Allocating scarce resources in real-time to reduce heart failure readmissions: a prospective, controlled study.

Objective: To test a multidisciplinary approach to reduce heart failure (HF) readmissions that tailors the intensity of care transition intervention to the risk of the patient using a suite of electronic medical record (EMR)-enabled programmes.

Methods: A prospective controlled before and after study of adult inpatients admitted with HF and two concurrent control conditions (acute myocardial infarction (AMI) and pneumonia (PNA)) was performed between 1 December 2008 and 1 December 2010 at a large urban public teaching hospital. An EMR-based software platform stratified all patients admitted with HF on a daily basis by their 30-day readmission risk using a published electronic predictive model.

The natural history of new-onset heart failure with a severely depressed left ventricular ejection fraction: implications for timing of implantable cardioverter-defibrillator implantation.

Background: Guidelines recommend that patients with new-onset systolic heart failure (HF) receive a trial of medical therapy before an implantable cardiac defibrillator (ICD). This strategy allows for improvement of left ventricular ejection fraction (LVEF), thereby avoiding an ICD, but exposes patients to risk of potentially preventable sudden cardiac death during the trial of medical therapy.

Methods: We reviewed a consecutive series of patients with HF of <6 months duration with a severely depressed LVEF (<30%) evaluated in a HF clinic (N = 224).

Relation of lack of knowledge about dietary sodium to hospital readmission in patients with heart failure.

It has previously been demonstrated that patients with heart failure (HF) in an urban public hospital had significant gaps in knowledge regarding dietary sodium restriction. The objective of this study was to determine what risk factors were associated with such gaps in knowledge and to determine if these gaps in knowledge would increase the risk for HF readmission. A standardized test of sodium knowledge (scored 0 to 10) was administered prospectively to 97 hospitalized patients with HF <48 hours before discharge.

Low voltage on the electrocardiogram is a marker of disease severity and a risk factor for adverse outcomes in patients with heart failure due to systolic dysfunction.

Background: The prognostic implications of low QRS voltage on the electrocardiogram (ECG) in heart failure (HF) are not well characterized.

Methods: We manually measured and summed the QRS voltage in all 12 leads of the ECG (sumQRS) in two cohorts: (1) 415 patients with a low left ventricular ejection fraction followed up in a HF clinic ("clinic cohort") and (2) 100 subjects with advanced HF who had an ECG within 1 year preceding cardiac transplantation ("pretransplant cohort"). Low voltage was defined as the lowest quartile of the clinic cohort (sumQRS <12 mV) and its prevalence was compared in the two cohorts.

High-sodium food choices by southern, urban African Americans with heart failure.

Background: Sodium restriction is important in the management of heart failure (HF). Although many low-sodium educational resources are available, few are directed specifically at urban African Americans.

Methods And Results: A registered dietitian prospectively interviewed 50 African-American and 25 white patients in an urban public hospital (derivation cohort) in Dallas, TX, using a food-frequency instrument that listed 146 food choices.

Beta-blocker therapy in patients with heart failure in the urban setting: moving beyond clinical trials.

Background: Despite their known benefits, beta-blockers (BBL) are not yet widely prescribed for heart failure, especially in the primary care setting. We wanted to identify patient characteristics that could guide primary care physicians in deciding whether they or a cardiologist should initiate BBL. A second objective was to determine the tolerability of BBL in clinical practice.

Therapy of heart failure in African Americans: lessons from an urban public hospital.

African-American patients with heart failure treated at urban public hospitals are at high risk for adverse outcomes likely due to complex socioeconomic factors. While establishing a heart failure disease management program at Parkland Memorial Hospital in Dallas, TX, the authors completed two studies that address the high rates of heart failure hospitalizations seen in this population. The first study found high rates of adverse outcomes following emergency department discharge for heart failure.

Impairments in dichotic listening in patients presenting anterior communicating artery aneurysm.

Impaired dichotic listening has been documented in numerous etiologies, but there is limited information on patients who present with anterior communicating artery (ACoA) aneurysm. The sequelae following ACoA aneurysm is frequently associated with neurobehavioral impairments, such as confabulation, memory, and behavior, as a result of the areas of innervation (DeLuca, 1992; DeLuca & Diamond, 1995). Clinical experience, however, shows ACoA aneurysm to also be associated with impairments in dichotic listening.