Efficacy and Cost of an Exercise Program for Functionally Impaired 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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Aspartate aminotransferase to alanine aminotransferase ratio is associated with frailty and mortality in older patients with heart failure

Scientific Reports ◽

10.1038/s41598-021-91368-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Daichi Maeda ◽

Nobuyuki Kagiyama ◽

Kentaro Jujo ◽

Kazuya Saito ◽

Kentaro Kamiya ◽

...

Keyword(s):

Heart Failure ◽

Older Patients ◽

Early Recognition ◽

Walk Distance ◽

Failure Data ◽

Patients With Heart Failure ◽

All Cause Mortality ◽

One Year ◽

Independent Marker

AbstractFrailty is a common comorbidity associated with adverse events in patients with heart failure, and early recognition is key to improving its management. We hypothesized that the AST to ALT ratio (AAR) could be a marker of frailty in patients with heart failure. Data from the FRAGILE-HF study were analyzed. A total of 1327 patients aged ≥ 65 years hospitalized with heart failure were categorized into three groups based on their AAR at discharge: low AAR (AAR < 1.16, n = 434); middle AAR (1.16 ≤ AAR < 1.70, n = 487); high AAR (AAR ≥ 1.70, n = 406). The primary endpoint was one-year mortality. The association between AAR and physical function was also assessed. High AAR was associated with lower short physical performance battery and shorter 6-min walk distance, and these associations were independent of age and sex. Logistic regression analysis revealed that high AAR was an independent marker of physical frailty after adjustment for age, sex and body mass index. During follow-up, all-cause death occurred in 161 patients. After adjusting for confounding factors, high AAR was associated with all-cause death (low AAR vs. high AAR, hazard ratio: 1.57, 95% confidence interval, 1.02–2.42; P = 0.040). In conclusion, AAR is a marker of frailty and prognostic for all-cause mortality in older patients with heart failure.

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Managing older patients with heart failure calls for a holistic approach

ESC Heart Failure ◽

10.1002/ehf2.13292 ◽

2021 ◽

Author(s):

Julia H.I. Wiersinga ◽

Hanneke F.M. Rhodius‐Meester ◽

Emma E.F. Kleipool ◽

Louis Handoko ◽

Albert C. Rossum ◽

...

Keyword(s):

Heart Failure ◽

Older Patients ◽

Holistic Approach ◽

Patients With Heart Failure

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Physical function and exercise training in older patients with heart failure

Nature Reviews Cardiology ◽

10.1038/nrcardio.2017.70 ◽

2017 ◽

Vol 14 (9) ◽

pp. 550-559 ◽

Cited By ~ 14

Author(s):

Andrew J. Stewart Coats ◽

Daniel E. Forman ◽

Mark Haykowsky ◽

Dalane W. Kitzman ◽

Amy McNeil ◽

...

Keyword(s):

Heart Failure ◽

Exercise Training ◽

Physical Function ◽

Older Patients ◽

Patients With Heart Failure

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Impact of a pharmacy team–led intervention program on the readmission rate of elderly patients with heart failure

American Journal of Health-System Pharmacy ◽

10.2146/ajhp170256 ◽

2018 ◽

Vol 75 (4) ◽

pp. 183-190 ◽

Cited By ~ 9

Author(s):

Pamela M. Moye ◽

Pui Shan Chu ◽

Teresa Pounds ◽

Maria Miller Thurston

Keyword(s):

Heart Failure ◽

Older Patients ◽

Readmission Rate ◽

Academic Medical Center ◽

Hospital Readmissions ◽

Intervention Group ◽

Historical Control Group ◽

Historical Control ◽

Control Group ◽

Patients With Heart Failure

Purpose The results of a study to determine whether pharmacy team–led postdischarge intervention can reduce the rate of 30-day hospital readmissions in older patients with heart failure (HF) are reported. Methods A retrospective chart review was performed to identify patients 60 years of age or older who were admitted to an academic medical center with a primary diagnosis of HF during the period March 2013–June 2014 and received standard postdischarge follow-up care provided by physicians, nurses, and case managers. The rate of 30-day readmissions in that historical control group was compared with the readmission rate in a group of older patients with HF who were admitted to the hospital during a 15-month intervention period (July 2014–October 2015); in addition to usual postdischarge care, these patients received medication reconciliation and counseling from a team of pharmacists, pharmacy residents, and pharmacy students. Results Twelve of 97 patients in the intervention group (12%) and 20 of 80 patients in the control group (25%) were readmitted to the hospital within 30 days of discharge (p = 0.03); 11 patients in the control group (55%) and 7 patients in the intervention group (58%) had HF-related readmissions (p = 0.85). Conclusion In a population of older patients with HF, the rate of 30-day all-cause readmissions in a group of patients targeted for a pharmacy team–led postdischarge intervention was significantly lower than the all-cause readmission rate in a historical control group.

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Digoxin use and lower risk of 30-day all-cause readmission in older patients with heart failure and reduced ejection fraction receiving β-blockers

Clinical Cardiology ◽

10.1002/clc.22889 ◽

2018 ◽

Vol 41 (3) ◽

pp. 406-412 ◽

Cited By ~ 7

Author(s):

Phillip H. Lam ◽

Poonam Bhyan ◽

Cherinne Arundel ◽

Daniel J. Dooley ◽

Helen M. Sheriff ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Lower Risk ◽

Older Patients ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

Β Blockers

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Preventing the rebound: improving care transition in hospital discharge processes

Australian Health Review ◽

10.1071/ah09777 ◽

2010 ◽

Vol 34 (4) ◽

pp. 445 ◽

Cited By ~ 52

Author(s):

Ian A. Scott

Keyword(s):

Heart Failure ◽

High Risk ◽

Older Patients ◽

Single Component ◽

Self Management ◽

Controlled Trials ◽

High Risk Patients ◽

Patients With Heart Failure ◽

Risk Patients ◽

Multicomponent Interventions

Background.Unplanned readmissions of recently discharged patients impose a significant burden on hospitals with limited bed capacity. Deficiencies in discharge processes contribute to such readmissions, which have prompted experimentation with multiple types of peridischarge interventions. Objective.To determine the relative efficacy of peridischarge interventions categorised into two groups: (1) single component interventions (sole or predominant) implemented either before or after discharge; and (2) integrated multicomponent interventions which have pre- and postdischarge elements. Design.Systematic metareview of controlled trials. Data collection.Search of four electronic databases for controlled trials or systematic reviews of trials published between January 1990 and April 2009 that reported effects on readmissions. Data synthesis.Among single-component interventions, only four (intense self-management and transition coaching of high-risk patients and nurse home visits and telephone support of patients with heart failure) were effective in reducing readmissions. Multicomponent interventions that featured early assessment of discharge needs, enhanced patient (and caregiver) education and counselling, and early postdischarge follow-up of high-risk patients were associated with evidence of benefit, especially in populations of older patients and those with heart failure. Conclusion.Peridischarge interventions are highly heterogenous and reported outcomes show considerable variation. However, multicomponent interventions targeted at high-risk populations that include pre- and postdischarge elements seem to be more effective in reducing readmissions than most single-component interventions, which do not span the hospital–community interface. What is known about this topic?Unplanned readmissions within 30 days of hospital discharge are common and may reflect deficiencies in discharge processes. Various peridischarge interventions have been evaluated, mostly single-component interventions that occur either before or after discharge, but failing to yield consistent evidence of benefit in reducing readmissions. More recent trials have assessed multicomponent interventions which involve pre- and postdischarge periods, but no formal review of such studies has been undertaken. What does this paper add?With the exception of intense self-management and transition coaching of high-risk patients, and nurse home visits and telephonic support for patients with heart failure, single-component interventions were ineffective in reducing readmissions. Multicomponent interventions demonstrated evidence of benefit in reducing readmissions by as much as 28%, with best results achieved in populations of older patients and those with heart failure. What are the implications for practitioners and managers?Hospital clinicians and managers should critically review and, where appropriate, modify their current discharge processes in accordance with these findings and negotiate the extra funding and personnel required to allow successful implementation of multicomponent discharge processes that transcend organisational boundaries.

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