Moving From Heart Failure Guidelines to Clinical Practice: Gaps Contributing to Readmissions in Patients With Multiple Comorbidities and Older Age

Pupalan Iyngkaran, Danny Liew, Christopher Neil, Andrea Driscoll, Thomas H. Marwick, David L. Hare

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

This feature article for the thematic series on congestive heart failure (CHF) readmissions aims to outline important gaps in guidelines for patients with multiple comorbidities and the elderly. Congestive heart failure diagnosis manifests as a 3-phase journey between the hospital and community, during acute, chronic stable, and end-of-life (palliative) phases. This journey requires in variable intensities a combination of multidisciplinary care within tertiary hospital or ambulatory care from hospital outpatients or primary health services, within the general community. Management goals are uniform, ie, to achieve the lowest New York Heart Association class possible, with improvement in ejection fraction, by delivering gold standard therapies within a CHF program. Comorbidities are an important common denominator that influences outcomes. Comorbidities include diabetes mellitus, chronic obstructive airways disease, chronic renal impairment, hypertension, obesity, sleep apnea, and advancing age. Geriatric care includes the latter as well as syndromes such as frailty, falls, incontinence, and confusion. Many systems still fail to comprehensively achieve all aspects of such programs. This review explores these factors.

Original languageEnglish
Pages (from-to)1-13
Number of pages13
JournalClinical Medicine Insights: Cardiology
Volume12
DOIs
Publication statusPublished - 1 Dec 2018

Keywords

  • comorbidity
  • elderly
  • geriatric
  • readmissions
  • translating guidelines
  • translational research

Cite this

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abstract = "This feature article for the thematic series on congestive heart failure (CHF) readmissions aims to outline important gaps in guidelines for patients with multiple comorbidities and the elderly. Congestive heart failure diagnosis manifests as a 3-phase journey between the hospital and community, during acute, chronic stable, and end-of-life (palliative) phases. This journey requires in variable intensities a combination of multidisciplinary care within tertiary hospital or ambulatory care from hospital outpatients or primary health services, within the general community. Management goals are uniform, ie, to achieve the lowest New York Heart Association class possible, with improvement in ejection fraction, by delivering gold standard therapies within a CHF program. Comorbidities are an important common denominator that influences outcomes. Comorbidities include diabetes mellitus, chronic obstructive airways disease, chronic renal impairment, hypertension, obesity, sleep apnea, and advancing age. Geriatric care includes the latter as well as syndromes such as frailty, falls, incontinence, and confusion. Many systems still fail to comprehensively achieve all aspects of such programs. This review explores these factors.",
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Moving From Heart Failure Guidelines to Clinical Practice : Gaps Contributing to Readmissions in Patients With Multiple Comorbidities and Older Age. / Iyngkaran, Pupalan; Liew, Danny; Neil, Christopher; Driscoll, Andrea; Marwick, Thomas H.; Hare, David L.

In: Clinical Medicine Insights: Cardiology, Vol. 12, 01.12.2018, p. 1-13.

Research output: Contribution to journalReview ArticleResearchpeer-review

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