Heart Failure Management in Nursing Homes: A Scoping Literature Review

Heckman, George A.; Shamji, Alyana Karim; Ladha, Raisa; Stapleton, Jackie; Boscart, Véronique; Boxer, Rebecca S.; Martin, Lora Bruyn; Crutchlow, Lauren; McKelvie, Robert S.

doi:10.1016/j.cjca.2018.04.006

Cited by 26 publications

(27 citation statements)

References 67 publications

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“…The OPTIMIZE-HF Registry observed that among 10,696 patients with HF and LVEF < 40, 28.6% did not receive β-blockers and only 6.7% of patients received the target dose of β-blockers [30]. These results stress the difficulties of obtaining such goals in real life mainly in the older people.…”

Section: Discussionmentioning

confidence: 99%

National survey on the management of heart failure in individuals over 80 years of age in French geriatric care units

et al. 2019

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Background To evaluate the prevalence and management of heart failure (HF) in very old patients in geriatric settings. Methods Members of the French Society of Geriatrics and Gerontology throughout France were invited to participate in a point prevalence survey and to include all patients ≥80 years old, hospitalized in geriatric settings, with HF (stable or decompensated) on June 18, 2012. General characteristics, presence of comorbidities, blood tests and medications were recorded. Results Among 7,197 patients in geriatric institution, prevalence of HF was 20.5% ( n = 1,478): (27% in acute care, 24.2% in rehabilitation care and 18% in nursing home). Mean age was 88.2 (SD = 5.2) and Charlson co morbidity score was high (8.49 (SD = 2.21)). Left ventricular ejection fraction (LVEF) was available in 770 (52%) patients: 536 (69.6%) had a preserved LVEF (≥ 50%), 120 (15.6%) a reduced LVEF (< 40%), and 114 (14.8%) a midrange LVEF (40–49%). Prescription of recommended HF drugs was low: 42.6% (629) used Angiotensin Converting Enzyme Inhibitors (ACEI) or Angiotensin Receptor Blockers (ARBs), 48.0% (709) β-blockers, and 21.9% (324) ACEI or ARB with β-blockers, even in reduced LVEF. In multivariate analysis ACEI or ARBs were more often used in patients with myocardial infarction (1.36 (1.04–1.78)), stroke (1.42 (1.06–1.91)), and diabetes (1.54 (1.14–2.06)). β blockers were more likely used in patients with myocardial infarction (2.06 (1.54–2.76)) and atrial fibrillation (1.70 (1.28–2.28)). Conclusion In this large very old population, prevalence of HF was high. Recommended HF drugs were underused even in reduced LVEF. These results indicate that management of HF in geriatric settings can still be improved. Electronic supplementary material The online version of this article (10.1186/s12877-019-1215-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

National survey on the management of heart failure in individuals over 80 years of age in French geriatric care units

et al. 2019

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“…Several studies of HF prevalence in the nursing home population have shown that prevalence is higher than expected in the comparable age group and that HF is often undiagnosed or misdiagnosed (8,25,29). There are several factors that make this more likely, but the accessibility and feasibility of diagnostic procedure of HF are the most common (13). To overcome this, and to ensure equity for all participants, the whole diagnostic procedure of HF in this study will be performed on-site in nursing homes.…”

Section: Discussionmentioning

confidence: 99%

“…However, owing to the limited accessibility of diagnostic and therapeutic procedures, the needs of the nursing home population for secondary healthcare procedures often remain unmet (11,12). The guidelines for both HF diagnosis and management are frequently not followed in the nursing home population, leading to sub-optimal or even inappropriate HF treatment, frequent instances of deterioration and poor quality of life (13). Both the diagnostics and management of heart failure in the nursing home population therefore remain important challenges for primary care physicians.…”

Section: Introductionmentioning

confidence: 99%

Optimisation of Heart Failure Management in Nursing Homes Using Point-of-Care Ultrasonography: Harmonious Trial Rationale and Design

Homar

Švab

Lainščak

2020

Slovenian Journal of Public Health

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AbstractIntroductionHeart failure is common in the nursing home population and presents many diagnostic and therapeutic challenges. Point-of-care ultrasonography is a bedside method that can be used to assess volume status more reliably than clinical examination. This trial was conceived to test whether point-of-care ultrasonography-guided management improves heart failure outcomes among nursing home residents.MethodsNursing home residents with heart failure will be enrolled in a multi-centre, prospective, randomised controlled trial. Residents will first be screened for heart failure. Patients with heart failure will be randomised in 1:1 fashion into two groups. Nursing home physicians will adjust diuretic therapy according to volume status for six months. Point-of-care ultrasonography will be used in the test group and clinical examination in the control group. The primary endpoint will be heart failure deterioration, defined as a composite of any of the following four events: the need for an intravenous diuretic application, the need for an emergency service intervention, the need for unplanned hospitalisation for non-injury causes, or death from whatever cause.Expected resultsThe expected prevalence of heart failure among nursing home residents is above 10%. Point-of-care ultrasonography-guided heart failure management will reduce the number of deteriorations of heart failure in the nursing home population.ConclusionThis study will explore the usefulness of point-of-care ultrasonography for heart failure management in the nursing home population.

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“…Indeed, as hospital length of stay declines and uses of SNF rises, 31 the importance of identifying best practices for HF management in SNFs will become increasingly evident 32 particularly since HF is a chronic problem that requires ongoing disease management. It is necessary to target these high risk patients throughout their care continuum to optimize medical therapy, reinforce self-management skills, and ensure adequate services are in place to regularly assess volume and symptoms to facilitate outpatient provider management.…”

Section: Discussionmentioning

confidence: 99%

Risk of Readmission After Discharge From Skilled Nursing Facilities Following Heart Failure Hospitalization: A Retrospective Cohort Study

Weerahandi

Bao

et al. 2019

Journal of the American Medical Directors Association

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Objective: Discharge to skilled nursing facilities (SNF) is common in patients with heart failure (HF). It is unknown whether the transition from SNF to home is risky for these patients. Our objective was to study outcomes for the 30 days after discharge from SNF to home among Medicare patients hospitalized with HF who had subsequent SNF stays of 30 days or less. Design: Retrospective cohort study. Setting and Participants: All Medicare fee-for-service beneficiaries 65 and older admitted 2012 to 2015 with a HF diagnosis discharged to SNF then subsequently discharged home. Measures: Patients were followed for 30 days following SNF discharge. We categorized patients by SNF length of stay: 1-6 days, 7-13 days, 14-30 days. For each group, we modeled time to a

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Heart Failure Management in Nursing Homes: A Scoping Literature Review

Cited by 26 publications

References 67 publications

National survey on the management of heart failure in individuals over 80 years of age in French geriatric care units

National survey on the management of heart failure in individuals over 80 years of age in French geriatric care units

Optimisation of Heart Failure Management in Nursing Homes Using Point-of-Care Ultrasonography: Harmonious Trial Rationale and Design

Risk of Readmission After Discharge From Skilled Nursing Facilities Following Heart Failure Hospitalization: A Retrospective Cohort Study

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