Heart failure: Evaluation and care of patients with left ventricular systolic dysfunction

Konstam, Marvin A.; Dracup, Kathleen; Baker, David W.; Bottorff, Michael B.; Brooks, Neil; Dacey, Robert A.; Dunbar, Sandra B.; Jackson, Anne B.; Jessup, Mariell; Johnson, Jerry; Jones, Robert H.; Luchi, Robert J.; Massie, Barry M.; Pitt, Bertram; Rose, Eric A.; Rubin, Lewis J.; Wright, Richard F.; Hadorn, David C.

doi:10.1016/1071-9164(95)90021-7

Cited by 222 publications

(173 citation statements)

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“…The extent of the public health care problem associated with heart failure is similar to that found in other countries [5, 16±21]. In one United States cost-of-illness study, the total health care cost for heart failure was estimated at more than $10 000 million in 1990 [5]. In another more detailed United States cost-of-illness study, the estimate was found to be even higher.…”

Section: Discussionsupporting

confidence: 70%

The health care costs of heart failure in Sweden

Rydén‐Bergsten

Andersson

1999

Journal of Internal Medicine

139

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Abstract. Ryde Ân-Bergsten T, Andersson F (AstraZeneca R&D, Lund; and AstraZeneca R&D, Mo Èlndal; Sweden). The health care costs of heart failure in Sweden. J Intern Med 1999; 246: 275±284.Aim. Heart failure is a common and serious condition requiring extensive health care resources. The aim of this study is to estimate the total treatment costs of heart failure in Sweden.Methods and results. The study is a prevalencebased cost-of-illness study. It includes costs of institutional care (hospitals and nursing homes), outpatient care, surgery and drugs. The costs are estimated based on official Swedish statistics, and on various clinical and epidemiological studies. The results are expressed in 1996 prices. The total annual treatment costs for heart failure are approximately Swedish kronor (SEK) 2000±2600 million, or nearly 2% of the Swedish health care budget. Institutional care is the single largest component, amounting to SEK 1300±1900 million, or about 65±75% of the costs of heart failure treatment. Conclusions. The results from this study indicate that heart failure is a costly condition. Efforts to develop effective management programmes that can reduce the need for expensive institutional care, without a negative impact on quality of life, morbidity and mortality, should be given high priority.

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Section: Discussionsupporting

confidence: 70%

The health care costs of heart failure in Sweden

Rydén‐Bergsten

Andersson

1999

Journal of Internal Medicine

139

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“…9 In addition, the major practice guidelines and some heart failure experts argue that many physicians have been too cautious in using ACE inhibitors, particularly among patients with relative hypotension or renal insufficiency. 8,9,19 Patients with asymptomatic hypotension or moderate renal insufficiency might benefit from the adequate dosage of these medications. 20,21 Our study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

“…7 The Agency for Health Care Policy and Research, the American College of Cardiology, and the American Heart Association all currently recommend the use of ACE inhibitors for patients with heart failure and left ventricular ejection fractions of 0.35 or less in their respective clinical practice guidelines. 8,9 A variety of studies originating from randomized controlled trials, 10,11 single institutions, 12,13 localized geographic areas, 14 and the pharmaceutical industry 15 suggest that physicians greatly underutilize ACE inhibitors. Given the prevalence of congestive heart failure, thousands of patients would benefit if physicians prescribed these therapeutic agents appropriately.…”

mentioning

confidence: 99%

Differences in generalist and specialist physicians’ knowledge and use of angiotensin-converting enzyme inhibitors for congestive heart failure

et al. 1997

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OBJECTIVE:To quantify the extent and determinants of underutilization of angiotensin-converting enzyme (ACE) inhibitors for patients with congestive heart failure, especially with respect to physician specialty and clinical indication. DESIGN:Survey of a national systematic sample of physicians. PARTICIPANTS:Five hundred family practitioners, 500 general internists, and 500 cardiologists. MEASUREMENTS AND MAIN RESULTS:Physicians' choice of medications were determined for four hypothetical patients with left ventricular systolic dysfunction: (1) new-onset, symptomatic; (2) asymptomatic; (3) chronic heart failure, on digitalis and diuretic; and (4) asymptomatic, post-myocardial infarction. For each patient, randomized controlled trials have demonstrated that ACE inhibitors decrease mortality or the progression of symptoms. Among the 727 eligible physicians returning surveys (adjusted response rate 58%), approximately 90% used ACE inhibitors for patients with chronic heart failure who were already taking digitalis and a diuretic. However, family practitioners and general internists chose ACE inhibitors less frequently ( p Յ .01) than cardiologists for the other indications. Respective rates of ACE inhibitor use for each simulated patient were new-onset, symptomatic (family practitioners 72%, general internists 76%, cardiologists 86%); asymptomatic (family practitioners 68%, general internists 78%, cardiologists 93%); and asymptomatic, postmyocardial infarction (family practitioners 58%, general internists 70%, cardiologists 94%). Compared with generalists, cardiologists were more likely ( p Յ .05) to increase ACE inhibitors to a target dosage (45% vs 26%) and to tolerate systolic blood pressures of 90 mm Hg or less (43% vs 15%). he appropriate role of generalist and specialist physicians in the care of patients is controversial. 1 It is generally assumed that the sickest, most complicated patients, as well as patients with rare disorders, benefit most from specialty care. However, the majority of patients with chronic diseases such as heart failure, diabetes, or chronic obstructive pulmonary disease initially are not severely ill, and are therefore first seen by the generalist physician. The most cost-effective threshold for specialty referral and the optimal mix of generalist and specialist care remain unknown. 2 Congestive heart failure is an ideal model to study variation in physicians' practice patterns among patients with chronic disease. This syndrome is common and presently the domain of both generalist and specialist physicians. Advances in cardiac transplantation and hemodynamically titrated therapy have made some of the sickest patients clear candidates for referral to cardiologists. 3 Recently, however, multicenter trials of angiotensin-converting enzyme (ACE) inhibitors have modified the standard of treatment for a broad range of patients with heart failure. 4 These medications have been found to decrease mortality in patients with chronic heart failure and ejection fractions of 0.35 or less, 5 decrease...

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“…There were no significant gender differences regarding quality of life. Self-care behaviour did not change significantly from baseline (31, [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]) to 12 month (29 [22,). There were no gender differences in self-care behaviour measured by the EHFScBS between baseline and 12 months.…”

Section: Study Patientsmentioning

confidence: 99%

Telephone Follow-Up of Self-Care Behaviour after a Single Session Education of Patients with Heart Failure in Primary Health Care

Holst

Willenheimer

Mårtensson

et al. 2007

European Journal of Cardiovascular Nursing

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Background: Improved self-care behaviour is a goal in educational programmes for patients with heart failure, especially in regard to daily self-weighing and salt and fluid restriction. Aims: The objectives of the present study were to: (1) describe self-care with special regard to daily self-weighing and salt and fluid restriction in patients with heart failure in primary health care, during one year of monthly telephone follow-up after a single session education, (2) to describe gender differences in regard to self-care and (3) to investigate if self-care was associated with health-related quality of life. Methods: The present analysis is a subgroup analysis of a larger randomised trial. After one intensive educational session, a primary health care nurse evaluated 60 patients (mean age 79 years, 52% males, 60% in New York Heart Association class III–IV) by monthly telephone follow-up during 12 months. Results: The intervention had no effect on quality of life measured by EuroQol 5D and no significant associations were found between quality of life and self-care behaviour. Self-care behaviour measured by The European Self-care Behaviour Scale remained unchanged throughout the study period. No significant gender differences were shown but women had a tendency to improve adherence to daily weight control between 3- and 12 months. Conclusion: The self-care behaviour and quality of life in patients with heart failure did not change during one year of monthly telephone follow-up after a single session education and this indicates a need for more extensive interventions to obtain improved self-care behaviour in these patients.

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Heart failure: Evaluation and care of patients with left ventricular systolic dysfunction

Cited by 222 publications

References 0 publications

The health care costs of heart failure in Sweden

The health care costs of heart failure in Sweden

Differences in generalist and specialist physicians’ knowledge and use of angiotensin-converting enzyme inhibitors for congestive heart failure

Telephone Follow-Up of Self-Care Behaviour after a Single Session Education of Patients with Heart Failure in Primary Health Care

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