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Alenazy B, Tharkar S, Kashour T, Alhabib KF, Alfaleh H, Hersi A. In-hospital ventricular arrhythmia in heart failure patients: 7 year follow-up of the multi-centric HEARTS registry. ESC Heart Fail 2019; 6:1283-1290. [PMID: 31750631 PMCID: PMC6989287 DOI: 10.1002/ehf2.12525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 08/20/2019] [Accepted: 09/06/2019] [Indexed: 02/06/2023] Open
Abstract
Aims The aim of this study was to determine the incidence, predictors, and short‐term and long‐term outcomes associated with in‐hospital sustained ventricular tachycardia (VT) and ventricular fibrillation (VF) collectively termed ventricular arrhythmia (VA) in the heart failure (HF) patients. Methods and results The HEart function Assessment Registry Trial in Saudi Arabia (HEARTS registry) is a prospective national registry of patients with chronic HF from18 tertiary care hospitals across Saudi Arabia. Diagnosis of HF was in accordance with American Heart Association/European Society of Cardiology definition criteria. The registry had enrolled 2610 HF patients during the 14 month recruitment period between October 2009 and December 2010. Occurrence of in‐hospital cardiac events, prognosis, and outcome were monitored during the 7 year follow‐up period. The incidence of in‐hospital VA in HF was 4.2%. VA was more common among men, and mean age was lesser than non‐VA patients (58.5 ± 16: 61.5 ± 15 years; P = 0.042). Smoking and family history of cardiomyopathy were significant risk factors of VA. Previous history of arrhythmia, ST elevated myocardial infarction, infections, and hypotension remained significant predictors of in‐hospital VA associated with three to seven times more risk. Patients with VA had higher rates of in‐hospital events like recurrent HF, haemodialysis, shock, sepsis, major bleeding, intra‐aortic balloon pump, and stroke compared with those without VA, all being highly significant (P < 0.001). After adjustment for age, gender, and co‐morbidities, in‐hospital VA increased the risk of cardiogenic shock by 24 times, dialysis and major bleeding by 10 times, and recurrent congestive HF and pacing by five times. Survival analysis showed that all‐cause mortality was significantly higher in the VA patients (P < 0.001). Presence of VA increased in‐hospital and 1 month mortality to 23 and 17 times, respectively. Conclusions Lower mean age of VA complicated HF patients is a matter of concern in the Saudi population. HF associated with VA increased in‐hospital events and all‐cause mortality indicating poor prognosis and survival. These findings enable risk stratification and reflect on the importance of early recognition of the clinical markers and predictors of VA prompting immediate management.
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Affiliation(s)
- Basel Alenazy
- King Fahad Cardiac Center, King Khalid University Hospital, College of Medicine, King Saud University, PO Box 7805, Riyadh, 11472, Saudi Arabia
| | - Shabana Tharkar
- Prince Sattam Chair for Epidemiology and Public Health Research, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Tarek Kashour
- King Fahad Cardiac Center, King Khalid University Hospital, College of Medicine, King Saud University, PO Box 7805, Riyadh, 11472, Saudi Arabia
| | - Khalid Faiz Alhabib
- King Fahad Cardiac Center, King Khalid University Hospital, College of Medicine, King Saud University, PO Box 7805, Riyadh, 11472, Saudi Arabia
| | - Hussam Alfaleh
- King Fahad Cardiac Center, King Khalid University Hospital, College of Medicine, King Saud University, PO Box 7805, Riyadh, 11472, Saudi Arabia
| | - Ahmad Hersi
- King Fahad Cardiac Center, King Khalid University Hospital, College of Medicine, King Saud University, PO Box 7805, Riyadh, 11472, Saudi Arabia
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Spatial remodelling of calcium release units may impair cardiac electro-mechanical function: A simulation study. Comput Biol Med 2019; 108:234-241. [DOI: 10.1016/j.compbiomed.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 11/17/2022]
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3
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Patel S, Veltri K. New Novel Treatment Approaches for Heart Failure With Reduced Ejection Fraction. J Pharm Pract 2017; 30:541-548. [DOI: 10.1177/0897190016649123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite availability of standardized drug therapies with proven beneficial outcomes, heart failure is associated with poor quality of life, increased hospital readmission, and high mortality rate. In the recent years, comprehensive understanding of the pathophysiological mechanisms of heart failure has led to the development and approval of 2 new pharmacological agents, sacubitril–valsartan and ivabradine. These agents are currently approved for use in heart failure with reduced ejection fraction (HFrEF) and present as novel approaches to further improve prognosis and outcomes in patients with HF. They offer alternative treatment options for patients who are intolerant or continue to be symptomatic despite utilization of standard HF drug therapies at optimally tolerated dosages. A review of these 2 novel agents in HFrEF, including information on pivotal trials that led to its approval and its place in therapy for HFrEF, is presented.
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Affiliation(s)
- Shreya Patel
- Pharmacy Practice, Touro College of Pharmacy, New York, NY, USA
| | - Keith Veltri
- Pharmacy Practice, Touro College of Pharmacy, New York, NY, USA
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4
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Affiliation(s)
- Paul J Hauptman
- Division of Cardiology, Department of Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
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5
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Moon C, Phelan CH, Lauver DR, Bratzke LC. Is sleep quality related to cognition in individuals with heart failure? Heart Lung 2015; 44:212-8. [PMID: 25796476 DOI: 10.1016/j.hrtlng.2015.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 01/30/2015] [Accepted: 02/08/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine how self-reported sleep quality and daytime symptoms are associated with selected domains of cognitive function among individuals with heart failure (HF). BACKGROUND HF patients suffer from poor sleep quality and cognitive decline. The relationship between sleep and cognition has not been well documented among individuals with HF. METHODS In this descriptive, cross-sectional study, 68 individuals with HF (male: 63%, mean age = 72 years, SD = 11) completed sleep questionnaires and a neuropsychological battery. RESULTS Participant had mean Pittsburgh Sleep Quality Index score of 5.04 (SD = 2.8). Regression analyses demonstrated neither sleep quality or excessive daytime sleepiness (EDS) were related to cognitive function, but daytime dysfunction was related to lower letter fluency and attention index. CONCLUSION Contrary to some earlier reports, subjective sleep and EDS in this group of individuals was not associated with cognitive decline.
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Affiliation(s)
- Chooza Moon
- University of Wisconsin-Madison, School of Nursing, 701 Highland Avenue, Madison, WI 53705, USA.
| | - Cynthia H Phelan
- University of Wisconsin-Madison, School of Nursing, 701 Highland Avenue, Madison, WI 53705, USA; William S. Middleton Memorial Veterans Hospital Geriatrics Research, Education and Clinical Center (GRECC), 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Diane R Lauver
- University of Wisconsin-Madison, School of Nursing, 701 Highland Avenue, Madison, WI 53705, USA
| | - Lisa C Bratzke
- University of Wisconsin-Madison, School of Nursing, 701 Highland Avenue, Madison, WI 53705, USA
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6
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Myles RC, Wang L, Bers DM, Ripplinger CM. Decreased inward rectifying K+ current and increased ryanodine receptor sensitivity synergistically contribute to sustained focal arrhythmia in the intact rabbit heart. J Physiol 2014; 593:1479-93. [PMID: 25772297 DOI: 10.1113/jphysiol.2014.279638] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 08/27/2014] [Accepted: 08/30/2014] [Indexed: 01/18/2023] Open
Abstract
KEY POINTS Heart failure leads to dramatic electrophysiological remodelling as a result of numerous cellular and tissue-level changes. Important cellular changes include increased sensitivity of ryanodine receptors (RyRs) to Ca(2+) release and down-regulation of the inward rectifying K(+) current (IK1), both of which contribute to triggered action potentials in isolated cells. We studied the role of increased RyR sensitivity and decreased IK1 in contributing to focal arrhythmia in the intact non-failing rabbit heart using optical mapping and pharmacological manipulation of RyRs and IK1. Neither increased RyR sensitivity or decreased IK1 alone led to significant increases in arrhythmia following local sympathetic stimulation; however, in combination, these two factors led to a significant increase in premature ventricular complexes and focal ventricular tachycardia. These results suggest synergism between increased RyR sensitivity and decreased IK1 in contributing to focal arrhythmia in the intact heart and may provide important insights into novel anti-arrhythmic treatments in heart failure. ABSTRACT Heart failure (HF) results in dramatic electrophysiological remodelling, including increased sensitivity of ryanodine receptors (RyRs) and decreased inward rectifying K(+) current (IK1), which predisposes HF myocytes to delayed afterdepolarizations and triggered activity. Therefore, we sought to determine the role of increased RyR sensitivity and decreased IK1 in contributing to focal arrhythmia in the intact non-failing heart. Optical mapping of transmembrane potential and intracellular Ca(2+) was performed in Langendorff-perfused rabbit hearts (n = 15). Local β-adrenergic receptor stimulation with noradrenaline (norepinephrine; NA, 50 μl, 250 μM) was applied to elicit focal activity (premature ventricular complexes (PVCs) or ventricular tachycardia (VT ≥ 3 beats)). NA was administered under control conditions (CTL) and following pretreatment with 50 μM BaCl2 to reduce IK1, or 200 μM caffeine (Caff) to sensitize RyRs, both alone and in combination. Local NA injection resulted in Ca(2+)-driven PVCs arising from the injection site in all hearts studied. No increase in NA-mediated PVCs was observed following pretreatment with either BaCl2 or Caff alone (CTL: 1.1 ± 0.7, BaCl2: 1.0 ± 0.7, Caff: 1.3 ± 0.8 PVCs/injection, P not significant). However, pretreatment with the combination of BaCl2 + Caff resulted in a significant increase in PVCs (2.3 ± 2.8 PVCs/injection, P < 0.05 vs. CTL, BaCl2, Caff). Additionally, pretreatment with BaCl2 + Caff led to sustained monomorphic VT arising from the NA application site in all hearts studied, which lasted up to 6 min following a single NA injection. VT was never observed under any other condition suggesting synergism between increased RyR sensitivity and decreased IK1 in contributing to focal activity. These findings may have important implications for the understanding and prevention of focal arrhythmia in HF.
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Affiliation(s)
- Rachel C Myles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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The effects of wenxin keli on left ventricular ejection fraction and brain natriuretic Peptide in patients with heart failure: a meta-analysis of randomized controlled trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:242589. [PMID: 24868236 PMCID: PMC4020470 DOI: 10.1155/2014/242589] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 02/21/2014] [Accepted: 03/25/2014] [Indexed: 11/21/2022]
Abstract
Objective. To evaluate the beneficial and adverse effects of Wenxin Keli (WXKL), either alone or in combination with Western medicine, on the left ventricular ejection fraction (LVEF) and plasma brain natriuretic peptide (BNP) in the treatment of heart failure (HF). Methods. Seven major electronic databases were searched to retrieve potential randomized controlled trials (RCTs) designed to evaluate the clinical effectiveness of WXKL, either alone or in combination with Western medicine, for HF, with the LVEF or BNP after eight weeks of treatment as main outcome measures. The methodological quality of the included studies was assessed using criteria from the Cochrane Handbook for Systematic Review of Interventions, Version 5.1.0, and analyzed using RevMan 5.1.0 software. Results. Eleven RCTs of WXKL were included. The methodological quality of the trials was generally evaluated as low. The risk of bias was high. The results of the meta-analysis showed that WXKL, either alone or in combination with Western medicine, was more effective in LVEF and BNP, compared with no medicine or Western medicine alone, in patients with HF or HF complicated by other diseases. Five of the trials reported adverse events, while the others did not mention them, indicating that the safety of WXKL remains uncertain. Conclusions. WXKL, either alone or in combination with Western medicine, appears to be more effective in improving the LVEF and BNP in patients with HF and HF complications.
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8
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Abstract
Today's healthcare delivery system is challenged with an escalating number of heart failure patients who have exhausted medical therapy and overwhelmed the limits of organ transplantation. Scientific and technological advances over the last 20 years have now brought new surgical options to this vast patient population, ranging from ventricular restoration surgery to surgical gene therapy and beyond. This article reviews the myriad of surgical options that are available to these patients, their benefits and shortcomings, as well as potential future directions.
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9
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Cordero A, Bertomeu-Martínez V, Mazón P, Fácila L, Cosín J, Bertomeu-González V, Rodriguez M, Andrés E, Galve E, Lekuona I, González-Juanatey JR. Patients with cardiac disease: Changes observed through last decade in out-patient clinics. World J Cardiol 2013; 5:288-294. [PMID: 24009818 PMCID: PMC3761182 DOI: 10.4330/wjc.v5.i8.288] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/05/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To describe current profile of patients with cardiovascular disease (CVD) and assessing changes through last decade.
METHODS: Comparison of patients with established CVD from two similar cross-sectional registries performed in 1999 (n = 6194) and 2009 (n = 4639). The types of CVD were coronary heart disease (CHD), heart failure (HF) and atrial fibrillation (AF). Patients were collected from outpatient clinics. Investigators were 80% cardiologist and 20% primary care practitioners. Clinical antecedents, major diagnosis, blood test results and medical treatments were collected from all patients.
RESULTS: An increase in all risk factors, except for smoking, was observed; a 54.4% relative increase in BP control was noted. CHD was the most prevalent CVD but HF and AF increased significantly, 41.5% and 33.7%, respectively. A significant reduction in serum lipid levels was observed. The use of statins increased by 141.1% as did all cardiovascular treatments. Moreover, the use of angiotensin-renin system inhibitors in patients with HF, beta-blockers in CHD patients or oral anticoagulants in AF patients increased by 83.0%, 80.3% and 156.0%, respectively (P < 0.01).
CONCLUSION: The prevalence of all cardiovascular risk factors has increased in patients with CVD through last decade. HF and AF have experienced the largest increases.
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Tsai AC. A typology of structural approaches to HIV prevention: a commentary on Roberts and Matthews. Soc Sci Med 2012; 75:1562-7; discussion 1568-71. [PMID: 22877933 PMCID: PMC3443954 DOI: 10.1016/j.socscimed.2012.06.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 06/30/2012] [Indexed: 01/29/2023]
Abstract
Renewed enthusiasm for biomedical HIV prevention strategies has followed the recent publication of several high-profile HIV antiretroviral therapy-based HIV prevention trials. In a recent article, Roberts and Matthews (2012) accurately note some of the shortcomings of these individually targeted approaches to HIV prevention and advocate for increased emphasis on structural interventions that have more fundamental effects on the population distribution of HIV. However, they make some implicit assumptions about the extent to which structural interventions are user-independent and more sustainable than biomedical or behavioral interventions. In this article, I elaborate a simple typology of structural interventions along these two axes and suggest that they may be neither user-independent nor sustainable and therefore subject to the same sustainability concerns, costs, and potential unintended consequences as biomedical and behavioral interventions.
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Affiliation(s)
- Alexander C Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, MA 02114, United States.
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11
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Ståhlberg M, Lund LH, Zabarovskaja S, Gadler F, Braunschweig F, Linde C. Cardiac resynchronization therapy: a breakthrough in heart failure management. J Intern Med 2012; 272:330-43. [PMID: 22882554 DOI: 10.1111/j.1365-2796.2012.02580.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Heart failure is now considered an epidemic. In patients with heart failure, electrical and mechanical dyssynchrony, evident primarily as prolongation of the QRS-complex on the surface electrocardiogram, is associated with detrimental effects on the cardiovascular system at several levels. In the past 10 years, studies have demonstrated that by stimulating both cardiac ventricles simultaneously, or almost simultaneously [cardiac resynchronization therapy (CRT)], the adverse effects of dyssynchrony can be overcome. Here, we provide a comprehensive overview of different aspects of CRT including the rationale behind and evidence for efficacy of the therapy. Issues with regard to gender effects and patient follow-up as well as a number of unresolved concerns will also be discussed.
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Affiliation(s)
- M Ståhlberg
- Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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12
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Simulation of arrhythmogenic effect of rogue RyRs in failing heart by using a coupled model. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2012; 2012:183978. [PMID: 23056145 PMCID: PMC3465912 DOI: 10.1155/2012/183978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 08/22/2012] [Indexed: 01/11/2023]
Abstract
Cardiac cells with heart failure are usually characterized by impairment of Ca2+ handling with smaller SR Ca2+ store and high risk of triggered activities. In this study, we developed a coupled model by integrating the spatiotemporal Ca2+ reaction-diffusion system into the cellular electrophysiological model. With the coupled model, the subcellular Ca2+ dynamics and global cellular electrophysiology could be simultaneously traced. The proposed coupled model was then applied to study the effects of rogue RyRs on Ca2+ cycling and membrane potential in failing heart. The simulation results suggested that, in the presence of rogue RyRs, Ca2+ dynamics is unstable and Ca2+ waves are prone to be initiated spontaneously. These release events would elevate the membrane potential substantially which might induce delayed afterdepolarizations or triggered action potentials. Moreover, the variation of membrane potential depolarization is indicated to be dependent on the distribution density of rogue RyR channels. This study provides a new possible arrhythmogenic mechanism for heart failure from subcellular to cellular level.
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13
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Stein GY, Kremer A, Shochat T, Bental T, Korenfeld R, Abramson E, Ben-Gal T, Sagie A, Fuchs S. The diversity of heart failure in a hospitalized population: the role of age. J Card Fail 2012; 18:645-53. [PMID: 22858081 DOI: 10.1016/j.cardfail.2012.05.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 05/22/2012] [Accepted: 05/24/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The prevalence of heart failure (HF) among hospitalized elderly patients is high and steadily growing. However, because most studies have focused mostly on young patients, little is known about the clinical characteristics, echocardiographic measures, prognostic factors, and outcome of hospitalized elderly HF patients. METHODS AND RESULTS We identified all HF patients aged ≥50 years who had undergone ≥1 echocardiography study and had been hospitalized during January 2000 to December 2009. A comparative analysis was performed between 3,897 "young" patients (aged 50-75 years) and 5,438 "elderly" patients (aged >75 years), followed for a mean 2.8 ± 2.6 years. Elderly HF patients were more often female (50% vs 35%; P < .0001) and had a higher prevalence of HF with preserved ejection fraction (64.8% vs 53%; P < .0001), more significant valvular disease (35.7% vs 32.5%; P < .0001), and lower rates of ischemic heart disease (65.5% vs 70.9%; P < .0001) and diabetes (34.4% vs 53.9%; P < .0001). Thirty-day and 1-year mortality rates were significantly higher among the elderly population (12.2% vs 6.9% [P < .0001] and 34.3% vs 21.2% [P < .0001], respectively). Prognostic markers differed significantly between age groups. Young-specific predictors were chronic renal failure, diastolic dysfunction, malignancy, and tricuspid regurgitation, whereas elderly-specific predictors were HF with reduced ejection fraction, chronic obstructive pulmonary disease, pulmonary hypertension, and mitral regurgitation. CONCLUSIONS Hospitalized elderly, compared with young, HF patients differed in prevalence of cardiac and noncardiac comorbid conditions, echocardiographic parameters, and predictors of short- and intermediate-term mortality. Identifying unique features in the elderly population may render age-tailored therapeutics.
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Affiliation(s)
- Gideon Y Stein
- Department of Internal Medicine B, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
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Dardiotis E, Giamouzis G, Mastrogiannis D, Vogiatzi C, Skoularigis J, Triposkiadis F, Hadjigeorgiou GM. Cognitive impairment in heart failure. Cardiol Res Pract 2012; 2012:595821. [PMID: 22720185 PMCID: PMC3375144 DOI: 10.1155/2012/595821] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 03/31/2012] [Indexed: 01/06/2023] Open
Abstract
Cognitive impairment (CI) is increasingly recognized as a common adverse consequence of heart failure (HF). Although the exact mechanisms remain unclear, microembolism, chronic or intermittent cerebral hypoperfusion, and/or impaired cerebral vessel reactivity that lead to cerebral hypoxia and ischemic brain damage seem to underlie the development of CI in HF. Cognitive decline in HF is characterized by deficits in one or more cognition domains, including attention, memory, executive function, and psychomotor speed. These deficits may affect patients' decision-making capacity and interfere with their ability to comply with treatment requirements, recognize and self-manage disease worsening symptoms. CI may have fluctuations in severity over time, improve with effective HF treatment or progress to dementia. CI is independently associated with disability, mortality, and decreased quality of life of HF patients. It is essential therefore for health professionals in their routine evaluations of HF patients to become familiar with assessment of cognitive performance using standardized screening instruments. Future studies should focus on elucidating the mechanisms that underlie CI in HF and establishing preventive strategies and treatment approaches.
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Affiliation(s)
- Efthimios Dardiotis
- Department of Neurology, University of Thessaly, University Hospital of Larissa, P.O. Box 1400, Larissa, Greece
| | - Gregory Giamouzis
- Department of Cardiology, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | | | - Christina Vogiatzi
- Department of Neurology, University of Thessaly, University Hospital of Larissa, P.O. Box 1400, Larissa, Greece
| | - John Skoularigis
- Department of Cardiology, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Filippos Triposkiadis
- Department of Cardiology, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Georgios M. Hadjigeorgiou
- Department of Neurology, University of Thessaly, University Hospital of Larissa, P.O. Box 1400, Larissa, Greece
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Rothberg MB, Cohen J, Lindenauer P, Maselli J, Auerbach A. Little evidence of correlation between growth in health care spending and reduced mortality. Health Aff (Millwood) 2012; 29:1523-31. [PMID: 20679657 DOI: 10.1377/hlthaff.2009.0287] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As rapid U.S. health care spending growth continues, the question of whether additional dollars purchase better health or unnecessary care remains in sharp focus for policy makers, large employers, and other stakeholders. To investigate this question, we measured changes in mortality and cost for seven common diagnoses at 122 U.S. hospitals from 2000 to 2004. After adjusting for inflation, we found little correlation between reduced mortality for certain conditions and increased spending on patients with those conditions. The message to be underscored once again for policy makers is that health care dollars provide inconsistent value, and future spending increases should be targeted to care that improves outcomes.
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Affiliation(s)
- Michael B Rothberg
- Tufts University School of Medicine, in Boston, Massachusetts, Baystate Medical Center, Springfield, Massachusetts, USA.
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Zapatero A, Barba R, Gonzalez N, Losa JE, Plaza S, Canora J, Marco J. Influencia de la obesidad y la desnutrición en la insuficiencia cardiaca aguda. Rev Esp Cardiol 2012; 65:421-6. [DOI: 10.1016/j.recesp.2011.09.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 09/12/2011] [Indexed: 12/14/2022]
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Al Suwaidi J, Asaad N, Al-Qahtani A, El-Menyar A, Al-Mulla AW, Singh R, AlBinali HA. Effect of Age on Outcome on Patients Hospitalized With Heart Failure: From a 20-Year Registry in a Middle-Eastern Country (1991-2010). ACTA ACUST UNITED AC 2012; 18:320-6. [PMID: 22507267 DOI: 10.1111/j.1751-7133.2012.00290.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Suwaidi JA, Asaad N, Al-Qahtani A, Al-Mulla AW, Singh R, Albinali HA. Prevalence and outcome of Middle-eastern Arab and South Asian patients hospitalized with heart failure: insight from a 20-year registry in a Middle-eastern country (1991–2010). ACTA ACUST UNITED AC 2012; 14:81-9. [DOI: 10.3109/17482941.2012.655298] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jacoby D, Albajrami O, Bellumkonda L. Natural history of end-stage LV dysfunction: has it improved from the classic Franciosa and Cohn Graph? Cardiol Clin 2011; 29:485-95. [PMID: 22062195 DOI: 10.1016/j.ccl.2011.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The pathophysiology of heart failure is complex, and downstream effects cause decline in multiple systems. Medical therapies intended to slow or reverse disease progression have been shown to improve prognosis in prospective trials. Improvement in prognosis has also been observed in large cohorts across time strata. However, near-term mortality for those with advanced disease remains unacceptably high. Prognosis in advanced heart failure may be assessed with the appropriate use of clinical prediction tools. Optimal timing of evaluation for heart transplantation and/or mechanical circulatory support depends on an understanding of these issues.
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Affiliation(s)
- Daniel Jacoby
- Division of Cardiology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06519, USA.
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20
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Averkov OV, Shevchenko IV, Mirilashvili TS, Kobalava ZD. Venous thromboembolism in patients with heart failure. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2011. [DOI: 10.15829/1728-8800-2011-4-101-106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This review is focussed on the problem of venous thromboembolism in patients with heart failure (HF). The results of the major clinical trials of antithrombotic therapy in HF patients are presented. The authors discuss comparative effectiveness, safety, and tolerability of unfractionated heparins, low molecular weight heparins, and fondaparinux. The results of the two trials, MAGELLAN and ADOPT, are expected to clarify the clinical potential of such oral anticoagulants as rivaroxaban and apixaban (Factor Xa inhibitors). The problem of low rates e of preventive antithrombotic administration is emphasized.
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Affiliation(s)
- O. V. Averkov
- Russian University of People’s Friendship, City Clinical Hospital No. 64
| | - I. V. Shevchenko
- Russian University of People’s Friendship, City Clinical Hospital No. 64
| | | | - Zh. D. Kobalava
- Russian University of People’s Friendship, City Clinical Hospital No. 64
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21
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Wong CY, Chaudhry SI, Desai MM, Krumholz HM. Trends in comorbidity, disability, and polypharmacy in heart failure. Am J Med 2011; 124:136-43. [PMID: 21295193 PMCID: PMC3237399 DOI: 10.1016/j.amjmed.2010.08.017] [Citation(s) in RCA: 246] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Revised: 08/20/2010] [Accepted: 08/27/2010] [Indexed: 12/20/2022]
Abstract
BACKGROUND Comorbidity, disability, and polypharmacy commonly complicate the care of patients with heart failure. These factors can change biological response to therapy, reduce patient ability to adhere to recommendations, and alter patient preference for treatment and outcome. Yet, a comprehensive understanding of the complexity of patients with heart failure is lacking. Our objective was to assess trends in demographics, comorbidity, physical function, and medication use in a nationally representative, community-based heart failure population. METHODS Using data from the National Health and Nutrition Examination Survey, we analyzed trends across 3 survey periods (1988-1994, 1999-2002, 2003-2008). RESULTS We identified 1395 participants with self-reported heart failure (n=581 in 1988-1994, n=280 in 1999-2002, n=534 in 2003-2008). The proportion of patients with heart failure who were ≥80 years old increased from 13.3% in 1988-1994 to 22.4% in 2003-2008 (P <.01). The proportion of patients with heart failure who had 5 or more comorbid chronic conditions increased from 42.1% to 58.0% (P <.01). The mean number of prescription medications increased from 4.1 to 6.4 prescriptions (P <.01). The prevalence of disability did not increase but was substantial across all years. CONCLUSION The phenotype of patients with heart failure changed substantially over the last 2 decades. Most notably, more recent patients have a higher percentage of very old individuals, and the number of comorbidities and medications increased markedly. Functional disability is prevalent, although it has not changed. These changes suggest a need for new research and practice strategies that accommodate the increasing complexity of this population.
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Affiliation(s)
| | - Sarwat I. Chaudhry
- Section of General Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
| | - Mayur M. Desai
- Division of Chronic Disease Epidemiology, School of Public Health, Yale University School of Medicine, New Haven, Conn
| | - Harlan M. Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
- Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
- Division of Health Policy and Administration, School of Public Health, Yale University School of Medicine, New Haven, Conn
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
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22
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NADPH oxidase inhibition ameliorates cardiac dysfunction in rabbits with heart failure. Mol Cell Biochem 2010; 343:143-53. [PMID: 20567884 DOI: 10.1007/s11010-010-0508-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 06/02/2010] [Indexed: 02/07/2023]
Abstract
Increased NADPH oxidase activity is found in both experimental and clinical HF. Here, we investigated the effects and mechanisms of NADPH oxidase inhibition on cardiac function in rabbits with HF. HF was induced by combined volume and pressure overload. Rabbits with HF or sham operation were randomized to orally receive apocynin, an inhibitor of NADPH oxidase (15 mg per day) or placebo for 8 weeks. Echocardiography was performed to examine the cardiac function and structure of the rabbits. Cardiac fibrosis was evaluated by masson's trichrome staining. The transforming growth factor-beta (TGF-β), connective tissue growth factor (CTGF), matrix metalloproteinase-2 (MMP-2), and matrix metalloproteinase-9 (MMP-9) expression were measured by real-time PCR. The expression of SERCA2a and phospholamban (PLB) was detected by reverse transcription-polymerase chain reaction and Western Blot. SERCA2a activity was evaluated by measuring the Pi liberated from ATP hydrolysis. Rabbits with HF exhibited cardiac dysfunction and fibrosis. These changes were associated with significant increases in myocardial NADPH oxidase activity and oxidative stress. Compared with sham-operated rabbits, the TGF-β, CTGF, MMP-2, and MMP-9 mRNA expression significantly increased, the expression of SERCA2a and PLB dramatically decreased, and the SERCA2a activity was lower in HF rabbits. Apocynin reduced NADPH oxidase activity and oxidative stress, decreased TGF-β, CTGF, MMP-2, and MMP-9 expression, attenuated cardiac fibrosis, increased SERCA2a and PLB expression, restored SERCA2a activity, and thereby ameliorated cardiac dysfunction. Thus, chronic NADPH oxidase inhibition ameliorated cardiac dysfunction by decreasing cardiac fibrosis and preserving SERCA2a expression and activity.
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23
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Bueno H, Ross JS, Wang Y, Chen J, Vidán MT, Normand SLT, Curtis JP, Drye EE, Lichtman JH, Keenan PS, Kosiborod M, Krumholz HM. Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993-2006. JAMA 2010; 303:2141-7. [PMID: 20516414 PMCID: PMC3020983 DOI: 10.1001/jama.2010.748] [Citation(s) in RCA: 583] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Whether decreases in the length of stay during the past decade for patients with heart failure (HF) may be associated with changes in outcomes is unknown. OBJECTIVE To describe the temporal changes in length of stay, discharge disposition, and short-term outcomes among older patients hospitalized for HF. DESIGN, SETTING, AND PARTICIPANTS An observational study of 6,955,461 Medicare fee-for-service hospitalizations for HF between 1993 and 2006, with a 30-day follow-up. MAIN OUTCOME MEASURES Length of hospital stay, in-patient and 30-day mortality, and 30-day readmission rates. RESULTS Between 1993 and 2006, mean length of stay decreased from 8.81 days (95% confidence interval [CI], 8.79-8.83 days) to 6.33 days (95% CI, 6.32-6.34 days). In-hospital mortality decreased from 8.5% (95% CI, 8.4%-8.6%) in 1993 to 4.3% (95% CI, 4.2%-4.4%) in 2006, whereas 30-day mortality decreased from 12.8% (95% CI, 12.8%-12.9%) to 10.7% (95% CI, 10.7%-10.8%). Discharges to home or under home care service decreased from 74.0% to 66.9% and discharges to skilled nursing facilities increased from 13.0% to 19.9%. Thirty-day readmission rates increased from 17.2% (95% CI, 17.1%-17.3%) to 20.1% (95% CI, 20.0%-20.2%; all P < .001). Consistent with the unadjusted analyses, the 2005-2006 risk-adjusted 30-day mortality risk ratio was 0.92 (95% CI, 0.91-0.93) compared with 1993-1994, and the 30-day readmission risk ratio was 1.11 (95% CI, 1.10-1.11). CONCLUSION For patients admitted with HF during the past 14 years, reductions in length of stay and in-hospital mortality, less marked reductions in 30-day mortality, and changes in discharge disposition accompanied by increases in 30-day readmission rates were observed.
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Affiliation(s)
- Héctor Bueno
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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24
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Lu L, Xia L, Ye X, Cheng H. Simulation of the effect of rogue ryanodine receptors on a calcium wave in ventricular myocytes with heart failure. Phys Biol 2010; 7:026005. [PMID: 20505230 DOI: 10.1088/1478-3975/7/2/026005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Calcium homeostasis is considered to be one of the most important factors for the contraction and relaxation of the heart muscle. However, under some pathological conditions, such as heart failure (HF), calcium homeostasis is disordered, and spontaneous waves may occur. In this study, we developed a mathematical model of formation and propagation of a calcium wave based upon a governing system of diffusion-reaction equations presented by Izu et al (2001 Biophys. J. 80 103-20) and integrated non-clustered or 'rogue' ryanodine receptors (rogue RyRs) into a two-dimensional (2D) model of ventricular myocytes isolated from failing hearts in which sarcoplasmic reticulum (SR) Ca(2+) pools are partially unloaded. The model was then used to simulate the effect of rogue RyRs on initiation and propagation of the calcium wave in ventricular myocytes with HF. Our simulation results show that rogue RyRs can amplify the diastolic SR Ca(2+) leak in the form of Ca(2+) quarks, increase the probability of occurrence of spontaneous Ca(2+) waves even with smaller SR Ca(2+) stores, accelerate Ca(2+) wave propagation, and hence lead to delayed afterdepolarizations (DADs) and cardiac arrhythmia in the diseased heart. This investigation suggests that incorporating rogue RyRs in the Ca(2+) wave model under HF conditions provides a new view of Ca(2+) dynamics that could not be mimicked by adjusting traditional parameters involved in Ca(2+) release units and other ion channels, and contributes to understanding the underlying mechanism of HF.
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Affiliation(s)
- Luyao Lu
- Department of Biomedical Engineering, Zhejiang University, Hangzhou, People's Republic of China
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25
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Ng TM, Tsai F, Khatri N, Barakat MN, Elkayam U. Venous Thromboembolism in Hospitalized Patients With Heart Failure. Circ Heart Fail 2010; 3:165-73. [DOI: 10.1161/circheartfailure.109.892349] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Tien M.H. Ng
- From the Heart Failure Program, Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine and School of Pharmacy, Los Angeles, Calif
| | - Fausan Tsai
- From the Heart Failure Program, Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine and School of Pharmacy, Los Angeles, Calif
| | - Nudrat Khatri
- From the Heart Failure Program, Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine and School of Pharmacy, Los Angeles, Calif
| | - Mohamad N. Barakat
- From the Heart Failure Program, Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine and School of Pharmacy, Los Angeles, Calif
| | - Uri Elkayam
- From the Heart Failure Program, Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine and School of Pharmacy, Los Angeles, Calif
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26
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Hawkins NM, Jhund PS, Simpson CR, Petrie MC, MacDonald MR, Dunn FG, MacIntyre K, McMurray JJ. Primary care burden and treatment of patients with heart failure and chronic obstructive pulmonary disease in Scotland. Eur J Heart Fail 2009; 12:17-24. [DOI: 10.1093/eurjhf/hfp160] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Pardeep S. Jhund
- BHF Cardiovascular Research Centre, Faculty of Medicine; University of Glasgow; Glasgow UK
| | - Colin R. Simpson
- Allergy and Respiratory Research Group, Centre for Population Health Sciences; University of Edinburgh; Edinburgh UK
| | | | | | | | - Kate MacIntyre
- Department of Public Health and Health Policy, Faculty of Medicine; University of Glasgow; Glasgow UK
| | - John J.V. McMurray
- BHF Cardiovascular Research Centre, Faculty of Medicine; University of Glasgow; Glasgow UK
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27
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Costantino G, Rusconi AM, Duca PG, Guzzetti S, Bossi I, Del Medico M, Pisano G, Bulgheroni M, Solbiati M, Furlan R, Montano N. Eligibility criteria in heart failure randomized controlled trials: a gap between evidence and clinical practice. Intern Emerg Med 2009; 4:117-22. [PMID: 18690492 DOI: 10.1007/s11739-008-0180-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Accepted: 07/08/2008] [Indexed: 01/06/2023]
Abstract
The aim of the present study was to compare the characteristics of patients referred to our heart failure outpatient clinic with those of patients enrolled in clinical trials on heart failure pharmacological treatment. Thus, we estimated the proportion of patients admitted to our heart failure outpatient clinic who would have been included in randomized controlled trials evaluating the effects of medical treatments on heart failure mortality, published over a 10 years period (1993-2003). Sixteen studies (n = 45276) and 299 consecutive outpatients, were included. On average, only 34% of the outpatients would have been included in at least one of the 16 trials (8-71%). The main reasons for exclusion were: NYHA class (70% were in NYHA class II), ejection fraction (29% had EF > 35%), co-morbidity (51% had co-morbidity, mainly renal failure, COPD, and disthyroidism), age (22% were older than 80 years), and occurrence of a recent acute event (50% experienced an ischemic coronary syndrome, revascularization, pulmonary edema, or stroke in the prior 6 months). These results underline the crucial role of patient selection in clinical trials, raising uncertainties about the complete applicability of trial results to clinical practice.
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Affiliation(s)
- Giorgio Costantino
- Division of Internal Medicine II, L. Sacco Hospital, University of Milan, Via GB Grassi 74, Milan, Italy.
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Aranda JM, Johnson JW, Conti JB. Current trends in heart failure readmission rates: analysis of Medicare data. Clin Cardiol 2009; 32:47-52. [PMID: 19143005 DOI: 10.1002/clc.20453] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Despite advances in optimal pharmacologic therapy, patients with heart failure (HF) continue to have significant rehospitalization rates. HYPOTHESIS We sought to provide current estimates on rates of readmission for Medicare patients with HF, and identify factors associated with an increased chance of readmission. METHODS We used Medicare data from the 5% sample Standard Analytical File Limited Data Set for the years 2002 through 2004 to calculate readmission rates for HF. Clinical factors associated with readmission rates were identified using multivariate logistic regression. RESULTS We identified 28,919 patients accounting for 38,849 HF hospitalizations in the 5% sample for 2003. These numbers project to an estimated 578,380 patients with 776,980 HF hospitalizations. In-hospital mortality was 4.4% with an average length of stay of 5.5 +/- 5.4 d. In the 6-9 mo following the initial HF admission, 60% of patients had 1 or more readmissions for any cause. Heart failure accounted for 28% of all readmissions. Factors associated with readmission for HF after the initial HF hospitalization included age < 65 y, geographic location, previous hospitalization, length of stay of initial HF hospitalization > 7 d, not receiving a cardiac device implant at the time of initial HF hospitalization, and history of comorbidities including diabetes, myocardial infarction, peripheral vascular disease, and stroke. CONCLUSIONS Medicare patients with HF continue to have significant morbidity and one of the highest in-hospital mortality rates of any HF patient population. Factors associated with worse outcomes after an initial HF hospitalization can be used to identify patients who require aggressive therapy and follow-up.
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Affiliation(s)
- Juan M Aranda
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.
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29
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Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJV. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Fail 2009; 11:130-9. [PMID: 19168510 PMCID: PMC2639415 DOI: 10.1093/eurjhf/hfn013] [Citation(s) in RCA: 398] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 08/31/2008] [Accepted: 11/03/2008] [Indexed: 11/12/2022] Open
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are global epidemics incurring significant morbidity and mortality. The combination presents many diagnostic challenges. Clinical symptoms and signs frequently overlap. Evaluation of cardiac and pulmonary function is often problematic and occasionally misleading. Echocardiography and pulmonary function tests should be performed in every patient. Careful interpretation is required to avoid misdiagnosis and inappropriate treatment. Airflow obstruction, in particular, must be demonstrated when clinically euvolaemic. Very high and very low concentrations of natriuretic peptides have high positive and negative predictive values for diagnosing HF in those with both conditions. Intermediate values are less informative. Both conditions are systemic disorders with overlapping pathophysiological processes. In patients with HF, COPD is consistently an independent predictor of death and hospitalization. However, the impact on ischaemic and arrhythmic events is unknown. Greater collaboration is required between cardiologists and pulmonologists to better identify and manage concurrent HF and COPD. The resulting symptomatic and prognostic benefits outweigh those attainable by treating either condition alone.
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Affiliation(s)
- Nathaniel Mark Hawkins
- Aintree Cardiac Centre, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK.
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30
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Why and when do patients with heart failure and normal left ventricular ejection fraction die? Analysis of >600 deaths in a community long-term study. Am Heart J 2008; 156:1184-90. [PMID: 19033017 DOI: 10.1016/j.ahj.2008.07.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Accepted: 07/10/2008] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of the study was to examine the causes of the death of patients with heart failure (HF) and evaluate the differences in this respect between patients with and without depression of left ventricular ejection fraction (LVEF). METHOD All patients hospitalized with HF between 1995 and 2002 in the cardiology service of a tertiary hospital were assessed. LVEF was evaluated by echocardiography during hospitalization and was considered normal when it was > or =50%. After a mean follow-up time of 3.7 +/- 2.8 years, 615 cases had terminated in death. RESULTS The most common cause was refractory HF, both in the whole group (39%) and in both the subgroups defined with respect to LVEF (normal and depressed). There was no statistically significant difference between the normal and depressed subgroups as regard the distribution of deaths, although the depressed group showed a somewhat greater incidence of sudden death (21% as against 16% in the normal group) and a somewhat smaller incidence of death due to refractory HF (37% as against 47%). However, in the depressed LVEF group, the cumulative risk of death due to acute myocardial infarction in the first 1.5 years first increased rapidly and then more slowly, whereas the reverse pattern was held in the normal left ventricular systolic function group, in which it was the cumulative risks of death from noncardiovascular or vascular noncardiac causes that initially increased more rapidly than later. CONCLUSIONS The spectrum of causes of death among patients with HF who have been hospitalized is independent of LVEF in the long term. In the short term, there are differences between patients with normal LVEF and depressed LVEF as regard the dynamics of the risks of death from acute myocardial infarction, noncardiac vascular causes, and noncardiovascular causes. These results may help orient the short-term and long-term management of HF, especially for patients with normal LVEF, for whom there is still no well-established consensus strategy.
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Swindle J, Burroughs TE, Schnitzler MA, Hauptman PJ. Short-term mortality and cost associated with cardiac device implantation in patients hospitalized with heart failure. Am Heart J 2008; 156:322-8. [PMID: 18657663 PMCID: PMC2840643 DOI: 10.1016/j.ahj.2008.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 04/03/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND The use of implantable cardiac devices in the management of heart failure has increased, but patient selection and inhospital outcomes in clinical practice have not been critically explored. Therefore, we evaluated the inhospital mortality and costs associated with patients with heart failure who received an implantable cardioverter defibrillator, cardiac resynchronization device, or device lead. METHODS We analyzed admissions with International Classification of Diseases, Ninth Revision, procedure codes for implantation/revision of cardioverter defibrillator or cardiac resynchronization device and a primary or secondary diagnosis code for heart failure in a prospective hospital database from 2004 to 2005. Odds ratios were calculated to quantify risk for mortality. Average accumulated costs over time were calculated before and after day of first device implant procedure. RESULTS Among 27,907 hospitalizations, inhospital mortality varied based on day of device implantation and use of intravenous inotropic therapy. Mortality was 0.3% for patients who did not require inotropic drugs versus 3.3%, 6.6%, and 15.2% for patients who required initiation of drug before, on the day of, or after device implantation, respectively. Logistic regression demonstrated that the most potent risk for inhospital mortality was the use of inotropic drugs. Similar trends were observed for any vasoactive therapy. There was a marked increase in costs associated with these admissions. CONCLUSIONS Implantation of cardiac devices during a hospitalization for heart failure may be associated with significant inhospital mortality if patients require intravenous vasoactive therapy. Risk stratification methodology that incorporates ongoing/anticipated need for these drugs will likely improve clinical decision making.
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Affiliation(s)
- Jason Swindle
- Center for Outcomes Research, Saint Louis University School of Medicine, St Louis, MO
| | - Thomas E. Burroughs
- Center for Outcomes Research, Saint Louis University School of Medicine, St Louis, MO
| | - Mark A. Schnitzler
- Center for Outcomes Research, Saint Louis University School of Medicine, St Louis, MO
| | - Paul J. Hauptman
- Center for Outcomes Research, Saint Louis University School of Medicine, St Louis, MO
- Division of Cardiology, Department of Medicine, Saint Louis University School of Medicine, St Louis, MO
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Hauptman PJ, Swindle J, Burroughs TE, Schnitzler MA. Resource utilization in patients hospitalized with heart failure: insights from a contemporary national hospital database. Am Heart J 2008; 155:978-985.e1. [PMID: 18513507 DOI: 10.1016/j.ahj.2008.01.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Accepted: 01/22/2008] [Indexed: 12/29/2022]
Abstract
BACKGROUND Heterogeneity of disease severity and clinical trajectory has been described among patients hospitalized with heart failure (HF). However, little is known about the variability in and contributors to costs associated with HF hospitalizations. We examined the distribution of costs associated with a HF diagnosis in a large contemporary hospital database. METHODS Diagnosis and procedure codes were systematically used to identify primary inpatient HF admissions to hospitals participating in the PREMIER database 2004-2005. Average costs per day and division of costs among hospital departments were evaluated based on patient and hospitalization characteristics. RESULTS Total number of hospitalizations was 278,214; 36% had a length of stay (LOS) >5 days. There was a clear association between type of intravenous therapy, LOS, inhospital mortality, and cost. For example, patients initiated on a single intravenous inotrope had a longer mean LOS (9.6 days), greater inhospital mortality rate (14.7%), and higher mean total cost ($18,411) than any other medical therapy administered during hospitalization. The single largest contributor to cost was room and board. Forty-six percent of hospitalizations with diagnosis-related group code 127 (n = 234,204) exceeded average Medicare reimbursement. Variables on admission associated with highest cost hospitalizations were age <75 years, non-black race, male sex, and urban teaching hospital status. CONCLUSIONS Length of stay is the determinant of cost for HF hospitalizations. Use of vasoactive therapy is a marker for longer LOS, higher mortality, and greater costs. Improved reimbursement rates or improved therapeutic options that lessen LOS are required if the costs of HF care are to be minimized.
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Affiliation(s)
- Paul J Hauptman
- Division of Cardiology, Department of Medicine, Saint Louis University School of Medicine, St Louis, MO 63110, USA.
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Abstract
BACKGROUND The relationship between major discharge diagnoses and prediction of in-hospital death has been intensively studied. The relation between the presenting complaint at the Emergency Department (ED) and in-hospital fatality, however, is less well known. OBJECTIVE To investigate if presenting complaints add information regarding in-hospital fatality risk for nonsurgical ED patients. METHODS Investigating the relationship of in-hospital fatality rate and presenting complaint by comparing the presenting complaints, discharge diagnoses and in-hospital fatality for all nonsurgical patients visiting the ED during 1 year. RESULTS Of 12,995 nonsurgical admissions, 40% were treated as in-hospital patients. Among these, 328 in-hospital deaths occurred. Age was the most powerful predictor of death in hospitalized patients (P<0.0001). After adjustment for age, the female sex was found to be protective [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58-0.92, P=0.007)]. Compared with the largest complaint group, chest pain with an in-hospital fatality rate of 2.5%, there was a significantly increased risk of dying among those with stroke-like symptoms (OR 2.04, 95% CI 1.35-3.08, P=0.0007), dyspnoea (OR 1.95, 95% CI 1.27-3.00, P=0.002) or general disability (OR 1.81, 95% CI 1.17-2.79, P=0.008). CONCLUSIONS The presenting complaint at the ED carries valuable information of the risk for in-hospital fatality in nonsurgical patients. This knowledge can be valuable in the prioritization between different patient groups in the process of initiating diagnostics and treatment procedures at the ED.
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Physician attitudes toward end-stage heart failure: a national survey. Am J Med 2008; 121:127-35. [PMID: 18261501 DOI: 10.1016/j.amjmed.2007.08.035] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 07/29/2007] [Accepted: 08/10/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite recent improvements in medical therapies, heart failure remains a prevalent condition that places significant burdens on providers, patients, and families. However, there is a paucity of data published describing physician beliefs about heart failure management, especially in its advanced stages. METHODS In order to better understand physician decision-making in end-stage heart failure, we used a stratified random sampling of physicians obtained from the Master File of the American Medical Association to survey cardiologists (n=600), geriatricians (n=250), and internists/family practitioners (n=600). RESULTS Response rate was 59.6% (highest among geriatricians). The vast majority (>90%) of respondents cited similarities between the clinical trajectory of end-stage heart failure and lung cancer or chronic obstructive pulmonary disease; however, only 15.7% stated that they could predict death at 6 months "most of the time" or "always." Inpatient volume was a predictor of confidence in predicting mortality (odds ratio=1.38, 95% confidence interval, 1.36-1.40). Less than one quarter of respondents formally measure quality of life. The experience with deactivation of implantable cardioverter defibrillators was limited: 59.8% of cardiologists, 88.0% of geriatricians, and 95.1% of internal medicine/family practice physicians have had 2 or fewer conversations with patients and families about this option. CONCLUSIONS Significant gaps in knowledge about and experience with end-stage heart failure exist among a large proportion of physicians. The growing prevalence and highly symptomatic nature of heart failure highlight the need to further evaluate and improve the way in which care is delivered to patients dying from the disease.
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Abstract
This paper provides an evidence-based review of the principles underlying palliative care for heart failure (HF), including its pathogenesis, staging, assessment, prognosis, and treatment. Approaches to advanced care planning, symptom management, hospice eligibility, home inotropic infusions, device management and improving the continuum of care in HF are discussed. The reader will be able to recognize advanced HF, use important elements of physical assessment, utilize Web-based prognostic and risk-stratification models, facilitate advance care planning, ensure optimal treatment, manage common symptoms and comorbid conditions, determine hospice eligibility, and consider issues related to withholding or withdrawal of inotropic infusions and devices used in HF refractory to standard treatment. The ultimate goal of palliative care for heart failure is to integrate knowledge of treatment advances and comfort measures and to provide them concurrently in a seamless continuum to patients with late-stage disease.
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Affiliation(s)
- Brad Stuart
- Sutter VNA and Hospice, 1900 Powell Street, Emeryville, CA 94608, USA.
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36
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Shahar E, Lee S. Historical trends in survival of hospitalized heart failure patients: 2000 versus 1995. BMC Cardiovasc Disord 2007; 7:2. [PMID: 17227584 PMCID: PMC1781956 DOI: 10.1186/1471-2261-7-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Accepted: 01/16/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Population-based secular trends in survival of patients with congestive heart failure (CHF) are central to public health research on the burden of the syndrome. METHODS Patients 35-79 years old with a CHF discharge code in 1995 or 2000 were identified in 22 Minneapolis-St. Paul hospitals. A sample of the records was abstracted (50% of 1995 records; 38% of 2000 records). A total of 2,257 patients in 1995 and 1,825 patients in 2000 were determined to have had a CHF-related hospitalization. Each patient was followed for one year to ascertain vital status. RESULTS The risk profile of the 2000 patient cohort was somewhat worse than that of the 1995 cohort in both sex groups, but the distributions of age and left ventricular ejection fraction were similar. Within one year of admission in 2000, 28% of male patients and 27% of female patients have died, compared to 36% and 27% of their counterparts in 1995, respectively. In various Cox regression models the average year effect (2000 vs. 1995) was around 0.75 for men and 0.95 to 1.00 for women. The use of angiotensin converting-enzyme inhibitors and beta-blockers was associated with substantially lower hazard of death during the subsequent year. CONCLUSION Survival of men who were hospitalized for CHF has improved during the second half of the 1990s. The trend in women was very weak, compatible with little to no change. Documented benefits of angiotensin converting-enzyme inhibitors and beta-blockers were evident in these observational data in both men and women.
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Affiliation(s)
- Eyal Shahar
- Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
| | - Seungmin Lee
- Department of Food and Nutrition, College of Human Ecology, Sungshin Women's University, Seoul, Korea
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Hauptman PJ, Mikolajczak P, George A, Mohr CJ, Hoover R, Swindle J, Schnitzler MA. Chronic inotropic therapy in end-stage heart failure. Am Heart J 2006; 152:1096.e1-8. [PMID: 17161059 PMCID: PMC2840644 DOI: 10.1016/j.ahj.2006.08.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Accepted: 08/08/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND Interventions in advanced heart failure that provide symptom relief and decrease hospital readmission are important. Chronic intravenous inotropic therapy represents a pharmacologic approach that has been advocated for palliative treatment. However, little is known about associated mortality and cost. Therefore, we sought to describe the impact of chronic infusions on resource use and survival. METHODS Data were reviewed for a 17-state Medicare region from 1995 to 2002. We obtained hospital and outpatient expenditures accrued up to 180 days before and after the initiation of chronic infusions. Health care use was defined by dollars reimbursed for drug and hospitalizations per beneficiary. Average accumulated cost curves were generated for dollars reimbursed for drug and for hospitalizations by days at risk. RESULTS The mean age of the cohort (n = 331) was 69.1 +/- 11.3 years. Mortality exceeded 40% at 6 months. Reductions in hospital days were observed at all time points. The amounts reimbursed at 30 and 60 days before and after initiation of inotrope favor drug therapy; however, at six months, the amounts reimbursed were greater due to the cost of milrinone. CONCLUSIONS Chronic intravenous inotrope use was associated with a high mortality. The cost for milrinone was significant, but there was a decrease in expenditures for subsequent hospitalizations. In the absence of appropriately designed clinical trials, the data suggest that the decision to use inotropes, the choice of inotrope, and the duration of treatment should reflect the impact on resource use.
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Affiliation(s)
- Paul J Hauptman
- Division of Cardiology, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.
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Kosiborod M, Lichtman JH, Heidenreich PA, Normand SLT, Wang Y, Brass LM, Krumholz HM. National trends in outcomes among elderly patients with heart failure. Am J Med 2006; 119:616.e1-7. [PMID: 16828634 DOI: 10.1016/j.amjmed.2005.11.019] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Revised: 11/28/2005] [Accepted: 11/29/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE Despite dramatic changes in heart failure management during the 1990s, little is known about the national heart failure mortality trends during this time period, particularly among the elderly. The purpose of this study was to determine temporal trends in outcomes of elderly patients with heart failure between 1992 and 1999. SUBJECTS AND METHODS We analyzed a national sample of 3,957,520 Medicare beneficiaries aged 65 years or more who were hospitalized with heart failure between 1992 and 1999, assessing temporal trends in 30-day and 1-year all-cause mortality and 30-day and 6-month all-cause hospital readmission. In risk-adjusted analyses, mortality and readmission for each year between 1994 and 1999 were compared with the referent year of 1993. RESULTS Crude 30-day and 1-year mortality decreased slightly (range for 1992-1999: 11.0%-10.3% and 32.5%-31.7%, respectively), whereas 30-day and 6-month readmission increased (10.2%-13.8% and 35.4%-40.3%, respectively). After risk adjustment, there was no change in 30-day mortality between 1993 and 1999 (eg, for 1999 vs 1993, odds ratio [OR] 1.01, 95% confidence interval [CI], 1.00-1.02). One-year mortality was lower in 1994 compared with 1993 (OR 0.91, 95% CI, 0.90-0.92), but data from subsequent years suggested no continuous improvement after 1994 (1999 vs 1993: OR 0.93, 95% CI, 0.92-0.94). Thirty-day readmission increased (1999 vs 1993: OR 1.09, 95% CI, 1.07-1.10), but there was no change in 6-month readmission (1999 vs 1993: OR 1.00, 95% CI, 0.99-1.01). CONCLUSION We found no substantial improvement in mortality and hospital readmission during the 1990s among elderly patients hospitalized with heart failure. These findings suggest that recent innovations in heart failure management have not yet translated into better outcomes in this population.
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Affiliation(s)
- Mikhail Kosiborod
- Mid America Heart Institute of Saint Luke's Hospital, Kansas City, MO, USA
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Tsai AC, Votruba M, Bridges JFP, Cebul RD. Overcoming bias in estimating the volume-outcome relationship. Health Serv Res 2006; 41:252-64. [PMID: 16430610 PMCID: PMC1681538 DOI: 10.1111/j.1475-6773.2005.00461.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine the effect of hospital volume on 30-day mortality for patients with congestive heart failure (CHF) using administrative and clinical data in conventional regression and instrumental variables (IV) estimation models. DATA SOURCES The primary data consisted of longitudinal information on comorbid conditions, vital signs, clinical status, and laboratory test results for 21,555 Medicare-insured patients aged 65 years and older hospitalized for CHF in northeast Ohio in 1991-1997. STUDY DESIGN The patient was the primary unit of analysis. We fit a linear probability model to the data to assess the effects of hospital volume on patient mortality within 30 days of admission. Both administrative and clinical data elements were included for risk adjustment. Linear distances between patients and hospitals were used to construct the instrument, which was then used to assess the endogeneity of hospital volume. PRINCIPAL FINDINGS When only administrative data elements were included in the risk adjustment model, the estimated volume-outcome effect was statistically significant (p=.029) but small in magnitude. The estimate was markedly attenuated in magnitude and statistical significance when clinical data were added to the model as risk adjusters (p=.39). IV estimation shifted the estimate in a direction consistent with selective referral, but we were unable to reject the consistency of the linear probability estimates. CONCLUSIONS Use of only administrative data for volume-outcomes research may generate spurious findings. The IV analysis further suggests that conventional estimates of the volume-outcome relationship may be contaminated by selective referral effects. Taken together, our results suggest that efforts to concentrate hospital-based CHF care in high-volume hospitals may not reduce mortality among elderly patients.
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Affiliation(s)
- Alexander C Tsai
- Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine WG-57, Cleveland, OH 44106-4945, USA
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Perna ER, Barbagelata A, Grinfeld L, García Ben M, Címbaro Canella JP, Bayol PA, Sosa Liprandi A. Overview of acute decompensated heart failure in Argentina: lessons learned from 5 registries during the last decade. Am Heart J 2006; 151:84-91. [PMID: 16368296 DOI: 10.1016/j.ahj.2005.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Accepted: 03/01/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND The acute decompensated heart failure (ADHF) is not as well characterized as the chronic phase, particularly in Latin American countries. Thus, the aim of this overview was to describe the clinical profile, treatment, and inhospital course of ADHF during the last decade in Argentina. METHODS Results obtained from 5 Argentinean prospective and multicenter registries, involving 2974 patients admitted for ADHF, were assessed. These registries were performed and published between 1992 and 2004. RESULTS The mean age was 65 to 70 years, and nearly 40% were female. Coronary artery disease was the main etiology in nearly 30% of the patients. Between 1992 and 2004, the use of angiotensin-converting enzyme inhibitors increased from 29.9% to 53.4% before admission and from 48.5% to 69.3% before discharge; the use of beta-blockers rose from 4.2% to 33.2% at admission and from 2.5% to 42.4% at predischarge (all P < .0001). Inhospital mortality rates in the first to the fifth registries were 12.1%, 4.6%, 10.5%, 8.9%, and 4.7% (P [trend] = .006). However, there were 98 (7.7%) deaths among 1272 patients before 2002, compared with 129 (7.6%) among 1702 since 2002 (P = .9). CONCLUSIONS The clinical profile of this largest sample of ADHF reported from a Latin American country is different from that observed in clinical trials and comparable to registries worldwide. Although an improvement in the use of recommended drugs was observed in the last decade, the average mortality has not changed. These findings might have implications in the design of multinational clinical trials.
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Affiliation(s)
- Eduardo R Perna
- Instituto de Cardiologia Juana F. Cabral, Corrientes, Argentina.
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Senni M, De Maria R, Gregori D, Gonzini L, Gorini M, Cacciatore G, Gavazzi A, Pulignano G, Porcu M, Maggioni AP. Temporal trends in survival and hospitalizations in outpatients with chronic systolic heart failure in 1995 and 1999. J Card Fail 2005; 11:270-8. [PMID: 15880335 DOI: 10.1016/j.cardfail.2004.11.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abstract Background Community and hospital studies have suggested that survival of patients with heart failure (HF) has increased; however, the causes of the improvement and the hospital readmission rates remain undetermined. Methods and Results We compared survival and hospital admission rates in 2 cohorts enrolled in a national registry of outpatients with HF secondary to left ventricular (LV) systolic dysfunction referred to cardiology centers in 1995 (n = 712) and 1999 (n = 603). One year after enrollment, 163 of 1315 patients (12%) were dead. Survival rates were 85% in the 1995 versus 91% in the 1999 cohort. Older age, New York Heart Association (NYHA) class III-IV, anemia, hyponatremia, hypotension, and a lower LV ejection fraction (LVEF) were associated to an increased risk of all-cause mortality by multivariate analysis. Furthermore a significant independent cohort effect was observed: the adjusted risk of death was 1.30 (95% CI 1.16-1.45) for the 1995 versus 1999 cohort (survival difference adjusted P = .0067). The proportion of patients admitted to hospital declined significantly in 1999 versus 1995, for all causes (20% versus 27%, P = .006), for cardiac causes (16% versus 22%, P = .002), and for worsening congestive heart failure (8% versus 15%, P = .0005). Survival free from HF admission was 69% in 1995 versus 84% in 1999 (adjusted P = .0001); NYHA class III-IV, hypotension, diuretics and a lower LVEF were associated to an increased risk of this combined end point by multivariate analysis, as well as the enrollment year (relative risk 1.38, 95% CI 1.22-1.56, P = .0039). Conclusion In a national cardiologic registry of outpatients with systolic HF, survival improved and hospital admissions decreased over a 4-year period. These results underscore the importance of networking and the careful implementation of practice guidelines to elevate standards of care.
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Affiliation(s)
- Michele Senni
- Cardiovascular Medicine, Department of Cardiovascvular and Internal Medicine, Riuniti Hospital, Bergamo, Italy
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Brown DW, Haldeman GA, Croft JB, Giles WH, Mensah GA. Racial or ethnic differences in hospitalization for heart failure among elderly adults: Medicare, 1990 to 2000. Am Heart J 2005; 150:448-54. [PMID: 16169322 DOI: 10.1016/j.ahj.2004.11.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2004] [Accepted: 11/13/2004] [Indexed: 11/22/2022]
Abstract
BACKGROUND Little is known about racial or ethnic differences in hospitalizations for heart failure (HF), the most common hospital diagnosis for Medicare enrollees. METHODS Using data from the Medicare Provider Analysis Record (1990-2000), we analyzed data for Medicare beneficiaries aged > or = 65 years who were hospitalized with a first-listed diagnosis of HF (International Classification of Diseases, Ninth Revision, Clinical Modification code 428). We assessed racial/ethnic differences in annual prevalences and discharge outcomes for patients hospitalized in 2000. RESULTS Prevalence of HF hospitalization increased over the 10-year period for white, black, Hispanic, and Asian enrollees. Prevalence was highest among those aged > or = 85 years; the age-adjusted prevalence was greater among men than women. Compared with white enrollees in 2000, the likelihood of a HF hospitalization was 1.5 times greater among black enrollees, 1.2 times greater among Hispanic enrollees, and 0.5 times less likely among Asian enrollees after adjustment for age and sex (P < .05 for all). Compared with white patients hospitalized with HF, black and Hispanic (but not Asian) patients were less likely than white patients to die in a hospital. A greater proportion of black, Hispanic, and Asian patients were discharged to home than white patients during 2000. CONCLUSION Prevalence of HF hospitalization was highest among black and Hispanic Medicare enrollees. Because Hispanic Americans and the elderly are the fastest-growing segments of the US population, HF will increase in importance as a public health concern and will require increased focus on culturally competent prevention and treatment strategies in the next decade.
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Affiliation(s)
- David W Brown
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
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Grigorian Shamagian L, Gonzalez-Juanatey JR, Roman AV, Acuña JMG, Lamela AV. The death rate among hospitalized heart failure patients with normal and depressed left ventricular ejection fraction in the year following discharge: evolution over a 10-year period. Eur Heart J 2005; 26:2251-8. [PMID: 15985441 DOI: 10.1093/eurheartj/ehi383] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To investigate whether changes in clinical characteristics and treatment strategies between 1991 and 2001 have had an impact on the survival of patients hospitalized with congestive heart failure (CHF) and whether those with normal left ventricular ejection fraction (LVEF> or =50%) differ in this respect from those with depressed LVEF. METHODS AND RESULTS We studied 1482 patients who had been admitted to the Cardiology Service of a tertiary Spanish hospital in the last 10 years with CHF. Among the 1110 for whom LVEF was evaluated, the prevalence of normal LVEF rose from 37% in the period 1991-96 (Period 1) to 47% in the period 2000-2001 (Period 3). The intensity of both diagnostic and therapeutic measures also increased during this 10-year period. The 1-year survival rate remained virtually unchanged in the whole group of patients, being 82, 84, and 82% in Periods 1, 2 (1997-99), and 3, respectively, even though the prognosis of patients with depressed LVEF (<50%) improved significantly, with 1-year survival rates of 76, 77, and 84% in Periods 1, 2, and 3, respectively; the normal LVEF group had decreasing 1-year survival rates of 88, 86, and 81% in Periods 1, 2, and 3, respectively, although the increased risk of death was not statistically significant. CONCLUSION Although in our centre the death rate among hospitalized CHF patients with depressed LVEF during the first year after discharge has tended to fall over the past 10 years, application of current clinical guidelines has led to no such decrease for patients with normal LVEF. This situation points to a need to reconsider the diagnostic and therapeutic strategy to be employed with this latter group of patients.
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Affiliation(s)
- Lilian Grigorian Shamagian
- Servicio de Cardiologia y Unidad Coronaria, Hospital Clinico Universitario de Santiago, Travesia Choupana s/n, 15706 Santiago de Compostela, Spain
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Goldberg RJ, Glatfelter K, Burbank-Schmidt E, Farmer C, Spencer FA, Meyer T. Trends in mortality attributed to heart failure in Worcester, Massachusetts, 1992 to 2001. Am J Cardiol 2005; 95:1324-8. [PMID: 15904637 DOI: 10.1016/j.amjcard.2005.01.076] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Revised: 01/27/2005] [Accepted: 01/26/2005] [Indexed: 11/23/2022]
Abstract
Sparse data are available, particularly from the more generalizable perspective of a population-based investigation, that describe recent trends in community death rates due to heart failure (HF). The objectives of this study were to describe a decade-long trend (1992 to 2001) in mortality attributed to HF among residents of the metropolitan area of Worcester, Massachusetts. A secondary study goal was to describe changes in death rates due to HF in men and in women, in subjects of different ages, and according to location of death. Death data tapes were obtained from the Massachusetts Department of Public Health for greater Worcester residents who died between 1992 and 2001. A total of 2,677 deaths from HF occurred in metropolitan Worcester residents between 1992 and 2001. Increases in crude death rates (per 100,000 population) attributed to HF were observed from 1992 (death rate 82) to 2001 (death rate 102). Adjustment for age attenuated the increase in community death rates due to HF. Slight increases in age-adjusted death rates from HF were noted in men, whereas age-adjusted mortality from HF in women decreased by 22% between our initial study year and the most recent study year. The elderly were at greatest risk for dying of HF and increases in HF death rates were observed in the oldest subjects (>/=85 years of age) over time. There was an increasing proportion of all deaths due to HF that occurred in the out-of-hospital setting in 2001 (61%) compared with 1992 (52%). The results of this study suggest changing patterns in death rates due to HF in a large northeastern community.
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Affiliation(s)
- Robert J Goldberg
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
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Adams KF, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, Berkowitz RL, Galvao M, Horton DP. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 2005; 149:209-16. [PMID: 15846257 DOI: 10.1016/j.ahj.2004.08.005] [Citation(s) in RCA: 1551] [Impact Index Per Article: 77.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The ADHERE is designed to study characteristics, management, and outcomes in a broad sample of patients hospitalized with acute decompensated heart failure. Heart failure is a leading cause of hospitalization for adults older than 65 years in the United States. Most available data on these patients are limited by patient selection criteria and study design of clinical trials and single-center studies. METHODS Participating hospitals identify patients with a primary or secondary discharge diagnosis of heart failure. Medical history, management, treatments, and health outcomes data are collected through review of medical records and entered into a database via secure web browser technology. RESULTS As of January 2004, data on 107 362 patients have been received from 282 participating hospitals. Of enrollees with available analyzable data (N = 105 388 from 274 hospitals), the mean age was 72.4 (+/-14.0), and 52% were women. The most common comorbid conditions were hypertension (73%), coronary artery disease (57%), and diabetes (44%). Evidence of mild or no impairment of systolic function was found in 46% of patients. Inhospital mortality was 4.0% and the median hospital length of stay was 4.3 days. CONCLUSIONS The ADHERE demonstrates both the feasibility and significant implications of gathering representative data on large numbers of patients hospitalized with heart failure. Initial data provided important insights into the clinical characteristics and patterns of care of these patients. Ongoing registry work will provide the framework for improved treatment strategies for patients hospitalized with decompensated heart failure.
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Affiliation(s)
- Kirkwood F Adams
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, USA.
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Affiliation(s)
- John J V McMurray
- Department of Cardiology, Western Infirmary, Glasgow G12 8QQ, Scotland, UK
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Hauptman PJ, Burroughs TE. Anything does not go: defining and refining interventions designed to improve quality in cardiovascular diseases. Am J Med 2004; 117:433-5. [PMID: 15380501 DOI: 10.1016/j.amjmed.2004.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kalantar-Zadeh K, Block G, Horwich T, Fonarow GC. Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J Am Coll Cardiol 2004; 43:1439-44. [PMID: 15093881 DOI: 10.1016/j.jacc.2003.11.039] [Citation(s) in RCA: 492] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2003] [Revised: 10/30/2003] [Accepted: 11/04/2003] [Indexed: 11/28/2022]
Abstract
Traditional risk factors of a poor clinical outcome and mortality in the general population, including body mass index (BMI), serum cholesterol, and blood pressure (BP), are also found to relate to outcome in patients with chronic heart failure (CHF), but in an opposite direction. Obesity, hypercholesterolemia, and high values of BP have been demonstrated to be associated with greater survival among CHF patients. These findings are in contrast to the well-known associations of over-nutrition, hypercholesterolemia, and hypertension with a poor outcome in the general population. The association between traditional cardiovascular risk factors and an adverse clinical outcome in CHF patients is referred to as "reverse epidemiology." The mechanisms for this inverse association in CHF is not clear. There are other populations with a similar risk factor reversal phenomenon, including patients with end-stage renal disease receiving dialysis, those with advanced malignancies, and individuals with advanced age. Several possible causes are hypothesized: the time discrepancy of the competing risk factors may play a role; the presence of the "malnutrition-inflammation complex syndrome" in CHF patients may explain the existence of reverse epidemiology; and a decreased level of lipoprotein molecules may distort their endotoxin-scavenging role, predisposing CHF patients with a low serum cholesterol level to inflammatory consequences of endotoxemia. It is possible that new goals for such traditional risk factors as BMI, serum cholesterol, and BP should be developed for CHF. Reverse epidemiology of conventional cardiovascular risk factors is observed in CHF and may have a bearing on the management of these patients; thus, it deserves further investigation.
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Estratificación del riesgo y prevención de la muerte súbita en pacientes con insuficiencia cardíaca. Rev Esp Cardiol 2004. [DOI: 10.1016/s0300-8932(04)77188-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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