High prevalence of undetected heart failure in long‐term care residents: findings from the Heart Failure in Care Homes (HFinCH) study

Hancock, Helen; Close, Helen; Mason, James; Murphy, Jerry; Fuat, Ahmet; Singh, Randhir; Wood, Esther; Belder, Mark de; Brennan, G.; Hussain, Nehal; Kumar, Nitin; Wilson, Doug; Hungin, A. P. S.

doi:10.1093/eurjhf/hfs165

Cited by 58 publications

(53 citation statements)

References 37 publications

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“…Hancock et al found a prevalence of AHF in almost a quarter of older residents in long-term care facilities, while Oudejans et al reported a prevalence of 46% in older patients admitted to hospital with HF symptoms. 1,27 The mean age and gender distributions of patients of these studies were comparable to those of our study population. As in our study, the final diagnosis of AHF was adjudicated in those studies by two specialists independently reviewing echocardiography, ECG, and physical findings indicating high quality of analysis.…”

Section: Acute Heart Failure In the Elderlysupporting

confidence: 75%

“…Of note, the Heart Failure in Care Homes (HFinCH) Diagnostic Accuracy Study suggested that up to half of older HF patients were undiagnosed, while three-quarters of patients previously diagnosed with HF had been misclassified. 1 Symptoms and signs might be substantially less clear in older patients compared to younger individuals, and they may be more difficult to detect due to the presence of one or several comorbid conditions. 27 …”

Section: Acute Heart Failure In the Elderlymentioning

confidence: 99%

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Multiple biomarker strategy for improved diagnosis of acute heart failure in older patients presenting to the emergency department

Bahrmann¹,

Bahrmann

Hofner

et al. 2014

European Heart Journal: Acute Cardiovascular Care

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Aim: Biomarkers can help to identity acute heart failure (AHF) as the cause of symptoms in patients presenting to the emergency department (ED). Older patients may prove a diagnostic challenge due to co-morbidities. Therefore we prospectively investigated the diagnostic performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) alone or in combination with other biomarkers for AHF upon admission at the ED. Methods: 302 non-surgical patients aged ≥ 70 years were consecutively enrolled upon admission to the ED. In addition to NT-proBNP, mid-regional pro-adrenomedullin (MR-proADM), mid-regional pro-atrial natriuretic peptide (MRproANP), C-terminal pro-endothelin-1 (CT-proET-1) and ultra-sensitive C-terminal pro-vasopressin (Copeptin-us) were measured at admission. Two cardiologists independently adjudicated the final diagnosis of AHF after reviewing all available baseline data excluding the biomarkers. We assessed changes in C-index, integrated discrimination improvement (IDI), and net reclassification improvement (NRI) for the multimarker approach. Results: AHF was diagnosed in 120 (40%) patients (age 81±6 years, 64 men, 56 women). Adding MR-ADM to NT-proBNP levels improved C-index (0.84 versus 0.81; p=0.045), and yielded IDI (3.3%; p=0.002), NRI (17%, p<0.001) and continuous NRI (33.3%; p=0.002). Adding CT-proET-1 to NT-proBNP levels improved C index (0.86 versus 0.81, p=0.031), and yielded robust IDI (12.4%; p<0.001), NRI (31.3%, p<0.001) and continuous NRI (69.9%; p<0.001). No other dual or triple biomarker combination showed a significant improvement of both C-index and IDI. Conclusion: In older patients presenting to the ED, the addition of CT-proET-1 or MR-proADM to NT-proBNP improves diagnostic accuracy of AHF. Both dual biomarker approaches offer significant risk reclassification improvement over NT-proBNP.

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Section: Acute Heart Failure In the Elderlysupporting

confidence: 75%

Section: Acute Heart Failure In the Elderlymentioning

confidence: 99%

Multiple biomarker strategy for improved diagnosis of acute heart failure in older patients presenting to the emergency department

Bahrmann¹,

Bahrmann

Hofner

et al. 2014

European Heart Journal: Acute Cardiovascular Care

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“…The reported prevalence of HF in nursing homes ranges from 20.0 to 37.4 %. 7 The Heart Failure in Care Homes (HFinCH) study 8 found a higher prevalence of HF in UK care-facility residents aged 65-100 years than in community populations. Most cases were previously undiagnosed and three-quarters of previously recorded cases were unconfirmed using the latest European Society of Cardiology (ESC) guidelines, echocardiogram and brain natriuretic peptide measurements.…”

Section: Care Planning In Skilled Nursing Facilitiesmentioning

confidence: 99%

Chronic Heart Failure Care Planning: Considerations in Older Patients

Hill

Taylor

2017

Cardiac Failure Review

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In developed countries, it is estimated that 1-2 % of the adult population has heart failure (HF), with the prevalence increasing to more than 10 % in those aged >70 years.1 Despite advances in therapies for heart failure with reduced ejection fraction (HFrEF), it remains a condition associated with significant morbidity and mortality, punctuated by episodes of unplanned hospitalisation. 2HF is one of the commonest causes of unscheduled hospital admissions 3 and data consistently show a lower uptake of evidencebased investigations and therapies in adults >75 years as well as higher HF-related mortality.4 Mortality and rehospitalisation rates are higher amongst patients discharged to skilled nursing facilities than those going home. 5 Older patients more frequently experience comorbidities, frailty, polypharmacy and cognitive impairment and these factors have a significant impact on outcomes. These aspects require proper evaluation to best assess and plan patients' long-termcare needs.In this review, we examine HF-care planning in relation to older patients. While current guidance has its limitations, we offer here a pragmatic approach to care planning in this patient population. Care Planning in Skilled Nursing FacilitiesWhile the majority of older people live at home alone, or with carers, in the UK 16 % of people aged >85 years live in care homes. 6 The spectrum of care ranges from sheltered housing to a variety of assisted living facilities, residential and nursing homes. The reported prevalence of HF in nursing homes ranges from 20.0 to 37.4 %. 7The Heart Failure in Care Homes (HFinCH) study 8 found a higher prevalence of HF in UK care-facility residents aged 65-100 years than in community populations. Most cases were previously undiagnosed and three-quarters of previously recorded cases were unconfirmed using the latest European Society of Cardiology (ESC) guidelines, echocardiogram and brain natriuretic peptide measurements. AbstractIn developed countries, it is estimated that more than 10 % of adults aged over 70 years have heart failure (HF). Despite therapeutic advances, it remains a condition associated with significant morbidity and mortality. It is one of the commonest causes of unscheduled hospital admissions in older adults and data consistently show a lower uptake of evidence-based investigations and therapies as well as higher rates of HF hospitalisations and mortality than in younger adults. These rates are highest amongst patients discharged to 'skilled nursing facilities', where comorbidities, frailty and cognitive impairment are common and have a significant impact on outcomes. In this review, we examine current guidance and its limitations and offer a pragmatic approach to management of HF in this elderly population.

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“…The precise prevalence of HF among SNF residents is unknown, with estimates ranging between 20% and 37.4%. 2,[16][17][18][19] Of the estimated 1 492 200 Americans (nearly 0.5% of the total US population) living as long-term residents in SNFs, 3 1 317 200 (nearly 90%) were ≥65 years of age, representing nearly 5% of the population aged ≥65 years. More than 70% of these were women, and nearly half were ≥85 years old.…”

Section: Epidemiology Of Hf In Snfsmentioning

confidence: 99%

Heart Failure Management in Skilled Nursing Facilities

Jurgens¹,

Goodlin²,

Dolansky³

et al. 2015

Circ: Heart Failure

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655H eart failure (HF) is a complex syndrome in which structural or functional cardiac abnormalities impair the filling of ventricles or left ventricular ejection of blood. HF disproportionately occurs in those ≥65 years of age.1 Among the estimated 1.5 to 2 million residents in skilled nursing facilities (SNFs) in the United States, cardiovascular disease is the largest diagnostic category, and HF is common. 2,3Despite the high prevalence of HF in SNF residents, none of the large randomized clinical trials of HF therapy included SNF residents, and very few included patients >80 years of age with complex comorbidities.Several issues make it important to address HF care in SNFs. The healthcare environment and characteristics of SNF residents are distinct from those of community-dwelling adults. Comorbid illness unrelated to HF (eg, dementia, hip fracture) increases with age >75 years, and these conditions may complicate both the initial HF diagnosis and ongoing management. [4][5][6] Morbidity and mortality rates are significantly increased for hospitalized older adults with HF discharged to SNFs compared with those discharged to other sites. 7Transitions between hospitals and SNFs may be problematic. 8SNF 30-day rehospitalization rates for HF range from 27% to 43%, 7,9,10 and long-term care residents sent to the emergency department are at increased risk for hospital admission and death.11 The purpose of this scientific statement is to provide guidance for management of HF in SNFs to improve patientcentered outcomes and reduce hospitalizations. This statement addresses unique issues of SNF care and adapts HF guidelines and other recommendations to this setting. MethodsThis scientific statement on HF management in SNFs was developed by a writing group of experts representing nursing, medicine (cardiology, geriatrics, nursing home physicians, and palliative medicine), pharmacology, physical therapy, dietary clinical management, research, and quality of care. Sponsors (the American Heart Association [AHA] and the Heart Failure Society of America) identified specific members of the writing group, and others were selected on the basis of known expertise. A literature search was performed using the key The current document is solely the responsibility of the authors and does not represent the official views of the National Heart, Lung, and Blood Institute or the Department of Health and Human Services.The American Heart Association and the Heart Failure Society of America make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This document was approved by the American Heart Association Science Advisory and Coordinating Committee on September 15, 2014, and by the...

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High prevalence of undetected heart failure in long‐term care residents: findings from the Heart Failure in Care Homes (HFinCH) study

Cited by 58 publications

References 37 publications

Multiple biomarker strategy for improved diagnosis of acute heart failure in older patients presenting to the emergency department

Multiple biomarker strategy for improved diagnosis of acute heart failure in older patients presenting to the emergency department

Chronic Heart Failure Care Planning: Considerations in Older Patients

Heart Failure Management in Skilled Nursing Facilities

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