Self-Care Monitoring of Heart Failure Symptoms and Lung Impedance at Home Following Hospital Discharge: Longitudinal Study.
- 作者列表："Aamodt IT","Lycholip E","Celutkiene J","von Lueder T","Atar D","Falk RS","Hellesø R","Jaarsma T","Strömberg A","Lie I
BACKGROUND:Self-care is key to the daily management of chronic heart failure (HF). After discharge from hospital, patients may struggle to recognize and respond to worsening HF symptoms. Failure to monitor and respond to HF symptoms may lead to unnecessary hospitalizations. OBJECTIVE:This study aimed to (1) determine the feasibility of lung impedance measurements and a symptom diary to monitor HF symptoms daily at home for 30 days following hospital discharge and (2) determine daily changes in HF symptoms of pulmonary edema, lung impedance measurements, and if self-care behavior improves over time when patients use these self-care monitoring tools. METHODS:This study used a prospective longitudinal design including patients from cardiology wards in 2 university hospitals-one in Norway and one in Lithuania. Data on HF symptoms and pulmonary edema were collected from 10 participants (mean age 64.5 years; 90% (9/10) male) with severe HF (New York Heart Association classes III and IV) who were discharged home after being hospitalized for an HF condition. HF symptoms were self-reported using the Memorial Symptom Assessment Scale for Heart Failure. Pulmonary edema was measured by participants using a noninvasive lung impedance monitor, the CardioSet Edema Guard Monitor. Informal caregivers aided the participants with the noninvasive measurements. RESULTS:The prevalence and burden of shortness of breath varied from participants experiencing them daily to never, whereas lung impedance measurements varied for individual participants and the group participants, as a whole. Self-care behavior score improved significantly (P=.007) from a median of 56 (IQR range 22-75) at discharge to a median of 81 (IQR range 72-98) 30 days later. CONCLUSIONS:Noninvasive measurement of lung impedance daily and the use of a symptom diary were feasible at home for 30 days in HF patients. Self-care behavior significantly improved after 30 days of using a symptom diary and measuring lung impedance at home. Further research is needed to determine if daily self-care monitoring of HF signs and symptoms, combined with daily lung impedance measurements, may reduce hospital readmissions.
背景: 自我护理是慢性心力衰竭日常管理的关键。出院后，患者可能难以识别和响应恶化的HF症状。未能监测和响应HF症状可能导致不必要的住院治疗。 目的: 本研究旨在 (1) 确定肺阻抗测量和症状日记在出院后30天内每天在家监测心力衰竭症状的可行性，(2) 确定肺水肿、肺阻抗测量、如果患者使用这些自我护理监测工具时，自我护理行为随着时间的推移而改善。 方法: 本研究采用前瞻性纵向设计，包括来自2所大学医院 (挪威1所，立陶宛1所) 心内科病房的患者。从10名患有严重HF (纽约心脏协会III和IV级) 的参与者 (平均年龄64.5岁; 90% (9/10) 为男性) 中收集关于HF症状和肺水肿的数据，这些参与者因HF状况住院后出院回家。使用心力衰竭的记忆症状评估量表自我报告HF症状。参与者使用无创肺阻抗监测器 (CardioSet effection Guard监测器) 测量肺水肿。非正式护理人员帮助参与者进行无创测量。 结果: 呼吸急促的患病率和负担从每天经历呼吸急促的参与者到从不经历呼吸急促的参与者有所不同，而肺阻抗测量结果在个体参与者和群体参与者整体上有所不同。自我护理行为评分显著改善 (P =.007)，从出院时的中位数56 (IQR范围22-75) 到30天后的中位数81 (IQR范围72-98)。 结论: 在心力衰竭患者中，每天无创测量肺阻抗和使用症状日记在家中进行30天是可行的。在家中使用症状日记和测量肺阻抗30天后，自我护理行为显著改善。需要进一步的研究来确定HF体征和症状的日常自我护理监测，结合每日肺阻抗测量，是否可以减少再入院。
METHODS::Aim: Heart failure is a serious complication of acute myocardial infarction leading to poor prognosis. We aimed at exploring time trends of heart failure and their impact on mortality among patients with an incident acute myocardial infarction. Methods: From the National Patient Danish Registry we collected data on all patients hospitalized with an incident of acute myocardial infarction during 2000-2009 and identified cases with in-hospital heart failure (presented on admission or developing heart failure during acute myocardial infarction hospitalization) or post-discharge heart failure (a hospitalization or outpatient visit following acute myocardial infarction discharge), and assessed in-hospital, 30-day and 1-year mortality. Results: Of the 78,814 patients included in the study, 10,248 (13.0%) developed in-hospital heart failure. The odds of in-hospital heart failure declined 0.9% per year (odds ratio=0.991, 95% confidence interval: 0.983-0.999). In-hospital heart failure was associated with 13% (odds ratio=1.13, 95% confidence interval: 1.06-1.20) and 14% (odds ratio=1.14, 95% confidence interval: 1.07-1.20) higher in-hospital and 30-day mortality, respectively. Of the 61,637 patients discharged alive without in-hospital heart failure, 5978 (9.7%) experienced post-discharge heart failure, 4116 (6.7%) were hospitalized and 1862 (3.0%) were diagnosed at outpatient clinics. The risk of heart failure requiring hospitalization declined 5.5% per year (hazard ratio=0.945, 95% confidence interval: 0.934-0.955) whereas the risk of heart failure diagnosed at outpatient clinics increased 13.4% per year (hazard ratio=1.134, 95% confidence interval: 1.115-1.153). Post-discharge heart failure was associated with 239% (hazard ratio=3.39, 95% confidence interval: 3.18-3.63) higher 1-year mortality. Conclusions: In-hospital and post-discharge heart failure requiring hospitalization decreased whereas post-discharge heart failure diagnosed at outpatient clinics increased among incident acute myocardial infarction patients during 2000-2009. The development of heart failure, especially after acute myocardial infarction discharge, indicates a poor prognosis.
METHODS::The number of patients with heart failure (HF) is rapidly increasing. Although hypertension is related to onset of HF, antihypertensive treatment status for these patients has not been fully examined. We conducted a claims-based study to discern the treatment status of Japanese hypertensive patients with HF. Two Japanese databases (2008-2016) from acute care hospitals and health insurance societies were used to analyze prescription rates for antihypertensive drug class or category of diuretics in all hypertensive patients and the subset of patients with HF. Totals of hypertensive patients and those with HF in each database in 2015 were 4,191,666 and 1,404,008 patient-months, and 1,382,732 and 148,194 patient-months, respectively. In the acute care hospitals database, calcium channel blockers (CCBs) (55.0-56.5%) and angiotensin II receptor blockers (49.4-54.7%) were prescribed most. β-blockers (38.7-48.0%) and diuretics (42.3-45.6%) were prescribed more for hypertensive patients with HF than for all hypertensive patients (21.5-24.8% and 25.5-26.7%, respectively). Loop diuretics were also prescribed more often for hypertensive patients with HF (68.3-76.0% from acute care hospitals and 47.8-55.8% from health insurance societies) than for all hypertensive patients (56.7-61.7% and 16.4-18.3%). The size of medical institution had a greater effect on drug selection than patient age in both patient groups. Given recommendations in guidelines for hypertensive patients with HF, the differences in drug choice in comparison with all hypertensive patients appear reasonable. However, some deviations, such as the high rate of CCBs in frontline and preference for angiotensin II receptor blockers over angiotensin-converting enzyme inhibitors, did not appear to follow guidelines.
METHODS::The management of type 2 diabetes mellitus (T2DM) essentially consists in controlling hyperglycaemia, together with other vascular risk factors, in order to reduce the incidence and severity of diabetic complications. Whereas glucose control using classical glucose-lowering agents (except perhaps metformin) largely fails to reduce cardiovascular disease (CVD), two new pharmacological classes, glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter type 2 inhibitors (SGLT2is), have proven their ability to reduce major cardiovascular events in patients with established CVD. Furthermore, SGLT2is reduced the risk of hospitalisation for heart failure and the progression of renal disease. According to the 2018 ADA-EASD consensus report, the choice of a second agent to be added to metformin should now be driven by the presence or not of atherosclerotic CVD, heart failure or renal disease, all conditions that should promote the use of a SGLT2i or a GLP-1 RA with proven efficacy. Thus endocrinologists have to face a new paradigm in the management of T2DM, with a shift from a primary objective of glucose control without inducing hypoglycaemia and weight gain to a goal of cardiovascular and renal protection, largely independent of glucose control. Of note, however, the latter remains crucial to reduce the risk of microangiopathy.