Browsing by Subject "heart failure"
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Item 911 Calls for Emergency Medical Services in Heart Failure: A Descriptive Qualitative Study(Wolters Kluwer, 2022-09) Jung, Miyeon; Hays, Laura M.; Pang, Peter S.; Newhouse, Robin P.; Arkins, Thomas P.; O'Donnell, Daniel; Cook, Ryan; Gradus-Pizlo, Irmina; McAdams, Ellen; Pressler, Susan J.; School of NursingBackground Heart failure (HF) is a common condition leading to activation of emergency medical services (EMS). Objective The aim of this study was to describe reasons given by persons with HF, family members, or other caregivers for requesting EMS activation during 911 calls. Methods In this descriptive qualitative study, a content analysis was performed on transcribed audio files of 383 EMS requests involving 383 persons with HF in the community. Results One hundred forty-seven calls (38.4%) were placed by the family members, 75 (19.6%) were placed by the patients, 56 (14.6%) were placed by healthcare workers or personnel from living facilities, and the remaining calls (n = 105, 27.4%) were placed by others (eg, friends, neighbors, officers). Three broad categories of symptoms, signs, and events were identified as the reasons for an EMS request. Frequently reported symptoms were breathing problems (55.4%), chest pain (18.3%), and other pain (eg, head, extremities) (16.7%). Signs included decreased consciousness (15.4%), swelling (5.7%), and bleeding (5.0%). The reported events involved falls (8.1%), heart attack (6.3%), hypoxic episodes (6.0%), stroke (5.2%), and post–hospital-discharge complications (4.7%). In most calls (74.9%), multiple reasons were reported and a combination of symptoms, signs, and events were identified. Heart failure diagnosis was mentioned in fewer than 10% of the calls. Conclusions Overall, symptoms and signs of HF exacerbation were common reasons to activate 911 calls. Falls were frequently reported. Under the duress of the emergent situations surrounding the 911 call, callers rarely mentioned the existence of HF. Interventions are needed to guide patients with HF and their family members to promote the management of HF to reduce EMS activation as well as to activate EMS quickly for acute changes in HF conditions.Item Achieving Guideline-Directed Heart Rate Control Early Posthospitalization(Elsevier, 2019) Jungbauer, Carsten; Maier, Lars S.; Emoto, Kikuo; Zirille, Francis M.; Mirro, Michael J.; Medicine, School of MedicineGuidelines for the treatment of heart failure (HF) recommend the titration of β blockers (BB) to a target dosage shown to be effective in clinical trials. The benefit of BBs is associated with heart rate (HR) control, with a target resting HR <70 bpm which in clinical trials have been associated with improved clinical outcomes. The primary purpose of this study was to gauge the ability to achieve guideline-directed medical therapy HR control in the early posthospitalization period for HF patients with the wearable cardioverter defibrillator (WCD), assessing whether the WCD could be used to evaluate HR both at rest and during activity to determine if targets were being met and to adequately direct clinical decision making. The WCD platform allows continuous recording of HR. To assess the guideline-directed therapy goals for reduction of resting HR, HR was evaluated both at rest (nighttime: midnight-7 a.m.; daytime: 7 a.m. midnight), and during activity of daily living. HR data during activity of daily living (ADL) and rest were collected from patients with HF that wore the WCD for ≥5 weeks (n = 1,353) between 2015 and 2017. First, 643,891 activity episodes from 1,353 patients were analyzed. Daytime and nighttime resting HRs significantly dropped from beginning to end of WCD use (day: 72.5 bpm vs 69.0 bpm, p <0.0001; night: 68.1 vs 64.3, p <0.0001). However, 43% of patients still had an average daytime resting HR ≥70 bpm during the last week of WCD use. When comparing a patient’s peak activity HR during the first week of WCD use to the last week, there was no difference (93.6 bpm vs 94.1 bpm, p = 0.23). During ADL, 31% of patients had a HR ≥100 bpm, 14% of patients had a HR ≥110 bpm, and 6% had a HR ≥120 bpm. In conclusion, months after hospital discharge, 43% of patients did not meet guideline-directed resting target HR control, indicating they may not have been effectively managed with BB. HR during ADL may have also been higher than preferred. Remote HR monitoring may help physicians to adequately titrate guideline-directed medical therapy, thus improving clinical outcomes in HF patients.Item Acute Heart Failure Assessment: The Role of Focused Emergency Cardiopulmonary Ultrasound in Identification and Early Management(Wiley, 2015-12) Ferre, Robinson M.; Chioncel, Ovidiu; Pang, Peter S.; Lang, Roberto M.; Gheorghiade, Mihai; Collins, Sean P.; Department of Emergency Medicine, IU School of MedicineItem African American Race Is Associated With Poorer Outcomes in Heart Failure Patients(Sage, 2017-04) Wierenga, Kelly L.; Dekker, Rebecca L.; Lennie, Terry A.; Chung, Misook L.; Dracup, Kathleen; School of NursingHealth care disparities associated with African American race may influence event-free survival in patients with heart failure (HF). A secondary data analysis included 863 outpatients enrolled in a multicenter HF registry. Cox regression was used to determine whether African American race was associated with shorter HF event-free survival after controlling for covariates. The multivariable-adjusted hazard ratios (95% confidence intervals [CI]) of older age (1.03, 95% CI = [1.01, 1.04]), New York Heart Association (NYHA) functional class (1.73, 95% CI = [1.29, 2.31]), depressive symptoms (1.05, 95% CI = [1.02, 1.07]), and African American race (1.64, 95% CI = [1.01, 2.68]) were predictors of shorter event-free survival (all ps < .05). Comparisons showed that NYHA functional class was predictive of shorter event-free survival in Caucasians (1.81, 95% CI = [1.33, 2.46]) but not in African Americans (1.24, 95% CI = [.40, 3.81]). African Americans with HF experienced a disparate risk of shorter event-free survival not explained by a variety of risk factors.Item Approach to Acute Heart Failure in the Emergency Department(Elsevier, 2017-09) Hunter, Benton R.; Martindale, Jennifer; Abdel-Hafez, Osama; Pang, Peter S.; Department of Emergency Medicine, School of MedicineAcute heart failure (AHF) patients rarely present complaining of ‘acute heart failure.’ Rather, they initially present to the emergency department (ED) with a myriad of chief complaints, symptoms, and physical exam findings. Such heterogeneity prompts an initially broad differential diagnosis; securing the correct diagnosis can be challenging. Although AHF may be the ultimate diagnosis, the precipitant of decompensation must also be sought and addressed. For those AHF patients who present in respiratory or circulatory failure requiring immediate stabilization, treatment begins even while the diagnosis is uncertain. The initial diagnostic workup consists of a thorough history and exam (with a particular focus on the cause of decompensation), an EKG, chest X-ray, laboratory testing, and point-of-care ultrasonography performed by a qualified clinician or technologist. We recommend initial treatment be guided by presenting phenotype. Hypertensive patients, particularly those in severe distress and markedly elevated blood pressure, should be treated aggressively with vasodilators, most commonly nitroglycerin. Normotensive patients generally require significant diuresis with intravenous loop diuretics. A small minority of patients present with hypotension or circulatory collapse. These patients are the most difficult to manage and require careful assessment of intra- and extra-vascular volume status. After stabilization, diagnosis, and management, most ED patients with AHF in the United States (US) are admitted. While this is understandable, it may be unnecessary. Ongoing research to improve diagnosis, initial treatment, risk stratification, and disposition may help ease the tremendous public health burden of AHF.Item Association Between Medication Adherence and the Outcomes of Heart Failure(Wiley, 2018) Hood, Sarah R.; Giazzon, Anthony J.; Seamon, Gwen; Lane, Kathleen A.; Wang, Jane; Eckert, George J.; Tu, Wanzhu; Murray, Michael D.; Biostatistics, School of Public HealthBackground Previous studies of heart failure patients have demonstrated an association between cardiovascular medication adherence and hospitalizations or a composite end point of hospitalization and death. Few studies have assessed the impact of treatment adherence within large general medical populations that distinguish the health outcomes of emergency department visits, hospitalization, and death. Objective To determine the association of incremental cardiovascular medication adherence on emergency department visits, hospitalization, and death in adult heart failure patients in Indiana. Design Retrospective cohort study conducted using electronic health record data from the statewide Indiana Network for Patient Care (INPC) between 2004 and 2009. Methods Patients were at least 18 years of age with a diagnosis of heart failure and prescribed at least one cardiovascular medication for heart failure. Adherence was measured as the proportion of days covered (PDC) using pharmacy transaction data. Clinical end points included emergency department visits, hospital admissions, length of hospital stay, and mortality. Generalized linear models were used to determine the effect of a 10% increase in PDC on clinical end points adjusting for age, sex, race, Charlson comorbidity index, and medications. Results Electronic health records were available for 55,312 patients (mean age ± standard deviation [SD] 68 ± 16 years; 54% women; 65% white). Mean PDC for all heart failure medications was 63% ± 23%. For every 10% increase in PDC, emergency department visits decreased 11% (rate ratio [RR] 0.89; 95% confidence interval [CI] 0.89‐0.89), hospital admissions decreased 6% (RR 0.94; 95% CI 0.94‐0.94), total length of hospital stay decreased 1% (RR 0.99; 95% CI 0.99‐1.00), and all‐cause mortality decreased 9% (odds ratio 0.91; 95% CI 0.90‐0.92). Conclusion Incremental medication adherence was associated with reductions in emergency department visits, hospital admissions, length of hospital stay, and all‐cause mortality.Item Bariatric Surgery–Induced Cardiac and Lipidomic Changes in Obesity‐Related Heart Failure with Preserved Ejection Fraction(Wiley, 2018) Mikhalkova, Deana; Holman, Sujata R.; Jiang, Hui; Sagir, Mohammed; Novak, Eric; Coggan, Andrew R.; O'Connor, Robert; Bashir, Adil; Jamal, Ali; Ory, Daniel S.; Schaffer, Jean E.; Eagon, J. Christopher; Peterson, Linda R.; Kinesiology, School of Physical Education and Tourism ManagementObjective To determine the effects of gastric bypass on myocardial lipid deposition and function and the plasma lipidome in women with obesity and heart failure with preserved ejection fraction (HFpEF). Methods A primary cohort (N = 12) with HFpEF and obesity underwent echocardiography and magnetic resonance spectroscopy both before and 3 months and 6 months after bariatric surgery. Plasma lipidomic analysis was performed before surgery and 3 months after surgery in the primary cohort and were confirmed in a validation cohort (N = 22). Results After surgery‐induced weight loss, Minnesota Living with Heart Failure questionnaire scores, cardiac mass, and liver fat decreased (P < 0.02, P < 0.001, and P = 0.007, respectively); echo‐derived e′ increased (P = 0.03), but cardiac fat was unchanged. Although weight loss was associated with decreases in many plasma ceramide and sphingolipid species, plasma lipid and cardiac function changes did not correlate. Conclusions Surgery‐induced weight loss in women with HFpEF and obesity was associated with improved symptoms, reverse cardiac remodeling, and improved relaxation. Although weight loss was associated with plasma sphingolipidome changes, cardiac function improvement was not associated with lipidomic or myocardial triglyceride changes. The results of this study suggest that gastric bypass ameliorates obesity‐related HFpEF and that cardiac fat deposition and lipidomic changes may not be critical to its pathogenesis.Item Can Music Touch the Heart? Commentary on the Benefits of Music Listening for People Living With Heart Failure(Elsevier, 2020-07) Fleming, Renée; Robb, Sheri L.; School of NursingPopular literary tradition depicts the heart as the seat of human emotion, and evidence of this is everywhere. We speak of music touching our heartstrings, we talk of having a change of heart, we place our hands over our hearts when we sing the national anthem. Of course, we know today that mental and emotional activity is centered in the brain, but can music actually affect our hearts? Is there medical and scientific evidence of music's effects on heart health?Item Cannabis Use and Heart Transplantation: Disparities and Opportunities to Improve Outcomes(American Heart Association, 2022-10-14) Ilonze, Onyedika J.; Vidot, Denise C.; Breathett, Khadijah; Camacho-Rivera, Marlene; Raman, Subha V.; Kobashigawa, Jon A.; Allen, Larry A.; Medicine, School of MedicineHeart transplantation (HT) remains the optimal therapy for many patients with advanced heart failure. Use of substances of potential abuse has historically been a contraindication to HT. Decriminalization of cannabis, increasing cannabis use, clinician biases, and lack of consensus for evaluating patients with heart failure who use cannabis all have the potential to exacerbate racial and ethnic and regional disparities in HT listing and organ allocation. Here' we review pertinent pre-HT and post-HT considerations related to cannabis use' and relative attitudes between opiates and cannabis are offered for context. We conclude with identifying unmet research needs pertaining to the use of cannabis in HT that can inform a standardized evaluation process.Item Cardiac biomarkers in pediatric cardiomyopathy: Study design and recruitment results from the Pediatric Cardiomyopathy Registry(Elsevier, 2019-06-01) Everitt, Melanie D.; Wilkinson, James D.; Shi, Ling; Towbin, Jeffrey A.; Colan, Steven D.; Kantor, Paul F.; Canter, Charles E.; Webber, Steven A.; Hsu, Daphne T.; Pahl, Elfriede; Addonizio, Linda J.; Dodd, Debra A.; Jefferies, John L.; Rossano, Joseph W.; Feingold, Brian; Ware, Stephanie M.; Lee, Teresa M.; Godown, Justin; Simpson, Kathleen E.; Sleeper, Lynn A.; Czachor, Jason D.; Razoky, Hiedy; Hill, Ashley; Westphal, Joslyn; Molina, Kimberly M.; Lipshultz, Steven E.; Pediatrics, School of MedicineBackground: Cardiomyopathies are a rare cause of pediatric heart disease, but they are one of the leading causes of heart failure admissions, sudden death, and need for heart transplant in childhood. Reports from the Pediatric Cardiomyopathy Registry (PCMR) have shown that almost 40% of children presenting with symptomatic cardiomyopathy either die or undergo heart transplant within 2 years of presentation. Little is known regarding circulating biomarkers as predictors of outcome in pediatric cardiomyopathy. Study Design: The Cardiac Biomarkers in Pediatric Cardiomyopathy (PCM Biomarkers) study is a multi-center prospective study conducted by the PCMR investigators to identify serum biomarkers for predicting outcome in children with dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM). Patients less than 21 years of age with either DCM or HCM were eligible. Those with DCM were enrolled into cohorts based on time from cardiomyopathy diagnosis: categorized as new onset or chronic. Clinical endpoints included sudden death and progressive heart failure. Results: There were 288 children diagnosed at a mean age of 7.2±6.3 years who enrolled in the PCM Biomarkers Study at a median time from diagnosis to enrollment of 1.9 years. There were 80 children enrolled in the new onset DCM cohort, defined as diagnosis at or 12 months prior to enrollment. The median age at diagnosis for the new onset DCM was 1.7 years and median time from diagnosis to enrollment was 0.1 years. There were 141 children enrolled with either chronic DCM or chronic HCM, defined as children ≥2 years from diagnosis to enrollment. Among children with chronic cardiomyopathy, median age at diagnosis was 3.4 years and median time from diagnosis to enrollment was 4.8 years. Conclusion: The PCM Biomarkers study is evaluating the predictive value of serum biomarkers to aid in the prognosis and management of children with DCM and HCM. The results will provide valuable information where data are lacking in children. Clinical Trial Registration: NCT01873976 https://clinicaltrials.gov/ct2/show/NCT01873976?term=PCM+Biomarker&rank=1