The futile cycle of hospital readmission in patients with diabetes

Swami, Janya; Korytkowski, Mary T.

doi:10.1016/j.jdiacomp.2017.06.006

Cited by 4 publications

(3 citation statements)

References 18 publications

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“… 7 Many patients will be readmitted multiple times within a year of first hospitalisation, in what seems a futile cycle of readmission and discharge. 8 This represents an enormous burden to patients, the health system, and the financial structures that support them. So much so that the prevention of readmission for heart failure has been prioritised, closely audited, and in some countries targeted by pay-for-performance incentives, with financial penalties for hospitals with the highest readmission rates.…”

Section: Introductionmentioning

confidence: 99%

Perspective Review: Type 2 Diabetes and Readmission for Heart Failure

Thomas

2018

Clin Med Insights Cardiol

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Heart failure is a leading cause for hospitalisation and for readmission, especially in patients over the age of 65. Diabetes is an increasingly common companion to heart failure. The presence of diabetes and its associated comorbidity increases the risk of adverse outcomes and premature mortality in patients with heart failure. In particular, patients with diabetes are more likely to be readmitted to hospital soon after discharge. This may partly reflect the greater severity of heart disease in these patients. In addition, agents that reduce the chances of readmission such as β-blockers, renin-angiotensin-aldosterone system blockers, and mineralocorticoid receptor antagonists are underutilised because of the perceived increased risks of adverse drug reactions and other limitations. In some cases, readmission to hospital is precipitated by acute decompensation of heart failure (re-exacerbation) leading to pulmonary congestion and/or refractory oedema. However, it appears that for most of the patients admitted and then discharged with a primary diagnosis of heart failure, most readmissions are not due to heart failure, but rather due to comorbidity including arrhythmia, infection, adverse drug reactions, and renal impairment/reduced hydration. All of these are more common in patients who also have diabetes, and all may be partly preventable. The many different reasons for readmission underline the critical value of multidisciplinary comprehensive care in patients admitted with heart failure, especially those with diabetes. A number of new strategies are also being developed to address this area of need, including the use of SGLT2 inhibitors, novel nonsteroidal mineralocorticoid antagonists, and neprilysin inhibitors.

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Section: Introductionmentioning

confidence: 99%

Perspective Review: Type 2 Diabetes and Readmission for Heart Failure

Thomas

2018

Clin Med Insights Cardiol

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“…Sumber lain juga mencatat bahwa kejadian komplikasi dan penyakit penyerta merupakan salah satu hambatan utama bagi pasien diabetes dalam menjalankan self-management yang berdampak pada meningkatnya angka rawat inap (Lin, Kent, Winn, Cohen, & Neumann, 2015;Swami & Korytkowski, 2017), menurunkan capaian target terapi (Magnan dkk, 2015), menurunkan kualitas hidup (Adriaanse, Drewes, van der Heide, Struijs, & Baan, 2016) serta menurunkan prognosis dan meningkatkan angka kematian (Ang, Heng, Saxena, Liew, & Chong, 2016;Palsson & Patel, 2014).…”

Section: Pertimbangan Etikunclassified

Self Management Pasien Diabetes Melitus dengan Komplikasi Kardiovaskular dan Implikasinya terhadap Indikator Klinik

Kurniawan¹,

Sari

Aisyah

2020

JPKI

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ABSTRAKPenyakit kardiovaskular merupakan salah satu komplikasi utama diabetes melitus (DM) dan berisiko memperburuk prognosis, kualitas hidup serta meningkatkan risiko kematian. Self-management merupakan kunci utama dalam pengelolaan penyakit maupun pencegahan komplikasi dan dampak negatif yang diakibatkanya. Penelitian deskriptif ini bertujuan untuk mengidentifikasi self-management pada pasien DM dengan komplikasi kardiovaskular beserta dampaknya terhadap indikator klinik. Seluruh pasien (123 orang) diabetes mellitus yang didiagnosa menderita penyakit kardiovaskular (hipertensi, dislipidemia, dan/atau coronary artery diseases) dilibatkan dari unit rawat jalan salah satu rumah sakit swasta di Kota Bandung, Jawa Barat secara total sampling. Data self-management dikumpulkan menggunakan kuesioner yang dikembangkan oleh peneliti yang mencakup 6 domain (pemantauan, aktivitas fisik, pencegahan komplikasi, diet, pengobatan, dan merokok) dan mencakup 28 item pernyataan dengan skor Alpha Chronbach 0,738 dan validitas (r 0,377-0,760). Adapun data tentang indikator klinik dikumpulkan berdasarkan data sekunder dari rekam medik yang mencakup tekanan darah, kadar gula darah sewaktu, dan kadar kolesterol. Data yang terkumpul dianalisis menggunakan analisis deskriptif dan uji beda. Hasil penelitian menunjukkan lebih dari setengah responden (54,5%) berada pada kategori self-management rendah dimana domain pemantauan merupakan domain dengan persentase kategori rendah paling besar (62,6%). Rerata skor self-management yang lebih tinggi ditemukan pada pasien yang mencapai target indikator klinik; tekanan darah sistolik 140mmHg, kolesterol darah 200mg%, dan gula darah sewaktu 200mg%. Namun, perbedaan skor self-management yang signifikan hanya ditemukan pada indikator gula darah (p = 0,05). Hasil penelitian ini menunjukkan bahwa pasien DM dengan komplikasi kardiovaskular di tempat penelitian ini perlu meningkatkan perilaku self-management terutama dalam aspek pemantauan. Penting juga bagi pihak rumah sakit untuk mengintensifkan upaya yang sudah dijalankan guna memfasilitasi kebutuhan tersebut. ABSTRACTCardiovascular problem is one of the main diabetes mellitus complications that potentially worsen patients’ prognosis, quality of life as well as increase the patient mortality rate. Self-management in the other hand is a key success of diseases management and complication prevention. This descriptive study aimed to identify self-management of diabetic patients who diagnosed with cardiovascular diseases and its impact on clinical indicators. All 123 diabetic patients with cardiovascular diseases (hypertension, dyslipidaemia, dan coronary artery diseases) were involved in this study (total sampling) and recruited from an outpatient clinic of a private hospital in Bandung Municipality, West-Java. Data self-management were collected using questionnaire developed by the researcher covering 6 domains (monitoring, Physical exercise, complication management and prevention, diet, medication and smoking) consisted of 28 items with Alpha Chronbach 0,738 and inter-item correlation r 0.377 - 0.760. Data regarding clinical indicators were secondarily collected from patients’ medical record including current blood pressure, blood sugar level and cholesterol level. Collected data were analysed descriptively and comparatively with significance at p 0.05. The results suggested that more than half patients (54.5%) report low level of self-management where monitoring domain found as the domain with the biggest percentage of low self-management category (62.6%). In addition, respondents with higher mean score of self-management was found in patient who achieved the clinical outcomes; blood pressure 140mmHg, cholesterol 200mg%, and blood glucose 200mg%. However, statistically significant finding only identified in blood glucose indicator (p = 0.05). These results indicated that diabetic patients with cardiovascular problem in this setting need program or strategy to improve their capability in performing self-management particularly in the monitoring aspect. It also is significance for hospital to address those issues.

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“…Worldwide, the mortality of chronic heart failure in patients within 5 years is over 50% [3,4]. Previous study has showed that almost two third patients experienced a readmission, 35.8% died of the hospitalization [5] and numerous patients will be readmitted once more within a year [6]. This brings about an enormous nancial burden on patients, families and society.…”

Section: Million Inmentioning

confidence: 99%

Analysis of differential gene expression of heart failure based on Gene Expression Omnibus database

Yan

Wang

Hou

et al. 2020

Preprint

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Background To screen and identify key genes involved in heart failure and explore underlying molecular mechanisms. Methods The expression profile of GSE26887 was downloaded from Gene Expression Omnibus (GEO), which contained 24 samples, including 19 left ventricle cardiac tissue of heart failure and 5 controls. The differentially expressed genes (DEGs) were obtained and got further analysis by bioinformatics methods. The DEGs and volcano plot were acquired with the use of ‘lima’ package in ‘R’ software and heat map was drawn through the ‘heatmap’ package. Gene ontology (GO) and pathway analysis of DEGs were performed by means of Database for Annotation, Visualization and Integrated Discovery (DAVID) and Kyoto Encyclopedia of Genes and Genomes (KEGG) online analyses, respectively. The DEGs interaction and network map were constructed through Search Tool for the Retrieval of Interacting Genes (STRING ) database and Cystoscope(v3.6.0)software. Results The transcriptome analysis of left ventricle cardiac tissue showed that 236 genes were differentially expressed between heart failure and control, of which 124 were significantly upregulated (P < 0.01) and 101 genes downregulated (P < 0.01). GO analysis uncovered that DEGs were enriched in extracellular space, extracellular matrix, extracellular matrix organization, cell adhesion, proteinaceous extracellular matrix and heparin binding. Thus, the function of extracellular matrix is mainly affected. The KEGG pathway enrichment indicated that the DEGs were involved in eight pathways, of these pathways, ECM-receptor interaction, Drug metabolism-cytochrome P450 and Pathogenic Escherichia coli infection are dominant. Protein-protein interaction (PPI) revealed the interactions of 30 protein products encoded of DEGs. Of the 30 protein products, the critical gene, called Interleukin-6 (IL6), was identified with the use of Cystoscope software. Conclusion Extracellular matrix and IL6 play an important role in the development of heart failure. Functional annotation and pathway analysis of these main genes were identified, which provide the basis for insight into the underlying pathogenetic mechanisms and predicting therapeutic targets of heart failure.

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The futile cycle of hospital readmission in patients with diabetes

Cited by 4 publications

References 18 publications

Perspective Review: Type 2 Diabetes and Readmission for Heart Failure

Perspective Review: Type 2 Diabetes and Readmission for Heart Failure

Self Management Pasien Diabetes Melitus dengan Komplikasi Kardiovaskular dan Implikasinya terhadap Indikator Klinik

Analysis of differential gene expression of heart failure based on Gene Expression Omnibus database

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