Effectiveness of nurse-led hospital-based heart failure programmes in octagenarians and nonagenarians: is age important?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Guerrero ◽  
L Alcoberro ◽  
J Vime ◽  
E Calero ◽  
E Hidalgo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Usual Care ◽  
Cox Regression ◽  
Oldest Old ◽  
Primary Diagnosis ◽  
Care Group ◽  
Old Patients ◽  
End Point ◽  
Period 2 ◽  
Intervention Modality

Abstract Background Efficacy of HF programmes in oldest old (octogenarians and nonagenarians) has not been fully explored. Methods We conducted a natural experiment evaluating all patients after hospitalization for heart failure as primary diagnosis between January 2017 and January 2019. We compared outcomes between patients discharged during Period #1, before the implementation of the program with patients discharged during Period #2, after the implementation of the 7-step bundle of interventions. We explored the interaction between age group (<80 vs. ≥80 years old) by the intervention modality (HF programme vs. usual care). Primary end-point was the combined end-point of all-cause death or all-cause hospitalization at 6 months after discharge from the index hospitalization. Results The study enroled 440 patients. Mean age of the whole cohort was 75±9 years. In the oldest old subgroup (n=160), mean age was 84±3. No differences were found in baseline characteristics of patients between usual care and HF program. 30-day all-cause readmission was significantly reduced in patients in the HF programme group compared to patients in the usual care group in both age strata. In unadjusted Cox regression analyses in the oldest old group, management of patients in the HF programme was significanty associated with a reduction in the risk of the primary end-point (HR: 0.50; 95% CI [0.29–0.85]; p=0.011). Conclusions Management of patients in a nurse-led integrated care-based heart failure programme results in reduction of all-cause death or all-cause hospitalizations in oldest old patients. Event-free survival cumulative curves. Funding Acknowledgement Type of funding source: None

scholarly journals Effect of comprehensive vasodilation vs usual care on mortality and heart failure rehospitalization in women with acute heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Wussler ◽  
J Walter ◽  
N Kozhuharov ◽  
A Goudev ◽  
D Flores ◽  
...  
Keyword(s):  
Heart Failure ◽  
Usual Care ◽  
Acute Heart Failure ◽  
Plasma Concentrations ◽  
Intervention Group ◽  
Absolute Difference ◽  
Care Group ◽  
Female Patients ◽  
End Point ◽  
All Cause Mortality

Abstract Background Guidelines recommend evaluating the risk/benefit ratio of novel therapies individually in women and men, as the pathophysiology and the response to treatment may differ between women and men. Among patients with acute heart failure (AHF), a strategy of intensive vasodilation, compared with usual care, overall did provide comparable outcomes. Purpose To evaluate the effect of a strategy that emphasized early intensive and sustained vasodilation in women with AHF. Methods In a randomized, open-label blinded-end-point trial patients hospitalized for AHF were enrolled in 10 hospitals in Switzerland, Bulgaria, Germany, Brazil, and Spain. Inclusion criteria were AHF expressed by acute dyspnea and increased plasma concentrations of natriuretic peptides, systolic blood pressure ≥100mmHg, and a plan for treatment in a general ward. Patients were randomized 1:1 to a strategy of early intensive and sustained vasodilation throughout the hospitalization or usual care. The primary end point was a composite of all-cause mortality or rehospitalization for AHF at 180 days. Results Among 788 patients randomized, 781 completed the trial and were eligible for the primary end point analysis. Of these 288 (36.9%) were women. The primary end point, a composite of all-cause mortality or rehospitalization for AHF at 180 days, occurred in 53 female patients (37.9%) in the intervention group (including 28 deaths [20.0%]) and in 34 female patients (23.0%) in the usual care group (including 22 deaths [14.9%]) (absolute difference for the primary end point, 14.9%; adjusted hazard ratio, 1.67 [95% CI: 1.08–2.59]; P=0.02). Clinically significant adverse events with early intensive and sustained vasodilation vs usual care included hypotension (8% vs 2%). Conclusion Among women with AHF, a strategy of early intensive and sustained vasodilation, compared with usual care, had a detrimental effect on a composite outcome of all-cause mortality and AHF rehospitalization at 180 days. Cox Proportional Hazard Curve Funding Acknowledgement Type of funding source: None

Treating Heart Failure in Older and Oldest Old Patients.

2015 ◽  
Vol 21 (13) ◽  
pp. 1659-1664 ◽  
Author(s):  
Davide Vetrano ◽  
Fabrizia Lattanzio ◽  
Anna Martone ◽  
Francesco Landi ◽  
Vincenzo Brandi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Oldest Old ◽  
Old Patients

B-type natriuretic peptides for the diagnosis of congestive heart failure in dyspneic oldest-old patients

2008 ◽  
Vol 41 (13) ◽  
pp. 1049-1054 ◽  
Author(s):  
Camille Chenevier-Gobeaux ◽  
Samuel Delerme ◽  
Jean-Christophe Allo ◽  
Martine Arthaud ◽  
Yann-Erick Claessens ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Natriuretic Peptides ◽  
Oldest Old ◽  
Old Patients

scholarly journals Clinical characteristics and manifestations in older patients with COVID-19

2020 ◽  
Author(s):  
Chenchen Wei ◽  
Ya Liu ◽  
Yapeng Liu ◽  
Kai Zhang ◽  
Dezhen Su ◽  
...  
Keyword(s):  
Heart Failure ◽  
Skeletal Muscle ◽  
Cardiovascular Diseases ◽  
Older Patients ◽  
Muscle Injury ◽  
Clinical Characteristics ◽  
Oldest Old ◽  
Cardiac Injury ◽  
Organ Damage ◽  
Old Patients

Abstract Background To investigate the clinical characteristics and manifestations of older patients with coronavirus disease 2019 (COVID-19). Methods In this retrospective study, 566 patients with confirmed COVID-19 were enrolled and the clinical characteristics, laboratory findings, complications and outcome data were collected and analyzed. Results Among the 566 patients (median age, 61.5 years) with COVID-19, 267 (47.2%) patients were male and 307 (54.2%) were elderly. Compared with younger patients, older patients had more underlying comorbidities and laboratory abnormalities. A higher rate of acute respiratory distress syndrome (ARDS), acute cardiac injury and heart failure was observed in the older group as compared with younger and middle-aged groups, particularly those oldest-old patients (> 75y) had more multi-organ damage. Older patients with COVID-19 were more likely to suffer from acute cardiac injury in cases with preexistenting cardiovascular diseases, while there was no difference among the three groups when patients had no history of cardiovascular diseases. Older patients present more severe and the mortality was 18.6%, which was higher than that in younger and middle-aged patients (P < 0.05). Multivariable analysis showed that age, lymphopenia, ARDS, acute cardiac injury, heart failure and skeletal muscle injury were associated with the death in older patients, while glucocorticoids should be carefully administered since it may increase the mortality in older patients. Conclusions Older patients, especially the oldest-old patients were more likely to exhibit significant systemic inflammation, pulmonary and extrapulmonary organ damage and a higher mortality. Advanced age, lymphopenia, ARDS, acute cardiac injury, heart failure and skeletal muscle injury were independent predictors of death in older patients and glucocorticoids may be harmful for older patients with COVID-19.

P5447Prognostic significance of carboxy-terminal telopeptide (ICTP) and Caspase-3 in patients with non-ischemic dilated cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I Kazukauskiene ◽  
V Baltruniene ◽  
D Bironaite ◽  
S Cibiras ◽  
K Rucinskas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Dilated Cardiomyopathy ◽  
Prognostic Value ◽  
Caspase 3 ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
End Point ◽  
Non Ischemic Dilated Cardiomyopathy ◽  
Carboxy Terminal

Abstract Background Non-ischemic dilated cardiomyopathy (niDCM) is a common debilitating disease leading to heart failure and poor prognosis. Therefore, a reliable diagnosis of niDCM and search of prognostic biomarkers is a task of paramount importance preventing final destruction of myocardium and improving the outcomes of the disease. The aim of the study was to evaluate the prognostic value of carboxy-terminal telopeptide (ICTP), a marker of myocardial collagen I degradation, and Caspase-3, a marker of apoptosis, in serum and endomyocardium biopsies (EMBs) of patients with niDCM. Methods 34 consecutive patients (male 25 (78%); 43.83±12.17 years) with niDCM (average of left ventricle (LV) end-diastolic diameter 6.94±0.78 cm, LV ejection fraction 24.97±6.93%, mean pulmonary capillary wedge pressure 32.9±8.7 mmHg) were enrolled in the study. The levels of ICTP and Caspase-3 in patients' serum and EMBs were measured by ELISA. After a follow-up period of 5 years, 18 patients (53%) have reached the primary composite end-point of heart failure: 6 patients (17.6%) died, 6 patients (17.6%) had heart transplantation and 6 patients (17.6%) underwent left ventricle assist device implantation. Results Univariate Cox proportional hazard model and ROC curve analysis identified levels of ICTP and Caspase-3 in serum as predictors of composite end-point (Table 1). However, the levels of ICTP and Caspase-3 in EMBs had no prognostic value. The cut-off values of serum biomarkers for prediction of the outcome were 13.43 pg/mg protein (sensitivity 67%; specificity 81%) for ICTP and 10.21 pg/mg protein (sensitivity 53%; specificity 87%) for Caspase-3. Univariate Cox regression analysis revealed that patients with higher levels of ICTP and Caspase-3 than cut-off values in serum had higher risk of reaching the composite end-point compared to the patients with lower cut-off values (HR 4.4 (95% CI: 1.6–12.1) and 3.15 (95% CI: 1.2–8.29), respectively). Kaplan-Meier survival analysis demonstrated that patients with serum Caspase-3 and ICTP levels above cut-off values had significantly worse outcome (p=0.01 and p=0.002, respectively). Table 1 Biomarkers (pg/mg protein) Mean ± SD HR (95% CI) p-value AUC (95% CI) ICTP in serum 15.26±10.59 1.052 (1.013–1.093) 0.009 0.71 (0.53–0.89) ICTP in EMB 132±295 0.999 (0.998–1.001) 0.56 0.45 (0.28–0.61) Caspase-3 in serum 7.78±9.86 1.047 (1.002–1.093) 0.04 0.69 (0.51–0.87) Caspase-3 in EMB 283±282 1 (0.998–1.002) 0.92 0.50 (0.28–0.72) Conclusion The findings show that increased serum levels of Caspase-3 and ICTP are significantly associated with poor outcome in patients with niDCM. Acknowledgement/Funding the Research Council of Lithuania (Grants nos. MIP-086/2012 and MIP-011/2014), the European Union, EU-FP7, SARCOSI Project (no. 291834)

scholarly journals Clinical characteristics and manifestations in older patients with COVID-19

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chenchen Wei ◽  
Ya Liu ◽  
Yapeng Liu ◽  
Kai Zhang ◽  
Dezhen Su ◽  
...  
Keyword(s):  
Heart Failure ◽  
Skeletal Muscle ◽  
Cardiovascular Diseases ◽  
Older Patients ◽  
Muscle Injury ◽  
Clinical Characteristics ◽  
Oldest Old ◽  
Cardiac Injury ◽  
Organ Damage ◽  
Old Patients

Abstract Background To investigate the clinical characteristics and manifestations of older patients with coronavirus disease 2019 (COVID-19). Methods In this retrospective study, 566 patients with confirmed COVID-19 were enrolled and the clinical characteristics, laboratory findings, complications and outcome data were collected and analyzed. Results Among the 566 patients (median age, 61.5 years) with COVID-19, 267 (47.2%) patients were male and 307 (54.2%) were elderly. Compared with younger patients, older patients had more underlying comorbidities and laboratory abnormalities. A higher rate of acute respiratory distress syndrome (ARDS), acute cardiac injury and heart failure was observed in the older group as compared with younger and middle-aged groups, particularly those oldest-old patients had more multi-organ damage. Older patients with COVID-19 were more likely to suffer from acute cardiac injury in cases with preexistenting cardiovascular diseases, while there was no difference among the three groups when patients had no history of cardiovascular diseases. Older patients presented more severe with the mortality of 18.6%, which was higher than that in younger and middle-aged patients (P < 0.05). Multivariable analysis showed that age, lymphopenia, ARDS, acute cardiac injury, heart failure and skeletal muscle injury were associated with death in older patients, while glucocorticoids might be harmful. Conclusions Older patients, especially the oldest-old patients were more likely to exhibit significant systemic inflammation, pulmonary and extrapulmonary organ damage and a higher mortality. Advanced age, lymphopenia, ARDS, acute cardiac injury, heart failure and skeletal muscle injury were independent predictors of death in older patients with COVID-19 and glucocorticoids should be carefully administered in older patients.

scholarly journals Clinical characteristics and manifestations in older patients with COVID-19

2020 ◽  
Author(s):  
Chenchen Wei ◽  
Ya Liu ◽  
Yapeng Liu ◽  
Kai Zhang ◽  
Dezhen Su ◽  
...  
Keyword(s):  
Heart Failure ◽  
Skeletal Muscle ◽  
Cardiovascular Diseases ◽  
Older Patients ◽  
Muscle Injury ◽  
Clinical Characteristics ◽  
Oldest Old ◽  
Cardiac Injury ◽  
Organ Damage ◽  
Old Patients

Abstract Background: To investigate the clinical characteristics and manifestations of older patients with coronavirus disease 2019 (COVID-19).Methods: In this retrospective study, 566 patients with confirmed COVID-19 were enrolled and the clinical characteristics, laboratory findings, complications and outcome data were collected and analyzed.Results: Among the 566 patients (median age, 61.5 years) with COVID-19, 267 (47.2%) patients were male and 307 (54.2%) were elderly. Compared with younger patients, older patients had more underlying comorbidities and laboratory abnormalities. A higher rate of acute respiratory distress syndrome (ARDS), acute cardiac injury and heart failure was observed in the older group as compared with younger and middle-aged groups, particularly those oldest-old patients (>75 years) had more multi-organ damage. Older patients with COVID-19 were more likely to suffer from acute cardiac injury in cases with preexistenting cardiovascular diseases, while there was no difference among the three groups when patients had no history of cardiovascular diseases. Older patients present more severe with the mortality of 18.6%, which was higher than that in younger and middle-aged patients (P<0.05). Multivariable analysis showed that age, lymphopenia, ARDS, acute cardiac injury, heart failure and skeletal muscle injury were associated with death in older patients, while glucocorticoids may be harmful.Conclusions: Older patients, especially the oldest-old patients were more likely to exhibit significant systemic inflammation, pulmonary and extrapulmonary organ damage and a higher mortality. Advanced age, lymphopenia, ARDS, acute cardiac injury, heart failure and skeletal muscle injury were independent predictors of death in older patients with COVID-19 and glucocorticoids should be carefully administered in older patients.

scholarly journals Cost-effectiveness of noninvasive telemedical interventional management in patients with heart failure: health economic analysis of the TIM-HF2 trial

2021 ◽  
Author(s):  
Hanna Sydow ◽  
Sandra Prescher ◽  
Friedrich Koehler ◽  
Kerstin Koehler ◽  
Marc Dorenkamp ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Health Economic ◽  
Usual Care ◽  
Usual Care Group ◽  
Cost Savings ◽  
Care Group ◽  
Interventional Management ◽  
Patients With Heart Failure ◽  
Intervention Costs

Abstract Background Noninvasive remote patient management (RPM) in patients with heart failure (HF) has been shown to reduce the days lost due to unplanned cardiovascular hospital admissions and all-cause mortality in the Telemedical Interventional Management in Heart Failure II trial (TIM-HF2). The health economic implications of these findings are the focus of the present analyses from the payer perspective. Methods and results A total of 1538 participants of the TIM-HF2 randomized controlled trial were assigned to the RPM and Usual Care group. Health claims data were available for 1450 patients (n = 715 RPM group, n = 735 Usual Care group), which represents 94.3% of the original TIM-HF2 patient population, were linked to primary data from the study documentation and evaluated in terms of the health care cost, total cost (accounting for intervention costs), costs per day alive and out of hospital (DAOH), and cost per quality-adjusted life year (QALY). The average health care costs per patient year amounted to € 14,412 (95% CI 13,284–15,539) in the RPM group and € 17,537 (95% CI 16,179–18,894) in the UC group. RPM led to cost savings of € 3125 per patient year (p = 0.001). After including the intervention costs, a cost saving of € 1758 per patient year remained (p = 0.048). Conclusion The additional noninvasive telemedical interventional management in patients with HF was cost-effective compared to standard care alone, since such intervention was associated with overall cost savings and superior clinical effectiveness. Graphical abstract

Effect of home-based telecardiology on chronic heart failure: Costs and outcomes

2005 ◽  
Vol 11 (1_suppl) ◽  
pp. 16-18 ◽  
Author(s):  
S Scalvini ◽  
S Capomolla ◽  
E Zanelli ◽  
M Benigno ◽  
D Domenighini ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Usual Care ◽  
Usual Care Group ◽  
Care Group ◽  
Home Based ◽  
Clinical Instability ◽  
One Year ◽  
The One ◽  
The Cost

Chronic heart failure (CHF) remains a common cause of disability. We have investigated the use of home-based telecardiology (HBT) in CHF patients. Four hundred and twenty-six patients were enrolled in the study: 230 in the HBT group and 196 in the usual-care group. HBT consisted of trans-telephonic follow-up and electrocardiogram (ECG) monitoring, followed by visits from the paramedical and medical team. A one-lead ECG recording was transmitted to a receiving station, where a nurse was available for reporting and interactive teleconsultation. The patient could call the centre when assistance was required (tele-assistance), while the team could call the patient for scheduled appointments (telemonitoring). The one-year clinical outcomes showed that there was a significant reduction in rehospitalizations in the HBT group compared with the usual-care group (24% versus 34%, respectively). There was an increase in quality of life in the HBT group (mean Minnesota Living Questionnaire scores 29 and 23.5, respectively). The total costs were lower in the HBT group (107,494 and 140,874, respectively). The results suggest that a telecardiology service can detect and prevent clinical instability, reduce rehospitalization and lower the cost of managing CHF patients.

Abstract 27: Impact of Telemonitoring on Health Status in Patients with Heart Failure

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Natalie Jayaram ◽  
Harlan M Krumholz ◽  
Sarwat I Chaudhry ◽  
Jennifer Mattera ◽  
Fengming Tang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Health Status ◽  
Usual Care ◽  
Primary Endpoint ◽  
Kansas City ◽  
Summary Score ◽  
Care Group ◽  
Patients With Heart Failure

Background: Although telemonitoring in patients with heart failure is not effective in reducing mortality or hospitalizations, less is known regarding its effect on patients’ health status, their symptoms, functioning and quality of life. Methods: The TeleHF study randomized 1,653 patients with recent heart failure hospitalization to telephonic monitoring (n=826) or usual care (n=827). Patients in the telemonitoring arm phoned in daily and responded to a series of automated questions regarding their symptoms and daily weight. Health status information, using the Kansas City Cardiomyopathy Questionnaire (KCCQ), was collected at baseline, 3 months, and at 6 months. The primary endpoint was change in KCCQ score from baseline to 3 and 6 months. Results: The baseline characteristics of the two treatment arms were similar; 42% were female and 39% were black. At baseline, there were no significant differences in KCCQ scores between the telemedicine and the usual care group. Both groups reported significant quality of life limitations with median KCCQ score of 59.9, and median scores of 75.0, 87.5 and 56.3 on the physical limitation, self-efficacy and social limitation subscales respectively. At 3 and 6 month follow-up, there were no significant differences between the two treatment groups with respect to the primary endpoint, change in KCCQ overall summary score or subscale scores from baseline (see table). Conclusion: Telemonitoring in a large group of patients with heart failure did not improve health status when compared to usual care. Failure to improve readmission or mortality rates combined with lack of effect on quality of life suggests that alternative solutions for management of this complex population should be sought.

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