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Mbalinda SN, Lusota DA, Muddu M, Musoke D, Nyashanu M. Strategies to improve the care of older adults 50 years and above living with HIV in Uganda. AIDS Res Ther 2023; 20:76. [PMID: 37925468 PMCID: PMC10625693 DOI: 10.1186/s12981-023-00550-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/18/2023] [Indexed: 11/06/2023] Open
Abstract
INTRODUCTION With effective antiretroviral therapy (ART), many persons living with HIV (PLHIV) live to old age. Caring for aged PLHIV necessitates the engagement of caregivers and patients to establish agreed-upon goals of treatment. However, there is limited literature on friendly and centered models of care for elderly PLHIV. We explored strategies to improve care in HIV clinics among PLHIV aged 50 years and above in Uganda. METHODS We conducted 40 in-depth interviews in two hospitals with elderly PLHIV aged 50 years and above who had lived with HIV for more than ten years. We explored strategies for improving care of elderly PLHIV at both health facility and community levels. The in-depth interviews were audio-recorded and transcribed verbatim. The thematic approach guided data analysis. RESULTS The elderly PLHIV suggested the following strategies to improve their care: creating geriatric clinics; increasing screening tests for non-communicable diseases in the ART clinics; community and home-based ART delivery; workshops at health facilities to provide health education on aging effectively; creating community support groups; financial assistance for the elderly PLHIV and advances in science. CONCLUSIONS There is need to improve community HIV care especially for the elderly and social and economic support in the community. Involving the elderly PLHIV in developing strategies to improve their health goes a long way to improve the patients' quality of care. There is a need to incorporate the raised strategies in HIV care or older adults.
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Affiliation(s)
- Scovia Nalugo Mbalinda
- Department of Nursing, College of Health Sciences, School of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Derrick Amooti Lusota
- Department of Nursing, College of Health Sciences, School of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Martin Muddu
- Makerere University Joint AIDS Program (MJAP), Kampala, Uganda
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mathew Nyashanu
- Department of Health & Allied Professions School of Social Science, Nottingham Trent University, Nottingham, UK
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Sharma Y, Horwood C, Hakendorf P, Thompson C. Response to: Outcomes of admission for heart failure under general and cardiological medicine services. QJM 2023; 116:816-817. [PMID: 37267212 DOI: 10.1093/qjmed/hcad117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Indexed: 06/04/2023] Open
Affiliation(s)
- Y Sharma
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia 5042, Australia
- Division of Medicine, Cardiac & Critical Care, Flinders Medical Centre, Adelaide, South Australia 5042, Australia
| | - C Horwood
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, South Australia 5042, Australia
| | - P Hakendorf
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, South Australia 5042, Australia
| | - C Thompson
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia 5005, Australia
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Hafkamp FJ, Tio RA, Otterspoor LC, de Greef T, van Steenbergen GJ, van de Ven ART, Smits G, Post H, van Veghel D. Optimal effectiveness of heart failure management - an umbrella review of meta-analyses examining the effectiveness of interventions to reduce (re)hospitalizations in heart failure. Heart Fail Rev 2022; 27:1683-1748. [PMID: 35239106 PMCID: PMC8892116 DOI: 10.1007/s10741-021-10212-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) is a major health concern, which accounts for 1-2% of all hospital admissions. Nevertheless, there remains a knowledge gap concerning which interventions contribute to effective prevention of HF (re)hospitalization. Therefore, this umbrella review aims to systematically review meta-analyses that examined the effectiveness of interventions in reducing HF-related (re)hospitalization in HFrEF patients. An electronic literature search was performed in PubMed, Web of Science, PsycInfo, Cochrane Reviews, CINAHL, and Medline to identify eligible studies published in the English language in the past 10 years. Primarily, to synthesize the meta-analyzed data, a best-evidence synthesis was used in which meta-analyses were classified based on level of validity. Secondarily, all unique RCTS were extracted from the meta-analyses and examined. A total of 44 meta-analyses were included which encompassed 186 unique RCTs. Strong or moderate evidence suggested that catheter ablation, cardiac resynchronization therapy, cardiac rehabilitation, telemonitoring, and RAAS inhibitors could reduce (re)hospitalization. Additionally, limited evidence suggested that multidisciplinary clinic or self-management promotion programs, beta-blockers, statins, and mitral valve therapy could reduce HF hospitalization. No, or conflicting evidence was found for the effects of cell therapy or anticoagulation. This umbrella review highlights different levels of evidence regarding the effectiveness of several interventions in reducing HF-related (re)hospitalization in HFrEF patients. It could guide future guideline development in optimizing care pathways for heart failure patients.
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Affiliation(s)
| | - Rene A. Tio
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Luuk C. Otterspoor
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Tineke de Greef
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | | | - Arjen R. T. van de Ven
- Netherlands Heart Network, Veldhoven, The Netherlands
- St. Anna Hospital, Geldrop, The Netherlands
| | - Geert Smits
- Netherlands Heart Network, Veldhoven, The Netherlands
- Primary care group Pozob, Veldhoven, The Netherlands
| | - Hans Post
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Dennis van Veghel
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e895-e1032. [PMID: 35363499 DOI: 10.1161/cir.0000000000001063] [Citation(s) in RCA: 671] [Impact Index Per Article: 335.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary. J Am Coll Cardiol 2022; 79:1757-1780. [DOI: 10.1016/j.jacc.2021.12.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e876-e894. [PMID: 35363500 DOI: 10.1161/cir.0000000000001062] [Citation(s) in RCA: 135] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
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7
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2022; 79:e263-e421. [PMID: 35379503 DOI: 10.1016/j.jacc.2021.12.012] [Citation(s) in RCA: 775] [Impact Index Per Article: 387.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. STRUCTURE Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Heidenreich PAULA, BOZKURT BIYKEM, AGUILAR DAVID, ALLEN LARRYA, BYUN JONIJ, COLVIN MONICAM, DESWAL ANITA, DRAZNER MARKH, DUNLAY SHANNONM, EVERS LINDAR, FANG JAMESC, FEDSON SAVITRIE, FONAROW GREGGC, HAYEK SALIMS, HERNANDEZ ADRIANF, KHAZANIE PRATEETI, KITTLESON MICHELLEM, LEE CHRISTOPHERS, LINK MARKS, MILANO CARMELOA, NNACHETA LORRAINEC, SANDHU ALEXANDERT, STEVENSON LYNNEWARNER, VARDENY ORLY, VEST AMANDAR, YANCY CLYDEW. 2022 American College of Cardiology/American Heart Association/Heart Failure Society of America Guideline for the Management of Heart Failure: Executive Summary. J Card Fail 2022; 28:810-830. [DOI: 10.1016/j.cardfail.2022.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Mueller-Leisse J, Brunn J, Zormpas C, Hohmann S, Hillmann HAK, Eiringhaus J, Bauersachs J, Veltmann C, Duncker D. Delayed Improvement of Left Ventricular Function in Newly Diagnosed Heart Failure Depends on Etiology—A PROLONG-II Substudy. SENSORS 2022; 22:s22052037. [PMID: 35271182 PMCID: PMC8914738 DOI: 10.3390/s22052037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 12/11/2022]
Abstract
In patients with newly diagnosed heart failure with reduced ejection fraction (HFrEF), three months of optimal therapy are recommended before considering a primary preventive implantable cardioverter-defibrillator (ICD). It is unclear which patients benefit from a prolonged waiting period under protection of the wearable cardioverter-defibrillator (WCD) to avoid unnecessary ICD implantations. This study included all patients receiving a WCD for newly diagnosed HFrEF (n = 353) at our center between 2012 and 2017. Median follow-up was 2.7 years. From baseline until three months, LVEF improved in patients with all peripartum cardiomyopathy (PPCM), myocarditis, dilated cardiomyopathy (DCM), or ischemic cardiomyopathy (ICM). Beyond this time, LVEF improved in PPCM and DCM only (10 ± 8% and 10 ± 12%, respectively), whereas patients with ICM showed no further improvement. The patients with newly diagnosed HFrEF were compared to 29 patients with a distinct WCD indication, which is an explantation of an infected ICD. This latter group had a higher incidence of WCD shocks and poorer overall survival. All-cause mortality should be considered when deciding on WCD prescription. In patients with newly diagnosed HFrEF, the potential for delayed LVEF recovery should be considered when timing ICD implantation, especially in patients with PPCM and DCM.
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Nordfonn OK, Morken IM, Bru LE, Larsen AI, Husebø AML. Burden of treatment in patients with chronic heart failure - A cross-sectional study. Heart Lung 2021; 50:369-374. [PMID: 33618147 DOI: 10.1016/j.hrtlng.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with heart failure (HF) must manage both a demanding treatment regimen and self-care, which may lead to a burden of treatment. The purpose of this study was to assess the levels of burdens from treatment and self-care and its associations with psychological distress and health-related quality of life. METHODS In this cross-sectional study we collected self-report data from 125 patients diagnosed with HF, New York Heart Association classification II and III, who received care in a nurse-led HF outpatient clinic. Clinical variables were collected from the medical records. Data analyses comprised descriptive statistics and partial correlations. RESULTS The participants mean age was 67 (±9.2), most were male (74,4%) and the majority had reduced ejection fraction (EF 35.4 ± 10.8). The highest mean burden scores emerged for insufficient medical information (34.65, range 0-86), difficulty with health care service (34.57, range 0-81), and physical and mental fatigue (34.12, range 0-90). Significant positive associations were observed between physical and mental fatigue from self-care, role and social activity limitation, and psychological distress, and health-related QoL. CONCLUSION Burden of treatment is an important aspect of HF treatment as it contributes to valuable knowledge on patient workload. This study emphasizes the need to simplify and tailor the treatment regimens to alleviate the burden.
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Affiliation(s)
- Oda Karin Nordfonn
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PB 8600 Forus, 4016 Stavanger, Norway.
| | - Ingvild Margreta Morken
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PB 8600 Forus, 4016 Stavanger, Norway; Department of Cardiology, Stavanger University Hospital, PB 8100, 4068 Stavanger, Norway
| | - Lars Edvin Bru
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PB 8600 Forus, 4016 Stavanger, Norway
| | - Alf Inge Larsen
- Department of Cardiology, Stavanger University Hospital, PB 8100, 4068 Stavanger, Norway; Department of Clinical Science, University of Bergen, PB 7800, 5020 Bergen, Norway
| | - Anne Marie Lunde Husebø
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, PB 8600 Forus, 4016 Stavanger, Norway
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Johnston J, Longman J, Ewald D, King J, Das S, Passey M. Study of potentially preventable hospitalisations (PPH) for chronic conditions: what proportion are preventable and what factors are associated with preventable PPH? BMJ Open 2020; 10:e038415. [PMID: 33168551 PMCID: PMC7654103 DOI: 10.1136/bmjopen-2020-038415] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The proportion of potentially preventable hospitalisations (PPH) which are actually preventable is unknown, and little is understood about the factors associated with individual preventable PPH. The Diagnosing Potentially Preventable Hospitalisations (DaPPHne) Study aimed to determine the proportion of PPH for chronic conditions which are preventable and identify factors associated with chronic PPH classified as preventable. SETTING Three hospitals in NSW, Australia. PARTICIPANTS Community-dwelling patients with unplanned hospital admissions between November 2014 and June 2017 for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes complications or angina pectoris. Data were collected from patients, their general practitioners (GPs) and hospital records. OUTCOME MEASURES Assessments of the preventability of each admission by an Expert Panel. RESULTS 323 admissions were assessed for preventability: 46% (148/323) were assessed as preventable, 30% (98/323) as not preventable and 24% (77/323) as unclassifiable. Statistically significant differences in proportions preventable were found between the three study sites (29%; 47%; 58%; p≤0.001) and by primary discharge diagnosis (p≤0.001).Significant predictors of an admission being classified as preventable were: study site; final principal diagnosis of CHF; fewer diagnoses on discharge; shorter hospital stay; GP diagnosis of COPD; GP consultation in the last 12 months; not having had a doctor help make the decision to go to hospital; not arriving by ambulance; patient living alone; having someone help with medications and requiring help with daily tasks. CONCLUSIONS That less than half the chronic PPH were assessed as preventable, and the range of factors associated with preventability, including site and discharge diagnosis, are important considerations in the validity of PPH as an indicator. Opportunities for interventions to reduce chronic PPH include targeting patients with CHF and COPD, and the provision of social welfare and support services for patients living alone and those requiring help with daily tasks and medication management.
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Affiliation(s)
- Jennifer Johnston
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Jo Longman
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Dan Ewald
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Jonathan King
- The Kirby Institute, Kensington, New South Wales, Australia
| | - Sumon Das
- Child Health Division, Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Megan Passey
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
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Timóteo AT, Silva TP, Moreira RI, Gonçalves A, Soares R, Ferreira RC. Heart failure units: State of the art in disease management. Rev Port Cardiol 2020; 39:341-350. [PMID: 32600930 DOI: 10.1016/j.repc.2020.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/17/2020] [Accepted: 02/01/2020] [Indexed: 10/24/2022] Open
Abstract
The prevalence of heart failure has increased over the past decades and is a major social and economic burden on healthcare services. Patient quality of life is severely impaired and heart failure is one of the main causes of death in Portugal. The functional organization of multidisciplinary teams engaged in the treatment of these patients is essential to improve health care provision and outcomes, specifically reducing mortality, hospital admissions, and improving quality of life. We describe current approaches to heart failure management and discuss the organization of heart failure units and cooperation among these units and also with other healthcare professionals.
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Affiliation(s)
- Ana Teresa Timóteo
- Unidades de Insuficiência Cardíaca e Transplantação Cardíaca, Serviço de Cardiologia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Nova Medical School, Lisboa, Portugal.
| | - Tiago Pereira Silva
- Unidades de Insuficiência Cardíaca e Transplantação Cardíaca, Serviço de Cardiologia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Rita Ilhão Moreira
- Unidades de Insuficiência Cardíaca e Transplantação Cardíaca, Serviço de Cardiologia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - António Gonçalves
- Unidades de Insuficiência Cardíaca e Transplantação Cardíaca, Serviço de Cardiologia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Rui Soares
- Unidades de Insuficiência Cardíaca e Transplantação Cardíaca, Serviço de Cardiologia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Rui Cruz Ferreira
- Unidades de Insuficiência Cardíaca e Transplantação Cardíaca, Serviço de Cardiologia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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Heart failure units: State of the art in disease management. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.02.008] [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] Open
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Chambers D, Cantrell A, Booth A. Implementation of interventions to reduce preventable hospital admissions for cardiovascular or respiratory conditions: an evidence map and realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BackgroundIn 2012, a series of systematic reviews summarised the evidence regarding interventions to reduce preventable hospital admissions. Although intervention effects were dependent on context, the reviews revealed a consistent picture of reduction across different interventions targeting cardiovascular and respiratory conditions. The research reported here sought to provide an in-depth understanding of how interventions that have been shown to reduce admissions for these conditions may work, with a view to supporting their effective implementation in practice.ObjectivesTo map the available evidence on interventions used in the UK NHS to reduce preventable admissions for cardiovascular and respiratory conditions and to conduct a realist synthesis of implementation evidence related to these interventions.MethodsFor the mapping review, six databases were searched for studies published between 2010 and October 2017. Studies were included if they were conducted in the UK, the USA, Canada, Australia or New Zealand; recruited adults with a cardiovascular or respiratory condition; and evaluated or described an intervention that could reduce preventable admissions or re-admissions. A descriptive summary of key characteristics of the included studies was produced. The studies included in the mapping review helped to inform the sampling frame for the subsequent realist synthesis. The wider evidence base was also engaged through supplementary searching. Data extraction forms were developed using appropriate frameworks (an implementation framework, an intervention template and a realist logic template). Following identification of initial programme theories (from the theoretical literature, empirical studies and insights from the patient and public involvement group), the review team extracted data into evidence tables. Programme theories were examined against the individual intervention types and collectively as a set. The resultant hypotheses functioned as synthesised statements around which an explanatory narrative referenced to the underpinning evidence base was developed. Additional searches for mid-range and overarching theories were carried out using Google Scholar (Google Inc., Mountain View, CA, USA).ResultsA total of 569 publications were included in the mapping review. The largest group originated from the USA. The included studies from the UK showed a similar distribution to that of the map as a whole, but there was evidence of some country-specific features, such as the prominence of studies of telehealth. In the realist synthesis, it was found that interventions with strong evidence of effectiveness overall had not necessarily demonstrated effectiveness in UK settings. This could be a barrier to using these interventions in the NHS. Facilitation of the implementation of interventions was often not reported or inadequately reported. Many of the interventions were diverse in the ways in which they were delivered. There was also considerable overlap in the content of interventions. The role of specialist nurses was highlighted in several studies. The five programme theories identified were supported to varying degrees by empirical literature, but all provided valuable insights.LimitationsThe research was conducted by a small team; time and resources limited the team’s ability to consult with a full range of stakeholders.ConclusionsOverall, implementation appears to be favoured by support for self-management by patients and their families/carers, support for services that signpost patients to consider alternatives to seeing their general practitioner when appropriate, recognition of possible reasons why patients seek admission, support for health-care professionals to diagnose and refer patients appropriately and support for workforce roles that promote continuity of care and co-ordination between services.Future workResearch should focus on understanding discrepancies between national and international evidence and the transferability of findings between different contexts; the design and evaluation of implementation strategies informed by theories about how the intervention being implemented might work; and qualitative research on decision-making around hospital referrals and admissions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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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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16
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Slater M, Bielecki J, Alba AC, Abrahamyan L, Tomlinson G, Mak S, MacIver J, Zieroth S, Lee D, Wong W, Krahn M, Ross H, Rac VE. Comparative effectiveness of the different components of care provided in heart failure clinics-protocol for a systematic review and network meta-analysis. Syst Rev 2019; 8:40. [PMID: 30711016 PMCID: PMC6359805 DOI: 10.1186/s13643-019-0953-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/18/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Heart failure (HF) is a complex chronic condition, leading to frequent hospitalization, decreased quality of life, and increased mortality. Current guidelines recommend that multidisciplinary care be provided in specialized HF clinics. A number of studies have demonstrated the effectiveness of these clinics; however, there is a wide range in the services provided across different clinics. This network meta-analysis will aim to identify the aspects of HF clinic care that are associated with the best outcomes: a reduction in mortality, hospitalization, and visits to emergency department (ED) and improvements to quality of life. METHODS Relevant electronic databases will be systematically searched to identify eligible studies. Controlled trials and observational cohort studies of adult (≥ 18 years of age) patients will be eligible for inclusion if they evaluate at least one component of guideline-based HF clinic care and report all-cause or HF-related mortality, hospitalizations, or ED visits or health-related quality of life assessed after a minimum follow-up of 30 days. Both controlled trials and observational studies will be included to allow us to compare the efficacy of the interventions in an ideal context versus their effectiveness in the real world. Two reviewers will independently perform both title and abstract full-text screenings and data abstraction. Study quality will be assessed through a modified Cochrane risk of bias tool for randomized controlled trials (RCTs) or the ROBINS-I tool for observational studies. The strength of evidence will be assessed using a modified Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system. Network meta-analysis methods will be applied to synthesize the evidence across included studies. To contrast findings between study designs, data from RCTs will be analyzed separately from non-randomized controlled trials and cohort studies. We will estimate both the probability that a particular component of care is the most effective and treatment effects for specified combinations of care. DISCUSSION To our knowledge, this will be the first study to evaluate the comparative effectiveness of the different components of care offered in HF clinics. The findings from this systematic review will provide valuable insight about which components of HF clinic care are associated with improved outcomes, potentially informing clinical guidelines as well as the design of future care interventions in dedicated HF clinics. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017058003.
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Affiliation(s)
- Morgan Slater
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Joanna Bielecki
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Ana Carolina Alba
- Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Lusine Abrahamyan
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - George Tomlinson
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Susanna Mak
- Division of Cardiology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Jane MacIver
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Shelley Zieroth
- Faculty of Medicine, The University of Manitoba, Winnipeg, MB, Canada
| | - Douglas Lee
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - William Wong
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Murray Krahn
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Heather Ross
- Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Ted Rogers Centre of Excellence in Heart Function, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Valeria E Rac
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada. .,Ted Rogers Centre of Excellence in Heart Function, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
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17
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Ketilsdottir A, Ingadottir B, Jaarsma T. Self-reported health and quality of life outcomes of heart failure patients in the aftermath of a national economic crisis: a cross-sectional study. ESC Heart Fail 2018; 6:111-121. [PMID: 30338668 PMCID: PMC6351898 DOI: 10.1002/ehf2.12369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 09/03/2018] [Accepted: 09/06/2018] [Indexed: 11/07/2022] Open
Abstract
AIMS There are indications that economic crises can affect public health. The aim of this study was to describe characteristics, health status, and socio-economic status of outpatient heart failure (HF) patients several years after a national economic crisis and to assess whether socio-economic factors were associated with patient-reported outcome measures (PROMs). METHODS AND RESULTS In this cross-sectional survey, PROMs were measured with seven validated instruments, as follows: self-care (the 12-item European Heart Failure Self-Care Behaviour scale), HF-related knowledge (Dutch Heart Failure Knowledge Scale), symptoms (Edmonton Symptom Assessment System), sense of security (Sense of Security in Care-'Patients' evaluation'), health status (EQ-5D visual analogue scale), health-related quality of life (HRQoL) (Kansas City Cardiomyopathy Questionnaire), and anxiety and depression (Hospital Anxiety and Depression Scale). Additional data were collected on access and use of health care, household income, demographics, and clinical status. The patients' (n = 124, mean age 73 ± 14.9, 69% male) self-care was low for exercising (53%) and weight monitoring (50%) but optimal for taking medication (100%). HF-specific knowledge was high (correct answers 12 out of 15), but only 38% knew what to do when symptoms worsened suddenly. Patients' sense of security was high (>70% had a mean score of 5 or 6, scale 1-6). The most common symptom was tiredness (82%); 12% reported symptoms of anxiety, and 18% had symptoms of depression. Patients rated their overall health (EQ-5D) on average at 65.5 (scale 0-100), and 33% had poor or very bad HRQoL. The monthly income per household was <€3900 for 84% of the patients. A total of 22% had difficulties making appointments with a general practitioner (GP), and 5% had no GP. On average, patients paid for six health care-related items, and >90% paid for medications, primary care, and visits to hospital and private clinics out of their own pocket. The cost of health care had changed for 71% of the patients since the 2008 economic crisis, and increased out-of-pocket costs were most often explained by a greater need for health care services and medication expenses. There was no significant difference in PROMs related to changes in out-of-pocket expenses after the crisis, income, or whether patients lived alone or with others. CONCLUSIONS This Icelandic patient population reported similar health-related outcomes as have been previously reported in international studies. This study indicates that even after a financial crisis, most of the patients have managed to prioritize and protect their health even though a large proportion of patients have a low income, use many health care resources, and have insufficient access to care. It is imperative that access and affordable health care services are secured for this vulnerable patient population.
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Affiliation(s)
- Audur Ketilsdottir
- Department of Medical Services, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Brynja Ingadottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Surgical Services, Landspitali University Hospital, Reykjavik, Iceland
| | - Tiny Jaarsma
- Division of Nursing Science, Department of Social and Welfare Studies, Faculty of Medicine and Health Sciences, Linköping University, Sweden
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18
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Bobrovitz N, Heneghan C, Onakpoya I, Fletcher B, Collins D, Tompson A, Lee J, Nunan D, Fisher R, Scott B, O’Sullivan J, Van Hecke O, Nicholson BD, Stevens S, Roberts N, Mahtani KR. Medications that reduce emergency hospital admissions: an overview of systematic reviews and prioritisation of treatments. BMC Med 2018; 16:115. [PMID: 30045724 PMCID: PMC6060538 DOI: 10.1186/s12916-018-1104-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/19/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Rates of emergency hospitalisations are increasing in many countries, leading to disruption in the quality of care and increases in cost. Therefore, identifying strategies to reduce emergency admission rates is a key priority. There have been large-scale evidence reviews to address this issue; however, there have been no reviews of medication therapies, which have the potential to reduce the use of emergency health-care services. The objectives of this study were to review systematically the evidence to identify medications that affect emergency hospital admissions and prioritise therapies for quality measurement and improvement. METHODS This was a systematic review of systematic reviews. We searched MEDLINE, PubMed, the Cochrane Database of Systematic Reviews & Database of Abstracts of Reviews of Effects, Google Scholar and the websites of ten major funding agencies and health charities, using broad search criteria. We included systematic reviews of randomised controlled trials that examined the effect of any medication on emergency hospital admissions among adults. We assessed the quality of reviews using AMSTAR. To prioritise therapies, we assessed the quality of trial evidence underpinning meta-analysed effect estimates and cross-referenced the evidence with clinical guidelines. RESULTS We identified 140 systematic reviews, which included 1968 unique randomised controlled trials and 925,364 patients. Reviews contained 100 medications tested in 47 populations. We identified high-to moderate-quality evidence for 28 medications that reduced admissions. Of these medications, 11 were supported by clinical guidelines in the United States, the United Kingdom and Europe. These 11 therapies were for patients with heart failure (angiotensin-converting-enzyme inhibitors, angiotensin II receptor blockers, aldosterone receptor antagonists and digoxin), stable coronary artery disease (intensive statin therapy), asthma exacerbations (early inhaled corticosteroids in the emergency department and anticholinergics), chronic obstructive pulmonary disease (long-acting muscarinic antagonists and long-acting beta-2 adrenoceptor agonists) and schizophrenia (second-generation antipsychotics and depot/maintenance antipsychotics). CONCLUSIONS We identified 11 medications supported by strong evidence and clinical guidelines that could be considered in quality monitoring and improvement strategies to help reduce emergency hospital admission rates. The findings are relevant to health systems with a large burden of chronic disease and those managing increasing pressures on acute health-care services.
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Affiliation(s)
- Niklas Bobrovitz
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG United Kingdom
- Centre for Evidence-Based Medicine, University of Oxford, Oxford, United Kingdom
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG United Kingdom
- Centre for Evidence-Based Medicine, University of Oxford, Oxford, United Kingdom
| | - Igho Onakpoya
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG United Kingdom
- Centre for Evidence-Based Medicine, University of Oxford, Oxford, United Kingdom
| | - Benjamin Fletcher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG United Kingdom
| | - Dylan Collins
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG United Kingdom
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Alice Tompson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG United Kingdom
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Joseph Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG United Kingdom
| | - David Nunan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG United Kingdom
- Centre for Evidence-Based Medicine, University of Oxford, Oxford, United Kingdom
| | - Rebecca Fisher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG United Kingdom
- The Health Foundation, London, United Kingdom
| | - Brittney Scott
- Department of Critical Care Medicine, University of Calgary, Calgary, Canada
- Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Canada
| | - Jack O’Sullivan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG United Kingdom
- Centre for Evidence-Based Medicine, University of Oxford, Oxford, United Kingdom
| | - Oliver Van Hecke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG United Kingdom
| | - Brian D. Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG United Kingdom
| | - Sarah Stevens
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG United Kingdom
| | - Nia Roberts
- Bodelian Libraries, University of Oxford, Oxford, UK
| | - Kamal R. Mahtani
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG United Kingdom
- Centre for Evidence-Based Medicine, University of Oxford, Oxford, United Kingdom
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19
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Huitema AA, Harkness K, Heckman GA, McKelvie RS. The Spoke-Hub-and-Node Model of Integrated Heart Failure Care. Can J Cardiol 2018; 34:863-870. [DOI: 10.1016/j.cjca.2018.04.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 12/16/2022] Open
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20
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Abrahamyan L, Sahakyan Y, Wijeysundera HC, Krahn M, Rac VE. Gender Differences in Utilization of Specialized Heart Failure Clinics. J Womens Health (Larchmt) 2018; 27:623-629. [PMID: 29319404 DOI: 10.1089/jwh.2017.6461] [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: 12/29/2022] Open
Abstract
BACKGROUND Although heart failure (HF) prevalence is equally high among men and women, observed differences in the provision of care are still not fully understood. We sought to evaluate gender differences in patient profiles, diagnostic testing, medication prescription, and referrals in specialized multidisciplinary ambulatory HF clinics in Ontario. MATERIALS AND METHODS Medical chart abstraction was conducted first by randomly selecting 9 (out of 34) HF clinics in Ontario, and then by randomly selecting 100 patient records in each clinic. Data on patient demographics, comorbidities, diagnostic tests, medication use, and referrals were abstracted, covering a period from the first clinic visit up to 1 year. Descriptive statistics and regression analysis were used to assess gender differences. RESULTS Of the 884 patients, only 314 were women (35.5%). At the first clinic visit, women were older, had better systolic function but worse functional status, and had a lower prevalence of hyperlipidemia, diabetes, and smoking than men. There were more women with non-ischemic HF etiology than men (63.9% vs. 43.3%, p < 0.001). Adjusted analysis did not reveal gender differences in the average number of echocardiographic assessments and in the prescription rates of evidence-based medications. Men were twice more likely to be referred to electrophysiology studies than women (18.6% vs. 7.8%, p < 0.001). The rates of dietary counseling and cardiac rehabilitation referrals were similarly low in both groups. CONCLUSIONS More men than women are treated in specialized ambulatory HF clinics. Although women differ from men in selected clinical characteristics, no major differences were observed in patient management. The reasons for low enrollment rates of women into the HF ambulatory clinics need further investigation.
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Affiliation(s)
- Lusine Abrahamyan
- 1 Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto , Toronto, Canada .,2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada
| | - Yeva Sahakyan
- 2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada
| | - Harindra C Wijeysundera
- 2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada .,3 Department of Medicine, University of Toronto , Toronto, Canada .,4 Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre , Toronto, Canada .,5 Institute for Clinical Evaluative Sciences (ICES) , Toronto, Canada
| | - Murray Krahn
- 1 Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto , Toronto, Canada .,2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada .,3 Department of Medicine, University of Toronto , Toronto, Canada .,5 Institute for Clinical Evaluative Sciences (ICES) , Toronto, Canada
| | - Valeria E Rac
- 1 Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto , Toronto, Canada .,2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada .,6 Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada
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21
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Abstract
Heart failure with preserved ejection fraction (HFpEF), a highly prevalent and complex clinical syndrome with high morbidity and mortality, is often unrecognized and not optimally treated. Clinical trials for HFpEF have been plagued by low enrollment, and clinicians often approach HFpEF patients with "therapeutic nihilism" given the perceived lack of available therapies based on the disappointing results of these prior trials. Due to these challenges, we have pioneered the successful creation of dedicated, specialized HFpEF clinical programs. Here, we discuss (1) the rationale for the development of a specialized HFpEF clinical program; (2) strategies for the systematic identification of HFpEF patients; (3) a standardized diagnostic and therapeutic approach; (4) validation of the HFpEF clinical program paradigm; (5) staffing and reimbursement considerations; (6) HFpEF clinical trial enrollment; and (7) challenges and future directions for HFpEF clinical programs. We conclude that it is feasible to create HFpEF clinical programs that fulfill the major unmet need of identifying and caring for patients with HFpEF. These clinics are essential for confirming the HFpEF diagnosis, providing standardized treatment, and facilitating clinical trial enrollment. It is our hope that the information provided here will encourage others to establish their own specialized HFpEF programs, thereby allowing for comprehensive care for these complex patients.
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22
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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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23
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Punchik B, Komarov R, Gavrikov D, Semenov A, Freud T, Kagan E, Goldberg Y, Press Y. Can home care for homebound patients with chronic heart failure reduce hospitalizations and costs? PLoS One 2017; 12:e0182148. [PMID: 28753675 PMCID: PMC5533329 DOI: 10.1371/journal.pone.0182148] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 07/13/2017] [Indexed: 11/19/2022] Open
Abstract
Background Congestive heart failure (CHF), a common problem in adults, is associated with multiple hospitalizations, high mortality rates and high costs. Purpose To evaluate whether home care for homebound patients with CHF reduces healthcare service utilization and overall costs. Methods A retrospective study of healthcare utilization among homebound patients who received home care for CHF from 2012–1015. The outcome measures were number of hospital admissions per month, total number of hospitalization days and days for CHF only, emergency room visits, and overall costs. A comparison was conducted between the 6-month period prior to entry into home care and the time in home care. Results Over the study period 196 patients were treated by home care for CHF with a mean age of 79.4±9.5 years. 113 (57.7%) were women. Compared to the six months prior to home care, there were statistically significant decreases in hospitalizations (46.3%), in the number of total in-hospital days (28.7%), in the number of in-hospital days for CHF (66.7%), in emergency room visits (47%), and in overall costs (23.9%). Conclusion Home care for homebound adults with CHF can reduce healthcare utilization and healthcare costs.
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Affiliation(s)
- Boris Punchik
- Home Care Unit, Clalit Health Services, Yasski Clinic, Beer-Sheva, Israel
- Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Roman Komarov
- Clalit Health Services, Southern District, Kenion Ha Negev Towers, Beer-Sheva, Israel
| | - Dmitry Gavrikov
- Home Care Unit, Clalit Health Services, Yasski Clinic, Beer-Sheva, Israel
- Clalit Health Services, Southern District, Kenion Ha Negev Towers, Beer-Sheva, Israel
| | - Anna Semenov
- Home Care Unit, Clalit Health Services, Yasski Clinic, Beer-Sheva, Israel
- Clalit Health Services, Southern District, Kenion Ha Negev Towers, Beer-Sheva, Israel
| | - Tamar Freud
- Department of Family Medicine, Siaal Family Medicine and Primary Care Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ella Kagan
- Home Care Unit, Clalit Health Services, Yasski Clinic, Beer-Sheva, Israel
- Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yury Goldberg
- Home Care Unit, Clalit Health Services, Yasski Clinic, Beer-Sheva, Israel
| | - Yan Press
- Home Care Unit, Clalit Health Services, Yasski Clinic, Beer-Sheva, Israel
- Department of Family Medicine, Siaal Family Medicine and Primary Care Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- * E-mail:
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Rajadurai J, Tse HF, Wang CH, Yang NI, Zhou J, Sim D. Understanding the Epidemiology of Heart Failure to Improve Management Practices: An Asia-Pacific Perspective. J Card Fail 2017; 23:327-339. [PMID: 28111226 DOI: 10.1016/j.cardfail.2017.01.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/13/2016] [Accepted: 01/18/2017] [Indexed: 01/08/2023]
Abstract
Heart failure (HF) is a major global healthcare problem with an estimated prevalence of approximately 26 million. In Asia-Pacific regions, HF is associated with a significant socioeconomic burden and high rates of hospital admission. Epidemiological data that could help to improve management approaches to address this burden in Asia-Pacific regions are limited, but suggest patients with HF in the Asia-Pacific are younger and have more severe signs and symptoms of HF than those of Western countries. However, local guidelines are based largely on the European Society of Cardiology and American College of Cardiology Foundation/American Heart Association guidelines, which draw their evidence from studies where Western patients form the major demographic and patients from the Asia-Pacific region are underrepresented. Furthermore, regional differences in treatment practices likely affect patient outcomes. In the following review, we examine epidemiological data from existing regional registries, which indicate that these patients represent a distinct subpopulation of patients with HF. In addition, we highlight that patients with HF are under-treated in the region despite the existence of local guidelines. Finally, we provide suggestions on how data can be enriched throughout the region, which may positively affect local guidelines and improve management practices.
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Affiliation(s)
- Jeyamalar Rajadurai
- Department of Cardiology, Subang Jaya Medical Centre, Subang Jaya, Malaysia.
| | - Hung-Fat Tse
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Chao-Hung Wang
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ning-I Yang
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jingmin Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - David Sim
- Department of Cardiology, National Heart Centre Singapore, Singapore
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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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Inamdar AA, Inamdar AC. Heart Failure: Diagnosis, Management and Utilization. J Clin Med 2016; 5:E62. [PMID: 27367736 PMCID: PMC4961993 DOI: 10.3390/jcm5070062] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/28/2016] [Accepted: 06/13/2016] [Indexed: 12/11/2022] Open
Abstract
Despite the advancement in medicine, management of heart failure (HF), which usually presents as a disease syndrome, has been a challenge to healthcare providers. This is reflected by the relatively higher rate of readmissions along with increased mortality and morbidity associated with HF. In this review article, we first provide a general overview of types of HF pathogenesis and diagnostic features of HF including the crucial role of exercise in determining the severity of heart failure, the efficacy of therapeutic strategies and the morbidity/mortality of HF. We then discuss the quality control measures to prevent the growing readmission rates for HF. We also attempt to elucidate published and ongoing clinical trials for HF in an effort to evaluate the standard and novel therapeutic approaches, including stem cell and gene therapies, to reduce the morbidity and mortality. Finally, we discuss the appropriate utilization/documentation and medical coding based on the severity of the HF alone and with minor and major co-morbidities. We consider that this review provides an extensive overview of the HF in terms of disease pathophysiology, management and documentation for the general readers, as well as for the clinicians/physicians/hospitalists.
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Affiliation(s)
- Arati A Inamdar
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ 07601, USA.
- Ansicht Scidel Inc., Edison, NJ 08837, USA.
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Staszewsky L, Cortesi L, Tettamanti M, Dal Bo GA, Fortino I, Bortolotti A, Merlino L, Latini R, Roncaglioni MC, Baviera M. Outcomes in patients hospitalized for heart failure and chronic obstructive pulmonary disease: differences in clinical profile and treatment between 2002 and 2009. Eur J Heart Fail 2016; 18:840-8. [PMID: 27098360 DOI: 10.1002/ejhf.519] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/12/2016] [Accepted: 02/27/2016] [Indexed: 12/20/2022] Open
Abstract
AIMS Heart failure (HF) and chronic obstructive pulmonary disease (COPD) frequently co-exist, and each is a major public health issue. In a large cohort of hospitalized HF patients, we evaluated: (i) the impact of COPD on clinical outcomes; (ii) whether outcomes and treatments changed from 2002 to 2009; and (iii) the relationship between outcomes and treatments focusing on beta-blockers (BBs) and bronchodilators (BDs). METHODS AND RESULTS From linkable Lombardy administrative health databases, we selected individuals with a discharge diagnosis of HF with or without concomitant COPD (HF yesCOPD and HF noCOPD) in 2002 and 2009. Patients were followed up for 4 years. Outcomes were total mortality, first readmission for HF, and their combination. Unadjusted and adjusted Cox proportional models and competing risk analyses were used. We identified 11 274 patients with HF noCOPD and 2837 with HF yesCOPD. HF yesCOPD patients in 2002 and 2009 had a 20% higher risk of the outcomes. From 2002 to 2009, BB and BD prescriptions increased significantly. In HF noCOPD patients, risks for mortality [adjusted hazard ratio (HR) 0.91, 95% confidence interval (CI) 0.86-0.97], first HF readmission (HR 0.79, 95% CI 0.74-0.85), and the combined endpoint (HR 0.88, 95% CI 0.84-0.92) declined (all P < 0.003) while in HF yesCOPD only the risk for first HF readmission dropped (HR 0.86, 95% CI 0.76-0.97; P = 0.018). BBs were associated with significantly lower mortality in both groups, but with a higher risk for first HF readmission in HF noCOPD. Outcomes did not significantly differ in HF yesCOPD treated or not with BDs. CONCLUSIONS The prognosis of patients hospitalized for HF, either with or without COPD, seemed to improve between 2002 and 2009, with possibly better survival of those on BBs. Because of residual confounding in observational studies, a randomized controlled trial should be considered to confirm these results.
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Affiliation(s)
- Lidia Staszewsky
- Laboratory of Cardiovascular Clinical Pharmacology, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - Laura Cortesi
- Laboratory of General Practice Research, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - Mauro Tettamanti
- Laboratory of Geriatric Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - Gabrio Andrea Dal Bo
- Unit of Internal and Respiratory Medicine, Fatebenefratelli e Oftalmico Hospital, Milan, Italy
| | - Ida Fortino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | | | - Luca Merlino
- Regional Health Ministry, Lombardy Region, Milan, Italy
| | - Roberto Latini
- Laboratory of Cardiovascular Clinical Pharmacology, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - Maria Carla Roncaglioni
- Laboratory of General Practice Research, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - Marta Baviera
- Laboratory of General Practice Research, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
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A systematic review of interventions to reduce hospitalisation in Parkinson's disease. Parkinsonism Relat Disord 2016; 24:3-7. [DOI: 10.1016/j.parkreldis.2016.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/05/2016] [Accepted: 01/10/2016] [Indexed: 11/22/2022]
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29
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Kato NP, Kinugawa K, Sano M, Kogure A, Sakuragi F, Kobukata K, Ohtsu H, Wakita S, Jaarsma T, Kazuma K. How effective is an in-hospital heart failure self-care program in a Japanese setting? Lessons from a randomized controlled pilot study. Patient Prefer Adherence 2016; 10:171-81. [PMID: 26937177 PMCID: PMC4762442 DOI: 10.2147/ppa.s100203] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although the effectiveness of heart failure (HF) disease management programs has been established in Western countries, to date there have been no such programs in Japan. These programs may have different effectiveness due to differences in health care organization and possible cultural differences with regard to self-care. Therefore, the purpose of this study was to evaluate the effectiveness of a pilot HF program in a Japanese setting. METHODS We developed an HF program focused on enhancing patient self-care before hospital discharge. Patients were randomized 1:1 to receive the new HF program or usual care. The primary outcome was self-care behavior as assessed by the European Heart Failure Self-Care Behavior Scale (EHFScBS). Secondary outcomes included HF knowledge and the 2-year rate of HF hospitalization and/or cardiac death. RESULTS A total of 32 patients were enrolled (mean age, 63 years; 31% female). There was no difference in the total score of the EHFScBS between the two groups. One specific behavior score regarding a low-salt diet significantly improved compared with baseline in the intervention group. HF knowledge in the intervention group tended to improve more over 6 months than in the control group (a group-by-time effect, F=2.47, P=0.098). During a 2-year follow-up, the HF program was related to better outcomes regarding HF hospitalization and/or cardiac death (14% vs 48%, log-rank test P=0.04). In Cox regression analysis after adjustment for age, sex, and logarithmic of B-type natriuretic peptide, the program was associated with a reduction in HF hospitalization and/or cardiac death (hazard ratio, 0.17; 95% confidence interval, 0.03-0.90; P=0.04). CONCLUSION The HF program was likely to increase patients' HF knowledge, change their behavior regarding a low-salt diet, and reduce HF hospitalization and/or cardiac events. Further improvement focused on the transition of knowledge to self-care behavior is necessary.
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Affiliation(s)
- Naoko P Kato
- Department of Therapeutic Strategy for Heart Failure, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- JSPS Postdoctoral Fellow for Research Abroad, Tokyo, Japan
- Correspondence: Naoko P Kato, Department of Therapeutic Strategy for Heart Failure, The University of Tokyo Graduate School of Medicine, 7-3-1, Hongo, Bunkyo-ku, Tokyo 1138655, Japan, Tel +81 3 5800 9082, Fax +81 3 5800 9082, Email
| | - Koichiro Kinugawa
- Department of Therapeutic Strategy for Heart Failure, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Miho Sano
- Department of Nursing, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Asuka Kogure
- Department of Nursing, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Fumika Sakuragi
- Department of Pharmacy, The University of Tokyo Hospital, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kihoko Kobukata
- Department of Nursing, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Ohtsu
- Department of Clinical Data Management, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Sanae Wakita
- Department of Nursing, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Keiko Kazuma
- Department of Adult Nursing, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Abstract
BACKGROUND Care of patients with inflammatory bowel disease (IBD) poses a significant burden to the health-care system. Repeat hospitalization in subgroups of IBD patients seems to be a large part of this issue; however, there are limited data examining the characteristics of these patients. The aim of this study was to characterize admission patterns in patients with IBD at a tertiary-care center and to identify preventable risk factors of 90-day readmission after an index IBD admission. METHODS Retrospective analysis was performed extracting data from an electronic medical record over a 2-year period. RESULTS Three hundred fifty-six patients were admitted at least once during the 2-year study period for an unplanned IBD-related reason. Of these, 48.9% were admitted once, 38.2% were admitted 2 to 4 times, and 12.9% were admitted 5 or more times during the study period. Patients with any admission within 90 days before index were excluded; n = 33. One hundred two patients had experienced a readmission by 90 days after index admission. Numerous demographic and medical factors were examined for association with readmission. The final Cox model included 3 variables: depression (HR = 1.99, 1.33-3.00), chronic pain (HR = 1.88, 1.14-3.10), and steroid use in the previous 6 months (HR = 1.33, 0.92-2.04). CONCLUSIONS Our findings suggest that patients with depression and chronic pain are at greatest risk for a readmission within 90 days after an initial IBD admission. Disease activity, represented by steroid use in the previous 6 months, was not related to readmission. Addressing these problems in the outpatient setting may reduce future hospitalizations.
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Baudouin C, Groshens S, Gueneau P, Rousseau M, Saura M, Hryschyschyn N, Hillani A, Dagorn J, Pitthan E, Jourdain P. [Medico-economic impact of an innovative management of CHF by HF unit]. Ann Cardiol Angeiol (Paris) 2015; 64:318-324. [PMID: 26482635 DOI: 10.1016/j.ancard.2015.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 09/03/2015] [Indexed: 06/05/2023]
Abstract
Chronic heart failure remains a frequent, severe and costly disease. Despite encouraging data from different countries, heart failure clinics are scarce in France. We have analyzed the impact of a heart failure clinic (UTIC of Pontoise) in terms of reduction of rehospitalizations and in hospitalization costs in 4855 consecutive patients. In our study, heart failure clinic management dramatically reduces HF related hospitalizations (RRR: -28 %, P=0.001) and HF related costs (55% reduction, P<0.001) regardless of comorbidities or disease severity. HF clinics have to be developed in France in order to optimize management of CHF and reduce the HF related costs.
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Affiliation(s)
- C Baudouin
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | | | - P Gueneau
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - M Rousseau
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - M Saura
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - N Hryschyschyn
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - A Hillani
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - J Dagorn
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - E Pitthan
- Instituto de Cardiologia, Porto Alegre, RS, 90040-371, Brésil
| | - P Jourdain
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France.
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Simmonds R, Glogowska M, McLachlan S, Cramer H, Sanders T, Johnson R, Kadam U, Lasserson D, Purdy S. Unplanned admissions and the organisational management of heart failure: a multicentre ethnographic, qualitative study. BMJ Open 2015; 5:e007522. [PMID: 26482765 PMCID: PMC4611875 DOI: 10.1136/bmjopen-2014-007522] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 07/13/2015] [Accepted: 08/17/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Heart failure is a common cause of unplanned hospital admissions but there is little evidence on why, despite evidence-based interventions, admissions occur. This study aimed to identify critical points on patient pathways where risk of admission is increased and identify barriers to the implementation of evidence-based interventions. DESIGN Multicentre, longitudinal, patient-led ethnography. SETTING National Health Service settings across primary, community and secondary care in three geographical locations in England, UK. PARTICIPANTS 31 patients with severe or difficult to manage heart failure followed for up to 11 months; 9 carers; 55 healthcare professionals. RESULTS Fragmentation of healthcare, inequitable provision of services and poor continuity of care presented barriers to interventions for heart failure. Critical points where a reduction in the risk of current or future admission occurred throughout the pathway. At the beginning some patients did not receive a formal clinical diagnosis, in addition patients lacked information about heart failure, self-care and knowing when to seek help. Some clinicians lacked knowledge about diagnosis and management. Misdiagnoses of symptoms and discontinuity of care resulted in unplanned admissions. Approaching end of life, patients were admitted to hospital when other options including palliative care could have been appropriate. CONCLUSIONS Findings illustrate the complexity involved in caring for people with heart failure. Fragmented healthcare and discontinuity of care added complexity and increased the likelihood of suboptimal management and unplanned admissions. Diagnosis and disclosure is a vital first step for the patient in a journey of acceptance and learning to self-care/monitor. The need for clinician education about heart failure and specialist services was acknowledged. Patient education should be seen as an ongoing 'conversation' with trusted clinicians and end-of-life planning should be broached within this context.
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Affiliation(s)
- Rosemary Simmonds
- Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Sarah McLachlan
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
| | - Helen Cramer
- Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tom Sanders
- Section of Public Health, ScHARR, University of Sheffield, Keele, UK
| | - Rachel Johnson
- Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Umesh Kadam
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
| | - Daniel Lasserson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - Sarah Purdy
- Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Jackevicius CA, de Leon NK, Lu L, Chang DS, Warner AL, Mody FV. Impact of a Multidisciplinary Heart Failure Post-hospitalization Program on Heart Failure Readmission Rates. Ann Pharmacother 2015; 49:1189-96. [PMID: 26259774 DOI: 10.1177/1060028015599637] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Specialized chronic heart failure (HF) clinics have demonstrated significant reductions in readmissions. Limited evidence is available regarding HF clinics in the immediate post-discharge period. OBJECTIVE To evaluate the effect of a multidisciplinary HF clinic on 90-day readmission rates and all-cause mortality in those recently discharged from a HF hospitalization. METHODS In this retrospective cohort study, patients discharged with a primary HF diagnosis who attended the HF postdischarge clinic in 2010-2012 were compared with controls from 2009. During 6 clinic visits, patients were seen by a physician assistant, clinical pharmacist specialist, and case manager, with care overseen by a cardiologist. The program focused on optimizing therapy, identifying HF etiology/precipitating factors, medication titration, education, and medication adherence. The primary outcome was 90-day HF readmission. A multivariate Cox proportional hazards model was used to compare outcomes. RESULTS Among the 277 patients (144 clinic, 133 control) in the study, 7.6% of patients in the clinic and 23.3% of patients in the control group were readmitted for HF within 90 days (aHR (adjusted hazard ratio) = 0.17; 95% CI = 0.07-0.41; P < 0.001; ARR (absolute risk reduction) = 15.7%; NNT (number needed to treat) = 7). Clinic patients had lower 90-day time-to-first HF readmission or all-cause mortality (9.0% vs 28.6%; aHR = 0.28; 95% CI = 0.06-0.31; P < 0.001; ARR = 19.6%; NNT = 6). CONCLUSIONS The multidisciplinary HF posthospitalization outpatient program was associated with a significant reduction in 90-day HF readmissions in patients who were recently discharged from a HF hospitalization.
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Affiliation(s)
- Cynthia A Jackevicius
- Western University of Health Sciences, Pomona, CA, USA VA Greater Los Angeles Healthcare System, CA, USA Institute for Clinical Evaluative Sciences, Toronto, ON, Canada University of Toronto, ON, Canada University Health Network, Toronto, ON, Canada
| | - Noelle K de Leon
- University of California, San Francisco Medical Center and School of Pharmacy, San Francisco, CA
| | - Lingyun Lu
- VA Greater Los Angeles Healthcare System, CA, USA California Northstate University College of Pharmacy, Elk Grove, CA
| | - Donald S Chang
- VA Greater Los Angeles Healthcare System, CA, USA University of California, Los Angeles, CA, USA
| | - Alberta L Warner
- VA Greater Los Angeles Healthcare System, CA, USA University of California, Los Angeles, CA, USA
| | - Freny Vaghaiwalla Mody
- VA Greater Los Angeles Healthcare System, CA, USA University of California, Los Angeles, CA, USA
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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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Hazarika R, Purdy S. Integrated care: demonstrating value and valuing patients. Future Hosp J 2015; 2:132-136. [PMID: 31098102 PMCID: PMC6460198 DOI: 10.7861/futurehosp.2-2-132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Integrated care could be seen as an overarching strategy to encourage service change and redesign, rather than solely as a means of cost reduction. Indeed, evidence for the economic benefits of integrated care is equivocal, although many of its components have clear benefits for the quality of services received by patients. Given the financial challenge facing the NHS, integrated care may represent a useful methodology to encourage fundamental service redesign. This level of change is required if the health service is to adapt and survive in the face of significant fiscal challenges.
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Moe GW, Ezekowitz JA, O'Meara E, Lepage S, Howlett JG, Fremes S, Al-Hesayen A, Heckman GA, Abrams H, Ducharme A, Estrella-Holder E, Grzeslo A, Harkness K, Koshman SL, McDonald M, McKelvie R, Rajda M, Rao V, Swiggum E, Virani S, Zieroth S, Arnold JMO, Ashton T, D'Astous M, Chan M, De S, Dorian P, Giannetti N, Haddad H, Isaac DL, Kouz S, Leblanc MH, Liu P, Ross HJ, Sussex B, White M. The 2014 Canadian Cardiovascular Society Heart Failure Management Guidelines Focus Update: anemia, biomarkers, and recent therapeutic trial implications. Can J Cardiol 2014; 31:3-16. [PMID: 25532421 DOI: 10.1016/j.cjca.2014.10.022] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 10/16/2014] [Accepted: 10/19/2014] [Indexed: 12/20/2022] Open
Abstract
The 2014 Canadian Cardiovascular Society Heart Failure Management Guidelines Update provides discussion on the management recommendations on 3 focused areas: (1) anemia; (2) biomarkers, especially natriuretic peptides; and (3) clinical trials that might change practice in the management of patients with heart failure. First, all patients with heart failure and anemia should be investigated for reversible causes of anemia. Second, patients with chronic stable heart failure should undergo natriuretic peptide testing. Third, considerations should be given to treat selected patients with heart failure and preserved systolic function with a mineralocorticoid receptor antagonist and to treat patients with heart failure and reduced ejection fraction with an angiotensin receptor/neprilysin inhibitor, when the drug is approved. As with updates in previous years, the topics were chosen in response to stakeholder feedback. The 2014 Update includes recommendations, values and preferences, and practical tips to assist the clinicians and health care workers to best manage patients with heart failure.
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Affiliation(s)
- Gordon W Moe
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | | | - Eileen O'Meara
- Institut de Cardiologie de Montréal, Montreal, Québec, Canada
| | - Serge Lepage
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Steve Fremes
- Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | - Abdul Al-Hesayen
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Howard Abrams
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Anique Ducharme
- Institut de Cardiologie de Montréal, Montreal, Québec, Canada
| | | | - Adam Grzeslo
- Joseph Brant Memorial Hospital, Burlington, Ontario, Canada; Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Harkness
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Michael McDonald
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert McKelvie
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Miroslaw Rajda
- QE II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vivek Rao
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Sean Virani
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Shelley Zieroth
- St Boniface General Hospital, Cardiac Sciences Program, Winnipeg, Manitoba, Canada
| | | | | | | | - Michael Chan
- Edmonton Cardiology Consultants, Edmonton, Alberta, Canada
| | - Sabe De
- Cape Breton Regional Hospital, Sydney, Nova Scotia, Canada
| | - Paul Dorian
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Simon Kouz
- Centre Hospitalier Régional de Lanaudière, Joliette, Québec and Université Laval, Québec, Canada
| | | | - Peter Liu
- Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather J Ross
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bruce Sussex
- Health Sciences Centre, St John's, Newfoundland, Canada
| | - Michel White
- Institut de Cardiologie de Montréal, Montreal, Québec, Canada
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O'Meara E, Thibodeau-Jarry N, Ducharme A, Rouleau JL. The Epidemic of Heart Failure: A Lucid Approach to Stemming the Rising Tide. Can J Cardiol 2014; 30:S442-54. [DOI: 10.1016/j.cjca.2014.09.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 09/30/2014] [Accepted: 09/30/2014] [Indexed: 01/11/2023] Open
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Ponikowski P, Anker SD, AlHabib KF, Cowie MR, Force TL, Hu S, Jaarsma T, Krum H, Rastogi V, Rohde LE, Samal UC, Shimokawa H, Budi Siswanto B, Sliwa K, Filippatos G. Heart failure: preventing disease and death worldwide. ESC Heart Fail 2014; 1:4-25. [DOI: 10.1002/ehf2.12005] [Citation(s) in RCA: 712] [Impact Index Per Article: 71.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
| | | | - Khalid F. AlHabib
- King Fahad Cardiac Centre; King Saud University; Riyadh Saudi Arabia
| | - Martin R. Cowie
- National Heart and Lung Institute; Imperial College London (Royal Brompton Hospital); London UK
| | - Thomas L. Force
- Center for Translational Medicine and Cardiology Division; Temple University School of Medicine; Philadelphia PA USA
| | - Shengshou Hu
- State Key Laboratory of Cardiovascular Disease; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Tiny Jaarsma
- Faculty of Health Sciences; Linköping University; Linköping Sweden
| | - Henry Krum
- Monash Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Vishal Rastogi
- Medical Advanced Heart Failure Program; Fortis Escorts Heart Institute; New Delhi India
| | - Luis E. Rohde
- Cardiovascular Division, Hospital de Clínicas de Porto Alegre; Medical School of the Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - Umesh C. Samal
- Heart Failure Subspecialty; Cardiological Society of India; Kolkata India
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Bambang Budi Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine; University of Indonesia, National Cardiovascular Center Harapan Kita; Jakarta Indonesia
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences; University of Cape Town, Cape Town, and Soweto Cardiovascular Research Unit, University of the Witwatersrand; Johannesburg South Africa
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital; University of Athens; Athens Greece
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Albert NM, Cohen B, Liu X, Best CH, Aspinwall L, Pratt L. Hospital nurses’ comfort in and frequency of delivering heart failure self-care education. Eur J Cardiovasc Nurs 2014; 14:431-40. [DOI: 10.1177/1474515114540756] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 06/02/2014] [Indexed: 01/11/2023]
Affiliation(s)
| | - Bonni Cohen
- Valdosta State University College of Nursing, USA
| | | | - Carolyn H Best
- Cleveland Clinic-Hillcrest Hospital, Mayfield Heights, USA
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Jaarsma T, Strömberg A. Heart failure clinics are still useful (more than ever?). Can J Cardiol 2014; 30:272-5. [PMID: 24468418 DOI: 10.1016/j.cjca.2013.09.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 09/20/2013] [Accepted: 09/22/2013] [Indexed: 11/16/2022] Open
Abstract
Heart failure (HF) clinics have had an important role in optimal HF management and the effectiveness of these clinics has been studied intensively. A HF clinic is one of the various ways to organize a HF disease management program. There is good evidence that HF disease management can improve outcomes in HF patients, but it is not clear what the optimal components of these programs are and what the relative effectiveness of a HF clinic is compared with other forms of HF management. After initial positive reports on the effect of HF clinics, these clinics were implemented in many countries, although in different formats and of varying quality. In this article we describe the initial need for HF clinics, reflect on their development over time, and discuss the role of HF clinics in context of the current need for HF disease management.
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Affiliation(s)
- Tiny Jaarsma
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
| | - Anna Strömberg
- Department of Medicine and Health Sciences, Division of Nursing, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Cardiology UHL, County Council of Östergötland, Linköping, Sweden
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Brettell R, Soljak M, Cecil E, Cowie MR, Tuppin P, Majeed A. Reducing heart failure admission rates in England 2004-2011 are not related to changes in primary care quality: national observational study. Eur J Heart Fail 2013; 15:1335-42. [PMID: 23845798 PMCID: PMC3834843 DOI: 10.1093/eurjhf/hft107] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Heart failure (HF) is an important clinical problem. Expert consensus has defined HF as a primary care-sensitive condition for which the risk of unplanned admissions may be reduced by high quality primary care, but there is little supporting evidence. We analysed time trends in HF admission rates in England and risk and protective factors for admission. METHODS AND RESULTS We used Hospital Episodes Statistics to produce indirectly standardized HF admission counts by general practice for 2004-2011. Clustered negative binomial regression analysis produced admission risk ratios and assessed the significance of potential explanatory covariates. These included population factors (deprivation; HF, coronary heart disease, and smoking prevalence), primary care resourcing [access; general practitioner (GP) supply], and primary care quality ('Quality and Outcomes Framework' indicator.) There were 327,756 HF admissions of patients registered with 8405 practices over the study period. There was a significant reduction in admissions over time, from 6.96/100,000 in 2004 to 5.60/100,000 in 2010 (P < 0.001). Deprivation and HF prevalence were risk factors for admission. GP supply and access protected against admission. However, these effects were small and did not explain the large and highly significant annual trend in falling admission rates. CONCLUSIONS The observed fall in admissions over time cannot be explained by the primary care covariates we included. This analysis suggests that the potential for further significant reduction in emergency HF admissions by improving clinical quality of primary care (as currently measured) may be limited. Further work is required to identify the reasons for the reduction in admissions.
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Affiliation(s)
- Rachel Brettell
- Department of Primary Care Health Sciences, University of Oxford, UK
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