George Heckman - Academia.edu (original) (raw)

Papers by George Heckman

Int J Palliat Nurs, 2013

The purpose of this study was to explore the experiences of long-term care (LTC) residents living... more The purpose of this study was to explore the experiences of long-term care (LTC) residents living and dying with heart failure (HF)and their family members. An exploratory descriptive design was used to collect data from seven LTC residents and seven family members. The data was analysed using thematic content analysis. The main themes that emerged from the data were: limited understanding of the HF diagnosis, living with restrictions and other comorbidities, making decisions about transitioning to end-of-life care, and learning and negotiating the lines of communication. Residents and family members communicated with many health-care providers about managing the HF symptoms but most often worked through the nurse when problems arose or decisions about care needed to be made. The findings from this study contribute to our understanding of residents' and family members' experiences in managing residents' HF in LTC.

A method is proposed to eliminate the central hole present in the annular beams emitted by lasers... more A method is proposed to eliminate the central hole present in the annular beams emitted by lasers equipped with unstable resonators. The method is based on the use of conical reflectors, or axicons. The first axicon is converging with a 45° cone angle; the second axicon is diverging with a 45° cone angle. The converging axicon has a central hole of diameter equal to the diameter of the diverging axicon. It can be shown that the combination of these two axicons yields an output laser beam with a near field of hyperbolic shape and a far field where 89% of power is contained in the central lobe. Inadequate axial positioning of the axicons or inappropriate values of the cone angles result in a degradation of the optical quality of the far field; the tolerance to such errors is evaluated for typical CO2 laser parameters.

Canadian family physician Medecin de famille canadien

To provide family physicians with a structured approach to patients presenting with memory diffic... more To provide family physicians with a structured approach to patients presenting with memory difficulties. The approach is based on an accredited memory clinic training program developed by the Centre for Family Medicine Memory Clinic in partnership with the Ontario College of Family Physicians. Use of a structured clinical reasoning approach can assist physicians in achieving an accurate diagnosis in patients presenting with memory difficulties. Delirium, depression, and reversible causes need to be excluded, followed by differentiation among normal cognitive aging, mild cognitive impairment, and dementia. Obtaining collateral history and accurate functional assessment are critical. Common forms of dementia can be clinically differentiated by the order in which symptoms appear and by how cognitive deficits evolve over time. Typically, early signs of Alzheimer dementia involve impairment in episodic memory, whereas dementia involving predominantly vascular causes might present with ea...

Developments in Cardiovascular Medicine, 2004

Chapter 1 AGING AND HEART DISEASE Irene D. Turpie and George A. Heckman ... BMJ 1994;308:1604-!60... more Chapter 1 AGING AND HEART DISEASE Irene D. Turpie and George A. Heckman ... BMJ 1994;308:1604-!608. 6. Cacciatore F, Abete P, Ferrara N, Calabrese C, Napoli C, Maggi S, Varrichio M, Rengo F. Congestive heart failure and cognitive impairment in an older population. ...

Canadian Journal of Cardiology, 2015

The Canadian Cardiovascular Society Heart Failure (HF) Guidelines Program has generated annual HF... more The Canadian Cardiovascular Society Heart Failure (HF) Guidelines Program has generated annual HF updates, including formal recommendations and supporting Practical Tips since 2006. Many clinicians indicate they routinely use the Canadian Cardiovascular Society HF Guidelines in their daily practice. However, many questions surrounding the actual implementation of the Guidelines into their daily practice remain. A consensus-based approach was used, including feedback from the Primary and Secondary HF Panels. This companion is intended to answer several key questions brought forth by HF practitioners such as appropriate timelines for initial assessments and subsequent reassessments of patients, the order in which medications should be added, how newer medications should be included in treatment algorithms, and when left ventricular function should be reassessed. A new treatment algorithm for HF with reduced ejection fraction is included. Several other practical issues are addressed such as an approach to management of hyperkalemia/hypokalemia, treatment of gout, when medications can be stopped, and whether a target blood pressure or heart rate is suggested. Finally, elements and teaching of self-care are described. This tool will hopefully function to allow better integration of the HF Guidelines into clinical practice.

Dementia developed in a patient with widespread neurologic manifestations; she died within 5 mont... more Dementia developed in a patient with widespread neurologic manifestations; she died within 5 months. Pathologic findings showed granulomatous inflammation with caseation necrosis, foreign body-type giant cells, and proliferative endarteritis with vascular occlusions. Broadrange polymerase chain reaction identified Mycobacterium neoaurum as the possible pathogen. Central nervous system infection by M. neoaurum may result in rapidly progressive dementia.

Pilot and Feasibility Studies, 2015

Background: Declines in function and quality of life, and an increased risk of cardiovascular eve... more Background: Declines in function and quality of life, and an increased risk of cardiovascular events, falls, and fractures occur with aging and may be amenable to exercise intervention. Primary care is an ideal setting for identifying older adults in need of exercise intervention. However, a cost-effective, generalizable model of chronic disease management using exercise in a real-world setting remains elusive. Our objective is to measure the feasibility, potential effectiveness, and implementation of an evidence-based Lifestyle-integrated Functional strength and balance Exercise (LiFE) intervention adapted as a group-based format (Mi-LiFE) for primary care to promote increased physical activity levels in older adults aged 75 years or older. We hypothesize that the intervention will be feasible without modification if ≥30 individuals are recruited over 6 months, ≥75 % of our sample is retained, and ≥50 % of our sample complete exercises ≥3 days per week. Methods/design: A pre-post pilot study design will be used to evaluate feasibility, potential effectiveness, and implementation outcomes over a 6-month period in physically inactive older adults ≥75 years recruited from a local family health team practice. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework will be applied to evaluate the public health effects of the intervention including outcomes both at the individual and organizational levels. A physical therapist will teach participants how to integrate strength and balance activities into their daily lives over one individual and four group-based sessions, and two phone calls. Assessments will be completed at baseline and 6 months. Feasibility outcomes include recruitment over 6 months, retention at follow-up, and adherence measured by activity diaries. Change in patient-centered and implementation outcomes that will be evaluated include physical activity levels using accelerometers and International Physical Activity Questionnaire, physical performance using short physical performance battery, quality of life using EQ5D questionnaire, falls and harms using daily calendar diaries and self-report, fidelity using descriptive feedback, barriers and facilitators to implementation using thematic content analysis, and process outcomes. Discussion: The feasibility and implementation of the Mi-LiFE intervention in primary care for older adults will be evaluated, as well as the effects of the intervention on secondary outcomes. If the intervention appears feasible, we will use the resultant information to design a larger trial.

Healthcare Management Forum, 2015

This study examined the prevalence of Control Intervention (CI) use in adult in-patient psychiatr... more This study examined the prevalence of Control Intervention (CI) use in adult in-patient psychiatric units/hospitals in Ontario and developed a profile of those patients who had CI use during their admission between April 2006 and March 2010. Control intervention types included mechanical/physical, chair prevents rising, acute control medications, and seclusion. The profiles of patients with control intervention use included an examination of sociodemographic, mental health service use, and mental health clinical characteristics.

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 28, 2000

Canadian family physician Medecin de famille canadien, 2015

To help family physicians better recognize frailty and its implications for managing elderly pati... more To help family physicians better recognize frailty and its implications for managing elderly patients. PubMed-MEDLINE was searched from 1990 to 2013. The search was restricted to English-language articles using the following groups of MeSH headings and key words: frail elderly, frail, frailty; aged, geriatrics, geriatric assessment, health services for the aged; and primary health care, community health services, and family practice. Frailty is common, particularly in elderly persons with complex chronic conditions such as heart failure and chronic obstructive pulmonary disease. Emerging evidence demonstrates the value of frailty as a predictor of adverse outcomes in older persons. While there is currently a lack of consensus as to how best to assess and diagnose frailty in primary care practice, individual markers of frailty such as low gait speed offer a promising feasible means of screening for frailty. Identification of frailty in primary care might provide an opportunity to del...

Developments in Cardiovascular Medicine, 2004

Page 1. Chapter 7 HEART FAILURE IN THE FRAIL ELDERLY George A. Heckman, Robert S. McKelvie, Irene... more Page 1. Chapter 7 HEART FAILURE IN THE FRAIL ELDERLY George A. Heckman, Robert S. McKelvie, Irene D. Turpie ... 30%, p<O.OOI). In the latter two studies, the severity of cognitive impairment was related to the severity of LV systolic dysfunction. ...

JACC: Heart Failure, 2015

The purpose of this study was to examine cerebral blood flow (CBF) supine and during upright sitt... more The purpose of this study was to examine cerebral blood flow (CBF) supine and during upright sitting in HF patients and control subjects to test the hypothesis that patients with HF will have a greater reduction in CBF from supine to seated compared with the control group. Reduced CBF has been reported in patients with heart failure (HF). However, previous work has only examined CBF while supine, although an upright posture common to daily living may lead to further reductions. In 22 HF patients and 22 age- and sex-matched control subjects, continuous heart rate, mean arterial pressure, and end-tidal carbon dioxide readings were collected while supine and seated upright. Cardiac output was estimated from pulse contour analysis and was corrected for body size (cardiac index). The right internal carotid artery was imaged by using ultrasound to estimate CBF. Heart rate increased less in response to the upright posture in HF patients versus control subjects (p = 0.006). Mean arterial pressure was unchanged, whereas end-tidal carbon dioxide decreased in response to position (p = 0.004) but did not differ between groups. Cardiac index was lower in patients with HF (p < 0.001) and decreased in both groups in response to the upright posture (p = 0.025), with a trend for a greater decrease in the HF group (p = 0.065). CBF decreased more in response to the upright posture in the HF group than in the control group (p = 0.007). The reduction in CBF was exaggerated in the upright posture in HF patients and may increase the risk for subsequent cognitive impairment.

Background: Inappropriate prescribing has been estimated to be as high as 40% in long-term care. ... more Background: Inappropriate prescribing has been estimated to be as high as 40% in long-term care. The purpose of this study was to develop a computer program that identifies potentially inappropriate drug prescriptions and to test its reliability.

Background: Bisphosphonates are indicated in the prevention and treatment of osteoporosis. Howeve... more Background: Bisphosphonates are indicated in the prevention and treatment of osteoporosis. However, bone mineral density (BMD) continues to decline in up to 15% of bisphosphonate users. While randomized trials have evaluated the efficacy of concurrent bisphosphonates and vitamin D, the incremental benefit of vitamin D remains uncertain.

Ageing Res, 2010

Patients with Creutzfeldt-Jakob disease (CJD) may exhibit characteristic abnormalities on the ele... more Patients with Creutzfeldt-Jakob disease (CJD) may exhibit characteristic abnormalities on the electroencephalogram (EEG). However, these abnormalities have been associated with a number of cases of drug toxicity. We report a case of CJD-like syndrome associated with gabapentin. A 78-year-old man was hospitalized for recurrent falls. Three months prior to admission, gabapentin was prescribed to treat symptoms of trigeminal neuralgia. The patient subsequently presented with a two-month history of worsening gait abnormalities, negative myoclonus, and cognitive impairment. The EEG showed diffuse background slowing with larger amplitude delta discharges, which at times appeared triphasic, raising the possibility of CJD. The gait abnormalities and myoclonus resolved and the EEG normalized after the gabapentin was discontinued. Several cases of drug-induced CJD-like syndrome have been reported, mainly presenting with cognitive impairment, myoclonus, Parkinsonism, and EEG abnormalities. This patient may have been predisposed to adverse neurological effects from gabapentin owing to age, concurrent renal insufficiency, and cardiac disease. We concluded that it is imperative to include drug toxicity in the differential diagnosis of patients presenting with clinical manifestations and EEG findings suggestive of CJD, particularly in the setting of advanced age and comorbidities. This work is licensed under a Creative Commons Attribution 3.0 License (by-nc 3.0) ©Copyright V.

Geriatric Medicine is well-suited to inform and lead healthcare system redesign to address the ne... more Geriatric Medicine is well-suited to inform and lead healthcare system redesign to address the needs of seniors with complex conditions. We posit that geriatricians must urgently consider how to "brand" Geriatric Medicine in a manner that garners active support from those outside the specialty, including how to adapt practice patterns to better meet the needs of patients and of the health-care system.

Heart failure (HF) is common in long-term care (LTC). Diagnostic uncertainty is important barrier... more Heart failure (HF) is common in long-term care (LTC). Diagnostic uncertainty is important barrier to optimal HF management, stemming from inadequate health information transfer upon LTC admission. We determine the utility of admission clinical information to confirm a HF diagnosis in new LTC residents.

Int J Palliat Nurs, 2013

The purpose of this study was to explore the experiences of long-term care (LTC) residents living... more The purpose of this study was to explore the experiences of long-term care (LTC) residents living and dying with heart failure (HF)and their family members. An exploratory descriptive design was used to collect data from seven LTC residents and seven family members. The data was analysed using thematic content analysis. The main themes that emerged from the data were: limited understanding of the HF diagnosis, living with restrictions and other comorbidities, making decisions about transitioning to end-of-life care, and learning and negotiating the lines of communication. Residents and family members communicated with many health-care providers about managing the HF symptoms but most often worked through the nurse when problems arose or decisions about care needed to be made. The findings from this study contribute to our understanding of residents' and family members' experiences in managing residents' HF in LTC.

A method is proposed to eliminate the central hole present in the annular beams emitted by lasers... more A method is proposed to eliminate the central hole present in the annular beams emitted by lasers equipped with unstable resonators. The method is based on the use of conical reflectors, or axicons. The first axicon is converging with a 45° cone angle; the second axicon is diverging with a 45° cone angle. The converging axicon has a central hole of diameter equal to the diameter of the diverging axicon. It can be shown that the combination of these two axicons yields an output laser beam with a near field of hyperbolic shape and a far field where 89% of power is contained in the central lobe. Inadequate axial positioning of the axicons or inappropriate values of the cone angles result in a degradation of the optical quality of the far field; the tolerance to such errors is evaluated for typical CO2 laser parameters.

Canadian family physician Medecin de famille canadien

To provide family physicians with a structured approach to patients presenting with memory diffic... more To provide family physicians with a structured approach to patients presenting with memory difficulties. The approach is based on an accredited memory clinic training program developed by the Centre for Family Medicine Memory Clinic in partnership with the Ontario College of Family Physicians. Use of a structured clinical reasoning approach can assist physicians in achieving an accurate diagnosis in patients presenting with memory difficulties. Delirium, depression, and reversible causes need to be excluded, followed by differentiation among normal cognitive aging, mild cognitive impairment, and dementia. Obtaining collateral history and accurate functional assessment are critical. Common forms of dementia can be clinically differentiated by the order in which symptoms appear and by how cognitive deficits evolve over time. Typically, early signs of Alzheimer dementia involve impairment in episodic memory, whereas dementia involving predominantly vascular causes might present with ea...

Developments in Cardiovascular Medicine, 2004

Chapter 1 AGING AND HEART DISEASE Irene D. Turpie and George A. Heckman ... BMJ 1994;308:1604-!60... more Chapter 1 AGING AND HEART DISEASE Irene D. Turpie and George A. Heckman ... BMJ 1994;308:1604-!608. 6. Cacciatore F, Abete P, Ferrara N, Calabrese C, Napoli C, Maggi S, Varrichio M, Rengo F. Congestive heart failure and cognitive impairment in an older population. ...

Canadian Journal of Cardiology, 2015

The Canadian Cardiovascular Society Heart Failure (HF) Guidelines Program has generated annual HF... more The Canadian Cardiovascular Society Heart Failure (HF) Guidelines Program has generated annual HF updates, including formal recommendations and supporting Practical Tips since 2006. Many clinicians indicate they routinely use the Canadian Cardiovascular Society HF Guidelines in their daily practice. However, many questions surrounding the actual implementation of the Guidelines into their daily practice remain. A consensus-based approach was used, including feedback from the Primary and Secondary HF Panels. This companion is intended to answer several key questions brought forth by HF practitioners such as appropriate timelines for initial assessments and subsequent reassessments of patients, the order in which medications should be added, how newer medications should be included in treatment algorithms, and when left ventricular function should be reassessed. A new treatment algorithm for HF with reduced ejection fraction is included. Several other practical issues are addressed such as an approach to management of hyperkalemia/hypokalemia, treatment of gout, when medications can be stopped, and whether a target blood pressure or heart rate is suggested. Finally, elements and teaching of self-care are described. This tool will hopefully function to allow better integration of the HF Guidelines into clinical practice.

Dementia developed in a patient with widespread neurologic manifestations; she died within 5 mont... more Dementia developed in a patient with widespread neurologic manifestations; she died within 5 months. Pathologic findings showed granulomatous inflammation with caseation necrosis, foreign body-type giant cells, and proliferative endarteritis with vascular occlusions. Broadrange polymerase chain reaction identified Mycobacterium neoaurum as the possible pathogen. Central nervous system infection by M. neoaurum may result in rapidly progressive dementia.

Pilot and Feasibility Studies, 2015

Background: Declines in function and quality of life, and an increased risk of cardiovascular eve... more Background: Declines in function and quality of life, and an increased risk of cardiovascular events, falls, and fractures occur with aging and may be amenable to exercise intervention. Primary care is an ideal setting for identifying older adults in need of exercise intervention. However, a cost-effective, generalizable model of chronic disease management using exercise in a real-world setting remains elusive. Our objective is to measure the feasibility, potential effectiveness, and implementation of an evidence-based Lifestyle-integrated Functional strength and balance Exercise (LiFE) intervention adapted as a group-based format (Mi-LiFE) for primary care to promote increased physical activity levels in older adults aged 75 years or older. We hypothesize that the intervention will be feasible without modification if ≥30 individuals are recruited over 6 months, ≥75 % of our sample is retained, and ≥50 % of our sample complete exercises ≥3 days per week. Methods/design: A pre-post pilot study design will be used to evaluate feasibility, potential effectiveness, and implementation outcomes over a 6-month period in physically inactive older adults ≥75 years recruited from a local family health team practice. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework will be applied to evaluate the public health effects of the intervention including outcomes both at the individual and organizational levels. A physical therapist will teach participants how to integrate strength and balance activities into their daily lives over one individual and four group-based sessions, and two phone calls. Assessments will be completed at baseline and 6 months. Feasibility outcomes include recruitment over 6 months, retention at follow-up, and adherence measured by activity diaries. Change in patient-centered and implementation outcomes that will be evaluated include physical activity levels using accelerometers and International Physical Activity Questionnaire, physical performance using short physical performance battery, quality of life using EQ5D questionnaire, falls and harms using daily calendar diaries and self-report, fidelity using descriptive feedback, barriers and facilitators to implementation using thematic content analysis, and process outcomes. Discussion: The feasibility and implementation of the Mi-LiFE intervention in primary care for older adults will be evaluated, as well as the effects of the intervention on secondary outcomes. If the intervention appears feasible, we will use the resultant information to design a larger trial.

Healthcare Management Forum, 2015

This study examined the prevalence of Control Intervention (CI) use in adult in-patient psychiatr... more This study examined the prevalence of Control Intervention (CI) use in adult in-patient psychiatric units/hospitals in Ontario and developed a profile of those patients who had CI use during their admission between April 2006 and March 2010. Control intervention types included mechanical/physical, chair prevents rising, acute control medications, and seclusion. The profiles of patients with control intervention use included an examination of sociodemographic, mental health service use, and mental health clinical characteristics.

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 28, 2000

Canadian family physician Medecin de famille canadien, 2015

To help family physicians better recognize frailty and its implications for managing elderly pati... more To help family physicians better recognize frailty and its implications for managing elderly patients. PubMed-MEDLINE was searched from 1990 to 2013. The search was restricted to English-language articles using the following groups of MeSH headings and key words: frail elderly, frail, frailty; aged, geriatrics, geriatric assessment, health services for the aged; and primary health care, community health services, and family practice. Frailty is common, particularly in elderly persons with complex chronic conditions such as heart failure and chronic obstructive pulmonary disease. Emerging evidence demonstrates the value of frailty as a predictor of adverse outcomes in older persons. While there is currently a lack of consensus as to how best to assess and diagnose frailty in primary care practice, individual markers of frailty such as low gait speed offer a promising feasible means of screening for frailty. Identification of frailty in primary care might provide an opportunity to del...

Developments in Cardiovascular Medicine, 2004

Page 1. Chapter 7 HEART FAILURE IN THE FRAIL ELDERLY George A. Heckman, Robert S. McKelvie, Irene... more Page 1. Chapter 7 HEART FAILURE IN THE FRAIL ELDERLY George A. Heckman, Robert S. McKelvie, Irene D. Turpie ... 30%, p<O.OOI). In the latter two studies, the severity of cognitive impairment was related to the severity of LV systolic dysfunction. ...

JACC: Heart Failure, 2015

The purpose of this study was to examine cerebral blood flow (CBF) supine and during upright sitt... more The purpose of this study was to examine cerebral blood flow (CBF) supine and during upright sitting in HF patients and control subjects to test the hypothesis that patients with HF will have a greater reduction in CBF from supine to seated compared with the control group. Reduced CBF has been reported in patients with heart failure (HF). However, previous work has only examined CBF while supine, although an upright posture common to daily living may lead to further reductions. In 22 HF patients and 22 age- and sex-matched control subjects, continuous heart rate, mean arterial pressure, and end-tidal carbon dioxide readings were collected while supine and seated upright. Cardiac output was estimated from pulse contour analysis and was corrected for body size (cardiac index). The right internal carotid artery was imaged by using ultrasound to estimate CBF. Heart rate increased less in response to the upright posture in HF patients versus control subjects (p = 0.006). Mean arterial pressure was unchanged, whereas end-tidal carbon dioxide decreased in response to position (p = 0.004) but did not differ between groups. Cardiac index was lower in patients with HF (p < 0.001) and decreased in both groups in response to the upright posture (p = 0.025), with a trend for a greater decrease in the HF group (p = 0.065). CBF decreased more in response to the upright posture in the HF group than in the control group (p = 0.007). The reduction in CBF was exaggerated in the upright posture in HF patients and may increase the risk for subsequent cognitive impairment.

Background: Inappropriate prescribing has been estimated to be as high as 40% in long-term care. ... more Background: Inappropriate prescribing has been estimated to be as high as 40% in long-term care. The purpose of this study was to develop a computer program that identifies potentially inappropriate drug prescriptions and to test its reliability.

Background: Bisphosphonates are indicated in the prevention and treatment of osteoporosis. Howeve... more Background: Bisphosphonates are indicated in the prevention and treatment of osteoporosis. However, bone mineral density (BMD) continues to decline in up to 15% of bisphosphonate users. While randomized trials have evaluated the efficacy of concurrent bisphosphonates and vitamin D, the incremental benefit of vitamin D remains uncertain.

Ageing Res, 2010

Patients with Creutzfeldt-Jakob disease (CJD) may exhibit characteristic abnormalities on the ele... more Patients with Creutzfeldt-Jakob disease (CJD) may exhibit characteristic abnormalities on the electroencephalogram (EEG). However, these abnormalities have been associated with a number of cases of drug toxicity. We report a case of CJD-like syndrome associated with gabapentin. A 78-year-old man was hospitalized for recurrent falls. Three months prior to admission, gabapentin was prescribed to treat symptoms of trigeminal neuralgia. The patient subsequently presented with a two-month history of worsening gait abnormalities, negative myoclonus, and cognitive impairment. The EEG showed diffuse background slowing with larger amplitude delta discharges, which at times appeared triphasic, raising the possibility of CJD. The gait abnormalities and myoclonus resolved and the EEG normalized after the gabapentin was discontinued. Several cases of drug-induced CJD-like syndrome have been reported, mainly presenting with cognitive impairment, myoclonus, Parkinsonism, and EEG abnormalities. This patient may have been predisposed to adverse neurological effects from gabapentin owing to age, concurrent renal insufficiency, and cardiac disease. We concluded that it is imperative to include drug toxicity in the differential diagnosis of patients presenting with clinical manifestations and EEG findings suggestive of CJD, particularly in the setting of advanced age and comorbidities. This work is licensed under a Creative Commons Attribution 3.0 License (by-nc 3.0) ©Copyright V.

Geriatric Medicine is well-suited to inform and lead healthcare system redesign to address the ne... more Geriatric Medicine is well-suited to inform and lead healthcare system redesign to address the needs of seniors with complex conditions. We posit that geriatricians must urgently consider how to "brand" Geriatric Medicine in a manner that garners active support from those outside the specialty, including how to adapt practice patterns to better meet the needs of patients and of the health-care system.

Heart failure (HF) is common in long-term care (LTC). Diagnostic uncertainty is important barrier... more Heart failure (HF) is common in long-term care (LTC). Diagnostic uncertainty is important barrier to optimal HF management, stemming from inadequate health information transfer upon LTC admission. We determine the utility of admission clinical information to confirm a HF diagnosis in new LTC residents.