scholarly journals Etiological Role of Diet in 30-Day Readmissions for Heart Failure: Implications for Reducing Heart Failure–Associated Costs via Culinary Medicine

2019 ◽  
Vol 14 (4) ◽  
pp. 351-360
Author(s):  
Alexander C. Razavi ◽  
Dominique J. Monlezun ◽  
Alexander Sapin ◽  
Leah Sarris ◽  
Emily Schlag ◽  
...  

Background. Reducing the under-30-day readmission for heart failure (HF) patients is a modifiable quality-of-care measure, yet the role of diet in HF readmissions and cost-effective HF care remain ill-defined. Methods. Medical chart review was conducted to determine cause(s) for HF treatment failure. Randomized controlled trial–backed machine learning models were employed to assess the relationship of culinary medicine education with HF 30-day readmission rate and cost. Results. Of 1031 HF admissions, 130 occurred within 30 days of discharge (12.61%.) Nearly two-thirds of individuals were male (64.02%), while the mean age and median length of stay were 64.33 ± 14.02 and 2, respectively. Medication noncompliance (34.62%) was the most common etiology for 30-day readmissions, followed by dietary noncompliance (16.92%), comorbidity (16.92%), a combination of dietary and medication noncompliance (10%), HF exacerbation (10%), iatrogenic (10%), and drug abuse (1.54%). Medication noncompliance contributed to the highest gross charge by readmission, costing a total of $1 802 096. Compared with traditional care, culinary medicine education for HF patients would prevent 93 HF readmissions and save $3.9 million in an estimated 4-year period. Conclusion. Though pharmacological treatment remains a focal point of HF management, diet-based approaches may improve tertiary HF prevention and reduce HF-associated health care expenditures.

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001184
Author(s):  
Nasrin Tayyari Dehbarez ◽  
Camilla Palmhøj Nielsen ◽  
Bettine Wulff Risør ◽  
Claus Vinther Nielsen ◽  
Vibeke Lynggaard

ObjectivesTo enhance adherence to cardiac rehabilitation (CR), a patient education programme called ‘learning and coping’ (LC-programme) was implemented in three hospitals in Denmark. The aim of this study was to investigate the cost–utility of the LC-programme compared with the standard CR-programme.Methods825 patients with ischaemic heart disease or heart failure were randomised to the LC-programme or the standard CR-programme and were followed for 3 years.A societal cost perspective was applied and quality-adjusted life years (QALY) were based on SF-6D measurements. Multiple imputation technique was used to handle missing data on the SF-6D. The statistical analyses were based on means and bootstrapped SEs. Regression framework was employed to estimate the net benefit and to illustrate cost-effectiveness acceptability curves.ResultsNo statistically significant differences were found between the two programmes in total societal costs (4353 Euros; 95% CI –3828 to 12 533) or in QALY (–0.006; 95% CI –0.053 to 0.042). At a threshold of 40 000 Euros, the LC-programme was found to be cost-effective at 15% probability; however, for patients with heart failure, due to increased cost savings, the probability of cost-effectiveness increased to 91%.ConclusionsWhile the LC-programme did not appear to be cost-effective in CR, important heterogeneity was noted for subgroups of patients. The LC-programme was demonstrated to increase adherence to the rehabilitation programme and to be cost-effective among patients with heart failure. However, further research is needed to study the dynamic value of heterogeneity due to the small sample size in this subgroup.


2017 ◽  
Vol 8 (1) ◽  
pp. 1-4
Author(s):  
Sandeep Lahiry ◽  
Rajasree Sinha ◽  
Shouvik Choudhury ◽  
Ayan Mukherjee

Background: Current Heart failure (HF) pharmacotherapy has been unsatisfactory in halting disease progression completely.Aims and Objective: To evaluate the role of LCZ696, a recent FDA-approved ACE -Neprilysin inhibitor (ARNi) in the management of HF from available trial data.Materials and Methods: Trial data on ‘LCZ696’ was assessed using PubMed search. Methodological filters were applied to limit retrieval to ‘Randomized Controlled Trial’ (RCT). Bibliographic databases with ‘Human’ data were selected. Trial data comparing ‘LCZ696’ to other drugs or placebo were accessed in full-text. CONSORT guidelines were used for quality assessment. Incomplete methodology, results in abstract form, duplicate publications were excluded. Data extraction forms were piloted and used to obtain uniform quality of data.Results: Multi-centric trial data (n=2) revealed noticeable benefits with ‘LCZ696’ in patients with HF with reduced ejection fraction (HFrEF), reducing cardiovascular death or hospitalization for HF by 20%; cardiovascular deaths by 20%; hospitalization for HF by 21% ; all cause mortality reduction by 20% as compared to ACE inhibitors (ACEi) (PARADIGM-HF; n=8442). Angioedema was notably absent. Decrease in high sensitivity Troponin-T, improvement in N-terminal-pro-BNP and left atrial dimensions suggested reduction of myocardial injury in HF with preserved ejection fraction (HFpEF) (PARAMOUNT trial; n=301).Conclusion: There is convincing evidence of the role of novel ARNi (Angiotensin receptor – Neprilysin Inhibitors) in HF pharmacotherapy. Its role in other cardiovascular conditions merits assessment.Asian Journal of Medical Sciences Vol.8(1) 2017 1-4


Heart India ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 68
Author(s):  
Aamir Rashid ◽  
Shamim Iqbal ◽  
Irfan Bhat ◽  
Jahangir Rashid ◽  
Imran Hafeez ◽  
...  

2021 ◽  
Vol 7 ◽  
Author(s):  
Marko Kumric ◽  
Tina Ticinovic Kurir ◽  
Josko Bozic ◽  
Duska Glavas ◽  
Tina Saric ◽  
...  

Because heart failure (HF) is more lethal than some of the common malignancies in the general population, such as prostate cancer in men and breast cancer in women, there is a need for a cost-effective prognostic biomarker in HF beyond natriuretic peptides, especially concerning congestion, the most common reason for the hospitalisation of patients with worsening of HF. Furthermore, despite diuretics being the mainstay of treatment for volume overload in HF patients, no randomised trials have shown the mortality benefits of diuretics in HF patients, and appropriate diuretic titration strategies in this population are unclear. Recently, carbohydrate antigen (CA) 125, a well-established marker of ovarian cancer, emerged as both a prognostic indicator and a guide in tailoring decongestion therapy for patients with HF. Hence, in this review the authors present the molecular background regarding the role of CA125 in HF and address valuable clinical aspects regarding the relationship of CA125 with both prognosis and therapeutic management in HF.


Author(s):  
Mohamed Fahmy Doheim ◽  
Mohamed Mostafa

Introduction : Carotid‐cavernous fistula (CCF) represents a well‐known multifaceted diagnostic challenge starting from clinical presentation till angiography. This case presentation and literature review shed the light on the value of a bedside transcranial duplex (TCD) as a timely and a plausible screening tool. Methods : A case presentation and a brief literature review of CCF diagnosed via transcranial temporal window and made time to angiography shorter than the MRI brain. A review of literature was conducted for the timely diagnostic role of transtemporal TCD compared to transorbital US and an MRI brain. Results : Our case report showed the valuable role of the bedside TCD in diagnosing CCF. There is a limited number of studies which tackled the timely diagnostic role of transtemporal TCD compared to transorbital US and an MRI brain from door to angiography. Conclusions : A large‐sampled randomized controlled trial is needed for evaluating the actual utility of a bed side time and cost‐effective Transtemporal TCD vs other state‐of‐art non‐angiographic diagnostic modalities such as MRI, CT and transorbital US.


2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P3339-P3339
Author(s):  
A. Dalbeni ◽  
G. Scaturro ◽  
P. Minuz ◽  
M. De Gan ◽  
P. Delva

2020 ◽  
Vol 134 (1) ◽  
pp. 71-72
Author(s):  
Naseer Ahmed ◽  
Masooma Naseem ◽  
Javeria Farooq

Abstract Recently, we have read with great interest the article published by Ibarrola et al. (Clin. Sci. (Lond.) (2018) 132, 1471–1485), which used proteomics and immunodetection methods to show that Galectin-3 (Gal-3) down-regulated the antioxidant peroxiredoxin-4 (Prx-4) in cardiac fibroblasts. Authors concluded that ‘antioxidant activity of Prx-4 had been identified as a protein down-regulated by Gal-3. Moreover, Gal-3 induced a decrease in total antioxidant capacity which resulted in a consequent increase in peroxide levels and oxidative stress markers in cardiac fibroblasts.’ We would like to point out some results stated in the article that need further investigation and more detailed discussion to clarify certain factors involved in the protective role of Prx-4 in heart failure.


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