Assessing the impact of heart failure specialist services on patient populations

Lyratzopoulos, Georgios; Cook, Gary; McElduff, Patrick; Havely, Daniel; Edwards, Richard; Heller, Richard F

doi:10.1186/1472-6963-4-10

Cited by 4 publications

(5 citation statements)

References 40 publications

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“…Male sex and older age were strongly and independently associated with higher readmission risk, along with diagnosis of heart failure and chronic obstructive pulmonary disease or asthma. Effective measures to reduce readmission rates for patients suffering from these two conditions in particular are available[13,14] but not always used[13,15,16]. Improving the availability of effective treatments for these two conditions could contribute greatly to the management of demand for emergency care in general.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing emergency medical readmission risk in a UK district general hospital: A prospective study

et al. 2005

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Section: Discussionmentioning

confidence: 99%

Factors influencing emergency medical readmission risk in a UK district general hospital: A prospective study

et al. 2005

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“…For spironolactone, the percentages were not available split by age and sex and our the estimated treatment rate was 25%. 9 Studies have suggested that 65% of heart failure patients are eligible for treatment with b blockers, 45 80% are eligible for treatment with ACE inhibitors, and 84% 45 are eligible for treatment with spironolactone. 9 It proved difficult to obtain information on drug specific levels of adherence for patients with heart failure.…”

Section: Resultsmentioning

confidence: 99%

“…9 Studies have suggested that 65% of heart failure patients are eligible for treatment with b blockers, 45 80% are eligible for treatment with ACE inhibitors, and 84% 45 are eligible for treatment with spironolactone. 9 It proved difficult to obtain information on drug specific levels of adherence for patients with heart failure. There was no such information available for patients in the UK and the data used are from Germany 46 and the USA 47 that estimate that 77% of patients adhere to spironolactone and b blockers and 71% adhere with treatment with ACE inhibitors.…”

Section: Resultsmentioning

confidence: 99%

“…9 Our analysis assumed a one year time horizon, therefore we used one year period prevalence of AMI and prevalence of heart failure to estimate the number of events prevented in new cases if NSF targets were met. Formula 3 assumes that the separate RRRs are independent for each drug as are the proportion receiving each drug (that is, the patients chance of receiving a particular drug does not depend on their receipt of other drugs).…”

Section: Methodsmentioning

confidence: 99%

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Population impact of stricter adherence to recommendations for pharmacological and lifestyle interventions over one year in patients with coronary heart disease

Heller²,

McElduff³

et al. 2005

Journal of Epidemiology & Community Health

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Study objective: To assess the potential number of lives saved associated with the full implementation of aspects of the National Service Framework (NSF) for coronary heart disease (CHD) in England using recently developed population impact measures. Design: Modelling study. Setting: Primary care. Data sources: Published data on prevalence of acute myocardial infarction and heart failure, baseline risk of mortality, the relative risk reduction associated with different interventions and the proportion treated, eligible for treatment and adhering to each intervention. Main results: Adopting the NSF recommendations for pharmacological interventions would prevent an extra 1027 (95% CI 418 to 1994) deaths in post-acute myocardial infarction (AMI) patients and an extra 37 899 (95% CI 25 690 to 52 503) deaths in heart failure patients in the first year after diagnosis. Lifestyle based interventions would prevent an extra 848 (95% CI 71 to 1 614) deaths in post-AMI patients and an extra 7249 (95% CI 995 to 16 696) deaths in heart failure patients. Conclusions: Moving from current to ''best'' practice as recommended in the NSF will have a much greater impact on one year mortality rates among heart failure patients compared with post-AMI patients. Meeting pharmacological based recommendations for heart failure patients will prevent more deaths than meeting lifestyle based recommendations. Population impact numbers can help communicate the impact on a population of the implementation of guidelines and, when created using local data, could help policy makers assess the local impact of implementing a range of health care targets.

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“…These data illustrate the advantages of referring heart failure patients to a heart failure center or heart failure specialist. The importance of close patient follow-up and education was also demonstrated by others [60][61][62]. Moreover, three months may not be enough time to establish individual optimized medication in many patients.…”

Section: Lvef Recovery Under Optimized Therapymentioning

confidence: 98%

Delayed Improvement of Left Ventricular Function in Newly Diagnosed Heart Failure Depends on Etiology—A PROLONG-II Substudy

Mueller-Leisse

Brunn

Zormpas

et al. 2022

Sensors

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In patients with newly diagnosed heart failure with reduced ejection fraction (HFrEF), three months of optimal therapy are recommended before considering a primary preventive implantable cardioverter-defibrillator (ICD). It is unclear which patients benefit from a prolonged waiting period under protection of the wearable cardioverter-defibrillator (WCD) to avoid unnecessary ICD implantations. This study included all patients receiving a WCD for newly diagnosed HFrEF (n = 353) at our center between 2012 and 2017. Median follow-up was 2.7 years. From baseline until three months, LVEF improved in patients with all peripartum cardiomyopathy (PPCM), myocarditis, dilated cardiomyopathy (DCM), or ischemic cardiomyopathy (ICM). Beyond this time, LVEF improved in PPCM and DCM only (10 ± 8% and 10 ± 12%, respectively), whereas patients with ICM showed no further improvement. The patients with newly diagnosed HFrEF were compared to 29 patients with a distinct WCD indication, which is an explantation of an infected ICD. This latter group had a higher incidence of WCD shocks and poorer overall survival. All-cause mortality should be considered when deciding on WCD prescription. In patients with newly diagnosed HFrEF, the potential for delayed LVEF recovery should be considered when timing ICD implantation, especially in patients with PPCM and DCM.

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Assessing the impact of heart failure specialist services on patient populations

Cited by 4 publications

References 40 publications

Factors influencing emergency medical readmission risk in a UK district general hospital: A prospective study

Factors influencing emergency medical readmission risk in a UK district general hospital: A prospective study

Population impact of stricter adherence to recommendations for pharmacological and lifestyle interventions over one year in patients with coronary heart disease

Delayed Improvement of Left Ventricular Function in Newly Diagnosed Heart Failure Depends on Etiology—A PROLONG-II Substudy

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