Partnerships for Blood Pressure Control in Washington State, December 2016-July 2017.

According to recent guidelines, 46% of U.S. adults have high blood pressure (i.e., hypertension). Traditionally addressed in clinical settings, only 54% of adults successfully manage their hypertension. Community-clinical partnerships that facilitate medication adherence and lifestyle changes are promising avenues to achieve population-level blood pressure control. We examined partnerships for blood pressure control in Washington State, their facilitators and barriers, and ways public health departments could foster partnerships. We conducted 41 semistructured interviews with clinic staff, community-based organization (CBO) staff, pharmacy staff, and community health workers (CHWs). The Centers for Disease Control and Prevention-adapted Himmelman Collaboration Continuum, which describes five levels of partnership intensity, guided our thematic analysis. We found variation across sectors in partnership frequency and intensity. Clinic and pharmacy staff reported fewer partnerships than CBO staff and CHWs, and mostly either low or very high intensity partnerships. CBO staff and CHWs described partnerships at each intensity level. Trust and having a shared mission facilitated partnerships. Competition, lack of time, limited awareness of resources, and lack of shared health records constituted barriers to partnership. Bringing potential partners together to discuss shared goals, increasing technological integration, and building awareness of resources may help bridge clinical and community silos and improve population-level blood pressure control.

Use of disease-modifying therapies in patients hospitalized with heart failure: a population-based perspective.

BACKGROUND: Little data are available about the hospital management of patients with decompensated heart failure (HF) with individual and combination medical therapies, particularly from the more generalizable perspective of a population-based investigation. The purpose of our study was to describe the use of different cardiac medications in 2463 patients with new-onset HF who were discharged from all greater Worcester, Massachusetts, hospitals during 2000. METHODS: On the basis of a review of medical records, we examined the prescribing of 2 classes of cardiac medications that have been shown to improve the long-term prognosis of patients with HF (angiotensin pathway inhibitors and beta-blockers). We also examined the use of 2 therapies commonly used to improve the symptomatic status of patients with acute HF (diuretics and digoxin). RESULTS: The mean age of the study sample was 76 years, and 57% were women. Approximately 1 in 5 patients were not prescribed beta-blockers or angiotensin inhibitors during their index hospitalization, whereas 1 in 3 patients were discharged with both of these effective cardiac medications. Diuretics were prescribed for virtually all patients (98%), followed by the use of digoxin in approximately half of patients (48%). The receipt of both beta-blockers and angiotensin pathway inhibitors was associated with several demographic, medical history, and clinical factors. Patients treated with both effective cardiac medications were also more likely to be counseled to monitor or modify several lifestyle factors that have been shown to be effective adjuncts to the medical management of patients with HF. CONCLUSIONS: Considerable opportunity remains for the more optimal hospital management of patients with decompensated HF.

Use of nonpharmacologic treatment approaches in patients with heart failure.

BACKGROUND: Patient education has been shown to beneficially impact the utilization of medical resources and certain outcomes in patients hospitalized with heart failure (HF). Little data are, however, available about the implementation of patient education and counseling of patients with HF in the community setting. The purpose of the present investigation was to examine the extent of health care provider recommendations for the monitoring or modification of lifestyle approaches or dietary factors in patients with new onset HF discharged from all greater Worcester (MA) hospitals in 2000. METHODS: The study sample consisted of 2411 metropolitan Worcester residents hospitalized at all 11 area medical centers with acute HF. Based on the review of medical records, we examined provider recommendations for the monitoring or modification of 5 lifestyle factors including salt restriction, dietary changes, increased physical activity, limitation of fluids, and daily monitoring of weight in hospital survivors of HF. RESULTS: Among all patients, approximately 22% were recommended to change either no or 1 lifestyle related factor, 2 in every 5 patients received recommendations to alter any 2 lifestyle characteristics, while 1 in 6 were counseled about the importance of monitoring or modifying 4 or more lifestyle or dietary factors. Physician counseling was associated with several demographic and clinical factors. Documentation of none or few patient education recommendations was also associated with the failure to receive multiple effective medical therapies for HF. CONCLUSIONS: The results of our community-wide investigation suggest that considerable opportunity remains for the more effective hospital counseling of patients with acute HF.

Incidence and hospital death rates associated with heart failure: a community-wide perspective.

PURPOSE: Despite often stated references to the emerging epidemic of heart failure in the United States, relatively little data are available describing the incidence and short-term death rates associated with this clinical syndrome. The objectives of this study were to describe the hospital incidence and death rates associated with acute heart failure and factors associated with an adverse hospital prognosis in residents of the Worcester, Mass, metropolitan area hospitalized at all greater Worcester medical centers with new onset heart failure in 2000. SUBJECTS AND METHODS: We reviewed the medical records of patients hospitalized for acute heart failure at all 11 area medical centers during 2000. New onset heart failure was diagnosed using standardized criteria. Regression analyses were performed to examine demographic and clinical factors associated with hospital death rates. RESULTS: During 2000, 2604 men and women from greater Worcester were diagnosed with new onset heart failure; 637 (24.5%) of these cases were initial events. The incidence and attack rates (per 100,000) of heart failure were 219 and 897, respectively. Occurrence of heart failure increased with advancing age, and women were at greater risk for heart failure than men (incidence rates [per 100,000] = 250 and 194, respectively). Hospital case-fatality rates were 5.1%. Hospital death rates were associated with several demographic and clinical characteristics. CONCLUSIONS: The results of this study suggest that heart failure is an important clinical syndrome affecting residents of this large northeast community. Several groups at high risk for developing or dying from heart failure can be identified and targeted for preventive efforts as well as for the receipt of effective treatment modalities.

Trends in mortality attributed to heart failure in Worcester, Massachusetts, 1992 to 2001.

Sparse data are available, particularly from the more generalizable perspective of a population-based investigation, that describe recent trends in community death rates due to heart failure (HF). The objectives of this study were to describe a decade-long trend (1992 to 2001) in mortality attributed to HF among residents of the metropolitan area of Worcester, Massachusetts. A secondary study goal was to describe changes in death rates due to HF in men and in women, in subjects of different ages, and according to location of death. Death data tapes were obtained from the Massachusetts Department of Public Health for greater Worcester residents who died between 1992 and 2001. A total of 2,677 deaths from HF occurred in metropolitan Worcester residents between 1992 and 2001. Increases in crude death rates (per 100,000 population) attributed to HF were observed from 1992 (death rate 82) to 2001 (death rate 102). Adjustment for age attenuated the increase in community death rates due to HF. Slight increases in age-adjusted death rates from HF were noted in men, whereas age-adjusted mortality from HF in women decreased by 22% between our initial study year and the most recent study year. The elderly were at greatest risk for dying of HF and increases in HF death rates were observed in the oldest subjects (>/=85 years of age) over time. There was an increasing proportion of all deaths due to HF that occurred in the out-of-hospital setting in 2001 (61%) compared with 1992 (52%). The results of this study suggest changing patterns in death rates due to HF in a large northeastern community.