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Variables Determining Higher Home Care Effectiveness in Patients with Chronic Cardiovascular Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095170. [PMID: 35564563 PMCID: PMC9102908 DOI: 10.3390/ijerph19095170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/18/2022] [Accepted: 04/22/2022] [Indexed: 02/01/2023]
Abstract
The aim of this cross-sectional study was to analyze the variables that influence the effectiveness of home care in patients with chronic cardiovascular disease and their informal caregivers. The study was conducted in 193 patients and their 161 informal caregivers. The study used the WHOQOL-BREF Quality of Life Questionnaire, the health behavior inventory questionnaire (HBI), the Camberwell assessment of need short appraisal schedule (CANSAS) and the hospital anxiety and depression scale–modified (HADS–M) version. Spearman’s rank correlation coefficient test and logistic regression were used for analyses. Analysis of patients revealed an association between home care effectiveness and the following variables (OR per unit): age (OR = 0.98, 95% CI: 0.95–0.99), educational level (OR = 1.45, 95% CI: 1.05–2.02), financial status (OR = 0.43, 95% CI: 0.21–0.83), medication irregularity (OR = 0.25, 95% CI: 0.07–0.72), presence of comorbidities (OR = 6.18, 95% CI: 1.83–23.78), health care services provided by a nurse (OR = 1.25, 95% CI: 1.03–1.64), and number of visits to a cardiology clinic (OR = 1.25, 95% CI: 1.02–1.59). There was no association between care effectiveness and sex (p = 0.28), place of residence (p = 0.757), duration of cardiovascular disease (p = 0.718), number of home visits (p = 0.154), nursing interventions (p = 0.16), and adherence to lifestyle change recommendations (p = 0.539) or proper dietary habits (p = 0.355). A greater chance of improved health care effectiveness was found in patients whose caregivers reported higher social (OR = 1.24, 95% CI: 1.09–1.44), psychological (OR = 1.68, 95% CI: 1.25–2.37), and physical (OR = 1.24, 95% CI: 1.05–1.49) quality of life. Patients with cardiovascular disease who were characterized by lower educational attainment, poorer financial status, fewer visits to cardiology clinics, lower utilization of medical services, poorer self-perception of mental and physical well-being, recent onset of disease symptoms, and irregular use of medications, were much more likely to have poorer health care effectiveness. Patients with cardiovascular disease and their caregivers can be well supported at home as long as the care model is tailored to the specific needs. This includes family care coordination in the health care team, home care, and general practice support.
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González-Franco Á, Cerqueiro González J, Arévalo-Lorido J, Álvarez-Rocha P, Carrascosa-García S, Armengou A, Guzmán-García M, Trullàs J, Montero-Pérez-Barquero M, Manzano L. Beneficios de un modelo asistencial integral en pacientes ancianos con insuficiencia cardíaca y elevada comorbilidad: programa UMIPIC. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zisis G, Carrington MJ, Oldenburg B, Whitmore K, Lay M, Huynh Q, Neil C, Ball J, Marwick TH. An m-Health intervention to improve education, self-management, and outcomes in patients admitted for acute decompensated heart failure: barriers to effective implementation. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:649-657. [PMID: 36713108 PMCID: PMC9707948 DOI: 10.1093/ehjdh/ztab085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/30/2021] [Indexed: 02/01/2023]
Abstract
Aims Effective and efficient education and patient engagement are fundamental to improve health outcomes in heart failure (HF). The use of artificial intelligence (AI) to enable more effective delivery of education is becoming more widespread for a range of chronic conditions. We sought to determine whether an avatar-based HF-app could improve outcomes by enhancing HF knowledge and improving patient quality of life and self-care behaviour. Methods and results In a randomized controlled trial of patients admitted for acute decompensated HF (ADHF), patients at high risk (≥33%) for 30-day hospital readmission and/or death were randomized to usual care or training with the HF-app. From August 2019 up until December 2020, 200 patients admitted to the hospital for ADHF were enrolled in the Risk-HF study. Of the 72 at high-risk, 36 (25 men; median age 81.5 years; 9.5 years of education; 15 in NYHA Class III at discharge) were randomized into the intervention arm and were offered education involving an HF-app. Whilst 26 (72%) could not use the HF-app, younger patients [odds ratio (OR) 0.89, 95% confidence interval (CI) 0.82-0.97; P < 0.01] and those with a higher education level (OR 1.58, 95% CI 1.09-2.28; P = 0.03) were more likely to enrol. Of those enrolled, only 2 of 10 patients engaged and completed ≥70% of the program, and 6 of the remaining 8 who did not engage were readmitted. Conclusions Although AI-based education is promising in chronic conditions, our study provides a note of caution about the barriers to enrolment in critically ill, post-acute, and elderly patients.
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Affiliation(s)
- Georgios Zisis
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia,Faculty of Medicine, Nursing and Health Science, University of Melbourne, Melbourne, VIC, Australia,Department of Cardiology, Western Health, Melbourne, VIC, Australia
| | - Melinda J Carrington
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brian Oldenburg
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia,School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Kristyn Whitmore
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Maria Lay
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia
| | - Christopher Neil
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Faculty of Medicine, Nursing and Health Science, University of Melbourne, Melbourne, VIC, Australia,Department of Cardiology, Western Health, Melbourne, VIC, Australia
| | - Jocasta Ball
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia,Faculty of Medicine, Nursing and Health Science, University of Melbourne, Melbourne, VIC, Australia,Department of Cardiology, Western Health, Melbourne, VIC, Australia,School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia,Menzies Institute for Medical Research, University of Tasmania, Australia,Corresponding author. Tel: +61 3 8532 1550. Trial registration: Australia New Zealand Clinical Trials Registry (ACTRN): ACTRN12618001273279
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González-Franco Á, Cerqueiro González JM, Arévalo-Lorido JC, Álvarez-Rocha P, Carrascosa-García S, Armengou A, Guzmán-García M, Trullàs JC, Montero-Pérez-Barquero M, Manzano L. Morbidity and mortality in elderly patients with heart failure managed with a comprehensive care model vs. usual care: The UMIPIC program. Rev Clin Esp 2021; 222:123-130. [PMID: 34615617 DOI: 10.1016/j.rceng.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Elderly patients with heart failure (HF) have a high degree of comorbidity which leads to fragmented care, with frequent hospitalizations and high mortality. This study evaluated the benefit of a comprehensive continuous care model (UMIPIC program) in elderly HF patients. METHODS AND RESULTS We prospectively analyzed data from the RICA registry on 2862 patients with HF treated in internal medicine departments. They were divided into two groups: one monitored in the UMIPIC program (UMIPIC group, n: 809) and another which received conventional care (RICA group, n: 2.053). We evaluated HF readmissions during 12 months of follow-up and total mortality after episodes of HF hospitalization. UMIPIC patients were older with higher rates of comorbidity and preserved ejection fraction than the RICA group. However, the UMIPIC group had a lower rate of HF readmissions (17% vs. 26%, p < .001) and mortality (16% vs. 27%, respectively; p < .001). In addition, we selected 370 propensity score-matched patients from each group and the differences in HF readmissions (15% UMIPIC vs. 30% RICA; hazard ratio [HR] = 0.44; 95% confidence interval [CI] 0.32-0.60; p < .001) and mortality (17% UMIPIC vs. 28% RICA; hazard ratio = 0.58; 95% CI 0.42-0.79; p = .001) were maintained. CONCLUSIONS The implementation of the UMIPIC program, based on comprehensive continuous care of elderly patients with HF and high comorbidity, markedly reduce HF readmissions and total mortality.
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Affiliation(s)
- Á González-Franco
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | | | - J C Arévalo-Lorido
- Servicio de Medicina Interna, Hospital Comarcal de Zafra, Zafra, Badajoz, Spain
| | - P Álvarez-Rocha
- Servicio de Medicina Interna y Cardiología, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
| | - S Carrascosa-García
- Servicio de Medicina Interna, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - A Armengou
- Servicio de Medicina Interna, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - M Guzmán-García
- Servicio de Medicina Interna, Hospital San Juan de la Cruz, Jaén, Spain
| | - J C Trullàs
- Servicio de Medicina Interna, Hospital d'Olot i comarcal de la Garrotxa, Girona, Spain; Laboratori de Reparació i Regeneració Tissular (TR2Lab), Facultat de Medicina, Universitat de Vic - Universitat Central de Catalunya, Vic, Barcelona, Spain
| | - M Montero-Pérez-Barquero
- Servicio de Medicina Interna, IMIBIC/Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, Spain
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Jiang Y, Koh KWL, Ramachandran HJ, Nguyen HD, Lim DS, Tay YK, Shorey S, Wang W. The effectiveness of a nurse-led home-based heart failure self-management programme (the HOM-HEMP) for patients with chronic heart failure: A three-arm stratified randomized controlled trial. Int J Nurs Stud 2021; 122:104026. [PMID: 34271265 DOI: 10.1016/j.ijnurstu.2021.104026] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although important, heart failure self-care remains a challenge for many patients. This study aimed to evaluate the effect of a nurse-led, home-based self-management psychosocial education intervention (HOM-HEMP). The primary outcome was patient's HF self-care in terms of maintenance, management and confidence. The secondary outcomes were cardiac self-efficacy, psychological wellbeing in terms of perceived social support, health related quality of life and levels of anxiety and depression. The clinical outcomes included New York Heart Association (NYHA) functional class and numbers of unplanned health service visits due to cardiac-related reasons. DESIGN A three-arm stratified randomized controlled trial was conducted (Clinical trial registration number: NCT03108235). METHODS A total of 213 participants admitted for heart failure were recruited from the inpatient wards of a tertiary public hospital in Singapore. They were randomly allocated to the control group, the experimental group A or the experimental group B. All participants received the usual care provided by the hospital. Participants in experimental groups A and B received the HOM-HEMP intervention, and those in experimental group B received an additional supplemental smartphone application. Data were collected at baseline, 6 weeks, 3 months and 6 months from baseline. RESULTS Compared to the control groups, participants in either of the experimental group had significantly higher levels of heart failure self-care maintenance (F = 4.222, p = 0.001), self-care confidence (F = 5.796, p < 0.001) and self-care management (p < 0.05) at 6-week, 3-month and 6-month follow-ups. In addition, both experimental groups had significantly higher levels of cardiac self-efficacy, better health related quality of life and lower depression levels than the control group after the study intervention. A higher proportion of participants in both experimental groups had a better New York Heart Association functional class at 6-week and 3-month follow-ups. Participants in the experimental group B also had significantly fewer cardiac-related unplanned hospital admissions and emergency room visits than the control group at 6-month follow-up. Results on perceived social support were not significant. The study outcomes in experimental group A and B were not significantly different at any of the post intervention follow-up. CONCLUSION The findings suggested that HOM-HEMP is an effective intervention for patients with heart failure in Singapore.
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Affiliation(s)
- Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD, 11,10 Medical Drive 117597, Singapore.
| | - Karen Wei Ling Koh
- National University Heart Centre Singapore, National University Hospital, Singapore.
| | - Hadassah Joann Ramachandran
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD, 11,10 Medical Drive 117597, Singapore.
| | - Hoang D Nguyen
- School of Computing Science, University of Glasgow, Singapore.
| | - Der Shin Lim
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD, 11,10 Medical Drive 117597, Singapore.
| | - Yee Kian Tay
- Regional Health System, National University Health System, Singapore.
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD, 11,10 Medical Drive 117597, Singapore.
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD, 11,10 Medical Drive 117597, Singapore.
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Raat W, Smeets M, Janssens S, Vaes B. Impact of primary care involvement and setting on multidisciplinary heart failure management: a systematic review and meta-analysis. ESC Heart Fail 2021; 8:802-818. [PMID: 33405392 PMCID: PMC8006678 DOI: 10.1002/ehf2.13152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 12/28/2022] Open
Abstract
Multidisciplinary disease management programmes (DMPs) are a cornerstone of modern guideline-recommended care for heart failure (HF). Few programmes are community initiated or involve primary care professionals, despite the importance of home-based care for HF. We compared the outcomes of different multidisciplinary HF DMPs in relation to their recruitment setting and involvement of primary care health professionals. We conducted a systematic review and meta-analysis of randomized controlled trials published in MEDLINE, Embase, and Cochrane between 2000 and 2020 using Cochrane Collaboration methodology. Our meta-analysis included 19 randomized controlled trials (7577 patients), classified according to recruitment setting and involvement of primary care professionals. Thirteen studies recruited in the hospital (n = 5243 patients) and six in the community (n = 2334 patients). Only six studies involved primary care professionals (n = 3427 patients), with two of these recruited in the community (n = 225 patients). Multidisciplinary HF DMPs that recruited in the community had no significant effect on all-cause and HF readmissions nor on mortality, irrespective of primary care involvement. Studies that recruited in the hospital demonstrated a significant reduction in mortality (relative risk 0.87, 95% confidence interval [CI] [0.76, 0.98]), HF readmissions (0.70, 95% CI [0.54, 0.89]), and all-cause readmissions (0.72, 95% CI [0.60, 0.87]). However, the difference in effect size between recruitment setting and involvement of primary care was not significant in a meta-regression analysis. Multidisciplinary HF DMPs that recruit in the community have no significant effect on mortality or hospital readmissions, unlike DMPs that recruit in the hospital, although the difference in effect size was not significant in a meta-regression analysis. Only six multidisciplinary studies involved primary care professionals. Given demographic evolutions and the importance of integrated home-based care for patients with HF, future multidisciplinary HF DMPs should consider integrating primary care professionals and evaluating the effectiveness of this model.
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Affiliation(s)
- Willem Raat
- Department of Public Health and Primary CareKU Leuven (KUL)Kapucijnenvoer 33, Blok J Bus 7001Leuven3000Belgium
| | - Miek Smeets
- Department of Public Health and Primary CareKU Leuven (KUL)Kapucijnenvoer 33, Blok J Bus 7001Leuven3000Belgium
| | - Stefan Janssens
- Department of Cardiovascular DiseasesUniversity Hospitals, KU Leuven (KUL)LeuvenBelgium
| | - Bert Vaes
- Department of Public Health and Primary CareKU Leuven (KUL)Kapucijnenvoer 33, Blok J Bus 7001Leuven3000Belgium
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Huesken A, Hoffmann R, Ayed S. Persistent effect of nurse-led education on self-care behavior and disease knowledge in heart failure patients. Int J Nurs Sci 2021; 8:161-167. [PMID: 33997129 PMCID: PMC8105549 DOI: 10.1016/j.ijnss.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 01/23/2021] [Accepted: 03/04/2021] [Indexed: 11/08/2022] Open
Abstract
Purpose The guidelines on the management of patients with heart failure support intensive patient education on self-care. The present study aimed to evaluate the short-term and long-term impacts of a structured education provided by a qualified heart failure nurse on patients’ self-care behavior and disease knowledge. Methods One hundred fifty patients (66 ± 12 years) hospitalized for heart failure participated in a structured one-hour educational session by a heart failure nurse. Patients completed a questionnaire comprising 15 questions (nine questions from the European Heart Failure Self-Care Behavior Scale [EHFScB-9] and six on the patients’ disease knowledge) one day before and one day and six months after the educational session. Possible responses for each question ranged from 1 (complete agreement) to 5 (complete disagreement). Results After the educational session, the total EHFScB-9 score improved from 24.31 ± 6.98 to 14.94 ± 6.22, and the disease knowledge score improved from 18.03 ± 5.44 to 10.74 ± 4.30 (both P < 0.001). Scores for individual questions ranged from 1.26 ± 0.81 (adherence to the medication protocol) to 3.66 ± 1.58 (everyday weighing habits) before the education. The greatest improvement after education was observed on response to weight gain (−2.00±1.57), daily weight control (−1.77 ± 1.64), and knowledge on the cause of patients’ heart failure (−1.53 ± 1.43). At 6-month follow-up, EHFScB-9 score was 17.33 ± 7.23 and knowledge score was 12.34 ± 5.30 (both P < 0.001 compared with baseline). No factor was predictive of an insufficient teaching effect. Conclusions The educational program led by a qualified nurse improves patients’ self-care behavior and disease knowledge with a persistent effect at 6-month follow-up. There are no patient characteristics which preclude the implementation of an educational session.
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Affiliation(s)
- Astrid Huesken
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
| | - Rainer Hoffmann
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
| | - Sofien Ayed
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Lingen, Germany
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Paguio JT, Yu DSF, Su JJ. Systematic review of interventions to improve nurses’ work environments. J Adv Nurs 2020; 76:2471-2493. [DOI: 10.1111/jan.14462] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/17/2020] [Accepted: 06/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Doris Sau Fung Yu
- Faculty of Medicine School of Nursing Hong Kong University Pokfulam Hong Kong SAR
| | - Jing Jing Su
- School of Nursing, the Hong Kong Polytechnic University Pokfulam Hong Kong SAR
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Thompson DR, Clark AM. Heart failure disease management interventions: time for a reappraisal. Eur J Heart Fail 2020; 22:578-580. [PMID: 32091664 DOI: 10.1002/ejhf.1777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/04/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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Su JJ, Yu DSF, Paguio JT. Effect of eHealth cardiac rehabilitation on health outcomes of coronary heart disease patients: A systematic review and meta-analysis. J Adv Nurs 2020; 76:754-772. [PMID: 31769527 DOI: 10.1111/jan.14272] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/22/2019] [Accepted: 11/19/2019] [Indexed: 12/15/2022]
Abstract
AIMS To evaluate the effects of eHealth cardiac rehabilitation (CR) on health outcomes of coronary heart disease patients and to identify programme design, which may lead to more effective health benefits. DESIGN A systematic review and meta-analysis following Cochrane Handbook for Systematic Reviews of Interventions. DATA SOURCES Medline, EMBASE, CLNAHL, Web of Science, Scopus, PsycINFO, Cochrane Central Register of Controlled Trails, PubMed and CNKI were searched over the period from 1806 to April 2019. REVIEW METHODS A systematic review and meta-analysis of randomized controlled trials to examine the effect of eHealth CR on health outcomes of coronary heart disease patients. We used RevMan 5.3 for risk of bias assessment and meta-analysis and GRADE software for generating findings. RESULTS In all, 14 trials with 1,783 participants were included. eHealth CR has significantly promoted duration of physical activity, daily steps, quality of life (QoL) and re-hospitalization. Using comparative analysis of programme design elements, including mode of delivery, intervention content, motivational strategies and social support, between the effective and ineffective eHealth CR, it was found that comprehensive empowerment strategies and follow-up care by tele-monitoring may be the crucial characteristics leading to more favourable treatment effect. CONCLUSION eHealth CR is effective in engaging patients in active lifestyle, improving QoL and reducing re-hospitalization. Future research needs to test the effects of comprehensive CR programmes by incorporating empowerment strategies and tele-monitoring as active components. IMPACT eHealth has been increasingly applied to increase accessibility and uptake of CR. Integrative evidence to indicate its effects on health outcomes is lacking. This review identified its positive effects on some behavioural, psychosocial and health service use outcomes. Together with insights about which programme design elements may positively shape the outcomes, this review informs the role and practice of cardiovascular nurses in promoting evidence-based eHealth CR.
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Affiliation(s)
- Jing Jing Su
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong
| | - Doris Sau Fung Yu
- The School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong
| | - Jenniffer Torralba Paguio
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong
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Belfiore A, Palmieri VO, Di Gennaro C, Settimo E, De Sario MG, Lattanzio S, Fanelli M, Portincasa P. Long-term management of chronic heart failure patients in internal medicine. Intern Emerg Med 2020; 15:49-58. [PMID: 30659413 DOI: 10.1007/s11739-019-02024-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 01/02/2019] [Indexed: 01/17/2023]
Abstract
Chronic heart failure (CHF) is one of the main disabilities in elderly patients requiring frequent hospitalizations with high health care costs. We studied the outcome of CHF outpatient management in reducing hospitalization after discharge from a division of Internal Medicine at a large 3rd referral regional Hospital. 147 CHF inpatients (M:F: 63:84; mean age 76 ± 9.6 years) admitted for acute exacerbation of CHF were followed up as outpatients at 1, 6, 12 and 24 months after discharge. At baseline, patients underwent: laboratory tests, ECG, echocardiogram and a dedicated-intensive health care educational program involving also their families. The rate of hospitalization in the same group of patients was compared with data from the previous 24 months, a period when patients had been seen elsewhere without disease management programs. Patients had high prevalence of comorbidities and the majority was in NYHA class III or IV. Hypertension and valvular heart disease were the most common causes for CHF. Systolic function was preserved (LVEF ≥ 50%) in 61.9% of cases. Functional NYHA class improved significantly after 6 months and remained stable at 24 months. There was a significant increase in the use of the renin-angiotensin system blockers, beta-blockers and diuretics compared to admission to the ward. At 24 months, hospital readmissions were decreased by 42% as compared to the previous 24 months. Risk factors for re-hospitalizations were anemia, NYHA class III or IV and previous hospitalizations. Establishing an intensive outpatient management program for CHF patients leads to long-term beneficial effects with improved clinical parameters and decreased hospitalization in the setting of Internal Medicine.
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Affiliation(s)
- Anna Belfiore
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.
| | - Vincenzo Ostilio Palmieri
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Carla Di Gennaro
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Enrica Settimo
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Maria Grazia De Sario
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Stefania Lattanzio
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Margherita Fanelli
- Biostatistic, Interdisciplinary Department of Medicine, University of Bari Medical School, Bari, Italy
| | - Piero Portincasa
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
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Smeets M, Aertgeerts B, Mullens W, Penders J, Vercammen J, Janssens S, Vaes B. Optimising standards of care of heart failure in general practice the OSCAR-HF pilot study protocol. Acta Cardiol 2019; 74:371-379. [PMID: 30507291 DOI: 10.1080/00015385.2018.1507426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Heart failure (HF) imposes a burden for patients and health economics. General practitioners (GPs) are confronted with the broadest range of HF management. Although guidelines exist, they are not fully implemented in the Belgian health care system. Methods: We will conduct a non-randomised, non-controlled prospective observational trial (six months follow-up) to implement a multifaceted intervention in Belgian general practice to support GPs in the implementation of evidence-based HF guidelines. The multifaceted intervention consists of an audit and feedback method to detect previously unrecognised patients with HF and to increase awareness for proactive HF management, an NT-proBNP point-of-care test to improve detection and adequate diagnosis of patients with HF and a specialist HF nurse to assist GPs in the education of patients, optimisation of treatment and follow-up after hospitalisation. All patients aged 40 years and older with a confirmed diagnosis of HF by their GP based on the clinical audit are eligible for participation. The main objective of this pilot study is to evaluate the feasibility of this multifaceted intervention and the evolution of predefined quality indicators. We will measure the impact on HF diagnosis, medication optimisation, multidisciplinary follow-up and patients' quality of life after six months. Additionally, the experiences of GPs and investigators will be studied. Conclusions: Heart failure is an important health problem in which GPs play a key role. Therefore, we will evaluate the feasibility of a multifaceted intervention to optimise diagnosis as well as implement the guideline recommended therapies in patients with HF in general practice.
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Affiliation(s)
- Miek Smeets
- Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium
| | - Bert Aertgeerts
- Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium
| | - Wilfried Mullens
- Faculty of Medicine and Life Sciences, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium
| | - Joris Penders
- Department of Clinical Biology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium
- Faculty of Medicine and Life Sciences, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Jan Vercammen
- Department of Cardiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium
| | - Stefan Janssens
- Department of Cardiovascular Diseases, Universitair Ziekenhuis Gasthuisberg, KU Leuven (KUL), Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium
- Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium
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Im J, Mak S, Upshur R, Steinberg L, Kuluski K. 'The Future is Probably Now': Understanding of illness, uncertainty and end-of-life discussions in older adults with heart failure and family caregivers. Health Expect 2019; 22:1331-1340. [PMID: 31560824 PMCID: PMC6882266 DOI: 10.1111/hex.12980] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/15/2019] [Accepted: 09/10/2019] [Indexed: 01/01/2023] Open
Abstract
Background Earlier end‐of‐life communication is critical for people with heart failure given the uncertainty and high‐risk of mortality in illness. Despite this, end‐of‐life communication is uncommon in heart failure. Left unaddressed, lack of end‐of‐life discussions can lead to discordant care at the end of life. Objective This study explores patients' and caregivers’ understanding of illness, experiences of uncertainty, and perceptions of end‐of‐life discussions in advanced illness. Design Interpretive descriptive qualitative study of older adults with heart failure and family caregivers. Fourteen semi‐structured interviews were conducted with 19 participants in Ontario, Canada. Interviews were transcribed verbatim and content analysis was used to analyse the data. Main results Understanding of illness was shaped by participants’ illness‐related experiences (e.g. symptoms, hospitalizations and self‐care routines) and the ability to adapt to challenges of illness. Participants were knowledgeable of heart failure management, and yet, were limited in their understanding of the consequences of illness. Participants adapted to the challenges of illness which appeared to influence their perception of overall health. Uncertainty reflected participants’ inability to connect manifestations of heart failure as part of the progression of illness towards the end of life. Most participants had not engaged in prior end‐of‐life discussions. Conclusion Detailed knowledge of heart failure management does not necessarily translate to an understanding of the consequences of illness. The ability to adapt to illness‐related challenges may delay older adults and family caregivers from engaging in end‐of‐life discussions. Future research is needed to examine the impact of addressing the consequences of illness in facilitating earlier end‐of‐life communication.
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Affiliation(s)
- Jennifer Im
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Susanna Mak
- Division of Cardiology, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Ross Upshur
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Leah Steinberg
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Kerry Kuluski
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
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14
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Smeets M, Zervas S, Leben H, Vermandere M, Janssens S, Mullens W, Aertgeerts B, Vaes B. General practitioners' perceptions about their role in current and future heart failure care: an exploratory qualitative study. BMC Health Serv Res 2019; 19:432. [PMID: 31253146 PMCID: PMC6599228 DOI: 10.1186/s12913-019-4271-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 06/17/2019] [Indexed: 12/28/2022] Open
Abstract
Background A comprehensive disease management programme (DMP) with a central role for general practitioners (GPs) is needed to improve heart failure (HF) care. However, previous research has shown that GPs have mixed experiences with multidisciplinary HF care. Therefore, in this study, we explore the perceptions that GPs have regarding their role in current and future HF care, prior to the design of an HF disease management programme. Methods This was a qualitative semi-structured interview study with Belgian GPs until data saturation was reached. The QUAGOL method was used for data analysis. Results In general, GPs wanted to assume a central role in HF care. Current interdisciplinary collaboration with cardiologists was perceived as smooth, partly because of the ease of access. In contrast, due to less well-established communication and the variable knowledge of nurses regarding HF care, collaboration with home care nurses was perceived as suboptimal. With regard to the future organization of HF care, all GPs confirmed the need for a structured chronic care approach and envisioned this as a multidisciplinary care pathway: flexible, patient-centred, without additional administration and with appropriate delegation of some critical tasks, including education and monitoring. GPs considered all-round general practice nurses as the preferred partner to delegate tasks to in HF care and reported limited experience in collaborating with specialist HF nurses. Conclusion GPs expressed the need for a protocol-driven care pathway in chronic HF care. However, in contrast to the existing care trajectories, this pathway should be flexible, without additional administrative burdens and with a central role for GPs. Electronic supplementary material The online version of this article (10.1186/s12913-019-4271-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Miek Smeets
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium.
| | - Sofia Zervas
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium
| | - Hanne Leben
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium
| | - Mieke Vermandere
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium
| | - Stefan Janssens
- Department of Cardiovascular Diseases, Universitair Ziekenhuis Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Wilfried Mullens
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, U Hasselt, Hasselt, Belgium.,Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Bert Aertgeerts
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, blok j bus 7001, 3000, Leuven, Belgium.,Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
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15
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Evaluation of a nurse-led intervention program in heart failure: A randomized trial. Med Clin (Barc) 2019; 152:431-437. [DOI: 10.1016/j.medcli.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 08/22/2018] [Accepted: 08/28/2018] [Indexed: 01/29/2023]
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16
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Healy L, Ledwidge M, Gallagher J, Watson C, McDonald K. Developing a disease management program for the improvement of heart failure outcomes: the do's and the don'ts. Expert Rev Cardiovasc Ther 2019; 17:267-273. [PMID: 30916595 DOI: 10.1080/14779072.2019.1596798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Heart failure is a highly prevalent condition affecting approximately 2% of people worldwide. Heart failure disease management programs (DMP) have shown a reduction in mortality and reduced hospitalization and are an established part of clinical guidelines; however, their presence is not widespread. Focusing on the application of proven therapies, patient education, diagnosis with work up of cause and easy access for clinical deterioration should be fundamental to the structure of the DMP. Multidisciplinary team care with early and timely recognition of potentially critical patients is essential, along with the inclusion of patients diagnosed in hospital as well as the community. Areas covered: The fundamental structure of a DMP along with the current gaps in evidence is outlined. Current challenges with the heart failure condition along with the current best evidence are covered. Articles were searched using MEDLINE containing the keywords; Chronic Heart Failure, Disease Management Program. We have also provided clinical opinion. Expert opinion: A multidisciplinary approach to disease management programs is essential to providing adequate care to patients. DMPs are an established part of current guidelines and should be a benchmark of treatment. Future resources should be focused on identifying patients at risk and early prevention.
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Affiliation(s)
- Liam Healy
- a Healthcare Group , St. Vincent's University Hospital , Dublin , Ireland
| | - Mark Ledwidge
- a Healthcare Group , St. Vincent's University Hospital , Dublin , Ireland
| | - Joe Gallagher
- b School of Medicine and Medical Science , University College Dublin , Dublin , Ireland
| | - Chris Watson
- a Healthcare Group , St. Vincent's University Hospital , Dublin , Ireland
| | - Kenneth McDonald
- a Healthcare Group , St. Vincent's University Hospital , Dublin , Ireland
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17
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Cainzos-Achirica M, Capdevila C, Vela E, Cleries M, Bilal U, Garcia-Altes A, Enjuanes C, Garay A, Yun S, Farre N, Corbella X, Comin-Colet J. Individual income, mortality and healthcare resource use in patients with chronic heart failure living in a universal healthcare system: A population-based study in Catalonia, Spain. Int J Cardiol 2019; 277:250-257. [DOI: 10.1016/j.ijcard.2018.10.099] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/11/2018] [Accepted: 10/29/2018] [Indexed: 10/28/2022]
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18
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Tárraga López PJ, Villar Inarejos MJ, Sadek IM, Madrona Marcos F, Tárraga Marcos L, Simón García MÁ. Quality care in the management of heart failure in a health area. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2018; 30:258-264. [PMID: 30262444 DOI: 10.1016/j.arteri.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/12/2018] [Accepted: 06/07/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyse the heart failure situation in a health area, as well quality criteria. METHOD Cross-sectional observational study of patients diagnosed with heart failure by collecting data from their clinical history in the «Turriano» computer program. The variables analysed were, comorbidities, control of cardiovascular risk factors, treatments, number of chronic diseases, and admissions. The level of adherence to drugs in relation to heart failure by determining the ratio between the percentage of prescribed drugs and drugs withdrawn from pharmacy is also analysed using the Turriano prescription program. The study consisted of an improvement cycle or evaluative cycle, following the methodology proposed by Palmer to evaluate the quality of ambulatory care. RESULTS A total of 161 patients were included, with a mean age of 81.24 years, and 54.6% were women. Almost all of them (95%) had disease associated high blood pressure, including diabetes 42.2%, dyslipidaemia 8.9%, obesity 49.1%, and cancer 13.7% Some type of heart disease was diagnosed in 62.2% of patients with 29.2% ischaemic heart disease, 46.6% cardiac arrhythmias, and 20.5% valve diseases. More than 60% had between 4 and 6 concomitant diseases. An acceptable control is observed as regards the cardiovascular risk factors. Diuretic treatment was taken by 70%, with 32% and 35% taking angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists. More than 20% have had 1-2 admissions in the last year, with cardiac decompensation being the main cause. There was 16% mortality. CONCLUSIONS Patients with heart failure have a significant number of chronic concomitant diseases, although there is an acceptable cardiovascular risk factors control. There are quality criteria that can be improved.
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Affiliation(s)
- Pedro J Tárraga López
- Medicina de Familia, Centro Salud Zona 5A, Albacete, España; Facultad de Medicina, Universidad de Castilla-La Mancha , Albacete, España.
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19
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Qin X, Hung J, Knuiman M, Teng THK, Briffa T, Sanfilippo FM. Evidence-based pharmacotherapies used in the postdischarge phase are associated with improved one-year survival in senior patients hospitalized with heart failure. Cardiovasc Ther 2018; 36:e12464. [PMID: 30126048 DOI: 10.1111/1755-5922.12464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/27/2018] [Accepted: 08/15/2018] [Indexed: 01/01/2023] Open
Abstract
AIM Hospitalized heart failure (HF) patients have a poor prognosis postdischarge. We determined whether renin-angiotensin system inhibitors (RASI) and β-blockers dispensed to patients within 60 days post-HF hospital discharge are associated with improved 1-year survival. METHODS A retrospective population-based study was conducted in 4897 seniors, aged 65-84 years, alive at 60 days postindex HF hospitalization in Western Australia over 2003-2008. Dispensing of RASI and β-blocker dispensing was identified from the Pharmaceutical Benefits Scheme claims database linked to hospital admission and death records. RESULTS At 1-year posthospital discharge, the all-cause mortality and all-cause death or HF rehospitalization rate was 13.5% (n = 663) and 24.4% (n = 1193), respectively. Postdischarge RASI and β-blocker were dispensed in 77.4% and 53.0% of patients, respectively. Their use was associated with a lower inverse probability treatment weighted (IPTW) HR for 1-year mortality of 0.70, 95% CI 0.61-0.81 and 0.79, 95% CI 0.68-0.92, respectively (both P < 0.0001), with a survival advantage most evident in the subgroup (70.1%) of patients with ischemic HF. In the overall cohort, these therapies were also associated with reduced IPTW HRs for all-cause death or HF rehospitalization (both P < 0.005) but not for HF rehospitalization exclusively. Use of a β-blocker was associated with a reduced IPTW HR for HF rehospitalization in the ischemic HF subgroup only. CONCLUSIONS In a cohort of senior patients hospitalized with HF, dispensing of a RASI or β-blocker within 60 days postdischarge is associated with a 1-year survival benefit. Early postdischarge support programs after recent HF hospitalization should include measures to optimize adherence to evidence-based medications.
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Affiliation(s)
- Xiwen Qin
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Joseph Hung
- Medical School, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Perth, Western Australia, Australia
| | - Matthew Knuiman
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Tiew-Hwa K Teng
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.,National Heart Centre Singapore, Singapore, Singapore
| | - Tom Briffa
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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20
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Benzo RP, Kirsch JL, Hathaway JC, McEvoy CE, Vickers KS. Health Coaching in Severe COPD After a Hospitalization: A Qualitative Analysis of a Large Randomized Study. Respir Care 2018; 62:1403-1411. [PMID: 29061910 DOI: 10.4187/respcare.05574] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND We recently demonstrated in a randomized study the feasibility and effectiveness of telephone-based health coaching using motivational interviewing on decreasing hospital readmissions and improving quality of life at 6 and 12 months after hospital discharge. In this qualitative study, we sought to explore the health-coaching intervention as seen from the perspective of the participants who received the intervention and the coaches who delivered it. METHODS Semistructured participant interviews (n = 24) and a focus group of all health coaches (n = 3) who participated in this study were conducted. Interviews and focus group were recorded and transcribed verbatim. Transcripts were analyzed using coding and categorizing techniques and thematic analysis. Mixed-method triangulation was used to merge quantitative and qualitative data. RESULTS Content analysis revealed 4 predominant themes of the coaching intervention: health-coaching relationship, higher participant confidence and reassurance (most related to improvement in physical quality of life), improved health-care system access (most related to decreased hospital readmissions), and increased awareness of COPD symptoms (most related to improvement in emotional quality of life). The strongest theme was the relationship with the health coach, including coach style and motivational interviewing approach. Health coaches' focus group also noted the importance of the coaching relationship as the most significant theme. CONCLUSIONS This study provided themes to further inform the delivery and implementation of health-coaching interventions in patients with COPD after hospital discharge. Health coaching forged partnerships and created a platform for patient engagement, which was confirmed by both participants and health coaches.
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Affiliation(s)
- Roberto P Benzo
- Mindful Breathing Laboratory, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Janae L Kirsch
- Mindful Breathing Laboratory, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Charlene E McEvoy
- HealthPartners Institute for Education and Research, Bloomington, Minnesota
| | - Kristin S Vickers
- Division of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
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21
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Curinier C, Solecki K, Dupuy AM, Breuker C, Lotierzo M, Zerkowski L, Kalmanovich E, Akodad M, Adda J, Battistella P, Castet-Nicolas A, Kuster N, Marques S, Soltani S, Chettouh M, Verchere A, Belloc C, Roubille C, Fesler P, Mercier G, Cristol JP, Audurier Y, Roubille F. Evaluation of the sST2-guided optimization of medical treatments of patients admitted for heart failure, to prevent readmission: Study protocol for a randomized controlled trial. Contemp Clin Trials 2018; 66:45-50. [PMID: 29414143 DOI: 10.1016/j.cct.2018.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 11/22/2022]
Affiliation(s)
- Corentin Curinier
- Cardiology Department, University Hospital of Montpellier, Montpellier, France.
| | - Kamila Solecki
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Anne-Marie Dupuy
- Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France
| | - Cyril Breuker
- Pharmacy Department, University Hospital of Montpellier, Montpellier, France; Internal Medicine and Hypertension Department, Lapeyronie Hospital, Montpellier University, Montpellier, France; Economic evaluation unit at Montpellier teaching hospital, University of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, Cedex 5, France
| | - Manuela Lotierzo
- Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France
| | - Laetitia Zerkowski
- Internal Medicine and Hypertension Department, Lapeyronie Hospital, Montpellier University, Montpellier, France
| | - Eran Kalmanovich
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Mariama Akodad
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Jérôme Adda
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Pascal Battistella
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | | | - Nils Kuster
- Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France
| | - Sandra Marques
- Cardiology Department, University Hospital of Montpellier, Montpellier, France; Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France; Pharmacy Department, University Hospital of Montpellier, Montpellier, France; Internal Medicine and Hypertension Department, Lapeyronie Hospital, Montpellier University, Montpellier, France; Economic evaluation unit at Montpellier teaching hospital, University of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, Cedex 5, France
| | - Sonia Soltani
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Marine Chettouh
- Cardiology Department, University Hospital of Montpellier, Montpellier, France
| | - Anne Verchere
- Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - Claire Belloc
- Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - Camille Roubille
- Internal Medicine and Hypertension Department, Lapeyronie Hospital, Montpellier University, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, Cedex 5, France
| | - Pierre Fesler
- Internal Medicine and Hypertension Department, Lapeyronie Hospital, Montpellier University, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, Cedex 5, France
| | - Grégoire Mercier
- Economic evaluation unit at Montpellier teaching hospital, University of Montpellier, Montpellier, France
| | - Jean-Paul Cristol
- Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, Cedex 5, France
| | - Yohan Audurier
- Pharmacy Department, University Hospital of Montpellier, Montpellier, France
| | - François Roubille
- Cardiology Department, University Hospital of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier, Cedex 5, France
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Oyanguren J, García-Garrido LL, Nebot Margalef M, Lekuona I, Comin-Colet J, Manito N, Roure J, Ruiz Rodriguez P, Enjuanes C, Latorre P, Torcal Laguna J, García-Gutiérrez S. Design of a multicentre randomized controlled trial to assess the safety and efficacy of dose titration by specialized nurses in patients with heart failure. ETIFIC study protocol. ESC Heart Fail 2017; 4:507-519. [PMID: 29154427 PMCID: PMC5695164 DOI: 10.1002/ehf2.12152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 01/25/2017] [Accepted: 02/17/2017] [Indexed: 01/06/2023] Open
Abstract
Aims Heart failure (HF) is associated with many hospital admissions and relatively high mortality, rates decreasing with administration of beta‐blockers (BBs), angiotensin‐converting‐enzyme inhibitors, angiotensin II receptor blockers, and mineralocorticoid receptor antagonists. The effect is dose dependent, suboptimal doses being common in clinical practice. The 2012 European guidelines recommend close monitoring and dose titration by HF nurses. Our main aim is to compare BB doses achieved by patients after 4 months in intervention (HF nurse‐managed) and control (cardiologist‐managed) groups. Secondary aims include comparing doses of the other aforementioned drugs achieved after 4 months, adverse events, and outcomes at 6 months in the two groups. Methods We have designed a multicentre (20 hospitals) non‐inferiority randomized controlled trial, including patients with new‐onset HF, left ventricular ejection fraction ≤40%, and New York Heart Association class II–III, with no contraindications to BBs. We will also conduct qualitative analysis to explore potential barriers to and facilitators of dose titration by HF nurses. In the intervention group, HF nurses will implement titration as prescribed by cardiologists, following a protocol. In controls, cardiologists will both prescribe and titrate doses. The study variables are doses of each of the drugs after 4 months relative to the target dose (%), New York Heart Association class, left ventricular ejection fraction, N‐terminal pro B‐type natriuretic peptide levels, 6 min walk distance, comorbidities, renal function, readmissions, mortality, quality of life, and psychosocial characteristics. Conclusions The trial seeks to assess whether titration by HF nurses of drugs recommended in practice guidelines is safe and not inferior to direct management by cardiologists. The results could have an impact on clinical practice.
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Affiliation(s)
- Juana Oyanguren
- Department of Cardiology, Galdakao Hospital-Barrualde, Osakidetza-Basque Health Service, Bilbao, Spain
| | - LLuisa García-Garrido
- Department of Cardiology, Girona University Hospital Dr. Josep Trueta, Girona, Spain
| | - Magdalena Nebot Margalef
- Department Cardiology, Catalan Institute of Health, Bellvitge University Hospital, IDIBELL, Institute of Biomedical Research, Barcelona, Spain
| | - Iñaki Lekuona
- Department of Cardiology, Galdakao Hospital-Barrualde, Osakidetza-Basque Health Service, Bilbao, Spain
| | - Josep Comin-Colet
- Department of Cardiology, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Nicolás Manito
- Department Cardiology, Catalan Institute of Health, Bellvitge University Hospital, IDIBELL, Institute of Biomedical Research, Barcelona, Spain
| | - Julia Roure
- Department of Cardiology, Girona University Hospital Dr. Josep Trueta, Girona, Spain
| | - Pilar Ruiz Rodriguez
- Department of Cardiology, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Cristina Enjuanes
- Department of Cardiology, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
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Flanagan S, Damery S, Combes G. The effectiveness of integrated care interventions in improving patient quality of life (QoL) for patients with chronic conditions. An overview of the systematic review evidence. Health Qual Life Outcomes 2017; 15:188. [PMID: 28962570 PMCID: PMC5622519 DOI: 10.1186/s12955-017-0765-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/24/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of integrated care interventions in improving the Quality of Life (QoL) for patients with chronic conditions. DESIGN A review of the systematic reviews evidence (umbrella review). DATA SOURCES Medline, Embase, ASSIA, PsychINFO, HMIC, CINAHL, Cochrane Library (including HTA database), DARE, and Cochrane Database of Systematic Reviews), EPPI-Centre, TRIP and Health Economics Evaluations databases. Reference lists of included reviews were searched for additional references not returned by electronic searches. REVIEW METHODS English language systematic reviews or meta-analyses published since 2000 that assessed the effectiveness of interventions in improving the QoL of patients with chronic conditions. Two reviewers independently assessed reviews for eligibility, extracted data, and assessed the quality of included studies. RESULTS A total of 41 reviews assessed QoL. Twenty one reviews presented quantitative data, 17 reviews were narrative and three were reviews of reviews. The intervention categories included case management, Chronic care model (CCM), discharge management, multidisciplinary teams (MDT), complex interventions, primary vs. secondary care follow-up, and self-management. CONCLUSIONS Taken together, the 41 reviews that assessed QoL provided a mixed picture of the effectiveness of integrated care interventions. Case management interventions showed some positive findings as did CCM interventions, although these interventions were more likely to be effective when they included a greater number of components. Discharge management interventions appeared to be particularly successful for patients with heart failure. MDT and self-management interventions showed a mixed picture. In general terms, interventions were typically more effective in improving condition-specific QoL rather than global QoL. This review provided the first overview of international evidence for the effectiveness of integrated care interventions for improving the QoL for patients with chronic conditions.
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Affiliation(s)
- Sarah Flanagan
- Research Fellow, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, West Midlands B15 2TT UK
| | - Sarah Damery
- Research Fellow, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, West Midlands B15 2TT UK
| | - Gill Combes
- Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands Research Lead for Chronic Conditions Theme, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, West Midlands B15 2TT UK
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Yun JE, Park JE, Park HY, Lee HY, Park DA. Comparative Effectiveness of Telemonitoring Versus Usual Care for Heart Failure: A Systematic Review and Meta-analysis. J Card Fail 2017; 24:19-28. [PMID: 28939459 DOI: 10.1016/j.cardfail.2017.09.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 09/11/2017] [Accepted: 09/15/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study aimed to evaluate the effectiveness of telemonitoring (TM) in the management of patients with heart failure (HF). METHODS AND RESULTS We searched Ovid-Medline, Ovid-Embase, and the Cochrane Library for randomized controlled trials published through May 2016. Outcomes of interest included clinical effectiveness (mortality, hospitalization, and emergency department visits) and patient-reported outcomes. TM was defined as the transmission of individual biologic data, such as weight, blood pressure, and heart rate. Thirty-seven randomized controlled trials (9582 patients) of TM met the inclusion criteria: 24 studies on all-cause mortality, 17 studies on all-cause hospitalization, 12 studies on HF-related hospitalization, and 5 studies on HF-related mortality. The risks of all-cause mortality (risk ratio [RR] 0.81, 95% confidence interval [CI] 0.70-0.94) and HF-related mortality (RR 0.68, 95% CI 0.50-0.91) were significantly lower in the TM group than in the usual care group. TM showed a significant benefit when ≥3 biologic data are transmitted or when transmission occurred daily. TM also reduced mortality risk in studies that monitored patients' symptoms, medication adherence, or prescription changes. CONCLUSIONS TM intervention reduces the mortality risk in patients with HF, and intensive monitoring with more frequent transmissions of patient data increases its effectiveness.
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Affiliation(s)
- Ji Eun Yun
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Jeong-Eun Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Hyun-Young Park
- Division of Cardiovascular Diseases, National Institute of Health, Cheongju-si, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong-Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea.
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Benzo R, Vickers K, Novotny PJ, Tucker S, Hoult J, Neuenfeldt P, Connett J, Lorig K, McEvoy C. Health Coaching and Chronic Obstructive Pulmonary Disease Rehospitalization. A Randomized Study. Am J Respir Crit Care Med 2017; 194:672-80. [PMID: 26953637 DOI: 10.1164/rccm.201512-2503oc] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Hospital readmission for chronic obstructive pulmonary disease (COPD) has attracted attention owing to the burden to patients and the health care system. There is a knowledge gap on approaches to reducing COPD readmissions. OBJECTIVES To determine the effect of comprehensive health coaching on the rate of COPD readmissions. METHODS A total of 215 patients hospitalized for a COPD exacerbation were randomized at hospital discharge to receive either (1) motivational interviewing-based health coaching plus a written action plan for exacerbations (the use of antibiotics and oral steroids) and brief exercise advice or (2) usual care. MEASUREMENTS AND MAIN RESULTS We evaluated the rate of COPD-related hospitalizations during 1 year of follow-up. The absolute risk reductions of COPD-related rehospitalization in the health coaching group were 7.5% (P = 0.01), 11.0% (P = 0.02), 11.6% (P = 0.03), 11.4% (P = 0.05), and 5.4% (P = 0.24) at 1, 3, 6, 9, and 12 months, respectively, compared with the control group. The odds ratios for COPD hospitalization in the intervention arm compared with the control arm were 0.09 (95% confidence interval [CI], 0.01-0.77) at 1 month postdischarge, 0.37 (95% CI, 0.15-0.91) at 3 months postdischarge, 0.43 (95% CI, 0.20-0.94) at 6 months postdischarge, and 0.60 (95% CI, 0.30-1.20) at 1 year postdischarge. The missing value rate for the primary outcome was 0.4% (one patient). Disease-specific quality of life improved significantly in the health coaching group compared with the control group at 6 and 12 months, based on the Chronic Respiratory Disease Questionnaire emotional score (emotion and mastery domains) and physical score (dyspnea and fatigue domains) (P < 0.05). There were no differences between groups in measured physical activity at any time point. CONCLUSIONS Health coaching may represent a feasible and possibly effective intervention designed to reduce COPD readmissions. Clinical trial registered with www.clinicaltrials.gov (NCT01058486).
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Affiliation(s)
- Roberto Benzo
- 1 Mindful Breathing Laboratory, Division of Pulmonary and Critical Care Medicine
| | | | - Paul J Novotny
- 3 Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Sharon Tucker
- 4 University of Iowa Hospitals & Clinics, Iowa City, Iowa
| | - Johanna Hoult
- 1 Mindful Breathing Laboratory, Division of Pulmonary and Critical Care Medicine
| | - Pamela Neuenfeldt
- 5 HealthPartners Institute for Education and Research, Bloomington, Minnesota
| | - John Connett
- 6 Academic Health Center, University of Minnesota, Minneapolis, Minnesota; and
| | - Kate Lorig
- 7 Stanford Patient Education Research Center, Palo Alto, California
| | - Charlene McEvoy
- 5 HealthPartners Institute for Education and Research, Bloomington, Minnesota
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Le Berre M, Maimon G, Sourial N, Guériton M, Vedel I. Impact of Transitional Care Services for Chronically Ill Older Patients: A Systematic Evidence Review. J Am Geriatr Soc 2017; 65:1597-1608. [PMID: 28403508 DOI: 10.1111/jgs.14828] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Transitions in care from hospital to primary care for older patients with chronic diseases (CD) are complex and lead to increased mortality and service use. In response to these challenges, transitional care (TC) interventions are being widely implemented. They encompass education on self-management, discharge planning, structured follow-up and coordination among the different healthcare professionals. We conducted a systematic review to determine the effectiveness of interventions targeting transitions from hospital to the primary care setting for chronically ill older patients.. Randomized controlled trials were identified through Medline, CINHAL, PsycInfo, EMBASE (1995-2015). Two independent reviewers performed the study selection, data extraction and assessment of study quality (Cochrane "Risk of Bias"). Risk differences (RD) and number needed to treat (NNT) or mean differences (MD) were calculated using a random-effects model. From 10,234 references, 92 studies were included. Compared to usual care, significantly better outcomes were observed: a lower mortality at 3 (RD: -0.02 [-0.05, 0.00]; NNT: 50), 6, 12 and 18 months post-discharge, a lower rate of ED visits at 3 months (RD: -0.08 [-0.15, -0.01]; NNT: 13), a lower rate of readmissions at 3 (RD: -0.08 [-0.14, -0.03]; NNT: 7), 6, 12 and 18 months and a lower mean of readmission days at 3 (MD: -1.33; [-2.15, -0.52]), 6, 12 and 18 months. No significant differences were observed in quality of life. In conclusion, TC improves transitions for older patients and should be included in the reorganization of healthcare services.
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Affiliation(s)
- Mélanie Le Berre
- Lady Davis Institute of the Jewish General Hospital, Montreal, Québec, Canada
| | - Geva Maimon
- Lady Davis Institute of the Jewish General Hospital, Montreal, Québec, Canada
| | - Nadia Sourial
- Lady Davis Institute of the Jewish General Hospital, Montreal, Québec, Canada
| | - Muriel Guériton
- Lady Davis Institute of the Jewish General Hospital, Montreal, Québec, Canada
| | - Isabelle Vedel
- Lady Davis Institute of the Jewish General Hospital, Montreal, Québec, Canada.,Department of Family Medicine, McGill University, Montreal, Québec, Canada
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Effectiveness and Factors Determining the Success of Management Programs for Patients With Heart Failure: A Systematic Review and Meta-analysis. ACTA ACUST UNITED AC 2017; 69:900-914. [PMID: 27692124 DOI: 10.1016/j.rec.2016.05.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/13/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Heart failure management programs reduce hospitalizations. Some studies also show reduced mortality. The determinants of program success are unknown. The aim of the present study was to update our understanding of the reductions in mortality and readmissions produced by these programs, elucidate their components, and identify the factors determining program success. METHODS Systematic literature review (1990-2014; PubMed, EMBASE, CINAHL, Cochrane Library) and manual search of relevant journals. The studies were selected by 3 independent reviewers. Methodological quality was evaluated in a blinded manner by an external researcher (Jadad scale). These results were pooled using random effects models. Heterogeneity was evaluated with the I2 statistic, and its explanatory factors were determined using metaregression analysis. RESULTS Of the 3914 studies identified, 66 randomized controlled clinical trials were selected (18 countries, 13 535 patients). We determined the relative risks to be 0.88 for death (95% confidence interval [95%CI], 0.81-0.96; P < .002; I2, 6.1%), 0.92 for all-cause readmissions (95%CI, 0.86-0.98; P < .011; I2, 58.7%), and 0.80 for heart failure readmissions (95%CI, 0.71-0.90; P < .0001; I2, 52.7%). Factors associated with program success were implementation after 2001, program location outside the United States, greater baseline use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, a higher number of intervention team members and components, specialized heart failure cardiologists and nurses, protocol-driven education and its assessment, self-monitoring of signs and symptoms, detection of deterioration, flexible diuretic regimen, early care-seeking among patients and prompt health care response, psychosocial intervention, professional coordination, and program duration. CONCLUSIONS We confirm the reductions in mortality and readmissions with heart failure management programs. Their success is associated with various structural and intervention variables.
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Maru S, Byrnes JM, Carrington MJ, Stewart S, Scuffham PA. Long-term cost-effectiveness of home versus clinic-based management of chronic heart failure: the WHICH? study. J Med Econ 2017; 20:318-327. [PMID: 27841726 DOI: 10.1080/13696998.2016.1261031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The cost-effectiveness of a heart failure management intervention can be further informed by incorporating the expected benefits and costs of future survival. METHODS This study compared the long-term costs per quality-adjusted life year (QALY) gained from home-based (HBI) vs specialist clinic-based intervention (CBI) among elderly patients (mean age = 71 years) with heart failure discharged home (mean intervention duration = 12 months). Cost-utility analysis was conducted from a government-funded health system perspective. A Markov cohort model was used to simulate disease progression over 15 years based on initial data from a randomized clinical trial (the WHICH? study). Time-dependent hazard functions were modeled using the Weibull function, and this was compared against an alternative model where the hazard was assumed to be constant over time. Deterministic and probabilistic sensitivity analyses were conducted to identify the key drivers of cost-effectiveness and quantify uncertainty in the results. RESULTS During the trial, mortality was the highest within 30 days of discharge and decreased thereafter in both groups, although the declining rate of mortality was slower in CBI than HBI. At 15 years (extrapolated), HBI was associated with slightly better health outcomes (mean of 0.59 QALYs gained) and mean additional costs of AU$13,876 per patient. The incremental cost-utility ratio and the incremental net monetary benefit (vs CBI) were AU$23,352 per QALY gained and AU$15,835, respectively. The uncertainty was driven by variability in the costs and probabilities of readmissions. Probabilistic sensitivity analysis showed HBI had a 68% probability of being cost-effective at a willingness-to-pay threshold of AU$50,000 per QALY. CONCLUSION Compared with CBI (outpatient specialized HF clinic-based intervention), HBI (home-based predominantly, but not exclusively) could potentially be cost-effective over the long-term in elderly patients with heart failure at a willingness-to-pay threshold of AU$50,000/QALY, albeit with large uncertainty.
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Affiliation(s)
- Shoko Maru
- a Centre for Applied Health Economics, School of Medicine and Population & Social Health Research, Menzies Health Institute Queensland, Griffith University , Nathan , QLD , Australia
| | - Joshua M Byrnes
- a Centre for Applied Health Economics, School of Medicine and Population & Social Health Research, Menzies Health Institute Queensland, Griffith University , Nathan , QLD , Australia
| | - Melinda J Carrington
- b Centre for Primary Care and Prevention, Mary MacKillop Institute for Health Research, Australian Catholic University , Melbourne , Victoria , Australia
| | - Simon Stewart
- c Centre for Research Excellence to Reduce Inequality in Heart Disease, Mary MacKillop Institute for Health Research, Australian Catholic University , Melbourne Victoria , Australia
| | - Paul A Scuffham
- a Centre for Applied Health Economics, School of Medicine and Population & Social Health Research, Menzies Health Institute Queensland, Griffith University , Nathan , QLD , Australia
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Korda RJ, Du W, Day C, Page K, Macdonald PS, Banks E. Variation in readmission and mortality following hospitalisation with a diagnosis of heart failure: prospective cohort study using linked data. BMC Health Serv Res 2017; 17:220. [PMID: 28320381 PMCID: PMC5359909 DOI: 10.1186/s12913-017-2152-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 03/10/2017] [Indexed: 11/24/2022] Open
Abstract
Background Hospitalisation for heart failure is common and post-discharge outcomes, including readmission and mortality, are often poor and are poorly understood. The purpose of this study was to examine patient- and hospital-level variation in the risk of 30-day unplanned readmission and mortality following discharge from hospital with a diagnosis of heart failure. Methods Prospective cohort study using data from the Sax Institute’s 45 and Up Study, linking baseline survey (Jan 2006-April 2009) to hospital and mortality data (to Dec 2011). Primary outcomes in those admitted to hospital with heart failure included unplanned readmission, mortality and combined unplanned readmission/mortality, within 30 days of discharge. Multilevel models quantified the variation in outcomes between hospitals and examined associations with patient- and hospital-level characteristics. Results There were 5074 participants with a heart failure admission discharged from 251 hospitals; 1052 (21%) had unplanned readmissions, 186 (3.7%) died, and 1146 (23%) had either/both outcomes within 30 days of discharge. Crude outcomes varied across hospitals, but between-hospital variation explained little of the total variation in outcomes (intraclass correlation coefficients (ICC) after inclusion of patient factors: 30-day unplanned readmission ICC = 0.0125 (p = 0.24); death ICC = 0.0000 (p > 0.99); unplanned readmission/death ICC = 0.0266 (p = 0.07)). Patient characteristics associated with a higher risk of unplanned readmission included: being male (male vs female, adjusted odds ratio (aOR) = 1.18, 95% CI: 1.00–1.37); prior hospitalisation for cardiovascular disease (aOR = 1.44, 1.08–1.91) and for anemia (aOR = 1.36, 1.14–1.63); comorbidities at admission (severe vs none: aOR = 1.26, 1.03–1.54); lower body-mass-index (obese vs normal weight: aOR = 0.77, 0.63–0.94); and lower social interaction scores. Similarly, risk of 30-day mortality was associated with patient- rather than hospital-level factors, in particular age (≥85y vs 45–< 75y: aOR = 3.23, 1.93–5.41) and comorbidity (severe vs none: aOR = 2.68, 1.82–3.94). Conclusions The issue of high readmission and mortality rates in people with heart failure appear to be system-wide, with the variation in these outcomes essentially attributable to variation between patients rather than hospitals. The findings suggest that there are limitations in using these outcomes as hospital performance measures in this patient population and support the need for patient-centred strategies to optimise heart failure management and outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2152-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rosemary J Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia.
| | - Wei Du
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - Cathy Day
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - Karen Page
- Deakin University, School of Nursing and Midwifery, Melbourne, Australia
| | - Peter S Macdonald
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia.,The Sax Institute, Sydney, Australia
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Larsson LG, Bäck-Pettersson S, Kylén S, Marklund B, Carlström E. Primary care managers’ perceptions of their capability in providing care planning to patients with complex needs. Health Policy 2017; 121:58-65. [DOI: 10.1016/j.healthpol.2016.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 11/11/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
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Telemonitoring is acceptable amongst community dwelling older Australians with chronic conditions. Collegian 2016; 23:383-90. [DOI: 10.1016/j.colegn.2015.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Srisuk N, Cameron J, Ski CF, Thompson DR. Randomized controlled trial of family-based education for patients with heart failure and their carers. J Adv Nurs 2016; 73:857-870. [DOI: 10.1111/jan.13192] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Nittaya Srisuk
- Faculty of Nursing; Surat Thani Rajabhat University; Surat Thani Thailand
- Centre for the Heart and Mind; Mary MacKillop Institute for Health Research; Australian Catholic University; Melbourne Australia
| | - Jan Cameron
- Department of Medicine; School of Clinical Sciences at Monash Health; Monash University; Clayton Australia
| | - Chantal F. Ski
- Centre for the Heart and Mind; Mary MacKillop Institute for Health Research; Australian Catholic University; Melbourne Australia
| | - David R. Thompson
- Centre for the Heart and Mind; Mary MacKillop Institute for Health Research; Australian Catholic University; Melbourne Australia
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Damery S, Flanagan S, Combes G. Does integrated care reduce hospital activity for patients with chronic diseases? An umbrella review of systematic reviews. BMJ Open 2016; 6:e011952. [PMID: 27872113 PMCID: PMC5129137 DOI: 10.1136/bmjopen-2016-011952] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 08/08/2016] [Accepted: 09/30/2016] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To summarise the evidence regarding the effectiveness of integrated care interventions in reducing hospital activity. DESIGN Umbrella review of systematic reviews and meta-analyses. SETTING Interventions must have delivered care crossing the boundary between at least two health and/or social care settings. PARTICIPANTS Adult patients with one or more chronic diseases. DATA SOURCES MEDLINE, Embase, ASSIA, PsycINFO, HMIC, CINAHL, Cochrane Library (HTA database, DARE, Cochrane Database of Systematic Reviews), EPPI-Centre, TRIP, HEED, manual screening of references. OUTCOME MEASURES Any measure of hospital admission or readmission, length of stay (LoS), accident and emergency use, healthcare costs. RESULTS 50 reviews were included. Interventions focused on case management (n=8), chronic care model (CCM) (n=9), discharge management (n=15), complex interventions (n=3), multidisciplinary teams (MDT) (n=10) and self-management (n=5). 29 reviews reported statistically significant improvements in at least one outcome. 11/21 reviews reported significantly reduced emergency admissions (15-50%); 11/24 showed significant reductions in all-cause (10-30%) or condition-specific (15-50%) readmissions; 9/16 reported LoS reductions of 1-7 days and 4/9 showed significantly lower A&E use (30-40%). 10/25 reviews reported significant cost reductions but provided little robust evidence. Effective interventions included discharge management with postdischarge support, MDT care with teams that include condition-specific expertise, specialist nurses and/or pharmacists and self-management as an adjunct to broader interventions. Interventions were most effective when targeting single conditions such as heart failure, and when care was provided in patients' homes. CONCLUSIONS Although all outcomes showed some significant reductions, and a number of potentially effective interventions were found, interventions rarely demonstrated unequivocally positive effects. Despite the centrality of integrated care to current policy, questions remain about whether the magnitude of potentially achievable gains is enough to satisfy national targets for reductions in hospital activity. TRIAL REGISTRATION NUMBER CRD42015016458.
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Affiliation(s)
- Sarah Damery
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, UK
| | - Sarah Flanagan
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, UK
| | - Gill Combes
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, UK
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Efectividad y determinantes del éxito de los programas de atención a pacientes con insuficiencia cardiaca: revisión sistemática y metanálisis. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.05.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Comín-Colet J, Enjuanes C, Lupón J, Cainzos-Achirica M, Badosa N, Verdú JM. Transiciones de cuidados entre insuficiencia cardiaca aguda y crónica: pasos críticos en el diseño de un modelo de atención multidisciplinaria para la prevención de la hospitalización recurrente. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.04.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jensen L, Troster SM, Cai K, Shack A, Chang YJR, Wang D, Kim JS, Turial D, Bierman AS. Improving Heart Failure Outcomes in Ambulatory and Community Care: A Scoping Study. Med Care Res Rev 2016; 74:551-581. [DOI: 10.1177/1077558716655451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Despite a large body of literature testing interventions to improve heart failure care, care is often suboptimal. This scoping study assesses organizational interventions to improve heart failure outcomes in ambulatory settings. Fifty-two studies and systematic reviews assessing multicomponent, self-management support, and eHealth interventions were included. Studies dating from the 1990s demonstrated that multicomponent interventions could reduce hospitalizations, readmissions, mortality, and costs and improve quality of life. Self-management support appeared more effective when included in multicomponent interventions. The independent contribution of eHealth interventions remains unclear. No studies addressed management of comorbidities, geriatric syndromes, frailty, or end of life care. Few studies addressed risk stratification or vulnerable populations. Limited reporting about intervention components, implementation methods, and fidelity presents challenges in adapting this literature to scale interventions. The use of standardized reporting guidelines and study designs that produce more contextual evidence would better enable application of this work in health system redesign.
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Affiliation(s)
| | | | | | - Avram Shack
- Ben-Gurion University of the Negev, Beersheba, Israel
| | | | - Dorothy Wang
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ji Soo Kim
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Arlene S. Bierman
- University of Toronto, Ontario, Canada
- St. Michael’s Hospital, Toronto, Ontario, Canada
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Comín-Colet J, Enjuanes C, Lupón J, Cainzos-Achirica M, Badosa N, Verdú JM. Transitions of Care Between Acute and Chronic Heart Failure: Critical Steps in the Design of a Multidisciplinary Care Model for the Prevention of Rehospitalization. ACTA ACUST UNITED AC 2016; 69:951-961. [PMID: 27282437 DOI: 10.1016/j.rec.2016.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 04/14/2016] [Indexed: 11/28/2022]
Abstract
Despite advances in the treatment of heart failure, mortality, the number of readmissions, and their associated health care costs are very high. Heart failure care models inspired by the chronic care model, also known as heart failure programs or heart failure units, have shown clinical benefits in high-risk patients. However, while traditional heart failure units have focused on patients detected in the outpatient phase, the increasing pressure from hospital admissions is shifting the focus of interest toward multidisciplinary programs that concentrate on transitions of care, particularly between the acute phase and the postdischarge phase. These new integrated care models for heart failure revolve around interventions at the time of transitions of care. They are multidisciplinary and patient-centered, designed to ensure continuity of care, and have been demonstrated to reduce potentially avoidable hospital admissions. Key components of these models are early intervention during the inpatient phase, discharge planning, early postdischarge review and structured follow-up, advanced transition planning, and the involvement of physicians and nurses specialized in heart failure. It is hoped that such models will be progressively implemented across the country.
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Affiliation(s)
- Josep Comín-Colet
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Programa Integrado de Atención a la Insuficiencia Cardiaca, Área Integral de Salud Barcelona Litoral Mar, Servicio Catalán de la Salud, Barcelona, Spain; Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Cristina Enjuanes
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Programa Integrado de Atención a la Insuficiencia Cardiaca, Área Integral de Salud Barcelona Litoral Mar, Servicio Catalán de la Salud, Barcelona, Spain; Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Josep Lupón
- Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain; Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Miguel Cainzos-Achirica
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, United States; Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Neus Badosa
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Programa Integrado de Atención a la Insuficiencia Cardiaca, Área Integral de Salud Barcelona Litoral Mar, Servicio Catalán de la Salud, Barcelona, Spain; Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - José María Verdú
- Programa Integrado de Atención a la Insuficiencia Cardiaca, Área Integral de Salud Barcelona Litoral Mar, Servicio Catalán de la Salud, Barcelona, Spain; Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Atención Primaria Sant Martí de Provençals, Instituto Catalán de la Salud, Barcelona, Spain; Instituto de investigación de Atención Primaria Jordi Gol, Instituto Catalán de la Salud, Barcelona, Spain
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Riley JP, Astin F, Crespo-Leiro MG, Deaton CM, Kienhorst J, Lambrinou E, McDonagh TA, Rushton CA, Stromberg A, Filippatos G, Anker SD. Heart Failure Association of the European Society of Cardiology heart failure nurse curriculum. Eur J Heart Fail 2016; 18:736-43. [DOI: 10.1002/ejhf.568] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 07/07/2015] [Accepted: 04/19/2016] [Indexed: 01/28/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Anna Stromberg
- Department of Medical and Health Sciences; Linköping University; Sweden
| | | | - Stefan D. Anker
- Department of Innovative Clinical Trials; University Medical Centre Göttingen (UMG); Göttingen Germany
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Kollia ZA, Giakoumidakis K, Brokalaki H. The Effectiveness of Nursing Education on Clinical Outcomes of Patients With Heart Failure: A Systematic Review. ACTA ACUST UNITED AC 2016. [DOI: 10.17795/jjcdc-35881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lê G, Morgan R, Bestall J, Featherstone I, Veale T, Ensor T. Can service integration work for universal health coverage? Evidence from around the globe. Health Policy 2016; 120:406-19. [DOI: 10.1016/j.healthpol.2016.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/12/2016] [Accepted: 02/16/2016] [Indexed: 11/15/2022]
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Can we engage caregiver spouses of patients with heart failure with a low-intensity, symptom-guided intervention? Heart Lung 2016; 45:114-20. [DOI: 10.1016/j.hrtlng.2015.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/04/2015] [Accepted: 12/22/2015] [Indexed: 11/17/2022]
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Chatrung C, Sorajjakool S, Amnatsatsue K. Wellness and Religious Coping Among Thai Individuals Living with Chronic Kidney Disease in Southern California. JOURNAL OF RELIGION AND HEALTH 2015; 54:2198-2211. [PMID: 25300413 DOI: 10.1007/s10943-014-9958-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This qualitative research is based on eight Thai participants living with chronic kidney disease living in Southern California. Four emerging themes are (a) wellness, (b) self-care, (c) impact of illness on life, and (d) religious coping. Family relations, social support, and religious coping affected self-care and how they managed their everyday activities. Knowledge about the disease and its mechanism were crucial to the decision-making process in relation to self-care. Good self-care and appropriate self-management led to wellness and improved quality of life. Religion provided a belief system focusing on the place of acceptance that was essential for coping with emotional stressors.
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Affiliation(s)
- Chutikarn Chatrung
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Bangkok, Thailand.
| | - Siroj Sorajjakool
- School of Religion, Loma Linda University, Loma Linda, CA, 92350, USA.
| | - Kwanjai Amnatsatsue
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Bangkok, Thailand.
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Inglis SC, Clark RA, Dierckx R, Prieto-Merino D, Cleland JGF. Structured telephone support or non-invasive telemonitoring for patients with heart failure. Cochrane Database Syst Rev 2015; 2015:CD007228. [PMID: 26517969 PMCID: PMC8482064 DOI: 10.1002/14651858.cd007228.pub3] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Specialised disease management programmes for heart failure aim to improve care, clinical outcomes and/or reduce healthcare utilisation. Since the last version of this review in 2010, several new trials of structured telephone support and non-invasive home telemonitoring have been published which have raised questions about their effectiveness. OBJECTIVES To review randomised controlled trials (RCTs) of structured telephone support or non-invasive home telemonitoring compared to standard practice for people with heart failure, in order to quantify the effects of these interventions over and above usual care. SEARCH METHODS We updated the searches of the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology AsseFssment Database (HTA) on the Cochrane Library; MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO), Science Citation Index Expanded (SCI-EXPANDED), Conference Proceedings Citation Index- Science (CPCI-S) on Web of Science (Thomson Reuters), AMED, Proquest Theses and Dissertations, IEEE Xplore and TROVE in January 2015. We handsearched bibliographies of relevant studies and systematic reviews and abstract conference proceedings. We applied no language limits. SELECTION CRITERIA We included only peer-reviewed, published RCTs comparing structured telephone support or non-invasive home telemonitoring to usual care of people with chronic heart failure. The intervention or usual care could not include protocol-driven home visits or more intensive than usual (typically four to six weeks) clinic follow-up. DATA COLLECTION AND ANALYSIS We present data as risk ratios (RRs) with 95% confidence intervals (CIs). Primary outcomes included all-cause mortality, all-cause and heart failure-related hospitalisations, which we analysed using a fixed-effect model. Other outcomes included length of stay, health-related quality of life, heart failure knowledge and self care, acceptability and cost; we described and tabulated these. We performed meta-regression to assess homogeneity (the null hypothesis) in each subgroup analysis and to see if the effect of the intervention varied according to some quantitative variable (such as year of publication or median age). MAIN RESULTS We include 41 studies of either structured telephone support or non-invasive home telemonitoring for people with heart failure, of which 17 were new and 24 had been included in the previous Cochrane review. In the current review, 25 studies evaluated structured telephone support (eight new studies, plus one study previously included but classified as telemonitoring; total of 9332 participants), 18 evaluated telemonitoring (nine new studies; total of 3860 participants). Two of the included studies trialled both structured telephone support and telemonitoring compared to usual care, therefore 43 comparisons are evident.Non-invasive telemonitoring reduced all-cause mortality (RR 0.80, 95% CI 0.68 to 0.94; participants = 3740; studies = 17; I² = 24%, GRADE: moderate-quality evidence) and heart failure-related hospitalisations (RR 0.71, 95% CI 0.60 to 0.83; participants = 2148; studies = 8; I² = 20%, GRADE: moderate-quality evidence). Structured telephone support reduced all-cause mortality (RR 0.87, 95% CI 0.77 to 0.98; participants = 9222; studies = 22; I² = 0%, GRADE: moderate-quality evidence) and heart failure-related hospitalisations (RR 0.85, 95% CI 0.77 to 0.93; participants = 7030; studies = 16; I² = 27%, GRADE: moderate-quality evidence).Neither structured telephone support nor telemonitoring demonstrated effectiveness in reducing the risk of all-cause hospitalisations (structured telephone support: RR 0.95, 95% CI 0.90 to 1.00; participants = 7216; studies = 16; I² = 47%, GRADE: very low-quality evidence; non-invasive telemonitoring: RR 0.95, 95% CI 0.89 to 1.01; participants = 3332; studies = 13; I² = 71%, GRADE: very low-quality evidence).Seven structured telephone support studies reported length of stay, with one reporting a significant reduction in length of stay in hospital. Nine telemonitoring studies reported length of stay outcome, with one study reporting a significant reduction in the length of stay with the intervention. One telemonitoring study reported a large difference in the total number of hospitalisations for more than three days, but this was not an analysis of length of stay per hospitalisation. Nine of 11 structured telephone support studies and five of 11 telemonitoring studies reported significant improvements in health-related quality of life. Nine structured telephone support studies and six telemonitoring studies reported costs of the intervention or cost effectiveness. Three structured telephone support studies and one telemonitoring study reported a decrease in costs and two telemonitoring studies reported increases in cost, due both to the cost of the intervention and to increased medical management. Adherence was rated between 55.1% and 98.5% for those structured telephone support and telemonitoring studies which reported this outcome. Participant acceptance of the intervention was reported in the range of 76% to 97% for studies which evaluated this outcome. Seven of nine studies that measured these outcomes reported significant improvements in heart failure knowledge and self-care behaviours. AUTHORS' CONCLUSIONS For people with heart failure, structured telephone support and non-invasive home telemonitoring reduce the risk of all-cause mortality and heart failure-related hospitalisations; these interventions also demonstrated improvements in health-related quality of life and heart failure knowledge and self-care behaviours. Studies also demonstrated participant satisfaction with the majority of the interventions which assessed this outcome.
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Affiliation(s)
- Sally C Inglis
- Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, Australia
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González-Guerrero JL, Alonso-Fernández T, García-Mayolín N, Gusi N, Ribera-Casado JM. Effect of A Follow-Up Program in Elderly Adults with Heart Failure with Cognitive Impairment After Hospital Discharge. J Am Geriatr Soc 2015; 63:1950-1. [DOI: 10.1111/jgs.13621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | | | | | - Narcís Gusi
- Faculty of Sports Sciences; University of Extremadura; Cáceres Spain
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Maru S, Byrnes J, Carrington MJ, Chan YK, Thompson DR, Stewart S, Scuffham PA. Cost-effectiveness of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort - The WHICH? study (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care). Int J Cardiol 2015; 201:368-75. [PMID: 26310979 DOI: 10.1016/j.ijcard.2015.08.066] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/02/2015] [Accepted: 08/03/2015] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the long-term cost-effectiveness of two multidisciplinary management programs for elderly patients hospitalized with chronic heart failure (CHF) and how it is influenced by patient characteristics. METHODS A trial-based analysis was conducted alongside a randomized controlled trial of 280 elderly patients with CHF discharged to home from three Australian tertiary hospitals. Two interventions were compared: home-based intervention (HBI) that involved home visiting with community-based care versus specialized clinic-based intervention (CBI). Bootstrapped incremental cost-utility ratios were computed based on quality-adjusted life-years (QALYs) and total healthcare costs. Cost-effectiveness acceptability curves were constructed based on incremental net monetary benefit (NMB). We performed multiple linear regression to explore which patient characteristics may impact patient-level NMB. RESULTS During median follow-up of 3.2 years, HBI was associated with slightly higher QALYs (+0.26 years per person; p=0.078) and lower total healthcare costs (AU$ -13,100 per person; p=0.025) mainly driven by significantly reduced duration of all-cause hospital stay (-10 days; p=0.006). At a willingness-to-pay threshold of AU$ 50,000 per additional QALY, the probability of HBI being better-valued was 96% and the incremental NMB of HBI was AU$ 24,342 (discounted, 5%). The variables associated with increased NMB were HBI (vs. CBI), lower Charlson Comorbidity Index, no hyponatremia, fewer months of HF, fewer prior HF admissions <1 year and a higher patient's self-care confidence. HBI's net benefit further increased in those with fewer comorbidities, a lower self-care confidence or no hyponatremia. CONCLUSIONS Compared with CBI, HBI is likely to be cost-effective in elderly CHF patients with significant comorbidity.
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Affiliation(s)
- Shoko Maru
- Centre for Applied Health Economics, School of Medicine, Population & Social Health Research, Menzies Health Institute Queensland, Griffith University, Australia.
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine, Population & Social Health Research, Menzies Health Institute Queensland, Griffith University, Australia
| | - Melinda J Carrington
- Centre for Primary Care and Prevention, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Yih-Kai Chan
- Centre for Primary Care and Prevention, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - David R Thompson
- Centre for Primary Care and Prevention, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Simon Stewart
- Centre for Research Excellence to Reduce Inequality in Heart Disease, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Paul A Scuffham
- Centre for Applied Health Economics, School of Medicine, Population & Social Health Research, Menzies Health Institute Queensland, Griffith University, Australia
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Seguimiento del paciente con insuficiencia cardíaca: coordinación e integración entre niveles asistenciales. ENFERMERIA CLINICA 2015; 25:218-9. [DOI: 10.1016/j.enfcli.2014.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 10/21/2014] [Accepted: 11/15/2014] [Indexed: 11/18/2022]
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47
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Jennings JH, Thavarajah K, Mendez MP, Eichenhorn M, Kvale P, Yessayan L. Predischarge Bundle for Patients With Acute Exacerbations of COPD to Reduce Readmissions and ED Visits. Chest 2015; 147:1227-1234. [DOI: 10.1378/chest.14-1123] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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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
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Cowie MR, Anker SD, Cleland JGF, Felker GM, Filippatos G, Jaarsma T, Jourdain P, Knight E, Massie B, Ponikowski P, López-Sendón J. Improving care for patients with acute heart failure: before, during and after hospitalization. ESC Heart Fail 2015; 1:110-145. [PMID: 28834628 DOI: 10.1002/ehf2.12021] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Acute heart failure (AHF) is a common and serious condition that contributes to about 5% of all emergency hospital admissions in Europe and the USA. Here, we present the recommendations from structured discussions among an author group of AHF experts in 2013. The epidemiology of AHF and current practices in diagnosis, treatment, and long-term care for patients with AHF in Europe and the USA are examined. Available evidence indicates variation in the quality of care across hospitals and regions. Challenges include the need for rapid diagnosis and treatment, the heterogeneity of precipitating factors, and the typical repeated episodes of decompensation requiring admission to hospital for stabilization. In hospital, care should involve input from an expert in AHF and auditing to ensure that guidelines and protocols for treatment are implemented for all patients. A smooth transition to follow-up care is vital. Patient education programmes could have a dramatic effect on improving outcomes. Information technology should allow, where appropriate, patient telemonitoring and sharing of medical records. Where needed, access to end-of-life care and support for all patients, families, and caregivers should form part of a high-quality service. Eight evidence-based consensus policy recommendations are identified by the author group: optimize patient care transitions, improve patient education and support, provide equity of care for all patients, appoint experts to lead AHF care across disciplines, stimulate research into new therapies, develop and implement better measures of care quality, improve end-of-life care, and promote heart failure prevention.
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Affiliation(s)
- Martin R Cowie
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
| | - Stefan D Anker
- Charité-University Medical Centre, Campus Virchow-Klinikum, Berlin, Germany
| | - John G F Cleland
- National Heart and Lung Institute, Imperial College London and Harefield Hospital, London, UK.,University of Hull, Hull, UK
| | | | | | - Tiny Jaarsma
- Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Patrick Jourdain
- René Dubos Hospital, Pontoise, France.,Paris Descartes University, Paris, France
| | | | - Barry Massie
- San Francisco Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | | | - José López-Sendón
- Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
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