Effect of A Follow‐Up Program in Elderly Adults with Heart Failure with Cognitive Impairment After Hospital Discharge

Guerrero, José L.; Alonso-Fernández, Teresa; García-Mayolín, N.; Gusi, Narcís; Ribera-Casado, José Manuel

doi:10.1111/jgs.13621

Cited by 6 publications

(10 citation statements)

References 11 publications

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“…In the studies measuring mortality, three reported a significant improvement. 18,24,28,35 The proportion of HFpEF patients in these studies was 67%, 35 47%, 18 and 27%, 28 respectively. Of these studies, only Stewart et al 28 reported separate HFpEF statistics (HFpEF defined as those with EF > 45%) and found no difference in percentage with HFpEF by survived or died.…”

Section: Discussionmentioning

confidence: 64%

“…Telemonitoring was included in the intervention in two studies, 18,22 and five provided medication adjustment by nurses or via general practitioners. [18][19][20]24,28 Patient assessment was included in all but two studies, 17,18 although the extent, frequency, and type of assessment varied. The duration of the interventions ranged from 3 months to over 2 years, and interventions in seven of the studies were ≥12 months.…”

Section: Interventions and Study Characteristicsmentioning

confidence: 99%

“…Only three reported a statistically significant result. 24,34,35 The remainder reported either no impact [17][18][19][20]27,30,33 ; positive trends in favour of the intervention such as shorter hospital stays, prolonged time to hospitalization, and lower total numbers hospitalized 22,32 ; or trends towards higher hospitalizations in intervention groups. 23,28,29 The effect of disease management programmes on self-care Nine studies evaluated the effect of the intervention on selfcare.…”

Section: The Effect Of Disease Management Programmes On Hospitalizationsmentioning

confidence: 99%

“…studies included patients labelled as HFpEF but without explicitly defining this population. [24][25][26] The remaining nine studies used either >45% [27][28][29] or 40% [30][31][32][33][34] as EF criterion to differentiate patients with HFpEF. The percentage of patients with HFpEF defined by the studies ranged between 22% and 77%.…”

Section: Heart Failure With Preserved Ejection Fraction Definitionmentioning

confidence: 99%

“…The duration of the interventions ranged from 3 months to over 2 years, and interventions in seven of the studies were ≥12 months. 18,20,22,24,27,29,32 All studies included at least one face-to-face encounter with patients, but telephone contact was used in all to deliver some of the intervention. Home visits were used in 11 studies.…”

Section: Interventions and Study Characteristicsmentioning

confidence: 99%

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Heart failure disease management: a systematic review of effectiveness in heart failure with preserved ejection fraction

et al. 2020

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Aims Heart failure with preserved ejection fraction (HFpEF) poses a substantial challenge for clinicians, but there is little guidance for effective management. The aim of this systematic review was to determine if there was evidence that disease management programmes (DMPs) improved outcomes for patients with HFpEF. Methods and results A systematic review of controlled studies in English or Greek of DMPs including patients with HFpEF from 2008 to 2018 was conducted using CINAHL, Cochrane, MEDLINE, and Embase. Interventions were assessed using a DMP taxonomy and scored for complexity and intensity. Bias was assessed using the Cochrane Collaboration tool. Initial and updated searches found 6089 titles once duplicates were removed. The final analysis included 18 studies with 5435 HF patients: 1866 patients (34%, study ranges 18–100%) had potential HFpEF (limited by variable definitions). Significant heterogeneity in terms of the population, intervention, comparisons, and outcomes prohibited meta‐analysis. Statistically significant or positive trends were found in mortality, hospitalization rates, self‐care ability, quality of life, anxiety, depression, and sleep, but findings were not robust or consistent. Four studies reported results separately for study‐defined HFpEF, with two finding less positive effect on outcomes. Conclusions Varying definitions of HFpEF used in studies are a substantial limitation in interpretation of findings. The reduced efficacy noted in contemporary HF DMP studies may not only be due to improvements in usual care but may also reflect inclusion of heterogeneous patients with HFpEF or HF with mid‐range EF who may not respond in the same way as HFrEF to individual components. Given that patients with HFpEF are older and multi‐morbid, DMPs targeting HFpEF should not rely on a single‐disease focus but provide care that addresses predisposing and presentation phenotypes and draws on the principles of comprehensive geriatric assessment. Other components could also be more targeted to HFpEF such as modification of lifestyle factors for which there is emerging evidence, rather than simply continuing the model of care used in HFrEF. Based on current evidence, HF DMPs may improve mortality, hospitalization rates, self‐care, and quality of life in patients with HFpEF; however, further research specifically tailored to appropriately defined HFpEF is required.

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