scholarly journals Feasibility and performance of a patient-oriented discharge instruction tool for heart failure

2019 ◽  
Vol 8 (3) ◽  
pp. e000489 ◽  
Author(s):  
Toni Schofield ◽  
Heather Ross ◽  
R Sacha Bhatia ◽  
Karen Okrainec
Keyword(s):  
Heart Failure ◽  
Patient Satisfaction ◽  
Signs And Symptoms ◽  
Care Group ◽  
Discharge Instructions ◽  
Discharge Instruction ◽  
Adherence To Diet ◽  
Phone Calls ◽  
And Performance

BackgroundThe provision of patient-centred discharge instructions is a pivotal goal for improving quality of care for patients with heart failure (HF) during care transitions. We tested the feasibility and performance of a novel discharge instruction tool co-designed with patients and adapted for HF; the patient-oriented discharge summary (PODS-HF) with the aim of improving communication, comprehension and adherence to discharge instructions.MethodsAn iterative process was used to adapt and implement an existing patient instruction tool for patients with HF (PODS-HF). A mixed methods approach was then used to explore patient experience, feasibility and performance using a pre–post study design among eligible patients admitted for HF over a 6-month period. Outcome measures included: the documentation of patient-centred instructions, a locally derived Average Discharge Score (ADS) based on the inclusion of instructions in nine key areas, patient satisfaction and understanding and adherence to instructions at 72 hours and 30 days determined using follow-up phone calls.Results19 patients were enrolled. The ADS increased by 68% with more consistent documentation. Patient satisfaction remained high. Patients provided PODS-HF reported receiving written information about HF related signs and symptoms to watch for (two out of five patients in the usual care group vs seven out of seven patients in the PODS-HF group; p=0.045). Patients also felt more confident to manage their own health and 30-day adherence to diet and exercise instructions improved while reducing the need for unscheduled visits. Quantitative results were supported by themes identified during follow-up calls, namely, the utility of written instructions and the importance of a follow-up call.ConclusionPODS-HF is a feasible tool for the delivery of patient-centred discharge instructions for patients with HF. The individual benefits of clarification and reinforcement made during follow-up calls among patients receiving this tool remains to be clarified.

scholarly journals Patient experiences using a novel tool to improve care transitions in patients with heart failure: a qualitative analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e026822 ◽  
Author(s):  
Toni Schofield ◽  
R Sacha Bhatia ◽  
Cindy Yin ◽  
Shoshana Hahn-Goldberg ◽  
Karen Okrainec
Keyword(s):  
Heart Failure ◽  
Care Transitions ◽  
Healthcare Providers ◽  
Discharge Summary ◽  
Lifestyle Changes ◽  
Discharge Instructions ◽  
Written Information ◽  
Phone Calls

ObjectiveTo evaluate the utility of a novel discharge tool adapted for heart failure (HF) on patient experience.DesignSemistructured interviews assessed the utility of a novel discharge tool adapted for HF; patient-oriented discharge summary (PODS-HF) at 72 hours and 30 days after leaving hospital. Interviews were recorded and transcribed verbatim. Three investigators used directed content analysis to determine themes and subthemes from the narrative data.SettingThe cardiology ward of an urban academic institution in Canada.Participants13 patients and caregivers completed 24 interviews. Eligible patients were >18 years and admitted with a diagnosis of HF.ResultsAnalysis revealed six interconnected themes: (1) Utility of discharge instructions: how patients perceive and use written and verbal instructions. Patients receiving PODS-HF identified value in the patient-centred summarised content. (2) Adherence: strategies used by patients to enhance adherence to medications, diet and lifestyle changes. PODS-HF provides a strong visual reminder, particularly early postdischarge. (3) Adaptation: how patients incorporate changes into ‘new norms’. This was more evident by 30 days, and those using PODS-HF had less unscheduled visits and readmissions. (4) Relationships with healthcare providers: patients’ perceptions of the roles of family physicians and specialists in follow-up care. (5) Role of family and caregivers: the pivotal role of caregivers in supporting adherence and adaptation. (6) Follow-up phone calls: the utility of follow-up calls, particularly early after discharge as a means of providing clarification, reassurance and education.ConclusionPODS-HF is a useful tool that increases patients’ confidence to self-manage and facilitates adherence by providing relevant written information to reference after discharge.

Abstract T MP103: Effect of Follow-up Phone Calls on 30-day Readmission Rates for Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Kelly Anderson
Keyword(s):  
Intervention Group ◽  
Signs And Symptoms ◽  
Lifestyle Changes ◽  
Phone Call ◽  
Control Group ◽  
Readmission Rates ◽  
Convenience Sample ◽  
Phone Calls ◽  
Number Of Patients

Background and Purpose: Patients who are hospitalized for a stroke or TIA go home with a great deal of information about risk factors, medications, diet and exercise, signs and symptoms of stroke and follow-up care. This information may be difficult for the patient or caregiver to understand and can be overwhelming in the face of a new life-changing event. In addition, The Centers for Medicare and Medicaid Services will start publicly reporting 30-day readmission rates beginning in 2016. The purpose of this study is to determine if follow-up phone calls with a nurse help to reduce 30 day readmission rates for patients with stroke and TIA. Methods: This study utilized a convenience sample of adult patients who were admitted for ischemic stroke, ICH, SAH or TIA from March 2013 to February 2014. Patients in the intervention group participated in a phone call seven days after discharge to assess their compliance with medications, physician appointments and lifestyle changes. The proportion of readmissions between the groups was compared with Fisher’s exact test. Results: The total number of patients enrolled in the study was 586 and there were no significant differences in demographics between the control and intervention groups. Of the 533 patients in the control group, 54 (10%) of them were readmitted, including 11 patients readmitted for elective surgical procedures. Of the 52 patients in the intervention group, 3 (5.7%) of them were readmitted before the 7-day phone call. Of the 49 patients who participated in the 7-day phone call, none of them were readmitted ( p =0.0098). Conclusions: Patients who participate in a 7-day phone call appear to benefit and are less likely to be readmitted to the hospital. Other strategies may need to be considered for patients who are at higher risk, and thus more likely to be readmitted within seven days of discharge. In addition, some providers may wish to reconsider how they schedule elective procedures for secondary stroke prevention.

scholarly journals Patient Satisfaction with the Emergency Department Experience in the Era of COVID-19: A National Survey

2021 ◽  
Vol 1 (2) ◽  
pp. 19-25
Author(s):  
Khadijah Banjar ◽  
Sharafaldeen Bin Nafisah
Keyword(s):  
Patient Satisfaction ◽  
Treatment Plan ◽  
Educational Status ◽  
National Scale ◽  
Discharge Instructions ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Sectional Analysis ◽  
The Relationship

Background Patient satisfaction with an ED visit is often overlooked during the ongoing COVID-19 pandemic, and requires further examination. Aim We aim to investigate, on a national scale, patients’ satisfaction during their ED encounter, and to explore the determinants of such satisfaction. Methods This is a cross-sectional analysis conducted between January and February 2021 throughout Saudi Arabia. Result The total number of patients was 508. The median satisfaction score for the clarity of information provided in the ED was 40 (SD=4.94), while satisfaction with the relationship with staff and ED routine revealed a median score of 39.9 (SD=5.08). We noted several determinants of ED satisfaction, including age, marital status, educational status, clarity of the treatment plan, improvement of their condition while in the ED, verbal and/or written discharge instructions, as well as a follow-up call two days after discharge. Conclusion Patient satisfaction is an integral part of the patient-centred approach in the ED, and should be continuously evaluated.  

scholarly journals Monoclonal Gammopathy of Undetermined Significance (MGUS): Indications for Pre-Diagnostic Testing, Subsequent Diagnoses, and Follow-up Practice

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2224-2224
Author(s):  
Aishwarya Ravindran ◽  
Kandace A. Lackore ◽  
Amy E. Glasgow ◽  
Matthew T. Drake ◽  
Ronald S. Go
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Laboratory Tests ◽  
Office Visit ◽  
Signs And Symptoms ◽  
Low Risk ◽  
Monoclonal Protein ◽  
Face To Face

Abstract Introduction: MGUS is generally an incidental finding in the diagnostic work-up for clinical signs and symptoms suggestive of lymphoplasmacytic malignancies (multiple myeloma, light chain amyloidosis, and Waldenström macroglobulinemia), which are relatively rare (<35,000 annual new cases in the US). While much is known about the natural history of MGUS, information regarding the pre- and post-diagnostic part of MGUS patient care is lacking. Our study objectives were to determine the following: 1) indications for monoclonal protein testing; 2) subsequent diagnoses found for those indications; 3) specialty of ordering clinicians; 4) follow-up patterns after MGUS diagnosis. Methods: We identified MGUS patients residing in southeastern Minnesota who were diagnosed from 2011-2014 and followed at the Mayo Clinic. Medical records were reviewed to confirm the diagnosis and obtain relevant clinical data. Laboratory tests and visits were identified using Current Procedural Terminology-4th edition (CPT-4) codes from billing data. We defined a follow-up visit as: 1) any face-to-face encounter linked to MGUS diagnosis 30 days after the date of MGUS diagnosis regardless of whether ancillary test was performed or not; and 2) MGUS-specific tests or laboratory tests linked to an MGUS diagnosis claim performed without a face-to-face encounter. Based on the Mayo Clinic MGUS risk stratification model, we classified our cohort into either low-risk or non-low risk. Criteria for low-risk used were: serum monoclonal protein <1.5 g/dL, IgG subtype, and normal serum free light chain ratio. Follow-up patterns were analyzed according to year of diagnosis, demographics, and the specialty of clinicians performing the follow-up. Results: 330 MGUS patients were included in the study. The median age at diagnosis was 73 years (range, 21-98) and most were males (59.7%). The common indications for monoclonal protein studies were neuropathy (19.6%), kidney disease (13.6%), anemia (12.7%), bone symptoms/signs (12.7%), cutaneous disorders (5.8%), congestive heart failure (4.8%), and hypercalcemia (2.7%). The most common subsequent diagnoses for these indications were neuropathy not otherwise specified (NOS;100%), chronic kidney disease NOS (35.5%), anemia of chronic kidney disease (19%), osteopenia/osteoporosis (45.2%), congestive heart failure NOS (57.1%), and dermatitis NOS (100%), respectively. The practice specialties that most commonly diagnosed MGUS were internal medicine (31.3%), neurology (13.7%), nephrology (10.3%), family medicine (6.1%), and hematology (5.8%). Low risk MGUS comprised 44.8% of the cohort. After a median follow-up of 53.5 months (range, 13.0-77.4; IQR, 40.8-77.4), the total number of follow-up visits was 937. Majority (85.5%) of the visits were a combination of office visit with laboratory testing, while the rest were either office visit (11.2%) or laboratory tests (3.3%) only. The distribution of patients by mean interval between visits was: every <6 months (7.9%); every 6-12 months (19.4%); every 13-24 months (15.2%), and every >24 months or no follow-up at all (57.6%). The follow-up patterns did not change significantly (Kruskal Wallis; P=0.6759) over time (Figure 1) and were similar when age groups were compared (Figure 2; P=0.1328). However, males were followed more frequently than females (P=0.0365). Among patients 80 years and older, 32.1% continued to be followed at least once every 2 years (Figure 2). Hematologists were more likely than non-hematologists to follow MGUS patients regardless of the risk category (Figures 3-4). Among low risk patients, 31.1%, 22.2%, 20.7%, and 19.1% had at least one follow-up during years 2, 3, 4, and 5, after MGUS diagnosis (Figure 3). Conclusions: Approximately 1/3 of MGUS diagnoses were made during the evaluation of signs and symptoms not related to lymphoplasmacytic malignancies. The subsequent diagnoses found were a wide variety of common diseases. Most MGUS diagnoses were made by general internists, neurologists, and nephrologists. Follow-up practices varied between hematologists and non-hematologists. Nearly 1/3 of the oldest old patients continued to have follow-up, despite limited life expectancy. Disclosures No relevant conflicts of interest to declare.

The Impact of Telephonic Follow-Up Within 2 Business Days Postdischarge on 30-Day Readmissions for Patients With Heart Failure

2021 ◽  
pp. JDNP-D-19-00079
Author(s):  
Victoria M. Chestnut ◽  
Karen Vadyak ◽  
Matthew M. McCambridge ◽  
Michael J. Weiss
Keyword(s):  
Heart Failure ◽  
Chart Review ◽  
Transitional Care ◽  
Hospital Readmissions ◽  
Hospital Discharges ◽  
Phone Calls ◽  
Adult Participants ◽  
Patients With Heart Failure ◽  
The Impact

BackgroundHeart failure (HF) is a chronic condition associated with high rates of hospital readmissions. The prevalence and costs of HF are expected to rise dramatically by 2030 (Heidenreich,et al., 2013).ObjectiveA 24-month, retrospective study was conducted using electronic medical record (EMR) chart review, seeking to identify if postdischarge follow-up phone calls decreased 30-day readmissions in individuals with HF.MethodsThe study included 705 adult participants who were admitted to the hospital for HF. Some received a postdischarge call within 2 business days of discharge, and some did not.ResultsParticipants who received the postdischarge call were less likely to be readmitted (20.1%) than participants who did not receive a postdischarge call (28.8%; p = .007). Participants who received the postdischarge call were more likely to have a follow-up visit within 14 days (70.1%) than participants who did not receive a postdischarge call (30.2%; p < .001).ConclusionsThe findings from this study may help to drive future transitional care strategies for individuals diagnosed with HF.Implications for NursingNurse-led transitional care interventions offer potential solutions to ensure safe, effective hospital discharges.

Abstract 12205: Prediction of Heart Failure Symptoms Using Framingham and ARIC Scores in Patients With Non Ischemic Risk Factors at 1 Year Follow up

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Hong Yang ◽  
Kazuaki Negishi ◽  
Mark Nolan ◽  
Ying Wang ◽  
Faisal Khan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Local Community ◽  
Absolute Risk ◽  
Signs And Symptoms ◽  
Left Ventricular ◽  
Risk Scores ◽  
Test Distance ◽  
Left Atrium Volume

Background: The Framingham heart failure score (FHS) and ARIC heart failure (HF) risk calculator are risk prediction tools that might facilitate the targeting of prevention strategies in pts with HF risk factors. We sought to compare their performance of predicting new HF symptoms in pts with risk factors. Method: Subjects ≥65 yo, with ≥ 1 HF risk (hypertension, type 2 diabetes, obesity, previous chemotherapy, family history of HF or previous cardiac history) were recruited from the local community. Absolute risk of incident HF risk was calculated using ARIC and FHS risk scores at baseline. Subjects underwent standard questionnaire, electrocardiogram, comprehensive echocardiogram and 6-minute walk (6MW) test. New HF based on Framingham criteria were assessed after a follow-up of 14±4 months. Results: Among 308 subjects (age 71±5 y; 50% men), median (IQR) 4 year risk of FHS and ARIC score were 4.0 (2-6.5) % and 6.2 (3.6-11.4) %, respectively. 19 participants developed new HF signs and symptoms (Framingham criteria). Compared with those remaining asymptomatic, those with new HF had higher ARIC score (p<0.001), more impaired GLS (p=0.036), larger left atrium volume (p=0.05) and left ventricular (LV) mass (p=0.049. They also had significant baseline 6MW test distance (p=0.003). There was no difference between their FHS score (p=0.325) and other conventional diastolic measures including LV ejection fraction, mitral E/A, e’ and E/e’ (p=0.108-0.804). AUC of ARIC and FHS were 0.74 (p=0.001) and 0.63 (p=0.057), respectively. The AUC of 6MW was 0.698 (p=0.005) (figure). Conclusion: The ARIC score appears to be more predictive than FHS score in prediction of new HF symptoms in non-ischemic stage A HF. 6MW test maybe used as an effective screening tool in community based process.

Identifying the Patient with Heart Failure

1995 ◽  
Vol 23 (3) ◽  
pp. 139-153 ◽  
Author(s):  
H Ikram
Keyword(s):  
Heart Failure ◽  
General Practitioner ◽  
Ventricular Dysfunction ◽  
Signs And Symptoms ◽  
Western World ◽  
Family Practitioner ◽  
Patient History

Heart failure is becoming an increasing concern to healthcare worldwide, and of particular concern in the Western world where the age of the population continues to rise. Furthermore, it has now become clear that, if heart failure is identified and treated in the earliest stages of ventricular dysfunction, the possibility of recovery from or substantial delay in progression to complete heart failure is extremely good and will give the patient a considerably improved quality of life. Certain signs and symptoms found on routine examination, coupled with knowledge of patient history, can indicate early heart failure. Patients will normally present to their family practitioner, who is likely to have long term, firsthand knowledge of the patient's medical and family history. Consequently, the general practitioner has a key role in identifying individuals with early heart failure. It is essential that the general practitioner is aware of the signs and symptoms of early heart failure, can interpret them correctly and knows what follow-up tests are necessary to confirm the diagnosis. Guidelines are presented here to assist the general practitioner in this task.

scholarly journals Cardiac contractility modulation therapy in elderly patients with chronic heart failure: results of the 12-month follow-up

2021 ◽  
Vol 28 (2) ◽  
pp. 5-10
Author(s):  
I. A. Chugunov ◽  
K. V. Davtyan ◽  
A. H. Topchyan ◽  
N. A. Mironova ◽  
E. M. Gupalo
Keyword(s):  
Heart Failure ◽  
Elderly Patients ◽  
Nyha Class ◽  
Cardiac Contractility ◽  
Signs And Symptoms ◽  
Left Ventricular ◽  
Additional Treatment ◽  
Cardiac Contractility Modulation ◽  
Reduced Ejection Fraction

Aim. This study aimed to evaluate the efficacy and safety of cardiac contractility modulation (CCM) therapy in elderly patients with heart failure with reduced ejection fraction (HFrEF).Methods. Sixteen patients older than 65 years old (median age 70 years) undergoing CCM Optimizer (Impulse Dynamics) device implantation due to HFrEF (NYHA class II - 9 (56%), III - 4 (25%), IV - 3 (19%)) were enrolled in this two-center observational study. Before implantation 6-minute walk test (6MWT), transthoracic echocardiography (TTE) was performed on all patients, and NTproBNP levels were assessed. The follow-up duration was 12 months with 2, 6, 12-month follow-up visits. Control 6MWT, TTE and NTproBNP tests were performed at 6-month and 12-month follow-up visits.Results. Two patients died during follow-up due to HF decompensation. The remaining patients showed a significant improvement in 6MWT (350 m vs 402.5 m, p=0,01). We also noted a tendency towards the left ventricular EF improvement (33% vs 40%, p=0,2) and lower values of NTproBNP levels (1112 pg/ml vs 527 pg/ml, p=0,19).Conclusion. CCM therapy is a safe and efficient additional treatment option to manage elderly patients with HFrEF for reducing signs and symptoms of HF.

48Remote monitoring of Heart Failure patients with a Multisensor ICD Algorithm: value of an alert-based follow-up strategy

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
D Pecora ◽  
V Tavoletta ◽  
A Dello Russo ◽  
E De Ruvo ◽  
F Ammirati ◽  
...  
Keyword(s):  
Heart Failure ◽  
Office Visit ◽  
Signs And Symptoms ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Office Visits ◽  
Ventricular Ejection Fraction ◽  
Increased Risk ◽  
Remote Data

Abstract Background The HeartLogic algorithm measures and combines multiple parameters, i.e. heart sounds, intrathoracic impedance, respiration pattern, night heart rate, and patient activity, in a single index. The associated alert has proved to be a sensitive and timely predictor of impending heart failure (HF) decompensation, and the HeartLogic alert condition was shown to identify patients during periods of significantly increased risk of HF events. Purpose To report the results of a multicenter experience of remote HF management with HeartLogic algorithm and appraise the value of an alert-based follow-up strategy. Methods The HeartLogic feature was activated in 104 patients (76 male, 71 ± 10 years, left ventricular ejection fraction 29 ± 7%). All patients were followed according to a standardized protocol that included remote data reviews and patient phone contacts every month and at the time of HeartLogic alerts. In-office visits were performed every 6 months or when deemed necessary. Results During a median follow-up of 13[11-18] months, centers performed remote follow-up at the time of 1284 scheduled monthly transmissions (10.5 per pt-year) and 100 HeartLogic alerts (0.82 alerts/pt-year). The mean delay from alert to the next monthly remote data review was 14 ± 8 days. Overall, the patient time in the alert state (i.e. HeartLogic index above the threshold) was 14% of the total observation period. HF events requiring active clinical actions were detected at the time of 11 (0.9%) monthly remote data reviews and at 43 (43%, p &lt; 0.001) HeartLogic alerts. Moderate to severe symptoms of HF were reported during 2% of remote visits when the patient was out of HeartLogic alert condition and during 15% of remote visits performed in alert condition (p &lt; 0.001). Out of 100 alerts, 17 required an in-office visit and 5 a hospitalization to manage the clinical condition. Overall, 282 scheduled and 56 unscheduled in-office visits were performed during follow-up. Any HF sign (i.e. S3 gallop, rales, jugular venous distension, edema) was detected during 18% of in-office visits when the patient was out of HeartLogic alert condition and during 34% of visits performed in alert condition (p = 0.002). Conclusions HeartLogic alerts are frequently associated with relevant actionable HF events. Events are detected earlier and the volume of alert-driven remote follow-ups is limited when compared with a monthly remote follow-up scheme. The probability of detecting common signs and symptoms of HF at regular remote or in-office assessment is extremely low when the patient is out of HeartLogic alert state. These results support the adoption of an alert-based follow-up strategy.

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