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Ali S, Tyerman J. Palliative Care for the Elderly With Heart Diseases in Tertiary Health care: A Concept Analysis. Am J Hosp Palliat Care 2024; 41:1061-1075. [PMID: 37963548 PMCID: PMC11318222 DOI: 10.1177/10499091231213606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The increasing incidence of heart failure (HF) in the elderly leads to increased mortality, hospitalization, length of hospital stay, and health care costs. Older adults often face multiple drug treatments, comorbidities, frailty, and cognitive problems, which require early palliative care. However, these patients do not receive adequate palliative care. OBJECTIVE This concept analysis aimed to develop an in-depth understanding of palliative care for elderly patients with cardiac diseases in tertiary care. DESIGN The analysis was guided by Walker and Avant's method, and databases were searched using keywords, such as palliative care, tertiary care, elderly, and heart. Covidence was used to review the results using the inclusion and exclusion criteria. RESULTS The World Health Organisation's definition of palliative care is widely accepted. Palliative care for older adults with heart disease in tertiary care is preceded by chronic illness, polypharmacy, symptom burden, physical and cognitive decline, comorbidities, and psychosocial/spiritual issues. The main attributes of palliative care for this population include health care professionals and patient education, holistic patient/family-centered care, symptom management, shared decision-making, early integration, advanced care planning, and a multidisciplinary approach. Palliative care improves elderly cardiac patients' and their family satisfaction while reducing readmission, hospital stays, and unnecessary invasive procedures. CONCLUSION Collaboration between hospitals, community organizations, transitional palliative care services, and research has the potential to improve early palliative care and the well-being of the elderly cardiac population. Advanced Practice Nurses (APNs) competencies play a crucial role in promoting palliative care in the elderly HF population.
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Affiliation(s)
- Sana Ali
- School of Nursing, Faculty of Health Sciences, The University of Ottawa, Ottawa, ON, Canada
| | - Jane Tyerman
- School of Nursing, Faculty of Health Sciences, The University of Ottawa, Ottawa, ON, Canada
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Surasura A, Siva Krishna Pavan Kumar BG, Chinamanagonda S, Durga D, Gubbala S. Understanding Hospital Readmissions: Insights, Patterns, and Interventions for Improvement in Chronic Kidney Disease. Cureus 2024; 16:e59524. [PMID: 38827006 PMCID: PMC11144055 DOI: 10.7759/cureus.59524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/25/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Hospital readmissions among chronic kidney disease (CKD) patients pose substantial challenges in healthcare, impacting both patients and healthcare systems. Understanding the patterns and determinants of CKD-related readmissions is crucial for devising effective interventions. OBJECTIVE This research aimed to investigate the factors contributing to hospital readmissions among CKD patients, identify the primary reasons for readmissions, and explore potential interventions to mitigate readmission risks. METHODS A retrospective analysis was conducted among a cohort of 300 CKD patients over an 18-month period at a tertiary care unit specializing in nephrology services. Data on demographics, CKD stages, comorbidities, reasons for readmissions, and lengths of hospital stays were analyzed. Logistic regression models were employed to identify predictors of readmissions. RESULTS Advancing CKD stages were associated with increased readmission rates, with higher rates observed in older patients. Cardiovascular complications and acute kidney injury were prominent reasons for readmissions. Age, comorbid conditions, and previous hospitalizations emerged as significant predictors of readmissions. Lengths of hospital stays during readmissions were also correlated with CKD stages. CONCLUSION The research underscores the complex interplay of demographic and clinical factors contributing to hospital readmissions among CKD patients. Tailored interventions addressing disease severity, comorbidities, and patient-specific characteristics are pivotal in reducing readmission risks and enhancing care outcomes for this population.
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Affiliation(s)
- Arun Surasura
- Internal Medicine, NRI Medical College and General Hospital, Guntur, IND
| | | | | | - Divya Durga
- Medicine, NRI Medical College and General Hospital, Guntur, IND
| | - Sahithi Gubbala
- Medicine, NRI Medical College and General Hospital, Guntur, IND
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Vogel TR, Kruse RL, Schlesselman C, Doss E, Camazine M, Popejoy LL. A qualitative study evaluating the discharge process for vascular surgery patients to identify significant themes for organizational improvement. Vascular 2024; 32:395-406. [PMID: 36287544 DOI: 10.1177/17085381221135267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Transition from the hospital to an outpatient setting is a multifaceted process requiring coordination among a variety of services and providers to ensure a high-quality discharge. Vascular surgery patients comprise a complex population that experiences high unplanned readmission rates. We performed a qualitative study to identify themes for process improvement for vascular surgery patients. A validated discharge process, RED (Re-Engineered Discharge), was used to identify additional actionable themes to create a more efficient discharge process tailored specifically to the vascular surgery population. METHODS A prospective, qualitative analysis at a tertiary center using a semi-structured focus group interview guide was performed to evaluate the current discharge process and identify opportunities for improvement. Focus groups were Zoom recorded, transcribed into electronic text files, and were loaded into Dedoose qualitative software for analysis using a directed content analysis approach. Two researchers independently thematically coded each transcript, starting with accepted discharge components to identify new thematic categories. Prior to analysis, all redundancy of codes was resolved, and all team members agreed on text categorization and coding. RESULTS Eight focus groups with a total of 38 participants were conducted. Participants included physicians (n = 13), nursing/ancillary staff (n = 14), advanced nurse practitioners (n = 2), social worker/dietitian/pharmacist (n = 3), and patients (n = 6). Transcript analyses revealed facilitators and barriers to the discharge process. In addition to traditional RED components, unique concepts pertinent to vascular surgery patients included patient complexity, social determinants of health, technology literacy, complexity of ancillary services, discharge appropriateness, and use of advanced nurse practitioners for continuity. CONCLUSIONS Specific themes were identified to target and enhance the future vRED (vascular Re-Engineered Discharge) bundle. Thematic targets for improvement include increased planning, organization, and communication prior to discharge to address vascular surgery patients' multiple comorbidities, extensive medication lists, and need for complex ancillary services at the time of discharge. Other thematic barriers discovered to improve include provider awareness of patient health literacy, patient understanding of complex discharge instructions, patient technology barriers, and intrinsic social determinants of health in this population. To address these discovered barriers, organizational targets to improve include enhanced social support, the use of advanced nurse practitioners for education reinforcement, and increased coordination. These results provide a framework for future quality improvement targeting the vascular surgery discharge process.
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Affiliation(s)
- Todd R Vogel
- Department of Surgery, Division of Vascular Surgery, University of Missouri System, Columbia, MI, USA
| | - Robin L Kruse
- Department of Surgery, Division of Vascular Surgery, University of Missouri System, Columbia, MI, USA
| | - Chase Schlesselman
- Department of Surgery, Division of Vascular Surgery, University of Missouri System, Columbia, MI, USA
| | - Elizabeth Doss
- Sinclair School of Nursing, University of Missouri System, Columbia, MO, USA
| | - Maraya Camazine
- Department of Surgery, Division of Vascular Surgery, University of Missouri System, Columbia, MI, USA
| | - Lori L Popejoy
- Sinclair School of Nursing, University of Missouri System, Columbia, MO, USA
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Sotoudeh GR, Mohammadi R, Mosallanezhad Z, Viitasara E, Soares JJF. A population study on factors associated with unintentional falls among Iranian older adults. BMC Geriatr 2023; 23:860. [PMID: 38102576 PMCID: PMC10724897 DOI: 10.1186/s12877-023-04571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Falls among older adults are a significant cause of disability, injury, and death worldwide. The high incidence of falls in older adults, combined with the increased susceptibility to injury of the older adult population, leads to severe global health issues. Further studies are needed to comprehensively evaluate the typical personal and environmental risk factors of falls in the Iranian elderly population. Future preventive strategies and intervention programs will be based on these findings. The study determined the risk factors associated with unintentional falls among a representative sample of older adults living in Tehran, the capital city of Iran. METHODS The study design was cross-sectional. The target population was men/women aged 65 years and over from the general population living in 22 different districts of Tehran who were selected by stratified random sampling. The researchers gathered the data using validated questionnaires and observations. The informed consent was obtained from all participants before starting the interview. Multivariate logistic regression analysis examined the association between falls occurring during the past 12 months with demographics/ socioeconomics and fall-related predictor factors. RESULTS The risk of falls was higher in women (47.0%) and those aged ≥ 75 years (44.1%). Older adults who were married had their fall risk reduced by 36.4% compared with other types of marital status. Older adults who were illiterate (48.1%), housewives (47.0%), and always had concerns about living expenses (53.9%) tended significantly to have a higher risk of falls. Moreover, participants who live with their family were less likely to fall than those who live alone (36.5% vs. 40.4%). Persons with safe homes were less likely to experience falls than persons with unsafe homes (30.9% vs. 41.4%). The logistic regression analysis showed that the female gender, being worried about living expenses, home safety, functional behavior, and function factors, were independently associated with the risk of falls during the past 12 months. CONCLUSIONS Our findings revealed that a wide range of intrinsic and extrinsic risk factors contributed to injurious falls; based on the literature, some are preventable. The present data may be helpful as a starting point and guide future efforts for health providers and policymakers to allocate additional resources and develop proper falls prevention or intervention programs at the community level.
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Affiliation(s)
- Gholam Reza Sotoudeh
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden.
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Mohammadi
- Division for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Zahra Mosallanezhad
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Eija Viitasara
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Joaquim J F Soares
- Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden
- Faculdade de Ciências Sociais e Tecnologia da Universidade Europeia, Universidade Europeia, Lisboa, Portugal
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Iyngkaran P, Usmani W, Hanna F, de Courten M. Challenges of Health Data Use in Multidisciplinary Chronic Disease Care: Perspective from Heart Failure Care. J Cardiovasc Dev Dis 2023; 10:486. [PMID: 38132654 PMCID: PMC10743507 DOI: 10.3390/jcdd10120486] [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: 09/24/2023] [Revised: 11/13/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
The healthcare sector generates approximately 30% of all the world's data volume, mostly for record keeping, compliance and regulatory requirements, and patient care. Healthcare data often exist in silos or on different systems and platforms due to decentralised storage and data protection laws, limiting accessibility for health service research. Thus, both the lack of access to data and more importantly the inability to control data quality and explore post-trial (phase IV) data or data with translational relevance have an impact on optimising care and research of congestive heart failure (CHF). We highlight that for some diseases, such as CHF, generating non-traditional data has significant importance, but is hindered by the logistics of accessing chronic disease data from separate health silos and by various levels of data quality. Modern multidisciplinary healthcare management of cardiovascular diseases-especially when spanning across community hubs to tertiary healthcare centres-increases the complexities involved between data privacy and access to data for healthcare and health service research. We call for an increased ability to leverage health data across systems, devices, and countries.
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Affiliation(s)
- Pupalan Iyngkaran
- Department of Health Sciences, Torrens University Australia, Melbourne 3000, Australia;
| | - Wania Usmani
- Department of Health Sciences, Torrens University Australia, Melbourne 3000, Australia;
| | - Fahad Hanna
- Public Health Program, Department of Health and Education, Torrens University Australia, Melbourne 3000, Australia;
| | - Maximilian de Courten
- Mitchell Institute for Health and Education Policy, Victoria University, Melbourne 3000, Australia;
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Elendu C, Amaechi DC, Elendu TC, Ashna M, Ross-Comptis J, Ansong SO, Egbunu EO, Okafor GC, Jingwa KA, Akintunde AA, Ogah CM, Edeko MO, Ibitoye AV, Ogunseye MO, Alakwe-Ojimba CE, Omeludike EK, Oguine CA, Afuh RN, Olawuni CA, Ekwem OR, Oyedele BA, Pius EI, Asekhauno MO, Ladele JA, Okoro CB, Monika Pouekoua BC, Adenikinju JS, Agu-ben CM, Aborisade O. Heart failure and diabetes: Understanding the bidirectional relationship. Medicine (Baltimore) 2023; 102:e34906. [PMID: 37713837 PMCID: PMC10508577 DOI: 10.1097/md.0000000000034906] [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] [Received: 06/25/2023] [Accepted: 08/03/2023] [Indexed: 09/17/2023] Open
Abstract
Heart failure and diabetes mellitus are 2 common and closely intertwined chronic conditions that often coexist in individuals. The relationship between heart failure and diabetes is bidirectional, meaning that each condition can influence the development and progression of the other. Understanding this complex interplay is crucial for optimizing the management and outcomes of patients with these comorbidities. This review comprehensively analyzed the literature to examine the bidirectional relationship between heart failure and diabetes. We searched various electronic databases and included studies that explored the pathophysiological mechanisms, epidemiology, clinical implications, and therapeutic considerations associated with this relationship. The bidirectional relationship between heart failure and diabetes is multifactorial and involves several interconnected mechanisms. Diabetes is a recognized risk factor for heart failure, increasing the risk of its development and accelerating its progression. On the other hand, heart failure can contribute to the development of insulin resistance and worsen glycemic control in patients with diabetes. Shared risk factors, such as obesity, hypertension, and dyslipidemia, contribute to development of both conditions. Additionally, hyperglycemia, insulin resistance, chronic inflammation, oxidative stress, and mitochondrial dysfunction play significant roles in the pathogenesis of heart failure in individuals with diabetes. The bidirectional relationship between heart failure and diabetes has important clinical implications. Patients with heart failure and diabetes have worse outcomes, including higher hospitalization rates, morbidity, and mortality, than those without diabetes. Optimal management strategies should target both conditions simultaneously, focusing on lifestyle modifications, pharmacotherapy, glycemic control, and cardiovascular risk reduction.
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Marques GS, Almeida AM, Gomes IC, Silva MRBD, Rezende BA. Primary care in supplementary health: assessment of costs in the care of older adult patients with heart diseases. Rev Bras Enferm 2023; 76:e20220486. [PMID: 37436234 DOI: 10.1590/0034-7167-2022-0486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 01/09/2023] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVES to identify whether implementing a supplementary Primary Health Care (PHC) system makes it possible to reduce care costs for older adults with heart diseases. METHODS a retrospective cohort of 223 patients with heart disease aged ≥ 60 years. Data were obtained from medical records and cost databases, assessed for a period of one year before and after PHC implementation. The results were expressed as mean absolute frequencies for number of hospitalizations and as average annual expenses expressed in dollars (US$) in relation to cost data. RESULTS there was a reduction in hospitalization expenses after implementing supplementary PHC (p=0.01) and a decrease in the frequency of hospitalizations for the entire sample (p=0.006). There was a reduction in the frequency of consultations at the Emergency Room among frail older adults (p=0.011). CONCLUSIONS there was a reduction in hospitalization costs and frequency of visits to the Emergency Room after supplementary PHC.
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Affiliation(s)
- Geórgia Silva Marques
- Faculdade de Ciências Médicas. Belo Horizonte, Minas Gerais, Brazil
- Fundação São Francisco Xavier. Ipatinga, Minas Gerais, Brazil
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Iyngkaran P, Hanna F, Andrew S, Horowitz JD, Battersby M, De Courten MP. Comparison of short and long forms of the Flinders program of chronic disease SELF-management for participants starting SGLT-2 inhibitors for congestive heart failure (SELFMAN-HF): protocol for a prospective, observational study. Front Med (Lausanne) 2023; 10:1059735. [PMID: 37305115 PMCID: PMC10255353 DOI: 10.3389/fmed.2023.1059735] [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: 10/02/2022] [Accepted: 03/31/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Congestive heart failure (CHF) causes significant morbidity and mortality. It is an epidemic, and costs are escalating. CHF is a chronic disease whose trajectory includes stable phases, periods of decompensation, and finally palliation. Health services and medical therapies must match the various patient needs. Chronic disease self-management (CDSM) programmes that are patient-focused, identify problems and set actionable goals that appear as a logical, cost-friendly method to navigate patient journeys. There have been challenges in standardising and implementing CHF programmes. Methods and analysis SELFMAN-HF is a prospective, observational study to evaluate the feasibility and validity of the SCRinHF tool, a one-page self-management and readmission risk prediction tool for CHF, with an established, comprehensive CDSM tool. Eligible patients will have CHF with left ventricular ejection fraction <40% and commenced sodium glucose co-transporter-2 inhibitors (SGLT2-i) within 6 months of recruitment. The primary endpoint is the 80% concordance in readmission risk predicted by the SCRinHF tool. The study will recruit >40 patients and is expected to last 18 months. Ethics and dissemination This study has been approved by the St Vincent's ethics committee (approval no. LRR 177/21). All participants will complete a written informed consent prior to enrolment in the study. The study results will be disseminated widely via local and international health conferences and peer-reviewed publications.
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Affiliation(s)
- Pupalan Iyngkaran
- Heart Failure & Cardiac Imaging, Torrens University, Melbourne, VIC, Australia
- Werribee Mercy Sub School, School of Medicine, University of Notre Dame, Werribee, VIC, Australia
| | - Fahad Hanna
- Public Health, Torrens University Australia, Melbourne, VIC, Australia
| | - Sharon Andrew
- Institute of Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - John David Horowitz
- Basil Hetzel Institute for Translational Health Research, University of Adelaide, Adelaide, SA, Australia
| | - Malcolm Battersby
- Flinders Health and Medical Research Institute, Southern Adelaide Local Health Network Mental Health Service, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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Wleklik M, Denfeld Q, Czapla M, Jankowska EA, Piepoli MF, Uchmanowicz I. A patient with heart failure, who is frail: How does this affect therapeutic decisions? Cardiol J 2023; 30:825-831. [PMID: 37067336 PMCID: PMC10635718 DOI: 10.5603/cj.a2023.0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 03/06/2023] [Accepted: 03/29/2023] [Indexed: 04/18/2023] Open
Abstract
Patients with heart failure (HF) are heterogeneous, not only related to comorbidities but also in the presentation of frailty syndrome. Frailty syndrome also affects patients with HF across the lifespan. Frailty in patients with HF has a significant impact on clinical features, diagnosis, management, adverse medical outcomes and costs. In everyday clinical practice, frail patients with HF require an individualized approach, often imposing the need to modify therapeutic decisions. The aim of this review is to illustrate how frailty and multimorbidity in HF can affect therapeutic decisions. The scientific evidence underlying this publication was obtained from an analysis of papers indexed in the PubMed database. The search was limited to articles published between 1990 and July 2022. The search was limited to full-text papers published in English. The database was searched for relevant MeSH phrases and their combinations and keywords including: "elderly, frail"; "frailty, elderly"; "frail older adults"; "frailty, older adults"; "adult, frail older"; "frailty, heart failure"; "frailty, multimorbidity"; "multimorbidity, heart failure"; "multimorbidity, elderly"; "older adults, cardiovascular diseases". In therapeutic decisions regarding patients with HF, additionally burdened with multimorbidity and frailty, it becomes necessary to individualize the approach in relation to optimization and treatment of coexisting diseases, frailty assessment, pharmacological and non-pharmacological treatment and in the implementation of invasive procedures in the form of implantable devices or cardiac surgery.
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Affiliation(s)
- Marta Wleklik
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Quin Denfeld
- School of Nursing, Oregon Health and Science University, Portland, OR, United States
| | - Michal Czapla
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland.
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.
- Group of Research in Care (GRUPAC), Faculty of Health Science, University of La Rioja, Logroño, Spain.
| | - Ewa A Jankowska
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Massimo Francesco Piepoli
- Dipartimento delle Scienze Biomediche per la Salute, University of Milan, Via Festa del Perdono, Milan, Italy
- Cardiology Unit, IRCCS Policlinico San Donato Milanese, Milan, Italy
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
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Niranjan B, de Courten MP, Iyngkaran P, Battersby M. Malthusian Trajectory for Heart Failure and Novel Translational Ambulatory Technologies. Curr Cardiol Rev 2023; 19:e240522205193. [PMID: 35611782 PMCID: PMC10280992 DOI: 10.2174/1573403x18666220524145646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION It has been estimated that congestive heart failure (CHF) will reach epidemic proportions and contribute to large unsustainable impacts on health budgets for any cardiovascular condition. Against other major trends in cardiovascular outcomes, readmission and disease burden continue to rise as the demographics shift. METHODS The rise in heart failure with preserved ejection fraction (HFpEF) among elderly women will present new challenges. Gold standard care delivers sustainable and cost-effective health improvements using organised care programs. When coordinated with large hospitals, this can be replicated universally. RESULTS A gradient of outcomes and ambulatory care needs to be shifted from established institutions and shared with clients and community health services, being a sizeable proportion of CHF care. CONCLUSION In this review, we explore health technologies as an emerging opportunity to address gaps in CHF management.
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Affiliation(s)
- Bidargaddi Niranjan
- Digital Health at College of Medicine and Public Health Flinders University & SAHMRI, Adelaide, Australia
| | - Maximilian P de Courten
- Mitchell Institute for Education and Health Policy, Victoria University, 300 Queen St, Melbourne, Australia
| | - Pupalan Iyngkaran
- Mitchell Institute, Victoria University, Melbourne, Australia and Werribee Mercy Sub School, School of Medicine Sydney, The University of Notre Dame Australia, Werribee, Australia
| | - Malcolm Battersby
- College of Medicine and Public Health, South Australian Health and Medical Research Institute, Southern Adelaide Local Health Network, Mental Health Division, Flinders Medical Centre, Flinders University, Adelaide, Australia
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Iyngkaran P, Hespe C, Hanna F, Horowitz JD, Battersby M, Nelson C, Andrew S, de Courten MP. The Wider Considerations in Closing Chronic Disease Gaps - Focus on Heart Failure and Implementation. Curr Cardiol Rev 2023; 19:e120522204690. [PMID: 35549873 PMCID: PMC10201899 DOI: 10.2174/1573403x18666220512160737] [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: 09/17/2021] [Revised: 02/09/2022] [Accepted: 03/08/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Heart failure (HF) is predominately a chronic disease. There are overlaps in HF and chronic disease research and care. Chronic disease and HF research are conducted with multiple goals. The overarching goal is "optimized patient outcomes at maximum costeffectiveness". However, observations on patients can come with many variables; thus, we see differences in clinical translation. This document discusses an argument for three important gaps common to HF and chronic disease, i.e., screening, self-management, and patient-reported outcomes (PRO), and provides a glance of how it could fit into the evidence tree. Pertinent arguments for a framework for health services and models of care are provided as a prelude to future consensus. METHODOLOGY 1) A preliminary literature review to identify a taxonomy for cardiovascular research, and 2) a review of the published literature describing the translation of research studies into clinical practice for cardiovascular disorders. A spectrum from observational to large randomized controlled trials to post-marketing studies were identified. DISCUSSION A brief discussion on traditional research and differences focusing on screening, mixed methods research concepts, and chronic diseases models of care. Six steps to facilitate this: 1) Research design; 2) Research application (translation) i. routine ii. challenges; 3. Transforming research to translational level; 4. Funding and infrastructure; 5. Clinical Centres of Research Excellence (CCRE) and collaboration; 6. Governance and cost-effectiveness. CONCLUSION Implementation research that aims to link research findings to improved patient outcomes in an efficient and effective way is a neglected area. Skills required to perform implementation research are complex. Ways to maximize translational impacts for chronic disease research to clinical practice are described in a HF context.
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Affiliation(s)
- Pupalan Iyngkaran
- Heart Failure & Cardiac Imaging, University of Notre Dame, Werribee Mercy Sub School, School of Medicine Sydney; Research Fellow Mitchell Institute, Victoria University, Victoria, Australia
| | - Charlotte Hespe
- General Practice and Primary Care Research, School of Medicine, Sydney, The University of Notre Dame Australia, 160 Oxford St, Darlinghurst, NSW 2010, PO Box 944 Broadway, NSW 2007, Australia
| | - Fahad Hanna
- Program of Public Health, Department of Health, Torrens University Australia, Australia
| | | | - Malcolm Battersby
- College of Medicine and Public Health, Flinders University Mental Health Program Lead, Flinders Health and Medical Research Institute, Southern Adelaide Local Health Network Mental Health Service, Melbourne, Australia
| | - Craig Nelson
- Division of Chronic and Complex Care and the Director of Nephrology, Melbourne, Australia
| | - Sharon Andrew
- Adjunct Professor of Nursing, Institute Health and Sport, Victoria University, PO Box 14428 Melbourne, Victoria 8001, Australia
| | - Maximilian P. de Courten
- Mitchell Institute for Education and Health Policy, Victoria University, 300 Queen St, Melbourne 3000, Australia
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Effects of a multidisciplinary management program on symptom burden and medication adherence in heart failure patients with comorbidities: A randomized controlled trial. BMC Nurs 2022; 21:346. [PMID: 36476375 PMCID: PMC9727875 DOI: 10.1186/s12912-022-01130-7] [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: 06/13/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Comorbidities in heart failure (HF) are a complex clinical challenge. There is little data on the benefits of multidisciplinary postdischarge management programs in such patients. This study aimed to examine the effects of a multidisciplinary management program (MMP) on symptom burden and medication adherence in HF patients with comorbidities. METHODS In this clinical trial study, 94 HF patients with comorbidities were assigned to intervention (n = 47) and control (n = 47) groups by the stratified-random method. The intervention group underwent MMP supervised by a nurse for two months after discharge, including multi-professional visits, telephone follow-ups, and an educational booklet. Medication adherence and symptom burden were assessed using Morisky Medication Adherence Scale (MMAS) and Edmonton Symptom Assessment Scale (ESAS), respectively, on three occasions: Before discharge, six weeks, and eight weeks after discharge. RESULTS Both groups almost matched at the baseline, and the most frequent comorbidities included myocardial infarction (MI), hypertension, peptic ulcer, and depression, respectively. The interactive effect of time in groups showed that mean changes in total scores of symptom burden and medication adherence were significantly different (P < 0.001) at other time points. A significant increase in medication adherence (P < 0.001) and a significant reduction in the burden of all symptoms were observed in the intervention group compared to the control group from Time 1 to Time 3. CONCLUSIONS The MMP (targeting comorbidity) is a promising strategy for managing symptoms and medication adherence in HF patients with comorbidities.
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Employment Characteristics and Risk of Hospitalization Among Older Adults Participating in the Mayo Clinic Biobank. Mayo Clin Proc Innov Qual Outcomes 2022; 6:552-563. [PMID: 36299252 PMCID: PMC9588999 DOI: 10.1016/j.mayocpiqo.2022.09.003] [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: 11/24/2022] Open
Abstract
Objective To determine the relationship between characteristics of employment and future hospitalization in older adults. Patients and Methods We conducted a survey of adults aged 65 years or older participating in the Mayo Clinic Biobank. Using a frequency-matched, case-control design, we compared patients who were hospitalized within 5 years of biobank enrollment (cases) with those who were not hospitalized (controls). We assessed the duration of work, age at first job, number of jobs, disability, retirement, and reasons for leaving work. We performed logistic regression analysis to assess the association of these factors with hospitalization, accounting for age, sex, comorbid conditions, and education level. Results Among 3536 participants (1600 cases and 1936 controls; median age, 68.5 years; interquartile range, 63.4-73.9 years), cases were older, more likely to be male, and had lower education levels. Comorbid illnesses had the largest association with hospitalization (odds ratio [OR], 4.09; 95% CI, 3.37-4.97 [highest vs lowest quartile]). On adjusted analyses, odds of hospitalization increased with the presence of disability (OR, 1.31; 95% CI, 1.01-1.69) and decreased with having 1 or 2 lifetime jobs vs no employment (OR, 0.77; 95% CI, 0.60-1.00). The length of work, furlough, age of retirement, childcare issues, and reasons for leaving a job were not associated with hospitalization. Conclusion This study reports an association between disability during work and hospitalization. On the basis of our findings, it may be important to obtain a more detailed work history from patients because it may provide further insight into their future health.
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Medvedeva E, Korostovtseva L, Bochkarev M, Shumeiko A, Berezina A, Simonenko M, Sazonova Y, Kozlenok A, Sviryaev Y. The Prognostic Role of Polysomnography Parameters in Heart Failure Patients with Previous Decompensation. J Clin Med 2022; 11:jcm11133656. [PMID: 35806941 PMCID: PMC9267942 DOI: 10.3390/jcm11133656] [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: 05/18/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Sleep-disordered breathing (SDB) is a widespread comorbidity in patients with chronic heart failure (HF) and may have a deleterious effect on the pathogenesis of HF. We aimed to evaluate the prognostic role of polysomnography parameters in HF patients with previous decompensation. Methods: 123 patients were included in the prospective cohort study. In addition to the standard examination, all patients underwent polysomnography (PSG). Results: The Kaplan−Meier analysis showed the incidence of the combined endpoint differs between LVEF categories ≤25.5% vs. >25.5% (χ2 = 9.6, log rank p = 0.002), NTpro-BNP > 680 vs. ≤680 pg/mL (χ2 = 12.7, log rank p = 0.001), VO2peak categories <16 vs. ≥16 mL/min/kg (χ2 = 14.2, log rank p = 0.001), VE/VCO2 slope ≥38.5 vs. <38.5 (χ2 = 14.5, log rank p = 0.001), wake after sleep onset >40 min vs. ≤40 min (χ2 = 9.7, log rank p = 0.03), and sleep stage 2 (S2) <44% vs. ≥44% (χ2 = 12.4, log rank p = 0.001). Conclusion: Among the PSG parameters, WASO > 40 min and S2 < 44% were associated with a combined endpoint in patients with previous decompensation of HF. Moreover, higher NT-proBNP and VE/VCO2 slope, lower LVEF, and VO2peak were also independent factors of a poor prognosis.
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Flynn MJ, Kronebusch BJ, Sikkink LA, Swanson KM, Niccum KJ, Crane SJ, Aoun B, Takahashi PY. Impact of the Registered Nurse Clinical Liaison Role in Ambulatory Care on Transitions of Care: A Retrospective Cohort Study. Prof Case Manag 2022; 27:58-66. [PMID: 35099419 DOI: 10.1097/ncm.0000000000000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF STUDY To determine the relationship between engagement with the novel register nurse care liaison (RNCL) and enrollment in care management compared with usual care in hospitalized patients. PRIMARY PRACTICE SETTING Patients in the hospital from January 1, 2019, to September 30, 2019, who would be eligible for care management. METHODOLOGY AND SAMPLE This was a retrospective cohort study. The authors compared a group of 419 patients who utilized the services of the RNCL at any time during their hospital stay with the RNCL to a propensity matched control group of 833 patients, which consisted of patients who were hospitalized during the same time as the RNCL intervention group. Our primary outcome was enrollment in care management programs. Our secondary outcome was 30-day readmissions, emergency department (ED) use, and office visits. The authors compared baseline characteristics and outcomes across groups using Wilcoxon-Mann-Whitney and χ2 tests and performed an adjusted analysis using conditional logistic regression models controlling for patient education and previous health care utilization. RESULTS The authors matched 419 patients who had engaged an RNCL to 833 patients in the usual care group; this comprised the analytic cohort for this study. The authors found 67.1% of patients enrolled in a care management program with RNCL compared with only 15.3% in usual care (p < .0001). The authors found higher rates of enrollment in all programs of care management. After the full adjustment, the odds ratio for enrollment in any program was 13.7 (95% confidence interval: 9.3, 20.2) for RNCL compared with usual care. There was no difference between groups with 30-day hospitalization or ED visit. CONCLUSION In this matched study of 419 patients with RNCL engagement, the authors found significantly higher enrollment in all care management programs. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE These findings encourage further study of this care model. This could help enhance enrollment in care management programs, increase relationships between inpatient practice and ambulatory practice, as well as increase communication across the continuum of care.
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Affiliation(s)
- Mollie J Flynn
- Mollie J. Flynn, BSN, RN , is a bachelor's prepared registered nurse at Mayo Clinic in Rochester. She serves as the sole nurse clinical liaison for the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Beckie J. Kronebusch, MS, APRN, CNS , is a master's prepared clinical nurse specialist. She currently works at Mayo Clinic Health System in La Crosse, Wisconsin
- Laura A. Sikkink, MSN, RN , is a master's prepared registered nurse. She is an ambulatory nurse manager, who manages the care coordination groups at the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Kristi M. Swanson, MS , is a master's prepared principal health services analyst. She currently works for Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic in Rochester, Minnesota
- Kelly J. Niccum, CCRP, PMP , is a project manager for the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery in Rochester, Minnesota
- Sarah J. Crane, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
- Bernard Aoun, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic. He is an instructor of medicine and is board certified in Geriatrics
- Paul Y. Takahashi, MD , is a consultant and section head in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
| | - Beckie J Kronebusch
- Mollie J. Flynn, BSN, RN , is a bachelor's prepared registered nurse at Mayo Clinic in Rochester. She serves as the sole nurse clinical liaison for the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Beckie J. Kronebusch, MS, APRN, CNS , is a master's prepared clinical nurse specialist. She currently works at Mayo Clinic Health System in La Crosse, Wisconsin
- Laura A. Sikkink, MSN, RN , is a master's prepared registered nurse. She is an ambulatory nurse manager, who manages the care coordination groups at the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Kristi M. Swanson, MS , is a master's prepared principal health services analyst. She currently works for Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic in Rochester, Minnesota
- Kelly J. Niccum, CCRP, PMP , is a project manager for the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery in Rochester, Minnesota
- Sarah J. Crane, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
- Bernard Aoun, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic. He is an instructor of medicine and is board certified in Geriatrics
- Paul Y. Takahashi, MD , is a consultant and section head in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
| | - Laura A Sikkink
- Mollie J. Flynn, BSN, RN , is a bachelor's prepared registered nurse at Mayo Clinic in Rochester. She serves as the sole nurse clinical liaison for the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Beckie J. Kronebusch, MS, APRN, CNS , is a master's prepared clinical nurse specialist. She currently works at Mayo Clinic Health System in La Crosse, Wisconsin
- Laura A. Sikkink, MSN, RN , is a master's prepared registered nurse. She is an ambulatory nurse manager, who manages the care coordination groups at the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Kristi M. Swanson, MS , is a master's prepared principal health services analyst. She currently works for Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic in Rochester, Minnesota
- Kelly J. Niccum, CCRP, PMP , is a project manager for the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery in Rochester, Minnesota
- Sarah J. Crane, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
- Bernard Aoun, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic. He is an instructor of medicine and is board certified in Geriatrics
- Paul Y. Takahashi, MD , is a consultant and section head in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
| | - Kristi M Swanson
- Mollie J. Flynn, BSN, RN , is a bachelor's prepared registered nurse at Mayo Clinic in Rochester. She serves as the sole nurse clinical liaison for the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Beckie J. Kronebusch, MS, APRN, CNS , is a master's prepared clinical nurse specialist. She currently works at Mayo Clinic Health System in La Crosse, Wisconsin
- Laura A. Sikkink, MSN, RN , is a master's prepared registered nurse. She is an ambulatory nurse manager, who manages the care coordination groups at the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Kristi M. Swanson, MS , is a master's prepared principal health services analyst. She currently works for Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic in Rochester, Minnesota
- Kelly J. Niccum, CCRP, PMP , is a project manager for the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery in Rochester, Minnesota
- Sarah J. Crane, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
- Bernard Aoun, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic. He is an instructor of medicine and is board certified in Geriatrics
- Paul Y. Takahashi, MD , is a consultant and section head in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
| | - Kelly J Niccum
- Mollie J. Flynn, BSN, RN , is a bachelor's prepared registered nurse at Mayo Clinic in Rochester. She serves as the sole nurse clinical liaison for the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Beckie J. Kronebusch, MS, APRN, CNS , is a master's prepared clinical nurse specialist. She currently works at Mayo Clinic Health System in La Crosse, Wisconsin
- Laura A. Sikkink, MSN, RN , is a master's prepared registered nurse. She is an ambulatory nurse manager, who manages the care coordination groups at the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Kristi M. Swanson, MS , is a master's prepared principal health services analyst. She currently works for Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic in Rochester, Minnesota
- Kelly J. Niccum, CCRP, PMP , is a project manager for the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery in Rochester, Minnesota
- Sarah J. Crane, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
- Bernard Aoun, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic. He is an instructor of medicine and is board certified in Geriatrics
- Paul Y. Takahashi, MD , is a consultant and section head in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
| | - Sarah J Crane
- Mollie J. Flynn, BSN, RN , is a bachelor's prepared registered nurse at Mayo Clinic in Rochester. She serves as the sole nurse clinical liaison for the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Beckie J. Kronebusch, MS, APRN, CNS , is a master's prepared clinical nurse specialist. She currently works at Mayo Clinic Health System in La Crosse, Wisconsin
- Laura A. Sikkink, MSN, RN , is a master's prepared registered nurse. She is an ambulatory nurse manager, who manages the care coordination groups at the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Kristi M. Swanson, MS , is a master's prepared principal health services analyst. She currently works for Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic in Rochester, Minnesota
- Kelly J. Niccum, CCRP, PMP , is a project manager for the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery in Rochester, Minnesota
- Sarah J. Crane, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
- Bernard Aoun, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic. He is an instructor of medicine and is board certified in Geriatrics
- Paul Y. Takahashi, MD , is a consultant and section head in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
| | - Bernard Aoun
- Mollie J. Flynn, BSN, RN , is a bachelor's prepared registered nurse at Mayo Clinic in Rochester. She serves as the sole nurse clinical liaison for the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Beckie J. Kronebusch, MS, APRN, CNS , is a master's prepared clinical nurse specialist. She currently works at Mayo Clinic Health System in La Crosse, Wisconsin
- Laura A. Sikkink, MSN, RN , is a master's prepared registered nurse. She is an ambulatory nurse manager, who manages the care coordination groups at the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Kristi M. Swanson, MS , is a master's prepared principal health services analyst. She currently works for Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic in Rochester, Minnesota
- Kelly J. Niccum, CCRP, PMP , is a project manager for the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery in Rochester, Minnesota
- Sarah J. Crane, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
- Bernard Aoun, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic. He is an instructor of medicine and is board certified in Geriatrics
- Paul Y. Takahashi, MD , is a consultant and section head in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
| | - Paul Y Takahashi
- Mollie J. Flynn, BSN, RN , is a bachelor's prepared registered nurse at Mayo Clinic in Rochester. She serves as the sole nurse clinical liaison for the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Beckie J. Kronebusch, MS, APRN, CNS , is a master's prepared clinical nurse specialist. She currently works at Mayo Clinic Health System in La Crosse, Wisconsin
- Laura A. Sikkink, MSN, RN , is a master's prepared registered nurse. She is an ambulatory nurse manager, who manages the care coordination groups at the Mayo Clinic Rochester/Kasson primary care clinic in Rochester, Minnesota
- Kristi M. Swanson, MS , is a master's prepared principal health services analyst. She currently works for Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic in Rochester, Minnesota
- Kelly J. Niccum, CCRP, PMP , is a project manager for the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery in Rochester, Minnesota
- Sarah J. Crane, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
- Bernard Aoun, MD , is a consultant in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic. He is an instructor of medicine and is board certified in Geriatrics
- Paul Y. Takahashi, MD , is a consultant and section head in Community Internal Medicine at the Mayo Clinic Rochester/Kasson primary care clinic
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Kowalska K, Walczak J, Femlak J, Młynarska E, Franczyk B, Rysz J. Empagliflozin-A New Chance for Patients with Chronic Heart Failure. Pharmaceuticals (Basel) 2021; 15:47. [PMID: 35056104 PMCID: PMC8779904 DOI: 10.3390/ph15010047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 11/27/2022] Open
Abstract
The heart failure (HF) epidemic is one of the challenges that has been faced by the healthcare system worldwide for almost 25 years. With an ageing world population and a fast-paced lifestyle that promotes the development of cardiovascular disease, the number of people suffering from heart failure will continue to rise. To improve the treatment regimen and consequently the prognosis and quality of life of heart failure patients, new therapeutic solutions have been introduced, such as an inclusion of Sodium-glucose co-transporter 2 (SGLT-2) inhibitors in a new treatment regimen as announced by the European Society of Cardiology in August 2021. This article focuses on the SGLT2 inhibitor empagliflozin and its use in patients with heart failure. Empagliflozin is a drug originally intended for the treatment of diabetes due to its glycosuric properties, yet its beneficial effects extend beyond lowering glycemia. The pleiotropic effects of the drug include nephroprotection, improving endothelial function, lowering blood pressure and reducing body weight. In this review we discuss the cardioprotective mechanism of the drug in the context of the benefits of empagliflozin use in patients with chronic cardiac insufficiency. Numerous findings confirm that despite its potential limitations, the use of empagliflozin in HF treatment is advantageous and effective.
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Affiliation(s)
| | | | | | - Ewelina Młynarska
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-549 Lodz, Poland; (K.K.); (J.W.); (J.F.); (B.F.); (J.R.)
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Regmi MR, Tandan N, Parajuli P, Bhattarai M, Maini R, Kulkarni A, Robinson R. Social Vulnerability Indices as a Risk Factor for Heart Failure Readmissions. Clin Med Res 2021; 19:116-122. [PMID: 34531268 PMCID: PMC8445658 DOI: 10.3121/cmr.2021.1603] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/05/2021] [Accepted: 04/16/2021] [Indexed: 12/11/2022]
Abstract
Objectives: The objective of our study was to use the parameters of social vulnerability index (SVI) to observe their association with the 30-day hospital readmissions in the heart failure population.Methods: Data required for analysis were extracted from the electronic medical record. The geographic SVI data was then merged with the clinical data. Qualitative variables and reported as frequency and quantitative variables and reported as the mean ± standard deviation. Variables from univariate analysis with a P value of ≤ 0.10 were evaluated using multivariate logistic regression with stepwise backward variable selection and receiver operating curve (ROC) analysis.Results: The odds ratio of readmission predicted by HOSPITAL score was 1.137 (P value = 0.004, 95% CI = 1.041-1.241). SVI parameter recording disability showed odds ratio of 1.521 (P value = 0.006, 95% CI = 1.125-2.058) and SVI parameter tracking vehicle ownership showed odds ratio of 15.355 (P value = 0.014, 95% CI = 1.755 - 134.383). The ROCs were generated for three scenarios: (i) HOSPITAL score only which had area under the curve (AUC) of 0.702 (P value = 0.015), (ii) SVI indicators tracking vehicle ownership and disability resulted in the AUC of 0.589 (P value = 0.016), and (iii) all of the above combined increased the AUC increased to 0.718 (P value = 0.015).Conclusions: Two social parameters (limited vehicle access and prevalence of disability) from the SVI showed a strong association with 30-day hospital readmissions.
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Affiliation(s)
- Manjari Rani Regmi
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Nitin Tandan
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Priyanka Parajuli
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Mukul Bhattarai
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Ruby Maini
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Abhishek Kulkarni
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Robert Robinson
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
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The Heart Failure with Preserved Ejection Fraction Conundrum-Redefining the Problem and Finding Common Ground? Curr Heart Fail Rep 2021; 17:34-42. [PMID: 32112345 DOI: 10.1007/s11897-020-00454-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Heart failure with preserved ejection fraction (HFpEF) or diastolic heart failure (DHF) makes up more than half of all congestive heart failure presentations (CHF). With an ageing population, the case load and the financial burden is projected to increase, even to epidemic proportions. CHF hospitalizations add too much of the financial and infrastructure strain. Unlike systolic heart failure (SHF), much is still either uncertain or unknown. Specifically, in epidemiology, the disease burden is established; however, risk factors and pathophysiological associations are less clear; diagnostic tools are based on rigid parameters without the ability to accurately monitor treatments effects and disease progression; finally, therapeutics are similar to SHF but without prognostic data for efficacy. RECENT FINDINGS The last several years have seen guidelines changing to account for greater epidemiological observations. Most of these remain general observation of shortness of breath symptom matched to static echocardiographic parameters. The introduction of exercise diastolic stress test has been welcome and warrants greater focus. HFpEF is likely to see new thinking in the coming decades. This review provides some of perspective on this topic.
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Association Between Use of EHR-Generated Dashboards and Hospital Outcomes in 30-Day Heart Failure Readmissions. J Healthc Manag 2020; 65:430-440. [PMID: 33186259 DOI: 10.1097/jhm-d-19-00207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
EXECUTIVE SUMMARY This study examined whether usage of clinical data from the electronic health record (EHR) to create organizational- and unit-level performance dashboards and assess adherence to clinical practice guidelines is associated with hospital outcomes in risk-adjusted 30-day readmissions for patients with a principal diagnosis of heart failure (HF). It further assesses the association between the metrics of hospital financial health and the usage of those EHR-generated tools.A cross-sectional study design was used. The study used data from the 2016 American Hospital Association Annual Survey Information Technology Supplement, the Pennsylvania Health Care Cost Containment Council's (PHC4's) 2017 Hospital Performance Report, and the PHC4 General Acute Care Hospitals Financial Analysis Report for fiscal year 2017. Contingency tables, likelihood-ratio chi-square tests, and logistic regression were applied for data analysis.Usage of the EHR to assess adherence to clinical practice guidelines and create EHR-generated unit-level performance dashboards, rather than organizational performance dashboards, was more strongly associated with the hospitals' rating in risk-adjusted 30-day readmissions for HF patients. An increase in hospitals' operating margin was associated with greater odds of the usage of the discussed EHR tools, after controlling for hospital control/ownership and the total number of beds.Usage of some EHR-generated analytical tools may be more strongly associated with lower-than-expected 30-day hospital readmissions in HF patients than with other tools. Better hospital financial health is linked with greater uptake of the discussed analytical tools. Further research could help to determine which EHR-generated tools are more effective in improving hospital outcomes in HF.
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Thomas MC, Iyngkaran P. Forensic interrogation of diabetic endothelitis in cardiovascular diseases and clinical translation in heart failure. World J Cardiol 2020; 12:409-418. [PMID: 32879703 PMCID: PMC7439453 DOI: 10.4330/wjc.v12.i8.409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/05/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023] Open
Abstract
Diabetic heart disease (DHD) can be classified as a primary consequence from several pathophysiological manifestation of diabetes mellitus (DM) on cardiac tissues or secondarily in extracardiac tissues and is encountered as either primary or secondary complications of DM. Endothelitis is inflammation of the vascular endothelium and is likely to be seen in the majority of patients who start to manifest an end organ complication of DM in this case DHD. Diabetes is a leading cause for many cardiovascular syndromes and diseases including congestive heart failure (CHF) however much remains unknown about the transition from diagnosed DM to clinical state and the contribution of the various mechanical and counterregulatory systems in the manifested complaint. Diastolic heart failure or heart failure with preserved ejection fraction (DHF/HFpEF), accounts for half of all CHF presentations, has DM as a major contributor, however, there remain large gaps in clinical and pathophysiological understanding. This review aims to explore the microscopic aspects in diabetic endothelitis and provide a clinical link to with context to HFpEF.
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Affiliation(s)
- Merlin C Thomas
- Department of Diabetes, Monash University, Melbourne 3004, Victoria, Australia
| | - Pupalan Iyngkaran
- Werribee Mercy Sub School, School of Medicine Sydney, University of Notre Dame, Northcote 3070, Victoria, Australia
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Li X, Xu G, Wei S, Zhang B, Yao H, Chen Y, Liu W, Wang B, Zhao J, Gao Y. Lingguizhugan decoction attenuates doxorubicin-induced heart failure in rats by improving TT-SR microstructural remodeling. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:360. [PMID: 31829159 PMCID: PMC6907350 DOI: 10.1186/s12906-019-2771-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 11/25/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Lingguizhugan decoction (LGZG), an ancient Chinese herbal formula, has been used to treat cardiovascular diseases in eastern Asia. We investigated whether LGZG has protective activity and the mechanism underlying its effect in an animal model of heart failure (HF). METHODS A rat model of HF was established by administering eight intraperitoneal injections of doxorubicin (DOX) (cumulative dose of 16 mg/kg) over a 4-week period. Subsequently, LGZG at 5, 10, and 15 mL/kg/d was administered to the rats intragastrically once daily for 4 weeks. The body weight, heart weight index (HWI), heart weight/tibia length ratio (HW/TL), and serum BNP level were investigated to assess the effect of LGZG on HF. Echocardiography was performed to investigate cardiac function, and H&E staining to visualize myocardial morphology. Myocardial ultrastructure and T-tubule-sarcoplasmic reticulum (TT-SR) junctions were observed by transmission electron microscopy. The JP-2 protein level was determined by Western blotting. The mRNA level of CACNA1S and RyR2 and the microRNA-24 (miR-24) level were assayed by quantitative RT-PCR. RESULTS Four weeks after DOX treatment, rats developed cardiac damage and exhibited a significantly increased BNP level compared with the control rats (169.6 ± 29.6 pg/mL versus 80.1 ± 9.8 pg/mL, P < 0.001). Conversely, LGZG, especially at the highest dose, markedly reduced the BNP level (93.8 ± 17.9 pg/mL, P < 0.001). Rats treated with DOX developed cardiac dysfunction, characterized by a strong decrease in left ventricular ejection fraction compared with the control (58.5 ± 8.7% versus 88.7 ± 4.0%; P < 0.001). Digoxin and LGZG improved cardiac dysfunction (79.6 ± 6.1%, 69.2 ± 2.5%, respectively) and preserved the left ventricular ejection fraction (77.9 ± 5.1, and 80.5 ± 4.9, respectively, P < 0.01). LGZG also improved the LVEDD, LVESD, and FS and eliminated ventricular hypertrophy, as indicated by decreased HWI and HW/TL ratio. LGZG attenuated morphological abnormalities and mitochondrial damage in the myocardium. In addition, a high dose of LGZG significantly downregulated the expression of miR-24 compared with that in DOX-treated rats (fold change 1.4 versus 3.4, P < 0.001), but upregulated the expression of JP-2 and antagonized DOX-induced T-tubule TT-SR microstructural remodeling. These activities improved periodic Ca2+ transients and cell contraction, which may underly the beneficial effect of LGZG on HF. CONCLUSIONS LGZG exerted beneficial effects on DOX-induced HF in rats, which were mediated in part by improved TT-SR microstructural remodeling.
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Iyngkaran P, Thomas M, Majoni SW. Perspectives On Optimizing Chronic Heart Failure Care Beyond Randomised Controlled Trials - What do we Consolidate and how do we Plan for the Future? Curr Cardiol Rev 2019; 15:158-160. [PMID: 31084591 PMCID: PMC6719389 DOI: 10.2174/1573403x1503190506101720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Pupalan Iyngkaran
- Consultant Cardiologist Heart West and Senior Lecturer Flinders University, NT Medical School, Darwin, Australia
| | - Merlin Thomas
- Biochemistry of Diabetes Complications, The Department of Diabetes, Monash University, Melbourne, Australia
| | - Sandawana W Majoni
- Clinical Dean Royal Darwin Hospital, TEHS, Renal Transplantation, Royal Darwin Hospital, Department of Nephrology, Division of Medicine, P.O. Box 41326, Tiwi, Darwin, Australia
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Iyngkaran P, Jelinek M. Health care in a globalised world: is there more than one type of patient? Med J Aust 2019; 210:211-212. [PMID: 30773648 DOI: 10.5694/mja2.50035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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