Research Square (Research Square),
Год журнала:
2023,
Номер
unknown
Опубликована: Ноя. 7, 2023
Abstract
Background:
Clinicians
are
the
conduits
of
high-quality
care
delivery.
have
driven
advancements
in
pharmacotherapeutics,
devices,
and
related
interventions
improved
morbidity
mortality
patients
with
congestive
heart
failure
over
past
decade.
Yet,
management
has
become
extraordinarily
complex
fueled
recommendations
from
American
Heart
Association
College
Cardiology
to
optimize
composition
team
reduce
health,
economic,
health
system
burden
high
length
stay
hospital
charges.
Therefore,
purpose
this
study
was
identify
extent
which
configuration
models
non-specialty
clinicians
were
associated
charges
during
hospitalizations
failure.
Methods:
This
performed
a
retrospective
analysis
EHR-extracted
data
on
3,099
their
encounters
Arkansas
Clinical
Data
Repository.
The
analyzed
using
binomial
logistic
regression
adjusted
odds
ratios
reflected
association
specific
(i.e.,
combination
clinical
roles)
Results:
Care
that
included
physicians,
residents,
advanced
nurse
practitioners
generally
greater
patient
having
or
charge
encounter.
Registered
nurses
only
role
found
within
all
consistently
been
decreased
Additionally,
validated
Van
Walraven
Elixhauser
Comorbidity
Score
by
finding
its
quartiles
statistically
significantly
Conclusions:
Cardiologists,
alone,
cannot
shoulder
caring
for
hospitalized
electronic
record
systems
hospitals
could
be
an
effective
method
isolating
tracking
risk
patients.
Within
multidisciplinary
teams,
registered
may
particularly
advancing
real-time
stratification
applying
at
point-of-care.
Circulation,
Год журнала:
2024,
Номер
149(7), С. 510 - 520
Опубликована: Янв. 23, 2024
Guideline-directed
medical
therapies
(GDMTs)
are
the
mainstay
of
treatment
for
heart
failure
with
reduced
ejection
fraction
(HFrEF),
but
they
underused.
Whether
sex
differences
exist
in
initiation
and
intensification
GDMT
newly
diagnosed
HFrEF
is
not
well
established.
JACC Heart Failure,
Год журнала:
2024,
Номер
12(8), С. 1365 - 1377
Опубликована: Март 25, 2024
US
nationwide
estimates
of
the
proportion
patients
newly
diagnosed
with
heart
failure
reduced
ejection
fraction
(HFrEF)
eligible
for
quadruple
medical
therapy,
and
associated
benefits
rapid
implementation,
are
not
well
characterized.
This
study
sought
to
characterize
degree
which
HFrEF
projected
in-hospital
initiation.
Among
hospitalized
in
Get
With
The
Guidelines
–
Heart
Failure
registry
from
2016-2023,
eligibility
criteria
based
on
regulatory
labeling,
guidelines,
expert
consensus
documents
were
applied
ARNI,
beta-blocker,
MRA,
SGLT2i
therapies.
Of
those
eligible,
effect
therapy
12-month
mortality
was
modeled
using
treatment
effects
pivotal
clinical
trials
utilized
by
ACC/AHA/HFSA
compared
observed
outcomes
among
treated
ACEI/ARB
beta-blockers.
33,036
HFrEF,
27,158
(82%)
30,613
(93%)
≥3
components.
From
2021-2023,
15.3%
prescribed
41.5%
triple
therapy.
Medicare
beneficiaries
incidence
24.7%
HF
hospitalization
22.2%.
Applying
relative
risk
reductions
trials,
complete
implementation
time
discharge
yield
absolute
10.4%
(number-needed-to-treat
[NNT]=10)
24.8%
(NNT=4)
no
GDMT.
In
this
cohort
more
than
4
5
as
at
discharge,
yet
less
1
6
it.
If
trial
can
be
fully
realized,
initiation
would
large
mortality.
European Journal of Heart Failure,
Год журнала:
2024,
Номер
26(3), С. 652 - 660
Опубликована: Фев. 1, 2024
Abstract
Aims
Patients
are
at
high
risk
of
death
or
readmission
following
hospitalization
for
heart
failure
(HF).
We
tested
the
effect
a
transitional
care
model
that
included
month‐long
nurse‐led
home
visits
and
long‐term
function
clinic
‐
with
services
titrated
to
estimated
clinical
events
on
3‐year
outcomes
hospitalization.
Methods
results
In
pragmatic,
stepped‐wedge
cluster
randomized
trial,
10
hospitals
were
intervention
versus
usual
care.
The
primary
outcome
was
composite
all‐cause
death,
readmission,
emergency
department
(ED)
visit.
Secondary
components
outcomes,
HF
readmissions
healthcare
resource
utilization.
There
2494
patients
(50.4%
female)
mean
age
77.7
years.
reached
in
1040
(94.2%)
1314
(94.5%)
group
3
did
not
reduce
(hazard
ratio
[HR]
0.92,
95%
confidence
interval
[CI]
0.81–1.05)
nor
component
overall,
although
numerically
reduced
ED
women
but
men
(HR
0.79,
CI
0.63–1.00
vs.
HR
0.98,
0.80–1.19;
sex‐treatment
interaction
p
=
0.23).
uptake
guideline‐directed
medical
therapy
no
different
than
care,
exception
sacubitril/valsartan,
which
increased
(3.3%
vs
1.5%;
relative
6.2,
1.92–20.06).
Conclusions
More
9
hospitalized
experienced
visit
A
improve
these
endpoints,
likely
because
there
major
differences
therapies
between
groups.
Clinical
Trial
Registration:
ClinicalTrials.gov
Identifier
NCT02112227.
Guideline-directed
medical
therapies
and
guideline-directed
nonpharmacological
improve
quality
of
life
survival
in
patients
with
heart
failure
(HF),
but
eligible
patients,
particularly
women
individuals
from
underrepresented
racial
ethnic
groups,
are
often
not
treated
these
therapies.
Implementation
science
uses
evidence-based
theories
frameworks
to
identify
strategies
that
facilitate
uptake
evidence
health.
In
this
scientific
statement,
we
provide
an
overview
implementation
trials
HF,
assess
their
use
conceptual
health
equity
principles,
pragmatic
guidance
for
HF.
Overall,
behavioral
nudges,
multidisciplinary
care,
digital
increased
HF
effectively
did
include
goals.
Few
studies
focused
on
achieving
by
engaging
stakeholders,
quantifying
barriers
facilitators
therapies,
developing
informed
theory
or
frameworks,
evaluating
measures
equity,
titrating
equity.
Among
studies,
feasibility
was
established
using
various
educational
promote
organizational
change
equitable
care.
A
couple
ongoing
randomized
controlled
There
is
great
need
additional
designed
delivery
therapy.
European Heart Journal - Digital Health,
Год журнала:
2024,
Номер
5(6), С. 670 - 682
Опубликована: Авг. 30, 2024
Abstract
The
2021
European
Society
of
Cardiology
guideline
on
diagnosis
and
treatment
acute
chronic
heart
failure
(HF)
the
2023
Focused
Update
include
recommendations
pharmacotherapy
for
patients
with
New
York
Heart
Association
(NYHA)
class
II–IV
HF
reduced
ejection
fraction.
However,
multinational
data
from
EVOLUTION
study
found
substantial
prescribing
inertia
guideline-directed
medical
therapy
(GDMT)
in
clinical
practice.
cause
was
multifactorial
included
limitations
organizational
resources.
Digital
solutions
like
digital
consultation,
remote
monitoring,
interrogation
cardiac
implantable
electronic
devices,
decision
support
systems,
multifaceted
interventions
are
increasingly
available
worldwide.
objectives
this
Clinical
Consensus
Statement
to
provide
(i)
examples
that
can
aid
optimization
prescription
GDMT,
(ii)
evidence-based
insights
GDMT
using
solutions,
(iii)
current
evidence
gaps
implementation
barriers
limit
adoption
practice,
(iv)
critically
discuss
strategies
achieve
equality
access,
reference
patient
subgroups.
Embracing
through
use
consults
monitoring
will
future-proof,
example
alerts
clinicians,
informing
them
suboptimal
GDMT.
Researchers
should
consider
employing
optimize
effectiveness
designs
fit
unique
sociotechnical
aspects
solutions.
Artificial
intelligence
handle
larger
sets
relieve
professionals’
workloads,
but
as
artificial
limited,
further
investigation
is
warranted.
