Precipitating factors and decision-making processes of short-term worsening heart failure despite “optimal” treatment (from the IN-CHF Registry)

Opasich, Cristina; Rapezzi, Claudio; Lucci, Donata; Gorini, Marco; Pozzar, F; Zanelli, Emanuela; Tavazzi, Luigi; Maggioni, Aldo P.

doi:10.1016/s0002-9149(01)01683-6

Cited by 124 publications

(72 citation statements)

References 23 publications

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“…Despite recent advances in care, HF outcomes remain poor, and hospitalizations related to HF have increased 289% over the past 2 decades, 11 with up to 55% of hospital admissions being potentially preventable. [32][33][34][35] For physicians who treat the nearly 5 million patients with HF in the United States, 11 mostly on an outpatient basis, the critical challenge is to effectively identify those patients at risk for subsequent clinical deterioration so that monitoring and therapy can be intensified and adverse events (including hospitalizations) can be prevented. Although current American College of Cardiology/American Heart Association (ACC/AHA) guidelines state that an "ongoing review of the patient's clinical status is critical to the appropriate selection and monitoring of treatments," 22 they provide few tools to assist clinicians in monitoring their patients.…”

Section: Discussionmentioning

confidence: 99%

Identifying Heart Failure Patients at High Risk for Near-Term Cardiovascular Events With Serial Health Status Assessments

et al. 2007

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Background-Identification of heart failure outpatients at increased risk for clinical deterioration remains a critical challenge, with few tools currently available to assist clinicians. We tested whether serial health status assessments with the Kansas City Cardiomyopathy Questionnaire (KCCQ) can identify patients at increased risk for mortality and hospitalization. Methods and Results-We evaluated 1358 patients with heart failure after an acute myocardial infarction in the Eplerenone's Neurohormonal Efficacy and Survival Study, a multicenter randomized trial that included serial KCCQ assessments. Cox proportional-hazards models were used to examine whether changes in KCCQ scores during successive outpatient visits were independently associated with all-cause mortality and cardiovascular mortality or hospitalization. Change in KCCQ (⌬KCCQ) was linearly associated with all-cause mortality (hazard ratio [HR], for each 5-point decrease in ⌬KCCQ, 1.11; 95% CI, 1.04 to 1.19) and the combined outcome of cardiovascular mortality or hospitalization (HR for each 5-point decrease in ⌬KCCQ, 1.12; 95% CI 1.07 to 1.18). In Kaplan-Meier survival analysis, all-cause mortality among patients with ⌬KCCQ of ՅϪ10, ϾϪ10 to Ͻ10, and Ͼ10 points was 26%, 16%, and 13%, respectively (Pϭ0.008). After multivariable adjustment, the linear relationship between ⌬KCCQ and both all-cause mortality and combined cardiovascular death and hospitalization persisted (HR, 1.09; 95% CI, 1.00 to 1.18; and HR, 1.11; 95% CI, 1.05 to 1.17 for each 5-point decrease in ⌬KCCQ, respectively). Conclusions-In heart failure outpatients, serial health status assessments with the KCCQ can identify high-risk patients and may prove useful in directing the frequency of follow-up and the intensity of treatment.

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Section: Discussionmentioning

confidence: 99%

Identifying Heart Failure Patients at High Risk for Near-Term Cardiovascular Events With Serial Health Status Assessments

et al. 2007

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“…It has been shown previously that many CHF patients fail to comply with their physician's instructions, e.g. by not taking prescribed medication or non-compliance with fluid intake restrictions [22,23]. Thus, enhancement of patient compliance due to the alert may have influenced our results in some events, and may play a hitherto underestimated effect in the management of CHF.…”

Section: Nt-probnp and Device Alertsmentioning

confidence: 92%

“…Thus, it has been suggested to evaluate relative changes in BNP levels rather than absolute values for individual therapy optimization [19]. Different studies have found a significant correlation between BNP, pulmonary capillary wedge pressure and left ventricular end-diastolic pressure [22][23][24]. Yu et al [8] retrospectively analysed trends in intrathoracic impedance in patients hospitalised for cardiac decompensation and revealed an inverse correlation between intrathoracic impedance and pulmonary capillary wedge pressure.…”

Section: Nt-probnp and Intrathoracic Impedancementioning

confidence: 99%

Intrathoracic impedance monitoring to detect chronic heart failure deterioration: Relationship to changes in NT‐proBNP

Lüthje

Vollmann

Drescher

et al. 2007

European J of Heart Fail

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Background: An alert algorithm, based on intrathoracic impedance monitoring, has been incorporated into a cardiac resynchronisation device (CRT) to detect pulmonary fluid accumulation, and to audibly alert patients to decompensating chronic heart failure (CHF). Aims: To evaluate this algorithm, alert events were correlated with changes in NT-proBNP concentration and CHF status. Methods and results: In a prospective observational study of 62 patients (89% male, aged 67 ± 1 year), NT-proBNP plasma concentrations, clinical CHF status, and device data were collected at enrolment, during regular follow-up and at device alerts. Over a mean follow-up of 27 ± 2 weeks, pooled data indicated a weak, but significant inverse relationship between relative changes in intrathoracic impedance and NT-proBNP (r = −0.3; p b 0.001). In 52 device alerts from 35 patients, NT-proBNP increased by 66 ± 19% from 2039 ± 331 pg/ml (p b 0.001). The increase in NT-proBNP was higher in alerts with clinical signs of CHF deterioration (n = 30, 89 ± 25%; p b 0.001) than in alert events without clinical signs (n = 22, 25 ± 15%; p =n.s.). Conclusion: Intrathoracic impedance based alert events are associated with a significant increase in NT-proBNP concentration. These data indicate that intrathoracic impedance monitoring might facilitate the outpatient management of CHF patients with implanted CRT devices.

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“…It has been proposed that these admissions are largely preventable, as the majority of HF rehospitalisations can be attributed to ineffective self-care [12][13][14][15][16][17][18][19][20]. Part of HF self-care includes recognising worsening HF symptoms early and appropriately interpreting their meaning in order to prompt care-seeking behaviour.…”

Section: Introductionmentioning

confidence: 99%

Care-seeking decisions for worsening symptoms in Heart Failure: a qualitative metasynthesis

Ivynian

DiGiacomo

Jha

et al. 2015

Heart, Lung and Circulation

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Purpose: Over 50% of heart failure (HF) patients delay seeking help for worsening symptoms until these reach acute levels and require emergency hospitalisation. This metasynthesis aimed to identify and explore factors influencing timely care-seeking in patients with HF.Methods: Electronic databases searched were Medline, EMBASE and CINAHL. Studies were included if they were peer reviewed journal articles written in English, and reported perspectives of HF patients following qualitative data collection and analysis. Forty articles underwent analysis following the approach of Thomas and Harden. Leventhal's self-regulatory model (SRM) was used to organise the literature.Results: Much of the literature fit within the SRM, however this model did not account for all factors that influence patients' care-seeking for worsening symptoms. Factors not accounted for included patients' appraisals of previous care-seeking experiences, perceived system and provider barriers to accessing care, and the influence of external appraisals. When added to factors already represented in the model, such as misattribution of symptoms, not identifying with HF diagnosis, cognitive status, lack of understanding information provided, adaptation to symptoms, and emotional responses, a more comprehensive account of patients' decision-making was revealed.Implications: This metasynthesis identified factors, as yet unaccounted for, in a prominent model, and has suggested a more comprehensive framework for addressing care-seeking in HF patients. This information can be used to tailor education, communication, and service initiatives to improve HF patients' responses to worsening symptoms, and target those most at risk of delay.

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Precipitating factors and decision-making processes of short-term worsening heart failure despite “optimal” treatment (from the IN-CHF Registry)

Cited by 124 publications

References 23 publications

Identifying Heart Failure Patients at High Risk for Near-Term Cardiovascular Events With Serial Health Status Assessments

Identifying Heart Failure Patients at High Risk for Near-Term Cardiovascular Events With Serial Health Status Assessments

Intrathoracic impedance monitoring to detect chronic heart failure deterioration: Relationship to changes in NT‐proBNP

Care-seeking decisions for worsening symptoms in Heart Failure: a qualitative metasynthesis

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