scholarly journals Introduction of a new scoring tool to identify clinically stable heart failure patients

2022 ◽  
Author(s):  
A. J. Gingele ◽  
L. Brandts ◽  
H. P. Brunner-La Rocca ◽  
G. Cleuren ◽  
C. Knackstedt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Secondary Care ◽  
Hospital Admissions ◽  
Clinical Status ◽  
Composite Endpoint ◽  
Specialist Care ◽  
Significant Difference ◽  
Scoring Tool ◽  
Stable Clinical Condition

Abstract Introduction Heart failure (HF) poses a burden on specialist care, making referral of clinically stable HF patients to primary care a desirable goal. However, a structured approach to guide patient referral is lacking. Methods The Maastricht Instability Score—Heart Failure (MIS-HF) questionnaire was developed to objectively stratify the clinical status of HF patients: patients with a low MIS-HF (0–2 points, indicating a stable clinical condition) were considered for treatment in primary care, whereas high scores (> 2 points) indicated the need for specialised care. The MIS-HF was evaluated in 637 consecutive HF patients presenting between 2015 and 2018 at Maastricht University Medical Centre. Results Of the 637 patients, 329 (52%) had a low score and 205 of these 329 (62%) patients were referred to primary care. The remaining 124 (38%) patients remained in secondary care. Of the 308 (48%) patients with a high score (> 2 points), 265 (86%) remained in secondary care and 41 (14%) were referred to primary care. The primary composite endpoint (mortality, cardiac hospital admissions) occurred more frequently in patients with a high compared to those with a low MIS-HF after 1 year of follow-up (29.2% vs 10.9%; odds ratio (OR) 3.36, 95% confidence interval (CI) 2.20–5.14). No significant difference in the composite endpoint (9.8% vs 12.9%; OR 0.73, 95% CI 0.36–1.47) was found between patients with a low MIS-HF treated in primary versus secondary care. Conclusion The MIS-HF questionnaire may improve referral policies, as it helps to identify HF patients that can safely be referred to primary care.

Perinatal Depression and Use of Health Services in British Women of Pakistani Origin

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
I. Mukherjee ◽  
M. Husain ◽  
S. Khan ◽  
N. Husain
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Perinatal Depression ◽  
Perinatal Period ◽  
Health Events ◽  
Care Services ◽  
Significant Difference ◽  
Pakistani Origin ◽  
Health Event ◽  
Depressed Mothers

Background:Perinatal depression (PND) has adverse effects on the well being of the mother-infant dyad. Women with PND often show different patterns of help seeking behaviour.Objective:We aimed to examine the association between PND and the reporting of health events and healthcare use in a cohort of British women of Pakistani origin.Method:Participants were recruited from antenatal clinics in the North West of England and followed up 6 months postnatal. Sixty-seven women diagnosed with depression using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) were compared with 156 non depressed controls in terms of reporting of health events elicited using the Life Events and Difficulties Schedule (LEDS). Health events included any condition that involved attending primary or secondary care.Results:Depressed mothers were 1.5 times more likely to report a health event within the perinatal period (p=0.005) and 1.8 times more likely to report a health event (0.031) outside the perinatal period. Depressed mothers were more likely to attend secondary care services for their children (p=0.001) but there was no significant difference in terms of attendance at primary care.Conclusion:Depressed mothers were more likely to report personal health events and more likely to access secondary care rather than primary care services for health events affecting their children. This highlights the hidden costs of this condition and the need for adequate diagnosis and management of this treatable but under recognised illness.

scholarly journals Clinical efficacy of various forms of continuing education of patients with chronic heart failure

2013 ◽  
Vol 4 (1) ◽  
pp. 55-62
Author(s):  
G. P Arutyunov ◽  
A. V Evzerikhina ◽  
A. K Rylova ◽  
V. I Lobzeva
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Performance Test ◽  
Hospital Admissions ◽  
Clinical Status ◽  
Developed Countries ◽  
Left Ventricular ◽  
Structured Learning ◽  
Lv Function ◽  
Minute Walk

Data from numerous epidemiological studies indicate that in many developed countries, heart failure is one of the most common, progressive and predictive of adverse complications of diseases of the cardiovascular system. At the moment, that is a rather acute problem of cardiac rehabilitation of such patients. The purpose of our study was to investigate the effect of various forms of structured learning in special schools for CHF patients on the clinical course and prognosis. Materials and Methods: This study consisted of two phases, including 158 patients with chronic heart failure II–III FC. Evaluated the survival of the knowledge, clinical status, distance of a 6-minute walk, Minnesota QoL questionnaire, adherence to therapy, the frequency of hospital admissions for heart failure decompensation, referral to the clinic, the frequency of deaths, the level of CRP, LV function the results of echocardiography. The results: the use of interactive learning will significantly improve patient compliance to treatment (D=5%), which in turn significantly improved the clinical condition of patients, quality of life, performance test, 6-minute walk, and left ventricular function, as well as reduced the number of hospitalizations with circulatory decompensation (1,6-times), and uptake to the clinic (up to 0,5 times a month). Thus, the use of interactive patient education is an integral part of the cardiorehabilitation events in patients with CHF.

scholarly journals GPs’ role in caring for children and young people with life-limiting conditions: a retrospective cohort study

2020 ◽  
Vol 70 (693) ◽  
pp. e221-e229
Author(s):  
Stuart Jarvis ◽  
Roger C Parslow ◽  
Catherine Hewitt ◽  
Sarah Mitchell ◽  
Lorna K Fraser
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Young People ◽  
Retrospective Cohort Study ◽  
Secondary Care ◽  
Retrospective Cohort ◽  
Clinical Practice Research Datalink ◽  
Children And Young People ◽  
Attendance Patterns ◽  
Significant Difference

BackgroundGPs are rarely actively involved in healthcare provision for children and young people (CYP) with life-limiting conditions (LLCs). This raises problems when these children develop minor illness or require management of other chronic diseases.AimTo investigate the association between GP attendance patterns and hospital urgent and emergency care use.Design and settingRetrospective cohort study using a primary care data source (Clinical Practice Research Datalink) in England. The cohort numbered 19 888.MethodCYP aged 0–25 years with an LLC were identified using Read codes (primary care) or International Classification of Diseases 10 th Revision (ICD-10) codes (secondary care). Emergency inpatient admissions and accident and emergency (A&E) attendances were separately analysed using multivariable, two-level random intercept negative binomial models with key variables of consistency and regularity of GP attendances.ResultsFace-to-face GP surgery consultations reduced, from a mean of 7.12 per person year in 2000 to 4.43 in 2015. Those consulting the GP less regularly had 15% (95% confidence interval [CI] = 10% to 20%) more emergency admissions and 5% more A&E visits (95% CI = 1% to 10%) than those with more regular consultations. CYP who had greater consistency of GP seen had 10% (95% CI = 6% to 14%) fewer A&E attendances but no significant difference in emergency inpatient admissions than those with lower consistency.ConclusionThere is an association between GP attendance patterns and use of urgent secondary care for CYP with LLCs, with less regular GP attendance associated with higher urgent secondary healthcare use. This is an important area for further investigation and warrants the attention of policymakers and GPs, as the number of CYP with LLCs living in the community rises.

A single centre study assessing the effectiveness of active monitoring, using telemedicine, in preventing heart failure admissions and death in a primary care population with systolic heart failure.

2020 ◽  
Author(s):  
Nicola Bowers ◽  
Ben Lodge ◽  
Charlie Clifford ◽  
Ricardo Pio Monti ◽  
Marc Phippen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Active Group ◽  
Control Group ◽  
P Value ◽  
Evidence Based ◽  
Significant Difference

Abstract BackgroundPatients with systolic heart failure are at high risk of admission to hospital and death. This can be reduced by ensuring that they are receiving all evidence-based heart failure medications and by detecting early signs of deterioration in their condition.MethodsWe recruited 209 primary care patients with echocardiographically proven left ventricular systolic dysfunction (ejection fraction < 40%). 84 patients consented to be actively monitored by the heart failure team using telemedicine. 125 patients consented to receiving usual care but allowing access to their medical records. The primary end-point was cardiovascular death or admission to hospital for heart failure at 1 year. Secondary end-points included the prescription of evidence-based heart failure medications and patient satisfaction at the end of the study.ResultsThere was no difference in the mortality rate between the groups (6.02% in the active group and 5.56% in control). There was a significant difference in hospital admission (10.84% in the active group and 1.59% in control; p-value of 0.0078). At the end of the study, in the active group v control group, 92% v 52% of patients were on a beta-blocker, 92% v 48% on ACE-I/ARB, and 60% v 30% on an MRA. There were no differences in the final doses achieved.ConclusionsActive telemonitoring in an elderly population with systolic heart failure did not reduce cardiovascular mortality or admission to hospital for heart failure over the 1 year of the study. It did result in more patients receiving evidence based heart failure medications.Trial registrationThis trial received ethical approval from the Health Research Authority London-City Road and Hampstead Research Ethics Committee (REC Reference: 16/L0/0070, IRAS project ID: 173818). The ClinicalTrials.gov Identifier number is: NCT04371731. This trial was retrospectively registered on 30/4/2020 and this study adheres to CONSORT guidelines

Abstract 15488: Epidemiological Profile of Cardiovascular Risk Factors and Outcomes in Patients With Solid Organ and Haematological Malignancies

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
David Chandrakumar ◽  
Gary Gan ◽  
Urmi Jethwani ◽  
Cindy Li ◽  
Aaia Aladdin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Composite Endpoint ◽  
Risk Profile ◽  
Solid Organ ◽  
Cardiovascular Risk Profile ◽  
Cardiac Events ◽  
Significant Difference

Introduction: Chemotherapy remains the cornerstone in the management of solid organ malignancies (SOM) and hematological malignancies (HM). Although life-prolonging, it is not without cost, with heart failure and arrhythmia becoming increasingly recognised complications of treatment. Although there is significant overlap in the chemotherapeutic management of SOM and HM, epidemiological information on the differential prevalence of baseline cardiovascular risk factors and outcomes in these populations is scarce. Hypothesis: A differential cardiovascular risk profile and clinical course will be appreciated in patients with SOM and HM undergoing chemotherapy. Methods: Retrospective observational study design. Patients admitted to our institution undergoing chemotherapy for SOM (2014-2018) or HM (2012-2015) were reviewed. Baseline demographic and clinical data was collated and patients were followed for up to five years following chemotherapy for occurrence of major adverse cardiac events (MACE) defined as the development of new-onset heart failure or arrhythmia. Results: 545 hematology and 435 oncology patients with malignancy were assessed. Compared to those with HM, those treated for SOM had a poorer cardiovascular risk profile (table 1). At mean follow-up period of 22.8±17.8 months, no significant difference in the incidence of the composite endpoint (9.4% vs 9.0%, p=0.45) or its components was observed. Higher rates of anthracycline therapy was observed in patients with HM (100% vs 17%, p < 0.01), however its use did not have a differential effect on MACE (12% vs 9%, p=0.25). Conclusions: Compared to patients treated for HM, patients with SOM had a greater burden of cardiovascular risk factors and lower use of anthracycline chemotherapy. Despite this, MACE occurred at similar rates in both groups. The use of anthracyclines was not associated with the development of MACE, suggesting alternative pathways contributing to its development.

Routes to diagnosis of heart failure: observational study using linked data in England

Heart ◽  
2017 ◽  
Vol 104 (7) ◽  
pp. 600-605 ◽  
Author(s):  
Alex Bottle ◽  
Dani Kim ◽  
Paul Aylin ◽  
Martin R Cowie ◽  
Azeem Majeed ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Natriuretic Peptide ◽  
Hospital Admissions ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Missed Opportunities ◽  
Specialist Referral ◽  
Care Consultation ◽  
Primary Care Practices

ObjectiveTimely diagnosis and management of heart failure (HF) is critical, but identification of patients with suspected HF can be challenging, especially in primary care. We describe the journey of people with HF in primary care from presentation through to diagnosis and initial management.MethodsWe used the Clinical Practice Research Datalink (primary care consultations linked to hospital admissions data and national death registrations for patients registered with participating primary care practices in England) to describe investigation and referral pathways followed by patients from first presentation with relevant symptoms to HF diagnosis, particularly alignment with recommendations of the National Institute for Health and Care Excellence guideline for HF diagnosis.Results36 748 patients had a diagnosis of HF recorded that met the inclusion criteria between 1 January 2010 and 31 March 2013. For 29 113 (79.2%) patients, this was first recorded in hospital. In the 5 years prior to diagnosis, 15 057 patients (41.0%) had a primary care consultation with one of three key HF symptoms recorded, 17 724 (48.2%) attended for another reason and 3967 (10.8%) did not see their general practitioner. Only 24% of those with recorded HF symptoms followed a pathway aligned with guidelines (echocardiogram and/or serum natriuretic peptide test and specialist referral), while 44% had no echocardiogram, natriuretic peptide test or referral.ConclusionsPatients follow various pathways to the diagnosis of HF. However, few appear to follow a pathway supported by guidelines for investigation and referral. There are likely to be missed opportunities for earlier HF diagnosis in primary care.

P1489An audit of 215,000 patients on primary care registers using novel electronic searches to identify patients with heart failure requiring treatment optimisation and complex device therapies

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P Chaggar ◽  
A D Grayson ◽  
N Connor ◽  
C Hughes
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Lv Function ◽  
Specialist Care ◽  
Device Therapy ◽  
Loop Recorder ◽  
Patients With Heart Failure

Abstract INTRODUCTION  Patients with heart failure (HF) may not routinely receive review from a HF specialist and understanding of which patients may benefit from specialist therapies is not widely appreciated by non-specialists.  Therefore, there may be frequent missed opportunities for patients under non-specialist care to access prognostically important therapies.  PURPOSE To identify high-risk patients in primary care with HF and left ventricular systolic dysfunction (LVSD) that require optimisation and consideration for complex device therapy. METHODS 15 general practitioner (GP) practices across Cornwall were audited between between July 2018 and August 2019 with a total population of 215,114 patients. The total combined HF register in these practices was 2,925. A further 2,238 patients were identified using the case finder element of GRASP-HF, an electronic search tool, to identify patients with HF +/- LVSD not coded correctly in GP records. Electronic records were manually reviewed and selected patients, potentially benefitting from further optimisation, were electronically reviewed by a Consultant Cardiologists for final screening before being invited into a specialist HF clinic at their local GP practice. All patients received an up to date ECG prior to specialist review. Outcomes of each patient clinical review were followed-up for a minimum of 1 month. RESULTS From 5,163 patients audited, 157 underwent clinic review with a Consultant Cardiologist at their local GP practice and are described below. Patient characteristics Mean age was 75 years, 78% were male, 51% had ischaemic cardiomyopathy and 27% had AF. 66% had severe LVSD (EF &lt;35%), 48% had broad QRS (&gt;120ms) and only 44% were deemed to be on optimal medical therapy. Of 88 patients not fully optimised, the proportion requiring optimisation of ACEi/ARB, beta-blocker, MRA, sacubitril-valsartan and ivabradine were 57%, 30%, 36%, 7% and 1%, respectively.   Patient outcomes Median follow up period was 7 months (range 2-15).  65% of all patients required further imaging of LV function to help determine onward management.  48% were potential candidates for device therapy and 3 patients (2%) were listed directly for device therapy while 5 patients (3%) declined.  In total, following complete assessment, 18 patients (11%) received device implantation (12 CRT-P, 2 CRT-D, 2 ICD and 1 loop recorder) and 25 patients (16%) received sacubitril-valsartan.  A change in patient clinical management was instituted in 64% of patients following specialist review. CONCLUSION This comprehensive audit of GP registers demonstrates a significant burden of patients with HF and LVSD who are not appropriately coded.  This audit also identifies frequent opportunities to intensify 1st and 2nd line medical therapies and patients that may benefit from specialist therapies including complex devices.  Primary care teams would benefit from regular review of their HF registers and from specialist outreach initiatives.

scholarly journals Continuity of care in heart failure patients

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
K Olsen ◽  
NF Falun ◽  
HK Keilegavlen
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Health Care ◽  
Continuity Of Care ◽  
Secondary Care ◽  
Health Care Services ◽  
Care Services ◽  
Discharge From Hospital ◽  
Patients Experience

Abstract Funding Acknowledgements Type of funding sources: None. Background  Heart failure (HF) requires follow-up over time and by several different health services. The positive effects of follow-up care in secondary care services is well known. However, there is a lack of knowledge in how HF patients experience continuity of care a through various health care services in secondary and primary care. Purpose To explore how HF patients experience continuity of care through secondary and primary health care services. Methods The study used an inductive design by performing four semi-structured focus group interviews. Overall, 17 patients, mean age of 71 years (range 42-95), 11 men and 6 women, All patients were receiving regular and individual follow-up by cardiac nurses in primary care after hospital discharge The interviews were analysed through qualitative content analysis. Results Gaps in continuity of care were described as challenging. Information about HF at the time of discharge from hospital were not always fully comprehended. Patients experienced physical strain of being lost and abandoned after discharge from hospital. They did not know whom to contact for follow-up.  Appointments with the GP was not agreed or scheduled weeks ahead. Patients appreciated home visit by a cardiac nurse in primary care who provided the patients with knowledge in self-care administration. When experiencing deterioration they could call the cardiac nurse, who could facilitate fast track to the hospital. Self-care was difficult to comprehend, especially for those experiencing comorbidities. Patients also  described the importance of sharing knowledge and experience of living with HF with other patients in a secondary care setting, organized by specialised cardiac nurses. Conclusions There are gaps in continuity in patients’ pathways, throughout both secondary and primary healthcare. Even though patients receive information at discharge from hospital, they felt insecure when returning home. Health care services in the primary care provided the patients with both knowledge and confidence as they regularly met the patients, both at home and in organized primary care meetings.

scholarly journals Opportunities and challenges of a novel cardiac output response to stress (CORS) test to enhance diagnosis of heart failure in primary care: a qualitative study

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703421
Author(s):  
Sarah Charman ◽  
Nduka Okwose ◽  
Gregory Maniatopoulos ◽  
Sara Graziadio ◽  
Luke Vale ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Cardiac Output ◽  
Qualitative Study ◽  
Secondary Care ◽  
Primary Care Physicians ◽  
Diagnostic Testing ◽  
Clinical Test ◽  
Output Response ◽  
Response To Stress

BackgroundPrimary care physicians lack access to an objective cardiac function test during diagnostic testing for suspected heart failure.AimTo determine the role of the novel Cardiac Output Response to Stress (CORS) test in the current diagnostic pathway for heart failure and the opportunities and challenges to potential implementation in primary care.MethodQualitative study using semi-structured in-depth interviews which were audiorecorded and transcribed verbatim. Data from the interviews were analysed thematically using an inductive approach. Fourteen healthcare professionals (six males, eight females) from primary (GPs, nurses, healthcare assistants, and practice managers) and secondary care (consultant cardiologists) participated.ResultsFour themes relating to opportunities and challenges surrounding the implementation of the new diagnostic technology were identified. These reflected that adoption of CORS test would be an advantage to primary care but the test had barriers to implementation which include establishment of clinical utility, suitability for immobile patients, and cost implication to GP practices.ConclusionThe development of a simple non-invasive clinical test to accelerate the diagnosis of heart failure in primary care maybe helpful to reduce unnecessary referrals to secondary care. The CORS test has the potential to serve this purpose however, factors such as cost-effectiveness, diagnostic accuracy, and seamless implementation in primary care have to be fully explored.

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