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      Physiological monitoring in the complex multimorbid heart failure patient - Conclusions

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          Abstract

          Comorbidities are increasingly recognized as crucial components of the heart failure syndrome. Main specific challenges are polypharmacy, poor adherence to treatments, psychological aspects, and the need of monitoring after discharge. The chronic multimorbid patient therefore represents a specific heart failure phenotype that needs an appropriate and continuous management over time. This supplement issue covers the key points of a series of meeting coordinated by the Heart Failure Association of the European Society of Cardiology (ESC), that have discussed the issues surrounding the effective monitoring of our ever more complex and multimorbid heart failure patients. Here, we present an overview of the complex issues from a healthcare delivery perspective.

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          Most cited references26

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          Physicians' guideline adherence is associated with better prognosis in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry

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            Trends in comorbidity, disability, and polypharmacy in heart failure.

            Comorbidity, disability, and polypharmacy commonly complicate the care of patients with heart failure. These factors can change biological response to therapy, reduce patient ability to adhere to recommendations, and alter patient preference for treatment and outcome. Yet, a comprehensive understanding of the complexity of patients with heart failure is lacking. Our objective was to assess trends in demographics, comorbidity, physical function, and medication use in a nationally representative, community-based heart failure population. Using data from the National Health and Nutrition Examination Survey, we analyzed trends across 3 survey periods (1988-1994, 1999-2002, 2003-2008). We identified 1395 participants with self-reported heart failure (n=581 in 1988-1994, n=280 in 1999-2002, n=534 in 2003-2008). The proportion of patients with heart failure who were ≥80 years old increased from 13.3% in 1988-1994 to 22.4% in 2003-2008 (P <.01). The proportion of patients with heart failure who had 5 or more comorbid chronic conditions increased from 42.1% to 58.0% (P <.01). The mean number of prescription medications increased from 4.1 to 6.4 prescriptions (P <.01). The prevalence of disability did not increase but was substantial across all years. The phenotype of patients with heart failure changed substantially over the last 2 decades. Most notably, more recent patients have a higher percentage of very old individuals, and the number of comorbidities and medications increased markedly. Functional disability is prevalent, although it has not changed. These changes suggest a need for new research and practice strategies that accommodate the increasing complexity of this population. Copyright © 2011 Elsevier Inc. All rights reserved.
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              Impact of medication nonadherence on hospitalizations and mortality in heart failure.

              Limited literature exists on the association between medication adherence and outcomes among patients with heart failure. We conducted a retrospective longitudinal cohort study of 557 patients with heart failure with reduced ejection fraction (HFrEF) (defined by EF <50%) in a large health maintenance organization. We used multivariable Cox proportional hazards models to assess the relationship between adherence (with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, β-blockers, and aldosterone antagonists) and the primary outcome of all-cause mortality plus cardiovascular hospitalizations. Mean follow-up time was 1.1 years. Nonadherence (defined as <80% adherence) was associated with a statistically significant increase in the primary outcome in the cohort overall (hazard ratio 2.07, 95% confidence interval 1.62-2.64; P < .0001). This association remained significant when all 3 classes of heart failure medications and the components of the composite end point were considered separately and when the adherence threshold was varied to 70% or 90%. Medication nonadherence was associated with an increased risk of all-cause mortality and cardiovascular hospitalizations in a community heart failure population. Further research is needed to define systems of care that optimize adherence among patients with heart failure. Copyright © 2011 Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Eur Heart J Suppl
                Eur Heart J Suppl
                ehjsupp
                European Heart Journal Supplements : Journal of the European Society of Cardiology
                Oxford University Press
                1520-765X
                1554-2815
                December 2019
                31 December 2019
                31 December 2019
                : 21
                : Suppl M , Physiological Monitoring of the Complex Multi-morbid Heart Failure Patient
                : M68-M71
                Affiliations
                [1 ] Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg/Saar, Germany
                [2 ] Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana , Via della Pisana 235, 00163 Rome, Italy
                Author notes
                Corresponding author. Tel: +49 6841 16 15031, Fax: +49 6841 16 15032, Email: michael.boehm@ 123456uks.eu
                Article
                suz232
                10.1093/eurheartj/suz232
                6937511
                31908622
                766d38ef-f199-40a5-b038-a9b4cee8b7b4
                Published on behalf of the European Society of Cardiology. © The Author(s) 2019.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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                Page count
                Pages: 4
                Categories
                Articles

                heart failure,adherence,healthcare systems,physiology
                heart failure, adherence, healthcare systems, physiology

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