Explore perceptions of physical activity/exercise in patients with chronic heart failure (HF). Al... more Explore perceptions of physical activity/exercise in patients with chronic heart failure (HF). Although activity/exercise are HF self-care expectations, perceptions of patients are not well understood. Ambulatory adults with HF were interviewed. Data were transcribed, categorized, and themes were developed. Of 48 participants, mean age was 58.8 ± 13.2 years. Themes that emerged were: patients not knowing and physicians not telling; scared into doing or not doing it; life gets in the way; meaningful support versus meaningless talk; emotional connections to exercise; value does not equal motivation to move; and disconnection between self-confidence and actions. Self-confidence in and value of physical activity/exercise were not primary motivators to action. Generally, physicians failed to provide details regarding exercise dose, length, warm-up and cool-down expectations, and usual and adverse effects. Patient perceptions of what physical activity/exercise means are multi-dimensional;...
Cigarette smoking is a well-established risk factor for cardiovascular disease yet several studie... more Cigarette smoking is a well-established risk factor for cardiovascular disease yet several studies have shown lower mortality after acute coronary syndromes in smokers compared with non-smokers, the so called 'smoker's paradox'. This study aimed to ascertain the relationship between smoking and clinical outcomes in patients hospitalized with heart failure (HF).
BACKGROUND: Depression is a risk factor of excessive morbidity and mortality in heart failure. We... more BACKGROUND: Depression is a risk factor of excessive morbidity and mortality in heart failure. We examined in-hospital treatment and postdischarge outcomes in hospitalized heart failure patients with a documented history of depression from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure. METHODS: We identified patient factors associated with depression history and evaluated the association of depression with hospital treatments and mortality, and early postdischarge mortality, emergency care, and rehospitalization. RESULTS: In 48,612 patients from 259 hospitals, depression history was present in 10.6% and occurred more often in females, whites, and those with common heart failure comorbidities, including chronic pulmonary obstructive disease (36% vs 27%), anemia (27% vs 16.5%), insulin-dependent diabetes mellitus (20% vs 16%), and hyperlipidemia (38% vs 31%), all P Ͻ.001. Patients with depression history were less likely to receive coronary interventions and cardiac devices, all P Ͻ.01; or be referred to outpatient disease management programs, P Ͻ.001. Length of hospital stay was longer with depression history (7.0 vs 6.4 days, P Ͻ.001). In 5791 patients followed-up at 60-90 days postdischarge, those with depression history had higher mortality (8.8% vs 6.4%; P Ï .025). After multivariable modeling, depression history remained a predictor of length of hospital stay, P Ͻ.001 and postdischarge mortality, P Ï .02. CONCLUSIONS: Depression history at heart failure hospitalization may be a predictor of prolonged length of hospital stay, less use of cardiac procedures and postdischarge disease management, and increased 60-90 day mortality. Patients with depression might represent a vulnerable group in which improved use of evidence-based treatment should be considered.
Background-Differences in hospital staffing may influence outcomes for patients with acute condit... more Background-Differences in hospital staffing may influence outcomes for patients with acute conditions, including heart failure (HF), depending on which day of the week the patients are admitted. This study examined the relationship between the day of the week patients are hospitalized for HF and death rate, length of stay (LOS), and rehospitalization rate. Methods and Results-A total of 259 US hospitals participating in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) submitted data on 48 612 patients with HF. Sixty-to 90-day postdischarge follow-up data were collected prospectively in a prespecified 10% sample. We analyzed day of admission and discharge, demographic, medical history, medication use, laboratory, and in-hospital procedure data for their association with hospital LOS and death rate. Patient characteristics were similar for weekday and weekend presentation. LOS was a median of 4.0 days and a mean of 5.7Ϯ5.7 days; in-hospital death rate was 3.8%. In-hospital and postdischarge risk of death were similar for each day of the week in the hospital and follow-up cohorts, respectively. LOS, however, was significantly influenced by day of admission, even after adjustment for other LOS risk factors. The shortest LOS by admission day of the week was Tuesday (5.39 days), and the longest was Friday (5.88 days; PϽ0.001). Conclusions-No differences in death rate by day of admission or discharge for HF hospitalizations were evident.
Explore perceptions of physical activity/exercise in patients with chronic heart failure (HF). Al... more Explore perceptions of physical activity/exercise in patients with chronic heart failure (HF). Although activity/exercise are HF self-care expectations, perceptions of patients are not well understood. Ambulatory adults with HF were interviewed. Data were transcribed, categorized, and themes were developed. Of 48 participants, mean age was 58.8 ± 13.2 years. Themes that emerged were: patients not knowing and physicians not telling; scared into doing or not doing it; life gets in the way; meaningful support versus meaningless talk; emotional connections to exercise; value does not equal motivation to move; and disconnection between self-confidence and actions. Self-confidence in and value of physical activity/exercise were not primary motivators to action. Generally, physicians failed to provide details regarding exercise dose, length, warm-up and cool-down expectations, and usual and adverse effects. Patient perceptions of what physical activity/exercise means are multi-dimensional;...
American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2014
It is unknown if disposable electrocardiographic lead wires (ECG-LWs) reduce infection rates comp... more It is unknown if disposable electrocardiographic lead wires (ECG-LWs) reduce infection rates compared with cleaned, reusable lead wires. To compare infection rates in intensive care unit (ICU) patients receiving disposable versus reusable ECG-LWs. Matched adult ICUs were randomly assigned to disposable or reusable ECG-LWs. Outcomes were bloodstream infection, ventilator-associated pneumonia, and chest surgical site infections. Patients' characteristics and infections were collected from hospital databases. Event rates were described by using total counts and rates per 100 patient days and were compared between groups by using generalized linear mixed-effect models weighted by patients' ICU length of stay. Overall, 4056 patients from 6 ICUs received disposable and 3184 patients from 5 ICUs received reusable ECG-LWs. The characteristics of the 2 groups were similar, except patients receiving disposable ECG-LWs were less likely to be discharged home (P = .03) and had more comor...
participating in GWTG-HF was divided into derivation (70%, n27 850) and validation (30%, n11 933)... more participating in GWTG-HF was divided into derivation (70%, n27 850) and validation (30%, n11 933) samples. Multivariable logistic regression identified predictors of in-hospital mortality in the derivation sample from candidate demographic, medical history, and laboratory variables collected at admission. In-hospital mortality rate was 2.86% (n1139). Age, systolic blood pressure, blood urea nitrogen, heart rate, sodium, chronic obstructive pulmonary disease, and
The presentation, natural history, clinical outcomes, and response to therapy in patients with he... more The presentation, natural history, clinical outcomes, and response to therapy in patients with heart failure differ in some ways across populations. Women, older adults, and non-Caucasian racial or ethnic groups comprise a substantial proportion of the overall heart failure population, but they have typically been underrepresented in clinical trials. As a result, uncertainty exists about the efficacy of some guideline-directed medical therapies and devices in specific populations, which may result in the under or over treatment of these patients. Even when guideline-based treatments are prescribed, socioeconomic, physical, or psychological factors may impact non-Caucasian and older adult patient groups to a different extent and impact the application, effectiveness, and tolerability of these therapies. Individualized therapy based on tailored biology (genetics, proteomics, metabolomics), socioeconomic and cultural considerations, and individual goals and preferences may be the optim...
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, Jan 15, 2015
In home infusions via tunneled catheter/peripherally inserted central catheter (TC/PICC) the risk... more In home infusions via tunneled catheter/peripherally inserted central catheter (TC/PICC) the risk of catheter-related bloodstream infection (CRBSI) and complications contribute to rehospitalization and costs. It is unknown if voiceover interactive PowerPoint (VOIPP) via digital video disc education improves clinical outcomes. In a quaternary care medical center and using a randomized, controlled, 2-group design, hospitalized patients with TC/PICC received usual care education or usual care (UC) plus VOIPP education prehospital discharge. A multiple-choice 6-item knowledge questionnaire was administered preeducation, immediately posteducation, and 7-10 days postdischarge. At 90 days, patients were assessed for CRBSI incidence rates per 1000 catheter-days, rehospitalization, CRBSI-related hospitalization, non-CRBSI complications and patient calls to the home parenteral nutrition (HPN) clinicians. Analysis of variance, Pearson χ(2), and Kruskal-Wallis test were used to compare results ...
We propose that Stage D advanced heart failure be defined as the presence of progressive and/or p... more We propose that Stage D advanced heart failure be defined as the presence of progressive and/or persistent severe signs and symptoms of heart failure despite optimized medical, surgical, and device therapy. Importantly, the progressive decline should be primarily driven by the heart failure syndrome. Formally defining advanced heart failure and specifying when medical and device therapies have failed is challenging, but signs and symptoms, hemodynamics, exercise testing, biomarkers, and risk prediction models are useful in this process. Identification of patients in Stage D is a clinically important task since treatments are inherently limited, morbidity is typically progressive, and survival is often short. Age, frailty, and psychosocial issues impact both outcomes and selection of therapy for Stage D patients. Heart transplant and mechanical circulatory support devices are potential treatment options in select patients. In addition to considering indications, contraindications, cl...
Journal of the Association for Vascular Access, 2011
To explore the level of RNs knowledge of managing vascular access devices (VADs)-peripherally ins... more To explore the level of RNs knowledge of managing vascular access devices (VADs)-peripherally inserted central catheters (PICCs) and midline catheters, and to determine if nurse characteristics are associated with knowledge level. Background: Education of nursing staff about VAD management can improve quality of care and assure standards of practice are maintained. Review of Literature: Minimal research is available on nurses' knowledge of managing VAD catheters. Methods: Nurses working on a colo-rectal unit who frequently manage VADs in a large tertiary-care medical center voluntarily completed one anonymous, validated, 10-item survey of VAD management themes. Analysis included descriptive and correlational statistics. Results: Of 36 nurses, (97% female, 53% full time), mean VAD knowledge score was 8.1 ± 1.4 (81% mean sum score). Perceived general level of comfort in flushing PICCs (r=.35, P=0.04), using Alteplase with PICCs (r=.36, P=0.03) and changing dressings (r=.38; P=0.03) were associated with higher knowledge scores. Of 10 items, 4
Background: Prior investigators have suggested that quality of life differs in men and women with... more Background: Prior investigators have suggested that quality of life differs in men and women with heart failure, especially in the physical functioning domain. The purpose of this study was to compare quality of life in men and women with heart failure to determine if differences exist after controlling for functional status, age, and ejection fraction. Methods: Data from a sample
American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2015
Disposable electrocardiographic lead wires (ECG-LWs) may not be as durable as reusable ones. To e... more Disposable electrocardiographic lead wires (ECG-LWs) may not be as durable as reusable ones. To examine differences in alarm events between disposable and reusable ECG-LWs. Two cardiac telemetry units were randomized to reusable ECG-LWs, and 2 units alternated between disposable and reusable ECG-LWs for 4 months. A remote monitoring team, blinded to ECG-LW type, assessed frequency and type of alarm events by using total counts and rates per 100 patient days. Event rates were compared by using generalized linear mixed-effect models for differences and noninferiority between wire types. In 1611 patients and 9385.5 patient days of ECG monitoring, patient characteristics were similar between groups. Rates of alarms for no telemetry, leads fail, or leads off were lower in disposable ECG-LWs (adjusted relative risk [95% CI], 0.71 [0.53-0.96]; noninferiority P < .001; superiority P = .03) and monitoring (artifact) alarms were significantly noninferior (adjusted relative risk [95% CI]: 0...
Differences in hospital staffing may influence outcomes for patients with acute conditions, inclu... more Differences in hospital staffing may influence outcomes for patients with acute conditions, including heart failure (HF), depending on which day of the week the patients are admitted. This study examined the relationship between the day of the week patients are hospitalized for HF and death rate, length of stay (LOS), and rehospitalization rate. A total of 259 US hospitals participating in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) submitted data on 48 612 patients with HF. Sixty- to 90-day postdischarge follow-up data were collected prospectively in a prespecified 10% sample. We analyzed day of admission and discharge, demographic, medical history, medication use, laboratory, and in-hospital procedure data for their association with hospital LOS and death rate. Patient characteristics were similar for weekday and weekend presentation. LOS was a median of 4.0 days and a mean of 5.7+/-5.7 days; in-hospital death ra...
Cardiac resynchronization therapy with defibrillator (CRT-D) reduces morbidity and mortality amon... more Cardiac resynchronization therapy with defibrillator (CRT-D) reduces morbidity and mortality among selected patients with heart failure in clinical trials. The effectiveness of this therapy in clinical practice has not been well studied. We compared a cohort of 4471 patients from the National Cardiovascular Data Registry's Implantable Cardioverter-Defibrillator (ICD) Registry hospitalized primarily for heart failure and who received CRT-D between April 1, 2006, and December 31, 2009, to a historical control cohort of 4888 patients with heart failure without CRT-D from the Acute Decompensated Heart Failure National Registry (ADHERE) hospitalized between January 1, 2002, and March 31, 2006. Both registries were linked with Medicare claims to evaluate longitudinal outcomes. We included patients from the ICD Registry with left ventricular ejection fraction ≤35% and QRS duration ≥120 ms who were admitted for heart failure. We used Cox proportional hazards models to compare outcomes w...
Heart failure (HF) afflicts nearly 6 million Americans, resulting in one million emergency depart... more Heart failure (HF) afflicts nearly 6 million Americans, resulting in one million emergency department (ED) visits and over one million annual hospital discharges. An aging population and improved survival from cardiovascular diseases is expected to further increase HF prevalence. Emergency providers play a significant role in the management of patients with acute heart failure (AHF). It is crucial that emergency physicians and other providers involved in early management understand the latest developments in diagnostic testing, therapeutics and alternatives to hospitalization. Further, clinical trials must be conducted in the ED in order to improve the evidence base and drive optimal initial therapy for AHF. Should ongoing and future studies suggest early phenotype-driven therapy improves in-hospital and post-discharge outcomes, ED treatment decisions will need to evolve accordingly. The potential impact of future studies which incorporate risk-stratification into ED disposition dec...
In 2009, the Get With The Guidelines-Heart Failure program enhanced the standard recognition of h... more In 2009, the Get With The Guidelines-Heart Failure program enhanced the standard recognition of hospitals by offering additional recognition if hospitals performed well on certain quality measures. We sought to determine whether initiation of this enhanced recognition opportunity led to acceleration in quality of care for all hospitals participating in the program. We examined hospital-level performance on 9 quality-of-care (process) measures that were added to an existing recognition program (based on existing published performance measures). The rate of increase in use over time 6 months to 2 years after the start of the program was compared with the rate of increase in use for the measures during the 18-month period prior to the start of the program. Use increased for all 9 new quality measures from 2008 to 2011. Among 4 measures with baseline use near or lower than 50%, a statistically significant greater increase in use during the program was seen for implantable cardioverter d...
Background The use of parenteral positive inotropic agents still remains a major component of the... more Background The use of parenteral positive inotropic agents still remains a major component of therapy for patients with advanced decompensated congestive heart failure (CHF). However, no consensus guidelines have been developed for the appropriate selection of a first-line inotropic therapy. We sought to compare the clinical outcome and economic cost of dobutamine-based and milrinone-based therapy in patients with acute exacerbation
Explore perceptions of physical activity/exercise in patients with chronic heart failure (HF). Al... more Explore perceptions of physical activity/exercise in patients with chronic heart failure (HF). Although activity/exercise are HF self-care expectations, perceptions of patients are not well understood. Ambulatory adults with HF were interviewed. Data were transcribed, categorized, and themes were developed. Of 48 participants, mean age was 58.8 ± 13.2 years. Themes that emerged were: patients not knowing and physicians not telling; scared into doing or not doing it; life gets in the way; meaningful support versus meaningless talk; emotional connections to exercise; value does not equal motivation to move; and disconnection between self-confidence and actions. Self-confidence in and value of physical activity/exercise were not primary motivators to action. Generally, physicians failed to provide details regarding exercise dose, length, warm-up and cool-down expectations, and usual and adverse effects. Patient perceptions of what physical activity/exercise means are multi-dimensional;...
Cigarette smoking is a well-established risk factor for cardiovascular disease yet several studie... more Cigarette smoking is a well-established risk factor for cardiovascular disease yet several studies have shown lower mortality after acute coronary syndromes in smokers compared with non-smokers, the so called 'smoker's paradox'. This study aimed to ascertain the relationship between smoking and clinical outcomes in patients hospitalized with heart failure (HF).
BACKGROUND: Depression is a risk factor of excessive morbidity and mortality in heart failure. We... more BACKGROUND: Depression is a risk factor of excessive morbidity and mortality in heart failure. We examined in-hospital treatment and postdischarge outcomes in hospitalized heart failure patients with a documented history of depression from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure. METHODS: We identified patient factors associated with depression history and evaluated the association of depression with hospital treatments and mortality, and early postdischarge mortality, emergency care, and rehospitalization. RESULTS: In 48,612 patients from 259 hospitals, depression history was present in 10.6% and occurred more often in females, whites, and those with common heart failure comorbidities, including chronic pulmonary obstructive disease (36% vs 27%), anemia (27% vs 16.5%), insulin-dependent diabetes mellitus (20% vs 16%), and hyperlipidemia (38% vs 31%), all P Ͻ.001. Patients with depression history were less likely to receive coronary interventions and cardiac devices, all P Ͻ.01; or be referred to outpatient disease management programs, P Ͻ.001. Length of hospital stay was longer with depression history (7.0 vs 6.4 days, P Ͻ.001). In 5791 patients followed-up at 60-90 days postdischarge, those with depression history had higher mortality (8.8% vs 6.4%; P Ï .025). After multivariable modeling, depression history remained a predictor of length of hospital stay, P Ͻ.001 and postdischarge mortality, P Ï .02. CONCLUSIONS: Depression history at heart failure hospitalization may be a predictor of prolonged length of hospital stay, less use of cardiac procedures and postdischarge disease management, and increased 60-90 day mortality. Patients with depression might represent a vulnerable group in which improved use of evidence-based treatment should be considered.
Background-Differences in hospital staffing may influence outcomes for patients with acute condit... more Background-Differences in hospital staffing may influence outcomes for patients with acute conditions, including heart failure (HF), depending on which day of the week the patients are admitted. This study examined the relationship between the day of the week patients are hospitalized for HF and death rate, length of stay (LOS), and rehospitalization rate. Methods and Results-A total of 259 US hospitals participating in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) submitted data on 48 612 patients with HF. Sixty-to 90-day postdischarge follow-up data were collected prospectively in a prespecified 10% sample. We analyzed day of admission and discharge, demographic, medical history, medication use, laboratory, and in-hospital procedure data for their association with hospital LOS and death rate. Patient characteristics were similar for weekday and weekend presentation. LOS was a median of 4.0 days and a mean of 5.7Ϯ5.7 days; in-hospital death rate was 3.8%. In-hospital and postdischarge risk of death were similar for each day of the week in the hospital and follow-up cohorts, respectively. LOS, however, was significantly influenced by day of admission, even after adjustment for other LOS risk factors. The shortest LOS by admission day of the week was Tuesday (5.39 days), and the longest was Friday (5.88 days; PϽ0.001). Conclusions-No differences in death rate by day of admission or discharge for HF hospitalizations were evident.
Explore perceptions of physical activity/exercise in patients with chronic heart failure (HF). Al... more Explore perceptions of physical activity/exercise in patients with chronic heart failure (HF). Although activity/exercise are HF self-care expectations, perceptions of patients are not well understood. Ambulatory adults with HF were interviewed. Data were transcribed, categorized, and themes were developed. Of 48 participants, mean age was 58.8 ± 13.2 years. Themes that emerged were: patients not knowing and physicians not telling; scared into doing or not doing it; life gets in the way; meaningful support versus meaningless talk; emotional connections to exercise; value does not equal motivation to move; and disconnection between self-confidence and actions. Self-confidence in and value of physical activity/exercise were not primary motivators to action. Generally, physicians failed to provide details regarding exercise dose, length, warm-up and cool-down expectations, and usual and adverse effects. Patient perceptions of what physical activity/exercise means are multi-dimensional;...
American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2014
It is unknown if disposable electrocardiographic lead wires (ECG-LWs) reduce infection rates comp... more It is unknown if disposable electrocardiographic lead wires (ECG-LWs) reduce infection rates compared with cleaned, reusable lead wires. To compare infection rates in intensive care unit (ICU) patients receiving disposable versus reusable ECG-LWs. Matched adult ICUs were randomly assigned to disposable or reusable ECG-LWs. Outcomes were bloodstream infection, ventilator-associated pneumonia, and chest surgical site infections. Patients' characteristics and infections were collected from hospital databases. Event rates were described by using total counts and rates per 100 patient days and were compared between groups by using generalized linear mixed-effect models weighted by patients' ICU length of stay. Overall, 4056 patients from 6 ICUs received disposable and 3184 patients from 5 ICUs received reusable ECG-LWs. The characteristics of the 2 groups were similar, except patients receiving disposable ECG-LWs were less likely to be discharged home (P = .03) and had more comor...
participating in GWTG-HF was divided into derivation (70%, n27 850) and validation (30%, n11 933)... more participating in GWTG-HF was divided into derivation (70%, n27 850) and validation (30%, n11 933) samples. Multivariable logistic regression identified predictors of in-hospital mortality in the derivation sample from candidate demographic, medical history, and laboratory variables collected at admission. In-hospital mortality rate was 2.86% (n1139). Age, systolic blood pressure, blood urea nitrogen, heart rate, sodium, chronic obstructive pulmonary disease, and
The presentation, natural history, clinical outcomes, and response to therapy in patients with he... more The presentation, natural history, clinical outcomes, and response to therapy in patients with heart failure differ in some ways across populations. Women, older adults, and non-Caucasian racial or ethnic groups comprise a substantial proportion of the overall heart failure population, but they have typically been underrepresented in clinical trials. As a result, uncertainty exists about the efficacy of some guideline-directed medical therapies and devices in specific populations, which may result in the under or over treatment of these patients. Even when guideline-based treatments are prescribed, socioeconomic, physical, or psychological factors may impact non-Caucasian and older adult patient groups to a different extent and impact the application, effectiveness, and tolerability of these therapies. Individualized therapy based on tailored biology (genetics, proteomics, metabolomics), socioeconomic and cultural considerations, and individual goals and preferences may be the optim...
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, Jan 15, 2015
In home infusions via tunneled catheter/peripherally inserted central catheter (TC/PICC) the risk... more In home infusions via tunneled catheter/peripherally inserted central catheter (TC/PICC) the risk of catheter-related bloodstream infection (CRBSI) and complications contribute to rehospitalization and costs. It is unknown if voiceover interactive PowerPoint (VOIPP) via digital video disc education improves clinical outcomes. In a quaternary care medical center and using a randomized, controlled, 2-group design, hospitalized patients with TC/PICC received usual care education or usual care (UC) plus VOIPP education prehospital discharge. A multiple-choice 6-item knowledge questionnaire was administered preeducation, immediately posteducation, and 7-10 days postdischarge. At 90 days, patients were assessed for CRBSI incidence rates per 1000 catheter-days, rehospitalization, CRBSI-related hospitalization, non-CRBSI complications and patient calls to the home parenteral nutrition (HPN) clinicians. Analysis of variance, Pearson χ(2), and Kruskal-Wallis test were used to compare results ...
We propose that Stage D advanced heart failure be defined as the presence of progressive and/or p... more We propose that Stage D advanced heart failure be defined as the presence of progressive and/or persistent severe signs and symptoms of heart failure despite optimized medical, surgical, and device therapy. Importantly, the progressive decline should be primarily driven by the heart failure syndrome. Formally defining advanced heart failure and specifying when medical and device therapies have failed is challenging, but signs and symptoms, hemodynamics, exercise testing, biomarkers, and risk prediction models are useful in this process. Identification of patients in Stage D is a clinically important task since treatments are inherently limited, morbidity is typically progressive, and survival is often short. Age, frailty, and psychosocial issues impact both outcomes and selection of therapy for Stage D patients. Heart transplant and mechanical circulatory support devices are potential treatment options in select patients. In addition to considering indications, contraindications, cl...
Journal of the Association for Vascular Access, 2011
To explore the level of RNs knowledge of managing vascular access devices (VADs)-peripherally ins... more To explore the level of RNs knowledge of managing vascular access devices (VADs)-peripherally inserted central catheters (PICCs) and midline catheters, and to determine if nurse characteristics are associated with knowledge level. Background: Education of nursing staff about VAD management can improve quality of care and assure standards of practice are maintained. Review of Literature: Minimal research is available on nurses' knowledge of managing VAD catheters. Methods: Nurses working on a colo-rectal unit who frequently manage VADs in a large tertiary-care medical center voluntarily completed one anonymous, validated, 10-item survey of VAD management themes. Analysis included descriptive and correlational statistics. Results: Of 36 nurses, (97% female, 53% full time), mean VAD knowledge score was 8.1 ± 1.4 (81% mean sum score). Perceived general level of comfort in flushing PICCs (r=.35, P=0.04), using Alteplase with PICCs (r=.36, P=0.03) and changing dressings (r=.38; P=0.03) were associated with higher knowledge scores. Of 10 items, 4
Background: Prior investigators have suggested that quality of life differs in men and women with... more Background: Prior investigators have suggested that quality of life differs in men and women with heart failure, especially in the physical functioning domain. The purpose of this study was to compare quality of life in men and women with heart failure to determine if differences exist after controlling for functional status, age, and ejection fraction. Methods: Data from a sample
American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2015
Disposable electrocardiographic lead wires (ECG-LWs) may not be as durable as reusable ones. To e... more Disposable electrocardiographic lead wires (ECG-LWs) may not be as durable as reusable ones. To examine differences in alarm events between disposable and reusable ECG-LWs. Two cardiac telemetry units were randomized to reusable ECG-LWs, and 2 units alternated between disposable and reusable ECG-LWs for 4 months. A remote monitoring team, blinded to ECG-LW type, assessed frequency and type of alarm events by using total counts and rates per 100 patient days. Event rates were compared by using generalized linear mixed-effect models for differences and noninferiority between wire types. In 1611 patients and 9385.5 patient days of ECG monitoring, patient characteristics were similar between groups. Rates of alarms for no telemetry, leads fail, or leads off were lower in disposable ECG-LWs (adjusted relative risk [95% CI], 0.71 [0.53-0.96]; noninferiority P < .001; superiority P = .03) and monitoring (artifact) alarms were significantly noninferior (adjusted relative risk [95% CI]: 0...
Differences in hospital staffing may influence outcomes for patients with acute conditions, inclu... more Differences in hospital staffing may influence outcomes for patients with acute conditions, including heart failure (HF), depending on which day of the week the patients are admitted. This study examined the relationship between the day of the week patients are hospitalized for HF and death rate, length of stay (LOS), and rehospitalization rate. A total of 259 US hospitals participating in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) submitted data on 48 612 patients with HF. Sixty- to 90-day postdischarge follow-up data were collected prospectively in a prespecified 10% sample. We analyzed day of admission and discharge, demographic, medical history, medication use, laboratory, and in-hospital procedure data for their association with hospital LOS and death rate. Patient characteristics were similar for weekday and weekend presentation. LOS was a median of 4.0 days and a mean of 5.7+/-5.7 days; in-hospital death ra...
Cardiac resynchronization therapy with defibrillator (CRT-D) reduces morbidity and mortality amon... more Cardiac resynchronization therapy with defibrillator (CRT-D) reduces morbidity and mortality among selected patients with heart failure in clinical trials. The effectiveness of this therapy in clinical practice has not been well studied. We compared a cohort of 4471 patients from the National Cardiovascular Data Registry's Implantable Cardioverter-Defibrillator (ICD) Registry hospitalized primarily for heart failure and who received CRT-D between April 1, 2006, and December 31, 2009, to a historical control cohort of 4888 patients with heart failure without CRT-D from the Acute Decompensated Heart Failure National Registry (ADHERE) hospitalized between January 1, 2002, and March 31, 2006. Both registries were linked with Medicare claims to evaluate longitudinal outcomes. We included patients from the ICD Registry with left ventricular ejection fraction ≤35% and QRS duration ≥120 ms who were admitted for heart failure. We used Cox proportional hazards models to compare outcomes w...
Heart failure (HF) afflicts nearly 6 million Americans, resulting in one million emergency depart... more Heart failure (HF) afflicts nearly 6 million Americans, resulting in one million emergency department (ED) visits and over one million annual hospital discharges. An aging population and improved survival from cardiovascular diseases is expected to further increase HF prevalence. Emergency providers play a significant role in the management of patients with acute heart failure (AHF). It is crucial that emergency physicians and other providers involved in early management understand the latest developments in diagnostic testing, therapeutics and alternatives to hospitalization. Further, clinical trials must be conducted in the ED in order to improve the evidence base and drive optimal initial therapy for AHF. Should ongoing and future studies suggest early phenotype-driven therapy improves in-hospital and post-discharge outcomes, ED treatment decisions will need to evolve accordingly. The potential impact of future studies which incorporate risk-stratification into ED disposition dec...
In 2009, the Get With The Guidelines-Heart Failure program enhanced the standard recognition of h... more In 2009, the Get With The Guidelines-Heart Failure program enhanced the standard recognition of hospitals by offering additional recognition if hospitals performed well on certain quality measures. We sought to determine whether initiation of this enhanced recognition opportunity led to acceleration in quality of care for all hospitals participating in the program. We examined hospital-level performance on 9 quality-of-care (process) measures that were added to an existing recognition program (based on existing published performance measures). The rate of increase in use over time 6 months to 2 years after the start of the program was compared with the rate of increase in use for the measures during the 18-month period prior to the start of the program. Use increased for all 9 new quality measures from 2008 to 2011. Among 4 measures with baseline use near or lower than 50%, a statistically significant greater increase in use during the program was seen for implantable cardioverter d...
Background The use of parenteral positive inotropic agents still remains a major component of the... more Background The use of parenteral positive inotropic agents still remains a major component of therapy for patients with advanced decompensated congestive heart failure (CHF). However, no consensus guidelines have been developed for the appropriate selection of a first-line inotropic therapy. We sought to compare the clinical outcome and economic cost of dobutamine-based and milrinone-based therapy in patients with acute exacerbation
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Papers by Nancy Albert