Identification and Prevention of Secondary Heart Failure: A Case Study

2017 ◽  
Vol 37 (4) ◽  
pp. 29-35 ◽  
Author(s):  
Vlad Gheorghiu ◽  
Thomas W. Barkley
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Acute Decompensated Heart Failure ◽  
Financial Burden ◽  
Hospital Readmissions ◽  
Decompensated Heart Failure ◽  
Clinical Syndrome ◽  
High Morbidity ◽  
Practice Nurses ◽  
Depth Analysis

Heart failure, a complex clinical syndrome affecting millions of Americans, is associated with high morbidity and mortality and a significant financial burden on the health care system. Recent health care reform efforts have focused on reducing 30-day heart failure hospital readmissions, increasing the cost-effectiveness of care provided to heart failure patients, and improving health outcomes for these patients. This case report describes an acutely ill patient with multiple comorbidities who was not initially admitted for heart failure but who developed acute decompensated heart failure during his hospital stay. The purpose of this in-depth analysis is to discuss the role of bedside nurses and advanced practice nurses in managing heart failure, describe the challenges of identifying secondary heart failure in patients with complex conditions, and suggest methods of improving health-related outcomes to prevent hospital readmissions.

Assessing Acute Decompensated Heart Failure – Strategies and Tools

2012 ◽  
Vol 8 (2) ◽  
pp. 128
Author(s):  
Ali Vazir ◽  
Martin R Cowie ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Pulse Contour Analysis ◽  
Decompensated Heart Failure ◽  
Rapid Onset ◽  
Clinical Syndrome ◽  
Response To Therapy ◽  
Contour Analysis ◽  
Physiological Variables ◽  
Co Morbidity

Acute heart failure – the rapid onset of, or change in, signs and/or symptoms of heart failure requiring urgent treatment – is a serious clinical syndrome, associated with high mortality and healthcare costs. History, physical examination and early 2D and Doppler echocardiography are crucial to the proper assessment of patients, and will help determine the appropriate monitoring and management strategy. Most patients are elderly and have considerable co-morbidity. Clinical assessment is key to monitoring progress, but a number of clinical techniques – including simple Doppler and echocardiographic tools, pulse contour analysis and impedance cardiography – can help assess the response to therapy. A pulmonary artery catheter is not a routine monitoring tool, but can be very useful in patients with complex physiology, in those who fail to respond to therapy as would be anticipated, or in those being considered for mechanical intervention. As yet, the serial measurement of plasma natriuretic peptides is of limited value, but it does have a role in diagnosis and prognostication. Increasingly, the remote monitoring of physiological variables by completely implanted devices is possible, but the place of such technology in clinical practice is yet to be clearly established.

scholarly journals Bioimpedance Vector Analysis for Heart Failure: Should We Put It on the Agenda?

2021 ◽  
Vol 8 ◽  
Author(s):  
Bo Liang ◽  
Rui Li ◽  
Jia-Yue Bai ◽  
Ning Gu
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Clinical Diagnosis ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Clinical Syndrome ◽  
Vector Analysis ◽  
Diagnosis And Management ◽  
Volume Assessment ◽  
Intracardiac Pressure

Heart failure is a clinical syndrome, resulting in increased intracardiac pressure and/or decreased cardiac output under rest or stress. In acute decompensated heart failure, volume assessment is essential for clinical diagnosis and management. More and more evidence shows the advantages of bioimpedance vector analysis in this issue. Here, we critically present a brief review of bioimpedance vector analysis in the prediction and management of heart failure to give a reference to clinical physicians and guideline makers.

Abstract 109: In-Hospital Worsening Heart Failure is Associated With Poor Patient Outcomes and Increased Health Care Utilization

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Adam D DeVore ◽  
Bradley G Hammill ◽  
Puza P Sharma ◽  
Laura G Qualls ◽  
Robert J Mentz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Health Care Utilization ◽  
Acute Decompensated Heart Failure ◽  
Clinical Status ◽  
Decompensated Heart Failure ◽  
Circulatory Support ◽  
Care Utilization ◽  
Cost Ratio ◽  
Advanced Therapies

Background: A subset of patients hospitalized with acute heart failure (AHF) experiences worsening clinical status while hospitalized and require escalation of therapy. This phenomenon, termed in-hospital worsening heart failure (WHF), is an endpoint for many clinical trials but limited data exist on the prevalence of WHF in clinical practice and associated outcomes. Methods: We analyzed inpatient data from Acute Decompensated Heart Failure National Registry (ADHERE) linked to Medicare claims data to describe outcomes and health care utilization of patients that developed WHF. In-hospital WHF was defined by any of the following: use of inotropes or intravenous vasodilators >12 hours after admission; initiation of mechanical circulatory support, hemodialysis, or ventilation after the first inpatient day; or transfer to the ICU after initial admission to a regular hospital ward. Patients with WHF were compared to those with an uncomplicated hospital course and those that had a complicated hospital presentation, defined as requiring the above advanced therapies on arrival. Results: The study population consisted of 63,727 patients hospitalized between 01/2001 and 12/2004. Of these, WHF developed in 7032 (11%), 15,361 (24%) presented with a complicated presentation and 41,334 (65%) with an uncomplicated hospital course. Observed mean length of stay was longest in the WHF cohort (10.0 days) followed by complicated presentation (6.3 days) and uncomplicated course (4.8 days). Patients with WHF also had higher observed rates of mortality and all-cause readmission at 30 days and 1 year after discharge (P<0.001; Figure). The adjusted hazard ratio for 30-day mortality was 2.56 (99% CI 2.34-2.80) for WHF compared to an uncomplicated hospital course and 1.29 (1.17-1.42) compared to a complicated presentation. Medicare payments were also higher for patients with WHF with an adjusted cost ratio at 30 days of 1.35 (99% CI 1.24-1.46) for WHF compared to an uncomplicated hospital course and 1.11 (1.02-1.22) compared to a complicated presentation. Conclusion: In a large, multicenter registry, in-hospital WHF was common and associated with higher rates of mortality, all-cause readmission, and Medicare payments. Preventing and treating WHF represents an important therapeutic target among patients hospitalized with AHF.

An academic medical centre's programme to develop clinical pathways to manage health care: focus on acute decompensated heart failure

2008 ◽  
Vol 12 (2) ◽  
pp. 45-55 ◽  
Author(s):  
Dawn Lombardo ◽  
Tania V Bridgeman ◽  
Nathalie De Michelis ◽  
Molly Nunez
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Clinical Pathway ◽  
Care Delivery ◽  
Acute Decompensated Heart Failure ◽  
Clinical Pathways ◽  
Medical Center ◽  
Decompensated Heart Failure ◽  
The United States ◽  
Public Health Issue

Heart failure (HF) is a major public health issue and acute decompensated heart failure (ADHF) is a leading cause of hospitalization in the USA. The United States health care delivery system is bound by regulatory agencies requiring strict compliance to key clinical indicators, which are publicly reported. Clinical pathway development is a systematic approach to managing health care that involves a high degree of collaboration between patients, physicians, nurses and various health-care team professionals. The University of California, Irvine Medical Center (UCIMC) developed an evidence-based multidisciplinary pathway for patients with ADHF. This clinical pathway incorporates universally proven assessment and treatment measures in ADHF. Adjunctive to this process are patient and nursing guides to the ADHF pathway. Utilization of this pathway has been shown to significantly impact clinical performance by early identification of potential negative clinical outcomes. Clinical pathways, such as the ADHF pathway, promote clinical excellence in caring for acute and chronic diseases states.

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