Medicine and Health Sciences Commons^™

Early Ambulation Predicts Length Of Stay And Discharge Location Following Left Ventricular Assist Device Implantation., Michael Shoemaker, Allison Gaskell, David Sefton, Kristen Vandebunte, Jessica Mcleod, Darshak Karia, Michael Dickinson, Asghar Khagani

Michael J Shoemaker, PT, DPT, PhD, GCS

Purpose: No prior study has specifically investigated the effects of early mobility following left ventricular assist device (LVAD) implantation. The purpose of the present study was to describe postoperative acute care rehabilitation management of patients with LVADs and to determine whether earlier mobilization and ambulation were significant predictors of shorter Length of Stay (LOS) and discharge (DC) home. Methods: A retrospective chart review of the initial acute care stay of 98 consecutive patients with first-time HeartMate II or HeartWare LVAD implantation was performed. Multivariate linear and logistic regression models were used to control for the confounding effects of the following …

Rehabilitation Considerations For The Older Adult With Heart Failure: A Review Of The Literature., Jessica L. Mcleod, Ashley A. Van Dam, Ashley K. Heiss, Michael J. Shoemaker

Michael J Shoemaker, PT, DPT, PhD, GCS

Affecting more than 5.1 million Americans in 2013, heart failure (HF) is a debilitating syndrome that causes dyspnea, reduced exercise tolerance, fatigue, and diminished quality of life. Most commonly diagnosed in individuals over 65 years of age, the prevalence of HF and its associated health care costs are expected to grow significantly. Aerobic exercise, resistance training, and inspiratory muscle training (IMT) are interventions that are currently used in the treatment of older adults with HF. A literature search was conducted for meta-analyses, systematic reviews, and large randomized control trials to evaluate the effect of aerobic exercise, resistance training, and IMT …

Analysis Of Daily Activity Data From Implanted Cardiac Defibrillators: The Minimum Clinically Important Difference And Relationship To Mortality/Life Expectancy, Michael J. Shoemaker, Amy B. Curtis, Eric Vangsnes, Michael G. Dickinson, Rajib Paul

Michael J Shoemaker, PT, DPT, PhD, GCS

Background: Daily activity is a potentially important measure for assessing prognosis in individuals with chronic heart failure (CHF), and few studies have investigated the prognostic value of daily activity measurement. The present study sought to determine whether there is an association between daily activity and mortality/mean life expectancy as predicted by the Seattle Heart Failure Model (SHFM), and to provide an estimate of the anchor-based minimum clinically important difference (MCID) for daily activity measured by single-axis accelerometers in implanted cardiac defibrillators. Methods: This study utilized a retrospective chart review of 102 medical records of patients with CHF and Medtronic® implanted …

Improved Survival After Heart Failure: A Community-Based Perspective, Samuel W. Joffe, Kristy T. Webster, David D. Mcmanus, Michael S. Kiernan, Darleen M. Lessard, Jorge L. Yarzebski, Chad E. Darling, Joel M. Gore, Robert J. Goldberg

Jorge L. Yarzebski

BACKGROUND: Heart failure is a highly prevalent, morbid, and costly disease with a poor long-term prognosis. Evidence-based therapies utilized over the past 2 decades hold the promise of improved outcomes, yet few contemporary studies have examined survival trends in patients with acute heart failure. The primary objective of this population-based study was to describe trends in short- and long-term survival in patients hospitalized with acute decompensated heart failure (ADHF). A secondary objective was to examine patient characteristics associated with decreased long-term survival.

METHODS AND RESULTS: We reviewed the medical records of 9748 patients hospitalized with ADHF at all 11 medical …

Improved Survival After Heart Failure: A Community-Based Perspective, Kristy T. Webster, Samuel W. Joffe, David D. Mcmanus, Michael S. Kiernan, Darleen M. Lessard, Jorge L. Yarzebski, Chad E. Darling, Joel M. Gore, Robert J. Goldberg

Jorge L. Yarzebski

Background: Heart failure is a highly prevalent, morbid, and costly disease with a poor long-term prognosis. Evidence-based therapies utilized over the past 2 decades hold the promise of improved outcomes, yet few contemporary studies have examined survival trends in patients with acute heart failure. Objectives: The primary objective of this population-based study was to describe trends in short and long-term survival in patients hospitalized with acute decompensated heart failure (ADHF). A secondary objective was to examine patient characteristics associated with decreased long-term survival. Methods and Results: We reviewed the medical records of 9,748 patients hospitalized with ADHF at all 11 …

Clinically Meaningful Change Estimates For The Six-Minute Walk Test And Daily Activity In Individuals With Chronic Heart Failure, Michael Shoemaker, A Curtis, E Vansgnes, M Dickinson

Michael J Shoemaker, PT, DPT, PhD, GCS

No abstract provided.

Interventions To Improve Daily Activity In Individuals With Copd And Chf: A Systematic Review, Michael Shoemaker, B Keenoy, B Smith, P Slotman

Michael J Shoemaker, PT, DPT, PhD, GCS

No abstract provided.

Longitudinal Daily Activity Patterns In Individuals With Chronic Heart Failure: Derivation And Association With Prognosis And Clinical Characteristics, Michael Shoemaker, Amy Curtis, Rajib Paul, Michael Dickinson, Alyssa Polso

Michael J Shoemaker, PT, DPT, PhD, GCS

No abstract provided.

Psychometric Testing Of The Self-Care Of Heart Failure Index, Barbara Riegel, Beverly Carlson, Debra K. Moser, Margaret Sebern, Frank D. Hicks, Virginia Roland

Margaret Sebern

Background: Self-care is believed to improve outcomes in heart failure (HF) patients. However, research testing this assumption is hampered by difficulties in measuring self-care. The purpose of this study was to evaluate the psychometric properties of a revised instrument measuring self-care in persons with HF, the Self-Care of Heart Failure Index (SCHFI). The SCHFI is a self-report measure comprised of 15 items rated on a 4-point response scale and divided into 3 subscales. Methods and Results: Psychometric testing was done using data from 760 HF patients (age 70.36 ± 12.3 years, 51% male) from 7 sites in the United States. …

A Systematic Review Of Validated Methods For Identifying Heart Failure Using Administrative Data, Jane Saczynski, Susan Andrade, Leslie Harrold, Jennifer Tjia, Sarah Cutrona, Katherine Dodd, Robert Goldberg, Jerry Gurwitz

Jennifer Tjia

PURPOSE: To identify and describe the validity of algorithms used to detect heart failure (HF) using administrative and claims data sources.

METHODS: A systematic review of PubMed and Iowa Drug Information Service searches of the English language was performed to identify studies published between 1990 and 2010 that evaluated the validity of algorithms for the identification of patients with HF using and claims data. Abstracts and articles were reviewed by two study investigators to determine their relevance on the basis of predetermined criteria.

RESULTS: The initial search strategy identified 887 abstracts. Of these, 499 full articles were reviewed and 35 …

Racial And Ethnic Differences In Hospice Use Among Patients With Heart Failure, Jane Givens, Jennifer Tjia, Chao Zhou, Ezekiel Emanuel, Arlene Ash

Jennifer Tjia

BACKGROUND: Heart failure is the leading noncancer diagnosis for patients in hospice care and the leading cause of hospitalization among Medicare beneficiaries. Racial and ethnic differences in hospice patients are well documented for patients with cancer but poorly described for those with heart failure.

METHODS: On the basis of a national sample of 98 258 Medicare beneficiaries 66 years and older on January 1, 2001, with a diagnosis of heart failure who had at least 1 physician or hospital encounter and who were not enrolled in hospice care between January 1 and December 31, 2000, we determined the effect of …

Triangulating Clinically Meaningful Change In The Six-Minute Walk Test In Individuals With Chronic Heart Failure: A Systematic Review, Michael Shoemaker, A Curtis, E Vansgnes, M Dickinson

Michael J Shoemaker, PT, DPT, PhD, GCS

No abstract provided.

30-Year Trends In Heart Failure In Patients Hospitalized With Acute Myocardial Infarction, David Mcmanus, Marcello Chinali, Jane Saczynski, Joel Gore, Jorge Yarzebski, Frederick Spencer, Darleen Lessard, Robert Goldberg

Jorge L. Yarzebski

Despite significant advances in its treatment, acute myocardial infarction (AMI) remains an important cause of heart failure (HF). Contemporary data remain lacking, however, describing long-term trends in incidence rates, demographic and clinical profiles, and outcomes of patients who develop HF as a complication of AMI. Our study sample consisted of 11,061 residents of the Worcester (Massachusetts) metropolitan area hospitalized with AMI at all greater Worcester hospitals in 15 annual study periods from 1975 to 2005. Overall, 32.4% of patients (n = 3,582) with AMI developed new-onset HF during their acute hospitalization. Patients who developed HF were generally older, more likely …

Body Mass Index, Treatment Practices, And Mortality In Patients With Acute Heart Failure, Timothy Fitzgibbons, Olga Hardy, Darleen Lessard, Joel Gore, Jorge Yarzebski, Robert Goldberg

Jorge L. Yarzebski

OBJECTIVES: Obesity is associated with an increased risk of heart failure (HF). Among patients presenting with acute HF, however, differences in clinical characteristics, treatment regimens, and short-term prognosis of varying weights are largely unknown, particularly from a broader population-based perspective. METHODS: A total of 3722 patients admitted with acute HF to 11 greater Worcester (Massachusetts, USA) hospitals during 1995 and 2000 were categorized as being lean (n = 216), normal weight (n = 1465), overweight (n = 1007), or obese (n = 1034) at the time of hospitalization. RESULTS: Obese patients with decompensated HF were significantly younger (mean age = …

Symptom Presentation In Patients Hospitalized With Acute Heart Failure., Robert Goldberg, Frederick Spencer, Mariana Szklo-Coxe, Mayra Tisminetzky, Jorge Yarzebski, Darleen Lessard, Joel Gore, William Gaasch

Jorge L. Yarzebski

OBJECTIVES: The objectives of this study were to examine the type and frequency of symptoms in patients hospitalized with acute heart failure (HF) as well as the relationship between symptom patterns and patient characteristics, treatment practices, and hospital outcomes in patients hospitalized with decompensated HF.

METHODS: The study sample consisted of 4537 residents of the Worcester, MA metropolitan area hospitalized for decompensated HF at 11 greater Worcester medical centers in 1995 and 2000.

RESULTS: The average age of the study sample was 76 years; the majority (57%) were women, and three-quarters of our patient population had been previously diagnosed with …

Delays In Seeking Medical Care In Hospitalized Patients With Decompensated Heart Failure, Robert Goldberg, Jordan Goldberg, Sean Pruell, Jorge Yarzebski, Darleen Lessard, Frederick Spencer, Joel Gore

Jorge L. Yarzebski

PURPOSE: The magnitude of, and factors associated with, prolonged delay in seeking medical care in patients with acute myocardial infarction has been well described. It is unknown, however, what the extent of, and factors associated with, prehospital delay are in patients hospitalized with acute heart failure. The purpose of this study was to examine patterns of prehospital delay, and factors associated with delay in seeking medical care, in patients hospitalized with acute heart failure at all 11 medical centers in the Worcester, Massachusetts metropolitan area. METHODS: The medical records of 2587 greater Worcester residents with decompensated heart failure who were …

Gender Differences And Factors Associated With The Receipt Of Thrombolytic Therapy In Patients With Acute Myocardial Infarction: A Community-Wide Perspective, Jorge Yarzebski, Nananda Col, Paul Pagley, Judith Savageau, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

In spite of national interest in gender differences in the presentation and management of chronic disease, limited information is available about possible gender differences in the receipt of thrombolytic therapy after acute myocardial infarction (AMI). As part of an ongoing community-based study of AMI, we examined gender differences in the receipt of thrombolytic therapy among 2885 patients with confirmed AMI. The study sample consisted of 1680 males and 1205 females with validated AMI who were admitted to 16 hospitals in the Worcester, Massachusetts, metropolitan area in four study periods between 1986 and 1991. During the years under study, 24.4% of …