scholarly journals Healthcare Disparity and Comorbidity Burden in Heart Failure Patients Over the Age of 80

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 628-629
Author(s):  
Anna Blach ◽  
Amanda Pangle ◽  
Jeanne Wei ◽  
Gohar Azhar
Keyword(s):  
Heart Failure ◽  
Clinical Care ◽  
Rural Setting ◽  
Healthcare Disparity ◽  
Heart Failure Patients ◽  
Black Patients ◽  
Comorbidity Burden ◽  
Diagnosis Of Dementia ◽  
Age Range ◽  
Morbid Conditions

Abstract The healthcare industry is currently struggling with providing access and coverage for a rapidly ageing and increasingly diverse population with multiple co-morbid conditions. This retrospective study analyzed the electronic health records of elderly heart failure patients (age range 80-103; mean 87 ±4.9) for common co-morbid conditions of hypertension, hyperlipidemia, dementia and diabetes mellitus. Chart review analysis of 316 patients showed a racial distribution of 251 White vs. 65 Black patients (79% vs. 21%). Male patients were under-represented (B= 13.8% and W= 26.3%). Females patients predominated (B= 86.2% and W= 73.7%). Overall, the prevalence of all four comorbidities was approximately three times higher in Blacks (18.5%) vs. White (7.2%). The proportion of Blacks and Whites with HTN and was comparable at 98.5 and 92.4% respectively. Hyperlipidemia was present in 84.6% Black and 63.3% White. The diagnosis of diabetes was higher in Blacks, 41.5% compared to Whites, 21.9%. The greatest disparity was in the diagnosis of dementia which was higher in Blacks, 61.5% vs Whites, 44.6%. Our study is unique for studying healthcare disparity in octogenarian and nonagenarian residing in a rural setting. Our results also highlight the importance of making a special effort to engage older Black patients in seeking healthcare in addition to designing strategies to reduce barriers that impede access and availability of resources and clinical care, especially in economically underserved regions of the country.

Abstract 18599: Clinical Assessment of Hemodynamic Profiles Predict Readmission and Mortality in Diastolic Heart Failure Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mohammed Siddiqui ◽  
Salpy V Pamboukian ◽  
Jose A Tallaj ◽  
Michael Falola ◽  
Sula Mazimba
Keyword(s):  
Heart Failure ◽  
Clinical Assessment ◽  
Diastolic Heart Failure ◽  
Clinical Care ◽  
Systolic Heart Failure ◽  
Health Care Expenditures ◽  
Left Ventricular ◽  
Readmission Rates ◽  
Heart Failure Patients ◽  
Increased Risk

Background: Reducing 30 day readmission rates for patients with heart failure (HF) has been a recent focus of lowering health care expenditures. Hemodynamic profiles (HP) have been associated with clinical outcomes in chronic systolic HF. The relationship of HP to outcomes in acute decompensated diastolic HF (DHF) has not been defined. Methods: This case-control study of 1892 DHF patients discharged alive from an academic hospital between 2002-2012 with left ventricular function greater or equal to 45% were categorized into 4 groups: Profile A, no evidence of congestion and hypoperfusion (dry-warm); Profile B, congestion with adequate perfusion (wet-warm); Profile C, congestion with hypoperfusion (wet-cold); and Profile L, hypoperfusion without congestion (dry-cold). All cause readmissions at 30 days and 1 year and mortality at 30 days and 1 year were examined. Statistical analysis using multivariable Cox Proportional hazard model was performed adjusting for demographic, clinical, care and hospital characteristics. Results: Of the 1892 patients, 1196 (63%) were females; mean age was 68 (±14) years. There were 724(38%), 1000 (53%), 88(5%) and 80 (4%) patients in the hemodynamic profiles A, B, C and L respectively. Profiles B and C were associated with an increased risk for 30-day all-cause HF readmission compared to profiles A and L: Hazard ratio (HR) [1.38 (95% C.I 1.17-1.61)], [1.39 (95% C.I 1.18-1.62)] for B and C profiles respectively. Profiles C and L were associated with increased mortality at 1 year: HR [1.46 (95% CI 1.06-1.89)] and [1.31 (95% CI 1.01-1.64)] for A and L profiles respectively (Table). Conclusions: Clinical assessment of HP can help identify DHF patients at increased risk of readmission and mortality, similar to systolic heart failure patients.

scholarly journals Understanding the Complexity of Heart Failure Risk and Treatment in Black Patients

2020 ◽  
Vol 13 (8) ◽  
Author(s):  
Aditi Nayak ◽  
Albert J. Hicks ◽  
Alanna A. Morris
Keyword(s):  
Heart Failure ◽  
Racial Disparities ◽  
Black Men ◽  
Relative Rate ◽  
Clinical Care ◽  
Future Research ◽  
First Year ◽  
Men And Women ◽  
Black And White ◽  
Black Patients

Although care of patients with heart failure (HF) has improved in the past decade, important disparities in HF outcomes persist based on race/ethnicity. Age-adjusted HF-related cardiovascular disease death rates are higher for Black patients, particularly among young Black men and women whose rates of death are 2.6- and 2.97-fold higher, respectively, than White men and women. Similarly, the rate of HF hospitalization for Black men and women is nearly 2.5-fold higher when compared with Whites, with costs that are significantly higher in the first year after HF hospitalization. While the relative rate of HF hospitalization has improved for other race/ethnic minorities, the disparity in HF hospitalization between Black and White patients has not decreased during the last decade. Although access to care and socioeconomic status have been traditional explanations for the observed racial disparities in HF outcomes, contemporary data suggest that novel factors including genetic susceptibility as well as social determinants of health and implicit bias may play a larger role in health outcomes than previously appreciated. The purpose of this review is to describe the complex interplay of factors that influence racial disparities in HF incidence, prevalence, and disease severity, with a highlight on evolving knowledge that will impact the clinical care and address future research needs to improve HF disparities in Blacks.

306 Impact of new technologies on the clinical care of heart failure patients

2007 ◽  
Vol 6 (1) ◽  
pp. 67-67
Author(s):  
L SANVICENTEURONDO ◽  
N GALOFRE ◽  
J GONZALEZ ◽  
E GALVEZ ◽  
M ALTIMIRA ◽  
...  
Keyword(s):  
Heart Failure ◽  
New Technologies ◽  
Clinical Care ◽  
Heart Failure Patients

Managing heart failure patients: when good-old-fashioned clinical care is not enough

Heart ◽  
2009 ◽  
Vol 95 (13) ◽  
pp. 1036-1037 ◽  
Author(s):  
V. M Conraads ◽  
C. J Vrints
Keyword(s):  
Heart Failure ◽  
Clinical Care ◽  
Heart Failure Patients

scholarly journals Multidisciplinary intensive education in the hospital improves outcomes for hospitalized heart failure patients in a Japanese rural setting

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Yoshiharu Kinugasa ◽  
Masahiko Kato ◽  
Shinobu Sugihara ◽  
Kiyotaka Yanagihara ◽  
Kensaku Yamada ◽  
...  
Keyword(s):  
Heart Failure ◽  
Rural Setting ◽  
Heart Failure Patients ◽  
Intensive Education

scholarly journals Biomarkers in Routine Heart Failure Clinical Care

2019 ◽  
Vol 5 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Sunil K Nadar ◽  
Muhammed Mujtaba Shaikh
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptides ◽  
Gold Standard ◽  
Clinical Condition ◽  
Clinical Care ◽  
The Other ◽  
Heart Failure Patients ◽  
First Time ◽  
Current Guidelines

Heart failure is a clinical condition with complex pathophysiology that involves many different processes. Diagnosis is often difficult in patients presenting for the first time with breathlessness. Many biomarkers have been identified that are elevated in heart failure and their role in assessing prognosis has also been investigated. However, at present the natriuretic peptides appear to be the gold standard biomarker against which the other biomarkers are compared. In this review we will examine the evidence behind the other biomarkers for use in heart failure patients and the current guidelines for their use.

scholarly journals Comorbidity burden among heart failure patients in a medicaid population

2013 ◽  
Vol 16 (3) ◽  
pp. A273
Author(s):  
F.T. Shaya ◽  
I.M. Breunig ◽  
M.R. Mehra
Keyword(s):  
Heart Failure ◽  
Heart Failure Patients ◽  
Comorbidity Burden ◽  
Medicaid Population

Implementation of the Mental Capacity Act: a national observational study of changes in place of death for older heart failure patients with or without comorbid dementia

2021 ◽  
Author(s):  
James M. Beattie ◽  
Irene J. Higginson ◽  
Theresa A. McDonagh ◽  
Wei Gao
Keyword(s):  
Heart Failure ◽  
Mental Capacity ◽  
Place Of Death ◽  
Care Homes ◽  
Appreciable Change ◽  
Heart Failure Patients ◽  
Comorbidity Burden ◽  
Dying At Home ◽  
Mental Capacity Act ◽  
At Home

Abstract Background: Heart failure is increasingly prevalent in the growing elderly population and commonly associated with cognitive impairment. This study compared trends in place of death (PoD) of heart failure patients with / without comorbid dementia over the period of implementation of the Mental Capacity Act (MCA) in October 2007, this legislation supporting patient-centred decision making for those with reduced agency.Methods: Analyses of death certification data for England between January 2001 and December 2018, describing the PoD and sociodemographic characteristics of all people ≥ 65 years registered with heart failure as the underlying cause of death, with / without a mention of comorbid dementia. Multiple Poisson regression modelling was used to determine the prevalence ratio (PR) of dying at home or in care homes compared to dying in hospital. Covariates included year of death, age, gender, marital status, comorbidity burden, index of multiple deprivation and urban / rural settings.Results:120,068 heart failure-related death records were included of which 8199 mentioned dementia as a contributory cause. The overall prevalence of dementia was 6.8%, the trend significantly increasing from 5.6% to 8.0% pre- and post-MCA (p<0.0001). Dementia was coded as unspecified (78.2%), Alzheimer’s disease (13.5%) and vascular (8.3%). Those with dementia were more commonly older, female, widowed, and had more comorbidities. Pre-MCA, PoD for heart failure patients without dementia was hospital 68.2%, care homes 20.2%, 10.7% dying at home. The corresponding figures for those with comorbid dementia were 47.6%, 48.0% and 4.2%, respectively. Following MCA enforcement, PoD for those without dementia shifted from hospital to home, PR: 1.026 [95%CI: 1.024-1.029]. This trend was not significant for those with dementia, PR: 1.001 [0.988-1.015], hospital deaths increasing. Care home deaths reduced for all, with or without dementia, PR: 0.959 [0.949-0.969], and PR: 0.996 [0.993-0.998], respectively. Hospice as PoD was rare for both groups (≤0.5%) with no appreciable change over the study period.Conclusions: Our analyses suggest the MCA did not materially affect the PoD of heart failure decedents with comorbid dementia, likely reflecting difficulties implementing this legislation in real-life clinical practice.

Abstract P031: Multimorbidity in Heart Failure with Preserved and Reduced Ejection Fraction: A Community Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Alanna M Chamberlain ◽  
Yariv Gerber ◽  
Sheila M McNallan ◽  
Shannon M Dunlay ◽  
Susan A Weston ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Chronic Conditions ◽  
Community Study ◽  
Chronic Obstructive ◽  
Reduced Ejection Fraction ◽  
Comorbidity Burden ◽  
Age And Sex ◽  
Morbid Conditions

Background: Multimorbidity is common in heart failure (HF), yet differences in co-morbid chronic conditions by type of HF (HF with preserved vs. reduced ejection fraction (EF)) are not well documented. Methods: We determined the prevalence and distribution of 25 chronic conditions by preserved vs. reduced EF among patients with incident HF enrolled in a community study from 9/2003-6/2012. HF was validated by the Framingham criteria, and an EF ≥50% defined preserved EF. Chronic conditions were identified within the 5 years prior to HF by codes defined by Centers for Medicare & Medicaid Services. Logistic regression determined associations of each comorbidity with type of HF (preserved vs. reduced EF) after adjusting for age and sex. Results: Among 668 incident HF patients (mean age 74±14, 51% male), the most common co-morbid conditions were hypertension, hyperlipidemia, and ischemic heart disease. Cataracts, rheumatoid arthritis/osteoarthritis, and anemia were also common, occurring in >1/3 of HF patients. On average, patients with preserved EF had 1 extra co-morbid condition compared to those with reduced EF (6 vs. 5, respectively). After adjusting for age and sex, comorbidities associated with HF with preserved EF include hypertension, hyperlipidemia, cataracts, rheumatoid arthritis/osteoarthritis, anemia, chronic kidney disease, chronic obstructive pulmonary disease, and depression, whereas a prior myocardial infarction was associated with presenting with reduced EF (figure). The remaining co-morbid conditions (including some not shown in the figure, such as breast, colorectal, lung, endometrial, and prostate cancer, and benign prostatic hyperplasia) were not associated with type of HF. Conclusions: HF patients presenting with preserved EF have more co-morbid chronic conditions compared to those with reduced EF. This excess comorbidity burden is important to characterize and understand as it may explain differences in outcomes and healthcare utilization between HF patients with preserved and reduced EF.

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