Examination about more realistic prognosis evaluation method, how long the patients with congestive heart failure can spend at home

Abstract Background From August 2015, for efficient medical care in congestive heart failure (CHF) cases, we had introduced a unique clinical pathway (PATH) provided the immediate use of Tolvaptan and comprehensive education by multi-disciplinary staff after admission. And by introduction of PATH, we confirmed the shortening effect of hospitalization period with CHF and the suppressive effect of readmission with CHF after discharge. But since almost CHF patients repeat hospitalization and discharge due to change of their medical condition, the investigation for only first readmission rate after discharge is not enough to assess the entire long clinical course of CHF. Recently we found one report about evaluation method for CHF clinical prognosis, how long CHF patients can stay healthy at their own home after discharge within a certain period. This evaluation method is considered to take into account the long clinical course of CHF. Purpose We investigated whether the CHF patients introduced PATH on admission could stay longer at their home than CHF patients without PATH. Methods Between April 2014 and July 2019, 471 CHF cases, who ware admitted in our hospital at first and could be followed up for at least 1 month after discharge, ware enrolled. We divided them to two groups, PATH- group before introducing PATH (until July 2015, 142 cases), and PATH+ group applied PATH (after August 2015, 329 cases). Between both groups, we investigated the readmission rate (RR) with CHF and the total period (TP) that patients could spend at home within1, 3, 6 and 12month after discharge. Results There were no significant differences in mean age, pre-hospital living status, or clinical status at admission between the two groups. On the other hand, due to efficient CHF care, the average length of hospital stay was significantly shorter (figure1). RR within 1, 3, 6 and 12 months after discharge ware all lower in PATH+ group. And TP within 1, 3, 6 and 12 months after discharge ware all longer in PATH+ group (figure2). Conclusion By introducing our unique clinical pathway for congestive heart failure cases requiring hospitalization, we could confirm not only the improvement of their conventional clinical prognosis index but also the improvement of their new and more realistic clinical prognosis index after discharge. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

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Our unique clinical pathway for congestive heart failure cases required admission achieved a dramatic reduction of their hospitalization period and a significant reduction of readmission with heart fa

European Heart Journal ◽

10.1093/ehjci/ehaa946.1241 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Takaishi ◽

T Kisinoue ◽

H Mori ◽

T Yoshino ◽

T Yamaji ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Patient Education ◽

Clinical Pathway ◽

Readmission Rate ◽

Age Distribution ◽

Activity Level ◽

Clinical Prognosis ◽

Hospitalization Period ◽

One Year

Abstract Background In recent years, the number of elderly congestive heart failure (CHF) cases has been increasing in Japan with the aging of the population. This tendency is particularly remarkable in rural areas where our facilities are located. After admission with CHF, the hospitalization period (PE) was prolonged due to various complications unique to the elderly, and re-exacerbation of CHF occurred shortly after discharge. Approximately 30% of them were readmitted within one year. From August 2015, for shortening of PE and reduction of CHF readmission through the efficiency of CHF treatment and comprehensive patient education, we had introduced a unique clinical pathway (PATH) that provided the immediate use of Tolvaptan and comprehensive education by multi-disciplinary staff after admission. Purpose In this study, we verified whether the improvement of clinical prognosis were achieved by introduction of PATH. Methods Between April 2014 and July 2019, 635 CHF cases (764 admissions) ware enrolled. We divided them to two groups, N-group before introducing PATH (198 cases, 262 admissions) and P-group applied PATH (437 cases, 502 admission). Between both groups, we compared the various acute care situation, PE and readmission rate with CHF within 1 year after discharge. Results There were no differences between P and N-group in mean age, distribution of underlying illness or daily activity level before admission. There ware not also differences about left ventricle function by echocardiography and various blood test data at admission. The enforcement rate of continuous infusion and the rate of urinary catheter placement were significantly lower in the P-group (71 vs 88%; p<0.0001, 52 vs 63%; p<0.01, respectively). And their enforcement duration was significantly shorter in P-group (4.6±5.3 vs 10.5±9.6 days; p<0.0001, 6.3±7.9 vs 12.8±13.1 days; p<0.0001 respectively). The enforcement rate of cardiac rehabilitation was significantly higher in group P (94 vs 84%; p<0.0001), and the starting time of rehabilitation was significantly earlier (2.9±1.5 vs 6.3±4.8th illness day; p<0.0001). As a result, the average HP was significantly shorter in group P (16.5±13.4 vs 28.6±24.1 days, p<0.0001). The readmission rate with CHF within one year after discharge was significantly lower in group P (23 vs 36%; p<0.001). Conclusion By the introduction of our original clinical pathway for congestive heart failure, the efficiency of medical care was achieved and the mean hospitalization period was widely shortened. In addition, by the through comprehensive patient education by multi-disciplinary staff involved in the pathway, the self-restraint life style after discharge seemed to be maintained and the readmission with worsening of heart failure was significantly suppressed. Funding Acknowledgement Type of funding source: None

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Evaluation of the efficacy of a nurse practitioner-led home-based congestive heart failure clinical pathway

Home Health Care Services Quarterly ◽

10.1080/01621424.2016.1175992 ◽

2016 ◽

Vol 35 (1) ◽

pp. 39-51 ◽

Cited By ~ 4

Author(s):

Jo-Ann Mary Moore

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Nurse Practitioner ◽

Clinical Pathway ◽

Home Based

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Patient engagement with digital disease management and readmission rates: The case of congestive heart failure

Health Informatics Journal ◽

10.1177/14604582211030959 ◽

2021 ◽

Vol 27 (3) ◽

pp. 146045822110309

Author(s):

Rudin Gjeka ◽

Kirit Patel ◽

Chandra Reddy ◽

Nora Zetsche

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Disease Management ◽

Readmission Rate ◽

Hospital Readmissions ◽

The Elderly ◽

Readmission Rates ◽

Management Platform ◽

High Readmission Rate ◽

Remote Patient

Congestive heart failure (CHF) is one of the most common diagnoses in the elderly United States Medicare (⩾ age 65) population. This patient population has a particularly high readmission rate, with one estimate of the 6-month readmission rate topping 40%. The rapid rise of mobile health (mHealth) presents a promising new pathway for reducing hospital readmissions of CHF, and, more generally, the management of chronic conditions. Using a randomized research design and a multivariate regression model, we evaluated the effectiveness of a hybrid mHealth model—the integration of remote patient monitoring with an applied health technology and digital disease management platform—on 45-day hospital readmissions for patients diagnosed with CHF. We find a 78% decrease in the likelihood of CHF hospital readmission for patients who were assigned to the digital disease management platform as compared to patients assigned to control.

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The incidence, clinical significance of depression and changes in its clinical course after a cardiac device implantation in patients with congestive heart failure

European Heart Journal ◽

10.1093/eurheartj/eht310.p5740 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P5740-P5740

Author(s):

T. Podolecki ◽

R. Pudlo ◽

M. Koziel ◽

J. Boidol ◽

K. Przybylska ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Clinical Significance ◽

Clinical Course ◽

Cardiac Device ◽

Device Implantation

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Congestive Heart Failure in Copper-Deficient Mice

Experimental Biology and Medicine ◽

10.1177/15353702-0322807-06 ◽

2003 ◽

Vol 228 (7) ◽

pp. 811-817 ◽

Cited By ~ 44

Author(s):

Laila Elsherif ◽

Raymond V. Ortines ◽

Jack T. Saari ◽

Y. James Kang

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Left Ventricle ◽

Diastolic Pressure ◽

Systolic Pressure ◽

Pressure Rise ◽

Experimental Models ◽

Left Ventricular ◽

Mouse Heart ◽

Total Period

Copper Deficiency (CuD) leads to hypertrophic cardiomyopathy in various experimental models. The morphological, electrophysiological, and molecular aspects of this hypertrophy have been under investigation for a long time. However the transition from compensated hypertrophy to decompensated heart failure has not been investigated in the study of CuD. We set out to investigate the contractile and hemodynamic parameters of the CuD mouse heart and to determine whether heart failure follows hypertrophy in the CuD heart. Dams of FVB mice were fed CuD or copper-adequate (CuA) diet starting from the third day post delivery and the weanling pups were fed the same diet for a total period of 5 weeks (pre- and postweanling). At week 4, the functional parameters of the heart were analyzed using a surgical technique for catheterizing the left ventricle. A significant decrease in left ventricle systolic pressure was observed with no significant change in heart rate, and more importantly contractility as measured by the maximal rate of left ventricular pressure rise (+dP/dt) and decline (−dP/dt) were significantly depressed in the CuD mice. However, left ventricle end diastolic pressure was elevated, and relaxation was impaired in the CuD animals; the duration of relaxation was prolonged. In addition to significant changes in the basal level of cardiac function, CuD hearts had a blunted response to the stimulation of the β-adrenergic agonist isoproterenol. Furthermore, morphological analysis revealed increased collagen accumulation in the CuD hearts along with lipid deposition. This study shows that CuD leads to systolic and diastolic dysfunction in association with histopathological changes, which are indices commonly used to diagnose congestive heart failure.

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