scholarly journals Comparison of management and outcomes of ED patients with acute decompensated heart failure between the Canadian and United States’ settings

CJEM ◽  
2015 ◽  
Vol 18 (2) ◽  
pp. 81-89 ◽  
Author(s):  
Anita Lai ◽  
Elliott Tenpenny ◽  
David Nestler ◽  
Erik Hess ◽  
Ian G. Stiell
Keyword(s):  
United States ◽  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Admission Rate ◽  
Decompensated Heart Failure ◽  
The United States ◽  
Health Records ◽  
Male Sex ◽  
Relapse Rates ◽  
The U.S

AbstractIntroductionThe objective of this study was to compare the emergency department (ED) management and rate of admission of acute decompensated heart failure (ADHF) between two hospitals in Canada and the United States and to compare the outcomes of these patients.MethodsThis was a health records review of adults presenting with ADHF to two EDs in Canada and the United States between January 1 and April 30, 2010. Outcome measures were admission to the hospital, myocardial infarction (MI), and death or relapse rates to the ED. Data were analysed using descriptive, univariate and multivariate analyses.ResultsIn total, 394 cases were reviewed and 73 were excluded. Comparing 156 Canadian to 165 U.S. patients, respectively, mean age was 76.0 and 75.8 years; male sex was 54.5% and 52.1%. Canadian and U.S. ED treatments were noninvasive ventilation 7.7% v. 12.8% (p=0.13); IV diuretics 77.6% v. 36.0% (p<0.001); IV nitrates 4.5% v. 6.7% (p=0.39). There were significant differences in rate of admission (50.6% v. 95.2%, p<0.001) and length of stay in ED (6.7 v. 3.0 hours, p<0.001). Proportion of Canadian and U.S. patients who died within 30 days of the ED visit was 5.1% v. 9.7% (p=0.12); relapsed to the ED within 30 days was 20.8% v. 17.5% (p=0.5); and had MI within 30 days was 2.0% v. 1.9% (p=1.0).ConclusionsThe U.S. and Canadian centres saw ADHF patients with similar characteristics. Although the U.S. site had almost double the admission rate, the outcomes were similar between the sites, which question the necessity of routine admission for patients with ADHF.

scholarly journals Temporal Trends in Hospitalization for Acute Decompensated Heart Failure in the United States, 1998–2011

2016 ◽  
Vol 183 (5) ◽  
pp. 462-470 ◽  
Author(s):  
Sunil K. Agarwal ◽  
Lisa Wruck ◽  
Miguel Quibrera ◽  
Kunihiro Matsushita ◽  
Laura R. Loehr ◽  
...  
Keyword(s):  
United States ◽  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Temporal Trends ◽  
Decompensated Heart Failure ◽  
The United States

scholarly journals Invasive Devices and Sensors for Remote Care of Heart Failure Patients

Sensors ◽  
2021 ◽  
Vol 21 (6) ◽  
pp. 2014
Author(s):  
Sumant P. Radhoe ◽  
Jesse F. Veenis ◽  
Jasper J. Brugts
Keyword(s):  
Heart Failure ◽  
Remote Monitoring ◽  
Hospital Admissions ◽  
Acute Decompensated Heart Failure ◽  
Admission Rate ◽  
Decompensated Heart Failure ◽  
Hospital Admission Rate ◽  
Remote Care ◽  
New Sensors ◽  
Near Future

The large and growing burden of chronic heart failure (CHF) on healthcare systems and economies is mainly caused by a high hospital admission rate for acute decompensated heart failure (HF). Several remote monitoring techniques have been developed for early detection of worsening disease, potentially limiting the number of hospitalizations. Over the last years, the scope has been shifting towards the relatively novel invasive sensors capable of measuring intracardiac filling pressures, because it is believed that hemodynamic congestion precedes clinical congestion. Monitoring intracardiac pressures may therefore enable clinicians to intervene and avert hospitalizations in a pre-symptomatic phase. Several techniques have been discussed in this review, and thus far, remote monitoring of pulmonary artery pressures (PAP) by the CardioMEMS (CardioMicroelectromechanical system) HF System is the only technique with proven safety as well as efficacy with regard to the prevention of HF-related hospital admissions. Efforts are currently aimed to further develop existing techniques and new sensors capable of measuring left atrial pressures (LAP). With the growing body of evidence and need for remote care, it is expected that remote monitoring by invasive sensors will play a larger role in HF care in the near future.

scholarly journals TEMPORAL TRENDS IN ACUTE DECOMPENSATED HEART FAILURE HOSPITALIZATIONS IN THE U.S., 1998-2011

2015 ◽  
Vol 65 (10) ◽  
pp. A1048
Author(s):  
Sunil K. Agarwal ◽  
Lisa Wruck ◽  
Pedro M. Quibrera ◽  
Kunihiro Matsushita ◽  
Laura Loehr ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Temporal Trends ◽  
Decompensated Heart Failure ◽  
The U.S

Remote TELEmonitoring and Health Coaching for patients with acute heart failure: results of the TELE-HC randomized trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Schulte ◽  
L Olson ◽  
C Bruce
Keyword(s):  
Heart Failure ◽  
Randomized Trial ◽  
Standard Care ◽  
Primary Outcome ◽  
Acute Decompensated Heart Failure ◽  
Treatment Strategies ◽  
Decompensated Heart Failure ◽  
The United States ◽  
Health Coaching ◽  
Funding Source

Abstract Introduction Patients discharged after acute decompensated heart failure (ADHF) have elevated risk for readmission due to multiple factors including suboptimal behavioral and social support. Telemonitoring interventions have shown inconsistent effectiveness in reducing HF readmissions. Patient-centered health coaching, when combined with telemonitoring, may be a viable model to engage patients in self-care behaviors and enhance patient experiences following acute hospitalization. Purpose This multicenter randomized trial evaluates whether remote telemonitoring combined with health coaching decreases 60 day readmission rates for patients with ADHF when compared to standard of care. Methods Patients with primary or secondary diagnosis of ADHF were consented and randomized prior to hospital discharge to either standard care or intervention of remote telemonitoring and health coaching. Within 2 days of hospital dismissal, intervention patients were onboarded to the remote monitoring platform, which links personal health sensors which collect on-body physiologic measures (ECG, heart rate, respiration rate, and activity via 3-axis accelerometer) with providers through secure mobile communication. A registered nurse was designated as the primary health coach focusing on disease management - including symptom recognition, adherence to treatment strategies, care coordination, medication matters, and problem solving. A social worker and nutritionist were also assigned. The primary outcome was all-cause mortality or readmission within 60 days of hospital dismissal. Statistical analysis included stratified log-rank tests and stratified Cochran-Mantel-Haenszel Chi-square test to account for site-stratified randomization. Results The study was halted due to low rate of subject accrual. Of planned 304 subjects, 143 were randomized between 2015 and 2019 at 6 sites in the United States. Dropout and withdrawal after randomization of 32 subjects (22%) left 112 analyzable for the primary endpoint. Many subject withdrawals after unblinded disclosure of arm allocation were related to treatment assignment. Immediate withdrawal without follow up in these subjects precluded an intention-to-treat analysis. Mean age was 69 years and subjects were more often male (56%) and non-Hispanic white (70%). In per-protocol analysis, using subjects adherent to protocol specified visits (n=112), we observe no difference in the primary outcome (26% among intervention vs 28% among standard care, Figure, p=0.77). There were also no differences among secondary outcomes of overall mortality (2% vs 7%, p=0.20) or composite emergency department visit, hospital admission, or death (35% vs 34%, p=0.85). Conclusions Among patients with heart failure, an intervention of remote telemonitoring and health coaching did not reduce all-cause readmission or mortality. Significant withdrawal rates suggest future studies may need to improve screening and study retention. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health, National Institute on Aging

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