Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morb...Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdiscipli-nary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic in-sight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.展开更多
Objective:This study aimed to determine the availability of community health management services and the relevant social determinants for elderly patients with chronic diseases.Methods:All data were obtained from the ...Objective:This study aimed to determine the availability of community health management services and the relevant social determinants for elderly patients with chronic diseases.Methods:All data were obtained from the 2013 random sampling household survey on an elderly population conducted by the School of Public Health of Peking University in an eastern metropolis in China.Information from the database of the above survey involving 1495 hypertensive or diabetic patients>60 years of age,as representatives of the city,were included.The study described the availability of follow-up services by community doctors among elderly hypertensive and diabetic patients during the 12 months before the survey.An ordinal multinomial logistic regression model was used to conduct the analysis on the influence of socio-economic background upon such availability.Results:Eighty-one percent of hypertensive patients and 84.7%of diabetic patients had not received any follow-up service from community doctors within 12 months prior to the survey.Among elderly hypertensive patients,those registered as non-agricultural household members,those with high and above-average income,as well as management personnel of government agencies,enterprises,and social programs have a greater chance of accepting follow-up service by community doctors because of their relatively higher socio-economic rankings.Among elderly diabetic patients,such socio-economic factors had no significant influence on the availability of the follow-up service for chronic diseases.Conclusion:The coverage of community health management services for elderly hypertensive and diabetic patients needs improvement.More effort should focus on promoting the availability of community health management services for elderly hypertensive patients,especially those with lower socio-economic status.展开更多
为探讨全科医生签约服务对高血压患者管理效果的作用,分层抽样抽取240名原发性高血压患者为签约组,另240名患者为对照组,签约服务前及1年后分别进行问卷调查,记录相关临床指标并进行分析.结果显示,较干预前,干预后签约组高血压患者收缩...为探讨全科医生签约服务对高血压患者管理效果的作用,分层抽样抽取240名原发性高血压患者为签约组,另240名患者为对照组,签约服务前及1年后分别进行问卷调查,记录相关临床指标并进行分析.结果显示,较干预前,干预后签约组高血压患者收缩压明显下降[134.60 mm Hg（1 mm Hg=0.133 kPa）比130.62 mm Hg],血压达标率明显提高（85.5％比56.3％）,血清总胆固醇、甘油三酯明显降低；干预后签约组与对照组血脂比较差异也有统计学意义,均P ＜0.05.提示全科医生签约服务有利于社区高血压管理效果的提高.展开更多
文摘Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdiscipli-nary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic in-sight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.
文摘Objective:This study aimed to determine the availability of community health management services and the relevant social determinants for elderly patients with chronic diseases.Methods:All data were obtained from the 2013 random sampling household survey on an elderly population conducted by the School of Public Health of Peking University in an eastern metropolis in China.Information from the database of the above survey involving 1495 hypertensive or diabetic patients>60 years of age,as representatives of the city,were included.The study described the availability of follow-up services by community doctors among elderly hypertensive and diabetic patients during the 12 months before the survey.An ordinal multinomial logistic regression model was used to conduct the analysis on the influence of socio-economic background upon such availability.Results:Eighty-one percent of hypertensive patients and 84.7%of diabetic patients had not received any follow-up service from community doctors within 12 months prior to the survey.Among elderly hypertensive patients,those registered as non-agricultural household members,those with high and above-average income,as well as management personnel of government agencies,enterprises,and social programs have a greater chance of accepting follow-up service by community doctors because of their relatively higher socio-economic rankings.Among elderly diabetic patients,such socio-economic factors had no significant influence on the availability of the follow-up service for chronic diseases.Conclusion:The coverage of community health management services for elderly hypertensive and diabetic patients needs improvement.More effort should focus on promoting the availability of community health management services for elderly hypertensive patients,especially those with lower socio-economic status.
文摘为探讨全科医生签约服务对高血压患者管理效果的作用,分层抽样抽取240名原发性高血压患者为签约组,另240名患者为对照组,签约服务前及1年后分别进行问卷调查,记录相关临床指标并进行分析.结果显示,较干预前,干预后签约组高血压患者收缩压明显下降[134.60 mm Hg（1 mm Hg=0.133 kPa）比130.62 mm Hg],血压达标率明显提高（85.5％比56.3％）,血清总胆固醇、甘油三酯明显降低；干预后签约组与对照组血脂比较差异也有统计学意义,均P ＜0.05.提示全科医生签约服务有利于社区高血压管理效果的提高.
