Clinical and Economic Implications of New Strategies for Heart Failure Management in the Managed Care Setting

2007 ◽  
Vol 27 (4 Part 2) ◽  
pp. 29S-32S ◽  
Author(s):  
Sandra L Chase ◽  
Kerry K Pickworth
Keyword(s):  
Heart Failure ◽  
Managed Care ◽  
Care Setting ◽  
Heart Failure Management ◽  
Economic Implications ◽  
New Strategies

Economic Implications of Self-treatment of Heartburn/Nonulcur Dyspepsia with Nonprescription Famotidine in a Managed Care Setting

1996 ◽  
Vol 2 (3) ◽  
pp. 263-271 ◽  
Author(s):  
Kimberly Kunz ◽  
Edgar Arundell ◽  
Miriam Cisternas ◽  
Alan Heaton
Keyword(s):  
Managed Care ◽  
Care Setting ◽  
Economic Implications

Abstract P107: Association of Longitudinal Change and Fluctuation in QT Interval with Cardiovascular Outcomes: A Cohort Study in a Managed Care Setting

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Carlos Iribarren ◽  
Alfred D Round ◽  
Liisa L Lyon ◽  
Joseph F Terdiman ◽  
Jonathan G Zaroff ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Arrest ◽  
Managed Care ◽  
Qt Interval ◽  
Care Setting ◽  
Coronary Syndrome ◽  
All Cause Mortality ◽  
Race Ethnicity ◽  
Linear Slope ◽  
Over Time

Purpose. Both long and short QT intervals are associated with life-threatening cardiac arrhythmias and adverse cardiovascular (CV) events, but prior studies have typically relied on a single baseline measure of the QT interval. We examined the prospective association of within-person change and fluctuation in QT length over time with subsequent CV outcomes and all-cause mortality in a managed care setting. Methods. We assembled a cohort of 187,901 Northern California Kaiser Permanente Medical Care Program (KPMCP) members who underwent three or more standard 12-lead ECGs as part of regular care between 1995 and 2008. Cohort-specific log-linear models stratified by gender, age and race/ethnicity were used to correct raw QT measurements for heart rate (QTc). Non-fatal and fatal CV outcomes and all-cause mortality were identified between the last ECG and right censoring event (CV event, death, termination of health plan membership or 12/31/2009; the median [SD] follow-up time was 4.1 [3.7] years). Cox regression models adjusting for age, gender, race/ethnicity, hypertension, diabetes, hyperlipidemia, smoking status and average QTc were used to simultaneously generate hazard ratios and 95% CI for tertiles 1 and 3 (versus tertile 2) of the linear slope of QTc (change in ms per year) and for tertiles 2 and 3 (versus tertile 1) of the root mean square error of QTc (RMSE, variability about the linear slope in ms). Results. The mean QTc slope and RMSE were +2.2 ms/year and 15.3 ms in men and +1.4 ms/year and 14.3 ms in women, respectively. In fully-adjusted models, the sex-specific tertile 3 of the QTc slope was associated with increased hazard of acute coronary syndrome (Number of events; Hazard Ratio; 95% Confidence Interval) (17,920; 1.34; 1.30-1.39), ischemic stroke (11,716; 1.30; 1.25-1.36), heart failure (42,909; 1.47; 1.44-1.51), cardiac arrest (4,700; 1.67; 1.55-1.79) and all-cause mortality (72,392; 1.43;1.40-1.45). In turn, the sex-specific tertile 3 of the RMSE was associated with increased hazard of heart failure (1.34;1.31-1.37), cardiac arrest (1.19;1,11-1.28) and all-cause mortality (1.06;1.04-1.08). Conclusions. In an insured population that underwent multiple ECGs, both linear increase and fluctuation of QTc over time were significantly and independently associated with adverse CV outcomes. Whether these associations are causal or represent confounding effects of medications warrant further research.

scholarly journals Treatment of Chronic Heart Failure in a Managed Care Setting

2003 ◽  
Vol 64 (1) ◽  
pp. 4-10
Author(s):  
John F. Schmedtje ◽  
Gregory W. Evans ◽  
Wesley Byerly ◽  
Mark King ◽  
Kelly Goonan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Managed Care ◽  
Care Setting

652 Is heart rate lowering per se beneficial in chronic heart failure management and permanent cardiac pacing?

2007 ◽  
Vol 6 (1) ◽  
pp. 139-139
Author(s):  
D LOGEART ◽  
V CIOBOTARU ◽  
J GUEFFET ◽  
F POUSSET ◽  
F ROUZET ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Chronic Heart Failure ◽  
Cardiac Pacing ◽  
Heart Failure Management ◽  
Per Se

Natriuretic Peptides – Addressing the Dilemma of Heart Failure Management

2011 ◽  
Vol 7 (2) ◽  
pp. 104
Author(s):  
Kenneth McDonald ◽  
Ulf Dahlström ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Physical Examination ◽  
Natriuretic Peptides ◽  
Normal Values ◽  
Outpatient Setting ◽  
Heart Failure Management ◽  
Effective Screening ◽  
Specific Symptoms ◽  
Objective Marker

Heart failure (HF) is characterised by non-specific symptoms and unremarkable physical examination; therefore, the need exists for an available objective marker of HF status. Natriuretic peptides (NPs) are a marker that can aid the dilemmas in present-day HF management. More effective screening for clinical deterioration would include changes in brain natriuretic peptide (BNP) levels. Normal values for BNP, <50–100 pg/ml, have excellent negative predictive value (NPV) in excluding HF as a diagnosis. BNP values that are significantly elevated, e.g. >500 pg/ml, make the diagnosis of HF more likely. There are now established and emerging uses for NPs in managing HF in the community. These include the role of NPs at the time of possible new presentation of HF, its role in prognostication and, finally, the increasing interest in using NPs to guide therapy in the outpatient setting.

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