Targeting occult heart failure in intensive care unit patients with acute chronic obstructive pulmonary disease exacerbation: Effect on outcome and quality of life

2014 ◽  
Vol 29 (2) ◽  
pp. 315.e7-315.e14 ◽  
Author(s):  
Dimitrios Matamis ◽  
Mathew Tsagourias ◽  
Athanasios Papathanasiou ◽  
Helen Sineffaki ◽  
Dimitra Lepida ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Chronic Obstructive ◽  
Disease Exacerbation ◽  
Obstructive Pulmonary Disease ◽  
Exacerbation Effect

Characteristics and outcomes of adults with chronic obstructive pulmonary disease and atrial fibrillation

Heart ◽  
2018 ◽  
Vol 104 (22) ◽  
pp. 1850-1858 ◽  
Author(s):  
Michael T Durheim ◽  
DaJuanicia N Holmes ◽  
Rosalia G Blanco ◽  
Larry A Allen ◽  
Paul S Chan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Symptom Burden ◽  
Smoking History ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

ObjectiveChronic obstructive pulmonary disease (COPD) is associated with the development of atrial fibrillation (AF), and may complicate treatment of AF. We examined the association between COPD and symptoms, quality of life (QoL), treatment and outcomes among patients with AF.MethodsWe compared patients with and without a diagnosis of COPD in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, a prospective registry that enrolled outpatients with AF not secondary to reversible causes, from both academic and community settings.ResultsAmong 9749 patients with AF, 1605 (16%) had COPD. Relative to patients without COPD, those with COPD were more likely to be older, current/former smokers (73% vs 43%), have heart failure (54% vs 29%) and coronary artery disease (49% vs 34%). Oral anticoagulant and beta blocker use were similar, whereas digoxin use was more common among patients with COPD. Symptom burden was generally higher, and QoL worse, among patients with COPD (median Atrial Fibrillation Effect on QualiTy-of-Life score 76 vs 83). Patients with COPD had higher risk of all-cause mortality (adjusted HR 1.52 (95% CI 1.32 to 1.74)), cardiovascular mortality (adjusted HR 1.51 (95% CI 1.24 to 1.84)) and cardiovascular hospitalisation (adjusted HR 1.15 (95% CI 1.05 to 1.26)). Patients with COPD also had higher risk of major bleeding events (adjusted HR 1.25 (95% CI 1.05 to 1.50)). There did not appear to be associations between COPD and AF progression, ischaemic events or new-onset heart failure.ConclusionsAmong patients with AF, COPD is associated with higher symptom burden, worse QoL, and worse cardiovascular and bleeding outcomes. These associations were not fully explained by cardiovascular risk factors, AF treatment or smoking history.Clinical registration numberNCT01165710

scholarly journals Healthcare utilisation trajectories in patients dying from chronic obstructive pulmonary disease, heart failure or cancer: a nationwide register-based cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e049661
Author(s):  
Anne Høy Seemann Vestergaard ◽  
Christian Fynbo Christiansen ◽  
Mette Asbjoern Neergaard ◽  
Jan Brink Valentin ◽  
Søren Paaske Johnsen
Keyword(s):  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Home Care ◽  
Healthcare Utilisation ◽  
Chronic Obstructive ◽  
Care Provision ◽  
Obstructive Pulmonary Disease ◽  
Patients With Cancer

ObjectivesTo investigate illness trajectories as reflected by healthcare utilisation, including hospital and intensive care unit admissions, consultations in general practice and home care provision, before death comparing people dying from chronic obstructive pulmonary disease (COPD), heart failure and cancer.DesignNationwide register-based cohort study.SettingData on all hospital admissions, including intensive care unit admissions, consultations in general practice and home care provision were obtained from nationwide Danish registries.ParticipantsAll adult decedents in Denmark dying from COPD, heart failure or cancer between 2006 and 2016.Outcome measuresFor each day within 5 years before death, we computed a daily prevalence proportion (PP) of being admitted to hospital or consulting a general practitioner. For each day within 6 months before death, we computed PPs of being admitted to intensive care or receiving home care. The PPs were plotted and compared by regression analyses adjusting for age, gender, comorbidity level, marital/cohabitation status, municipality and income level.ResultsAmong 1 74 086 patients dying from COPD (n=22 648), heart failure (n=11 498) or cancer (n=139 940), the PPs of being admitted to hospital or consulting a general practitioner showed similar steady progression and steep increase in the last year of life for all patient populations. The PP of being admitted to intensive care showed modest increase during the last 6 months of life, accelerating in the last month, for all patient populations. For patients with COPD and heart failure, the PP of receiving home care remained stable during the last 6 months of life but increased steadily for patients with cancer.ConclusionWe found limited differences in healthcare resource utilisation at the end of life for people with COPD, heart failure or cancer, indicating comparable illness trajectories.This supports the need to reconsider efforts in achieving equal access to palliative care interventions, which is still mainly offered to patients with cancer.

An integrated care facilitation model improves quality of life and reduces use of hospital resources by patients with chronic obstructive pulmonary disease and chronic heart failure

2010 ◽  
Vol 16 (4) ◽  
pp. 326 ◽  
Author(s):  
Stephen Bird ◽  
Michelle Noronha ◽  
Helen Sinnott
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Health Care ◽  
Self Management ◽  
Chronic Obstructive ◽  
Hospital Inpatient ◽  
Obstructive Pulmonary Disease ◽  
Bed Days

As part of the Department of Human Services Hospital Admissions Risk Program (HARP), a group of acute and community based health care providers located in the western suburbs of Melbourne formed a consortium to reduce the demand on hospital emergency services and improve health outcomes for patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). The model of care was designed by a team of multidisciplinary specialists and medical consultants. In addition to receiving normal care, patients recruited to the project were assessed by ‘Care Facilitators’, who identified unmet health care needs and provided information, advice and education for the patient concerning their condition and self-management. Patients declining recruitment received all normal care services. The patients’ rates of emergency department (ED) presentations, inpatient admissions and hospital inpatient bed-days before and after their recruitment were calculated from the Western Health patient activity records, and pre- versus post-recruitment rates were compared using ANOVA. Changes relative to the ongoing use by those who declined recruitment were compared using the group-by-time interaction. Patient health outcomes were assessed using established disease-specific tools, and pre- versus post-recruitment values were compared using paired t-tests. Patients recruited to the COPD project reduced (P < 0.05) their emergency presentations, admissions and hospital inpatient bed-days by 10, 25 and 18%, respectively, whereas those declining recruitment increased their usage by 45, 41 and 51% respectively. Recruited CHF patients also displayed reductions in emergency presentations (39%), admissions (36%) and hospital inpatient bed-days (33%), whereas those who declined recruitment displayed lesser reductions for ED presentations (26%) and admissions (20%), and increased their use of hospital inpatient bed-days (15%). The recruited COPD patients reported a significant reduction in their symptoms (P < 0.005) and the CHF patients reported an improvement in their overall health and quality of life scores (P < 0.001). The outcome measures used in this evaluation suggest that an integrated care facilitation model that is patient focussed, provides an education component to promote greater self-management compliance and delivers a continuum of care through the acute and community health sectors, may reduce the utilisation of acute health care facilities and benefit the patient.

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