The Impact of Transitions of Care Pharmacist Services and Identification of Risk Predictors in Heart Failure Readmission

2019 ◽  
pp. 089719001988417 ◽  
Author(s):  
Marci Wood ◽  
Tracey Sweeney ◽  
Molly Trayah ◽  
Maria Civalier ◽  
Wesley McMillian
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Angiotensin Receptor Blockers ◽  
Significant Risk ◽  
Retrospective Chart Review ◽  
Transitions Of Care ◽  
Converting Enzyme Inhibitors ◽  
Increased Risk ◽  
Risk Predictors ◽  
The Impact

Background: Heart failure (HF) is a prevalent and costly disease state for adult Americans, with 30-day readmissions rates for patients with HF utilized to limit hospital compensation. Objective: To determine the impact of the transitions of care (TOC) service at our institution on 30-day all-cause and HF readmissions and identify predictive risk factors for 30-day all-cause readmission. Methods: Retrospective chart review of patients aged 18 years and older admitted with HF and all subsequent readmissions between October 1, 2015, and September 30, 2017. A weighted logistic regression model was developed to determine risk factors for 30-day all-cause readmission. Results: There were no significant differences in all-cause or HF readmission rates analyzed by TOC service involvement. Significant risk predictors for 30-day all-cause readmission included discharge to a rehabilitation facility (odds ratio [OR] = 9.3) or home with home health (OR = 1.6) versus home with self-care. Comorbidities associated with an increased risk of 30-day all-cause readmission included diabetes, coronary artery disease, and aortic stenosis. Use of angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and spironolactone was associated with decreased risk of 30-day all-cause readmission. Conclusion: Identified predictors in the patient population with HF at our institution may be used to target patients at increased risk of all-cause readmission within 30 days.

Accuracy of Antiretroviral Prescribing in a Community Teaching Hospital: A Medication Use Evaluation

2019 ◽  
pp. 089719001985784
Author(s):  
Jacob Lines ◽  
Paul Lewis
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Medication Error ◽  
Medication Errors ◽  
Retrospective Chart Review ◽  
The United States ◽  
Error Rates ◽  
Transitions Of Care ◽  
Hiv Diagnosis ◽  
Increased Risk

Background: Medication errors account for nearly 250 000 deaths in the United States annually, with approximately 60% of errors occurring during transitions of care. Previous studies demonstrated that almost 80% of participants with human immunodeficiency virus (HIV) have experienced a medication error related to their antiretroviral therapy (ART). Objective: This retrospective chart review examines propensity and type of ART-related errors and further seeks to identify risk factors associated with higher error rates. Methods: Participants were identified as hospitalized adults ≥18 years old with preexisting HIV diagnosis receiving home ART from July 2015 to June 2017. Medication error categories included delays in therapy, dosing errors, scheduling conflicts, and miscellaneous errors. Logistic regression was used to examine risk factors for medication errors. Results: Mean age was 49 years, 76.5% were men, and 72.1% used hospital-supplied medication. For the primary outcome, 60.3% (41/68) of participants had at least 1 error, with 31.3% attributed to delays in therapy. Logistic regression demonstrated multiple tablet regimens (odds ratio [OR]: 3.40, 95% confidence interval [CI]: 1.22-9.48, P = .019) and serum creatinine (SCr) ≥1.5 mg/dL (OR: 8.87, 95% CI: 1.07-73.45, P = .043) were predictive for risk of medication errors. Regimens with significant drug–drug interactions (eg, cobicistat-containing regimens) were not significantly associated with increased risk of medication errors. Conclusions and Relevance: ART-related medication error rates remain prevalent and exceeded 60%. Independent risk factors for medication errors include use of multiple tablet regimens and SCr ≥1.5 mg/dL.

scholarly journals Risk factors for acute kidney injury among patients with chikungunya: a multi-center experience from the 2017 chikungunya outbreak in Dhaka, Bangladesh

2019 ◽  
Vol 9 (3) ◽  
pp. 193-196
Author(s):  
Shahana Zaman ◽  
Muhammad Abdur Rahim ◽  
Mehruba Alam Ananna ◽  
Ishrat Jahan ◽  
Tufayel Ahmed Chowdhury ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Angiotensin Receptor Blockers ◽  
Significant Risk ◽  
Kidney Injury ◽  
Febrile Illness ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Adult Patients ◽  
Converting Enzyme Inhibitors

Background: Chikungunya is an emerging viral infection in Bangladesh. This self-limiting febrile illness may have acute life-threating features including cardiomyopathy and encephalitis. Acute kidney injury (AKI) is less well described complication of chikungunya. This study was designed to evaluate risk factors for AKI among patients with chikungunya virus infection. Methods: This case-control study was done in 3 different centers in Dhaka, Bangladesh from July to October 2017. Adult patients (>18 years) with confirmed diagnosis of chikungunya were included in this study. AKI was diagnosed as per Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury. Patients suffering from chikungunya complicated by AKI were cases and those without AKI were controls. Results: Total patients were 107 (male 61) with a mean age of 35.6 (range 19-84) years. Common comorbidities were diabetes mellitus (DM) (20.6%), hypertension (17.8%) and chronic kidney disease (CKD) (12.1%). Common presentations included fever (86.9%) or recent history of fever (13.1%), joint pain (88.8%), rash (23.4%), pruritus (15.9%), gastro-intestinal (GI) features like diarrhea and/or vomiting (28%), lymphadenopathy (12.1%), gum swelling/oral ulcer (4.1%) and oedema (8.4%). Fourteen (13.1%) patients required hospitalization. Eleven (10.3%) cases were complicated by AKI. Among the risk factors for AKI, comorbidities like DM (OR 28.73, 95% CI 5.57-148.10, p 0.0001) and CKD (OR 31.0, 95% CI 2.94-326.7, p <0.0001), GI features (OR 16.07, 95% CI 3.22-80.14, p 0.0007), requirement of hospitalization (OR 23.10, 95% CI 2.37-226.31, p <0.0001) and use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) (OR 6.65, 95% CI 1.77-24.98, p 0.005) were significant. Conclusions: One-tenth of adult patients suffering from chikungunya were complicated by AKI in this study. DM, CKD, diarrhea and/or vomiting, hospitalization and use of ACEIs/ARBs appeared as significant risk factors for AKI. Birdem Med J 2019; 9(3): 193-196

scholarly journals Influence of Tumor Thrombus on Occurrence of Distant Venous Thromboembolism and Survival in Patients With Renal Cell Carcinoma After Surgery

2019 ◽  
Vol 25 ◽  
pp. 107602961882328 ◽  
Author(s):  
Hyunkyung Park ◽  
Chang Wook Jeong ◽  
Hyeongdong Yuk ◽  
Ja Hyeon Ku ◽  
Hyeon Hoe Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Cell Carcinoma ◽  
Venous Thromboembolism ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Tumor Thrombus ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Increased Risk ◽  
The Impact

Tumor thrombus is a unique characteristic of renal cell carcinoma (RCC). However, only a few studies have reported its clinical influence on the occurrence of venous thromboembolism (VTE). This study aimed to clarify the influence of tumor thrombus and other risk factors for VTE and to elucidate the impact of tumor thrombus on survival outcomes. We retrospectively reviewed data from patients with RCC who underwent radical or partial nephrectomy from September 1999 to August 2015 at Seoul National University Hospital. A total of 2762 patients were enrolled. The 1- and 5-year cumulative incidences of VTE were 0.5% ± 0.1% and 1.5% ± 0.3%, respectively. During a median follow-up of 39.0 months (95% confidence interval [CI], 37.1-41.0 months), deep vein thrombosis occurred in 13 patients and pulmonary embolism in 15 patients. Patients with tumor thrombus (diagnosed by surgical pathology findings) had a significantly higher incidence of VTE than those without thrombus (odds radio 8.160, 95% CI, 1.480-45.004). Older age (≥60 years) and higher preoperative C-reactive protein (>0.5 mg/dL) were also significant risk factors for VTE. Additionally, tumor thrombus was independently associated with worse progression-free survival (PFS) but not with overall survival (OS) in multivariable analysis (hazard ratio [HR] 1.916, 95% CI, 1.295-2.834 for PFS; HR 1.164, 95% CI, 0.755-1.793 for OS). In conclusion, the incidence of VTE was relatively low in patients who underwent surgery for RCC. Nevertheless, patients with tumor thrombus had an increased risk of VTE and should be closely monitored for VTE.

Nonmelanoma Skin and Mucosal Cancers After Hematopoietic Cell Transplantation

2006 ◽  
Vol 24 (7) ◽  
pp. 1119-1126 ◽  
Author(s):  
Wendy Leisenring ◽  
Debra L. Friedman ◽  
Mary E.D. Flowers ◽  
Jeffrey L. Schwartz ◽  
H. Joachim Deeg
Keyword(s):  
Risk Factors ◽  
Cell Carcinoma ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Chronic Gvhd ◽  
Significant Risk ◽  
Hematopoietic Cell ◽  
Allogeneic Hct ◽  
Increased Risk ◽  
The Impact

Purpose To evaluate the incidence of and risk factors for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in survivors of hematopoietic cell transplantation (HCT). Patients and Methods The impact of patient-, disease-, treatment-, and toxicity-related factors on risk of BCC and SCC was determined in a retrospective cohort study of 4,810 patients who received allogeneic HCT and who survived for at least 100 days. Results Among allogeneic HCT recipients, 237 developed at least one skin or mucosal cancer (BCC, n = 158; SCC, n = 95). Twenty-year cumulative incidences of BCC and SCC were 6.5% and 3.4%, respectively. Total-body irradiation was a significant risk factor for BCC (P = .003), most strongly among patients younger than 18 years old at HCT (P = .02, interaction). Light-skinned patients had an increased risk of BCC (P = .01). Acute graft-versus-host disease (GVHD) increased the risk of SCC (P = .02), whereas chronic GVHD increased the risk of both BCC (P = .01) and SCC (P < .001). Conclusion This analysis suggests that immutable factors, such as age and complexion, have a significant impact on BCC and SCC. However, specific treatment (radiotherapy) and transplantation complications (GVHD) may modify that risk. These additional risk factors suggest the contribution of immunologic mechanism DNA and tissue repair in the development of BCC and SCC. We confirm previous reports that exposure to ionizing radiation increases the risk of BCC but not SCC. Survivors of HCT should be monitored for the development of BCC and SCC and use preventive strategies.

scholarly journals Infections as Novel Risk Factors of Atherosclerotic Cardiovascular Diseases: Pathophysiological Links and Therapeutic Implications

2021 ◽  
Vol 10 (12) ◽  
pp. 2539
Author(s):  
Piotr Szwed ◽  
Aleksandra Gąsecka ◽  
Mateusz Zawadka ◽  
Ceren Eyileten ◽  
Marek Postuła ◽  
...  
Keyword(s):  
Risk Factors ◽  
Helicobacter Pylori ◽  
Cardiovascular Diseases ◽  
Periodontal Disease ◽  
Angiotensin Receptor Blockers ◽  
Residual Risk ◽  
Converting Enzyme Inhibitors ◽  
Therapeutic Implications ◽  
Increased Risk ◽  
Atherosclerotic Cardiovascular Diseases

Atherosclerotic cardiovascular diseases (ASCVD) are the major cause of mortality worldwide. Despite the continuous progress in ASCVD therapy, the residual risk persists beyond the management of traditional risk factors. Several infections including Helicobacter pylori infection, periodontal disease, and viral infections are associated with the increased risk of ASCVD, both directly by damage to the heart muscle and vasculature, and indirectly by triggering a systemic proinflammatory state. Hence, beyond the optimal management of the traditional ASCVD risk factors, infections should be considered as an important non-classical risk factor to enable early diagnosis and appropriate treatment. Here, we summarized the currently available evidence regarding the role of inflammation in ASCVD and the association between the particular infections and pathogens (Helicobacter pylori, periodontal disease, pneumonia, Cytomegalovirus, Human immunodeficiency virus, Herpes simplex virus, and severe acute respiratory syndrome coronavirus 2) on the development and progression of ASCVD. We also speculated about the potential therapeutic implications of the anti-inflammatory and anti-infective drugs on ASCVD outcomes, including drugs routinely administered in patients with ASCVD (statins, P2Y12 receptor inhibitors, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers) and novel strategies aiming at residual risk reduction (colchicine, anti-cytokine drugs, and methotrexate). Considering the emerging association between infections and ASCVD, it is crucial to determine the possible advantages of infection prevention and treatment in patients with ASCVD.

scholarly journals Perioperative Risk Factors Predisposing to Atrial Fibrillation After CABG Surgery

2021 ◽  
Vol 24 (2) ◽  
pp. E402-E406
Author(s):  
Alaa Omar ◽  
Ehab m elshihy ◽  
Mahmoud singer ◽  
David Zarif ◽  
Omar dawoud
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Revascularization ◽  
Significant Risk ◽  
Perioperative Risk ◽  
Electrolyte Imbalance ◽  
Perioperative Risk Factors ◽  
Increased Risk ◽  
The Impact

Objectives: To detect perioperative risk factors for atrial fibrillation (AF) after coronary artery bypass graft (CABG) and to assess the impact of AF on outcome and postoperative complications. Methods: We undertook a prospective observational study of 1000 consecutive patients who underwent isolated CABG in Cairo University hospitals and other centers from March 2019 to November 2020. Patients were subsequently divided into 2 groups depending on the occurrence of postoperative AF. Preoperative, intraoperative, and postoperative risk factors were recorded for all patients, as well as postoperative mortality, complications, and hospital and intensive care unit (ICU) lengths of stay. Results: Postoperative atrial fibrillation (POAF) occurred in 78 patients (7.8%), with significant risk factors of age (P = .001), low ejection fraction (P = .001), absence of preoperative beta-blocker use (P = .001), and presence of right coronary artery lesion (P = .003). The intraoperative significant risk factor was the absence of total coronary revascularization (P = .001). Postoperative significant risk factors were electrolyte imbalance (P = .001) and postoperative inotropes (P = .02). Patients with postoperative AF had increased risk of mortality (P = .001) and longer ICU (P = .001) and hospital (P = .001) stays. Conclusion: The risk of POAF can be decreased by modifying perioperative adjustable risk factors, namely routinely using preoperative beta-blockers (unless contraindicated), achieving total coronary revascularization, avoiding postoperative electrolyte imbalance, and avoiding unnecessary use of inotropic support.

Abstract MP033: Socioeconomic Disparities in the Risk of Developing Heart Failure: Prospective Findings from the Moli-Sani Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Marialaura Bonaccio ◽  
Augusto Di Castelnuovo ◽  
Simona Costanzo ◽  
Mariarosaria Persichillo ◽  
Livia Rago ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Health Behaviors ◽  
Educational Level ◽  
Household Income ◽  
Health Behaviours ◽  
Annual Household Income ◽  
Increased Risk ◽  
Low Education ◽  
The Impact

Introduction: The association between socioeconomic status (SES) and the risk of cardiovascular disease and all-cause mortality is well-established, while the impact of SES on heart failure (HF) incidence is less explored. Hypothesis: We tested the hypothesis of a SES gradient in the risk of HF. Methods: Population-based cohort study on 22,395 individuals (mean age 55.3±11.7, 47.7% men) free from HF at baseline randomly recruited from the general population included in the Moli-sani study (Italy). The cohort was followed up for a median of 7.6 years (168,031 person-years). Annual household income (Euros) and educational level were used as SES indicators. Presence of risk factors at baseline and a panel of health behaviours were tested as possible mediators of the association between SES and incident HF. Incident HF at follow-up was defined by HF hospitalization or HF death, according to the International Classification of Diseases-Ninth Revision (ICD-9). Hazard ratios (HR) with 95% confidence intervals were calculated by Cox-proportional hazard models. Results: We identified 757 first HF events. Both lowest education (middle and secondary schools) and household income (<60,000 Euros/y) were separately associated with increased risk of HF as compared with the highest category (Table). After simultaneous adjustment, the association of income appeared to be largely explained by education. The inclusion of traditional risk factors, biomarkers of heart failure and health-behaviors into the model attenuated the association of low education with HF incidence by 12%, 3.8% and 11.5%, respectively. Overall, the full explanatory model accounted for 23.8% of the educational gradient in the risk of HF (Table). Conclusions: Educational level, rather than income, is an independent predictor of HF development. Excess risk associated with low education was partially explained by traditional health risk factors, biomarkers of subclinical damage and health-behaviors.

Impact of Clinical Audit on Adherence to the Guidelines Directed Medical Therapy in Patients Admitted with Heart Failure

2020 ◽  
Vol 15 (2) ◽  
pp. 117-123
Author(s):  
Aashiq A. Shukkoor ◽  
Nimmy E. George ◽  
Shanmugasundaram Radhakrishnan ◽  
Sivakumar Velusamy ◽  
Tamilarasu kaliappan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Acute Heart Failure ◽  
Medical Therapy ◽  
Clinical Audit ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Reduced Ejection Fraction ◽  
The Impact

Background: The adoption of guideline recommendations of pharmacotherapy to improve the clinical course of Heart Failure (HF) remains below par. Our objective is to evaluate the impact of clinical audit on adherence to the Guideline-Directed Medical Therapy (GDMT) in patients admitted with acute heart failure with reduced ejection fraction (EF). Methods: A prospective interventional study was conducted over a period of 12 months from June 2018 to May 2019 in all patients admitted with acute heart failure with reduced ejection fraction. The discharge prescriptions of patients who met the inclusion criteria were audited for appropriateness in the usage of neurohormonal blockers and Ivabradine, by a clinical pharmacist on a monthly basis. Audit results were presented to the practicing physicians every month and feedback was given. Results: Discharge prescriptions of 716 patients who presented with HF were audited for the reasonable or unreasonable omission of neurohormonal blocking drugs. The first-month audit revealed that the unreasonable omission of Angiotensin-Converting Enzyme Inhibitors/ Angiotensin Receptor Blockers/ Angiotensin Receptor Neprilisin Inhibitors ( ACEI/ARB/ARNI), Betablockers and Mineralocorticoid Receptor Antagonists (MRA) were 24.5%, 13.1%, and 9.09% respectively, which reduced to nil at the end of the study period (p=0.00). Initiation of Ivabradine before prescribing or achieving the target dose of Betablocker was noted in 38.18% of patients in the first month, which was also reduced to nil (p=0.00) at the end of the study. Conclusion: This study reveals that periodic clinical audit improves adherence to GDMT in patients admitted with heart failure with reduced ejection fraction.

scholarly journals Heart Failure Prescribing Quality at Discharge from a Critical Care Unit in Egypt: The Impact of Multidisciplinary Care

Pharmacy ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 159
Author(s):  
Seif El Hadidi ◽  
Naglaa Samir Bazan ◽  
Stephen Byrne ◽  
Ebtissam Darweesh ◽  
Margaret Bermingham
Keyword(s):  
Heart Failure ◽  
Critical Care ◽  
Guideline Adherence ◽  
Clinical Pharmacist ◽  
Critical Care Unit ◽  
Angiotensin Receptor Blockers ◽  
Multidisciplinary Care ◽  
Converting Enzyme Inhibitors ◽  
The Impact ◽  
Adherence Index

Discharge prescriptions for heart failure (HF) patients may not adhere to the clinical practice guidelines. This study aimed to assess the impact of the clinical pharmacist as a member of a multidisciplinary team on the quality of prescribing to HF patients at discharge from a Critical Care Unit (CCU) in Egypt. This was a retrospective cohort study of HF patients discharged from the CCU between January 2013 and December 2017. Guideline Adherence Index (GAI-3) was used to assess guideline-directed prescribing at discharge. Multidisciplinary care was introduced to the CCU on 1 January 2016. The study included 284 HF patients, mean (±SD) age 66.7 ± 11.5 years, 53.2% male. Heart failure with reduced ejection fraction affected 100 patients (35.2%). At discharge, loop diuretics were prescribed to 85.2% of patients; mineralocorticoid receptor antagonists to 54.9%; angiotensin-converting enzyme inhibitors/angiotensin receptor blockers to 51.4%; and β-blockers to 29.9%. Population Guideline Adherence Index (GAI-3) was 45.5%. High-GAI was prescribed to 136 patients (47.9%). Patients with High-GAI were younger; less affected by chronic kidney disease and had fewer comorbidities than those without High-GAI. Prescription of β-blocker increased (24.1% vs. 38.6%, p < 0.001) and digoxin utilization decreased (34.7% vs. 23.7%, p < 0.049) after the introduction of the multidisciplinary care. The inclusion of a clinical pharmacist in the multidisciplinary care team may have a role in optimizing the prescribing of HF guideline-directed therapies at discharge from this setting.

scholarly journals Post-transplant anemia and associated risk factors: the impact of steroid-free therapy

2013 ◽  
Vol 131 (6) ◽  
pp. 369-376
Author(s):  
Claudia Maria Costa Oliveira ◽  
Paula Sátiro Timbó ◽  
Sanna Roque Pinheiro ◽  
Janaína Gonçalves Silva Leite ◽  
Luciana Sátiro Timbó ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Transplantation ◽  
Angiotensin Receptor Blockers ◽  
Graft Function ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Delayed Graft Function ◽  
Donor Age ◽  
Converting Enzyme Inhibitors ◽  
Associated Risk Factors ◽  
The Impact

CONTEXT AND OBJECTIVE: The prevalence of post-renal transplant anemia (PTA) reported in the literature is variable and several factors contribute towards its pathophysiology. This study aimed to investigate the prevalence of PTA, its associated risk factors and the impact of therapy without steroids. DESIGN AND SETTING: Retrospective cohort study in a renal transplantation unit at a tertiary hospital. METHODS: Anemia was defined as hemoglobin (Hb) < 12 g/dl in female adult recipients and < 13 g/dl in males. Donor and recipient age and gender, type of donor, creatinine, delayed graft function, acute rejection, use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) and therapy without steroids were investigated as risk factors for PTA through multivariate logistical regression analysis. RESULTS: Evaluations were performed on 258 recipients (mean age: 38.8 years; 60.5% males; 35.7% did not receive steroids). Anemia was diagnosed in 38% of the patients (at the sixth month, M6), 28% (M12), 32% (M24) and 45% (at last follow up). Donor age > 50 years was associated with greater risks of PTA at M6 (odds ratio (OR) = 4.68) and M24 (OR = 6.57), as well as with therapy without steroids at M6 (OR = 2.96). Delayed graft function was independently associated with PTA at M6 (OR = 3.66) and M12 (OR = 2.85). CONCLUSION: The lowest prevalence of PTA was observed between M9 and M24 after renal transplantation. Delayed graft function, donor age and therapy without steroids were the most important factors associated with PTA.

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