651
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Lebensstiländerungen zur Förderung der kardiovaskulären Gesundheit in Deutschland und Schweden. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54:213-20. [DOI: 10.1007/s00103-010-1202-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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652
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A qualitative meta-analysis of heart failure self-care practices among individuals with multiple comorbid conditions. J Card Fail 2011; 17:413-9. [PMID: 21549299 DOI: 10.1016/j.cardfail.2010.11.011] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 11/19/2010] [Accepted: 11/22/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Most heart failure (HF) patients have other comorbid conditions. HF self-care requires medication and diet adherence, daily weight monitoring, and a thoughtful response to symptoms when they occur. Self-care is complicated when other chronic conditions have additional self-care requirements. The purpose of this study is to explore how comorbidity influences HF self-care. METHODS Using qualitative descriptive meta-analysis techniques, transcripts from 3 mixed methods studies (n = 99) were reexamined to yield themes about perceptions about HF and self-care and to explore the influence on HF self-care. The Charlson Comorbidity Index identified comorbid conditions. RESULTS The sample was 74% Caucasian, 66% male (mean age of 59.6 years ± 15 years). Fifty-three percent of the sample was New York Heart Association Class III. All had at least 1 other chronic condition. Narrative accounts revealed that adherence to diet, symptom monitoring, and differentiating symptoms from multiple conditions were the most challenging self-care skills. Emerging themes included 1) attitudes drive self-care prioritization and 2) fragmented self-care instruction leads to poor self-care integration and self-care skill deficits. CONCLUSIONS Individuals with multiple chronic conditions are vulnerable to poor self-care. Research testing coaching interventions that integrate self-care requirements and focus on developing skill in self-care across multiple chronic conditions is needed.
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653
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Duschek N, Skrinjar E, Waldhör T, Vutuc C, Daniel G, Hübl W, Assadian A. N-terminal pro B-type natriuretic peptide (NT pro-BNP) is a predictor of long-term survival in male patients of 75 years and older with high-grade asymptomatic internal carotid artery stenosis. J Vasc Surg 2011; 53:1242-50. [PMID: 21215559 DOI: 10.1016/j.jvs.2010.10.123] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 10/27/2010] [Accepted: 10/27/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Carotid endarterectomy (CEA) is commonly performed for asymptomatic high-grade internal carotid artery (ICA) stenosis to prevent stroke. However, despite advancing age of the society, for patients older than 75 years, there is no recommendation by the European guidelines for CEA, as this age group might not benefit from this intervention due to a limited life expectancy. OBJECTIVE We assessed N-terminal pro B-type natriuretic peptide (NT pro-BNP) as a predictive marker for long-term survival in this particular patient population in order to stratify patients for an improved surgical outcome. METHODS In a nonrandomized single-center clinical trial, we prospectively studied mortality rates of 205 consecutive patients (80 women, 125 men; mean age, 75 ± 10 years) with asymptomatic high-grade ICA stenosis in relation to preoperative plasma NT pro-BNP levels. We estimated cumulative survival over 5 years by Kaplan-Meier curves and established a proportional hazard-model by Cox regression. RESULTS In male patients, higher levels of preoperative NT pro-BNP levels were associated with a significantly increased long-term mortality. Those 75 years or older had the same survival rate as younger patients, if NT pro-BNP levels were low, making them thus eligible for CEA. CONCLUSIONS The results of our study suggest that preoperative plasma levels of NT pro-BNP are a valuable tool for the stratification of male patients. Male patients older than 75 years with low levels of NT pro-BNP should be referred for carotid revascularization, as they will most likely enjoy the benefit of surgery.
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Affiliation(s)
- Nikolaus Duschek
- Department of General and Vascular Surgery, Wilhelminenspital, Vienna, Austria.
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654
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Anxiety and Depression in Implanted Cardioverter-Defibrillator Recipients and Heart Failure: A Review. Heart Fail Clin 2011; 7:59-68. [DOI: 10.1016/j.hfc.2010.08.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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655
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Exercise Adherence Issues, Behavior Change Readiness, and Self-Motivation in Hospitalized Patients with Coronary Heart Disease. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2011. [DOI: 10.1097/01592394-201102020-00002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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656
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Abstract
Depression is a common comorbid condition in heart failure, and there is growing evidence that it increases the risks of mortality and other adverse outcomes, including rehospitalization and functional decline. The prognostic value of depression depends, in part, on how it is defined and measured. The few studies that have compared different subsets of patients with depression suggest that major (or severe) depression is a stronger predictor of mortality than is minor (or mild) depression. Whether depression is a causal risk factor for heart failure mortality, or simply a risk marker, has not yet been established, but mechanistic research has identified several plausible behavioral and biologic pathways. Further research is needed to clarify the relationships among depression, heart failure, and adverse outcomes, as well as to develop efficacious interventions for depressive disorders in patients with heart failure.
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Affiliation(s)
- Kenneth E Freedland
- Department of Psychiatry, Behavioral Medicine Center, Washington University School of Medicine, 4320 Forest Park Avenue, St Louis, MO 63108, USA.
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657
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Son YJ, Kim HG, Kim EH, Choi S, Lee SK. Application of support vector machine for prediction of medication adherence in heart failure patients. Healthc Inform Res 2010; 16:253-9. [PMID: 21818444 PMCID: PMC3092139 DOI: 10.4258/hir.2010.16.4.253] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 09/14/2010] [Indexed: 12/16/2022] Open
Abstract
Objectives Heart failure (HF) is a progressive syndrome that marks the end-stage of heart diseases, and it has a high mortality rate and significant cost burden. In particular, non-adherence of medication in HF patients may result in serious consequences such as hospital readmission and death. This study aims to identify predictors of medication adherence in HF patients. In this work, we applied a Support Vector Machine (SVM), a machine-learning method useful for data classification. Methods Data about medication adherence were collected from patients at a university hospital through self-reported questionnaire. The data included 11 variables of 76 patients with HF. Mathematical simulations were conducted in order to develop a SVM model for the identification of variables that would best predict medication adherence. To evaluate the robustness of the estimates made with the SVM models, leave-one-out cross-validation (LOOCV) was conducted on the data set. Results The two models that best classified medication adherence in the HF patients were: one with five predictors (gender, daily frequency of medication, medication knowledge, New York Heart Association [NYHA] functional class, spouse) and the other with seven predictors (age, education, monthly income, ejection fraction, Mini-Mental Status Examination-Korean [MMSE-K], medication knowledge, NYHA functional class). The highest detection accuracy was 77.63%. Conclusions SVM modeling is a promising classification approach for predicting medication adherence in HF patients. This predictive model helps stratify the patients so that evidence-based decisions can be made and patients managed appropriately. Further, this approach should be further explored in other complex diseases using other common variables.
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Affiliation(s)
- Youn-Jung Son
- Department of Nursing, Soonchunhyang University, Cheonan, Korea
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658
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Abstract
Theory-based teaching strategies for promoting adherence to a low-sodium diet among patients with heart failure are presented in this article. The strategies, which are based on the theory of planned behavior, address patient attitude, subjective norm, and perceived control as patients learn how to follow a low-sodium diet. Home health clinicians can select a variety of the instructional techniques presented to meet individual patient learning needs.
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659
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Quality of life and symptoms of depression in advanced heart failure patients and their partners. Curr Opin Support Palliat Care 2010; 4:233-7. [PMID: 20966757 DOI: 10.1097/spc.0b013e328340744d] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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660
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:293-304. [DOI: 10.1097/spc.0b013e328340e983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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661
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Mokashi SA, Schmitto JD, Lee LS, Rawn JD, Bolman III RM, Shekar PS, Couper GS, Chen FY. Ventricular Assist Device in Patients With Prosthetic Heart Valves. Artif Organs 2010; 34:1030-4. [DOI: 10.1111/j.1525-1594.2010.01102.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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662
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Jurgens CY, Shurpin KM, Gumersell KA. Challenges and Strategies for Heart Failure Symptom Management in Older Adults. J Gerontol Nurs 2010; 36:24-33. [DOI: 10.3928/00989134-20100930-06] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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663
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Dorner B, Friedrich EK, Posthauer ME. Position of the American Dietetic Association: individualized nutrition approaches for older adults in health care communities. ACTA ACUST UNITED AC 2010; 110:1549-53. [PMID: 20882714 DOI: 10.1016/j.jada.2010.08.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
It is the position of the American Dietetic Association that the quality of life and nutritional status of older adults residing in health care communities can be enhanced by individualization to less-restrictive diets. The American Dietetic Association advocates for registered dietitians to assess and evaluate the need for nutrition interventions tailored to each person's medical condition, needs, desires, and rights. Dietetic technicians, registered, assist registered dietitians in the assessment and implementation of individualized nutrition care. Health care practitioners must assess risks vs benefits of therapeutic diets, especially for older adults. Food is an essential component of quality of life; an unpalatable or unacceptable diet can lead to poor food and fluid intake, resulting in undernutrition and related negative health effects. Including older individuals in decisions about food can increase the desire to eat and improve quality of life. The Practice Paper of the American Dietetic Association: Individualized Nutrition Approaches for Older Adults in Health Care Communities provides guidance to practitioners on implementation of individualized diets and nutrition care.
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Affiliation(s)
- Becky Dorner
- Nutrition Consulting Services, Becky Dorner & Associates, Inc., Akron, OH, USA
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664
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Chan YK, Stewart S, Calderone A, Scuffham P, Goldstein S, Carrington MJ. Exploring the potential to remain "Young @ Heart": initial findings of a multi-centre, randomised study of nurse-led, home-based intervention in a hybrid health care system. Int J Cardiol 2010; 154:52-8. [PMID: 20888653 DOI: 10.1016/j.ijcard.2010.08.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 08/27/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND Disease management programs have been shown to improve health outcomes in high risk individuals in many but not all health care systems. METHODS Young @ Heart is a multi-centre, randomised controlled study of a nurse-led, home-based intervention (HBI) program vs. usual care (UC) in privately insured patients in Australia aged ≥ 45 years following an acute cardiac admission. Intensity of HBI is tailored to an individual's clinical stability, management and risk profile. The primary endpoint is the rate of all-cause stay during a mean of 2.5 years follow-up. RESULTS A target of 602 adults (72% men) were randomised to HBI (n=306) or UC (n=296); their initial profiles being well matched. At baseline, 71% were overweight (body mass index 29.7 ± 3.9 kg/m(2)) and 66% had an elevated blood pressure (153 ± 18/89 ± 7 mm Hg). Over half had a history of smoking and 39% had a sub-optimal total cholesterol level >4 mmol/L. Overall, 62% (376 cases) were treated for coronary artery disease (27% with multi-vessel disease and 39% underwent cardiac revascularisation). A further 20% (120 cases) were treated for a cardiac arrhythmia (predominantly atrial fibrillation) and 19% type 2 diabetes mellitus. At 7-14 days post-discharge, 293 (96%) HBI patients received a home visit triggering urgent clinical review and/or enhanced clinical management in many patients. CONCLUSIONS The Young @ Heart intervention is a well accepted and potentially effective intervention to reduce recurrent hospital stay in privately insured cardiac patients in Australia.
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Affiliation(s)
- Yih-Kai Chan
- Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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665
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666
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Developing an instrument to measure heart failure disease management program intensity and complexity. Circ Cardiovasc Qual Outcomes 2010; 3:324-30. [PMID: 20484202 DOI: 10.1161/circoutcomes.109.877324] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Comparing disease management programs and their effects is difficult because of wide variability in program intensity and complexity. The purpose of this effort was to develop an instrument that can be used to describe the intensity and complexity of heart failure (HF) disease management programs. METHODS AND RESULTS Specific composition criteria were taken from the American Heart Association (AHA) taxonomy of disease management and hierarchically scored to allow users to describe the intensity and complexity of the domains and subdomains of HF disease management programs. The HF Disease Management Scoring Instrument (HF-DMSI) incorporates 6 of the 8 domains from the taxonomy: recipient, intervention content, delivery personnel, method of communication, intensity/complexity, and environment. The 3 intervention content subdomains (education/counseling, medication management, and peer support) are described separately. In this first test of the HF-DMSI, overall intensity (measured as duration) and complexity were rated using an ordinal scoring system. Possible scores reflect a clinical rationale and differ by category, with zero given only if the element could potentially be missing (eg, surveillance by remote monitoring). Content validity was evident as the instrument matches the existing AHA taxonomy. After revision and refinement, 2 authors obtained an inter-rater reliability intraclass correlation coefficient score of 0.918 (confidence interval, 0.880 to 0.944, P<0.001) in their rating of 12 studies. The areas with most variability among programs were delivery personnel and method of communication. CONCLUSIONS The HF-DMSI is useful for describing the intensity and complexity of HF disease management programs.
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667
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Can principles of the Chronic Care Model be used to improve care of the older person in the acute care sector? Collegian 2010; 17:63-9. [DOI: 10.1016/j.colegn.2010.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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668
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Thompson KA, Philip KJ, Simsir S, Schwarz ER. Review: The New Concept of ‘‘Interventional Heart Failure Therapy’’: Part 2—Inotropes, Valvular Disease, Pumps, and Transplantation. J Cardiovasc Pharmacol Ther 2010; 15:231-43. [DOI: 10.1177/1074248410369111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent advances in heart failure therapy include a variety of mechanical and device-based technologies that target structural aspects of heart failure that cannot be treated with drug therapy alone; these newer therapies can collectively be described as interventional heart failure therapy. This article is the second in a 2-part series reviewing interventional heart failure therapy. Interventions included in this discussion include those indicated for the treatment of end-stage refractory heart failure, including interventional medical therapy, interventional treatment of valvular disease, mechanical assist devices, and heart transplantation. Also included is a review of the currently available catheter-based pumps, which are intended to provide temporary support in patients with acute hemodynamic compromise. The use of cellular or stem cell therapy for the treatment of heart failure is an emerging interventional therapy and data supporting its use for the treatment heart failure will also be presented, as will a discussion of the role of palliative care and self-care in heart failure therapy.
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Affiliation(s)
- Keith A. Thompson
- Department of Medicine, Division of Cardiology, Cedars Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Kiran J. Philip
- Department of Medicine, Division of Cardiology, Cedars Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Sinan Simsir
- Department of Medicine, Division of Cardiology, Cedars Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Ernst R. Schwarz
- Department of Medicine, Division of Cardiology, Cedars Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA,
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669
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Blakeman T, Bower P, Reeves D, Chew-Graham C. Bringing self-management into clinical view: a qualitative study of long-term condition management in primary care consultations. Chronic Illn 2010; 6:136-50. [PMID: 20444765 DOI: 10.1177/1742395309358333] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To understand social processes underpinning support for self-management of long-term conditions in primary care. METHODS Comparative analysis of observational and interview data concerning the management of long-term conditions in UK primary-care consultations. Analysis of recordings of primary care consultations (n = 86) was conducted in conjunction with analysis of semi-structured interviews with health professionals (n = 17) and patients (n = 12) living with a long-term condition. RESULTS A key finding was the infrequency with which self-management topics became legitimate objects for discussion in consultations. Analysis suggested that the maintenance of self-other relations was a prime objective for both patients and professionals, and the introduction of self-management topics threatened this process. Technology and the division of labour among primary-care professionals reinforced this tension. DISCUSSION In order for self-management support to become embedded and integrated into primary care, interventions concerning long-term condition management need to take into account this tension underpinning care.
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Affiliation(s)
- Tom Blakeman
- NPCRDC, The University of Manchester Williamson Building, Manchester, UK.
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670
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American Heart Association. J Cardiovasc Nurs 2010. [DOI: 10.1097/jcn.0b013e3181d6d896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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671
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Lee CS, Moser DK, Lennie TA, Riegel B. Event-free survival in adults with heart failure who engage in self-care management. Heart Lung 2010; 40:12-20. [PMID: 20561885 DOI: 10.1016/j.hrtlng.2009.12.003] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Revised: 11/02/2009] [Accepted: 12/10/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Self-care management in heart failure (HF) involves decision-making to evaluate, and actions to ameliorate symptoms when they occur. This study sought to compare the risks of all-cause mortality, hospitalization, or emergency-room admission among HF patients who practice above-average self-care management, those who practice below-average self-care management, and those who are symptom-free. METHODS A secondary analysis was conducted of data collected on 195 HF patients. A Cox proportional hazards model was used to examine the association between self-care management and event risk. RESULTS The sample consisted of older (mean ± standard deviation=61.3 ± 11 years), predominantly male (64.6%) adults, with an ejection fraction of 34.7% ± 15.3%; 60.1% fell within New York Heart Association class III or IV HF. During an average follow-up of 364 ± 288 days, 4 deaths, 82 hospitalizations, and 5 emergency-room visits occurred as first events. Controlling for 15 common confounders, those who engaged in above-average self-care management (hazard ratio, .44; 95% confidence interval, .22 to .88; P < .05) and those who were symptom-free (hazard ratio, 0.48; 95% confidence interval, .24 to .97; P < .05) ran a lower risk of an event during follow-up than those engaged in below-average self-care management. CONCLUSION Symptomatic HF patients who practice above-average self-care management have an event-free survival benefit similar to that of symptom-free HF patients.
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Affiliation(s)
- Christopher S Lee
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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672
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Understanding and Promoting Effective Self-Care During Heart Failure. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2010; 12:1-9. [DOI: 10.1007/s11936-009-0053-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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673
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Brenner S, Störk S, Angermann CE. [Treatment of chronic left ventricular failure]. Internist (Berl) 2009; 50:1325-36. [PMID: 19921109 DOI: 10.1007/s00108-009-2466-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Rising prevalence and disease-related costs render chronic heart failure a rapidly growing socioeconomic challenge. Guideline-adjusted diagnosis and appropriate therapy are successful in improving mortality, morbidity, functional status and quality of life of patients with chronic left ventricular failure. Corresponding state-of-art recommendations were recently published in the updated European and American treatment guidelines. They determine a stepwise escalation of pharmacological and surgical treatment measures according to increasing disease severity. Still, the complexity of the heart failure syndrome demands to tailor diagnostic procedures and therapy to the patients' individual needs and circumstances.
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Affiliation(s)
- S Brenner
- Medizinische Klinik und Poliklinik I, Universität Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Deutschland
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