The Average Lifespan of Patients Discharged from Hospital with Heart Failure

Alter, David A.; Ko, Dennis T.; Tu, Jack V.; Stukel, Thérèse A.; Lee, Douglas S.; Laupacis, Andreas; Chong, Alice; Austin, Peter C.

doi:10.1007/s11606-012-2072-y

Cited by 49 publications

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“…Furthermore, it is important to note that our cohort of AMI patients was assembled from 2004 to 2005, and treatment patterns may have changed over time. Finally, although the calculation of projected life expectancy was previously validated, [9][10][11][12] we were unable to validate our estimates against the actual estimates in the EFFECT cohort because the majority of patients were still alive in our study cohort.…”

Section: Discussionmentioning

confidence: 91%

“…Prior study has suggested that the lower treatment propensity for higher risk patients is associated with clinicians' concerns of patients experiencing adverse events with acute reperfusion therapy. 11,19 To overcome this care gap, we think a paradigm shift in improving our understanding of life expectancies is needed. The primary issue is that the majority of current clinical prediction tools estimate baseline risks of patients.…”

Section: Discussionmentioning

confidence: 99%

“…It has been evaluated against traditional survival analytic techniques, and applied to clinical trial data, observational studies, and cost-effectiveness analyses. [9][10][11][12] In our study, we estimated the life expectancy for each myocardial infarction patient who survived to hospital discharge with the following steps. First, the observed 2-year survival in the EFFECT cohort was modeled using a traditional time-based Cox proportional hazards model with time-to-death as the primary outcome.…”

Section: Estimation Of Projected Life Expectancymentioning

confidence: 99%

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Relationship Between Care Gaps and Projected Life Expectancy After Acute Myocardial Infarction

Austin

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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Background-Higher-risk patients may not receive evidence-based therapy because of limited life expectancy, which is a composite measure that encompasses many patient factors, including age, frailty, and comorbidities. In this study, we evaluated the extent to which treatment care gaps can be explained by a difference in projected life expectancy. Methods and Results-An observational cohort study was conducted on acute myocardial infarction patients hospitalized in Ontario, Canada. Projected life expectancy was estimated using actual survival data with extrapolation using proportional hazard models adjusting for important covariates. The relationship between projected life expectancy with statins and reperfusion therapy was examined using generalized linear models. Among the 7001 acute myocardial infarction patients, 84.3% were prescribed statins and 72.9% were treated with reperfusion therapy. When projected life expectancy was <10 years, the likelihood of receiving either treatment declined progressively with reduction in life expectancy (P<0.001). At the 25th percentile of projected life expectancies, the likelihood of receiving a statin decreased by 1.4% (95% confidence interval, 1.0-1.8%), and acute reperfusion therapy decreased by 2.6% (95% confidence interval, 1.8-3.3%) for each year decline in projected life expectancy. Conclusions-Life expectancy of a patient strongly influences evidence-based treatment in acute myocardial infarction. It was seen not only among patients with limited life expectancies but also among those with many years to live. Treatment care gaps may reflect clinicians' synthesis about frailty and life-expectancy gains. (Circ Cardiovasc Qual Outcomes. 2014;7:581-588.)

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Estimation Of Projected Life Expectancymentioning

confidence: 99%

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Relationship Between Care Gaps and Projected Life Expectancy After Acute Myocardial Infarction

Austin

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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“…3 Multimorbidity greatly increases the risk of hospitalization and death among HF patients. 4,5,6,7 Efforts to reduce these risks are particularly challenging given the limited data available to guide clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Treatment Effectiveness in Heart Failure with Comorbidity: Lung Disease and Kidney Disease

Gurwitz

Magid

Smith

et al. 2017

J American Geriatrics Society

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OBJECTIVES Recognizing the challenges of therapeutic decision-making for heart failure (HF) patients with comorbid conditions, our study objectives were to assess: (1) the clinical effectiveness of beta-blocker therapy in patients with HF and chronic lung disease; and (2) the clinical effectiveness of ACE inhibitors/angiotensin II receptor blockers (ARBs) in patients with HF and chronic kidney disease. DESIGN Retrospective cohort study. SETTING Large community-based cohorts of HF patients. PARTICIPANTS Patients with HF with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF). METHODS We undertook separate new-user cohort studies to assess the effectiveness of: (1) beta-blocker therapy in HF and chronic lung disease; and (2) ACE inhibitors/angiotensin II receptor blockers (ARBs) in HF and chronic kidney disease. For the HF-chronic lung disease dyad group, we included patients who had a chronic lung disease diagnosis (ICD-9 codes 490-496, 518). For the HF-chronic kidney disease dyad group, we included patients who had an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2. The clinical outcomes of interest were death from any cause, hospitalization for HF, and hospitalization from any cause. We fitted pooled logistic marginal structural models (MSM) using inverse probability weighting, stratified by HF type. RESULTS Among HFrEF patients with chronic lung disease, beta-blocker therapy was protective for death (RR 0.58, 95% confidence interval (CI) 0.44–0.77) and hospitalization for HF (RR 0.78, 95% CI 0.60–1.00). Among those with HFpEF, no statistically significant associations of beta-blocker therapy use with any of the outcomes were observed. We found ACE inhibitor/ARB use to be protective for all three outcomes of interest for patients with HFrEF including death from any cause, hospitalization for HF, and hospitalization from any cause (RR 0.60, 95% 0.40–0.91; RR 0.43, 95% CI 0.28–0.67; and RR 0.63, 95% CI 0.45–0.89, respectively), as well as for patients with HFpEF (RR 0.52, 95% CI 0.33–0.81; RR 0.35, 95% CI 0.18–0.68; and RR 0.67, 95% CI 0.47–0.95, respectively). CONCLUSION Large observational studies may allow for the identification of important subgroups of the HF population that might benefit from existing treatment approaches. Our findings may also better inform the design of more definitive future observational studies and randomized trials.

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“…Many patients who survive from myocardial infarction (MI) are often left with a significant impairment of left ventricular systolic function due to ischemic cardiomyopathy triggering the remodeling of the left ventricle and fibrosis. Ischemic cardiomyopathy can lead to a poor quality of life and a poor prognosis with high mortality of more than 25% within the first year of diagnosis [2,3]. Current treatment strategies, including optimal pharmacotherapy, cardiac resynchronization therapy, and implantable cardioverter-defibrillators, slow progression of the MI to heart failure, improve systolic function, and prevent fatal arrhythmias that can cause sudden cardiac death [4][5][6][7]; however, they cannot stimulate cell regeneration to recover the loss of functional myocytes.…”

Section: Introductionmentioning

confidence: 99%

Current Concepts in Stem Cell Therapy for Cardiovascular Diseases: What We Know and Don't Know

Jeon

2015

Hanyang Med Rev

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Medical therapies and mechanical interventions for the treatment of myocardial infarction (MI) and ischemic heart failure have seen great progress. However, current therapies only slow the progression to heart failure, but do not stimulate regeneration to recover the loss of functional myocytes. Stem cell-based therapy is a novel modality that can potentially be used for the treatment of ischemic cardiac injury and heart failure wherein cardiac tissue is regenerated thereby improving cardiac function and reducing the morbidity and mortality of patients. Many preclinical and clinical trials have employed various types of stem cells including bone marrow-derived mononuclear cells, skeletal myoblasts, resident cardiac stem cells, mesenchymal stem cells, and endothelial progenitor cells, and these studies have suggested great potential for the clinical application of stem cell therapy for cardiac disease. Here we will review and summarize the current evidence indicating the potential of stem cell therapy, focusing on the clinical trials conducted to date. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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The Average Lifespan of Patients Discharged from Hospital with Heart Failure

Abstract: The development of risk-adjusted life-tables for heart failure populations is feasible and mirrored those with advanced malignant diseases. Average life span varied widely across clinical risk strata, and may be less accurate among those at or near their end of life.

Cited by 49 publications

References 50 publications

Relationship Between Care Gaps and Projected Life Expectancy After Acute Myocardial Infarction

Relationship Between Care Gaps and Projected Life Expectancy After Acute Myocardial Infarction

Treatment Effectiveness in Heart Failure with Comorbidity: Lung Disease and Kidney Disease

Current Concepts in Stem Cell Therapy for Cardiovascular Diseases: What We Know and Don't Know

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