Predicting costs of care in heart failure patients.

Background: Identifying heart failure patients most likely to suffer poor outcomes is an essential part of delivering interventions to those most likely to benefit. We sought a comprehensive account of heart failure events and their cumulative economic burden by examining patient characteristics that predict increased cost or poor outcomes.

Methods: We collected electronic medical data from members of a large HMO who had a heart failure diagnosis and an echocardiogram from 1999-2004, and followed them for one year.

Predicting poor outcomes in heart failure.

Background: Health plans must prioritize disease management efforts to reduce hospitalization and mortality rates in heart failure patients.

Methods And Results: We developed a risk model to predict the 5-year risk of mortality or hospitalization for heart failure among patients at a large health maintenance organization. We identified 4696 patients who had an echocardiogram and a heart failure diagnosis from 1999 to 2004.

Integrating clinical trial findings into practice through risk stratification: the case of heart failure management.

Heart failure case management programs have been shown in clinical trials to be highly effective at preventing future hospitalizations. But the absolute benefits of these programs depend on the baseline risk of outcome in the treated population. Because baseline risks of hospitalization in trials are often higher than community-based samples, translating trial results to the community setting may be misleading.

Arrhythmias after orthotopic heart transplantation.

Background: Arrhythmias frequently occur after orthotopic heart transplantation (OHT).

Methods And Results: The most common are ventricular premature complexes, atrial premature complexes, sinus or junctional bradycardia, atrial fibrillation, and atrial flutter, all of which have varying clinical significance depending on associated or causative conditions. Unique etiologic factors such as allograft rejection, transplant coronary artery disease, and altered anatomy and autonomic nervous system changes require that arrhythmias be treated differently after OHT compared with the general population.

Decreased recipient survival following orthotopic heart transplantation with use of hearts from donors with projectile brain injury.

Background: Fatal gunshot injury to the brain can cause significant alterations in the neuroendocrine state and myocardial dysfunction. Therefore heart allografts from these donors may result in graft failure following orthotopic heart transplantation (OHTx). We evaluated whether receiving a heart from a donor who died from fatal gunshot wound to the brain independently affected the outcome of transplantation.

Consensus statement: Palliative and supportive care in advanced heart failure.

Background: A consensus conference was convened to define the current state and important gaps in knowledge and needed research on "Palliative and Supportive Care in Advanced Heart Failure."

Evidence: Evidence was drawn from expert opinion and from extensive review of the medical literature, evidence-based guidelines, and reviews.

Conclusions: The conference identified gaps in current knowledge, practice, and research relating to prognostication, symptom management, and supportive care for advanced heart failure (HF).

Common cardiovascular issues encountered in geriatric critical care.

The incidence and prevalence of CV disease is high in the growing US elderly population. It is common for CV disease to be either the primary or secondary problem for elderly patients receiving critical care. The therapeutic options for CV problems experienced in the critical care setting range from medical management with the goal of symptom relief and comfort care to invasive therapies such as PCI, intraaortic balloon pump therapy, invasive monitoring, and cardiac surgery.

Familial cardiomyopathies: significant causes of heart failure.

Familial dilated cardiomyopathies (FDCMs) account for about one third of idiopathic dilated cardiomyopathies, yet clinicians under-appreciate their prevalence. Among the inherited cardiomyopathies, FDCMs account for the greatest burden of heart failure and its associated morbidities. This paper summarizes significant molecular-genetic data, and discusses clinical manifestations of the major inherited cardiomyopathies, and the importance of clinical and genetic screening.

Periodic rescreening is indicated for family members at risk of developing familial dilated cardiomyopathy.

Objectives: This study evaluated the role of clinical rescreening of family members at risk for familial dilated cardiomyopathy (FDC).

Background: Familial dilated cardiomyopathy is a genetic cardiomyopathy that usually is transmitted in an autosomal dominant pattern and may underlie from one-quarter to one-half of idiopathic dilated cardiomyopathy (IDC) diagnoses. Thus, FDC may present with advanced heart failure (HF) or sudden cardiac death (SCD).