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Sankaranarayanan R, Rasoul D, Murphy N, Kelly A, Nyjo S, Jackson C, O'Connor J, Almond P, Jose N, West J, Kaur R, Oguguo C, Douglas H, Lip GYH. Telehealth-aided outpatient management of acute heart failure in a specialist virtual ward compared with standard care. ESC Heart Fail 2024. [PMID: 39138875 DOI: 10.1002/ehf2.15003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 06/17/2024] [Accepted: 07/15/2024] [Indexed: 08/15/2024] Open
Abstract
AIMS The aim of this propensity score matched cohort study was to assess the outcomes of telehealth-guided outpatient management of acute heart failure (HF) in our virtual ward (HFVW) compared with hospitalized acute HF patients. METHODS AND RESULTS This cohort study (May 2022-October 2023) assessed outcomes of telehealth-guided outpatient acute HF management using bolus intravenous furosemide in a HF-specialist VW. Propensity score matching (PSM) was performed using logistic regression to adjust for potential differences in baseline patient characteristics between HFVW and standard care [Get With The Guidelines-HF score, clinical frailty score (CFS), Charlson co-morbidity index (CCI), NT-proBNP, and ejection fraction]. Clinical outcomes (re-hospitalizations and mortality) were compared at 1, 3, 6, and 12 months versus standard care-SC (acute HF patients managed without telehealth in 2021). Five hundred fifty-four HFVW ADHF patients (age 73.1 ± 10.9 years; 46% female) were compared with 404 ADHF patients (74.2 ± 11.8; P = 0.15 and 49% female) in the standard care-SC cohort. After propensity score matching for baseline patient characteristics, re-hospitalizations were significantly lower in the HFVW compared with SC (1 month-HFVW 8.6% vs. SC-21.5%, P < 0.001; 3 months-21% vs. 30%, P = 0.003; 6 months-28% vs 41%, P < 0.001 and 12 months-47% vs. 57%, P = 0.005) and mortality was also lower at 1 month (5% vs. 13.7%; P < 0.001), 3 months (9.5% vs. 15%; P = 0.001), 6 months (15% vs. 21%; P = 0.03), and 12 months (20% vs. 26%; P = 0.04). Multivariate logistic regression analysis showed that compared with standard care, HFVW management was associated with lower odds of readmission (1-month odds ratio (OR) = 0.3 [95% Confidence Interval CI 0.2-0.5], P < 0.0001; 3 month OR = 0.15 [0.1-0.3], P < 0.0001; 6-month OR = 0.35 [0.2-0.6], P = 0.0002; 12-month OR = 0.25 [0.15-0.4], P ≤ 0.001 and mortality (1-month OR = 0.26 [0.14-0.48], P < 0.0001; 3-month OR = 0.11 [0.04-0.27], P < 0.0001; 6-month OR = 0.35, [0.2; 0.61], P = 0.0002; 12-month OR = 0.6 [0.48; 0.73], P = 0.03. Higher GWTG-HF score independently predicted increased odds of re-hospitalization (1-month OR = 1.2 [1.1-1.3], P < 0.001; 3-month OR = 1.5 [1.37; 1.64], P < 0.0001; 6-month OR = 1.3 [1.2-1.4], P < 0.0001; 12-month OR = 1.1 [1.05-1.2], P = 0.03) as well as mortality (1-month OR = 1.21 [1.1-1.3], P < 0.0001; 3-month OR = 1.3 [1.2-1.4], P < 0.0001; 6-month OR = 1.2 [1.1-1.3], P < 0.0001; 12-month OR = 1.3 [1.1-1.7], P = 0.02). Similarly higher CFS also independently predicted increased odds of re-hospitalizations (1-month OR = 1.9 [1.5-2.4], P < 0.0001; 3-month OR = 1.8 [1.3-2.4], P = 0.0003; 6-month OR = 1.4 [1.1-1.8], P = 0.015; 12-month OR 1.9 [1.2-3], P = 0.01]) and mortality (1-month OR = 2.1 [1.6-2.8], P < 0.0001; 3-month OR = 1.8 [1.2-2.6], P = 0.006; 6-month OR = 2.34 [1.51-5.6], P = 0.0001; 12-month OR = 2.6 [1.6-7], P = 0.02). Increased daily step count while on HFVW independently predicted reduced odds of re-hospitalizations (1-month OR = 0.85[0.7-0.9], P = 0.005), 3-month OR = 0.95 [0.93-0.98], P = 0.003 and 1-month mortality (OR = 0.85 [0.7-0.95], P = 0.01), whereas CCI predicted adverse 12-month outcomes (OR = 1.2 [1.1-1.4], P = 0.03). CONCLUSIONS Telehealth-guided specialist HFVW management for ADHF may offer a safe and efficacious alternative to hospitalization in suitable patients. Daily step count in HFVW can help predict risk of short-term adverse clinical outcomes.
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Affiliation(s)
- Rajiv Sankaranarayanan
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- GIRFT (Getting It Right First Time), NHS England, London, UK
- North West Coast Cardiac Clinical Network, NHS England, London, UK
| | - Debar Rasoul
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Naomi Murphy
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
| | - AnneMarie Kelly
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
| | - Siji Nyjo
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
| | - Carolyn Jackson
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
| | - Jane O'Connor
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
| | | | - Nisha Jose
- Health Technology and Access Services, Community Services Division, Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Jenni West
- Health Innovation North West Coast, Academic Health Sciences Network, Liverpool, UK
| | - Rosie Kaur
- CCIO Medical Lead for Remote Monitoring Cheshire and Merseyside, Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Chukwemeka Oguguo
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
| | - Homeyra Douglas
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool University Hospitals NHS Foundation Trust, Aintree Hospital, Liverpool, UK
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Tunnell NC, Corner SE, Roque AD, Kroll JL, Ritz T, Meuret AE. Biobehavioral approach to distinguishing panic symptoms from medical illness. Front Psychiatry 2024; 15:1296569. [PMID: 38779550 PMCID: PMC11109415 DOI: 10.3389/fpsyt.2024.1296569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/19/2024] [Indexed: 05/25/2024] Open
Abstract
Panic disorder is a common psychiatric diagnosis characterized by acute, distressing somatic symptoms that mimic medically-relevant symptoms. As a result, individuals with panic disorder overutilize personal and healthcare resources in an attempt to diagnose and treat physical symptoms that are often medically benign. A biobehavioral perspective on these symptoms is needed that integrates psychological and medical knowledge to avoid costly treatments and prolonged suffering. This narrative review examines six common somatic symptoms of panic attacks (non-cardiac chest pain, palpitations, dyspnea, dizziness, abdominal distress, and paresthesia), identified in the literature as the most severe, prevalent, or critical for differential diagnosis in somatic illness, including long COVID. We review somatic illnesses that are commonly comorbid or produce panic-like symptoms, their relevant risk factors, characteristics that assist in distinguishing them from panic, and treatment approaches that are typical for these conditions. Additionally, this review discusses key factors, including cultural considerations, to assist healthcare professionals in differentiating benign from medically relevant symptoms in panic sufferers.
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Affiliation(s)
- Natalie C. Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Psychiatry & Behavioral Sciences, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Sarah E. Corner
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Andres D. Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Primary Care Department, Miami VA Healthcare System, Miami, FL, United States
| | - Juliet L. Kroll
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Alicia E. Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
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Ivynian SE, Ferguson C, Newton PJ, DiGiacomo M. The role of illness perceptions in delayed care-seeking in heart failure: A mixed-methods study. Int J Nurs Stud 2024; 150:104644. [PMID: 38016267 DOI: 10.1016/j.ijnurstu.2023.104644] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/30/2023] [Accepted: 11/04/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Unclear illness perceptions are common in heart failure. The self-regulation model of illness behaviour highlights factors that may impact how people with chronic illness choose to cope with or manage their condition and has been used to study pre-hospital delay for stroke and acute myocardial infarction. The principles of self-regulation can be applied in heart failure to help illuminate the link between unclear illness perceptions and sub-optimal symptom self-management. OBJECTIVE Informed by the self-regulation model of illness behaviour, this study examines the role of illness perceptions in coping responses that lead to delayed care-seeking for heart failure symptoms. DESIGN Mixed-methods phenomenological study. SETTING(S) Quaternary referral hospital - centre of excellence for cardiovascular care and heart transplantation. PARTICIPANTS Seventy-two symptomatic patients with heart failure participated in a survey assessing illness perceptions. A subset of fifteen individuals was invited to participate in semi-structured interviews. METHODS Illness perceptions were assessed using the Brief Illness Perception Questionnaire. In-depth semi-structured interviews were conducted to elicit previous care-seeking experiences and decision-making that led to a passive, or active coping response to worsening symptoms. Descriptive statistics were used to report questionnaire findings, and open-ended responses were grouped into descriptive categories. Interpretative phenomenological analysis was undertaken on interview transcripts. RESULTS Participants perceived little personal control over their condition and mostly attributed heart failure to lifestyle factors such as diet and lack of activity. Cognitive dissonance between perceived self-identity and heart failure-identity led to a highly emotional response which drove coping towards avoidance strategies and denial. CONCLUSIONS This study demonstrates the use of the principles of self-regulation in heart failure and offers a framework to understand how patient representations and emotional responses can inform behaviour in illness. Findings highlight the value of empowering patients to take control of their health and the need to help align values (e.g. independence) with behaviours (e.g. actively addressing problems) to facilitate optimal symptom self-management.
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Affiliation(s)
- Serra E Ivynian
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Australia.
| | - Caleb Ferguson
- School of Nursing, University of Wollongong and Centre for Chronic & Complex Care, Blacktown Hospital, Western Sydney Local Health District, NSW, Australia
| | - Phillip J Newton
- School of Nursing & Midwifery, University of Newcastle, Australia
| | - Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Australia
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Ploux S, Strik M, Ramirez FD, Buliard S, Chauvel R, Dos Santos P, Haïssaguerre M, Jobbé‐Duval A, Picard F, Riocreux C, Eschalier R, Bordachar P. Remote management of worsening heart failure to avoid hospitalization in a real-world setting. ESC Heart Fail 2023; 10:3637-3645. [PMID: 37797957 PMCID: PMC10682851 DOI: 10.1002/ehf2.14553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/04/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023] Open
Abstract
AIMS From a patient and health system perspective, managing worsening heart failure (WHF) as an outpatient has become a priority. Remote management allows early detection of WHF, enabling timely intervention with the aim of preventing hospitalization. The objective of the study was to evaluate the feasibility and safety of remotely managing WHF events using a multiparametric platform. METHODS AND RESULTS All patients enrolled in the heart failure remote management programme of the Bordeaux University Hospital Telemedicine Center between 1 January and 31 December 2021 were included in the study. Follow-up data were collected until 1 March 2022. Inclusion criteria were chronic heart failure (HF) with New York Heart Association ≥II symptoms and an elevated B-type natriuretic peptide (BNP > 100 pg/mL or N-terminal-pro-BNP > 1000 pg/mL). Patient assessments were performed remotely and included measurements of body weight, blood pressure, heart rate, symptoms, biochemical parameters, and data from cardiac implantable electronic devices when available. In total, 161 patients (71 ± 11 years old, 79% male) were followed for a mean of 291 ± 66 days with a mean adherence to the remote monitoring system of 80 ± 20%. Over this period, 52 (32.3%) patients had 105 WHF events, of which 66 (63%) were successfully managed remotely, the remaining requiring hospitalization. Freedom from WHF events and hospitalization at 300 days were 66% and 85%, respectively (P < 0.001 for the difference). Increased level of BNP was associated with an increased risk of WHF event [hazard ratio (HR) per unit increase in BNP: 1.001; 95% confidence interval (CI) 1-1.002; P = 0.001] and hospitalization (HR 1.002; 95% CI 1.002-1.003; P = 0.002). A decrease in the level of glomerular filtration rate was associated with an increased risk of hospitalization (HR per unit decrease in estimated glomerular filtration rate: 0.946; 95% CI 0.906-0.989; P = 0.014). WHF event recurrence and (re)hospitalization rates at 1-month were similar among patients managed remotely (18% and 12%, respectively) and those requiring hospitalization (21% and 10%, respectively). Iatrogenic complications occurred more often during hospitalization than remote management (26% vs. 3%, P < 0.001). CONCLUSIONS Our study suggests that remote management of WHF events based on a multiparametric approach led by a telemedical centre is feasible and safe. Adopting such a strategy for patients with chronic HF could reduce HF-related hospitalizations with expected benefits for patients, care providers, and health care systems.
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Affiliation(s)
- Sylvain Ploux
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
| | - Marc Strik
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
| | - F. Daniel Ramirez
- Division of CardiologyUniversity of Ottawa Heart InstituteOttawaCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
| | - Samuel Buliard
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
| | - Rémi Chauvel
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
| | - Pierre Dos Santos
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
| | - Michel Haïssaguerre
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
| | - Antoine Jobbé‐Duval
- Department of Heart Failure and Transplant‘Louis Pradel’ Cardiologic Hospital, Hospices Civils de LyonLyonFrance
| | - François Picard
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
| | - Clément Riocreux
- Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT)Clermont Université, Université d'AuvergneClermont‐FerrandFrance
- Department of CardiologyCHU Clermont‐FerrandClermont‐FerrandFrance
| | - Romain Eschalier
- Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT)Clermont Université, Université d'AuvergneClermont‐FerrandFrance
- Department of CardiologyCHU Clermont‐FerrandClermont‐FerrandFrance
| | - Pierre Bordachar
- Cardio‐Thoracic UnitBordeaux University Hospital (CHU)PessacFrance
- IHU LirycElectrophysiology and Heart Modeling Institute, fondation Bordeaux UniversitéBordeauxFrance
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Khan WJ, Arriola-Montenegro J, Mutschler MS, Bensimhon D, Halmosi R, Toth K, Alexy T. A novel opportunity to improve heart failure care: focusing on subcutaneous furosemide. Heart Fail Rev 2023; 28:1315-1323. [PMID: 37439967 DOI: 10.1007/s10741-023-10331-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
The prevalence of heart failure (HF) continues to rise in developed nations. Symptomatic congestion is the most common reason for patients to seek medical attention, and management often requires intravenous (IV) diuretic administration in the hospital setting. Typically, the number of admissions increases as the disease progresses, not only impacting patient survival and quality of life but also driving up healthcare expenditures. pH-neutral furosemide delivered subcutaneously using a proprietary, single-use infusor system (Furoscix) has a tremendous potential to transition in-hospital decongestive therapy to the outpatient setting or to the patient's home. This review is aimed at providing an overview of the pharmacodynamic and pharmacokinetic profile of the novel pH-neutral furosemide in addition to the most recent clinical trials demonstrating its benefit when used in the home setting. Given the newest data and approval by the Food and Drug Administration in the US, it has the potential to revolutionize the care of patients with decompensated HF. Undoubtedly, it will lead to improved quality of life as well as significantly reduced healthcare costs related to hospital admissions.
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Affiliation(s)
- Wahab J Khan
- Department of Medicine, Avera Health, Sioux Falls, SD, 57105, USA
| | - Jose Arriola-Montenegro
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Melinda S Mutschler
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Daniel Bensimhon
- Division of Cardiovascular Medicine, Cone Health, Greensboro, NC, 27401, USA
| | - Robert Halmosi
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7624, Pecs, Hungary
| | - Kalman Toth
- Division of Cardiology, 1st Department of Medicine, Medical School, University of Pecs, 7624, Pecs, Hungary
| | - Tamas Alexy
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, 55455, USA.
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Coatsworth-Puspoky R, Dahlke S, Duggleby W, Hunter KF. Safeguarding survival: Older persons with multiple chronic conditions' unplanned readmission experiences: A mixed methods systematic review. J Clin Nurs 2023; 32:5793-5815. [PMID: 37095609 DOI: 10.1111/jocn.16705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 04/26/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study was to create a holistic understanding of the psychosocial processes of older persons with multiple chronic conditions' experience with unplanned readmission experiences within 30 days of discharge home and identify factors influencing these psychosocial processes. DESIGN Mixed methods systematic review. DATA SOURCES Six electronic databases (Ovid MEDLINE (R) All 1946-present, Scopus, CINAHL, Embase, PsychINFO and Web of Science). REVIEW METHODS Peer-reviewed articles published between 2010 and 2021 and addressed study aims (n = 6116) were screened. Studies were categorised by method: qualitative and quantitative. Qualitative data synthesis used a meta-synthesis approach and applied thematic analysis. Quantitative data synthesis used vote counting. Data (qualitative and quantitative) were integrated through aggregation and configuration. RESULTS Ten articles (n = 5 qualitative; n = 5 quantitative) were included. 'Safeguarding survival' described older persons' unplanned readmission experience. Older persons experienced three psychosocial processes: identifying missing pieces of care, reaching for lifelines and feeling unsafe. Factors influencing these psychosocial processes included chronic conditions and discharge diagnosis, increased assistance with functional needs, lack of discharge planning, lack of support, increased intensity of symptoms and previous hospital readmission experiences. CONCLUSIONS Older persons felt more unsafe as their symptoms increased in intensity and unmanageability. Unplanned readmission was an action older persons required to safeguard their recovery and survival. RELEVANCE TO CLINICAL PRACTICE Nurses play a critical role in assessing and addressing factors that influence older persons' unplanned readmission. Identifying older persons' knowledge about chronic conditions, discharge planning, support (caregivers and community services), changes in functional needs, intensity of symptoms and past readmission experiences may prepare older persons to cope with their return home. Focusing on their health-care needs across the continuum of care (community, home and hospital) will mitigate the risks for unplanned readmission within 30 days of discharge. REPORTING METHOD PRISMA guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution due to design.
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Affiliation(s)
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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7
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Liu Z, Zhu Y, Zhang L, Wu M, Huang H, Peng K, Zhao W, Chen S, Peng X, Li N, Zhang H, Zhou Y, Chen Y, Xiao S, Yi L, Fan J, Zeng J. Impact of signs and symptoms on the prognosis of patients with HFmrEF. BMC Cardiovasc Disord 2023; 23:420. [PMID: 37620764 PMCID: PMC10464266 DOI: 10.1186/s12872-023-03436-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Worsening of heart failure (HF) symptoms is the leading cause of medical contact and hospitalization of patients with mildly reduced ejection fraction (HFmrEF). The prognostic value of signs and symptoms for patients with HFmrEF is currently unclear. This study investigated the prognostic impact of signs and symptoms in HFmrEF patients. METHODS A Cox proportional risk regression model analyzed the relationship between the number of signs/symptoms and outcomes in 1691 hospitalized HFmrEF patients. Ten significant signs and symptoms were included. Patients were divided into three groups (A: ≤2, B: 3-5, C: ≥6 signs/symptoms). Stratified analysis on male and female patients was performed. The primary endpoint was all-cause mortality, and the secondary outcome was a composite of cardiovascular death and heart failure readmission (CV events) post-discharge. RESULTS After a median follow-up of 33 months, all-cause mortality occurred in 457 patients and CV events occurred in 977 patients. Incidence of all-cause mortality was 20.7%, 32.3%* and 49.4%*† in group A, B and C of male patients, (*P < 0.05 vs. A, †P < 0.05 vs. B) and 18.8%, 33.6% and 55.8%* in group A, B and C of female patients. Incidence of CV events was 64.8%, 70.1%* and 87.5%* in group A, B and C of male patients, 61.9%, 75.3%, and 86.1%* in group A, B and C of female patients. Multivariate Cox regression showed older age, renal insufficiency, higher number of signs and symptoms (≥ 3, hazard ratio [HR] 1.317, 95% confidence interval [CI] 1.070-1.621, P = 0.009; ≥6, HR 1.982, 95% CI 1.402-2.801, P < 0.001), myocardial infarction, stroke, faster heart rate on admission, and diabetes were independently associated with all-cause mortality(all P < 0.05). Similarly, higher number of signs and symptoms (≥ 3, HR 1.271, 95% CI 1.119-1.443, P < 0.001; ≥6, HR 1.955, 95% CI 1.524-2.508, P < 0.001), older age, renal insufficiency, atrial fibrillation, and diabetes were independently associated with cardiovascular events (all P < 0.05). CONCLUSIONS Higher number of symptoms and signs is associated with increased risk of all-cause mortality and CV events in HFmrEF patients. Our results highlight the prognostic importance of careful inquiry on HF symptoms and related physical examination in HFmrEF patients.
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Affiliation(s)
- Zhican Liu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Yunlong Zhu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China.
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
| | - Lingling Zhang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Mingxin Wu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Haobo Huang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Ke Peng
- Department of Scientific Research, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Wenjiao Zhao
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Sihao Chen
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Xin Peng
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Na Li
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Hui Zhang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Yuying Zhou
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Yongliang Chen
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Sha Xiao
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Liqing Yi
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Jie Fan
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China
| | - Jianping Zeng
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411100, China.
- Graduate Collaborative Training Base of Xiangtan Central Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
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8
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Zhao Q, Mei J, Zhang X, Dong X, Zhang Y, Fan X. Determining Holistic Factors Related to Depressive Symptoms in Patients With Heart Failure. Clin Nurs Res 2023; 32:359-365. [PMID: 36068938 DOI: 10.1177/10547738221121437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Identifying modifiable factors associated with depressive symptoms is important to develop corresponding strategies. This study aimed to determine the holistic factors related to depressive symptoms in heart failure (HF) patients. It was a secondary analysis of a cross-sectional study. We recruited 329 hospitalized HF patients from two hospitals in China. It is found that HF patients had a relatively high proportion (28.27%) of depressive symptoms. Red blood cell distribution width (RDW) (β = .222, p = .011) and physical symptoms (β = .151, p < .001) were positively associated with depressive symptoms, whereas resilience (β = -.241, p < .01) and family functioning (β = -.288, p = .001) were negatively associated with depressive symptoms. Thus, early screening and management of depressive symptoms are warranted. RDW may serve as a marker for screening depressive symptoms. Moreover, interventions focused on relieving physical symptoms and enhancing resilience and family functioning may reduce depressive symptoms.
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Affiliation(s)
- Qiuge Zhao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | | | - Xiuting Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiaoyu Dong
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yilin Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiuzhen Fan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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9
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Soydara C, Jurgens C, Lewis G. Postexercise oxygen uptake recovery delay among patients with heart failure: A systematic review. HEART AND MIND 2023. [DOI: 10.4103/hm.hm_42_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
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10
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Matsuda M, Saito N, Miyawaki I. Effectiveness of daily activity record-based self-monitoring intervention for patients with chronic heart failure: A study protocol. Contemp Clin Trials Commun 2022; 30:101017. [PMID: 36276263 PMCID: PMC9583036 DOI: 10.1016/j.conctc.2022.101017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 08/17/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022] Open
Abstract
Background The prevention of recurrent readmission among heart failure (HF) patients requires support for appropriate self-care behaviors to prevent exacerbation of HF and self-monitoring to allow for patients’ early perception of physical changes during exacerbations. Such support may enable patients to seek early consultation. This study developed a self-monitoring intervention that aimed at increasing the perception of patient-unique physical sensations caused by HF, based on daily activity records of patients. Method A parallel two-arm randomized controlled trial is being conducted with 68 HF patients early after their discharge. Participants in both groups wear a wristwatch activity tracker from time-of-discharge. Participants in the self-monitoring intervention group receive support to reflect on their actual daily activities and the associated physical sensations they experienced, based on their daily activity records. The primary outcome is participants’ “Asking for Help” dimension of self-care behavior, measured using the European Heart Failure Self-Care Behavior Scale at one month follow-up after intervention. Conclusion This study is the first trial to use an activity tracker as a tool for symptom perception among HF patients. The problem of delayed consultations during exacerbations may be resolved by assisting patients in improving their perception of their unique physical sensations associated with specific daily activities, based on their daily activity records. If the effect is clarified, it could lead to the construction of new nursing interventions for continuous disease management that aim towards re-hospitalization prevention. This is the first trial using an activity tracker for symptom perception in HF. Intervention focuses on physical sensations perception along with daily activities. Trial will test intervention's effect on early consultation behavior and readmission.
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Affiliation(s)
- Misako Matsuda
- Department of Nursing, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe, Hyogo, 654-0142, Japan,Corresponding author.
| | - Nao Saito
- School of Nursing, Public University Corporation Miyagi University, 1-1 Gakuen, Taiwa-cho, Kurokawa-gun, Miyagi, 981-3298, Japan
| | - Ikuko Miyawaki
- Department of Nursing, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe, Hyogo, 654-0142, Japan
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11
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Lee JH, Hwang KK. End-of-Life Care for End-stage Heart Failure Patients. Korean Circ J 2022; 52:659-679. [PMID: 36097835 PMCID: PMC9470494 DOI: 10.4070/kcj.2022.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 11/11/2022] Open
Abstract
Efforts to improve end-of-life (EOL) care have generally been focused on cancer patients, but high-quality EOL care is also important for patients with other serious medical illnesses including heart failure (HF). Recent HF guidelines offer more clinical considerations for palliative care including EOL care than ever before. Because HF patients can experience rapid, unexpected clinical deterioration or sudden death throughout the disease trajectory, choosing an appropriate time to discuss issues such as advance directives or hospice can be challenging in real clinical situations. Therefore, EOL issues should be discussed early. Conversations are important for understanding patient and family expectations and developing mutually agreed goals of care. In particular, high-quality communication with patient and family through a multidisciplinary team is necessary to define patient-centered goals of care and establish treatment based on goals. Control of symptoms such as dyspnea, pain, anxiety/depression, fatigue, nausea, anorexia, and altered mental status throughout the dying process is an important issue that is often overlooked. When quality-of-life outweighs expanding quantity-of-life, the transition to EOL care should be considered. Advanced care planning including resuscitation (i.e., do-not resuscitate order), device deactivation, site for last days and bereavement support for the family should focus on ensuring a good death and be reviewed regularly. It is essential to ensure that treatment for all HF patients incorporates discussions about the overall goals of care and individual patient preferences at both the EOL and sudden changes in health status. In this review, we focus on EOL care for end-stage HF patients.
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Affiliation(s)
- Ju-Hee Lee
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Kyung-Kuk Hwang
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.
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12
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Lin CY, Dracup K, Pelter MM, Biddle MJ, Moser DK. Association of psychological distress with reasons for delay in seeking medical care in rural patients with worsening heart failure symptoms. J Rural Health 2022; 38:713-720. [PMID: 33783853 PMCID: PMC10106011 DOI: 10.1111/jrh.12573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The impact of depressive symptoms and anxiety on rural patients' decisions to seek care for worsening heart failure (HF) symptoms remains unknown. The purposes of this study were (1) to describe rural patients' reasons for delay in seeking care for HF, and (2) to determine whether depressive symptoms or anxiety was associated with patients' reasons for delay in seeking medical care for worsening symptoms. METHODS A total of 611 rural HF patients were included. Data on reasons for patient delay in seeking medical care (The Reasons for Delay Questionnaire), depressive symptoms (PHQ-9), and anxiety (BSI-ANX) were collected. Statistical analyses included chi-square and multiple regression. RESULTS A total of 85.4% of patients reported at least 1 reason for delay. Patients with higher levels of depressive symptoms were more likely to cite embarrassment, problems with transportation, and financial concerns as a reason for delay. Patients with anxiety not only cited nonsymptom-related reasons but also reported symptom-related reasons for delay in seeking care (ie, symptoms seemed vague, not sure of symptoms, symptoms didn't seem to be serious enough, and symptoms were different from the last episode). In multiple regression, patients with greater depressive symptoms and anxiety had a greater number of reasons for delay in seeking care (P = .003 and P = .023, respectively). CONCLUSIONS Our findings suggest that enhancement of patients' symptom appraisal abilities and improvement in psychological distress may result in a reduction in delay in seeking medical care for worsening symptoms in rural patients with HF.
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Affiliation(s)
- Chin-Yen Lin
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Kathleen Dracup
- School of Nursing, University of California, San Francisco, California
| | - Michele M. Pelter
- School of Nursing, University of California, San Francisco, California
| | | | - Debra K. Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky
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13
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Coatsworth-Puspoky R, Dahlke S, Duggleby W, Hunter KF. Older persons with multiple chronic conditions' experiences of unplanned readmission: An integrative review. Int J Older People Nurs 2022; 17:e12481. [PMID: 35621261 DOI: 10.1111/opn.12481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/01/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND As persons, 60 years of age and older live longer, they are more likely to develop one or more chronic conditions. Rising numbers of older persons with multiple chronic conditions (MCCs) will increase the need for home healthcare services and hospital services and unplanned readmissions will increase globally. AIM The aim of this integrative review was to explore the experiences of older persons with MCCs' unplanned readmission from home to hospital within 30 days of discharge using an integrative review. METHOD Whittemore and Knafl's method was followed to address the research aim. Four databases (Ovid MEDLINE, Scopus, CINAHL and Embase) were searched between 2005 and 2020, suitability for inclusion was assessed, and data were extracted and analysed using content analysis. RESULTS Thirteen articles (10 qualitative, one quantitative, and two mixed methods) were included in this review. Three themes emerged from the data that reflected older persons with MCCs' unplanned readmission experiences. These themes included (a) feelings of security, support and relief; (b) undesirable challenges at home (struggling to manage care and balancing support needs); and (c) unpleasant feelings and emotions (feelings of fear and mistrust, feelings of disappointment and loss, feelings of anxiousness and pressure). CONCLUSION Research about unplanned readmission to the hospital does not provide sufficient detail or understanding about older persons with MCCs' experiences or their psychosocial experiences. Addressing research gaps related to the psychosocial processes and factors associated with unplanned readmission is needed to expand the current understanding of the process and concept of unplanned readmission.
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Affiliation(s)
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, USA
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, USA
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14
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Reeder KM, Peek GM, Nazir N. Prehospitalization Symptom Perceptions, Lay Consultations, and Treatment-Seeking for Acute Decompensating Heart Failure: Implications for Nursing Practice. Crit Care Nurs Clin North Am 2022; 34:129-140. [DOI: 10.1016/j.cnc.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Care-seeking and delay of care during COPD exacerbations. NPJ Prim Care Respir Med 2022; 32:7. [PMID: 35169140 PMCID: PMC8847354 DOI: 10.1038/s41533-022-00269-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022] Open
Abstract
Patients who receive earlier treatment for acute exacerbations of chronic obstructive pulmonary disease (COPD) have a better prognosis, including earlier symptom resolution and reduced risk of future emergency-department visits (ED) or hospitalizations. However, many patients delay seeking care or do not report worsening symptoms to their healthcare provider. In this study, we aimed to understand how patients perceived their breathing symptoms and identify factors that led to seeking or delaying care for an acute exacerbation of COPD. We conducted semistructured interviews with 60 individuals following a recent COPD exacerbation. Participants were identified from a larger study of outpatients with COPD by purposive sampling by exacerbation type: 15 untreated, 15 treated with prednisone and/or antibiotics in the outpatient setting, 16 treated in an urgent care or ED setting, and 14 hospitalized. Data were analyzed using inductive content analysis. Participants were primarily male (97%) with a mean age of 69.1 ± 6.9 years, mean FEV1 1.42 (±0.63), and mean mMRC dyspnea of 2.7 (±1.1). We identified 4 primary themes: (i) access and attitudinal barriers contribute to reluctance to seek care, (ii) waiting is a typical response to new exacerbations, (iii) transitioning from waiting to care-seeking: the tipping point, and (iv) learning from and avoiding worse outcomes. Interventions to encourage earlier care-seeking for COPD exacerbations should consider individuals’ existing self-management approaches, address attitudinal barriers to seeking care, and consider health-system changes to increase access to non-emergent outpatient treatment for exacerbations. Clinical Trial Registration NCT02725294
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16
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Imanuel Tonapa S, Inayati A, Sithichoksakulchai S, Daryanti Saragih I, Efendi F, Chou FH. Outcomes of nurse-led telecoaching intervention for patients with heart failure: A systematic review and meta-analysis of randomised controlled trials. J Clin Nurs 2021; 31:1125-1135. [PMID: 34535943 DOI: 10.1111/jocn.16025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/20/2021] [Accepted: 08/17/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Studies have identified that nurse-led telephone health coaching benefited the continuity of care in patients with heart failure. However, the effect of nurse-led telephone health coaching remains inconclusive among the previous studies. AIM This review aimed to determine the effects of nurse-led telecoaching among patients with heart failure. DESIGN This study was a systematic review and meta-analysis of randomised controlled trials. This study was reported in accordance with the PRISMA guideline. METHODS Seven databases (PubMed, Embase, CINAHL, Web of Science, MEDLINE, Cochrane library and Ovid) were electronically searched up to 20 October 2020. The eligibility criteria were a randomised controlled trial study on heart failure patients, with the intervention led by a nurse through telephone coaching. Two authors independently evaluated the methodological quality using the modified Jadad scale. The Comprehensive Meta-Analysis software version 3.0 with a random effect model was used to conduct a meta-analysis, and Begg's and Egger's tests were performed to assess publication bias. Furthermore, sensitivity analysis was carried out. RESULTS A total of 12 randomised controlled trials were met eligibility criteria and representing 1938 heart failure patients. The results showed that the nurse-led telecoaching significantly enhanced patients' self-care behaviour (SMD = .84, 95%CI [0.45-1.24], p < .001) and improved quality of life (SMD = .23, 95%CI [0.06-0.39], p = .007). CONCLUSION Nurse-led telecoaching appears to enhance self-care behaviour and improve quality of life in patients with heart failure. Further research needs to build the evidence for nurse-led telecoaching intervention, including understanding its mechanisms of action (e.g. frequency, components) and identifying its moderating factors. RELEVANCE TO CLINICAL PRACTICE Implementation of nurse-led telecoaching is deemed helpful in promoting continuity of care because it was an accessible and sustainable intervention to improve patients' self-care and quality of life.
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Affiliation(s)
- Santo Imanuel Tonapa
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Nursing, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia
| | - Aini Inayati
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Nursing, Faculty of Health Science, Alma Ata University, Yogyakarta, Indonesia
| | - Siriluk Sithichoksakulchai
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Fundamental Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | | | - Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia.,School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Fan-Hao Chou
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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17
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Sethares KA, Chin E. Age and gender differences in physical heart failure symptom clusters. Heart Lung 2021; 50:832-837. [PMID: 34311226 DOI: 10.1016/j.hrtlng.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Gender differences exist in structure and function of the heart resulting in HF symptom variation. Previous HF symptom cluster research described symptom clusters that were linked to functional status, mortality, quality of life and rehospitalization. Age and gender differences between cluster groups were described in one study. OBJECTIVES Identify physical HF symptom clusters and explore age and gender differences between clusters. METHODS Secondary analysis study of adults with HF. Cluster analysis was conducted using hierarchical agglomerative clustering techniques. A pictorial dendrogram output displays clusters. RESULTS Three symptom clusters were identified in this sample of 133 older HF patients that differed by gender (p = 0.04), age (p = 0.00) and beta blocker use (p = 0.01). Symptom clusters were consistent with worsening HF, acute HF and chronic HF. CONCLUSION Symptom clusters differ by age and gender. Education should be directed at increasing patient awareness of their individual symptom clusters.
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Affiliation(s)
- Kristen A Sethares
- Department of Adult Nursing, College of Nursing and Health Sciences, University of Massachusetts Dartmouth, 285 Old Westport Rd. North Dartmouth 02747, MA, United States.
| | - Elizabeth Chin
- Department of Adult Nursing, College of Nursing and Health Sciences, University of Massachusetts Dartmouth, 285 Old Westport Rd. North Dartmouth 02747, MA, United States
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18
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Lin CY, Hammash M, Miller JL, Schrader M, Mudd-Martin G, Biddle MJ, Moser DK. Delay in seeking medical care for worsening heart failure symptoms: predictors and association with cardiac events. Eur J Cardiovasc Nurs 2021; 20:454-463. [PMID: 33580784 DOI: 10.1093/eurjcn/zvaa032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/31/2020] [Accepted: 12/03/2020] [Indexed: 01/04/2023]
Abstract
AIMS The association of delay in seeking medical care to subsequent cardiac events remains unknown in patients with worsening heart failure (HF) symptoms. The aims of this study were to (i) identify factors predicting care-seeking delay and (ii) examine the impact of care-seeking delay on subsequent cardiac rehospitalization or death. METHODS AND RESULTS We studied 153 patients hospitalized with an exacerbation of HF. Potential predictors of delay including demographic, clinical, psychosocial, cognitive, and behavioural variables were collected. Patients were followed for 3 months after discharge to determine time to the first cardiac rehospitalization or death. The median delay time was 134 h (25th and 75th percentiles 49 and 364 h). Non-linear regression showed that New York Heart Association functional class III/IV (P = 0.001), worse depressive symptoms (P = 0.004), better HF knowledge (P = 0.003), and lower perceived somatic awareness (P = 0.033) were predictors of delay time from patient perception of worsening HF to subsequent hospital admission. Cox regression revealed that patients who delayed longer (more than 134 h) had a 1.93-fold higher risk of experiencing cardiac events (P = 0.044) compared to non-delayers. CONCLUSIONS Care-seeking delay in patients with worsening HF symptoms was significantly associated with an increased risk of rehospitalization and mortality after discharge. Intervention strategies addressing functional status, psychological state, cognitive and behavioural factors are essential to reduce delay and thereby improve outcomes.
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Affiliation(s)
- Chin-Yen Lin
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Muna Hammash
- School of Nursing, University of Louisville, 555 S Floyd Street, Louisville, KY 40202, USA
| | - Jennifer L Miller
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Melanie Schrader
- School of Nursing, University of Louisville, 555 S Floyd Street, Louisville, KY 40202, USA
| | - Gia Mudd-Martin
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Martha J Biddle
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Debra K Moser
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
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Beauvais F, Tartière L, Pezel T, Motet C, Aumont MC, Baudry G, Eicher JC, Galinier M, Gellen B, Guihaire J, Legallois D, Lequeux B, Mika D, Mouquet F, Salvat M, Taieb C, Zorès F, Berthelot E, Damy T. First symptoms and health care pathways in hospitalized patients with acute heart failure: ICPS2 survey. A report from the Heart Failure Working Group (GICC) of the French Society of Cardiology. Clin Cardiol 2021; 44:1144-1150. [PMID: 34173675 PMCID: PMC8364729 DOI: 10.1002/clc.23666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/26/2021] [Accepted: 05/26/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Acute heart failure (AHF) is a common serious condition that contributes to about 5% of all emergency hospital admissions in Europe. HYPOTHESIS To assess the type and chronology of the first AHF symptoms before hospitalization and to examine the French healthcare system pathways before, during and after hospitalization. MATERIAL AND METHODS A retrospective observational study including patients hospitalized for AHF RESULTS: 793 patients were included, 59.0% were men, 45.6% identified heart failure (HF) as the main cause of hospitalization; 36.0% were unaware of their HF. Mean age was 72.9 ± 14.5 years. The symptoms occurring the most before hospitalization were dyspnea (64.7%) and lower limb edema (27.7%). Prior to hospitalization, 47% had already experienced symptoms for 15 days; 32% of them for 2 months. Referral to hospital was made by the emergency medical assistance service (SAMU, 41.6%), a general practitioner (GP, 22.3%), a cardiologist (19.5%), or the patient (16.6%). The modality of referral depended more on symptom acuteness than on type of symptoms. A sudden onset of AHF symptoms led to making an emergency call or to spontaneously attending an emergency room (ER), whereas cardiologists were consulted when symptoms had already been present for over 15 days. Cardiologists referred more patients to cardiology departments and fewer patients to the ER than general practitioners or the SAMU. CONCLUSION This study described the French healthcare system pathways before, during and after hospitalization AHF. AHF clinic network should be developed to provide adequate care for all HF patients and create awareness regarding AHF symptoms.
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Affiliation(s)
| | - Lamia Tartière
- Department of Cardiology, Hôpital Leon Berard, Hyères, France
| | - Théo Pezel
- Department of Cardiology, CHU Lariboisière, APHP, Paris, France
| | - Chloé Motet
- Faculty of Medicine, University of Nantes, Nantes, France
| | | | - Guillaume Baudry
- HCL, Service Insuffisance cardiaque, Hôpital Louis Pradel, Bron, France
| | | | | | - Barnabas Gellen
- Department of Cardiology, ELSAN - Polyclinique de Poitiers, Poitiers, France
| | - Julien Guihaire
- Department of Cardiology, Hôpital Marie Lanelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Le Plessis Robinson, France
| | | | - Benoit Lequeux
- Department of Cardiology, CHU Poitiers, Poitiers, France
| | - Delphine Mika
- Inserm, UMR-S 1180, Université Paris-Saclay, Chatenay-Malabry, France
| | | | - Muriel Salvat
- Department of Cardiology, CHU de Grenoble, Grenoble, France
| | | | | | | | - Thibaud Damy
- Department of Cardiology, Referral Center for Cardiac Amyloidosis and DHU ATVB, CHU Henri Mondor, APHP, Creteil, France
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20
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Lin CY, Hammash M, Mudd-Martin G, Biddle MJ, Dignan M, Moser DK. Older and younger patients' perceptions, evaluations, and responses to worsening heart failure symptoms. Heart Lung 2021; 50:640-647. [PMID: 34091110 DOI: 10.1016/j.hrtlng.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Whether recognition and prompt response to worsening symptoms are worse in older compared with younger patients with heart failure (HF) is unclear. OBJECTIVES The aims of this study were to compare older and younger patients (1) perceptions, evaluations, and responses to worsening HF symptoms, and (2) responses once worsening symptoms were perceived. METHODS A mixed-methods study was conducted and to compare data between older (≥ 65) and younger (< 65) in 185 patients hospitalized with HF. RESULTS There were few differences attributed to age. In response to higher perceived symptom distress, patients in both groups did nothing and hoped their symptoms would go away (p = 0.004), ignored symptoms and continued doing what they were doing (p = 0.002), or laid down to relax (p < 0.001). CONCLUSIONS The majority of patients, regardless of age, did not recognize, interpret, and respond appropriately to HF symptoms. Interventions should be tested that target better symptom appraisal and promote appropriate symptom responses in patients with HF across all ages.
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Affiliation(s)
- Chin-Yen Lin
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, United States.
| | - Muna Hammash
- School of Nursing, University of Louisville, 555 S Floyd Street, Louisville, KY, United States.
| | - Gia Mudd-Martin
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, United States.
| | - Martha J Biddle
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, United States.
| | - Mark Dignan
- Department of Internal Medicine, University of Kentucky, 800 Rose Street, Room CC44, Lexington, KY, United States.
| | - Debra K Moser
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, United States.
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21
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Patel H, Szkinc-Olsson G, Lennartsson Al Liddawi M. A qualitative study of nurses' experiences of self-care counseling in migrant patients with heart failure. Int J Nurs Sci 2021; 8:279-288. [PMID: 34307776 PMCID: PMC8283704 DOI: 10.1016/j.ijnss.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/14/2021] [Accepted: 05/19/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives This study aims to enhance researchers’ and nurses’ understanding of how to best support migrant patients with heart failure in self-care management. Previous research on self-care in heart failure patients has highlighted its importance, particularly among migrant populations. Nurses play an important role in informing and engaging patients with chronic conditions like heart failure to support their active participation in self-care. However, nurses’ experiences of providing self-care counseling to migrant populations with heart failure have not been studied. Methods A qualitative study was conducted. Nurses working with migrant patients with HF (n = 13) from different types of facility in Western Sweden were interviewed between October and December 2020. Data were collected using semi-structured interviews and analyzed using inductive thematic analysis. Results The main theme that emerged from the interviews was the difficulty for nurses “to find balance” in self-care counseling. The nurses during self-care counseling had: “to accept challenges,” “to use creative strategies,” faced “problems related to health literacy,” and “to work according to their (the nurses’) obligations.” It was evident that nurses faced several challenges in counseling migrants in self-care, including language and cultural barriers, time resource constraints, low levels of health literacy, and experienced disharmony between the law and their professional norms. They perceived building caring relationships with their patients to be crucial to fostering health-promoting self-care processes. Conclusions To increase self-care adherence, nurses must become more sensitive to cultural differences and adapt self-care counseling to patients’ health literacy. The findings of this research support and challenge nurses in providing the best counsel to migrant patients with heart failure living in Sweden’s multi-ethnic society. Policymakers in the health care organization should act to facilitate mutual cultural understanding between all involved partners for patient-safe self-care counseling.
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Affiliation(s)
- Harshida Patel
- Institute of Health Care and Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Grazyna Szkinc-Olsson
- Institute of Health Care & Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Sweden
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Coatsworth-Puspoky R, Duggleby W, Dahlke S, Hunter K. Unplanned readmission for older persons: A concept analysis. J Adv Nurs 2021; 77:4291-4305. [PMID: 34028852 DOI: 10.1111/jan.14893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/09/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this concept analysis is to define and analyse the concept of unplanned readmission to hospital for older persons. DESIGN Review the literature and analyse the concept of unplanned readmission. METHOD Guided by Walker and Avant's eight-stage method of concept analysis, four databases (Ovid MEDLINE, Scopus, CINAHL, and Embase) were searched between 1946 and 2020 for empirical studies focused on older persons with multiple chronic conditions, experiences or perspectives and unplanned readmission. A total of 34 articles (10 quantitative, 17 qualitative, three mixed methods), one concept analysis and three historical articles were included. RESULTS An unplanned readmission is an experience, process and event. The proposed definition of unplanned readmission is an older person's need for acute care treatment for an urgent or emergent health crisis that has occurred after a previous hospitalization(s). Unplanned readmission is characterized by the attributes of older persons' previous hospitalization(s), the urgent or emergent nature of the older persons' health and the older persons' need for acute care hospital services to resolve their health crisis. CONCLUSION Unplanned readmission is a complex concept that is different from planned and emergency visits/admissions and readiness for discharge. These findings provide a link for understanding unplanned readmission as a consequence of discharge readiness. Analysing this concept supports the need for older persons to seek unplanned readmission for acute care treatment of urgent and emergent health crisis, reduces the blame that older persons may feel from questions related to preventability, and stresses the need to include older persons' experiences in the development and expansion of nursing theory, interventions and current understandings of unplanned readmission.
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Affiliation(s)
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Heo S, Moser DK, Lennie TA, Kim J, Turrise S, Troyan PJ, Kang J, Jones HJ. Self-care strategies and interventions needed in patients with heart failure: from patient perspectives-a qualitative study. Eur J Cardiovasc Nurs 2021; 20:540-546. [PMID: 34008023 DOI: 10.1093/eurjcn/zvaa033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/29/2020] [Accepted: 12/11/2020] [Indexed: 11/13/2022]
Abstract
AIMS Most patients with heart failure (HF) have symptoms. Poor self-care has been associated with the development or worsening symptoms. Thus, to improve HF symptoms, it may be critical to understand self-care and interventions targeting improvements in HF symptoms needed from patients' perspectives. To explore patients' perceptions of self-care strategies of individual symptoms, HF symptom improvement, and interventions needed to improve HF symptoms in patients with HF. METHODS AND RESULTS Qualitative data were collected from 20 patients with HF using a semi-structured open-ended interview guide. Data were analysed using content analysis. Five themes appeared: (i) use of a variety of strategies with some knowledge deficit and inefficiency, (ii) uncertainty in symptom improvement, (iii) consideration of several possible self-care strategies, (iv) use of situation-specific strategies in seeking treatment, and (v) willingness to receive comprehensive and realistic interventions. Patients used a variety of self-care strategies, including taking medication, reducing activities, and changing diet and position, but many reported having a lack of knowledge and multiple HF symptoms. Several patients were uncertain whether symptoms could be improved, but all patients reported that they would participate in comprehensive and realistic intervention sessions to gain knowledge about their symptoms and management strategies, and to receive emotional support from healthcare providers and peer patients. CONCLUSION Patients with HF used several self-care strategies with the hope of symptom improvements but were uncertain about the effectiveness. More effective, comprehensive, and realistic interventions need to be delivered to patients with HF to enhance their ability to manage their symptoms.
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Affiliation(s)
- Seongkum Heo
- Mercer University, Georgia Baptist College of Nursing, 3001 Mercer University Drive, Atlanta, GA 30341, USA
| | - Debra K Moser
- University of Kentucky, College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Terry A Lennie
- University of Kentucky, College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - JinShil Kim
- Gachon University, 191 Hambakmeoro, Yeonsu-gu, Incheon 21936, South Korea
| | - Stephanie Turrise
- University of North Carolina, Wilmington, School of Nursing, 601 S. College Road, Wilmington, NC 28403, USA
| | - Pattie J Troyan
- Mercer University, Georgia Baptist College of Nursing, 3001 Mercer University Drive, Atlanta, GA 30341, USA
| | - JungHee Kang
- University of Kentucky, College of Nursing, 2201 Regency Rd, Suite, 403, Lexington, KY 40503, USA
| | - Holly J Jones
- University of Cincinnati, College of Nursing, P.O. Box 210038, Cincinnati, OH 45221-0038, USA
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Nunes Dos-Santos G, da-Conceição AP, Heo S, de-Lucena-Ferretti-Rebustini RE, Bottura Leite de-Barros AL, Batista Santos V, Takáo-Lopes C. Symptom Status Questionnaire - Heart Failure - Brazilian Version: cross-cultural adaptation and content validation. Heart Lung 2021; 50:525-531. [PMID: 33836442 DOI: 10.1016/j.hrtlng.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Brazil, there are no instruments available to measure the presence, frequency, severity and distress related to heart failure (HF) symptoms. AIMS To adapt the Symptom Status Questionnaire - HF (SSQ-HF) into Brazilian Portuguese and to examine the content validity of the adapted version. METHODS The instrument was translated, back-translated and evaluated by an expert committee for semantic, idiomatic, cultural, and conceptual equivalences. An agreement ≥80% was considered adequate. The adapted version was evaluated by both an expert committee (n = 9) for clarity, theoretical relevance and practical relevance (acceptable content validity coefficient (CVC): ≥0.70), and by a patient committee regarding understanding (n = 40). RESULTS The adapted version obtained 100% agreement regarding the equivalences. The total instrument CVC was 0.99. All patients understood the items. CONCLUSION The SSQ-HF-Brazilian version has satisfactory evidence of equivalence and content validity. Additional psychometric tests are deemed to confirm that the instrument can be used in Brazil.
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Affiliation(s)
- Gabriela Nunes Dos-Santos
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil; Escola Paulista de Enfermagem, Universidade Federal de São Paulo, Rua Napoleão de Barros 754, CEP 04024-002, Vila Clementino, São Paulo, SP, Brazil
| | | | - Seongkum Heo
- Piedmont Healthcare Endowed Chair, Georgia Baptist College of Nursing of Mercer University, Atlanta, Georgia
| | | | - Alba Lucia Bottura Leite de-Barros
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, Rua Napoleão de Barros 754, CEP 04024-002, Vila Clementino, São Paulo, SP, Brazil
| | - Vinicius Batista Santos
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, Rua Napoleão de Barros 754, CEP 04024-002, Vila Clementino, São Paulo, SP, Brazil
| | - Camila Takáo-Lopes
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, Rua Napoleão de Barros 754, CEP 04024-002, Vila Clementino, São Paulo, SP, Brazil.
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Abstract
BACKGROUND Accurate symptom perception is a fundamentally essential component of self-care for patients with heart failure (HF) so they can make appropriate decisions about their symptoms. OBJECTIVE The purpose of this integrative review was to describe the pathways of the symptom perception process and its contributing factors in patients with HF. METHODS A comprehensive literature search was conducted using PubMed, EMBASE, and PsycINFO databases to identify studies describing the symptom perception process (symptom detection, comprehension, and response) in adult patients with HF. RESULTS Two pathways of the symptom perception process were identified from 42 articles: ideal and undesirable pathways. Patients in the ideal symptom perception pathway had a comprehensive understanding of HF and a firm belief in the importance of self-care, were vigilant, and possessed good decision-making skills. They also were able to successfully use their experiences for future care. However, patients in the undesirable symptom perception pathway had a limited understanding of HF with poor symptom monitoring skills and inaccurate judgments about symptoms. Diverse factors contributing to the symptom perception process were identified (eg, levels of understandings of HF and social support). CONCLUSION Our review indicated that symptom perception was likely to diversify the pathway of HF management. A variety of contributing factors to the symptom perception process were found to be intertwined. The findings of our review can inform the development of best patient education practice, although further research needs to be conducted to understand why and how patients can follow the most appropriate path from their past experiences.
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Takei M, Harada K, Shiraishi Y, Matsuda J, Iwasaki Y, Yamamoto Y, Matsushita K, Miyazaki T, Miyamoto T, Iida K, Tanimoto S, Nagatomo Y, Hosoda T, Kohsaka S, Yamamoto T, Nagao K, Takayama M. Delay in seeking treatment before emergent heart failure readmission and its association with clinical phenotype. J Intensive Care 2020; 8:65. [PMID: 32864143 PMCID: PMC7448509 DOI: 10.1186/s40560-020-00482-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background Many patients with emergent heart failure (HF) readmission have a delay between symptom onset and hospitalization. The present study aimed to characterize the interval between symptom onset and hospitalization in patients being readmitted for HF and to compare the clinical phenotypes of patients with delay before emergent readmission with those who presented to the hospital earlier. Methods Data for a total of 2073 consecutive patients was collected from the Tokyo CCU Network database; the patients were divided into delayed (those who sought medical help > 2 days after symptom onset; n = 271) and early groups (remaining patients; n = 1802), and their clinical characteristics and mode of presentation were compared. Results Age, sex, and laboratory findings including brain natriuretic peptide and serum creatinine levels were not significantly different between the two groups. Patients in the delayed group had greater chronic fluid retention and symptoms not associated with respiratory failure, whereas those in the early group were more likely to have acute respiratory distress, faster heart and respiration rates, and higher systolic blood pressure. Conclusions More than one in ten patients with HF readmission delay seeking treatment > 2 days after symptom onset. Patients who delayed seeking treatment showed the phenotype of chronic fluid retention, whereas those who presented to the hospital earlier had the phenotype of acute respiratory failure.
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Affiliation(s)
- Makoto Takei
- Tokyo CCU Network Scientific Committee, Tokyo, Japan.,Department of Cardiology, Saiseikai Central Hospital, Mita 1-4-17, Minato-ku, Tokyo, 108-0073 Japan
| | | | | | - Junya Matsuda
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | | | | | | | - Kiyosi Iida
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Yuji Nagatomo
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Toru Hosoda
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Shun Kohsaka
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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Koshy AO, Gallivan ER, McGinlay M, Straw S, Drozd M, Toms AG, Gierula J, Cubbon RM, Kearney MT, Witte KK. Prioritizing symptom management in the treatment of chronic heart failure. ESC Heart Fail 2020; 7:2193-2207. [PMID: 32757363 PMCID: PMC7524132 DOI: 10.1002/ehf2.12875] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/31/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic heart failure (CHF) is a chronic, progressive disease that has detrimental consequences on a patient's quality of life (QoL). In part due to requirements for market access and licensing, the assessment of current and future treatments focuses on reducing mortality and hospitalizations. Few drugs are available principally for their symptomatic effect despite the fact that most patients' symptoms persist or worsen over time and an acceptance that the survival gains of modern therapies are mitigated by poorly controlled symptoms. Additional contributors to the failure to focus on symptoms could be the result of under‐reporting of symptoms by patients and carers and a reliance on insensitive symptomatic categories in which patients frequently remain despite additional therapies. Hence, formal symptom assessment tools, such as questionnaires, can be useful prompts to encourage more fidelity and reproducibility in the assessment of symptoms. This scoping review explores for the first time the assessment options and management of common symptoms in CHF with a focus on patient‐reported outcome tools. The integration of patient‐reported outcomes for symptom assessment into the routine of a CHF clinic could improve the monitoring of disease progression and QoL, especially following changes in treatment or intervention with a targeted symptom approach expected to improve QoL and patient outcomes.
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Affiliation(s)
- Aaron O Koshy
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Elisha R Gallivan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Melanie McGinlay
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sam Straw
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Michael Drozd
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Anet G Toms
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John Gierula
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Richard M Cubbon
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Mark T Kearney
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
| | - Klaus K Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK
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Guirguis K. Prescribed heart failure pharmacotherapy: How closely do GPs adhere to treatment guidelines? Res Social Adm Pharm 2020; 16:935-940. [DOI: 10.1016/j.sapharm.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/18/2019] [Accepted: 10/06/2019] [Indexed: 10/25/2022]
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Taniguchi C, Okada A, Seto N, Shimizu Y. How visiting nurses detect symptoms of disease progression in patients with chronic heart failure. Int J Qual Stud Health Well-being 2020; 15:1735768. [PMID: 32114970 PMCID: PMC7067190 DOI: 10.1080/17482631.2020.1735768] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: Chronic heart failure patients are often rehospitalized because they fail to seek appropriate, timely care. However, both patients and nurses experience difficulties in detecting signs of heart failure exacerbation. We aimed to qualitatively investigate how visiting nurses detect symptoms of disease progression in chronic heart failure patients in their homes. Methods: Participants were three experienced home-visit chronic heart failure nurses who completed one-to-one interviews. Data were analysed using the qualitative synthesis method (KJ method). Results: Six themes were identified that reflected detection of disease exacerbation and nursing support to prevent disease progression: difficulty of judging deterioration in patients with comorbidities; ascertaining conditions needing immediate intervention; detection of illness progression from changes in the patient’s appearance; inferring instability in physical condition from patients’ concerns and questions; arranging to ensure continued management of the patient post discharge; and instructing patients to ensure they never return to their old habits. Conclusions: The findings indicate that nurses experience challenges in detecting illness progression and judging when outpatient or hospital care is needed. However, nurses use a range of signs and symptoms to determine deterioration. Home-visit nurses thus play a crucial role in the post-hospital care of chronic heart failure patients.
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Affiliation(s)
- Chinatsu Taniguchi
- School of Nursing, Mukogawa Women's University, Hyogo, Japan.,Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ayako Okada
- Faculty of Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan
| | - Natsuko Seto
- Faculty of Nursing/Graduate School of Nursing, Kansai Medical University, Osaka, Japan
| | - Yasuko Shimizu
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
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Santos GC, Liljeroos M, Dwyer AA, Jaques C, Girard J, Strömberg A, Hullin R, Schäfer-Keller P. Symptom perception in heart failure: a scoping review on definition, factors and instruments. Eur J Cardiovasc Nurs 2019; 19:100-117. [DOI: 10.1177/1474515119892797] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background:Symptom perception in heart failure has been identified as crucial for effective self-care that is a modifiable factor related to decreased hospital readmission and improved survival.Aims:To review systematically the heart failure symptom perception literature and synthesise knowledge on definition, description, factors and instruments.Methods:We conducted a scoping review including studies reporting patient-reported symptom perception in adults with heart failure. Structured searches were conducted in Medline, PubMed, Embase, CINAHL, PsychINFO, Web of Science, Cochrane, JBI and grey literature. Two authors independently reviewed references for eligibility. Data were charted in tables and results narratively summarised.Results:The search yielded 3057 references, of which 106 were included. The definition of heart failure symptom perception comprised body listening, monitoring signs, recognising, interpreting and labelling symptoms, and furthermore awareness of and assigning meaning to the change. Symptom monitoring, recognition and interpretation were identified as challenging. Symptom perception facilitators include prior heart failure hospitalisation, heart failure self-care maintenance, symptom perception confidence, illness uncertainty and social support. Barriers include knowledge deficits, symptom clusters and lack of tools/materials. Factors with inconsistent impact on symptom perception include age, sex, education, experiences of living with heart failure, comorbidities, cognitive impairment, depression and symptom progression. One instrument measuring all dimensions of heart failure symptom perception was identified.Conclusion:Heart failure symptom perception definition and description have been elucidated. Several factors facilitating or hampering symptom perception are known. Further research is needed to determine a risk profile for poor symptom perception – which can then be taken into consideration when supporting heart failure self-care.
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Affiliation(s)
- Gabrielle Cécile Santos
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland - Fribourg, Switzerland
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Maria Liljeroos
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Andrew A Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, USA
| | - Cécile Jaques
- Medical Library, Research and Education Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Josepha Girard
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland - Fribourg, Switzerland
| | - Anna Strömberg
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Roger Hullin
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Petra Schäfer-Keller
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland - Fribourg, Switzerland
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Lyth J, Lind L, Persson HL, Wiréhn AB. Can a telemonitoring system lead to decreased hospitalization in elderly patients? J Telemed Telecare 2019; 27:46-53. [PMID: 31291794 DOI: 10.1177/1357633x19858178] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Growing populations of elderly patients with chronic obstructive pulmonary disease (COPD) or heart failure (HF) require more healthcare. A four-year telehealth intervention - the Health Diary system based on digital pen technology - was implemented. We hypothesized that study patients with advanced COPD or HF would have lower rates of hospitalization when using the Health Diary. The aim was to investigate the effects of the intervention on healthcare costs and the number of hospitalizations, as well as other care required in COPD and HF patients. METHODS Patients were introduced to the telemonitoring system which was supervised by a specialized hospital-based home care (HBHC) unit. Staff associated with this unit were responsible for the healthcare provided. The study included patients with COPD or HF, aged ≥ 65 years who were frequently hospitalized due to exacerbations - at least two inpatient episodes within the last 12 months. Observed number of hospitalizations and total healthcare costs were compared with the expected values, which were calculated using the generalized estimating equations (GEE) method. RESULTS A total of 36 COPD and 58 HF patients with advanced stages of disease were included. The number of hospitalizations was significantly reduced for both HF and COPD patients participating in telemonitoring. Accordingly, hospitalization costs were significantly reduced for both groups, but the total healthcare cost was not significantly different from the expected costs. CONCLUSION A telemonitoring system, the Health Diary, combined with a specialized HBHC unit significantly decreases the need for hospital care in elderly patients with advanced HF or COPD without increasing total healthcare costs.
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Affiliation(s)
- Johan Lyth
- Research and Development Unit in Region Östergötland and Department of Medical and Health Sciences, Linköping University, Sweden
| | - Leili Lind
- Department of Biomedical Engineering/Health Informatics, Linköping University, Sweden.,RISE Research Institutes of Sweden AB / Division ICT SICS East, c/o Linköping University, Linköping, Sweden
| | - Hans L Persson
- Department of Respiratory Medicine, Department of Medical and Health Sciences, Linköping University, Sweden
| | - Ann-Britt Wiréhn
- Research and Development Unit in Region Östergötland and Department of Medical and Health Sciences, Linköping University, Sweden
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Daley C, Al-Abdulmunem M, Holden RJ. Knowledge among patients with heart failure: A narrative synthesis of qualitative research. Heart Lung 2019; 48:477-485. [PMID: 31227224 DOI: 10.1016/j.hrtlng.2019.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/15/2019] [Accepted: 05/18/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients' knowledge of heart failure (HF) is integral to improved outcomes. However, the HF literature has not adequately explored the nature of patients' knowledge of HF as part of their lived experience. OBJECTIVES We aimed to characterize the nature of patients' knowledge of HF, in the context of living with the disease. METHODS We conducted a narrative synthesis of qualitative studies that addressed patients' knowledge of HF. Studies were systematically searched and retrieved from MEDLINE, CINAHL, PsycINFO and PsycARTICLES databases. Findings were synthesized using an iterative coding process carried out by multiple analysts and reported following Enhancing Transparency in the Reporting of Qualitative Health Research (ENTREQ) criteria. RESULTS Analysis of 73 eligible articles produced five themes: the content that comprises HF knowledge; development of HF knowledge over time; application of HF knowledge for decision making; communication of information between clinicians and patients; and patients' experience of knowledge. CONCLUSION The nature of patients' knowledge of HF is both explicit and implicit, dynamic, and personal. This multidimensional model of knowledge-in-context calls for equally multidimensional research and intervention design.
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Affiliation(s)
- Carly Daley
- Department of BioHealth Informatics, IUPUI, Indianapolis, IN, USA; Parkview Mirro Center for Research and Innovation, Parkview Health, Fort Wayne, IN, USA.
| | | | - Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA.
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Fatigue in heart failure outpatients: levels, associated factors, and the impact on quality of life. ACTA ACUST UNITED AC 2019; 4:e103-e112. [PMID: 31211277 PMCID: PMC6555087 DOI: 10.5114/amsad.2019.85406] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/24/2019] [Indexed: 12/12/2022]
Abstract
Introduction Heart failure (HF) patients experience various psychosocial issues and physical symptoms such as fatigue, which adversely affect their quality of life (QoL). The aim of the study was to assess levels of fatigue in HF outpatients and the associated factors, as well as to explore the correlation between fatigue and QoL. Material and methods One hundred and thirty patients were enrolled in the study. Data collection was performed by the completion of “Minnesota Living With Heart Failure” questionnaire (MLHFQ) and the Greek version of the Modified Fatigue Impact Scale (MFIS-Greek). Data also included self-reported patients’ characteristics. Results Of the 130 HF outpatients, 50% scored above 69 (median) in total fatigue and above 41 and 29 (median) in physical and mental fatigue, respectively. Furthermore, 50% scored above 66 (median) in total QoL and above 32.5 and 13 (median) in the physical and mental state, respectively. These values indicate moderate to high impact of HF on fatigue and on patients’ QoL. Total fatigue was statistically significantly associated with NYHA stage (p = 0.001), confidence to acknowledge health deteriorations (p = 0.004), decrease in appetite (p = 0.001), dyspnoea at night (p = 0.001), oedema in lower limbs (p = 0.023), relation with health professionals (p = 0.031), and whether patients had limited daily activities (p = 0.002), social contacts (p = 0.014), and if they had financial worries (p = 0.003). Finally, as the score of fatigue increased, so the QoL score also increased. Conclusions A broader understanding of this distressing symptom in HF may contribute to the development of suitable interventions with the ultimate goal of improving QoL.
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Bell-Davies F, Goyder C, Gale N, Hobbs FDR, Taylor CJ. The role of informal carers in the diagnostic process of heart failure: a secondary qualitative analysis. BMC Cardiovasc Disord 2019; 19:92. [PMID: 31014239 PMCID: PMC6480764 DOI: 10.1186/s12872-019-1075-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 04/10/2019] [Indexed: 11/16/2022] Open
Abstract
Background Heart failure (HF) is a common clinical syndrome, particularly in older people, and symptoms can develop gradually. The aim of this study was to explore the role of informal carers in the HF diagnostic process. Methods Secondary analysis of qualitative interviews with 16 participants with a new diagnosis of HF. Original interviews were conducted in the participant’s home, with carers present in some cases. Interview transcripts were re-analysed using the Framework Method for themes pertaining to informal carers and how they were involved in the diagnostic process. Results Informal carers often noticed symptoms, such as breathlessness, before participants. In some cases, carers colluded with participants in normalising symptoms but over time, when symptoms failed to resolve or got worse, they encouraged participants to seek medical help. Adult children of participants commonly initiated help-seeking behaviour. During the diagnostic process, carers coordinated participants’ healthcare through advocacy and organisation. Carers were keen to be informed about the diagnosis, but both participants and carers struggled to understand some aspects of the term ‘heart failure’. Conclusions Carers play a crucial role in HF diagnosis, particularly in initiating contact with healthcare services, and should be empowered to encourage people with HF symptoms to seek medical help. Improving public awareness of HF could mean informal carers are more likely to notice symptoms. The important role of carers in supporting the patient’s route to diagnosis should be incorporated into future care pathways and explored in further research.
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Affiliation(s)
- Frances Bell-Davies
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Clare Goyder
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Nicola Gale
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
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Sauer AJ, Cole R, Jensen BC, Pal J, Sharma N, Yehya A, Vader J. Practical guidance on the use of sacubitril/valsartan for heart failure. Heart Fail Rev 2019; 24:167-176. [PMID: 30565021 PMCID: PMC6394573 DOI: 10.1007/s10741-018-9757-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sacubitril/valsartan is a first-in-class angiotensin receptor-neprilysin inhibitor (ARNI) that has been recommended in clinical practice guidelines to reduce morbidity and mortality in patients with chronic, symptomatic heart failure (HF) with reduced ejection fraction (HFrEF). This review provides an overview of ARNI therapy, proposes strategies to improve the implementation of sacubitril/valsartan in clinical practice, and provides clinicians with evidence-based, practical guidance on the use of sacubitril/valsartan in patients with HFrEF. Despite evidence demonstrating the benefits of ARNI therapy over standard of care, only a fraction of eligible patients takes sacubitril/valsartan. Barriers preventing the prescription of sacubitril/valsartan in eligible patients may include practitioners' unfamiliarity with ARNIs, safety concerns, and payer reimbursement issues. The optimal implementation of sacubitril/valsartan in clinical practice has the potential to reduce the overall burden of HF. Throughout this review, we describe our experience with sacubitril/valsartan, including strategies for the management of adverse events and common patient concerns. In addition, a strategy for the gradual introduction of sacubitril/valsartan using a treatment sequence scheme is proposed.
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Affiliation(s)
- Andrew J Sauer
- Center for Advanced Heart Failure and Heart Transplantation, The University of Kansas Health System, 3901 Rainbow Boulevard Mailstop 1072, Kansas City, KS, 66160, USA.
| | - Robert Cole
- Center for Heart Failure Therapy and Transplantation, Emory University, Atlanta, GA, USA
| | - Brian C Jensen
- UNC McAllister Heart Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jay Pal
- Division of Cardiothoracic Surgery, University of Colorado, Aurora, CO, USA
| | - Nakul Sharma
- Libin Cardiovascular Institute of Alberta, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amin Yehya
- Advanced Heart Failure and Heart Transplant, Piedmont Heart Institute, Atlanta, GA, USA
| | - Justin Vader
- Department of Medicine, Division of Cardiology, Washington University in St Louis, St Louis, MO, USA
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Heo S, Moser DK, Lennie TA, Grudnowski S, Kim J, Turrise S. Patients’ Beliefs About Causes and Consequences of Heart Failure Symptoms. West J Nurs Res 2019; 41:1623-1641. [DOI: 10.1177/0193945918823786] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients’ perceptions of the causes and consequences of heart failure (HF) symptoms may impact effective self-management. The purpose of this study was to describe and explore patients’ perceptions of HF symptom status and the causes and consequences on their daily lives in patients with HF. Descriptive and qualitative data were obtained from 20 patients using a semistructured interview guide. Data were analyzed using content analysis and descriptive statistics. Participants reported 15 symptoms (median = 4). Five themes were (a) multiple causes and multiple symptoms; (b) knowing some causes, but still unclear; (c) not being able to live life as previously did; (d) facing emotional distress due to HF symptoms; and (e) development of new priorities and lifestyles. The findings demonstrate that all participants perceived considerable difficulties living with HF symptoms. More comprehensive interventions need to be delivered to patients to manage multiple causes and symptoms effectively.
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Affiliation(s)
- Seongkum Heo
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Alpert CM, Smith MA, Hummel SL, Hummel EK. Symptom burden in heart failure: assessment, impact on outcomes, and management. Heart Fail Rev 2018; 22:25-39. [PMID: 27592330 DOI: 10.1007/s10741-016-9581-4] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Evidence-based management has improved long-term survival in patients with heart failure (HF). However, an unintended consequence of increased longevity is that patients with HF are exposed to a greater symptom burden over time. In addition to classic symptoms such as dyspnea and edema, patients with HF frequently suffer additional symptoms such as pain, depression, gastrointestinal distress, and fatigue. In addition to obvious effects on quality of life, untreated symptoms increase clinical events including emergency department visits, hospitalizations, and long-term mortality in a dose-dependent fashion. Symptom management in patients with HF consists of two key components: comprehensive symptom assessment and sufficient knowledge of available approaches to alleviate the symptoms. Successful treatment addresses not just the physical but also the emotional, social, and spiritual aspects of suffering. Despite a lack of formal experience during cardiovascular training, symptom management in HF can be learned and implemented effectively by cardiology providers. Co-management with palliative medicine specialists can add significant value across the spectrum and throughout the course of HF.
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Affiliation(s)
- Craig M Alpert
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michael A Smith
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA.,Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USA
| | - Scott L Hummel
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Ellen K Hummel
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. .,Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI, USA. .,University of Michigan Frankel Cardiovascular Center, 1500 East Medical Center Dr., SPC 5233, Ann Arbor, MI, 48109-5233, USA.
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38
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Riegel B, Dickson VV, Lee CS, Daus M, Hill J, Irani E, Lee S, Wald JW, Moelter ST, Rathman L, Streur M, Baah FO, Ruppert L, Schwartz DR, Bove A. A mixed methods study of symptom perception in patients with chronic heart failure. Heart Lung 2018; 47:107-114. [PMID: 29304990 PMCID: PMC5857218 DOI: 10.1016/j.hrtlng.2017.11.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/31/2017] [Accepted: 11/05/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early heart failure (HF) symptoms are frequently unrecognized for reasons that are unclear. We explored symptom perception in patients with chronic HF. METHODS We enrolled 36 HF out-patients into a longitudinal sequential explanatory mixed methods study. We used objectively measured thoracic fluid accumulation and daily reports of signs and symptoms to evaluate accuracy of detected changes in fluid retention. Patterns of symptom interpretation and response were explored in telephone interviews conducted every 2 weeks for 3-months. RESULTS In this sample, 44% had a mismatch between objective and subjective fluid retention; younger persons were more likely to have mismatch. In interviews, two patterns were identified: those able to interpret and respond appropriately to symptoms were higher in decision-making skill and the quality of social support received. CONCLUSION Many HF patients were poor at interpreting and managing their symptoms. These results suggest a subgroup of patients to target for intervention.
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Affiliation(s)
- Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
| | | | - Christopher S Lee
- School of Nursing, Oregon Health & Sciences University, Portland, OR, USA
| | - Marguerite Daus
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Hill
- Community Healthcare Network, New York, NY, USA
| | - Elliane Irani
- School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Solim Lee
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Joyce W Wald
- Heart Failure - Transplant Program, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen T Moelter
- Department of Behavioral and Social Sciences, University of the Sciences, Philadelphia, PA, USA
| | - Lisa Rathman
- The Heart Group of Lancaster General Health/PENN Medicine, Philadelphia, PA, USA
| | - Megan Streur
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Foster Osei Baah
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Linda Ruppert
- Department of Medicine, Section of Cardiology, Louis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Daniel R Schwartz
- Department of Medicine, Section of Cardiology, Louis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Alfred Bove
- Department of Medicine, Section of Cardiology, Louis Katz School of Medicine, Temple University, Philadelphia, PA, USA
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Testing a Holistic Meditation Intervention to Address Psychosocial Distress in Patients With Heart Failure. J Cardiovasc Nurs 2018; 33:126-134. [DOI: 10.1097/jcn.0000000000000435] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Lee JS, Lempp H, Srivastava V, Barley E. Reasons for Accident and Emergency department attendance by people with chronic obstructive pulmonary disease or heart failure: recipients and providers' perspectives. An exploratory study. BMJ Open Respir Res 2018; 5:e000244. [PMID: 29387421 PMCID: PMC5786948 DOI: 10.1136/bmjresp-2017-000244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/22/2017] [Indexed: 11/05/2022] Open
Abstract
Introduction Fifteen million people are affected by one or more long-term conditions in England. The cost of caring for this patient group increases every year. Several studies have been conducted to find out why people with those conditions choose to access Accident and Emergency (A&E) frequently. To our knowledge, there is no study that compares the three groups (patients, family members and hospital clinicians), and this approach may enhance understanding of A&E admissions in England. Therefore, an exploratory study was undertaken to identify key factors that contribute to A&E admissions as perceived by patients with chronic obstructive pulmonary disease (COPD) and heart failure (HF), their family members (or carers) and hospital clinicians. Methods A mixed methods approach was undertaken: (1) semistructured interviews with patients and their family members (or carers) and (2) a self-developed survey with hospital clinicians. A purposive sample of 15 patients (9 COPD, 6 HF), 6 family members and carers (2 COPD, 4 HF) and 13 hospital clinicians (5 doctors, 8 nurses) participated in the study. Results The patients’ main reason for A&E admission was severe exacerbation of their symptoms and all three parties (patients, family members or carers, hospital clinicians) agreed with this decision. Three key factors were highlighted in relation to A&E attendance: (1) patients’ health-seeking behaviour, (2) perceptions about general practitioner (GP) and A&E services by patients and (3) patients’ attitudes towards managing their own conditions. Conclusions Improving patients’ perceptions of GP services in the management of exacerbations of HF and COPD will be important to increase patients’ trust in GP services so that patients will access primary care in a timely manner to prevent exacerbations of symptoms that require A&E admission. This may be achieved by developing a close collaboration between the patients, family members (carers) and hospital clinicians over time.
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Affiliation(s)
- Jeong Su Lee
- Occupational Therapy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Heidi Lempp
- Academic Rheumatology, Faculty of life Science and Medicine, King's College London, London, UK
| | - Vivek Srivastava
- Acute Medicine, Guys' and St Thomas' NHS Foundation Trust, London, UK
| | - Elizabeth Barley
- College of Nursing, Midwifery and Healthcare, University of West London, London, UK
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Pope CA, Davis BH, Wine L, Nemeth LS, Axon RN. A Triangulated Qualitative Study of Veteran Decision-Making to Seek Care During Heart Failure Exacerbation: Implications of Dual Health System Use. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2018; 55:46958017751506. [PMID: 29482411 PMCID: PMC5833170 DOI: 10.1177/0046958017751506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 07/21/2017] [Accepted: 11/17/2017] [Indexed: 11/17/2022]
Abstract
Among Veterans, heart failure (HF) contributes to frequent emergency department visits and hospitalization. Dual health care system use (dual use) occurs when Veterans Health Administration (VA) enrollees also receive care from non-VA sources. Mounting evidence suggests that dual use decreases efficiency and patient safety. This qualitative study used constructivist grounded theory and content analysis to examine decision making among 25 Veterans with HF, for similarities and differences between all-VA users and dual users. In general, all-VA users praised specific VA providers, called services helpful, and expressed positive capacity for managing HF. In addition, several Veterans who described inadvertent one-time non-VA health care utilization in emergent situations more closely mirrored all-VA users. By contrast, committed dual users more often reported unmet needs, nonresponse to VA requests, and faster services in non-VA facilities. However, a primary trigger for dual use was VA telephone referral for escalating symptoms, instead of care coordination or primary/specialty care problem-solving.
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Affiliation(s)
- Charlene A. Pope
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, USA
| | - Boyd H. Davis
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- University of North Carolina at Charlotte, USA
| | - Leticia Wine
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | | | - Robert N. Axon
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, USA
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42
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Park LG, Dracup K, Whooley MA, McCulloch C, Jin C, Moser DK, Clark RA, Pelter MM, Biddle M, Howie Esquivel J. Symptom Diary Use and Improved Survival for Patients With Heart Failure. Circ Heart Fail 2017; 10:e003874. [PMID: 29158435 PMCID: PMC5705062 DOI: 10.1161/circheartfailure.117.003874] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 10/11/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Attention to symptoms of weight gain and dyspnea are central tenets of patient education in heart failure (HF). However, it is not known whether diary use improves patient outcomes. The aims of this study were to compare mortality among rural patients with HF who completed versus did not complete a daily diary of weight and symptom self-assessment and to identify predictors of diary use. METHODS AND RESULTS This is a secondary analysis of a 3-arm randomized controlled trial on HF education of self-care with 2 intervention groups versus control who were given diaries for 24 months to track daily weight, HF symptoms, and response to symptom changes. Mean age was 66±13, 58% were men, and 67% completed diaries (n=393). We formed 5 groups (no use, low, medium, high, and very high) based on the first 3 months of diary use and then analyzed time to event (cardiac mortality, all-cause mortality, and HF-related readmission) starting at 3 months. Compared with patients with no diary use, high and very high diary users were less likely to experience all-cause mortality (P=0.02 and P=0.01, respectively). Self-reported sedentary lifestyle was associated with less diary use in an adjusted model (odds ratio, 0.66; 95% confidence interval, 0.46-0.95; P=0.03). Depression and sex were not significant predictors of diary use in the adjusted model. CONCLUSIONS In this study of 393 rural patients with HF, we found that greater diary use was associated with longer survival. These findings suggest that greater engagement in self-care behaviors is associated with better HF outcomes. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique Identifier: NCT00415545.
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Affiliation(s)
- Linda G Park
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.).
| | - Kathleen Dracup
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.)
| | - Mary A Whooley
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.)
| | - Charles McCulloch
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.)
| | - Chengshi Jin
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.)
| | - Debra K Moser
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.)
| | - Robyn A Clark
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.)
| | - Michele M Pelter
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.)
| | - Martha Biddle
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.)
| | - Jill Howie Esquivel
- From the Department of Community Health Systems (L.G.P.), Department of Physiological Nursing (K.D., M.M.P.), Department of Medicine (M.A.W.), Department of Epidemiology & Biostatistics (M.A.W., C.M., C.J.), University of California, San Francisco, CA; Department of Acute & Specialty Care, University of Virginia, Charlottesville (J.H.E.); San Francisco Veterans Affairs Medical Center, San Francisco, CA (L.G.P., M.A.W.); College of Nursing, University of Kentucky, Lexington (D.K.M., M.B.); and School of Nursing and Midwifery, Flinders University, Adelaide, Australia (R.A.C.)
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Park J, Moser DK, Griffith K, Harring JR, Johantgen M. Exploring Symptom Clusters in People With Heart Failure. Clin Nurs Res 2017; 28:165-181. [DOI: 10.1177/1054773817729606] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with heart failure (HF) experience multiple symptoms or symptom clusters. The purposes of this study were to (a) determine if distinct latent classes of HF symptoms could be identified, and (b) explore whether sociodemographic and clinical characteristics influenced symptom cluster membership. A total of 4,011 HF patients recruited from outpatient setting completed the Minnesota Living With Heart Failure Questionnaire (MLHFQ), including five physical symptoms (edema, shortness of breath, fatigue-increased need to rest, fatigue-low energy, and sleep difficulties) and three psychological symptoms (worrying, feeling depressed, and cognitive problems). Four distinct classes using latent class profile analysis were identified: low distress (Class 1), physical distress (Class 2), psychological distress (Class 3), and high distress (Class 4). Significant differences among the four latent classes were found for age, education level, and comorbidities. Symptom clusters are useful for recognition of HF symptoms, allowing for the development of strategies that target symptom groups.
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Affiliation(s)
- Jumin Park
- National Institutes of Health Clinical Center, Bethesda, MD, USA
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Gilbert EM, Xu WD. Rationales and choices for the treatment of patients with NYHA class II heart failure. Postgrad Med 2017; 129:619-631. [PMID: 28670961 DOI: 10.1080/00325481.2017.1344082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Heart failure (HF) in the United States represents a significant burden for patients and a tremendous strain on the healthcare system. Patients receiving a diagnosis of HF can be placed into 1 of 4 New York Heart Association (NYHA) functional classifications; the greatest proportion of patients are in the NYHA class II category, which is defined as patients having a slight limitation of physical activity but who are comfortable at rest, and for whom ordinary physical activity results in symptoms of HF. Because the severity of NYHA class II HF may be perceived as mild or unalarming by this definition, the urgency to treat this type of HF may be overlooked. However, these patients are optimal candidates for active intervention because their HF is at a critical point on the disease progression continuum when untoward changes can be halted or reversed. This review discusses the physiological consequences of NYHA class II HF with reduced ejection fraction and describes recent clinical trials that have demonstrated a therapeutic benefit for patients in this population. In doing so, we hope to establish that patients with NYHA class II disease merit careful attention and to provide reassurance to the treating community that options are available for these patients.
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Affiliation(s)
- Edward M Gilbert
- a Division of Cardiology , University of Utah , Salt Lake City , UT , USA
| | - Weining David Xu
- a Division of Cardiology , University of Utah , Salt Lake City , UT , USA
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45
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Ängerud KH, Boman K, Brännström M. Areas for quality improvements in heart failure care: quality of care from the family members' perspective. Scand J Caring Sci 2017; 32:346-353. [PMID: 28543624 DOI: 10.1111/scs.12468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/21/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The complex needs of people with chronic heart failure (HF) place great demands on their family members, and it is important to ask family members about their perspectives on the quality of HF care. OBJECTIVE To describe family members' perceptions of quality of HF care in an outpatient setting. METHODS A cross-sectional study using a short form of the Quality from Patients' Perspective (QPP) questionnaire for data collection. The items in the questionnaire measure four dimensions of quality, and each item consists of both the perceived reality of the care and its subjective importance. The study included 57 family members of patients with severe HF in NYHA class III-IV. RESULTS Family members reported areas for quality improvements in three out of four dimensions and in dimensionless items. The lowest level of perceived reality was reported for treatment for confusion and loss of appetite. Treatment for shortness of breath, access to the apparatus and access to equipment necessary for medical care were the items with the highest subjective importance for the family members. CONCLUSION Family members identified important areas for quality improvement in the care for patients with HF in an outpatient setting. In particular, symptom alleviation, information to patients, patient participation and access to care were identified as areas for improvements. Thus, measuring quality from the family members' perspective with the QPP might be a useful additional perspective when it comes to the planning and implementation of changes in the organisation of HF care.
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Affiliation(s)
| | - Kurt Boman
- Research Unit Skellefteå, Department of Medicine, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Margareta Brännström
- Department of Nursing, Umeå University, Umeå, Sweden.,The Arctic Research Centre, Umeå University, Umeå, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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Gardner CL, Liu F, Fontelo P, Flanagan MC, Hoang A, Burke HB. Assessing the usability by clinicians of VISION: A hierarchical display of patient-collected physiological information to clinicians. BMC Med Inform Decis Mak 2017; 17:41. [PMID: 28410579 PMCID: PMC5391572 DOI: 10.1186/s12911-017-0435-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The inability of patients to accurately and completely recount their clinical status between clinic visits reduces the clinician's ability to properly manage their patients. One way to improve this situation is to collect objective patient information while the patients are at home and display the collected multi-day clinical information in parallel on a single screen, highlighting threshold violations for each channel, and allowing the viewer to drill down to any analog signal on the same screen, while maintaining the overall physiological context of the patient. All this would be accomplished in a way that was easy for the clinician to view and use. METHODS Patients used five mobile devices to collect six heart failure-related clinical variables: body weight, systolic and diastolic blood pressure, pulse rate, blood oxygen saturation, physical activity, and subjective input. Fourteen clinicians practicing in a heart failure clinic rated the display using the System Usability Scale that, for acceptability, had an expected mean of 68 (SD, 12.5). In addition, we calculated the Intraclass Correlation Coefficient of the clinician responses using a two-way, mixed effects model, ICC (3,1). RESULTS We developed a single-screen temporal hierarchical display (VISION) that summarizes the patient's home monitoring activities between clinic visits. The overall System Usability Scale score was 92 (95% CI, 87-97), p < 0.0001; the ICC was 0.89 (CI, 0.79-0.97), p < 0.0001. CONCLUSION Clinicians consistently found VISION to be highly usable. To our knowledge, this is the first single-screen, parallel variable, temporal hierarchical display of both continuous and discrete information acquired by patients at home between clinic visits that presents clinically significant information at the point of care in a manner that is usable by clinicians.
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Affiliation(s)
- Cubby L Gardner
- 59th Medical Wing, Science and Technology, JBSA-Lackland, TX, USA.
| | - Fang Liu
- National Library of Medicine, Bethesda, MD, 20814, USA
| | - Paul Fontelo
- National Library of Medicine, Bethesda, MD, 20814, USA
| | - Michael C Flanagan
- Cardiology Clinic, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Albert Hoang
- F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Harry B Burke
- F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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47
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Walthall H, Jenkinson C, Boulton M. Living with breathlessness in chronic heart failure: a qualitative study. J Clin Nurs 2017; 26:2036-2044. [PMID: 27731919 DOI: 10.1111/jocn.13615] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore how patients with Chronic Heart Failure describe their experiences of breathlessness, the pattern of their breathlessness, how daily life is affected and how they adjust to and manage these symptoms. BACKGROUND Chronic Heart Failure is a highly prevalent syndrome often with poor outcomes and in a patient group who are predominately elderly. Breathlessness is the main symptom experienced by patients and often relates to decompensation and hospitalisation, yet subtle changes described by patients are often not discussed with health care professionals. DESIGN A descriptive qualitative design. METHODS Twenty-five participants with heart failure with reduced ejection fraction (HF-rEF) from a tertiary referral centre in England were recruited. Each participant took part in a semi-structured interview exploring the effect of breathlessness had on their lives. Data was analysed through Braun and Clarke's framework for thematic analysis. RESULTS All participants reported experiencing breathlessness daily. Four sub-themes were identified in their accounts: nature of breathlessness, emotional impact of breathlessness, impact of breathlessness on daily life and managing breathlessness. CONCLUSION Participants were able to give vivid descriptions of breathlessness and the way it affected their lives. RELEVANCE TO CLINICAL PRACTICE Health care professionals need to take account of each patient's personal assessment of their own breathlessness and how this is having an effect on their life and ability to undertake activities of daily living. Self-care management strategies need to be developed so that subtle changes can be assessed by the patient and reviewed by the healthcare professional to avoid hospitalisation and increased mortality risks.
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Affiliation(s)
- Helen Walthall
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mary Boulton
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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48
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Ängerud KH, Boman K, Ekman I, Brännström M. Areas for quality improvements in heart failure care: quality of care from the patient's perspective. Scand J Caring Sci 2016; 31:830-838. [DOI: 10.1111/scs.12404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Karin H. Ängerud
- Department of Nursing; Umeå University; Umeå Sweden
- The Arctic Research Centre; Umeå University; Umeå Sweden
| | - Kurt Boman
- Research Unit Skellefteå; Department of Medicine; Umeå University; Umeå Sweden
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences; University of Gothenburg; Gothenburg Sweden
- Centre for Person-Centred Care; University of Gothenburg (GPCC); Gothenburg Sweden
| | - Margareta Brännström
- Department of Nursing; Umeå University; Umeå Sweden
- The Arctic Research Centre; Umeå University; Umeå Sweden
- Centre for Person-Centred Care; University of Gothenburg (GPCC); Gothenburg Sweden
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49
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Nahlén Bose C, Elfström ML, Björling G, Persson H, Saboonchi F. Patterns and the mediating role of avoidant coping style and illness perception on anxiety and depression in patients with chronic heart failure. Scand J Caring Sci 2016; 30:704-713. [DOI: 10.1111/scs.12297] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/26/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Catarina Nahlén Bose
- The Swedish Red Cross University College; Stockholm Sweden
- Department of Clinical Sciences Danderyd Hospital; Karolinska Institutet; Stockholm Sweden
- Sophiahemmet University; Stockholm Sweden
| | - Magnus L. Elfström
- Academy of Health; Care and Social Welfare; Mälardalen University; Eskilstuna/Västerås Sweden
| | - Gunilla Björling
- The Swedish Red Cross University College; Stockholm Sweden
- Department of Clinical Sciences Danderyd Hospital; Karolinska Institutet; Stockholm Sweden
| | - Hans Persson
- Department of Clinical Sciences Danderyd Hospital; Karolinska Institutet; Stockholm Sweden
| | - Fredrik Saboonchi
- The Swedish Red Cross University College; Stockholm Sweden
- Department of Clinical Neuroscience; Division of Insurance Medicine; Karolinska Institutet; Stockholm Sweden
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50
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Vat M, Common C, Laizner AM, Borduas C, Maheu C. Reasons for returning to the emergency department following discharge from an internal medicine unit: perspectives of patients and the liaison nurse clinician. J Clin Nurs 2015; 24:3605-14. [PMID: 26467172 DOI: 10.1111/jocn.13011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2015] [Indexed: 12/30/2022]
Abstract
AIMS AND OBJECTIVES To understand the patients' reasons for returning to the emergency department soon after their discharge from an internal medicine unit and to compare these reasons with the liaison nurse clinician's risk assessment tools used for discharge planning. BACKGROUND Returns to the emergency departments soon after discharge from the hospital are a recurrent problem. Factors precipitating readmission to hospital have been analysed through the lens of health care providers, but few studies have explored the patients' perspectives on their reasons for returning to the emergency departments. DESIGN A qualitative, descriptive study. METHODS Semi-structured interviews were conducted with a convenience sample of eight patients recruited from a major teaching hospital in Montreal, Canada. Three different data sources were triangulated: patients' perspectives obtained through interviews and data from the tools used by the liaison nurse clinician, the Bounceback Probability Legend and the LACE Index Scoring Tool. RESULTS Most patients attributed their return to the emergency department on being discharged too soon, feeling weak at discharge, having limited help at home with managing chronic illnesses and insufficient discharge instructions. participants' reasons for returning differed from those predicted by the liaison nurse clinician's evaluation using the risk assessment tools of each participant's risk of return. CONCLUSIONS This study highlights patients' frailty upon discharge from the hospital and their informational need on their health condition and their support need to rely on during convalescence at home. Patient's readiness and concerns were not integrated as part of the liaison nurse clinician's evaluation tools for discharge planning. This led to discrepancies between the perspectives of the patients and the liaison nurse clinician about discharge planning. RELEVANCE TO CLINICAL PRACTICE Health care professionals should evaluate patients' understanding of their illness, their readiness for self-management and work collaboratively with patients to assess concerns before discharge, so that appropriate support can be mobilised to prevent readmission.
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Affiliation(s)
- Molywan Vat
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Carol Common
- MUHC - adult sites, McGill University Health Centre, Montreal, QC, Canada
| | - Andrea Maria Laizner
- Ingram School of Nursing, McGill University, Montreal, QC, Canada.,MUHC Research Institute, Montreal, QC, Canada
| | - Coralie Borduas
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Christine Maheu
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
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