Relation of Dyspnea Severity on Admission for Acute Heart Failure With Outcomes and Costs

Mentz, Robert J.; Mi, Xiaojuan; Sharma, Puneet; Qualls, Laura G.; DeVore, Adam D.; Johnson, Katherine Waltman; Fonarow, Gregg C.; Curtis, Lesley H.; Hernandez, Adrian F.

doi:10.1016/j.amjcard.2014.09.048

Cited by 42 publications

(47 citation statements)

References 22 publications

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“…One study has shown that breathlessness severity correlates statistically significantly with 5-year survival rate for patients with COPD 10. Another large study in heart failure patients with breathlessness showed that greater severity of baseline breathlessness was associated with mortality and readmission 11. The link with mortality indicates that optimal management of breathlessness is important for patient outcomes, as well as symptom control, and has led to calls for clinicians to consider measuring breathlessness routinely 14…”

Section: Impact Of Breathlessnessmentioning

confidence: 99%

Managing breathlessness: a palliative care approach

Chin

Booth

2016

Postgraduate Medical Journal

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Breathlessness is an important and common symptom globally, affecting patients with a variety of malignant and non-malignant diseases. It causes considerable suffering to patients and also their families, and is a significant cost to healthcare systems. Optimal management of the symptom should therefore be of interest and importance to a wide range of clinicians. Best practice in the management of breathlessness consists of both non-pharmacological and pharmacological interventions as evidenced by recent randomised controlled trials of multidisciplinary breathlessness support services. As well as providing evidence for integration of early palliative care into respiratory services, these revealed that patient distress due to breathlessness can be significantly reduced and better outcomes can be achieved at lower cost than standard care.

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Section: Impact Of Breathlessnessmentioning

confidence: 99%

Managing breathlessness: a palliative care approach

Chin

Booth

2016

Postgraduate Medical Journal

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“…Numerous studies have identified dyspnea as the strongest predictor of readmission [10][11][12][13][14][15][16]. Up to 77% of patients who were admitted for acute episodes of heart failure initially presented to the emergency department with dyspnea [13].…”

Section: Literature Reviewmentioning

confidence: 99%

Factors associated with heart failure readmissions from skilled nursing facilities

Ak¹

2017

Interventional-Cardiology

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Background: Despite guideline-driven pharmacological therapies and careful transitional care, the rates of preventable hospital re-admission of heart failure patients and associated costs remain unacceptably high in the SNF populations. Transfer to SNF is one strategy to limit hospitalizations. As such, 25% of patients are still symptomatic at time of discharge.Purpose: The objective of this study is to identify patient factors affecting re-admissions of HF patients residing in SNF within 30-days.Methods: A retrospective electronic chart review was completed on patients > 65 years with HF who were admitted into large medical center between 2012 and 2014. Descriptive statistics and univariate analyses using the chi-square test or Fisher's exact test for categorical variables and the Mann-Whitney test for continuous data was used to compare patients readmitted within 30 days vs. those who were not readmitted within 30 days. Significant factors associated with readmission in the univariate analysis (p < 0.10) were included for a multivariate logistic regression model. The analysis of LOS was accomplished by applying standard methods of survival analysis, i.e., computing the Kaplan-Meier product limit curves, where the data were stratified by readmission within 30 days (Yes vs. No). No data were considered 'censored'. The groups were compared using the log-rank test. The median rates for each group were obtained from the Kaplan-Meier/Product-Limit Estimates and their corresponding 95% confidence intervals were computed, using Greenwood's formula to calculate the standard error. Unless otherwise specified, a result was considered statistically significant at the p < 0.05 level of significance.Results: Fifteen variables: creatinine, weight difference, CKD, Angina, Arrhythmia, VHD, Tobacco, ADL, independent in bathing, independent in the toilet, S3 Heart sounds present, HJR, AF, Nitrates, and Hydralazine, were identified for the multivariate logistic regression as potential risk factors associated with "readmission within 30 days". Based on 23 readmissions within 30 days, our final model included only 2 predictor variables. Creatinine and ADLs were included in the final model as this subset of predictors was found to be the best for prediction of "readmission within 30 days". Creatinine (p < 0.0087) and ADLs (p < 0.0077) were both significantly associated with readmission within 30 days in the final logistic regression model. Every 1-unit increase in creatinine was associated with an 87% increase in the odds of being readmitted within 30 days (OR = 1.87). Those patients who require assistance with ADLs were over 9 times more likely to be readmitted within 30 days (OR = 9.25) as compared to patients who are independent.

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“…A recent randomized trial of 2331 patients, with CHF and an ejection fraction (EF) ≤ 35 showed that compared to Whites, African-Americans patients (N=749) tended to be younger, had lower SES, higher rates of hypertension and diabetes with less ischemic etiology [8]. Additionally, African Americans had increased prevalence of modifiable risk factors, lower exercise performance and higher rate of CHF related re-hospitalization, than Whites [8]. [14].…”

Section: Introductionmentioning

confidence: 99%

“…However, when SES is included in the model, Hispanics and African Americans had modestly lower 30-day and 1-year mortality rates than Whites, but there were similar 30-day re-hospitalization rates among these ethnic groups [12,13]. A recent randomized trial of 2331 patients, with CHF and an ejection fraction (EF) ≤ 35 showed that compared to Whites, African-Americans patients (N=749) tended to be younger, had lower SES, higher rates of hypertension and diabetes with less ischemic etiology [8]. Additionally, African Americans had increased prevalence of modifiable risk factors, lower exercise performance and higher rate of CHF related re-hospitalization, than Whites [8].…”

Section: Introductionmentioning

confidence: 99%

“…In patients with CHF and reduced ejection fraction (HFrEF) and anemia presents a higher risk of mortality and morbidity in older males, with renal dysfunction [7]. Dyspnea at rest is associated with higher 30-day mortality and CHF readmission, longer length of stay, and higher healthcare costscompared with dyspnea with moderate activity [8].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Alzheimer Disease in Hospitalized Patients with Congestive Heart Failure

Okunji¹,

Js²,

Nm³

et al. 2017

Int J Nurs Clin Pract

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Background: Alzheimer's disease (AD) may be the most critical medical condition of the 21st century in part because it affects more than 5 million Americans, including one out of eight Americans aged 65 or older, and nearly half of those being over the age of 85. It is also recognized that cardiovascular disease (CVD) risks can catalyze the development of AD. AD and congestive heart failure (CHF) often occur together and thus increase the cost of care and health resources. We investigated the prevalence of AD in patients hospitalized with CHF. In addition, factors that affect the outcomes of this special population were determined. Methods: Data from the National Inpatient Samples (NIS) were extracted and analyzed using ICD 9 codes (CHF 428, PD 331) for the main diagnosis. For continuous variables, we calculated the mean and standard deviations and evaluated significant differences of these factors by Alzheimer disease status using the t-test. For categorical variables, we obtained the counts (proportions) and evaluated significant differences using the Chi-square and Fisher's exact test Propensity score was utilized to match age, gender and race using logistic model for hospital death and generalized linear model for length of stay (LOS) and hospital charges. Results: The overall characteristics of matched participants with CHF and AD status showed that average age of inpatients was ~84 (SD=6.31). The prevalence of inpatients with both CHF and AD was significant (p < .0001) for females, 62.91% (n = 12,054) and for males, 37.09% (n = 7,107). White patients with CHF and AD were predominant with 76.20% (14,600) when compared with other races. While diabetes (26.05%), obstructive sleep apnea (5.67%), morbid-obesity (3.36%) were prevalent for inpatient without AD, renal insufficiency (3.60%) and stroke (2.10%) were prevalent in patient with AD. Patients with low income ($1 -$38,999) were admitted more with 6,290 (33.40%) than those with higher income ($39,000 -> $63,000). Finally, patient with CHF and AD stayed longer with higher mortality rates than those without AD, p< 0.0001. Age and race significantly affected all the outcomes, p< 0.0001 while gender showed significance for hospital death and charges (p< 0.0001). Hospital death was not affected by patient's household income but its interesting to note that LOS was affected by patients with household income between $39,000 -$62,999 and hospital charge by patients with higher household incomes from $48.000 and above. Stroke was the only comorbidity that significantly (p<0.0001) affected hospital death while diabetes significantly (p< 0.0001) affected LOS. However, diabetes, stroke and morbid obesity significantly (p< 0.0068) influenced the patient hospital charges. For hospital characteristics, it is important to note that LOS and hospital charge were significantly (p =0.0001) affected irrespective of the hospital teaching status. Conclusion:The prevalence of CHF and AD may be higher in females than males, with white patients admitted more often than other...

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Relation of Dyspnea Severity on Admission for Acute Heart Failure With Outcomes and Costs

Cited by 42 publications

References 22 publications

Managing breathlessness: a palliative care approach

Managing breathlessness: a palliative care approach

Factors associated with heart failure readmissions from skilled nursing facilities

Prevalence of Alzheimer Disease in Hospitalized Patients with Congestive Heart Failure

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