The investigator, Paul J. Hauptman MD, proposes a program of research focused on congestive heart failure in its advanced stages. This is a disease of increasing prevalence, especially in the elderly, accounting for high morbidity and mortality. However, little is known about actual and self-reported practice. The research program is in two complementary parts. ? ? The first is designed to examine the use of chronic continuous outpatient intravenous infusions of inotropic drugs, a therapy associated with high costs, unproven clinical efficacy and the potential to shorten survival while achieving palliation. The investigator will use administrative and clinical data from several Medicare databases including the records of a Durable Medical Equipment carrier encompassing a 17-state region and Medicare Provider Analysis and Review (MedPAR), Carrier, Denominator and Hospice Analytical Files for the period 1997-2000. Specifically, the population of older Medicare beneficiaries receiving, and the physicians prescribing, this therapy will be described and contrasted with the demographics and outcomes of older patients hospitalized for heart failure but not receiving the drugs. The data will be used to develop predictors of inotropic agent use and mortality in this group at risk for re-admission and death. ? ? The second part is designed to assess physicians' knowledge about, attitudes toward and practices regarding the care of end-stage heart failure patients including perceptions of patient prognosis, quality of life, efficacy/toxicities of inotropic drugs and the role for hospice in a survey of 1200 cardiologists, geriatricians, internists and family/general practitioners. Approximately one-third of the physicians will be known prescribers of inotropic drugs. We plan to investigate how physicians make decisions and the degree to which the care an end-stage patient receives is influenced by physician specialty, volume, or other factors. Formal survey development methodology including performance of focus groups, cognitive interviews, and pilot testing will be applied. These studies will form the conceptual framework for an intervention study designed to address, at physician and patient levels, the process of selection of care options for older heart failure patients near the end of life. ? ? ?
|Swindle, Jason P; Rich, Michael W; McCann, Patrick et al. (2010) Implantable cardiac device procedures in older patients: use and in-hospital outcomes. Arch Intern Med 170:631-7|
|Swindle, Jason; Burroughs, Thomas E; Schnitzler, Mark A et al. (2008) Short-term mortality and cost associated with cardiac device implantation in patients hospitalized with heart failure. Am Heart J 156:322-8|
|Hauptman, Paul J; Swindle, Jason; Burroughs, Thomas E et al. (2008) Resource utilization in patients hospitalized with heart failure: insights from a contemporary national hospital database. Am Heart J 155:978-985.e1|
|Hauptman, Paul J; Swindle, Jason; Hussain, Zainal et al. (2008) Physician attitudes toward end-stage heart failure: a national survey. Am J Med 121:127-35|
|Hauptman, Paul J; Schnitzler, Mark A; Swindle, Jason et al. (2006) Use of nesiritide before and after publications suggesting drug-related risks in patients with acute decompensated heart failure. JAMA 296:1877-84|