The Impact of Rurality on 30-Day Preventable Readmission, Illness Severity, and Risk of Mortality for Heart Failure Medicare Home Health Beneficiaries

2015 ◽  
Vol 32 (2) ◽  
pp. 176-187 ◽  
Author(s):  
Hsueh-Fen Chen ◽  
Erin Carlson ◽  
Taiye Popoola ◽  
Sumihiro Suzuki
Keyword(s):  
Heart Failure ◽  
Illness Severity ◽  
Home Health ◽  
Risk Of Mortality ◽  
The Impact ◽  
Preventable Readmission

scholarly journals The Role of Depression and Anxiety in Frail Patients with Heart Failure

Diseases ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 45 ◽  
Author(s):  
Elisabeta Ioana Hiriscau ◽  
Constantin Bodolea
Keyword(s):  
Heart Failure ◽  
Psychological Factors ◽  
Strong Predictor ◽  
Depression And Anxiety ◽  
Negative Outcomes ◽  
Frail Patients ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Reported Data ◽  
The Impact

An increased interest regarding the impact of frailty on the prognosis of cardiovascular disease (CVD) has been observed in the last decade. Frailty is a syndrome characterized by a reduced biological reserve that increases the vulnerability of an individual in relation to stressors. Among the patients with CVD, a higher incidence of frailty has been reported in those with heart failure (HF). Regardless of its conceptualizations, frailty is generally associated with negative outcomes in HF and an increased risk of mortality. Psychological factors, such as depression and anxiety, increase the risk of negative outcomes on the cardiac function and mortality. Depression and anxiety are found to be common factors impacting the heart disease and quality of life (QoL) in patients with HF. Depression is considered an independent risk factor of cardiac-related incidents and death, and a strong predictor of rehospitalization. Anxiety seems to be an adequate predictor only in conjunction with depression. The relationship between psychological factors (depression and anxiety) and frailty in HF has hardly been documented. The aim of this paper is to review the reported data from relevant studies regarding the impact of depression and anxiety, and their effects on clinical outcomes and prognosis in frail patients with HF.

scholarly journals Impact of heart failure on stroke mortality and recurrence

Heart Asia ◽  
2019 ◽  
Vol 11 (1) ◽  
pp. e011139 ◽  
Author(s):  
Tiberiu A Pana ◽  
Adrian D Wood ◽  
Jesus A Perdomo-Lampignano ◽  
Somsak Tiamkao ◽  
Allan B Clark ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Sector ◽  
Stroke Recurrence ◽  
Stroke Mortality ◽  
The Public ◽  
Risk Of Mortality ◽  
Reduction Strategies ◽  
Stroke Type ◽  
Risk Reduction Strategies ◽  
The Impact

ObjectiveWe aimed to examine the impact of heart failure (HF) on stroke mortality (in-hospital and postdischarge) and recurrence in a national stroke cohort from Thailand.MethodsWe used a large, insurance-based database including all stroke admissions in the public health sector in Thailand between 2004 and 2015. Logistic and Royston-Parmar regressions were used to quantify the effect of HF on in-hospital and long-term outcomes, respectively. All models were adjusted for age, sex and comorbidities and stratified by stroke type: acute ischaemic stroke (AIS) or intracerebral haemorrhage (ICH). Multistate models were constructed using flexible survival techniques to predict the impact of HF on the disease course of a patient with stroke (baseline-[recurrence]-death). Only first-ever cases of AIS or ICH were included in the multistate analysis.Results608 890 patients (mean age 64.29±13.72 years, 55.07% men) were hospitalised (370 527 AIS, 173 236 ICH and 65 127 undetermined pathology). There were 398 663 patients with first-ever AIS and ICH. Patients were followed up for a median (95% CI) of 4.47 years (4.45 to 4.49). HF was associated with an increase in postdischarge mortality in AIS (HR [99% CI] 1.69 [1.64 to 1.74]) and ICH (2.59 [2.07 to 3.26]). HF was not associated with AIS recurrence, while ICH recurrence was only significantly increased within the first 3 years after discharge (1.79 [1.18 to 2.73]).ConclusionsHF increases the risk of mortality in both AIS and ICH. We are the first to report on high-risk periods of stroke recurrence in patients with HF with ICH. Specific targeted risk reduction strategies may have significant clinical impact for mortality and recurrence in stroke.

scholarly journals Impact of Acute Hemoglobin Falls in Heart Failure Patients: A Population Study

2020 ◽  
Vol 9 (6) ◽  
pp. 1869
Author(s):  
Cristina Lopez ◽  
Jose Luis Holgado ◽  
Antonio Fernandez ◽  
Inmaculada Sauri ◽  
Ruth Uso ◽  
...  
Keyword(s):  
Heart Failure ◽  
Kidney Injury ◽  
First Episode ◽  
Heart Failure Patients ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
The Impact ◽  
Worse Prognosis ◽  
Significant Mortality

Aims: This study assessed the impact of acute hemoglobin (Hb) falls in heart failure (HF) patients. Methods: HF patients with repeated Hb values over time were included. Falls in Hb greater than 30% were considered to represent an acute episode of anemia and the risk of hospitalization and all-cause mortality after the first episode was assessed. Results: In total, 45,437 HF patients (54.9% female, mean age 74.3 years) during a follow-up average of 2.9 years were analyzed. A total of 2892 (6.4%) patients had one episode of Hb falls, 139 (0.3%) had more than one episode, and 342 (0.8%) had concomitant acute kidney injury (AKI). Acute heart failure occurred in 4673 (10.3%) patients, representing 3.6/100 HF patients/year. The risk of hospitalization increased with one episode (Hazard Ratio = 1.30, 95% confidence interval (CI) 1.19–1.43), two or more episodes (HR = 1.59, 95% CI 1.14–2.23, and concurrent AKI (HR = 1.61, 95% CI 1.27–2.03). A total of 10,490 patients have died, representing 8.1/100 HF patients/year. The risk of mortality was HR = 2.20 (95% CI 2.06–2.35) for one episode, HR = 3.14 (95% CI 2.48–3.97) for two or more episodes, and HR = 3.20 (95% CI 2.73–3.75) with AKI. In the two or more episodes and AKI groups, Hb levels at the baseline were significantly lower (10.2–11.4 g/dL) than in the no episodes group (12.8 g/dL), and a higher and significant mortality in these subgroups was observed. Conclusions: Hb falls in heart failure patients identified those with a worse prognosis requiring a more careful evaluation and follow-up.

scholarly journals Treatment of Heart Failure Patients with Anxiolytics Is Associated with Adverse Outcomes, with and without Depression

2020 ◽  
Vol 9 (12) ◽  
pp. 3967
Author(s):  
Donna R. Zwas ◽  
Andre Keren ◽  
Offer Amir ◽  
Israel Gotsman
Keyword(s):  
Heart Failure ◽  
Real World ◽  
Nyha Class ◽  
Cardiac Risk ◽  
Adverse Outcomes ◽  
Study Cohort ◽  
Risk Of Mortality ◽  
One Year ◽  
Untreated Individuals ◽  
The Impact

Background: Few studies have evaluated the effect of pharmacologic treatment of anxiety on outcomes in heart failure (HF) patients. This study examined the impact of treatment with anxiolytics on clinical outcomes in a real-world sample of HF patients with and without depression. Methods: Patients diagnosed with HF were retrieved from a large HMO database. Patients prescribed anxiolytic medication and patients diagnosed with depression and/or prescribed anti-depressant medication were followed for cardiac-related hospitalizations and death. Results: The study cohort included 6293 HF patients. Treatment with anxiolytics was associated with decreased one-year survival compared to untreated individuals, with a greater reduction in survival seen in patients diagnosed with depression and/or treated with anti-depressants. Multi-variable analysis adjusting for age, sex, NYHA class, cardiac risk factors and laboratory parameters found that treatment with anxiolytics remained a predictor of mortality even when adjusting for depression. Depression combined with anxiolytic treatment was predictive of increased mortality, and treatment with anxiolytics alone, depression alone and anxiolytic treatment together with depression were each associated with an increased hazard ratio for a composite outcome of death and hospitalization. Conclusions: In this real-world study of HF patients, both treatment with anxiolytics and depression were associated with increased mortality, and anxiolytic therapy remained a predictor of mortality when adjusting for depression. Treatment of anxiety together with depression was associated with the highest risk of mortality. Safe and effective treatment for anxiety and depression is warranted to alleviate the detrimental impact of these disorders on quality and of life and adverse events.

Abstract 107: Home Health Care After Discharge is Associated With Less Early Readmissions for Patients With Acute Myocardial Infarction

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Muhammad A Sheikh ◽  
David Ngendahimana ◽  
Salil V Deo ◽  
Sajjad Raza ◽  
Salah Altarabsheh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Health Care ◽  
Acute Myocardial Infarction ◽  
Logistic Regression ◽  
Regression Model ◽  
Home Health Care ◽  
Home Health ◽  
The Impact ◽  
To Receive

Objective: Home health care (HHC) is a support tool to transition patients after discharge and acute myocardial infarction (AMI) is a significant cause of morbidity and mortality in the U.S. However, little is known regarding the impact of HHC on AMI patients. We sought to identify predictors of readmissions among AMI patients, characteristics of those who receive HHC and investigate the association of HHC with readmission. Methods: We queried the National Readmission Database (NRD) (January 2012 - December 2014), to identify patients discharged after AMI and selected patients who were discharged home with (HHC+) and without HHC (HHC-). We reported national estimates with survey methods with weights provided in our data. After univariate exploratory analyses, we developed a regression model to identify the probability of each patient to receive HHC. From the propensity score, we calculated average treatment on the treated (ATT) weights. These ATT weights were included in the logistic regression model to determine the impact of HHC on readmission after adjusting for available clinical confounders. We considered post-weighting standardized differences <10% as appropriate for our ATT model. To determine clinical factors associated with readmission, we also performed a multi-variable logistic regression with readmission as the end-point. All results were reported as risk ratios (RR) with their 95% confidence intervals (CI). Results: Between January 2012 to December 2014, 406,237 patients were treated for AMI and discharged home with or without HHC. Among these 9.4% (38,215) received HHC. HHC+ patients were older (mean age 77 ± 11 vs 60 ±12 years p<0.001), more likely to be female (53.6% vs. 26.9%, p <0.001), and have cancer (3.7% vs 1.3%, p <0.001), congestive heart failure (5.7% vs. 0.5%, p <0.001), chronic pulmonary disease (23.2% vs. 12.7%, p <0.001), chronic kidney disease (26.9% vs 6.9%, p <0.001), diabetes (35.6% vs. 26.7%, p <0.001), hypertension (70.7% vs. 64.8%, p <0.001) and peripheral vascular disease (14.6% vs 6.4%, p <0.001). Patients readmitted after MI were more likely to be older and have diabetes (RR 1.42, 95% CI 1.37-1.48), CHF (RR 5.89, CI 5.55-6.26) or COPD (RR 1.59, 1.52-1.65). Unadjusted 30-day readmission rate was 20.9% for HHC+ and 8.2% for HHC- patients. Propensity-weighted adjustment for covariates yielded 36,979 HHC+ patients and 37,785 HHC- patients. Adjusted risk rations (RR) for 30-day readmission were computed using ATT weights, and HHC+ patients had significantly lower readmission risk (RR 0.89, 95% CI 0.82 - 0.96) compared to HHC- (RR 1.12, 95% CI 1.04 - 1.21; p < 0.001) Conclusion: In the United States, a small proportion of patients receive home health care after discharge post-AMI. Older, females and those with diabetes or heart failure are more likely to receive home health care. Use of home health care may be associated with lower 30-day readmission rates after AMI.

scholarly journals Management of Arrhythmias in Heart Failure

2017 ◽  
Vol 10 ◽  
Author(s):  
Ilaria Spoletini ◽  
Andrew Coats
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Mortality And Morbidity ◽  
Ablative Therapies ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Patients With Heart Failure ◽  
Inflammatory Processes ◽  
The Impact

Patients with heart failure (HF) often develop ventricular and supraventricular arrhythmias, due in large part to electrical conduction abnormalities of the heart in this syndrome. Cardiac remodeling and neurohumoral activation typical of HF create a substrate that increases the risk of developing arrhythmias and/or worsening pre- existing arrhythmias. Advances in our understanding of the underlying pathophysiological mechanisms of HF have reinforced the importance of neurohumoral, mechanical and inflammatory processes as progressively more severe pump dysfunction occurs. This combination increases the likelihood of arrhythmias, both atrial and ventricular, such that ventricular arrhythmias are found in up to 80% of patients with severe HF, conferring additional risk of mortality and morbidity, in particular via an increased risk of sudden cardiac death. Arrhythmias are also responsible for an increased risk of rehospitalisation in one-third of HF patients. The high risk of arrhythmias should always be considered during the clinical management of all HF patients, due their association with worse prognosis and increased mortality. In particular, HF and atrial fibrillation mutually worsen the impact of each other. Treatment of atrial fibrillation in the setting of HF includes a variety of approaches such as drugs, devices and ablation. Restoration of sinus rhythm is not superior to optimal rate control, and the deleterious effects of antiarrhythmic drugs should be considered. Finally, cardiac function, symptoms, and quality of life may improve with catheter-based ablative therapies in appropriately selected patients with HF.

Characteristics and outcome of acute heart failure in infective endocarditis: focus on cardiogenic shock

2021 ◽  
Author(s):  
Juan M Pericàs ◽  
Marta Hernández-Meneses ◽  
Patricia Muñoz ◽  
Manuel Martínez-Sellés ◽  
Ana Á lvarez-Uria ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Cardiogenic Shock ◽  
Acute Heart Failure ◽  
Heart Block ◽  
Left Ventricle Ejection Fraction ◽  
Regression Analyses ◽  
Risk Of Mortality ◽  
The Impact ◽  
Very High

Abstract Background Studies investigating the impact of cardiogenic shock (CS) on endocarditis are lacking. We aimed to investigate the characteristics and outcomes of endocarditis patients presenting with acute heart failure (AHF), particularly of those developing CS. Methods Prospectively collected cohort from 35 Spanish centers (2008-2018). Logistic regression analyses were performed to identify risk factors for developing CS and predictors of mortality. Results Amongst 4,856 endocarditis patients, 1,652 (34%) had AHF and 244 (5%) CS. Compared to patients without AHF and AHF but no CS, patients with CS presented higher rates of surgery (40.5%, 52.5% and 68%,p&lt;.001) and in-hospital mortality (16.3%,39.1%, and 52.5%). Compared to patients with septic shock, CS patients presented higher rates of surgery (42.5% vs. 68%, p&lt;.001), and lower rates of in-hospital and 1-year mortality (62.3% vs. 52.5%,p.008;and 65.3% vs. 57.4%,p.030). Severe aortic and mitral regurgitation (OR 2.47, 95%CI 1.82-3.35 and OR 3.03, 95%CI 2.26-4.07, both p&lt;.001), left-ventricle ejection fraction&lt;60% (OR 1.72, 95%CI 1.22-2.40, p.002), heart block (OR 2.22, 95%CI 1.41-3.47, p.001), tachyarrhythmias (OR 5.07,95%CI 3.13-8.19, p&lt;.001) and acute kidney failure (OR 2.29, 95%CI 1.73-3.03,p&lt;.001) were associated to a higher likelihood of developing CS. Prosthetic endocarditis (OR 2.03, 95%CI 1.06-3.88, p.032), S. aureus (OR 3.10, 95%CI 1.16-8.30, p.024), tachyarrhythmias (OR 3.09,95%CI 1.50-10.13, p.005), and not performing cardiac surgery (OR 11.40, 95%CI 4.83-26.90, p&lt;.001) were associated to a higher risk of mortality. Conclusions Acute heart failure is common among patients with endocarditis. Cardiogenic shock is associated to very high mortality and should be promptly identified and assessed for cardiac surgery.

scholarly journals Home Health Care Nursing Visit Intensity and Heart Failure Patient Outcomes

2011 ◽  
Vol 23 (6) ◽  
pp. 412-420 ◽  
Author(s):  
Jennifer S. Riggs ◽  
Elizabeth A. Madigan ◽  
Richard H. Fortinsky
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Activities Of Daily Living ◽  
Home Health Care ◽  
Daily Living ◽  
Secondary Analysis ◽  
Patient Characteristics ◽  
Home Health ◽  
Nursing Visit ◽  
The Impact

This study is a secondary analysis of data for 107 home health care heart failure patients. The authors investigate the impact of patient characteristics and nursing visit intensity on change in activities of daily living (ADL) status and instrumental activities of daily living (IADL) status and improvement/stabilization of dyspnea. Prior hospital stay (ß = .38, p = .001) and nursing visit intensity (ß = –.39, p = .001) predict improvement in ADL status. The model for change in IADL status is not significant. Patients with more than two comorbidities (OR = 6.5, p = .04) and patients who received higher nursing visit intensity (OR = 7.0, p = .04) are more likely to have improved/stabilized dyspnea at home care discharge.

What is the impact of depressive and anxious symptoms on quality of life in veterans with heart failure?

2010 ◽  
Author(s):  
J. A. Cully ◽  
L. L. Phillips ◽  
M. E. Kunik ◽  
M. A. Stanley ◽  
A. Deswal
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
The Impact
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