IntroductionHeart failure (HF) is one of the most common causes of hospitalization and readmissions. Approximately six million Americans are living with HF. Among patients with HF, hospitalization rate in the United States is higher for those over age 65, making it one of the leading causes of hospitalization in this age group. Furthermore, about 15% of those who were hospitalized with HF were readmitted within 30 days and 30% within 60 days. HF and chronic kidney disease (CKD) share many risk factors; therefore, it is expected that CKD is more prevalent in HF. About 50% of patients with HF also have concomitant CKD. Those patients have been found to have an increased risk of mortality and morbidity. This risk increases as glomerular filtration rate (GFR) decreases. Strategies to reduce the hospitalization rate in patients with HF include optimizing evidence-based drug and device therapies, addressing the causes of HF, treating comorbidities, and improving management of care. In our study, we aim to find an association between HF and the patient’s renal function as well as the GFR level. This study investigates the effect of renal function on HF morbidity and readmission rate.MethodsWe performed a retrospective study looking at 132 patients who were admitted to the hospital with HF and compared their measured GFR at three key time periods: admissions, discharges, and readmissions at 30 days. A Pearson product-moment correlation coefficient was calculated to determine the association between the GFR and readmission in HF admission cases.ResultsThere is a statistically significant difference in the readmission rate based on the change in GFR between admission and discharge (Admit GFR – Discharge GFR; t = 2.28; p < 0.05). We found that patients who were readmitted in 30 days had an average decrease in GFR by 2.46 ml/min/1.73 m2, whereas patients with a lower readmission rate had an average increase in GFR by 1.92 ml/min/1.73 m2.ConclusionA decline in renal function due to hospitalization in patients with renal failure is associated with an increase in readmission for HF. Providers should be cognizant of the need to optimize renal function as well as cardiac function during hospitalization.
Introduction: Survival and neurological outcomes from the out of hospital cardiac arrest (OHCA) varies from one region to another depending on the different practices followed by the emergency personnel. Our study looked into neuro-cognitive outcomes post OHCA before and after adopting a pit crew model approach in one of the largest counties in Kansas. Methods: The data was collected by the emergency medical services (EMS) before transitioning (from 2010 - 2012) and after transitioning (from 2013-2016) to the pit crew approach. The patient demographics and resuscitation variables were similar and comparable including the emergency and fire department personnel. The primary outcomes were the average number of pauses >10 seconds and the cerebral performance post return of spontaneous circulation (ROSC) Results: The average number of CPR pause time > 10 seconds post pit crew model was 1 vs 5 (p=0.01). Cerebral performance post return of spontaneous circulation using pit crew approach with good cerebral performance was 56% vs 47% (p=0.2), moderate cerebral disability was 17% vs 23% (p=0.19), severe cerebral disability was 8% vs 11% (p=0.44) and in coma/vegetative state was 8% vs 16% (p=0.001). Conclusion: This focused model of high-quality CPR performance with the individualized assigned task has shown a declining trend in the rates of cerebral disability especially with moderate and severe cerebral performance including the patients in coma or vegetative state. More studies with better neuro-cognitive follow-up care after ROSC is needed to further establish the superiority of pit crew model approach.
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