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Feijó MK, Ruschel KB, Bernardes D, Ferro EB, Rohde LE, Biolo A, Rabelo da Silva ER. Effects of a diuretic adjustment algorithm protocol on heart failure admissions: A randomized clinical trial. J Telemed Telecare 2021; 27:288-297. [PMID: 33966521 DOI: 10.1177/1357633x211009640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the effectiveness of a diuretic adjustment algorithm (DAA) in maintaining clinical stability and reducing HF readmissions using telemonitoring technologies. METHODS Randomized clinical trial of patients with an indication for furosemide dose adjustment during routine outpatient visits. In the intervention group (IG), the diuretic dose was adjusted according to the DAA and the patients received telephone calls for 30 days. In the control group (CG), the diuretic dose was adjusted by a physician at baseline only. Co-primary outcomes were hospital readmission and/or emergency department visits due to decompensated HF within 90 days, and a 2-point change in the Clinical Congestion Score and/or a deterioration in New York Heart Association functional class within 30 days. RESULTS A total of 206 patients were included. Most patients were male (n=119; 58%), with a mean age of 62 (SD 13) years. Four patients (2%) in the IG and 14 (7%) in the CG were hospitalized for HF (odds ratio (OR) 0.31 (0.10-0.91); p=0.04). Multivariate analysis showed a reduction of 67% in readmissions and/or emergency department visits due to decompensated HF in the IG compared with the CG (95% CI 0.13-0.88; p=0.027). Regarding the combined outcome of HF readmission and/or emergency department visits or clinical instability, the IG had 20% fewer events than the CG within 30 days (IG: n=48 (23%), CG: n=70 (34%); OR 0.80 (0.63-0.93); p=0.03). DISCUSSION Using DAA improved the combined outcome in these outpatients, with favorable and significant results that included a reduction in HF admissions and in clinical instability. (NCT02068937).
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Affiliation(s)
- Maria Kef Feijó
- School of Nursing, Universidade Federal do Rio Grande do Sul, Brazil
| | - Karen Brasil Ruschel
- National Institute of Science and Technology for Health Technology Assessment (IATS), Brazil
| | - Daniela Bernardes
- School of Nursing, Universidade Federal do Rio Grande do Sul, Brazil
- Cardiology and Cardiovascular Sciences Program, Universidade Federal do Rio Grande do Sul, Brazil
| | - Eduarda B Ferro
- School of Nursing, Universidade Federal do Rio Grande do Sul, Brazil
| | - Luis E Rohde
- Cardiology and Cardiovascular Sciences Program, Universidade Federal do Rio Grande do Sul, Brazil
- Cardiovascular Division, Heart Failure Clinic Hospital de Clínicas de Porto Alegre, Brazil
| | - Andreia Biolo
- Cardiology and Cardiovascular Sciences Program, Universidade Federal do Rio Grande do Sul, Brazil
- Cardiovascular Division, Heart Failure Clinic Hospital de Clínicas de Porto Alegre, Brazil
| | - Eneida Rejane Rabelo da Silva
- School of Nursing, Universidade Federal do Rio Grande do Sul, Brazil
- Cardiology and Cardiovascular Sciences Program, Universidade Federal do Rio Grande do Sul, Brazil
- Cardiovascular Division, Heart Failure Clinic Hospital de Clínicas de Porto Alegre, Brazil
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Hastenteufel LCT, Clausell N, Neyeloff JL, Domingues FB, Caballero LG, Silva ERRD, Goldraich LA. Continuous Intravenous Inotropes in Ward Units: Expanding Therapy Outside Intensive Care using a Safety-Oriented Protocol. Arq Bras Cardiol 2019; 112:573-576. [PMID: 31188963 PMCID: PMC6555580 DOI: 10.5935/abc.20190078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/16/2019] [Indexed: 01/25/2023] Open
Abstract
Selected clinically stable patients with heart failure (HF) who require prolonged
intravenous inotropic therapy may benefit from its continuity out of the
intensive care unit (ICU). We aimed to report on the initial experience and
safety of a structured protocol for inotropic therapy in non-intensive care
units in 28 consecutive patients hospitalized with HF that were discharged from
ICU. The utilization of low to moderate inotropic doses oriented by a
safety-focused process of care may reconfigure their role as a transition
therapy while awaiting definitive advanced therapies and enable early ICU
discharge.
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Affiliation(s)
| | - Nadine Clausell
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil
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Cardoso PC, Gussatschenko Caballero L, Brasil Ruschel K, Pereira de Moraes MA, Rabelo da Silva ER. Profile of the nursing diagnoses in stable heart disease patients. Invest Educ Enferm 2019; 37:e08. [PMID: 31487445 PMCID: PMC7871490 DOI: 10.17533/udea.iee.v37n2e08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 06/04/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To identify the nursing diagnoses through reports in the medical records of patients monitored in a specialized ischemic heart disease outpatient clinic. METHODS Cross-sectional study with retrospective data collection in the medical records. From the data collected, the nursing diagnoses were proposed by the researchers and submitted for validation by specialist cardiology nurses. RESULTS A total of 13 nursing diagnoses were evaluated from the medical records of 50 outpatients with the following validation agreements among the specialists: Ineffective health management (100%), Noncompliance (100%), Sedentary lifestyle (100%), Activity intolerance (100%), Decreased cardiac output (88%), Risk of decreased cardiac tissue perfusion (65%), Risk of intolerance to activity (65%), Acute pain (76%), Ineffective health maintenance (65%), Risk-prone health behavior (65%), Risk for decreased cardiac output (65%), Risk for intolerance to activity (65%), Ineffective respiratory pattern (53%), Impaired memory (29%). CONCLUSIONS In this study, the nursing diagnoses validated for stable heart disease patients were linked to adherence to treatment and to the cardiovascular responses of the patients, reinforcing the importance of early intervention. These results allow the multidisciplinary team to individualize the goals and interventions proposed for ischemic heart disease patients.
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Affiliation(s)
| | | | - Karen Brasil Ruschel
- Institute for Health Technology Assessment, Federal University of Rio Grande do Sul, Brazil,
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Rohde LEP, Montera MW, Bocchi EA, Clausell NO, Albuquerque DCD, Rassi S, Colafranceschi AS, Freitas AFD, Ferraz AS, Biolo A, Barretto ACP, Ribeiro ALP, Polanczyk CA, Gualandro DM, Almeida DR, Silva ERRD, Figueiredo EL, Mesquita ET, Marcondes-Braga FG, Cruz FDDD, Ramires FJA, Atik FA, Bacal F, Souza GEC, Almeida GLGD, Ribeiro GCDA, Villacorta H, Vieira JL, Souza JDD, Rossi JM, Figueiredo JAD, Moura LAZ, Goldraich LA, Beck-da-Silva L, Danzmann LC, Canesin MF, Bittencourt MI, Garcia MI, Bonatto MG, Simões MV, Moreira MDCV, Silva MMFD, Olivera MTD, Silvestre OM, Schwartzmann PV, Bestetti RB, Rocha RM, Simões R, Pereira SB, Mangini S, Alves SMM, Ferreira SMA, Issa VS, Barzilai VS, Martins WDA. Diretriz Brasileira de Insuficiência Cardíaca Crônica e Aguda. Arq Bras Cardiol 2019; 111:436-539. [PMID: 30379264 DOI: 10.5935/abc.20180190] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Luis Eduardo Paim Rohde
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil.,Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | | | - Edimar Alcides Bocchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | | | | | | | | | | | - Andreia Biolo
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Antonio C. Pereira Barretto
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Carisi Anne Polanczyk
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil.,Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | - Danielle Menosi Gualandro
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | | | - Estêvão Lanna Figueiredo
- Hospital Lifecenter, Belo Horizonte, MG - Brasil.,Hospital Vera Cruz, Belo Horizonte, MG - Brasil
| | | | - Fabiana G. Marcondes-Braga
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Fátima das Dores da Cruz
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Felix José Alvarez Ramires
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Fernando Bacal
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Germano Emilio Conceição Souza
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.,Hospital Regional de São José dos Campos, São José dos Campos, SP - Brasil
| | | | | | | | | | - João David de Souza
- Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE - Brasil
| | | | | | | | | | - Luis Beck-da-Silva
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Luiz Claudio Danzmann
- Universidade Luterana do Brasil, Canoas, RS - Brasil.,Hospital da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | | | | | | | | | - Marcus Vinícius Simões
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP - Brasil
| | - Maria da Consolação Vieira Moreira
- Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brasil.,Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG - Brasil
| | | | - Mucio Tavares de Olivera
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Pedro Vellosa Schwartzmann
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP - Brasil.,Hospital Unimed Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | | | | | - Ricardo Simões
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
| | | | - Sandrigo Mangini
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | | | - Silvia Moreira Ayub Ferreira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Victor Sarli Issa
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Wolney de Andrade Martins
- Universidade Federal Fluminense, Niterói, RJ - Brasil.,Complexo Hospitalar de Niterói, Niterói, RJ - Brasil
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