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1.
Glenna Schluck Wei Wu James Whyte Laurie Abbott 《Heart & lung : the journal of critical care》2018,47(5):458-464
Background
Emergency room utilization and hospital readmission rates are disproportionately high for heart failure patients (HF). Emergency department (ED) utilization is intimately intertwined with hospital readmissions.Objective
Describe the arrival time distribution of HF patients presenting to the ED.Method
The study analyzed heart failure discharge data from the Florida State Emergency Department Database and the Florida State Inpatient Database from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. Data were treated as a Poisson process and analyzed using functional data analysis tools.Results
HF arrivals are multi-modal with the largest peak arrival time in the middle of the day as well as a smaller peak in the early morning hours, especially in rural areas.Conclusions
The arrival pattern has minor differences in rural and urban areas. HF clinic appointments should be established in the early morning hours when these patients utilize the ED. 相似文献2.
Ana C. Alba Stephen D. Walter Gordon H. Guyatt Wayne C. Levy Jiming Fang Heather J. Ross Douglas S. Lee 《Journal of cardiac failure》2018,24(11):735-745
Background
Prognostic evaluation in heart failure (HF) is important to predict future events and decide timely management. Many HF patients are treated with the use of an implantable cardioverter-defibrillator (ICD). This study aimed to validate a meta-analytically derived prognostic score to predict survival in ICD-HF patients.Methods and Results
The HF Meta-score includes 14 independent mortality predictors identified in a meta-analysis, including age, sex, ethnicity, diabetes, chronic obstructive pulmonary disease, peripheral vascular disease, atrial fibrillation, ischemic cardiomyopathy, history of HF admission, New York Heart Association functional class, left ventricular ejection fraction, renal function, QRS duration, secondary prevention indication, and ICD shocks. The HF Meta-score performance was evaluated in comparison with the Seattle Heart Failure Model (SHFM) and the SHOCKED predictors in a cohort of 9860 ambulatory ICD patients from the Ontario provincial database for 2007–2011. During 3-year follow-up, 1816 patients died. The HF Meta-score showed excellent calibration, very good discrimination (c-statistic 0.74) and enhanced risk classification compared with the SHOCKED predictors, with better reclassifying in 19% and 56% of patients for 1- and 3-year survival, respectively. HF Meta-score performance was similar to the SHFM.Conclusions
The HF Meta-score is an evidence-based derived model that provides an accurate prognosis assessment in HF patients with ICDs. Its development strategy permits further incorporation of new predictors when evidence becomes available. 相似文献3.
4.
Khadijah Breathett Scott Maffett Randi E. Foraker Rod Sturdivant Kristina Moon Ayesha Hasan Veronica Franco Sakima Smith Brent C. Lampert Sitaramesh Emani Garrie Haas Rami Kahwash Ray E. Hershberger Philip F. Binkley Laura Helmkamp Kathryn Colborn Pamela N. Peterson Nancy Sweitzer William T. Abraham 《The American journal of medicine》2018,131(8):974-978
Background
Heart failure education programs are not standardized. The best form of education is unclear. We evaluated whether addition of a novel tablet application to nurse practitioner (NP) education was superior to NP education alone in reducing 30-day readmission after heart failure hospitalization.Methods
From February 2015-March 2016, patients admitted to a quaternary academic center with primary diagnosis of heart failure were randomized to 1) treatment – NP education plus tablet application (interactive conditional logic program that flags patient questions to medical staff), or 2) control – NP education. The primary outcome was reduction in 30-day readmission rate. Secondary outcomes included satisfaction and education assessed via survey.Results
Randomization included 60 patients to treatment and 66 to control. A total of 13 patients withdrew prior to intervention (treatment n = 4, control n = 1) or were lost to follow-up (treatment n = 3, control n = 5). The 30-day readmission rate trended lower for treatment compared with control, but results were not statistically significant (13.2% [7/53], 26.7% [16/60], respectively, P = .08). Similarly, satisfaction trended higher with treatment than control (P = .08). Treatment patients rated explanations from their physicians higher than control (Always: 83.7%, 55.8%, respectively, P = .01).Conclusions
NP education plus tablet use was not associated with significantly lower 30-day readmission rates in comparison with NP alone, but a positive trend was seen. Patient satisfaction trended higher and heart failure explanations were better with NP education plus tablet. A larger study is needed to determine if NP education plus tablet reduces readmission rates following heart failure admission. 相似文献5.
Ubolrat Piamjariyakul Noreen C. Thompson Christy Russell Carol E. Smith 《Heart & lung : the journal of critical care》2018,47(3):211-215
Background
African Americans with heart failure (HF) have the highest rates of depression among all ethnicities in the USA.Objectives
To compare the effects by race on depressive symptoms and topics discussed in the first clinic appointment after HF hospitalization.Methods
This study is a secondary analysis of data from a randomized clinical trial testing a patient group discussion of HF self-management with 93 Caucasians and 77 African Americans.Results
Reduction in depressive symptoms was significantly greater among African American patients within the intervention group (F = 3.99, p = .047) than controls. There were significant differences by race in four topics (dietitian referral, appointment date, help preparing discussion questions, and advice on worsening HF symptoms) concerning patient-physician discussions.Conclusion
The intervention showed greater effect in reducing depressive symptoms among African Americans than Caucasians. Preparing patients for discussions at physician appointments on diet, depressive symptoms, and HF symptoms is recommended. 相似文献6.
Wenjia Guo Tingting Lv Fei She Guobin Miao Yuanwei Liu Rong He Yajun Xue Nang Kham Nu Jing Yang Kun Li Ping Zhang 《Heart & lung : the journal of critical care》2018,47(5):516-524
Background
Heart rate variability (HRV), modulated by cardiac autonomic function, is impaired in obstructive sleep apnea (OSA). However, the effect of continuous positive airway pressure (CPAP) on HRV is debated.Objectives
To investigate the associations between CPAP and HRV in OSA.Methods
Based on literature from five databases published through August 2017, we performed a meta-analysis of cohort studies of OSA treated with CPAP. The change of low-frequency band (LF), high-frequency band (HF) and the ratio between LF and HF (LHR) were analyzed.Results
Eleven studies were included. Decreased LF (SMD = ?0.32, 95%CI: ?0.62,?0.01; P = 0.043) and HF (SMD = ?0.51, 95%CI: ?0.95, ?0.08, P = 0.020) were shown while measured on CPAP. When measured off CPAP, HF was increased remarkably (SMD: 0.31, 95%CI: 0.02, 0.60, P = 0.034).Conclusions
CPAP can improve autonomic activity, which might be one mechanism to reduce the risk of cardiovascular diseases in OSA. 相似文献7.
Daniel Rosen Janice D. McCall Brian A. Primack 《The American journal of medicine》2017,130(11):1326-1330
Background
Congestive heart failure is the leading cause of hospital readmissions. We aimed to assess adherence to and effectiveness of a telehealth protocol designed to prevent hospital admissions for congestive heart failure.Methods
We recruited a random sample of 50 patients with congestive heart failure (mean age 61 years) from a managed care organization. We developed a telehealth platform allowing for daily, real-time reporting of health status and video conferencing. We defined adherence as the percentage of days on which the patient completed the daily check-in protocol. To assess efficacy, we compared admission and readmission rates between the 6-month intervention period and the prior 6 months. Primary outcomes were admissions and readmissions due to congestive heart failure, and secondary outcomes were admissions and readmissions due to any cause.Results
Forty-eight patients (96%) completed the protocol. Approximately half (46%) were at high risk for readmission according to standardized measures. Median 120-day adherence was 96% (interquartile range, 92%-98%), and adherence did not significantly differ across sex, race, age, living situation, depression, cognitive ability, or risk for readmission. Approximately equal proportions of patients were admitted for all causes during the 6-month intervention period versus the comparison period (37% vs 43%; P = .32). Half as many patients were admitted for congestive heart failure during the 6-month intervention period compared with the comparison period (12% vs 25%; P = .11).Conclusion
Adherence to this telehealth protocol was excellent and consistent, even among high-risk patients. Future research should test the protocol using a more rigorous randomized design. 相似文献8.
9.
Quin E. Denfeld James O. Mudd Wohaib Hasan Jill M. Gelow Shirin O. Hiatt Kerri Winters-Stone Christopher S. Lee 《Heart & lung : the journal of critical care》2018,47(4):281-284
Background
The relationship between physical heart failure (HF) symptoms and pathophysiological mechanisms is unclear.Objective
To quantify the relationship between plasma β-adrenergic receptor kinase-1 (βARK1) and physical symptoms among adults with HF.Methods
We performed a secondary analysis of data collected from two studies of adults with HF. Plasma βARK1 was quantified using an enzyme-linked immunosorbent assay. Physical symptoms were measured with the HF Somatic Perception Scale (HFSPS). Generalized linear modeling was used to quantify the relationship between βARK1 and HFSPS scores.Results
The average age (n = 94) was 54.5 ± 13.1 years, 76.6% were male, and a majority (83.0%) had Class III or IV HF. βARK1 was significantly associated with HFSPS scores (β = 0.22 ± 0.10, p = 0.038), adjusting for other predictors of physical symptoms (model R2 = 0.250, F(7, 70) = 3.34, p = 0.004).Conclusions
Higher βARK1 is associated with worse physical HF symptoms, pinpointing a potential pathophysiologic underpinning. 相似文献10.
Oronzo Chialà Ercole Vellone Leonie Klompstra Giorgio Alberto Ortali Anna Strömberg Tiny Jaarsma 《Heart & lung : the journal of critical care》2018,47(5):465-470
Background
Symptoms of anxiety, depression, and cognitive impairment are common in heart failure (HF) patients, but there are inconsistencies in the literature regarding their relationship and effects on exercise capacity.Objectives
The aim of this study was to explore the relationships between exercise capacity and anxiety, depression, and cognition in HF patients.Methods
This was a secondary analysis on the baseline data of the Italian subsample (n = 96) of HF patients enrolled in the HF-Wii study. Data was collected with the 6-minute walk test (6MWT), Hospital Anxiety and Depression Scale, and Montreal Cognitive Assessment.Results
The HF patients walked an average of 222 (SD 114) meters on the 6MWT. Patients exhibited clinically elevated anxiety (48%), depression (49%), and severe cognitive impairment (48%). Depression was independently associated with the distance walked on the 6MWT.Conclusions
The results of this study reinforced the role of depression in relation to exercise capacity and call for considering strategies to reduce depressive symptoms to improve outcomes of HF patients. 相似文献11.
Benjamin Laliberte Brent N. Reed Sandeep Devabhakthuni Kristin Watson Vijay Ivaturi Tao Liu Stephen S. Gottlieb 《Journal of cardiac failure》2017,23(10):746-752
Background
Heart failure (HF) is associated with high 30-day readmission rates and places significant financial burden on the health care system. The aim of this study was to determine if the duration of observation on an oral loop diuretic before discharge is associated with a reduction in 30-day HF readmission in patients with acute decompensated HF (ADHF).Methods and Results
This was a retrospective study of adult patients admitted for ADHF at a large academic medical center. A total of 123 patients were included. Baseline characteristics were similar between groups. The primary outcome of 30-day HF readmission occurred in 11 of 61 patients (18%) observed on an oral loop diuretic for <24 hours and in 2 of 62 patients (3.2%) observed on an oral loop diuretic for ≥24 hours (P?=?.023). Readmissions for 60- and 90-day HF were also significantly lower in patients observed for ≥24 hours (P?=?.014 and P?=?.049, respectively). Associations became stronger after multivariate analysis (P?<?.001). Observation for <24 hours and previous admission within 30 days were independent predictors of 30-day HF readmission (P?=?.03).Conclusions
Observation of patients on an oral loop diuretic for <24 hours was associated with significantly higher 30-day HF readmission. Therefore, observation on an oral loop diuretic for ≥24 hours before discharge in patients presenting with ADHF should be strongly considered. 相似文献12.
Kelly D. Stamp Marilyn Prasun Christopher S. Lee Tiny Jaarsma Mariann R. Piano Nancy M. Albert 《Heart & lung : the journal of critical care》2018,47(2):169-175
Background
Heart Failure (HF) is a public health problem globally affecting approximately 6 million in the United States.Objectives
A tailored position statement was developed by the American Association of Heart Failure Nurses (AAHFN) and their Research Consortium to assist researchers, funding institutions and policymakers with improving HF clinical advancements and outcomes.Methods
A comprehensive review was conducted using multiple search terms in various combinations to describe gaps in HF nursing science. Based on gaps described in the literature, the AAHFN made recommendations for future areas of research in HF.Results
Nursing has made positive contributions through disease management interventions, however, quality, rigorous research is needed to improve the lives of patients and families while advancing nursing science.Conclusions
Advancing HF science is critical to managing and improving patient outcomes while promoting the nursing profession. Based on this review, the AAHFN is putting forth a call to action for research designs that promote validity, sustainability, and funding of future nursing research. 相似文献13.
Dima Saab Rosane Nisenbaum Irfan Dhalla Stephen W. Hwang 《Journal of general internal medicine》2016,31(9):1011-1018
BACKGROUND
Hospital readmission rates are a widely used quality indicator that may be elevated in disadvantaged populations.OBJECTIVE
The objective of this study was to compare the hospital readmission rate among individuals experiencing homelessness with that of a low-income matched control group, and to identify risk factors associated with readmission within the group experiencing homelessness.DESIGN
We conducted a 1:1 matched cohort study comparing 30-day hospital readmission rates between homeless patients and low-income controls matched on age, sex and primary reason for admission. Multivariate analyses using generalized estimating equations were used to assess risk factors associated with 30-day readmission in the homeless cohort.PARTICIPANTS
This study examined a cohort of 1,165 homeless adults recruited at homeless shelters and meal programs in Toronto, Ontario, between 6 December 2004 and 20 December 2005.MAIN MEASURES
The primary outcome was the occurrence of an unplanned medical or surgical readmission within 30 days of discharge from hospital.KEY RESULTS
Between 6 December 2004 and 31 March 2009, homeless participants (N?=?203) had 478 hospitalizations and a 30-day readmission rate of 22.2 %, compared to 300 hospitalizations and a readmission rate of 7.0 % among matched controls (OR?=?3.79, 95 % CI 1.93-7.39). In the homeless cohort, having a primary care physician (OR?=?2.65, 95 % CI 1.05-6.73) and leaving against medical advice (OR?=?1.96, 95 % CI 0.99-3.86) were associated with an increased risk of 30-day readmission.CONCLUSIONS
Homeless patients had nearly four times the odds of being readmitted within 30-days as compared to low-income controls matched on age, sex and primary reason for admission to hospital. Further research is needed to evaluate interventions to reduce readmissions among this patient population.14.
Jonathan D. Davis Margaret A. Olsen Kerry Bommarito Shane J. LaRue Mohammed Saeed Michael W. Rich Justin M. Vader 《The American journal of medicine》2017,130(1):93.e9-93.e28
Background
Thirty-day readmission following heart failure hospitalization impacts hospital performance measures and reimbursement. We investigated readmission characteristics and the magnitude of 30-day hospital readmissions after hospital discharge for heart failure using the Healthcare Cost and Utilization Project State Inpatient Databases (SID).Methods
Adults aged ≥ 40 years hospitalized with a primary discharge diagnosis of heart failure from 2007-2011 were identified in the California, New York, and Florida SIDs. Characteristics of patients with and without 7-, 8 to 30-, and 30-day readmission, and primary readmission diagnoses and risk factors for readmission were examined.Results
We identified 547,068 patients with mean age 74.7 years; 50.7% were female, and 65.4% were White. Of 117,123 patients (21.4%) readmitted within 30 days (median 12 days), 69.7% had a non-heart failure primary readmission diagnosis. Patients with 30-day readmissions more frequently had a history of previous admission with heart failure as a secondary diagnosis, fluid and electrolyte disorders, and chronic deficiency anemia. There were no significant clinical differences at baseline between those patients whose first readmission was in the first 7 days after discharge vs in the next 23 days. The most common primary diagnoses for 30-day non-heart failure readmissions were other cardiovascular conditions (14.9%), pulmonary disease (8.5%), and infections (7.7%).Conclusions
In this large all-payer cohort, ～70% of 30-day readmissions were for non-heart failure causes, and the median time to readmission was 12 days. Future interventions to reduce readmissions should focus on common comorbid conditions that contribute to readmission burden. 相似文献15.
Recurrent hospitalizations for severe hypoglycemia and hyperglycemia among U.S. adults with diabetes
Rozalina G. McCoy Jeph Herrin Kasia J. Lipska Nilay D. Shah 《Journal of diabetes and its complications》2018,32(7):693-701
Aims
Examine 30-day readmissions for recurrent hypoglycemia and hyperglycemia in a national cohort of adults with diabetes.Methods
Retrospective analysis of data from OptumLabs Data Warehouse for all adults with diabetes hospitalized January 1, 2009 to December 31, 2014 with a principal diagnosis of hypoglycemia or hyperglycemia. We examined the rates and risk factors of 30-day readmissions for hypoglycemia and hyperglycemia.Results
After 6419 index hypoglycemia hospitalizations, 1.2% were readmitted for recurrent hypoglycemia, 0.2% for hyperglycemia, and 8.6% for other causes. Multimorbidity was the strongest predictor of recurrent hypoglycemia. After 6872 index hyperglycemia hospitalizations, 4.0% were readmitted for recurrent hyperglycemia, 0.4% for hypoglycemia, and 5.4% for other causes. Recurrent hyperglycemia was less likely in older patients (OR 0.6, 95% CI 0.5–0.9 for 45–64 vs. <45?years) and with the addition of a new glucose-lowering medication at index discharge (OR 0.40; 95% CI 0.2–0.7). New hypoglycemia readmissions were most likely among patients ≥75?years (OR 13.3, 95% CI 2.4–73.4, vs. <45?years).Conclusions
Patients hospitalized for hyperglycemia are often readmitted for recurrent hyperglycemia, while patients hospitalized for hypoglycemia are generally readmitted for unrelated causes. Early recognition of high risk patients may identify opportunities to improve post-discharge management and reduce these events. 相似文献16.
Roy Xiao Jacob A. Miller William J. Zafirau Eiran Z. Gorodeski James B. Young 《The American journal of medicine》2018,131(4):395-407.e35
Background
As healthcare costs rise, home health care represents an opportunity to reduce preventable adverse events and costs following hospital discharge. No studies have investigated the utility of home health care within the context of a large and diverse patient population.Methods
A retrospective cohort study was conducted between 1/1/2013 and 6/30/2015 at a single tertiary care institution to assess healthcare utilization after discharge with home health care. Control patients discharged with “self-care” were matched by propensity score to home health care patients. The primary outcome was total healthcare costs in the 365-day post-discharge period. Secondary outcomes included follow-up readmission and death. Multivariable linear and Cox proportional hazards regression were used to adjust for covariates.Results
Among 64,541 total patients, 11,266 controls were matched to 6,363 home health care patients across 11 disease-based Institutes. During the 365-day post-discharge period, home health care was associated with a mean unadjusted savings of $15,233 per patient, or $6,433 after adjusting for covariates (p?<?0.0001). Home health care independently decreased the hazard of follow-up readmission (HR 0.82, p?<?0.0001) and death (HR 0.80, p?<?0.0001). Subgroup analyses revealed that home health care most benefited patients discharged from the Digestive Disease (death HR 0.72, p?<?0.01), Heart & Vascular (adjusted savings of $11,453, p?<?0.0001), Medicine (readmission HR 0.71, p?<?0.0001), and Neurological (readmission HR 0.67, p?<?0.0001) Institutes.Conclusions
Discharge with home health care was associated with significant reduction in healthcare utilization and decreased hazard of readmission and death. These data inform development of value-based care plans. 相似文献17.
Nancy M. Albert James F. Bena Denise Buxbaum Linda Martensen Shannon L. Morrison Marilyn A. Prasun Kelly D. Stamp 《Heart & lung : the journal of critical care》2018,47(3):184-191
Background
Research findings on the value of nurse certification were based on subjective perceptions or biased by correlations of certification status and global clinical factors. In heart failure, the value of certification is unknown.Objectives
Examine the value of certification based nurses' decision-making.Methods
Cross-sectional study of nurses who completed heart failure clinical vignettes that reflected decision-making in clinical heart failure scenarios. Statistical tests included multivariable linear, logistic and proportional odds logistic regression models.Results
Of nurses (N = 605), 29.1% were heart failure certified, 35.0% were certified in another specialty/job role and 35.9% were not certified. In multivariable modeling, nurses certified in heart failure (versus not heart failure certified) had higher clinical vignette scores (p = 0.002), reflecting higher evidence-based decision making; nurses with another specialty/role certification (versus no certification) did not (p = 0.62).Conclusions
Heart failure certification, but not in other specialty/job roles was associated with decisions that reflected delivery of high-quality care. 相似文献18.
Federica Dellafiore Harleah G. Buck Gianluca Pucciarelli Claudio Barbaranelli Marco Paturzo Rosaria Alvaro Ercole Vellone 《Heart & lung : the journal of critical care》2018,47(6):553-561
Background
Higher patient-caregiver mutuality is associated with improved patient and caregiver outcomes, but no studies have tested the psychometric characteristics of the mutuality scale (MS) in heart failure (HF) patient and caregiver population.Objectives
To test the validity and reliability of the MS.Methods
A cross-sectional design. The MS validity and reliability were tested with confirmatory factor analysis (CFA) and hypothesis testing, and with Cronbach's alpha and model-based internal consistency index, respectively.Results
CFA supported the validity of the MS in the HF patient and caregiver versions. Hypothesis testing showed significant correlations between both versions of the MS and anxiety, depression, quality of life, and self-care. Also, MS caregiver version scores correlated significantly with caregiver preparedness. Cronbach's alphas and the model-based internal consistency index ranged between 0.72 and 0.94 in both versions.Conclusions
The Mutuality Scale showed supportive validity and reliability for HF patients and caregivers. 相似文献19.
Barbara Riegel Victoria Vaughan Dickson Christopher S. Lee Marguerite Daus Julia Hill Elliane Irani Solim Lee Joyce W. Wald Stephen T. Moelter Lisa Rathman Megan Streur Foster Osei Baah Linda Ruppert Daniel R. Schwartz Alfred Bove 《Heart & lung : the journal of critical care》2018,47(2):107-114
Background
Early heart failure (HF) symptoms are frequently unrecognized for reasons that are unclear. We explored symptom perception in patients with chronic HF.Methods
We enrolled 36 HF out-patients into a longitudinal sequential explanatory mixed methods study. We used objectively measured thoracic fluid accumulation and daily reports of signs and symptoms to evaluate accuracy of detected changes in fluid retention. Patterns of symptom interpretation and response were explored in telephone interviews conducted every 2 weeks for 3-months.Results
In this sample, 44% had a mismatch between objective and subjective fluid retention; younger persons were more likely to have mismatch. In interviews, two patterns were identified: those able to interpret and respond appropriately to symptoms were higher in decision-making skill and the quality of social support received.Conclusion
Many HF patients were poor at interpreting and managing their symptoms. These results suggest a subgroup of patients to target for intervention. 相似文献20.
Pulmonary Congestion by Lung Ultrasound in Ambulatory Patients With Heart Failure With Reduced or Preserved Ejection Fraction and Hypertension 总被引：1，自引：0，他引：1
Kristin H. Dwyer Allison A. Merz Eldrin F. Lewis Brian L. Claggett Daniela R. Crousillat Emily S. Lau Montane B. Silverman Julie Peck Jose Rivero Susan Cheng Elke Platz 《Journal of cardiac failure》2018,24(4):219-226