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Abstract
Persons with heart failure (HF) symptoms delay up to 7 days before seeking treatment. Delay can result in worse symptoms and potentially impact outcomes. The purpose of this review was to describe predictors and outcomes of delay in HF patients. Demographic factors, increased symptom number, social factors, greater HF knowledge, lower anxiety, and depression predicted increased delay. HF patients had difficulty recognizing and interpreting symptoms of HF. Results are conflicting related to symptom pattern, time of care seeking, and history of HF as predictors of delay. The only outcome predicted by delay was length of stay with those delaying longer reporting longer lengths of stay. Future research related to delay should include theoretical frameworks and larger, more ethnically diverse samples from multiple sites and link delay to outcomes. Valid and reliable instruments are needed to measure delay and related factors. HF education should include supportive others.
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Clark AP, McDougall G, Riegel B, Joiner-Rogers G, Innerarity S, Meraviglia M, Delville C, Davila A. Health Status and Self-care Outcomes After an Education-Support Intervention for People With Chronic Heart Failure. J Cardiovasc Nurs 2015; 30:S3-13. [PMID: 24978157 PMCID: PMC4276559 DOI: 10.1097/jcn.0000000000000169] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The rising cost of hospitalizations for heart failure (HF) care mandates intervention models to address education for self-care success. The effectiveness of memory enhancement strategies to improve self-care and learning needs further examination. OBJECTIVE The objective of this study was to examine the effects of an education-support intervention delivered in the home setting, using strategies to improve health status and self-care in adults/older adults with class I to III HF. Our secondary purpose was to explore participants' subjective perceptions of the intervention. METHODS This study used a randomized, 2-group design. Fifty people were enrolled for 9 months and tested at 4 time points-baseline; after a 3-month education-support intervention; at 6 months, after 3 months of telephone/e-mail support; and 9 months, after a 3-month period of no contact. Advanced practice registered nurses delivered the intervention. Memory enhancement methods were built into the teaching materials and delivery of the intervention. We measured the intervention's effectiveness on health status outcomes (functional status, self-efficacy, quality of life, emotional state/depressive symptoms, and metamemory) and self-care outcomes (knowledge/knowledge retention, self-care ability). Subjects evaluated the usefulness of the intervention at the end of the study. RESULTS The mean age of the sample was 62.4 years, with a slight majority of female participants. Participants were well educated and had other concomitant diseases, including diabetes (48%) and an unexpected degree of obesity. The intervention group showed significant improvements in functional status, self-efficacy, and quality of life (Kansas City Cardiomyopathy Questionnaire); metamemory Change and Capacity subscales (Metamemory in Adulthood Questionnaire); self-care knowledge (HF Knowledge Test); and self-care (Self-care in Heart Failure Index). Participants in both groups improved in depressive scores (Geriatric Depression Scale). CONCLUSIONS An in-home intervention delivered by advanced practice registered nurses was successful in several health status and self-care outcomes, including functional status, self-efficacy, quality of life, metamemory, self-care status, and HF knowledge.
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Affiliation(s)
- Angela P Clark
- Angela P. Clark, PhD, RN, ACNS-BC, FAAN, FAHA Associate Professor of Nursing Emerita, The University of Texas at Austin. Graham McDougall, PhD, RN, FAAN, FGSA Professor of Nursing, The University of Alabama at Tuscaloosa. Barbara Riegel, PhD, RN, FAHA, FAAN Professor of Nursing, School of Nursing, The University of Pennsylvania, Philadelphia. Glenda Joiner-Rogers, PhD, RN, ACNS-BC Assistant Professor of Clinical Nursing, The University of Texas at Austin. Sheri Innerarity, PhD, RN, ACNS-BC, FNP Associate Professor of Clinical Nursing, The University of Texas at Austin. Martha Meraviglia, PhD, RN, ACNS-BC Associate Professor of Clinical Nursing, The University of Texas at Austin. Carol Delville, PhD, RN, ACNS-BC Assistant Professor of Clinical Nursing, The University of Texas at Austin. Ashley Davila, MSN, ACNS-BC Clinical Nurse Specialist, Texas Diabetes and Endocrinology, Austin
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Li CC, Shun SC. Understanding self care coping styles in patients with chronic heart failure: A systematic review. Eur J Cardiovasc Nurs 2015; 15:12-9. [DOI: 10.1177/1474515115572046] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 01/19/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Chia-Chien Li
- Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shiow-Ching Shun
- Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
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Reeder KM, Ercole PM, Peek GM, Smith CE. Symptom perceptions and self-care behaviors in patients who self-manage heart failure. J Cardiovasc Nurs 2015; 30:E1-7. [PMID: 24335834 PMCID: PMC4116472 DOI: 10.1097/jcn.0000000000000117] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with heart failure (HF) are at heightened risk for acute exacerbation requiring hospitalization. Although timely reporting of symptoms can expedite outpatient treatment and avoid the need for hospitalization, few patients recognize and respond to symptoms until acutely ill. OBJECTIVE The purpose of this study was to explore patients' perceptions of symptoms and self-care behaviors for symptom relief, leading up to a HF hospitalization. METHODS To examine prehospitalization symptom scenarios, semistructured interviews were conducted with 60 patients hospitalized for acute decompensated HF. RESULTS Thirty-seven patients (61.7%) said that they had a sense that "something just wasn't quite right" before their symptoms began but were unable to specify further. Signs and symptoms most often recognized by the patients were related to dyspnea (85%), fatigue (53.3%), and edema (41.7%). Few patients interpreted their symptoms as being related to worsening HF and most often attributed symptoms to changes in diet (18.3%) and medications (13.3%). Twenty-six patients (43.3%) used self-care strategies to relieve symptoms before hospital admission. More than 40% of the patients had symptoms at least 2 weeks before hospitalization. CONCLUSIONS Despite the wide dissemination of HF evidence-based guidelines, important components of symptom self-management remain suboptimal. Because most of HF self-management occurs in the postdischarge environment, research is needed that identifies how patients interpret symptoms of HF in the specific contexts in which patients self-manage their HF. These findings suggest the need for interventions that will help patients expeditiously recognize, accurately interpret, and use appropriate and safe self-care strategies for symptoms.
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Affiliation(s)
- Katherine M Reeder
- Katherine M. Reeder, PhD, RN Research Assistant Professor, Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri. Patrick M. Ercole, PhD, MPH Assistant Professor, Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri. Gina M. Peek, MSN, RN Assistant Professor, Newman Division of Nursing, Emporia State University, Kansas. Carol E. Smith, PhD, RN, FAAN Professor, School of Nursing & Preventive Medicine, Kansas University Medical Center, Kansas City
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Näsström L, Jaarsma T, Idvall E, Årestedt K, Strömberg A. Patient participation in patients with heart failure receiving structured home care--a prospective longitudinal study. BMC Health Serv Res 2014; 14:633. [PMID: 25519812 PMCID: PMC4279700 DOI: 10.1186/s12913-014-0633-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 12/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient participation is important for improving outcomes, respect for self-determination and legal aspects in care. However, how patients with heart failure view participation and which factors may be associated with participation is not known. The aim of this study was therefore to describe the influence of structured home care on patient participation over time in patients diagnosed with heart failure, and to explore factors associated with participation in care. METHODS The study had a prospective pre-post longitudinal design evaluating the influence of structured home care on participation in patients at four different home care units. Patient participation was measured using 3 scales and 1 single item. Self-care behavior, knowledge, symptoms of depression, socio- demographic and clinical characteristics were measured to explore factors associated with patient participation. Repeated measure ANOVA was used to describe change over time, and stepwise regression analyses were used to explore factors associated with patient participation. RESULTS One hundred patients receiving structured heart failure home care were included. Mean age was 82 years, 38 were women and 80 were in New York Heart Association functional class III. One aspect of participation, received information, showed a significant change over time and had increased at both six and twelve months. Better self-care behavior was associated with all four scales measuring different aspects of participation. Experiencing lower degree of symptoms of depression, having better knowledge, being of male sex, being of lower age, cohabiting and having home help services were associated with one or two of the four scales measuring different aspects of participation. CONCLUSION Patients experienced a fairly high level of satisfaction with participation in care at baseline, and there was a significant improvement over time for participation with regard to received information after being admitted to structured home care. Higher level of patient participation was consistently associated with better self-care behavior. This study shows that patient participation may need to be further focused upon, and that the association with self-care may be interesting to target in future interventions.
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Affiliation(s)
- Lena Näsström
- Department of Medical and Health Sciences, Linköping University, Linköping, 581 85, Sweden.
| | - Tiny Jaarsma
- Department of Social and Welfare studies, Linköping University, Norrköping, Sweden.
| | - Ewa Idvall
- Department of Care Science, Malmö University, and Department of Intensive Care and Perioperative Medicine, Skåne University Hospital, Malmö, Sweden.
| | - Kristofer Årestedt
- School of Health and Caring Sciences, Linnaeus University, Kalmar, and Palliative Research Centre, Ersta Sköndal University Collage and Ersta Hospital, Stockholm, Sweden. .,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Anna Strömberg
- Department of Medical and Health Sciences, Linköping University, and Department of Cardiology, County Council of Östergötland, Linköping, Sweden.
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58
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A Place to Get Worse: Perspectives on Avoiding Hospitalization from Patients with End-Stage Cardiopulmonary Disease. J Hosp Palliat Nurs 2014; 16:338-345. [PMID: 25328448 DOI: 10.1097/njh.0000000000000081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee KS, Lennie TA, Warden S, Jacobs-Lawson JM, Moser DK. A comprehensive symptom diary intervention to improve outcomes in patients with HF: a pilot study. J Card Fail 2014; 19:647-54. [PMID: 24054342 DOI: 10.1016/j.cardfail.2013.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 06/12/2013] [Accepted: 07/01/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Patients with heart failure must monitor for and recognize escalating symptoms to take action to relieve symptoms and decrease hospitalizations. However, symptom monitoring is not commonly performed. One way to promote patients' engagement in symptom monitoring is by providing a symptom diary. PURPOSE The aim of this study was to test the effect of a comprehensive daily symptom diary intervention on event-free survival and health-related quality of life (HRQOL). METHODS Patients were randomized into either intervention (n = 23) or usual-care groups (n = 21). The intervention group received a symptom diary with self-care education and counseling at baseline with 5 follow-up calls for 3 months. All patients were interviewed to obtain survival data at 1 month and 3 months. HRQOL was measured at baseline, 1 month, and 3 months. Kaplan-Meier curves with the log-rank test were used to compare group differences in time to first event. Linear mixed models were conducted to examine the relationship between groups and changes in HRQOL over 3 months. RESULTS The intervention group had longer event-free survival than the usual-care group (P = .03). There were no differences in changes in HRQOL scores between the groups over 3 months. CONCLUSIONS Positive effects of the intervention on survival were found. However, there was no significant difference in changes in HRQOL.
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Affiliation(s)
- Kyoung Suk Lee
- School of Nursing, University of Wisconsin, Madison, Wisconsin.
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61
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Abstract
In the assessment of dyspnea one has to take into account both the patient's own experience of the symptom and the clinicians observations of breathing rates, sounds and effort to get a complete picture. In addition, to choose appropriate treatment, the underlying cause of dyspnea needs to be assessed. While tools for clinical evaluation of heart failure have gained great interest in research and found a place in guidelines and clinical practice, the same cannot be said for instruments to assess patient self-reported dyspnea. To date, no specific dyspnea rating tool has been recommend over another. Reports from clinical practice are lacking and large; international studies in this field are warranted.
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Affiliation(s)
- Barbro Kjellström
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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Johansson P, Nieuwenhuis M, Lesman-Leegte I, van Veldhuisen DJ, Jaarsma T. Depression and the delay between symptom onset and hospitalization in heart failure patients. Eur J Heart Fail 2014; 13:214-9. [DOI: 10.1093/eurjhf/hfq200] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Peter Johansson
- Department of Cardiology; Linköping University Hospital; SE-58185, Linköping Sweden
- Department of Medicine and Health Sciences, Division of Cardiovascular Medicine; Faculty of Health Sciences Linköping University; Linköping Sweden
| | - Maurice Nieuwenhuis
- Department of Cardiology; University Medical Centre Groningen, University of Groningen; Groningen The Netherlands
| | - Ivonne Lesman-Leegte
- Department of Cardiology; University Medical Centre Groningen, University of Groningen; Groningen The Netherlands
| | - Dirk J. van Veldhuisen
- Department of Cardiology; University Medical Centre Groningen, University of Groningen; Groningen The Netherlands
| | - Tiny Jaarsma
- Department of Cardiology; University Medical Centre Groningen, University of Groningen; Groningen The Netherlands
- Department of Social and Welfare Studies; Faculty of Health Sciences Linköping University; Norrköping Sweden
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Ekman I, Granger B, Swedberg K, Stenlund H, Boman K. Measuring shortness of breath in heart failure (SOB-HF): development and validation of a new dyspnoea assessment tool. Eur J Heart Fail 2014; 13:838-45. [DOI: 10.1093/eurjhf/hfr062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Inger Ekman
- Gothenburg University Centre for Person-Centred Care (GPCC); Gothenburg Sweden
- Gothenburg University Centre for Person-Centred Care (GPCC); Gothenburg Sweden
| | - Bradi Granger
- Duke University Health Systems and Duke University School of Nursing; Durham NC USA
| | - Karl Swedberg
- Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy; University of Gothenburg; Sweden
- Gothenburg University Centre for Person-Centred Care (GPCC); Gothenburg Sweden
| | - Hans Stenlund
- Department of Medicine, Skellefteå County Hospital, HeartNet, Skeria, Skellefteå and Institute of Public Health and Clinical Medicine; Umeå University; Sweden
| | - Kurt Boman
- Department of Medicine, Skellefteå County Hospital, HeartNet, Skeria, Skellefteå and Institute of Public Health and Clinical Medicine; Umeå University; Sweden
- Department of Epidemiology; Institute of Public Health and Clinical Medicine, Umeå University; Sweden
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Ekman I, Kjellström B, Falk K, Norman J, Swedberg K. Impact of device-guided slow breathing on symptoms of chronic heart failure: a randomized, controlled feasibility study. Eur J Heart Fail 2014; 13:1000-5. [DOI: 10.1093/eurjhf/hfr090] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Inger Ekman
- Institute of Health and Care Sciences, the Sahlgrenska Academy; University of Gothenburg; Sweden
- Centre for Person-centered Care, (GPCC); University of Gothenburg; Sweden
| | - Barbro Kjellström
- Department of Cardiology; the Karolinska institute; Stockholm Sweden
| | - Kristin Falk
- Institute of Health and Care Sciences, the Sahlgrenska Academy; University of Gothenburg; Sweden
| | - Jonna Norman
- Institute of Health and Care Sciences, the Sahlgrenska Academy; University of Gothenburg; Sweden
| | - Karl Swedberg
- Centre for Person-centered Care, (GPCC); University of Gothenburg; Sweden
- Department of Emergency and Cardiovascular Medicine, the Sahlgrenska Academy; University of Gothenburg; Sweden
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Patel H, Shafazand M, Ekman I, Höjgård S, Swedberg K, Schaufelberger M. Home care as an option in worsening chronic heart failure- A pilot study to evaluate feasibility, quality adjusted life years and cost-effectiveness. Eur J Heart Fail 2014; 10:675-81. [DOI: 10.1016/j.ejheart.2008.05.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2007] [Revised: 04/11/2008] [Accepted: 05/22/2008] [Indexed: 11/25/2022] Open
Affiliation(s)
- Harshida Patel
- Institute of Health and Care Sciences, Sahlgrenska Academy; Sweden
- The Vårdal Institute, Göteborg University; Göteborg Sweden
| | - Masoud Shafazand
- Departments of Emergency and Cardiovascular Medicine, Sahlgrenska Academy; Göteborg Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy; Sweden
| | - Sören Höjgård
- Swedish Institute for Food and Agricultural Economics; Sweden
| | - Karl Swedberg
- Departments of Emergency and Cardiovascular Medicine, Sahlgrenska Academy; Göteborg Sweden
| | - Maria Schaufelberger
- Departments of Emergency and Cardiovascular Medicine, Sahlgrenska Academy; Göteborg Sweden
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Davidson PM, Inglis SC, Newton PJ. Self-care in patients with chronic heart failure. Expert Rev Pharmacoecon Outcomes Res 2014; 13:351-9. [DOI: 10.1586/erp.13.25] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Affiliation(s)
- Jillian Riley
- Head of Postgraduate Education (Nursing) Royal Brompton and Harefield NHS Foundation Trust, and Course Director MSc Cardiorespiratory Nursing, Imperial College, London
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68
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Riley J. Acute decompensated heart failure: diagnosis and management. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2013; 22:1290-1295. [PMID: 24335866 DOI: 10.12968/bjon.2013.22.22.1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Chronic heart failure is common in the UK, with a prevalence estimated at 3% of people aged between 65 and 74 years. This prevalence increases with age and affects approximately 15% of the older population (British Heart Foundation, 2011). A significant number of such people are diagnosed after presenting to their local emergency department with severe breathlessness. Advances in patient management have improved outcomes, but the prognosis remains poor. A recent epidemiological study of patients with heart failure in north west London reported that around 14% of patients die within 6 months of diagnosis (Mehta et al, 2009). The UK national audit data of 2011-2012 reported that approximately 11% of patients admitted to hospital with acute heart failure die during their in-hospital stay. For those discharged, there is a greater-than-25% risk of death within 12 months. This risk of in-hospital and 12-month mortality varies widely, but appears to largely relate to the inpatient management and organisation of follow-up (National Institute for Cardiovascular Outcomes Research, 2012).
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Affiliation(s)
- Jillian Riley
- Head of Postgraduate Education (Nursing), Royal Brompton and Harefield NHS Foundation Trust and Course Director, MSc Cardiorespiratory Nursing, Imperial College, London
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69
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Mohammadzadeh N, Safdari R, Rahimi A. Multi-agent system as a new approach to effective chronic heart failure management: key considerations. Healthc Inform Res 2013; 19:162-6. [PMID: 24195010 PMCID: PMC3810523 DOI: 10.4258/hir.2013.19.3.162] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 09/22/2013] [Accepted: 09/24/2013] [Indexed: 11/23/2022] Open
Abstract
Objectives Given the importance of the follow-up of chronic heart failure (CHF) patients to reduce common causes of re-admission and deterioration of their status that lead to imposing spiritual and physical costs on patients and society, modern technology tools should be used to the best advantage. The aim of this article is to explain key points which should be considered in designing an appropriate multi-agent system to improve CHF management. Methods In this literature review articles were searched with keywords like multi-agent system, heart failure, chronic disease management in Science Direct, Google Scholar and PubMed databases without regard to the year of publications. Results Agents are an innovation in the field of artificial intelligence. Because agents are capable of solving complex and dynamic health problems, to take full advantage of e-Health, the healthcare system must take steps to make use of this technology. Key factors in CHF management through a multi-agent system approach must be considered such as organization, confidentiality in general aspects and design and architecture points in specific aspects. Conclusions Note that use of agent systems only with a technical view is associated with many problems. Hence, in delivering healthcare to CHF patients, considering social and human aspects is essential. It is obvious that identifying and resolving technical and non-technical challenges is vital in the successful implementation of this technology.
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Affiliation(s)
- Niloofar Mohammadzadeh
- Department of Health Information Management, Tehran University of Medical Sciences, Tehran, Iran
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Näsström LM, Idvall EAC, Strömberg AE. Heart failure patients' descriptions of participation in structured home care. Health Expect 2013; 18:1384-96. [PMID: 23961912 DOI: 10.1111/hex.12120] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND To strengthen the patient's position in health care, patient participation has been decreed in policy documents and legalizations. For patients suffering from heart failure, self-care is an important part of disease management and participation is crucial to succeed with this. OBJECTIVE To examine how heart failure patients receiving structured home care described participation in the care. DESIGN Qualitative study. SETTING AND PARTICIPANTS Thirteen men and six women, aged between 63 and 90 years, were interviewed. The informants received structured home care at four home care units in Sweden. The interviews were analysed using qualitative content analysis. RESULTS Five categories with associated subcategories describing participation in care were identified: communication between patients and health-care professionals (HCPs) including time and space for dialogue and exchange of care-related information, accessibility to care through awareness of the plan for home visits or feasibility to initiate home visits, active involvement in care by engaging in self-care and collaboration with HCPs, trustful relation with HCPs, with confidence in competence and individually adapted care, options for decision making, by making decisions or entrusting decisions. CONCLUSIONS Patient participation could be strengthened through structured home care. Participation was facilitated when there was a balance between the patient's own preferences to influence care and the health-care professional's actions and values and the organization of care. Barriers to participation could depend on the health-care organization, lack of continuity and confidence in HCPs.
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Affiliation(s)
- Lena M Näsström
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
| | - Ewa A-C Idvall
- Department of Care Science, Malmö University, Malmö, Sweden.,Department of Intensive Care and Perioperative Medicine, Skåne University Hospital, Malmö, Sweden
| | - Anna E Strömberg
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden.,Department of Cardiology, County Council of Östergötland, Linköping, Sweden.,Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
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71
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Zambroski CH, Bekelman DB. Palliative symptom management in patients with heart failure. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/096992608x346206] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Vellone E, Riegel B, D'Agostino F, Fida R, Rocco G, Cocchieri A, Alvaro R. Structural equation model testing the situation-specific theory of heart failure self-care. J Adv Nurs 2013; 69:2481-92. [DOI: 10.1111/jan.12126] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2013] [Indexed: 01/09/2023]
Affiliation(s)
| | - Barbara Riegel
- School of Nursing; University of Pennsylvania; Philadelphia USA
| | | | - Roberta Fida
- Department of Psychology; “Sapienza” University; Rome Italy
| | - Gennaro Rocco
- Center of Excellence for Nursing Scholarship; Rome Italy
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Dudas K, Olsson LE, Wolf A, Swedberg K, Taft C, Schaufelberger M, Ekman I. Uncertainty in illness among patients with chronic heart failure is less in person-centred care than in usual care. Eur J Cardiovasc Nurs 2013; 12:521-8. [PMID: 23303766 DOI: 10.1177/1474515112472270] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many patients with chronic heart failure (CHF) experience uncertainty regarding the treatment and characteristics of their illness. Person-centred care (PCC) emphasizes patient involvement in care. We have previously shown that PCC improved outcomes such as length of hospital stay and activities of daily living in patients with CHF. The impact of PCC on self-reported uncertainty in illness among patients hospitalized for CHF is still unknown. AIM To evaluate whether PCC is associated with less self-reported uncertainty in illness compared with usual care in patients hospitalized for worsening CHF. METHODS Using a controlled before-and-after design, eligible CHF patients were assigned to either a usual care group or a PCC intervention group. Patient-reported uncertainty in illness was assessed at hospital discharge with the Cardiovascular Population Scale (CPS). The CPS consists of two domains: 1) Ambiguity (about illness severity); and 2) Complexity (of treatment and system of care). RESULTS Two hundred and forty-eight patients were included in the study; 123 in the usual care group and 125 in the PCC intervention. The PCC group had better scores than the usual care group in the CPS domains complexity (M=15.2, SD=4.7 vs. M=16.8, SD=4.7; p=0.020) and ambiguity (M=27.8, SD=6.6 vs. M=29.8, SD=6.9; p=0.041). CONCLUSION Patients with CHF were less uncertain in their illness after PCC, which may help to equip and empower patients to manage their illness. Together with earlier findings of shortened hospital stay and improved activities of daily living, this indicates that PCC should be a standard approach for hospital care of patients with worsening CHF.
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Affiliation(s)
- Kerstin Dudas
- 1Institute of Health and Care Science, Gothenburg, Sweden
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Eicher M, Delmas P, Cohen C, Baeriswyl C, Viens Python N. Version Française de la Théorie de Gestion des Symptômes (TGS) et son application. Rech Soins Infirm 2013. [DOI: 10.3917/rsi.112.0014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
Nearly 50% of adults have one or more chronic illnesses. Self-care is considered essential in the management of chronic illness, but the elements of self-care in this context have not been specified in a middle-range theory. This article describes a middle-range theory of self-care that addresses the process of maintaining health with health promoting practices within the context of the management required of a chronic illness. The key concepts include self-care maintenance, self-care monitoring, and self-care management. Assumptions and propositions of the theory are specified. Factors influencing self-care including experience, skill, motivation, culture, confidence, habits, function, cognition, support from others, and access to care are described.
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77
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Clark AM, Savard LA, Spaling MA, Heath S, Duncan AS, Spiers JA. Understanding help-seeking decisions in people with heart failure: a qualitative systematic review. Int J Nurs Stud 2012; 49:1582-97. [PMID: 22721677 DOI: 10.1016/j.ijnurstu.2012.05.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 04/23/2012] [Accepted: 05/23/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To understand the process of help-seeking among heart failure patients from the perspectives of patients, caregivers and health professionals. DESIGN Systematic review using qualitative meta-synthesis. METHODS A systematic search (20th May 2011) was conducted to identify studies published in English as full papers ≥1995 reporting primary qualitative data with extractable heart failure-specific data or themes related to help-seeking in patients, caregivers or health professionals. Databases searched were: CINAHL, Medline, PsycInfo, Social Science Citation Index, Embase, Social policy/Practice, SocIndex, Ageline, Health Source Nursing, Scopus; additionally, we consulted with experts and manually searched references. RESULTS 58 studies (990 patients; 274 female, 527 male, 189 sex not described; 229 caregivers, 79 health professionals) were included. Heart failure help-seeking was embedded in daily experiences of heart failure but ongoing symptoms were confusing, ambiguous and disruptive; little support was available from professionals to interpret the presence and significance of fluctuations in symptoms for help-seeking. Other significant barriers to help-seeking were: avoidance-based coping, fear of hospitals and misplaced reluctance to be burdensome. Help-seeking was facilitated by good involvement and frank communication between patients, caregivers and health professionals and the presence of a sense of elevated personal risk. CONCLUSION Health services should harness primary care providers and support patients and caregivers to prioritize development of objective symptom monitoring skills, recognize and personally assimilate the elevated risks of heart failure and help-seeking delays and discourage avoidance-based coping and unwarranted concerns that downplay the significance of heart failure and urgency to address symptoms.
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79
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Gallagher R, Sullivan A, Hales S, Gillies G, Burke R, Tofler G. Symptom patterns, duration and responses in newly diagnosed patients with heart failure. Int J Nurs Pract 2012; 18:133-9. [DOI: 10.1111/j.1440-172x.2012.02010.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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80
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Shafazand M, Patel H, Ekman I, Swedberg K, Schaufelberger M. Patients with worsening chronic heart failure who present to a hospital emergency department require hospital care. BMC Res Notes 2012; 5:132. [PMID: 22401538 PMCID: PMC3315737 DOI: 10.1186/1756-0500-5-132] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 03/08/2012] [Indexed: 11/28/2022] Open
Abstract
Background Chronic heart failure (CHF) is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors. To characterise patients with CHF who seek an emergency department (ED) because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital. Method Patients (n = 2,648) seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF. Results Although several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate. Conclusion The vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.
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Affiliation(s)
- Masoud Shafazand
- Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra, University of Gothenburg, Gothenburg, Sweden.
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81
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Johansson P, van der Wal M, van Veldhuisen DJ, Jaarsma T. Association between prehospital delay and subsequent clinical course in patients with/hospitalized for heart failure. J Card Fail 2012; 18:202-7. [PMID: 22385940 DOI: 10.1016/j.cardfail.2011.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 12/19/2011] [Accepted: 12/21/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND The clinical consequences of prehospital delay in heart failure (HF) patients are unknown. This study explores the relationship between prehospital delay of HF patients and length of hospital stay, plasma values of brain natriuretic peptides (BNP) as well as the association of delay with all-cause mortality, readmission for HF, or all-cause readmissions during short- (60 days) and long-term (18 months) follow-up. METHODS Data from 1023 hospitalized HF patients mean aged 71 years from the Coordinating study evaluating Outcomes of Advising and Counselling in HF study were analyzed. RESULTS Patients who delayed less than 1 day had significantly shorter stay in hospital (10 days vs. 11 days, P = 0.033). They also had significantly (P = 0.004) lower median plasma values of BNP (377 pg/mL) at discharge compared to patients who delayed >24 hours (492 pg/mL). Delay was not related to all-cause mortality and/or readmissions for HF. CONCLUSION Although patients with a prehospital delay less than 1 day were more symptomatic on admission, they had a shorter hospital stay as well as lower plasma values of BNP at discharge. Delay was not associated hospital readmissions or mortality after discharge.
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Affiliation(s)
- Peter Johansson
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden.
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82
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Dendale P, De Keulenaer G, Troisfontaines P, Weytjens C, Mullens W, Elegeert I, Ector B, Houbrechts M, Willekens K, Hansen D. Effect of a telemonitoring-facilitated collaboration between general practitioner and heart failure clinic on mortality and rehospitalization rates in severe heart failure: the TEMA-HF 1 (TElemonitoring in the MAnagement of Heart Failure) study. Eur J Heart Fail 2011; 14:333-40. [PMID: 22045925 DOI: 10.1093/eurjhf/hfr144] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
AIMS Chronic heart failure (CHF) patients are frequently rehospitalized within 6 months after an episode of fluid retention. Rehospitalizations are preventable, but this requires an extensive organization of the healthcare system. In this study, we tested whether intensive follow-up of patients through a telemonitoring-facilitated collaboration between general practitioners (GPs) and a heart failure clinic could reduce mortality and rehospitalization rate. METHODS AND RESULTS One hunderd and sixty CHF patients [mean age 76 ± 10 years, 104 males, mean left ventricular ejection fraction (LVEF) 35 ± 15%] were block randomized by sealed envelopes and assigned to 6 months of intense follow-up facilitated by telemonitoring (TM) or usual care (UC). The TM group measured body weight, blood pressure, and heart rate on a daily basis with electronic devices that transferred the data automatically to an online database. Email alerts were sent to the GP and heart failure clinic to intervene when pre-defined limits were exceeded. All-cause mortality was significantly lower in the TM group as compared with the UC group (5% vs. 17.5%, P = 0.01). The total number of follow-up days lost to hospitalization, dialysis, or death was significantly lower in the TM group as compared with the UC group (13 vs. 30 days, P = 0.02). The number of hospitalizations for heart failure per patient showed a trend (0.24 vs. 0.42 hospitalizations/patient, P = 0.06) in favour of TM. CONCLUSION Telemonitoring-facilitated collaboration between GPs and a heart failure clinic reduces mortality and number of days lost to hospitalization, death, or dialysis in CHF patients. These findings need confirmation in a large trial.
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Affiliation(s)
- Paul Dendale
- Hasselt University, Faculty of Medicine, Diepenbeek, Belgium.
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83
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Factors Associated With Patient Delay in Seeking Care After Worsening Symptoms in Heart Failure Patients. J Card Fail 2011; 17:657-63. [DOI: 10.1016/j.cardfail.2011.04.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 03/16/2011] [Accepted: 04/06/2011] [Indexed: 11/22/2022]
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84
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Son YJ, Lee Y, Song EK. Adherence to a sodium-restricted diet is associated with lower symptom burden and longer cardiac event-free survival in patients with heart failure. J Clin Nurs 2011; 20:3029-38. [DOI: 10.1111/j.1365-2702.2011.03755.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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85
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Gravely S, Tamim H, Smith J, Daly T, Grace SL. Non-symptom-related factors contributing to delay in seeking medical care by patients with heart failure: a narrative review. J Card Fail 2011; 17:779-87. [PMID: 21872149 DOI: 10.1016/j.cardfail.2011.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 05/03/2011] [Accepted: 05/05/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Delay in seeking timely medical care by patients with acute coronary syndrome and stroke has been well established in the literature, but less is known about delay in care-seeking behavior by patients with heart failure (HF). The purpose of this narrative review was to synthesize the literature regarding non-symptom-related factors that contribute to delay in seeking medical care for HF symptoms. METHODS AND RESULTS A literature search of Scopus, Medline, and Pubmed was conducted for published articles from database inception to July 2009. Available evidence has shown that non-symptom-related factors, such as HF severity, HF history, age, and ethnocultural background, were related to delay in certain studies; however, null results have also been reported. Other non-symptom-related factors, such as male gender, initial contact with a primary care physician, arriving in the emergency department by means other than ambulance, and patient responses such as self-care, low anxiety, and hopelessness, may play a role in longer delay. CONCLUSIONS Although this review identified several non-symptom-related factors that may be implicated in care-seeking delay, health care professionals should be vigilant in identifying all high-risk individuals and educating them about warning signs of HF. Moreover, access to outpatient chronic disease management programs that may have potential to reduce care-seeking delay behavior should be explored.
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86
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Suh MK, Chen CA, Woodbridge J, Tu MK, Kim JI, Nahapetian A, Evangelista LS, Sarrafzadeh M. A remote patient monitoring system for congestive heart failure. J Med Syst 2011; 35:1165-79. [PMID: 21611788 DOI: 10.1007/s10916-011-9733-y] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 05/03/2011] [Indexed: 11/25/2022]
Abstract
Congestive heart failure (CHF) is a leading cause of death in the United States affecting approximately 670,000 individuals. Due to the prevalence of CHF related issues, it is prudent to seek out methodologies that would facilitate the prevention, monitoring, and treatment of heart disease on a daily basis. This paper describes WANDA (Weight and Activity with Blood Pressure Monitoring System); a study that leverages sensor technologies and wireless communications to monitor the health related measurements of patients with CHF. The WANDA system is a three-tier architecture consisting of sensors, web servers, and back-end databases. The system was developed in conjunction with the UCLA School of Nursing and the UCLA Wireless Health Institute to enable early detection of key clinical symptoms indicative of CHF-related decompensation. This study shows that CHF patients monitored by WANDA are less likely to have readings fall outside a healthy range. In addition, WANDA provides a useful feedback system for regulating readings of CHF patients.
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Affiliation(s)
- Myung-kyung Suh
- Computer Science Department, University of California, Los Angeles, CA, USA.
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87
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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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88
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Abstract
BACKGROUND Physical symptoms are likely to occur in clusters that may be associated with adverse outcome in patients with heart failure (HF). Despite the importance of early recognition of worsening symptoms in HF management, the impact of physical symptoms on adverse outcome has not been explored in the context of symptom clusters. PURPOSE The purposes of this study were to explore which physical symptom clusters occur in HF patients and to determine the impact of symptom clusters on event-free survival. METHODS A total of 421 patients (60% male; 62 [SD, 14] years; 72% New York Heart Association class II/III) completed the modified Memorial Symptom Assessment Scale-Heart Failure to measure physical symptoms during an index hospitalization in Seoul, Korea. Times to first event of cardiac rehospitalization and cardiac death were collected for 12 months after discharge and confirmed by review of hospital records. An agglomerative hierarchical clustering approach with Ward's method was used to identify symptom clusters. Hierarchical Cox hazard regression was used to determine the impact of symptom clusters on cardiac rehospitalization and cardiac mortality. RESULTS Two distinct symptom clusters, the dyspneic and the weary symptom clusters, occurred in patients with HF. Shortness of breath, difficulty breathing when lying flat, and waking up breathless at night comprised the dyspneic symptom cluster. Lack of energy, lack of appetite, and difficulty sleeping comprised the weary symptom cluster. In hierarchical Cox hazard regression, elevated distress from the weary symptom cluster independently predicted cardiac rehospitalization (hazard ratio, 1.45; 95% confidence interval, 1.09-1.93), and increased distress from the dyspneic symptom cluster independently predicted cardiac mortality (hazard ratio, 2.00; 95% confidence interval, 1.16-3.34). CONCLUSION The weary and the dyspneic symptom clusters predicted cardiac rehospitalization and cardiac mortality, respectively. Patient education for self-monitoring of symptoms should focus on symptom clusters rather than single symptom.
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89
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Albert N, Trochelman K, Li J, Lin S. Signs and symptoms of heart failure: are you asking the right questions? Am J Crit Care 2010; 19:443-52. [PMID: 19940253 DOI: 10.4037/ajcc2009314] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients may not verbalize common and atypical signs and symptoms of heart failure and may not understand their association with worsening disease and treatments. OBJECTIVES To examine prevalence of signs and symptoms relative to demographics, care setting, and functional class. METHODS A convenience sample of 276 patients (164 ambulatory, 112 hospitalized) with systolic heart failure completed a 1-page checklist of signs and symptoms experienced in the preceding 7 days (ambulatory) or in the 7 days before hospitalization. Demographic and medical history data were collected. RESULTS Mean age was 61.6 (SD, 14.8) years, 65% were male, 58% were white, and 45% had ischemic cardiomyopathy. Hospitalized patients reported more sudden weight gain, weight loss, severe cough, low/orthostatic blood pressure, profound fatigue, decreased exercise, restlessness/confusion, irregular pulse, and palpitations (all P < .05). Patients in functional class IV reported more atypical signs and symptoms of heart failure (severe cough, nausea/vomiting, diarrhea or loss of appetite, and restlessness, confusion, or fainting, all P <or= .001). Sudden weight gain increased from 5% in functional class I to 37.5% in functional class IV (P < .001). Dyspnea occurred in all functional classes (98%-100%) and both settings (92%-100%). Profound fatigue was associated with worsening functional class (P < .001) and hospital setting (P = .001); paroxysmal nocturnal dyspnea was associated with functional class IV (P = .02) and hospital setting (P < .001). CONCLUSION Profound fatigue is more reliable than dyspnea as an indicator of functional class. Nurses must recognize atypical signs and symptoms of worsening functional class to determine clinical status and facilitate patient care decisions.
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Affiliation(s)
- Nancy Albert
- Nancy Albert is director of nursing research and innovation in the Nursing Institute and a clinical nurse specialist in the Kaufman Center for Heart Failure, Kathleen Trochelman is a nurse researcher in nursing research and innovation at the Nursing Institute, and Jianbo Li is a statistician and Songhua Lin is a statistical programmer, both in Quantitative Health Sciences, at Cleveland Clinic in Cleveland, Ohio
| | - Kathleen Trochelman
- Nancy Albert is director of nursing research and innovation in the Nursing Institute and a clinical nurse specialist in the Kaufman Center for Heart Failure, Kathleen Trochelman is a nurse researcher in nursing research and innovation at the Nursing Institute, and Jianbo Li is a statistician and Songhua Lin is a statistical programmer, both in Quantitative Health Sciences, at Cleveland Clinic in Cleveland, Ohio
| | - Jianbo Li
- Nancy Albert is director of nursing research and innovation in the Nursing Institute and a clinical nurse specialist in the Kaufman Center for Heart Failure, Kathleen Trochelman is a nurse researcher in nursing research and innovation at the Nursing Institute, and Jianbo Li is a statistician and Songhua Lin is a statistical programmer, both in Quantitative Health Sciences, at Cleveland Clinic in Cleveland, Ohio
| | - Songhua Lin
- Nancy Albert is director of nursing research and innovation in the Nursing Institute and a clinical nurse specialist in the Kaufman Center for Heart Failure, Kathleen Trochelman is a nurse researcher in nursing research and innovation at the Nursing Institute, and Jianbo Li is a statistician and Songhua Lin is a statistical programmer, both in Quantitative Health Sciences, at Cleveland Clinic in Cleveland, Ohio
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90
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Gravely-Witte S, Jurgens CY, Tamim H, Grace SL. Length of delay in seeking medical care by patients with heart failure symptoms and the role of symptom-related factors: a narrative review. Eur J Heart Fail 2010; 12:1122-9. [PMID: 20685686 DOI: 10.1093/eurjhf/hfq122] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS The delay in seeking timely medical care by patients with acute coronary syndrome and stroke is well established. Less is known about the delay in patients with heart failure (HF). Reducing the delay in seeking care and the early initiation of treatment is associated with improved outcomes in patients with HF. The purpose of this narrative review was to describe the length of the delay in seeking care for HF symptoms and identify symptom-related factors that contribute to the delay in seeking medical care. METHODS AND RESULTS A literature search was conducted to identify English language studies that (i) describe the length of care-seeking delay for HF symptoms and/or (ii) identify symptom-related factors that contribute to delay in seeking medical care. The results of this review demonstrate that upon hospital admission patients report wide variations in median symptom time course from 2 h to 7 days from the onset of symptoms to hospital admission. The ability of patients to recognize, interpret, and appraise HF symptoms has been demonstrated to be limited. Symptom characteristics such as dyspnoea, oedema, orthopnoea, higher somatic awareness, higher symptom distress, nocturnal symptom onset, and the pattern of symptom onset were related to longer delay in care-seeking for HF symptoms. Furthermore, cognitive responses to HF may also play an important role in symptom appraisal. CONCLUSION Delays in seeking care for HF symptoms have been shown to range from hours to days from symptom onset to hospital admission. Healthcare professionals should therefore be more vigilant in identifying high-risk individuals and educating them about the warning signs of HF. Moreover, access to outpatient chronic disease management programmes may have the potential to reduce these delays.
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Affiliation(s)
- Shannon Gravely-Witte
- York University, Faculty of Health, Norman Bethune College 368, 4700 Keele Street, Toronto, Ontario, Canada M3J 1P3
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91
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Moser DK, Frazier SK, Worrall-Carter L, Biddle MJ, Chung ML, Lee KS, Lennie TA. Symptom variability, not severity, predicts rehospitalization and mortality in patients with heart failure. Eur J Cardiovasc Nurs 2010; 10:124-9. [PMID: 20637697 DOI: 10.1016/j.ejcnurse.2010.05.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 05/20/2010] [Accepted: 05/26/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Inability of heart failure (HF) patients to recognize worsening symptoms that herald an exacerbation is a common reason for HF readmissions. AIMS To examine the relationship between patterns of HF symptom variability, and HF event-free survival. METHODS Patients with HF (N=71) rated HF symptoms daily for 30 days. Symptoms were rated on a 10 point scale anchored at the extreme ends by "worst symptom could be" and "best symptom could be". Patients were followed for an average of 1 year to track HF and cardiac rehospitalizations and all-cause mortality. RESULTS Cox regression comparing event-free survival between patients who had highly variable symptom ratings across the 30-days and those whose symptoms were less variable revealed worse event-free survival in patients with more variable symptoms of shortness of breath or edema. Symptom variability predicted event-free survival independently of severity of symptoms, ejection fraction, comorbidities, age and gender. Symptom severity did not predict rehospitalization or mortality. CONCLUSION Regardless of symptom severity, patients whose symptoms fluctuated in an improving and worsening pattern were at substantially greater risk for poorer event-free survival. These patients may become accustomed to this pattern such that they expect symptoms to improve and thus do not seek treatment with worsening symptoms.
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Affiliation(s)
- Debra K Moser
- University of Kentucky, Lexington, KY 40536-0232, United States.
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92
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Pulignano G, Del Sindaco D, Minardi G, Tarantini L, Cioffi G, Bernardi L, Di Biagio D, Leonetti S, Giovannini E. Translation and validation of the Italian version of the European Heart Failure Self-care Behaviour Scale. J Cardiovasc Med (Hagerstown) 2010; 11:493-8. [DOI: 10.2459/jcm.0b013e328335fbf5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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93
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Cameron J, Worrall-Carter L, Page K, Riegel B, Lo SK, Stewart S. Does cognitive impairment predict poor self-care in patients with heart failure? Eur J Heart Fail 2010; 12:508-15. [PMID: 20354031 DOI: 10.1093/eurjhf/hfq042] [Citation(s) in RCA: 206] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Cognitive impairment occurs often in patients with chronic heart failure (CHF) and may contribute to sub-optimal self-care. This study aimed to test the impact of cognitive impairment on self-care. METHODS AND RESULTS In 93 consecutive patients hospitalized with CHF, self-care (Self-Care of Heart Failure Index) was assessed. Multiple regression analysis was used to test a model of variables hypothesized to predict self-care maintenance, management, and confidence. Variables in the model were mild cognitive impairment (MCI; Mini-Mental State Exam and Montreal Cognitive Assessment), depressive symptoms (Cardiac Depression Scale), age, gender, social isolation, education level, new diagnosis, and co-morbid illnesses. Sixty-eight patients (75%) were coded as having MCI and had significantly lower self-care management (eta(2)= 0.07, P < 0.01) and self-confidence scores (eta(2)= 0.05, P < 0.05). In multivariate analysis, MCI, co-morbidity index, and NYHA class III or IV explained 20% of the variance in self-care management (P < 0.01); MCI made the largest contribution explaining 9% of the variance. Increasing age and symptoms of depression explained 13% of the variance in self-care confidence scores (P < 0.01). CONCLUSION Cognitive impairment, a hidden co-morbidity, may impede patients' ability to make appropriate self-care decisions. Screening for MCI may alert health professionals to those at greater risk of failed self-care.
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Affiliation(s)
- Jan Cameron
- School of Nursing & Midwifery (Victoria), Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia.
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94
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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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95
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Welstand J, Carson A, Rutherford P. Living with heart failure: An integrative review. Int J Nurs Stud 2009; 46:1374-85. [DOI: 10.1016/j.ijnurstu.2009.03.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 01/29/2009] [Accepted: 03/10/2009] [Indexed: 10/20/2022]
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96
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Jurgens CY, Hoke L, Byrnes J, Riegel B. Why do elders delay responding to heart failure symptoms? Nurs Res 2009; 58:274-82. [PMID: 19609179 DOI: 10.1097/nnr.0b013e3181ac1581] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Elders with heart failure (HF) are at risk for frequent hospitalizations for symptom management. Repeated admissions are partly related to delay in responding to HF symptoms. Contextual factors such as prior illness experiences and social/emotional factors may affect symptom interpretation and response. The Self-Regulation Model of Illness guided this study as it acknowledges the dynamic nature of illness and influence of contextual factors and social environment on the interpretation and response to symptoms. OBJECTIVE The purpose of this study was to describe contextual factors related to symptom recognition and response among elders hospitalized with decompensated HF. METHODS A mixed-methods design was used. The HF Symptom Perception Scale (physical factors), Specific Activity Scale (functional performance), and Response to Symptoms Questionnaire (cognitive/emotional factors) were administered to participants aged >or=65 years. Symptom duration and clinical details were collected by interview and chart review. Open-ended questions addressing the symptom experience, including the context in which symptoms occurred, were audiotaped, transcribed, analyzed, and compared across cases to inform the quantitative data. RESULTS The convenience sample (n = 77) was 48% female, 85.7% were non-Hispanic White, and mean age was 75.9 years (SD = 7.7 years). Functional performance was low (81% class III/IV). The most frequently reported symptoms were dyspnea, dyspnea on exertion, and fatigue. Median duration of early symptoms of HF decompensation was 5 to 7 days, but dyspnea duration ranged from 30 minutes to 90 days before action was taken. Longer dyspnea duration was associated with higher physical symptom distress (r = .30) and lower anxiety (r = -.31). Sensing and attributing meaning to early symptoms of HF decompensation were problematic. DISCUSSION The physical symptom experience and the cognitive and emotional response to HF symptoms were inadequate for timely care seeking for most of this older aged sample.
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Affiliation(s)
- Corrine Y Jurgens
- School of Nursing, Stony Brook University, Stony Brook, NY 11794-8240, USA.
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97
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Falk K, Patel H, Swedberg K, Ekman I. Fatigue in Patients with Chronic Heart Failure — A Burden Associated with Emotional and Symptom Distress. Eur J Cardiovasc Nurs 2009; 8:91-6. [DOI: 10.1016/j.ejcnurse.2008.07.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 04/28/2008] [Accepted: 07/02/2008] [Indexed: 11/28/2022]
Affiliation(s)
- Kristin Falk
- Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Sweden
| | - Harshida Patel
- Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Sweden
- The Vårdal Institute, The Swedish Institute for Health Sciences, Lund, Sweden
| | - Karl Swedberg
- Department of Emergency and Cardiovascular Medicine, the Sahlgrenska Academy at Göteborg University, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Sweden
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98
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Clark AM, Freydberg CN, McAlister FA, Tsuyuki RT, Armstrong PW, Strain LA. Patient and informal caregivers' knowledge of heart failure: necessary but insufficient for effective self-care. Eur J Heart Fail 2009; 11:617-21. [PMID: 19414477 DOI: 10.1093/eurjhf/hfp058] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Self-care of heart failure (HF) is a process that is important, complex, and challenging. Little is understood of the contextual factors influencing self-care. We aimed to examine the individual and contextual factors perceived by patients and their informal caregivers' to influence their willingness and capacity to undertake effective HF self-care. METHODS AND RESULTS This was a qualitative study using semi-structured interviews with 42 patients with HF (NYHA Class II and III, mean age: 76 years, 64% males) and 30 nominated caregivers (63% spouses). All patients experienced severe and intrusive HF symptoms; a large proportion of patients practiced some of the range of recommended self-care activities. However, links between knowledge of HF and self-care were weak and long delays in seeking professional care were frequent. Factors consistently reported to influence self-care were faith in health professionals, beliefs about the local health system, and values linked to work associated with place, history, and culture. CONCLUSION Knowledge of HF and its management is a necessary though not sufficient determinant of HF self-care. Individual and contextual factors influence willingness and capacity to undertake effective HF self-care.
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Affiliation(s)
- Alexander M Clark
- Faculty of Nursing, Level 3 CSB, University of Alberta, Edmonton, AB, Canada T6R 2R6.
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99
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Hedemalm A, Schaufelberger M, Ekman I. Reported Adherence and Social Support Among Immigrants Compared to Native Swedes. J Immigr Minor Health 2009; 12:124-31. [DOI: 10.1007/s10903-009-9235-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Accepted: 02/13/2009] [Indexed: 10/21/2022]
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100
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Annema C, Luttik ML, Jaarsma T. Reasons for readmission in heart failure: Perspectives of patients, caregivers, cardiologists, and heart failure nurses. Heart Lung 2009; 38:427-34. [PMID: 19755193 DOI: 10.1016/j.hrtlng.2008.12.002] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Revised: 12/01/2008] [Accepted: 12/01/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Despite efforts to improve outcomes in heart failure (HF), readmission rates remain relatively high. Reasons for readmission from different perspectives (patient, caregiver, health care providers) may help to optimize the future management of patients with HF. The aims of this study are to 1) gain insight into reasons for HF readmission from the perspective of patients, caregivers, cardiologists, and HF nurses; 2) examine similarities and differences in perspectives on the reason for an HF readmission, and 3) describe possibilities to prevent an HF readmission from different perspectives. METHODS AND RESULTS Data on reasons for readmission were collected on 173 readmissions. Perspectives of patients, caregivers, cardiologists, and HF nurses were collected by interview and questionnaire. Worsening HF as the sole reason for readmission was reported most often; however, 36% of caregivers, 56% of patients, and 63% to 65% of health care providers indicated that other factors, such as comorbidity, nonadherence, and nonoptimal medication, were important contributing factors. In only 34% of readmissions, patients and their caregivers agreed with health care providers on the underlying reason. Respondents reported that 23% to 31% of the readmissions could probably have been prevented if adherence were higher, patients requested help earlier, and adequate multidisciplinary professional help were available. CONCLUSION To prevent future readmissions of patients with HF, it is important to fully understand the reasons for readmission by gaining insight on the reason for readmission from different perspectives. Also, we may need another approach to prevent adverse outcomes in which other medical problems and new strategies to improve adherence have to be considered.
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Affiliation(s)
- Coby Annema
- Department of Cardiology, University Medical Center Groningen, The Netherlands
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