Real world effectiveness of primary implantable cardioverter defibrillators implanted during hospital admissions for exacerbation of heart failure or other acute co-morbidities: cohort study of older patients with heart failure

ObjectivesThis study aims to investigate the prevalence of impairment of activities of daily living (ADLs) in older patients with heart failure (HF), and to examine the impact of ADL impairment on readmission after discharge.Design and settingsA prospective cohort study was conducted in patients aged ≥65 years with HF admitted to a tertiary hospital in Vietnam from August 2016 to June 2017. Difficulties with six ADLs were assessed by a questionnaire. Participants were classified into two categories (with and without ADL impairment). The associations of ADL impairment with 3-month readmission were examined using logistic regression models.ResultsThere were 180 participants (mean age 80.6±8.2, 50% female) and 26.1% were classified as having ADL impairment. The most common impaired activity was bathing (21.1%), followed by transferring (20.0%), toileting (12.2%), dressing (8.9%), eating (3.3%), and continence (2.8%). During 3-month follow-up, 32.8% of the participants were readmitted to hospitals (55.3% in participants with ADL impairment, 24.8% in those without ADL impairment, p<0.001). ADL impairment significantly increased the risk of 3-month readmission (adjusted OR 2.75, 95% CI 1.25 to 6.05, p=0.01).ConclusionsIn summary, ADL impairment was common in older hospitalised patients with HF and was associated with increased readmission. These findings suggest further studies on ADL assessment and intervention during transition care for older patients with HF after discharge to prevent readmission.

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Response by Schrage et al to Letter Regarding Article, “Association Between Use of Primary-Prevention Implantable Cardioverter-Defibrillators and Mortality in Patients With Heart Failure: A Prospective Propensity Score-Matched Analysis From the Swedish Heart Failure Registry”

Circulation ◽

10.1161/circulationaha.120.045603 ◽

2020 ◽

Vol 141 (11) ◽

Author(s):

Benedikt Schrage ◽

Cecilia Linde ◽

Frieder Braunschweig ◽

Gianluigi Savarese

Keyword(s):

Heart Failure ◽

Primary Prevention ◽

Propensity Score ◽

Implantable Cardioverter Defibrillators ◽

Patients With Heart Failure ◽

Cardioverter Defibrillators

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Hospitalisation at the end of life among cancer and non-cancer patients in Denmark: a nationwide register-based cohort study

BMJ Open ◽

10.1136/bmjopen-2019-033493 ◽

2020 ◽

Vol 10 (6) ◽

pp. e033493

Author(s):

Anne Høy Seemann Vestergaard ◽

Mette Asbjoern Neergaard ◽

Christian Fynbo Christiansen ◽

Henrik Nielsen ◽

Thomas Lyngaa ◽

...

Keyword(s):

Heart Failure ◽

Cohort Study ◽

End Of Life ◽

Cancer Patients ◽

Hospital Admissions ◽

Place Of Death ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Partner Status ◽

Patients With Heart Failure

ObjectivesEnd-of-life hospitalisations may not be associated with improved quality of life. Studies indicate differences in end-of-life care for cancer and non-cancer patients; however, data on hospital utilisation are sparse. This study aimed to compare end-of-life hospitalisation and place of death among patients dying from cancer, heart failure or chronic obstructive pulmonary disease (COPD).DesignA nationwide register-based cohort study.SettingData on all in-hospital admissions obtained from nationwide Danish medical registries.ParticipantsAll decedents dying from cancer, heart failure or COPD disease in Denmark between 2006 and 2015.Outcome measuresData on all in-hospital admissions within 6 months and 30 days before death as well as place of death. Comparisons were made according to cause of death while adjusting for age, sex, comorbidity, partner status and residential region.ResultsAmong 154 235 decedents, the median total bed days in hospital within 6 months before death was 19 days for cancer patients, 10 days for patients with heart failure and 11 days for patients with COPD. Within 30 days before death, this was 9 days for cancer patients, and 6 days for patients with heart failure and COPD. Compared with cancer patients, the adjusted relative bed day use was 0.65 (95% CI, 0.63 to 0.68) for heart failure patients and 0.68 (95% CI, 0.66 to 0.69) for patients with COPD within 6 months before death. Correspondingly, this was 0.65 (95% CI, 0.63 to 0.68) and 0.70 (95% CI, 0.68 to 0.71) within 30 days before death.Patients had almost the same risk of dying in hospital independently of death cause (46.2% to 56.0%).ConclusionPatients with cancer, heart failure and COPD all spent considerable part of their end of life in hospital. Hospital use was highest among cancer patients; however, absolute differences were small.

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Modern pacemaker therapy

Medicinski pregled ◽

10.2298/mpns1012822k ◽

2010 ◽

Vol 63 (11-12) ◽

pp. 822-826

Author(s):

Dragan Kovacevic ◽

Vasilije Topalov ◽

Milan Mijatov

Keyword(s):

Heart Failure ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Modern Medicine ◽

Implantable Cardioverter Defibrillators ◽

Bundle Branch Block ◽

Pacemaker Therapy ◽

Patients With Heart Failure ◽

Cardioverter Defibrillators

Introduction. Pacemakers are devices that modern medicine and cardiology cannot be imagined without. The technique of implantation comes to surgical procedure where all principles of asepsis and antisepsis have to be respected. Although some complications do happen, they are rather rare. Results. After the implantation of the device, the patient is not handicapped (unless the heart was additionally damaged). On the contrary, the patient returns to his work and functions normally within his family in most of the cases. The first medical appointment is scheduled a month after the implantation and the following are three and six months after. Types of devices. Today there are ?new types of electrostimulation?- implantable cardioverter defibrillators and multisite electrostimulators. The former is implanted in patients at high risk of sudden cardiac death and the latter in patients with heart failure and left bundle branch block. Owing to these devices, the sudden cardiac death can be prevented successfully and the quality of a patient?s life is improved.

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Inequitable distribution of implantable cardioverter defibrillators in Ontario

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462307070389 ◽

2007 ◽

Vol 23 (3) ◽

pp. 354-361 ◽

Cited By ~ 9

Author(s):

Jacob A. Udell ◽

David N. Juurlink ◽

Alexander Kopp ◽

Douglas S. Lee ◽

Jack V. Tu ◽

...

Keyword(s):

Heart Failure ◽

Fold Increase ◽

Population Based ◽

Implantable Cardioverter Defibrillators ◽

Icd Implantation ◽

Coronary Syndrome ◽

Patients With Heart Failure ◽

History Of ◽

And Gender ◽

Cardioverter Defibrillators

Objectives:Implantable cardioverter defibrillator (ICD) therapy reduces the risk of sudden death in patients with ischemic cardiomyopathy, but their novelty and cost may represent barriers to utilization. The objective of this study was to examine the influence of age, gender, place of residence, and socioeconomic status on rates of ICD implantation for the primary prevention of death.Methods:We conducted a population-based retrospective cohort study involving the entire province of Ontario, Canada. Patients were eligible if they had survived following hospitalization for heart failure from 1 January 1993, to 31 March 2004, and previously sustained an acute coronary syndrome within 5 years. Patients with an existing ICD or a documented history of cardiac arrest were excluded, as were patients who died in the hospital. Primary outcome was ICD implantation.Results:We identified 48,426 patients hospitalized for heart failure who survived to hospital discharge. Of these, 440 received an ICD, with a gradual 30-fold increase in implantation rates over the study period (.12–3.9 percent). ICD recipients were more likely to be men (odds ratio [OR] = 4.14; 95 percent confidence interval [CI], 3.24–5.30), younger than 75 years of age (OR = 3.19; 95 percent CI, 2.57–3.96), reside in a metropolitan area (OR = 1.42; 95 percent CI, 1.04–1.9), and live in a higher socioeconomic neighborhood (OR = 1.32; 95 percent CI, 1.08–1.61).Conclusions:Among patients with heart failure and a previous myocardial infarction, ICD use is increasing in Ontario. However, the application of this technology is characterized by major sociodemographic inequities. The causes and consequences of the pronounced age and gender discrepancies, in particular, warrant further investigation.

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Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy in the Treatment of Heart Failure with Reduced Ejection Fraction

International Cardiovascular Forum Journal ◽

10.17987/icfj.v10i0.445 ◽

2017 ◽

Vol 10 ◽

Cited By ~ 2

Author(s):

Ilaria Spoletini ◽

Andrew Coats

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Cardiac Resynchronization Therapy ◽

Cardiac Resynchronization ◽

Implantable Cardioverter Defibrillators ◽

Resynchronization Therapy ◽

Device Therapy ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

Cardioverter Defibrillators

It has been long acknowledged that electrical-conduction disturbances may be both a cause of heart failure and a consequence of it. In fact, many patients with heart failure have an asynchronous contraction pattern of the heart muscle that further reduces the heart ability to pump blood. Electrical disturbances may therefore result in progressive left ventricular dysfunction, due to the added effects of HF-related electrical dyssynchrony. For this reason, device therapy may play a key role in the management of patients with heart failure and reduced ejection fraction (HFrEF). In particular, Implantable Cardioverter- Defibrillators (ICD) and Cardiac Resynchronization Therapy (CRT) may improve ejection fraction by reestablishing mechanical synchrony, possibly reversing symptoms and signs of heart failure, in addition to the more obvious role of ICD in terminating ventricular arrhythmias that threaten sudden death. Recommendations on device therapy from the current guidelines on heart failure management put out by the ESC/HFA in 2016 update our understanding of the evidence base for the use of ICD and CRT in HFrEF. We review these recommendations and the evidence behind them.

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