Epidemiological and assistance care profile of patients with heart failure in a regional reference municipality (original) (raw)
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Lancet, 2002
Interpretation Results from this survey suggest that most patients with heart failure are appropriately investigated, although this finding might be as a result of high rates of hospital admissions. However, treatment seems to be less than optimum, and there are substantial variations in practice between countries. The inconsistencies between physicians' knowledge and the treatment that they deliver suggests that improved organisation of care for heart failure is required. *See end for a full list of committee members and national and regional co-ordinators. See http://image.thelancet.com/extras/01art10209webappendix.pdf for full list of investigators
Heart failure in primary care: co-morbidity and utilization of health care resources
Family Practice, 2013
Background. In order to ensure proper management of primary care (PC) services, the efficiency of the health professionals tasked with such services must be known. Patients with heart failure (HF) are characterized by advanced age, high co-morbidity and high resource utilization. Objective. To ascertain PC resource utilization by HF patients and variability in the management of such patients by GPs. Methods. Descriptive, cross-sectional study targeting a population attended by 129 GPs over the course of 1 year. All patients with diagnosis of HF in their clinical histories were included, classified using the Adjusted Clinical Group system and then grouped into six resource utilization bands (RUBs). Resource utilization and Efficiency Index were both calculated. Results. One hundred per cent of patients with HF were ranked in RUBs 3, 4 and 5. The highest GP visit rate was 20 and the lowest in excess of 10 visits per year. Prescription drug costs for these patients ranged from €885 to €1422 per patient per year. Health professional efficiency varied notably, even after adjustment for co-morbidity (Efficiency Index Variation Ratio of 28.27 for visits and 404.29 for prescription drug cost). Conclusions. Patients with HF register a high utilization of resources, and there is great variability in the management of such patients by health professionals, which cannot be accounted for by the degree of case complexity.
Improvement of primary care for patients with chronic heart failure: a pilot study
BMC Health Services Research, 2010
Background: Many patients with chronic heart failure (CHF) receive treatment in primary care, but data have shown that the quality of care for these patients needs to be improved. We aimed to evaluate the impact and feasibility of a programme for improving primary care for patients with CHF. Methods: An observational study was performed in 19 general practices in the southeastern part of the Netherlands, evaluation involving 15 general practitioners and 77 CHF patients. The programme for improvement comprised educational and organizational components and was delivered by a trained practice visitor to the practices. The evaluation was based on case registration forms completed by health professionals and telephone interviews. Results: Management relating to diet and physical exercise seemed to have improved as eight patients were referred to dieticians and five to physiotherapists. The seasonal influenza vaccination rate increased from 94% to 97% (75/77). No impact on smoking was observed. Pharmaceutical treatment was adjusted according to guideline recommendations in 12% of the patients (9/77); 7 patients started recommended medication and 2 patients received dosage adjustments. General practitioners perceived the programme to be feasible. Clinical task delegation to nurses and assistants increased in some practices, but collaboration with other healthcare providers remained limited. Conclusions: The improvement programme proved to have moderate impact on patient care. Its effectiveness should be tested in a larger rigorous evaluation study using modifications based on the pilot experiences.
Role of family physicians in the prevention of heart failure
Здоров'я суспільства, 2018
Background. Heart failure is a life-threatening disease, and its solution should be seen as a global health priority. Heart failure is indeed a complex disease and has until now been the leading cause of morbidity and mortality in developing and developed countries. Standardized medical therapy was successful in the early stages of heart failure. The advanced stages of heart failure require frequent hospitalization because of the presence of severe heart failure and / or associated co-morbid conditions that require the strict implementation of an adequately individualized multidisciplinary approach and quality measures. Materials and methods. In our review Ukrainian and international clinical guidelines, recommendations, documents and scientific literature were used. Results. The range of diseases that predispose patients to heart failure is extremely wide. Health care professionals in all clinical disciplines should receive education to identify patients with diseases that increase the risk of heart failure and prescribe preventive medications. This ensures that as many people as possible get access to therapyEven after the development of heart failure, premature deaths can be prevented if they are taught to recognize symptoms and seek immediate medical attention. Public awareness campaigns on these messages have a great potential for improving outcomes for patients with heart failure and, ultimately, for saving lives.Compliance with the recommendations of clinical practice is also associated with improved results for patients with heart failure. However, there are significant differences in how closely the doctors follow the recommendations. In order to promote equitable care, improvements should be promoted through the use of indicators and incentives for hospitals that are appropriate to local conditions. The policy should facilitate the research needed to create an evidence base for performance indicators that reflect improved outcomes for patients. Conclusions. Prevention of heart failure is of paramount importance. Ensuring access to preventive drugs should be provided to those who are at greatest risk for developing heart failure, regardless of age, sex or income. Cost-effective information, education and support programs to reduce the risk of heart failure should be at the forefront of public health guidelines. Lifestyle events can have a significant impact on the health of the world, because obesity, diabetes, cigarette smoking and high blood pressure significantly increase the likelihood of heart failure. Renewing commitment to public education the importance of healthy nutrition and weight, regular exercise and prevention of smoking should be a priority for policy makers.
American Heart Journal, 2009
Background Disease management programs (DMPs) are developed to address the high morbi-mortality and costs of congestive heart failure (CHF). Most studies have focused on intensive programs in academic centers. Washington County Hospital (WCH) in Hagerstown, MD, the primary reference to a semirural county, established a CHF DMP in 2001 with standardized documentation of screening and participation. Linkage to electronic records and state vital statistics enabled examination of the CHF population including individuals participating and those ineligible for the program. Methods All WCH inpatients with CHF International Classification of Diseases, Ninth Revision code in any position of the hospital list discharged alive. Results Of 4,545 consecutive CHF admissions, only 10% enrolled and of those only 52.2% made a call. Enrollment in the program was related to: age (OR 0.64 per decade older, 95% CI 0.58-0.70), CHF as the main reason for admission (OR 3.58, 95% CI 2.4-4.8), previous admission for CHF (OR 1.14, 95% CI 1.09-1.2), and shorter hospital stay (OR 0.94 per day longer, 95% CI 0.87-0.99). Among DMP participants mortality rates were lowest in the first month (80/1000 person-years) and increased subsequently. The opposite mortality trend occurred in nonenrolled groups with mortality in the first month of 814 per 1000 person-years in refusers and even higher in ineligible (1569/1000 person-years). This difference remained significant after adjustment. Re-admission rates were lower among participants who called consistently (adjusted incidence rate ratio 0.62, 95% CI 0.52-0.77). Conclusion Only a small and highly select group participated in a low-intensity DMP for CHF in a community-based hospital. Design of DMPs should incorporate these strong selective factors to maximize program impact.
Public Health, 2005
To compare the management of heart failure with the standards set out in the National Service Framework for Coronary Heart Disease. A cross-sectional study in 26 general practices, with a combined list size of 256,188, that are members of the Kent, Surrey and Sussex Primary Care Research Network. Information was extracted on the management of 2129 patients with heart failure, of whom 2097 were aged 45 years and over. The prevalence of heart failure was 8.3 per 1000. Prevalence rates increased with age, from 0.2 per 1000 in people aged under 35 years of age to 125 per 1000 in those aged 85 years and over. Coronary heart disease (present in 47%) was the most common comorbid condition in men with heart failure, whereas hypertension (present in 46%) was the most common condition in women. Recording of cardiovascular risk factors was generally higher in younger patients than in older patients, and in men than in women. Blood pressure (92% of men and 90% of women) and smoking status (84% of men and 77% of women) were generally the best-recorded cardiovascular risk factors. Blood electrolytes were recorded in about 83% of men and 75% of women. Only 17% of men and 11% of women with heart failure had a record of undergoing an echocardiogram. Use of angiotensin-converting enzyme (ACE) inhibitors or antagonists was 76% in men with heart failure and 68% in women; lowest rates were seen in older patients. Uptake of influenza immunization was generally high, at 85% in men and 84% in women. The use of ACE inhibitors in patients with heart failure was higher than in some previous studies. However, many patients have no documentation in their computerized medical records of having undergone key investigations, such as echocardiography.
The Open General & Internal Medicine Journal, 2010
Introduction: Little is known about the obstacles to patients' compliance to Heart Failure (HF) treatment. Heart Failure management programs seem to be a strategy to overcome these problems. Aim: To evaluate in HF outpatients the role that socioeconomic characteristics and knowledge about the disease play in their compliance to treatment and long term mortality. Population and methods: We conducted a prospective study of consecutive HF outpatients attending our HF Clinic. Structured questionnaires directed to the patient or care giver were used. Patients´ socioeconomic characteristics and understanding of the disease, as well as, predictors of long term mortality were accessed. Results: We included 59 consecutive NYHA II-III HF patients, age 70.5±11.9 years. Sixty three percent were male and 59.3% had left ventricular systolic dysfunction. Most patients had multiple comorbidities, were polymedicated, lived with their family and belonged to middle-low or low Graffar socioeconomic class. Eighty five percent were retired, median monthly income was 350 , 41.5% had primary education and 22.6% were illiterate. More than half did not know they had HF, what HF was nor its main symptoms/ signs. Four year mortality was 23.6 %. Not knowing "what HF is" was the unique predictor of long-term mortality (p= 0.035; OR 0.097; CI: 0.011-0.846). Conclusions: In our study Heart Failure patients were elderly, retired, and frequently dependent. Literacy was predominantly low. The need of polypharmacy, poor income and poor understanding of the disease were the rule. The later was even a predictor of long term mortality. Heart Failure management programs must be tailored to the needs of their users, taking into account their social environment.
Real world heart failure epidemiology and outcome: A population-based analysis of 88,195 patients
PLOS ONE, 2017
Background Heart failure (HF) is frequent and its prevalence is increasing. We aimed to evaluate the epidemiologic features of HF patients, the 1-year follow-up outcomes and the independent predictors of those outcomes at a population level. Methods and results Population-based longitudinal study including all prevalent HF cases in Catalonia (Spain) on December 31st, 2012. Patients were divided in 3 groups: patients without a previous HF hospitalization, patients with a remote (>1 year) HF hospitalization and patients with a recent (<1 year) HF admission. We analyzed 1year all-cause and HF hospitalizations, and allcause mortality. Logistic regression was used to identify the independent predictors of each of those outcomes. A total of 88,195 patients were included. Mean age was 77 years, 55% were women. Comorbidities were frequent. Fourteen percent of patients had never been hospitalized, 71% had a remote HF hospitalization and 15% a recent hospitalization. At 1year follow-up, all-cause and HF hospitalization were 53% and 8.8%, respectively. Oneyear all-cause mortality rate was 14%, and was higher in patients with a recent HF hospitalization (24%). The presence of diabetes mellitus, atrial fibrillation or chronic kidney disease was independently associated with all-cause and HF hospitalization and all-cause mortality. Hospital admissions and emergency department visits the previous year were also found to be independently associated with the three study outcomes.
Heart, 2007
Aim: To determine whether an intensive intervention at a heart failure (HF) clinic by a combination of a clinician and a cardiovascular nurse, both trained in HF, reduces the incidence of hospitalisation for worsening HF and/or all-cause mortality (primary end point) and improves functional status (including left ventricular ejection fraction, New York Heart Association (NYHA) class and quality of life) in patients with NYHA class III or IV. Setting: Two regional teaching hospitals in The Netherlands. Methods: 240 patients were randomly allocated to the 1-year intervention (n = 118) or usual care (n = 122). The intervention consisted of 9 scheduled patient contacts-at day 3 by telephone, and at weeks 1, 3, 5, 7 and at months 3, 6, 9 and 12 by a visit-to a combined, intensive physician-and-nurse-directed HF outpatient clinic, starting within a week after hospital discharge from the hospital or referral from the outpatient clinic. Verbal and written comprehensive education, optimisation of treatment, easy access to the clinic, recommendations for exercise and rest, and advice for symptom monitoring and self-care were provided. Usual care included outpatient visits initialised by individual cardiologists in the cardiology departments involved and applying the guidelines of the European Society of Cardiology. Results: During the 12-month study period, the number of admissions for worsening HF and/or all-cause deaths in the intervention group was lower than in the control group (23 vs 47; relative risk (RR) 0.49; 95% confidence interval (CI) 0.30 to 0.81; p = 0.001). There was an improvement in left ventricular ejection fraction (LVEF) in the intervention group (plus 2.6%) compared with the usual care group (minus 3.1%; p = 0.004). Patients in the intervention group were hospitalised for a total of 359 days compared with 644 days for those in the usual care group. Beneficial effects were also observed on NYHA classification, prescription of spironolactone, maximally reached dose of b-blockers, quality of life, self-care behaviour and healthcare costs. Conclusion: A heart failure clinic involving an intensive intervention by both a clinician and a cardiovascular nurse substantially reduces hospitalisations for worsening HF and/or all-cause mortality and improves functional status, while decreasing healthcare costs, even in a country with a primary-care-based healthcare system.
Medicina clínica práctica, 2020
To analyze the epidemiological characteristics of heart failure (HF) and estimate the burden of the disease on the health service by means of real world data (RWD). Patients and methods: All patients discharged from any Basque Health Service hospital after a first admission for HF between 2011 and 2015. Data sources: Databases of our health service. Outcomes: 30-and 365-day admissions, potentially avoidable hospitalizations (PAHs), mortality. Statistical analysis: Descriptive statistics, age-standardized event rates. Results: The cohort was composed of 15,109 patients (mean age 79.8 ± 10.1 years). At discharge patients had a median of 8 chronic conditions. 36% of them had had hospitalizations and 83% had visited a specialist (42% of them a cardiologist) during the previous year. Mortality was 24.5% within 365 days after discharge. Within 30 days after discharge, there were 2608 unplanned admissions, 49% for non-cardiovascular disease (CVD), 36% for HF and 15% for a CVD other than HF. 34% were classified as PAH. In the first 365 days after discharge, there were 14,559 hospitalizations, 54% for non-CVD reasons, 32% for HF and 13% for a CVD other than HF. Overall, 35% were PAHs. Conclusion: (1) People admitted for HF are old, and they have multimorbidity and high rates of admissions due to non-CVD reasons and PAHs after discharge. These finding suggest the need of strengthening continuity of care and managing comorbidities. (2) Besides, most people admitted for HF have previous contacts with the Healthcare system, which suggests opportunities for prevention before disease worsening.