1
|
Zheng H, Zhan H. Preventing Anthracycline-Associated Heart Failure: What Is the Role of Dexrazoxane?: JACC: CardioOncology Controversies in Cardio-Oncology. JACC CardioOncol 2024; 6:318-321. [PMID: 38774009 PMCID: PMC11103021 DOI: 10.1016/j.jaccao.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024] Open
Affiliation(s)
- Haoyi Zheng
- Saint Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Huichun Zhan
- Department of Medicine, Stony Brook School of Medicine, Stony Brook, New York, USA
- Medical Service, Northport VA Medical Center, Northport, New York, USA
| |
Collapse
|
2
|
Mahmoudi Z, Chenaghlou M, Zare H, Safaei N, Yousefi M. Heart failure: a prevalence-based and model-based cost analysis. Front Cardiovasc Med 2023; 10:1239719. [PMID: 38107256 PMCID: PMC10722181 DOI: 10.3389/fcvm.2023.1239719] [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: 06/13/2023] [Accepted: 09/08/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Heart failure (HF) imposes a heavy economic burden on patients, their families, and society as a whole. Therefore, it is crucial to quantify the impact and dimensions of the disease in order to prioritize and allocate resources effectively. Methods This study utilized a prevalence-based, bottom-up, and incidence-based Markov model to assess the cost of illness. A total of 502 HF patients (classes I-IV) were recruited from Madani Hospital in Tabriz between May and October 2022. Patients were followed up every two months for a minimum of two and a maximum of six months using a person-month measurement approach. The perspective of the study was societal, and both direct and indirect costs were estimated. Indirect costs were calculated using the Human Capital (HC) method. A two-part regression model, consisting of the Generalized Linear Model (GLM) and Probit model, was used to analyze the relationship between HF costs and clinical and demographic variables. Results The total cost per patient in one year was 261,409,854.9 Tomans (21,967.21 PPP). Of this amount, 207,147,805.8 Tomans (17,407.38 PPP) (79%) were indirect costs, while 54,262,049.09 Tomans (4,559.84 PPP) (21%) were direct costs. The mean lifetime cost was 2,173,961,178 Tomans. Premature death accounted for the highest share of lifetime costs (48%), while class III HF had the lowest share (2%). Gender, having basic insurance, and disease class significantly influenced the costs of HF, while comorbidity and age did not have a significant impact. The predicted amount closely matched the observed amount, indicating good predictive power. Conclusion This study revealed that HF places a significant economic burden on patients in terms of both direct and indirect costs. The substantial contribution of indirect costs, which reflect the impact of the disease on other sectors of the economy, highlights the importance of unpaid work. Given the significant variation in HF costs among assessed variables, social and financial support systems should consider these variations to provide efficient and fair support to HF patients.
Collapse
Affiliation(s)
- Zahra Mahmoudi
- Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Chenaghlou
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Naser Safaei
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmood Yousefi
- Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
3
|
Drak D, Fulcher J, Kilian J, Chong JJH, Grover R, Sindone AP, Adams M, Lattimore JD, Keech AC. Guideline-based audit of the hospital management of heart failure with reduced ejection fraction. Intern Med J 2023; 53:1595-1601. [PMID: 35666643 DOI: 10.1111/imj.15830] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heart failure is a major burden in Australia in terms of morbidity, mortality and healthcare expenditure. Multiple evidence-based therapies are recommended for heart failure with reduced ejection fraction (HFrEF), but data on physician adherence to therapy guidelines are limited. AIM To compare use of HFrEF therapies against current evidence-based guidelines in an Australian hospital inpatient population. METHODS A retrospective review of patients admitted with a principal diagnosis of HFrEF across six metropolitan hospitals in Sydney, Australia, between January 2015 and June 2016. Use of medical and device therapies was compared with guideline recommendations using individual patient indications/contraindications. Readmission and mortality data were collected for a 1-year period following the admission. RESULTS Of the 1028 HFrEF patients identified, 39 were being managed with palliative intent, leaving 989 patients for the primary analysis. Use of beta-blockers (87.7% actual use/93.6% recommended use) and diuretics (88.4%/99.3%) was high among eligible patients. There were large evidence-practice gaps for angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB; 66.4%/89.0%) and aldosterone antagonists (41.0%/77.1%). In absolute terms, use of these therapies each increased by over 11% from admission. Ivabradine (11.5%/21.2%), automated internal cardiac defibrillators (29.5%/66.1%) and cardiac resynchronisation therapy (13.1%/28.7%) were used in a minority of eligible patients. Over the 1-year follow-up period, the mortality rate was 14.8%, and 44.2% of patients were readmitted to hospital at least once. CONCLUSION Hospitalisation is a key mechanism for initiation of HFrEF therapies. The large evidence-practice gaps for ACEI/ARB and aldosterone antagonists represent potential avenues for improved HFrEF management.
Collapse
Affiliation(s)
- Douglas Drak
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Jordan Fulcher
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia
| | - Jens Kilian
- Department of Cardiology, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
| | - James J H Chong
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
- Centre for Heart Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Rominder Grover
- Sydney Local Health District, Canterbury Hospital, Sydney, New South Wales, Australia
| | - Andrew P Sindone
- Heart Failure Unit, Department of Cardiac Rehabilitation, Concord Hospital, Sydney, New South Wales, Australia
| | - Mark Adams
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jo-Dee Lattimore
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Anthony C Keech
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
Khajavi A, Moshki M, Minaee S, Vakilian F, Montazeri A, Hashemizadeh H. Chronic heart failure health-related quality of life questionnaire (CHFQOLQ-20): development and psychometric properties. BMC Cardiovasc Disord 2023; 23:165. [PMID: 36991337 PMCID: PMC10061999 DOI: 10.1186/s12872-023-03197-9] [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: 08/27/2022] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is an important outcome indicator for chronic diseases. This study aimed to develop a new instrument for assessment of HRQoL in chronic heart failure (CHF) and evaluate its psychometric properties. METHODS This study included two steps of conceptualization and item generation, and assessment of the psychometric properties of an instrument for measuring HRQoL in patients with CHF. A sample of 495 patients with confirmed diagnosis of heart failure participated in the study. In addition to content validity, exploratory and confirmatory factor analyses, concurrent validity, convergent validity, known groups comparison were performed to assess construct validity. Internal consistency, and stability were estimated by the Cronbach's alpha, the MacDonal's Omega, and intraclass correlation coefficients. RESULTS The content validity of the developed chronic heart failure quality of life questionnaire was assessed by 10 experts. The exploratory factor analysis indicated a four-factor solution for the instrument containing 21 items that jointly accounted for 65.65% of variance observed. The confirmatory factor analysis confirmed the four factor solution with the following fit indexes (χ2/df = 2.214, CFI = 0.947, NFI = 0.91, TLI = 0.937, IFI = 0.947, GFI = 0.899, AGFI = 0.869, RMSEA = 0.063). However, at this stage one item was removed. The concurrent and convergent validity of the CHFQOLQ-20 were established using the Short Form Health Survey (SF-36), and the MacNew Heart Disease Quality of Life Questionnaire, respectively. The known-groups validity as assessed by using the New York Heart Association (NYHA) functional classification showed that the questionnaire discriminated well between patients who differed in functional classification. The internal consistency and test-retest reliability of the CHFQOLQ-20 were satisfactory, with a Cronbach's alpha and intraclass correlation coefficient (ICC) values of 0.93 and 0.84, respectively. CONCLUSION The results confirmed that CHFQOLQ-20 is a valid and reliable instrument for measuring quality of life (QoL) in patients with CHF. It is a short and easy-to-use instrument that is also capable of assessing the cognitive functioning, which has been overlooked in previous questionnaires.
Collapse
Affiliation(s)
- Abdoljavad Khajavi
- Department of Community Medicine, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Mahdi Moshki
- Department of Health Education and Health Promotion, School of Health, Gonabad University of Medical Sciences, Gonabad, Iran.
- Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.
| | - Shima Minaee
- Department of Cardiovascular Diseases, Razavi Hospital, Mashhad, Iran
| | - Farveh Vakilian
- Department of Cardiology, Preventive Atherosclerotic Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Montazeri
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
- Faculty of Humanity Sciences, University of Sciences & Culture, Tehran, Iran
| | - Haydeh Hashemizadeh
- Department of Nursing, Quchan Branch, Islamic Azad University, Quchan, Iran.
| |
Collapse
|
5
|
Pradhan SK, Adnani H, Safadi R, Yerigeri K, Nayak S, Raina R, Sinha R. Cardiorenal syndrome in the pediatric population: A systematic review. Ann Pediatr Cardiol 2022; 15:493-510. [PMID: 37152514 PMCID: PMC10158476 DOI: 10.4103/apc.apc_50_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/26/2022] [Accepted: 08/17/2022] [Indexed: 03/03/2023] Open
Abstract
The concept of cardiorenal syndrome (CRS) is derived from the crosstalk between the heart and kidneys in pathological conditions. Despite the rising importance of CRS, there is a paucity of information on the understanding of its pathophysiology and management, increasing both morbidity and mortality for patients. This review summarizes the existing conceptual pathophysiology of different types of CRS and delves into the associated therapeutic modalities with a focus on pediatric cases. Prospective or retrospective observational studies, comparative studies, case reports, case-control, and cross-sectional studies that include pediatric patients with CRS were included in this review. Literature was searched using PubMed, EMBASE, and Google Scholar with keywords including "cardio-renal syndrome, type," "reno-cardio syndrome," "children," "acute kidney injury," and "acute decompensated heart failure" from January 2000 to January 2021. A total of 14 pediatric studies were ultimately included and analyzed, comprising a combined population of 3608 children of which 32% had CRS. Of the 14 studies, 57% were based on type 1 CRS, 14% on types 2 and 3 CRS, and 7% were on types 4 and 5 CRS. The majority of included studies were prospective cohort, although a wide spectrum was observed in terms of patient age, comorbidities, etiologies, and treatment strategies. Commonly observed comorbidities in CRS type 1 were hematologic, oncologic, cardiology-related side effects, muscular dystrophy, and pneumonia/bronchiolitis. CRS, particularly type 1, is prevalent in children and has a significant risk of mortality. The current treatment regimen primarily involves diuretics, extracorporeal fluid removal, and treatment of underlying etiologies and comorbidities.
Collapse
Affiliation(s)
- Subal Kumar Pradhan
- Division of Pediatric Nephrology, Sardar Vallabhbhai Patel Post Graduate Institute of Pediatrics and SCB Medical College, Cuttack, Odisha, India
| | - Harsha Adnani
- Anne Arundel Medical Center, Luminis Health System, Annapolis, Maryland, USA
| | - Rama Safadi
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio, USA
| | - Keval Yerigeri
- Department of Nephrology, Akron, Ohio, USA, Children’s Hospital, Akron, Ohio, USA
| | - Snehamayee Nayak
- Department of Pediatrics, Sardar Vallabhbhai Patel Post Graduate Institute of Pediatrics and SCB Medical College, Cuttack, Odisha, India
| | - Rupesh Raina
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio, USA
- Department of Nephrology, Akron, Ohio, USA, Children’s Hospital, Akron, Ohio, USA
| | - Rajiv Sinha
- Division of Pediatric Nephrology, Institute of Child Health, Kolkata, West Bengal, India
- Department of Pediatrics, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| |
Collapse
|
6
|
Bundgaard JS, Mogensen UM, Christensen S, Ploug U, Rørth R, Ibsen R, Kjellberg J, Køber L. Healthcare cost variation in patients with heart failure: a nationwide study. Public Health 2022; 207:88-93. [PMID: 35594807 DOI: 10.1016/j.puhe.2022.03.019] [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: 08/19/2021] [Revised: 01/28/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Heart failure (HF) imposes a major economic burden; however, the individual management for patients varies, potentially leading to large cost heterogeneity. The aim of this study was to investigate the spectrum of health cost by patients with HF and factors associated with high direct health cost. STUDY DESIGN This was a nationwide, retrospective longitudinal study. METHODS Using Danish nationwide registries from 2012 to 2015, we identified all patients aged >18 years with a first-time diagnosis of HF. Total health costs were investigated using two perspectives-at index and during 3 years of follow-up. Patients were investigated by decile cost groups. A multivariable logistic regression was used to identify variables associated with being in the highest cost decile compared with the rest (90%). RESULTS A total of 11,170 patients with HF were included, and those in the highest cost decile (n = 1117, 10%) were younger (69 vs. 75 years), fewer were females (34% vs. 43%), and more were inpatients (83% vs. 70%) compared with the rest of the patients with HF (n = 10,053, 90%). Patients in the highest cost decile (10%) incurred a 30 times higher cost with a mean total health cost in index year of €86,607 compared with €2893 for patients in lowest cost decile (10%). The results were similar for 3 years aggregated (€139,473 vs. €4086), corresponding to a 34 times higher cost. CONCLUSION In patients with HF, a large total health cost heterogeneity exists with younger age, inpatient admittance, male sex, and comorbidities being associated with a higher likelihood of belonging to the highest cost group.
Collapse
Affiliation(s)
- J Skov Bundgaard
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark.
| | - U M Mogensen
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark
| | | | | | - R Rørth
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark
| | | | - J Kjellberg
- Danish Institute for Health Services Research, Copenhagen, Denmark
| | - L Køber
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark
| |
Collapse
|
7
|
Almeida DRD, Pereira-Barretto AC, Forestiero FJ, Nakamuta JS, Bichels A. The Medical Burden of Heart Failure: A Comparative Delineation with Cancer in Brazil. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.36660/ijcs.20200382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
8
|
Heidarpour M, Sourani Z, Vakhshoori M, Bondariyan N, Emami SA, Fakhrolmobasheri M, Seyedhossaini S, Shafie D. Prognostic utility of shock index and modified shock index on long-term mortality in acute decompensated heart failure; Persian Registry of cardioVascular diseasE/Heart Failure (PROVE/HF) study. Acta Cardiol 2022; 78:217-226. [PMID: 35098893 DOI: 10.1080/00015385.2022.2030554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Shock index (SI) and modified SI (MSI) are used for prognosis in patients with cardiovascular diseases (CVDs), especially myocardial infarction. However, the utility of these indices in heart failure(HF) is less frequently investigated. We aimed to evaluate the long-term prognostic capability of SI and MSI among Iranian HF patients. METHODS This retrospective cohort study was implemented in the context of the Persian Registry Of cardioVascular diseasE/HF (PROVE/HF). A total of 3896 acute decompensated HF (ADHF) patients were enrolled from March 2016 to March 2020. SI and MSI were assessed at admission. Receiver operating characteristic (ROC) and Kaplan-Meier curves were used to define optimum SI and MSI cut-off points and depict mortality during follow-up, respectively. The association of CVD death according to different SI and MSI cut-off points and quartiles was assessed through univariate and multivariate regression hazard models. RESULTS Mean age of participants was 70.22 ± 12.65 years (males: 62.1%). We found 0.66 (sensitivity:62%, specificity: 51%) and 0.87 (sensitivity: 61%, specificity: 51%) as optimised cut-off points for SI and MSI, respectively. Mean follow-up was 10.26 ± 7.5 months and 1110 (28.5%) deaths occurred during this time. Multivariate adjusted models revealed patients had SI ≥ 0.66 or within the third and fourth quartiles had higher likelihood of mortality compared to reference group (hazard ratio(HR): 1.58, 95%CI: 1.39-1.80, p < 0.001, HR: 1.38,95%CI:1.14-1.66, p = 0.001 and HR:2.00,95%CI:1.68-2.38, p < 0.001, respectively). MSI outcomes were similar (MSI ≥ 0.87: HR: 1.52,95%CI: 1.34-1.72, p < 0.001, third quartile (0.89 ≤ MSI < 1.00):HR:1.23,95%CI:1.009-1.50, p = 0.041, fourth quartile (MSI ≥ 1.00): HR: 1.80,95%CI: 1.53-2.13, p < 0.001). Kaplan-Meier curves showed patients with higher SI and MSI cut-off values and quartiles had lower survival rates. CONCLUSION Higher SI and MSI values were associated with increased mortality risk, and these two bedside indices could be appropriately considered for long-term prognosis in ADHF patients.
Collapse
Affiliation(s)
- Maryam Heidarpour
- Department of Endocrinology, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Sourani
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrbod Vakhshoori
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Niloofar Bondariyan
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sayed Ali Emami
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Fakhrolmobasheri
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Davood Shafie
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
9
|
Lorenzovici L, Bârzan-Székely A, Farkas-Ráduly S, Pană BC, Csanádi M, Chiriac ND, Kaló Z. Burden of Chronic Heart Failure in Romania. Healthcare (Basel) 2022; 10:healthcare10010107. [PMID: 35052271 PMCID: PMC8775306 DOI: 10.3390/healthcare10010107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/03/2022] [Accepted: 01/03/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic heart failure (CHF) affects millions of people across the world, with increasing trends in prevalence, putting ever increasing pressure on the healthcare system. The aim of this study was to assess the financial burden of CHF hospital care on the public healthcare sector in Romania by estimating the number of inpatient episodes and the associated costs. Additionally, societal costs associated with missed work and premature death of CHF patients were also estimated. The national claims database was analyzed to estimate the number of CHF patients. Cost data was extracted from a pool of nine public hospitals in Romania. In 2019, 375,037 CHF patient episodes were identified on specific wards at the national level. The average cost calculated for the selected nine hospitals was EUR 996. The calculated weighted national average cost per patient episode was EUR 1002, resulting in a total cost of EUR 376 million at the national level. The cost of workdays missed summed up to EUR 122 million, while the annual costs associated with the premature death of CHF patients was EUR 230 million. In conclusion, the prevalence of CHF in Romania is high, accounting for a large proportion of hospitalizations, which translates into large costs for the national payer.
Collapse
Affiliation(s)
- László Lorenzovici
- Syreon Research Romania, 540004 Tirgu Mures, Romania; (L.L.); (S.F.-R.)
- Department of Doctoral Studies, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, 540142 Tirgu Mures, Romania
| | - Andrea Bârzan-Székely
- Syreon Research Romania, 540004 Tirgu Mures, Romania; (L.L.); (S.F.-R.)
- Correspondence:
| | | | - Bogdan C. Pană
- Department of Public Health, University of Medicine and Pharmacy “Carol Davila” Bucharest, 020021 Bucharest, Romania;
| | - Marcell Csanádi
- Syreon Research Institute, 1142 Budapest, Hungary; (M.C.); (Z.K.)
| | | | - Zoltán Kaló
- Syreon Research Institute, 1142 Budapest, Hungary; (M.C.); (Z.K.)
- Center for Health Technology Assessment, Semmelweis University, 1091 Budapest, Hungary
| |
Collapse
|
10
|
Kebe B, Getachew M, Molla Y, Bahiru B, Dessie B. Management, survival, and predictors of mortality among hospitalized heart failure patients at Debre Markos comprehensive specialized hospital, Northwest Ethiopia: Prospective cohort study. SAGE Open Med 2021; 9:20503121211057336. [PMID: 34925834 PMCID: PMC8673877 DOI: 10.1177/20503121211057336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/14/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Heart failure is a major public health problem worldwide. Since heart failure with reduced ejection fraction and preserved ejection fraction are different clinical entities, in-hospital mortality may occur at different rates. This study aimed to assess the management, survival, and predictors of mortality among hospitalized heart failure patients at Debre Markos comprehensive specialized medical ward. Methods: A prospective cohort study was conducted on 228 heart failure patients at Debre Markos Comprehensive Specialized Hospital medical wards. A structured data collection tool was used to collect data. Data were analyzed using SPSS version 21.0. The Kaplan–Meier survival curve was used to investigate if there was a difference in the in-hospital survival between heart failure with a reduced ejection fraction and heart failure with a preserved ejection fraction. Those variables having p-value < 0.05 were considered statistically significant. Results: From the 228 participants, 126 (55.3%) were females with a mean age of 53.32 ± 15.68 years. One hundred thirty-three (58.3%) patients were presented with preserved (⩾50%) level of ejection fraction. The all-cause in-hospital death rate was 12.7%, and the risk of in-hospital mortality was higher in heart failure patients with reduced ejection fraction (7.4% vs 5.3%; p = 0.005). Current occupation (p = 0.041), elevated serum creatinine (p = 0.010), reduced ejection fraction (p = 0.017), and asthma/chronic obstructive pulmonary disease comorbidity (p = 0.002) were the independent predictors of high hospital mortality. Conclusion: The rate of in-hospital mortality among heart failure patients was high. Healthcare providers should provide effective education activities and define disease management strategies for patients with reduced ejection fractions.
Collapse
Affiliation(s)
- Bekalu Kebe
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Melese Getachew
- Pharmaceutics Unit, Department of Pharmacy, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Yalew Molla
- Pharmacology Unit, Department of Pharmacy, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Bereket Bahiru
- Social Pharmacy Unit, Department of Pharmacy, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Bekalu Dessie
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| |
Collapse
|
11
|
Helms TM, Perings CA, Sommer P, Köhler F, Frey N, von Haehling S, Tiefenbacher C, Rybak K, Sack S, Stockburger M. Positionspapier zur Zertifizierung von Telemedizinzentren. DER KARDIOLOGE 2021. [DOI: 10.1007/s12181-021-00522-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
12
|
Helms TM, Köpnick A, Leber A, Zugck C, Steen H, Karle C, Remppis A, Zippel-Schultz B. [Heart failure care in a digitalized future : A discourse on resource-sparing structures and self-determined patients]. Internist (Berl) 2021; 62:1180-1190. [PMID: 34648044 DOI: 10.1007/s00108-021-01173-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
Digital health solutions, applications of artificial intelligence (AI) and new technologies, such as cardiac magnetic resonance imaging and cardiac human genetics are currently being validated in cardiac healthcare pathways. They show promising approaches for improving existing healthcare structures in the future by strengthening the focus on predictive, preventive and personalized medicine. In addition, the accompanying use of digital health applications will become increasingly more important in the future healthcare, especially in patients with chronic diseases. In this article, the authors describe a case of chronic heart failure (HF) as an example to provide an overview of how digitalized healthcare can be efficiently designed across sectors and disciplines in the future. Moreover, the importance of a self-determined patient management for the treatment process itself is underlined. Since HF is frequently accompanied by various comorbidities during the course of the disease that are often recognized only after a delay, the necessity for a timely simultaneous and preventive treatment of multiple comorbidities in cardiovascular diseases is emphasized. Against this background the currently separately applied disease management programs (DMP) are critically questioned. The development of a holistic DMP encompassing all indications for the treatment of chronic diseases may pave the way to a more efficient medical care system.
Collapse
Affiliation(s)
- Thomas M Helms
- Deutsche Stiftung für chronisch Kranke, Fürth, Deutschland. .,Peri Cor Arbeitsgruppe Kardiologie/Ass. UCSF, Hamburg, Deutschland.
| | - Anne Köpnick
- Deutsche Stiftung für chronisch Kranke, Fürth, Deutschland
| | | | - Christian Zugck
- Kardiologie, Kardiologische Praxis im Steiner Thor, Straubing, Deutschland
| | | | | | - Andrew Remppis
- Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Deutschland
| | | |
Collapse
|
13
|
Gokhroo RK, Anushri K, Tarik MT, Kailash C, Rajesh N, Ashish K, Manish G, Subhash C. 1 year follow Up results of "ARTIM HF TRIAL" (angiotensin receptor neprilysin inhibitor effect on TEI index & left ventricular mass in heart failure). Indian Heart J 2021; 73:205-210. [PMID: 33865519 PMCID: PMC8065347 DOI: 10.1016/j.ihj.2021.01.010] [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] [Received: 04/07/2020] [Revised: 12/08/2020] [Accepted: 01/08/2021] [Indexed: 12/11/2022] Open
Abstract
Background Sacubitril/Valsartan (ARNI) has now class 1 recommendation for treatment of heart failure with reduced ejection fraction (HFrEF). It has been shown to reduce cardiovascular morbidity & mortality in Heart failure with reduced ejection fraction (HFrEF) and significant improvement in all echocardiographic parameters besides TEI index. Tei index is a marker of inflammation, myocardial cell metabolism and its contractile function has not been evaluated as a distinctive entity so we took up this study to evaluate the effects of ARNI on the LV functions using two dimensional (2D)ECHO parameters in Indian population and to assess TEI index for myocardial function. Methods 256 patients with class II, III or IV HF and EF<40% were enrolled. 171(66.8%) were males and 85(33.2%) were females. Patients were evaluated at baseline, 6 and 12 months for LVEF, LV mass &,LVMPI. Drug was discontinued in 2 patients due to angioedema, in 5 patients due to acute kidney injury and in 2 patients due to hypotension. LV mass measurement done by linear echocardiographic method and Flow Doppler method used for TEI index calculation. Results Baseline parameters in 247 patients were mean EF = 26.33 ± 6.28%, mean LV mass = 270.84 ± 68.94 gm, mean Tei Index = 0.852 ± 0.22. ARNI use was associated with an average gradual increase in EF, from a mean baseline of 26.33 ± 6.28% to 33.88 ± 7.73%(p = 0.000001) after 1 year of treatment. There was a significant progressive reduction of 57.97 g/m2 in mean LV mass index after 1 year of treatment (p = 0.000001).TEI index showed significant reduction from baseline mean 0.85 ± 0.22 to 0.70 ± 0.12(p = 0.000001)after 1 year of treatment. Conclusion Use of ARNI as additive adjunct to standard care of treatment resulted in significant progressive decline in LV mass and increase in TEI index.
Collapse
Affiliation(s)
- Rajendra Kumar Gokhroo
- Post Graduate Department of Cardiology, Jawaharlal Nehru Medical College and Hospital, Ajmer, India.
| | - Kaul Anushri
- Post Graduate Department of Cardiology, Jawaharlal Nehru Medical College and Hospital, Ajmer, India.
| | - M T Tarik
- Post Graduate Department of Cardiology, Jawaharlal Nehru Medical College and Hospital, Ajmer, India.
| | - C Kailash
- Post Graduate Department of Cardiology, Jawaharlal Nehru Medical College and Hospital, Ajmer, India.
| | - N Rajesh
- Post Graduate Department of Cardiology, Jawaharlal Nehru Medical College and Hospital, Ajmer, India.
| | - K Ashish
- Post Graduate Department of Cardiology, Jawaharlal Nehru Medical College and Hospital, Ajmer, India.
| | - G Manish
- Post Graduate Department of Cardiology, Jawaharlal Nehru Medical College and Hospital, Ajmer, India.
| | - C Subhash
- Post Graduate Department of Cardiology, Jawaharlal Nehru Medical College and Hospital, Ajmer, India.
| |
Collapse
|
14
|
Nkadimeng SM, Steinmann CML, Eloff JN. Effects and safety of Psilocybe cubensis and Panaeolus cyanescens magic mushroom extracts on endothelin-1-induced hypertrophy and cell injury in cardiomyocytes. Sci Rep 2020; 10:22314. [PMID: 33339902 PMCID: PMC7749179 DOI: 10.1038/s41598-020-79328-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/08/2020] [Indexed: 02/04/2023] Open
Abstract
Prevalence of major depression in people with chronic heart failure is higher than in normal populations. Depression in heart failure has become a major issue. Psilocybin-containing mushrooms commonly known as magic mushrooms, have been used since ancient times for their mind healing properties. Their safety in cardiovascular disease conditions is not fully known and may pose as a risk for users suffering from these illnesses. Study investigates the effects and safety of Psilocybe cubensis and Panaeolus cyanescens magic mushrooms use from genus Psilocybe and Panaeolus respectively, in a pathological hypertrophy conditions in which endothelin-1 disorder is a contributor to pathogenesis. We examined the effects of the mushrooms extracts on endothelin-1-induced hypertrophy and tumor necrosis factor-α (TNF- α)-induced cell injury in H9C2 cardiomyocytes. Mushrooms were oven dried and extracted with cold and boiling-hot water. H9C2 cardiomyocytes were induced with endothelin-1 prior to treatment with extracts over 48 h. Cell injury was stimulated with TNF-α. Results proposed that the water extracts of Panaeolus cyanescens and Psilocybe cubensis did not aggravate the pathological hypertrophy induced by endothelin-1 and also protected against the TNF-α-induced injury and cell death in concentrations used. Results support medicinal safe use of mushrooms under controlled conditions and cautioned use of higher concentrations.
Collapse
Affiliation(s)
- Sanah M Nkadimeng
- Phytomedicine Programme, Paraclinical Sciences Department, University of Pretoria, P/Bag X04, Onderstepoort, Pretoria, 0110, Gauteng, South Africa.
| | - Christiaan M L Steinmann
- Physiology Department, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Jacobus N Eloff
- Phytomedicine Programme, Paraclinical Sciences Department, University of Pretoria, P/Bag X04, Onderstepoort, Pretoria, 0110, Gauteng, South Africa
| |
Collapse
|
15
|
Lopaschuk GD, Karwi QG, Ho KL, Pherwani S, Ketema EB. Ketone metabolism in the failing heart. Biochim Biophys Acta Mol Cell Biol Lipids 2020; 1865:158813. [PMID: 32920139 DOI: 10.1016/j.bbalip.2020.158813] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/26/2020] [Accepted: 09/05/2020] [Indexed: 12/13/2022]
Abstract
The high energy demands of the heart are met primarily by the mitochondrial oxidation of fatty acids and glucose. However, in heart failure there is a decrease in cardiac mitochondrial oxidative metabolism and glucose oxidation that can lead to an energy starved heart. Ketone bodies are readily oxidized by the heart, and can provide an additional source of energy for the failing heart. Ketone oxidation is increased in the failing heart, which may be an adaptive response to lessen the severity of heart failure. While ketone have been widely touted as a "thrifty fuel", increasing ketone oxidation in the heart does not increase cardiac efficiency (cardiac work/oxygen consumed), but rather does provide an additional fuel source for the failing heart. Increasing ketone supply to the heart and increasing mitochondrial ketone oxidation increases mitochondrial tricarboxylic acid cycle activity. In support of this, increasing circulating ketone by iv infusion of ketone bodies acutely improves heart function in heart failure patients. Chronically, treatment with sodium glucose co-transporter 2 inhibitors, which decreases the severity of heart failure, also increases ketone body supply to the heart. While ketogenic diets increase circulating ketone levels, minimal benefit on cardiac function in heart failure has been observed, possibly due to the fact that these dietary regimens also markedly increase circulating fatty acids. Recent studies, however, have suggested that administration of ketone ester cocktails may improve cardiac function in heart failure. Combined, emerging data suggests that increasing cardiac ketone oxidation may be a therapeutic strategy to treat heart failure.
Collapse
Affiliation(s)
- Gary D Lopaschuk
- Cardiovascular Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
| | - Qutuba G Karwi
- Cardiovascular Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Department of Pharmacology, College of Medicine, University of Diyala, Diyala, Iraq
| | - Kim L Ho
- Cardiovascular Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Simran Pherwani
- Cardiovascular Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Ezra B Ketema
- Cardiovascular Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
16
|
Verhestraeten C, Heggermont WA, Maris M. Clinical inertia in the treatment of heart failure: a major issue to tackle. Heart Fail Rev 2020; 26:1359-1370. [PMID: 32474794 PMCID: PMC8510913 DOI: 10.1007/s10741-020-09979-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Despite an enormous improvement in heart failure management during the last decades, the hospitalization and mortality rate of heart failure patients still remain very high. Clinical inertia, defined as the lack of treatment intensification in a patient not at evidence-based goals for care, is an important underlying cause. Clinical inertia is extensively described in hypertension and type 2 diabetes mellitus, but increasingly recognized in heart failure as well. Given the well-established guidelines for the management of heart failure, these are still not being reflected in clinical practice. While the absolute majority of patients were treated by guideline-directed heart failure drugs, only a small percentage of these patients reached the correct guideline-recommended target dose of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers, mineralocorticoid receptor antagonists, and angiotensin receptor-neprilysin inhibitors. This considerable under-treatment leads to a large number of avoidable hospitalizations and deaths. This review discusses clinical inertia in heart failure and explains its major contributing factors (i.e., physician, patient, and system) and touches upon some recommendations to prevent clinical inertia and ameliorate heart failure treatment.
Collapse
Affiliation(s)
| | - Ward A Heggermont
- Cardiovascular Center OLV Aalst, Moorselbaan 164, 9300, Aalst, Belgium.,Cardiovascular Research Center Maastricht, Universiteitssingel 50, 6202, Maastricht, The Netherlands
| | - Michael Maris
- Novartis Pharma nv-sa, Medialaan 40, 1800, Vilvoorde, Belgium.
| |
Collapse
|
17
|
Harshaw-Ellis K. Using advance care planning for end-of-life care in heart failure improves outcomes. Evid Based Nurs 2020; 24:ebnurs-2019-103249. [PMID: 32229504 DOI: 10.1136/ebnurs-2019-103249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2020] [Indexed: 06/10/2023]
|
18
|
Barrett M, Boyne J, Brandts J, Brunner-La Rocca HP, De Maesschalck L, De Wit K, Dixon L, Eurlings C, Fitzsimons D, Golubnitschaja O, Hageman A, Heemskerk F, Hintzen A, Helms TM, Hill L, Hoedemakers T, Marx N, McDonald K, Mertens M, Müller-Wieland D, Palant A, Piesk J, Pomazanskyi A, Ramaekers J, Ruff P, Schütt K, Shekhawat Y, Ski CF, Thompson DR, Tsirkin A, van der Mierden K, Watson C, Zippel-Schultz B. Artificial intelligence supported patient self-care in chronic heart failure: a paradigm shift from reactive to predictive, preventive and personalised care. EPMA J 2019; 10:445-464. [PMID: 31832118 PMCID: PMC6882991 DOI: 10.1007/s13167-019-00188-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/23/2019] [Indexed: 12/23/2022]
Abstract
Heart failure (HF) is one of the most complex chronic disorders with high prevalence, mainly due to the ageing population and better treatment of underlying diseases. Prevalence will continue to rise and is estimated to reach 3% of the population in Western countries by 2025. It is the most important cause of hospitalisation in subjects aged 65 years or more, resulting in high costs and major social impact. The current "one-size-fits-all" approach in the treatment of HF does not result in best outcome for all patients. These facts are an imminent threat to good quality management of patients with HF. An unorthodox approach from a new vision on care is required. We propose a novel predictive, preventive and personalised medicine approach where patients are truly leading their management, supported by an easily accessible online application that takes advantage of artificial intelligence. This strategy paper describes the needs in HF care, the needed paradigm shift and the elements that are required to achieve this shift. Through the inspiring collaboration of clinical and high-tech partners from North-West Europe combining state of the art HF care, artificial intelligence, serious gaming and patient coaching, a virtual doctor is being created. The results are expected to advance and personalise self-care, where standard care tasks are performed by the patients themselves, in principle without involvement of healthcare professionals, the latter being able to focus on complex conditions. This new vision on care will significantly reduce costs per patient while improving outcomes to enable long-term sustainability of top-level HF care.
Collapse
Affiliation(s)
- Matthew Barrett
- University College of Dublin, Catherine McAuley Education & Research Centre, Mater Misericordiae University Hospital, Nelson Street, Dublin, 7 Ireland
| | - Josiane Boyne
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202AZ Maastricht, The Netherlands
| | - Julia Brandts
- Department of Cardiology, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202AZ Maastricht, The Netherlands
| | | | - Kurt De Wit
- Thomas More University of Applied Science, Kleinhoefstraat 4, 2240 Geel, Belgium
| | - Lana Dixon
- Belfast Health and Social Care Trust, A Floor, Belfast City Hospital, Lisburn Rd, Belfast, BT9 7AB UK
| | - Casper Eurlings
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202AZ Maastricht, The Netherlands
| | | | - Olga Golubnitschaja
- Radiological Clinic, Universitätsklinikum Bonn, Excellence University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Arjan Hageman
- Sananet Care BV, Rijksweg Zuid 37, 6131AL Sittard, Netherlands
| | | | - André Hintzen
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202AZ Maastricht, The Netherlands
| | - Thomas M. Helms
- German Foundation for the Chronically Ill, Alexanderstrasse 26, 90762 Fürth, Germany
| | - Loreena Hill
- Queen’s University Belfast, 97 Lisburn Rd, Belfast, BY9 7BL UK
| | | | - Nikolaus Marx
- Department of Cardiology, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Kenneth McDonald
- University College of Dublin, Catherine McAuley Education & Research Centre, Mater Misericordiae University Hospital, Nelson Street, Dublin, 7 Ireland
| | - Marc Mertens
- Thomas More University of Applied Science, Kleinhoefstraat 4, 2240 Geel, Belgium
| | - Dirk Müller-Wieland
- Department of Cardiology, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Alexander Palant
- German Foundation for the Chronically Ill, Alexanderstrasse 26, 90762 Fürth, Germany
| | - Jens Piesk
- Nurogames GmbH, Schaafenstrasse 25, 50676 Cologne, Germany
| | | | - Jan Ramaekers
- Sananet Care BV, Rijksweg Zuid 37, 6131AL Sittard, Netherlands
| | - Peter Ruff
- Exploris AG, Tödistrasse 52, 8002 Zürich, Switzerland
| | - Katharina Schütt
- Department of Cardiology, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Yash Shekhawat
- Nurogames GmbH, Schaafenstrasse 25, 50676 Cologne, Germany
| | - Chantal F. Ski
- Queen’s University Belfast, 97 Lisburn Rd, Belfast, BY9 7BL UK
| | | | | | | | - Chris Watson
- Queen’s University Belfast, 97 Lisburn Rd, Belfast, BY9 7BL UK
| | | |
Collapse
|
19
|
[Position paper telemonitoring : From the Nucleus Members of the AG33 Telemonitoring of the DGK and associated members]. Herzschrittmacherther Elektrophysiol 2019; 30:287-297. [PMID: 31278607 DOI: 10.1007/s00399-019-0630-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The position paper of the working group 33/Telemonitoring in the German Society for Cardiology e. V. (DGK) discusses the importance of digital solutions in the German health care system and highlights the application possibilities and potentials of telemonitoring in the treatment of patients with cardiac diseases. In addition to telemonitoring of acute ischaemic diseases, acute coronary syndrome and acute cardiac arrhythmias, telemonitoring of chronic cardiac diseases is discussed. Chronic diseases, such as chronic heart failure, are age-associated and present society with the great challenge of providing high-quality, yet cost-efficient care to an increasing number of patients in the future. Telemonitoring offers an opportunity to meet this challenge. However, the introduction of telemonitoring and the associated changes for patients, doctors and other service providers must be accompanied by measures to ensure the acceptance of telemonitoring and the secure handling of sensitive data as well as the quality of telemonitoring services.
Collapse
|
20
|
Bundgaard JS, Mogensen UM, Christensen S, Ploug U, Rørth R, Ibsen R, Kjellberg J, Køber L. The economic burden of heart failure in Denmark from 1998 to 2016. Eur J Heart Fail 2019; 21:1526-1531. [PMID: 31359583 DOI: 10.1002/ejhf.1577] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/26/2019] [Accepted: 07/09/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Heart failure (HF) imposes a large burden on both the individual and the society. The aim of this study was to investigate the economic burden (either direct or indirect costs) attributed to patients with HF before, at, and after time of diagnosis. METHODS AND RESULTS Using Danish nationwide registries we identified all patients > 18 years with a first-time diagnosis of HF from 1998-2016 and matched them 1:1 with a control group from the background population on age, gender, marital status, and educational level. The economic analysis of the total costs after diagnosis was based on direct costs including hospitalization, procedures, medication, and indirect costs including social welfare and lost productivity to estimate the annual cost of HF. A total of 176 067 HF patients with a median age of 76 (interquartile range 67-84) years and 55% male were included. Patients with HF incurred an average of €17 039 in total annual direct (€11 926) and indirect (€5113) healthcare costs peaking at year of diagnosis compared to €5936 in the control group with the majority attributable to inpatient admissions. The total annual net costs including public transfer after index HF were €11 957 higher in patients with HF compared to controls and the economic consequences were evident more than 2 years prior to the diagnosis of HF. CONCLUSION Patients with HF impose significantly higher total annual healthcare costs compared to a matched control group with findings evident more than 2 years prior to HF diagnosis.
Collapse
Affiliation(s)
- Johan S Bundgaard
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark
| | - Ulrik M Mogensen
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark.,Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | | | | | - Rasmus Rørth
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark
| | | | - Jakob Kjellberg
- Danish Institute for Health Services Research, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark
| |
Collapse
|
21
|
Lima LFD, Barbosa F, Simões MV, Navarro AM. Heart failure, micronutrient profile, and its connection with thyroid dysfunction and nutritional status. Clin Nutr 2018; 38:800-805. [PMID: 29551406 DOI: 10.1016/j.clnu.2018.02.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 02/12/2018] [Accepted: 02/25/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Heart failure (HF) is a growing public health issue; its risk factors include inappropriate dietary intake of microelements such as iodine, selenium, zinc and iron, which may lead to thyroid dysfunction. OBJECTIVE This study aimed to assess the correlation among the functional class stages of patients with HF, iodine, selenium, iron and zinc levels with the presence of thyroid dysfunction. METHODOLOGY One hundred nine patients from the HF outpatient clinic of the Clinics Hospital of Ribeirão Preto whose blood and urine were collected for micronutrient analysis and laboratory tests were selected. The subjects' weight and height were also measured to calculate their BMI. First, a descriptive analysis of the data was made into tables, and then statistical analyses were done at a 5% significance level (p < 0.05). RESULTS Most patients whose data was analysed were elderly and overweight. Excess ioduria, serum selenium and zinc, erythrocyte zinc and deficiency in serum iron and erythrocyte selenium were observed. The prevalence of thyroid dysfunction was 8.3%. Multivariate logistic regression verified that thyroid dysfunction increases the chance of classification in functional class III or IV (p = 0.015; OR = 8.72) by 8.7 times; each year of age increases the chance by 4.6% of classification in functional class III or IV (p = 0.008; odds ratio [OR] = 1.05), and each unit of BMI increases the chance of classification in functional class III or IV by 9.2% (p = 0.028; OR = 1.09). CONCLUSION Patients with HF were deficient in serum iron and erythrocyte selenium. No connection was found between hypothyroidism and mineral deficiency, which seems to be related more to the severity of the disease than to the micronutrient nutritional profile.
Collapse
Affiliation(s)
- Livia Fernandes de Lima
- Department of Internal Medicine, Medical School of Ribeirão Preto, Avenida Bandeirantes 3900, Monte Alegre, 14049-900 Ribeirão Preto, SP, Brazil.
| | - Fernando Barbosa
- Department of Clinical, Toxicological and Bromatological Analyses, Faculty of Pharmacy of Ribeirão Preto, Avenida do Café s/n, Monte Alegre, 14049-903 Ribeirão Preto, SP, Brazil
| | - Marcus Vinícius Simões
- Department of Internal Medicine, Medical School of Ribeirão Preto, Avenida Bandeirantes 3900, Monte Alegre, 14049-900 Ribeirão Preto, SP, Brazil
| | - Anderson Marliere Navarro
- Department of Internal Medicine, Medical School of Ribeirão Preto, Avenida Bandeirantes 3900, Monte Alegre, 14049-900 Ribeirão Preto, SP, Brazil
| |
Collapse
|
22
|
Conrad N, Judge A, Tran J, Mohseni H, Hedgecott D, Crespillo AP, Allison M, Hemingway H, Cleland JG, McMurray JJV, Rahimi K. Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. Lancet 2018; 391:572-580. [PMID: 29174292 PMCID: PMC5814791 DOI: 10.1016/s0140-6736(17)32520-5] [Citation(s) in RCA: 736] [Impact Index Per Article: 122.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/06/2017] [Accepted: 08/09/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Large-scale and contemporary population-based studies of heart failure incidence are needed to inform resource planning and research prioritisation but current evidence is scarce. We aimed to assess temporal trends in incidence and prevalence of heart failure in a large general population cohort from the UK, between 2002 and 2014. METHODS For this population-based study, we used linked primary and secondary electronic health records of 4 million individuals from the Clinical Practice Research Datalink (CPRD), a cohort that is representative of the UK population in terms of age and sex. Eligible patients were aged 16 years and older, had contributed data between Jan 1, 2002, and Dec 31, 2014, had an acceptable record according to CPRD quality control, were approved for CPRD and Hospital Episodes Statistics linkage, and were registered with their general practice for at least 12 months. For patients with incident heart failure, we extracted the most recent measurement of baseline characteristics (within 2 years of diagnosis) from electronic health records, as well as information about comorbidities, socioeconomic status, ethnicity, and region. We calculated standardised rates by applying direct age and sex standardisation to the 2013 European Standard Population, and we inferred crude rates by applying year-specific, age-specific, and sex-specific incidence to UK census mid-year population estimates. We assumed no heart failure for patients aged 15 years or younger and report total incidence and prevalence for all ages (>0 years). FINDINGS From 2002 to 2014, heart failure incidence (standardised by age and sex) decreased, similarly for men and women, by 7% (from 358 to 332 per 100 000 person-years; adjusted incidence ratio 0·93, 95% CI 0·91-0·94). However, the estimated absolute number of individuals with newly diagnosed heart failure in the UK increased by 12% (from 170 727 in 2002 to 190 798 in 2014), largely due to an increase in population size and age. The estimated absolute number of prevalent heart failure cases in the UK increased even more, by 23% (from 750 127 to 920 616). Over the study period, patient age and multi-morbidity at first presentation of heart failure increased (mean age 76·5 years [SD 12·0] to 77·0 years [12·9], adjusted difference 0·79 years, 95% CI 0·37-1·20; mean number of comorbidities 3·4 [SD 1·9] vs 5·4 [2·5]; adjusted difference 2·0, 95% CI 1·9-2·1). Socioeconomically deprived individuals were more likely to develop heart failure than were affluent individuals (incidence rate ratio 1·61, 95% CI 1·58-1·64), and did so earlier in life than those from the most affluent group (adjusted difference -3·51 years, 95% CI -3·77 to -3·25). From 2002 to 2014, the socioeconomic gradient in age at first presentation with heart failure widened. Socioeconomically deprived individuals also had more comorbidities, despite their younger age. INTERPRETATION Despite a moderate decline in standardised incidence of heart failure, the burden of heart failure in the UK is increasing, and is now similar to the four most common causes of cancer combined. The observed socioeconomic disparities in disease incidence and age at onset within the same nation point to a potentially preventable nature of heart failure that still needs to be tackled. FUNDING British Heart Foundation and National Institute for Health Research.
Collapse
Affiliation(s)
- Nathalie Conrad
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK; Bristol National Institute for Health Research Biomedical Research Centre, Musculoskeletal Research Unit, Southmead Hospital, University of Bristol, Bristol, UK; Medical Research Council Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Jenny Tran
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Hamid Mohseni
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Deborah Hedgecott
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | | | - Moira Allison
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Harry Hemingway
- The Farr Institute of Health Informatics Research, University College London, London, UK; The National Institute for Health Research, Biomedical Research Centre, University College London Hospitals NHS Foundation Trust/University College London, London, UK
| | - John G Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK; National Heart & Lung Institute, Imperial College London, London, UK
| | - John J V McMurray
- Institute for Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kazem Rahimi
- The George Institute for Global Health, University of Oxford, Oxford, UK; Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| |
Collapse
|
23
|
Howlett J, Comin‐Colet J, Dickstein K, Fuat A, Pölzl G, Delaney S. Clinical practices and attitudes regarding the diagnosis and management of heart failure: findings from the CORE Needs Assessment Survey. ESC Heart Fail 2018; 5:172-183. [PMID: 28921886 PMCID: PMC5793971 DOI: 10.1002/ehf2.12205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/09/2017] [Accepted: 07/14/2017] [Indexed: 11/12/2022] Open
Abstract
AIMS CORE is a continuing medical education initiative designed to support the evidence-based management of heart failure (HF) in the primary and secondary care settings. The goal of the CORE Needs Assessment Survey is to describe current clinical practice patterns and attitudes among global stakeholders in HF care. METHODS AND RESULTS The CORE Steering Committee guided the development of survey questions to assess clinical practice, confidence, and attitudes/perceptions among cardiologists, primary care physicians, and nurses involved in HF management. In total, 346 healthcare professionals from Australia (n = 59), Austria (n = 59), Canada (n = 60), Spain (n = 58), Sweden (n = 52), and the UK (n = 58) contributed survey data. Results revealed multiple gaps over the spectrum of HF care, including diagnosis (low recognition of the signs and symptoms of HF and limited use of diagnostic tests), treatment planning (underuse of recommended agents and subtherapeutic dosing), treatment monitoring and adjustment (lack of adherence to recommendations), and long-term management (low confidence in providing patient education). Although primary care and specialist physicians and nurses shared common unmet needs, healthcare professional-specific clinical gaps were also identified. CONCLUSIONS The CORE Needs Assessment Survey provides timely data describing current clinical practices and attitudes among physicians and nurses regarding key aspects of HF care. These findings will be useful for guiding the development of interventions tailored to the specific educational needs of different provider types and designed to support the evidence-based care of patients with HF.
Collapse
Affiliation(s)
- Jonathan Howlett
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryCalgaryAlbertaCanada
| | | | - Kenneth Dickstein
- University of BergenBergenNorway
- Stavanger University HospitalStavangerNorway
| | | | | | | |
Collapse
|
24
|
Mishra S, Mohan JC, Nair T, Chopra VK, Harikrishnan S, Guha S, Ramakrishnan S, Ray S, Sethi R, Samal UC, Sarat Chandra K, Hiremath MS, Banerjee AK, Kumar S, Das MK, Deb PK, Bahl VK. Management protocols for chronic heart failure in India. Indian Heart J 2018; 70:105-127. [PMID: 29455764 PMCID: PMC5903070 DOI: 10.1016/j.ihj.2017.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Heart failure is a common clinical syndrome and a global health priority. The burden of heart failure is increasing at an alarming rate worldwide as well as in India. Heart failure not only increases the risk of mortality, morbidity and worsens the patient's quality of life, but also puts a huge burden on the overall healthcare system. The management of heart failure has evolved over the years with the advent of new drugs and devices. This document has been developed with an objective to provide standard management guidance and simple heart failure algorithms to aid Indian clinicians in their daily practice. It would also inform the clinicians on the latest evidence in heart failure and provide guidance to recognize and diagnose chronic heart failure early and optimize management.
Collapse
Affiliation(s)
- S Mishra
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - J C Mohan
- Department of Cardiology, Fortis Hospital, Shalimar Bagh, New Delhi, 110088, India
| | - Tiny Nair
- Department of Cardiology, PRS Hospital, Thiruvananthapuram, 695002, India
| | - V K Chopra
- Department of Clinical and Preventive Cardiology, Medanta - The Medicity, Gurugram, Haryana, 122001, India
| | - S Harikrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011, India
| | - S Guha
- Department of Cardiology, Medical College, Kolkata, 700073, India
| | - S Ramakrishnan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - S Ray
- Department of Cardiology, Vivekananda Institute of Medical Sciences, Kolkata, 70026, India
| | - R Sethi
- Department of Cardiology, King George's Medical University, Ludhiana, Uttar Pradesh, 226003, India
| | - U C Samal
- Heart Failure Subspecialty, Cardiological Society of India, Kolkata, India
| | - K Sarat Chandra
- Department of Cardiology, Institute of Post Graduate Medical Education & Research and Memorial Hospital, Kolkata, 700020, India
| | - M S Hiremath
- Department of Cardiology, Ruby Hall Clinic, Pune, 411001, India
| | - A K Banerjee
- Department of Cardiology, Institute of Post Graduate Medical Education & Research and Memorial Hospital, Kolkata, 700020, India
| | - S Kumar
- Cardiological Society of India, Kolkata, India
| | - M K Das
- Cardiological Society of India, Kolkata, India
| | - P K Deb
- Cardiological Society of India, Kolkata, India
| | - V K Bahl
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| |
Collapse
|
25
|
Jeyanantham K, Kotecha D, Thanki D, Dekker R, Lane DA. Effects of cognitive behavioural therapy for depression in heart failure patients: a systematic review and meta-analysis. Heart Fail Rev 2017; 22:731-741. [PMID: 28733911 PMCID: PMC5635071 DOI: 10.1007/s10741-017-9640-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This systematic review and meta-analysis aimed to evaluate the effects of cognitive behavioural therapy (CBT) on depression, quality of life, hospitalisations and mortality in heart failure patients. The search strategy was developed for Ovid MEDLINE and modified accordingly to search the following bibliographic databases: PubMed, EMBASE, PsycINFO, CENTRAL and CINAHL. Databases were searched from inception to 6 March 2016 for randomised controlled trials (RCTs) or observational studies that used CBT in heart failure patients with depression or depressive symptoms. Six studies were identified: 5 RCTs and 1 observational study, comprising 320 participants with predominantly NYHA classes II-III, who were mostly male, with mean age ranging from 55 to 66 years. Compared to usual care, CBT was associated with a greater improvement in depression scores both initially after CBT sessions (standardised mean difference -0.34, 95% CI -0.60 to -0.08, p = 0.01) and at 3 months follow-up (standardised mean difference -0.32, 95% CI -0.59 to -0.04, p = 0.03). Greater improvement in quality of life scores was evident for the CBT group initially after CBT sessions, but with no difference at 3 months. Hospital admissions and mortality were similar, regardless of treatment group. CBT may be more effective than usual care at improving depression scores and quality of life for heart failure patients initially following CBT and for depression at 3 months. Larger and more robust RCTs are needed to evaluate the long-term clinical effects of CBT in heart failure patients.
Collapse
Affiliation(s)
- Kishaan Jeyanantham
- The Medical School, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Dipak Kotecha
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK
- Monash University Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, Australia
| | - Devsaagar Thanki
- The Medical School, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | | | - Deirdre A Lane
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK.
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| |
Collapse
|
26
|
Boisvert S, Proulx-Belhumeur A, Gonçalves N, Doré M, Francoeur J, Gallani MC. An integrative literature review on nursing interventions aimed at increasing self-care among heart failure patients. Rev Lat Am Enfermagem 2017; 23:753-68. [PMID: 26444179 PMCID: PMC4623739 DOI: 10.1590/0104-1169.0370.2612] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze and summarize knowledge concerning critical components of interventions that have been proposed and implemented by nurses with the aim of optimizing self-care by heart failure patients. METHODS PubMed and CINAHL were the electronic databases used to search full peer-reviewed papers, presenting descriptions of nursing interventions directed to patients or to patients and their families and designed to optimize self-care. Forty-two studies were included in the final sample (n=4,799 patients). RESULTS this review pointed to a variety and complexity of nursing interventions. As self-care encompasses several behaviors, interventions targeted an average of 3.6 behaviors. Educational/counselling activities were combined or not with cognitive behavioral strategies, but only about half of the studies used a theoretical background to guide interventions. Clinical assessment and management were frequently associated with self-care interventions, which varied in number of sessions (1 to 30); length of follow-up (2 weeks to 12 months) and endpoints. CONCLUSIONS these findings may be useful to inform nurses about further research in self-care interventions in order to propose the comparison of different modalities of intervention, the use of theoretical background and the establishment of endpoints to evaluate their effectiveness.
Collapse
Affiliation(s)
- Sophie Boisvert
- Faculté des sciences infirmières, Université Laval, Québec, QC, CA
| | | | - Natalia Gonçalves
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BR
| | - Michel Doré
- Faculté des sciences infirmières, Université Laval, Québec, QC, CA
| | - Julie Francoeur
- Institut universitaire de cardiologie et pneumologie de Québec, Québec, QC, CA
| | | |
Collapse
|
27
|
Bazzano LAL, Marshall MK, Harrold R, Pak KJ, van Driel ML. Interventions to improve evidence-based prescribing in heart failure. Hippokratia 2016. [DOI: 10.1002/14651858.cd011253.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Lydia AL Bazzano
- Ochsner Health System; Internal Medicine Residency/Dept of Hospital Medicine-Ochsner; 1514 Jefferson Hwy New Orleans Louisiana USA 70121
| | - Marilyn K Marshall
- University of Queensland Ochsner Clinical School at Ochsner Medical Center; School of Medicine; 1415 Jefferson Hwy New Orleans Louisiana USA 70121
| | - Robert Harrold
- University of Queensland Ochsner Clinical School at Ochsner Medical Center; School of Medicine; 1415 Jefferson Hwy New Orleans Louisiana USA 70121
| | - Kirk J Pak
- Ochsner Clinic Foundation; Department of Internal Medicine; 1514 Jefferson Hwy New Orleans Louisiana USA 70121
| | - Mieke L van Driel
- The University of Queensland; Discipline of General Practice, School of Medicine; Brisbane Queensland Australia 4029
- Ghent University; Department of Family Medicine and Primary Health Care; 1K3, De Pintelaan 185 Ghent Belgium 9000
| |
Collapse
|
28
|
Pattenden JF, Roberts H, Lewin RJP. Living with Heart Failure; Patient and Carer Perspectives. Eur J Cardiovasc Nurs 2016; 6:273-9. [PMID: 17383236 DOI: 10.1016/j.ejcnurse.2007.01.097] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Revised: 01/17/2007] [Accepted: 01/29/2007] [Indexed: 11/26/2022]
Abstract
Patients with heart failure have multiple readmissions to hospital, a poor prognosis and varying quality of life. This paper explores how patients with heart failure and their family carers cope with daily life. 36 patients and 20 family caregivers were interviewed in five centres in the UK. Analysis showed that living with heart failure can be frightening, restrictive and distressing for both patients and their family carers. Patients found most difficulty coping with functional limitation and adapting to living with heart failure, but also reported particular problems due to side effects of medications, co-morbidities and a lack of psychosocial support and rehabilitation services. Those with less socio-economic resources found it harder to cope. Patients from minority ethnic groups held different beliefs about the illness and its treatment, and some had profound problems communicating with health and social care professionals that made managing the disease even more difficult. Caring for a person with heart failure often has a considerable impact on the psychological and physical health of family caregivers. Psychosocial support and rehabilitation services provided at diagnosis and after an acute episode would enable families to better manage living with this syndrome.
Collapse
Affiliation(s)
- J F Pattenden
- British Heart Foundation Care and Education Research Group, Department of Health Sciences, Seebohm Rowntree Building Area 4, University of York, York YO10 5DD, England, United Kingdom.
| | | | | |
Collapse
|
29
|
Nayar P, Yu F, Chandak A, Kan GL, Lowes B, Apenteng BA. Risk Factors for In-Hospital Mortality in Heart Failure Patients: Does Rurality, Payer or Admission Source Matter? J Rural Health 2016; 34:103-108. [PMID: 27273735 DOI: 10.1111/jrh.12186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 04/04/2016] [Accepted: 05/02/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Considering the high prevalence of heart failure and the economic burden of the disease, factors that influence in-hospital mortality are of importance in improving outcomes of care for this patient population. The purpose of this study was to examine the determinants of in-hospital mortality for adult heart failure patients. METHODS The study design is a retrospective observational study design using the 2010 Nebraska Hospital Discharge data set including 4,319 hospitalizations for 3,521 heart failure patients admitted to 79 hospitals in Nebraska. Hierarchical logistic regression models including patient- and hospital-specific random intercepts were analyzed. Covariates included in the analysis were patient age in years, gender, comorbidity status, length of stay, primary payer, type and source of admission, transfers, and rurality of county of residence. RESULTS Overall, 3.5% of heart failure patients died during their hospital stay. In logistic regression analysis that adjusted for age, sex, and comorbidities, the odds of dying in hospital for heart failure patients increased with age (OR = 1.03, 95% CI: 1.01-1.04), co-morbidity (OR = 1.15; 95% CI: 1.05-1.25) and length of stay (OR = 1.03, 95% CI: 1.01-1.05). The patient's gender, payer source, rurality of county of residence, source, and type of admission were not risk factors for in-hospital death. CONCLUSION Increasing age, comorbidity and length of stay were risk factors for in-hospital death for heart failure. An understanding of the risk factors for in-hospital death is critical to improving outcomes of care for heart failure patients.
Collapse
Affiliation(s)
- Preethy Nayar
- Department of Health Services Research & Administration, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Fang Yu
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Aastha Chandak
- Department of Health Services Research & Administration, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ge Lin Kan
- Department of Environmental and Occupational Health, University of Nevada, Las Vegas, Nevada
| | - Brian Lowes
- Division of Cardiology, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Bettye A Apenteng
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia
| |
Collapse
|
30
|
Ng AYM, Wong FKY, Lee PH. Effects of a transitional palliative care model on patients with end-stage heart failure: study protocol for a randomized controlled trial. Trials 2016; 17:173. [PMID: 27037096 PMCID: PMC4815195 DOI: 10.1186/s13063-016-1303-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 03/18/2016] [Indexed: 12/25/2022] Open
Abstract
Background Heart failure (HF) is characterized by high rates of readmission after hospitalization, and readmission is a major contributor to healthcare costs. The transitional care model has proven efficacy in reducing the readmission rate and economic outcomes, and increasing satisfaction with care. However, the effectiveness of the transitional care model has not been evaluated in patients with end-stage HF. This study was designed to compare the customary hospital-based care and a comprehensive transitional care model, namely the Home-based Palliative HF Program (HPHP), in terms of readmission rate, quality of life, and satisfaction with care among end-stage HF patients under palliative care. Methods/design This is a randomized controlled trial taking place in hospitals in Hong Kong. We have been recruiting patients with end-stage HF who are identified as appropriate for palliative care during hospitalization, on referral by their physicians. A set of questionnaires is collected from each participant upon discharge. Participants are randomized to receive usual care (customary hospital-based care) or the intervention (HPHP). The HPHP will be implemented for up to 12 months. Outcome measures will be performed at 1, 3, 6, and 12 months post-discharge. The primary outcome of this study is quality of life measured by the Chronic Heart Failure Questionnaire - Chinese version; secondary outcomes include readmission rate, symptom intensity, functional status, and satisfaction with care. Discussion This study is original and will provide important information for service development in the area of palliative care. The introduction of palliative care to end-stage organ failure patients is new and has received increasing attention worldwide in the last decade. This study adopts the randomized controlled trial, a vigorous research design, to establish scientific evidence in exploring the best model for end-stage HF patients receiving palliative care. Trial registration This trial was registered as NCT02086305 on 7 March 2014 in the United States Clinical Trials Registration, and in the Clinical Trials Registry, Hong Kong University with the trial number UW12202. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1303-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alina Yee Man Ng
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Frances Kam Yuet Wong
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
| | - Paul Hong Lee
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| |
Collapse
|
31
|
Sahle BW, Owen AJ, Mutowo MP, Krum H, Reid CM. Prevalence of heart failure in Australia: a systematic review. BMC Cardiovasc Disord 2016; 16:32. [PMID: 26852410 PMCID: PMC4744379 DOI: 10.1186/s12872-016-0208-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the absence of a systematic collection of data pertaining to heart failure, summarizing the data available from individual studies provides an opportunity to estimate the burden of heart failure. The present study systematically reviewed the literature to estimate the incidence and prevalence rates of heart failure in Australia. METHODS Studies reporting on prevalence or incidence of heart failure published between 1990 and 2015 were identified through a systematic search of Embase, PubMed, Ovid Medline, MeSH, Scopus and websites of the Australian Institute of Health, and Welfare and Australian Bureau of Statistics. RESULTS The search yielded a total of 4978 records, of which thirteen met the inclusion criteria. There were no studies reporting on the incidence of heart failure. The prevalence of heart failure in the Australian population ranged between 1.0% and 2.0%, with a significant proportion of cases being previously undiagnosed. The burden of heart failure was higher among Indigenous than non-Indigenous Australians (age-standardized prevalence rate ratio of 1.7). Heart failure was prevalent in women than men, and in rural and remote regions than in the metropolitan and capital territories. CONCLUSION This systematic review highlights the limited available data on the epidemiology of heart failure in Australia. Population level studies, using standardized approaches, are needed in order to precisely describe the burden of HF in the population.
Collapse
Affiliation(s)
- Berhe W Sahle
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Vic, 3004, Australia.
- School of Public Health, Mekelle University, Mekelle, Ethiopia.
| | - Alice J Owen
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Vic, 3004, Australia.
| | - Mutsa P Mutowo
- School of Public Health, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Henry Krum
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Vic, 3004, Australia.
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Vic, 3004, Australia.
- School of Public Health, Curtin University, Perth, Australia.
| |
Collapse
|
32
|
Sparks R, Celler B, Okugami C, Jayasena R, Varnfield M. Telehealth Monitoring of Patients in the Community. JOURNAL OF INTELLIGENT SYSTEMS 2016. [DOI: 10.1515/jisys-2014-0123] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractThis article outlines a decision support system that seeks to help community nurses monitor the well-being of their chronically ill patients. It is designed for nurses to stay in contact with their patients without spending unnecessary time on less productive aspects of community nursing, such as avoidable driving to and from patients’ houses and taking measurements of vital signs to assess their health condition. It therefore allows the nurse to spend more time on managing the factors that could lead to a healthier patient. The decision support system is developed for two levels of mathematical capability. Nurses with a statistical background are provided with in-depth information allowing them to detect changes in mean, mean square error (and hence variation), and correlations using a variation on dynamic principle components. Less mathematically inclined nurses are offered information about trends, change points, and a simpler multivariate view of a patient’s well-being involving parallel coordinate plots.
Collapse
Affiliation(s)
- Ross Sparks
- 1Commonwealth Scientific and Industrial Research Organisation Digital Productivity Flagship, Locked Bag 17, New South Wales 1670, Australia
| | - Branko Celler
- 1Commonwealth Scientific and Industrial Research Organisation Digital Productivity Flagship, Locked Bag 17, New South Wales 1670, Australia
| | - Chris Okugami
- 1Commonwealth Scientific and Industrial Research Organisation Digital Productivity Flagship, Locked Bag 17, New South Wales 1670, Australia
| | - Rajiv Jayasena
- 1Commonwealth Scientific and Industrial Research Organisation Digital Productivity Flagship, Locked Bag 17, New South Wales 1670, Australia
| | - Marlien Varnfield
- 1Commonwealth Scientific and Industrial Research Organisation Digital Productivity Flagship, Locked Bag 17, New South Wales 1670, Australia
| |
Collapse
|
33
|
Home telehealth uptake and continued use among heart failure and chronic obstructive pulmonary disease patients: a systematic review. Ann Behav Med 2015; 48:323-36. [PMID: 24763972 PMCID: PMC4223578 DOI: 10.1007/s12160-014-9607-x] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Home telehealth has the potential to benefit heart failure (HF) and chronic obstructive pulmonary disease (COPD) patients, however large-scale deployment is yet to be achieved. Purpose The aim of this review was to assess levels of uptake of home telehealth by patients with HF and COPD and the factors that determine whether patients do or do not accept and continue to use telehealth. Methods This research performs a narrative synthesis of the results from included studies. Results Thirty-seven studies met the inclusion criteria. Studies that reported rates of refusal and/or withdrawal found that almost one third of patients who were offered telehealth refused and one fifth of participants who did accept later abandoned telehealth. Seven barriers to, and nine facilitators of, home telehealth use were identified. Conclusions Research reports need to provide more details regarding telehealth refusal and abandonment, in order to understand the reasons why patients decide not to use telehealth. Electronic supplementary material The online version of this article (doi:10.1007/s12160-014-9607-x) contains supplementary material, which is available to authorized users.
Collapse
|
34
|
Mont L, Marín F, Dalmau FGB, Martínez MS, Cullere JG. Clinical development of rivaroxaban: emerging new clinical evidences? Future Cardiol 2015; 11:565-83. [PMID: 26111102 DOI: 10.2217/fca.15.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Rivaroxaban has proven efficacious in a variety of conditions. In fact, rivaroxaban has been approved for the prevention of venous thromboembolism after elective hip or knee replacement surgery, for the prevention and treatment of deep vein thrombosis and pulmonary embolism, for the prevention of stroke in patients with nonvalvular atrial fibrillation and for the prevention of atherothrombotic events after acute coronary syndrome with elevated cardiac biomarkers. However, clinical development of rivaroxaban is ongoing. Considering published and on-going randomized clinical trials, noninterventional studies and registries, over 275,000 patients are being analyzed. The aim of this review was to update the clinical development of rivaroxaban, including completed and ongoing studies not only randomized clinical trials, but also clinical practice studies.
Collapse
Affiliation(s)
- Luís Mont
- Arrhythmia Section, Institut del Torax, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Francisco Marín
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto de Investigación Biosanitaria Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | | | - Marianela Sánchez Martínez
- Cardiovascular Critical Unit, Department of Cardiology. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jaime Gallego Cullere
- Neurology Department and Stroke Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| |
Collapse
|
35
|
Korajkic A, Poole SG, MacFarlane LM, Bergin PJ, Dooley MJ. Impact of a Pharmacist Intervention on Ambulatory Patients with Heart Failure: A Randomised Controlled Study. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2011.tb00679.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | - Michael J Dooley
- Alfred Health, Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Parkville Victoria
| |
Collapse
|
36
|
Obiegło M, Uchmanowicz I, Wleklik M, Jankowska-Polańska B, Kuśmierz M. The effect of acceptance of illness on the quality of life in patients with chronic heart failure. Eur J Cardiovasc Nurs 2015; 15:241-7. [DOI: 10.1177/1474515114564929] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 11/28/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Monika Obiegło
- Department of Clinical Nursing, Wroclaw Medical University, Poland
| | | | - Marta Wleklik
- Department of Clinical Nursing, Wroclaw Medical University, Poland
| | | | - Mateusz Kuśmierz
- Department of Cardiology, T Marciniak Memorial Specialist Hospital, Wroclaw, Poland
| |
Collapse
|
37
|
Parissis J, Athanasakis K, Farmakis D, Boubouchairopoulou N, Mareti C, Bistola V, Ikonomidis I, Kyriopoulos J, Filippatos G, Lekakis J. Determinants of the direct cost of heart failure hospitalization in a public tertiary hospital. Int J Cardiol 2014; 180:46-9. [PMID: 25438208 DOI: 10.1016/j.ijcard.2014.11.123] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 11/19/2014] [Accepted: 11/22/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Heart failure (HF) is the first reason for hospital admission in the elderly and represents a major financial burden, the greatest part of which results from hospitalization costs. We sought to analyze current HF hospitalization-related expenditure and identify predictors of cost in a public tertiary hospital in Europe. METHOD We performed a retrospective chart review of 197 consecutive patients, aged 56±16years, 80% male, with left ventricular ejection fraction (LVEF) of 30±10%, hospitalized for HF in a major university hospital in Athens, Greece. The survey involved the number of hospitalization days, laboratory investigations and medical therapies. Patients who were hospitalized in CCU/ICU or underwent interventional procedures or device implantations were excluded from analysis. Costs were estimated based on the Greek healthcare system perspective in 2013. RESULTS Patients were hospitalized for a median of 7 days with a total direct cost of €3198±3260/patient. The largest part of the expenses (79%) was attributed to hospitalization (ward), while laboratory investigations and medical treatment accounted for 17% and 4%, respectively. In multivariate analysis, pre-admission New York Heart Association NYHA class (p=0.001), serum creatinine (p=0.003) and NT-proBNP (p=0.004) were significant independent predictors of hospitalization cost. CONCLUSION Direct cost of HF hospitalization is high particularly in patients with more severe symptoms, profound neurohormonal activation and renal dysfunction. Strategies to lower hospitalization rates are warranted in the current setting of financial constraints faced by many European countries.
Collapse
Affiliation(s)
- John Parissis
- Heart Failure Unit, Department of Cardiology, Athens University Hospital "Attikon", Greece
| | - Kostas Athanasakis
- Department of Health Economics, National School of Public Health, Athens, Greece
| | - Dimitrios Farmakis
- Heart Failure Unit, Department of Cardiology, Athens University Hospital "Attikon", Greece.
| | | | - Christina Mareti
- Department of Health Economics, National School of Public Health, Athens, Greece
| | - Vasiliki Bistola
- Heart Failure Unit, Department of Cardiology, Athens University Hospital "Attikon", Greece
| | - Ignatios Ikonomidis
- Heart Failure Unit, Department of Cardiology, Athens University Hospital "Attikon", Greece
| | - John Kyriopoulos
- Department of Health Economics, National School of Public Health, Athens, Greece
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Athens University Hospital "Attikon", Greece
| | - John Lekakis
- Heart Failure Unit, Department of Cardiology, Athens University Hospital "Attikon", Greece
| |
Collapse
|
38
|
Risk prediction in patients with heart failure: a systematic review and analysis. JACC-HEART FAILURE 2014; 2:440-6. [PMID: 25194291 DOI: 10.1016/j.jchf.2014.04.008] [Citation(s) in RCA: 267] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/11/2014] [Accepted: 04/15/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study sought to review the literature for risk prediction models in patients with heart failure and to identify the most consistently reported independent predictors of risk across models. BACKGROUND Risk assessment provides information about patient prognosis, guides decision making about the type and intensity of care, and enables better understanding of provider performance. METHODS MEDLINE and EMBASE were searched from January 1995 to March 2013, followed by hand searches of the retrieved reference lists. Studies were eligible if they reported at least 1 multivariable model for risk prediction of death, hospitalization, or both in patients with heart failure and reported model performance. We ranked reported individual risk predictors by their strength of association with the outcome and assessed the association of model performance with study characteristics. RESULTS Sixty-four main models and 50 modifications from 48 studies met the inclusion criteria. Of the 64 main models, 43 models predicted death, 10 hospitalization, and 11 death or hospitalization. The discriminatory ability of the models for prediction of death appeared to be higher than that for prediction of death or hospitalization or prediction of hospitalization alone (p = 0.0003). A wide variation between studies in clinical settings, population characteristics, sample size, and variables used for model development was observed, but these features were not significantly associated with the discriminatory performance of the models. A few strong predictors emerged for prediction of death; the most consistently reported predictors were age, renal function, blood pressure, blood sodium level, left ventricular ejection fraction, sex, brain natriuretic peptide level, New York Heart Association functional class, diabetes, weight or body mass index, and exercise capacity. CONCLUSIONS There are several clinically useful and well-validated death prediction models in patients with heart failure. Although the studies differed in many respects, the models largely included a few common markers of risk.
Collapse
|
39
|
Rangel I, Gonçalves A, de Sousa C, Almeida PB, Rodrigues J, Macedo F, Silva Cardoso J, Maciel MJ. Global longitudinal strain as a potential prognostic marker in patients with chronic heart failure and systolic dysfunction. Rev Port Cardiol 2014; 33:403-9. [PMID: 25155003 DOI: 10.1016/j.repc.2014.01.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 12/27/2013] [Accepted: 01/02/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE The prognostic value of myocardium deformation measurements in chronic heart failure (CHF) is still poorly addressed. The purpose of this study was to evaluate the correlation of left ventricular (LV) global longitudinal strain (GLS) with clinical and prognostic indicators in patients with CHF and systolic dysfunction. METHODS Ambulatory patients with CHF and LV ejection fraction (LVEF) <45% were studied by two-dimensional and Doppler transthoracic echocardiogram with assessment of GLS. An indication of prognostic status was obtained by the Seattle Heart Failure Model (SHFM) prognostic estimates for life expectancy. RESULTS We included 54 CHF patients (mean age 55±12 years; 80% male). GLS was significantly correlated with NYHA functional class (r=0.41, p=0.002), BNP levels (r=0.47, p=0.001), LVEF (r=-0.69, p<0.001) and LV end-diastolic pressure, assessed by E/e' ratio (r=0.35, p<0.014) and left atrial maximal volume index (r=0.57, p<0.001). A significant correlation was found between GLS and SHFM prognostic estimates for life expectancy (r=-0.41, p=0.002). The multivariate logistic regression analysis showed that GLS independently predicted an estimated life expectancy <10 years (OR 2.614 [95% CI 1.010-6.763]). The corresponding area under the ROC curve was 0.802 (0.653-0.951) and the best obtained threshold was -9.5 (80% sensitivity, 65% specificity, p=0.003). CONCLUSIONS GLS was strongly associated with a higher disease severity status and predicted a lower prognostic estimate for life expectancy.
Collapse
Affiliation(s)
- Inês Rangel
- Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal.
| | | | - Carla de Sousa
- Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal
| | - Pedro Bernardo Almeida
- Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal
| | - João Rodrigues
- Faculty of Medicine of Porto University, Porto, Portugal
| | - Filipe Macedo
- Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal
| | - José Silva Cardoso
- Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal
| | - Ma Júlia Maciel
- Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal
| |
Collapse
|
40
|
Global longitudinal strain as a potential prognostic marker in patients with chronic heart failure and systolic dysfunction. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
41
|
Boyne JJJ, Van Asselt ADI, Gorgels APM, Steuten LMG, De Weerd G, Kragten J, Vrijhoef HJM. Cost-effectiveness analysis of telemonitoring versus usual care in patients with heart failure: the TEHAF-study. J Telemed Telecare 2013; 19:242-8. [PMID: 24163233 DOI: 10.1177/1357633x13495478] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We examined the incremental cost-effectiveness of telemonitoring (TM) versus usual care (UC) in patients with congestive heart failure (CHF). In one university and two general hospitals, 382 patients were randomised to usual care or telemonitoring and followed for 1 year. Hospital-related and home costs were estimated, based on resource use multiplied by the appropriate unit prices. Effectiveness was expressed as QALYs gained. Information was gathered, using 3 monthly costs diaries and questionnaires. The mean age of the patients was 71 years (range 32-93), 59% were male and 64% lived with a partner. Health related quality of life improved by 0.07 points for the usual care and 0.1 points for the telemonitoring group, but the difference between groups was not significant. There were no significant differences in annual costs per patient between groups. At a threshold of €50,000 the probability of telemonitoring being cost-effective was 48%. The cost effectiveness analysis showed a high level of decision uncertainty, probably caused by the divergence between the participating institutions. It is therefore premature to draw an unambiguous conclusion regarding cost-effectiveness for the whole group.
Collapse
Affiliation(s)
- Josiane J J Boyne
- Department of Patient and Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
42
|
Boyne JJJ, Vrijhoef HJM, Spreeuwenberg M, De Weerd G, Kragten J, Gorgels APM. Effects of tailored telemonitoring on heart failure patients' knowledge, self-care, self-efficacy and adherence: a randomized controlled trial. Eur J Cardiovasc Nurs 2013; 13:243-52. [PMID: 23630403 DOI: 10.1177/1474515113487464] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The education of patients with heart failure (HF) is an essential part of disease management. The perspectives of an increasing number of patients and a shortage of professionals force healthcare to explore new strategies in supporting patients to be better informed and more active. METHODS Three hundred and eighty-two patients with HF (age 71±SD 11.2 years) were randomly assigned to either a telemonitoring or a usual care group. Patients received four postal questionnaires to assess their levels of self-reported knowledge, self-care, self-efficacy and adherence. Generalized estimating equations analysis was performed to assess the effects of telemonitoring during the 1-year follow-up. Corrections for baseline were performed if needed. RESULTS Baseline differences between groups were found for self-care (p=0.001) and self-efficacy (p=0.024). Knowledge of patients in the telemonitoring group significantly improved with 0.9 point on a 15-points scale (p<0.001). Their self-care abilities improved with 1.5 point on a 10-item scale whereas no changes were found in patients receiving usual care (p<0.001). Self-efficacy of patients in the intervention group improved significantly after 6 months yet was not significantly different after 3 months and 1 year. For patients in the intervention group adherence improved for daily weighing (p<0.001) during the whole follow-up and for fluid intake (p=0.019) after 3 months and after 12 months (p=0.086). Adherence for activity recommendations improved (p=0.023) after 3 months and importance of medication adherence increased after 6 (p=0.012) and 12 months (p=0.037). No effects were found regarding appointments, diet, smoking and use of alcohol. CONCLUSIONS Tailored telemonitoring was found to educate patients with HF and to improve their self-care abilities and sense of self-efficacy.
Collapse
Affiliation(s)
- Josiane J J Boyne
- 1Department of Patient and Care, Maastricht University Medical Centre, and CAPHRI, Department of Health Services Research, Maastricht University, The Netherlands
| | | | | | | | | | | |
Collapse
|
43
|
Jiang K, Shah K, Daniels L, Maisel AS. Review on natriuretic peptides: where we are, where we are going. ACTA ACUST UNITED AC 2013; 2:1137-53. [PMID: 23496424 DOI: 10.1517/17530059.2.10.1137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Tremendous advances have been made in our understanding of the pathophysiology and treatment of congestive heart failure. However, diagnosis of the disease still remains difficult, even with a comprehensive physical examination. Symptoms such as dyspnea are nonspecific and insensitive indicators for heart failure, which can go largely undetected. Several studies have suggested the need for new diagnostic capabilities, especially with the increasing prevalence of heart failure in the US. The discovery of natriuretic peptides as diagnostic biomarkers has been one of the most critical advances for the management of heart failure. Both B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide have the potential to diagnose heart failure, assess prognostic risk of rehospitalization and mortality, and even help guide treatment. Their relative cost-effectiveness and availability have also facilitated their acceptance into many emergency departments, clinics and in-patient units as standard care when evaluating patients with suspected heart failure. Our understanding of the natriuretic peptide system is still in its infancy, but natriuretic peptides have emerged as important diagnostic and prognostic tools that have generated interest in finding broader applications for their use. OBJECTIVE The purpose of this review is to discuss the clinical approaches and future applications of natriuretic peptides in diagnosing and managing treatment of congestive heart failure. METHOD A comprehensive review of studies to assess the utility of natriuretic peptides for diagnosis and prognosis of heart failure and other conditions. CONCLUSION Natriuretic peptides are powerful tools to aid the physician in the diagnosis, prognosis and management of heart failure in both in-patient and out-patient settings. However, natriuretic peptides should be used as an adjunct test as many circumstances can also influence changes in natriuretic peptide levels.
Collapse
Affiliation(s)
- Kevin Jiang
- VA San Diego Medical Center and the University of California, Division of Cardiology, Department of Medicine, VAMC, 3350 La Jolla Village Dr, San Diego, CA 92161, USA +1 858 552 8585 ; +1 858 552 7490 ;
| | | | | | | |
Collapse
|
44
|
Bennett DA, Eliasz TK, Forbes A, Kiszely A, Khosla R, Petrinic T, Praveen D, Shrivastava R, Xin D, Patel A, Macmahon S, Rahimi K. Study protocol: systematic review of the burden of heart failure in low- and middle-income countries. Syst Rev 2012; 1. [PMID: 23190572 PMCID: PMC3534577 DOI: 10.1186/2046-4053-1-59] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Setting priorities for the prevention and management of heart failure requires an empirical understanding of the pattern of disease burden. We aim to describe the methods for a systematic review of the literature on burden of heart failure in low- and middle-income countries (LMIC) and how this information will be synthesized to produce useful estimates that can inform policy and practice. METHODS We will conduct a comprehensive search strategy for articles published between 1995 and April 2012 related to incidence, prevalence and treatment of heart failure in LMIC. Populations will be coded as urban, rural, or combined and studies classified as national, sub-national, healthcare system-based, or community level. Details from eligible studies will be extracted independently by two reviewers using a pre-designed data extraction form that will cover information on demographics, diagnostic criteria including disease incidence and prevalence, medical history, medication history, and hospital- or community-based management and outcomes. We will assess the reporting and methodological quality of the included studies and conduct a quantitative summary of reported outcomes where appropriate. DISCUSSION Currently, there are important gaps in our knowledge on the burden of heart failure in LMIC and this systematic review aims to provide useful information that improves our knowledge in this field. Results are expected to be publicly available in early 2013.
Collapse
Affiliation(s)
- Derrick A Bennett
- George Centre for Healthcare Innovation, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Ahmedov M, Green J, Azimov R, Avezova G, Inakov S, Mamatkulov B. Addressing the challenges of improving primary care quality in Uzbekistan: a qualitative study of chronic heart failure management. Health Policy Plan 2012; 28:458-66. [PMID: 22987825 DOI: 10.1093/heapol/czs091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Uzbekistan has a well-developed primary care system, with universal access to care, but faces challenges in improving the quality of clinical care provided. This study aimed to identify barriers to quality improvement by focusing on one common condition, Chronic Heart Failure (CHF), for which there are evidence-based international guidelines for management. To identify the challenges to improving the quality of care for CHF in line with such guidelines we took a qualitative approach, interviewing 15 physicians and 30 patients in detail about their experiences of CHF management. Despite recent improvements to the training of primary care physicians, their access to up-to-date information was limited, and they were disproportionately reliant on information from pharmaceutical companies. The main barriers to implementing international standards of care were: reluctance of physicians (and patients) to abandon ineffective interventions; enduring, system-wide incentives for clinically unnecessary hospitalization; and the lack of structural support for evidence-based health services improvement. Patients were in general positive about adherence to medications, but faced some problems in affording drugs and hospital care. Future interventions to strengthen primary care should be implemented with evaluations of their impact on the processes and outcomes of care for chronic conditions.
Collapse
Affiliation(s)
- Mohir Ahmedov
- School of Public Health, Tashkent Medical Academy, Tashkent, Uzbekistan.
| | | | | | | | | | | |
Collapse
|
46
|
A meta-analysis of the therapeutic effects of glucagon-like Peptide-1 agonist in heart failure. INTERNATIONAL JOURNAL OF PEPTIDES 2012; 2012:249827. [PMID: 22811735 PMCID: PMC3395195 DOI: 10.1155/2012/249827] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 03/08/2012] [Accepted: 03/09/2012] [Indexed: 01/11/2023]
Abstract
We conducted a meta-analysis of the existing literature of the therapeutic effects of using GLP-1 agonists to improve the metabolism of the failing heart. Animal studies showed significant improvement in markers of cardiac function, such as left ventricular ejection fraction (LVEF), with regular GLP-1 agonist infusions. In clinical trials, the potential effects of GLP-1 agonists in improving cardiac function were modest: LVEF improved by 4.4% compared to placebo (95% C.I 1.36–7.44, P = 0.005). However, BNP levels were not significantly altered by GLP-1 agonists in heart failure. In two trials, a modest increase in heart rate by up to 7 beats per minute was noted, but meta-analysis demonstrated this was not significant statistically. The small number of studies plus variation in the concentration and length of the regime between the trials would limit our conclusions, even though statistically, heterogeneity chi-squared tests did not reveal any significant heterogeneity in the endpoints tested. Moreover, studies in non-diabetics with heart failure yielded conflicting results. In conclusion, the use of GLP-1 agonists has at best a modest effect on ejection fraction improvement in heart failure, but there was no significant improvement in BNP levels in the meta-analysis.
Collapse
|
47
|
Molloy GJ, Johnston DW, Johnston M, Gao C, Witham MD, Struthers AD, McMurdo MET. Using the demand-control model of job strain to predict caregiver burden and caregiver satisfaction in the informal caregivers of heart failure patients. Br J Health Psychol 2010; 13:401-17. [PMID: 17535502 DOI: 10.1348/135910707x203363] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The demand-control (D-C) model of job strain has generated a considerable body of empirical support in predicting psychological health outcomes in the context of work. This study aimed to extend previous work using the D-C model of job strain to predict caregiver burden and satisfaction in the informal caregivers of patients with heart failure. DESIGN AND METHOD Data were gathered from 60 caregiver/patient dyads in a cross-sectional design. Patients with chronic stable heart failure were recruited from out-patient clinics. The dependent variables were caregiver burden and satisfaction. Demand and control were measured using both patient- and caregiver-derived measures. RESULTS The D-C model accounted for 15 and 19% of the variance in caregiver burden, after controlling for age, gender and relationship to the patient. Lower control was associated with higher burden. The D-C model did not predict caregiver satisfaction. CONCLUSION The D-C model was associated with caregiver burden, but not satisfaction in caregivers, with control being the dominant predictor. Research linking the theory and findings from job strain and informal caregiving studies may elucidate both fields of research. Using the demand-control model of job strain to predict caregiver burden and caregiver satisfaction in the informal caregivers of heart failure patients.
Collapse
Affiliation(s)
- Gerard J Molloy
- Department of Epidemiology & Public Health, University College London, UK.
| | | | | | | | | | | | | |
Collapse
|
48
|
West RL, Hernandez AF, O'Connor CM, Starling RC, Califf RM. A review of dyspnea in acute heart failure syndromes. Am Heart J 2010; 160:209-14. [PMID: 20691823 DOI: 10.1016/j.ahj.2010.05.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Accepted: 05/15/2010] [Indexed: 10/19/2022]
Abstract
In acute heart failure syndrome (AHFS), dyspnea is one of the most common but least understood presenting symptoms for hospitalization. For this reason, dyspnea relief is increasingly becoming a focus in the development of therapies for the treatment of AHFS, and currently stands as an acceptable primary end point for regulatory approval by governmental agencies. This raises the question of how best to measure such a subjective symptom. In this review, we will describe the basis for dyspnea, provide a detailed description of the strengths and weaknesses of the current best tools used to measure it, and describe future directions for future development of dyspnea measurement in AHFS.
Collapse
|
49
|
Abstract
BACKGROUND Chronic heart failure is a growing public health issue that is reaching epidemic proportions. In the last few years, multidisciplinary management programs have been developed to improve its management. Yet, some patients take advantage of these programs, whereas others do not. METHODS Several demographic, medical, and social variables were evaluated as contributors to dropout after enrollment into a multidisciplinary heart failure program using a nested case-control design. A total of 14 patients and 42 controls were interviewed using a standardized questionnaire. Possible associations were explored by means of chi Mantel-Haenszel test and a binary logistic regression model. RESULTS The only significant factor associated with dropout was social isolation. Patients who lived alone, without family support, had a significantly greater dropout risk (odds ratio, 12.5; 95% confidence interval, 1.35-11.6). CONCLUSIONS For patients who live alone, an individualized approach may be better than a multidisciplinary management program, but this hypothesis should be investigated in future studies.
Collapse
|
50
|
Cheyne-Stokes Respiration in Patients with Heart Failure. Lung 2009; 188:5-14. [DOI: 10.1007/s00408-009-9200-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 11/12/2009] [Indexed: 11/27/2022]
|