Clinical Pathway Versus a Usual Plan of Care for Patients With Congestive Heart Failure: What???s the Difference?

2001 ◽  
Vol 19 (3) ◽  
pp. 142-150 ◽  
Author(s):  
Lois M. Hoskins ◽  
Sr. Linda Thiel ◽  
Benita Walton-Moss ◽  
Helene M. Clark ◽  
Mary Ann Schroeder
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Clinical Pathway ◽  
The Difference

Congestive Heart Failure in Older Women Treated With Adjuvant Anthracycline Chemotherapy for Breast Cancer

2007 ◽  
Vol 25 (25) ◽  
pp. 3808-3815 ◽  
Author(s):  
Mary C. Pinder ◽  
Zhigang Duan ◽  
James S. Goodwin ◽  
Gabriel N. Hortobagyi ◽  
Sharon H. Giordano
Keyword(s):  
Breast Cancer ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cox Regression ◽  
Breast Cancer Patients ◽  
Cox Regression Analysis ◽  
The Difference ◽  
Artery Disease ◽  
Medicare Database ◽  
Anthracycline Chemotherapy

Purpose Limited data are available on long-term cardiac safety of adjuvant anthracycline chemotherapy in breast cancer patients over age 65 years. We evaluated rates and predictors of congestive heart failure (CHF) in this population. Patients and Methods We used the Surveillance, Epidemiology, and End Results Medicare database and included women with no history of CHF who were age 66 to 80 years and diagnosed with stage I to III breast cancer from 1992 to 2002. Cumulative rates of CHF were estimated, and multivariable Cox regression analysis was used to determine factors associated with the development of CHF. Results A total of 43,338 women were included. Anthracycline-treated women were younger, with fewer comorbidities and more advanced disease than women who received nonanthracycline or no chemotherapy (P < .001 for each). The adjusted hazard ratio (HR) for CHF was 1.26 (95% CI, 1.12 to 1.42) for women aged 66 to 70 treated with anthracycline compared with other chemotherapy. For women aged 71 to 80, adjuvant chemotherapy type was not associated with CHF. The following baseline characteristics were significant predictors of CHF: age (HR, 1.79 per 10 years; 95% CI, 1.66 to 1.93), black race (HR, 1.40; 95% CI, 1.30 to 1.50), trastuzumab treatment (HR, 1.46; 95% CI, 1.21 to 1.77), hypertension (HR, 1.45; 95% CI, 1.39 to 1.52), diabetes (HR, 1.74; 95% CI, 1.66 to 1.83), and coronary artery disease (HR, 1.58; 95% CI, 1.39 to 1.79). Left-sided radiotherapy did not confer an elevated risk of CHF (HR, 1.04; 95% CI, 0.98 to 1.11). Conclusion Women aged 66 to 70 years who received adjuvant anthracyclines had significantly higher rates of CHF. The difference in rates of CHF continued to increase through more than 10 years of follow-up.

Effectiveness of the Clinical Pathway in the Management of Congestive Heart Failure

2003 ◽  
Vol 96 (7) ◽  
pp. 661-663 ◽  
Author(s):  
Aparna Ranjan ◽  
Leena Tarigopula ◽  
Rakesh K. Srivastava ◽  
Olugbenga O. Obasanjo ◽  
Eugene Obah
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Clinical Pathway

scholarly journals Analisis Minimalisasi Biaya Obat Antihipertensi antara Kombinasi Ramipril-Spironolakton dengan Valsartan pada Pasien Gagal Jantung Kongestif di Rumah Sakit Pemerintah XY di Jakarta Tahun 2014

2017 ◽  
Vol 1 (4) ◽  
Author(s):  
Cyntiya Rahmawati ◽  
Atik Nurwahyuni
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cost Containment ◽  
Clinical Pathway ◽  
Cost Effective ◽  
Sectio Caesarea ◽  
Fee For Service ◽  
Incentive Structure ◽  
Drug Usage ◽  
Total Cost

AbstrakSistem pembayaran prospektif dengan paket tarif INA-CBG’s untuk kasus dengan jaminan BPJS menuntut rumah sakit agar dapat melakukan kendali biaya. Penelitian ini bertujuan untuk menilai upaya Cost Containment RS XY melalui penerapan Clinical Pathway, formularium, dan struktur insentif. Studi dilakukan pada kasus Sectio Caesarea periode Januari-Maret 2016 secara kuantitatif dengan membandingkan selisih klaim BPJS dan tagihan RS serta menilai penerapan Clinical Pathway dan secara kualitatif dengan wawancara mendalam. Total Selisih yang didapat sebesar Rp.1.014.125.684,00 dengan rata-rata selisih sebesar Rp.4.899.157,89 per kasus. Didapatkan 84% kasus memiliki length of stay sesuai Clinical Pathway (CP). Dari kasus tersebut, 96% visitasi dokter sesuai, 21% penggunaan obat dan BHP sesuaidengan, 48% pemeriksaan laboratorium sesuai dengan yang ditentukan dalam CP. Formularium yang digunakan sesuai dengan formularium nasional. RS XY belum memiliki sistem evaluasi untuk menilai penerapan clinical pathway dan penggunaan obat. Struktur insentif yang digunakan adalah sistem fee-for-service pada staf medik yang tidak sesuai dengan metode pembayaran jasa medis yang prospektif. AbstractProspective payment system with INA-CBG’s fare for cases using BPJS Insurance demands hospital to control their cost. This study aims to see the cost containment in XY Hospital through the implementation of clinical pathway, drug formulary, and incentive structure. The study looked into Sectio Caesarea cases from January to March 2016, using quantitative method, comparing BPJS claim with hospital billing and assesst the implementation of clinical pathwayusing qualitative method through in depth interview. Result shows there is deficit amount of Rp.1.014.125.684,00 and the average of deficit per case is Rp.4.899.157,89. Eighty four percent of cases have length of stay in accordance with clinical pathway. From those cases, 96% has concordant doctors visit, 21% has concordant drug usage, and 48% has concordant laboratory diagnostic test. The hospital formulary uses the national formulary. It is foundthat XY Hospital does not have an evaluation system for clinical pathway implementation and drug usage. The incentive structure that is used is fee-for-service system which is not suitable for prospective payment method. Keywords: Cost containment; cost control; prospective payment; INA-CBG’s tariff  AbstrakHipertensi merupakan salah satu faktor risiko gagal jantung kongestif. Di rawat inap RS Pemerintah XY pada tahun 2014, gagal jantung kongestif masuk dalam daftar 10 penyakit terbanyak, dengan biaya total yang cukup besar dan terdapat selisih tarif antara tarif RS dengan tarif JKN. Penelitian ini bertujuan untuk memilih alternatif yang lebih efisien antara ramipril-spironolakton dengan valsartan pada pengobatan gagal jantung kongestif di RS Pemerintah XY tahun 2014. Pendekatan kuantitatif membandingkan nilai rata-rata biaya total dua alternatif pengobatan gagal jantung kongestif, yaitu ramipril-spironolakton dengan valsartan dengan menggunakan perspektif Rumah Sakit. Komponen biaya langsung medis yang dihitung adalah biaya obat, biaya jasa dokter dan biaya rawat inap. Hasil penelitian menunjukkan pada pasien gagal jantung kongestif di RS Pemerintah XY tahun 2014 didapatkan: (1) Nilai rata-ratabiaya total penggunaan obat ramipril-spironolakton sebesar Rp.2.527.743, sedangkan rata-rata biaya total penggunaan obat valsartan sebesar Rp.2.430.923; (2) Obat ramipril-spironolakton efektivitasnya tidak berbeda signifikan atau setara dengan obat valsartan; (3) Adanya penghematan pada rata-rata biaya total obat valsartan sebesar Rp.96.820 per pasien; (4) Adanya penghematan pada biaya rawat inap obat valsartan sebesar Rp.299.031 per pasien. Obat valsartan memberikan nilai rupiah yang terendah menjadi pilihan yang lebih efisien dibandingkan obat ramipril-spironolakton pada pasien gagal jantung kongestif. AbstractHypertension is one of risk factors for congestive heart failure as the top 10 most prevalent diseases in XY Public Hospital in 2014.It has a large number of total cost and cost deviation between hospital and JKN rate. This study aimed to choose an alternative thatis more cost-effective to treat congestive heart failure at XY Hospital in 2014. This was a quantitative research using retrospective cross-sectional analysis. The study compared the average value of total cost of two alternative treatments, ramipril-spironolactone with valsartan by using Hospital’s perspective. Direct medical cost components were cost of drugs, cost of physicians’ services and  cost of hospitalizations. This study found that: (1) The average total cost of ramipril-spironolactone was Rp.2.527.743; whereas the average total cost of valsartan was Rp.2.430.923; (2) Ramipril-spironolactone’s effectiveness was not significantly different from valsartan; (3) There was cost saving on the average of total cost using valsartan’s drug as many as Rp96.820 per patient; (4) There was cost saving on hospitalization cost using valsartan’s drug for Rp299.031 per patient. Valsartan provided the lowest value and more cost-effective than ramipril-spironolactone for patient with congestive heart failure.

Attenuation of pressor responses to arginine vasopressin in right-sided congestive heart failure

1990 ◽  
Vol 258 (6) ◽  
pp. H1882-H1888
Author(s):  
C. K. Stone ◽  
N. Imai ◽  
C. D. Sladek ◽  
C. S. Liang
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Arginine Vasopressin ◽  
Pressor Response ◽  
Aortic Pressure ◽  
Peripheral Vascular ◽  
Pressor Responses ◽  
Vasoconstrictor Effect ◽  
The Difference ◽  
Mean Aortic Pressure

Although arginine vasopressin (AVP) is elevated in heart failure, inhibition of the vasopressinergic V1-receptor produces minimal changes in blood pressure. To determine whether the V1 vasoconstrictor effect is attenuated in heart failure, we randomly administered three increasing doses of AVP and methoxamine intravenously to 11 dogs with right-sided congestive heart failure (RHF) and 7 sham-operated dogs. Plasma AVP was elevated in RHF (21 +/- 3 pg/ml) compared with sham-operated dogs (3.8 +/- 0.6 pg/ml). While the pressor response to methoxamine was similar in the two groups, AVP caused a smaller increase in mean aortic pressure in RHF dogs than sham-operated dogs. To determine whether the difference in the pressor response to AVP was caused by greater reflex withdrawal of the sympathetic activity in RHF than sham-operated dogs, we also administered AVP after these animals had been pretreated with prazosin and propranolol. Adrenoceptor blockade exaggerated the pressor response to AVP; however, the increase in mean aortic pressure was still smaller in RHF than sham-operated dogs. The diminished pressor response in adrenoceptor-blocked RHF dogs was associated with a smaller increase in total peripheral vascular resistance compared with similarly treated sham dogs. Thus, although the pressor response to AVP was offset by baroreflex activation, the attenuated pressor effect of AVP in heart failure cannot be explained by sympathetic withdrawal alone. AVP probably exerts a smaller direct vasoconstrictor effect when the vasopressinergic system is chronically activated in heart failure.

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

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Takaishi ◽  
T Iida ◽  
T Kishinoue ◽  
H Mori ◽  
T Yamaji ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Clinical Pathway ◽  
Readmission Rate ◽  
Evaluation Method ◽  
Clinical Course ◽  
Total Period ◽  
Clinical Prognosis ◽  
Hospitalization Period ◽  
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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