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Dai L, Dorje T, Gootjes J, Shah A, Dembo L, Rankin J, Hillis G, Robinson S, Atherton JJ, Jacques A, Reid CM, Maiorana A. Primary care Adherence To Heart Failure guidelines IN Diagnosis, Evaluation and Routine management (PATHFINDER): a randomised controlled trial protocol. BMJ Open 2023; 13:e063656. [PMID: 36972959 PMCID: PMC10069547 DOI: 10.1136/bmjopen-2022-063656] [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: 04/29/2022] [Accepted: 02/06/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION General practitioners (GPs) routinely provide care for patients with heart failure (HF); however, adherence to management guidelines, including titrating medication to optimal dose, can be challenging in this setting. This study will evaluate the effectiveness of a multifaceted intervention to support adherence to HF management guidelines in primary care. METHODS AND ANALYSIS We will undertake a multicentre, parallel-group, randomised controlled trial of 200 participants with HF with reduced ejection fraction. Participants will be recruited during a hospital admission due to HF. Following hospital discharge, the intervention group will have follow-up with their GP scheduled at 1 week, 4 weeks and 3 months with the provision of a medication titration plan approved by a specialist HF cardiologist. The control group will receive usual care. The primary endpoint, assessed at 6 months, will be the difference between groups in the proportion of participants being prescribed five guideline-recommended treatments; (1) ACE inhibitor/angiotensin receptor blocker/angiotensin receptor neprilysin inhibitor at least 50% of target dose, (2) beta-blocker at least 50% of target dose, (3) mineralocorticoid receptor antagonist at any dose, (4) anticoagulation for patients diagnosed with atrial fibrillation, (5) referral to cardiac rehabilitation. Secondary outcomes will include functional capacity (6-minute walk test); quality of life (Kansas City Cardiomyopathy Questionnaire); depressive symptoms (Patient Health Questionnaire-2); self-care behaviour (Self-Care of Heart Failure Index). Resource utilisation will also be assessed. ETHICS AND DISSEMINATION Ethical approval was granted by the South Metropolitan Health Service Ethics Committee (RGS3531), with reciprocal approval at Curtin University (HRE2020-0322). Results will be disseminated via peer-reviewed publications and conferences. TRIAL REGISTRATION NUMBER ACTRN12620001069943.
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Affiliation(s)
- Liying Dai
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Tashi Dorje
- Department of Cardiology, Mount Hospital, Perth, Western Australia, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Cardiology, Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - Jan Gootjes
- WA Cardiology, Perth, Western Australia, Australia
| | - Amit Shah
- Department of Cardiology and Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Lawrence Dembo
- Department of Cardiology and Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Jamie Rankin
- Department of Cardiology and Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Graham Hillis
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Suzanne Robinson
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Deakin Health Economics, Deakin University, Melbourne, Western Australia, Australia
| | - John J Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Angela Jacques
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Christopher M Reid
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew Maiorana
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Department of Allied Health, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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Mavragani A, Löf M, Maddison R, Nourse R. Feasibility and Acceptability of Wearable Cameras to Assess Self-care in People With Heart Failure: Pilot Study. JMIR Form Res 2023; 7:e40536. [PMID: 36800215 PMCID: PMC9984995 DOI: 10.2196/40536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 12/17/2022] [Accepted: 01/05/2023] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Heart failure (HF) is a common chronic condition that affects over 26 million people worldwide. It is a progressive and debilitating disease with a broad symptom profile, intermittently marked by periods of acute decompensation. People with HF generally do not self-manage their condition well (eg, monitoring symptoms, taking medications regularly, physical activity, etc). A better understanding of self-care activities and what factors may indicate deterioration is warranted. OBJECTIVE The aim of this study was to determine the feasibility and acceptability of using wearable cameras to assess self-care activities in people with HF. The study objectives were to (1) explore whether changes in self-care activities could be identified prior to hospitalization and (2) determine the acceptability of wearable cameras to people with HF. METHODS A total of 30 people recently diagnosed with HF wore a camera for a maximum of 30 days; the camera took a photo every 30 seconds in the forward-facing direction. At the end of the study, all 30 participants were presented with 8 statements of acceptability, scored on a 5-point Likert scale. To determine whether camera images could identify changes in self-care activities and lifestyle risk factors before hospitalization, we analyzed images from participants (n=8) who were hospitalized during the 30-day study period. Images from the period immediately prior to hospitalization and a comparison were selected for each participant. Images were manually coded according to 9 different event categories relating to self-care and lifestyle risk factors, and events were compared between the 2 periods. RESULTS The participants reported high acceptability for wearing the cameras, as most strongly agreed or agreed that they were comfortable to wear (28/30, 93%) and easy to use (30/30, 100%). The results of the camera image analysis showed that participants undertook fewer activities of daily living (P=.008) and were more sedentary (P=.02) prior to being hospitalized, compared to a period nonadjacent to hospitalization. CONCLUSIONS Adults with HF were accepting of using a wearable camera for periods within a 30-day time frame. Wearable cameras were a feasible approach for providing data on selected self-care activities and lifestyle risk factors for HF and offer the potential to be a valuable tool for improving our understanding of self-care.
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Affiliation(s)
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Rebecca Nourse
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Telerehabilitation Approaches for People with Chronic Heart Failure: A Systematic Review and Meta-Analysis. J Clin Med 2022; 12:jcm12010064. [PMID: 36614865 PMCID: PMC9820837 DOI: 10.3390/jcm12010064] [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: 11/22/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Telerehabilitation (TR) for chronic heart failure (CHF) allows for overcoming distance barriers and reducing exacerbations. However, little is known about TR descriptors, components, and efficacy in CHF. METHODS This work systematically reviewed the TR strategies of randomized controlled trials in people with CHF. A meta-analysis was run to test its effect on exercise capacity and quality of life compared to no rehabilitation (NI) and conventional intervention (CI). RESULTS Out of 6168 studies, 11 were eligible for the systematic review, and 8 for the meta-analysis. TR intervention was individual and multidimensional, with a frequency varying from 2 to 5 times per 8-12 weeks. The TR components mainly included an asynchronous model, monitoring/assessment, decision, and offline feedback. A few studies provided a comprehensive technological kit. Minimal adverse events and high adherence were reported. A large effect of TR compared to NI and a non-inferiority effect compared to CI was registered on exercise capacity, but no effects of TR compared to NI and CI on quality of life were observed. CONCLUSIONS TR for people with CHF adopted established effective strategies. Future interventions may identify the precise TR dose for CHF, technological requirements, and engagement components affecting the patient's quality of life.
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Zisis G, Yang Y, Huynh Q, Whitmore K, Lay M, Wright L, Carrington MJ, Marwick TH. Nurse-Provided Lung and Inferior Vena Cava Assessment in Patients With Heart Failure. J Am Coll Cardiol 2022; 80:513-523. [PMID: 35902175 DOI: 10.1016/j.jacc.2022.04.064] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/01/2022] [Accepted: 04/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Residual congestion detected using handheld ultrasound may be associated with increased risk of readmission and death after hospitalization for acute decompensated heart failure (ADHF). However, effective application necessitates routine use by nonexperts delivering clinical care. OBJECTIVES The objective of this study was to determine the ability of heart failure (HF) nurses to deliver a predischarge lung and inferior vena cava (IVC) assessment (LUICA) to predict 90-day outcomes. METHODS In this multisite, prospective, observational study, HF nurses scanned 240 patients with ADHF (median age: 77 years; 56% men) using a 9-zone LUICA protocol. Obtained images were reviewed by independent nurses who were blinded to clinical characteristics and outcomes. Based on a B-line cut-off of 10, patients were dichotomized as congested (n = 115) or not congested (n = 125). RESULTS Congested patients were more likely to have previous cardiac operations, long-standing HF (>6 months), and renal impairment. At 90 days, HF readmission or mortality occurred in 42 congested patients (37%) compared with 18 noncongested patients (14%). Pulmonary congestion increased at 30-day (OR: 3.86; 95% CI: 1.65-8.99; P < 0.01) and 90-day (OR: 3.42; 95% CI: 1.82-6.4; P < 0.01) HF readmission or mortality risk and 90-day mortality (OR: 5.18; 95% CI: 1.44-18.69; P < 0.01). Pulmonary congestion increased the 90-day odds of HF readmission and/or death by 3.3- to 4.2-fold (P < 0.01), independent of demographics, HF characteristics, comorbidities, and event risk score. Over 90 days, days alive out of hospital were fewer (78.3 ± 21.4 days vs 85.5 ± 12.4 days; P < 0.01) in congested patients. CONCLUSIONS LUICA can be a powerful tool for detection of predischarge residual congestion. HF nurses can obtain images and provide diagnostic reports that are predictive of ADHF outcomes.
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Affiliation(s)
- Georgios Zisis
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; The University of Melbourne, Baker Department of Cardiometabolic Health, Melbourne, Victoria, Australia; Western Health, Melbourne, Victoria, Australia; The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Yang Yang
- Western Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Eastern Health, Melbourne, Victoria, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; The University of Melbourne, Baker Department of Cardiometabolic Health, Melbourne, Victoria, Australia
| | - Kristyn Whitmore
- Menzies Institute for Medical Research, Hobart, Tasmania, Australia
| | - Maria Lay
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Leah Wright
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Western Health, Melbourne, Victoria, Australia
| | - Melinda J Carrington
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; The University of Melbourne, Baker Department of Cardiometabolic Health, Melbourne, Victoria, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; The University of Melbourne, Baker Department of Cardiometabolic Health, Melbourne, Victoria, Australia; Western Health, Melbourne, Victoria, Australia; The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Menzies Institute for Medical Research, Hobart, Tasmania, Australia.
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Healthcare providers’ perspectives on using smart home systems to improve self-management and care in people with heart failure: A qualitative study. Int J Med Inform 2022; 167:104837. [DOI: 10.1016/j.ijmedinf.2022.104837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/24/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022]
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Islam SMS, Nourse R, Uddin R, Rawstorn JC, Maddison R. Consensus on Recommended Functions of a Smart Home System to Improve Self-Management Behaviors in People With Heart Failure: A Modified Delphi Approach. Front Cardiovasc Med 2022; 9:896249. [PMID: 35845075 PMCID: PMC9276993 DOI: 10.3389/fcvm.2022.896249] [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: 03/14/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Smart home systems could enhance clinical and self-management of chronic heart failure by supporting health monitoring and remote support, but evidence to guide the design of smart home system functionalities is lacking. Objective To identify consensus-based recommendations for functions of a smart home system that could augment clinical and self-management for people living with chronic heart failure in the community. Methods Healthcare professionals caring for people living with chronic heart failure participated in a two-round modified Delphi survey and a consensus workshop. Thirty survey items spanning eight chronic health failure categories were derived from international guidelines for the management of heart failure. In survey Round 1, participants rated the importance of all items using a 9-point Liket scale and suggested new functions to support people with chronic heart failure in their homes using a smart home system. The Likert scale scores ranged from 0 (not important) to 9 (very important) and scores were categorized into three groups: 1-3 = not important, 4-6 = important, and 7-9 = very important. Consensus agreement was defined a priori as ≥70% of respondents rating a score of ≥7 and ≤ 15% rating a score ≤ 3. In survey Round 2, panel members re-rated items where consensus was not reached, and rated the new items proposed in earlier round. Panel members were invited to an online consensus workshop to discuss items that had not reached consensus after Round 2 and agree on a set of recommendations for a smart home system. Results In Round 1, 15 experts agreed 24/30 items were "very important", and suggested six new items. In Round 2, experts agreed 2/6 original items and 6/6 new items were "very important". During the consensus workshop, experts endorsed 2/4 remaining items. Finally, the expert panel recommended 34 items as "very important" for a smart home system including, healthy eating, body weight and fluid intake, physical activity and sedentary behavior, heart failure symptoms, tobacco cessation and alcohol reduction, medication adherence, physiological monitoring, interaction with healthcare professionals, and mental health among others. Conclusion A panel of healthcare professional experts recommended 34-item core functions in smart home systems designed to support people with chronic heart failure for self-management and clinical support. Results of this study will help researchers to co-design and protyping solutions with consumers and healthcare providers to achieve these core functions to improve self-management and clinical outcomes in people with chronic heart failure.
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Alkouri O, Hendriks JM, Magarey J, Schultz T. Predictors of Effective Self-care Interventions Among Jordanians With Heart Failure. Clin Nurs Res 2022; 31:1276-1286. [PMID: 35135377 DOI: 10.1177/10547738211068968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Jordan has dramatic increases in the prevalence of risk factors for heart failure. However, there are few studies addressing heart failure self-care in Jordan. Identifying predictors of heart failure self-care among Jordanian patients is crucial in providing comprehensive care including addressing risk factors. The study aimed to identify predictors of self-care behaviors among Jordanians with heart failure. A cross sectional study with a convenience sample of 300 Jordanian patients was performed in an educational hospital in the north of Jordan. Differences in the level of self-care between selected sociodemographic and clinical variables were identified using univariate statistics, and multiple regression was used to adjust estimates for covariates. The predictors of self-care were insomnia (p ≤ .001) and marital status (p = .018). Identifying factors influencing self-care can assist with addressing the causes of insomnia to ensure effective treatment, providing patients with social support, and eventually promoting heart failure self-care.
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Affiliation(s)
| | | | | | - Tim Schultz
- Flinders University, Adelaide, SA, South Australia
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Tong B, Osborne C, Horwood CM, Hakendorf PH, Woodman RJ, Li JY. The prevalence, characteristics, and risk factors of frequently readmitted patients to an internal medicine service. Intern Med J 2021; 52:1561-1568. [PMID: 34031965 DOI: 10.1111/imj.15395] [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: 10/31/2020] [Revised: 04/07/2021] [Accepted: 04/24/2021] [Indexed: 11/28/2022]
Abstract
AIMS To determine the prevalence, characteristics and risk factors associated with frequent readmissions to an internal medicine service at a tertiary public hospital. METHOD A retrospective observational study was conducted at an internal medicine service in a tertiary teaching hospital between 1st January 2010 and the 30th June 2016. Frequent readmission was defined as four or more readmissions within 12 months of discharge from the index admission. Demographic and clinical characteristics, and potential risk factors were evaluated. RESULTS 50 515 patients were included, 1657 (3.3%) had frequent readmissions and were associated with nearly 2.5 times higher in 12-month mortality rates. They were older, had higher rates of Indigenous Australians (3.2%), more disadvantaged status (Index of Relative Socio-Economic Disadvantage decile of 5.3), and more comorbidities (mean Charlson comorbidity index 1.4) in comparison, to infrequent readmission group. The mean length of hospital stay during the index admission was 6 days for frequent readmission group (21.4% staying more than 7 days) with higher incidence of discharge against medical advice (2.0% higher). Intensive care unit admission rate was 6.6% for frequent readmission group compared to 3.9% for infrequent readmission group. Multivariate analysis showed mental disease and disorders, neoplastic, and alcohol/drug use and alcohol/drug induced organic mental disorders are associated with frequent readmission. CONCLUSION The risk factors associated with frequent readmission were older age, indigenous status, being socially disadvantaged, having higher comorbidities, and discharging against medical advice. Conditions that lead to frequent readmissions were mental disorders, alcohol/drug use and alcohol/drug induced organic mental disorders, and neoplastic disorders.
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Affiliation(s)
- Bcy Tong
- College of Medicine & Public Health, Flinders University, Adelaide, South Australia
| | - Cdi Osborne
- College of Medicine & Public Health, Flinders University, Adelaide, South Australia
| | - C M Horwood
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, South Australia
| | - P H Hakendorf
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, South Australia
| | - R J Woodman
- College of Medicine & Public Health, Flinders University, Adelaide, South Australia.,Centre for Epidemiology and Biostatistics, College of Medicine & Public Health, Flinders University, Adelaide, South Australia
| | - J Y Li
- College of Medicine & Public Health, Flinders University, Adelaide, South Australia.,Department of Renal Medicine, Flinders Medical Centre, Adelaide, South Australia
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Liao Y, Wen H, Ge S, Zhong W, Liang Y, Yu L, Lu L. Effects of traditional Chinese exercise in patients with chronic heart failure: A systematic review and meta-analysis. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Zisis G, Huynh Q, Yang Y, Neil C, Carrington MJ, Ball J, Maguire G, Marwick TH. Rationale and design of a risk-guided strategy for reducing readmissions for acute decompensated heart failure: the Risk-HF study. ESC Heart Fail 2020; 7:3151-3160. [PMID: 32696559 PMCID: PMC7524087 DOI: 10.1002/ehf2.12897] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS Heart failure (HF) readmission commonly arises owing to insufficient patient knowledge and failure of recognition of the early stages of recurrent fluid congestion. In previous work, we developed a score to predict short-term hospital readmission and showed that higher-risk patients benefit most from a disease management programme (DMP) that included enhancing knowledge and education by a nurse. We aim to evaluate the effectiveness of a novel, nurse-led HF DMP in selected patients at high risk of short-term hospital readmission, using ultrasound-guided diuretic management and artificial intelligence to enhance HF knowledge in an outpatient setting. METHODS AND RESULTS Risk-HF is a prospective multisite randomized controlled trial that will allocate 404 patients hospitalized with acute decompensated HF, and ≥33% risk of readmission and/or death at 30 days, into risk-guided nurse intervention (DMP-Plus group) compared with usual care. Intervention elements include (i) fluid management with a handheld ultrasound (HHU) device at point of care; (ii) post-discharge follow-up; (iii) optimal programmed drug titration; (iv) better transition of care; (v) intensive self-care education via an avatar-based 'digital health coach'; and (vi) exercise guidance through the digital coach. Usual care involves standard post-discharge hospital care. The primary outcome is reduced death and/or hospital readmissions at 30 days post-discharge, and secondary outcomes include quality of life, fluid management efficacy, and feasibility and patient engagement. Assuming that our intervention will reduce readmissions and/or deaths by 50%, with a 1:1 ratio of intervention vs. usual care, we plan to randomize 404 patients to show a difference at a statistical power of 80%, using a two-sided alpha of 0.05. We anticipate this recruitment will be achieved by screening 2020 hospitalized HF patients for eligibility. An 8 week pilot programme of our digital health coach in 21 HF patients, age > 75 years, showed overall improvements in quality of life (13 of 21), self-care (12 of 21), and HF knowledge (13 of 21). A pilot of the use of HHU by nurses showed that it was feasible and accurate. CONCLUSIONS The Risk-HF trial will evaluate the effectiveness of a risk-guided intervention to improve HF outcomes and will evaluate the efficacy of trained HF nurses delivering a fluid management protocol that is guided by lung ultrasound with an HHU at point of care.
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Affiliation(s)
- Georgios Zisis
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Vic., 3004, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Vic., Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Vic., Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Vic., 3004, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Vic., Australia
| | - Yang Yang
- Faculty of Medicine, University of Melbourne, Melbourne, Vic., Australia.,Western Health, Melbourne, Vic., Australia.,Monash University, Melbourne, Vic., Australia.,Eastern Health, Melbourne, Vic., Australia
| | - Christopher Neil
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Vic., 3004, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Vic., Australia.,Western Health, Melbourne, Vic., Australia
| | - Melinda J Carrington
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Vic., 3004, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Vic., Australia
| | - Jocasta Ball
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Vic., 3004, Australia.,Monash University, Melbourne, Vic., Australia.,Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Vic., Australia
| | - Graeme Maguire
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Vic., 3004, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Vic., Australia.,Western Health, Melbourne, Vic., Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Vic., 3004, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Vic., Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Vic., Australia.,Western Health, Melbourne, Vic., Australia
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Hsieh V, Paull G, Hawkshaw B. Heart Failure Integrated Care Project: overcoming barriers encountered by primary health care providers in heart failure management. AUST HEALTH REV 2020; 44:451-458. [DOI: 10.1071/ah18251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 08/01/2019] [Indexed: 01/07/2023]
Abstract
ObjectiveHeart failure (HF) is associated with increased morbidity and mortality. A significant proportion of HF patients will have repeated hospital presentations. Effective integration between general practice and existing HF management programs may address some of the challenges in optimising care for this complex patient population. The Heart Failure Integrated Care Project (HFICP) investigated the barriers encountered by primary healthcare providers in providing care to patients with HF in the community.
MethodsFive general practices in the St George and Sutherland regions (NSW, Australia) that employed practice nurses (PNs) were enrolled in the project. Participants responded to a printed survey that asked about their perceived role in the management of HF patients and their current knowledge and confidence in managing this condition. Participants also took part in a focus group meeting and were asked to identify barriers to improving HF patient management in general practice, and to offer suggestions about how the project could assist them to overcome those barriers.
ResultsBarriers to effective delivery of HF management in general practice included clinical factors (consultation time limitations, underutilisation of patient management systems, identifying patients with HF, lack of patient self-care materials), professional factors (suboptimal hospital discharge summary letters, underutilisation of PNs), organisation factors (difficulties in communication with hospital staff, lack of education regarding HF management) and system issues (no Medicare rebate for B-type natriuretic peptide testing, insufficient Medicare rebate for using PN in chronic disease management).
ConclusionsThe HFICP identified several barriers to improving integrated management for HF patients in the Australian setting. These findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between hospitals and primary care providers in delivering better care to HF patients.
What is known about the topic?Multidisciplinary HF programs are heterogeneous in their structures, they have low patient participation rates and a significant proportion of HF patients have further presentations to hospital with HF. Integrating the care of HF patients into the primary care system following hospital admission remains challenging.
What does this paper add?This paper identified several factors that hinder the effective delivery of care by primary care providers to patients with HF.
What are the implications for practitioners?The findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between tertiary health facilities and primary care providers in delivering better care to HF patients.
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Multimorbidity and the Risk of All-Cause 30-Day Readmission in the Setting of Multidisciplinary Management of Chronic Heart Failure: A Retrospective Analysis of 830 Hospitalized Patients in Australia. J Cardiovasc Nurs 2019; 33:437-445. [PMID: 28107252 DOI: 10.1097/jcn.0000000000000391] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multimorbidity has an adverse effect on health outcomes in hospitalized individuals with chronic heart failure (CHF), but the modulating effect of multidisciplinary management is unknown. OBJECTIVE The aim of this study was to test the hypothesis that increasing morbidity would independently predict an increasing risk of 30-day readmission despite multidisciplinary management of CHF. METHODS We studied patients hospitalized for any reason with heart failure receiving nurse-led, postdischarge multidisciplinary management. We profiled a matrix of expected comorbidities involving the most common coexisting conditions associated with CHF and examined the relationship between multimorbidity and 30-day all-cause readmission. RESULTS A total of 830 patients (mean age 73 ± 13 years and 65% men) were assessed. Multimorbidity was common, with an average of 6.6 ± 2.4 comorbid conditions with sex-based differences in prevalence of 4 of 10 conditions. Within 30 days of initial hospitalization, 216 of 830 (26%) patients were readmitted for any reason. Greater multimorbidity was associated with increasing readmission (4%-44% for those with 0-1 to 8-9 morbid conditions; adjusted odds ratio, 1.25; 95% confidence interval, 1.13-1.38) for each additional condition. Three distinct classes of patient emerged: class 1-diabetes, metabolic, and mood disorders; class 2-renal impairment; and class 3-low with relatively fewer comorbid conditions. Classes 1 and 2 had higher 30-day readmission than class 3 did (adjusted P < .01 for both comparisons). CONCLUSIONS These data affirm that multimorbidity is common in adult CHF inpatients and in potentially distinct patterns linked to outcome. Overall, greater multimorbidity is associated with a higher risk of 30-day all-cause readmission despite high-quality multidisciplinary management. More innovative approaches to target-specific clusters of multimorbidity are required to improve health outcomes in affected individuals.
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Abstract
PURPOSE Previous studies on the 'treatment gap' in patients with heart failure (HF) have focused either on prescribing or patients' adherence to prescribed treatment. This study sought to determine whether or not recent initiatives to close the gap have also minimised any mismatches between physicians' expectation of their patients' medications, medications in the patients' possession and their actual medication use. METHODS A cross-sectional observational survey was conducted from December 2015 to June 2016 in The Alfred Hospital HF clinic in Melbourne, Australia. Patients were invited to participate if they had chronic HF (NYHA class II to IV), were aged ≥ 60 years, had no history of HF related hospitalisation within the past 6 months and were prescribed at least two HF medications. RESULTS Of 123 eligible patients, 102 were recruited into the study. Beta-blockers, mineralocorticoid receptor antagonists, loop diuretics and statins were associated with the highest rates of mismatches of drugs and doses, ranging from 10 to 17%. Discrepancy of total daily doses was the most common type of mismatch. Overall, only 23.5% of the patients were taking the right drugs at the right doses as expected by their cardiologists/HF specialists. CONCLUSIONS Despite improved prescribers' adherence to guideline-directed medical therapy, there remain considerable mismatches between prescribers' expectation of patients' HF medications, medications in patients' possession and their actual medication use. Initiatives to improve this situation are urgently needed.
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Taheri A, Mansouri AD, Mansoori P, Asad RI. Management of fluid status and cardiovascular function in patients with diffuse skin inflammation. J DERMATOL TREAT 2018; 30:506-510. [PMID: 30252553 DOI: 10.1080/09546634.2018.1528328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: Skin inflammation causes vasodilation and increased vascular permeability, which may result in decreased blood pressure and peripheral edema. Patients with erythroderma usually compensate for low blood pressure with fluid retention and increased cardiac output. However, if the heart cannot support increased cardiac output, blood pressure will stay low, resulting in severe compensatory fluid retention, which leads to decompensated congestive heart failure, and pulmonary edema. Treatment for high-output congestive heart failure focuses on the primary pathology, which is skin inflammation. However, aggressive treatment of the inflammation with glucocorticoids may result in rapid resorption of extravascular fluid into the intravascular space and occurrence or aggravation of pulmonary edema. Erythrodermic patients with no clinical heart failure are also at risk for developing pulmonary edema if they receive glucocorticoids and/or intravascular fluids. Most hospitalists and dermatologists are not familiar with fluid administration and ways to manage cardiovascular function and blood pressure in patients with skin inflammation. Objectives and methods: In this article, we discuss the pathophysiology of vascular and fluid changes in the context of diffuse skin inflammation and provide some basic guidelines that can be presented to hospitalists by dermatologists. Limitations: Most of the recommendations and guidelines in the article are based on basic science and on the personal experience of the authors and are not supported by controlled trials. Capsule summary Diffuse skin inflammation causes major changes in the cardiovascular system and in the perfusion of internal organs. We provide guidelines for management of fluid status and cardiovascular function in patients with diffuse skin inflammation. Dermatologists can provide hospitalists or primary care providers with these guidelines to help them with creating better treatment plans.
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Affiliation(s)
- Arash Taheri
- a Bethany Medical Center , Greensboro , NC , USA.,b Department of Internal Medicine, Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Amanda D Mansouri
- c Center College of Medicine, University of Tennessee Health Science , Memphis , TN , USA
| | - Parisa Mansoori
- d Department of Pathology, Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Rahimullah Imran Asad
- e Department of Pulmonary and Critical Care, Wake Forest School of Medicine , Winston-Salem , NC , USA.,f Department of Anesthesiology, Wake Forest School of Medicine , Winston-Salem , NC , USA
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Huynh Q, Negishi K, De Pasquale C, Hare J, Leung D, Stanton T, Marwick TH. Effects of post‐discharge management on rates of early re‐admission and death after hospitalisation for heart failure. Med J Aust 2018; 208:485-491. [DOI: 10.5694/mja17.00809] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 02/23/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Quan Huynh
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS
- Baker Heart and Diabetes Institute, Melbourne, VIC
| | - Kazuaki Negishi
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS
| | | | - James Hare
- Baker Heart and Diabetes Institute, Melbourne, VIC
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Lima LFD, Barbosa F, Simões MV, Navarro AM. Heart failure, micronutrient profile, and its connection with thyroid dysfunction and nutritional status. Clin Nutr 2018; 38:800-805. [PMID: 29551406 DOI: 10.1016/j.clnu.2018.02.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 02/12/2018] [Accepted: 02/25/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Heart failure (HF) is a growing public health issue; its risk factors include inappropriate dietary intake of microelements such as iodine, selenium, zinc and iron, which may lead to thyroid dysfunction. OBJECTIVE This study aimed to assess the correlation among the functional class stages of patients with HF, iodine, selenium, iron and zinc levels with the presence of thyroid dysfunction. METHODOLOGY One hundred nine patients from the HF outpatient clinic of the Clinics Hospital of Ribeirão Preto whose blood and urine were collected for micronutrient analysis and laboratory tests were selected. The subjects' weight and height were also measured to calculate their BMI. First, a descriptive analysis of the data was made into tables, and then statistical analyses were done at a 5% significance level (p < 0.05). RESULTS Most patients whose data was analysed were elderly and overweight. Excess ioduria, serum selenium and zinc, erythrocyte zinc and deficiency in serum iron and erythrocyte selenium were observed. The prevalence of thyroid dysfunction was 8.3%. Multivariate logistic regression verified that thyroid dysfunction increases the chance of classification in functional class III or IV (p = 0.015; OR = 8.72) by 8.7 times; each year of age increases the chance by 4.6% of classification in functional class III or IV (p = 0.008; odds ratio [OR] = 1.05), and each unit of BMI increases the chance of classification in functional class III or IV by 9.2% (p = 0.028; OR = 1.09). CONCLUSION Patients with HF were deficient in serum iron and erythrocyte selenium. No connection was found between hypothyroidism and mineral deficiency, which seems to be related more to the severity of the disease than to the micronutrient nutritional profile.
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Affiliation(s)
- Livia Fernandes de Lima
- Department of Internal Medicine, Medical School of Ribeirão Preto, Avenida Bandeirantes 3900, Monte Alegre, 14049-900 Ribeirão Preto, SP, Brazil.
| | - Fernando Barbosa
- Department of Clinical, Toxicological and Bromatological Analyses, Faculty of Pharmacy of Ribeirão Preto, Avenida do Café s/n, Monte Alegre, 14049-903 Ribeirão Preto, SP, Brazil
| | - Marcus Vinícius Simões
- Department of Internal Medicine, Medical School of Ribeirão Preto, Avenida Bandeirantes 3900, Monte Alegre, 14049-900 Ribeirão Preto, SP, Brazil
| | - Anderson Marliere Navarro
- Department of Internal Medicine, Medical School of Ribeirão Preto, Avenida Bandeirantes 3900, Monte Alegre, 14049-900 Ribeirão Preto, SP, Brazil
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Kirchhof P. The future of atrial fibrillation management: integrated care and stratified therapy. Lancet 2017; 390:1873-1887. [PMID: 28460828 DOI: 10.1016/s0140-6736(17)31072-3] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/20/2017] [Accepted: 03/10/2017] [Indexed: 02/06/2023]
Abstract
Atrial fibrillation is one of the major cardiovascular health problems: it is a common, chronic condition, affecting 2-3% of the population in Europe and the USA and requiring 1-3% of health-care expenditure as a result of stroke, sudden death, heart failure, unplanned hospital admissions, and other complications. Early diagnosis of atrial fibrillation, ideally before the first complication occurs, remains a challenge, as shown by patients who are only diagnosed with the condition when admitted to hospital for acute cardiac decompensation or stroke. Once diagnosed, atrial fibrillation requires chronic, multidimensional management in five domains (acute management, treatment of underlying and concomitant cardiovascular conditions, stroke prevention therapy, rate control, and rhythm control). The consistent provision of these treatment options to all patients with atrial fibrillation is difficult, despite recent improvements in organisation of care, knowledge about atrial fibrillation, and treatment options. Integrated care models that provide patient-centred care in, or close to, the patient's community while maintaining access to all specialist treatment options, emerge as the best approach to achieve consistent delivery of these chronic treatments to all patients with atrial fibrillation. Ongoing research efforts will establish when to initiate oral anticoagulation in patients with device-detected atrial high-rate episodes, quantify the prognostic effect of early and comprehensive rhythm control therapy, including atrial fibrillation ablation, and delineate optimum methods to reduce bleeding complications in patients treated with anticoagulation. Additionally, research efforts are needed to define different types of atrial fibrillation on the basis of the main causes of atrial fibrillation to pave the way for the clinical development of stratified atrial fibrillation therapy.
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Affiliation(s)
- Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; Sandwell and West Birmingham Hospitals NHS Trust and University Hospitals Birmingham NHS Foundation NHS Trust, Birmingham, UK; Atrial Fibrillation NETwork, Münster, Germany.
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Parajuli DR, Franzon J, McKinnon RA, Shakib S, Clark RA. Role of the Pharmacist for Improving Self-care and Outcomes in Heart Failure. Curr Heart Fail Rep 2017; 14:78-86. [DOI: 10.1007/s11897-017-0323-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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20
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For the improvement of Heart Failure treatment in Portugal - Consensus statement. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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21
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Fonseca C, Brito D, Cernadas R, Ferreira J, Franco F, Rodrigues T, Morais J, Silva Cardoso J. Pela melhoria do tratamento da insuficiência cardíaca em Portugal – documento de consenso. Rev Port Cardiol 2017; 36:1-8. [DOI: 10.1016/j.repc.2016.10.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 11/26/2022] Open
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Iyngkaran P, Liew D, McDonald P, Thomas MC, Reid C, Chew D, Hare DL. Phase 4 Studies in Heart Failure - What is Done and What is Needed? Curr Cardiol Rev 2016; 12:216-30. [PMID: 27280303 PMCID: PMC5011189 DOI: 10.2174/1573403x12666160606121458] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/18/2015] [Accepted: 01/11/2016] [Indexed: 02/07/2023] Open
Abstract
Congestive heart failure (CHF) therapeutics is generated through a well-described evidence generating process. Phases 1 - 3 of this process are required prior to approval and widespread clinical use. Phase 3 in almost all cases is a methodologically sound randomized controlled trial (RCT). After this phase it is generally accepted that the treatment has a significant, independent and prognostically beneficial effect on the pathophysiological process. A major criticism of RCTs is the population to whom the result is applicable. When this population is significantly different from the trial cohort the external validity comes into question. Should the continuation of the evidence generating process continue these problems might be identified. Post marketing surveillance through phase 4 and comparative effectiveness studies through phase 5 trials are often underperformed in comparison to the RCT. These processes can help identify remote adverse events and define new hypotheses for community level benefits. This review is aimed at exploring the post-marketing scene for CHF therapeutics from an Australian health system perspective. We explore the phases of clinical trials, the level of evidence currently available and options for ensuring greater accountability for community level CHF clinical outcomes.
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Affiliation(s)
- Pupalan Iyngkaran
- Cardiologist & Senior Lecturer NT Medical School, Flinders University, Australia.
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23
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Providing palliative care for cardiovascular disease from a perspective of sociocultural diversity: a global view. Curr Opin Support Palliat Care 2016; 10:11-7. [PMID: 26808051 DOI: 10.1097/spc.0000000000000188] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This article discusses the available information on providing palliative care for cardiovascular disease (CVD) for individuals from culturally and linguistically diverse populations, and argues the need for cultural competence and awareness of healthcare providers. RECENT FINDINGS The burden of CVD is increasing globally and access to palliative care for individuals and populations is inconsistent and largely driven by policy, funding models, center-based expertise and local resources. Culture is an important social determinant of health and moderates health outcomes across the life trajectory. Along with approachability, availability, accommodation, affordability and appropriateness, culture moderates access to services. Health disparities and inequity of access underscore the importance of ensuring services meet the needs of diverse populations and that care is provided by individuals who are culturally competent. In death and dying, the vulnerability of individuals, families and communities is most pronounced. Using a social-ecological model as an organising framework, we consider the evidence from the literature in regard to the interaction between the individual, interpersonal relationships, community and society in promoting access to individuals with cardiovascular disease. SUMMARY This review highlights the need for considering individual, provider and system factors to tailor and target healthcare services to the needs of culturally diverse populations. Beyond translation of materials, there is a need to understand the cultural dimensions influencing health-seeking behaviors and acceptance of palliative care and ensuring the cultural competence of health professionals in both primary and specialist palliative care.
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Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37:2893-2962. [PMID: 27567408 DOI: 10.1093/eurheartj/ehw210] [Citation(s) in RCA: 4742] [Impact Index Per Article: 592.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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25
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Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GYH, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg 2016; 50:e1-e88. [DOI: 10.1093/ejcts/ezw313] [Citation(s) in RCA: 602] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Abstract
Patients with chronic heart failure (CHF) living in rural areas face an increased risk of adverse cardiovascular events. Even in countries with universal access to health care, rural areas are characteristically underserved, with reduced health care providers supply, greater distance to health care centers, decreased physician density with higher reliance on generalists, and high health care staff turnover. On the other hand, patient-related characteristics vary widely among published data. This review describes the epidemiology of CHF in rural or remote settings, organizational and patient-related factors involved in cardiovascular outcomes, and the role of interventions to improve rural health care.
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Affiliation(s)
- Hugo E Verdejo
- Division of Cardiovascular Diseases, Advanced Center for Chronic Diseases FONDAP ACCDis, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Marcoleta 367, CP 8330024, Santiago, Chile.
| | - Catterina Ferreccio
- Advanced Center for Chronic Diseases FONDAP ACCDis, Division of Public Health and Family Medicine, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Marcoleta 434, CP 8330073, Santiago, Chile
| | - Pablo F Castro
- Division of Cardiovascular Diseases, Advanced Center for Chronic Diseases FONDAP ACCDis, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Marcoleta 367, CP 8330024, Santiago, Chile
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27
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Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GYH, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 2016; 18:1609-1678. [PMID: 27567465 DOI: 10.1093/europace/euw295] [Citation(s) in RCA: 1318] [Impact Index Per Article: 164.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Stefan Agewall
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - John Camm
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Gonzalo Baron Esquivias
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Werner Budts
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Scipione Carerj
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Filip Casselman
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Antonio Coca
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Raffaele De Caterina
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Spiridon Deftereos
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Dobromir Dobrev
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - José M Ferro
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Gerasimos Filippatos
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Donna Fitzsimons
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Bulent Gorenek
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Maxine Guenoun
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Stefan H Hohnloser
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Philippe Kolh
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Gregory Y H Lip
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Athanasios Manolis
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - John McMurray
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Piotr Ponikowski
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Raphael Rosenhek
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Frank Ruschitzka
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Irina Savelieva
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Sanjay Sharma
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Piotr Suwalski
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Juan Luis Tamargo
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Clare J Taylor
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Isabelle C Van Gelder
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Adriaan A Voors
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Stephan Windecker
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Jose Luis Zamorano
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Katja Zeppenfeld
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
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Miró Ò, Escoda R, Martín-Sánchez F, Herrero P, Jacob J, Rizzi M, Aguirre A, Andueza J, Bueno H, Llorens P. Assessment of the knowledge and perception of support of patients with heart failure SOPICA study IN SPAIN. Rev Clin Esp 2016. [DOI: 10.1016/j.rceng.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stokes MB, Bergin P, McGiffin D. Role of long-term mechanical circulatory support in patients with advanced heart failure. Intern Med J 2016; 46:530-40. [DOI: 10.1111/imj.12817] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/12/2015] [Indexed: 01/24/2023]
Affiliation(s)
- M. B. Stokes
- Department of Advanced Heart Failure/Transplantation; The Alfred Hospital; Melbourne Victoria Australia
| | - P. Bergin
- Department of Advanced Heart Failure/Transplantation; The Alfred Hospital; Melbourne Victoria Australia
| | - D. McGiffin
- Department of Advanced Heart Failure/Transplantation; The Alfred Hospital; Melbourne Victoria Australia
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Bharathan R, Farag M, Hayes K. The value of multidisciplinary team meetings within an early pregnancy assessment unit. J OBSTET GYNAECOL 2016; 36:789-793. [DOI: 10.3109/01443615.2016.1154510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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31
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Miró Ò, Escoda R, Martín-Sánchez FJ, Herrero P, Jacob J, Rizzi M, Aguirre A, Andueza JA, Bueno H, Llorens P. Assessment of the knowledge and perception of support of patients with heart failure SOPICA study IN SPAIN. Rev Clin Esp 2016; 216:237-47. [PMID: 27000272 DOI: 10.1016/j.rce.2016.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 02/22/2016] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To understand the perceptions of patients with heart failure (HF) concerning their disease, treatment and support, as well as the specialists who provide care after a decompensation, and to determine whether there is a relationship between the type of specialist involved in the follow-up and the medium-term prognosis. METHODS A multicentre, prospective cohort study consecutively included patients with acute HF in the emergency department. The patients were interviewed by telephone 91-180days after their emergency department visit. We investigated the relationship between the type of specialist who performed the follow-up and the emergency department visits or hospitalisations using Cox regression models, with progressive adjustment by groups of potential confounders of these relationships. RESULTS We interviewed 785 patients. Thirty-three percent (95%CI: 30%-36%) considered their disease mild, 64% (60%-67%) required help from third parties for daily activities, 65% (61%-68%) had no recent therapeutic changes, and 69% (67%-72%) received the same treatment in the exacerbations. The perceived support varied significantly depending on the factor under consideration (from greater to lesser: family, hospital, emergency department, health centre, religion and patient associations; p<.05 in all comparisons). Thirty-nine percent (36%-43%) of the patients with decompensations consulted directly with the emergency department, with no prior changes in treatment. At discharge, general practitioners (74%, 71%-77%) and cardiologists (74%, 70%-77%) were the most involved in the follow-up, although the specialty was not related to the prognosis. CONCLUSION There are various aspects of the perception of patients with HF concerning their disease that are susceptible to future interventions. Patient follow-up involves various specialties, but all achieve similar results in the medium term.
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Affiliation(s)
- Ò Miró
- Área de Urgencias, Hospital Clínic, Barcelona; Grupo de Investigación «Urgencias: Procesos y Patologías», IDIBAPS, Barcelona, España.
| | - R Escoda
- Área de Urgencias, Hospital Clínic, Barcelona; Grupo de Investigación «Urgencias: Procesos y Patologías», IDIBAPS, Barcelona, España
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - P Herrero
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España
| | - J Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - M Rizzi
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - A Aguirre
- Servicio de Urgencias, Hospital del Mar, Barcelona, España
| | - J A Andueza
- Servicio de Urgencias, Hospital Gregorio Marañón, Madrid, España
| | - H Bueno
- Servicio de Urgencias, Hospital Gregorio Marañón, Madrid, España; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España; Instituto de Investigación i+12 y Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España; Universidad Complutense de Madrid, Madrid, España
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Alicante, España
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Evans RS, Benuzillo J, Horne BD, Lloyd JF, Bradshaw A, Budge D, Rasmusson KD, Roberts C, Buckway J, Geer N, Garrett T, Lappé DL. Automated identification and predictive tools to help identify high-risk heart failure patients: pilot evaluation. J Am Med Inform Assoc 2016; 23:872-8. [PMID: 26911827 DOI: 10.1093/jamia/ocv197] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/20/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Develop and evaluate an automated identification and predictive risk report for hospitalized heart failure (HF) patients. METHODS Dictated free-text reports from the previous 24 h were analyzed each day with natural language processing (NLP), to help improve the early identification of hospitalized patients with HF. A second application that uses an Intermountain Healthcare-developed predictive score to determine each HF patient's risk for 30-day hospital readmission and 30-day mortality was also developed. That information was included in an identification and predictive risk report, which was evaluated at a 354-bed hospital that treats high-risk HF patients. RESULTS The addition of NLP-identified HF patients increased the identification score's sensitivity from 82.6% to 95.3% and its specificity from 82.7% to 97.5%, and the model's positive predictive value is 97.45%. Daily multidisciplinary discharge planning meetings are now based on the information provided by the HF identification and predictive report, and clinician's review of potential HF admissions takes less time compared to the previously used manual methodology (10 vs 40 min). An evaluation of the use of the HF predictive report identified a significant reduction in 30-day mortality and a significant increase in patient discharges to home care instead of to a specialized nursing facility. CONCLUSIONS Using clinical decision support to help identify HF patients and automatically calculating their 30-day all-cause readmission and 30-day mortality risks, coupled with a multidisciplinary care process pathway, was found to be an effective process to improve HF patient identification, significantly reduce 30-day mortality, and significantly increase patient discharges to home care.
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Affiliation(s)
- R Scott Evans
- Medical Informatics, Intermountain Healthcare Biomedical Informatics, University of Utah
| | - Jose Benuzillo
- Intermountain Healthcare Cardiovascular Clinical Program
| | - Benjamin D Horne
- Intermountain Heart Institute, Intermountain Medical Center Genetic Epidemiology Division, Department of Internal Medicine, University of Utah
| | | | | | - Deborah Budge
- Intermountain Heart Institute, Intermountain Medical Center
| | | | | | | | - Norma Geer
- McKay Dee Hospital Cardiovascular Program
| | | | - Donald L Lappé
- Intermountain Healthcare Cardiovascular Clinical Program Intermountain Heart Institute, Intermountain Medical Center
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Newton PJ, Davidson PM, Reid CM, Krum* H, Hayward C, Sibbritt DW, Banks E, MacDonald PS. Acute heart failure admissions in New South Wales and the Australian Capital Territory: the NSW HF Snapshot Study. Med J Aust 2016; 204:113.e1-8. [DOI: 10.5694/mja15.00801] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/23/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Phillip J Newton
- Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Sydney, NSW
| | - Patricia M Davidson
- Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Sydney, NSW
- Johns Hopkins University, Baltimore, Md, USA
| | - Christopher M Reid
- Curtin University, Perth, WA
- Monash Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, VIC
| | - Henry Krum*
- Monash Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, VIC
| | | | - David W Sibbritt
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Sydney, NSW
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
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Multidisciplinary Management of Chronic Heart Failure: Principles and Future Trends. Clin Ther 2015; 37:2225-33. [DOI: 10.1016/j.clinthera.2015.08.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 08/20/2015] [Accepted: 08/22/2015] [Indexed: 12/31/2022]
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Page K. A systematic approach to chronic heart failure care: a consensus statement. Med J Aust 2015; 202:361. [PMID: 25877113 DOI: 10.5694/mja14.01383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/03/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Karen Page
- National Heart Foundation of Australia, Melbourne, VIC, Australia.
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Huynh QL, Saito M, Blizzard CL, Eskandari M, Johnson B, Adabi G, Hawson J, Negishi K, Marwick TH, Huynh Q, Marwick T, DePasquale C, Leung D, Hare J, Stanton T. Roles of Nonclinical and Clinical Data in Prediction of 30-Day Rehospitalization or Death Among Heart Failure Patients. J Card Fail 2015; 21:374-381. [DOI: 10.1016/j.cardfail.2015.02.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 02/18/2015] [Indexed: 11/27/2022]
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Inglis SC, Clark RA. A systematic approach to chronic heart failure care: a consensus statement. Med J Aust 2015; 202:361. [PMID: 25877112 DOI: 10.5694/mja14.01175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/27/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Sally C Inglis
- University of Technology, Sydney, Sydney, NSW, Australia.
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Stewart S, Ball J, Horowitz JD, Marwick TH, Mahadevan G, Wong C, Abhayaratna WP, Chan YK, Esterman A, Thompson DR, Scuffham PA, Carrington MJ. Standard versus atrial fibrillation-specific management strategy (SAFETY) to reduce recurrent admission and prolong survival: pragmatic, multicentre, randomised controlled trial. Lancet 2015; 385:775-84. [PMID: 25467562 DOI: 10.1016/s0140-6736(14)61992-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Patients are increasingly being admitted with chronic atrial fibrillation, and disease-specific management might reduce recurrent admissions and prolong survival. However, evidence is scant to support the application of this therapeutic approach. We aimed to assess SAFETY--a management strategy that is specific to atrial fibrillation. METHODS We did a pragmatic, multicentre, randomised controlled trial in patients admitted with chronic, non-valvular atrial fibrillation (but not heart failure). Patients were recruited from three tertiary referral hospitals in Australia. 335 participants were randomly assigned by computer-generated schedule (stratified for rhythm or rate control) to either standard management (n=167) or the SAFETY intervention (n=168). Standard management consisted of routine primary care and hospital outpatient follow-up. The SAFETY intervention comprised a home visit and Holter monitoring 7-14 days after discharge by a cardiac nurse with prolonged follow-up and multidisciplinary support as needed. Clinical reviews were undertaken at 12 and 24 months (minimum follow-up). Coprimary outcomes were death or unplanned readmission (both all-cause), measured as event-free survival and the proportion of actual versus maximum days alive and out of hospital. Analyses were done on an intention-to-treat basis. The trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTRN 12610000221055). FINDINGS During median follow-up of 905 days (IQR 773-1050), 49 people died and 987 unplanned admissions were recorded (totalling 5530 days in hospital). 127 (76%) patients assigned to the SAFETY intervention died or had an unplanned readmission (median event-free survival 183 days [IQR 116-409]) and 137 (82%) people allocated standard management achieved a coprimary outcome (199 days [116-249]; hazard ratio 0·97, 95% CI 0·76-1·23; p=0·851). Patients assigned to the SAFETY intervention had 99·5% maximum event-free days (95% CI 99·3-99·7), equating to a median of 900 (IQR 767-1025) of 937 maximum days alive and out of hospital. By comparison, those allocated to standard management had 99·2% (95% CI 98·8-99·4) maximum event-free days, equating to a median of 860 (IQR 752-1047) of 937 maximum days alive and out of hospital (effect size 0·22, 95% CI 0·21-0·23; p=0·039). INTERPRETATION A post-discharge management programme specific to atrial fibrillation was associated with proportionately more days alive and out of hospital (but not prolonged event-free survival) relative to standard management. Disease-specific management is a possible strategy to improve poor health outcomes in patients admitted with chronic atrial fibrillation. FUNDING National Health and Medical Research Council of Australia.
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Affiliation(s)
- Simon Stewart
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.
| | - Jocasta Ball
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - John D Horowitz
- The Queen Elizabeth Hospital and University of Adelaide, Adelaide, SA, Australia
| | | | - Gnanadevan Mahadevan
- The Queen Elizabeth Hospital and University of Adelaide, Adelaide, SA, Australia
| | - Chiew Wong
- Department of Cardiology, Footscray Hospital, Melbourne, VIC, Australia
| | - Walter P Abhayaratna
- Division of Medicine, Canberra Hospital and Australian National University, Canberra, ACT, Australia
| | - Yih K Chan
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Adrian Esterman
- Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - David R Thompson
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Paul A Scuffham
- Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia
| | - Melinda J Carrington
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
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Teng TK, Hung J, Katzenellenbogen JM, Bessarab DC, Thompson SC. Better prevention and management of heart failure in Aboriginal Australians. Med J Aust 2015. [DOI: 10.5694/j.1326-5377.2015.tb04229.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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