decreased with the severity of CHF (NYHA class). A relationship between illness acceptance and HRQoL was analyzed by structural equation modeling. Model 1 was based on the assumption that HRQoL is modulated by illness acceptance, and model 2 tested the opposite relationship. Both models included patient age and NYHA class as extrinsic determinants of AIS and MLHFQ scores, respectively. Model 2 proved to be well fitted (χ [df = 2] = 3.22, P = .20, root-mean-square error of approximation = 0.055). Scores on the AIS correlated inversely with age (bage->AIS = -0.15, SE = 0.05, P = .002) and HRQoL (bQoL->AIS = -0.15, SE = 0.02, P < .001), and an increase in NYHA class was reflected by an increase in HRQoL scores (bNYHA->QoL = 5.75, SE = 1.97, P = .004). CONCLUSION Patients with CHF may not accept their disease due to deteriorated HRQoL. As a result, they may be uninvolved in the therapeutic process, which leads to exacerbation of CHF, further deterioration of HRQoL, and inability to accept the illness.
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50
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Smeets CJ, Storms V, Vandervoort PM, Dreesen P, Vranken J, Houbrechts M, Goris H, Grieten L, Dendale P. A Novel Intelligent Two-Way Communication System for Remote Heart Failure Medication Uptitration (the CardioCoach Study): Randomized Controlled Feasibility Trial. JMIR Cardio 2018; 2:e8. [PMID: 31758773 PMCID: PMC6834244 DOI: 10.2196/cardio.9153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/19/2017] [Accepted: 01/02/2018] [Indexed: 12/16/2022] Open
Abstract
Background European Society of Cardiology guidelines for the treatment of heart failure (HF) prescribe uptitration of angiotensin-converting enzyme inhibitors (ACE-I) and β-blockers to the maximum-tolerated, evidence-based dose. Although HF prognosis can drastically improve when correctly implementing these guidelines, studies have shown that they are insufficiently implemented in clinical practice. Objective The aim of this study was to verify whether supplementing the usual care with the CardioCoach follow-up tool is feasible and safe, and whether the tool is more efficient in implementing the guideline recommendations for β-blocker and ACE-I. Methods A total of 25 HF patients were randomly assigned to either the usual care control group (n=10) or CardioCoach intervention group (n=15), and observed for 6 months. The CardioCoach follow-up tool is a two-way communication platform with decision support algorithms for semiautomatic remote medication uptitration. Remote monitoring sensors automatically transmit patient’s blood pressure, heart rate, and weight on a daily basis. Results Patients’ satisfaction and adherence for medication intake (10,018/10,825, 92.55%) and vital sign measurements (4504/4758, 94.66%) were excellent. However, the number of technical issues that arose was large, with 831 phone contacts (median 41, IQR 32-65) in total. The semiautomatic remote uptitration was safe, as there were no adverse events and no false positive uptitration proposals. Although no significant differences were found between both groups, a higher number of patients were on guideline-recommended medication dose in both groups compared with previous reports. Conclusions The CardioCoach follow-up tool for remote uptitration is feasible and safe and was found to be efficient in facilitating information exchange between care providers, with high patient satisfaction and adherence. Trial Registration ClinicalTrials.gov NCT03294811; https://clinicaltrials.gov/ct2/show/NCT03294811 (Archived by WebCite at http://www.webcitation.org/6xLiWVsgM)
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Affiliation(s)
- Christophe Jp Smeets
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Valerie Storms
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Pieter M Vandervoort
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Pauline Dreesen
- Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Julie Vranken
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Future Health Department, Ziekenhuis Oost-Limburg, Genk, Belgium.,Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | | | - Hanne Goris
- Department of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Lars Grieten
- Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Paul Dendale
- Department of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
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