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Moreines LT, David D, Murali KP, Dickson VV, Brody A. The perspectives of older adults related to transcatheter aortic valve replacement: An integrative review. Heart Lung 2024; 68:23-36. [PMID: 38901178 DOI: 10.1016/j.hrtlng.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/10/2024] [Accepted: 05/31/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Aortic Stenosis (AS) is a common syndrome in older adults wherein the narrowing of the aortic valve impedes blood flow, resulting in advanced heart failure.1 AS is associated with a high mortality rate (50 % at 6 months if left untreated), substantial symptom burden, and reduced quality of life.1-3 Transcatheter aortic valve replacement (TAVR) was approved in 2012 as a less invasive alternative to surgical valve repair, offering a treatment for older frail patients. Although objective outcomes have been widely reported,4 the perspectives of older adults undergoing the TAVR process have never been synthesized. OBJECTIVES To contextualize the perspectives and experiences of older adults undergoing TAVR. METHODS An integrative review was conducted using Whittemore and Knafl's five-stage methodology.5 Four electronic databases were searched in April 2023. Articles were included if a qualitative methodology was used to assess the perceptions of older adults (>65 years old) undergoing or recovering from TAVR. RESULTS Out of 4619 articles screened, 12 articles met the criteria, representing 353 individuals from 10 countries. Relevant themes included the need for an individualized care plan, caregiver and family support, communication and education, persistent psychosocial and physical symptoms, and the unique recovery journey. CONCLUSION Older adults with AS undergoing TAVR generally perceive their procedure positively. Improved interdisciplinary and holistic management, open communication, symptom assessment, support, and education is needed.
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Affiliation(s)
| | - Daniel David
- New York University Rory Meyers College of Nursing
| | | | | | - Abraham Brody
- New York University Rory Meyers College of Nursing; New York University Grossman School of Medicine
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2
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Vora J, Cherney D, Kosiborod MN, Spaak J, Kanumilli N, Khunti K, Lam CSP, Bachmann M, Fenici P. Inter-relationships between cardiovascular, renal and metabolic diseases: Underlying evidence and implications for integrated interdisciplinary care and management. Diabetes Obes Metab 2024; 26:1567-1581. [PMID: 38328853 DOI: 10.1111/dom.15485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
Cardiovascular, renal and metabolic (CaReMe) diseases are individually among the leading global causes of death, and each is associated with substantial morbidity and mortality. However, as these conditions commonly coexist in the same patient, the individual risk of mortality and morbidity is further compounded, leading to a considerable healthcare burden. A number of pathophysiological pathways are common to diseases of the CaReMe spectrum, including neurohormonal dysfunction, visceral adiposity and insulin resistance, oxidative stress and systemic inflammation. Because of the shared pathology and common co-occurrence of the CaReMe diseases, the value of managing these conditions holistically is increasingly being realized. A number of pharmacological and non-pharmacological approaches have been shown to offer simultaneous metabolic, cardioprotective and renoprotective benefits, leading to improved patient outcomes across the CaReMe spectrum. In addition, increasing value is being placed on interdisciplinary team-based and coordinated care models built on greater integration between specialties to increase the rate of early diagnosis and adherence to practice guidelines, and improve clinical outcomes. This interdisciplinary approach also facilitates integration between primary and specialty care, improving the patient experience, optimizing resources, and leading to efficiencies and cost savings. As the burden of CaReMe diseases continues to increase, implementation of innovative and integrated care delivery models will be essential to achieve effective and efficient chronic disease management and to ensure that patients benefit from the best care available across all three disciplines.
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Affiliation(s)
- Jiten Vora
- Department of Endocrinology, Royal Liverpool University Hospital, Liverpool, UK
| | - David Cherney
- Toronto General Hospital Research Institute, Department of Medicine, Division of Nephrology University of Toronto, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Banting and Best Diabetes Centre, Toronto, Ontario, Canada
- Department of Medicine, UHN, Toronto, Ontario, Canada
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Jonas Spaak
- HND Centrum, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Carolyn S P Lam
- National Heart Center Singapore and Duke-National University of Singapore, Singapore, Singapore
| | | | - Peter Fenici
- School of Medicine and Surgery, Catholic University, Rome, Italy
- Biomagnetism and Clinical Physiology International Center (BACPIC), Rome, Italy
- Medical Affairs, AstraZeneca Lab, Milan, Italy
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Barker K, Rydberg L, Lanphere J, Malmut L, Neal J, Eickmeyer S. The utility of inpatient rehabilitation in heart transplantation: A review. Clin Transplant 2024; 38:e15182. [PMID: 37922201 DOI: 10.1111/ctr.15182] [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: 08/22/2023] [Revised: 10/18/2023] [Accepted: 10/27/2023] [Indexed: 11/05/2023]
Abstract
Heart transplantation is considered definitive treatment for patients with end-stage heart failure. Unfortunately, medical and functional complications are common after heart transplantation for a variety of reasons, and these may impact the patients' functional recovery. Rehabilitation is often needed post-operatively to improve functional outcomes. This review article aims to discuss the transplanted heart exercise physiology that may affect the rehabilitation process and provide an overview of the functional benefits of inpatient rehabilitation for cardiac and surgical specialties who may be less familiar with post-acute care rehabilitation options for their patients.
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Affiliation(s)
- Kim Barker
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Leslie Rydberg
- Northwestern University Feinberg School of Medicine, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | | | - Laura Malmut
- MedStar National Rehabilitation Network, Washington, USA
- Department of Physical Medicine and Rehabilitation, Georgetown University School of Medicine, Washington, USA
| | - Jacqueline Neal
- Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah Eickmeyer
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, USA
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Rossi LP, Granger BB, Bruckel JT, Crabbe DL, Graven LJ, Newlin KS, Streur MM, Vadiveloo MK, Walton-Moss BJ, Warden BA, Volgman AS, Lydston M. Person-Centered Models for Cardiovascular Care: A Review of the Evidence: A Scientific Statement From the American Heart Association. Circulation 2023; 148:512-542. [PMID: 37427418 DOI: 10.1161/cir.0000000000001141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Cardiovascular disease remains the leading cause of death and disability in the United States and globally. Disease burden continues to escalate despite technological advances associated with improved life expectancy and quality of life. As a result, longer life is associated with multiple chronic cardiovascular conditions. Clinical guidelines provide recommendations without considering prevalent scenarios of multimorbidity and health system complexities that affect practical adoption. The diversity of personal preferences, cultures, and lifestyles that make up one's social and environmental context is often overlooked in ongoing care planning for symptom management and health behavior support, hindering adoption and compromising patient outcomes, particularly in groups at high risk. The purpose of this scientific statement was to describe the characteristics and reported outcomes in existing person-centered care delivery models for selected cardiovascular conditions. We conducted a scoping review using Ovid MEDLINE, Embase.com, Web of Science, CINAHL Complete, Cochrane Central Register of Controlled Trials through Ovid, and ClinicalTrials.gov from 2010 to 2022. A range of study designs with a defined aim to systematically evaluate care delivery models for selected cardiovascular conditions were included. Models were selected on the basis of their stated use of evidence-based guidelines, clinical decision support tools, systematic evaluation processes, and inclusion of the patient's perspective in defining the plan of care. Findings reflected variation in methodological approach, outcome measures, and care processes used across models. Evidence to support optimal care delivery models remains limited by inconsistencies in approach, variation in reimbursement, and inability of health systems to meet the needs of patients with chronic, complex cardiovascular conditions.
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Bose S, Groat D, Dinglas VD, Akhlaghi N, Banner-Goodspeed V, Beesley SJ, Greene T, Hopkins RO, Mir-Kasimov M, Sevin CM, Turnbull AE, Jackson JC, Needham DM, Brown SM. Association Between Unmet Nonmedication Needs After Hospital Discharge and Readmission or Death Among Acute Respiratory Failure Survivors: A Multicenter Prospective Cohort Study. Crit Care Med 2023; 51:212-221. [PMID: 36661449 DOI: 10.1097/ccm.0000000000005709] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To characterize early unmet nonmedication discharge needs (UDNs), classified as durable medical equipment (DME), home health services (HHS), and follow-up medical appointments (FUAs) and explore their association with 90-day readmission and mortality among survivors of acute respiratory failure (ARF) who were discharged home. DESIGN Prospective multicenter cohort study. SETTING Six academic medical centers across United States. PARTICIPANTS Adult survivors of ARF who required an ICU stay and were discharged home from hospital. INTERVENTIONS None. Exposure of interest was the proportion of UDN for the following categories: DME, HHS, and FUA ascertained within 7-28 days after hospital discharge. MEASUREMENTS AND MAIN RESULTS Two hundred eligible patients were recruited between January 2019 and August 2020. One-hundred ninety-five patients were included in the analytic cohort: 118 were prescribed DME, 134 were prescribed HHS, and 189 needed at least one FUA according to discharge plans. 98.4% (192/195) had at least one identified nonmedication need at hospital discharge. Median (interquartile range) proportion of unmet needs across three categories were 0 (0-15%) for DME, 0 (0-50%) for HHS, and 0 (0-25%) for FUA, and overall was 0 (0-20%). Fifty-six patients (29%) had 90-day death or readmission. After adjusting for prespecified covariates, having greater than the median level of unmet needs was not associated with an increased risk of readmission or death within 90 days of discharge (risk ratio, 0.89; 0.51-1.57; p = 0.690). Age, hospital length of stay, Acute Physiology and Chronic Health Evaluation II severity of illness score, and Multidimensional Scale Perceived Social Support score were associated with UDN. CONCLUSIONS UDN were common among survivors of ARF but not significantly associated a composite outcome of 90-day readmission or death. Our results highlight the substantial magnitude of UDN and identifies areas especially vulnerable to lapses in healthcare coordination.
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Affiliation(s)
- Somnath Bose
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Center for Anesthesia Research Excellence, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Danielle Groat
- Department of Critical Care, Intermountain Medical Center, Salt Lake City, UT
- Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT
| | - Victor D Dinglas
- Outcomes After Critical Illness and Surgery (OACIS) Group, and Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Narjes Akhlaghi
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Valerie Banner-Goodspeed
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Center for Anesthesia Research Excellence, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Sarah J Beesley
- Department of Critical Care, Intermountain Medical Center, Salt Lake City, UT
- Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT
- Division of Pulmonary Medicine, University of Utah, Salt Lake City, UT
| | - Tom Greene
- Department of Biostatistics and Epidemiology, University of Utah, Salt Lake City, UT
| | - Ramona O Hopkins
- Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT
| | - Mustafa Mir-Kasimov
- Division of Pulmonary Medicine, University of Utah, Salt Lake City, UT
- Section of Pulmonary and Critical Care Medicine, George E Wahlen VA Medical Center, Salt Lake City, UT
| | - Carla M Sevin
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Alison E Turnbull
- Outcomes After Critical Illness and Surgery (OACIS) Group, and Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - James C Jackson
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Group, and Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Samuel M Brown
- Department of Critical Care, Intermountain Medical Center, Salt Lake City, UT
- Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT
- Division of Pulmonary Medicine, University of Utah, Salt Lake City, UT
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Marshall V, Jewett-Tennant J, Shell-Boyd J, Stevenson L, Hearns R, Gee J, Schaub K, LaForest S, Taveira TH, Cohen L, Parent M, Dev S, Barrette A, Oliver K, Wu WC, Ball SL. Healthcare providers experiences with shared medical appointments for heart failure. PLoS One 2022; 17:e0263498. [PMID: 35130320 PMCID: PMC8820643 DOI: 10.1371/journal.pone.0263498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
Shared medical appointments (SMAs) offer a means for providing knowledge and skills needed for chronic disease management to patients. However, SMAs require a time and attention investment from health care providers, who must understand the goals and potential benefits of SMAs from the perspective of patients and providers. To better understand how to gain provider engagement and inform future SMA implementation, qualitative inquiry of provider experience based on a knowledge-attitude-practice model was explored. Semi-structured interviews were conducted with 24 health care providers leading SMAs for heart failure at three Veterans Administration Medical Centers. Rapid matrix analysis process techniques including team-based qualitative inquiry followed by stakeholder validation was employed. The interview guide followed a knowledge-attitude-practice model with a priori domains of knowledge of SMA structure and content (understanding of how SMAs were structured), SMA attitude/beliefs (general expectations about SMA use), attitudes regarding how leading SMAs affected patients, and providers. Data regarding the patient referral process (organizational processes for referring patients to SMAs) and suggested improvements were collected to further inform the development of SMA implementation best practices. Providers from all three sites reported similar knowledge, attitude and beliefs of SMAs. In general, providers reported that the multi-disciplinary structure of SMAs was an effective strategy towards improving clinical outcomes for patients. Emergent themes regarding experiences with SMAs included improved self-efficacy gained from real-time collaboration with providers from multiple disciplines, perceived decrease in patient re-hospitalizations, and promotion of self-management skills for patients with HF. Most providers reported that the SMA-setting facilitated patient learning by providing opportunities for the sharing of experiences and knowledge. This was associated with the perception of increased comradery and support among patients. Future research is needed to test suggested improvements and to develop best practices for training additional sites to implement HF SMA.
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Affiliation(s)
- Vanessa Marshall
- Research, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States of America
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States of America
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Jeri Jewett-Tennant
- Health System Education/Opioid Data 2 Action, The Center for Health Affairs, Cleveland, Ohio, United States of America
| | - Jeneen Shell-Boyd
- Research, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States of America
| | - Lauren Stevenson
- Research, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States of America
| | - Rene Hearns
- Research, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States of America
| | - Julie Gee
- Research, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States of America
| | - Kimberley Schaub
- Research, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States of America
| | - Sharon LaForest
- Research, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States of America
| | - Tracey H. Taveira
- Medicine, Providence VA Medical Center, Providence, Rhode Island, United States of America
- College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, United States of America
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, United States of American
| | - Lisa Cohen
- Medicine, Providence VA Medical Center, Providence, Rhode Island, United States of America
- College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, United States of America
| | - Melanie Parent
- Medicine, Providence VA Medical Center, Providence, Rhode Island, United States of America
| | - Sandesh Dev
- Medicine, Southern Arizona VA Health Care System, Tucson, Arizona, United States of America
| | - Amy Barrette
- Medicine, Providence VA Medical Center, Providence, Rhode Island, United States of America
| | - Karen Oliver
- Medicine, Providence VA Medical Center, Providence, Rhode Island, United States of America
| | - Wen-Chih Wu
- Medicine, Providence VA Medical Center, Providence, Rhode Island, United States of America
- College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, United States of America
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, United States of American
- Medicine, Southern Arizona VA Health Care System, Tucson, Arizona, United States of America
| | - Sherry L. Ball
- Research, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States of America
- * E-mail:
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