1
|
Smith AB, Jung M, O'Donnell D, White FA, Pressler SJ. Pain, Return to Community Status, and 90-Day Mortality Among Hospitalized Patients With Heart Failure. J Cardiovasc Nurs 2024:00005082-990000000-00202. [PMID: 38915135 DOI: 10.1097/jcn.0000000000001114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND Pain is common among patients with heart failure but has not been examined with short-term discharge outcomes. The purpose was to examine whether pain at discharge predicts return to community status and 90-day mortality among hospitalized patients with heart failure. METHODS Data from medical records of 2169 patients hospitalized with heart failure were analyzed in this retrospective cohort study. The independent variable was a diagnosis of pain at discharge. Outcomes were return to community status (yes/no) and 90-day mortality. Logistic regression was used to address aims. Covariates included age, gender, race, vital signs, comorbid symptoms, comorbid conditions, cardiac devices, and length of stay. RESULTS The sample had a mean age of 66.53 years, and was 57.4% women and 55.9% Black. Of 2169 patients, 1601 (73.8%) returned to community, and 117 (5.4%) died at or before 90 days. Patients with pain returned to community less frequently (69.6%) compared with patients without pain (75.2%), which was a statistically significant relationship (odds ratio, 0.74; 95% confidence interval, 0.57-0.97; P = .028). Other variables that predicted return to community status included age, comorbid conditions, dyspnea, fatigue, systolic blood pressure, and length of stay. Pain did not predict increased 90-day mortality. Variables that predicted mortality included age, liver disease, and systolic blood pressure. CONCLUSION Patients with pain were less likely to return to community but did not have higher 90-day mortality. Pain in combination with other symptoms and comorbid conditions may play a role in mortality if acute pain versus chronic pain can be stratified in a future study.
Collapse
|
2
|
Mentias A, Keshvani N, Sumarsono A, Desai R, Khan MS, Menon V, Hsich E, Bress AP, Jacobs J, Vasan RS, Fonarow GC, Pandey A. Patterns, Prognostic Implications, and Rural-Urban Disparities in Optimal GDMT Following HFrEF Diagnosis Among Medicare Beneficiaries. JACC. HEART FAILURE 2024; 12:1044-1055. [PMID: 37943222 DOI: 10.1016/j.jchf.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Patterns and disparities in guideline-directed medical therapy (GDMT) uptake for heart failure with reduced ejection fraction (HFrEF) across rural vs urban regions are not well described. OBJECTIVES This study aims to evaluate patterns, prognostic implications, and rural-urban differences in GDMT use among Medicare beneficiaries following new-onset HFrEF. METHODS Patients with a diagnosis of new-onset HFrEF in a 5% Medicare sample with available data for Part D medication use were identified from January 2015 through December 2020. The primary exposure was residence in rural vs urban zip codes. Optimal triple GDMT was defined as ≥50% of the target daily dose of beta-blockers, ≥50% of the target daily dose of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker or any dose of sacubitril/valsartan, and any dose of mineralocorticoid receptor antagonist. The association between the achievement of optimal GDMT over time following new-onset HFrEF diagnosis and risk of all-cause mortality and subsequent HF hospitalization was also evaluated using adjusted Cox models. The association between living in rural vs urban location and time to optimal GDMT achievement over a 12-month follow-up was assessed using cumulative incidence curves and adjusted Fine-Gray subdistribution hazard models. RESULTS A total of 41,296 patients (age: 76.7 years; 15.0% Black; 27.6% rural) were included. Optimal GDMT use over the 12-month follow-up was low, with 22.5% initiated on any dose of triple GDMT and 9.1% on optimal GDMT doses. Optimal GDMT on follow-up was significantly associated with a lower risk of death (HR: 0.89 [95% CI: 0.85-0.94]; P < 0.001) and subsequent HF hospitalization (HR: 0.93 [95% CI: 0.87-0.98]; P = 0.02). Optimal GDMT use at 12 months was significantly lower among patients living in rural (vs urban) areas (8.4% vs 9.3%; P = 0.02). In adjusted analysis, living in rural (vs urban) locations was associated with a significantly lower probability of achieving optimal GDMT (HR: 0.92 [95% CI: 0.86-0.98]; P = 0.01 Differences in optimal GDMT use following HFrEF diagnosis accounted for 16% of excess mortality risk among patients living in rural (vs urban) areas. CONCLUSIONS Use of optimal GDMT following new-onset HFrEF diagnosis is low, with substantially lower use noted among patients living in rural vs urban locations. Suboptimal GDMT use following new-onset HFrEF was associated with an increased risk of mortality and subsequent HF hospitalization.
Collapse
Affiliation(s)
- Amgad Mentias
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Andrew Sumarsono
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | - Venu Menon
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eileen Hsich
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Adam P Bress
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Joshua Jacobs
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Ramachandran S Vasan
- School of Public Health, Department of Population Health, and Division of Cardiology, Long School of Medicine, University of Texas San Antonio, San Antonio, Texas, USA
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center, Los Angeles, California, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| |
Collapse
|
3
|
Kinugasa Y, Nakamura K, Hirai M, Manba M, Ishiga N, Sota T, Nakayama N, Ohta T, Kato M, Adachi T, Fukuki M, Hirota Y, Mizuta E, Mura E, Nozaka Y, Omodani H, Tanaka H, Tanaka Y, Watanabe I, Mikami M, Yamamoto K. Association of a Transitional Heart Failure Management Program With Readmission and End-of-Life Care in Rural Japan. Circ Rep 2024; 6:168-177. [PMID: 38736846 PMCID: PMC11082435 DOI: 10.1253/circrep.cr-24-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 05/14/2024] Open
Abstract
Background: Evidence on transitional care for heart failure (HF) in Japan is limited. Methods and Results: We implemented a transitional HF management program in rural Japan in 2019. This involved collaboration with general practitioners or nursing care facilities and included symptom monitoring by medical/nursing staff using a handbook; standardized discharge care planning and information sharing on self-care and advance care planning using a collaborative sheet; and sharing expertise on HF management via manuals. We compared the outcomes within 1 year of discharge among patients hospitalized with HF in the 2 years before program implementation (2017-2018; historical control, n=198), in the first 2 years after program implementation (2019-2020; Intervention Phase 1, n=205), and in the second 2 years, following program revision and regional dissemination (2021-2022; Intervention Phase 2, n=195). HF readmission rates gradually decreased over Phases 1 and 2 (P<0.05). This association was consistent regardless of physician expertise, follow-up institution, or the use of nursing care services (P>0.1 for interaction). Mortality rates remained unchanged, but significantly more patients received end-of-life care at home in Phase 2 than before (P<0.05). Conclusions: The implementation of a transitional care program was associated with decreased HF readmissions and increased end-of-life care at home for HF patients in rural Japan.
Collapse
Affiliation(s)
- Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University Yonago Japan
| | - Kensuke Nakamura
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University Yonago Japan
| | - Masayuki Hirai
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University Yonago Japan
| | - Midori Manba
- Division of Nursing, Tottori University Hospital Yonago Japan
| | - Natsuko Ishiga
- Division of Rehabilitation, Tottori University Hospital Yonago Japan
| | - Takeshi Sota
- Division of Rehabilitation, Tottori University Hospital Yonago Japan
| | | | - Tomoki Ohta
- Division of Pharmacy, Tottori University Hospital Yonago Japan
| | - Masahiko Kato
- Department of Pathobiological Science and Technology, School of Health Science, Faculty of Medicine, Tottori University Yonago Japan
| | | | - Masaharu Fukuki
- Department of Cardiology, Yonago Medical Center Yonago Japan
| | | | | | - Emiko Mura
- Visiting Nurse Station Nanbu Kohoen Yonago Japan
| | | | - Hiroki Omodani
- Omodani Internal Medicine and Cardiovascular Medicine Clinic Yonago Japan
| | - Hiroaki Tanaka
- Department of Cardiology, Tottori Prefecture Sakaiminato General Hospital Sakaiminato Japan
| | | | - Izuru Watanabe
- Department of Nursing, Sanin Rosai Hospital Yonago Japan
| | | | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University Yonago Japan
| |
Collapse
|
4
|
Meng Y, Zhang T, Ge X, Zheng Q, Feng T. Physical activity changes and related factors in chronic heart failure patients during the postdischarge transition period: a longitudinal study. BMC Cardiovasc Disord 2024; 24:232. [PMID: 38684960 PMCID: PMC11059695 DOI: 10.1186/s12872-024-03881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Physical activity (PA) is essential and effective for chronic heart failure (CHF) patients. A greater understanding of the longitudinal change in PA and its influencing factors during the postdischarge transition period may help create interventions for improving PA. The aims of this study were (1) to compare the change in PA, (2) to examine the influencing factors of PA change, and (3) to verify the mediating pathways between influencing factors and PA during the postdischarge transition period in CHF patients. METHODS A total of 209 CHF patients were recruited using a longitudinal study design. The Chinese version of the International Physical Activity Questionnaire (IPAQ), Patient-reported Outcome Measure for CHF (CHF-PRO), and the Chinese version of the Tampa Scale for Kinesiophobia Heart (TSK-Heart) were used to assess PA, CHF-related symptoms, and kinesiophobia. The IPAQ score was calculated (1) at admission, (2) two weeks after discharge, (3) two months after discharge, and (4) three months after discharge. Two additional questionnaires were collected during admission. Generalized estimating equation (GEE) models were fitted to identify variables associated with PA over time. We followed the STROBE checklist for reporting the study. RESULTS The PA scores at the four follow-up visits were 1039.50 (346.50-1953.00) (baseline/T1), 630.00 (1.00-1260.00) (T2), 693.00 (1-1323.00) (T3) and 693.00 (160.88-1386.00) (T4). The PA of CHF patients decreased unevenly, with the lowest level occurring two weeks after discharge, and gradually improving at two and three months after discharge. CHF-related symptoms and kinesiophobia were significantly associated with changes in PA over time. Compared with before hospitalization, an increase in CHF-related symptoms at two weeks and two months after discharge was significantly associated with decreased PA. According to our path analysis, CHF-related symptoms were positively and directly associated with kinesiophobia, and kinesiophobia was negatively and directly related to PA. Moreover, CHF-related symptoms are indirectly related to PA through kinesiophobia. CONCLUSION PA changed during the postdischarge transition period and was associated with CHF-related symptoms and kinesiophobia in CHF patients. Reducing CHF-related symptoms helps improve kinesiophobia in CHF patients. In addition, the reduction in CHF-related symptoms led to an increase in PA through the improvement of kinesiophobia. TRIAL REGISTRATION The study was registered in the Chinese Clinical Trial Registry (11/10/2022 ChiCTR2200064561 retrospectively registered).
Collapse
Affiliation(s)
- Yingtong Meng
- Cardiology Department II ward I, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, People's Republic of China
| | - Tingting Zhang
- Cardiology Department II ward I, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, People's Republic of China
| | - Xiaohua Ge
- Department of Nursing, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, People's Republic of China.
| | - Qingru Zheng
- Department of Intensive Care Medicine, The Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200233, People's Republic of China
| | - Tienan Feng
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| |
Collapse
|
5
|
Brooman-White R, Blakeman T, McNab D, Deaton C. Informing understanding of coordination of care for patients with heart failure with preserved ejection fraction: a secondary qualitative analysis. BMJ Qual Saf 2024; 33:232-245. [PMID: 37802647 DOI: 10.1136/bmjqs-2023-016583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/15/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Patients with heart failure with preserved ejection fraction (HFpEF) are a complex and underserved group. They are commonly older patients with multiple comorbidities, who rely on multiple healthcare services. Regional variation in services and resourcing has been highlighted as a problem in heart failure care, with few teams bridging the interface between the community and secondary care. These reports conflict with policy goals to improve coordination of care and dissolve boundaries between specialist services and the community. AIM To explore how care is coordinated for patients with HFpEF, with a focus on the interface between primary care and specialist services in England. METHODS We applied systems thinking methodology to examine the relationship between work-as-imagined and work-as-done for coordination of care for patients with HFpEF. We analysed clinical guidelines in conjunction with a secondary applied thematic analysis of semistructured interviews with healthcare professionals caring for patients with HFpEF including general practitioners, specialist nurses and cardiologists and patients with HFpEF themselves (n=41). Systems Thinking for Everyday Work principles provided a sensitising theoretical framework to facilitate a deeper understanding of how these data illustrate a complex health system and where opportunities for improvement interventions may lie. RESULTS Three themes (working with complexity, information transfer and working relationships) were identified to explain variability between work-as-imagined and work-as-done. Participants raised educational needs, challenging work conditions, issues with information transfer systems and organisational structures poorly aligned with patient needs. CONCLUSIONS There are multiple challenges that affect coordination of care for patients with HFpEF. Findings from this study illuminate the complexity in coordination of care practices and have implications for future interventional work.
Collapse
Affiliation(s)
- Rosalie Brooman-White
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Thomas Blakeman
- Centre for Primary Care, University of Manchester Faculty of Medical and Human Sciences, Manchester, UK
| | - Duncan McNab
- Medical Directorate, NHS Education for Scotland, Glasgow, UK
| | - Christi Deaton
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| |
Collapse
|
6
|
Hwang YS, Kim WJ, Kim TH, Park Y, Jung SM, Jo HS. Cost-utility analysis of transitional care services for older inpatients with chronic obstructive pulmonary disease (COPD) in Korea. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:19. [PMID: 38431579 PMCID: PMC10908012 DOI: 10.1186/s12962-024-00526-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with a high readmission rate and poses a significant disease burden. South Korea initiated pilot projects on transitional care services (TCS) to reduce readmissions. However, evidence from cost-effectiveness analyses remains undiscovered. This study aimed to evaluate the cost-effectiveness of TCS in patients with COPD from the healthcare system' perspective. METHOD A cost-utility analysis was conducted using a Markov model containing six components of possible medical use after discharge. Transition probabilities and medical costs were extracted from the National Health Insurance Service Senior Cohort (NHIS-SC), and utility data were obtained from published literature. Sensitivity analyses were performed to test the robustness of the results. RESULTS Conducting TCS produced an incremental quality-adjusted life years gain of 0.231, 0.275, 0.296 for those in their 60s, 70s, and 80s, respectively, and cost savings of $225.16, $1668, and $2251.64 for those in their 60s, 70s, and 80s, respectively, per patient over a 10-year time horizon. The deterministic sensitivity analysis indicated that the TCS cost and the cost of readmission by other diseases immensely impact the results. The probabilistic sensitivity analyses showed that the probability that the incremental cost-effectiveness ratio is below $23,050 was over 85%, 93%, and 97% for those in the 60s, 70s, and 80s, respectively. CONCLUSIONS TCS was the dominant option compared to usual care. However, it is advantageous to the healthcare budget preferentially consider patients aged over 70 years with severe TCS symptoms. In addition, it is essential to include the management of underlying comorbidities in TCS intervention. TRIAL REGISTRATION Clinical Research Information Service (CRIS), KCT0007937. Registered on 24 November 2022.
Collapse
Affiliation(s)
- Yu Seong Hwang
- Department of Health Policy and Management, School of Medicine, Kangwon National University, Chuncheon-si, Gangwon State, Republic of Korea
| | - Woo Jin Kim
- Department of Internal Medicine and Environmental Health Center, School of Medicine , Kangwon National University , Chuncheon-si, Gangwon State, Republic of Korea
| | - Tae Hyun Kim
- Department of Healthcare Management, Yonsei University Graduate School of Public Health, Seoul, Republic of Korea
| | - Yukyung Park
- Department of Preventive Medicine, Kangwon National University Hospital, Chuncheon-si, Gangwon State, Republic of Korea
| | - Su Mi Jung
- Team of Public Medical Policy Development, Gangwon State Research Institute for People's Health, Chuncheon-si, Gangwon State, Republic of Korea
| | - Heui Sug Jo
- Department of Health Policy and Management, School of Medicine, Kangwon National University, Chuncheon-si, Gangwon State, Republic of Korea.
- Department of Preventive Medicine, Kangwon National University Hospital, Chuncheon-si, Gangwon State, Republic of Korea.
- Team of Public Medical Policy Development, Gangwon State Research Institute for People's Health, Chuncheon-si, Gangwon State, Republic of Korea.
| |
Collapse
|
7
|
Bryant E, DeBlasis B, Langdon KD, Salisbury H. Transitions of Care. J Cardiovasc Nurs 2024; 39:104-106. [PMID: 38200646 DOI: 10.1097/jcn.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
|
8
|
Sulemanjee N, Vizgirda V, Naik K, Redman C, Tarasenko L, Jacobs I. A mixed-methods landscape assessment of supportive care for heart failure. Future Cardiol 2024; 20:55-66. [PMID: 38456443 DOI: 10.2217/fca-2023-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/23/2024] [Indexed: 03/09/2024] Open
Abstract
Aim: Understanding factors that shape leading health systems' (LHS) perspectives around heart failure (HF) treatment. Patients & methods: First of its kind study using a cross-sectional, descriptive, mixed-method design (from executives and frontline healthcare providers) with quantitative survey (n = 35) and qualitative interview (n = 12) data from 47 participants (41 different LHS). Results: 97% of LHS had dedicated HF programs, but variations in maturity highlights opportunities for care standardization. Treatment innovations continue, though practitioners may struggle to keep pace amid provider/patient barriers. HF programs strive to co-locate supportive care services to optimize treatment, but access can prove challenging. Conclusion: Opportunities exist, with external partner support, for LHS to become more comprehensive HF care providers, increasing standardization of care across LHS and improved HF treatment.
Collapse
Affiliation(s)
- Nasir Sulemanjee
- Aurora Health Care (now part of AdvocateHealth), Milwaukee, WI 53202, USA
| | - Vida Vizgirda
- Aurora Health Care (now part of AdvocateHealth), Milwaukee, WI 53202, USA
| | - Krishna Naik
- The Health Management Academy, Arlington, VA 22209, USA
| | | | | | | |
Collapse
|
9
|
Storm M, Morken IM, Austin RC, Nordfonn O, Wathne HB, Urstad KH, Karlsen B, Dalen I, Gjeilo KH, Richardson A, Elwyn G, Bru E, Søreide JA, Kørner H, Mo R, Strömberg A, Lurås H, Husebø AML. Evaluation of the nurse-assisted eHealth intervention 'eHealth@Hospital-2-Home' on self-care by patients with heart failure and colorectal cancer post-hospital discharge: protocol for a randomised controlled trial. BMC Health Serv Res 2024; 24:18. [PMID: 38178097 PMCID: PMC10768157 DOI: 10.1186/s12913-023-10508-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Patients with heart failure (HF) and colorectal cancer (CRC) are prone to comorbidity, a high rate of readmission, and complex healthcare needs. Self-care for people with HF and CRC after hospitalisation can be challenging, and patients may leave the hospital unprepared to self-manage their disease at home. eHealth solutions may be a beneficial tool to engage patients in self-care. METHODS A randomised controlled trial with an embedded evaluation of intervention engagement and cost-effectiveness will be conducted to investigate the effect of eHealth intervention after hospital discharge on the self-efficacy of self-care. Eligible patients with HF or CRC will be recruited before discharge from two Norwegian university hospitals. The intervention group will use a nurse-assisted intervention-eHealth@Hospital-2-Home-for six weeks. The intervention includes remote monitoring of vital signs; patients' self-reports of symptoms, health and well-being; secure messaging between patients and hospital-based nurse navigators; and access to specific HF and CRC health-related information. The control group will receive routine care. Data collection will take place before the intervention (baseline), at the end of the intervention (Post-1), and at six months (Post-2). The primary outcome will be self-efficacy in self-care. The secondary outcomes will include measures of burden of treatment, health-related quality of life and 30- and 90-day readmissions. Sub-study analyses are planned in the HF patient population with primary outcomes of self-care behaviour and secondary outcomes of medication adherence, and readmission at 30 days, 90 days and 6 months. Patients' and nurse navigators' engagement and experiences with the eHealth intervention and cost-effectiveness will be investigated. Data will be analysed according to intention-to-treat principles. Qualitative data will be analysed using thematic analysis. DISCUSSION This protocol will examine the effects of the eHealth@ Hospital-2-Home intervention on self-care in two prevalent patient groups, HF and CRC. It will allow the exploration of a generic framework for an eHealth intervention after hospital discharge, which could be adapted to other patient groups, upscaled, and implemented into clinical practice. TRIAL REGISTRATION Clinical trials.gov (ID 301472).
Collapse
Affiliation(s)
- Marianne Storm
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway.
- Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway.
| | - Ingvild Margreta Morken
- Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway
- Department of Quality and Health Technologies, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Rosalynn C Austin
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Department of Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- National Institute of Health and Care Research (NIHR) Applied Research Collaborative (ARC) Wessex, Southampton, SO17 1BJ, UK
| | - Oda Nordfonn
- Department of Health and Caring Science, Western Norway University of Applied Science, Stord, Norway
| | - Hege Bjøkne Wathne
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
| | - Kristin Hjorthaug Urstad
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Bjørg Karlsen
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
| | - Ingvild Dalen
- Department of Quality and Health Technologies, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Section of Biostatistics, Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Kari Hanne Gjeilo
- Department of Public Health and Nursing, Faculty of Medicine, and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Cardiology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Alison Richardson
- National Institute of Health and Care Research (NIHR) Applied Research Collaborative (ARC) Wessex, Southampton, SO17 1BJ, UK
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Mailpoint 11, Clinical Academic Facility (Room AA102), South Academic Block, Tremona Road, Southampton, SO16 6YD, UK
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Edvin Bru
- Centre for Learning Environment, University of Stavanger, Stavanger, Norway
| | - Jon Arne Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hartwig Kørner
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rune Mo
- Department of Cardiology, St. Olav's Hospital, and Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University, Linköping, Sweden
| | - Hilde Lurås
- Avdeling for Helsetjenesteforskning (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Marie Lunde Husebø
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway
| |
Collapse
|
10
|
Belfiore A, Stranieri R, Novielli ME, Portincasa P. Reducing the hospitalization epidemic of chronic heart failure by disease management programs. Intern Emerg Med 2024; 19:221-231. [PMID: 38151590 DOI: 10.1007/s11739-023-03458-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 10/10/2023] [Indexed: 12/29/2023]
Abstract
Chronic heart failure is the most common cause of hospitalization in Europe and rates are steadily increasing due to aging of the population. Hospitalization identifies a fundamental change in the natural history of heart failure (HF) increasing the risk of re-hospitalization and mortality. Heart failure management programs improve the quality of care for HF patients and reduce hospitalization burden. The goals of the heart failure management programs include optimization of drug therapy, patient education, early recognition of signs of decompensation, and management of comorbidities. Randomized clinical trials evidenced that system of care for heart failure patients improved adherence to treatment and reduced unplanned re-admissions to hospital. Multidisciplinary programs and home-visiting have shown improved efficacy with reductions in HF and all-cause hospitalizations and mortality. Community HF clinics should take care of the management of stable patients in strict contact with primary care, while hospital out-patients clinics should care of patients with severe disease or persistent clinical instability, candidates to advanced treatment options. In any case a holistic, patient-centered approach is suggested, to optimize care considering the needs of the individual patient. Telemonitoring is a new opportunity for HF patients, because it allows the continuity of care at home. All heart failure patients should require follow-up in a specific management program, but most of date come from clinical trials that included high-risk patients. While clinical trials have a specified duration (from months to some years), lifelong follow-up is recommended with differentiated approaches according to the patient's need.
Collapse
Affiliation(s)
- Anna Belfiore
- Clinica Medica "A. Murri" & Division Internal Medicine, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University "Aldo Moro" Medical School, Bari, Italy.
| | - Rosa Stranieri
- Clinica Medica "A. Murri" & Division Internal Medicine, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University "Aldo Moro" Medical School, Bari, Italy
| | - Maria Elena Novielli
- Clinica Medica "A. Murri" & Division Internal Medicine, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University "Aldo Moro" Medical School, Bari, Italy
| | - Piero Portincasa
- Clinica Medica "A. Murri" & Division Internal Medicine, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University "Aldo Moro" Medical School, Bari, Italy
| |
Collapse
|
11
|
Kinugasa Y, Adachi T, Fukuki M, Hirota Y, Ishiga N, Kato M, Mizuta E, Mura E, Nozaka Y, Omodani H, Tanaka H, Tanaka Y, Watanabe I, Yamamoto K, Mikami M. Factors affecting the willingness of nursing care staffs for cooperation with heart failure care and the role of internet video education. J Gen Fam Med 2024; 25:19-27. [PMID: 38239992 PMCID: PMC10792320 DOI: 10.1002/jgf2.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/18/2023] [Accepted: 10/29/2023] [Indexed: 01/22/2024] Open
Abstract
Background With the aging of heart failure (HF) patients, collaboration between medical and nursing care facilities is essential for HF care. The aims of this study were: (1) to identify the factors that affect willingness of nursing care staffs to cooperate with HF care; (2) to test whether the internet video education is useful in improving their willingness to collaborate. Methods A web-based questionnaire was e-mailed to 417 registered medical corporations that operated nursing care facilities in the prefecture where the authors work. Medical and care staff working at each facility were asked their willingness to cooperate with HF care and their problems about collaboration. Machine learning analysis was used to assess the factors associated with unwillingness to cooperate. After watching a 6-min YouTube video explaining HF and community collaboration, we reaffirmed their willingness to cooperate. Results We received responses from 76 medical and care staff members. Before watching the video, 32.9% of participants stated that they were unwilling to cooperate with HF care. Machine learning analysis showed that job types, perceived problems of collaboration, and low opportunities to learn about HF were associated with unwillingness to cooperation. After watching the video, we observed an increase from 67.1% to 80.3% (p < 0.05) of participants willing to cooperate with HF care. Conclusions Job types, perceived problems of collaboration, and low opportunities to learn about HF are associated with unwillingness of nursing care staff for HF care. Internet videos are potential learning tool that can easily promote community collaboration for HF.
Collapse
Affiliation(s)
- Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of MedicineTottori UniversityYonagoJapan
| | | | | | | | - Natsuko Ishiga
- Division of RehabilitationTottori University HospitalYonagoJapan
| | - Masahiko Kato
- Department of Pathobiological Science and Technology, School of Health Science, Faculty of MedicineTottori UniversityYonagoJapan
| | | | - Emiko Mura
- Visiting Nurse Station Nanbu KohoenYonagoJapan
| | | | - Hiroki Omodani
- Omodani Internal Medicine and Cardiovascular Medicine ClinicYonagoJapan
| | - Hiroaki Tanaka
- Department of CardiologyTottori Prefecture Sakaiminato General HospitalSakaiminatoJapan
| | | | | | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of MedicineTottori UniversityYonagoJapan
| | | |
Collapse
|
12
|
Zavaleta-Monestel E, Arguedas-Chacón S, Quirós-Romero A, Chaverri-Fernández JM, Serrano-Arias B, Díaz-Madriz JP, García-Montero J, Speranza-Sanchez MO. Optimizing Heart Failure Management: A Review of the Clinical Pharmacist Integration to the Multidisciplinary Health Care Team. INTERNATIONAL JOURNAL OF HEART FAILURE 2024; 6:1-10. [PMID: 38303921 PMCID: PMC10827703 DOI: 10.36628/ijhf.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/01/2023] [Accepted: 10/23/2023] [Indexed: 02/03/2024]
Abstract
Heart failure (HF) stands as a prevalent chronic ailment, imposing a substantial burden on global healthcare systems due to recurrent hospitalizations, intricate management, persistent symptoms, and polypharmacy challenges. The augmentation of patient safety and treatment efficacy across various care stages, facilitated by a multidisciplinary HF team inclusive of a clinical pharmacist, emerges as paramount. Evidence underscores that the collaborative engagement of a physician and a clinical pharmacist engenders proficient and secure management, forestalling avoidable adversities stemming from drug reactions and prescription inaccuracies. This synergistic approach tailors treatments optimally to individual patients. Post-discharge, the vulnerability of HF patients to re-hospitalization looms large, historically holding sway as the foremost cause of 30-day readmissions. Diverse strategies have been instituted to fortify patient well-being, leading to the formulation of specialized transitional care programs that shepherd patients effectively from hospital to outpatient settings. These initiatives have demonstrably curtailed readmission rates. This review outlines a spectrum of roles assumed by clinical pharmacists within the healthcare cohort, spanning inpatient care, transitional phases, and outpatient services. Moreover, it traverses a compendium of studies spotlighting the affirmative impact instigated by integrating clinical pharmacists into these fields.
Collapse
Affiliation(s)
- Esteban Zavaleta-Monestel
- Pharmacy Department, Hospital Clínica Bíblica, San José, Costa Rica
- Heart Failure Program, Hospital Clínica Bíblica, San José, Costa Rica
- Faculty of Pharmacy, Universidad de Ciencias Médicas, San José, Costa Rica
| | - Sebastián Arguedas-Chacón
- Pharmacy Department, Hospital Clínica Bíblica, San José, Costa Rica
- Heart Failure Program, Hospital Clínica Bíblica, San José, Costa Rica
| | - Alonso Quirós-Romero
- Pharmacy Department, Hospital Clínica Bíblica, San José, Costa Rica
- Faculty of Pharmacy, University of Costa Rica, San José, Costa Rica
| | | | | | | | - Jonathan García-Montero
- Pharmacy Department, Hospital Clínica Bíblica, San José, Costa Rica
- Faculty of Pharmacy, Universidad de Ciencias Médicas, San José, Costa Rica
| | | |
Collapse
|
13
|
Hsiao YL, Bass EB, Wu AW, Kelly D, Sylvester C, Berkowitz SA, Bellantoni M. Preventing Avoidable Rehospitalizations through Standardizing Management of Chronic Conditions in Skilled Nursing Facilities. J Am Med Dir Assoc 2023; 24:1910-1917.e3. [PMID: 37690461 DOI: 10.1016/j.jamda.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES This study evaluated the impact of standardized care protocols, as a part of a quality improvement initiative (J10ohns Hopkins Community Health Partnership, J-CHiP), on hospital readmission rates for patients with a diagnosis of congestive heart failure (CHF) and/or chronic obstructive pulmonary disease (COPD) after being discharged to skilled nursing facilities (SNFs). DESIGN A retrospective study comparing 30-day hospital readmission rates the year before and 2 years following the implementation of the care protocol interventions. SETTINGS AND PARTICIPANTS Patients discharged from Johns Hopkins Hospital or Johns Hopkins Bayview Medical Center to the participating SNFs diagnosed with CHF and/or COPD. METHODS The standardized protocols included medical provider or nurse assessments on SNF admission, multidisciplinary care planning, and medication management to avoid unplanned readmissions to the hospital. Descriptive analyses were conducted to illustrate the 30-day readmission rates before and after protocol implementation. RESULTS There were 1128 patients in the pre-J-CHiP cohort and 2297 patients in the J-CHiP cohort. About half of the patients with a recorded diagnosis of CHF without COPD had the standardized protocol initiated, whereas 47% of the patients with a recorded diagnosis of COPD without CHF had the standardized protocol initiated. Of patients with recorded diagnoses of COPD and CHF, 49% had both protocols initiated. A reduction in the readmission rate was observed for patients with COPD protocols, from 23.5% in 2011 to 12.1% in 2015. However, fluctuations in the readmission rates were observed for patients who initiated the CHF protocols. CONCLUSIONS AND IMPLICATIONS There were improvements in the readmission rates in this study, especially for patients who had initiated standardized care protocols in the SNFs. Our findings demonstrate great value in standardizing care management and strengthening collaboration with chronic care settings to facilitate a smooth transition of medically complex patients discharged from large health care systems. Future interventions could consider assessing nonclinical factors that may impact preventable hospital readmissions.
Collapse
Affiliation(s)
- Ya Luan Hsiao
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Bass
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Albert W Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Denise Kelly
- Division of Geriatric Medicine and Gerontology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Carol Sylvester
- Office of Population Health, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Scott A Berkowitz
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michele Bellantoni
- Division of Geriatric Medicine and Gerontology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
| |
Collapse
|
14
|
Khan WJ, Arriola-Montenegro J, Mutschler MS, Bensimhon D, Halmosi R, Toth K, Alexy T. A novel opportunity to improve heart failure care: focusing on subcutaneous furosemide. Heart Fail Rev 2023; 28:1315-1323. [PMID: 37439967 DOI: 10.1007/s10741-023-10331-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
The prevalence of heart failure (HF) continues to rise in developed nations. Symptomatic congestion is the most common reason for patients to seek medical attention, and management often requires intravenous (IV) diuretic administration in the hospital setting. Typically, the number of admissions increases as the disease progresses, not only impacting patient survival and quality of life but also driving up healthcare expenditures. pH-neutral furosemide delivered subcutaneously using a proprietary, single-use infusor system (Furoscix) has a tremendous potential to transition in-hospital decongestive therapy to the outpatient setting or to the patient's home. This review is aimed at providing an overview of the pharmacodynamic and pharmacokinetic profile of the novel pH-neutral furosemide in addition to the most recent clinical trials demonstrating its benefit when used in the home setting. Given the newest data and approval by the Food and Drug Administration in the US, it has the potential to revolutionize the care of patients with decompensated HF. Undoubtedly, it will lead to improved quality of life as well as significantly reduced healthcare costs related to hospital admissions.
Collapse
Affiliation(s)
- Wahab J Khan
- Department of Medicine, Avera Health, Sioux Falls, SD, 57105, USA
| | - Jose Arriola-Montenegro
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Melinda S Mutschler
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Daniel Bensimhon
- Division of Cardiovascular Medicine, Cone Health, Greensboro, NC, 27401, USA
| | - Robert Halmosi
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7624, Pecs, Hungary
| | - Kalman Toth
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7624, Pecs, Hungary
| | - Tamas Alexy
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, 55455, USA.
| |
Collapse
|
15
|
Maleki M, Mardani A, Iloonkashkooli R, Khachian A, Glarcher M, Vaismoradi M. The effect of hospital-to-home transitional care using a digital messaging application on the health outcomes of patients undergoing CABG and their family caregivers: a randomized controlled trial study protocol. Front Cardiovasc Med 2023; 10:1224302. [PMID: 38028499 PMCID: PMC10644205 DOI: 10.3389/fcvm.2023.1224302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives Given the increasing trend of care transition from healthcare settings to patients' own home, patients and their family caregivers should take more responsibilities for care at own home. This study is going to investigate the effect of a transitional care program from hospital to own home using a digital messaging application on patients' undergoing coronary artery bypass graft (CABG) surgery and their family caregivers' health outcomes. Methods A parallel randomized controlled trial study will be conducted in a hospital in a metropolis located in southwestern Iran. Sampling will be performed sequentially and the eligible dyad of patients and family caregivers will be randomly assigned to intervention and control groups. The intervention group will receive a transitional care program for 8 weeks using the WhatsApp on the mobile phone based on the person-centered care approach, but the control group will receive routine care for patient's transition. Data collection will be conducted at baseline, immediately after the intervention, and two months after the intervention using demographic questionnaire, Cardiac Self-Efficacy Scale (CSES), MacNew Heart Disease Health-Related Quality of Life questionnaire (MNHD-Q), Cardiac Symptom Scale (CSS), Morisky Medication Adherence Scale, and Caregiver Burden Scale (CBS). Descriptive and inferential statistics will be used for data analysis. Conclusions The results of this study will allow evaluating the effectiveness of an innovative transitional care program to patients' own home using a digital messaging application. If the transitional program is shown feasible and effective it can be incorporated into existing care programs and stimulate further studies on the use of digital solutions for improving the continuity of care in own home.
Collapse
Affiliation(s)
- Maryam Maleki
- Pediatric and Neonatal Intensive Care Nursing Education Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Mardani
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | | | - Alice Khachian
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Manela Glarcher
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia
| |
Collapse
|
16
|
de la Espriella R, Núñez-Marín G, Codina P, Núñez J, Bayés-Genís A. Biomarkers to Improve Decision-making in Acute Heart Failure. Card Fail Rev 2023; 9:e13. [PMID: 37942188 PMCID: PMC10628997 DOI: 10.15420/cfr.2023.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/19/2023] [Indexed: 11/10/2023] Open
Abstract
Acute heart failure (AHF) is a complex clinical syndrome that requires prompt diagnosis, risk stratification and effective treatment strategies to reduce morbidity and mortality. Biomarkers are playing an increasingly important role in this process, offering valuable insights into the underlying pathophysiology and facilitating personalised patient management. This review summarises the significance of various biomarkers in the context of AHF, with a focus on their clinical applications to stratify risk and potential for guiding therapy choices.
Collapse
Affiliation(s)
| | - Gonzalo Núñez-Marín
- Department of Cardiology, Hospital Clínico Universitario de ValenciaValencia, Spain
| | - Pau Codina
- Heart Institute, Hospital Universitari Germans Trias i PujolBarcelona, Spain
| | - Julio Núñez
- Department of Cardiology, Hospital Clínico Universitario de ValenciaValencia, Spain
- Department of Medicine, Universitat de ValènciaValencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades CardiovascularesMadrid, Spain
| | - Antoni Bayés-Genís
- Heart Institute, Hospital Universitari Germans Trias i PujolBarcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades CardiovascularesMadrid, Spain
- Department of Medicine, Universitat Autònomoa de BarcelonaBarcelona, Spain
| |
Collapse
|
17
|
Liu S, Xiong XY, Chen H, Liu MD, Wang Y, Yang Y, Zhang MJ, Xiang Q. Transitional Care in Patients with Heart Failure: A Concept Analysis Using Rogers' Evolutionary Approach. Risk Manag Healthc Policy 2023; 16:2063-2076. [PMID: 37822727 PMCID: PMC10563773 DOI: 10.2147/rmhp.s427495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023] Open
Abstract
Objective The purpose of this study was to clarify the concept of transitional care in patients with heart failure. Background Transitional care is increasingly being applied in patients with heart failure, but the concept of transitional care in heart failure patients is not uniform and confused with other definitions, which limits further research and practice on transitional care for these patients. Design Rodgers' evolutionary concept analysis. Methods A comprehensive literature search was conducted using the PUBMED, EMBASE, EBSCO, Chinese Biological Medicine (CBM), CNKI, and WANFANG databases (up to January 26, 2023). We used Rodgers' evolutionary concept analysis method to identify related concepts, attributes, antecedents, and consequences of transitional care in patients with heart failure. Results A total of 33 articles were included. The following attributes belonging to transitional care in patients with heart failure were extracted from the literature: self-care, multidisciplinary collaboration, and information transmission. The antecedents were patients' health status, the health literacy of patients and caregivers, the role functions of the main implementer and social and medical resources. Consequences were separated into two categories: patient-centered health outcomes (all-cause mortality, health-related quality of life, discharge preparedness, self-care behaviors, satisfaction of patients) and healthcare utilization outcomes (hospital readmission, length of hospital stay, emergency department visits). Conclusion This study found that transitional care in heart failure patients is a systemic care process during a vulnerable period that improves patient self-management and coordination between hospital resources and social support systems for continuous management to promote smooth patient transitions between different locations. This concept analysis will inform healthcare providers in designing evidence-based interventions and quality improvement strategies to ensure that transition processes lead to desired outcomes. In addition, this study will also be helpful for developing specific assessment tools to identify patients with HF who need transitional care.
Collapse
Affiliation(s)
- Si Liu
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
- Nursing Department, the Second Affiliated Hospital of Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Xiao-yun Xiong
- Nursing Department, the Second Affiliated Hospital of Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Hua Chen
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Meng-die Liu
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Ying Wang
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Ying Yang
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Mei-jun Zhang
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Qin Xiang
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| |
Collapse
|
18
|
Capdevila Aguilera C, Vela Vallespín E, Clèries Escayola M, Yun Viladomat S, Fernández Solana C, Alcober Morte L, Monterde Prat D, Hidalgo Quirós E, Calero Molina E, José Bazán N, Moliner Borja P, Piera Jiménez J, Ruiz Muñoz M, Corbella Virós X, Jiménez-Marrero S, Garay Melero A, Ramos Polo R, Alcoberro Torres L, Pons Riverola A, Enjuanes Grau C, Comín-Colet J. Population-based evaluation of the impact of socioeconomic status on clinical outcomes in patients with heart failure in integrated care settings. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:803-812. [PMID: 36963612 DOI: 10.1016/j.rec.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/07/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION AND OBJECTIVES Low socioeconomic status (SES) is associated with poor outcomes in patients with heart failure (HF). We aimed to examine the influence of SES on health outcomes after a quality of care improvement intervention for the management of HF integrating hospital and primary care resources in a health care area of 209 255 inhabitants. METHODS We conducted a population-based pragmatic evaluation of the implementation of an integrated HF program by conducting a natural experiment using health care data. We included all individuals consecutively admitted to hospital with at least one ICD-9-CM code for HF as the primary diagnosis and discharged alive in Catalonia between January 1, 2015 and December 31, 2019. We compared outcomes between patients exposed to the new HF program and those in the remaining health care areas, globally and stratified by SES. RESULTS A total of 77 554 patients were included in the study. Death occurred in 37 469 (48.3%), clinically-related hospitalization in 41 709 (53.8%) and HF readmission in 29 755 (38.4%). On multivariate analysis, low or very low SES was associated with an increased risk of all-cause death and clinically-related hospitalization (all Ps <.05). The multivariate models showed a significant reduction in the risk of all-cause death (HR, 0.812; 95%CI, 0.723-0.912), clinically-related hospitalization (HR, 0.886; 95%CI, 0.805-0.976) and HF hospitalization (HR, 0.838; 95%CI, 0.745-0.944) in patients exposed to the new HF program compared with patients exposed to the remaining health care areas and this effect was independent of SES. CONCLUSIONS An intensive transitional HF management program improved clinical outcomes, both overall and across SES strata.
Collapse
Affiliation(s)
- Cristina Capdevila Aguilera
- Departamento de Gerencia, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Departamento de Ciencias Clínicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, Spain
| | - Emili Vela Vallespín
- Unidad de Información y Conocimiento, Servicio Catalán de la Salud (CatSalut), Barcelona, Spain; Digitalización para la Sostenibilidad del Sistema Sanitario DS3-IDIBELL, Servicio Catalán de la Salud (CatSalut), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montse Clèries Escayola
- Unidad de Información y Conocimiento, Servicio Catalán de la Salud (CatSalut), Barcelona, Spain; Digitalización para la Sostenibilidad del Sistema Sanitario DS3-IDIBELL, Servicio Catalán de la Salud (CatSalut), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Yun Viladomat
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Medicina Interna, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Coral Fernández Solana
- Servicio de Atención Primaria, Delta del Llobregat e IDIAP, Barcelona, Spain; Servicio de Atención Primaria, Instituto Catalán de la Salud, Barcelona, Spain
| | - Laia Alcober Morte
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Atención Primaria, Delta del Llobregat e IDIAP, Barcelona, Spain; Servicio de Atención Primaria, Instituto Catalán de la Salud, Barcelona, Spain
| | - David Monterde Prat
- Digitalización para la Sostenibilidad del Sistema Sanitario DS3-IDIBELL, Servicio Catalán de la Salud (CatSalut), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Atención Primaria, Instituto Catalán de la Salud, Barcelona, Spain
| | - Encarna Hidalgo Quirós
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Atención Primaria, Delta del Llobregat e IDIAP, Barcelona, Spain; Servicio de Atención Primaria, Instituto Catalán de la Salud, Barcelona, Spain
| | - Esther Calero Molina
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria José Bazán
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Moliner Borja
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Piera Jiménez
- Digitalización para la Sostenibilidad del Sistema Sanitario DS3-IDIBELL, Servicio Catalán de la Salud (CatSalut), L'Hospitalet de Llobregat, Barcelona, Spain; Facultad de Informática, Multimedia y Telecomunicaciones, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Marta Ruiz Muñoz
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella Virós
- Grupo de investigación en Enfermedades Sistémicas, Vasculares y Envejecimiento (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Facultad de Medicina, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Santiago Jiménez-Marrero
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alberto Garay Melero
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Raúl Ramos Polo
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lidia Alcoberro Torres
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alexandra Pons Riverola
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Enjuanes Grau
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Josep Comín-Colet
- Departamento de Ciencias Clínicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, Spain; Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain.
| |
Collapse
|
19
|
Chae S, Davoudi A, Song J, Evans L, Hobensack M, Bowles KH, McDonald MV, Barrón Y, Rossetti SC, Cato K, Sridharan S, Topaz M. Predicting emergency department visits and hospitalizations for patients with heart failure in home healthcare using a time series risk model. J Am Med Inform Assoc 2023; 30:1622-1633. [PMID: 37433577 PMCID: PMC10531127 DOI: 10.1093/jamia/ocad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/24/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVES Little is known about proactive risk assessment concerning emergency department (ED) visits and hospitalizations in patients with heart failure (HF) who receive home healthcare (HHC) services. This study developed a time series risk model for predicting ED visits and hospitalizations in patients with HF using longitudinal electronic health record data. We also explored which data sources yield the best-performing models over various time windows. MATERIALS AND METHODS We used data collected from 9362 patients from a large HHC agency. We iteratively developed risk models using both structured (eg, standard assessment tools, vital signs, visit characteristics) and unstructured data (eg, clinical notes). Seven specific sets of variables included: (1) the Outcome and Assessment Information Set, (2) vital signs, (3) visit characteristics, (4) rule-based natural language processing-derived variables, (5) term frequency-inverse document frequency variables, (6) Bio-Clinical Bidirectional Encoder Representations from Transformers variables, and (7) topic modeling. Risk models were developed for 18 time windows (1-15, 30, 45, and 60 days) before an ED visit or hospitalization. Risk prediction performances were compared using recall, precision, accuracy, F1, and area under the receiver operating curve (AUC). RESULTS The best-performing model was built using a combination of all 7 sets of variables and the time window of 4 days before an ED visit or hospitalization (AUC = 0.89 and F1 = 0.69). DISCUSSION AND CONCLUSION This prediction model suggests that HHC clinicians can identify patients with HF at risk for visiting the ED or hospitalization within 4 days before the event, allowing for earlier targeted interventions.
Collapse
Affiliation(s)
- Sena Chae
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Anahita Davoudi
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Jiyoun Song
- Columbia University School of Nursing, New York City, New York, USA
| | - Lauren Evans
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Mollie Hobensack
- Columbia University School of Nursing, New York City, New York, USA
| | - Kathryn H Bowles
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | | | - Yolanda Barrón
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Sarah Collins Rossetti
- Columbia University School of Nursing, New York City, New York, USA
- Department of Biomedical Informatics, Columbia University, New York City, New York, USA
| | - Kenrick Cato
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Sridevi Sridharan
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Maxim Topaz
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
- Columbia University School of Nursing, New York City, New York, USA
- Data Science Institute, Columbia University, New York City, New York, USA
| |
Collapse
|
20
|
Rossi LP, Granger BB, Bruckel JT, Crabbe DL, Graven LJ, Newlin KS, Streur MM, Vadiveloo MK, Walton-Moss BJ, Warden BA, Volgman AS, Lydston M. Person-Centered Models for Cardiovascular Care: A Review of the Evidence: A Scientific Statement From the American Heart Association. Circulation 2023; 148:512-542. [PMID: 37427418 DOI: 10.1161/cir.0000000000001141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Cardiovascular disease remains the leading cause of death and disability in the United States and globally. Disease burden continues to escalate despite technological advances associated with improved life expectancy and quality of life. As a result, longer life is associated with multiple chronic cardiovascular conditions. Clinical guidelines provide recommendations without considering prevalent scenarios of multimorbidity and health system complexities that affect practical adoption. The diversity of personal preferences, cultures, and lifestyles that make up one's social and environmental context is often overlooked in ongoing care planning for symptom management and health behavior support, hindering adoption and compromising patient outcomes, particularly in groups at high risk. The purpose of this scientific statement was to describe the characteristics and reported outcomes in existing person-centered care delivery models for selected cardiovascular conditions. We conducted a scoping review using Ovid MEDLINE, Embase.com, Web of Science, CINAHL Complete, Cochrane Central Register of Controlled Trials through Ovid, and ClinicalTrials.gov from 2010 to 2022. A range of study designs with a defined aim to systematically evaluate care delivery models for selected cardiovascular conditions were included. Models were selected on the basis of their stated use of evidence-based guidelines, clinical decision support tools, systematic evaluation processes, and inclusion of the patient's perspective in defining the plan of care. Findings reflected variation in methodological approach, outcome measures, and care processes used across models. Evidence to support optimal care delivery models remains limited by inconsistencies in approach, variation in reimbursement, and inability of health systems to meet the needs of patients with chronic, complex cardiovascular conditions.
Collapse
|
21
|
Garcia Brás P, Gonçalves AV, Reis JF, Moreira RI, Pereira-da-Silva T, Rio P, Timóteo AT, Silva S, Soares RM, Ferreira RC. Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies: Still a Powerful Tool? Biomedicines 2023; 11:2208. [PMID: 37626705 PMCID: PMC10452308 DOI: 10.3390/biomedicines11082208] [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: 06/30/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND New therapies with prognostic benefits have been recently introduced in heart failure with reduced ejection fraction (HFrEF) management. The aim of this study was to evaluate the prognostic power of current listing criteria for heart transplantation (HT) in an HFrEF cohort submitted to cardiopulmonary exercise testing (CPET) between 2009 and 2014 (group A) and between 2015 and 2018 (group B). METHODS Consecutive patients with HFrEF who underwent CPET were followed-up for cardiac death and urgent HT. RESULTS CPET was performed in 487 patients. The composite endpoint occurred in 19.4% of group A vs. 7.4% of group B in a 36-month follow-up. Peak VO2 (pVO2) and VE/VCO2 slope were the strongest independent predictors of mortality. International Society for Heart and Lung Transplantation (ISHLT) thresholds of pVO2 ≤ 12 mL/kg/min (≤14 if intolerant to β-blockers) and VE/VCO2 slope > 35 presented a similar and lower Youden index, respectively, in group B compared to group A, and a lower positive predictive value. pVO2 ≤ 10 mL/kg/min and VE/VCO2 slope > 40 outperformed the traditional cut-offs. An ischemic etiology subanalysis showed similar results. CONCLUSION ISHLT thresholds showed a lower overall prognostic effectiveness in a contemporary HFrEF population. Novel parameters may be needed to improve risk stratification.
Collapse
Affiliation(s)
- Pedro Garcia Brás
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
| | - António Valentim Gonçalves
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
| | - João Ferreira Reis
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
| | - Rita Ilhão Moreira
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
| | - Tiago Pereira-da-Silva
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
| | - Pedro Rio
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
| | - Ana Teresa Timóteo
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas (NMS|FCM), 1169-056 Lisbon, Portugal
| | - Sofia Silva
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
| | - Rui M. Soares
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
| | - Rui Cruz Ferreira
- Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal
| |
Collapse
|
22
|
Missiou A, Ntalaouti E, Lionis C, Evangelou E, Tatsioni A. Underreporting contextual factors preclude the applicability appraisal in primary care randomized controlled trials. J Clin Epidemiol 2023; 160:24-32. [PMID: 37311513 DOI: 10.1016/j.jclinepi.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 05/21/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To assess applicability reporting in randomized controlled trials (RCTs) conducted in primary care (PC). STUDY DESIGN AND SETTING We used a random sample of PC RCTs published between 2000 and 2020 to assess applicability. We extracted data related to setting, population, intervention (including implementation), comparator, outcomes, and context. Based on data availability, we assessed whether the five predefined applicability questions were adequately addressed by each PC RCT. RESULTS Adequately described elements that were reported frequently (>50%) included the responsible organization for intervention provision (97, 93.3%), study population characteristics (94, 90.4%), intervention implementation including monitoring and evaluation (92, 88.5%), intervention components (89, 85.6%), time frame (82, 78.8%), baseline prevalence (58, 55.8%), and the type of setting and location (53, 51%). Elements that were often underreported included contextual factors, that is, evidence of differential effects across sociodemographic or other groupings (2, 1.9%), intervention components tailored for specific settings (7, 6.7%), health system structure (32, 30.8%), factors affecting implementation (40, 38.5%) and organization structure (50, 48.1%). The proportion of trials that adequately addressed each applicability question ranged between 1% and 20.2%, while none RCT could address all of them. CONCLUSION Underreporting contextual factors jeopardize the appraisal of applicability in PC RCTs.
Collapse
Affiliation(s)
- Aristea Missiou
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleni Ntalaouti
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete, Greece; Department of Health, Medicine and Care, General Practice, Linköping University, Linköping, Sweden
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece; Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
| |
Collapse
|
23
|
Wang CH, Kao FY, Tsai SL, Lee CM. Policy-Driven Post-Acute Care Program Lowers Mortality Rate and Medical Expenditures After Hospitalization for Acute Heart Failure: A Nationwide Propensity Score-Matched Study. J Am Med Dir Assoc 2023; 24:978-984.e4. [PMID: 37146642 DOI: 10.1016/j.jamda.2023.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE The beneficial effects of multidisciplinary disease management programs have been demonstrated. The present study investigated the effects of a policy-driven, health insurance-reimbursed, heart failure (HF) post-acute care (PAC) program on mortality, health care service utilization, and readmission expenses for patients following hospitalization for HF. DESIGN This was a retrospective propensity score-matched cohort study using the Taiwan National Health Insurance Research Database. SETTING AND PARTICIPANTS In total, 4346 patients (2173 receiving HF-PAC and 2173 controls) with left ventricular ejection fraction of ≤40% who were discharged following hospitalization for HF were included for analysis. METHODS All patients were followed up after discharge for all-cause mortality, emergency visits within 30 days, and length of stay and medical expenses for readmission within 180 days after discharge. RESULTS After propensity score matching, baseline characteristics of the HF-PAC and control groups were similar. During a mean follow-up period of 1.59 ± 0.92 years, according to the Cox multivariable analysis, HF-PAC reduced mortality by 48% compared with the control group, independent of traditional risk factors (hazard ratio = 0.520, 95% CI = 0.452-0.597, P < .001). Kaplan-Meier curves revealed that HF-PAC was associated with a higher cumulative survival rate (log-rank = 96.43, P < .001). HF-PAC also decreased the frequency of emergency visits after discharge by 23% in the 30 days post discharge and decreased length of stay and medical expenses related to readmission by 61% and 63%, respectively, in the 180 days post discharge (all P < .001). CONCLUSIONS AND IMPLICATIONS HF-PAC reduces short-term all-cause emergency visits, length of stay, and medical expenses for all-cause readmission and all-cause mortality in patients discharged following hospitalization for HF. Our findings suggest that PAC should include care continuity, optimal adaptation of transitional care components, and HF cardiologist engagement with multidisciplinary coordination.
Collapse
Affiliation(s)
- Chao-Hung Wang
- Division of Cardiology, Department of Internal Medicine, Heart Failure Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Feng-Yu Kao
- National Health Administration, Ministry of Health and Welfare, Taiwan
| | - Shu-Ling Tsai
- National Health Administration, Ministry of Health and Welfare, Taiwan; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Chii-Ming Lee
- Department of Cardiology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.
| |
Collapse
|
24
|
Khodneva Y, Levitan EB, Arora P, Presley CA, Oparil S, Cherrington AL. Disparities in Postdischarge Ambulatory Care Follow-Up Among Medicaid Beneficiaries With Diabetes, Hospitalized for Heart Failure. J Am Heart Assoc 2023; 12:e029094. [PMID: 37284763 PMCID: PMC10356027 DOI: 10.1161/jaha.122.029094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/18/2023] [Indexed: 06/08/2023]
Abstract
Background Ambulatory follow-up for all patients with heart failure (HF) is recommended within 7 to 14 days after hospital discharge to improve HF outcomes. We examined postdischarge ambulatory follow-up of patients with comorbid diabetes and HF from a low-income population in primary and specialty care. Methods and Results Adults with diabetes and first hospitalizations for HF, covered by Alabama Medicaid in 2010 to 2019, were included and the claims analyzed for ambulatory care use (any, primary care, cardiology, or endocrinology) within 60 days after discharge using restricted mean survival time regression and negative binomial regression. Among 9859 Medicaid-covered adults with diabetes and first hospitalization for HF (mean age, 53.7 years; SD, 9.2 years; 47.3% Black; 41.8% non-Hispanic White; 10.9% Hispanic/Other [Other included non-White Hispanic, American Indian, Pacific Islander and Asian adults]; 65.4% women, 34.6% men), 26.7% had an ambulatory visit within 0 to 7 days, 15.2% within 8 to 14 days, 31.3% within 15 to 60 days, and 26.8% had no visit; 71% saw a primary care physician and 12% a cardiology physician. Black and Hispanic/Other adults were less likely to have any postdischarge ambulatory visit (P<0.0001) or the visit was delayed (by 1.8 days, P=0.0006 and by 2.8 days, P=0.0016, respectively) and were less likely to see a primary care physician than non-Hispanic White adults (adjusted incidence rate ratio, 0.96 [95% CI, 0.91-1.00] and 0.91 [95% CI, 0.89-0.98]; respectively). Conclusions More than half of Medicaid-covered adults with diabetes and HF in Alabama did not receive guideline-concordant postdischarge care. Black and Hispanic/Other adults were less likely to receive recommended postdischarge care for comorbid diabetes and HF.
Collapse
Affiliation(s)
- Yulia Khodneva
- Department of Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Emily B. Levitan
- Department of Epidemiology, School of Public HealthUniversity of Alabama at BirminghamBirminghamALUSA
| | - Pankaj Arora
- Department of Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Caroline A. Presley
- Department of Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Suzanne Oparil
- Department of Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Andrea L. Cherrington
- Department of Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| |
Collapse
|
25
|
Sokos G, Kido K, Panjrath G, Benton E, Page R, Patel J, Smith PJ, Korous S, Guglin M. Multidisciplinary Care in Heart Failure Services. J Card Fail 2023; 29:943-958. [PMID: 36921886 DOI: 10.1016/j.cardfail.2023.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/01/2023] [Accepted: 02/05/2023] [Indexed: 03/18/2023]
Abstract
The American College of Cardiology/American Heart Association/Heart Failure Society of American 2022 guidelines for heart failure (HF) recommend a multidisciplinary team approach for patients with HF. The multidisciplinary HF team-based approach decreases the hospitalization rate for HF and health care costs and improves adherence to self-care and the use of guideline-directed medical therapy. This article proposes the optimal multidisciplinary team structure and each team member's delineated role to achieve institutional goals and metrics for HF care. The proposed HF-specific multidisciplinary team comprises cardiologists, surgeons, advanced practice providers, clinical pharmacists, specialty nurses, dieticians, physical therapists, psychologists, social workers, immunologists, and palliative care clinicians. A standardized multidisciplinary HF team-based approach should be incorporated to optimize the structure, minimize the redundancy of clinical responsibilities among team members, and improve clinical outcomes and patient satisfaction in their HF care.
Collapse
Affiliation(s)
- George Sokos
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Kazuhiko Kido
- Department of Clinical Pharmacy, West Virginia University School of Pharmacy, Morgantown, West Virginia.
| | - Gurusher Panjrath
- School of Medicine and Health Sciences, George Washington University, North Englewood, Maryland
| | - Emily Benton
- Department of Medicine, University of Colorado, Boulder, Colorado
| | - Robert Page
- Department of Clinical Pharmacy, at the University of Colorado Denver Skaggs School of Pharmacy, Denver, Colorado
| | - Jignesh Patel
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Patrick J Smith
- Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Shelly Korous
- Advanced Heart Failure Program, Indiana University Health, Indianapolis, Indiana
| | - Maya Guglin
- Department of Medicine, Indiana University Health, Indianapolis, Indiana
| |
Collapse
|
26
|
Higgason N, Soroka O, Goyal P, Mahmood SS, Pinheiro LC. Suboptimal Cardiology Follow-Up Among Patients With and Without Cancer Hospitalized for Heart Failure. Am J Cardiol 2023; 196:79-86. [PMID: 37019746 PMCID: PMC10297727 DOI: 10.1016/j.amjcard.2023.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/19/2023] [Accepted: 02/25/2023] [Indexed: 04/07/2023]
Abstract
Many patients hospitalized for heart failure (HF) do not receive recommended follow-up cardiology care, and non-White patients are less likely to receive follow-up than White patients. Poor HF management may be particularly problematic in patients with cancer because cardiovascular co-morbidity can delay cancer treatments. Therefore, we sought to describe outpatient cardiology care patterns in patients with cancer hospitalized for HF and to determine if receipt of follow-up varied by race/ethnicity. SEER (Surveillance, Epidemiology, and End Results) data from 2007 to 2013 linked to Medicare claims from 2006 to 2014 were used. We included patients aged 66+ years with breast, prostate, or colorectal cancer, and preexisting HF. Patients with cancer were matched to patients in a noncancer cohort that included individuals with HF and no cancer. The primary outcome was receipt of an outpatient, face-to-face cardiologist visit within 30 days of HF hospitalization. We compared follow-up rates between cancer and noncancer cohorts, and stratified analyses by race/ethnicity. A total of 2,356 patients with cancer and 2,362 patients without cancer were included. Overall, 43% of patients with cancer and 42% of patients without cancer received cardiologist follow-up (p = 0.30). After multivariable adjustment, White patients were 15% more likely to receive cardiology follow-up than Black patients (95% confidence interval [CI] 1.02 to 1.30). Black patients with cancer were 41% (95% CI 1.11 to 1.78) and Asian patients with cancer were 66% (95% CI 1.11 to 2.49) more likely to visit a cardiologist than their noncancer counterparts. In conclusion, less than half of patients with cancer hospitalized for HF received recommended follow-up with a cardiologist, and significant race-related differences in cardiology follow-up exist. Future studies should investigate the reasons for these differences.
Collapse
Affiliation(s)
- Noel Higgason
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas.
| | - Orysya Soroka
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Parag Goyal
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York; Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Syed S Mahmood
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Laura C Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York; Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| |
Collapse
|
27
|
Michelis KC. Cardiology Follow-Up Among Patients With Cancer and Patients Without Cancer Hospitalized for Heart Failure: Still Much Room for Improvement. Am J Cardiol 2023; 196:77-78. [PMID: 37088637 DOI: 10.1016/j.amjcard.2023.03.021] [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: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 04/25/2023]
Affiliation(s)
- Katherine C Michelis
- Division of Cardiology, Department of Medicine, Dallas Veterans Affairs Medical Center, Dallas, Texas; Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
| |
Collapse
|
28
|
Butler J, Petrie MC, Bains M, Bawtinheimer T, Code J, Levitch T, Malvolti E, Monteleone P, Stevens P, Vafeiadou J, Lam CSP. Challenges and opportunities for increasing patient involvement in heart failure self-care programs and self-care in the post-hospital discharge period. RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:23. [PMID: 37046357 PMCID: PMC10097448 DOI: 10.1186/s40900-023-00412-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/25/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND People living with heart failure (HF) are particularly vulnerable after hospital discharge. An alliance between patient authors, clinicians, industry, and co-developers of HF programs can represent an effective way to address the unique concerns and obstacles people living with HF face during this period. The aim of this narrative review article is to discuss challenges and opportunities of this approach, with the goal of improving participation and clinical outcomes of people living with HF. METHODS This article was co-authored by people living with HF, heart transplant recipients, patient advocacy representatives, cardiologists with expertise in HF care, and industry representatives specializing in patient engagement and cardiovascular medicine, and reviews opportunities and challenges for people living with HF in the post-hospital discharge period to be more integrally involved in their care. A literature search was conducted, and the authors collaborated through two virtual roundtables and via email to develop the content for this review article. RESULTS Numerous transitional-care programs exist to ease the transition from the hospital to the home and to provide needed education and support for people living with HF, to avoid rehospitalizations and other adverse outcomes. However, many programs have limitations and do not integrally involve patients in the design and co-development of the intervention. There are thus opportunities for improvement. This can enable patients to better care for themselves with less of the worry and fear that typically accompany the transition from the hospital. We discuss the importance of including people living with HF in the development of such programs and offer suggestions for strategies that can help achieve these goals. An underlying theme of the literature reviewed is that education and engagement of people living with HF after hospitalization are critical. However, while clinical trial evidence on existing approaches to transitions in HF care indicates numerous benefits, such approaches also have limitations. CONCLUSION Numerous challenges continue to affect people living with HF in the post-hospital discharge period. Strategies that involve patients are needed, and should be encouraged, to optimally address these challenges.
Collapse
Affiliation(s)
- Javed Butler
- Department of Medicine (L605), University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
- Baylor Scott and White Research Institute, Dallas, TX, USA.
| | - Mark C Petrie
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Marc Bains
- HeartLife Foundation, Vancouver, BC, Canada
| | | | - Jillianne Code
- HeartLife Foundation, Vancouver, BC, Canada
- Faculty of Education, University of British Columbia, Vancouver, BC, Canada
| | | | - Elmas Malvolti
- Global Medical Affairs, BioPharmaceuticals Business Unit, AstraZeneca, Central Cambridge, UK
| | - Pasquale Monteleone
- Global Corporate Affairs, Biopharmaceuticals Business Unit, AstraZeneca, Cambridge, UK
| | - Petrina Stevens
- Global Medical Evidence, BioPharmaceuticals Business Unit, AstraZeneca, Cambridge, UK
| | - Jenny Vafeiadou
- Global Digital Health, Biopharmaceuticals Business Unit, AstraZeneca, Cambridge, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore & Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
29
|
Marques I, Mendonça D, Teixeira L. One-year rehospitalisation and mortality after acute heart failure hospitalisation: a competing risk analysis. Open Heart 2023; 10:openhrt-2022-002167. [PMID: 36941025 PMCID: PMC10030761 DOI: 10.1136/openhrt-2022-002167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/04/2023] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE To identify factors that independently predict the risk of rehospitalisation and death after acute heart failure (AHF) hospital discharge in a real-world setting, considering death without rehospitalisation as a competing event. METHODS Single-centre, retrospective, observational study enrolling 394 patients discharged from an index AHF hospitalisation. Overall survival was evaluated using Kaplan-Meier and Cox regression models. For the risk of rehospitalisation, survival analysis considering competing risks was performed: rehospitalisation was the event of interest, and death without rehospitalisation was the competing event. RESULTS During the first year after discharge, 131 (33.3%) patients were rehospitalised for AHF and 67 (17.0%) died without being readmitted; the remaining 196 patients (49.7%) lived without further hospitalisations. The 1-year overall survival estimate was 0.71 (SE=0.02). After adjusting for gender, age and left ventricle ejection fraction, the results showed that the risk of death was higher in patients with dementia, higher levels of plasma creatinine (PCr), lower levels of platelet distribution width (PDW) and at Q4 of red cell distribution width (RDW). Multivariable models showed that the risk of rehospitalisation was increased in patients with atrial fibrillation, higher PCr or taking beta-blockers at discharge. Furthermore, the risk of death without AHF rehospitalisation was higher in males, those aged ≥80 years, patients with dementia or RDW at Q4 on admission (compared with Q1). Taking beta-blockers at discharge and having a higher PDW on admission reduced the risk of death without rehospitalisation. CONCLUSION When assessing rehospitalisation as a study endpoint, death without rehospitalisation should be considered a competing event in the analyses. Data from this study reveal that patients with atrial fibrillation, renal dysfunction or taking beta-blockers are more likely to be rehospitalised for AHF, while older men with dementia or high RDW are more prone to die without hospital readmission.
Collapse
Affiliation(s)
- Irene Marques
- Serviço de Medicina Interna, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
- ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Denisa Mendonça
- ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
- Departamento de Estudos de Populações, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
- Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal
| | - Laetitia Teixeira
- Departamento de Estudos de Populações, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| |
Collapse
|
30
|
Bose S, Groat D, Dinglas VD, Akhlaghi N, Banner-Goodspeed V, Beesley SJ, Greene T, Hopkins RO, Mir-Kasimov M, Sevin CM, Turnbull AE, Jackson JC, Needham DM, Brown SM. Association Between Unmet Nonmedication Needs After Hospital Discharge and Readmission or Death Among Acute Respiratory Failure Survivors: A Multicenter Prospective Cohort Study. Crit Care Med 2023; 51:212-221. [PMID: 36661449 DOI: 10.1097/ccm.0000000000005709] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To characterize early unmet nonmedication discharge needs (UDNs), classified as durable medical equipment (DME), home health services (HHS), and follow-up medical appointments (FUAs) and explore their association with 90-day readmission and mortality among survivors of acute respiratory failure (ARF) who were discharged home. DESIGN Prospective multicenter cohort study. SETTING Six academic medical centers across United States. PARTICIPANTS Adult survivors of ARF who required an ICU stay and were discharged home from hospital. INTERVENTIONS None. Exposure of interest was the proportion of UDN for the following categories: DME, HHS, and FUA ascertained within 7-28 days after hospital discharge. MEASUREMENTS AND MAIN RESULTS Two hundred eligible patients were recruited between January 2019 and August 2020. One-hundred ninety-five patients were included in the analytic cohort: 118 were prescribed DME, 134 were prescribed HHS, and 189 needed at least one FUA according to discharge plans. 98.4% (192/195) had at least one identified nonmedication need at hospital discharge. Median (interquartile range) proportion of unmet needs across three categories were 0 (0-15%) for DME, 0 (0-50%) for HHS, and 0 (0-25%) for FUA, and overall was 0 (0-20%). Fifty-six patients (29%) had 90-day death or readmission. After adjusting for prespecified covariates, having greater than the median level of unmet needs was not associated with an increased risk of readmission or death within 90 days of discharge (risk ratio, 0.89; 0.51-1.57; p = 0.690). Age, hospital length of stay, Acute Physiology and Chronic Health Evaluation II severity of illness score, and Multidimensional Scale Perceived Social Support score were associated with UDN. CONCLUSIONS UDN were common among survivors of ARF but not significantly associated a composite outcome of 90-day readmission or death. Our results highlight the substantial magnitude of UDN and identifies areas especially vulnerable to lapses in healthcare coordination.
Collapse
Affiliation(s)
- Somnath Bose
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Center for Anesthesia Research Excellence, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Danielle Groat
- Department of Critical Care, Intermountain Medical Center, Salt Lake City, UT
- Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT
| | - Victor D Dinglas
- Outcomes After Critical Illness and Surgery (OACIS) Group, and Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Narjes Akhlaghi
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Valerie Banner-Goodspeed
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Center for Anesthesia Research Excellence, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Sarah J Beesley
- Department of Critical Care, Intermountain Medical Center, Salt Lake City, UT
- Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT
- Division of Pulmonary Medicine, University of Utah, Salt Lake City, UT
| | - Tom Greene
- Department of Biostatistics and Epidemiology, University of Utah, Salt Lake City, UT
| | - Ramona O Hopkins
- Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT
| | - Mustafa Mir-Kasimov
- Division of Pulmonary Medicine, University of Utah, Salt Lake City, UT
- Section of Pulmonary and Critical Care Medicine, George E Wahlen VA Medical Center, Salt Lake City, UT
| | - Carla M Sevin
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Alison E Turnbull
- Outcomes After Critical Illness and Surgery (OACIS) Group, and Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - James C Jackson
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Group, and Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Samuel M Brown
- Department of Critical Care, Intermountain Medical Center, Salt Lake City, UT
- Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT
- Division of Pulmonary Medicine, University of Utah, Salt Lake City, UT
| |
Collapse
|
31
|
Weber C, Hung J, Hickling S, Li I, Murray K, Briffa T. Unplanned 30-day readmissions, comorbidity and impact on one-year mortality following incident heart failure hospitalisation in Western Australia, 2001-2015. BMC Cardiovasc Disord 2023; 23:25. [PMID: 36647020 PMCID: PMC9843857 DOI: 10.1186/s12872-022-03020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Readmissions within 30 days after heart failure (HF) hospitalisation is considered an important healthcare quality metric, but their impact on medium-term mortality is unclear within an Australian setting. We determined the frequency, risk predictors and relative mortality risk of 30-day unplanned readmission in patients following an incident HF hospitalisation. METHODS From the Western Australian Hospitalisation Morbidity Data Collection we identified patients aged 25-94 years with an incident (first-ever) HF hospitalisation as a principal diagnosis between 2001 and 2015, and who survived to 30-days post discharge. Unplanned 30-day readmissions were categorised by principal diagnosis. Logistic and Cox regression analysis determined the independent predictors of unplanned readmissions in 30-day survivors and the multivariable-adjusted hazard ratio (HR) of readmission on mortality within the subsequent year. RESULTS The cohort comprised 18,241 patients, mean age 74.3 ± 13.6 (SD) years, 53.5% males, and one-third had a modified Charlson Comorbidity Index score of ≥ 3. Among 30-day survivors, 15.5% experienced one or more unplanned 30-day readmission, of which 53.9% were due to cardiovascular causes; predominantly HF (31.4%). The unadjusted 1-year mortality was 15.9%, and the adjusted mortality HR in patients with 1 and ≥ 2 cardiovascular or non-cardiovascular readmissions (versus none) was 1.96 (95% confidence interval (CI) 1.80-2.14) and 3.04 (95% CI, 2.51-3.68) respectively. Coexistent comorbidities, including ischaemic heart disease/myocardial infarction, peripheral arterial disease, pneumonia, chronic kidney disease, and anaemia, were independent predictors of both 30-day unplanned readmission and 1-year mortality. CONCLUSION Unplanned 30-day readmissions and medium-term mortality remain high among patients who survived to 30 days after incident HF hospitalisation. Any cardiovascular or non-cardiovascular readmission was associated with a two to three-fold higher adjusted HR for death over the following year, and various coexistent comorbidities were important associates of readmission and mortality risk. Our findings support the need to optimize multidisciplinary HF and multimorbidity management to potentially reduce repeat hospitalisation and improve survival.
Collapse
Affiliation(s)
- Courtney Weber
- grid.1012.20000 0004 1936 7910School of Population and Global Health, University of Western Australia, Crawley, WA Australia
| | - Joseph Hung
- grid.1012.20000 0004 1936 7910Medical School, University of Western Australia, Crawley, WA Australia
| | - Siobhan Hickling
- grid.1012.20000 0004 1936 7910School of Population and Global Health, University of Western Australia, Crawley, WA Australia
| | - Ian Li
- grid.1012.20000 0004 1936 7910School of Population and Global Health, University of Western Australia, Crawley, WA Australia
| | - Kevin Murray
- grid.1012.20000 0004 1936 7910School of Population and Global Health, University of Western Australia, Crawley, WA Australia
| | - Tom Briffa
- grid.1012.20000 0004 1936 7910School of Population and Global Health, University of Western Australia, Crawley, WA Australia
| |
Collapse
|
32
|
Hashimoto S, Kitakata H, Kohsaka S, Fujisawa D, Shiraishi Y, Nakano N, Sekine O, Kishino Y, Katsumata Y, Yuasa S, Fukuda K, Kohno T. Confidence in self-care after heart failure hospitalization. J Cardiol 2023; 81:42-48. [PMID: 36241046 DOI: 10.1016/j.jjcc.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/02/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Understanding patient perspectives of self-care is critical for improving multidisciplinary education programs and adherence to such programs. However, perspectives of self-care for patients with heart failure (HF) as well as the association between patient perspectives and patient-physician communication remain unclear. METHODS Confidence levels regarding self-care behaviors (eight lifestyle behaviors and four consulting behaviors) and self-monitoring were assessed using a self-administered questionnaire survey, which was directly distributed by dedicated physicians and nurses to consecutive patients hospitalized with HF in a tertiary-level hospital. Patient-physician communication was evaluated according to the quality of physician-provided information regarding "treatment and treatment choices" and "prognosis" using the Prognosis and Treatment Perception Questionnaire. Out of 202 patients, 187 (92.6 %) agreed to participate, and 176 completed the survey [valid response rate, 87.1 %; male, 67.0 %; median age, 73 (63-81) years]. Multivariate logistic regression analyses were conducted to predict low confidence in self-care (score in the lowest quartile). RESULTS High confidence (confident or completely confident >75 % of patients) was observed for all self-care behavior categories except low-salt diet (63.1 %), regular exercise (63.1 %), and flu vaccination (65.9 %). Lower confidence in self-care behavior was associated with low quality of patient-physician communication. With regard to self-monitoring, 62.5 % of patients were not confident in distinguishing worsening symptoms of HF from other diseases; non-confidence was also associated with low quality of patient-physician communication. CONCLUSIONS Hospitalized patients with HF had low confidence regarding regular exercise, salt restriction, and flu vaccination. The results also suggest patient-physician communication affects patient confidence.
Collapse
Affiliation(s)
- Shun Hashimoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroki Kitakata
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Naomi Nakano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Otoya Sekine
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshikazu Kishino
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshinori Katsumata
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan.
| |
Collapse
|
33
|
Adherence to Self-Care Recommendations and Associated Factors among Adult Heart Failure Patients in West Gojjam Zone Public Hospitals, Northwest Ethiopia. Int J Chronic Dis 2022; 2022:9673653. [PMID: 36590698 PMCID: PMC9798104 DOI: 10.1155/2022/9673653] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/03/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background Self-care practices are an important part of heart failure patient management and essential to control symptoms of the disease and its exacerbation. However, poor adherence to these self-care behaviors could be associated with an increase in hospitalization, morbidity, and mortality. Even if it is an important part of management for heart failure patients, yet information is not adequate in the study area about adherence to self-care recommendations and associated factors among heart failure patients. Purpose To assess self-care recommendation adherence and associated factors among heart failure patients in West Gojjam Zone public hospitals. Methods Institutional-based cross-sectional study was conducted on 304 selected heart failure patients attending follow-up at public hospitals in West Gojjam Zone from March 16 to April 16, 2021. Consecutive sampling technique based on patient arrival with proportional allocation to each hospital was employed to select the study participants. Data were collected through face-to-face interview and reviewing patients' medical records. Data were entered into EpiData version 3.1 and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Binary logistic regression model was fitted to assess the association between adherence to self-care recommendations and associated factors. P value < 0.05 with 95% confidence interval (CI) was considered to declare a statistically significant association in multivariable logistic regression. Results In this study, 304 patients participated with a response rate of 97.4%. Only 32.9% of them had good adherence to self-care recommendations. Having good knowledge on heart failure (adjusted odds ratio (AOR) = 4.6; 95% CI: 1.82, 11.86), no depression (AOR = 6.1; 95% CI: 1.92, 19.37), having strong social support (AOR = 3.57; 95% CI: 1.56-8.33), age 30-49 years (AOR = 3.37; 95% CI: 1.14, 9.89), and college and above level of education (AOR = 6.17; 95% CI: 1.22, 31.25) were factors significantly associated with good adherence to self-care recommendations. Conclusion This study showed that most of the heart failure patients had poor adherence to self-care recommendations. Policymakers and other stakeholders should develop and implement appropriate strategies to increase patients' adherence level to self-care recommendations by emphasizing on addressing identified factors.
Collapse
|
34
|
Abassade P, Cohen L, Fels A, Chatellier G, Sacco E, Beaussier H, Fleury L, Komajda M, Cador R. [Impact of Home Return Assistance Service in Heart Failure (PRADO-IC) on the one year re-hospitalisation and mortality in a heart failure hospitalized population of patients]. Ann Cardiol Angeiol (Paris) 2022; 71:267-275. [PMID: 35940973 DOI: 10.1016/j.ancard.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Congestive heart failure (CHF) is associated with prolonged and recurrent hospitalizations; the prognosis remains poor. Since 2013, the Caisse Primaire d'Assurance Maladie (CPAM) has set up a support program PRADO-IC (support program for returning home after hospitalisation for heart failure). The aim of this study was to evaluate the impact of PRADO-IC on the heart failure readmission rate and death rate at one year. METHODS From September 2016 to September 2018, all patients hospitalized for heart failure at Saint-Joseph Hospital were included in an observational study. The inclusion in PRADO-IC program was at physician's discretion. Two groups were compared according to the inclusion in PRADO-IC or not (T). The primary endpoints were the comparison of one-year mortality and heart failure readmission rate between the two groups. RESULTS Six hundred and thirty-three patients were included, 262 in the PRADO-IC group and 371 in the non-PRADO group. Patients in the PRADO-IC cohort more frequently present severity criteria (age, weight, BNP level, arrhythmia, anemia, renal failure). Mortality at one year (19.5% vs 16.2%, p = 0.28) are equivalent in both groups. There were no significant differences in one-year rehospitalization rate for heart failure (HF) (35.1% in PRADO cohort vs 28% in T group, p = 0.06), the time to first hospitalization (74.5 days in PRADO vs 54.5 days in T, p = 0.55) and the length of hospitalization (6.0 days in PRADO vs 7.0 days in T, p = 0.29) between the two groups. Age, hyponatremia, anemia, cancer, HF re-hospitalization were variables linked to a risk of mortality, in a multivariable analysis. CONCLUSION Our study shows that the PRADO-IC program concerned to the most severe patients. Despite this, the one-year mortality and the HF readmission rate are similar between the two groups.
Collapse
Affiliation(s)
- Philippe Abassade
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75014, Paris, France.
| | - Léa Cohen
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75014, Paris, France
| | - Audrey Fels
- Département de Recherche Clinique, Groupe Hospitalier Paris Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France
| | - Gilles Chatellier
- Département de Recherche Clinique, Groupe Hospitalier Paris Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France
| | - Emmanuelle Sacco
- Département de Recherche Clinique, Groupe Hospitalier Paris Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France
| | - Hélène Beaussier
- Département de Recherche Clinique, Groupe Hospitalier Paris Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France
| | - Laetitia Fleury
- Direction Régionale du Service Médical (DRSM) d'Île de France, 17 Place de l'Argonne 75019, Paris, France
| | - Michel Komajda
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75014, Paris, France
| | - Romain Cador
- Service de Cardiologie, Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75014, Paris, France
| |
Collapse
|
35
|
Carter J, Donelan K, Thorndike AN. Patient Perspectives on Home-Based Care and Remote Monitoring in Heart Failure: A Qualitative Study. J Prim Care Community Health 2022; 13:21501319221133672. [PMID: 36305386 PMCID: PMC9619261 DOI: 10.1177/21501319221133672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION As individual interventions, home-based care and remote monitoring have been shown to help prevent hospitalizations for those with heart failure (HF) although both interventions have been limited by scalability and technical constraints, respectively. Few qualitative studies have explored patient perspectives, including acceptability, barriers, and facilitators of HF care inclusive of both interventions. The objective of this study is to explore patient perceptions on HF management at home, the use of home-based remote monitoring, and the value of home-based care. METHODS Qualitative interviews (N = 27) were conducted via phone (12/2020-3/2021) with adults with HF. A framework analysis was used to identify main themes along with verbatim transcription for coding and analyses. There were 5 key interview domains: general HF knowledge, perceptions of the value of home-based care, unmet needs related to the social determinants of health (SDOH), experience with healthcare technology and remote monitoring, and challenges in HF home management. RESULTS Five major themes emerged. Patients reported: (1) home-based care plan instructions are understood; (2) following medication, diet, and fluid management instructions are challenging due to difficult adherence to and implementation at home; (3) financial limitations serve as barriers to acquiring healthy food; (4) home-based support is a valuable component of managing medications, diet, and fluid; (5) despite limited use of technology, strong willingness to use remote monitoring is present amongst most. CONCLUSIONS Participants reported understanding of care plan instructions and challenges adhering to care plans at home. Barriers included needing more home-based support for medications, diet, and fluid management and requiring additional assistance with financial barriers related to unmet social needs. A combined intervention inclusive of remote monitoring and home-based support has potential to improve home-based strategies and clinical outcomes for HF patients.
Collapse
Affiliation(s)
- Jocelyn Carter
- Massachusetts General Hospital, Boston, MA, USA,Jocelyn Carter, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Blake 15, Boston, MA 02114, USA.
| | | | | |
Collapse
|
36
|
Washida K, Kato T, Ozasa N, Morimoto T, Yaku H, Inuzuka Y, Tamaki Y, Seko Y, Yamamoto E, Yoshikawa Y, Shiba M, Kitai T, Yamashita Y, Taniguchi R, Iguchi M, Nagao K, Kawase Y, Nishimoto Y, Kuragaichi T, Hotta K, Morinaga T, Toyofuku M, Furukawa Y, Ando K, Kadota K, Sato Y, Kuwahara K, Kimura T. A comparison between hospital follow-up and collaborative follow-up in patients with acute heart failure. ESC Heart Fail 2022; 10:353-365. [PMID: 36237154 PMCID: PMC9871700 DOI: 10.1002/ehf2.14200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/31/2022] [Accepted: 09/29/2022] [Indexed: 02/03/2023] Open
Abstract
AIMS There are no previous studies focusing on collaborative follow-ups between hospitals and clinics for patients discharged after acute heart failure (AHF) in Japan. The purpose of this study was to determine the status of collaboration between hospitals and clinics for patients with AHF in Japan and to compare patient characteristics and clinical outcomes using a large Japanese observational database. METHODS AND RESULTS Of 4056 consecutive patients hospitalized for AHF in the Kyoto Congestive Heart Failure registry, we analysed 2862 patients discharged to go home, who were divided into 1674 patients (58.5%) followed up at hospitals with index hospitalization (hospital follow-up group) and 1188 (41.5%) followed up in a collaborative fashion with clinics or other general hospitals (collaborative follow-up group). The primary outcome was a composite of all-cause death or heart failure (HF) hospitalization within 1 year after discharge. Previous hospitalization for HF and length of hospital stay longer than 15 days were associated with hospital follow-up. Conversely, ≥80 years of age, hypertension, and cognitive dysfunction were associated with collaborative follow-up. The cumulative 1-year incidence of the primary outcome, all cause death, and cardiovascular death were similar between the hospital and collaborative follow-up groups (31.6% vs. 29.6%, P = 0.51, 13.1% vs, 13.9%, P = 0.35, 8.4% vs. 8.2%, P = 0.96). Even after adjusting for confounders, the difference in risk for patients in the hospital follow-up group relative to those in the collaborative follow-up group remained insignificant for the primary outcome, all-cause death, and cardiovascular death (HR: 1.11, 95% CI: 0.97-1.27, P = 0.14, HR: 1.10, 95% CI: 0.91-1.33, P = 0.33, HR: 0.96, 95% CI: 0.87-1.05, P = 0.33). The cumulative 1-year incidence of HF hospitalization was higher in the hospital follow-up group than in the collaborative follow-up group (25.5% vs. 21.3%, P = 0.02). The risk of HF hospitalization was higher in the hospital follow-up group than in the collaborative follow-up group (HR: 1.19, 95% CI: 1.01-1.39, P = 0.04). CONCLUSIONS In patients hospitalized for AHF, 41.5% received collaborative follow-up after discharge. The risk of HF hospitalization was higher in the hospital follow-up group than in the collaborative follow-up, although risk of the primary outcome, all-cause death, and cardiovascular death were similar between groups.
Collapse
Affiliation(s)
- Koichi Washida
- Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
| | - Takao Kato
- Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
| | - Neiko Ozasa
- Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
| | | | - Hidenori Yaku
- Department of CardiologyMitsubishi Kyoto HospitalKyotoJapan
| | | | - Yodo Tamaki
- Division of CardiologyTenri HospitalNaraJapan
| | - Yuta Seko
- Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
| | - Erika Yamamoto
- Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
| | - Yusuke Yoshikawa
- Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
| | - Masayuki Shiba
- Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
| | - Takeshi Kitai
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Yugo Yamashita
- Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
| | - Ryoji Taniguchi
- Department of CardiologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiHyogoJapan
| | - Moritake Iguchi
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Kazuya Nagao
- Department of CardiologyOsaka Red Cross HospitalOsakaJapan
| | - Yuichi Kawase
- Department of CardiologyKurashiki Central HospitalOkayamaJapan
| | - Yuji Nishimoto
- Department of CardiologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiHyogoJapan
| | - Takashi Kuragaichi
- Department of CardiologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiHyogoJapan
| | - Kozo Hotta
- Department of CardiologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiHyogoJapan
| | | | - Mamoru Toyofuku
- Department of CardiologyJapanese Red Cross Wakayama Medical CenterWakayamaJapan
| | - Yutaka Furukawa
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeHyogoJapan
| | - Kenji Ando
- Department of CardiologyKokura Memorial HospitalFukuokaJapan
| | | | - Yukihito Sato
- Department of CardiologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiHyogoJapan
| | - Koichiro Kuwahara
- Department of Cardiovascular MedicineShinshu University Graduate School of MedicineNaganoJapan
| | - Takeshi Kimura
- Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
| |
Collapse
|
37
|
Al Sattouf A, Farahat R, Khatri AA. Effectiveness of Transitional Care Interventions for Heart Failure Patients: A Systematic Review With Meta-Analysis. Cureus 2022; 14:e29726. [PMID: 36340534 PMCID: PMC9621739 DOI: 10.7759/cureus.29726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 11/21/2022] Open
Abstract
Heart failure is a leading cause of hospitalizations. Heart failure patients were found to have a high incidence of re-admission after discharge. This highlights a care gap during the transition from hospital to home environment and interventions were utilized to cover this care gap. The aim of this review was to evaluate the effectiveness of these interventions. This was investigated in terms of re-admissions, mortality, emergency department (ED) visits, and quality of life. An exhaustive systematic search was conducted in electronic databases, which include MEDLINE, CINAHL, AMED, Cochrane library, and PubMed. Databases were explored for literature published in English between April 2012 and April 2022. The review included 13 randomized controlled trials and comprised a total of 7,693 heart failure patients with 3,835 receiving transitional care interventions (TCIs) and 3,858 receiving standard care. It was found that implementing TCIs resulted in a reduction of all-cause re-admission and all-cause mortality. Although it is controversial if TCIs improve quality of life, TCIs were noted to decrease the frequency of ED visits. Telephone support interventions proved most efficacious among other interventions in reducing hospital readmissions, and were found effective in reducing mortality in combination with other interventions, i.e. clinic visits. Additionally, telemonitoring is found beneficial in supporting patients just after discharge, the most vulnerable period, for medically optimizing and monitoring patients during the care gap.
Collapse
|
38
|
Uchmanowicz I, Wleklik M, Foster M, Olchowska-Kotala A, Vellone E, Kaluzna-Oleksy M, Szczepanowski R, Uchmanowicz B, Reczuch K, Jankowska EA. Digital health and modern technologies applied in patients with heart failure: Can we support patients’ psychosocial well-being? Front Psychol 2022; 13:940088. [PMID: 36275212 PMCID: PMC9580561 DOI: 10.3389/fpsyg.2022.940088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022] Open
Abstract
Despite advances in the treatment of heart failure (HF), the physical symptoms and stress of the disease continue to negatively impact patients’ health outcomes. Technology now offers promising ways to integrate personalized support from health care professionals via a variety of platforms. Digital health technology solutions using mobile devices or those that allow remote patient monitoring are potentially more cost effective and may replace in-person interaction. Notably, digital health methods may not only improve clinical outcomes but may also improve the psycho-social status of HF patients. Using digital health to address biopsychosocial variables, including elements of the person and their context is valuable when considering chronic illness and HF in particular, given the multiple, cross-level factors affecting chronic illness clinical management needed for HF self-care.
Collapse
Affiliation(s)
- Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Marta Wleklik
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Marva Foster
- Center for Healthcare Organization and Implementation Research (CHOIR), Boston VA Healthcare System, Boston, MA, United States
- Department of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Agnieszka Olchowska-Kotala
- Department of Medical Humanities and Social Science, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Ercole Vellone
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marta Kaluzna-Oleksy
- Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland
| | - Remigiusz Szczepanowski
- Department of Computer Science and Systems Engineering, Wrocław University of Science and Technology, Wrocław, Poland
| | - Bartosz Uchmanowicz
- Department of Family and Pediatric Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
- *Correspondence: Bartosz Uchmanowicz,
| | - Krzysztof Reczuch
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
- Institute of Heart Diseases, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa Anita Jankowska
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
- Institute of Heart Diseases, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
39
|
Liaw FY, Chang YW, Chang YD, Shih LW, Tsai PF. Using drawing and situated learning to teach transitional care to post-graduate residents. BMC MEDICAL EDUCATION 2022; 22:687. [PMID: 36131340 PMCID: PMC9494879 DOI: 10.1186/s12909-022-03738-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The "draw-and-talk" technique has become popular in medical training, as it can help healthcare practitioners develop empathic understanding of patients and contribute to personal transformation. We adopted this method to make the teaching of transitional care planning more relevant to post-graduate residents undergoing their internal medicine training at a medical center in Taiwan. METHODS Before the conventional lecture on discharge planning, trainees were invited to draw their "home" and "life as older adults" and share their drawings with others. Subsequently, they were guided to consider whether their home would be livable if they either had a disability or were old. The drawings and narratives were analyzed thematically, and feedback on the session was collected. RESULTS Trainees were initially of the opinion that they did not have any role in discharge planning. However, the emphasis on the self-experience of drawing and the thematic use of "home" and "elderly life" led to reflective discussions about post-discharge care. The session provoked constructive self-reflection and meta-cognitive awareness and encouraged residents to actively participate in transition care plans. Response to the draw-and-talk session was overwhelmingly favorable. CONCLUSIONS Post-graduate residents in Taiwan conventionally do not have much interest or autonomy regarding their patients' lives outside the hospital. The use of drawing and reflection is a simple and inexpensive method to contextualize discharge planning in participants' real lives, engage them in actively visualizing the healthcare needs of older adults and patients with disability, and initiate thinking about the impact of discharge preparations, follow-up care, and barriers to care at home. Draw-and-talk might be helpful in improving residents' knowledge and empathy toward patients preparing for discharge, which is crucial for the quality of transitional care.
Collapse
Affiliation(s)
- Fang-Yih Liaw
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Humanities in Medicine, College of Humanities and Social Sciences, Taipei Medical University, No. 250, Wu Shin Street, Taipei City, 110, Taiwan
| | - Yaw-Wen Chang
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yan-Di Chang
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Li-Wen Shih
- Graduate Institute of Humanities in Medicine, College of Humanities and Social Sciences, Taipei Medical University, No. 250, Wu Shin Street, Taipei City, 110, Taiwan
| | - Po-Fang Tsai
- Graduate Institute of Humanities in Medicine, College of Humanities and Social Sciences, Taipei Medical University, No. 250, Wu Shin Street, Taipei City, 110, Taiwan.
| |
Collapse
|
40
|
Yenjai N, Asdornwised U, Wongkongkam K, Pinjaroen N. A comprehensive discharge planning program on fatigue and functional status of patients with hepatocellular carcinoma undergoing transarterial chemoembolization: A randomized clinical controlled trial. BELITUNG NURSING JOURNAL 2022; 8:287-295. [PMID: 37546491 PMCID: PMC10401379 DOI: 10.33546/bnj.2140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 08/08/2023] Open
Abstract
Background Post transarterial chemoembolization (post-TACE) causes side effects that impact patients, which leads to fatigue symptoms and reduced functional status. However, unrelieved fatigue and reduced functional status may cause patients to withdraw from treatment and negatively affect their lives. Unfortunately, the patients post-TACE only receive routine medical care at the hospital but no follow-up and continuity of care back home. Therefore, comprehensive discharge planning for these problems is necessary. Objective This study examined the effectiveness of the comprehensive discharge planning program on fatigue and functional status of patients with hepatocellular carcinoma undergoing transarterial chemoembolization. Methods A randomized clinical controlled trial was used. Fifty-two patients who met the study criteria were randomly assigned to an experimental group (n = 26) receiving the comprehensive discharge planning plus routine care and a control group (n = 26) receiving routine care only. The discharge planning program was developed based on the Transitional Care Model. A demographic and health data questionnaire, Fatigue Severity Scale (FSS), and Enforced Social Dependency Scale (ESDS) were used for data collection. Chi-square, Fisher's exact, Wilcoxon signed-rank, and Mann-Whitney U tests were used for data analysis. Results The mean scores for fatigue at 30 days after treatment between the experimental and control groups were significantly different (p = 0.003). The mean scores for the fatigue symptoms in the experimental and control groups were 1.27 ± 0.58 and 1.77 ± 0.85, respectively. The functional status from Day 7 to Day 14 after transarterial chemoembolization was different (p = 0.020). In addition, the mean scores for functional status between the experimental and control groups were significantly different (p = 0.020). On Day 14, after transarterial chemoembolization, the experimental group had an increased score in functional status from Day 7 over the scores for those in the control group. Conclusion The comprehensive discharge planning program effectively reduces fatigue symptoms and enhances the functional status in patients with hepatocellular carcinoma undergoing transarterial chemoembolization. Therefore, the comprehensive discharge planning program can be used by nurses and multidisciplinary teams in order to achieve the effectiveness of nursing care for patients.
Collapse
Affiliation(s)
- Nawiya Yenjai
- Master of Nursing Science Program in Adult and Gerontological Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | | | | | - Nutcha Pinjaroen
- Radiology Department, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
41
|
Niu Q, Liu W, Wang F, Tian L, Dong Y. The Utility of Cognitive Screening in Asian Patients With Heart Failure: A Systematic Review. Front Psychiatry 2022; 13:930121. [PMID: 35911251 PMCID: PMC9329604 DOI: 10.3389/fpsyt.2022.930121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background The prevalence of undiagnosed cognitive impairment in patients with heart failure is alarmingly high in Asia. There is still no consensus on cognitive screening tools to detect cognitive impairment in the Asian heart failure population. The clinical implications based on our systematic review may help to improve cognitive screening practice for patients with heart failure in Asia. Methods This review is registered in the PROSPERO (CRD42021264288). Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach, we searched PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature, Scopus, the Web of Science, PsycINFO, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang Data in English and Chinese literatures concerning heart failure and cognitive impairment. Results The search yielded 21 eligible studies. Only in five studies, cognitive brief tests, including the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), and the Mini-Cog, were used as cognitive screening tools for Asian patients with heart failure. In the rest 16 studies, brief cognitive tests were used as screening tools for global cognition. Only one study validated screening tests against a gold standard formal neuropsychological assessment test battery. Among these studies, patients with heart failure tended to perform worse than patients without heart failure. The presence of cognitive impairment in patients with heart failure is associated with poorer self-care, quality of life, and hospital readmission. Conclusion Brief cognitive tests have been used in Asian patients with heart failure and these tests are frequently used as a measure of global cognitive function for cognitive screening. However, validating brief cognitive tests against a gold standard formal neuropsychological assessment in Asian patients with heart failure is lacking. Future studies need to address methodological issues to validate cognitive screening measures in a larger population of Asian patients with heart failure.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/.
Collapse
Affiliation(s)
- Qi Niu
- School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - WeiHua Liu
- School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | | | - LiYa Tian
- School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - YanHong Dong
- School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
42
|
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e895-e1032. [PMID: 35363499 DOI: 10.1161/cir.0000000000001063] [Citation(s) in RCA: 623] [Impact Index Per Article: 311.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Hernandez AF, Albert NM, Allen LA, Ahmed R, Averina V, Boehmer JP, Cowie MR, Chien CV, Galvao M, Klein L, Kwan B, Lam CSP, Ruble SB, Stolen CM, Stein K. Multiple cArdiac seNsors for mAnaGEment of Heart Failure (MANAGE-HF) - Phase I Evaluation of the Integration and Safety of the HeartLogic Multisensor Algorithm in Patients With Heart Failure. J Card Fail 2022; 28:1245-1254. [PMID: 35460884 DOI: 10.1016/j.cardfail.2022.03.349] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/06/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patients with heart failure and reduced ejection fraction (HFrEF) suffer from a relapsing and remitting disease, where early treatment changes may improve outcomes. We assessed the clinical integration and safety of the HeartLogic multi-sensor index and alerts in heart failure care. METHODS The Multiple cArdiac seNsors for mAnaGEment of Heart Failure (MANAGE-HF) study enrolled 200 patients with HFrEF (< 35%), NYHA class II-III symptoms, implanted with a CRT-D or ICD, who had either a hospitalization for HF within 12 months or unscheduled visit for HF exacerbation within 90 days or an elevated natriuretic peptide concentration (BNP≥150 pg/mL or NT-proBNP≥600 pg/mL). This phase included development of an alert management guide and evaluated changes in medical treatment, natriuretic peptide levels, and safety. RESULTS Mean age of participants was 67 years, 68% were men, 81% were white, and 61% had a HF hospitalization in prior 12 months. During follow-up there were 585 alert cases with an average of 1.76 alert cases/pt-yr. HF medications were augmented during 74% of the alert cases. HF treatment augmentation within 2 weeks from an initial alert was associated with more rapid recovery of the HeartLogic Index. Five SAEs (0.015 per pt-year) occurred in relation to alert-prompted medication change. NTproBNP levels decreased from median of 1316 pg/mL at baseline to 743 pg/mL at 12 months (p<0.001). CONCLUSIONS HeartLogic alert management was safely implemented in HF care and may optimize HF management. This phase supports further evaluation in larger studies. TRIAL REGISTRATION ClinicalTrials.gov (NCT03237858).
Collapse
Affiliation(s)
- Adrian F Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
| | - Nancy M Albert
- Nursing Institute and George M. and Linda H. Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - John P Boehmer
- Division of Cardiology, Department of Medicine Penn State University College of Medicine, Hershey, Pennsylvania
| | - Martin R Cowie
- Royal Brompton Hospital & Faculty of Lifesciences & Medicine, King's College London, London, United Kingdom
| | - Christopher V Chien
- Division of Cardiology, Department of Medicine University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Marie Galvao
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Liviu Klein
- Division of Cardiology, Department of Medicine, UC San Francisco, San Francisco, CA
| | | | - Carolyn S P Lam
- National Heart Centre Singapore & Duke National University of Singapore, Singapore
| | | | | | | | | |
Collapse
|
44
|
Xu H, Granger BB, Drake CD, Peterson ED, Dupre ME. Effectiveness of Telemedicine Visits in Reducing 30-Day Readmissions Among Patients With Heart Failure During the COVID-19 Pandemic. J Am Heart Assoc 2022; 11:e023935. [PMID: 35229656 PMCID: PMC9075458 DOI: 10.1161/jaha.121.023935] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background The COVID‐19 pandemic resulted in a rapid implementation of telemedicine into clinical practice. This study examined whether early outpatient follow‐up via telemedicine is as effective as in‐person visits for reducing 30‐day readmissions in patients with heart failure. Methods and Results Using electronic health records from a large health system, we included patients with heart failure living in North Carolina (N=6918) who were hospitalized between March 16, 2020 and March 14, 2021. All‐cause readmission within 30 days after discharge was examined using weighted logistic regression models. Overall, 7.6% (N=526) of patients received early telemedicine follow‐up, 38.8% (N=2681) received early in‐person follow‐up, and 53.6% (N=3711) did not receive follow‐up within 14 days of discharge. Compared with patients without early follow‐up, those who received early follow‐up were younger, were more likely to be Medicare beneficiaries, had more comorbidities, and were less likely to live in an disadvantaged neighborhood. Relative to in‐person visits, those with telemedicine follow‐up were of similar age, sex, and race but with generally fewer comorbidities. Overall, the 30‐day readmission rate (19.0%) varied among patients who received telemedicine visits (15.0%), in‐person visits (14.0%), or no follow‐up (23.1%). After covariate adjustment, patients who received either telemedicine (odds ratio [OR], 0.55; 95% CI, 0.44–0.72) or in‐person (OR, 0.52; 95% CI, 0.45–0.60) visits were similarly less likely to be readmitted within 30 days compared with patients with no follow‐up. Conclusions During the COVID‐19 pandemic, the use of telemedicine visits for early follow‐up increased rapidly. Patients with heart failure who received outpatient follow‐up either via telemedicine or in‐person had better outcomes than those who received no follow‐up.
Collapse
Affiliation(s)
- Hanzhang Xu
- Department of Family Medicine and Community Health Duke University Durham NC.,Duke University School of Nursing Duke University Durham NC.,Center for the Study of Aging and Human Development Duke University Durham NC
| | | | - Connor D Drake
- Department of Population Health Sciences Duke University Durham NC
| | - Eric D Peterson
- Office of the Provost University of Texas Southwestern Medical Dallas TX.,Department of Internal Medicine University of Texas Southwestern Medical Dallas TX
| | - Matthew E Dupre
- Center for the Study of Aging and Human Development Duke University Durham NC.,Department of Population Health Sciences Duke University Durham NC.,Duke Clinical Research Institute Duke University Durham NC.,Department of Sociology Duke University Durham NC
| |
Collapse
|
45
|
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2022; 79:e263-e421. [PMID: 35379503 DOI: 10.1016/j.jacc.2021.12.012] [Citation(s) in RCA: 730] [Impact Index Per Article: 365.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. STRUCTURE Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
Collapse
|
46
|
González-Franco Á, Cerqueiro González J, Arévalo-Lorido J, Álvarez-Rocha P, Carrascosa-García S, Armengou A, Guzmán-García M, Trullàs J, Montero-Pérez-Barquero M, Manzano L. Beneficios de un modelo asistencial integral en pacientes ancianos con insuficiencia cardíaca y elevada comorbilidad: programa UMIPIC. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
47
|
Morken IM, Storm M, Søreide JA, Urstad KH, Karlsen B, Husebø AML. Posthospitalization Follow-Up of Patients With Heart Failure Using eHealth Solutions: Restricted Systematic Review. J Med Internet Res 2022; 24:e32946. [PMID: 35166680 PMCID: PMC8889479 DOI: 10.2196/32946] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/09/2021] [Accepted: 12/03/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a clinical syndrome with high incidence rates, a substantial symptom and treatment burden, and a significant risk of readmission within 30 days after hospitalization. The COVID-19 pandemic has revealed the significance of using eHealth interventions to follow up on the care needs of patients with HF to support self-care, increase quality of life (QoL), and reduce readmission rates during the transition between hospital and home. OBJECTIVE The aims of this review are to summarize research on the content and delivery modes of HF posthospitalization eHealth interventions, explore patient adherence to the interventions, and examine the effects on the patient outcomes of self-care, QoL, and readmissions. METHODS A restricted systematic review study design was used. Literature searches and reviews followed the (PRISMA-S) Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension checklist, and the CINAHL, MEDLINE, Embase, and Cochrane Library databases were searched for studies published between 2015 and 2020. The review process involved 3 groups of researchers working in pairs. The Mixed Methods Appraisal Tool was used to assess the included studies' methodological quality. A thematic analysis method was used to analyze data extracted from the studies. RESULTS A total of 18 studies were examined in this review. The studies were published between 2015 and 2019, with 56% (10/18) of them published in the United States. Of the 18 studies, 16 (89%) were randomized controlled trials, and 14 (78%) recruited patients upon hospital discharge to eHealth interventions lasting from 14 days to 12 months. The studies involved structured telephone calls, interactive voice response, and telemonitoring and included elements of patient education, counseling, social and emotional support, and self-monitoring of symptoms and vital signs. Of the 18 studies, 11 (61%) provided information on patient adherence, and the adherence levels were 72%-99%. When used for posthospitalization follow-up of patients with HF, eHealth interventions can positively affect QoL, whereas its impact is less evident for self-care and readmissions. CONCLUSIONS This review suggests that patients with HF should receive prompt follow-up after hospitalization and eHealth interventions have the potential to improve these patients' QoL. Patient adherence in eHealth follow-up trials shows promise for successful future interventions and adherence research. Further studies are warranted to examine the effects of eHealth interventions on self-care and readmissions among patients with HF.
Collapse
Affiliation(s)
- Ingvild Margreta Morken
- Department of Quality and Health Technologies, University of Stavanger, Stavanger, Norway
- Research Group for Nursing and Health Sciences, Stavanger University Hospital, Stavanger, Norway
| | - Marianne Storm
- Department of Public Health, University of Stavanger, Stavanger, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Jon Arne Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kristin Hjorthaug Urstad
- Department of Quality and Health Technologies, University of Stavanger, Stavanger, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Bjørg Karlsen
- Department of Public Health, University of Stavanger, Stavanger, Norway
| | - Anne Marie Lunde Husebø
- Research Group for Nursing and Health Sciences, Stavanger University Hospital, Stavanger, Norway
- Department of Public Health, University of Stavanger, Stavanger, Norway
| |
Collapse
|
48
|
Yun S, Enjuanes C, Calero-Molina E, Hidalgo E, José N, Calvo E, Verdú-Rotellar JM, Garcimartín P, Chivite D, Formiga F, Jiménez-Marrero S, Garay A, Alcoberro L, Moliner P, Corbella X, Comín-Colet J. Effectiveness of telemedicine in patients with heart failure according to frailty phenotypes: Insights from the iCOR randomised controlled trial. Eur J Intern Med 2022; 96:49-59. [PMID: 34656406 DOI: 10.1016/j.ejim.2021.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The potential impact of telemedicine (TM) in the monitoring of patients with heart failure (HF) is still uncertain particularly in the frailest patients. The aim of this study was to define the efficacy of a TM-based managed care solution across different HF patient frailty phenotypes. METHODS We performed a clustering analysis on the basis of 8 frailty-related dimensions to the HF-patients included in the 'insuficiència Cardíaca Optimització Remota' (iCOR) randomised study comparing TM vs. usual care (UC) in HF patients. The primary study endpoint was the incidence of a non-fatal HF event after 6 months of inclusion. The healthcare-related costs in each study group and cluster were also evaluated. The event rates of primary and secondary study endpoints were calculated for each cluster. Cox proportional-hazards regression models were used to evaluate the effect of cluster, treatment group and the interaction term cluster by treatment group on study endpoints. RESULTS 5 different frailty phenotypes were identified. The positive effect of TM compared to UC strategy was consistent across all frailty phenotypes (p-value for interaction 0.711). The risk of experiencing a primary event was significantly lower in patients that underwent allocation to the TM arm compared to UC (p-value = 0.016). Ultimately, the healthcare costs were significantly reduced in patients allocated to the TM compared to UC in all 5 frailty phenotypes (all p-value < 0.05). CONCLUSIONS Non-invasive TM-based follow-up tools are effective compared to UC follow-up in preventing HF events in the early post-discharge period, regardless of the 5 frailty phenotypes.
Collapse
Affiliation(s)
- Sergi Yun
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Enjuanes
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Esther Calero-Molina
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Encarnación Hidalgo
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria José
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elena Calvo
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Faculty of medicine and Health Sciences, School of Nursing, University of Barcelona (UB), Barcelona, Spain
| | - José María Verdú-Rotellar
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Jordi Gol Primary Care Research Institute, Catalan Institute of Heath, Barcelona, Spain
| | - Paloma Garcimartín
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Outpatient Clinics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Escuela Superior de Enfermería del Mar, Parc de Salut Mar, Barcelona, Spain
| | - David Chivite
- Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francesc Formiga
- Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Santiago Jiménez-Marrero
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Cardio-Oncology Unit, Bellvitge University Hospital and Catalan Institute of Oncology, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Alberto Garay
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Cardio-Oncology Unit, Bellvitge University Hospital and Catalan Institute of Oncology, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Lídia Alcoberro
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Moliner
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Cardio-Oncology Unit, Bellvitge University Hospital and Catalan Institute of Oncology, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Hestia Chair in Integrated Health and Social Care, School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Josep Comín-Colet
- Community Heart Failure Program, Departments of Cardiology and Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona (UB), Barcelona, Spain.
| |
Collapse
|
49
|
Udod S, Lobchuk M, Avery L, Armah N. Using the Donabedian framework to examine transitional care for cardiac patients and family caregivers. Leadersh Health Serv (Bradf Engl) 2022; ahead-of-print. [DOI: 10.1108/lhs-10-2021-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims to examine how health-care managers in acute care and post-acute care facilities support and plan to improve transitional care for cardiac patients and their family caregivers, to better manage care in the home.
Design/methodology/approach
A qualitative descriptive approach, guided by appreciative inquiry was used in this study. A purposive sample of 16 participants were engaged in the study. Participants completed a demographic questionnaire, the caregiver policy lens questionnaire and participated in one of four focus group interviews. The semi-structured focus group interviews were audio-recorded and analyzed using thematic analysis.
Findings
Using Donabedian’s framework, six major themes contributed to how health-care managers can improve transitional care: structure included supporting personnel and continuing education; process included enacting approaches of care, coordinating care among the health-care team and calling to work upstream; and outcomes included needing to clarify expectations of home care services and witnessing the impact of the caregiver role.
Originality/value
These findings demonstrate the importance of Donabedian’s core dimensions of structure and processes in influencing caregiver outcomes. These results emphasize the central role of the manager in influencing system change to improve transitional care.
Collapse
|
50
|
Denfeld QE, Camacho SA, Dieckmann N, Hiatt SO, Davis MR, Cramer DV, Rupert A, Habecker BA, Lee CS. Background and Design of the Biological and Physiological Mechanisms of Symptom Clusters in Heart Failure (BIOMES-HF) Study. J Card Fail 2022; 28:973-981. [PMID: 35045322 DOI: 10.1016/j.cardfail.2022.01.003] [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: 09/14/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Symptoms, which often cluster together, are a significant problem in heart failure (HF). There is considerable heterogeneity in symptom burden, particularly in the vulnerable transition period after a hospitalization for HF, and the biological underpinnings of symptom during transitions are unclear. The purpose of this paper is to describe the background and design of a study that addresses these knowledge gaps, entitled "Biological and Physiological Mechanisms of Symptom Clusters in Heart Failure" (BIOMES-HF). STUDY DESIGN AND METHODS BIOMES-HF is a prospective gender- and age-balanced longitudinal study of 240 adults during the 6-month transition period after a HF hospitalization. The aims are to: 1) identify clusters of change in physical symptoms, 2) quantify longitudinal associations between biomarkers and physical symptoms, and 3) quantify longitudinal associations between physical frailty and physical symptoms among adults with heart failure. We will measure multiple symptoms, biomarkers, and physical frailty at discharge and then at 1 week and 1, 3, and 6 months post-hospitalization. We will use growth mixture modeling and longitudinal mediation modeling to examine changes in symptoms, biomarkers, and physical frailty post-HF hospitalization and associations therein. CONCLUSIONS This innovative study will advance HF symptom science by utilizing a multi-biomarker panel and the physical frailty phenotype to capture the multifaceted nature of HF. Using advanced quantitative modeling, we will characterize heterogeneity and identify potential mechanisms of symptoms in HF. As a result, this research will pinpoint amenable targets for intervention to provide better, individualized treatment to improve symptom burden in HF. BRIEF LAY SUMMARY Adults with heart failure may have significant symptom burden. This study is designed to shed light on our understanding of the role of biological and physiological mechanisms in explaining heart failure symptoms, particularly groups of co-occurring symptoms, over time. We will explore how symptoms, biomarkers, and physical frailty changes after a heart failure hospitalization. The knowledge generated from this study will be used to guide the management and self-care for adults with heart failure.
Collapse
Affiliation(s)
- Quin E Denfeld
- Oregon Health & Science University School of Nursing, Portland, OR, USA; Oregon Health & Science University Knight Cardiovascular Institute Portland, OR, USA.
| | - S Albert Camacho
- Oregon Health & Science University Knight Cardiovascular Institute Portland, OR, USA
| | - Nathan Dieckmann
- Oregon Health & Science University School of Nursing, Portland, OR, USA; Oregon Health & Science University School of Medicine Division of Psychology, Portland, OR
| | - Shirin O Hiatt
- Oregon Health & Science University School of Nursing, Portland, OR, USA
| | | | - Daniela V Cramer
- Oregon Health & Science University School of Nursing, Portland, OR, USA
| | - Allissah Rupert
- Oregon Health & Science University School of Nursing, Portland, OR, USA
| | - Beth A Habecker
- Oregon Health & Science University Knight Cardiovascular Institute Portland, OR, USA; Oregon Health & Science University Department of Chemical Physiology & Biochemistry, Portland, OR, USA
| | - Christopher S Lee
- Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA; Australian Catholic University, Melbourne, Australia
| |
Collapse
|