scholarly journals Moving From Heart Failure Guidelines to Clinical Practice: Gaps Contributing to Readmissions in Patients With Multiple Comorbidities and Older Age

2018 ◽  
Vol 12 ◽  
pp. 117954681880935 ◽  
Author(s):  
Pupalan Iyngkaran ◽  
Danny Liew ◽  
Christopher Neil ◽  
Andrea Driscoll ◽  
Thomas H Marwick ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Congestive Heart Failure ◽  
Heart Association ◽  
Multidisciplinary Care ◽  
The Elderly ◽  
Tertiary Hospital ◽  
Chronic Obstructive ◽  
Common Denominator ◽  
Chronic Renal Impairment

This feature article for the thematic series on congestive heart failure (CHF) readmissions aims to outline important gaps in guidelines for patients with multiple comorbidities and the elderly. Congestive heart failure diagnosis manifests as a 3-phase journey between the hospital and community, during acute, chronic stable, and end-of-life (palliative) phases. This journey requires in variable intensities a combination of multidisciplinary care within tertiary hospital or ambulatory care from hospital outpatients or primary health services, within the general community. Management goals are uniform, ie, to achieve the lowest New York Heart Association class possible, with improvement in ejection fraction, by delivering gold standard therapies within a CHF program. Comorbidities are an important common denominator that influences outcomes. Comorbidities include diabetes mellitus, chronic obstructive airways disease, chronic renal impairment, hypertension, obesity, sleep apnea, and advancing age. Geriatric care includes the latter as well as syndromes such as frailty, falls, incontinence, and confusion. Many systems still fail to comprehensively achieve all aspects of such programs. This review explores these factors.

scholarly journals Classification of Congestive Heart Failure from ECG Segments with a Multi-Scale Residual Network

Symmetry ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 2019
Author(s):  
Dengao Li ◽  
Ye Tao ◽  
Jumin Zhao ◽  
Hang Wu
Keyword(s):  
Heart Failure ◽  
New York ◽  
Congestive Heart Failure ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Heart Association ◽  
Residual Network ◽  
Ecg Signals ◽  
Multi Scale ◽  
New York Heart Association

Congestive heart failure (CHF) poses a serious threat to human health. Once the diagnosis of CHF is established, clinical experts need to assess the severity of CHF in a timely manner. It is proved that electrocardiogram (ECG) signals are useful for assessing the severity of CHF. However, since the ECG perturbations are subtle, it is difficult for doctors to detect the differences of ECGs. In order to help doctors to make an accurate diagnosis, we proposed a novel multi-scale residual network (ResNet) to automatically classify CHF into four classifications according to the New York Heart Association (NYHA) functional classification system. Furthermore, in order to make the reported results more realistic, we used an inter-patient paradigm to divide the dataset, and segmented the ECG signals into two different intervals. The experimental results show that the proposed multi-scale ResNet-34 has achieved an average positive predictive value, sensitivity and accuracy of 93.49%, 93.44% and 93.60% respectively for two seconds of ECG segments. We have also obtained an average positive predictive value, sensitivity and accuracy of 94.16%, 93.79% and 94.29% respectively for five seconds of ECG segments. The proposed method can be used as an auxiliary tool to help doctors to classify CHF.

scholarly journals Analytical and Clinical Evaluation of the Bayer ADVIA Centaur Automated B-Type Natriuretic Peptide Assay in Patients with Heart Failure: A Multisite Study

2004 ◽  
Vol 50 (5) ◽  
pp. 867-873 ◽  
Author(s):  
Alan H B Wu ◽  
Milton Packer ◽  
Andrew Smith ◽  
Rachel Bijou ◽  
Daniel Fink ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Natriuretic Peptide ◽  
Clinical Performance ◽  
Volume Overload ◽  
Heart Association ◽  
Reference Intervals ◽  
Chronic Obstructive ◽  
Blood Collection ◽  
High Dose

Abstract Background: B-Type natriuretic peptide (BNP) is released from the left ventricle of the heart into the circulation in response to ventricular stretching and volume overload. Increased BNP concentrations are associated with heart failure (HF). Methods: We evaluated the analytical and clinical performance of the Bayer ADVIA Centaur® BNP assay. Studies included precision, analytical correlation (against the Shionogi ShionoRIA™ and Biosite Triage® BNP assays), BNP results for blood collected in plastic tubes containing EDTA vs other collection tubes, high-dose hook effect, detection limits, and interferences. The clinical performance was tested on 2243 blood samples collected from 983 apparently healthy individuals, 538 patients with chronic disease but without HF (renal insufficiency, chronic obstructive pulmonary disease, diabetes, and hypertension), and 722 patients with HF (New York Heart Association classes I-IV). Results: The ADVIA Centaur assay had total imprecision (CV) of 3.4%, 2.9%, and 2.4% at BNP concentrations of 48, 461, and 1768 ng/L, respectively. The Passing–Bablok correlations to the ShionoRIA and Triage were as follows: ADVIA Centaur = 1.11(ShionoRIA) − 1.19 ng/L (r = 0.98); ADVIA Centaur = 0.78(Triage) + 5.89 ng/L (r = 0.92), respectively. Of the different blood collection tubes, only EDTA plastic tubes (with and without the barrier gel) were acceptable. The lower detection limit was 0.5 ng/L, and there were no interferences from common analytes, other neuropeptides, or unusual antibodies. BNP exhibited different reference intervals according to age and gender. BNP concentrations increased progressively as the severity of HF increased. Conclusions: The ADVIA Centaur is the first commercially available BNP assay for use on an automated immunochemistry platform. This assay has good analytical and clinical performance characteristics for diagnosing HF.

Factors associated with health-related quality of life in stable ambulatory congestive heart failure patients: Systematic review

2018 ◽  
Vol 25 (5) ◽  
pp. 472-481 ◽  
Author(s):  
Anneleen Baert ◽  
Delphine De Smedt ◽  
Johan De Sutter ◽  
Dirk De Bacquer ◽  
Paolo Emilio Puddu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
New York ◽  
Congestive Heart Failure ◽  
Heart Association ◽  
Functional Class ◽  
Factors Associated ◽  
Related Quality ◽  
New York Heart Association

Background Since improved treatment of congestive heart failure has resulted in decreased mortality and hospitalisation rates, increasing self-perceived health-related quality of life (HRQoL) has become a major goal of congestive heart failure treatment. However, an overview on predictieve factors of HRQoL is currently lacking in literature. Purpose The aim of this study was to identify key factors associated with HRQoL in stable ambulatory patients with congestive heart failure. Methods A systematic review was performed. MEDLINE, Web of Science and Embase were searched for the following combination of terms: heart failure, quality of life, health perception or functional status between the period 2000 and February 2017. Literature screening was done by two independent reviewers. Results Thirty-five studies out of 8374 titles were included for quality appraisal, of which 29 were selected for further data extraction. Four distinct categories grouping different types of variables were identified: socio-demographic characteristics, clinical characteristics, health and health behaviour, and care provider characteristics. Within the above-mentioned categories the presence of depressive symptoms was most consistently related to a worse HRQoL, followed by a higher New York Heart Association functional class, younger age and female gender. Conclusion Through a systematic literature search, factors associated with HRQoL among congestive heart failure patients were investigated. Age, gender, New York Heart Association functional class and depressive symptoms are the most consistent variables explaining the variance in HRQoL in patients with congestive heart failure. These findings are partly in line with previous research on predictors for hard endpoints in patients with congestive heart failure.

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