Deaths from heart failure and cancer: location trends

2020 ◽  
pp. bmjspcare-2020-002275 ◽  
Author(s):  
Izza Shahid ◽  
Pankaj Kumar ◽  
Muhammad Shahzeb Khan ◽  
Abdul Wahab Arif ◽  
Muhammad Zain Farooq ◽  
...  
Keyword(s):  
Heart Failure ◽  
College Education ◽  
Population Level ◽  
Multivariable Logistic Regression Analysis ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Dying Patients ◽  
Location Of Death ◽  
Level Data ◽  
At Home

BackgroundIncreasing utilisation of hospice services has been a major focus in oncology, while only recently have cardiologists realised the similar needs of dying patients with heart failure (HF). We examined recent trends in locations of deaths in these two patient populations to gain further insight.MethodsComplete population-level data were obtained from the Mortality Multiple Cause-of-Death Public Use Record from the National Center for Health Statistics database, from 2013 to 2017. Location of death was categorised as hospital, home, hospice facility or nursing facility. Demographic characteristics evaluated by place of death included age, sex, race, ethnicity, marital status and education, and a multivariable logistic regression analysis was performed to analyse possible associations.ResultsAmong 2 780 715 deaths from cancer, 27% occurred in-hospital and 14% in nursing facilities; while among 335 350 HF deaths, 27% occurred in-hospital and 30% in nursing facilities. Deaths occurred at hospice facilities in 14% of patients with cancer, compared with just 8.7% in HF (p=0.001). For both patients with HF and cancer, the proportion of at-home and in-hospice deaths increased significantly over time, with majority of deaths occurring at home. In both cancer and HF, patients of non-Hispanic ethnicity (cancer: OR 1.29, (1.27 to 1.31), HF: OR 1.14, (1.07 to 1.22)) and those with some college education (cancer: OR 1.10, (1.09 to 1.11); HF: OR 1.06, (1.04 to 1.09)) were significantly more likely to die in hospice.ConclusionDeaths in hospital or nursing facilities still account for nearly half of cancer or HF deaths. Although positive trends were seen with utilisation of hospice facilities in both groups, usage remains low and much remains to be achieved in both patient populations.

"Utilization of smart thermostat data at the population level to identify sleep parameters and time spent at home" (Preprint)

2021 ◽  
Author(s):  
Niloofar Jalali ◽  
Kirti Sundar Sahu ◽  
Arlene Oetomo ◽  
Plinio Pelegrini Morita
Keyword(s):  
Sleep Duration ◽  
Smart Home ◽  
Population Level ◽  
Sleep Time ◽  
Sleep Patterns ◽  
Level Data ◽  
Sleep Parameters ◽  
Reported Data ◽  
Smart Thermostat ◽  
At Home

BACKGROUND Sleep behaviour and time spent at home are important determinants of human health. Research on sleep patterns has traditionally relied on self-reported data. This methodology suffers from bias and population-level data collection is challenging. Advances in Smart Home technology and the Internet of Things (IoT) have the potential to overcome these challenges to behavioural monitoring. OBJECTIVE The objective of this study is to evaluate the use of smart home thermostat data to evaluate household sleep patterns and the time spent at home, and how these behaviours are influenced by weekday, seasonal and seasonal weekday variations. METHODS The 2018 ecobee "Donate your Data" dataset for 481 North American households was collected for use in this study. Daily sleep cycles were identified based on sensor activation and used to quantify sleep time, wake-up time, sleep duration, and time spent at home. Each household's record was divided into different subsets based on seasonal, weekday, and seasonal weekday scales. RESULTS Overall, our results indicate that sleep parameters (sleep time, wake-up time, and sleep duration) were significantly influenced by the day of the week but were not strongly affected by season. In contrast, time spent at home was dependent on both weekdays and the season. CONCLUSIONS This is the first study to utilize smart home thermostat data to monitor sleep parameters and time spent at home and their dependence on weekdays, seasonal, and seasonal weekday variations at the population level. This type of analysis can influence and report on public health policy at the population level.

Abstract 15301: Skilled Nursing Facilities and 30-day Hospital Readmissions in Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sheila M Manemann ◽  
Alanna M Chamberlain ◽  
Jennifer St. Sauver ◽  
Susan A Weston ◽  
Ruoxiang Jiang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Readmissions ◽  
Skilled Nursing Facility ◽  
International Classification Of Diseases ◽  
Revolving Door ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Classification Of Diseases ◽  
The Impact

Background: Referral to a skilled nursing facility (SNF) should contribute to reducing hospital readmissions; however, a “revolving door” phenomenon after admission to SNF has been hypothesized to drive readmissions. The urgent need to study the impact of SNF on readmissions in heart failure (HF) was recently emphasized, yet this has never been studied in the community. Objectives: To evaluate the association between discharge to SNF and 30-day readmissions in a community cohort of hospitalized incident HF patients. Methods: Olmsted County, MN residents hospitalized with first ever (incident) HF (International Classification of Diseases-9 th Revision code 428) from 1995 through 2010 were identified. HF was validated by Framingham criteria. Patients residing in a SNF prior to hospitalization were excluded from the analysis. Logistic regression was used to examine the association between discharge to SNF and 30-day readmissions. Results: Among 1360 HF patients (mean age 74±14, 47% male), 241(18%) were referred to a SNF. Overall, 296 (22%) patients were readmitted within 30-days after index hospitalization. The proportion of 30-day readmissions was greater among patients discharged to a SNF compared to patients discharged home (27% vs 21%, p=0.031). After adjustment for age and sex, patients discharged to a SNF had a 40% increase in the odds of having a hospital readmission within 30 days post HF compared to those discharged home (OR: 1.42, 95% CI 1.01-1.99). Further adjustment for year of HF diagnosis, ejection fraction, anemia, renal function, dementia and cancer did not alter the strength of the association (OR: 1.43, 95% CI: 0.99-2.09). Conclusion: Among community patients with HF, 30-day readmissions remain frequent and are more likely to occur among patients discharged to a SNF compared to those discharged home. These data provide new insight into the drivers of HF readmissions and suggest that interventions targeted to HF patients in SNFs may be warranted.

scholarly journals Deaths in critical care and hospice—prevalence, trends, influences: a national decedent cohort study

2021 ◽  
pp. bmjspcare-2021-003157
Author(s):  
Jonathan Mayes ◽  
Stela McLachlan ◽  
Emma Carduff ◽  
Joanne McPeake ◽  
Kirsty J Boyd ◽  
...  
Keyword(s):  
Critical Care ◽  
Cohort Study ◽  
End Of Life ◽  
Cause Of Death ◽  
Support Services ◽  
Multinomial Logistic Regression ◽  
Population Level ◽  
Critical Care Units ◽  
Location Of Death ◽  
Level Data

ObjectivesEnd-of-life and bereavement care support services differ in critical care and inpatient hospice settings. There are limited population-level data comparing deaths in these two locations. We aimed to compare the characteristics of people who die in critical care units and in hospices, identify factors associated with place of death and report 12-year trends in Scotland.MethodsWe undertook a cohort study of decedents aged ≥16 years in Scotland (2005–2017). Location of death was identified from linkage to the Scottish Intensive Care Society Audit Group database and National Records of Scotland Death Records. We developed a multinomial logistic regression model to identify factors independently associated with location of death.ResultsThere were 710 829 deaths in Scotland, of which 36 316 (5.1%) occurred in critical care units and 42 988 (6.1%) in hospices. As a proportion of acute hospital deaths, critical care deaths increased from 8.0% to 11.2%. Approximately one in eight deaths in those aged under 40 years occurred in critical care. Factors independently associated with hospice death included living in less deprived areas, cancer as the cause of death and presence of comorbidities. In contrast, liver disease and accidents as the cause of death and absence of comorbidities were associated with death in critical care.ConclusionsSimilar proportions of deaths in Scotland occur in critical care units and hospices. Given the younger age profile and unexpected nature of deaths occurring in critical care units, there is a need for a specific focus on end-of-life and bereavement support services in critical care units.

696 Hospital at home: descriptive study of patients with chronic heart failure (CrHF) attended at home

2006 ◽  
Vol 5 (1) ◽  
pp. 158-159
Author(s):  
J GUILLAMONT ◽  
A SOLE ◽  
S GONZALEZ ◽  
A PEREZITURRIAGA ◽  
C DAVILA ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Descriptive Study ◽  
Hospital At Home ◽  
At Home

scholarly journals Population-Level Prevalence, Bother, and Treatment Behavior for Urinary Incontinence in an Eastern European Country: Findings from the LUTS POLAND Study

2021 ◽  
Vol 10 (11) ◽  
pp. 2314
Author(s):  
Mikolaj Przydacz ◽  
Marcin Chlosta ◽  
Piotr Chlosta
Keyword(s):  
Quality Of Life ◽  
Urinary Incontinence ◽  
Rural Areas ◽  
Eastern European Country ◽  
Population Level ◽  
Eastern European ◽  
Level Data ◽  
Urban And Rural Areas ◽  
Eastern European Countries

Objectives: Population-level data are lacking for urinary incontinence (UI) in Central and Eastern European countries. Therefore, the objective of this study was to estimate the prevalence, bother, and behavior regarding treatment for UI in a population-representative group of Polish adults aged ≥ 40 years. Methods: Data for this epidemiological study were derived from the larger LUTS POLAND project, in which a group of adults that typified the Polish population were surveyed, by telephone, about lower urinary tract symptoms. Respondents were classified by age, sex, and place of residence. UI was assessed with a standard protocol and established International Continence Society definitions. Results: The LUTS POLAND survey included 6005 completed interviews. The prevalence of UI was 14.6–25.4%; women reported a greater occurrence compared with men (p < 0.001). For both sexes, UI prevalence increased with age. Stress UI was the most common type of UI in women, and urgency UI was the most prevalent in men. We did not find a difference in prevalence between urban and rural areas. Individuals were greatly bothered by UI. For women, mixed UI was the most bothersome, whereas for men, leak for no reason was most annoying. More than half of respondents (51.4–62.3%) who reported UI expressed anxiety about the effect of UI on their quality of life. Nevertheless, only around one third (29.2–38.1%) of respondents with UI sought treatment, most of whom received treatment. Persons from urban and rural areas did not differ in the degrees of treatment seeking and treatment receiving. Conclusion: Urinary incontinence was prevalent and greatly bothersome among Polish adults aged ≥ 40 years. Consequently, UI had detrimental effects on quality of life. Nonetheless, most affected persons did not seek treatment. Therefore, we need to increase population awareness in Poland about UI and available treatment methods, and we need to ensure adequate allocation of government and healthcare system resources.

scholarly journals The domestication of Cucurbita argyrosperma as revealed by the genome of its wild relative

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Josué Barrera-Redondo ◽  
Guillermo Sánchez-de la Vega ◽  
Jonás A. Aguirre-Liguori ◽  
Gabriela Castellanos-Morales ◽  
Yocelyn T. Gutiérrez-Guerrero ◽  
...  
Keyword(s):  
Defense Mechanisms ◽  
Population Level ◽  
Growth Hormones ◽  
Comparative Genomic ◽  
Structural Variants ◽  
Closely Related Species ◽  
Level Data ◽  
Genomic Analyses ◽  
Genotype By Sequencing ◽  
Regulation Of Growth

AbstractDespite their economic importance and well-characterized domestication syndrome, the genomic impact of domestication and the identification of variants underlying the domestication traits in Cucurbita species (pumpkins and squashes) is currently lacking. Cucurbita argyrosperma, also known as cushaw pumpkin or silver-seed gourd, is a Mexican crop consumed primarily for its seeds rather than fruit flesh. This makes it a good model to study Cucurbita domestication, as seeds were an essential component of early Mesoamerican diet and likely the first targets of human-guided selection in pumpkins and squashes. We obtained population-level data using tunable Genotype by Sequencing libraries for 192 individuals of the wild and domesticated subspecies of C. argyrosperma across Mexico. We also assembled the first high-quality wild Cucurbita genome. Comparative genomic analyses revealed several structural variants and presence/absence of genes related to domestication. Our results indicate a monophyletic origin of this domesticated crop in the lowlands of Jalisco. We found evidence of gene flow between the domesticated and wild subspecies, which likely alleviated the effects of the domestication bottleneck. We uncovered candidate domestication genes that are involved in the regulation of growth hormones, plant defense mechanisms, seed development, and germination. The presence of shared selected alleles with the closely related species Cucurbita moschata suggests domestication-related introgression between both taxa.

A population-based analysis in 375,233 cases of heart failure stages A, B and C. Real world epidemiology of prevalence and temporal trends in South-European populations

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Jimenez ◽  
M Cainzos-Achirica ◽  
D Monterde ◽  
L Garcia-Eroles ◽  
C Enjuanes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Conditions ◽  
Temporal Trends ◽  
Population Level ◽  
Population Based ◽  
Relative Increase ◽  
Funding Source ◽  
Private Company ◽  
Healthcare Database ◽  
Evolutionary Changes

Abstract Background Prevalence of congestive heart failure (CHF) and predisposing conditions has described previously. Most of these studies evaluated centre-European or north-American populations. However, the prevalence and evolutionary changes of Heart Failure stages A, B and C has not been fully elucidated in Mediterranean cohorts. Purpose To estimate the prevalence of CHF (HF Stage C) and four additional key chronic cardiovascular, metabolic and renal conditions predisposing to the development of CHF (HF Stages A and B) at a population level in a south-European healthcare area. We analysed the evolutionary changes in the prevalence in these five conditions. Methods In a healthcare area of 1,3Millions inhabitants, we extracted health related information of all individuals ≥55 years old. We analysed data of 375,233 individuals included in the population-based healthcare database of a public Institute of Health between 2015 and 2017. The conditions of interest were CHF, chronic kidney disease (CKD), diabetes mellitus (DM), ischemic heart disease (IHD) and hypertension (HTN). Results The prevalence of chronic conditions was high, particularly of HTN (48.2–48.9%) and DM individuals (14.6–14.8%). The other conditions were less frequent, with prevalence around 2–4% for IHD, 5–9% for CKD and 2–4% for CHF (Table). However, the less frequent conditions had a striking upward trend with over 1,500 new prevalent cases per year between 2015 and 2017 for CHF (45% relative increase), more than 2,500 new prevalent cases for IHD (67% relative increase) and more than 4,000 new prevalent cases per year for CKD (44% relative increase). Conclusion In this south European cohort, there were a high prevalence of HTN and DM as risk factors and a significant trend of increasing prevalence in high cost chronic conditions such as CHF, IHD and CKD. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): The present study was funded by an unrestricted research grant from Vifor Pharma.

scholarly journals Nursing consultation practice for psychosocial problems on heart failure patiens in hospital-based outpatient clinic

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
ERWIN Erwin ◽  
ELLY Nurachmah ◽  
TUTI Herawati
Keyword(s):  
Heart Failure ◽  
Support System ◽  
Family Environment ◽  
Outpatient Clinic ◽  
Social Problems ◽  
Family Members ◽  
Psychosocial Problems ◽  
The Family ◽  
Hospital Outpatients ◽  
At Home

Abstract Funding Acknowledgements Type of funding sources: None. Background The client"s condition for heart failure requires environmental support to be able to be confident and able to carry out activities according to the directions given while the patient is undergoing treatment in the hospital, but sometimes in the client"s time period at home there will be situations where patients may experience complaints or changes in conditions that can affect his cardiovascular status. Purpose this study is conducted to identify psychological and social problems and needs of heart failure clients with a qualitative approach of observation, invite individuals or families to participate, motivate individuals to develop the potential to maintain optimal health. In addition, this study was conducted to assess the need and effectiveness of the practice of consulting for heart failure nursing in hospital outpatients Method qualitative observation approach in nursing consulting practice using steps of the nursing process consisting of an assessment of physical, psychological and social conditions and client needs, formulating problems, making plans and taking care of actions in accordance with the problems that exist by nurses in the outpatient clinic at home sick. Results Clients who came to the outpatient clinic had various  psychological and social problems. From the observations and interviews it was found that psychological and social problems were the most common causes. Psychosocial problems arise due to the client himself, life companion (husband or wife) and family members who live together. So that the family system to support clients with heart failure is not awakened. Health education and promotion to clients, life companions, and family members of heart failure clients who live at home are needed when the client controls health to maintain the client"s health support system while at home. All clients and families in this study stated that the practice of nursing consultations in hospital outpatients is very helpful for clients and families to improve the situation they face. Conclusion the practice of nursing consultations can identify the problems and needs of clients and families. Strengthening the client support system for heart failure at home is needed so that psychological and social problems can be reduced when the client is in the family environment. Nursing consultation practices at outpatient hospitals are needed to help motivate clients and families in maintaining and increasing care and support for clients who suffer from heart failure while at home. Psychosocial problems The client felt anxious, lack of attention, complained sleeping difficulty, often forgot taking medicine, and forgot managing fluid intakeThe client,while at home, was fastidious and wanted to many, was difficult to be told or managed, was always suspicious with their spouse"s activity easily got angry or temperamental, the client"s child felt annoyed because the client acted annoying, the client"s spouse felt annoyed because the client was impatient and temperamentalPsychological, and social problems in heart failure patients

scholarly journals Acceptability, Feasibility and Preliminary Evaluation of a Novel, Personalised, Home-Based Physical Activity Intervention for Chronic Heart Failure (Active-at-Home-HF): a Pilot Study

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Nduka C. Okwose ◽  
Leah Avery ◽  
Nicola O’Brien ◽  
Sophie Cassidy ◽  
Sarah J. Charman ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Heart Failure ◽  
Pilot Study ◽  
Chronic Heart Failure ◽  
Physical Activity Intervention ◽  
Step Count ◽  
Home Based ◽  
At Home

Abstract Purpose Less than 10% of heart failure patients in the UK participate in cardiac rehabilitation programmes. The present pilot study evaluated feasibility, acceptability and physiological effects of a novel, personalised, home-based physical activity intervention in chronic heart failure. Methods Twenty patients (68 ± 7 years old, 20% females) with stable chronic heart failure due to reduced left ventricular ejection fraction (31 ± 8 %) participated in a single-group, pilot study assessing the feasibility and acceptability of a 12-week personalised home-based physical activity intervention aiming to increase daily number of steps by 2000 from baseline (Active-at-Home-HF). Patients completed cardiopulmonary exercise testing with non-invasive gas exchange and haemodynamic measurements and quality of life questionnaire pre- and post-intervention. Patients were supported weekly via telephone and average weekly step count data collected using pedometers. Results Forty-three patients were screened and 20 recruited into the study. Seventeen patients (85%) completed the intervention, and 15 (75%) achieved the target step count. Average step count per day increased significantly from baseline to 3 weeks by 2546 (5108 ± 3064 to 7654 ± 3849, P = 0.03, n = 17) and was maintained until week 12 (9022 ± 3942). Following completion of the intervention, no adverse events were recorded and quality of life improved by 4 points (26 ± 18 vs. 22 ± 19). Peak exercise stroke volume increased by 19% (127 ± 34 vs. 151 ± 34 m/beat, P = 0.05), while cardiac index increased by 12% (6.8 ± 1.5 vs. 7.6 ± 2.0 L/min/m2, P = 0.19). Workload and oxygen consumption at anaerobic threshold also increased by 16% (49 ± 16 vs. 59 ± 14 watts, P = 0.01) and 10% (11.5 ± 2.9 vs. 12.8 ± 2.2 ml/kg/min, P = 0.39). Conclusion The Active-at-Home-HF intervention is feasible, acceptable and effective for increasing physical activity in CHF. It may lead to improvements in quality of life, exercise tolerance and haemodynamic function. Trial Registration www.clinicaltrials.gov NCT0367727. Retrospectively registered on 17 September 2018.

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