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Romanò M. New Disease Trajectories of Heart Failure: Challenges in Determining the Ideal Timing of Palliative Care Implementation. J Palliat Med 2024. [PMID: 38973549 DOI: 10.1089/jpm.2023.0681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background: The disease trajectory of heart failure (HF), along with other organ failures, is still being elucidated. The trajectory is represented as a descending saw-tooth curve, indicating the frequent exacerbations and hospitalizations and slow progression to death. However, the clinical pattern of HF is no longer unique because of the definition of three distinct phenotypes, according to different values of ejection fraction (EF): HF with reduced EF (HFrEF), mildly reduced EF (HFmEF), and preserved EF (HFpEF). Patients with HFrEF have access to pharmacological and nonpharmacological treatments that have been shown to reduce mortality, unlike the other two classes for which no effective therapies are present. Therefore, their disease trajectories are markedly different. Methods: In this study, multiple new disease trajectories of HFrEF are being proposed, ranging from a complete and persistent recovery to rapid clinical deterioration and premature death. These new trajectories pose challenges to early implementation of palliative care (PC), as indicated in the guidelines. Results: From these considerations, we discuss how the improved prognosis of HFrEF because of effective treatment could paradoxically delay the initiation of early PC, especially with the insufficient palliative knowledge and training of cardiologists, who usually believe that PC is required only at the end of life. Conclusions: The novel therapeutic approaches for HF discussed in this study highlight the clinical specificity and peculiar needs of patients with HF. The changing model of disease trajectories of patients with HF will provide new opportunities for the early implementation of PC.
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Affiliation(s)
- Massimo Romanò
- Organizing Committee Master in Palliative Care. University of Milan, Milano, Italy
- Hospice of Abbiategrasso, Milan, Italy
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2
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Shore S, Harrod M, Vitous A, Silveira MJ, McIlvennan CK, Cascino TM, Langa KM, Ho PM, Nallamothu BK. Prognosis Communication in Heart Failure: Experiences and Preferences of End-Stage Heart Failure Patients and Care Partners. Circ Cardiovasc Qual Outcomes 2024; 17:e010662. [PMID: 38775053 DOI: 10.1161/circoutcomes.123.010662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/22/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Patients with heart failure (HF) overestimate survival compared with model-predicted estimates, but the reasons for this discrepancy are poorly understood. We characterized how patients with end-stage HF and their care partners understand prognosis and elicited their preferences around prognosis communication. METHODS We conducted in-depth, semistructured interviews with patients with end-stage HF and their care partners between 2021 and 2022 at a tertiary care center in Michigan. Participants were asked to describe barriers they faced to understanding prognosis. All interviews were coded and analyzed using an iterative content analysis approach. RESULTS Fifteen patients with end-stage HF and 15 care partners participated, including 7 dyads. The median patient age was 66.5 years (range, 31-80) and included 9 of 15 (60%) White participants and 9 of 15 (60%) were males. Care partners included 10 of 15 (67%) White participants and 6 of 15 (40%) were males. Care partners were partners (n=7, 47%), siblings (n=4, 27%), parents (n=2, 13%), and children (n=2, 13%). Most patients demonstrated a poor understanding of their prognosis. In contrast, care partners commonly identified the patient's rapidly declining trajectory. Patients and care partners described ineffective prognosis communication with clinicians, common barriers to understanding prognosis, and similar suggestions on improving prognosis communication. Barriers to understanding prognosis included (1) conversation avoidance by physicians, (2) information inconsistency across different physicians, (3) distractions during prognosis communication due to emphasis on other conditions, and (4) confusion related to the use of medical jargon. Most patients and care partners wanted discussions around prognosis to begin early in the course of the disease, repeated routinely using layperson's terms, incorporating both quality of life and survival assessments, and involving care partners. Both patients and care partners did not expect precise survival estimates. CONCLUSIONS Patients with end-stage HF demonstrate a poor understanding of their prognosis compared with their care partners. Patients and care partners are open to discussing prognosis early, using direct and patient-centered language.
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Affiliation(s)
- Supriya Shore
- Division of Cardiovascular Disease, Department of Internal Medicine (S.S., T.C., B.K.N.), University of Michigan, Ann Arbor
| | - Molly Harrod
- Center for Clinical Management Research (M.H.), VA Ann Arbor Health Care System, MI
| | - Ann Vitous
- Geriatric Research and Clinical Center (A.V.), VA Ann Arbor Health Care System, MI
| | - Maria J Silveira
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine (M.J.S.), University of Michigan, Ann Arbor
| | - Colleen K McIlvennan
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora (C.K.M.I., P.M.H.)
| | - Thomas M Cascino
- Division of Cardiovascular Disease, Department of Internal Medicine (S.S., T.C., B.K.N.), University of Michigan, Ann Arbor
| | - Kenneth M Langa
- Department of Internal Medicine, Institute for Social Research (K.M.L.), University of Michigan, Ann Arbor
| | - P Michael Ho
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora (C.K.M.I., P.M.H.)
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Disease, Department of Internal Medicine (S.S., T.C., B.K.N.), University of Michigan, Ann Arbor
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Grady KL, Dew MA, Pagani FD, Spertus JA, Hsich E, Yuzefpolskaya M, Lampert B, Kirklin JK, Petty M, Kao A, Yancy C, Hartupee J, Pamboukian SV, Johnson M, Murray M, Wu T, Andrei AC. A comparison of quality-adjusted life years in older adults after heart transplantation versus long-term mechanical support: Findings from the SUSTAIN-IT study. J Heart Lung Transplant 2024:S1053-2498(24)01680-2. [PMID: 38762215 DOI: 10.1016/j.healun.2024.05.008] [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: 02/14/2024] [Revised: 04/19/2024] [Accepted: 05/12/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND The quality-adjusted life year (QALY) measures disease burden and treatment, combining overall survival and health-related quality of life (HRQOL). We estimated QALYs in 3 groups of older patients (60-80 years) with heart failure (HF) who underwent heart transplantation (HT, with pre-transplant mechanical circulatory support [HT MCS] or HT without pre-transplant MCS [HT Non-MCS]) or long-term MCS (destination therapy). We also identified factors associated with gains in QALYs through 24 months follow-up. METHODS Of 393 eligible patients enrolled (10/1/15-12/31/18) at 13 U.S. sites, 161 underwent HT (n = 68 HT MCS, n = 93 HT Non-MCS) and 144 underwent long-term MCS. Survival and HRQOL data were collected through 24 months. QALY health utilities were based on patient self-report of EQ-5D-3L dimensions. Mean-restricted QALYs were compared among groups using generalized linear models. RESULTS For the entire cohort, mean age in years closest to surgery was 67 (standard deviation, SD: 4.7), 78% were male, and 83% were White. By 18 months post-surgery, sustained significant differences in adjusted average ± SD QALYs emerged across groups, with the HT Non-MCS group having the highest average QALYs (24-month window: HT Non-MCS = 22.58 ± 1.1, HT MCS = 19.53 ± 1.33, Long-term MCS = 19.49 ± 1.3, p = 0.003). At 24 months post-operatively, a lower gain in QALYs was associated with HT MCS, long-term MCS, a lower pre-operative LVEF, NYHA class III or IV before surgery, and an ischemic or other etiology of HF. CONCLUSIONS Determination of QALYs may provide important information for policy makers and clinicians to consider regarding benefits of HT and long-term MCS as treatment options for older patients with HF.
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Affiliation(s)
- Kathleen L Grady
- Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois.
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - John A Spertus
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Eileen Hsich
- Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York
| | - Brent Lampert
- Department of Medicine, Division of Cardiovascular Medicine, Ohio State University, Columbus, Ohio
| | | | - Michael Petty
- Department of Nursing, University of Minnesota Medical Center, Fairview, Minnesota
| | - Andrew Kao
- Cardiovascular Disease, Advanced Heart Failure and Transplant Cardiology, St. Luke's Health System, Kansas City, Missouri
| | - Clyde Yancy
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Justin Hartupee
- Department of Medicine, Division of Cardiovascular Medicine, Washington University, St. Louis, Missouri
| | - Salpy V Pamboukian
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - Maryl Johnson
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin, Madison, Wisconsin
| | - Margaret Murray
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin, Madison, Wisconsin
| | - Tingqing Wu
- Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
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Lamp J, Wu Y, Lamp S, Afriyie P, Ashur N, Bilchick K, Breathett K, Kwon Y, Li S, Mehta N, Pena ER, Feng L, Mazimba S. Characterizing advanced heart failure risk and hemodynamic phenotypes using interpretable machine learning. Am Heart J 2024; 271:1-11. [PMID: 38336159 PMCID: PMC11042988 DOI: 10.1016/j.ahj.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Although previous risk models exist for advanced heart failure with reduced ejection fraction (HFrEF), few integrate invasive hemodynamics or support missing data. This study developed and validated a heart failure (HF) hemodynamic risk and phenotyping score for HFrEF, using Machine Learning (ML). METHODS Prior to modeling, patients in training and validation HF cohorts were assigned to 1 of 5 risk categories based on the composite endpoint of death, left ventricular assist device (LVAD) implantation or transplantation (DeLvTx), and rehospitalization in 6 months of follow-up using unsupervised clustering. The goal of our novel interpretable ML modeling approach, which is robust to missing data, was to predict this risk category (1, 2, 3, 4, or 5) using either invasive hemodynamics alone or a rich and inclusive feature set that included noninvasive hemodynamics (all features). The models were trained using the ESCAPE trial and validated using 4 advanced HF patient cohorts collected from previous trials, then compared with traditional ML models. Prediction accuracy for each of these 5 categories was determined separately for each risk category to generate 5 areas under the curve (AUCs, or C-statistics) for belonging to risk category 1, 2, 3, 4, or 5, respectively. RESULTS Across all outcomes, our models performed well for predicting the risk category for each patient. Accuracies of 5 separate models predicting a patient's risk category ranged from 0.896 +/- 0.074 to 0.969 +/- 0.081 for the invasive hemodynamics feature set and 0.858 +/- 0.067 to 0.997 +/- 0.070 for the all features feature set. CONCLUSION Novel interpretable ML models predicted risk categories with a high degree of accuracy. This approach offers a new paradigm for risk stratification that differs from prediction of a binary outcome. Prospective clinical evaluation of this approach is indicated to determine utility for selecting the best treatment approach for patients based on risk and prognosis.
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Affiliation(s)
- Josephine Lamp
- Department of Computer Science, University of Virginia, Charlottesville, VA.
| | - Yuxin Wu
- Department of Computer Science, University of California, Los Angeles, CA
| | - Steven Lamp
- Department of Computer Science, University of Virginia, Charlottesville, VA
| | - Prince Afriyie
- Department of Statistics, University of Virginia, Charlottesville, VA
| | - Nicholas Ashur
- Department of Cardiovascular Medicine, University of Virginia, Charlottesville, VA
| | - Kenneth Bilchick
- Department of Cardiovascular Medicine, University of Virginia, Charlottesville, VA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Younghoon Kwon
- Department of Cardiovascular Medicine, University of Washington, Seattle, WA
| | - Song Li
- Department of Cardiovascular Medicine, University of Washington, Seattle, WA
| | - Nishaki Mehta
- Department of Cardiology, William Beaumont Oakland University School of Medicine, Royal Oak, MI
| | - Edward Rojas Pena
- Department of Cardiovascular Medicine, University of Virginia, Charlottesville, VA
| | - Lu Feng
- Department of Computer Science, University of Virginia, Charlottesville, VA
| | - Sula Mazimba
- Department of Cardiovascular Medicine, University of Virginia, Charlottesville, VA; Transplant Institute, AdventHealth, Orlando, FL
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Chuzi S, Manning K. Integration of palliative care across the spectrum of heart failure care and therapies: considerations, contemporary data, and challenges. Curr Opin Cardiol 2024; 39:218-225. [PMID: 38567949 DOI: 10.1097/hco.0000000000001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW Heart failure (HF) is characterized by significant symptoms, compromised quality of life, frequent hospital admissions, and high mortality, and is therefore well suited to palliative care (PC) intervention. This review elaborates the current PC needs of patients with HF across the spectrum of disease, including patients who undergo advanced HF surgical therapies, and reviews the current data and future directions for PC integration in HF care. RECENT FINDINGS Patients with chronic HF, as well as those who are being evaluated for or who have undergone advanced HF surgical therapies such as left ventricular assist device or heart transplantation, have a number of PC needs, including decision-making, symptoms and quality of life, caregiver support, and end-of-life care. Available data primarily supports the use of PC interventions in chronic HF to improve quality of life and symptoms. PC skills and teams may also help address preparedness planning, adverse events, and psychosocial barriers in patients who have had HF surgeries, but more data are needed to determine association with outcomes. SUMMARY Patients with HF have tremendous PC needs across the spectrum of disease. Despite this, more data are needed to determine the optimal timing and structure of PC interventions in patients with chronic HF, left ventricular assist device, and heart transplantation. Future steps must be taken in clinical, research, and policy domains in order to optimize care.
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Affiliation(s)
- Sarah Chuzi
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katharine Manning
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center
- Section of Palliative Medicine, Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Maddox TM, Januzzi JL, Allen LA, Breathett K, Brouse S, Butler J, Davis LL, Fonarow GC, Ibrahim NE, Lindenfeld J, Masoudi FA, Motiwala SR, Oliveros E, Walsh MN, Wasserman A, Yancy CW, Youmans QR. 2024 ACC Expert Consensus Decision Pathway for Treatment of Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2024; 83:1444-1488. [PMID: 38466244 DOI: 10.1016/j.jacc.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
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7
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Rajan R, Hui JMH, Al Jarallah MA, Tse G, Chan JSK, Satti DI, Hui CTC, Sun Y, Lee YHA, Liu Y, Vijayaraghavan G, Al-Zakwani I, AlObaid L. The modified Rajan's heart failure risk score predicts all-cause mortality in patients hospitalized for heart failure with reduced ejection fraction: a retrospective cohort study. Ann Med Surg (Lond) 2024; 86:1843-1849. [PMID: 38576988 PMCID: PMC10990347 DOI: 10.1097/ms9.0000000000001646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/11/2023] [Indexed: 04/06/2024] Open
Abstract
Background The dimensionless Rajan's heart failure (R-hf) risk score was proposed to predict all-cause mortality in patients hospitalized with chronic heart failure (HF) and reduced ejection fraction (EF) (HFrEF). Purpose To examine the association between the modified R-hf risk score and all-cause mortality in patients with HFrEF. Methods Retrospective cohort study included adults hospitalized with HFrEF, as defined by clinical symptoms of HF with biplane EF less than 40% on transthoracic echocardiography, at a tertiary centre in Dalian, China, between 1 November 2015, and 31 October 2019. All patients were followed up until 31 October 2020. A modified R-hf risk score was calculated by substituting brain natriuretic peptide (BNP) for N-terminal prohormone of BNP (NT-proBNP) using EF× estimated glomerular filtration rate (eGFR)× haemoglobin (Hb))/BNP. The patients were stratified into tertiles according to the R-hf risk score. The measured outcome was all-cause mortality. The score performance was assessed using C-statistics. Results A total of 840 patients were analyzed (70.2% males; mean age, 64±14 years; median (interquartile range) follow-up 37.0 (27.8) months). A lower modified R-hf risk score predicted a higher risk of all-cause mortality, independent of sex and age [1st tertile vs. 3rd tertile: adjusted hazard ratio (aHR), 3.46; 95% CI: 2.11-5.67; P<0.001]. Multivariate Cox regression analysis indicated that a lower modified R-hf risk score was associated with increased cumulative all-cause mortality [univariate: (1st tertile vs. 3rd tertile: aHR, 3.45; 95% CI: 2.11-5.65; P<0.001) and multivariate: (1st tertile vs. 3rd tertile: aHR 2.21, 95% CI: 1.29-3.79; P=0.004)]. The performance of the model, as reported by C-statistic was 0.67 (95% CI: 0.62-0.72). Conclusion The modified R-hf risk score predicted all-cause mortality in patients hospitalized with HFrEF. Further validation of the modified R-hf risk score in other cohorts of patients with HFrEF is needed before clinical application.
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Affiliation(s)
- Rajesh Rajan
- Department of Cardiology, Sabah Al Ahmad Cardiac Center, Kuwait City, Kuwait
| | - Jeremy Man Ho Hui
- Heart Failure and Structural Heart Disease Unit, Cardiovascular Analytics Group, Hong Kong, China—United Kingdom collaboration
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Gary Tse
- Heart Failure and Structural Heart Disease Unit, Cardiovascular Analytics Group, Hong Kong, China—United Kingdom collaboration
| | - Jeffrey Shi Kai Chan
- Heart Failure and Structural Heart Disease Unit, Cardiovascular Analytics Group, Hong Kong, China—United Kingdom collaboration
| | - Danish Iltaf Satti
- Heart Failure and Structural Heart Disease Unit, Cardiovascular Analytics Group, Hong Kong, China—United Kingdom collaboration
| | - Chloe Tsz Ching Hui
- Heart Failure and Structural Heart Disease Unit, Cardiovascular Analytics Group, Hong Kong, China—United Kingdom collaboration
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yuxi Sun
- Heart Failure and Structural Cardiology Division, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yan Hiu Athena Lee
- Heart Failure and Structural Heart Disease Unit, Cardiovascular Analytics Group, Hong Kong, China—United Kingdom collaboration
| | - Ying Liu
- Heart Failure and Structural Cardiology Division, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | - Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman & Gulf Health Research, Muscat, Oman
| | - Laura AlObaid
- Department of Medicine, Faculty of Medicine, Royal College of Surgeons, Dublin, Ireland
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8
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Turgeon RD, Fernando S, Bains M, Code J, Hawkins NM, Koshman S, Straatman L, Toma M, Virani SA, MacDonald BJ, Snow ME. Qualitative Analysis of Patient Decisional Needs for Medications to Treat Heart Failure. Circ Heart Fail 2024; 17:e011445. [PMID: 38581405 PMCID: PMC11008452 DOI: 10.1161/circheartfailure.123.011445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/30/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The development of tools to support shared decision-making should be informed by patients' decisional needs and treatment preferences, which are largely unknown for heart failure (HF) with reduced ejection fraction (HFrEF) pharmacotherapy decisions. We aimed to identify patients' decisional needs when considering HFrEF medication options. METHODS This was a qualitative study using semi-structured interviews. We recruited patients with HFrEF from 2 Canadian ambulatory HF clinics and clinicians from Canadian HF guideline panels, HF clinics, and Canadian HF Society membership. We identified themes through inductive thematic analysis. RESULTS Participants included 15 patients and 12 clinicians. Six themes and associated subthemes emerged related to HFrEF pharmacotherapy decision-making: (1) patient decisional needs included lack of awareness of a choice or options, difficult decision timing and stage, information overload, and inadequate motivation, support and resources; (2) patients' decisional conflict varied substantially, driven by unclear trade-offs; (3) treatment attribute preferences-patients focused on both benefits and downsides of treatment, whereas clinicians centered discussion on benefits; (4) quality of life-patients' definition of quality of life depended on pre-HF activity, though most patients demonstrated adaptability in adjusting their daily activities to manage HF; (5) shared decision-making process-clinicians' described a process more akin to informed consent; (6) decision support-multimedia decision aids, virtual appointments, and primary-care comanagement emerged as potential enablers of shared decision-making. CONCLUSIONS Patients with HFrEF have several decisional needs, which are consistent with those that may respond to decision aids. These findings can inform the development of HFrEF pharmacotherapy decision aids to address these decisional needs and facilitate shared decision-making.
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Affiliation(s)
- Ricky D. Turgeon
- University of British Columbia, Vancouver, BC, Canada (R.D.T., S.F., J.C., N.M.H., L.S., M.T., S.A.V., B.J.M.D., M.E.S.)
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada (R.D.T., S.F., M.E.S.)
| | - Saranee Fernando
- University of British Columbia, Vancouver, BC, Canada (R.D.T., S.F., J.C., N.M.H., L.S., M.T., S.A.V., B.J.M.D., M.E.S.)
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada (R.D.T., S.F., M.E.S.)
| | - Marc Bains
- The HeartLife Foundation, Vancouver, BC, Canada (M.B., J.C.)
| | - Jillianne Code
- University of British Columbia, Vancouver, BC, Canada (R.D.T., S.F., J.C., N.M.H., L.S., M.T., S.A.V., B.J.M.D., M.E.S.)
- The HeartLife Foundation, Vancouver, BC, Canada (M.B., J.C.)
| | - Nathaniel M. Hawkins
- University of British Columbia, Vancouver, BC, Canada (R.D.T., S.F., J.C., N.M.H., L.S., M.T., S.A.V., B.J.M.D., M.E.S.)
| | - Sheri Koshman
- Mazankowski Alberta Heart Institute and the Division of Cardiology, University of Alberta, Edmonton, AB, Canada (S.K.)
| | - Lynn Straatman
- University of British Columbia, Vancouver, BC, Canada (R.D.T., S.F., J.C., N.M.H., L.S., M.T., S.A.V., B.J.M.D., M.E.S.)
| | - Mustafa Toma
- University of British Columbia, Vancouver, BC, Canada (R.D.T., S.F., J.C., N.M.H., L.S., M.T., S.A.V., B.J.M.D., M.E.S.)
| | - Sean A. Virani
- University of British Columbia, Vancouver, BC, Canada (R.D.T., S.F., J.C., N.M.H., L.S., M.T., S.A.V., B.J.M.D., M.E.S.)
| | - Blair J. MacDonald
- University of British Columbia, Vancouver, BC, Canada (R.D.T., S.F., J.C., N.M.H., L.S., M.T., S.A.V., B.J.M.D., M.E.S.)
| | - M. Elizabeth Snow
- University of British Columbia, Vancouver, BC, Canada (R.D.T., S.F., J.C., N.M.H., L.S., M.T., S.A.V., B.J.M.D., M.E.S.)
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada (R.D.T., S.F., M.E.S.)
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9
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Prasad P, Chandrashekar P, Golwala H, Macon CJ, Steiner J. Functional Mitral Regurgitation: Patient Selection and Optimization. Interv Cardiol Clin 2024; 13:167-182. [PMID: 38432760 DOI: 10.1016/j.iccl.2023.11.001] [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] [Indexed: 03/05/2024]
Abstract
Functional mitral regurgitation appears commonly among all heart failure phenotypes and can affect symptom burden and degree of maladaptive remodeling. Transcatheter mitral valve edge-to-edge repair therapies recently became an important part of the routine heart failure armamentarium for carefully selected and medically optimized candidates. Patient selection is considering heart failure staging, relevant comorbidities, as well as anatomic criteria. Indications and device platforms are currently expanding.
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Affiliation(s)
- Pooja Prasad
- Division of Cardiology, University of California-San Francisco, 505 Parnassus Avenue, Suite M1182, Box 0124, San Francisco, CA 94143, USA
| | - Pranav Chandrashekar
- Knight Cardiovascular Institute, Oregon Health & Science University, 3161 SW Pavilion Loop, Portland, OR 97239, USA
| | - Harsh Golwala
- Knight Cardiovascular Institute, Oregon Health & Science University, 3161 SW Pavilion Loop, Portland, OR 97239, USA
| | - Conrad J Macon
- Knight Cardiovascular Institute, Oregon Health & Science University, 3161 SW Pavilion Loop, Portland, OR 97239, USA
| | - Johannes Steiner
- Knight Cardiovascular Institute, Oregon Health & Science University, 3161 SW Pavilion Loop, Portland, OR 97239, USA.
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10
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Beattie JM, Castiello T, Jaarsma T. The Importance of Cultural Awareness in the Management of Heart Failure: A Narrative Review. Vasc Health Risk Manag 2024; 20:109-123. [PMID: 38495057 PMCID: PMC10944309 DOI: 10.2147/vhrm.s392636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/27/2024] [Indexed: 03/19/2024] Open
Abstract
Heart failure is a commonly encountered clinical syndrome arising from a range of etiologic cardiovascular diseases and manifests in a phenotypic spectrum of varying degrees of systolic and diastolic ventricular dysfunction. Those affected by this life-limiting illness are subject to an array of burdensome symptoms, poor quality of life, prognostic uncertainty, and a relatively onerous and increasingly complex treatment regimen. This condition occurs in epidemic proportions worldwide, and given the demographic trend in societal ageing, the prevalence of heart failure is only likely to increase. The marked upturn in international migration has generated other demographic changes in recent years, and it is evident that we are living and working in ever more ethnically and culturally diverse communities. Professionals treating those with heart failure are now dealing with a much more culturally disparate clinical cohort. Given that the heart failure disease trajectory is unique to each individual, these clinicians need to ensure that their proposed treatment options and responses to the inevitable crises intrinsic to this condition are in keeping with the culturally determined values, preferences, and worldviews of these patients and their families. In this narrative review, we describe the importance of cultural awareness across a range of themes relevant to heart failure management and emphasize the centrality of cultural competence as the basis of appropriate care provision.
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Affiliation(s)
- James M Beattie
- School of Cardiovascular Medicine and Sciences, King’s College London, London, UK
- Department of Palliative Care and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Teresa Castiello
- Department of Cardiology, Croydon University Hospital, London, UK
- Department of Cardiovascular Imaging, King’s College London, London, UK
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Nursing Science, Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands
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11
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Morrison ML. Patient decision-making in left ventricular assist devices for destination therapy. Int J Palliat Nurs 2024; 30:108-117. [PMID: 38517852 DOI: 10.12968/ijpn.2024.30.3.108] [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] [Indexed: 03/24/2024]
Abstract
BACKGROUND Heart failure is a common life-limiting disease. A destination therapy for people who will not have a heart transplant is a left ventricular assist device. AIMS To discover how patients who have a left ventricular assist device for destination therapy make decisions about their healthcare after implantation of the device. METHODS A descriptive qualitative design with semi-structured, in-depth interviews with 11 participants who are living with a left ventricular assist device for destination therapy. FINDINGS People with a left ventricular assist device felt they had 'no choice' when making decisions about their healthcare. CONCLUSION Engaging with patients to contemplate present and future healthcare decisions is a complex process that includes cognitive processes within the patient. Clinicians need to be aware that a gap may occur between what is said and what is heard in communication.
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Affiliation(s)
- Megan L Morrison
- Nurse Practitioner, Palliative and Geriatric Medicine Inova Fairfax Hospital, US
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12
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Badrish N, Sheifer S, Rosner CM. Systems of care for ambulatory management of decompensated heart failure. Front Cardiovasc Med 2024; 11:1350846. [PMID: 38455722 PMCID: PMC10918851 DOI: 10.3389/fcvm.2024.1350846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/25/2024] [Indexed: 03/09/2024] Open
Abstract
Heart failure (HF) represents a worldwide health burden and the annual per patient cost to treat HF in the US is estimated at $24,383, with most of this expense driven by HF related hospitalizations. Decompensated HF is a leading cause for hospital admissions and is associated with an increased risk of subsequent morbidity and mortality. Many hospital admissions for decompensated HF are considered preventable with timely recognition and effective intervention.Systems of care that include interventions to facilitate early recognition, timely and appropriate intervention, intensification of care, and optimization to prevent recurrence can help successfully manage decompensated HF in the ambulatory setting and avoid hospitalization.
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Affiliation(s)
- Narotham Badrish
- Department of Cardiology, Inova Schar Heart and Vascular, Falls Church, VA, United States
| | - Stuart Sheifer
- Department of Cardiology, Inova Schar Heart and Vascular, Falls Church, VA, United States
- Department of Cardiology, Virginia Heart, Falls Church, VA, United States
| | - Carolyn M. Rosner
- Department of Cardiology, Inova Schar Heart and Vascular, Falls Church, VA, United States
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13
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Shore S, Li H, Zhang M, Whitney R, Gross AL, Bhatt AS, Nallamothu BK, Giordani B, Briceño EM, Sussman JB, Gutierrez J, Yaffe K, Griswold M, Johansen MC, Lopez OL, Gottesman RF, Sidney S, Heckbert SR, Rundek T, Hughes TM, Longstreth WT, Levine DA. Trajectory of Cognitive Function After Incident Heart Failure. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.09.24302608. [PMID: 38370803 PMCID: PMC10871464 DOI: 10.1101/2024.02.09.24302608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background The size/magnitude of cognitive changes after incident heart failure (HF) are unclear. We assessed whether incident HF is associated with changes in cognitive function after accounting for pre-HF cognitive trajectories and known determinants of cognition. Methods This pooled cohort study included adults without HF, stroke, or dementia from six US population-based cohort studies from 1971-2019: Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and Northern Manhattan Study. Linear mixed-effects models estimated changes in cognition at the time of HF (change in the intercept) and the rate of cognitive change over the years after HF (change in the slope), controlling for pre-HF cognitive trajectories and participant factors. Change in global cognition was the primary outcome. Change in executive function and memory were secondary outcomes. Cognitive outcomes were standardized to a t-score metric (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition. Results The study included 29,614 adults (mean [SD] age was 61.1 [10.5] years, 55% female, 70.3% White, 22.2% Black 7.5% Hispanic). During a median follow-up of 6.6 (Q1-Q3: 5-19.8) years, 1,407 (4.7%) adults developed incident HF. Incident HF was associated with an acute decrease in global cognition (-1.08 points; 95% CI -1.36, -0.80) and executive function (-0.65 points; 95% CI -0.96, -0.34) but not memory (-0.51 points; 95% CI -1.37, 0.35) at the time of the event. Greater acute decreases in global cognition after HF were seen in those with older age, female sex and White race. Individuals with incident HF, compared to HF-free individuals, demonstrated faster declines in global cognition (-0.15 points per year; 95% CI, -0.21, -0.09) and executive function (-0.16 points per year; 95% CI -0.23, -0.09) but not memory ( -0.11 points per year; 95% CI -0.26, 0.04) compared with pre-HF slopes. Conclusions In this pooled cohort study, incident HF was associated with an acute decrease in global cognition and executive function at the time of the event and faster declines in global cognition and executive function over the following years.
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Affiliation(s)
| | - Hanyu Li
- University of Michigan, Ann Arbor, MI, USA
| | - Min Zhang
- University of Michigan, Ann Arbor, MI, USA
| | | | - Alden L. Gross
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ankeet S. Bhatt
- Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, CA, USA
| | | | | | | | | | | | | | - Michael Griswold
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, MD, USA
| | - Stephen Sidney
- Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, CA, USA
| | | | - Tatjana Rundek
- University of Miami – Miller School of Medicine, Evelyn F. McKnight Brain Institute, FL, USA
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14
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Hyun J, Kim AR, Lee SE, Kim MS. B-lines by lung ultrasound as a predictor of re-intubation in mechanically ventilated patients with heart failure. Front Cardiovasc Med 2024; 11:1351431. [PMID: 38390441 PMCID: PMC10881858 DOI: 10.3389/fcvm.2024.1351431] [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: 12/06/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction There have been few studies on predictors of weaning failure from MV in patients with heart failure (HF). We sought to investigate the predictive value of B-lines measured by lung ultrasound (LUS) on the risk of weaning failure from mechanical ventilation (MV) and in-hospital outcomes. Methods This was a single-center, prospective observational study that included HF patients who were on invasive MV. LUS was performed immediate before ventilator weaning. A positive LUS exam was defined as the observation of two or more regions that had three or more count of B-lines located bilaterally on the thorax. The primary outcome was early MV weaning failure, defined as re-intubation within 72 h. Results A total of 146 consecutive patients (mean age 70 years; 65.8% male) were enrolled. The total count of B-lines was a median of 10 and correlated with NT-pro-BNP level (r2 = 0.132, p < 0.001). Early weaning failure was significantly higher in the positive LUS group (9 out of 64, 14.1%) than the negative LUS group (2 out of 82, 2.4%) (p = 0.011). The rate of total re-intubation during the hospital stay (p = 0.004), duration of intensive care unit stay (p = 0.004), and hospital stay (p = 0.010) were greater in the positive LUS group. The negative predictive value (NPV) of positive LUS was 97.6% for the primary outcome. Conclusion B-lines measured by LUS can predict the risk of weaning failure. Considering the high NPV of positive LUS, it may help guide the decision of weaning in patients on invasive MV due to acute decompensated HF.
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Affiliation(s)
- Junho Hyun
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ah-Ram Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Eun Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min-Seok Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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15
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Robert R, Goldberg M. [Palliative care: Time to clarify the lexical field]. Rev Med Interne 2024; 45:61-64. [PMID: 38267321 DOI: 10.1016/j.revmed.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Affiliation(s)
- R Robert
- CIC Inserm 1402, médecine intensive réanimation, université de Poitiers, CHU de Poitiers, 86000 Poitiers, France.
| | - M Goldberg
- UMRi CNRS 7266, laboratoire littoral, environnement et sociétés, université de La Rochelle, 17000 La Rochelle, France.
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16
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Tobita K, Sakamoto H, Inami T, Fujisawa D, Takeuchi K, Kikuchi H, Ito J, Goda A, Soejima K, Kohno T. Understanding Patient Perspectives Toward Shared Decision-Making in Patients With Pulmonary Hypertension. Am J Cardiol 2024; 212:23-29. [PMID: 37984635 DOI: 10.1016/j.amjcard.2023.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/15/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
Clinical guidelines for pulmonary hypertension (PH) recommend shared decision-making and individualized treatment. However, patient perspectives on PH treatment goals, preference toward a decision-making style of treatment, and adoption of shared decision-making remain unclear. This cross-sectional questionnaire-based study assessed the patients' preferred and actual participation role in treatment decision-making, rated on 5 scales (ranging from passive [patients leave all decisions to physicians] to active [patients make the decision after physicians show patients several options]) and evaluated the concordance between preferred and actual participation roles. The important factors underlying patients' perspectives in treatment decision-making (i.e., prognosis; symptom, financial, family, and social burdens; patient values; and physician recommendation) were evaluated. Univariate logistic regression analysis was performed to determine the patients with a positive preference toward "physician recommendation" in treatment decision-making. Among 130 patients with PH (median age: 58 years; mean pulmonary arterial pressure: 23 mm Hg; 27.7% were males), 59.2% preferred that "physicians make the decision regarding treatment after showing patients therapeutic options (i.e., intermediate between passive and active roles)." The patient-preferred and actual participation roles in decision-making had moderate agreement (Cohen's kappa = 0.46). The most important factor in treatment decisions was "symptom burden reduction" (93.8%). Although 85.0% of patients chose "physician recommendation" as an important factor, 49.6% chose "alignment with my values." The determinants of patients who chose "physician recommendation" were less severe hemodynamics and better functional capacity. In conclusion, patients with PH preferred that the "physicians make the decision after showing patients therapeutic options" and prioritized physician recommendation over their values.
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Affiliation(s)
- Kazuki Tobita
- Department of Physical Therapy, Saitama Medical University Faculty of Health and Medical Care, Saitama, Japan; Departments of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Hayato Sakamoto
- Department of Rehabilitation, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Takumi Inami
- Departments of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kaori Takeuchi
- Departments of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Hanako Kikuchi
- Departments of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Junnosuke Ito
- Departments of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Ayumi Goda
- Departments of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kyoko Soejima
- Departments of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Takashi Kohno
- Departments of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan.
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17
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Moody SY, Bell CL, Lindenberger EC, Reid MC. Adaptive Care Planning: A paradigm shift. J Am Geriatr Soc 2024; 72:337-345. [PMID: 38193787 PMCID: PMC11215758 DOI: 10.1111/jgs.18731] [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: 08/04/2023] [Revised: 11/06/2023] [Accepted: 11/19/2023] [Indexed: 01/10/2024]
Abstract
A key challenge of implementing advance care planning lies in the fact that decisions made in advance require patients and their family members to imagine what their clinical picture will look like rather than knowing or experiencing the clinical circumstances as they unfold. Even more important is the acknowledgment of the unpredictability of a given clinical course. This type of situation requires adaptiveness and flexibility in decision-making that frequently occurs in the moment(s) triggered by changes in health state(s). We describe an alternative frameshifting approach called "Adaptive Care Planning (AdaptCP)," which features an evolving communication between physicians and patients/families with ongoing incorporation of the patient's/family's perspective. This process continues iteratively until each decision can be reached in a way that is both harmonious with the patient's/family's perspective and is consistent with medical treatment options that are actionable for the healthcare team. We include a table of tools drawn from the literature that can help clinicians when implementing AdaptCP.
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Affiliation(s)
- Sandra Y. Moody
- Department of Medicine/Divisions of Hospital & Geriatrics Medicine, University of California, San Francisco, California, USA
| | - Christina L. Bell
- Hawaii Permanente Medical Group, Department of Geriatric Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Elizabeth C. Lindenberger
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - M. Carrington Reid
- Department of Medicine/Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA
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18
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Wanhainen A, Van Herzeele I, Bastos Goncalves F, Bellmunt Montoya S, Berard X, Boyle JR, D'Oria M, Prendes CF, Karkos CD, Kazimierczak A, Koelemay MJW, Kölbel T, Mani K, Melissano G, Powell JT, Trimarchi S, Tsilimparis N, Antoniou GA, Björck M, Coscas R, Dias NV, Kolh P, Lepidi S, Mees BME, Resch TA, Ricco JB, Tulamo R, Twine CP, Branzan D, Cheng SWK, Dalman RL, Dick F, Golledge J, Haulon S, van Herwaarden JA, Ilic NS, Jawien A, Mastracci TM, Oderich GS, Verzini F, Yeung KK. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2024; 67:192-331. [PMID: 38307694 DOI: 10.1016/j.ejvs.2023.11.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with aneurysms of the abdominal aorta and iliac arteries in succession to the 2011 and 2019 versions, with the aim of assisting physicians and patients in selecting the best management strategy. METHODS The guideline is based on scientific evidence completed with expert opinion on the matter. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to a modified European Society of Cardiology grading system, where the strength (class) of each recommendation is graded from I to III and the letters A to C mark the level of evidence. RESULTS A total of 160 recommendations have been issued on the following topics: Service standards, including surgical volume and training; Epidemiology, diagnosis, and screening; Management of patients with small abdominal aortic aneurysm (AAA), including surveillance, cardiovascular risk reduction, and indication for repair; Elective AAA repair, including operative risk assessment, open and endovascular repair, and early complications; Ruptured and symptomatic AAA, including peri-operative management, such as permissive hypotension and use of aortic occlusion balloon, open and endovascular repair, and early complications, such as abdominal compartment syndrome and colonic ischaemia; Long term outcome and follow up after AAA repair, including graft infection, endoleaks and follow up routines; Management of complex AAA, including open and endovascular repair; Management of iliac artery aneurysm, including indication for repair and open and endovascular repair; and Miscellaneous aortic problems, including mycotic, inflammatory, and saccular aortic aneurysm. In addition, Shared decision making is being addressed, with supporting information for patients, and Unresolved issues are discussed. CONCLUSION The ESVS Clinical Practice Guidelines provide the most comprehensive, up to date, and unbiased advice to clinicians and patients on the management of abdominal aorto-iliac artery aneurysms.
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19
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Revathi T, Balasubramaniam S, Sureshkumar V, Dhanasekaran S. An Improved Long Short-Term Memory Algorithm for Cardiovascular Disease Prediction. Diagnostics (Basel) 2024; 14:239. [PMID: 38337755 PMCID: PMC10855367 DOI: 10.3390/diagnostics14030239] [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: 11/21/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 02/12/2024] Open
Abstract
Cardiovascular diseases, prevalent as leading health concerns, demand early diagnosis for effective risk prevention. Despite numerous diagnostic models, challenges persist in network configuration and performance degradation, impacting model accuracy. In response, this paper introduces the Optimally Configured and Improved Long Short-Term Memory (OCI-LSTM) model as a robust solution. Leveraging the Salp Swarm Algorithm, irrelevant features are systematically eliminated, and the Genetic Algorithm is employed to optimize the LSTM's network configuration. Validation metrics, including the accuracy, sensitivity, specificity, and F1 score, affirm the model's efficacy. Comparative analysis with a Deep Neural Network and Deep Belief Network establishes the OCI-LSTM's superiority, showcasing a notable accuracy increase of 97.11%. These advancements position the OCI-LSTM as a promising model for accurate and efficient early diagnosis of cardiovascular diseases. Future research could explore real-world implementation and further refinement for seamless integration into clinical practice.
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Affiliation(s)
- T.K. Revathi
- Department of Computer Science and Engineering, Sona College of Technology, Salem 636005, India;
| | | | - Vidhushavarshini Sureshkumar
- Department of Computer Science and Engineering, Faculty of Engineering and Technology, SRM Institute of Science and Technology, Vadapalani Campus, Chennai 600026, India;
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20
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Sephien A, Dayto DC, Reljic T, Katz JN, Lenneman AJ, Prida X, Joly JM, Kumar A. Efficacy of Decision Aids in The Use of Left Ventricular Assist Device in Patients With Advanced Heart Failure: A Systematic Review and Meta-Analysis of Randomized Control Trials. Am J Cardiol 2024; 211:255-258. [PMID: 37979637 DOI: 10.1016/j.amjcard.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/02/2023] [Accepted: 11/11/2023] [Indexed: 11/20/2023]
Abstract
Although left ventricular assist device (LVAD) implantation can improve survival in patients with end-stage heart failure, it is not without risk. Numerous complications are possible, and durable support requires substantial lifestyle changes. The use of various knowledge-assessment tools may allow for more informed patient decisions. To synthesize the totality of the evidence, we conducted a systematic review and meta-analysis to summarize the efficacy of decision aid (DA) use in patients with advanced heart failure who are eligible for LVAD. Any randomized controlled trial (RCT) evaluating the efficacy of DAs in patients considering LVAD was eligible for inclusion. A complete search of EMBASE and PubMed was conducted from the start until June 8, 2023. The primary outcome was patients' LVAD knowledge. Data extraction was performed independently by 2 reviewers. Data were pooled using a random-effects model. Of the 575 references, 2 RCTs randomizing 490 patients were included in this study. DAs were associated with no significant change in LVAD knowledge (standardized mean difference 0.07, 95% confidence interval -0.24 to 0.39, p = 0.64) or decisional conflict (mean difference -1.48, 95% confidence interval -5.28 to 2.32, p = 0.45). The certainty of the evidence ranged from moderate to very low. The use of DAs in LVAD-eligible patients with advanced heart failure resulted in no difference in patients' knowledge of LVAD after LVAD education. The findings from this study will aid in the power analysis of a well-designed RCT to evaluate and encourage further investigation into the efficacy and relevance of DAs in preparing patients for a life with LVAD.
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Affiliation(s)
- Andrew Sephien
- Division of Cardiovascular Disease, Section of Advanced Heart Failure and Transplantation, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Denisse Camille Dayto
- Department of Internal Medicine, HCA Healthcare/USF Morsani GME Consortium: HCA Florida Citrus Hospital, Inverness, Florida
| | - Tea Reljic
- Department of Internal Medicine, Research Methodology and Biostatistics Core, Office of Research
| | - Jason N Katz
- Division of Cardiology, NYU Grossman School of Medicine, New York, New York
| | - Andrew J Lenneman
- Division of Cardiovascular Disease, Section of Advanced Heart Failure and Transplantation, University of Alabama at Birmingham, Birmingham, Alabama
| | - Xavier Prida
- Division of Cardiovascular Sciences, University of South Florida, Tampa, Florida
| | - Joanna M Joly
- Division of Cardiovascular Disease, Section of Advanced Heart Failure and Transplantation, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ambuj Kumar
- Department of Internal Medicine, Research Methodology and Biostatistics Core, Office of Research
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21
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Ventoulis I, Kamperidis V, Abraham MR, Abraham T, Boultadakis A, Tsioukras E, Katsiana A, Georgiou K, Parissis J, Polyzogopoulou E. Differences in Health-Related Quality of Life among Patients with Heart Failure. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:109. [PMID: 38256370 PMCID: PMC10818915 DOI: 10.3390/medicina60010109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Heart failure (HF) is characterized by a progressive clinical course marked by frequent exacerbations and repeated hospitalizations, leading to considerably high morbidity and mortality rates. Patients with HF present with a constellation of bothersome symptoms, which range from physical to psychological and mental manifestations. With the transition to more advanced HF stages, symptoms become increasingly more debilitating, interfere with activities of daily living and disrupt multiple domains of life, including physical functioning, psychological status, emotional state, cognitive function, intimate relationships, lifestyle status, usual role activities, social contact and support. By inflicting profuse limitations in numerous aspects of life, HF exerts a profoundly negative impact on health-related quality of life (HRQOL). It is therefore not surprising that patients with HF display lower levels of HRQOL compared not only to the general healthy population but also to patients suffering from other chronic diseases. On top of this, poor HRQOL in patients with HF becomes an even greater concern considering that it has been associated with unfavorable long-term outcomes and poor prognosis. Nevertheless, HRQOL may differ significantly among patients with HF. Indeed, it has consistently been reported that women with HF display poorer HRQOL compared to men, while younger patients with HF tend to exhibit lower levels of HRQOL than their older counterparts. Moreover, patients presenting with higher New York Heart Association (NYHA) functional class (III-IV) have significantly more impaired HRQOL than those in a better NYHA class (I-II). Furthermore, most studies report worse levels of HRQOL in patients suffering from HF with preserved ejection fraction (HFpEF) compared to patients with HF with reduced ejection fraction (HFrEF) or HF with mildly reduced ejection fraction (HFmrEF). Last, but not least, differences in HRQOL have been noted depending on geographic location, with lower HRQOL levels having been recorded in Africa and Eastern Europe and higher in Western Europe in a recent large global study. Based on the observed disparities that have been invariably reported in the literature, this review article aims to provide insight into the underlying differences in HRQOL among patients with HF. Through an overview of currently existing evidence, fundamental differences in HRQOL among patients with HF are analyzed based on sex, age, NYHA functional class, ejection fraction and geographic location or ethnicity.
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Affiliation(s)
- Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - Vasileios Kamperidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St Kiriakidi 1, 54636 Thessaloniki, Greece;
| | - Maria Roselle Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, University of California, San Francisco, CA 94117, USA; (M.R.A.); (T.A.)
| | - Theodore Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, University of California, San Francisco, CA 94117, USA; (M.R.A.); (T.A.)
| | - Antonios Boultadakis
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece; (A.B.); (J.P.); (E.P.)
| | - Efthymios Tsioukras
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - Aikaterini Katsiana
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - Konstantinos Georgiou
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, 50200 Ptolemaida, Greece; (E.T.); (A.K.); (K.G.)
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece; (A.B.); (J.P.); (E.P.)
| | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece; (A.B.); (J.P.); (E.P.)
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22
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McClung JA, Frishman WH, Aronow WS. The Role of Palliative Care in Cardiovascular Disease. Cardiol Rev 2024:00045415-990000000-00182. [PMID: 38169299 DOI: 10.1097/crd.0000000000000634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The American Heart Association has recommended that palliative care be integrated into the care of all patients with advanced cardiac illnesses. Notwithstanding, the number of patients receiving specialist palliative intervention worldwide remains extremely small. This review examines the nature of palliative care and what is known about its delivery to patients with cardiac illness. Most of the published literature on the subject concern advanced heart failure; however, some data also exist regarding patients with heart transplantation, pulmonary hypertension, valvular disease, congenital heart disease, indwelling devices, mechanical circulatory support, and advanced coronary disease. In addition, outcome data, certification requirements, workforce challenges, barriers to implementation, and a potential caveat about palliative care will also be examined. Further work is required regarding appropriate means of implementation, quality control, and timing of intervention.
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Affiliation(s)
- John Arthur McClung
- From the Departments of Cardiology and Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
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Rivera FB, Choi S, Carado GP, Adizas AV, Bantayan NRB, Loyola GJP, Cha SW, Aparece JP, Rocha AJB, Placino S, Ansay MFM, Mangubat GFE, Mahilum MLP, Al-Abcha A, Suleman N, Shah N, Suboc TMB, Volgman AS. End-Of-Life Care for Patients With End-Stage Heart Failure, Comparisons of International Guidelines. Am J Hosp Palliat Care 2024; 41:87-98. [PMID: 36705612 DOI: 10.1177/10499091231154575] [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] [Indexed: 01/28/2023] Open
Abstract
Heart failure (HF) is a chronic, debilitating condition associated with significant morbidity, mortality, and socioeconomic burden. Patients with end-stage HF (ESHF) who are not a candidate for advanced therapies will continue to progress despite standard medical therapy. Thus, the focus of care shifts from prolonging life to controlling symptoms and improving quality of life through palliative care (PC). Because the condition and prognosis of HF patients evolve and can rapidly deteriorate, it is imperative to begin the discussion on end-of-life (EOL) issues early during HF management. These include the completion of an advance directive, do-not-resuscitate orders, and policies on device therapy and discontinuation as part of advance care planning (ACP). ESHF patients who do not have indications for advanced therapies or those who wish not to have a left ventricular assist device (LVAD) or heart transplant (HT) often experience high symptom burden despite adequate medical management. The proper identification and assessment of symptoms such as pain, dyspnea, nausea, depression, and anxiety are essential to the management of ESHF and may be underdiagnosed and undertreated. Psychological support and spiritual care are also crucial to improving the quality of life during EOL. Caregivers of ESHF patients must also be provided supportive care to prevent compassion fatigue and improve resilience in patient care. In this narrative review, we compare the international guidelines and provide an overview of end-of-life and palliative care for patients with ESHF.
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Affiliation(s)
| | - Sarang Choi
- Ateneo de Manila School of Medicine and Public Health, Pasig City, Philippines
| | - Genquen Philip Carado
- University of the East Ramon Magsaysay Memorial Medical Center, Inc, Quezon City, Philippines
| | - Arcel V Adizas
- University of the Philippines-Philippine General Hospital, Manila, Philippines
| | | | | | | | | | | | - Siena Placino
- St Luke's Medical Center College of Medicine, William H. Quasha Memorial, Manila, Philippines
| | | | | | | | - Abdullah Al-Abcha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Natasha Suleman
- Department of Palliative Care, Lincoln Medical Center, Bronx, NY, USA
| | - Nishant Shah
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
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24
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Grady KL, Kallen MA, Beiser DG, Lindenfeld J, Teuteberg J, Allen LA, McIlvennan CK, Rich J, Yancy C, Lee CS, Denfeld QE, Kiernan M, Walsh MN, Adler E, Ruo B, Stehlik J, Kirklin JK, Bedjeti K, Cella D, Hahn EA. Novel measures to assess ventricular assist device patient-reported outcomes: Findings from the MCS A-QOL study. J Heart Lung Transplant 2024; 43:36-50. [PMID: 37591454 PMCID: PMC10867283 DOI: 10.1016/j.healun.2023.08.007] [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: 03/09/2023] [Revised: 07/24/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Generic and heart failure-specific measures do not capture unique aspects of living with a ventricular assist device (VAD). Using state-of-the-science psychometric measurement methods, we developed a measurement system to assess post-ventricular assist device adjustment and health-related quality of life (HRQOL). METHODS Patients were recruited from 10/26/16-2/29/20 from 12 U.S. VAD programs. We created a dataset of participants (n = 620) enrolled before left (L)VAD implantation, with data at 3- or 6- months post-implantation (group1 [n = 154]), and participants enrolled after LVAD implantation, with data at one timepoint (group 2 [n = 466]). We constructed 5 item banks: 3 modified from existing measures and 2 new measures. Analyses included item response theory (IRT) modeling, differential item functioning tests for systematic measurement bias, and indicators of reliability and validity. RESULTS Of 620 participants, 56% (n = 345) were implanted as destination therapy, 51% (n = 316) were <12 months post-implantation, mean age = 57.3 years, 78% (n = 485) male, 70% (n = 433) White, 58% (n = 353) married/partnered, and 58% (n = 357) with >high school education. We developed 5 new VAD item banks/measures: 6-item VAD Team Communication; 12-item Self-efficacy Regarding VAD Self-care; 11-item Being Bothered by VAD Self-care and Limitations; 7-item Satisfaction with Treatment; and 11-item Stigma. Cronbach's alpha reliability ranged from good (≥0.80) to excellent (≥0.90) for item banks/measures. All measures, except VAD Team Communication, demonstrated at least moderate correlations (≥0.30) with construct validity indicators. CONCLUSIONS These measures meet IRT modeling assumptions and requirements; scores demonstrate reliability and validity. Use of these measures may assist VAD clinicians to inform patients about VADs as a treatment option and guide post-VAD interventions.
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Affiliation(s)
- Kathleen L Grady
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
| | - Michael A Kallen
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - David G Beiser
- Section of Emergency Medicine, University of Chicago, Chicago, Illinois
| | - JoAnn Lindenfeld
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | | | - Larry A Allen
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Colleen K McIlvennan
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Jonathan Rich
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Clyde Yancy
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | | | - Quin E Denfeld
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Michael Kiernan
- Department of Medicine, Tufts University, Boston, Massachusetts
| | | | - Eric Adler
- Department of Medicine, University of California-San Diego, La Jolla, California
| | - Bernice Ruo
- Department of Medicine, University of California-San Diego, La Jolla, California
| | - Josef Stehlik
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | | | - Katy Bedjeti
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Dave Cella
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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25
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Zaidi D, Kirkpatrick JN, Fedson SE, Hull SC. Deactivation of Left Ventricular Assist Devices at the End of Life: Narrative Review and Ethical Framework. JACC. HEART FAILURE 2023; 11:1481-1490. [PMID: 37768252 DOI: 10.1016/j.jchf.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/06/2023] [Accepted: 08/08/2023] [Indexed: 09/29/2023]
Abstract
Left ventricular assist devices (LVADs) have become an increasingly common advanced therapy in patients with severe symptomatic heart failure. Their unique nature in prolonging life through incorporation into the circulatory system raises ethical questions regarding patient identity and values, device ontology, and treatment categorization; approaching requests for LVAD deactivation requires consideration of these factors, among others. To that end, clinicians would benefit from a deeper understanding of: 1) the history and nature of LVADs; 2) the wider context of device deactivation and associated ethical considerations; and 3) an introductory framework incorporating best practices in requests for LVAD deactivation (specifically in controversial situations without obvious medical or device-related complications). In such decisions, heart failure teams can safeguard patient preferences without compromising ethical practice through more explicit advance care planning before LVAD implantation, early integration of hospice and palliative medicine specialists (maintained throughout the disease process), and further research interrogating behaviors and attitudes related to LVAD deactivation.
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Affiliation(s)
- Danish Zaidi
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - James N Kirkpatrick
- Division of Cardiology, University of Washington, Seattle, Washington, USA; Department of Bioethics and Humanities, University of Washington, Seattle, Washington, USA
| | - Savitri E Fedson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA; Department of Medicine, Michael E DeBakey VA Medical Center, Houston, Texas, USA
| | - Sarah C Hull
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Program for Biomedical Ethics, Yale School of Medicine, New Haven, Connecticut, USA.
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26
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Page RL, Chow SL. Polypharmacy and the Clinical Inertia Conundrum for GDMT. JACC. HEART FAILURE 2023; 11:1518-1520. [PMID: 37768247 DOI: 10.1016/j.jchf.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/26/2023] [Accepted: 08/11/2023] [Indexed: 09/29/2023]
Affiliation(s)
- Robert L Page
- Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
| | - Sheryl L Chow
- Department of Pharmacy Practice and Administration, Western University of Health Sciences, College of Pharmacy, Pomona, California, USA; Department of Medicine, Division of Cardiology, University of California, Irvine Medical Center, Orange, California, USA.
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27
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Mewton N, Donal E, Picard F, Derimay F, Grinberg D, Boulch DM, Bochaton T, Piriou N, De Lorgeril A, Samson G, Rouleau F, Riche B, Trochu JN. Prognostic impact of precipitated cardiac decompensation in symptomatic heart failure with reduced ejection fraction and severe secondary mitral regurgitation. Am Heart J 2023; 265:83-91. [PMID: 37271359 DOI: 10.1016/j.ahj.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 05/19/2023] [Accepted: 05/28/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Our aim was to assess the distribution of primary (with no trigger) and secondary (with a decompensation trigger) heart failure events in a severe heart failure population and their association with 2-year all-cause mortality in the Mitra.Fr study. METHODS We included 304 patients with symptomatic heart failure, and severe mitral regurgitation and guideline directed medical therapy randomized to medical therapy alone or medical therapy with percutaneous mitral valve repair. According to the follow-up, we defined 3 categories of events: follow-up without any heart failure event, at least 1 decompensation starting with a primary heart failure decompensation or starting with a precipitated secondary heart failure event. The primary outcome was 2-years all-cause mortality. RESULTS A total of 179 patients (59 %) had at least 1 heart failure decompensation within 24-months of follow-up. 129 heart failure decompensations (72%) were a first primary heart failure and 50 (28%) were a first secondary decompensation. Finally, 30 patients had both types of decompensations but these were not taken into account for the comparison of primary and secondary decompensations. Primary decompensations were 3-times more frequent than secondary decompensations, but the mean number of heart failure decompensations was similar in the "Primary heart failure group" compared to the "Secondary heart failure group": (1.94 ± 1.39 vs 1.80 ± 1.07 respectively; P = .480). Compared to patients without heart failure decompensation, patients with "Only primary decompensation" or with "Only secondary decompensation" had a significantly increased risk of death (HR = 4.87, 95% CI [2.86, 8.32] and 2.68 95%CI [1.64, 4.37] respectively). All-cause mortality, was not significantly different between these 2 type of decompensations (HR = 1.82, 95% CI [0.93, 3.58]; P = .082), but each additional heart failure recurrence was associated with a significant increase in mortality risk (HR = 1.27, 95% CI [1.08; 1.50]; P = .005). CONCLUSIONS In heart failure with reduced ejection fraction and severe secondary mitral regurgitation patients, primary heart failure decompensations were 3-times more frequent compared to precipitated decompensations with a nonsignificant trend in increased risk of all-cause mortality. Our results fail to support the differentiation between primary and secondary decompensations as they seem to portend the same outcome impact.
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Affiliation(s)
- Nathan Mewton
- Heart Failure Department, Centre d'Investigation Clinique, Inserm 1407, CarMeN Inserm 1060, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France.
| | - Erwan Donal
- Cardiology Department, Hospital University Rennes, LTSI UMR1099, INSERM, Rennes, France
| | - François Picard
- Heart Failure Department, Aquitaine Expert Center for Primary Pulmonary Hypertension, University Hospital Bordeaux, Bordeaux, France
| | - François Derimay
- Heart Failure Department, Centre d'Investigation Clinique, Inserm 1407, CarMeN Inserm 1060, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Daniel Grinberg
- Cardiac Surgery Department, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Delphine Maucort Boulch
- Biostatistics Department, Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, F-69003, Lyon, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Lyon, France
| | - Thomas Bochaton
- Heart Failure Department, Centre d'Investigation Clinique, Inserm 1407, CarMeN Inserm 1060, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Piriou
- Cardiology Department, Clinique cardiologique et des maladies vasculaires Pôle hospitalo-universitaire institut du thorax et du système nerveux CIC INSERM 1413 - Institut du Thorax- UMR INSERM 1087 Université de Nantes, Nantes, France
| | - Amélie De Lorgeril
- Heart Failure Department, Centre d'Investigation Clinique, Inserm 1407, CarMeN Inserm 1060, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Geraldine Samson
- Heart Failure Department, Centre d'Investigation Clinique, Inserm 1407, CarMeN Inserm 1060, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Rouleau
- Cardiology department, University Hospital Angers, Angers, France
| | - Benjamin Riche
- Biostatistics Department, Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, F-69003, Lyon, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Lyon, France
| | - Jean Noël Trochu
- Cardiology Department, Clinique cardiologique et des maladies vasculaires Pôle hospitalo-universitaire institut du thorax et du système nerveux CIC INSERM 1413 - Institut du Thorax- UMR INSERM 1087 Université de Nantes, Nantes, France
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Sekine O, Kitakata H, Kohsaka S, Fujisawa D, Nakano N, Shiraishi Y, Kishino Y, Katsumata Y, Yuasa S, Fukuda K, Kohno T. Perspectives of hospitalized heart failure patients: preferred and perceived participation roles in treatment decisions. Heart Vessels 2023; 38:1244-1255. [PMID: 37264250 DOI: 10.1007/s00380-023-02275-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 05/24/2023] [Indexed: 06/03/2023]
Abstract
Shared decision-making (SDM) is a pivotal process in seeking optimal individual treatment and incorporating clinical evidence and patients' autonomous preferences. However, patients' actual attitudes toward participation in decision-making for state-of-the-art heart failure (HF) treatment remain unclear. We conducted a questionnaire-based survey distributed by nurses and physicians specializing in HF care to assess patients' preferred and perceived participation roles in treatment decision-making during the index hospitalization, rated on five scales (from extremely passive to purely autonomous attitudes). Simultaneously, we investigated the important factors underlying treatment decision-making from the perspective of hospitalized HF patients. Of the 202 patients who were approached by our multidisciplinary HF team between 2017 and 2020, 166 (82.2%) completed the survey. Logistic regression analyses were conducted to identify the clinical determinants of patients who reported that they left all decisions to physicians (i.e., extremely passive attitude). Of the 166 participants (male 67.5%, median age 73 years), 32.5% preferred an extremely passive attitude, while 61.4% reported that they actually chose an extremely passive attitude. A sole determinant of choosing an extremely passive decision-making role was lower educational status (odds ratio: 2.11, 95% confidence interval 1.11-4.00). The most important factor underlying the decision-making was "Physician recommendation" (89.2%). Notably, less than 50% considered "In alignment with my values and preferences" as an important factor underlying treatment decision-making. The majority of HF patients reported that they chose an extremely passive approach, and patients prioritized physician recommendation over their own values and preferences.
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Affiliation(s)
- Otoya Sekine
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Hiroki Kitakata
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Naomi Nakano
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yoshikazu Kishino
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yoshinori Katsumata
- Institute for Integrated Sports Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Takashi Kohno
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
- Department of Cardiovascular Medicine, Faculty of Medicine, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
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Ozdemir S, Lee JJ, Yeo KK, Sim KLD, Finkelstein EA, Malhotra C. A Prospective Cohort Study of Medical Decision-Making Roles and Their Associations with Patient Characteristics and Patient-Reported Outcomes among Patients with Heart Failure. Med Decis Making 2023; 43:863-874. [PMID: 37767897 DOI: 10.1177/0272989x231201609] [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] [Indexed: 09/29/2023]
Abstract
OBJECTIVE Among patients with heart failure (HF), we examined 1) the evolution of patient involvement in decision making over 2 y, 2) the association of patient characteristics with decision-making roles, and 3) the association of decision-making roles with distress, spiritual well-being, and quality of physician communication. METHODS We administered the survey every 4 mo over 24 mo to patients with New York Heart Association class 3/4 symptoms recruited from inpatient clinics. The decision-making roles were categorized as no patient involvement, physician/family-led, joint (with family and/or physicians), patient-led, or patient-alone decision making. The associations between patient characteristics and decision-making roles were assessed using a mixed-effects ordered logistic regression, whereas those between patient outcomes and decision-making roles were investigated using mixed-effects linear regressions. RESULTS Of the 557 patients invited, 251 participated in the study. The most common roles in decision making at baseline assessment were "no involvement" (27.53%) and "patient-alone decision making" (25.10%). The proportions of different decision-making roles did not change over 2 y (P = 0.37). Older age (odds ratio [OR] = 0.97; P = 0.003) and being married (OR = 0.63; P = 0.035) were associated with lower involvement in decision making. Chinese ethnicity (OR = 1.91; P = 0.003), higher education (OR = 1.87; P = 0.003), awareness of terminal condition (OR = 2.00; P < 0.001), and adequate self-care confidence (OR = 1.74; P < 0.001) were associated with greater involvement. Compared with no patient involvement, joint (β = -0.58; P = 0.026) and patient-led (β = -0.59; P = 0.014) decision making were associated with lower distress, while family/physician-led (β = 4.37; P = 0.001), joint (β = 3.86; P < 0.001), patient-led (β = 3.46; P < 0.001), and patient-alone (β = 3.99; P < 0.001) decision making were associated with better spiritual well-being. CONCLUSION A substantial proportion of patients was not involved in decision making. Patients should be encouraged to participate in decision making since it is associated with lower distress and better spiritual well-being. HIGHLIGHTS The level of involvement in medical decision making did not change over time among patients with heart failure. A substantial proportion of patients were not involved in decision making throughout the 24-mo study period.Patients' involvement in decision making varied by age, ethnicity, education level, marital status, awareness of the terminal condition, and confidence in self-care.Compared with no patient involvement in decision making, joint and patient-led decision making were associated with lower distress, and any level of patient involvement in decision making was associated with better spiritual well-being.
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Affiliation(s)
- Semra Ozdemir
- Signature Program in Health Services and Systems Research, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
- Department of Population Health Sciences, Duke Clinical Research Institute, Duke University, USA
| | - Jia Jia Lee
- Research Associate, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | | | | | - Eric Andrew Finkelstein
- Signature Program in Health Services and Systems Research, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Duke Global Health Institute, Duke University, USA
| | - Chetna Malhotra
- Signature Program in Health Services and Systems Research, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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31
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Walenczyk KM, Cavanagh CE, Skanderson M, Feder SL, Soliman AA, Justice A, Burg MM, Akgün KM. Advance directive screening among veterans with incident heart failure: Comparisons among people aging with and without HIV. Heart Lung 2023; 61:1-7. [PMID: 37023581 PMCID: PMC10524135 DOI: 10.1016/j.hrtlng.2023.03.018] [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: 12/27/2022] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Heart failure (HF) is common among people aging with HIV (PWH) and without HIV (PWoH). Despite the poor prognosis for HF, advance directives (AD) completion is low but has not been compared among PWH and PWoH. OBJECTIVES Determine the prevalence and predictors of AD screening among PWH and PWoH with incident HF. METHODS We included Veterans with an incident HF diagnosis code from 2013-2018 in the Veterans Aging Cohort Study (VACS) without prior AD screening. Health records were reviewed for AD screening note titles within -30 days to 1-year post-HF diagnosis. Analyses were stratified by HIV status. Trends in annual AD screening were evaluated with the Cochran-Mantel-Haenszel test. The associations of AD screening with demographics, disease severity (Charlson Comorbidity Index, VACS 2.0 Index), and healthcare encounters (cardiology, palliative care, hospitalization) were evaluated with Cox proportional hazards regression. RESULTS HF was diagnosed in 4516 Veterans (28.2% PWH, 71.8% PWoH). Annual AD screening rates increased in both groups (Ptrend<0.0001) and aggregate rates were higher among PWH than PWoH (53.5% vs. 48.2%, p=.001). In both groups, the likelihood of AD screening increased with greater disease severity, palliative care contact, and hospitalization (HR range=1.04-3.32, all p≤.02) but not with cardiology contact (p≥.53). CONCLUSIONS AD screening rates after incident HF remain suboptimal but increased over time and were higher in PWH. Future quality improvement and implementation efforts should aim for universal AD screening with incident HF diagnosis, initiated by providers skilled in discussing AD, including in the cardiology subspecialty setting.
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Affiliation(s)
- Kristie M Walenczyk
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Cardiology, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Casey E Cavanagh
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Shelli L Feder
- Medicine Service, VA Connecticut Healthcare System, West Haven, CT, USA; Yale School of Nursing, New Haven, CT, USA
| | - Ann A Soliman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Medicine Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Amy Justice
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Medicine Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Matthew M Burg
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Cardiology, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Kathleen M Akgün
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Medicine Service, VA Connecticut Healthcare System, West Haven, CT, USA
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Fraser M, McIlvennan CK, Joseph N, Alexy T. From the Other Side of the Exam Room: Using the New Universal Definition and Classification of Heart Failure to Engage Patients and Caregivers. J Card Fail 2023; 29:1338-1339. [PMID: 35158024 DOI: 10.1016/j.cardfail.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/29/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Meg Fraser
- University of Minnesota, Minneapolis, Minnesota
| | | | | | - Tamas Alexy
- University of Minnesota, Minneapolis, Minnesota.
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Haywood HB, Sauer AJ, Allen LA, Albert NM, Devore AD. The Promise and Risks of mHealth in Heart Failure Care. J Card Fail 2023; 29:1298-1310. [PMID: 37479053 DOI: 10.1016/j.cardfail.2023.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/04/2023] [Accepted: 07/01/2023] [Indexed: 07/23/2023]
Abstract
Mobile health (mHealth) is an emerging approach to health care. It involves wearable, connected technologies that facilitate patient-symptom or physiological monitoring, support clinical feedback to patients and physicians, and promote patients' education and self-care. Evolving algorithms may involve artificial intelligence and can assist in data aggregation and health care teams' interpretations. Ultimately, the goal is not merely to collect data; rather, it is to increase actionability. mHealth technology holds particular promise for patients with heart failure, especially those with frequently changing clinical status. mHealth, ideally, can identify care opportunities, anticipate clinical courses and augment providers' capacity to implement, titrate and monitor interventions safely, including evidence-based therapies. Although there have been marked advancements in the past decade, uncertainties remain for mHealth, including questions regarding optimal indications and acceptable payment models. In regard to mHealth capability, a better understanding is needed of the incremental benefit of mHealth data over usual care, the accuracy of specific mHealth data points in making clinical care decisions, and the efficiency and precision of algorithms used to dictate actions. Importantly, emerging regulations in the wake of COVID-19, and now the end of the federal public health emergency, offer both opportunity and risks to the broader adoption of mHealth-enabled services. In this review, we explore the current state of mHealth in heart failure, with particular attention to the opportunities and challenges this technology creates for patients, health care providers and other stakeholders.
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Affiliation(s)
- Hubert B Haywood
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Andrew J Sauer
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | - Larry A Allen
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| | - Nancy M Albert
- Nursing Institute and Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, OH
| | - Adam D Devore
- Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
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Rosca A, Karzig-Roduner I, Kasper J, Rogger N, Drewniak D, Krones T. Shared decision making and advance care planning: a systematic literature review and novel decision-making model. BMC Med Ethics 2023; 24:64. [PMID: 37580704 PMCID: PMC10426137 DOI: 10.1186/s12910-023-00944-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/02/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND AND AIMS Shared decision making (SDM) and advance care planning (ACP) are important evidence and ethics based concepts that can be translated in communication tools to aid the treatment decision-making process. Although both have been recommended in the care of patients with risks of complications, they have not yet been described as two components of one single process. In this paper we aim to (1) assess how SDM and ACP is being applied, choosing patients with aortic stenosis with high and moderate treatment complication risks such as bleeding or stroke as an example, and (2) propose a model to best combine the two concepts and integrate them in the care process. METHODS In order to assess how SDM and ACP is applied in usual care, we have performed a systematic literature review. The included studies have been analysed by means of thematic analysis as well as abductive reasoning to determine which SDM and ACP steps are applied as well as to propose a model of combining the two concepts into one process. RESULTS The search in Medline, Cinahl, Embase, Scopus, Web of science, Psychinfo and Cochrane revealed 15 studies. Eleven describe various steps of SDM while four studies discuss the documentation of goals of care. Based on the review results and existing evidence we propose a model that combines SDM and ACP in one process for a complete patient informed choice. CONCLUSION To be able to make informed choices about immediate and future care, patients should be engaged in both SDM and ACP decision-making processes. This allows for an iterative process in which each important decision-maker can share their expertise and concerns regarding the care planning and advance care planning. This would help to better structure and prioritize information while creating a trustful and respectful relationship between the participants. PROSPERO 2019. CRD42019124575.
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Affiliation(s)
- Ana Rosca
- Clinical ethics, Stadtspital Zürich, Birmensdorferstrasse 497, Zürich, 8063, Switzerland.
| | - Isabelle Karzig-Roduner
- Institute of Biomedical Ethics and History of Medicine, Clinical Ethics, University of Zürich, University Hospital Zürich, Zürich, Switzerland
| | - Jürgen Kasper
- Department of Nursing and Health Promotion, Oslo metropolitan Universita, Oslo, Norway
| | - Niek Rogger
- University of Applied Sciences Leiden, Leiden, Netherlands
| | - Daniel Drewniak
- Institute of Biomedical Ethics and History of Medicine, University of Zürich, Zürich, Switzerland
| | - Tanja Krones
- Institute of Biomedical Ethics and History of Medicine, Clinical Ethics, University of Zürich, University Hospital Zürich, Zürich, Switzerland
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Bhattacharya A, Chakrabarty S, Cabrales J, VanHorn A, Lemoine J, Tsao L, Jaber BL. Implementation of a palliative care consultation trigger tool for hospitalised patients with acute decompensated heart failure. BMJ Open Qual 2023; 12:e002330. [PMID: 37597855 PMCID: PMC10441042 DOI: 10.1136/bmjoq-2023-002330] [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: 02/28/2023] [Accepted: 07/28/2023] [Indexed: 08/21/2023] Open
Abstract
Heart failure is a leading cause of hospitalisations. Integration of palliative care services with medical therapy in the management of hospitalised patients with heart failure is imperative. Unfortunately, there are no standardised criteria for palliative care referrals among hospitalised patients with acute decompensated heart failure. The objective of our quality improvement project was to develop and implement a palliative care consult trigger tool for hospitalised patients with acute decompensated heart failure. We found that among eligible patients, palliative care referrals were underused, likely contributing to misalignment of goals of care and suboptimal advance care planning. We developed a trigger tool and designed and implemented structured multicomponent educational interventions to improve the appropriateness and timeliness of inpatient palliative care consultations in this high-risk population. The educational interventions led to a significant increase in the rate of appropriate inpatient palliative care consultations among hospitalised patients with acute decompensated heart failure (46.3% vs 27.7%; p=0.02). In addition, palliative care referrals resulted in better alignment of goals of care at the time of hospital discharge, as measured by a significant increase in the completion rate of a healthcare proxy form (11.4% vs 47.2%; p<0.001) and a Medical Order for Life-Sustaining Treatment form (2.0% vs 24.1%; p<0.001), as well as the establishment of a Do-Not-Resuscitate order (2.7% vs 29.6%; p<0.001). Furthermore, the intervention resulted in a significant decrease in the hospital readmission rate up to 90 days post-discharge (43.6% vs 8.3%; p<0.001). This quality improvement project calls for the development and adoption of standardised criteria for palliative care referrals to benefit hospitalised patients with heart failure and reduce symptom burden, align goals of care and improve quality of life.
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Affiliation(s)
- Adhiraj Bhattacharya
- Department of Medicine, Saint Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Satyaki Chakrabarty
- Division of Nephrology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts, USA
| | - Jose Cabrales
- Division of Nephrology, Stanford University, Stanford, California, USA
| | - Alixis VanHorn
- Palliative Care Service, Saint Elizabeth's Medical Center, Boston, Massachusetts, USA
| | - Jaclyn Lemoine
- Division of Cardiovascular Medicine, Saint Elizabeth's Medical Center, Boston, Massachusetts, USA
| | - Lana Tsao
- Division of Cardiovascular Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bertrand L Jaber
- Department of Medicine, Saint Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
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Gazaway S, Wells RD, Azuero A, Pisu M, Guastaferro K, Rini C, Taylor R, Reed RD, Harrell ER, Bechthold AC, Bratches RW, McKie P, Lowers J, Williams GR, Rosenberg AR, Bakitas MA, Kavalieratos D, Dionne-Odom JN. Decision support training for advanced cancer family caregivers: Study protocol for the CASCADE factorial trial. Contemp Clin Trials 2023; 131:107259. [PMID: 37286131 PMCID: PMC10527385 DOI: 10.1016/j.cct.2023.107259] [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: 03/27/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Patients with advanced cancer face numerous decisions when diagnosed and often receive decision support from family caregivers. The CASCADE (CAre Supporters Coached to be Adept DEcision partners) factorial trial intervention aims to train caregivers in skills to provide effective decision support to patients and identify most effective intervention components. METHODS This is a 2-site, single-blind, 24 factorial trial to test components of the CASCADE decision support training intervention for family caregivers of patients with newly-diagnosed advanced cancer delivered by specially-trained, telehealth, palliative care lay coaches over 24 weeks. Family caregivers (target N = 352) are randomly assigned to one of 16 combinations of four components with two levels each: 1) psychoeducation on effective decision partnering principles (1 vs. 3 sessions); 2) decision support communication training (1 session vs. none); 3) Ottawa Decision Guide training (1 session vs. none) and 4) monthly follow-up (1 call vs. calls for 24 weeks). The primary outcome is patient-reported decisional conflict at 24 weeks. Secondary outcomes include patient distress, healthcare utilization, caregiver distress, and quality of life. Mediators and moderators (e.g., sociodemographics, decision self-efficacy, social support) will be explored between intervention components and outcomes. Results will be used to build two versions of CASCADE: one with only effective components (d ≥ 0.30) and another optimized for scalability and cost. DISCUSSION This protocol describes the first factorial trial, informed by the multiphase optimization strategy, of a palliative care decision-support intervention for advanced cancer family caregivers and will address the field's need to identify effective components that support serious illness decision-making. TRIAL REGISTRATION NCT04803604.
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Affiliation(s)
- Shena Gazaway
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Rachel D Wells
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Maria Pisu
- Division of Preventive Medicine, UAB Heersink School of Medicine, Birmingham, AL, USA
| | - Kate Guastaferro
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, USA
| | - Christine Rini
- Cancer Survivorship Institute, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Richard Taylor
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Rhiannon D Reed
- Division of Transplantation, Department of Medicine, UAB, Birmingham, AL, USA
| | - Erin R Harrell
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Reed W Bratches
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Peg McKie
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Jane Lowers
- Division of Palliative Medicine, Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | | | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Department of Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
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JI RQ, WANG B, ZHANG JG, SU SH, LI L, YU Q, JIANG XY, FU X, FANG XH, MA XW, TIAN AX, LI J. Independent prognostic value of the congestion and renal index in patients with acute heart failure. J Geriatr Cardiol 2023; 20:516-526. [PMID: 37576479 PMCID: PMC10412541 DOI: 10.26599/1671-5411.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Clinical outcomes are poor if patients with acute heart failure (AHF) are discharged with residual congestion in the presence of renal dysfunction. However, there is no single indication to reflect the combined effects of the two related pathophysiological processes. We, therefore, proposed an indicator, congestion and renal index (CRI), and examined the associations between the CRI and one-year outcomes and the incremental prognostic value of CRI compared with the established scoring systems in a multicenter prospective cohort of AHF. METHODS We enrolled AHF patients and calculated the ratio of thoracic fluid content index divided by estimated glomerular filtration rate before discharge, as CRI. Then we examined the associations between CRI and one-year outcomes. RESULTS A total of 944 patients were included in the analysis (mean age 63.3 ± 13.8 years, 39.3% women). Compared with patients with CRI ≤ 0.59 mL/min per kΩ, those with CRI > 0.59 mL/min per kΩ had higher risks of cardiovascular death or HF hospitalization (HR = 1.56 [1.13-2.15]) and all-cause death or all-cause hospitalization (HR = 1.33 [1.01-1.74]). CRI had an incremental prognostic value compared with the established scoring system. CONCLUSIONS In patients with AHF, CRI is independently associated with the risk of death or hospitalization within one year, and improves the risk stratification of the established risk models.
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Affiliation(s)
- Run-Qing JI
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Bin WANG
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Jin-Guo ZHANG
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Shu-Hong SU
- Department of Cardiology, Xinxiang Central Hospital, Xinxiang, China
| | - Li LI
- Department of Cardiology, Shanxi Fenyang Hospital, Fenyang, China
| | - Qin YU
- Department of Cardiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Xian-Yan JIANG
- Heart Center, Qingdao Fuwai Cardiovascular Hospital, Qingdao, China
| | - Xin FU
- Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xue-Hua FANG
- Department of Cardiology, Beijing Liangxiang Hospital, Beijing, China
| | - Xiao-Wen MA
- Department of Cardiology, Qinyang People’s Hospital, Qinyang, China
| | - Ao-Xi TIAN
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Jing LI
- National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
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Inagaki N, Seto N, Lee K, Takahashi Y, Nakayama T, Hayashi Y. The role of critical care nurses in shared decision-making for patients with severe heart failure: A qualitative study. PLoS One 2023; 18:e0288978. [PMID: 37471342 PMCID: PMC10358911 DOI: 10.1371/journal.pone.0288978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023] Open
Abstract
AIM Patients with severe heart failure undergo highly invasive and advanced therapies with uncertain treatment outcomes. For these patients, shared decision-making is necessary. To date, the nursing perspective of the decision-making process for patients facing difficulties and how nurses can support patients in this process have not been fully elucidated. This study aimed to clarify the perceptions of critical care nurses regarding situations with patients with severe heart failure that require difficult decision-making, and their role in supporting these patients. METHODS Individual semi-structured interviews were conducted with 10 certified nurse specialists in critical care nursing at nine hospitals in Japan. A qualitative inductive method was used and the derived relationships among the themes were visually structured and represented. RESULTS The nurses' perceptions on patients' difficult situations in decision-making were identified as follows: painful decisions under uncertainties; tense relationships; wavering emotions during decision-making; difficulties in coping with worsening medical conditions; patients' wishes that are difficult to realize or estimate; and difficulties in transitioning from advanced medical care. Critical care nurses' roles were summarized into six themes and performed collaboratively within the nursing team. Of these, the search for meaning and value was fundamental. Two positions underpin the role of critical care nurses. The first aims to provide direct support and includes partnerships and rights advocacy. The second aims to provide a holistic perspective to enable necessary adjustments, as indicated by situation assessments and mediation. By crossing various boundaries, co-creating, and forming a good circular relationship in the search for meaning and values, the possibility of expanding treatment and recuperation options may be considered. CONCLUSIONS Patients with severe heart failure have difficulty participating in shared decision-making. Critical care nurses should collaborate within the nursing team to improve interprofessional shared decision-making by providing decisional support to patients that focuses on values and meaning.
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Affiliation(s)
- Noriko Inagaki
- Graduate School of Nursing, Kansai Medical University, Hirakata, Osaka, Japan
| | - Natsuko Seto
- Graduate School of Nursing, Kansai Medical University, Hirakata, Osaka, Japan
| | - Kumsun Lee
- Graduate School of Nursing, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yoshimitsu Takahashi
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan
| | - Yuko Hayashi
- Graduate School of Nursing, Kansai Medical University, Hirakata, Osaka, Japan
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Doi M, Maruyama Y, Kaneda A, Minamizaki M, Fukada M, Kanoya Y. Comprehensive end-of-life care practices for older patients with heart failure provided by specialized nurses: a qualitative study. BMC Geriatr 2023; 23:350. [PMID: 37277709 PMCID: PMC10240706 DOI: 10.1186/s12877-023-04050-6] [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: 01/25/2023] [Accepted: 05/18/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The context of end-of-life care for older heart failure patients with a complex clinical course provided by certified nurse specialists in gerontology (GCNSs) and Certified nurses in chronic heart failure (CNCHFs) is unclear; therefore, this study aims to describe comprehensive nursing practice for older patients with heart failure at their end of life. METHODS This study adopts a qualitative descriptive design using content analysis. Five GCNSs, and five CNCHFs were interviewed using a web app from January to March 2022. RESULTS Thirteen categories of nursing practices for older patients with heart failure were generated: (1) Provide thorough acute care by a multidisciplinary team to alleviate dyspnea, (2) Assess psychiatric symptoms and use a suitable environment to perform treatment, (3) Explain the progression of heart failure with the doctor, (4) Build a trusting relationship with the patient and family and implement advance care planning (ACP) early during the patient's recovery, (5) Involve multiple professions to help patients to achieve their desired life, (6) Perform ACP always in collaboration with multiple professionals, (7) Provide lifestyle guidance according to patients' feelings so that they can continue living at home after discharge from the hospital, (8) Provide palliative and acute care in parallel with multiple professions, (9) Achieve end-of-life care at home through multidisciplinary cooperation, (10) Provide basic nursing care to the patient and family until the moment of death, (11) Provide concurrent acute and palliative care as well as psychological support to alleviate physical and mental symptoms, (12) Share the patient's prognosis and future wishes with multiple professionals, and (13) Engage in ACP from early stages, through several conversations with patients and their families. CONCLUSIONS Specialized nurses provide acute care, palliative care, and psychological support to alleviate physical and mental symptoms throughout the different stages of chronic heart failure. In addition to nursing care by specialized nurses at each stage shown in this study, it is important to initiate ACP early in the end-of-life stage and to provide care for patients with multiple professionals.
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Affiliation(s)
- Mana Doi
- Department of Gerontological Nursing, Nursing Course, School of Medicine, Yokohama City University, 3-9 Fukuura Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan.
- Tokyo Healthcare University, Chiba Faculty of Nursing, 1-1042-2 Kaijincho-Nishi, Funabashi, Chiba, 273-8710, Japan.
| | - Yukie Maruyama
- Department of Gerontological Nursing, Nursing Course, School of Medicine, Yokohama City University, 3-9 Fukuura Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Akiko Kaneda
- Department of Gerontological Nursing, Nursing Course, School of Medicine, Yokohama City University, 3-9 Fukuura Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Maya Minamizaki
- Department of Gerontological Nursing, Nursing Course, School of Medicine, Yokohama City University, 3-9 Fukuura Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Masami Fukada
- Department of Gerontological Nursing, Nursing Course, School of Medicine, Yokohama City University, 3-9 Fukuura Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Yuka Kanoya
- Department of Gerontological Nursing, Nursing Course, School of Medicine, Yokohama City University, 3-9 Fukuura Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
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Hoerold M, Heytens H, Debbeler CM, Ehrentreich S, Rauwolf T, Schmeißer A, Gottschalk M, Bitzer EM, Braun-Dullaeus RC, Apfelbacher CJ. An evidence map of systematic reviews on models of outpatient care for patients with chronic heart diseases. Syst Rev 2023; 12:80. [PMID: 37149625 PMCID: PMC10163805 DOI: 10.1186/s13643-023-02227-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 03/30/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Chronic heart disease affects millions of people worldwide and the prevalence is increasing. By now, there is an extensive literature on outpatient care of people with chronic heart disease. We aimed to systematically identify and map models of outpatient care for people with chronic heart disease in terms of the interventions included and the outcomes measured and reported to determine areas in need of further research. METHODS We created an evidence map of published systematic reviews. PubMed, Cochrane Library (Wiley), Web of Science, and Scopus were searched to identify all relevant articles from January 2000 to June 2021 published in English or German language. From each included systematic review, we abstracted search dates, number and type of included studies, objectives, populations, interventions, and outcomes. Models of care were categorised into six approaches: cardiac rehabilitation, chronic disease management, home-based care, outpatient clinic, telemedicine, and transitional care. Intervention categories were developed inductively. Outcomes were mapped onto the taxonomy developed by the COMET initiative. RESULTS The systematic literature search identified 8043 potentially relevant publications on models of outpatient care for patients with chronic heart diseases. Finally, 47 systematic reviews met the inclusion criteria, covering 1206 primary studies (including double counting). We identified six different models of care and described which interventions were used and what outcomes were included to measure their effectiveness. Education-related and telemedicine interventions were described in more than 50% of the models of outpatient care. The most frequently used outcome domains were death and life impact. CONCLUSION Evidence on outpatient care for people with chronic heart diseases is broad. However, comparability is limited due to differences in interventions and outcome measures. Outpatient care for people with coronary heart disease and atrial fibrillation is a less well-studied area compared to heart failure. Our evidence mapping demonstrates the need for a core outcome set and further studies to examine the effects of models of outpatient care or different interventions with adjusted outcome parameters. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42020166330).
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Affiliation(s)
- Madlen Hoerold
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany.
| | - Heike Heytens
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Carla Maria Debbeler
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Saskia Ehrentreich
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Thomas Rauwolf
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Alexander Schmeißer
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Marc Gottschalk
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Eva Maria Bitzer
- Department of Public Health and Health Education, University of Education Freiburg, Kunzenweg 21, Freiburg, Baden-Würtemberg, 79117, Germany
| | - Ruediger C Braun-Dullaeus
- Department of Angiology and Cardiology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
| | - Christian J Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, Sachsen-Anhalt, 39120, Germany
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Butler J, Petrie MC, Bains M, Bawtinheimer T, Code J, Levitch T, Malvolti E, Monteleone P, Stevens P, Vafeiadou J, Lam CSP. Challenges and opportunities for increasing patient involvement in heart failure self-care programs and self-care in the post-hospital discharge period. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:23. [PMID: 37046357 PMCID: PMC10097448 DOI: 10.1186/s40900-023-00412-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/25/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND People living with heart failure (HF) are particularly vulnerable after hospital discharge. An alliance between patient authors, clinicians, industry, and co-developers of HF programs can represent an effective way to address the unique concerns and obstacles people living with HF face during this period. The aim of this narrative review article is to discuss challenges and opportunities of this approach, with the goal of improving participation and clinical outcomes of people living with HF. METHODS This article was co-authored by people living with HF, heart transplant recipients, patient advocacy representatives, cardiologists with expertise in HF care, and industry representatives specializing in patient engagement and cardiovascular medicine, and reviews opportunities and challenges for people living with HF in the post-hospital discharge period to be more integrally involved in their care. A literature search was conducted, and the authors collaborated through two virtual roundtables and via email to develop the content for this review article. RESULTS Numerous transitional-care programs exist to ease the transition from the hospital to the home and to provide needed education and support for people living with HF, to avoid rehospitalizations and other adverse outcomes. However, many programs have limitations and do not integrally involve patients in the design and co-development of the intervention. There are thus opportunities for improvement. This can enable patients to better care for themselves with less of the worry and fear that typically accompany the transition from the hospital. We discuss the importance of including people living with HF in the development of such programs and offer suggestions for strategies that can help achieve these goals. An underlying theme of the literature reviewed is that education and engagement of people living with HF after hospitalization are critical. However, while clinical trial evidence on existing approaches to transitions in HF care indicates numerous benefits, such approaches also have limitations. CONCLUSION Numerous challenges continue to affect people living with HF in the post-hospital discharge period. Strategies that involve patients are needed, and should be encouraged, to optimally address these challenges.
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Affiliation(s)
- Javed Butler
- Department of Medicine (L605), University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
- Baylor Scott and White Research Institute, Dallas, TX, USA.
| | - Mark C Petrie
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Marc Bains
- HeartLife Foundation, Vancouver, BC, Canada
| | | | - Jillianne Code
- HeartLife Foundation, Vancouver, BC, Canada
- Faculty of Education, University of British Columbia, Vancouver, BC, Canada
| | | | - Elmas Malvolti
- Global Medical Affairs, BioPharmaceuticals Business Unit, AstraZeneca, Central Cambridge, UK
| | - Pasquale Monteleone
- Global Corporate Affairs, Biopharmaceuticals Business Unit, AstraZeneca, Cambridge, UK
| | - Petrina Stevens
- Global Medical Evidence, BioPharmaceuticals Business Unit, AstraZeneca, Cambridge, UK
| | - Jenny Vafeiadou
- Global Digital Health, Biopharmaceuticals Business Unit, AstraZeneca, Cambridge, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore & Duke-NUS Medical School, Singapore, Singapore
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42
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Bernhardt AM, Copeland H, Deswal A, Gluck J, Givertz MM. The International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support. J Heart Lung Transplant 2023; 42:e1-e64. [PMID: 36805198 DOI: 10.1016/j.healun.2022.10.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Hannah Copeland
- Department of Cardiac Surgery, Lutheran Health Physicians, Fort Wayne, Indiana
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Gluck
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Michael M Givertz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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43
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Watanabe Y, Inoue T, Nakano S, Okada H. Prognosis of Patients with Acute Kidney Injury due to Type 1 Cardiorenal Syndrome Receiving Continuous Renal Replacement Therapy. Cardiorenal Med 2023; 13:158-166. [PMID: 36966533 DOI: 10.1159/000527111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 09/05/2022] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION The prognosis of patients with acute kidney injury (AKI) caused by type 1 cardiorenal syndrome (CRS) requiring continuous renal replacement therapy (CRRT) is unclear. We investigated the in-hospital mortality and prognostic factors in these patients. METHODS We retrospectively identified 154 consecutive adult patients who received CRRT for AKI caused by type 1 CRS between January 1, 2013, and December 31, 2019. We excluded patients who underwent cardiovascular surgery and those with stage 5 chronic kidney disease. The primary outcome was in-hospital mortality. Cox proportional hazards analysis was performed to analyze independent predictors of in-hospital mortality. RESULTS The median age of patients at admission was 74.0 years (interquartile range: 63.0-80.0); 70.8% were male. The in-hospital mortality rate was 68.2%. Age ≥80 years (hazard ratio [HR], 1.87; 95% confidence interval [CI], 1.21-2.87; p = 0.004), previous hospitalization for acute heart failure (HR, 1.67; 95% CI, 1.13-2.46; p = 0.01), vasopressor or inotrope use (HR, 5.88; 95% CI, 1.43-24.1; p = 0.014), and mechanical ventilation at CRRT initiation (HR, 2.24; 95% CI, 1.46-3.45; p < 0.001) were associated with in-hospital mortality. CONCLUSION In our single-center study, the use of CRRT for AKI due to type 1 CRS was associated with high in-hospital mortality.
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Affiliation(s)
- Yusuke Watanabe
- Department of Nephrology, Saitama Medical University, Saitama, Japan
- Division of Dialysis Center and Department of Nephrology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tsutomu Inoue
- Department of Nephrology, Saitama Medical University, Saitama, Japan
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hirokazu Okada
- Department of Nephrology, Saitama Medical University, Saitama, Japan
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Rapelli G, Giusti EM, Donato S, Parise M, Pagani AF, Pietrabissa G, Bertoni A, Castelnuovo G. “The heart in a bag”: The lived experience of patient-caregiver dyads with left ventricular assist device during cardiac rehabilitation. Front Psychol 2023; 14:1116739. [PMID: 37089738 PMCID: PMC10114412 DOI: 10.3389/fpsyg.2023.1116739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/17/2023] [Indexed: 03/12/2023] Open
Abstract
ObjectiveThe Left Ventricular Assist Device (LVAD) has increasingly become a primary therapeutic option for longer-waiting heart transplant lists. Although survival rates are growing, the device requires complex home care. Therefore, the presence of a caregiver trained in the LVAD management is important for the success of the therapy. The LVAD leads both patients and their caregivers to experience new challenges and adapt to new lifestyle changes and limitations – but their subjective beliefs before home management remained little explored.DesignThis study identified, using a phenomenological hermeneutic approach, the main components of the LVAD experience of six patient-caregiver dyads interviewed during cardiac rehabilitation.ResultsWe identified 4 master themes: Being between life and death, Being human with a heart of steel, Sharing is caring (and a burden), and Being small and passive.ConclusionThe knowledge from this study can be used as a guide for healthcare providers in counseling LVAD recipients and their caregivers.
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Affiliation(s)
- Giada Rapelli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Emanuele Maria Giusti
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Lombardy, Italy
| | - Silvia Donato
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Miriam Parise
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | | | - Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Lombardy, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
- *Correspondence: Giada Pietrabissa,
| | - Anna Bertoni
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Lombardy, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
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45
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Forsyth P, Beezer J, Bateman J. Holistic approach to drug therapy in a patient with heart failure. Heart 2023:heartjnl-2022-321764. [PMID: 36898707 DOI: 10.1136/heartjnl-2022-321764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Heart failure (HF) is a growing global public health problem affecting at least 26 million people worldwide. The evidence-based landscape for HF treatment has changed at a rapid rate over the last 30 years. International guidelines for the management of HF now recommend the use of four pillars in all patients with reduced ejection fraction: angiotensin receptor neprilysin inhibitors or ACE inhibitors, beta blockers, mineralocorticoid receptor antagonists and sodium-glucose co-transporter-2 inhibitors. Beyond the main four pillar therapies, numerous further pharmacological treatments are also available in specific patient subtypes. These armouries of drug therapy are impressive, but where does this leave us with individualised and patient-centred care? This paper reviews the common considerations needed to provide a holistic, tailored and individual approach to drug therapy in a patient with HF with reduced ejection fraction, including shared decision making, initiating and sequencing of HF pharmacotherapy, drug-related considerations, polypharmacy and adherence.
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Affiliation(s)
- Paul Forsyth
- Pharmacy, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Janine Beezer
- Pharmacy, South Tyneside and Sunderland Royal Hospital, Sunderland, UK
| | - Joanne Bateman
- Pharmacy, Countess of Chester Hospital NHS Foundation Trust, Chester, Cheshire West and Chester, UK
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Ródenas-Alesina E, Romero-Farina G, Herrador L, Jordán P, Espinet-Coll C, Pizzi MN, Ribera A, Ferreira-González I, Aguadé-Bruix S. Development of a risk score for patients with ischaemic cardiomyopathy. Arch Cardiovasc Dis 2023; 116:145-150. [PMID: 36759315 DOI: 10.1016/j.acvd.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Ischaemic cardiomyopathy is a leading cause of heart failure and is associated with a poor prognosis. AIM To evaluate predictors of major adverse cardiovascular events (MACE) and to develop a risk score for the disease. METHODS All patients with ischaemic cardiomyopathy referred to a tertiary hospital between 2010 and 2018 for stress-rest gated single-photon emission computed tomography (SPECT) were included retrospectively (n=747). Clinical and gated SPECT-derived variables were analysed as predictors of MACE, a combined endpoint of cardiovascular mortality, heart failure hospitalization or myocardial infarction during follow-up. A multivariable Cox model using backwards stepwise regression with competing risks was used to select the best parsimonious model. RESULTS After a median follow-up of 4.7 years, 313 patients had MACE (41.9%). Independent predictors of MACE were previous heart failure admission, worsening angina or dyspnoea, estimated glomerular filtration rate ≤60mL/min/1.73 m2, age>73 years, diabetes, atrial fibrillation, end-diastolic volume index>83mL/m2 and>12% of scarred myocardium. A risk score ranging from 0 to 12 classified patients as at intermediate risk (event rate of 4.0 MACE per 100 person-years), high risk (11.3 MACE per 100 person-years) or very high risk (27.8 MACE per 100 person-years). The internally validated area under the curve was 0.720 (95% confidence interval 0.660-0.740) and calibration was adequate (Hosmer-Lemeshow test P=0.28) for MACE. CONCLUSIONS In patients with ischaemic cardiomyopathy, a simple risk score using dichotomic and readily available variables obtained from clinical assessment and gated SPECT accurately predicts the risk of MACE.
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Affiliation(s)
- Eduard Ródenas-Alesina
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain.
| | - Guillermo Romero-Farina
- Nuclear Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; Centro de Investigación Biomédica En Red: Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain
| | - Lorena Herrador
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Pablo Jordán
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Carina Espinet-Coll
- Nuclear Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - María Nazarena Pizzi
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain; Centro de Investigación Biomédica En Red: Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain
| | - Aida Ribera
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain; Centro de Investigación Biomédica En Red: Epidemiología y Salud Pública (CIBER-ESP), 28029 Madrid, Spain
| | - Ignacio Ferreira-González
- Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain; Centro de Investigación Biomédica En Red: Epidemiología y Salud Pública (CIBER-ESP), 28029 Madrid, Spain
| | - Santiago Aguadé-Bruix
- Nuclear Cardiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; Centro de Investigación Biomédica En Red: Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain
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Menegazzo WR, Santos ABS, Foppa M, Scolari FL, Barros FC, Stein R, da Silveira AD. Prognostic value of right ventricular strain and peak oxygen consumption in heart failure with reduced ejection fraction. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:501-509. [PMID: 36319776 DOI: 10.1007/s10554-022-02747-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/13/2022] [Indexed: 11/12/2022]
Abstract
Our purpose is to evaluate the combined predictive value of cardiopulmonary exercise testing (CPET) and echocardiographic evidence of left ventricular (LV) and right ventricular (RV) strain in predicting mortality and heart transplant (HTx) in a series of outpatients with heart failure with reduced ejection fraction (HFrEF). A retrospective cohort study of 66 patients with HFrEF (median age, 57 years; 51% women) who underwent CPET and echocardiography (up to 90 days apart) to assess prognosis. The primary outcome was a composite of death and need for HTx. At a median follow-up of 27 [20-39] months, 19 patients (29%) experienced the primary outcome. In unadjusted analysis, most echocardiographic and CPET parameters were associated with the primary outcome, including percentage of predicted peak oxygen consumption (ppVO2), VE/VCO2 slope, LV ejection fraction, and LV and RV longitudinal strain. After adjusting for other clinical, echocardiographic and CPET variables, RV free wall longitudinal strain and ppVO2 remained significantly associated with the primary outcome. Kaplan-Meier survival curves for death and HTx, based on the best cutoff values, showed lower survival rates in patients with impairment in both ppVO2 and RV FW-LS than in those with one or neither parameter impaired (p < 0.001). RV dysfunction and low cardiorespiratory fitness were independent markers of death and need for HTx. Impairment of both ppVO2 and RV FW-LS had a strong additive impact on prognostic assessment in this cohort of patients with HFrEF.
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Affiliation(s)
- Willian Roberto Menegazzo
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. .,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Angela Barreto Santiago Santos
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Murilo Foppa
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Fernando Luis Scolari
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Fernando Colares Barros
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Ricardo Stein
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Research Group in Exercise Cardiology (Cardio-Ex), Porto Alegre, RS, Brazil
| | - Anderson Donelli da Silveira
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Research Group in Exercise Cardiology (Cardio-Ex), Porto Alegre, RS, Brazil
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48
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Bernhardt AM, Copeland H, Deswal A, Gluck J, Givertz MM. The International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support. J Card Fail 2023; 29:304-374. [PMID: 36754750 DOI: 10.1016/j.cardfail.2022.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Hannah Copeland
- Department of Cardiac Surgery, Lutheran Health Physicians, Fort Wayne, Indiana
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Gluck
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Michael M Givertz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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49
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Kittleson MM, DeFilippis EM, Bhagra CJ, Casale JP, Cauldwell M, Coscia LA, D'Souza R, Gaffney N, Gerovasili V, Ging P, Horsley K, Macera F, Mastrobattista JM, Paraskeva MA, Punnoose LR, Rasmusson KD, Reynaud Q, Ross HJ, Thakrar MV, Walsh MN. Reproductive health after thoracic transplantation: An ISHLT expert consensus statement. J Heart Lung Transplant 2023; 42:e1-e42. [PMID: 36528467 DOI: 10.1016/j.healun.2022.10.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
Pregnancy after thoracic organ transplantation is feasible for select individuals but requires multidisciplinary subspecialty care. Key components for a successful pregnancy after lung or heart transplantation include preconception and contraceptive planning, thorough risk stratification, optimization of maternal comorbidities and fetal health through careful monitoring, and open communication with shared decision-making. The goal of this consensus statement is to summarize the current evidence and provide guidance surrounding preconception counseling, patient risk assessment, medical management, maternal and fetal outcomes, obstetric management, and pharmacologic considerations.
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Affiliation(s)
- Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Ersilia M DeFilippis
- Division of Cardiology, New York Presbyterian-Columbia University Irving Medical Center, New York, New York
| | - Catriona J Bhagra
- Department of Cardiology, Cambridge University and Royal Papworth NHS Foundation Trusts, Cambridge, UK
| | - Jillian P Casale
- Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, Maryland
| | - Matthew Cauldwell
- Department of Obstetrics, Maternal Medicine Service, St George's Hospital, London, UK
| | - Lisa A Coscia
- Transplant Pregnancy Registry International, Gift of Life Institute, Philadelphia, Pennsylvania
| | - Rohan D'Souza
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Gaffney
- Lung Transplant Service, Alfred Hospital, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | | | - Patricia Ging
- Department of Pharmacy, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Kristin Horsley
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Francesca Macera
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy; Dept of Cardiology, Cliniques Universitaires de Bruxelles - Hôpital Erasme, Brussels, Belgium
| | - Joan M Mastrobattista
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine Houston, Texas
| | - Miranda A Paraskeva
- Lung Transplant Service, Alfred Hospital, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Lynn R Punnoose
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Quitterie Reynaud
- Cystic Fibrosis Adult Referral Care Centre, Department of Internal Medicine, Hospices civils de Lyon, Pierre Bénite, France
| | - Heather J Ross
- Peter Munk Cardiac Centre of the University Health Network, Toronto, Ontario, Canada; Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Mitesh V Thakrar
- Department of Medicine, Division of Respirology, University of Calgary, Calgary, Alberta, Canada
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50
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MacDonald BJ, Barry AR, Turgeon RD. Decisional Needs and Patient Treatment Preferences for Heart Failure Medications: A Scoping Review. CJC Open 2023; 5:136-147. [PMID: 36880079 PMCID: PMC9984897 DOI: 10.1016/j.cjco.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background Pharmacologic management of heart failure with reduced ejection fraction (HFrEF) involves several medications. Decision aids informed by patient decisional needs and treatment preferences could assist in making HFrEF medication choices; however, these are largely unknown. Methods We searched MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), without language restriction, for qualitative, quantitative, and mixed-method studies that included patients with HFrEF or clinicians providing HFrEF care, and reported data on decisional needs or treatment preferences applicable to HFrEF medications. We classified decisional needs using a modified version of the Ottawa Decision Support Framework (ODSF). Results From 3996 records, we included 16 reports describing 13 studies (n = 854). No study explicitly assessed ODSF decisional needs; however, 11 studies reported ODSF-classifiable data. Patients commonly reported having inadequate knowledge or information, and difficult decisional roles. No study systematically assessed treatment preferences, but 6 studies reported on attribute preferences. Reducing mortality and improving symptoms frequently were ranked as being important, whereas cost importance rankings varied, and adverse events generally were ranked as being less important. Conclusion This scoping review identified key decisional needs regarding HFrEF medications, notably inadequate knowledge or information, and difficult decisional roles, which can readily be addressed by decision aids. Future studies should systematically explore the full scope of ODSF-based decisional needs in patients with HFrEF, along with relative preferences among treatment attributes to further inform development of individualized decision aids.
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Affiliation(s)
- Blair J MacDonald
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arden R Barry
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ricky D Turgeon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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