Weight Gain May Save a Heart Failure Patient's Life

2006 ◽  
Vol 39 (1) ◽  
pp. 39
Author(s):  
MITCHEL L. ZOLER
Keyword(s):  
Heart Failure ◽  
Weight Gain

Long-Term Weight Gain Associated With High Omentin Levels at Hospital Discharge Improves Prognosis of Patients Following Acute Heart Failure

2018 ◽  
Vol 12 (3) ◽  
pp. 231-239
Author(s):  
Rosa M. Agra-Bermejo ◽  
Rocio Gonzalez-Ferreiro ◽  
J. Nicolos Lopez-Canoa ◽  
Alfonso Varela-Roman ◽  
Ines Gomez-Otero ◽  
...  
Keyword(s):  
Heart Failure ◽  
Weight Gain ◽  
Hospital Discharge ◽  
Acute Heart Failure

Abstract 2095: Health Policy: Can an Open Access Model for Intravenous Diuretics in an Outpatient Heart Failure Disease Management Program Reduce Hospital Costs?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Dylan L Steen ◽  
Valerie Reed ◽  
Gwendolyn Roxas ◽  
Maria Fonseca ◽  
Barbara Lopez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Weight Gain ◽  
Open Access ◽  
Disease Management ◽  
Disease Management Program ◽  
Hospital Costs ◽  
Cost Savings ◽  
Management Program ◽  
Inpatient Cost ◽  
Heart Failure Disease Management

Background: Heart failure (HF) is the most frequent discharge diagnosis for patients older than 65 and one of the most expensive diseases to treat for CMS. Patients with early symptoms of decompensated HF may need access to IV diuretics when oral medications used in a sliding scale dosage are no longer effective. Indigent patients without access to a private physician are at particular risk of having to use the emergency room (ER) for this reason. This model results in more costs and potential admissions. We sought to reduce ER use and improve quality of care and service to indigent patients followed in a Heart Failure Disease Management Program (HFDMP). Methods: Grant funding was procured to provide free furosemide IVP, potassium and metolazone for patients enrolled in a HFDMP at Jackson Memorial Hospital. The HFDM program consist of intense patient education using DVD’s in both English and Spanish, written material, log books for weight, activity, blood pressure and diuretic use. Patients are instructed to weight daily and add an additional oral dose of furosemide at home for weight gain of greater than 2 pounds. For weight gain of greater than 5 pounds unresponsive to oral therapy, patients were given access to the clinic without an appointment for “walk-in” IVP furosemide, potassium and metolazone. Results: 173 new patients were enrolled into program in 3 months (10/07 through 12/31/07). Of these, 115 visits for IVP furosemide were recorded from 54 patients. 16 patients used it multiple times (range 2–11). Average ER cost for all CHF patient seen and discharged after diuresis at JMH is $25,692. Therefore, an estimated cost savings of 115 avoidable ER visits is $2,954,586. In the last three quarters of 2007, of all CHF patients seen in the ER, 96.6% are admitted. The average inpatient cost for a primary diagnosis of CHF was $26,404.05 (LOS 5.25 days). The average for a CHF patient seen and discharged from the ER was $5,295 (LOS <48hrs). All monetary values are Billed Charges. Conclusion: An open access IVP furosemide program is cost effective alternative to ER and inpatient treatment for CHF patients requiring diuresis.

Abstract 14563: Improving Monitoring Outcomes and Quality of Life for Heart Failure Patients in Telehomecare Program

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Valeria E Rac ◽  
Yeva Sahakyan ◽  
Nida Shahid ◽  
Aleksandra Stanimirovic ◽  
Iris Fan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Blood Pressure ◽  
Weight Gain ◽  
Repeated Measures ◽  
Linear Mixed Model ◽  
Small Sample ◽  
Daily Weight Gain ◽  
Heart Failure Patients

Introduction: Introduced in 2007 by the Ontario Telemedicine Network, the Telehomecare program provides monitoring of patient’s parameters and coaching sessions. There is an inconclusive data on the association of participation and patient-level outcomes. Hypothesis: We hypothesized that blood pressure (BP), daily weight fluctuation and quality of life would improve among heart failure patients participating in the Telehomecare. Methods: We applied a time series study design to analyze patients’ blood pressure and weight, transmitted via telemonitoring devices on a daily basis. Longitudinal surveys were conducted on a small sample of prospectively enrolled patients (n=22) to assess quality of life using EQ-5D and SF-12 over the three-month period. Daily weight gain was defined as an increase of ≥2 lbs between two consecutive measurements. The data for the period of July 2012 to March 2015 was analysed by repeated measures with generalized linear mixed model procedures in SAS. Results: Overall 1354 patients with heart failure (52% women) were enrolled with average age of 76.3±11.1. During the first month of enrolment, one third of the patients (n=433) had elevated BP with a monthly average systolic BP of 150.3±9.6 mm Hg and diastolic BP of 76.7±12.8, in comparison with adequately controlled (n=921) patients, who had an average systolic BP of 118.8±13.5 mm Hg and diastolic BP of 66.4±9.6 mm Hg. Over the seven month period, we found significant reduction in systolic (by 11.0 mm Hg; 95% CI 9.3-12.7) and diastolic BP (by 6.0 mm Hg; 95% CI 4.9-7.3) among patients who had elevated values at baseline, adjusted for age and gender. During the first month of enrolment, weight gain of ≥2 lbs was registered for 8% of days. The likelihood of daily weight gain slightly declined over the seven month period (OR 0.86. 95% CI 0.75-0.98). Physical and mental component scores of SF-12 and EQ 5D’s index score did not improve significantly except for EQ 5D visual analogue scale scores. Conclusion: In conclusion, changes observed in the patient monitoring parameters over time pointed out that hypertensive patients might benefit the most from the Telehomecare. The survey evaluations failed to detect any significant impact of the Telehomecare on the patients’ quality of life.

Incidence, Clinical Features and Outcome of Patients with Differentiation Syndrome in Acute Promyelocytic Leukemia Treated with All-Trans Retinoic Acid (ATRA) Alone Versus ATRA Plus Idarubicin Versus ATRA Plus Arsenic Trioxide.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1044-1044
Author(s):  
Sameer A Parikh ◽  
Hagop Kantarjian ◽  
Farhad Ravandi ◽  
Gautam Borthakur ◽  
Stefan Faderl ◽  
...  
Keyword(s):  
Heart Failure ◽  
Weight Gain ◽  
Promyelocytic Leukemia ◽  
Newly Diagnosed ◽  
Trans Retinoic Acid ◽  
All Trans Retinoic Acid ◽  
Group 3 ◽  
Frontline Therapy ◽  
Group 2 ◽  
Group 1

Abstract Abstract 1044 Poster Board I-66 Background: Differentiation Syndrome (DS) in patients (pts) with acute promyelocytic leukemia (APL) remains a source of significant morbidity and mortality. DS is reported in 2-27% of pts with newly diagnosed APL treated with all-trans retinoic acid (ATRA) alone or in combination with idarubicin (IDA). More recently, arsenic trioxide (ATO) has been used in combination with ATRA as frontline therapy to improve rates of complete remission (CR) and overall survival (OS). It has been postulated that with the use of ATO, the risk of DS may decrease. Aim To describe the incidence, characteristics and outcome of differentiation syndrome with various modalities of ATRA-based therapy used for APL. Methods: We reviewed the records of 167 pts with newly diagnosed APL treated at our institution from 1992-2009 with three regimens: ATRA + IDA (Group 1), liposomal ATRA (Group 2) and ATRA plus ATO (Group 3). Patients in Group 1 (n=52; 1992-1997) received induction with ATRA 45mg/m2 orally daily in two divided doses until CR and IDA 12mg/m2 IV daily for 4 days. Group 2 (n=34; 1997-2000) received liposomal ATRA at 90mg/m2 IV every other day until CR. Patients in Group3 (n=82; 2002-2009) received 45mg/m2 ATRA orally daily in two divided doses, 9mg/m2 gemtuzumab ozogamicin if the WBC count exceeded 30 ×109/L in the first 4 weeks of therapy, ATO 0.15mg/kg/day IV starting on day 10 in 47 patients and on day 1 in 35 patients, and methylprednisolone (50 mg daily for 5 days) to prevent DS. A diagnosis of DS was made by the presence of: dyspnea, unexplained fever, weight gain, peripheral edema, unexplained hypotension, acute renal failure or congestive heart failure, and particularly by a chest radiograph demonstrating interstitial pulmonary infiltrates, or pleuropericardial effusion [Sanz MA, Blood. 2009;113(9):1875-91].Patients with ≥4 features were classified as having severe DS and those with ≤3 mild DS. No single sign or symptom was considered sufficient for diagnosis of DS. Patients with a final diagnosis of pneumonia, sepsis, diffuse alveolar hemorrhage and decompensated heart failure were not considered to have DS. Patients who developed DS ≤7 days of starting therapy with ATRA were classified as “early DS” and others as having “late DS”. Results: Forty one patients (24%) were diagnosed with DS: 14 (27%) in Group 1, 12 (35%) in Group 2, and 15 (18%) in Group 3. Baseline characteristics of patients with DS in each group are shown in Table. Dyspnea, weight gain and pulmonary infiltrates were the most common features of DS in all groups. The median number of days to develop DS after starting ATRA was 3 (1-15) in Group 1, 5 (2-18) in Group 2 and 10 (1-18) in Group 3. ATRA was held in 8 pts (57%) in Group 1, 9 pts (75%) in Group 2, and 8 pts (53%) in Group 3. Intravenous corticosteroids were used for treatment of all patients with DS. CR was achieved in 7 (50%) pts in group 1, 10 (83%) in Group 2 and 14 (93%) in Group 3. The number of patients who died during induction therapy was 6, 2 and 1 in Groups 1, 2 and 3 respectively. There were no deaths directly attributable to DS in any groups. Three-year survival was 65% for pts with DS and 83% for those without DS (p-value: 0.07). Conclusion: The incidence of DS is higher when ATRA alone is used as frontline therapy for APL. With ATRA + ATO (and prophylaxis with corticosteroids) there is a trend for decreased frequency and more delayed occurrence of DS. The severity of DS appears lower for patients not receiving chemotherapy with ATRA. With adequate management, a diagnosis of DS during induction therapy for APL does not influence outcomes independent of therapy. Disclosures: Ravandi: Cephalon: Consultancy, Honoraria.

Signs and Symptoms of Heart Failure: Are You Asking the Right Questions?

2010 ◽  
Vol 19 (5) ◽  
pp. 443-452 ◽  
Author(s):  
Nancy Albert ◽  
Kathleen Trochelman ◽  
Jianbo Li ◽  
Songhua Lin
Keyword(s):  
Heart Failure ◽  
Weight Gain ◽  
Clinical Status ◽  
Systolic Heart Failure ◽  
Hospital Setting ◽  
Signs And Symptoms ◽  
Functional Class ◽  
Convenience Sample ◽  
Loss Of Appetite ◽  
Class Iv

Background Patients may not verbalize common and atypical signs and symptoms of heart failure and may not understand their association with worsening disease and treatments. Objectives To examine prevalence of signs and symptoms relative to demographics, care setting, and functional class. Methods A convenience sample of 276 patients (164 ambulatory, 112 hospitalized) with systolic heart failure completed a 1-page checklist of signs and symptoms experienced in the preceding 7 days (ambulatory) or in the 7 days before hospitalization. Demographic and medical history data were collected. Results Mean age was 61.6 (SD, 14.8) years, 65% were male, 58% were white, and 45% had ischemic cardiomyopathy. Hospitalized patients reported more sudden weight gain, weight loss, severe cough, low/orthostatic blood pressure, profound fatigue, decreased exercise, restlessness/confusion, irregular pulse, and palpitations (all P &lt; .05). Patients in functional class IV reported more atypical signs and symptoms of heart failure (severe cough, nausea/vomiting, diarrhea or loss of appetite, and restlessness, confusion, or fainting, all P ≤ .001). Sudden weight gain increased from 5% in functional class I to 37.5% in functional class IV (P &lt; .001). Dyspnea occurred in all functional classes (98%–100%) and both settings (92%–100%). Profound fatigue was associated with worsening functional class (P &lt; .001) and hospital setting (P = .001); paroxysmal nocturnal dyspnea was associated with functional class IV (P = .02) and hospital setting (P &lt; .001). Conclusion Profound fatigue is more reliable than dyspnea as an indicator of functional class. Nurses must recognize atypical signs and symptoms of worsening functional class to determine clinical status and facilitate patient care decisions.

Abstract 2702: Changes in Filling Pressures Rather than in Daily Weights Predict Heart Failure Events with Active Heart Failure Disease Management

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Dale G Renlund ◽  
Mark F Aaron ◽  
Anthony Magalski ◽  
Yong K Cho ◽  
Mariell Jessup ◽  
...  
Keyword(s):  
Heart Failure ◽  
Weight Gain ◽  
Disease Management ◽  
Fluid Overload ◽  
Patient Contact ◽  
Study Enrollment ◽  
Major Increase ◽  
Cardiac Filling ◽  
Event Rates ◽  
Medication Adjustment

Introduction : While active heart failure (HF) disease management (HFM) that includes frequent patient contact and education about symptoms, daily weights, and medication adjustment has been shown to decrease HF events, recurrent HF hospitalization for fluid overload remains frequent. To determine whether HF events that occur despite HFM can still be predicted from changes in serial weights and filling pressures, HF events were analyzed from the COMPASS-HF trial. Methods and Results : After a recent HF hospitalization and COMPASS-HF study enrollment at 28 experienced HF centers, 274 patients received HF education and averaged 24.7 staff contacts/6 months. HF event rates decreased from 1.9 in the 6 months prior to enrollment to 0.85 and 0.67 during 6 months after enrollment in the study (control and treatment arms, respectively). For 66 HF events, home weights and invasively measured right ventricular diastolic pressures (RVDP) transmitted from home were available from 7 weeks previously and were defined as baseline. RVDP rose steadily from 4 weeks to 1 day prior to the HF event, while weights varied without major increase until 1 day prior (figure ). RVDP increased by ≥ 2 mm Hg at least 1 week prior to 39/66 events (59%), while weight gain increased by ≥ 2 pounds at least 1 week prior to 19/66 events (29%). Conclusions : Events occurring despite HFM, which includes diuretic adjustment for symptoms and weight gain, were predicted by increasing cardiac filling pressures but not by weight gain. In addition to changes in daily weights, increases in filling pressures may guide interventions to avert HF events otherwise not anticipated from routine weights and frequent HFM contact.

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