This document discusses management of acute heart failure, including pre-discharge and post-discharge care. It describes four clinical states of heart failure and emphasizes opportunities to prevent hospitalization during the pre-acute and post-acute phases. The CHAMPION trial found that managing heart failure guided by pulmonary artery pressure monitoring reduced heart failure hospitalizations compared to standard care. Post-discharge management strategies like nurse follow-up calls and physician visits in the first month were discussed to help prevent readmission.
We aimed to investigate the potential effects of fi x-dose atorvastatin plus amlodipine treatment and amlodipine alone treatment for 24 weeks on blood pressure, arterial stiffness and endothelial function in patients with hypertension and hypercholesterolemia. In a single-blinded, randomized, placebo-controlled and parallel design, 60 hypertensive and hypercholesterolemic patients were allocated to receive atorvastatin 10 mg/day plus amlodipine 5 mg/day or amlodipine 5 mg/day for 24 weeks. Central blood pressure was reduced significantly greater in atorvastatin plus amlodipine group than in amlodipine group after 12 and 24 weeksâ treatment. Both amlodipine and atorvastatin plus amlodipine therapy signifi cantly improved Flow-Mediated Dilation (FMD) compared to baseline (p < 0.01), the effect of atorvastatin plus amlodipine therapy was even greater after 24 weeks(p < 0.05). Atorvastatin plus amlodipine therapy signifi cantly decreased Heart Rate-Adjusted Augmentation Index (AIx@HR75), carotid-femoral and brachial-ankle Pulse Wave Velocity (PWV) when compared with baseline in both 12 weeks and 24 weeksâ administration, while amlodipine therapy not. FMD improvement was independently correlated with change in TC (ÎČ = -0.416, P = 0.004), while arterial stiffness improvement assessed with AIx@HR75 and baPWV, was correlated with change in central SBP (ÎČ = 0.772, P < 0.001, and ÎČ = 0.420, P = 0.003, respectively) in multivariate linear stepwise model. Fixed-dose amlodipine and atorvastatin treatment for 24 weeks reduced central BP and arterial stiffness, improved endothelial function greater than amlodipine therapy. Our findings suggested decrease in TC was the independent protective factor for endothelial function improvement and decrease in central SBP was the independent protective factor for arterial stiffness reduction during the follow-up period.
COMPARES OPTIMAL MEDICAL THERAPY WITH INVASIVE THERAPY IN A PATIENT WITH STABLE ISCHEMIC HEART DISEASE WITH MODERATE TO SEVERE MYOCARDIAL ISCHEMIA ON NON INVASIVE STRESS TESTING
We aimed to investigate the potential effects of fi x-dose atorvastatin plus amlodipine treatment and amlodipine alone treatment for 24 weeks on blood pressure, arterial stiffness and endothelial function in patients with hypertension and hypercholesterolemia. In a single-blinded, randomized, placebo-controlled and parallel design, 60 hypertensive and hypercholesterolemic patients were allocated to receive atorvastatin 10 mg/day plus amlodipine 5 mg/day or amlodipine 5 mg/day for 24 weeks. Central blood pressure was reduced significantly greater in atorvastatin plus amlodipine group than in amlodipine group after 12 and 24 weeksâ treatment. Both amlodipine and atorvastatin plus amlodipine therapy signifi cantly improved Flow-Mediated Dilation (FMD) compared to baseline (p < 0.01), the effect of atorvastatin plus amlodipine therapy was even greater after 24 weeks(p < 0.05). Atorvastatin plus amlodipine therapy signifi cantly decreased Heart Rate-Adjusted Augmentation Index (AIx@HR75), carotid-femoral and brachial-ankle Pulse Wave Velocity (PWV) when compared with baseline in both 12 weeks and 24 weeksâ administration, while amlodipine therapy not. FMD improvement was independently correlated with change in TC (ÎČ = -0.416, P = 0.004), while arterial stiffness improvement assessed with AIx@HR75 and baPWV, was correlated with change in central SBP (ÎČ = 0.772, P < 0.001, and ÎČ = 0.420, P = 0.003, respectively) in multivariate linear stepwise model. Fixed-dose amlodipine and atorvastatin treatment for 24 weeks reduced central BP and arterial stiffness, improved endothelial function greater than amlodipine therapy. Our findings suggested decrease in TC was the independent protective factor for endothelial function improvement and decrease in central SBP was the independent protective factor for arterial stiffness reduction during the follow-up period.
COMPARES OPTIMAL MEDICAL THERAPY WITH INVASIVE THERAPY IN A PATIENT WITH STABLE ISCHEMIC HEART DISEASE WITH MODERATE TO SEVERE MYOCARDIAL ISCHEMIA ON NON INVASIVE STRESS TESTING
Copyright 2016 American Medical Association. All rights reserv.docxmelvinjrobinson2199
Â
Copyright 2016 American Medical Association. All rights reserved.
Intensive vs Standard Blood Pressure Control
and Cardiovascular Disease Outcomes in Adults Aged â„75 Years
A Randomized Clinical Trial
Jeff D. Williamson, MD, MHS; Mark A. Supiano, MD; William B. Applegate, MD, MPH; Dan R. Berlowitz, MD; Ruth C. Campbell, MD, MSPH;
Glenn M. Chertow, MD; Larry J. Fine, MD; William E. Haley, MD; Amret T. Hawfield, MD; Joachim H. Ix, MD, MAS; Dalane W. Kitzman, MD;
John B. Kostis, MD; Marie A. Krousel-Wood, MD; Lenore J. Launer, PhD; Suzanne Oparil, MD; Carlos J. Rodriguez, MD, MPH;
Christianne L. Roumie, MD, MPH; Ronald I. Shorr, MD, MS; Kaycee M. Sink, MD, MAS; Virginia G. Wadley, PhD; Paul K. Whelton, MD;
Jeffrey Whittle, MD; Nancy F. Woolard; Jackson T. Wright Jr, MD, PhD; Nicholas M. Pajewski, PhD; for the SPRINT Research Group
IMPORTANCE The appropriate treatment target for systolic blood pressure (SBP) in older
patients with hypertension remains uncertain.
OBJECTIVE To evaluate the effects of intensive (<120 mm Hg) compared with standard
(<140 mm Hg) SBP targets in persons aged 75 years or older with hypertension
but without diabetes.
DESIGN, SETTING, AND PARTICIPANTS A multicenter, randomized clinical trial of patients aged
75 years or older who participated in the Systolic Blood Pressure Intervention Trial (SPRINT).
Recruitment began on October 20, 2010, and follow-up ended on August 20, 2015.
INTERVENTIONS Participants were randomized to an SBP target of less than 120 mm Hg
(intensive treatment group, n = 1317) or an SBP target of less than 140 mm Hg (standard
treatment group, n = 1319).
MAIN OUTCOMES AND MEASURES The primary cardiovascular disease outcome was a
composite of nonfatal myocardial infarction, acute coronary syndrome not resulting in a
myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and death
from cardiovascular causes. All-cause mortality was a secondary outcome.
RESULTS Among 2636 participants (mean age, 79.9 years; 37.9% women), 2510 (95.2%)
provided complete follow-up data. At a median follow-up of 3.14 years, there was a
significantly lower rate of the primary composite outcome (102 events in the intensive
treatment group vs 148 events in the standard treatment group; hazard ratio [HR], 0.66
[95% CI, 0.51-0.85]) and all-cause mortality (73 deaths vs 107 deaths, respectively; HR, 0.67
[95% CI, 0.49-0.91]). The overall rate of serious adverse events was not different between
treatment groups (48.4% in the intensive treatment group vs 48.3% in the standard
treatment group; HR, 0.99 [95% CI, 0.89-1.11]). Absolute rates of hypotension were 2.4% in
the intensive treatment group vs 1.4% in the standard treatment group (HR, 1.71 [95% CI,
0.97-3.09]), 3.0% vs 2.4%, respectively, for syncope (HR, 1.23 [95% CI, 0.76-2.00]), 4.0% vs
2.7% for electrolyte abnormalities (HR, 1.51 [95% CI, 0.99-2.33]), 5.5% vs 4.0% for acute
kidney injury (HR, 1.41 [95% CI, 0.98-2.04]), and 4.9% vs 5.5% for inj.
Copyright 2016 American Medical Association. All rights reserv.docxbobbywlane695641
Â
Copyright 2016 American Medical Association. All rights reserved.
Intensive vs Standard Blood Pressure Control
and Cardiovascular Disease Outcomes in Adults Aged â„75 Years
A Randomized Clinical Trial
Jeff D. Williamson, MD, MHS; Mark A. Supiano, MD; William B. Applegate, MD, MPH; Dan R. Berlowitz, MD; Ruth C. Campbell, MD, MSPH;
Glenn M. Chertow, MD; Larry J. Fine, MD; William E. Haley, MD; Amret T. Hawfield, MD; Joachim H. Ix, MD, MAS; Dalane W. Kitzman, MD;
John B. Kostis, MD; Marie A. Krousel-Wood, MD; Lenore J. Launer, PhD; Suzanne Oparil, MD; Carlos J. Rodriguez, MD, MPH;
Christianne L. Roumie, MD, MPH; Ronald I. Shorr, MD, MS; Kaycee M. Sink, MD, MAS; Virginia G. Wadley, PhD; Paul K. Whelton, MD;
Jeffrey Whittle, MD; Nancy F. Woolard; Jackson T. Wright Jr, MD, PhD; Nicholas M. Pajewski, PhD; for the SPRINT Research Group
IMPORTANCE The appropriate treatment target for systolic blood pressure (SBP) in older
patients with hypertension remains uncertain.
OBJECTIVE To evaluate the effects of intensive (<120 mm Hg) compared with standard
(<140 mm Hg) SBP targets in persons aged 75 years or older with hypertension
but without diabetes.
DESIGN, SETTING, AND PARTICIPANTS A multicenter, randomized clinical trial of patients aged
75 years or older who participated in the Systolic Blood Pressure Intervention Trial (SPRINT).
Recruitment began on October 20, 2010, and follow-up ended on August 20, 2015.
INTERVENTIONS Participants were randomized to an SBP target of less than 120 mm Hg
(intensive treatment group, n = 1317) or an SBP target of less than 140 mm Hg (standard
treatment group, n = 1319).
MAIN OUTCOMES AND MEASURES The primary cardiovascular disease outcome was a
composite of nonfatal myocardial infarction, acute coronary syndrome not resulting in a
myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and death
from cardiovascular causes. All-cause mortality was a secondary outcome.
RESULTS Among 2636 participants (mean age, 79.9 years; 37.9% women), 2510 (95.2%)
provided complete follow-up data. At a median follow-up of 3.14 years, there was a
significantly lower rate of the primary composite outcome (102 events in the intensive
treatment group vs 148 events in the standard treatment group; hazard ratio [HR], 0.66
[95% CI, 0.51-0.85]) and all-cause mortality (73 deaths vs 107 deaths, respectively; HR, 0.67
[95% CI, 0.49-0.91]). The overall rate of serious adverse events was not different between
treatment groups (48.4% in the intensive treatment group vs 48.3% in the standard
treatment group; HR, 0.99 [95% CI, 0.89-1.11]). Absolute rates of hypotension were 2.4% in
the intensive treatment group vs 1.4% in the standard treatment group (HR, 1.71 [95% CI,
0.97-3.09]), 3.0% vs 2.4%, respectively, for syncope (HR, 1.23 [95% CI, 0.76-2.00]), 4.0% vs
2.7% for electrolyte abnormalities (HR, 1.51 [95% CI, 0.99-2.33]), 5.5% vs 4.0% for acute
kidney injury (HR, 1.41 [95% CI, 0.98-2.04]), and 4.9% vs 5.5% for inj.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
Â
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, weâll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
Â
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Welcome to Secret Tantric, Londonâs finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the cityâs most beautiful masseuses.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Â
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
Â
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Â
Pubricaâs team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
Â
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...
Â
Pre and post- discharge management.
1. Acute Heart Failure Essentials:
Pre- and Post-Discharge Management
William T. Abraham, MD, FACP, FACC, FAHA, FESC
Professor of Medicine, Physiology, and Cell Biology
Chair of Excellence in Cardiovascular Medicine
Director, Division of Cardiovascular Medicine
Associate Dean for Clinical Research
Director, Clinical Trials Management Office
Deputy Director, Davis Heart & Lung Research Institute
The Ohio State University
Division of Cardiovascular Medicine
3. 3
Four Clinical States of Heart Failure
Time
Stable
1
Stable
1
Pre-Acute
Heart Failure
2
Acute
Heart Failure
(Hospitalization)
3
Post-Acute
Heart Failure
4
Days to Weeks
4. 4
Pre-Acute Heart Failure: Opportunity to
Prevent Hospitalization
Time
Pre-Acute
Heart Failure
2
Days to Weeks
5. How Do We Prevent Heart Failure Hospitalizations?
Maintain Optimal Fluid / Pressure Status
Too âWetâ (High Pressures)
Increased symptoms, increased risk of
hospitalization, increased risk of
arrhythmias, increased mortality
âJust Rightâ (Normal Pressures)
Feel well, low risk for hospitalization or
death
Too âDryâ (Low Pressures)
Hypotension, dizziness, risk of syncope,
worsening kidney function
6. 6
Pre-Acute Heart Failure: The Development
of Acute Decompensation
Physiologic markers of the development of acute decompensation:
Pressure
Changes
Impedance
Changes
Weight Changes,
HF Symptoms
Hospitalization
Time
Stable
Decompensation
Autonomic
Adaptation
7. 7
Pre-Acute Heart Failure: The Development
of Acute Decompensation
Physiologic markers of the development of acute decompensation:
Pressure
Changes
Impedance
Changes
Weight Changes,
HF Symptoms
Hospitalization
Time
Stable
Decompensation
Autonomic
Adaptation
Unreliable, late, and
indirect markers8,9
May be used in
risk stratification,
but not actionable4-7Enables proactive
and personalized HF
management1-3
1. Steimle AE, et al. Circulation, 1997
2. Abraham WT, et al. Lancet, 2011
3. Ritzema J, et al. Circulation, 2010
4. Abraham WT, HFSA, 2009
5. Conraads VM, et al. EHJ, 2011
6. Whellan DJ, et al. JACC, 2010
7. van Veldhuisen DJ, et al. Circulation, 2011
8. Chaudry SI, et al. NEJM 2010
9. Anker SD, et al. AHA 2010
8. The Pulmonary Artery Pressure
Measurement System*
Catheter-based delivery system
*FDA approved May 28, 2014
MEMS-based pressure sensor
Home electronics PA Measurement database
9. 9
CHAMPION:Â Â CardioMEMS Heart Sensor Allows Monitoring of
Pressure to Improve Outcomes in NYHA Class III Heart Failure
Patients
550 Pts
w/ CM Implants
All Pts Take Daily
Readings
Treatment
270 Pts
Management Based on
Hemodynamics + Traditional Info
Control
280 Pts
Management Based on
Traditional Info
Primary Endpoint: HF Hospitalizations at 6 Months
Additional Analysis: HF Hospitalizations at All Days (~15 M mean F/U)
Multiple Secondary Endpoints
§ Trial Designed by
Steering Committee with
active FDA input
§ Prospective, multi-center,
randomized, controlled
single-blind clinical trial
§ All subjects followed in
their randomized single-
blind study assignment
until the last patient
reached 6 months of
follow-up
§ 64 US Centers
§ PIs: William Abraham,
Phil Adamson
Abraham WT, et al. Lancet 2011
10. 10
Hypothesis of the CHAMPION Trial
Medications should be adjusted based on
pulmonary artery pressures
unless contraindicated by clinical status of patient
In addition to basing treatment
on signs and symptoms
Heart failure
hospitalizations
11. CHAMPION Clinical Trial: Managing to
Target PA Pressures
550 Pts w/CMEMS Implants
All Pts Take Daily readings
Treatment
270Â Pts
Management Based onÂ
PA Pressure +Traditional Info
Control
280Â Pts
Management Based onÂ
Traditional Info
ther
Primary Endpoint: rate of HF Hospitalization
26 (
Secondary Endpoints included:
§ Change in PA Pressure at 6 months
§ No. of patients admitted to hospital for HF
§ Days alive outside of hospital
§ QOL
PA pressures were managed to target goalÂ
pressures by physicians with appropriateÂ
titration of HF medications.
Target Goal PA Pressures:
§ PA Pressure Systolic 15 â 35 mmHg
§ PA Pressure diastolic 8 â 20 mmHg
§ PA Pressure mean 10 â 25 mmHg
Adamson PB, et al., J Card Fail 2011
Abraham WT, et al., Lancet 2011
Treatment RecommendationsÂ
for Elevated PA Pressures
âą Add or increase diuretic
â increase/add loop diuretic
â change loop diuretic
â add thiazide diuretic
â IV loop diuretic
âą Add or increase vasodilator
â add or increase nitrate
12. Cumulative HF Hospitalizations Reduced
At 6 Months and Full Duration of Randomized Study
0
20
40
60
80
100
120
140
160
180
200
220
240
260
280
Days from Implant
0 90 180 270 360 450 540 630 720 810 900
270 262 244 210 169 131 108 82 29 5 1
280 267 252 215 179 137 105 67 25 10 0
No. at Risk
Treatment
Control
Treatment (158 HF Hospitalizations)
Control (254 HF Hospitalizations)
Study Duration
37% RRR, p < 0.0001
†6 Months
28% RRR,
p = 0.0002
> 6 Months
45% RRR,
p < 0.0001
13. Reduction in Hospitalizations Over Full
Duration of Randomized Study
Treatment
(n=270)
Control
(n=280)
AbsoluteÂ
Reduction
RelativeÂ
Reduction p-value
HR (CI)
Heart Failure
Hospitalizations
182 279 97
0.67
(0.55 â 0.80)
<0.0001
Death or
Heart Failure
Hospitalizations
232 343 111 0.69
(0.59 â 0.82)
<0.0001
Results from Andersen Gill model
Hazard Ratio (HR) and 95% Confidence Interval (CI)
All Cause
Hospitalizations
554 672 118
0.84
(0.75 â 0.95)
0.0032
Death or All
Cause
Hospitalizations
604 736 132
0.84
(0.76 â 0.94)
0.0017
15. PA Pressure-Guided Therapy Benefits
Patients with Common HF Comorbidities
Comorbidity N size (control) N size (treatment)
HF Hospitalization rateÂ
reduction at 15 monthsÂ
in treatment group
History of myocardialÂ
infarction1 137 134
46%
(p < 0.001 vs. control)
COPD2,3 96 91
41%
(p = 0.0009 vs. control)
PulmonaryÂ
hypertension4 163 151
36%
(p = 0.0002 vs. control)
AF5 135 120
41%
(p < 0.0001 vs. control)
Chronic Kidney Disease6 150 147
42%
(p = 0.0001 vs. control)
1. Strickland WL, et al. JACC 2011
2. Criner G, et al. European Respiratory Journal, 2012
3. Martinez F, et al. European Respiratory Journal, 2012
4. Benza R, et al. Journal of Cardiac Failure, 2012
5. Miller AB, et al. JACC, 2012
6. Abraham et al., HFSA 2014
16. Impact of PA Pressure Guided HF Management
on HF Hospitalizations in GDMT Population
0.39
0.69
HFrEF Patients on ACE/ARB and Beta Blocker Prior to
Implant
HF hospitalization rates
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
AnnualizedHFHospitalizationRate
PA Pressure Guided HF Management (Treatment Group)
Guideline Directed Standard of Care (Control Group)
43% Relative Risk Reduction
[HR 0.57, 95% CI 0.45-0.74, p<0.0001]
Number needed to treat: 3
Abraham et al. ACC 2015
17. Impact of PA Pressure Guided HF Management on
All-Cause Mortality in GDMT Population
57% Relative Risk Reduction
[HR 0.43, 95% CI 0.24-0.76, p=0.0026]
Number needed to treat: 7
Abraham et al. ACC 2015
18. 18
Post-Acute Heart Failure: Opportunity to
Prevent Rehospitalization
Time
Post-Acute
Heart Failure
4
Days to Weeks
19. 19
Post-Acute Heart Failure: Relapse Before
Recovery
More than 50% of ADHF patient discharged from the hospital are still âwetâ and
do not receive adequate ongoing diuresis as outpatients1
Rehospitalization
Time
Stable
Hospitalization
1Adams KF, et al., Am Heart J 2006
20. 117
31
18
60
13
4
HF Hospitalizations All Cause 30 Day Readmissions HF 30 Day Readmissions
0
20
40
60
80
100
120
Number of Hospitalizations
Control (Standard of Care) Treatment (PA pressure monitoring)
§ Retrospective analysis of patients 65 years or older (n = 245)
§ Compared 30-day readmissions and HF hospitalizations between
patients managed with
PA pressure vs Standard of Care
§ Results showed statistically significant reductions in readmissions and
HF hospitalizations
in treatment group
CHAMPION Clinical Trial: Substantial reduction in
30-day readmissions in Medicare-eligible patients
Adamson, et al. AHA 2014
58% reduction
p = 0.0062
78% reduction
p = 0.0027
In Medicare-eligible patients 65 years or older PA pressure monitoring with the
CardioMEMSâą HF System significantly reduced 30-day readmissions
49% reduction
p < 0.0001
21. 21
What Else Can We Do to Prevent
Rehospitalization?
Yancy CW, et al., Circulation 2013
Accessed at http://circ.ahajournals.org/content/128/16/e240
22. Ohio State Post-Discharge Management
§ Nurse navigator calls patient 48 hours post-
discharge to review discharge instruction (diet,
medications) and assess how the patient is doing
§ Nurse practitioner sees the patient 7 days post-
discharge for comprehensive in-clinic assessment,
diuretic dose adjustment, and GDMT dose titration
if indicated
§ Heart failure physician sees patient 3-4 weeks
post-discharge comprehensive in-clinic
assessment, diuretic dose adjustment, and GDMT
dose titration if indicated
23. Other Post-Discharge Considerations
§ Many patient continue to exhibit some degree of
resistance to oral diuretics
§ May need to consider outpatient use of
intravenous (or subcutaneous?) diuretic therapy
§ May use Emergency Department Observation Unit
to treat relapsing patients, before they require
rehospitalization
§ Revaluate for precipitating causes of worsening
heart failure