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

BMJ Open ◽  
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.

scholarly journals Predictors of hospitalizations for heart failure decompensation in patients with comorbid occupational chronic obstructive pulmonary disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L.A Shpagina ◽  
O.S Kotova ◽  
I.S Shpagin ◽  
G.V Kuznetsova ◽  
N.V Kamneva ◽  
...  
Keyword(s):  
Heart Failure ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Chronic Obstructive ◽  
Length Of Service ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Patients With Heart Failure ◽  
Occupational Copd ◽  
Heart Failure Decompensation

Abstract Background Heart failure decompensation requiring hospitalization is an important event, associated with mortality and investigating its predictors is topical problem. Chronic obstructive pulmonary disease (COPD) is a common comorbidity for heart failure. Both conditions share common molecular mechanisms such as systemic inflammation. COPD is heterogeneous and subpopulations with different inflammation patterns may interact with heart failure in different manner. Airway inflammation in occupational COPD may differs from COPD in tobacco smokers. Additionally cardiotoxicity of industrial chemicals influence heart failure features. Despite this biological plausibility, heart failure and occupational COPD comorbidity is not studied enough. Purpose To reveal predictors of hospitalizations for heart failure decompensation in patients with heart failure and occupational COPD comorbidity. Methods Occupational COPD patients (n=115) were investigated in a prospective cohort observational study. Comparison group – 115 tobacco smokers with COPD. Control group – 115 healthy persons. Controls were selected by propensity score matching, covariates were COPD duration, age and gender. Then COPD groups were stratified according to heart failure. Working conditions, echocardiography, spirometry, pulsoxymetry, 6-mitute walking test were done. Molecular markers of tissue damage – chemokine ligand 18 (CCL 18), lactate dehydrogenase, cardiac troponin T, N-terminal pro-B-type natriuretic peptide (NT pro-BNP), protein S100 beta, von Willebrand factor were measured in serum by ELISA. Follow up after initial assessment was 12 month. Predictors were determined by Cox proportional hazards regression with ROC analysis. Results Heart failure rate in occupational COPD patients were higher – 54.8% versus 36.5% in tobacco smokers with COPD, p<0.05. Heart failure with preserved ejection fraction was predominant – 40.9%. Prevalence of biventricular heart failure was 38.3%, isolated right heart failure – 13%, left heart failure – 2.6%. Cumulative hospitalization rate in occupational COPD with heart failure group was higher than in comparison group, 17.5% and 9.5% respectively, p=0.01. In Cox proportional hazards regression model predictors of hospitalizations for heart failure decompensation during 12 months in this group were length of service (HR 1.22, 95% CI: 1.03–2.5), aromatic hydrocarbons concentration at workplaces air (HR 1.4, 95% CI: 1.15–1.96), serum protein S100 beta (HR 1.10, 95% CI: 1.02–1.87), SaO2 (HR 1.2, 95% CI: 1.06–2.13). Area under the ROC curve was 0.82. Conclusion Length of service, aromatic hydrocarbons concentration at workplaces air, serum protein S100 beta, SaO2 are considered to be independent risk factors of heart failure decompensation required hospitalization in patients with heart failure and occupational COPD comorbidity. Funding Acknowledgement Type of funding source: None

scholarly journals Long-term Effects of Telemonitoring on Healthcare Usage in Patients with Heart Failure or COPD (Preprint)

2018 ◽  
Author(s):  
Jorien Maria Margaretha van der Burg ◽  
Nasir Ahmad Aziz ◽  
Maurits C. Kaptein ◽  
Martine J.M. Breteler ◽  
Joris H. Jansen ◽  
...  
Keyword(s):  
Heart Failure ◽  
The Netherlands ◽  
Healthcare Costs ◽  
Hospital Admissions ◽  
Disease Stage ◽  
Chronic Obstructive ◽  
Home Telemonitoring ◽  
Copd Patients ◽  
Patients With Heart Failure

UNSTRUCTURED Objective The aim of this study was to evaluate the effectiveness of home telemonitoring in reducing healthcare usage and costs in patients with heart failure or chronic obstructive pulmonary disease (COPD). Design The study was a retrospective observational study with a pre-post research design and a follow-up duration of up to 3 years, based on hospital data collected in the period 2012-2016. Setting Data was collected at the Slingeland Hospital in Doetinchem, The Netherlands. Participants In 2012 the Slingeland Hospital in The Netherlands started a telemonitoring program for patients with COPD or heart failure as part of their usual care. Patients were eligible for the telemonitoring program if they were in an advanced disease stage (New York Heart Association (NYHA) functional class 3 or 4; COPD gold stage 3 or 4), received treatment for their condition by a cardiologist or pulmonary specialist at the Slingeland Hospital, were proficient in Dutch and capable of providing informed consent. Exclusion criteria were absence of the cognitive, physical or logistical ability required to fully participate in the program. Hundred seventy-seven patients with heart failure and 83 patients with COPD enrolled the program between 2012 and 2016. Intervention Using a touchscreen, participants with heart failure recorded their weight (daily), blood pressure and heart rate (once a week) through connected instruments, and completed a questionnaire about their symptoms (once a week). Symptoms in patients with COPD were monitored via the Clinical COPD Questionnaire (CCQ), which participants were asked to complete twice per week. All home registrations were sent via a telemonitoring application (cVitals, FocusCura, Driebergen-Rijssenburg) on the iPad to a medical service center were a trained nurse monitored the data and contacted the patient by video chat or a specialised nurse in the hospital in case of abnormal results, such as deviations from a preset threshold or alterations in symptom score. Outcome measures The primary outcome was the number of hospitalisations; the secondary outcomes were total number of hospitalisation days and healthcare costs during the follow-up period. Generalised Estimating Equations were applied to account for repeated measurements, adjusting for sex, age and length of follow-up. Results In heart failure patients (N=177), after initiation of home telemonitoring both the number of hospitalisations and the total number of hospitalisation days significantly decreased (incidence rate ratio of 0.35 (95% CI: 0.26-0.48) and 0.35 (95% CI: 0.24-0.51), respectively), as did the total healthcare costs (exp(B) = 0.11 (95% CI: 0.08-0.17)), all p < 0.001. In COPD patients (N=83) neither the number of hospitalisations nor the number of hospitalisation days changed compared to the pre-intervention period. However, the average healthcare costs were about 54% lower in COPD patients after the start of the home telemonitoring intervention (exp(B) = 0.46, 95% CI 0.25-0.84, p = 0.011). Conclusion Integrated telemonitoring significantly reduced the number of hospital admissions and days spent in hospital in patients with heart failure, but not in patients with COPD. Importantly, in both patients with heart failure and COPD the intervention substantially reduced the total healthcare costs.

Abstract 14099: Beta-blockers Reduce Mortality in Patients With Heart Failure or Ischemic Heart Disease and Chronic Obstructive Pulmonary Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mohammed Ruzieh ◽  
Aaron Baugh ◽  
lama jebbawi ◽  
Andrew J Foy
Keyword(s):  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Beta Blockers ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Risk Of Mortality ◽  
Patients With Heart Failure ◽  
Reduced Risk

Introduction: In patients with heart failure (HF) and ischemic heart disease (IHD), beta-blockers (BB) are associated with improved mortality. However, in patients with co-morbid chronic obstructive pulmonary disease (COPD), this drug class is less utilized due to concerns about an unfavorable impact on the morbidity and mortality. Patients with COPD and heart disease have higher mortality than those with heart disease alone. There is a need to clarify the safety of BB in this population. Objective: To assess the effect of BB therapy on mortality in patients with heart disease and COPD. Methods: We performed a systematic search of MEDLINE and PubMed inception until May 30, 2020 to identify articles of BB use in patients with COPD. The risk ratio (RR) of mortality with BB use was calculated using the Mantel Haenszel random effect model. Statistical analysis was performed using Review Manager Web (RevMan Web). A two-sided p value of < 0.05 was considered statistically significant. Results: A total of 16 studies were included in this meta-analysis, comprising 133,538 patients (44,893 received BB, 88,381 received no control drug, and 264 received placebo). BB use was associated with reduced risk of mortality overall (14.8% vs. 19.9%, RR: 0.67, 95% CI: 0.57 - 0.79), in patients with IHD (18.6% vs. 26.6%, RR: 0.64, 95% CI: 0.50 - 0.82), and in patients with HF (8.1% vs. 23.6%, RR: 0.56, 95% CI: 0.41 - 0.75), Figure. BB were used to treat hypertension in one study, and it was associated with reduced risk of mortality (6.2% vs. 13.4%, RR: 0.46, 95% CI: 0.28 - 0.78). In contrast, βB use was not associated with statistically significant reduced risk of mortality when given without a specified cardiovascular indication (25.0% vs. 32.5%, RR: 0.82, 95% CI: 0.59 - 1.15), figure. Conclusion: Beta-blockers are associated with improved mortality in patients with HF or IHD and COPD. A diagnosis of COPD should not preclude treatment with beta-blockers, as previous concerns likely over-stated risk.

scholarly journals Ambulance staff and end-of-life hospital admissions: A qualitative interview study

2018 ◽  
Vol 32 (9) ◽  
pp. 1465-1473 ◽  
Author(s):  
Sarah Hoare ◽  
Michael P Kelly ◽  
Larissa Prothero ◽  
Stephen Barclay
Keyword(s):  
End Of Life ◽  
Hospital Admissions ◽  
Qualitative Interviews ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Policy Problem ◽  
Dying Patients ◽  
Qualitative Interview Study ◽  
At Home

Background: Hospital admissions for end-of-life patients, particularly those who die shortly after being admitted, are recognised to be an international policy problem. How patients come to be transferred to hospital for care, and the central role of decisions made by ambulance staff in facilitating transfer, are under-explored. Aim: To understand the role of ambulance staff in the admission to hospital of patients close to the end of life. Design: Qualitative interviews, using particular patient cases as a basis for discussion, analysed thematically. Participants/setting: Ambulance staff ( n = 6) and other healthcare staff (total staff n = 30), involved in the transfer of patients (the case-patients) aged more than 65 years to a large English hospital who died within 3 days of admission with either cancer, chronic obstructive pulmonary disease or dementia. Results: Ambulance interviewees were broadly positive about enabling people to die at home, provided they could be sure that they would not benefit from treatment available in hospital. Barriers for non-conveyance included difficulties arranging care particularly out-of-hours, limited available patient information and service emphasis on emergency care. Conclusion: Ambulance interviewees fulfilled an important role in the admission of end-of-life patients to hospital, frequently having to decide whether to leave a patient at home or to instigate transfer to hospital. Their difficulty in facilitating non-hospital care at the end of life challenges the negative view of near end-of-life hospital admissions as failures. Hospital provision was sought for dying patients in need of care which was inaccessible in the community.

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