scholarly journals Long-term Effects of Telemonitoring on Healthcare Usage in Patients with Heart Failure or COPD (Preprint)

2018 ◽  
Author(s):  
Jorien Maria Margaretha van der Burg ◽  
Nasir Ahmad Aziz ◽  
Maurits C. Kaptein ◽  
Martine J.M. Breteler ◽  
Joris H. Jansen ◽  
...  
Keyword(s):  
Heart Failure ◽  
The Netherlands ◽  
Healthcare Costs ◽  
Hospital Admissions ◽  
Disease Stage ◽  
Chronic Obstructive ◽  
Home Telemonitoring ◽  
Copd Patients ◽  
Patients With Heart Failure

UNSTRUCTURED Objective The aim of this study was to evaluate the effectiveness of home telemonitoring in reducing healthcare usage and costs in patients with heart failure or chronic obstructive pulmonary disease (COPD). Design The study was a retrospective observational study with a pre-post research design and a follow-up duration of up to 3 years, based on hospital data collected in the period 2012-2016. Setting Data was collected at the Slingeland Hospital in Doetinchem, The Netherlands. Participants In 2012 the Slingeland Hospital in The Netherlands started a telemonitoring program for patients with COPD or heart failure as part of their usual care. Patients were eligible for the telemonitoring program if they were in an advanced disease stage (New York Heart Association (NYHA) functional class 3 or 4; COPD gold stage 3 or 4), received treatment for their condition by a cardiologist or pulmonary specialist at the Slingeland Hospital, were proficient in Dutch and capable of providing informed consent. Exclusion criteria were absence of the cognitive, physical or logistical ability required to fully participate in the program. Hundred seventy-seven patients with heart failure and 83 patients with COPD enrolled the program between 2012 and 2016. Intervention Using a touchscreen, participants with heart failure recorded their weight (daily), blood pressure and heart rate (once a week) through connected instruments, and completed a questionnaire about their symptoms (once a week). Symptoms in patients with COPD were monitored via the Clinical COPD Questionnaire (CCQ), which participants were asked to complete twice per week. All home registrations were sent via a telemonitoring application (cVitals, FocusCura, Driebergen-Rijssenburg) on the iPad to a medical service center were a trained nurse monitored the data and contacted the patient by video chat or a specialised nurse in the hospital in case of abnormal results, such as deviations from a preset threshold or alterations in symptom score. Outcome measures The primary outcome was the number of hospitalisations; the secondary outcomes were total number of hospitalisation days and healthcare costs during the follow-up period. Generalised Estimating Equations were applied to account for repeated measurements, adjusting for sex, age and length of follow-up. Results In heart failure patients (N=177), after initiation of home telemonitoring both the number of hospitalisations and the total number of hospitalisation days significantly decreased (incidence rate ratio of 0.35 (95% CI: 0.26-0.48) and 0.35 (95% CI: 0.24-0.51), respectively), as did the total healthcare costs (exp(B) = 0.11 (95% CI: 0.08-0.17)), all p < 0.001. In COPD patients (N=83) neither the number of hospitalisations nor the number of hospitalisation days changed compared to the pre-intervention period. However, the average healthcare costs were about 54% lower in COPD patients after the start of the home telemonitoring intervention (exp(B) = 0.46, 95% CI 0.25-0.84, p = 0.011). Conclusion Integrated telemonitoring significantly reduced the number of hospital admissions and days spent in hospital in patients with heart failure, but not in patients with COPD. Importantly, in both patients with heart failure and COPD the intervention substantially reduced the total healthcare costs.

scholarly journals Predictors of hospitalizations for heart failure decompensation in patients with comorbid occupational chronic obstructive pulmonary disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L.A Shpagina ◽  
O.S Kotova ◽  
I.S Shpagin ◽  
G.V Kuznetsova ◽  
N.V Kamneva ◽  
...  
Keyword(s):  
Heart Failure ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Chronic Obstructive ◽  
Length Of Service ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Patients With Heart Failure ◽  
Occupational Copd ◽  
Heart Failure Decompensation

Abstract Background Heart failure decompensation requiring hospitalization is an important event, associated with mortality and investigating its predictors is topical problem. Chronic obstructive pulmonary disease (COPD) is a common comorbidity for heart failure. Both conditions share common molecular mechanisms such as systemic inflammation. COPD is heterogeneous and subpopulations with different inflammation patterns may interact with heart failure in different manner. Airway inflammation in occupational COPD may differs from COPD in tobacco smokers. Additionally cardiotoxicity of industrial chemicals influence heart failure features. Despite this biological plausibility, heart failure and occupational COPD comorbidity is not studied enough. Purpose To reveal predictors of hospitalizations for heart failure decompensation in patients with heart failure and occupational COPD comorbidity. Methods Occupational COPD patients (n=115) were investigated in a prospective cohort observational study. Comparison group – 115 tobacco smokers with COPD. Control group – 115 healthy persons. Controls were selected by propensity score matching, covariates were COPD duration, age and gender. Then COPD groups were stratified according to heart failure. Working conditions, echocardiography, spirometry, pulsoxymetry, 6-mitute walking test were done. Molecular markers of tissue damage – chemokine ligand 18 (CCL 18), lactate dehydrogenase, cardiac troponin T, N-terminal pro-B-type natriuretic peptide (NT pro-BNP), protein S100 beta, von Willebrand factor were measured in serum by ELISA. Follow up after initial assessment was 12 month. Predictors were determined by Cox proportional hazards regression with ROC analysis. Results Heart failure rate in occupational COPD patients were higher – 54.8% versus 36.5% in tobacco smokers with COPD, p&lt;0.05. Heart failure with preserved ejection fraction was predominant – 40.9%. Prevalence of biventricular heart failure was 38.3%, isolated right heart failure – 13%, left heart failure – 2.6%. Cumulative hospitalization rate in occupational COPD with heart failure group was higher than in comparison group, 17.5% and 9.5% respectively, p=0.01. In Cox proportional hazards regression model predictors of hospitalizations for heart failure decompensation during 12 months in this group were length of service (HR 1.22, 95% CI: 1.03–2.5), aromatic hydrocarbons concentration at workplaces air (HR 1.4, 95% CI: 1.15–1.96), serum protein S100 beta (HR 1.10, 95% CI: 1.02–1.87), SaO2 (HR 1.2, 95% CI: 1.06–2.13). Area under the ROC curve was 0.82. Conclusion Length of service, aromatic hydrocarbons concentration at workplaces air, serum protein S100 beta, SaO2 are considered to be independent risk factors of heart failure decompensation required hospitalization in patients with heart failure and occupational COPD comorbidity. Funding Acknowledgement Type of funding source: None

scholarly journals Hospitalisation at the end of life among cancer and non-cancer patients in Denmark: a nationwide register-based cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e033493
Author(s):  
Anne Høy Seemann Vestergaard ◽  
Mette Asbjoern Neergaard ◽  
Christian Fynbo Christiansen ◽  
Henrik Nielsen ◽  
Thomas Lyngaa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
End Of Life ◽  
Cancer Patients ◽  
Hospital Admissions ◽  
Place Of Death ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Partner Status ◽  
Patients With Heart Failure

ObjectivesEnd-of-life hospitalisations may not be associated with improved quality of life. Studies indicate differences in end-of-life care for cancer and non-cancer patients; however, data on hospital utilisation are sparse. This study aimed to compare end-of-life hospitalisation and place of death among patients dying from cancer, heart failure or chronic obstructive pulmonary disease (COPD).DesignA nationwide register-based cohort study.SettingData on all in-hospital admissions obtained from nationwide Danish medical registries.ParticipantsAll decedents dying from cancer, heart failure or COPD disease in Denmark between 2006 and 2015.Outcome measuresData on all in-hospital admissions within 6 months and 30 days before death as well as place of death. Comparisons were made according to cause of death while adjusting for age, sex, comorbidity, partner status and residential region.ResultsAmong 154 235 decedents, the median total bed days in hospital within 6 months before death was 19 days for cancer patients, 10 days for patients with heart failure and 11 days for patients with COPD. Within 30 days before death, this was 9 days for cancer patients, and 6 days for patients with heart failure and COPD. Compared with cancer patients, the adjusted relative bed day use was 0.65 (95% CI, 0.63 to 0.68) for heart failure patients and 0.68 (95% CI, 0.66 to 0.69) for patients with COPD within 6 months before death. Correspondingly, this was 0.65 (95% CI, 0.63 to 0.68) and 0.70 (95% CI, 0.68 to 0.71) within 30 days before death.Patients had almost the same risk of dying in hospital independently of death cause (46.2% to 56.0%).ConclusionPatients with cancer, heart failure and COPD all spent considerable part of their end of life in hospital. Hospital use was highest among cancer patients; however, absolute differences were small.

scholarly journals Differences in the Outcome of Patients with COPD according to Body Mass Index

2020 ◽  
Vol 9 (3) ◽  
pp. 710 ◽  
Author(s):  
Zichen Ji ◽  
Javier de Miguel-Díez ◽  
Christian Reynaldo Castro-Riera ◽  
José María Bellón-Cano ◽  
Virginia Gallo-González ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Hospital Admissions ◽  
Obesity Paradox ◽  
Chronic Obstructive ◽  
P Value ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Critical Unit

Background: In chronic obstructive pulmonary disease (COPD), the “obesity paradox” is a phenomenon without a clear cause. The objective is to analyze the complications of COPD patients according to their body mass index (BMI). Methods: An observational study with a six-year prospective follow-up of 273 COPD patients who attended a spirometry test in 2011. Survival and acute events were analyzed according to the BMI quartiles. Results: A total of 273 patients were included. BMI quartiles were ≤24.23; 24.24–27.69; 27.70–31.25; ≥31.26. During the follow-up, 93 patients died. No differences were found in exacerbations, pneumonia, emergency visits, hospital admissions or income in a critical unit. Survival was lower in the quartile 1 of BMI with respect to each of the 2–4 quartiles (p-value 0.019, 0.013, and 0.004, respectively). Advanced age (hazard ratio, HR 1.06; 95% confidence interval, CI 1.03–1.09), low pulmonary function (HR 0.93; 95% CI 0.86–0.99), exacerbator with chronic bronchitis phenotype (HR 1.76; 95% CI 1.01–3.06), high Charlson (HR 1.32, 95% CI 1.18–1.49), and the quartile 1 of BMI (HR 1.99, 95% CI 1.08–3.69) were identified as risk factors independently associated with mortality. Conclusions: In COPD, low BMI conditions a lower survival, although not for having more acute events.

Acute Diuretic-Sparing Effects of Sacubitril-Valsartan: Staying in the Loop

2021 ◽  
pp. 089719002110106
Author(s):  
Nicholas J. Orvin ◽  
Janna C. Beavers ◽  
Stuart D. Russell
Keyword(s):  
Heart Failure ◽  
Loop Diuretic ◽  
Hospital Admissions ◽  
Total Daily Dose ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Ed Visits ◽  
Sparing Effect ◽  
Median Change

Background: Previous literature has suggested a potential diuretic sparing effect as early as 6 months following sacubitril-valsartan initiation in patients with heart failure with reduced ejection fraction (HFrEF); however, whether this effect manifests earlier after initiation is unclear. Objective: To evaluate the acute diuretic-sparing effects of sacubitril-valsartan. Methods: This was a single-center, retrospective analysis of outpatients with HFrEF initiated on sacubitril-valsartan with follow up within 90 ± 30 days and a concomitant loop diuretic prescription. The primary outcome was the percent of patients with an increase, decrease or no change in loop diuretic total daily dose (TDD). Key secondary outcomes included change in loop diuretic TDD (mg furosemide equivalents) and hospital admissions or emergency department (ED) visits. Results: A total of 145 patients were included (overall cohort) with 120 continuing sacubitril-valsartan at follow up (on-treatment cohort). In the on-treatment cohort, 20% (n = 24) had a reduction in loop diuretic TDD and 10% had an increase (n = 12). Median change in loop diuretic TDD was unchanged from baseline to follow up (p 0.13). In patients on >80 mg TDD of furosemide at baseline (n = 9), mean change was-53 ± 44 mg (p 0.006). Hospitalizations (6.2%) and ED visits (0.7%) for heart failure were infrequent. Conclusion: Patients may require a loop diuretic dose reduction within 2-3 months following sacubitril-valsartan initiation. This diuretic-sparing effect appears larger in those on higher baseline loop diuretic doses, and closer follow up may be warranted for these patients.

scholarly journals Recognition of cognitive impairment and depressive symptoms in older patients with heart failure

2020 ◽  
Author(s):  
F. M. M. Oud ◽  
P. E. Spies ◽  
R. L. Braam ◽  
B. C. van Munster
Keyword(s):  
Heart Failure ◽  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Outpatient Clinic ◽  
Hospital Admissions ◽  
Depression Scale ◽  
Cognitive Status ◽  
Optimal Care ◽  
Patients With Heart Failure

Abstract Introduction Cognitive impairment and depression in patients with heart failure (HF) are common comorbidities and are associated with increased morbidity, readmissions and mortality. Timely recognition of cognitive impairment and depression is important for providing optimal care. The aim of our study was to determine if these disorders were recognised by clinicians and, secondly, if they were associated with hospital admissions and mortality within 6 months’ follow-up. Methods Patients (aged ≥65 years) diagnosed with HF were included from the cardiology outpatient clinic of Gelre Hospitals. Cognitive status was evaluated with the Montreal Cognitive Assessment test (score ≤22). Depressive symptoms were assessed with the Geriatric Depression Scale (score >5). Patient characteristics were collected from electronic patient files. The clinician was blinded to the tests and asked to assess cognitive status and mood. Results We included 157 patients. Their median age was 79 years (65–92); 98 (62%) were male. The majority had New York Heart Association functional class II. Cognitive impairment was present in 56 (36%) patients. Depressive symptoms were present in 21 (13%) patients. In 27 of 56 patients (48%) cognitive impairment was not recognised by clinicians. Depressive symptoms were not recognised in 11 of 21 patients (52%). During 6 months’ follow-up 24 (15%) patients were readmitted for HF-related reasons and 18 (11%) patients died. There was no difference in readmission and mortality rate between patients with or without cognitive impairment and patients with or without depressive symptoms. Conclusion Cognitive impairment and depressive symptoms were infrequently recognised during outpatient clinic visits.

Abstract 250: Real-world Rates and Costs of Heart Failure Events Among Patients with Hyperlipidemia

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Kathleen M Fox ◽  
Rajeshwari S Punekar ◽  
Akshara Richhariya ◽  
Maxine D Fisher ◽  
Shravanthi R Gandra ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Real World ◽  
Healthcare Costs ◽  
Index Event ◽  
Patients With Heart Failure ◽  
History Of

Background: This real-world retrospective cohort study estimated the rate of heart failure events and total healthcare costs among patients with hyperlipidemia. Methods: Patients (aged 18-64 years) with hyperlipidemia diagnosis and/or lipid-lowering medications were identified from the HealthCore Integrated Research Database SM from 1/1/2007 to 12/31/2008 and followed until 2/28/2013. Patients were stratified by cardiovascular (CV) risk level as (1) secondary prevention with a history of myocardial infarction, stroke, unstable angina, or revascularization, (2) modified coronary heart disease (CHD) risk equivalent (RE) without a history of CV events but with peripheral artery disease, type 2 diabetes, abdominal aortic aneurysm, ischemic heart disease, stable angina, or TIA, and (3) primary prevention without a history of CV events or CHD RE. Patients with new CV event hospitalization during follow-up were propensity score-matched to patients without new CV events within each cohort. Proportion of patients with heart failure events and incremental total costs during 2 years of follow-up were evaluated. Results: Before matching, 62,427 patients had ≥1 CV event (13.2% secondary prevention, 38.4% CHD RE, 48.5% primary prevention). For patients with ≥1 CV event during follow-up, 38.8% of secondary prevention, 42.6% of CHD RE, and 30.0% of primary prevention had heart failure as their index event. Of patients with heart failure index event, 58.3% of secondary prevention, 47.3% of CHD RE, and 30.5% of primary prevention patients had 1 or more heart failure events over 2 years. Among patients with ≥1 heart failure events, 36.2% of secondary prevention, 30.0% of CHD RE, and 17.7% of primary prevention patients had ≥3 heart failure events over 2 years. Among matched patients (85-87% of patients), incremental total cost over 2 years for patients with heart failure as their index event compared with patients without CV events was $56,078 for secondary prevention, $53,247 for CV RE, and $49,637 for primary prevention cohorts. Conclusions: The rate and recurrence of heart failure among hyperlipidemic patients is very high and the long term healthcare costs substantial in this real-world 2-year study.

scholarly journals Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Antonio Leon-Justel ◽  
Jose I. Morgado Garcia-Polavieja ◽  
Ana Isabel Alvarez-Rios ◽  
Francisco Jose Caro Fernandez ◽  
Pedro Agustin Pajaro Merino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Admissions ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Secondary Outcome ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients ◽  
Ed Visits ◽  
The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

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