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Physical Activity & HF Prevention

Physical Activity & HF Prevention

Current guidelines from the American Heart Association (AHA) and other groups for adults recommend a minimum of at least 150 minutes of moderate-intensity aerobic physical activity (PA) per week. Despite this recommendation, some studies have suggested that even more PA can better protect patients from adverse cardiac events. Prior studies have shown that there appears to be an inverse association between PA and risk of heart failure (HF). “The role of PA in coronary heart disease has been studied comprehensively, but few analyses have focused exclusively on the quantitative relationship between the amount—or specific dose—of regular PA and the risk of HF,” says Ambarish Pandey, MD. In a study published in Circulation, Dr. Pandey and colleagues pooled data from 12 studies from United States and Europe. The analysis collectively included 370,460 patients with varying levels of PA at baseline and 20,203 HF events over an average of follow-up about of 15 years. PA was measured by self-reported levels of activity using standard questionnaires. According to the research team, this approach provided an opportunity to assess the dose-response relationship between PA and HF risk in the general population.   More Is Better “Our findings suggest a dose-dependent inverse association between PA levels and risk for HF such that  patients who had the highest levels of PA had a significantly lower risk of developing HF than those with the lowest levels of PA,” says Dr. Pandey. This relationship was consistent across all age, sex, race, and geographic location based subgroups studied. Participants who engaged in guideline recommended minimum levels of PA—150 minutes of moderate intensity PA per week—had modest reductions in...
Transitional Care Interventions to Prevent HF Readmissions

Transitional Care Interventions to Prevent HF Readmissions

According to published research, heart failure (HF) is a leading cause of hospitalization and healthcare costs in the United States. Current estimates show that up to 25% of patients hospitalized with HF are readmitted within 30 days. Early hospital readmissions following an initial hospitalization for HF are related to a variety of conditions. About one-third can be attributed to HF, whereas the rest are related to other conditions, such as renal disorders, pneumonia, and arrhythmias. In an effort to reduce readmission rates for HF, CMS began decreasing reimbursements to hospitals with excessive risk-standardized readmissions in 2012. With this policy in place, hospitals have been incentivized to develop programs to reduce HF readmission rates. “Although significant advances have occurred with regard to the quality of how acute and chronic HF are managed, hospital readmissions in this population continue to be a problem,” says Cynthia Feltner, MD, MPH. She adds that there is uncertainty about the effectiveness of interventions to support the transition of care for people with HF. Transitional care interventions are designed to prevent readmissions among patients transitioning from one care setting to another. Several models have been created, with the goal of avoiding poor outcomes caused by uncoordinated care. “These interventions focus on patient or caregiver education, medication reconciliation, and coordination among healthcare professionals involved in the transition,” Dr. Feltner says. A Systematic Review In a systematic review published in Annals of Internal Medicine, Dr. Feltner and colleagues examined transitional care interventions for people with HF as part of AHRQ’s Effective Health Care Program. The authors reviewed a broad range of intervention types that aimed to prevent readmissions...
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,...
Flu Vaccination & Cardiovascular Outcomes

Flu Vaccination & Cardiovascular Outcomes

Studies have shown that recent influenza-like infection is a non-traditional cardiovascular disease (CVD) risk factor that has been linked to fatal and non-fatal atherothrombotic events. “There is interest in learning more about the potential association between influenza and subsequent CVD events,” says Jacob A. Udell, MD, MPH, FRCPC. A Systematic Review & Meta-Analysis Small, observational randomized clinical trials (RCTs) have suggested that influenza vaccination helps reduce the risk of cardiovascular events, leading several medical associations to recommend universal vaccination in patients with or at risk of CVD. In an issue of JAMA, Dr. Udell and colleagues had a study published that more closely examined the link between flu vaccinations and prevention of cardiovascular events. The systematic review and meta-analysis consisted of RCTs of influenza vaccine that studied cardiovascular events as efficacy or safety outcomes. For the study, five published RCTs and another unpublished RCT involving more than 6,700 patients in total met inclusion criteria. Analyses were stratified by subgroups of patients with and without a history of acute coronary syndrome (ACS) within 1 year of randomization. Fewer patients treated with the flu vaccine developed a major adverse cardiovascular event when compared with placebo or control groups (2.9% vs 4.7%, respectively). The addition of the unpublished data did not materially change the results. “The potential impact that this preventive strategy may have on high-risk CVD patients is significant.” “The greatest treatment effect was seen among patients with recent ACS,” adds Dr. Udell. In a subgroup analysis of three RCTs of patients with pre-existing coronary artery disease (CAD), the risk of major adverse cardiovascular events among patients with a history of...
Updated Guidelines for Heart Failure

Updated Guidelines for Heart Failure

Recently, the American College of Cardiology Foundation (ACCF) and American Heart Association (AHA) jointly released an expanded clinical practice guideline for the management of patients with heart failure (HF). The update, published in the Journal of the American College of Cardiology was designed to assist clinicians in selecting the best management strategies for patients. “The guideline updates definitions and classifications for HF, increases the emphasis on patient-centric outcomes, and introduces ‘guideline- directed medical therapy’ (GDMT),” explains Clyde W. Yancy, MD, MSc, FACC, who chaired the ACCF/AHA writing committee. Descriptions & Classifications of Heart Failure The ACCF/AHA guideline update provides a more focused approach on dilated cardiomyopathies and the appropriate evaluation of patients. This includes family and genetic screening and counseling. “The guidelines once again endorse four stages of disease progression: Stages A thru D,” explains Dr. Yancy. “Stage A patients are those with positive risk factors, whereas Stage B patients have existing but still asymptomatic left ventricular function.” “The expectations are highest for hospitalized patients with HF because of their vast resource consumption from initial admissions to subsequent readmissions.” Stage C is the classic patient with congestive HF, but importantly, Dr. Yancy says this patient group is now well dichotomized as having HF with reduced ejection fraction (EF) or HF with preserved EF. “Best therapies are aligned with each stage, specifically risk factor modification, pre-emptive medical and device therapies for asymptomatic left ventricular dysfunction, and classic evidence-based therapies for symptomatic HF patients with reduced EF,” he says. “The guidelines also provide a treatment algorithm for Stage C HF patients with reduced EF [Figure]. The algorithm, known as GDMT, can...
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