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Heart Failure VI: Adjunct Therapies01:22

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Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
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Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
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Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
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Permanent Supportive Housing and Cardiovascular Outcomes Among Veterans Experiencing Homelessness: A

Sameed Ahmed M Khatana1,2,3,4, Jingyi Wu5,6, Peter W Groeneveld5,7,8,9

  • 1Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. sameed.khatana@pennmedicine.upenn.edu.

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Veterans experiencing homelessness with cardiovascular disease (CVD) who received permanent supportive housing (PSH) through the HUD-VASH program showed a significant reduction in emergency department visits and hospitalizations. This highlights the effectiveness of PSH in managing chronic CVD in this vulnerable population.

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Area of Science:

  • Public Health
  • Cardiovascular Medicine
  • Health Services Research

Background:

  • Homeless veterans face a high prevalence of cardiovascular disease (CVD).
  • Effective interventions are needed to improve health outcomes for this population.
  • The Department of Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program offers permanent supportive housing (PSH).

Purpose of the Study:

  • To investigate the association between obtaining PSH via HUD-VASH and changes in health outcomes.
  • Specifically examining outcomes among homeless Veterans with CVD.

Main Methods:

  • A difference-in-differences (DID) approach was employed.
  • Compared outcomes for Veterans receiving a HUD-VASH voucher and entering PSH within one month (early group) versus those remaining unhoused for at least six months (delayed group).
  • Participants were Veterans aged 18+ with diagnosed CVD, experiencing homelessness for ≥6 months, who received a HUD-VASH voucher between 2016-2019.

Main Results:

  • The study included 970 Veterans with CVD experiencing homelessness (845 early PSH group, 125 delayed PSH group).
  • A significant decrease in the 6-month probability of cardiovascular emergency department visits or hospitalizations was observed in the early PSH group (16.3% to 11.9%).
  • No statistically significant change was found in the delayed PSH group (13.4% to 18.1%), with a DID estimate of -9.1 percentage points (p=0.04).

Conclusions:

  • Obtaining permanent supportive housing through the HUD-VASH program is linked to a significant reduction in CVD-related emergency care.
  • This suggests PSH is a valuable strategy for managing chronic cardiovascular conditions in homeless Veterans.