Monitoring peripheral edema of heart failure patients at home: Device, algorithm, and clinic study

2017 ◽  
Author(s):  
Jianchu Yao ◽  
Elizabeth M. B. Weaver ◽  
Brandon D. Langley ◽  
Stephanie M. George ◽  
Sonya R. Hardin
Keyword(s):  
Heart Failure ◽  
Peripheral Edema ◽  
Heart Failure Patients ◽  
Clinic Study ◽  
At Home

scholarly journals CARE MANAGEMENT CHALLENGES AND PROGNOSTIC TOOLS FOR HEART FAILURE PATIENTS IN HOSPICE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S791-S791
Author(s):  
Ruth Masterson Creber ◽  
Lizeyka Jordan ◽  
Dawon Baik ◽  
David Russell
Keyword(s):  
Heart Failure ◽  
End Of Life ◽  
Medical Devices ◽  
Care Management ◽  
Qualitative Interviews ◽  
Heart Failure Patients ◽  
Performance Scale ◽  
Worse Prognosis ◽  
Management Issues ◽  
At Home

Abstract Heart failure (HF) patients enroll in hospice at lower rates despite their worse prognosis. This multi-method study explores the characteristics and challenges associated with caring for HF patients. Data from qualitative interviews with hospice providers (n=32) and quantitative records (N=1,114) were used to identify care management issues and prognostic tools. Hospice providers described HF patients unique and often unpredictable symptomatology, their limited understanding and discordant hospice expectations, and difficulties managing symptoms at home. Providers also highlighted HF patients use of assistive medical devices and complex medication regimens. Palliative Performance Scale (PPSv2) scores at hospice enrollment were found to be strongly associated with hospice survival (AUC: 7 days=0.80; 14 days=0.77) and live discharge risk (PPSv2 50-70% AOR=5.68 [CI=3.66-8.79]). Findings underscore the need for specially-tailored trainings and protocols for providers to prevent unplanned discharges and support HF patients at end-of-life.

Palliative Care Consultation Affects How and Where Heart Failure Patients Die

2020 ◽  
pp. 104990912096356
Author(s):  
Richard Pham ◽  
Casey McQuade ◽  
Alex Somerfeld ◽  
Sandra Blakowski ◽  
Gavin W. Hickey
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Chi Square ◽  
Code Status ◽  
Heart Failure Patients ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Dying At Home ◽  
The Impact ◽  
At Home

Objective: Determine the role of palliative care on terminal code status and setting of death for those with heart failure. Background: Although palliative care consultation (PCC) has increased for many conditions, PCC has not increased in those with cardiovascular disease. While it has been shown that the majority of those with heart failure die in medical facilities, the impact of PCC on terminal code status and setting of death requires further analysis. Methods: Patients admitted with heart failure between 2014-2015 at an academic VA Healthcare System were reviewed. Primary outcome was terminal code status. Secondary outcomes included setting of death, hospice utilization, and mortality scores. Student t-testing and Chi-square testing were performed where appropriate. Results: 334 patients were admitted with heart failure and had a median follow up time of 4.3 years. 196 patients died, with 122 (62%) receiving PCC and 74 (38%) without PCC. Patients were more likely to have terminal code statuses of comfort measures with PCC (OR = 4.6, p = 0.002), and less likely to be full code (OR = 0.09, p < 0.001). 146 patients had documented settings of death and were more likely to receive hospice services with PCC (OR 6.76, p < 0.001). A patient’s chance of dying at home was not increased with PCC (OR 0.49, p = 0.07), but they were more likely to die with inpatient hospice (OR = 17.03; p < 0.001). Conclusion: Heart failure patients who received PCC are more likely to die with more defined care preferences and with hospice services. This does not translate to dying at home.

scholarly journals Using a game computer to stimulate activity at home in heart failure patients. The study design

2011 ◽  
Vol 11 (7) ◽  
Author(s):  
Leonie Verheijden Klompstra ◽  
Anna Strömberg ◽  
Andrea Turolla ◽  
Tiny Jaarsma
Keyword(s):  
Heart Failure ◽  
Study Design ◽  
Stimulate Activity ◽  
Heart Failure Patients ◽  
At Home

Implementation of the Mental Capacity Act: a national observational study of changes in place of death for older heart failure patients with or without comorbid dementia

2021 ◽  
Author(s):  
James M. Beattie ◽  
Irene J. Higginson ◽  
Theresa A. McDonagh ◽  
Wei Gao
Keyword(s):  
Heart Failure ◽  
Mental Capacity ◽  
Place Of Death ◽  
Care Homes ◽  
Appreciable Change ◽  
Heart Failure Patients ◽  
Comorbidity Burden ◽  
Dying At Home ◽  
Mental Capacity Act ◽  
At Home

Abstract Background: Heart failure is increasingly prevalent in the growing elderly population and commonly associated with cognitive impairment. This study compared trends in place of death (PoD) of heart failure patients with / without comorbid dementia over the period of implementation of the Mental Capacity Act (MCA) in October 2007, this legislation supporting patient-centred decision making for those with reduced agency.Methods: Analyses of death certification data for England between January 2001 and December 2018, describing the PoD and sociodemographic characteristics of all people ≥ 65 years registered with heart failure as the underlying cause of death, with / without a mention of comorbid dementia. Multiple Poisson regression modelling was used to determine the prevalence ratio (PR) of dying at home or in care homes compared to dying in hospital. Covariates included year of death, age, gender, marital status, comorbidity burden, index of multiple deprivation and urban / rural settings.Results:120,068 heart failure-related death records were included of which 8199 mentioned dementia as a contributory cause. The overall prevalence of dementia was 6.8%, the trend significantly increasing from 5.6% to 8.0% pre- and post-MCA (p<0.0001). Dementia was coded as unspecified (78.2%), Alzheimer’s disease (13.5%) and vascular (8.3%). Those with dementia were more commonly older, female, widowed, and had more comorbidities. Pre-MCA, PoD for heart failure patients without dementia was hospital 68.2%, care homes 20.2%, 10.7% dying at home. The corresponding figures for those with comorbid dementia were 47.6%, 48.0% and 4.2%, respectively. Following MCA enforcement, PoD for those without dementia shifted from hospital to home, PR: 1.026 [95%CI: 1.024-1.029]. This trend was not significant for those with dementia, PR: 1.001 [0.988-1.015], hospital deaths increasing. Care home deaths reduced for all, with or without dementia, PR: 0.959 [0.949-0.969], and PR: 0.996 [0.993-0.998], respectively. Hospice as PoD was rare for both groups (≤0.5%) with no appreciable change over the study period.Conclusions: Our analyses suggest the MCA did not materially affect the PoD of heart failure decedents with comorbid dementia, likely reflecting difficulties implementing this legislation in real-life clinical practice.

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