Home-Based Intervention in Congestive Heart Failure

Stewart, Simon; Horowitz, John D.

doi:10.1161/01.cir.0000019067.99013.67

Cited by 273 publications

(45 citation statements)

References 27 publications

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“…The observed deficit of memory and attention might be relevant to explain the reported low compliance with therapy of CHF patients [15,38,44]. Previous experience with dedicated units has shown that a comprehensive rehabilitation program can significantly improve both duration and quality of life in older CHF patients [6,32,33,37,38]. It remains to be defined whether it can halt or reverse cognitive deterioration as well as whether treating depression positively affects cognitive performance.…”

Section: Discussionmentioning

confidence: 99%

Cognitive impairment: a key feature of congestive heart failure in the elderly

Trojano

Incalzi

Acanfora

et al. 2003

Journal of Neurology

147

142

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Congestive heart failure (CHF) has been proposed as a possible cause of cognitive dysfunction but only a few studies have directly assessed cognitive performance in CHF. The aim of the present study was to compare the cognitive patterns of patients with CHF and patients having cardiovascular diseases uncomplicated by CHF (no-CHF group). In a multicenter observational case-control study, we studied 149 hospitalized elderly CHF patients in the New York Heart Association (NYHA) class II (CHFm, m: moderate), 159 CHF patients in NYHA class III-IV (CHFs, s: severe), and 207 no-CHF patients. Patients underwent a multidimensional assessment and neuropsychological tests for the following cognitive domains: attention, visual-spatial intelligence, verbal attainment, verbal and visuo-spatial memory. Neuropsychological performances of groups were compared by multivariate analysis. Correlates of an abnormal performance on at least three neuropsychological tests were assessed by logistic regression analysis. CHFs performed worse than no-CHF patients on 4 of the 7 neuropsychological measures, the largest difference being in tests of attention and verbal learning (p < 0.001). Prevalence of abnormal performance on at least 3 tests was 57.9 % in CHFs, 43% in CHFm and 34.3 % in no-CHF groups (chi square = 17.3, p < 0.0001). The following qualified as independent correlates of the outcome at logistic regression analysis: CHFs group membership (Odds Ratio-OR = 2.56, 95% Confidence Interval-CI = 1.49-4.40), depression (OR = 2.37, 95% CI = 1.54-3.66), hypertension (OR = 1.88, 95% CI = 1.18-2.99). Our results demonstrate that cognitive impairment is common among CHF patients and seems to be causally related to CHF severity, depression and hypertension. The cognitive dysfunction also characterizes a relevant fraction of patients with cardiovascular diseases uncomplicated by CHF.

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Section: Discussionmentioning

confidence: 99%

Cognitive impairment: a key feature of congestive heart failure in the elderly

Trojano

Incalzi

Acanfora

et al. 2003

Journal of Neurology

147

142

View full text Add to dashboard Cite

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“…There is no evidence that patients with milder forms of CHF are hospitalised more often today than in the past. Home-based care of patients with worsening CHF after initial discharge from hospital may reduce re-hospitalisation, mortality or both [23]. Many patients treated for CHF experience worsening symptoms long before seeking medical attention [22], which, if discovered earlier, might be managed at home rather than in hospital.…”

Section: Introductionmentioning

confidence: 99%

Patients with worsening chronic heart failure who present to a hospital emergency department require hospital care

et al. 2012

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BackgroundChronic heart failure (CHF) is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors.To characterise patients with CHF who seek an emergency department (ED) because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital.MethodPatients (n = 2,648) seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF.ResultsAlthough several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate.ConclusionThe vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.

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“…Interventions were initially chosen based upon the literature and hypothesized reasons for reduced follow-up by the primary investigator (KB), 10–15 and were reduced during the review to 10 interventions (Figure 1, Supplement). A five-point Likert scale was used to evaluate different interventions with respect to: 1) how likely each intervention would facilitate attending a post-discharge appointment (1= Very much to 5= Not at all) and 2) the likelihood of using an intervention if available (1= Absolutely to 5= Definitely not).…”

Section: Methodsmentioning

confidence: 99%

“…7–9 Consequently, offering appointments in the patient’s home, telephone visits, and telemedicine have been associated with reduction in readmissions for HF. 10–15 However, patient preferences about how to facilitate follow-up after HF hospitalization are ill-defined.…”

mentioning

confidence: 99%

Patient Perceptions on Facilitating Follow-Up After Heart Failure Hospitalization

Breathett

Damico

Adesanya

et al. 2017

Circ: Heart Failure

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Background Timely follow-up after hospitalization for heart failure (HF) is recommended. However, follow-up is suboptimal, especially in lower socioeconomic groups. Patient-centered solutions for facilitating follow-up post HF hospitalization have not been extensively evaluated. Methods and Results Face-to-face surveys were conducted between 2015 and 2016 among 83 racially diverse adult patients (61% African-American, 34% Caucasian, 5% Other) hospitalized for HF at a university hospital centered in a low-income area of Columbus, Ohio. Patient perceptions of methods to facilitate follow-up post HF hospitalization and likelihood of using interventions were investigated using a Likert scale: 1=very much to 5=not at all. Results were analyzed by Wilcoxon signed rank test with Bonferroni correction. The response rate was 82%. The annual household income was <$35,000 for 49% of patients. An appointment near the patient’s home was the most desired intervention (77%), followed by reminder message (73%), transportation to appointment (63%), and elimination of co-payment (59%). Interventions most likely to be used if provided were similarly ranked: reminder message (48%), appointment near home (46%), elimination of co-pay (46%), and transportation to appointment (39%). There were significant differences (p=0.001) in high-ranking interventions related to location (appointment near home, transportation, home appointment) and reminder for visit compared to low-ranking interventions related to time (weekend appointment, appointment after 5pm) and telemedicine. Conclusions Among this cohort of racially diverse low-income patients hospitalized with HF, an appointment near the patient’s home and a reminder message were the most desired interventions to facilitate follow-up. Further study of similar populations nationwide is warranted.

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Home-Based Intervention in Congestive Heart Failure

Cited by 273 publications

References 27 publications

Cognitive impairment: a key feature of congestive heart failure in the elderly

Cognitive impairment: a key feature of congestive heart failure in the elderly

Patients with worsening chronic heart failure who present to a hospital emergency department require hospital care

Patient Perceptions on Facilitating Follow-Up After Heart Failure Hospitalization

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