Czech Society of Cardiology Guidelines for the Diagnosis and Treatment of Chronic Heart Failure 2011

Commonalities among dietary recommendations from 2010-2021 clinical practice guidelines: A meta-epidemiological study from the American College of Lifestyle Medicine

Clinical practice guidelines (CPGs) provide recommendations to clinicians based on current medical knowledge to guide and reduce variability in clinical care. With advances in nutrition science research, CPGs increasingly include dietary guidance; however, the degree of consistency in dietary recommendations across CPGs has not been investigated. Using a systematic review approach adapted for meta-epidemiological research, this study compared dietary guidance from current guidelines developed by governments, major medical professional societies, and large health stakeholder associations due to their often well-defined and standardized processes for guideline development. CPGs making recommendations for dietary patterns and food groups or components for generally healthy adults or those with pre-specified chronic diseases were eligible. Literature from January 2010-2022 was searched in five bibliographic databases and augmented by searches in point-of-care resource databases and relevant websites. Reporting followed an adapted Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and included narrative synthesis and summary tables. The protocol was pre-published on PROSPERO (CRD42021226281). Seventy-eight CPGs for major chronic conditions (autoimmune=7, cancers=5, cardiovascular-related=35, digestive=11, diabetes=12, weight-related=4, or multiple=3) and general health promotion (n=1) were included. Nearly all (91%) made dietary pattern recommendations, and roughly half (49%) endorsed patterns centered around plant foods. Overall, CPGs were most closely aligned in promoting consumption of major plant food groups (vegetables=74% of CPGs, fruit=69%, whole grains=58%) while discouraging intake of alcohol (62%) and salt or sodium (56%). CVD and diabetes CPGs were similarly aligned with additional messaging to consume legumes/pulses (60% of CVD CPGs; 75%, diabetes), nuts and seeds (67%, CVD), and low-fat dairy (60%, CVD). Diabetes guidelines discouraged sweets/added sugars (67%) and sweetened beverages (58%). This alignment across CPGs should boost clinician confidence in relaying such dietary guidance to patients in accordance with their relevant CPGs.

Self care in patients with chronic heart failure. Pilot study - self care includes problems

AIM

The goal of this pilot study was to define the scope of therapeutic self-care demand in heart failure (HF) patients according to the concepts of self-care postulated by D.E. Orem and to determine the level of problems experienced and self-care in these patients.

METHODS

A questionnaire consisting of 7 areas with closed format questions was developed according to the definition. The level of patient problems and level of self-care actions were mapped in each area. The questionnaire was distributed at the hospital outpatient clinic. The study group consisted of 47 heart failure patients (14 women) with following characteristics: average age 68 years, average BMI 29.4, resynchronization therapy 21%, hypertension 69.8%, diabetes mellitus 25.6%, coronary artery disease 46.5%, dilated cardiomyopathy 46.5%, obesity 46.5%, smoking history 39.5% (present and past smoking together), other cardiac disease 16.28%, condition after myocardial infarction 27.8% (NYHA II 41%, NYHA III 56.8%, NYHA IV 2.2%).

RESULTS

The greatest problems were in the area of physical activity, sleep and fatigue, the least were in the area of chest pain and blood circulation. The greatest self-care agency was shown in the area of managing problems with physical activities and sleep, the lowest in the area of liquid intake and output. In the patients' subjective opinion, fatigue and sleep problems had the greatest impact on the quality of life. There were no substantial differences in either area based on gender.

CONCLUSIONS

The data can serve as a foundation for modifying the extent and structure of patient education for more comprehensive and more effective out‑patient treatment of HF.