| 51. |
- Stolfo, Davide, et al.
(författare)
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Association between beta-blocker use and mortality/morbidity in older patients with heart failure with reduced ejection fraction. A propensity score-matched analysis from the Swedish Heart Failure Registry
- 2020
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Ingår i: European Journal of Heart Failure. - : WILEY. - 1388-9842 .- 1879-0844. ; 22:1, s. 103-112
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Tidskriftsartikel (refereegranskat)abstract
- Background Beta-blockers reduce mortality and morbidity in heart failure (HF) with reduced ejection fraction (HFrEF). However, patients older than 80 years are poorly represented in randomized controlled trials. We assessed the association between beta-blocker use and outcomes in HFrEF patients aged amp;gt;= 80 years. Methods and results We included patients with an ejection fraction amp;lt;40% and aged amp;gt;= 80 years from the Swedish HF Registry. The association between beta-blocker use, all-cause mortality and cardiovascular (CV) mortality/HF hospitalization was assessed by Cox proportional hazard models in a 1:1 propensity score-matched cohort. To assess consistency, the same analyses were performed in a positive control cohort with age amp;lt;80 years. A negative control outcome analysis was run using hospitalization for cancer as endpoint. Of 6562 patients aged amp;gt;= 80 years, 5640 (86%) received beta-blockers. In the matched cohort including 1732 patients, beta-blocker use was associated with a significant reduction in the risk of all-cause mortality [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.79-0.99]. Reduction in CV mortality/HF hospitalization was not significant (HR 0.94, 95% CI 0.85-1.05) due to the lack of association with HF hospitalization, whereas CV death was significantly reduced. After adjustment rather than matching for the propensity score in the overall cohort, beta-blocker use was associated with reduced risk of all outcomes. In patients aged amp;lt;80 years, use of beta-blockers was associated with reduced risk of all-cause death (HR 0.79, 95% CI 0.68-0.92) and of the composite outcome (HR 0.88, 95% CI 0.77-0.99). Conclusions In HFrEF patients amp;gt;= 80 years of age, use of beta-blockers was high and was associated with improved all-cause and CV survival.
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| 52. |
- van Eijk, Jorna, et al.
(författare)
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Integrating telemedicine in routine heart failure management: Experiences of healthcare professionals - A qualitative study
- 2024
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Ingår i: Digital Health. - : SAGE PUBLICATIONS LTD. - 2055-2076. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Objective To describe the experiences of healthcare professionals with integrating telemedicine in routine heart failure (HF) care.Methods Semi-structured interviews were conducted with healthcare professionals (n = 19) in the Netherlands who were involved in decision-making, implementation or routine use of telemedicine in HF management. Using purposive sampling, nurses, cardiologists and managers were selected to be interviewed. Interviews were performed in-person, recorded and transcribed verbatim. Interview data were analysed using a reflexive thematic analysis.Results This study identified four themes: (1) Responsibility - the lack of a clear delineation of roles and responsibilities among healthcare professionals, patients and suppliers in telemedicine. (2) Confidence and safety - telemedicine is seen by healthcare professionals as capable of enhancing safety, yet also introduces the risk of fostering a false sense of security among patients. (3) Collaboration - actively involving end-users in the development and implementation of telemedicine promotes the adoption. (4) Processes and mutual agreements - rather than replacing traditional care, telemedicine is perceived as an adjunct to it. Structured care pathways support telemedicine implementation, and personalised telemedicine can empower patients in self-care.Conclusions Telemedicine is a promising intervention in the management of HF. However, existing systems and care pathways have resulted in limited adoption. Improvements in the collaboration and establishing clear agreements on responsibilities between professional, patient and supplier can lead to more confidence in adopting telemedicine. Structured care pathways can be supportive. A personalised telemedicine approach can ensure that telemedicine remains manageable for patient and professional.
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| 53. |
- van Eijk, Jorna, et al.
(författare)
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Which heart failure patients benefit most from non-invasive telemedicine? An overview of current evidence and future directions
- 2024
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Ingår i: Netherlands Heart Journal. - : BOHN STAFLEU VAN LOGHUM BV. - 1568-5888 .- 1876-6250. ; 32:9, s. 304-314
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Forskningsöversikt (refereegranskat)abstract
- Telemedicine in heart failure (HF) management may positively impact health outcomes, but varied effects in studies hinder guidance in HF guidelines. Evidence on the effectiveness of telemedicine in HF subpopulations is limited. We conducted a scoping review to evaluate and synthesise evidence on the effectiveness of telemedicine across HF subpopulations that could guide telemedicine strategies in routine practice. Meta-analyses concerning randomised controlled trials (RCTs) with subgroup analyses on telemedicine effectives were identified in PubMed. We identified 15 RCTs, encompassing 21 different subgroups based on characteristics of HF patients. Findings varied across studies and no definite evidence was found about which patients benefit most from telemedicine. Subgroup definitions were inconsistent, not always a priori defined and subgroups contained few patients. Some studies found heterogeneous effects of telemedicine on mortality and hospitalisation across subgroups defined by: New York Heart Association (NYHA) classification, previous HF decompensation, implantable device, concurrent depression, time since hospital discharge and duration of HF. Patients represented in the RCTs were mostly male, aged 65-75 years, with HF with reduced ejection fraction and NYHA class II/III. Traditional RCTs have not been able to provide clinicians with guidance; continuous real-world evidence generation could enhance monitoring and identify who benefits from telemedicine.
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