Study protocol for a cohort study of patients with advanced heart failure in Singapore

Malhotra, Chetna; Foo, R Marcus C; Singh, Ratna; Özdemir, Semra; Teo, Irene; Sim, David; Jaufeerally, Fazlur; Than, Aung; Keong, Yeo Khung; Nadkarni, Nivedita; Finkelstein, Eric A.

doi:10.1136/bmjopen-2018-022248

Cited by 14 publications

(9 citation statements)

References 23 publications

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“…Written informed consent was obtained from all eligible patients who agreed to participate in the study. The study protocol has been published 24 . The study was approved by the SingHealth Centralised Institutional Review Board (2016/3046).…”

Section: Methodsmentioning

confidence: 99%

Multifactorial risk factors for hospital readmissions among patients with symptoms of advanced heart failure

Malhotra,

Chaudhry,

Keong

et al. 2024

ESC Heart Failure

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AimsEconomic burden of heart failure is attributed to hospital readmissions. Previous studies assessing risk factors for readmissions have focused on single group of risk factors, were limited to 30‐day readmissions, or did not account for competing risk of mortality. This study investigates the biological, socio‐economic, and behavioural risk factors predicting hospital readmissions while accounting for the competing risk of mortality.Methods and resultsIn this prospective cohort study, we recruited 250 patients hospitalized with symptoms of advanced heart failure [New York Heart Association (NYHA) Class III and IV] between July 2017 and April 2019. We analysed their baseline survey data and their hospitalization records over the next 4.5 years (July 2017 to January 2022). We used a joint‐frailty model to determine the multifactorial risk factors for all‐cause and unplanned hospital readmissions and mortality. At the time of recruitment, patients' mean (SD) age was 66 (12) years, majority being male (72%) and NYHA class IV (68%) with reduced ejection fraction (72%). 87% of the patients had poor self‐care behaviours, 51% had diabetes and 56% had weak grip strength. Within 2 years of a hospital admission, 74% of the patients had at least one readmission. Among all readmissions during follow‐up, 68% were unplanned. Results from the multivariable regression analysis shows that the independent risk factors for hospital readmissions were biologic—weak grip strength [hazard ratio (95% CI): 1.59 (1.06, 2.13)], poor functional status [1.79 (0.98, 2.61)], diabetes [1.42 (0.97, 1.86)]; behavioural—poor self‐care [1.66 (0.84, 2.49)], and socio‐economic—preference for maximal life extension at high cost for those with high education [1.98 (1.17, 2.80)]. Risk factors for unplanned hospital readmissions were similar. A higher hospital readmission rate increased the risk of mortality [1.86 (1.23, 2.50)]. Other risk factors for mortality were biologic—weak grip strength [3.65 (0.57, 6.73)], diabetes [2.52 (0.62, 4.42)], socio‐economic—lower education [2.45 (0.37, 4.53)], and being married [2.53 (0.37, 4.69)]. Having a private health insurance [0.40 (0.08, 0.73)] lowered the risk for mortality.ConclusionsRisk factors for hospital readmissions and mortality are multifactorial. Many of these factors, such as weak grip strength, diabetes, poor self‐care behaviours, are potentially modifiable and should be routinely assessed and managed in cardiac clinics and hospital admissions.

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Section: Methodsmentioning

confidence: 99%

Multifactorial risk factors for hospital readmissions among patients with symptoms of advanced heart failure

Malhotra,

Chaudhry,

Keong

et al. 2024

ESC Heart Failure

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“…We used data from a prospective cohort study titled Singapore Cohort of Patients with Advanced Heart Failure (SCOPAH) 23 . Between July 2017 and April 2019, we enrolled 251 HF patients from two public hospitals in Singapore.…”

Section: Methodsmentioning

confidence: 99%

Weak grip strength predicts higher unplanned healthcare utilization among patients with heart failure

Poco,

Finkelstein,

Sim

et al. 2023

ESC Heart Failure

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AimsFrailty increases healthcare utilization and costs for patients with heart failure but is challenging to assess in clinical settings. Hand grip strength (GS) is a single‐item measure of frailty yet lacks evidence as a potential screening tool to identify patients at risk of higher unplanned events and related healthcare costs. We examined the association of baseline and longitudinal GS measurements with healthcare utilization and costs among patients with advanced heart failure.Methods and resultsBetween July 2017 and April 2019, we enrolled 251 patients with symptoms of advanced heart failure (New York Heart Association class III or IV) in a prospective cohort study in Singapore. We measured GS at baseline and every 4 months for 2 years and linked patients' survey data with their medical and billing records. We categorized patients as having weak GS if their GS measurement was below the 5th percentile of the age‐ and gender‐specific normative GS values in Singapore. We assessed the association between baseline GS and healthcare utilization (unplanned and planned events and healthcare costs, total costs, and length of inpatient stay) over the next 2 years using regression models. We investigated the association between longitudinal 4‐monthly GS assessments and the ensuing 4 months of healthcare utilization and costs using mixed‐effects logistic and two‐part regression models. At baseline, 22.5% of patients had weak GS. Baseline and longitudinal GS measurements were significantly associated with longer length of inpatient stay, greater likelihood of unplanned events, and higher related costs. Patients with weak GS had higher odds of an unplanned event occurring by 8 percentage points [95% confidence interval (CI) (0.01, 0.14), P = 0.026], incurred longer inpatient stays by 4 days [95% CI (1.97, 6.79), P = 0.003], and additional SG$ 4792 [US$ ~ 3594, 95% CI (1894, 7689), P = 0.014] in unplanned healthcare costs over the next 4 months.ConclusionsGS is a simple tool to identify and monitor heart failure patients at risk of unplanned events, longer inpatient stays, and higher related healthcare costs. Findings support its routine use in clinical settings.

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“…This study analyzed data gathered over 24 mo from a prospective cohort study of patients with advanced HF in Singapore (Singapore Cohort of Patients with Advanced Heart Failure; SCOPAH). 26 About 30% of health expenditures are paid out-of-pocket in Singapore. The country has a mandatory low-cost public health insurance system with high deductibles.…”

Section: Study Setting and Samplementioning

confidence: 99%

A Prospective Cohort Study of Medical Decision-Making Roles and Their Associations with Patient Characteristics and Patient-Reported Outcomes among Patients with Heart Failure

Ozdemir,

Lee,

Yeo

et al. 2023

Med Decis Making

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Objective Among patients with heart failure (HF), we examined 1) the evolution of patient involvement in decision making over 2 y, 2) the association of patient characteristics with decision-making roles, and 3) the association of decision-making roles with distress, spiritual well-being, and quality of physician communication. Methods We administered the survey every 4 mo over 24 mo to patients with New York Heart Association class 3/4 symptoms recruited from inpatient clinics. The decision-making roles were categorized as no patient involvement, physician/family-led, joint (with family and/or physicians), patient-led, or patient-alone decision making. The associations between patient characteristics and decision-making roles were assessed using a mixed-effects ordered logistic regression, whereas those between patient outcomes and decision-making roles were investigated using mixed-effects linear regressions. Results Of the 557 patients invited, 251 participated in the study. The most common roles in decision making at baseline assessment were “no involvement” (27.53%) and “patient-alone decision making” (25.10%). The proportions of different decision-making roles did not change over 2 y ( P = 0.37). Older age (odds ratio [OR] = 0.97; P = 0.003) and being married (OR = 0.63; P = 0.035) were associated with lower involvement in decision making. Chinese ethnicity (OR = 1.91; P = 0.003), higher education (OR = 1.87; P = 0.003), awareness of terminal condition (OR = 2.00; P < 0.001), and adequate self-care confidence (OR = 1.74; P < 0.001) were associated with greater involvement. Compared with no patient involvement, joint (β = −0.58; P = 0.026) and patient-led (β = −0.59; P = 0.014) decision making were associated with lower distress, while family/physician-led (β = 4.37; P = 0.001), joint (β = 3.86; P < 0.001), patient-led (β = 3.46; P < 0.001), and patient-alone (β = 3.99; P < 0.001) decision making were associated with better spiritual well-being. Conclusion A substantial proportion of patients was not involved in decision making. Patients should be encouraged to participate in decision making since it is associated with lower distress and better spiritual well-being. Highlights The level of involvement in medical decision making did not change over time among patients with heart failure. A substantial proportion of patients were not involved in decision making throughout the 24-mo study period. Patients’ involvement in decision making varied by age, ethnicity, education level, marital status, awareness of the terminal condition, and confidence in self-care. Compared with no patient involvement in decision making, joint and patient-led decision making were associated with lower distress, and any level of patient involvement in decision making was associated with better spiritual well-being.

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Study protocol for a cohort study of patients with advanced heart failure in Singapore

Cited by 14 publications

References 23 publications

Multifactorial risk factors for hospital readmissions among patients with symptoms of advanced heart failure

Multifactorial risk factors for hospital readmissions among patients with symptoms of advanced heart failure

Weak grip strength predicts higher unplanned healthcare utilization among patients with heart failure

A Prospective Cohort Study of Medical Decision-Making Roles and Their Associations with Patient Characteristics and Patient-Reported Outcomes among Patients with Heart Failure

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