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Tawfik B, Jacobson K, Brown-Glaberman U, Kosich M, Van Horn ML, Nemunaitis J, Dayao Z, Pankratz VS, Sussman AL, Guest DD. Developing questions to assess and measure patients' perceived survival benefit from adjuvant endocrine therapy in breast cancer: a mixed methods pilot study. Clin Exp Med 2024; 24:36. [PMID: 38353722 PMCID: PMC10867096 DOI: 10.1007/s10238-023-01261-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/09/2023] [Indexed: 02/16/2024]
Abstract
This mixed method study developed multiple question types to understand and measure women's perceived benefit from adjuvant endocrine therapy. We hypothesis that patients do not understand this benefit and sought to develop the questions needed to test this hypothesis and obtain initial patient estimates. From 8/2022 to 3/2023, qualitative interviews focused on assessing and modifying 9 initial varied question types asking about the overall survival (OS) benefit from adjuvant endocrine therapy. Subsequent focus groups modified and selected the optimal questions. Patients' self-assessment of their OS benefit was compared to their individualized PREDICT model results. Fifty-three patients completed the survey; 42% Hispanic, 30% rural, and 47% with income < $39,999 per year. Patients reported adequate health care literacy (61.5%) and average confidence about treatment and medication decisions 49.4 (95% CI 24.4-59.5). From the original 9 questions, 3 modified questions were ultimately found to capture patients' perception of this OS benefit, focusing on graphical and prose styles. Patients estimated an OS benefit of 42% compared to 4.4% calculated from the PREDICT model (p < 0.001). In this group with considerable representation from ethnic minority, rural and low-income patients, qualitative data showed that more than one modality of question type was needed to clearly capture patients' understanding of treatment benefit. Women with breast cancer significantly overestimated their 10-year OS benefit from adjuvant endocrine therapy compared to the PREDICT model.
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Affiliation(s)
- Bernard Tawfik
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.
- Department of Internal Medicine, Division of Hematology/Oncology, UNM Comprehensive Cancer Center, 1 University of New Mexico, MSC 07-4025, Albuquerque, NM, 87131-0001, USA.
| | - Kendal Jacobson
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Ursa Brown-Glaberman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Department of Internal Medicine, Division of Hematology/Oncology, UNM Comprehensive Cancer Center, 1 University of New Mexico, MSC 07-4025, Albuquerque, NM, 87131-0001, USA
| | - Mikaela Kosich
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - M Lee Van Horn
- University of New Mexico College of Education and Human Sciences, Albuquerque, NM, USA
| | - Jacklyn Nemunaitis
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Department of Internal Medicine, Division of Hematology/Oncology, UNM Comprehensive Cancer Center, 1 University of New Mexico, MSC 07-4025, Albuquerque, NM, 87131-0001, USA
| | - Zoneddy Dayao
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Department of Internal Medicine, Division of Hematology/Oncology, UNM Comprehensive Cancer Center, 1 University of New Mexico, MSC 07-4025, Albuquerque, NM, 87131-0001, USA
| | - V Shane Pankratz
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Mexico Department of Internal Medicine, Division of Epidemiology, Biostatistics and Preventive Medicine, University of New, Albuquerque, NM, USA
| | - Andrew L Sussman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Dolores D Guest
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Mexico Department of Internal Medicine, Division of Epidemiology, Biostatistics and Preventive Medicine, University of New, Albuquerque, NM, USA
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Niriayo YL, Yemane B, Asgedom SW, Teklay G, Gidey K. Prevalence and predictors of poor self-care behaviors in patients with chronic heart failure. Sci Rep 2024; 14:1984. [PMID: 38263418 PMCID: PMC10805850 DOI: 10.1038/s41598-024-52611-5] [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: 07/13/2023] [Accepted: 01/21/2024] [Indexed: 01/25/2024] Open
Abstract
Despite the indispensable role of self-care behavior in managing heart failure, the practice of self-care behavior remains poor, especially in developing countries. There is a scarcity of research focusing on poor self-care behavior and its determinants within our specific context. Therefore, the objective of this study was to investigate the prevalence and predictors of poor self-care behavior among ambulatory heart failure patients. A facility-based cross-sectional study was conducted at a tertiary care hospital in Ethiopia, involving patients with heart failure. We utilized the European Heart Failure Self-Care Behavior Scale (EHFScBS-9) to evaluate adherence to self-care behaviors. Data were gathered through patient interviews and a review of medical records. A binary logistic regression analysis was performed to identify predictors of poor self-care behavior in heart failure patients. We included a total of 343 participants in the final analysis of this study. The findings revealed that a majority of the patients (73.8%) demonstrated poor overall self-care behavior. Specifically, the majority of patients did not engage in regular exercise (76.1%), failed to consult doctors in case of rapid weight gain (75.6%), did not monitor weight daily (71.5%), did not restrict fluid intake (69.9%), and did not contact doctors in case of experiencing fatigue (68.6%). Additionally, 32.4% of patients did not reach out to doctors when experiencing shortness of breath, 30% did not restrict salt intake, 29% did not adhere to prescribed medication, and only 7% did not consult doctors if edema occurred. Our findings indicated that rural residence (AOR: 5.76, 95% CI: 2.47-13.43), illiteracy (AOR: 2.64, 95% CI: 1.52-6.31), prior hospitalization (AOR: 2.09, 95% CI: 1.21-3.61), and taking five or more medications (AOR: 1.83, 1.01-3.33) were significant predictors of poor self-care behavior. In conclusion, a majority of the participants in our study demonstrated poor self-care behavior. Risk factors for this behavior included rural residence, illiteracy, prior hospitalization, and taking five or more medications. Therefore, it is crucial to prioritize these high-risk patients and implement interventional programs aimed at improving self-care behaviors and overall treatment outcomes in heart failure patients.
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Affiliation(s)
- Yirga Legesse Niriayo
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia.
| | - Bisrat Yemane
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Solomon Weldegebreal Asgedom
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Gebrehiwot Teklay
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kidu Gidey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
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Driscoll A, Watts JJ, Meagher S, Kennedy R, Mar R, Johnson D, Hare DL, Faourque O, Gao L. Cost-effectiveness of an inpatient nurse practitioner in heart failure. Eur J Cardiovasc Nurs 2024; 23:33-41. [PMID: 37067006 DOI: 10.1093/eurjcn/zvad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/18/2023]
Abstract
AIMS Heart failure (HF) nurse practitioners (NPs) are an important part of the HF specialist team, and their impact on the cost-effectiveness of their role is unknown. The aim of this study was to determine the cost-effectiveness of a HF NP inpatient service compared with current practice of no HF NP service from a health system perspective at 12 months and 3 years. METHODS AND RESULTS We developed a Markov model to estimate costs, effects, and cost-effectiveness for hospitalized HF patients and seen by a HF NP service compared with usual care at 12 months and 3 years. Costs and effects were taken from a retrospective observational cohort study. Transition probabilities and utilities were derived from published studies. A total of 500 patients were included (250 patients in the HF NP service vs. 250 patients in usual care). Average age was 77.7 ± 11 years, and 54% were male. At 12 months, the HF NP group was cheaper and more effective compared with no HF NP [$23 031 vs. $25 111 (AUD), respectively; quality-adjusted life years (QALYs) were 0.68 in HF NP group compared with 0.66 in usual care]. The incremental cost-effectiveness ratio showed a savings of $109 474 per QALY gained at 12 months and a savings of $270 667 per QALY gained at 3 years in favour of the HF NP service. CONCLUSION The HF NP service was cost-effective with lower costs and higher QALYs compared with no HF NP service. Economic evaluations alongside randomized controlled trials are warranted.
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Affiliation(s)
- Andrea Driscoll
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Jennifer J Watts
- School of Health Economics, Deakin University, Burwood, Australia
| | - Sharon Meagher
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Rhoda Kennedy
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Ronald Mar
- Clinical Costing Department, Austin Health, Melbourne, Australia
| | - Doug Johnson
- Department of General Medicine, Melbourne Health, Melbourne, Australia
- School of Medicine, University of Melbourne, Parkville, Australia
| | - David L Hare
- Department of Cardiology, Austin Health, Melbourne, Australia
- School of Medicine, University of Melbourne, Parkville, Australia
| | - Omar Faourque
- Department of Cardiology, Austin Health, Melbourne, Australia
- School of Medicine, University of Melbourne, Parkville, Australia
| | - Lan Gao
- School of Health Economics, Deakin University, Burwood, Australia
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Ahmed M, Shafiq A, Zahid M, Dhawadi S, Javaid H, Rehman MEU, Chachar MA, Siddiqi AK. Clinical Outcomes With Nurse-Coordinated Multidisciplinary Care in Patients With Heart Failure: A Systematic Review and Meta-analysis. Curr Probl Cardiol 2024; 49:102041. [PMID: 37595855 DOI: 10.1016/j.cpcardiol.2023.102041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 08/20/2023]
Abstract
The American Heart Association (AHA) and the European Society of Cardiology (ESC) recommend nurse-inclusive multidisciplinary care for patients with heart failure (HF). However, there is no meta-analysis that focuses specifically on the impact of nurse-coordinated multidisciplinary care. Considering this literature gap, we conducted this review that seeks to systematically synthesize the current evidence available regarding the impact of nurse-coordinated multidisciplinary care on clinical outcomes in patients with HF. A comprehensive search was done using PubMed/Medline, Cochrane Library, and EMBASE from inception till July 2023 for randomized controlled trials (RCTs) comparing nurse-coordinated multidisciplinary care with usual care in adult patients (>18 years) with acute or chronic HF. Data about all-cause mortality, HF-related hospitalizations, and all-cause hospitalizations was extracted, pooled, and analyzed. Forrest plots were generated using the random effects model. A total of 30 RCTs were included in the analysis with a total of 7950 HF patients. Our pooled analysis demonstrated a significant reduction in all-cause mortality in HF patients who received nurse-coordinated multidisciplinary care (RR = 0.80, 95% CI: 0.72-0.88, P = 0.0001). Similarly, there was a significantly lesser risk of HF-related hospitalizations (RR = 0.56, 95% CI: 0.45-0.71, P = 0.00001) and all-cause hospitalizations (RR = 0.78, 95% CI: 0.70-0.87, P = 0.0001) among HF patients with nurse-coordinated multidisciplinary care as compared to the usual care. Nurse-coordinated multidisciplinary care significantly reduces the risk of all-cause mortality, HF-related hospitalizations, and all-cause hospitalizations in HF patients' posthospital discharge.
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Affiliation(s)
- Mushood Ahmed
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Aimen Shafiq
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Maheen Zahid
- Department of Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan
| | - Siwar Dhawadi
- Department of Medicine, Faculty of Medicine Monastir, Mosastir, Tunisia
| | - Hira Javaid
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
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Schjødt I, Mols RE, Eiskjær H, Bakos I, Horváth-Puhó E, Gustafsson F, Kristensen SL, Larsson JE, Løgstrup BB. Long-Term Medical Treatment and Adherence in Patients With Left Ventricular Assist Devices: A Danish Nationwide Cohort Study. ASAIO J 2023; 69:e482-e490. [PMID: 37792681 DOI: 10.1097/mat.0000000000002057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
The use of a left ventricular assist device (LVAD) in treating advanced heart failure has increased. However, data regarding medical treatment and adherence following LVAD implantation is sparse, particularly whether socioeconomic factors (cohabitation status, educational level, employment status, and income) and multimorbidity influence these aspects, which are known to impact adherence in heart failure patients. We performed a nationwide cohort study of 119 patients with LVAD implanted between January 1, 2006, and December 31, 2018, who were discharged alive with LVAD therapy. We linked individual-level data from clinical LVAD databases, the Scandiatransplant Database, and Danish medical and administrative registers. Medical treatment 90-day pre-LVAD and 720-day post-LVAD were assessed using descriptive statistics in 90-day intervals. Medication adherence (proportion of days covered ≥80%) was assessed 181- to 720-day post-LVAD. The proportions of patients using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (88.7%), beta-blockers (67.0%), mineralocorticoid receptor antagonists (62.9%), warfarin (87.6%), and aspirin (55.7%) within 90-day post-LVAD were higher than pre-LVAD and were stable during follow-up. Medication adherence ranged from 86.7% (aspirin) to 97.8% (warfarin). Socioeconomic factors and multimorbidity did not influence medical medication use and adherence. Among LVAD patients, medical treatment and adherence are at high levels, regardless of socioeconomic background and multimorbidity.
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Affiliation(s)
- Inge Schjødt
- From the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke E Mols
- From the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Eiskjær
- From the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - István Bakos
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | | | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Søren L Kristensen
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Johan E Larsson
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Brian B Løgstrup
- From the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Chow JSF, Sykes A, De Guzman J, Bonfield V, Maurya N. Telemonitoring for health education and self-management in South Western Sydney. Aust J Prim Health 2023; 29:490-500. [PMID: 36914937 DOI: 10.1071/py22067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 02/12/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Telemonitoring (TM) plays an important role in the self-management of chronic diseases. This study aimed to assess the feasibility of TM in early stages of chronic care for self-management and recognition of signs and symptoms of exacerbation, with a view to completing the TM program in an optimal timeframe to encourage independence and self-management. METHODS This study was conducted from 2019 to 2020. Included in the study were patients with chronic conditions at an early stage of their disease residing in the South Western Sydney region. Eligible patients were allocated a TM device for 6months. Their routine tests data were sent in real time to health care professionals. Following assessment by a TM coordinator, suitable patients were off-boarded (deactivation of monitoring device) after 6months. Data on hospitalisation/emergency department presentation and surveys were collected to assess the impact of TM on the level of the patient's understanding of their signs and symptoms of exacerbation, self-care, and quality of life. RESULTS Out of 44 patients approached, seven were off-boarded at the 6-month timeframe. The follow-up data on the hospitalisation/emergency department presentation during monitoring and 12months post off-boarding showed a reduction in the frequency of hospitalisation/nil admissions. Patients reported an increased understanding of their health condition and confidence in managing their own health with the support of TM. CONCLUSION The result demonstrates the feasibility of TM as a tool for health education and self-management in the coordination of care for chronic disease patients; however, the small sample size was a limitation.
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Affiliation(s)
- Josephine Sau Fan Chow
- South Western Sydney Local Health District, Sydney, NSW, Australia; and Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; and University of Sydney, Sydney, NSW, Australia; and University of New South Wales, Sydney, NSW, Australia; and Western Sydney University, Sydney, NSW, Australia
| | - Amanda Sykes
- South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Joyce De Guzman
- South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Vicki Bonfield
- South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Nutan Maurya
- South Western Sydney Local Health District, Sydney, NSW, Australia
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Hikaka J, Abey-Nesbit R, McIntosh B, Schluter PJ, Nishtala PS, Scrase R, Jamieson HA. Utility of Big Data to Explore Medication Adherence in Māori and Non-Māori Community-Dwelling Older Adults with Heart Failure in Aotearoa New Zealand: A Cross-sectional Study. Drugs Aging 2023; 40:847-855. [PMID: 37386345 PMCID: PMC10450015 DOI: 10.1007/s40266-023-01044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Medication adherence improves morbidity and mortality-related outcomes in heart failure, and knowledge of patterns of medication adherence supports patient and clinician decision-making. Routinely collected national data facilitate the exploration of medication adherence and associated factors in older adults with heart failure, including the association between ethnicity and adherence. There are known inequities in access to medicines between Māori (Indigenous People of Aotearoa New Zealand) and non-Māori, yet ethnic variation in medicines adherence in community-dwelling older adults with heart failure has not been explored. OBJECTIVE Here we identify medication adherence rates for community-dwelling older adults diagnosed with heart failure and differences in adherence rates between Māori and non-Māori. METHODS Cross-sectional analysis of interRAI (comprehensive standardised assessment) data in a continuously recruited national cohort from 2012 to 2019. RESULTS Overall, 13,743 assessments (Māori N = 1526) for older community-dwelling adults with heart failure diagnoses were included. The mean age of participants was 74.5 years [standard deviation (SD) 9.1 years] for Māori and 82.3 years (SD 7.8 years) non-Māori. In the Māori cohort, 21.8% did not adhere fully to their medication regimen, whereas in the non-Māori cohort, this figure was 12.8%. After adjusting for confounders, the Māori cohort were more likely to be medication non-adherent than non-Māori [prevalence ratio 1.53, 95% confidence interval (CI) 1.36-1.73]. CONCLUSIONS There was a significant disparity between Māori and non-Māori concerning medication adherence. Given the international use of the interRAI-HC assessment tool, these results have significant transferability to other countries and allow the identification of underserved ethnic groups for which culturally appropriate interventions can be targeted.
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Affiliation(s)
- Joanna Hikaka
- Facility of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Brendon McIntosh
- Department of Medicine, University of Otago, Christchurch, New Zealand
- Kia Kaha Chemists, Christchurch, New Zealand
| | - Philip J Schluter
- Te Kaupeka Oranga/Faculty of Health, Te Whare Wānanga o Waitaha/University of Christchurch, Christchurch, 8041, New Zealand
- Primary Care Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Prasad S Nishtala
- Department of Life Sciences, Centre for Therapeutic Innovation, University of Bath, Bath, United Kingdom
| | - Richard Scrase
- Department of Medicine, University of Otago, Burwood Campus, PO box, 4345, Christchurch, New Zealand
| | - Hamish A Jamieson
- Department of Medicine, University of Otago, Burwood Campus, PO box, 4345, Christchurch, New Zealand.
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8
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Tawfik B, Jacobson K, Brown-Glaberman U, Kosich M, Horn ML, Nemunaitis J, Dayao Z, Pankratz VS, Sussman AL, Guest D. Developing Questions to Assess and Measure Patients' Perceived Survival Benefit from Adjuvant Endocrine Therapy in Breast Cancer: A Mixed Methods Pilot Study. RESEARCH SQUARE 2023:rs.3.rs-3260720. [PMID: 37645964 PMCID: PMC10462253 DOI: 10.21203/rs.3.rs-3260720/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Purpose This mixed methods study developed multiple question types to understand and measure women's perceived benefit from adjuvant endocrine therapy. We hypothesis that patients do not understand this benefit and sought to develop the questions needed to test this hypothesis and obtain initial patient estimates. Methods From 8/2022 to 3/2023, qualitative interviews focused on assessing and modifying 9 initial varied question types asking about the overall survival (OS) benefit from adjuvant endocrine therapy. Subsequent focus groups modified and selected the optimal questions. Patients' self-assessment of their OS benefit was compared to their individualized PREDICT model results. Results Fifty-three patients completed the survey; 42% Hispanic, 30% rural, and 47% with income <$39,999 per year. Patients reported adequate health care literacy (61.5%) and average confidence about treatment and medication decisions 49.4 (95% CI 24.4-59.5). From the original 9 questions, 3 modified questions were ultimately found to capture patients' perception of this OS benefit, focusing on graphical and prose styles. Patients estimated an OS benefit of 42% compared to 4.4% calculated from the PREDICT model (p < 0.001). Conclusion In this group with considerable representation from ethnic minority, rural and low-income patients, qualitative data showed that more than one modality of question type was needed to clearly capture patients' understanding of treatment benefit. Women with breast cancer significantly overestimated their 10-year OS benefit from adjuvant endocrine therapy compared to the PREDICT model.
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Affiliation(s)
| | | | | | | | - M Lee Horn
- University of New Mexico College of Education and human Sciences
| | | | - Zoneddy Dayao
- University of New Mexico Comprehensive Cancer Center
| | | | | | - Dolores Guest
- University of New Mexico Comprehensive Cancer Center
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Alshehri AM, Almogbel YS, Alonazi RE, Alshehri WM, Alkhelaifi HA, Almutairi SA, Alenazi OS, Alali AZ. Pharmacists' Knowledge and Intention to Provide Palliative Care Services in Saudi Arabia: Using the Theory of Planned Behaviour. Healthcare (Basel) 2023; 11:2173. [PMID: 37570413 PMCID: PMC10418381 DOI: 10.3390/healthcare11152173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/17/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Providing palliative care to patients with life-threatening illnesses requires multidisciplinary efforts from different healthcare providers. Identifying the attitude, knowledge, and intentions of pharmacists to provide this service in Saudi Arabia is essential. Therefore, this study aimed to identify the palliative care knowledge, intentions, attitudes, subjective norms, and perceived behavioural control of pharmacists and what factors predict their intentions. Cross-sectional questionnaires based on the theory of planned behaviour were distributed to pharmacists in hospitals and community pharmacies. They included items that measured palliative care knowledge, attitudes, intentions, subjective norms, and the perceived behavioural control of pharmacists and identified other sociodemographic and pharmacy-practice-related items. In total, 131 pharmacists completed the questionnaires, showing an average score on palliative knowledge (8.82 ± 1.96; range: 1-14), strong intentions (5.84 ± 1.41; range: 1-7), positive attitudes (6.10 ± 1.47; range: 1-7), positive subjective norms (5.31 ± 1.32; range: 1-7), and positive perceived behavioural control (5.04 ± 1.21; range: 1-7). Having completed a pharmacy residency program, working longer hours per week, having a more positive attitude, and perceived stronger subjective norms were significantly associated with a strong intention to provide palliative care services. Therefore, enabling and motivating pharmacists to complete pharmacy residency programs and improve their attitudes could increase their intentions to provide these services.
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Affiliation(s)
- Ahmed M. Alshehri
- Clinical Pharmacy Department, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 16273, Saudi Arabia; (S.A.A.); (O.S.A.); (A.Z.A.)
| | - Yasser S. Almogbel
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah 51452, Saudi Arabia;
| | - Rana E. Alonazi
- Pharmacology Department, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 16273, Saudi Arabia;
| | - Waleed M. Alshehri
- Clinical Pharmacy Department, King Fahad Medical City, Riyadh 11525, Saudi Arabia;
| | - Hind A. Alkhelaifi
- Contracts Management Department, National Unified Procurement Company (NUPCO), Riyadh 12251, Saudi Arabia;
| | - Salman A. Almutairi
- Clinical Pharmacy Department, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 16273, Saudi Arabia; (S.A.A.); (O.S.A.); (A.Z.A.)
| | - Omar S. Alenazi
- Clinical Pharmacy Department, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 16273, Saudi Arabia; (S.A.A.); (O.S.A.); (A.Z.A.)
| | - Ali Z. Alali
- Clinical Pharmacy Department, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 16273, Saudi Arabia; (S.A.A.); (O.S.A.); (A.Z.A.)
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10
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MacDonald BJ, Barry AR, Turgeon RD. Decisional Needs and Patient Treatment Preferences for Heart Failure Medications: A Scoping Review. CJC Open 2023; 5:136-147. [PMID: 36880079 PMCID: PMC9984897 DOI: 10.1016/j.cjco.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background Pharmacologic management of heart failure with reduced ejection fraction (HFrEF) involves several medications. Decision aids informed by patient decisional needs and treatment preferences could assist in making HFrEF medication choices; however, these are largely unknown. Methods We searched MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), without language restriction, for qualitative, quantitative, and mixed-method studies that included patients with HFrEF or clinicians providing HFrEF care, and reported data on decisional needs or treatment preferences applicable to HFrEF medications. We classified decisional needs using a modified version of the Ottawa Decision Support Framework (ODSF). Results From 3996 records, we included 16 reports describing 13 studies (n = 854). No study explicitly assessed ODSF decisional needs; however, 11 studies reported ODSF-classifiable data. Patients commonly reported having inadequate knowledge or information, and difficult decisional roles. No study systematically assessed treatment preferences, but 6 studies reported on attribute preferences. Reducing mortality and improving symptoms frequently were ranked as being important, whereas cost importance rankings varied, and adverse events generally were ranked as being less important. Conclusion This scoping review identified key decisional needs regarding HFrEF medications, notably inadequate knowledge or information, and difficult decisional roles, which can readily be addressed by decision aids. Future studies should systematically explore the full scope of ODSF-based decisional needs in patients with HFrEF, along with relative preferences among treatment attributes to further inform development of individualized decision aids.
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Affiliation(s)
- Blair J MacDonald
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arden R Barry
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ricky D Turgeon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Medication Nonadherence and Associated Factors among Heart Failure Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Int J Chronic Dis 2023; 2023:1824987. [PMID: 36691596 PMCID: PMC9867578 DOI: 10.1155/2023/1824987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 01/15/2023] Open
Abstract
Background Medication nonadherence, being one of the best predictors of hospitalization, increases the mortality rate and hospital readmission and reduces the quality of life of heart failure (HF) patients. Therefore, this study is aimed at assessing medication nonadherence and associated factors among HF patients at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Methods A cross-sectional study was conducted among 245 adult patients with HF from June to August 2017. The data were collected by using the medication Adherence Report Scale (MARS-5) and then entered and analyzed using SPSS® (IBM Corporation) version 24. Summary statistics were presented using frequency, proportion, and mean. Binary logistic regression analysis was done for identifying factors associated with medication nonadherence with a 95% confidence level and p value of less than 0.05. Results Among 245 patients with HF, about a quarter (23.7%) of them were medication nonadherent. More than one-third (37%) of HF patients had a history of at least one HF medication discontinuation. Refilling problems (48%) and getting better from the illness (27%) were the most commonly reported reasons for nonadherence. Presence of comorbidity (AOR = 2.761; 95%CI = 1.364, 5.589), taking three or more types of medication (AOR = 2.805; 95%CI = 1.404, 5.60), and being unmarried (AOR = 2.638, 95%CI = 1.279, 5.443) was significantly associated with medication nonadherence. Conclusion The self-reported medication nonadherence among HF patients was considerably high. Refilling problems and getting better from the illness were the most commonly reported reasons for nonadherence. The presence of comorbid illness, taking three or more types of medication, and being unmarried was significantly associated factors of medication nonadherence. Awareness creation among patients on the importance of medication adherence and targeted efforts to assess and mitigate reasons for medication nonadherence may be helpful.
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Meraz R, Osteen K, McGee JS, Noblitt P, Viejo H. Applying Stress and Coping Theory to Understand Diuretic Adherence Experiences in Persons with Heart Failure. West J Nurs Res 2023; 45:67-77. [PMID: 35711104 DOI: 10.1177/01939459221106122] [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: 11/15/2022]
Abstract
Despite the benefits of diuretics for treating the symptoms of heart failure (HF), patients may report side effects and intentionally not adhere to diuretic regimens. Positive internal motivators, such as positive emotions, may benefit individuals in their adaptation to medication-related stress. However, there has been limited study of these potential motivators in those with HF. Using a descriptive qualitative approach, 82 adults taking diuretics for HF were interviewed. This study applied stress and coping theory to understand the diuretic-taking experiences of patients with HF. Data analysis revealed three themes: (a) diuretics are bothersome, (b) staying positive in the mid of hardship, and (c) adapting to endure. Findings suggest that adherent participants stayed positive amid the perceived hardship, maintaining resilient and grateful attitudes. Adherent participants adapted to bothersome diuretic effects and utilized creative strategies. More research is needed to understand the relationships between resilience, adaptive coping, and diuretic adherence.
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Affiliation(s)
- Rebecca Meraz
- Baylor University Louise Herrington School of Nursing, Dallas, TX, USA
| | - Kathryn Osteen
- Baylor University Louise Herrington School of Nursing, Dallas, TX, USA
| | | | - Paul Noblitt
- Baylor Scott & White Medical Center, Irving, TX, USA
| | - Henry Viejo
- Baylor Scott & White Heart and Vascular Hospital, Fort Worth, TX, USA
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Self-Care Behaviors in Patients with Hypertension to Prevent Hypertensive Emergencies: a Qualitative Study Based on the Theory of Planned Behavior. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2022. [DOI: 10.2478/jce-2022-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Abstract
Background: Hypertension is a crucial general health issue. Severe and acute hypertension needs urgent medical intervention. Self-care behaviors can help patients with hypertension in controlling blood pressure and preventing hypertensive emergencies. This study aimed to determine the perception of hypertension towards self-care behaviors using constructs of the theory of planned behavior (TPB) in critically ill patients with hypertension to prevent hypertensive emergencies.
Material and Methods: This study was conducted based on the directed qualitative content analysis of 33 critically ill patients with hypertension who participated in semi-structured interviews and focus group discussions. Results: The data were analyzed based on the four main categories of TPB. The attitude category consisted of positive and negative subcategories. The subjective norms category consisted of authority of healthcare staff, family support and approval, and influence of friends subcategories. The perceived behavioral control category included discipline, self-control, receiving consultation, individual concerns, financial problems, access to medicine, food culture, and coronavirus limitations subcategories. The behavioral intention category had intention to perform the behavior and intention to continue a behavior subcategories.
Conclusion: The results revealed the requirement for a multidimensional approach to improve attitude, subjective norms, and behavioral control for performing self-care behaviors to reduce the number of hypertensive emergencies in critically ill patients with hypertension. Factors affecting self-care included socioeconomic status, family support, governmental organizations, and participants’ health condition.
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Rapelli G, Donato S, Parise M, Pagani AF, Castelnuovo G, Pietrabissa G, Giusti E, Bertoni A. Yes, I can (with you)! Dyadic coping and self-management outcomes in cardiovascular disease: The mediating role of health self-efficacy. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2604-e2617. [PMID: 34985787 DOI: 10.1111/hsc.13704] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/18/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
Cardiac patients show alarming levels of nonadherence to medications. It is important to consider also patient activation levels. Furthermore, the partner could have a supporting role in these processes. The aim of this study was to investigate the mediating role of patient health self-efficacy (HSE) in the link between dyadic coping (DC) and two self-management outcomes (i.e. medication adherence and patient activation) across the first 6 months of cardiac disease. One hundred couples completed two self-report questionnaires during the hospitalisation for cardiac disease and 6 months after discharge. A longitudinal and dyadic research design was adopted. Cross-sectional analyses at T0 revealed that patient-provided and perceived positive DC and common DC are positively associated with HSE, which in turn is positively associated with medication adherence. HSE mediated the association between patient positive and common DC styles, with the only exception of Patient-provided positive DC, and patient activation. Conversely, patient-provided and perceived negative DC are negatively associated with HSE, which in turns is positively associated with medication adherence and patient activation. Prospective analyses showed that only patient-perceived negative DC at discharge is negatively associated with HSE at T1, which in turns is positively associated with patient activation over time. These results suggest to consider patient perceived and provided DC as antecedents of self-management outcomes via patient HSE. Furthermore, our results recommend to pay particular attention to negative DC, whose negative consequences are manifested also over time, planning interventions targeting partners' awareness of their own DC style.
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Affiliation(s)
- Giada Rapelli
- Department of Psychology, Università Cattolica del Sacro Cuore - Milano, Milan, Italy
- Psychology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Silvia Donato
- Department of Psychology, Università Cattolica del Sacro Cuore - Milano, Milan, Italy
- Family Studies and Research University Centre, Università Cattolica del Sacro Cuore -Milano, Largo Gemelli, 1, 20123, Milan, Italy
| | - Miriam Parise
- Department of Psychology, Università Cattolica del Sacro Cuore - Milano, Milan, Italy
- Family Studies and Research University Centre, Università Cattolica del Sacro Cuore -Milano, Largo Gemelli, 1, 20123, Milan, Italy
| | - Ariela F Pagani
- Department of Humanities, University of Urbino, Via Saffi, 15 - 61019 Urbino, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Università Cattolica del Sacro Cuore - Milano, Milan, Italy
- Psychology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giada Pietrabissa
- Department of Psychology, Università Cattolica del Sacro Cuore - Milano, Milan, Italy
- Psychology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Emanuele Giusti
- Department of Psychology, Università Cattolica del Sacro Cuore - Milano, Milan, Italy
- Psychology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Anna Bertoni
- Department of Psychology, Università Cattolica del Sacro Cuore - Milano, Milan, Italy
- Family Studies and Research University Centre, Università Cattolica del Sacro Cuore -Milano, Largo Gemelli, 1, 20123, Milan, Italy
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Sadeghiazar S, Mobasseri K, Gholizadeh L, Sarbakhsh P, Allahbakhshian A. Illness acceptance, medication adherence and the quality of life in patients with heart failure: A path analysis of a conceptual model. Appl Nurs Res 2022; 65:151583. [DOI: 10.1016/j.apnr.2022.151583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/18/2022] [Accepted: 04/03/2022] [Indexed: 11/16/2022]
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16
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Bates DW, Cheng HY, Cheung NT, Jew R, Mir F, Tamblyn R, Li YC. ‘Improving smart medication management’: an online expert discussion. BMJ Health Care Inform 2022; 29:bmjhci-2021-100540. [PMID: 35477691 PMCID: PMC9047882 DOI: 10.1136/bmjhci-2021-100540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/18/2022] [Indexed: 11/04/2022] Open
Abstract
Medication safety continues to be a problem inside and outside the hospital, partly because new smart technologies can cause new drug-related challenges to prescribers and patients. Better integrated digital and information technology (IT) systems, improved education on prescribing for prescribers and greater patient-centred care that empowers patients to take control of their medications are all vital to safer and more effective prescribing. In July 2021, a roundtable discussion was held as a spin-off meeting of the International Forum on Quality and Safety in Health Care Europe 2021 to discuss challenges and future direction in smart medication management. This manuscript summarises the discussion focusing on the aspects of digital and IT systems, safe prescribing, improved communication and education, and drug adherence.
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Affiliation(s)
- David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - N T Cheung
- Hong Kong Hospital Authority, Hong Kong, Hong Kong
| | - Rita Jew
- ISMP, Horsham, Pennsylvania, USA
| | - Fraz Mir
- Addenbrooke's Hospital, Cambridge, UK
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17
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Leigh JW, Gerber BS, Gans CP, Kansal MM, Kitsiou S. Smartphone Ownership and Interest in Mobile Health Technologies for Self-care Among Patients With Chronic Heart Failure: Cross-sectional Survey Study. JMIR Cardio 2022; 6:e31982. [PMID: 35029533 PMCID: PMC8800088 DOI: 10.2196/31982] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/18/2021] [Accepted: 11/21/2021] [Indexed: 12/26/2022] Open
Abstract
Background Heart failure (HF) is a highly prevalent chronic condition that places a substantial burden on patients, families, and health care systems worldwide. Recent advances in mobile health (mHealth) technologies offer great opportunities for supporting many aspects of HF self-care. There is a need to better understand patients’ adoption of and interest in using mHealth for self-monitoring and management of HF symptoms. Objective The purpose of this study is to assess smartphone ownership and patient attitudes toward using mHealth technologies for HF self-care in a predominantly minority population in an urban clinical setting. Methods We conducted a cross-sectional survey of adult outpatients (aged ≥18 years) at an academic outpatient HF clinic in the Midwest. The survey comprised 34 questions assessing patient demographics, ownership of smartphones and other mHealth devices, frequently used smartphone features, use of mHealth apps, and interest in using mHealth technologies for vital sign and HF symptom self-monitoring and management. Results A total of 144 patients were approached, of which 100 (69.4%) participated in the study (63/100, 63% women). The participants had a mean age of 61.3 (SD 12.25) years and were predominantly Black or African American (61/100, 61%) and Hispanic or Latino (18/100, 18%). Almost all participants (93/100, 93%) owned a cell phone. The share of patients who owned a smartphone was 68% (68/100). Racial and ethnic minorities that identified as Black or African American or Hispanic or Latino reported higher smartphone ownership rates compared with White patients with HF (45/61, 74% Black or African American and 11/18, 61% Hispanic or Latino vs 9/17, 53% White). There was a moderate and statistically significant association between smartphone ownership and age (Cramér V [ΦC]=0.35; P<.001), education (ΦC=0.29; P=.001), and employment status (ΦC=0.3; P=.01). The most common smartphone features used by the participants were SMS text messaging (51/68, 75%), internet browsing (43/68, 63%), and mobile apps (41/68, 60%). The use of mHealth apps and wearable activity trackers (eg, Fitbits) for self-monitoring of HF-related parameters was low (15/68, 22% and 15/100, 15%, respectively). The most popular HF-related self-care measures participants would like to monitor using mHealth technologies were physical activity (46/68, 68%), blood pressure (44/68, 65%), and medication use (40/68, 59%). Conclusions Most patients with HF have smartphones and are interested in using commercial mHealth apps and connected health devices to self-monitor their condition. Thus, there is a great opportunity to capitalize on the high smartphone ownership among racial and ethnic minority patients to increase reach and enhance HF self-management through mHealth interventions.
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Affiliation(s)
- Jonathan W Leigh
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States.,Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Ben S Gerber
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worchester, MA, United States
| | - Christopher P Gans
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Mayank M Kansal
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Spyros Kitsiou
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
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18
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Celano CM, Golden J, Healy BC, Longley RM, Huffman JC. Predictors of completion and response to a psychological intervention to promote health behavior adherence in heart failure. Int J Psychiatry Med 2022; 57:21-34. [PMID: 33461359 PMCID: PMC8300859 DOI: 10.1177/0091217421989830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Most individuals with heart failure (HF) struggle to adhere to one or more health behaviors, and interventions to promote adherence are time-intensive and costly. In this analysis, we examined the predictors of engagement and response related to a telephone-delivered health behavior intervention for individuals with HF. METHOD Using data from two pilot trials (N = 25) of a behavioral intervention for individuals with New York Heart Association (NYHA) class I-II HF, we examined predictors of intervention engagement and response using linear and mixed effects regression analyses. Predictors included medical (NYHA class, physical health-related quality of life [HRQoL], and HF symptoms) and intervention (ease and usefulness/utility ratings of the first intervention exercise) characteristics. Outcomes included percentage of sessions completed, accelerometer-measured physical activity, and sodium intake. RESULTS Lower physical HRQoL and more frequent HF symptoms were associated with completion of more sessions. In contrast, more frequent HF symptoms and higher NYHA class were associated with less physical activity improvement. Finally, participants' ratings of the first session's utility were associated with greater improvements in physical activity at follow-up. CONCLUSIONS These findings suggest that while individuals with greater functional impairment are more engaged in a behavioral intervention, they may be less able to increase physical activity in response to the program. Furthermore, the perceived utility of an initial session may predict longer-term behavior change. Larger studies are needed to clarify the presence of additional predictors and determine how they can be used to better tailor health behavior interventions.
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Affiliation(s)
- Christopher M. Celano
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Julia Golden
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Brian C. Healy
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA,Departments of Neurology and Biostatistics, Harvard Medical School, Boston, MA, USA
| | - Regina M. Longley
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jeff C. Huffman
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Abstract
Polypharmacy and heart failure are becoming increasingly common due to an ageing population and the rise of multimorbidity. Treating heart failure necessitates prescribing of multiple medications, in-line with national and international guidelines predisposing patients to polypharmacy. This review aims to identify how polypharmacy has been defined among heart failure patients in the literature, whether a standard definition in relation to heart failure could be identified and to describe the prevalence. The Healthcare Database Advanced Search (HDAS) was used to search EMBASE, MEDLINE, PubMed, Cinahl and PsychInfo from inception until March 2021. Articles were included of any design, in patients ≥ 18 years old, with a diagnosis of heart failure; that explicitly define and measure polypharmacy. Data were thereafter extracted and described using a narrative synthesis approach. A total of 7522 articles were identified with 22 meeting the inclusion criteria. No standard definition of polypharmacy was identified. The most common definition was that of " ≥ 5 medications." Polypharmacy prevalence was high in heart failure populations, ranging from 17.2 to 99%. Missing or heterogeneous methods for defining heart failure and poor patient cohort characterisation limited the impact of most studies. Polypharmacy, most commonly defined as ≥ 5 medications, is highly prevalent in the heart failure population. There is a need for an internationally agreed definition of polypharmacy, allowing accurate review of polypharmacy issues. Whether an arbitrary numerical cut-off is a suitable definition, rather than medication appropriateness, remains unclear. Further studies are necessary to understand the relationship between polypharmacy with specific types of heart failure and related comorbidities.
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20
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Assisted Living and Medication Adherence in Super-Aged Patients With Heart Failure in the Japanese population. J Cardiovasc Pharmacol 2021; 79:467-471. [PMID: 34983904 DOI: 10.1097/fjc.0000000000001212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Poor adherence to medication in patients with heart failure (HF) is associated with poor clinical outcomes. Although social support has been reported to improve medication adherence in patients with HF, the detailed underlying mechanism of this association is unclear. This study investigated appropriate social support types to ensure medication adherence, as well as patient characteristics that benefit from such social support in patients with HF. This was a retrospective observational study investigating the association of social support with medication adherence in 824 patients with HF who were registered in a prospective multicenter database. First, we analyzed the association between social support types and poor medication adherence leading to hospitalization. An interaction analysis was performed to detect patients' characteristics that benefited most from social support in terms of medical adherence. Fifty (6.1%) patients were hospitalized for poor adherence to medications. Multivariable analysis revealed that not receiving assisted living, which was defined as having supporting individuals at least once a week, was independently associated with poor medication adherence-related hospitalization. An interaction analysis revealed that patients with dementia benefited from assisted living significantly, while male patients or current smokers did not. Summarily, assisted living at least once a week was appropriate for improving medication adherence for patients with HF and was particularly effective for patients with dementia. Performed in a super-aging region in Japan, this study may also suggest the relevance of social support in preventing HF exacerbation in other developed countries that will experience an aging society in the near future.
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21
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van den Berk-Clark C, Pickard J, Davis D, Scherrer JF. The Role of Impulsive Decision Making on Health Behavior Related to Cardiovascular Disease Risk Among Older Adults With Hypertension. J Gerontol Nurs 2021; 47:22-30. [PMID: 34704864 DOI: 10.3928/00989134-20211013-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to investigate whether older adults who are more impulsive also tend to engage in more health behaviors associated with increased risk for cardiovascular disease (CVD). We analyzed data from the Health and Retirement Study. Logistic regression analysis was performed to determine the likelihood of medication adherence, alcohol consumption, and exercise among older adults with hypertension. Adjusted regression results revealed higher impulsive decision making was associated with greater likelihood of obesity (odds ratio [OR] = 2.96, 95% confidence interval [CI] [1.00, 8.92]), lower likelihood of medication adherence (OR = 0.37, 95% CI [0.15, 0.92]), and regular drinking (OR = 0.36, 95% CI [0.15, 0.87]). Higher impulsive decision making was associated with lower likelihood of regular exercise only in unadjusted models. Older adults with hypertension who had higher impulsive decision making engaged in health behaviors associated with increased risk for CVD. Health care providers should consider the range of strategies offered through behavioral economics to improve health in these at-risk populations. [Journal of Gerontological Nursing, 47(11), 22-30.].
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22
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Iacoviello M, Vitale E, Corbo MD, Correale M, Brunetti ND. Disease-modifier Drugs in Patients with Advanced Heart Failure: How to Optimize Their Use? Heart Fail Clin 2021; 17:561-573. [PMID: 34511205 DOI: 10.1016/j.hfc.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Therapy based on disease-modifier drugs is among the required criteria to diagnose advanced heart failure (AdvHF). Nevertheless, several conditions, such as hospitalization, hypotension, renal dysfunction, electrolyte abnormalities, medical inertia, and patients' adherence, can make the maintenance of optimal medical therapy in patients with AdvHF challenging. Moreover, in recent years, new classes of drugs able have been shown to be able to further modify the natural history of heart failure with reduced ejection fraction, but they are still not widely adopted. This article discusses the optimal use of disease-modifier drugs in patients with AdvHF as well as the possible usefulness of the new therapeutic opportunities.
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Affiliation(s)
- Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, Foggia, Italy.
| | - Enrica Vitale
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, Foggia, Italy
| | - Maria Delia Corbo
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, Foggia, Italy
| | - Michele Correale
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, Foggia, Italy
| | - Natale Daniele Brunetti
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, Foggia, Italy
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Haynes SC, Tancredi DJ, Tong K, Hoch JS, Ong MK, Ganiats TG, Evangelista LS, Black JT, Auerbach A, Romano PS. The Effect of Rehospitalization and Emergency Department Visits on Subsequent Adherence to Weight Telemonitoring. J Cardiovasc Nurs 2021; 36:482-488. [PMID: 32398500 PMCID: PMC8091911 DOI: 10.1097/jcn.0000000000000689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Weight telemonitoring may be an effective way to improve patients' ability to manage heart failure and prevent unnecessary utilization of health services. However, the effectiveness of such interventions is dependent upon patient adherence. OBJECTIVE The purpose of this study was to determine how adherence to weight telemonitoring changes in response to 2 types of events: hospital readmissions and emergency department visits. METHODS The Better Effectiveness After Transition-Heart Failure trial examined the effectiveness of a remote telemonitoring intervention compared with usual care for patients discharged to home after hospitalization for decompensated heart failure. Participants were followed for 180 days and were instructed to transmit weight readings daily. We used Poisson regression to determine the within-person effects of events on subsequent adherence. RESULTS A total of 625 events took place during the study period. Most of these events were rehospitalizations (78.7%). After controlling for the number of previous events and discharge to a skilled nursing facility, the rate for adherence decreased by nearly 20% in the 2 weeks after a hospitalization compared with the 2 weeks before (adjusted rate ratio, 0.81; 95% confidence interval: 0.77-0.86; P < .001). CONCLUSIONS Experiencing a rehospitalization had the effect of diminishing adherence to daily weighing. Providers using telemonitoring to monitor decompensation and manage medications should take advantage of the potential "teachable moment" during hospitalization to reinforce the importance of adherence.
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Kitsiou S, Gerber BS, Kansal MM, Buchholz SW, Chen J, Ruppar T, Arrington J, Owoyemi A, Leigh J, Pressler SJ. Patient-centered mobile health technology intervention to improve self-care in patients with chronic heart failure: Protocol for a feasibility randomized controlled trial. Contemp Clin Trials 2021; 106:106433. [PMID: 33991686 PMCID: PMC8222185 DOI: 10.1016/j.cct.2021.106433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/09/2021] [Accepted: 05/08/2021] [Indexed: 12/25/2022]
Abstract
This randomized controlled trial aims to determine the feasibility and preliminary efficacy of a patient-centered, mobile health technology intervention (iCardia4HF) in patients with chronic Heart Failure (HF). Participants (n = 92) are recruited and randomized 1:1 to the intervention or control group. The intervention group receives a commercial HF self-care app (Heart Failure Storylines), three connected health devices that interface with the app (Withings weight scale and blood pressure monitor, and Fitbit activity tracker), and a program of individually tailored text-messages targeting health beliefs, self-care self-efficacy, HF-knowledge, and physical activity. The control group receives the same connected health devices, but without the HF self-care app and text messages. Follow-up assessments occur at 30 days and 12 weeks. The main outcome of interest is adherence to HF self-care assessed objectively through time-stamped data from the electronic devices and also via patient self-reports. Primary measures of HF self-care include medication adherence and adherence to daily weight monitoring. Secondary measures of HF self-care include adherence to daily self-monitoring of HF symptoms and blood pressure, adherence to low-sodium diet, and engagement in physical activity. Self-reported HF self-care and health-related quality of life are assessed with the Self-care Heart Failure Index and the Kansas City Cardiomyopathy Questionnaire, respectively. Hospitalizations and emergency room visits are tracked in both groups over 12 weeks as part of our safety protocol. This study represents an important step in testing a scalable mHealth solution that has the potential to bring about a new paradigm in self-management of HF.
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Affiliation(s)
- Spyros Kitsiou
- Department of Biomedical & Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America.
| | - Ben S Gerber
- Division of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Mayank M Kansal
- Division of Cardiology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Susan W Buchholz
- College of Nursing, Michigan State University, East Lansing, MI, United States of America
| | - Jinsong Chen
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Todd Ruppar
- Department of Adult Health and Gerontological Nursing, College of Nursing, Rush University, Chicago, IL, United States of America
| | - Jasmine Arrington
- Department of Biomedical & Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Ayomide Owoyemi
- Department of Biomedical & Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Jonathan Leigh
- Department of Biomedical & Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Division of Cardiology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Susan J Pressler
- School of Nursing, Indiana University, Bloomington, IN, United States of America
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Campbell G, Auyeung V, Ismail TF. Smartphone and email capabilities of heart failure patients. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:5-6. [PMID: 36711175 PMCID: PMC9708004 DOI: 10.1093/ehjdh/ztab008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/12/2021] [Accepted: 01/25/2021] [Indexed: 02/01/2023]
Affiliation(s)
- Gayle Campbell
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK,School of BMEIS, King’s College London, London, UK,Corresponding author.
| | - Vivian Auyeung
- Institute of Pharmaceutical Science, King’s College London, London, UK
| | - Tevfik F Ismail
- Cardiology Department, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK,School of BMEIS, King’s College London, London, UK
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Fetensa G, Fekadu G, Turi E, Tolossa T, Wakuma B, Etefa W, Habte A, Yadecha B, Bekele F. Self-care behaviour and associated factors among chronic heart failure clients on follow up at selected hospitals of Wollega zones, Ethiopia. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Wheat HL, Irani E, Hughes J, Josephson R, Dolansky MA. Insights from Monitoring Aspirin Adherence: A Medication Adherence Cascade Tool. Patient Prefer Adherence 2021; 15:1639-1646. [PMID: 34345165 PMCID: PMC8325059 DOI: 10.2147/ppa.s315296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/29/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Adherence to recommended medications is a key issue in the care of patients with cardiovascular disease (CVD) and barriers to adherence are well established during the medication adherence cascade, the processes of prescribing, obtaining, taking, and maintaining medication use. Aspirin avoids many of the barriers in the medication adherence cascade as it does not require a prescription (prescribing) and is inexpensive, easily accessible (obtaining), prescribed once-daily (taking) as an over-the-counter medication and is generally perceived by patients as safe (maintaining). The purpose of this paper is to report aspirin adherence and propose the Medication Adherence Cascade Tool to assist clinicians to consider all aspects of medication adherence. METHODS Adherence to aspirin was monitored with an electronic pillbox. Frequency analysis, independent T-tests, and ANOVA were completed on 151 patients with underlying heart failure who were prescribed aspirin within a larger parent study. Chi-square tests were completed to assess differences in baseline demographic characteristics. FINDINGS Mean aspirin adherence was 82.2% overall, with 11.9% of sample with adherence 50%, 18.5% with adherence 50-80%, and 69.5% with adherence ≥80%. Greater adherence was observed in self-identified White as compared to Black patients (84.47% vs 73.53%; p = 0.014), and patients ≥70 years of age compared to <70 years (87.00% vs 77.49%; p = 0.009). INTERPRETATION Aspirin adherence was suboptimal despite the fact that it addresses most of the barriers on the medication adherence cascade (ie, relatively easy access, low cost, and low risk). A Medication Adherence Cascade Tool (MACT) is proposed as a clinical guide to facilitate patient-provider co-production of strategies to address medication adherence. The tool can assist patients and providers to co-produce adherence to achieve optimal medication benefits.
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Affiliation(s)
- Heather L Wheat
- Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Correspondence: Heather L Wheat Department of Medicine, Case Western Reserve University, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USATel +1 216 844-8447 Email
| | - Elliane Irani
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Joel Hughes
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Richard Josephson
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Medicine, Division of Cardiology, Case Western Reserve University, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mary A Dolansky
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Pendyal A, Rosenthal MS, Spatz ES, Cunningham A, Bliesener D, Keene DE. "When you're homeless, they look down on you": A qualitative, community-based study of homeless individuals with heart failure. Heart Lung 2021; 50:80-85. [PMID: 32792114 PMCID: PMC7738391 DOI: 10.1016/j.hrtlng.2020.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Outpatient heart failure (HF) care involves intensive self-management (SM). Effective HF SM is associated with improved outcomes. Homelessness poses challenges to successful SM. OBJECTIVES To identify the ways in which homelessness may impede successful SM of HF and engagement with the healthcare system. METHODS We conducted open-ended, semi-structured interviews with homeless adults with HF. Data were analyzed by a multidisciplinary team using a grounded theory approach. RESULTS We interviewed 19 participants, 11 (58%) of whom were homeless at the time of interview. Interviews revealed a combination of influences on HF SM. Major themes included instability and lack of routine, tradeoffs between basic necessities and HF SM, and stigmatization by healthcare providers. CONCLUSIONS Anticipatory guidance aimed at the unique challenges faced by homeless individuals with HF may aid successful SM. HF providers should simlpify medication regimes and engage in non-stigmatizing discourse. Larger-scale interventions include the creation of medical respite programs.
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Affiliation(s)
- Akshay Pendyal
- Novant Health Heart and Vascular Institute, Presbyterian Medical Center, 1718 E. 4th Street, Charlotte, NC 28204, USA; National Clinician Scholars Program, Yale School of Medicine, PO Box 208088, New Haven, CT 06520, USA.
| | - Marjorie S Rosenthal
- National Clinician Scholars Program, Yale School of Medicine, PO Box 208088, New Haven, CT 06520, USA; Department of Pediatrics, Yale School of Medicine, PO Box 208064, New Haven, CT 06520-8064, USA
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale School of Medicine, 1 Church Street, New Haven, CT 06510, USA; Section of Cardiovascular Medicine, Yale School of Medicine, PO Box 208017, New Haven, CT 06520-8017, USA
| | | | - Dawn Bliesener
- Community partner, Yale School of Medicine, PO Box 208088, New Haven, CT 06520, USA
| | - Danya E Keene
- National Clinician Scholars Program, Yale School of Medicine, PO Box 208088, New Haven, CT 06520, USA; Yale School of Public Health, P.O. Box 208034, New Haven, CT 06520-0834, USA
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29
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Celano CM, Freedman ME, Harnedy LE, Park ER, Januzzi JL, Healy BC, Huffman JC. Feasibility and preliminary efficacy of a positive psychology-based intervention to promote health behaviors in heart failure: The REACH for Health study. J Psychosom Res 2020; 139:110285. [PMID: 33160091 PMCID: PMC7719591 DOI: 10.1016/j.jpsychores.2020.110285] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Most patients with heart failure (HF) struggle to adhere to health behaviors, and existing health behavior interventions have significant limitations. We developed a 12-week, phone-delivered, combined positive psychology (PP) and motivational interviewing (MI) intervention to promote well-being and adherence to physical activity, diet, and medications. In this three-arm, randomized trial, we assessed the feasibility, acceptability, and preliminary efficacy of the intervention compared to treatment as usual and MI-alone conditions in 45 patients with HF and suboptimal health behavior adherence. METHODS Participants in the PP-MI or MI-alone conditions completed weekly phone sessions for 12 weeks. Those in PP-MI completed weekly PP exercises and set health behavior goals, while those in the MI-alone condition learned about HF-specific health behaviors and identified potential behavior changes. Primary study outcomes were feasibility (sessions completed) and acceptability (0-10 ratings of PP exercise ease and utility). The intervention's impact on psychological and behavioral outcomes was assessed using mixed effects regression analyses. RESULTS Participants in the PP-MI condition completed 73% of sessions and rated PP exercises as easy to complete (mean = 7.5 [SD 1.7] out of 10) and subjectively useful (mean = 7.5 [SD 1.6] out of 10). Compared to the control conditions, PP-MI led to medium effect-size improvements in positive affect (Cohen's d = 0.32-0.77), moderate to vigorous physical activity (d = 0.41-0.74), and medication adherence (d = 0.48-0.78). CONCLUSION This PP-MI intervention was feasible, well-accepted, and associated with promising improvements in well-being and health behavior outcomes. Larger trials are needed to examine this intervention's impact on health behavior adherence and other important outcomes (NCT03220204).
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Affiliation(s)
- Christopher M. Celano
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Corresponding author at: Massachusetts General Hospital, 125 Nashua Street, Suite 324, Boston, MA 02114, USA. (C.M. Celano)
| | | | - Lauren E. Harnedy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Elyse R. Park
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - James L. Januzzi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA,Baim Institute for Clinical Research, Boston, MA, USA
| | - Brian C. Healy
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA,Departments of Neurology and Biostatistics, Harvard Medical School, Boston, MA, USA
| | - Jeff C. Huffman
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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30
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Aggarwal N, Ahmed M, Basu S, Curtin JJ, Evans BJ, Matheny ME, Nundy S, Sendak MP, Shachar C, Shah RU, Thadaney-Israni S. Advancing Artificial Intelligence in Health Settings Outside the Hospital and Clinic. NAM Perspect 2020; 2020:202011f. [PMID: 35291747 PMCID: PMC8916812 DOI: 10.31478/202011f] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
| | | | | | | | | | - Michael E Matheny
- Vanderbilt University Medical Center and Tennessee Valley Healthcare System VA
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Matta S, Hsu JW, Iwashyna TJ, Baum MY, Langa KM, Nicholas LH. Identifying Cohabiting Couples in Administrative Data: Evidence from Medicare Address Data. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2020; 21:238-247. [PMID: 34149307 DOI: 10.1007/s10742-020-00229-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Marital status is recognized as an important social determinant of health, income, and social support, but is rarely available in administrative data. We assessed the feasibility of using exact address data and zip code history to identify cohabiting couples using the 2018 Medicare Vital Status file and ZIP codes in the 2011-2014 Master Beneficiary Summary Files. Medicare beneficiaries meeting our algorithm displayed characteristics consistent with assortative mating and resembled known married couples in the Health and Retirement Study linked to Medicare claims. Address information represents a promising strategy for identifying cohabiting couples in administrative data including healthcare claims and other data types.
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Affiliation(s)
- Sasmira Matta
- The Wharton School, University of Pennsylvania, Department of Health Care Management and Economics, 3641 Locust Walk, Philadelphia, PA 19106.,Leonard Davis Institute of Health Economics, 3641 Locust Walk, Philadelphia, PA 19106
| | - Joanne W Hsu
- Board of Governors of the Federal Reserve System, Constitution Ave NW & 20 Street Northwest, Washington, DC 20551
| | - Theodore J Iwashyna
- University of Michigan Pulmonary and Critical Care Medicine, 1500 E Medical Center Dr SPC 5360, Ann Arbor, MI 48109.,University of Michigan Institute for Social Research, 426 Thompson Street, Ann Arbor, MI 48104
| | - Micah Y Baum
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, 624 N. Broadway, Baltimore, MD 21205
| | - Kenneth M Langa
- University of Michigan Institute for Social Research, 426 Thompson Street, Ann Arbor, MI 48104.,University of Michigan Department of Internal Medicine, 1500 E Medical Center Dr SPC 5368, Ann Arbor, MI 48109
| | - Lauren Hersch Nicholas
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, 624 N. Broadway, Baltimore, MD 21205.,The Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205
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32
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Myers SL, Siegel EO, Hyson DA, Bidwell JT. A qualitative study exploring the perceptions and motivations of patients with heart failure who transitioned from non-adherence to adherence. Heart Lung 2020; 49:817-823. [PMID: 33011459 DOI: 10.1016/j.hrtlng.2020.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/15/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Management of heart failure (HF) involves complex self-care recommendations. Many patients have difficulty adhering to these recommendations, and mechanisms that support behavior change are poorly understood. OBJECTIVE The objective of this study was to explore the perceptions and motivations of individuals with HF who became adherent to HF treatment recommendations after being non-adherent. METHODS This was a qualitative descriptive study. Participants were recruited from cardiology clinics and completed a semi-structured interview on their experiences and motivations for self-care behavior change. Data was analyzed using thematic analysis. The sample size (n = 8) was sufficient to achieve saturation. RESULTS Five themes were identified: experiencing mortality, optimism and hope, making connections between behavior and health, self-efficacy, and the role of the clinician. The temporal chronological sequence of these themes across participants varied. CONCLUSIONS This study adds to our current understanding of HF self-care by suggesting mechanisms that may enhance existing self-care interventions, and demonstrating the important role of the clinician.
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Affiliation(s)
- Sharon L Myers
- Heart and Vascular Center, University of California, Davis, 2335 Stockton Blvd, Sacramento, CA, 95817, United States.
| | - Elena O Siegel
- Betty Irene Moore School of Nursing, University of California, Davis, 2450 48th St, Sacramento, CA, 95817, United States.
| | - Dianne A Hyson
- College of Social Sciences and Interdisciplinary Studies, California State University, Sacramento, 6000 J St, Sacramento, CA, 95819, United States.
| | - Julie T Bidwell
- Betty Irene Moore School of Nursing, University of California, Davis, 2450 48th St, Sacramento, CA, 95817, United States.
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Abstract
BACKGROUND Inadequate self-care is linked to poor health outcomes in heart failure (HF). Self-care depends on decision-making abilities, but links between self-care and brain injury to executive decision-making regulatory areas (prefrontal cortices) are unclear. OBJECTIVE We investigated the relationships between HF self-care and status of prefrontal cortices. METHODS Magnetic resonance imaging-based diffusion tensor imaging was performed in 21 patients with HF (age, 53.8 ± 7.9 years; 15 men; left ventricular ejection fraction, 25.1% ± 6.1%), and self-care and executive function were measured with the Self-care of Heart Failure Index (SCHFI) and Trail Making Test B. Using diffusion tensor imaging data, mean diffusivity (MD) maps were calculated and region-of-interest analyses were performed on the left and right prefrontal brain areas. Statistical analyses consisted of partial correlations (covariates, age, and gender). RESULTS The mean ± SD SCHFI scores were 70.78 ± 11.37 for maintenance, 70 ± 17.32 for management, and 74.91 ± 15.76 for confidence. The mean ± SD Trail Making Test B score was 90.2 ± 73.3 seconds. The mean ± SD MD values (higher values indicate tissue injury) of the left and right prefrontal cortices were 1.46 ± 0.16 (×10 mm/s) and 1.44 ± 0.14 (×10 mm/s), respectively. Significant negative correlations emerged between prefrontal MD values and SCHFI maintenance (left/right, r = -0.64/-0.70; P < .003) and SCHFI management (r = -0.93/-0.86; P < .003). Significant positive correlations were observed between prefrontal MD values and Trail Making Test B (r = 0.71/0.74; P < .001). A nonsignificant correlation emerged between prefrontal MD values and SCHFI confidence scores. CONCLUSIONS Brain tissue integrity in executive function regulatory regions is associated with HF self-care for maintenance and management. The findings indicate that protection and brain injury repair in executive control areas may improve HF self-care.
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Andersen J, Gerds TA, Hlatky MA, Gislason G, Schou M, Torp-Pedersen C, Møller S, Madelaire C, Strandberg-Larsen K. The mediating role of effective treatments in the relationship between income level and survival in patients with heart failure: a sex- and cohabitation-stratified study. Eur J Prev Cardiol 2020; 28:78-86. [PMID: 33623976 DOI: 10.1093/eurjpc/zwaa005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/23/2020] [Accepted: 07/09/2020] [Indexed: 11/12/2022]
Abstract
AIMS Patients with heart failure and low income have a high mortality risk. We examined whether lower survival among low-income patients with heart failure could be explained by different use of β -blockers, renin-angiotensin system inhibitors (RASi), and implanted devices compared with high-income patients. METHODS AND RESULTS We linked Danish national registries to identify patients with new-onset heart failure between 2005 and 2016. A total of 18 308 patients was included in the main analysis. We collected information on medical treatment and device therapy after discharge. We investigated the remaining income disparity if everybody had the same probability of treatment as the high-income patients. We used causal mediation analysis to examine to what extent treatment differences mediate the association between income and 1-year mortality in strata defined by sex and cohabitation status. If low-income patients had the same probability of initiating β-blockers and RASi treatment as high-income patients, low-income men who lived alone would increase initiation of treatment by 12.4% (CI: 10.0% to 14.9%) and as a result reduce their absolute 1-year mortality by 1.0% (CI: -1.4% to -0.5%). If low-income patients had the same probability of not having breaks in medical treatment and getting device therapy, as high-income patients, low-income patients would increase the probability of not having breaks in treatment between 1.8% and 5.8% and increase the probability of getting device therapy between 1.0% and 3.8%, across strata of sex and cohabitation status. CONCLUSION Lower rates of treatment initiation appear to mediate the poorer survival seen among patients with heart failure and low income, but only in males living alone.
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Affiliation(s)
- Julie Andersen
- Department of Research, The Danish Heart Foundation, Vognmagergade 7, 3.sal, 1120 Copenhagen, Denmark
| | - Thomas A Gerds
- Department of Research, The Danish Heart Foundation, Vognmagergade 7, 3.sal, 1120 Copenhagen, Denmark.,Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen, Denmark
| | - Mark A Hlatky
- Department of Health Research and Policy, Campus Drive, Stanford University School of Medicine, Stanford, CA, USA
| | - Gunnar Gislason
- Department of Research, The Danish Heart Foundation, Vognmagergade 7, 3.sal, 1120 Copenhagen, Denmark.,Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 6, 2900 Hellerup, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 6, 2900 Hellerup, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark.,Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark
| | - Sidsel Møller
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 6, 2900 Hellerup, Copenhagen, Denmark
| | - Christian Madelaire
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 6, 2900 Hellerup, Copenhagen, Denmark
| | - Katrine Strandberg-Larsen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark
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Haynes SC, Tancredi DJ, Tong K, Hoch JS, Ong MK, Ganiats TG, Evangelista LS, Black JT, Auerbach A, Romano PS. Association of Adherence to Weight Telemonitoring With Health Care Use and Death: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2010174. [PMID: 32648924 PMCID: PMC7352152 DOI: 10.1001/jamanetworkopen.2020.10174] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Adherence to telemonitoring may be associated with heart failure exacerbation but is not included in telemonitoring algorithms. OBJECTIVE To assess whether telemonitoring adherence is associated with a patient's risk of hospitalization, emergency department visit, or death. DESIGN, SETTING, AND PARTICIPANTS This post hoc secondary analysis of the Better Effectiveness After Transition-Heart Failure randomized clinical trial included patients from 6 academic medical centers in California who were eligible if they were hospitalized for decompensated heart failure and excluded if they were discharged to a skilled nursing facility, were expected to improve because of a medical procedure, or did not have the cognitive or physical ability to participate. The trial compared a telemonitoring intervention with usual care for patients with heart failure after hospital discharge from October 12, 2011, to September 30, 2013. Data analysis was performed from November 8, 2016, to May 10, 2019. INTERVENTIONS The intervention group (n = 722) received heart failure education, telephone check-ins, and a wireless telemonitoring system that allowed the patient to transmit weight, blood pressure, heart rate, and selected symptoms. The control group (n = 715) received usual care. Patients were followed up for 180 days after discharge. MAIN OUTCOMES AND MEASURES The main outcome was within-person risk of hospitalization, emergency department visit, or death by week during the study period. Poisson regression was used to determine the within-person association of adherence to daily weighing with the risk of experiencing these events in the following week. RESULTS Among the 538 participants (mean [SD] age, 70.9 [14.1] years; 287 [53.8%] male; 269 [50.7%] white) in the present analysis, adherence was lowest during the first week after enrollment but steadily increased, peaking between days 26 and 60 at 69%, or 371 transmissions. Adherence to weight telemonitoring was associated with events in the following week; an increase in adherence by 1 day was associated with a 19% decrease in the rate of death in the following week (incidence rate ratio, 0.81; 95% CI, 0.73-0.90) and an 11% decrease in the rate of hospitalization (incidence rate ratio, 0.89; 95% CI, 0.86-0.91). Adherence in the previous week was not associated with reduced rates of emergency department visits (incidence rate ratio, 0.95; 95% CI, 0.90-1.02). CONCLUSIONS AND RELEVANCE In this study, lower adherence to weight telemonitoring in a given week was associated with an increased risk of subsequent hospitalization or death in the following week. It is unlikely that this is a result of the telemonitoring intervention; rather, adherence may be an important factor associated with a patient's health status.
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Affiliation(s)
- Sarah C. Haynes
- Center for Health and Technology, Department of Pediatrics, University of California, Davis, Sacramento
| | - Daniel J. Tancredi
- Center for Healthcare Policy and Research, Department of Pediatrics, University of California, Davis, Sacramento
| | - Kathleen Tong
- Adventist Heart and Vascular Institute, St Helena, California
| | - Jeffrey S. Hoch
- Center for Healthcare Policy and Research, Department of Public Health Sciences, University of California, Davis, Sacramento
| | - Michael K. Ong
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Theodore G. Ganiats
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla
| | | | - Jeanne T. Black
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Andrew Auerbach
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco
| | - Patrick S. Romano
- Center for Healthcare Policy and Research, Division of General Medicine, University of California, Davis, Sacramento
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Celano CM, Beale EE, Freedman ME, Mastromauro CA, Feig EH, Park ER, Huffman JC. Positive psychological constructs and health behavior adherence in heart failure: A qualitative research study. Nurs Health Sci 2020; 22:620-628. [PMID: 32125066 DOI: 10.1111/nhs.12704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 02/19/2020] [Accepted: 03/02/2020] [Indexed: 12/17/2022]
Abstract
Psychological well-being may play an important role in health behavior adherence and cardiovascular health, but there has been limited study of well-being in patients with heart failure. In this descriptive qualitative research study, we interviewed 30 patients with heart failure to explore their psychological experiences with heart failure and the perceived associations between positive psychological constructs and adherence to physical activity, diet, and medication recommendations. Interviews were transcribed, then coded in NVivo using directed and conventional content analysis, and the Consolidated Criteria for Reporting Qualitative Research checklist was applied to report our findings. Participants spontaneously reported positive psychological constructs both during an acute phase of illness and 3 months later. Participants most commonly experienced gratitude, acceptance, connectedness, and faith in the setting of heart failure. In contrast, pride, determination, and hope were identified most frequently as playing a role in health behavior adherence. Finally, participants reported a reinforcing relationship between positive constructs and health behavior engagement. These findings suggest that interventions to boost positive constructs have the potential to improve well-being and health behavior adherence in patients with heart failure.
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Affiliation(s)
- Christopher M Celano
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eleanor E Beale
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Melanie E Freedman
- Department of Psychology, Northwestern University, Chicago, Illinois, USA
| | - Carol A Mastromauro
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily H Feig
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elyse R Park
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeff C Huffman
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Montalescot G, Brotons C, Cosyns B, Crijns HJ, D'Angelo A, Drouet L, Eberli F, Lane DA, Besse B, Chan A, Vicaut E, Darius H. Educational Impact on Apixaban Adherence in Atrial Fibrillation (the AEGEAN STUDY): A Randomized Clinical Trial. Am J Cardiovasc Drugs 2020; 20:61-71. [PMID: 31243691 PMCID: PMC6978445 DOI: 10.1007/s40256-019-00356-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction Adherence to non-vitamin-K oral anticoagulants (NOACs) may be lower than to vitamin K antagonists because NOACs do not require routine monitoring. Objective We assessed the impact of an educational program on adherence and persistence with apixaban in patients with non-valvular atrial fibrillation (NVAF). Methods Patients with NVAF eligible for NOACs with one or more stroke risk factor (prior stroke/transient ischemic attack, age ≥ 75 years, hypertension, diabetes, or symptomatic heart failure) were randomized (1:1) to standard of care (SOC) or SOC with additional educational (information booklet, reminder tools, virtual clinic access). The primary outcome was adherence to apixaban (2.5 or 5 mg twice daily) at 24 weeks. Patients receiving the educational program were re-randomized (1:1) to continue the program for 24 further weeks or to switch to secondary SOC. Implementation adherence and persistence were reassessed at 48 weeks. Results In total, 1162 patients were randomized (SOC, 583; educational program, 579). Mean implementation adherence ± standard deviation (SD) at 24 weeks was 91.6% ± 17.1 for SOC and 91.9% ± 16.1 for the educational program arm; results did not differ significantly between groups at any time-point. At 48 weeks, implementation adherence was 90.4% ± 18.0, 90.1% ± 18.6, and 89.3% ± 18.1 for continued educational program, SOC, and secondary SOC, respectively; and corresponding persistence was 86.1% (95% confidence interval [CI] 81.3–89.7), 85.2% (95% CI 81.5–88.2), and 87.8% (95% CI 83.4–91.1). Serious adverse events were similar across groups. Conclusion High implementation adherence and persistence with apixaban were observed in patients with NVAF receiving apixaban. The educational program did not show additional benefits. Clinical trial registration This study is registered at ClinicalTrials.gov [NCT01884350]. Electronic supplementary material The online version of this article (10.1007/s40256-019-00356-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gilles Montalescot
- Sorbonne University, ACTION Study Group, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtriėre, 47 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Carlos Brotons
- Sardenya Primary Health Care Centre-Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Bernard Cosyns
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Harry J Crijns
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Armando D'Angelo
- Coagulation Service and Thrombosis Research Unit, Scientific Institute San Raffaele, Milan, Italy
| | | | - Franz Eberli
- Department of Cardiology, Stadtspital Triemli, Zurich, Switzerland
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, L7 8TX, United Kingdom
| | - Bruno Besse
- Global Clinical Research, Bristol-Myers Squibb, Paris, France
| | - Anthony Chan
- Internal Medicine, Pfizer Healthcare Ireland, Dublin, Ireland
| | - Eric Vicaut
- Université Paris 7, the ACTION Study Group, Methodology and Statistical Unit, Centre Hospitalier Universitaire Lariboisière (AP-HP), Paris, France
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Partner presence in the emergency department and adherence to daily cardiovascular medications in patients evaluated for acute coronary syndrome. J Behav Med 2020; 43:402-410. [PMID: 31997128 DOI: 10.1007/s10865-020-00139-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
Abstract
Stressful health situations may compromise spouses'/partners' ability to provide patients with support. We tested whether partner status/partner presence in the emergency department (ED) were associated with patients' adherence to daily cardiovascular medications and whether effects differed by age/gender. Participants were 189 patients evaluated for acute coronary syndrome at an urban academic ED (MAge = 62.18; 57.1% male; 58.7% Hispanic). Participants self-reported partner status/partner presence. Medication adherence was measured using an electronic pillcap. For male patients, having a partner was associated with increased adherence in the first month post-discharge, OR 1.94, p < .001, but having a partner present in the ED was associated with lower adherence, OR 0.33, p < .001. The opposite effect was evident for female patients. Partner status/partner presence in the ED are associated with medication adherence during the first month post discharge, with opposing effects for male and female patients.
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Mene-Afejuku TO, Pernia M, Ibebuogu UN, Chaudhari S, Mushiyev S, Visco F, Pekler G. Heart Failure and Cognitive Impairment: Clinical Relevance and Therapeutic Considerations. Curr Cardiol Rev 2019; 15:291-303. [PMID: 31456512 PMCID: PMC8142355 DOI: 10.2174/1573403x15666190313112841] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 12/19/2022] Open
Abstract
Heart failure (HF) is a devastating condition characterized by poor quality of life, numerous complications, high rate of readmission and increased mortality. HF is the most common cause of hospitalization in the United States especially among people over the age of 64 years. The number of people grappling with the ill effects of HF is on the rise as the number of people living to an old age is also on the increase. Several factors have been attributed to these high readmission and mortality rates among which are; poor adherence with therapy, inability to keep up with clinic appointments and even failure to recognize early symptoms of HF deterioration which may be a result of cognitive impairment. Therefore, this review seeks to compile the most recent information about the links between HF and dementia or cognitive impairment. We also assessed the prognostic consequences of cognitive impairment complicating HF, therapeutic strategies among patients with HF and focus on future areas of research that would reduce the prevalence of cognitive impairment, reduce its severity and also ameliorate the effect of cognitive impairment coexisting with HF.
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Affiliation(s)
- Tuoyo O Mene-Afejuku
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Monica Pernia
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Uzoma N Ibebuogu
- Department of Internal Medicine (Cardiology), University of Tennessee Health Sciences Center, Memphis, Tennessee TN, United States
| | - Shobhana Chaudhari
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Savi Mushiyev
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Ferdinand Visco
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Gerald Pekler
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York NY, United States
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Narechania S, Torbic H, Tonelli AR. Treatment Discontinuation or Interruption in Pulmonary Arterial Hypertension. J Cardiovasc Pharmacol Ther 2019; 25:131-141. [PMID: 31594400 DOI: 10.1177/1074248419877409] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a progressive disease, which can be potentially fatal. The management of a complex disease like PAH requires a multidisciplinary approach from a team consisting of physicians, nurses, social workers, and pharmacists. Adherence to PAH-specific therapy is one of the key factors in the management of this disease. Poor adherence to treatment is a common problem in PAH as it is in many chronic diseases. Management of medication interruptions is a challenge in patients with PAH that can lead to negative consequences. However, for most PAH-specific drugs, there are no clear guidelines on how to manage temporary or abrupt medication discontinuations. In this review, we summarized the available literature and provide suggestions on how to manage interruptions of PAH-specific therapies.
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Affiliation(s)
- Shraddha Narechania
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Heather Torbic
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
| | - Adriano R Tonelli
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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Massouh A, Skouri H, Cook P, Huijer HAS, Khoury M, Meek P. Self-care confidence mediates self-care maintenance and management in patients with heart failure. Heart Lung 2019; 49:30-35. [PMID: 31371031 DOI: 10.1016/j.hrtlng.2019.07.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/22/2019] [Accepted: 07/25/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Literature highlights the influence of self-care confidence on self-care in patients with heart failure (HF), but little is known whether it explains the influence of other determinants of self-care. OBJECTIVES To examine whether confidence explained the associations of social support and HF-knowledge with self-care. METHODS In a descriptive, correlational study, 100 patients with HF completed questionnaires on self-care, social support, and HF-specific knowledge. Regression analyses were used to examine associations between perceived support and HF-knowledge and self-care. RESULTS Self-care confidence mediated the association between social support and self-care maintenance (path reduced from Beta = 0.713 to 0.395) and HF-knowledge and maintenance (path reduced from Beta = 2.569 to 1.798) and management (path reduced from Beta = -0.272 to -0.144). CONCLUSION Self-care confidence explains the influence of social support and knowledge on self-care. Supporting self-care confidence may be a key target for interventions to improve disease management and behaviors in patients with HF.
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Affiliation(s)
- Angela Massouh
- American University of Beirut, School of Nursing, Lebanon
| | - Hadi Skouri
- American University of Beirut Medical Center, Department of Cardiology, Lebanon.
| | - Paul Cook
- University of Colorado, Denver; College of Nursing, United States
| | | | - Maurice Khoury
- American University of Beirut Medical Center, Department of Cardiology, Lebanon
| | - Paula Meek
- University of Colorado, Denver; College of Nursing, United States
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Tripoliti EE, Karanasiou GS, Kalatzis FG, Bechlioulis A, Goletsis Y, Naka K, Fotiadis DI. HEARTEN KMS - A knowledge management system targeting the management of patients with heart failure. J Biomed Inform 2019; 94:103203. [PMID: 31071455 DOI: 10.1016/j.jbi.2019.103203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 11/19/2022]
Abstract
The aim of this work is to present the HEARTEN Knowledge Management System, one of the core modules of the HEARTEN platform. The HEARTEN platform is an mHealth collaborative environment enabling the Heart Failure patients to self-manage the disease and remain adherent, while allowing the other ecosystem actors (healthcare professionals, caregivers, nutritionists, physical activity experts, psychologists) to monitor the patient's health progress and offer personalized, predictive and preventive disease management. The HEARTEN Knowledge Management System is a tool which provides multiple functionalities to the ecosystem actors for the assessment of the patient's condition, the estimation of the patient's adherence, the prediction of potential adverse events, the calculation of Heart Failure related scores, the extraction of statistics, the association of patient clinical and non-clinical data and the provision of alerts and suggestions. The innovation of this tool lays in the analysis of multi-parametric personal data coming from different sources, including for the first time breath and saliva biomarkers, and the use of machine learning techniques. The HEARTEN Knowledge Management System consists of nine modules. The accuracy of the KMS modules ranges from 78% to 95% depending on the module/functionality.
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Affiliation(s)
- Evanthia E Tripoliti
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas, GR 45110 Ioannina, Greece
| | - Georgia S Karanasiou
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas, GR 45110 Ioannina, Greece
| | - Fanis G Kalatzis
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas, GR 45110 Ioannina, Greece
| | - Aris Bechlioulis
- 2(nd) Department of Cardiology, University of Ioannina, GR 45110 Ioannina, Greece.
| | - Yorgos Goletsis
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas, GR 45110 Ioannina, Greece; Department of Economics, University of Ioannina, GR 45110 Ioannina, Greece.
| | - Katerina Naka
- 2(nd) Department of Cardiology, University of Ioannina, GR 45110 Ioannina, Greece
| | - Dimitrios I Fotiadis
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas, GR 45110 Ioannina, Greece; Department of Materials Science and Engineering, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, GR 45110 Ioannina, Greece.
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Forsyth P, Richardson J, Lowrie R. Patient-reported barriers to medication adherence in heart failure in Scotland. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 27:443-450. [PMID: 30675955 DOI: 10.1111/ijpp.12511] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Medication adherence is the end result of a complex set of interwoven factors. Non-adherence with medication in heart failure patients is associated with excess mortality and morbidity. Studies describing interventions to improve adherence in heart failure are limited by a lack of robust methods and inconsistent outcomes. The aim of this evaluation was to explore the barriers to medication adherence in Scottish heart failure patients in order to inform the development of complex interventions. METHODS Qualitative patient interviews. Participants were aged ≥18 years with current or previous signs or symptoms of clinical heart failure, reduced left ventricular ejection fraction ≤45% and confirmed adherence of <80% in tablet counts of heart failure therapy. Thematic analysis was employed. KEY FINDINGS Eleven patients were recruited. The median age was 79 years old, and participants were typically from socially deprived communities. Participants were prescribed a mean 9.9 different medications per day. Seven distinct themes emerged around barriers to medication adherence: co-morbidity; treatment burden; health literacy; trust in NHS; socioeconomic factors; autonomy and health expectations. CONCLUSIONS The factors affecting medication adherence in heart failure are multi-factorial and are unlikely to be improved by one single-faceted intervention. Future interventions need to treat patients holistically, build their trust as partners, simplify complex treatment regimens where possible and involve educational and social elements. The skill set and opportunities afforded to pharmacists may be well placed to deliver many of these aspects but this would need tested in the context of the development of complex interventions.
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Affiliation(s)
| | - Janice Richardson
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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Riegel B, Lee S, Hill J, Daus M, Baah FO, Wald JW, Knafl GJ. Patterns of adherence to diuretics, dietary sodium and fluid intake recommendations in adults with heart failure. Heart Lung 2019; 48:179-185. [PMID: 30638609 DOI: 10.1016/j.hrtlng.2018.12.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Three behaviors advocated to minimize fluid-related hospitalizations in patients with heart failure (HF) are restricted sodium and fluid intake and consistent oral diuretic use. Adherence to behaviors intended to decrease risk of hospitalization is believed to vary over time, but surprisingly little research has addressed patterns of adherence in HF patients. OBJECTIVE To describe patterns over time of 3 recommended self-care behaviors (i.e., diet, fluid intake, and diuretic dosing) in adults with HF and to determine how time and behavior influenced adherence rates. METHODS We enrolled 24 adults hospitalized for a HF exacerbation and discharged on a loop diuretic into a descriptive, longitudinal pilot study. Over 3-months, diuretic use was measured using electronic event monitoring, and participants were telephoned regularly to assess sodium and fluid intake. Data were summarized for each 2-week intervals. RESULTS The overall adherence rates were 42.4% for low sodium diet, 96.4% for fluid restriction, and 84.7% for the diuretic regimen. Early after hospital discharge, medication adherence was the highest, and dietary adherence was the lowest, but adherence to diet and diuretic use decreased significantly over time. CONCLUSION Although participants were just discharged from the hospital after an acute exacerbation of HF, all three behavioral patterns decreased markedly over the 3-month follow-up period.
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Affiliation(s)
- Barbara Riegel
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, 19104-4217 PA, USA.
| | - Solim Lee
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, 19104-4217 PA, USA
| | - Julia Hill
- Family Nurse Practitioner, North End Waterfront Health, Boston, MA, USA
| | - Marguerite Daus
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, 19104-4217 PA, USA
| | - Foster Osei Baah
- School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, 19104-4217 PA, USA
| | - Joyce W Wald
- Advanced heart failure and transplant program, university of Pennsylvania, Philadelphia, PA, USA
| | - George J Knafl
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA
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Niriayo YL, Kumela K, Kassa TD, Angamo MT. Drug therapy problems and contributing factors in the management of heart failure patients in Jimma University Specialized Hospital, Southwest Ethiopia. PLoS One 2018; 13:e0206120. [PMID: 30352096 PMCID: PMC6198973 DOI: 10.1371/journal.pone.0206120] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 10/08/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Drug therapy problem (DTP) is any unwanted incident related to medication therapy that actually or potentially affects the desired goals of treatment. Heart failure (HF) patients are more likely to experience DTP owing to multiple prescriptions and comorbidities. Despite the serious negative impact of DTP on treatment outcomes, there is a dearth of study on DTP among HF patients in Ethiopia. OBJECTIVE The main aim of this study was to assess the prevalence and contributing factors of DTP among ambulatory HF patients in Jimma University Specialized Hospital, Ethiopia. METHODS A hospital based prospective observational study was conducted. Written informed consent was obtained from each patient after full explanation of the study. Data were collected through patient interview and expert review of medical, medication and laboratory records of one-year follow-up from May 2015 to April 2016. DTPs were identified using Cipolle's method followed by consensus review with experts. Binary logistic regression was performed to identify factors contributing to DTP. A p<0.05 was considered statistically significant in all analyses. RESULT Of 340 study participants; male to female ratio was equivalent, the mean (± SD = standard deviation) age was 50.5±15.6 years. Eight hundred eighty DTPs were identified equating 2.6 ±1.8 DTPs per patient. The frequently identified DTPs were dosage too low (27.8%), ineffective drug therapy (27.6%) and need additional drug therapy (27.4%). Most commonly implicated drugs were beta-blockers (34.4%), angiotensin converting enzyme inhibitors (24.8%), statins (16.5%) and antithrombotics (13.1%). Factors contributing to DTP were age >50 years (AOR [adjusted odd ratio] = 5.43, 95%CI [95% confidence interval] = 2.03-14.50); negative medication belief (AOR = 3.50, 95%CI = 1.22-10.05); poor involvement of patients in the therapeutic decision makings (AOR = 4.11, 95%CI = 1.91-8.88); number of co-morbidity≥2(AOR = 5.26, 95%CI = 2.38-11.65) and number of medications ≥5 (AOR = 3.68, 95%CI = 1.28-10.51). CONCLUSION DTPs are common among ambulatory care HF patients. Patients with older age, negative medication belief, polypharmacy, co-morbidities and those who were poorly involved in the therapeutic decision were more likely to experience DTP. Despite traditional prescription refilling, an integrated multidisciplinary approach involving patients and clinically trained pharmacists should be implemented in the patient care process at ambulatory care clinics in order to improve overall outcomes and reduce DTPs and associated burdens in HF patients.
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Affiliation(s)
- Yirga Legesse Niriayo
- Department of Clinical Pharmacy, School of Pharmacy,College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kabaye Kumela
- Department of Clinical Pharmacy, School of Pharmacy, Faculty of Health Sciences, Jimma University, Jimma, Oromyia, Ethiopia
| | - Tesfaye Dessale Kassa
- Department of Clinical Pharmacy, School of Pharmacy,College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Mulugeta Tarekegn Angamo
- Department of Clinical Pharmacy, School of Pharmacy, Faculty of Health Sciences, Jimma University, Jimma, Oromyia, Ethiopia
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobar, Australia
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Rabelo-Silva ER, Saffi MAL, Aliti GB, Feijó MK, Linch GFDC, Sauer JM, Martins SM. Precipitating factors of decompensation of heart failure related to treatment adherence: multicenter study-EMBRACE. REVISTA GAUCHA DE ENFERMAGEM 2018; 39:e20170292. [PMID: 30365756 DOI: 10.1590/1983-1447.2018.20170292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 07/02/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the precipitating factors of heart failure decompensation between adherent and non-adherent patients to treatment. METHODS Cross-sectional study of a multicenter cohort study. Patients over 18 years of age with decompensated heart failure (functional class III/IV) were eligible. The structured questionnaire was used to collect the data and evaluate the reasons for decompensation. The irregular use of medication prior to hospitalization and inadequate salt and fluid intake were considered as poor adherence to treatment. RESULTS A total of 556 patients were included, mean age 61 ± 14 years old, 362 (65%) male. The main factor of decompensation was poor adherence, representing 55% of the sample. Patients who reported irregular use of medications in the last week had a 22% greater risk of being hospitalized due to poor adherence than the patients who adhered to treatment. CONCLUSION The EMBRACE study showed that in patients with heart failure, poor adherence was the main factor of exacerbation.
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Affiliation(s)
- Eneida Rejane Rabelo-Silva
- Universidade Federal do Rio Grande do Sul (UFRGS). Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil.,Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Graziella Badin Aliti
- Universidade Federal do Rio Grande do Sul (UFRGS). Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil.,Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil
| | - Maria Karolina Feijó
- Universidade Federal do Rio Grande do Sul (UFRGS). Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Jaquelini Messer Sauer
- Universidade Federal do Rio Grande do Sul (UFRGS). Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Silvia Marinho Martins
- Hospital Universitário Osvaldo Cruz (HUOC). Recife, Pernambuco, Brasil.,Pronto-Socorro Cardiológico Universitário de Pernambuco (PROCAPE). Recife, Pernambuco, Brasil
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Abstract
UNLABELLED Patients with heart failure (HF) frequently struggle to adhere to health behaviors, and psychological factors may contribute to nonadherence. We examined the feasibility and acceptability of a 10-week, positive psychology (PP)-based intervention to promote health behavior adherence in patients (N = 10) with mild to moderate HF and suboptimal health behavior adherence. Participants engaged in weekly phone sessions, completed PP exercises (e.g., writing a gratitude letter, using a personal strength), and set goals related to diet, medication adherence, and physical activity. Feasibility was assessed by the number of sessions completed, and acceptability by participant ratings of ease and utility. Preliminary efficacy was measured by changes in psychological and adherence outcomes. The intervention was feasible (87% of exercises completed) and acceptable. Furthermore, in exploratory analyses, the intervention was associated with improvements in psychological and health behavior adherence outcomes. Larger, randomized trials are needed to further investigate the utility of this intervention. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02938052.
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48
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Bocchi EA, da Cruz FÁDD, BrandÃo SM, Issa V, Ayub-Ferreira SM, Brunner la Rocca HP, Wijk SS. Cost-Effectiveness Benefits of a Disease Management Program:The REMADHE Trial Results. J Card Fail 2018; 24:627-637. [DOI: 10.1016/j.cardfail.2018.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 04/16/2018] [Accepted: 04/25/2018] [Indexed: 01/16/2023]
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Suzuki T, Shiga T, Omori H, Tatsumi F, Nishimura K, Hagiwara N. Self-Reported Non-adherence to Medication in Japanese Patients with Cardiovascular Diseases. Am J Cardiovasc Drugs 2018; 18:311-316. [PMID: 29748918 DOI: 10.1007/s40256-018-0278-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Non-adherence to medication is an important problem in cardiovascular treatment. The aim of this study was to assess self-reported non-adherence in Japanese patients with cardiovascular disease. METHODS A total of 1372 outpatients at three university hospitals who completed self-reported questionnaires were analyzed in this prospective study (mean age 67 ± 12 years; 31% female). Self-reported adherence to cardiovascular drugs was measured with a modified Siegal scale. Depressive symptoms were defined as a Patient Health Questionnaire-9 score of ≥ 10. RESULTS A total of 227 patients (17%) were defined as non-adherent. Multiple logistic regression analysis showed that ≥ 2 times daily dosing frequency, age < 65 years and active employment were significantly associated with non-adherence, with odds ratios of 4.42 [95% confidence interval (CI) 3.02-6.48], 1.70 (95% CI 1.23-2.35) and 1.43 (95% CI 1.03-1.99), respectively. However, depression was not a significant factor in non-adherence. CONCLUSIONS Our study showed that self-reported non-adherence to medications was 17% in Japanese patients with cardiovascular disease in the university hospital setting. Daily dosing frequency, younger age and employment were significantly associated with non-adherence. TRIAL REGISTRATION University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) no. UMIN 000023514.
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Affiliation(s)
- Tsuyoshi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Hisako Omori
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Fujio Tatsumi
- Department of Cardiology, Institute of Geriatrics, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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50
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Abstract
Community pharmacists are often not included in home healthcare teams; their absence from such teams places patients undergoing transitions at risk for potential medication-related errors. However, community pharmacists can improve medication adherence and decrease heart failure (HF)-related hospital readmission rates. The expansion of home medication teaching services for patients by community pharmacists to reach as many patients as possible could only augment those benefits. Community pharmacists provide home health services including medication reconciliation and teaching. In the near future, all HF patients should be allowed to receive one in-home visit by a community pharmacist so that they can improve their lifestyles and enhance their medical treatment. Home visits and home healthcare by community pharmacists can reduce avoidable hospital readmissions of patients with HF.
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