Mayo Clinic proceedings
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Mayo Clinic proceedings · May 2014
ReviewContemporary strategies in the diagnosis and management of heart failure.
Heart failure (HF) is an important public health problem, and strategies are needed to improve outcomes and decrease health care resource utilization and costs. Its prevalence has increased as the population ages, and HF continues to be associated with a high mortality rate and frequent need for hospitalization. The total cost of care for patients with HF was $30.7 billion in 2012, and it is estimated to more than double to $69.8 billion by 2030. ⋯ We are in the midst of a rapid evolution in our ability to care for patients with end-stage HF (stage D) because of the introduction of and improvements in mechanical circulatory support. Left ventricular assist devices used as destination therapy offer an important therapeutic option to patients who do not qualify for heart transplant because of advanced age or excessive comorbidity. This review provides a thorough update on contemporary strategies in the diagnosis and management of HF by stage (A to D) that have emerged during the past several years.
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Mayo Clinic proceedings · May 2014
Serum polyclonal immunoglobulin free light chain levels predict mortality in people with chronic kidney disease.
To determine whether elevated serum polyclonal free light chain (FLC) levels predict mortality in a population of individuals with chronic kidney disease (CKD). ⋯ High cFLC levels independently predict mortality in people with CKD.
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Mayo Clinic proceedings · May 2014
ReviewClinician's checklist for reading and using an article about patient-reported outcomes.
Clinicians need evidence-based medicine to help them make clinical decisions with their patients. For many health problems, the goal of treatment is to help the patient to function and feel better. To measure patient functioning, well-being, and symptoms, questionnaires referred to as patient-reported outcome (PRO) measures are often used. ⋯ Patient-reported outcomes play an increasingly prominent role in clinical research and practice, and this trend has the potential to improve the patient-centeredness of care. Clinicians will need to understand how to use PROs to partner with patients and help them function and feel better. The proposed Clinician's Checklist can help clinicians systematically evaluate PRO studies by determining whether the study design was appropriate and whether the measurement approach was adequate and properly executed as well as by assisting in the interpretation and application of the results to a specific patient population.
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Mayo Clinic proceedings · May 2014
Impact of prior admissions on 30-day readmissions in medicare heart failure inpatients.
To determine how all-cause hospitalizations within 12 months preceding an index heart failure (HF) hospitalization affect risk stratification for 30-day all-cause readmission. ⋯ In Medicare inpatients with HF, prior all-cause admissions strongly increase all-cause readmission risk and markedly improve risk stratification for 30-day readmission.
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Mayo Clinic proceedings · May 2014
Predicting 1-year mortality rate for patients admitted with an acute exacerbation of chronic obstructive pulmonary disease to an intensive care unit: an opportunity for palliative care.
The objective of this study was to develop a model to aid clinicians in better predicting 1-year mortality rate for patients with an acute exacerbation of chronic obstructive pulmonary disease admitted to the medical intensive care unit (ICU) with the goal of earlier initiation of palliative care and end-of-life communications in this patient population. This retrospective cohort study included patients from a medical ICU from April 1, 1995, to November 30, 2009. Data collected from the Acute Physiology and Chronic Health Evaluation III database included demographic characteristics; severity of illness scores; noninvasive and invasive mechanical ventilation time; ICU and hospital length of stay; and ICU, hospital, and 1-year mortality. ⋯ Age and hospital length of stay were identified as independent determinants of mortality at 1 year by using multivariate analysis, and the predictive model developed had an area under the operating curve of 0.68. Bootstrap analysis with 1000 iterations validated the model, age, and hospital length of stay, entered the model 100% of the time (area under the operating curve=0.687; 95% CI, 0.686-0.688). A simple model using age and hospital length of stay may be informative for providers willing to identify patients with chronic obstructive pulmonary disease with high 1-year mortality rate who may benefit from end-of-life communications and from palliative care.