Delayed hospital presentation in acute decompensated heart failure: Clinical and patient reported factors

Darling, Chad E.; Saczynski, Jane S.; McManus, David D.; Lessard, Darleen M.; Spencer, Frederick A.; Goldberg, Robert J.

doi:10.1016/j.hrtlng.2013.01.007

Cited by 38 publications

(22 citation statements)

References 21 publications

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“…Details of the study have been previously described 27. Nurse and physician interviewers conducted daily reviews of computerized hospital admission data for patients with an admission diagnosis of possible HF (International Classification of Disease-9 code 428).…”

Section: Methodsmentioning

confidence: 99%

Cognitive impairment and self-care in heart failure

Hajduk¹,

Lemon²,

McManus³

et al. 2013

CLEP

109

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BackgroundHeart failure (HF) is a prevalent chronic disease in older adults that requires extensive self-care to prevent decompensation and hospitalization. Cognitive impairment may impact the ability to perform HF self-care activities. We examined the association between cognitive impairment and adherence to self-care in patients hospitalized for acute HF.DesignProspective cohort study.Setting and participantsA total of 577 patients (mean age = 71 years, 44% female) hospitalized for HF at five medical centers in the United States and Canada.Measurements and methodsParticipants were interviewed for information on self-reported adherence to self-care using the European Heart Failure Self-care Behaviour Scale. We assessed cognitive impairment in three domains (memory, processing speed, and executive function) using standardized measures. Patients’ demographic and clinical characteristics were obtained through medical record review. Multivariable linear regression was used to examine the association between cognitive impairment and self-care practices adjusting for demographic and clinical factors.ResultsA total of 453 patients (79%) were impaired in at least one cognitive domain. Average adherence to self-care activities among patients with global cognitive impairment did not differ significantly from those without cognitive impairment (30.5 versus 29.6; 45-point scale). However, impaired memory was associated with lower self-care scores (P = 0.006) in multivariable models.ConclusionCognitive impairment is highly prevalent among older patients hospitalized for HF. Memory impairment is associated with poorer adherence to self-care practices. Screening for memory impairment in patients with HF may help to identify patients at risk for poor self-care who may benefit from tailored disease management programs.

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Section: Methodsmentioning

confidence: 99%

Cognitive impairment and self-care in heart failure

Hajduk¹,

Lemon²,

McManus³

et al. 2013

CLEP

109

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“…17, 18 Our ancillary study added measures of cognition and included 1,115 patients with ADHF who were enrolled between July 2007 and April, 2011 at five urban medical centers in Worcester (MA), Providence (RI), and Hamilton, Ontario. The study was approved by each institution’s Committee for the Protection of Human Subjects in Research.…”

Section: Methodsmentioning

confidence: 99%

“…17, 18 Nurse and physician interviewers conducted daily reviews of computerized hospital admission data for patients with an admission diagnosis of possible HF (International Classification of Disease-9 code 428). Interviewers then performed a preliminary review of each patient’s medical record to determine if patients satisfied the Framingham criteria for HF.…”

Section: Methodsmentioning

confidence: 99%

Cognitive status in patients hospitalized with acute decompensated heart failure

Levin

Hajduk²,

McManus

et al. 2014

American Heart Journal

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Structured Abstract Background Cognitive impairment is highly prevalent in patients with heart failure and is associated with adverse outcomes. However, whether specific cognitive abilities (e.g., memory versus executive function) are impaired in heart failure has not been fully examined. We investigated the prevalence of impairment in three cognitive domains in patients hospitalized with acute decompensated heart failure (ADHF) and the associations of impairment with demographic and clinical characteristics. Methods The sample included 744 patients hospitalized with ADHF (mean age = 72 years, 46% female) at 5 medical centers. Impairment was assessed in three cognitive domains (memory, processing speed, executive function) using standardized measures. Demographic and clinical characteristics were obtained from a structured interview and medical record review. Results A total of 593 of 744 (80%) patients were impaired in at least one cognitive domain; 32%, 31%, and 17% of patients were impaired in one, two, or all three cognitive domains, respectively. Patients impaired in more than one cognitive domain were significantly older, had less formal education, and had more non-cardiac comorbidities (all p’s < 0.05). In multivariable adjusted analyses, patients with older age and lower education had higher odds of impairment in two or more cognitive domains. Depressed patients had twice the odds of being impaired in all three cognitive domains (OR = 1.98, 95% CI: 1.08, 3.64). Conclusion Impairments in executive function, processing speed and memory are common among patients hospitalized for ADHF. Recognition of these prevalent cognitive deficits is critical for the clinical management of these high risk patients.

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“…[2] In the United States, the number of HF cases is estimated to be close to 6 million. [2–3] Further, the 5-year mortality rates among HF patients almost rival those of cancer patients. [2] Overall hospital care constitutes a third of all health care expenditures in the United States, and represent a significant impact to the US economy.…”

Section: Introductionmentioning

confidence: 99%

Association of gender and length of stay among Puerto Ricans hospitalized with decompensated heart failure

et al. 2016

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Heart failure (HF) is a serious, chronic, and progressive condition which may require hospitalization if decompensated. Each year, in the UnitedStates, there are approximately 1 million hospitalizations due to decompensated HF at a cost of $39 billion. Because limited information examining the association between gender and length of stay (LOS) is available in the published literature for Puerto Ricans hospitalized with decompensated HF, we aim to investigate gender differences related to LOS in this population.This study is a secondary data analysis of the Puerto Rico Cardiovascular Disease Surveillance System database, which is a nonconcurrent prospective study carried out in 2007 and 2009. LOS was dichotomized into ≤5 days or ≥6 days (extended) categories. The χ2 test was used to examine associations between categorical variables. Binary logistic regression was used to estimate unadjusted and adjusted odds ratios of extended LOS. Collinearity was assessed using Pearson correlation coefficients. A P value of 0.05 and 95% confidence intervals were used to evaluate statistical significance.A total of 1724 patients (47.6% women) comprised our study population. The average age of women was 72.5 ± 13.4 years; the average age of men was 67.2 ± 14.5 years. For both women and men, median LOS was 5 days (interquartile range = 5 days). Women were more likely than men to have diabetes mellitus, hypertension, and dyslipidemia, but current smoking was higher in men than in women. The proportion of patients with extended LOS was similar for men (43.3%) and women (45.1%) (P = 0.448). Likewise, the odds for extended LOS was comparable for both genders (OR = 1.1, 95% CI = 0.9, 1.4). Patients admitted with recurrent decompensated HF hospitalizations had shorter LOS than patients with initial episodes (OR = 0.7, 95% CI = 0.6, 0.9). However, factors that prolonged the LOS included the presence of renal failure (OR = 1.7; 95% IC = 1.3, 2.1) and ejection fraction (EF) <35% (OR 0.7; 95% CI 0.6, 0.9).Although we were not able to find statistically significant association between LOS and gender in Puerto Rican patients hospitalized with decompensated HF our findings suggest that incidental episodes and having an EF <35% increase the odds of extended LOS.

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Delayed hospital presentation in acute decompensated heart failure: Clinical and patient reported factors

Cited by 38 publications

References 21 publications

Cognitive impairment and self-care in heart failure

Cognitive impairment and self-care in heart failure

Cognitive status in patients hospitalized with acute decompensated heart failure

Association of gender and length of stay among Puerto Ricans hospitalized with decompensated heart failure

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