Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This is a controlled pilot study of twenty patients to see if heart failure management can be optimised in the community using telemedicine. The study seeks to examine the feasibility, acceptability and reliability of using telemedicine in this context. Heart failure is a common condition. It is an important cause of mortality and morbidity and has large cost implications for the NHS. Most patients are managed in the UK in General Practice based on clinical assessment by the practitioner. Twenty patients with a mean age of 75.1 years and mean New York Heart Association grade of 1.75 were randomised in to two equal groups (telemonitoring and control) and observed for a period of three months. All twenty patients had a Cardiologist assessment and quality of life measurement at the beginning and end of the study. Patients in the telemedicine group had their blood pressure, pulse and weight data collected daily and undertook a weekly video conference with the nurse. Control patients had their blood pressure, weight and pulse measured at six weekly intervals. The study has been extended for a further six months beyond its initial three-month observation period to see if the initial short term benefit in the telemedicine group is maintained.
 ...
PMID:A controlled pilot study in the use of telemedicine in the community on the management of heart failure--a report of the first three months. 1074 31

BACKGROUND: Over recent years increased emphasis has been given to performance monitoring of NHS hospitals, including overall number of hospital readmissions, which however are often sub-optimally adjusted for case-mix. We therefore conducted a study to examine the effect of various patient and disease factors on the risk of emergency medical readmission. METHODS: The study setting was a District General Hospital in Greater Manchester and the study period was 4.5-years. All index emergency medical admission during the study period leading to a live discharge were included in the study (n = 20,209). A multivariable proportional hazards modelling was used, based on Hospital Episodes Statistics data, to examine the influence of various baseline factors on readmission risk. Deprivation status was measured with the Townsend deprivation index score. Hazard ratios (HR) and associated 95% confidence intervals (CI) of unplanned emergency medical admission by sex, age group, admission method, diagnostic group, number of coded co-morbidities, length of stay and patient's deprivation status quartile, were calculated. RESULTS: Significant independent predictors of readmission risk at 12 months were male sex (HR 1.13, CI: 1.07-1.2), age (age >75 (HR 1.57, CI 1.45-1.7), number of coded co-morbidities (HR for >4 coded co-morbidities: 1.49 CI: 1.26-1.76), admission via GP referral (HR 0.93, CI 0.88-0.99) and primary diagnosis of heart failure (HR 1.33, CI: 1.16-1.53) and chronic obstructive pulmonary disease/asthma (HR 1.34, CI: 1.21-1.48). Higher level of deprivation was also significantly and independently associated and with increased emergency medical readmission risk at three (HR for the most deprived quartile 1.21, CI: 1.08-1.35), six (HR 1.21, CI: 1.1-1.33) and twelve months (HR 1.25, CI: 1.16-1.36). CONCLUSIONS: There is a potential for improving health and reducing demand for emergency medical admissions with more effective management of patients with heart failure and chronic obstructive airways disease/asthma. There is also a potential for improving health and reducing demand if reasons for increased readmission risk in more deprived patients are understood. The potential influence of deprivation status on readmission risk should be acknowledged, and NHS performance indicators adjustment for deprivation case-mix would be prudent.
 ...
PMID:Factors influencing emergency medical readmission risk in a UK district general hospital: A prospective study. 1602 19

Heart failure is a complex disorder that affects patients and their carers in many ways. Recommendations for improving the quality of care for people with heart failure are set out in the government's National Service Framework for Coronary Heart Disease (Department of Health (DH) 2000a) and in the guideline commissioned by the National Institute for Clinical Excellence (NICE 2003a), which describes best practice for the management of patients with heart failure. This article discusses the role of the district nurse in meeting the challenges of the NICE guideline, and suggests that district nurses are better placed than other health professionals in primary care to have a central role in delivering such care. The contribution of district nurses to the management of patients with chronic diseases and those who are terminally ill at home is also discussed. The impact of The NHS Cancer Plan (DH 2000b) on the care of cancer patients in primary care is examined briefly to ascertain whether the NICE guideline is likely to have a similar impact on the scope and capacity of district nursing.
 ...
PMID:The district nurse's role in managing patients with heart failure. 1575 25

The Darlington heart failure service model, part of the South Durham Heart Failure Network, was devised to overcome barriers to accurate diagnosis and effective management of heart failure. It involves rapid diagnosis of left ventricular systolic dysfunction (LVSD) and ongoing heart failure management. A weekly one stop diagnostic clinic, run by a general practitioner (GP) specialist and a heart failure nurse, is jointly funded by the primary care trust and the South Durham NHS Trust. If LVSD is confirmed, a management plan is formulated which includes patient education and initiation of evidence based treatment. The heart failure nursing service is invaluable in bridging the gap between primary and secondary care. Local guidelines, together with continuing education of GPs and practice nurses, and the new General Medical Services contract, should further increase the uptake of evidence based treatments at target doses.
 ...
PMID:Bridging the treatment gap: the primary care perspective. 1583 10

Heart failure (HF) is a complex, incurable condition with a number of causes. Symptoms may vary depending on the stage of HF, as well as the origin. HF is a costly condition to the NHS with readmission rates among the highest for any condition in the UK. However, many of these readmissions are preventable. Educating the patient and his/her family has been shown to reduce readmission rates, which could ease the financial burden on the NHS. This article reviews the literature surrounding current HF issues, and aims to explore the current guidelines of managing HF and examine the role of the nurse. Readers will be given an overview of the causes and symptoms, along with medication management and the clinical skills required. Psychological conditioning plays an important role in the patients' physical wellbeing. A clear understanding of knowing how HF should be managed can improve a patient's outlook and enable him/her to take control of his/her condition.
 ...
PMID:Counting the cost of heart failure to the patient, the nurse and the NHS. 2113 20

This study developed a method for measuring change in socio-economic equity in health care utilisation using small-area level administrative data. Our method provides more detailed information on utilisation than survey data but only examines socio-economic differences between neighbourhoods rather than individuals. The context was the English NHS from 2001 to 2008, a period of accelerated expenditure growth and pro-competition reform. Hospital records for all adults receiving non-emergency hospital care in the English NHS from 2001 to 2008 were aggregated to 32,482 English small areas with mean population about 1500 and combined with other small-area administrative data. Regression models of utilisation were used to examine year-on-year change in the small-area association between deprivation and utilisation, allowing for population size, age-sex composition and disease prevalence including (from 2003 to 2008) cancer, chronic kidney disease, coronary heart disease, diabetes, epilepsy, hypertension, hypothyroidism, stroke, transient ischaemic attack and (from 2006 to 2008) atrial fibrillation, chronic obstructive pulmonary disease, obesity and heart failure. There was no substantial change in small-area associations between deprivation and utilisation for outpatient visits, hip replacement, senile cataract, gastroscopy or coronary revascularisation, though overall non-emergency inpatient admissions rose slightly faster in more deprived areas than elsewhere. Associations between deprivation and disease prevalence changed little during the period, indicating that observed need did not grow faster in more deprived areas than elsewhere. We conclude that there was no substantial deterioration in socio-economic equity in health care utilisation in the English NHS from 2001 to 2008, and if anything, there may have been a slight improvement.
 ...
PMID:Measuring change in health care equity using small-area administrative data - evidence from the English NHS 2001-2008. 2281

Chronic heart failure affects around 750000 people per year in the UK. Despite the development of evidence-based treatments the 1-year survival rate is poorer than for many common cancers. Quality of life is poor, with breathlessness, peripheral oedema and fatigue being common symptoms. Through clinical audit a community heart failure nurse identified that the palliative care needs of patients with advanced heart failure were not being adequately addressed in his locality. A more cohesive way of managing these patients was required. Joint working between heart failure and palliative care clinicians as well as the development of an advanced heart failure shared care pathway and supporting tools resulted in patients with heart failure having improved access to palliative care, more of these patients dying in their preferred place of care, and the provision of a holistic heart failure service spanning referral to end of life. The impact of chronic heart failure on both individual patients and the NHS is considerable. With interdisciplinary and interorganisational collaboration, a new approach to managing patients with heart failure has been developed that has resulted in improved patient care.
 ...
PMID:Development of an end-of-life care pathway for patients with advanced heart failure in a community setting. 2288 3

In the UK, over 900,000 patients have chronic heart failure and more than 60,000 develop the condition each year.(1,2) Patients with heart failure suffer significantly reduced quality of life and have a poor prognosis. It is estimated that heart failure accounts for around 2% of the total NHS budget, 70% of which is related to the costs of hospitalisation.(3) The main pharmacological interventions that are currently used to manage heart failure include angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor antagonists (AIIRAs), beta-blockers and aldosterone antagonsists. Ivabradine (Procoralan - Servier) is a "pure heart rate lowering agent, acting by selective and specific inhibition of the cardiac pacemaker I(f) current that controls the spontaneous diastolic depolarisation in the sinus node and regulates heart rate".(4) It has been licensed in the UK since 2006 for the symptomatic treatment of chronic stable angina in patients with normal sinus rhythm.(5) Earlier this year ivabradine was granted marketing authorisation for the treatment of chronic heart failure. Here we review the role of ivabradine for this new indication.
 ...
PMID:Ivabradine for chronic heart failure? 2306 52

Telemonitoring involves remotely monitoring patients' vital signs. It is an innovative and promising development in the care of people with heart failure that may reduce hospital admissions and the burden on the NHS, as well as improve patients' quality of life and clinical outcomes. This article describes what telemonitoring is and explores the evidence base for its use. The role of the nurse in telemonitoring is also discussed, with particular reference to dealing with and responding to alerts. The development and implementation of new technology is essential to improve the delivery of healthcare and optimise patient outcomes, and telemonitoring may play an important role in the future of heart failure services.
 ...
PMID:Benefits of telemonitoring in the care of patients with heart failure. 2310 Dec 98

A novel amperometric magnetoimmunosensor using an indirect competitive format is developed for the sensitive detection of the amino-terminal pro-B-type natriuretic peptide (NT-proBNP). The immunosensor design involves the covalent immobilization of the antigen onto carboxylic-modified magnetic beads (HOOC-MBs) activated with N-(3-dimethylaminopropyl)-N'-ethylcarbodiimide (EDC) and N-hydroxysulfosuccinimide (sulfo-NHS), and further incubation in a mixture solution containing variable concentrations of the antigen and a fixed concentration of an HRP-labeled detection antibody. Accordingly, the target NT-proBNP in the sample and that immobilized on the MBs compete for binding to a fixed amount of the specific HRP-labeled secondary antibody. The immunoconjugate-bearing MBs are captured by a magnet placed under the surface of a disposable gold screen-printed electrode (Au/SPE). The amperometric responses measured at -0.10 V (vs. a Ag pseudo-reference electrode), upon addition of 3,3',5,5'-tetramethylbenzidine (TMB) as electron transfer mediator and H2O2 as the enzyme substrate, are used to monitor the affinity reaction. The developed magnetoimmunosensor provides attractive analytical characteristics in 10-times diluted human serum samples, exhibiting a linear range of clinical usefulness (0.12-42.9 ng mL(-1)) and a detection limit of 0.02 ng mL(-1), which can be used in clinical diagnosis of chronic heart failure in the elderly and for classifying patients at risk of death after heart transplantation. The magnetoimmunosensor was successfully applied to the analysis of spiked human serum samples.
 ...
PMID:Disposable amperometric magnetoimmunosensor for the sensitive detection of the cardiac biomarker amino-terminal pro-B-type natriuretic peptide in human serum. 2374 3


1 2 Next >>