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Compassionate Allowances Outreach Hearing Cardiovascular Disease &
Compassionate Allowances Outreach Hearing Cardiovascular Disease &
Cardiovascular Disease
Cardiovascular Disease
Social Security Disability
Social Security Disability
Heart Failure
Heart Failure
HF: Highest 30-day Rehospitalization Rate
HF: Highest 30-day Rehospitalization Rate
Outcomes in Patients Hospitalized with HF
Outcomes in Patients Hospitalized with HF
Causes of Hospital Readmission for CHF
Causes of Hospital Readmission for CHF
Heart Failure Symptoms
Heart Failure Symptoms
Evaluating Heart Failure Status
Evaluating Heart Failure Status
HF: Compassionate Allowances
HF: Compassionate Allowances
Congenital Cardiovascular Disease
Congenital Cardiovascular Disease
Impact of Congenital Heart Disease
Impact of Congenital Heart Disease
Symptomatic Progression for Adults with Congenital Heart Disease
Symptomatic Progression for Adults with Congenital Heart Disease
Heart Transplantation
Heart Transplantation
Heart Transplantation
Heart Transplantation
Heart Transplantation Issues
Heart Transplantation Issues
The Disability Process
The Disability Process
The Disability Process
The Disability Process
AHA Recommendations
AHA Recommendations
AHA Recommendations: Compassionate Allowances List
AHA Recommendations: Compassionate Allowances List
AHA Recommendations: Compassionate Allowances List
AHA Recommendations: Compassionate Allowances List
AHA Recommendations: Compassionate Allowances List
AHA Recommendations: Compassionate Allowances List
AHA Recommendations: Compassionate Allowances List
AHA Recommendations: Compassionate Allowances List
AHA Recommendations: Compassionate Allowances List
AHA Recommendations: Compassionate Allowances List
Thank You Questions
Thank You Questions

Презентация: «Compassionate Allowances Outreach Hearing Cardiovascular Disease Multiple Organ Transplants». Автор: David Brentz, Design and Media Services, Nat'l Ctr. Файл: «Compassionate Allowances Outreach Hearing Cardiovascular Disease Multiple Organ Transplants.ppt». Размер zip-архива: 375 КБ.

Compassionate Allowances Outreach Hearing Cardiovascular Disease Multiple Organ Transplants

содержание презентации «Compassionate Allowances Outreach Hearing Cardiovascular Disease Multiple Organ Transplants.ppt»
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1 Compassionate Allowances Outreach Hearing Cardiovascular Disease &

Compassionate Allowances Outreach Hearing Cardiovascular Disease &

Multiple Organ Transplants Social Security Administration November 9, 2010

Ileana Pi?a, MD, MPH American Heart Association

2 Cardiovascular Disease

Cardiovascular Disease

81 million American adults – more than 1 in 3 – have one or more types of CVD # 1 killer of Americans – including women Includes high blood pressure, coronary heart disease, heart failure, stroke, and congenital cardiovascular defects

3 Social Security Disability

Social Security Disability

CVD can affect ability to work, comply with medical care, engage in activities of daily living Complex process; application denied or require multiple applications 24-month waiting period for Medicare CVD events may occur before eligibility (hospitalizations or death)

4 Heart Failure

Heart Failure

Often the final pathway of a multitude of heart disorders Affects 5.8 million Americans Chronic and progressive Affects children and adults One of the worst sequelae of any heart disease Many hospitalizations and high mortality Cannot be cured

5 HF: Highest 30-day Rehospitalization Rate

HF: Highest 30-day Rehospitalization Rate

Jencks et al. N Engl J Med 2009;360:1418-28.

6 Outcomes in Patients Hospitalized with HF

Outcomes in Patients Hospitalized with HF

Mortality

Hospital Readmissions

50%

50%

33%

20%

12%

6 Months

30 Days

30 Days

12 Months

5 Years

100

100

75

75

50

50

25

25

0

0

Mean LOS: 6.5 days

Annual mortality rate- NYHA class III HF- 12% [COPERNICUS DATA] NYHA class II HF- 7% [SCD-HeFT DATA]

Fonarow, GC. Rev Cardiovasc Med. 2002;3(suppl 4):S3 Jong P et al. Arch Intern Med. 2002;162:1689

7 Causes of Hospital Readmission for CHF

Causes of Hospital Readmission for CHF

Over 2/3 of HF Hospitalizations Preventable

Diet Noncompliance 24%

Rx Noncompliance 24%

16% Inappropriate Rx

17% Other

19% Failure to Seek Care

Post d/c monitoring

Annals of Internal Medicine 122:415-21, 1995

8 Heart Failure Symptoms

Heart Failure Symptoms

Shortness of breath Swelling in feet, ankles, legs, or abdomen Weight gain Tiredness, fatigue Persistent coughing or wheezing Lack of appetite or nausea Confused or impaired thinking Symptoms may be present even at rest

9 Evaluating Heart Failure Status

Evaluating Heart Failure Status

LV Function Non-invasive imaging (MRI, Transthoracic Echo, Doppler) Cardiac catheterization BNP and NT-Pro-BNP Predictive of mortality; CV events; overall prognosis Highly variable; lacks specificity; false positives Functional Capacity Most accurate is cardiopulmonary exercise testing 6 minute walk to determine function of sicker patients Prognosis for Improvement No reliable scales or measures

10 HF: Compassionate Allowances

HF: Compassionate Allowances

With medical therapy: 6-min walk distance less than 309 feet VO2 max less than 50% of predicted Or are dependent upon inotrope therapy or mechanical support Cardiac rehab may not available or not covered Extremely high risk of mortality Should be considered for Compassionate Allowances List

11 Congenital Cardiovascular Disease

Congenital Cardiovascular Disease

9 out of every 1,000 births Severe malformations – complete absence of one or more chambers (hypoplastic left heart syndrome, single ventricle) or valves (aortic, tricuspid or pulmonary atresia) Increases the risk of pulmonary hypertension, arrhythmias, infective endocarditis, congestive heart failure, and the need for anticoagulants

12 Impact of Congenital Heart Disease

Impact of Congenital Heart Disease

Severe functional limitations Highly specialized care required; frequent office visits and hospitalization; complicated medicine regimens Often full-time care giver support Developmental delays or learning difficulties Adults may not be able to work

13 Symptomatic Progression for Adults with Congenital Heart Disease

Symptomatic Progression for Adults with Congenital Heart Disease

Variable Worst Prognosis: single ventricle or systemic right ventricle Frequently develop HF as adults

14 Heart Transplantation

Heart Transplantation

Waiting for a heart transplant: Have advanced heart failure and a poor prognosis Those most likely to be offered a heart have a 50% 1-year mortality Most are unable to drive and require transportation; usually cannot work May have constant infusion of an intravenous drug

15 Heart Transplantation

Heart Transplantation

Waiting for a heart transplant: 20 - 25% of children do not receive an organ in time due to severity of illness and donor scarcity Reasons for transplants in children are age-dependent: Birth – 1 year: congenital 1 – 10 years: congenital and cardiomyopathy

16 Heart Transplantation Issues

Heart Transplantation Issues

VAD – bridge to transplant – wound care and battery change assistance Rejection, immunosuppression, co-morbidities and malignancies Impaired exercise capacity Cardiac rehab may not available Medication side effects (muscle weakness; drug induced diabetes, obesity, and high blood pressure)

17 The Disability Process

The Disability Process

Severe CVD can result in: Major life changes: physical, financial, professional, social, emotional, and psychological Mobility and stamina challenges Inability to work; career-ending; lack of income Increasing dependence on others for care

18 The Disability Process

The Disability Process

Hurdles applying for disability benefits: Confusing and lengthy process Denials and reapplications common 2-year wait until eligible for Medicare Rehabilitation not readily available Patients are very ill, helpless on many levels Timely assistance is critical

19 AHA Recommendations

AHA Recommendations

Reduce the time between submission of disability application and approval of benefits Offer temporary disability benefits for those with severe CVD until a complete review is completed Reduce the 24-month Medicare waiting period

20 AHA Recommendations: Compassionate Allowances List

AHA Recommendations: Compassionate Allowances List

Advanced HF patients who are candidates for LVAD or heart transplant Adults with CVD and class IV symptoms and cyanotic adult congenital heart disease where transplant is the only option Class IV symptoms with intractable primary pulmonary hypertension where lung transplantation is the only hope

21 AHA Recommendations: Compassionate Allowances List

AHA Recommendations: Compassionate Allowances List

Class IV disease where a treatment option exists, (hypertrophic cardiomyopathy [surgery], sarcoid heart disease, amyloidosis, [? immunosuppression], prolonged QT interval with SCD [implanted defibrillator], etc.) HF patients with a 6-min walk distance less than 309 feet, VO2 max less than 50% of predicted, or are dependent upon inotrope therapy or mechanical support

22 AHA Recommendations: Compassionate Allowances List

AHA Recommendations: Compassionate Allowances List

Fulminant giant cell myocarditis in which urgent intervention is required Lymphomatous invasion of the heart Congenital heart disease with Eisenmenger physiology and pulmonary vascular disease Congenital heart disease and NYHA Class 4 symptoms

23 AHA Recommendations: Compassionate Allowances List

AHA Recommendations: Compassionate Allowances List

Congenital heart disease and severe cyanosis (tetralogy of Fallot, transposition of the great arteries, tricuspid atresia, pulmonary atresia, truncus arteriosus and total anomalous pulmonary venous connection) Congenital heart disease after Fontan palliative surgery and protein losing enteropathy Congenital heart disease after Fontan with systolic or diastolic dysfunction

24 AHA Recommendations: Compassionate Allowances List

AHA Recommendations: Compassionate Allowances List

Transposition of the great vessels after Mustard procedure and RV dysfunction Hypoplastic left heart syndrome Valvular atresia – aortic, tricuspid, pulmonary valve Single ventricle patients with congestive heart failure Childhood myocardial infarction

25 Thank You Questions

Thank You Questions

American Heart Association www.heart.org

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