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Tackling Heart Failure Readmissions

Tackling Heart Failure Readmissions

According to recent estimates, heart failure (HF) currently affects about 6 million adults in the United States, and the prevalence is projected to increase 25% by 2030. When HF patients are hospitalized, it represents a turning point in the natural history of their disease. “About 25% of HF patients who are discharged from the hospital are readmitted within 30 days,” says Clyde W. Yancy, MD, MSc, FACC. HF patients often need to be readmitted because the underlying cause of HF worsens. Hospitalizations are responsible for the majority of the nearly $40 billion that is spent annually for HF care in the U.S. As a result, these hospitalizations have become a focal point for quality improvement efforts and initiatives aimed at reducing costs. In an effort to improve outcomes, CMS has mandated that hospitals report their 30-day readmission rates for HF and acute myocardial infarction (AMI). The problem with this approach, according to Dr. Yancy, is that public reporting of outcomes is not effective as a hospital performance indicator. “Readmission rates, particularly for HF, are not a good marker of quality of care,” he says. “The emphasis on 30-day readmissions is misguided because the primary driver of these events is often patient population and the community that is served by hospitals.” Clinical investigations have also suggested that public reporting does not provide effective incentives for improvement and has had only minor effects on outcomes. Widespread Concern The changing paradigm to deny payment for HF readmissions within 30 days of discharge has led to widespread concern across hospitals. “Implementing HF programs and readmission reduction strategies are undertakings that require significant analysis,...
Refusal of Curative Care in the ED

Refusal of Curative Care in the ED

Resuscitating and stabilizing acutely ill or injured patients is a top priority for ED personnel, but traditional aggressive approaches to care may sometimes not suit the needs of those with advanced chronic illnesses who present to the ED with critical or terminal events. When seriously ill ED patients decline care targeted to cure disease, it may be challenging to rapidly shift treatment plans, especially if physicians feel unprepared and untrained for such scenarios. Framing the Conversation “When managing seriously ill patients who refuse curative care, it’s important to consider patient decision-making capacity,” says Sangeeta Lamba, MD. Pertinent information and options, including the risks of refusing care, should be provided. Ideally, patients will be able to communicate that they understand this information and verbalize their rationale for refusal based on personal goals. “It’s also important to involve the patient’s family, surrogates, or healthcare proxy,” adds Dr. Lamba. With clinical deterioration, patients may lose their ability to communicate. Others can then assist with decision making, especially if they know what patients value. “ED clinicians should first discuss overall patient goals and values before addressing specific procedures or issues,” Dr. Lamba says. “This information can help physicians frame future conversations and treatment plans to achieve patients’ objectives. It’s vital to understand the ‘why’ behind patient refusal and to use appropriate language and tone when having such conversations.” The ED team should also present viable alternatives if optimal treatment is not desired by patients or their family. Handling Transitions Once goals are clarified, patients may need to be shifted from curative care to a comfort-care approach. This transition must occur seamlessly and be...
Smoking Cessation in People With HIV/AIDS

Smoking Cessation in People With HIV/AIDS

Published research shows that cigarette smoking rates among people living with HIV/AIDS are substantially higher than those of the general public. “The prevalence of smoking adults in the United States is about 18%, but that figure increases to approximately 50% for people with HIV/AIDS,” says Damon J. Vidrine, DrPH, MS. “Furthermore, people with HIV/AIDS are at higher risk from the adverse health consequences of smoking, including heart disease, cancer, pulmonary disease, and overall mortality.” A recent study found that more than 60% of deaths among people living with HIV/AIDS can be attributed to smoking. “Smoking can also interfere with the efficacy of medications used to keep HIV/AIDS under control,” adds Ellen R. Gritz, PhD. Despite compelling evidence suggesting that people with HIV/AIDS could benefit considerably from smoking cessation treatment, large-scale trials conducted exclusively in these patients are scarce. “Few studies have looked at interventions that have been effective for long-term smoking abstinence in these patients,” says Dr. Gritz. “We need more studies that focus on the unique needs of people with HIV/AIDS in the context of this patient group being economically disadvantaged.” A Unique Smoking Cessation Intervention Dr. Gritz, Dr. Vidrine, and colleagues had a study published in Clinical Infectious Diseases that compared a usual care (UC) approach with an innovative cell phone counseling-based smoking cessation intervention in low-income, multiethnic people with HIV/AIDS who smoked. “We wanted to develop and implement a smoking cessation intervention that addressed the complex medical and social needs encountered by these patients,” says Dr. Vidrine. “This is one of the largest studies to look at a smoking cessation intervention that exclusively targets people living...
SCAI 2014

SCAI 2014

New research is being presented at SCAI 2014, the Society for Cardiovascular Angiography and Intervetions annual scientific sessions, from May 28 to 31 in Las Vegas. Meeting Highlights Radial Access PCI for STEMI Renal Artery Stenting Outcomes Gender Differences Following Angioplasty    News From the Meeting Comparison of Lesion Level Decision Making in the Cath Lab Using Hyperemic and Non-Hyperemic Pressure Wire Derived Indices of Stenosis Severity: The VERIFY-2 Study Effect of a Real Time Radiation Monitoring Device on Radiation Exposure During Cardiac Catheterization: The Radiation Reduction during Cardiac Catheterization Using Real Time Monitoring (RadiCure) Study Diamondback 360° Coronary Orbital Atherectomy System for Treating De Novo, Severely Calcified Lesions: ORBIT II 1-Year Results and Cost Comparison to a Sample of Medicare Hospital Claims 3-Dimensional Quantitative Coronary Angiography Using Coronary Catheters as Objective Markers Reliably Unmasks Severe Occult Stenosis in Diffusely Diseased Vessels: New Results from the IQ-CATEGORIZE Lesions Study SCAI 2014 Scientific Sessions Hildner Lecture Tackles Looming Shortage of Interventional Cardiologists Dr. Charles Chambers Inducted as 38th SCAI President SCAI 2014 Lecture Highlights Why Tiny Hearts Need Big Innovations SCAI 2014 Scientific Sessions Founders’ Lectureto Emphasize the Next Phase of Innovation in Interventional Cardiology Pediatric and Congenital Interventional Cardiologists Should Complete One Year of Additional Training New SCAI Toolkit Guides Pediatric Cath Lab Quality Improvement SCAI Publishes New Treatment Recommendations for Common Form of Peripheral Artery Disease Online AUC App Is Fast, Easy Source of Real-Time Quality Data in Cath Lab Smart Technology Plays Useful Role in Pediatric Interventional Cardiology Smoking Makes Arterial Plaques More Vulnerable to Rupture Studies Add Insight Into Heparin-Bivalirudin Controversy in PCI New Study Supports...
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