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Xu M, Ruan T, Huang X, Han B, Li Y, Ding Y, Zhu L. Care-seeking delay of patients with heart failure in China: a mixed-method study. ESC Heart Fail 2024; 11:2086-2099. [PMID: 38567397 PMCID: PMC11287340 DOI: 10.1002/ehf2.14757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/24/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
AIM This study aims to explore the duration and influencing factors of care-seeking delay among patients with heart failure (HF) in China. METHODS AND RESULTS A convergent mixed method containing a cross-sectional study and two parts of qualitative studies was designed, following the STROBE and COREQ guidelines. Convenience sampling was applied to recruit patients with HF from two general hospitals from December 2021 to December 2022. Purposive sampling was used to enrol healthcare professionals from two general hospitals and two community hospitals from June to November 2022. Among the 258 patients with HF in the cross-sectional study, the median duration of care-seeking delay was 7.5 days. The result integration indicated that the delay duration was influenced by the dyspnoea symptom burden, the oedema symptom burden, and the depression status. The lower dyspnoea symptom burden, the higher oedema symptom burden, and the higher depression score were related to the prolonged care-seeking delay duration. The duration was also affected by the COVID-19 pandemic, level of support from medical system, and the symptom management abilities of the caregivers. The COVID-19 pandemic, low level of support from medical system, and limited symptom management abilities of caregivers were related to the prolonged care-seeking delay duration. CONCLUSIONS Care-seeking delay among patients with HF needs attention in China. The duration of care-seeking delay of patients with HF was influenced by the dyspnoea symptom burden, the oedema symptom burden, and depression status, as well as the COVID-19 pandemic, level of support from medical system, and the symptom management abilities of the caregivers.
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Affiliation(s)
- Mengqi Xu
- Department of NursingShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Tiantian Ruan
- School of NursingShanghai Jiao Tong UniversityShanghaiChina
| | - Xiaoli Huang
- Department of CardiologyShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Beibei Han
- Department of CardiologyShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yingqi Li
- Department of CardiologyShanghai Eighth People's HospitalShanghaiChina
| | - Yuan Ding
- School of NursingShanghai Jiao Tong UniversityShanghaiChina
| | - Lingyan Zhu
- Department of NursingShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
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2
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Okada A, Tsuchihashi-Makaya M, Nagao N, Ochiai R. Somatic Changes Perceived by Patients With Heart Failure During Acute Exacerbation: A Qualitative Study Using Text Mining. J Cardiovasc Nurs 2023; 38:23-32. [PMID: 35467568 DOI: 10.1097/jcn.0000000000000915] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with heart failure (HF) often inadequately perceive their symptoms. This may be because the medical terms do not match the somatic changes experienced by patients. To improve symptom perception, healthcare professionals must understand the somatic changes as perceived by patients. OBJECTIVE This study aims to analyze patients' narratives about somatic changes in patients with HF by text mining and to clarify the overall description of somatic changes using patients' expressions. METHODS Semistructured interviews were conducted on 21 patients hospitalized for acute exacerbation of HF. Qualitative data obtained from the interviews were analyzed by content analysis through text mining. RESULTS Among the 21 patients, 76.2% were men. The mean (SD) age was 71.3 (13.7) years. The most frequently used terms were "breath," "distressed," "feet," and " ha-ha (gasping sound)" (46, 40, 29, and 28 times, respectively). The somatic changes noticed by patients could be categorized into medical jargon such as "dyspnea on exertion," "exercise intolerance," "fatigue," "paroxysmal nocturnal dyspnea," "frequent urination," "increased sputum," "weight gain," "feet and face edema," "abdominal edema," and "ankle edema." However, the expressions of somatic changes used by the patients were diverse. CONCLUSIONS The findings of patient-specific expressions of symptoms suggest that there is a need to assess symptoms not only using medical jargon but also by focusing on patient-specific expressions.
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Lin CY, Dracup K, Pelter MM, Biddle MJ, Moser DK. Association of psychological distress with reasons for delay in seeking medical care in rural patients with worsening heart failure symptoms. J Rural Health 2022; 38:713-720. [PMID: 33783853 PMCID: PMC10106011 DOI: 10.1111/jrh.12573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The impact of depressive symptoms and anxiety on rural patients' decisions to seek care for worsening heart failure (HF) symptoms remains unknown. The purposes of this study were (1) to describe rural patients' reasons for delay in seeking care for HF, and (2) to determine whether depressive symptoms or anxiety was associated with patients' reasons for delay in seeking medical care for worsening symptoms. METHODS A total of 611 rural HF patients were included. Data on reasons for patient delay in seeking medical care (The Reasons for Delay Questionnaire), depressive symptoms (PHQ-9), and anxiety (BSI-ANX) were collected. Statistical analyses included chi-square and multiple regression. RESULTS A total of 85.4% of patients reported at least 1 reason for delay. Patients with higher levels of depressive symptoms were more likely to cite embarrassment, problems with transportation, and financial concerns as a reason for delay. Patients with anxiety not only cited nonsymptom-related reasons but also reported symptom-related reasons for delay in seeking care (ie, symptoms seemed vague, not sure of symptoms, symptoms didn't seem to be serious enough, and symptoms were different from the last episode). In multiple regression, patients with greater depressive symptoms and anxiety had a greater number of reasons for delay in seeking care (P = .003 and P = .023, respectively). CONCLUSIONS Our findings suggest that enhancement of patients' symptom appraisal abilities and improvement in psychological distress may result in a reduction in delay in seeking medical care for worsening symptoms in rural patients with HF.
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Affiliation(s)
- Chin-Yen Lin
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Kathleen Dracup
- School of Nursing, University of California, San Francisco, California
| | - Michele M. Pelter
- School of Nursing, University of California, San Francisco, California
| | | | - Debra K. Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky
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4
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Reeder KM, Peek GM, Nazir N. Prehospitalization Symptom Perceptions, Lay Consultations, and Treatment-Seeking for Acute Decompensating Heart Failure: Implications for Nursing Practice. Crit Care Nurs Clin North Am 2022; 34:129-140. [DOI: 10.1016/j.cnc.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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5
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Pham V, Greiner B, Ottwell R, Vassar M, Hartwell M. Cross-Sectional Analysis of Patient-Centered Language Use in Journals Publishing Research Focused on Heart Failure. J Patient Cent Res Rev 2021; 8:248-254. [PMID: 34322577 DOI: 10.17294/2330-0698.1821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Detrimental effects of using non-patient-centered language (nPCL) have been reported for diabetes, mental illness, and obesity, and both the American Medical Association (AMA) and International Committee of Medical Journal Editors (ICMJE) recommend using patient-centered language in medical literature. Heart failure is a common yet stigmatized disease, and nPCL may further propagate stigma. This study analyzed current use of nPCL in journals focused on heart failure research and also examined whether the journals steer authors to adhere to AMA or ICMJE guidelines regarding nPCL. Methods Following systematic search of PubMed for heart failure-related articles published from May 1, 2018, to April 30, 2020, cross-sectional analysis was performed. Each selected article was inspected for an array of nPCL terms and frequency of nPCL usage. Chi-squared tests and multivariable logistic regressions were used to assess relationships between study characteristics and nPCL use. Results Of the 195 articles fully analyzed, 108 (55.4%) contained a nPCL term, the most frequently used being "heart failure patient" (78.7%), "burden" (23.1%), and "suffer" (15.7%). Use of nPCL was disproportionately more common in original research articles (63.5%) and less common in case reports (18.2%). Articles that did not detail any treatment or intervention used the most nPCL (71.1%). No statistically significant association was found between a journal's impact factor and its adherence to AMA or ICMJE recommendations. Conclusions nPCL is widely used in publications reporting on heart failure. We encourage authors and journals to reduce nPCL to help decrease the stigma patients with this disease often encounter.
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Affiliation(s)
- Vivian Pham
- Department of Internal Medicine, University of Oklahoma Medical Center, Oklahoma City, OK.,College of Osteopathic Medicine, Oklahoma State University Center for Health Sciences, Tulsa, OK
| | - Benjamin Greiner
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | - Ryan Ottwell
- College of Osteopathic Medicine, Oklahoma State University Center for Health Sciences, Tulsa, OK.,Department of Internal Medicine, University of Oklahoma-Tulsa School of Community Medicine, Tulsa, OK
| | - Matt Vassar
- College of Osteopathic Medicine, Oklahoma State University Center for Health Sciences, Tulsa, OK
| | - Micah Hartwell
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK
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Lin CY, Hammash M, Miller JL, Schrader M, Mudd-Martin G, Biddle MJ, Moser DK. Delay in seeking medical care for worsening heart failure symptoms: predictors and association with cardiac events. Eur J Cardiovasc Nurs 2021; 20:454-463. [PMID: 33580784 DOI: 10.1093/eurjcn/zvaa032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/31/2020] [Accepted: 12/03/2020] [Indexed: 01/04/2023]
Abstract
AIMS The association of delay in seeking medical care to subsequent cardiac events remains unknown in patients with worsening heart failure (HF) symptoms. The aims of this study were to (i) identify factors predicting care-seeking delay and (ii) examine the impact of care-seeking delay on subsequent cardiac rehospitalization or death. METHODS AND RESULTS We studied 153 patients hospitalized with an exacerbation of HF. Potential predictors of delay including demographic, clinical, psychosocial, cognitive, and behavioural variables were collected. Patients were followed for 3 months after discharge to determine time to the first cardiac rehospitalization or death. The median delay time was 134 h (25th and 75th percentiles 49 and 364 h). Non-linear regression showed that New York Heart Association functional class III/IV (P = 0.001), worse depressive symptoms (P = 0.004), better HF knowledge (P = 0.003), and lower perceived somatic awareness (P = 0.033) were predictors of delay time from patient perception of worsening HF to subsequent hospital admission. Cox regression revealed that patients who delayed longer (more than 134 h) had a 1.93-fold higher risk of experiencing cardiac events (P = 0.044) compared to non-delayers. CONCLUSIONS Care-seeking delay in patients with worsening HF symptoms was significantly associated with an increased risk of rehospitalization and mortality after discharge. Intervention strategies addressing functional status, psychological state, cognitive and behavioural factors are essential to reduce delay and thereby improve outcomes.
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Affiliation(s)
- Chin-Yen Lin
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Muna Hammash
- School of Nursing, University of Louisville, 555 S Floyd Street, Louisville, KY 40202, USA
| | - Jennifer L Miller
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Melanie Schrader
- School of Nursing, University of Louisville, 555 S Floyd Street, Louisville, KY 40202, USA
| | - Gia Mudd-Martin
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Martha J Biddle
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
| | - Debra K Moser
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, USA
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7
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Beauvais F, Tartière L, Pezel T, Motet C, Aumont MC, Baudry G, Eicher JC, Galinier M, Gellen B, Guihaire J, Legallois D, Lequeux B, Mika D, Mouquet F, Salvat M, Taieb C, Zorès F, Berthelot E, Damy T. First symptoms and health care pathways in hospitalized patients with acute heart failure: ICPS2 survey. A report from the Heart Failure Working Group (GICC) of the French Society of Cardiology. Clin Cardiol 2021; 44:1144-1150. [PMID: 34173675 PMCID: PMC8364729 DOI: 10.1002/clc.23666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/26/2021] [Accepted: 05/26/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Acute heart failure (AHF) is a common serious condition that contributes to about 5% of all emergency hospital admissions in Europe. HYPOTHESIS To assess the type and chronology of the first AHF symptoms before hospitalization and to examine the French healthcare system pathways before, during and after hospitalization. MATERIAL AND METHODS A retrospective observational study including patients hospitalized for AHF RESULTS: 793 patients were included, 59.0% were men, 45.6% identified heart failure (HF) as the main cause of hospitalization; 36.0% were unaware of their HF. Mean age was 72.9 ± 14.5 years. The symptoms occurring the most before hospitalization were dyspnea (64.7%) and lower limb edema (27.7%). Prior to hospitalization, 47% had already experienced symptoms for 15 days; 32% of them for 2 months. Referral to hospital was made by the emergency medical assistance service (SAMU, 41.6%), a general practitioner (GP, 22.3%), a cardiologist (19.5%), or the patient (16.6%). The modality of referral depended more on symptom acuteness than on type of symptoms. A sudden onset of AHF symptoms led to making an emergency call or to spontaneously attending an emergency room (ER), whereas cardiologists were consulted when symptoms had already been present for over 15 days. Cardiologists referred more patients to cardiology departments and fewer patients to the ER than general practitioners or the SAMU. CONCLUSION This study described the French healthcare system pathways before, during and after hospitalization AHF. AHF clinic network should be developed to provide adequate care for all HF patients and create awareness regarding AHF symptoms.
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Affiliation(s)
| | - Lamia Tartière
- Department of Cardiology, Hôpital Leon Berard, Hyères, France
| | - Théo Pezel
- Department of Cardiology, CHU Lariboisière, APHP, Paris, France
| | - Chloé Motet
- Faculty of Medicine, University of Nantes, Nantes, France
| | | | - Guillaume Baudry
- HCL, Service Insuffisance cardiaque, Hôpital Louis Pradel, Bron, France
| | | | | | - Barnabas Gellen
- Department of Cardiology, ELSAN - Polyclinique de Poitiers, Poitiers, France
| | - Julien Guihaire
- Department of Cardiology, Hôpital Marie Lanelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Le Plessis Robinson, France
| | | | - Benoit Lequeux
- Department of Cardiology, CHU Poitiers, Poitiers, France
| | - Delphine Mika
- Inserm, UMR-S 1180, Université Paris-Saclay, Chatenay-Malabry, France
| | | | - Muriel Salvat
- Department of Cardiology, CHU de Grenoble, Grenoble, France
| | | | | | | | - Thibaud Damy
- Department of Cardiology, Referral Center for Cardiac Amyloidosis and DHU ATVB, CHU Henri Mondor, APHP, Creteil, France
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8
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Heo S, Moser DK, Lennie TA, Kim J, Turrise S, Troyan PJ, Kang J, Jones HJ. Self-care strategies and interventions needed in patients with heart failure: from patient perspectives-a qualitative study. Eur J Cardiovasc Nurs 2021; 20:540-546. [PMID: 34008023 DOI: 10.1093/eurjcn/zvaa033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/29/2020] [Accepted: 12/11/2020] [Indexed: 11/13/2022]
Abstract
AIMS Most patients with heart failure (HF) have symptoms. Poor self-care has been associated with the development or worsening symptoms. Thus, to improve HF symptoms, it may be critical to understand self-care and interventions targeting improvements in HF symptoms needed from patients' perspectives. To explore patients' perceptions of self-care strategies of individual symptoms, HF symptom improvement, and interventions needed to improve HF symptoms in patients with HF. METHODS AND RESULTS Qualitative data were collected from 20 patients with HF using a semi-structured open-ended interview guide. Data were analysed using content analysis. Five themes appeared: (i) use of a variety of strategies with some knowledge deficit and inefficiency, (ii) uncertainty in symptom improvement, (iii) consideration of several possible self-care strategies, (iv) use of situation-specific strategies in seeking treatment, and (v) willingness to receive comprehensive and realistic interventions. Patients used a variety of self-care strategies, including taking medication, reducing activities, and changing diet and position, but many reported having a lack of knowledge and multiple HF symptoms. Several patients were uncertain whether symptoms could be improved, but all patients reported that they would participate in comprehensive and realistic intervention sessions to gain knowledge about their symptoms and management strategies, and to receive emotional support from healthcare providers and peer patients. CONCLUSION Patients with HF used several self-care strategies with the hope of symptom improvements but were uncertain about the effectiveness. More effective, comprehensive, and realistic interventions need to be delivered to patients with HF to enhance their ability to manage their symptoms.
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Affiliation(s)
- Seongkum Heo
- Mercer University, Georgia Baptist College of Nursing, 3001 Mercer University Drive, Atlanta, GA 30341, USA
| | - Debra K Moser
- University of Kentucky, College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Terry A Lennie
- University of Kentucky, College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - JinShil Kim
- Gachon University, 191 Hambakmeoro, Yeonsu-gu, Incheon 21936, South Korea
| | - Stephanie Turrise
- University of North Carolina, Wilmington, School of Nursing, 601 S. College Road, Wilmington, NC 28403, USA
| | - Pattie J Troyan
- Mercer University, Georgia Baptist College of Nursing, 3001 Mercer University Drive, Atlanta, GA 30341, USA
| | - JungHee Kang
- University of Kentucky, College of Nursing, 2201 Regency Rd, Suite, 403, Lexington, KY 40503, USA
| | - Holly J Jones
- University of Cincinnati, College of Nursing, P.O. Box 210038, Cincinnati, OH 45221-0038, USA
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9
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Lee KS, Lennie TA, Moser DK. Prospective Evaluation of Association Between Negative Emotions and Heart Failure Symptom Severity. Psychol Res Behav Manag 2021; 13:1299-1310. [PMID: 33380847 PMCID: PMC7769157 DOI: 10.2147/prbm.s282493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/21/2020] [Indexed: 11/23/2022] Open
Abstract
Background Prior studies of symptoms in heart failure (HF) were largely cross-sectional and symptoms were measured using retrospective recall. Because negative emotions influence information processing, retrospective symptom reports by patients with depressive symptoms and anxiety may be biased. The purpose of this study was to determine whether there are differences in patterns of symptom changes, measured prospectively, over 15 days by levels of depressive symptoms and anxiety. Methods HF patients (N=52) rated daily symptom severity for shortness of breath (SOB), fatigue, sleep disturbance, and edema over 15 days on a 10-point visual analogue scale. Patients were grouped into higher vs lower levels of depressive symptoms and anxiety, respectively, based on median scores of Brief Symptom Inventory subscales. Latent growth curve modeling was used to examine whether patterns of symptom changes over 15 days differed in higher vs lower levels of depressive symptom and anxiety groups. Results Those in the higher depressive symptom group had lower levels of baseline symptom severity in SOB (β: -1.46), fatigue (β: -1.71), sleep disturbance (β: -1.78), and edema (β: -1.97) than those in the lower depressive symptom group. However, there were no significant differences in rates of changes in the severity of any of the four symptoms between groups. Anxiety was not associated with baseline severity of symptoms or rates of changes in any of the four symptoms. Conclusion Depressive symptoms, but not anxiety, were associated with daily symptom experience. HF patients with higher levels of depressive symptoms may perceive their symptom severity differently than patients with lower levels of depressive symptoms.
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Affiliation(s)
- Kyoung Suk Lee
- Seoul National University, College of Nursing, The Research Institute of Nursing Science, Seoul, South Korea
| | - Terry A Lennie
- University of Kentucky, College of Nursing, Lexington, KY, USA
| | - Debra K Moser
- University of Kentucky, College of Nursing, Lexington, KY, USA
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10
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Lang M, Yeung T, Mendoza DP, Flores EJ, Som A, Lang AL, Pianykh OS, Lee SI, Saini S, Little BP, Succi MD. Imaging Volume Trends and Recovery During the COVID-19 Pandemic: A Comparative Analysis Between a Large Urban Academic Hospital and Its Affiliated Imaging Centers. Acad Radiol 2020; 27:1353-1362. [PMID: 32830030 PMCID: PMC7428785 DOI: 10.1016/j.acra.2020.08.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 01/30/2023]
Abstract
Rationale and Objectives While affiliated imaging centers play an important role in healthcare systems, little is known of how their operations are impacted by the COVID-19 pandemic. Our goal was to investigate imaging volume trends during the pandemic at our large academic hospital compared to the affiliated imaging centers. Materials and Methods This was a descriptive retrospective study of imaging volume from an academic hospital (main hospital campus) and its affiliated imaging centers from January 1 through May 21, 2020. Imaging volume assessment was separated into prestate of emergency (SOE) period (before SOE in Massachusetts on March 10, 2020), “post-SOE” period (time after “nonessential” services closure on March 24, 2020), and “transition” period (between pre-SOE and post-SOE). Results Imaging volume began to decrease on March 11, 2020, after hospital policy to delay nonessential studies. The average weekly imaging volume during the post-SOE period declined by 54% at the main hospital campus and 64% at the affiliated imaging centers. The rate of imaging volume recovery was slower for affiliated imaging centers (slope = 6.95 for weekdays) compared to main hospital campus (slope = 7.18 for weekdays). CT, radiography, and ultrasound exhibited the lowest volume loss, with weekly volume decrease of 41%, 49%, and 53%, respectively, at the main hospital campus, and 43%, 61%, and 60%, respectively, at affiliated imaging centers. Mammography had the greatest volume loss of 92% at both the main hospital campus and affiliated imaging centers. Conclusion Affiliated imaging center volume decreased to a greater degree than the main hospital campus and showed a slower rate of recovery. Furthermore, the trend in imaging volume and recovery were temporally related to public health announcements and COVID-19 cases.
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Affiliation(s)
- Min Lang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114; Harvard Medical School, Boston, Massachusetts
| | | | - Dexter P Mendoza
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114; Harvard Medical School, Boston, Massachusetts
| | - Efren J Flores
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114; Harvard Medical School, Boston, Massachusetts
| | - Avik Som
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114; Harvard Medical School, Boston, Massachusetts
| | - Angela L Lang
- Harvard Medical School, Boston, Massachusetts; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Oleg S Pianykh
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114; Harvard Medical School, Boston, Massachusetts
| | - Susanna I Lee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114; Harvard Medical School, Boston, Massachusetts
| | - Sanjay Saini
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114; Harvard Medical School, Boston, Massachusetts
| | - Brent P Little
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114; Harvard Medical School, Boston, Massachusetts
| | - Marc D Succi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114; Harvard Medical School, Boston, Massachusetts; Medically Engineered Solutions in Healthcare (MESH) Incubator, Massachusetts General Hospital, Boston, Massachusetts.
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11
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Takei M, Harada K, Shiraishi Y, Matsuda J, Iwasaki Y, Yamamoto Y, Matsushita K, Miyazaki T, Miyamoto T, Iida K, Tanimoto S, Nagatomo Y, Hosoda T, Kohsaka S, Yamamoto T, Nagao K, Takayama M. Delay in seeking treatment before emergent heart failure readmission and its association with clinical phenotype. J Intensive Care 2020; 8:65. [PMID: 32864143 PMCID: PMC7448509 DOI: 10.1186/s40560-020-00482-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background Many patients with emergent heart failure (HF) readmission have a delay between symptom onset and hospitalization. The present study aimed to characterize the interval between symptom onset and hospitalization in patients being readmitted for HF and to compare the clinical phenotypes of patients with delay before emergent readmission with those who presented to the hospital earlier. Methods Data for a total of 2073 consecutive patients was collected from the Tokyo CCU Network database; the patients were divided into delayed (those who sought medical help > 2 days after symptom onset; n = 271) and early groups (remaining patients; n = 1802), and their clinical characteristics and mode of presentation were compared. Results Age, sex, and laboratory findings including brain natriuretic peptide and serum creatinine levels were not significantly different between the two groups. Patients in the delayed group had greater chronic fluid retention and symptoms not associated with respiratory failure, whereas those in the early group were more likely to have acute respiratory distress, faster heart and respiration rates, and higher systolic blood pressure. Conclusions More than one in ten patients with HF readmission delay seeking treatment > 2 days after symptom onset. Patients who delayed seeking treatment showed the phenotype of chronic fluid retention, whereas those who presented to the hospital earlier had the phenotype of acute respiratory failure.
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Affiliation(s)
- Makoto Takei
- Tokyo CCU Network Scientific Committee, Tokyo, Japan.,Department of Cardiology, Saiseikai Central Hospital, Mita 1-4-17, Minato-ku, Tokyo, 108-0073 Japan
| | | | | | - Junya Matsuda
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | | | | | | | - Kiyosi Iida
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Yuji Nagatomo
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Toru Hosoda
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | - Shun Kohsaka
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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12
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Schirmer CM, Ringer AJ, Arthur AS, Binning MJ, Fox WC, James RF, Levitt MR, Tawk RG, Veznedaroglu E, Walker M, Spiotta AM. Delayed presentation of acute ischemic strokes during the COVID-19 crisis. J Neurointerv Surg 2020; 12:639-642. [PMID: 32467244 PMCID: PMC7295853 DOI: 10.1136/neurintsurg-2020-016299] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND The COVID-19 pandemic has disrupted established care paths worldwide. Patient awareness of the pandemic and executive limitations imposed on public life have changed the perception of when to seek care for acute conditions in some cases. We sought to study whether there is a delay in presentation for acute ischemic stroke patients in the first month of the pandemic in the US. METHODS The interval between last-known-well (LKW) time and presentation of 710 consecutive patients presenting with acute ischemic strokes to 12 stroke centers across the US were extracted from a prospectively maintained quality database. We analyzed the timing and severity of the presentation in the baseline period from February to March 2019 and compared results with the timeframe of February and March 2020. RESULTS There were 320 patients in the 2-month baseline period in 2019, there was a marked decrease in patients from February to March of 2020 (227 patients in February, and 163 patients in March). There was no difference in the severity of the presentation between groups and no difference in age between the baseline and the COVID period. The mean interval from LKW to the presentation was significantly longer in the COVID period (603±1035 min) compared with the baseline period (442±435 min, P<0.02). CONCLUSION We present data supporting an association between public awareness and limitations imposed on public life during the COVID-19 pandemic in the US and a delay in presentation for acute ischemic stroke patients to a stroke center.
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Affiliation(s)
- Clemens M Schirmer
- Department of Neurosurgery and Neuroscience Institute, Geisinger Health System, Wilkes-Barre, PA, United States
- Department of Neurosurgery, Geisinger Commonwealth School of Medicine, Scranton, PA, United States
- Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | | | - Adam S Arthur
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mandy J Binning
- Global Neurosciences Institute, Pennington, NJ, United States
| | - W Christopher Fox
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Robert F James
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Michael R Levitt
- Neurological Surgery, Radiology and Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Rabih G Tawk
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, United States
| | | | - Melanie Walker
- Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Alejandro M Spiotta
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Taniguchi C, Okada A, Seto N, Shimizu Y. How visiting nurses detect symptoms of disease progression in patients with chronic heart failure. Int J Qual Stud Health Well-being 2020; 15:1735768. [PMID: 32114970 PMCID: PMC7067190 DOI: 10.1080/17482631.2020.1735768] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: Chronic heart failure patients are often rehospitalized because they fail to seek appropriate, timely care. However, both patients and nurses experience difficulties in detecting signs of heart failure exacerbation. We aimed to qualitatively investigate how visiting nurses detect symptoms of disease progression in chronic heart failure patients in their homes. Methods: Participants were three experienced home-visit chronic heart failure nurses who completed one-to-one interviews. Data were analysed using the qualitative synthesis method (KJ method). Results: Six themes were identified that reflected detection of disease exacerbation and nursing support to prevent disease progression: difficulty of judging deterioration in patients with comorbidities; ascertaining conditions needing immediate intervention; detection of illness progression from changes in the patient’s appearance; inferring instability in physical condition from patients’ concerns and questions; arranging to ensure continued management of the patient post discharge; and instructing patients to ensure they never return to their old habits. Conclusions: The findings indicate that nurses experience challenges in detecting illness progression and judging when outpatient or hospital care is needed. However, nurses use a range of signs and symptoms to determine deterioration. Home-visit nurses thus play a crucial role in the post-hospital care of chronic heart failure patients.
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Affiliation(s)
- Chinatsu Taniguchi
- School of Nursing, Mukogawa Women's University, Hyogo, Japan.,Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ayako Okada
- Faculty of Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan
| | - Natsuko Seto
- Faculty of Nursing/Graduate School of Nursing, Kansai Medical University, Osaka, Japan
| | - Yasuko Shimizu
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
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Kwan GF, Yan LD, Isaac BD, Bhangdia K, Jean-Baptiste W, Belony D, Gururaj A, Martineau L, Vertilus S, Pierre-Louis D, Fenelon DL, Hirschhorn LR, Benjamin EJ, Bukhman G. High Poverty and Hardship Financing Among Patients with Noncommunicable Diseases in Rural Haiti. Glob Heart 2020; 15:7. [PMID: 32489780 PMCID: PMC7218772 DOI: 10.5334/gh.388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/19/2019] [Indexed: 11/25/2022] Open
Abstract
Background Poverty is a major barrier to healthcare access in low-income countries. The degree of equitable access for noncommunicable disease (NCD) patients is not known in rural Haiti. Objectives We evaluated the poverty distribution among patients receiving care in an NCD clinic in rural Haiti compared with the community and assessed associations of poverty with sex and distance from the health facility. Methods We performed a cross-sectional study of patients with NCDs attending a public-sector health center in rural Haiti 2013-2016, and compared poverty among patients with poverty among a weighted community sample from the Haiti 2012 Demographic and Health Survey. We adapted the multidimensional poverty index: people deprived ≥44% of indicators are among the poorest billion people worldwide. We assessed hardship financing: borrowing money or selling belongings to pay for healthcare. We examined the association between facility distance and poverty adjusted for age and sex using linear regression. Results Of 379 adults, 72% were women and the mean age was 52.5 years. 17.7% had hypertension, 19.3% had diabetes, 3.1% had heart failure, and 33.8% had multiple conditions. Among patients with available data, 197/296 (66.6%) experienced hardship financing. The proportions of people who are among the poorest billion people for women and men were similar (23.3% vs. 20.3%, p > 0.05). Fewer of the clinic patients were among the poorest billion people compared with the community (22.4% vs. 63.1%, p < 0.001). Patients who were most poor were more likely to live closer to the clinic (p = 0.002). Conclusion Among patients with NCD conditions in rural Haiti, poverty and hardship financing are highly prevalent. However, clinic patients were less poor compared with the community population. These data suggest barriers to care access particularly affect the poorest. Socioeconomic data must be collected at health facilities and during community-level surveillance studies to monitor equitable healthcare access. Highlights Poverty and hardship financing are highly prevalent among NCD patients in rural Haiti.Patients attending clinic are less poor than expected from the community.People travelling farther to clinic are less poor.Socioeconomic data should be collected to monitor healthcare access equity.
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Affiliation(s)
- Gene F. Kwan
- Boston University School of Medicine, Boston, MA, US
- Boston Medical Center, Boston, MA, US
- Partners In Health, Boston, MA, US
- Harvard Medical School, Boston, MA, US
| | | | | | | | | | | | | | - Louine Martineau
- Zanmi Lasante, HT
- Tufts New England Medical Center, Boston, MA, US
| | - Serge Vertilus
- Zanmi Lasante, HT
- Hôpital Universitaire de Mirebalais, HT
| | | | | | | | - Emelia J. Benjamin
- Boston University School of Medicine, Boston, MA, US
- Boston University School of Public Health, Boston, MA, US
| | - Gene Bukhman
- Harvard Medical School, Boston, MA, US
- Brigham and Women’s Hospital, Boston, MA, US
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15
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Singh SM, Koh M, Fang J, Ko DT. Risk of cardiac events during the Super Bowl. Eur J Prev Cardiol 2019; 27:1222-1224. [PMID: 31067126 DOI: 10.1177/2047487319848534] [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: 11/15/2022]
Affiliation(s)
- Sheldon M Singh
- Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | | | | | - Dennis T Ko
- Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, Canada.,ICES, Toronto, Canada
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Symptom Perception, Evaluation, Response to Symptom, and Delayed Care Seeking in Patients With Acute Heart Failure. J Cardiovasc Nurs 2019; 34:36-43. [DOI: 10.1097/jcn.0000000000000526] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Posada-Quintero HF, Reljin N, Eaton-Robb C, Noh Y, Riistama J, Chon KH. Analysis of Consistency of Transthoracic Bioimpedance Measurements Acquired with Dry Carbon Black PDMS Electrodes, Adhesive Electrodes, and Wet Textile Electrodes. SENSORS (BASEL, SWITZERLAND) 2018; 18:E1719. [PMID: 29861438 PMCID: PMC6022212 DOI: 10.3390/s18061719] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/15/2018] [Accepted: 05/24/2018] [Indexed: 12/03/2022]
Abstract
The detection of intrathoracic volume retention could be crucial to the early detection of decompensated heart failure (HF). Transthoracic Bioimpedance (TBI) measurement is an indirect, promising approach to assessing intrathoracic fluid volume. Gel-based adhesive electrodes can produce skin irritation, as the patient needs to place them daily in the same spots. Textile electrodes can reduce skin irritation; however, they inconveniently require wetting before each use and provide poor adherence to the skin. Previously, we developed waterproof reusable dry carbon black polydimethylsiloxane (CB/PDMS) electrodes that exhibited a good response to motion artifacts. We examined whether these CB/PDMS electrodes were suitable sensing components to be embedded into a monitoring vest for measuring TBI and the electrocardiogram (ECG). We recruited N = 20 subjects to collect TBI and ECG data. The TBI parameters were different between the various types of electrodes. Inter-subject variability for copper-mesh CB/PDMS electrodes and Ag/AgCl electrodes was lower compared to textile electrodes, and the intra-subject variability was similar between the copper-mesh CB/PDMS and Ag/AgCl. We concluded that the copper mesh CB/PDMS (CM/CB/PDMS) electrodes are a suitable alternative for textile electrodes for TBI measurements, but with the benefit of better skin adherence and without the requirement of wetting the electrodes, which can often be forgotten by the stressed HF subjects.
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Affiliation(s)
| | - Natasa Reljin
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269 USA.
| | - Caitlin Eaton-Robb
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269 USA.
| | - Yeonsik Noh
- College of Nursing, University of Massachusetts Amherst, Amherst, MA 01003, USA.
- Department of Electrical and Computer Engineering, University of Massachusetts Amherst, Amherst, MA 01003, USA.
| | | | - Ki H Chon
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269 USA.
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Riegel B, Dickson VV, Lee CS, Daus M, Hill J, Irani E, Lee S, Wald JW, Moelter ST, Rathman L, Streur M, Baah FO, Ruppert L, Schwartz DR, Bove A. A mixed methods study of symptom perception in patients with chronic heart failure. Heart Lung 2018; 47:107-114. [PMID: 29304990 PMCID: PMC5857218 DOI: 10.1016/j.hrtlng.2017.11.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/31/2017] [Accepted: 11/05/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early heart failure (HF) symptoms are frequently unrecognized for reasons that are unclear. We explored symptom perception in patients with chronic HF. METHODS We enrolled 36 HF out-patients into a longitudinal sequential explanatory mixed methods study. We used objectively measured thoracic fluid accumulation and daily reports of signs and symptoms to evaluate accuracy of detected changes in fluid retention. Patterns of symptom interpretation and response were explored in telephone interviews conducted every 2 weeks for 3-months. RESULTS In this sample, 44% had a mismatch between objective and subjective fluid retention; younger persons were more likely to have mismatch. In interviews, two patterns were identified: those able to interpret and respond appropriately to symptoms were higher in decision-making skill and the quality of social support received. CONCLUSION Many HF patients were poor at interpreting and managing their symptoms. These results suggest a subgroup of patients to target for intervention.
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Affiliation(s)
- Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
| | | | - Christopher S Lee
- School of Nursing, Oregon Health & Sciences University, Portland, OR, USA
| | - Marguerite Daus
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Hill
- Community Healthcare Network, New York, NY, USA
| | - Elliane Irani
- School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Solim Lee
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Joyce W Wald
- Heart Failure - Transplant Program, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen T Moelter
- Department of Behavioral and Social Sciences, University of the Sciences, Philadelphia, PA, USA
| | - Lisa Rathman
- The Heart Group of Lancaster General Health/PENN Medicine, Philadelphia, PA, USA
| | - Megan Streur
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Foster Osei Baah
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Linda Ruppert
- Department of Medicine, Section of Cardiology, Louis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Daniel R Schwartz
- Department of Medicine, Section of Cardiology, Louis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Alfred Bove
- Department of Medicine, Section of Cardiology, Louis Katz School of Medicine, Temple University, Philadelphia, PA, USA
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Hasegawa S, Nakano S, Tanno J, Iwanaga S, Kato R, Muramatsu T, Watanabe Y, Okada H, Senbonmatsu T, Nakamoto H, Nishimura S. Effect of cardiovascular risk factors and time of hospital presentation on mortality of maintenance hemodialysis patients presenting with acute pulmonary edema. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-016-0092-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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20
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Park J, Moser DK, Griffith K, Harring JR, Johantgen M. Exploring Symptom Clusters in People With Heart Failure. Clin Nurs Res 2017; 28:165-181. [DOI: 10.1177/1054773817729606] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with heart failure (HF) experience multiple symptoms or symptom clusters. The purposes of this study were to (a) determine if distinct latent classes of HF symptoms could be identified, and (b) explore whether sociodemographic and clinical characteristics influenced symptom cluster membership. A total of 4,011 HF patients recruited from outpatient setting completed the Minnesota Living With Heart Failure Questionnaire (MLHFQ), including five physical symptoms (edema, shortness of breath, fatigue-increased need to rest, fatigue-low energy, and sleep difficulties) and three psychological symptoms (worrying, feeling depressed, and cognitive problems). Four distinct classes using latent class profile analysis were identified: low distress (Class 1), physical distress (Class 2), psychological distress (Class 3), and high distress (Class 4). Significant differences among the four latent classes were found for age, education level, and comorbidities. Symptom clusters are useful for recognition of HF symptoms, allowing for the development of strategies that target symptom groups.
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Affiliation(s)
- Jumin Park
- National Institutes of Health Clinical Center, Bethesda, MD, USA
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21
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Zacharias M, Joffe S, Konadu E, Meyer T, Kiernan M, Lessard D, Goldberg RJ. Clinical epidemiology of heart failure with preserved ejection fraction (HFpEF) in comparatively young hospitalized patients. Int J Cardiol 2016; 202:918-21. [PMID: 26479959 PMCID: PMC4656064 DOI: 10.1016/j.ijcard.2015.09.114] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 09/24/2015] [Accepted: 09/27/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND While heart failure with preserved ejection fraction (HFpEF) is primarily a disease of old age, risk factors that contribute to HFpEF are not limited to older patients. The objectives of this population-based observational study were to describe the clinical epidemiology of HFpEF in younger (<65 years) as compared with older (≥65 years) patients hospitalized with acute decompensated heart failure. METHODS AND RESULTS We reviewed the medical records of residents of central Massachusetts hospitalized with HFpEF at all 11 greater Worcester (MA) medical centers during the 5 study years of 1995, 2000, 2002, 2004, and 2006. Among the 2398 patients hospitalized with confirmed HFpEF, 357 (14.9%) were <65 years old. Younger patients were more likely to be male, non-Caucasian, obese, and to have a history of diabetes and chronic kidney disease than older patients with HFpEF. Younger patients hospitalized with HFpEF were less likely to have received commonly prescribed cardiac medications, had a longer hospital stay, and experienced significantly lower post-discharge death rates than older hospitalized patients. CONCLUSION While HFpEF is predominantly a disease of old age, data from longitudinal studies remain needed to identify risk factors in younger individuals that may predispose them to the development of HFpEF.
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Affiliation(s)
- Michael Zacharias
- University Hospitals, Case Medical Center, Section of Heart Failure and Transplantation, Cleveland, OH, United States
| | - Samuel Joffe
- Catholic Medical Center, Department of Medicine, Manchester, NH, United States
| | | | - Theo Meyer
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Michael Kiernan
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.
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22
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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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24
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Athilingam P, Edwards JD, Valdes EG, Ji M, Guglin M. Computerized auditory cognitive training to improve cognition and functional outcomes in patients with heart failure: Results of a pilot study. Heart Lung 2015; 44:120-8. [PMID: 25592205 DOI: 10.1016/j.hrtlng.2014.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Feasibility and efficacy of computerized auditory cognitive training (ACT) was examined among patients with heart failure (HF). BACKGROUND Individuals with HF have four times increased risk of cognitive impairment, yet cognitive intervention studies are sparse. METHODS A pilot randomized controlled design was used. RESULTS The ACT group (n = 9) and control group (n = 8) had similar baseline characteristics. Seven participants (78%) completed ≥ 18 hours of ACT. Medium effect sizes were observed for improved cognition as indicated by auditory processing speed (d = 0.78), speech processing (d = 0.88), and working memory (d = 0.44-0.50). Small effect sizes were found for improved functional outcomes including HF selfcare (d = 0.34), Timed Instrumental Activities of Daily Living (d = 0.32), Six-Minute Walk Test (d = 0.38) and Short-Form-36 (d = 0.22) relative to controls. CONCLUSION Results indicated ACT is feasible among persons with HF. Despite a small sample size, ACT showed potential for improved speed of processing and working memory and improved functional outcomes, and warrants further exploration.
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Affiliation(s)
| | | | - Elise G Valdes
- School of Aging Studies, University of South Florida, USA
| | - Ming Ji
- College of Nursing, University of South Florida, USA
| | - Maya Guglin
- Cardiovascular Medicine, University of Kentucky, Lexington, USA
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25
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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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Cognitive status in patients hospitalized with acute decompensated heart failure. Am Heart J 2014; 168:917-23. [PMID: 25458656 DOI: 10.1016/j.ahj.2014.08.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/16/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cognitive impairment is highly prevalent in patients with heart failure and is associated with adverse outcomes. However, whether specific cognitive abilities (eg, memory vs executive function) are impaired in heart failure has not been fully examined. We investigated the prevalence of impairment in 3 cognitive domains in patients hospitalized with acute decompensated heart failure (ADHF) and the associations of impairment with demographic and clinical characteristics. METHODS The sample included 744 patients hospitalized with ADHF (mean age 72 years, 46% female) at 5 medical centers. Impairment was assessed in 3 cognitive domains (memory, processing speed, executive function) using standardized measures. Demographic and clinical characteristics were obtained from a structured interview and medical record review. RESULTS A total of 593 (80%) of 744 patients were impaired in at least 1 cognitive domain; 32%, 31%, and 17% of patients were impaired in 1, 2, or all 3 cognitive domains, respectively. Patients impaired in more than 1 cognitive domain were significantly older, had less formal education, and had more noncardiac comorbidities (all P values < .05). In multivariable adjusted analyses, patients with older age and lower education had higher odds of impairment in 2 or more cognitive domains. Depressed patients had twice the odds of being impaired in all 3 cognitive domains (odds ratio 1.98, 95% CI 1.08-3.64). CONCLUSION Impairments in executive function, processing speed, and memory are common among patients hospitalized for ADHF. Recognition of these prevalent cognitive deficits is critical for the clinical management of these high-risk patients.
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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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Kato N, Kinugawa K, Nakayama E, Tsuji T, Kumagai Y, Imamura T, Maki H, Shiga T, Hatano M, Yao A, Miura C, Komuro I, Nagai R. Insufficient self-care is an independent risk factor for adverse clinical outcomes in Japanese patients with heart failure. Int Heart J 2014; 54:382-9. [PMID: 24309448 DOI: 10.1536/ihj.54.382] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Self-care is a cornerstone for the successful management of heart failure (HF). The purpose of this study was to examine the impacts of HF self-care on prognosis in Japanese patients with HF. A total of 283 HF outpatients (age 64 ± 14, 70% male, 52% HFrEF) were enrolled. We asked patients to answer about their adhevence to 5 self-care behaviors (medication, eating a low-sodium diet, regular exercise, daily weight check, and treatment seeking behavior). On the basis of the results, we classified patients into a good self-care group and a poor self-care group. The primary outcome was HF hospitalization and/or cardiac death. In total, 65% of patients were classified into the poor self-care group. During a median follow-up of 2 years, cardiac events occurred more frequently in the poor self-care group (22% versus 9.6%, P = 0.013). Poor self-care was an independent risk factor for cardiac events in Cox regression analysis adjusted for clinical parameters (hazard ratio = 2.86, P = 0.005). Poor self-care was also associated with an increased number of HF hospitalizations as well as an extended length of hospital stay for HF. Poor knowledge about HF was an independent determinant for poor self-care in multivariate logistic regression analysis (odds ratio = 0.92, P = 0.019). Insufficient self-care is an independent risk factor for cardiac events in Japanese patients with HF.
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Affiliation(s)
- Naoko Kato
- Department of Therapeutic Strategy for Heart Failure, The University of Tokyo Graduate School of Medicine
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Patterns of symptom recognition, interpretation, and response in heart failure patients: an integrative review. J Cardiovasc Nurs 2013; 28:348-59. [PMID: 22580629 DOI: 10.1097/jcn.0b013e3182531cf7] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heart failure (HF) is a chronic illness affecting more than 5 million Americans, and it continues to lead healthcare-related expenditures in the United States. Hospitalization rates remain high and are caused by many factors, including poor self-care behaviors. Self-care research is growing, and a situation-specific theory for the HF population is now published. Self-care management, which is part of self-care, includes a series of responses and actions that the individual living with HF assumes in response to a change in baseline health. A critical aspect of enacting a self-care management plan is the ability to recognize changes in baseline health as being related to HF. PURPOSE This integrative review examined research to date on self-reported patterns of symptom recognition, an antecedent to self-care management, and treatment-seeking behaviors in HF patients. CONCLUSIONS Descriptive research strategies were predominantly used to examine symptom recognition, interpretation, and response in HF patients. Seven studies used retrospective approaches, such as chart review or patient recall, to collect data, and 7 studies collected data from the patient prospectively. The quantitative portion of 2 mixed-methods study was also analyzed. Dyspnea was the most frequently reported symptom across all studies reviewed. Dyspnea was characterized in terms of duration and was defined inconsistently across studies. In some studies, duration of dyspnea was associated with treatment-seeking delays. Elderly patients and newly diagnosed HF patients are more likely to delay treatment seeking for onset of symptoms. CLINICAL IMPLICATIONS Research is limited on symptom recognition and treatment-seeking behaviors in HF patients. Evidence suggests that symptom recognition may be impaired in the elderly population. Research studies to date on symptom recognition have largely been descriptive; no studies in this review followed patients' ability to recognize and respond to symptoms prospectively in their home environment. Symptoms may vary and their pattern may influence patients' recognition and/or response patterns.
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Ghuman AK, Newth CJL, Khemani RG. Impact of gender on sepsis mortality and severity of illness for prepubertal and postpubertal children. J Pediatr 2013; 163:835-40.e1. [PMID: 23706357 DOI: 10.1016/j.jpeds.2013.04.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/04/2013] [Accepted: 04/10/2013] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To investigate differences in sepsis mortality between prepubertal and postpubertal males and females. STUDY DESIGN This was a retrospective review of the Virtual PICU Systems (VPS) database (including 74 pediatric intensive care units [PICUs]) for 2006-2008. We included prepubertal (aged 2-7 years) and postpubertal (aged 16-21 years) children with a primary diagnosis of sepsis admitted to a participating PICU. RESULTS Prepubertal females (n = 272; 9.9% mortality) and prepubertal males (n = 303; 10.9% mortality) had similar mortality and severity of illness (Pediatric Index of Mortality 2 risk of mortality [PIM 2 ROM]). Postpubertal females (n = 233; mortality, 5.6%) had lower mortality than postpubertal males (n = 212; mortality, 11.8%; P = .03). PIM 2 ROM was higher for postpubertal males than postpubertal females (P = .02). After controlling for hospital specific effects with multivariate modeling, in postpubertal children, female gender was independently associated with a lower initial severity of illness (PIM 2 ROM: OR, 0.77; 95% CI, 0.62-0.96; P = .02). CONCLUSION Sepsis mortality is similar in prepubertal males and females. However, postpubertal males have a higher sepsis mortality than postpubertal females, likely related to their greater severity of illness on PICU admission. These outcome differences in postpubertal children may reflect a hormonal influence on the response to infection or differences in underlying comorbidities, source of infection, or behavior.
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Affiliation(s)
- Anoopindar K Ghuman
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
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Dunlay SM, Roger VL. Gender differences in the pathophysiology, clinical presentation, and outcomes of ischemic heart failure. Curr Heart Fail Rep 2013; 9:267-76. [PMID: 22864856 DOI: 10.1007/s11897-012-0107-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Despite advances in the treatment of acute myocardial infarction (MI), heart failure (HF) remains a frequent acute and long-term outcome of ischemic heart disease (IHD). In response to acute coronary ischemia, women are relatively protected from apoptosis, and experience less adverse cardiac remodeling than men, frequently resulting in preservation of left ventricular size and ejection fraction. Despite these advantages, women are at increased risk for HF- complicating acute MI when compared with men. However, women with HF retain a survival advantage over men with HF, including a decreased risk of sudden death. Sex-specific treatment of HF has been hindered by historical under-representation of women in clinical trials, though recent work has suggested that women may have a differential response to some therapies such as cardiac resynchronization. This review highlights the sex differences in the pathophysiology, clinical presentation and outcomes of ischemic heart failure and discusses key areas worthy of further investigation.
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Affiliation(s)
- Shannon M Dunlay
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Darling C, Saczynski JS, McManus DD, Lessard D, Spencer FA, Goldberg RJ. Delayed hospital presentation in acute decompensated heart failure: clinical and patient reported factors. Heart Lung 2013; 42:281-6. [PMID: 23474108 DOI: 10.1016/j.hrtlng.2013.01.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 01/29/2013] [Accepted: 01/31/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patients with acute decompensated heart failure (ADHF) often wait a considerable amount of time before going to the hospital. Prior studies have examined the reasons why such delays may occur, but additional studies are needed to identify modifiable factors contributing to these delays. PURPOSE To describe care-seeking delay times, factors associated with prolonged delay, and patient's thoughts and actions in adult men and women hospitalized with ADHF. METHODS We surveyed 1271 patients hospitalized with ADHF at 8 urban medical centers between 2007 and 2010. RESULTS The average age of our study population was 73 years, 47% were female, and 72% had prior heart failure. The median duration of pre-hospital delay prior to hospital presentation was 5.3 h. Patients who delayed longer than the median were older, more likely to have diabetes, peripheral edema, to have symptoms that began in the afternoon, and to have contacted their medical provider(s) about their symptoms. Prolonged care seekers were less likely to have attributed their symptoms to ADHF, less likely to want to have bothered their doctor or family, and were more likely to be concerned about missing work due to their illness (all p values < 0.05). CONCLUSIONS Care-seeking delays are common among patients with ADHF. A variety of factors contribute to these delays, which in some cases may represent efforts to manage ADHF symptoms at home. More research is needed to better understand the detrimental effects of these delays and how best to encourage timely care-seeking behavior in the setting of ADHF.
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Affiliation(s)
- Chad Darling
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA
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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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Factors associated with delayed care-seeking in hospitalized patients with heart failure. Heart Lung 2011; 41:244-54. [PMID: 22054724 DOI: 10.1016/j.hrtlng.2011.09.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 09/09/2011] [Accepted: 09/10/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study sought to evaluate the contributions of symptom recognition and clinical factors to delays in care-seeking. METHODS A descriptive correlational study design was used to study 75 patients (mean age, 74.7 years; SD, 10.86 years; range, 40 to 96 years) admitted to a tertiary-care medical center with recurrent symptoms (New York Heart Association classes 2 to 4). The sample was 52% male and 85.3% white. The Heart Failure Somatic Perception Scale (HFSPS) was used to examine symptoms, and additional data were collected on physiologic, social, and demographic factors. RESULTS The mean HFSPS score was 37.52 (range, 2 to 74; possible range, 0 to 90). Subjects reported 2 to 16 out of 18 possible symptoms. Durations of individual symptoms ranged from 5 minutes to 8 years, with individual patients describing a variety of symptom combinations and multiple time frames, depending on the specific symptom. Most subjects (80%) reported a mixture of acute and chronic symptoms. A pattern of chronic vs. acute symptoms was associated with proactive vs. emergent care-seeking, respectively. The HFSPS scores did not correlate with care-seeking behavior. CONCLUSION Symptom recognition is a complex phenomenon, and few factors differentiate emergent from proactive care-seeking.
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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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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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Abstract
BACKGROUND Because patients with heart failure (HF) experience multiple symptoms simultaneously, it is necessary to explore symptom clusters rather than individual symptoms to determine their impact on outcomes. Given gender differences in symptom experience, examination of potential gender differences in clusters is reasonable. OBJECTIVE The objective of the study was to compare symptom clusters between men and women with HF, differences in patient characteristics among symptom clusters, and the impact of symptom clusters on cardiac event-free survival. METHODS A total of 331 patients with HF recruited from HF clinics were included (35% were female and 62% were of New York Heart Association classes III/IV). Cluster analysis was used to identify symptom clusters between men and women based on ratings of distress related to 7 symptoms. Analysis of variance or chi test was used to compare characteristics of patient groups that were divided by the median split of total distress scores of each cluster. Cox proportional hazards regression was used to determine whether total scores of symptom distress in symptom clusters predicted time to first cardiac event. RESULTS Two identical symptom clusters were identified in men and women: a physical symptom cluster composed of dyspnea, fatigue/increased need to rest, fatigue/low energy, and sleep disturbances and an emotional/cognitive symptom cluster composed of worrying, feeling depressed, and cognitive problems. Patients with higher distress from the physical symptom cluster were primarily females and of New York Heart Association classes III and IV (P < .05). Patients with higher distress from the emotional/cognitive symptom cluster were younger than those with lower distress (P < .05). The total symptom distress score in the emotional/cognitive cluster, but not the physical cluster, was an independent predictor of cardiac event-free survival (hazard ratio, 1.18; 95% confidence interval, 1.03-1.37). CONCLUSION Although distress for individual symptoms may differ between men and women, they both experienced identical symptom clusters. Only the emotional/cognitive cluster predicted a higher risk for a cardiac event. These results suggested that interventions should be developed that consider symptom clusters. Targeting patients who have high distress from emotional/cognitive symptoms may be particularly important as they may be most vulnerable for adverse outcomes.
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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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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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Risk factors and comorbidities in a community-wide sample of patients hospitalized with acute systolic or diastolic heart failure: the Worcester Heart Failure Study. Coron Artery Dis 2010; 21:137-43. [PMID: 20305550 DOI: 10.1097/mca.0b013e328334eb46] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Few epidemiological studies have examined differences in the prevalence of risk factors and comorbidities in patients with systolic heart failure (HF), as compared with those with diastolic HF. METHODS We analyzed data from 1426 residents of the Worcester (MA) metropolitan area hospitalized at all 11 greater Worcester medical centers for acute HF during 1995 and 2000 who had data available on ejection fraction (EF) findings during hospitalization. The analysis was conducted based on the presence of either normal (diastolic HF) as compared with reduced (systolic HF) EF, using an EF cutpoint of at least 50%. RESULTS The average age of study patients was 71 years, 56% were women, and 43% had diastolic HF. Patients with diastolic HF were more likely to be older, female, obese, and to have higher systolic blood pressures and lower heart rates at the time of hospital presentation than patients with systolic HF. In contrast, patients with systolic HF had a greater prevalence of diabetes, previous myocardial infarction, and a history of alcohol abuse as compared with patients with diastolic HF. In multivariate analyses, the strongest metabolic correlates of diastolic HF were obesity, hypertension, and clustered metabolic risk factors; diabetes was associated with the occurrence of systolic HF. CONCLUSION The results of our population-based investigation show that multiple risk factors and comorbidities are present in patients with systolic and diastolic HF. Consideration of these comorbidities and risk factors should be taken into account in distinguishing patients with diastolic HF from those with systolic HF and in their optimal management.
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