scholarly journals Impact of COVID-19 on chronic disease management

2021 ◽  
Vol 9 (8) ◽  
pp. 2510
Author(s):  
Srikar Sama ◽  
Alekhya Gajjala
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Chronic Disease ◽  
Kidney Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Routine Care ◽  
Review Article ◽  
Potential Impact ◽  
The Impact

Routine care for chronic disease is an ongoing major challenge. We aimed to evaluate the impact of COVID-19 on routine care for chronic diseases. A deeper understanding helps to increase the health system’s resilience and adequately prepare for the next waves of the pandemic. Diabetes, heart failure, chronic kidney disease, and hypertension were the most impacted conditions due to the reduction in access to care. It is important routine care continues in spite of the pandemic, to avoid a rise in non-COVID-19-related morbidity and mortality. This is a review article discussing the potential impact of COVID-19 on chronic disease management.

scholarly journals Incorporating Behavioral Trigger Messages Into a Mobile Health App for Chronic Disease Management: Randomized Clinical Feasibility Trial in Diabetes

10.2196/15927 ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. e15927
Author(s):  
Scott Sittig ◽  
Jing Wang ◽  
Sriram Iyengar ◽  
Sahiti Myneni ◽  
Amy Franklin
Keyword(s):  
Chronic Disease ◽  
Disease Management ◽  
Mobile Health ◽  
Self Efficacy ◽  
Chronic Disease Management ◽  
Text Messages ◽  
Feasibility Trial ◽  
Significant Difference ◽  
Within Subjects ◽  
The Impact

Background Although there is a rise in the use of mobile health (mHealth) tools to support chronic disease management, evidence derived from theory-driven design is lacking. Objective The objective of this study was to determine the impact of an mHealth app that incorporated theory-driven trigger messages. These messages took different forms following the Fogg behavior model (FBM) and targeted self-efficacy, knowledge, and self-care. We assess the feasibility of our app in modifying these behaviors in a pilot study involving individuals with diabetes. Methods The pilot randomized unblinded study comprised two cohorts recruited as employees from within a health care system. In total, 20 patients with type 2 diabetes were recruited for the study and a within-subjects design was utilized. Each participant interacted with an app called capABILITY. capABILITY and its affiliated trigger (text) messages integrate components from social cognitive theory (SCT), FBM, and persuasive technology into the interactive health communications framework. In this within-subjects design, participants interacted with the capABILITY app and received (or did not receive) text messages in alternative blocks. The capABILITY app alone was the control condition along with trigger messages including spark and facilitator messages. A repeated-measures analysis of variance (ANOVA) was used to compare adherence with behavioral measures and engagement with the mobile app across conditions. A paired sample t test was utilized on each health outcome to determine changes related to capABILITY intervention, as well as participants’ classified usage of capABILITY. Results Pre- and postintervention results indicated statistical significance on 3 of the 7 health survey measures (general diet: P=.03; exercise: P=.005; and blood glucose: P=.02). When only analyzing the high and midusers (n=14) of capABILITY, we found a statistically significant difference in both self-efficacy (P=.008) and exercise (P=.01). Although the ANOVA did not reveal any statistically significant differences across groups, there is a trend among spark conditions to respond more quickly (ie, shorter log-in lag) following the receipt of the message. Conclusions Our theory-driven mHealth app appears to be a feasible means of improving self-efficacy and health-related behaviors. Although our sample size is too small to draw conclusions about the differential impact of specific forms of trigger messages, our findings suggest that spark triggers may have the ability to cue engagement in mobile tools. This was demonstrated with the increased use of capABILITY at the beginning and conclusion of the study depending on spark timing. Our results suggest that theory-driven personalization of mobile tools is a viable form of intervention. Trial Registration ClinicalTrials.gov NCT04132089; http://clinicaltrials.gov/ct2/show/NCT004122089

Abstract 321: Impact Of Chronic Kidney Disease On Heart Failure Outcomes In A Minority Cohort

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
TAOPHEEQ MUSTAPHA ◽  
VARIJA BHOGIREDDY ◽  
HARTMAN MADU ◽  
ADU BOACHIE ◽  
ABDUL OSENI ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
African American ◽  
Kidney Disease ◽  
Prognostic Impact ◽  
Mortality And Morbidity ◽  
Ckd Stage ◽  
Significant Difference ◽  
The Mean ◽  
The Impact

BACKGROUND: Heart failure (HF) and Chronic kidney disease (CKD) are major public health problems that often co-exist with a resultant high mortality and morbidity. Most of the studies evaluating their reciprocal prognostic impact have focused on mortality in majority populations. There is limited literature on the impact of CKD on HF morbidities in ethnic minorities. AIMS: Our study seeks to compare HF outcomes in patients with or without CKD in an African-American predominant cohort. METHODS: We obtained data from the NGH at Meharry Heart Failure Cohort; a comprehensive retrospective HF database comprised of patient care data (HF admissions, non-HF admissions, and emergency room visits) were assessed from January 2006 to December 2008. The study group consist of 306 subjects with a mean age of 65±15 years. 81% were African-American (AA), 19% Caucasian and 48.5% are females. Following the NKF KDOQI guidelines, 5 stages of CKD were outlined based on GFR. RESULTS: The overall prevalence of CKD in this population is 54.2%. CKD stage 1 was most prevalent with 45.8%, prevalence for stages 2-5 are 21.6%, 18.3%, 9.5% and 4.9% respectively. The comparison of the mean of ER visits, non HF hospitalizations and HF hospitalizations between normal and CKD patients was done using independent t-test and showed no significant difference in the mean number of ER visits (p=0.564), or HF hospitalizations(p=0.235). However, there is a statistically significant difference in the mean number of non -HF hospitalizations between normal and CKD patients (p=0.031). CONCLUSION: This study shows that the prevalence of CKD in this minority -predominant HF cohort is similar to prior studies in majority populations. However, only the non-HF hospitalizations were significantly increased in the CKD group. Future prospective studies will be needed to define the implications of this in the management of HF patients with CKD.

P5475Essential thrombocytosis is associated with worse hospital outcomes in patients presented with acute myocardial infarction: a propensity score analysis of the National Inpatient Sample

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Wu ◽  
B Liu ◽  
Y Zheng
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Propensity Score ◽  
Matched Control ◽  
National Inpatient Sample ◽  
Essential Thrombocytosis ◽  
The Impact

Abstract Background/Introduction Essential thrombocytosis (ET) is a rare disease characterized by vasomotor symptom, thrombotic event, and hemorrhage. Due to its rare occurrence, limited data are available to examine the impact of ET on acute myocardial infarction (AMI). Purpose To evaluate the impact of ET on hospital outcomes of AMI. Methods We use the 2016 National Inpatient sample database to identify all the admissions with a principal diagnosis of AMI with or without ET. A matched control group was then generated using propensity score from age, sex, race, location, insurance, income, hospital type, hospital location, Charlsoncat Comorbidity Score. Prevalence, baseline characteristic of AMI patient with or without ET was described and compared. Univariable logistic regression was used to measure mortality and the rate of catheterization. Results ET was found in 0.28% (1,814) in total AMI admissions (641,854). Age (69.52 vs 69.70), female percentage (48.04% vs 48.03%) and baseline comorbidities including STEMI (27.49% vs 25.08%), diabetes (33.03% vs 30.51%), heart failure (40.18 vs 45.89%) and chronic kidney disease (22.05% vs 26.28%) was found to be comparable between two groups (p>0.05, table 1). Compared to non ET group, ET is associated with significantly higher hospital mortality (5.74% vs 2.43%, OR 2.44 [1.09–5.48], p=0.03), prolonged length of stay (7.61 vs 4.30 days, p<0.01). Interestingly, ET is also associated with lower utilization of cardiac catheterization (37.46% vs 46.52%, p=0.01). Essential Thrombocytosis and AMI Parameter AMI with ET Matched control: AMI without ET Odds ratio (95% CI) P value (n=1,814) (n=1,814) Age, years 69.52±0.72 69.70±0.70 p>0.05 Female, % 48.04 48.03 p>0.05 STEMI, % 27.49 25.08 p>0.05 Hypertension, % 81.57 83.08 p>0.05 Diabetes, % 33.03 30.51 p>0.05 Heart failure, % 40.18 45.89 p>0.05 Chronic kidney disease, % 22.05 26.28 p>0.05 Mortality, % 5.74 2.43 2.44 (1.09–5.48) p=0.03 Catheterization, % 37.46 46.52 0.68 (0.51–0.91) P=0.01 Length of stay, days 7.61±0.48 4.30±0.21 P<0.01 Values are reported as mean ± S.E. Categorical variables are represented as frequency. Conclusion ET is infrequently observed in patients with AMI. Having ET is associated with higher hospital mortality, longer hospital stay and lower utilization of cardiac catheterization. Acknowledgement/Funding None

scholarly journals Finerenone Reduces Risk of Incident Heart Failure in Patients With Chronic Kidney Disease and Type 2 Diabetes: Analyses from the FIGARO-DKD Trial

Circulation ◽  
2021 ◽  
Author(s):  
Gerasimos Filippatos ◽  
Stefan D. Anker ◽  
Rajiv Agarwal ◽  
Luis M. Ruilope ◽  
Peter Rossing ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Lower Risk ◽  
Cardiovascular Death ◽  
History Of ◽  
The Impact ◽  
New Onset

Background: Chronic kidney disease (CKD) and type 2 diabetes (T2D) are independently associated with heart failure (HF), a leading cause of morbidity and mortality. In the FIDELIO-DKD and FIGARO DKD trials, finerenone (a selective, nonsteroidal mineralocorticoid receptor antagonist) improved cardiovascular outcomes in patients with albuminuric CKD and T2D. These prespecified analyses from FIGARO-DKD assessed the impact of finerenone on clinically important HF outcomes. Methods: Patients with T2D and albuminuric CKD (urine albumin-to-creatinine ratio [UACR] ≥30 to <300 mg/g and estimated glomerular filtration rate [eGFR] ≥25 to ≤90 ml/min/1.73 m 2 , or UACR ≥300 to ≤5000 mg/g and eGFR ≥60 ml/min/1.73 m 2 ,), without symptomatic HF with reduced ejection fraction, were randomized to finerenone or placebo. Time-to-first event outcomes included: new-onset HF (first hospitalization for HF [HHF] in patients without a history of HF at baseline); cardiovascular death or first HHF; HF-related death or first HHF; first HHF; cardiovascular death or total (first or recurrent) HHF; HF-related death or total HHF; and total HHF. Outcomes were evaluated in the overall population and in prespecified subgroups categorized by baseline HF history (as reported by the investigators). Results: Overall, 7352 patients were included in these analyses; 571 (7.8%) had a history of HF at baseline. New-onset HF was significantly reduced with finerenone versus placebo (1.9% versus 2.8%; hazard ratio [HR], 0.68 [95% CI 0.50-0.93]; P =0.0162). In the overall population, the incidences of all HF outcomes analyzed were significantly lower with finerenone than placebo, including a 18% lower risk of cardiovascular death or first HHF (HR, 0.82 [95% CI 0.70-0.95]; P =0.011), a 29% lower risk of first HHF (HR, 0.71 [95% CI 0.56-0.90]; P =0.0043) and a 30% lower rate of total HHF (rate ratio, 0.70 [95% CI, 0.52- 0.94]). The effects of finerenone on improving HF outcomes were not modified by a history of HF. The incidence of treatment-emergent adverse events was balanced between treatment groups. Conclusions: The results from these FIGARO-DKD analyses demonstrate that finerenone reduces new-onset HF and improves other HF outcomes in patients with CKD and T2D, irrespective of a history of HF.

scholarly journals Chronic disease management in heart failure: focus on telemedicine and remote monitoring

2021 ◽  
Vol 22 (2) ◽  
pp. 403
Author(s):  
Paulino Alvarez ◽  
Alex Sianis ◽  
Jessica Brown ◽  
Abbas Ali ◽  
Alexandros Briasoulis
Keyword(s):  
Heart Failure ◽  
Chronic Disease ◽  
Disease Management ◽  
Remote Monitoring ◽  
Chronic Disease Management

The Use and Evaluations of IT in Chronic Disease Management

2011 ◽  
pp. 1075-1092
Author(s):  
Julia Adler-Milstein ◽  
Ariel Linden
Keyword(s):  
Information Technology ◽  
Chronic Disease ◽  
Disease Management ◽  
Information Technologies ◽  
Chronic Disease Management ◽  
Program Effectiveness ◽  
Management Program ◽  
Evaluation Strategies ◽  
Broad Array ◽  
The Impact

This chapter describes the broad array of information technologies currently used in programs that manage individuals with chronic diseases and discusses evaluation strategies to assess the impact of implementing programs that incorporate such technologies. More specifically, it describes the three components of a chronic disease management program and then details the technologies commonly used in each component. Three evaluation designs well-suited to measure DM program effectiveness are also discussed. The intent of this chapter is to educate readers on the range of approaches to incorporating information technology into chronic disease management and the most appropriate evaluation designs that will strengthen the understanding of which approaches are most successful.

MO488HOSPITALISATION EVENTS IN PEOPLE WITH CHRONIC KIDNEY DISEASE AND MULTIPLE LONG-TERM CONDITIONS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Michael Sullivan ◽  
Bhautesh Jani ◽  
Alex McConnachie ◽  
Frances Mair ◽  
Patrick Mark
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Risk Groups ◽  
Routine Care ◽  
Self Report ◽  
Uk Biobank ◽  
Long Term Conditions ◽  
Event Rates ◽  
The Impact

Abstract Background and Aims: Chronic Kidney Disease (CKD) typically co-exists with multiple long-term conditions (LTCs). The impact of CKD combined with multiple LTCs on hospitalisation rates is not known. We hypothesised that hospitalisation rates would be high in people with multiple LTCs, particularly in those with CKD. We also hypothesised that the association between multiple LTCs and hospitalisation would be greatest in subgroups and with certain patterns of LTCs. Method: Two cohorts were studied in parallel: UK Biobank (2006-2019) and Secure Anonymised Information Linkage Databank (SAIL: 2011-2018, Wales, UK). UK Biobank is a prospective research cohort. SAIL is a routine care database. Participants were included if their kidney function was measured at baseline. LTCs were obtained from self-report (UK Biobank) and primary care read codes (SAIL). Participants were categorised into zero, one, two, three and four or more LTCs with and without CKD. CKD was defined as estimated glomerular filtration rate less than 60 ml/min/1.73m2 (single blood test for UK Biobank, two blood tests three months apart for SAIL). Hospitalisation events were obtained from linked hospital records. Results: Among 469,344 of 502,503 UK Biobank participants, those without CKD had a median age of 58 and a median of 1 LTC. Those with CKD had a median age of 64 and a median of 2 LTCs. Among 1,620,490 of 2,768,862 SAIL participants, those without CKD had a median age of 50 and a median of 1 LTC. Those with CKD had a median age of 79 and a median of 4 LTCs. Participants with four or more LTCs had high event rates (Rate Ratios (RRs) 5.35 (95% CI 5.20-5.51)/3.77 (95% CI 3.71-3.82)) with higher rates in CKD (RRs 8.99 (95% CI 8.47-9.54)/9.92 (95% CI 9.75-10.09)). Amongst those with CKD, the association between each increase in LTC count and hospitalisation was greatest in those under the age of 50 (RRs 1.93 (95% CI 1.73-2.16)/1.35(95% CI 1.29-1.41)). Event rates were highest in those with eGFR&lt;30ml/min/1.73m2, but the impact of multiple LTCs was weaker in these participants compared to those with higher eGFRs. Event rates were high in certain patterns of LTCs: cardiometabolic LTCs (RRs 4.45 (95% CI 4.02-4.92)/2.81 (95% CI 2.71-2.91)), complex patterns (RRs 3.60 (95% CI 3.26-3.96)/2.91 (95% CI 2.81-3.01)) and physical/mental LTCs (RRs 3.30 (95% CI 2.86-3.80)/3.18 (95% CI 3.06-3.30)). Conclusion: People with multiple LTCs have high rates of hospitalisation and the rates are augmented in those with CKD. The impact of multiple LTCs is greatest in younger patients and in those with certain patterns of LTCs. Strategies should be developed to prevent hospitalisations in these high-risk groups. Hospitalisation Events by Chronic Kidney Disease (CKD) status and number of Long-term conditions (LTCs) in UK Biobank Hospitalisation Events by Chronic Kidney Disease (CKD) status and number of Long-term conditions (LTCs) in SAIL

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