scholarly journals Diagnosis and Management of Heart Failure in Elderly Patients from Hospital Admission to Discharge: Position Paper

2021 ◽  
Vol 10 (16) ◽  
pp. 3519
Author(s):  
Thibaud Damy ◽  
Tahar Chouihed ◽  
Nicholas Delarche ◽  
Gilles Berrut ◽  
Patrice Cacoub ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care Professionals ◽  
Transitional Care ◽  
Hospital Setting ◽  
The Elderly ◽  
Geriatric Syndrome ◽  
Post Discharge ◽  
Atypical Symptoms ◽  
Patient Pathway ◽  
Adequate Care

Multidisciplinary management of worsening heart failure (HF) in the elderly improves survival. To ensure patients have access to adequate care, the current HF and French health authority guidelines advise establishing a clearly defined HF patient pathway. This pathway involves coordinating multiple disciplines to manage decompensating HF. Yet, recent registry data indicate that insufficient numbers of patients receive specialised cardiology care, which increases the risk of rehospitalisation and mortality. The patient pathway in France involves three key stages: presentation with decompensated HF, stabilisation within a hospital setting and transitional care back out into the community. In each of these three phases, HF diagnosis, severity and precipitating factors need to be promptly identified and managed. This is particularly pertinent in older, frail patients who may present with atypical symptoms or coexisting comorbidities and for whom geriatric evaluation may be needed or specific geriatric syndrome management implemented. In the transition phase, multi-professional post-discharge management must be coordinated with community health care professionals. When the patient is discharged, HF medication must be optimised, and patients educated about self-care and monitoring symptoms. This review provides practical guidance to clinicians managing worsening HF in the elderly.

OP39 Evaluation Of Discharge Planning And Transitional Care For The Elderly

2018 ◽  
Vol 34 (S1) ◽  
pp. 15-15
Author(s):  
Maggy Wassef ◽  
Marc-Olivier Trepanier ◽  
Sylvie Beauchamp
Keyword(s):  
Readmission Rate ◽  
Transitional Care ◽  
Discharge Planning ◽  
Grey Literature ◽  
The Elderly ◽  
Narrative Synthesis ◽  
Local Data ◽  
Post Discharge ◽  
Level Of Evidence

Introduction:According to our local data, elderly patients accounted for 14 percent of the population yet, represent 58 percent of hospitalization and, they are more likely to return after discharge. These patients are more likely to return to the hospital following discharge. In order to meet ministerial target for length of stay of patient on a stretcher, the UETMIS-SS was requested to evaluate interventions aiming to improve the fluidity of patient trajectories in the acute care services. The objective of this health technology assessment is to evaluate the effectiveness of discharge planning and transitional care interventions aiming at reducing the readmission rate of the elderly.Methods:An umbrella review was conducted following the PRISMA statement to summarize the scientific evidence. The search was conducted in five databases along with the grey literature search. Two reviewers independently performed the study selection, the quality assessment and the data extraction. To better illustrate the activities and the healthcare professionals (HCP) involved in the interventions, an analytical framework was developed. Results were summarized in a narrative synthesis. The contextual and experiential data were collected through interviews with HCP and directorates from different settings. The level of evidence was and a committee was then held to elaborate the recommendations.Results:In the nine systematic reviews included in the narrative synthesis, three models were identified: Post-discharge planning and follow-up by the same HCP was established to be effective in reducing the readmission rate. Discharge planning interventions with follow-up by non-specific HCP have been shown to be promising, while discharge planning without follow-up after the hospital discharge has shown to be ineffective in reducing the readmission rate.Conclusions:An individualized discharge plan, coordination of services and follow-up performed by the same HCP is established to be effective in reducing readmission rate.

scholarly journals Designing an eHealth Coaching Solution to Improve Transitional Care of Seniors’ with Heart Failure: End-User Needs

2021 ◽  
Author(s):  
Jessica Rochat ◽  
Alexandra Villaverde ◽  
Helge Klitzing ◽  
Tore Langemyr Larsen ◽  
Martin Vogel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Transitional Care ◽  
Psychosocial Support ◽  
Informal Caregivers ◽  
Information Access ◽  
User Needs ◽  
End User ◽  
Post Discharge ◽  
Transfer Of Information

Based on scientific studies, heart failure is the principal cause of hospitalization among seniors. More than 50% of elderly with heart failure are readmitted to hospital within six months. Readmission is linked with poor compliance with medical treatment and recommendations, emphasizing the need for a tool to help seniors better comply with post-discharge measures. The goal of this study was to identify end-user needs for the development of a coaching solution aiming to support elderly patients but also formal and informal caregivers. End-user needs were identified through interviews with the three end-user profiles: seniors with heart failure and formal and informal caregivers. The results present six categories of needs: daily treatment follow-up; healthcare network communication; transfer of information; synchronization with current digital tools; information access; and psychosocial support. The identified needs will help to develop an eHealth solution to improve care management and coaching after discharge.

Abstract 305: Characteristics of Heart Failure Patients Referred to the Bridge Transitional Care Clinic By Time to Readmission

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
George Cholack ◽  
Joshua Garfein ◽  
Rachel H Krallman ◽  
Delaney Feldeisen ◽  
Kim Eagle ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Characteristics ◽  
Transitional Care ◽  
Discharge Planning ◽  
Nyha Class ◽  
Index Admission ◽  
Post Discharge ◽  
Care Clinic ◽  
Early Readmission

Background: Readmission reduction initiatives emphasize prompt follow-up post-discharge. Identifying factors that influence early readmission may inform discharge planning. We compared characteristics of heart failure (HF) patients (pts) based on time to readmission to determine which pt characteristics were associated with early readmission. Methods: Pts referred to the BRIDGE clinic following index admission for HF from 2008-2017 were eligible. Demographics and inpatient clinical characteristics were compared between 1) pts who were and were not readmitted within 30 days post-index discharge, and 2) pts who were readmitted early (0-7 days post-discharge) versus late (8-30 days post-discharge). Results: Of 978 HF pts, 226 (23.1%) were readmitted within 30 days. Compared to those not readmitted, 30-day readmits were more likely to be male, white, and have higher NYHA class, longer index stay, ICU admission during index admission, and lower Hgb, higher Cr, and higher BUN during index admission. Among those with a 30 day readmit, 56 (24.8%) were readmitted within 7 days of discharge. Early readmits were more often female (p=0.07) and had index stays in the ICU (p=0.07). Conclusion: Pts readmitted within 30 days had more complicated hospital courses than those not readmitted, and those readmitted early had higher incidences of females and index stays in the ICU. Efforts to define a high risk subset of HF pts likely to be readmitted early and targeting them for enhanced discharge planning is warranted.

scholarly journals Heart failure in the elderly: A geriatric syndrome. Picture of the modern situation

2019 ◽  
Vol 89 (1) ◽  
Author(s):  
Valentina Fagotto ◽  
Alessandro Cavarape ◽  
Alessandro Boccanelli
Keyword(s):  
Heart Failure ◽  
Older Patients ◽  
Clinical Presentation ◽  
The Elderly ◽  
Geriatric Syndrome ◽  
Diagnostic Work ◽  
Patient’S History ◽  
Work Up ◽  
Diagnostic Work Up

Among the older patients’ cohort, the aetiology of heart failure is peculiar and differs in many ways from the younger one, both in its epidemiology, diagnostic work-up and clinical presentation. Focusing on this population, we could assume that heart failure is a real geriatric syndrome, characterized by several features, which coexist with other comorbidities and require specific and targeted cares. It is therefore necessary to examine the global burden of heart failure and the patient’s history rather than the causal cardiomyopathy - frequently more than one in the elderly - facing with the condition, bearing in mind the quality of life even before its duration.

scholarly journals Heart failure with preserved ejection fraction in elderly. From pathophysiology to treatment: an unresolved problem

2019 ◽  
Vol 89 (2) ◽  
Author(s):  
Matteo Beltrami ◽  
Carlo Fumagalli
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Beta Blockers ◽  
The Elderly ◽  
Clinical Syndrome ◽  
Geriatric Syndrome ◽  
Preserved Ejection Fraction ◽  
Modern Approach ◽  
Reducing Costs ◽  
Net Clinical Benefit

Heart failure with preserved ejection fraction (HFpEF) has a significant impact on healthcare resources and while its occurrence in the elderly is increasing, its prognosis has not improved. Despite the prevalence of HFpEF, the understanding of its pathophysiology is still incomplete, and optimal treatment remains largely undefined. The net clinical benefit of medical treatment with ACE inhibitors, ARBs, MRAs and beta-blockers has led to the incorporation of these drugs into HF clinical practice guidelines. However, little or no progress has been done for patients with HFpEF and there are no convincing and validated therapies able to reduce mortality or morbidity. HFpEF is a heterogeneous clinical syndrome embracing varieties of phenotypes and could benefit from a phenotype-specific approach. In the era of precision medicine, targeted approaches have proved effective in various disciplinary medical settings and for this reason this modern approach should be encouraged also in cardiology. In elderly patients, multi-level strategies and interventions aimed at improving adherence to guidelines and tailoring therapy, could be the key to improving outcome, and to reducing costs related to HF-related re-admissions. In the present review we briefly discuss current information available regarding pathophysiology, outcome, treatment and safety of the most common drugs used in this “geriatric syndrome”.

scholarly journals EP.FRI.1067 Exploring the Patient Journey and Social Care following Emergency Laparotomy in the Elderly: A Systematic Review of Qualitative Studies

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Anthony Chan ◽  
Paul Goldsmith ◽  
Andrew Watson ◽  
Panos Stathakis ◽  
Stella Smith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Lived Experience ◽  
Hospital Setting ◽  
The Elderly ◽  
Easy Access ◽  
Emergency Laparotomy ◽  
High Morbidity ◽  
Post Discharge ◽  
Patient Journey ◽  
Factors Affecting

Abstract Aims Frailty is associated with high morbidity following emergency laparotomy. Objective scores such as P-POSSUM are well recognised in predicting outcomes such as morbidity and mortality. Qualitative factors affecting recovery and rehabilitation are less established. This review explores the lived experiences of elderly patients following emergency laparotomy to identify factors to improve post-hospital care.   Methods A systematic review of the medical and nursing literature was performed using MEDLINE, Web of Science Core Collection and CINAHL Plus in January 2020. Qualitative and phenomenological studies were identified using keywords ‘emergency’, ‘laparotomy’, ‘abdo*’ and ‘surgery’. Cancer studies were excluded. Themes were extracted for ‘lines of argument’ synthesis to build a general interpretation of findings. The review is registered with PROSPERO (CRD42019159751).  Results The search identified 569 unique citations of which 551 were excluded after screening and 17 excluded following full-text review. One study was included (Thomsen et al, 2014) exploring postoperative care for 18 patients following emergency abdominal surgery. Thematic analysis was limited to the hospital setting. Patients described Critical Care as a safe environment for recovery and rehabilitation because of higher nursing ratios. Patients placed emphasis on ready access to staff and timely interventions which was particularly poor on surgical wards. Specific barriers, particularly patient concerns regarding recovery, were not explored. Conclusions This review highlights the importance of easy access to staff and inpatient services following emergency laparotomy but demonstrates the lack of qualitative evidence exploring the lived experience of the immediate post-discharge period that impacts on rehabilitation back to normal activities.

scholarly journals Treatment and management of advanced heart failure in elderly

2019 ◽  
Vol 89 (1) ◽  
Author(s):  
Nidal Tourkmani
Keyword(s):  
Heart Failure ◽  
Elderly Patients ◽  
Health Care Professionals ◽  
The Elderly ◽  
Advanced Heart Failure ◽  
Circulatory Support ◽  
High Morbidity ◽  
Open Communication ◽  
Limiting Condition ◽  
End Stage

Heart failure (HF) is a life-limiting condition, associated with high morbidity. End-stage, known as advanced heart failure (AHF), is more common among the elderly. HF patients’ disease trajectory is more variable and unpredictable than the trajectory for most oncologic illnesses. Despite a growing armamentarium of resources the management of AHF patients can be complex. Advances in medical therapy have dramatically improved the quality of life and survival of patients with end-stage HF. The majority of studies reveal lack of knowledge of HF among elderly patients. Mechanical circulatory support can provide bridge-to-transplantation therapy in eligible patients or destination therapy in those ineligible for heart transplantation like the majority of elderly patients with HF. The palliative care stage, considered as treatment basically aimed at controlling symptoms, may last a long time in some patients and should not simply be regarded as the final phase. Studies show that patients with AHF may have a poor understanding of their condition and its outcome and, therefore, guidelines recommend health care professionals to have an open communication with patients and their families about the AHF trajectory, including discussing their preferences for future care, acknowleding the risk of a sudden death, and the possibility of deactivation of devices (i.e. implantable defibrillators) in the end-of-life. This contribution is an attempt to have a brief overview of strategies for the management of HF terminal stage in elderly.

Abstract 16135: Hyponatremia is Related to Higher 30-Day Rehospitalization and 1-Year Mortality Rates in Patients Admitted With an Acute Coronary Syndrome: TRACE-CORE

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Brendan C Merchant ◽  
David D McManus ◽  
Darleen Lessard ◽  
Joel M Gore ◽  
Robert J Goldberg ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Serum Sodium ◽  
Odds Ratio ◽  
Transitional Care ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Discharge Outcomes ◽  
Early Readmission

Introduction: Although hospital survival rates are improving among patients admitted with an acute coronary syndrome (ACS), early readmission is common and 1-year survival remains less than optimal. Improved risk stratification during an index ACS admission could direct greater surveillance or transitional care interventions for vulnerable patient populations prior to discharge from the hospital. While hyponatremia is associated with adverse outcomes after acute decompensated heart failure, less is known about whether hyponatremia relates to key post-discharge outcomes in patients discharged from the hospital after an ACS. Hypothesis: Hyponatremia is associated with early readmission and 1-year mortality in hospital survivors of an ACS. Methods: Using data from TRACE-CORE (Transitions, Risks, and Actions in Coronary Events - Center for Outcomes Research and Education), a diverse cohort of 2,081 patients discharged after an ACS, we examined the associations of admission hyponatremia (serum sodium ≤ 134 mmol/L) with 30-day readmission and 1-year all-cause mortality. Results: Cohort mean age was 61 (SD 11.3) years, 34% were women and 19% non-white. Hyponatremia was present in 10.9% and patients with hyponatremia had more pre-existing hypertension (p=0.002) and diabetes mellitus (p=0.001). GRACE scores and maximum troponin values were significantly higher in hyponatremic patients (p= 0.001 and 0.05, respectively). There was no significant difference in prior heart failure or home diuretic use between the two groups. Overall 1-year mortality was 4.58% and 30-day all-cause readmission rate was 13.46%. For patients with hyponatremia on admission, unadjusted odds of 30-day readmission were 36% higher (Odds Ratio 1.36, 95% CI 1.00 to 1.85) and 1-year mortality odds were almost 3-fold higher (Odds Ratio 2.79, 95% CI 1.71 to 4.55). Conclusions: Hyponatremia was associated with higher early readmission and lower 1-year survival. Serum sodium levels may represent a cost-effective biomarker of adverse post-discharge outcomes. The potential incremental prognostic information of serum sodium when added to existing readmission and post-discharge mortality risk prediction instruments should be investigated.

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