Heart Failure in Hispanics

Introduction Heart failure (HF) is a leading cause of hospitalisation in China, which is experiencing a rapid increase in cardiovascular disease prevalence. Yet, little is known about current burden of disease, quality of care and treatment outcomes of HF in China. The objective of this paper is to describe the study methodology, data collection and abstraction, and progress to date of the China Patient-centered Evaluative Assessment of Cardiac Events 5 Retrospective Heart Failure Study (China PEACE 5r-HF). Methods and analysis The China PEACE 5r-HF Study will examine a nationally representative sample of more than 10 000 patient records hospitalised for HF in 2015 in China. The study is a retrospective cohort study. Patients have been selected using a two-stage sampling design stratified by economic–geographical regions. We will collect patient characteristics, diagnostic testing, treatments and in-hospital outcomes, including death and complications, and charges of hospitalisation. Data quality will be monitored by a central coordinating centre and will address case ascertainment, data abstraction and data management. As of October 2017, we have sampled 15 538 medical records from 189 hospitals, and have received 15 057 (96.9%) of these for data collection, and completed data abstraction and quality control on 7971. Ethics and dissemination The Central Ethics Committee at the Chinese National Center for Cardiovascular Diseases approved the study. All collaborating hospitals accepted central ethics committee approval with the exception of 15 hospitals, which obtained local approval by internal ethics committees. Findings will be disseminated in future peer-reviewed papers and will serve as a foundation for improving the care for HF in China. Trial registration number NCT02877914.

https://bmjopen.bmj.com/content/bmjopen/8/5/e020918.full.pdf

The China Patient-centered Evaluative Assessment of Cardiac Events (China PEACE) retrospective heart failure study design.

• Quantitative: 2nd analysis provided significant results. Staff may not have been catching all symptoms reported by patients •Third analysis: Differences on three questions where patient score was much higher than staff score: pain, other symptoms, and self worth •Qualitative: Expert reviewers provided thematic analysis of patient problems: physical symptoms and suffering, care management, self care behaviors, and psychological experiences • Similar studies, main problems: Dyspnea, multiple problems, emotional domain problems (Guyatt, 1993; Bausewein, Nauck, von Mackensen, Borasio, & Higginson, 2005; Yu, Lee, Kwong, Thompson & Woo, 2007; Annema, Luttik, Jaarsma, 2009)

/pdf/exploration-of-self-care-following-distribution-of-acute-4bss60exq4.pdf

Exploration of self-care following distribution of acute management tool for elder heart failure patients in clinic setting

The therapeutic management and health challenges caused by atrial fibrillation (AF) differ between different groups. The purpose of this study was to investigate the clinical features of patients hospitalized with AF and to explore the use of anticoagulation treatments in Han and Uygur patients in Xinjiang, northwest China. Data were collected from a retrospective descriptive study involving patients hospitalized at 13 hospitals in Xinjiang, China from Jul 1, 2014 to Jun 31, 2015. Anticoagulation management was measured according to guideline-recommended risk scores. A total of 4,181 patients with AF were included (mean age 69.5 ± 11.7 years, 41.4% females; 71.5% Han, 28.5% Uygur). The prevalence of AF in Uygur individuals may occur earlier than in Han individuals (mean age 64.9 vs 71.3, P < 0.001). Most of the hospitalized patients with AF had a high risk of stroke (CHA2DS2-VASc score ≥2; 80.6% Han vs 73.7% Uygur, P < 0.05); this risk was especially high in elderly patients. In AF patients, the application of anticoagulants according to the guidelines is far from expected, and the underutilization of anticoagulants exists in both ethnic groups.

/pdf/ethnicity-and-anticoagulation-management-of-hospitalized-3znmdluc5r.pdf

Ethnicity and anticoagulation management of hospitalized patients with atrial fibrillation in northwest China.

Background Heart failure (HF) is a condition that affects millions of Americans and costs $30 billion to treat annually. HF is the cause for frequent hospitalizations. Self-care practices have been found to improve quality of life, decrease hospitalizations, and reduce treatment costs. Participants Fifteen adult patients with a HF diagnosis ages 18 to 70 voluntarily participated in the implementation of a protocol aimed at improving self-care behaviors in patients with HF in a private cardiology practice located in a southeastern city. Methods The project was a quality improvement design. A protocol was implemented using resources from the American Heart Association. Monitoring logs were provided to patients to record daily weights, sodium intake, blood pressure, and symptoms. Educational resources included information about medications and a list of valid HF websites. Participants were provided medication organizers and a two-liter container with which to monitor daily fluid intake. The written information and logs were compiled in red folders. Results Of the 15 participants, there were no hospital admissions or readmissions for HF during the implementation period. Leg and ankle swelling worsened; dyspnea improved; fewer participants felt like a burden to their family; HF knowledge improved. Discussion The findings indicate the feasibility of implementing the protocol throughout a private practice organization.

Implementing a Protocol to Improve Self-Care Behaviors in Adult Patients With Heart Failure.

Background: Hypertension is a major factor associated with heart failure (HF).While effective blood pressure (BP) control is recommended in patients with HF, little is known regarding treatment and control rates in these patients.

Methods: The analyses assessed HF patients from 195 hospitals participating in the GWTG-HF quality improvement program from January 2005 through September 2006. Patients with hypertension were assessed for number and type of hypertension treatment as well as BP control rates. Analyses were stratified by race-sex groups with multivariate logistic regression models using the generalized estimating equations methods assessed the factors associated with multiple treatment, type of therapy, and BP control levels.

Results: Of 37,318 HF patients, 62.3% (23,257) had diagnosed hypertension. The majority (67.3%) of these high-risk individuals were treated with 3 or more hypertension drugs, which was significantly varied by race-sex groups. The use of ACEI (64.6%), beta blockers (79.9%), angiotensin receptor blockers (18.5%), diuretics (62.4%), loop diuretic (73.8%), and calcium channel blockers (13.3%) significantly varied by race-sex groups. BP control rates (< 140/90 mm Hg) at discharge significantly varied by race-sex group (total 70.8%; white males (WM) 76.3%; white females (WF) 71.1%; black males (BM) 63.0%; and black females (BF) 62.9%). Significant factors associated with BP control at discharge included age, race-sex (WF vs. BF, WM vs. BF), atrial fibrillation, hyperlipidemia, coronary heart disease, ICD, pacemaker, history of MI, and not having one or more of the following co-morbid conditions: diabetes, peripheral vascular disease, CVA and renal disease. Control rates considering BP < 130/80 mm Hg (52.3%) showed similar significant variation by race-sex group (WM 57.4%; WF 53.7%; BM 42.3%.; and BF 44.4%).

Conclusions: The less than optimal blood pressure control levels and the gender/racial disparities support continued emphasis on hypertension treatment and control among patients with heart failure.

Abstract 3466: Hypertension Treatment and Control Among Patients Hospitalized with Heart Failure: An Analysis of Get With The Guidelines Heart Failure

Disparate quality of care for black and hispanic heart failure (HF) patients: A report from Get With the Guidelines-Heart Failure (GWTG-HF)

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Abstract 3466: Hypertension Treatment and Control Among Patients Hospitalized with Heart Failure: An Analysis of Get With The Guidelines Heart Failure

Disparate quality of care for black and hispanic heart failure (HF) patients: A report from Get With the Guidelines-Heart Failure (GWTG-HF)