1
|
Puckett CM, Thammana RV, Goodlin SJ. Multidomain Approach to Integration of Heart Failure and Palliative Care. Circ Cardiovasc Qual Outcomes 2024; 17:e010565. [PMID: 38712554 DOI: 10.1161/circoutcomes.123.010565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Affiliation(s)
- Carrie M Puckett
- Department of Cardiology (C.M.P.)
- Veterans Health Administration, Portland, OR (C.M.P.)
- Division of Cardiovascular Medicine, Knight Cardiovascular (C.M.P.), Oregon Health & Science University, Portland
| | - Rekha V Thammana
- Geriatrics and Palliative Care, Division of Rehabilitation and Long-Term Care (R.V.T.)
- Department of Hematology and Medical Oncology (R.V.T.), Oregon Health & Science University, Portland
| | - Sarah J Goodlin
- Patient-Centered Education and Research, Department of Medicine (S.J.G.), Oregon Health & Science University, Portland
| |
Collapse
|
2
|
Fraser M, Barnes SG, Barsness C, Beavers C, Bither CJ, Boettger S, Hallman C, Keleman A, Leckliter L, McIlvennan CK, Ozemek C, Patel A, Pierson NW, Shakowski C, Thomas SC, Whitmire T, Anderson KM. Nursing care of the patient hospitalized with heart failure: A scientific statement from the American Association of Heart Failure Nurses. Heart Lung 2024; 64:e1-e16. [PMID: 38355358 DOI: 10.1016/j.hrtlng.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Meg Fraser
- University of Minnesota MHealth Physicians, Minneapolis, MN, USA.
| | | | | | - Craig Beavers
- University of Kentucky College of Pharmacy, Lexington, KY, USA
| | | | | | | | - Anne Keleman
- MedStar Washington Section of Palliative Care, Washington, DC, USA
| | | | | | - Cemal Ozemek
- University of Illinois at Chicago, Cardiac Rehabilitation, College of Applied Health Sciences, Chicago, IL, USA
| | - Amit Patel
- Ascension St. Vincent Medical Group Cardiology, Indianapolis, IN, USA
| | - Natalie W Pierson
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | | | | | | | | |
Collapse
|
3
|
Liu Y, Tao L, Liu M, Ma L, Xu Y, Zhao C. The impact of palliative care on the physical and mental status and quality of life of patients with chronic heart failure: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e36607. [PMID: 38115251 PMCID: PMC10727569 DOI: 10.1097/md.0000000000036607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Chronic heart failure (CHF) is the terminal stage of several diseases. The present study aimed to investigate the impact of palliative care on the physical and mental status and quality of life of patients with CHF. METHODS This single-center randomized controlled clinical trial was conducted at Xiangtan Central Hospital. A total of 103 cases were included and divided into a study group (n = 54) and a control group (n = 49). The control group received usual care, whereas the study group received usual care plus palliative care. Statistical analyses were conducted on Simplified Coping Style Questionnaire, negative emotions, Minnesota Living with Heart Failure Questionnaire scores, and nursing satisfaction before and after intervention in the 2 groups. RESULTS After the intervention, the positive coping style score in the research group was higher than that in the control group, while the negative coping style score was lower than that of the control group (P < .05). After the intervention, the Beck Anxiety Inventory and Beck Depression Inventory-II scores of the 2 groups decreased compared to before the intervention, and the study group had lower scores than the control group (P < .05). After the intervention, the Minnesota Living with Heart Failure Questionnaire scores of the 2 groups decreased compared to those before the intervention, and the study group had lower scores than the control group (P < .05). Nursing satisfaction of the research group (94.44%) was higher than that of the control group (81.63%) (P < .05). CONCLUSIONS Adopting palliative care to intervene in CHF patients can effectively regulate their physical and mental state, alleviate negative emotions, transform coping styles towards the disease, and improve their quality of life, with high patient satisfaction.
Collapse
Affiliation(s)
- Yulan Liu
- Department of Cardiovascular Two District, Xiangtan City Central Hospital, Hunan Province, China
| | - Liang Tao
- Department of Cardiovascular Two District, Xiangtan City Central Hospital, Hunan Province, China
| | - Min Liu
- Department of Cardiovascular Two District, Xiangtan City Central Hospital, Hunan Province, China
| | - Lulu Ma
- Department of Cardiovascular Two District, Xiangtan City Central Hospital, Hunan Province, China
| | - Yi Xu
- Department of Cardiovascular Two District, Xiangtan City Central Hospital, Hunan Province, China
| | - Cui Zhao
- Department of Cardiovascular Two District, Xiangtan City Central Hospital, Hunan Province, China
| |
Collapse
|
4
|
Ingadottir B, Jaarsma T, Norland K, Ketilsdóttir A. Sense of Security Mediates the Relationship Between Self-care Behavior and Health Status of Patients With Heart Failure: A Cross-sectional Study. J Cardiovasc Nurs 2023; 38:537-545. [PMID: 37816081 DOI: 10.1097/jcn.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND Promoting patients' sense of security is among the goals of nursing care within heart failure management. OBJECTIVE The aim of this study was to examine the role of sense of security in the relationship between self-care behavior and health status of patients with heart failure. METHODS Patients recruited from a heart failure clinic in Iceland answered a questionnaire about their self-care (European Heart Failure Self-care Behavior Scale; possible scores, 0-100), their sense of security (Sense of Security in Care-Patients' Evaluation; possible scores, 1-100), and their health status (Kansas City Cardiomyopathy Questionnaire, including symptoms, physical limitations, quality of life, social limitations, and self-efficacy domains; possible scores, 0-100). Clinical data were extracted from electronic patient records. Regression analysis was used to examine the mediation effect of sense of security on the relationship between self-care and health status. RESULTS The patients (N = 220; mean [SD] age, 73.6 [13.8] years; 70% male, 49% in New York Heart Association functional class III) reported a high sense of security (mean [SD], 83.2 [15.2]) and inadequate self-care (mean [SD], 57.2 [22.0]); their health status, as assessed by all domains of the Kansas City Cardiomyopathy Questionnaire, was fair to good except for self-efficacy, which was good to excellent. Self-care was associated with health status ( P < .01) and sense of security ( P < .001). Regression analysis confirmed the mediating effect of sense of security on the relationship between self-care and health status. CONCLUSIONS Sense of security in patients with heart failure is an important part of daily life and contributes to better health status. Heart failure management should not only support self-care but also aim to strengthen sense of security through positive care interaction (provider-patient communication) and the promotion of patients' self-efficacy, and by facilitating access to care.
Collapse
|
5
|
Bagheri I, Yousefi H, Bahrami M, Shafie D. Quality of Palliative Care Guidelines in Patients with Heart Failure: A Systematic Review of Quality Appraisal using AGREE II Instrument. Indian J Palliat Care 2023; 29:7-14. [PMID: 36846280 PMCID: PMC9943939 DOI: 10.25259/ijpc_46_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/19/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives While the principles for developing clinical practice guidelines (CPGs) are well established, the quality of published guidelines is very diverse. The present study was conducted to evaluate the quality of existing CPGs in palliative care for heart failure patients. Material and Methods The study was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-analyses. A systematic search was conducted in the Excerpta Medica Database, MEDLINE/PubMed, CINAHL databases and Guideline internet sites: National Institute for Clinical Excellence, National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, Guidelines International Network and National Health and Medical Research Council for CPGs published through April 2021. Criteria for including CPGs were: Containing palliative measures for patients with heart failure over 18 years old and preferably interprofessional guidelines that focus on only one dimension of palliative care or focus on diagnosis, definition and treatment were excluded from the study. After initial screening, five appraisers rated the quality of the final selection of CPGs using the Appraisal of Guidelines for Research and Evaluation, 2nd edition (AGREE II). Results From 1501 records, seven guidelines were selected for analysis. The 'scope and purpose' and 'clarity of presentation' domains obtained the highest mean and 'rigor of development' and 'applicability' domains obtained the lowest mean scores. Three categories of recommendations were: (1) Strongly recommended (guidelines 1, 3, 6 and 7); (2) recommended with modifications (guideline 2) and (3) not recommended (guidelines 4 and 5). Conclusion Clinical guidelines for palliative care in patients with heart failure were of moderate-to-high quality, with the main deficiencies occurring in the rigor of development and applicability domains. The results inform clinicians and guideline developers of the strengths and weaknesses of each CPG. To improve the quality of palliative care CPGs in the future, it is recommended that developers pay detailed attention to all domains of the AGREE II criteria. Funding agent: Isfahan University of Medical Sciences. (IR.MUI.NUREMA.REC.1400.123).
Collapse
Affiliation(s)
- Imane Bagheri
- Department of Adult Health Nursing, College of Nursing and Midwifery, Isfahan, Iran
| | - Hojatollah Yousefi
- Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, Isfahan, Iran
| | - Masoud Bahrami
- Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, Isfahan, Iran
| | - Davood Shafie
- Department of Cardiology, Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
6
|
Steinberg L, Isenberg SR, Mak S, Meaney C, Lokuge B, Arvanitis J, Goldman R, Wegier P, Husain AF. HeartFull: Feasibility of an Integrated Program of Care for Patients with Advanced Stage of Heart Failure. Am J Hosp Palliat Care 2022; 39:1194-1202. [PMID: 35128951 DOI: 10.1177/10499091211069626] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Patients at an advanced stage of heart failure (AHF), specifically chronic severe symptomatic heart failure defined as New York Heart Association III/IV with hospitalization in the year prior, have high mortality, healthcare utilization, and low palliative care involvement. OBJECTIVES The primary objectives were to determine the feasibility of recruiting patients and engaging cardiology and palliative healthcare providers in a program of integrated care for AHF (HeartFull); the proportion of patients who died in non-acute care settings. Secondary objectives were to describe patient-reported outcomes and pre-post comparison of healthcare utilization. METHODS Patients were recruited from an urban academic hospital with expert heart failure care and a 24/7 inpatient and home palliative service. Utilization, disposition, and surveys were collected monthly for up to 20 months. RESULTS Of 46 patients referred, 30 (65%) agreed to participate, 27 died during the study period, 19 (70%) died in non-acute care settings, while 8 (30%) died in hospital. We found no significant difference in pre- and post-intervention rates of hospitalization (RR .715; CI .360, 1.388; P = .3180), nor emergency visits (RR .678; CI .333, 1.338; P = .2590), but both trended downward. No significant changes were observed in patient-reported outcomes. CONCLUSION In an urban academic hospital with palliative care, it was feasible to implement an integrated program for AHF. Patients died at home or in a palliative care unit at rates similar to palliative oncology patients and at higher rates than the general AHF population. HeartFull is now part of clinical practice.
Collapse
Affiliation(s)
- Leah Steinberg
- Temmy Latner Centre for Palliative Care, 518775Sinai Health System, Toronto, Ontario, Canada.,Department of Family & Community Medicine, 7938University of Toronto, Toronto, Ontario, Canada
| | - Sarina R Isenberg
- Temmy Latner Centre for Palliative Care, 518775Sinai Health System, Toronto, Ontario, Canada.,Department of Family & Community Medicine, 7938University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, 7938University of Toronto, Toronto, Ontario, Canada.,90755Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Susanna Mak
- Anna Prosserman Health Function Clinic, 518775Sinai Health System, Toronto, Ontario, Canada.,Division of Cardiology, Department of Medicine, 12366University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Christopher Meaney
- Department of Family & Community Medicine, 7938University of Toronto, Toronto, Ontario, Canada
| | - Bhadra Lokuge
- Temmy Latner Centre for Palliative Care, 518775Sinai Health System, Toronto, Ontario, Canada
| | - Jennifer Arvanitis
- Temmy Latner Centre for Palliative Care, 518775Sinai Health System, Toronto, Ontario, Canada.,Department of Family & Community Medicine, 7938University of Toronto, Toronto, Ontario, Canada
| | - Russell Goldman
- Temmy Latner Centre for Palliative Care, 518775Sinai Health System, Toronto, Ontario, Canada.,Department of Family & Community Medicine, 7938University of Toronto, Toronto, Ontario, Canada
| | - Pete Wegier
- Temmy Latner Centre for Palliative Care, 518775Sinai Health System, Toronto, Ontario, Canada.,Department of Family & Community Medicine, 7938University of Toronto, Toronto, Ontario, Canada.,90755Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Amna F Husain
- Temmy Latner Centre for Palliative Care, 518775Sinai Health System, Toronto, Ontario, Canada.,Department of Family & Community Medicine, 7938University of Toronto, Toronto, Ontario, Canada.,90755Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Jardim PP, Cavalcanti ACD, Borges AS, Flores PVP, Rosa CA. Sinais e sintomas de pacientes com insuficiência cardíaca em cuidados paliativos: revisão de escopo. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2022-0064pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivo Mapear a produção de conhecimento acerca dos sinais e sintomas de pacientes com insuficiência cardíaca em cuidados paliativos. Método Revisão de escopo conduzida de acordo com a metodologia JBI e com a redação guiada pelo Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist. A busca foi realizada em setembro de 2021 por dois revisores independentes nas bases de dados referenciais e em portais de informação e de literatura cinzenta, utilizando majoritariamente os descritores “heart failure”, “signs and symptoms” e “palliative care”, com o operador booleano “and”, sem recorte temporal. Resultados Foram incluídos 34 artigos publicados entre 2001 e 2021, provenientes de revistas nacionais e internacionais, sendo 21 publicados nos Estados Unidos da América. Por meio desses artigos, foi possível mapear 93 sinais e sintomas, sendo que os mais frequentes foram dor, dispneia, fadiga, náusea e depressão. Conclusão Implicações para a prática esta revisão de escopo produziu um mapa da produção científica sobre os sinais e sintomas de insuficiência cardíaca em cuidados paliativos. O conhecimento dos sinais e sintomas auxilia os profissionais da saúde no desenvolvimento de técnicas e tecnologias para avaliar a severidade da insuficiência cardíaca, planejar intervenções paliativas e avaliar os seus resultados.
Collapse
|
8
|
Hansen MP. Using the Evidence for Palliative Care to Improve Outcomes for Patients With Heart Failure. Am J Crit Care 2021; 30:479-482. [PMID: 34719707 DOI: 10.4037/ajcc2021905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Mary P. Hansen
- Mary P. Hansen is a heart failure clinical nurse specialist, Veterans Administration, Portland Health Care System, Portland, Oregon
| |
Collapse
|
9
|
Goodlin SJ. RESPONSE: Comprehensive Training for Heart Failure Clinicians: The Integration of Palliative Care. J Am Coll Cardiol 2021; 77:504-505. [PMID: 33509402 DOI: 10.1016/j.jacc.2020.11.072] [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: 11/30/2022]
Affiliation(s)
- Sarah J Goodlin
- Patient-Centered Education and Research, Portland Oregon, USA, and Sandy Utah, USA; Geriatrics and Palliative Medicine, VA Portland Health Care System, Department of Medicine Oregon Health and Sciences University Portland, Oregon, USA.
| |
Collapse
|
10
|
Higginbotham K, Jones I, Johnson M. A grounded theory study: Exploring health care professionals decision making when managing end stage heart failure care. J Adv Nurs 2021; 77:3142-3155. [PMID: 33991123 DOI: 10.1111/jan.14852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 03/16/2021] [Accepted: 03/21/2021] [Indexed: 11/27/2022]
Abstract
AIM To explore how healthcare professionals in an acute medical setting make decisions when managing the care of patients diagnosed with end stage heart failure, and how these decisions impact directly on the patient's end of life experience. DESIGN A constructivist grounded theory approach was adopted. METHOD A purposive sample was used to recruit participants that included 16 registered nurses, 15 doctors and 16 patients. Data were collected using semi-structured interviews and focus groups over a 12-month period of fieldwork concluding in 2017. The interviews were recorded and transcribed and the data were analysed using constant comparison and QSR NVivo. FINDINGS Four theoretical categories emerged from the data to explain how healthcare professionals and patients negotiated the process of decision making when considering end of life care. These were: signposting symptoms, organizing care, being informed and recognizing dying. The themes revolved around a core category 'a vicious cycle of heart failure care'. CONCLUSION Healthcare professionals need to engage in informed decision making with patients to break this 'vicious cycle of care' by identifying key stages in the terminal phase of heart failure and correctly signposting the patient to the most suitable healthcare care professional for intervention. IMPACT This study provides a theoretical framework to explain a 'vicious cycle of care' for patients diagnosed with end stage heart failure. This theory grounded in data demonstrates the need for both acute and primary care to design an integrative end of life care pathway for heart failure patients which addresses the need for early shared decision making between the healthcare professional, family and the patient when it comes to end of life conversations.
Collapse
Affiliation(s)
- Karen Higginbotham
- School of Nursing and Allied Health, Liverpool John Moore University, Liverpool, UK
| | - Ian Jones
- School of Nursing and Allied Health, Liverpool John Moore University, Liverpool, UK
| | - Martin Johnson
- School of Health and Society, University of Salford, Manchester, UK
| |
Collapse
|