Power to the Patients: A Heart Failure Transitions of Care Program in a Heart Resource Center

Heart failure (HF) is a common presentation in patients with type 2 diabetes mellitus (T2DM). Previous studies revealed that the HbA1c level is significantly associated with HF. However, little is known about the association between HbA1c variability and HF. We aimed to evaluate the association of mean and variability of HbA1c with HF in patients with T2DM. Using Diabetes Share Care Program data, patients with T2DM who had mean HbA1c (HbA1c-Mean), and HbA1c variability (tertiles of HbA1c-SD and HbA1c-adjSD) within 12–24 months during 2001–2008 were included. The cutoffs of HbA1c-Mean were set at <7%, 7–7.9%, and ≥8%. Hazard ratios (HRs) for HF during 2008–2018 were estimated using Cox proportional hazard models. A total of 3824 patients were included, of whom 315 patients developed HF during the observation period of 11.72 years. The associated risk of HF increased with tertiles of HbA1c variability and cutoffs of HbA1c-Mean. In mutually adjusted models, HbA1c-Mean showed a consistent dose-response association with HF, while the association of HbA1c variability with HF disappeared. Among patients with HbA1c-Mean <7%, the associated risk of HF in patients with HbA1c variability in tertile 3 was comparable to patients with HbA1c-Mean ≥8%. In conclusion, mean HbA1c was an independent predictor of HF and not explained by HbA1c variability. In addition to absolute HbA1c level, targeting on stability of HbA1c in patients with good glycemic control was also important for the development of HF in patients with T2DM.

Download Full-text

Heart Failure Transitions of Care: A Pharmacist-Led Post-Discharge Pilot Experience

Progress in Cardiovascular Diseases ◽

10.1016/j.pcad.2017.08.005 ◽

2017 ◽

Vol 60 (2) ◽

pp. 249-258 ◽

Cited By ~ 15

Author(s):

Sherry K. Milfred-LaForest ◽

Julie A. Gee ◽

Adam M. Pugacz ◽

Ileana L. Piña ◽

Danielle M. Hoover ◽

...

Keyword(s):

Heart Failure ◽

Transitions Of Care ◽

Post Discharge ◽

Pilot Experience

Download Full-text

The Effects of Telemonitoring on Patient Compliance With Self-Management Recommendations and Outcomes of the Innovative Telemonitoring Enhanced Care Program for Chronic Heart Failure: Randomized Controlled Trial (Preprint)

10.2196/preprints.17559 ◽

2019 ◽

Author(s):

Hang Ding ◽

Rajiv Jayasena ◽

Sheau Huey Chen ◽

Andrew Maiorana ◽

Alison Dowling ◽

...

Keyword(s):

Heart Failure ◽

Randomized Controlled Trial ◽

Chronic Heart Failure ◽

Patient Compliance ◽

Controlled Trial ◽

Care Program ◽

Self Management ◽

Control Group ◽

Randomized Controlled ◽

Management Recommendations

BACKGROUND Telemonitoring enables care providers to remotely support outpatients in self-managing chronic heart failure (CHF), but the objective assessment of patient compliance with self-management recommendations has seldom been studied. OBJECTIVE This study aimed to evaluate patient compliance with self-management recommendations of an innovative telemonitoring enhanced care program for CHF (ITEC-CHF). METHODS We conducted a multicenter randomized controlled trial with a 6-month follow-up. The ITEC-CHF program comprised the provision of Bluetooth-enabled scales linked to a call center and nurse care services to assist participants with weight monitoring compliance. Compliance was defined a priori as weighing at least 4 days per week, analyzed objectively from weight recordings on the scales. The intention-to-treat principle was used to perform the analysis. RESULTS A total of 184 participants (141/184, 76.6% male), with a mean age of 70.1 (SD 12.3) years, were randomized to receive either ITEC-CHF (n=91) or usual care (control; n=93), of which 67 ITEC-CHF and 81 control participants completed the intervention. For the compliance criterion of weighing at least 4 days per week, the proportion of compliant participants in the ITEC-CHF group was not significantly higher than that in the control group (ITEC-CHF: 67/91, 74% vs control: 56/91, 60%; <i>P</i>=.06). However, the proportion of ITEC-CHF participants achieving the stricter compliance standard of at least 6 days a week was significantly higher than that in the control group (ITEC-CHF: 41/91, 45% vs control: 23/93, 25%; <i>P</i>=.005). CONCLUSIONS ITEC-CHF improved participant compliance with weight monitoring, although the withdrawal rate was high. Telemonitoring is a promising method for supporting both patients and clinicians in the management of CHF. However, further refinements are required to optimize this model of care. CLINICALTRIAL Australian New Zealand Clinical Trial Registry ACTRN12614000916640; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366691

Download Full-text

Identify Early and Involve Everyone: Interdisciplinary Comprehensive Care Pathway Developed for Inpatient Management and Transitions of Care for Heart Failure Patients Reported Using SQUIRE 2.0 Guidelines

Cureus ◽

10.7759/cureus.21123 ◽

2022 ◽

Author(s):

Rishi Thaker ◽

Kevin Pink ◽

Sita Garapati ◽

Donna Zarandi ◽

Purvi Shah ◽

...

Keyword(s):

Heart Failure ◽

Care Pathway ◽

Transitions Of Care ◽

Comprehensive Care ◽

Heart Failure Patients ◽

Inpatient Management

Download Full-text

Cost-effectiveness of a transitional home-based palliative care program for patients with end-stage heart failure

Palliative Medicine ◽

10.1177/0269216317706450 ◽

2017 ◽

Vol 32 (2) ◽

pp. 476-484 ◽

Cited By ~ 14

Author(s):

Frances Kam Yuet Wong ◽

Ching So ◽

Alina Yee Man Ng ◽

Po-Tin Lam ◽

Jeffrey Sheung Ching Ng ◽

...

Keyword(s):

Heart Failure ◽

Palliative Care ◽

Cost Effectiveness ◽

Care Program ◽

Palliative Care Program ◽

Home Based ◽

End Stage Heart Failure ◽

End Stage ◽

Transitional Home

Download Full-text

Improving the Safety and Continuity Of Medicines management at Transitions of care (ISCOMAT): protocol for a process evaluation of a cluster randomised control trial

BMJ Open ◽

10.1136/bmjopen-2020-040493 ◽

2020 ◽

Vol 10 (11) ◽

pp. e040493

Author(s):

Catherine Powell ◽

Liz Breen ◽

Beth Fylan ◽

Hanif Ismail ◽

Sarah L Alderson ◽

...

Keyword(s):

Heart Failure ◽

Process Evaluation ◽

Controlled Trial ◽

Transitions Of Care ◽

Randomised Control Trial ◽

Behavioural Intervention ◽

Medicines Management ◽

Care Programme ◽

Cluster Randomised ◽

The Uk

IntroductionA key priority for the UK National Health Service and patients is to ensure that medicines are used safely and effectively. However, medication changes are not always optimally communicated and implemented when patients transfer from hospital into community settings. Heart failure is a common reason for admission to hospital. Patients with heart failure have a high burden of morbidity, mortality and complex pharmacotherapeutic regimens. The Improving the Safety and Continuity Of Medicines management at Transitions of care programme comprises a cluster randomised controlled trial which will test the effectiveness of a complex behavioural intervention aimed at improving medications management at the interface between hospitals discharge and community care. We will conduct a rigorous process evaluation to inform interpretation of the trial findings, inform implementation of the intervention on a wider scale and aid dissemination of the intervention.Methods and analysisThe process evaluation will be conducted in six purposively selected intervention sites (ie, hospital trusts and associated community pharmacies) using a mixed-methods design. Fidelity and barriers/enablers of implementation of the Medicines at Transitions Intervention (MaTI) will be explored using observation, interviews (20 patients, 40 healthcare professionals), surveys and routine trial data collection on adherence to MaTI. A parallel mixed analysis will be applied. Qualitative data will be thematically analysed using Framework analysis and survey data will be analysed descriptively. Data will be synthesised, triangulated and mapped to the Consolidated Framework for Implementation Research where appropriate. The process evaluation commenced on June 2018 and is due to end on February 2021.Ethics and disseminationApproved by Research Ethics Committee and the UK Health Research Authority REC: 18/YH/0017/IRAS: 231 431. Findings will be disseminated via academic and policy conferences, peer-reviewed publications and social media.Trial registration numberISRCTN66212970.

Download Full-text

Heart Failure is Highly Prevalent and Difficult to Diagnose in Severe Exacerbations of COPD Presenting to the Emergency Department

Journal of Clinical Medicine ◽

10.3390/jcm9082644 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2644

Author(s):

Mariaenrica Tinè ◽

Erica Bazzan ◽

Umberto Semenzato ◽

Davide Biondini ◽

Elisabetta Cocconcelli ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Retrospective Chart Review ◽

Care Program ◽

Final Diagnosis ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Factors Affecting ◽

Risk Of Death ◽

Copd Patients

Background: Some 20% of patients with stable Chronic Obstructive Pulmonary Disease (COPD) might have heart failure (HF). HF contribution to acute exacerbations of COPD (AECOPD) presenting to the emergency department (ED) is not well established. Aims: To assess (1) the HF incidence in patients presenting to the ED with AECOPD; (2) the concordance between ED and respiratory ward (RW) diagnosis; (3) the factors associated with risk of death after hospital discharge. Methods: Retrospective chart review of 119 COPD patients presenting to ED for acute exacerbation of respiratory symptoms and then admitted to RW where a final diagnosis of AECOPD, AECOPD and HF and AECOPD and OD (other diagnosis), was obtained. ED and RW diagnosis were then compared. Factors affecting survival at follow-up were investigated. Results: At RW, 40.3% of cases were diagnosed of AECOPD, 40.3% of AECOPD and HF and 19.4% of AECOPD and OD, with ED diagnosis coinciding with RW’s in 67%, 23%, and 57% of cases respectively. At RW, 60% of patients in GOLD1 had HF, of which 43% were diagnosed at ED, while 40% in GOLD4 had HF that was never diagnosed at ED. Lack of inclusion in a COPD care program, HF, and early readmission for AECOPD were associated with mortality. Conclusions: HF is highly prevalent and difficult to diagnose in patients in all GOLD stages presenting to the ED with severe AECOPD, and along with lack of inclusion in a COPD care program, confers a high risk for mortality.

Download Full-text