scholarly journals Hepatorenal dysfunction identifies high‐risk patients with acute heart failure: insights from the RELAX‐AHF trial

2019 ◽  
Vol 6 (6) ◽  
pp. 1188-1198 ◽  
Author(s):  
Jan Biegus ◽  
Biniyam Demissei ◽  
Douwe Postmus ◽  
Gad Cotter ◽  
Beth A. Davison ◽  
...  
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Acute Heart Failure ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Preventing the rebound: improving care transition in hospital discharge processes

2010 ◽  
Vol 34 (4) ◽  
pp. 445 ◽  
Author(s):  
Ian A. Scott
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Older Patients ◽  
Single Component ◽  
Self Management ◽  
Controlled Trials ◽  
High Risk Patients ◽  
Patients With Heart Failure ◽  
Risk Patients ◽  
Multicomponent Interventions

Background.Unplanned readmissions of recently discharged patients impose a significant burden on hospitals with limited bed capacity. Deficiencies in discharge processes contribute to such readmissions, which have prompted experimentation with multiple types of peridischarge interventions. Objective.To determine the relative efficacy of peridischarge interventions categorised into two groups: (1) single component interventions (sole or predominant) implemented either before or after discharge; and (2) integrated multicomponent interventions which have pre- and postdischarge elements. Design.Systematic metareview of controlled trials. Data collection.Search of four electronic databases for controlled trials or systematic reviews of trials published between January 1990 and April 2009 that reported effects on readmissions. Data synthesis.Among single-component interventions, only four (intense self-management and transition coaching of high-risk patients and nurse home visits and telephone support of patients with heart failure) were effective in reducing readmissions. Multicomponent interventions that featured early assessment of discharge needs, enhanced patient (and caregiver) education and counselling, and early postdischarge follow-up of high-risk patients were associated with evidence of benefit, especially in populations of older patients and those with heart failure. Conclusion.Peridischarge interventions are highly heterogenous and reported outcomes show considerable variation. However, multicomponent interventions targeted at high-risk populations that include pre- and postdischarge elements seem to be more effective in reducing readmissions than most single-component interventions, which do not span the hospital–community interface. What is known about this topic?Unplanned readmissions within 30 days of hospital discharge are common and may reflect deficiencies in discharge processes. Various peridischarge interventions have been evaluated, mostly single-component interventions that occur either before or after discharge, but failing to yield consistent evidence of benefit in reducing readmissions. More recent trials have assessed multicomponent interventions which involve pre- and postdischarge periods, but no formal review of such studies has been undertaken. What does this paper add?With the exception of intense self-management and transition coaching of high-risk patients, and nurse home visits and telephonic support for patients with heart failure, single-component interventions were ineffective in reducing readmissions. Multicomponent interventions demonstrated evidence of benefit in reducing readmissions by as much as 28%, with best results achieved in populations of older patients and those with heart failure. What are the implications for practitioners and managers?Hospital clinicians and managers should critically review and, where appropriate, modify their current discharge processes in accordance with these findings and negotiate the extra funding and personnel required to allow successful implementation of multicomponent discharge processes that transcend organisational boundaries.

Development and validation of the Tool for Pharmacists to Predict 30-day hospital readmission in patients with Heart Failure (ToPP-HF)

2021 ◽  
Author(s):  
Melissa R Riester ◽  
Laura McAuliffe ◽  
Christine Collins ◽  
Andrew R Zullo
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Hospital Readmission ◽  
Left Ventricular Ejection ◽  
Day Hospital ◽  
High Risk Patients ◽  
C Statistic ◽  
Patients With Heart Failure ◽  
Risk Patients ◽  
Development And Validation

Abstract Purpose Pharmacists are well positioned to provide transitions of care (TOC) services to patients with heart failure (HF); however, hospitalizations for patients with HF likely exceed the capacity of a TOC pharmacist. We developed and validated a tool to help pharmacists efficiently identify high-risk patients with HF and maximize their potential impact by intervening on patients at the highest risk for 30-day all-cause readmission. Methods We conducted a retrospective cohort study including adults with HF admitted to a health system between October 1, 2016, and October 31, 2019. We randomly divided the cohort into development (n = 2,114) and validation (n = 1,089) subcohorts. Nine models were applied to select the most important predictors of 30-day readmission. The final tool, called the Tool for Pharmacists to Predict 30-day hospital readmission in patients with Heart Failure (ToPP-HF) relied upon multivariable logistic regression. We assessed discriminative ability using the C statistic and calibration using the Hosmer-Lemeshow goodness-of-fit test. Results The risk of 30-day all-cause readmission was 15.7% (n = 331) and 18.8% (n = 205) in the development and validation subcohorts, respectively. The ToPP-HF tool included 13 variables: number of hospital admissions in previous 6 months; admission diagnosis of HF; number of scheduled medications; chronic obstructive pulmonary disease diagnosis; number of comorbidities; estimated glomerular filtration rate; hospital length of stay; left ventricular ejection fraction; critical care requirement; renin-angiotensin-aldosterone system inhibitor use; antiarrhythmic use; hypokalemia; and serum sodium. Discriminatory performance (C statistic of 0.69; 95% confidence interval [CI], 0.65-0.73) and calibration (Hosmer-Lemeshow P = 0.28) were good. Conclusions The ToPP-HF performs well and can help pharmacists identify high-risk patients with HF most likely to benefit from TOC services.

scholarly journals Preventing acute kidney injury in high-risk patients by temporarily discontinuing medication – an observational study in general practice

2019 ◽  
Author(s):  
Suzanne J Faber ◽  
Nynke Scherpbier ◽  
Hans Peters ◽  
Annemarie Uijen
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
High Risk ◽  
Kidney Injury ◽  
Cross Sectional Study ◽  
Fluid Loss ◽  
Cross Sectional ◽  
High Risk Patients ◽  
Risk Patients ◽  
Raas Inhibitors

Abstract Background Elderly, patients with chronic kidney disease (CKD) and patients with heart failure who continue using renin-angiotensin-aldosterone-system (RAAS) inhibitors, diuretics, or non-steroidal-anti-inflammatory drugs (NSAIDs) during times of fluid loss have a high risk of developing complications like acute kidney injury (AKI). The aim of this study was to assess how often advice to discontinue high-risk medication was offered to high-risk patients consulting the general practitioner (GP) with increased fluid loss. Furthermore, we assessed the number and nature of the complications that occurred after GP consultation. Methods We performed a cross-sectional study with patients from seven Dutch general practices participating in the Family Medicine Network between 1-6-2013 and 1-7-2018. We included patients who used RAAS-inhibitors, diuretics, or NSAIDs, and had at least one of the following risk factors: age ≥70 years, CKD, or heart failure. From this population, we selected patients with a ‘dehydration-risk’ episode (vomiting, diarrhoea, fever, chills, or gastrointestinal infection). We manually checked their electronic patient files and assessed the percentage of episodes in which advice to discontinue the high-risk medication was offered and whether a complication occurred in three months after the ‘dehydration-risk’ episode. Results We included 3607 high-risk patients from a total of 44.675 patients (8.1%). We found that patients were advised to discontinue the high-risk medication in 38 (4.6%) of 816 ‘dehydration-risk’ episodes. In 59 of 816 episodes (7.1%) complications (mainly AKI) occurred. Conclusions Dutch GPs do not frequently advise high-risk patients to discontinue high-risk medication during ‘dehydration-risk’ episodes. Complications occur frequently. Timely discontinuation of high-risk medication needs attention.

Dementia screening in elderly high-risk patients following heart failure decompensation may predict unfavorable long-term clinical outcomes

2021 ◽  
Vol 69 (3) ◽  
Author(s):  
Konrad STEPIEN ◽  
Patrycja FURCZYNSKA ◽  
Magdalena ZALEWSKA ◽  
Karol NOWAK ◽  
Aleksandra WLODARCZYK ◽  
...  
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Clinical Outcomes ◽  
High Risk Patients ◽  
Dementia Screening ◽  
Risk Patients ◽  
Heart Failure Decompensation

Anthracycline cardiotoxicity: an update on mechanisms, monitoring and prevention

Heart ◽  
2017 ◽  
Vol 104 (12) ◽  
pp. 971-977 ◽  
Author(s):  
Peter A Henriksen
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Anthracycline Cardiotoxicity ◽  
High Risk Patients ◽  
Risk Patients ◽  
Clinical Heart Failure

Anthracycline chemotherapy causes dose-related cardiomyocyte injury and death leading to left ventricular dysfunction. Clinical heart failure may ensue in up to 5% of high-risk patients. Improved cancer survival together with better awareness of the late effects of cardiotoxicity has led to growing recognition of the need for surveillance of anthracycline-treated cancer survivors with early intervention to treat or prevent heart failure. The main mechanism of anthracycline cardiotoxicity is now thought to be through inhibition of topoisomerase 2β resulting in activation of cell death pathways and inhibition of mitochondrial biogenesis. In addition to cumulative anthracycline dose, age and pre-existing cardiac disease are risk markers for cardiotoxicity. Genetic susceptibility factors will help identify susceptible patients in the future. Cardiac imaging with echocardiographic measurement of global longitudinal strain and cardiac troponin detect early myocardial injury prior to the development of left ventricular dysfunction. There is no consensus on how best to monitor anthracycline cardiotoxicity although guidelines advocate quantification of left ventricular ejection fraction before and after chemotherapy with additional scanning being justified in high-risk patients. Patients developing significant left ventricular dysfunction with or without clinical heart failure should be treated according to established guidelines. Liposomal encapsulation reduces anthracycline cardiotoxicity. Dexrazoxane administration with anthracycline interferes with binding to topoisomerase 2β and reduces both cardiotoxicity and subsequent heart failure in high-risk patients. Angiotensin inhibition and β-blockade are also protective and appear to prevent the development of left ventricular dysfunction when given prior or during chemotherapy in patients exhibiting early signs of cardiotoxicity.

scholarly journals Putting veterans with heart failure FIRST improves follow-up and reduces readmissions

2019 ◽  
Vol 8 (1) ◽  
pp. e000386 ◽  
Author(s):  
Serena Michelle Ogunwole ◽  
Jason Phillips ◽  
Amber Gossett ◽  
John Richard Downs
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Best Practices ◽  
Implementation Strategies ◽  
Quality Improvement Initiative ◽  
Medicine Department ◽  
High Risk Patients ◽  
Resource Limited ◽  
Risk Patients

BackgroundDespite improvements in length of stay and mortality, congestive heart failure (CHF) remains the most common cause of 30-day readmissions to the hospital. Though multiple studies have found that early follow-up after discharge (eg, within 7 days) is critical to improving 30-day readmissions, implementation strategies are challenging in resource-limited settings. Here we present a quality improvement initiative aimed at improving early follow-up while maximising available resources.MethodsThis was a medical resident-driven initiative. A process map of the discharge and follow-up appointment process was created that identified multiple areas for improvement. Based on these findings, a two-part intervention was implemented. First, heart failure discharge education with focus on early follow-up was disseminated to providers throughout the internal medicine department. Subsequently, improved identification of high-risk patients (Failure Intervention Risk StratificationTool) and innovative use of the existing electronic medical record (EMR) were employed to sustain and improve on gains from the first set of interventions.ResultsWe increased our 7-day follow-up rate from 47% to 57% (p=0.429) and decreased the average time to follow-up from 17.6 days to 8.7 days (p=0.016) following the first intervention. The percentage of patients readmitted within 30 days after discharge at baseline (2012–2013) and following the first intervention (education and standardisation of follow-up scheduling) and second intervention (risk stratification, intensive follow-up and EMR change) was 25% and 21%, respectively. Thirty-day mortality rate decreased from 10% in 2011 to 7.16% in December 2015.ConclusionClose hospital discharge follow-up and identification of high-risk patients with CHF are useful approaches to reduce readmissions. Using the existing EMR tool for identifying high-risk patients and improving adherence to best practices is an effective intervention. In patients with CHF these strategies improved time to follow-up and 30-day readmissions while decreasing mortality.

P914Balloon aortic valve valvuloplasty as palliative therapy in severe aortic valve stenosis: 10 years experience in a single centre

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Mantovani ◽  
M A Clavel ◽  
F Jayme ◽  
L Valli ◽  
R M De Mola ◽  
...  
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Palliative Therapy ◽  
Medical Attention ◽  
High Risk Population ◽  
High Risk Patients ◽  
Risk Patients

Abstract Background Improved technology together with greater operator experience has led to refinement of balloon aortic valve valvuloplasty (BAV) in recent years. It may provide a palliative treatment option in high-risk patients, highly symptomatic, for whom no other invasive therapy is available. However, there has not been universal adoption of BAV as a standalone therapy. Methods A retrospective analysis of ten years of practice of BAV as palliative strategy in patient with symptomatic aortic stenosis between March 2008 and June 2018 was performed. Demographic, clinical, procedural, and follow-up data on all patients were collected. Results A total of 152 patients (95 women, 63%) with a mean age of 85±6 years underwent BAV. All patients had severe aortic stenosis, were considered not suitable to aortic valve replacement nor Trans-catheter aortic valve implantation (TAVI) for appreciable comorbidity (STS score 9±5) and had severe symptoms mainly of heart failure which required medical attention. A statistically significant decrease in trans-valvular gradient was observed (peak to peak gradient before BAV 52±22 mmHg, after BAV 29±16 mmHg, delta gradient 24±14 mmHg; p<0.0001). Only one patient, who undergone BAV because of cardiogenic shock, died during the procedure. Considering the high-risk population, intra-hospital mortality was low (7 patients died, 4%). Mortality at 1-year follow-up was 43% and survival free from new hospitalization for heart failure was 63% at 1-year follow-up and 53% at 2 years follow-up. 19 patients (13%) required repeated BAV during follow-up. Conclusion BAV as a palliative procedure in high-risk patients who are highly symptomatic, has a low operative mortality in our experience. BAV is associated with a significant reduction in aortic valve gradient and is valuable since half of the patients were alive without re-hospitalizations for heart failure at 2 years follow-up. Acknowledgement/Funding None

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