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13. Use of Imaging-Guided Decongestion for Reducing Heart Failure Readmission and Death in High-risk Patients: A multi-site Randomized Trial of a Nurse-led Strategy at Point-of-Care

Author

Zisis, Georgios, primary, Carrington, Melinda J, additional, MD, Yang Yang, additional, Huynh, Quan, additional, Lay, Maria, additional, Whitmore, Kristyn, additional, Hare, James L., additional, Hopper, Ingrid, additional, Dwyer, Nathan, additional, and Marwick, Thomas H, additional

Published
2023
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16. Use of Imaging-guided Decongestion for Reducing Heart Failure Readmission and Death in High-risk Patients: A Multi-site Randomized Trial of a Nurse-led Strategy at the Point of Care.

Author

ZISIS, GEORGIOS, CARRINGTON, MELINDA J., YANG, YANG, HUYNH, QUAN, LAY, MARIA, WHITMORE, KRISTYN, HARE, JAMES L., HOPPER, INGRID, DWYER, NATHAN, and MARWICK, THOMAS H.

Abstract

Nurse-led disease management programs (DMPs) decrease readmission after acute decompensated heart failure (HF). We sought whether readmissions could be further reduced by lung ultrasound (LUS)-guided decongestion before discharge and during DMP. Of 290 patients hospitalized with acute decompensated HF, 122 at high risk for readmission or mortality were randomized to receive usual care (UC) (n = 64) or UC plus intervention (DMP-Plus) (n = 58), comprising LUS-guided management before discharge and during at-home follow-up. Residual congestion was identified by ≥10 B-lines detected in 8 lung zones. The outcomes included a composite of readmission and/or mortality at 30 and 90 days, and 90-day HF readmission. Residual congestion was detected equally among the patient groups. The 30-day composite outcome occurred in 28% DMP-plus patients and 22% UC patients (odd ratio [OR], 1.36; 95% confidence interval [CI], 0.59–3.1; P =.5) and the 90-day HF readmission outcome occurred in 22% and 31%, respectively (odds ratio, 0.63; 95% CI, 0.28–1.43; P =.3). Residual congestion, identified at predischarge LUS examination in high-risk patients, was associated with early (<14-day) HF readmission (relative risk, 1.19; 95% CI, 1.06–1.32; P =.002) and multiple (≥2) readmissions over 90 days of follow-up (relative risk, 1.09; 95% CI, 1.01–1.16; P =.012), independent of demographics and comorbidities. Readmission in patients with incomplete decongestion before discharge occurs within the first 2 weeks. However, our DMP-plus strategy did not improve the primary outcome. [ABSTRACT FROM AUTHOR]

Published
2024
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19. Establishing a pragmatic framework to optimise health outcomes in heart failure and multimorbidity (ARISE-HF): A multidisciplinary position statement

Author

Stewart, Simon, Riegel, Barbara, Boyd, Cynthia, Ahamed, Yasmin, Thompson, David R., Burrell, Louise M., Carrington, Melinda J., Coats, Andrew, Granger, Bradi B., Hides, Julie, Weintraub, William S., Moser, Debra K., Dickson, Victoria Vaughan, McDermott, Cressida J., Keates, Ashley K., and Rich, Michael W.

Published
2016
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22. Differences in predictors of incident heart failure according to atherosclerotic cardiovascular disease status.

Author

Dawson, Luke P., Carrington, Melinda J., Haregu, Tilahun, Nanayakkara, Shane, Jennings, Garry, Dart, Anthony, Stub, Dion, and Kaye, David

Subjects
HEART failure, CARDIOVASCULAR diseases, HDL cholesterol, WAIST-hip ratio, SYSTOLIC blood pressure, WAIST circumference
Abstract

Aims: Heart failure (HF) is a common cause of morbidity and mortality, related to a broad range of sociodemographic, lifestyle, cardiometabolic, and comorbidity risk factors, which may differ according to the presence of atherosclerotic cardiovascular disease (ASCVD). We assessed the association between incident HF with baseline status across these domains, overall and separated according to ASCVD status. Methods and results: We included 5758 participants from the Baker Biobank cohort without HF at baseline enrolled between January 2000 and December 2011. The primary endpoint was incident HF, defined as hospital admission or HF‐related death, determined through linkage with state‐wide administrative databases (median follow‐up 12.2 years). Regression models were fitted adjusted for sociodemographic variables, alcohol intake, smoking status, measures of adiposity, cardiometabolic profile measures, and individual comorbidities. During 65 987 person‐years (median age 59 years, 38% women), incident HF occurred among 784 participants (13.6%) overall. Rates of incident HF were higher among patients with ASCVD (624/1929, 32.4%) compared with those without ASCVD (160/3829, 4.2%). Incident HF was associated with age, socio‐economic status, alcohol intake, smoking status, body mass index (BMI), waist circumference, waist–hip ratio, systolic blood pressure (SBP), and low‐ and high‐density lipoprotein cholesterol (LDL‐C and HDL‐C), with non‐linear relationships observed for age, alcohol intake, BMI, waist circumference, waist–hip ratio, SBP, LDL‐C, and HDL‐C. Risk factors for incident HF were largely consistent regardless of ASCVD status, although diabetes status had a greater association with incident HF among patients without ASCVD. Conclusions: Incident HF is associated with a broad range of baseline sociodemographic, lifestyle, cardiometabolic, and comorbidity factors, which are mostly consistent regardless of ASCVD status. These data could be useful in efforts towards developing risk prediction models that can be used in patients with ASCVD. [ABSTRACT FROM AUTHOR]

Published
2023
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43. Abstract 11963: A Digital Heart Failure Coach Intervention for Improving Education, Self-Management and Outcomes in Patients Admitted for Acute Decompensated Heart Failure: Barriers to Effective Implementation

Author

Zisis, Georgios, primary, Carrington, Melinda J, additional, Oldenburg, Brian, additional, Whitmore, Kristyn, additional, Lay, Maria, additional, Huynh, Quan, additional, Neil, Christopher, additional, Ball, Jocasta, additional, and Marwick, Thomas, additional

Published
2021
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46. The Gut Microbiome of Heart Failure With Preserved Ejection Fraction

Author

Beale, Anna L., primary, O’Donnell, Joanne A., additional, Nakai, Michael E., additional, Nanayakkara, Shane, additional, Vizi, Donna, additional, Carter, Kaye, additional, Dean, Eliza, additional, Ribeiro, Rosilene V., additional, Yiallourou, Stephanie, additional, Carrington, Melinda J., additional, Marques, Francine Z., additional, and Kaye, David M., additional

Published
2021
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