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Journal articles on the topic 'Elderly, chronic heart failure, outpatient management'

Author: Grafiati

Published: 10 March 2023

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1

Veenis, Jesse F., Hans-Peter Brunner-La Rocca, Gerard CM Linssen, Peter R. Geerlings, Marco WF Van Gent, Ismail Aksoy, Liane Oosterom, Arno HM Moons, Arno W. Hoes, and Jasper J. Brugts. "Age differences in contemporary treatment of patients with chronic heart failure and reduced ejection fraction." European Journal of Preventive Cardiology 26, no. 13 (March 13, 2019): 1399–407. http://dx.doi.org/10.1177/2047487319835042.

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Background Elderly patients are underrepresented in clinical trials but comprise the majority of heart failure patients. Data on age-specific use of heart failure therapy are limited. The European Society of Cardiology heart failure guidelines provide no age-specific treatment recommendations. We investigated practice-based heart failure management in a large registry at heart failure outpatient clinics. Design and methods We studied 8351 heart failure with reduced ejection fraction patients at 34 Dutch outpatient clinics between 2013 and 2016. The mean age was 72.3 ± 11.8 years and we divided age into three categories: less than 60 years (13.9%); 60–74 years (36.0%); and 75 years and over (50.2%). Results Elderly heart failure with reduced ejection fraction patients (≥75 years) received significantly fewer beta-blockers (77.8% vs. 84.2%), renin–angiotensin system inhibitors (75.2% vs. 89.7%), mineralocorticoid receptor antagonists (50.6% vs. 59.6%) and ivabradine (2.9% vs. 9.3%), but significantly more diuretics (88.1% vs. 72.6%) compared to patients aged less than 60 years ( Pfor all trends < 0.01). Moreover, the prescribed target dosages were significantly lower in elderly patients. Also, implantable cardioverter defibrillator (18.9% vs. 44.1%) and cardiac resynchronisation therapy device (14.6% vs. 16.7%) implantation rates were significantly lower in elderly patients. A similar trend in drug prescription was observed in patients with heart failure with mid-range ejection fraction as in heart failure with reduced ejection fraction. Conclusion With increasing age, heart failure with reduced ejection fraction patients less often received guideline-recommended medication prescriptions and also in a lower dosage. In addition, a lower percentage of implantable cardioverter defibrillator and cardiac resynchronisation therapy device implantation in elderly patients was observed.

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Kim, Han-Na, Asim A. Mohammed, Anju Bhardwaj, Shafiq Rehman, Shawn A. Gregory, Justine A. Barajas, Linda J. Barajas, et al. "DO ELDERLY PATIENTS WITH HEART FAILURE DUE TO LEFT VENTRICULAR SYSTOLIC DYSFUNCTION BENEFIT FROM NT-PROBNP-GUIDED HEART FAILURE MANAGEMENT? RESULTS FROM THE PROBNP OUTPATIENT TAILORED CHRONIC HEART FAILURE THERAPY (PROTECT) STUDY." Journal of the American College of Cardiology 57, no. 14 (April 2011): E394. http://dx.doi.org/10.1016/s0735-1097(11)60394-x.

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Gaggin, Hanna K., Asim A. Mohammed, Anju Bhardwaj, Shafiq U. Rehman, Shawn A. Gregory, Rory B. Weiner, Aaron L. Baggish, Stephanie A. Moore, Marc J. Semigran, and James L. Januzzi. "Heart Failure Outcomes and Benefits of NT-proBNP-Guided Management in the Elderly: Results From the Prospective, Randomized ProBNP Outpatient Tailored Chronic Heart Failure Therapy (PROTECT) Study." Journal of Cardiac Failure 18, no. 8 (August 2012): 626–34. http://dx.doi.org/10.1016/j.cardfail.2012.05.005.

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Khaniukov, Oleksii, and Oleksandra Smolianova. "Quality of life and medication adherence in patients with chronic heart failure associated with arterial hypertension and chronic kidney disease." Journal of V. N. Karazin Kharkiv National University, Series "Medicine", no. 43 (December 1, 2021): 40–48. http://dx.doi.org/10.26565/2313-6693-2021-43-05.

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As a permanent blockage of the pathogenetic chains of the disease prevents its progression and decompensation, medication adherence remains a cornerstone in the management of chronic heart failure. Poor adherence leads to an increase in chronic heart failure manifestations and frequent hospitalizations, resulting in quality of life deterioration. Aim. To characterize the quality of life in the elderly with chronic heart failure with preserved ejection fraction on the background of arterial hypertension and chronic kidney disease, and to determine the effect of medication adherence on the quality of life. Materials and methods. The prospective study included 122 patients aged 64 [62; 68] years with chronic heart failure on the background of arterial hypertension and chronic kidney disease. All participants underwent a clinical examination, a creatinine level determination with subsequent calculation of GFR EPI, a 6-minute walk test, an assessment according to the Minnesota Living with Heart Failure Questionnaire, and the Morisky Green Medication Adherence Scale. Based on the medication adherence level, the participants were divided into 2 groups. Results. Patients in both groups were comparable in age, sex, and ejection fraction. The patients in the non-adherent cohort had more comorbid diseases, greater systolic blood pressure and functional class according to NYHA, higher heart rate, a larger percentage of patients with lung crackles and GFR EPI less than 60 ml/min/1.73m2, lower GFR EPI, the shorter distance at 6-minute walk test, and the worse quality of life. The the quality of life was (the first figure – during hospitalization, the second - after 6 months, the third - after 12 months): 50 [39; 61], 42 [31; 50] and 40 [29; 50] scores among all the patients; 58.5 [48; 62], 47 [42; 52] and 47.5 [38; 54] scores – among non-adherent cohort; 41 [35, 53], 30 [28; 40] is the 29 [27; 40] scores - among the adherent patients. Conclusion. The quality of life of non-adherent patients was significantly worse in comparison with those who were more adherent to therapy. This difference was observed during both hospitalization and repeated outpatient observations. Medication adherence remained a significant quality of life predictor at all three visits: worsening in adherence level resulted in a quality of life deterioration. As the mediators causing the connection between medication adherence and the quality of life were patients' characteristics indicating poor diseases compensation.

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Iyngkaran, Pupalan, Danny Liew, Christopher Neil, Andrea Driscoll, Thomas H. Marwick, and David L. Hare. "Moving From Heart Failure Guidelines to Clinical Practice: Gaps Contributing to Readmissions in Patients With Multiple Comorbidities and Older Age." Clinical Medicine Insights: Cardiology 12 (January 2018): 117954681880935. http://dx.doi.org/10.1177/1179546818809358.

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This feature article for the thematic series on congestive heart failure (CHF) readmissions aims to outline important gaps in guidelines for patients with multiple comorbidities and the elderly. Congestive heart failure diagnosis manifests as a 3-phase journey between the hospital and community, during acute, chronic stable, and end-of-life (palliative) phases. This journey requires in variable intensities a combination of multidisciplinary care within tertiary hospital or ambulatory care from hospital outpatients or primary health services, within the general community. Management goals are uniform, ie, to achieve the lowest New York Heart Association class possible, with improvement in ejection fraction, by delivering gold standard therapies within a CHF program. Comorbidities are an important common denominator that influences outcomes. Comorbidities include diabetes mellitus, chronic obstructive airways disease, chronic renal impairment, hypertension, obesity, sleep apnea, and advancing age. Geriatric care includes the latter as well as syndromes such as frailty, falls, incontinence, and confusion. Many systems still fail to comprehensively achieve all aspects of such programs. This review explores these factors.

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Velayati, Farnia, Haleh Ayatollahi, and Morteza Hemmat. "A Systematic Review of the Effectiveness of Telerehabilitation Interventions for Therapeutic Purposes in the Elderly." Methods of Information in Medicine 59, no. 02/03 (May 2020): 104–9. http://dx.doi.org/10.1055/s-0040-1713398.

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Abstract Background Many elderly people suffer from chronic health conditions and mobility limitations. Therefore, they may benefit from traditional rehabilitation or telerehabilitation interventions as an alternative for this type of services. Objective The purpose of this study was to compare the effectiveness of telerehabilitation interventions with traditional rehabilitation services for therapeutic purposes in the elderly. Methods This systematic review was conducted in 2018. The searched databases were Cochrane Library, PubMed, Scopus, Web of Science, Embase, and ProQuest. The search was conducted with no time or language limitation. The selected papers included the randomized clinical trial studies in which elderly people aged 60 and over used telerehabilitation services for treatment purposes. The quality of the studies was evaluated by using the physiotherapy evidence database (PEDro) scale. Data were extracted by using a data extraction form and findings were narratively synthesized. Results After screening the retrieved papers, eight articles were selected to be included in the study. According to the findings, telerehabilitation was used for the elderly after stroke, chronic obstructive pulmonary disease (COPD), total knee replacement, and in patients with the comorbidity of COPD and chronic heart failure. Overall, in most studies, there was no significant difference between the intervention and control groups and the level of improvements was similar for most outcomes. Conclusion Telerehabilitation services can be regarded as an alternative to traditional rehabilitation approaches to reduce outpatient resource utilization and improve quality of life. However, more rigorous studies are suggested to investigate the effectiveness of telerehabilitation services for specific diseases or health conditions.

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Martemianova, E. G. "CLINICAL ASPECTS OF ETHYLMETHYLHYDROXYPYRIDINE SUCCINATE IN ELDERLY PATIENTS WITH CARDIOVASCULAR PATHOLOGY." Cardiovascular Therapy and Prevention 17, no. 2 (April 20, 2018): 57–62. http://dx.doi.org/10.15829/1728-8800-2018-2-57-62.

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Aim. To evaluate efficacy and safety of original ethylmethylhydroxypyridine succinate (Mexidol) in cardiological patients ≥75 year old.Material and methods. In the observational study, according to ethical standards of Khelsinki Declaration, with informed consent, 24 patients participated, age 7588 y. o. Inclusion criteria: age ≥75 y. o.; already diagnosed coronary heart disease (CHD) and/or chronic heart failure (CHF); Mexidol usage. Exclusion criteria: absent informed consent, severe comorbidities. Mean age of the patients at inclusion 80,33±4,06 y. o.; 16 (66,7%) females and 8 (33,3%) males. Patients consequently visited office of cardiologist with the diagnoses: chronic CHD (I25.0I25.9), CHF with preserved systolic function (I50.0I50.9). All patients were consulted by neurologist, had an established diagnosis of cerebrovascular disease (I6567). To reduce the symptoms of frailty, among the neurologist recommendations, with accordance to routine clinical practice, the original Mexidol was included. Mexidol was prescribed by a scheme of manufacturer: intravenous infusions 500 mg x 5 days, then per os 125 mg t. i.d.; overall treatment — 8 weeks.Results. Statistically significant results were noted in 6 months from the study start. There was significant increase of 6 minute walking distance in men from 304,00±87,09 to 388,63±92,28 m (р=0,01), in women from 346,06±56,81 to 427,69±76,87 m (р=0,003); also there were less signs of frailty. No one patient showed significant worsening of the condition; during the overall followup, patients did not call emergency or primary care physicians and did not hospitalize.Conclusion. In comorbidity patients aged ≥75 y. o. at Mexidol treatment, there was increase of 6minute walking test distance, decrease of asthenia signs, that witness for the medication efficacy. All patients showed good tolerability of the drug that witness for safety. Obviously, there are broad trials needed to sum up a gerontological algorithm of CHD and CHF patient management in outpatient setting.

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Jiang, Xinchan, Jiaqi Yao, and Joyce HS You. "Telemonitoring Versus Usual Care for Elderly Patients With Heart Failure Discharged From the Hospital in the United States: Cost-Effectiveness Analysis." JMIR mHealth and uHealth 8, no. 7 (July 6, 2020): e17846. http://dx.doi.org/10.2196/17846.

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Background Telemonitoring-guided interventional management reduces the need for hospitalization and mortality of patients with chronic heart failure (CHF). Objective This study aimed to analyze the cost-effectiveness of usual care with and without telemonitoring-guided management in patients with CHF discharged from the hospital, from the perspective of US health care providers. Methods A lifelong Markov model was designed to estimate outcomes of (1) usual care alone for all postdischarge patients with CHF (New York Heart Association [NYHA] class I-IV), (2) usual care and telemonitoring for all postdischarge patients with CHF, (3) usual care for all postdischarge patients with CHF and telemonitoring for patients with NYHA class III to IV, and (4) usual care for all postdischarge patients with CHF plus telemonitoring for patients with NYHA class II to IV. Model inputs were derived from the literature and public data. Sensitivity analyses were conducted to assess the robustness of model. The primary outcomes were total direct medical cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Results In the base case analysis, universal telemonitoring group gained the highest QALYs (6.2967 QALYs), followed by the telemonitoring for NYHA class II to IV group (6.2960 QALYs), the telemonitoring for NYHA class III to IV group (6.2450 QALYs), and the universal usual care group (6.1530 QALYs). ICERs of the telemonitoring for NYHA class III to IV group (US $35,393 per QALY) and the telemonitoring for NYHA class II to IV group (US $38,261 per QALY) were lower than the ICER of the universal telemonitoring group (US $100,458 per QALY). One-way sensitivity analysis identified five critical parameters: odds ratio of hospitalization for telemonitoring versus usual care, hazard ratio of all-cause mortality for telemonitoring versus usual care, CHF hospitalization cost and monthly outpatient costs for NYHA class I, and CHF hospitalization cost for NYHA class II. In probabilistic sensitivity analysis, probabilities of the universal telemonitoring, telemonitoring for NYHA class II to IV, telemonitoring for NYHA class III to IV, and universal usual care groups to be accepted as cost-effective at US $50,000 per QALY were 2.76%, 76.31%, 18.6%, and 2.33%, respectively. Conclusions Usual care for all discharged patients with CHF plus telemonitoring-guided management for NYHA class II to IV patients appears to be the preferred cost-effective strategy.

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Bloom, Allison, Sunil Suchindran, and Micah T. Mcclain. "725. Clinical Outcomes of Elderly Individuals Presenting with Acute Respiratory Infections." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S260. http://dx.doi.org/10.1093/ofid/ofy210.732.

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Abstract Background Elderly individuals experience increased morbidity and mortality from acute respiratory infections (ARI), which are complicated by difficulties defining etiologies of ARI and risk-stratifying patients in order to guide care. A number of scoring tools have been developed to predict illness severity and patient outcome for proven pneumonia, however less is known about the use of such metrics for all causes of ARIs. Methods We analyzed risk factors, clinical course and major outcomes of individuals ≥60 years of age presenting to the emergency department with a clinical diagnosis of ARI over a 5-year period. Results Of the enrolled individuals 40 had proven viral infection and 52 proven bacterial infections, but 184 patients with clinically adjudicated ARI (67%) remained without a proven microbial etiology despite extensive workup. Age (71.5 vs. 65.9 years, P < 0.001) and presence of cancer and heart failure were strongly predictive of illness severe enough to require hospital admission as compared with treatment in the outpatient setting. Of those with proven etiology, individuals with bacterial infection were more likely to require hospital and ICU admission (P < 0.001). When applied to this study, a modified PORT score was found to correlate more closely with clinical outcome measures than a modified CURB-65 (r, 0.54 vs. 0.39). Jackson symptom scores, historically used for viral illness, were found to inversely correlate with outcomes (r, −0.34) and show potential for differentiating viral and bacterial etiologies (P = 0.02). Interestingly, a multivariate analysis showed that a novel scoring tool utilizing sex, heart rate, respiratory rate, blood pressure, BUN, glucose and presence of chronic lung disease and cancer was highly predictive of poor outcome in elderly subjects with all-cause ARI. Conclusion Elderly subjects are at increased risk for poor clinical outcomes from ARI and their clinical management remains challenging. However, modified PORT, CURB-65, Jackson symptom score, and a novel scoring tool presented herein all offer some predictive ability for all-cause ARI in elderly subjects. Such broadly applicable scoring metrics have the potential to assist in treatment and triage decisions at the point of care. Disclosures All authors: No reported disclosures.

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Bottle, Alex, Kate Honeyford, Faiza Chowdhury, Derek Bell, and Paul Aylin. "Factors associated with hospital emergency readmission and mortality rates in patients with heart failure or chronic obstructive pulmonary disease: a national observational study." Health Services and Delivery Research 6, no. 26 (July 2018): 1–60. http://dx.doi.org/10.3310/hsdr06260.

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BackgroundHeart failure (HF) and chronic obstructive pulmonary disease (COPD) lead to unplanned hospital activity, but our understanding of what drives this is incomplete.ObjectivesTo model patient, primary care and hospital factors associated with readmission and mortality for patients with HF and COPD, to assess the statistical performance of post-discharge emergency department (ED) attendance compared with readmission metrics and to compare all the results for the two conditions.DesignObservational study.SettingEnglish NHS.ParticipantsAll patients admitted to acute non-specialist hospitals as an emergency for HF or COPD.InterventionsNone.Main outcome measuresOne-year mortality and 30-day emergency readmission following the patient’s first unplanned admission (‘index admission’) for HF or COPD.Data sourcesPatient-level data from Hospital Episodes Statistics were combined with publicly available practice- and hospital-level data on performance, patient and staff experience and rehabilitation programme website information.ResultsOne-year mortality rates were 39.6% for HF and 24.1% for COPD and 30-day readmission rates were 19.8% for HF and 16.5% for COPD. Most patients were elderly with multiple comorbidities. Patient factors predicting mortality included older age, male sex, white ethnicity, prior missed outpatient appointments, (long) index length of hospital stay (LOS) and several comorbidities. Older age, missed appointments, (short) LOS and comorbidities also predicted readmission. Of the practice and hospital factors we considered, only more doctors per 10 beds [odds ratio (OR) 0.95 per doctor;p < 0.001] was significant for both cohorts for mortality, with staff recommending to friends and family (OR 0.80 per unit increase;p < 0.001) and number of general practitioners (GPs) per 1000 patients (OR 0.89 per extra GP;p = 0.004) important for COPD. For readmission, only hospital size [OR per 100 beds = 2.16, 95% confidence interval (CI) 1.34 to 3.48 for HF, and 2.27, 95% CI 1.40 to 3.66 for COPD] and doctors per 10 beds (OR 0.98;p < 0.001) were significantly associated. Some factors, such as comorbidities, varied in importance depending on the readmission diagnosis. ED visits were common after the index discharge, with 75% resulting in admission. Many predictors of admission at this visit were as for readmission minus comorbidities and plus attendance outside the day shift and numbers of admissions that hour. Hospital-level rates for ED attendance varied much more than those for readmission, but the omega statistics favoured them as a performance indicator.LimitationsData lacked direct information on disease severity and ED attendance reasons; NHS surveys were not specific to HF or COPD patients; and some data sets were aggregated.ConclusionsFollowing an index admission for HF or COPD, older age, prior missed outpatient appointments, LOS and many comorbidities predict both mortality and readmission. Of the aggregated practice and hospital information, only doctors per bed and numbers of hospital beds were strongly associated with either outcome (both negatively). The 30-day ED visits and diagnosis-specific readmission rates seem to be useful performance indicators.Future workHospital variations in ED visits could be investigated using existing data despite coding limitations. Primary care management could be explored using individual-level linked databases.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Kaldara, Elisabeth, Despina Sanoudou, Stamatis Adamopoulos, and John N. Nanas. "Outpatient management of chronic heart failure." Expert Opinion on Pharmacotherapy 16, no. 1 (December 5, 2014): 17–41. http://dx.doi.org/10.1517/14656566.2015.978286.

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Gramsky, Cecelia, Sharon Josephson, Mary Langford, Carol Offutt, and Sue Wingate. "Outpatient management of chronic heart failure." Critical Care Nursing Clinics of North America 15, no. 4 (December 2003): 501–9. http://dx.doi.org/10.1016/s0899-5885(02)00095-3.

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Levine, Barbara S., and Margaret L. Hall. "Management of Chronic Heart Failure in the Outpatient." AACN Clinical Issues: Advanced Practice in Acute and Critical Care 9, no. 2 (May 1998): 257–67. http://dx.doi.org/10.1097/00044067-199805000-00008.

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Lye, M. "Chronic Heart Failure — Mechanisms and Management." Scottish Medical Journal 42, no. 5 (October 1997): 138–40. http://dx.doi.org/10.1177/003693309704200507.

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Over 80% of patients with chronic heart failure are over the age of 65 years.1 A number of community based studies over the years have indicated that up to half of elderly patients with heart failure are undiagnosed and therefore untreated.2 The high proportion of elderly patients with heart failure who are undiagnosed is probably due to the nonspecific presentation of the condition, heart failure symptoms being over shadowed by co-morbid conditions and the haemodynamic presentation of diastolic dysfunction, vide infra.3–5 Measurement of plasma atrial natriuretic peptide levels may be helpful in identifying elderly patients at risk of, or in the early stages of heart failure.6 Paradoxically, there are also a number of elderly patients who are being treated for heart failure who do not have the condition.7 Even with the secular changes occurring in lifestyles (smoking, diet, exercise) the prevalence of heart failure will continue to increase well into the next century because of the continuing increase in the number of older people. Difficulties with diagnosis of heart failure may be related to the observation that cardiologists tend to concentrate on young cardiac patients.

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Arboscello, Eleonora, Elisa Molinari, Francesco Tolomeo, Lisette Del Corso, Luana Vignolo, Gianluca Ubezio, Paolo Carlier, et al. "Ambulatory Management of Anemia: A Retrospective View from an Italian Multidisciplinary Team." Blood 126, no. 23 (December 3, 2015): 5583. http://dx.doi.org/10.1182/blood.v126.23.5583.5583.

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Abstract Anemia is one of the most prevalent clinic condition leading to a specialist medical consult. In 2014 our Internal Medicine unit started a Multidisciplinary Anemia Ambulatory (Internist, Immune-Hematologist, Hematologist) with the purpose to rapidly manage, diagnosis and treatment of anemic patients, giving a direct connection between general practitioners and hospital services. We treated and collected data on patients come to our attention in a tertiary care hospital in Genoa (Liguria), an area characterized by elderly population, which often carries more than one comorbidity with the purpose of better define the epidemiology of such a prevalent but underestimated issue. From January 1st 2014 a total of 212 patients came to our attention for internist consult due to anemia: 165 female and 47 male, medium age 63,23 years (F 58,86, M 78,57, range 19-100). A precise classification of anemia was determined for 187 patients: 130 had iron deficiency anemia (IDA, 61,32%), 17 multifactorial anemia (inflammatory disorders, chronic kidney disease and combined deficiency, 8,02%), 16 combined deficiency anemia (iron and vitamins, 7,55%), 9 chronic kidney disease related anemia (4,25%), 7 anemia secondary to inflammatory chronic disorder (3,30%), 5 B12 deficiency (2,36%), 2 both folate and B12 deficiency (0,94%), 1 folate deficiency (0,47%). Twenty-five patients were not classified due to lack of data. Severity of anemia was defined according to WHO criteria: 53 patients (25%) presented mild anemia (Hb 129 - 110 g/L), 123 (58%) moderate anemia (Hb 109 - 80 g/L), 33 (15,6%) severe anemia (Hb < 80 g/L). Three patients were not anemic at the baseline evaluation. We considered comorbidities of internistic relevance, which could be worsened by anemia: cardiovascular (coronary heart disease, arrhythmias, heart failure), 30 patients; neurologic (ischemic and degenerative diseases), 19 patients; respiratory disease (COPD and asthma), 11 patients. Eleven patients had 2 comorbidities (cardiovascular and respiratory or neurological) and 3 patients had all three comorbidities. Patients were treated according to clinical practice in relation to type, severity and clinical manifestation of anemia. One hundred and thirty patients needed more than one access to ambulatory to correct anemia; data from the second access were: patient responders (normalization of Hb levels or improvement of at least 20 g/L): 78 patients; partial responders (improvement of Hb levels from 5 to 20 g/L): 34 patients; non responders: 18 patients. Fourteen patients needed at least 1 blood red cells transfusion, 12 with severe anemia and 2 with moderate anemia. A total of 93 patients needed deep diagnostic insight through specialist pathways, such as hematologic (4 patients), gastroenterologic (39 patients), gynecologic (37 patients), both gastroenterologic and gynecologic (13 patients). All patients were managed as outpatients, except for 8 patients which required hospitalization due to severity of clinical findings: 4 patients were hospitalized in Internal Medicine ward, 1 patients in Gynecology and 3 patients needed access through Emergency Care Unit. Among IDA patients, 92 were treated with intravenous iron supplement: 32 with sodium ferric gluconate (SFG) (medium 16,68 vials, range 8-43) and 50 with ferric carboxymaltose (FC) (medium 1,04 vials). Nine patients treated with SFG experienced allergic reaction, so they were switched to FC. Patients treated with SFG were successfully treated for 69,56% and 26,08% responded partially. One patient treated with FC experienced allergic reaction, so he was switched to oral therapy. FC patients fully responded in 76% and 22% were partial responders. These preliminary data shows that Multidisciplinary Anemia Ambulatory and its diagnostic-therapeutic path, with the involvement of different Specialists and Operative Unit, resulted in an improvement of the coordination and continuity of care, reducing sanitary cost in terms of hospitalization, drugs rationalization and quality of life for patients. More data will derive from the newborn Anemia Regional Register, which will lead to a better comprehension of the real size of anemia in our local epidemiology, in which health derived costs are rising together with ageing of the comorbid population which often needs longitudinal assistance, coordination and continuity of care. Disclosures No relevant conflicts of interest to declare.

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Bereda, Gudisa. "Pathophysiology and Management Chronic Heart Failure." South Asian Research Journal of Biology and Applied Biosciences 4, no. 2 (May 6, 2022): 26–36. http://dx.doi.org/10.36346/sarjbab.2022.v04i02.001.

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Chronic heart failure refers to a clinical state of systemic and pulmonary congestion resulting from inability of the heart to pump as much blood as required for the adequate metabolism of the body. The commonest causes of heart failure are coronary artery disease, hypertension and diabetes, however, hypertension and diabetes have been found to be stronger risk factors in elderly women and coronary artery disease and smoking are stronger risk factors in elderly men. Pathophysiologically, heart failure is either an inadequate cardiac output for the organism’s metabolic demands or an adequate cardiac output that is due to neurohormonal compensation, which means the inability of the heart to supply blood to the tissues according to their needs without additional strain. The pharmacological treatment of chronic heart failure with reduced ejection fraction is now based on four classes of drugs that have been proven to reduce mortality among heart failure patients such as angiotensinogen converting enzyme inhibitors or angiotensin II receptor blockers, beta-blockers, aldosterone antagonists and sodium-glucose co-transporter 2 inhibitors. Angiotensinogen converting enzyme inhibitors or angiotensin II receptor blocker therapy should be initiated at a low dose with very gradual up titration, monitoring renal function and serum potassium levels closely. Chronic heart failure treatment with direct inhibitors of aldosterone receptors brought about a significant improvement in terms of survival and hospitalizations.

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Malloy, Michael J., and Larry M. Lopez. "Management of Congestive Heart Failure in the Elderly." Drug Intelligence & Clinical Pharmacy 22, no. 10 (October 1988): 788–92. http://dx.doi.org/10.1177/106002808802201013.

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A universally accepted description of appropriate therapy for treatment of congestive heart failure (CHF) has yet to be agreed upon, especially in the elderly. Numerous studies have provided data that question use of a digitalis glycoside as the agent of choice in treatment of chronic CHF. Several clinicians have suggested that diuretics, particularly thiazide diuretics, be used as initial agents in the treatment of this condition. Evidence now demonstrates that drug therapy with enalapril or the combination of hydralazine and isosorbide dinitrate reduces the mortality related to chronic CHF. Additional studies are required to clarify respective roles of diuretics, digitalis glycosides, and vasodilators in the management of chronic CHF.

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McDonald, Ken. "Disease Management of Chronic Heart Failure in the Elderly." Disease Management & Health Outcomes 15, no. 6 (2007): 333–39. http://dx.doi.org/10.2165/00115677-200715060-00002.

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Mosalpuria, Kailash, Sunil K. Agarwal, Sirin Yaemsiri, Bredy Pierre-Louis, Samir Saba, Rene Alvarez, and Stuart D. Russell. "Outpatient Management of Heart Failure in the United States, 2006–2008." Texas Heart Institute Journal 41, no. 3 (June 1, 2014): 253–61. http://dx.doi.org/10.14503/thij-12-2947.

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Better outpatient management of heart failure might improve outcomes and reduce the number of rehospitalizations. This study describes recent outpatient heart-failure management in the United States. We analyzed data from the National Ambulatory Medical Care Survey of 2006–2008, a multistage random sampling of non-Federal physician offices and hospital outpatient departments. Annually, 1.7% of all outpatient visits were for heart failure (51% females and 77% non-Hispanic whites; mean age, 73 ± 0.5 yr). Typical comorbidities were hypertension (62%), hyperlipidemia (36%), diabetes mellitus (35%), and ischemic heart disease (29%). Body weight and blood pressure were recorded in about 80% of visits, and health education was given in about 40%. The percentage of patients taking β-blockers was 38%; the percentage taking angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) was 32%. Medication usage did not differ significantly by race or sex. In multivariate-adjusted logistic regression models, a visit to a cardiologist, hypertension, heart failure as a primary reason for the visit, and a visit duration longer than 15 minutes were positively associated with ACEI/ARB use; and a visit to a cardiologist, heart failure as a primary reason for the visit, the presence of ischemic heart disease, and visit duration longer than 15 minutes were positively associated with β-blocker use. Chronic obstructive pulmonary disease was negatively associated with β-blocker use. Approximately 1% of heart-failure visits resulted in hospitalization. In outpatient heart-failure management, gaps that might warrant attention include suboptimal health education and low usage rates of medications, specifically ACEI/ARBs and β-blockers.

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Kreifels, Erin, and Mary Tracy. "Chronic Heart Failure Management in Rural Primary Care." Journal of Doctoral Nursing Practice 9, no. 1 (2016): 20–28. http://dx.doi.org/10.1891/2380-9418.9.1.20.

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Background: Heart failure has been identified as a diagnosis associated with significant morbidity and mortality with inconsistent outcomes. As of October 1, 2012, the Centers for Medicare and Medicaid Services (CMS) began reducing payments to penalize hospitals for excessive heart failure readmissions and publicly reporting readmission rates. The rationale for the reduction in payments is that many heart failure–related admissions could have been prevented through improved outpatient management. In 2013, Medicare reimbursement cuts were applied to critical access hospitals. This most recent decrease in reimbursement to critical access hospitals paired with lack of reimbursement for heart failure related 30-day hospital readmissions provided the basis for implementing a heart failure management program. Participants: Thirteen adult patients, older than the age of 19 years, voluntarily participated in the heart failure management program in a rural primary care clinic located in the Midwest. Methods: The project was a quality improvement design. A chronic heart failure management program was implemented using the American Heart Association and the Institute for Health Care Improvement guidelines for heart failure management. Educational resources with monitoring logs for weights and symptoms were provided to each patient at the initial visit. Nursing staff filled out a heart failure flow sheet at each heart failure–related visit, and each patient who presented was then contacted 1 month from his or her initial visit date to discuss patient concerns. Results: Of the 13 individuals who presented for the initial visit, 11 had the flow record completed. One patient came in for subsequent visits because of changes in medications and follow-up. The flow record was filled out entirely on these 2 subsequent visits. There were 2 heart failure admissions during the 12-week implementation period, and neither were readmissions. Both patients followed up within 1 week of hospital discharge. There were no heart failure readmissions during the 12-week implementation period. Discussion: The findings of this project support the long-term feasibility of a chronic heart failure management program.

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Malloy, Michael. "The Pharmacologic Management of Chronic Congestive Heart Failure in the Elderly." Journal of Geriatric Drug Therapy 6, no. 4 (January 25, 1993): 5–39. http://dx.doi.org/10.1300/j089v06n04_03.

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Rywik, Tomasz M., Stefan L. Rywik, Jerzy Korewicki, Grażyna Broda, Aleksandra Sarnecka, and Joanna Drewla. "A survey of outpatient management of elderly heart failure patients in Poland—treatment patterns." International Journal of Cardiology 95, no. 2-3 (June 2004): 177–84. http://dx.doi.org/10.1016/j.ijcard.2003.04.027.

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BART, B., V. LARINA, and M. BRODSKII. "761 Non-pharmacologic management among patients with chronic heart failure in outpatient clinics." European Journal of Heart Failure Supplements 2, no. 1 (June 2003): 164. http://dx.doi.org/10.1016/s1567-4215(03)90498-x.

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Ibrahim, Ahmed, Motaz Baibars, M. Chadi Alraies, and Guilherme H. Oliveira. "Should target natriuretic peptide levels be used for outpatient management of chronic heart failure?" Cleveland Clinic Journal of Medicine 79, no. 1 (January 2012): 22–25. http://dx.doi.org/10.3949/ccjm.79a.11066.

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Chuzi, Sarah, Esther S. Pak, Akshay S. Desai, Kristen G. Schaefer, and Haider J. Warraich. "Role of Palliative Care in the Outpatient Management of the Chronic Heart Failure Patient." Current Heart Failure Reports 16, no. 6 (December 2019): 220–28. http://dx.doi.org/10.1007/s11897-019-00440-3.

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Gregoroff, Susan J., Robert S. McKelvie, and Sylvia Szabo. "The impact of an outpatient heart failure clinic on hospital costs and admissions." Leadership in Health Services 17, no. 1 (March 1, 2004): 1–11. http://dx.doi.org/10.1108/13660750410516221.

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This study of 216 congestive heart failure (CHF) patients at a large teaching hospital in south‐central Ontario was undertaken to determine whether the patients managed in an outpatient heart failure clinic used fewer hospital resources (as expressed in number of admissions, complexity of admission, and length of stay (LOS)) than a matched cohort who were not managed in an outpatient clinic. Statistical significance of LOS opportunities could not be demonstrated (owing to sample size), however, the heart failure clinic is making a positive impact on all types of admissions (CHF and non‐CHF) in terms of LOS and suggests that management in an outpatient setting for chronic disease states is important for acute care hospitals to consider.

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Trullàs, Joan Carles, Luís Manzano, Francesc Formiga, Oscar Aramburu-Bodas, María Angustias Quesada-Simón, José Luís Arias-Jiménez, David García-Escrivá, Jorge Manuel Romero-Requena, Rosa Jordana-Comajuncosa, and Manuel Montero-Pérez-Barquero. "Heart Failure with Recovered Ejection Fraction in a Cohort of Elderly Patients with Chronic Heart Failure." Cardiology 135, no. 3 (2016): 196–201. http://dx.doi.org/10.1159/000447287.

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Objective: The aim of this study was to determine whether patients with heart failure (HF) who recover left ventricular ejection fraction (LVEF), termed here as ‘Rec-HF', have a distinct clinical profile and prognosis compared with patients with HF and reduced LVEF (HF-REF) or HF and preserved LVEF (HF-PEF). Methods: We evaluated and classified patients from the Spanish Heart Failure Registry into three categories based on enrollment/follow-up echocardiograms: HF-PEF (LVEF ≥50%), HF-REF (LVEF persistently <50%) and Rec-HF (LVEF on enrollment <50% but normalized during follow-up). Results: A total of 1,202 patients were included, 1,094 with HF-PEF, 81 with HF-REF and 27 with Rec-HF. The three groups included patients of advanced age (mean age 75 years) with comorbidities. Rec-HF patients were younger, with a better functional status, lower prevalence of diabetes mellitus, dementia and cerebrovascular disease, and higher prevalence of COPD. The etiology of HF was more frequently ischemic and alcoholic and less frequently hypertensive. After a median follow-up of 367 days, the unadjusted hazard ratios for death in the Rec-HF versus HF-PEF and HF-REF groups were 0.11 (95% CI 0.02-080; p = 0.029) and 0.31 (95% CI 0.04-2.5; p = 0.274). Results were statistically nonsignificant in multivariate-adjusted models. Conclusion: Rec-HF is also present in elderly patients with HF but it is necessary to further investigate the natural history and optimal pharmacologic management of this ‘new HF syndrome'.

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Doi, Yoshinori, Takashi Furuno, Toru Kubo, Naohito Yamasaki, and Hiroaki Kitaoka. "Cardiovascular disease in the elderly: Management of atrial fibrillation and chronic heart failure." Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics 51, no. 3 (2014): 218–21. http://dx.doi.org/10.3143/geriatrics.51.218.

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Okunev, I. M., A. M. Kochergina, and V. V. Kashtalap. "Chronic and acute decompensated heart failure: topical issues." Complex Issues of Cardiovascular Diseases 11, no. 2 (June 26, 2022): 184–95. http://dx.doi.org/10.17802/2306-1278-2022-11-2-184-195.

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Highlights. The article is a review of current literary data on the problem of acute decompensated heart failure. The review highlights the basic principles of the diagnosis and treatment, as well as the problems of their implementation into clinical practice.Abstract Acute decompensated heart failure (ADHF) is a life-threatening condition that requires an emergency hospitalization for intensive treatment. Moreover, it is the event that worsens the patient's further prognosis. Frequent rehospitalizations for decompensation of heart failure reduce life expectancy and quality, and are also a significant economic problem in practical health care. The increasing number of patients with heart failure leads to the growing number of patients seeking medical help for acute decompensated heart failure. More than half of the patients are re-hospitalized within a year for the same reason. The predicted increase in the prevalence of CHF worldwide makes the management of such patients a global medical and social problem. Patients delay, low compliance and insufficient ambulatory monitoring are the factors that need to be influenced in order to improve the prognosis. The article is a review of literary data on the epidemiology of ADHF, diagnosis, treatment and outpatient observation of patients with acute decompensated heart failure. The problems of compliance, the prospects for modern methods of remote monitoring and the possibilities of new drugs are discussed in the article.

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Boylan, Paul, Tina Joseph, Genevieve Hale, Cynthia Moreau, Matthew Seamon, and Renee Jones. "Chronic Obstructive Pulmonary Disease and Heart Failure Self-Management Kits for Outpatient Transitions of Care." Consultant Pharmacist 33, no. 3 (March 1, 2018): 152–58. http://dx.doi.org/10.4140/tcp.n.2018.152.

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Rochmawati, Erna, and Sarah Amalia. "Self-care Behavior and Frailty Syndrome among Elderly Patients with Heart Failure." Open Access Macedonian Journal of Medical Sciences 9, T4 (April 15, 2021): 231–35. http://dx.doi.org/10.3889/oamjms.2021.5773.

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BACKGROUND: The development of technology gives an impact on life expectancy in the elderly. In Yogyakarta, the total of the elderly was higher than in other provinces in Indonesia. The elderly experience a decreased functional state that may lead to impaired body organs, such as heart failure. Heart failure has increasingly become a serious health problem. At present, 80% of elderly patients experience heart failure because of a decrease in functional status. The elderly may also experience frailty syndrome, which can provide a poor prognosis in terms of mortality, rehospitalization, and quality of life. It needs complex management; one of these is self-care behavior that can prevent the spread of frailty syndrome. AIM: The study aims to assess the correlation between self-care behavior and frailty syndrome in elderly patients with heart failure. METHODS: The study included 87 elderly patients with heart failure who visited the cardiology outpatient unit in two private hospitals. Self-care was measured using the self-care heart failure index, and frailty syndrome was assessed using the frailty index. A correlation test was conducted using Spearman rho. RESULTS: The result showed inadequate self-care behavior with a mean score of 48.70. The mean score of frailty syndrome was 0.142, categorized in the pre-frail phase. No correlation was found between self-care behavior and frailty syndrome with p=0.20. CONCLUSION: Self-care behavior in elderly patients with heart failure is still inadequate and in the pre-frail phase. Nurses and other health professionals should consider intervention to increase self-care behavior among the elderly and screening to increase their awareness of frailty syndrome.

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Ekman, I. "Feasibility of a nurse-monitored, outpatient-care programme for elderly patients with moderate-to-severe, chronic heart failure." European Heart Journal 19, no. 8 (August 1998): 1254–60. http://dx.doi.org/10.1053/euhj.1998.1095.

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Hill, Eilidh, and Jackie Taylor. "Chronic Heart Failure Care Planning: Considerations in Older Patients." Cardiac Failure Review 03, no. 01 (2017): 46. http://dx.doi.org/10.15420/cfr.2016:15:2.

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In 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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Konradi, A. O., O. M. Drapkina, S. V. Nedogoda, G. P. Arutyunov, Yu A. Karpov, Zh D. Kobalava, Ya A. Orlova, D. A. Sychev, and S. K. Zyryanov. "Management of patients with hypertension, coronary heart disease and chronic heart failure during the COVID-19 pandemic in the primary care setting." "Arterial’naya Gipertenziya" ("Arterial Hypertension") 28, no. 4 (August 25, 2022): 464–76. http://dx.doi.org/10.18705/1607-419x-2022-28-4-464-476.

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On December 1, 2021, a meeting of the Council of experts on the treatment of hypertension, coronary heart disease, and chronic heart failure during the COVID-19 pandemic was held remotely to adjust and adapt current approaches to outpatient treatment of the above pathologies under the current epidemiological situation. The meeting was attended by leading Russian specialists from federal medical research centers of cardiology and therapy.

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Ibrahim, Nasrien E., Hanna K. Gaggin, Dustin J. Rabideau, Parul U. Gandhi, Aditi Mallick, and James L. Januzzi. "Worsening Renal Function during Management for Chronic Heart Failure with Reduced Ejection Fraction: Results From the Pro-BNP Outpatient Tailored Chronic Heart Failure Therapy (PROTECT) Study." Journal of Cardiac Failure 23, no. 2 (February 2017): 121–30. http://dx.doi.org/10.1016/j.cardfail.2016.07.440.

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Boytsov, S. A., Yu E. Efremova, N. V. Lazareva, Yu A. Dolgusheva, and E. V. Sorokin. "Ways to improve outpatient care for cardiovascular diseases." National Health Care (Russia) 2, no. 4 (October 19, 2022): 5–11. http://dx.doi.org/10.47093/2713-069x.2021.2.4.5-11.

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The article presents the modern strategy of an outpatient cardiovascular care improvement. The modernization of primary health care in outpatient network is based on primary and secondary prevention of cardiovascular diseases including an improvement of outpatient observation, development of an outpatient high-risk offices network, advancement of telemedical consulting, increase of preferential medication provision effectiveness, increase of quality management patients with chronic heart failure and development of vertically integrated medical information system. Improvement of cardiovascular outpatient care will reduce cardiovascular mortality in the whole population.

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Ekman, I. "Erratum Feasibility of a nurse-monitored, outpatient-care program for elderly patients with moderate-to-severe, chronic heart failure." European Heart Journal 21, no. 9 (May 1, 2000): 784. http://dx.doi.org/10.1053/euhj.2000.2161.

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Sobieszek, Grzegorz, Tomasz Powrózek, Marcin Mazurek, Anna Skwarek-Dziekanowska, and Teresa Małecka-Massalska. "Electrical and Hormonal Biomarkers in Cachectic Elderly Women with Chronic Heart Failure." Journal of Clinical Medicine 9, no. 4 (April 4, 2020): 1021. http://dx.doi.org/10.3390/jcm9041021.

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Background: Cachexia is an unfavorable metabolic syndrome causing involuntary weight loss followed by muscle wasting, which can lead to the exacerbation of chronic heart failure (CHF), and considerably increases mortality rate among CHF patients. Unfortunately, until now it has not been possible to determine factors that could improve clinical options for cachexia management or enable the identification of patients at risk of its development. We assessed how cachexia conditions in CHF reflect cardiac and laboratory parameters in comparison with non-cachectic patients. Methods: 66 women were enrolled to the study group and underwent meticulous screening, according to recent clinical guidelines, in order to enable CHF and cachexia detection. Body composition was evaluated by bioelectrical impedance analysis (BIA) and laboratory tests were supplemented by analysis of plasma circulating irisin. Results: A negative correlation between irisin concentration and both CRP and TNF-α was recorded (R = −0.362 and R = −0.243; p < 0.05). Irisin concentration positively correlated with EF% (R = 0.253; p = 0.046) and negatively with LVESd, LVEDd and NT-proBNP (R = −0.326, −0.272, and −0.320; p < 0.05). Both low levels of circulating irisin and Capacitance of membrane (Cm) were selected as unfavorable factors affecting cachexia in CHF patients (OR = 1.39 and 34.49; p < 0.05). Combination of Cm, irisin, CRP and albumin demonstrated sensitivity of 93.3% and specificity of 85.3% (AUC = 0.949) for distinguishing between cachectic and non-cachectic CHF patients. Conclusions: Selected parameters reliably reflect cachectic conditions in CHF, and the proposed approach for cachexia based on the combined analysis of at least a few non-invasive markers could offer new opportunities for improving clinical outcomes in CHF patients.

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Paul, S. "Impact of a nurse-managed heart failure clinic: a pilot study." American Journal of Critical Care 9, no. 2 (March 1, 2000): 140–46. http://dx.doi.org/10.4037/ajcc2000.9.2.140.

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BACKGROUND: One approach to optimize clinical and economic management of congestive heart failure is the use of multidisciplinary outpatient clinics in which advanced practice nurses coordinate care. One such clinic was developed in 1995 at a southeastern university hospital to enhance management of patients with chronic congestive heart failure. OBJECTIVES: To evaluate the effects of a multidisciplinary outpatient heart failure clinic on the clinical and economic management of patients with congestive heart failure. METHODS: Data on hospital readmissions, emergency department visits, length of stay, charges, and reimbursement from the 6 months before 15 patients joined a heart failure clinic were compared with data from the 6 months after the patients joined the clinic. RESULTS: The patients had a total of 38 hospital admissions (151 hospital days) in the 6 months before joining the clinic and 19 admissions (72 hospital days) in the 6 months afterward. The mean length of stay decreased from 4.3 days in the 6 months before joining to 3.8 days in the 6 months afterward, and the number of emergency department visits also decreased, although neither decrease was statistically significant. Mean inpatient hospital charges decreased from $10,624 per patient admission to $5893. Reimbursements were $7751 (73% collection rate) and $5138 (87% collection rate), respectively. CONCLUSIONS: Patients seemed to benefit from participation in the heart failure clinic. If a healthcare provider is available to manage early signs and symptoms of worsening heart failure, hospital readmissions may be decreased and patients' outcomes may be improved.

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Pellizzer, Anne-Marie, and Henry Krum. "Clinical Utility of Digoxin in Elderly Patients in Sinus Rhythm with Chronic Heart Failure." Australian Journal of Hospital Pharmacy 27, no. 5 (October 1997): 406–9. http://dx.doi.org/10.1002/jppr1997275406.

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41

Adamson, Philip B. "Ambulatory Hemodynamics in Patients With Chronic Heart Failure: Implications for Volume Management in Elderly Patients." American Journal of Geriatric Cardiology 14, no. 5 (September 2005): 236–41. http://dx.doi.org/10.1111/j.1076-7460.2005.02596.x.

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GAZIZYANOVA, V. M., and O. V. BULASHOVA. "Chronic heart failure associated with chronic obstructive pulmonary disease in elderly and senile patients: clinical parallels." Practical medicine 19, no. 6 (2021): 52–57. http://dx.doi.org/10.32000/2072-1757-2021-6-52-57.

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In recent decades, the leading trend in the development of modern society is the aging of the population, as well as an increase in the proportion of elderly and senile people. Aging has a significant impact on the clinical characteristics, course and prognosis of diseases, changes the management tactics and treatment standards. As a rule, these patients are highly comorbid, which must be taken into account in terms of pharmacotherapy of the underlying and competing diseases. The purpose was to study the clinical characteristics of elderly and senile patients with chronic heart failure (CHF) in association with chronic obstructive pulmonary disease (COPD). Material and methods. The study included 104 patients with CHF, mainly of ischemic etiology, in combination with COPD, who were divided into 3 groups: 1 — younger than 60 years old, 2 — 60–79 years old, 3 — over 80 years old. To verify the clinical condition, the following studies were carried out: a 6-minute walk test, an assessment on the clinical condition scale, spirometry, echocardiography (Echo-KG), and an assessment of the quality of life according to the Minnesota questionnaire. Results. Patients older than 80 years old differed from those younger than 60 years old by high scores on assessment scale (p = 0,038), left ventricular ejection fraction (LVEF), (p = 0,007), and low heart rate (р = 0,021). The echocardiography parameters of patients over 80 years old were characterized by low values of systolic pressure in the pulmonary artery (PAP) and end diastolic size (EDS) in comparison with those under 60 years of age (p = 0,004 and p = 0,038). When studying the respiratory function, it was noted that in patients with CHF in combination with COPD, the forced expiratory volume in the first second decreases with increasing age (FEV10 and functional vital capacity of the lungs (FVC), as well as Tiffno index. Conclusion. The study results demonstrated that the clinical profile of a patient with CHF in combination with COPD differs depending on age, which requires an integral approach to patient management tactics and stratification of the risk of adverse events.

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Sedlar, Natasa, Mitja Lainscak, and Jerneja Farkas. "Living with Chronic Heart Failure: Exploring Patient, Informal Caregiver, and Healthcare Professional Perceptions." International Journal of Environmental Research and Public Health 17, no. 8 (April 13, 2020): 2666. http://dx.doi.org/10.3390/ijerph17082666.

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Due to the complexity of heart failure (HF) and its treatment process, a high level of patient and informal caregiver engagement is required for management results. We aimed to explore the views of HF patients, informal caregivers, and healthcare professionals about personal experiences, perceived needs, and barriers to optimal HF management. A qualitative study using semi-structured interviews with HF patients (n = 32), their informal caregivers (n = 21), and healthcare professionals (n = 5) was conducted in the outpatient HF clinic in Slovenia in 2018. A content analysis method was used to analyze the data. Negative emotional response to disease and its limitations (especially the inability to continue with work) and changes in family roles were the most prevalent topics regarding the impact of HF on livelihood. Among the most common barriers to HF self-care, were the difficulties in changing lifestyle, financial difficulties due to the disease, traditional cuisine/lack of knowledge regarding a healthy diet and lack of self-confidence regarding physical activity. Despite psychological and social difficulties due to HF being highlighted by patients and informal caregivers, only healthcare professionals emphasized the need to address psychosocial aspects of care in HF management. Established differences could inform the implementation of necessary support mechanisms in HF management.

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Yaméogo, NV, LJ Kagambèga, JDE Sib, A. Tall Thiam, KJ Koudougou, GRC Millogo, AK Samadoulougou, J. Simporé, and P. Zabsonré. "Death prognosis factors of chronic heart failure in the elderly in Burkina Faso." Archives of Clinical Hypertension 8, no. 1 (January 5, 2022): 001–4. http://dx.doi.org/10.17352/ach.000030.

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Background: Heart failure is the main reason for hospitalization in the cardiology department of Yalgado Ouédraogo University Hospital. The main causes of heart failure are arterial hypertension and myocardial ischemia. Mortality is high during hospitalization and can reach 48%. The follow-up of patients after hospitalization is difficult with many lost to follow-up. The medium and long term prognosis of chronic heart failure is not known in our country. Objective: Identify death prognosis factors of heart failure in elderly subjects aged at least 60 years old. Patients and Method: We conducted a retrospective, cross-sectional study that consisted of systematic inclusion from hospitalization registers of patients of both sexes aged at least 60 years, hospitalized in the cardiology department CHU Yalgado Ouédraogo from January 1 to December 31, 2016. We assessed the type of heart failure, electrocardiographic and echocardiographic parameters, comorbidities, etiologies of heart failure as well as the intra-hospital evolution during this hospitalization until discharge. After including these patients, they were called to participate in the study (which ran from December 1 to 31, 2020) by giving informed consent. We collected follow-up data (since discharge from the first hospitalization, i.e., one consultation each month for at least 42 months) from the patients’ individual follow-up diaries (rehospitalization, improvement, therapeutic compliance). We then performed a complete clinical examination, an electrocardiogram, a cardiac echography, and a biological workup including blood count, creatinine level, liver function tests, blood glucose and blood ionogram. Results: We included 87 elderly subjects representing 53.05% of all patients received for chronic heart failure in the cardiology department in 2016. The mean age was 71.49 ± 8.46 years and the sex ratio was 2. High blood pressure was the main cardiovascular risk factor in 62.07% of cases. In-hospital mortality was 20.69%, and factors associated with it included male sex (OR= 11.60 p < 0.01), renal dysfunction on admission (OR= 1.30 p= 0.03), and cardiogenic shock developed during hospitalization (OR= 10.30 p < 0.01). Mortality at approximately 4 years was 67.47% with a mean time to death of 13.60 months. No independent factor was found to predict death after discharge. Conclusion: The prognosis of heart failure in the elderly is poor in our context. The in-hospital death prognosis facteur are renal dysfunction, cardiogenic shock, An early and adapted management of this age group will improve survival.

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Weiner, Rory B., Aaron L. Baggish, Annabel A. Chen-Tournoux, Jane E. Marshall, Han-Na Kim, Anju Bhardwaj, Asim A. Mohammed, et al. "IMPROVEMENT OF ECHOCARDIOGRAPHIC PARAMETERS ASSOCIATED WITH NT-PROBNP GUIDED HEART FAILURE MANAGEMENT: MECHANISTIC INSIGHTS FROM THE PROBNP OUTPATIENT TAILORED CHRONIC HEART FAILURE (PROTECT) STUDY." Journal of the American College of Cardiology 57, no. 14 (April 2011): E2030. http://dx.doi.org/10.1016/s0735-1097(11)62030-5.

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Goodman, David A., and Andrew H. Slattengren. "Which loop diuretic is most effective for the management of chronic heart failure in the outpatient setting?" Evidence-Based Practice 17, no. 10 (October 2014): 14. http://dx.doi.org/10.1097/01.ebp.0000540799.41037.72.

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Chernyavskaya, T. K., E. P. Kakorina, and I. V. Samorodskaya. "Clinical portrait of a patient with chronic heart failure and its outpatient management in the Moscow region." Medical Technologies. Assessment and Choice, no. 3 (2022): 60. http://dx.doi.org/10.17116/medtech20224403160.

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Chinaglia, A., G. Gaschino, R. Asteggiano, G. Titta, and R. Trinchero. "A multidisciplinary management outpatient program for chronic congestive heart failure improves clinical outcome and reduces resource utilization." European Journal of Heart Failure 2 (June 2000): 25–26. http://dx.doi.org/10.1016/s1388-9842(00)80090-2.

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Applefeld, Mark M., Kathryn A. Newman, Frederick J. Sutton, William P. Reed, David S. Roffman, Barry S. Talesnick, and William R. Grove. "Outpatient dobutamine and dopamine infusions in the management of chronic heart failure: Clinical experience in 21 patients." American Heart Journal 114, no. 3 (September 1987): 589–95. http://dx.doi.org/10.1016/0002-8703(87)90757-5.

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Ripley, Toni L., and Thomas A. Hennebry. "Pharmacotherapy of Chronic Heart Failure in the Elderly: A Review of the Evidence." Clinical Medicine Insights: Therapeutics 2 (January 2010): CMT.S2794. http://dx.doi.org/10.4137/cmt.s2794.

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Heart failure (HF) is a very prevalent disease in the United States and in Europe, with the highest prevalence among older patients. Population estimates suggest substantial growth among the elderly over the next four decades. However, older patients are underrepresented in clinical trials evaluating HF therapies and are less likely to receive the medications shown in these trials to reduce the morbidity and mortality associated with HF. Age-related differences exist in cardiovascular function that may affect disease progression, clinical presentation, and/or response to therapy. Further, medication use in older patients is complicated by physiologic changes in pharmacokinetics and the presence of multiple co-morbidities, which leads to polypharmacy and the related complications. We reviewed the pharmacotherapy clinical trials in HF to review the results specifically in older patients. Trials were included in this review if clinical endpoints were evaluated, if data regarding the participants’ age was reported, and if the intervention studied was in a medication class that is generally recommended for patients with HF by published guidelines. Although some non-randomized data shows benefits of standard therapies may be maintained among patients with HF ≥ 60 years old, the randomized controlled trials that have been published to date showed no benefit and no harm in this group. Cautious HF management among older patients is critical as additional evidence is pursued.

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