TY - JOUR
T1 - Moving From Heart Failure Guidelines to Clinical Practice
T2 - Gaps Contributing to Readmissions in Patients With Multiple Comorbidities and Older Age
AU - Iyngkaran, Pupalan
AU - Liew, Danny
AU - Neil, Christopher
AU - Driscoll, Andrea
AU - Marwick, Thomas H.
AU - Hare, David L.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - 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.
AB - 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.
KW - comorbidity
KW - elderly
KW - geriatric
KW - readmissions
KW - translating guidelines
KW - translational research
UR - http://www.scopus.com/inward/record.url?scp=85058563337&partnerID=8YFLogxK
U2 - 10.1177/1179546818809358
DO - 10.1177/1179546818809358
M3 - Review Article
C2 - 30618487
AN - SCOPUS:85058563337
VL - 12
SP - 1
EP - 13
JO - Clinical Medicine Insights: Cardiology
JF - Clinical Medicine Insights: Cardiology
SN - 1179-5468
ER -