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Improved outcome with standardized plan for clinical management of acute decompensated chronic heart failure

BACKGROUND: Our overall goal is to improve clinical care for inpatients with chronic heart failure (CHF). A retrospective assessment of CHF patients admitted to our hospital over the past decade (2005 vs. 2014) indicated a need for better strategies to evaluate clinical treatment, implement best pra...

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Autores principales: Edvinsson, Marie-Louise, Stenberg, Albin, Åström-Olsson, Karin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Science Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6379241/
https://www.ncbi.nlm.nih.gov/pubmed/30800146
http://dx.doi.org/10.11909/j.issn.1671-5411.2019.01.002
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author Edvinsson, Marie-Louise
Stenberg, Albin
Åström-Olsson, Karin
author_facet Edvinsson, Marie-Louise
Stenberg, Albin
Åström-Olsson, Karin
author_sort Edvinsson, Marie-Louise
collection PubMed
description BACKGROUND: Our overall goal is to improve clinical care for inpatients with chronic heart failure (CHF). A retrospective assessment of CHF patients admitted to our hospital over the past decade (2005 vs. 2014) indicated a need for better strategies to evaluate clinical treatment, implement best practices and achieve optimal patient outcome. To that purpose, we developed a standardized plan to improve in-hospital treatment of acute decompensated CHF patients. METHODS & RESULTS: Retrospective chart reviews were conducted to compare three cohorts of CHF patients admitted to the University Hospital of Lund at different time points over a 12-year period: 2005 (365 patients), 2014 (172 patients) and 2017–2018 (57 patients). Little improvement was seen between 2005 and 2014 with respect to one-year mortality (35% vs. 34%) and adequate treatment with recommended medications, e.g., use of renin-angiotensin system blockers (45% vs. 51%). A standardized treatment plan was devised to improve outcomes. A third cohort, treated under the plan (2017–2018), was compared with the 2014 cohort. One-year mortality (18% vs. 34%) and 30-day readmission (5% vs. 30%) were dramatically decreased, and adherence to medication guidelines was achieved. Key elements of the plan included well-defined treatment procedures, enhanced communication and teamwork, education, adequate time for treatment (5 days) and post-discharge follow-up as necessary. Natriuretic peptide (NT-proBNP) levels were useful for assessing patient status, prognosis and response to treatment. CONCLUSION: Development of a standard plan for clinical management of acute decompensated CHF patients resulted in significant improvements in patient outcome, as reflected in decreased rates of 30-day readmission and one-year mortality.
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spelling pubmed-63792412019-02-22 Improved outcome with standardized plan for clinical management of acute decompensated chronic heart failure Edvinsson, Marie-Louise Stenberg, Albin Åström-Olsson, Karin J Geriatr Cardiol Research Article BACKGROUND: Our overall goal is to improve clinical care for inpatients with chronic heart failure (CHF). A retrospective assessment of CHF patients admitted to our hospital over the past decade (2005 vs. 2014) indicated a need for better strategies to evaluate clinical treatment, implement best practices and achieve optimal patient outcome. To that purpose, we developed a standardized plan to improve in-hospital treatment of acute decompensated CHF patients. METHODS & RESULTS: Retrospective chart reviews were conducted to compare three cohorts of CHF patients admitted to the University Hospital of Lund at different time points over a 12-year period: 2005 (365 patients), 2014 (172 patients) and 2017–2018 (57 patients). Little improvement was seen between 2005 and 2014 with respect to one-year mortality (35% vs. 34%) and adequate treatment with recommended medications, e.g., use of renin-angiotensin system blockers (45% vs. 51%). A standardized treatment plan was devised to improve outcomes. A third cohort, treated under the plan (2017–2018), was compared with the 2014 cohort. One-year mortality (18% vs. 34%) and 30-day readmission (5% vs. 30%) were dramatically decreased, and adherence to medication guidelines was achieved. Key elements of the plan included well-defined treatment procedures, enhanced communication and teamwork, education, adequate time for treatment (5 days) and post-discharge follow-up as necessary. Natriuretic peptide (NT-proBNP) levels were useful for assessing patient status, prognosis and response to treatment. CONCLUSION: Development of a standard plan for clinical management of acute decompensated CHF patients resulted in significant improvements in patient outcome, as reflected in decreased rates of 30-day readmission and one-year mortality. Science Press 2019-01 /pmc/articles/PMC6379241/ /pubmed/30800146 http://dx.doi.org/10.11909/j.issn.1671-5411.2019.01.002 Text en Institute of Geriatric Cardiology http://creativecommons.org/licenses/by-nc-sa/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License, which allows readers to alter, transform, or build upon the article and then distribute the resulting work under the same or similar license to this one. The work must be attributed back to the original author and commercial use is not permitted without specific permission.
spellingShingle Research Article
Edvinsson, Marie-Louise
Stenberg, Albin
Åström-Olsson, Karin
Improved outcome with standardized plan for clinical management of acute decompensated chronic heart failure
title Improved outcome with standardized plan for clinical management of acute decompensated chronic heart failure
title_full Improved outcome with standardized plan for clinical management of acute decompensated chronic heart failure
title_fullStr Improved outcome with standardized plan for clinical management of acute decompensated chronic heart failure
title_full_unstemmed Improved outcome with standardized plan for clinical management of acute decompensated chronic heart failure
title_short Improved outcome with standardized plan for clinical management of acute decompensated chronic heart failure
title_sort improved outcome with standardized plan for clinical management of acute decompensated chronic heart failure
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6379241/
https://www.ncbi.nlm.nih.gov/pubmed/30800146
http://dx.doi.org/10.11909/j.issn.1671-5411.2019.01.002
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