Heart Failure Core Measures-A Multidisciplinary Approach

Heart & Lung ◽  
2009 ◽  
Vol 38 (3) ◽  
pp. 277
Author(s):  
C. Hinojosa ◽  
J. Giardina ◽  
K. Radtke ◽  
C. Vournazos
Keyword(s):  
Heart Failure ◽  
Multidisciplinary Approach ◽  
Core Measures

Abstract 268: Multidisciplinary Approach to the Heart Failure Patient Significantly Improves Adherence to Evidence-Based Medicine Beyond Core Measures

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
George G Sokos ◽  
Jessica Lazar ◽  
Terri Hilliard ◽  
Evelyn Ozanich ◽  
Amresh Raina ◽  
...  
Keyword(s):  
Heart Failure ◽  
Multidisciplinary Team ◽  
Multidisciplinary Approach ◽  
Variable Cost ◽  
Quality Improvement Initiative ◽  
Evidence Based ◽  
Post Discharge ◽  
Post Intervention ◽  
Aldosterone Antagonists ◽  
Core Measures

Background: Adherence to heart failure core measures has been a focus of all hospitals in the past several years and has become even more important with the advent of pay for performance. Core measures address basic heart failure care, but do not include utilization of all evidence-based therapies which improve long term outcomes. We hypothesized that an in-hospital multidisciplinary heart failure (HF) management program could improve adherence to evidence-based guidelines beyond core measures. Methods: As a quality improvement initiative, we formed a multidisciplinary team to improve compliance with HF evidence-based therapy. Interventions included multiple educational sessions, discharge and post-discharge transition improvements, concurrent and post-discharge chart abstraction, revised patient education, and real-time provider education. Charts were abstracted in 525 consecutive HF inpatients between Jul 2010 and Mar 2011. Data was collected in the GWTG-HF (Outcome Inc) Registry. Pre-intervention compliance data (Jul-Sep) was compared to post-intervention (Nov-Mar) data with a paired t test and the Mann-Whitney rank sum test. Direct variable cost was analyzed for defect-free cases versus cases with defects. Results: Baseline Demographics: Mean age was 69 years, 42% female, 20% black, 55% ischemic etiology, mean LVEF=37%. Prior to the multidisciplinary intervention, overall defect-free care was excellent at over 89% (see figure) but there was a relative underutilization of aldosterone antagonists, hydralazine/nitrate therapy, CRT-D and anticoagulation for AF. Post-intervention, adherence improved to over 90% for all 8 evidence based therapies including: evidence-based beta-blocker (p=0.002), aldosterone antagonist (p<0.001), hydralazine nitrate (p=0.04), ICD placed or prescribed (p<0.001), CRT-D (p=0.002), anticoagulation for afib (p=0.04), and DVT prophylaxis (p=0.04). Mean direct variable cost per case was higher at $8249 in defect cases versus $6951 in defect-free cases. Conclusions: In this single center experience, interventions led by a HF multidisciplinary team can significantly improve adherence to evidence-based therapies, beyond core HF measures. A multidisciplinary approach to inpatient HF care has the potential to decrease HF related costs.

Improvement of Heart Failure Core Measures Compliance and Readmission Rates through a Multidisciplinary Approach

2006 ◽  
Vol 12 (6) ◽  
pp. S103
Author(s):  
Sandra L. Chase ◽  
David R. Burt ◽  
Donna K. Garrett ◽  
Kathleen A. Johnston ◽  
David L. Langholz
Keyword(s):  
Heart Failure ◽  
Multidisciplinary Approach ◽  
Readmission Rates ◽  
Core Measures

scholarly journals Unusual Presentation of Kratom Overdose With Rhabdomyolysis, Transient Hearing Loss, and Heart Failure

2021 ◽  
Vol 9 ◽  
pp. 232470962110050
Author(s):  
Vikram Sangani ◽  
Naseem Sunnoqrot ◽  
Kurdistan Gargis ◽  
Akshay Ranabhotu ◽  
Abbas Mubasher ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hearing Loss ◽  
Cardiac Death ◽  
Multidisciplinary Approach ◽  
Kidney Injury ◽  
Lethal Effect ◽  
Limited Information ◽  
Emergency Physicians ◽  
Behavioral Impairment ◽  
Elevated Creatinine

Kratom mainly grows in Southeast Asia. It is widely used for pain management and opioid withdrawal, which is available online for cheaper prices. Alkaloids extracted from kratom such as mitragynine and 7-hydroxy mitragynine exhibit analgesic properties by acting through µ receptors. Commonly reported side effects of kratom include hypertension, tachycardia, agitation, dry mouth, hallucinations, cognitive and behavioral impairment, cardiotoxicity, renal failure, cholestasis, seizures, respiratory depression, coma, and sudden cardiac death from cardiac arrest. Rhabdomyolysis is a less commonly reported lethal effect of kratom. Limited information is available in the literature. In this article, we present a case of a 45-year-old female who is overdosed with kratom and presented with lethargy, confusion, transient hearing loss, and right lower extremity swelling and pain associated with weakness who was found to have elevated creatinine phosphokinase. She was diagnosed with rhabdomyolysis, compartment syndrome, multiorgan dysfunction including acute kidney injury, liver dysfunction, and cardiomyopathy. She underwent emergent fasciotomy and required hemodialysis. Her renal and liver function subsequently improved. We described the case and discussed pharmacology and adverse effects of kratom toxicity with a proposed mechanism and management. We conclude that it is essential for emergency physicians, internists, intensivists, cardiologists, and nephrologists to be aware of these rare manifestations of kratom and consider a multidisciplinary approach.

Abstract 214: Multidisciplinary Approach to Improve Process Measures and Prevent Heart Failure Readmissions

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
George Syros ◽  
Mitesh Kabadi ◽  
Sarah Blanchard ◽  
Kristin Aviles ◽  
Claire Melvin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Performance Measures ◽  
Multidisciplinary Approach ◽  
High Risk Patient ◽  
Care Staff ◽  
Rank Test ◽  
Fluid Restriction ◽  
Post Discharge ◽  
Readmission Rates ◽  
Process Measures

Background: Approximately 5.2 million Americans have heart failure (HF). HF morbidity and mortality is high, and 27% of patients are readmitted at 1 month and 50% at six months. Objective: To determine the effect of a multidisciplinary approach on Hospital Quality Alliance (HQA) performance and 30-day HF readmission rates. Methods: A one year, prospective, observational study on the effect of a multidisciplinary approach on 30-day HF readmissions was performed and compared to the prior year’s readmission rate at a University affiliated community hospital. HF patients were identified by case and unit nurse managers, who also screened for intravenous diuretic use to determine if patients had HF but were admitted under another diagnosis. HF patients were clustered geographically where daily multidisciplinary rounds with the unit nurse and care manager, pharmacist, social worker, nutritionist, medical and nursing staff took place. The goal was to ensure compliance with the established HQA Performance Measures, initiate appropriate discharge planning, and assess functional status. Patients were educated on 2 gram sodium diet, 2 liter fluid restriction, daily weight monitoring, and smoking cessation. Follow-up appointments with their PCP or cardiologist were scheduled. Upon discharge, nursing and medical staff provided medication and home management instructions. The patient’s PCP was called by the attending physician or cardiovascular fellow as well as the Skilled Nurse Facility, Rehabilitation, and Home Care staff, when applicable. Targeted in-home support immediately following discharge from the hospital was provided. High risk patient had an in-home 2-3 day post discharge visit by VNA and a Pharmacist to access their weight, medications, and physical activity progress. Results: During the intervention year, 355 CHF patients were discharged and compared to 318 patients in the year prior. The 30 day readmissions were reduced from 79 (24.8 %) to 64 (18.03%), p = 0.04 by Wilcoxon Signed-Rank Test. The Heart Failure National Inpatient Quality Measures performance increased from 95% ± 3.8% (2010) to 99.6% ± 0.5% (2011) - p = 0.008 . Conclusions: With implementation of penalties by Medicare in 2013 for 30 day HF readmissions, strategies to reduce them are critical. A comprehensive intervention involving multiple specialties and appropriate patients’ disposition can reduce 30-day readmission rates as well as improve Heart Failure National Inpatient Quality Performance Measures. Further evaluation of this treatment approach, including an assessment of cost-effectiveness, is warranted.

Development of the Mexican Heart Team: The Long and Winding Road

Cardiology ◽  
2016 ◽  
Vol 135 (1) ◽  
pp. 53-55
Author(s):  
J. Alfredo Merino-Rajme ◽  
Lilian G. Delgado-Espejel ◽  
Julieta D. Morales-Portano ◽  
Marco A. Alcántara-Meléndez ◽  
J. Francisco García-García ◽  
...  
Keyword(s):  
Heart Failure ◽  
Developing Country ◽  
Cause Of Death ◽  
Optimal Strategy ◽  
Multidisciplinary Approach ◽  
Mortality Rates ◽  
Heart Team ◽  
Current Article

Heart failure (HF) is the leading cause of death worldwide. Efforts to decrease HF mortality rates include a multidisciplinary approach management. Although evidence suggests that this has been an optimal strategy for treating HF, the model remains not widely implanted. The current article explores the rationale behind the formation of a Heart Team in a developing country and its development despite the lack of an allocated budget.

A Multidisciplinary Approach at the Primary Care Level Improves Heart Failure Care

2013 ◽  
Vol 19 (8) ◽  
pp. S42-S43
Author(s):  
Kathleen Tong ◽  
Sharon Myers ◽  
Patricia Poole ◽  
Jennifer Nguyen ◽  
Erin Griffin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Multidisciplinary Approach ◽  
Care Level ◽  
Primary Care Level ◽  
Heart Failure Care

Cardiology consultation in oncology practice: a 5-year survey

2020 ◽  
Vol 50 (12) ◽  
pp. 1419-1425
Author(s):  
Kazuko Tajiri ◽  
Ikuo Sekine ◽  
Hiroyuki Naito ◽  
Momoko Murata ◽  
Siqi Li ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Venous Thromboembolism ◽  
Cancer Treatment ◽  
Multidisciplinary Approach ◽  
Long Term Outcomes ◽  
Oncology Practice ◽  
The University

Abstract Objective Onco-cardiology services are expanding rapidly in Japan. To provide a better service, it is important to consider the needs of oncologists. However, little is known regarding specific needs for which oncologists should consult cardiologists to manage cardiovascular problems of their patients. We analysed cardiology consultations sought by oncologists to evaluate the role of cardiologists in cancer treatment. Method We retrospectively investigated consecutive 2064 cardiology consultations of cancer patients in the University of Tsukuba Hospital, Tsukuba, Japan, between January 2014 and December 2018. Results The most common timing of cardiology consultation was before the commencement of cancer treatment (n = 1355; 65.7%), followed by after the commencement of cancer treatment (n = 686; 33.2%). Among the 361 consultations before the administration of anticancer drugs, 235 (65.1%) were for anthracycline-based regimens. There were 506 (24.5%) consultations for the management of cardiovascular emergencies developing after the commencement of cancer treatment; venous thromboembolism was the most frequent (n = 125; 24.7%), followed by atrial fibrillation (n = 110; 21.7%) and heart failure (n = 74; 14.6%). There were marked differences in the types of cardiovascular emergencies depending on the type of cancer. Conclusions This survey revealed the various cardiovascular problems for which oncologists sought interventions by cardiologists. A multidisciplinary approach in an onco-cardiology service is essential to achieve optimal long-term outcomes.

Cancer therapy and heart failure: Successful management through collaborative interdisciplinary practice.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 123-123
Author(s):  
Anecita P. Fadol ◽  
Jean-Bernard Durand ◽  
Barbara L. Summers ◽  
Myrshia L. Woods ◽  
Katie Lewis ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cancer Treatment ◽  
Hospital Length Of Stay ◽  
Team Approach ◽  
Care Providers ◽  
Successful Management ◽  
Improvement Project ◽  
Average Hospital ◽  
Patients With Cancer ◽  
Core Measures

123 Background: Heart failure (HF) is a clinical problem of emerging importance in cancer care. The advances in cancer detection and complex treatment regimens have resulted in increased cancer treatment induced HF. The literature indicates that more than 50% of all patients exposed to anthracyclines will show some degree of cardiac dysfunction either acutely or 10 to 20 years after treatment, and 5% of those patients will develop overt HF. Successful management requires a collaborative, interdisciplinary approach. The purpose of this presentation is to discuss how the “Heart Success Program” (HSP) resulted in cost effective and clinical quality outcomes in patients with cancer and HF. Methods: The HSP was piloted in the emergency center and telemetry units with high volume admission of HF patients. The HSP includes comprehensive education of patients, families, and health care providers regarding HF management in cancer patients. HSP implementation includes a HF order set, patient education booklet, and educational videotape specific for patients with cancer and HF. Weekly interdisciplinary clinical rounds provide a forum for discussion of identified patient’s problems and formulation of solutions. Endpoint outcomes include compliance with the Center for Medicare and Medicaid Services (CMS) core measures for HF, as well as decreasing HF readmissions. Results: The pilot implementation of the HSP resulted in decreased hospital length of stay by 57%, and average hospital admission cost by 60%. Despite multiple co morbid conditions, patients were discharged with improved functional status and compliance with CMS HF core measures. Conclusions: The findings from this quality improvement project showed significant impact in clinical and cost outcomes for patients with cancer and HF. The multidisciplinary team approach that provided support to patients and their families and allowed for patients to continue their cancer treatment resulting in improved outcomes. As we move toward value-based purchasing, the HSP provides an example of how collaboration and standardized process improvement impacts cost and quality in the oncology population.

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