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Hadidi SE, Bazan NS, Byrne S, Darweesh E, Bermingham M. Factors influencing prescribing by critical care physicians to heart failure patients in Egypt: a cross-sectional survey. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2022. [DOI: 10.1186/s43094-022-00429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Heart failure (HF) guideline-led prescribing improves patient outcomes; however, little is known about the factors influencing guideline-led prescribing in critical care settings. This study used a cross-sectional survey to assess the factors that influence physicians when prescribing to heart failure patients in a critical care setting in Egypt.
Results
The response rate was 54.8%. The international HF guidelines were the primary source of prescribing information for 84.2% of respondents. Staff were more familiar with the latest guideline recommendations than associate staff (86.7% vs 36.8%, p = 0.012) and considered patient’s perspectives more often (86.7% vs 26.3%, p = 0.036). Renal function was the clinical factor that most frequently influenced the prescribing of loop diuretics or renin–angiotensin–aldosterone system inhibitors. Pulmonary function influenced beta-blockers prescription. The most frequently cited barrier to guideline-led prescribing was the absence of locally drafted guidelines. A majority of prescribers agreed that implementation of clinical pharmacy services, physician education and electronic reminders may improve the implementation of guideline-led prescribing.
Conclusions
Although experienced physicians are familiar with and use international guidelines, physicians would welcome local guidance on HF prescribing and greater clinical pharmacist input.
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Buchan TA, Kugathasan L, Kobulnik J, Poon S, Runeckles K, Fan S, Ross HJ, Alba AC. Increased Mortality in Patients With Acutely Decompensated Heart Failure During the COVID-19 Pandemic in Toronto, Canada. CJC Open 2022; 4:772-781. [PMID: 35765461 PMCID: PMC9221741 DOI: 10.1016/j.cjco.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022] Open
Abstract
Background Methods Results Conclusions
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Arenas Ochoa LF, González-Jaramillo V, Saldarriaga C, Lemos M, Krikorian A, Vargas JJ, Gómez-Batiste X, Gonzalez-Jaramillo N, Eychmüller S. Prevalence and characteristics of patients with heart failure needing palliative care. BMC Palliat Care 2021; 20:184. [PMID: 34856953 PMCID: PMC8638101 DOI: 10.1186/s12904-021-00850-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/16/2021] [Indexed: 12/28/2022] Open
Abstract
Background Few hospitals and heart failure (HF) clinics offer concurrent palliative care (PC) together with life-prolonging therapies. To know the prevalence of patients in HF clinics needing PC and useful tools to recognize them are the first steps to extending PC in those settings. However, it is still unknown whether tools commonly used to identify patients with HF needing PC can correctly distinguish them. Two systematic reviews found that the NECesidades PALiativas (NECPAL) tool was one of the two most commonly used tools to asses PC needs in HF patients. Therefore, we assessed 1) the prevalence of PC needs in HF clinics according to the NECPAL tool, and 2) the characteristics of the patients identified as having PC; mainly, their quality of life (QoL), symptom burden, and psychosocial problems. Methods This cross-sectional study was conducted at two HF clinics in Colombia. We assessed the prevalence of PC in the overall sample and in subgroups according to clinical and demographic variables. We assessed QoL, symptom burden, and psychosocial problems using the 12-Item Short-Form Health Survey (SF-12), the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Edmonton Symptom Assessment System (ESAS). We compared the results of these tools between patients identified as having PC needs (+NECPAL) and patients identified as not having PC needs (–NECPAL). Results Among the 178 patients, 78 (44%) had PC needs. The prevalence of PC needs was twice as nigh in patients NYHA III/IV as in patients NYHA I/II and almost twice as high in patients older than 70 years as in patients younger than 70 years. Compared to –NECPAL patients, +NECPAL patients had worse QoL, more severe shortness of breath, tiredness, drowsiness, and pain, and more psychosocial problems. Conclusion The prevalence of PC needs in outpatient HF clinics is high and is even higher in older patients and in patients at more advanced NYHA stages. Compared to patients identified as not having PC needs, patients identified as having PC needs have worse QoL, more severe symptoms, and greater psychosocial problems. Including a PC provider in the multidisciplinary team of HF clinics may help to assess and cover these needs. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00850-y.
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Affiliation(s)
- Luisa Fernanda Arenas Ochoa
- Pain and Palliative Care Group, School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia.,Department of Palliative Care, Clínica Cardio VID, Medellín, Colombia
| | - Valentina González-Jaramillo
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland. .,Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - Clara Saldarriaga
- Department of Cardiology, Clínica Cardio VID, Medellín, Colombia.,Cardiology Department, Universidad de Antioquia, Medellín, Colombia
| | - Mariantonia Lemos
- Department of Psychology, School of Humanities, Universidad EAFIT, Medellín, Colombia
| | - Alicia Krikorian
- Pain and Palliative Care Group, School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - John Jairo Vargas
- Pain and Palliative Care Group, School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia.,Institute of Cancerology, Clínica Las Américas, Medellin, Colombia
| | - Xavier Gómez-Batiste
- Chair Qualy Palliative Care, Faculty Medicine, University of Vic/Central of Catalonia, Barcelona, Spain
| | - Nathalia Gonzalez-Jaramillo
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Steffen Eychmüller
- University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
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Fowokan A, Frankfurter C, Dobrow MJ, Abrahamyan L, Mcdonald M, Virani S, Harkness K, Lee DS, Pakosh M, Ross H, Grace SL. Referral and access to heart function clinics: A realist review. J Eval Clin Pract 2021; 27:949-964. [PMID: 33020996 DOI: 10.1111/jep.13489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 12/24/2022]
Abstract
RATIONALE, AIM, AND OBJECTIVES Heart failure (HF) clinics are highly effective, yet not optimally utilized. A realist review was performed to identify contexts (eg, health system characteristics, clinic capacity, and siting) and underlying mechanisms (eg, referring provider knowledge of clinics and referral criteria, barriers in disadvantaged patients) that influence utilization (provider referral [ie, of all appropriate and no inappropriate patients] and access [ie, patient attends ≥1 visit]) of HF clinics. METHODS Following an initial scoping search and field observation in a HF clinic, we developed an initial program theory in conjunction with our expert panel, which included patient partners. Then, a literature search of seven databases was searched from inception to December 2019, including Medline; Grey literature was also searched. Studies of any design or editorials were included; studies regarding access to cardiac rehabilitation, or a single specialist for example, were excluded. Two independent reviewers screened the abstracts, and then full-texts. Relevant data from included articles were used to refine the program theory. RESULTS A total of 29 papers from five countries (three regions) were included. There was limited information to support or refute many elements of our initial program theory (eg, referring provider knowledge/beliefs, clinic inclusion/exclusion criteria), but refinements were made (eg, specialized care provided in each clinic, lack of patient encouragement). Lack of capacity, geography, and funding arrangements were identified as contextual factors, explaining a range of mechanistic processes, including patient clinical characteristics and social determinants of health as well as clinic characteristics that help to explain inappropriate and low use of HF clinics (outcome). CONCLUSION Given the burden of HF and benefit of HF clinics, more research is needed to understand, and hence overcome sub-optimal use of HF clinics. In particular, an understanding from the perspective of referring providers is needed.
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Affiliation(s)
| | | | - Mark J Dobrow
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lusine Abrahamyan
- University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Sean Virani
- St. Paul's Hospital, University of British Columbia, and Cardiac Services BC, Vancouver, British Columbia, Canada
| | - Karen Harkness
- CorHealth Ontario, Toronto, Ontario, Canada.,School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Douglas S Lee
- University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Maureen Pakosh
- Library & Information Services, University Health Network, Toronto, Ontario, Canada
| | - Heather Ross
- University Health Network, Toronto, Ontario, Canada
| | - Sherry L Grace
- University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Faculty of Health, York University, Toronto, Ontario, Canada
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5
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A 2020 Environmental Scan of Heart Failure Clinics in Ontario. CJC Open 2021; 3:929-935. [PMID: 34401700 PMCID: PMC8348555 DOI: 10.1016/j.cjco.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Multidisciplinary heart failure (HF) clinics decrease hospital admission rates and healthcare use, while improving patient outcomes. To understand the contemporary availability of HF clinics in Ontario, Canada, and the services provided, we performed an environmental scan of physician-led and nurse practitioner (NP)–led HF clinics. Methods Between November, 2019 and February 2020, we identified Ontario HF clinics led by physicians or NPs. Following an invitation, we conducted a semi-structured interview to evaluate the services offered and qualitatively compared our findings to the results of the 2010 Ontario provincial survey. Results The number of HF clinics (36 vs 34 in 2010) and physicians (157 vs 143 in 2010) have not changed since the 2010 survey. Of the 36 clinics we identified, 30 participated in our interview (22 physician-led and 8 NP-led). Twenty-five clinics (83%) were hospital-based, of which 9 (30%) were part of an academic institution. Comparisons of our findings to the 2010 study on 30 clinics show an approximately 3-fold increase (P <0.001) in both median annual and new patient visits. As previously reported, the clinics varied in services offered, but trended toward an increased availability of onsite echocardiography, exercise-stress testing, and nuclear cardiology. Conclusions Compared to the survey performed a decade ago, the number of HF clinics and physicians have not changed, and the services provided remain heterogenous. However, the increased number of patients served suggests a greater demand for these clinics. Improving the accessibility of these clinics and standardizing the service model are critical to improving patient outcomes.
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Stiell IG, Mielniczuk L, Clark HD, Hebert G, Taljaard M, Forster AJ, Wells GA, Clement CM, Brinkhurst J, Brown EL, Nemnom MJ, Perry JJ. Interdepartmental program to improve outcomes for acute heart failure patients seen in the emergency department. CAN J EMERG MED 2021; 23:169-179. [PMID: 33709357 DOI: 10.1007/s43678-020-00047-x] [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: 05/11/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Acute heart failure patients often have an uncertain or delayed follow-up after discharge from the ED. Our goal was to introduce rapid-access specialty clinics to ensure acute heart failure patients were seen within 7 days, in an effort to reduce admissions and improve follow-up care. METHODS This prospective cohort study was conducted at two campuses of a large tertiary care hospital. We enrolled acute heart failure patients who presented to the ED with shortness of breath and were later discharged. Following a 12-month before period, we introduced rapid-access acute heart failure clinics staffed by cardiology and internal medicine. We allowed for a 3-month implementation period and then observed outcomes over the subsequent 12-month after period. The primary outcome was hospital admission within 30 days. Secondary outcomes included mortality and actual access to specialty care. RESULTS Patients in the before (N = 355) and after periods (N = 374) were similar for age and most characteristics. Segmented autoregression analysis demonstrated there was a pre-existing trend to fewer admissions. Attendance at a specialty clinic increased from 17.8 to 42.1% (P < 0.01) and the median days to the clinic decreased from 13 to 6 days (P < 0.01). 30-days mortality did not change. CONCLUSION Implementation of rapid-access clinics for acute heart failure patients discharged from the ED did not lead to an overall decrease in hospital admissions. It did, however, lead to increased access to specialist care, reduced follow-up times, without an increase in return ED visits or mortality. Widespread use of this rapid-access approach to a specialist can improve care for acute heart failure patients discharged home from the ED.
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Affiliation(s)
- Ian G Stiell
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Lisa Mielniczuk
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Heather D Clark
- Division of Internal Medicine, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Guy Hebert
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Alan J Forster
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - George A Wells
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Catherine M Clement
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jennifer Brinkhurst
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Erica L Brown
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marie-Joe Nemnom
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Roche SL, Crossland DS, Adachi I, Broda C, Jansen K, Hickey E. Mechanical Circulatory Support for the Failing Sub-Aortic Right Ventricle in Adults. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2021; 24:2-9. [PMID: 34116778 DOI: 10.1053/j.pcsu.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 11/11/2022]
Abstract
Patients with ccTGA or d-TGA managed via atrial switch (Mustard or Senning operations) have biventricular circulations with a sub-aortic right ventricle (2V-RV). Other than in a tiny percentage of ccTGA patients, premature heart failure (HF) is common, driven by chronic RV dilatation and dysfunction and/or tricuspid regurgitation. These patients are different from the general HF population in that they are younger, more heterogeneous, are predisposed to pulmonary hypertension and present unique and complex surgical challenges. Despite their young age, they experience disproportionately poor access to advanced therapies and are often disqualified for transplant by pulmonary hypertension, HLA sensitization, program risk-tolerance and psychosocial issues. Mechanical support of the subaortic RV with ventricular assist device (subaortic RVAD, also known as SVAD), although technically challenging, can be an effective alternative to palliative care and offers high likelihood of bridging patients to heart transplant candidacy. In addition, temporary trans-catheter SVAD Impella support has been advantageous for stabilization of decompensated 2V-RV patients or as bridge to durable SVAD support. Improved awareness of and access to specialist ACHD-HF teams offering mechanical support (and transplantation) for 2V-RV patients is increasingly urgent for this aging population, and will improve options and outcomes for these patients as HF emerges.
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Affiliation(s)
- S Lucy Roche
- Peter Munk Cardiac Center, University Health Network and the Department of Medicine, University of Toronto, Toronto, Canada
| | - David S Crossland
- Adult and Paediatric Heart Unit, Freeman Hospital, Newcastle Upon Tune Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Iki Adachi
- Texas Children's Hospital Heart Center, Texas Children's Hospital and Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Christopher Broda
- Texas Children's Hospital Heart Center, Texas Children's Hospital and Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Katrijn Jansen
- Adult and Paediatric Heart Unit, Freeman Hospital, Newcastle Upon Tune Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Edward Hickey
- Texas Children's Hospital Heart Center, Texas Children's Hospital and Department of Surgery, Baylor College of Medicine, Houston, Texas.
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8
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Fentie Wendie T, Tarekegn Angamo M. Drug-Therapy Problems and Predictors among Hospitalized Heart-Failure Patients: A Prospective Observational Study. Drug Healthc Patient Saf 2020; 12:281-291. [PMID: 33376412 PMCID: PMC7764776 DOI: 10.2147/dhps.s268923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/14/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Heart-failure patients are at high risk of experiencing drug-therapy problems, owing to polypharmacy, comorbidities, and usually advanced age. Drug-therapy problems can lead to poor clinical outcomes, increased health-care costs and decreased quality of life, and thus strategies for identifying, resolving, and preventing them are urgently needed. Therefore, this study aimed at investigating the incidence and predictors of drug-therapy problems among hospitalized heart-failure patients. METHODS This hospital-based prospective observational study was conducted from February 1 to May 31, 2014 at Jimma University Specialized Hospital. Patients of either sex aged 18 years and above with chronic heart failure and complete medical records were enrolled. Patients with high-output heart failure, <1 day of hospital stay, unwilling to give written informed consent, and unconscious without caregivers were excluded. Data were collected from medication charts, laboratory reports, patients/caregivers, morning multidisciplinary meetings, and ward rounds. Multivariate binary logistic regression analysis was done to identify independent predictors of drug-therapy problems. RESULTS A total of 104 heart-failure patients (mean age 51.20±15.66 years, females 51.9%) were consecutively enrolled, and 95 (91.3%) had experienced at least one drug-therapy problem (total 268, mean 2.82±1.39 encounters per patient). Of these problems, 45.5% were the need for additional drugs, followed by noncompliance (22.0%), inappropriate dosing (9.3%), unnecessary drugs (9.0%), ineffective drugs (8.2%), and adverse drug reactions (6.0%). None of the independent variables was found to be an independent predictor of having at least one drug-therapy problem. However, the number of clinical/pharmacological risk factors (AOR 7.93), female sex (AOR 3.24), and length of hospital stay (AOR 12.98) were predictors of noncompliance. CONCLUSION Patients suffered from a large number of drug-therapy problems. Drugs with survival benefit were underused. Noncompliance and the need for additional drug therapy were the most frequently identified drug-therapy problems. Numbers of clinical/pharmacological risk factors, length of hospital stay, and female sex were identified as predictors for noncompliance.
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Affiliation(s)
| | - Mulugeta Tarekegn Angamo
- Department of Pharmacy, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
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9
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Barry AR, Lee C. Pharmacist- or Nurse Practitioner-Led Assessment and Titration of Sacubitril/Valsartan in a Heart Failure Clinic: A Cohort Study. Can J Hosp Pharm 2020; 73:186-192. [PMID: 32616944 PMCID: PMC7308157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Sacubitril/valsartan is a first-in-class angiotensin receptor-neprilysin inhibitor indicated in the management of heart failure with reduced ejection fraction, based on the results of the PARADIGM-HF trial. Practice-based studies are needed to validate its effect in real-world settings. Clinical pharmacists are ideally situated to assess and titrate sacubitril/valsartan. OBJECTIVE To evaluate the utilization, safety, and tolerability of sacubitril/valsartan in a multidisciplinary heart failure clinic, with assessment and titration by a clinical pharmacist or a nurse practitioner. METHODS A retrospective cohort study was conducted at a heart failure clinic in Abbotsford, Canada. Included were adult patients with heart failure who were currently or formerly taking sacubitril/valsartan. Data collected for the period October 2015 to February 2019 included patient characteristics, New York Heart Association (NYHA) classification, concurrent medications, sacubitril/valsartan dose, adverse effects, and discontinuation rate. RESULTS In total, 128 patients were included. Mean age was 70.1 years, 98 (77%) of the patients were men, and 79 (62%) had NYHA class 2 heart failure. The clinical pharmacist managed care for 78 (61%) of the patients, and the nurse practitioner managed care for 50 (39%). Forty-one (32%) of the patients met modified PARADIGM-HF inclusion criteria. Eighty-five (66%) of the patients achieved the target dose of sacubitril/valsartan, with similar proportions for the clinical pharmacist and nurse practitioner groups, over a mean of 2.2 clinic visits. Patients who achieved the sacubitril/valsartan target dose, relative to those who did not, were significantly younger and had higher mean systolic blood pressure at baseline. Twenty-nine percent of patients (35/119) had an improvement in NYHA classification from before initiation of sacubitril/valsartan to achievement of target or maximally tolerated dose. Eighty-five (66%) of the patients experienced an adverse effect, primarily hypotension, and 12 (9%) required a dose reduction. Only 9 (7%) patients discontinued therapy. CONCLUSIONS This study demonstrates the real-world safety and tolerability of sacubitril/valsartan in the treatment of heart failure, and reinforces that clinical pharmacists can effectively assess and titrate medications in a multidisciplinary heart failure clinic.
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Affiliation(s)
- Arden R Barry
- , BSc, BSc(Pharm), PharmD, ACPR, is a Clinical Pharmacy and Research Specialist with the Abbotsford Regional Hospital and Cancer Centre, Lower Mainland Pharmacy Services, Abbotsford, British Columbia, and Assistant Professor (Partner) with the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
| | - Candy Lee
- , BSc(Pharm), ACPR, is Clinical Pharmacist with the Surrey Memorial Hospital, Lower Mainland Pharmacy Services, Surrey, British Columbia
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10
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He J, Balmain S, Kobulnik J, Schofield A, Mak S. The Role of Ambulatory Heart Failure Clinics to Avoid Heart Failure Admissions. CJC Open 2020; 2:15-21. [PMID: 32159132 PMCID: PMC7063658 DOI: 10.1016/j.cjco.2019.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 11/16/2019] [Indexed: 01/06/2023] Open
Abstract
Background There is a complex relationship between heart failure (HF) clinic services and health outcomes. We hypothesized that ambulatory clinic activity may be associated with both hospital admission and also with avoidance of admission. Methods A retrospective comparative cohort study was conducted examining activity in an ambulatory HF Clinic. Consecutive clinic visits in 2013 were recorded (n = 1728) and periods of high-intensity utilization (HIU) were identified (n = 128). A HIU period was defined by ≥2 consecutive clinic visits within 30 days, ending after 30 days passed without an additional clinic visit. For each HIU period identified, patient characteristics (n = 107) and all clinic visits (n = 324) were examined. HIU periods were then classified by association with hospital admission (±30 days). Results In 2013, 18.8% of all clinic visits occurred during HIU periods, involving 13.7% of the clinic population. Thirty-eight percent of HIU periods were associated with 62 total hospital admissions (±30 days), of which 58% (n = 36) were for a primary diagnosis of HF. In addition,17 HIU periods met criteria for admission avoided, and 7 HIU periods occurring after hospital discharge also met criteria for admission avoided. Conclusions We identified periods of intensive ambulatory clinic activity dedicated to patients with high burdens of comorbidities and both HF and non-HF–related admissions. These periods were also associated with episodes of successful decongestion with oral diuretics, resulting in avoidance of admission. Identifying HF patients who can be treated successfully or who are likely to require admission may be helpful for allocating clinic resources.
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Affiliation(s)
- Jessica He
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sean Balmain
- Anna Prosserman Heart Function Clinic, Mount Sinai Hospital, Toronto, Ontario, Canada.,Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy Kobulnik
- Anna Prosserman Heart Function Clinic, Mount Sinai Hospital, Toronto, Ontario, Canada.,Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anne Schofield
- Anna Prosserman Heart Function Clinic, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Susanna Mak
- Anna Prosserman Heart Function Clinic, Mount Sinai Hospital, Toronto, Ontario, Canada.,Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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11
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Li KL, Fang CH, Ferastraoaru D, Akbar NA, Jerschow E, Abuzeid WM. Patient Satisfaction and Efficiency Benefits of a Novel Multidisciplinary Rhinology and Allergy Clinic. Ann Otol Rhinol Laryngol 2020; 129:699-706. [PMID: 32059621 DOI: 10.1177/0003489420905859] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the sinonasal mucosa and with strong associations to other immune-mediated comorbidities. Patients often require referral to both an otolaryngologist and an allergist/immunologist. This study is the first in the literature to describe a multidisciplinary clinic that offers patient care by subspecialists in rhinology and in allergy/immunology. METHODS One hundred twenty-nine patients were seen in the Comprehensive Sinus and Allergy Clinic (CSAC) between January 2016 and June 2017 and 43 selected patients were seen in both the standalone allergy and rhinology clinics over the same time period. Patient satisfaction was retrospectively assessed using a modified Press-Ganey satisfaction survey. Time to evaluation and time to follow up appointment were compared between the CSAC and both the standalone rhinology and allergy/immunology clinics. RESULTS Patients seen in the CSAC reported high satisfaction with the amount of time spent with the physicians (98.3%), quality of medical care (9.3 ± 1.0), and most importantly, the convenience of seeing two physicians in one day (9.5 ± 1.2). Time from referral placement to clinic evaluation (P ≤ .02) and time to follow up appointment (P ≤ .002) was significantly shorter for the CSAC than for the standalone Rhinology or Allergy clinics. CONCLUSION Patients reported high satisfaction with the medical care provided and were also seen much faster in our multidisciplinary clinic as compared to standalone rhinology or allergy/immunology clinics. Overall, a multidisciplinary approach may be beneficial to patients presenting to tertiary referral centers with CRS and atopic conditions.
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Affiliation(s)
- Kevin L Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Denisa Ferastraoaru
- Department of Allergy & Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nadeem A Akbar
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elina Jerschow
- Department of Allergy & Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Waleed M Abuzeid
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
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12
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Donio PJ, Freitas C, Austin PC, Ross HJ, Abdel-Qadir HM, Wijeysundera HC, Tu K, Cram P, Liu P, Abrams H, Udell JA, Mak S, Farkouh ME, Tu JV, Wang X, Tobe SW, Lee DS. Comparison of Readmission and Death Among Patients With Cardiac Disease in Northern vs Southern Ontario. Can J Cardiol 2019; 35:341-351. [PMID: 30825954 DOI: 10.1016/j.cjca.2019.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/25/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Geographic factors may influence cardiovascular disease outcomes in Canada. Circulatory diseases are a major reason for higher population mortality rates in Northern Ontario, but it is unknown if hospitalized patients with cardiovascular disease experience differential outcomes compared with those in the South. METHODS We examined 30-day and 1-year mortality and readmissions for patients hospitalized with acute myocardial infarction (AMI), heart failure (HF), atrial fibrillation (AF), or stroke in Northern compared with Southern Ontario, using the Canadian Institute for Health Information Discharge Abstract Database (2005-2016). Northern patients were defined as those residing and hospitalized in the Northwest or Northeast Local Health Integration Network regions. We used multiple Cox proportional hazards regression analysis for time-to-first event and Prentice-Williams-Peterson method to evaluate repeat and multiply admitted patients. RESULTS A total of 47,745 Northern and 465,353 Southern patients hospitalized with AMI (n = 182,158), HF (n = 130,770), AF (n = 72,326), or stroke (n = 127,844) were studied. Rates of first readmission were higher among Northern patients for AMI (adjusted hazard ratio [HR], 1.32), HF (HR, 1.16), AF (HR, 1.21), and stroke (HR, 1.27) compared with Southern patients (all P < 0.001). Repeat readmission rates among Northern patients for AMI (HR, 1.23), HF (HR, 1.13), AF (HR, 1.18), and stroke (HR, 1.22) were also increased (all P < 0.001 vs Southern). Thirty-day mortality did not differ significantly between Northern and Southern patients. CONCLUSIONS Readmissions were increased in those residing and hospitalized in the North. To reduce readmissions in the North, the quality of postacute transitional care should be examined further.
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Affiliation(s)
- Patrick J Donio
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Cassandra Freitas
- Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Peter C Austin
- ICES, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Heather J Ross
- Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Husam M Abdel-Qadir
- University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Karen Tu
- University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Peter Cram
- University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Peter Liu
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Howard Abrams
- University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Jacob A Udell
- University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Susanna Mak
- Mount Sinai Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Michael E Farkouh
- University Health Network, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Jack V Tu
- ICES, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | | | - Sheldon W Tobe
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Douglas S Lee
- Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
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13
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Crossland DS, Van De Bruaene A, Silversides CK, Hickey EJ, Roche SL. Heart Failure in Adult Congenital Heart Disease: From Advanced Therapies to End-of-Life Care. Can J Cardiol 2019; 35:1723-1739. [PMID: 31813505 DOI: 10.1016/j.cjca.2019.07.626] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/12/2019] [Accepted: 07/23/2019] [Indexed: 12/14/2022] Open
Abstract
There is mounting recognition that some of the most urgent problems of adult congenital heart disease (ACHD) are the prevention, diagnosis, and management of heart failure (HF). Recent expert consensus and position statements not only emphasize a specific and pressing need to tackle HF in ACHD (ACHD-HF) but also highlight the difficulty of doing so given a current sparsity of data. Some of the challenges will be addressed by this review. The authors are from 3 different centres; each centre has an established subspeciality ACHD-HF clinic and is able to provide heart transplant, multiorgan transplant, and mechanical support for patients with ACHD. Appropriate care of this complex population requires multidisciplinary ACHD-HF teams evaluate all possible treatment options. The risks and benefits of nontransplant ACHD surgery, percutaneous structural and electrophysiological intervention, and ongoing conservative management must be considered alongside those of transplant strategies. In our approach, advanced care planning and palliative care coexist with the consideration of advanced therapies. An ethos of shared decision making, guided by the patient's values and preferences, strengthens clinical care, but requires investment of time as well as skilled communication. In this review, we aim to offer practical real-world advice for managing these patients, supported by scientific data where it exists.
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Affiliation(s)
- David S Crossland
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom; Cardiovascular Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | | | - Candice K Silversides
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Edward J Hickey
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - S Lucy Roche
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.
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14
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Joret MO, Osman K, Dean A, Cao C, van der Werf B, Bhamidipaty V. Multidisciplinary clinics reduce treatment costs and improve patient outcomes in diabetic foot disease. J Vasc Surg 2019; 70:806-814. [PMID: 30850290 DOI: 10.1016/j.jvs.2018.11.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/04/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Diabetic foot disease poses a significant and rising financial burden on health care systems worldwide. This study investigated the effect of a new multidisciplinary diabetic foot clinic (MDDFC) in a large tertiary hospital on patient outcomes and treatment cost. METHODS Patients' records were retrospectively reviewed to identify all patients who had been managed in a new MDDFC between July 2014 and July 2017. The wound episode-the period from initial presentation to the achievement of a final wound outcome-was identified, and all relevant inpatient and outpatient costs were extracted using a fully absorbed activity-based costing methodology. Risk factor, treatment, outcome, and costing data for this cohort were compared with a group of patients with diabetic foot wounds who had been managed in the same hospital before the advent of the MDDFC using a generalized linear mixed model. RESULTS The MDDFC and pre-MDDFC cohorts included 73 patients with 80 wound episodes and 225 patients with 265 wound episodes, respectively. Compared with the pre-MDDFC cohort, the MDDFC group had fewer inpatient admissions (1.56 vs 2.64; P ≤ .001). MDDFC patients had a lower major amputation rate (3.8% vs 27.5%; P ≤ .001), a lower mortality rate (7.5% vs 19.2%; P ≤ .05), and a higher rate of minor amputation (53.8% vs 31.7%; P ≤ .01). No statistically significant difference was noted in the rate of excisional débridement, skin graft, and open or endovascular revascularization. In the MDDFC cohort, the median total cost, inpatient cost, and outpatient cost per wound episode was New Zealand dollars (NZD) 22,407.465 (U.S. dollars [USD] 17,253.74), NZD 21,638.93 (USD 16,661.97), and NZD 691.915 (USD 532.77), respectively. The MDDFC to pre-MDDFC wound episode total cost ratio was 0.7586 (P < .001). CONCLUSIONS This study is the first to compare the cost and treatment outcomes of diabetic foot patients treated in a large tertiary hospital before and after the introduction of an MDDFC. The results show that an MDDFC improves patient outcomes and reduces the cost of treatment. MDDFCs should be adopted as the standard of care for diabetic foot patients.
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Affiliation(s)
- Maximilian O Joret
- Department of Vascular Surgery, Auckland Hospital, ADHB, Auckland, New Zealand
| | - Kareem Osman
- Department of Vascular Surgery, Auckland Hospital, ADHB, Auckland, New Zealand
| | - Anastasia Dean
- Department of Vascular Surgery, Auckland Hospital, ADHB, Auckland, New Zealand
| | - Colin Cao
- Department of Business Intelligence, ADHB, Auckland, New Zealand
| | - Bert van der Werf
- Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Venu Bhamidipaty
- Department of Vascular Surgery, Auckland Hospital, ADHB, Auckland, New Zealand.
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15
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Tobe SW. What Can Declining Kidney Function Tell Us About Heart Failure? Can J Cardiol 2018; 34:1261-1263. [DOI: 10.1016/j.cjca.2018.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022] Open
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16
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Tárraga López PJ, Villar Inarejos MJ, Sadek IM, Madrona Marcos F, Tárraga Marcos L, Simón García MÁ. Quality care in the management of heart failure in a health area. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2018; 30:258-264. [PMID: 30262444 DOI: 10.1016/j.arteri.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/12/2018] [Accepted: 06/07/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyse the heart failure situation in a health area, as well quality criteria. METHOD Cross-sectional observational study of patients diagnosed with heart failure by collecting data from their clinical history in the «Turriano» computer program. The variables analysed were, comorbidities, control of cardiovascular risk factors, treatments, number of chronic diseases, and admissions. The level of adherence to drugs in relation to heart failure by determining the ratio between the percentage of prescribed drugs and drugs withdrawn from pharmacy is also analysed using the Turriano prescription program. The study consisted of an improvement cycle or evaluative cycle, following the methodology proposed by Palmer to evaluate the quality of ambulatory care. RESULTS A total of 161 patients were included, with a mean age of 81.24 years, and 54.6% were women. Almost all of them (95%) had disease associated high blood pressure, including diabetes 42.2%, dyslipidaemia 8.9%, obesity 49.1%, and cancer 13.7% Some type of heart disease was diagnosed in 62.2% of patients with 29.2% ischaemic heart disease, 46.6% cardiac arrhythmias, and 20.5% valve diseases. More than 60% had between 4 and 6 concomitant diseases. An acceptable control is observed as regards the cardiovascular risk factors. Diuretic treatment was taken by 70%, with 32% and 35% taking angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists. More than 20% have had 1-2 admissions in the last year, with cardiac decompensation being the main cause. There was 16% mortality. CONCLUSIONS Patients with heart failure have a significant number of chronic concomitant diseases, although there is an acceptable cardiovascular risk factors control. There are quality criteria that can be improved.
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Affiliation(s)
- Pedro J Tárraga López
- Medicina de Familia, Centro Salud Zona 5A, Albacete, España; Facultad de Medicina, Universidad de Castilla-La Mancha , Albacete, España.
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17
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Bader F, Atallah B, Sadik ZG, Tbishat L, Gabra G, Soliman M, Bakr K, Ferrer R, Stapleton J, Khalil M. Nurse-led education for heart failure patients in developing countries. ACTA ACUST UNITED AC 2018; 27:690-696. [PMID: 29953275 DOI: 10.12968/bjon.2018.27.12.690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Heart failure readmissions are associated with significant morbidity and mortality. Adequate education on adherence and self-care behaviours can affect readmission rates positively and nurses are at the frontline of patient education. Such education is valuable when establishing heart failure programmes in developing countries, in light of the challenging socioeconomic circumstances in these. This study aimed to evaluate nurses' heart failure knowledge, to assess patients' baseline knowledge, and to evaluate the effectiveness of structured nurse-driven education. METHODS a total of 131 cardiac centre-based nurses and 30 chronic heart failure patients participated in the study in Kuwait. Patients were surveyed a second time 3 to 6 months later, while being followed at an advanced heart failure clinic by dedicated heart failure nurses. RESULTS the majority of the nurses (80%) had not received heart failure education previously, although they were able to recognise most heart failure symptoms. Significant improvement in patients' knowledge was noted between the initial and follow-up surveys. CONCLUSION establishing a dedicated advanced heart failure programme to care for patients in a developing country can result in significant improvement in disease awareness and self-care behaviours when led by well-trained heart failure nurses. More research is needed to determine if these findings are shared by other countries in the Middle-East and other developing countries.
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Affiliation(s)
- Feras Bader
- Staff Physician, Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates (UAE)
| | - Bassam Atallah
- Cardiology Pharmacotherapy Specialist, Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, UAE
| | - Ziad G Sadik
- Senior Pharmacotherapy Specialist, Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, UAE
| | - Laith Tbishat
- Resident, General Surgery Department, Royal Medical Services, Amman, Jordan
| | - Guirgis Gabra
- Clinical Associate, Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Medhat Soliman
- Clinical Associate, Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Khalid Bakr
- Clinical Associate, Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Richard Ferrer
- Heart Failure and Transplant Nurse Coordinator, Clinical and Nursing Department, Cleveland Clinic Abu Dhabi, UAE
| | - Judy Stapleton
- Heart Failure and Transplant Nurse Coordinator, Clinical and Nursing Department, Cleveland Clinic Abu Dhabi, UAE
| | - Mohammed Khalil
- Staff Physician, Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
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18
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Schluck G, Wu W, Whyte J, Abbott L. Emergency department arrival times in Florida heart failure patients utilizing Fisher-Rao curve registration: A descriptive population-based study. Heart Lung 2018; 47:458-464. [PMID: 29907362 DOI: 10.1016/j.hrtlng.2018.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 05/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emergency room utilization and hospital readmission rates are disproportionately high for heart failure patients (HF). Emergency department (ED) utilization is intimately intertwined with hospital readmissions. OBJECTIVE Describe the arrival time distribution of HF patients presenting to the ED. METHOD The study analyzed heart failure discharge data from the Florida State Emergency Department Database and the Florida State Inpatient Database from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. Data were treated as a Poisson process and analyzed using functional data analysis tools. RESULTS HF arrivals are multi-modal with the largest peak arrival time in the middle of the day as well as a smaller peak in the early morning hours, especially in rural areas. CONCLUSIONS The arrival pattern has minor differences in rural and urban areas. HF clinic appointments should be established in the early morning hours when these patients utilize the ED.
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Affiliation(s)
- Glenna Schluck
- College of Nursing, Florida State University, 98 Varsity Way, PO Box 3064310, Tallahassee, FL 32306-4310.
| | - Wei Wu
- Department of Statistics, College of Arts and Sciences, Florida State University, Tallahassee, FL
| | - James Whyte
- College of Nursing, Florida State University, Tallahassee, FL
| | - Laurie Abbott
- College of Nursing, Florida State University, Tallahassee, FL
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19
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Duero Posada JG, Moayedi Y, Zhou L, McDonald M, Ross HJ, Lee DS, Bhatia RS. Clustered Emergency Room Visits Following an Acute Heart Failure Admission: A Population-Based Study. J Am Heart Assoc 2018; 7:e007569. [PMID: 29588312 PMCID: PMC5907582 DOI: 10.1161/jaha.117.007569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/13/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND While it is well known that heart failure patients presenting to the emergency room (ER) have high short-term mortality after discharge, the outcomes of patients with heart failure with repeated ER visits within a short time are not known. In this study, we aimed to determine whether clustering is associated with an increased risk of death. METHODS AND RESULTS This is a retrospective, population-based cohort study with an accrual window between 2003 and 2014 and maximal follow-up up to and including March 31, 2015. Data were obtained from administrative databases from Ontario, Canada. Clustering was defined a priori as 3 or more ER visits within a 6-month period. The main outcome of interest was time to death conditional on 6-month survival. A total of 72 810 patients with an index hospitalization for acute heart failure were evaluated. ER clustering was observed in 15.1% of the population. Increased burden of comorbidities, primary rural residence, and lack of primary care provider were identified as factors associated with ER clustering. Age- and sex-adjusted mortality for clustered patients was higher than for nonclustered (hazard ratio [HR] 1.51; 95% confidence interval, 1.47-1.55, P<0.0001). Adjusted mortality risk was also higher for patients with clustered ER visits (HR 1.42; 95% confidence interval 1.38-1.46; P<0.0001). CONCLUSIONS Clustering, as defined by 3 or more ER visits for any reason within 6 months of index heart failure hospitalization reflects a novel risk factor associated with increased mortality. Future research into the strategies to better manage complex patients with heart failure with recurrent ER visits are warranted.
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Affiliation(s)
- Juan G Duero Posada
- Department of Medicine, University of Toronto, ON, Canada
- Division of Cardiology, University of Toronto, ON, Canada
| | - Yasbanoo Moayedi
- Department of Medicine, University of Toronto, ON, Canada
- Division of Cardiology, University of Toronto, ON, Canada
| | - Limei Zhou
- Institute for Clinical Evaluative Sciences, ON, Canada
| | - Michael McDonald
- Department of Medicine, University of Toronto, ON, Canada
- Division of Cardiology, University of Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, ON, Canada
| | - Heather J Ross
- Department of Medicine, University of Toronto, ON, Canada
- Division of Cardiology, University of Toronto, ON, Canada
- Ted Rogers Centre for Heart Research, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, ON, Canada
| | - Douglas S Lee
- Department of Medicine, University of Toronto, ON, Canada
- Division of Cardiology, University of Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, ON, Canada
| | - R Sacha Bhatia
- Department of Medicine, University of Toronto, ON, Canada
- Division of Cardiology, University of Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, ON, Canada
- Women's College Hospital Institute for Health System Solutions and Virtual Care, ON, Canada
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20
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Phenotype, management and predictors of outcome in a large cohort of adult congenital heart disease patients with heart failure. Int J Cardiol 2018; 252:80-87. [DOI: 10.1016/j.ijcard.2017.10.086] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 10/13/2017] [Accepted: 10/23/2017] [Indexed: 11/18/2022]
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21
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Abrahamyan L, Sahakyan Y, Wijeysundera HC, Krahn M, Rac VE. Gender Differences in Utilization of Specialized Heart Failure Clinics. J Womens Health (Larchmt) 2018; 27:623-629. [PMID: 29319404 DOI: 10.1089/jwh.2017.6461] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Although heart failure (HF) prevalence is equally high among men and women, observed differences in the provision of care are still not fully understood. We sought to evaluate gender differences in patient profiles, diagnostic testing, medication prescription, and referrals in specialized multidisciplinary ambulatory HF clinics in Ontario. MATERIALS AND METHODS Medical chart abstraction was conducted first by randomly selecting 9 (out of 34) HF clinics in Ontario, and then by randomly selecting 100 patient records in each clinic. Data on patient demographics, comorbidities, diagnostic tests, medication use, and referrals were abstracted, covering a period from the first clinic visit up to 1 year. Descriptive statistics and regression analysis were used to assess gender differences. RESULTS Of the 884 patients, only 314 were women (35.5%). At the first clinic visit, women were older, had better systolic function but worse functional status, and had a lower prevalence of hyperlipidemia, diabetes, and smoking than men. There were more women with non-ischemic HF etiology than men (63.9% vs. 43.3%, p < 0.001). Adjusted analysis did not reveal gender differences in the average number of echocardiographic assessments and in the prescription rates of evidence-based medications. Men were twice more likely to be referred to electrophysiology studies than women (18.6% vs. 7.8%, p < 0.001). The rates of dietary counseling and cardiac rehabilitation referrals were similarly low in both groups. CONCLUSIONS More men than women are treated in specialized ambulatory HF clinics. Although women differ from men in selected clinical characteristics, no major differences were observed in patient management. The reasons for low enrollment rates of women into the HF ambulatory clinics need further investigation.
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Affiliation(s)
- Lusine Abrahamyan
- 1 Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto , Toronto, Canada .,2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada
| | - Yeva Sahakyan
- 2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada
| | - Harindra C Wijeysundera
- 2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada .,3 Department of Medicine, University of Toronto , Toronto, Canada .,4 Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre , Toronto, Canada .,5 Institute for Clinical Evaluative Sciences (ICES) , Toronto, Canada
| | - Murray Krahn
- 1 Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto , Toronto, Canada .,2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada .,3 Department of Medicine, University of Toronto , Toronto, Canada .,5 Institute for Clinical Evaluative Sciences (ICES) , Toronto, Canada
| | - Valeria E Rac
- 1 Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto , Toronto, Canada .,2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada .,6 Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada
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McDonald MA, Ashley EA, Fedak PW, Hawkins N, Januzzi JL, McMurray JJ, Parikh VN, Rao V, Svystonyuk D, Teerlink JR, Virani S. Mind the Gap: Current Challenges and Future State of Heart Failure Care. Can J Cardiol 2017; 33:1434-1449. [DOI: 10.1016/j.cjca.2017.08.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 11/24/2022] Open
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Multidisciplinary Heart Failure Clinics Are Associated With Lower Heart Failure Hospitalization and Mortality: Systematic Review and Meta-analysis. Can J Cardiol 2017; 33:1237-1244. [DOI: 10.1016/j.cjca.2017.05.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 05/16/2017] [Accepted: 05/16/2017] [Indexed: 11/15/2022] Open
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Ezekowitz JA, O'Meara E, McDonald MA, Abrams H, Chan M, Ducharme A, Giannetti N, Grzeslo A, Hamilton PG, Heckman GA, Howlett JG, Koshman SL, Lepage S, McKelvie RS, Moe GW, Rajda M, Swiggum E, Virani SA, Zieroth S, Al-Hesayen A, Cohen-Solal A, D'Astous M, De S, Estrella-Holder E, Fremes S, Green L, Haddad H, Harkness K, Hernandez AF, Kouz S, LeBlanc MH, Masoudi FA, Ross HJ, Roussin A, Sussex B. 2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure. Can J Cardiol 2017; 33:1342-1433. [PMID: 29111106 DOI: 10.1016/j.cjca.2017.08.022] [Citation(s) in RCA: 443] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 08/28/2017] [Accepted: 08/28/2017] [Indexed: 02/06/2023] Open
Abstract
Since the inception of the Canadian Cardiovascular Society heart failure (HF) guidelines in 2006, much has changed in the care for patients with HF. Over the past decade, the HF Guidelines Committee has published regular updates. However, because of the major changes that have occurred, the Guidelines Committee believes that a comprehensive reassessment of the HF management recommendations is presently needed, with a view to producing a full and complete set of updated guidelines. The primary and secondary Canadian Cardiovascular Society HF panel members as well as external experts have reviewed clinically relevant literature to provide guidance for the practicing clinician. The 2017 HF guidelines provide updated guidance on the diagnosis and management (self-care, pharmacologic, nonpharmacologic, device, and referral) that should aid in day-to-day decisions for caring for patients with HF. Among specific issues covered are risk scores, the differences in management for HF with preserved vs reduced ejection fraction, exercise and rehabilitation, implantable devices, revascularization, right ventricular dysfunction, anemia, and iron deficiency, cardiorenal syndrome, sleep apnea, cardiomyopathies, HF in pregnancy, cardio-oncology, and myocarditis. We devoted attention to strategies and treatments to prevent HF, to the organization of HF care, comorbidity management, as well as practical issues around the timing of referral and follow-up care. Recognition and treatment of advanced HF is another important aspect of this update, including how to select advanced therapies as well as end of life considerations. Finally, we acknowledge the remaining gaps in evidence that need to be filled by future research.
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Affiliation(s)
| | - Eileen O'Meara
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | | | - Michael Chan
- Edmonton Cardiology Consultants, Edmonton, Alberta, Canada
| | - Anique Ducharme
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | - Adam Grzeslo
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Serge Lepage
- Université de Sherbrooke, Sherbrooke, Québec, Canada
| | | | | | - Miroslaw Rajda
- QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | - Sean A Virani
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Sabe De
- London Health Sciences, Western University, London, Ontario, Canada
| | | | - Stephen Fremes
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lee Green
- University of Alberta, Edmonton, Alberta, Canada
| | - Haissam Haddad
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Karen Harkness
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Simon Kouz
- Centre Hospitalier Régional de Lanaudière, Joliette, Québec, Canada
| | | | | | | | - Andre Roussin
- Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Bruce Sussex
- Memorial University, St John's, Newfoundland, Canada
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Whitaker-Brown CD, Woods SJ, Cornelius JB, Southard E, Gulati SK. Improving quality of life and decreasing readmissions in heart failure patients in a multidisciplinary transition-to-care clinic. Heart Lung 2016; 46:79-84. [PMID: 28034562 DOI: 10.1016/j.hrtlng.2016.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 11/01/2016] [Accepted: 11/11/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The purpose was to pilot the feasibility and impact of a 4-week transition-to-care program on quality of life for heart failure patients. BACKGROUND The transition from the acute care to the outpatient setting has been shown to be a critical time with heart failure patients. METHODS A pre- and post-test design was used. Quality of Life, measured by the Minnesota Living with Heart Failure Questionnaire, and hospital readmissions were the outcomes. A convenience sample of 50 persons was recruited into a multidisciplinary transition-to-care program for heart failure patients following hospitalization. Thirty-six (72%) completed the study. RESULTS There was a significant improvement in quality of life. Men reported greater improvement in physical symptoms and less emotional distress when compared to women. Only 2 participants were readmitted within 30 days. CONCLUSIONS Study findings support improved quality of life and decreased readmission rates following a multidisciplinary transition-to care program for heart failure patients.
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Affiliation(s)
- Charlene D Whitaker-Brown
- University of North Carolina at Charlotte, School of Nursing, College of Health and Human Services, 9201 University City Blvd., Charlotte, NC 28223, USA; Sanger Heart & Vascular Institute's Heart Success Clinic, Carolinas Medical Center-Main, 1000 Blythe Blvd., Charlotte, NC 28203, USA.
| | - Stephanie J Woods
- University of North Carolina at Charlotte, School of Nursing, College of Health and Human Services, 9201 University City Blvd., Charlotte, NC 28223, USA
| | - Judith B Cornelius
- University of North Carolina at Charlotte, School of Nursing, College of Health and Human Services, 9201 University City Blvd., Charlotte, NC 28223, USA
| | - Erik Southard
- Indiana State University, College of Nursing, Health, & Human Services, Landsbaum Center 217, 200 North Seventh Street, Terre Haute, IN 47809, USA
| | - Sanjeev K Gulati
- Sanger Heart & Vascular Institute's Heart Success Clinic, Carolinas Medical Center-Main, 1000 Blythe Blvd., Charlotte, NC 28203, USA
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Murphy TM, Waterhouse DF, James S, Casey C, Fitzgerald E, O'Connell E, Watson C, Gallagher J, Ledwidge M, McDonald K. A comparison of HFrEF vs HFpEF's clinical workload and cost in the first year following hospitalization and enrollment in a disease management program. Int J Cardiol 2016; 232:330-335. [PMID: 28087180 DOI: 10.1016/j.ijcard.2016.12.057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 12/04/2016] [Accepted: 12/16/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Admission with heart failure (HF) is a milestone in the progression of the disease, often resulting in higher intensity medical care and ensuing readmissions. Whilst there is evidence supporting enrolling patients in a heart failure disease management program (HF-DMP), not all reported HF-DMPs have systematically enrolled patients with HF with preserved ejection fraction (HFpEF) and there is a scarcity of literature differentiating costs based on HF-phenotype. METHODS 1292 consenting, consecutive patients admitted with a primary diagnosis of HF were enrolled in a hospital based HF-DMP and categorized as HFpEF (EF≥45%) or HFrEF (EF<45%). Hospitalizations, primary care, medications, and DMP workload with associated costs were evaluated assessing DMP clinic-visits, telephonic contact, medication changes over 1year using a mixture of casemix and micro-costing techniques. RESULTS The total average annual cost per patient was marginally higher in patients with HFrEF €13,011 (12,011, 14,078) than HFpEF, €12,206 (11,009, 13,518). However, emergency non-cardiovascular admission rates and average cost per patient were higher in the HFpEF vs HFrEF group (0.46 vs 0.31 per patient/12months) & €655 (318, 1073) vs €584 (396, 812). In the first 3months of the outpatient HF-DMP the HFrEF population cost more on average €791 (764, 819) vs €693 (660, 728). CONCLUSION There are greater short-term (3-month) costs of HFrEF versus HFpEF as part of a HF-DMP following an admission. However, long-term (3-12month) costs of HFpEF are greater because of higher non-cardiovascular rehospitalisations. As HFpEF becomes the dominant form of HF, more work is required in HF-DMPs to address prevention of non-cardiovascular rehospitalisations and to integrate hospital based HF-DMPs into primary healthcare structures.
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Affiliation(s)
- T M Murphy
- Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland
| | - D F Waterhouse
- Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland
| | - S James
- Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland
| | - C Casey
- Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland
| | - E Fitzgerald
- Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland
| | - E O'Connell
- Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland
| | - C Watson
- Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland; Centre for Experimental Medicine, Queen's University Belfast, Northern Ireland
| | - J Gallagher
- Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland
| | - M Ledwidge
- Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland
| | - K McDonald
- Heart Failure Unit, St Vincent's University Hospital, Dublin 4, Ireland.
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Abstract
Heart failure with reduced ejection fraction (HFrEF) represents at least half of the cases of heart failure, which is a syndrome defined as the inability of the heart to supply the body's tissues with an adequate amount of blood under conditions of normal cardiac filling pressure. HFrEF is responsible for high costs and rates of mortality, morbidity, and hospital admissions, mainly in developed countries. Thus, the need for better diagnostic methods and therapeutic approaches and consequently better outcomes is clear. In this article, we review the principal aspects of pathophysiology and diagnosis of HFrEF, with focus on emerging biomarkers and on recent echocardiographic methods for the assessment of left ventricular function. Furthermore, we discuss several major developments in pharmacological and nonpharmacological treatment of HFrEF in the last years, including cardiac resynchronization therapy, implantable cardioverter defibrillators, and the recent and promising drug LCZ696, focusing on current indications, unanswered questions, and other relevant aspects.
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Frankenstein L, Fröhlich H, Cleland JGF. Multidisciplinary Approach for Patients Hospitalized With Heart Failure. ACTA ACUST UNITED AC 2016; 68:885-91. [PMID: 26409892 DOI: 10.1016/j.rec.2015.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/04/2015] [Indexed: 12/24/2022]
Abstract
Acute heart failure describes the rapid deterioration, over minutes, days or hours, of symptoms and signs of heart failure. Its management is an interdisciplinary challenge that requires the cooperation of various specialists. While emergency providers, (interventional) cardiologists, heart surgeons, and intensive care specialists collaborate in the initial stabilization of acute heart failure patients, the involvement of nurses, discharge managers, and general practitioners in the heart failure team may facilitate the transition from inpatient care to the outpatient setting and improve acute heart failure readmission rates. This review highlights the importance of a multidisciplinary approach to acute heart failure with particular focus on the chain-of-care delivered by the various services within the healthcare system.
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Affiliation(s)
- Lutz Frankenstein
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Heidelberg, Germany.
| | - Hanna Fröhlich
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Heidelberg, Germany
| | - John G F Cleland
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, United Kingdom
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Krumholz HM, Hsieh A, Dreyer RP, Welsh J, Desai NR, Dharmarajan K. Trajectories of Risk for Specific Readmission Diagnoses after Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia. PLoS One 2016; 11:e0160492. [PMID: 27716841 PMCID: PMC5055318 DOI: 10.1371/journal.pone.0160492] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 07/20/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The risk of rehospitalization is elevated in the immediate post-discharge period and declines over time. It is not known if the extent and timing of risk vary across readmission diagnoses, suggesting that recovery and vulnerability after discharge differ by physiologic system. OBJECTIVE We compared risk trajectories for major readmission diagnoses in the year after discharge among all Medicare fee-for-service beneficiaries hospitalized with heart failure (HF), acute myocardial infarction (AMI), or pneumonia from 2008-2010. METHODS We estimated the daily risk of rehospitalization for 12 major readmission diagnostic categories after accounting for the competing risk of death after discharge. For each diagnostic category, we identified (1) the time required for readmission risk to peak and then decline 50% from maximum values after discharge; (2) the time required for readmission risk to approach plateau periods of minimal day-to-day change; and (3) the extent to which hospitalization risks are higher among patients recently discharged from the hospital compared with the general elderly population. RESULTS Among >3,000,000 hospitalizations, the yearly rate of rehospitalization was 67.0%, 49.5%, and 55.3% after hospitalization for HF, AMI, and pneumonia, respectively. The extent and timing of risk varied by readmission diagnosis and initial admitting condition. Risk of readmission for gastrointestinal bleeding/anemia peaked particularly late after hospital discharge, occurring 10, 6, and 7 days after hospitalization for HF, AMI, and pneumonia, respectively. Risk of readmission for trauma/injury declined particularly slowly, requiring 38, 20, and 38 days to decline by 50% after hospitalization for HF, AMI, and pneumonia, respectively. CONCLUSIONS Patterns of vulnerability to different conditions that cause rehospitalization vary by time after hospital discharge. This finding suggests that recovery of various physiologic systems occurs at different rates and that post-discharge interventions to minimize vulnerability to specific conditions should be tailored to their underlying risks.
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Affiliation(s)
- Harlan M. Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States of America
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, United States of America
- Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Angela Hsieh
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States of America
| | - Rachel P. Dreyer
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States of America
| | - John Welsh
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States of America
| | - Nihar R. Desai
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States of America
| | - Kumar Dharmarajan
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States of America
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Dunbar-Yaffe R, Stitt A, Lee JJ, Mohamed S, Lee DS. Assessing Risk and Preventing 30-Day Readmissions in Decompensated Heart Failure: Opportunity to Intervene? Curr Heart Fail Rep 2016; 12:309-17. [PMID: 26289741 PMCID: PMC4768253 DOI: 10.1007/s11897-015-0266-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Heart failure (HF) patients are at high risk of hospital readmission, which contributes to substantial health care costs. There is great interest in strategies to reduce rehospitalization for HF. However, many readmissions occur within 30 days of initial hospital discharge, presenting a challenge for interventions to be instituted in a short time frame. Potential strategies to reduce readmissions for HF can be classified into three different forms. First, patients who are at high risk of readmission can be identified even before their initial index hospital discharge. Second, ambulatory remote monitoring strategies may be instituted to identify early warning signs before acute decompensation of HF occurs. Finally, strategies may be employed in the emergency department to identify low-risk patients who may not need hospital readmission. If symptoms improve with initial therapy, low-risk patients could be referred to specialized, rapid outpatient follow-up care where investigations and therapy can occur in an outpatient setting.
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Affiliation(s)
- Richard Dunbar-Yaffe
- Institute for Clinical Evaluative Sciences, University of Toronto, 2075 Bayview Avenue, Room G-106, Toronto, ON, M4N 3M5, Canada
| | - Audra Stitt
- Institute for Clinical Evaluative Sciences, University of Toronto, 2075 Bayview Avenue, Room G-106, Toronto, ON, M4N 3M5, Canada
| | - Joseph J Lee
- Institute for Clinical Evaluative Sciences, University of Toronto, 2075 Bayview Avenue, Room G-106, Toronto, ON, M4N 3M5, Canada
| | - Shanas Mohamed
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Douglas S Lee
- Institute for Clinical Evaluative Sciences, University of Toronto, 2075 Bayview Avenue, Room G-106, Toronto, ON, M4N 3M5, Canada. .,Peter Munk Cardiac Centre and Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada. .,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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Brunner-La Rocca HP, Fleischhacker L, Golubnitschaja O, Heemskerk F, Helms T, Hoedemakers T, Allianses SH, Jaarsma T, Kinkorova J, Ramaekers J, Ruff P, Schnur I, Vanoli E, Verdu J, Zippel-Schultz B. Challenges in personalised management of chronic diseases-heart failure as prominent example to advance the care process. EPMA J 2016; 7:2. [PMID: 26913090 PMCID: PMC4765020 DOI: 10.1186/s13167-016-0051-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/15/2015] [Indexed: 12/31/2022]
Abstract
Chronic diseases are the leading causes of morbidity and mortality in
Europe, accounting for more than 2/3 of all death causes and 75 % of the healthcare
costs. Heart failure is one of the most prominent, prevalent and complex chronic
conditions and is accompanied with multiple other chronic diseases. The current
approach to care has important shortcomings with respect to diagnosis, treatment and
care processes. A critical aspect of this situation is that interaction between
stakeholders is limited and chronic diseases are usually addressed in
isolation. Health care in Western countries requires an innovative approach to
address chronic diseases to provide sustainability of care and to limit the
excessive costs that may threaten the current systems. The increasing prevalence of
chronic diseases combined with their enormous economic impact and the increasing
shortage of healthcare providers are among the most critical threats. Attempts to
solve these problems have failed, and future limitations in financial resources will
result in much lower quality of care. Thus, changing the approach to care for
chronic diseases is of utmost social importance.
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Affiliation(s)
- Hans-Peter Brunner-La Rocca
- Heart Failure Clinic, Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202AZ Maastricht, The Netherlands
| | | | | | | | - Thomas Helms
- German Foundation for the Chronically Ill, Fürth, Germany
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Gu M, Ma Y, Zhou T, Xia Y. Evaluation of a Community Health Service Center-Based Intervention Program for Managing Chronic Heart Failure. Balkan Med J 2016; 33:45-51. [PMID: 26966617 DOI: 10.5152/balkanmedj.2015.150023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 07/03/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although the role of primary care for the management of patients with chronic heart failure (CHF) has been highly recommended, structural involvement of primary care in heart failure (HF) management programs is extremely limited. AIMS To examine the feasibility and applicability of two most recommended forms of care delivery mode, home visit and telephone support, for CHF management in the setting of community health service center (CHSC). STUDY DESIGN Prospective study. METHODS This study was conducted in two CHSCs in Beijing, China. Care delivery was led by trained general practitioners or community nurses via home visits in one CHSC and telephone support in the other. Data regarding the change in mortality and hospitalization rate during 12 months and self-care level at 6 months were prospectively collected and compared across the intervention groups. RESULTS A total of 329 patients were included, with 142 in the home visit group and 187 in the telephone support group. Patients in both groups had frequent visits to CHSC (8.1±5.9 in the home visit and 7.7±4.1 in the telephone support group, p=0.45) during the follow-up period. Compared to the telephone support group, patients in the home visit group showed a reduction in all-cause mortality (14.1% versus 20.3%, p=0.14), one or more hospitalizations due to any cause (33.8% versus 44.2%, p=0.12) and one or more hospitalizations due to cardiac cause (17.6% versus 24.6%, p=0.13) in the home visit group. The absolute differences were 6.2% (95% CI: 1.9%, 14.3%), 8.4% (95% CI: 2.1%, 18.9%) and 7.3% (95% CI: 1.5%, 16.1%), respectively, although the results were not statistically significant. After 6 months of intervention, patients in both groups achieved marked improvement in self-care with reference to their own baseline values. CONCLUSION Although no statistical difference was observed between the two care delivery approaches regarding the clinical outcomes of interest, given the high participation rates, the acceptable rate of adverse events, frequent CHSC visits and patients' preferences in the current study, it was concluded that CHSC might be the optimal setting for delivering care to CHF patients in China.
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Affiliation(s)
- Moli Gu
- Department of Nursing, No. 1 Hospital affiliated to General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Yanlan Ma
- Department of Nursing, No. 1 Hospital affiliated to General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Ti Zhou
- Department of Nursing, No. 1 Hospital affiliated to General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Yunfeng Xia
- The Cadre Ward, No. 1 Hospital affiliated to General Hospital of the Chinese People's Liberation Army, Beijing, China
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Aranda JM. Strategies to Reduce Heart Failure Hospitalizations and Readmissions: How Low Can We Go? CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2015. [DOI: 10.15212/cvia.2015.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kiernan MS, Joseph SM, Katz JN, Kilic A, Rich JD, Tallman MP, Van Buren P, Lyons JJ, Bethea B, Eckman P, Gosev I, Lee SS, Soleimani B, Takayama H, Patel CB, Uriel N. Sharing the care of mechanical circulatory support: collaborative efforts of patients/caregivers, shared-care sites, and left ventricular assist device implanting centers. Circ Heart Fail 2015; 8:629-35. [PMID: 25991805 DOI: 10.1161/circheartfailure.114.001767] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael S Kiernan
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.).
| | - Susan M Joseph
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Jason N Katz
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Ahmet Kilic
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Jonathan D Rich
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Mark P Tallman
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Peter Van Buren
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - James J Lyons
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Brian Bethea
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Peter Eckman
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Igor Gosev
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Sangjin S Lee
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Behzad Soleimani
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Hiroo Takayama
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Chetan B Patel
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Nir Uriel
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
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A qualitative study of the current state of heart failure community care in Canada: what can we learn for the future? BMC Health Serv Res 2015. [PMID: 26216103 PMCID: PMC4515922 DOI: 10.1186/s12913-015-0955-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background In North America and other industrialized countries, heart failure (HF) has become a national public health priority. Studies indicate there is significant heterogeneity in approaches to treat and manage HF and suggest targeted changes in health care delivery are needed to reduce unnecessary health care utilization and to optimize patient outcomes. Most recent published studies have reported on the care of HF patients in tertiary care hospitals and the perspective of non-specialist stakeholders on HF management, such as general practitioners and clinics or hospital administrators is rarely considered. This study explores the current state of community-based HF care in Canada as experienced by various healthcare stakeholders providing or coordinating care to HF patients. Methods This study employed a qualitative exploratory research design consisting of semi-structured telephone interviews conducted with health care providers and health care administrators working outside of tertiary care in the four most populous Canadian provinces. A modified thematic analysis process was used and the different data sources were triangulated. Findings were collectively interpreted by the authors. Results Twenty-eight participants were recruited in the study: eight cardiologists, five general practitioners/family physicians, eight nurse practitioners/registered nurses, four hospital pharmacists and three health care administrators/directors. Participants reported a lack of stakeholder engagement throughout the continuum of care, which hinders the implementation of a coordinated approach to quality HF care. Four substantive themes emerged that indicated challenges and gaps in the optimal treatment and management of HF in community settings: 1) challenges in the risk assessment and early diagnosis of HF, 2) challenges in ensuring efficient and consistent transition from acute care setting to the community, 3) challenges of primary care providers to optimally treat and manage HF patients, and 4) challenges in promoting a holistic approach in HF management. Conclusions As health systems evolve from tertiary-based care to community-based outpatient services for the management of chronic diseases, this study’s findings pinpoint challenges that have been observed in the Canadian context and can stimulate and orient dialogue toward solutions for a more coordinated approach to improve the care of HF patients and reduce pressure on the healthcare system.
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Kraus S, Ntusi NAB. Specialist multidisciplinary hypertrophic cardiomyopathy clinics: should they be the standard of care? Intern Med J 2015; 45:237-8. [DOI: 10.1111/imj.12686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 01/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- S. Kraus
- Division of Cardiology, Department of Medicine; University of Cape Town and Groote Schuur Hospital; Cape Town South Africa
| | - N. A. B. Ntusi
- Division of Cardiology, Department of Medicine; University of Cape Town and Groote Schuur Hospital; Cape Town South Africa
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Cowie MR, Anker SD, Cleland JGF, Felker GM, Filippatos G, Jaarsma T, Jourdain P, Knight E, Massie B, Ponikowski P, López-Sendón J. Improving care for patients with acute heart failure: before, during and after hospitalization. ESC Heart Fail 2015; 1:110-145. [PMID: 28834628 DOI: 10.1002/ehf2.12021] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Acute heart failure (AHF) is a common and serious condition that contributes to about 5% of all emergency hospital admissions in Europe and the USA. Here, we present the recommendations from structured discussions among an author group of AHF experts in 2013. The epidemiology of AHF and current practices in diagnosis, treatment, and long-term care for patients with AHF in Europe and the USA are examined. Available evidence indicates variation in the quality of care across hospitals and regions. Challenges include the need for rapid diagnosis and treatment, the heterogeneity of precipitating factors, and the typical repeated episodes of decompensation requiring admission to hospital for stabilization. In hospital, care should involve input from an expert in AHF and auditing to ensure that guidelines and protocols for treatment are implemented for all patients. A smooth transition to follow-up care is vital. Patient education programmes could have a dramatic effect on improving outcomes. Information technology should allow, where appropriate, patient telemonitoring and sharing of medical records. Where needed, access to end-of-life care and support for all patients, families, and caregivers should form part of a high-quality service. Eight evidence-based consensus policy recommendations are identified by the author group: optimize patient care transitions, improve patient education and support, provide equity of care for all patients, appoint experts to lead AHF care across disciplines, stimulate research into new therapies, develop and implement better measures of care quality, improve end-of-life care, and promote heart failure prevention.
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Affiliation(s)
- Martin R Cowie
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
| | - Stefan D Anker
- Charité-University Medical Centre, Campus Virchow-Klinikum, Berlin, Germany
| | - John G F Cleland
- National Heart and Lung Institute, Imperial College London and Harefield Hospital, London, UK.,University of Hull, Hull, UK
| | | | | | - Tiny Jaarsma
- Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Patrick Jourdain
- René Dubos Hospital, Pontoise, France.,Paris Descartes University, Paris, France
| | | | - Barry Massie
- San Francisco Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | | | - José López-Sendón
- Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
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Reply. J Am Coll Cardiol 2015; 65:107-108. [DOI: 10.1016/j.jacc.2014.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/07/2014] [Indexed: 11/22/2022]
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Price E, Baker R, Krause J, Keen C. Organisation of services for people with cardiovascular disorders in primary care: transfer to primary care or to specialist-generalist multidisciplinary teams? BMC FAMILY PRACTICE 2014; 15:158. [PMID: 25245456 PMCID: PMC4262997 DOI: 10.1186/1471-2296-15-158] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 09/09/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND An ageing population and high levels of multimorbidity increase rates of GP and specialist consultations. Constraints on health care funding are leading to additional pressure for the adoption of safe and cost-effective alternatives to specialist care, in some cases by shifting services to primary care. DISCUSSION In this paper we argue, having searched for evidence on approaches to shifting care for some people with cardiovascular problems from secondary to primary care, that a collaborative, multidisciplinary approach is required to achieve high quality outcomes from cardiovascular care in the primary care setting. Simply transferring patients from specialist care to management by primary care teams is likely to lead to worse outcomes than services that involve both specialists and primary care teams together, in planned and effectively managed systems of care.The care of patients with certain chronic conditions in the community, if appropriately organised, can achieve the same health outcomes as ambulatory care by hospital specialists. However, shared care by GPs and specialists for patients with chronic heart failure after discharge from hospital can deliver better patient survival. The existing models of shared care include specialists working in an ambulatory care setting (in Central and Eastern Europe) or in hospital based outreach clinics, and cardiology care organised by GPs in the UK and Australia, which have demonstrated reductions in referral rates. SUMMARY Current research supports the idea of the management of certain chronic health conditions in primary care based on the integration of GPs and specialists into multidisciplinary teams, based on availability of reliable evidence about cost-effectiveness, health care outcomes, patient preference and incentives for GPs. Evaluation of such schemes is mandatory, however, to ensure that the expected benefits do materialise.
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Affiliation(s)
- Egle Price
- />Department of Health Sciences, University of Leicester, 22-28 Princess Road West, LE1 6TP Leicester, UK
- />6 Northage Close, Quorn, Loughborough, Leicestershire, LE128AT UK
| | - Richard Baker
- />Department of Health Sciences, University of Leicester, 22-28 Princess Road West, LE1 6TP Leicester, UK
| | - Jane Krause
- />Department of Health Sciences, University of Leicester, 22-28 Princess Road West, LE1 6TP Leicester, UK
| | - Christine Keen
- />NIHR RDS East Midlands, Faculty of Health & Life Sciences, Innovation Centre, De Montfort University, The Gateway, Leicester, LE1 9BH UK
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Jankowska EA, Kalicinska E, Drozd M, Kurian B, Banasiak W, Ponikowski P. Comparison of clinical profile and management of outpatients with heart failure with reduced left ventricular ejection fraction treated by general practitioners and cardiologists in contemporary Poland: the results from the DATA-HELP registry. Int J Cardiol 2014; 176:852-8. [PMID: 25156847 DOI: 10.1016/j.ijcard.2014.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 06/19/2014] [Accepted: 08/02/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We sought to determine and compare clinical profile and management of outpatients with heart failure with reduced ejection fraction (HFREF) treated by cardiologists and general practitioners (GPs) in Poland. METHODS All the 790 randomly selected cardiologists and GPs in the DATA-HELP registry, which included 5563 patients, filled out questionnaires about 10 consecutive outpatients with HFREF. RESULTS Outpatients managed by GPs were older (69±10 vs 66±12 years), and the prevalence of men was less marked (58% vs 67%). They also had higher left ventricular ejection fraction (38±6% vs 35±8%) and had more pulmonary congestion (63% vs 49%) and peripheral oedema (66% vs 51%), compared with those treated by cardiologists (all p<0.001). Hypertension (74% vs 66%), previous stroke and/or transient ischaemic attack (21% vs 16%), diabetes (40% vs 30%), and chronic obstructive pulmonary disease (14% vs 11%) were more common in outpatients of GPs (all p<0.001). GPs were less likely to prescribe β-blocker (95% vs 97%, p<0.01), mineralocorticoid receptor antagonist (MRA) (56% vs 64%, p<0.001), and loop diuretic (61% vs 64%, p<0.05) or use PCI (33% vs 44%, p<0.001), CABG (11% vs 16%, p<0.001), ICD (4% vs 10%, p<0.001), or CRT (1% vs 5%, p<0.001). Prescription of renin-angiotensin system inhibitors (94% vs 94%, p>0.2) and digoxin (20% vs 21%, p>0.2) by GPs and cardiologists was similar. CONCLUSION In contemporary Poland, most outpatients with HFREF receive drugs that improve survival and undergo revascularisation procedures, although devices are rare, but the clinical profiles and management of those treated by GPs and cardiologists differ. Outpatients treated by GPs are older and have more co-morbidities. Outpatients treated by cardiologists more commonly receive β-blocker, MRA, ICD, and CRT, and undergo coronary revascularisations.
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Affiliation(s)
- Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland; Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.
| | - Elzbieta Kalicinska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland; Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Marcin Drozd
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | - Waldemar Banasiak
- Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland; Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
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Dracup K, Moser DK, Pelter MM, Nesbitt TS, Southard J, Paul SM, Robinson S, Cooper LS. Randomized, Controlled Trial to Improve Self-Care in Patients With Heart Failure Living in Rural Areas. Circulation 2014; 130:256-64. [DOI: 10.1161/circulationaha.113.003542] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Kathleen Dracup
- From the University of California San Francisco, School of Nursing, San Francisco (K.D., S.M.P., S.R.); University of Kentucky, College of Nursing, Lexington (D.K.M.); University of Nevada, Reno (M.M.P.); University of California, School of Medicine, Davis (T.S.N., J.S.); and National Heart, Lung and Blood Institute, Bethesda, MD (L.S.C.)
| | - Debra K. Moser
- From the University of California San Francisco, School of Nursing, San Francisco (K.D., S.M.P., S.R.); University of Kentucky, College of Nursing, Lexington (D.K.M.); University of Nevada, Reno (M.M.P.); University of California, School of Medicine, Davis (T.S.N., J.S.); and National Heart, Lung and Blood Institute, Bethesda, MD (L.S.C.)
| | - Michele M. Pelter
- From the University of California San Francisco, School of Nursing, San Francisco (K.D., S.M.P., S.R.); University of Kentucky, College of Nursing, Lexington (D.K.M.); University of Nevada, Reno (M.M.P.); University of California, School of Medicine, Davis (T.S.N., J.S.); and National Heart, Lung and Blood Institute, Bethesda, MD (L.S.C.)
| | - Thomas S. Nesbitt
- From the University of California San Francisco, School of Nursing, San Francisco (K.D., S.M.P., S.R.); University of Kentucky, College of Nursing, Lexington (D.K.M.); University of Nevada, Reno (M.M.P.); University of California, School of Medicine, Davis (T.S.N., J.S.); and National Heart, Lung and Blood Institute, Bethesda, MD (L.S.C.)
| | - Jeffrey Southard
- From the University of California San Francisco, School of Nursing, San Francisco (K.D., S.M.P., S.R.); University of Kentucky, College of Nursing, Lexington (D.K.M.); University of Nevada, Reno (M.M.P.); University of California, School of Medicine, Davis (T.S.N., J.S.); and National Heart, Lung and Blood Institute, Bethesda, MD (L.S.C.)
| | - Steven M. Paul
- From the University of California San Francisco, School of Nursing, San Francisco (K.D., S.M.P., S.R.); University of Kentucky, College of Nursing, Lexington (D.K.M.); University of Nevada, Reno (M.M.P.); University of California, School of Medicine, Davis (T.S.N., J.S.); and National Heart, Lung and Blood Institute, Bethesda, MD (L.S.C.)
| | - Susan Robinson
- From the University of California San Francisco, School of Nursing, San Francisco (K.D., S.M.P., S.R.); University of Kentucky, College of Nursing, Lexington (D.K.M.); University of Nevada, Reno (M.M.P.); University of California, School of Medicine, Davis (T.S.N., J.S.); and National Heart, Lung and Blood Institute, Bethesda, MD (L.S.C.)
| | - Lawton S. Cooper
- From the University of California San Francisco, School of Nursing, San Francisco (K.D., S.M.P., S.R.); University of Kentucky, College of Nursing, Lexington (D.K.M.); University of Nevada, Reno (M.M.P.); University of California, School of Medicine, Davis (T.S.N., J.S.); and National Heart, Lung and Blood Institute, Bethesda, MD (L.S.C.)
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Comín-Colet J, Verdú-Rotellar JM, Vela E, Clèries M, Bustins M, Mendoza L, Badosa N, Cladellas M, Ferré S, Bruguera J. Eficacia de un programa integrado hospital-atención primaria para la insuficiencia cardiaca: análisis poblacional sobre 56.742 pacientes. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.12.007] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Comín-Colet J, Verdú-Rotellar JM, Vela E, Clèries M, Bustins M, Mendoza L, Badosa N, Cladellas M, Ferré S, Bruguera J. Efficacy of an integrated hospital-primary care program for heart failure: a population-based analysis of 56,742 patients. ACTA ACUST UNITED AC 2014; 67:283-93. [PMID: 24774591 DOI: 10.1016/j.rec.2013.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/03/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES The efficacy of heart failure programs has been demonstrated in clinical trials but their applicability in the real world practice setting is more controversial. This study evaluates the feasibility and efficacy of an integrated hospital-primary care program for the management of patients with heart failure in an integrated health area covering a population of 309,345. METHODS For the analysis, we included all patients consecutively admitted with heart failure as the principal diagnosis who had been discharged alive from all of the hospitals in Catalonia, Spain, from 2005 to 2011, the period when the program was implemented, and compared mortality and readmissions among patients exposed to the program with the rates in the patients of all the remaining integrated health areas of the Servei Català de la Salut (Catalan Health Service). RESULTS We included 56,742 patients in the study. There were 181,204 hospital admissions and 30,712 deaths during the study period. In the adjusted analyses, when compared to the 54,659 patients from the other health areas, the 2083 patients exposed to the program had a lower risk of death (hazard ratio=0.92 [95% confidence interval, 0.86-0.97]; P=.005), a lower risk of clinically-related readmission (hazard ratio=0.71 [95% confidence interval, 0.66-0.76]; P<.001), and a lower risk of readmission for heart failure (hazard ratio=0.86 [95% confidence interval, 0.80-0.94]; P<.001). The positive impact on the morbidity and mortality rates was more marked once the program had become well established. CONCLUSIONS The implementation of multidisciplinary heart failure management programs that integrate the hospital and the community is feasible and is associated with a significant reduction in patient morbidity and mortality.
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Affiliation(s)
- Josep Comín-Colet
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain; Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares del Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - José María Verdú-Rotellar
- Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain; Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares del Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Atención Primaria Sant Martí de Provençals, Institut Català de la Salut, Barcelona, Spain; Institut d'Investigació d'Atenció Primària Jordi Gol, Institut Català de la Salut, Barcelona, Spain
| | - Emili Vela
- División de Análisis de la Demanda y la Actividad, Servei Català de la Salut, Barcelona, Spain
| | - Montse Clèries
- División de Análisis de la Demanda y la Actividad, Servei Català de la Salut, Barcelona, Spain
| | - Montserrat Bustins
- División de Análisis de la Demanda y la Actividad, Servei Català de la Salut, Barcelona, Spain
| | - Lola Mendoza
- Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain; Centro de Atención Primaria Poble Nou, Institut Català de la Salut, Barcelona, Spain
| | - Neus Badosa
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain; Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares del Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Mercè Cladellas
- Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares del Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Sofía Ferré
- Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain
| | - Jordi Bruguera
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain; Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut, Barcelona, Spain; Grupo de Investigación Biomédica en Enfermedades del Corazón, Programa de Investigación en Procesos Inflamatorios y Cardiovasculares del Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
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