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Rizzuto N, Charles G, Knobf MT. Decreasing 30-Day Readmission Rates in Patients With Heart Failure. Crit Care Nurse 2022; 42:13-19. [PMID: 35908767 DOI: 10.4037/ccn2022417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Heart failure affects approximately 6.2 million adults in the United States and has an estimated national cost of $30.7 billion annually. Despite advances in treatment, heart failure is a leading cause of hospital readmissions. Nonadherence to treatment plans, lack of education, and lack of access to care contribute to poorer outcomes. LOCAL PROBLEM For patients with heart failure, the mean readmission rate is 21% nationally and 23% in New York State. Before the pilot heart failure program began, the 30-day readmission rate in the study institution was 28.6%. METHODS A multidisciplinary team created a heart failure self-care pilot program that was implemented on a hospital telemetry unit with 47 patients. Patients received education on their disease process, medications, diet, exercise, and early symptom recognition. Patients received a follow-up telephone call 48 to 72 hours after discharge and were seen by a cardiologist within a week of discharge. RESULTS The 30-day readmission rate for heart failure decreased by 16.6% after implementation of the pilot program, which improved patient adherence to their medication and treatment plan and resulted in a reduction of readmissions. DISCUSSION Patients in the pilot program represented diverse backgrounds. Socioeconomic factors such as the lack of affordable, healthy food choices and easy access to resources were associated with worse outcomes. CONCLUSIONS The evidence-based heart failure program improved knowledge, early symptom recognition, lifestyle modification, and adherence to medication, treatment plan, and follow-up appointments. The multidisciplinary team approach to the heart failure program reduced gaps in care and improved coordination and transition of care.
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Affiliation(s)
- Nancy Rizzuto
- Nancy Rizzuto is an adult nurse practitioner and the Director of Nursing, Critical Care, and Cardiology Services, Brookdale University Hospital, Brooklyn, New York
| | - Greg Charles
- Greg Charles is a program director for Cardiology Services and an angioplasty specialist, Brookdale University Hospital
| | - M Tish Knobf
- M. Tish Knobf is a professor of nursing, Yale University School of Nursing, Orange, Connecticut
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2
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When is enough, enough? Exploring ethical and team considerations in paediatric cardiac care dilemmas. Curr Opin Cardiol 2022; 37:109-114. [PMID: 34698666 DOI: 10.1097/hco.0000000000000926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Therapies for paediatric congenital and acquired heart disease continue to evolve and the appropriateness of pursuing life sustaining interventions at margins of standard therapy is ethically challenging. RECENT FINDINGS With ongoing emphasis on shared decision making, recent literature explored physician and parental perspectives on communication with families and offering interventions for complex congenital heart disease and advanced heart failure. The inclusion of parental values and views in this process is now widely accepted. Identified outstanding challenges include difficulty with prognostication from the outset, adjusting long-term goals of care to changes in clinical parameters, need for consistency in communication including regular review meetings with family or surrogate decision-makers. Bioethics consultation and multidisciplinary team reviews may be helpful supports. Palliative care involvement in this population improves quality of life and alleviates parental distress but this collaboration is not optimized. SUMMARY Decision to offer, forgo, or discontinue life-sustaining therapies for children with heart disease has nuanced and context-specific considerations, and must integrate burdens of interventions with patient and family values. Thus, decision making remains complex and demands thoughtful review of not only risks and benefits, but views and values, clearly communicated to team and family.
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Zylberglait Lisigurski M, Fernandez M, Chokshi B, Lamaa N, Feiz H. ICD Discussions: Closing the Gap between What We Say and What They Understand. South Med J 2018; 111:501-503. [PMID: 30075477 DOI: 10.14423/smj.0000000000000842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Marlena Fernandez
- From the Internal Medicine Residency Training Program at Aventura Hospital and Medical Center, Miami, Florida
| | - Binna Chokshi
- From the Internal Medicine Residency Training Program at Aventura Hospital and Medical Center, Miami, Florida
| | - Nader Lamaa
- From the Internal Medicine Residency Training Program at Aventura Hospital and Medical Center, Miami, Florida
| | - Hamid Feiz
- From the Internal Medicine Residency Training Program at Aventura Hospital and Medical Center, Miami, Florida
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4
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Werdecker L, Kujawa M, Schneider N, Neitzke G. [Advance care planning: A qualitative investigation on patients' perspectives with advanced heart failure]. Z Gerontol Geriatr 2018; 52:157-163. [PMID: 29671084 DOI: 10.1007/s00391-018-1385-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/27/2018] [Accepted: 03/09/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Hospice and Palliative Care Act (2015) promotes advance care planning (ACP) for patients in nursing homes, but chronically ill patients living at home can also benefit from ACP. OBJECTIVE The aim of the study was to analyze the perception of ACP consultations by patients with advanced heart failure. MATERIAL AND METHODS Patients (70 years and older) with advanced heart failure participated in two physician-led ACP consultations. Afterwards, two evaluative interviews were conducted with each participant. All consultations and interviews were analyzed by grounded theory considering the coding paradigm. Finally, an empirical grounded typology was conducted. RESULTS A total of 30 patients participated in at least 1 ACP consultation, whereas 18 persons completed an interview. Successful ACP consultations depend not only on the discussion but also on the patient's requirements: willingness to discuss ACP, their illness, death and dying, and the experienced and preferred role in healthcare decision-making. From the patient's viewpoint ACP consultation can result in an advance directive, but an informed rejection of ACP or the creation of new assumptions for the future are also possible outcomes. CONCLUSION The ACP discussions should to be aligned to patients' preferences in terms of communication and content. It is important to accept a rejection of dealing with ACP or conducting an advance directive. The patients' view needs to be integrated into future research.
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Affiliation(s)
- Lena Werdecker
- Institut für Geschichte, Ethik und Philosophie der Medizin, Medizinische Hochschule Hannover, Hannover, Deutschland. .,Fakultät für Gesundheit, Institut für Integrative Gesundheitsversorgung und Gesundheitsförderung, Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, Witten, 58448, Deutschland.
| | - Matthias Kujawa
- Institut für Geschichte, Ethik und Philosophie der Medizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Nils Schneider
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Gerald Neitzke
- Institut für Geschichte, Ethik und Philosophie der Medizin, Medizinische Hochschule Hannover, Hannover, Deutschland
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Willemsen D, Cordes C, Bjarnason-Wehrens B, Knoglinger E, Langheim E, Marx R, Reiss N, Schmidt T, Workowski A, Bartsch P, Baumbach C, Bongarth C, Phillips H, Radke R, Riedel M, Schmidt S, Skobel E, Toussaint C, Glatz J. [Rehabilitation standards for follow-up treatment and rehabilitation of patients with ventricular assist device (VAD)]. Clin Res Cardiol Suppl 2016; 11 Suppl 1:2-49. [PMID: 26882905 DOI: 10.1007/s11789-015-0077-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The increasing use of ventricular assist devices (VADs) in terminal heart failure patients provides new challenges to cardiac rehabilitation physicians. Structured cardiac rehabilitation strategies are still poorly implemented for this special patient group. Clear guidance and more evidence for optimal modalities are needed. Thereby, attention has to be paid to specific aspects, such as psychological and social support and education (e.g., device management, INR self-management, drive-line care, and medication).In Germany, the post-implant treatment and rehabilitation of VAD Patients working group was founded in 2012. This working group has developed clear recommendations for the rehabilitation of VAD patients according to the available literature. All facets of VAD patients' rehabilitation are covered. The present paper is unique in Europe and represents a milestone to overcome the heterogeneity of VAD patient rehabilitation.
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Affiliation(s)
- Detlev Willemsen
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland.
| | - C Cordes
- Gollwitzer-Meier-Klinik, Bad Oeynhausen, Deutschland
| | - B Bjarnason-Wehrens
- Institut für Kreislaufforschung und Sportmedizin, Deutsche Sporthochschule Köln, Köln, Deutschland
| | | | - E Langheim
- Reha-Zentrum Seehof der DRV-Bund, Teltow, Deutschland
| | - R Marx
- MediClin Fachklinik Rhein/Ruhr, Essen, Deutschland
- Universität Witten/Herdecke, Witten, Deutschland
| | - N Reiss
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - T Schmidt
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - A Workowski
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - P Bartsch
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - C Baumbach
- Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Deutschland
| | - C Bongarth
- Klinik Höhenried, Bernried am Starnberger See, Deutschland
| | - H Phillips
- Reha Parcs Steinhof, Erkrath, Deutschland
| | - R Radke
- Christiaan-Barnard-Klinik, Dahlen-Schmannewitz, Dahlen, Deutschland
| | - M Riedel
- Klinik Fallingbostel, Bad Fallingbostel, Deutschland
| | - S Schmidt
- Gollwitzer-Meier-Klinik, Bad Oeynhausen, Deutschland
| | - E Skobel
- Rehaklinik "An der Rosenquelle", Aachen, Deutschland
| | - C Toussaint
- m&i Fachklinik Herzogenaurach, Herzogenaurach, Deutschland
| | - J Glatz
- Reha-Zentrum Seehof der DRV-Bund, Teltow, Deutschland
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Piamjariyakul U, Werkowitch M, Wick J, Russell C, Vacek JL, Smith CE. Caregiver coaching program effect: Reducing heart failure patient rehospitalizations and improving caregiver outcomes among African Americans. Heart Lung 2015; 44:466-73. [DOI: 10.1016/j.hrtlng.2015.07.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 07/28/2015] [Accepted: 07/31/2015] [Indexed: 11/28/2022]
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Katz JN, Waters SB, Hollis IB, Chang PP. Advanced therapies for end-stage heart failure. Curr Cardiol Rev 2015; 11:63-72. [PMID: 24251460 PMCID: PMC4347211 DOI: 10.2174/1573403x09666131117163825] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 06/09/2013] [Accepted: 09/27/2013] [Indexed: 11/22/2022] Open
Abstract
Management of the advanced heart failure patient can be complex. Therapies include cardiac transplantation and mechanical circulatory support, as well inotropic agents for the short-term. Despite a growing armamentarium of resources, the clinician must carefully weigh the risks and benefits of each therapy to develop an optimal treatment strategy. While cardiac transplantation remains the only true “cure” for end-stage disease, this resource is limited and the demand continues to far outpace the supply. For patients who are transplant-ineligible or likely to succumb to their illness prior to transplant, ventricular assist device therapy has now become a viable option for improving morbidity and mortality. Particularly for the non-operative pa-tient, intravenous inotropes can be utilized for symptom control. Regardless of the treatments considered, care of the heart failure patient requires thoughtful dialogue, multidisciplinary collaboration, and individualized care. While survival is important, most patients covet quality of life above all outcomes. An often overlooked component is the patient’s control over the dying process. It is vital that clinicians make goals-of-care discussions a priority when seeing patients with advanced heart failure. The use of palliative care consultation is well-validated and facilitates these difficult conversations to ensure that all patient needs are ultimately met.
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Affiliation(s)
| | | | | | - Patricia P Chang
- Division of Pulmonary & Critical Care Medicine, 160 Dental Circle, CB#7075, Burnett-Womack Building, 6th Floor, Chapel Hill, NC 27599-7075, USA.
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Dilemmas in end-stage heart failure. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2015; 12:57-65. [PMID: 25678905 PMCID: PMC4308459 DOI: 10.11909/j.issn.1671-5411.2015.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/04/2014] [Accepted: 11/11/2014] [Indexed: 12/24/2022]
Abstract
Heart failure (HF), a complex clinical syndrome due to structural or functional disorder of the heart, is a major global health issue, with a prevalence of over 5.8 million in the USA alone, and over 23 million worldwide. As a leading cause of hospitalizations among patients aged 65 years or older, HF is a major consumer of healthcare resources, creating a substantial strain on the healthcare system. This paper discusses the epidemiology of HF, financial impact, and multifaceted predicaments in end-stage HF care. A search was conducted on the U.S. National Library of Medicine website (www.pubmed.gov) using keywords such as end-stage heart failure, palliative care, ethical dilemmas. Despite the poor prognosis of HF (worse than that for many cancers), many HF patients, caregivers, and clinicians are unaware of the poor prognosis. In addition, the unpredictable clinical trajectory of HF complicates the planning of end-of-life care, such as palliative care and hospice, leading to underutilization of such resources. In conclusion, ethical dilemmas in end-stage HF are numerous, embroiling not only the patient, but also the caregiver, healthcare team, and society.
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Chamsi-Pasha H, Chamsi-Pasha MA, Albar MA. Ethical challenges of deactivation of cardiac devices in advanced heart failure. Curr Heart Fail Rep 2015; 11:119-25. [PMID: 24619521 DOI: 10.1007/s11897-014-0194-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
More than 23 million adults worldwide have heart failure (HF). Although survival after heart failure diagnosis has improved over time, mortality from heart failure remains high. At the end of life, the chronic HF patient often becomes increasingly symptomatic, and may have other life-limiting comorbidities as well. Multiple trials have shown a clear mortality benefit with the use of implantable cardioverter defibrillators (ICDs) in patients with cardiomyopathy and ventricular arrhythmia. However, patients who have an ICD may be denied the chance of a sudden cardiac death, and instead are committed to a slower terminal decline, with frequent DC shocks that can be painful and decrease the quality of life, greatly contributing to their distress and that of their families during this period. While patients with ICDs are routinely counseled with regard to the benefits of ICDs, they have a poor understanding of the options for device deactivation and related ethical and legal implications. Deactivating an ICD or not performing a generator change is both legal and ethical, and is supported by guidelines from both sides of the Atlantic. Patient autonomy is paramount, and no patient is committed to any therapy that they no longer wish to receive. Left ventricular assist devices (LVADs) were initially used as bridge in patients awaiting heart transplantation, but they are currently implanted as destination therapy (DT) in patients with end-stage heart failure who have failed to respond to optimal medical therapy and who are ineligible for cardiac transplantation. The decision-making process for initiation and deactivation of LVAD is becoming more and more ethically and clinically challenging, particularly for elderly patients.
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Affiliation(s)
- Hassan Chamsi-Pasha
- Head of Non-Invasive Cardiology, Department of Cardiology, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia,
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10
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Piamjariyakul U, Myers S, Werkowitch M, Smith CE. End-of-life preferences and presence of advance directives among ethnic populations with severe chronic cardiovascular illnesses. Eur J Cardiovasc Nurs 2014; 13:185-9. [DOI: 10.1177/1474515113519523] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Sarah Myers
- School of Nursing, University of Kansas, USA
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11
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Rady MY, Verheijde JL. Ethical considerations in end-of-life deactivation of durable mechanical circulatory support devices. J Palliat Med 2013; 16:1498-502. [PMID: 24160742 DOI: 10.1089/jpm.2013.0343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mohamed Y Rady
- 1 Department of Critical Care, Mayo Clinic Hospital , Phoenix, Arizona
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